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March 2010

Cancer of the Nervous System: 2010

Arch Neurol. 2010;67(3):272. doi:10.1001/archneurol.2010.24

In this issue of the Archives, we present a survey of articles that cover the important clinical and basic scientific advances in neuro-oncology during the last 5 years. Clearly, investigators in this field are innovative, and progress is being made on several fronts in understanding the molecular and cellular changes causal of nervous system neoplasm and developing new therapies. The molecular and genetic changes that occur in sequence in converting the normal astrocyte to a grade 4 glioblastoma cell have been elucidated recently and are presented herein. Glioblastomas are produced due to genetic mutations and resultant altered functions, and individuals are associated with increased risk as a result of several genomic polymorphisms. How these various genetic mutations and altered functions and associated polymorphisms are connected remain unknown, but insights are continuing to emerge and are discussed herein. Molecular targets for potential therapy have been proposed based on these findings and are an important advance in eventually finding effective therapy for this most common and malignant brain tumor. Therapy for glioblastomas—including use of temozolomide, 5-aminolevulinic acid for more complete surgical resection, external beam radiation, intensity-modulated radiation therapy, use of antibodies and inhibitors to the epidermal growth factor receptor, antiangiogenesis therapy, immunotherapy, histone deacetylase inhibitors, and gene therapy—are concisely reviewed. A phase 1 clinical trial with ABT-510, a thrombospondin-1 mimetic drug with antiangiogenic properties when used concurrently with temozolomide and radiotherapy, is reported. O-(2-[18F]-fluoroethyl)-L-tyrosine is a new positron emission tomography tracer that is promising to image and diagnose high-grade gliomas. Primary central nervous system lymphoma is a rare but troubling neoplasm, and, although remissions may be achieved, the tumor relapses in most cases. Primary central nervous system lymphoma is increased significantly in the immune-incompetent person and is the focus of a review. Myelopathies in patients with cancer and new strategies in the management of leptomeningeal metastases are 2 important areas of therapeutic concern and are discussed in detail. An emerging and growing area of related neurological disease in patients with cancer is the paraneoplastic syndromes, and a large database of these patients is presented to provide an overview of the clinical incidence of specific syndromes and therapeutic outcomes. The diagnostic achievement in evaluating paraneoplastic disease by evaluating the cancer detection rate with whole-body positron emission tomography–computed tomography is presented. Positron emission tomography–computed tomography improves detection of cancers when other screening tests are negative in the setting of seropositivity for a neuronal nuclear or cytoplasmic autoantibody marker of cancer.

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