| 1: Am J Clin Oncol. 2004 Oct;27(5):516-21. |
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Does stereotactic eligibility for the treatment of
glioblastoma cause selection bias in randomized studies?
Lustig RA, Scott CB, Curran WJ.
Department of Radiation Oncology, Hospital of the University of
Pennsylvania, Philadelphia, PA, USA. lustig@xrt.upenn.edu
The purpose of this study was to evaluate the potential selection bias using
stereotactic eligibility as a criteria for participation in studies of
glioblastoma multiforme. Radiation Therapy Oncology Group (RTOG) 90-06
comparing 60 Gy in 30 fractions with BCNU and 72 Gy in 60 fractions with
BCNU was analyzed based on eligibility criteria used to enter patients on
RTOG 93-05 using a stereotactic boost for patients with glioblastoma. Five
hundred nine patients with histopathologically confirmed glioblastoma
multiforme were analyzed; of these, 137 met criteria for 93-05 and 372 did
not. Recursive partitioning analysis (RPA) was used to evaluate for
differences. The RPA distribution in stereotactic radiosurgery
(SRS)-eligible and -ineligible patients was similar. The median survival for
RPA class 3 SRS-eligible patients was 1.4 years and -ineligible patients 1.4
years. For RPA class 4, the median survival was 1.0 years for eligible
patients and 0.9 years for ineligible patients (P = 0.0421). For class 5
patients, the median survival was 8.3 months versus 7.2 months (P = 0.09).
RPA class 6 patients had a median survival of 1.7 months versus 2.7 months
for ineligible patients (P = 0.199). By analyzing previously randomized
patients in a study not using a stereotactic boost, there does not appear to
be a survival benefit for those patients who fit the criteria for
consideration of a stereotactic boost in patients with glioblastoma
multiforme.
PMID: 15596923 [PubMed - in process]
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| 2: Am J Clin Oncol. 2004 Oct;27(5):505-9. |
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Recursive partitioning analysis classifications I and II:
applicability evaluated in a randomized trial for resected single brain
metastases.
Regine WF, Rogozinska A, Kryscio RJ, Tibbs PA, Young AB, Patchell RA.
Department of Radiation Medicine, University of Kentucky, Lexington,
Kentucky, USA. wregine@umm.edu
PURPOSE: Radiation Therapy Oncology Group (RTOG) recursive partitioning
analysis (RPA) prognostic classes I and II for patients with brain
metastases is derived from a database made up primarily of patients with
unresected and multiple metastases. An analysis of a previously published
randomized trial was performed to determine the applicability of these RPA
prognostic classes in the setting of resection of single metastases to the
brain. PATIENTS AND METHODS: Ninety-five patients with single metastases to
the brain that were treated with complete surgical resection entered this
study. Patients were randomly assigned to treatment with postoperative whole
brain radiotherapy (WBRT) (n = 49 patients) or no further brain treatment (n
= 46 patients). All patients entered on this study had a Karnofsky
performance status of > or =70. Therefore, although the RTOG RPA has 3
classes, only patients with RPA classes I (n = 26) or II (n = 69) were
eligible for this study analysis. RESULTS: For RPA class I, the median
survival was 10.9 months versus 9.8 months for class II patients (P = 0.45).
Multivariate analysis showed that only postoperative WBRT, independent of
RPA class I or II, lessened the risk of brain tumor recurrence (P <
0.0001). CONCLUSION: This analysis of a randomized trial evaluating
postoperative WBRT in the treatment of single metastases to the brain showed
no difference in survival between RPA class I or II patients. In addition,
the use of postoperative WBRT after complete surgical resection of single
brain metastases results in substantially better control of disease in the
brain independent of RPA classes I or II.
PMID: 15596921 [PubMed - in process]
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| 3: Am J Clin Oncol. 2004 Oct;27(5):452-6. |
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Role of her-2/neu overexpression and clinical features at
presentation as predictive factors in meningiomas.
Potti A, Panwalkar A, Langness E, Sholes K, Tendulkar K, Chittajalu S,
Koch M.
Division of Hematology, Duke University Medical Center, Durham, NC, USA.
anil.potti@duke.edu
Prediction of outcome in patients with meningiomas remains a significant
problem to date. We have evaluated the role of symptoms at presentation and
overexpression of her-2/neu overexpression as independent prognostic factors
in meningiomas. In a retrospective study on patients with biopsy-proven
diagnosis of meningioma, her-2/neu overexpression was evaluated using
immunohistochemistry (IHC) performed on paraffin-embedded specimens. An IHC
score of > or =2+ was considered positive for overexpression. Two hundred
thirty-seven patients thus identified between January 1986 and December 1999
included 149 females and 88 males, with a mean age of 63.44 years. Survival
was estimated using the Kaplan-Meier method. Incidence of meningiomas in
females (62.8%) was significantly greater than in males. Focal
neurodeficits, headache, and seizures (39.66%) were the most common
presenting complaints and were not related to tumor behavior/outcome.
Syncope at presentation was associated with a decreased survival, but this
symptom constituted only 2.53% of the total, so reliable conclusions could
not be drawn. Only 6 (2.53%) specimens revealed HER-2/neu overexpression by
IHC. HER-2/neu overexpression is not a predictor of tumor behavior and has
no role as a prognostic factor in meningiomas. Syncope as the clinical
presentation at diagnosis may predict a poor outcome, but needs further
investigation.
PMID: 15596909 [PubMed - in process]
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| 4: Am J Clin Oncol. 2004 Oct;27(5):441-4. |
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Long-term survival after gamma knife radiosurgery for
primary and metastatic brain tumors.
Jagannathan J, Petit JH, Balsara K, Hudes R, Chin LS.
Department of Neurological Surgery, University of Maryland Medical Center,
Baltimore, MD 21201-1595, USA.
In this paper, we studied factors related to long-term survival after gamma
knife radiosurgery (GKS) for primary and metastatic brain tumors. We
examined all cases of brain metastases and malignant glioma treated with GKS
between September 1994 and December 1998. All patients with survival
exceeding 2 years were studied retrospectively using prospectively acquired
data. A total of 22 patients, with an average age of 56, were identified,
which accounts for 11% of the total patients treated during this time
interval. Seventeen of 22 are still alive with a mean follow-up of 48
months. Sixteen patients had metastatic tumors, whereas 6 had a malignant
glioma. Thirteen of 15 patients with metastases had a controlled primary
site, and the other 2 patients did not have a primary site identified. These
2 patients were among the 3 that died during the follow-up period. Fourteen
patients developed symptomatic radiation necrosis by MRI criteria with 4
confirmed by biopsy. Quality-of-life factors were assessed in 20 of 22
patients using a modified Spitzer scale, which showed a high level of
functioning in all of the long-term survivors (mean score 8.65 of 10), and
only 1 patient had a Karnofsky Performance Score of less than 70. We
conclude that radiosurgery provides a noninvasive and effective way of
controlling brain tumors, while preserving quality of life.
PMID: 15596906 [PubMed - in process]
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| 5: Arch Neurol. 2004 Dec;61(12):1948-52. |
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Recovery of anterograde amnesia in a case of
craniopharyngioma.
Kupers RC, Fortin A, Astrup J, Gjedde A, Ptito M.
PET Center, Center for Functionally Integrative Neuroscience, Aarhus
University and University Hospital, Norrebrogade 44, Building 30, DK-8000
Aarhus, Denmark. ron@pet.auh.dk
BACKGROUND: Studies of the amnesic syndrome have indicated that
telencephalic and diencephalic structures are critical components of the
memory system. The exact role of the mammillary bodies (MBs) in human memory
remains elusive, since few cases of selective MB damage have been reported.
OBJECTIVE: To study a case of severe anterograde amnesia due to a
third-ventricle craniopharyngioma with severe MB compression. DESIGN: Case
report. SETTING: Neurosurgery clinic of an academic hospital. PATIENT: A
53-year old woman who developed severe anterograde amnesia due to a
third-ventricle craniopharyngioma strongly compressing the MBs and, to a
lesser extent, the right hippocampus. INTERVENTIONS: Surgical excision of
the tumor and neuropsychological testing and positron emission tomography
during an associative memory test before and 2 months after tumor removal. A
postsurgical magnetic resonance image did not show evidence of damage to the
hypothalamus, thalamus, hippocampus, or MBs. MAIN OUTCOME MEASURES: Changes
in brain imaging data and results of neuropsychological testing. RESULTS:
After tumor removal, the patient showed a complete recovery of memory
functions. Performance on the associative memory test was at chance level
before surgery and dramatically improved postoperatively. Results of the
preoperative positron emission tomographic study showed no activity in
memory-related structures. In contrast, a significant blood flow increase
occurred in the anterior thalamic nuclei postoperatively. CONCLUSIONS: These
behavioral and brain imaging data stress the importance of the MBs in this
patient's amnesia. Our data further suggest that the clinical prognosis of
decompressing the mammillothalamic tract is excellent, even in cases of
massive compression.
PMID: 15596618 [PubMed - in process]
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| 6: Arch Neurol. 2004 Nov;61(11):1790. |
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Ring enhancement after hemorrhagic stroke.
Wong AA, Henderson RD, O'Sullivan JD, Read SJ, Rajah T.
Department of Neruology, Royal Brisbane and Women's Hospital, Herston,
Queensland, Australia. andrewa_wong@health.qld.gov.au
Publication Types:
PMID: 15534191 [PubMed - indexed for MEDLINE]
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| 7: Arch Pathol Lab Med. 2004 Jul;128(7):749-58. |
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Textiloma (gossypiboma) mimicking recurrent intracranial
tumor.
Ribalta T, McCutcheon IE, Neto AG, Gupta D, Kumar AJ, Biddle DA, Langford
LA, Bruner JM, Leeds NE, Fuller GN.
Department of Pathology, Hospital Clinic, Institut d'Investigacions
Biomediques August Pi i Suner (IDIBAPS), Universitat de Barcelona,
Barcelona, Spain.
CONTEXT: Resorbable substances used to achieve hemostasis during
neurosurgical procedures comprise 3 principal classes based on chemical
composition: (1) gelatin sponge, (2) oxidized cellulose, and (3)
microfibrillar collagen. Nonresorbable hemostatic aides include various
forms of cotton and rayon-based hemostats (cottonoids and kites). Resorbable
and nonresorbable hemostatic agents have been reported to cause symptomatic
mass lesions, most commonly following intra-abdominal surgery. Histologic
examination typically shows a core of degenerating hemostatic agent
surrounded by an inflammatory reaction. Each agent exhibits distinctive
morphologic features that often permit specific identification.
Hemostat-associated mass lesions have been variously referred to as
textilomas, gossypibomas, gauzomas, or muslinomas. OBJECTIVES: The aims of
this study were to (1) identify cases of histologically proven cases of
textiloma in neurosurgical operations, (2) characterize the specific
hemostatic agent associated with textiloma formation, and (3) characterize
the preoperative magnetic resonance imaging appearance of textiloma. DESIGN:
Cases in which a textiloma constituted the sole finding on repeat surgery
for recurrent brain tumor, or was a clinically significant component of a
radiologically identified mass lesion together with residual tumor,
constituted the study set. RESULTS: Five textilomas were identified and
evaluated. The primary neoplasm was different in each case and included
pituitary adenoma, tanycytic ependymoma, anaplastic astrocytoma,
gliosarcoma, and oligodendroglioma. In all cases, preoperative magnetic
resonance imaging suggested recurrent tumor. Textilomas included all
categories of resorbable hemostatic agent. Other foreign bodies were present
in some cases; the origin of these foreign bodies was traced to fibers shed
from nonresorbable hemostatic material placed temporarily during surgery and
removed before closure (cottonoids and kites). Inflammatory reactions
included giant cells, granulomas, and fibroblastic proliferation.
Microfibrillar collagen (Avitene) textilomas were associated with a striking
eosinophil infiltration that was not seen with any other hemostatic agent.
CONCLUSIONS: Hemostatic agents may produce clinically symptomatic,
radiologically apparent mass lesions. When considering a mass lesion arising
after intracranial surgery, the differential diagnosis should include
textiloma along with recurrent tumor and radiation necrosis.
PMID: 15214828 [PubMed - indexed for MEDLINE]
 http://arpa.allenpress.com/pdfserv/10.1043/1543-2165(2004)128<749:TGMRIT>2.0.CO;2
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| 8: Arch Pathol Lab Med. 2004 Jul;128(7):776-80. |
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Oncocytic transformation in pituitary adenomas:
immunohistochemical analyses of 65 cases.
Niveiro M, Aranda FI, Paya A, Boix E, Peiro G, Pico A.
Department of Pathology, General Universitary Hospital of Alicante, Pintor
Baeza s/n, 03010-Alicante, Spain.
CONTEXT: Oncocytic change in pituitary adenomas has been evaluated by
electron microscopy and more recently by immunohistochemistry. The clinical
significance of this change is not well known, although some reports suggest
a relationship with more aggressive behavior. OBJECTIVE: To assess the
frequency of oncocytic change in pituitary adenomas and to correlate this
finding with clinicopathologic factors. DESIGN: We studied oncocytic change
in a series of 65 pituitary adenomas by immunohistochemistry. According to
the percentage of oncocytic cells stained by antimitochondrial antibody,
adenomas were classified in 3 groups: 50% or more, 10% to 49%, and 1% to 9%
of oncocytic cells. RESULTS: Eight cases (12.3%) showing at least 50% of
oncocytic cells were classified as oncocytic adenomas: 6 were gonadotroph
adenomas and 2 were null-cell adenomas. Among the remaining cases, 9 (14%;
all gonadotroph adenomas) showed 10% to 49% oncocytic cells, and in 14 cases
(21.5%; 5 gonadotroph adenomas, 6 somatotroph adenomas, 2 corticotroph
adenomas, and 1 thyrotroph adenoma) between 1% and 9% were shown. Patients
with adenomas that showed oncocytic change presented more frequently at a
higher average age (P =.05), but no relationship with extrasellar extension
or proliferative activity measured by Ki-67 was observed. In somatotroph
adenomas, cases with oncocytic change showed higher percentages of Ki-67 (P
=.05) but no correlation with extrasellar extension or cytokeratin staining
(dot pattern versus perinuclear) was found. CONCLUSION: Adenomas with
oncocytic change present more frequently in older patients, but they are not
clinically more aggressive. In addition, somatotroph adenomas with oncocytic
cells show similar cytokeratin pattern and higher proliferative activity,
which is not correlated with local aggressiveness.
PMID: 15214824 [PubMed - indexed for MEDLINE]
http://arpa.allenpress.com/pdfserv/10.1043/1543-2165(2004)128<776:OTIPAI>2.0.CO;2
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| 9: Arch Pathol Lab Med. 2004 Jul;128(7):811-2. |
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Pathologic quiz case: back pain in a 48-year-old woman.
Myxopapillary ependymoma.
Berns SM, Wiacek M, Pearl GS.
Department of Pathology, Orlando Regional Health Care, Orlando, Fla 32806,
USA. stephenmberns@aol.com
Publication Types:
PMID: 15214814 [PubMed - indexed for MEDLINE]
http://arpa.allenpress.com/pdfserv/10.1043/1543-2165(2004)128<811:PQCBPI>2.0.CO;2
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| 10: Br J Cancer. 2004 Sep 13;91(6):1105-11. |
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Identification of two contiguous minimally deleted
regions on chromosome 1p36.31-p36.32 in oligodendroglial tumours.
Dong Z, Pang JS, Ng MH, Poon WS, Zhou L, Ng HK.
1Department of Anatomical and Cellular Pathology, Prince of Wales Hospital,
The Chinese University of Hong Kong, Hong Kong, China.
Loss of the short arm of chromosome 1 is a hallmark of oligodendroglial
tumours (OTs). Deletion mapping studies in OTs have revealed multiple
commonly deleted regions on chromosome 1p, suggesting that there are more
than one tumour suppressor gene. To map critical deletion regions on 1p, a
series of 25 OTs were examined for loss of heterozygosity (LOH) on 19
polymorphic markers across the 1p arm using microsatellite analysis. Our
study revealed that 60% of tumours had LOH of all informative markers on 1p
and identified one tumour showing LOH at telomeric markers only. Since this
deletion region lies in one of the critical deletion intervals defined
previously, we then screened another series of 27 OTs specifically at 1p36.3
for LOH using nine polymorphic markers. A total of 12% (six out of 52) of
tumours were found to carry interstitial deletions. The allelic status and
the deletion breakpoints in these tumours with interstitial deletion were
further verified by fluorescent in situ hybridisation. The small overlapping
intervals facilitated the delineation of two contiguous minimally deleted
regions of 0.76 Mb, defined by D1S468 and D1S2845, and of 0.41 Mb, bound by
D1S2893 and D1S1608, on 1p36.31-36.32. Based on current reference human
genome sequence these deletion regions have been sequenced almost to
entirety and contain eight annotated genes. TP73, DFFB and SHREW1 are the
only known genes located in these deletion regions, while the others are
uncharacterised novel genes. In conclusion, our study has narrowed down the
critical tumour suppressor loci on 1p36.3, in which two minimally deleted
regions are mapped, and markedly reduced the number of candidate genes to be
screened for their involvement in OT development.
PMID: 15475940 [PubMed - indexed for MEDLINE]
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| 11: Cancer Genet Cytogenet. 2004 Oct 15;154(2):131-7. |
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Positional gene expression analysis identifies 12q
overexpression and amplification in a subset of neuroblastomas.
Su WT, Alaminos M, Mora J, Cheung NK, La Quaglia MP, Gerald WL.
Department of Surgery, Division of Pediatric Surgery, Memorial
Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Neuroblastoma is a heterogeneous disease with variable clinical behaviors.
Unique molecular features are associated with clinically relevant subgroups.
We performed a comprehensive microarray gene expression analysis of 95
neuroblastomas in an effort to define clinically important molecular
subtypes. A subset of tumors overexpressed several contiguous genes located
at 12q13 approximately q15 and were studied further. By microarray, 5 of 95
neuroblastomas had overexpression of genes mapped to 12q13.1 approximately
q15, suggesting an amplification event in this region. Positional expression
mapping identified the narrowest region of overlap containing 21 genes, with
11 genes overexpressed in all five cases. Fluorescence in situ hybridization
demonstrated 3 neuroblastomas with more than a 10-fold increase in 12q gene
copies and 9 with 3- to 5-fold increases. Amplification and overexpression
of genes at 12q13 approximately q15 were observed in a small subset of
neuroblastomas. Although amplification of 12q has been previously reported
in neuroblastoma cell lines, this is the first demonstration in tumor
samples, and it defines a distinct subset that has not been described
previously. The expressed genes mapped closely to the complex amplicon
reported in sarcomas, and they identify critical genes and pathways affected
by 12q gene amplification.
PMID: 15474148 [PubMed - indexed for MEDLINE]
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| 12: Cancer Res. 2004 Oct 15;64(20):7513-25. |
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Modulation of gene expression in human central nervous
system tumors under methionine deprivation-induced stress.
Kokkinakis DM, Liu X, Chada S, Ahmed MM, Shareef MM, Singha UK, Yang S,
Luo J.
The University of Pittsburgh Cancer Institute and the Department of
Pathology, Hillman Cancer Institute, Pittsburgh, Pennsylvania, USA.
Methionine deprivation imposes a metabolic stress, termed methionine stress,
that inhibits mitosis and induces cell cycle arrest and apoptosis. The
methionine-dependent central nervous system tumor cell lines DAOY
(medulloblastoma), SWB61 (anaplastic oligodendroglioma), SWB40 (anaplastic
astrocytoma), and SWB39 (glioblastoma multiforme) were compared with
methionine-stress resistant SWB77 (glioblastoma multiforme). The
cDNA-oligoarray analysis and reverse transcription-PCR verification
indicated common changes in gene expression in methionine-dependent cell
lines to include up-regulation/induction of cyclin D1, mitotic arrest
deficient (MAD)1, p21, growth arrest and DNA-damage-inducible (GADD)45
alpha, GADD45 gamma, GADD34, breast cancer (BRCA)1, 14-3-3sigma, B-cell
CLL/lymphoma (BCL)1, transforming growth factor (TGF)-beta, TGF-beta-induced
early response (TIEG), SMAD5, SMAD7, SMAD2, insulin-like growth factor
binding protein (IGFBP7), IGF-R2, vascular endothelial growth factor (VEGF),
TNF-related apoptosis-inducing ligand (TRAIL), TNF-alpha converting enzyme
(TACE), TRAIL receptor (TRAIL-R)2, TNFR-related death receptor (DR)6, TRAF
interacting protein (I-TRAF), IL-6, MDA7, IL-1B convertase (ICE)-gamma,
delta and epsilon, IRF1, IRF5, IRF7, interferon (IFN)-gamma and receptor
components, ISG15, p65-NF-kappaB, JUN-B, positive cofactor (PC)4,
C/ERB-beta, inositol triphosphate receptor I, and methionine
adenosyltransferase II. On the other hand, cyclins A1, A2, B1 and B2, cell
division cycle (CDC)2 and its kinase, CDC25 A and B, budding uninhibited by
benzimidazoles (BUB)1 and 3, MAD2, CDC28 protein kinase (CKS)1 and 2,
neuroepithelial cell transforming gene (NET)1, activator of S-phase kinase
(ASK), CDC14B phosphatase, BCL2, TGF-beta activated kinase (TAK)1, TAB1,
c-FOS, DNA topoisomerase II, DNA polymerase alpha, dihydrofolate reductase,
thymidine kinase, stathmin, and MAP4 were down-regulated. In the methionine
stress-resistant SWB77, only 20% of the above genes were affected, and then
only to a lesser extent. In addition, some of the changes observed in SWB77
were opposite to those seen in methionine-dependent tumors, including
expression of p21, TRAIL-R2, and TIEG. Despite similarities, differences
between methionine-dependent tumors were substantial, especially in regard
to regulation of cytokine expression. Western blot analysis confirmed that
methionine stress caused the following: (a) a marked increase of GADD45alpha
and gamma in the wt-p53 cell lines SWB61 and 40; (b) an increase in GADD34
and p21 protein in all of the methionine-dependent lines; and (c) the
induction of MDA7 and phospho-p38 in DAOY and SWB39, consistent with marked
transcriptional activation of the former under methionine stress. It was
additionally shown that methionine stress down-regulated the highly active
phosphatidylinositol 3'-kinase pathway by reducing AKT phosphorylation,
especially in DAOY and SWB77, and also reduced the levels of retinoblastoma
(Rb) and pRb (P-ser780, P-ser795, and P-ser807/811), resulting in a shift in
favor of unphosphorylated species in all of the methionine-dependent lines.
Immunohistochemical analysis showed marked inhibition of nuclear
translocation of nuclear factor kappaB under methionine stress in
methionine-dependent lines. In this study we show for the first time that
methionine stress mobilizes several defined cell cycle checkpoints and
proapoptotic pathways while coordinately inhibiting prosurvival mechanisms
in central nervous system tumors. It is clear that methionine stress-induced
cytotoxicity is not restricted by the p53 mutational status.
PMID: 15492278 [PubMed - indexed for MEDLINE]
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| 13: Childs Nerv Syst. 2004 Jul;20(7):499-501. |
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A non-infantile case of desmoplastic infantile
astrocytoma.
Kato M, Yano H, Okumura A, Shinoda J, Sakai N, Shimokawa K.
Department of Neurosurgery, Gifu University School of Medicine, 40
Tsukasa-machi, 500-8705 Gifu, Japan. masayasu@cc.gifu-u.ac.jp
CASE REPORT: We describe a very rare non-infantile case of desmoplastic
infantile astrocytoma (DIA). A 9-year-old boy presented with motor weakness
and sensory disturbance in his right upper and lower limbs. CT and MRI
showed a contrast-enhanced large cystic tumor in the left sensorimotor area.
We successfully resected the entire tumor. Its histopathological features
were typical of DIA. OUTCOME: The patient's neurological symptoms improved
postoperatively. Neither radiotherapy nor chemotherapy was used
postoperatively. The patient developed normally and had been doing well for
12 months after surgery without tumor recurrence.
Publication Types:
PMID: 14997329 [PubMed - indexed for MEDLINE]
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| 14: Childs Nerv Syst. 2004 Jul;20(7):494-5. |
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Late appearance of hydrocephalus associated with
posttraumatic intradiploic arachnoid cyst.
Kadri H, Mawla AA.
Division of Pediatric Neurosurgery, Department of Neurosurgery, Moassat
University Hospital, Mazza Street, Damascus, Syria. drkadri@hotmail.com
CASE REPORT: We present a case of a posttraumatic intradiploic arachnoid
cyst associated with hydrocephalus in a 16-year-old boy. The diagnosis was
missed 2 years previously, when an MRI following a transient gait
disturbance failed to show the intradiploic extension of the cyst. He
presented to us with hydrocephalus and a CT scan clearly identified the
intradiploic position of the cyst. OUTCOME: A fenestration between the
lateral ventricle and the cyst with aqueductoplasty and ETV were performed
with good results.
Publication Types:
PMID: 14986043 [PubMed - indexed for MEDLINE]
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| 15: Childs Nerv Syst. 2004 Jul;20(7):485-8. |
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Hydrocephalus due to cerebrospinal fluid overproduction
by bilateral choroid plexus papillomas.
Fujimura M, Onuma T, Kameyama M, Motohashi O, Kon H, Yamamoto K, Ishii K,
Tominaga T.
Department of Neurosurgery, Tohoku University Graduate School of Medicine,
1-1 Seiryo-machi, 980-8574 Aoba-ku, Sendai, Japan.
fujimur@nsg.med.tohoku.ac.jp
CASE REPORT: A 10-month-old boy, with congenital deafness and blindness
associated with chromosomal deletion [46XY, del(13)(q32)], presented with
intractable ascites 9 months after ventriculo-peritoneal shunting for
congenital hydrocephalus. Revision of the ventriculo-atrial shunt resulted
in shunt failure 1 month later. External ventricular drainage revealed
cerebrospinal fluid (CSF) overproduction (2,000 ml/day). Magnetic resonance
imaging showed marked lobular enlargement of the bilateral choroid plexuses
extending from the trigone to the body and inferior horn of the lateral
ventricle. Multi-staged resection was performed via bilateral
temporo-occipital transcortical approaches, and CSF production significantly
decreased to 100 ml/day postoperatively. Histological assessment of the
villous surface suggested villous hyperplasia of the choroid plexus and
thorough evaluation including the proximal portion of the lobular lesion
near the attachment revealed choroid plexus papilloma. He was discharged
after ventriculo-peritoneal shunting without additional neurological
deficits except for hyperreflexia of the left extremities. CONCLUSION: CSF
overproduction caused by bilateral choroid plexus papillomas can result in
hydrocephalus. Radical resection of the bilateral ventricular lesions should
be considered for this entity. Thorough evaluation of the surgical specimen
is recommended because histological examination of only the lobular surface
of the choroid plexus lesion may fail to identify choroid plexus neoplasm.
Publication Types:
PMID: 14986042 [PubMed - indexed for MEDLINE]
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| 16: Clin Cancer Res. 2004 May 15;10(10):3528-34. |
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Imatinib mesylate efficiently achieves therapeutic
intratumor concentrations in vivo but has limited activity in a xenograft
model of small cell lung cancer.
Wolff NC, Randle DE, Egorin MJ, Minna JD, Ilaria RL Jr.
Division of Hematology/Oncology, Department of Medicine, Simmons Cancer
Center , University of Texas Southwestern Medical Center, Dallas, Texas
75390, USA.
PURPOSE: Despite recent advances in cancer therapy, long-term survival in
small cell lung cancer (SCLC) remains uncommon, underscoring the need for
novel therapeutic approaches. Previous studies have identified constitutive
expression of the receptor tyrosine kinase, c-Kit, and its ligand, stem cell
factor, in a substantial proportion of SCLC specimens. The purpose of this
study was to determine whether imatinib mesylate, an inhibitor of c-Kit,
could achieve therapeutic concentrations in tumors and in brain (a frequent
site of SCLC metastasis) and interfere with SCLC tumor growth in vivo.
EXPERIMENTAL DESIGN: Human SCLC tumor cell lines with constitutive c-kit
expression and tyrosine phosphorylation (NCI-H209, NCI-H526, and NCI-H1607)
were used to establish SCLC tumor xenografts in NCr nude
(nu/nu)-immunodeficient mice. SCLC tumor-bearing mice were randomly assigned
to imatinib or control (water) administered twice a day by oral gavage.
Imatinib concentrations in plasma, brain, and tumor were quantitated and
correlated with tumor response. RESULTS: Therapeutic concentrations of
imatinib were achieved in plasma and tumor xenografts but not in the brain.
Imatinib blocked the constitutive activation of c-kit in SCLC tumor cell
lines in vitro but had a negligible effect on SCLC xenograft growth in vivo.
CONCLUSIONS: Orally administered imatinib rapidly reaches therapeutic
concentrations in SCLC xenografts, suggesting the feasibility of combining
imatinib with other novel or traditional chemotherapeutic agents in SCLC or
other solid tumors. The c-Kit signaling pathway does not appear to play a
critical role in SCLC proliferation and viability in vivo, however,
suggesting that imatinib is unlikely to be effective as monotherapy for
SCLC.
PMID: 15161712 [PubMed - indexed for MEDLINE]
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| 17: Int J Cancer. 2004 Dec 20;112(6):1081-2. |
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Pdgfr-alpha in 1p/19q LOH oligodendrogliomas.
Hartmann C, Xu X, Bartels G, Holtkamp N, Gonzales IA, Tallen G, von
Deimling A.
Publication Types:
PMID: 15386438 [PubMed - indexed for MEDLINE]
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| 18: Int J Radiat Oncol Biol Phys. 2004 Dec 1;60(5):1515-9. |
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Factors predicting local tumor control after gamma knife
stereotactic radiosurgery for benign intracranial meningiomas.
Dibiase SJ, Kwok Y, Yovino S, Arena C, Naqvi S, Temple R, Regine WF, Amin
P, Guo C, Chin LS.
Department of Radiation Oncology, Cooper University Hospital, Camden, NJ.
PURPOSE: To determine the long-term outcomes and prognostic factors in
benign intracranial meningiomas treated with gamma knife stereotactic
radiosurgery (GK-SRS). METHODS AND MATERIALS: Between 1992 and 2000, 162
patients with benign meningiomas were treated with GK-SRS at the University
of Maryland Medical Center. Complete follow-up was available in 137
patients. All patients underwent magnetic resonance imaging (MRI)-based
treatment planning. Serial MRIs and clinical exams were performed to assess
tumor response. GK-SRS was the primary treatment in 85 patients (62%),
whereas 52 patients (48%) had prior surgical resections. The median
prescribed dose was 14 Gy (range, 4-25 Gy) to the 50% isodose line. The
median tumor volume, treatment volume, and conformity index were 4.5 cc
(range, 0.32-80.0 cc), 6.3 cc (range, 1.0-75.2 cc), and 1.34 (range,
0.65-3.16), respectively. The median follow-up for the entire cohort was 4.5
years (range, 0.33-10.5 years). The following factors were included in the
statistical analysis for disease-free survival (DFS) and overall survival
(OS): sex, age, dose, gross tumor volume (GTV), conformity index (CI), and
dural tail coverage. RESULTS: Serial MRI analysis was available in 121
patients (88.3%). Decrease in tumor size was observed in 34 patients
(28.1%), whereas there was no change in 77 patients (63.6%), for a crude
radiographic control rate of 91.7%. Increase in tumor size was seen in 10
patients (8.3%). New neurologic deficits attributed to the treatment
developed in 10 patients (8.3%). The mean DFS and OS for the entire cohort
are 4.6 years and 5.0 years, respectively. The 5-year actuarial DFS and OS
were 86.2% and 91.0%, respectively. Univariate analysis revealed GTV, sex,
CI, and dural tail treatment to be significant prognostic factors. Patients
with GTV </=10 cc also had longer survivals, with the 5-years DFS and OS
of 91.9% vs. 68.0% (p = 0.038) and 100% vs. 59.7% (p = 0.0001),
respectively. The 5-years actuarial DFS and OS for females vs. males were
90.2% vs. 74.2% (p = 0.0094) and 91.6% vs. 89.1% (p = 0.016), respectively.
Patients with CI >/=1.4 achieved a longer DFS, with a 5-year DFS of 95.2%
vs. 77.3% (p = 0.01). Patients who had the dural tail treated also had
higher 5-year DFS (96.0% vs. 77.9%, p = 0.038). Patients with lower
conformity (i.e., CI >/=1.4) tended to have the dural tail covered in the
prescription isodose line (p = 0.04). The only factor significant in the
multivariate analysis was for patients with GTV >10 cc, who had a worse
DFS (hazard ratio 4.58, p = 0.05). CONCLUSIONS: This report adds to the
literature that supports the efficacy and safety of GK-SRS in the management
of patients with benign intracranial meningiomas. Our report identified male
patients, patients with a CI <1.4, and tumor size greater than 10 cc to
have a worse prognosis. Patients who were treated with less conformal plans
to cover the dural tail had better outcomes. Our data clearly demonstrate
the need to adequately cover the dural tail in patients treated with GK-SRS
for benign intracranial meningiomas.
PMID: 15590183 [PubMed - in process]
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| 19: Int J Radiat Oncol Biol Phys. 2004 Nov 15;60(4):1314-24. |
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Dose conformation of intensity-modulated stereotactic
photon beams, proton beams, and intensity-modulated proton beams for
intracranial lesions.
Baumert BG, Norton IA, Lomax AJ, Davis JB.
Radiation-Oncology, University Hospital Zurich, Zurich, Switzerland.
brigitta.baumert@maastro.nl
PURPOSE: This study evaluates photon beam intensity-modulated stereotactic
radiotherapy (IMSRT) based on dynamic leaf motion of a micromultileaf
collimator (mMLC), proton beams, and intensity-modulated proton therapy
(IMPT) with respect to target coverage and organs at risk. METHODS AND
MATERIALS: Dose plans of 6 stereotactically treated patients were
recalculated for IMSRT by use of the same field setup and an inverse
planning algorithm. Proton and IMPT plans were calculated anew. Three
different tumor shapes, multifocal, ovoid, and irregular, were analyzed, as
well as dose to organs-at-risk (OAR) in the vicinity of the planning target
volume (PTV). Dose distributions were calculated from beam-setup data for a
manual mMLC for stereotactically guided conformal radiotherapy (SCRT), a
dynamic mMLC for IMSRT, the spot-scanning technique for protons, and a
modified spot-scanning technique for IMPT. SCRT was included for a part of
the comparison. Criteria for assessment were PTV coverage, dose-volume
histograms (DVH), volumes of specific isodoses, and the dose to OAR.
RESULTS: Dose conformation to the PTV is equally good for all three
techniques and tumor shapes considered. The volumes of the 90% and 80%
isodose were comparable for all techniques. For the 50% isodose volume, a
divergence between the two modes was seen. In 3 cases, this volume is
smaller for IMSRT, and in the 3 other cases, it is smaller for IMPT. This
difference was even more pronounced for the volumes of the 30% isodose; IMPT
shows further improvement over conventional protons. OAR in concavities
(e.g., the brainstem) were similarly well spared by protons and IMSRT. IMPT
spares critical organs best. Fewer proton beams are required to achieve
similar results. CONCLUSIONS: The addition of intensity modulation improves
the conformality of mMLC-based SCRT. Conformation of dose to the PTV is
comparable for IMSRT, protons, and IMPT. Concerning the sparing of OAR,
IMSRT is equivalent to IMPT, and IMPT is superior to conventional protons.
The advantage of protons lies in the lower integral dose.
Publication Types:
PMID: 15519805 [PubMed - indexed for MEDLINE]
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| 20: J Clin Oncol. 2004 Nov 15;22(22):4649-51. |
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Complications of therapy in cancer patients: Case 3.
Toxic epidermal necrolysis induced by oral phenobarbital and whole-brain
radiotherapy in a breast cancer patient.
Vincenzi B, Santini D, Grilli C, La Cesa A, Dianzani C, Tonini G.
University Campus Bio-Medico, Rome, Italy.
Publication Types:
PMID: 15542817 [PubMed - indexed for MEDLINE]
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| 21: J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1636-8. |
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Intramedullary tuberculoma mimicking primary CNS
lymphoma.
Mohit AA, Santiago P, Rostomily R.
Department of Neurological Surgery, University of Washington School of
Medicine, Seattle, USA. abmohit@u.washington.edu
The incidence of primary central nervous system lymphoma (PCNSL) has been on
the rise in the setting of immunodeficiency syndromes such as acquired
immune deficiency syndrome (AIDS). Its diagnosis has been facilitated by the
advent of a cerebrospinal fluid (CSF) Epstein-Barr virus (EBV) PCR assay.
The reported high sensitivity and specificity of this assay has made it the
cornerstone of diagnosis of PCNSL, replacing more traditional methods such
as an open CNS biopsy. Here, we have described a patient with a known
history of C3 AIDS presenting with lower extremity weakness and eventual
myelopathy who was later diagnosed as having intramedullary PCNSL after
detection of EBV DNA in his CSF. After failing to respond to radiotherapy,
he underwent a spinal cord biopsy revealing intramedullary tuberculoma. This
case illustrates the risk of misdiagnosis with this assay and the importance
of histological confirmation of a pathological lesion prior to
implementation of therapy.
Publication Types:
PMID: 15489405 [PubMed - indexed for MEDLINE]
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| 22: J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1632-5. |
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Effects of dexamethasone on peritumoural oedematous
brain: a DT-MRI study.
Sinha S, Bastin ME, Wardlaw JM, Armitage PA, Whittle IR.
Neurosciences, Western General Hospital, Crewe Road, Edinburgh, EH4 2XU, UK.
OBJECTIVES: Glucocorticoids (dexamethasone) are thought to reduce
peritumoural brain oedema by decreasing the permeability of neoplastic
capillaries and/or enhancing the clearance of extracellular water. Diffusion
tensor magnetic resonance imaging (DT-MRI) was used to measure the water
diffusion parameters of oedematous and normal brain in a group of patients
with intracranial tumours before and after steroid treatment. METHODS:
Fifteen patients with intracranial tumours (seven with high-grade glioma,
four with metastatic carcinoma and four with meningioma) were examined
before and 48-72 h after dexamethasone treatment (16 mg/day). The mean
diffusivity (<D>) and fractional anisotropy (FA) were measured for
oedematous brain and apparently normal contralateral white matter before and
after steroid therapy. RESULTS: In all three patient groups there was a
significant decrease in <D> of oedematous brain after steroid
treatment (p<0.01). There was no significant change in FA of oedematous
brain after treatment in any of the three groups. There was also no
significant change in either <D> or FA of apparently normal
contralateral white matter after treatment. CONCLUSION: These data indicate
that dexamethasone produces a localised reduction in the magnitude of
extracellular water molecule mobility, and hence water content, in
peritumoural oedematous brain. Furthermore, the magnitude of these changes
is similar for both intra- and extra-axial tumours.
PMID: 15489404 [PubMed - indexed for MEDLINE]
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| 23: J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1524-31. |
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Evidence for distinct cognitive deficits after focal
cerebellar lesions.
Gottwald B, Wilde B, Mihajlovic Z, Mehdorn HM.
Department of Neurosurgery, Christian Albrechts Universitat, Kiel, Germany.
b.gottwald@zip-kiel.de
OBJECTIVES: Anatomical evidence and lesion studies, as well as functional
magnetic resonance imaging (fMRI) studies, indicate that the cerebellum
contributes to higher cognitive functions. Cerebellar posterior lateral
regions seem to be relevant for cognition, while vermal lesions seem to be
associated with changes in affect. However, the results remain
controversial. Deficits of patients are sometimes still attributed to motor
impairment. METHODS: We present data from a detailed neuropsychological
examination of 21 patients with cerebellar lesions due to tumour or
haematoma, and 21 controls matched for age, sex, and years of education.
RESULTS: Patients showed deficits in executive function, and in attentional
processes such as working memory and divided attention. Further analysis
revealed that patients with right-sided lesions were in general more
impaired than those with left-sided lesions. CONCLUSIONS: Those hypotheses
that suggest that lesions of the right cerebellar hemisphere lead to verbal
deficits, while those of the left lead to non-verbal deficits, have in part
been confirmed. The generally greater impairment of those patients with a
right-sided lesion has been interpreted as resulting from the connection of
the right cerebellum to the left cerebral hemisphere, which is dominant for
language functions and crucial for right hand movements. Motor impairment
was correlated with less than half of the cognitive measures, with no
stronger tendency for correlation with cognitive tests that require motor
responses discernible. The results are discussed on the basis of an
assumption that the cerebellum has a predicting and preparing function,
indicating that cerebellar lesions lead to a "dysmetria of
thought."
PMID: 15489381 [PubMed - indexed for MEDLINE]
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Volume 3, Supplement 22 - 29 December 2004