From the Guidelines
Brain cancer treatment should prioritize a multidisciplinary approach, including surgery, radiation therapy, and chemotherapy, to improve morbidity, mortality, and quality of life outcomes. When considering treatment options, factors such as tumor type, location, size, and the patient's age and overall health are crucial in determining the best course of action. For example, glioblastoma, the most aggressive form of brain cancer, has a median survival of 12-15 months with standard treatment, which typically includes surgery, radiation therapy, and chemotherapy with temozolomide (Temodar) at doses of 150-200 mg/m² for 5 consecutive days every 28 days 1. Radiation therapy usually involves doses of 60 Gy delivered in 30 fractions over 6 weeks, and surgery aims to remove as much tumor as possible while preserving neurological function. Symptoms of brain cancer vary depending on tumor location but may include headaches, seizures, cognitive changes, vision problems, and balance issues. Early detection is crucial for better outcomes, so any persistent neurological symptoms should prompt medical evaluation. In cases of metastatic brain tumors, the role of surgery, radiosurgery, and radiation therapy is critical, and guidelines recommend considering factors such as tumor size, location, and patient performance status when deciding on the best treatment approach 1. Overall, a comprehensive treatment plan that takes into account the individual patient's needs and tumor characteristics is essential for improving outcomes in brain cancer. Key considerations include:
- Tumor type and grade
- Patient age and performance status
- Tumor location and size
- Presence of metastases
- Symptom management and quality of life By prioritizing these factors and using a multidisciplinary approach, healthcare providers can develop effective treatment plans that improve morbidity, mortality, and quality of life outcomes for patients with brain cancer.
From the FDA Drug Label
14 CLINICAL STUDIES 14. 1 Newly Diagnosed Glioblastoma Multiforme
Five hundred and seventy-three patients were randomized to receive either temozolomide (TMZ)+Radiotherapy (RT) (n=287) or RT alone (n=286). The addition of concomitant and maintenance temozolomide to radiotherapy in the treatment of patients with newly diagnosed GBM showed a statistically significant improvement in overall survival compared to radiotherapy alone ( Figure 1). The hazard ratio (HR) for overall survival was 0.63 (95% CI for HR=0.52 to 0.75) with a log-rank P<0. 0001 in favor of the temozolomide arm. The median survival was increased by 2.5 months in the temozolomide arm.
Temozolomide is used in the treatment of brain cancer, specifically glioblastoma multiforme (GBM). The drug has shown a statistically significant improvement in overall survival when used in combination with radiotherapy compared to radiotherapy alone. Key points include:
- Median survival increased by 2.5 months with temozolomide
- Hazard ratio of 0.63 in favor of the temozolomide arm
- Temozolomide is used in combination with radiotherapy for the treatment of newly diagnosed GBM 2
From the Research
Brain Cancer Overview
- Brain cancer is a type of cancer that occurs in the brain, with malignant primary brain tumors causing more than 15,000 deaths per year in the United States 3.
- The annual incidence of primary malignant brain tumors is approximately 7 per 100,000 individuals and increases with age 3.
- Five-year survival is approximately 36%, with approximately 49% of malignant brain tumors being glioblastomas, and 30% being diffusely infiltrating lower-grade gliomas 3.
Symptoms and Diagnosis
- Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%) 3.
- Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors 3.
- Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics 3.
Treatment Options
- Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation 3, 4, 5.
- For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone 3.
- In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% 3.
- Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation 3.
Surgical Management
- Outcomes in patients with glioblastoma are strongly correlated with extent of initial surgical resection 6.
- Intraoperative MRI, 5-ALA, and neuronavigation are surgical tools that can help achieve a maximal safe resection 6.
- Stereotactic radiosurgery and brachytherapy can be used to enhance local control for brain metastases in conjunction with surgery, while combinatorial approaches are increasingly employed in patients with multiple metastases 6.
Chemotherapy
- The role of chemotherapy in malignant gliomas, especially glioblastoma multiforme, has been inconclusive 5.
- However, a recent trial by the European Organisation for Research and Treatment of Cancer and the National Cancer Institute of Canada combining radiation therapy with temozolomide for newly diagnosed glioblastoma patients showed a significantly improved survival benefit over radiation therapy alone 5.
- Molecular genetic studies are becoming indispensable aids in the diagnosis and treatment of the malignant gliomas, with allelic loss of chromosome 1p being a significant predictor of chemosensitivity 5.