National Cancer Institute®
Last Modified: April 1, 2002
UI - 11686021
AU - Plautz GE; Shu S
TI - Adoptive immunotherapy of CNS malignancies.
SO - Cancer Chemother Biol Response Modif 2001;19():327-38
AD - Department of Pediatrics, 333 Cedar Street LMP 4087, Yale University School of Medicine, New Haven, CT 06520-8064, USA.
Although many patients with malignant brain tumors can be rendered free of bulk disease by current surgery and radiotherapy techniques, complete tumor eradication is extremely difficult to achieve, raising interest for T-cell adoptive immunotherapy. Conclusive experimental data generated by many investigators coupled with clinical experience have debunked many of the theoretical 'obstacles' to immunotherapy in the CNS. First, there does not appear to be a significant vascular barrier in brain tumors to prevent trafficking of systemically administered activated T cells. Moreover, T cells stimulated in the periphery by DC vaccination are able to mediate regression of established intracranial tumors. Second, brain tumor patients are able to mount an immune response against autologous tumor. Not surprisingly, patient factors such as tumor burden, corticosteroid use, advanced age, or recent chemotherapy can inhibit the immune response to tumor. Directing this type of therapy to patients without these factors may improve the likelihood of response. Third, therapeutic immune responses occurring within the CNS against tumors derived from CNS tissue have not been associated with clinical signs of autoimmune reactions against normal brain tissue. The general toxicity associated with the systemic adoptive transfer of ex vivo activated LN cells is very low. Toxicity of activated T cells delivered locally into the tumor resection cavity likewise is low and transient. Current phase II clinical trials of AI are in progress to determine the response rate for patients with newly diagnosed malignant gliomas. Future developments to characterize shared brain tumor antigens and develop more effective strategies for vaccination may lead to a more effective and broadly applicable therapy for CNS malignancies.
UI - 11702889
AU - Panigrahi M
TI - Supracerebellar transtentorial approach.
SO - J Neurosurg 2001 Nov;95(5):916-7
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 approach enabled tumor removal, aneurysm clipping, and vascular bypass procedures. The authors' experience suggests that this approach can be used routinely in treating lesions in the posterior temporomedial region.
UI - 11702890
AU - Frank G; Pasquini E; Mazzatenta D
TI - Extended transsphenoidal approach.
SO - J Neurosurg 2001 Nov;95(5):917-8
The authors have developed an extended transsphenoidal approach with submucosal posterior ethmoidectomy for resection of tumors located in the cavernous sinus or the suprasellar region that are difficult to remove via the conventional transsphenoidal approach. Surgery was performed using this approach in 14 patients with large pituitary adenomas, three patients with craniopharyngiomas, and one patient with a meningioma of the tuberculum sellae. The submucosal dissection of the nasal septum used in the conventional transsphenoidal approach was extended to the superior lateral wall of the nasal cavity to expose the bony surface of the superior turbinate lying under the nasal mucosa. Submucosal posterior ethmoidectomy widened the area visualized through the conventional transsphenoidal approach both superiorly and laterally. This provided a safer and less invasive access to lesions in the cavernous sinus or the suprasellar region through the sphenoid sinus. Using this approach the authors encountered no postoperative complications, such as olfactory disturbance, cranial nerve palsy, or arterial injury. In this article the authors present the surgical methods used in this approach.
UI - 11903465
AU - De Santis A; Villani R; Sinisi M; Stocchetti N; Perucca E
TI - Add-on phenytoin fails to prevent early seizures after surgery for supratentorial brain tumors: a randomized controlled study.
SO - Epilepsia 2002 Feb;43(2):175-82
AD - Institute of Neurosurgery, Policlinico IRCCS, University of Milan, Italy.
PURPOSE: To determine the potential effectiveness of phenytoin (PHT) in preventing early postoperative seizures in patients undergoing craniotomy for supratentorial brain tumors. METHODS: Two hundred patients requiring elective craniotomy for supratentorial brain tumors were randomized to two groups of equal size, with a prospective, open-label, controlled design. One group received PHT (18 mg/kg as an intravenous intraoperative load, followed by additional daily doses aimed at maintaining serum PHT concentrations within the 10- to 20-aeg/ml range) for 7 consecutive days. In the other group, PHT was not administered. More than 90% of patients in both groups continued to take preexisting anticonvulsant medication (AEDs) with carbamazepine or phenobarbital throughout the study. The primary efficacy end point was the number of patients remaining free from seizures during the 7-day period after the operation. RESULTS: Of 100 patients allocated to PHT, 13 experienced seizures during the 7-day observation period, compared with 11 of 100 patients in the placebo group (p > 0.05). Most seizures occurred in the first day after surgery in both groups. There were no differences between groups in the proportion of patients experiencing more than one seizure, but there was a trend for generalized seizures to be more common in PHT-treated patients than in controls (11 vs. five patients, respectively). Status epilepticus occurred in one patient in the PHT group and in two patients in the control group. Of the 13 PHT-treated seizure patients, 11 had serum PHT concentrations within the target range, and only two had concentrations below range on the days their seizures occurred. CONCLUSIONS: PHT, given at dosages producing serum concentrations within the target range, failed to prevent early postoperative seizures in patients treated with concomitant AEDs. Prophylactic administration of PHT cannot be recommended in these patients.
UI - 8407404
AU - Allam A; Taghian A; Gioioso D; Duffy M; Suit HD
TI - Intratumoral heterogeneity of malignant gliomas measured in vitro.
SO - Int J Radiat Oncol Biol Phys 1993 Sep 30;27(2):303-8
AD - Edwin L. Steele Laboratory of Radiation Biology, Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
PURPOSE: To evaluate the extent of intratumoral heterogeneity of radiation sensitivity in malignant gliomas, by comparing the intrinsic radiation sensitivity of different glioma sublines derived from the same tumor. METHODS AND MATERIALS: The study was performed on five early established malignant gliomas (passage 3-10). Each specimen was quickly cut into three equal pieces (except for one specimen, where only two pieces were obtained). Each piece was processed independently, disintegrated into single cell suspension using a cocktail of enzymes. Survival curve assays, using colony formation as an end-point, were performed for each subline. Comparison between the intrinsic radiation sensitivity of sublines was calculated using the surviving fraction at 2 Gy and the mean inactivation dose as the measured parameters. The DNA content of the cell lines as well as their cell cycle analysis was determined using flow cytometry. RESULTS: The mean calculated surviving fraction at 2 Gy of all the sublines was 0.37 +/- 0.14, the mean mean inactivation dose was 1.98 +/- 0.63. The intertumoral coefficient of variation for the calculated surviving fraction at 2 Gy of all cell lines was 38%, while that for intratumoral heterogeneity was 25%. Three of the 5 tumors showed a statistically significant difference in the surviving fraction at 2 Gy and mean inactivation dose values of their sublines (p < 0.05). This difference in radiation sensitivity between sublines of the same tumor was not attributed to a difference either in the ploidy status or in the distribution of cells in the cell cycle. CONCLUSION: There is a significant intratumoral heterogeneity of radiation sensitivity in some malignant gliomas. This heterogeneity may limit the predictive power of surviving fraction at 2 Gy or mean inactivation dose, especially when their values are based upon a single measurement/single biopsy. In the meantime, this heterogeneity may be a factor in the discrepancy between unexpectedly sensitive tumor cell lines in vitro and their high clinical radiation resistance.
UI - 11902320
AU - Kameyama S; Fukuda M; Tomikawa M; Morota N; Oishi M; Wachi M; Kanazawa
TI - O; Sasagawa M; Kakita A; Takahashi H Surgical strategy and outcomes for epileptic patients with focal cortical dysplasia or dysembryoplastic neuroepithelial tumor.
SO - Epilepsia 2001;42 Suppl 6():37-41
AD - Department of Functional Neurosurgery, Epilepsy Center, National Nishi-Niigata Central Hospital, Masago, Japan.
PURPOSE: The purpose of this study was to clarify and compare the influence of surgical strategy on relief from seizures in patients with focal cortical dysplasia (FCD) and those with dysembryoplastic neuroepithelial tumor (DNT). METHODS: Six patients with FCD and five patients with DNT, all of whom underwent surgical resection for medically intractable epilepsy, were compared in terms of presurgical seizure types and frequency, location of lesions, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT) with 99mTc-ECD, scalp electroencephalogram (EEG), and long-term video-EEG recording. Prolonged subdural recordings and intraoperative electrocorticograms (ECoG) were analyzed. The influences of surgical strategies on seizure outcomes were retrospectively analyzed. RESULTS: In all the FCD patients, ictal SPECT revealed hyperperfusion in the regions where MRI showed FCD. Interictal epileptiform activity and ictal seizure onset on ECoG performed with subdural electrodes were localized on the FCD itself. In contrast, the tumors of all the DNT patients were depicted as hypoperfuse areas on interictal SPECT scans. Ictal SPECT in one DNT patient showed hyperperfusion in the area enclosing the tumor. Interictal spiking in all DNT patients and ictal seizure onset in two DNT patients were not in the lesions themselves but in an area enclosing the lesion. All but one patient with FCD who underwent total lesionectomy became seizure free. All DNT patients who underwent resection of the epileptogenic cortex associated with lesionectomy became seizure free or achieved a 90% reduction in seizures. CONCLUSIONS: FCD has intrinsic epileptogenicity, whereas DNT is encompassed by epileptogenic cortical areas. Therefore, total lesionectomy is an essential strategy for FCD, whereas resection of the epileptic focus associated with lesionectomy of a DNT lesion is necessary to control seizures.
UI - 11870182
AU - Stupp R; Dietrich PY; Ostermann Kraljevic S; Pica A; Maillard I; Maeder
TI - P; Meuli R; Janzer R; Pizzolato G; Miralbell R; Porchet F; Regli L; de Tribolet N; Mirimanoff RO; Leyvraz S Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide.
SO - J Clin Oncol 2002 Mar 1;20(5):1375-82
AD - Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. firstname.lastname@example.org
PURPOSE: Temozolomide is a novel oral alkylating agent with demonstrated efficacy as second-line therapy for patients with recurrent anaplastic astrocytoma and glioblastoma multiforme (GBM). This phase II study was performed to determine the safety, tolerability, and efficacy of concomitant radiation plus temozolomide therapy followed by adjuvant temozolomide therapy in patients with newly diagnosed GBM. PATIENTS AND METHODS: Sixty-four patients were enrolled onto this open-label, phase II trial. Temozolomide (75 mg/m(2)/d x 7 d/wk for 6 weeks) was administered orally concomitant with fractionated radiotherapy (60 Gy total dose: 2 Gy x 5 d/wk for 6 weeks) followed by temozolomide monotherapy (200 mg/m(2)/d x 5 days, every 28 days for six cycles). The primary end points were safety and tolerability, and the secondary end point was overall survival. RESULTS: Concomitant radiation plus temozolomide therapy was safe and well tolerated. Nonhematologic toxicities were rare and mild to moderate in severity. During the concomitant treatment phase, grade 3 or 4 neutropenia, thrombocytopenia, or both were observed in 6% of patients, including two severe infections with Pneumocystis carinii. During adjuvant temozolomide, 2% and 6% of cycles were associated with grade 3 and 4 neutropenia or thrombocytopenia, respectively. Median survival was 16 months, and the 1- and 2-year survival rates were 58% and 31%, respectively. Patients younger than 50 years old and patients who underwent debulking surgery had the best survival outcome. CONCLUSION: Continuous daily temozolomide and concomitant radiation is safe. This regimen of concomitant chemoradiotherapy followed by adjuvant chemotherapy may prolong the survival of patients with glioblastoma. Further investigation is warranted, and a randomized trial is ongoing.
UI - 11870183
AU - Groves MD; Puduvalli VK; Hess KR; Jaeckle KA; Peterson P; Yung WK; Levin
TI - VA Phase II trial of temozolomide plus the matrix metalloproteinase inhibitor, marimastat, in recurrent and progressive glioblastoma multiforme.
SO - J Clin Oncol 2002 Mar 1;20(5):1383-8
AD - Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
PURPOSE: Novel therapies are needed for patients with recurrent glioblastoma multiforme (GBM). Because there is evidence that temozolomide (TMZ) has some activity in GBM and is well tolerated, and because of laboratory evidence that metalloproteinases are important in glioma cell invasion, the combination of TMZ and the matrix metalloproteinase inhibitor marimastat (MRM) in patients with recurrent GBM was studied. PATIENTS AND METHODS: Forty-four patients with recurrent GBM after standard radiotherapy were enrolled. For 19 patients, this therapy was their first chemotherapy after tumor progression after irradiation; 25 others had received chemotherapy previously. TMZ 150 to 200 mg/m(2) days 1 to 5 and MRM 50 mg days 8 to 28 was administered at 28-day intervals for two cycles; then patients were reevaluated. Treatment continued until progression of tumor or toxicity developed. RESULTS: Joint and tendon pain was the major therapy-related toxicity and was reported in 47% of patients. Five patients (11%) were removed from the study because of intolerable joint pain. For all patients, the progression-free survival (PFS) at 6 months was 39%. Median PFS was 17 weeks, median overall survival was 45 weeks, and 12-month PFS was 16%. CONCLUSION: The combination of TMZ and MRM resulted in a PFS at 6 months that exceeded the literature target by 29%. This drug combination met phase II study criteria; further study in recurrent patients with GBM might be warranted. Further study of therapy-induced joint pain is necessary.
UI - 11870184
AU - Reardon DA; Akabani G; Coleman RE; Friedman AH; Friedman HS; Herndon JE
TI - 2nd; Cokgor I; McLendon RE; Pegram CN; Provenzale JM; Quinn JA; Rich JN; Regalado LV; Sampson JH; Shafman TD; Wikstrand CJ; Wong TZ; Zhao XG; Zalutsky MR; Bigner DD Phase II trial of murine (131)I-labeled antitenascin monoclonal antibody 81C6 administered into surgically created resection cavities of patients with newly diagnosed malignant gliomas.
SO - J Clin Oncol 2002 Mar 1;20(5):1389-97
AD - Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. email@example.com
PURPOSE: To assess the efficacy and toxicity of intraresection cavity (131)I-labeled murine antitenascin monoclonal antibody 81C6 and determine its true response rate among patients with newly diagnosed malignant glioma. PATIENTS AND METHODS: In this phase II trial, 120 mCi of (131)I-labeled murine 81C6 was injected directly into the surgically created resection cavity of 33 patients with previously untreated malignant glioma (glioblastoma multiforme [GBM], n = 27; anaplastic astrocytoma, n = 4; anaplastic oligodendroglioma, n = 2). Patients then received conventional external-beam radiotherapy followed by a year of alkylator-based chemotherapy. RESULTS: Median survival for all patients and those with GBM was 86.7 and 79.4 weeks, respectively. Eleven patients remain alive at a median follow-up of 93 weeks (range, 49 to 220 weeks). Nine patients (27%) developed reversible hematologic toxicity, and histologically confirmed, treatment-related neurologic toxicity occurred in five patients (15%). One patient (3%) required reoperation for radionecrosis. CONCLUSION: Median survival achieved with (131)I-labeled 81C6 exceeds that of historical controls treated with conventional radiotherapy and chemotherapy, even after accounting for established prognostic factors including age and Karnofsky performance status. The median survival achieved with (131)I-labeled 81C6 compares favorably with either (125)I interstitial brachy-therapy or stereotactic radiosurgery and is associated with a significantly lower rate of reoperation for radionecrosis. Our results confirm the efficacy of (131)I-labeled 81C6 for patients with newly diagnosed malignant glioma and suggest that a randomized phase III study is indicated.
UI - 10790718
AU - MacConnachie A M
TI - Temozolomide (Temodal) for treatment of primary brain tumours.
SO - Intensive Crit Care Nurs 2000 Feb;16(1):59-60
Although the outlook for patients with malignant gliomas continues to be very poor, progress in neurosurgery and radiotherapy, supported by new development in chemotherapy, offer some hope for the future. Temozolomide has recently been introduced by Schering-Plough Ltd (Welwyn Garden City, UK) as a new treatment which merits further investigation in this situation.
UI - 11692641
AU - Lunsford LD; Niranjan A
TI - The rationale for rational surgery for fibrillary astrocytomas.
SO - Clin Neurosurg 2001;48():20-36
AD - Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
UI - 11692648
AU - Piepmeier JM
TI - Cerebral gliomas: how tumor biology affects management.
SO - Clin Neurosurg 2001;48():3-9
AD - Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
UI - 11692653
AU - Laws ER; Shaffrey ME
TI - Surgical management of intracranial gliomas--biopsy, resection, or watchful waiting.
SO - Clin Neurosurg 2001;48():37-45
AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia, USA.
UI - 11692656
AU - Schmidt MH; Chang SM; Berger MS
TI - An appraisal of chemotherapy: in the blood or in the brain?
SO - Clin Neurosurg 2001;48():46-59
AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
UI - 11692657
AU - Croteau D; Mikkelsen T; Rempel SA; Bogler O; Rosenblum M
TI - New innovations and developments for glioma treatment.
SO - Clin Neurosurg 2001;48():60-81
AD - Department of Neurosurgery, Henry Ford Health System, Hermelin Brain Tumor Center, Detroit, Michigan, USA.
UI - 11898150
AU - Schwenka J; Ignoffo RJ
TI - Temozolomide. A new option for high-grade astrocytomas.
SO - Cancer Pract 2000 Nov-Dec;8(6):311-3
AD - University of California, San Francisco, California, USA.
UI - 11798939
AU - Zhang J; Wang Z; Jia G
TI - [Resection of neoplasm in fourth ventricle and at the back of pons through cerebellomedullary fissure approach]
SO - Zhonghua Yi Xue Za Zhi 2001 Jun 10;81(11):645-7
AD - Department of Neurosurgery, Tiantan Hospital, Beijing 100050, China.
OBJECTIVE: To investigate the advantage of cerebellomedullary fissure approach to resect the space occupying lesion in the fourth ventricle region and at the back of pons and to discuss the microsurgical skills. METHODS: The craniotomy is through the posterior fossa. To maximize the width of exposure, a long skin incision is made from the occipital protuberance down to the C4-5 level, and a free occipital bone flap is turned. The tonsils of cerebellum are reached by opening the tonsillovermian fissure and then moved upward so as to expose the operating field. Neoplasm in the fourth ventricle and at the back of pons was resected. RESULTS: Among the 23 cases, total resection was achieved in 20, and subtotal resection in 3. CONCLUSION: The cerebellomedullary fissure approach can provide a panoramic view between the two lateral recesses and from the obex to the aqueduct without excision of neural tissue. During the operation, the inferior vermis is not incised. The vessels and nervous tissue are extracted at a minimum extent. Such a procedure is much safer.
UI - 11758495
AU - Hori A
TI - Quality of life in patients after meningioma resection.
SO - Acta Neurochir (Wien) 2001 Oct;143(10):1080-1
UI - 11844233
AU - Nwokedi EC; DiBiase SJ; Jabbour S; Herman J; Amin P; Chin LS
TI - Gamma knife stereotactic radiosurgery for patients with glioblastoma multiforme.
SO - Neurosurgery 2002 Jan;50(1):41-6; discussion 46-7
AD - Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201, USA.
OBJECTIVE: Stereotactic radiosurgery (SRS) has become an effective therapeutic modality for the treatment of patients with glioblastoma multiforme (GBM). This retrospective review evaluates the impact of SRS delivered on a gamma knife (GK) unit as an adjuvant therapy in the external beam radiotherapy (EBRT) at the University of Maryland Medical Center. Of these 82 patients, 64 with a minimum follow-up duration of at least 1 month are the focus of this analysis. Of the 64 assessable patients, 33 patients were treated with EBRT alone (Group 1), and 31 patients received both EBRT plus a GK-SRS boost (Group 2). GK-SRS was administered to most patients within 6 weeks of the completion of EBRT. The median EBRT dose was 59.7 Gy (range, 28-070.2 Gy), and the median GK-SRS dose to the prescription volume was 17.1 Gy (range, 10-28 Gy). The median age of the study population was 50.4 years, and the median pretreatment Karnofsky performance status was 80. Patient-, tumor-, and treatment-related variables were analyzed by Cox regression analysis, and survival curves were generated by the Kaplan-Meier product limit. RESULTS: Median overall survival for the entire cohort was 16 months, and the actuarial survival rate at 1, 2, and 3 years were 67, 40, and 26%, respectively. When comparing age, Karnofsky performance status, extent of resection, and tumor volume, no statistical differences where discovered between Group 1 versus Group 2. When comparing the overall survival of Group 1 versus Group 2, the median survival was 13 months versus 25 months, respectively (P = 0.034). Age, Karnofsky performance status, and the addition of GK-SRS were all found to be significant predictors of overall survival via Cox regression analysis. No acute Grade 3 or Grade 4 toxicity was encountered. CONCLUSION: The addition of a GK-SRS boost in conjunction with surgery and EBRT significantly improved the overall survival time in this retrospective series of patients with GBM. A prospective, randomized validation of the benefit of SRS awaits the results of the recently completed Radiation Therapy Oncology Group's trial RTOG 93-05.
UI - 11896114
AU - Chan JL; Lee SW; Fraass BA; Normolle DP; Greenberg HS; Junck LR;
TI - Gebarski SS; Sandler HM Survival and failure patterns of high-grade gliomas after three-dimensional conformal radiotherapy.
SO - J Clin Oncol 2002 Mar 15;20(6):1635-42
AD - Departments of Radiation Oncology, Neurology, and Radiology, University of Michigan Medical Center, Ann Arbor, MI.
PURPOSE: The goal of three-dimensional (3-D) conformal radiation is to increase the dose delivered to tumor while minimizing dose to surrounding normal brain. Previously it has been shown that even escalated doses of 70 to 80 Gy have failure patterns that are predominantly local. This article describes the failure patterns and survival seen with high-grade gliomas given 90 Gy using a 3-D conformal intensity-modulated radiation technique. PATIENTS AND METHODS: From gliomas were treated to 90 Gy. For those that recurred, failure patterns were defined in terms of percentage of recurrent tumor located within the high-dose region. Recurrences with more than 95% of their volume within the high-dose region were considered central; those with 80% to 95%, 20% to 80%, and less than 20% were considered in-field, marginal, and distant, respectively. RESULTS: The median age was 55 years, and median follow-up was 11.7 months. At time of analysis, 23 (67.6%) of 34 patients had developed radiographic evidence of recurrence. The patterns of failure were 18 (78%) of 23 central, three (13%) of 23 in-field, two (9%) of 23 marginal, and zero (0%) of 23 distant. The median survival was 11.7 months, with 1-year survival of 47.1% and 2-year survival of 12.9%. No significant treatment toxicities were observed. CONCLUSION: Despite dose escalation to 90 Gy, the predominant failure pattern in high-grade gliomas remains local. This suggests that close margins used in highly conformal treatments do not increase the risk of marginal or distant recurrences. Our results indicate that intensification of local radiotherapy with dose escalation is feasible and deserves further evaluation for high-grade gliomas.
UI - 11878221
AU - Belov AI; Cherekaev VA; Reshetov IV; Kapitanov DN; Vinokurov AG; Zaitsev
TI - AM; Bekiashev AKh [Plastic surgical repair of the base of the skull after removing a craniofacial tumor]
SO - Zh Vopr Neirokhir Im N N Burdenko 2001 Oct-Dec;(4):5-9; discussion 9-10
UI - 9815919
AU - Debinski W; Obiri NI; Powers SK; Pastan I; Puri RK
TI - Human glioma cells overexpress receptors for interleukin 13 and are extremely sensitive to a novel chimeric protein composed of interleukin 13 and pseudomonas exotoxin.
SO - Clin Cancer Res 1995 Nov;1(11):1253-8
AD - The Milton S. Hershey Medical Center, The Pennsylvania State University College of Medicine, Department of Surgery, Division of Neurosurgery, Hershey, Pennsylvania 17033, USA. firstname.lastname@example.org
Recently, we have demonstrated that a spectrum of human adenocarcinoma cell lines express binding sites for interleukin 13 (IL-13). These cells are killed by a chimeric protein composed of human (h) IL-13 and a derivative of Pseudomonas exotoxin, PE38QQR (Debinski et al., J. Biol. Chem., 270: 16775-16780, 1995). The cell killing was hIL-13- and hIL-4-specific, indicating that a common binding site for the two cytokines is present in several solid tumor cell lines. Herein, we report that an array of established glioma cell lines is killed by very low concentrations of hIL-13-PE38QQR, often reaching <1 ng/ml (<20 pM). Glioma cells express up to 30,000 molecules of IL-13 receptor/cell which has intermediate affinity toward hIL-13. hIL-13-PE38QQR is more active (up to 3 logs difference in cytotoxic activities) than are the corresponding chimeric toxins containing hIL-4 or hIL-6. The cytotoxic action of hIL-13-PE38QQR is blocked by an excess of hIL-13 on all cell lines studied, and it is not neutralized by hIL-4 on some of these cells. Our results show that human brain cancers richly express receptors for IL-13. Furthermore, the interaction detected previously between receptors for IL-13 and IL-4 on solid tumors cell lines is of a qualitatively different character in U-251 MG and U-373 MG glioma cells. The receptor for IL-13 may represent a new marker of brain cancers and an attractive target for anticancer therapies.
UI - 11586643
AU - Smekalov AS
TI - [Variation cardiac intervalometry -- a component of neurophysiological monitoring]
SO - Anesteziol Reanimatol 2001 Jul-Aug;(4):8-11
The course of intraoperative period is retrospectively analyzed in patients operated on for bulky formations of the brain. Mathematical analysis of cardiac rhythm structure, performed using an original method within the framework of operation monitoring, detected early signs of disorders in adaptation systems, indicative of insufficient anesthesia and overrun physiological permissiveness during the main stages of operation. The results of the study extend our notions on the potentialities of traditional monitoring and improve the efficiency of neuroanesthesiological support and choice of surgical strategy.
UI - 11870521
AU - Joshi BH; Leland P; Silber J; Kreitman RJ; Pastan I; Berger M; Puri RK
TI - IL-4 receptors on human medulloblastoma tumours serve as a sensitive target for a circular permuted IL-4-Pseudomonas exotoxin fusion protein.
SO - Br J Cancer 2002 Jan 21;86(2):285-91
AD - Laboratory of Molecular Tumour Biology, Division of Cellular and Gene Therapies, Center for Biologics, Evaluation and Research, Food and Drug Administration, NIH Building 29B, Room 2NN10, 29 Lincoln Dr., Bethesda, Maryland, MD 20892, USA.
Cytotoxins directed to interleukin-4 receptors have shown to mediate relatively selective cytotoxicity against a variety of human cancer cells in vitro and in vivo. In an ongoing Phase I clinical trial, a recombinant protein comprised of circularly permuted IL-4 fused to a mutated form of Pseudomonas exotoxin (the fusion protein termed IL-4(38-37)-PE38KDEL or cpIL4-PE) has shown antitumour activity against malignant glioma. Human medulloblastomas are neuroectodermal tumours that occur in children and have a poor prognosis. The goal of this study was to determine whether human medulloblastoma derived cell lines express interleukin-4 receptor and whether interleukin-4 receptor expression is accompanied by sensitivity to cpIL4-PE. Medulloblastoma cell lines express interleukin-4 receptor at the protein and mRNA levels as determined by binding, indirect immunofluorescence and RT--PCR studies. These cells expressed IL-4Ralpha (also known as IL-4Rbeta) and IL-13Ralpha1 (also known as IL-13Ralpha') chains, however common gamma(c), a component of the interleukin-4 receptor system in immune cells was not detected. Consistent with the expression of IL-4R, cpIL4-PE was found to be highly and specifically cytotoxic to four of five medulloblastoma cell lines. Susceptibility of medulloblastoma cell lines to cpIL4-PE seemed to correlate closely to the functional IL-4 binding sites in general as demonstrated by 125I-IL-4 binding, but did not seem to correlate with mRNA or cell surface immunoreactive receptor protein expression. The sensitivity of medulloblastoma cells to cpIL4-PE could be eliminated by concurrent incubation with IL-4 or IL-13, but not with IL-2. None of these cell lines showed any change in proliferation upon treatment with exogenous IL-4. These studies establish the interleukin-4 receptor as a medulloblastoma-associated target for possible tumour-directed cancer therapy. Further studies are warranted to investigate interleukin-4 receptor expression in primary medulloblastoma tumours and sensitivity to cpIL-4PE in vitro and in vivo. Copyright 2002 The Cancer Research Campaign
UI - 11902299
AU - Mitchell A E; Elder J E; Mackey D A; Waters K D; Ashley D M
TI - Visual improvement despite radiologically stable disease after treatment with carboplatin in children with progressive low-grade optic/thalamic gliomas.
SO - J Pediatr Hematol Oncol 2001 Dec;23(9):572-7
AD - Department of Hematology and Oncology, Royal Children's Hospital, Parkville, Victoria, Australia.
BACKGROUND: The purpose of this study was to examine the clinical and radiologic response to carboplatin by children with progressive 1999, 12 consecutive children were treated with monthly carboplatin for progressive optic/thalamic gliomas. RESULTS: Five children have completed 12 cycles of carboplatin and five children are currently receiving treatment. Two children had progressive disease noted both clinically and radiologically. Nine children have stable radiologic disease and one child has had a partial radiologic response to chemotherapy. Eight children have had regular visual assessments. Four children (three with stable radiology and one with a partial radiologic response) have had improvement in their vision. Three children with radiologically stable disease have had no change in vision. One child has had deterioration in vision despite radiologically stable disease. CONCLUSIONS: The results suggest that the clinical response of optic/thalamic gliomas to carboplatin, as measured by visual acuity and visual fields, may be better than predicted by radiologic assessment. These data suggest that a prospective clinical study is warranted of the role of carboplatin in children with progressive optic/thalamic gliomas and visual impairment.
UI - 11201639
AU - Miyazawa T; Nawashiro H; Shima K; Bertalanffy H
TI - Early experiences of haemostasis on brain tumour surgery with Argon Plasma Coagulation (APC).
SO - Acta Neurochir (Wien) 2000;142(11):1247-51
AD - Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
OBJECTIVE: We first applied a novel haemostatic strategy involving Argon Plasma Coagulation (APC), an innovative no-touch electrocoagulation technique in which a high-frequency alternating current is delivered to the tissue through ionized argon gas, to brain tumour surgery, and report its usefulness and limitations. METHODS: The APC system we used comprised an APC 300 developed by ERBE Elektromedizin GmbH, Germany. We applied APC to 13 brain tumours in 12 patients (5 meningiomas, 4 sarcomas, 2 glioblastomas, and 2 pituitary adenomas). To avoid unnecessary thermal injury to the tissue as much as possible, power/gas flow settings of 20 and 40 W were used. The impact time was varied individually but was around several seconds per one impact. The argon jet (1.5-4.5 L/min) clears a field of pooled blood and evenly conducts electrical energy to the target tissue. A thin and flexible probe particularly increased the usefulness of APC for haemostasis on deep-seated skull base tumour operations under a microscope. CONCLUSION: All patients were successfully treated and satisfied with the surgical results without any complications due to APC. APC appears to be an excellent alternative strategy for achieving haemostasis on vascular-rich brain tumour surgery, and may be valuable for the management of patients with coagulation defects.
UI - 11776711
AU - Goodell TT; Muller PJ
TI - Photodynamic therapy: a novel treatment for primary brain malignancy.
SO - J Neurosci Nurs 2001 Dec;33(6):296-300
AD - Oregon Medical Laser Center/Providence St. Vincent Medical Center, 9205 SW Barnes Road, Portland, OR 97225, USA.
Providing therapy that conserves healthy brain tissue while effectively killing cancerous tissue remains a major challenge in the treatment of primary malignant brain tumors. The most common primary brain malignancies tend to recur despite intensive therapy, and the side effects of radiotherapy and chemotherapy can have considerable influence on health and quality of life. Photodynamic therapy (PDT) is a new technology being investigated to fulfill the need for a targeted cancer treatment that may reduce tumor recurrence and extend survival with few adverse effects. An investigational treatment, PDT employs wavelength-specific light in combination with a photosensitizing agent. The photosensitizing agent accumulates in tumor cells and is activated by nonthermal light, producing radical oxygen species that locally kill tumor cells. The selectivity of the process makes PDT appealing in the brain, where conservation of healthy tissue is vital. The most widely studied photosensitizer causes several weeks of ocular and cutaneous photosensitivity. Nursing care of the PDT patient includes intracranial pressure monitoring, neurological assessment, and intensive patient and family education. Many new photosensitizing compounds and varying methods of light delivery are being studied. This technology shows promise for the treatment of primary brain malignancies.
UI - 11915482
AU - Meyer P; Orliaguet G; Blanot S; Cuttaree H; Jarreau MM; Charron B; Carli
TI - P [Anesthesia-resuscitation for intracranial expansive processes in children]
SO - Ann Fr Anesth Reanim 2002 Feb;21(2):90-102
AD - Departement d'anesthesie-reanimation chirurgicale, secteur pediatrique, CHU Necker-Enfants Malades, 149, rue de Sevres 75015 Paris, France. email@example.com
The most frequent space-occupying cerebral lesions in children are brain tumors, mostly posterior fossa tumors and haematoma resulting from arteriovenous malformation rupture. They result in intracranial hypertension, directly or by compression of the cerebrospinal fluid pathway resulting in hydrocephalus. Their localization and compressive effects are responsible for specific neurological deficits and general problems. Posterior fossa lesions carry a high risk of obstructive hydrocephalus, cranial nerves palsy and brain stem compression, pituitary and chiasmatic tumors a risk of blindness, pituitary deficiency and diabetes insipidus, and cortical tumors a risk of motor deficit and epilepsy. All these parameters must be analyzed before choosing anaesthetic protocols, and surgical techniques. In the presence of life-threatening intracranial hypertension, emergency anaesthetic induction, tracheal intubation and ventilation are life-saving. The specific treatment consists in either hydrocephalus derivation, initial medical treatment with osmotherapy, or rarely surgical removal. In other situations, surgical process requires a highly deep, stable anaesthesia with perfect control of cerebral haemodynamics. Surgical positioning is complex for these long lasting procedures and carries specific risks. The most common is venous air embolism in the sitting position that must be prevented by the use of specific measures. In the postoperative period, the risk of neurological and general complications commands close surveillance, fast track extubation must be adapted on an individual basis.
UI - 11926909
AU - Batra PS; Dutra JC; Wiet RJ
TI - Auditory and facial nerve function following surgery for cerebellopontine angle meningiomas.
SO - Arch Otolaryngol Head Neck Surg 2002 Apr;128(4):369-74
AD - Division of Otolaryngology-Head and Neck Surgery, Evanston Northwestern Healthcare, 1000 Central St, Suite 610, Evanston, IL 60201, USA.
OBJECTIVE: To investigate the postoperative auditory and facial nerve function results after cerebellopontine angle meningioma removal. DESIGN: Retrospective chart review. SETTING: Tertiary care referral center. PATIENTS: Twenty-one patients undergoing surgical removal of cerebellopontine angle meningiomas by the senior author (R.J.W.). INTERVENTIONS: Translabyrinthine or retrosigmoid approach for tumor extirpation. MAIN OUTCOME MEASURES: Postoperative auditory (pure-tone average and speech discrimination score) and facial (House-Brackmann scale) function within 1 year of follow-up. RESULTS: Twenty-three operations were performed on 21 patients. Hearing preservation through the retrosigmoid approach was attempted in 11 patients (48%). Normal hearing (class A) was preserved in 9 of 10 patients. Normal postoperative facial nerve function (House-Brackmann grade I) was conserved in 11 (65%) of 17 patients. CONCLUSIONS: This review demonstrates that successful hearing preservation is possible with meningiomas. Therefore, the retrosigmoid approach should be used whenever serviceable hearing is present preoperatively. Normal facial nerve function can also be preserved in the majority of patients.
UI - 11903181
AU - Walker DG; Kaye AH
TI - Diagnosis and management of astrocytomas, oligodendrogliomas and mixed gliomas: a review.
SO - Australas Radiol 2001 Nov;45(4):472-82
AD - Department of Neurosurgery, Royal Brisbane Hospital, Herston, Queensland, Australia. firstname.lastname@example.org
Low-grade gliomas are a diverse group of neoplasms which, as the name implies, are thought to arise from glial cells. Common among this group are astrocytomas (low-grade astrocytoma; LGA), oligodendrogliomas and mixed gliomas. Among these, LGA is the commonest low-grade glioma and, occasionally, although incorrectly, the terms are used interchangeably. Advances in imaging technology have improved the accuracy of preoperative diagnosis. The management of low-grade gliomas is controversial. Recent evidence suggests that previously considered standard therapy (i.e. surgery plus radiotherapy) may not be in the patient's best interests. A review of the available published research concerning low-grade gliomas is therefore timely.
UI - 11785014
AU - Gelabert Gonzalez M; Garcia Allut A; Fernandez Villa JM; Gonzalez Garcia
TI - J; Martinez Rumbo R [Intracranial ependymomas]
SO - Rev Neurol 2001 Nov 16-30;33(10):980-6
AD - Servicio de Neurocirugia.Dpto. de Cirugia; Hospital General de Galicia, Santiago de Compostela, 15705, Espana. email@example.com
INTRODUCTION: Ependymomas are tumours derived from ependymal cells, found lining the cerebral ventricles and central canal of spinal cord. Intracranial ependymomas account for 2 6% of all neoplasms of the central nervous system and at least half present in the first two decades of life. DEVELOPMENT: We review the epidemiological, clinical, neuropathological details, neuroradiological aspects and treatment of intracranial ependymomas. CONCLUSIONS: Ependymomas of the posterior fossa predominate in children, while supratentorial tumours are more common in adults. This analysis of the literature further highlight that total tumour removal is the treatment of choice for intracranial ependymomas. Postoperative survival was predominantly dependent on the histological grade of malignancy, the extension of surgery and the age of the patient.
UI - 11943886
AU - Paulino AC; Wen BC; Buatti JM; Hussey DH; Zhen WK; Mayr NA; Menezes AH
TI - Intracranial ependymomas: an analysis of prognostic factors and patterns of failure.
SO - Am J Clin Oncol 2002 Apr;25(2):117-22
AD - Department of Radiology, Division of Radiation Oncology, The University of Iowa College of Medicine, Iowa City, Iowa, USA.
From 1965 to 1997, 49 patients were diagnosed and treated for intracranial ependymoma at one institution. Tumor location was infratentorial in two thirds, and pathology was low grade in 38 patients (78%). Gross total resection of the primary tumor was achieved in 21 (43%). Thirty-six patients received adjuvant radiotherapy; the entire neuraxis was treated in 14, whole brain in 10, and local field only in 12. Median follow-up was 9.6 years (range, 2-33 years). The 5-, 10-, and 15-year overall survival rates were 71.4%, 63.5%, and 63.5% for craniospinal radiotherapy, 60.0%, 60.0%, and 40.0% for whole brain radiotherapy, and 80.8%, 64.6%, and 64.6% for local field radiotherapy (p = 0.88). The 5-, 10-, and 15-year local control rates were 60.3%, 54.4%, and 48.9%. The prognostic factors for a better local control rate were gross total resection (p = 0.021) and low grade histology (p = 0.031). Seventeen of 43 (39.5%) M0 patients did not respond to treatment; all had local failure and 4 also had a spinal relapse. Spinal relapse developed in 3 of 31 (10%) M0 patients who did not receive spinal radiotherapy, whereas 1 of 12 (8%) who had spinal radiotherapy did not respond to treatment in the spine. The results of this study indicate that local radiotherapy is sufficient for M0 patients with intracranial ependymoma.