A Smell Test for Alzheimer’s?

May 25, 2012 – There is a large body of evidence for an association between hyposmia and Alzheimer’s dementia (AD), but the predictive value of olfactory dysfunction in the development of Alzheimer’s disease (AD) is uncertain, a new review of the topic concludes.

“We establish through a systematic review the lack of proven evidence that loss-of-smell tests can be used to clinically predict future AD,” Cyrus A. Raji, MD, PhD, from University of Pittsburgh Medical Center Mercy Hospital in Pennsylvania, who worked on the study, told Medscape Medical News.

“It’s a big public health message. This has been a huge topic in recent years, and some popular websites even promote smell tests for Alzheimer’s,” Dr. Raji added. [Read more…]

Current Treatment Strategies for Malignant Gliomas

a report by

Michael Weller

Chairman, Department of Neurology, University Hospital Zurich

Anaplastic astrocytomas, oligoastrocytomas and oligodendrogliomas (World Health Organization (WHO) grade III) and glioblastomas (WHO grade IV) are collectively referred to as malignant gliomas, whereas WHO grade I and II gliomas are designated low-grade gliomas.1 For decades, neurosurgical resection – whenever possible – and post-operative radiotherapy have been the cornerstones of treatment for malignant gliomas. Most chemo­therapeutic agents active in other types of cancer produced little benefit for glioma patients, with the possible exception of nitrosoureas. In contrast, recent years have seen significant advances in the fields of neurosurgical resection, radio-oncological treatment approaches and, most significantly, medical therapy (see Table 1), exemplified by the approval of temozolomide for newly diagnosed glioblastoma.2 [Read more…]

Current Treatment Options in Adult Glioblastoma

a report by Christopher E Pelloski, MD1 and Mark R Gilbert, MD2

1. Assistant Professor, Departments of Radiation Oncology and Pathology; 2. Professor and Deputy Chair, Department of Neuro-oncology, University of Texas MD Anderson Cancer Center

The purpose of this article is to review the current treatment options for patients with glioblastoma (GBM). The current standard of care involves maximal safe surgical resection followed by concurrent chemotherapy with radiation followed by adjuvant chemotherapy. Although level 1 evidence supports the use of this treatment, GBM remains incurable and most patients will succumb to the disease within two years of diagnosis. The need for better treatments has led to the development of numerous experimental agents that are currently in various phases of pre-clinical and clinical application. The new treatment approaches provide hope that significant treatment advances are likely, but will require a collaborative effort between laboratory-based and clinical investigators. [Read more…]

State-of-the-art Therapy for Glioblastoma Multiforme

a report by Henry S Friedman, MD

James B Powell Jr Professor of Neuro-oncology, Dukes University Medical Center

The treatment of patients with glioblastoma multiforme (GBM) is conventionally considered to be a palliative venture with no hope of cure. Traditionally, patients are treated with maximal surgical resection based on the premise that, although surgery is not a curative procedure, a major resection provides for a longer survival and better quality of life.1 Radiotherapy increases the duration of survival, but again is not a curative intervention.2 The role of chemotherapy, specifically focusing on a foundation of chloroethylating agents such as carmustine (BCNU) or lomustine (CCNU), has been controversial with an equal number of clinicians arguing in favor of or against this treatment. Meta-analysis makes it clear that there is a small increase in median survival associated with the addition of these agents, but a consensus was never reached regarding their use.3 [Read more…]

The Role of Radiosurgery in the Management of Brain Metastases

a report by David Roberge, MD

Assistant Professor, Radiation Oncology, McGill University

It was decades after the introduction of the first concept of stereotactic radiosurgery (SRS) at the Karolinska Institute1 that stereotactic irradiation began to see widespread use in the treatment of brain tumors. Despite many technical changes since the 1950s, radiosurgery remains a radiotherapy technique characterized by accurate delivery of high doses of radiation in a single session to small, stereotactically defined targets with sharp dose fall-off outside the targeted volume. Such a treatment appears ideally suited to parenchymal brain metastases—tumors geographically well delimited with minimal infiltration into the adjacent brain.2 Unfortunately, such metastases are a common occurrence, representing approximately 250,000 cases per year in the US alone.3 Thus, even if only a fraction of these patients are referred for SRS, the management of brain metastases invariably represents a significant fraction of the workload of a radiosurgery practice. Until recently most reports supporting the use of SRS were retrospective case series. This has changed with the publication of randomized trials characterizing the benefits of SRS in the management of newly diagnosed brain oligometastases. [Read more…]

Current Trends in the Treatment for Brain Metastasis

Antonio Marcilio Padula Omuro is an Attending Physician at the Hôpital Pitié-Salpétrière in Paris. He has published several papers on brain tumours and is a member of the European Organisation for Research and Treatment of Cancer (EORTC) Brain Tumor Group. Dr Omuro trained in neurology at the University of São Paulo, Brazil, and in clinical neuro-oncology at the Memorial Sloan-Kettering Cancer Center, New York.

Brain metastasis is a feared complication of cancer that is associated with a significant decrease in quality of life and a dismal prognosis. The risk of developing brain metastasis has been estimated at around 25% in all cancer patients; however, this incidence has been increasing in many common cancer types, particularly breast and NSCLC. This can be explained by several factors including the inability of certain chemotherapy agents to cross an intact blood–brain barrier (BBB), as well as an inherent propensity for the development of brain metastasis observed in long-term cancer survivors. [Read more…]

Glioblastoma Multiforme—Past, Present, and Future

The most common cancer arising from the brain is the glioblastoma multiforme (GBM). It is also the most deadly,1 representing the most aggressive subtype among the gliomas, a collection of tumors including astrocytomas and oligodendrogliomas. In 1926, Bailey and Cushing, in describing ‘spongioblastoma multiforme’, the label then used for GBM, noted that:

“It is from this group doubtless that the generally unfavorable impression regarding gliomas as a whole has been gained. It is not only the largest single group in the series…but at the same time is one of the most malignant…In the five unoperated cases, the average duration of life from the onset of symptoms was only three months, which speaks well on the whole for the average survival period of twelve months for those surgically treated. [Read more…]

Current Management of High-grade Astrocytic Neoplasms— Small but Tangible Progress

A report by Renato V La Rocca, MD, Oncologist and Director, Kentuckiana Cancer Institute, Kentucky

The last five years have seen an evolution in the management of high-grade astrocytic tumors comparable in scope yet greater in magnitude to that of the prior 40 years. This is thanks to the convergence of three factors: the introduction of an oral agent with antitumor activity beyond the blood–brain barrier and modest systemic toxicity (temozolomide); the demonstration through a well-conducted randomized trial of the superiority of multimodality therapy; and the fact that we now stand on the threshold of additional progress through key advances in translational biology, which, in many cancers, is providing new targets for therapeutic intervention.

Astrocytic tumors have long been the bane of neurosurgeons, radiation therapists, and neuro-oncologists. Although they account for only 2.3% of all cancer-related deaths in the US,1 little if any substantial progress in brain imaging and treatment had been made until the first years of this millennium. Characteristics of high-grade glial tumors compared with other cancers are its unique location, robust invasive and angiogenic capabilities without a significant propensity to metastasize outside of the central nervous system (CNS), and the profound histological and molecular heterogeneity within tumor specimens. [Read more…]