Brain Cancers

Zolinza for maintenance in glioblastoma

With the advent of biologic therapies, many new avenues to approach recalcitrant and difficult diseases have emerged. Once such cancer is the brain cancer glioblastoma(GBM). It is tempting to use Zolinza(vorinostate) for maintenance after attaining a remission of glioblastoma, because this is a disease that almost always comes back. Unfortunately, there is as of yet no literature supporting the use of Zolnza for maintenance for gliolastoma. A recent

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Chemo with vincristine, carboplatin and Temodar

Low grade astrocytoma occurrs in adults and children but is more commonly a pediatric disease. Radiotherapy is relatively contraindicated in children because it stunts their intellectual growth. Chemotherapy may be used in young children to avoid or to delay radiotherapy because of its potential neurologic sequelae. To date, the most active chemotherapy regimen for these tumors is carboplatin and vincristine. These agents show objective response

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What is available for metastatic and aggressive meningioma

Most meningiomas are slow and benign, but a small subset can be aggressive and ahs agressive pathological features. In a 2008 review of the aggressive types, atypical and anaplastic-meningiomas, the mean overall survival for atypical meningiomas was found to be 11.9 years vs. 3.3 years for anaplastic meningiomas. Meningiomas often depend and blood vessels and and it is reasonable to consider anti blood vessel therapy for meningioma. In particular,

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Thalidomide for glioblastoma

Glioblastoma Multiforme is a difficult to treat disease but also a disease in which significant progress has been achieved. One drug that has been extensivly studied is thalidomide.  An early small study showed   a 5%  partial response and 42%  stable disease. The median survival was 31 weeks and the 1-year survival was 35%. Patients who had a partial response or stable disease appeared to have benefitted. It appears that thalidomide has some

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How often to scan the brain after radiosurgery

How to follow a patient with brain mets after radiosurgery is becoming a more and more common question becasue treatments that control cancer in the rest of the boady are getting to be more and more effective and patients are living longer before cancer comes back in the brain or in the body. One does not want to overmonitor but also not to miss metastses when they come back. Many patietns remain disease free for many months even years after radiosurgery

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Irinotecan for brain metastases of lung and breast cancer

Because irinotecan penetrates the brain-blood barrier and has an effect in primary brain cancer, there is some interest in using it for brain metastasis, especially for lung cancer and breast cancer. Most studies of irinotecan had been for brain mets of small(SCLC) and non-small cell lung cancer(NSMCLC) and not breast cancer and have had mixed results. One study enrolled several different cancer types and reported complete responses with irinotecan-based

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Ganglioglioma

Gangliogliomas are rare pediatric brain tumors that are fortunately associated with a high rate of cure. Only about 10% behave aggessively. Because of their rarity, no prospective studies have been performed regarding gangliogliomas. Data suggest a historic 20-year survival rate of approximately 80 percent. According to a recent review of four types of treatment complete removal should be performed whenever safely possible and does not require

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How to dose Temodar after Glioblastoma surgery

Chemoradiation after resection is well established for glioblastoma. Three randomized studies,have all showed a benefit for it. TEMODAR® (temozolomide) is FDA indicated for the treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and then as maintenance treatment.  One way to dose Temodar is with the Stupp protocol: Temodar 75 mg/m2 for 42 days with radiation. This is the dose and schedule in

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Temodar for Glioblastoma: Making a difference

Glioblastoma is a disease for which there were few options available until recently. The past several years brought several new potentially promising. Temozolomide (brand names Temodar and Temodal) is an oral alkylating drug. It is FDA indicated is indicated for the treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and then as maintenance treatment. TEMODAR is indicated for the treatment of adult

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PET for glioblastoma

PET is more and more frequently used to visualize brain cancers. However, PET is not medically appropriate to follow glioblastoma because it not supported by credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community.  PET for brain cancer is not included in the NCCN guidelines and CMS does not cover PET for this diagnosis. Occasionally, PET can provide information to differentiate

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