• Independent researchers have identified mutations in the histone H3.3-coding gene H3F3A in a large proportion of pediatric cases of gliobastoma multiforme (GBM) and diffuse intrinsic pontine glioma (DIPG), an aggressive brainstem astrocytic tumor that occurs almost exclusively in children. (genengnews.com)
  • Diffuse intrinsic pontine glioma (DIPG) is a brainstem malignancy that occurs relatively rarely in childhood and young adulthood and carries a median survival of less than one year. (esmo.org)
  • Symptoms of a pontine glioma may start suddenly and get worse very quickly. (kidshealth.org)
  • High-grade gliomas of the brainstem, such as "typical diffuse intrinsic pontine glioma" (as well as histologically and genetically diagnosed "diffuse midline gliomas HR K27M mutated WHO-grade IV", as long as they are located in the brainstem), account for about one third of all HGG in children and teenagers. (gpoh.de)
  • Determine the concentration of interleukin-13 PE38QQR immunotoxin that produces histologic evidence of toxicity to tumor and the corresponding toxic effects of this drug when administered via continuous intratumoral infusion prior to second resection in patients with recurrent resectable supratentorial malignant glioma. (knowcancer.com)
  • Astrocytoma is the most common brain tumor (see image shown below), accounting for more than half of all primary CNS malignancies in children. (medscape.com)
  • Treatment of astrocytomas depends on the location and grade of the tumor. (medscape.com)
  • The most widely accepted grading schema for astrocytomas is the World Health Organization [WHO] that assigns a grade from I to IV based on the degree of anaplasia of tumor cells, proliferation index values and genetic alterations. (medscape.com)
  • Due to the uniqueness of the clinical material, we focused our attention on rare brain tumor types-ganglioglioma (GG) and pilocytic astrocytoma (PA). (hindawi.com)
  • However, they are both clinically and histologically heterogeneous, and tumor recurrence or anaplastic progression occurs in some cases [ 6 ]. (hindawi.com)
  • In summary, our data highlight MCT4 /SLC16A3 as a key gene for distinct hallmarks of tumor malignancy in glioma cells. (hindawi.com)
  • We investigated the impact on tumor malignancy in F98 glioma cells using in silico analysis, in vitro cell culture assays, and ex vivo vascular organotypic glioma impact model (VOGIM) [ 35 ] by implanting F98 cells into rat brain slices. (hindawi.com)
  • The most frequent type of brain tumor is Glioma from grade I to grade IV according to the rate of malignancy. (frontiersin.org)
  • Pediatric gliomas represent the most common brain tumor in children. (frontiersin.org)
  • Recent histopathological confirmation of WHO grade 3 AA - Received EBRT and temozolomide chemotherapy prior to first tumor progression or recurrence of WHO Grade 3 AA. (mycancergenome.org)
  • Gliomas also can be named according to the type of glial cells involved or the location of the tumor. (childrenshospital.org)
  • This concept has led to the proposal to simplify brain tumor classification to reflect the degree of anaplasia present by grading the tumors from grade I (benign) to grade IV (malignant). (medlink.com)
  • A tumor that develops in any area of the brain stem is called a brain stem glioma . (kidshealth.org)
  • A tumor that develops along this pathway is called an optic pathway glioma. (kidshealth.org)
  • Safe surgical resection is the primary treatment for all grades of gliomas, a category of brain tumor whose most malignant grades are considered to be cancer. (medscape.com)
  • The grade of a tumor may be used to tell the difference between slow-growing and fast-growing types of the tumor. (kaiserpermanente.org)
  • High-grade glioma (HGG) are the most frequent malignant primary brain tumor, which account for 80% of all gliomas in the United States, and are encountered with an annual incidence of 5.26 per 100,000 population, or 17,000 new cases diagnosed per year. (surgicalneurologyint.com)
  • The World Health Organization (WHO) classification of gliomas is used to define the type and grade of tumor, but the prognosis and response to treatment may vary among tumors even in the same subtype of tumor. (surgicalneurologyint.com)
  • In this study, we investigated the mRNA expression and association between TERT and GABPA/B isoforms in tumor samples of different glioma grades. (oncotarget.com)
  • Furthermore they fail to provide physiologic and functional information that is crucial for tumor grading, predicting clinical outcome and response to therapy. (radiologykey.com)
  • Diffusion tensor imaging (DTI) is an advanced MR technique that describes the movement of water molecules, useful to study microstructural differences among different tumor types and grades. (radiologykey.com)
  • Perfusion MR imaging can play an important role in determining the malignancy grade of brain tumor. (radiologykey.com)
  • Surgical resection is the primary treatment for all tumor grades. (medscape.com)
  • Compared to grade II tumors, anaplastic astrocytomas are more cellular, demonstrate more atypia, and mitoses are seen. (wikipedia.org)
  • WHO grade I tumors include pilocytic astrocytomas and subependymal giant cell astrocytomas. (medscape.com)
  • WHO grade II tumors include diffuse astrocytomas, oligodendrogliomas and pleomorphic xanthoastrocytomas. (medscape.com)
  • WHO grade III tumors include anaplastic astrocytomas and anaplastic pleomorphic xanthoastrocytomas. (medscape.com)
  • Most astrocytomas are indolent low-grade (ie, WHO grade I-II) tumors for which surgical resection alone is sufficient to cure. (medscape.com)
  • The prognosis decreases for low-grade tumors in unresectable locations and remains very poor for high-grade astrocytomas in spite of the addition of radiotherapy and chemotherapy. (medscape.com)
  • Gangliogliomas are generally benign WHO grade I tumors, most commonly located in the temporal lobes of children and young adults. (hindawi.com)
  • PAs are a distinct histologic and biologic subset of gliomas that account for approximately 5.1% of all these tumors. (hindawi.com)
  • Almost all are generally considered WHO grade I tumors [ 8 ]. (hindawi.com)
  • Monocarboxylate transporter 4 (MCT4, SLC16A3 ) is elevated under hypoxic conditions in many malignant tumors including gliomas. (hindawi.com)
  • Malignant gliomas are the most common primary malignant brain tumors with an increasing incidence of up to nine per 100,000 habitants over the last years [ 1 , 2 ]. (hindawi.com)
  • The incidence of brain tumors in children is about 5 cases per 100,000 population, 75% of which are classified as gliomas ( 2 ). (frontiersin.org)
  • Clinical trials to date have benefited only limited subsets of patients, accentuating the fact that pediatric high-grade gliomas (HGGs) constitute an extremely heterogeneous group of highly aggressive brain tumors. (frontiersin.org)
  • In the present study, MDR1 P-gp was immunodetected by Western blot analysis in 60 human brain tumors, including meningiomas, schwannomas, low-grade gliomas (astrocytomas, pilocytic astrocytomas) and high-grade gliomas (anaplastic astrocytomas, glioblastomas and anaplastic oligodendrogliomas). (nih.gov)
  • This phase I trial studies the side effects and the best dose of wild-type reovirus (viral therapy) when given with sargramostim in treating younger patients with high grade brain tumors that have come back or that have not responded to standard therapy. (mayo.edu)
  • Integrated histopathologic and molecular characterization of brain tumors such as gliomas should be standard practice. (jnccn.org)
  • Pediatric-type diffuse high-grade gliomas continue to be one of the most difficult types of brain tumors to treat in children, given their infiltrative nature and low probability of successful gross total resection. (medlink.com)
  • Recognizing that brain tumors contained heterogeneous cell populations, gliomas were classified based on the morphological appearance and presumed histogenesis of the predominant cell type. (medlink.com)
  • Anaplastic astrocytomas are a historical term used to denote histological grade III diffuse astrocytic tumors (regardless of molecular markers). (radiopaedia.org)
  • The key features present in anaplastic astrocytomas that were absent in low-grade tumors were mitotic activity and cellular pleomorphism. (radiopaedia.org)
  • The key to distinguishing anaplastic astrocytomas from low-grade tumors was the presence of enhancement which should generally be absent in the latter 1 . (radiopaedia.org)
  • Tumors in the pons are called pontine gliomas (or diffuse intrinsic pontine gliomas, DIPG). (kidshealth.org)
  • Midbrain tumors may cause eye symptoms similar to pontine gliomas, along with headaches and vomiting. (kidshealth.org)
  • According to the 2007 World Health Organization(WHO) classification of tumors of the central nervous system, the WHO defines diffusely astrocytic tumors with cytological atypia as grade II (diffuse astrocytoma), those also showing anaplasia and mitotic activity as grade III (AA), and tumors additionally showing microvascular proliferation and/or necrosis as WHO grade IV. (upmc.edu)
  • The expression of GFAP is used to distinguish astrocytic neoplasms from epithelial or mesenchymal tumors that may on occasion mimic a glioma [3]. (upmc.edu)
  • The worse prognosis of advanced high grade gliomas always promotes the clinicians to evolve the new approaches to deal with these types of aggressive tumors. (world-sci.com)
  • The most common primary brain tumors are gliomas. (sheclick.com)
  • Recently, the treatment of newly diagnosed anaplastic glioma (AG) has changed, particularly in patients with 1p19q codeleted tumors. (surgicalneurologyint.com)
  • Gliomas are the most common primary tumors of the central nervous system (CNS). (oncotarget.com)
  • Gliomas are primary tumors that originate in brain parenchyma. (msdmanuals.com)
  • Астроцитоми Astrocytomas are central nervous system tumors that develop from astrocytes. (msdmanuals.com)
  • The current World Health Organization (WHO) classification of primary brain tumors lists GBM as a grade IV astrocytoma . (medscape.com)
  • Among primary brain tumors, malignant astrocytomas are the most common in all age groups. (medscape.com)
  • The growth rate and mean interval between onset of symptoms and diagnosis is approximately 1.5-2 years but is highly variable, being intermediate between that of low-grade astrocytomas and glioblastomas. (wikipedia.org)
  • Unlike glioblastomas (WHO grade IV), anaplastic astrocytomas lack vascular proliferation and necrosis on pathologic evaluation. (wikipedia.org)
  • The St. Jude-Washington University team reports its findings in Nature Genetics in a paper titled "Somatic histone H3 alterations in pediatric diffuse intrinsic pontine gliomas and nonbrainstem glioblastomas. (genengnews.com)
  • Unlike glioblastomas, anaplastic astrocytomas lacked frank necrosis 1 . (radiopaedia.org)
  • Compared to glioblastomas, there were relatively few trials looking at treatment regimens for anaplastic astrocytoma 3 . (radiopaedia.org)
  • As is the case with everything about anaplastic astrocytomas, the prognosis was also intermediate between low-grade astrocytomas and glioblastomas. (radiopaedia.org)
  • This is an Open Access article distributed under the terms of the Creative Commons grade II and III gliomas are not as common as glioblastomas. (bvsalud.org)
  • All GA-binding proteins progress through the glioma grades and have the highest expression levels in secondary glioblastomas. (oncotarget.com)
  • The present study confirms the upregulation of TERT in primary glioblastomas while all GABP proteins rise with the malignancy of the gliomas. (oncotarget.com)
  • Anaplastic astrocytomas, in particular, can later evolve into glioblastomas (called secondary glioblastomas). (msdmanuals.com)
  • 80%) in secondary glioblastomas that have progressed from low-grade or anaplastic astrocytomas. (who.int)
  • mutations high frequency of IDH1/2 mutations in oligodendrogliomas, astrocytomas and in alteRations in the RB1 pathway in The TET2 gene encodes the -KG- secondary glioblastomas derived thereof low-gRade diffuse gliomas lacking dependent enzyme that catalyses suggests that these tumours share a common genetic alteRations the conversion of 5-methylcytosine to common progenitor cell population. (who.int)
  • Anaplastic astrocytomas fall under the category of high grade gliomas (WHO grade III-IV), which are pathologically undifferentiated gliomas that carry a poor clinical prognosis. (wikipedia.org)
  • PMAs have a tendency to disseminate and, in some reports, have a worse prognosis compared with pilocytic astrocytomas. (medscape.com)
  • Despite advances in surgical techniques and multimodal treatment regimens with radio-, chemo-, and immunotherapy [ 3 - 5 ], the prognosis for malignant glioma patients is very poor with a median survival time of approximately 15 months after diagnosis [ 6 , 7 ]. (hindawi.com)
  • In recent years, thanks to the study of genetic variants, significant information associated with the prognosis and clinical course of glioma has been acquired. (frontiersin.org)
  • The current WHO classification of human astrocytomas has limitation in predicting prognosis and diagnosis. (upmc.edu)
  • Molecular characterization and Biomarkers are becoming increasingly important in the management of HGG especially with respect to anaplastic glioma (AG) that have refined prognosis and increasingly are predictive with respect to treatment. (surgicalneurologyint.com)
  • 1p/19q codeletion and IDH1/2 mutation identified a subtype of anaplastic oligoastrocytomas with prognosis as favorable as anaplastic oligodendrogliomas. (cdc.gov)
  • Correlation of IDH1/2 mutation with clinicopathologic factors and prognosis in anaplastic gliomas: a report of 203 patients from China. (cdc.gov)
  • Oligodendrogliomas (WHO grade II) are among the slowest-growing gliomas. (msdmanuals.com)
  • Like astrocytomas, oligodendrogliomas can evolve into more aggressive forms, such as anaplastic oligodendrogliomas (WHO grade III), which are managed accordingly. (msdmanuals.com)
  • Multidisciplinary management of adult anaplastic oligodendrogliomas and anaplastic mixed oligo-astrocytomas. (medscape.com)
  • WHO grades I-IV have extremely different 5-year survival rates up from 95% for grades I and II gliomas to 15-35% for grade IV gliomas or even less than 1% for DIPG ( 3 ). (frontiersin.org)
  • DIPG, which are usually diagnosed by imaging, frequently turn out as "diffuse midline gliomas histone 3 K27M-mutated (WHO-grade III)" based on their histology and molecular biological characteristics and are, therefore, classified by the WHO as an entity of their own. (gpoh.de)
  • Current treatments for gliomas use chemotherapy, radiotherapy, tyrosine kinase inhibitors, monoclonal antibodies and surgery, but each of the treatment strategies has several serious side effects. (frontiersin.org)
  • The purpose of this study is to compare the efficacy and safety of eflornithine in combination with lomustine, compared to lomustine taken alone, in treating patients whose anaplastic astrocytoma has recurred/progressed after radiation and temozolomide chemotherapy. (mycancergenome.org)
  • Conventional therapy for malignant gliomas consists primarily of surgical debulking followed by radiation therapy and possibly chemotherapy. (jnccn.org)
  • In this article, we summarize these trials and discuss ongoing clinical trials involving implantable chemotherapy-containing polymers in the treatment of patients with malignant gliomas. (jnccn.org)
  • Because the brain stem is an area of the brain where surgery can be difficult, brain stem gliomas are often treated with radiation therapy (high-energy X-rays that kill cancer cells) and/or chemotherapy . (kidshealth.org)
  • Optic pathway gliomas are usually treated with chemotherapy, although radiation also can be used. (kidshealth.org)
  • High-grade glioma (HGG) are optimally treated with maximum safe surgery, followed by radiotherapy (RT) and/or systemic chemotherapy (CT). (surgicalneurologyint.com)
  • Weller M. Chemotherapy for low-grade gliomas: when? (medscape.com)
  • based on histological criteria, the World Health Organization (WHO) introduced a malignancy classification system grading from I to IV ( 1 ). (frontiersin.org)
  • All studies show increasing value of Ki-67/MIB-1 labeling index with increasing grade of malignancy. (upmc.edu)
  • Various types of high-grade gliomas (HGG) have been identified based on their localization within the central nervous system (CNS), the cell of origin and the degree of malignancy. (gpoh.de)
  • These gliomas can be further subgrouped based on their histological and molecular characteristics, which provide inside into their origin and degree of malignancy. (gpoh.de)
  • Although its cells are frequently of low-grade malignancy, this tumour is classified as a highly malignant glioma because of its distinct growth pattern. (gpoh.de)
  • Prognostic significance of histomolecular subgroups of adult anaplastic (WHO Grade III) gliomas: applying the 'integrated' diagnosis approach. (cdc.gov)
  • Seizures are less common among patients with anaplastic astrocytomas compared to low-grade lesions. (wikipedia.org)
  • The impact of concurrent temozolomide with adjuvant radiation and IDH mutation status among patients with anaplastic astrocytoma. (cdc.gov)
  • High-grade gliomas originate from a malignant transformation of glial cells (glia). (gpoh.de)
  • Several phase III clinical trials show that implantation of carmustine-containing biodegradable polymers prolongs survival in patients with both recurrent and newly diagnosed malignant gliomas. (jnccn.org)
  • Each year, about 60 to 80 children and adolescents younger than 15 years of age are newly diagnosed with a high-grade glioma in Germany. (gpoh.de)
  • This MRI shows a pilocytic astrocytoma of the cerebellum. (medscape.com)
  • In the present study, we aim to determine the prevalence of BRAF V600E mutations in a series of ganglioglioma (GG) and pilocytic astrocytoma (PA) cases. (hindawi.com)
  • Most high-grade gliomas occur sporadically or without identifiable cause. (wikipedia.org)
  • Determine the efficacy of talampanel, in terms of 6-month progression-free survival, in patients with recurrent high-grade gliomas. (knowcancer.com)
  • Genomic research of high grade glioma (HGG) has revealed complex biology with potential for therapeutic impact. (nih.gov)
  • In this article, the authors present a comprehensive review of the basic principles and practices underlying the causes, diagnosis, treatment, and outcomes of pediatric-type diffuse high-grade glioma. (medlink.com)
  • Molecular characterization of pediatric-type diffuse high-grade glioma is explored. (medlink.com)
  • There are four distinct subtypes of pediatric-type diffuse high-grade glioma with different, distinct characteristics. (medlink.com)
  • Given the involvement of various parts of the brain by pediatric-type diffuse high-grade gliomas, the presenting symptoms vary greatly. (medlink.com)
  • however, this is not universally true of diffuse pediatric high-grade gliomas. (medlink.com)
  • Most cases in the literature were diagnosed of AVM pre-operatively and then coexistence of high grade glioma was noted in the pathology examination. (upmc.edu)
  • High grade astrocytoma is impressed according to the result of high MIB-1/Ki-67 labeling index and strongly positive reaction with GFAP. (upmc.edu)
  • The high-grade gliomas have an incidence of 6.03/100,000. (archive.org)
  • To describe the role of gamma knife radiosurgery in the management of patients with recurrent or unresectable high-grade gliomas. (world-sci.com)
  • During a 15-months interval, 54 patients underwent gamma knife stereotactic radiosurgery as part of multimodal treatment of their recurrent or unresectable high-grade gliomas. (world-sci.com)
  • Gamma Knife radiosurgery is a useful adjunctive intervention in the management of recurrent or unresectable high grade gliomas to have better local controls and increased time to progression of disease with lower complication rates. (world-sci.com)
  • This phase I trial studies the side effects and best dose of ubidecarenone injectable nanosuspension (BPM31510) in treating patients with high-grade glioma (anaplastic astrocytoma or glioblastoma) that has come back and have been previously treated with bevacizumab. (stanford.edu)
  • High grade gliomas foster an environment rich in angiogenic factors that promote neovascularity. (the-medical-dictionary.com)
  • Highly malignant or high-grade gliomas (HGG) are tumours of the central nervous system (CNS). (gpoh.de)
  • High-grade gliomas in children and adolescents are rare. (gpoh.de)
  • By being able to migrate within the central nervous system for various centimetres, high-grade gliomas can induce the development of new tumours. (gpoh.de)
  • Without the appropriate therapy, high-grade gliomas can be lethal within only a few months. (gpoh.de)
  • High-grade gliomas account for approximately 15 to 20 % of CNS tumours in children and adolescents. (gpoh.de)
  • About two thirds of high-grade gliomas are usually found in other parts of the CNS, especially in the cerebral cortex. (gpoh.de)
  • High-grade malignant glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. (medscape.com)
  • High-grade astrocytomas (HGAs) are slightly more common in whites than in blacks, Latinos, and Asians. (medscape.com)
  • Based on the hypothesis that cancer cells may not be able to metabolize ketones as efficiently as normal brain cells, the ketogenic diet (KD) has been proposed as a complementary or alternative therapy for treatment of malignant gliomas. (biomedcentral.com)
  • Advances in the treatment of malignant gliomas. (medscape.com)
  • Under the modified WHO classification, GBM differs from anaplastic astrocytomas (AA) by the presence of necrosis under the microscope. (medscape.com)
  • [ 1 ] Astrocytoma is one of 3 distinct types of gliomas in the brain, although mixed cell types occur as well. (medscape.com)
  • Astrocytomas comprise a wide range of neoplasms that differ in their extent of invasiveness, morphological features, tendency for progression, and clinical course. (medscape.com)
  • In contrast, certain molecular features are favorable prognostic markers in grade II-III gliomas: 1p19q codeletion correlates with greatly improved progression-free and overall survival, and the presence of an IDH mutation is a strongly favorable prognostic marker for overall survival. (medscape.com)
  • MGMT promoter hypermethylation is a frequent, early, and consistent event in astrocytoma progression, and not correlated with TP53 mutation. (cdc.gov)
  • To this end they sequenced the H3F3A gene in 784 glioma samples of different grades and histological diagnoses and from patients of all ages. (genengnews.com)
  • IDH1/2 mutations are the histological classification and avoids the TeT2 pRomoteR methylation in low- most significant predictor of favourable ambiguity inherent to the diagnosis of gRade diffuse gliomas lacking idh1/2 outcome of glioblastoma patients. (who.int)
  • Enhanced expression of TERT in gliomas is a result of two hotspot mutations, C228T and C250T, at the promoter region. (oncotarget.com)
  • In addition, the majority of diffuse astrocytomas (about 60%) carry TP53 mutations, which constitute a prognostic marker for shorter survival. (who.int)
  • IDH1 mutations in diffusely infiltrating astrocytomas: grade specificity, association with protein expression, and clinical relevance. (cdc.gov)
  • Inclusion Criteria: Patients must meet all of the following inclusion criteria to be eligible for participation in this study: - Surgical or biopsy-proven diagnosis of WHO grade 3 AA. (mycancergenome.org)
  • A biopsy was done and the diagnosis was Grade III anaplastic astrocytoma. (cancer.org)
  • Previously reported long-term survivors of GBM may be patients diagnosed with GBM who actually harbor low-grade glioma, pleomorphic xanthoastrocytoma, ganglioglioma, or other lesions. (medscape.com)
  • Management of diffuse low-grade cerebral gliomas. (medscape.com)
  • 90%) low-grade diffuse gliomas DNA demethylation. (who.int)
  • Immunohistochemical profiles of IDH1, MGMT and P53: practical significance for prognostication of patients with diffuse gliomas. (cdc.gov)
  • The frequency and prognostic effect of TERT promoter mutation in diffuse gliomas. (cdc.gov)
  • However, a small proportion (less than 5%) of persons with malignant astrocytoma have a definite or suspected hereditary predisposition. (wikipedia.org)
  • Surgery is recommended for grade II with maximal safe resection. (medscape.com)
  • Although temozolomide is effective for treating recurrent anaplastic astrocytoma, its role as an adjuvant to radiation therapy has not been fully tested. (wikipedia.org)
  • IDH1 mutation and MGMT methylation status predict survival in patients with anaplastic astrocytoma treated with temozolomide-based chemoradiotherapy. (cdc.gov)
  • Resection (all patients): Patients undergo maximal resection (en bloc, if feasible) followed by placement of 2-3 peritumoral catheters (4 days after completion of pre-resection infusion for the initial cohorts of patients and at study entry for subsequent cohorts of patients). (knowcancer.com)
  • I got graded a III after they said my AA was originally a II so craniotomy and complete resection was done. (cancer.org)
  • Alfredo Quinones-Hinojosa, Thomas Kosztowski, Henry Brem (2011) Malignant Gliomas. (upmc.edu)
  • Pilocytic astrocytomas (ie, WHO grade I) arise throughout the neuraxis, but preferred sites include the optic nerve, optic chiasm/hypothalamus, thalamus and basal ganglia, cerebral hemispheres, cerebellum, and brain stem. (medscape.com)
  • Johannessen AL, Torp SH (2006) The clinical value of Ki-67/MIB-1 labeling index in human astrocytomas Pathol Oncol Res Epub 200612:143-7. (upmc.edu)
  • DMBT1 homozygous deletion in diffuse astrocytomas is associated with unfavorable clinical outcome. (cdc.gov)
  • In general, these are tumours that are classified as WHO-grade III or WHO-grade IV according to the grading system of the World Health Organization (WHO classification). (gpoh.de)
  • Typical median survival for anaplastic astrocytoma is 2-3 years. (wikipedia.org)
  • Glutathione S-transferase polymorphisms are associated with survival in anaplastic glioma patients. (cdc.gov)
  • Anaplastic astrocytomas have also been associated with previous exposure to vinyl chloride and to high doses of radiation therapy to the brain. (wikipedia.org)