Table Of ContentA. B. M. F. Karim E. R. Laws, Jr. (Eds.)
GLIOMA
Principles and Practice
in Neuro-Oncology
With 62 Figures and 38 Tables
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Hong Kong Barcelona Budapest
Dr. A. B. M. F. Karim
Department of Radiation Oncology,
Free University Hospital,
P.O. Box 7057,
The Netherlands 1007 MB Amsterdam
Dr. Edward R. Laws, Jr.
Department of Neurological Surgery,
George Washington University
Medical Center,
2150 Pennsylvania Ave. NW,
Washington DC 20037, USA
ISBN -13: 978-3-540-52286-7 e-ISBN -13: 978-3-642-84127-9
DOl: 10.1007/978-3-642-84127-9
Library of Congress Cataloging-in-Publication Data
Glioma: principles and practice in neuro-oncology 1 A.B.M.F. Karim, E.R. Laws, Jr.
(eds.).
Includes index.
ISBN-I3: 978-3-540-52286-7
1. Gliomas. I. Karim; Abul Bashr Mohammed FazluI. II. Laws, Junior, Edward R.
[DNLM: 1. Brain Neoplasms - diagnosis. 2. Brain Neoplasms-therapy. 3. Glioma. WL
358 G5607] RC280.B7G581991 616.99'281-dc20 DNLM/DLC for Library of Congress
91-4599CIP .
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Preface
Many recent developments in neuro-oncology relevant to clinical
practice have contributed to improved patient care. The most im-
portant impact of these developments on treatment may have
been a change in the attitudes of the neuro-oncologists involved in
making decisions regarding patients with gliomas. From an era of
uncertainty which led to therapeutic nihilism, we have entered one
of active interventions based on objective parameters for the treat-
ment of gliomas, which may be either slow-growing or rapid kil-
lers.
The histopathological characteristics of gliomatous lesions are
intriguing, and it is only recently that a clearer picture has begun
to emerge. A group of dedicated neuropathologists has been at-
tempting to reach a consensus on pathological classification and
grading, providing an important landmark in the field of neuro-
oncology. This book does not mean to provide exhaustive details
on the histopathology of gliomas, but rather highlights the main
problems in an authoritative chapter. This chapter attempts to
guide the reader to a better understanding of all aspects of the
neuropathology of glioma.
Neuroradiology has recently seen several breakthroughs. Im-
ages unimaginable a decade ago are now providing us with an al-
most three-dimensional impression. But the concomitant illusions
and artifacts must also be kept in mind, and pragmatic ideas are
carefully put forward in this book about the developing body of
knowledge concerning the newer imaging techniques.
In other chapters of this book, prominent authors have
reviewed their experiences with multimodal approaches to treat-
ment of gliomas and their results. Although at the present state of
knowledge controversies on the topic of treatment are not totally
avoidable, a broad consensus has crystallized. The logical discus-
sions in this volume will help the reader to formulate policies in
the 4ay-to-day treatment of patients with gliomas. The chapters
on treatment include virtually all innovative treatment
methodologies with promise, hopefully enabling the reader to get
consistent help. The most renowned workers in their fields have
updated their own and other available data on surgery,
radiotherapy, and chemotherapy for both adult and childhood
gliomas in various chapters in this book. Others deal with the role
VI Preface
of hypoxic sensitizers, steroid hormones, stereotactic interstitial
or external therapy in primary or recurrent tumors, and boron-
neutron capture therapy. The damage to normal brain tissues as-
sociated with these experimental forms of therapy is given major
emphasis. Sometimes a slowly growing lesion changes course by
dedifferentiation and becomes the most virulent of malignancies.
This can happen both with untreated primary gliomas and with
tumor remnants after treatment. This book also contains a chap-
ter from an authority on the fate of these tumors.
The question of cure of patients with gliomas and the quality
of life after cure has very rarely been confronted in neuro-
oncology. A chapter on this topic unfolds the realities and indi-
cates future directions.
The last word on treatment cannot be spoken as yet, but such
a diversity of topics as is covered here has not recently been dealt
with together in one volume. Our purpose is to provide the reader
with a book from which guidelines may be obtained for better
patient care.
Amsterdam, A.B.M.F.Karim, MD, FRCR, PhD
January 1991 E.R.Laws, Jr, MD, FACS
Contributors
Afra,D.
National Institute of Neurosurgery,
Amerikai lit 57,1145 Budapest, Hungary
Alphen, van H. A. M.
Department of Neurosurgery, Free University Hospital,
Postbus 7057,1007 MB Amsterdam, The Netherlands
Bleehen, N. M.
University Departmentand Medical Research Council Unit
of Clinical Oncology and Radiotherapeutics,
Addenbrookes Hospital, Hills Road,
Cambridge CB22QQ, United Kingdom
Chierego, G.
Department of Medical Physics, City Hospital,
Viale Rodolfi, 36100 Vicenza, Italy
Colombo,F.
Department ofNe urosurgery, City Hospital,
Viale Rodolfi, 36100 Vicenza, Italy
Fankhauser, H.
Neurosurgical Service, Centre Hospitalier Universitaire Vaudois,
1011 Lausanne, Switzerland
Ghibbeke, van M.
Statistician, EORTC Data Centre,
Avenue E. Mounier 83-B11, 1200 Brussels, Belgium
Gonzalez, D. G.
Department of Radiation Oncology, Academic Medical Centre,
Meibergdreef9, 1105 AZ Amsterdam, The Netherlands
Guthrie, B. L.
Department of Neurosurgery, George Washington University
Medical Center, 2150 Pennsylvania Avenue,
N. W., Washington, DC 20037, USA
VIII Contributors
Gutin,P.H.
Department of Neurological Surgery, Long Hospital,
Room L75, University of California,
San Francisco, California 94143-0226, USA
Hatanaka, H.
Department of Neurosurgery, Teikyo Univ. School of Medicine,
11-1 Kaga 2-chome, Itabashi-ku, Tokyo 173, Japan
Kaiser, M. C.
Service de Radiologie, Clinique Sacn~-Coeur, 48A, Avenue
Gaston Diderich, 1420 Luxembourg-Ville, Luxembourg
Karim, A. B. M. F.
Department of Radiation Oncology, Free University Hospital,
Postbus 7057,1007 MBAmsterdam, The Netherlands
Kim,T.H.
Division of Pediatric Hematology and Oncology,
Emory University, Atlanta, Georgia, USA
Kogel, van der A. J.
Sint-Radboudziekenhuis, Instituut voor Radiotherapie,
University of Nijmegen, Geert Grooteplein Zuid 32,
6525 GA Nijmegen, The Netherlands
Kralendonk, J. H.
Department of Radiation Oncology, Free University Hospital,
Postbus 7057; 1007 MB Amsterdam, The Netherlands
Larson, D. A.,
Department of Radiation Oncology, Long Hospital, Room L 75,
University of California, San Francisco,
California 94143-0226, USA
Laws, Jr. E. R.
Department of Neurosurgery, George Washington University
Medical Center,
2150 Pennsylvania Avenue, N. W., Washington, DC 20037, USA
Marchetti, C.
Department of Medical Physics, City Hospital,
Viale Rodolfi, 36100 Vicenza, Italy
Miiller, W.
Pathologisches Institut der U niversitat zu K61n,
Abteilung Neuropathologie, 5000 K61n, FRG
Contributors IX
Nordman,E.
Department of Oncology and Radiotherapy, University ofTurku,
Kiinamyllynkatu 4-8, 20520 Turku 52, Finland
Ostertag C. B.
Abteilung Stereotaktische Neurochirurgie,
Hugstetter Str. 55,7800 Freiburg i. Br., FRG
Pozza,F.
Department of Radiotherapy, City Hospital,
Viale Rodolfi, 36100 Vicenza, Italy
Ragab,A.H.
Division of Pediatric Hematology and Oncology,
Emory University, Atlanta, Georgia, USA
Rao,B.R.
Department of Endocrinology, Free University Hospital,
Postbus 7057, 1007 MB Amsterdam, The Netherlands
Razek,A.
Therapy Associates Inc., 906 S. Hebron,
Box 15040, Evansville, Indiana 477160-0040, USA
Roelvink, N. C. A
Ostwalt 5, 4290 Bocholt, FRG
Rutten, E. H. J. M.
Department of Radiotherapy, University Hospital St. Radboud,
Geert Grooteplein Zuid 32, 6500 HB Nijmegen, The Netherlands
Schueren, van der E.
Department of Oncology, University Hospital Sint Rafael,
Capucijnenvoer 33, 3000 Leuven, Belgium
Slotman, B.J.
Department of Endocrinology, Free University Hospital,
Postbus 7057, 1007 MB Amsterdam, The Netherlands
Sneed,P.K.
Department of Radiation Oncology, Long Hospital,
Room L75, University of California,
San Francisco, California 94143-0226, USA
Stam,F.C.
Department of Neuropathology, Free University Hospital,
Postbus 7057,1007 MB Amsterdam, The Netherlands
x Contributors
Thomas, D. G. T.
Department of Neurological Surgery, Institute of Neurology,
National Hospital for Neurology and Neurosurgery,
Queen Square, London WCl E 3BG, United Kingdom
Tribolet, de N.
Neurosurgical Service, Centre Hospitalier Universitaire Vaudois,
1011 Lausanne, Switzerland
Contents
Pitfalls and Controversies in the Treatment of Gliomas
A.B.M.F. KarimandJ.H. Kralendonk. . . . . . . 1
The Problems of Pathological Diagnosis
F.C. Stam . . . . . . . . . . . . . . . . . . . . . 17
M,odern Imaging for Cerebral Gliomas:
Breakthroughs and Limitations
M. C. Kaiser and J. H. I(ralendonk. . . ....... 37
The Impact of Modern Imaging Techniques
on the Policy for Treating Cerebral Gliomas
H. A. M. van Alphen . . . . . . . . . . ... 57
Management of Supratentorial Low-Grade Gliomas
B.L. Guthrie and E.R. Laws. . . . . . . . . . . 75
Surgery in the Treatment of Malignant Glioma:
Current Status and Future Perspectives
N. de Tribolet and H. Fankhauser. . .. ...... 93
Evolution of Modern Radiation Therapy
in the Treatment of Gliomas
E. Nordman. . . . . . . . . .. ........ 107
Raqiotherapy for Malignant Gliomas
A.B.M.F. Karim, E. van der Schueren, D. G. Gonzalez, and
M. van Glabbeke. . . . . . . . . . . . . . .. . 121
Stereotactic Interstitial Radiotherapy in the Treatment
of Gliomas: Current Status, Results, and the Future
C. B,. Ostertag. . . . . . . . . . . . . .. ... 125
Stereotactic External Radiotherapy for Gliomas:
Techniques, Dosimetry, Results
F. Pozza, F. Colombo, C. Marchetti, and G. Chierego . 139
Hypoxic Cell Sensitizers in the Management of Brain Tumors
N. M. Bleehen. . . . . . . . . . . . . . . . . . . . 153
