Neuro-Oncology

http://neuro-oncology.oxfordjournals.org/cgi/content/short/14/1/101?rss=1

Tuesday, December 27, 2011

Cognitive functions in primary CNS lymphoma after single or combined modality regimens

The standard treatment for primary CNS lymphoma (PCNSL) involves high-dose methotrexate-based chemotherapy (HD-MTX) alone or in combination with whole brain radiotherapy (WBRT). The combined modality regimen carries a substantial risk for cognitive impairment, and HD-MTX alone has been used more often recently in part to reduce neurotoxicity. In this study, we assessed cognitive functioning and quality of life in PCNSL survivors treated with WBRT + HD-MTX or HD-MTX alone. Fifty PCNSL patients in disease remission underwent a posttreatment baseline neuropsychological evaluation, and a subset of patients completed a follow-up evaluation. Quality of life and extent of white matter disease and atrophy on MRI were assessed. Comparisons according to treatment type after controlling for age and time since treatment completion showed that patients treated with HD-MTX alone had significantly higher scores on tests of selective attention and memory than patients treated with the combined modality regimen. Patients treated with WBRT + HD-MTX had impairments across most cognitive domains, and these were of sufficient severity to interfere with quality of life, as over 50% were not working due to their illness. Patients treated with HD-MTX alone did not meet criteria for cognitive impairment but scored within 1 SD below the normative sample on most tests. Patients with more extensive white matter disease had lower scores on tests of set-shifting and memory. Cognitive dysfunction was more prevalent in PCNSL survivors treated with WBRT + HD-MTX compared with patients treated with HD-MTX alone.

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Júlio Leonardo B. Pereira

http://dx.doi.org/10.1002%2Fcncr.27373

Survival outcomes in atypical teratoid rhabdoid tumor for patients undergoing radiotherapy in a Surv

Abstract

BACKGROUND:

Atypical teratoid rhabdoid tumor (ATRT) is a rare central nervous system malignancy with a poor prognosis that affects mostly young children. Although radiotherapy (RT) historically has been delayed in patients aged <3 years, emerging evidence suggests a role for RT to achieve long-term survivorship. Clinical features and age-dependent trends of RT use were evaluated for patients with ATRT.

METHODS:

The National Cancer Institute's Surveillance, Epidemiology, and End Results database was used to identify 144 patients with ATRT from 1973 to 2008. The primary endpoint was median overall survival (OS). Clinical and treatment variables were assessed for an association with OS using Cox proportional hazards models. Landmark analysis was used to correct for immortal time bias of adjuvant RT.

RESULTS:

The median age at diagnosis was 1 year (range, 0-67 years). Gross total resection of the primary tumor was achieved in 39% of patients, and 33% of patients received RT. From 1992 to 2008, RT use increased 2.4-fold in patients aged ≤3 years. The median OS for was 10 months. In multivariate analyses, metastatic disease (hazard ratio, 2.83; 95% confidence interval, 1.53-5.23; P = .001) and RT (hazard ratio, 0.10; 95% confidence interval, 0.01-0.73; P = .02) were identified as independent predictors of survival. Landmark analysis confirmed a robust association between RT use and survival, which was attenuated in patients ages 4 to 17 years compared with younger patients.

CONCLUSIONS:

The current results indicated that RT may offer a significant survival benefit for patients with ATRT and that patients aged ≤3 years may derive more benefit from initial RT compared with older children. The authors concluded that prospective clinical trials are needed to examine the role of RT in the initial management of ATRT in patients aged <3 years. Cancer 2011. © 2011 American Cancer Society.

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Júlio Leonardo B. Pereira

http://neuro-oncology.oxfordjournals.org/cgi/content/short/14/1/109?rss=1

Molecular prognostic factors of anaplastic oligodendroglial tumors and its relationship: a single in

The increased chemosensitivity of oligodendroglial tumors has been associated with loss of heterozygosity (LOH) on chromosomes 1p and 19q. Other clinical and molecular factors have also been identified as being prognostic and predictive for treatment outcome. Seventy-seven patients with anaplastic oligodendroglioma (AO) or anaplastic oligoastrocytoma (AOA), treated in Beijing Tiantan Hospital from 2006 through 2008, were reviewed. LOH 1p, LOH 19q, IDH1 mutation, O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and protein expression level of MGMT, P53, EGFR, and Ki-67 were evaluated. Age at diagnosis, LOH 1p and 19q, IDH1 mutation, P53 expression level, reoperation when progression, and adjuvant chemotherapy were statistically significant factors for overall survival (OS) in univariate analysis. Further multivariate analysis showed that age at diagnosis (P = .010), LOH 1p and 19q (P = .016), IDH1 mutation (P = .011), and reoperation after progression (P = .048) were independent predictors for longer survival in these patients. Nonrandom associations were found between LOH 1p and LOH 19q, MGMT promoter methylation and LOH 1p or 19q, IDH1 mutation and LOH 1p and 19q, IDH1 mutation and MGMT promoter methylation, whereas mutual exclusion was found between MGMT promoter methylation and MGMT expression level. The present study confirmed that age at diagnosis, LOH 1p and 19q, IDH1 mutation, and reoperation after progression were independent significant prognostic factors for patients with anaplastic oligodendroglial tumors. Inter-relationship between LOH 1p, LOH 19q, IDH1 mutation, MGMT promoter methylation, and MGMT expression level were also revealed. Future clinical trials for AO and AOA should consider the molecular alterations of patients.

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Júlio Leonardo B. Pereira

http://neuro-oncology.oxfordjournals.org/cgi/content/short/14/1/64?rss=1

Microglia isolated from patients with glioma gain antitumor activities on poly (I:C) stimulation

The role of microglia, the brain-resident macrophages, in glioma biology is still a matter of debate. Clinical observations and in vitro studies in the mouse model indicate that microglia and macrophages that infiltrate the brain tumor tissue in high numbers play a tumor-supportive role. Here, we provide evidence that human microglia isolated from brain tumors indeed support tumor cell growth, migration, and invasion. However, after stimulation with the Toll-like receptor 3 agonist poly (I:C), microglia secrete factors that exerted toxic and suppressive effects on different glioblastoma cell lines, as assessed in cytotoxicity, migration, and tumor cell spheroid invasion assays. Remarkably, these effects were tumor-specific because the microglial factors impaired neither growth nor viability of astrocytes and neurons. Culture supernatants of tumor cells inhibited the poly (I:C) induction of this microglial M1-like, oncotoxic profile. Microglia stimulation before coculture with tumor cells circumvented the tumor-mediated suppression, as demonstrated by the ability to kill and phagocytose glioma cells. Our results show, for the first time to our knowledge, that human microglia exert tumor-supporting functions that are overridden by tumor-suppressing activities gained after poly (I:C) stimulation.

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Júlio Leonardo B. Pereira

http://neuro-oncology.oxfordjournals.org/cgi/content/short/14/1/29?rss=1

Identification of microRNAs in the cerebrospinal fluid as biomarker for the diagnosis of glioma

Malignant gliomas are the most common and lethal primary intracranial tumors. To date, no reliable biomarkers for the detection and risk stratification of gliomas have been identified. Recently, we demonstrated significant levels of microRNAs (miRNAs) to be present in cerebrospinal fluid (CSF) samples from patients with primary CNS lymphoma. Because of the involvement of miRNA in carcinogenesis, miRNAs in CSF may serve as unique biomarkers for minimally invasive diagnosis of glioma. The objective of this pilot study was to identify differentially expressed microRNAs in CSF samples from patients with glioma as potential novel glioma biomarkers. With use of a candidate approach of miRNA quantification by reverse-transcriptase polymerase chain reaction (qRT-PCR), miRNAs with significant levels in CSF samples from patients with gliomas were identified. MiR-15b and miR-21 were differentially expressed in CSF samples from patients with gliomas, compared to control subjects with various neurologic disorders, including patients with primary CNS lymphoma and carcinomatous brain metastases. Receiver-operating characteristic analysis of miR-15b level revealed an area under the curve of 0.96 in discriminating patients with glioma from patients without glioma. Moreover, inclusion of miR-15b and miR-21 in combined expression analyses resulted in an increased diagnostic accuracy with 90% sensitivity and 100% specificity to distinguish patients with glioma from control subjects and patients with primary CNS lymphoma. In conclusion, the results of this pilot study demonstrate that miR-15b and miR-21 are markers for gliomas, which can be assessed in the CSF by means of qRT-PCR. Accordingly, miRNAs in the CSF have the potential to serve as novel biomarkers for the detection of gliomas.

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Júlio Leonardo B. Pereira

http://neuro-oncology.oxfordjournals.org/cgi/content/short/14/1/87?rss=1

Tumor pseudoprogression following radiosurgery for vestibular schwannoma

We sought to characterize vestibular schwannoma (VS) pseudoprogression after radiosurgery to assess its incidence, causative factors, and association with radiation-induced adverse effects. We performed a retrospective study of VS treated with Gamma Knife radiosurgery during 2005–2009. Seventy-five patients had at least 24 months of clinical and radiographic follow-up (median, 29 months) and were included. Tumor response was calculated volumetrically using Gamma plan software on consecutive MRIs. All treatment plans were reviewed for dosimetry characteristics. Forty-nine VS (65%) were stable or regressed after treatment. Seventeen (23%) underwent pseudoprogression, with onset of enlargement at 6 months. Seven (9%) remained larger than initial treatment volume at last follow-up. Nine (12%) had persistent growth. Three patients underwent subsequent microsurgery. One patient required intervention at 3 months for cystic enlargement; otherwise, all patients with progressive enlargement had stable VS until at least 24 months. Twenty-six patients (34.7%) developed nonauditory adverse radiation effects after treatment, including cranial neuropathy, ataxia, and hydrocephalus. There was no statistical association between onset of clinical deterioration and tumor response. Volume changes in the first 24 months after radiosurgery rarely herald treatment failure. Any volume change after 24 months is indicative of treatment failure. Pseudoprogression does not appear to be independently linked to radiation-induced morbidity, and there are no patient-related or radiosurgical parameters that predict tumor response.

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Júlio Leonardo B. Pereira

http://neuro-oncology.oxfordjournals.org/cgi/content/short/14/1/53?rss=1

Evaluation of brain tumor vessels specific contrast agents for glioblastoma imaging

A mouse model of glioblastoma multiforme was used to determine the accumulation of a targeted contrast agent in tumor vessels. The contrast agent, consisting of superparamagnetic iron oxide coated with dextran, was functionalized with an anti-insulin-like-growth-factor binding protein 7 (anti-IGFBP7) single domain antibody. The near infrared marker, Cy5.5, was also attached for an in vivo fluorescence study. A 9.4T magnetic resonance imaging (MRI) system was used for in vivo studies on days 10 and 11 following tumor inoculation. T₂ relaxation time was used to measure the accumulation of the contrast agent in the tumor. Changes in tumor to brain contrast because of active targeting were compared with a nontargeted contrast agent. Effective targeting was confirmed with near infrared measurements and fluorescent microscopic analysis. The results showed that there was a statistically significant (P < .01) difference in normalized T₂ between healthy brain and tumor tissue 10 min, 1 h, and 2 h point postinjection of the anti-IGFBP7 single domain antibody targeted and nontargeted iron oxide nanoparticles. A statistical difference remained in animals treated with targeted nanoparticles 24 h postinjection only. The MRI, near infrared imaging, and fluorescent microscopy studies showed corresponding spatial and temporal changes. We concluded that the developed anti-IGFBP7-iron oxide single domain antibody-targeted MRI contrast agent selectively binds to abnormal vessels within a glioblastoma. T₂-weighted MRI and near infrared imaging are able to detect the targeting effects in brain tumors.

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Júlio Leonardo B. Pereira

http://www.medicalnewstoday.com/releases/239313.php

Changes Identified In The Brains Of Patients With Spinal Cord Compression

Spinal degeneration is an unavoidable part of aging. For some, it leads to compression of the spinal cord which can cause problems with dexterity, numbness in the hands, the ability to walk, and in some cases, bladder and bowel function...

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Júlio Leonardo B. Pereira

http://rss.cnn.com/~r/rss/cnn_health/~3/PbF5trR4-h8/index.html

Where are we in 40-year war against cancer?

Since the National Cancer Act was passed in 1971, more time and money has been put towards cancer research over the past 40 years.

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Júlio Leonardo B. Pereira

http://www.medpagetoday.com/Neurology/GeneralNeurology/30397

Gene Mutations Linked to Brain Disease (CME/CE)

(MedPage Today) -- Mutations in the CSF1R gene appear to be responsible for the development of hereditary diffuse leukoencephalopathy with spheroids (HDLS), according to an international team of researchers.

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Júlio Leonardo B. Pereira

http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSCONTENT&_method=citationSearch&_piikey=S1529943011014550&_version=1&md5=4505bf42a778125db6afa6765383f967

Saturday, December 24, 2011

Spinal glioblastoma multiforme of the conus medullaris with holocordal and intracranial spread in a

Publication year: 2011
Source: The Spine Journal, Available online 23 December 2011
Kanji Mori, Shinji Imai, Junji Shimizu, Takashi Taga, Mitsuaki Ishida, ...
Background contextSpinal glioblastoma multiforme (GBM) is a rare clinical entity. According to our review of the literature, only 15 cases of spinal GBM originating from the conus medullaris (CM) have been reported. Furthermore, there has been no case of spinal GBM originating from the CM with holocordal and intracranial involvements, which were already present at the time of initial diagnosis. Despite a variety of treatments, the previous studies have uniformly reported poor results of this lethal condition.PurposeThe present report illustrates a 10-year-old girl with spinal GBM with rare involvement pattern, that is, the tumor originating from the CM with the holocordal and intracranial involvements, undergoing a novel chemotherapy regimen.Study designA case report and review of literature.MethodsMagnetic resonance (MR) imaging with gadolinium enhancement clearly revealed holocordal and intracranial lesions, which were otherwise unidentifiable by plane MR imaging. Open biopsy was performed. After histologic diagnosis, novel chemotherapy regimen, that is, simultaneous high-dose chemotherapy (cyclophosphamide, cisplatin, vincristine, and etoposide) combined with autologous peripheral blood stem cell transplantation (auto-PBSCT), intrathecal injections of both methotrexate and dexamethasone, and radiotherapy, which respected the tolerance threshold of the spinal cord, were performed.ResultsNovel chemotherapy regimen achieved marked tumor regression until the 12th month of treatment. The patient became ambulatory with T-shaped canes and has returned to the school life. Unfortunately, the patient died because of the relapse of the tumor 14 months after the initial diagnosis; however, this strategy has achieved longer survival than previously reported mean survival (12 months).ConclusionsThe authors advocate enhanced MR imaging of the whole central nervous system for the potential spreading of this disease. This is the first report of simultaneous high-dose chemotherapy combined with auto-PBSCT, intrathecal injections of antineoplastic agents, and radiotherapy for the treatment of spinal GBM, which achieved marked tumor regression. We believe that accumulated experiences in the treatment of this lethal condition might contribute well to improve its therapeutic outcome.

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Júlio Leonardo B. Pereira

http://www.ro-journal.com/content/6/1/177

Thursday, December 22, 2011

Radiotherapy and "new" drugs - new side effects?

Background and Purpose: Targeted drugs have augmented the cancer treatment armamentarium. Based on the molecular specificity, it was initially believed that these drugs had significantly less side effects. However, currently it is accepted that all of these agents have their specific side effects. Based on the given multimodal approach, special emphasis has to be placed on putative interactions of conventional cytostatic drugs, targeted agents and other modalities. The interaction of targeted drugs with radiation harbours special risks, since the awareness for interactions and even synergistic toxicities is lacking. At present, only limited is data available regarding combinations of targeted drugs and radiotherapy. This review gives an overview on the current knowledge on such combined treatments.Material and Methods: Using the following MESH headings and combinations of these terms pubmed database was searched: Radiotherapy AND cetuximab / trastuzumab / panitumumab / nimotuzumab, bevacizumab, sunitinib / sorafenib / lapatinib / gefitinib / erlotinib / sirolimus, thalidomide / lenalidomide as well as erythropoietin. For citation crosscheck the ISI web of science database was used employing the same search terms. Results: Several classes of targeted substances may be distinguished: Small molecules including kinase inhibitors and specific inhibitors, antibodies, and anti-angiogenic agents. Combination of these agents with radiotherapy may lead to specific toxicities or negatively influence the efficacy of RT. Though there is only little information on the interaction of molecular targeted radiation and radiotherapy in clinical settings, several critical incidents are reported. Conclusions: The addition of molecular targeted drugs to conventional radiotherapy outside of approved regimens or clinical trials warrants a careful consideration especially when used in conjunction in hypo-fractionated regimens. Clinical trials are urgently needed in order to address the open question in regard to efficacy, early and late toxicity.

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Júlio Leonardo B. Pereira

http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSCONTENT&_method=citationSearch&_piikey=S0959804911009701&_version=1&md5=296edb5157eb4a60aa9a5a8d7c1da8dd

Socio-economic implications of cancer survivorship: Results from the PROFILES registry

Publication year: 2011
Source: European Journal of Cancer, Available online 21 December 2011
Floortje Mols, Melissa S.Y. Thong, Pauline Vissers, Tamar Nijsten, Lonneke V. van de Poll-Franse
IntroductionThe goal of this large population-based study was to examine the socio-economic implications of cancer survivorship.MethodsIndividuals alive and diagnosed with colorectal cancer and melanoma between 1998 and 2007 or Hodgkin lymphoma, non-Hodgkin lymphoma or multiple myeloma between 1999 and 2008 as registered in the Eindhoven Cancer Registry received a questionnaire on work changes and problems with obtaining a new (or extended) health care insurance, life insurance or a home loan; 70% (n = 2892) responded.ResultsResults showed that 28% of all cancer patients experienced changes in their work situation after cancer. Most of them switched to part-time work or stopped working entirely. Patients (3.4%) who tried to obtain a different or upgrade their health care insurance experienced problems and in most cases, these were eventually resolved. Problems with life insurance were somewhat more common with 18% of those who tried to obtain a life insurance experiencing problems. The majority of these patients was rejected by the insurance company (61%) or was accepted at a higher premium (22%). Of the 21% who tried to obtain a home loan, 9% experienced problems. However, 22.2% got accepted eventually, 27.8% got accepted but at a higher mortgage payment and 22.2% got rejected but were eventually accepted by another bank.ConclusionsAlmost a third of cancer survivors experienced changes in their work situation after cancer. Problems with obtaining health insurance, life insurance and home loans were also common.

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Júlio Leonardo B. Pereira

http://www.redjournal.org/article/PIIS0360301610035650/abstract?rss=yes

Tuesday, December 20, 2011

Analysis of Dose at the Site of Second Tumor Formation After Radiotherapy to the Central Nervous Sys

Purpose: Second tumors are an uncommon complication of multimodality treatment of childhood cancer. The present analysis attempted to correlate the dose received as a component of primary treatment and the site of the eventual development of a second tumor.Methods and Materials: We retrospectively identified 16 patients who had received radiotherapy to sites in the craniospinal axis and subsequently developed a second tumor. We compared the historical fields and port films of the primary treatment with the modern imaging of the second tumor locations. We classified the location of the second tumors as follows: in the boost field; marginal to the boost field, but in a whole-brain field; in a whole-brain field; marginal to the whole brain/primary treatment field; and distant to the field. We divided the dose received into 3 broad categories: high dose (>45 Gy), moderate dose (20–36 Gy), and low dose (<20 Gy).Results: The most common location of the second tumor was in the whole brain field (57%) and in the moderate-dose range (81%).Conclusions: Our data contradict previous publications that suggested that most second tumors develop in tissues that receive a low radiation dose. Almost all the second tumors in our series occurred in tissue within a target volume in the cranium that had received a moderate dose (20–36 Gy). These findings suggest that a major decrease in the brain volume that receives a moderate radiation dose is the only way to substantially decrease the second tumor rate after central nervous system radiotherapy.

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Júlio Leonardo B. Pereira

http://www.ro-journal.com/content/6/1/176

Apoptosis induction and tumor cell repopulation: The yin and yang of radiotherapy

The induction of tumor cell death is a central goal of radiotherapy. Surprisingly, a recent study sheds new light on this process, and the results presented by Huang et al. strongly question the benefit of radiation-induced apoptosis for the outcome of cancer radiotherapy.

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Júlio Leonardo B. Pereira

http://www.springerlink.com/content/617614358506j477/

Monday, December 19, 2011

Independent prognostic value of pre-treatment 18-FDG-PET in high-grade gliomas

Abstract

The prognostic value of PET with (18F)-fluoro-2-deoxy-d-glucose (FDG) has been shown in high-grade gliomas (HGG), but not compared with consensual prognostic factors. We sought to evaluate the independent predictive value of pre-treatment FDG-PET on overall (OS) and event-free survival (EFS). We retrospectively analyzed 41 patients with histologically-confirmed HGG (31 glioblastomas and 10 anaplastic gliomas). The pre-treatment uptake of FDG was assessed qualitatively by five-step visual metabolic grading, and quantitatively by the ratio between the tumor and contralateral maximal standardized uptake value (T/CL). EFS and OS following PET were compared with FDG uptake by univariate analysis, and by two multivariate analyses: one including main consensual prognostic factors (age, KPS, extent of surgery and histological grade), and the other including the classification system of the Radiation Therapy Oncology Group (Recursive Partitioning Analysis, RPA). Median OS and EFS were 13.8 and 7.4 months, respectively, for glioblastomas, and over 25.8 and 12 months, respectively, for anaplastic gliomas (P = 0.040 and P = 0.027). The T/CL ratio predicted OS in the entire group [P = 0.003; Hazard Ratio (HR) = 2.3] and in the glioblastoma subgroup (P = 0.018; HR = 2), independently of age, Karnofsky performance status, histological grade, and surgery, and independently of RPA classification. T/CL ratio tended to predict EFS in the whole group (P = 0.052). The prognostic value of visual metabolic grade on OS was less significant than T/CL ratio, both in the entire group and in the glioblastoma subgroup (P = 0.077 and P = 0.059). Quantitative evaluation of the ratio between the maximal tumor and contralateral uptake in pre-treatment FDG-PET provides significant additional prognostic information in newly-diagnosed HGG, independently of consensual prognostic factors.

Content Type Journal Article
Category Clinical Study - Patient Study
Pages 1-9
DOI 10.1007/s11060-011-0771-6
Authors
- Cécile Colavolpe, APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France
- Philippe Metellus, APHM, Hôpital de la Timone, Service de Neurochirurgie, 13005 Marseille, France
- Julien Mancini, APHM, Hôpital de la Timone, Service de Santé Publique et d'Information Médicale, 13005 Marseille, France
- Maryline Barrie, APHM, Hôpital de la Timone, Unité de Neuro-Oncologie, 13005 Marseille, France
- Céline Béquet-Boucard, APHM, Hôpital de la Timone, Unité de Neuro-Oncologie, 13005 Marseille, France
- Dominique Figarella-Branger, Aix-Marseille Université, UMR 911 Inserm, 13005 Marseille, France
- Olivier Mundler, APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France
- Olivier Chinot, Aix-Marseille Université, UMR 911 Inserm, 13005 Marseille, France
- Eric Guedj, APHM, Hôpital de la Timone, Service Central de Biophysique et Médecine Nucléaire, 13005 Marseille, France

Journal Journal of Neuro-Oncology
Online ISSN 1573-7373
Print ISSN 0167-594X

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Júlio Leonardo B. Pereira

http://www.springerlink.com/content/1648603865504775/

Medulloblasoma: challenges for effective immunotherapy

Abstract

For medulloblastoma patients, the current therapeutic paradigm of surgery followed by radiation and chemotherapy can lead to long-term remission. However, the sequelae of treatment can be very debilitating, particularly in young children. Immunotherapy is an attractive treatment approach to optimize the targeting of tumor cells while sparing the vulnerable surrounding brain that is still developing in children. Understanding the relationship between medulloblastoma and the immune system is critical to develop effective immunologic-based treatment strategies for these patients. This review focuses on current knowledge of tumor immunology and the factors that contribute to the lack of immune system recognition of these tumors. The specificity of tumor antigens present in medulloblastoma is also discussed along with a summary of early clinical immunotherapy results.

Content Type Journal Article
Category Topic Review
Pages 1-10
DOI 10.1007/s11060-011-0776-1
Authors
- Adam M. Sonabend, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA
- Alfred T. Ogden, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA
- Lisa M. Maier, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA
- David E. Anderson, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA
- Peter Canoll, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA
- Jeffrey N. Bruce, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA
- Richard C. E. Anderson, Department of Neurological Surgery, Neurological Institute, New York Presbyterian Columbia University, 710 West 168th Street, New York, NY 10032, USA

Journal Journal of Neuro-Oncology
Online ISSN 1573-7373
Print ISSN 0167-594X

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Júlio Leonardo B. Pereira

http://www.medicalnewstoday.com/releases/239305.php

Saturday, December 17, 2011

RTOG Activates Study To Determine Best Treatment Strategies For Patients With Glioma Brain Tumors

Treatment remains controversial for patients diagnosed with a low-risk, low-grade glioma (LGG) brain tumor. These patients have significantly better prognosis than patients diagnosed with more aggressive high-grade glioma, and their clinical care often involves ongoing observation for tumor changes with imaging studies...

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Júlio Leonardo B. Pereira

http://www.ro-journal.com/content/6/1/173

Spinal radiosurgery - efficacy and safety after prior conventional radiotherapy

Background: Conventional external beam radiotherapy is a standard procedure for treatment of spinal metastases. In case of progression spinal cord tolerance limits further radiotherapy in pre-irradiated areas. Spinal stereotactic radiotherapy is a non-invasive option to re-treat pre-irradiated patients. Nevertheless, spinal radiosurgery results in relevant dose deposition within the myelon with potential toxicity. Aim of the study was to retrospectively analyse the efficacy and feasibility for salvage radiosurgery of spinal metastases. Methods: During a period of 4 years (2005-2009) 70 lesions in 54 patients were treated in 60 radiosurgery sessions and analysed. Clinical (pain, sensory and motor deficit) and radiological (CT/MRI) follow-up data were collected prospectively after radiosurgery. Pain - as main symptom - was classified by the Visual Analogue Scale (VAS) score. Every patient received single session radiosurgery after having been treated first-line with conventionally fractionated radiotherapy. Kaplan-Meier method and life tables were used to analyse freedom from local failure and overall survival. Results: At a median follow-up of 14.5 months the actuarial rates of freedom from local failure at 6/12/18 months were 93%, 88% and 85%, respectively. The median radiosurgery dose was 1 x 18 Gy (range 10-28 Gy) to the median 70% isodose. The VAS score of patients with pain (median 6) dropped significantly (median 4, p=0.002). In 6 out of 7 patients worse sensory or motor deficit after SRS was caused by local or distant failures (diagnosed by CT/MRI). One patient with metastatic renal cell carcinoma developed a progressive complete paraparesis one year after the last treatment at lumbar level L3. Due to multiple surgery and radiosurgery treatments at the lumbar region and further local progression, the exact reason remained unclear. Apart from that, no CTC grade III or higher toxicity has been observed. Conclusions: By applying spinal radiosurgery relevant radiation doses can be limited to small parts of the myelon. This prevents myelopathic side effects and makes it an effective and safe treatment option for well-suited patients. Especially for previously irradiated patients with local failure or pain salvage SRS represents a valuable treatment option with high local control rates, low toxicity and significant pain reduction.

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Júlio Leonardo B. Pereira