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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Brain Tumor - April 2002
National Cancer Institute®
Last Modified: April 1, 2002
Table of Contents
1
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.
2
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.
3
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.
4
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.
5
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.
6
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.
7
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. roger.stupp@chuv.hospvc.ch
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.
8
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.
9
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. reard003@mc.duke.edu
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.
10
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.
11
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.
12
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.
13
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.
14
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.
15
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.
16
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.
17
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.
18
UI - 11758495
AU - Hori A
TI -
Quality of life in patients after meningioma resection.
SO - Acta Neurochir (Wien) 2001 Oct;143(10):1080-1
19
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.
20
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.
21
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
22
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. debinski@debin.nsr.hmc.psu.edu
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.
23
UI - 9575487
AU - Veggeberg S
TI -
Targeting toxins to brain tumors.
SO - Mol Med Today 1998 Mar;4(3):93
24
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.
25
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
26
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.
27
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.
28
UI - 11693149
AU - Elmaci I
TI -
Coagulation (APC).
SO - Acta Neurochir (Wien) 2001 Sep;143(9):964
29
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.
30
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.
philippe.meyer@nck.ap-hop-paris.fr
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.
31
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.
32
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. dividgwalker@oxemail.com.au
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.
33
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. cimigego@usc.es
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.
34
UI - 11900997
AU - Bradley WG
TI -
Achieving gross total resection of brain tumors: intraoperative MR
imaging can make a big difference.
SO - AJNR Am J Neuroradiol 2002 Mar;23(3):348-9
35
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.
36
UI - 11789276
AU - Zhang J; Lu S; Liu W
TI -
[Further clinical study of acupuncture anesthesia for supratentorial
craniocerebral operations]
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