Recent advances in the treatment of central nervous system tumors

IntroductionCentral nervous system (CNS) tumors cause a significant amount of morbidity and mortality. More research is needed to improve the prognosis of patients with CNS tumors, and especially for those with malignant gliomas. The advances over the last several years in the treatment of adult central nervous system tumors are reviewed here.Materials and methodsPhase II and Phase III trials published in major peer-reviewed journals between 2005 and 2006 were examined. Adult central nervous system tumors including malignant glioma, low-grade glioma, primary central nervous system lymphoma, brain metastases, and neoplastic meningitis, were included.ResultsPhase II treatment trials for patients with gliomas dominated the literature in the time-period examined. Trials primarily addressed radiotherapy as well as chemotherapy in the treatment of gliomas. A number of trials examined targeted agents as single agents and in combination with systemic therapy in glioma patients. A few studies evaluated the role of chemotherapy and radiation in metastatic disease and primary CNS lymphoma.ConclusionsTemozolomide is now the new standard of care in combination with radiation therapy for newly diagnosed glioblastomas. The optimal dosing and length of adjuvant temozolomide treatment remains unclear, and there remains no current role for neo-adjuvant therapy. Targeted agents that can be used in the salvage or front-line setting, alone or in combination with systemic therapy, will likely be the focus of future research. For metastatic brain tumors, more studies are needed to examine the exact role of radiosurgery, whole brain radiation, and the role of other therapies such as temozolomide or targeted agents. For primary CNS lymphomas, the role of various high-dose methotrexate regimens is being actively investigated.