| 1: AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1705-8. |
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MR spectroscopy in the diagnosis of cerebral amyloid
angiopathy presenting as a brain tumor.
Safriel Y, Sze G, Westmark K, Baehring J.
Department of Radiology, Neuroradiology Section, Yale University School of
Medicine, 333 Cedar Street, New Haven, CT 06520, USA.
We present two cases of focal, tumefactive, masslike lesions of diffuse
cerebral amyloid angiopathy (CAA) that presented as areas of increased
signal intensity on long TR sequences without contrast enhancement or
restricted diffusion. MR spectroscopy revealed normal metabolite ratios and
unremarkable spectra. Pathologic tissue showed CAA and CAA with angitis of
the CNS. Tumefactive CAA is a rare condition, and we describe its
characteristics at MR spectroscopy and diffusion-weighted imaging.
PMID: 15569734 [PubMed - in process]
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| 2: AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1696-704. |
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Brain tumor classification by proton MR spectroscopy:
comparison of diagnostic accuracy at short and long TE.
Majos C, Julia-Sape M, Alonso J, Serrallonga M, Aguilera C, Acebes JJ,
Arus C, Gili J.
Institut de Diagnostic per la Imatge, CSU de Bellvitge, Autovia de
Castelldefels km 2.7, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
BACKGROUND AND PURPOSE: Different TE can be used for obtaining MR spectra of
brain tumors. The purpose of this study was to determine the influence of
the TE used in brain tumor classification by comparing the performance of
spectra obtained at two different TE (30 ms and 136 ms). METHODS: One
hundred fifty-one studies of patients with brain tumors (37 meningiomas, 12
low grade astrocytomas, 16 anaplastic astrocytomas, 54 glioblastomas, and 32
metastases) were retrospectively selected from a series of 378 consecutive
examinations of brain masses. Single voxel proton MR spectroscopy at TE 30
ms and 136 ms was performed with point-resolved spectroscopy in all cases.
Fitted areas of nine resonances of interest were normalized to water. Tumors
were classified into four groups (meningioma, low grade astrocytoma,
anaplastic astrocytoma, and glioblastoma-metastases) by means of linear
discriminant analysis. The performance of linear discriminant analysis at
each TE was assessed by using the leave-one-out method. RESULTS: Tumor
classification was slightly better at short TE (123 [81%] of 151 cases
correctly classified) than at long TE (118 [78%] of 151 cases correctly
classified). Meningioma was the only group that showed higher sensitivity
and specificity at long TE. Improved results were obtained when both TE were
considered simultaneously: the suggested diagnosis was correct in 105 (94%)
of 112 cases when both TE agreed, whereas the correct diagnosis was
suggested by at least one TE in 136 (90%) of 151 cases. CONCLUSION: Short TE
provides slightly better tumor classification, and results improve when both
TE are considered simultaneously. Meningioma was the only tumor group in
which long TE performed better than short TE.
PMID: 15569733 [PubMed - in process]
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| 3: Am J Clin Oncol. 2004 Dec;27(6):640-641. |
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Primary Presentation of Glioblastoma Multiforme With
Leptomeningeal Metastasis in the Absence of Previous Craniotomy: A Case
Report.
Pohar S, Taylor W, Chandan VS, Shah H, Sagerman RH.
From the *Department of Radiation Oncology, SUNY Upstate Medical University,
Syracuse, NY; daggerDepartment of Pathology, United Hospital Services,
Binghamton, NY; and the double daggerDepartment of Pathology, SUNY Upstate
Medical University, Syracuse, NY.
Glioblastoma multiforme is a highly malignant glioma with a well-known
tendency for intracranial spread but rarely for extracranial spread. We
report a case of an adult woman who presented with symptoms of
leptomeningeal metastasis from an intracranial glioblastoma multiforme
located adjacent to the lateral ventricle. There have been very few cases of
glioblastoma multiforme presenting with leptomeningeal metastasis in the
absence of previous therapeutic intervention.
PMID: 15577447 [PubMed - as supplied by publisher]
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| 4: Am J Clin Oncol. 2004 Dec;27(6):632-634. |
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Brain Metastases in Renal Cell Cancer: Diagnostic and
Therapeutic Aspects.
Nieder C, Grosu AL, Grzadziel A, Schlegel J, Molls M.
From the *Departments of Radiation Oncology and daggerPathology, Klinikum
rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675
Munich, Germany, (Tel): 89-4140-4501; (fax): 89-4140-4880. E-mail:
cnied@hotmail.com.
A 67-year-old patient with metastatic renal cell cancer was treated with
fractionated stereotactic radiotherapy to a hemorrhagic pons metastasis. He
then developed multiple cystic brain lesions, suggestive of diffuse
metastatic spread. However, further work-up revealed abscesses from
bronchopneumonia. Diagnostic and therapeutic aspects as well as potential
pitfalls in the management of patients with brain metastases are discussed.
PMID: 15577443 [PubMed - as supplied by publisher]
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| 5: Cancer. 2004 Dec 1; [Epub ahead of print] |
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Increased risk of brain metastases in patients with
HER-2/neu-positive breast carcinoma.
Altaha R, Crowell E, Hobbs G, Higa G, Abraham J.
Section of Hematology/Oncology, Mary Babb Randolph Cancer Center, West
Virginia University, Morgantown, West Virginia.
No abstract.
PMID: 15578684 [PubMed - as supplied by publisher]
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| 6: Clin Cancer Res. 2004 Nov 15;10(22):7613-20. |
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A clinicobiological model predicting survival in
medulloblastoma.
Ray A, Ho M, Ma J, Parkes RK, Mainprize TG, Ueda S, McLaughlin J, Bouffet
E, Rutka JT, Hawkins CE.
Divisions of Neurosurgery, Oncology, and Pathology, The Hospital for Sick
Children, Toronto, Ontario, Canada.
PURPOSE: The purpose of this study was to determine the relative
contributions of biological and clinical predictors of survival in patients
with medulloblastoma (MB). EXPERIMENTAL DESIGN: Clinical presentation and
survival information were obtained for 119 patients who had undergone
surgery for MB at the Hospital for Sick Children (Toronto, Ontario, Canada)
between 1985 and 2001. A tissue microarray was constructed from the tumor
samples. The arrays were assayed for immunohistochemical expression of MYC,
p53, platelet-derived growth factor receptor-alpha, ErbB2, MIB-1, and TrkC
and for apoptosis (terminal deoxynucleotidyl transferase-mediated nick end
labeling). Both univariable and multivariable analyses were conducted to
characterize the association between survival and both clinical and
biological markers. For the strongest predictors of survival, a weighted
predictive score was calculated based on their hazard ratios (HRs). The sum
of these scores was then used to give an overall prediction of survival
using a nomogram. RESULTS: The four strongest predictors of survival in the
final multivariable model were the presence of metastatic disease at
presentation (HR, 2.02; P = 0.01) and p53 (HR, 2.29; P = 0.02), TrkC (HR,
0.65; P = 0.14), and ErbB2 (HR, 1.51; P = 0.21) immunopositivity. A linear
prognostic index was derived, with coefficients equal to the logarithm of
these HRs. The 5-year survival rate for patients at the 10(th), 50(th), and
90(th) percentiles of the score distribution was 80.0%, 71.0%, and 35.7%,
respectively, with radiation therapy and 70.5%, 58.5%, and 20.0%,
respectively, without radiation therapy. CONCLUSIONS: In this study, we
demonstrate an approach to combining both clinical and biological markers to
quantify risk in MB patients. This provides further prognostic information
than can be obtained when either clinical factors or biological markers are
studied separately and establishes a framework for comparing prognostic
markers in future clinical studies.
PMID: 15569993 [PubMed - in process]
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| 7: J Clin Oncol. 2004 Dec 1;22(23):4727-34. |
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Second-Line Chemotherapy With Irinotecan Plus Carmustine
in Glioblastoma Recurrent or Progressive After First-Line Temozolomide
Chemotherapy: A Phase II Study of the Gruppo Italiano Cooperativo di
Neuro-Oncologia (GICNO).
Brandes AA, Tosoni A, Basso U, Reni M, Valduga F, Monfardini S, Amista P,
Nicolardi L, Sotti G, Ermani M.
Department of Medical Oncology, University Hospital, Via Gattamelata 64,
Padova, Italy; e-mail: aabrandes@unipd.it.
PURPOSE Glioblastoma multiforme (GBM), the most frequent brain tumor in
adults, is not considered chemosensitive. Nevertheless, there is widespread
use of first-line chemotherapy, often with temozolomide, as a therapeutic
option in patients with progressive disease after surgery and radiotherapy.
However, at the time of second recurrence and/or progression, active and
noncross-resistant chemotherapy regimens are required. The aim of the
present multicenter phase II trial, therefore, was to ascertain the efficacy
of second-line carmustine (BCNU) and irinotecan chemotherapy. PATIENTS AND
METHODS Patients with histologically confirmed GBM, recurring or progressing
after surgery, standard radiotherapy and a first-line temozolomide-based
chemotherapy, were considered eligible. The primary end-point was
progression-free survival at 6 months (PFS-6), and secondary end-points
included response rate, toxicity, and survival. All patients were on
enzyme-inducing antiepileptic prophylaxis. Chemotherapy consisted of BCNU
(100 mg/m(2) on day 1) plus irinotecan (175 mg/m(2)/weekly for 4 weeks),
every 6 weeks, for a maximum of eight cycles. In the absence of grade 2
toxicity, the irinotecan dose was increased to 200 mg/m(2). Results A total
of 42 patients (median age, 53.4 years; median Karnofsky performance status,
80; range, 60 to 90) were included in the study. PFS-6 was 30.3% (95% CI,
18.5% to 49.7%). Median time to progression was 17 weeks (95% CI, 11.9 to
23.9). Nine partial responses (21.4%; 95% CI, 9% to 34%) were obtained.
Toxicity was manageable. CONCLUSION The BCNU plus irinotecan regimen seems
active and non-cross-resistant in patients with GBM with recurrence after
temozolomide-based chemotherapy.
PMID: 15570079 [PubMed - in process]
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| 8: Neurosurgery. 2004 Dec;55(6):1410-9. |
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Silencing of Monocarboxylate Transporters via Small
Interfering Ribonucleic Acid Inhibits Glycolysis and Induces Cell Death in
Malignant Glioma: An in Vitro Study.
Mathupala SP, Parajuli P, Sloan AE.
Department of Neurological Surgery and Karmanos Cancer Institute, Wayne
State University School of Medicine, Detroit, Michigan.
OBJECTIVE: Dependence on glycolysis is a hallmark of malignant tumors. As a
consequence, these tumors generate more lactate, which is effluxed from
cells by monocarboxylate transporters (MCTs). We hypothesized that 1) MCT
expression in malignant tumors may differ from normal tissue in quantity,
isoform, or both; and 2) silencing MCT expression would induce intracellular
acidification, resulting in decreased proliferation and/or increased cell
death. METHODS: We quantified expression of MCT isoforms in human
glioblastoma multiforme and glioma-derived cells lines by Western blot
analysis. MCTs that were abundant or specific to glioma then were targeted
in the model U-87 MG glioma cell line via small interfering ribonucleic
acid-mediated gene silencing and tested for inhibition of lactate efflux,
intracellular pH changes, reduced proliferation, and/or induction of cell
death. RESULTS: MCT 1 and 2 were the primary isoforms expressed in human
glioblastoma multiforme and glioma-derived cell lines. In contrast, MCT 3
was the predominantly expressed isoform in normal brain. Small interfering
ribonucleic acid specific for MCT 1 and 2 reduced expression of these
isoforms in U-87 MG cells to barely detectable levels and reduced lactate
efflux by 30% individually and 85% in combination, with a concomitant
decrease of intracellular pH by 0.6 units (a fourfold increase in
intracellular H(+)). Prolonged silencing of both MCTs reduced viability by
75% individually and 92% in combination, as measured by both phenotypic and
flow cytometric analyses. CONCLUSION: MCT targeting significantly reduced
the viability of U-87 MG cells mediated by both apoptosis and necrosis. This
indicates that the strategy may be a useful therapeutic avenue for treatment
of patients with malignant glioma.
PMID: 15574223 [PubMed - in process]
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| 9: Neurosurgery. 2004 Dec;55(6):1280-9. |
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[18F]Fluorodeoxyglucose-Positron Emission Tomography in
Patients with Medulloblastoma.
Gururangan S, Hwang E, Herndon JE 2nd, Fuchs H, George T, Coleman RE.
The Brain Tumor Center at Duke, Department of Pediatrics, Duke University
Medical Center, Durham, North Carolina.
OBJECTIVE: We evaluated the [(18)F]fluorodeoxyglucose (FDG) accumulation
during positron emission tomography (PET) in patients with medulloblastoma
and examined the relationship of intensity of uptake with patient outcome
after the initial scan. METHODS: Magnetic resonance imaging and FDG-PET
scans of brain and spine were used to assess FDG uptake by visual grade
(qualitative analysis) and metabolic activity ratios (T(max)/G(mean) and
T(max)/W(mean)). Patients were divided into two groups based on either
confirmation of tumor by biopsy and/or death resulting from progressive
disease after the initial FDG-PET scan (Group A) or no intervention for the
suspected lesion shown on magnetic resonance imaging after the initial
FDG-PET scan but currently alive without evidence of disease (Group B).
RESULTS: Twenty-two patients with either recurrent (n = 21) or newly
diagnosed (n = 1) medulloblastoma underwent brain (n = 18) or whole-body (n
= 4) FDG-PET scans after magnetic resonance imaging evidence of suspected
tumor. The median qualitative analysis was 3 (range, 0-4) in 17 Group A
patients compared with 0 (range, 0-1) in 5 Group B patients (P = 0.0003).
The mean T(max)/G(mean) and T(max)/W(mean) ratios for 16 Group A patients
were 1.3 (range, 0.1-3.8) and 2.10 (range, 0.4-5.2), respectively, compared
with 0.80 (range, 0.20-1.5) and 1.3 (range, 0.5-1.9) in 5 Group B patients
(P = 0.2 for both parameters, not significant). There was a significant
negative correlation between increased FDG uptake and survival. Higher
qualitative analysis and T(max)/W(mean) were associated with significantly
poorer 2-year overall survival after the initial scan (71% versus 15% for
qualitative analysis grade of <3 versus >/=3, P = 0.001; 46% versus 0%
for T(max)/W(mean) </=2.5 versus >2.5, P = 0.004). CONCLUSION:
Increased FDG uptake is observed in medulloblastoma and is correlated
negatively with survival.
PMID: 15574210 [PubMed - in process]
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| 10: Neurosurgery. 2004 Dec;55(6):1275-9. |
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Spinal en plaque meningiomas: a contemporary experience.
Caroli E, Acqui M, Roperto R, Ferrante L, D'Andrea G.
Department of Neurological Sciences and Neurosurgery, Policlinico S. Andrea,
University of Rome "La Sapienza," Rome, Italy.
OBJECTIVE: Spinal en plaque meningiomas are rare and challenging lesions
because of their tendency to induce spinal arachnoiditis. The surgical
treatment of this type of meningioma is more complex than that of classic
meningioma. METHODS: We report seven cases of spinal en plaque meningiomas
and review all the cases reported in the literature accessible to us by a
MEDLINE search. RESULTS: All patients underwent microsurgery. Complete tumor
removal was achieved in three patients. Subtotal removal was performed in
four patients. A permanent neurological worsening was observed in one
patient. CONCLUSION: Spinal meningiomas en plaque bear a prognosis poorer
than that of classic meningiomas with regard to the possibility of a
definitive surgical cure because recurrence or postoperative arachnoiditis
occurs frequently. Total surgical removal should be attempted only when a
clear plane of cleavage between tumor and arachnoid exists.
PMID: 15574209 [PubMed - in process]
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| 11: Neurosurgery. 2004 Dec;55(6):1263-74. |
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Meningiomas invading the superior sagittal sinus:
surgical experience in 108 cases.
Dimeco F, Li KW, Casali C, Ciceri E, Filippini G, Broggi G, Solero CL.
Department of Neurosurgery, Istituto Nazionale Neurologico "C.
Besta," Milan, Italy, and Department of Neurological Surgery, Johns
Hopkins School of Medicine, Baltimore, Maryland.
OBJECTIVE: Radical resection of meningiomas invading the superior sagittal
sinus (SSS) presents several hazards. Some surgeons consider SSS invasion a
contraindication for complete resection, and others advocate total resection
with venous reconstruction. There is a lack of published large series to
provide definitive guidelines for the surgical treatment of these complex
cases. We report our 15-year experience with surgery of parasagittal
meningiomas invading the SSS. METHODS: Between 1986 and 2001, 108 patients
(73 women, 35 men; age range, 22-83 yr; mean age, 56.2 yr) underwent surgery
at the Neurological Institute "C. Besta" of Milan for tumors
invading the SSS. Parasagittal meningiomas not invading the SSS were
excluded from this series. RESULTS: Simpson Grade I to II removal was
achieved in 100 patients. Thirty patients with meningiomas totally occluding
the SSS had complete resection of the encased portion of the sinus.
Histological examination revealed 86 benign (79.6%), 16 atypical (14.8%),
and 4 malignant (3.7%) meningiomas along with 2 hemangiopericytomas. There
were two perioperative deaths. Serious complications included brain swelling
(nine patients; 8.3%) and postoperative hematoma (two patients; 1.85%).
Follow-up ranged from 19 to 223 months (mean, 79.5 mo). One patient was lost
to follow-up. Tumors recurred in 15 patients (13.9%). After multivariate
analysis, histological type, tumor size, and Simpson grade were confirmed as
significant independent prognostic factors for recurrence. CONCLUSION: On
the basis of our results, we conclude that if the sinus is partially
invaded, it can be opened to obtain as complete a resection as possible and
to attempt to preserve the patency of the sinus. If the sinus is obstructed,
the portion of the sinus involved can be resected completely. In both
situations, extreme care is vital to preservation of cortical veins, which
may offer important collateral drainage. With our approach, good results are
achieved and it is not necessary to reconstruct the sinus.
PMID: 15574208 [PubMed - in process]
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Volume 3, Supplement 17 - 6 December 2004