Neuro Oncology

Neuro-oncology is a medical specialty focused on diagnosing, treating, and managing tumors affecting the nervous system, including the brain, spinal cord, and nerves. It combines neurology and oncology expertise.

Scope of Practice

Neuro-oncologists handle both primary tumors that start in the nervous system and secondary tumors that have spread from other areas of the body. They treat conditions such as gliomas (like glioblastoma), meningiomas, CNS lymphomas, spinal cord tumors, and metastatic brain tumors. They also manage neurological issues caused by cancer or its treatments, such as seizures and cognitive problems.

Multidisciplinary Approach

Managing these conditions requires collaboration among specialists. The neuro-oncologist coordinates care with professionals like neurosurgeons, radiation oncologists, neuroradiologists, neuropathologists, and support staff.

Treatments and Research

Treatment plans are tailored to each patient and may include surgery, radiation therapy, systemic therapies (chemotherapy, targeted therapy, immunotherapy), and supportive care to manage symptoms and improve quality of life. Research in neuro-oncology is ongoing to find more effective treatments.

Treatment Modalities

A. Surgery
Goal: Maximal safe resection (remove as much tumor as possible without harming vital brain tissue).

Techniques:
Microsurgery and neuronavigation
Awake craniotomy for speech/motor mapping
Intraoperative MRI and fluorescence-guided surgery (5-ALA)

Used post-surgery to control microscopic disease.
Techniques:
External beam radiation
Stereotactic radiosurgery (Gamma Knife, CyberKnife)
Proton beam therapy (for pediatric or deep tumors)

Temozolomide (TMZ): Standard for glioblastoma.
PCV regimen (Procarbazine, CCNU, Vincristine): For oligodendrogliomas.
Carmustine (BCNU) wafers: Implanted locally after surgery.

Bevacizumab (Avastin): Anti-angiogenic therapy for recurrent GBM.
EGFR inhibitors: For tumors with EGFR amplification.
Tumor Treating Fields (TTF): Uses low-intensity electric fields to disrupt tumor cell division.
Immunotherapy: Checkpoint inhibitors and personalized vaccines under study.