Oncology Recapitulates Neurology
Unlike Ernst Haeckel’s theory that “ontogeny recapitulates phylogeny,”1 it is no myth that neuro-oncology interfaces with almost the entirety of neurology and its related fields, including neurogenetics, neuropathology, neuroimmunology, neuroradiology, neuro-ophthalmology, epilepsy, vascular neurology, cognitive neurology, headache/migraine, the neurology of systemic disease, and palliative care. Similarly, this issue, so skillfully and carefully guest edited by Dr Amy A. Pruitt, while keeping us up-to-date about the most modern diagnostic and treatment options and their neurologic sequelae in neuro-oncology patients, also offers a unique opportunity to keep abreast of the many neurologic advances that impact our understanding of neurologic diseases in general.
The issue begins with the article by Drs Patrick Y. Wen and Jason T. Huse, who provide an important introduction to the articles that follow by summarizing the 2016 World Health Organization classification system on primary central nervous system tumors, a classification that for the first time includes molecular genetic characteristics, along with traditional histopathology, to more accurately categorize these tumors. Next, Drs Lakshmi Nayak and David A. Reardon review the diagnosis and current management of high-grade gliomas, focusing on promising new therapies for these lesions. Dr David Schiff then summarizes the diagnosis and current management options of the low-grade gliomas, a tumor type that the author notes requires the most involvement by neurologists for reasons such as challenges in diagnosis, the frequent presence of seizures, and patients’ longevity.
Dr Pruitt next discusses the epidemiology, treatment, and complications of central nervous system metastases, highlighting the varied presentations, management options, and prognoses. Drs Catherine H. Han and Tracy T. Batchelor then review the diagnosis and management of patients with primary central nervous system lymphoma who are immunocompetent.
Drs Joshua P. Klein and Jorg Dietrich discuss neuroimaging as it pertains to neuro-oncology, given the importance of neuroimaging in the assessment of neuro-oncologic patients and the particular importance of the neurologist in the clinical interpretation of the cause and significance of imaging findings. Dr Nimish A. Mohile next describes the recognition and management of the many medical complications, common and emergent, that can occur in patients with brain tumors. Dr Eric Lancaster then provides a thorough review of the most recent information about the diagnosis and management of the growing number of paraneoplastic disorders of the central and peripheral nervous systems. Drs Roy E. Strowd III and Jaishri O. Blakeley discuss the many common histologically benign tumors (and associated syndromes) that neurologists encounter and are commonly involved in diagnosing and managing, such as meningiomas, schwannomas, and pituitary adenomas.
Dr Tobias Walbert reviews palliative care, end-of-life care, and advance care planning in neuro-oncology, with emphasis on the importance of symptom management and palliative care in improving the quality of life in patients with advanced brain tumors. In the final review article of the issue, Drs Mai Dang and Peter C. Phillips discuss the classification, diagnosis, and management of the most common pediatric brain tumors, highlighting the many recent developments.
In addition to the articles described above, Dr Pruitt has also created very useful appendices to enhance the issue.