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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Brain Tumor - January 2002
National Cancer Institute®
Last Modified: January 1, 2002
Table of Contents
1
UI - 11417414
AU - Eder HG; Leber KA; Eustacchio S; Pendl G
TI -
The role of gamma knife radiosurgery in children.
SO - Childs Nerv Syst 2001 May;17(6):341-6; discussion 347
AD - Department of Neurosurgery, Karl-Franzens University, Auenbruggerplatz
29, 8036 Graz, Austria. hans.eder@kfunigraz.ac.at
OBJECTS: Despite advances in microneurosurgery, the surgical management
of deep-seated lesions is still associated with a high risk. Gamma knife
radiosurgery (GKRS), however, has improved the outcome of cerebral
tumors and arteriovenous malformations (AVMs) in delicate areas.
with intracranial lesions were treated with GKRS. There were 12
low-grade gliomas, 12 high-grade gliomas, 7 craniopharyngiomas, 3
hamartomas, 2 meningiomas of the skull base, 2 vestibular schwannomas, 1
pituitary adenoma, 1 choroid plexus papilloma, and 10 AVMs. The mean
size of the pathologies was 4.6 cm3 (range: 0.21-25.5 cm3). A mean
marginal dose of 16 Gy (8-25 Gy) was applied to a mean isodose surface
of 50% (35-90%). Clinical and neuroradiological follow-up were analyzed
for outcome. Follow-up periods of 45 of these patients ranged from 8 to
79 months (mean 36 months); 5 patients were lost to follow-up. Neoplasms
decreased in size in 15 cases (41%), remained unchanged in 13 patients
(35%), and increased in 9 cases (24%). AVMs obliterated in 3 children
(38%) within 24 months. Neurological follow-up demonstrated improved
clinical status in 7 patients (15.5%), stable neurological status in 31
cases (69%) and clinical deterioration in 7 patients (15.5%). The
treatment was well tolerated and no complications occurred. CONCLUSIONS:
GKRS represents a safe and effective treatment option for benign
neoplasms or AVMs in pediatric patients and may extend survival times of
children with malignant lesions.
2
UI - 11434661
AU - Corrias A; Einaudi S; Ricardi U; Sandri A; Besenzon L; Altare F;
TI -
Artesani L; Genitori L; Andreo M; De Sanctis C
Thyroid diseases in patients treated during pre-puberty for
medulloblastoma with different radiotherapic protocols.
SO - J Endocrinol Invest 2001 Jun;24(6):387-92
AD - Division of Pediatric Endocrinology, Regina Margherita Hospital, Turin,
Italy. endop50@hotmail.com
We evaluated thyroid disease in 32 patients treated, during pre-puberty,
for medulloblastoma, followed for at least 4 years and without relapse
during observation. After surgery the patients underwent chemotherapy
(CT) and radiotherapy (RT). The protocols were as follows: 20 patients
(group A) SNC 76 and SNC 85 protocols which included conventional
fractionated RT (36-40 Gy to the craniospinal axis and a 14-18 Gy boost
to the posterior fossa, administered as 1.5-1.8 Gy per fraction per day)
and a junction between the cranial and the spinal fields at C2-C3 level;
12 patients (group B) SNC 91 protocol which included hyperfractionated
RT (36 Gy to the craniospinal axis and a 30 Gy boost to the posterior
fossa; this was administred as 1 Gy per fraction twice per day) and a
junction at levels C5-C6 or C6-C7 level. The mean age at diagnosis was
7.4+/-3.2 years for group A and 8.4+/-2.6 years for group B. Thyroid
function was evaluated yearly and ultrasonographic characteristics every
2 years. The patients were followed for a mean of 10.8+/-3.8 for group A
and 6+/-1.4 years for group B. Primary hypothyroidism was diagnosed in
16 group A patients and 4 group B patients, and central hypothyroidism
was diagnosed in 2 group A patients (difference in risk of developing
hypothyroidism evaluated with a Wilcoxon-test: p=0.048). Ultrasonography
showed reduced thyroid volume in 7 group A cases, and structural changes
in 21 patients (17 group A, 4 group B); 9 L-thyroxine-treated patients
were confirmed hypothyroid after having stopped therapy. A thyroid
nodule was detected in two cases (one from each group). In conclusion,
our data indicate that thyroid injury may be diminished by the use of
hyperfractionation and low-junction radiotherapy in the treatment of
medulloblastoma.
3
UI - 11425963
AU - Boiardi A
TI -
PCV chemotherapy for recurrent glioblastoma multiforme.
SO - Neurology 2001 Jun 26;56(12):1782
4
UI - 11437284
AU - Kubota M; Saeki N; Yamaura A; Ono J; Ozawa Y
TI -
Influences of venous involvement on postoperative brain damage following
the anterior interhemispheric approach.
SO - Acta Neurochir (Wien) 2001;143(4):321-5; discussion 325-6
AD - Department of Neurosurgery, Chiba University School of Medicine,
Chiba-shi, Japan.
BACKGROUND: The anterior interhemispheric approach offers us an
excellent surgical view for suprasellar lesions. Following this
approach, we occasionally encounter postoperative brain damage in the
frontal lobes. To assess the determinants of such a complication, we
undertook a clinical study. METHOD: Potential causes for such brain
damage were evaluated in 28 consecutive patients with suprasellar
tumours extirpated using this approach. We focused particularly on the
influences of venous involvement during surgery. The draining territory
index (DTI) was originally devised for estimating the extent of the
draining area of the sacrificed bridging veins. FINDINGS: CT evident
brain damage was observed in five of 28 patients (17.8%), but only one
patient (3.6%) showed clinically significant postoperative deficits. The
patient's age, tumour pathology, tumour character, tumour size, duration
of surgery, and radicality of the surgery did not affect the incidence
of the brain damage. Of the twelve patients whose bridging veins were
sacrificed during surgery, four (33.3%) showed brain damage in the
frontal lobes. In contrast, such damage was observed in only one patient
out of 16 (6.3%) whose bridging veins were preserved. Among the
brain-damaged group, the average DTI of the sacrificed veins was
significantly higher than that among the non-brain-damaged group.
INTERPRETATION: Venous involvement during surgery significantly
aggravated postoperative brain damage following the anterior
interhemispheric approach. The DTI was useful in predicting the risk of
brain damage, and a large bridging vein with a DTI over 50% should not
be sacrificed during surgery.
5
UI - 11437285
AU - Zimmermann M; Seifert V; Trantakis C; Raabe A
TI -
Open MRI-guided microsurgery of intracranial tumours in or near eloquent
brain areas.
SO - Acta Neurochir (Wien) 2001;143(4):327-37
AD - Neurosurgical Clinic, Johann Wolfgang Goethe-University Frankfurt am
Main, Germany.
OBJECTIVES: Preservation of brain function while maximizing resection is
the main aim of brain tumour surgery. The purpose of this study was to
evaluate the efficacy of intra-operative magnetic resonance imaging to
preserve brain function in patients with tumours in or near eloquent
fifty-eight craniotomies for intracranial tumours or vascular
malformations have been performed at the University of Leipzig using a
0.5 T superconducting MR system "SIGNA SP" (General Electric Medical
Systems, USA). In 32 of these patients (15 male/17 female) with
intracranial tumours, located in or near eloquent brain areas
(sensorimotor cortex/speech center), 34 craniotomies were performed
using the image guidance of the interventional MRI. RESULTS: Using
intra-operative MRI criteria, complete tumour removal could be achieved
in 28 (82%) of 34 procedures. In 3 patients only subtotal tumour removal
was possible, because the residual tumour was not visible on the
intra-operative MR images, but could be identified on early diagnostic
follow-up MR-scans. In 3 patients, incomplete tumour resection was
performed in order to avoid neurological impairment. In these patients
intra-operative MR-images revealed residual tissue abnormalities
involving or encroaching on deep brain structures or motor/language
cortex. Pre-operative neurological status was unchanged in 24 patients
(70%), worsened in 4 patients (12%) and improved in 6 patients (18%).
CONCLUSIONS: Intra-operative MRI is helpful for navigation as well as to
demonstrate the tumour margins to achieve a complete and safe resection
of intracranial lesions located in or near eloquent brain areas. It
enables an image based functional monitoring of the brain which is
critical for motor, sensory or language function. Complications related
to the surgical procedure are reduced and the risk of neurological
deterioration due to tumour removal and postoperative complications is
minimized.
6
UI - 11451205
AU - Wassenberg MW; Bromberg JE; Witkamp TD; Terhaard CH; Taphoorn MJ
TI -
White matter lesions and encephalopathy in patients treated for primary
central nervous system lymphoma.
SO - J Neurooncol 2001 Mar;52(1):73-80
AD - Department of Neurology, University Medical Centre, Utrecht University,
The Netherlands.
A retrospective analysis of the clinical presentations and neuroimaging
characteristics of 33 patients with a primary central nervous system
lymphoma (PCNL) who received cranial radiotherapy was performed to
assess incidence of and risk factors for radiation-induced
encephalopathy. CT and MRI scans were revised by a neurologist and a
radiologist in conference. White matter abnormalities before and after
radiotherapy on the last scan before recurrence were quantified
according to a semi-quantitative scale. All available medical records
were retrieved and reviewed with respect to demographic and
tumor-related variables, treatment modalities, disease-free and overall
survival and clinical symptoms and signs of encephalopathy. CT and MRI
scans showed severe white matter lesions in 75% of 20 patients and in
86% of patients aged more than 60 years. Forty percent of patients
presented with new clinical signs of cognitive impairment a median of
14.5 months after initial diagnosis (8.5 months after radiotherapy). The
risk of white matter lesions appeared greater in patients aged >60 (RR
1.2, 95% CI = 0.8-2.0), in patients with prior white matter lesions (RR
1.3, 95% CI = 0.8-2.1) and in patients with multifocal cerebral lymphoma
(RR 1.5, 95% CI = 1.0-2.1). In conclusion, the risk of white matter
lesions and clinical symptoms and signs of encephalopathy is high in
patients treated by radiotherapy for PCNL. The risk appears to be
greatest in older patients, patients with multifocal tumor and in those
with prior white matter lesions on CT or MRI.
7
UI - 11465396
AU - Chiou SM; Lunsford LD; Niranjan A; Kondziolka D; Flickinger JC
TI -
Stereotactic radiosurgery of residual or recurrent craniopharyngioma,
after surgery, with or without radiation therapy.
SO - Neuro-oncol 2001 Jul;3(3):159-66
AD - Department of Neurological Surgery and Radiation Oncology, Center for
Image-Guided Neurosurgery, University of Pittsburgh Medical Center, PA
15213-2582, USA.
This study evaluated the role of stereotactic radiosurgery in the
multimodality management of craniopharyngioma patients whose prior
therapies failed. Ten consecutive patients (3 males and 7 females) had
radiosurgery for craniopharyngioma during a 10-year interval. Their ages
ranged from 9 to 64 years (median, 14.5 years). The median interval
between diagnosis and radiosurgery was 46.5 months. In total, 12
stereotactic radiosurgical procedures were performed to control the
solid component of the tumor (2 intrasellar and 10 suprasellar tumors).
The median tumor volume was 1.35 cm3. One to 9 isocenters with different
beam diameters were used; the median marginal dose was 16.4 Gy; and the
dose to the optic apparatus was limited to less than 8 Gy. Clinical and
imaging follow-up data were obtained at a median of 63 months (range,
13-150 months) from radiosurgery. Overall, 7 of 12 tumors became smaller
or vanished within a median of 8.5 months. Prior visual defects
objectively improved in 6 patients. One patient with prior visual defect
deteriorated further and lost vision 9 months after radiosurgery.
Multimodality therapy is often necessary for patients with refractory
solid and cystic craniopharyngiomas. Stereotactic radiosurgery is a
reasonable option in select patients with small recurrent or residual
craniopharyngioma.
8
UI - 11465399
AU - Fouladi M; Jenkins J; Burger P; Langston J; Merchant T; Heideman R;
TI -
Thompson S; Sanford A; Kun L; Gajjar A
Pleomorphic xanthoastrocytoma: favorable outcome after complete surgical
resection.
SO - Neuro-oncol 2001 Jul;3(3):184-92
AD - Department of Hematology-Oncology, St Jude Children's Research Hospital,
Memphis, TN 38105-2794, USA.
To describe the clinical features, histologic characteristics, and
management of patients with pleomorphic xanthoastrocytoma (PXA), we
reviewed data on 13 children who had histologically confirmed PXA and
were referred to the neuro-oncology service between 1985 and 1999.
Neuro-imaging with CT and/or MRI documented the anatomic location, tumor
extent, and degree of resection. There were 3 males and 10 females;
median age was 12.9 years (range, 8.2-17.2 years). The most frequent
presentations included seizures (n = 8) and headache (n = 5). Tumor
sites included temporal (n = 5), parietal (n = 3), frontal (n = 1),
frontoparietal (n = 1), parietooccipital (n = 1), and temporoparietal (n
= 1) lobes and the spinal cord (n = 1). CT/MRI revealed a cystic
component in 6 patients, with cyst wall enhancement in 3 patients. The
solid component was uniformly enhancing in 11 patients. Vasogenic edema
was present in 9 patients, and calcification was noted in 4 patients.
Histopathologic findings included meningeal invasion in 12 patients,
calcifications in 4, and necrosis in 2. Mitotic figures (1-12 per
high-power field) were seen in 8 patients. Gross total resection was
achieved in 8 patients, near total resection in 1, and subtotal
resection in 4. Ten patients were alive with a median follow-up of 41
months at this writing. Two patients died of progressive disease, and 1
died of an unrelated cause. In conclusion, pleomorphic xanthoastrocytoma
is a rare neoplasm in childhood, commonly presenting with seizures.
Gross total resection without adjuvant therapy provides prolonged
disease control, as seen in 6 of 7 patients (85%) in our series.
9
UI - 11465401
AU - Visted T; Bjerkvig R; Enger PO
TI -
Cell encapsulation technology as a therapeutic strategy for CNS
malignancies.
SO - Neuro-oncol 2001 Jul;3(3):201-10
AD - Department of Anatomy and Cell Biology, University of Bergen, Norway.
Gene therapy using viral vectors has to date failed to reveal its
definitive clinical usefulness. Cell encapsulation technology represents
an alternative, nonviral approach for the delivery of biologically
active compounds to tumors. This strategy involves the use of
genetically engineered producer cells that secrete a protein with
therapeutic potential. The cells are encapsulated in an immunoisolating
material that makes them suitable for transplantation. The capsules, or
bioreactors, permit the release of recombinant proteins that may assert
their effects in the tumor microenvironment. During the last decades,
there has been significant progress in the development of encapsulation
technologies that comprise devices for both macro- and
microencapsulation. The polysaccharide alginate is the most commonly
used material for cell encapsulation and is well tolerated by various
tissues. A wide spectrum of cells and tissues has been encapsulated and
implanted, both in animals and humans, indicating the general
applicability of this approach for both research and medical purposes,
including CNS malignancies. Gliomas most frequently recur at the
resection site. To provide local and sustained drug delivery, the
bioreactors can be implanted in the brain parenchyma or in the
ventricular system. The development of comprehensive analyses of geno-
and phenotypic profiles of a tumor (genomics and proteomics) may provide
new and important guidelines for choosing the optimal combination of
bioreactors and recombinant proteins for therapeutic use.
10
UI - 11471487
AU - Paganelli G; Bartolomei M; Ferrari M; Cremonesi M; Broggi G; Maira G;
TI -
Sturiale C; Grana C; Prisco G; Gatti M; Caliceti P; Chinol M
Pre-targeted locoregional radioimmunotherapy with 90Y-biotin in glioma
patients: phase I study and preliminary therapeutic results.
SO - Cancer Biother Radiopharm 2001 Jun;16(3):227-35
AD - Division of Nuclear Medicine, European Institute of Oncology, Milan,
Italy.
The aim of this study was to determine the maximum-tolerated dose, of a
pre-targeting three-step (3-S) method employing 90Y-biotin in the
locoregional radioimmunotherapy (RIT) of recurrent high grade glioma,
and to investigate the antitumor efficacy of this new treatment.
Twenty-four patients with recurrent glioma underwent second surgical
debulking and implantation of a catheter into the surgical resection
cavity (SRC), in order to introduce the radioimmunotherapeutic agents
[biotinylated monoclonal antibody (MoAb), avidin and 90Y-biotin]. Eight
patients with anaplastic astrocytoma (AA) and 16 patients with
glioblastoma (GBM) were injected with biotinylated anti-tenascin MoAb (2
mg), then with avidin (10 mg; 24 h later) and finally 90Y-biotin (18 h
later). Each patient received two of these treatments 8-10 weeks apart.
The injected activity ranged from 0.555 to 1.110 GBq (15-30 mCi). Dosage
was escalated by 0.185 GBq (5 mCi) in four consecutive groups. The
treatment was well tolerated without acute side effects up to 0.740 GBq
(20 mCi). The maximum tolerated activity was 1.110 GBq (30 mCi) limited
by neurological toxicity. None of the patients developed hematologic
toxicity. In three patients infection occurred around the catheter. The
average absorbed dose to the normal brain was minimal compared with that
received at the SRC interface. At first control (after 2 months),
partial (PR) and minor (MR) responses were observed in three GBM (1 PR;
2 MR) and three AA patients (1 PR; 2 MR) with an overall objective
response rate of 25%. Stable disease (SD) was achieved in seven GBM and
five AA patients (50%). There was disease progression in six GBM
patients (25%), but in none of the AA patients. At the dosage of 0.7-0.9
GBq per cycle, locoregional 3-S-RIT was safe and produced an objective
response in 25% of patients. Based on these encouraging results, phase
II studies employing 3-S-RIT soon after first debulking are justified.
11
UI - 11485231
AU - Ildan F; Tuna M; Gocer IA; Erman T; Cetinalp E
TI -
Intracerebral ganglioglioma: clinical and radiological study of eleven
surgically treated cases with follow-up.
SO - Neurosurg Rev 2001 Jul;24(2-3):114-8
AD - Cukurova University School of Medicine, Department of Neurosurgery,
Balcali, Adana, Turkey. fildanm@superonline.com
BACKGROUND: Gangliogliomas are rare benign tumors of the CNS consisting
of differentiated neural elements and low-grade glial cells. METHODS: We
reviewed our experience of 11 patients with histologically proven
ganglioglioma who were surgically treated since 1986 at Cukurova
University Medical Center. These patients presented at 18 to 45 years of
age. Five were women and six were men. The most common initial symptom
was seizures (in nine of 11 patients), which had sometimes persisted
over long periods of time. At the time of diagnosis, four patients had
focal neurological deficits and three had signs or symptoms of increased
intracranial pressure. The cystic and well-circumscribed characteristics
of these lesions were detected on computed tomography (CT). Despite
their appearance on CT, all but one of the lesions were found to be
mostly solid at operation. Magnetic resonance imaging (MRI) in six
patients revealed abnormally high signal intensity on T2-imaging. The
temporal lobe was the main tumor location (seven patients). All cases
were diagnosed according to the Russel and Rubinstein histological
criteria for ganglioglioma. RESULTS: Ten patients had radical total
resection and one had subtotal resection. No patient underwent
postoperative radiation or chemotherapy. Except for one, all are still
alive and free of progressive disease 1 to 11 years (mean 6.2) after
operation. Six are seizure-free and three have improved seizure control
under anticonvulsant therapy. CONCLUSIONS: We conclude that
ganglioglioma is a distinct histological phenomenon with mildly
predictable clinical symptoms (seizures), mildly characteristic
radiological features, and long-term survival after surgical resection
without the need of adjuvant treatment such as radiotherapy.
12
UI - 11487189
AU - Signorelli F; Guyotat J; Isnard J; Schneider F; Mohammedi R; Bret P
TI -
The value of cortical stimulation applied to the surgery of malignant
gliomas in language areas.
SO - Neurol Sci 2001 Feb;22(1):3-10
AD - Neurosurgery Service B, Neurologic Hospital, Lyon, France.
This study analyzes the utility of peroperative cortical language
mapping applied to the surgery of high-grade gliomas situated within or
in close vicinity to speech areas. Fifteen consecutive patients
harboring high-grade gliomas located in the dominant hemisphere, causing
regressive or minor language troubles, underwent awake craniotomy in our
stimulation under local anesthesia for language mapping, initially
described by Ojemann and colleagues, was applied with some
modifications. All patients tolerated awake craniotomy except one, who
was intubated after the mapping procedure. Mapping results confirmed a
high variability in location of language sites. It was possible to
achieve a gross total tumor removal in all cases. Nine patients (60%)
exhibited a transient postoperative aggravation. Two patients (13%)
presented permanent phasic aggravation. One patient died 16 days after
surgery from pulmonary embolism. Five patients died for tumor
progression, with a mean survival time of 16.4 months and a median
high-quality survival period of 14.2 months. With a mean follow-up of
9.9 months (range, 18-6 months), the 9 survivors are recurrence-free and
reveal no significant change in linguistic abilities. This technique is
well tolerated and consents to maximize the extent of surgical removal
while minimizing the risks of permanent postoperative deficits. This
results in an improvement of survival and quality of life.
13
UI - 11468326
AU - van den Bent MJ; Keime-Guibert F; Brandes AA; Taphoorn MJ; Kros JM;
TI -
Eskens FA; Carpentier AF
Temozolomide chemotherapy in recurrent oligodendroglioma.
SO - Neurology 2001 Jul 24;57(2):340-2
AD - Department of Neuro-Oncology, University Hospital Rotterdam/Rotterdam
Cancer Center, the Netherlands. bent@neuh.azr.nl
The authors determined the tolerance, response rate, and duration of
recurrent anaplastic oligodendroglioma in 30 patients to temozolomide
given orally at 150 to 200 mg/m2 on days 1 through 5 in cycles of 28
days. Nine patients responded: 7 of 27 patients (26%) treated with
temozolomide after prior PCV chemotherapy and 2 of 3 chemotherapy-naive
patients (both complete response). Median time to progression in
responding patients was 13 months. Temozolomide shows promise and has an
acceptable safety profile in recurrent anaplastic oligodendroglial
tumors. Patients not responding to PCV may respond to temozolomide.
14
UI - 11482697
AU - Zevgaridis D; Medele RJ; Muller A; Hischa AC; Steiger HJ
TI -
Meningiomas of the sellar region presenting with visual impairment:
impact of various prognostic factors on surgical outcome in 62 patients.
SO - Acta Neurochir (Wien) 2001;143(5):471-6
AD - Department of Neurosurgery, Klinikum Mannheim, University of Heidelberg,
Germany.
BACKGROUND: Meningiomas of the supra- and parasellar region can cause
insidious visual loss by optic nerve compression. 62 cases with such
tumours affecting the anterior optic pathways were analysed to assess
the surgical results and prognostic factors with particular attention to
visual outcome. METHOD: In all patients, visual deterioration was the
first clinical manifestation. Eleven lesions had their origin at the
anterior clinoid process, 24 at the tuberculum sellae, 10 at the planum
sphenoidale, two in the optic canal, 10 in the medial sphenoidal wing,
and five in the olfactory groove. All patients underwent microsurgical
tumour resection. Median age at the time of operation was 54 years,
median duration of symptoms seven months. The mean follow-up time was
5.2 years (range 2 to 8 years). Statistical analysis of prognostic
factors (gender, age, tumour location, tumour size, duration of
symptoms, brain tumour interface, resection grade, preoperative visual
loss, Glascow Outcome Score) was performed using univariate and
multivariate analysis. FINDINGS: The severe morbidity rate was 6.4%. Two
patients died within the first 30 postoperative days. Overall, vision
improved in 39 (65%) patients, in 11 (18%) it was unchanged, and worse
in 10 (17%). Visual prognosis was favourably affected by age under 54
years (p < 0.025), duration of symptoms of less than seven months (p <
0.037), and the presence of an intact arachnoid membrane around the
lesion (p < 0.001). Severe preoperative loss of visual acuity (<0.02)
appeared to be an unfavourable prognostic factor (p < 0.047).
INTERPRETATION: Possible difficulties and surgical outcome in such
patients can be predicted successfully. These facts in connection with
new therapeutic modalities (radiosurgery, adjuvant therapies) will
demand a careful risk assessment and should influence the treatment
strategies and the degree of operative aggressiveness in the future.
15
UI - 11508532
AU - Kim SK; Wang KC; Hwang YS; Kim KJ; Cho BK
TI -
Intractable epilepsy associated with brain tumors in children: surgical
modality and outcome.
SO - Childs Nerv Syst 2001 Aug;17(8):445-52
AD - Division of Pediatric Neurosurgery and Clinical Research Institute,
Seoul National University Children's Hospital and Neurological Research
Institute, Korea.
OBJECTS: The aim of this study was to evaluate the role of surgical
modality in children with brain tumors and intractable epilepsy.
METHODS: Twenty-three patients who were treated for brain tumors and
retrospectively reviewed. The most common tumors were dysembryoplastic
neuroepithelial tumors (n=9), oligodendrogliomas (n=6), and
gangliogliomas (n=5). Six patients exhibited cortical dysplasia. The
mean duration of follow-up was 43.4 months (range 12 to 125 months).
Seizure outcome was more favorable (Engel's classes I and II) in
patients with a complete resection of tumor (14/14 vs 6/9 for incomplete
resection; P<0.05). There was no significant difference in seizure
outcome between lesionectomy (n=13) and epilepsy surgery (n=10). The
likelihood of requiring postoperative antiepileptic drugs was not
influenced by the extent of resection or type of surgery. CONCLUSIONS:
On the basis of this study, we conclude that the complete resection of
these tumors can be an appropriate initial treatment for children with
brain tumors who experience intractable epilepsy.
16
UI - 11571537
AU - Maleniak TC; Darling JL; Lowenstein PR; Castro MG
TI -
Adenovirus-mediated expression of HSV1-TK or Fas ligand induces cell
death in primary human glioma-derived cell cultures that are resistant
to the chemotherapeutic agent CCNU.
SO - Cancer Gene Ther 2001 Aug;8(8):589-98
AD - Molecular Medicine and Gene Therapy Unit, School of Medicine, University
of Manchester, Manchester M13 9PT, UK.
Due to minimal treatment success with surgery, radiotherapy, and
chemotherapy, the aim of this study was to test the therapeutic
potential of gene therapy for the treatment of glioblastoma multiforme
(GBM). We have quantitatively analyzed two gene therapy approaches using
short-term human glioma cell cultures derived from surgical biopsies
(designated IN859, IN1612, IN2045, IN1760, and IN1265) and compared the
results of gene therapy with the chemosensitivity of the same cells. All
of the glioma cell cultures tested were susceptible to recombinant
adenovirus (RAd)-mediated infection. Expression of herpes simplex virus
type 1-thymidine kinase (RAd128), followed by ganciclovir treatment,
induced apoptosis in all of the glioma cell cultures studied, including
three that are resistant to the chemotherapeutic drug
1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU). Expression of
murine Fas ligand (RAdhCMV-mFasL) also induced cell death in four of the
five cell cultures studied. One cell culture that was resistant to CCNU
was also resistant to apoptosis induced by mFasL expression. These
results suggest that sensitivity to chemotherapeutic agents does not
necessarily correlate with the sensitivity to gene therapy treatments.
RAds expressing therapeutic gene products in human glioma cell cultures
are able to induce apoptosis even in some cells that are resistant to a
commonly used chemotherapeutic agent. Therefore, RAd-mediated gene
transfer could be a good candidate to further develop gene therapy for
the treatment of GBM.
17
UI - 11561035
AU - Roux FE; Ibarrola D; Lotterie JA; Chollet F; Berry I
TI -
Perimetric visual field and functional MRI correlation: implications for
image-guided surgery in occipital brain tumours.
SO - J Neurol Neurosurg Psychiatry 2001 Oct;71(4):505-14
AD - Institut National de la Sante Et de la Recherche Medicale, Unite 455,
Department of Neurosurgery, Hopital Purpan, F-31059, Toulouse, France.
rouxfran@compuserve.com
OBJECTIVE: To compare the results of visual functional MRI with those of
perimetric evaluation in patients with visual field defects and
retrochiasmastic tumours and in normal subjects without visual field
defect. The potential clinical usefulness of visual functional MRI data
during resective surgery was evaluated in patients with occipital lobe
tumours. METHODS: Eleven patients with various tumours and visual field
defects and 12 normal subjects were studied by fMRI using bimonocular or
monocular repetitive photic stimulation (8 Hz). The data obtained were
analyzed with the statistical parametric maps software (p<10(-8)) and
were compared with the results of Goldmann visual field perimetric
evaluation. In patients with occipital brain tumours undergoing surgery,
the functional data were registered in a frameless stereotactic device
and the images fused into anatomical three standard planes and three
dimensional reconstructions of the brain surface. RESULTS: Two studies
of patients were discarded, one because of head motion and the other
because of badly followed instructions. On the remaining patients the
functional activations found in the visual cortex were consistent with
the results of perimetric evaluation in all but one of the patients and
all the normal subjects although the results of fMRI were highly
dependent on the choices of the analysis thresholds. Visual functional
MRI image guided data were used in five patients with occipital brain
tumours. No added postoperative functional field defect was detected.
CONCLUSIONS: There was a good correspondence between fMRI data and the
results of perimetric evaluation although dependent on the analysis
thresholds. Visual fMRI data registered into a frameless stereotactic
device may be useful in surgical planning and tumour removal.
18
UI - 11568904
AU - Liu L; Vapiwala N; Munoz LK; Winick NJ; Weitman S; Strauss LC; Frankel
TI -
LS; Rosenthal DI
A phase I study of cranial radiation therapy with concomitant continuous
infusion paclitaxel in children with brain tumors.
SO - Med Pediatr Oncol 2001 Oct;37(4):390-2
AD - Department of Radiation Oncology, University of Pennsylvania Medical
Center, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA.
BACKGROUND: The prognosis of children with high-grade astrocytomas of
the central nervous system is grim and has not been substantially
improved by conventional chemoradiotherapy. We performed a
multi-institutional phase I study to determine the toxicities and
tolerance of concurrent external beam radiation of the brain and a
unique dose-schedule of paclitaxel as a radiation sensitizer. PROCEDURE:
Paclitaxel was delivered intravenously as a continuous 24 h/day, 7
days/week infusion during the entire 6-week course of fixed schedule
standard radiation therapy. The dose of paclitaxel was escalated in
patient cohorts in standard phase I design. RESULTS: Eleven patients
(eight brain stem gliomas, one glioblastoma multiforme, and two
gliomatosis cerebri) were treated. Dose-limiting toxicity was
encountered in the two patients treated at 6 mg/(m(2)/24 h), both of
whom developed severe obstipation requiring prolonged hospitalization.
CONCLUSIONS: We have shown in this first study of its kind that
paclitaxel can be administered safely to children as a 6-week continuous
infusion concurrent with cranial irradiation. The maximally tolerated
and recommended phase II dose is 4 mg/(m(2)/day). The benefits of
taxanes as clinical radiation sensitizers for children with high-grade
gliomas, if any, remain to be determined. Copyright 2001 Wiley-Liss,
Inc.
19
UI - 11562879
AU - Gelabert-Gonzalez M; Fernandez-Villa JM; Lopez-Garcia E; Gonzalez-Garcia
TI -
J; Garcia-Allut A
[Choroid plexus tumors]
SO - Rev Neurol 2001 Jul 16-31;33(2):177-83
AD - Servicio de Neurocirugia.Dpto. de Cirugia; Hospital General de Galicia,
Santiago de Compostela, 15705, Espana. cimigego@usc.es
INTRODUCTION and OBJECTIVE: Tumors of the choroid plexus are rare tumors
of neuro ectodermal origin, accounting for less 1% of intracranial
tumors in all ages. Most cases present in children less than 2 years of
age. These tumors have been classified according to histopathological
criteria into papilloma and carcinoma. DEVELOPMENT: We review the
epidemiological, clinical, neuropathological details, neuroradiological
aspects and treatment of choroid plexus tumors. CONCLUSIONS: Choroid
plexus tumors may present with overt intracranial hypertension with or
without focal neurological signs. In the adult population, headaches are
the most commonly encountered symptom. The CT characteristics of CPT are
well characterized. On non enhanced studies the tumor appears as a
smooth or lobulated mass, hyperdense in relation to surrounding brain
parenchyma. With intravenous contrast, there is marked, homogeneous
enhancement. With MRI these tumors showed an iso intensity in T1
weighted images and iso hypo intensity in T2 weighted images, with
marked enhancement after gadolinium. The treatment of choice is total
surgical excision with minimal damage to the surrounding neural
elements. For carcinomas, adjuvant treatment in the form of chemotherapy
supplemented by radiation therapy in older children.
20
UI - 11584184
AU - Walsh DC; Kakkar AK
TI -
Thromboembolism in brain tumors.
SO - Curr Opin Pulm Med 2001 Sep;7(5):326-31
AD - Department of Surgical Oncology, Technology and Intensive Care, Imperial
College School of Medicine, Hammersmith Hospital, London W12 0SH, UK.
Venous thromboembolism commonly affects patients receiving treatment for
primary and secondary cerebral tumors. We review the recent literature
on the molecular mechanisms underlying this hypercoagulable state and
clinical studies of antithrombotic prophylaxis and therapy in this
population. A computerized search of the MEDLINE database for articles
from 1966 to the present day. Keywords/search terms used were glioma,
astrocytoma, glioblastoma multiforme, cerebral tumor, primary brain
tumour, secondary brain tumour, venous thromboembolism,
thromboprophylaxis, heparin, warfarin, anticoagulants, and caval
filters. Although neurological deficit has been identified as an
independent risk factor for thrombosis it is also clear that malignant
brain tumors induce changes in the makeup of circulating blood, making
it more likely to clot. Concern for the perceived risk of perioperative
intracranial bleeding with antithrombotic prophylaxis appears not to be
justified by the available evidence. Prospective assessment of low
molecular weight heparins for prophylaxis and treatment of established
thrombosis is required. Antithrombotic therapy may also offer advantages
over intracaval devices in prevention of secondary pulmonary embolism in
patients with brain tumors.
21
UI - 11578729
AU - Lutterbach J; Guttenberger R; Pagenstecher A
TI -
Gliosarcoma: a clinical study.
SO - Radiother Oncol 2001 Oct;61(1):57-64
AD - Abteilung Strahienheilkunde, Radiologische Universitatsklinik,
Hugstetter Strasse 55, 79106, Freiburg i. Br., Germany.
BACKGROUND AND PURPOSE: Gliosarcomas are rare biphasic neoplasms of the
central nervous system composed of a glioblastoma multiforme (GBM)
admixed with a sarcomatous component. There are conflicting reports
regarding their clinical aggressiveness. Four hundred and twenty-two
consecutive patients with GBM were treated at our hospital between 1980
and 1999, among them 12 gliosarcomas. The goal of this study was to
examine clinical features, treatment, survival and patterns of failure
of gliosarcoma patients and to compare them with the entire group of GBM
patients. This comparison was refined by a matched pair analysis with a
group of 12 GBM patients selected for age, Karnofsky performance status,
resection status, fractionation scheme and total dose (control GBM
group). MATERIALS AND METHODS: Seven gliosarcoma patients were male,
five female, with a median age of 56 years (range 37-76 years). The
median tumor size was 4.5 cm (range 3-8 cm). The locations, all
supratentorial, included temporal in six, parietal in five, frontal in
four and occipital in one patient. All patients underwent tumor
resection followed by postoperative radiation therapy. RESULTS: Median
survival was 11.5 months for the gliosarcoma group, 8.1 months for the
entire GBM group (log rank test, P=0.16) and 11.0 months for the control
GBM group (log rank test, P=0.36). All gliosarcoma patients had local
tumor recurrences and died due to neurologic causes within 19.3 months
after radiation therapy. CONCLUSIONS: With regard to clinical features,
survival and patterns of failure, gliosarcomas and GBM cannot be
distinguished clinically. Therefore, the same principles should be
applied for the treatment of these tumors.
22
UI - 11593525
AU - Zhang R; Zhou L
TI -
Medulloblastoma.
SO - Chin Med J (Engl) 1999 Apr;112(4):297-301
AD - Department of Neurosurgery, Hua Shan Hospital, Shanghai Medical
University, Shanghai 200040, China.
OBJECTIVE: To elucidate the diagnosis, treatment and prognosis of
medulloblastoma in both children and adults. METHODS: A retrospective
review was conducted in 80 patients with medulloblastoma confirmed
pathologically during the period of 1984 and 1995. Multivariate analysis
and comparison were made of the therapeutic effects of operation,
radiotherapy and chemotherapy as well as the survival period. RESULTS:
There were 42 males and 38 females with average age at diagnosis being
9.1 years in children and 25.1 years in adults. All patients were
operated on to remove the tumour. Cerebral aqueduct re-opening was got
through in 54 cases (67.5%), and Torkilsen's shunt was carried out at
the same time for the rest patients. Seventeen patients had
ventriculoperitoneal shunt, and 13 of them were performed after surgical
excision of the tumour. Complete follow-up information was obtained in
61 patients (76%) for a period of 6 months to 14 years. During the
follow-up, 27 patients received postoperative craniospinal irradiation,
and 27 local radiation. Fourteen patients were subjected to adjuvant
chemotherapy. The overall 5-year and 10-year survival rates were 50.5%
and 27.89% respectively. The 5-year survival rate was higher in adults
than in children (P < 0.05), whereas the 10-year survival rate was
similar. Thirty-two patients died of relapse or metastasis between 6
months and 10 years after initial surgical therapy, and the mean
recurrence time was 3.5 years. CONCLUSIONS: Operation and postoperative
regular radiotherapy were important therapeutic modalities for
medulloblastoma. Total or subtotal removal of the tumour combined with
craniospinal radiotherapy can improve patients' survival rate. The
survival period of medulloblastoma patients is consistent with Collins'
law, that is, the period of risk for survival is the age at initial
diagnosis plus 9 months. Only few patients can gain long-term survival.
23
UI - 11601281
AU - Du G; Zhou L
TI -
Neuronavigation for the resection of cavernous angiomas.
SO - Chin Med J (Engl) 1999 Aug;112(8):725-7
AD - Department of Neurosurgery, Huashan Hospital, Shanghai Medical
University, Shanghai 200040, China. dghong@online.sh.cn
OBJECTIVE: To introduce the use of the StealthStation neuronavigator
combined with preoperative computerized tomography (CT) in resection of
intracranial cavernous angiomas (CAs). METHODS: The StealthStation
neuronavigator was used to provide a realtime correlation of the
operating field and the computerized images in 6 patients with CAs. All
patients suffered from epileptic seizures. Four patients underwent
keyhole surgery and 2 underwent small skin-flap craniotomy. The mean
follow-up was 4.5 months. RESULTS: With the guidance of neuronavigator,
lesionectomy associated with removal of hemosiderin deposition, gliosis
and calcification was performed precisely. The mean fiducial error was
from 1.65 mm to 4.53 mm, the predicted accuracy at 10 cm was between
1.82 mm and 3.28 mm, and the sustained accuracy ranged from 0.50 mm to
3.45 mm. CONCLUSION: The StealthStation neuronavigator is reliable and
accurate in the resection of CAs.
24
UI - 11595081
AU - Huang ME; Wartella J; Kreutzer J; Broaddus W; Lyckholm L
TI -
Functional outcomes and quality of life in patients with brain tumours:
a review of the literature.
SO - Brain Inj 2001 Oct;15(10):843-56
AD - Rehabilitation and Research Center, Department of Physical Medicine and
Rehabilitation, Virginia Commonwealth University, Medical College of
Virginia Hospitals, Richmond, VA 23298, USA.mehuang@hsc.vcu.edu
OBJECTIVE: To review the literature with respect to functional outcomes
and quality of life as it pertains to individuals with brain tumours.
MAIN OUTCOMES: Most functional outcome papers have focused on acute
inpatient rehabilitation. In general, patients with brain tumours have
comparable rates of functional gains as other models of neurologic
disability. Tumour type and concomitant treatment do not impact
functional outcome. Functional independence may predict survivability in
certain populations. Numerous instruments are used to measure the
multiple facets of quality of life. Depression, anger and fatigue can
impact both physical and psychological aspects of quality of life. The
physical and functional aspects can vary depending on the tumour type.
Treatment regimens can negatively impact quality of life. CONCLUSION:
Brain tumour patients experience changes in function and quality of life
during their disease course. Rehabilitation services may offer a unique
opportunity to influence both functional outcome and more closely assess
quality of life in these individuals.
25
UI - 11597375
AU - Chastagner P; Bouffet E; Grill J; Kalifa C
TI -
What have we learnt from previous phase II trials to help in the
management of childhood brain tumours?
SO - Eur J Cancer 2001 Nov;37(16):1981-93
AD - Department of Paediatric Oncology, Hopital d'Enfants, CHU Nancy, 54500,
Vandoeuvre, France. p.chastagner@chu-nancy.fr
Contrary to major advances in cure rates observed for almost all
childhood cancers, progress in reducing brain tumour survival rates
remains very limited. Although new drug development in oncology is
founded on principles outlined in the organised methodology of phase I,
II, and III trials, based on rig
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