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This is a multi-specialty book on the diagnosis, evaluation, and treatment of CNS metastases of the brain and spine. Written by renowned experts in their fields, the book covers essential contemporary topics in CNS metastases care. The book is divided into seven parts that begin with chapters that cover the fundamental biology of disease so that subsequent chapters on imaging, diagnosis, treatment, and palliation can be properly contextualized. This text also provides a framework for understanding the biology of radiation therapy so that radiation treatment options of the brain and spine can be more fully understood. New medications and technologies are reviewed from the perspective of maximizing efficacy and minimizing toxicity, independently and as combinatorial therapy. Central Nervous System Metastases: Diagnosis and Treatment serves as a practical reference for health care providers and trainees. It provides the comprehensive, detailed perspective required to provide holistic care to patients with metastatic disease to the brain and spine.
This book provides a comprehensive overview of brain metastases, from the molecular biology aspects to therapeutic management and perspectives. Due to the increasing incidence of these tumors and the urgent need to effectively control brain metastatic diseases in these patients, new therapeutic strategies have emerged in recent years. The volume discusses all these innovative approaches combined with new surgical techniques (fluorescence, functional mapping, integrated navigation), novel radiation therapy techniques (stereotactic radiosurgery) and new systemic treatment approaches such as targeted- and immunotherapy. These combination strategies represent a new therapeutic model in brain metastatic patients in which each medical practitioner (neurosurgeon, neurologist, medical oncologist, radiation oncologist) plays a pivotal role in defining the optimal treatment in a multidisciplinary approach. Written by recognized experts in the field, this book is a valuable tool for neurosurgeons, neuro-oncologists, neuroradiologists, medical oncologists, radiation oncologists, cognitive therapists, basic scientists and students working in the area of brain tumors.
Brain metastases are the most dreaded complication of systemic cancer, affecting some 170,000 people a year, a far greater incidence than primary brain tumors. This book presents current information on the presentation and management of patients with brain metastases, providing available data, giving guidelines that can be applied in day to day practice, updated information for neurosurgeons, radiation oncologists, medical oncologists, and neuron-oncologists, and as an overview for physicians in training.
Approximately 40% of lung cancer patients will develop central nervous system (CNS) metastases during the course of their disease. Most of these are brain metastases, but up to 10% will develop leptomeningeal metastases. Known risk factors for CNS metastases development are small cell lung cancer (SCLC), adenocarcinoma histology, epidermal growth factor receptor (EGFR) mutant or anaplastic lymphoma kinase (ALK) rearranged lung cancer, advanced nodal status, tumor stage and younger age. CNS metastases can have a negative impact on quality of life (QoL) and overall survival (OS). The proportion of lung cancer patients diagnosed with CNS metastases has increased over the years due to increased use of brain imaging as part of initial cancer staging, advances in imaging techniques and better systemic disease control. Post contrast gadolinium enhanced magnetic resonance imaging (gd-MRI) is preferred, however when this is contra-indicated a contrast enhanced computed tomography (CE-CT) is mentioned as an alternative option. When CNS metastases are diagnosed, local treatment options consist of radiotherapy (stereotactic or whole brain) and surgery. Local treatment can be complicated by symptomatic radiation necrosis for which no high level evidence based treatment exists. Moreover, differential diagnosis with metastasis progression is difficult. Systemic treatment options have expanded over the last years. Until recently, chemotherapy was the only treatment option with a poor penetration in the CNS. Angiogenesis inhibitors are promising in the treatment of primary CNS tumors as well as radiation necrosis but clinical trials of anti-angiogenic agents in NSCLC have largely excluded patients with CNS metastases. Furthermore, research has also focused on methods to prevent development of CNS disease, for example with prophylactic cranial irradiation. Recently, checkpoint inhibitors have become available for NSCLC patients, and tyrosine kinase inhibitors (TKIs) have improved prognosis significantly in those with a druggable driver mutation. Newer TKIs are often designed to have better CNS penetration compared to first-generation TKIs. Despite advances in treatment options CNS metastases remain a problem in lung cancer and cause morbidity and mortality. This Research Topic provides an extensive resource of articles describing advances in CNS metastases management in lung cancer patients, from prevention to diagnosis and treatment.
Since the late 1960s, the survival rate in children and adolescents diagnosed with cancer has steadily improved, with a corresponding decline in the cancer-specific death rate. Although the improvements in survival are encouraging, they have come at the cost of acute, chronic, and late adverse effects precipitated by the toxicities associated with the individual or combined use of different types of treatment (e.g., surgery, radiation, chemotherapy). In some cases, the impairments resulting from cancer and its treatment are severe enough to qualify a child for U.S. Social Security Administration disability benefits. At the request of Social Security Administration, Childhood Cancer and Functional Impacts Across the Care Continuum provides current information and findings and conclusions regarding the diagnosis, treatment, and prognosis of selected childhood cancers, including different types of malignant solid tumors, and the effect of those cancers on childrenâ (TM)s health and functional capacity, including the relative levels of functional limitation typically associated with the cancers and their treatment. This report also provides a summary of selected treatments currently being studied in clinical trials and identifies any limitations on the availability of these treatments, such as whether treatments are available only in certain geographic areas.
Most cancer deaths are a result of metastasis. The spread of a primary tumor to colonize neighboring and distant organs is the relentless endgame that defines the neoplastic process. Patients who have been diagnosed with cancer are treated to prevent both the recurrence of the tumor at the site of origin and metastasis that would re-stage them as advanced stage IV cancer. Historically and still with some types of cancer, stage IV is perceived by patients as “terminal.” Fortunately, recent molecular therapies have extended the lives of patients with advanced cancer and reassuringly people living with metastatic disease increasingly visit our clinics. What is the path forward? Given that the consilience of science and medicine is a dynamic art from which therapies arise, it would be misguided to consider any single work adequate at capturing the horizon for research. So with humility we constructed this text as primer for scientists. It begins with a broad introduction to the clinical management of common cancers. This is intended to serve as a foundation for investigators to consider when developing basic science hypotheses. Unquestionably, medical and surgical care of cancer patients reveals biology and dictates how novel therapeutics will ultimately be evaluated in clinical trials. The second section of this text offers provocative and evolving insights that underscore the breadth of science involved in the elucidation of cancer metastasis biology. The text concludes with information that integrates scientific and clinical foundations to highlight translational research. This book serves as a framework for scientists to conceptualize clinical and translational knowledge on the complexity of disease that is metastatic cancer.
Thoroughly revised to reflect the latest advances in neurosurgery, radiation oncology, chemotherapy, biological therapy, and the basic sciences, the Second Edition of this highly acclaimed volume is the most comprehensive, current reference on tumors of the central and peripheral nervous system. More than 100 of the foremost authorities present multimodality treatment strategies for specific tumor types and examine the mechanisms of tumorigenesis. Coverage includes state-of-the-art information on image-guided surgery, local delivery systems, intraoperative imaging, proton beam therapy, conformal systems, radiosurgery, new drugs and biological agents, and cell cycle deregulation and chromosomal abnormalities in tumorigenesis. This edition contains over 400 illustrations.
Although distant metastases are the most dreaded situation in the evolution of cancer of every organ, the medical literature has surprisingly given little attention to the anatomical relationship between the primary tumor and metastasic sites. Only risk factors, treatment possibilities, and survival results are extensively examined. Stimulated by the occurrence in his practice of some puzzling and unexpected metastases, the author reviewed more than 12,000 references. He looked for anatomical relationships highlighting the relation between the location of the primary tumors and the particular patterns of metastasis observed. It would seem that the `pathways and flows' are apparently a more decisive factor in the implantation of the metastases than the `seed and soil' properties of the cancer cells and the metastatic site. Aided by his colleague Dr. T. Geukens, M.D., the author includes original anatomical drawings, illustrating the sometimes unexpected pathways the cancer cells follow in order to reach the organs where they will become lodged and give rise to metastatic tumors. The subject has apparently not been exhausted in the literature and several ideas are given for further research.
This updated edition remains the essential text for pathologists seeking to make accurate diagnoses from the vast number of differentials.