Overview In 2010, an estimated 22,020 new cases of primary brain and other nervous system neoplasms were diagnosed in the United States,1 and approximately 13,140 deaths occurred from these tumors. The incidence of primary malignant brain tumors has been increasing over the past 30 years, especially in elderly persons.2 Metastatic disease to the central nervous system (CNS) occurs much more frequently, with an estimated incidence approximately 10 times that of primary brain tumors. Between 20% and 40% of patients with systemic cancer will develop brain metastases.3 NOTE: This manuscript highlights only a portion of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Central Nervous System Cancers. Please refer to www.NCCN.org for the complete NCCN Guidelines. Principles of Management Primary and metastatic brain tumors are a heterogeneous group of neoplasms with varied outcomes and management strategies. Primary brain tumors range from pilocytic astrocytomas, which are very uncommon, noninvasive, and surgically curable, to glioblastoma multiforme, the most common intraparenchymal brain tumor in adults, which is highly invasive and virtually incurable. Likewise, patients with metastatic brain disease may have rapidly progressive systemic disease or no systemic cancer at all. These patients may have one or dozens of brain metastases, and may have a malignancy that is either highly responsive or highly resistant to radiation or chemotherapy. Because of this marked heterogeneity, the prognostic features and treatment options for brain tumors must be carefully reviewed on an individual basis and sensitively communicated to each patient. In addition, CNS tumors are associated with...
  • 1.

    JemalASiegelRXuJWardE. Cancer Statistics, 2010. CA Cancer J Clin2010;60::277300.

  • 2.

    MaherEAMcKeeAC. Neoplasms of the central nervous system. In: SkarinATCanellosGP eds. Atlas of diagnostic oncology 3rd edition. London, United Kingdom: Elsevier Science Ltd; 2003.

    • Search Google Scholar
    • Export Citation
  • 3.

    PatchellRA. The management of brain metastases. Cancer Treat Rev2003;29:533540.

  • 4.

    SawayaRHammoudMSchoppaD. Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery1998;42:10441055.

    • Search Google Scholar
    • Export Citation
  • 5.

    Central Brain Tumor Registry of the United States. CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2004–2006. 2010. Available at: http://www.cbtrus.org/reports/reports.html. Accessed September 29 2010.

    • Search Google Scholar
    • Export Citation
  • 6.

    CurranWJJrScottCBHortonJ. Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst1993;85:704710.

    • Search Google Scholar
    • Export Citation
  • 7.

    CairncrossJGUekiKZlatescuMC. Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst1998;90:14731479.

    • Search Google Scholar
    • Export Citation
  • 8.

    CairncrossGBerkeyBShawE. Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup Radiation Therapy Oncology Group trial 9402. J Clin Oncol2006;24:27072714.

    • Search Google Scholar
    • Export Citation
  • 9.

    LawsERParneyIFHuangW. Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg2003;99:467473.

    • Search Google Scholar
    • Export Citation
  • 10.

    SimpsonJRHortonJScottC. Influence of location and extent of surgical resection on survival of patients with glioblastoma multiforme: results of three consecutive Radiation Therapy Oncology Group (RTOG) clinical trials. Int J Radiat Oncol Biol Phys1993;26:239244.

    • Search Google Scholar
    • Export Citation
  • 11.

    WoodJRGreenSBShapiroWR. The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol1988;6:338343.

    • Search Google Scholar
    • Export Citation
  • 12.

    LacroixMAbi-SaidDFourneyDR. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg2001;95:190198.

    • Search Google Scholar
    • Export Citation
  • 13.

    BarkerFGIIChangSMGutinPH. Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery1998;42:709720.

    • Search Google Scholar
    • Export Citation
  • 14.

    ParkJKHodgesTArkoL. Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol2010;28:38383843.

  • 15.

    WalkerMDAlexanderEJrHuntWE. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg1978;49:333343.

    • Search Google Scholar
    • Export Citation
  • 16.

    KristiansenKHagenSKollevoldT. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer1981;47:649652.

    • Search Google Scholar
    • Export Citation
  • 17.

    Keime-GuibertFChinotOTaillandierL. Radiotherapy for glioblastoma in the elderly. N Engl J Med2007;356:15271535.

  • 18.

    RoaWBrasherPMBaumanG. Abbreviated course of radiation therapy in older patients with glioblastoma multiforme: a prospective randomized clinical trial. J Clin Oncol2004;22:15831588.

    • Search Google Scholar
    • Export Citation
  • 19.

    SouhamiLSeiferheldWBrachmanD. Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol. Int J Radiat Oncol Biol Phys2004;60:853860.

    • Search Google Scholar
    • Export Citation
  • 20.

    LaperriereNJLeungPMMcKenzieS. Randomized study of brachytherapy in the initial management of patients with malignant astrocytoma. Int J Radiat Oncol Biol Phys1998;41:10051011.

    • Search Google Scholar
    • Export Citation
  • 21.

    Medical Research Council Brain Tumor Working Party. Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial. J Clin Oncol2001;19:509518.

    • Search Google Scholar
    • Export Citation
  • 22.

    StewartLA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet2002;359:10111018.

    • Search Google Scholar
    • Export Citation
  • 23.

    FineHADearKBLoefflerJS. Meta-analysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer1993;71:25852597.

    • Search Google Scholar
    • Export Citation
  • 24.

    BremHPiantadosiSBurgerPC. Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet1995;345:10081012.

    • Search Google Scholar
    • Export Citation
  • 25.

    ValtonenSTimonenUToivanenP. Interstitial chemotherapy with carmustine-loaded polymers for high-grade gliomas: a randomized double-blind study. Neurosurgery1997;41:4448; discussion 48–49.

    • Search Google Scholar
    • Export Citation
  • 26.

    WestphalMHiltDCBorteyE. A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro Oncol2003;5:7988.

    • Search Google Scholar
    • Export Citation
  • 27.

    WestphalMRamZRiddleV. Gliadel wafer in initial surgery for malignant glioma: long-term follow-up of a multicenter controlled trial. Acta Neurochir (Wien)2006;148:269275; discussion 275.

    • Search Google Scholar
    • Export Citation
  • 28.

    StuppRMasonWPvan den BentMJ. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med2005;352:987996.

  • 29.

    StuppRHegiMEMasonWP. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol2009;10:459466.

    • Search Google Scholar
    • Export Citation
  • 30.

    ClarkeJLIwamotoFMSulJ. Randomized phase II trial of chemoradiotherapy followed by either dose-dense or metronomic temozolomide for newly diagnosed glioblastoma. J Clin Oncol2009;27:38613867.

    • Search Google Scholar
    • Export Citation
  • 31.

    BrandesAAVastolaFBassoU. A prospective study on glioblastoma in the elderly. Cancer2003;97:657662.

  • 32.

    MinnitiGDe SanctisVMuniR. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma in elderly patients. J Neurooncol2008;88:97103.

    • Search Google Scholar
    • Export Citation
  • 33.

    GlantzMChamberlainMLiuQ. Temozolomide as an alternative to irradiation for elderly patients with newly diagnosed malignant gliomas. Cancer2003;97:22622266.

    • Search Google Scholar
    • Export Citation
  • 34.

    HegiMEDiserensACGorliaT. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med2005;352:9971003.

  • 35.

    MollemannMWolterMFelsbergJ. Frequent promoter hypermethylation and low expression of the MGMT gene in oligodendroglial tumors. Int J Cancer2005;113:379385.

    • Search Google Scholar
    • Export Citation
  • 36.

    WickWHartmannCEngelC. NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide. J Clin Oncol2009;27:58745880.

    • Search Google Scholar
    • Export Citation
  • 37.

    PerryJRRizekPCashmanR. Temozolomide rechallenge in recurrent malignant glioma by using a continuous temozolomide schedule: the ``rescue'' approach. Cancer2008;113:21522157.

    • Search Google Scholar
    • Export Citation
  • 38.

    PerryJRBelangerKMasonWP. Phase II trial of continuous dose-intense temozolomide in recurrent malignant glioma: RESCUE study. J Clin Oncol2010;28:20512057.

    • Search Google Scholar
    • Export Citation
  • 39.

    YungWKPradosMDYaya-TurR. Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse. Temodal Brain Tumor Group. J Clin Oncol1999;17:27622771.

    • Search Google Scholar
    • Export Citation
  • 40.

    TriebelsVHTaphoornMJBrandesAA. Salvage PCV chemotherapy for temozolomide-resistant oligodendrogliomas. Neurology2004;63:904906.

  • 41.

    ChamberlainMCTsao-WeiDD. Salvage chemotherapy with cyclophosphamide for recurrent, temozolomide-refractory glioblastoma multiforme. Cancer2004;100:12131220.

    • Search Google Scholar
    • Export Citation
  • 42.

    BrandesAABassoUVastolaF. Carboplatin and teniposide as third-line chemotherapy in patients with recurrent oligodendroglioma or oligoastrocytoma: a phase II study. Ann Oncol2003;14:17271731.

    • Search Google Scholar
    • Export Citation
  • 43.

    ChamberlainMCWei-TsaoDDBlumenthalDTGlantzMJ. Salvage chemotherapy with CPT-11 for recurrent temozolomide-refractory anaplastic astrocytoma. Cancer2008;112:20382045.

    • Search Google Scholar
    • Export Citation
  • 44.

    FultonDUrtasunRForsythP. Phase II study of prolonged oral therapy with etoposide (VP16) for patients with recurrent malignant glioma. J Neurooncol1996;27:149155.

    • Search Google Scholar
    • Export Citation
  • 45.

    FriedmanHSPradosMDWenPY. Bevacizumab alone and in combination with irinotecan in recurrent glioblastoma. J Clin Oncol2009;27:47334740.

    • Search Google Scholar
    • Export Citation
  • 46.

    VredenburghJJDesjardinsAHerndonJEII. Bevacizumab plus irinotecan in recurrent glioblastoma multiforme. J Clin Oncol2007;25:47224729.

    • Search Google Scholar
    • Export Citation
  • 47.

    KreislTNKimLMooreK. Phase II trial of single-agent bevacizumab followed by bevacizumab plus irinotecan at tumor progression in recurrent glioblastoma. J Clin Oncol2009;27:740745.

    • Search Google Scholar
    • Export Citation
  • 48.

    ChamberlainMCJohnstonS. Bevacizumab for recurrent alkylator-refractory anaplastic oligodendroglioma. Cancer2009;115:17341743.

  • 49.

    ChamberlainMCJohnstonS. Salvage chemotherapy with bevacizumab for recurrent alkylator-refractory anaplastic astrocytoma. J Neurooncol2009;91:359367.

    • Search Google Scholar
    • Export Citation
  • 50.

    NordenADYoungGSSetayeshK. Bevacizumab for recurrent malignant gliomas: efficacy, toxicity, and patterns of recurrence. Neurology2008;70:779787.

    • Search Google Scholar
    • Export Citation
  • 51.

    SoffiettiRRudaRTrevisanE. Phase II study of bevacizumab and nitrosourea in patients with recurrent malignant glioma: a multicenter Italian study [abstract]. J Clin Oncol2009;27(Suppl 15S):Abstract 2012.

    • Search Google Scholar
    • Export Citation
  • 52.

    TaillibertSVincentLAGrangerB. Bevacizumab and irinotecan for recurrent oligodendroglial tumors. Neurology2009;72:16011606.

  • 53.

    VredenburghJJDesjardinsAHerndonJEII. Phase II trial of bevacizumab and irinotecan in recurrent malignant glioma. Clin Cancer Res2007;13:12531259.

    • Search Google Scholar
    • Export Citation
  • 54.

    McGirtMJThanKDWeingartJD. Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme. J Neurosurg2009;110:583588.

    • Search Google Scholar
    • Export Citation
  • 55.

    TsienCGalbanCJChenevertTL. Parametric response map as an imaging biomarker to distinguish progression from pseudoprogression in high-grade glioma. J Clin Oncol2010;28:22932299.

    • Search Google Scholar
    • Export Citation
  • 56.

    LouisDNOhgakiHWiestlerOD. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol2007;114:97109.

  • 57.

    SurawiczTSMcCarthyBJKupelianV. Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990–1994. Neuro Oncol1999;1:1425.

    • Search Google Scholar
    • Export Citation
  • 58.

    KunschnerLJKutteschJHessKYungWK. Survival and recurrence factors in adult medulloblastoma: the M.D. Anderson Cancer Center experience from 1978 to 1998. Neuro Oncol2001;3:167173.

    • Search Google Scholar
    • Export Citation
  • 59.

    PadovaniLSunyachMPPerolD. Common strategy for adult and pediatric medulloblastoma: a multicenter series of 253 adults. Int J Radiat Oncol Biol Phys2007;68:433440.

    • Search Google Scholar
    • Export Citation
  • 60.

    CarrieCLassetCAlapetiteC. Multivariate analysis of prognostic factors in adult patients with medulloblastoma. Retrospective study of 156 patients. Cancer1994;74:23522360.

    • Search Google Scholar
    • Export Citation
  • 61.

    ChanAWTarbellNJBlackPM. Adult medulloblastoma: prognostic factors and patterns of relapse. Neurosurgery2000;47:623631.

  • 62.

    FrostPJLaperriereNJWongCS. Medulloblastoma in adults. Int J Radiat Oncol Biol Phys1995;32:951957.

  • 63.

    ChargariCFeuvretLLevyA. Reappraisal of clinical outcome in adult medulloblastomas with emphasis on patterns of relapse. Br J Neurosurg2010;24:460467.

    • Search Google Scholar
    • Export Citation
  • 64.

    DouglasJGBarkerJLEllenbogenRGGeyerJR. Concurrent chemotherapy and reduced-dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average-risk medulloblastoma: efficacy and patterns of failure. Int J Radiat Oncol Biol Phys2004;58:11611164.

    • Search Google Scholar
    • Export Citation
  • 65.

    MerchantTEKunLEKrasinMJ. Multi-institution prospective trial of reduced-dose craniospinal irradiation (23.4 Gy) followed by conformal posterior fossa (36 Gy) and primary site irradiation (55.8 Gy) and dose-intensive chemotherapy for average-risk medulloblastoma. Int J Radiat Oncol Biol Phys2008;70:782787.

    • Search Google Scholar
    • Export Citation
  • 66.

    DeutschMThomasPRKrischerJ. Results of a prospective randomized trial comparing standard dose neuraxis irradiation (3,600 cGy/20) with reduced neuraxis irradiation (2,340 cGy/13) in patients with low-stage medulloblastoma. A Combined Children's Cancer Group-Pediatric Oncology Group Study. Pediatr Neurosurg1996;24:167176.

    • Search Google Scholar
    • Export Citation
  • 67.

    GermanwalaAVMaiJCTomyczND. Boost Gamma Knife surgery during multimodality management of adult medulloblastoma. J Neurosurg2008;108:204209.

    • Search Google Scholar
    • Export Citation
  • 68.

    RiffaudLSaikaliSLerayE. Survival and prognostic factors in a series of adults with medulloblastomas. J Neurosurg2009;111:478487.

  • 69.

    HerrlingerUSteinbrecherARiegerJ. Adult medulloblastoma: prognostic factors and response to therapy at diagnosis and at relapse. J Neurol2005;252:291299.

    • Search Google Scholar
    • Export Citation
  • 70.

    PackerRJGajjarAVezinaG. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol2006;24:42024208.

    • Search Google Scholar
    • Export Citation
  • 71.

    AshleyDMMeierLKerbyT. Response of recurrent medulloblastoma to low-dose oral etoposide. J Clin Oncol1996;14:19221927.

  • 72.

    ChamberlainMCKormanikPA. Chronic oral VP-16 for recurrent medulloblastoma. Pediatr Neurol1997;17:230234.

  • 73.

    DunkelIJGardnerSLGarvinJHJr. High-dose carboplatin, thiotepa, and etoposide with autologous stem cell rescue for patients with previously irradiated recurrent medulloblastoma. Neuro Oncol2010;12:297303.

    • Search Google Scholar
    • Export Citation
  • 74.

    GillPLitzowMBucknerJ. High-dose chemotherapy with autologous stem cell transplantation in adults with recurrent embryonal tumors of the central nervous system. Cancer2008;112:18051811.

    • Search Google Scholar
    • Export Citation
  • 75.

    CohenMEDuffnerP eds. Brain tumors in children 2nd edition. New York, NY: McGraw-Hill; 1994.

  • 76.

    ChangCHHousepianEMHerbertCJr. An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology1969;93:13511359.

    • Search Google Scholar
    • Export Citation
  • 77.

    BrandesAAFranceschiETosoniA. Adult neuroectodermal tumors of posterior fossa (medulloblastoma) and of supratentorial sites (stPNET). Crit Rev Oncol Hematol2009;71:165179.

    • Search Google Scholar
    • Export Citation
  • 78.

    SchellingerKAProppJMVillanoJLMcCarthyBJ. Descriptive epidemiology of primary spinal cord tumors. J Neurooncol2008;87:173179.

  • 79.

    GrimmSChamberlainMC. Adult primary spinal cord tumors. Expert Rev Neurother2009;9:14871495.

  • 80.

    GezenFKahramanSCanakciZBedukA. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976)2000;25:727731.

  • 81.

    SoleroCLFornariMGiombiniS. Spinal meningiomas: review of 174 operated cases. Neurosurgery1989;25:153160.

  • 82.

    VolppPBHanKKaganARTomeM. Outcomes in treatment for intradural spinal cord ependymomas. Int J Radiat Oncol Biol Phys2007;69:11991204.

    • Search Google Scholar
    • Export Citation
  • 83.

    YangSYangXHongG. Surgical treatment of one hundred seventy-four intramedullary spinal cord tumors. Spine (Phila Pa 1976)2009;34:27052710.

    • Search Google Scholar
    • Export Citation
  • 84.

    RacoAEspositoVLenziJ. Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery2005;56:972981.

  • 85.

    BenesVIIIBarsaPBenesVJrSuchomelP. Prognostic factors in intramedullary astrocytomas: a literature review. Eur Spine J2009;18:13971422.

    • Search Google Scholar
    • Export Citation
  • 86.

    MilanoMTJohnsonMDSulJ. Primary spinal cord glioma: a Surveillance, Epidemiology, and End Results database study. J Neurooncol2010;98:8392.

    • Search Google Scholar
    • Export Citation
  • 87.

    SgourosSMalluciCLJackowskiA. Spinal ependymomas—the value of postoperative radiotherapy for residual disease control. Br J Neurosurg1996;10:559566.

    • Search Google Scholar
    • Export Citation
  • 88.

    LeeTTGromelskiEBGreenBA. Surgical treatment of spinal ependymoma and post-operative radiotherapy. Acta Neurochir (Wien)1998;140:309313.

    • Search Google Scholar
    • Export Citation
  • 89.

    RyuSIKimDHChangSD. Stereotactic radiosurgery for hemangiomas and ependymomas of the spinal cord. Neurosurg Focus2003;15:E10.

  • 90.

    GersztenPCBurtonSAOzhasogluC. Radiosurgery for benign intradural spinal tumors. Neurosurgery2008;62:887895.

  • 91.

    DoddRLRyuMRKamnerdsupaphonP. CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery2006;58:674685.

    • Search Google Scholar
    • Export Citation
  • 92.

    Garces-AmbrossiGLMcGirtMJMehtaVA. Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine2009;11:591599.

    • Search Google Scholar
    • Export Citation
  • 93.

    MahmoodACaccamoDVTomecekFJMalikGM. Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery1993;33:955963.

  • 94.

    VernooijMWIkramMATangheHL. Incidental findings on brain MRI in the general population. N Engl J Med2007;357:18211828.

  • 95.

    LieuASHowngSL. Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res2000;38:4552.

  • 96.

    CampbellBAJhambAMaguireJA. Meningiomas in 2009: controversies and future challenges. Am J Clin Oncol2009;32:7385.

  • 97.

    NathooNUgokweKChangAS. The role of 111indium-octreotide brain scintigraphy in the diagnosis of cranial, dural-based meningiomas. J Neurooncol2007;81:167174.

    • Search Google Scholar
    • Export Citation
  • 98.

    NyuykiFPlotkinMGrafR. Potential impact of (68)Ga-DOTATOC PET/CT on stereotactic radiotherapy planning of meningiomas. Eur J Nucl Med Mol Imaging2010;37:310318.

    • Search Google Scholar
    • Export Citation
  • 99.

    GehlerBPaulsenFOksuzMO. [68Ga]-DOTATOC-PET/CT for meningioma IMRT treatment planning. Radiat Oncol2009;4:56.

  • 100.

    NakamuraMRoserFMichelJ. The natural history of incidental meningiomas. Neurosurgery2003;53:6270.

  • 101.

    OliveroWCListerJRElwoodPW. The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg1995;83:222224.

    • Search Google Scholar
    • Export Citation
  • 102.

    StaffordSLPerryASumanVJ. Primarily resected meningiomas: outcome and prognostic factors in 581 Mayo Clinic patients, 1978 through 1988. Mayo Clin Proc1998;73:936942.

    • Search Google Scholar
    • Export Citation
  • 103.

    MahmoodAQureshiNHMalikGM. Intracranial meningiomas: analysis of recurrence after surgical treatment. Acta Neurochir (Wien)1994;126:5358.

    • Search Google Scholar
    • Export Citation
  • 104.

    MathiesenTLindquistCKihlstromLKarlssonB. Recurrence of cranial base meningiomas. Neurosurgery1996;39:27; discussion 8–9.

  • 105.

    PerryAStaffordSLScheithauerBW. Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol1997;21:14551465.

  • 106.

    SimpsonD. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry1957;20:2239.

  • 107.

    CondraKSBuattiJMMendenhallWM. Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys1997;39:427436.

    • Search Google Scholar
    • Export Citation
  • 108.

    SoyuerSChangELSelekU. Radiotherapy after surgery for benign cerebral meningioma. Radiother Oncol2004;71:8590.

  • 109.

    AghiMKCarterBSCosgroveGR. Long-term recurrence rates of atypical meningiomas after gross total resection with or without postoperative adjuvant radiation. Neurosurgery2009;64:5660; discussion 60.

    • Search Google Scholar
    • Export Citation
  • 110.

    HugEBDevriesAThorntonAF. Management of atypical and malignant meningiomas: role of high-dose, 3D-conformal radiation therapy. J Neurooncol2000;48:151160.

    • Search Google Scholar
    • Export Citation
  • 111.

    YangSYParkCKParkSH. Atypical and anaplastic meningiomas: prognostic implications of clinicopathological features. J Neurol Neurosurg Psychiatry2008;79:574580.

    • Search Google Scholar
    • Export Citation
  • 112.

    PollockBEStaffordSLUtterA. Stereotactic radiosurgery provides equivalent tumor control to Simpson grade 1 resection for patients with small- to medium-size meningiomas. Int J Radiat Oncol Biol Phys2003;55:10001005.

    • Search Google Scholar
    • Export Citation
  • 113.

    KondziolkaDMathieuDLunsfordLD. Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery2008;62:5358; discussion 58–60.

    • Search Google Scholar
    • Export Citation
  • 114.

    NewtonHBScottSRVolpiC. Hydroxyurea chemotherapy for meningiomas: enlarged cohort with extended follow-up. Br J Neurosurg2004;18:495499.

    • Search Google Scholar
    • Export Citation
  • 115.

    ChamberlainMCGlantzMJFadulCE. Recurrent meningioma: salvage therapy with long-acting somatostatin analogue. Neurology2007;69:969973.

    • Search Google Scholar
    • Export Citation
  • 116.

    ChamberlainMCGlantzMJ. Interferon-alpha for recurrent World Health Organization grade 1 intracranial meningiomas. Cancer2008;113:21462151.

    • Search Google Scholar
    • Export Citation
  • 117.

    Barnholtz-SloanJSSloanAEDavisFG. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol2004;22:28652872.

    • Search Google Scholar
    • Export Citation
  • 118.

    SchoutenLJRuttenJHuveneersHATwijnstraA. Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer2002;94:26982705.

    • Search Google Scholar
    • Export Citation
  • 119.

    LinNUBellonJRWinerEP. CNS metastases in breast cancer. J Clin Oncol2004;22:36083617.

  • 120.

    EichlerAFLoefflerJS. Multidisciplinary management of brain metastases. Oncologist2007;12:884898.

  • 121.

    BarkerFGII. Craniotomy for the resection of metastatic brain tumors in the U.S., 1988-2000: decreasing mortality and the effect of provider caseload. Cancer2004;100:9991007.

    • Search Google Scholar
    • Export Citation
  • 122.

    PatchellRATibbsPARegineWF. Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA1998;280:14851489.

    • Search Google Scholar
    • Export Citation
  • 123.

    PaekSHAuduPBSperlingMR. Reevaluation of surgery for the treatment of brain metastases: review of 208 patients with single or multiple brain metastases treated at one institution with modern neurosurgical techniques. Neurosurgery2005;56:10211034.

    • Search Google Scholar
    • Export Citation
  • 124.

    StarkAMTscheslogHBuhlR. Surgical treatment for brain metastases: prognostic factors and survival in 177 patients. Neurosurg Rev2005;28:115119.

    • Search Google Scholar
    • Export Citation
  • 125.

    SuhJH. Stereotactic radiosurgery for the management of brain metastases. N Engl J Med2010;362:11191127.

  • 126.

    AoyamaHShiratoHTagoM. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA2006;295:24832491.

    • Search Google Scholar
    • Export Citation
  • 127.

    O'NeillBPIturriaNJLinkMJ. A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases. Int J Radiat Oncol Biol Phys2003;55:11691176.

    • Search Google Scholar
    • Export Citation
  • 128.

    RadesDKueterJDVeningaT. Whole brain radiotherapy plus stereotactic radiosurgery (WBRT+SRS) versus surgery plus whole brain radiotherapy (OP+WBRT) for 1-3 brain metastases: results of a matched pair analysis. Eur J Cancer2009;45:400404.

    • Search Google Scholar
    • Export Citation
  • 129.

    SchogglAKitzKReddyM. Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases. Acta Neurochir (Wien)2000;142:621626.

    • Search Google Scholar
    • Export Citation
  • 130.

    MuacevicAWowraBSiefertA. Microsurgery plus whole brain irradiation versus Gamma Knife surgery alone for treatment of single metastases to the brain: a randomized controlled multicentre phase III trial. J Neurooncol2008;87:299307.

    • Search Google Scholar
    • Export Citation
  • 131.

    AkyurekSChangELMahajanA. Stereotactic radiosurgical treatment of cerebral metastases arising from breast cancer. Am J Clin Oncol2007;30:310314.

    • Search Google Scholar
    • Export Citation
  • 132.

    LoefflerJSKooyHMWenPY. The treatment of recurrent brain metastases with stereotactic radiosurgery. J Clin Oncol1990;8:576582.

  • 133.

    NoelGMedioniJValeryCA. Three irradiation treatment options including radiosurgery for brain metastases from primary lung cancer. Lung Cancer2003;41:333343.

    • Search Google Scholar
    • Export Citation
  • 134.

    NoelGProudhomMAValeryCA. Radiosurgery for re-irradiation of brain metastasis: results in 54 patients. Radiother Oncol2001;60:6167.

  • 135.

    SheehanJKondziolkaDFlickingerJLunsfordLD. Radiosurgery for patients with recurrent small cell lung carcinoma metastatic to the brain: outcomes and prognostic factors. J Neurosurg2005;102 (suppl):247254.

    • Search Google Scholar
    • Export Citation
  • 136.

    PatchellRATibbsPAWalshJW. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med1990;322:494500.

    • Search Google Scholar
    • Export Citation
  • 137.

    VechtCJHaaxma-ReicheHNoordijkEM. Treatment of single brain metastasis: radiotherapy alone or combined with neurosurgery?Ann Neurol1993;33:583590.

    • Search Google Scholar
    • Export Citation
  • 138.

    MintzAHKestleJRathboneMP. A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis. Cancer1996;78:14701476.

    • Search Google Scholar
    • Export Citation
  • 139.

    AndrewsDWScottCBSperdutoPW. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet2004;363:16651672.

    • Search Google Scholar
    • Export Citation
  • 140.

    KondziolkaDPatelALunsfordLD. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys1999;45:427434.

    • Search Google Scholar
    • Export Citation
  • 141.

    CooperJSSteinfeldADLerchIA. Cerebral metastases: value of reirradiation in selected patients. Radiology1990;174:883885.

  • 142.

    SadikovEBezjakAYiQL. Value of whole brain re-irradiation for brain metastases—single centre experience. Clin Oncol (R Coll Radiol)2007;19:532538.

    • Search Google Scholar
    • Export Citation
  • 143.

    WongWWSchildSESawyerTEShawEG. Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys1996;34:585590.

    • Search Google Scholar
    • Export Citation
  • 144.

    GuerrieriMWongKRyanG. A randomised phase III study of palliative radiation with concomitant carboplatin for brain metastases from non-small cell carcinoma of the lung. Lung Cancer2004;46:107111.

    • Search Google Scholar
    • Export Citation
  • 145.

    VergerEGilMYayaR. Temozolomide and concomitant whole brain radiotherapy in patients with brain metastases: a phase II randomized trial. Int J Radiat Oncol Biol Phys2005;61:185191.

    • Search Google Scholar
    • Export Citation
  • 146.

    AntonadouDParaskevaidisMSarrisG. Phase II randomized trial of temozolomide and concurrent radiotherapy in patients with brain metastases. J Clin Oncol2002;20:36443650.

    • Search Google Scholar
    • Export Citation
  • 147.

    AgarwalaSSKirkwoodJMGoreM. Temozolomide for the treatment of brain metastases associated with metastatic melanoma: a phase II study. J Clin Oncol2004;22:21012107.

    • Search Google Scholar
    • Export Citation
  • 148.

    KrownSENiedzwieckiDHwuWJ. Phase II study of temozolomide and thalidomide in patients with metastatic melanoma in the brain: high rate of thromboembolic events (CALGB 500102). Cancer2006;107:18831890.

    • Search Google Scholar
    • Export Citation
  • 149.

    LassmanABAbreyLEShahGD. Systemic high-dose intravenous methotrexate for central nervous system metastases. J Neurooncol2006;78:255260.

    • Search Google Scholar
    • Export Citation
  • 150.

    CocconiGLotticiRBisagniG. Combination therapy with platinum and etoposide of brain metastases from breast carcinoma. Cancer Invest1990;8:327334.

    • Search Google Scholar
    • Export Citation
  • 151.

    FranciosiVCocconiGMichiaraM. Front-line chemotherapy with cisplatin and etoposide for patients with brain metastases from breast carcinoma, nonsmall cell lung carcinoma, or malignant melanoma: a prospective study. Cancer1999;85:15991605.

    • Search Google Scholar
    • Export Citation
  • 152.

    RiveraEMeyersCGrovesM. Phase I study of capecitabine in combination with temozolomide in the treatment of patients with brain metastases from breast carcinoma. Cancer2006;107:13481354.

    • Search Google Scholar
    • Export Citation
  • 153.

    HeddeJPNeuhausTSchullerH. A phase I/II trial of topotecan and radiation therapy for brain metastases in patients with solid tumors. Int J Radiat Oncol Biol Phys2007;68:839844.

    • Search Google Scholar
    • Export Citation
  • 154.

    NeuhausTKoYMullerRP. A phase III trial of topotecan and whole brain radiation therapy for patients with CNS-metastases due to lung cancer. Br J Cancer2009;100:291297.

    • Search Google Scholar
    • Export Citation
  • 155.

    LangFFChangELAbi-SaidD. Metastatic brain tumors. In: WinnH ed. Youman's Neurological Surgery 5th edition. Philadelphia, PA: Saunders; 2004:10771097.

    • Search Google Scholar
    • Export Citation
  • 156.

    TsaoMNLloydNWongR. Whole brain radiotherapy for the treatment of multiple brain metastases. Cochrane Database Syst Rev2006;3:CD003869.

  • 157.

    WongDAFornasierVLMacNabI. Spinal metastases: the obvious, the occult, and the impostors. Spine (Phila Pa 1976)1990;15:14.

  • 158.

    IbrahimACrockardAAntoniettiP. Does spinal surgery improve the quality of life for those with extradural (spinal) osseous metastases? An international multicenter prospective observational study of 223 patients. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2007. J Neurosurg Spine2008;8:271278.

    • Search Google Scholar
    • Export Citation
  • 159.

    ByrneTN. Spinal cord compression from epidural metastases. N Engl J Med1992;327:614619.

  • 160.

    SchmidtMHKlimoPJrVrionisFD. Metastatic spinal cord compression. J Natl Compr Canc Netw2005;3:711719.

  • 161.

    Helweg-LarsenSSorensenPS. Symptoms and signs in metastatic spinal cord compression: a study of progression from first symptom until diagnosis in 153 patients. Eur J Cancer1994;30A:396398.

    • Search Google Scholar
    • Export Citation
  • 162.

    LevackPGrahamJCollieD. Don't wait for a sensory level—listen to the symptoms: a prospective audit of the delays in diagnosis of malignant cord compression. Clin Oncol (R Coll Radiol)2002;14:472480.

    • Search Google Scholar
    • Export Citation
  • 163.

    SundaresanNRothmanAManhartKKelliherK. Surgery for solitary metastases of the spine: rationale and results of treatment. Spine (Phila Pa 1976)2002;27:18021806.

    • Search Google Scholar
    • Export Citation
  • 164.

    NorthRBLaRoccaVRSchwartzJ. Surgical management of spinal metastases: analysis of prognostic factors during a 10-year experience. J Neurosurg Spine2005;2:564573.

    • Search Google Scholar
    • Export Citation
  • 165.

    TomitaKKawaharaNKobayashiT. Surgical strategy for spinal metastases. Spine (Phila Pa 1976)2001;26:298306.

  • 166.

    TokuhashiYMatsuzakiHOdaH. A revised scoring system for preoperative evaluation of metastatic spine tumor prognosis. Spine (Phila Pa 1976)2005;30:21862191.

    • Search Google Scholar
    • Export Citation
  • 167.

    van der LindenYMDijkstraSPVonkEJ. Prediction of survival in patients with metastases in the spinal column: results based on a randomized trial of radiotherapy. Cancer2005;103:320328.

    • Search Google Scholar
    • Export Citation
  • 168.

    BartelsRHFeuthTvan der MaazenR. Development of a model with which to predict the life expectancy of patients with spinal epidural metastasis. Cancer2007;110:20422049.

    • Search Google Scholar
    • Export Citation
  • 169.

    ChoiDCrockardABungerC. Review of metastatic spine tumour classification and indications for surgery: the consensus statement of the Global Spine Tumour Study Group. Eur Spine J2010;19:215222.

    • Search Google Scholar
    • Export Citation
  • 170.

    ElerakyMPapanastassiouIVrionisFD. Management of metastatic spine disease. Curr Opin Support Palliat Care2010;4:182188.

  • 171.

    KlimoPJrThompsonCJKestleJRSchmidtMH. A meta-analysis of surgery versus conventional radiotherapy for the treatment of metastatic spinal epidural disease. Neuro Oncol2005;7:6476.

    • Search Google Scholar
    • Export Citation
  • 172.

    WithamTFKhavkinYAGalliaGL. Surgery insight: current management of epidural spinal cord compression from metastatic spine disease. Nat Clin Pract Neurol2006;2:8794; quiz 116.

    • Search Google Scholar
    • Export Citation
  • 173.

    PatchellRATibbsPARegineWF. Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial. Lancet2005;366:643648.

    • Search Google Scholar
    • Export Citation
  • 174.

    PatilCGLadSPSantarelliJBoakyeM. National inpatient complications and outcomes after surgery for spinal metastasis from 1993-2002. Cancer2007;110:625630.

    • Search Google Scholar
    • Export Citation
  • 175.

    ItshayekEYamadaJBilskyM. Timing of surgery and radiotherapy in the management of metastatic spine disease: a systematic review. Int J Oncol2010;36:533544.

    • Search Google Scholar
    • Export Citation
  • 176.

    MaranzanoEBellavitaRRossiR. Short-course versus split-course radiotherapy in metastatic spinal cord compression: results of a phase III, randomized, multicenter trial. J Clin Oncol2005;23:33583365.

    • Search Google Scholar
    • Export Citation
  • 177.

    GersztenPCMendelEYamadaY. Radiotherapy and radiosurgery for metastatic spine disease: what are the options, indications, and outcomes?Spine (Phila Pa 1976)2009;34:S7892.

    • Search Google Scholar
    • Export Citation
  • 178.

    GersztenPCBurtonSAOzhasogluCWelchWC. Radiosurgery for spinal metastases: clinical experience in 500 cases from a single institution. Spine (Phila Pa 1976)2007;32:193199.

    • Search Google Scholar
    • Export Citation
  • 179.

    MendelEBourekasEGersztenPGolanJD. Percutaneous techniques in the treatment of spine tumors: what are the diagnostic and therapeutic indications and outcomes?Spine (Phila Pa 1976)2009;34:S93100.

    • Search Google Scholar
    • Export Citation
  • 180.

    SorensenSHelweg-LarsenSMouridsenHHansenHH. Effect of high-dose dexamethasone in carcinomatous metastatic spinal cord compression treated with radiotherapy: a randomised trial. Eur J Cancer1994;30A:2227.

    • Search Google Scholar
    • Export Citation
  • 181.

    VechtCJHaaxma-ReicheHvan PuttenWL. Initial bolus of conventional versus high-dose dexamethasone in metastatic spinal cord compression. Neurology1989;39:12551257.

    • Search Google Scholar
    • Export Citation
  • 182.

    HeimdalKHirschbergHSletteboH. High incidence of serious side effects of high-dose dexamethasone treatment in patients with epidural spinal cord compression. J Neurooncol1992;12:141144.

    • Search Google Scholar
    • Export Citation
  • 183.

    KwokYRegineWFPatchellRA. Radiation therapy alone for spinal cord compression: time to improve upon a relatively ineffective status quo. J Clin Oncol2005;23:33083310.

    • Search Google Scholar
    • Export Citation
  • 184.

    RadesDStalpersLJAVeningaT. Evaluation of five radiation schedules and prognostic factors for metastatic spinal cord compression. J Clin Oncol2005;23:33663375.

    • Search Google Scholar
    • Export Citation
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