New Developments in Neuro-Oncology

The standard of care in adult glioblastoma is tumour resection followed by concomitant radio-/chemotherapy with temozolomide and adjuvant temozolomide. To improve this standard, clinical trials are currently evaluating the efficacy and toxicity of inhibitors of angiogenesis, tyrosine kinase inhibitors and other substances to inhibit proliferation and! or induce apoptosis. Two European multicentre trials in elderly patients with glioblastoma have revealed discrepant results, which as yet show only marginal differences between these modalities in terms of overall survival. For recurrent malignant glioma, re-operation, re-irradiation and salvage medical treatment can be offered. Re-irradiation, chemotherapy and targeted therapies" are subjects of clinical trials currently underway. There is no "standard" therapy for primary CNS lymphoma (PCNSL). Methotrexate (MTX)-based chemotherapy should be considered first. The usefulness of consolidating" radiotherapy after chemotherapy is questioned due to results of the largest prospective randomised phase III trial carried out on this entity. No survival benefit could be found in patients receiving whole brain radiotherapy (WBRT) after complete response to MIX-based chemotherapy in comparison to those treated with chemotherapy alone and salvage WBRT for relapse. In patients aged 65 years or younger, cure is the aim; a single-arm phase II trial on conventional MIX-based systemic and intraventricular chemotherapy has revealed long-term survival of more than 8 years in about half of the patients up to the age of 65 years with good quality of life.