National Cancer Institute®
Last Modified: January 1, 2002
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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.
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.
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.
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.
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. email@example.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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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. email@example.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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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. email@example.com
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.
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.firstname.lastname@example.org
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.
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. email@example.com
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