Spinal schwannoma with acute subarachnoid hemorrhage: a
diagnostic challenge.
Parmar H, Pang BC, Lim CC, Chng SM, Tan KK.
Department of Neuroradiology, National Neuroscience Institute, Singapore,
Republic of Singapore.
We report a case of spinal intradural schwannoma presenting with
intracranial subarachnoid hemorrhage. Cerebral angiography studies were
negative, but MR imaging of the spine revealed a large hemorrhagic tumor in
the thoraco-lumbar junction. The tumor was misdiagnosed as ependymoma of the
conus medullaris. This case illustrates the importance of a high index of
suspicion for spinal disease in angiographically-negative subarachnoid
hemorrhage and pitfalls in MR diagnosis of thoraco-lumbar tumors.
Publication Types:
Case Reports
Review
Review of Reported Cases
PMID: 15140733 [PubMed - indexed for MEDLINE]
2: AJNR Am J Neuroradiol. 2004 May;25(5):761-5.
Diagnostic value of contrast-enhanced fluid-attenuated
inversion recovery MR imaging of intracranial metastases.
Ercan N, Gultekin S, Celik H, Tali TE, Oner YA, Erbas G.
Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.
BACKGROUND AND PURPOSE: Postcontrast fluid-attenuated inversion recovery
(FLAIR) imaging effectively depicts parenchymal and leptomeningeal
metastases, as reported in limited patient groups. We compared postcontrast
T1-weighted (T1W) and FLAIR imaging in a larger group. METHODS: Sixty-nine
patients with known malignancy and suspected cranial metastases underwent
axial FLAIR and spin-echo T1W imaging with and then without intravenous
gadopentetate dimeglumine. Postcontrast images were compared for lesion
conspicuity and enhancement, number of parenchymal metastases, and extension
of leptomeningeal-cisternal metastases. RESULTS: Parenchymal metastases were
demonstrated in 33 patients. Compared with T1W images, postcontrast FLAIR
images showed more metastases in five patients, an equal number in 20, and
fewer lesions in eight. Regarding lesion conspicuity, postcontrast FLAIR
imaging was superior in five patients, equal in one, and inferior in 27. For
enhancement, FLAIR imaging was superior in five, equal in five, and inferior
in 23. Superior FLAIR results for lesion number, conspicuity, and
enhancement were observed in the same five patients; in these patients,
FLAIR imaging was performed as the second postcontrast sequence. Eleven
patients had leptomeningeal-cisternal metastases; lesion conspicuity,
extension, and enhancement were superior on postcontrast FLAIR images in
eight. In five of eight patients, FLAIR imaging was performed as the second
postcontrast sequence. Four patients had cranial-nerve metastases; in three,
postcontrast FLAIR imaging was superior for lesion conspicuity and
extension. In two of these patients, FLAIR imaging was the second
postcontrast sequence. CONCLUSION: Postcontrast FLAIR imaging is a valuable
adjunct to postcontrast T1W imaging. Precontrast and postcontrast FLAIR
imaging effectively delineates parenchymal metastases, particularly
leptomeningeal-cisternal and cranial-nerve metastases.
PMID: 15140715 [PubMed - indexed for MEDLINE]
3: Cancer. 2004 Sep 23 [Epub ahead of print]
Parent proxy-reported health-related quality of life and
fatigue in pediatric patients diagnosed with brain tumors and acute
lymphoblastic leukemia.
Meeske K, Katz ER, Palmer SN, Burwinkle T, Varni JW.
Childrens Center for Cancer and Blood Diseases, Childrens Hospital Los
Angeles, Los Angeles, California.
BACKGROUND: Pediatric patients with brain tumors (BT) are often excluded
from health-related quality of life (HRQOL) studies even though they
experience more severe disease and treatment-related sequelae than children
with other types of cancer. Parent proxy assessments of HRQOL allow for
greater inclusion of children who are developmentally immature, physically
ill, or cognitively impaired. METHODS: Parents of children ages 2-18 years
who were diagnosed at Childrens Hospital Los Angeles and Children's Hospital
San Diego with BT (n = 86) or acute lymphoblastic leukemia (ALL; n = 170)
evaluated their children's HRQOL over the previous week using the
parent-proxy versions of the Pediatric Quality of Life Inventory (PedsQL
trade mark ) 4.0 Generic Core scales, the PedsQL trade mark 3.0 Acute Cancer
Module, and the PedsQL trade mark Multidimensional Fatigue scales. Multiple
regression analyses were used to determine the independent effect of the
child's diagnosis on HRQOL. Separate analyses were conducted for patients
receiving treatment, patients who had not received treatment for < 12
months, and patients who had not received treatment for >/= 12 months.
RESULTS: Patients with BT exhibited more problems than patients with ALL in
the physical, social, psychosocial, school, cognitive, and fatigue domains
of HRQOL. The Core Physical Health, Core Psychosocial Health, and Fatigue
Total scores for patients with BT demonstrated peak improvements for
children who had not received treatment for < 12 months and sharp
declines for children who had not received treatment for >/= 12 months.
The Core Physical Health and Fatigue Total scores for patients with ALL were
highest (better HRQOL) for those who had not received treatment for >/=
12 months. CONCLUSIONS: Pediatric patients and survivors of BT experienced
more fatigue and HRQOL problems than patients with ALL, and HRQOL differed
by treatment status. Cancer 2004. Copyright 2004 American Cancer Society.
PMID: 15389475 [PubMed - as supplied by publisher]
4: Cancer. 2004 Sep 23 [Epub ahead of print]
Can we afford to add chemotherapy to radiotherapy for
glioblastoma multiforme? Cost-identification analysis of concomitant and
adjuvant treatment with temozolomide until patient death.
Wasserfallen JB, Ostermann S, Pica A, Mirimanoff RO, Leyvraz S, Villemure
JG, Stupp R.
Health Technology Assessment Unit, University Hospital Center of Vaud,
Lausanne, Switzerland.
BACKGROUND: Adding temozolomide (TMZ) to standard radiotherapy as a
first-line therapy for glioma may increase costs to a disproportionate
degree compared with the resulting survival benefits. METHODS: Forty-six
consecutive patients (28 males and 18 females; median age, 52 years; age
range, 24-70 years) received concomitant TMZ with radiotherapy for 6 weeks
followed by adjuvant TMZ for 6 cycles, and they were followed until disease
recurrence and then until death. The authors assessed the costs associated
with the four phases of treatment from a hospital-centered perspective.
RESULTS: Treatment was discontinued early in 3 patients, 9 patients, and 15
patients during concomitant TMZ, before adjuvant TMZ, and during adjuvant
TMZ, respectively. Karnofsky index values varied between 85% (at the
beginning of treatment) and 76% (at the end of treatment). The nature of
care after disease recurrence was diverse. Overall survival ranged from 1.4
months to 64.3 months (median, 15.8 months) and was better if surgical
debulking could be carried out before treatment. Global costs amounted to
euro39,092 +/- euro21,948 (concomitant TMZ, euro14,539 +/- euro4998;
adjuvant TMZ, euro13,651 +/- euro4320; follow-up, euro6363 +/- euro6917; and
recurrence, euro12,344 +/- euro18,327), with 53% of these costs being
related to the acquisition of TMZ; this represented an eightfold increase in
cost compared with radiotherapy alone. CONCLUSIONS: TMZ may be an effective
but costly adjuvant outpatient therapy for patients with glioblastoma
multiforme. Definite cost-effectiveness/utility must be assessed in a
randomized Phase III trial. Cancer 2004. Copyright 2004 American Cancer
Society.
PMID: 15389472 [PubMed - as supplied by publisher]
5: Int J Cancer. 2004 Aug 25 [Epub ahead of print]
Occupational risk factors for low grade and high grade
glioma: Results from an international case control study of adult brain
tumours.
Schlehofer B, Hettinger I, Ryan P, Blettner M, Preston-Martin S, Little
J, Arslan A, Ahlbom A, Giles GG, Howe GR, Menegoz F, Rodvall Y, Choi WN,
Wahrendorf J.
Unit of Environmental Epidemiology, German Cancer Research Centre,
Heidelberg, Germany.
The majority of suspected occupational risk factors for adult brain tumours
have yet to be confirmed as etiologically relevant. Within an international
case-control study on brain tumours, lifelong occupational histories and
information on exposures to specific substances were obtained by direct
interviews to further investigate occupational risk factors for glioma. This
is one of the largest studies of brain tumours in adults, including 1,178
cases and 1987 population controls from 8 collaborating study centres
matched for age, gender and centre. All occupational information, was
aggregated into 16 occupational categories. In a pooled analysis, odds
ratios (OR), adjusted for education, were estimated separately for men and
women and for high-grade glioma (HGG) and low-grade glioma (LGG), focusing
especially on 6 categories defined a priori: agricultural, chemical,
construction, metal, electrical/electronic and transport. For men, an
elevated OR of glioma associated with the category "metal" (OR =
1.24, 95% CI 0.96-1.62) was seen, which appeared to be largely accounted for
by LGG (OR = 1.59, 95% CI 1.00-2.52). For the other 5 occupational
categories, no elevated risks for glioma were observed. For women the only
noteworthy observation for the 6 a priori categories was an inverse
association with the "agriculture" category (OR = 0.60, 95% CI
0.36-0.99). Apart from the 6 major categories, women working in food
production or food processing (category "food") showed an
increased OR of 1.95 (95% CI 1.04-3.68). None of the 20 substance groups was
positively associated with glioma risk. Although some other point estimates
were elevated, they lacked statistical significance. The results do not
provide evidence of a strong association between occupational exposures and
glioma development.
PMID: 15386358 [PubMed - as supplied by publisher]
6: Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):531-6.
A pilot study of preirradiation chemotherapy and 1800 cGy
craniospinal irradiation in young children with medulloblastoma.
Division of Pediatric Hematology-Oncology, Children's Hospital of
Pittsburgh, Pittsburgh, PA, USA.
PURPOSE: Craniospinal irradiation (CSI) is necessary in the treatment of
medulloblastoma, although it results in significant long-term sequelae,
particularly in young children. We prospectively evaluated the feasibility
of giving preirradiation chemotherapy followed by 1800 cGy CSI to young
children with localized medulloblastoma. METHODS AND MATERIALS: Between
January 1993 and July 1997, 7 consecutive patients (age, 20-64 months) with
M0 medulloblastoma were enrolled. After surgical resection, patients
received 4 months of multiagent chemotherapy followed by 1800 cGy CSI and
5400 cGy to the posterior fossa. RESULTS: Median follow-up is 8.9 years. No
patient developed progressive disease during chemotherapy. One patient
developed widespread metastatic recurrence 2 months after completing
radiation therapy and died. Two additional patients developed isolated
frontal horn relapses 32 and 36 months after initial diagnosis and received
further irradiation and chemotherapy. Both of these patients remain alive
7.1 and 3.6 years from the time of recurrence. Four of the six survivors
have endocrine deficits. All of the survivors require special assistance in
school. CONCLUSIONS: Craniospinal irradiation doses of 1800 cGy may not be
adequate to prevent exoprimary recurrences. Despite the CSI dose reduction,
neuroendocrine and neurocognitive sequelae are substantial.
PMID: 15380589 [PubMed - in process]
7: Int J Radiat Oncol Biol Phys. 2004 Oct 1;60(2):353-7.
Phase II study of temozolomide and thalidomide with
radiation therapy for newly diagnosed glioblastoma multiforme.
Chang SM, Lamborn KR, Malec M, Larson D, Wara W, Sneed P, Rabbitt J, Page
M, Nicholas MK, Prados MD.
Department of Neurological Surgery, University of California, San Francisco,
San Francisco, CA, USA.
PURPOSE: The chemotherapeutic agent temozolomide (TMZ) and the
antiangiogenic agent thalidomide have both demonstrated antitumor activity
in patients with recurrent malignant glioma. The objectives of this study
were to determine if the combined strategy of these oral agents with
radiation therapy (RT) is associated with an improved median survival of
patients with newly diagnosed glioblastoma multiforme and to evaluate
toxicity. METHODS AND MATERIALS: Sixty-seven patients were enrolled in this
trial. Radiotherapy parameters were a total dose of 60 Gy delivered in 2 Gy
fractions over 6 weeks. Temozolomide was administered starting the first day
of RT at 150 mg/m(2) daily for 5 days every 4 weeks for the first cycle and
escalated to a maximum dose of 200 mg/m(2). Thalidomide was started on Day 7
of RT at 200 mg and escalated by 100-200 mg every 1-2 weeks depending on
patient tolerance, to a maximum of 1,200 mg daily. RESULTS: Sixty-one
patients have progressed, with a median time to progression of 22 weeks.
Fifty-six patients have died, and the median survival was 73 weeks.
CONCLUSIONS: This strategy of combination TMZ, thalid and RT was relatively
well tolerated with favorable survival outcome for patients with GM when
compared to patients not treated with adjuvant chemotherapy and similar to
those who have received nitrosourea adjuvant chemotherapy. It is unclear the
added advantage thalid has in combination with TMZ for this patient
population.
PMID: 15380566 [PubMed - in process]
8: J Clin Oncol. 2004 Sep 1;22(17):3639-40.
Challenging manifestations of malignancies. Case 1.
Polycythemia and high serum erythropoietin level as a result of
hemangioblastoma.
Kuhne M, Sidler D, Hofer S, Lugli A, Ludwig Ch.
Department of Oncology, Claraspital, Basel, Switzerland.
Publication Types:
Case Reports
PMID: 15337812 [PubMed - indexed for MEDLINE]
9: J Clin Oncol. 2004 Sep 1;22(17):3608-17.
CNS metastases in breast cancer.
Lin NU, Bellon JR, Winer EP.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
02115, USA.
As systemic therapy of metastatic breast cancer improves, CNS involvement is
becoming a more widespread problem. This article summarizes the current
knowledge regarding the incidence, clinical presentation, diagnosis,
prognosis, and treatment of CNS metastases in patients with breast cancer.
When available, studies specific to breast cancer are presented; in studies
in which many solid tumors were evaluated together, the proportion of
patients with breast cancer is noted. On the basis of data from randomized
trials and retrospective series, neurosurgery and stereotactic radiosurgery
(SRS) may prolong survival in patients with single brain metastases. The
treatment of multiple metastases remains controversial, as does the routine
use of whole-brain radiotherapy (WBRT) after either surgery or SRS. Although
it is widely assumed that chemotherapy is of limited benefit, data from case
series and case reports suggest otherwise. WBRT, neurosurgery, SRS, and
medical therapy each have a role in the treatment of CNS metastases;
however, neurologic symptoms frequently are not fully reversible, even with
appropriate therapy. Studies specifically targeted toward this group of
patients are needed.
Discrepancy between lesion distributions on methionine
PET and MR images in patients with glioblastoma multiforme: insight from a
PET and MR fusion image study.
Miwa K, Shinoda J, Yano H, Okumura A, Iwama T, Nakashima T, Sakai N.
Department of Neurosurgery, Gifu University School of Medicine, 40
Tsukasa-machi, Gifu 500-8705, Japan. junshino@cc.gifu-u.ac.jp
OBJECTIVE: To examine (11)C-methyl methionine (MET) accumulation on positron
emission tomographic (PET) imaging of glioblastoma multiforme to determine
the distribution of metabolic abnormality compared with magnetic resonance
imaging (MRI). METHODS: Contemporaneous MRI was superimposed on
corresponding MET-PET images in 10 patients with newly diagnosed
glioblastoma multiforme before treatment. Differences between the extended
area of MET accumulation on PET imaging (MET area), the gadolinium (Gd)
enhanced area on T1 weighted images (Gd area), and the abnormal high signal
intensity area on T2 weighted images (T2-high area) were assessed. RESULTS:
The MET area was larger than the Gd area and included the entire Gd area.
The discrepancy in volume between the MET and Gd areas became greater with
increasing tumour diameter. On average, 58.6% of the MET area was located
within the Gd area, 90.1% within 10 mm outside the Gd area, 98.1% within 20
mm, and 99.8% within 30 mm. A newly developed Gd area had emerged in five of
the 10 cases up to the time of study. In three of the five cases this was in
the MET area even after complete surgical resection of the Gd area on the
initial MRI; in the remaining two it originated in the residual Gd area
after surgery. In all cases, the T2-high area was larger than the MET area.
The MET area extended partly beyond the T2-high area in nine cases, and was
completely within it in one. CONCLUSIONS: Glioblastoma multiforme cells may
extend over the Gd area and more widely with increasing tumour size on
Gd-MRI. The T2-high area includes the greater part of the tumour but not its
entire area. The methods reported may be useful in planning surgical
resection, biopsy, or radiosurgery.
PMID: 15377696 [PubMed - in process]
11: Neurology. 2003 Oct 28;61(8):1148.
Asymptomatic giant arachnoidal cyst.
De Angelis D, Venturiero V, Coiro P, Bragoni M, Paolucci S, Scoppetta C.
Fondazione Santa Lucia I.R.C.C.S.-Via Ardeatina, 306 00179 Rome, Italy.
mielis@tiscali.it
Publication Types:
Case Reports
PMID: 14581686 [PubMed - indexed for MEDLINE]
12: Oncogene. 2004 Sep 20 [Epub ahead of print]
RNAi-mediated inhibition of cathepsin B and uPAR leads to
decreased cell invasion, angiogenesis and tumor growth in gliomas.
1Program of Cancer Biology, Department of Biomedical and Therapeutic
Sciences, University of Illinois College of Medicine- Peoria, IL, USA.
RNA interference (RNAi) provides a powerful method for gene silencing in
eukaryotic cells, including proliferating mammalian cells. Here, we
determined whether RNAi could be utilized to inhibit the expression of
proteases implicated in the extracellular matrix degradation, which is
characteristic of tumor progression. We have previously shown that antisense
stable clones of uPAR and cathepsin B were less invasive and did not form
tumors when injected intracranially ex vivo. Since antisense-mediated gene
silencing does not completely inhibit the translation of target mRNA and
high molar concentrations of antisense molecules are required to achieve
gene silencing, we used the RNAi approach to silence uPAR and cathepsin B in
this study. We found that the expression of double-stranded RNA leads to the
efficient and specific inhibition of endogenous uPAR and cathepsin B protein
expression in glioma cell lines as determined by Western blotting. We also
found the RNAi of uPAR and cathepsin B reduces glioma cell invasion and
angiogenesis in in vitro and in vivo models. Intratumoral injections of
plasmid vectors expressing hpRNA for uPAR and cathepsin B resulted in the
regression of pre-established intracranial tumors. Further, RNAi for uPAR
and cathepsin B inhibited cell proliferation and reduced the levels of pERK
and pFAK compared to controls. Taken together, our findings indicate for the
first time that RNAi operates in human glioma cells with potential
application for cancer gene therapy.Oncogene advance online publication, 20
September 2004; doi:10.1038/sj.onc.1207879
PMID: 15378018 [PubMed - as supplied by publisher]
Volume 3, Supplement 3 - 28
September 2004