Primary Central Nervous System Tumors in Adults

It is important that before treatment is initiated, the precise diagnosis of brain tumor has been made and fits with the clinical, radiographic, and histologic findings. With low-grade gliomas, maximal surgical resection should be attempted. We delay radiation therapy unless the patient has significant neurologic symptoms that could be alleviated by treatment. Patients with glioblastoma multiforme (GBM) and anaplastic astrocytoma should undergo maximum surgical resection, postoperative radiation therapy, and adjuvant chemotherapy with bischloroethylnitrosourea (BCNU) or intensive procarbazine, chloroethylcyclohexylnitrosourea (CCNU), and vincristine (PCV) therapy, respectively. Patients with anaplastic oligodendroglioma (AO) and mixed anaplastic oligodendroglioma-astrocytoma (AOA) should undergo maximal surgical resection, postoperative radiation therapy, and intensive adjuvant PCV therapy. Meningiomas are usually managed with surgery alone; radiation therapy is used if the meningioma is malignant or recurs. Tamoxifen or hydroxyurea may be useful for recurrent meningiomas. Patients with primary central nervous system (CNS) lymphoma undergo biopsy; surgical resection of the tumor is not necessary. We treat immunocompetent patients with multimethod therapy. Patients with AIDS and primary CNS lymphoma receive radiation alone. Because the prognosis for primary CNS lymphomas has not changed significantly in the past 20 years, patients with these tumors should be enrolled in clinical trials if possible. Novel approaches, such as targeting angiogenesis, using signal transduction or invasion, or employing genes affecting growth control, are being pursued.