Scientific and Clinical Challenges within Neuro-Oncology
| Autor: | Marissa Barbaro, Rajiv Magge, Howard A. Fine |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Central nervous system Brain tumor Medical Oncology Blood–brain barrier 03 medical and health sciences 0302 clinical medicine Immune system Glioma medicine Humans Intensive care medicine Brain Neoplasms business.industry Neurotoxicity medicine.disease Radiation therapy Clinical trial medicine.anatomical_structure Neurology 030220 oncology & carcinogenesis Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 151:402-410 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2021.01.151 |
| Popis: | Both primary and metastatic brain tumors carry poor prognoses despite modern advances in medical therapy, radiation therapy, and surgical techniques. Gliomas, including glioblastoma (GBM), are particularly difficult to treat, and high-grade gliomas have poor outcomes. Treatment of brain tumors involves a unique set of scientific and clinical challenges, which are often not present in the treatment of systemic malignancies. With respect to scientific challenges, the anatomy and physiology of brain tumors (including the blood-brain barrier, blood-tumor barrier, and blood-cerebrospinal fluid barrier) prevent adequate drug delivery into the central nervous system. The unique nature of the immune system in the central nervous system as well as the immunosuppressive microenvironment of tumors such as GBM also create therapeutic roadblocks in the treatment of brain tumors. Tumor heterogeneity, particularly in GBM, has classically been believed to contribute to multitherapy resistance; however, recent data suggest that this may not be the case. Clinical challenges include neurologic and medical comorbidities of patients with brain tumor, as well as potential toxicity of tumor-directed treatment. Clinical trials investigating new treatment paradigms are needed, but several roadblocks exist to good and promising clinical trial availability. |
| Databáze: | OpenAIRE |
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