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Clinical investigation survival prediction in high-grade
gliomas by MRI perfusion before and during early stage of RT.
Cao
Y, Tsien
CI, Nagesh
V, Junck
L, Ten
Haken R, Ross
BD, Chenevert
TL, Lawrence
TS.
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI;
Department of Radiology, University of Michigan, Ann Arbor, MI.
PURPOSE: To determine whether cerebral blood volume (CBV) and cerebral blood
flow can predict the response of high-grade gliomas to radiotherapy (RT) by
taking into account spatial heterogeneity and temporal changes in perfusion.
METHODS AND MATERIALS: Twenty-three patients with high-grade gliomas
underwent conformal RT, with magnetic resonance imaging perfusion before and
at Weeks 1-2 and 3-4 during RT. Tumor perfusion was classified as high,
medium, or low. The prognostic values of pre-RT perfusion and the changes
during RT for early prediction of tumor response to RT were evaluated.
RESULTS: The fractional high-CBV tumor volume before RT and the
fluid-attenuated inversion recovery imaging tumor volume were identified as
predictors for survival (p = 0.01). Changes in tumor CBV during the early
treatment course also predicted for survival. Better survival was predicted
by a decrease in the fractional low-CBV tumor volume at Week 1 of RT vs.
before RT, a decrease in the fractional high-CBV tumor volume at Week 3 vs.
Week 1 of RT, and a smaller pre-RT fluid-attenuated inversion recovery
imaging tumor volume (p = 0.01). CONCLUSION: Early temporal changes during
RT in heterogeneous regions of high and low perfusion in gliomas might
predict for different physiologic responses to RT. This might also open the
opportunity to identify tumor subvolumes that are radioresistant and might
benefit from intensified RT.
PMID: 16298499 [PubMed - as supplied by publisher]..
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Inter-institutional variance of postoperative
radiotherapy and follow up for meningiomas in Germany. Impact of changes of
the WHO classification.
Simon
M, Bostrom
J, Koch
P, Schramm
J.
Neurochirurgische Klinik, Universitatsklinikum Bonn, Germany.
OBJECTIVE: To document and critically analyze the impact of the revised WHO
2000 histological classification for meningiomas on indications for
postoperative radiotherapy/radiosurgery and MRI follow-up protocols.
METHODS: The current (2000) WHO classification was used to grade 57
meningiomas operated at our institution, which had previously been reviewed
in 1999. All German Neurosurgical Departments performing intracranial
microsurgery were asked to detail their guidelines for radiation therapy and
follow-up for meningiomas of different WHO grades. RESULTS: Use of the
current criteria downgraded 7/15 (47%) atypical (WHO grade II, MII)
meningiomas to grade I (MI), and 4/6 (67%) anaplastic (WHO grade III, MIII)
tumors to grade II. Indications for radiotherapy/radiosurgery and MRI
follow-up protocols varied substantially with the histological grade and
between institutions. E.g. after an incomplete resection,
radiotherapy/radiosurgery recommendations differed between MI and MII in
30/58 (52%), and between MII and MIII in 34/56 (61%) units. CONCLUSIONS:
Correlative studies combining treatment and outcome data with a standardized
histopathological analysis are warranted to properly define indications for
radiotherapy/radiosurgery and follow-up protocols after surgery for
meningiomas of different histological grades. The use of changing grading
paradigms during recent years renders decision making based on local and
published experience difficult. The relatively high number of meningiomas
classified as atypical/WHO grade II in current practice would argue against
an uncritically aggressive approach to these tumors.
PMID: 16306156 [PubMed - as supplied by publisher]..
Expression of the tumor necrosis factor
receptor-associated factors 1 and 2 and regulation of the nuclear
factor-kappaB antiapoptotic activity in human gliomas.
Conti
A, Ageunnouz
M, La
Torre D, Cardali
S, Angileri
FF, Buemi
C, Tomasello
C, Iacopino
DG, D'Avella
D, Vita
G, Tomasello
F.
Department of Neuroscience, Neurosurgical and Neurological Clinics,
University of Messina School of Medicine, Messina, Italy.
alfredo.conti@unime.it
OBJECT: Tumor necrosis factor receptor (TNFR)-associated factors (TRAFs) are
a recently established group of proteins involved in the intracellular
signaling of the TNFR superfamily members. The TRAFs have been implicated in
promoting cell survival through the activation of transcription factor
nuclear factor (NF)-kappaB. The authors investigated the expression of
NF-kappaB, caspase 3, TRAF1, TRAF2, and TRAF-associated NF-kappaB
activator/TRAF-interacting protein (TANK/I-TRAF), a regulator of TRAF
activity, in human gliomas. METHODS: Tumor samples were obtained in 27 adult
patients harboring seven low-grade gliomas, nine anaplastic astrocytomas,
and 11 glioblastomas multiforme. The NF-kappaB activation was analyzed using
the electrophoresis mobility shift assay; TRAF1, TRAF2, TANK/I-TRAF, and
caspase 3 expression were studied using Western blot analysis. Upregulated
NF-kappaB DNA-binding activity, compared with that in normal brain tissue,
was detected in all tumor samples (p = 0.002). The level of NF-kappaB
activity showed some correlation with World Health Organization tumor grades
(p = 0.01), even though variable activity levels were demonstrated in
relation to tissue heterogeneity, which resulted in a substantial number of
outliers in the quantitative analysis. Increased levels of TRAF1, TRAF2, and
TANK/ I-TRAF were expressed in astrocytomas compared with levels in normal
brain tissue (p = 0.02, 0.006, and 0.01, respectively). CONCLUSIONS: Data in
this study confirm the upregulation of NF-kappaB in gliomas and reveal a
correlation between levels of this transcription factor and tumor grade. A
constitutive expression of TRAF1, TRAF2, and TANK/I-TRAF in human gliomas
was documented. These proteins are involved in the intracellular signal
transduction of the TNFR superfamily and in the control of NF-kappaB
expression and its antiapoptotic activity.
PMID: 16304992 [PubMed - in process]..
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Depression and functional outcome in patients with brain
tumors: a population-based 1-year follow-up study.
Mainio
A, Hakko
H, Niemela
A, Koivukangas
J, Rasanen
P.
Departments of Psychiatry and Neurosurgery, Oulu University Hospital, Oulu,
Finland. arja.mainio@oulu.fi
OBJECT: The authors analyzed changes in depression and contemporary
functional states by using valid tools in a population-based study sample
during a 1-year follow-up period. METHODS: The study population consisted of
77 patients with a solitary primary brain tumor treated surgically at the
Oulu Clinic for Neurosurgery. Each patient's depressive status, according to
the Beck Depression Inventory (BDI), and functional outcome, based on the
Karnofsky Performance Scale (KPS), were evaluated before the tumor was
surgically treated as well as 3 months and 1 year after surgery. Before
surgery 27 patients (35%) had BDI scores indicating the presence of
depression. These scores were significantly higher in patients with a
history of depression (p = 0.017) and in those with a lower functional
outcome (p = 0.015). In the entire study sample the severity of depression
decreased statistically significantly (p = 0.031) at 3 months postsurgery. A
lower functional status (KPS score < or = 70) in patients was
significantly associated with high depression scores at the 3-month (p =
0.000) and 1-year (p = 0.005) assessments. The decrease in the level of
depression was significant in patients with an anterior tumor (p = 0.049)
and those with a pituitary adenoma (p = 0.019). CONCLUSIONS: Affective
disorders among patients with brain tumors must be considered immediately
after surgery, especially in persons with a depression history and in those
with a coincident physical disability.
PMID: 16304988 [PubMed - in process]..
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Surgery for primary brain tumors at United States
academic training centers: results from the Residency Review Committee for
neurological surgery.
Jane
JA Jr, Sulton
LD, Laws
ER Jr.
Department of Neurological Surgery, University of Virginia Health System,
Charlottesville, Virginia 22908, USA.
OBJECT: Surgery for primary brain tumors has been an important index of the
quality of neurosurgical training programs in the US. The scope of such
cases and the proportion of surgeries performed transsphenoidally are an
interesting means of tracking the effectiveness of residency education.
METHODS: Program Information Forms from the 94 American Council for Graduate
Medical Education-approved US neurosurgical residency programs were reviewed
for the period between 2000 and 2003. Particular attention was focused on an
analysis of the cases requiring craniotomy for primary brain tumor and
transsphenoidal surgery. The mean annual number of primary brain tumor cases
per program was 195, with a range from 36 to 724 cases. The proportion of
primary brain tumors accessed transsphenoidally was 20%. The mean annual
number of transsphenoidal operations performed at academic training centers
was 39. A wide range in the frequency of transsphenoidal cases from one
program to another was also noted. Almost one third of training centers
performed fewer than 20 transsphenoidal operations annually and 80%
performed fewer than 50. CONCLUSIONS: Most neurosurgical training programs
provide residents with excellent experience in craniotomy for primary brain
tumors. Practice with transsphenoidal surgery, however, is less well
represented and tends to be clustered at several active centers. The
implications for neurosurgical education are significant.
PMID: 16304981 [PubMed - in process]..
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A congenital brain tumor associated with assisted in
vitro fertilization. Case report.
Das
A, Simmons
C, Danielpour
M.
Maxine Dunitz Neurosurgical Institute, USA. Asha_Das@eisai.com
In this report the authors describe the clinical features of a rare neonatal
anaplastic astrocytoma in the setting of in vitro fertilization (IVF). The
infant had been conceived using IVF and was born full term to a 29-year-old
prima gravida mother. At birth, the baby boy was irritable and demonstrated
poor feeding. Cranial ultrasonography and magnetic resonance imaging
revealed an echogenic mass in the left hemisphere with midline shift and
hydrocephalus. Grosstotal resection of an anaplastic astrocytoma was
followed by chemotherapy with temozolomide and vincristine. Previous cases
of neonatal brain tumors occurring in the setting of assisted reproduction
are reviewed. A possible association between IVF and congenital
neuroepithelial tumors is highlighted.
PMID: 16302619 [PubMed - in process]..
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Influence of tumor location on the presentation and
evolution of craniopharyngiomas.
Meuric
S, Brauner
R, Trivin
C, Souberbielle
JC, Zerah
M, Sainte-Rose
C.
Universite Paris V, France.
OBJECT: This study was performed to optimize the management of
craniopharyngiomas, particularly by identifying factors predicting weight
changes to prevent obesity. METHODS: A series of 35 patients who had
undergone surgery at a mean age of 7.4 +/- 3.7 years (standard deviation
[SD]) and had been followed up until 14.9 +/- 5 years of age by the same
endocrinologist were assigned to one of three groups according to their
hypothalamic involvement: Group 1 (10 patients) had no involvement, Group 2
(eight patients) had compression without involvement, and Group 3 (17
patients) had severe involvement. Abnormal height and/or weight evolution
indicated the craniopharyngioma in only 17% of the patients, although these
elements were present at diagnosis in 85%. Before surgery, 85% of the
patients lacked growth hormone, 24% lacked thyroid-stimulating hormone, 15%
lacked adrenocorticotropin hormone, and 12% lacked antidiuretic hormone. All
had complete hypothalamic-pituitary deficiencies after surgery. The body
mass index (BMI) before surgery (mean SD 1.1 +/- 1.6) was positively
correlated with BMI 1 year after surgery (mean SD 3.1 +/- 2), which
correlated with the BMI at the last evaluation (mean SD 3.1 +/- 1.9; p <
0.0001 for both). Before surgery, patients in Group 3 had a greater BMI than
did Group 1 (p < 0.02). The BMI of Group 1 patients did not change, but
those of Groups 2 and 3 patients increased during the 1st year after surgery
(p < 0.02 and p = 0.0003, respectively), with no further change. The
changes occurred mainly during the first 3 months after surgery in Group 1,
during the first 6 months in Group 2, and throughout the year in Group 3.
CONCLUSIONS: The degree of hypothalamic involvement by the craniopharyngioma
determines the presentation and predicts weight changes after surgery.
PMID: 16302613 [PubMed - in process]..-
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Volume 4, Number 49 - 29 November 2005