Evidence based practice in Neuro-oncology

423 Pages·2021·12.727 MB·English

by  Supriya Mallick, Prashanth Giridhar, Goura K. Rath

Evidence based
practice in
Neuro-oncology
Supriya Mallick
Prashanth Giridhar
Goura K. Rath
Editors
123
Evidence based practice in Neuro-oncology
Supriya Mallick • Prashanth Giridhar
Goura K. Rath
Editors
Evidence based practice in
Neuro-oncology
Editors
Supriya Mallick Prashanth Giridhar
Department of Radiation Oncology Department of Radiation Oncology
National Cancer Institute, AIIMS National Cancer Institute, AIIMS
Haryana Haryana
India India
Goura K. Rath
Department of Radiation Oncology, All
India Institute of Medical Sciences
National Cancer Institute, All India Institute
of Medical Sciences, Jhajjar, Haryana
New Delhi
India
ISBN 978-981-16-2658-6 ISBN 978-981-16-2659-3 (eBook)
https://doi.org/10.1007/978-981-16-2659-3
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Foreword
The editors of Evidence Based Practice in Neuro-oncology need to be commended for
compiling a succinct and informative book. The text integrates the radiological, patho-
logical, and clinical aspects of management of central nervous system tumors. Optimal
utilization of surgery, radiation, chemotherapy, and newer targeted therapy as a treat-
ment in brain tumors requires a clear understanding of a range of issues, and this book
provides information vividly to the clinician involved in brain tumor management,
particularly those who are in training and new to practice. The book is divided into
mainly four parts—the first part includes anatomy relevant to oncology, epidemiol-
ogy, and pathology of CNS tumors, the second part includes clinical examination and
imaging relevant to neuro-oncology, the third part includes basics relating to radio-
therapy, and the last part includes a description of individual tumors including clinical
management and follow-up. The chapter on neuro-anatomy has been well compiled
and necessary for every neuro-oncologist—surgeon, radiation or medical oncologist.
The chapters on pathology explain nicely the molecular classifications relevant to the
oncologist keeping in line the WHO updates. The chapters on individual tumors are
crisp and point wise. Future directions explained in chapters provide an insight to the
reader regarding direction of research and help keep the reader up to date with current
research. Careful attention is given to the concepts that are crucial in understanding
modern treatment modalities. The chapters on neuro-cognitive deficits and endocrine
effects make the reader aware of long-term issues for patients of brain tumors and will
help in better management. The information in this book is presented in a logical and
straightforward manner, thus offering an enjoyable learning experience.
During my long association with prestigious All India Institute of Medical
Sciences, New Delhi, I got the opportunity to work with Prof. Rath who is well
known for his contribution to the fraternity of Oncology. I feel proud of Dr. Supriya
Mallick and Dr. Prashanth G whom I myself introduced to the subject of Neuro-
Oncology. In fact, most of the authors are well known in their respective fields and
have presented a beautiful teamwork. It is a great honor and a privilege for me to
write a foreword for this book. I am confident that many clinicians would signifi-
cantly benefit from the information provided by the authors.
P. K. Julka
All India Institute of Medical Sciences
New Delhi, India
v
Contents
Part I Epidemiology, Neuro-Anatomy and Neuro- Pathology
for a Neuro-Oncologist
1 Epidemiology and Demography of Brain Tumors . . . . . . . . . . . . . . . . . 3
Pritee A. Patil and Prashanth Giridhar
2 Neuro-Anatomy for Oncologist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Doris George Yohannan, Reba Babu Alex, Aswathy Maria Oommen,
and Chandrasekharan Kesavadas
3 Pathology, Molecular Biology and Classification of Gliomas . . . . . . . . 37
Suvendu Purkait
4 Pathology and Molecular Pathology of Ependymoma . . . . . . . . . . . . . 57
Aruna Nambirajan, Agrima Sharma, and Mehar Chand Sharma
5 Pathology and Molecular Pathology of Meningioma. . . . . . . . . . . . . . . 67
Aruna Nambirajan, Jyostna Singh, and Vaishali Suri
6 Pathology and Molecular Biology of Medulloblastoma . . . . . . . . . . . . 79
Kavneet Kaur and Chitra Sarkar
Part II C linical Examination, Neuro-Imaging and Basics of Radiotherapy
in Neuro-Oncology
7 Radiology in Modern Neuro-Oncology Practice . . . . . . . . . . . . . . . . . . 91
Ashima Chander and S. Leve Joseph Devarajan
8 PET in Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Sneha Prakash, Meghana Prabhu, and Nishikant Avinash Damle
9 Fundamentals of Radiation for Neuro-Oncology . . . . . . . . . . . . . . . . . . 125
V. R. Anjali, Supriya Mallick, and Rony Benson
10 Stereotactic Radiosurgery: Planning and Evaluation . . . . . . . . . . . . . . 139
Sandeep Muzumder and M. G. John Sebastian
11 Radiation Induced Brain Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Supriya Mallick and Aman Sharma
vii
viii Contents
Part III Management of Brain Tumours
12 Grade 1 Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Shikha Goyal and Renu Madan
13 Grade 2 Gliomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Shikha Goyal and Renu Madan
14 Oligodendroglioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Supriya Mallick
15 Anaplastic Astrocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Dodul Mondal and Neelam Singh
16 Mixed Gliomas or Oligoastrocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
BhanuPrasad Venkatesulu
17 Glioblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Supriya Mallick
18 Management of Gliomatosis Cerebri . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Supriya Mallick and Prashanth Giridhar
19 Pleomorphic Xanthoastrocytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Supriya Mallick and V. R. Anjali
20 Astroblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Supriya Mallick
21 Nervous System Hemangioblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249
Dodul Mondal
22 Rare/Uncommon Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
Supriya Mallick
23 Medulloblastoma and Other Embryonal Brain Tumors . . . . . . . . . . . . 271
Subhas Pandit and Simit Sapkota
24 Ependymoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Prashanth Giridhar, Aruna Nambirajan, and Rony Benson
25 Intracranial Germ Cell Tumour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Prashanth Giridhar and Rony Benson
26 Management of Pineal Region Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Supriya Mallick
27 Skull Base Chordoma and Chondrosarcoma . . . . . . . . . . . . . . . . . . . . . 299
Soumyajit Roy
28 Intracranial Hemangiopericytoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Dodul Mondal, V. R. Anjali, and Supriya Mallick
Contents ix
29 Management of Choroid Plexus Carcinoma . . . . . . . . . . . . . . . . . . . . . 315
Supriya Mallick
30 Meningioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Yousra Izzuddeen
31 Pituitary Tumors: Diagnosis and Management . . . . . . . . . . . . . . . . . . . 331
Renu Madan, Arun Yadav, and Shikha Goyal
32 Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
Prashanth Giridhar
33 Acoustic Neuroma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
V. R. Anjali
34 Spinal Cord Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357
BhanuPrasad Venkatesulu
35 Brain Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363
Prashanth Giridhar
36 Paediatric CNS Tumours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Prashanth Giridhar
37 Primary Central Nervous System Lymphoma . . . . . . . . . . . . . . . . . . . . 395
Supriya Mallick and Prashanth Giridhar
Part IV Miscellaneous
38 Neurocognition in Neurooncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403
Prashanth Giridhar
39 Syndromes Associated with Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . 413
Subhas Pandit and Abish Adhikari
40 Endocrine Management in Neurooncology . . . . . . . . . . . . . . . . . . . . . . 419
Geethu Antony
About the Editors
Supriya Mallick completed his training in radiation oncology from All India

Institute of Medical Sciences, New Delhi. He is now working as assistant professor,
Department of Radiation Oncology, National Cancer Institute-India (NCI-India).
He has more than 100 peer-reviewed publications and has delivered oral and poster
presentations in numerous international meetings. He has published numerous orig-
inal articles and meta-analysis of various tumors of the brain and spine. He is also
conducting various trials in the field of neuro-oncology. He has also contributed
chapters to many textbooks on radiation oncology.
Prashanth Giridhar is Radiation Oncologist by training and is currently working

as Senior Research Associate at National Cancer Institute, Jhajjar, AIIMS, New
Delhi. Dr. Prashanth has done his MBBS degree from JIPMER and then completed
his postgraduation in AIIMS, New Delhi. He is a very refined researcher and has
many publications in journals of international repute to his credit.
Goura K. Rath completed his training in radiation oncology from All India

Institute of Medical Sciences, New Delhi. He is currently chief of B.R. Ambedkar
Institute-Rotary Cancer Hospital, All India Institute of Medical Sciences, New
Delhi. He has more than 250 peer-reviewed publications and is the recipient of
Doctor K.M. Rai Memorial Oration award. He is also one of the editors of the text-
book Textbook of Radiation Oncology: Principles and Practice, Elsevier, 2003, and
is also the author of many chapters in several textbooks in the field of radiation
oncology.
xi
Part I
Epidemiology, Neuro-Anatomy and
Neuro- Pathology for a Neuro-Oncologist