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Review
. 2020 Oct;10(5):458-465.
doi: 10.1212/CPJ.0000000000000765.

Clinical neuro-oncology for the neurologist

Rimas V Lukas  1 , Jennie W Taylor  1 , Sylvia C Kurz  1 , Nimish A Mohile  1
Affiliations
Review

Clinical neuro-oncology for the neurologist

Rimas V Lukas et al. Neurol Clin Pract. 2020 Oct.

Abstract

Purpose of review: Neuro-oncologic patients are routinely encountered in clinical practice. Neuro-oncology is a rapidly evolving field, so understanding the most classic paradigms and contemporary advances will optimize patient care.

Recent findings: We discuss the recent reclassification of tumors via molecular characteristics as it applies to direct clinical practice and review the contemporary standard of care for infiltrating gliomas, meningiomas, brain metastases, and CNS lymphoma.

Summary: We provide a straightforward primer on neuro-oncology with a focus on the brain tumors most commonly encountered by the adult neurologist and a clear emphasis on clinically relevant points including those which have recently become incorporated into our standard management. We cite key reviews to allow interested readers an opportunity to gain a more comprehensive understanding of specific topics.

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Figures

Figure 1
Figure 1. MRI appearance of CNS tumors on axial T1 postcontrast sequences
(A) Images from a 48-year-old woman with triple-negative breast cancer. A large left frontal relatively well-circumscribed lesion with substantial surrounding edema is noted. Multiple additional similar smaller lesions were noted on other cuts. (B) A 76-year-old woman with a left temporal region meningioma. The extra-axial homogeneously enhancing lesion arises from the dura. (C) A 73-year-old woman with IDHwt glioblastoma. A large heterogeneous right temporal/insular lesion is seen. (D) A 52-year-old woman with an IDH-mutated anaplastic astrocytoma. A large right frontal area of decreased signal with small areas of enhancement is noted. (E) Images of a 57-year-old man with a progressive grade 2 oligodendroglioma who had initially presented with seizures a number of years prior. An area of increased FLAIR is noted in the subcortical right frontal lobe. (F) Image of an 84-year-old woman with primary CNS lymphoma. Image demonstrates classic deep location of tumor with homogenous contrast enhancement. FLAIR = fluid-attenuated inversion recovery; IDH = isocitrate dehydrogenase.
Figure 2
Figure 2. Diagnostic classification scheme for infiltrating gliomas
See this image and copyright information in PMC

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