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From the Editor (provided as webpage)
John McVicker, MD, FACS

Neuro-oncology: The Promiscuous Discipline
Edward Arenson, MD

The relatively new field of neuro-oncology has arisen in response to the long overdue surge in interest in central nervous system (CNS) tumors by health care professionals. Since this field has no history or tradition, its definition remains elusive. What is clear is that the field concerns itself with the care (mostly postsurgical) of patients with CNS tumors. A neuro-oncologist typically assumes full responsibility for the care of patients with CNS tumors following surgery if ongoing care is necessary. Certainly all patients with malignant CNS tumors, low-grade or high-grade, completely or partially resected, should be followed by a neuro-oncologist. In addition, patients with benign tumors complicated by ongoing issues such as seizures, functional impairment, or significant comorbidities frequently benefit from the care of a neuro-oncologist who essentially becomes the primary care physician for issues related to the tumor.

Neurosurgery for Brain Tumors: Same Goal, New Technology
Timothy Fullagar, MD

The role of the neurosurgeon in the optimal management of a patient with a central nervous system tumor has evolved in some ways, particularly the new standard of being a member of a multidisciplinary neuro-oncology team. This team includes other neurosurgeons as well as neuro-oncologists, radiation oncologists, neuroradiologists, neuropsychologists, nurses, social workers and other professionals who meet regularly to insure a team approach to patient management. However, there has been no change in the principle mandate and responsibility of the surgical neuro-oncologist, to remove the tumor. What has changed is how this is achieved more safely and more often. This article will address these improvements and explain the technology that has facilitated this progress.

Gamma Knife Radiosurgery at Swedish Medical Center
D. Marshall Davis, MD

Stereotactic radiosurgery (SRS) utilizes therapeutic radiation in a novel fashion by combining many narrow “pencil” beams arrayed from multiple directions, precisely focused on a small target. This allows the absorbed radiation dose to be deposited at this focal intersection point while simultaneously minimizing dose deposition in surrounding non-target tissues. Dr. Lars Leksell initially developed this technology in Sweden and the first dedicated device to perform SRS was the GammaKnife in 1967. Initially devised to substitute for standard neurosurgery within inaccessible regions of the brain, it is now considered a standard therapy option for a variety of medical conditions.

Neuropsychology’s Evolving Role in the Modern Management of Patients with Central Nervous System Tumors
Nancy Powers, PsyD and Kevin Reilly, PsyD

The standard of care for patients with central nervous system (CNS) tumors includes a multidisciplinary team of professionals who provide for diverse complex medical and supportive care to insure a balanced approach to care of the needs of each patient. The role of a neuropsychologist continues to evolve as newer approaches to treatment extend survival. In this article, the current role of the neuropsychologist on the brain tumor team will be highlighted.

Role of the Patient Care Coordinator
Stacey Per, LCSW

The Patient Care Coordinator provides a bridge between the medical and the supportive services at the Colorado Neurological Institute’s Center for Brain and Spinal Tumors. The medical component is comprised of the various physicians and the medical intervention they prescribe. The supportive care component encompasses the Patient Care Coordinator, the Program Assistant, and the Neuropsychologists as well as the menu of programs offered to our patients and families.

Chemotherapy for Brain Tumors: Current Status and Controversy
Edward Arenson, MD

The current status of chemotherapy for primary malignant tumors of the central nervous system (CNS) is controversial and complex. Despite the fact that it is well known in the oncology community that cancer is virtually never cured with single agent chemotherapy (monotherapy), the current “standard” treatment for glioblastoma, the most lethal of all CNS tumors, is single agent temozolomide (TMZ). This relatively new drug has the advantage of being an oral agent, relatively low toxicity profile and crossing the blood brain barrier. Furthermore, it is easy for oncologists to give. A recent study has clearly demonstrated that survival is improved (3 months) if this drug is given both during and after radiation therapy.1 However, the disease remains essentially incurable with this approach. The principle argument against using TMZ in combination with other drugs is that, thus far, studies have not established the safety and efficacy of such combinations.

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