Semin Neurol 2007; 27(4): 312-324
DOI: 10.1055/s-2007-985333
Copyright © 2007 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Brain Tumors: Current Issues in Diagnosis and Management

Mark K. Lyons1 , Sujay A. Vora2
  • 1Department of Neurological Surgery, Mayo Clinic Arizona, Phoenix, Arizona
  • 2Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
Further Information

Publication History

Publication Date:
15 August 2007 (online)

ABSTRACT

There has been significant progress made in the diagnosis and treatment of brain tumors over the past 15 years. This has largely been due to significant advances in radiographic imaging capabilities that have allowed for much earlier detection of disease, both new and recurrent. Advances in surgical and radiotherapy techniques and technology have also affected the care of these patients. More recent advances in chemotherapy options and double and triple crossover clinical trials are beginning to have an impact in the treatment of malignant brain tumors. This article will address the 4 most common brain tumors practicing physicians see and will review the current concepts in treating these tumors.

REFERENCES

  • 1 Central Brain Tumor Registry of the United States (CBTRUS). Available at: http://www.cbtrus.org/2002/2002products.htm. Accessed 2006
  • 2 Surawicz T S, McCarthy B J, Kupelian V, Jukich P J, Bruner J M, Davis F G. Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990-1994.  Neuro Oncol. 1999;  1 14-25
  • 3 Bondy M, Ligon B L. Epidemiology and etiology of intracranial meningiomas: a review.  J Neurooncol. 1996;  29 197-205
  • 4 Claus E B, Bondy M L, Schildkraut J M, Wiemels J L, Wrensch M, Black P M. Epidemiology of intracranial meningiomas.  Neurosurgery. 2005;  57 1088-1095
  • 5 Kalkanis S N, Quinones-Hinojosa A, Buzney E, Ribaudo H J, Black P M. Quality of life following surgery for intracranial meningiomas at Brigham and Women's Hospital: a study of 164 patients using a modification of the functional assessment of cancer therapy-brain questionnaire.  J Neurooncol. 2000;  48 233-241
  • 6 Kondziolka D, Levy E I, Niranjan A, Flickinger J C, Lunsford L D. Long-term outcomes after meningioma radiosurgery: physician and patient perspectives.  J Neurosurg. 1999;  91 44-50
  • 7 De Jesus O, Sekhar L N, Parikh H K, Wright D C, Wagner D P. Long-term follow-up of patients with meningiomas involving the cavernous sinus: recurrence, progression, and quality of life.  Neurosurgery. 1996;  39 915-919
  • 8 Longstreth W T, Dennis L K, McGuire V M, Drangsholt M T, Koepsell T D. Epidemiology of intracranial meningioma.  Cancer. 1993;  72 639-648
  • 9 Hardell L, Nasman A, Pahlson A, Hallquist A, Hansson M K. Use of cellular telephones and the risk for brain tumors: a case/control study.  Int J Oncol. 1999;  15 113-116
  • 10 Johansen C, Boice J, McLaughlin J, Olsen J. Cellular telephones and cancer: a nationwide cohort study in the United States, 1985-1994.  J Natl Cancer Inst. 2001;  93 203-207
  • 11 Dreyer N A, Loughlin J E, Rothman K J. Cause-specific mortality in cellular telephone users.  JAMA. 1999;  282 1814-1816
  • 12 Rothman K J, Loughlin J E, Fuch D P, Dreyer N A. Overall mortality of cellular telephone customers.  Epidemiology. 1996;  7 303-305
  • 13 Schlehofer B, Blettner M, Preston-Martin S et al.. Role of medical history in brain tumor development: results from the International Adult Brain Tumor Study.  Int J Cancer. 1999;  82 155-160
  • 14 Brenner A V, Linet M S, Fine H A et al.. History of allergies and autoimmune diseases and risk of brain tumors in adults.  Int J Cancer. 2002;  99 252-259
  • 15 Schuz J, Boher E, Berg G et al.. Cellular phones, cordless phones, and the risks of glioma and meningioma (Interphone Study Group, Germany).  Am J Epidemiol. 2006;  163 512-520
  • 16 Morgan L L. Letter to the editor: Cellular phones, cordless phones, and the risks of glioma and meningioma (Interphone Study Group, Germany).  Am J Epidemiol. 2006;  164 294-295
  • 17 Donnell M S, Meyer G A, Donegan W L. Estrogen-receptor protein in intracranial meningioma.  J Neurosurg. 1979;  50 499-502
  • 18 Black P M. Meningiomas.  Neurosurgery. 1993;  32 643-657
  • 19 Carroll R S, Zhang J, Black P M. Expression of estrogen receptors alpha and beta in human meningiomas.  J Neurooncol. 1999;  42 109-116
  • 20 Hsu D W, Efrid J T, Hedley-Whyte E T. Progesterone and estrogen receptors in meningiomas: prognostic considerations.  J Neurosurg. 1997;  86 113-120
  • 21 Maxwell M, Galanopoulos T, Neville-Golden J, Antoniades H N. Expression of androgen and progesterone receptors in primary human meningiomas.  J Neurosurg. 1993;  78 456-462
  • 22 Chen J, Chen G. Expression of androgen receptor in meningiomas.  J Tongji Med Univ. 2001;  21 140-142
  • 23 Jhawar B S, Colditz G, Fuchs C, Stampfer M. Sex hormone exposures and risk for meningiomas.  J Neurosurg. 2003;  99 848-853
  • 24 Busch D. Genetic susceptibility to radiation and chemotherapy injury: diagnosis and management.  Int J Radiat Oncol Biol Phys. 1994;  30 997-1002
  • 25 Wrensch M, Minn Y, Chew T, Bondy M, Berger M. Epidemiology of primary brain tumors: current concepts and review of the literature.  Neuro Oncol. 2002;  4 278-299
  • 26 Ron E, Modn B, Boice J D et al.. Tumors of the brain and nervous system after radiotherapy in childhood.  N Engl J Med. 1988;  319 1033-1039
  • 27 Longstreth W T, Phillips L E, Drangsholt M T et al.. Dental x-rays and the risk of intracranial meningioma.  Cancer. 2004;  100 1026-1034
  • 28 Bateman B T, Pile-Spellman J, Gutin P H, Berman M F. Meningioma resection in the elderly: nationwide inpatient sample, 1998-2002.  Neurosurgery. 2005;  57 866-872
  • 29 Saberi H, Meybodi A T, Rezai A S. Levine-Sekhar grading system for prediction of the extent of resection of cranial base meningiomas revisited: study of 124 cases.  Neurosurg Rev. 2006;  29 138-144
  • 30 Goldsmith B J, Wara W M, Wilson C B et al.. Postoperative irradiation for subtotally resected meningiomas: a retrospective analysis of 140 patients treated from 1967-1990.  J Neurosurg. 1994;  80 195-201
  • 31 Modha A, Gutin P H. Diagnosis and treatment of atypical and anaplastic meningiomas: a review.  Neurosurgery. 2005;  57 538-550
  • 32 Cusimano M D, Sekhar L N, Sen C N et al.. The results of surgery for benign tumours of the cavernous sinus.  Neurosurgery. 1995;  37 1-10
  • 33 Chin L S, Szerlip N J, Regine W F. Stereotactic radiosurgery for meningiomas.  Neurosurg Focus. 2003;  14 e6
  • 34 Torres R C, Frighetto L, De Salles A A et al.. Radiosurgery and stereotactic radiotherapy for intracranial meningiomas.  Neurosurg Focus. 2003;  14 e5
  • 35 Olson J D, Riedel E MA, DeAngelis L M. Long-term outcome of low-grade oligodendroglioma and mixed astrocytoma.  Neurology. 2000;  54 1442-1448
  • 36 Rutka J T, Weyerbrock A, Liang M L. Gliomas: Quo Vadis. .  Clin Neurosurg. 2006;  53 58-63
  • 37 Walker D G, Kaye A H. Low grade glial neoplasms.  J Clin Neurosci. 2003;  10 1-13
  • 38 Paleologos N A. Chemotherapy for low-grade gliomas.  Expert Rev Neurother. 2005;  5 S21-S24
  • 39 Mehta N, Silverberg W. Role of radiotherapy in the treatment of gliomas.  Expert Rev Neurother. 2005;  5 S51-S61
  • 40 Cavaliere R, Lopes M BS, Schiff D. Low-grade gliomas: an update on pathology and therapy.  Lancet Neurol. 2005;  4 760-770
  • 41 Daumas-Duport C, Scheithauer B W, O'Fallon J, Kelly P J. Grading system of astrocytomas: a simple and reproducible method.  Cancer. 1988;  62 2152-2165
  • 42 Lyons M K, Kelly P J. Computer-assisted stereotactic biopsy and volumetric resection of thalamic pilocytic astrocytomas: report of 23 cases.  Stereotact Funct Neurosurg. 1992;  59 100-104
  • 43 Lyons M K. Pilocytic astrocytoma with spontaneous intracranial hemorrhages in an elderly adult.  Clin Neurol Neurosurg. 2007;  109 76-80
  • 44 Laws E R, Taylor W F, Clifton M B, Okazaki H. Neurosurgical management of low grade astrocytoma of the cerebral hemispheres.  J Neurosurg. 1984;  61 665-673
  • 45 Shaw E G, Scheithauer B W, O'Fallon J R, Davis D H. Mixed oligoastrocytomas: a survival and prognostic factor analysis.  Neurosurgery. 1994;  34 577-582
  • 46 Pignatti F, van den Bent M, Curran D. Prognostic factors for survival in adult patients with cerebral low-grade glioma.  J Clin Oncol. 2002;  20 2076-2084
  • 47 Leighton C, Fisher B, Bauman G. Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation.  J Clin Oncol. 1997;  15 1294-1301
  • 48 Wrensch M, Minn Y, Chew T, Bondy M, Berger M S. Epidemiology of primary brain tumors: current concepts and review of the literature.  Neuro-oncol. 2002;  4 278-299
  • 49 Franzini A, Leocata L, Cajola L, Servello D, Allegranza A, Broggi G. Low-grade glial tumors in basal ganglia and thalamus: natural history and biological reappraisal.  Neurosurgery. 1994;  35 817-820
  • 50 Scanlon P W, Taylor W F. Radiotherapy of intracranial astrocytomas: analysis of 417 cases treated from 1960 through 1969.  Neurosurgery. 1979;  5 301-308
  • 51 Coons S W, Johnson P C, Scheithauer B W, Yates A J, Pearl D K. Improving diagnostic accuracy and interobserver concordance in the classification and grading of primary gliomas.  Cancer. 1997;  79 1381-1393
  • 52 Hart M N, Petito C K, Earle K M. Mixed gliomas.  Cancer. 1974;  33 134-140
  • 53 Soffietti R, Chio A, Giordana M T, Vasario E, Schiffer D. Prognostic factors in well-differentiated cerebral astrocytomas in the adult.  Neurosurgery. 1989;  24 686-692
  • 54 Kreth F W, Faist M, Rossner R, Ostertag C B. Supratentorial World Health Organization grade 2 astrocytomas and oligoastrocytomas: a new pattern of prognostic factors.  Cancer. 1997;  79 370-379
  • 55 van den Bent M J, Afra D, de Witte O et al.. Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial.  Lancet. 2005;  366 985-990
  • 56 Shaw E, Arusell R, Scheithauer B W. Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial low-grade gliomas: initial report of a North Central Cancer treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study.  J Clin Oncol. 2002;  20 2267-2276
  • 57 Piepmeier J, Christopher S, Spencer D. Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas.  Neurosurgery. 1996;  38 872-878
  • 58 Philippon J H, Clemenceau S H, Fauchon F H, Foncin J F. Supratentorial low-grade astrocytomas in adults.  Neurosurgery. 1993;  32 554-559
  • 59 Bauman G, Lote K, Larson D. Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis.  Int J Radiat Oncol Biol Phys. 1999;  45 923-929
  • 60 Kelly P J, Daumas-Duport C, Scheithauer B W, Kall B A, Kispert D B. Stereotactic histologic correlations of computerized tomography and magnetic resonance imaging defined abnormalities in patients with glial neoplasms.  Mayo Clin Proc. 1987;  62 450-459
  • 61 Keles G E, Lamborn K R, Berger M S. Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome.  J Neurosurg. 2001;  95 735-745
  • 62 Lunsford L D, Somaza S, Kondziolka D, Flickinger J C. Survival after stereotactic biopsy and irradiation of cerebral nonanaplastic, nonpilocytic astrocytoma.  J Neurosurg. 1995;  82 523-529
  • 63 Janny P, Cure H, Mohr M. Low grade supratentorial astrocytomas: management and prognostic factors.  Cancer. 1994;  73 1937-1945
  • 64 Nicolato A, Gerosa M A, Fina P, Iuzzolino P, Giorgiutti F, Bricolo A. Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adults.  Surg Neurol. 1995;  44 208-221
  • 65 Bahary J P, Villemure J G, Choi S. Low-grade pure and mixed cerebral astrocytomas treated in the CT scan era.  J Neurooncol. 1996;  27 173-177
  • 66 Leighton C, Fisher B. Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation.  J Clin Oncol. 1997;  15 1294-1301
  • 67 Grabenbauer G G, Roedel C M, Paulus W. Supratentorial low-grade glioma: results and prognostic factors following postoperative radiotherapy.  Strahlenther Onkol. 2000;  176 259-264
  • 68 Berger M S, Rostomily R C. Low grade gliomas: functional mapping resection strategies, extent of resection and outcome.  J Neurooncol. 1997;  34 85-101
  • 69 Daumas-Duport C, Scheithauer B W, Kelly P J. A histologic and cytologic method for the spatial definition of gliomas.  Mayo Clin Proc. 1987;  62 435-449
  • 70 Kelly P J. Volumetric stereotactic surgical resection of intra-axial brain mass lesions.  Mayo Clin Proc. 1988;  63 1186-1198
  • 71 Shaw E G, Daumas-Duport C, Scheithauer B W. Radiation therapy in the management of low-grade supratentorial astrocytomas.  J Neurosurg. 1989;  70 853-861
  • 72 Medbery C A, Strauss S M, Steinberg J D, Cotelingam J D, Fisher W S. Low-grade astrocytomas: treatment results and prognostic variables.  Int J Radiat Oncol Biol Phys. 1988;  15 837-841
  • 73 Kaye A H, Walker D G. Low grade astrocytomas: controversies in management.  J Clin Neurosci. 2000;  7 475-483
  • 74 Vertosick F T, Selker R G, Arena V C. Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography.  Neurosurgery. 1991;  28 496-501
  • 75 Whitton A C, Bloom H J. Low grade glioma of the cerebral hemispheres in adults: a retrospective analysis of 88 cases.  Int J Radiat Oncol Biol Phys. 1990;  18 783-786
  • 76 Karim A B, Maat B. A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844.  Int J Radiat Oncol Biol Phys. 1996;  36 549-556
  • 77 Imperato J P, Paleologos N A, Vick N A. Effects of treatment on long-term survivors with malignant astrocytomas.  Ann Neurol. 1990;  28 818-822
  • 78 Gregor A, Cull A, Traynor E, Stewart M, Lander F, Love S. Neuropsychometric evaluation of long-term survivors of adult brain tumours: relationship with tumour and treatment parameters.  Radiother Oncol. 1996;  41 55-59
  • 79 Morris D E, Bourland J D, Rosenman J G, Shaw E G. Three-dimensional conformal radiation treatment planning and delivery for low- and intermediate-grade gliomas.  Semin Radiat Oncol. 2001;  11 124-137
  • 80 Eyre H J, Crowley J J, Townsend J J. A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected low-grade gliomas: a Southwest Oncology Group Study.  J Neurosurg. 1993;  78 909-914
  • 81 Schiffer D, Dutto A. Prognostic factors in oligodendroglioma.  Can J Neurol Sci. 1997;  24 313-319
  • 82 Soffietti R, Ruda R, Bradac G B, Schiffer D. PCV chemotherapy for recurrent oligodendrogliomas and oligoastrocytomas.  Neurosurgery. 1998;  43 1066-1073
  • 83 Cairncross J G, MacDonald D R. Successful chemotherapy for recurrent malignant oligodendroglioma.  Ann Neurol. 1988;  23 360-364
  • 84 Chahlavi A, Kanner A, Peereboom D, Staugaitis S M, Elson P, Barnett G. Impact of chromosome 1p status in response of oligodendroglioma to temozolimide: preliminary results.  J Neurooncol. 2003;  61 267-273
  • 85 Brada M, Viviers L, Abson C. Phase II study of primary temozolimide chemotherapy in patients with WHO grade II gliomas.  Ann Oncol. 2003;  14 1715-1721
  • 86 Pace A, Vidiri A, Galie E. Temozolomide chemotherapy for progressive low-grade glioma: clinical benefits and radiological response.  Ann Oncol. 2003;  14 1722-1726
  • 87 Buckner J C, Gesme D, O'Fallon J R. Phase II trial of procarbazine, lomustine, and vincristine as initial therapy for patients with low-grade oligodendroglioma or oligoastrocytoma: efficacy and associations with chromosomal abnormalities.  J Clin Oncol. 2003;  21 251-255
  • 88 van den Bent M J, Taphoorn M J, Brandes A A. Phase II study of first-line chemotherapy with temozolimide in recurrent oligodendroglial tumors: the European Organization for Research and Treatment of Cancer Brain Tumor Group Study 26971.  J Clin Oncol. 2003;  21 2525-2528
  • 89 Quinn J A, Reardon D A, Friedman A H. Phase II trial of temozolimide in patients with progressive low-grade glioma.  J Clin Oncol. 2003;  21 646-651
  • 90 Hoang-Xuan K, Capelle L, Kujas M. Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions.  J Clin Oncol. 2004;  22 3133-3138
  • 91 van den Bent M J, Chinot O, Boogerd W et al.. Second-line chemotherapy with temozolimide in recurrent oligodendroglioma after PVC (procarbazine, lomustine and vincristine) chemotherapy: EORTC Brain Tumor Group phase II study 26972.  Ann Oncol. 2003;  14 599-602
  • 92 Lim L C, Rosenthal M A, Maartens N et al.. Management of brain metastases.  Intern Med J. 2004;  34 270-278
  • 93 Zimm S, Wampler G L, Stablein D et al.. Intracerebral metastases in solid-tumor patients: natural history and results of treatment.  Cancer. 1981;  48 384-394
  • 94 Wen P Y, Loeffler J S. Brain metastases.  Curr Treat Options Oncol. 2000;  1 447-458
  • 95 Delattre J Y, Krol G, Thaler H T et al.. Distribution of brain metastases.  Arch Neurol. 1988;  45 741-744
  • 96 Gaspar L, Scott C, Rotman M et al.. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials.  Int J Radiat Oncol Biol Phys. 1997;  37 745-751
  • 97 Patchell R A, Tibbs P A, Walsh J W et al.. A randomized trial of surgery in the treatment of single metastases to the brain.  N Engl J Med. 1990;  322 494-500
  • 98 Vecht C J, Haaxma-Reiche H, Noordijk E M et al.. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?.  Ann Neurol. 1993;  33 583-590
  • 99 Patchell R A, Tibbs P A, Regine W F et al.. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.  JAMA. 1998;  280 1485-1489
  • 100 DeAngelis L M, Delattre J Y, Posner J B. Radiation-induced dementia in patients cured of brain metastases.  Neurology. 1989;  39 789-796
  • 101 Regine W F, Huhn J L, Patchell R A et al.. Risk of symptomatic brain tumor recurrence and neurologic deficit after radiosurgery alone in patients with newly diagnosed brain metastases: results and implications.  Int J Radiat Oncol Biol Phys. 2002;  52 333-338
  • 102 Mehta M P, Shapiro W R, Glantz M J et al.. Lead-in phase to randomized trial of motexafin gadolinium and whole-brain radiation for patients with brain metastases: centralized assessment of magnetic resonance imaging, neurocognitive, and neurologic end points.  J Clin Oncol. 2002;  20 3445-3453
  • 103 Stea B, Shaw E, Pinter T et al.. Efaproxiral red blood cell concentration predicts efficacy in patients with brain metastases.  Br J Cancer. 2006;  94 1777-1784
  • 104 Abrey L E, Christodoulou C. Temozolomide for treating brain metastases.  Semin Oncol. 2001;  28 34-42
  • 105 Margolin K, Atkins B, Thompson A et al.. Temozolomide and whole brain irradiation in melanoma metastatic to the brain: a phase II trial of the Cytokine Working Group.  J Cancer Res Clin Oncol. 2002;  128 214-218
  • 106 Flickinger J C, Kondziolka D, Lunsford L D et al.. A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis.  Int J Radiat Oncol Biol Phys. 1994;  28 797-802
  • 107 Andrews D W, Scott C B, Sperduto P W et al.. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.  Lancet. 2004;  363 1665-1672
  • 108 Sneed P K, Suh J H, Goetsch S J et al.. A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases.  Int J Radiat Oncol Biol Phys. 2002;  53 519-526
  • 109 Aoyama H, Shirato H, Tago M et al.. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.  JAMA. 2006;  295 2483-2491
  • 110 Ohgaki H, Dessen P, Jourde B et al.. Genetic pathways to glioblastoma: a population-based study.  Cancer Res. 2004;  64 6892-6899
  • 111 Curran Jr W J, Scott C B, Horton J et al.. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials.  J Natl Cancer Inst. 1993;  85 704-710
  • 112 Kreth F W, Berlis A, Spiropoulou V et al.. The role of tumor resection in the treatment of glioblastoma multiforme in adults.  Cancer. 1999;  86 2117-2123
  • 113 Simpson J R, Horton J, Scott C et al.. Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials.  Int J Radiat Oncol Biol Phys. 1993;  26 239-244
  • 114 Westphal M, Ram Z, Riddle V et al.. Gliadel wafer in initial surgery for malignant glioma: long-term follow-up of a multicenter controlled trial.  Acta Neurochir (Wien). 2006;  148 269-275 , discussion 275
  • 115 Gaspar L E, Fisher B J, Macdonald D R et al.. Supratentorial malignant glioma: patterns of recurrence and implications for external beam local treatment.  Int J Radiat Oncol Biol Phys. 1992;  24 55-57
  • 116 Kleinberg L, Slick T, Enger C et al.. Short course radiotherapy is an appropriate option for most malignant glioma patients.  Int J Radiat Oncol Biol Phys. 1997;  38 31-36
  • 117 Roa W, Brasher P M, Bauman G et al.. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial.  J Clin Oncol. 2004;  22 1583-1588
  • 118 Loeffler J S, Alexander III E, Shea W M et al.. Radiosurgery as part of the initial management of patients with malignant gliomas.  J Clin Oncol. 1992;  10 1379-1385
  • 119 Loeffler J S, Shrieve D C, Alexander III E. Radiosurgery for glioblastoma multiforme: the importance of selection criteria.  Int J Radiat Oncol Biol Phys. 1994;  30 731-733
  • 120 Sarkaria J N, Mehta M P, Loeffler J S et al.. Radiosurgery in the initial management of malignant gliomas: survival comparison with the RTOG recursive partitioning analysis. Radiation Therapy Oncology Group.  Int J Radiat Oncol Biol Phys. 1995;  32 931-941
  • 121 Loeffler J S, Alexander III E, Hochberg F H et al.. Clinical patterns of failure following stereotactic interstitial irradiation for malignant gliomas.  Int J Radiat Oncol Biol Phys. 1990;  19 1455-1462
  • 122 Stewart L A. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials.  Lancet. 2002;  359 1011-1018
  • 123 Stupp R, Mason W P, van den Bent M J et al.. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma.  N Engl J Med. 2005;  352 987-996
  • 124 Hegi M E, Diserens A C, Gorlia T et al.. MGMT gene silencing and benefit from temozolomide in glioblastoma.  N Engl J Med. 2005;  352 997-1003
  • 125 Olivi A, Grossman S A, Tatter S et al.. Dose escalation of carmustine in surgically implanted polymers in patients with recurrent malignant glioma: a New Approaches to Brain Tumor Therapy CNS Consortium trial.  J Clin Oncol. 2003;  21 1845-1849
  • 126 Combs S E, Widmer V, Thilmann C et al.. Stereotactic radiosurgery (SRS): treatment option for recurrent glioblastoma multiforme (GBM).  Cancer. 2005;  104 2168-2173
  • 127 Combs S E, Gutwein S, Thilmann C et al.. Stereotactically guided fractionated re-irradiation in recurrent glioblastoma multiforme.  J Neurooncol. 2005;  74 167-171
  • 128 Gabayan A J, Green S B, Sanan A et al.. GliaSite brachytherapy for treatment of recurrent malignant gliomas: a retrospective multi-institutional analysis.  Neurosurgery. 2006;  58 701-709
  • 129 Wen P Y, Yung W K, Lamborn K R et al.. Phase I/II study of imatinib mesylate for recurrent malignant gliomas: North American Brain Tumor Consortium Study 99-08.  Clin Cancer Res. 2006;  12 4899-4907
  • 130 Yung W K, Albright R E, Olson J et al.. A phase II study of temozolomide vs. procarbazine in patients with glioblastoma multiforme at first relapse.  Br J Cancer. 2000;  83 588-593
  • 131 Belda-Iniesta C, Carpeno Jde C, Saenz E C et al.. Long term responses with cetuximab therapy in glioblastoma multiforme.  Cancer Biol Ther. 2006;  5 912-914
  • 132 Freeman III B B, Daw N C, Geyer J R et al.. Evaluation of gefitinib for treatment of refractory solid tumors and central nervous system malignancies in pediatric patients.  Cancer Invest. 2006;  24 310-317
  • 133 Penne K, Bohlin C, Schneider S et al.. Gefitinib (Iressa, ZD1839) and tyrosine kinase inhibitors: the wave of the future in cancer therapy.  Cancer Nurs. 2005;  28 481-486
  • 134 Sathornsumetee S, Rich J N. New treatment strategies for malignant gliomas.  Expert Rev Anticancer Ther. 2006;  6 1087-1104

Sujay A VoraM.D. 

Department of Radiation Oncology, Mayo Clinic Arizona

5777 East Mayo Boulevard, Phoenix, AZ 85054

    >