Advances in neuro-oncology during the last 20 years have led to some general controversies regarding the impact of different treatment options on the different tumor types. Surgery has increasingly become feasible due to progress in technology, but the value of the extent of resection, in terms of prognosis, is still controversial. Two main issues are to be addressed regarding radiation therapy: will new treatment techniques, such as conformal radiotherapy, be able to improve tumor control in radioresistant tumors (i.e., high-grade gliomas) while sparing the normal nervous tissue? Can radiotherapy be delayed at tumor progression in chemosensitive tumors (lymphomas, anaplastic oligodendrogliomas, or germ cell tumors)? As for chemotherapy, the superiority over standard treatments of unconventional methods of drug delivery (high-dose chemotherapy with stem cell rescue, interstitial chemotherapy, opening of the blood-brain barrier with mannitol or bradykinin agonists) needs to be proven. Furthermore, the usefulness in clinical practice of biologic markers (O6-alkyltransferase, loss of 1p and 19q) to predict chemosensitivity and select patients for treatment is unclear. Some controversies are peculiar for low-grade tumors: immediate versus delayed treatment? Cytostatic versus cytotoxic drugs? Challenges for the future will be the use of techniques of functional neuroimaging (PET, MRS) for evaluating the response and the translation from the biological into the clinical setting of some forms of treatment (immunotherapy, gene therapy, biologic therapies) which are attractive for controlling a minimal residual disease.
Controversies and perspectives in neuro-oncology
Soffietti R.
2000-01-01
Abstract
Advances in neuro-oncology during the last 20 years have led to some general controversies regarding the impact of different treatment options on the different tumor types. Surgery has increasingly become feasible due to progress in technology, but the value of the extent of resection, in terms of prognosis, is still controversial. Two main issues are to be addressed regarding radiation therapy: will new treatment techniques, such as conformal radiotherapy, be able to improve tumor control in radioresistant tumors (i.e., high-grade gliomas) while sparing the normal nervous tissue? Can radiotherapy be delayed at tumor progression in chemosensitive tumors (lymphomas, anaplastic oligodendrogliomas, or germ cell tumors)? As for chemotherapy, the superiority over standard treatments of unconventional methods of drug delivery (high-dose chemotherapy with stem cell rescue, interstitial chemotherapy, opening of the blood-brain barrier with mannitol or bradykinin agonists) needs to be proven. Furthermore, the usefulness in clinical practice of biologic markers (O6-alkyltransferase, loss of 1p and 19q) to predict chemosensitivity and select patients for treatment is unclear. Some controversies are peculiar for low-grade tumors: immediate versus delayed treatment? Cytostatic versus cytotoxic drugs? Challenges for the future will be the use of techniques of functional neuroimaging (PET, MRS) for evaluating the response and the translation from the biological into the clinical setting of some forms of treatment (immunotherapy, gene therapy, biologic therapies) which are attractive for controlling a minimal residual disease.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.