| 1: Cancer. 2005 Jan 6; [Epub ahead of print] |
|
-
Cost-effectiveness of proton radiation in the treatment
of childhood medulloblastoma.
Lundkvist J, Ekman M, Ericsson SR, Jonsson B, Glimelius B.
Medical Management Center, Karolinska Institutet, Stockholm, Sweden.
BACKGROUND: Radiation therapy is an important component in the treatment of
medulloblastoma; however, in many patients, it is associated with risk of
late adverse events. Proton radiation therapy has potential to reduce the
risk of adverse events compared with conventional radiation, but it is
associated with a higher treatment cost. The objective of the current study
was to assess the cost-effectiveness of proton therapy compared with
conventional radiation therapy in the treatment of childhood
medulloblastoma. METHODS: The consequences of radiation therapy were
evaluated using a Markov simulation model. Children age 5 years with
medulloblastoma were followed. The patients were at risk of several types of
adverse events, including hearing loss, intelligence quotient (IQ) loss,
hypothyroidism, growth hormone deficiency (GHD), osteoporosis, cardiac
disease, and secondary malignancies. The patients also were at risk of death
and were divided into risk groups for normal death, death due to tumor
recurrence, treatment-related cardiac death, treatment-related subsequent
tumor death, or treatment-related other death. A review of the literature
was conducted to estimate the parameters in the model. RESULTS: The
base-case results showed that proton therapy was associated with 23,600 in
cost savings and 0.68 additional quality-adjusted life-years per patient.
The analyses showed that reductions in IQ loss and GHD contributed to the
greatest part of the cost savings and were the most important parameters for
cost-effectiveness. CONCLUSIONS: The results of the current study indicated
that proton radiation therapy can be cost-effective and cost-saving compared
with conventional radiation therapy in the treatment of children with
medulloblastoma if the appropriate patients are selected for the therapy.
However, there have been few long-term follow-up studies, and more much
information on the long-term consequences of radiation therapy is needed.
Cancer 2005. (c) 2005 American Cancer Society.
PMID: 15637691 [PubMed - as supplied by publisher]
-
| 2: Int J Radiat Oncol Biol Phys. 2005 Jan 1;61(1):185-91. |
|
Temozolomide and concomitant whole brain radiotherapy in
patients with brain metastases: A phase II randomized trial.
Verger E, Gil M, Yaya R, Vinolas N, Villa S, Pujol T, Quinto L, Graus F.
Hospital Clinic and Institut d'Investigacio Biomedica August Pi i Sunyer,
Universitat de Barcelona, Barcelona, Spain.
PURPOSE: To evaluate the safety profile and efficacy of whole brain
radiotherapy (WBRT) concomitantly with temozolomide (TMZ) in patients with
brain metastases (BM). METHODS AND MATERIALS: Patients with BM were randomly
assigned to 30 Gy of WBRT with or without concomitant TMZ (75 mg/m(2)/d)
plus two cycles of TMZ (200 mg/m(2)/d for 5 days). The primary outcome was
analysis of neurologic toxicity. The primary efficacy measures were 90-day
progression-free survival of BM and the radiologic response at Days 30 and
90. RESULTS: We enrolled 82 patients. No neurologic acute toxicity was
observed. Grade 3 or worse hematologic toxicity was seen in 3 patients and
Grade 3 or worse vomiting in 1 patient of the WBRT plus TMZ arm. The
objective response rate at 30 and 90 days and overall survival were similar
in both arms. The percentage of patients with progression-free survival of
BM at 90 days was 54% for WBRT vs. 72% for WBRT and TMZ (p = 0.03). Death
from BM was greater in the WBRT arm (69% vs. 41%, p = 0.03). CONCLUSION: The
concomitant use of RT with TMZ was well tolerated and resulted in
significantly better progression-free survival of BM at 90 days. Although
caution should be used, these results suggest TMZ could improve local
control of BM.
PMID: 15629610 [PubMed - in process]
-
| 3: J Clin Oncol. 2004 Dec 1;22(23):4799-801. |
|
-
Case 1. Metastatic breast cancer presenting with
panhypopituitarism.
Khandwala HM, Mirchandani D, Chibbar R, Chow V.
Department of Medicine, Division of Endocrinology, Pahotlogy and Radiology,
University of Saskatchewan, Saskatchewan, Canada.
Publication Types:
PMID: 15570089 [PubMed - indexed for MEDLINE]
-
| 4: J Clin Oncol. 2004 Dec 1;22(23):4743-51. |
|
-
Short-term efficacy of methylphenidate: a randomized,
double-blind, placebo-controlled trial among survivors of childhood cancer.
Mulhern RK, Khan RB, Kaplan S, Helton S, Christensen R, Bonner M, Brown
R, Xiong X, Wu S, Gururangan S, Reddick WE.
Division of Behavioral Medicine, Department of Hematology/Oncology, St Jude
Children's Research Hospital, Memphis, TN 38105-2794, USA.
raymond.mulhern@stjude.org
PURPOSE: Children surviving acute lymphoblastic leukemia (ALL) and malignant
brain tumors (BTs) have a higher incidence of attention and learning
problems in school than do their healthy peers. The present study tests the
hypothesis that the psychostimulant methylphenidate (MPH) improves cognitive
and social functioning among these patients. PATIENTS AND METHODS: We report
on 83 long-term survivors of ALL and BT identified as having attentional
deficits on behavioral testing and parent or teacher report, and problems
with academic achievement. The 47 male and 36 female patients ranged from
0.6 to 14.3 years (median, 5.4 years) of age at diagnosis and 6.7 to 17.9
years (median, 11.9 years) of age at participation. The patients (40 ALL, 43
BT) participated in a randomized, double-blind, 3-week home cross-over trial
of placebo (bid), low-dose MPH (0.3 mg/kg; maximum dose, 10 mg bid), and
moderate-dose MPH (0.6 mg/kg; maximum dose, 20 mg bid). The primary end
points were weekly teacher and parent reports on the Conners' Rating Scales
and Social Skills Rating System. RESULTS: Compared to placebo, significant
improvement with MPH was reported by teachers and parents on the Conners'
Rating Scales and by teachers on the Social Skills Rating System. However,
no consistent advantage of moderate dose over low dose was observed. Of
those participating, 66 (79.5%) of the 83 patients continued on best
clinical management. CONCLUSION: Treatment with MPH can at least temporarily
reduce some attentional and social deficits among survivors of childhood ALL
and BT. Long-term follow-up will reveal those subsets of patients who are
more likely to benefit from MPH.
Publication Types:
- Clinical Trial
- Randomized Controlled Trial
PMID: 15570081 [PubMed - indexed for MEDLINE]
-
| 5: J Neurosurg. 2004 Dec;101(6):1065-9. |
|
Intracranial metastatic parathyroid carcinoma. Case
report and review of the literature.
Kern M, Lee G, Robbins P, Bynevelt M, Watson P.
Department of Neurosurgery , Radiology, Sir Charles Gairdner Hospital,
University of Western Australia Nedlands, Australia. michael_kern@gmx.de
Parathyroid carcinoma (PTC) is a rare pathological entity, with fewer than
400 reported cases. Intracranial metastasis of a PTC is exceptional; only
five other cases have been identified in the English literature. The authors
present a unique case of a patient with a solitary intracerebral metastasis
of a PTC in an individual presumed to have hereditary hyperparathyroidism
who had concomitant papillary and follicular carcinomas of the thyroid. The
literature relevant to the management of these rare lesions is reviewed and
discussed.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15597772 [PubMed - indexed for MEDLINE]
-
| 6: J Neurosurg. 2004 Dec;101(6):1061-4. |
|
Primary extraskeletal osteosarcoma in the pineal region.
Case report.
Saesue P, Chankaew E, Chawalparit O, Na Ayudhya NS, Muangsomboon S,
Sangruchi T.
Division of Neurosurgery, Department of Surgery, Siriraj Hospital, Mahidol
University, Bangkok, Thailand. sipas@mucc.mahidol.ac.th
Primary extraskeletal osteosarcoma occurring in the brain parenchyma is
distinctly uncommon, with only five cases having been reported. The authors
describe the case of a 45-year-old man who presented with progressive
headache and diplopia. Computerized tomography scanning and magnetic
resonance imaging results revealed a pineal region tumor with obstructive
hydrocephalus. The patient underwent partial resection of the tumor. The
histological examination showed large pleomorphic tumor cells embedded in
osteoid matrix. Immunohistochemical analysis was negative for various
antibodies and thus excluded a glial, germ cell, epithelial, and lymphoid
tumor origin. Only vimentin showed strong positivity in most of the tumor
cells. Ultrastructurally, the tumor cells were rich in dilated rough
endoplasmic reticula. Clear zones between tumor cells and osteoid matrix
were observed. The osteoid matrix was made up of small collagen fibrils and
hydroxyapatite deposits. The tumor was not attached to the bone structure of
the skull. These findings are consistent with the features of extraskeletal
osteosarcoma. Data from complete medical and radiological studies excluded a
metastatic origin for this tumor. Partial resection and postoperative
radiotherapy had provided tumor control at 11 months after the onset of
symptoms. This is the first reported case of a primary extraskeletal
osteosarcoma occurring in the pineal region.
Publication Types:
PMID: 15597771 [PubMed - indexed for MEDLINE]
-
| 7: J Neurosurg. 2004 Dec;101(6):1057-60. |
|
Cavernous hemangioma extending to extracranial,
intracranial, and orbital regions. Case report.
Puca A, Colosimo C, Tirpakova B, Lauriola L, Di Rocco F.
Institute of Neurosurgery, Catholic University Medical School of Rome,
Italy. alfredopuca@tiscali.it
Extraaxial cavernous hemangiomas are rare intracranial lesions that can be
located in different cranial compartments. Extension across different tissue
planes such as the subcutaneous tissue, skull, orbital cavity, intracranial
dura mater, and extracranial trigeminal divisions within the same patient
has not been previously reported. This 32-year-old woman suffered left
exophthalmos, left sixth nerve palsy, and trigeminal neuropathy. Magnetic
resonance imaging studies revealed an extensive multicompartmental lesion,
with enhancement following Gd administration. A left orbitopterional
approach allowed removal of several cavernomatous lesions located in the
orbit, frontotemporal dura, and lateral wall of the cavernous sinus. A
histologically based diagnosis of extraaxial cavernous hemangioma was made.
In the postoperative period the patient experienced a regression of her
symptoms. The authors report on a case of cavernous hemangioma with a unique
extension to different intracranial/extracranial compartments. Although
radical removal of the lesion was not feasible, partial excision allowed for
satisfactory clinical control of the patient's symptoms.
Publication Types:
PMID: 15597770 [PubMed - indexed for MEDLINE]
-
| 8: J Neurosurg. 2004 Dec;101(6):1053-6. |
|
Resolution of diabetes insipidus following gamma knife
surgery for a solitary metastasis to the pituitary stalk. Case report.
Piedra MP, Brown PD, Carpenter PC, Link MJ.
Mayo Medical School, Division of Radiation Oncology and Endocrinology,
Rochester, Minnesota 55905, USA.
The authors present the case of a 58-year-old woman who presented with
symptoms of diabetes insipidus (DI) 1 year after she was found to have a
Stage 3 (of 4) estrogen receptor-positive infiltrating ductal adenocarcinoma
of the left breast with pulmonary and bone metastases. Magnetic resonance
images demonstrated a solitary site of metastasis in the patient's pituitary
stalk, and gamma knife surgery (GKS) was performed to treat the lesion.
Three months after GKS the patient was able to reduce the medication she
required for the DI. There was no evidence of pituitary failure and no
negative effect on her vision.
Publication Types:
PMID: 15597769 [PubMed - indexed for MEDLINE]
-
| 9: J Neurosurg. 2004 Dec;101(6):1049-52. |
|
Esthesioneuroblastoma of the pituitary gland: a
clinicopathological entity? Case report and review of the literature.
Mariani L, Schaller B, Weis J, Ozdoba C, Seiler RW.
Division of Neuroradiology, Neurosurgical Department, University Hospital,
Inselspital, Bern, Switzerland. luigi.mariani@insel.ch
Esthesioneuroblastoma (olfactory neuroblastoma) is a rare, malignant
neoplasm that typically arises in the nasal vault, invades adjacent tissues,
and causes locoregional (cervical lymph nodes) and distant metastases. Only
two cases of tumors arising in the sellar region that had the histological
characteristics of esthesioneuroblastoma have been reported in the
literature to date. The authors present the case of a 35-year-old woman with
secondary amenorrhea and a rapidly growing tumor located in the
adenohypophysis. After total removal of the lesion through a
transseptal-transsphenoidal approach, the histological examination revealed
an esthesioneuroblastoma Grade II/III according to Hyams. Considering the
particular location of the lesion and the absence of residual tumor on
postoperative magnetic resonance imaging, no adjuvant therapy was performed.
The patient remained free from tumor recurrence 2 years postoperatively.
Because all published cases of this esthestoneuroblastoma have been large
neuroblastic tumors of the pituitary gland arising in middle-aged women,
pituitary neuroblastoma might represent a rare, specific clinicopathological
entity.
Publication Types:
- Case Reports
- Review
- Review of Reported Cases
PMID: 15597768 [PubMed - indexed for MEDLINE]
-
| 10: J Neurosurg. 2004 Dec;101(6):1045-8. |
|
Recurrent intracranial solitary fibrous tumor with
cerebrospinal fluid dissemination. Case report.
Miyashita K, Hayashi Y, Fujisawa H, Hasegawa M, Yamashita J.
Department of Neurosurgery, Kanazawa University Hospital, Kanazawa, Japan.
Solitary fibrous tumor (SFT) is a benign and rare neoplasm. To date, only 37
patients with intracranial SFTs have been reported. Although a number of the
tumors were recurrent and some later underwent malignant transformation,
none of these lesions progressed to cerebrospinal fluid (CSF) dissemination.
In this paper the authors report a case of SFT in which the lesion recurred
several times and ultimately was disseminated by the CSF. The patient was a
63-year-old woman with multiple intracranial and spinal tumors. Fifteen
years before this presentation, at the age of 48 she had been hospitalized
for resection of a falcotentorial tumor. During the ensuing 15 years she
underwent multiple surgeries and sessions of radiation therapy for recurrent
lesions. The exclusive location of her tumors in the subarachnoid space at
the end of this 15-year period indicate CSF dissemination of the tumor. The
tumor that was resected when the patient was 48 years old and the latest
resected lesion were analyzed by performing immunohistological CD34,
epithelial membrane antigen, vimentin, S100 protein, and reticulin staining,
and determining the MIB-1 labeling index (LI). Most of the results were
identical, and both tumors were diagnosed as SFT according to a staining
pattern that showed a strong and diffuse positive reaction for CD34.
Nevertheless, the authors noted that the MIB-1 LI increased from less than
1% in the original tumor to 13% in the latest tumor. The increased
proliferation of MIB-1 indicates that the malignant transformation could
have occurred during tumor recurrence with CSF dissemination.
Publication Types:
PMID: 15597767 [PubMed - indexed for MEDLINE]
-
| 11: Mayo Clin Proc. 2004 Dec;79(12):1588; author reply
1588-9. |
|
Comment on:
Zero efficacy with cesium chloride self-treatment for
brain cancer.
Samadani U, Marcotte P.
Publication Types:
- Case Reports
- Comment
- Letter
PMID: 15595349 [PubMed - indexed for MEDLINE]
-
| 12: Mayo Clin Proc. 2004 Dec;79(12):1487-8. |
|
Comment on:
"Antiepileptic" not
"antiepileptogenic" drug therapy: ineffective prophylaxis of
seizures.
Cascino GD.
Publication Types:
PMID: 15595330 [PubMed - indexed for MEDLINE]
|
Volume 4, Number 3 - 11 January 2005