Neuro-oncology is a specialized field of medicine that focuses on the diagnosis and treatment of tumors of the brain, spine, and nervous system. It encompasses a variety of conditions, including primary brain tumors (like gliomas, meningiomas, and medulloblastomas) as well as metastatic tumors that spread from other parts of the body to the brain. Neuro-oncology also deals with neurodegenerative diseases that may overlap with malignancy, such as paraneoplastic syndromes.

Incidence: Most common cancer among women worldwide.

In neuro-oncology, the treatment modalities for brain and spine tumors are tailored to the type, location, grade, and stage of the tumor, as well as the patient’s overall health. The primary treatment options include surgery, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. These can be used alone or in combination.

Goal: To remove the tumor, alleviate symptoms, and obtain a biopsy for diagnosis.

Indications: Surgery is often the first-line treatment for accessible tumors, especially if they are causing significant pressure or neurological deficits.

Types of Surgery:

Goal: To enhance the body’s immune system to recognize and destroy cancer cells.

Mechanisms: : Immunotherapy can involve monoclonal antibodies, checkpoint inhibitors, vaccines, and adoptive cell transfer.

Agents:

Checkpoint Inhibitors::Pembrolizumab (Keytruda) and nivolumab (Opdivo) are being explored in clinical trials for glioblastomas and other brain cancers.

Immunotoxins:Monoclonal antibodies conjugated to toxins to specifically target cancer cells.

Indications:Glioblastomas, brain metastases, and in clinical trials for other brain tumors.

Goal:To explore new treatment options for patients who may not respond to standard therapies.

Approach: Trials may involve new chemotherapy drugs, novel radiation techniques, or emerging immunotherapies.

Indications:Patients with recurrent or refractory tumors, such as glioblastomas, who have limited treatment options.

Goal:To manage symptoms, improve quality of life, and provide support for patients with advanced or inoperable tumors.

Approach: May include pain management, corticosteroids (e.g., dexamethasone) for swelling, anticonvulsants for seizures, and symptom management.

End-of-life care:Focus on comfort and minimizing suffering in patients with terminal brain cancer.

Multidisciplinary Approach

Neuro-oncology often involves a team of specialists

Treatment plans in neuro-oncology are highly individualized, depending on tumor type, patient health, and response to initial treatments. With advances in precision medicine, new therapies, and clinical trials, neuro-oncology continues to evolve, offering hope for improved outcomes, especially in previously hard-to-treat tumors.