What We treat

Gliomas

Gliomas are ‘primary’ brain tumors, which means they are derived from the brain tissue itself. Common subtypes include astrocytoma, oligodendroglioma, glioblastoma, and gliosarcoma. All gliomas are graded based upon World Health Organization (WHO) criteria:

Grade I: Slow-growing tumor cells; almost normal appearance; least aggressive 
Grade II: Relatively slow-growing cells; slightly abnormal appearance; can invade nearby tissue; may recur as a higher-grade tumor 
Grade III: Faster-dividing cells; abnormal appearance; infiltrates normal tissue 
Grade IV: Rapidly-dividing and abnormal cells; contains necrotic areas of nonviable tissue

Grade II, III, and IV gliomas are most common in adults. Grade IV gliomas (known as glioblastomas or gliosarcomas) are the most common primary brain cancer in adults. Glioblastoma is a rapidly growing tumor that can occur at any age, but its incidence increases with advanced age. Grades I, II, and III gliomas are less aggressive and often seen in younger populations, yet can still recur and defy conventional therapies. All gliomas cause symptoms through a combination of mass effect on the surrounding brain and direct infiltration of the brain tissue.

A primary focus of the Ivy Brain Tumor Center is gliomas.

Grade II, III, and IV gliomas are most common in adults. Grade IV gliomas (known as glioblastomas or gliosarcomas) are the most common primary brain cancer in adults. For this reason, our clinical trials cover all grades and subtypes of adult gliomas.

Brain Metastases

Brain metastases, or ‘secondary’ brain tumors, originate from cancer in another part of the body. Up to 40% of systemic cancer patients develop brain metastases, which most commonly occur in middle-aged adults. These tumors can present as solitary masses or as multiple lesions in the brain. As metastatic brain tumors grow, they create pressure on and change the function of surrounding brain tissue. Any cancer can spread to the brain, but the most common sources of brain metastases are cancers from the lung, breast, colon, kidney, and skin. Ivy Brain Tumor Center clinical trials target a variety of metastatic tumors, with entry criteria in some studies restricted to the cancer-of-origin and, in other studies, determined purely by the genetic abnormalities of the tumor, irrespective of its origin.

Meningiomas

Meningiomas are also ‘primary’ brain tumors and they are derived from the lining of the brain (known as the meninges). Unlike gliomas, meningiomas are categorized by the WHO into grades I, II, and III. A grade I meningioma, which is the most common type, is a slow-growing tumor that can be cured if it is completely removed by surgery. Grades II and III meningiomas are less common, but can grow quickly and are likely to spread within the brain despite maximal treatment. Most patients with a meningioma will have a tumor at only one site, but it also is possible to have several tumors growing simultaneously in different parts of the brain. Meningiomas can dirtectly infiltrate the brain tissue, but their symptoms are most often due to their mass effect on the brain. As with gliomas, these tumors are defined by their genetic aberrancies. Accordingly, our clinical trial criteria are driven by specific molecular signatures associated with aggressive meningiomas, rather than the grade or histological subtype. 

Ependymomas

Ependymomas arise from the ependymal cells that line the ventricles of the brain and the center of the spinal cord. They are relatively rare in adults, accounting for 2-3% of ‘primary’ brain tumors. These tumors are graded as follows:

Grade I: Very slow-growing tumors. Subtypes include subependymomas and myxopapillary ependymomas. 
Grade II: Intermediate growth rate. Further divided into other subtypes, including cellular ependymomas, papillary ependymomas, clear cell ependymomas, and tancytic ependymomas.
Grade III: Faster-dividing cells; abnormal appearance; infiltrates normal tissue 
Grade IV: 
Faster-growing tumors also known as anaplastic ependymomas. While less common than grade II ependymomas, these are more likely to recur despite maximal therapy.

Clinical trials for ependymomas are uncommon and there are no proven therapies beyond surgery and radiotherapy. For these reasons, the Ivy Brain Tumor Center places a particular emphasis on cultivating experimental therapy options within our clinical trials portfolio for this underserved patient population.

Craniopharyngiomas

A craniopharyngioma is a tumor arising from small nests of cells near the pituitary stalk at the base of the skull, near the pituitary gland, third ventricle, and optic nerve. Like most brain tumors, the exact cause of craniopharyngioma is not known. Craniopharyngiomas represent 2-5% of all primary brain tumors in adults.  This tumor tends to be found in two age groups—patients up to age 14 and patients over age 45. They are more common in African-American patients. Although these tumors are designated as grade I by the WHO, their clinical course is far from benign. Symptoms arise from increased pressure on the optic tract and pituitary gland, leading to visual impairment, endocrine dysfunction, and obesity. Since there are limited treatment options, clinical trials are an important part of managing this group of patients, yet there are very few options nationwide.  

Pineal-Region Tumors

Tumor types occurring in the pineal region of the brain may or may not involve the pineal gland. True pineal cell tumors are defined as pineocytoma, pineoblastoma, and mixed pineal tumors. Pineocytomas are slow-growing, WHO grade II tumors with a typically cystic appearance. Mixed, or intermediate-grade, pineal-region tumors can be WHO grade III and are more aggressive. Pineoblastomas are WHO grade IV tumors that are the most aggressive variety. Pineal-region tumors represent less than 1% of all primary brain tumors. These tumors tend to occur in young adults between 20 and 40 years old. Approximately 10-20% of these tumors, particularly pineoblastomas, have the potential to spread through the cerebrospinal fluid to other areas of the brain and spine. Like most brain tumors, the exact cause of pineal-region tumors is not known. Other tumors may occur in this region, but are not necessarily pineal tumors. These include: germinoma, non-germinoma (e.g., teratoma, endodermal sinus tumor, embryonal cell tumor, choriocarcinoma, and mixed tumors), meningioma, astrocytoma, ganglioglioma, and dermoid cysts. Clinical trials for pineal-region tumors are uncommon, but since there are no proven therapies beyond surgery and radiotherapy, developing new drugs for these patients is critical.

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