Table of Contents

I. Introduction
• Definition of brain cancer
• Primary and secondary brain tumors
• Types of brain tumors
II. Types of Brain Tumors
III. Fluorescent Marker for Accurate Removal of Brain Tumor
• Use of chemical to highlight tumor cells
• Study involving patients suspected of high-grade gliomas
• Importance of identifying low-grade glioma cells
IV. Challenges in treating brain tumors
V. Study shows association of migraine history and brain tumor
VI. Novel approach for treatment of Glioblastoma
VII. Brain tumors with Optune


Brain tumor: Survival rates predominantly low

Brain cancer can either be primary or secondary meaning it has either originated in the brain or has started in another part of the body and spread to the brain. Among adults, secondary brain tumors are more common than the primary. Although there are various types of brain tumors, gliomas are the common form developing in the supportive cells (glial cell) of the brain. The benign tumors of the brain are usually slow growing and rarely spread whereas the malignant tumors grow rapidly, are invasive and can be life-threatening. The first line of treatment for brain cancer with poor prognosis is the surgical removal of the tumor followed by chemotherapy and radiation treatments. However, the treatment for brain cancer continues to be a challenge even with the current medical advancement. The five-year survival for brain tumors is estimated to be about 33% and with the aggressive form of brain tumor such as glioblastoma multiforme, the survival rate is around 5%.

One of the main challenges of treatment, for instance, is that it is harder to deliver chemotherapy to the sites as it requires the heavy doses to pass through the blood-brain barrier. Also, the heavy doses make it difficult for patients to tolerate as it results in systemic toxicity. Therefore, research continues to battle in the hope of identifying novel treatments with more options and to prolong the survival of the patients.


Types of Brain Tumors

Astrocytoma: A common form of gliomas developing from the glial cells that provides structure in the brain and the spinal cord.

CNS Lymphoma: This is the development of cancer in the lymph tissue of the brain or the spinal cord.

Ependymoma: It is a relatively rare form of cancer developing in the passageway of the brain where CSF is produced and stored.

Glioblastoma: Also known as ‘astrocytoma grade IV’, it is highly malignant and mostly develops in the cerebral hemisphere of the brain.

Oligodendroglioma: This develops in the cells that are responsible for the production of myelin, a substance that envelops the nerves.

Glioma: The most common form of brain cancer that makes up about 70% of all primary malignant brain tumors.

Medulloblastoma: This is considered as the fast-growing high-grade tumors which mostly occur in the cerebellum and can spread to other parts of the central nervous system.

Craniopharyngioma: These rare tumors are mostly benign and develop near the pituitary gland.

Meningioma: It is considered as one of the most common primary brain tumor that develops in the layers of the meninges and is generally noncancerous.


Fluorescent Marker to Guide Surgeons for the Accurate Removal of Brain Tumor

Treatment for brain tumor usually involves a surgery which is a challenging task that removes much of cancer as possible while avoiding healthy brain cells. Recently, details about the use of a chemical that highlights the tumor cells in the brain was presented at the 2018 National Cancer Research Institute (NCRI) Cancer Conference. This trial illustrates that the use of the fluorescent marker could help distinguish the healthy brain cells and the high-grade cells which ultimately can improve individual’s survival.

‘The advantage of this technique is that it may highlight more quickly high-grade disease within a tumor during neurosurgery. What this means is that more of the tumor can be removed more safely and with fewer complications and that’s better for the patient.’

The study involved patients suspected of high-grade gliomas were given a drink containing 5-ALA. Out of a total of 99 patients, surgeons reported seeing fluorescence in 85 patients. However, the research indicates that other types of markers are also required for identifying low-grade glioma cells.



A Study shows Association of Migraine History and Brain Tumor

As the initial symptom of brain tumors are the headaches and migraines which are identified among people, therefore there was a speculation whether to consider migraine history with the risk of brain tumor. A new study shows an association with prior migraine history and brain tumor particularly at higher risk for the male population. The study identified 11,325 adults with a first-time brain tumor diagnosis between January 1, 2006 and December 31, 2013. However, more research is required to determine the underlying mechanism to substantiate these findings.

‘As brain neoplasms are most treatable in their earlier stage, our results suggest to increase awareness of the possibilities of brain tumors among patients with migraine for both early detection and patient health. Appropriate adherence to screening and regular medical follow-ups after a migraine diagnosis might assist in early recognition of key symptoms of malignant brain tumors’, wrote the researchers.



A Novel Approach for Treatment of Glioblastoma

Recent findings show that the process of alternative splicing is deregulated in cancer and is involved in cancer progression. The drugs that usually are used to target the splicing process show high toxicity in vivo. MKNK2 gene produces the two protein products; MNK2a that inhibits cancer growth and MNK2b that supports cancer growth through a process called RNA alternative splicing. In many of the cancers including glioblastoma, MNK2b is up-regulated while Mnk2a is down-regulated. This novel approach focuses on increasing the production of tumor-suppressing protein and decreasing the production of the tumor-stimulating protein. Also, as one of the challenges of treating glioblastoma is the immediate resistance to chemotherapy, this approach is focused on enabling the cells to become chemotherapy-sensitive again. Therefore, MKNK2 splicing modulation can be considered either as a single or a combined therapy for the disease.



Brain tumors with Optune

Optune (NovoTTF-100A System) is a new, non-invasive technique used for the treatment of recurrent glioblastoma multiforme when other forms of treatments such as surgery, cancer drug or radiation does not work effectively. This device connects to the scalp and is made up of components such as an electric field generator and four INE insulated transducer arrays. Optune can be used by the adult patients and works by delivering low-intensity, alternating electrical fields that disrupt the reproduction of cancer cells, inhibits the growth thereby preventing it from spreading quickly. The clinical trials of Optune show prolonged survival among the newly diagnosed cases treated alongside with temozolomide (TMZ).  The median survival of patients was 20.9 when treated with Optune plus TMZ in relationship to 16 months when treated with TMZ only.