Evidence based practice in Neuro-oncology

Foreword
Contents
About the Editors
Part I: Epidemiology, Neuro-Anatomy and Neuro-Pathology for a Neuro-Oncologist
1: Epidemiology and Demography of Brain Tumors
1.1 Introduction
1.2 Risk Factors
1.3 Risk Factors Common for Brain Tumors
1.4 Pediatric Brain Tumors
1.5 Genetic Syndromes Associated with Pediatric Brain Tumors
1.6 Brain Tumor in Adults
1.7 Survival Outcomes
References
2: Neuro-Anatomy for Oncologist
2.1 Introduction
2.2 The ‘Environments’ of the Brain
2.2.1 The Bony Framework
2.2.1.1 Oncological Significance
2.2.2 Cranial Nerves
2.2.2.1 Oncological Significance
2.2.3 The Meninges
2.2.3.1 Dura Mater Around the Brain and Dural Folds
Oncological Significance
2.2.3.2 The Pia, Arachnoid and Subarachnoid Space
2.3 Spinal Cord
2.3.1 Oncological Significance
2.4 Brainstem
2.4.1 Oncologic Significance
2.5 Cerebellum
2.5.1 Oncological Significance
2.6 Diencephalon: The Thalamus, Hypothalamus and Epithalamus
2.6.1 Thalamus
2.6.1.1 Oncological Significance
2.6.2 Epithalamus
2.6.2.1 Oncological Significance
2.6.3 Hypothalamus
2.6.3.1 Oncological Significance
2.7 Pituitary Gland
2.8 Cerebrum: Sulci, Gyri, Functional Areas
2.8.1 Oncological Significance
2.9 White Matter of Cerebrum
2.10 Basal Ganglia
2.10.1 Oncological Significance
2.11 Ventricles of the Brain
2.11.1 Oncological Significance
References
3: Pathology, Molecular Biology and Classification of Gliomas
3.1 Evolving Concept of Classification of Glioma and Integrated Diagnosis
3.2 Diffuse Gliomas
3.2.1 Diffuse Astrocytomas (DA), IDH Mutant (WHO Grade II) and Anaplastic Astrocytoma (AA), IDH Mutant (WHO Grade III)
3.2.1.1 Microscopy
3.2.1.2 Molecular Profile
3.2.2 Diffuse Astrocytoma, IDH Wild Type (WHO Grade II) and Anaplastic Astrocytoma, IDH Wild Type (WHO Grade III)
3.2.2.1 Histology
3.2.2.2 Molecular Profile
3.2.3 Glioblastoma, IDH Wild Type, WHO Grade IV
3.2.3.1 Microscopy
3.2.3.2 Molecular Profile
3.2.4 Glioblastoma, IDH Mutant Type
3.2.4.1 Molecular Profile
3.2.5 Diffuse Midline Glioma (DMG), H3K27M Mutant
3.2.5.1 Microscopy
3.2.5.2 Molecular Profile
3.2.6 Diffuse glioma H3.3 G34 – Mutant
3.2.6.1 Microscopy
3.2.6.2 Molecular profile
3.2.7 Pediatric-Type Low-Grade Diffuse Glioma
3.2.7.1 Microscopy
3.2.7.2 Molecular Profile
3.2.8 Oligodendroglioma (OG), IDH Mutant, and 1p/19q Co-Deleted
3.2.8.1 Anaplastic Oligodendroglioma (AO), IDH Mutant, and 1p/19q Co-Deleted
3.2.8.2 Microscopy
3.2.8.3 Molecular Profile
3.2.9 Oligoastrocytoma
3.3 Diffuse Glioma: Approach to Diagnosis
3.4 Other Astrocytic Tumors
3.4.1 Pilocytic Astrocytoma (PA), WHO Grade1
3.4.1.1 Microscopy
3.4.1.2 Molecular Profile
3.4.1.3 Pilocytic Astrocytoma with Anaplasia
3.5 Not Otherwise Specified (NOS) and Not Elsewhere Classified (NEC) Categories
3.5.1 Not Otherwise Specified (NOS)
3.5.2 Not Elsewhere Classified (NEC)
References
4: Pathology and Molecular Pathology of Ependymoma
4.1 Introduction
4.2 Pathology
4.2.1 Subependymoma
4.2.2 Myxopapillary Ependymoma
4.2.3 Ependymoma and Anaplastic Ependymoma
4.2.4 Ependymoma, RELA Fusion Positive
4.3 Molecular Pathology
4.3.1 PFA Molecular Subgroup (Pediatric Type)
4.3.2 Spinal Ependymoma, NMYC Amplified
4.4 Future Perspectives
References
5: Pathology and Molecular Pathology of Meningioma
5.1 Introduction
5.2 Pathology
5.2.1 Gross Pathology
5.2.2 Histopathology and WHO Grade
5.2.3 Immunophenotype
5.2.4 Molecular Pathology
5.2.4.1 NF2 Meningiomas
5.2.4.2 Non-NF2 Meningiomas
5.2.4.3 Familial Syndromes
5.2.4.4 TERT Promotor Mutations
5.2.4.5 DMD Mutations
5.2.4.6 Epigenetics
5.3 Prognosis and Outcome
5.4 Future Perspectives
References
6: Pathology and Molecular Biology of Medulloblastoma
6.1 Introduction
6.2 Clinical Profile
6.3 Integrated Diagnosis
6.4 Medulloblastomas, Histologically Defined
6.4.1 Classic Medulloblastoma (Fig. 6.1a)
6.4.2 Desmoplastic/Nodular (D/N) Medulloblastoma (Fig. 6.1b, c)
6.4.3 Medulloblastoma with Extensive Nodularity (MBEN)
6.4.4 Large Cell/Anaplastic (LC/a) Medulloblastoma (Fig. 6.1d)
6.4.5 Patterns
6.5 Medulloblastomas, Molecularly Defined
6.5.1 Medulloblastoma, WNT-Activated
6.5.2 Medulloblastoma, SHH-Activated
6.5.3 Medulloblastoma, Non-WNT/Non-SHH
6.6 Risk Stratification
6.6.1 Clinical Risk Stratification: Chang Staging System
6.6.2 Refined Risk Stratification [17]
6.6.2.1 According to WHO 2016 Classification [1]
6.6.3 Benefits of Risk Stratification
6.7 Management
6.8 Approach to Diagnosis
6.9 Future Perspectives
References
Part II: Clinical Examination, Neuro-Imaging and Basics of Radiotherapy in Neuro-Oncology
7: Radiology in Modern Neuro-Oncology Practice
7.1 Plain Radiography
7.2 Computed Tomography (CT)
7.2.1 Physical Principles
7.3 Basic Cross-Sectional Neuroanatomy
7.4 Role of CT in Neuro-Oncologic Imaging
7.5 Magnetic Resonance Imaging
7.6 Basic MRI Sequences
7.6.1 T1 Weighted Image
7.6.2 T2 Weighted Image
7.6.3 FLAIR
7.6.4 SWI
7.6.5 DWI
7.6.6 STIR
7.6.7 Post Contrast-Enhanced MRI
7.7 Conventional/Structural MRI Evaluation in Brain Tumors
7.8 Advanced Cross-Sectional Imaging Techniques in Neuro-Oncology
7.8.1 CT Perfusion
7.8.1.1 Technique
7.8.2 Advanced MRI Techniques
7.8.3 MRS
7.8.3.1 Clinical Applications in Brain Tumor Imaging
7.8.4 MR Perfusion
7.8.4.1 DSC Perfusion
7.8.4.2 DCE Perfusion
7.8.4.3 ASL Perfusion
7.8.4.4 Technique
7.8.4.5 Clinical Applications
7.8.5 Functional MRI (fMRI)
7.8.5.1 Technique
7.8.5.2 Clinical Applications
7.8.6 DTI
References
8: PET in Brain Tumors
8.1 Introduction
8.2 Significance of the Blood–Brain Barrier
8.3 Advantages of PET in Brain Tumor Imaging
8.4 Role of PET
8.4.1 Tumor Detection, Delineation of Tumor, and Differential Diagnosis of Brain Tumors
8.4.2 Tumor Grading
8.4.3 Disease Prognosis
8.4.4 Diagnosis of Recurrent Brain Tumors and Differentiating between Post-therapy Radiation Necrosis from Residual/Recurrent Brain Tumor
8.4.5 Planning Stereotactic Biopsy
8.5 PET Tracers
8.5.1 Glucose Metabolism
8.5.2 Amino Acid Transport
8.5.3 Cellular Proliferation
8.5.4 Hypoxia Imaging
8.5.5 Theragnostic Agent
8.5.6 18F-FDG
8.6 Amino Acid Tracers
8.7 Other Radiopharmaceuticals
8.7.1 18F-Fluorothymidine (18F-FLT)
8.7.2 18F-FMISO
8.7.3 11C-Choline (CHO) and 18F-Fluorocholine (FCHO)
8.7.4 SSTR Ligands (68Ga DOTA-TOC and DOTA-NOC)
8.7.5 68Ga-PSMA
8.8 PET-MRI
8.9 Conclusion
References
9: Fundamentals of Radiation for Neuro-Oncology
9.1 Introduction
9.1.1 Important Events
9.1.2 Mechanism of Radiation Action
9.1.3 Evolution of Radiation Delivery
9.1.4 Process of Radiation Treatment Planning
9.2 Treatment Target Volumes and Organ at Risk
9.3 Radiation Induced Brain Injury
9.3.1 Pathophysiology
9.4 Necrosis of Brain
9.5 Reirradiation
9.5.1 Target Volume Delineation
9.5.2 Dose in Reirradiation
9.6 Threshold of Radiation Necrosis
9.7 OAR Delineation
References
Suggested Reading
10: Stereotactic Radiosurgery: Planning and Evaluation
10.1 Introduction
10.2 Plan Evaluation of SRS
10.2.1 Technique and Target Selection
10.2.2 Dose Calculation Grid
10.2.3 Isodose Prescription
10.2.4 Dose to Brain and Critical OARs
10.2.5 Qualitative Assessment: Spatial Dose Distribution
10.2.6 Quantitative Assessment: DVH and Derived Indices
10.2.6.1 Dose-Volume Histogram (DVH)
10.2.6.2 Dose Variation at Edge of Target: Conformity Index
10.2.6.3 Dose Variation Outside Target: Gradient Index
10.2.6.4 Dose Variation Inside Target: Homogeneity Index
10.2.6.5 Clinical Significance of DVH Indices
10.3 Approval of SRS Plan
10.4 Reporting of SRS
10.5 Conclusion
References
11: Radiation Induced Brain Injury
11.1 Necrosis of Brain
References
Part III: Management of Brain Tumours
12: Grade 1 Gliomas
12.1 Introduction
12.2 Epidemiology
12.3 Pathology
12.4 Clinical Presentation
12.4.1 Other Astrocytic Tumors
12.4.1.1 Pilocytic Astrocytoma (WHO Grade I)
12.4.1.2 Subependymal Giant Cell Astrocytomas
12.4.2 Other Gliomas
12.4.2.1 Angiocentric Glioma
12.4.3 Neuronal and Mixed Neuronal-Glial Tumors
12.4.3.1 Dysembryoplastic Neuroepithelial Tumor (WHO Grade I)
12.4.3.2 Ganglioglioma (WHO Grade I)
12.4.3.3 Gangliocytoma
12.4.3.4 Dysplastic Gangliocytoma of the Cerebellum
12.4.3.5 Desmoplastic Infantile Astrocytoma and Ganglioglioma
12.4.3.6 Papillary Glioneuronal Tumor
12.4.3.7 Rosette-Forming Glioneuronal Tumor
References
13: Grade 2 Gliomas
13.1 Introduction
13.2 Epidemiology
13.3 Pathology and Molecular Characteristics
13.4 Imaging in LGGs
13.4.1 Computed Tomography (CT) Scan
13.4.2 Multiparametric Magnetic Resonance Imaging (MRI)
13.4.3 Positron Emission Tomography (PET)-CT Scans
13.5 Treatment
13.5.1 Surgery
13.5.2 Adjuvant Radiotherapy and Chemotherapy
13.5.2.1 Timing of Radiotherapy
13.5.2.2 Dose of Radiotherapy
13.5.2.3 Radiotherapy Target Volume and Technique
13.5.2.4 Addition of Chemotherapy Following Adjuvant RT
13.5.2.5 Radiotherapy Versus Chemotherapy
13.5.2.6 Choice of Adjuvant Chemotherapy: PCV Versus TMZ
13.5.3 Which Patients with LGG may Do Well with Observation Only
13.5.4 Prognostic Factors
13.5.5 Reirradiation/Salvage
13.6 “Other” Astrocytic Tumors
13.6.1 Pleomorphic Xanthoastrocytoma Grade 2
13.7 Other Gliomas
13.7.1 Chordoid Glioma of Third Ventricle
13.8 Mixed Neuronal and Neuronal-Glial Tumors
13.8.1 Central Neurocytoma
13.8.2 Extraventricular Neurocytoma
13.8.3 Cerebellar Liponeurocytoma
13.9 Response to Treatment
13.10 Treatment-Related Morbidity
13.10.1 Early/Acute Effects
13.10.2 Delayed Effects: Hearing, Neurocognition, and Neuroendocrine Dysfunction
13.10.3 Pseudoprogression and Radiation Necrosis
13.11 Current Status and Future Directions
References
14: Oligodendroglioma
14.1 Introduction
14.2 Epidemiology
14.2.1 Risk Factors
14.3 Diagnostic Workup
14.3.1 Radiology
14.3.1.1 CT
14.3.1.2 MRI
14.3.2 Pathology
14.4 Prognostic Factors (Favorable) [1]
14.5 Surgery
14.6 Radiation
14.6.1 Radiation for ODG Grade II
14.6.1.1 Optimum Timing
14.6.1.2 Dose
14.6.1.3 Target Volume
14.6.2 Radiation Technique
14.6.3 Supportive Treatment During Radiation
14.6.4 Radiation Alone Vs Radiation with Chemotherapy Vs Chemotherapy Alone for Grade II ODG
14.7 Radiation Alone Vs Radiation with Chemotherapy Vs Chemotherapy Alone for Anaplastic Oligodendroglioma
14.8 Evolving Approaches
14.8.1 Proton Therapy
References
15: Anaplastic Astrocytoma
15.1 Introduction and Epidemiology
15.2 Anatomy
15.3 Risk Factors
15.4 Clinical Presentation
15.5 Evaluation
15.6 Treatment
15.7 Radiotherapy Technical Details
15.8 Toxicity
15.9 Follow-up
15.10 Treatment of Recurrence
References
16: Mixed Gliomas or Oligoastrocytoma
16.1 Introduction
16.2 Clinical Presentation
16.3 Management
16.4 Surgery
16.5 Adjuvant Therapy
16.6 Follow-up
References
17: Glioblastoma
17.1 Introduction
17.2 Epidemiology
17.2.1 Risk Factors
17.3 Diagnostic Workup
17.4 Prognostic Factors (Good)
17.5 Surgery
17.6 Adjuvant Therapy
17.6.1 Radiotherapy
17.6.2 Optimum Timing
17.6.3 Dose
17.6.4 Target Volume
17.6.5 Radiation Technique
17.6.6 Supportive Treatment During Radiation
17.7 Chemotherapy
17.7.1 Temozolomide Forms the Backbone of Chemotherapy in GBM and Is Given Concurrently with RT Followed by Maintenance Phase
17.7.2 Bevacizumab Has Been Extensively Evaluated in GBM. It Is a Humanized Monoclonal Antibody Targeted Against Vascular Endothelial Growth Factor (VEGF-A)
17.7.3 Novel Anti-Angiogenic Therapy
17.7.3.1 Integrins
17.7.3.2 Anti-EGFR Monoclonal Antibody
17.7.3.3 Non-Conventional Therapy (Novo TTF)
17.8 Outcome
17.9 Evolving Approaches in Adjuvant Radiotherapy
17.10 Recurrence
17.10.1 Diagnosis Is a Challenge as Progression and Radionecrosis Closely Resemble (Fig. 17.2)
17.10.2 Management of Recurrent GBM [18]
17.11 Special Variants
17.11.1 Pediatric GBM
17.11.2 Elderly GBM
17.11.3 Spinal GBM
17.11.4 Gliosarcoma
17.11.5 GBM-PNET
17.11.6 Other Variants of GBM
References
18: Management of Gliomatosis Cerebri
18.1 Introduction
18.2 Symptoms and Signs
18.3 Diagnosis
18.4 Histopathology and Molecular Classification: [13]
18.5 Differential Diagnosis: [7, 16]
18.6 Future Trials
18.7 Conclusion
References
19: Pleomorphic Xanthoastrocytoma
19.1 Introduction [1–4]
19.2 Classification
19.3 Investigation
19.3.1 Appearance on CT Scan
19.3.2 MRI
19.4 Pathology
19.5 Treatment
19.5.1 Surgical Excision [5]
19.5.2 Radiation [2, 3, 6–10]
19.5.2.1 Indications for Adjuvant RT
19.5.2.2 Target Volume
19.5.2.3 Dose
19.5.3 Chemotherapy
19.6 Results [2, 3]
19.6.1 Prognostic Factors (Favorable)
19.7 Follow-up
19.8 Treatment Algorithm
References
20: Astroblastoma
20.1 Introduction
20.2 Clinical Presentation
20.3 Radiology
20.4 Surgery
20.5 Pathology
20.6 Adjuvant Therapy
20.6.1 Radiation
20.6.2 Chemotherapy
20.6.3 Survival Outcome
20.6.4 Prognostic Factors for Survival
20.7 Follow-up
20.8 Treatment Algorithm [69]
Suggested Reading
21: Nervous System Hemangioblastoma
21.1 Introduction and Epidemiology
21.2 Site of Origin
21.3 Clinical Manifestation
21.4 Pathology
21.5 Imaging
21.6 Treatment
References
22: Rare/Uncommon Brain Tumors
22.1 Ganglioglioma
22.1.1 Introduction [1, 2]
22.1.2 Classification
22.1.3 Investigation
22.1.4 Pathology
22.1.5 Treatment
22.1.5.1 Surgical Excision
22.1.5.2 Radiation
Indications for Adjuvant RT
Target Volume
Dose
22.1.5.3 Chemotherapy
22.1.6 Results
22.1.6.1 Prognostic Factors (Favorable for AGG)
22.1.7 Follow-up
22.1.8 Treatment Algorithm [1]
22.2 Plasmacytoma
22.2.1 Introduction
22.2.2 Investigation
22.2.3 Treatment
22.2.3.1 Surgical Excision
22.2.3.2 Radiation
Indications for Adjuvant RT
Target Volume
Dose
22.2.4 Chemotherapy
22.2.5 Follow-up
22.3 Rosette Forming Glioneuronal Tumors
22.4 Embryonal Tumors with Multilayered Rosettes (ETMR)
22.4.1 Introduction
22.4.2 Pathology [7, 8]
22.4.3 Radiographic Features
22.4.4 Treatment
22.4.4.1 Surgery
22.4.4.2 Radiation
22.4.4.3 Chemotherapy
22.4.5 Survival Outcome [7, 8]
22.4.6 Follow-up
22.5 Supratentorial PNET: WHO 2016 Has Dropped This Terminology
22.5.1 Introduction
22.5.2 Investigation
22.5.3 Pathology
22.5.4 Treatment
22.5.4.1 Surgical Excision
22.5.4.2 Radiation
22.5.4.3 Chemotherapy
22.5.5 Results
22.5.5.1 Prognostic Factors
22.5.6 Follow-up
22.6 ATRT
22.6.1 Introduction
22.6.2 Pathology [10]
22.6.3 Radiographic Features
22.6.4 Treatment
22.6.4.1 Surgery
22.6.4.2 Radiation [11–13]
22.6.4.3 Chemotherapy
22.6.5 Survival Outcome
22.6.6 Follow-up
22.7 Neurocytoma
22.7.1 Introduction [14]
22.7.2 Pathology
22.7.3 Radiographic Features
22.7.4 Treatment
22.7.4.1 Surgery
22.7.4.2 Radiation [15–17]
22.7.4.3 Chemotherapy
22.7.5 Survival Outcome
22.7.5.1 Central Neurocytoma
22.7.6 Follow-up
22.7.7 Treatment Algorithm [15–17]
References
23: Medulloblastoma and Other Embryonal Brain Tumors
23.1 Epidemiology
23.2 Pathology and Classification
23.3 Clinical Presentation
23.3.1 Workup
23.4 Imaging
23.4.1 Staging and Risk Stratification
23.4.2 Treatment Approach
23.4.2.1 Average-Risk Medulloblastoma
23.4.2.2 High-Risk Medulloblastoma
23.4.2.3 Medulloblastoma in Infants
23.4.3 Radiotherapy Technique
23.4.4 Target Volumes in CSI Treatment
23.4.5 Monitoring During Radiotherapy
23.4.6 Chemotherapy
23.4.7 Side Effects and Long-Term Issues
23.5 Ongoing Trials and Future Direction
23.6 Other Embryonal Tumors
References
24: Ependymoma
24.1 Introduction
24.2 Workup
24.3 Management of Ependymoma
24.4 Volumes to Be Included for Post-operative Radiotherapy
24.5 Future Directions
References
25: Intracranial Germ Cell Tumour
25.1 Introduction
25.2 Histological Subtypes
25.3 Workup: (Both Germinoma and NGGCT)
25.4 Management
25.5 Radiotherapy Dose Prescription
25.6 Volumes to Be Included in Craniospinal Irradiation
25.7 Volumes to Be Included in Whole Ventricular Radiotherapy
References
26: Management of Pineal Region Tumors
26.1 Introduction
26.2 Pathological Classification of Pineal Region Tumors: [6]
26.3 Epidemiology
26.4 Clinical Presentation: [8, 9]
26.5 Endoscopy
26.6 Imaging: [13]
26.7 Overview of the Management of Various Pineal Region Tumors
26.8 Future Prospects
26.9 Conclusion
References
27: Skull Base Chordoma and Chondrosarcoma
27.1 Introduction
27.2 Origin and Histology of Chordoma and Chondrosarcoma
27.3 Clinical Presentation
27.4 Imaging Findings
27.5 Management
27.6 Surgery
27.7 Radiation Therapy
27.8 Role of Systemic Treatment
References
28: Intracranial Hemangiopericytoma
28.1 Introduction
28.2 Pathology
28.3 MGS Grading System for I-HPC
28.4 Imaging
28.4.1 CT Scan
28.4.2 MRI
28.5 Surgery
28.6 Radiation
28.6.1 Indications for Adjuvant RT
28.6.2 Target Volume
28.6.3 Dose
28.7 Chemotherapy
28.8 Follow-up
References
29: Management of Choroid Plexus Carcinoma
29.1 Introduction
29.2 Epidemiology
29.3 Clinical Presentation
29.4 Genetic Mutations and Pathogenesis in CPC
29.5 Imaging
29.6 Histopathology: [16]
29.7 Differential Diagnosis
29.8 Treatment of CPCs
29.8.1 Surgery
29.8.2 Adjuvant Therapy
29.8.3 Radiation Therapy
29.8.4 Chemotherapy
29.9 Conclusion
29.10 Management Protocol for Choroid Plexus Carcinoma
References
30: Meningioma
30.1 Introduction and Epidemiology
30.2 Etiology and Risk Factors
30.3 Pathology
30.3.1 WHO Classification
30.4 Molecular Pathology
30.5 Clinical Features and Evaluation
30.6 Neuro-Radiology
30.6.1 High Grade Features Include
30.6.2 Radiological Differentials
30.7 Management
30.7.1 Surgery
30.8 Post-operative Radiotherapy
30.8.1 Grade 1 Meningioma
30.8.2 Dose of RT
30.8.3 Grade 2 (Atypical) and Grade 3(Anaplastic) Meningiomas
30.8.4 Spinal Meningiomas
30.8.5 Recurrent Tumors
30.9 Summary of Adjuvant Treatment
30.10 Late Effects of Radiotherapy
30.11 Techniques of Radiotherapy
30.12 Recent Advances
References
31: Pituitary Tumors: Diagnosis and Management
31.1 Introduction
31.2 Pituitary Anatomy and Physiology
31.3 Classification of Pituitary Adenoma
31.4 Etiology and Pathogenesis
31.5 Clinical Presentation
31.6 Evaluation
31.7 Classification
31.8 Treatment
31.9 Follow-up
31.10 Conclusions
References
32: Craniopharyngioma
32.1 Introduction
32.2 Epidemiology
32.3 Clinical Presentation [8]
32.4 Radiology
32.4.1 Appearance on CT
32.4.2 Appearance on MRI
32.5 Management
32.6 Pathology
32.7 Adjuvant Therapy [8]
32.7.1 Radiation
32.7.1.1 Management of Recurrence
32.7.2 Long-Term Sequelae
32.7.2.1 Pituitary Dysfunction
32.7.2.2 Hypothalamic Dysfunction
References
33: Acoustic Neuroma
33.1 Introduction
33.2 Symptoms
33.3 Investigation
33.4 Grading System
33.5 Histopathology
33.6 Management
33.6.1 Conservative/Observation
33.6.1.1 Predicting Factors for Rapid Growth
33.6.1.2 Limitation
33.6.2 Surgery
33.6.2.1 Indication
33.6.2.2 The Surgical Approaches are Mainly Three Types (Table 33.3)
33.6.3 Radiotherapy
33.6.3.1 Indications
33.6.3.2 Radiation Techniques (Table 33.4)
33.6.3.3 Specific Highlights of Radiation
33.6.3.4 Proton Therapy
33.6.4 Systemic Therapy
33.6.5 Quality of Life
33.7 Treatment Summary in Flowchart
References
34: Spinal Cord Tumors
34.1 Introduction
34.2 Clinical Symptoms
34.3 Management (Table 34.1)
34.4 Intramedullary Tumors
34.5 Intradural–Extramedullary Tumors
34.6 Extradural Tumors
34.7 Chemotherapy
34.8 Radiation
References
35: Brain Metastases
35.1 Introduction
35.2 Clinical Features
35.3 Diagnosis
35.4 Biopsy Is Indicated if Primary Cancer Is Unknown and Patient Presents with Brain Metastases on Imaging
35.4.1 Standard Management
35.5 Radiotherapy Management Protocols
35.5.1 Stereotactic Radiosurgery
35.6 Dose Prescription in Multiple Metastases and Post-op SRS
35.7 Volumes for Contouring
35.8 Premedication
35.9 Dose Coverage and Constraints
35.10 Medical Management in Brain Metastases
35.11 Blood–Brain Barrier
35.12 Molecular Targets of Metastases Involved in BBB Disruption and Their Function [7]
35.13 Genetic Alterations as per Tumour Type
35.14 Targeted Therapy Showing Benefit in Brain Metastases (List Includes Only Drugs with Proven Evidence)
References
36: Paediatric CNS Tumours
36.1 What Will This Chapter Cover?
36.2 Introduction
36.3 Management of Various Paediatric CNS Tumours
36.3.1 Low-Grade Glioma
36.3.2 Investigations
36.3.3 Treatment
36.3.3.1 At Initial Diagnosis
36.3.3.2 Inoperable Sites
36.3.4 Radiation Therapy
36.3.4.1 Indications
36.3.5 High-Grade Glioma
36.3.6 Investigations
36.3.7 Treatment
36.3.7.1 At Initial Diagnosis
36.3.7.2 Adjuvant Treatment
36.3.7.3 Inoperable Disease (Diffuse Intrinsic Pontine Glioma; Thalamic Glioma)
36.3.7.4 Progressive Disease
36.3.8 Medulloblastoma
36.3.9 Treatment
36.3.10 Work Up: (After Surgery)
36.3.11 Risk Stratification for Adjuvant Therapy
36.3.12 Adjuvant Therapy
36.3.13 Dose Prescription
36.3.14 Reduced Dose CSI Regimen
36.3.15 Radiation Therapy Volumes
36.3.16 Adjuvant Chemotherapy
36.3.16.1 Indications
36.3.17 Relapsed Medulloblastoma
36.3.18 Atypical Teratoid Rhabdoid Tumour (ATRT)
36.3.18.1 Management
36.3.18.2 Adjuvant Therapy
36.3.18.3 Radiation Therapy
36.4 Pre-irradiation Induction Therapy
36.5 Chemoradiation Induction Therapy
36.6 Post-radiation Induction Therapy
36.7 Maintenance Therapy
36.8 Continuation Therapy with Doxorubicin (Patients Who Have Received <18 Gy RT to Thoracic Spine/Mediastinum)
36.9 Continuation Therapy without Doxorubicin (Patients Who Have Received >18 Gy RT to Thoracic Spine/Mediastinum)
36.10 Intrathecal Therapy
37: Primary Central Nervous System Lymphoma
37.1 Types
37.2 Presentation
37.3 Workup
37.4 Radiologic Characteristics
37.4.1 CT
37.4.2 MRI
37.5 Differential Diagnosis
37.6 Histology
37.7 Prognostic Factors
37.8 Recurrent PCNSL
References
Part IV: Miscellaneous
38: Neurocognition in Neurooncology
38.1 What Is Neurocognition?
38.2 Major Neurocognitive Domains
38.2.1 Causes for Neurocognitive Decline in Brain Tumours [2]
38.3 Tumour-Induced Neurocognitive Decline
38.3.1 Depending on Location of Tumour [3]
38.3.2 Depending Also on Rate of Growth of Tumour
38.4 Treatment-Associated Neurocognitive Decline
38.4.1 Impact of Surgery
38.4.2 Impact of Radiotherapy [4–6]
38.4.3 Impact of Chemotherapy/Targeted Therapy [7–13]
38.4.4 Impact of Anti-Epileptics [14]
38.4.5 Impact of Steroids [15]
38.4.6 Impact of Tumour-Treating Fields on Cognition [16]
38.4.7 Management of Neurocognitive Decline
References
Suggested Reading
39: Syndromes Associated with Brain Tumors
39.1 Introduction
39.1.1 Neurofibromatosis Type 1
39.1.2 Neurofibromatosis Type 2
39.1.3 Tuberous Sclerosis Complex
39.1.4 Von Hippel–Lindau Syndrome
39.1.5 Multiple Hamartoma (Cowden) Syndrome
39.1.6 Brain Tumor Polyposis (Turcot) Syndrome
39.1.7 Nevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome)
39.1.8 Li–Fraumeni Syndrome
References
40: Endocrine Management in Neurooncology
40.1 Introduction
40.2 Hypothalamo-Pituitary Axis Dysfunction
40.2.1 Effect of Sellar Tumours on Hypothalamo–Pituitary Function
40.2.2 Effect of Radiotherapy on Hypothalamo–Pituitary Function
40.2.3 Effect of Drugs on Hypothalamo–Pituitary Function
40.3 Assessment of Pituitary Function
40.3.1 GH Deficiency
40.3.2 Central Precocious Puberty
40.3.3 Adrenocorticotropic Hormone Deficiency
40.3.4 Thyroid-Stimulating Hormone Deficiency
40.3.5 Gonadotropin Deficiency
40.3.6 ADH Deficiency (Vasopressin)
40.4 Pituitary Adenoma and Hypersecretion Syndromes
40.4.1 Prolactinoma [5]
40.4.1.1 Clinical Features
40.4.1.2 Diagnosis
40.4.1.3 Treatment
40.4.2 Growth Hormone-Secreting Pituitary Adenoma [6]
40.4.2.1 Clinical Features
40.4.2.2 Diagnosis
40.4.2.3 Treatment
40.4.3 ACTH-Producing Pituitary Adenoma [7]
40.4.3.1 Clinical Features
40.4.3.2 Diagnosis
40.4.3.3 Treatment [8]
40.4.4 TSH-Producing Pituitary Adenoma
References