- Cancer Types
Information about risk, prevention, screening, symptoms, diagnosis, treatment, and support for all cancers Cancer A to Z - Cancer Treatment
Cancer Treatment
Information about cancer treatment, including surgery, chemotherapy, radiation therapy, clinical trials, proton therapy, complementary medicine, and cutting edge technologies.
- Risk and Prevention
- Cancer Drugs
- Support
Support
Ways for cancer patients and caregivers to cope with cancer, side effects, nutrition, general cancer support issues, grief/end of life issues, and shared survivor's experiences.
- Healthcare Professionals
- Clinical Trials
My Patient Treatment Binder
OncoLink Blogs
What's My Cancer Risk?
OncoPilot: Navigating Your Cancer Journey
Community Events Calendar
OncoLink eNews
Abramson Cancer CenterNCI CANCERLIT® Search: Therapy of Brain Tumor - October 2002
National Cancer Institute®
Last Modified: October 1, 2002
- Multidrug resistance in brain tumors: roles of the blood-brain barrier.
- Absence of movement disorders after surgical resection of glioma invading the right striatum.
- The endocrine effects of long-term treatment with mifepristone (RU 486).
- Cerebral cavernomas in the adult. Review of the literature and analysis of 72 surgically treated patients.
- Intra-arterial carboplatin and intravenous etoposide for the treatment of recurrent and progressive non-GBM gliomas.
- Postoperative radiotherapy for intracranial ependymoma: analysis of prognostic factors and patterns of failure.
- Astrocytomas of the cerebral peduncle in children: surgical experience in seven patients.
- Is the sitting or the prone position best for surgery for posterior fossa tumours in children?
- The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized comparison of surgery, external radiotherapy, and carmustine versus
- Long-term outcome after resection of benign cerebellar astrocytomas in children and young adults (0-19 years): report of 110 consecutive cases.
- The use of temozolomide in recurrent malignant gliomas.
- Angiosarcomas--clinical profile, pathology and management.
- Transcranial electrical motor evoked potential monitoring for brain tumor resection.
- Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors.
- Transcranial electrical motor evoked potential monitoring for brain tumor resection.
- Induction chemotherapy and involved-field radiotherapy for intracranial germinoma.
- Fetal and ovarian radiation dose in patients undergoing gamma knife radiosurgery.
- The role of radiosurgery for the treatment of pineal parenchymal tumors.
- Correlations between magnetic resonance spectroscopy and image-guided histopathology, with special attention to radiation necrosis.
- Rathke cleft cyst: diagnostic and therapeutic considerations.
- Local injection of the 90Y-labelled peptidic vector DOTATOC to control gliomas of WHO grades II and III: an extended pilot study.
- Brachytherapy: Results of two different therapy strategies for patients with primary glioblastoma multiforme.
- Brachytherapy. Results of two different therapy strategies for patients with primary glioblastoma multiforme.
- Childhood brain tumours: new directions in management.
- Poor-prognosis high-grade gliomas: evolving an evidence-based standard of care.
- [Epidemiologic studies of cerebellopontine angle tumors surgically treated in Maracaibo, Venezuela, in 1985-1999]
- Salvage chemotherapy with CPT-11 for recurrent glioblastoma multiforme.
Table of Contents
1
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, Hopital 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.
2
UI - 12186465
AU - Duffau H; Denvil D; Capelle L
TI -
Absence of movement disorders after surgical resection of glioma
invading the right striatum.
SO - J Neurosurg 2002 Aug;97(2):363-9
AD - Department of Neurosurgery, Hopital de la Salpetriere, Paris, France.
hugues.duffau@psl.ap-hop-paris.fr
OBJECT: Despite the high frequency of striatal lesions, the rate of
movement disorders reported in the literature is lower than expected (<
10%). To maximize the extent of resection in low-grade gliomas invading
the right striatum, the authors performed a striatal resection in a
series of 14 patients, observed the lack of movement disorders following
these procedures, and discuss herein the mechanisms likely to explain
these findings. METHODS: Fourteen patients harboring a low-grade glioma
that was infiltrating the right nondominant striatum, and in whom the
results of neurological examination were normal, underwent surgery in
which intraoperative electrical mapping was used, allowing the
identification of pyramidal pathways. The striatum was resected in all
procedures, and corticospinal tracts were systematically detected and
preserved. Ten patients presented with a transient postoperative motor
deficit, and nine with a loss of interest and affect. These symptoms all
resolved within 3 months, except for one case of persistent hemiparesis.
No postoperative movement disorder was noted, even transitorily. All
resections were categorized as either total or subtotal on control
magnetic resonance images. CONCLUSIONS: These findings show that the
nondominant striatum can be removed in cases of glioma invasion without
inducing even transitory movement disorders. This phenomenon could be
explained by the combined resection of the two classes of striatal
neurons, an associated pallidal and thalamocortical resection, or a
compensatory recruitment of parallel networks. Thus, these results may
allow the surgeon to maximize the extent of removal of low-grade gliomas
involving basal ganglia. Striatal resection may induce transient
hemiparesis and "athymhormic syndrome," however, necessitating that the
patient be clearly informed before surgery.
3
UI - 1646217
AU - Lamberts SW; Koper JW; de Jong FH
TI -
The endocrine effects of long-term treatment with mifepristone (RU 486).
SO - J Clin Endocrinol Metab 1991 Jul;73(1):187-91
AD - Department of Medicine, Erasmus University, Rotterdam, The Netherlands.
Mifepristone (RU 486) is a compound with progesterone as well as
cortisol-blocking activities. We investigated the endocrine effects of
long-term therapy of 10 patients with meningiomas with 200 mg
mifepristone daily for 1 yr. Most patients initially complained of
nausea, vomiting, and/or tiredness. In four patients prednisone (7.5
mg/day) had to be given simultaneously in order to overcome these
side-effects. In retrospect those patients who presented with the most
severe side-effects showed the most rapidly occurring activation of the
hypothalamo-pituitary-adrenal-axis, as measured by an increase of
circulating cortisol levels as well as of urinary cortisol excretion.
Therapy with RU 486 activated the hypothalamo-pituitary-adrenal axis,
resulting in a resetting of this system at a higher level at which the
diurnal rhythm and the responsiveness to CRH stimulation were
maintained, whereas the sensitivity to dexamethasone had diminished.
Secondarily the production of androstenedione and estradiol increased
considerably. These endocrine changes were caused by the induction of
partial cortisol receptor resistance during therapy with RU 486. The
compensatory overproduction of androgens and consequently of estrogens
during long-term RU 486 therapy might limit its use as a single
treatment in the treatment of estrogen-dependent cancer.
4
UI - 11954761
AU - Bertalanffy H; Benes L; Miyazawa T; Alberti O; Siegel AM; Sure U
TI -
Cerebral cavernomas in the adult. Review of the literature and analysis
of 72 surgically treated patients.
SO - Neurosurg Rev 2002 Mar;25(1-2):1-53; discussion 54-5
AD - Department of Neurosurgery, Philipps University of Marburg, Germany.
bertalan@post.med.uni-marburg.de
The authors review the pertinent literature dealing with all aspects of
cerebral cavernous malformations in the adult. Clinical,
neuroradiological, pathological, and epidemiological aspects are
presented. The clinical significance of bleeding from cavernous
malformations and various hemorrhage patterns are discussed in relation
to the factors that influence hemorrhage rates. Recent reports
describing the genetic mechanisms of inheritance, de novo formation, and
angiogenesis of cavernomas are reviewed as well. Brainstem cavernomas
have received special attention, since their clinical management is
controversial in the literature. Presently, microsurgical removal is
favored by the majority of authors and stereotactic radiosurgery appears
to be inappropriate for prevention of bleeding from a cavernoma. Our own
case material consists of data of 72 patients operated upon during the
past 5 years. Twenty-four patients harbored the lesion within the
brainstem, 18 within the deep white matter of the hemispheres, 12 in the
basal ganglia or thalamus, 11 in superficial areas of the hemisphere,
and seven within the cerebellum. The perioperative morbidity rate was
29.2% (21/72) while the rate of long-term morbidity was 5.5% (4/72),
with no mortality in this series. It is concluded that cerebral
cavernous malformations, including lesions in critical regions of the
brain, can be treated microsurgically with excellent results and an
acceptable morbidity.
5
UI - 11949830
AU - Newton HB; Slivka MA; Stevens CL; Bourekas EC; Christoforidis GA; Baujan
TI -
MA; Chakeres DW
Intra-arterial carboplatin and intravenous etoposide for the treatment
of recurrent and progressive non-GBM gliomas.
SO - J Neurooncol 2002 Jan;56(1):79-86
AD - Department of Neurology, The Ohio State University Medical Center and
James Cancer Hospital and Solove Research Institute, Columbus 43210,
USA. newton.12@osu.edu
Recurrent and progressive non-GBM gliomas are a diverse group of brain
tumors that often respond poorly to adjuvant chemotherapy treatment.
Regional intra-arterial (IA) administration of chemotherapy may result
in increased tumor uptake of drug, with improvement in response rates
and time to progression (TTP). Twenty-five patients with recurrent or
progressive non-GBM gliomas were treated with IA carboplatin (200
mg/m2/d) and intravenous (IV) etoposide (100 mg/m2/d) for 2 days every 4
weeks. Patients ranged in age from 22 to 68 years (mean 37.8). All but
one patient had received standard irradiation, and eight patients had
attempted prior chemotherapy. Five of 25 patients had objective
responses (20%), while another 15 patients had stable disease (60%),
receiving a total of 318 IA treatment procedures. There was one complete
response (4.0%), three partial responses (12.0%), one minor response
(4.0%), 15 stable diseases (60.0%), and five progressive diseases
(20.0%). The median TTP was 24.2 weeks overall and 32 weeks in
responders. Overall median survival was 34.2 weeks. Therapy was well
tolerated, with mainly hematologic toxicity. Two patients had embolic
complications. Although these are preliminary results, IA carboplatin
and IV etoposide have modest activity against recurrent and progressive
non-GBM gliomas and warrants further study.
6
UI - 11949831
AU - Oya N; Shibamoto Y; Nagata Y; Negoro Y; Hiraoka M
TI -
Postoperative radiotherapy for intracranial ependymoma: analysis of
prognostic factors and patterns of failure.
SO - J Neurooncol 2002 Jan;56(1):87-94
AD - Department of Radiology, Faculty of Medicine, Kyoto University, Japan.
oya@kuhp.kyoto-u.ac.jp
The long-term results of external beam radiotherapy following surgical
resection in patients with intracranial ependymomas were evaluated to
identify the prognostic factors and the pattern of recurrence. Between
were treated with external beam irradiation with >40 Gy following
surgery. Total doses of 40.5-63.4Gy were delivered to the tumor site in
22-46 fractions over 33-101 days. Six patients with spinal deposit or
positive cerebrospinal fluid cytology received whole spinal axis
irradiation, and 4 patients received prophylactic spinal irradiation.
The median follow-up of surviving patients was 110 months. The 10-year
overall and relapse-free survival rates were 47% and 42%, respectively.
In multivariate analysis, female gender, lower tumor grade and total
resection were found to be associated with better relapse-free survival.
Twenty of 26 recurrences developed at the primary tumor site (inside the
irradiation field), two at the unirradiated cerebellum and spinal cord,
and four at the spinal cord without intracranial failure. Only one of 34
patients with supratentorial tumors developed isolated spinal
metastasis, whereas 3 of 14 patients with infratentorial tumors did so.
Regarding the late neurotoxicity of radiotherapy, one of the 15
long-term (>4 years) survivors whose psychosocial status could be
evaluated showed marked cognitive impairment. It was suggested that the
use of new treatment strategies to improve local control would be
warranted, and that prophylactic whole spinal axis irradiation appeared
to be of more benefit in patients with infratentorial tumors than in
those with supratentorial tumors.
7
UI - 12042921
AU - Tomita T; Cortes RF
TI -
Astrocytomas of the cerebral peduncle in children: surgical experience
in seven patients.
SO - Childs Nerv Syst 2002 May;18(5):225-30
AD - Division of Pediatric Neurosurgery, Children's Memorial Hospital, 2300
Children's Plaza, Chicago, IL 60614, USA. ttomita@childrensmemorial.org
OBJECTS: Cerebral peduncle tumors are rare in childhood but often
consist of benign astrocytomas. Surgical resection, however, is
considered to be detrimental because of the highly sensitive neural
structures. These tumors are often treated by radiation therapy (RT). We
resected such tumors in seven patients, whom we then followed up without
adjuvant therapy. The surgical approach and postoperative course are
analyzed.METHODS: Seven children, ranging in age from 4 to 16 years,
were treated from 1993 to 2000. Tumors showed extension in various
directions to the thalamus, pons and neighboring cisterns. All were
treated by surgical resection through a subtemporal approach: total
resection was achieved in three and subtotal resection in four.
Operative complications were minimal. Two patients were worse after
surgery, albeit temporarily, in motor, oculomotor or memory functions.
All the tumors were benign astrocytomas. None of the patients received
postoperative RT. Only one patient had a recurrence during the follow-up
period, which ranged from 1 year to 8.5 years in duration.CONCLUSIONS:
Benign astrocytomas of the cerebral peduncle are amenable to radical
tumor resection by an appropriate surgical approach and with
microsurgical techniques. Even following subtotal resection, these
tumors frequently remain stable or involute. These children can be
spared RT.
8
UI - 11696117
AU - Orliaguet GA; Hanafi M; Meyer PG; Blanot S; Jarreau MM; Bresson D; Zerah
TI -
M; Carli PA
Is the sitting or the prone position best for surgery for posterior
fossa tumours in children?
SO - Paediatr Anaesth 2001;11(5):541-7
AD - Departement d'Anesthesie Reanimation, CHU Necker-Enfants Malades, Paris,
France. gorlia@club-internet.fr
BACKGROUND: The aim of this study was to compare complications in
children operated for posterior fossa tumours in the sitting position
with those in the prone position. METHODS: We retrospectively assessed
the perioperative course of posterior fossa tumour (PFT) surgery
according to the operating position. Sixty children were operated in the
sitting position (SP) and 19 in the prone position (PP). Preoperative
data were not different between groups. RESULTS: Patients in the PP
group received a larger median (95% confidence interval) volume of
intraoperative blood transfusion than patients in the SP group [200
(20-325) versus 0 (0-80) ml, P=0.04]. Intraoperative complications, as
well as severe perioperative complications were more frequent in the PP
group (P=0.01). The median duration of tracheal intubation [20 (18-24)
versus 36 (18-72) h, P=0.037], of ICU stay [2 (2-3) versus 4 (2-5) days,
P=0.02] and of hospital stay [11 (9-12) versus 14 (10-20) days, P=0.02]
was longer in the PP group compared with the SP group. CONCLUSIONS: PFT
surgery in the sitting position in children is not associated with an
increased number or severity of perioperative complications, while the
postoperative course appears better in this position.
9
UI - 12182772
AU - Selker RG; Shapiro WR; Burger P; Blackwood MS; Arena VC; Gilder JC;
TI -
Malkin MG; Mealey JJ Jr; Neal JH; Olson J; Robertson JT; Barnett GH;
Bloomfield S; Albright R; Hochberg FH; Hiesiger E; Green S; Brain Tumor
Cooperative Group
The Brain Tumor Cooperative Group NIH Trial 87-01: a randomized
comparison of surgery, external radiotherapy, and carmustine versus
surgery, interstitial radiotherapy boost, external radiation therapy,
and carmustine.
SO - Neurosurgery 2002 Aug;51(2):343-55; discussion 355-7
AD - rselker@msn.com
OBJECTIVE: The objective of the Brain Tumor Cooperative Group NIH Trial
87-01 trial was to investigate the effect of additional implanted
radiation therapy in newly diagnosed patients with pathologically
confirmed malignant gliomas. METHODS: The study involved a randomized
comparison of surgery, external beam radiotherapy, and carmustine (BCNU)
versus surgery, external beam therapy, interstitial radiotherapy boost,
and BCNU in newly diagnosed malignant gliomas. (125)I was chosen as best
suited for this effort because it allowed preimplantation planning and
postimplantation quality assurance review. Two hundred ninety-nine
patients met the eligibility criteria and were randomized into the two
continued for an additional 3 years. Twenty-nine patients were
identified as having committed protocol violations and were excluded,
resulting in 270 subjects in the Valid Study Group. One hundred
thirty-seven patients received external beam radiation and BCNU, and 133
underwent the (125)I implantation plus external beam radiation and BCNU
therapy. RESULTS: The overall median survival for the Valid Study Group
was 64.3 weeks. The median survival for patients receiving additional
therapy of (125)I was 68.1 weeks, and median survival for those
receiving only external beam radiation and BCNU was 58.8 weeks. The
cumulative proportion surviving between the two treatment groups was not
statistically significantly different (log-rank test, P = 0.101). As in
other studies in the literature, age, Karnofsky score, and pathology
were predictors of mortality. Additional analyses incorporating an
adjustment for these prognostic variables, either in a stratified
analysis or Cox proportional hazards model, did not result in
statistically significant differences in the cumulative proportion of
patients surviving between the two treatment groups. CONCLUSION: We
conclude that there is no long-term survival advantage of increased
radiation dose with (125)I seeds in newly diagnosed glioma patients.
10
UI - 12145515
AU - Due-Tonnessen BJ; Helseth E; Scheie D; Skullerud K; Aamodt G; Lundar T
TI -
Long-term outcome after resection of benign cerebellar astrocytomas in
children and young adults (0-19 years): report of 110 consecutive cases.
SO - Pediatr Neurosurg 2002 Aug;37(2):71-80
AD - Department of Neurosurgery, National Hospital, Rikshospitalet, N-0027
Oslo, Norway.
The objective of this retrospective study was to present long-term
follow-up data for 110 consecutive children and young adults treated for
a benign cerebellar astrocytoma at our institution between 1960 and
2001. Mean age at presentation was 8.9 years. The total surgical
mortality was 9%, but declined from 16% in 1960-1977 to 0% in 1988-2001.
At the close of the study 97/110 patients were still alive. Nine deaths
were surgery related, 2 patients died of shunt-related causes and 2
patients died due to tumor recurrence. Five-, 10- and 25-year survival
were 90, 89 and 85%, respectively. Multiple Cox regression analysis
showed that tumor infiltration of the brain stem and the time period of
surgery were the only explanatory variables significantly associated
with survival. Five-year survival improved from 79% in the time period
of 1960-1977 to 100% in the time period of 1988-2001. Tumor recurrence
after total tumor resection was observed in 5 of 76 (7%) evaluable
patients. Growth of residual tumor after subtotal tumor resection was
observed in 7 of 26 (27%) evaluable patients. Recent followup MR
revealed regression of residual tumor in 14 of 16 patients. Only 5 of
these patients had received radiotherapy. Thus, spontaneous regression
of residual tumor is a more frequent event than growth of residual
tumor. The functional outcome was favorable in 82% of the patients
[Karnofsky performance index (KPI) > or = 90]. Eighteen percent of the
patients had moderate to severe disabilities (KPI 50-80). CONCLUSIONS:
Benign cerebellar astrocytoma is a surgical disease where the prognosis
with respect to both survival and functional outcome is favorable.
Spontaneous regression of residual tumor is frequently encountered,
allowing for observation of residual tumors instead of performing a
second resection in cases where a second resection carries a high risk
of neurological sequelae. Copyright 2002 S. Karger AG, Basel
11
UI - 12297119
AU - Gaya A; Rees J; Greenstein A; Stebbing J
TI -
The use of temozolomide in recurrent malignant gliomas.
SO - Cancer Treat Rev 2002 Apr;28(2):115-20
AD - Department of Radiotherapy, Hammersmith Hospitals NHS Trust, Fulham
Palace Road, London W6 8RF, UK. amgaya@hhnt.org
Gliomas are the most common primary intracerebral tumours and over 60%
of these are malignant. Standard treatment in the UK for patients with a
good performance status consists of surgery and postoperative
radiotherapy, however, recurrence is almost inevitable. Treatment of
recurrent malignant gliomas (MG) is limited to further surgery,
chemotherapy and novel biological therapies. The response rate to
standard chemotherapy protocols for recurrent MG is less than 30%.
Temozolomide (Temodar-US, Temodal-Rest of World) is an oral alkylating
agent with a similar chemical structure to dacarbazine, and has recently
been licensed in the UK for second line treatment of recurrent MG.
Several phase II studies and one randomised trial suggest that
Temozolomide improves time to progression and quality of life but not
overall survival. The drug is well tolerated with dose limiting
myelosuppression and thrombocytopenia occurring in less than 10% of
patients at current dosage schedules. A randomised trial comparing
Temozolomide with best first line adjuvant chemotherapy (PCV) is about
to start recruiting patients. Further clinical studies investigating its
role in neoadjuvant treatment or in combination with radiotherapy or
other chemotherapeutic approaches are ongoing.
12
UI - 12365113
AU - Sur RK; Nayler S; Ahmed SN; Donde B; Uijs RR; Cooper K; Giraud A
TI -
Angiosarcomas--clinical profile, pathology and management.
SO - S Afr J Surg 2000 May;38(1):13-6
AD - Department of Radiation Oncology and Anatomical Pathology, University of
the Witwatersrand, South African Institute for Medical Research,
Johannesburg.
Files of 8 patients with primary angiosarcomas treated in the Department
of Radiation Oncology at the University of the Witwatersrand from 1982
to 1995 were identified. None of these patients had received prior
radiotherapy or chemotherapy which would have predisposed them to the
formation of an angiosarcoma. Slides of 6 patients were reviewed. Five
of the 6 were confirmed as having angiosarcomas, while 1 patient was
found to have a peripheral neuro-epithelial tumour. Four patients had
angiosarcomas of the breast, while there was 1 patient each with
angiosarcoma of the skin, intestine and brain. Complete excision was the
primary modality of management whenever possible. Postoperative
radiotherapy was given in cases of incomplete excision, patient refusal
of radical surgery or gross tumour. Four patients died within 4 months
of diagnosis. Three patients are alive (2 with no evidence of disease)
22-96 months after diagnosis. In 1 patient follow-up details were not
available as he did not return for treatment. Angiosarcomas are
aggressive malignant tumours arising from the endothelial cells.
Complete surgical excision is the treatment of choice in the management
of this aggressive disease, which has a poor prognosis.
13
UI - 11334274
AU - Zhou HH; Kelly PJ
TI -
Transcranial electrical motor evoked potential monitoring for brain
tumor resection.
SO - Neurosurgery 2001 May;48(5):1075-80; discussion 1080-1
AD - Department of Anesthesiology, New York University Medical Center, New
York 10016, USA.
OBJECTIVE: This study was designed to examine whether transcranial
electrical motor evoked potential (MEP) monitoring is safe, feasible,
and valuable for brain tumor surgery. METHODS: Fifty consecutive
patients undergoing brain tumor resection were studied, using nitrous
oxide/propofol anesthesia. MEPs were continuously recorded throughout
surgery, using a Sentinel 4 evoked potential system (Axon Systems, Inc.,
Hauppauge, NY). The MEPs were elicited by transcranial electrical
stimulation (train of 5; stimulation rate, 0.5-2 Hz; square wave pulse
with a time constant of 0.5 ms; stimulation intensity, 40-160 mA)
through spiral electrodes placed over the primary motor cortex and were
recorded by needle electrodes inserted into the contralateral
orbicularis oris, biceps, abductor pollicis brevis, and anterior
tibialis muscles. When MEP amplitudes decreased by more than 50%, MEP
stimulation was repeated, with increased stimulation intensity, and MEP
changes were reported to the surgeon. The motor function of each patient
was examined before and after surgery, using a reproducible scale. The
relationship between MEP amplitude decreases and worsening motor status
was analyzed using linear regression. RESULTS: Preoperative neurological
examinations revealed mild to moderate motor deficits (2/5 to 4/5) for
38% of patients (19 of 50 patients). Most of the patients (96%)
exhibited recordable baseline MEPs. Persistent MEP decreases of more
than 50% were noted for eight patients (16%) (11 muscles). The MEPs were
completely abolished in two patients (three muscles). The degree of
postoperative worsening of motor status was correlated with the degree
of intraoperative MEP amplitude reduction (r = -0.864; P < 0.001).
CONCLUSION: Persistent intraoperative MEP reductions of more than 50%
were associated with postoperative motor deficits. The degree of MEP
amplitude reduction was correlated with postoperative worsening of motor
status. Transcranial electrical MEP monitoring is feasible, safe, and
valuable for brain tumor surgery.
14
UI - 11821471
AU - Aoyama H; Shirato H; Ikeda J; Fujieda K; Miyasaka K; Sawamura Y
TI -
Induction chemotherapy followed by low-dose involved-field radiotherapy
for intracranial germ cell tumors.
SO - J Clin Oncol 2002 Feb 1;20(3):857-65
AD - Department of Radiation Medicine, Hokkaido University Graduate School of
Medicine, Sapporo, Japan.
PURPOSE: To investigate the efficacy of chemotherapy followed by
low-dose involved-field radiotherapy for the treatment of intracranial
germ cell tumors (GCTs). PATIENTS AND METHODS: Thirty-three patients
with GCTs, including 16 pure germinomas, 11 human chorionic
gonadotropin-beta (HCG-beta)-secreting germinomas, three mixed GCTs
composed of immature teratomas plus germinomas (IMT/G), and three highly
malignant mixed GCTs, were treated. Etoposide and cisplatin (EP) were
used for the treatment of solitary pure germinomas, and ifosfamide,
cisplatin, and etoposide (ICE) were used for the treatment of other
GCTs. The dose schedule was 24 Gy for germinomas and 40 to 54 Gy for
other GCTs. An involved-field set-up was used except for highly
malignant GCTs, in which craniospinal irradiation was used. The median
follow-up was 58 months (range, 18 to 102 months). RESULTS:
Disease-related, overall, and relapse-free survival rates at 5 years
were 100%, 93%, and 69% for all patients, 100%, 100%, and 86% for
patients with pure germinomas, and 100%, 75%, and 44% for patients with
HCG-beta-secreting germinomas, respectively. All six patients with
nongerminomatous GCTs were alive at the last follow-up. All eight
relapses (one pure germinoma, five HCG-beta-secreting germinomas, and
two IMT/G), except one in a course of salvage treatment, were salvaged
and free of disease at the last follow-up. No decline was observed in
the full-scale, verbal, or performance intelligence quotient at 12 to 51
months after the treatment in 11 patients. CONCLUSION: Our results
support an excellent prognosis after EP and ICE regimens followed by
radiotherapy. Dose and volume can be reduced to 24 Gy in 12 fractions
and involve a field set-up after EP chemotherapy for the treatment of
pure germinomas.
15
UI - 11859835
AU - Deletis V; Camargo AB
TI -
Transcranial electrical motor evoked potential monitoring for brain
tumor resection.
SO - Neurosurgery 2001 Dec;49(6):1488-9
16
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
17
UI - 12361645
AU - Ioffe V; Hudes RS; Shepard D; Simard JM; Chin LS; Yu C
TI -
Fetal and ovarian radiation dose in patients undergoing gamma knife
radiosurgery.
SO - Surg Neurol 2002 Jul;58(1):32-41; discussion 41
AD - Department of Radiation Oncology, Greenebaum Cancer Center, University
of Maryland School of Medicine, Baltimore, Maryland 21229, USA.
BACKGROUND: It is difficult to estimate the fetal or ovarian radiation
dosage for female patients undergoing Gamma Knife radiosurgery. Our
goals are to determine the fetal and ovarian radiation dose at various
distances from a cranial isocenter, to provide a reference for
practitioners to estimate the fetal dose with respect to gestational
age, and to identify the components of pelvic extracranial radiation.
METHODS: An anthropomorphic phantom and ion chamber were used to measure
the dose at 50, 60, and 70 cm from a cranial isocenter and at three
points within the transverse plane for the supine position. Each
measurement consisted of a 5-minute exposure. Additional measurements
were taken for four collimator sizes, the prone position, off-axis, and
with one-half of all collimator holes plugged. RESULTS: The values of
the fetal and ovarian dose rates ranged from 0.27 cGy/min to 0.05
cGy/min based on distance from the isocenter. The fetal and ovarian dose
can be up to 8.1 cGy for a 30-minute Gamma Knife treatment. The dose
fell off more rapidly than predicted by the inverse square law. There
was no dependence of fetal dose rate on collimator size. No advantage to
the prone position could be shown. Leakage and collimator scatter are
the main components of extracranial dose 50 to 70 cm from the isocenter.
CONCLUSIONS: The fetal and ovarian dose is a function of treatment time
and distance from the isocenter. We recommend pregnancy status
assessment in women of reproductive age and treatment plan design using
large volume shots in order to minimize treatment time.
18
UI - 12234394
AU - Kondziolka D; Hadjipanayis CG; Flickinger JC; Lunsford LD
TI -
The role of radiosurgery for the treatment of pineal parenchymal tumors.
SO - Neurosurgery 2002 Oct;51(4):880-9
AD - Department of Neurological Surgery, University of Pittsburgh School of
Medicine, Pennsylvania, USA.
OBJECTIVE: Radiosurgery is an appealing alternative management strategy
for selected patients with biopsy-proved pineal parenchymal tumors. The
purpose of this report was to clarify its role in conjunction with other
surgical, radiation, and medical approaches. METHODS: We retrospectively
evaluated 16 patients who had undergone radiosurgery as the primary or
adjuvant treatment for pineal parenchymal tumors. Ten patients (62.5%)
had pineocytomas, two (12.5%) had mixed pineocytoma and pineoblastoma,
and four (25%) had pineoblastomas. The mean marginal dose was 15 Gy, and
the mean tumor volume was 5.0 cm(3). The mean follow-up periods from the
time of diagnosis or the time of radiosurgery were 61 and 52 months,
respectively. RESULTS: The overall actuarial 2- and 5-year survival
rates after diagnosis were 75.0 and 66.7%, respectively. In 14 patients
who were evaluated with imaging, 4 (29%) demonstrated complete
remission, 8 (57%) had partial remission, 2 (14%) had no change, and no
patient had local progression. The local tumor control rate (complete
remission, partial remission, or no change) was 100%. Five patients died
during follow-up. One patient with a pineocytoma and three patients with
pineoblastomas died secondary to leptomeningeal or extracranial spread
tumor. No cause of death was established for one patient. Two patients
developed adverse radiation effects after radiosurgery. CONCLUSION: Our
initial experience suggests that stereotactic radiosurgery is a valuable
primary management modality for patients with pineocytomas. As adjuvant
therapy, radiosurgery may be used to boost local tumor dose during
multimodality management of malignant pineal parenchymal tumors.
19
UI - 12234397
AU - Rock JP; Hearshen D; Scarpace L; Croteau D; Gutierrez J; Fisher JL;
TI -
Rosenblum ML; Mikkelsen T
Correlations between magnetic resonance spectroscopy and image-guided
histopathology, with special attention to radiation necrosis.
SO - Neurosurgery 2002 Oct;51(4):912-9; discussion 919-20
AD - Hermelin Brain Tumor Center, Henry Ford Hospital, Detroit, Michigan
48202, USA. nsjar@neuro.hfh.edu
OBJECTIVE: The differentiation of tumor recurrence from radiation
necrosis in patients with malignant gliomas who have been treated
previously remains a challenge. Magnetic resonance imaging,
single-photon emission computed tomography, and positron emission
tomography cannot provide definitive histopathological insight.
Multivoxel proton magnetic resonance spectroscopic imaging ((1)H MRSI)
may be reliable in guiding the clinical management of untreated
patients; however, its value in managing previously treated patients
remains unclear. METHODS: Twenty-seven patients who had been treated
previously with surgery, radiotherapy, and chemotherapy and reoperated
for clinical and/or radiographic signs that caused suspicion for
recurrent disease were studied. Tissues were categorized into four
groups: spectroscopically normal, pure tumor, mixed tumor and radiation
necrosis, and pure radiation necrosis. Spectral data for choline (Cho),
lipid-lactate (Lip-Lac), N-acetylaspartate, and creatine (Cr) were
analyzed as Cho/normal Cr (nCr), Lip-Lac/Cho, Lip-Lac/nCr,
N-acetylaspartate/Cho, N-acetylaspartate/nCr, and Cho/normal Cho (nCho).
Stereotactic biopsies were obtained within 48 hours of (1)H MRSI and
were directly correlated digitally with (1)H MRSI data. Logistic
regression analysis was performed on the basis of data obtained from 99
(1)H MRSI observations to determine whether the (1)H MRSI ratios varied
according to tissue category. RESULTS: (1)H MRSI ratios were found to
distinguish pure tumor from pure necrosis. The odds of a biopsy's being
pure tumor and having either a Cho/nCr value greater than 1.79 or a
Lip-Lac/Cho value less than 0.75 are seven times the odds of that
biopsy's being pure necrosis (odds ratio, 7.00; P = 0.0136). The odds of
a biopsy's being pure necrosis and having either a Cho/nCr value less
than 0.89 or a Cho/nCho value less than 0.66 are six times the odds of
that biopsy's being pure tumor (odds ratio, 5.71; P = 0.0329). The odds
of a biopsy's being pure necrosis and having either a Lip-Lac/Cho value
greater than 1.36 or a Lip-Lac/nCr value greater than 2.84 are more than
five times the odds of the biopsy's being pure tumor (odds ratio, 5.25;
P = 0.0322). In addition, although only marginally significant,
Lip-Lac/Cho and Lip-Lac/nCr ratios distinguish pure tumor from pure
necrosis. No values suggested that mixed specimens could be
distinguished in a statistically significant way from either pure tumor
or pure necrosis. CONCLUSION: The data that we gathered suggest that
metabolite ratios derived on the basis of (1)H MRSI spectral patterns do
allow reliable differential diagnostic statements to be made when the
tissues are composed of either pure tumor or pure necrosis, but the
spectral patterns are less definitive when tissues composed of varying
degrees of mixed tumor and necrosis are examined.
20
UI - 12368625
AU - Kasperbauer JL; Orvidas LJ; Atkinson JL; Abboud CF
TI -
Rathke cleft cyst: diagnostic and therapeutic considerations.
SO - Laryngoscope 2002 Oct;112(10):1836-9
AD - Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
55905, USA. Kasperbauer.jan@mayo.edu
OBJECTIVE: To highlight diagnostic and therapeutic issues about Rathke
cleft cysts for otorhinolaryngologists. STUDY DESIGN: Retrospective.
METHODS: We retrospectively reviewed data collected on Rathke cleft
cysts between 1978 and 1998: presenting symptoms, visual acuity,
surgical treatment, complications, recurrences, and effect on daily
activity. RESULTS: Twenty-nine patients were diagnosed with a Rathke
cleft cyst (11 male and 18 female patients; mean age, 46 y). The most
common presenting symptom was head pain (55%). The majority (59%) of
cases demonstrated suprasellar extension on preoperative imaging, with
pituitary dysfunction identified in 66%. Recurrence occurred in eight
patients (28%). Postoperative visual function improved or remained
stable in all patients. Persistent pituitary dysfunction required
hormonal supplementation in seven patients (24%). Only one patient with
an astrocytoma in addition to a Rathke cleft cyst did not maintain the
ability to perform normally on an assessment of activities of daily
living, a striking contrast to patients with craniopharyngioma.
CONCLUSIONS: Conclusions were as follows: 1) Rathke cleft cysts must be
considered as sources of head pain and pituitary dysfunction. 2)
Persistent or recurrent cyst formation occurs in approximately one-third
of the patients. Recurrence may take many years, and follow-up imaging
is recommended for at least a decade. 3) Maintenance of the ability to
perform the activities of normal daily living can be expected after
surgical management. 4) Most Rathke cleft cysts can be managed through
transnasal exposure of the sella. 5) Packing the sella may result in
predisposition to recurrent cyst formation.
21
UI - 11914886
AU - Schumacher T; Hofer S; Eichhorn K; Wasner M; Zimmerer S; Freitag P;
TI -
Probst A; Gratzl O; Reubi JC; Maecke R; Mueller-Brand J; Merlo A
Local injection of the 90Y-labelled peptidic vector DOTATOC to control
gliomas of WHO grades II and III: an extended pilot study.
SO - Eur J Nucl Med Mol Imaging 2002 Apr;29(4):486-93
AD - Institute of Nuclear Medicine, University Hospitals, Basel, Switzerland.
We have previously presented preliminary observations on targeting
somatostatin receptor-positive malignant gliomas of all grades by local
injection of the radiolabelled peptidic vector 90Y-DOTATOC. We now
report on our more thorough clinical experience with this novel
compound, focussing on low-grade and anaplastic gliomas. Small peptidic
vectors have the potential to target invisible infiltrative disease
within normal surrounding brain tissue, thereby opening a window of
opportunity for early intervention. Five progressive gliomas of WHO
grades II and III and five extensively debulked low-grade gliomas were
treated with varying fractions of 90Y-DOTATOC. The vectors were locally
injected into the resection cavity or into solid tumour. The activity
per single injection ranged from 555 to 1,875 MBq, and the cumulative
activity from 555 to 7,030 MBq, according to tumour volumes and
eloquence of the affected brain area, yielding dose estimates from
76+/-15 to 312+/-62 Gy. Response was assessed by the clinical status, by
steroid dependence and, every 4-6 months, by magnetic resonance imaging
and fluorine-18 fluorodeoxyglucose positron emission tomography. In the
five progressive gliomas, lasting responses were obtained for at least
13-45 months without the need for steroids. Radiopeptide brachytherapy
had been the only modality applied to counter tumour progression.
Interestingly, we observed the slow transformation of a solid, primarily
inoperable anaplastic astrocytoma into a resectable multi-cystic lesion
2 years after radiopeptide brachytherapy. Based on these observations,
we also assessed the feasibility of local radiotherapy following
extensive debulking, which was well tolerated. Targeted beta-particle
irradiation based on diffusible small peptidic vectors appears to be a
promising modality for the treatment of malignant gliomas.
22
UI - 10870063
AU - Koot RW; Maarouf M; Hulshof MC; Voges J; Treuer H; Koedooder C; Sturm V;
TI -
Bosch DA
Brachytherapy: Results of two different therapy strategies for patients
with primary glioblastoma multiforme.
SO - Cancer 2000 Jun 15;88(12):2796-802
AD - Department of Neurosurgery, Academic Medical Center, Amsterdam, The
Netherlands.
BACKGROUND: In the current study, the authors describe and compare two
different strategies of brachytherapy for the treatment of patients with
primary glioblastoma multiforme (GBM). METHODS: The study was comprised
of 84 patients. Forty-five patients were implanted with permanent or
temporary low activity iodine-125 ((125)I) seeds in Cologne and 21
patients were implanted with temporary iridium-192 ((192)Ir) wires in
Amsterdam. Both groups received external beam radiation therapy (EBRT);
the (125)I group received 10-30 grays (Gy) with the implant in situ and
the (192)Ir group received 60 Gy before implantation. In Cologne,
implantation was performed after a diagnostic stereotactic biopsy
whereas in Amsterdam implantation took place after cytoreductive
diagnostic surgery. In addition, 18 patients in Amsterdam served as a
control group. This group received only EBRT after cytoreductive
surgery. RESULTS: In both groups the mean age of the patients was
between 50-55 years, with 80% of the patients age > 45 years. The mean
implantation volume encompassed by the referenced isodose was 23 cm(3)
for (125)I and 48 cm(3) for (192)Ir. Initial dose rates were 2. 5-2.9
centigrays (cGy)/hour for permanent (125)I, 4.6 cGy/hour for temporary
(125)I, and 44-100 cGy/hour (mean, 61 cGy) for (192)Ir. A total dose of
50-60 Gy, 60-80 Gy, and 40 Gy, respectively, was administered at the
outer margins of the tumor. The median survival was approximately 16
months for both the (125)I group and the (192)Ir group. This was 6
months longer than the median survival in the control group.
Reoperations were performed in 4 patients in the (125)I group (9%)
versus 7 patients in the (192)Ir group (33%). No complications or late
reactions were reported in the (125)I group, whereas one case of
hemorrhage and three cases of delayed stroke were observed in the
(192)Ir group. CONCLUSIONS: The equal median survival times in these two
brachytherapy groups with such different dose rate radiation schedules
support the hypothesis that dose rate does not play a major role in the
survival of patients with primary GBM. Copyright 2000 American Cancer
Society.
23
UI - 11267965
AU - Vordermark D
TI -
Brachytherapy. Results of two different therapy strategies for patients
with primary glioblastoma multiforme.
SO - Cancer 2001 Mar 15;91(6):1185-6
24
UI - 10728209
AU - Packer RJ
TI -
Childhood brain tumours: new directions in management.
SO - Eur J Paediatr Neurol 1997;1(5-6):133-8
AD - Department of Neurology, Children's National Medical Center, Washington,
DC 20010, USA.
25
UI - 12217793
AU - Gupta T; Sarin R
TI -
Poor-prognosis high-grade gliomas: evolving an evidence-based standard
of care.
SO - Lancet Oncol 2002 Sep;3(9):557-64
AD - Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
Patients with high-grade glioma (HGG) can be classified as having a
favourable prognosis (younger or with good performance status) or a poor
prognosis (older or with poor performance status) with median survival
of 12-24 months and 6-9 months, respectively. The standard management
for the favourable subgroup is maximum safe resection followed by
adjuvant conventionally fractionated radio therapy, with or without
chemotherapy. However, most patients with HGG have a poor prognosis and
their optimum management has yet to be defined. In the poor-prognosis
HGG subgroup, short-course radiotherapy is equivalent to conventional
radiotherapy in terms of survival and palliation (level II evidence),
but chemotherapy is not recommend ed (level II evidence). The problems
with the existing systems of prognosis are discussed and a pragmatic
system proposed. Owing to lack of any level I evidence, the need to
conduct prospective randomised trials with quality of life and
palliative effect as primary endpoints is emphasised. Until such time,
maximum safe resection followed by a short course of focal radiotherapy
is recommended as the standard of care in poor prognosis HGG.
26
UI - 11939089
AU - Arismendi G; Bohorquez M; Romero de Amaro Z; Cardozo D; Luzardo G;
TI -
Molina O; Cardozo J
[Epidemiologic studies of cerebellopontine angle tumors surgically
treated in Maracaibo, Venezuela, in 1985-1999]
SO - Neurocirugia (Astur) 2002 Feb;13(1):22-6
AD - Departamento de Patologia, Hospital General del Sur, Maracaibo.
OBJECTIVE: To analyze the epidemiological, clinical and
neuropathological data of cases of cerebellopontine angle (CPA) tumors.
MATERIAL AND METHODS: The clinical records, neuroimaging and
neuropathological studies of 50 patients with diagnosis of CPA tumor
operated in different hospitals of Maracaibo, Venezuela, during the
lapse January 1st, 1985-December 31, 1999 were reviewed. The variables
age, gender, side of the lesion and neuropathological diagnosis were
analyzed. RESULTS: A 2:1 female to male ratio was observed. Median age
was 48 +/- 12.7 years. Acoustic neuromas (AN) represented 48% of the
cases, whereas nonacoustic neuroma tumors (NANT) made up for the rest
(52%). Meningiomas were the second more commonly diagnosed lesions, they
constituted 32% of the cases. Meningiomas and AN were more frequent in
women, their ratios being 7:1 and 1.6:1, respectively. In 60% of the
cases the signs and symptoms became eloquent in patients of the fourth
and fifth decades of life. CONCLUSIONS: The difference between our
results and the ones previously reported in the medical literature are
due in part to the predominance of female patients in our series.
Endocrinologic, genetic and biochemical factors could also be
responsible; nevertheless, this does not constitute the objective of the
present study.
27
UI - 11995820
AU - Chamberlain MC
TI -
Salvage chemotherapy with CPT-11 for recurrent glioblastoma multiforme.
SO - J Neurooncol 2002 Jan;56(2):183-8
AD - University of Southern California, Norris Comprehensive Cancer Hospital,
Department of Neurology, Los Angeles 90033-0804, USA. chamberl@usc.edu
BACKGROUND: A prospective Phase II study of CPT-11 in adult patients
with recurrent supratentorial glioblastoma multiforme (GBM). METHODS:
Forty patients (25 men, 15 women) ages 32-71 years (median 59), with
recurrent GBM were treated. All patients had previously been treated
with surgery and involved field radiotherapy (median dose 60 Gy; range
59-60). Additionally, all patients were treated with adjuvant
chemotherapy (BCNU in 20, PCV in 18, Procarbazine in 2). Twenty-five
patients (62%) were on anticonvulsants (phenytoin in 15, carbamazepine
in 10) and 26 patients (65%) were on dexamethasone. Recurrent disease
was defined by neuroradiographic disease progression (>25% increase in
tumor dimensions) using gadolinium-enhanced MR imaging. The starting
dose of CPT-11 was 400 mg/m2 followed in three weeks by 500 mg/m2,
operationally defined as one cycle. At week 6, all patients were
evaluated with MRI and neurological examination. RESULTS: All patients
were evaluable. Two doses (one cycle) of CPT-11 were administered to all
patients. CPT-11-related toxicity included: diarrhea (16 patients, 40%);
thrombocytopenia (9 patients, 23%); and neutropenia (6 patients, 15%).
No patient required transfusion nor was treatment for neutropenic fever
required. No treatment-related deaths were observed. All patients
demonstrated progressive disease following one cycle of CPT-11.
CONCLUSIONS: The lack of response to CPT-11 in this patient group with
recurrent GBM suggests either CPT-11 has minimal activity or CPT-11
doses/schedule utilized in this study were sub-optimal. The latter is
supported by the modest toxicity seen in this study and the previously
documented enhanced clearance of CPT-11 in patients on anticonvulsants
and dexamethasone.
The above citations and abstracts reflect those newly added to CANCERLIT for the month and topic listed in the title. The citations have been retrieved from CANCERLIT using a predefined search strategy of indexed subject terms. Although the search strategy has been refined as best as possible, citations may appear that are not directly related to the topic, and occasionally relevant references may be omitted.
Cancer Types
Bone Cancer
Brain Tumors
Breast Cancer
Carcinoid Tumors
Endocrine System Cancers
Gastrointestinal Cancers
Gynecologic Cancers
Head and Neck Cancers
Leukemia
Lung Cancers
Lymphomas
Myelomas
Pediatric Cancers
Penile Cancer
Prostate Cancer
Sarcomas
Skin Cancers
Testicular Cancer
Thyroid Cancer
Urinary Tract Cancers
OncoLink Vet
Cancer Treatment
Biologic Therapy
Bone Marrow Transplants
Chemotherapy
Clinical Trials
Complementary Medicine
Gene Therapy
General Treatment Concerns
Hormone Therapy
PDT Center
Proton Therapy
Radiation Oncology
Surgical Oncology
Targeted Therapies
Vaccine Therapies
Cancer Support
Caregivers
Hospice Care and Bereavement
Nutrition and Cancer
Sexuality & Fertility
Side Effects
Support
Survivorship
Exercise and Cancer
Cancer Resources
Cancer News
OncoLink University
Nurses' Notes
Conferences
Newly Diagnosed Patients
Causes and Prevention
Legal and Financial Information for Patients
LGBT Resources
NCI Resources
Global Resources
Cancer Resource List
Resources for Young Adults
OncoLink Media Library
OncoLink TV
Book, Music and Video Reviews
Ask the Experts
Brown Bag Chat
Tracy's Corner
About OncoLink
About OncoLink
Giving to OncoLink
Contact Information
Usage Policy
Editorial Board
How to Partner with OncoLink
Link to OncoLink
Mission Statement
