National Cancer Institute®
Last Modified: July 1, 2002
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.
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.
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.
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. firstname.lastname@example.org
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.
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
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.
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. email@example.com
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.
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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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. email@example.com
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.
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.
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. firstname.lastname@example.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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
UI - 11998608
AU - Quinn AM
TI - CyberKnife: a robotic radiosurgery system.
SO - Clin J Oncol Nurs 2002 May-Jun;6(3):149, 156
AD - email@example.com
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.
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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. email@example.com
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.
UI - 11990827
AU - Walsh DC; Kakkar AK
TI - Thromboprophylaxis.
SO - J Neurosurg 2002 Apr;96(4):806-7; discussion 807
UI - 11990828
AU - Bailey S; Campbell J; Haines S
TI - Thromboprophylaxis.
SO - J Neurosurg 2002 Apr;96(4):807-8; discussion 808-9
UI - 11990829
AU - Stummer W; Steiger HJ
TI - Resection of glioblastoma.
SO - J Neurosurg 2002 Apr;96(4):809-10; discussion 810
UI - 11990830
AU - Silbergeld DL; Rostomily RC
TI - Resection of glioblastoma.
SO - J Neurosurg 2002 Apr;96(4):809; discussion 810
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. firstname.lastname@example.org
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