[Brain tumor surgery in adults.] / Felnottkori agydaganatok sebészete.

Despite the advanced medical and radiation therapy, the role of surgical resection of brain neoplasms still remains indisputable. The maximal safe resection of benign brain tumors may result in complete recovery of the patient. Surgery of malignant tumors can resolve mass effect, improve the neurological condition of the patient providing the possibility for further complex oncotherapy based on molecular level histopathology results. The advances in technical and multidisciplinary environment of brain tumor surgery facilitate more radical and safer resection resulting in better outcomes and preservation of quality of life, even in case of tumors which were considered inoperable until recently. In this review we present the recent technical innovations used in brain tumor surgery and discuss the surgical strategy of the most common tumor types (gliomas, meningiomas, cranial nerve tumors and brain metastases). The surgical management of complex skull base tumors, pituitary tumors, as well as neuro-endoscopic surgery and pediatric brain tumors are discussed in other papers of this special issue.

The Solute Carrier MFSD1 Decreases the Activation Status of ß1 Integrin and Thus Tumor Metastasis.

Solute carriers are increasingly recognized as participating in a plethora of pathologies, including cancer. We describe here the involvement of the orphan solute carrier Major Facilitator Superfamily Domain-containing protein 1 (MFSD1) in the regulation of tumor cell migration. Loss of MFSD1 enabled higher levels of metastasis in experimental and spontaneous metastasis mouse models. We identified an increased migratory potential in MFSD1-/- tumor cells which was mediated by increased focal adhesion turnover, reduced stability of mature inactive ß1 integrin, and the resulting increased integrin activation index. We show that MFSD1 promoted recycling to the cell surface of endocytosed inactive ß1 integrin and thereby protected ß1 integrin from proteolytic degradation; this led to dampening of the integrin activation index. Furthermore, downregulation of MFSD1 expression was observed during the early steps of tumorigenesis, and higher MFSD1 expression levels correlate with a better cancer patient prognosis. In sum, we describe a requirement for endolysosomal MFSD1 in efficient ß1 integrin recycling to suppress tumor cell dissemination.

[Treatment-induced tumor-like lesions in the course of neurooncological therapy]. / Tumort utánzó barrierzavarok a neuroonkológiai terápia során.

The proper interpretation of imaging changes in the course of multimodal neurooncological therapy (neurosurgery, radiotherapy, chemotherapy, stereotactic radiosurgery) is crucial. The appearance of abnormal or new contrast-enhancing lesions does not indicate obvious tumor progression, in the contrary they are frequently induced by the oncological therapy itself. The differentiation of real tumor progression from therapy-induced lesions is essential, since the diagnosis of progressive disease results in the termination of the current regimen and initiation of second or third line therapy, if possible. The most common frequent therapy-induced tumor-like lesions include the followings: pseudoprogression seen at 1-3 months after the completion of concomittant radiochemotherapy of high-grade gliomas, real radiation necrosis which can develop even years after the completion of fractionated external beam radiotherapy of gliomas, and radiation necrosis seen after stereotactic radiosurgery delivered to metastatic brain tumors. The absorbable hemostatic materials applied to the wall of resection cavity during brain tumor surgery might cause delayed disturbancies in the blood brain barrier, inducing abnormal signal changes and contrast enhancement mimicking residual or recurrent tumor. Cerebrovascular ischemic lesions might cause cortical enhancement in the subacute stage, which may be misinterpreted as leptomeningeal tumor spread. The correct assessment of imaging findings requires special knowledge and multidisciplinary consultation, therefore the treatment and follow-up of brain tumor patients should be linked to brain tumor centers staffed by experts in the field of neurosurgery, neurooncology and brain tumor imaging.