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Neurologic Complications in Adult Cancer Survivorship. 成人癌症幸存者的神经并发症。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2024-02-01 Epub Date: 2024-01-06 DOI: 10.1055/s-0043-1777424
Tresa Michelle McGranahan, Karl Cristie Figuracion, Myron Goldberg, David P Sheppard
{"title":"Neurologic Complications in Adult Cancer Survivorship.","authors":"Tresa Michelle McGranahan, Karl Cristie Figuracion, Myron Goldberg, David P Sheppard","doi":"10.1055/s-0043-1777424","DOIUrl":"10.1055/s-0043-1777424","url":null,"abstract":"<p><p>Over the past decade, the improvement in cancer diagnostics and therapeutics has extended the overall survival of patients diagnosed with cancer including brain cancer. However, despite these unprecedented medical successes, patients continue to experience numerous neurologic complications after treatment that interfere with their independence, functionality, and overall quality of life. These include, among others, cognitive impairment, endocrinopathies, peripheral and cranial neuropathies, and vasculopathy. This article describes the long-term neurologic complications cancer survivors commonly experience to increase awareness of these complications and discuss treatments when available. Further research is necessary to understanding of mechanisms of neurologic injury and advance diagnosis and treatment. Effective patient education, monitoring, and managing neurologic issues after cancer treatment may improve independence, functionality, and quality of life during survivorship.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"90-101"},"PeriodicalIF":2.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neurorehabilitation for Adults with Brain and Spine Tumors. 成人脑和脊柱肿瘤的神经康复。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2024-02-01 Epub Date: 2023-12-04 DOI: 10.1055/s-0043-1777407
Hanna Hunter, Evelyn Qin, Allison Wallingford, April Hyon, Amar Patel
{"title":"Neurorehabilitation for Adults with Brain and Spine Tumors.","authors":"Hanna Hunter, Evelyn Qin, Allison Wallingford, April Hyon, Amar Patel","doi":"10.1055/s-0043-1777407","DOIUrl":"10.1055/s-0043-1777407","url":null,"abstract":"<p><p>Central nervous system (CNS) malignancies (i.e. brain and spine tumors) and their treatments can result in a multitude of neurologic deficits. Patients with CNS malignancies experience physical, cognitive, and psychosocial sequelae that can impact their mobility and quality of life. Neurorehabilitation can play a critical role in maintaining independence, preventing disability, and optimizing safety with activities of daily living. This review provides an overview of the neurorehabilitation approaches for patients with CNS malignancies, neurologic impairments frequently treated, and rehabilitation interventions in various health care settings. In addition, we will highlight rehabilitative outcomes between patients with nononcologic neurologic conditions compared to brain and spine tumors. Finally, we address medical challenges that may impact rehabilitation care in these medically complex cancer patients.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"64-73"},"PeriodicalIF":2.7,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evolving Barriers to Clinical Trial Enrollment and Clinical Care in Neuro-oncology in the Face of COVID-19 面对 COVID-19，神经肿瘤学临床试验注册和临床护理的障碍不断变化
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-29 DOI: 10.1055/s-0043-1777421
Nikhil Grandhi, Alice Y. Zhou, Margaret O. Johnson, Omar H. Butt
{"title":"Evolving Barriers to Clinical Trial Enrollment and Clinical Care in Neuro-oncology in the Face of COVID-19","authors":"Nikhil Grandhi, Alice Y. Zhou, Margaret O. Johnson, Omar H. Butt","doi":"10.1055/s-0043-1777421","DOIUrl":"https://doi.org/10.1055/s-0043-1777421","url":null,"abstract":"<p>The lack of treatments with durable response in neuro-oncology highlights the critical need for clinical trials to advance patient care. The intersection of relatively low incidence, evolving classification schema, and entrenched community, healthcare provider, and organizational factors have been historic challenges against successful trial enrollment and implementation. The additional need for multidisciplinary, often tertiary-level care, further magnifies latent national and international health inequities with rural and under-served populations. The COVID-19 pandemic both unveiled fundamental weaknesses in historical approaches and prompted the necessity of new approaches and systems for conducting clinical trials. Here, we provide an overview of traditional barriers to clinical trial enrollment in neuro-oncology, the effect of COVID-19 on these barriers, and the discovery of additional systemic weaknesses. Finally, we discuss future directions by reflecting on lessons learned with strategies to broaden access of care and streamline clinical trial integration into clinical practice.</p> ","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":"17 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139064256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cancer Predisposition Syndromes in Neuro-Oncology 神经肿瘤学中的癌症易感综合征
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-14 DOI: 10.1055/s-0043-1777702
Brian Na, Shilp Shah, Phioanh Leia Nghiemphu
{"title":"Cancer Predisposition Syndromes in Neuro-Oncology","authors":"Brian Na, Shilp Shah, Phioanh Leia Nghiemphu","doi":"10.1055/s-0043-1777702","DOIUrl":"https://doi.org/10.1055/s-0043-1777702","url":null,"abstract":"<p>Although most primary central and peripheral nervous system (NS) tumors occur sporadically, there are a subset that may arise in the context of a cancer predisposition syndrome. These syndromes occur due to a pathogenic mutation in a gene that normally functions as a tumor suppressor. With increased understanding of the molecular pathogenesis of these tumors, more people have been identified with a cancer predisposition syndrome. Identification is crucial, as this informs surveillance, diagnosis, and treatment options. Moreover, relatives can also be identified through genetic testing. Although there are many cancer predisposition syndromes that increase the risk of NS tumors, in this review, we focus on three of the most common cancer predisposition syndromes, neurofibromatosis type 1, neurofibromatosis type 2, and tuberous sclerosis complex type 1 and type 2, emphasizing the clinical manifestations, surveillance guidelines, and treatment options.</p> ","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":"86 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Neuro-oncology Treatment Strategies for Primary Glial Tumors 原发性胶质瘤的神经肿瘤学治疗策略
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-14 DOI: 10.1055/s-0043-1776764
Fernando Santos-Pinheiro, Jerome J. Graber
{"title":"Neuro-oncology Treatment Strategies for Primary Glial Tumors","authors":"Fernando Santos-Pinheiro, Jerome J. Graber","doi":"10.1055/s-0043-1776764","DOIUrl":"https://doi.org/10.1055/s-0043-1776764","url":null,"abstract":"<p>Primary brain tumors underwent reclassification in the 2021 World Health Organization update, relying on molecular findings (especially isocitrate dehydrogenase mutations and chromosomal changes in 1p, 19q, gain of chromosome 7 and loss of chromosome 10). Newer entities have also been described including histone 3 mutant midline gliomas. These updated pathologic classifications improve prognostication and reliable diagnosis, but may confuse interpretation of prior clinical trials and require reclassification of patients diagnosed in the past. For patients over seventy, multiple studies have now confirmed the utility of shorter courses of radiation, and the risk of post-operative delirium. Ongoing studies are comparing proton to photon radiation. Long term follow up of prior clinical trials have confirmed the roles and length of chemotherapy (mainly temozolomide) in different tumors, as well as the wearable novottf device. New oral isocitrate dehydrogenase inhibitors have also shown efficacy in clinical trials.</p> ","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":"46 1","pages":""},"PeriodicalIF":2.7,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138690375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Brain Tumors in Adolescents and Young Adults: A Review. 青少年和年轻人的脑肿瘤：综述。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1055/s-0043-1776775
Julien Rousseau, Julie Bennett, Mary Jane Lim-Fat
{"title":"Brain Tumors in Adolescents and Young Adults: A Review.","authors":"Julien Rousseau, Julie Bennett, Mary Jane Lim-Fat","doi":"10.1055/s-0043-1776775","DOIUrl":"10.1055/s-0043-1776775","url":null,"abstract":"<p><p>Brain tumors account for the majority of cancer-related deaths in adolescents and young adults (AYAs), defined as individuals aged 15 to 39. AYAs constitute a distinct population in which both pediatric- and adult-type central nervous system (CNS) tumors can be observed. Clinical manifestations vary depending on tumor location and often include headaches, seizures, focal neurological deficits, and signs of increased intracranial pressure. With the publication of the updated World Health Organization CNS tumor classification in 2021, diagnoses have been redefined to emphasize key molecular alterations. Gliomas represent the majority of malignant brain tumors in this age group. Glioneuronal and neuronal tumors are associated with longstanding refractory epilepsy. The classification of ependymomas and medulloblastomas has been refined, enabling better identification of low-risk tumors that could benefit from treatment de-escalation strategies. Owing to their midline location, germ cell tumors often present with oculomotor and visual alterations as well as endocrinopathies. The management of CNS tumors in AYA is often extrapolated from pediatric and adult guidelines, and generally consists of a combination of surgical resection, radiation therapy, and systemic therapy. Ongoing research is investigating multiple agents targeting molecular alterations, including isocitrate dehydrogenase inhibitors, SHH pathway inhibitors, and BRAF inhibitors. AYA patients with CNS tumors should be managed by multidisciplinary teams and counselled regarding fertility preservation, psychosocial comorbidities, and risks of long-term comorbidities. There is a need for further efforts to design clinical trials targeting CNS tumors in the AYA population.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"909-928"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Central Nervous System Lymphoma. 中枢神经系统淋巴瘤。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-01 Epub Date: 2023-11-23 DOI: 10.1055/s-0043-1776783
Trusha Shah, Vyshak A Venur
{"title":"Central Nervous System Lymphoma.","authors":"Trusha Shah, Vyshak A Venur","doi":"10.1055/s-0043-1776783","DOIUrl":"10.1055/s-0043-1776783","url":null,"abstract":"<p><p>Central nervous system lymphoma (CNSL) is a rare and aggressive malignancy that primarily affects the brain, spinal cord, and meninges. This article provides a comprehensive overview of the current understanding of CNSL encompassing its epidemiology, pathophysiology, clinical presentation, diagnosis, treatment modalities, and prognosis. Although the main focus is on primary CNS lymphoma (PCNSL), ocular lymphoma, primary leptomeningeal lymphoma, and secondary CNS lymphoma are also discussed. The pathobiology of CNSL involves the infiltration of malignant lymphocytes within the CNS parenchyma or leptomeninges. Various risk factors and immunological mechanisms contribute to its development, including immunodeficiency states, chronic inflammation, and genomic alterations. Accurate diagnosis is crucial for appropriate management, given the heterogeneous clinical presentation. The neuroimaging, systemic imaging, and other modalities for diagnosis and evaluation for extent of disease involvement will be discussed. Additionally, the importance of histopathological examination, cerebrospinal fluid (CSF) analysis, and molecular testing in confirming the diagnosis and guiding treatment decisions are highlighted. The treatment landscape for CNSL has evolved significantly. Therapeutic approaches encompass a multimodal strategy combining high-dose methotrexate-based chemotherapy, consolidation with whole-brain radiation therapy, and high-dose chemotherapy with stem cell rescue. Recent advancements in targeted therapies and immunomodulatory agents offer promising avenues for future treatment options. We review the clinical outcomes and prognostic factors influencing the survival of CNSL patients, including age, performance status, disease stage, and genetic abnormalities.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"825-832"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138300514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Classification and Grading of Central Nervous System Tumors According to the World Health Organization 5th Edition. 根据世界卫生组织第5版，中枢神经系统肿瘤的分类和分级。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1055/s-0043-1776793
Rebecca A Yoda, Patrick J Cimino
{"title":"Classification and Grading of Central Nervous System Tumors According to the World Health Organization 5th Edition.","authors":"Rebecca A Yoda, Patrick J Cimino","doi":"10.1055/s-0043-1776793","DOIUrl":"10.1055/s-0043-1776793","url":null,"abstract":"<p><p>The World Health Organization (WHO) released the 5th edition of its classification of central nervous system (CNS) tumors in 2021. Advances in the landscape of molecular tumor pathophysiology prompted major revisions to the previous edition released in 2016, some of which were first introduced by the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official WHO (cIMPACT-NOW). The 2021 classification system integrates newly gained molecular insights to guide changes in tumor taxonomy and nomenclature, introduces several new types of tumors, and expands the use of molecular testing for diagnosis and grading, with a particular impact on adult-type and pediatric-type gliomas, ependymomas, and embryonal tumors. These updates aim to promote clear and accurate diagnoses, yield more reliable prognostic information, and enable the selection of optimal therapies. Familiarity with these changes will be of great importance for clinicians involved in the management of CNS tumor patients.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"833-844"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72211606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Leptomeningeal Carcinomatosis from Solid Tumor Malignancies: Treatment Strategies and Biomarkers. 实体瘤恶性肿瘤引起的脑膜轻脑膜癌:治疗策略和生物标志物。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-01 Epub Date: 2023-11-21 DOI: 10.1055/s-0043-1776996
Rachna Malani, Ankush Bhatia, Allison Betof Warner, Jonathan T Yang
{"title":"Leptomeningeal Carcinomatosis from Solid Tumor Malignancies: Treatment Strategies and Biomarkers.","authors":"Rachna Malani, Ankush Bhatia, Allison Betof Warner, Jonathan T Yang","doi":"10.1055/s-0043-1776996","DOIUrl":"10.1055/s-0043-1776996","url":null,"abstract":"<p><p>Leptomeningeal metastases/diseases (LMDs) are a late-stage complication of solid tumor or hematologic malignancies. LMD is spread of cancer cells to the layers of the leptomeninges (pia and arachnoid maters) and subarachnoid space seen in 3 to 5% of cancer patients. It is a disseminated disease which carries with it significant neurologic morbidity and mortality. Our understanding of disease pathophysiology is currently lacking; however, advances are being made. As our knowledge of disease pathogenesis has improved, treatment strategies have evolved. Mainstays of treatment such as radiotherapy have changed from involved-field radiotherapy strategies to proton craniospinal irradiation which has demonstrated promising results in recent clinical trials. Systemic treatment strategies have also improved from more traditional chemotherapeutics with limited central nervous system (CNS) penetration to more targeted therapies with better CNS tumor response. Many challenges remain from earlier clinical detection of disease through improvement of active treatment options, but we are getting closer to meaningful treatment.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"859-866"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138292243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intracranial Germ Cell Tumors. 颅内生殖细胞瘤。
IF 2.7 4区 医学
Seminars in Neurology Pub Date : 2023-12-01 Epub Date: 2023-11-14 DOI: 10.1055/s-0043-1776763
Teri Danielle You Ying Yeoh, Vincent Nga, Miriam Kimpo, Simon S Lo, Balamurugan Vellayappan
{"title":"Intracranial Germ Cell Tumors.","authors":"Teri Danielle You Ying Yeoh, Vincent Nga, Miriam Kimpo, Simon S Lo, Balamurugan Vellayappan","doi":"10.1055/s-0043-1776763","DOIUrl":"10.1055/s-0043-1776763","url":null,"abstract":"<p><p>Intracranial germ cell tumors are rare tumors occurring in adolescents and young adults, which include germinomas and non-germinomatous type germ cell tumors (NGGCT). In the past few decades, cooperative trial groups in Europe and North America have developed successful strategies to improve survival outcomes and decrease treatment-related toxicities. New approaches to establishing diagnosis have deferred the need for radical surgery. The 5-year event-free survival (EFS) is above 90% and even patients who present with metastatic germinoma can still be cured with chemotherapy and craniospinal irradiation. The combination of surgery, chemotherapy, and radiation therapy is tailored to patients based on grouping and staging. For NGGCT, neoadjuvant chemotherapy followed by delayed surgery for residual disease and radiotherapy can yield a 5-year EFS of 70%. Further strategies should focus on reducing long-term complications while preserving high cure rates.</p>","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"897-908"},"PeriodicalIF":2.7,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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