Andrew Lin

Is there a role for early chemotherapy in the management of pituitary adenomas

Pituitary adenomas are benign intracranial neoplasms that are frequently well-controlled with standard treatments that include surgical resection, radiotherapy, and agents that modulate hormonal excess. Unfortunately, a subset of patients remains uncontrolled or develops complications from these interventions. For these patients, chemotherapy is an additional treatment option that could improve outcomes. Temozolomide is an oral chemotherapy with a favorable side-effect profile that has shown activity against pituitary adenomas. Its non-overlapping toxicity and ability to induce rapid tumor regression renders it a potentially important adjunctive treatment. In patients with tumors that cannot be optimally addressed with standard treatments, there may be a role for early initiation of temozolomide.

Neurologic Emergencies in the Patients With Cancer: Diagnosis and Management

Neurologic complications of cancer are common and are frequently life-threatening events. Certain neurologic emergencies occur more frequently in the cancer population, specifically elevated intracranial pressure, epidural cord compression, status epilepticus, ischemic and hemorrhagic stroke, central nervous system infection, and treatment-associated neurologic dysfunction. These emergencies require early diagnosis and prompt treatment to ensure the best possible outcome and are best managed in the intensive care unit. This article reviews the presentation, pathophysiology, and management of the most common causes of acute neurologic decompensation in the patient with cancer.

The Prevalence and Impact of Neurological Disease in Cancer

Advancements in treatment have improved life expectancy for many patients with cancer; as a consequence, cancer patients are acquiring more neurologic symptoms over the course of their disease. Neurologic complications of cancer are common and frequently treatable when the problem is diagnosed both correctly and expeditiously. Neurooncology developed into a subspecialty of neurology to address this need; it deals with the neurologic complications of primary central nervous system and systemic cancers, which manifest as neurologic deficits or pain, and occur as a direct complication of cancer itself, the indirect activity of cancer on the nervous system, or as a consequence of treatment toxicity.