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About Brain Tumors1
What is a brain tumor?
A brain tumor is a mass that forms from abnormal cell growth in the brain. There
are two basic types of tumors: primary and metastatic. Primary brain tumors originate
in the brain, whereas metastatic tumors are the result of a cancer that originated
elsewhere in the body and spread to the brain.
Benign versus malignant
When tumors are diagnosed, they are classified as benign or malignant. A benign
tumor is made up of very slow-growing cells that have distinct borders and rarely
spread. Benign brain tumors can be life threatening if they are located in a vital
area of the brain.
A malignant tumor often is rapid growing, invasive and life threatening. Malignant
brain tumors are referred to as brain cancer and rarely spread beyond the brain
and spinal cord.
The grade of a tumor
Tumors are assigned a grade to indicate the severity of the cancer. The grade assigned
depends on several factors, such as:
- Similarity of tumor cells to normal cells
- Rate of growth/indication of uncontrolled growth
- Dead (known as necrotic) cells in the center of the tumor
- The potential to invade or spread to surrounding tissue
- Blood supply to the tumor
Grade I tumors are the least severe and have the highest potential for survival.
Grade II tumors are still slow growing but have the potential to recur, sometimes
at a higher grade. A grade III tumor is malignant (cancerous) and has a high tendency
to recur at a higher grade. The most severe tumors are grade IV tumors. They are
able to form new blood vessels to help maintain their growth, and they have areas
of dead cells in their centers. Glioblastoma multiforme is the most common example
of a grade IV brain tumor.
High-grade malignant glioma
A glioma is a brain tumor that starts in certain cells called glial cells, which
are formed mainly from astrocytes. Astrocytes (named for their star-like shape)
form part of the supportive tissue in the brain and provide nutrients, support and
insulation for neurons. A high-grade tumor is malignant, life threatening, invasive
and usually fast growing.
Glioblastoma multiforme (GBM)
A glioblastoma multiforme is a grade IV malignant glioma. 30% of all primary brain
tumors are diagnosed as GBMs. These are the most aggressive of all gliomas. Get
a visual demonstration of the brain,
and learn about common
brain tumor symptoms.
References
Prescribing Information
Important Safety Information
Indications:
GLIADEL® Wafer is indicated in patients with newly diagnosed high-grade
malignant glioma as an adjunct to surgery and radiation. GLIADEL is also indicated
in patients with recurrent glioblastoma multiforme as an adjunct to surgery.
Contraindication:
GLIADEL® Wafer should not be given to patients who have demonstrated
a previous hypersensitivity to carmustine or any of the components of GLIADEL.
Warnings:
Patients undergoing craniotomy for malignant glioma and implantation of GLIADEL
should be monitored closely for known complications of craniotomy, including seizures,
intracranial infections, abnormal wound healing, and brain edema.
Cases of intracerebral mass effect unresponsive to corticosteroids have been described
in patients treated with GLIADEL, including one case leading to brain herniation.
Precautions:
Communication between the surgical resection cavity and the ventricular system should
be avoided to prevent the wafers from migrating into the ventricular system and
causing obstructive hydrocephalus. If a communication larger than the diameter of
a wafer exists, it should be closed prior to wafer implantation.
Computed tomography and magnetic resonance imaging of the head may demonstrate enhancement
in the brain tissue surrounding the resection cavity after implantation of GLIADEL.
This enhancement may represent edema and inflammation caused by GLIADEL or tumor
progression.
The short-term and long-term toxicity profiles of GLIADEL when given in conjunction
with chemotherapy have not been fully explored.
Pregnancy and Nursing:
There are no studies assessing the reproductive toxicity of GLIADEL. Carmustine,
the active component of GLIADEL, can cause fetal harm when administered to a pregnant
woman.
It is recommended that patients receiving GLIADEL discontinue nursing.
Adverse Events:
Seizures:
In the initial surgery trial, the incidence of seizures was 33.3% in patients receiving
GLIADEL and 37.5% in patients receiving placebo. Grand mal seizures occurred in
5% of GLIADEL-treated patients and 4.2% of placebo-treated patients. The incidence
of seizures within the first 5 days after wafer implantation was 2.5% in the GLIADEL
group and 4.2% in the placebo group.
In the surgery for recurrent disease trial, the incidence of post-operative seizures
was 19% in both patients receiving GLIADEL and placebo. In this study, 12/22 (54%)
of patients treated with GLIADEL and 2/22 (9%) of placebo patients experienced the
first new or worsened seizure within the first five post-operative days. The median
time to onset of the first new or worsened post-operative seizure was 3.5 days in
patients treated with GLIADEL and 61 days in placebo patients.
Brain Edema:
In the initial surgery trial, brain edema was noted in 22.5% of patients treated
with GLIADEL and in 19.2% of patients treated with placebo. Development of brain
edema with mass effect (due to tumor recurrences, intracranial infection, or necrosis)
may necessitate re-operation and, in some cases, removal of GLIADEL or its remnants.
Healing Abnormalities:
The following healing abnormalities have been reported in clinical trials of GLIADEL:
wound dehiscence, delayed wound healing, subdural, subgaleal or wound effusions,
and cerebrospinal fluid leak. In the initial surgery trial, healing abnormalities
occurred in 15.8% of GLIADEL-treated patients and in 11.7% of placebo recipients.
Cerebrospinal fluid leaks occurred in 5% of GLIADEL recipients and 0.8% of those
given placebo. During surgery, a water-tight dural closure should be obtained to
minimize the risk of cerebrospinal fluid leak.
In the surgery for recurrent disease trial, the incidence of healing abnormalities
was the 14% of GLIADEL treated patients and 5% in patients receiving placebo wafers.
Intracranial Infection:
In the initial surgery trial, the incidence of brain abscess or meningitis was 5%
in patients treated with GLIADEL and 6% in patients receiving placebo. In the recurrent
setting, the incidence of brain abscess or meningitis was 4% in patients treated
with GLIADEL and 1% in patients receiving placebo.
Please see the Prescribing Information for more information.
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