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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Brain Tumor - October 2001
National Cancer Institute®
Last Modified: November 21, 2001
Table of Contents
1
UI - 20250008
AU - Batchelor T
TI -
Temozolomide for malignant brain tumours.
SO - Lancet 2000 Apr 1;355(9210):1115-6
AD - Brain Tumor Center, Massachusetts General Hospital, Boston 02114, USA.
2
UI - 20520898
AU - Osoba D
TI -
Effects of temozolomide in malignant brain tumours.
SO - Lancet 2000 Jul 22;356(9226):342
3
UI - 21428317
AU - Orlov IuA; Zentani S
TI -
[Postoperative mutism in children with the posterior fossa tumors]
SO - Zh Vopr Neirokhir Im N N Burdenko 2001 Jan-Mar;(1):6-9; discussion 10
Over 10 years (1990-1999), the Pediatric Department, Ukrainian Institute
of Neurosurgery named after Academician A. P. Romodanov, operated on 376
children with posterior fossa tumors. Thirty two 8.7% children developed
a posterior fossa syndrome and cerebellar mutism syndrome
postoperatively. This paper gives a detailed analysis of the date
available in the world literature on the incidence and causes of mutism,
and mechanisms of its development. Many factors predisposing to mutism
were identified, but no anatomic structures responsible for its
formation were found. In the authors' opinion, mutism may not result
from anatomic structures, but from the functioning of afferent or
efferent connections to this brain region bilaterally.
4
UI - 21236056
AU - Ozkose Z; Yardim S; Yurtlu S; Dogulu F; Kaymaz M; Pasaoglu A
TI -
The effects of intravenous fentanyl and lidocaine infiltration on the
hemodynamic response to skull pin placement.
SO - Neurosurg Rev 2001 Mar;24(1):35-7
AD - zerrinoz@hotmail.com
The aim of this study was to evaluate the effects of intravenous
fentanyl and local lidocaine infiltration on the hemodynamic response to
Mayfield skull pin head holder (MH) placement. Forty-five patients
scheduled for elective craniotomy were studied. They were randomly
divided into three groups. Group F received fentanyl 2 microg/kg IV 5
min before placement of the MH, group L was administered plain lidocaine
3 ml 1% by infiltration at each pin site 1 minute before placement, and
both methods were applied together in group FL. Mean blood pressure
(MAP) and heart rate (HR) were recorded at 5 preset times. In group F
during and after MH placement, MAP and HR were significantly higher than
in the L and FL groups. In the L group, there was significantly higher
MAP and HR during the placement of MH than in the FL group. In the FL
group, there was no significant increase in MAP or HR at any time of the
recordings. We conclude that intravenous fentanyl with local
infiltration of lidocaine into the periosteum is effective in reducing
the hemodynamic response to MH placement in patients undergoing
craniotomy.
5
UI - 21310139
AU - Singh RR; Ayyangar KM; Shen B; Gearheart D; Saw CB
TI -
Comparative study between IMRT with NOMOS BEAK and linac-based
radiosurgery in the treatment of intracranial lesions.
SO - Med Dosim 2001 Spring;26(1):47-53
AD - Department of Radiation Oncology, Christian Medical College & Hospital,
Vellore, India.
A comparative study was undertaken to examine intracranial irradiation
using intensity-modulation radiation therapy (IMRT) and linear
accelerator-based radiosurgery. The IMRT was examined using the Peacock
system with a BEAK attachment. A clinical case involving a metastatic
brain lesion, treated with 3 radiosurgery isocenters, was planned for
IMRT. The radiosurgery was planned using the Leibinger planning system.
The IMRT was planned using the CORVUS planning system. The CORVUS
planning system uses an inverse planning algorithm, a recent development
in radiotherapy. Isodose distributions and dose volume histograms were
generated and compared. Analysis of the dosimetry shows that the dose
conformity and homogeneity within the target using the RTOG guidelines
are superior for IMRT. The advantages of IMRT using inverse planning
system include the ease of planning and execution of treatment,
especially for cases that involve concave targets that require multiple
isocenters using radiosurgery.
6
UI - 21341674
AU - Shirsat NV; Kayal JJ; Shaikh S; Mehta A
TI -
Growth inhibition and differentiation of C6 glioma cells on treatment
with hmba.
SO - Cell Biol Int 2001;25(7):621-7
AD - Neuro-Oncology Division, Cancer Research Institute, Tata Memorial
Centre, Parel, Mumbai-400012, India. cri3@soochak.ncst.ernet.in
HMBA, a differentiation inducer belonging to the class of hybrid polar
compounds, is known to induce terminal differentiation of a number of
leukemic and solid tumour cell lines. In this report we have shown that
HMBA markedly inhibits growth of C6 glioma cells at non-cytotoxic
concentrations ranging from 2.5 m m to 10 m m in a dose-dependent
manner. The growth inhibitory effect can be detected as early as 18--24
h. By the sixth day the growth inhibition decreases at all the
concentrations tested. Treatment with HMBA results in an accumulation of
C6 cells in G0/G1 phase along with a decrease in the number of cells in
S phase. HMBA induces morphological differentiation of C6 cells and
increases expression of glial fibriliary acidic protein (GFAP), a marker
for mature astrocytes. HMBA induces c-fos and represses
cycloheximide-induced c-jun and fra-1 expression. HMBA-induced growth
inhibition of C6 cells is accompanied by a decrease in Cdk4 protein
levels. However, HMBA fails to sustain low Cdk4 levels, which may be
responsible for HMBA's failure to sustain the growth inhibitory effect.
Copyright 2001 Academic Press.
7
UI - 21407682
AU - Gelabert-Gonzalez M; Fernandez-Villa J
TI -
Mutism after posterior fossa surgery. Review of the literature.
SO - Clin Neurol Neurosurg 2001 Jul;103(2):111-4
AD - Neurosurgical Service, Department of Surgery, University of Santiago de
Compostela, Santiago de Compostela, Spain. cimigego@usc.es
Mutism is an infrequent and transitory complication observed following
posterior fossa surgery. Patients become mute in the immediate
postoperative period, with restoration of speech within a few weeks. A
review of the literature disclosed 157 patients with this condition. The
anatomical structures thought to be involved are the connections between
the cerebella dentate nucleous, the ventrolateral nucleous of the
contalateral thalamus and the supplementary motor area. We reviewed 157
of cerebellar mutism; however several reports did not give sufficient
information about the patients and 134 cases were selected for this
study. The ages of the patients ranged from 2 to 61 years and the
vermisat was the site of the tumour in 89% of the cases. All tumours
were considered to be large or very large. The mutism lasted from 4 days
to 52 months and was transient in all cases.
8
UI - 21407674
AU - Folkersma H; Mooij JJ
TI -
Follow-up of 13 patients with surgical treatment of cerebral cavernous
malformations: effect on epilepsy and patient disability.
SO - Clin Neurol Neurosurg 2001 Jul;103(2):67-71
AD - Department of Neurosurgery, University Hospital AZG, P.O. Box 30001,
9700 RB, Groningen, The Netherlands.
OBJECTIVE: We report a series of 13 patients with surgical treatment of
cerebral cavernous malformation (CM). The aim of this study was to
investigate postoperative patient disability and seizure control in
patients with CM in order to clarify indications for neurosurgical
removal. In our series we emphasize the beneficial effect of excision of
CMs. We also give an overview of the current literature covering options
for treatment in surgically inaccessible CMs. METHODS: In this
retrospective study we describe the clinical outcomes of neurosurgical
intervention in 13 patients with a CM. Seven patients had epilepsy at
presentation and six had focal neurological deficits due to
intracerebral haemorrhage (five patients) or mass effect due to the CM
(one patient). The modified Rankin scale was used to define patient
disability pre- and postoperatively. An overview of the indications for
surgery and postoperative outcome with follow up periods of 1-6 years
(mean: 3.3 years) are provided. RESULTS: In all patients presenting with
epilepsy a reduction in seizure frequency was seen. Four of them became
seizure-free postoperatively. The six patients with neurological
deficits due to intracerebral haemorrhage or mass effect due to the CM
showed clinical improvement postoperatively, two of them made full
recoveries. Improvement of the postoperative Rankin score was seen in
six of 13 patients. CONCLUSION: Improvement in seizure control and
reduction in patient disability warrants surgical intervention in
symptomatic CMs.
9
UI - 21406158
AU - Adams EJ; Suter BL; Warrington AP; Black P; Saran F; Brada M
TI -
Design and implementation of a system for treating paediatric patients
with stereotactically-guided conformal radiotherapy.
SO - Radiother Oncol 2001 Sep;60(3):289-97
AD - Joint Department of Physics, The Royal Marsden NHS Trust, Downs Road,
Sutton, Surrey SM2 5PT, UK.
BACKGROUND AND PURPOSE: Stereotactically-guided conformal radiotherapy
(SCRT) allows the delivery of highly conformal dose distributions to
localised brain tumours. This is of particular importance for children,
whose often excellent long-term prognosis should be accompanied by low
toxicity. The commercial immobilisation system in use at our hospital
for adults was felt to be too heavy for children, and precluded the use
of anaesthesia, which is sometimes required for paediatric patients.
This paper therefore describes the design and implementation of a system
for treating children with SCRT. This system needed to be well tolerated
by patients, with good access for treating typical childhood
malignancies. MATERIALS AND METHODS: A lightweight frame was developed
for immobilisation, with a shell-based alternative for patients
requiring general anaesthetic. Procedures were set up to introduce the
patients to the frame system in order to maximise patient co-operation
and comfort. Film measurements were made to assess the impact of the
frame on transmission and surface dose. The reproducibility of the
systems was assessed using electronic portal images. RESULTS: Both frame
and shell systems are in clinical use. The frame weighs 0.6 kg and is
well tolerated. It has a transmission of 92-96%, and fields which pass
through it deliver surface doses of 58-82% of the dose at d(max),
compared to 18% when no frame is present. However, the frame is
constructed to maximise the availability of unobstructed beam
directions. Reproducibility measurements for the frame showed a mean
random error of 1.0+/-0.2mm in two dimensions (2D) and 1.4+/-0.7 mm in
3D. The mean systematic error in 3D was 2.2mm, and 90% of all overall 3D
errors were less than 3.4mm. For the shell system, the mean 2D random
error was 1.5+/-0.2mm. CONCLUSIONS: Two well-tolerated immobilisation
devices have been developed for fractionated SCRT treatment of
paediatric patients. A lightweight frame system gives a wide range of
possible unobstructed beam directions, although beams that intersect the
frame are not precluded, provided that output corrections are applied. A
shell system allows the use of general anaesthesia. Both systems give
reproducible immobilisation to complement the high-precision treatment
delivery.
10
UI - 21449540
AU - Carlotti AP; Bohn D; Rutka JT; Singh S; Berry WA; Sharman A; Cusimano M;
TI -
Halperin ML
A method to estimate urinary electrolyte excretion in patients at risk
for developing cerebral salt wasting.
SO - J Neurosurg 2001 Sep;95(3):420-4
AD - Department of Critical Care Medicine, Hospital for Sick Children,
Toronto, Ontario, Canada.
OBJECT: Two major criteria are necessary to diagnose cerebral salt
wasting (CSW): a cerebral lesion and a large urinary excretion of Na+
and Cl- at a time when the extracellular fluid (ECF) volume is
contracted. Nevertheless, it is difficult for the physician to confirm
from bedside observation that a patient has a contracted ECF volume.
Hyponatremia, although frequently present, should not be a criterion for
a diagnosis of salt wasting. A contracted ECF volume is unlikely if
there are positive balances of Na+ and Cl-. The goal of this study was
to assess the accuracy of calculating balances for Na+ plus K+ and of
Cl- over 1 to 10 days in an intensive care unit (ICU) setting. METHODS:
A prospective comparison of measured and estimated quantities of Na+
plus K+ and of Cl- excreted over 1 to 10 days in 10 children and 12
adults who had recently received a traumatic brain injury or undergone
recent neurosurgery. Plasma concentrations of electrolytes were recorded
at the beginning and end of the study period. The total volumes infused
and excreted and the concentrations of Na+, K+, and Cl- in the infusate
were obtained from each patient's ICU chart. The electrolytes in the
patients' urine were measured and calculated. Correlations between
measured and calculated values for excretions of Cl- and of Na+ plus K+
were excellent. CONCLUSIONS: Mass balances for Na+ plus K+ and for Cl-
can be accurately estimated. These data provide information to support
or refute a clinical diagnosis of CSW. The danger of relying on balances
for these electrolytes measured within a single day to diagnose CSW is
illustrated.
11
UI - 21449562
AU - Ziyal IM; Ozgen T
TI -
Transtentorial approach to the posterior temporomedial structures.
SO - J Neurosurg 2001 Sep;95(3):541
The supracerebellar transtentorial (SCTT) approach, a modification of
the infratentorial supracerebellar approach, facilitates simple and
minimally invasive access to posterior temporomedial structures without
requiring retraction of the temporal or occipital lobe. The SCTT
approach was used in 16 patients over a 3-year period. Eleven patients
harbored tumors confined to, or located mainly within, the posterior
hippocampal formation, three patients harbored aneurysms (one ruptured
posterior cerebral artery [PCA] aneurysm at the P2-P3 junction, one
ruptured giant PCA [P2] aneurysm, and one giant basilar artery-superior
cerebellar artery aneurysm), one patient had juvenile-type moyamoya
disease, and one patient suffered from medically intractable epilepsy.
In these patients, the SC
12
UI - 21449563
AU - Alberti O; Riegel T; Hellwig D; Bertalanffy H
TI -
Frameless navigation and endoscopy.
SO - J Neurosurg 2001 Sep;95(3):541-3
OBJECT: Frameless computerized neuronavigation has been increasingly
used in intracranial endoscopic neurosurgery. However, clear indications
for the application of neuronavigation in neuroendoscopy have not yet
been defined. The purpose of this study was to determine in which
intracranial neuroendoscopic procedures frameless neuronavigation is
necessary and really beneficial compared with a free-hand endoscopic
approach. METHODS: A frameless infrared-based computerized neuronavi-
gation system was used in 44 patients who underwent intracranial
endoscopic procedures, including 13 third ventriculostomies, nine
aqueductoplasties. eight intraventricular tumor biopsy procedures or
resections, six cystocisternostomies in arachnoid cysts, five colloid
cyst removals, four septostomies in multiloculated hydrocephalus, four
cystoventriculostomies in intraparenchymal cysts, two aqueductal stent
placements, and fenestration of one pineal cyst and one cavum veli
interpositi. All interventions were successfully accomplished. In all
procedures, the navigational system guided the surgeons precisely to the
target. Navigational tracking was helpful in entering small ventricles,
in approaching the posterior third ventricle when the foramen of Monro
was narrow, and in selecting the best approach to colloid cysts.
Neuronavigation was essential in some cystic lesions lacking clear
landmarks, such as intraparenchymal cysts or multiloculated
hydrocephalus. Neuronavigation was not necessary in standard third
ventriculostomies, tumor biopsy procedures, and large sylvian arachnoid
cysts, or for approaching the posterior third ventricle when the foramen
of Monro was enlarged. CONCLUSIONS: Frameless neuronavigation has proven
to be accurate, reliable, and extremely useful in selected intracranial
neuroendoscopic procedures. Image-guided neuroendoscopy improved the
accuracy of the endoscopic approach and minimized brain trauma.
13
UI - 21190901
AU - Doolittle ND; Muldoon LL; Brummett RE; Tyson RM; Lacy C; Bubalo JS;
TI -
Kraemer DF; Heinrich MC; Henry JA; Neuwelt EA
Delayed sodium thiosulfate as an otoprotectant against
carboplatin-induced hearing loss in patients with malignant brain
tumors.
SO - Clin Cancer Res 2001 Mar;7(3):493-500
AD - Department of Neurology, Oregon Health Sciences University, Portland
97201, USA.
Carboplatin is effective in the treatment of malignant brain tumors.
However, when administered in conjunction with osmotic opening of the
blood-brain barrier (BBB), carboplatin is ototoxic. The purpose of this
study was to determine whether delayed administration of sodium
thiosulfate (STS), given after BBB closure, provided protection against
carboplatin ototoxicity. Patients underwent monthly treatment with
intra-arterial carboplatin (200 mg/m2/day x 2) in conjunction with
osmotic opening of the BBB, for up to 1 year. Audiological assessment
was conducted at baseline and within 24 h before each monthly treatment.
STS was administered i.v. as one (20 g/m2) or two (20 g/m2 and 16 g/m2)
15-min doses, depending on baseline hearing status. The initial group
received the first STS dose 2 h (or 2 and 6 h) after carboplatin (STS2)
and a subsequent group received STS 4 h (or 4 and 8 h) after carboplatin
(STS4). Audiological data were compared with a historical comparison
group (HCG) treated with carboplatin without STS. Spearman correlation
coefficients comparing STS 2 (n = 24), STS4 (n = 17), and HCG (n = 19)
indicated significantly lower rates of ototoxicity with increased delay
in STS (P = 0.0006). On the basis of the analysis of hearing levels,
there were significant differences among the two STS groups and HCG at
8000 Hz (P = 0.0010) and at 4000 Hz (P = 0.0075). The log-rank test for
time to ototoxicity indicated a significant difference between STS4 and
HCG (P = 0.0018). Delayed STS was effective in protecting against
carboplatin-induced hearing loss. STS delayed to 4 h after carboplatin
significantly decreased time to development of ototoxicity and rate of
ototoxicity when compared with HCG.
14
UI - 21262953
AU - Telfeian AE; Philips MF; Crino PB; Judy KD
TI -
Postoperative epilepsy in patients undergoing craniotomy for
glioblastoma multiforme.
SO - J Exp Clin Cancer Res 2001 Mar;20(1):5-10
AD - Dept. of Neurosurgery, Hospital of the University of Pennsylvania,
Philadelphia 19104, USA. Telfeian@mail.med.upenn.edu
Glioblastoma multiforme (GBM) has associated with it one of the poorest
prognoses among brain tumors. Postoperative seizures and the side
effects of anticonvulsants, routinely given for prophylactic purposes,
add to patient morbidity. The primary goal of this study was to
determine who, of those undergoing craniotomy for GBM resection, is at
risk for epilepsy. We studied 72 consecutive patients who underwent
craniotomy and palliative resection for GBM. Twenty-nine presented with
seizures and 17 had postoperative seizures. All patients were treated
with a postoperative anticonvulsant for at least six months;
anticonvulsants were continued longer if there was a postoperative
seizure. Patient factors examined for an association with risk for
postoperative seizure included age, sex, tumor size, tumor location,
adjuvant therapy, postoperative complications and history of
preoperative seizures. The majority of patients with no prior seizure
history and who seized postoperatively had their first seizure after
withdrawal from their anticonvulsant medication. All, but one, of the
patients with both pre- and postoperative seizures had their first
postoperative seizure while still on anticonvulsants. Smaller tumor size
and frontal resection were associated with an increased risk of
postoperative seizures. Our data suggests that those who do not present
with seizures and undergo GBM resection may still be prone to seize but
more easily protected from postoperative seizures with anticonvulsant
therapy than patients who present with seizures; resection of frontal
tumors and smaller tumors seemed to indicate an increased risk for
postoperative seizures.
15
UI - 21277034
AU - Anderson RC; Elder JB; Parsa AT; Issacson SR; Sisti MB
TI -
Radiosurgery for the treatment of recurrent central neurocytomas.
SO - Neurosurgery 2001 Jun;48(6):1231-7; discussion 1237-8
AD - Department of Neurosurgery, New York Presbyterian Medical Center, New
York, USA.
OBJECTIVE: Central neurocytomas are benign neoplasms with neuronal
differentiation typically located in the lateral ventricles of young
adults. Although the treatment of choice is complete surgical excision,
patients may experience local recurrence. Adjuvant therapy for patients
with residual or recurrent tumor has included reoperation, radiotherapy,
or chemotherapy. To avoid the side effects of conventional radiotherapy
in young patients, we present a series of patients with clear evidence
of tumor progression who were treated with gamma knife radiosurgery.
METHODS: Four patients (ages 20-49 yr; mean, 28 yr) who presented with
an intraventricular mass on magnetic resonance imaging scans and
underwent craniotomy for tumor resection were reviewed retrospectively.
Histopathological analysis confirmed central neurocytoma in all cases.
Each patient was followed up clinically and radiographically with serial
magnetic resonance imaging. When radiographic signs of tumor progression
were evident, patients were treated with radiosurgery. RESULTS: Complete
radiographic tumor resection was achieved in all patients. There were no
major postoperative complications. Local tumor progression was detected
on magnetic resonance imaging scans 9 to 25 months after surgery
(median, 17.5 mo). All patients achieved complete response to
radiosurgery with reduction in tumor size. There have been no
complications from radiosurgery. Follow-up ranged from 12 to 28 months
(mean, 16.5 mo) after radiosurgery, and from 24 to 84 months (mean, 54.5
mo) after initial presentation. CONCLUSION: Radiosurgery with the gamma
knife unit provides safe and effective adjuvant therapy after surgical
resection of central neurocytomas. Radiosurgery may eliminate the need
for reoperation and avoid the possible long-term side effects from
conventional radiotherapy in young patients.
16
UI - 21276951
AU - Hinata H; Inakoshi H; Sakai K; Ogawa Y; Kobayashi M; Wakushima H; Obara
TI -
T; Shibamoto Y
Estimation of time parameter of LQ-model in fractionated radiotherapy of
medulloblastoma.
SO - Radiat Med 2001 Mar-Apr;19(2):61-70
AD - Department of Radiological Technology, Niigata University School of
Health Sciences, Japan.
PURPOSE: To estimate the dose required to counteract accelerated
proliferation, gamma/alpha, of medulloblastoma (MB) cells during
fractionated radiotherapy. MATERIALS AND METHODS: Sixty-five patients
with MB (local control rate at 5 years: 73%) treated between 1980 and
1990 at our university hospitals were analyzed. The gamma/alpha was
estimated by applying the profile likelihood method to Cox's
proportional hazards model including the maximum value of
time-incorporated biologically effective dose, tBEDmax. The tBEDmax was
conditionally calculated with various settings of alpha/beta, time to
kick off accelerated proliferation, Tk, and gamma/alpha. Pretreatment
T-stage, log(age+1), extent of removal, and use of chemotherapy and
immunotherapy were also included in the multivariate model. RESULTS:
When alpha/beta was taken to be 10 Gy, the estimate of gamma/alpha was
0.52 Gy/day (95% confidence limits: 0.29-0.75) for 0 day of Tk and was
0.55 Gy/day (0.30-0.80) for 21 days of Tk. The gamma/alpha values tended
to be larger in the T3 subgroup and in the non-total removal subgroup
than in all patients, by about 0.05 Gy/day and 0.1 Gy/day, respectively.
When alpha/beta was taken to be 25 Gy, the estimated values were about
0.05 Gy/day smaller than these values. CONCLUSION: The estimated
gamma/alpha values were considerably large. Therefore, it is preferable
to take this consumed dose per day into consideration in planning and
conducting treatments for MB.
17
UI - 21279724
AU - Jeremic B; Shibamoto Y; Grujicic D; Stojanovic M; Milicic B; Nikolic N;
TI -
Dagovic A; Aleksandrovic J
Concurrent accelerated hyperfractionated radiation therapy and
carboplatin/etoposide in patients with malignant glioma: long-term
results of a phase II study.
SO - J Neurooncol 2001 Jan;51(2):133-41
AD - Department of Oncology, University Hospital, Kragujevac, Yugoslavia.
bjeremic@meo.uni-tuebingen.de
PURPOSE: Feasibility, antitumor activity and toxicity of accelerated
hyperfractionated radiation therapy (Acc Hfx RT) and concurrent
carboplatin/etoposide (CBDCA/VP 16) chemotherapy were investigated in
patients with malignant glioma. MATERIAL AND METHODS: Seventy-nine
patients with either glioblastoma multiforme (GBM) (n = 61) or
anaplastic astrocytome (AA) (n = 18) entered into a phase II study on
the use of Acc Hfx RT with 60 Gy in 40 fractions in 20 treatment days
over 4 weeks and concurrent CBDCA, 200 mg/m2, and VP 16, 200 mg/m2, both
given once weekly during the RT course. RESULTS: The median survival
time for all 79 patients was 14 months (11 and 44 months for GBM and AA
patients, respectively), while the 2- and 4-year survival was
respectively 33% and 11% for all patients, 13% and 1.6% for GBM
patients, and 100% and 44% for AA patients (p < 0.0001). The median time
to progression for all patients was 12 months (9 and 40 months for GBM
and AA, respectively), while the 2- and 4-year progression-free survival
(PFS) was respectively 28% and 10% (all patients), 10% and 1.7% (GBM)
and 89% and 39% (AA) (p < 0.0001). Multivariate analysis showed that
age, performance status, and preoperative size of tumor influenced
survival in GBM. Only 5 (6%) patients experienced grade 3 leukopenia and
6 (8%) patients experienced grade 3 thrombocytopenia. No late RT-induced
toxicity was observed to date. CONCLUSIONS: Although Acc Hfx RT/CBDCA +
VP 16 was feasible and little toxic, it failed to improve
survival/progression-free survival over that obtained with other
currently used regimens. These results do not justify the investigation
of this regimen in a phase III trial.
18
UI - 21395383
AU - Hlavats'kyi OIa
TI -
[Application of ultrasonic aspiration in surgical treatment of glial
tumors]
SO - Klin Khir 2001;(5):44-6
Results of surgical treatment of 139 patients with cerebral glioma of
supratentorial localization were analyzed. The method of ultrasonic
aspiration of tumor was applied for the surgical intervention radicalism
raising. Application of ultrasonic aspiration had guaranteed the
conditions for the controlled excision of tumoral tissue, the hemostasis
performance, permitted to reduce cerebral traumatization and to preserve
main vessels in the tumor environment, promoted the uncomplicated
postoperative period course, rapid reconvalescence of the patients, the
neurologic functions preservation, reduction of the patient's
invalidization possibility, improvement of his quality of life.
19
UI - 21453166
AU - Barker FG 2nd; Simmons ML; Chang SM; Prados MD; Larson DA; Sneed PK;
TI -
Wara WM; Berger MS; Chen P; Israel MA; Aldape KD
EGFR overexpression and radiation response in glioblastoma multiforme.
SO - Int J Radiat Oncol Biol Phys 2001 Oct 1;51(2):410-8
AD - Department of Neurological Surgery, Neuro-Oncology Service and Brain
Tumor Research Center, University of California, San Francisco,
California, USA. barker@helix.mgh.harvard.edu
PURPOSE: Recent studies have suggested relative radioresistance in
glioblastoma multiforme (GM) tumors in older patients, consistent with
their shorter survival. Two common molecular genetic abnormalities in GM
are age related: epidermal growth factor receptor (EGFR) overexpression
in older patients and p53 mutations in younger patients. We tested
whether these abnormalities correlated with clinical heterogeneity in GM
response to radiation treatment. METHODS AND MATERIALS: Radiographically
assessed radiation response (5-level scale) was correlated with EGFR
immunoreactivity, p53 immunoreactivity, and p53 exon 5-8 mutation status
in 170 GM patients treated using 2 prospective clinical protocols.
Spearman rank correlation and proportional-odds ordinal regression were
used for univariate and multivariate analysis. RESULTS: Positive EGFR
immunoreactivity predicted poor radiographically assessed radiation
response (p = 0.046). Thirty-three percent of tumors with no EGFR
immunoreactivity had good radiation responses (>50% reduction in tumor
size by CT or MRI), compared to 18% of tumors with intermediate EGFR
staining and 9% of tumors with strong staining. There was no significant
relationship between p53 immunoreactivity or mutation status and
radiation response. Significant relationships were noted between EGFR
score and older age and between p53 score or mutation status and younger
age. CONCLUSION: The observed relative radioresistance of some GMs is
associated with overexpression of EGFR.
20
UI - 21453167
AU - Reni M; Ferreri AJ; Guha-Thakurta N; Blay JY; Dell'Oro S; Biron P;
TI -
Hochberg FH
Clinical relevance of consolidation radiotherapy and other main
therapeutic issues in primary central nervous system lymphomas treated
with upfront high-dose methotrexate.
SO - Int J Radiat Oncol Biol Phys 2001 Oct 1;51(2):419-25
AD - Department of Radiochemotherapy, San Raffaele H. Scientific Institute,
Milan, Italy. reni.michele@hsr.it
PURPOSE: To evaluate the optimal dose of methotrexate (MTX) and the
efficacy of other drugs, intrathecal chemotherapy (CHT), and
radiotherapy (RT) in primary brain lymphomas. METHODS AND MATERIALS: Two
hundred eighty-eight immunocompetent patients with histologically
documented, previously untreated primary brain lymphomas, receiving CHT
containing high-dose MTX (> or =1 g/m(2)) with or without RT were
selected from 19 prospective series. The impact on survival of the MTX
dose (<3 g/m(2) vs.> or =3 g/m(2)), the main drugs, intrathecal CHT, and
combination CHT (mono-CHT vs. poly-CHT) was assessed, according to the
intention-to-treat principle. The role of post-CHT irradiation
(immediate vs. delayed RT) was evaluated in 119 patients with a complete
response to CHT. The whole brain and tumor bed dose (<40 Gy vs. > or =40
Gy) was assessed in 70 irradiated complete responders. RESULTS: No
difference in overall survival (OS) was detected between mono-CHT and
combination CHT (p = 0.38). MTX > or =3 g/m(2) (p = 0.04), thiotepa (p =
0.03), and intrathecal CHT (p = 0.03) improved the OS, and nitrosoureas
(p = 0.01) correlated with a worse survival. In multivariate analysis,
limited to patients receiving MTX > or =3 g/m(2), only the addition of
cytarabine improved the OS; nitrosoureas reduced MTX efficacy. Of the
119 complete responders, 70 received immediate RT. A RT dose of > or =40
Gy to the whole brain or tumor bed did not improve OS. The 3-year OS was
similar between the immediate and delayed RT groups. In multivariate
analysis, RT delay had no negative impact on survival. CONCLUSIONS: MTX
> or =3 g/m(2) seems to improve survival in primary brain lymphoma
patients. The efficacy of additional drugs, except for cytarabine,
remains unproved. Randomized trials are needed to confirm that RT
withdrawal yields no detrimental effect in complete responders.
21
UI - 21463159
AU - Chamberlain MC; Jaeckle KA
TI -
Medical Research Council adjuvant trial in high-grade gliomas.
SO - J Clin Oncol 2001 Oct 1;19(19):3997-9
22
UI - 21244710
AU - Lopez Flores G; Ochoa Zaldivar L; Salva S; Gonzalez Quintana J; Guerra
TI -
Figueredo E; Teijeiro J; Morales JM; Perez A; Estupinan B; Fermin E;
Padron A; Piedra J
[Stereotaxic biopsy and 192Ir implant in intracranial tumors. A review
of 7 years of experience]
SO - Rev Neurol 2001 Mar 1-15;32(5):401-5
AD - Servicio de Neurocirugia; Centro Internacional de Restauracion
Neurologica (CIREN), La Habana, 11300, Cuba. gerardo@neuro.sld.cu
INTRODUCTION. The combination of stereotaxic techniques, advances in
neuroimaging and the creation of continually improving software has
permitted stereotaxic biopsy of cerebral lesions at the most varied
sites. Improvement in the method of permanent interstitial radiation
(brachytherapy) improves the precision with which the radioactive
sources may be inserted, releasing a maximum dose of radiation to the
tumour with minimum radiation to the surrounding tissue. PATIENTS AND
METHODS. We treated 237 patients (aged 1 to 78 years) with intracranial
lesions, all included in the protocol of our centre. Stereotaxic systems
of Leksell, Riechert-Mundinger, Micromar and Estereoflex were used. The
procedure was in three stages: acquisition of the image, surgical
planning and surgical operation. The imaging guide was the computerized
axial tomography (CAT). RESULTS. Stereotaxic biopsy guided by CAT images
was done in 153 patients. These were divided into three groups, taking
the biopsy findings as the reference: group A (primary tumors, 128),
group B (metastatic tumors, 15) and group C (non-malignant lesions, 10).
Ninety six permanent implants of 192Ir were inserted, with a low dose of
4-7 cGy/h and a total dose of 80-120 Gy. CONCLUSIONS.Stereotaxic biopsy
is a very effective procedure with a significantly low range of
complications. The permanent implant with a low dose rate, well situated
and using a source of 192Ir is a safe, simple, effective method for the
treatment of primary and recurrent glial tumours, and non-glial tumours
which fulfil criteria for this type of brachytherapy.
23
UI - 21244714
AU - Ochoa Zaldivar LA; Estupinan Diaz B; Lopez Flores G; Garcia Maeso I;
TI -
Fermin Hernandez E; Padron Sanchez A; Guerra Figueredo E; Teijeiro
Amador J; Morales JM; Jordan J; Villegas Anchon A; Torres A
[Stereotaxic microsurgical resection of intracranial tumors guided by
imaging and assisted by computer]
SO - Rev Neurol 2001 Mar 1-15;32(5):417-22
AD - Servicio de Neurocirugia; Centro Internacional de Restauracion
Neurologica (CIREN), La Habana, 11300, Cuba. ochoa@neuro.sld.cu
INTRODUCTION. The microsurgical techniques for resection of intracranial
lesions are limited where anatomical references do not exist or cannot
be used as guides in the dissection of deeply located lesions or in more
superficial eloquent areas. The stereotaxic guide, guided by imaging
gives precise volumetric and geometric definition in intracranial
lesions. Its application in the resection of intracranial tumors has
special characteristics due to their biological condition and varied
localization. OBJECTIVES. Spatial orientation during surgery is
essential. We show this application of stereotaxic surgery in the Centro
Internacional de Restauracion Neurologica (CIREN) in La Havana, Cuba,
operations done using stereotaxis in 62 patients with intracranial
cerebral tumors. PATIENTS AND METHODS. The procedure was divided into
three stages: acquiring an image, computerized axial tomography and
surgical planning, with the STASSIS planning system and microsurgical
procedures, including systems of stereotaxis: Leksell, Micromar and
Estereoflex. RESULTS. Of the total, 27 of these patients had glial
tumors, 33 non-glial tumors and only 2 had non-neoplastic lesions of
different sites and sizes. A total of 30 resections were done. Surgical
morbidity was minimal and there was no surgical mortality.
CONCLUSIONS.The main advantages of this method are: exact localization
of the site for craniotomy, easy spatial orientation and ease in
distinguishing the delimitation between the tumour and the healthy
tissue. It has been shown that Estereoflex may be used in cerebral
microsurgery.
24
UI - 21277299
AU - Bernstein M
TI -
Outpatient craniotomy for brain tumor: a pilot feasibility study in 46
patients.
SO - Can J Neurol Sci 2001 May;28(2):120-4
AD - Division of Neurosurgery, Toronto Western Hospital, University Health
Network, ON, Canada.
BACKGROUND: Since 1991 the author has routinely performed awake
craniotomy for intra-axial brain tumors with low complication rate and
low resource utilization. In late 1996 a pilot study was initiated to
assess the feasibility of performing craniotomy for tumor resection as
an outpatient procedure. METHODS: A rigorous protocol was developed and
adhered to, based around the patient's arrival at hospital at 6:00 a.m,
undergoing image-guided awake craniotomy with cortical mapping, and
being discharged by 6:00 p.m. RESULTS: During the 48 month period from
and of those, 46 patients were entered into the outpatient craniotomy
protocol. Pathology in the 46 intent-to-treat group was: 21 metastasis,
19 glioma, and six miscellaneous. Four patients required conversion to
inpatients and one patient was readmitted later the same evening due to
headache. Thus 41/46 patients successfully completed the protocol (89%).
There were five complications in the 46 intent-to-treat group (10.9%).
CONCLUSIONS: Outpatient craniotomy for brain tumor is a feasible option
which appears safe and effective for selected patients. Besides being
resource-friendly, the procedure may be psychologically less traumatic
to patients than standard craniotomy for brain tumor. Proper prospective
studies including satisfaction surveys would help resolve these issues
and will be the next step.
25
UI - 21297812
AU - Vinchon M; Assaker R; Soto-Ares G; Ruchoux MM; Dhellemmes P
TI -
[Cerebellar pilocytic astrocytomas in children. Report of 72 cases]
SO - Neurochirurgie 2001 May;47(2-3 Pt 1):83-91
AD - Service de Neurochirurgie Pediatrique, Hopital Roger-Salengro, CHRU,
59037 Lille Cedex, France.
BACKGROUND AND PURPOSE: Cerebellar pilocytic astrocytoma (CPA) bears a
well-deserved reputation of benignity. However, these tumors infiltrate
the brainstem in a number of cases, and total removal may cause
morbidity, whereas subtotal removal can lead to recurrence. MATERIAL AND
METHODS: To define guidelines for tumor removal, management of tumor
remnants and recurrence, we reviewed 72 cases of CPA of childhood
operated on in our department since the introduction of CT. RESULTS:
Surgical removal was total in 57 cases, had to be withheld because of
brainstem infiltration in nine cases, and was revealed subtotal by
postoperative imaging in six cases. Two of the latter were reoperated
on; six had only radiological controls and did not progress. Early in
the series, eight children had external irradiation because of subtotal
removal or recurrence. Three children were reoperated on for tumor
recurrence, between six and eight years after complete removal. We had
no tumor-related mortality; long-term disability could be related to
previous mental retardation, the severity of clinical state at
presentation, and complications of surgery and irradiation. CONCLUSION:
The goal of surgery is to cure the patient with minimal morbidity,
however, total removal is not always possible. In our experience: i)
tumor remnants can be surveyed radiologically, and reoperated only in
case of progression; ii) the indications for radiotherapy should be the
exception; iii) clinical and radiological follow-up should be protracted
beyond entry into adulthood.
26
UI - 21433225
AU - Pavlicevic G; Roganovic Z
TI -
[Surgical treatment of malignant brain astrocytomas]
SO - Vojnosanit Pregl 2001 May-Jun;58(3):305-11
27
UI - 21449116
AU - Karsila-Tenovuo S; Jahnukainen K; Peltomaki T; Minn H; Kulmala J; Salmi
TI -
TT; Ronning O
Disturbances in craniofacial morphology in children treated for solid
tumors.
SO - Oral Oncol 2001 Oct;37(7):586-92
AD - Department of Oral Development and Orthodontics, Institute of Dentistry,
University of Turku, Lemminkaisenkatu 2, FIN-20520 Turku, Finland.
susanna.karsila-tenovuo@utu.fi
Because of increased survival rates in childhood cancer, special
interest has been focused on the side-effects of the therapy and the
quality of life in long-term survivors. Our aim was to investigate
craniofacial growth in children who had received different kinds of
antineoplastic therapies for solid tumors. A total of 40 children
treated in the Turku University Central Hospital were examined and
divided into three different groups. Group 1 comprised 18 children
treated for intracranial tumors with cranial irradiation (CRI) and
chemotherapy (CT) including alkylating agents. Seven children out of 18
in this group received growth hormone (GH) therapy. In Group 2, 11
children with extracranial solid tumors also received multiagent CT
including alkylating agents, but no CRI. Group 3 consisted of 11
children treated for Wilm's tumor with CT, which did not include
alkylating agents or CRI. A total of 19 linear and four angular
variables from the lateral cephalograms of the subjects were measured.
Most deviations in craniofacial structures were found in children
treated with combined CRI and multiagent CT. All disturbances were seen
in the vertical measurements which were reduced when compared to the
matched controls. It seems reasonable to assume that impaired growth
following combined radio- and chemotherapy, as well as GH treatment,
particularly affects cartilage-mediated growth. However, the deviations
seen in the present study were fairly minor and did not usually require
clinical consideration.
28
UI - 21203030
AU - Chintagumpala M; Berg S; Blaney SM
TI -
Treatment controversies in medulloblastoma.
SO - Curr Opin Oncol 2001 May;13(3):154-9
AD - Texas Children's Cancer Center, Baylor College of Medicine, Houston,
Texas 77030, USA.
Medulloblastoma, the most common primary malignant brain tumor in
children, is a radiosensitive and chemosensitive tumor. Nevertheless,
medulloblastoma remains a management challenge for the clinical
oncologist, because the optimal sequence and dosage for each treatment
modality has not yet been defined. In addition, effective management
strategies for medulloblastoma may result in profound neuroendocrine and
neuropsychologic sequelae. In this article, we review the clinical and
biologic prognostic factors for classifying medulloblastoma, current
strategies for the management of this disease, and potential strategies
to prevent or minimize long-term treatment sequelae.
29
UI - 21435043
AU - Anonymous
TI -
Pediatric Brain Tumor Foundation of the United States: supporting the
search for the cause and cure of childhood brain tumors.
SO - Neuro-oncol 1999 Jan;1(1):27-9
30
UI - 21435048
AU - Paleologos NA; Cairncross JG
TI -
Treatment of oligodendroglioma: an update.
SO - Neuro-oncol 1999 Jan;1(1):61-8
AD - Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
Oligodendrogliomas are rare primary brain tumors. Significant attention
has recently been focused on these interesting neoplasms because of
their unique chemosensitivity and the durability of some of these
responses. Surgery and radiation continue to play important roles in the
treatment of oligodendrogliomas. Molecular genetic analyses have given
new insight into the allelic deletions that distinguish these tumors and
their progression from indolent to more aggressive forms. In the future,
molecular genetic analysis may guide therapeutic decisions concerning
patients with oligodendroglioma and may help us learn more about how to
best treat other malignant brain neoplasms.
31
UI - 21435049
AU - Levin VA
TI -
Chemotherapy for brain tumors of astrocytic and oligodendroglial
lineage: the past decade and where we are heading.
SO - Neuro-oncol 1999 Jan;1(1):69-80
AD - Department of Neuro-Oncology, Brain Tumor Center, M.D. Anderson Cancer
Center, University of Texas, Houston, TX 77030, USA.
Over the past three decades, we have made great strides in the treatment
of most, but not all, brain tumors. Dramatic advances have occurred in
diagnostic imaging, neurosurgery, neuroanesthesia, radiotherapy, and
chemotherapy for CNS tumors. Unfortunately, our progress has not yet met
our expectations. Because of the infiltrative nature of most primary
brain tumors, neurosurgery can never be expected to be curative for the
majority of gliomas. Because infiltrative tumors interdigitate with
normal brain cells and are not highly sensitive to irradiation, one
cannot expect radiotherapy to be curative without serious damage to
normal brain cells. The hope for a cure, then, rests with chemotherapy.
Those who administer chemotherapy to patients with CNS tumors fully
expect that, in time, long-term survival and, ultimately, the cure will
become an everyday reality. To achieve that reality, however, new
treatment concepts and drugs are needed.
32
UI - 21435056
AU - Duffner PK; Horowitz ME; Krischer JP; Burger PC; Cohen ME; Sanford RA;
TI -
Friedman HS; Kun LE
The treatment of malignant brain tumors in infants and very young
children: an update of the Pediatric Oncology Group experience.
SO - Neuro-oncol 1999 Apr;1(2):152-61
AD - State University of New York at Buffalo, School of Medicine and
Biomedical Sciences, Roswell Park Center Institute, Buffalo, NY, USA.
33
UI - 21435058
AU - Merchant TE; Happersett L; Finlay JL; Leibel SA
TI -
Preliminary results of conformal radiation therapy for medulloblastoma.
SO - Neuro-oncol 1999 Jul;1(3):177-87
AD - Department of Radiation Oncology, St. Jude Children's Research Hospital,
332 N. Lauderdale, Memphis, TN 38105-2794, USA.
Radiation therapy for medulloblastoma consists of postoperative
irradiation of the intracranial and spinal subarachnoid volume with an
additional boost to the primary site of disease in the posterior fossa.
The entire posterior fossa is usually included in the boost volume.
Conformal radiation therapy techniques may be used to boost the primary
site alone and substantially reduce the dose received by normal tissues,
including the supratentorial brain, the middle and inner ear, and the
hypothalamus. Using these techniques to irradiate only the tumor bed or
r
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