| 1: Brain.
2006 Jul 10; [Epub ahead of print] |
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Irradiation and hypoxia promote homing of haematopoietic
progenitor cells towards gliomas by TGF-{beta}-dependent
HIF-1{alpha}-mediated induction of CXCL12.
Tabatabai G, Frank B, Mohle R, Weller M, Wick
W.
Laboratory of Molecular Neuro-Oncology, Department of General Neurology and
Hertie Institute for Clinical Brain Research, Tubingen, Germany.
Previously we defined a pathway of transforming growth factor beta (TGF-beta)
and stromal cell-derived factor-1/CXC chemokine ligand 12
(SDF-1alpha/CXCL12) dependent migration of adult haematopoietic stem and
progenitor cells (HPC) towards glioma cells in vitro and their homing to
experimental gliomas in vivo. Hypoxia is a critical aspect of the
microenvironment of gliomas and irradiation is an essential part of the
standard therapy. To evaluate the therapeutic potential of HPC as vectors
for a cell-based therapy of gliomas, we investigated the impact of hypoxia
and irradiation on the attraction of HPC by glioma cells. Temozolomide (TMZ)
treatment and hyperthermia served as controls. Supernatants of irradiated or
hypoxic LNT-229 glioma cells promote HPC migration in vitro. Reporter assays
reveal that the CXCL12 promoter activity is enhanced in LNT-229 cells at 24
h after irradiation at 8 Gy or after exposure to 1% oxygen for 12 h. The
irradiation- and hypoxia-induced release of CXCL12 depends on hypoxia
inducible factor-1 alpha (HIF-1alpha), but not on p53. Induction of
transcriptional activity of HIF-1alpha by hypoxia or irradiation requires an
intact TGF-beta signalling cascade. This delineates a novel stress
signalling cascade in glioma cells involving TGF-beta, HIF-1alpha and
CXCL12. Stress stimuli can be irradiation, hypoxia or TMZ, but not
hyperthermia. Cerebral irradiation of nude mice at 21 days after
intracerebral implantation of LNT-229 glioma induces tumour satellite
formation and enhances the glioma tropism of HPC to the tumour bulk and even
to these satellites in vivo. These data suggest that the use of HPC as
cellular vectors in the treatment of glioblastoma may well be combined with
irradiation or other anti-angiogenic therapies that induce tumour hypoxia.
PMID: 16835250 [PubMed - as supplied by publisher].
| 2: Int
J Cancer. 2006 Jul 5; [Epub ahead of print] |
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History of allergies and risk of glioma in adults.
Schoemaker MJ, Swerdlow AJ, Hepworth SJ, McKinney PA,
van Tongeren M, Muir KR.
Section of Epidemiology, Institute of Cancer Research, Sutton SM2 5NG,
United Kingdom.
Epidemiological studies have consistently reported an inverse association
between a history of allergic disease and risk of glioma. The reason for
this association is unclear, and there is a lack of studies with the detail
and size to explore the association in depth. We conducted a UK
population-based case-control study with 965 glioma cases and 1,716 controls
to investigate glioma risk in relation to allergic disease. Risk was reduced
in subjects reporting a history of asthma (odds ratio (OR) = 0.71, 95%
confidence interval (CI): 0.54-0.92), hay fever (OR = 0.73, 95% CI:
0.59-0.90), eczema (OR = 0.74, 95% CI: 0.56-0.97) and other allergies (OR =
0.65, 95% CI: 0.47-0.90). Risk was reduced for all the main histological
groups. There was no significant trend of risk with age, at the onset of
each condition, or the number of conditions reported. Risk reductions were
strongest for asthma or hay fever with recent onset. Risk in asthmatic
subjects was not related to frequency of use of antiasthmatic drugs, but was
significantly reduced for use of antiallergenic medication among subjects
with hay fever. The study showed an inverse association of glioma risk with
allergic disease. Possible reasons for the association, as well as potential
immunological aetiology, include confounding, bias and reverse causality.
(c) 2006 Wiley-Liss, Inc.
PMID: 16823851 [PubMed - as supplied by publisher]..
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| 3: Int
J Radiat Oncol Biol Phys. 2006 Jul 11; [Epub ahead of print] |
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Early change in glucose metabolic rate measured using fdg-pet
in patients with high-grade glioma predicts response to temozolomide but not
temozolomide plus radiotherapy.
Charnley N, West CM, Barnett CM, Brock C, Bydder
GM, Glaser M, Newlands ES, Swindell R, Matthews
J, Price P.
Wolfson Molecular Imaging Centre, The University of Manchester, Christie
Hospital NHS Trust, Manchester, United Kingdom.
PURPOSE: To compare the ability of positron emission tomography (PET) to
predict response to temozolomide vs. temozolomide plus radiotherapy. METHODS
AND MATERIALS: Nineteen patients with high-grade glioma (HGG) were studied.
Patients with recurrent glioma received temozolomide 75 mg/m(2) daily for 7
weeks (n = 8). Newly diagnosed patients received temozolomide 75 mg/m(2)
daily plus radiotherapy 60 Gy/30 fractions over 6 weeks, followed by six
cycles of adjuvant temozolomide 200 mg/m(2)/day (Days 1-5 q28) starting 1
month after radiotherapy (n = 11). [(18)F]Fluorodeoxyglucose ([(18)F]FDG)
PET scan and magnetic resonance imaging (MRI) were performed at baseline,
and 7 and 19 weeks after initiation of temozolomide administration. Changes
in glucose metabolic rate (MRGlu) and MRI response were correlated with
patient survival. RESULTS: In the temozolomide-alone group, patients who
survived >26 vs. </=26 weeks showed a greater reduction in MRGlu
measured at 7 weeks with median changes of -34% and -4%, respectively (p =
0.02). PET responders, defined as a reduction in MRGlu >/=25%, survived
longer than nonresponders with mean survival times of 75 weeks (95% CI,
34-115 vs. 20 weeks (95% CI, 14-26) (p = 0.0067). In the small group of
patients studied, there was no relationship between MRI response and
survival (p = 0.52). For patients receiving temozolomide plus radiotherapy,
there was no difference in survival between PET responders and nonresponders
(p = 0.32). CONCLUSIONS: Early changes in MRGlu predict response to
temozolomide, but not temozolomide plus radiotherapy.
PMID: 16839701 [PubMed - as supplied by publisher]...
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| 4: Int
J Radiat Oncol Biol Phys. 2006 Jul 1;65(3):788-99. Epub 2006
May 6. |
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Patterns of practice and survival in a retrospective
analysis of 1722 adult astrocytoma patients treated between 1985 and 2001 in
12 Italian radiation oncology centers.
Magrini SM, Ricardi U, Santoni R, Krengli M, Lupattelli
M, Cafaro I, Scoccianti S, Menichelli C, Bertoni
F, Enrici RM, Tombolini V, Buglione M, Pirtoli L.
Department of Radiation Oncology, University of Brescia, Brescia, Italy.
PURPOSE: To analyze the patterns of practice and survival in a series of
1722 adult astrocytoma patients treated in 12 Italian radiotherapy centers.
METHODS AND MATERIALS: A total of 1722 patients were treated with
postoperative radiotherapy (90% World Health Organization [WHO] Grade 3-4,
62% male, 44% aged >60 years, 25% with severe neurologic deficits, 44%
after gross total resection, 52% with high-dose radiotherapy, and 16% with
chemotherapy). Variations in the clinical-therapeutic features in three
subsequent periods (1985 through 2001) were evaluated, along with overall
survival for the different subgroups. RESULTS: The proportion of women, of
older patients, of those with worse neurologic performance status (NPS),
with WHO Grade 4, and with smaller tumors increased with time, as did the
proportion of those treated with radical surgery, hypofractionated
radiotherapy, and more sophisticated radiotherapy techniques, after staging
procedures progressively became more accurate. The main prognostic factors
for overall survival were age, sex, neurologic performance status, WHO
grade, extent of surgery, and radiation dose. CONCLUSIONS: Recently, broader
selection criteria for radiotherapy were adopted, together with simpler
techniques, smaller total doses, and larger fraction sizes for the worse
prognostic categories. Younger, fit patients are treated more aggressively,
more often in association with chemotherapy. Survival did not change over
time. The accurate evaluation of neurologic status is therefore of utmost
importance before the best treatment option for the individual patient is
chosen.
Publication Types:
- Evaluation Studies
- Multicenter Study
PMID: 16682131 [PubMed - indexed for MEDLINE].
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| 5: Neurology. 2006 Jul
11;67(1):156-8. |
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Pilot study of the combination of EGFR and mTOR
inhibitors in recurrent malignant gliomas.
Doherty L, Gigas DC, Kesari S, Drappatz J, Kim
R, Zimmerman J, Ostrowsky L, Wen PY.
Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center,
Boston, MA 02115, USA.
Malignant gliomas are frequently characterized by amplification of the
epidermal growth factor receptor (EGFR) and loss of PTEN tumor suppressor
gene. Twenty-eight heavily pretreated patients with recurrent malignant
gliomas were administered EGFR inhibitors (gefitinib or erlotinib) in
combination with the mTOR (mammalian target of rapamycin) inhibitor
sirolimus. The regimens were reasonably well tolerated. Nineteen percent of
patients experienced a partial response and 50% had stable disease.
Six-month progression-free survival for glioblastoma patients was 25%.
PMID: 16832099 [PubMed - in process]..
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| 6: Neurosurgery. 2006
Jul;59(1):115-25; discussion 115-25. |
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Intraoperative language localization in multilingual
patients with gliomas.
Bello L, Acerbi F, Giussani C, Baratta P, Taccone
P, Songa V, Fava M, Stocchetti N, Papagno C,
Gaini SM.
Department of Neurological Sciences, University of Milan, Fondazione IRCCS
Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
lorenzo.bello@unimi.it
OBJECTIVE: Intraoperative localization of speech is problematic in patients
who are fluent in different languages. Previous studies have generated
various results depending on the series of patients studied, the type of
language, and the sensitivity of the tasks applied. It is not clear whether
languages are mediated by multiple and separate cortical areas or shared by
common areas. Globally considered, previous studies recommended performing a
multiple intraoperative mapping for all the languages in which the patient
is fluent. The aim of this work was to study the feasibility of performing
an intraoperative multiple language mapping in a group of multilingual
patients with a glioma undergoing awake craniotomy for tumor removal and to
describe the intraoperative cortical and subcortical findings in the area of
craniotomy, with the final goal to maximally preserve patients' functional
language. METHODS: Seven late, highly proficient multilingual patients with
a left frontal glioma were submitted preoperatively to a battery of tests to
evaluate oral language production, comprehension, and repetition. Each
language was tested serially starting from the first acquired language.
Items that were correctly named during these tests were used to build
personalized blocks to be used intraoperatively. Language mapping was
undertaken during awake craniotomies by the use of an Ojemann cortical
stimulator during counting and oral naming tasks. Subcortical stimulation by
using the same current threshold was applied during tumor resection, in a
back and forth fashion, and the same tests. RESULTS: Cortical sites
essential for oral naming were found in 87.5% of patients, those for the
first acquired language in one to four sites, those for the other languages
in one to three sites. Sites for each language were distinct and separate.
Number and location of sites were not predictable, being randomly and widely
distributed in the cortex around or less frequently over the tumor area.
Subcortical stimulations found tracts for the first acquired language in
four patients and for the other languages in three patients. Three of these
patients decreased their fluency immediately after surgery, affecting the
first acquired language, which fully recovered in two patients and partially
in one. The procedure was agile and well tolerated by the patients.
CONCLUSION: These findings show that multiple cortical and subcortical
language mapping during awake craniotomy for tumor removal is a feasible
procedure. They support the concept that intraoperative mapping should be
performed for all the languages in which the patient is fluent in to
preserve functional integrity.
PMID: 16823307 [PubMed - in process].
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| 7: Neurosurgery. 2006
Jul;59(1):86-97; discussion 86-97. |
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Results of surgical resection for progression of brain
metastases previously treated by gamma knife radiosurgery.
Truong MT, St Clair EG, Donahue BR, Rush SC, Miller
DC, Formenti SC, Knopp EA, Han K, Golfinos JG.
Department of Radiation Oncology, Boston University School of Medicine,
Boston, Massachusetts 02118, USA. mttruong@partners.org
OBJECTIVE: To determine treatment outcome after surgical resection for
progressive brain metastases after gamma knife radiosurgery (GKR) and to
explore the role of dynamic contrast agent-enhanced perfusion magnetic
resonance imaging (MRI) and proton spectroscopic MRI studies (MRS/P) in
predicting pathological findings. METHODS: Between 1997 and 2002, 32
patients underwent surgical resection for suspected progression of brain
metastases from a cohort of 245 patients with brain metastases treated with
GKR. Postradiosurgery MRI surveillance was performed at 6 and 12 weeks, and
then every 12 weeks after GKR. In some cases, additional MRI scanning with
spectroscopy or perfusion (MRS/P) was used to aid differentiation of
radiation change from tumor progression. The decision to perform
neurosurgical resection was based on MRI or clinical evidence of lesion
progression among patients with a Karnofsky performance score of 60 or more
and absent or stable systemic disease. RESULTS: Thirteen percent (32 out of
245) of patients and 6% (38 out of 611) of lesions required surgical
resection after GKR. The median time from GKR to surgical resection was 8.6
months (range, 1.7-27.1 mo). The 6-, 12-, and 24-month actuarial survival
from time of GKR was 97, 78, and 47% for the resected patients and 65, 40,
and 19% for the nonresected patients (P < 0.0001). The two-year survival
rate of patients requiring two resections after GKR was 100% compared with
39% for patients undergoing one resection (P = 0.02). The median survival of
resected patients was 27.2 months (range, 7.0-72.5 mo) from the diagnosis of
brain metastases, 19.9 months (range, 5.0-60.7 mo) from GKR, and 8.9 months
(range, 0.2-53.1 mo) from surgical resection. Tumor was found in 90% of
resected specimens and necrosis alone in 10%. MRS/P studies were performed
in 15 resected patients. Overall, MRS/P predicted tumor in 11 lesions,
confirmed pathologically in nine lesions, and necrosis alone was found in
two. The MRS/P predicted necrosis alone in three, whereas pathology revealed
viable tumor in two and necrosis in one lesion. CONCLUSION: Surgical
intervention of progressive brain metastases after GKR in selected patients
leads to a meaningful improvement in survival rates. Further studies are
necessary to determine the role of MRS/P in the postradiosurgery
surveillance of brain metastases.
PMID: 16823304 [PubMed - in process]...
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| 8: Neurosurgery. 2006
Jul;59(1):60-6; discussion 60-6. |
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Use of diffusion weighted magnetic resonance imaging in
predicting early postoperative outcome of new neurological deficits after
brain tumor resection.
Khan RB, Gutin PH, Rai SN, Zhang L, Krol G,
DeAngelis LM.
Division of Neurology St. Jude Children's Research Hospital, Memphis,
Tennessee 38105, USA. raja.khan@stjude.org
OBJECTIVE: To study risk factors for the development of postoperative
neurological deficits after brain tumor resection and to define prognostic
factors for recovery. METHODS: We prospectively studied 82 brain tumor
patients undergoing tumor resection. Pre- and postoperative neurological
examination, functional and performance status, cancer treatment,
cardiovascular risk factors, seizure history, and blood pressure and oxygen
saturation were recorded perioperatively. Postoperative magnetic resonance
imaging scans were obtained within 72 hours of surgery, and the radiologist
was blinded to the patient's status. Abnormalities on magnetic resonance
diffusion weighted images were classified as new if they extended beyond the
tumor cavity margins and were absent before surgery. RESULTS: Of the 80
assessable patients, 24 had a new or increased postoperative deficit by at
least one point on the National Institutes of Health Stroke Scale. Presence
of preoperative neurological deficits predicted development of postoperative
deficits, whereas a new diffusion weighted imaging lesion after craniotomy
predicted incomplete recovery of a new postoperative deficit. CONCLUSION:
Postoperative diffusion magnetic resonance imaging is useful in predicting
early functional recovery from new deficits after brain tumor surgery.
PMID: 16823301 [PubMed - in process]..
| 9: Oncogene. 2006 Jul
13;25(30):4256. |
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Gene expression profiling identifies molecular subtypes
of gliomas.
Shai R, Shi T, Kremen TJ, Horvath S, Liau LM,
Cloughesy TF, Mischel PS, Nelson SF.
PMID: 16837969 [PubMed - in process]...
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| 10: Surg Neurol.
2006 Jun;65(6):635-6. |
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Comment on:
- Surg Neurol. 1993 Nov;40(5):437-8.
A revolution in skull base surgery: the quality of life
matters!
Ausman JI.
Publication Types:
PMID: 16720196 [PubMed - indexed for MEDLINE]
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| 11: Surg Neurol.
2006 Jun;65(6):611-4. |
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A large arachnoid cyst of the lateral ventricle extending
from the supracerebellar cistern--case report.
Park SW, Yoon SH, Cho KH, Shin YS.
Department of Neurosurgery, Kangwon National University, College of
Medicine, Chunchon 200-701, South Korea.
BACKGROUND: The pathogenetic mechanism of intraventricular arachnoid cyst
development is still controversial, but is believed to originate from the
vascular mesenchyme or as an extension of the arachnoid cyst in the
subarachnoid space into the ventricle through the choroidal fissure. We
report a case supporting the extension hypothesis and suggest differential
points between an intraventricular arachnoid cyst that extended from the
supracerebellar space and a lateral ventricular diverticulum that extended
into the supracerebellar cistern. CASE DESCRIPTION: A 12-month-old girl
presented with macrocephaly and developmental delay. Her magnetic resonance
imaging showed an arachnoid cyst that had developed from the supracerebellar
space in the posterior fossa, and which extended into the left lateral
ventricle resulting in expansion of the left lateral ventricle and
displacing the choroids plexus anteriorly and laterally and the midline to
the right. We treated an intraventricular arachnoid cyst by endoscopic
fenestration resulting in dramatic reduction of the intraventricular
arachnoid cyst with large bilateral subdural fluid collection. We performed
a subduroperitoneal shunt for subdural fluid collection and subsequent
cystoperitoneal shunt for the remnant cyst. CONCLUSION: We suggest that this
case supports the extension hypothesis from the subarachnoid space through
the choroidal fissure into the lateral ventricle. We also suggest that one
of the radiological differential points between an intraventricular
arachnoid cyst and a ventricular diverticulum is displacement and
compression of the choroid plexus of the lateral ventricle.
Publication Types:
PMID: 16720186 [PubMed - indexed for MEDLINE]
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| 12: Surg Neurol.
2006 Jun;65(6):604-10. |
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Psammomatous choroid plexus papilloma: three cases with
atypical characteristics.
Tena-Suck ML, Lopez-Gomez M, Salinas-Lara C, Arce-Arellano
RI, Biol AS, Renbao-Bojorquez D.
Departament of Neuropathology, National Institute of Neurology and
Neurosurgery, Mexico City, Mexico 14269. tenasuck@yahoo.com
BACKGROUND: Intravertricular papillary neoplasms are derived from choroid
plexus epithelium. Although choroid plexus tumors account for 0.4% to 0.6%
of all brain tumors, they represent 2% to 4%. Approximately 80% of choroid
plexus carcinomas arise in children. CASES DESCRIPTION: We describe 3 cases
of choroid plexus papilloma (CPP) with profuse psammomatous bodies and
calcifications that have lost their normal papillary architecture.
Immunohistochemistry was positive for glial fibrillary acidic protein in 2
cases, and proliferating cellular nuclear antigen index was higher compared
with regular CPPs. All 3 patients were female and were 12, 40, and 48 years
old, respectively. CONCLUSION: We describe psammomatous CPPs and suggest a
difference from CPPs because of the more aggressive clinical course, and
higher nuclear proliferation index (proliferating cellular nuclear antigen)
than the CPPs that lack psammoma bodies.
Publication Types:
PMID: 16720185 [PubMed - indexed for MEDLINE].
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| 13: Surg Neurol.
2006 Jun;65(6):595-603. |
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Meningioangiomatosis associated with neurofibromatosis:
report of 2 cases in a single family and review of the literature.
Omeis I, Hillard VH, Braun A, Benzil DL, Murali
R, Harter DH.
Department of Neurosurgery, New York Medical College, Valhalla, NY 10595,
USA. ibrahim_omeis@nymc.edu
BACKGROUND: Meningioangiomatosis (MA) is a rare benign disorder. It may
occur sporadically or in association with neurofibromatosis (NF). The
sporadic type typically presents with seizures, whereas that associated with
NF is often asymptomatic. Of the 100 cases reported, only 14 are associated
with NF. We now report 2 additional cases of MA associated with
neurofibromatosis 2 (NF2) in a single family, with one occurring in the
cerebellum. The etiology, pathology, and imaging features of MA are
presented. CASE DESCRIPTION: A 38-year-old woman (patient 1) presented with
a 4-month history of ataxia. She had been diagnosed previously with NF2.
Magnetic resonance imaging (MRI) scans of the brain revealed bilateral
acoustic neuromas and multiple calcified intracranial lesions. Her
13-year-old daughter (patient 2) presented with complex partial seizures.
MRI scans of the brain revealed bilateral acoustic neuromas and a right
parietal mass. Patient 1 underwent a suboccipital craniotomy to resect the
right-sided acoustic neuroma. A small portion of normal-appearing cerebellar
cortex was resected to avoid undue retraction. Histopathologic examination
showed the presence of a lesion consistent with MA. Patient 2 underwent a
right temporal-parietal craniotomy to remove the enhancing epileptogenic
right posterior temporoparietal lesion. Histopathologic analysis showed a
lesion consistent with meningioma and MA. CONCLUSIONS: MA has been reported
infrequently in association with NF2. We now report 2 cases of MA associated
with NF2 in one family, and we add the cerebellum to possible locations of
occurrence. MA should be considered in the differential diagnosis of
cortical lesions, particularly in patients with NF2.
Publication Types:
PMID: 16720184 [PubMed - indexed for MEDLINE]..
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| 14: Surg Neurol.
2006 Jun;65(6):590-4. |
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Secondary central nervous system involvement by
follicular lymphoma: case report and review of the literature.
Grupka NL, Seinfeld J, Ryder J, Lillehei KO, Kleinschmidt-Demasters
BK.
Department of Pathology, University of Colorado, Denver, CO 80262, USA.
BACKGROUND: We report a patient with indolent stage IV follicular lymphoma,
grade 1, initially successfully treated with chemotherapy, who later
developed aggressive diffuse large B-cell lymphoma in the parieto-occipital
lobe 8 years after initial presentation. The differing patterns of
lymphomatous involvement of the central nervous system (CNS) are briefly
reviewed, with a focus on the patterns seen in secondary CNS spread by
low-grade lymphomas. CASE DESCRIPTION: A 53-year-old man was diagnosed with
stage IV follicular lymphoma, grade 1, in 1996. Although initial
chemotherapy was successful, he developed several recurrences of lymphoma
over the following years. In May 2004, he presented with a discrete, single,
massive parieto-occipital lobe brain lesion. The mass failed to regress with
empiric cranial external beam radiotherapy. Because of suspicion of an
unusual infection, the lesion was surgically excised in its entirety. The
mass proved to be an aggressive diffuse large B-cell lymphoma, transformed
from his previous follicular cell lymphoma, with retention of strong Bcl-2
and Bcl-6 immunoreactivity. CONCLUSIONS: Parenchymal brain involvement, as
opposed to dural or leptomeningeal, is a relatively uncommon pattern of
spread to the CNS for systemic lymphomas. More significantly, follicular
lymphomas are one of the least frequent types of indolent lymphomas to
develop clinically apparent, secondary CNS spread. The presentation of an
indolent follicular lymphoma with transformation to an aggressive diffuse
large B-cell lymphoma within the brain parenchyma is rare. Its manifestation
as a massive, singular lesion is unique and prompted diagnostic confusion.
Publication Types:
PMID: 16720183 [PubMed - indexed for MEDLINE].
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Volume 5, Number 29 - 17 July 2006