Central nervous system cancer

Treatments

CNS cancer patients are managed by a multidisciplinary team where neurosurgeons, neuroradiologists, neuroendocrinologists, neurologists, medical oncologists, pathologists, and radiation therapists address each patient's case together to determine the most appropriate treatment for each situation.

The primary treatment for most primary brain tumors is surgical resection. More than 200 patients are operated on each year at the Cliniques Universitaires Saint-Luc for malignant and benign tumors of the nervous system. In our institution, an ultra-modern surgical complex has been developed, which will remain at the top of the world rankings for many years to come. A high field MRI room is coupled to the neurosurgery room. This makes it possible to check the quality of the surgical resection during the operation. If there is a residue, the operation is continued at the same time.

Surgical techniques have developed considerably. Neuronavigation allows for computer-assisted surgery. The neuronavigation system projects planned data into the eyepieces of the microscope that the neurosurgeon uses to operate. It is like a GPS for the surgeon. It allows to locate a lesion with great precision, to know exactly, via the computer screen, the position of the tumor and of the neurosurgeon's instruments in the brain, and thus to determine very precisely the optimal trajectory towards the chosen target. This technique is mainly used for pathologies requiring millimetric precision. The benefits of this surgical method for the patient are significant due to the precision it provides, resulting in a significant increase in the rate of macroscopically complete resection (i.e., removal of all visible tumor). Neuronavigation also allows for a better targeting of the intervention area and therefore for smaller scars and openings. The risks are therefore limited, recovery is faster, and the hospital stay is shorter.

A state-of-the-art equipment, unique in Belgium, consists of a very high field MRI room coupled to the neurosurgery room. Neuronavigation has become a common practice.

After surgical resection of the tumor, it is analyzed by a pathologist to establish a precise histological diagnosis. When the tumor is aggressive or cannot be completely removed because of its infiltration in important areas, additional treatment must be considered. Post-operative radiation therapy is therefore often indicated. Thanks to developments in imaging and computer technology, the volume to be treated as well as the areas at risk are precisely delineated, allowing the placement (in 3 dimensions) of the radiation beams in order to deliver a homogeneous dose to the tumor volume while preserving the surrounding healthy tissue. In neuro-oncology, the Hi-Art tomotherapy irradiation technique is mainly used to treat skull base tumors. This device allows on the one hand an even more targeted irradiation and on the other hand a very high precision of treatment. Only a few centers, including ours, have this device in Belgium. 

The advent of new chemotherapeutic agents that are effective in the treatment of brain tumors has radically changed the treatment of these cancers. These chemotherapies can be administered concurrently with radiotherapy in the treatment of certain tumors or as an adjunct to it. They increase the survival of patients but also their quality of life.

Another revolution in the treatment of malignant brain tumors is the emergence of targeted therapies. Some drugs specifically destroy tumor cells by interacting with receptors expressed on tumor cells or their ligands (anti-EGF). Other molecules specifically target the vessels that feed the tumors (anti-VEGF).

Another axis of development is the identification of genetic signatures as prognostic and predictive factors of the response to chemotherapy (MGMT methylation, chromosomal loss: 1p19q).