National Cancer Institute®
Last Modified: August 1, 2002
UI - 11837537
AU - Uematsu Y; Fujita K; Tanaka Y; Shimizu M; Oobayashi S; Itakura T; Kubo K
TI - Gamma knife radiosurgery for neuroepithelial tumors: radiological and histological changes.
SO - Neuropathology 2001 Dec;21(4):298-306
AD - Department of Neurological Surgery, Wakayama Medical University, Wakayama City, Japan. firstname.lastname@example.org
Gamma knife radiosurgery (RS) has been introduced as a modern therapy for brain tumors. However, the effects of RS for neuroepithelial tumors are still obscure. The present study investigates the radiological and histological changes after RS to elucidate the biological effect. There were seven cases (two males and five females), ranging from 4 to 71 years with a mean age of 33 years. Two cases were located in the brainstem, another two in the cerebellum, and one each in the thalamus, the hypothalamus, and the frontal lobe. Histologically, two cases had gangliogliomas, four astrocytomas (1 pilocytic, 1 fibrillary, 2 anaplastic), and one glioblastoma. RS was performed after surgery with a central dose of 30-36 Gy. All cases were evaluated radiologically on MRI before and after RS. Four cases (3 astrocytomas and 1 glioblastoma) which neurologically deteriorated after RS were reoperated. These cases were examined using HE and immunohistochemical studies with antibodies of CD34, alpha-smooth muscle actin (SMA), p53, p21 and MIB-1 on the sections before and after RS. MRI demonstrated perifocal edema and intratumoral hypointensity on T2 weighted imaging (T2WI), suggesting radionecrosis in most of the cases within 6 months after RS. In the central part of the RS, destructive changes were observed in the tumor cells and endothelial cells: decrease in the tumor cell population, coagulation necrosis, and fibrinoid degeneration of vascular walls were revealed. In the peripheral part, however, some tumors contained viable tumor cells intermingled with blood vessels showing endothelial and pericytic proliferations. The increase of MIB-1 staining index was found in only one case. The p21 immunoreactivity was increased in endothelial cells, although the p53 immunoreactivity was unchanged. These results suggested that radionecrosis occurred earlier and more frequently in neuroepithelial tumors after RS than after conventional radiation.
UI - 11560039
AU - Pedachenko IeH; Hlavats'kyi OIa; Popadynets' II
TI - [Prognosis of brain death in the surgical treatment of supratentorial glial tumors]
SO - Lik Sprava 2001 May-Jun;(3):87-9
Results are presented of prognostication of death of the brain in surgical treatment of 1056 patients with glioma of supratentorial localization. Prognostically unfavourable factors for development of vital disturbances are determined, the main ones being advanced age, low quality of life before surgery, vascular and hypertensive type of the disease course, high degree anaplasia, the ability of the tumor to store a contrast, deep localization of the tumor, its partial resection. Predominance of the sum of unfavourable signs over favourable ones suggested to us a high risk of operation which came to be lower with the use of microsurgical techniques.
UI - 11922695
AU - Haines SJ
TI - Moving targets and ghosts of the past: outcome measurement in brain tumour therapy.
SO - J Clin Neurosci 2002 Mar;9(2):109-12
AD - Department of Neurological Surgery, Medical University of South Carolina, Charleston 29425, USA.
Evaluation of novel therapies for brain tumours should logically consider quality and quantity of patient survival as primary endpoints. The urgency of the problem, however, frequently leads investigators to use surrogate endpoints and historical controls in order to more rapidly evaluate outcome. To examine the impact of the use of surrogate endpoints and historical controls on the evaluation of innovative brain tumour therapy, selective literature review of three content areas (intraarterial chemotherapy for malignant glioma, interstitial brachytherapy for malignant glioma and stereotactic radiosurgery for cerebral metastasis and malignant glioma) was carried out. The impact of surrogate outcome measures and use of historical controls was assessed by comparing the results of trials using these methods and randomised clinical trials. In the evaluation of both intraarterial chemotherapy and interstitial brachytherapy, promising results in early phase trials were not confirmed in randomised clinical trials. This result can be explained by selection bias and predicted by the use of controls carefully selected from large treatment data bases. In the evaluation of stereotactic radiosurgery, early phase trials are promising, but randomised clinical trials have not yet been done. Prior experience suggests that the early promising results with stereotactic radiosurgery should be subjected to randomised clinical trial validation before being considered proven. Careful selection of controls for early phase trials is necessary if erroneous conclusions are to be avoided. Copyright 2002, Elsevier Science Ltd. All rights reserved.
UI - 12057797
AU - Jaing TH; Wang HS; Hung IJ; Tseng CK; Yang CP; Hung PC; Lui TN
TI - Intracranial germ cell tumors: a retrospective study of 44 children.
SO - Pediatr Neurol 2002 May;26(5):369-73
AD - Division of Hematology, Chang Gung Children's Hospital, Taoyuan, Taiwan.
This 16-year retrospective study review sought to determine the factors influencing prognosis and treatment results of all patients with primary intracranial germ cell tumors treated at our hospital who were younger than 17 years of age at the time of diagnosis. A total of 44 patients were treated during the study period, including 32 males and 12 females with a male:female ratio of 2.67:1. The median age at diagnosis was 12 years and 5 months of age (range = 2-16 years). The 44 intracranial germ cell tumors consisted of 27 pure germinomas (61.4%) and 17 nongerminomatous germ cell tumors, including 10 mixed germ cell tumors (22.7%), three yolk sac tumors (7.8%), two immature teratomas (4.5%), and two choriocarcinomas (4.5%). Univariate analysis of prognostic factors using Kaplan-Meier survival estimates revealed that only histologic tumor type was correlated with outcome (P < 0.005). The projected 5-year overall survival and event-free survival rate of patients with germinomas vs those with intracranial germ cell tumors were 92.6%, 92.6% vs 47.3%, and 42.1%, respectively. Our analysis suggests that radiation involving the spinal axis has limited usefulness in patients with intracranial germ cell tumor, although better results have been obtained for germinomas using radiotherapy in this study.
UI - 12073541
AU - Sipos L; Vitanovics D; Afra D
TI - [Treatment of recidive malignant gliomas with temozolomide]
SO - Orv Hetil 2002 May 26;143(21):1201-4
AD - Orszagos Idegsebeszeti Tudomanyos Intezet, Budapest.
INTRODUCTION: The prognosis of malignant gliomas despite of the recent advances of diagnostical and therapeutical techniques remains poor. The majority of gliomas following total removal and postoperative radiotherapy recurs. In case of recurrencies reoperation is rarely possible and chemotherapy is the last treatment modality. METHODS: Forty patients with recurrent malignant gliomas had been treated with temozolomide (Temodal). The treatment had to be stopped in four cases. RESULTS: Complete remission was observed in 3, partial in 11, progressive disease in 4 and stable disease in 50% of the cases with CT and/or MR images. The mean progress free interval was 6.25 and the mean survival time 9 months. According to the primary histology the mean survival time for glioblastoma patients was 6.8 and for anaplastic astrocytoma or mixed oligoastrocytoma patients 12.2 months. CONCLUSIONS: Due to its low toxicity and relatively long survival time after recurrency temozolomide seems to be a promising drug in the treatment of recurrent malignant gliomas.
UI - 12122942
AU - Afra D; Sipos L; Vitanovics D
TI - [Chemotherapy of recurrent supratentorial malignant gliomas (phase II study)]
SO - Ideggyogy Sz 2002 Jan 20;55(1-2):38-44
AD - Orszagos Idegsebeszeti Tudomanyos Intezet, Budapest.
At the Hungarian National Institute of Neurosurgery 73 recurrent supratentorial malignant tumours were treated by chemotherapy during the last ten years. Chemotherapy was applied after postoperative radiotherapy but in some cases following reoperation only. All cases were clinically and by CT or MRI verified recurrences. Forty-three patients received BCNU-DBD (dibromodulcitol) treatment (23 anaplastic astrocytoma--AA, and 20 glioblastoma multiforme--GM): day 1. BCNU 150 mg/sq.m. in i.v. infusion, day 2. dibromdulcitol 1000 mg/sq orally was given. This course was repeated every six weeks, altogether 2-8 times. Sixteen patients with AA responded with complete or partial regression but only 6 did with GM. Median survival was 14 and 7 months, the difference proved to be significant, p = 0.0091. PCV combination (procarbazine, CCNU, vincristine) was applied to 16 patients with AA and 14 cases with recurrent oligodendroglioma (O). Treatment started with vincristine 1.5 mg/sq.m. i.v. (2.0 mg maximum), the next day CCNU 100 mg/sq.m. was given, followed by procarbazine 60 mg/sq.m. on days 8-22. and finished by the same dose of vincristine on day 30. The course was repeated after one month, mostly six times. Six patients with AA did not respond; in cases of oligodendroglioma all but one responded with complete or partial improvement. It is remarkable that no significant difference was found between the survivals of BCNU-DBD or PCV treated AA patients. Chemotherapy of supratentorial malignant glioma recurrences with nitroso-ureas and their combination proved to be efficacious. It also seems, that in recurrent cases lower grade gliomas show better response rate than glioblastomas.
UI - 12118029
AU - Kleinberg L; Grossman SA; Carson K; Lesser G; O'Neill A; Pearlman J;
TI - Phillips P; Herman T; Gerber M Survival of patients with newly diagnosed glioblastoma multiforme treated with RSR13 and radiotherapy: results of a phase II new approaches to brain tumor therapy CNS consortium safety and efficacy study.
SO - J Clin Oncol 2002 Jul 15;20(14):3149-55
AD - Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231-2410, USA. email@example.com
PURPOSE: The objectives of this phase II study were to determine survival, safety, pharmacokinetics (PK), and pharmacodynamics (PD) of 2,4-[[(3,5-dimethylanilino)carbonyl]methyl]phenoxy]-2-methylpropionic acid (RSR13, efaproxiral) 100 mg/kg per day administered with standard cranial radiotherapy (RT) for the treatment of glioblastoma multiforme (GBM). RSR13, a synthetic allosteric modifier of hemoglobin, is a radiation-enhancing agent that noncovalently binds to hemoglobin, reduces oxygen-binding affinity, and increases oxygen unloading to hypoxic tissue. PATIENTS AND METHODS: Fifty patients with newly diagnosed GBM (Karnofsky performance status >or= 60) were enrolled onto this multicenter phase II study. Patients received daily RSR13 100 mg/kg intravenously infused for 30 minutes immediately before cranial RT (60 Gy in 30 fractions). Supplemental oxygen was given during RSR13 infusion and continued until after the RT treatment was completed. RT was given within 30 minutes of the end of RSR13 infusion. PK and PD determinations were performed. RESULTS: The median survival for the RSR13-treated patients was 12.3 months with 1-year and 18-month survival rates of 54% and 24%, respectively. Twenty-four percent of patients had greater than grade 2 toxicity, which was generally transient and self-limited. A significant PD effect on hemoglobin-oxygen binding affinity was demonstrated for most patients. CONCLUSION: RSR13 (100 mg/kg) administered immediately before cranial RT is well tolerated and is pharmacodynamically active. Median survival in excess of 1 year is favorable.
UI - 12049471
AU - Company FZ
TI - Stereotactic synchrotron microbeam radiotherapy.
SO - Australas Phys Eng Sci Med 2002 Mar;25(1):16-21
AD - School of Engineering and Industrial Design, University of Western Sydney, Kingswood, NSW. firstname.lastname@example.org
Highly collimated synchrotron x-ray beams with high fluence rate may be used in stereotactic radiotherapy of brain tumours. Several monochromatic x-ray beams having uniform microscopic thickness ie (microplanar beams) are directed to the center of the tumour from varying directions, delivering lethal dose to the target volume while sparing normal cells. This proposed technique takes advantage of the hypothesised repair mechanism of capillaries between closely spaced microplanar beam zones. The sharply dropping lateral dose profile of a microplanar beam provides low scattered dose to the off-target interbeam volume. In close proximity to the target volume, relatively high secondary electron doses close to the edge of the beams overlap and produce a high dose region between angled beams. This allows precise targeting and prevents gradual blurring of the higher and lower dose margins in the target volume. The advantages of stereotactic microplanar beam radiotherapy will be lost as the dose between microplanar beams exceeds the tolerance dose of the dose limiting tissues. Therefore to minimize the risks of delayed radiation damage it is essential to optimize the interbeam doses inside a human head phantom. The EGS4 Monte Carlo code is used to calculate the lateral dose profiles and depth dose of a 100 keV single microplanar beam in the phantom. A general equation for absorbed dose as a function of depth and lateral distances is derived for the single beam. Several microplanar beams are directed into the target volume at the center of the phantom. Using the equation, maximum dose on the beam axis (primary + total scattered dose) and the minimum interbeam dose (total scattered dose) are calculated at different depths and an isodose map of the phantom is obtained. A stereotactic microplanar beam radiotherapy model is proposed for a 10 mm diameter (approximately spherical) tumour at the center of the phantom.
UI - 12135190
AU - Chao TY
TI - Primary brain lymphoma.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2002 Apr;65(4):135-7
UI - 12145066
AU - Talke P; Caldwell JE; Brown R; Dodson B; Howley J; Richardson CA
TI - A comparison of three anesthetic techniques in patients undergoing craniotomy for supratentorial intracranial surgery.
SO - Anesth Analg 2002 Aug;95(2):430-5, table of contents
AD - Department of Anesthesia and Perioperative Medicine, University of California, San Francisco, California 94143, USA. email@example.com
Several anesthetic techniques have been used successfully to provide anesthesia for resection of intracranial supratentorial mass lesions. One technique used to enhance recovery involves changing anesthesia from vapor-based to propofol-based for cranial closure. However, there are no data to support a beneficial effect of this approach in the immediate postoperative period after craniotomy. We evaluated 3 anesthetic techniques in 60 patients undergoing elective surgery for supratentorial mass lesions. Patients were randomly assigned to three anesthesia study groups: propofol infusion, isoflurane inhalation, and these two techniques combined. In the combination group, once the dura was closed, isoflurane was discontinued and propofol infusion simultaneously started. We studied intra- and postoperative hemodynamics and several recovery variables for 2 h after the end of anesthesia. Baseline and average intraoperative blood pressure and heart rate values did not differ among the groups. Heart rate and blood pressure increased similarly in all groups in response to intubation and pin placement and postoperatively. None of the recovery event times (open eyes, extubation, follow commands, oriented, Aldrete score) or psychomotor test performance differed significantly. We conclude that the sequential administration of isoflurane and propofol did not provide earlier recovery and cognition than the intraoperative use of isoflurane alone. IMPLICATIONS: We evaluated three anesthetic techniques with and without propofol in patients undergoing elective surgery for supratentorial mass lesions by using a prospective, randomized clinical study design and found that the three anesthetics did not differ in intra- or postoperative hemodynamic stability or early postoperative recovery variables.
UI - 11955412
AU - Zhan S; Li Z; Lin Z; Xu Z; Lin X; Li G; Shu H; Zhou D; Tang K
TI - [Application of neuroendoscopy in brain surgery]
SO - Zhonghua Wai Ke Za Zhi 2002 Mar;40(3):187-90
AD - Department of Neurosurgery, Guangdong Provincial People's Hospital, Guangzhou 510080, China.
OBJECTIVE: To investigate the effect of neuroendoscope on surgery. METHODS: 315 patients were treated with neuroendoscope. Endoscopic neurosurgery (EN) was used in 219 patients, endoscope-assisted microneurosurgery (EAM) in 72, and endoscope-controlled microneurosurgery (ECM) in 24. RESULTS: 201 (91.8%) of the 219 patients underwent EN effectively. In 72 patients who underwent EAM there was less retraction during tumor removal and visual control was improved. 21 (87.5%) of the 24 patients underwent ECM effectively. No severe complications were observed. CONCLUSION: Neuroendoscopy can reduce tissue trauma, improve visualization during tumor removal, and reduce complications.
UI - 12128295
AU - Desai KI; Nadkarni TD; Muzumdar DP; Goel AH
TI - Surgical management of colloid cyst of the third ventricle--a study of 105 cases.
SO - Surg Neurol 2002 May;57(5):295-302; discussion 302-4
AD - Department of Neurosurgery, King Edward Memorial Hospital, Seth G. S. Medical College, Parel, Mumbai, India.
BACKGROUND: Colloid cyst of the third ventricle is a relatively rare intracranial tumor. It generates tremendous interest for the neurosurgeon because of its benign nature, deep location, and an excellent prognosis when diagnosed early and excised. METHOD: A retrospective analysis of 105 cases of third ventricle colloid cyst treated between 1967 to 1998 was conducted. The clinical presentation, radiological findings, different surgical approaches, and outcome were analyzed. The transcallosal and transcortical-transventricular approaches were predominantly used. Memory and psychological assessment were carried out both pre- and postoperatively. A computerized tomography (CT) scan was performed during follow-up. RESULTS: The male to female ratio was 1.5:1. The age of the patients ranged from 10 to 68 years. Headache was the most common symptom. Papilledema and short-term memory disturbances were the most common signs. In 5 patients the colloid cyst was detected incidentally.Surgery for colloid cyst was performed in 93 patients. Transcallosal and transcortical-transventricular approaches were performed in 62 and 30 patients, respectively. In 1 patient the cyst was excised through the subfrontal lamina terminalis approach. Total excision was achieved in 90 patients, while partial cyst excision was done in three patients. Moderate to severe lateral ventricular enlargement was found in 76 patients at presentation. A ventriculoperitoneal shunt was the only surgical procedure performed in 7 patients. In 16 patients colloid cyst excision was conducted after cerebrospinal fluid (CSF) diversion via a shunt. No surgical treatment of any kind was performed in 5 patients. Five patients died. Eighty-six patients came for follow-up, with a range from 1 month to 25 years (average 3 years and 8 months). Postoperatively, transient recent memory deficits occurred in 14 patients, while a permanent recent memory loss was noted in 2 patients. There was no incidence of postoperative disconnection syndrome or behavioral disturbance. A CT scan was performed in 44 patients during follow-up. Recurrence was detected in 1 patient in whom the cyst had been partially excised. CONCLUSIONS: Colloid cyst, although a benign tumor, is surgically challenging because of its deep midline location. Early detection and total excision of the colloid cyst carries an excellent prognosis.
UI - 11995420
AU - Metzger AK; Lewin JS
TI - Optimizing brain tumor resection. Low-field interventional MR imaging.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):651-7, ix
AD - Departments of Neurological Surgery, Radiation Oncology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA.
In this article, the authors describe their strategy for intraoperative MR image guidance of tumor resection at low-field (0.2 T) strength. It is their opinion that intraoperative imaging is most useful in assessing the resection of intrinsic, infiltrating brain tumors; boundaries of the tumor cannot be clearly distinguished with the surgeon's eyes, and therefore, this discussion predominantly applies to the surgical resection of gliomas.
UI - 11995421
AU - Alexander E 3rd
TI - Optimizing brain tumor resection. Midfield interventional MR imaging.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):659-72
AD - Department of Surgery, Division of Neurosurgery, University of Massachusetts Medical Center, Worcester, Massachusetts, USA.
The development of the intraoperative MR imager represents an important example of creative vision and interdisciplinary teamwork. The result is a remarkable tool for neurosurgical applications. MRT allows surgical manipulation under direct visualization of the intracranial contents through the eye of the surgeon and through the volumetric images of the MR imaging system. This technology can be applied to cranial and spinal cases, and forseeably can encompass application to the entire gamut of neurosurgical efforts. The author's experience has been that this device is easy and comfortable for the surgeon to use. Image acquisition, giving views in the plane of choice, lasts no more than 2 to 60 seconds (depending on the imaging method), and does not increase the duration of a given procedure substantially. The author believes that the information received through intraoperative MR imaging scanning ultimately will contribute to decreasing the duration of surgery. Future possibilities include combining the intraoperative MR imager with other technologies, such as the endoscope, focused ultrasound, robotics, and the evaluation of brain function intraoperatively. The development of the intraoperative MR imager marks a significant advance in neurosurgery, an advance that will revolutionize intraoperative visualization as fully as the operating microscope. The combination of intraoperative visualization and precise surgical navigation is unparalleled, and its enhancement of surgical applications will be widespread. Considering the remarkable potential of the intraoperative MR imager for neurosurgical applications, optimal magnet design, image quality, and navigational methods are necessary to capitalize on the advantages of this revolutionary tool. The intraoperative MR imaging system that the author's team has developed and used has combined these features, and allows the performance of open surgical procedures without the need of patient or magnet repositioning. By using advanced navigational tools and computer technology, it represents an integration of frameless stereotactic methods with real-time interactive imaging. The midfield imager provides sufficient spatial and temporal resolution and image quality to assess anatomy and pathology adequately, to monitor a surgical procedure, and make image-based decisions. The intraoperative use of this unique system is not limited to biopsies or limited-access procedures. The entire range of neurosurgical procedures can be performed, if the requisite instrumentation is available. Much work remains to be done, however. The team did not develop this system only to enable the performance of current neurosurgical procedures. Forty years ago, the operating microscope enabled not only the performance of undreamt-of procedures but opened the door to entire new subspecialties. The entire landscape of neurosurgery will change at a fundamental level as the full ramifications of this exciting idea come to fruition. The holy grail of image-guided surgery is a seamless interface between the eye and hand in the purest sense (i.e., the mind's eye and hand). Ideally, this seamless interface represents effortless flow between the procedural goal compared with the present situation and the manipulation of the tools available to accomplish the task, whether they be the scalpel, drill, laser, ultrasonic aspirator, phased array focused ultrasound, microrobot, or high-dose irradiator. As in the realm of high-performance military jet fighters, the physical limits of the human being demarcate the confining boundary of the system. Those limits are much tighter around the domain of tool manipulation, where the surgeon will yield, early on, to the enhanced performance of robotics and other technical adjuncts. The era of large open magnet imaging systems for surgical procedures then will come to a close; however, the grander era of the surgeon's integration of precision-guided, multimodality therapeutics will just be beginning. The future will be very bright, indeed.
UI - 11995422
AU - Tummala RP; Chu RM; Liu H; Truwit CL; Hall WA
TI - Optimizing brain tumor resection. High-field interventional MR imaging.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):673-83
AD - Department of Neurosurgery, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA.
High-field strength iMRI guidance is an effective tool for brain tumor resection. Although its use lengthens the average time for a craniotomy, the reward is a more extensive tumor excision compared with conventional neurosurgery without an increased risk to the patient (Table 4). Although intraoperative patient transfer into and out of the magnet is cumbersome, the possibility for complete resection, especially for a low-grade glioma, makes the effort worthwhile. The cost and technical support required for this system presently limits its use to only a few sites worldwide. As with any technology, further refinements will make this system less expensive and more attainable. Practical consideration aside, high-field strength iMRI is presently [table: see text] the most effective tool available for brain tumor resection. Because of its novelty, future studies are necessary to determine if this technology lowers the incidence of and extends the duration to tumor recurrence as the preliminary data in children suggests. These are the ultimate measures of efficacy for any brain tumor treatment. Based on the rapid advancement of technology, will today's high-field strength interventional magnet become tomorrow's low-field system? Very high-field strength designs may improve diagnostic capabilities through higher resolution, but their interventional applications may be hindered by increased sensitivity for clinically insignificant abnormalities and decreased specificity for clinically relevant lesions. As new technology is developed, clinicians must continue to explore and refine the existing high-field strength iMRI to make it cost-effective and widely applicable.
UI - 11995423
AU - Jolesz FA; Kikinis R; Talos IF
TI - Neuronavigation in interventional MR imaging. Frameless stereotaxy.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):685-93, ix
AD - Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. firstname.lastname@example.org
The main thrust of diagnostic MR imaging is to discern normal and pathologic patient morphology and function. Intraprocedural imaging, however, serves a different goal: to furnish the surgeon or interventionalist with updates on intraoperative changes and how they may modify preintervention data. Although researchers have not established whether MR image-guided therapy can improve clinical outcomes and reduce complication rates definitively, the intraoperative and preoperative data generated will improve the ability of every neurosurgeon to navigate in the surgical field more accurately.
UI - 11995424
AU - Liu H; Hall WA; Truwit CL
TI - Neuronavigation in interventional MR imaging. Prospective stereotaxy.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):695-704
AD - Departments of Radiology, Biomedical Engineering, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA. email@example.com
A practical MR imaging-based guidance/control methodology has been developed successfully and validated for improving the performance of stereotactic neurosurgerical procedures such as brain lesion biopsy. The use of the device and method in 40 routine MR-guided procedures has revealed its potential as an alternative approach. Superior to the traditional stereotactic systems, which rely on the old images, the new method, based on prospective guidance, can provide good and acceptable targeting accuracy in the presence of brain shift. Furthermore, the use of MR monitoring of the overall neurosurgical procedure provides another independent assurance for the success of a complicated surgery. The advantages of the new surgical guidance system and method are simple and compatible with the existing capabilities of conventional MR scanners. More importantly, it allows a more effective surgical guidance in the presence of brain shift during the typical neurosurgery. Another important advantage of the guidance method and device is the performance of a truly MR-guided neurosurgical procedure in a conventional, short bore high field MR scanner. Surgical procedures using the guidance system and method have been accepted by radiologists and neurosurgeons as an attractive MR-based stereotactic approach. It can be expected that this guidance scheme will be a useful addition to the MR-based stereotactic system for neurosurgery, and animal research, in which cumbersome stereotactic frames have been used.
UI - 11995425
AU - Hall WA; Liu H; Martin AJ; Truwit CL
TI - Minimally invasive procedures. Interventional MR image-guided neurobiopsy.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):705-13
AD - Departments of Neurosurgery, Radiation Oncology, Radiology, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA. firstname.lastname@example.org
Neurobiopsy using intraoperative MR imaging represents a natural progression from stereotaxis in the method with which neurosurgeons perform brain biopsy.
UI - 11995427
AU - Broaddus WC; Gillies GT; Kucharczyk J
TI - Minimally invasive procedures. Advances in image-guided delivery of drug and cell therapies into the central nervous system.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):727-35
AD - Division of Neurosurgery, Virginia Commonwealth University/Medical College of Virginia, Richmond, USA. email@example.com
Image-guided transparenchymal delivery of drugs is an emerging neurosurgical modality that holds the promise of delivering various agents directly across the blood-brain barrier. Potential large-scale applications for convection-enhanced delivery of drugs through the interstitial space include the delivery of chemotherapeutic agents and gene therapy vectors for the treatment of brain tumors and the delivery of neurotrophic factors and neurotransmitters for the treatment of neurodegenerative disorders. The related technique of direct intraparenchymal injection of cells provides a means for transplanting neural stem cells into the brain for the treatment of degenerative diseases. Significant advances in catheter design, infusion strategies, and imaging technology have brought these procedures into the mainstream of human clinical testing, with clinical applications potentially on the near horizon.
UI - 11995429
AU - Straube T; Kahn T
TI - Thermal therapies in interventional MR imaging. Laser.
SO - Neuroimaging Clin N Am 2001 Nov;11(4):749-57
AD - Klinik und Poliklinik fur Diagnostische Radiologie, Universitatsklinikum Leipzig AoR, Leipzig, Germany.
Laser ablation of cerebral tumors is an alternative to surgical excision and radiosurgery; however, more clinical testing is necessary. Various MR parameters can be used during laser ablation to detect structural as well as temperature changes in near real-time for diagnostic and therapeutic applications. Unfortunately, MR-guided ablation does not solve the problem of defining a precise target in high-grade tumors of the central nervous system.
UI - 10439748
AU - Jansen GF; van Praagh BH; Kedaria MB; Odoom JA
TI - Jugular bulb oxygen saturation during propofol and isoflurane/nitrous oxide anesthesia in patients undergoing brain tumor surgery.
SO - Anesth Analg 1999 Aug;89(2):358-63
AD - Department of Anesthesiology, Academic Medical Centre, University of Amsterdam, The Netherlands.
We investigated, in brain tumor patients, the jugular bulb venous oxygen partial pressure (PjO2) and hemoglobin saturation (SjO2), the arterial to jugular bulb venous oxygen content difference (AJDO2), and middle cerebral artery blood flow velocity (Vmca) during anesthesia, and the effect of hyperventilation on these variables. Twenty patients were randomized to receive either isoflurane/ nitrous oxide/fentanyl (Group 1) or propofol/fentanyl (Group 2). At normoventilation (PacO2 35 +/- 2 mm Hg in Group 1 and 33 +/- 3 mm Hg in Group 2), SjO2 and PjO2 were significantly higher in Group 1 than in Group 2 (SjO2 60% +/- 6% and 49% +/- 13%, respectively; P = 0.019) (PjO2 32 +/- 3 and 27 +/- 5 mm Hg, respectively; P = 0.027). In Group 2, 5 of 10 patients had SjO2 < 50%, and 3 of these patients had SjO2 < 40% and AJDO2 > 9 mL/dL. All patients in Group 1 had SjO2 > 50%. During hyperventilation, there were no differences in SjO2, PjO2, or AJDO2 between the two groups. On hyperventilation, there was no correlation between the relative decreases of Vmca and 1/AJDO2 (r = 0.21, P = 0.41). The results indicate during propofol anesthesia, half of the brain tumor patients showed signs of cerebral hypoperfusion, but not during isoflurane/nitrous oxide anesthesia. Furthermore, during PacO2 manipulations, shifts in Vmca are inadequate to evaluate brian oxygen delivery in these patients. Implications: During propofol anesthesia at normoventilation, 50% of brain tumor patients showed signs suggesting cerebral hypoperfusion, but this could not be demonstrated during isoflurane/nitrous oxide anesthesia. During PacO2 manipulations, consecutive measurements of the cerebral blood flow velocity may be inadequate to assess cerebral oxygenation.
UI - 12053159
AU - Lopes M; Duffau H; Capelle L; Meningaud JP; Herve C
TI - [Proposing surgical management to a patient with low-grade glioma: controversies and ethical consequences]
SO - Neurochirurgie 2002 May;48(2-3 Pt 1):69-74
AD - Service de Neurochirurgie, Hopital de la Salpetriere, 47-83, boulevard de l'Hopital, 75651 Paris Cedex 13, France. firstname.lastname@example.org
The therapeutic controversies surrounding low-grade glioma result mainly from the lack of certainty about their histological definition, and, from our imperfect knowledge of the natural history of the disease. Heterogeneous surgical management is the consequence of this situation, which renders difficult to propose the best attitude to each individual patient, thus raising ethical questions, because the absence of a consensus. Performing prospective studies able to analyse these different modalities is mandatory whenever we want to be enable to give to our patients the best answer in their precise case, and furthermore to justify back our acts too.
UI - 12128128
AU - Uy NW; Woo SY; Teh BS; Mai WY; Carpenter LS; Chiu JK; Lu HH; Gildenberg
TI - P; Trask T; Grant WH; Butler EB Intensity-modulated radiation therapy (IMRT) for meningioma.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1265-70
AD - Department of Radiology/Section of Radiation Oncology, The Methodist Hospital and Baylor College of Medicine, Houston, TX, USA.
PURPOSE: To assess the safety and efficacy of intensity-modulated radiation therapy (IMRT) in the treatment of intracranial meningioma. METHODS AND MATERIALS: Forty patients with intracranial meningioma (excluding optic nerve sheath meningiomas) were treated using IMRT with the NOMOS Peacock system between 1994 and 1999. Twenty-five patients received IMRT after surgery either as adjuvant therapy for incomplete resection or for recurrence, and 15 patients received definitive IMRT after presumptive diagnosis based on imaging. Thirty-two patients had skull base lesions, and 8 had nonskull base lesions. The prescribed dose ranged from 40 to 56 Gy (median 50.4 Gy) at 1.71 to 2 Gy per fraction, and the volume of the primary target ranged from 1.55 to 324.57 cc (median 20.22 cc). The mean dose to the target ranged from 44 to 60 Gy (median 53 Gy). Follow-up ranged from 6 to 71 months (median 30 months). Acute and chronic toxicity were assessed using Radiation Therapy Oncology Group (RTOG) morbidity criteria and tumor response was assessed by patient report, examination, and imaging. Overall survival, progression-free survival, and local control were calculated using the Kaplan-Meier method. RESULTS: Cumulative 5-year local control, progression-free survival, and overall survival were 93%, 88%, and 89%, respectively. Two patients progressed after IMRT, one locally and one distantly. Each was treated with IMRT after multiple recurrences of benign meningioma over many years. Both were found to have malignant meningioma at the time of relapse after IMRT, and it is likely their tumors had already undergone malignant change by the time IMRT was given. Defined normal structures generally received a significantly lower dose than the target. The most common acute central nervous system (CNS) toxicity was mild headache, usually relieved with steroids. One patient experienced RTOG Grade 3 acute CNS toxicity, and 2 experienced Grade 3 or higher late CNS toxicity, with one possible treatment-related death. No toxicity was observed with mean doses to the optic nerve/chiasm up to 47 Gy and maximum doses up to 55 Gy. CONCLUSION: IMRT is a promising new technology that is safe and efficacious in the primary and adjuvant treatment of intracranial meningiomas. A history of local aggression may indicate malignant degeneration and predict a poorer outcome. Toxicity data are encouraging, but the potential for serious side effects exists, as demonstrated by one possible treatment-related death. Larger cohort and longer follow-up are needed to better define efficacy and late toxicity of IMRT.
UI - 12128129
AU - Merchant TE; Kiehna EN; Miles MA; Zhu J; Xiong X; Mulhern RK
TI - Acute effects of irradiation on cognition: changes in attention on a computerized continuous performance test during radiotherapy in pediatric patients with localized primary brain tumors.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1271-8
AD - Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA. email@example.com
PURPOSE: To assess sustained attention, impulsivity, and reaction time during radiotherapy (RT) for pediatric patients with localized primary brain tumors. METHODS AND MATERIALS: Thirty-nine patients (median age 12.3 years, range 5.9-22.9) with primary brain tumors were evaluated prospectively using the computerized Conners' continuous performance test (CPT) before and during conformal RT (CRT). The data were modeled to assess the longitudinal changes in the CPT scores and the effects of clinical variables on these changes during the first 50 days after the initiation of CRT. RESULTS: The CPT scores exhibited an increasing trend for errors of omission (inattentiveness), decreasing trend for errors of commission (impulsivity), and slower reaction times. However, none of the changes were statistically significant. The overall index, which is an algorithm-based weighted sum of the CPT scores, remained within the range of normal throughout treatment. Older patients (age >12 years) were more attentive (p < 0.0005), less impulsive (p < 0.07), and had faster reaction times (p < 0.001) at baseline than the younger patients. The reaction time was significantly reduced during treatment for the older patients and lengthened significantly for the younger patients (p < 0.04). Patients with a shunted hydrocephalus (p < 0.02), seizure history (p < 0.0006), and residual tumor (p < 0.02) were significantly more impulsive. Nonshunted patients (p < 0.0001), those with more extensive resection (p < 0.0001), and patients with ependymoma (p < 0.006) had slower initial reaction times. CONCLUSION: Children with brain tumors have problems with sustained attention and reaction time resulting from the tumor and therapeutic interventions before RT. The reaction time slowed during treatment for patients <12 years old. RT, as administered in the trial from which these data were derived, has limited acute effects on changes in the CPT scores measuring attention, impulsiveness, and reaction time.
UI - 12128138
AU - Krempien RC; Schubert K; Zierhut D; Steckner MC; Treiber M; Harms W;
TI - Mende U; Latz D; Wannenmacher M; Wenz F Open low-field magnetic resonance imaging in radiation therapy treatment planning.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1350-60
AD - Department of Clinical Radiology, University of Heidelberg, Heidelberg, Germany. firstname.lastname@example.org
PURPOSE: To evaluate the possibilities of an open low-field magnetic resonance imaging (MRI) scanner in external beam radiotherapy treatment (RT) planning. METHODS AND MATERIALS: A custom-made flat tabletop was constructed for the open MR, which was compatible with standard therapy positioning devices. To assess and correct image distortion in low-field MRI, a custom-made phantom was constructed and a software algorithm was developed. A total of 243 patients (43 patients with non-small-cell lung cancer, 155 patients with prostate cancer, and 45 patients with brain tumors) received low-field MR imaging in addition to computed 2001 before the start of the irradiation. RESULTS: Open low-field MRI provided adequate images for RT planning in nearly 95% of the examined patients. The mean and the maximal distortions 15 cm around the isocenter were reduced from 2.5 mm to 0.9 mm and from 6.1 mm to 2.1 mm respectively. The MRI-assisted planning led to better discrimination of tumor extent in two-thirds of the patients and to an optimization in lung cancer RT planning in one-third of the patients. In prostate cancer planning, low-field MRI resulted in significant reduction (40%) of organ volume and clinical target volume (CTV) compared with CT and to a reduction of the mean percentage of rectal dose of 15%. In brain tumors, low-field MR image quality was superior compared with CT in 39/45 patients for planning purposes. CONCLUSIONS: The data presented here show that low-field MRI is feasible in RT treatment planning when image correction regarding system-induced distortions is performed and by selecting MR imaging protocol parameters with the emphasis on adequate images for RT planning.
UI - 12128139
AU - Palmer MR; Goorley JT; Kiger WS; Busse PM; Riley KJ; Harling OK;
TI - Zamenhof RG Treatment planning and dosimetry for the Harvard-MIT Phase I clinical trial of cranial neutron capture therapy.
SO - Int J Radiat Oncol Biol Phys 2002 Aug 1;53(5):1361-79
AD - Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. email@example.com
PURPOSE: A Phase I trial of cranial neutron capture therapy (NCT) was conducted at Harvard-MIT. The trial was designed to determine maximum tolerated NCT radiation dose to normal brain. METHODS AND MATERIALS: Twenty-two patients with brain tumors were treated by infusion of boronophenylalanine-fructose (BPA-f) followed by exposure to epithermal neutrons. The study began with a prescribed biologically weighted dose of 8.8 RBE (relative biologic effectiveness) Gy, escalated in compounding 10% increments, and ended at 14.2 RBE Gy. BPA-f was infused at a dose 250-350 mg/kg body weight. Treatments were planned using MacNCTPlan and MCNP 4B. Irradiations were delivered as one, two, or three fields in one or two fractions. RESULTS: Peak biologically weighted normal tissue dose ranged from 8.7 to 16.4 RBE Gy. The average dose to brain ranged from 2.7 to 7.4 RBE Gy. Average tumor dose was estimated to range from 14.5 to 43.9 RBE Gy, with a mean of 25.7 RBE Gy. CONCLUSIONS: We have demonstrated that BPA-f-mediated NCT can be precisely planned and delivered in a carefully controlled manner. Subsequent clinical trials of boron neutron capture therapy at Harvard and MIT will be initiated with a new high-intensity, high-quality epithermal neutron beam.
UI - 11891728
AU - Madsen SJ; Sun CH; Tromberg BJ; Hirschberg H
TI - Development of a novel indwelling balloon applicator for optimizing light delivery in photodynamic therapy.
SO - Lasers Surg Med 2001;29(5):406-12
AD - Department of Health Physics, University of Nevada, Las Vegas, Nevada 89154, USA. firstname.lastname@example.org
BACKGROUND AND OBJECTIVE: A human glioma spheroid model is used to investigate the efficacy of different light delivery schemes in 5-aminolevulinic acid (ALA)--mediated photodynamic therapy (PDT). The results provide the rationale for the development of an indwelling balloon applicator for optimizing light delivery. STUDY DESIGN/MATERIALS AND METHODS: Human glioma spheroids were incubated in ALA (100 or 1000 microg /ml-1) for 4 hours and subjected to various light irradiation schemes. In one set of experiments, spheroid survival was monitored as a function of light fluence rate (5-200 mW cm-2). In all cases, spheroids were exposed to fluences of either 25 or 50 J cm-2. In a second study, the effects of repeated weekly PDT treatments, using sub-threshold fluences, were investigated. One group of spheroids was subjected to three treatments using fluences of 12, 12, and 25 J cm-2. Results were compared to spheroids receiving single treatments of either 12 or 25 J cm-2. A fluence rate of 25 mW cm-2 was used for all three groups of spheroids. In all cases, the effect of a given irradiation scheme was evaluated by monitoring spheroid growth. RESULTS: Low fluence rates produce greater cell kill than high fluence rates. The minimum effective fluence rate in human glioma spheroids is approximately 10 mW cm-2. Repeated weekly PDT treatments with sub-threshold fluences result in significant cell kill. In spheroids surviving the PDT treatments, growth is suppressed for the duration of the treatment period. CONCLUSION: The results of the in vitro studies support the development of an indwelling balloon applicator for the delivery of light doses in long term multi-fractionated PDT regimens.
UI - 12132939
AU - Parker BC; Shiu AS; Maor MH; Lang FF; Liu HH; White RA; Antolak JA
TI - PTV margin determination in conformal SRT of intracranial lesions.
SO - J Appl Clin Med Phys 2002 Summer;3(3):176-89
AD - Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA. email@example.com
The planning target volume (PTV) includes the