Neurological cancers
Tuesday, 8 June 2010 marked World Brain Tumour Awareness Day and presents a timely reminder to reflect on current progress in evidence-based neuro-oncology. Brain tumours, although rare, represent a disproportionately high burden of life years lost due to malignancy. The burgeoning of novel molecular therapies signifies a renaissance period for this hitherto neglected specialty, whilst the last decade has seen the introduction of carmustine wafer implants (Gliadel®) and Temozolomide as the first new treatments for high grade glioma in almost 30 years. The Cochrane Library has led the way in providing critical appraisal of both these therapies, underpinning their integration into clinical practice. Renewed interest in established treatments has been generated with findings highlighting the lack of evidence for surgical resection in high grade glioma and single brain metastasis.
The future of neuro-oncology is likely to involve the development of individualised therapy and the use of more sophisticated operative techniques; translating these advances into improved clinical outcomes, including greater emphasis on quality of life, will require building on the foundation of the reviews in this collection.
The Cochrane Gynaecological Cancer Review Group is the host for a large number of cancer reviews which fall outside the scope of any other current Cochrane Review Group. The majority of reviews on neurological cancer fit within this category, although the Cochrane Back Group and the Cochrane Childhood Cancer Group have topic-specific reviews within their scope. View full list of reviews.
Image credit: Simon Fraser/Newcastle Hospitals NHS Trust/Science Photo Library
Oligodendroglioma and oligoastrocytoma
Adjuvant treatment of anaplastic oligodendrogliomas and oligoastrocytomas
Anaplastic oligodendrogliomas (AO) and anaplastic oligoastrocytomas (AOA) are known to be chemosensitive tumours. This review compares radiotherapy (RT) plus chemotherapy versus RT alone (standard of care) in adults with newly diagnosed AO or mixed AOA, who have undergone surgery. It also aims to investigate the prognostic and predictive value of loss of heterozygosity of chromosomes 1p and 19q. Outcomes analysed include overall survival (OS), progression-free survival (PFS), and treatment toxicity greater than or equal to grade 3. [Download PDF]
Glioma
Biopsy versus resection for high grade glioma
Patients with a presumed primary brain tumour from clinical examination and radiological investigation have two initial surgical management options; biopsy or resection. In certain acute situations such as severe raised intracranial pressure, surgical resection is clinically indicated. Where surgical resection is not practical, biopsy is the only reasonable option. Most patients fall somewhere between these extremes, and in these cases it is uncertain which procedure offers the best surgical option for the patient. This review aims to estimate the clinical effectiveness of surgical resection compared to biopsy in patients with a new lesion suspicious of malignant glioma. [Download PDF]
Chemotherapeutic wafers for high grade glioma
Standard treatment for high grade glioma (HGG) usually entails biopsy or surgical resection where possible followed by radiotherapy. Systemic chemotherapy is usually only given in selected cases and its use is often limited by side effects. Implanting wafers impregnated with chemotherapy agents into the resection cavity represents a novel means of delivering drugs to the central nervous system (CNS) with fewer side effects. This review aims to assess whether chemotherapeutic wafers have any advantage over conventional therapy for HGG. [Download PDF]
Temozolomide for high grade glioma
High grade glioma (HGG) is an aggressive form of brain tumour. Treatment usually entails biopsy or resection where possible, followed by radiotherapy. Temozolomide is a novel oral chemotherapeutic drug that penetrates into the brain and has a low incidence of adverse effects. This review aims to assess whether temozolomide holds any advantage over conventional therapy for HGG in either primary or recurrent disease settings. [Download PDF]
Neuroblastoma
Despite the development of new treatment options, the prognosis of high-risk neuroblastoma patients is still poor; more than half of patients experience disease recurrence. High-dose chemotherapy and haematopoietic stem cell rescue (i.e. myeloablative therapy) might improve survival. This review aims to compare the effectiveness of myeloablative therapy with conventional therapy in children with high-risk neuroblastoma. [Download PDF]
Metastatic disease
Interventions for the treatment of metastatic extradural spinal cord compression in adults
Metastatic epidural spinal cord compression (MESCC) is often treated with radiotherapy and corticosteroids. Recent reports suggest benefit from decompressive surgery. The aim of this review is to determine effectiveness and adverse effects of radiotherapy, surgery and corticosteroids in MESCC. [Download PDF]
Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases
The treatment of brain metastasis is generally palliative, with whole brain radiation therapy (WBRT), since most patients have uncontrollable systemic cancer. In certain circumstances, such as single brain metastasis, death may be more likely from brain involvement than systemic disease. In this group surgical resection has been proposed to relieve symptoms and prolong survival. This review aims to assess the clinical effectiveness of surgical resection plus WBRT versus WBRT alone in the treatment of single brain metastasis. [Download PDF]
Whole brain radiotherapy for the treatment of multiple brain metastases
Brain radiotherapy is used to treat cancer participants who have brain metastases from various primary malignancies. This review aims to assess the effectiveness and adverse effects of whole brain radiotherapy (WBRT) in adult participants with multiple metastases to the brain. [Download PDF]
Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases
Historically, whole brain radiation therapy (WBRT) has been the main treatment for brain metastases. Stereotactic radiosurgery (SRS) delivers high dose focused radiation and is being increasingly utilized to treat brain metastases. The benefit of adding radiosurgery to WBRT is unclear. This review aims to assess the efficacy of WBRT plus radiosurgery versus WBRT alone in the treatment of brain metastases. [Download PDF]
Treatment of co-morbid depression
Pharmacological treatment of depression in patients with a primary brain tumour
Patients with a primary brain tumour often experience depression, for which drug treatment may be prescribed. However, these patients are also at high risk of epileptic seizures, cognitive impairment and fatigue, all of which are potential side-effects of antidepressants. This review aims to assess the benefits and harms of pharmacological treatment of depression in patients with a primary brain tumour. [Download PDF]
