Central nervous system

Primary central nervous system tumors (CNS) make up for a heterogeneous group of neoplasms for clinical and biological behavior. The causes remain to be defined. Inherited predisposition to glioma is suggested by a number of rare inherited cancer syndromes, such as Turcot's and Li-Fraumeni syndromes and neurofibromatosis, which however, even collectively, account for <5% of glioma cases. CNS tumors differ in many ways from other tumors. First, these tumors are separated by an important natural barrier, the blood-brain barrier, with the aim of defending the CNS from external noxa but, in the case of cancer, limiting the efficacy of therapy. Second, the tumors of the CNS are malignant not only because of their biological behavior but because of their localization. Even very small and slow-growing tumors localized at important regions of the brain, like the brain stem, can have serious, deleterious, and fatal impact. Finally, tumors of the CNS have a direct impact on the quality of life of patients, with long-term disabling effects on everyday life. Therefore, tumors of the CNS require early diagnosis and a rapid multidisciplinary approach to choose optimal treatment. In these cases, special attention must be taken to select chemotherapies and targeting agents that do cross the blood-brain barrier. The focus of this chapter is side effects from chemotherapies used to treat a wide variety of tumors, from gliomas to metastatic (meningeal disease) lesions from other organs. This chapter will discuss main complications from the treatment of CNS disease (glioma, medulloblastoma, and carcinomatous meningitis), specifically from radiotherapy, from cytotoxic, from targeted anticancer therapy, from immunotherapy, and from supportive care measures.