| 1: AJNR
Am J Neuroradiol. 2005 Jun;26(6):1475-8. |
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Well-circumscribed, minimally enhancing glioblastoma
multiforme of the trigone: a case report and review of the literature.
Park P, Choksi VR, Gala VC, Kaza AR, Murphy HS, Ramnath S.
Department of Neurosurgery, University of Michigan Health System, Ann Arbor,
MI.
Glioblastoma multiforme (GBM) is known to present within the lateral
ventricle but is relatively infrequent and predominantly found in the
frontal horn or body of the ventricle. A GBM located within the trigone is
rare, and one that appears well-circumscribed, homogeneous, and minimally
contrast enhancing, as demonstrated in this patient, is highly unusual.
PMID: 15956518 [PubMed - in process]
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| 2: AJNR
Am J Neuroradiol. 2005 Jun;26(6):1469-74. |
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Iron particles enhance visualization of experimental
gliomas with high-resolution sonography.
Nolte I, Vince GH, Maurer M, Herbold C, Goldbrunner R, Solymosi L, Stoll
G, Bendszus M.
Department of Neuroradiology, University of Wurzburg, Germany.
BACKGROUND AND PURPOSE: Intraoperative MR imaging and sonography are used
for navigation during neurosurgical procedures. The purpose of this
experimental study was to evaluate the potential of high-resolution
sonography using superparamagnetic iron oxide (SPIO) particles as a contrast
medium to delineate brain tumors and to relate these findings with those of
MR imaging. METHODS: C6 gliomas were implanted in 36 rats. Eleven days after
tumor implantation, the animals underwent MR imaging with a 1.5-T MR imaging
unit. Twelve animals received gadopentetate dimeglumine immediately before
the MR examination, 12 animals were injected with SPIO particles 24 hours
before MR imaging, and 12 animals received no contrast agent. Immediately
after MR imaging, the animals were sacrificed and their brains were removed
and placed in saline. Sonography was performed instantly after brain
removal. Brains were embedded in paraffin, and sections were stained for
iron with Perl's stain and for macrophages with ED-1 immunohistochemistry.
RESULTS: At MR imaging, the tumors appeared hyperintense on T2-weighted and
gadolinium-enhanced T1-weighted images. After application of SPIO particles,
they became markedly hypointense on T2-weighted images and hypo- to
hyperintense on T1-weighted images. On sonograms, gliomas were iso- to
slightly hyperechoic to normal brain parenchyma on nonenhanced and on
gadolinium-enhanced images. After application of SPIO particles, tumors
became markedly hyperechoic and were distinctly demarcated from the
surrounding brain tissue. CONCLUSION: SPIO particles improved the detection
and demarcation of the experimental gliomas on sonograms, which may improve
intraoperative neuronavigation with sonography.
PMID: 15956517 [PubMed - in process]
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| 3: AJNR
Am J Neuroradiol. 2005 Jun;26(6):1461-8. |
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Mapping the functional anatomy of sentence comprehension
and application to presurgical evaluation of patients with brain tumor.
Ashtari M, Perrine K, Elbaz R, Syed U, Thaden E, McIlree C,
Dolgoff-Kaspar R, Clarke T, Diamond A, Ettinger A.
Department of Radiology and Neurology, Long Island Jewish Division of the
North Shore-Long Island Jewish Health System, New Hyde Park, New York, NY.
BACKGROUND AND PURPOSE: The main clinical indication for functional MR
imaging (fMRI) has been to preoperatively map the cortex. Motor paradigms to
activate the cortex are simple and robust; however, language tasks show
greater variability and difficulty. The aim of this study was to develop a
language task with an adequate control task to engage the areas of the
posterior temporal lobe responsible for sentence comprehension. METHODS: We
performed a cloze paradigm requiring silent reading of a visually presented
sentence-completion task based on semantic meaning versus a letter-scanning
epoch requiring the completion of nonlinguistic strings or a rest period.
Before this task was clinically used in two patients epilepsy and cavernous
angioma, its feasibility and accuracy were tested in 14 healthy right-handed
participants. RESULTS: Results showed significant activation of the
posterior temporal cortex, including a broad area across the posterior left
temporal cortex extending into the inferior parietal lobule. When the
sentence completion-minus-letter string task was compared with the sentence
completion-minus-rest task, increased activation was present in the
posterior temporal lobe. CONCLUSION: Decreased significant activation during
the sentence completion-minus-rest contrast may be attributed to increased
noise from intersubject variability in the rest period. Our results suggest
that this task elucidates areas important to reading comprehension in the
posterior and inferior temporal regions that verbal fluency and auditory
discrimination tasks do not. Data from two cases are summarized to exemplify
the input of this task for neurosurgery.
PMID: 15956516 [PubMed - in process]
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| 4: AJNR
Am J Neuroradiol. 2005 Jun;26(6):1446-54. |
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Dynamic susceptibility-weighted perfusion imaging of
high-grade gliomas: characterization of spatial heterogeneity.
Lupo JM, Cha S, Chang SM, Nelson SJ.
Department of Radiology, University of California, San Francisco.
BACKGROUND AND PURPOSE: The advent of new anti-angiogenic therapies has
created the need for better defining regions of abnormal vascularity in
order to add specificity to the classification of high-grade gliomas. This
study investigated MR imaging parameters corresponding to the peak height
and percent recovery of the T2* relaxivity curve to characterize
angiogenesis and microvascular leakage within the T2 and contrast-enhancing
abnormalities in high-grade gliomas. METHODS: Dynamic
susceptibility-weighted MR imaging was performed in 41 patients with
untreated high-grade glioma during the first pass and recirculation phase of
a gadolinium bolus injection. Normalized peak height and percent recovery of
the post-bolus signal were calculated on a voxel by voxel basis within the
T2 and contrast-enhancing lesions (T2L, CEL) and compared between grade III
and grade IV gliomas. RESULTS: Grade IV gliomas showed significantly larger
volumes of abnormal peak height and recovery compared to grade III patients
(P < .01). Within the CEL, grade IV gliomas exhibited significantly
higher peak height values than grade III patients (P < .05). Enhancing
grade III patients (n = 7) demonstrated higher minimum values of percent
recovery within both regions compared to grade IV patients. Non-enhancing
grade III gliomas (n = 11) had significantly elevated minimum percent
recovery values when compared to the T2L-CEL region in grade IV patients (n
= 23; P < .05). CONCLUSION: Direct measurement of the spatial
distribution of tumor microvasculature characteristics has shown
considerable heterogeneity within different regions of grade III and grade
IV gliomas. Peak height and percent recovery parameters help to improve the
specificity for characterization of the degree of angiogenesis and
microvascular leakage in these tumors and may be useful in evaluating
response to treatment.
PMID: 15956514 [PubMed - in process]
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| 5: AJNR
Am J Neuroradiol. 2005 Jun;26(6):1413-9. |
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Neurologic complications after particle embolization of
intracranial meningiomas.
Bendszus M, Monoranu CM, Schutz A, Nolte I, Vince GH, Solymosi L.
Department of Neuroradiology, University of Wurzburg, Wurzburg, Germany.
BACKGROUND AND PURPOSE: Preoperative embolization of meningiomas is
frequently used to facilitate surgery and to reduce intraoperative blood
loss. The purpose of this study was to evaluate the frequency of
procedure-related neurologic complications during and after particle
embolization of intracranial meningiomas. METHODS: Between 1996 and 2004,
185 consecutive patients underwent particle embolization of an intracranial
meningioma. Devascularization was performed by means of superselective
probing of the tumor-feeding vessels and ensuing free-flow embolization with
spherical particles. All procedures were performed with systemic
heparinization. RESULTS: Six patients (3.2%) had ischemic events with
neurologic deficit. Two had amaurosis, and four patients presented with
hemiparesis. Hemorrhage occurred in six patients (3.2%). In five of these
patients, rapid microsurgical tumor removal resulted in a favorable outcome
without persistent neurologic deficit. In one patient, massive intratumoral,
subarachnoid, and subdural hemorrhage was lethal. CONCLUSION: Particle
embolization of meningiomas is associated with a substantial risk of
ischemic and hemorrhagic events. The individual risk-to-benefit ratio of
embolization should be thoroughly considered.
PMID: 15956508 [PubMed - in process]
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| 6: Cancer. 2005 Jun 10; [Epub
ahead of print] |
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Proliferation and progesterone receptor status in benign
meningiomas are not age dependent.
Roser F, Nakamura M, Ritz R, Bellinzona M, Dietz K, Samii M, Tatagiba MS.
Department of Neurosurgery, University of Tubingen, Tubingen, Germany.
BACKGROUND: Some authors have suggested that the biology of meningiomas
differs according to a patient's age. Proliferation, vascularity, and
hormonal status in meningiomas can be used to describe changes during aging.
In the current study, proliferation activity with the Ki-67/MIB-1 antibody
was evaluated by immunohistochemistry in meningioma tissue specimens from
young and elderly patients. METHODS: Over the past 25 years, tissue samples
from 1766 patients with meningiomas were evaluated. Of these, 588 tumor
specimens from 554 patients who underwent surgery between 1990 and 2000 were
evaluated immunohistochemically. The proliferation index (LI) and
progesterone receptor (PR) in meningiomas were quantitatively estimated in
elderly (age >/= 70 years) and young patients (age < 70 years).
Patients' charts including surgical records, discharge letters, pathology
reports, and imaging studies were reviewed. Correlations with histologic
subtype, disease recurrence-free survival, resection grade, location, size,
vascularity, and tumor calcification were calculated as well. Only patients
with a well documented follow-up were included in the statistical evaluation
(n = 385). RESULTS: Compared with the young group of 344 patients with
meningioma (age < 70 years; mean age, 51.9 years; range, 18-69 years),
the elderly population (age >/= 70 years; n = 41; mean age, 74.9 years;
range, 70-88 years) showed a male-to-female ratio of 3.2: 1. Both groups had
an identical median Ki-67 LI of 3.0% and a PR status of 56.1% versus 58.4 %.
No statistically significant differences in disease recurrence-free survival
could be found in the two groups. CONCLUSIONS: Proliferation rates and PR
status in benign intracranial meningiomas did not appear to be age
dependent. Cancer 2005. (c) 2005 American Cancer Society.
PMID: 15952201 [PubMed - as supplied by publisher]
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| 7: Cancer
Genet Cytogenet. 2005 Jul 1;160(1):1-14. |
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Molecular cytogenetic analysis of chromosomes 1 and 19 in
glioma cell lines.
Law ME, Templeton KL, Kitange G, Smith J, Misra A, Feuerstein BG, Jenkins
RB.
Department of Laboratory Medicine and Pathology, Division of Laboratory
Genetics, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN
55905.
Deletions of chromosome 1p and 19q arms are frequent genetic abnormalities
in primary human gliomas and are especially common in oligodendrogliomas.
However, the chromosome 1p and 19q status of many glioma cell lines has not
been established. Using homozygosity mapping, fluorescence in situ
hybridization (FISH), and comparative genomic hybridization to arrayed BAC
(CGHa), we screened 17 glioma cell lines for chromosome 1 and 19 deletions.
Sequence tagged site polymorphisms were used to evaluate the cell lines for
regions of chromosome 1p and 19q homozygosity. Cell lines A172, U251, TP265,
U118, SW1088, U87, SW1783, and D32 contained significant regions of 19q
homozygosity. In addition, A172, U87, TP483, D37, U118, MO67, and TP265
contained significant regions of 1p homozygosity. FISH probes localized to
1p36.32 and 19q13.33 as well as CGHa were used to determine which cell lines
had deletions of 1p and/or 19q. Cell lines A172, U87, TP483, TP265, H4,
U251, and D37 were deleted for portions of 1p. CGHa and homozygosity mapping
of these cell lines define a 700-kilobase (Kb) common deletion region that
is encompassed by a larger deletion region previously mapped in sporadic
gliomas. This common deletion region is localized at 1p36.31 and includes
CHD5, a putative tumor suppressor gene. Cell line A172 was observed to have
a deletion between 19q13.33 and 19q13.41, while U87 was observed to have a
smaller deletion of 19q13.33. Cell lines A172 and U87 contain 1p and 19q
deletions similar to those found in sporadic gliomas and will be useful
cellular reagents for evaluating the function of putative 1p and 19q glioma
tumor suppressor genes.
PMID: 15949564 [PubMed - in process]
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| 8: Cancer Res. 2005 Jun
15;65(12):5428-38. |
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Glioblastomas Induce T-Lymphocyte Death by Two Distinct
Pathways Involving Gangliosides and CD70.
Chahlavi A, Rayman P, Richmond AL, Biswas K, Zhang R, Vogelbaum M,
Tannenbaum C, Barnett G, Finke JH.
Department of Neurosurgery, Brain Tumor Institute, Department of Immunology,
Lerner Research Institute, and Department of Cell Biology, Cleveland Clinic
Foundation, Cleveland, Ohio.
Here we report that glioblastoma multiforme (GBM) mediates immunosuppression
by promoting T-cell death via tumor-associated CD70 and gangliosides that
act through receptor-dependent and receptor-independent pathways,
respectively. GBM lines cocultured with T cells induced lymphocyte death.
The GBM lines were characterized for their expression of CD70, Fas ligand
(FasL), and tumor necrosis factor-alpha (TNF-alpha), and the possible
participation of those molecules in T-cell killing was assessed by doing
GBM/T cell cocultures in the presence of anti-CD70 antibodies, Fas fusion
proteins, or anti-TNF-alpha antibodies. CD70 but not TNF-alpha or FasL is
responsible for initiating T-cell death via the receptor-dependent pathway.
Of the four GBM cell lines that induced T-cell death, three highly expressed
CD70. Two nonapoptogenic GBM lines (CCF3 and U138), on the other hand, had
only minimally detectable CD70 expression. Blocking experiments with the
anti-CD70 antibody confirmed that elevated CD70 levels were involved in the
apoptogenicity of the three GBM lines expressing that molecule. Gangliosides
were found to participate in the induction of T-cell apoptosis, because the
glucosylceramide synthase inhibitor (PPPP) significantly reduced the
abilities of all four apoptogenic lines to kill the lymphocytes.
High-performance liquid chromatography (HPLC) and mass spectroscopy revealed
that GM2, GM2-like gangliosides, and GD1a were synthesized in abundance by
all four apoptogenic GBM lines but not by the two GBMs lacking activity.
Furthermore, gangliosides isolated from GBM lines as well as HPLC fractions
containing GM2 and GD1a were directly apoptogenic for T cells. Our results
indicate that CD70 and gangliosides are both products synthesized by GBMs
that may be key mediators of T-cell apoptosis and likely contribute to the
T-cell dysfunction observed within the tumor microenvironment.
PMID: 15958592 [PubMed - in process]
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| 9: Cancer Res. 2005 Jun
15;65(12):5310-6. |
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Inhibition of DNA repair by a herpes simplex virus vector
enhances the radiosensitivity of human glioblastoma cells.
Hadjipanayis CG, Deluca NA.
Departments of Neurological Surgery and Molecular Genetics and Biochemistry,
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
Expression of the herpes simplex virus (HSV) protein, ICP0, from the viral
genome, rendered two radioresistant human glioblastoma multiforme cell lines
more sensitive to the effects of ionizing radiation. Using the
3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide and clonogenic
survival assays, U87-MG and T98 cell survival was more greatly decreased as
a function of ionizing radiation dose when ICP0 was preexpressed in cells
compared with when ICP0 was not expressed. Consistent with previous results,
we found that the catalytic subunit of DNA-dependent protein kinase was
degraded as a function of ICP0 in both cell types. This most likely resulted
in the inhibition of DNA repair as inferred by the persistence of gammaH2AX
foci or DNA double-strand breaks. Enhanced apoptosis was also found to occur
following irradiation of U87-MG cells preinfected with the ICP0-producing
HSV-1 mutant, d106. Our results suggest that expression of ICP0 in human
glioblastoma multiforme cells inhibits the repair of DNA double-strand
breaks after ionizing radiation treatment, decreasing the survival of these
cells in part by induction of apoptosis.
PMID: 15958578 [PubMed - in process]
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| 10: Cancer Res. 2005
Jun 15;65(12):5248-55. |
|
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Sensitization of glioma cells to fas-dependent apoptosis
by chemotherapy-induced oxidative stress.
Xia S, Rosen EM, Laterra J.
The Kennedy-Krieger Institute and Departments of Neurology, Oncology, and
Neuroscience, The Johns Hopkins School of Medicine, Baltimore, Maryland.
A prominent feature of glioblastoma is its resistance to death from Fas
pathway activation. In this study, we explored the modulation of Fas-induced
glioblastoma death with chemotherapeutic agents. Camptothecin significantly
increased the glioblastoma cell death response to Fas receptor activation
regardless of p53 status. Sublethal concentrations of camptothecin reduced
the IC(50) of agonistic anti-Fas antibody (CH-11) 10-fold, from 500 to 50
ng/mL, in human U87 glioblastoma cells (p53 wild-type). Cell viability in
response to camptothecin, CH-11 alone, and the combination of camptothecin +
CH-11 was found to be 84%, 85%, and 47% (P < 0.001), respectively. A
similar pattern of relative cytotoxicity was found in U373 cells (p53
mutant). We further examined the pathways and mechanisms involved in this
apparent synergistic cytotoxic response. Cell death was found to be
predominantly apoptotic involving both extrinsic and intrinsic pathways as
evidenced by annexin V staining, cleavage of caspases (3, 8, and 9),
increased caspase activities, Smac release, and cytoprotection by caspase
inhibitors. Expression of Fas-associated death domain, and not Fas, Fas
ligand, or caspase proteins, increased following cell treatment with
camptothecin + CH-11. Camptothecin treatment enhanced c-jun-NH(2)-kinase
activation in response to CH-11, but inhibition of c-jun-NH(2)-kinase did
not prevent cell death induced by the combination treatment. Reactive oxygen
species, especially H(2)O(2), were elevated following camptothecin
treatment; and H(2)O(2) enhanced cell death induced by CH-11. The
antioxidants glutathione and N-acetyl-cysteine prevented cell death induced
by camptothecin + CH-11. These findings show that camptothecin synergizes
with Fas activation to induce glioblastoma apoptosis via a mechanism
involving reactive oxygen species and oxidative stress pathways.
PMID: 15958570 [PubMed - in process]
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| 11: Cancer Res. 2005
Jun 15;65(12):5190-4. |
|
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Cathepsin d is a potential serum marker for poor
prognosis in glioma patients.
Fukuda ME, Iwadate Y, Machida T, Hiwasa T, Nimura Y, Nagai Y, Takiguchi
M, Tanzawa H, Yamaura A, Seki N.
Departments of Neurological Surgery, Biochemistry and Genetics, Functional
Genomics, Molecular Pathology, and Clinical Molecular Biology, Chiba
University Graduate School of Medicine, Chiba, Japan.
Cathepsin D is an aspartyl protease involved in protein catabolism and
tissue remodeling which can be secreted from cancer cells. To identify a
potential serum marker for gliomas, we investigated the gene expression
levels of cathepsin D in 87 tissue samples and measured the protein
concentrations in sera of glioma patients. The tissue samples consisted of
43 glioblastomas, 13 anaplastic astrocytomas, 22 astrocytomas, and 9 normal
brain tissues. The results of real-time quantitative reverse
transcription-PCR analysis showed that cathepsin D transcript levels became
significantly higher as the glioma grade advanced (P = 0.0466, glioblastoma
and anaplastic astrocytoma; P = 0.0008, glioblastoma and astrocytoma; P =
0.0271, glioblastoma and normal brain tissue; unpaired t test).
Immunohistochemical analysis with anti-cathepsin D antibody revealed dense
and spotty staining in the tumor cells with high transcript levels. The low
expression of cathepsin D significantly correlated with long survival of the
glioma patients. Furthermore, the glioblastoma patients with high gene
expression of cathepsin D lived significantly shorter than those with low
expression (P = 0.0104, Cox-Mantel log-rank test) and frequently had
leptomeningeal dissemination (P = 0.0016, chi(2) test). The multivariate
analysis confirmed that the cathepsin D expression level was an independent
predictor for short survival (P = 0.0102, Cox proportional hazard regression
model). Measurement of the serum cathepsin D concentrations by ELISA showed
a significant increase in the patients with high-grade gliomas as compared
with the low-grade tumors (P = 0.0081, chi(2) test). These results
collectively suggest that cathepsin D could be a potential serum marker for
the prediction of aggressive nature of human gliomas.
PMID: 15958563 [PubMed - in process]
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| 12: Cancer Res. 2005
Jun 15;65(12):5070-5. |
|
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Meningioma transcript profiles reveal deregulated notch
signaling pathway.
Cuevas IC, Slocum AL, Jun P, Costello JF, Bollen AW, Riggins GJ,
McDermott MW, Lal A.
Brain Tumor Research Center, Department of Neurological Surgery, University
of California, San Francisco, California.
Meningiomas constitute the second most common central nervous system tumor,
and yet relatively little is known about the molecular events that are
important for the pathogenesis and malignant progression of these tumors. We
have used serial analysis of gene expression to compare the transcriptomes
of nonneoplastic meninges and meningiomas of all malignancy grades. A novel
finding from this screen is the induction of three components of the Notch
signaling pathway: the transcription factor, hairy and enhancer of Split1
(HES1) and two members of the Groucho/transducin-like enhancer of Split
family of corepressors, TLE2 and TLE3. TLE corepressors interact and
modulate the activity of a wide range of transcriptional regulatory systems,
one of which is HES1. We have shown that the transcript and protein levels
of HES1, the Notch2 and Notch1 receptors and the Jagged1 ligand are induced
in meningiomas of all grades, whereas induction of TLE2 and TLE3 occurs
specifically in higher-grade meningiomas. Meningioma cell lines express
components of the Notch signaling pathway and an inhibitor of this pathway
suppresses meningioma cell survival. These results suggest that deregulated
expression of the Notch pathway is a critical event in meningioma
pathogenesis and that modulation of this and potentially other signaling
pathways by TLE corepressors leads to a more malignant phenotype.
PMID: 15958550 [PubMed - in process]
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| 13: Cancer Res. 2005
Jun 15;65(12):4975-8. |
|
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Targeting medulloblastoma: small-molecule inhibitors of
the sonic hedgehog pathway as potential cancer therapeutics.
Romer J, Curran T.
Department of Developmental Neurobiology, St. Jude Children's Research
Hospital, Memphis, Tennessee.
Medulloblastoma is the most common malignant pediatric brain tumor for which
no satisfactory treatments exist. The Sonic Hedgehog signaling pathway seems
to play an important role in the pathology of this disease. Here we review
our recent demonstration that a small-molecule inhibitor of this pathway can
regress tumors that arise in a transgenic mouse model of medulloblastoma.
These and other findings suggest that inhibitors of Sonic Hedgehog signaling
may offer an effective way to target some malignancies.
PMID: 15958535 [PubMed - in process]
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| 14: Cancer Res. 2005
May 1;65(9):3846-52. |
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Cooperation between Cdk4 and p27kip1 in tumor
development: a preclinical model to evaluate cell cycle inhibitors with
therapeutic activity.
Sotillo R, Renner O, Dubus P, Ruiz-Cabello J, Martin-Caballero J,
Barbacid M, Carnero A, Malumbres M.
Molecular Oncology, Centro Nacional de Investigaciones Oncologicas (CNIO),
Madrid, Spain.
Deregulation of the G1-S transition of the cell cycle is a common feature of
human cancer. Tumor-associated alterations in this process frequently affect
cyclin-dependent kinases (Cdk), their regulators (cyclins, INK4 inhibitors,
or p27Kip1), and their substrates (retinoblastoma protein). Although these
proteins are generally thought to act in a linear pathway, mutations in
different components frequently cooperate in tumor development. Using
gene-targeted mouse models, we report in this article that Cdk4 resistance
to INK4 inhibitors, due to the Cdk4 R24C mutation, strongly cooperates with
p27(Kip1) deficiency in tumor development. No such cooperation is observed
between Cdk4 R24C and p18(INK4c) absence, suggesting that the only function
of p18INK4c is inhibiting Cdk4 in this model. Cdk4(R/R) knock in mice, which
express the Cdk4 R24C mutant protein, develop pituitary tumors with complete
penetrance and short latency in a p27Kip1-/- or p27Kip1+/- background. We
have investigated whether this tumor model could be useful to assess the
therapeutic activity of cell cycle inhibitors. We show here that exposure to
flavopiridol, a wide-spectrum Cdk inhibitor, significantly delays tumor
progression and leads to tumor-free survival in a significant percentage of
treated mice. These data suggest that genetically engineered tumor models
involving key cell cycle regulators are a valuable tool to evaluate drugs
with potential therapeutic benefit in human cancer.
PMID: 15867383 [PubMed - indexed for MEDLINE]
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| 15: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Early adjuvant radiotherapy toward long-term survival and
better quality of life for craniopharyngiomas-a study in single institute.
Moon SH, Kim IH, Park SW, Kim I, Hong S, Park CI, Wang KC, Cho BK.
Department of Radiation Oncology, Seoul National University College of
Medicine, 28 Yongon-dong, Jongno-gu, Seoul, 110-744, South Korea.
OBJECTIVES: The objective of the study is to compare survival and quality of
life (QoL) by the delivery time of adjuvant radiotherapy (RT), early or
late, for craniopharyngiomas. METHODS AND MATERIALS: Fifty patients received
RT between 1985 and 2002. Early RT (n=25) was delivered within 3 months
after initial surgery, whereas late RT (n=25) was combined with or without
reoperation after progression or relapse. Radiation dose ranged from 45 to
55.8 Gy with a median of 54 Gy. The median follow-up was 130 months.
RESULTS: Progression-free survival rates at 5 and 10 years were 95.9 and
91.2%, respectively. The overall or progression-free survival was not
influenced by RT time. Initial tumor size was the only prognostic factor
(p=0.034) for progression-free survival in univariate analysis. Better
visual acuity or field was maintained, and diabetes insipidus was partly
improved with early RT, but all were deteriorated as tumor progressed
without early RT. Visual functions were not worsened after late RT.
CONCLUSIONS: The survival was excellent with adjuvant RT, early or late.
Poor QoL with late RT resulted from relapsed tumor and repeated surgery but
was not associated with RT itself. Thus, early RT with precision technique
is highly recommended for better QoL and excellent survival, unless
contraindicated.
PMID: 15959734 [PubMed - as supplied by publisher]
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| 16: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Craniopharyngioma in childhood: our evidence-based
approach to management.
Thompson D, Phipps K, Hayward R.
Department of Neurosurgery, Great Ormond Street Hospital for Children NHS
Trust, London, WC1N 3JH, UK, thompd@gosh.nhs.uk.
OBJECTIVES: In 1996 we published our results for treatment of childhood
craniopharyngioma. That study did not only reveal that there was a
significant morbidity associated with our then policy of attempted radical
removal followed by post-operative radiotherapy in those cases with residual
disease, but also that risk factors for poor outcome could be identified
based on the clinical and radiological findings at presentation. As result
of that study, we redefined the role of radical surgery in the treatment of
craniopharyngioma and developed a new treatment strategy in an attempt to
improve the quality of outcome without compromising tumour control. Our aims
in this paper were to compare the results of our current treatment strategy
with that reported in the 1996 paper to assess whether we have achieved this
goal. METHODS: A detailed assessment of the treatment pathway and outcome
was undertaken for children treated for craniopharyngioma in our unit from
1996 to 2004. This included a morbidity score based on visual, motor,
cognitive, hypothalamic and endocrinological data obtained from our
neuro-oncology database and review of clinical records. Where possible we
have attempted to record data in the same manner as for our previous study
allowing for meaningful comparison. RESULTS: Forty-eight children with
craniopharyngioma presented in the study period. On the basis of clinical
presentation and radiological findings, 25 were deemed suitable for
attempted radical surgery and 23 were treated with various subtotal surgical
procedures. Radiotherapy was used in patients over the age of 5 years where
residual tumour was present or progressed after the initial surgical
intervention(s). Morbidity scores, particularly in relation to visual and
cognitive outcome, are improved and there was no surgical mortality in the
current series. CONCLUSIONS: A treatment paradigm for childhood
craniopharyngioma is presented which improves the quality of outcome without
compromising tumour control.
PMID: 15959733 [PubMed - as supplied by publisher]
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| 17: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Childhood craniopharyngioma: Vancouver experience.
Hukin J, Visser J, Sargent M, Goddard K, Fryer C, Steinbok P.
Division of Neurology and Oncology, British Columbia Children's Hospital,
4480 Oak St., Vancouver, V6H 3V4, Canada, jhukin@cw.bc.ca.
OBJECTIVE: To present our institution's experience in the management of
childhood craniopharyngioma since 1982. METHODS: We retrospectively reviewed
the records of all children diagnosed with craniopharyngioma at our
children's hospital from its opening in 1982 through to 2003. One
neuroradiologist systematically reviewed the neuroimaging. Kaplan-Meier
curves were used to analyze the progression-free survival and the overall
survival from the time of the first definitive intervention. CONCLUSIONS:
Most children diagnosed with craniopharyngioma are long-term survivors.
Survivors suffer from multiple deficits in the long term. A conservative
surgical and radiotherapeutic approach and avoiding interventions that are
known to cause severe morbidity may minimize these. The use of intracystic
bleomycin is a strategy that allows the delay of more aggressive therapies
in select patients.
PMID: 15959732 [PubMed - as supplied by publisher]
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| 18: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Malignant meningioma as a second malignancy after therapy
for acute lymphatic leukemia without cranial radiation.
Regel JP, Schoch B, Sandalcioglu IE, Wieland R, Westermeier C, Stolke D,
Wiedemayer H.
Department of Neurosurgery, University Medical School Essen, Hufelandstrasse
55, 45122, Essen, Germany, jens.regel@uni-essen.de.
RATIONALE: Meningiomas in the pediatric age group are very rare tumors,
comprising about 1-4.2% of all primary pediatric intracranial tumors. CASE
REPORT: We present a 17-year-old patient who suffered from an
intraventricular malignant meningioma. At the age of 2 years, acute
lymphatic leukemia (common ALL [cALL]) was diagnosed and successfully
treated with chemotherapy. There was no cranial radiation therapy. In
December 2001, 13 years after diagnosis of cALL, he complained of headache,
vomiting, and walking difficulties. Magnetic resonance imaging showed an
enhancing mass with cystic components in the trigone of the right lateral
ventricle. The tumor was removed completely. Histological diagnosis revealed
a malignant papillary meningioma. After removal of a recurrent meningioma 16
months later, he received local radiotherapy. CONCLUSION: Pathogenetic
mechanisms, treatment options, and prognosis of meningiomas and secondary
malignancies of this age group are discussed.
PMID: 15954007 [PubMed - as supplied by publisher]
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| 19: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Radical resection of craniopharyngioma.
Zuccaro G.
Department of Neurosurgery, Hospital Nacional de Pediatria Juan P. Garrahan,
Buenos Aires, Argentina.
INTRODUCTION: The best management of craniopharyngioma in children remains a
controversial topic among neurosurgeons. The two treatments for
craniopharyngioma most commonly discussed in the literature are primary
total resection and limited resection followed by radiotherapy. Without
ignoring the challenging behavior of these tumors, we strongly believe that
the first approach in a child with a craniopharyngioma is to attempt total
removal. Trying to remove a craniopharyngioma that has been treated
previously with other methods is, in our experience, much more dangerous
because of adherences of the tumor to vascular and neural structures.
MATERIAL AND METHODS: Between 1988 and 2004, we operated on 153 patients
with craniapharyngioma (40% female and 60% male), whose ages at the time of
surgery ranged from 15 days to 21 years (mean 10.5 years). Eighty-seven
percent of the patients were found to have some visual disturbance and 42%
endocrinological alterations. Fifty-four percent of the patients presented
hydrocephalus, but only 18% had shunting. Gross total removal was attempted
in all patients. Among the 153 patients, the tumor was prechiasmatic in 35
and retrochiasmatic in 112; in ten, these were considered giant forms, and
eight had a posterior fossa extension. We performed 84 single and 69
combined approaches. RESULTS: We achieved total removal in 69% of our
patients. None of our patients regarded as having undergone total tumor
resection disclosed recurrence after a follow-up of 1-16 years. Radiation
therapy was administered in children with subtotal removal. All children
underwent total removal, but only 62% of those who underwent subtotal
removal had good outcomes. After surgery, endocrinological status worsened
in almost all patients, but visual status improved markedly. CONCLUSIONS:
The treatment of choice in craniopharyngioma in childhood is total resection
in order to avoid radiation therapy and recurrence. When total resection is
not possible, subtotal resection plus radiation therapy is the alternative.
PMID: 15954005 [PubMed - as supplied by publisher]
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| 20: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Craniopharyngioma in children: Marseille experience.
Lena G, Paredes AP, Scavarda D, Giusiano B.
Department of Pediatric Neurosurgery, Hopital des Enfants La Timone, 264,
Rue Saint Pierre, 13385, Marseille, Cedex 05, France, gabriel.lena@ap-hm.fr.
OBJECTIVES: The management of craniopharyngioma in children represents a
challenging problem. If radical excision is recommended by many authors as
the initial treatment, in some cases, particularly in recurrent tumours,
other methods (gamma knife surgery and intracystic bleomycin) can be very
useful. Even if craniopharyngioma is a benign tumour, recurrences are
frequent, and the aim of our study was to analyse our results, to try to
determine some prognostic factors of recurrences and to discuss about a new
strategy concerning the initial management of these tumours. METHODS:
Forty-seven children with craniopharyngioma were treated in the Department
of Pediatric Neurosurgery. All of the patients, but five children treated by
intracystic bleomycin, underwent a surgical resection of the tumour as
initial treatment with the goal of achieving gross total removal (GTR) of
the tumour. Two children had radiotherapy and gamma knife treatment,
respectively, following surgery for a tumoural residue. All the children had
a magnetic resonance imaging (MRI) study 3 months after surgery to evaluate
the results of the initial treatment. Using statistical analysis, some
prognostic factors (age, sex, location, aspect, size of the tumour and
result of the first MRI) have been studied. RESULTS: Forty-two children were
operated on, but one died in the immediate postoperative period from a major
stroke due to carotid spasm. GTR, defined as the absence of residue on the
first MRI control, was achieved in 27 children (65.8%), but 7 patients
(25.9%) presented recurrence. Subtotal removal (STR) was obtained in 14
children (34.2%), but 9 patients (64.3%) developed a recurrence defined as
the growth of the residual tumour with or without clinical symptoms. Five
children having a small- or moderate-size cystic craniopharyngioma were
treated using one-stage (three cases) or two-stage (two cases) intracystic
bleomycin and any presented recurrence. All the prognostic factors studied,
except one (presence of a residue on the first MRI control), do not have a
statistical significance. CONCLUSION: Craniopharyngioma in children remains
a formidable tumour, and regardless of whatever progress made in their
management, the incidence of recurrences is still elevated and severe
sequelae can be observed. There are no prognostic factors among those
studied concerning the recurrences of these tumours except the quality of
the exeresis confirmed by the first postoperative MRI.
PMID: 15954004 [PubMed - as supplied by publisher]
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| 21: Childs
Nerv Syst. 2005 Jun 14; [Epub ahead of print] |
|
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Use of interferon alpha in intratumoral chemotherapy for
cystic craniopharyngioma.
Cavalheiro S, Dastoli PA, Silva NS, Toledo S, Lederman H, da Silva MC.
Department of Neurology and Neurosurgery, Pediatric Oncology Institute,
Federal University of Sao Paulo-Escola Paulista de Medicina, Rua Botucatu
591/42, 4023-061, Sao Paulo, Brazil, iscava@uol.com.br.
OBJECTIVES: This study analyzed the intratumoral activity of interferon
alpha (IFN-alpha) in the treatment of cystic craniopharyngiomas. PATIENTS
AND METHODS: From January 2000 to January 2004, nine patients presenting
with cystic craniopharyngiomas were treated with intratumoral injection of
IFN-alpha at the Pediatric Oncology Institute of the Federal University of
Sao Paulo-Escola Paulista de Medicina. Age ranged from 1 year and 10 months
to 18 years (mean 10 years). All intratumoral catheters were inserted by a
subfrontal approach. Doses varied from 36 to 108 MU. RESULTS: There was
complete disappearance of the lesion in seven cases. In two cases, partial
reduction of tumor size was observed at follow-up. Follow-up varied from 1
year to 3 years and 6 months (mean 1 year 8 months). CONCLUSIONS: IFN-alpha
proved to be an effective drug in the control of cystic craniopharyngiomas.
Additional studies should be carried out to determine the optimal dose of
IFN-alpha in the treatment of cystic craniopharyngioma. In addition, other
drugs possessing high efficacy and low neurotoxicity should be analyzed.
PMID: 15954003 [PubMed - as supplied by publisher]
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| 22: Childs
Nerv Syst. 2005 Jun 11; [Epub ahead of print] |
|
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Individualized treatment of craniopharyngioma in
children: ways and means.
Marchal JC, Klein O, Thouvenot P, Bernier V, Moret C, Chastagner P.
Unit of Paediatric Neurosurgery, Hopital Central, 27 avenue de Lattre de
Tassigny, 54000, Nancy, France, jc.marchal@chu-nancy.fr.
BACKGROUND: Medium- and long-term prognosis of craniopharyngioma is
overwhelmed by the risks of hypothalamic and visual impairment. This problem
has been underestimated for a long time because the major concern for the
neurosurgeon was the risk of recurrences, their best prevention being
thought to be complete tumour resection. Today, we know that radical surgery
not only is not an absolute guarantee against recurrences but also can cause
hypothalamic and visual complications. METHODS: The authors suggest that
instead of complete removal, the first choice treatment should be, when
possible, a less aggressive, multistaged and personalized treatment. In this
perspective they focus on other therapeutic methods: endocavity treatment of
cysts with rhenium-186, triconformational radiotherapy, radiosurgery, and
widespread use of the trans-sphenoidal approach. CONCLUSIONS: These simple
methods should reduce the risks of visual aggravation and metabolic
syndrome.
PMID: 15952028 [PubMed - as supplied by publisher]
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| 23: Childs
Nerv Syst. 2005 Feb;21(2):148-9. Epub 2004 Dec 4. |
|
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Adaptation of skull clamp for use in image-guided surgery
of children in the first 2 years of life.
Sgouros S, Grainger MC, McCallin S.
Department of Neurosurgery, Birmingham Children's Hospital, Steelhouse Lane,
Birmingham, B4 6NH, UK. S.Sgouros@bham.ac.uk
INTRODUCTION: We describe a simple but effective modification of the skull
clamp, aimed at stabilising the head of very young children, while avoiding
the risk of creating a depressed skull fracture, in order to enable the
utilisation of image-guidance in such young patients. METHODS: We machined
three small perspex discs 3 cm in diameter. On the outer surface of these
pads we drilled reception holes for the pins to prevent slippage. To avoid
direct contact with the skin, we interfaced a thick pad of soft felt. During
intraoperative positioning, the weight of the head was supported by a
suction bean-bag placed on the operating table. Hence, the clamp apparatus
was employed only to secure the head position, and not to support the weight
of the head, thus requiring less clamp force. We employed this modification
in three children (aged 9, 13 and 15 months) who required image-guided
surgery for brain tumours. OUTCOME: In all cases the head remained immobile
throughout the operation, making possible the accurate use of image
guidance. At the end of the operation, some transient skin redness was
noticed in the contact areas, which settled in a few days.
Publication Types:
PMID: 15580511 [PubMed - indexed for MEDLINE]
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| 24: Childs
Nerv Syst. 2005 Feb;21(2):138-43. Epub 2004 Aug 12. |
|
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Childhood choroid plexus papillomas: operative
complications.
Kumar R, Singh S.
Department of Neurosurgery and Anaesthesia, Sanjay Gandhi Post Graduate
Institute of Medical Sciences, Lucknow-226014, UP, India.
rajkumar@sgpgi.ac.in
METHODS: Eight children (below 12 years of age) operated on for
intraventricular choroid plexus papilloma (CPP) were retrospectively
reviewed to identify the factors responsible for their high postoperative
morbidity and mortality. Seven of these patients were aged between 2 months
and 2 years and 1 was aged 12 years. Six CPP lesions were in the lateral
ventricles and the remaining 2 were in the anterior third ventricle. All
children presented with features of raised intracranial pressure. Due to
gross hydrocephalus with severe manifestations at admission two patients
required CSF diversion before definitive surgery. RESULTS: Microsurgical
excision of CPPs was achieved in 7 and near total removal of the tumor in an
8th child. Brain shift was noted during operation and was attributed to
acute CSF drainage and/or tumor excision in all cases. External ventricular
drainage was postoperatively placed in 2 patients, who ultimately required
shunt installation. One child died during definitive surgery. Due to
neurological deterioration 6 of the remaining 7 patients had a postoperative
CT scan within a week of surgery. One had an uneventful recovery, and
pneumocephalus and subdural effusion were found in all 6 scanned children.
Pneumocephalus was significant enough in 4 of them to warrant a surgical
evacuation. CONCLUSION: Acute CSF drainage leading to significant
intraoperative brain shift, postoperative external ventricular drainage,
pneumocephalus, subdural effusion, and persistent postoperative
hydrocephalus were identified as chief factors for higher morbidity in these
children.
Publication Types:
PMID: 15309472 [PubMed - indexed for MEDLINE]
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| 25: Childs
Nerv Syst. 2005 Feb;21(2):150-5. Epub 2004 May 25. |
|
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Pediatric embryonal tumor with epithelial immunophenotype
showing absence of hSNF5/INI1 expression.
Sakai K, Shigeta H, Ogiso Y, Hongo K, Kobayashi S, Hirose T.
Department of Neurosurgery, Shinshu University School of Medicine, Asahi
3-1-1, Matsumoto 390-8621, Japan. skeiichi@hsp.md.shinshu-u.ac.jp
CASE REPORT: A case of a histologically unclassified brain tumor in a
32-month-old boy is reported. He presented with vomiting, appetite loss, and
right motor weakness. MR images revealed a huge mass in the left
frontoparietal region that was enhanced after the administration of Gd-DTPA.
The mass was removed three times because of its recurrence. RESULTS:
Histologically, the tumor was composed largely of small-undifferentiated
round cells without any patterns of differentiation. Immunohistochemically,
the tumor cells were positive for cytokeratin and focally for epithelial
membrane antigen (EMA). Glial fibrillary acidic protein (GFAP), S-100
protein and neuronal markers were negative. Electron microscopic
investigations demonstrated no evidence of specific differentiation. MIB-1
staining index was 10-40%. The origin of the tumor was not detected.
Expression of the hSNF5/INI1 of this tumor was not detected by reverse
transcription-polymerase chain reaction (RT-PCR). The patient has been in a
good condition for 7 years after the first operation. CONCLUSIONS: Based on
the immunohistochemical findings, the tumor was descriptively diagnosed as
an embryonal tumor with an epithelial immunophenotype. The hSNF5/INI1 gene
has recently been reported to act as a tumor suppressor in atypical
teratoid/rhabdoid tumors. The hSNF5/INI1 gene may lead to tumorigenesis in
this case.
Publication Types:
PMID: 15168054 [PubMed - indexed for MEDLINE]
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| 26: Childs
Nerv Syst. 2005 Feb;21(2):171-5. Epub 2004 May 12. |
|
-
Primary spinal cord oligodendroglioma: case report and
review of the literature.
Fountas KN, Karampelas I, Nikolakakos LG, Troup EC, Robinson JS.
Department of Neurosurgery, Medical Center of Central Georgia, Mercer
University School of Medicine, 840 Pine Street, Suite 880, Macon, GA 31201,
USA. knfountasmd@excite.com
OBJECTS: The objectives were to present a case of pediatric spinal
oligodendroglioma and review the existing literature written in English on
the subject of human spinal oligodendrogliomas. A comparison of the
clinical, radiologic, and pathologic characteristics, as they relate to
those already described in similar cases, was also attempted. METHODS:
Thorough evaluation of the patient's clinical course was undertaken.
Presenting symptoms and signs are reported. The perioperative radiologic
features of the case are presented and the intraoperative details as well as
the pathologoanatomic findings and follow-up history are provided. We
subsequently performed a thorough search in the literature focusing on the
number, characteristics, treatment modalities, and prognosis of patients
with spinal cord oligodendrogliomas. CONCLUSIONS: Spinal oligodendrogliomas
are a distinctly rare type of nervous system tumor, especially in the
pediatric population. An international registry addressing all of their
clinical and pathobiological characteristics would be of great benefit to
patients harboring these rare tumors.
Publication Types:
PMID: 15138790 [PubMed - indexed for MEDLINE]
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| 27: Childs
Nerv Syst. 2005 Feb;21(2):156-60. Epub 2004 Apr 17. |
|
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Supratentorial malignant ependymoma in childhood: 16
years without relapse after hemispherectomy.
Ahmadi R, Schmitt HP, Kunze S, Steiner HH.
Department of Neurosurgery, University of Heidelberg, INF 400, 69120,
Heidelberg, Germany. rezvan.ahmadi@med.uni-heidelberg.de
INTRODUCTION: Malignant intracranial ependymomas in childhood have a poor
prognosis, supratentorial ependymomas have the poorest clinical course with
a survival rate after 5 years of 45%. The most important prognostic factor
in these cases is a radical operation, which cannot usually, however,
prevent relapse. CASE REPORT: We demonstrate the case of a large malignant
ependymoma of the left cerebral hemisphere in a child who has so far lived
for 16 years without relapse after an extensive but uncomplicated left-sided
hemispherectomy. The patient has also shown an improvement in her
preoperative neurologic deficits. Her epilepsy, which was difficult to
manage preoperatively, has been completely eliminated. She went to a special
school for handicapped children and now works there. She does not need any
help in handling everyday activities. CONCLUSION: This case shows the
significance of complete tumor resection in malignant ependymomas, which
may, under certain circumstances, lead to lasting tumor control.
Publication Types:
PMID: 15095106 [PubMed - indexed for MEDLINE]
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| 28: Childs
Nerv Syst. 2005 Feb;21(2):165-70. Epub 2004 Apr 7. |
|
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Cervical lipoblastomatosis producing quadriparesis: case
report of surgery with chemotherapy and 10-year follow-up.
O'Brien D, Aquilina K, Farrell M, Breathnach F, Allcutt D.
Department of Neurosurgery, Royal Liverpool Children's Hospital NHS Trust,
Alder Hey, Eaton Road, Liverpool, L12 2AP, UK. dfobstl@hotmail.com
INTRODUCTION: Cervical lipoblastomatosis is a rare spinal tumour. Management
of recurrence and long-term outcome data are not well described. CASE
REPORT: A 10-month-old infant presented with an upper extremity weakness.
Magnetic resonance imaging (MRI) revealed an extradural cervical spinal
tumour. It was debulked and histopathology revealed it to be
lipoblastomatosis. The infant improved postoperatively. However, 5 months
later the patient deteriorated and developed quadriparesis. The patient was
managed with a more extensive resection and had chemotherapy. Ten years
post-presentation the patient is well having made a full recovery and is
living a normal life. Recent MRI shows minimal residual quiescent tumour.
CONCLUSION: The treatment of cervical lipoblastomatosis should involve the
resection of as much tumour as possible at the first sitting as recurrence
can be a problem. In cases of spinal recurrence we recommend aggressive
decompression and adjuvant chemotherapy.
Publication Types:
PMID: 15071750 [PubMed - indexed for MEDLINE]
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| 29: Clin
Cancer Res. 2005 Jun 15;11(12):4479-86. |
|
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Targeting the c-Met Pathway Potentiates Glioblastoma
Responses to {gamma}-Radiation.
Lal B, Xia S, Abounader R, Laterra J.
Authors' Affiliations: Departments of Neurology, Oncology and Neuroscience,
The Johns Hopkins University School of Medicine and The Kennedy Krieger
Research Institute, Baltimore, Maryland.
PURPOSE: Resistance to current cytotoxic therapies limits the treatment of
most solid malignancies. This results, in part, from the overactivation of
receptor tyrosine kinases and their downstream pathways in tumor cells and
their associated vasculature. In this report, we ask if targeting the
multifunctional mitogenic, cytoprotective, and angiogenic scatter
factor/hepatocyte growth factor (SF/HGF)/c-Met pathway potentiates antitumor
responses to gamma-radiation.EXPERIMENTAL DESIGN: Endogenous expression of
SF/HGF and c-Met was targeted in U87 MG human malignant glioma cells and
xenografts using chimeric U1/ribozymes. The effects of U1/ribozymes +/-
gamma-radiation on glioma cell proliferation, apoptosis, xenograft growth,
and animal survival were examined.RESULTS: U1/ribozymes knocked down SF/HGF
and c-Met mRNA and protein levels, sensitized cells to gamma-radiation (P
< 0.005), and enhanced radiation-induced caspase-dependent cytotoxicity
in vitro (P < 0.005). Intravenous U1/ribozyme therapy as liposome/DNA
complexes or radiation alone modestly and transiently inhibited the growth
of s.c. U87 xenografts. Combining the therapies caused tumor regression and
a 40% tumor cure rate. In animals bearing intracranial xenografts, long-term
survival was 0% in response to radiation, 20% in response to intratumoral
adenoviral-based U1/ribozyme delivery, and 80% (P < 0.0005) in response
to combining U1/ribozymes with radiation. This apparent synergistic
antitumor response was associated with a approximately 70% decrease in cell
proliferation (P < 0.001) and a approximately 14- to 40-fold increase in
apoptosis (P < 0.0001) within xenografts.CONCLUSIONS: Targeting the
SF/HGF/c-Met pathway markedly potentiates the antiglioma response to
gamma-radiation. Clinical trials using novel SF/HGF/c-Met pathway inhibitors
in glioma and other malignancies associated with c-Met activation should
ultimate include concurrent radiation and potentially other cytotoxic
therapeutics.
PMID: 15958633 [PubMed - in process]
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| 30: Clin
Cancer Res. 2005 Jun 15;11(12):4388-92. |
|
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Low-molecular weight caldesmon as a potential serum
marker for glioma.
Zheng PP, Hop WC, Sillevis Smitt PA, van den Bent MJ, Avezaat CJ, Luider
TM, Kros JM.
Authors' Affiliations: Departments of Pathology, Epidemiology and
Biostatistics, Neurology, and Neurosurgery, Erasmus Medical Center,
Rotterdam, the Netherlands.
PURPOSE: Testing the feasibility of using the serum low-molecular weight
caldesmon (l-CaD) level as a serum marker for the presence of
glioma.EXPERIMENTAL DESIGN: Within a total of 230 serum samples, the l-CaD
level was measured in healthy volunteers (30), patients with gliomas (57),
nonglial intracranial tumors (107), and nontumor neurologic diseases (36) by
ELISA. The specificity of the assay was monitored by combination of
immunoprecipitation and immunoblotting.RESULTS: The serum level of l-CaD is
significantly higher in the group of glioma patients as compared with any of
the other groups (P < 0.001). The cutoff value of 45 yields optimal
sensitivity and specificity of the assay (91% and 84%, respectively; area
under the curve score = 0.91). The specificity of ELISA was confirmed by the
immunoprecipitation/immunoblotting control experiments. There were no
significant differences in serum l-CaD levels between patients with low- or
high-grade gliomas.CONCLUSIONS: The serum l-CaD level as determined by ELISA
is a good discriminator between glioma patients versus patients with other
intracranial tumors, other neurologic diseases, and healthy people.
Prospective studies are required to test the contribution of the assay in
making the diagnosis of glioma, or its feasibility for monitoring the tumor
during treatment.
PMID: 15958622 [PubMed - in process]
-
| 31: Int
J Cancer. 2005 Jun 14; [Epub ahead of print] |
|
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Association of a single nucleotide polymorphism in the
matrix metalloproteinase-1 promoter with glioblastoma.
McCready J, Broaddus WC, Sykes V, Fillmore HL.
Department of Anatomy and Neurobiology, Virginia Commonwealth University,
Medical College of Virginia Campus,Richmond, VA, USA.
A key feature in the malignant behavior of glioblastoma is the tendency to
invade host brain tissue surrounding the primary tumor site. Several members
of the matrix metalloproteinase family are thought to contribute to this
invasive capacity. A single nucleotide polymorphism has been described in
the matrix metalloproteinase-1 (MMP-1) promoter that consists of either the
presence or absence of a guanine nucleotide at position -1607. The presence
of the guanine base creates a functional binding site for members of the ETS
family of transcription factors and has been shown to increase MMP-1
transcription. The purpose of our study was to characterize this
polymorphism in human glioblastoma. Promoter genotyping was performed on
brain tumor tissue obtained from 81 patients and compared to 57 healthy
individuals. The 2G/2G genotype is more prevalent in glioblastoma tissue
compared to healthy individuals (p = 0.01). mRNA and protein expression were
measured in a subset of brain tumor and normal brain tissue samples. MMP-1
protein levels are significantly higher in glioblastoma tissue compared to
normal brain (p = 0.001). Electromobility shift assays and promoter assays
were performed to assess binding capability and transcriptional activity,
respectively. Proteins present in glioma cell lines can specifically bind
the 2G promoter probe. MMP-1 transcription is significantly higher in cells
transfected with the 2G promoter when compared to cells transfected with the
1G promoter (p<0.02). This polymorphism may provide a mechanism for
increased expression of MMP-1 in malignant gliomas via elevation of MMP-1
mRNA transcription and may underlie the invasive phenotype. (c) 2005
Wiley-Liss, Inc.
PMID: 15957163 [PubMed - as supplied by publisher]
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| 32: J
Clin Oncol. 2005 Jun 20;23(18):4235-6. |
|
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How lymphotoxic is dose-intensified temozolomide? The
glioblastoma experience.
Wick W, Weller M.
PMID: 15961774 [PubMed - in process]
 
| 33: J
Clin Oncol. 2005 Jun 20;23(18):4127-36. |
|
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Use of magnetic resonance imaging to assess
blood-brain/blood-glioma barrier opening during conformal radiotherapy.
Cao Y, Tsien CI, Shen Z, Tatro DS, Ten Haken R, Kessler ML, Chenevert TL,
Lawrence TS.
Department of Radiation Oncology, University of Michigan, 1500 E Medical
Center Dr, Rm B2C438, Box 0010, Ann Arbor, MI 48109-0010; e-mail:
yuecao@med.umich.edu.
PURPOSE For chemotherapy to act synergistically and safely with radiation
against high-grade gliomas, drugs must pass the endothelial junctions of the
blood-tumor barrier (BTB) to reach all tumor cells, and should not pass the
blood-brain barrier (BBB) to cause toxicity to normal brain. The objective
of this study was to assess BBB/BTB status using magnetic resonance imaging
(MRI) during a course of radiotherapy of high-grade gliomas. PATIENTS AND
METHODS Sixteen patients with grade 3 or 4 supratentorial malignant glioma
receiving conformal radiotherapy (RT) underwent contrast-enhanced MRI
before, during, and after completion of RT. A gadolinium
diethylenetriaminepentaacetic acid (Gd-DTPA) uptake index was analyzed with
respect to the tumor and RT dose received. Results In the nonenhanced tumor
region, contrast uptake increased significantly after the receipt of
approximately 10 Gy (P < .01), and reached a maximum after the receipt of
approximately 30 Gy. In the initially contrast-enhanced tumor region,
contrast uptake decreased over the course of RT and became significant after
completion of RT in patients without progressive disease. The healthy brain
showed only nonsignificant changes during and after irradiation. CONCLUSION
Contrast MRI reveals increases in Gd-DTPA uptake in the initially
nonenhanced tumor region but not in the remaining brain during the course of
RT, suggesting opening of the BTB. This finding suggests that the effect of
conformal radiation is more selective on the BTB than the BBB, and there may
be a window extending from 1 week after the initiation of radiotherapy to 1
month after the completion of treatment during which a pharmaceutical agent
has maximum access to high-grade gliomas.
PMID: 15961760 [PubMed - in process]
-
-
Epidermal growth factor receptor, protein kinase B/Akt,
and glioma response to erlotinib.
Haas-Kogan DA, Prados MD, Tihan T, Eberhard DA, Jelluma N, Arvold ND,
Baumber R, Lamborn KR, Kapadia A, Malec M, Berger MS, Stokoe D.
Department of Neurosurgery, Brain Tumor Research Center, University of
California-San Francisco, 1600 Divisadero Street, Suite H1031, San
Francisco, CA 94143, USA. hkogan@radonc17.ucsf.edu
BACKGROUND: The epidermal growth factor receptor (EGFR) tyrosine kinase
inhibitor erlotinib (also known as Tarceva or OSI-774) has shown promising
response rates in malignant gliomas. We investigated the association between
expression of EGFR and downstream signaling components and the response of
malignant gliomas to erlotinib in a phase I trial of erlotinib administered
either alone or with the alkylating agent temozolomide. METHODS: Expression
of EGFR and ligand-independent EGFRvIII mutant proteins and of
phosphorylated protein kinase B (PKB)/Akt in specimens from glioma patients
were assessed by immunohistochemistry. EGFR gene amplification was evaluated
by fluorescence in situ hybridization. Mutations in PTEN and EGFR were
assessed by polymerase chain reaction amplification and sequencing. Response
was evaluated by sequential magnetic resonance imaging every 2 months. The
Cochran-Mantel-Haenzel test was used to assess associations between
biomarker status and response. All statistical tests were two-sided.
RESULTS: Of 41 glioma patients, eight responded to treatment. Response to
erlotinib was associated with EGFR expression (P = .07) and EGFR
amplification (P = .08). These associations were stronger and statistically
significant among the 29 patients initially diagnosed with glioblastoma
multiforme (P = .03 and P = .02, respectively). Among six responders with
sufficient tumor tissue, none had EGFRvIII mutations. None of the 22 tumors
with high levels of phosphorylated PKB/Akt responded to erlotinib treatment,
whereas eight of the 18 tumors with low levels of phosphorylated PKB/Akt
responded to erlotinib treatment (P < .001). The level of phosphorylated
PKB/Akt was also associated with time to progression (P < .001).
CONCLUSIONS: Among glioma patients, those with glioblastoma multiforme
tumors who have high levels of EGFR expression and low levels of
phosphorylated PKB/Akt had better response to erlotinib treatment than those
with low levels of EGFR expression and high levels of phosphorylated
PKB/Akt.
PMID: 15956649 [PubMed - in process]
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| 35: J
Natl Cancer Inst. 2005 Jun 15;97(12):868-9. |
|
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Erlotinib in gliomas: should selection be based on EGFR
and Akt analyses?
Cappuzzo F.
Publication Types:
PMID: 15956643 [PubMed - in process]
| 36: J Neurosurg.
2005 May;102(5):951-5. |
|
Supraorbital craniotomy for parasellar lesions. Technical
note.
Noguchi A, Balasingam V, McMenomey SO, Delashaw JB Jr.
Department of Neurosurgery, Kyorin University School of Medicine, Tokyo,
Japan.
The authors present a modification to a previously reported supraorbital
craniotomy procedure that is smaller, simpler, safe, and cosmetically
pleasing. Minimal brain retraction is used without compromising the surgical
exposure of the orbital roof, floor of the anterior fossa, and the
parasellar region to treat tumoral lesions that are located medial to the
ipsilateral optic nerve as well as aneurysms of the anterior communicating
artery.
PMID: 15926729 [PubMed - indexed for MEDLINE]
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| 37: J Neurosurg.
2005 May;102(5):945-50. |
|
Extradural anterior clinoidectomy. Technical note.
Noguchi A, Balasingam V, Shiokawa Y, McMenomey SO, Delashaw JB Jr.
Division of Skull Base Neurosurgery, Department of Neurological Surgery,
Oregon Health & Science University, Portland, Oregon 97239, USA.
The anterior clinoid process (ACP), located on the skull base, is a
relatively small structure, although its removal provides enormous gain in
facilitating the management of lesions--either tumors or aneurysms--in the
paraclinoid region and upper basilar artery. The extensive surgical field
gained contributes to safer exposure of the neurovascular elements in the
vicinity while avoiding excessive and hazardous retraction of the brain. In
this report the authors present a technically simpler avenue for performing
an extradural anterior clinoidectomy after reviewing the anatomy of the ACP
and its anatomical variations. Additionally, the original Dolenc procedure
and its subseqtient derivatives are compared and contrasted to the authors'
simpler and less laborious technique. Different clinical situations in which
to use the procedure are described based on the authors' experience from 60
cases (40 aneurysm cases and 20 tumor cases) during a 4-year period.
PMID: 15926728 [PubMed - indexed for MEDLINE]
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| 38: J Neurosurg.
2005 May;102(5):938-9. |
|
Suture knot on the repair splint: a simple method to
facilitate reconstruction of the sella turcica during endonasal endoscopic
transsphenoidal surgery. Technical note.
Kubo S, Hasegawa H, Inui T, Tominaga S, Yoshimine T.
Department of Neurosurgery, Tominaga Hospital, and Department of
Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan.
sig-kubo@momo.so-net.ne.jp
Reconstruction of the sellar floor after pituitary tumor removal is
sometimes difficult because the repair graft is difficult to handle in the
narrow space. This is especially problematic if the endonasal endoscopic
approach is used. The authors devised a technique to facilitate this
procedure by placing a suture knot on the repair splint. This allows the
material to be grasped securely with forceps and improves manipulation even
within the narrow nasal cavity. This technique has proved useful when
performing the endonasal endoscopic approach, and it is also expected to be
useful when conducting the conventional sublabial transsphenoidal approach.
PMID: 15926726 [PubMed - indexed for MEDLINE]
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| 39: J Neurosurg.
2005 May;102(5):922-6. |
|
Intracranial endovascular stent placement for symptomatic
metastatic non-hodgkin lymphoma. Case report.
Rajpal S, Niemann DB, Aagaard-Kienitz B, Turk AS.
Department of Neurosurgery, University of Wisconsin Medical School, Madison,
Wisconsin 53792, USA.
A case of cranial-based metastatic non-Hodgkin lymphoma with cerebral
vascular compromise is presented. The patient underwent intracranial
endovascular stent placement resulting in an improvement in his symptoms.
This is the first reported case of endovascular stent placement for an
intracranial neoplasm in the literature to date.
Publication Types:
PMID: 15926722 [PubMed - indexed for MEDLINE]
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| 40: J Neurosurg.
2005 May;102(5):832-41. |
|
Comment in:
The extended direct endonasal transsphenoidal approach
for nonadenomatous suprasellar tumors.
Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP, Martin
NA.
Divisions of Neurosurgery and Endocrinology, University of California at Los
Angeles School of Medicine, USA.
OBJECT: The extended transsphenoidal approach, which requires a bone and
dural opening through the tuberculum sellae and posterior planum
sphenoidale, is increasingly used for the treatment of nonadenomatous
suprasellar tumors. The authors present their experiences in using the
direct endonasal approach in patients with nonadenomatous suprasellar
tumors. METHODS: Surgery was performed with the aid of an operating
microscope and angled endoscopes were used to assess the completeness of
resection. Bone and dural defects were repaired using abdominal fat,
collagen sponge, titanium mesh, and, in most cases, lumbar drainage of
cerebrospinal fluid (CSF). Twenty-six procedures for tumor removal were
performed in 24 patients (ages 9-79 years), including two repeated
operations for residual tumor. Gross-total removal could be accomplished in
only 46% of patients, with near-gross-total removal or better in 74% of 23
patients (five of eight with craniopharyngiomas, six of seven with
meningiomas, five of six with Rathke cleft cysts, and one of two with a
dermoid or epidermoid cyst); a patient with a lymphoma only underwent
biopsy. Of 13 patients with tumor-related visual loss, 85% improved
postoperatively. The complications that occurred included five patients
(21%) with postoperative CSF leaks, one patient (4%) with bacterial
meningitis; five patients (21%) with new endocrinopathy; and two patients
(8%) who needed to undergo repeated operations to downsize suprasellar fat
grafts. The only permanent neurological deficit was anosmia in one patient;
there were no intracranial vascular injuries. CONCLUSIONS: The direct
endonasal skull-base approach provides an effective minimally invasive means
for resecting or debulking nonadenomatous suprasellar tumors that have
traditionally been approached through a sublabial or transcranial route.
Procedures in the supraglandular space can be performed effectively with
excellent visualization of the optic apparatus while preserving pituitary
function in most cases. The major challenge remains developing consistently
effective techniques to prevent postoperative CSF leaks.
PMID: 15926706 [PubMed - indexed for MEDLINE]
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| 41: J Neurosurg.
2005 May;102(4 Suppl):403-6. |
|
Spinal intramedullary arachnoid cyst in a 4-year-old
girl: a rare cause of treatable acute quadriparesis: case report.
Sharma A, Karande S, Sayal P, Ranadive N, Dwivedi N.
Department of Neurosurgery, Lokmanya Tilak Municipal Medical College and
General Hospital, Sion, Mumbai (Bombay), India.
The authors report their experience in successfully treating a 4-year-old
girl who presented with sudden onset of quadriparesis that lasted for 20
days. Magnetic resonance (MR) imaging of the spine revealed an
intramedullary cystic lesion extending from C-4 to C-6. A C4-6 laminectomy
was performed followed by a median myelotomy. The cyst was decompressed and
most of the cyst wall was excised. The histopathological findings were
consistent with those of an arachnoid cyst. By postoperative Day 3, power
had gradually returned to normal in all her limbs. On follow-up reviews at 2
and 17 months, the results of her neurological examinations remained normal.
Follow-up MR imaging of the spine at 17 months revealed an intramedullary
residual cystic lesion extending from C-5 to C-6, without any mass effect.
An intramedullary arachnoid cyst should be considered in the differential
diagnosis of an intramedullary cystic lesion.
Publication Types:
PMID: 15926392 [PubMed - indexed for MEDLINE]
| 42: Neurol Res.
2005 Jun;27(4):371-7. |
|
-
Expression of VEGF and its receptors in different brain
tumors.
Huang H, Held-Feindt J, Buhl R, Mehdorn HM, Mentleinz R.
Department of Neurosurgery, The First Affiliated Hospital, Zhejiang
University School of Medicine, Hangzhou, People's Republic of China.
INTRODUCTION: Vascular endothelial growth factor (VEGF) and its receptors
VEGFR-1 and -2 are considered to play a major in tumor angiogenesis, which
is a prerequisite for growth of solid tumors. Glioblastoma multiforme is a
prominent example of VEGF-induced tumor vascularization; however, little is
known about VEGF and in particular VEGFR expression in other types of brain
tumors. METHODS: VEGFR mRNA was quantified by real time RT-PCR in 12
different types of brain tumors and compared to VEGF protein content
measured by ELISA. VEGF splice variants were determined by an RT-PCR method.
RESULTS: VEGF protein was highest in glioblastoma and metastatic kidney
tumors. In all types of tumors the diffusible splice forms VEGF(121) and
VEGF(165) were expressed; VEGF(189) was minor in a few tumors. Expression of
VEGF receptors did not necessarily correlate with VEGF content. Both were
highly expressed in glioblastomas, but in meningiomas VEGF was low and VEGFR
high, and in metastatic tumors the reverse. With few exceptions, in
particular oligodendrogliomas, VEGFR-1 expression was parallel to VEGFR-2
expression. Interestingly, for the astrocytic gliomas, the expression of
VEGFR correlated well to the tumor malignancy, even better than VEGF
content. CONCLUSIONS: These results show that VEGF and VEGFR expression in
various types of brain tumors differ and are not necessarily parallel.
PMID: 15949234 [PubMed - in process]
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| 43: Neurol Res.
2005 Jun;27(4):358-62. |
|
-
Accuracy of frameless and frame-based image-guided
stereotactic brain biopsy in the diagnosis of glioma: comparison of biopsy
and open resection specimen.
Woodworth G, McGirt MJ, Samdani A, Garonzik I, Olivi A, Weingart JD.
Departments of Neurosurgery and Oncology, Johns Hopkins School of Medicine,
Baltimore, Maryland 21287, USA.
OBJECTIVES: Tissue heterogeneity and rapid tumor progression may decrease
the accuracy a prognostic value of stereotactic brain biopsy in the
diagnosis of gliomas. Correct tumor grading is therefore dependent on the
accuracy of biopsy needle placement. There has been a dramatic increase in
the utilization of frameless image-guided stereotactic brain biopsy;
however, its accuracy in the diagnosis of glioma remains unstudied. METHODS:
The diagnoses of 21 astrocytic brain tumors were derived using image-guided
stereotactic biopsy (12 frame-based, nine frameless) and followed by open
resection of the lesion 1.5 (0.5-4) months later. The histologic diagnoses
yielded by the biopsy were compared with subsequent histologic diagnosis
from open tumor resection. RESULTS: Histology of 21 stereotactic biopsies
accurately represented the greater lesion at open resection a median of 45
days later in 16 (76%) cases and correctly guided therapy in 19 (91%) cases.
Biopsy accuracy of frameless versus frame-based stereotaxis was similar (89
versus 66%, p=0.21). In three (14%) cases, biopsy specimens were adequate to
diagnose glioma; however, histology was insufficient for definitive tumor
grading. Anaplastic oligodendroglioma (ODG) was under-graded as low-grade
ODG in one (5%) case. Biopsy of new onset glioblastoma multiforme (GBM)
yielded necrosis/gliosis and was termed non-diagnostic in one patient.
Tumors <50 cm(3) were 8-fold less likely to accurately represent the
grade of the entire lesion at resection compared with lesions <50 cm(3)
(OR, 8.8; 95% CI, 0.9-100, p=0.05). DISCUSSION: Both frameless and
frame-based MRI-guided stereotactic brain biopsy are safe and accurately
represent the larger glioma mass sufficiently to guide subsequent therapy.
Large tumor volume had a higher incidence of non-concordance. Increasing the
number of specimens taken through the long dimension of large tumors may
improve diagnostic accuracy.
PMID: 15949232 [PubMed - in process]
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| 44: Neurol Res.
2005 Jun;27(4):351-7. |
|
-
Evaluation of intra-operative ultrasound imaging in brain
tumor resection: a prospective study.
Renner C, Lindner D, Schneider JP, Meixensberger J.
Department of Neurosurgery, University of Leipzig, Leipzig, Germany.
renc@medizin.uni-leipzig.de
AIMS: The purpose of our study was to evaluate intra-operative ultrasound
(IOUS) as a tool of resection control after brain tumor surgery. In
addition, we looked for tumor species suitable for ultrasound
representation. METHODS: Using a Siemens Omnia Sonoline Ultrasound, 36
tumors were examined, high-grade gliomas (62%), metastases (22%) and others
(16%). We focused on tumor imaging by ultrasound with regard to its
reliability of tumor expansion and margins. Evaluation of the images was
carried out by correlating the ultrasound-based intra-operative measured
tumor volume before and after resection with a pre- and post-operative
(within 48 hours) measured volume by MRI. The IOUS measurements were
performed by the neurosurgeon and the MRI measurements by the
neuroradiologist. Thus, the measurement procedures were blinded.
Corresponding to a deviation of the ultrasound volume by 10, 20 and > 20%
from the MRI volume, the correlation was ranked good, moderate and poor. For
assessing the agreement between these two methods of imaging, the
statistical analysis was conducted using a method described by Bland and
Altman. RESULTS: High-grade gliomas mostly showed a moderate or poor
correlation in comparing IOUS- and MRI-tumor volumetry resulting in
incomplete resection. Metastases resulted in a good to moderate correlation
with a satisfactory extent of resection. The other tumors had poor images
with larger tumor residues. The MRI measured volumes tended to be larger on
average; the deviation grew with tumor size .CONCLUSION: The reliability of
IOUS depends on tumor type. It is beneficial to use IOUS for the resection
of metastases and a few high-grade gliomas. Concerning the volumetric
accuracy, the value of IOUS is worse than its value of navigation and
resection control.
PMID: 15949231 [PubMed - in process]
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| 45: Neuroradiology. 2005
Jun 11; [Epub ahead of print] |
|
-
Intraoperative MRI to guide the resection of primary
supratentorial glioblastoma multiforme-a quantitative radiological analysis.
Schneider JP, Trantakis C, Rubach M, Schulz T, Dietrich J, Winkler D,
Renner C, Schober R, Geiger K, Brosteanu O, Zimmer C, Kahn T.
Diagnostic Radiology, University of Leipzig, Liebigstr. 20, 04103, Leipzig,
Germany, schneidj@medizin.uni-leipzig.de.
Patients with supratentorial high-grade glioma underwent surgery within a
vertically open 0.5-T magnetic resonance (MR) system to evaluate the
efficacy of intraoperative MR guidance in achieving gross-total resection.
For 31 patients, preoperative clinical data and MR findings were consistent
with the putative diagnosis of a high-grade glioma, in 23 cases in eloquent
regions. Tumor resections were carried out within a 0.5-T MR SIGNA SP/i (GE
Medical Systems, USA). The resection of the lesion was carried out using
fully MR compatible neurosurgical equipment and was stopped at the point
when the operation was considered complete by the surgeon viewing the
operation field with the microscope. We repeated imaging to determine the
residual tumor volume only visible with MRI. Areas of tissue that were
abnormal on these images were localized in the bed of resection by using
interactive MR guidance. The procedure of resection, imaging control and
interactive image guidance was repeated where necessary. Almost all tissue
with abnormal characteristics was resected, with the exception of tissue
localized in eloquent brain areas. The diagnosis of glioblastoma was
confirmed in all 31 cases. When comparing the tumor volume before resection
and at the point where the neurosurgeon would otherwise have terminated
surgery ("first control"), residual tumor tissue was detectable in
29/31 patients; the mean residual tumor volume was 30.7+/-24%. After
repeated resections under interactive image guidance the mean residual tumor
volume was 15.1%. At this step we found tumor remnants only in 20/31
patients. The perioperative morbidity (12.9%) was low. Twenty-seven patients
underwent sufficient postoperative radiotherapy. We found a significant
difference (log(rank)p=0.0037) in the mean survival times of the two groups
with complete resection (n=10, median survival time 537 days) and incomplete
resection (n=17, median survival time 237 days). The resection of primary
glioblastoma multiforme under intraoperative MR guidance as demonstrated is
a possibility to achieve a more complete removal of the tumor than with
conventional techniques. In our small but homogeneous patient group we found
an increase in the median survival time in patients with MRI for complete
tumor resection, and the overall surgical morbidity was low.
PMID: 15951997 [PubMed - as supplied by publisher]
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Volume 4, Number 26 - 19 June 2005