Advances in precision diagnostics aid accurate detection of CNS tumors

Thanks to new methods of precision diagnostics, such as DNA sequencing and epigenetic analyses, it is becoming increasingly possible to identify specific central nervous system (CNS) tumors accurately and to provide targeted treatment. The Comprehensive Cancer Center (CCC) of MedUni Vienna and Vienna General Hospital is one of the top centers in the world for diagnosing and treating this type of tumor. CCC researchers have now been actively involved as authors in the latest edition of the World Health Organization (WHO) classification of CNS tumors. This work is regarded as the most important standard work on the classification of brain tumors and it has recently been published in the run-up to World Brain Tumor Day on 8 June.

The new reference work covers the entire spectrum of brain tumors in both children and adults. It describes and classifies the diseases, explains what causes them and therefore provides a basis for therapeutic decisions. A total of 122 authors from 19 different countries have contributed to the current issue of the WHO classification of CNS tumors. Austria was represented in this by two experts from the CCC: Johannes Hainfellner, acting director of MedUni Vienna's Clinical Institute for Neurology and Matthias Preusser, University Department of Internal Medicine I at MedUni Vienna and Vienna General Hospital.

Precise classification as a basis for successful treatment

This revised and expanded classification of brain tumors is therefore up-to-date and important, because, previously, tumors were classified purely on the basis of histological characteristics, without taking adequate account of new molecular changes. Hainfellner: "Using the methods of precision medical diagnostics, that is to say DNA sequencing and epigenetic analyses plus histology, it became increasingly clear that the known types of tumor can be divided into an expanding number of subtypes with different prognoses. The new methods allow us to determine the nature of the different diseases more precisely, along with their molecular causes. That allows more accurate application of the available therapies and better prognoses for the patients affected."

Service for the whole of Austria

The result of this increasingly accurate breakdown into subgroups is that there are now more and more (sub)types of tumor, each affecting fewer patients. Consequently, the individual tumor types become rare diseases. Preusser: "In the medium term this will result in the development of centers like ours, because very costly molecular-biological testing is required to arrive at valid diagnoses. These tests require experienced specialist staff with the appropriate know-how and also a huge array of expensive high-tech equipment."

Hainfellner adds: "Modern, advanced medical diagnosis of brain tumors relies heavily on the expertise of academic neuropathology. For this reason, smaller centers treating smaller numbers of cases and with standard pathology facilities without the benefit of university neuropathology have neither the requisite capacity nor the necessary routine." MedUni Vienna and Vienna General Hospital's CCC is therefore a central resource, providing a service to the whole of Austria.

Preusser: "Our center contributed to the current classification on various levels: directly as authors but also on a scientific level through its clinical and basic scientific preparatory work. It has not only provided input in relation to adult brain tumors but also to infantile brain tumors, thanks to the outstanding collaboration between the Working Group headed by Irene Slavc of the University Department of Paediatrics, Thomas Czech from the University Department of Neurosurgery, Christine Haberler from the Clinical Institute of Neurology, Walter Berger from the Institute for Cancer Research at MedUni Vienna and St. Anna's Children's Hospital."