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| {{Infobox_Disease |
| | #Redirect [[Brain tumor]] |
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| {{Adult brain tumors}}
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| {{CMG}}
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| '''Associate Editor in Chief:''' {{CZ}}
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| ==[[Adult brain tumors overview|Overview]]==
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| ==[[Adult brain tumors historical perspective|Historical Perspective]]==
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| ==[[Adult brain tumors classification|Classification]]==
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| ==[[Adult brain tumors pathophysiology|Pathophysiology]]==
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| ==[[Adult brain tumors causes|Causes]]==
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| ==[[Adult brain tumors differential diagnosis|Differentiating Adult brain tumors from other Diseases]]==
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| ==[[Adult brain tumors epidemiology and demographics|Epidemiology and Demographics]]==
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| ==[[Adult brain tumors risk factors|Risk Factors]]==
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| ==[[Adult brain tumors screening|Screening]]==
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| ==[[Adult brain tumors natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
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| ==Diagnosis==
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| [[Adult brain tumors history and symptoms|History and Symptoms]] | [[Adult brain tumors physical examination|Physical Examination]] | [[Adult brain tumors laboratory findings|Laboratory Findings]] | [[Adult brain tumors electrocardiogram|EKG]] | [[Adult brain tumors chest x ray|Chest X ray]] | [[Adult brain tumors CT|CT]] | [[Adult brain tumors MRI|MRI]] | [[Adult brain tumors echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Adult brain tumors other imaging findings|Other Imaging Findings]] | [[Adult brain tumors other diagnostic studies|Other Diagnostic Studies]]
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| ==Treatment==
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| [[Adult brain tumors medical therapy|Medical Therapy]] | [[Adult brain tumors surgery|Surgery]] | [[Adult brain tumors primary prevention|Primary Prevention]] | [[Adult brain tumors secondary prevention|Secondary Prevention]] | [[Adult brain tumors cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Adult brain tumors future or investigational therapies|Future or Investigational Therapies]] | |
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| ==Case Studies==
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| [[Adult brain tumors case study one|Case #1]]
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| ==Treatment==
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| Surgical removal is recommended for most types of brain tumors in most locations, and their removal should be as complete as possible within the constraints of preservation of neurologic function. An exception to this role for surgery is deep-seated tumors such as pontine gliomas, which are diagnosed on clinical evidence and treated without initial surgery approximately 50% of the time. In most cases, however, diagnosis by biopsy is preferred. Stereotaxic biopsy can be used for lesions that are difficult to reach and resect.
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| Radiation therapy has a major role in the treatment of patients, as evidenced in the EORTC-22845 and MRC-BR04 trials, for example, with most tumor types and can increase the cure rate or prolong disease-free survival. Radiation therapy may also be useful in the treatment of recurrences in patients initially treated with surgery alone.
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| Chemotherapy may prolong survival in patients with some tumor types and has been reported to lengthen disease-free survival in patients with gliomas, medulloblastoma, and some germ cell tumors. Local chemotherapy with a nitrosourea applied to a polymer placed directly in the brain during surgery has been shown to be a safe modality and is under clinical evaluation.
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| Surgery and radiation therapy are the primary modalities used to treat tumors of the spinal axis; therapeutic options vary according to the histology of the tumor. The experience with chemotherapy for primary spinal cord tumors is rare; no reports of controlled clinical trials are available for these types of tumors. Chemotherapy is indicated for most patients with leptomeningeal involvement (from a primary or metastatic tumor) and a positive cerebrospinal fluid cytology. Most patients require treatment with corticosteroids, particularly if they are receiving radiation therapy.
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| For patients with brain tumors, two primary goals of surgery include:
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| (1) establishing a histologic diagnosis and
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| (2) reducing intracranial pressure by removing as much tumor as is safely possible to preserve neurological function.
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| Total elimination of primary intraparenchymal tumors by surgery alone is extremely rare. Radiation therapy and chemotherapy options vary according to histology and anatomic site of the brain tumor. Therapy involving surgically implanted carmustine-impregnated polymer combined with postoperative external-beam radiation therapy (EBRT) has a role in the treatment of high-grade gliomas. Dexamethasone, mannitol, and furosemide are used to treat the peritumoral edema associated with brain tumors. Use of anticonvulsants is mandatory for patients with seizures.
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| Novel biologic therapies under clinical evaluation for patients with brain tumors include dendritic cell vaccination, tyrosine kinase receptor inhibitors, farnesyl transferase inhibitors, viral-based gene therapy, oncolytic viruses, epidermal growth factor receptor inhibitors and vascular endothelial growth factor inhibitors, and other antiangiogenesis agents.
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| Patients who have brain tumors that are either infrequently curable or unresectable should be considered candidates for clinical trials that evaluate radiosensitizers, hyperthermia, or interstitial brachytherapy used in conjunction with EBRT to improve local control of the tumor or for studies that evaluate new drugs and biological response modifiers.
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| ==References==
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| {{refbegin|2}}
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| 1. Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000.
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| 2. Brain and spinal cord. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed. New York, NY: Springer, 2002, pp 387-90.
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| 3. Kleihues P, Burger PC, Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3 (3): 255-68, 1993.
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| 4. Cavenee WK, Furnari FB, Nagane M, et al.: Diffusely infiltrating astrocytomas. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 10-21.
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| 5. Burger PC, Scheithauer BW, Paulus W, et al.: Pilocytic astrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 45-51.
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| 6. Kleihues P, Davis RL, Ohgaki H, et al.: Diffuse astrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 22-6.
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| 7. Kitange GJ, Templeton KL, Jenkins RB: Recent advances in the molecular genetics of primary gliomas. Curr Opin Oncol 15 (3): 197-203, 2003.
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| 8. Kleihues P, Davis RL, Coons SW, et al.: Anaplastic astrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 27-8.
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| 9. Kleihues P, Burger PC, Collins VP, et al.: Glioblastoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 29-39.
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| 10. Kepes JJ, Louis DN, Giannini C, et al.: Pleomorphic xanthoastrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 52-4.
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| 11. Wiestler OD, Lopes BS, Green AJ, et al.: Tuberous sclerosis complex and subependymal giant cell astrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 227-30.
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| 12. Reifenberger G, Kros JM, Burger PC, et al.: Oligodendroglioma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 56-61.
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| 13. Ueki K, Nishikawa R, Nakazato Y, et al.: Correlation of histology and molecular genetic analysis of 1p, 19q, 10q, TP53, EGFR, CDK4, and CDKN2A in 91 astrocytic and oligodendroglial tumors. Clin Cancer Res 8 (1): 196-201, 2002.
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| 14. Giordana MT, Ghimenti C, Leonardo E, et al.: Molecular genetic study of a metastatic oligodendroglioma. J Neurooncol 66 (3): 265-71, 2004.
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| 15. Kitange GJ, Smith JS, Jenkins RB: Genetic alterations and chemotherapeutic response in human diffuse gliomas. Expert Rev Anticancer Ther 1 (4): 595-605, 2001.
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| 16. Hoang-Xuan K, Capelle L, Kujas M, et al.: Temozolomide as initial treatment for adults with low-grade oligodendrogliomas or oligoastrocytomas and correlation with chromosome 1p deletions. J Clin Oncol 22 (15): 3133-8, 2004.
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| 17. Reifenberger G, Kros JM, Burger PC, et al.: Anaplastic oligodendroglioma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 62-4.
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| 18. Cairncross JG, Ueki K, Zlatescu MC, et al.: Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90 (19): 1473-9, 1998.
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| 19. Ino Y, Betensky RA, Zlatescu MC, et al.: Molecular subtypes of anaplastic oligodendroglioma: implications for patient management at diagnosis. Clin Cancer Res 7 (4): 839-45, 2001.
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| 20. Reifenberger G, Kros JM, Burger PC, et al.: Oligoastrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 65-7.
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| 21. Reifenberger G, Kros JM, Burger PC, et al.: Anaplastic oligoastrocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 68-9.
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| 22. Wiestler OD, Schiffer D, Coons SW, et al.: Myxopapillary ependymoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 78-9.
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| 23. Wiestler OD, Schiffer D: Subependymoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 80-1.
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| 24. Wiestler OD, Schiffer D, Coons SW, et al.: Ependymoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 72-6.
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| 25. Lantos PL, Rosenblum MK: Astroblastoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 88-9.
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| 26. Brat DJ, Scheithauer BW, Cortez SC, et al.: Chordoid glioma of the third ventricle. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 90-1.
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| 27. Lantos PL, Bruner JM: Gliomatosis cerebri. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 92-3.
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| 28. Nelson JS, Bruner JM, Wiestler OD, et al.: Ganglioglioma and gangliocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 96-8.
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| 29. Taratuto AL, VandenBerg SR, Rorke LB: Desmoplastic infantile astrocytoma and ganglioglioma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 99-102.
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| 30. Daumas-Duport C, Pietsch T, Lantos PL: Dysembryoplastic neuroepithelial tumour. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 103-6.
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| 33. Kleihues P, Chimelli L, Giangaspero F: Cerebellar liponeurocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 110-1.
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| 34. Soffer D, Scheithauer BW: Paraganglioma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 112-4.
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| 36. Giangaspero F, Bigner SH, Kleihues P, et al.: Medulloblastoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 129-37.
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| 40. Mena H, Nakazato Y, Jouvet A, et al.: Pineocytoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 118-20.
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| 45. Rosenblum MK, Matsutani M, Van Meir EG: CNS germ cell tumors. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 208-14.
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| 49. Janzer RC, Burger PC, Giangaspero F, et al.: Craniopharyngioma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 244-6.
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| 50. Böhling T, Plate KH, Haltia MJ, et al.: Von Hippel-Lindau disease and capillary haemangioblastoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 223-6.
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| 51. Woodruff JM, Kourea HP, Louis DN, et al.: Schwannoma. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 164-6.
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| 52. Wen PY, Black PM, Loeffler JS: Treatment of metastatic cancer. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001, pp 2655-70.
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| 54. Nelson JS, Von Deimling A, Petersen I, et al.: Metastatic tumours of the CNS. In: Kleihues P, Cavenee WK, eds.: Pathology and Genetics of Tumours of the Nervous System. Lyon, France: International Agency for Research on Cancer, 2000, pp 250-3.
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| {{Refend}}
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| [[Category:Oncology]]
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