Central Nervous System Tumors Flashcards
Etiology of CNS cancer
- genetics: Li-Fraumeni, neurofibromatosis, V Hippel-Lindau
- previous radiation
- greater risk in males than females
Epidemiology of CNS cancer
- true primary CNS tumors are rare
- most are metastatic
Histology of CNS cancer
neuro-epithelial tumors:
1. glioma: astrocytoma, ependymoma, oligodendroglioma, glioblastoma (most common in adults)
2. embrional: medulloblastoma (most common in children)
3. pinealoma
4. neuronal origin
5. peripheral nerves: schwannoma, neurofibroma
non-neuroepithelial tumors:
- meningioma (most common primary, mostly benign)
- choroid plexus
- germinoma
- primary CNS lymphoma
- hypophysis tumor
- mesenchymal tumor
Symptoms of CNS cancer
- general or focal, affecting motor/sensory pathways, coorcination, vision, cognitive function
- partial/global seizures
- headaches as a result of increased intracranial pressure
Diagnosis of CNS cancer
- MRI is standard (best structural information)
- CT in emergencies
- molecular pathology is needed
- diffuse tensor imaging: to review pathways
- stereotactic biopsy is required
Radiotherapy for CNS cancer
gliomas:
- amino acid-based PET to determine gross tumor volume
- RT with 3D technique and IMRT
ependymoma:
- low risk: RT with 3D IMRT (only tumor area)
- high risk: whole craniospinal axis RT + boost RT
medulloblastoma: whole craniospinal axis RT
meningioma: SBRT
Surgical therapy for CNS cancer
- surgery is first option
- glioma: maximally safe resection
- goal of surgery is least possible neurological deficits
- for unresectable tumors (ie. brain stem tumors): chemotherapy, RT, or a combination
Pharmacological therapy for CNS cancer
glioblastomas
- bevacizumab (angiogenesis inhibitor)
- temzolomide based chemo (postop.)
- lomustine w/ or w/o probarbazin and vincristine (recurrent tumors)
ependymomas: platinum based
medulloblastomas: cisplatin-cychlophphamide-vincristine
meningiomas: drugs have poor effect
