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Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Brain Tumor - June 2002
National Cancer Institute®
Last Modified: June 1, 2002
- Survival of children under 3 years old with medulloblastoma: a study from the Mexican Cooperative Group for Childhood Malignancies (AMOHP).
- Prognostic factors for cerebellar astrocytomas in children: a study of 102 cases.
- White matter disease in children treated for malignant brain tumors.
- A phase II study of extended low-dose temozolomide in recurrent malignant gliomas.
- Prevalence of thrombophilia and central venous catheter-associated neck vein thrombosis in 41 children with cancer--a prospective study.
- Visual improvement despite radiologically stable disease after treatment with carboplatin in children with progressive low-grade optic/thalamic
- Retrosigmoid approach for small and medium-sized acoustic neuromas.
- [Chemo-radiotherapy for malignant brain tumors]
- Primitive neuroectodermal tumors/medulloblastoma.
- Chemotherapeutic dose intensification for treatment of malignant brain tumors: recent developments and future directions.
- Temozolomide (Temodal) for treatment of primary brain tumours.
- The impact of cranial irradiation on GH responsiveness to GHRH plus GH-releasing peptide-6.
- [Precision of conventional simulation: which extent of accuracy is reachable in head and neck region?]
- Does the extent of surgery have an impact on the survival of patients who receive postoperative radiation therapy for supratentorial low-grade
- PCV chemotherapy for oligodendroglioma: response analyzed on T2 weighted-MRI.
- Long-term outcome in patients with central neurocytoma following stereotactic biopsy and radiation therapy.
- Neurosurgical management of paediatric germ cell tumours of the central nervous system--a multi-disciplinary team approach for the new
- Overexpression of cyclooxygenase-2 (COX-2) in human primitive neuroectodermal tumors: effect of celecoxib and rofecoxib.
- [Some aspects of drug- and radiation-resistance of malignant brain tumors]
- Surgical treatment of patients with low-grade astrocytomas and medically intractable seizures.
- Intensity-modulated radiosurgery/radiotherapy using a micromultileaf collimator.
- Imaging appearance of a new radiation therapy delivery device for CNS tumors.
- Pre-irradiation semi-intensive chemotherapy with carboplatin and cyclophosphamide in malignant glioma: a phase II study.
- Surgical resection of grade II astrocytomas in the superior frontal gyrus.
- Volumetric stereotaxy and the supratentorial occipitosubtemporal approach in the resection of posterior hippocampus and parahippocampal
Table of Contents
1
UI - 11935242
AU - Rivera-Luna R; Lopez E; Rivera-Marquez H; Rivera-Ortegon F;
TI -
Altamirano-Alvarez E; Mercado G; Covarrubias G; Rueda-Franco F;
Marhx-Bracho A; Gutierrez P
Survival of children under 3 years old with medulloblastoma: a study
from the Mexican Cooperative Group for Childhood Malignancies (AMOHP).
SO - Childs Nerv Syst 2002 Feb;18(1-2):38-42
AD - Department of Oncology, Instituto Nacional de Pediatria, Insurgentes Sur
3700-C, Mexico, D.F. Mexico 04530. riveraluna@infosel.net.mx
BACKGROUND: The prognosis of medulloblastoma in children under 3 years
of age is poor. METHODS: A retrospective analysis was performed to
evaluate children under 3 years of age with medulloblastoma. Overall
survival (OS) and progression-free survival (PFS) were assessed in
children with and without metastasis. RESULTS: A total of 534 children
were diagnosed with medulloblastoma during the study period, 49 (9.1%)
of whom were under 3 years of age and were evaluated. Their ages ranged
from 5 to 35 months with a mean of 18.5 months. In 39 (79.6%) of these
patients the tumors were staged as T3M0 or under, while 10 (20.4%) had
metastasis at diagnosis. The OS was 38% and PFS 37% in the whole series,
while PFS was 32% in those with metastasis and 40% in those without (
P=0.78). For those who received radiotherapy the PFS was 62%, and in
those not treated with radiotherapy PFS was nil ( P=0.0001). When the
children were divided into those who received surgical treatment plus
chemotherapy and those who received surgery plus radiotherapy plus
chemotherapy, the PFS was nil and 66%, respectively ( P=0.00001).
CONCLUSION: Because of the high morbidity of radiotherapy in children
under 3 years old, surgery continues to be the basis of improved
prognosis, followed by chemotherapy.
2
UI - 11786699
AU - Desai KI; Nadkarni TD; Muzumdar DP; Goel A
TI -
Prognostic factors for cerebellar astrocytomas in children: a study of
102 cases.
SO - Pediatr Neurosurg 2001 Dec;35(6):311-7
AD - Department of Neurosurgery, King Edward Memorial Hospital, Seth G.S.
Medical College, Parel, Mumbai, India. drketandesai@hotmail.com
OBJECTIVE: To evaluate the prognostic factors influencing the length of
survival of pediatric patients with cerebellar astrocytomas. METHODS:
The clinical data of 102 patients under the age of 12 years with
cerebellar astrocytomas were retrospectively analyzed. The radiological
features, surgical findings, histology and adjuvant radiotherapy were
reviewed. Patients were followed up on an outpatient basis. Computerized
tomography (CT) scans of the brain were performed to detect recurrence.
RESULTS: The age of the patients at presentation varied from 10 months
to 12 years. The mean age at presentation was 7 years and 11 months. The
average duration of symptoms was 5.8 months. The clinical features were
predominantly related to intracranial hypertension and the location of
the tumor. Twenty-six tumors were located in the vermis and 76 in the
cerebellar hemisphere. The brain stem was involved in 20 patients. All
102 patients had a preoperative contrast-enhanced CT scan. Midline
vermian tumors were predominantly solid and enhancing, whilst the
hemispheric tumors were cystic and nonenhancing. The tumors were graded
into three subgroups based on histological characteristics: pilocytic
astrocytoma, low-grade fibrillary astrocytoma and high-grade fibrillary
astrocytoma. Total, radical and subtotal excision, as determined by the
surgical impression, were performed in 82, 16 and 4 patients,
respectively. Postoperative radiotherapy was administered to 12
patients. CSF diversion was carried out in 11 of 79 cases who had
moderate to severe hydrocephalus. CONCLUSIONS: Our study has shown that
the location of the tumor (p < 0.05), histological grade (p < 0.001) and
the extent of tumor resection (p < 0.001) have a significant and
definitive relationship to the length of survival of pediatric patients
with cerebellar astrocytomas. The patient's age (p > 0.05) does not
influence the outcome. We could not evaluate the effect of brain stem
involvement and adjuvant radiotherapy in our study because of the small
sample size. Copyright 2001 S. Karger AG, Basel
3
UI - 11862439
AU - Dietrich U; Wanke I; Mueller T; Wieland R; Moellers M; Forsting M;
TI -
Stolke D
White matter disease in children treated for malignant brain tumors.
SO - Childs Nerv Syst 2001 Dec;17(12):731-8
AD - Department of Neuroradiology, Gilead Hospital, Burgsteig 13, 33617
Bielefeld, Germany. Dietrich@radiologie.gilead.de
OBJECTS: The objects of the study reported were to recognize different
patterns of white matter disease (WMD) in the follow-up of children
after surgery, radiation and/or chemotherapy for malignant primary brain
tumors and to evaluate statistical data on the incidence of WMD and
various risk factors. METHODS: Magnetic resonance imaging (MRI) records
were evaluated retrospectively in the routine follow-up (range 6 months
to 15 years after surgery) of 44 children with malignant primary brain
tumors treated with surgery and radiotherapy and/or chemotherapy.
RESULTS: WMD was diagnosed in 28 children and subclassified into
circumscribed white matter lesions (WML) and diffuse atrophy. WML were
the most common finding ( n=13), followed by atrophy ( n=7) and the
combination of both ( n=8). Statistical analysis revealed slightly more
frequent atrophy in children younger than 5 years. WML could be linked
with supratentorial location of the tumor, follow-up longer than 5
years, and the presence of a ventricular shunt. Intrathecal chemotherapy
was also a factor, but because of the small sample size of the group
this might not be valid. None of the children had neurological deficits
attributed to these findings, but the impact on neuropsychological
development was not determined.
4
UI - 11772431
AU - Khan RB; Raizer JJ; Malkin MG; Bazylewicz KA; Abrey LE
TI -
A phase II study of extended low-dose temozolomide in recurrent
malignant gliomas.
SO - Neuro-oncol 2002 Jan;4(1):39-43
AD - Department of Neurology, Memorial Sloan-Kettering Cancer Center, New
York, NY 10021, USA.
Temozolomide is an effective agent in the treatment of recurrent
malignant gliomas. The standard dosage is 150-200 mg/m2 per day for 5
days in a 28-day cycle. A prior phase I study established a chronic
daily temozolomide dose that significantly increased the total dose
administered and suggested a superior response rate. In a prospective
phase II trial, we treated 35 patients with recurrent malignant gliomas
with temozolomide 75 mg/m2 per day for 42 consecutive days in a 70-day
cycle. Median age was 55 years (range, 27-73 years) and median Karnofsky
performance score was 70 (range, 60-90). Twenty-eight (79%) patients had
glioblastoma multiforme, 3 (9%) anaplastic astrocytoma, 2 (6%)
anaplastic oligodendroglioma, and 2 (6%) anaplastic oligoastrocytoma.
All but one had prior radiotherapy, and 27 had prior chemotherapy. There
were 2 partial (anaplastic astrocytoma) and 3 minor (glioblastoma
multiforme) radiographic responses; 17 patients had progressive disease
at the end of the first cycle. In 55 cycles of temozolomide, there were
8 episodes of asymptomatic drug-related grade 3 toxicity: 6 lymphopenia,
1 neutropenia, and 1 thrombocytopenia. Median progression-free survival
and overall survival were 2.5 and 8.7 months (2.3 and 7.7 months in
glioblastoma multiforme patients). At 6 months, progression-free
survival and overall survival rates were 27% and 67% (19% and 60% in
glioblastoma multiforme). Quality of life scores did not change
significantly during treatment. We conclude that the extended low-dose
schedule of temozolomide is well tolerated in heavily pre-treated
patients; however, our results do not support an improved rate of
response or survival.
5
UI - 11984801
AU - Ruud E; Holmstrom H; Natvig S; Wesenberg F
TI -
Prevalence of thrombophilia and central venous catheter-associated neck
vein thrombosis in 41 children with cancer--a prospective study.
SO - Med Pediatr Oncol 2002 Jun;38(6):405-10
AD - Department of Pediatrics, The National Hospital, Norway.
ellen.ruud@rikshospitalet.no
BACKGROUND: This study was designed to prospectively evaluate the
prevalence of thrombophilia and central venous catheter-associated neck
vein thrombosis in children with cancer. PROCEDURE: Children with cancer
and central lines, treated at the National Hospital in Norway, were
consecutively enrolled in the study. Biochemical analysis of
thrombophilia and Doppler ultrasonography of neck veins were performed
at inclusion, and ultrasonography was repeated 3-5 months later. We
recorded systematically positive blood-cultures and days with
intravenous antibiotics. In a subgroup of 13 patients with acute
lymphoblastic leukaemia, the thrombophilia parameters were re-evaluated
during asparaginase therapy. RESULTS: Forty-one children were included
in the study and observed for a mean of 266 days (range 95-569 days).
Eighteen patients (44%) developed venous thrombosis (VT), visualized by
Doppler ultrasonography of the catheterized vein. Some clots were
transient, but blood clots with diameters > 0.5 cm (n = 11) had a
tendency to remain (P = 0.14). Twelve children (29%) were classified as
thrombophilic at inclusion, with elevated serum levels of homocysteine
and lipoprotein (a) as the most frequent alterations. Transient
thrombophilia developed in all patients during asparaginase-therapy.
Within the limitations of our study, we did not find any significant
correlation between thrombophilia and development of VT, nor thrombosis
and infectious disease. CONCLUSIONS: VT develops frequently in
paediatric cancer patients with central lines, but the clinical
implication of this observation remains to be clarified. Copyright 2002
Wiley-Liss, Inc.
6
UI - 11902299
AU - Mitchell AE; Elder JE; Mackey DA; Waters KD; Ashley DM
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.
7
UI - 11875340
AU - Magnan J; Barbieri M; Mora R; Murphy S; Meller R; Bruzzo M; Chays A
TI -
Retrosigmoid approach for small and medium-sized acoustic neuromas.
SO - Otol Neurotol 2002 Mar;23(2):141-5
AD - ORL Unit, Hopital Nord, Marseille cedex, France.
OBJECTIVE: Clinical study of the keyhole acoustic neuroma retrosigmoid
approach for facial nerve and hearing preservation. STUDY DESIGN: This
referral hospital care unit. PATIENTS: A total of 119 consecutive
patients with a tumor size of <25 mm in the cerebellopontine angle
corrected by a retrosigmoid approach were included in the study.
INTERVENTIONS: Standard audiometric and imaging assessments, complete
tumor removal by using endoscopy-assisted control, and nerve monitoring.
MAIN OUTCOME MEASURES: House-Brackmann facial nerve grade and hearing
level by the American Academy of Otolaryngology-Head and Neck Surgery
classification. RESULTS: Grades I and II facial nerve function was
obtained in 96% of cases, measurable hearing was preserved in 49% of
cases, and 30% of cases achieved serviceable hearing. CONCLUSION: The
retrosigmoid approach is a safe and reliable approach in random patients
with small and medium-sized acoustic neuromas.
8
UI - 12040669
AU - Kochi M; Ushio Y
TI -
[Chemo-radiotherapy for malignant brain tumors]
SO - Gan To Kagaku Ryoho 2002 May;29(5):669-76
AD - Dept. of Neurosurgery, Kumamoto University Medical School.
I) Malignant gliomas: Randomized clinical trials conducted in the USA
showed that radiotherapy plus chemotherapy with nitrosoureas offered a
long-term survival advantage to patients younger than 60 years old with
malignant gliomas. Combination chemotherapy, such as
procarbazine/CCNU/vincristine (PCV) must be tested further, and
intra-arterial chemotherapy with nitrosoureas offered no survival
advantage. Combination chemotherapy with PCV showed efficacy for
patients with anaplastic oligodendroglioma and anaplastic
oligoastrocytoma. II) Medulloblastoma: The addition of chemotherapy to
radiotherapy improved the survival of patients with poor risk
medulloblastoma, and may reduce the required craniospinal radiation dose
in patients with good risk medulloblastoma. III) Primary CNS lymphoma
(PCNSL): Combination of chemotherapy with high-dose MTX and radiotherapy
improved survival of patients with PCNSL; however, the neurotoxicity
produced by this treatment modality is a serious problem in older
patients. IV) Intracranial germ cell tumors: The addition of
chemotherapy to radiotherapy may produce long term survival with good
quality of life in patients with germinoma. Neoadjuvant therapy
consisting of chemotherapy and radiotherapy followed by complete
surgical excision improved survival of patients with intracranial
nongerminomatous germ cell tumors.
9
UI - 11936998
AU - Weil MD
TI -
Primitive neuroectodermal tumors/medulloblastoma.
SO - Curr Neurol Neurosci Rep 2002 May;2(3):205-9
AD - Sirius Medicine, LLC, 584 West Douglas Road, Fort Collins, CO 80524,
USA. mweil@frii.com
The therapy for medulloblastoma/primitive neuroectodermal tumors of the
central nervous system is surgery, followed by combination
chemo-radiotherapy. The radiation field is the entire craniospinal axis,
which is only avoided when treating infants. The treatment is,
therefore, lengthy and toxic. Less aggressive therapy is given to
patients who clinically appear to have less evidence of disease.
Intensive basic research has begun to identify genetic factors of the
disease, but these remain far from clinical application.
10
UI - 11937000
AU - Kraemer DF; Fortin D; Neuwelt EA
TI -
Chemotherapeutic dose intensification for treatment of malignant brain
tumors: recent developments and future directions.
SO - Curr Neurol Neurosci Rep 2002 May;2(3):216-24
AD - Department of Neurology, Oregon Health & Science University, 3181 S.W.
Sam Jackson Park Road, Portland, OR 97201, USA.
Despite a large amount of research on malignant brain tumors over the
past 70 years, the prognosis for most tumor types is poor. One current
focus of research is increasing dose intensity of chemotherapeutic
agents. Various ways to increase dose intensity include high-dose
chemotherapy followed by stem cell rescue (eg, bone marrow transplant),
blood-brain barrier disruption or use of RMP7 to increase transvascular
drug delivery, local delivery of chemotherapeutic agents (convection
enhancement or clysis, antibody conjugates, and biodegradable polymers),
chemoprotective agents, and tumor sensitizers. Improved identification
of patients likely to respond to a given regimen may also increase the
effectiveness of chemotherapy. We also discuss approaches to improve the
design of nonrandomized trials by identifying and controlling potential
confounding variables. This will improve the quality of individual
studies and perhaps the comparability across studies.
11
UI - 10790718
AU - MacConnachie AM
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.
12
UI - 11994347
AU - Popovic V; Pekic S; Golubicic I; Doknic M; Dieguez C; Casanueva FF
TI -
The impact of cranial irradiation on GH responsiveness to GHRH plus
GH-releasing peptide-6.
SO - J Clin Endocrinol Metab 2002 May;87(5):2095-9
AD - Institute of Endocrinology, Diabetes and Diseases of Metabolism,
University Clinical Center, 11000 Belgrade, Yugoslavia. popver@eunet.yu
Patients treated with cranial radiation are at risk of GH deficiency
(GHD). We evaluated somatotroph responsiveness to maximal provocative
tests exploring the GH releasable pool in relation to the impact of
radiation damage to the hypothalamic-pituitary unit. The GH-releasing
effect of GHRH plus GH secretagogue [GH-releasing peptide (GHRP)-6]
(GHRH+GHRP-6) was studied in 22 adult patients (age, 23.2 +/- 1.4 yr; 8
female and 14 male; mean body mass index, 22.6 +/- 0.7 kg/m(2)) who
received cranial radiation for primary brain tumor distant from
hypothalamic-pituitary region 7.6 +/- 0.7 yr before GH testing. Two
stimulatory tests for GH secretion were employed: insulin tolerance test
(ITT, 0.15 IU/kg regular insulin i.v. bolus); and GHRH+GHRP-6 test: GHRH
(Geref Serono, Madrid, Spain; l microg/kg) plus GHRP-6 (CLINALFA,
Laufelingen, Switzerland; 1 microg/kg) as i.v. bolus. Serum GH was
measured (Delphia; Perkin Elmer, Wallac, Turku, Finland) at -30, -15, 0,
15, 30, 45, 60, 90, and 120 min. Anterior pituitary function was normal
in all except in 1 female with hyperprolactinemia. Twelve out of 22
irradiated patients were GH-deficient (GHD) with both tests. Eleven out
of 22 (50%) irradiated patients were severely GHD, according to the ITT
(GH < 3 microg/liter; mean GH peak, 1.5 +/- 0.5 microg/liter). In 9
irradiated patients, in whom ITT was performed as well, mean peak GH
after the GHRH+GHRP-6 test was 6.2 +/- 0.8 microg/liter, which is
considered as severe GHD, according to our own cut-off for the test
(peak GH < 10 microg/liter). GH responses to both tests were highly
concordant, but the differential in the GH peak concentrations between
GHD and non-GHD irradiated patients was significantly larger for the
GHRH+GHRP-6 test than that for the ITT. The 2 discordant responses, i.e.
poor response to the ITT and good response to the GHRH+GHRP-6 test, were
found in 1 hyperprolactinemic female patient and in 1 other female. One
irradiated patient was diagnosed as GHD only with the combined test,
because ITT was contraindicated because of epilepsy. PRL and cortisol
responses to ITT were normal in all irradiated patients and did not
depend on the GH status. IGF-I levels were not informative or
discriminative between the GHD and non-GHD irradiated adult patients. In
conclusion, the use of GH secretagogues plus GHRH is an easy, reliable
and accurate way of assessing GH secretion in cranially irradiated
patients. Impairment of the GH releasable pool in the irradiated
patients, with a maximal provocative test, reflects alterations in the
hypothalamic-pituitary unit caused by radiotherapy.
13
UI - 12040759
AU - Gross MW; Spahn U; Engenhart-Cabillic R
TI -
[Precision of conventional simulation: which extent of accuracy is
reachable in head and neck region?]
SO - Strahlenther Onkol 2002 Apr;178(4):216-22
AD - Klinik fur Strahlentherapie und Radioonkologie, Philipps-Universitat
Marburg. gross@mailer.uni-marburg.de
PURPOSE: In this prospective investigation we tested the absolute
accuracy of a conventional localization of the isocenter obtained from a
three-dimensional treatment plan in conformal radiotherapy of head and
neck tumors. PATIENTS AND METHODS: 41 isocenters in 41 consecutive
patients with histologically proven tumors of the brain or head and neck
region were included into this investigation. In all cases a
stereotactic mask (Stryker-Leibinger) was made for fixation and
positioning of the patients. The stereotactically guided fractionated
radiotherapy was carried out on the base of CT and MRI. The stereotactic
coordinates were defined by an external localization system. Afterwards
each patient underwent a conventional simulation using exclusively
anatomical reference points. Additionally, the patients were adjusted to
the linac isocenter using a stereotactic targeting device. Deviations
between the simulated and the external adjusted target point coordinates
were recorded in X-, Y- and Z-direction and spatial error was
calculated. RESULTS: Mean deviation was 2.15, 2.54, and 2.69 mm for X-,
Y-, and Z-direction, respectively. The largest deviation was found in
Z-direction with a maximum of over 11 mm. The spatial deviation per
patient amounted 1.3-12.2 mm with a mean of 5.1 and a median value of
4.5 mm. That means that in half of the cases a deviation of 5 up to over
12 mm occurs in conventional simulation. Only in a quarter of the sample
the deviation was 4 mm or below. CONCLUSION: The planning target volume
definition requires a consideration of the inaccuracy of the
conventional simulation. A reduction of the safety margin in the
planning target volume assumes the use of the stereotactic target
positioner. This is to postulate especially for the treatment of benign
lesions or lesions or lesions adjacent to critical structures.
14
UI - 11992388
AU - Lo SS; Cho KH; Hall WA; Hernandez WL; Kossow RJ; Lee CK; Clark HB
TI -
Does the extent of surgery have an impact on the survival of patients
who receive postoperative radiation therapy for supratentorial low-grade
gliomas?
SO - Int J Cancer 2001;96 Suppl():71-8
AD - Department of Therapeutic Radiology-Radiation Oncology, University of
Minnesota Hospital and Clinic, Minneapolis, Minnesota, USA.
los@karmanos.org
We evaluate the impact of extent of surgery (EOS) on survival of
patients with supratentorial nonpilocytic low-grade gliomas (LGG)
treated with postoperative radiation therapy (PORT). Sixty-five patients
with pathologically confirmed supratentorial nonpilocytic LGG (36
astrocytomas and 29 oligodendrogliomas) were treated with PORT after
different extents of surgery: 12 gross total resections (GTR), 27
minimal or subtotal resections (MR/SR), and 26 biopsies (B). EOS was
confirmed with postoperative imaging. The median radiation dose
delivered was 5,940 cGy (range, 4,950-6,620 cGy). One of 12 patients
(8%) in the GTR group and 12 of 53 patients (23%) in the less than GTR
group demonstrated contrast enhancement. The median follow-up was 61
months (range 5-194 month). The 10-year overall survival (OS) was 82.5%
and 32% for the GTR and the less than GTR groups, respectively (P =
0.0008). The corresponding 10-year disease-specific survival (DSS) was
90% and 41.4%%, respectively (P = 0.001). Multivariate analysis showed
that only contrast enhancement and EOS were predictors for OS and DSS.
Our data suggest that EOS correlates with OS and DSS in patients who
have PORT. GTR should be the goal if technically achievable without
causing significant morbidity, and its combination with PORT is
compatible with long-term survival. Copyright 2002 Wiley-Liss, Inc.
15
UI - 11804282
AU - Diabira S; Rousselet MC; Gamelin E; Soulier P; Jadaud E; Menei P
TI -
PCV chemotherapy for oligodendroglioma: response analyzed on T2
weighted-MRI.
SO - J Neurooncol 2001 Oct;55(1):45-50
AD - Department of Neurosurgery, University Hospital of Angers, France.
OBJECTIVE: Because oligodendroglioma are infiltrative tumors, the Mac
Donald's response criteria, usually used for solid and contrast-enhanced
tumors, seem not to be adapted. To precise more relevant radiological
criteria, the radiological response of oligodendroglioma to PCV
chemotherapy was evaluated on T2 weighted-MRI sequences only. METHODS:
25 patients with oligodendroglioma grade A or B were retrospectively
analyzed. They were treated with up to six cycles of PCV standard
regimen. Tumor size was calculated before and at the end of the
treatment, on T2 weighted-MRI, by two methods: volumetric reconstruction
(method 1) and maximal cross-sectional area (method 2). Responses were
defined according to new criteria on T2 weighted-MRI. RESULTS: According
to these criteria and with the method 1, 7 of 25 patients (28%) had a
partial response to the PCV, 14 patients (56%) had stabilized disease,
and 4 patients (16%) had progressive disease. With the method 2, 6 had
partial response (24%), 18 had stabilized disease (72%) and 1 had
progressive disease. CONCLUSION: Response rate to PCV chemotherapy in
this study was lower than response observed in the literature. Because
of the infiltrative feature of oligodendroglioma, we think that the
radiological response of these tumors should be evaluated on T2
weighted-MRI. The two methods of tumor size estimation used in this
study were almost equivalent. Then, the maximal cross-sectional area
measurement, more practical, could be retained.
16
UI - 12046730
AU - Kulkarni V; Rajshekhar V; Haran RP; Chandi SM
TI -
Long-term outcome in patients with central neurocytoma following
stereotactic biopsy and radiation therapy.
SO - Br J Neurosurg 2002 Apr;16(2):126-32
AD - Department of Neurological Sciences, Christian Medical College and
Hospital, Vellore, Tamil Nadu, India.
Total excision is usually the recommended treatment for central
neurocytomas. The role of radiation therapy in their management is
controversial, and is usually reserved for partially resected or
recurrent tumours. Long-term outcome was studied in patients with
central neurocytoma who were treated with radiation therapy. By
retrospective chart review, eight patients with intraventricular
tumours, who had undergone radiation therapy following stereotactic
biopsy, were identified. The diagnosis of neurocytoma was confirmed
based on positive immunostaining with synaptophysin. Clinical and
radiological follow-up was obtained. Of eight patients, one died 5 years
after treatment from shunt dysfunction and 1 had disseminated
intracranial disease 15 months after treatment. Six patients were
symptom-free at a mean follow-up period of 78 months and had good local
control as demonstrated by CT. Since this tumour can be confused with an
oligodendroglioma or an ependymoma on routine histopathology (as
happened in seven of our cases); immunohistochemical studies with
synaptophysin should be routinely performed for intraventricular glial
tumours. Our study supports the beneficial effect of radiation therapy
in the management of these tumours.
17
UI - 12046745
AU - Nicholson JC; Punt J; Hale J; Saran F; Calaminus G; Germ Cell Tumour
TI -
Working Groups of the United Kingdom Children's Cancer Study Group
(UKCCSG) and International Society of Paediatric Oncology (SIOP)
Neurosurgical management of paediatric germ cell tumours of the central
nervous system--a multi-disciplinary team approach for the new
millennium.
SO - Br J Neurosurg 2002 Apr;16(2):93-5
18
UI - 11911965
AU - Patti R; Gumired K; Reddanna P; Sutton LN; Phillips PC; Reddy CD
TI -
Overexpression of cyclooxygenase-2 (COX-2) in human primitive
neuroectodermal tumors: effect of celecoxib and rofecoxib.
SO - Cancer Lett 2002 Jun 6;180(1):13-21
AD - Division of Neuro-Oncology, Joseph Stokes Research Institute #515G, 3516
Civic Center Blvd, The Children's Hospital of Philadelphia,
Philadelphia, PA 19104, USA.
In this study the role of cyclooxygenase-2 (COX-2) in primitive
neuroectodermal tumor (PNET) the most malignant brain tumors of
childhood was investigated. COX-2 expression in human brain tumor biopsy
samples (seven/seven) was about 6-8-fold higher than normal brain tissue
and several PNET cell lines also express COX-2. The effect of selective
COX-2 inhibitors, celecoxib and rofecoxib on the growth of two PNET cell
lines (DAOY and PFSK) was determined. Celecoxib was more potent than
rofecoxib in suppressing cell growth. Growth inhibition by celecoxib and
rofecoxib was independent of Bcl-2 expression. Celecoxib suppressed the
expression of Akt and activated the caspase-3 in DAOY and PFSK, whereas
rofecoxib did not have such an effect.
19
UI - 12046326
AU - Medianik IA; Fraerman AP
TI -
[Some aspects of drug- and radiation-resistance of malignant brain
tumors]
SO - Zh Vopr Neirokhir Im N N Burdenko 2002 Jan-Mar;(1):30-3
20
UI - 11939941
AU - Gunnarsson T; Olafsson E; Sighvatsson V; Hannesson B
TI -
Surgical treatment of patients with low-grade astrocytomas and medically
intractable seizures.
SO - Acta Neurol Scand 2002 Apr;105(4):289-92
AD - Department of Neurosurgery, The National University Hospital, Reykjavik,
Iceland. thorsteinn.gunnarsson@lio.se
OBJECTIVE: Low-grade astrocytomas can present with seizures that respond
poorly to antiseizure medications, with a consequent reduction in the
quality of life, because of both seizures and the medication's
side-effects. We report our experience with operative treatment of such
patients. SUBJECTS AND METHODS: Five patients (two children and three
adults) with supratentorial low-grade astrocytomas associated with
severe seizures were operated on. We followed the effects of the
operation on post-operative neurological deficit, seizure frequency and
the quality of life. RESULTS: No serious neurological complications
followed the operations. The patients were followed for a median period
of 12 months (6-46). Post-operatively, three of the patients became
seizure-free, one experiences only auras, and one had a great reduction
in seizure frequency and severity. All patients reported great
improvement in their quality of life. CONCLUSION: Resections of
low-grade astrocytomas in patients with medically intractable seizures
are safe procedures that effectively control seizures in the majority of
patients, resulting in significant improvement in the patients' quality
of life.
21
UI - 11444516
AU - Leavitt DD; Watson G; Tobler M; Williams G; Gaffney DK; Shrieve DC
TI -
Intensity-modulated radiosurgery/radiotherapy using a micromultileaf
collimator.
SO - Med Dosim 2001 Summer;26(2):143-50
AD - Department of Radiation Oncology, University of Utah School of Medicine,
Salt Lake City, USA.
Intensity modulation with inverse treatment planning for 3 clinical
stereotactic radiotherapy cases were directly compared against forward
planning techniques using beam modification by enhanced dynamic wedge.
Dose-volume histogram (DVH) analysis demonstrated that a significant
reduction in dose to neighboring critical structures can-be achieved
through intensity modulation patterns determined from inverse planning,
while a marginal change is achieved in the target volume dose
uniformity. This study also demonstrates that the intensity modulated
dose patterns generated from inverse planning may differ significantly
from the intuitive beam modified patterns developed in the forward
planning model. These results suggest that one advantage of intensity
modulated radiosurgery/radiotherapy with inverse planning is the
significant reduction in dose to normal tissue and critical structures,
with its coincident implications for dose escalation studies.
22
UI - 11673185
AU - Dame EA; Putzer GJ; Pearlman JL; Murtagh FR
TI -
Imaging appearance of a new radiation therapy delivery device for CNS
tumors.
SO - AJNR Am J Neuroradiol 2001 Oct;22(9):1806-7
23
UI - 11901309
AU - Vinolas N; Gil M; Verger E; Villa S; Pujol T; Ceral L; Garcia M; Graus F
TI -
Pre-irradiation semi-intensive chemotherapy with carboplatin and
cyclophosphamide in malignant glioma: a phase II study.
SO - Anticancer Drugs 2002 Feb;13(2):163-7
AD - Institut Clinic de Malalties Hemato-Oncologique, Hospital Clinic,
University of Barcelona, Spain. nvinolas@clinic.ub.es
We undertook a phase II trial in 17 patients with malignant glioma and
large measurable disease to assess response rate and survival with
pre-irradiation chemotherapy, using higher doses than standard, trying
to improve the outcome. Patients characteristics were: male/female 10/7,
age 49 (range 23-59), median Karnofsky index 90% (range 70-100),
glioblastoma multiforme/anaplastic astrocytoma 14/3. Treatment consisted
of 2 cycles of carboplatin 200 mg/m(2) days 1-3 (or AUC x 8, total dose)
plus cyclophosphamide 1000 mg/m(2) days 1-3. One partial response (6.5%)
and two stabilizations (13.5%) were observed after pre-irradiation
chemotherapy. Twelve out of 15 patients (80%) progressed after
chemotherapy. Median survival time was 7.6 months and the survival at 1
year was 33%. Main toxicity was hematologic in the first cycle:
neutropenia grade 4 in 100%; thrombocytopenia grade 4 in 73% and grade 3
in 27%; anemia grade 3 in 7%; in the second cycle: neutropenia and
thrombocytopenia grade 4 in 100% and anemia grade 3 in 50%). No toxic
death was related to treatment. This regimen showed limited activity in
malignant glioma with large residual disease after surgery or biopsy.
24
UI - 11950399
AU - Peraud A; Meschede M; Eisner W; Ilmberger J; Reulen HJ
TI -
Surgical resection of grade II astrocytomas in the superior frontal
gyrus.
SO - Neurosurgery 2002 May;50(5):966-75; discussion 975-7
AD - Department of Neurosurgery, Klinikum Grobetahadern,
Ludwig-Maximilians-University, Munich, Germany.
aurelia.peraud@helios.med.uni-muenchen.de
OBJECTIVE: Surgery in the superior frontal gyrus partially involving the
supplementary motor area (SMA) may be followed by contralateral
transient weakness and aphasia initially indistinguishable from damage
to the primary motor cortex. However, recovery is different, and SMA
deficits may resolve completely within days to weeks. No study has
assessed the distinct postoperative deficits after tumor resection in
the SMA on a homogeneous patient group. METHODS: Twenty-four patients
with World Health Organization Grade II astrocytomas in the superior
frontal gyrus consecutively treated by surgery were studied. Degree and
duration of postoperative deficits were evaluated according to tumor
location and boundaries via magnetic resonance imaging scans,
intraoperative neuromonitoring results, and extent of tumor resection.
RESULTS: Postoperatively, motor deficits were evident in 21 of 24 and
speech deficits in 9 of 12 patients. Motor function quickly recovered in
11 and speech function in 3 patients. None of the 12 patients in whom
the posterior tumor resection line was at a distance of more than 0.5 cm
from the precentral sulcus experienced persistent motor deficits. Eight
of these patients developed typical SMA syndrome with transient
initiation difficulties. Seven of 12 patients in whom the tumor extended
to the precentral sulcus still had motor deficits at the 12-month
follow-up assessment. CONCLUSION: Surgery for Grade II gliomas in the
superior frontal gyrus is more likely to result in permanent morbidity
when the resection is performed at a distance of less than 0.5 cm from
the precentral gyrus or positive stimulation points. Therefore, cortical
mapping of motor and speech function, in critical cases under local
anesthesia with the patient as his or her own monitor, is recommended;
resection should be tailored to obtain good functional outcome and
maintain quality of life.
25
UI - 11950400
AU - Russell SM; Kelly PJ
TI -
Volumetric stereotaxy and the supratentorial occipitosubtemporal
approach in the resection of posterior hippocampus and parahippocampal
gyrus lesions.
SO - Neurosurgery 2002 May;50(5):978-88
AD - Department of Neurosurgery, New York University School of Medicine, New
York, New York, USA.
OBJECTIVE: Resection of intracranial tumors in the posterior hippocampus
and the parahippocampal gyrus can be associated with significant
morbidity because of the parenchymal resection and the cortical
retraction often required in gaining access to this infrequently
explored region. With the use of image guidance, the occipitosubtemporal
(OST) approach requires neither lateral cortical resection nor the
placement of brain retractors to gain surgical access to the posterior
hippocampus and the parahippocampal gyrus, and this approach is
associated with a high rate of gross total tumor resection. METHODS: The
computer-assisted volumetric stereotactic OST approach was used to
resect 40 posterior hippocampus and parahippocampal gyrus tumors in 34
consecutive patients during an 8-year period. Patient, radiographic, and
surgical outcome data were collected retrospectively. RESULTS: The
series included operations in 25 men and 15 women, and the patients'
average age was 40.3 years (range, 15-69 yr). Twenty-five of the 40
procedures were performed to remove lesions in the dominant hemisphere,
and previous craniotomies for resection had been performed in 12 of 40
cases. In 38 of 40 cases, histopathological analysis revealed a glial
neoplasm, and 50% of these tumors were high-grade lesions.
Preoperatively, 23 patients were neurologically intact before 40
procedures, whereas visual field deficits were noted in 7 patients, mild
hemiparesis was documented in 4 patients, and other neurological
deficits were present in 9 patients. An excellent outcome (Glasgow
Outcome Scale Grade 5) was noted after 38 (95%) of the 40
computer-assisted volumetric stereotactic OST procedures. Permanent
postoperative hemiparesis (Glasgow Outcome Scale Grade 4) occurred after
one procedure, and a second patient, despite being neurologically
unchanged postoperatively and despite having had an optimal tumor
resection, died on postoperative Day 33 (Glasgow Outcome Scale Grade 1).
Complete resection of the preoperatively defined tumor volume was noted
on postoperative gadolinium-enhanced magnetic resonance imaging
examinations after 39 (97.5%) of the 40 procedures. The average duration
of clinical follow-up was 15.9 months (range, 0.5-67 mo). CONCLUSION: We
think that the OST approach is well suited to the resection of tumors in
the posterior hippocampus and the parahippocampal gyrus. By allowing the
neurosurgeon to avoid unnecessary brain resection and retraction, this
approach reduces the risk of injury to important lateral temporal and
occipital lobe cortex and tracts. In addition, the resection of a
posterior hippocampus or parahippocampal gyrus mass with the OST
approach relieves temporal horn entrapment. Computer-assisted volumetric
stereotaxy helps the neurosurgeon to maintain precise spatial and
anatomic orientation and accurately delineates the margin between the
tumor and the surrounding neural tissue.
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