In the current issue of Neuro-Oncology Practice Coven et al. review a number of challenges that contribute to delays in the initial diagnosis of childhood CNS cancer, including the variety of signs and symptoms by which these tumors may present and the multitude of health care providers involved in the evaluation and subsequent diagnosis of childhood CNS tumors. This information will serve as the baseline to evaluate the effectiveness of an adapted web-based HeadSmart program developed in the UK to educate health care providers about pediatric brain tumor signs and symptoms and thereby reduce the time to diagnosis.
Aboian et al. tackle the challenging area of radiographically diagnosing recurrent medulloblastoma and demonstrate that the diagnosis of distal and leptomeningeal recurrent medulloblastoma is improved by use of diffusion-weighted imaging versus conventional contrast-enhancing imaging.
Vision loss in patients after radiation involving the optic nerve and bevacizumab can present diagnostic challenges that have been previously suspected of representing treatment effects. However, Nguyen et al. report on a case of pathologically confirmed recurrent glioblastoma infiltrating the prechiasmatic and chiasmatic optic nerve after treatment that included bevacizumab, emphasizing the clinical diagnostic challenges in this population.
Pierobon et al. review nearly four decades of experience within the Italian AIEOP Soft Tissue Sarcoma Committee treating a rare disease, rhabdomyosarcoma, with rare CNS involvement. Their experience confirms the rarity of initial presentation in the CNS and the poor prognosis of disease spread to the CNS, but successful treatment of a small number of patients offers hope and underscores the need to rapidly identify patients at risk for CNS dissemination.
Initial experience using valproic acid as a radiation sensitizer appeared promising, and in this issue Krauze et al. describe the adverse event profile in long-term survivors and argue for ongoing evaluation of this treatment approach.
Davies et al. analyzed recent SEER-Medicare data for glioblastoma patients over 65 years old to determine whether the use of bevacizumab was associated with improved survival time. They report reductions in the risk of death associated with the use of bevacizumab in this patient population. Perhaps just as instructive is their careful consideration and discussion of confounders inherent in such retrospective cohort controlled research.
Manier et al. review the impact on daily function and psychosocial wellbeing of changes to head and neck patients’ physical appearance and body image associated with their treatment. They argue that patients with primary brain tumor similarly suffer from changes in physical appearance and body image that warrant further attention and management to maximize their quality of life.
There has been increased collection of health-related quality of life (HRQOL) questionnaires in clinical studies and clinical trials involving patients with brain metastasis. DiRisio et al. conducted a timely analysis of the appropriateness of existing measures for this population and the quality of reporting of the data collected in subsequent publications. The results suggest that we have work to do to develop and validate such a measure for the purpose of monitoring patients with brain metastasis. Moreover, the quality of HRQOL data reporting is also currently lacking and may benefit from more rigorous adherence to ISOQOL standards.