Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Oncology Reports
Erschienen in: Current Oncology Reports 3/2021

01.03.2021 | Neuro-oncology (KS Nevel, Section Editor)

Updates on Surgical Management and Advances for Brain Tumors

verfasst von: Maricruz Rivera, Sofya Norman, Ryka Sehgal, Rupa Juthani

Erschienen in: Current Oncology Reports | Ausgabe 3/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

This review summarizes the modern approach to surgical management of malignant brain tumors, highlighting new technology and multimodal treatment paradigms.

Recent Findings

Outcomes in patients with glioblastoma are strongly correlated with extent of initial surgical resection. Intraoperative MRI, 5-ALA, and neuronavigation are surgical tools that can help achieve a maximal safe resection. 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. Advances in surgical techniques allow for minimally invasive approaches, including the use of tubular retractors, endoscopes, and laser interstitial thermal therapy.

Summary

Primary and metastatic brain tumors require a multimodal, multidisciplinary approach to treatment. Surgical resection can be paired with radiation for metastases to maximize tumor control, expanding systemic options. Technological innovations have improved the safety of surgical resection, while expanding the surgical options and indications for treatment.
Literatur
1.
Ostrom QT, Cioffi G, Gittleman H, Patil N, Waite K, Kruchko C, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2012–2016. Neuro-Oncol. 2019;21(Supplement_5):v1–100.PubMedPubMedCentralCrossRef
2.
3.
Sanai N, Berger MS. Surgical oncology for gliomas: the state of the art. Nat Rev Clin Oncol. 2018;15(2):112–25.PubMedCrossRef
4.
Anjum K, Shagufta BI, Abbas SQ, Patel S, Khan I, Shah SAA, et al. Current status and future therapeutic perspectives of glioblastoma multiforme (GBM) therapy: a review. Biomed Pharmacother. 2017;92:681–9.PubMedCrossRef
5.
Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016;2(11):1460–9.PubMedPubMedCentralCrossRef
6.
Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg. 2016;124(4):977–88.PubMedCrossRef
7.••
Wijnenga MMJ, French PJ, Dubbink HJ, WNM D, Atmodimedjo PN, Kros JM, et al. The impact of surgery in molecularly defined low-grade glioma: an integrated clinical, radiological, and molecular analysis. Neuro-Oncol. 2018;20(1):103–12 This paper advocates maximal resection as first line for molecularly characterized low-grade gliomas. In addition, a second operation may be warranted in IDH-mutant subtype astrocytomas for monitoring or resection of even small amounts of residual tumor.PubMedCrossRef
8.••
Hollon TC, Pandian B, Adapa AR, Urias E, Save AV, Khalsa SSS, et al. Near real-time intraoperative brain tumor diagnosis using stimulated Raman histology and deep neural networks. Nat Med. 2020;26(1):52–8 This paper characterizes a novel strategy for facilitating fast and accurate intraoperative tissue diagnosis combining by an optical imaging tool with deep convolutional neural networks. This automated parallel-workflow strategy is not inferior to existing laboratory-based pathology and provides a framework for streamlining tissue diagnosis during surgery.PubMedPubMedCentralCrossRef
9.
Rahman M, Abbatematteo J, De Leo EK, Kubilis PS, Vaziri S, Bova F, et al. The effects of new or worsened postoperative neurological deficits on survival of patients with glioblastoma. J Neurosurg. 2017;127(1):123–31.PubMedCrossRef
10.
Golub D, Hyde J, Dogra S, Nicholson J, Kirkwood KA, Gohel P, Loftus S, Schwartz TH. Intraoperative MRI versus 5-ALA in high-grade glioma resection: a network meta-analysis. J Neurosurg 2020;1–15.
11.
Stepp H, Stummer W. 5-ALA in the management of malignant glioma. Lasers Surg Med. 2018;50(5):399–419.PubMedCrossRef
12.
Gandhi S, Tayebi Meybodi A, Belykh E, Cavallo C, Zhao X, Syed MP, et al. Survival outcomes among patients with high-grade glioma treated with 5-aminolevulinic acid–guided surgery: a systematic review and meta-analysis. Front Oncol. 2019;9:620.PubMedPubMedCentralCrossRef
13.
Haider SA, Lim S, Kalkanis SN, Lee IY. The impact of 5-aminolevulinic acid on extent of resection in newly diagnosed high grade gliomas: a systematic review and single institutional experience. J Neuro-Oncol. 2019;141(3):507–15.CrossRef
14.
Hakozaki T, Okuma Y. Management of non-small cell lung cancer harboring epidermal growth factor receptor mutations in the era of first-line osimertinib. J Thorac Dis. 2019;11(7):2664–8.PubMedPubMedCentralCrossRef
15.
Hatiboglu MA, Akdur K, Sawaya R. Neurosurgical management of patients with brain metastasis. Neurosurg Rev. 2020;43(2):483–95.PubMedCrossRef
16.
Fuentes R, Osorio D, Expósito Hernandez J, Simancas-Racines D, Martinez-Zapata MJ, Bonfill Cosp X. Surgery versus stereotactic radiotherapy for people with single or solitary brain metastasis. Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, editor. Cochrane Database Syst Rev. 2018 [cited 2020 Aug 19]; Available from: http://​doi.​wiley.​com/​10.​1002/​14651858.​CD012086.​pub2
17.
Tanguturi S, Warren LEG. The current and evolving role of radiation therapy for central nervous system metastases from breast cancer. Curr Oncol Rep. 2019;21(6):50.PubMedCrossRef
18.••
Brown PD, Ballman KV, Cerhan JH, Anderson SK, Carrero XW, Whitton AC, et al. Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol. 2017;18(8):1049–60 This study randomly assigned patients with prior resection of brain metastasis to either postoperative SRS or WBRT. It showed no difference in overall survival between the 2 treatment groups and decreased cognitive function in the WBRT cohort.PubMedPubMedCentralCrossRef
19.
Grosu A-L, Frings L, Bentsalo I, Oehlke O, Brenner F, Bilger A, et al. Whole-brain irradiation with hippocampal sparing and dose escalation on metastases: neurocognitive testing and biological imaging (HIPPORAD) – a phase II prospective randomized multicenter trial (NOA-14, ARO 2015–3, DKTK-ROG). BMC Cancer. 2020;20(1):532.PubMedPubMedCentralCrossRef
20.
Chu L, Ni J, Yang X, Tong T, Wang J, Yin F, et al. Radiographic features of metastatic brain tumors from ALK-rearranged non-small cell lung cancer: implications for optimal treatment modalities. J Cancer. 2019;10(26):6660–5.PubMedPubMedCentralCrossRef
21.
Nguyen TK, Sahgal A, Detsky J, Soliman H, Myrehaug S, Tseng C-L, et al. Single-fraction stereotactic radiosurgery versus hippocampal-avoidance whole brain radiation therapy for patients with 10 to 30 brain metastases: a dosimetric analysis. Int J Radiat Oncol. 2019;105(2):394–9.CrossRef
22.•
Churilla TM, Chowdhury IH, Handorf E, Collette L, Collette S, Dong Y, et al. Comparison of local control of brain metastases with stereotactic radiosurgery vs surgical resection: a secondary analysis of a randomized clinical trial. JAMA Oncol. 2019;5(2):243 This secondary analysis of a randomized trial stratified patients into cohorts of surgical resection versus SRS to determine whether local control of brain metastases differed between the two treatment groups. The investigation showed similar control of brain metastases between the two cohorts over time; SRS initially had better control over tumor recurrence than surgical resection, but this benefit decreased with time.PubMedCrossRef
23.
Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, editor. Cochrane Database Syst Rev [Internet]. 2017 [cited 2020 Aug 19]; Available from: http://​doi.​wiley.​com/​10.​1002/​14651858.​CD006121.​pub4
24.
Marchan EM, Peterson J, Sio TT, Chaichana KL, Harrell AC, Ruiz-Garcia H, et al. Postoperative cavity stereotactic radiosurgery for brain metastases. Front Oncol. 2018;8:342.PubMedPubMedCentralCrossRef
25.
Navarria P, Pessina F, Clerici E, Franceschini D, Gay LG, De Rose F, et al. Surgery followed by hypofractionated radiosurgery on the tumor bed in oligometastatic patients with large brain metastases. Results of a phase 2 study. Int J Radiat Oncol. 2019 Dec;105(5):1095–105.CrossRef
26.
Dumont Lecomte D, Lequesne J, Geffrelot J, Lesueur P, Barraux V, Loiseau C, et al. Hypofractionated stereotactic radiotherapy for challenging brain metastases using 36 Gy in six fractions. Cancer/Radiothérapie. 2019;23(8):860–6.CrossRef
27.•
Soliman H, Myrehaug S, Tseng C-L, Ruschin M, Hashmi A, Mainprize T, et al. Image-guided, Linac-based, surgical cavity-hypofractionated stereotactic radiotherapy in 5 daily fractions for brain metastases. Neurosurgery. 2019;85(5):E860–9 A 5-fraction paradigm for delivery of SRS demonstrated improved local control in the management of brain metastases after resection.PubMedCrossRef
28.
D’Andrea MA, Reddy GK. Extracranial abscopal responses in advanced lung cancer induced by brain radiation: Am J Clin Oncol. 2019.
29.
30.
Lithgow K, Siqueira I, Senthil L, Chew HS, Chavda SV, Ayuk J, et al. Pituitary metastases: presentation and outcomes from a pituitary center over the last decade. Pituitary. 2020;23(3):258–65.PubMedPubMedCentralCrossRef
31.
Marchioni D, Gulino A, Sacchetto L, Pinna G, Musumeci A, Molteni G. Expanded endoscopic approach for anterior skull base tumors: experience of a multidisciplinary skull base team. J Craniofac Surg. 2019;30(6):1730–3.PubMedCrossRef
32.
Zacharia BE, Romero FR, Rapoport SK, Raza SM, Anand VK, Schwartz TH. Endoscopic endonasal management of metastatic lesions of the anterior skull base: case series and literature review. World Neurosurg. 2015;84(5):1267–77.PubMedCrossRef
33.•
Shafiq AR, Wernicke AG, Riley CA, Morgenstern PF, Nedialkova L, Pannullo SC, et al. Placement of cesium-131 permanent brachytherapy seeds using the endoscopic endonasal approach for recurrent anaplastic skull base meningioma: case report and technical note. J Neurosurg. 2020;132(3):921–6 This case report describes for the first time the feasibility of using an endoscopic endonasal approach for the permanent placement of Cs-131 brachytherapy seeds, and a thorough discussion of techniques. The authors discuss comparisons with I-125 seeds and additional means of complication minimization.CrossRef
34.
Jackson C, Gallia G, Chaichana K. Minimally invasive biopsies of deep-seated brain lesions using tubular retractors under exoscopic visualization. J Neurol Surg Part Cent Eur Neurosurg. 2017;78(06):588–94.CrossRef
35.
Gassie K, Alvarado-Estrada K, Bechtle P, Chaichana K. Surgical management of deep-seated metastatic brain tumors using minimally invasive approaches. J Neurol Surg Part Cent Eur Neurosurg. 2019;80(03):198–204.CrossRef
36.
Patel B, Kim AH. Laser Interstitial Thermal Therapy. 6.
37.
Chaunzwa TL, Deng D, Leuthardt EC, Tatter SB, Mohammadi AM, Barnett GH, et al. Laser thermal ablation for metastases failing radiosurgery: a multicentered retrospective study. Neurosurgery. 2018;82(1):56–63.PubMedCrossRef
38.•
Shah AH, Semonche A, Eichberg DG, Borowy V, Luther E, Sarkiss CA, et al. The role of laser interstitial thermal therapy in surgical neuro-oncology: series of 100 consecutive patients. Neurosurgery. 2020;87(2):266–75 As one of the largest trials of LITT to date, this study served to expand the safety and outcomes profile of this methodology. In particular for treatment-failed or surgically inaccessible tumors, LITT presents a safe and reliable option for tumor management.PubMedCrossRef
39.
Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, et al. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging. 2019;19(1):65.PubMedPubMedCentralCrossRef
40.
Rao MS, Hargreaves EL, Khan AJ, Haffty BG, Danish SF. Magnetic resonance-guided laser ablation improves local control for postradiosurgery recurrence and/or radiation necrosis. Neurosurgery. 2014;74(6):658–67.PubMedCrossRef
41.
Ali MA, Carroll KT, Rennert RC, Hamelin T, Chang L, Lemkuil BP, et al. Stereotactic laser ablation as treatment for brain metastases that recur after stereotactic radiosurgery: a multiinstitutional experience. Neurosurg Focus. 2016;41(4):E11.PubMedCrossRef
42.
43.
Appelboom G, Detappe A, LoPresti M, Kunjachan S, Mitrasinovic S, Goldman S, et al. Stereotactic modulation of blood-brain barrier permeability to enhance drug delivery. Neuro-Oncol. 2016;18(12):1601–9.PubMedPubMedCentralCrossRef
44.•
Iorio-Morin C, Mercure-Cyr R, Figueiredo G, Touchette CJ, Masson-Côté L, Mathieu D. Repeat stereotactic radiosurgery for the management of locally recurrent brain metastases. J Neurooncol. 2019;145(3):551–9 Repeat SRS provides a meaningful palliative and therapeutic strategy for patients with locally recurrent metastases. This study emphasizes the potential for longer-term relief provided by repeat SRS in a select group of patients.PubMedCrossRef
45.
Parikh BB, Neil EC. Evolving strategies to potentially further optimize surgical interventions in brain cancer. Curr Oncol Rep. 2020;22(4):32.PubMedCrossRef
46.
Wernicke AG, Lazow SP, Taube S, Yondorf MZ, Kovanlikaya I, Nori D, et al. Surgical technique and clinically relevant resection cavity dynamics following implantation of Cesium-131 brachytherapy in patients with brain metastases. Oper Neurosurg. 2016;12(1):49–60.CrossRef
47.
Routman DM, Yan E, Vora S, Peterson J, Mahajan A, Chaichana KL, et al. Preoperative stereotactic radiosurgery for brain metastases. Front Neurol. 2018;9:959.PubMedPubMedCentralCrossRef
48.
El Shafie R, Tonndorf-Martini E, Schmitt D, Weber D, Celik A, Dresel T, et al. Pre-operative versus post-operative radiosurgery of brain metastases—volumetric and dosimetric impact of treatment sequence and margin concept. Cancers. 2019;11(3):294.PubMedCentralCrossRef
49.
Huff W, Agrawal N, Shapiro S, Miller J, Kulwin CG, Shah M, et al. Efficacy of pre-operative stereotactic radiosurgery followed by surgical resection and correlative radiobiological analysis for patients with Q_4 brain metastases: study protocol for a phase II trial. Radiat Oncol Lond Engl. 2018;13.
Metadaten
Titel
Updates on Surgical Management and Advances for Brain Tumors
verfasst von
Maricruz Rivera
Sofya Norman
Ryka Sehgal
Rupa Juthani
Publikationsdatum
01.03.2021
Verlag
Springer US
Erschienen in
Current Oncology Reports / Ausgabe 3/2021
Print ISSN: 1523-3790
Elektronische ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-020-01005-7

Weitere Artikel der Ausgabe 3/2021

Current Oncology Reports 3/2021 Zur Ausgabe

Evolving Therapies (RM Bukowski, Section Editor)

Targeting KRAS in Colorectal Cancer

Evolving Therapies (RM Bukowski, Section Editor)

Statins as Potential Chemoprevention or Therapeutic Agents in Cancer: a Model for Evaluating Repurposed Drugs

Integrative Care (C Lammersfeld, Section Editor)

The Presence of Complementary and Alternative Medicine Recommendations in Head and Neck Cancer Guidelines: Systematic Review and Quality Assessment

Genitourinary Cancers (DP Petrylak and JW Kim, Section Editors)

Post-Diagnostic Dietary and Lifestyle Factors and Prostate Cancer Recurrence, Progression, and Mortality

Cardio-oncology (EH Yang, Section Editor)

Microtubule Inhibitors and Cardiotoxicity

Letter to the Editor

Lack of Evidence Does Not Equal Lack of Benefit: Neoadjuvant Chemotherapy and Trimodality Therapy in Selected Patients with Muscle-Invasive Bladder Cancer

Neu im Fachgebiet Onkologie

Erhöhte Mortalität bei postpartalem Brustkrebs

07.05.2024 Mammakarzinom Nachrichten

Auch für Trägerinnen von BRCA-Varianten gilt: Erkranken sie fünf bis zehn Jahre nach der letzten Schwangerschaft an Brustkrebs, ist das Sterberisiko besonders hoch.

Hypertherme Chemotherapie bietet Chance auf Blasenerhalt

07.05.2024 Harnblasenkarzinom Nachrichten

Eine hypertherme intravesikale Chemotherapie mit Mitomycin kann für Patienten mit hochriskantem nicht muskelinvasivem Blasenkrebs eine Alternative zur radikalen Zystektomie darstellen. Kölner Urologen berichten über ihre Erfahrungen.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Bessere Prognose mit links- statt rechtsseitigem Kolon-Ca.

06.05.2024 Kolonkarzinom Nachrichten

Menschen mit linksseitigem Kolonkarzinom leben im Mittel zweieinhalb Jahre länger als solche mit rechtsseitigem Tumor. Auch aktuell ist das Sterberisiko bei linksseitigen Tumoren US-Daten zufolge etwa um 11% geringer als bei rechtsseitigen.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise