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Medical management of patients with
brain tumors
Patrick Y. Wen1,*,
David Schiff2, Santosh Kesari1,
Jan Drappatz1, Debra C. Gigas1
and Lisa Doherty1
1Division
of Neuro-Oncology, Department of Neurology, Brigham and Women’s
Hospital and Center for Neuro-Oncology, Dana-Farber Brigham and
Women’s Cancer Center, SW430D, 44 Binney Street, Boston, MA 02115,
USA. 2Neuro-Oncology
Center, University of Virginia Health Sciences Center, Box 800432,
Charlottesville, VA 22908-0432, USA. *Correspondence: Patrick Y. Wen,
Email: pwen@partners.org, Phone: +1-617-632-2166, Fax:
+1-617-632-4773. -- Received: 20 April 2006 Accepted:
3 May 2006 Published online: 29 June 2006.
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The most common medical problems in brain
tumor patients include the management of seizures, peritumoral edema,
medication side effects, venous thromboembolism (VTE), fatigue and
cognitive dysfunction.
Despite their importance, there are
relatively few studies specifically addressing these issues.
There is increasing evidence that brain
tumor patients who have not had a seizure do not benefit from
prophylactic antiepileptic medications.
Patients on corticosteroids are at greater
risk of Pneumocystis jerovecii pneumonia and may benefit from
prophylactic therapy.
There is also growing evidence suggesting
that anticoagulation may be more effective than inferior vena cava IVC)
filtration devices for treating VTE in brain tumor patients and the
risk of hemorrhage with anticoagulation is relatively small.
Low-molecular weight heparin may be more
effective than coumadin. Medications such as modafinil and
methylphenidate have assumed an increasing role in the treatment of
fatigue, while donepezil and memantine may be helpful with memory
loss.
Keywords: Anticonvulsants, Corticosteroids, Pneumocystis
pneumonitis, Venous thromboembolic disease, Fatigue
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