Diagnosis and management of complications from the treatment of primary central nervous system tumors in adults

Michael Weller; Emilie Le Rhun; Martin Van den Bent; Susan M Chang; Timothy F Cloughesy; Roland Goldbrunner; Yong-Kil Hong; Rakesh Jalali; Michael D Jenkinson; Giuseppe Minniti; Motoo Nagane; Evangelia Razis; Patrick Roth; Roberta Rudà; Ghazaleh Tabatabai; Patrick Y Wen; Susan C Short; Matthias Preusser

doi:10.1093/neuonc/noad038

Diagnosis and management of complications from the treatment of primary central nervous system tumors in adults

Neuro Oncol. 2023 Jul 6;25(7):1200-1224. doi: 10.1093/neuonc/noad038.

Authors

Michael Weller¹, Emilie Le Rhun^{1

2}, Martin Van den Bent³, Susan M Chang⁴, Timothy F Cloughesy⁵, Roland Goldbrunner⁶, Yong-Kil Hong⁷, Rakesh Jalali⁸, Michael D Jenkinson⁹, Giuseppe Minniti^{10

11}, Motoo Nagane¹², Evangelia Razis¹³, Patrick Roth¹, Roberta Rudà¹⁴, Ghazaleh Tabatabai¹⁵, Patrick Y Wen¹⁶, Susan C Short^{17

18}, Matthias Preusser¹⁹

Affiliations

¹ Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
² Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland.
³ The Brain Tumour Center at the Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
⁴ Department of Neurological Surgery, University of California, San Francisco, California, USA.
⁵ Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
⁶ Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany.
⁷ Brain Tumor Center, Hallym University Sacred Heart Hospital, Anyang, South Korea.
⁸ Neuro Oncology Cancer Management Team, Apollo Proton Cancer Centre, Chennai, India.
⁹ Department of Neurosurgery, The Walton Centre NHS Foundation Trust & University of Liverpool, Liverpool, UK.
¹⁰ Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy.
¹¹ IRCCS Neuromed, Pozzilli, IS, Italy.
¹² Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan.
¹³ Third Department of Medical Oncology, Hygeia Hospital, Marousi, Athens, Greece.
¹⁴ Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin, Italy.
¹⁵ Department of Neurology & Neuro-Oncology, Hertie Institute for Clinical Brain Research, Center for Neurooncology, Comprehensive Cancer Center, German Cancer Consortium (DKTK), Partner site Tübingen, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
¹⁶ Center for Neuro-oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA.
¹⁷ Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
¹⁸ Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
¹⁹ Division of Oncology, Department of Medicine 1, Medical University, Vienna, Austria.

Abstract

Central nervous system (CNS) tumor patients commonly undergo multimodality treatment in the course of their disease. Adverse effects and complications from these interventions have not been systematically studied, but pose significant challenges in clinical practice and impact function and quality of life, especially in the management of long-term brain tumor survivors. Here, the European Association of Neuro-Oncology (EANO) has developed recommendations to prevent, diagnose, and manage adverse effects and complications in the adult primary brain CNS tumor (except lymphomas) patient population with a specific focus on surgery, radiotherapy, and pharmacotherapy. Specifically, we also provide recommendations for dose adaptations, interruptions, and reexposure for pharmacotherapy that may serve as a reference for the management of standard of care in clinical trials. We also summarize which interventions are unnecessary, inactive or contraindicated. This consensus paper should serve as a reference for the conduct of standard therapy within and outside of clinical trials.

Keywords: adverse affects; dose; interruptions; prevention; reexposure; toxicity.

MeSH terms

Adult
Brain Neoplasms* / diagnosis
Brain Neoplasms* / pathology
Brain Neoplasms* / therapy
Central Nervous System Neoplasms* / diagnosis
Central Nervous System Neoplasms* / therapy
Combined Modality Therapy
Humans
Lymphoma*
Quality of Life