Clinical presentation, diagnosis, and pharmacotherapy of patients with primary brain tumors

OBJECTIVE: TO briefly review the clinical presentation and diagnosis of pat ients with primary brain tumors, followed by an in-depth; sun;ey of the per tinent pharmacotherapy. DATA SOURCES: A detailed search of the neurologic, neurosurgical, and oncol ogic literature for basic science research, clinical studies, and review ar ticles related to chemotherapy and pharmacotherapy of primary brain tumors. STUDY SELECTION: Relevant studies on tissue culture systems, animals, and h umans examining the mechanisms of action, pharmacokinetics, clinical pharma cology, and treatment results of chemotherapeutic agents for primary brain tumors. In addition, studies of pharmacologic agents administered for suppo rtive care and symptom control are reviewed. DATA SYNTHESIS: Primary brain tumors derive from cells within the intracran ial cavity and generally present with headache, seizure activity, cognitive changes, and weakness. They are diagnosed most efficiently with magnetic r esonance imaging. After diagnosis, the most common supportive medications i nclude corticosteroids, gastric acid inhibitors, and anticonvulsants. Chemo therapy is adjunctive treatment for patients with malignant tumors and sele cted recurrent or progressive benign neoplasms. In general, the most effect ive chemotherapeutic drugs are alkylating agents such as the nitrosoureas, procarbazine, cisplatin, and carboplatin. Other agents used include cycloph osphamide, methotrexate. vincristine, and etoposide. Angiogenesis inhibitor s and gene therapy comprise some of the novel therapeutic strategies under investigation. CONCLUSIONS: The efficacy of chemotherapy for primary brain tumors remains modest. Novel agents must be discovered that are more specific and attack t umor cells at the molecular level of tumorigenesis. Furthermore, strategies must be developed to counteract the pervasive problem of brain tumor chemo resistance.