| 1: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1532-4. |
|
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Symptomatic Stenosis of the Cavernous Portion of the
Internal Carotid Artery due to an Irresectable Medial Sphenoid Wing
Meningioma: Treatment By Endovascular Stent Placement.
Heye S, Maleux G, Van Loon J, Wilms G.
Department of Radiology, University Hospital Gasthuisberg, Leuven, Belgium.
SUMMARY:A 48-year-old woman, with right-sided proptosis and decreased visual
acuity, presented with acute left sensorimotor deficit. Recent ischemia in
the right posterior watershed area was found on CT and MR imaging, as well
as a right-sided medial sphenoid wing meningioma causing high-grade stenotic
encasement of the cavernous portion of the right internal carotid artery.
Because the patient was symptomatic and complete resection of the meningioma
was impossible, the stenosis was successfully treated with a
balloon-expanding stent.
PMID: 16908574 [PubMed - in process]
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| 2: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1438-40. |
|
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MR Spectroscopy-Aided Differentiation: "Giant"
Extra-Axial Tuberculoma Masquerading as Meningioma.
Khanna PC, Godinho S, Patkar DP, Pungavkar SA, Lawande
MA.
Department of Magnetic Resonance Imaging, Nanavati Hospital, Mumbai, India.
SUMMARY: Tuberculosis is common in the developing world and in developed
nations secondary to increasing immunocompromise in the population. It
commonly causes meningitis and parenchymal tuberculomas. We present a case
of an unusual masslike "giant" extra-axial tuberculoma during
pregnancy. Unusual morphology and size at imaging made meningioma a close
differential. MR spectroscopy served to complement MR imaging, providing
diagnostic confirmation and depicted findings characteristic of a
tuberculoma.
PMID: 16908553 [PubMed - in process]
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| 3: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1432-7. |
|
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[11C]Methionine PET, Histopathology, and Survival in
Primary Brain Tumors and Recurrence.
Ceyssens S, Van Laere K, de Groot T, Goffin J, Bormans
G, Mortelmans L.
Division of Nuclear Medicine, University Hospital Leuven, Leuven, Belgium.
BACKGROUND AND PURPOSE: [(11)C]Methionine (MET) PET imaging is a sensitive
technique for visualizing primary brain tumors and recurrence/progression
after therapy. The aim of this study was to evaluate the relationship
between the uptake of MET and histopathologic grading and to investigate the
prognostic value of the tracer, in both settings. METHODS: Cerebral uptake
of MET was determined in 52 patients: in 26 patients for primary staging
(group A) and 26 patients with suspected brain tumor recurrence/progression
after therapy (group B). Semiquantitative methionine uptake indices (UI)
defined by the tumor (maximum)-to-background ratio was correlated with tumor
grade and final outcome. RESULTS: Overall median survival was 34.9 months.
MET showed pathologically increased uptake in 41 of 52 scans. Although a
weak linear correlation between MET uptake and grading was observed (R =
0.38, P = .028), analysis of variance showed no significant differences in
MET UI between tumor grades for either group A or B. Benign and grade I
lesions showed significant difference in MET uptake in comparison with
higher grade lesions (P = .006). Using Kaplan-Meier survival analysis, no
thresholds could be found at which MET was predictive for survival.
Proportional hazard regression showed that only WHO grading class (low
versus high) was predictive of survival (P = .015). CONCLUSION:
Interindividual MET uptake variability does not allow noninvasive grading on
an individual patient basis. Moreover, there is no significant prognostic
value in studying maximal methionine UI in brain tumors. The clinical use of
MET should therefore be primarily focused on questions such as detection of
recurrence, biopsy guidance, and radiation therapy target volume
delineation.
PMID: 16908552 [PubMed - in process]2
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| 4: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1426-31. |
|
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Disarrangement of Fiber Tracts and Decline of Neuronal
Density Correlate in Glioma Patients--A Combined Diffusion Tensor Imaging
and 1H-MR Spectroscopy Study.
Goebell E, Fiehler J, Ding XQ, Paustenbach S, Nietz
S, Heese O, Kucinski T, Hagel C, Westphal M,
Zeumer H.
Department of Neuroradiology, University of Hamburg, Hamburg, Germany.
BACKGROUND AND PURPOSE: Diffusion tensor imaging (DTI) and MR spectroscopy
are noninvasive, quantitative tools for the preoperative assessment of
gliomas with which the quantitative parameter fractional anisotropy (FA) and
the concentration of neurometabolites N-acetylaspartate (NAA), choline (Cho),
creatine (Cr) of the brain can be determined. Measurements of FA and NAA
reflect the integrity of fiber tracts and the presence of neurons,
respectively. This investigation examines changes of FA and NAA and compares
these different aspects in architecture of gliomas after spatial
coregistration. METHODS: DTI and chemical shift (1)H-MR spectroscopy was
performed in 34 healthy volunteers and 69 patients with histologically
confirmed (n = 48) or morphologically suspected (n = 21) non-necrotic brain
glioma. Volumes of interest (VOIs) were placed in the tumor center (TC), the
tumor border (TB), the normal-appearing white matter adjacent to the tumors
(TNWM), and in the white matter of the contralateral hemisphere (NWMC).
Median FA values and NAA/Cr and NAA/Cho ratios were calculated in the
patients' VOIs and the gray and white matter of the volunteers. Correlations
of FA values and NAA ratios were calculated. RESULTS: Continuous changes of
FA and NAA from the tumor center to the periphery (the adjacent white matter
and the contra-lateral hemisphere, respectively) were observed, where median
values were: TC: 0.73 +/- 0.45, 0.47 +/- 0.58, 0.17 +/- 0.15 (NAA/Cr, NAA/Cho,
FA); TB: 1.06 +/- 0.53, 1.00 +/- 0.15, 0.23 +/- 0.08; TNWM: 1.42 +/- 2.48,
1.21 +/- 0.95, 0.34 +/- 0.09; and NWMC: 1.63 +/- 0.72, 1.56 +/- 1.34, 0.38
+/- 0.08. Correlation of median FA values and NAA ratios in the cumulative
group of patients was high (r = 0.99 [NAA/Cr], 0.95 [NAA/ Cho] at P <
.01). Correlation between the individual NAA ratios and the FA values was
moderate (r = 0.53 [NAA/Cr], 0.51 [NAA/Cho] at P < .01). CONCLUSION: In
gliomas, the degree of tissue organization decreases continuously from the
surrounding tissue toward the center of the tumor accompanied by a
concordant decrease of NAA. This uniform behavior of FA and NAA reflects a
decreasing integrity of both neuronal structures and fibers.
PMID: 16908551 [PubMed - in process]
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| 5: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1419-25. |
|
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Diffusion-weighted Imaging of Metastatic Brain Tumors:
Comparison with Histologic Type and Tumor Cellularity.
Hayashida
Y, Hirai
T, Morishita
S, Kitajima
M, Murakami
R, Korogi
Y, Makino
K, Nakamura
H, Ikushima
I, Yamura
M, Kochi
M, Kuratsu
JI, Yamashita
Y.
Department of Diagnostic Radiology, Graduate School of Medical Sciences,
Kumamoto University, Kumamoto, Japan.
BACKGROUND AND PURPOSE: On diffusion-weighted imaging (DWI), metastatic
tumors of the brain may exhibit different signal intensities (SI) depending
on their histology and cellularity. The purpose of our study was to verify
the hypotheses (1) that SI on DWI predict the histology of metastases and
(2) that apparent diffusion coefficient (ADC) values reflect tumor
cellularity. MATERIALS AND METHODS: We assessed conventional MR images, DWI,
and ADC maps of 26 metastatic brain lesions from 26 patients, 13 of whom
underwent surgery after the MR examination. Two radiologists performed
qualitative assessment by consensus of the SI on DWI in areas corresponding
to their enhancing portions. We measured the contrast-to-noise ratio (CNR)
on T2-weighted images and normalized ADC (nADC) values, and compared them
with tumor cellularity. RESULTS: The mean SI on DWI and the CNR on
T2-weighted images were significantly lower in well differentiated than in
poorly differentiated adenocarcinomas and lesions other than adenocarcinoma.
The mean nADC value was significantly higher in well differentiated than
poorly differentiated adenocarcinomas and lesions other than adenocarcinoma.
All 3 small-cell carcinomas and 1 large-cell neuroendocrine carcinoma
exhibited high SI on DWI. The nADC value showed a significant inverse
correlation with tumor cellularity. There was no significant correlation
between the CNR and tumor cellularity. CONCLUSION: The SI on DWI may predict
the histology of metastases; well differentiated adenocarcinomas tended to
be hypointense, and small- and large-cell neuroendocrine carcinomas showed
hyperintensity. Their ADC values reflect tumor cellularity.
PMID: 16908550 [PubMed - in process]2
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| 6: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1412-8. |
|
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3T 1H-MR Spectroscopy in Grading of Cerebral Gliomas:
Comparison of Short and Intermediate Echo Time Sequences.
Kim
JH, Chang
KH, Na
DG, Song
IC, Kwon
BJ, Han
MH, Kim
K.
Department of Radiology, Seoul Municipal Boramae Hospital, Seoul, Korea.
BACKGROUND AND PURPOSE: Echo time (TE) can have a large influence on the
spectra in proton MR spectroscopy ((1)H-MR spectroscopy). The purpose of
this study was to comparatively assess the diagnostic value of 3T single-voxel
(1)H-MR spectroscopy with short or intermediate TEs in grading cerebral
gliomas. METHODS: Single voxel (1)H-MR spectroscopy was performed at 3T in
35 patients with cerebral glioma. The spectra were obtained with both short
(35 ms) and intermediate TEs (144 ms). Metabolite ratios of choline (Cho)/creatine
(Cr), Cho/N-acetylaspartate (NAA), lipid and lactate (LL)/Cr and
myo-inositol (mIns)/Cr were calculated and compared between short and
intermediate TEs in each grade. After receiver operating characteristic
curve analysis, diagnostic accuracy for each TE in differentiating
high-grade glioma from low-grade glioma was compared. RESULTS: At short TE,
Cho/Cr and Cho/NAA ratios were significantly lower, and LL/Cr and mIns/Cr
were significantly higher, compared with those at intermediate TE,
regardless of tumor grade. Lactate inversion at intermediate TE was found in
only 2 patients. At both TEs, there were significant differences in Cho/Cr
and LL/Cr ratios between low- and high-grade gliomas. Diagnostic accuracy
was slightly higher at short TE alone or combined with intermediate TE than
intermediate TE alone (85.7% versus 82.9%). CONCLUSION: Metabolite ratios
were significantly different between short and intermediate TE. Cho/Cr and
LL/Cr ratios at either TE were similarly useful in differentiating
high-grade gliomas from low-grade gliomas. If only a single spectroscopic
sequence can be acquired, short TE seems preferable because of poor lactate
inversion at intermediate TE on 3T single-voxel (1)H-MR spectroscopy.
PMID: 16908549 [PubMed - in process]2
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| 7: AJNR
Am J Neuroradiol. 2006 Aug;27(7):1404-11. |
|
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A systematic literature review of magnetic resonance
spectroscopy for the characterization of brain tumors.
Hollingworth
W, Medina
LS, Lenkinski
RE, Shibata
DK, Bernal
B, Zurakowski
D, Comstock
B, Jarvik
JG.
Departments of Radiology, University of Washington, Seattle, Wash.
BACKGROUND AND PURPOSE: Proton MR spectroscopy ((1)H-MR spectroscopy) is a
potentially useful adjunct to anatomic MR imaging in the characterization of
brain tumors. We performed an updated systematic review of the evidence.
METHODS: We employed a standardized search strategy to find studies
published during 2002-2004. We reviewed studies measuring diagnostic
accuracy and diagnostic, therapeutic, or health impact of (1)H-MR
spectroscopy. We abstracted information on study design, (1)H-MR
spectroscopy technique, and methodologic quality. We categorized studies
into 5 subgroups: (1) metastasis versus high-grade tumor; (2) high-versus
low-grade tumor; (3) recurrent tumor versus radiation necrosis; (4) tumor
extent; and (5) tumor versus non-neoplastic lesion. RESULTS: We identified
26 studies evaluating diagnostic performance, diagnostic impact, or
therapeutic impact. No articles evaluated patient health or
cost-effectiveness. Methodologic quality was mixed; most used histopathology
as the reference standard but did not specify blinded interpretation of
histopathology. One large study demonstrated a statistically significant
increase in diagnostic accuracy for indeterminate brain lesions from 55%,
based on MR imaging, to 71% after analysis of (1)H-MR spectroscopy. Several
studies have found that (1)H-MR spectroscopy is highly accurate for
distinguishing high- and low-grade gliomas, though the incremental benefit
of (1)H-MR spectroscopy in this setting is less clear. Interpretation for
the other clinical subgroups is limited by the small number of studies.
CONCLUSION: The current evidence on the accuracy of (1)H-MR spectroscopy in
the characterization of brain tumors is promising. However, additional
high-quality studies are needed to convince policy makers. We present
guidelines to help focus future research in this area.
PMID: 16908548 [PubMed - in process]2
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| 8: Cancer.
2006 Aug 14; [Epub ahead of print] |
|
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Phase I study of capecitabine in combination with
temozolomide in the treatment of patients with brain metastases from breast
carcinoma.
Rivera
E, Meyers
C, Groves
M, Valero
V, Francis
D, Arun
B, Broglio
K, Yin
G, Hortobagyi
GN, Buchholz
T.
Department of Breast Medical Oncology, University of Texas M. D. Anderson
Cancer Center, Houston, Texas.
BACKGROUND: A single-institution Phase I clinical trial was conducted to
determine the maximum tolerated dose (MTD) and define the safety profile of
temozolomide and capecitabine when used in combination to treat brain
metastases from breast cancer. METHODS: Patients were eligible if they had
bidimensionally measurable supratentorial or infratentorial brain metastasis
from histologically confirmed breast carcinoma. Patients could have received
up to 3 prior chemotherapy regimens. Temozolomide and capecitabine were
administered concomitantly to 4 sequential cohorts at different dosing
levels on Days 1-5 and Days 8-12, with cycles repeated every 21 days until
disease progression. RESULTS: Twenty-four patients with multiple brain
lesions were treated, including 14 patients with newly diagnosed brain
metastases and 10 patients with recurrent brain metastases. Only 1 patient
was chemotherapy-naive. Fatigue and nausea were the most commonly observed
toxicities observed at any dose levels. Significant antitumor activity was
observed, with a total of 1 complete and 3 partial responses (18% objective
response rate) in the brain. The median response duration was 8 weeks
(range, 6-64 weeks) and the median time to progression in the brain was 12
weeks (range, 3-70 weeks). Neurocognitive function improved or remained
stable in patients with a response or stable disease. CONCLUSIONS: The
combination of temozolomide and capecitabine is an active, well-tolerated
regimen. The observed antitumor activity warrants further evaluation of this
combination as an alternative to or in combination with whole-brain
radiation therapy for the treatment of multiple brain metastases. Cancer
2006. (c) 2006 American Cancer Society.
PMID: 16909414 [PubMed - as supplied by publisher]3
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| 9: Cancer
Res. 2006 Aug 15;66(16):7864-7869. |
|
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Mammalian Target of Rapamycin Inhibition Promotes
Response to Epidermal Growth Factor Receptor Kinase Inhibitors in PTEN-Deficient
and PTEN-Intact Glioblastoma Cells.
Wang
MY, Lu
KV, Zhu
S, Dia
EQ, Vivanco
I, Shackleford
GM, Cavenee
WK, Mellinghoff
IK, Cloughesy
TF, Sawyers
CL, Mischel
PS.
Departments of Pathology and Laboratory Medicine, Neurology, Medicine,
Molecular and Medical Pharmacology, Henry E. Singleton Brain Tumor Program,
and Howard Hughes Medical Institute, David Geffen School of Medicine,
University of California at Los Angeles.
The epidermal growth factor receptor (EGFR) is commonly amplified,
overexpressed, and mutated in glioblastoma, making it a compelling molecular
target for therapy. We have recently shown that coexpression of EGFRvIII and
PTEN protein by glioblastoma cells is strongly associated with clinical
response to EGFR kinase inhibitor therapy. PTEN loss, by dissociating
inhibition of the EGFR from downstream phosphatidylinositol 3-kinase (PI3K)
pathway inhibition, seems to act as a resistance factor. Because 40% to 50%
of glioblastomas are PTEN deficient, a critical challenge is to identify
strategies that promote responsiveness to EGFR kinase inhibitors in patients
whose tumors lack PTEN. Here, we show that the mammalian target of rapamycin
(mTOR) inhibitor rapamycin enhances the sensitivity of PTEN-deficient tumor
cells to the EGFR kinase inhibitor erlotinib. In two isogenic model systems
(U87MG glioblastoma cells expressing EGFR, EGFRvIII, and PTEN in relevant
combinations, and SF295 glioblastoma cells in which PTEN protein expression
has been stably restored), we show that combined EGFR/mTOR kinase inhibition
inhibits tumor cell growth and has an additive effect on inhibiting
downstream PI3K pathway signaling. We also show that combination therapy
provides added benefit in promoting cell death in PTEN-deficient tumor
cells. These studies provide strong rationale for combined mTOR/EGFR kinase
inhibitor therapy in glioblastoma patients, particularly those with PTEN-deficient
tumors. (Cancer Res 2006; 66(16): 7864-9).
PMID: 16912159 [PubMed - as supplied by publisher]2
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| 10: Cancer
Res. 2006 Aug 15;66(16):7843-8. |
|
-
Stem Cell-like Glioma Cells Promote Tumor Angiogenesis
through Vascular Endothelial Growth Factor.
Bao
S, Wu
Q, Sathornsumetee
S, Hao
Y, Li
Z, Hjelmeland
AB, Shi
Q, McLendon
RE, Bigner
DD, Rich
JN.
Departments of Surgery, Pathology, Medicine, and Neurobiology.
Malignant gliomas are highly lethal cancers dependent on angiogenesis.
Critical tumor subpopulations within gliomas share characteristics with
neural stem cells. We examined the potential of stem cell-like glioma cells
(SCLGC) to support tumor angiogenesis. SCLGC isolated from human
glioblastoma biopsy specimens and xenografts potently generated tumors when
implanted into the brains of immunocompromised mice, whereas non-SCLGC tumor
cells isolated from only a few tumors formed secondary tumors when
xenotransplanted. Tumors derived from SCLGC were morphologically
distinguishable from non-SCLGC tumor populations by widespread tumor
angiogenesis, necrosis, and hemorrhage. To determine a potential molecular
mechanism for SCLGC in angiogenesis, we measured the expression of a panel
of angiogenic factors secreted by SCLGC. In comparison with matched non-SCLGC
populations, SCLGC consistently secreted markedly elevated levels of
vascular endothelial growth factor (VEGF), which were further induced by
hypoxia. In an in vitro model of angiogenesis, SCLGC-conditioned medium
significantly increased endothelial cell migration and tube formation
compared with non-SCLGC tumor cell-conditioned medium. The proangiogenic
effects of glioma SCLGC on endothelial cells were specifically abolished by
the anti-VEGF neutralizing antibody bevacizumab, which is in clinical use
for cancer therapy. Furthermore, bevacizumab displayed potent antiangiogenic
efficacy in vivo and suppressed growth of xenografts derived from SCLGC but
limited efficacy against xenografts derived from a matched non-SCLGC
population. Together these data indicate that stem cell-like tumor cells can
be a crucial source of key angiogenic factors in cancers and that targeting
proangiogenic factors from stem cell-like tumor populations may be critical
for patient therapy. (Cancer Res 2006; 66(16): 7843-8).
PMID: 16912155 [PubMed - in process]3
-
| 11: Clin
Cancer Res. 2006 Aug 15;12(16):4899-907. |
|
-
Phase I/II Study of Imatinib Mesylate for Recurrent
Malignant Gliomas: North American Brain Tumor Consortium Study 99-08.
Wen
PY, Yung
WK, Lamborn
KR, Dahia
PL, Wang
Y, Peng
B, Abrey
LE, Raizer
J, Cloughesy
TF, Fink
K, Gilbert
M, Chang
S, Junck
L, Schiff
D, Lieberman
F, Fine
HA, Mehta
M, Robins
HI, Deangelis
LM, Groves
MD, Puduvalli
VK, Levin
V, Conrad
C, Maher
EA, Aldape
K, Hayes
M, Letvak
L, Egorin
MJ, Capdeville
R, Kaplan
R, Murgo
AJ, Stiles
C, Prados
MD.
Authors' Affiliations: Dana-Farber/Brigham and Women's Cancer Center,
Boston, Massachusetts.
PURPOSE: Phase I: To determine the maximum tolerated doses, toxicities, and
pharmacokinetics of imatinib mesylate (Gleevec) in patients with malignant
gliomas taking enzyme-inducing antiepileptic drugs (EIAED) or not taking
EIAED. Phase II: To determine the therapeutic efficacy of imatinib.
EXPERIMENTAL DESIGN: Phase I component used an interpatient dose escalation
scheme. End points of the phase II component were 6-month progression-free
survival and response. RESULTS: Fifty patients enrolled in the phase I
component (27 EIAED and 23 non-EIAED). The maximum tolerated dose for non-EIAED
patients was 800 mg/d. Dose-limiting toxicities were neutropenia, rash, and
elevated alanine aminotransferase. EIAED patients received up to 1,200 mg/d
imatinib without developing dose-limiting toxicity. Plasma exposure of
imatinib was reduced by approximately 68% in EIAED patients compared with
non-EIAED patients. Fifty-five non-EIAED patients (34 glioblastoma
multiforme and 21 anaplastic glioma) enrolled in the phase II component.
Patients initially received 800 mg/d imatinib; 15 anaplastic glioma patients
received 600 mg/d after hemorrhages were observed. There were 2 partial
response and 6 stable disease among glioblastoma multiforme patients and 0
partial response and 5 stable disease among anaplastic glioma patients.
Six-month progression-free survival was 3% for glioblastoma multiforme and
10% for anaplastic glioma patients. Five phase II patients developed
intratumoral hemorrhages. CONCLUSIONS: Single-agent imatinib has minimal
activity in malignant gliomas. CYP3A4 inducers, such as EIAEDs,
substantially decreased plasma exposure of imatinib and should be avoided in
patients receiving imatinib for chronic myelogenous leukemia and
gastrointestinal stromal tumors. The evaluation of the activity of
combination regimens incorporating imatinib is under way in phase II trials.
PMID: 16914578 [PubMed - in process]3
-
| 12: Int
J Radiat Oncol Biol Phys. 2006 Aug 10; [Epub ahead of
print] |
|
-
Five-year survivors of brain metastases: a
single-institution report of 32 patients.
Chao
ST, Barnett
GH, Liu
SW, Reuther
AM, Toms
SA, Vogelbaum
MA, Videtic
GM, Suh
JH.
Radiation Oncology Brain Tumor Institute, Taussig Cancer Center, The
Cleveland Clinic Foundation, Cleveland, OH USA.
PURPOSE: To report on 32 patients who survived >/=5 years from brain
metastases treated at a single institution. METHODS AND MATERIALS: The
records of 1288 patients diagnosed with brain metastases between 1973 and
1999 were reviewed. Patients were treated with whole-brain radiation therapy
(WBRT), surgery, and/or stereotactic radiosurgery (SRS). Thirty-two (2.5%)
>/=5-year survivors were identified. Factors contributing to long-term
survival were identified. RESULTS: Median survival was 9.3 years for
>/=5-year survivors. Seven of these patients lived >/=10 years. Female
gender was the only patient characteristic that correlated with better
survival (p = 0.0369). When these patients were compared with <5-year
survivors, age <65 years (p = 0.0044), control of the primary at
diagnosis (p = 0.0052), no systemic disease (p = 0.0012), recursive
partitioning analysis (RPA) Class 1 (p = 0.0002 with Class 2; p = 0.0022
with Class 3), and single brain metastasis (p = 0.0018) were associated with
long-term survival in the univariate logistic regression model. In the
multivariate model, RPA Class 1 compared with Class 2 (OR = 0.39, p =
0.0196), surgery (OR = 0.16, p < 0.0001), and SRS (OR = 0.41, p = 0.0188)
were associated with long-term survival. CONCLUSIONS: For patients with good
prognostic factors such as young age, good RPA characteristics and single
metastasis, treatment with surgery or SRS offers the best chance for
long-term survival.
PMID: 16904847 [PubMed - as supplied by publisher]3
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| 13: Int
J Radiat Oncol Biol Phys. 2006 Sep 1;66(1):263-70. |
|
-
Response of intracerebral human glioblastoma xenografts
to multifraction radiation exposures.
Ozawa
T, Faddegon
BA, Hu
LJ, Bollen
AW, Lamborn
KR, Deen
DF.
Brain Tumor Research Center, Department of Neurological Surgery, University
of California San Francisco, San Francisco, CA.
Purpose: We investigated the effects of fractionated radiation treatments on
the life spans of athymic rats bearing intracerebral brain tumors. Methods
and Materials: U-251 MG or U-87 MG human glioblastoma cells were implanted
into the brains of athymic rats, and the resulting tumors were irradiated
once daily with various doses of ionizing radiation for 5 consecutive days
or for 10 days with a 2-day break after Day 5. Results: Five daily doses of
1 and 1.5 Gy, and 10 doses of 0.75 and 1 Gy, cured some U-251 MG tumors.
However, five daily doses of 0.5 Gy increased the survival time of animals
bearing U-251 MG tumors 5 days without curing any animals of their tumors.
Ten doses of 0.3 Gy given over 2 weeks extended the lifespan of the host
animals 9 days without curing any animals. For U-87 MG tumors, 5 daily doses
of 3 Gy produced an increased lifespan of 8 days without curing any animals,
and 10 doses of 1 Gy prolonged lifespan 5.5 days without curing any animals.
The differences in extension of life span between the 5- and 10-fraction
protocols were minor for either tumor type. Conclusion: The finding that the
U-251 MG tumors are more sensitive than U-87 MG tumors, despite the fact
that U-251 MG tumors contain many more hypoxic cells than U-87 MG tumors,
suggests the intrinsic cellular radiosensitivities of these cell lines are
more important than hypoxia in determining their in vivo radiosensitivities.
PMID: 16904526 [PubMed - in process]2
-
| 14: J
Clin Oncol. 2006 Aug 1;24(22):3597-603. |
|
-
Comment in:
- J
Clin Oncol. 2006 Aug 1;24(22):3524-6.
Decision analysis for prophylactic cranial irradiation
for patients with small-cell lung cancer.
Lee
JJ, Bekele
BN, Zhou
X, Cantor
SB, Komaki
R, Lee
JS.
Department of Biostatistics & Applied Mathematics, The University of
Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. jjlee@mdanderson.org
PURPOSE: Prophylactic cranial irradiation (PCI) has been shown to provide
survival benefit in patients with limited disease small-cell lung cancer
(LD-SCLC) who have achieved complete response. However, PCI may also produce
long-term neurotoxicity (NT). The benefits and risks of PCI in LD-SCLC are
evaluated. METHODS: We developed a decision-analytic model to compare
quality-adjusted life expectancy (QALE) in a cohort of SCLC patients who do
or do not receive PCI by varying survival rates and the frequency and
severity of PCI-related NT. Sensitivity analyses were applied to examine the
robustness of the optimal decision. RESULTS: At current published survival
rates (26% 5-year survival rate with PCI and 22% without PCI) and a low NT
rate, PCI offered a benefit over no PCI (QALE = 4.31 and 3.70 for mild NT
severity; QALE = 4.09 and 3.70 for substantial NT severity, respectively).
With a moderate NT rate, PCI was still preferred. If the PCI survival rate
increased to 40%, PCI outperformed no PCI with a mild NT severity. However,
no PCI was preferred over PCI (QALE = 5.72 v 5.47) with substantial NT
severity. Two-way sensitivity analyses showed that PCI was preferred for low
NT rates, mild NT severity, and low long-term survival rates. Otherwise, no
PCI was preferred. CONCLUSION: The current data suggest PCI offers better
QALE than no PCI in LD-SCLC patients who have achieved complete response. As
the survival rate for SCLC patients continues to improve, NT rate and NT
severity must be controlled to maintain a favorable benefit-risk ratio for
recommending PCI.
PMID: 16877726 [PubMed - indexed for MEDLINE]2
-
| 15: J
Clin Oncol. 2006 Aug 1;24(22):3524-6. |
|
-
Comment on:
- J
Clin Oncol. 2006 Aug 1;24(22):3597-603.
Models support prophylactic cranial irradiation.
Mehta
MP.
Publication Types:
PMID: 16877718 [PubMed - indexed for MEDLINE]
-
| 16: J
Natl Cancer Inst. 2006 Aug 2;98(15):1088-91. |
|
-
Highly active antiretroviral therapy and human
immunodeficiency virus-associated primary cerebral lymphoma.
Bower
M, Powles
T, Nelson
M, Mandalia
S, Gazzard
B, Stebbing
J.
Department of Oncology and HIV Medicine, The Chelsea and Westminster
Hospital, 369 Fulham Rd., London SW10 9NH, United Kingdom.
From a cohort of 9621 human immunodeficiency virus type 1-infected
individuals, we identified 61 patients with primary central nervous system
lymphoma (PCL) who had a median survival of 1.3 months. We compared
clinicopathologic variables of patients who were treated in the pre-highly
active antiretroviral therapy (HAART) and HAART eras and investigated
whether exposure to antiretroviral agents with differing cerebrospinal fluid
penetrations was associated with risk for PCL. All statistical tests were
two-sided. Incidence of PCL was lower in the HAART era (1.2 cases per 1000
patient-years, 95% confidence interval [CI] = 0.8 to 1.9) than in the pre-HAART
era (three cases per 1000 years, 95% CI = 2.1 to 4.0; P<.001), and
overall survival was longer (median survival = 32 days, range = 5-315 days,
versus 48 days, range = 15-1136 days; log rank P = .03). In the HAART era,
fewer patients had prior acquired immunodeficiency syndrome-defining
illnesses than in the pre-HAART era (64% versus 90%; P = .013), and patients
were more likely to have the diagnosis of PCL confirmed histologically or by
polymerase chain reaction (77% versus 26%; P<.001). Exposure to specific
antiretroviral agents was not associated with risk for PCL.
PMID: 16882946 [PubMed - indexed for MEDLINE]2
-
| 17: Neurosurgery.
2006 May;58(5):985-9; discussion 985-9. |
|
-
Internet-based neuro-oncology patient recruitment.
Komotar
RJ, Zacharia
BE, Mocco
J, Ransom
ER, Davis
JP, Gasparis
G, Bruce
JN, Anderson
RC.
Department of Neurological Surgery, Columbia University, New York, New York,
USA.
THE PRIVACY RULE, as part of the Health Insurance Portability and
Accountability Act, was implemented in 2003 as a response to public concern
over potential abuses of private health information. Although the Privacy
Rule was not intended to place limits on clinical research, its complexity
has caused much confusion throughout the academic medicine and research
communities. Many clinical and translational researchers have created
clinical databases or human tissue banks to facilitate future research.
Maintenance of such databases is considered a research activity under the
Privacy Rule, and researchers are, therefore, subject to its regulations. We
present a novel Internet-based method to generate and maintain a
neurooncology patient registry and human tissue bank. Through our web site,
we secure both Health Insurance Portability and Accountability Act research
authorization and informed consent, enabling us to contact the treating
physician for clinical data and pathological specimens. Considering the
importance of continued use of clinical databases and tissue banks in the
genetic era of medicine, our method offers one way for researchers to adapt
to the changing world of clinical research.
PMID: 16639336 [PubMed - indexed for MEDLINE]
-
| 18: Neurosurgery.
2006 May;58(5):891-8; discussion 891-8. |
|
-
Postoperative radiosurgery for malignant spinal tumors.
Rock
JP, Ryu
S, Shukairy
MS, Yin
FF, Sharif
A, Schreiber
F, Abdulhak
M, Kim
JH, Rosenblum
ML.
Department of Neurological Surgery, Hermelin Brain Tumor Center, Henry Ford
Hospital, Detroit, Michigan 48202, USA. nsjar@neuro.hfh.edu
OBJECTIVE: Although, as a primary therapy, radiosurgery for spinal tumors is
becoming more common in clinical practice and is associated with encouraging
clinical results, we wanted to evaluate outcomes after radiosurgery in a
series of postoperative patients. METHODS: We examined the medical records
of 18 postoperative patients who received radiosurgical treatment to their
residual spinal tumors: metastatic carcinoma (10), sarcoma (3), multiple
myeloma/plasmacytoma (4), and giant cell tumor (1). Marginal radiosurgical
doses ranged from 6 to 16 Gy (mean, 11.4 Gy) prescribed to the 90% isodose
line. All regions of the spine received treatment: 2 cervical, 15 thoracic,
and 1 lumbosacral. The volume of irradiated spinal elements receiving 30,
50, and 80% of the total dose ranged from 0.51 to 11.05, 0.19 to 6.34, and
0.06 to 1.73 cm, respectively. Treatment sessions (i.e., patient in to
patient out of the room) varied between 20 and 40 minutes. Follow-up ranged
from 4 to 36 months (median, 7 mo). RESULTS: Even though significant doses
of radiation were delivered to all regions of the spinal cord and nerve
roots coincidentally involved in the treatments, only one patient in this
series developed progressive symptoms possibly attributable to a toxic
effect of the radiosurgery. Of those patients initially presenting with
neurological deficits, 92% either remained neurologically stable or
improved. CONCLUSION: Our observations suggest that radiosurgery as
prescribed in this series of postoperative patients with residual spinal
tumor is well-tolerated and associated with little to no significant
morbidity.
PMID: 16639323 [PubMed - indexed for MEDLINE]3
-
| 19: Neurosurgery.
2006 May;58(5):881-90; discussion 881-90. |
|
-
Subependymomas: an analysis of clinical and imaging
features.
Ragel
BT, Osborn
AG, Whang
K, Townsend
JJ, Jensen
RL, Couldwell
WT.
Department of Neurosurgery, University of Utah, and Huntsman Cancer
Institute, Salt Lake City 84132, USA.
OBJECTIVE: Subependymomas are slow-growing, benign tumors usually found
incidentally in the fourth ventricle at autopsy. They are typically
associated with the ventricular system and become apparent clinically only
when symptoms of hydrocephalus or mass effect develop. We review clinical,
histological, and contemporary radiographic presentations of 16
subependymomas, including 2 intraparenchymal tumors. METHODS: We
retrospectively evaluated eight patients with pathologically proven
subependymomas. Initial magnetic resonance imaging and magnetic resonance
spectroscopy were reviewed when available. Imaging was also available on
eight outside subependymoma cases reviewed by our radiology department.
RESULTS: Twelve of these subependymomas were intraventricular, one was in
the posterior fossa, two were intraparenchymal, and one was an
intramedullary spinal cord tumor. These lesions were hypo- to hyperintense
on T1- and T2-weighted magnetic resonance imaging, with minimal to moderate
enhancement. Initial complaints included headache, seizures, tingling
sensations, and weakness. Among our eight patients who underwent gross total
resection with no adjuvant therapy, no recurrences have been noted on
follow-up magnetic resonance imaging. CONCLUSION: Subependymomas are rare,
representing only 0.51% of all central nervous system tumors operated on
during an 8-year period at the University of Utah. Clinical symptoms were
associated with tumor location: intracranial masses caused headaches,
seizures, and neurological complaints, and spinal cord locations resulted in
neurological deficit. The authors review the clinical presentation,
management, and contemporary radiographic appearance of this rare tumor.
PMID: 16639322 [PubMed - indexed for MEDLINE]2
-
| 20: Neurosurgery.
2006 May;58(5):E999; discussion E999. |
|
-
Removal of an orbital metallic foreign body to facilitate
magnetic resonance imaging: technical case report.
Deen
HG, Miller
DA, Kostick
DA, Jaeckle
KA.
Department of Neurosurgery, Mayo Clinic Jacksonville, Jacksonville, Florida
32224, USA. hdeen@mayo.edu
OBJECTIVE AND IMPORTANCE: Magnetic resonance imaging (MRI) is the imaging
modality of choice for brain tumors and other lesions of the central nervous
system. However, this procedure is contraindicated in patients with orbital
metallic foreign bodies. In such cases, the usual clinical strategy is to
manage the patient without the benefit of MRI scans and, instead, to rely on
less sensitive imaging modalities in particular computed tomographic
scanning. CLINICAL PRESENTATION: Two patients, one with a posterior fossa
mass and one with suspected central nervous system lymphoma, were seen at
our institution. MRI scanning was recommended, but had been precluded in
both patients by the presence of metal fragments in the orbit. INTERVENTION:
In each case, the orbital foreign body was successfully localized and
removed. Postprocedure computed tomographic scanning confirmed complete
removal. MRI scanning was then performed without difficulty. The first
patient underwent posterior fossa craniotomy and removal of the tumor, which
proved to be a medulloblastoma. The second patient was found to have
evidence of lymphoma in the cranial base and meninges and was treated with
radiotherapy and systemic and intrathecal chemotherapy. MRI scanning
provided superior diagnostic information and spared both patients the risks
and discomfort of myelography and exposure to ionizing radiation from
multiple computerized tomographic scans. CONCLUSION: Two patients with
central nervous system tumors underwent removal of a metal fragment in the
orbit for the specific purpose of facilitating MRI scans. This is a
practical, straightforward concept, which should be considered when MRI
scanning is needed for optimal patient management.
Publication Types:
PMID: 16639311 [PubMed - indexed for MEDLINE]2
-
| 21: Neurosurgery.
2006 May;58(5):E990; discussion E990. |
|
-
Pontine atypical neurocytoma: case report.
Swinson
BM, Friedman
WA, Yachnis
AT.
Department of Neurosurgery, University of Florida, Gainesville 32610, USA.
OBJECTIVE AND IMPORTANCE: Neurocytomas are typically located within the
supratentorial ventricular system. Extraventricular neurocytomas are very
rare, and this is only the second reported case of a pontine neurocytoma. We
discuss the clinical presentation, histology, and treatment of these rare
tumors. CLINICAL PRESENTATION: A 58-year-old man presented with a 4-month
history of headache and unilateral facial and distal extremity paresthesia.
Magnetic resonance imaging (MRI) scans demonstrated a 2.6 x 2.2-cm
ring-enhancing cystic mass in the right pons. INTERVENTION: MRI-guided
stereotactic biopsy yielded a diagnosis of atypical neurocytoma. Because of
the location and malignant histological features of the tumor, the patient
was initially treated with external beam radiation therapy. Several months
later, MRI scans demonstrated tumor progression. The patient then underwent
three rounds of temozolomide chemotherapy, during and after which his
symptoms worsened. Aggressive subtotal resection of the tumor was achieved
via a right suboccipital craniectomy. CONCLUSION: Twenty-eight months
postoperatively, the patient is symptom free, and MRI scans demonstrate no
evidence of residual or recurrent tumor.
Publication Types:
PMID: 16639306 [PubMed - indexed for MEDLINE]2
-
| 22: Neurosurgery.
2006 Apr;58(4):710-8; discussion 710-8. |
|
-
A novel platform for image-guided ultrasound.
Tirakotai
W, Miller
D, Heinze
S, Benes
L, Bertalanffy
H, Sure
U.
Department of Neurosurgery, Philipps University, Marburg, Germany.
OBJECTIVE: The combination of classic neuronavigation and intraoperative
ultrasound is a recent innovation in image guidance technology. However,
this technique requires two hardware components (neuronavigation and an
ultrasound system). It was the aim of the study to describe a new simplified
technology of a so-called one-platform navigation system developed by our
institution in collaboration with the industry and to demonstrate its range
of various applications. METHODS: An ultrasound device (IGSonic; BrainLAB,
Munich, Germany) is integrated into the VectorVision2 navigation system (BrainLAB,
Munich, Germany). The IGSonic Probe 10V5 is connected to the VectorVision
Navigation station via an IGSonic Device Box. Once the ultrasound probe is
calibrated, the navigated ultrasound displays the sonographic image of the
intracranial anatomy on the navigation screen in a composed overlay fashion.
It might depict vascular structures within the ultrasound plane by a duplex
mode. Ultrasound can also be operated independently from navigation.
RESULTS: The VectorVision2 system combines intraoperative ultrasound data
sets with preoperatively acquired neuronavigation data sets in plug and play
fashion. The system provides a cost-effective intraoperative imaging
modality that offers a good anatomic orientation by various composite
images, including the display of the amount of brain shift. In our
institution, the comprehensible interface led to a routine use of the
technology by several neurosurgeons who had not been familiar with the
ultrasound technology before. CONCLUSION: The integration of an ultrasound
device into an existing navigation system has been successfully developed.
The system offers a friendly user interface and cost-effective
intraoperative imaging feedback. Although brain shift can be visualized by
an image overlay technology as demonstrated by the present system, future
developments should aim at fusion techniques of both intra- and preoperative
image data sets.
PMID: 16575335 [PubMed - indexed for MEDLINE]
-
| 23: Neurosurgery.
2006 Apr;58(4):674-85; discussion 674-85. |
|
-
CyberKnife radiosurgery for benign intradural
extramedullary spinal tumors.
Dodd
RL, Ryu
MR, Kamnerdsupaphon
P, Gibbs
IC, Chang
SD Jr, Adler
JR Jr.
Department of Neurosurgery, Stanford University School of Medicine,
Stanford, California 94305, USA.
OBJECTIVE: Microsurgical resection of benign intradural extramedullary
spinal tumors is generally safe and successful, but patients with
neurofibromatosis, recurrent tumors, multiple lesions, or medical problems
that place them at higher surgical risk may benefit from alternatives to
surgery. In this prospective study, we analyzed our preliminary experience
with image-guided radiosurgical ablation of selected benign spinal neoplasms.
METHODS: Since 1999, CyberKnife (Accuray, Inc., Sunnyvale, CA) radiosurgery
was used to manage 51 patients (median age, 46 yr; range, 12-86 yr) with 55
benign spinal tumors (30 schwannomas, nine neurofibromas, 16 meningiomas) at
Stanford University Medical Center. Total treatment doses ranged from 1600
to 3000 cGy delivered in consecutive daily sessions (1-5) to tumor volumes
that varied from 0.136 to 24.6 cm. RESULTS: Less than 1 year
postradiosurgery, three of the 51 patients in this series (one meningioma,
one schwannoma, and one neurofibroma) required surgical resection of their
tumor because of persistent or worsening symptoms; only one of these lesions
was larger radiographically. However, 28 of the 51 patients now have greater
than 24 months clinical and radiographic follow-up. After a mean follow-up
of 36 months, all of these later lesions were either stable (61%) or smaller
(39%). Two patients died from unrelated causes. Radiation-induced myelopathy
appeared 8 months postradiosurgery in one patient. CONCLUSION: Although more
patients studied over an even longer follow-up period are needed to
determine the long-term efficacy of spinal radiosurgery for benign
extra-axial neoplasms, short-term clinical benefits were observed in this
prospective analysis. The present study demonstrates that CyberKnife
radiosurgical ablation of such tumors is technically feasible and associated
with low morbidity.
PMID: 16575331 [PubMed - indexed for MEDLINE]2
-
| 24: Neurosurgery.
2006 Apr;58(4):640-6; discussion 640-6. |
|
-
Dexamethasone and enhancing solitary cerebral mass
lesions: alterations in perfusion and blood-tumor barrier kinetics shown by
magnetic resonance imaging.
Wilkinson
ID, Jellineck
DA, Levy
D, Giesel
FL, Romanowski
CA, Miller
BA, Griffiths
PD.
Academic Unit of Radiology, University of Sheffield, Sheffield, United
Kingdom. i.d.wilkinson@shef.ac.uk
OBJECTIVE: Glucocorticoid analogues are often administered to patients with
intracranial space-occupying lesions. Clinical response can be dramatic, but
the neurophysiological response is not well documented. This study sought to
investigate the blood-lesion barrier, blood-brain barrier, and cerebral
perfusion characteristics of patients who have undergone such therapy using
magnetic resonance imaging. METHODS: Seventeen patients with intracranial
mass-enhancing lesions underwent magnetic resonance imaging before and after
3 days of high-dose dexamethasone therapy. Assessments of blood-lesion
barrier and blood-brain barrier integrity were based on a dynamic
T1-weighted exogenous contrast technique that yielded the normalized maximal
change in contrast uptake (T1-uptake). Perfusion was assessed using a
dynamic T2*-weighted exogenous contrast technique to yield relative regional
cerebral blood volume and first-moment mean transit time. Comparisons were
made in T1-uptake, regional cerebral blood volume, and first-moment mean
transit time of both enhancing lesion and contralateral normal-appearing
white matter (CNAWM) obtained before and after dexamethasone. RESULTS:
Significant reduction in T1-uptake was observed (19% decrease, P < 0.005)
within enhancing pathological tissue, whereas no significant alteration was
detected in CNAWM. Regional cerebral blood volume was significantly reduced
in both enhancing tissue (28% decrease, P < 0.005) and in CNAWM (20%
decrease, P < 0.001). Bolus first-moment mean transit time significantly
increased (2.0 s prolongation, P < 0.05) in CNAWM, whereas there was no
significant change (1.4 s prolongation, P > 0.05) within enhancing
tissue. CONCLUSION: Glucocorticoid-analogue therapy not only affects the
permeability of the blood-lesion barrier and lesion blood volume but also
affects blood flow within normal-appearing contralateral parenchyma. There
is a need for controls in steroid therapy in magnetic resonance imaging
studies, which involve assessments of cerebrovascular function.
PMID: 16575327 [PubMed - indexed for MEDLINE]2
-
| 25: Neurosurgery.
2006 Apr;58(4):E799; author reply E799. |
|
-
Comment on:
- Neurosurgery.
2005 May;56(5):1066-74; discussion 1066-74.
Pituitary carcinoma: a clinicopathological review.
Sivan
M.
Publication Types:
PMID: 16575311 [PubMed - indexed for MEDLINE]
-
| 26: Neurosurgery.
2006 Feb;58(2):365-72; discussion 365-72. |
|
-
Noninvasive bioluminescence imaging of luciferase
expressing intracranial U87 xenografts: correlation with magnetic resonance
imaging determined tumor volume and longitudinal use in assessing tumor
growth and antiangiogenic treatment effect.
Szentirmai
O, Baker
CH, Lin
N, Szucs
S, Takahashi
M, Kiryu
S, Kung
AL, Mulligan
RC, Carter
BS.
Neurosurgical Service, Massachusetts General Hospital and Harvard Medical
School, Boston 02114, USA.
OBJECTIVE: Outcome studies in rodent tumor models rely on both histological
and noninvasive study end points. Intracranial models require special tools
to observe tumor growth over time noninvasively, such as magnetic resonance
imaging (MRI), computed tomographic scanning, or cranial window techniques.
These techniques share disadvantages in terms of cost, technical expertise
required, and overall animal throughput for analysis. In this report, we
sought to validate the use of the relatively newer technique of
bioluminescence imaging (BLI) of intracranial glioblastoma xenograft growth
by comparing it with gadolinium-enhanced MRI. METHODS: U87MG glioma cell
lines genetically engineered to express the firefly luciferase gene were
stereotactically injected into nude mice in the left frontal lobe. Weekly
BLI and MRI were performed after the inoculation of tumor cells. For BLI,
tumor growth was assessed as the peak BLI after systemic injection of
luciferin substrate. MRI-based growth curves were created by
three-dimensional volumetric reconstruction of axial gadolinium-enhanced MRI
data covering the whole brain. In a separate experiment, mice were treated
with adenoviruses encoding antiangiogenic soluble vascular endothelial
growth factor receptors, and treatment effect was monitored by BLI. RESULTS:
Untreated tumor growth was readily detected and observed over time by serial
BLI measurements. Furthermore, tumor-derived light emission was highly
correlated with volume of tumor as assessed by MRI. Furthermore, the tested
antiangiogenic treatment effect was readily detected using this technique,
suggesting the power of the technique for sensitive monitoring of novel
therapeutics. CONCLUSION: BLI offers a simple and rapid technique for
assessing intracranial glioblastoma growth in rodent models noninvasively,
which correlates well with MRI. The speed of the BLI technique can increase
experimental throughput, allows for targeted histological analysis in
animals showing the greatest treatment effects, and provides new insights
into the kinetics of intracranial tumor growth in the setting of different
treatments.
Publication Types:
PMID: 16462491 [PubMed - indexed for MEDLINE]
-
| 27: Neurosurgery.
2006 Feb;58(2):347-54; discussion 347-54. |
|
-
Increased expression of 5-lipoxygenase in high-grade
astrocytomas.
Nathoo
N, Prayson
RA, Bondar
J, Vargo
L, Arrigain
S, Mascha
EJ, Suh
JH, Barnett
GH, Golubic
M.
Brain Tumor Institute, The Cleveland Clinic Foundation, Cleveland, Ohio
44195, USA.
OBJECTIVE: 5-Lipoxygenase (5-LO) oxidizes arachidonic acid into
proinflammatory eicosanoids that may promote tumorigenesis. In this study,
we investigated whether 5-LO is expressed in human astrocytomas and what
effect its expression may have on patient outcome. METHODS: Increased 5-LO
messenger ribonucleic acid and protein expression was detected by the
polymerase chain reaction and antibody-based approaches, respectively, in
surgical astrocytoma specimens and established glioblastoma multiforme cell
lines compared with primary cell culture from the human white matter.
RESULTS: Immunohistochemical analysis revealed predominantly nuclear 5-LO
staining in 44 of 49 glioblastoma multiforme samples (90%), 8 of 10 (80%)
anaplastic astrocytomas samples, and 3 of 13 (23%) low-grade astrocytoma
samples analyzed. Double-staining experiments with anti-CD-68 (macrophage/microglial
marker) and anti-5-LO antibodies suggest that both CD-68-positive and
CD-68-negative tumor cells express 5-LO protein. Staining of 5-LO was
significantly more frequent in high-grade than in low-grade tumors (P =
0.001). Patients whose tumors expressed 5-LO were significantly older, had
lower preoperative Karnofsky performance scores and shorter survival than
patients whose tumors did not express 5-LO. After adjusting for pathological
diagnosis and age, respectively, neither Karnofsky performance score nor
survival were significantly associated with 5-LO staining. CONCLUSION: These
data indicate that 5-LO is overexpressed in high-grade astrocytomas and
supports the idea that eicosanoids may play a role in tumorigenesis of these
brain tumors.
PMID: 16462489 [PubMed - indexed for MEDLINE]3
-
| 28: Neurosurgery.
2006 Feb;58(2):E387; discussion E387. |
|
-
Spinal cord compression in a patient with a pain pump for
failed back syndrome: a chalk-like precipitate mimicking a spinal cord
neoplasm: case report.
Wadhwa
RK, Shaya
MR, Nanda
A.
Department of Neurosurgery, Louisiana State University, Health Sciences
Center, Shreveport 71130-3932, USA.
OBJECTIVE AND IMPORTANCE: The use of intrathecal morphine has been effective
with few complications for chronic intractable pain of both benign and
malignant origins. A rare but serious problem that exists is the formation
of an inflammatory mass at the catheter tip of the pain pump. CLINICAL
PRESENTATION: We report the case of a 67-year-old female patient with failed
back syndrome who presented with sensory complaints and back pain.
INTERVENTION: Magnetic resonance imaging revealed impingement on the
thoracic cord by a mass. The mass was originally thought to be a spinal cord
tumor; however, operation and chemical analysis of the mass showed that it
was a bupivacaine precipitate at the tip of the catheter of the pain pump.
CONCLUSION: This is the first such case, to our knowledge, of a bupivacaine
precipitate mimicking a spinal cord tumor.
Publication Types:
PMID: 16462469 [PubMed - indexed for MEDLINE]
-
| 29: Oncogene.
2006 Aug 14; [Epub ahead of print] |
|
-
Downregulation of RUNX3 and TES by hypermethylation in
glioblastoma.
Mueller
W, Nutt
CL, Ehrich
M, Riemenschneider
MJ, von
Deimling A, van
den Boom D, Louis
DN.
[1] 1Department of Pathology, Cancer Center and Neurosurgical Service,
Massachusetts General Hospital, Boston, MA, USA [2] 2Harvard Medical School,
Boston, MA, USA.
Glioblastoma, the most aggressive and least treatable form of malignant
glioma, is the most common human brain tumor. Although many regions of
allelic loss occur in glioblastomas, relatively few tumor suppressor genes
have been found mutated at such loci. To address the possibility that
epigenetic alterations are an alternative means of glioblastoma gene
inactivation, we coupled pharmacological manipulation of methylation with
gene profiling to identify potential methylation-regulated, tumor-related
genes. Duplicates of three short-term cultured glioblastomas were exposed to
5 muM 5-aza-dC for 96 h followed by cRNA hybridization to an oligonucleotide
microarray (Affymetrix U133A). We based candidate gene selection on
bioinformatics, reverse transcription-polymerase chain reaction (RT-PCR),
bisulfite sequencing, methylation-specific PCR and matrix-assisted laser
desorption/ionization time-of-flight mass spectrometry. Two genes identified
in this manner, RUNX3 and Testin (TES), were subsequently shown to harbor
frequent tumor-specific epigenetic alterations in primary glioblastomas.
This overall approach therefore provides a powerful means to identify
candidate tumor-suppressor genes for subsequent evaluation and may lead to
the identification of genes whose epigenetic dysregulation is integral to
glioblastoma tumorigenesis.Oncogene advance online publication, 14 August
2006; doi:10.1038/sj.onc.1209805.
PMID: 16909125 [PubMed - as supplied by publisher]2
-
| 30: Oncogene.
2006 Aug 7; [Epub ahead of print] |
|
-
NF-kappaB-independent sensitization of glioblastoma cells
for TRAIL-induced apoptosis by proteasome inhibition.
La
Ferla-Bruhl K, Westhoff
MA, Karl
S, Kasperczyk
H, Zwacka
RM, Debatin
KM, Fulda
S.
1University Children's Hospital, Ulm, Germany.
The transcription factor nuclear factor-kappaB (NF-kappaB) is a key
regulator of stress-induced transcriptional activation and has been
implicated in mediating primary or acquired apoptosis resistance in various
cancers. In the present study, we therefore investigated the role of NF-kappaB
in regulating apoptosis in malignant glioma, a prototypic tumor refractory
to current treatment approaches. Here, we report that constitutive NF-kappaB
DNA-binding activity was low or moderate in eight different glioblastoma
cell lines compared to Hodgkin's lymphoma cells, known to harbor aberrant
constitutive NF-kappaB activity. Specific inhibition of NF-kappaB by
overexpression of inhibitor of kappaB (IkappaB)alpha superrepressor did not
enhance spontaneous apoptosis of glioblastoma cells. Also, overexpression of
IkappaBalpha superrepressor had no significant impact on apoptosis induced
by two prototypic classes of apoptotic stimuli, that is, chemotherapeutic
drugs or death-inducing ligands such as TNF-related apoptosis inducing
ligand (TRAIL), which are known to trigger NF-kappaB activation as part of a
cellular stress response. Similarly, inhibition of NF-kappaB by the
proteasome inhibitor MG132 did not increase doxorubicin (Doxo)-induced
apoptosis of glioblastoma cells, although it prevented DNA binding of NF-kappaB
complexes in response to Doxo. Interestingly, proteasome inhibition
significantly sensitized glioblastoma cells for TRAIL-induced apoptosis.
These findings indicate that the characteristic antiapoptotic function of
NF-kappaB reported for many cancers is not a primary feature of glioblastoma
and thus, specific NF-kappaB inhibition may not be effective for
chemosensitization of glioblastoma. Instead, proteasome inhibitors, which
enhanced TRAIL-induced apoptosis in an NF-kappaB-independent manner, may
open new perspectives to increase the efficacy of TRAIL-based regimens in
glioblastoma, which warrants further investigation.Oncogene advance online
publication, 7 August 2006; doi:10.1038/sj.onc.1209841.
PMID: 16909119 [PubMed - as supplied by publisher]
-
| 31: Oncogene.
2006 Aug 7; [Epub ahead of print] |
|
-
ATR-dependent radiation-induced gammaH2AX foci in
bystander primary human astrocytes and glioma cells.
Burdak-Rothkamm
S, Short
SC, Folkard
M, Rothkamm
K, Prise
KM.
1Gray Cancer Institute, Mount Vernon Hospital, Northwood, UK.
Radiotherapy is an important treatment for patients suffering from
high-grade malignant gliomas. Non-targeted (bystander) effects may influence
these cells' response to radiation and the investigation of these effects
may therefore provide new insights into mechanisms of radiosensitivity and
responses to radiotherapy as well as define new targets for therapeutic
approaches. Normal primary human astrocytes (NHA) and T98G glioma cells were
irradiated with helium ions using the Gray Cancer Institute microbeam
facility targeting individual cells. Irradiated NHA and T98G glioma cells
generated signals that induced gammaH2AX foci in neighbouring non-targeted
bystander cells up to 48 h after irradiation. gammaH2AX bystander foci were
also observed in co-cultures targeting either NHA or T98G cells and in
medium transfer experiments. Dimethyl sulphoxide, Filipin and
anti-transforming growth factor (TGF)-beta 1 could suppress gammaH2AX foci
in bystander cells, confirming that reactive oxygen species (ROS) and
membrane-mediated signals are involved in the bystander signalling pathways.
Also, TGF-beta 1 induced gammaH2AX in an ROS-dependent manner similar to
bystander foci. ROS and membrane signalling-dependent differences in
bystander foci induction between T98G glioma cells and normal human
astrocytes have been observed. Inhibition of ataxia telangiectasia mutated
(ATM) protein and DNA-PK could not suppress the induction of bystander
gammaH2AX foci whereas the mutation of ATM- and rad3-related (ATR) abrogated
bystander foci induction. Furthermore, ATR-dependent bystander foci
induction was restricted to S-phase cells. These observations may provide
additional therapeutic targets for the exploitation of the bystander
effect.Oncogene advance online publication, 7 August 2006;
doi:10.1038/sj.onc.1209863.
PMID: 16909103 [PubMed - as supplied by publisher]
-
| 32: Surg Neurol. 2006 Sep;66S1:S30-S34. |
|
-
Microvascular density and vascular endothelial growth
factor have little correlation with prognosis of craniopharyngioma.
Xu
J, Zhang
S, You
C, Wang
X, Zhou
Q.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu
610041, PR China; Department of Medical Genetics, West China Hospital,
Sichuan University, Chengdu 610041, PR China; Division of Human Morbid
Genomics, National Key Laboratory of Biotherapy, Sichuan University, Chengdu
610041, PR China.
BACKGROUND: Craniopharyngioma is histologically a benign epithelial tumor
located in the supersellar cistern that often presents aggressive growth and
repeated recurrence. The authors hypothesized that craniopharyngioma
recurrence and invasive growth are angiogenesis dependent and evaluated the
significance of vascularization in the prognosis of craniopharyngioma by a
prospective cohort study. METHODS: The cohorts consisted of 32 patients with
AE and 31 patients with SP tumor. The primary and recurrence removal
specimens of the cohort patients were gathered. Microvascular density and
VEGF protein in the recurrence group and recurrence-free group were detected
by the immunohistochemistry avidin-biotin-peroxidase method and analyzed
quantitatively through computer-assisted microscopy to evaluate the
correlation of MVD and VEGF with prognosis of craniopharyngiomas. RESULTS:
The average follow-up phase was 63.34 months; 14 of 32 patients with AE and
6 of 31 patients with SP had recurrence and underwent operation again.
Although MVD and VEGF have significant difference between AE and SP (P =
.000, P = .018, respectively), MVD and VEGF have no statistical difference
between the recurrence group and recurrence-free group (P > .05).
CONCLUSIONS: Microvascular density and VEGF in craniopharyngioma tissue have
no correlation with prognosis of the tumor, which may be explained by the
minimal blood circulation in the craniopharyngioma. Adamantine epithelioma
showed more tendency to recur than SP.
PMID: 16904996 [PubMed - as supplied by publisher]2
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| 33: Surg Neurol. 2006 Jul;66(1):62-7; discussion 67-8. |
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Variations of disseminated choroid plexus papilloma: 2
case reports and a review of the literature.
McCall
T, Binning
M, Blumenthal
DT, Jensen
RL.
Department of Neurosurgery, University of Utah, Salt Lake City, UT 84132,
USA.
BACKGROUND: Choroid plexus papillomas are typically considered benign
lesions, but histology is not always predictive of their behavior. These
tumors can metastasize anywhere along the neuraxis and may be
intraventricular, subarachnoid, or intraparenchymal. We present 2 cases that
illustrate the wide diversity with which choroid plexus papillomas can
disseminate. CASE DESCRIPTIONS: The patient described in case 1 had a
primary fourth ventricular choroid plexus papilloma that produced diffuse
cystic subarachnoid and leptomeningeal lesions. Patient 2 also had a primary
fourth ventricular tumor but with subsequent suprasellar and spinal drop
metastases. Patient 1 was treated with temozolomide, resulting in regression
of symptoms including headache and dizziness. Patient 2 has been treated
with several modalities, including radiation therapy and chemotherapy, with
slowing of symptom progression. CONCLUSIONS: Variations of choroid plexus
papilloma dissemination include intraventricular, subarachnoid, and
leptomeningeal nodules or cystic lesions, and intraparenchymal locations.
There is no consensus on the most effective treatment for choroid plexus
papilloma metastases; surgical resection, chemotherapy, and radiation
therapy may all yield benefits. The prognosis for patients with disseminated
choroid plexus papilloma can range from prolonged stable disease and
symptoms to death within months.
Publication Types:
PMID: 16793445 [PubMed - indexed for MEDLINE]2
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| 34: Surg Neurol. 2006 Jul;66(1):56-61; discussion 61. |
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Arachnoid cysts in adults: long-term follow-up of
patients treated with internal shunts to the subdural compartment.
Helland
CA, Wester
K.
Section for Neurosurgery, Department of Surgical Sciences, University of
Bergen, N-5021 Bergen, Norway.
BACKGROUND: We have previously presented an alternative method for surgical
decompression of intracranial arachnoid cysts. This minimally invasive
method, with insertion of an internal shunt from the cyst to the subdural
compartment, seemed to be an efficient and simple, and hence promising
technique. The aim of the present study was to investigate the long-term
results of this procedure. METHODS: This study is a questionnaire-based
retrospective study that includes 31 adult patients (>18 years) who were
operated on in our department for an arachnoid cyst in the temporal fossa or
overlying the frontal convexity with the internal shunt technique between
April 1990 and October 2003. Follow-up ranged from 15 months to 14.8 years
(mean = 8.2 years). RESULTS: Of the patients, 83% were asymptomatic or had
insignificant complaints at follow-up. A total of 17% reported no reduction
of the preoperative complaints. No patient experienced worsening of the
symptoms. The cyst was no longer visible on postoperative radiologic
examinations in 37% of the patients. In 37%, the postoperative fluid volume
was less than 50% of the original volume. In 13%, the cyst volume was
reduced but the postoperative volume was greater than 50% of the original
cyst volume. Thus, the cyst was unchanged in only 13% of the patients. There
was no correlation between volume reduction and clinical improvement. A
complication (subdural hygroma or hematoma) occurred in 7 patients, all with
temporal cysts, leading to reoperation in 4. None of the complications
caused permanent neurologic deficits or invalidity. Seven patients were
reoperated on because of suspected or established treatment failure.
CONCLUSIONS: The internal shunt technique is a relatively simple, safe, and
efficient alternative method for treatment of arachnoid cysts. It should be
considered a valuable alternative in the treatment of arachnoid cysts.
PMID: 16793443 [PubMed - indexed for MEDLINE]2
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| 35: Surg Neurol. 2006 Jul;66(1):46-9; discussion 49. |
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Sellar floor reconstruction after transsphenoidal surgery
using fibrin glue without grafting or implants: technical note.
Seda
L, Camara
RB, Cukiert
A, Burattini
JA, Mariani
PP.
Department of Neurosurgery, Hospital Brigadeiro, Sao Paulo-SP CEP 04544-000,
Brazil.
BACKGROUND: Different techniques have already been described for
reconstructing the sellar floor after transsphenoidal (TS) procedures. This
paper reports on the use of fibrin glue alone without grafting or the use of
implants in the reconstruction of the sellar floor after TS. METHODS: Five
hundred sixty-seven patients who submitted to TS for pituitary and sellar
region tumors were studied. No intraoperative cerebrospinal fluid (CSF) leak
occurred in 503 patients (group 1); in the remaining 64 patients (group 2),
intraoperative CSF leak was noted. In group 1 patients, closure of the
sellar floor consisted of packing the surgical bed with hemostatic material
only. When CSF leak was noted, the surgical bed was covered with a layer of
hemostatic material and the intrasellar space was filled up with fibrin
glue. An additional layer of hemostatic material was added at the topography
of the preexisting sellar floor, and a second amount of fibrin glue was
applied over it. At the end of surgery, a continuous lumbar CSF drainage
system was installed in group 2 patients and kept for 5 days. Prophylactic
antibiotics were administered during this period. RESULTS: We did not
observe delayed CSF leak, meningitis, or visual loss in group 1 patients. In
group 2, 2 patients presented with complications: 1 patient got meningitis
but no overt CSF leak, and the other disclosed a delayed postoperative leak
treated by reoperation. DISCUSSION: Our results showed that closure of the
sellar floor with hemostatic material and fibrin glue without grafting or
the use of implants is a safe and efficient method to prevent postoperative
complications after TS. Generally speaking, there is no need for grafting or
the use of implants at the end of TS.
PMID: 16793438 [PubMed - indexed for MEDLINE]
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| 36: Surg Neurol. 2006 Jul;66(1):18-25. |
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The pathophysiologic mechanism of cerebellar mutism.
Ozgur
BM, Berberian
J, Aryan
HE, Meltzer
HS, Levy
ML.
Pediatric Neurosurgery, Children's Hospital of San Diego, San Diego, CA
92123, USA. bozgur@ucsd.edu
OBJECTIVE: Cerebellar mutism (CM) is a postoperative complication of mainly
pediatric posterior fossa surgery. Multiple theories exist for explaining
this phenomenon. We have made an attempt to further understand this entity
given a particularly interesting case as it relates to multiple
pathophysiologic pathways. METHODS: We have reviewed the details surrounding
a particularly interesting case of CM. A retrospective analysis of this
patient's clinical history and recovery is described. An extensive
literature review has been performed in conjunction with an attempt to help
elucidate details and a better understanding of CM. RESULTS: A thorough
analysis of existing theories as to the pathophysiologic mechanism of CM has
been performed as it relates to the details of this particular case. A case
is described in which a child exhibiting CM abruptly improved and made a
relatively quick recovery after the triggering of the melodic speech pathway
by way of watching and beginning to sing along with a video. It appears that
this incident involving a familiar song catalyzed various speech pathways,
which apparently were in some state of shock. This phenomenon seems to be a
temporary entity involving not only the mechanical coordination of speech
production, but also the initiation of speech itself. CONCLUSIONS: Evidence
exists for a pathophysiologic pathway for speech by way of coordinating
phonation and articulation. In addition, there seems to exist a pathway by
which the initiation of speech may be altered or halted by posterior fossa
pathology, namely, vermian or dentate nuclear injury. In particular to this
case, we found that the incidental appreciation of other forms of speech,
melodic in this instance, may be the key to help stimulate and accelerate
the recovery from CM.
Publication Types:
PMID: 16793430 [PubMed - indexed for MEDLINE]2
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| 37: Surg Neurol. 2006 Jul;66(1):11-7; discussion 17. |
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Wilbrand's knee: does it exist?
Lee
JH, Tobias
S, Kwon
JT, Sade
B, Kosmorsky
G.
Department of Neurosurgery, The Cleveland Clinic Foundation, Cleveland, OH
44195, USA. leej@ccf.org
OBJECTIVE: In 1904, Hermann Wilbrand reported that nasal ON fibers form a
loop into the contralateral ON, subsequently referred to as Wilbrand's knee.
He had further theorized that a lesion affecting Wilbrand's knee would
develop a distinct visual field defect characterized by an ipsilateral
central scotoma with a contralateral superotemporal visual field defect. We
present clinical evidence that disputes the existence of Wilbrand's knee.
METHODS: A retrospective analysis of 3 patients whose ONs were divided at
the ON-chiasm junction is presented. Two patients had an ONS meningioma and
the other patient had sarcoidosis of the ON. Resection of the lesion and the
ON up to the nerve-chiasm junction was done to prevent the disease from
extending into the OC and the contralateral ON. The patients had detailed
neuro-ophthalmologic evaluations preoperatively and postoperatively.
RESULTS: After the resection of the ON at the ON-chiasm junction in the 3
patients, junctional scotoma could not be detected by visual perimetry.
CONCLUSION: No clinical perimetric evidence was found to support the
existence of Wilbrand's knee in the anterior visual pathway.
Publication Types:
PMID: 16793428 [PubMed - indexed for MEDLINE]
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Volume 5, Number 34 - 21 August 2006