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Survival rates in patients with primary malignant brain
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data, 1973-1991. J Neurosurg. 1998;88:1-10.
The largest epidemiological study of brain tumours, sponsored by the Central Brain
Tumour Registry of the United States (CBTRUS), a sister organization of the American Brain
Tumour Association (ABTA), contains significant information on the current profile of primary malignant brain
tumours. The study of over 20,000 patients with brain tumours covers 18 years during which the diagnosis and treatment of brain
tumours evolved rapidly. Considerable improvements in survival rates between the years of 1973 to 1980 and the more recent era of 1986 to 1991 were noted for children and adults with medulloblastoma, as well as adults with astrocytoma
(non-malignant) and oligodendroglioma. Glioblastoma multiforme continues to the most intractable brain
tumours with little improvement in survival despite dramatic advances in diagnostic and surgical technology.
Gately S, Soff GA, Brem S. The potential role of basic fibroblast growth factor in the transformation of cultured primary human
foetal astrocytes and the proliferation of human glioma (U-87) cells. Neurosurgery. 1995;37:723-730.
The switch to the malignant phenotype may be linked to the gene expression of specific oncogenes and growth factors. In animal models and in vitro experiments, basic fibroblast growth factor is linked with the proliferation, invasion, and angiogenesis response of malignant brain
tumour cells. These data support the development of pharmacological compounds that suppress the expression or inhibit the action of these growth factors.
Fernandez PM, Brem S. Malignant brain tumours in the elderly. Clin Geriatr Med. 1997;13:327-338.
The increase in the incidence of primary brain tumours in the elderly over the last decade represents a serious health problem. Surgery remains the mainstay of the management of malignant gliomas, and the extent of the resection is one factor linked to the length of survival. This article reviews standard treatment modalities as well as novel approaches in clinical trials to treat newly diagnosed and recurrent glioblastomas.
Brem S, Rozental JM, Moskal JR. What is the etiology of human brain tumours? A report on the first Lebow
Conference. Cancer. 1995; 76:709-713.
The key to the optimal treatment of brain tumours will be the clear understanding of the biological origins, preventable factors, and specific control mechanisms. The puzzle of what causes brain
tumours remains complex with theories linking it to environmental (eg, electromagnetic radiation), genetic, dietary, and hereditary factors. The Lebow Conference, attended by prominent scientists and clinicians, identified new avenues of research across multiple scientific disciplines.
Brem H, Piantadosi S, Burger PC, et al. Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent
gliomas. Lancet. 1995; 345:1008-1012.
This prospective, randomised, placebo-controlled, multicentre trial of 222 patients is noteworthy because it reports a new treatment that is safe and effective for recurrent malignant gliomas. The study was conducted under rigorous control and opens the door for further trials with more effective drugs.
Harbaugh KS, Black PM. Strategies in the surgical management of malignant
gliomas. Semin Surg Oncol. 1998;14:26-33.
This article reviews the current neurosurgical technology including MRI guidance and stereotaxy to maximize the safe removal of the brain
tumour while sparing "eloquent" and vital areas of brain.
Fetell MR, Grossman SA, Fisher JD, et al. Pre-irradiation paclitaxel in glioblastoma multiforme: efficacy, pharmacology, and drug interactions. New Approaches to Brain
Tumour Therapy Central Nervous System Consortium. J Clin Oncol. 1997;15:3121-3128.
The plasma concentrations of paclitaxel in patients taking enzyme-inducing antiepileptic drugs (eg, diphenylhydantoin, carbamazepine, phenobarbital) were significantly lower than in patients not taking these antiseizure medication. Thus, the concomitant administration of
antiseizure medication introduces an important variable in interpreting efficacy data, pharmacokinetics, and toxicity of novel agents for treatment of brain
Lang FF, Sawaya R. Surgical treatment of metastatic brain tumours. Semin Surg Oncol. 1998; 14:53-63.
This article provides a clear exposition of criteria for selection of suitable candidates for surgery, emphasizing that multiple or recurrent brain metastases can be successfully removed with an increase in survival and enhancement of the quality of life, often complementing other available modalities such as stereotactic radiosurgery and whole-brain irradiation.
Jacobs W, Mikkelsen T, Smith R, et al. Inhibitory effects of CAI in glioblastoma growth and
invasion. J Neurooncol. 1997;32:93-101.
CAI, carboxyamide-triazole, is an anticancer agent developed as an inhibitor of selected signal transduction pathways. CAI inhibits the invasive phenotype of human glioma cell lines and decreases production of the 72kDa and 92 kDa type IV collagenases, thus suggesting a potential for benefit in the treatment of high-grade astrocytomas.
Harsh GR 4th. Management of recurrent gliomas and meningiomas. In: Kaye AH, Laws ER Jr, eds. Brain
Tumours: An Encyclopedic Approach. New York, NY: Churchill Livingstone; 1995:413-428.
This report represents a superb overview of the multimodality treatment of gliomas in an outstanding reference source for the modern approach to brain
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