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Tumours of the brain and skull 

Tumours of the brain and skull
Tumours of the brain and skull

Robert Grant

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date: 13 December 2019

Over the last 10 years, there have been several important advances in cell biology, molecular genetics, and targeted therapies in neuro-oncology. Improved neurosurgical techniques such as frameless stereotaxy, awake craniotomy, and intra-operative MRI, safer methods of directing radiotherapy, new chemotherapy approaches, and novel modalities of therapy provide optimism that there will eventually be some improvements in treatment-related morbidity and survival. There has also been an increasing change from individual clinician decision making to decision making by multidisciplinary teams of neurosurgeons, neurologists, clinical oncologists, neuropathologists, neuroradiologists, and specialist nurses with the aim of improving decision making, management planning across specialties, communication, and enrolment in suitable clinical trials. In addition, Good Clinical Practice guidelines, an international ethical and scientific quality standard for designing, conducting, recording, and reporting trials, increases the onus and responsibilities on clinical investigators to perform trials to the highest standard and to have the trials externally monitored, and the trial conduct and results audited. While these obligatory and statutory responsibilities are labour intensive and time consuming, they should improve the quality of trials by limiting the possibility of unintentional bias or fraud. Improving the recording of serious adverse event reporting through trial quality assurance and quality control procedures will help ensure that a balanced view of the effects of a drug or procedure is identified earlier than in the past. It will be interesting to see how research develops over the next decade.

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