Glioblastoma and Other Primary Brain Malignancies in Adults: A Review
Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%. Approximately 49% of malignant brain tumors a...
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| Veröffentlicht in: | JAMA : the journal of the American Medical Association 2023-02, Vol.329 (7), p.574-587 |
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| description | Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%.
Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P |
| doi_str_mv | 10.1001/jama.2023.0023 |
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Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P < .001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P = .06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P = .02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation.
The incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide.</description><identifier>ISSN: 0098-7484</identifier><identifier>ISSN: 1538-3598</identifier><identifier>EISSN: 1538-3598</identifier><identifier>DOI: 10.1001/jama.2023.0023</identifier><identifier>PMID: 36809318</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Adult ; Alkylation ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biopsy ; Brain ; Brain - pathology ; Brain cancer ; Brain Neoplasms - diagnosis ; Brain Neoplasms - epidemiology ; Brain Neoplasms - therapy ; Brain tumors ; Central nervous system ; Cognition ; Contrast agents ; Gadolinium ; Glioblastoma ; Glioblastoma - diagnosis ; Glioblastoma - epidemiology ; Glioblastoma - therapy ; Glioma ; Glioma - diagnosis ; Glioma - epidemiology ; Glioma - therapy ; Humans ; Lymphoma ; Lymphoma - diagnosis ; Lymphoma - epidemiology ; Lymphoma - therapy ; Magnetic resonance imaging ; Medical imaging ; Neuroimaging ; Radiation ; Seizures ; Signs and symptoms ; Temozolomide ; Temozolomide - therapeutic use ; Tumors</subject><ispartof>JAMA : the journal of the American Medical Association, 2023-02, Vol.329 (7), p.574-587</ispartof><rights>Copyright American Medical Association Feb 21, 2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c379t-64ed4dca2bbd391cf4dd5d7993ab65b8bee649ca2113800a13a81a513b49e14f3</citedby><cites>FETCH-LOGICAL-c379t-64ed4dca2bbd391cf4dd5d7993ab65b8bee649ca2113800a13a81a513b49e14f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36809318$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schaff, Lauren R</creatorcontrib><creatorcontrib>Mellinghoff, Ingo K</creatorcontrib><title>Glioblastoma and Other Primary Brain Malignancies in Adults: A Review</title><title>JAMA : the journal of the American Medical Association</title><addtitle>JAMA</addtitle><description>Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%.
Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P < .001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P = .06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P = .02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation.
The incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide.</description><subject>Adult</subject><subject>Alkylation</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biopsy</subject><subject>Brain</subject><subject>Brain - pathology</subject><subject>Brain cancer</subject><subject>Brain Neoplasms - diagnosis</subject><subject>Brain Neoplasms - epidemiology</subject><subject>Brain Neoplasms - therapy</subject><subject>Brain tumors</subject><subject>Central nervous system</subject><subject>Cognition</subject><subject>Contrast agents</subject><subject>Gadolinium</subject><subject>Glioblastoma</subject><subject>Glioblastoma - diagnosis</subject><subject>Glioblastoma - epidemiology</subject><subject>Glioblastoma - therapy</subject><subject>Glioma</subject><subject>Glioma - diagnosis</subject><subject>Glioma - epidemiology</subject><subject>Glioma - therapy</subject><subject>Humans</subject><subject>Lymphoma</subject><subject>Lymphoma - diagnosis</subject><subject>Lymphoma - epidemiology</subject><subject>Lymphoma - therapy</subject><subject>Magnetic resonance imaging</subject><subject>Medical imaging</subject><subject>Neuroimaging</subject><subject>Radiation</subject><subject>Seizures</subject><subject>Signs and symptoms</subject><subject>Temozolomide</subject><subject>Temozolomide - therapeutic use</subject><subject>Tumors</subject><issn>0098-7484</issn><issn>1538-3598</issn><issn>1538-3598</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkctLAzEQh4MoWh9Xj7LgxcvWzCbbJF6kFl-gKKLnMLtJ25R9aLJb8b83pSpqDglhvvyYyUfIIdAhUAqnC6xxmNGMDWncNsgAciZTliu5SQaUKpkKLvkO2Q1hQeMCJrbJDhtJqhjIAbm8rlxbVBi6tsYEG5M8dHPrk0fvavQfyYVH1yT3WLlZg03pbEjifWz6qgtnyTh5sktn3_fJ1hSrYA--zj3ycnX5PLlJ7x6ubyfju7RkQnXpiFvDTYlZURimoJxyY3IjlGJYjPJCFtaOuIp1ACYpRWAoAXNgBVcW-JTtkfN17mtf1NaUtuk8Vvp13axu0em_lcbN9axdagDOcyFUTDj5SvDtW29Dp2sXSltV2Ni2DzoTQipJMwERPf6HLtreN3G-SMX_A6oyFqnhmip9G4K3059ugOqVIr1SpFeK9EpRfHD0e4Yf_NsJ-wTcdYyU</recordid><startdate>20230221</startdate><enddate>20230221</enddate><creator>Schaff, Lauren R</creator><creator>Mellinghoff, Ingo K</creator><general>American Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7TK</scope><scope>7TS</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>P64</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230221</creationdate><title>Glioblastoma and Other Primary Brain Malignancies in Adults: A Review</title><author>Schaff, Lauren R ; Mellinghoff, Ingo K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c379t-64ed4dca2bbd391cf4dd5d7993ab65b8bee649ca2113800a13a81a513b49e14f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Alkylation</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biopsy</topic><topic>Brain</topic><topic>Brain - pathology</topic><topic>Brain cancer</topic><topic>Brain Neoplasms - diagnosis</topic><topic>Brain Neoplasms - epidemiology</topic><topic>Brain Neoplasms - therapy</topic><topic>Brain tumors</topic><topic>Central nervous system</topic><topic>Cognition</topic><topic>Contrast agents</topic><topic>Gadolinium</topic><topic>Glioblastoma</topic><topic>Glioblastoma - diagnosis</topic><topic>Glioblastoma - epidemiology</topic><topic>Glioblastoma - therapy</topic><topic>Glioma</topic><topic>Glioma - diagnosis</topic><topic>Glioma - epidemiology</topic><topic>Glioma - therapy</topic><topic>Humans</topic><topic>Lymphoma</topic><topic>Lymphoma - diagnosis</topic><topic>Lymphoma - epidemiology</topic><topic>Lymphoma - therapy</topic><topic>Magnetic resonance imaging</topic><topic>Medical imaging</topic><topic>Neuroimaging</topic><topic>Radiation</topic><topic>Seizures</topic><topic>Signs and symptoms</topic><topic>Temozolomide</topic><topic>Temozolomide - therapeutic use</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schaff, Lauren R</creatorcontrib><creatorcontrib>Mellinghoff, Ingo K</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JAMA : the journal of the American Medical Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schaff, Lauren R</au><au>Mellinghoff, Ingo K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Glioblastoma and Other Primary Brain Malignancies in Adults: A Review</atitle><jtitle>JAMA : the journal of the American Medical Association</jtitle><addtitle>JAMA</addtitle><date>2023-02-21</date><risdate>2023</risdate><volume>329</volume><issue>7</issue><spage>574</spage><epage>587</epage><pages>574-587</pages><issn>0098-7484</issn><issn>1538-3598</issn><eissn>1538-3598</eissn><abstract>Malignant primary brain tumors cause more than 15 000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals and increases with age. Five-year survival is approximately 36%.
Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P < .001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P = .06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P = .02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation.
The incidence of primary malignant brain tumors is approximately 7 per 100 000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide.</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>36809318</pmid><doi>10.1001/jama.2023.0023</doi><tpages>14</tpages></addata></record> |
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| subjects | Adult Alkylation Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biopsy Brain Brain - pathology Brain cancer Brain Neoplasms - diagnosis Brain Neoplasms - epidemiology Brain Neoplasms - therapy Brain tumors Central nervous system Cognition Contrast agents Gadolinium Glioblastoma Glioblastoma - diagnosis Glioblastoma - epidemiology Glioblastoma - therapy Glioma Glioma - diagnosis Glioma - epidemiology Glioma - therapy Humans Lymphoma Lymphoma - diagnosis Lymphoma - epidemiology Lymphoma - therapy Magnetic resonance imaging Medical imaging Neuroimaging Radiation Seizures Signs and symptoms Temozolomide Temozolomide - therapeutic use Tumors |
| title | Glioblastoma and Other Primary Brain Malignancies in Adults: A Review |
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