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NCI CANCERLIT® Search: Therapy of Brain Tumor - July 2002
National Cancer Institute®
Last Modified: July 1, 2002
- Temporary ventricular drainage and emergency radiotherapy in the management of hydrocephalus associated with germinoma.
- Outcomes and prognostic factors in recurrent glioma patients enrolled onto phase II clinical trials.
- Medical Research Council adjuvant trial in high-grade gliomas.
- [Report on the Scientific Conference "On earlier diagnosis of intracranial tumors." Elblag, October 4, 2001]
- The position of the neurologist in neuro-oncology.
- Induction chemotherapy and involved-field radiotherapy for intracranial germinoma.
- [Operative therapy for lesions in insula]
- Radiation therapy for incompletely resected supratentorial low-grade glioma in adults.
- Support needs of brain tumour patients and their carers: the place of a telephone service.
- [Guidelines of proper use of antineoplastic agents. Brain tumors]
- [Stereotactic irradiation using linear accelerator]
- Postoperative fluid-attenuated inversion recovery MR imaging of cerebral gliomas: initial results.
- [Assessment of the degree of resection of high grade supratentorial gliomas with early postoperative magnetic resonance]
- Choroid plexus tumours: a surgically treated series.
- Phase II study of carboplatin in children with progressive low-grade gliomas.
- [ANOCEF MEETING December 8, 2001. Summary of the meeting]
- Primary central nervous system lymphomas.
- Adults with newly diagnosed high-grade gliomas.
- Pediatric glial tumors.
- Pharmacotherapy of primary CNS lymphoma.
- [Delayed radiation-induced optic neuropathy in patients with tumors in the chiasmal-sellar area after radiation therapy]
- Intensity modulated radiotherapy (IMRT) decreases treatment-related morbidity and potentially enhances tumor control.
- CyberKnife: a robotic radiosurgery system.
- Biocavity laser will tell surgeons when to stop cutting.
- Malignant gliomas.
- Concomitant radiotherapy and metronomic temozolomide in pediatric high-risk brain tumors.
- Radiotherapy-induced cerebral abnormalities in patients with low-grade glioma.
- Late cognitive and radiographic changes related to radiotherapy: initial prospective findings.
- Intrathecal methotrexate affects cognitive function in children with medulloblastoma.
- Neurocognitive sequelae of cancer treatment.
- Modelling normal tissue isoeffect distribution in conformal radiotherapy of glioblastoma provides an alternative dose escalation pattern through
- Multidrug resistance in brain tumors: roles of the blood-brain barrier.
- Hypothyroidism in children with medulloblastoma: a comparison of 3600 and 2340 cGy craniospinal radiotherapy.
- Thromboprophylaxis.
- Thromboprophylaxis.
- Resection of glioblastoma.
- Resection of glioblastoma.
- [Initial experiences with adjuvant locoregional radioimmunotherapy using 131I-labeled monoclonal antibodies against tenascin (BC-4) for treatment
- New perspectives for the diagnosis and treatment of oligodendroglioma.
- Changing boundaries in the treatment of malignant gliomas.
- Topotecan combined with myeloablative doses of thiotepa and carboplatin for neuroblastoma, brain tumors, and other poor-risk solid tumors in
- Radiotherapy for medulloblastoma in children: a perspective on current international clinical research efforts.
Table of Contents
1
UI - 12066901
AU - Buatti JM; Friedman WA
TI -
Temporary ventricular drainage and emergency radiotherapy in the
management of hydrocephalus associated with germinoma.
SO - J Neurosurg 2002 Jun;96(6):1020-2
AD - Department of Radiation Oncology, University of Iowa, Iowa City, USA.
OBJECT: The authors used an alternative strategy to avoid shunt
placement for hydrocephalus associated with germinoma, and the ensuing
complications. METHODS: Between 1998 and 2000, five patients presenting
with germinomas of the pineal area and symptomatic obstructive
hydrocephalus were treated with a novel strategy. On arrival, they
underwent ventriculostomy placement and one of several surgical
procedures to obtain tissue for diagnosis. Within several days of the
initial diagnosis, stereotactically guided fractionated radiotherapy was
started. All patients experienced rapid tumor shrinkage and resolution
of hydrocephalus, allowing discontinuation of external ventricular
drainage without the need for permanent shunting of cerebrospinal fluid.
To date, follow up reveals 100% radiographically and clinically
confirmed tumor control. CONCLUSIONS: Prompt resolution of hydrocephalus
and absence of complications make this a potentially valuable therapy
for control of germinomas and their symptoms.
2
UI - 10561324
AU - Wong ET; Hess KR; Gleason MJ; Jaeckle KA; Kyritsis AP; Prados MD; Levin
TI -
VA; Yung WK
Outcomes and prognostic factors in recurrent glioma patients enrolled
onto phase II clinical trials.
SO - J Clin Oncol 1999 Aug;17(8):2572
AD - Departments of Neuro-Oncology and Biomathematics, The University of
Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
PURPOSE: To determine aggregate outcomes and prognostic covariates in
patients with recurrent glioma enrolled onto phase II chemotherapy
trials. PATIENTS AND METHODS: Patients from eight consecutive phase II
trials included 225 with recurrent glioblastoma multiforme (GBM) and 150
with recurrent anaplastic astrocytoma (AA). Their median age was 45
years (range, 15 to 82 years) and their median Karnofsky performance
score was 80 (range, 60 to 100). Prognostic covariates were analyzed
with respect to tumor response, progression-free survival (PFS), and
overall survival (OS) by multivariate logistic and Cox proportional
hazards regression analyses. RESULTS: Overall, 34 (9%) had complete or
partial response, whereas 80 (21%) were alive and progression-free at 6
months (APF6). The median PFS was 10 weeks and median OS was 30 weeks.
Histology was a robust prognostic factor across all outcomes. GBM
patients had significantly poorer outcomes than AA patients. The APF6
proportion was 15% for GBM and 31% for AA, whereas the median PFS was 9
weeks for GBM and 13 weeks for AA. Results were also significantly
poorer for patients with more than two prior surgeries or chemotherapy
regimens. CONCLUSION: Histology is a dominant factor in determining
outcome in patients with recurrent glioma enrolled onto phase II trials.
Future trials should be designed with separate histology strata.
3
UI - 11579124
AU - Chamberlain MC; Jaeckle KA
TI -
Medical Research Council adjuvant trial in high-grade gliomas.
SO - J Clin Oncol 2001 Oct 1;19(19):3997-9
4
UI - 12046517
AU - Derenda M
TI -
[Report on the Scientific Conference "On earlier diagnosis of
intracranial tumors." Elblag, October 4, 2001]
SO - Neurol Neurochir Pol 2002 Mar-Apr;36(2):416-9
AD - Oddzialu Neurochirurgii Wojewodzkiego Szpitala Zespolonego w Elblagu.
5
UI - 11985627
AU - Grisold W; Heimans JJ; Postma TJ; Grant R; Soffietti R; The
TI -
Neuro-Oncology Panel of the EFNS
The position of the neurologist in neuro-oncology.
SO - Eur J Neurol 2002 May;9(3):201-5
AD - Ludwig Boltzmann Institute for NeuroOncology, Vienna, Austria.
wolfgang.grisold@kfj.magwien.gv.at
Neuro-oncology is a growing new subspeciality with a strong
interdisciplinary character. This position paper explains the role of
neurology in the multidisciplinary field of neurosurgeons,
radiotherapists and general oncologists, dealing with neuro-oncological
patients. The paper delineates the varied spectrum of the field of
neuro-oncology which expands from primary brain tumours, to metastatic
and non-metastatic effects of systemic cancer on the central and
peripheral nervous system, neurotoxicity due to cancer treatment and
issues of quality of life. It has been written by the scientific
neuro-oncology panel of the European Federation of Neurological
Societies (EFNS) to delineate the situation of neuro-oncology in Europe,
and facilitate the understanding and implementation of this
subspeciality in the future.
6
UI - 12065573
AU - Paulino AC
TI -
Induction chemotherapy and involved-field radiotherapy for intracranial
germinoma.
SO - J Clin Oncol 2002 Jun 15;20(12):2911; discussion 2911-2
7
UI - 11798808
AU - Wang L; Zhao J
TI -
[Operative therapy for lesions in insula]
SO - Zhonghua Yi Xue Za Zhi 2000 Jul;80(7):507-8
AD - Department of Neurosurgery, Beijing TianTan Hospital. Beijing 100050,
China.
OBJECTIVE: To probe into the significance of treating lesions in insula
trans-sylvian approach in reducing cerebral injury in peri-tumor regions
and post-operative complications. METHODS: All patients were operated on
through fronto-temporal approach. The key procedure was that arachnoid
membrane in the sylvian should not only be splited sharply under
microscope but also be splited from the superface till to tumors in the
insula. RESULTS: Post-operative CT showed no signs of cerebral injury.
None of all the 15 patients suffered aphasia or memory change.
CONCLUSION: Trans-sylvian approach is an effective operative way in
treating lesions in insula.
8
UI - 11817700
AU - Jeremic B; Bamberg M
TI -
Radiation therapy for incompletely resected supratentorial low-grade
glioma in adults.
SO - J Neurooncol 2001 Nov;55(2):101-12
AD - Department of Radiation Oncology, University Hospital, Tuebingen,
Germany. bjeremic@med.uni-tuebingen.de
In this review on current concepts in radiation therapy in the treatment
of incompletely resected supratentorial low-grade glioma, a number of
important issues are discussed. They include indication for radiation
therapy, timing (early vs delayed), dose response issue, impact of
modern neuroimaging, 'optimal' treatment fields, impact of histology,
new and promising approaches as well as quality of life in this disease
are also discussed. This disease remains a focus of investigations in
neuro-oncology owing to the fact that a number of questions discussed in
the text are still far from being optimally addressed and answers are,
therefore, lacking. New studies and more patients are needed to get more
insight into this disease.
9
UI - 11951401
AU - Curren JR
TI -
Support needs of brain tumour patients and their carers: the place of a
telephone service.
SO - Int J Palliat Nurs 2001 Jul;7(7):331-7
AD - Beatson Oncology Centre, Western Infirmary, Glasgow, UK.
Although the survival rate for many cancers has improved over the past
two decades this has not happened for most patients with a primary
malignant brain tumour. Numbers of patients diagnosed with this
condition each year are small, and as expertise is often very limited,
information, advice, and support can be difficult for patients and
carers to access. The role of the appropriately trained nurse in meeting
these needs has been well researched and published literature supports
the development of such roles. The use of the telephone for providing
information and support has become more common in recent years. The
Regional Cancer Centre in the west of Scotland covers a wide
geographical area and it was considered appropriate to initiate such a
service for patients and their carers in that area to provide easier
access to specialist knowledge and advice and subsequently improve
continuity of care. This article discusses some of the support and
informational needs of patients with brain tumours and their carers,
which highlight reasons for introducing the telephone service in this
cancer centre. The results of a 2-year audit of the service will be also
be presented.
10
UI - 12109447
AU - Kochi M; Namashio Y
TI -
[Guidelines of proper use of antineoplastic agents. Brain tumors]
SO - Gan To Kagaku Ryoho 2002 Jun;29(6):1065-73
11
UI - 12094684
AU - Shirato H; Aoyama H; Hida K; Sawamura Y; Miyasaka K; Iwasaki Y
TI -
[Stereotactic irradiation using linear accelerator]
SO - No Shinkei Geka 2002 Jun;30(6):579-91
AD - Department of Radiology, Hokkaido University School of Medicine,
North-15 West-6, Kita-ku, Sapporo, Hokkaido 060-8648, Japan.
12
UI - 11702135
AU - Essig M; Metzner R; Bonsanto M; Hawighorst H; Debus J; Tronnier V; Knopp
TI -
MV; van Kaick G
Postoperative fluid-attenuated inversion recovery MR imaging of cerebral
gliomas: initial results.
SO - Eur Radiol 2001;11(10):2004-10
AD - Department of Radiology, German Cancer Research Center, University
Hospitals, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany.
m.essig@dkfz-heidelberg.de
Fluid-attenuated inversion-recovery (FLAIR) imaging has shown to be a
valuable imaging modality in the assessment of intra-axial brain tumors;
however, no data are available about the role of this technique in the
clinically important postoperative stage. The purpose of this study was
to evaluate the diagnostic potential of FLAIR MR imaging in residual
tumor after surgical resection of cerebral gliomas. Fifteen patients
with residual cerebral gliomas were examined within the first 18 days
after partial surgical resection of cerebral gliomas. The imaging
protocol included T1-weighted spin echo, T2- and proton-density-weighted
fast spin echo, and FLAIR imaging with identical slice parameters. T1
and FLAIR were repeated after contrast media application. Detection and
delineation of residual tumor were the primary parameters of the image
analysis. Additionally, the influence of image artifacts on the image
interpretation was assessed. On FLAIR images residual signal
abnormalities at the border of the resection cavities were observed in
all patients, whereas T2- and T1-weighted images present residual
abnormalities in 13 of 15 and 10 of 15 patients, respectively. The FLAIR
imaging was found to be superior to conventional imaging sequences in
the delineation of these changes and comparable to contrast enhanced
T1-weighted imaging in the delineation of residual enhancing lesions.
Because of protein cell components and blood byproducts within the
resection cavity, FLAIR imaging was unable to suppress the cerebrospinal
fluid (CSF) in 4 patients. After the decomposition of proteins and
blood, CSF could again be completely suppressed and residual or
recurrent tumors were clearly identified. Our preliminary study has
shown that FLAIR may be a valuable diagnostic modality in the early
postoperative MR imaging after resection of cerebral gliomas due to its
better delineation of residual pathologic signal at the border of the
resection cavity. It should therefore be integrated into the early
and/or intraoperative MR imaging protocol.
13
UI - 11706434
AU - Pesudo Martinez JV; Gonzalez-Darder JM; Feliu Tatay R; Belloch Ugarte V;
TI -
Vera Roman J; Gil Salu JL
[Assessment of the degree of resection of high grade supratentorial
gliomas with early postoperative magnetic resonance]
SO - Neurocirugia (Astur) 2001;12(1):43-50
AD - Servicio de Neurocirugia, Hospital General de Castellon, ERESA.
In this paper we report the results of a prospective study in which we
evaluate the degree of tumor removal of 25 supratentorial high grade
gliomas by means of an MRI performed in the early postoperative period.
In all cases, there was preoperative enhancement 8 patients had been
previously operated on while the others had their first operation. In
all cases the postoperative early MRI was performed within the first
week and in 15 within the first 3 days. In order to evaluate the degree
of tumor removal the presence or not of enhancement was considered and
if it existed, classified as linear or nodular. RESULTS: To avoid
postsurgical artifacts it is important to perform the MRI as soon as
possible after surgery, especially within the first 3 days. Generally,
linear enhancement disappeared on subsequent follow-up examinations,
showing that it probably does no represent residual, tumor while nodular
enhancement usually does. Survival with the high-grade tumors was
slightly higher in the group without postoperative enhancement or linear
one than in the group with nodular enhancement but the difference was
not significant.
14
UI - 11706439
AU - Barbosa M; Rebelo O; Barbosa P; Lacerda A; Fernandes R
TI -
Choroid plexus tumours: a surgically treated series.
SO - Neurocirugia (Astur) 2001;12(1):7-16
AD - Department of Neurosurgery, Coimbra's University Hospital (HUC),
Portugal.
Choroid plexus tumours-carcinomas and papillomas are rare, especially in
adults, and they pose some problems in their diagnosis and management.
We have reviewed a series of nine cases from our institution surgically
treated during the last 18 years. Their clinical charts,
neuroradiological examinations, surgical technique, neuropathology and
follow-up were analysed. In only one case total removal proved to be
impossible, but even in cases of total removal recurrence appeared in
two cases (one carcinoma and one papilloma). Morbility is especially
associated with posterior fossa tumours. These rare tumours are managed
surgically. They are usually associated with hydrocephalus, and it is
difficult to forecast whether or not permanent CSF drainage will be
required. A long-term follow-up is needed in patients with this type of
tumour.
15
UI - 12089224
AU - Gururangan S; Cavazos CM; Ashley D; Herndon JE 2nd; Bruggers CS;
TI -
Moghrabi A; Scarcella DL; Watral M; Tourt-Uhlig S; Reardon D; Friedman
HS
Phase II study of carboplatin in children with progressive low-grade
gliomas.
SO - J Clin Oncol 2002 Jul 1;20(13):2951-8
AD - Duke University Medical Center, Durham, NC 27710, USA.
gurur002@mc.duke.edu
PURPOSE: To assess the rate of tumor response and activity of
carboplatin in stabilizing the growth of progressive low-grade gliomas.
PATIENTS AND METHODS: Eligible patients received carboplatin 560 mg/m(2)
intravenously every 4 weeks for 1 year after maximum tumor response or
until disease progression or unacceptable toxicity. RESULTS: Between
range, 6 to 204) were enrolled onto this study. Patients received a
median of 11 cycles of carboplatin (range, one to 29). Median follow-up
from the time of enrollment was 55 months (range, 10 to 93). The overall
objective response (complete response [CR] + partial response [PR] +
minor response [MR]) and disease stabilization (CR + PR + stable disease
+ MR) rates to carboplatin treatment were 28% (95% confidence interval
[CI], 18% to 38%) and 85% (95% CI, 74% to 93%), respectively. Eleven and
14 patients suffered progressive disease on study and after stopping
therapy, respectively. Toxicity was predominantly myelosuppression and
included grade 3/4 neutropenia in 56 patients and grade 3/4
thrombocytopenia in 40 patients. The 3-year failure-free survival (FFS)
and overall survival (OS) for all patients were 64% (95% CI, 54% to 76%)
and 84% (95% CI, 76% to 93%), respectively. Patients with diencephalic
tumors had inferior FFS and OS compared with those with tumor at other
sites (38% v 74% for FFS, P =.011; 54% v 91% for OS, P =.004).
Neurofibromatosis type 1 patients with progressive low-grade glioma had
a significantly better OS (95% v 80%; P =.052). CONCLUSION: Carboplatin,
in the schedule used in this study, produced disease stabilization or
improvement in a majority of children with progressive low-grade glioma,
with manageable toxicity. Improved treatment strategies are particularly
required for patients with diencephalic tumors.
16
UI - 11984496
AU - Noel G; Mammar H; Ferrand R; Desblancs C; Nauraye C; Mazeron JJ
TI -
[ANOCEF MEETING December 8, 2001. Summary of the meeting]
SO - Rev Neurol (Paris) 2002 Apr;158(4):497-509
AD - Centre de protontherapie d'Orsay, Orsay, France.
17
UI - 12057111
AU - DeAngelis LM
TI -
Primary central nervous system lymphomas.
SO - Curr Treat Options Oncol 2001 Aug;2(4):309-18
AD - Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY
10021-6700, USA. deangell@mskcc.org
Primary central nervous system lymphoma (PCNSL) is widely regarded as
one of the primary brain tumors most amenable to treatment. Although
whole brain radiotherapy was the cornerstone of therapy for decades,
recent work clearly indicates that chemotherapy has become the primary
focus of treatment for this disease. The initial treatment of PCNSL for
all patients, including the elderly, should be chemotherapy using a
high-dose methotrexate-based regimen. Although cranial irradiation has
often been combined with methotrexate, the unacceptably high incidence
of late neurotoxicity, particularly in older patients, has caused many
to eliminate radiotherapy, especially in those older than age 60 years.
Emerging data support the validity of this approach, and the development
of more efficacious chemotherapeutic regimens has been the focus of
recent research.
18
UI - 12057096
AU - Croteau D; Mikkelsen T
TI -
Adults with newly diagnosed high-grade gliomas.
SO - Curr Treat Options Oncol 2001 Dec;2(6):507-15
AD - Hermelin Brain Tumor Center, Henry Ford Hospital, 2799 West Grand
Boulevard, Detroit, MI 48202, USA. nsdac@neuro.hfh.edu
Despite tremendous advances in brain tumor molecular biology and several
emerging novel therapies, multimodality therapy that includes surgery,
radiation therapy (RT), and chemotherapy is still the cornerstone of
high-grade glioma treatment. The first step in high-grade glioma therapy
is surgery and a maximal resection should be attempted to reduce the
tumor burden before initiation of other adjuvant therapies. External
beam radiation therapy (EBRT) generally follows surgery, using
conventional dosage, and fractionation, and ideally a three-dimensional
conformal technique. Stereotactic radiosurgery (SRS) to maximize
cytoreduction may be used in selected cases. Because no curative
chemotherapy exists for high-grade glioma, we always consider an
investigational agent either before or concurrently with RT. However,
the use of a standard cytotoxic agent, such as temozolomide alone or
combined with 13-cis-retinoic acid also is a rational choice
particularly for patients with relatively good prognostic factors for
whom an investigational agent would not be available. The management of
anaplastic oligodendroglioma does not differ significantly from other
high-grade gliomas in terms of surgery, RT, or investigational or
protocol agent; however, these tumors appear to respond to chemotherapy
that includes a combination of procarbazine, CCNU, and vincristine (PCV)
[1**]. The vincristine provides more toxicity than benefit and it is our
practice to only use a combination of procarbazine and CCNU (PC). A
single agent, such as temozolomide is an increasingly used and rational
choice for anaplastic oligodendroglioma. It is our belief that early,
aggressive multimodality treatment still provides the best chance for
long-term control of high-grade gliomas, particularly in patients with
good prognostic factors. However, despite best therapy and
state-of-the-art technology, most patients with high-grade glioma will
experience progression or recurrence and will require either a change in
the ongoing therapeutic strategy or additional treatment. Better
therapies are necessary and progress will only be made through
investigation of promising agents in well-designed clinical trials.
19
UI - 12057098
AU - Cohen KJ; Broniscer A; Glod J
TI -
Pediatric glial tumors.
SO - Curr Treat Options Oncol 2001 Dec;2(6):529-36
AD - Pediatric Oncology, Johns Hopkins Oncology Center, CMSC-800, 600 N.
Wolfe Street, Baltimore, MD 21287, USA. kcohen@jhmi.edu
Glial neoplasms in children comprise many heterogeneous tumors that
include pilocytic and fibrillary astrocytomas, ependymomas, and the
diffuse intrinsic pontine gliomas. In contrast to adults, most of whom
present with high-grade fibrillary neoplasms, alternate histologies
represent most cases seen in the pediatric setting. In addition,
although most adult gliomas are supratentorial in location, in
pediatrics infratentorial tumors (posterior fossa and brain stem)
predominate. We discuss three specific tumors: diffuse intrinsic pontine
gliomas; pilocytic astrocytomas; and ependymomas. Maximal surgical
resection is the mainstay of therapy for both pilocytic astrocytomas and
ependymomas. Failure to achieve an optimal resection often results in
progression and the need for further therapy for patients with pilocytic
astrocytomas, and is ultimately fatal in most children with subtotally
resected ependymomas. Surgical resection has no role in the treatment of
pontine gliomas. Focal radiation therapy is included routinely in the
treatment of ependymomas, and it has been shown to improve event-free
survival. This therapy also is used in the treatment of pontine gliomas
because radiation treatment appears to slow inevitable tumor
progression. Radiation therapy in pilocytic astrocytomas is generally
reserved for patients who progress after an initial surgical resection
or for those patients with midline tumors; these patients are poor
candidates for aggressive surgical resection. The role of chemotherapy
in these tumors is in evolution. Chemotherapy for pilocytic
astrocytomas, particularly in young children (for whom radiation therapy
is avoided), appears to be effective in the treatment of a subset of
patients. Up-front chemotherapy is generally reserved for the youngest
children who present with ependymoma. In the recurrence setting,
chemotherapy has shown some activity, although this approach is never
curative. Despite the application of various chemotherapeutics and other
biologic agents, none of these therapies has improved the prognosis for
patients with the uniformly lethal pontine glioma.
20
UI - 11772332
AU - Park DM; Abrey LE
TI -
Pharmacotherapy of primary CNS lymphoma.
SO - Expert Opin Pharmacother 2002 Jan;3(1):39-49
AD - Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275
York Avenue, New York, NY 10021, USA.
Primary CNS lymphoma (PCNSL) is distinguished from other brain tumours
by its striking response to chemotherapy. Surgery has little role (if
any) in the treatment of PCNSL. Radiation therapy has been proven to
prolong survival but its use is complicated by delayed neurological
toxicity, particularly among the elderly. Progress in understanding the
physiology of the blood-brain barrier (BBB) and the pharmacology of
chemotherapeutic agents has substantially improved the treatment and
prognosis of this disease. The single most effective agent is
methotrexate (MTX). The goal of delivering an adequate dose of MTX to
the brain and the cerebrospinal fluid (CSF) has been achieved by a
variety of strategies, including systemic high dose, intra-arterial
injection following pharmacological disruption of the BBB and
intrathecal (it.) administration. MTX-based combination chemotherapy has
yielded the best results to date but the prognosis of patients with
PCNSL remains significantly worse than comparable patients with systemic
non-Hodgkin's lymphoma (NHL). Ongoing trials continue to test novel
combinations of agents, doses and improved routes of delivery with the
hope of improving disease control and diminishing treatment-related
neurotoxicity.
21
UI - 11845703
AU - Serova NK; Eliseeva NM; Lazareva LA; Arutiunov NV; Shishkina LV
TI -
[Delayed radiation-induced optic neuropathy in patients with tumors in
the chiasmal-sellar area after radiation therapy]
SO - Vestn Oftalmol 2001 Nov-Dec;117(6):9-13
Six clinical observations of a rare condition, delayed radiation-induced
optic neuropathy (RON) are presented. RON developed in patients with
brain tumors treated by radiotherapy and radiosurgery; in the majority
of patients the condition developed during exposure to therapeutic
doses; its incidence was 0.5% of the total number of patients treated by
radiotherapy during this period. Asymmetrical chiasmal syndrome
developed rapidly in all the patients. Clinical diagnosis of RON was
confirmed by magnetic resonance tomography in all cases, and in one case
by morphological analysis. Conservative therapy including hyperbaric
oxygenation just stabilized the visual function. Remote period of
observation was 42 months.
22
UI - 12094538
AU - Teh BS; Mai WY; Grant WH 3rd; Chiu JK; Lu HH; Carpenter LS; Woo SY;
TI -
Butler EB
Intensity modulated radiotherapy (IMRT) decreases treatment-related
morbidity and potentially enhances tumor control.
SO - Cancer Invest 2002;20(4):437-51
AD - Department of Radiology, Section of Radiation Oncology, Baylor College
of Medicine, Methodist Hospital, Houston, TX, USA.
Intensity modulated radiation therapy (IMRT), a new form of
three-dimensional conformal radiation therapy (3DCRT), optimizes the
concept of computer-controlled radiation deposition in tumor (target)
while sparing adjacent normal structures. A retrospective review was
done on the initial 185 patients with tumors in different sites
including prostate cancer, head and neck cancer, pediatric tumors, adult
brain tumors, and previously irradiated recurrent tumors treated with
IMRT. Preliminary findings indicate that IMRT is a new clinically
feasible tool in radiation oncology. Treatment-related morbidity profile
was favorable. Tumor response, local control, and the ability to
palliate previously irradiated patients are encouraging. Intensity
modulated radiation therapy will allow dose escalation, leading to
better tumor control.
23
UI - 11998608
AU - Quinn AM
TI -
CyberKnife: a robotic radiosurgery system.
SO - Clin J Oncol Nurs 2002 May-Jun;6(3):149, 156
AD - quinnae@msx.upmc.edu
The CyberKnife is a radiosurgical system consisting of a linear
accelerator and robotic arm. Using guidance imaging, the system
precisely locates tumors and delivers multiple beams of radiation
therapy directly to the tumor site while minimizing radiation exposure
of surrounding tissue. The CyberKnife has the capacity to treat tumors
up to 6 cm in size and holds promise as a new radiosurgery treatment
modality.
24
UI - 12061371
AU - Zuboy J
TI -
Biocavity laser will tell surgeons when to stop cutting.
SO - Curr Treat Options Oncol 2000 Jun;1(2):91
25
UI - 12057153
AU - Burton EC; Prados MD
TI -
Malignant gliomas.
SO - Curr Treat Options Oncol 2000 Dec;1(5):459-68
AD - Department of Neurological Surgery, University of California, San
Francisco, 400 Parnassus 808A, San Francisco, CA, 94143-0372, USA.
Gliomas are a heterogeneous group of neoplasms that comprise the
majority of tumors originating in the central nervous system (CNS). In
adults, the most frequently encountered of these are high-grade or
malignant neoplasms of astrocytic and oligodendrocytic lineage, ie,
anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), and
anaplastic oligodendroglioma (AO), respectively. Tumors of mixed lineage
are also seen, the most common of which is designated anaplastic
oligoastrocytoma (AOA). Standard treatment for these tumors is typically
surgery, followed by radiation then chemotherapy. Surgery is required
for a definitive histopathologic diagnosis, which in turn will dictate
subsequent therapy options. Moreover, aggressive tumor resection
improves survival outcomes, and in many cases, the patient's neurologic
function. We generally advocate the safest, maximal resection attainable
for patients with these tumors as a way to improve prognosis. In almost
all cases, surgery is followed by radiation therapy. Postsurgical
irradiation is the most effective treatment currently available for
improving survival. There is also mounting evidence to suggest that
additional radiation, given in the form of brachytherapy or
radiosurgery, at initial diagnosis as a "boost" to standard radiation or
at tumor recurrence, may provide added improvement in survival outcome.
Radiosurgery and brachytherapy are therapies often used to treat
eligible patients at this institution. Adjuvant chemotherapy,
conventionally given after radiation, may offer a modest survival
benefit in some patients with GBM. Bischloroethylnitrosourea (BCNU) is
the typical first-line agent used, but chemotherapy seems to be most
beneficial in young patients, with little if any impact on survival for
patients over 60 years old. At this institution, we often defer
treatment with adjuvant chemotherapy for elderly patients with GBM due
to lack of efficacy and the attendant risk with chemotherapy. For
anaplastic astrocytomas, oligodendrogliomas, and oligoastrocytomas, a
commonly accepted standard is adjuvant chemotherapy following
irradiation with the three-drug regimen--procarbazine, CCNU, and
vincristine (PCV). This is due to an earlier clinical trial that showed
a survival advantage in patients treated with adjuvant PCV compared with
patients that received BCNU. However, recent data suggest that treatment
with either PCV or BCNU may be appropriate. Both regimens now appear to
have equal efficacy for anaplastic gliomas in light of a more recent
analysis done with larger numbers of patients. AOs are a unique case
with respect to tumor chemosensitivity and patient survival. Molecular
studies have identified a subpopulation of patients with AO whose tumors
have lost chromosomes 1p and 19q. Patients with this molecular pattern
have an exceptional responsiveness to PCV chemotherapy and have
prolonged survival. Currently, trials are being conducted to confirm
this finding and to determine the best treatment regimen for these
patients, with particular regard to the timing of radiation and
chemotherapy.
26
UI - 12088104
AU - Sterba J; Pavelka Z; Slampa P
TI -
Concomitant radiotherapy and metronomic temozolomide in pediatric
high-risk brain tumors.
SO - Neoplasma 2002;49(2):117-20
AD - Dept. of Pediatric Oncology University Hospital Brno, Children's
Hospital, Czech Republic. jsterb@fnbrno.cz
Temozolomide, an oral alkylating agent has a significant activity in
preclinical testing and in clinical trials in adults and children as
well. Penetration across the blood brain barrier has been documented. In
adult and pediatric phase I and II trials a five-day every 28 days
schedule was first approved for clinical use. With respect to
temozolomide proximal mechanism of resistance, and further to increase
dose intensity, new schedules are proposed to use more prolonged drug
exposure. Higher doses of metronomic temozolomide were piloted. Eight
children with poor prognosis brain tumors were eligible. Treatment
consisted from concomitant radiotherapy given 1x170 cGy, 5d/wk, for
total dose 55/56 Gy, together with temozolomide 90 mg/m2/day for 42
days. No further dose escalation has been planned for this group of
patients. Myelosuppression was the primary toxicity, occurring around
day 21. Nonhematologic toxicities were infrequent and in no case dose
limiting toxicity (DLT) occurred. The most common nonhematologic
toxicity was vomiting, effectively managed with antiemetics. Six
responses were documented. The best responses (CR) were seen in 2
patients with high-risk medulloblastomas, who have progressed early
after neurosurgery. Furthermore, one more patient had CR and 3 patients
PR at the end of temozolomide treatment. We have piloted novel dose
schedule of temozolomide and evaluated clinical toxicities in a cohort
of 8 children. This is the first study to report feasibility and
tolerability of 90 mg/m2/day of temozolomide treatment in metronomic
fashion. In addition, we have documented encouraging responses in
children with medulloblastomas, progressing early after their initial
surgery.
27
UI - 12105319
AU - Postma TJ; Klein M; Verstappen CC; Bromberg JE; Swennen M; Langendijk
TI -
JA; Taphoorn MJ; Scheltens P; Slotman BJ; van der Ploeg HM; Aaronson NK;
Heimans JJ
Radiotherapy-induced cerebral abnormalities in patients with low-grade
glioma.
SO - Neurology 2002 Jul 9;59(1):121-3
AD - Department of Neurology, Vrije Universiteit Medical Center, Amsterdam,
The Netherlands. TJ.Postma@vumc.nl
Abnormalities on CT or MRI and neuropsychological performance in
patients with low-grade glioma, with (n = 23) or without (n = 16) prior
cerebral radiotherapy, were evaluated. Cerebral atrophy was observed in
14 of 23 patients (61%) treated with prior radiotherapy, and in 1 of 16
patients (6%) without prior radiotherapy. White matter abnormalities
were observed in six patients, all of whom were treated with prior
radiotherapy. These radiologic cerebral abnormalities correlated with
cognitive performance.
28
UI - 12105305
AU - Armstrong CL; Hunter JV; Ledakis GE; Cohen B; Tallent EM; Goldstein BH;
TI -
Tochner Z; Lustig R; Judy KD; Pruitt A; Mollman JE; Stanczak EM; Jo MY;
Than TL; Phillips P
Late cognitive and radiographic changes related to radiotherapy: initial
prospective findings.
SO - Neurology 2002 Jul 9;59(1):40-8
AD - Departments of Neurology, University of Pennsylvania Medical School,
Children's Hospital of Philadelphia, PA 19104, USA.
armstrongc@email.chop.edu
BACKGROUND: Assumptions about the damaging effects of radiotherapy (XRT)
are based on studies in which total dose, dose fraction, treatment
volume, degree of malignancy, chemotherapy, tumor recurrence, and
neurologic comorbidity interact with XRT effects. This is a prospective,
long-term study of XRT effects in adults, in which total dose and dose
fraction were constrained and data related to tumor recurrence and
neurologic comorbidity (e.g., hypertension) were excluded. METHODS: The
effects of XRT on the cognitive and radiographic outcomes of 26 patients
with low-grade, supratentorial, brain tumors yearly from baseline (6
weeks after surgery and immediately before XRT) and yearly to 6 years
were examined. Radiographic findings were examined regionally. RESULTS:
Selective cognitive declines (in visual memory) emerged only at 5 years,
whereas ratings of clinical MRI (T2 images) showed mild accumulation of
hyperintensities with post-treatment onset from 6 months to 3 years,
with no further progression. White matter atrophy and total
hyperintensities demonstrated this effect, with subcortical and deep
white matter, corpus callosum, cerebellar structures, and pons
accounting for these changes over time. About half of the patients
demonstrated cognitive decline and treatment-related hyperintensities.
CONCLUSIONS: There was no evidence of a general cognitive decline or
progression of white matter changes after 3 years. Results argue for
limited damage from XRT at this frequently used dose and volume in the
absence of other clinical risk factors.
29
UI - 12105306
AU - Riva D; Giorgi C; Nichelli F; Bulgheroni S; Massimino M; Cefalo G;
TI -
Gandola L; Giannotta M; Bagnasco I; Saletti V; Pantaleoni C
Intrathecal methotrexate affects cognitive function in children with
medulloblastoma.
SO - Neurology 2002 Jul 9;59(1):48-53
AD - Developmental Neurology Unit, Istituto Nazionale Neurologico C. Besta,
Milano, Italy. driva@istituto-besta.it
BACKGROUND: Cognitive impairment occurs after malignant brain tumor
treatment in children, following brain radiotherapy and systemic and
intrathecal chemotherapy. OBJECTIVES: 1) To compare two groups of
children who underwent surgery for cerebellar medulloblastoma with their
cousins and siblings, assessing intelligence, executive function,
attention, visual perception, and short-term memory. Both groups were
treated with the same combined radiotherapy-chemotherapy, but differed
in that only one group received intrathecal methotrexate (MTX+). 2) To
relate these measures to MRI findings (leukomalacia). RESULTS: The two
groups performed worse than their control subjects in all tests. The
MTX+ group younger than 10 years performed significantly worse in all
tests, particularly executive ones. The group older than 10 years
performed significantly worse only in short-term memory. Younger
patients without MTX performed significantly worse than controls only in
some neuropsychological measures; there were no differences between
older patients and control subjects. Only in the MTX+ group was there a
direct correlation between extent of leukomalacia and performance in
some tests. CONCLUSIONS: The administration of intrathecal methotrexate
to children with medulloblastoma worsens the cognitive deficits induced
by chemotherapy and radiotherapy. The use of intrathecal methotrexate in
the treatment of medulloblastoma and other malignancies should be
reassessed.
30
UI - 12105300
AU - Packer RJ; Mehta M
TI -
Neurocognitive sequelae of cancer treatment.
SO - Neurology 2002 Jul 9;59(1):8-10
31
UI - 12102161
AU - Mangel L; Skriba Z; Major T; Polgar C; Fodor J; Somogyi A; Nemeth G
TI -
Modelling normal tissue isoeffect distribution in conformal radiotherapy
of glioblastoma provides an alternative dose escalation pattern through
hypofractionation without reducing the total dose.
SO - Acta Oncol 2002;41(2):162-8
AD - National Institute of Oncology, Department of Radiotherapy, Budapest,
Hungary.
The purpose of this study was to prove that by using conformal external
beam radiotherapy (RT) normal brain structures can be protected even
when applying an alternative approach of biological dose escalation:
hypofractionation (HOF) without total dose reduction (TDR). Traditional
2-dimensional (2D) and conformal 3-dimensional (3D) treatment plans were
prepared for 10 gliomas representing the subanatomical sites of the
supratentorial brain. Isoeffect distributions were generated by the
biologically effective dose (BED) formula to analyse the effect of
conventionally fractionated (CF) and HOF schedules on both the spatial
biological dose distribution and biological dose-volume histograms. A
comparison was made between 2D-CF (2.0 Gy/day) and 3D-HOF (2.5 Gy/day)
regimens, applying the same 60 Gy total doses. Integral biologically
effective dose (IBED) and volumes received biologically equivalent to a
dose of 54 Gy or more (V-BED54) were calculated for the lower and upper
brain stem as organs of risk. The IBED values were lower with the 3D-HOF
than with the 2D-CF schedule in each tumour location, means 22.7+/-17.1
and 40.4+/-16.9 in Gy, respectively (p < 0.0001). The V-BED54 values
were also smaller or equal in 90% of the cases favouring the 3D-HOF
scheme. The means were 2.7+/-4.8 ccm for 3D-HOF and 10.7+/-12.7 ccm for
2D-CF (p = 0.0006). Our results suggest that with conformal RT, fraction
size can gradually be increased. HOF radiotherapy regimens without TDR
shorten the treatment time and seem to be an alternative way of dose
escalation in the treatment of glioblastoma.
32
UI - 11831641
AU - Regina A; Demeule M; Laplante A; Jodoin J; Dagenais C; Berthelet F;
TI -
Moghrabi A; Beliveau R
Multidrug resistance in brain tumors: roles of the blood-brain barrier.
SO - Cancer Metastasis Rev 2001;20(1-2):13-25
AD - Laboratoire de Medecine Moleculaire, Hjpital Sainte-Justine-Universite
du Quebec a Montreal, Canada.
Malignant brain tumors and brain metastases present a formidable
clinical challenge against which no significant advances have been made
over the last decade. Multidrug resistance (MDR) is one of the main
factors in the failure of chemotherapy against central nervous system
tumors. The MDR1 gene encoding P-glycoprotein (P-gp), a drug efflux pump
which plays a significant role in modulating MDR in a wide variety of
human cancers, is highly expressed in the blood-brain barrier (BBB). The
BBB controls central nervous system exposure to many endogenous and
exogenous substances. The exact molecular mechanisms by which the BBB is
involved in the resistance of brain tumors to chemotherapy remain to be
identified. The purpose of this review is to summarize reports
demonstrating that P-gp, one of the most phenotypically important
markers of the BBB, is present in primary brain tumors and thus plays a
crucial role in their clinical resistance to chemotherapy.
33
UI - 12062595
AU - Paulino AC
TI -
Hypothyroidism in children with medulloblastoma: a comparison of 3600
and 2340 cGy craniospinal radiotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Jul 1;53(3):543-7
AD - Department of Radiation Oncology, The University of Iowa College of
Medicine, University of Iowa Health Care and Children's Hospital of
Iowa, Iowa City, IA, USA. arnold@radonc.emory.org
PURPOSE: To determine if low-dose craniospinal irradiation (2340 cGy)
with chemotherapy is associated with a lower incidence of hypothyroidism
compared to standard dose (3600 cGy) with or without chemotherapy in
children with medulloblastoma. PATIENTS AND METHODS: Between 1980 and
1999, 32 patients < or =20 years old survived after craniospinal
irradiation with or without chemotherapy. Twenty patients received 3600
cGy craniospinal irradiation (CSI), whereas 12 had 2340 cGy CSI; all
patients received a posterior fossa boost to a total dose 5040-5580 cGy.
The median ages at the time of CSI for those receiving 2340 cGy and 3600
cGy were 7.2 and 10.2 years, respectively. Chemotherapy (CT) was
employed in 22 children. All children who received 2340 cGy had CT
consisting of vincristine, CCNU, and either cisplatin or
cyclophosphamide. Ten of 20 (50%) patients receiving 3600 cGy had CT;
the most common regimen was vincristine, CCNU, and prednisone.
Serum-free thyroxine and thyroid-stimulating hormone concentrations were
measured in all children at variable times after radiotherapy.
Thyroid-stimulating hormone responses to i.v. thyrotrophin-releasing
hormone were assessed in those suspected of having central
hypothyroidism. Median follow-up for children receiving 2340 cGy was 5
years (range: 2-11.2 years), whereas for those receiving 3600 cGy,
follow-up was 12.5 years (range: 2.4-20 years). RESULTS: Eighteen
patients (56%) developed hypothyroidism at a median time after
radiotherapy of 41 months (range: 10 months to 18 years). Primary
hypothyroidism was more common than central hypothyroidism (38% and
19%). All 7 children <5 years developed hypothyroidism, whereas 9 of 15
(60%) ages 5-10 and 2 of 10 (20%) age >10 years had hypothyroidism (p <
0.001). Hypothyroidism was documented in 10 of 12 (83%) who had 2340 cGy
+ CT, 6 of 10 (60%) who had 3600 cGy + CT, and 2 of 10 (20%) who had
3600 cGy without CT (p < 0.025). CONCLUSIONS: Current treatment regimens
consisting of chemotherapy and 2340 cGy craniospinal irradiation
followed by a posterior fossa boost for medulloblastoma do not show a
reduction of hypothyroidism. Young age and use of chemotherapy were
associated with a higher incidence of hypothyroidism.
34
UI - 11990827
AU - Walsh DC; Kakkar AK
TI -
Thromboprophylaxis.
SO - J Neurosurg 2002 Apr;96(4):806-7; discussion 807
35
UI - 11990828
AU - Bailey S; Campbell J; Haines S
TI -
Thromboprophylaxis.
SO - J Neurosurg 2002 Apr;96(4):807-8; discussion 808-9
36
UI - 11990829
AU - Stummer W; Steiger HJ
TI -
Resection of glioblastoma.
SO - J Neurosurg 2002 Apr;96(4):809-10; discussion 810
37
UI - 11990830
AU - Silbergeld DL; Rostomily RC
TI -
Resection of glioblastoma.
SO - J Neurosurg 2002 Apr;96(4):809; discussion 810
38
UI - 12109031
AU - Popperl G; Gotz C; Gildehaus FJ; Yousry TA; Reulen HJ; Hahn K; Tatsch K
TI -
[Initial experiences with adjuvant locoregional radioimmunotherapy using
131I-labeled monoclonal antibodies against tenascin (BC-4) for treatment
of glioma (WHO III and IV)]
SO - Nuklearmedizin 2002 Jun;41(3):120-8
AD - Klinik und Poliklinik fur Nuklearmedizin, Munchen, Deutschland.
gpoepper@nuk.med.uni-muenchen.de
AIM: None of the established treatments (surgery, radiotherapy,
chemotherapy) for malignant glioma has improved its very poor prognosis.
Adjuvant locoregional radio-immunotherapy (RIT) represents a new
therapeutic approach. We present our initial experience with this
therapeutic tool with respect to adverse effects, biokinetics and
clinical follow-up. METHODS: Following surgery and radiotherapy, 12
patients with glioma (4, WHO stage III; 8, WHO stage IV) underwent 1-5
RIT-cycles (average dose 1100 MBq 131labelled monoclonal BC-4
antibodies) at six week intervals. Follow-up included serial FDG-PET and
MRI investigations. Evaluation of biokinetics included whole body scans,
together with analysis of blood, urine and fluid from the tumor cavity.
RESULTS: Following RIT, four patients experienced temporary seizures,
which, in one case, were associated with temporary aphasia. Eight
patients developed HAMA (human anti-mouse antibodies) during follow-up.
Mean biologic half-life of the radiopharmaceutical in the resection
cavity was 3.9 d (range: 1.0-10.2 d) and remained stable
intraindividually during further RIT-cycles. The antibody/radionuclide
conjugate remained stable in the tumor cavity for at least 5 d. Median
survival presently stands at 18.5 months compared to 9.7 months in a
historical patient group (n = 89) undergoing conventional therapeutic
strategies. Five patients show no signs of recurrence. In three patients
with post-surgical evidence of residual tumor, one patient showed
partial remission, one stable disease, and one progress
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