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Paul L. Kornblith and Michael Walker

I n the past decade, there has been increased interest in the role of chemotherapy in the treatment of malignant tumors of the brain and spinal cord. The major focus of the effort to develop chemotherapy programs has been on the malignant gliomas. Although some series of cases have been reported involving other types of central nervous system neoplasia, the series are too small and the data not subjected to careful controls. Thus, the emphasis in this review will be on the role of chemotherapy as an adjunct in the treatment of malignant gliomas of the brain

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Kendra Peterson, Nina Paleologos, Peter Forsyth, David R. Macdonald, J. Gregory Cairncross, and Oligodendroglioma Study Group

O ligodendroglioma is a chemosensitive brain tumor. In striking contrast to other types of malignant glioma, anaplastic oligodendroglioma responds predictably to chemotherapy. 4 Responses have been observed to a variety of drugs, 1–3, 5–7, 10, 13, 16 principally alkylating agents, and PCV (procarbazine, lomustine (CCNU), and vincristine) 11 has emerged as the treatment of choice. As currently configured, PVC displays substantial antioligodendroglioma activity. Nevertheless, recurrent tumors that previously had been irradiated are not cured by a course of

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Dorcas S. Fulton, Victor A. Levin, William M. Wara, Michael S. Edwards, and Charles B. Wilson

some exophytic tumors can be extensively resected with good results. 5 For the remainder, surgical exploration has been advocated to confirm the diagnosis, to obtain a biopsy specimen, or to rule out the presence of a cyst that could be aspirated. 6, 12 It is well established that radiation therapy (RT) prolongs survival time; 7, 10, 14 with RT, median survival periods of 5 to 47 months and a 5-year survival incidence of up to 41% have been reported. 2, 7, 8, 10, 11, 13, 14 Because of the increased survival time produced by the use of chemotherapy as an adjuvant

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Mark Bernstein, Alfonso Villamil, George Davidson, and Charles Erlichman

T he effects of chemotherapy on meningiomas are not well known because there is a paucity of clinical data. The reasons for this are twofold: meningiomas can usually be effectively treated with surgery and/or radiation therapy, and therefore further adjuvant therapy is seldom required; and, intuitively, one would not expect chemotherapeutic agents to be effective in a slowly growing tumor with a low mitotic index such as meningioma. We report necrosis in a meningioma that produced clinical neurological deterioration in a patient receiving systemic chemotherapy

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Jeffrey G. Rosenstock, Roger J. Packer, Larissa Bilaniuk, Derek A. Bruce, Jerri-Lynne Radcliffe, and Peter Savino

despite being histologically low-grade gliomas; 2) vision rarely improves after x-ray treatment; 3) progressive disease may occur years after treatment with radiation therapy (RT); and 4) significant late sequelae affecting intellect and hormonal function are frequent, and may in part be secondary to RT. The standard therapeutic approach for chiasmatic optic gliomas has been by biopsy or subtotal resection followed by RT. 7, 35 The role of chemotherapy in the treatment of these childhood tumors is unknown. Over the past 7 years, we have treated children harboring

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John P. Kapp, Robert L. Ross, and Elton M. Tucker

B ecause the ophthalmic artery arises from the internal carotid artery (ICA), a drug that is infused into the cervical ICA is also delivered to the eye. Ocular complications, including visual loss, vasculitis, cataract formation, and neovascularization of the anterior chamber, have been reported in connection with the administration of drugs currently being investigated for intra-arterial brain-tumor chemotherapy. These drugs include 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) and cis-diaminedichloroplatinum (II) (Cisplatinum). 2–5 In the case of BCNU, an

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M. Stephen Mahaley Jr., Stephen W. Hipp, Edward J. Dropcho, Linda Bertsch, Sharon Cush, Tammy Tirey, and G. Yancey Gillespie

A lthough the very first investigations of chemotherapy in the management of malignant gliomas in the 1950's utilized intra-arterial routes of administration, 4, 12, 27 effective agents were first identified in the 1970's in clinical trials of systemic 1,3-bis(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (BCNU) chemotherapy. 3, 26 Since then, a number of agents have been shown to provide a definite although modest antiglioma effect following intravenous administration. It was not until the 1980's that a significant interest in intra-arterial chemotherapy for

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Herbert B. Newton

median effective total dose reported by most authors is 15 Gy (range 13–20 Gy). Chemotherapy of Meningiomas: Overview The role of adjuvant chemotherapy in patients with meningiomas remains unclear and continues to evolve. 1 , 6 , 8 , 9 , 26 , 36 , 40 , 62 Chemotherapy has been applied mainly to inoperable lesions, especially in the setting of tumor progression or recurrence after some form of radiotherapy. Numerous approaches have been taken, including the use of traditional cytotoxic drugs, molecular agents, immunomodulators, and hormone-manipulating drugs

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J. Bob Blacklock, Donald C. Wright, Robert L. Dedrick, Ronald G. Blasberg, Robert J. Lutz, John L. Doppman, and Edward H. Oldfield

chemotherapy. The results of this study suggest particular caution in using indwelling infusion pumps to deliver antineoplastic agents at extremely low infusion rates. The principles that govern drug streaming have important implications for the treatment of malignancies in the brain as well as in any organ in which intra-arterial infusion of chemotherapeutic agents is used. The efficacy and safety of intra-arterial chemotherapy cannot be established until clinical trials are conducted in which intravascular drug streaming has been reliably eliminated. References

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Willem Wassenaar, Charles H. Tator, and Wei Sum So

one-half the total amount of tumor present. Fig. 6. Photomicrograph of posterior view of decalcified coronal section of brain in a mouse 35 days after implantation of solid tumor fragment. The skull (pale line, arrow ) is discontinuous under the large extracranial tumor mass at the site of implantation. The extracranial tumor (arrowhead) is almost equal in size to the intracranial tumor (crossed arrow) . H & E, X 23. Discussion The ideal brain tumor model for chemotherapy experiments should include the following characteristics: 1) the tumor