Gliomatosis cerebri medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
[[Radiotherapy]] and [[chemotherapy]] are recommended among all patients who develop gliomatosis cerebri. [[Temozolomide]] and [[PCV regimen|PCV 3 combination chemotherapy]] are the preferred drugs for the treatment of high-grade and low-grade gliomatosis cerebri, respectivel Supportive therapy for gliomatosis cerebri includes [[anticonvulsants]] and [[corticosteroids]]. | |||
==Medical Therapy== | ==Medical Therapy== | ||
The | The medical therapy of gliomatosis cerebri includes: | ||
===1. Radiotherapy=== | |||
*[[Radiation|Post-operative radiotherapy]] is recommended among all patients who develop gliomatosis cerebri.<ref name="pmid21301914">{{cite journal| author=Inoue T, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Tominaga T| title=Prognostic factors for patients with gliomatosis cerebri: retrospective analysis of 17 consecutive cases. | journal=Neurosurg Rev | year= 2010 | volume= 34 | issue= 2 | pages= 197-208 | pmid=21301914 | doi=10.1007/s10143-010-0306-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21301914 }} </ref> | |||
*Radiotherapy may not cure the cancer but can control the tumor, delay recurrence, and increase survival. | |||
*Radiation therapy is associated with temporary improvement of clinical symptoms.<ref name="pmid22740882">{{cite journal| author=Rajz GG, Nass D, Talianski E, Pfeffer R, Spiegelmann R, Cohen ZR| title=Presentation patterns and outcome of gliomatosis cerebri. | journal=Oncol Lett | year= 2012 | volume= 3 | issue= 1 | pages= 209-213 | pmid=22740882 | doi=10.3892/ol.2011.445 | pmc=PMC3362440 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22740882 }} </ref> | |||
*[[Radiation|External beam radiation therapy]] is preferred to whole brain radiotherapy.<ref name="pmid11708542">{{cite journal| author=Hejazi N, Witzmann A, Hergan K| title=Gliomatosis cerebri: intra vitam stereotactic determination in two cases and review of the literature. | journal=Br J Neurosurg | year= 2001 | volume= 15 | issue= 5 | pages= 396-401 | pmid=11708542 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11708542 }} </ref> | |||
*The median dose of radiation is 60 Gy (range: 50-72 Gy).<ref name="pmid21301914">{{cite journal| author=Inoue T, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Tominaga T| title=Prognostic factors for patients with gliomatosis cerebri: retrospective analysis of 17 consecutive cases. | journal=Neurosurg Rev | year= 2010 | volume= 34 | issue= 2 | pages= 197-208 | pmid=21301914 | doi=10.1007/s10143-010-0306-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21301914 }} </ref> | |||
=== | ===2. Chemotherapy=== | ||
*[[Chemotherapy]] is indicated as adjuvant therapy for gliomatosis cerebri. | *[[Chemotherapy]] is indicated as adjuvant therapy for gliomatosis cerebri. | ||
*[[Temozolomide]] ([[Temodar]]) is the preferred drug for the treatment of gliomatosis cerebri. | *[[Temozolomide]] ([[Temodar]]) is the preferred drug for the treatment of high-grade gliomatosis cerebri.<ref name="pmid15277636">{{cite journal| author=Levin N, Gomori JM, Siegal T| title=Chemotherapy as initial treatment in gliomatosis cerebri: results with temozolomide. | journal=Neurology | year= 2004 | volume= 63 | issue= 2 | pages= 354-6 | pmid=15277636 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15277636 }} </ref><ref name="pmid14684203">{{cite journal| author=Lodi R, Setola E, Tonon C, Ambrosetto P, Franceschi E, Crinò L et al.| title=Gliomatosis cerebri: clinical, neurochemical and neuroradiological response to temozolomide administration. | journal=Magn Reson Imaging | year= 2003 | volume= 21 | issue= 9 | pages= 1003-7 | pmid=14684203 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14684203 }} </ref> | ||
*Other chemotherapeutic drugs that may be used for the treatment of gliomatosis cerebri include: | *[[PCV regimen|PCV 3 combination chemotherapy]] is the preferred drug regimen for slow growing, low-grade gliomatosis cerebri.<ref name="pmid15798516">{{cite journal| author=Sanson M, Napolitano M, Cartalat-Carel S, Taillibert S| title=[Gliomatosis cerebri]. | journal=Rev Neurol (Paris) | year= 2005 | volume= 161 | issue= 2 | pages= 173-81 | pmid=15798516 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15798516 }} </ref> | ||
**[[CCNU]] is administered on day 1, [[procarbazine]] is administered daily for 14 days beginning on day 8, and [[vincristine]] is administered on days 8 and 29 of each 6-week cycle of therapy.<ref name="pmid7407756">{{cite journal| author=Levin VA, Edwards MS, Wright DC, Seager ML, Schimberg TP, Townsend JJ et al.| title=Modified procarbazine, CCNU, and vincristine (PCV 3) combination chemotherapy in the treatment of malignant brain tumors. | journal=Cancer Treat Rep | year= 1980 | volume= 64 | issue= 2-3 | pages= 237-44 | pmid=7407756 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7407756 }} </ref> | |||
*Other chemotherapeutic drugs that may be used for the treatment of gliomatosis cerebri include:<ref name="pmid12325066">{{cite journal| author=Herrlinger U, Felsberg J, Küker W, Bornemann A, Plasswilm L, Knobbe CB et al.| title=Gliomatosis cerebri: molecular pathology and clinical course. | journal=Ann Neurol | year= 2002 | volume= 52 | issue= 4 | pages= 390-9 | pmid=12325066 | doi=10.1002/ana.10297 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12325066 }} </ref><ref name="pmid24744992">{{cite journal| author=Qaddoumi I, Kocak M, Pai Panandiker AS, Armstrong GT, Wetmore C, Crawford JR et al.| title=Phase II Trial of Erlotinib during and after Radiotherapy in Children with Newly Diagnosed High-Grade Gliomas. | journal=Front Oncol | year= 2014 | volume= 4 | issue= | pages= 67 | pmid=24744992 | doi=10.3389/fonc.2014.00067 | pmc=PMC3978340 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24744992 }} </ref><ref name="pmid8905746">{{cite journal| author=Kyritsis AP, Yung WK, Jaeckle KA, Bruner J, Gleason MJ, Ictech SE et al.| title=Combination of 6-thioguanine, procarbazine, lomustine, and hydroxyurea for patients with recurrent malignant gliomas. | journal=Neurosurgery | year= 1996 | volume= 39 | issue= 5 | pages= 921-6 | pmid=8905746 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8905746 }} </ref> | |||
**[[Carmustine]] | **[[Carmustine]] | ||
**[[Cisplatin]] | **[[Cisplatin]] | ||
**[[Erlotinib]] | **[[Erlotinib]] | ||
**[[ | **[[Hydroxyurea]] | ||
**[[thioguanine|6-thioguanine]] | |||
===Supportive treatment=== | ===3. Supportive treatment=== | ||
*Supportive therapy for gliomatosis cerebri includes [[anticonvulsants]] and [[corticosteroids]], which focuses on relieving symptoms and improving the patient’s neurologic function. | *Supportive therapy for gliomatosis cerebri includes [[anticonvulsants]] and [[corticosteroids]], which focuses on relieving symptoms and improving the patient’s neurologic function.<ref name="pmid22740882">{{cite journal| author=Rajz GG, Nass D, Talianski E, Pfeffer R, Spiegelmann R, Cohen ZR| title=Presentation patterns and outcome of gliomatosis cerebri. | journal=Oncol Lett | year= 2012 | volume= 3 | issue= 1 | pages= 209-213 | pmid=22740882 | doi=10.3892/ol.2011.445 | pmc=PMC3362440 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22740882 }} </ref> | ||
**[[Anticonvulsants]] are administered to the patients who have a [[seizure]]. [[Phenytoin]] given concurrently with [[radiation]] may have serious skin reactions such as [[erythema multiforme]] and [[Stevens-Johnson syndrome]]. | **[[Anticonvulsants]] are administered to the patients who have a [[seizure]]. [[Phenytoin]] given concurrently with [[radiation]] may have serious skin reactions such as [[erythema multiforme]] and [[Stevens-Johnson syndrome]]. | ||
**[[Corticosteroids]], usually [[dexamethasone]] given 4-10 mg every 4-6 h, can reduce peritumoral [[edema]], diminish mass effect, and lower [[intracranial pressure]] with a decrease in [[headache]] or [[drowsiness]]. | **[[Corticosteroids]], usually [[dexamethasone]] given 4-10 mg every 4-6 h, can reduce peritumoral [[edema]], diminish mass effect, and lower [[intracranial pressure]] with a decrease in [[headache]] or [[drowsiness]]. | ||
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[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
[[Category:Neurosurgery]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Neurology]] | |||
[[Category:Neurosurgery]] | [[Category:Neurosurgery]] | ||
Latest revision as of 12:19, 25 October 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Radiotherapy and chemotherapy are recommended among all patients who develop gliomatosis cerebri. Temozolomide and PCV 3 combination chemotherapy are the preferred drugs for the treatment of high-grade and low-grade gliomatosis cerebri, respectivel Supportive therapy for gliomatosis cerebri includes anticonvulsants and corticosteroids.
Medical Therapy
The medical therapy of gliomatosis cerebri includes:
1. Radiotherapy
- Post-operative radiotherapy is recommended among all patients who develop gliomatosis cerebri.[1]
- Radiotherapy may not cure the cancer but can control the tumor, delay recurrence, and increase survival.
- Radiation therapy is associated with temporary improvement of clinical symptoms.[2]
- External beam radiation therapy is preferred to whole brain radiotherapy.[3]
- The median dose of radiation is 60 Gy (range: 50-72 Gy).[1]
2. Chemotherapy
- Chemotherapy is indicated as adjuvant therapy for gliomatosis cerebri.
- Temozolomide (Temodar) is the preferred drug for the treatment of high-grade gliomatosis cerebri.[4][5]
- PCV 3 combination chemotherapy is the preferred drug regimen for slow growing, low-grade gliomatosis cerebri.[6]
- CCNU is administered on day 1, procarbazine is administered daily for 14 days beginning on day 8, and vincristine is administered on days 8 and 29 of each 6-week cycle of therapy.[7]
- Other chemotherapeutic drugs that may be used for the treatment of gliomatosis cerebri include:[8][9][10]
3. Supportive treatment
- Supportive therapy for gliomatosis cerebri includes anticonvulsants and corticosteroids, which focuses on relieving symptoms and improving the patient’s neurologic function.[2]
- Anticonvulsants are administered to the patients who have a seizure. Phenytoin given concurrently with radiation may have serious skin reactions such as erythema multiforme and Stevens-Johnson syndrome.
- Corticosteroids, usually dexamethasone given 4-10 mg every 4-6 h, can reduce peritumoral edema, diminish mass effect, and lower intracranial pressure with a decrease in headache or drowsiness.
References
- ↑ 1.0 1.1 Inoue T, Kumabe T, Kanamori M, Sonoda Y, Watanabe M, Tominaga T (2010). "Prognostic factors for patients with gliomatosis cerebri: retrospective analysis of 17 consecutive cases". Neurosurg Rev. 34 (2): 197–208. doi:10.1007/s10143-010-0306-1. PMID 21301914.
- ↑ 2.0 2.1 Rajz GG, Nass D, Talianski E, Pfeffer R, Spiegelmann R, Cohen ZR (2012). "Presentation patterns and outcome of gliomatosis cerebri". Oncol Lett. 3 (1): 209–213. doi:10.3892/ol.2011.445. PMC 3362440. PMID 22740882.
- ↑ Hejazi N, Witzmann A, Hergan K (2001). "Gliomatosis cerebri: intra vitam stereotactic determination in two cases and review of the literature". Br J Neurosurg. 15 (5): 396–401. PMID 11708542.
- ↑ Levin N, Gomori JM, Siegal T (2004). "Chemotherapy as initial treatment in gliomatosis cerebri: results with temozolomide". Neurology. 63 (2): 354–6. PMID 15277636.
- ↑ Lodi R, Setola E, Tonon C, Ambrosetto P, Franceschi E, Crinò L; et al. (2003). "Gliomatosis cerebri: clinical, neurochemical and neuroradiological response to temozolomide administration". Magn Reson Imaging. 21 (9): 1003–7. PMID 14684203.
- ↑ Sanson M, Napolitano M, Cartalat-Carel S, Taillibert S (2005). "[Gliomatosis cerebri]". Rev Neurol (Paris). 161 (2): 173–81. PMID 15798516.
- ↑ Levin VA, Edwards MS, Wright DC, Seager ML, Schimberg TP, Townsend JJ; et al. (1980). "Modified procarbazine, CCNU, and vincristine (PCV 3) combination chemotherapy in the treatment of malignant brain tumors". Cancer Treat Rep. 64 (2–3): 237–44. PMID 7407756.
- ↑ Herrlinger U, Felsberg J, Küker W, Bornemann A, Plasswilm L, Knobbe CB; et al. (2002). "Gliomatosis cerebri: molecular pathology and clinical course". Ann Neurol. 52 (4): 390–9. doi:10.1002/ana.10297. PMID 12325066.
- ↑ Qaddoumi I, Kocak M, Pai Panandiker AS, Armstrong GT, Wetmore C, Crawford JR; et al. (2014). "Phase II Trial of Erlotinib during and after Radiotherapy in Children with Newly Diagnosed High-Grade Gliomas". Front Oncol. 4: 67. doi:10.3389/fonc.2014.00067. PMC 3978340. PMID 24744992.
- ↑ Kyritsis AP, Yung WK, Jaeckle KA, Bruner J, Gleason MJ, Ictech SE; et al. (1996). "Combination of 6-thioguanine, procarbazine, lomustine, and hydroxyurea for patients with recurrent malignant gliomas". Neurosurgery. 39 (5): 921–6. PMID 8905746.