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Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Management of Specific Tumor Types and Locations

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These patients are appropriate candidates for clinical trials designed to improve local control by adding newer forms of treatment. Information about ongoing clinical trials is available from the NCI Web site.

Mixed Gliomas

Standard treatment options:

  1. Surgery plus radiation therapy.
  2. Surgery plus radiation therapy plus chemotherapy.

Mixed glial tumors, which include oligoastrocytoma (WHO grade II) and anaplastic oligoastrocytoma (WHO grade III), have a prognosis similar to that for astrocytic tumors of corresponding grades and can be treated as such.

Ependymal Tumors

Grade I and II ependymal tumors

Standard treatment options:

  1. Surgery alone if the tumor is totally resectable.
  2. Surgery followed by radiation therapy to known or suspected residual tumor.

Ependymomas (WHO grade II) and ependymal tumors (WHO grade I), i.e., subependymoma and myxopapillary ependymomas, are often curable.

Anaplastic ependymomas

Standard treatment options:

  • Surgery plus radiation therapy.[9]

Anaplastic ependymomas (WHO grade III) have variable prognoses that depend on the location and extent of disease. Frequently, but not invariably, anaplastic ependymomas have worse prognoses than lower grade ependymal tumors.

Embryonal Cell Tumors: Medulloblastomas

Standard treatment options:

  • Surgery plus craniospinal radiation therapy for good-risk patients.[10]

Treatment options under clinical evaluation:

  • Surgery plus craniospinal radiation therapy and various chemotherapy regimens are being evaluated for poor-risk patients.[10]

Medulloblastoma occurs primarily in children, but it also occurs with some frequency in adults.[11] Other embryonal tumors are pediatric conditions. (Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)

Pineal Parenchymal Tumors

Standard treatment options:

  1. Surgery plus radiation therapy for pineocytoma.
  2. Surgery plus radiation therapy and chemotherapy for pineoblastoma.

Pineocytoma (WHO grade II), pineoblastoma (WHO grade IV), and pineal parenchymal tumors of intermediate differentiation are diverse tumors that require special consideration. Pineocytomas are slow growing and carry variable prognoses for cure. Pineoblastomas are more rapidly growing and have worse prognoses. Pineal parenchymal tumors of intermediate differentiation have unpredictable growth and clinical behavior.

Meningeal Tumors

Grade I meningiomas

Standard treatment options:

  1. Active surveillance with deferred treatment, especially for incidentally discovered asymptomatic tumors.[12,13].
  2. Surgery.
  3. Surgery plus radiation therapy is used in selected cases, such as for patients with known or suspected residual disease or with recurrence after previous surgery.
  4. Radiation therapy for patients with unresectable tumors.[14]
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