Stuart A. Grossman, MD

In this article, we review the role of temozolomide in the management of patients with primary brain tumors, brain metastases, leptomeningeal carcinomatosis, and other selected CNS cancers.

This review describes the anatomy of the blood-brain barrier and currently available methods to quantify the entry of therapeutic compounds into the brain. It also summarizes data from a variety of approaches designed to improve drug delivery to the central nervous system.

In this article, we provide a brief overview of the management of grade II astrocytomas, oligodendrogliomas, and mixed oligoastrocytomas-the three most heavily encountered and studied of the low-grade gliomas.

Cancer causes pain as it invades bone, compresses nerves, produces obstructive symptoms in the pulmonary, gastrointestinal, and genitourinary systems, and distends involved visceral organs. This manuscript reviews progress in cancer pain management during the past 2 decades. Since the 1980s, we have seen (1) genuine advances in research on the biology of pain, (2) new approaches to the treatment of cancer pain, and (3) important changes in the health-care system to ensure that pain is appropriately assessed and managed. Currently, clinicians have the appropriate diagnostic and therapeutic tools to ensure that the vast majority of patients with cancer pain can be comfortable during their illness. Nevertheless, too many patients with terminal malignancies continue to die in pain in nations around the globe. An effective strategy to make alleviating pain a major health-care priority remains the primary challenge to effectively palliating patients with cancer pain.

The overall strategy for appropriatemanagement of cancerpain has been well described inalgorithms that are the result of cooperativeefforts by experts from manydisciplines and cancer centers withinNorth America.[1] Conceptually, theapproach to cancer pain is straightforward.The etiology of the pain mustbe evaluated rapidly, and importantaspects of the patient’s history andphysical examination that could influencetreatment approaches must beidentified. Therapeutic options availableto patients with cancer pain areextensive and, if properly applied, resultin prompt and excellent pain relieffor most patients.

Drs. Kochhar and coauthors areto be congratulated for providingconcrete examples ofopioid dosing errors that contributeto inadequate management of cancerpain. As the authors note, controllingcancer pain is far more complicatedthan the World Health Organization’sthree-step ladder of nonsteroidal antiinflammatorydrug (NSAID)/aspirin,codeine, and morphine would suggest.