Glioblastoma and Other Primary Brain Malignancies in Adults: A Review.

in JAMA by Lauren R Schaff, Ingo K Mellinghoff

TLDR

  • Malignant primary brain tumors are a type of cancer that starts in the brain. These tumors can be treated with surgery, chemotherapy, and radiation. The study looked at different ways to treat these tumors and found that some treatments work better than others. The study also found that a combination of treatments, like surgery and chemotherapy, can be more effective than just one treatment. The study suggests that a team of doctors, including neurosurgeons, oncologists, and radiologists, is needed to treat these tumors effectively.

Abstract

Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%. Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P < .001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P = .06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P = .02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation. The incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide.

Overview

  • The study focuses on malignant primary brain tumors, their incidence, symptoms, and treatment options in the United States. The hypothesis being tested is the effectiveness of different treatment options for different types of malignant brain tumors. The methodology used for the experiment includes a review of existing literature and analysis of clinical trials. The primary objective of the study is to provide a comprehensive overview of malignant primary brain tumors and their treatment options.

Comparative Analysis & Findings

  • The study compares the outcomes observed under different experimental conditions or interventions for malignant primary brain tumors. The results show that the combination of temozolomide with radiotherapy improved survival for patients with glioblastoma, while the combination of procarbazine, lomustine, and vincristine improved survival for patients with anaplastic oligodendroglial tumors with 1p/19q codeletion. The study also highlights the effectiveness of high-dose methotrexate-containing regimens for the treatment of primary CNS lymphoma. The key findings of the study support the use of targeted therapies and combination therapies for the treatment of malignant primary brain tumors.

Implications and Future Directions

  • The study's findings have significant implications for the field of research and clinical practice. The study highlights the importance of targeted therapies and combination therapies for the treatment of malignant primary brain tumors. The study also identifies areas for future research, such as the development of new targeted therapies and the evaluation of different treatment options for other types of malignant brain tumors. The study suggests that a multidisciplinary approach, involving neurosurgeons, oncologists, and radiologists, is necessary for the effective treatment of malignant primary brain tumors.
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