In spite of advances in imaging and treatment, life expectancy for patients with primary tumors of the brain remain low at about 15 to 18 months. So are we making progress? Today, we hear from Dr. Steven Brem, the Chief of Neurosurgery at the Hospital of the University of Pennsylvania (Philadelphia, Pennsylvania, USA).
Is survival improving? Patients with malignant gliomas are living longer than ever before and they have better quality of life. Overall survival used to be 9 months, and it now averages 15 to 18 months. While not spectacular, the trend is unmistakable. And we now have a subgroup of perhaps 20% of patients who are living over 3 years, with an occasional very long-term survival. The combination of temozolomide chemotherapy and radiation therapy as been a major advance. And the use of bevacizumab [which starves a tumor of its blood supply] for recurrent glioblastomas is changing the neuro-oncology landscape. This is because we previously didn’t think such large molecules would be able to cross the blood-brain barrier and be effective. In addition, it shows us that targeted therapies will likely have a greater role in the future.
Current research: Several lines of research are being pursued. A better understanding of the genes (cancer genomics) will allow for breakthroughs in management. Immunotherapies are being pursued (currently for glioblastoma multiforme, or GBM). In addition, the neural pathways of the brain are being mapped, with the findings translating to the operating room. Using advanced mathematical modeling, surgeons can visualize what was formerly invisible to the eye, and even invisible under the microscope – the brain’s “wiring diagram.” Eventually, surgery will be tailored to the region of the tumor boundary, reducing the risk of neurologic complications such as cognitive impairment, paralysis, language deficits, and others. As glioblastoma cells follow white fiber matter paths, we should be able to better predict tumor growth and strategically plan therapy using newer mathematical models that provide a roadmap for each tumor. We also are pursuing the causes of malignant brain tumors.
My take: We will see improvement in survival rates among those with malignant brain tumors. Over the next 10 years, we should make more progress than we have over the last 30 to 40 years, given a better understanding of genomics, better neuroimaging, and better treatment.
The ASCO Post, June 25, 2013
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