National Cancer Institute®
Last Modified: November 21, 2001
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.
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 - email@example.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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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. email@example.com
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.
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.
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.
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.
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.
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