Preface

Management of primary and metastatic malignancies involving the central nervous system (CNS) (brain and spine) remains a challenge. Although there have been significant improvements in responses to tumor target-directed therapies in recent years, surgery and radiation remain our primary approaches to the management of CNS malignancies. Advanced unresectable primary and secondary tumors of the CNS are commonly "resistant to systemic therapies" because of the lack of knowledge regarding the best mechanism(s) for drugs to penetrate the blood–brain barrier.

Since the book *New Approaches to the Management of Primary and Secondary CNS Tumors* (IntechOpen) was published in 2017, significant progress has been made: Phase I neurooncology trials for new drugs have increased worldwide, several drugs have been approved as target-specific immunotherapies for the management of brain and spinal malignancies, and new pathways for cancer cells to enter the CNS have been identified.

In addition, major advances in the management of CNS malignancies through molecular and imaging analyses, magnetic devices, and tumor-targeted immunotherapies with/without stereotactic radiosurgery are now available, many of which are discussed in this book. Moreover, the US FDA and other worldwide Orphan Designated Drug and Device programs are inducing incentives for the pharmaceutical and device industries to become more involved in the management of CNS malignancies.

## *There is light at the end of the tunnel!*

**II**

**Section 5**

System Lymphomas

Radiation and Laser Therapy for CNS Tumors **103**

**Chapter 7 105**

**Chapter 8 121**

**Chapter 9 133**

**Chapter 10 153**

Chemo/Immunotherapies for CNS Tumors **171**

**Chapter 11 173**

**Chapter 12 193**

**Chapter 13 203**

**Chapter 14 213**

Nutritional Support **253**

**Chapter 15 255**

A Nutrition Perspective on the Ketogenic Diet as Therapy for Malignant

The Role of Radiotherapy in the Treatment of Primary Central Nervous

Pediatric Medulloblastoma: A Radiation Oncologist Perspective

*by Alexa Semonche, Daniel Eichberg, Ashish Shah and Michael E. Ivan*

*by Annabelle Trojan, Heliodor Kasprzak, Oscar Gutierrez, Pedro Penagos, Ignacio Briceno, Heber O. Siachoque, Donald D. Anthony, Alvaro Alvarez* 

Advances in the Systemic Treatment of Melanoma Brain Metastases

Angiogenesis in Malignant Gliomas and Bevacizumab Resistance

*by Meral Kurt, Candan Demiröz Abakay and Ali Altay*

Neoplastic Brain, Glioblastoma, and Immunotherapy

Innovations in Metastatic Brain Tumor Treatment *by Caleb Stewart, Brody Stewart and Marcus L. Ware*

Toxicity of Cranial and Spinal Cord Irradiation

*by Jason Naziri and Steven J. DiBiase*

*by Meenu Gupta and Mushtaq Ahmad*

Laser Ablation for Gliomas

**Section 6**

*and Jerzy Trojan*

*by Philip Friedlander*

*by Scott G. Turner*

**Section 7**

Brain Cancer *by Meredith Morgan* Every chapter in *Brain and Spinal Tumors—Primary and Secondary* reviews development of new approaches through neurooncological collaborations, in-depth discussions, and/or reviews of diagnostic and therapeutic concepts that will improve the management of patients with neurooncology challenges.

Metastatic tumors involving the brain and spine are "increasing in occurrence" because drugs are effective versus periphery malignancies (lung, breast, etc.), but are not as effective versus brain and spine malignancies (primary and secondary). Overall, long-term responses for malignancies involving the CNS still remain depressing.

There remains a paucity of useful anticancer therapeutic tools for pediatric and adolescent oncology patients with tumors involving the CNS, who are otherwise healthy, but are seldom referred for clinical trials with novel new agents because they are <18 years of age. However, without new therapies, the management and support for the pediatric and adolescent age groups with primary and secondary CNS malignancies will remain inadequate; these are areas of oncology for which more clinical research efforts are badly needed.

However, in spite of the above deficiencies, the authors who have written chapters are "weaving their webs and establishing their roles in neurooncology." It is the editors' hopes that all readers are also pursuing their dreams and able to accomplish their goals. Only through new research endeavors and concepts are there possibilities of eradicating malignancies involving the CNS.

*Each of us has been given the wisdom to reach our goals—just think about where we have been and where we are now—please do not stop!*

In summary, it is an honor and pleasure to be an editor of *Brain and Spinal Tumors— Primary and Secondary'* and assist in bringing together dozens of clinicians and scientist-researchers to describe their research contributions that will benefit the neurooncology community's need for new advancements to improve the management of malignancies of the CNS.

> **Lee Roy Morgan, MD, PhD,** CEO, DEKK-TEC, Inc., New Orleans, LA, United States

> > **1**

Section 1

Principles of

Neuropharmacology

and Experimental

Therapeutics

**Feyzi Birol Sarica** Associate Professor, Giresun University Faculty of Medicine, Turkey

## Section 1
