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Despite significant advances in cancer research and treatment, one form of cancer - brain tumors - remain particularly feared, and for good reason. Because of their location, brain tumors can severely impact an individual's personality, memories and basic motor skills, robbing the patient of their very being. The impact on family and friends is felt greatly, as their loved one may be *lost* to them even earlier than feared. While there are more than 120 types of brain tumors, for the most common and serious adult tumors, Glioblastoma multiforme (GBM), the chances of living 5 years is less than 3%. Most patients will live no more than a year or two despite aggressive therapy.

However, few maladies manage to both simultaneously confound researchers in their mystery, yet hold such promise for the cure and management as prominently as brain tumors. There is strong belief that some significant breakthroughs in brain tumor treatment may only be 4-6 years away. Complementing traditional chemotherapeutic and surgical approaches, four emerging breakthroughs are discussed here which are rapidly transforming the treatment of brain tumors and related conditions.

Gene Therapy

Gene therapy approaches involve the insertion of genes into growing brain tumors, rendering them more sensitive to some chemotherapeutic agents that are relatively non-toxic to the rest of the body. Some promising experiments have demonstrated that with insertion of genes into animal brain tumor cells and administration of chemotherapy, complete destruction of the tumor may be possible without spread of the tumor. Other approaches in gene therapy include substitution of abnormal genes for normal genes, the repair of abnormal genes via selective reverse mutation, and gene regulation (i.e., altering the instructions within a gene to *turn on or off*).

Vaccines

One area showing substantial promise in brain tumor treatment is based on an immunotherapeutic approach; that is, using a patient's immune system as an instrument for cancer therapy. This approach is premised on a body's immune response toward cells bearing tumor markers or antigens. One major focus area has been *active immunotherapy*, described as the administration of the tumor antigenic material to help *vaccinate* a patient against their own tumor. Other vaccine approaches, including Dendritic cell-based vaccines, Cytokine immunogene therapy, Bacterial and viral tumor vaccines, and GBM-specific molecular pathway vaccines are also being considered. The vaccine approach holds challenges that need to be evaluated against other treatment options that may require crucial patient choices, but they are continuing to emerge as an area of significant promise.

Stereotactic Radiosurgery/Radiotherapy

There is growing usage of stereotactic radiosurgery and radiotherapy among neurosurgeons. The tools, used for the non-invasive treatment of tumors and other brain, head, spine and neck conditions, use sophisticated mechanical systems and image-guided technology to treat tumors, using high, targeted doses of radiation (in a single session) to attack the tumor and minimizing contact with healthy tissue. The image guidance systems direct the radiation to the tumor; some systems shape the radiation beam to map to the exact shape of the tumor, and software can help direct the ideal access points to the tumor.

Dual Agent Drug Therapies

Some of the field's leading researchers have concluded that traditional treatment for many brain tumors has started with a faulty premise; namely, that interventions for brain tumors were simply a palliative effort designed to decrease patient discomfort and increase stabilization. The conclusion is that while these therapies have shown some success on their own, when multiple therapeutic agents are combined, (an approach more commonly used with cancers not as fatal) an increasing number of brain tumor patients are seeing increases in survival. Also, newer drugs are showing the ability to block the growth of tumors by attempting to interfere with their proteins that control tumor growth. And other, specialized treatment regimens are being formulated for patients whose tumors are shown to grow at an accelerated rate compared with typical tumors.

These are but four of the emerging approaches where we may continue to see major breakthroughs in treatment or management of brain tumors. The hope in all these courses is that ultimately, brain tumors may in some cases be curable or at least achieve status as a manageable disease, as with many other serious and chronic conditions such as diabetes.