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Supportive management in neuro-oncology: opportunities for patient care, teaching, and research

Introduction Since the publication of studies demonstrating the benefit of radiation for high-grade gliomas [1], life-saving and life-extending advances for patients with the most common neuro-oncological problems have been few. There are notable exceptions. For high-grade gliomas, systemic and intratumor chemotherapy have been shown to have modest survival benefits [2,3]. For low-grade gliomas, we finally have a study proving that radiation delays progression [4], but some might be disappointed with the amount of benefit, and the design of that study did not allow determination of how much radiation affects survival. For brain metastases, two of three studies show benefit to resection of single metastases in appropriately selected patients, and stereotactic radiosurgery has been shown to be of benefit in some circumstances. For spinal cord compression from cancer, surgical removal of tumor was recently shown to preserve and improve ambulation [5]. In addition to these advances, incremental advances in surgery, radiation, and chemotherapy have undoubtedly contributed to small gains in outcomes.