Emerging Subspecialties in Neurology: Neuro-oncology

Abstract

Neuro-oncology is a unique, developing neurologic subspecialty that combines many aspects of neurology with those of cancer biology. The neuro-oncologist is expert in both the diagnosis and management of primary brain tumors and neurologic complications of cancer. A career in neuro-oncology presents opportunities to utilize a multidisciplinary team approach and the application of cutting-edge technology toward patient treatment while providing compassionate patient care. Neuro-oncology can trace its modern origins to the 1970s, when the first therapeutic trials were begun. The treatment and management of primary brain tumors is now a rapidly evolving field. The World Health Organization recognizes approximately 100 different types of primary and secondary brain tumors.1,2 Glioblastoma, which is the most common and aggressive type of primary brain tumor, has an incidence of 4 to 5 cases per 100,000. For patients with glioblastoma, life expectancies are measured in months rather than years, with median survival after diagnosis of only 12 to 14 months. In the past, surgical resection and radiation therapy were the main treatment options offered to these patients. In the last several years, studies have shown that chemotherapy provides a significant clinical benefit for patients with malignant brain tumors.3 More recently, molecular markers that predict response to treatment are beginning to be identified in glioblastoma.4 Clinical trials that incorporate biologic endpoints and correlative studies are improving our understanding of the mechanisms of disease and tumor response to treatment. This greater knowledge will lead to the development of more effective agents and individualized treatments based on specific tumor profiles. In addition to glioblastoma, the neuro-oncologist manages less common tumors, including other types of glioma, germ cell tumors, meningiomas, medulloblastomas, and primary CNS lymphomas, and becomes familiar with the cancers' different biologic and molecular profiles, and treatment approaches. Despite the often poor prognosis of patients …