Principles and possibilities - Concurrent chemotherapy and radiotherapy inpatients with brain tumors

Because treatment for most brain turners remains inadequate, there has been a sustained interest in using concurrent chemotherapy and radiotherapy to improve local control, prolong overall survival, and reduce treatment-relat ed toxicity. Unfortunately, many currently available radiosensitizers are e ither ineffective against brain tumors or have a reduced ability to cross t he blood-brain barrier when administered systemically. Many agents also hav e overlapping toxicities with cranial irradiation or enhance the toxicity o f radiation in a way that potentially compromises care. Finally, the additi on of chemotherapy to cranial irradiation complicates the assessment of tum or response. Despite these barriers, trials with a number of promising agen ts are currently under way. These trials have already provided crucial insi ghts into the pharmacokinetics, clinical pharmacology, and practical manage ment of brain tumor patients with concurrent chemotherapy and radiotherapy. These findings should rapidly lead to the safer and more effective use of combined-modality therapy inpatients with central nervous system cancer.