| 1: Am
J Clin Oncol. 2005 Apr;28(2):180-7. |
|
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Predictors of tumor control in patients treated with
linac-based stereotactic radiosurgery for metastatic disease to the brain.
Schomas DA, Roeske JC, MacDonald RL, Sweeney PJ, Mehta N, Mundt AJ.
Department of Radiation and Cellular Oncology, The University of Chicago,
Chicago, Illinois 60637, USA.
OBJECTIVE: The objective of this study was to determine predictive factors
for local control (LC) of brain metastases (BM) treated with Linac-based
stereotactic radiosurgery (LB-SRS). METHODS: Between January 1994 and July
2001, 80 patients (126 BM) underwent LB-SRS. All patients had follow-up
imaging with computed tomography (40%) or magnetic resonance imaging (60%).
Most patients had either lung (41%) or renal cell (20%) cancer. The median
SRS prescription dose was 18 Gy (range, 10-21 Gy). Most patients (86%) also
received whole-brain radiotherapy (WBRT). LC was defined as the absence of
enlargement of the BM on follow-up scans. Actuarial LC analyses were
performed by the method of Kaplan-Meier and compared with the log-rank test.
Factors analyzed included histology, volume, prescription dose, maximum and
minimum tumor dose, target volume ratio, number of arcs and isocenters,
total degrees, and WBRT. Multivariate analysis was accomplished. RESULTS: At
a median follow up of 8.8 months, 11 BM failed (8.7%). The 1-and 2-year
actuarial LC rates were 88.6% and 77.2%, respectively. The most significant
factors correlated with LC were prescription (P = 0.0004) and minimum tumor
(P = 0.002) doses, and tumor volume (P = 0.04). On multivariate analysis,
the sole factor correlated with LC was minimum tumor dose (P = 0.03).
CONCLUSION: Our results confirm that LB-SRS is associated with excellent LC
rates in the majority of patients treated. However, particular attention
should be given to minimum target dose to ensure optimal outcome.
PMID: 15803014 [PubMed - indexed for MEDLINE]
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| 2: Cancer. 2005 Jun 22; [Epub
ahead of print] |
|
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Pro-gastrin-releasing peptide as a factor predicting the
incidence of brain metastasis in patients with small cell lung carcinoma
with limited disease receiving prophylactic cranial irradiation.
Yonemori K, Sumi M, Fujimoto N, Ito Y, Imai A, Kagami Y, Ikeda H.
Division of Radiation Oncology, National Cancer Center Hospital, Tokyo,
Japan.
BACKGROUND: Prophylactic cranial irradiation (PCI) reduces the incidence of
brain metastasis with an effect on overall survival in patients with small
cell lung carcinoma (SCLC). In spite of multidisciplinary intensive
treatment approaches, many patients still experience brain metastasis. The
authors retrospectively analyzed the characteristics of the first failure
event due to brain metastasis (FBM) in patients treated with PCI. METHODS:
Between January 1990 and April 2004, 71 patients with limited disease SCLC
were treated with PCI after completing systemic treatment at the National
Cancer Center Hospital (Tokyo, Japan). Univariate and multivariate analyses
were used to identify factors related to FBM and survival. RESULTS: The FBM
and overall incidence of brain metastasis (OBM) were 16.9 % (12 of 71) and
26.8% (19 of 71), respectively. Median time to progressive disease and
median survival were 8.4 months and 21.6 months, respectively. Elevation of
pro-gastrin-releasing peptide (Pro GRP) level before PCI was found to be a
significant predictive and prognostic factor for FBM, OBM, and survival on
multivariate analysis (P = 0.007, P = 0.025, and P = 0.009, respectively).
CONCLUSIONS: An elevated Pro GRP level before PCI was found to be
significantly related to FBM and survival, and should be considered before
PCI is performed. Cancer 2005. (c) 2005 American Cancer Society.
PMID: 15973666 [PubMed - as supplied by publisher]
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| 3: Cancer. 2005 Jun 21; [Epub
ahead of print] |
|
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S100beta as a predictor of brain metastases.
Vogelbaum MA, Masaryk T, Mazzone P, Mekhail T, Fazio V, McCartney S,
Marchi N, Kanner A, Janigro D.
Brain Tumor Institute, The Cleveland Clinic Foundation, Cleveland, Ohio.
BACKGROUND: The identification of brain metastases in patients with
malignant disease has important implications for determining their treatment
and prognosis. Asymptomatic metastatic brain tumors may be detected by
surveillance imaging techniques, but longitudinal follow-up of patients who
are at risk is sporadic primarily due to cost. Because the development of
brain metastases is accompanied and detected by extravasation of contrast
agents across the blood-brain barrier (BBB), the authors hypothesized that
peripheral analysis of the BBB indicator S100beta may be useful as a
screening tool for brain metastases in patients who have no neurologic
symptoms. METHODS: Thirty-eight patients were enrolled for the current
study. All patients had newly diagnosed lung carcinoma and had no neurologic
symptoms or known history of brain metastasis. Patients underwent an initial
magnetic resonance imaging (MRI) scans and S100beta blood tests. S100beta
tests were repeated in a subset of patients at the time of routine follow-up
MRI scans. RESULTS: Based on imaging studies and on serum S100beta analyses,
the patients were divided in 3 categories: 1) patients with normal S100beta
levels (0.08 +/- 0.02 mug/L; n = 22 patients) and normal MRI scans; 2)
patients with elevated S100beta levels (0.5 +/- 0.28 mug/L; n = 8 patients)
and pronounced microvascular changes on MRI scans but with no metastases;
and 3) patients with elevated S100beta levels (0.28 +/- 0.19 mug/L; n = 7
patients) and metastatic brain tumor(s) on MRI scans. CONCLUSIONS: Because
of the significant overlap in S100beta levels between patients with cerebral
microvascular diseases and patients with brain metastases, the authors
concluded that the serum S100beta level may be used as a surveillance tool
to predict or detect brain metastases if appropriate prescreening radiologic
tests are obtained and if patients who are candidates for false-positive
results are identified and excluded. Cancer 2005. (c) 2005 American Cancer
Society.
PMID: 15971200 [PubMed - as supplied by publisher]
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| 4: Childs
Nerv Syst. 2005 Jun 22; [Epub ahead of print] |
|
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Craniopharyngiomas: our experience in Lyon.
Mottolese C, Szathmari A, Berlier P, Hermier M.
Pediatric Neurosurgical Service, Hopital Neurologique et Neurochirurgical
"Pierre Wertheimer", 59 Boulevard Pinel, Lyon Cedex 3, France,
carmine.mottolese@chu-lyon.fr.
OBJECTIVE: We reviewed our experience in surgical treatment of
craniopharyngiomas. Surgical treatment of craniopharyngiomas in children
represents a challenge for neurosurgeons because it presents a different set
of surgical problems. Results are controversial and debates concerning
strategies to ameliorate the rate of success and to decrease the rate of
morbidity and mortality are ongoing. Post-surgical quality of life is
related to the anatomical relationship between the hypothalamic region,
vascular structures and optic pathways. DISCUSSION: From 1985 to 2004, 60
children (age range, 4 months to 18 years) were treated in our institution.
Since 1987, all patients were studied with pre- and postoperative MRI. Two
groups of patients were distinguished: a group of 36 patients treated with
surgical direct surgery; a second group of 24 patients treated only with
intracystic chemotherapy with bleomycin (18 patients) or associated with
surgery (six patients). In the first group, the removal of lesion was total
in 74% of cases. Two patients died in the early postoperative period and two
more died later (early mortality of 5% and late mortality of 11%). All
patients presented ante-pituitary insufficiency and diabetes insipidus,
which required substitutive treatment. Twenty-two patients presented with
visual problems, including amaurosis in two cases. In the group treated with
bleomycin, 18 patients presented a primary cystic or a mixed form of
craniopharyngioma and six patients showed a cystic recurrence. Eighteen
patients were treated with bleomycin only. The dose used varied from 30 mg
to a maximal dose of 150 mg, with a middle dose of 60 mg in the large
majority of cases. In this group, the cyst disappeared in 12 patients and
reduced to 30% of its initial volume, and stabilization of the lesion was
achieved in the other six patients. Only 11 patients presented partial
endocrine insufficiency. Of the 18 patients, 16 were of school age, 14 of
whom were following a normal educational program and two an assisted
program. No mortality was reported. CONCLUSION: Our experience showed that
in the group treated with intracystic chemotherapy alone, results were
better with a low rate of morbidity and mortality. Endocrinological, visual
and neuropsychological evaluations were also correlated with better outcome.
In cases of cystic craniopharyngiomas, we considered bleomycin as the
treatment of choice. For solid forms or for cases resistant to intracystic
chemotherapy with bleomycin, direct surgery has to be proposed.
PMID: 15971075 [PubMed - as supplied by publisher]
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| 5: Childs
Nerv Syst. 2005 Jun 18; [Epub ahead of print] |
|
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The pathogenesis of craniopharyngiomas.
Prabhu VC, Brown HG.
Department of Neurosurgery, Loyola University Medical Center, 2160, South
1st Avenue, Maywood, IL, 60153, USA, vprabhu@lumc.edu.
OBJECTIVE: The objective of the study is to review the pathogenesis of
craniopharyngiomas. METHODS: A literature review of articles relating to the
embryogenesis of the pituitary gland and sella and the pathogenesis of
craniopharyngiomas was performed. CONCLUSIONS: Craniopharyngiomas are
benign, epithelial neoplasms of the sella and parasellar region seen in
children and adults that may arise from neoplastic transformation of
ectoderm-derived epithelial cell remnants of Rathke's pouch and the
craniopharyngeal duct.
PMID: 15965669 [PubMed - as supplied by publisher]
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| 6: Childs
Nerv Syst. 2005 Jun 18; [Epub ahead of print] |
|
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Craniopharyngioma: a personal (Boston) experience.
Scott RM.
Department of Neurosurgery, The Children's Hospital, Boston, MA, USA.
BACKGROUND: The author reports his experience with 79 craniopharyngiomas
operated since 1988. The review demonstrates that the biological behavior of
these tumors is extremely variable, and that surgical management requires
resourcefulness, judgement, and flexibility in the operating room. RESULTS:
Tumors will recur after total resection (15% in this series) and after
subtotal resection and radiation therapy (22%) and adjuvant treatments of
all types, and no treatment guarantees a cure. CONCLUSION: The invasiveness
of the tumor leads to difficult-to-treat long-term complications,
particularly obesity and behavior disturbances. An extremely long-term
follow-up of up to 20 years is necessary in many patients in order to
determine the ultimate outcome of treatment.
PMID: 15965668 [PubMed - as supplied by publisher]
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| 7: Childs
Nerv Syst. 2005 Jun 18; [Epub ahead of print] |
|
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Craniopharyngiomas of childhood: the CHLA experience.
Sosa IJ, Krieger MD, McComb JG.
Division of Neurological Surgery, Department of Neurological Surgery, Keck
School of Medicine, Childrens Hospital of Los Angeles, University of
Southern California, 1300 N. Vermont Avenue, Suite 1006, Los Angeles, CA,
90027, USA, GMcComb@chla.usc.edu.
OBJECTIVE: To improve the outcome of children with craniopharyngiomas by
analyzing how they were treated. METHODS: The records of patients who
underwent operation at Childrens Hospital of Los Angeles (CHLA) from 1993 to
2004 were reviewed. RESULTS: Identified were 19 girls and 16 boys with an
age range from 9 days to 16 years (mean 7 years, mode 3 years). Tumor
control was achieved in 34 of 35 patients and was accomplished with
reasonable outcome in terms of neurological deficits and overall level of
function. In 25 patients, complete tumor resection was obtained with surgery
alone, 18 with the first resection, and 7 with repeat operative
intervention. Nine children received radiation therapy after the first or
second recurrence. On retrospective review, there were no consistently
identifiable features that would lead one to determine preoperatively which
tumors would fall into a given category. CONCLUSION: We believe that the
surgeon must determine a preoperative plan that maximizes the chance for a
gross total removal of the craniopharyngioma. The biggest challenge
intraoperatively is to determine whether to continue with the attempt at
gross total removal or stop short of that goal before producing a
significant irreversible neurological deficit. A staged removal using
different operative corridors also needs to be considered.
PMID: 15965667 [PubMed - as supplied by publisher]
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| 8: Childs
Nerv Syst. 2005 Mar;21(3):240-3. Epub 2004 Nov 20. |
|
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Primary lumbosacral Wilms tumor associated with
diastematomyelia and occult spinal dysraphism. A report of a rare case and a
short review of literature.
Sharma MC, Sarat Chandra P, Goel S, Gupta V, Sarkar C.
Department of Pathology, All India Institute of Medical Sciences, New Delhi
110029, India.
BACKGROUND: The occurrence of an extrarenal Wilms tumor in the lumbosacral
region is an extremely uncommon condition. CASE REPORT: We report a case of
Wilms tumor in the lumbosacral region that was associated with
diastematomyelia and occult spina bifida. An 18-month-old girl presented
with a swelling over the lower back with a tuft of hair on it, which she had
had since birth. Imaging of the spine revealed spina bifida, bony
diastematomyelia, and tethered cord. Excision of the bony spur and
detethering of the cord was done. After a year, she had recurrence of
swelling at the same site, weakness of both lower limbs, and incontinence of
bladder and bowel. Excision of the mass and bony spur and detethering of the
spinal cord were done. Histopathological examination showed features of a
Wilms tumor.
Publication Types:
PMID: 15742208 [PubMed - indexed for MEDLINE]
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| 9: Childs
Nerv Syst. 2005 Mar;21(3):221-6. Epub 2004 Dec 14. |
|
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Intracranial ependymomas in childhood: recurrence,
reoperation, and outcome.
Vinchon M, Leblond P, Noudel R, Dhellemmes P.
Department of Pediatric Neurosurgery, University Hospital, Lille, France.
m-vinchon@chru-lille.fr
INTRODUCTION: Intracranial ependymomas (IE) in children are aggressive
tumors, and total resection (TR) is considered to be the most powerful
predictor of outcome. The data regarding recurrent IE (RIE), in particular
the role of reoperation, are scarce in the literature. METHODS AND RESULTS:
We studied 70 cases of IE in children operated on for IE since the advent of
computed imaging. TR was achieved at initial surgery in 38 out of 70 cases.
After a mean follow-up of 76.1 months, 33 out of 70 tumors had progressed.
Eighteen were reoperated, achieving TR in 12 out of 18 cases. The morbidity
associated with reoperation was minimal, especially compared with the first
operation. After a mean follow-up of 74.7 months after reoperation, 10 out
of 18 patients had died of tumor progression, 1 had a stable tumor, and 7
were tumor free. When TR was achieved, the overall survival rate was 7 out
of 12. CONCLUSION: Total resection is the only curative treatment for RIE
and is often possible, especially when the initial resection was total.
Publication Types:
PMID: 15599561 [PubMed - indexed for MEDLINE]
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| 10: Childs
Nerv Syst. 2005 Mar;21(3):259-61. Epub 2004 Sep 2. |
|
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Huge arachnoid cyst in the posterior fossa: controversial
discussion for selection of the surgical approach.
Tsuboi Y, Hamada H, Hayashi N, Kurimoto M, Hirashima Y, Endo S.
Department of Neurosurgery, Toyama Medical and Pharmaceutical University,
2630 Sugitani, Toyama 930-0194, Japan.
CASE REPORT: We report a case of a huge posterior fossa arachnoid cyst with
hydrocephalus. This 15-month-old girl presented with macrocrania and
psychomotor retardation. Magnetic resonance (MR) imaging demonstrated
ventriculomegaly and a huge cystic lesion in the posterior fossa. A
membranectomy was performed microscopically and the patient had a good
postoperative course. OUTCOME: Magnetic resonance imaging 1 year after the
operation revealed adequate reduction in the size of the ventricle and cyst.
Progressive macrocrania discontinued and normal development was obtained.
Publication Types:
PMID: 15349742 [PubMed - indexed for MEDLINE]
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| 11: Childs
Nerv Syst. 2005 Mar;21(3):230-3. Epub 2004 Aug 27. |
|
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The use of neoadjuvant chemotherapy to achieve complete
surgical resection in recurring supratentorial anaplastic ependymoma.
Valera ET, Machado HR, Santos AC, de Oliveira RS, Araujo D, Neder L, Tone
LG.
Pediatric Department, School of Medicine of Ribeirao Preto, University of
Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, CEP 14049-900, Ribeirao
Preto, Sao Paulo, Brazil. elvisvalera@hotmail.com
INTRODUCTION: Ependymoma is a central nervous system neoplasm that is often
managed with surgery and radiotherapy. The benefits of chemotherapy in
treating this tumor remain poorly defined. CASE REPORT: The use of a
platinum-based chemotherapy as a neoadjuvant treatment to permit complete
surgical resection of a supratentorial anaplastic ependymoma recurring for
the third time is described. DISCUSSION: This paper also discusses the
possible use of chemotherapy as a strategy that may allow tumor shrinkage
and ease tumor resection in giant recurring ependymomas.
Publication Types:
PMID: 15338180 [PubMed - indexed for MEDLINE]
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| 12: Int
J Radiat Oncol Biol Phys. 2005 Jun 17; [Epub ahead of print] |
|
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Cognitive function after radiotherapy for supratentorial
low-grade glioma: A north central cancer treatment group prospective study.
Laack NN, Brown PD, Ivnik RJ, Furth AF, Ballman KV, Hammack JE, Arusell
RM, Shaw EG, Buckner JC.
Division of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
PURPOSE: To evaluate the effects of cranial radiotherapy (RT) on cognitive
function in patients with supratentorial low-grade glioma. METHODS AND
MATERIALS: Twenty adult patients with supratentorial low-grade glioma were
treated with 50.4 Gy (10 patients) or 64.8 Gy (10 patients) localized RT.
The patients then were evaluated with an extensive battery of psychometric
tests at baseline (before RT) and at approximately 18-month intervals for as
long as 5 years after completing RT. To allow patients to serve as their own
controls, cognitive performance was evaluated as change in scores over time.
All patients underwent at least two evaluations. RESULTS: Baseline test
scores were below average compared with age-specific norms. At the second
evaluation, the groups' mean test scores were higher than their initial
performances on all psychometric measures, although the improvement was not
statistically significant. No changes in cognitive performance were seen
during the evaluation period when test scores were analyzed by age,
treatment, tumor location, tumor type, or extent of resection. CONCLUSIONS:
Cognitive function was stable after RT in these patients evaluated
prospectively during 3 years of follow-up. Slight improvements in some
cognitive areas are consistent with practice effects attributable to
increased familiarity with test procedures and content.
PMID: 15964709 [PubMed - as supplied by publisher]
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| 13: J
Clin Oncol. 2005 May 20;23(15):3624-6. |
|
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Case 2. Hemangioblastomas: diagnosis of von Hippel-Lindau
disease and antiangiogenic treatment with SU5416.
Schuch G, de Wit M, Holtje J, Laack E, Schilling G, Hossfeld DK, Fiedler
W, Scigalla P, Jacobs MS.
Department of Medicine, University Hospital Hamburg-Eppendorf, University of
Hamburg, Germany.
Publication Types:
PMID: 15908674 [PubMed - indexed for MEDLINE]
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| 14: J
Clin Oncol. 2005 May 20;23(15):3605-13. |
|
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Neoplastic meningitis.
Chamberlain MC.
Department of Neuro-Oncology, University of S Florida, H. Lee Moffitt Cancer
Center & Research Institute, 12902 Magnolia Dr, Suite 3136, Tampa, FL
33612, USA. chambemc@moffitt.usf.edu
Neoplastic meningitis (NM) is a common problem in neuro-oncology occurring
in approximately 5% of all patients with cancer, and is the third most
common site of CNS metastases. NM is a disease affecting the entire
neuraxis, and therefore clinical manifestations are pleomorphic affecting
the spine, cranial nerves, and cerebral hemispheres. Because of craniospinal
disease involvement, staging and treatment need to encompass all CSF
compartments. Treatment of NM utilizes involved-field radiotherapy of bulky
or symptomatic disease sites and intra-CSF drug therapy. The inclusion of
concomitant systemic therapy may benefit patients with NM and may obviate
the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is
confined to three chemotherapeutic agents (ie, methotrexate, cytarabine, and
thiotepa) administered by a variety of schedules either by intralumbar or
intraventricular drug delivery. Although treatment of NM is palliative with
an expected median patient survival of 2 to 6 months, it often affords
stabilization and protection from further neurologic deterioration in
patients with NM.
Publication Types:
PMID: 15908671 [PubMed - indexed for MEDLINE]
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| 15: J
Clin Oncol. 2005 May 20;23(15):3366-75. |
|
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Evaluation of five radiation schedules and prognostic
factors for metastatic spinal cord compression.
Rades D, Stalpers LJ, Veninga T, Schulte R, Hoskin PJ, Obralic N,
Bajrovic A, Rudat V, Schwarz R, Hulshof MC, Poortmans P, Schild SE.
Department of Radiation Oncology, University Hospital Hamburg, Martinistr.
52, D-20246 Hamburg, Germany. Rades.Dirk@gmx.net
PURPOSE: To study five radiotherapy (RT) schedules and potential prognostic
factors for functional outcome in metastatic spinal cord compression (MSCC).
PATIENTS AND METHODS: One thousand three hundred four patients who were
irradiated from January 1992 to December 2003 were included in this
retrospective review. The schedules of 1 x 8 Gy in 1 day (n = 261), 5 x 4 Gy
in 1 week (n = 279), 10 x 3 Gy in 2 weeks (n = 274), 15 x 2.5 Gy in 3 weeks
(n = 233), and 20 x 2 Gy in 4 weeks (n = 257) were compared for motor
function, ambulatory status, and in-field recurrences. The following
potential prognostic factors were investigated: age, sex, performance
status, histology, number of involved vertebra, interval from cancer
diagnosis to MSCC, pretreatment ambulatory status, and time of developing
motor deficits before RT. A multivariate analysis was performed with the
ordered logit model. RESULTS: Motor function improved in 26% (1 x 8 Gy), 28%
(5 x 4 Gy), 27% (10 x 3 Gy), 31% (15 x 2.5 Gy), and 28% (20 x 2 Gy); and
posttreatment ambulatory rates were 69%, 68%, 63%, 66%, and 74% (P = .578),
respectively. On multivariate analysis, age, performance status, primary
tumor, involved vertebra, interval from cancer diagnosis to MSCC,
pretreatment ambulatory status, and time of developing motor deficits were
significantly associated with functional outcome, whereas the RT schedule
was not. Acute toxicity was mild, and late toxicity was not observed.
In-field recurrence rates at 2 years were 24% (1 x 8 Gy), 26% (5 x 4 Gy),
14% (10 x 3 Gy), 9% (15 x 2.5 Gy), and 7% (20 x 2 Gy) (P < .001). Neither
the difference between 1 x 8 Gy and 5 x 4 Gy (P = .44) nor between 10 x 3
Gy, 15 x 2.5 Gy, and 20 x 2 Gy (P = .71) was significant. CONCLUSION: The
five RT schedules provided similar functional outcome. The three more
protracted schedules seemed to result in fewer in-field recurrences. To
minimize treatment time, the following two schedules are recommended: 1 x 8
Gy for patients with poor predicted survival and 10 x 3 Gy for other
patients. Results should be confirmed in a prospective randomized trial.
Publication Types:
PMID: 15908648 [PubMed - indexed for MEDLINE]
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| 16: J
Clin Oncol. 2005 May 20;23(15):3308-10. Epub 2005 Feb 28. |
|
Comment on:
Radiation therapy alone for spinal cord compression: time
to improve upon a relatively ineffective status quo.
Kwok Y, Regine WF, Patchell RA.
Publication Types:
PMID: 15738546 [PubMed - indexed for MEDLINE]
 
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| 17: J
Clin Oncol. 2005 May 20;23(15):3358-65. Epub 2005 Feb 28. |
|
Comment in:
Short-course versus split-course radiotherapy in
metastatic spinal cord compression: results of a phase III, randomized,
multicenter trial.
Maranzano E, Bellavita R, Rossi R, De Angelis V, Frattegiani A, Bagnoli
R, Mignogna M, Beneventi S, Lupattelli M, Ponticelli P, Biti GP, Latini P.
U.O. di Radioterapia Oncologica, Azienda Ospedaliera S Maria, Via T di
Joannuccio, 1, 05100 Terni, Italy. ernesto.maranzano@libero.it
PURPOSE: Hypofractionated radiotherapy (RT) is often used in the treatment
of metastatic spinal cord compression (MSCC). This randomized trial was
planned to assess the clinical outcome and toxicity of two different
hypofractionated RT regimens in MSCC. PATIENTS AND METHODS: Three hundred
patients with MSCC were randomly assigned to a short-course RT (8 Gy x 2
days) or to a split-course RT (5 Gy x 3; 3 Gy x 5). Only patients with a
short life expectancy entered the protocol. Median follow-up was 33 months
(range, 4 to 61 months). RESULTS: A total of 276 (92%) patients were
assessable; 142 (51%) treated with the short-course and 134 (49%) treated
with the split-course RT regimen. There was no significant difference in
response, duration of response, survival, or toxicity found between the two
arms. When short- versus split-course regimens were compared, after RT 56%
and 59% patients had back pain relief, 68% and 71% were able to walk, and
90% and 89% had good bladder function, respectively. Median survival was 4
months and median duration of improvement was 3.5 months for both arms.
Toxicity was equally distributed between the two arms: grade 3 esophagitis
or pharyngitis was registered in four patients (1.5%), grade 3 diarrhea
occurred in four patients (1.5%), and grade 3 vomiting or nausea occurred in
10 patients (6%). Late toxicity was never recorded. CONCLUSION: Both
hypofractionated RT schedules adopted were effective and had acceptable
toxicity. However, considering the advantages of the short-course regimen in
terms of patient convenience and machine time, it could become the RT
regimen of choice in the clinical practice for MSCC patients.
Publication Types:
- Clinical Trial
- Clinical Trial, Phase III
- Multicenter Study
- Randomized Controlled Trial
PMID: 15738534 [PubMed - indexed for MEDLINE]
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| 18: J
Neurol Neurosurg Psychiatry. 2005 Jul;76(7):977-83. |
|
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Surgical management of tuberculum sellae meningiomas:
involvement of the optic canal and visual outcome.
Schick U, Hassler W.
Clinic of Neurological Surgery, Wedau Kliniken, Zu den Rehwiesen 9, 47055
Duisburg, Germany. Uta_Schick@web.de.
OBJECTIVE: To present a large series of surgically treated tuberculum sellae
meningiomas with particular regard to involvement of the optic canal and
visual outcome. METHODS: A retrospective analysis was done on 53 patients
(40 female) with meningiomas originating from the tuberculum sellae who
underwent surgery between 1991 and 2002. The standard surgical approach
consisted of pterional craniotomy. Sixteen meningiomas extended posteriorly
onto the diaphragma sella, 29 anteriorly to the planum sphenoidale, and 19
to the anterior clinoid process. Thirty seven tumours involved the optic
canal, three bilaterally. Follow up ranged from 6 to 108 months (mean 29.9
months). RESULTS: Total macroscopic resection was achieved in 48 patients.
Median tumour size was 2.6 cm. Postoperatively, visual acuity improved in 20
patients and deteriorated in seven. Preoperative and postoperative visual
acuity worsened with increasing duration of preoperative symptoms and with
increasing age. Extension into the intraconal space was a negative
predictor. However, tumour size did not influence visual acuity. Recurrence
occurred in two cases (21 and 69 months postoperatively). Two patients died
from causes unrelated to the tumour. CONCLUSIONS: In the majority of
patients with tuberculum sellae meningiomas, total resection may be achieved
through a pterional approach with minimal complications.
PMID: 15965205 [PubMed - in process]
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| 19: J
Neuropathol Exp Neurol. 2005 May;64(5):398-403. |
|
The p15(INK4b)/p16(INK4a)/RB1 pathway is frequently
deregulated in human pituitary adenomas.
Ogino A, Yoshino A, Katayama Y, Watanabe T, Ota T, Komine C, Yokoyama T,
Fukushima T.
Department of Neurological Surgery, Nihon University School of Medicine,
30-1 Oyaguchi-Kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
ayoshino@med.nihon-u.ac.jp
Pituitary adenomas are common benign intracranial neoplasms. However, their
tumorigenesis is not yet clearly defined. Inactivation of genes involved in
the negative cell-cycle regulatory p15(INK4b) - p16(INK4a) -cyclin
D/CDK4-RB1-mediated pathway (RB1 pathway) is one of the most common and
important mechanisms in the growth advantage of tumor cells. Recently, much
attention has been focused on the importance of alternative mechanisms of
gene inactivation, particularly promoter hypermethylation in the
transcriptional silencing of such tumor-suppressor genes. Based on the rare
occurrence of inactivation by gene mutations and deletions of the RB1
pathway in pituitary adenomas, we investigated the deregulation of the RB1
pathway in 42 sporadic human pituitary adenomas, especially focusing on the
methylation status of this pathway as determined by a methylation-specific
polymerase chain reaction assay. Homozygous deletion of the p15(INK4b) or
p16(INK4a) gene was detected in one adenoma each. Amplification of the CDK4
gene was not apparent in any of the pituitary adenomas presently examined.
Promoter hypermethylation of the p15(INK4b), p16(INK4a), and RB1 genes was
detected in 15 (35.7%), 30 (71.4%), and 12 (28.6%) of the adenomas,
respectively. Promoter hypermethylation of the p15(INK4b) gene coincided
with p16(INK4a) alteration and/or RB1 methylation, whereas p16(INK4a) and
RB1 methylations tended to be mutually exclusive (p = 0.019). Thus, the vast
majority of the adenomas (38 of 42, 90.5%) displayed alterations of the RB1
pathway. None of the clinicopathologic features, including the proliferation
cell index, was significantly correlated with any particular methylation
status. Our results suggest that inactivation of the RB1 pathway may play a
causal role in pituitary tumorigenesis, with hypermethylation of the
p16(INK4a) gene being the most common deregulation, and further provide
evidence that RB1 and p16(INK4a) methylations tend to be mutually exclusive
but occasionally coincide with p15(INK4b) methylation.
PMID: 15892297 [PubMed - indexed for MEDLINE]
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| 20: J
Neuropathol Exp Neurol. 2005 May;64(5):391-7. |
|
INI1 protein expression distinguishes atypical
teratoid/rhabdoid tumor from choroid plexus carcinoma.
Judkins AR, Burger PC, Hamilton RL, Kleinschmidt-DeMasters B, Perry A,
Pomeroy SL, Rosenblum MK, Yachnis AT, Zhou H, Rorke LB, Biegel JA.
Department of Pathology, University of Pennsylvania School of Medicine and
Children's Hospital of Philadelphia, 3615 Civic Center Blvd., Philadelphia,
PA 19104, USA.
Central nervous system atypical teratoid/rhabdoid tumor (AT/RT) and choroid
plexus carcinoma (CPC) are rare, highly malignant tumors that predominantly
arise in infants and young children. Overlapping clinical, histologic,
ultrastructural, or immunophenotypic features may obscure the diagnosis in
some cases. AT/RT is characterized by deletions and/or mutations of the INI1
tumor-suppressor gene on chromosome band 22q11.2. We have recently developed
an INI1 immunohistochemical staining assay. Negative staining of tumor cells
resulting from inactivation of the INI1 gene is a consistent feature of
AT/RT. Mutations of INI1 in some CPCs have been reported. The purpose of the
present study was to determine if immunohistochemical staining with an INI1
antibody would provide a sensitive means of distinguishing between CPC and
AT/RT. We examined 28 tumors with a submitted diagnosis of CPC. Twenty-one
CPCs showed retained expression of INI1 and seven tumors showed loss of INI1
expression. Cytogenetic, FISH, and/or INI1 mutation results were also
available for 13 tumors. In three of the seven cases, monosomy 22 was the
only cytogenetic abnormality, suggestive of AT/RT. However, monosomy 22 was
also identified in 3 tumors with complex karyotypes that retained INI1
expression. The 7 tumors that were immunonegative for INI1 had features that
were consistent with AT/RT. Immunostaining for INI1 protein is retained in
the majority of CPC and is lost in AT/RT. This expression pattern seems to
better define the 2 groups of tumors than does light or electron microscopy,
routine immunohistochemistry, or cytogenetic analysis alone.
PMID: 15892296 [PubMed - indexed for MEDLINE]
| 21: Surg Neurol.
2005 May;63(5):476-9. |
|
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Cerebellar mutism in adults after posterior fossa
surgery: a report of 2 cases.
Sherman JH, Sheehan JP, Elias WJ, Jane JA Sr.
Department of Neurological Surgery, University of Virginia, Charlottesville,
VA 22908, USA. js2bx@virginia.edu
BACKGROUND: Mutism has been associated with injury to midline cerebellar
structures secondary to degenerative disease, tumors, hemorrhage, or
surgery. Typically, cerebellar mutism syndrome (CMS) has been seen in
children and only rarely described in adults after surgery of the posterior
fossa. This syndrome typically arises 48 hours after the initiating event
and resolves approximately 7 to 8 weeks later. Characteristics of CMS
include complete absence of speech without impaired consciousness, other
cranial nerve deficits, or long tract signs. CASE DESCRIPTION: The authors
report on 2 patients each of whom developed cerebellar mutism after tumor
resection using a posterior fossa approach. The first patient underwent
gross total resection of a pineal region tumor via a supracerebellar
approach. The second patient underwent posterior fossa decompression for a
left cerebellar hemispheric renal cell carcinoma metastasis with adjacent
hemorrhage. One patient displayed a variant of cerebellar mutism with severe
ataxic dysarthria without complete absence of speech, whereas the other
demonstrated frank mutism. After neuroimaging studies confirmed the absence
of a surgically treatable postoperative cause for the patients' symptoms,
they were managed in a supportive fashion (eg, speech therapy) and improved
within 3.5 months and 1 year, respectively. CONCLUSION: It is paramount that
neurosurgeons be aware of cerebellar mutism with regard to its very rare
occurrence in adults, its time of onset, and typical self-limiting course.
Publication Types:
PMID: 15883080 [PubMed - indexed for MEDLINE]
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| 22: Surg Neurol.
2005 May;63(5):459-66; discussion 466. |
|
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Management of Rathke's cleft cysts.
Sade B, Albrecht S, Assimakopoulos P, Vezina JL, Mohr G.
Division of Neurosurgery, Sir Mortimer B. Davis-Jewish General Hospital,
McGill University, Montreal, Quebec, Canada H3T 1E2.
BACKGROUND: Incidental diagnosis of Rathke's cleft cysts (RCCs) has
increased due to the improvements in imaging techniques; however,
symptomatic cases are rare and accurate preoperative diagnosis can be
difficult. METHODS: Files and magnetic resonance imaging (MRI) of 10
surgically treated patients with RCC and 8 conservatively managed cases with
a suspected diagnosis were reviewed retrospectively. Clinical, radiological,
and histological features as well as intraoperative findings were
scrutinized. RESULTS: In the surgical group, headache was present in 4
patients, hormonal abnormality in 4, visual deficits in 3, and
otolaryngological symptoms in 2. Two of the nonsurgical cases had
hyperprolactinemia, and the remaining were asymptomatic. The cyst had
suprasellar extension (SSE) in 9 patients and was entirely suprasellar in 1
in the surgical group. It was purely intrasellar in 6 nonsurgical cases and
had SSE in 2. The cyst content showed hyperintense MRI signal in the
majority of T1 and T2 images in both groups. Transsphenoidal surgery was
performed in 8 and transcranial surgery in 2 patients. Squamous metaplasia
and inflammation was present in 3 cases each. Initial hormonal deficiencies
did not improve postoperatively and new deficits were observed in 2 cases.
There was no recurrence with an average follow-up of 32 months. CONCLUSIONS:
Rathke's cleft cysts is a rare pathology with a wide spectrum of clinical
and radiological features. Reactive inflammation of the normal pituitary
gland may have a role in the pathogenesis of hormonal deficiency, in
addition to compression. Preoperative recognition of the anteriorly
displaced normal residual gland may be important in avoiding postoperative
hormonal deficiency after transsphenoidal approach.
PMID: 15883073 [PubMed - indexed for MEDLINE]
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Volume 4, Number 27 - 28 June 2005