Tuesday, February 28, 2012

Pilocytic astrocytoma survival in adults: analysis of the surveillance, epidemiology, and end result

Abstract  
Pilocytic astrocytoma is a WHO grade 1 brain tumor common in children. Relatively little is known about the behavior of pilocytic astrocytomas in adult patients, largely due to the rarity of pilocytic astrocytoma in this population. Some data suggest that adults share the excellent prognosis seen in children, while other reports suggest more aggressive tumor behavior in adult patients. Patients diagnosed with pilocytic astrocytoma between 1973 and 2008 were identified in the National Cancer Institute Surveillance, Epidemiology, and End Results Program database. Age-group specific survival was analyzed with overall, expected, and cancer-specific survival rates. Further survival analyses were performed with the Kaplan–Meier method and Cox Proportional Hazards models. 3,066 patients with pilocytic astrocytoma were identified, including 865 patients aged 20 years and older. Survival rates declined significantly with age, from 96.5% 60-month survival in patients 5–19 years (95% CI 95.3–97.4) to 52.9% 60-month survival in adult patients 60+ years of age (95% CI 38.4–65.5), with a corresponding decrease in relative and cancer-specific survival rates. Gross total resection was a positive prognostic indicator in adults, while patients receiving radiation had shorter survival regardless of extent of resection. Pilocytic astrocytoma is associated with higher mortality in adult patients than in children and teens, and survival decreases with increasing age in adults. The morbidity of pilocytic astrocytoma in adults provides rationale for future trials of adjuvant treatment in high-risk patients.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-7
  • DOI 10.1007/s11060-012-0829-0
  • Authors
    • Derek R. Johnson, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
    • Paul D. Brown, Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
    • Evanthia Galanis, Department of Oncology, Mayo Clinic, Rochester, MN, USA
    • Julie E. Hammack, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA





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Monday, February 27, 2012

Measuring clinical outcomes in neuro-oncology. A battery to evaluate low-grade gliomas (LGG)

Abstract  
We describe how a neuropsychological evaluation in patients with brain tumors should be performed, specifically in the case of low-grade gliomas. Neuropsychological examination is crucial before starting any treatment as well as during the follow-up, since it can improve neurosurgery techniques and reveal potential cognitive effects of chemotherapy and radiotherapy, besides planning rehabilitation. We underline that sensitive and wide-ranging tests are required; specific tasks based on the lesion site should be added. Moreover, some tests can provide additional information about the evolution of the tumor. A careful, thorough examination improves quality of life.

  • Content Type Journal Article
  • Category Baseline Neuropsychological Investigations and Batteries
  • Pages 1-7
  • DOI 10.1007/s11060-012-0824-5
  • Authors
    • Costanza Papagno, Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy
    • Alessandra Casarotti, Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy
    • Alessandro Comi, Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy
    • Marcello Gallucci, Dipartimento di Psicologia, Università di Milano-Bicocca, Milan, Italy
    • Marco Riva, Neurochirurgia, Università degli Studi di Milano, Milan, Italy
    • Lorenzo Bello, Neurochirurgia, Università degli Studi di Milano, Milan, Italy





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Cognition and resective surgery for diffuse infiltrative glioma: an overview

Abstract  
Compared to classical oncological outcome measures such as time to progression and survival, the importance of cognitive functioning in patients with diffuse infiltrative brain tumors has only recently been recognized. Apart from the relatively low incidence and the invariably fatal outcome of gliomas, the general assumption that cognitive assessment is time-consuming and burdensome contributes to this notion. Our understanding of the effects of brain surgery on cognition, for instance, is largely based on studies in surgical patients with refractory epilepsy, with only a limited number of studies in surgical patients with gliomas. The impact of other factors affecting cognition in glioma patients such as direct tumor effects, radiotherapy and chemotherapy, and medical treatment, including anti-epileptic drugs and steroids, have been studied more extensively. The purpose of this paper is to provide an overview of cognition in patients with diffuse infiltrative gliomas and the impact of resective surgery as well as other tumor and treatment-related factors.

  • Content Type Journal Article
  • Category Effects of Standard of Art Treatment
  • Pages 1-10
  • DOI 10.1007/s11060-012-0811-x
  • Authors
    • Martin Klein, Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
    • Hugues Duffau, Department of Neurosurgery, Hôpital Gui de Chauliac, and INSERM U1051, Institute for Neurosciences of Montpellier, Team "Brain Plasticity, Human Stem Cells and Glial Tumors," Montpellier University Medical Center, Montpellier, France
    • Philip C. De Witt Hamer, Neurosurgical Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands





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Sunday, February 26, 2012

Agnosias: recognition disorders in patients with brain tumors

Abstract  
Two main varieties of recognition disorders are distinguished in neuropsychology: agnosias and semantic disorders. The term agnosias is generally used to denote recognition defects limited to a single perceptual modality (which is itself apparently intact), whereas the term semantic disorders is used to denote recognition defects involving all the sensory modalities in a roughly similar manner. Brain tumors can be one of the aetiologies underlying agnosias and semantic disorders. However, due to the heterogeneity and the rarity of recognition disorders, their investigation can be useful only to suggest or exclude the oncological nature of a brain lesion, but not to systematically monitor the clinical outcome in tumor patients. Furthermore, the relevance of recognition disorders as a hint toward a diagnosis of brain tumor varies according to the type of agnosia and of semantic disorder and the localization of the underlying brain pathology. The hypothesis that a variety of agnosia (or of semantic disorder) may be due to a neoplastic lesion can, therefore, be advanced if it is consistent with our knowledge about the usual localization and the growing patterns of different types of brain tumors.

  • Content Type Journal Article
  • Category Baseline Neuropsychological Investigations and Batteries
  • Pages 1-4
  • DOI 10.1007/s11060-012-0823-6
  • Authors
    • Guido Gainotti, Center for Neuropsychological Research, Department of Neurosciences, Policlinico Gemelli, Catholic University of Rome, Largo A. Gemelli, 800168 Rome, Italy





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Spinal and paraspinal giant cervical cavernous malformation with postpartum presentation

Journal of Neurosurgery: Spine, Volume 0, Issue 0, Page 1-5, Ahead of Print.
Cavernous malformations (CMs) are found throughout the CNS but are relatively uncommon in the spine. In this report, the authors describe a giant CM with the imaging appearance of an aggressive, invasive, expansive tumor in the cervical spine. The intradural extramedullary portion of the tumor originated from a cervical nerve root; histologically, the lesion was identified as an intraneural CM. Most of the tumor extended into the paraspinal tissues. The tumor was also epidural, intraosseous, and osteolytic and had completely encased cervical nerve roots, peripheral nerves, branches of the brachial plexus, and the vertebral artery on the right side. It became symptomatic during the puerperal period. Gross-total resection was achieved using staged operative procedures, complex dural reconstruction, spinal fixation, and fusion. Clinical, radiographic, and histological details, as well as a discussion of the relevant literature, are provided.





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Staged resection of large vestibular schwannomas

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-8, Ahead of Print.
Object Staged resection of large vestibular schwannomas (VSs) has been proposed as a strategy to improve facial nerve outcomes and morbidity. The authors report their experience with 2-stage resections of large VSs and analyze the indications, facial nerve outcomes, surgical results, and complications. The authors compare these results with those of a similar cohort of patients who underwent a single-stage resection. Methods A retrospective review of all patients (age > 18 years) who underwent surgery from 2002 to 2010 for large (≥ 3 cm) VSs at the authors' institution with a minimum of 6 months follow-up was undertaken. A first-stage retrosigmoid approach (without meatal drilling) was performed to remove the cerebellopontine angle portion of the tumor and to decompress the brainstem. A decision to stage the operation was made intraoperatively if there was cerebellar or brainstem edema, excessive tumor adherence to the facial nerve or brainstem, a poorly stimulating facial nerve, or a thinned or splayed facial nerve. A second-stage translabyrinthine approach was performed at a later date to remove the remaining tumor. The single-stage resection consisted of a retrosigmoid approach with meatal drilling. Patient charts were evaluated for tumor size, extent of resection, tumor recurrence, House-Brackmann facial nerve function grade, and complications. Results Twenty-eight and 19 patients underwent 2- or single-stage resection of a large VS, respectively. The average tumor size was 3.9 cm (range 3.2–7 cm) in the 2-stage group and 3.9 cm (range 3.1–5 cm) in the single-stage group. The mean follow-up was 36 ± 19 months in the 2-stage group versus 24 ± 14 months in the single-stage group. Gross-total or near-total resection was achieved in 27 (96.4%) of 28 patients in the 2-stage group and 15 (79%) of 19 patients in the single-stage group (p < 0.01). Anatomical facial nerve preservation was achieved in all but 1 patient (94.7%), and there were no recurrences on follow-up imaging in the 2-stage group. Good facial nerve functional outcome (House-Brackmann Grades I and II) at last follow-up was achieved in 23 (82%) of 28 patients in the 2-stage group and 10 (53%) of 19 patients in the single-stage group (p < 0.01). Cerebrospinal fluid leak–related complications (intracranial hypotension, blood patch, and lumboperitoneal shunt for pseudomeningocele) were more common in the 2-stage group. There were no postoperative strokes, hemorrhages, or deaths in either group. Conclusions The authors' results suggest that staged resection of large VSs may potentially achieve better facial nerve outcomes. There does not appear to be added neurological morbidity with staged resections.





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Saturday, February 25, 2012

Cognitive outcome as part and parcel of clinical outcome in brain tumor surgery

Abstract  
Although validated tools (neuropsychological tests, patient reported outcomes, mood and psychological profile) were first introduced many years ago in clinical practice, the impact of the tumor itself on patient cognition has not been extensively studied. Furthermore, while outcome research is evolving in an attempt to adapt the use of different tools to the preoperative and postoperative phases, the standard guidelines for evaluating outcome after brain surgery, by neurological examination and complication assessment, are frequently neglected in the current literature. This article attempts to provide an appraisal of the evidence for the impact of surgical treatment on cognitive function of brain tumor patients within the context of general outcome.

  • Content Type Journal Article
  • Category Effects of Standard of Art Treatment
  • Pages 1-6
  • DOI 10.1007/s11060-012-0818-3
  • Authors
    • A. Talacchi, Section of Neurosurgery, Department of Neurosciences, University of Verona, P. Stefani 1, 37126 Verona, Italy
    • D. d'Avella, Clinical Neurosurgery, Department of Neurosciences, University of Padua, Padua, Italy
    • L. Denaro, Clinical Neurosurgery, Department of Neurosciences, University of Padua, Padua, Italy
    • B. Santini, Section of Neurosurgery, Department of Neurosciences, University of Verona, P. Stefani 1, 37126 Verona, Italy
    • P. Meneghelli, Section of Neurosurgery, Department of Neurosciences, University of Verona, P. Stefani 1, 37126 Verona, Italy
    • S. Savazzi, Section of Physiology, Department of Neurosciences, University of Verona, Verona, Italy
    • M. Gerosa, Section of Neurosurgery, Department of Neurosciences, University of Verona, P. Stefani 1, 37126 Verona, Italy





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Neurological outcome of childhood brain tumor survivors

Abstract  
We assessed neurological and neurocognitive outcome in childhood brain tumor survivors. Altogether, 75 out of 80 brain tumor survivors diagnosed below 17 years between 1983 and 1997; and treated in Tampere University Hospital, Finland, were invited to participate in this population-based cross-sectional study. Fifty-two (69%) participated [mean age 14.2 (3.8–28.7) years, mean follow-up 7.5 (1.5–15.1) years]. Neurological status was abnormal in 69% cases. All were ambulatory, but only 50% showed normal motor function. Twenty-nine percent showed clumsiness/mild asymmetry and 21% hemiparesis. One suffered from intractable epilepsy. According to structured interview, 87% coped normally in daily living. Median full-scale IQ was 85 (39–110) in 21 6–16 year olds (70%); in 29% IQ was <70. Thirty of the 44 school-aged subjects attended school with normal syllabus and 32% needed special education. Six of the 16 patients over 18 years of age were working. Regarding quality of life, 38% were active without disability, 33% active with mild disability, 21% were partially disabled, but capable of self-care, and 8% had severe disability, being incapable of self-care. Supratentorial/hemispheric tumor location, tumor reoperations, shunt revisions and chemotherapy were associated with neurological, cognitive and social disabilities. In conclusion, of the 52 survivors, neurological status was abnormal in 69%; 71% lived an active life with minor disabilities, 29% had major neurological, cognitive and social disabilities, and 8% of them were incapable of self-care. Predictors of these disabilities included supratentorial/hemispheric tumor location, tumor reoperations, shunt revisions and chemotherapy. Survivors need life-long, tailor-made multiprofessional support and follow-up.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-9
  • DOI 10.1007/s11060-012-0816-5
  • Authors
    • Sari Pietilä, Department of Pediatrics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
    • Raija Korpela, Department of Pediatrics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
    • Hanna L. Lenko, Department of Pediatrics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
    • Hannu Haapasalo, Department of Pathology, Centre for Laboratory Medicine, Tampere University Hospital, Tampere, Finland
    • Riitta Alalantela, School of Humanities and Social Sciences, University of Tampere, Tampere, Finland
    • Pirkko Nieminen, School of Humanities and Social Sciences, University of Tampere, Tampere, Finland
    • Anna-Maija Koivisto, Tampere School of Public Health, University of Tampere, Tampere, Finland
    • Anne Mäkipernaa, Department of Medicine, Division of Hematology, Coagulation Disorders, Helsinki University Central Hospital, Helsinki, Finland





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Thursday, February 23, 2012

The impact of chemotherapy on cognitive outcomes in adults with primary brain tumors

Abstract  
There is growing recognition that chemotherapy may have short and long term impact on cognitive function of cancer patients. However, the impact of chemotherapy on the cognition of adult patients with primary brain tumor has not been extensively studied. This article will review the evidence for both positive and negative impact of chemotherapy on cognitive function of adult brain tumor patients as well as potential confounding factors.

  • Content Type Journal Article
  • Category Effects of Standard of Art Treatment
  • Pages 1-6
  • DOI 10.1007/s11060-012-0807-6
  • Authors
    • Lauren E. Abrey, Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland





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Embryonal cancers in Europe

Publication year: 2012
Source: European Journal of Cancer, Available online 20 February 2012
Gemma Gatta, Andrea Ferrari, Charles A. Stiller, Guido Pastore, Gianni Bisogno, ...
Embryonal cancers are a heterogeneous group of rare cancers which mainly occur in children and adolescents. The aim of the present study was to estimate the burden (incidence, prevalence, survival and proportion of cured) for the principal embryonal cancers in Europe (EU27), using population-based data from cancer registries (CRs) participating in RARECARE.We identified 3322 cases diagnosed from 1995 to 2002 (latest period for which data are available): 44% neuroblastoma, 35% nephroblastoma, 13% retinoblastoma and 6% hepatoblastoma. Very few cases of pulmonary blastoma (43 cases) and pancreatoblastoma (seven cases) were diagnosed.About 2000 new embryonal cancers were estimated every year in EU27, for an annual incidence rate of 4 per million (1.8 neuroblastoma, 1.4 nephroblastoma, and 0.5 retinoblastoma); 91% of cases occurred in patients under 15 years. Five-year relative survival for all embryonal cancers was 80% (99% retinoblastoma, 90% nephroblastoma, 71% hepatoblastoma and 68% neuroblastoma). Overall survival was lower in adolescents and adults than in those under 15 years. The cure rate was estimated at 80%. Slightly less than 40,000 persons were estimated alive in EU27 with a diagnosis of embryonal cancer in 2008. Nephroblastoma was the most prevalent (18,150 cases in EU27), followed by neuroblastoma (12,100), retinoblastoma (5200), hepatoblastoma (2700) and pulmonary blastoma (614).This is the first study to delineate the embryonal cancer burden in Europe by age, sex and European region. Survival/cure rate is generally high, but there are considerable gaps in our understanding of the natural histories of these rare diseases particularly in adults.





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Meningioma Surgery in the Elderly: Outcome and Validation of 2 Proposed Grading Score Systems

BACKGROUND: Although population age increases, published evidence on meningioma treatment in the elderly is scarce. OBJECTIVE: In order to improve selection for surgery, we investigated our patients' collective, using 2 proposed risk assessment systems, the Clinical-Radiological Grading System (CRGS) and the SKALE score (sex, Karnofsky, American Society of Anesthesiology [ASA] score, location, edema). METHODS: We retrospectively assessed morbidity and mortality in 164 patients aged ≥65, operated on for an intracranial meningioma. Medical and surgical records were reviewed and analyzed. CRGS and SKALE scores were calculated. The ability of both CRGS and SKALE and all single factors to predict death within 12 months was analyzed by the use of multivariate logistic regression modeling. RESULTS: Eleven patients died (6.7%). Logistic regression for CRGS/SKALE showed a significant relationship with 12 months mortality. Age, Simpson resection grade, and sex were not significant predictors when investigated alone. In multivariate logistic regression, including all proposed factors, only concomitant disease and edema (CRGS) as well as ASA score and preoperative Karnofsky Performance Scale (SKALE) showed a significant relationship to mortality. After stepwise reduction of the full multivariate regression model to its significant terms, only concomitant disease and ASA remained significant for CRGS (P < .001) and SKALE (P = .003), respectively. CONCLUSION: Meningioma resection in the elderly is possible with some mortality. We were unable to reproduce the utility of 2 proposed grading systems for mortality prediction when extending to younger patients. In single-factor analysis, only concomitant disease and ASA score remained significant. The decision whether to operate should be taken individually. Patients with severe concomitant disease or high ASA score should be advised not to undergo surgical therapy independently from other factors.





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Incidence of brain metastases as a first site of recurrence among women with triple receptor–negativ

Abstract

BACKGROUND:

This retrospective study sought to define the incidence of brain metastases as a first site of recurrence among women with triple receptor–negative breast cancer (TNBC).

METHODS:

A total of 2448 patients with stage I through III TNBC who were diagnosed between 1990 and 2010 were identified. We computed the cumulative incidence of developing brain metastases as a first site of recurrence at 2 and 5 years. Cox proportional hazards models were fitted to determine factors that could predict for the development of brain metastases as a first site of recurrence. The Kaplan-Meier product limit method was used to compute survival following a diagnosis of brain metastases.

RESULTS:

At a median follow-up of 39 months, 115 (4.7%) patients had developed brain metastases as a first site of recurrence. The cumulative incidence at 2 and 5 years was 3.7% (95% confidence interval [CI] = 2.9%-4.5%) and 5.4% (95% CI = 4.4%-6.5%), respectively. Among patients with stage I, II, and III disease, the 2-year cumulative incidence of brain metastases was 0.8%, 3.1%, and 8%, respectively (P < .0001). The 5-year cumulative incidence was 2.8%, 4.6%, and 9.6% among patients with stage I, II, and III disease, respectively (P < .0001). In the multivariable model, patients with stage III disease had a significant increase in the risk of developing brain metastases as a first site of recurrence (hazards ratio = 3.51; 95% CI = 1.85-6.67; P = .0001) compared to patients with stage I disease. Those with stage II disease had a nonsignificant increased risk of developing brain metastases as a first site of recurrence (hazards ratio = 1.61; 95% CI = 0.92-2.81; P = .10) compared with patients with stage I disease. Median survival following a diagnosis of brain metastases was 7.2 months (range, 5.7-9.4 months).

CONCLUSIONS:

Patients with nonmetastatic TNBC have a high early incidence of developing brain metastases as a first site of recurrence, which is associated with subsequent poor survival. Patients with stage III TNBC in particular would be an ideal cohort in which to research preventive strategies. Cancer 2012;. © 2012 American Cancer Society.






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Monday, February 20, 2012

Restricting resident work hours: The good, the bad, and the ugly

Objectives: Inadequate sleep and long work hours are long-standing traditions in the medical profession, and work schedules are especially intense in resident physicians. However, it has been increasingly recognized that the extreme hours commonly worked by residents may have substantial occupational and patient safety consequences. Largely because of these concerns, new regulations related to resident work hours came into effect July 2011, in the United States. Residents in their first year of training are now restricted to a maximum shift length of 16 hrs, with residents in subsequent years restricted to a maximum of 24 hrs. The purpose of this review is to summarize the literature regarding resident work hours in the intensive care unit, focusing on the potential positive and negative impacts of work hour limits. Data Sources: The authors electronically searched MEDLINE, manually searched reference lists from retrieved articles, and reviewed their own personal databases for articles relevant to resident work hour limits. Methods and Main Results: To function well, humans, including physicians, require adequate sleep. Resident work hour limits will likely reduce the incidence of fatigue-related medical errors and improve resident safety and quality of life. However, a reduction in work hours may not represent the panacea for patient safety given the potential for increased errors because of discontinuity. Furthermore, there may be other substantial negative impacts, including reduced clinical exposure, erosion of professionalism, and inadequate preparation for independent practice. Costs of implementation are likely to be substantial. Conclusion: Currently, there is fairly limited evidence available, and a more in-depth understanding of this complex topic is required to design a residency experience that will provide the next generation of physicians the best compromise between education, experience, and quality patient care. In the end, the primary goal of the postgraduate medical education system must be to ensure the creation of healthy physicians who can provide excellent clinical care in this complex interdisciplinary medical industry and who will have long fulfilling careers providing this outstanding care to their patients.





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Sunday, February 19, 2012

Language testing in brain tumor patients

Abstract  
Neuropsychological testing is not a luxury in the management of patients with brain tumors. Regardless of the therapeutic approach selected in each case (but, especially in the case of awake surgery), it provides information on the status of language and other cognitive functions. This information can be used preoperatively to identify eloquent areas and to provide a baseline against which further examinations can be evaluated, intraoperatively to identify eloquent areas, and post-operatively and at follow-up to ascertain the short-term and long-term consequences of surgery, as well as those of other treatments (chemotherapy and radiotherapy), and to plan and monitor rehabilitative treatments.

  • Content Type Journal Article
  • Category Baseline neuropsychological investigations and batteries
  • Pages 1-6
  • DOI 10.1007/s11060-012-0810-y
  • Authors
    • G. Miceli, CeRiN (Center for Neurocognitive Rehabilitation), CIMeC (Center for Mind/Brain Sciences), University of Trento, Via Matteo del Ben 5A, 38068 Rovereto, TN, Italy
    • R. Capasso, CeRiN (Center for Neurocognitive Rehabilitation), CIMeC (Center for Mind/Brain Sciences), University of Trento, Via Matteo del Ben 5A, 38068 Rovereto, TN, Italy
    • A. Monti, CeRiN (Center for Neurocognitive Rehabilitation), CIMeC (Center for Mind/Brain Sciences), University of Trento, Via Matteo del Ben 5A, 38068 Rovereto, TN, Italy
    • B. Santini, Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy
    • A. Talacchi, Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy





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Intraoperative magnetic resonance imaging to reduce the rate of early reoperation for lesion resecti

Journal of Neurosurgery: Pediatrics, Volume 9, Issue 3, Page 259-264, March 2012.
Object This study describes the pediatric experience with a dual-multifunction-room IMRIS 1.5-T intraoperative magnetic resonance imaging (iMRI) suite and analyzes its impact on clinical variables associated with neurosurgical resection of intracranial lesions, including safety and efficacy. Methods Since the inception of the iMRI–guided resection program in April 2008 at both Barnes-Jewish and St. Louis Children's Hospital, a prospective database recorded the clinical variables associated with demographics and outcome with institutional review board approval. A similarly approved retrospective database was constructed from February 2006 to March 2010 for non–iMRI resections. These databases were retrospectively reviewed for clinical variables associated with resection of pediatric (age 20 months–21 years) intracranial lesions including brain tumors and focal cortical dysplasia. Patient demographics, operative time, estimated blood loss, additional resection, length of stay, pathology, and complications were analyzed. Results The authors found that 42 iMRI–guided resections were performed, whereas 103 conventional resections had been performed without the iMRI. The mean patient age was 10.5 years (range 20 months–20 years) in the iMRI group and 9.8 years (range 2–21 years) in the conventional group (p = 0.41). The mean duration of surgery was 350 minutes in the iMRI group and 243 minutes in the conventional group (p < 0.0001). The mean hospital stay was 8.2 days in the iMRI group, and 6.6 days in the conventional group, and this trended toward significance (p = 0.05). In the first 2 weeks postoperatively, there were 8 reoperations (7.77%) in the conventional group compared with none in the iMRI group, which was not significant in a 2-tailed test (p = 0.11) but trended toward significance in a 1-tailed test (p = 0.06). The significant complications included reoperation for hydrocephalus or infection: 6.8% (conventional) versus 4.8% (iMRI). Conclusions Intraoperative MR imaging–guided resections resulted in a trend toward reduction in the need for repeat surgery in the immediate 2-week postoperative period compared with conventional pediatric neurosurgical resections for tumor or focal cortical dysplasia. Although there is an increased operative time, the iMRI suite offers a comparable safety and efficacy profile while potentially reducing the per-case cost by diminishing the need for early reoperation.





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Risk for leptomeningeal seeding after resection for brain metastases: implication of tumor location

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-10, Ahead of Print.
Object Surgical spillage has been one of the causative factors for the development of leptomeningeal seeding (LMS) after resection of brain metastases. In this paper, the authors' goal was to define the factors related to the development of LMS and to evaluate the difference according to tumor location. Methods The authors retrospectively analyzed 242 patients who had undergone resection for brain metastases. The factors investigated included tumor location with proximity to the CSF pathway (that is, contacting, involved with, or separated from the CSF pathway), the method of resection, and the use of the Cavitron Ultrasonic Surgical Aspirator (CUSA). Results A total of 39 patients (16%) developed LMS at a median of 6.0 months (range 1–42 months) after resection. The risk of developing LMS was significantly higher in patients whose tumors were resected piecemeal than in those whose tumors were removed en bloc, with a hazard ratio (HR) of 4.08 (p < 0.01). The incidence of LMS was significantly higher in patients in whom the CUSA was used, and the HR was 2.64 (p < 0.01). The proximity of tumor to the CSF pathway in the involved group conferred an increased risk of LMS compared with the separated group (HR 11.36, p < 0.01). The risk of piecemeal resection for LMS was significant only in involved lesions (p < 0.01), and the use of the CUSA in both contact and involved lesions increased the incidence of LMS (p < 0.01 and p < 0.03, respectively). Conclusions The authors suggest that piecemeal resection using the CUSA should be limited because of the risk of postsurgical LMS, especially when the tumor is in contact with the CSF pathway.





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Perception of cancer recurrence risk: More information is better

Publication year: 2012
Source: Patient Education and Counseling, Available online 9 January 2012
Kimberly M. Kelly, Mayank Ajmera, Sandipan Bhattacharjee, Rini Vohra, Gerry Hobbs, ...
ObjectiveBreast cancer is the most common cancer among women worldwide. Given the advances in extending survival, the number of recently diagnosed breast cancer patients and longer-term breast cancer survivors is growing. The goals of this study were to better understand (1) perceptions of provider cancer recurrence risk communication, (2) perceived risk of breast cancer recurrence in cancer patients and survivors, and (3) accuracy of perceived risk.MethodsA survey was conducted on women with a prior breast cancer (n = 141).ResultsApproximately 40% of women perceived that providers had not talked about their breast cancer recurrence risk; although only 1 person reported not wanting a physician to talk to her about her risk. Women were largely inaccurate in their assessments of risk. Greater worry, living in a rural area, and longer time since diagnosis were associated with greater inaccuracy. Women tended to think about distal recurrence of cancer as often of local recurrence.ConclusionsPerceived risk of breast cancer recurrence was inaccurate, and patients desired more communication about recurrence risk.Patients implicationsConsistent with findings from other studies, greater efforts are needed to improve the communication of cancer recurrence risk to patients. Attention should be paid to those from rural areas and to distal cancer recurrence in women with a previous history of breast cancer.





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Health literacy and cancer prevention: Two new instruments to assess comprehension

Publication year: 2012
Source: Patient Education and Counseling, Available online 12 January 2012
Kathleen M. Mazor, Douglas W. Roblin, Andrew E. Williams, Sarah M. Greene, Bridget Gaglio, ...
ObjectivesAbility to understand spoken health information is an important facet of health literacy, but to date, no instrument has been available to quantify patients' ability in this area. We sought to develop a test to assess comprehension of spoken health messages related to cancer prevention and screening to fill this gap, and a complementary test of comprehension of written health messages.MethodsWe used the Sentence Verification Technique to write items based on realistic health messages about cancer prevention and screening, including media messages, clinical encounters and clinical print materials. Items were reviewed, revised, and pre-tested. Adults aged 40–70 participated in a pilot administration in Georgia, Hawaii, and Massachusetts.ResultsThe Cancer Message Literacy Test-Listening is self-administered via touchscreen laptop computer. No reading is required. It takes approximately 1 hour. The Cancer Message Literacy Test-Reading is self-administered on paper. It takes approximately 10 min.ConclusionsThese two new tests will allow researchers to assess comprehension of spoken health messages, to examine the relationship between listening and reading literacy, and to explore the impact of each form of literacy on health-related outcomes.Practice implicationsResearchers and clinicians now have a means of measuring comprehension of spoken health information.





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Different perspectives on communication quality and emotional functioning during routine oncology co

Publication year: 2012
Source: Patient Education and Counseling, Available online 17 January 2012
Hanna Fagerlind, Åsa Kettis, Ida Bergström, Bengt Glimelius, Lena Ring
ObjectiveTo determine quality of communication in routine oncology consultations from patient, physician, and observer perspectives, and to determine agreement of emotional function content in consultations from these three perspectives.MethodsIn total, 69 consultations were included. Perceived quality of communication and whether or not emotional functioning had been discussed was evaluated with patient- and physician-reported questionnaires. Observer perspective was evaluated by content analysis of audio records of the consultations. Agreement between perspectives was analyzed and means compared using linear mixed models.ResultsThe patients' ratings of communication quality differed significantly from those of both the physician and observer. Observer and physician scores did not differ significantly. Physicians rated emotional functioning as discussed more often than was reported from patient and observer perspectives.ConclusionThe patients' view of the quality of communication differed from that of the physician and observer. Whether emotional functioning was discussed or not was also perceived differently by patients, physicians, and observer.Practice implicationsThe underpinnings and implications of these results need to be further explored regarding how to move toward a higher degree of shared understanding, where different perspectives are more in alignment, and how to develop more valid methods for evaluating communication.





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Thursday, February 16, 2012

Prediction of high-grade meningioma by preoperative MRI assessment

Abstract  
High-grade (World Health Organization grades II and III) meningiomas grow aggressively and recur frequently, resulting in a poor prognosis. Assessment of tumor malignancy before treatment initiation is important. We attempted to determine predictive factors for high-grade meningioma on magnetic resonance (MR) imaging before surgery. We reviewed 65 meningiomas (39 cases, benign; 26 cases, high-grade) and assessed four factors: (1) tumor–brain interface (TBI) on T1-weighted imaging (T1WI), (2) capsular enhancement (CapE), i.e., the layer of the tumor–brain interface on gadolinium-enhanced T1WI (T1Gd), (3) heterogeneity on T1Gd, and (4) tumoral margin on T1Gd. All four factors were useful in distinguishing high-grade from benign meningiomas, according to univariate analysis. On multivariate regression analysis, unclear TBI and heterogeneous enhancement were independent predictive factors for high-grade meningioma. In meningiomas with an unclear TBI and heterogeneous enhancement, the probability of high-grade meningioma was 98%. Our data suggest that this combination of factors obtained from conventional sequences on MR imaging may be useful to predict high-grade meningioma.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-6
  • DOI 10.1007/s11060-012-0809-4
  • Authors
    • Yosuke Kawahara, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
    • Mitsutoshi Nakada, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
    • Yutaka Hayashi, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
    • Yutaka Kai, Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
    • Yasuhiko Hayashi, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
    • Naoyuki Uchiyama, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan
    • Hiroyuki Nakamura, Department of Environmental and Preventive Medicine, Kanazawa University, Kanazawa, Japan
    • Jun-ichi Kuratsu, Department of Neurosurgery, Kumamoto University, Kumamoto, Japan
    • Jun-ichiro Hamada, Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan





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Factors affecting the cerebral network in brain tumor patients

Abstract  
Brain functions, including cognitive functions, are frequently disturbed in brain tumor patients. These disturbances may result from the tumor itself, but also from the treatment directed against the tumor. Surgery, radiotherapy and chemotherapy all may affect cerebral functioning, both in a positive as well as in a negative way. Apart from the anti-tumor treatment, glioma patients often receive glucocorticoids and anti-epileptic drugs, which both also have influence on brain functioning. The effect of a brain tumor on cerebral functioning is often more global than should be expected on the basis of the local character of the disease, and this is thought to be a consequence of disturbance of the cerebral network as a whole. Any network, whether it be a neural, a social or an electronic network, can be described in parameters assessing the topological characteristics of that particular network. Repeated assessment of neural network characteristics in brain tumor patients during their disease course enables study of the dynamics of neural networks and provides more insight into the plasticity of the diseased brain. Functional MRI, electroencephalography and especially magnetoencephalography are used to measure brain function and the signals that are being registered with these techniques can be analyzed with respect to network characteristics such as "synchronization" and "clustering". Evidence accumulates that loss of optimal neural network architecture negatively impacts complex cerebral functioning and also decreases the threshold to develop epileptic seizures. Future research should be focused on both plasticity of neural networks and the factors that have impact on that plasticity as well as the possible role of assessment of neural network characteristics in the determination of cerebral function during the disease course.

  • Content Type Journal Article
  • Category Methods and Clinical Tools for Outcome Assessments
  • Pages 1-7
  • DOI 10.1007/s11060-012-0814-7
  • Authors
    • Jan J. Heimans, Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
    • Jaap C. Reijneveld, Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands





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Tuesday, February 14, 2012

No Cancer Benefit from Vitamin B, Omega-3 Supplements in Heart Patients

Taking different doses of either did not alter cancer incidence, death rates significantly, study says

HealthDay news image

Source: HealthDay





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Monday, February 13, 2012

Subependymal seeding of low-grade oligodendroglial neoplasms: a case series

Abstract  
The CSF dissemination of low-grade glial tumors is a known albeit rare entity. Few cases have been reported in the literature. We describe a unique series of six patients with supratentorial low-grade gliomas who presented to our institution at ages 20–41 years, and developed signal abnormality along the margin of the fourth ventricle without enhancement at variable times during their disease course (0 to 95 months). MR spectroscopy and perfusion-weighted imaging through the region of abnormality in two of these patients were consistent with a low-grade glial tumor. We hypothesize that this finding represents dissemination of the supratentorial low-grade glioma along the ventricular ependyma or through the ventricular CSF. Although the small size of our series does not allow us to draw statistically significant conclusions, this abnormality correlates with progression of the supratentorial disease with or without features of a higher grade malignancy. Additional variables that were present in all six patients include the presence of an oligodendroglial component within the supratentorial tumor, mutated IDH1, and the supratentorial tumor contacting the ventricular margin. All six patients were males.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-10
  • DOI 10.1007/s11060-012-0800-0
  • Authors
    • Manal Nicolasjilwan, Department of Radiology, Neuroradiology Division, University of Virginia, P.O. Box 800170, Fedex: 1215 Lee Street-New Hospital, 1st Floor, Room 1011, Charlottesville, VA 22908-0170, USA
    • M. Beatriz Lopes, Department of Pathology (Neuropathology), University of Virginia, Charlottesville, VA, USA
    • James Larner, Department of Radiation Therapy, University of Virginia, Charlottesville, VA, USA
    • Max Wintermark, Department of Radiology, Neuroradiology Division, University of Virginia, P.O. Box 800170, Fedex: 1215 Lee Street-New Hospital, 1st Floor, Room 1011, Charlottesville, VA 22908-0170, USA
    • David Schiff, Departments of Neurology, Neurological Surgery, and Medicine, University of Virginia, Charlottesville, VA, USA





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Seizure prophylaxis and melanoma brain metastases

Abstract  
Melanoma has a high propensity to metastasize to the brain. In patients with brain metastases (BM) survival is limited, neurologic morbidity is high, with seizure incidence reported up to 67%. Current guidelines recommend against antiepileptic drug prophylaxis (AED PPX) in patients without a history of seizure. We reviewed our experience with melanoma BM to determine the efficacy of AED PPX in the era of second generation AED and to delineate risk factors associated with development of seizures. We reviewed records of all patients treated at Memorial Sloan-Kettering Cancer Center with melanoma and BM between May 2006 and October 2008. Seizure risk was studied relative to BM characteristics at diagnosis and AED PPX. We identified 109 patients. Median age was 61 years (range 29–91); 56% had no neurologic symptoms at diagnosis. On neuroimaging, 94% (102/109) had cortical lesions, 60% (65/109) had more than one supratentorial lesion, 54% (59/109) had hemorrhage. Seizure led to diagnosis of BM in 13% (14/109); 20% (22/109) developed seizures later. On univariate analysis among patients without a seizure at diagnosis, AED-PPX was significantly associated with decreased risk of seizure (P = 0.03) with 3-month seizure rate of 0% compared to 17% without AED-PPX. Hemorrhage (P < 0.001) and multiple supratentorial metastases (P = 0.03) were associated with increased seizure risk. Melanoma patients with multiple supratentorial BM and hemorrhage may have an increased risk of seizure. AED PPX may be effective in selected patients, and should be addressed in a randomized controlled trial.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-6
  • DOI 10.1007/s11060-012-0802-y
  • Authors
    • S. A. Goldlust, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
    • M. Hsu, Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
    • A. B. Lassman, Department of Neurology, Columbia University Medical Center, The Neurological Institute of New York, 710 West 168th Street, New York, NY 10032-3784, USA
    • K. S. Panageas, Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
    • E. K. Avila, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA





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Sunday, February 12, 2012

Endoscopic treatment of intraventricular cystic tumors

Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Konstantinos Margetis, Mark M. Souweidane
ObjectiveIntraventricular cystic tumors constitute a surgical challenge, due to their deep location and the histologically benign nature of most of them. We aim to present concisely yet comprehensively, the role of neuroendoscopy in the treatment of intraventricular cystic tumors.MethodsA literature review searched for applications of endoscopy in the treatment of intraventricular cystic tumors. Our experience was added to the presented data. In controversial issues a comparison was made with traditional treatment methods.ResultsIntraventricular endoscopy has been successfully used in the treatment of the whole range of intraventricular cystic tumors. The most common indication is the treatment of colloid cysts. In the treatment of colloid cysts, a comparison with microsurgical techniques showed that endoscopy is advantageous in regards to operative morbidity and post-operative shunt dependency, but is associated with a slightly higher recurrence rate.ConclusionIntraventricular endoscopy has emerged as a viable option in the treatment of intraventricular cystic tumors.





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Endoscopic Third Ventriculostomy and Posterior Fossa Tumors

Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Federico Di Rocco, Carlos Eduardo Jucá, Michel Zerah, Christian Sainte-Rose
BackgroundThe management of hydrocephalus associated to a posterior fossa tumor is debated. Some authors emphasize the advantages of an immediate tumor removal which may normalize the cerebrospinal fluid (CSF) dynamics. However, in the clinical practice the mere excision of the lesion has been demonstrated to be accompanied by a persisting hydrocephalus in about one third of the cases.Preoperative endoscopic third ventriculostomy (ETV) offers several advantages. It may control the intracranial pressure (ICP), avoid the necessity of an emergency procedure, allow to schedule the operation for tumor removal appropriately, and eliminate the risks related to the presence of an external drainage. The procedure also reduces the incidence of postoperative hydrocephalus. A final advantage, more difficult to weight, but obvious to the neurosurgeon, is the possibility to remove the lesion with a relaxed brain and normal ICP.In the post-operative phase, ETV can be used in case of persisting hydrocephalus, both in patients who underwent only the excision of the tumor or also in subjects whose preoperative ETV failed as a consequence of intraventricular bleeding with secondary closure of the stoma (redoETV). The main advantage of postoperative ETV is that the procedure is carried out only in case of persisting hydrocephalus; its use is consequently more selective than preoperative ETV. The disadvantage consists in the common use of an external CSF drainage in the first post-operative days which is necessary to control the pressure and for ruling out those cases that reach a spontaneous cure of the hydrocephalus.MethodsThe authors review the criteria for patient selection and the results of ETV performed in case of hydrocephalus secondary to a posterior fossa tumor.Results and conclusionspreoperative ETV constitutes an effective procedure for controlling the hydrocephalus associated to posterior fossa tumors. It might lower the rate of persistent postoperative hydrocephalus and result in a short hospital stay. Low rates of patients requiring an extrathecal – CSF shunt device are also reported by authors who utilize ETV postoperatively. As, however, the assessment of the persistent hydrocephalus in these children is based on prolonged ICP monitoring through an external CSF drainage, their results are weighted by a major risk of infective complications and longer duration hospital stay.





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Thursday, February 9, 2012

Evaluation of Selective Tumor Detection by Clinical Magnetic Resonance Imaging using Antibody-conjug

Publication year: 2012
Source: Journal of Controlled Release, Available online 25 January 2012
Takayoshi Koyama, Mari Shimura, Yuzuru Minemoto, Satoshi Nohara, Sayaka Shibata, ...
Active targeting by monoclonal antibodies (mAbs) combined with nanosize superparamagnetic iron oxide (SPIO) is a promising technology for magnetic resonance imaging (MRI) diagnosis. However, the clinical applicability of this technology has not been investigated using appropriate controls. It is important to evaluate the targeting technology using widely used clinical 1.5-Tesla MRI in addition to the high-Tesla experimental MRI. In this study, we measured mAb-conjugated dextran-coated SPIO nanoparticles (CMDM)in vivousing clinical 1.5-Tesla MRI. MRI of tumor-bearing mice was performed using a simple comparison between positive and negative tumors derived from the same genetic background in each mouse. The system provided significant tumor-targeting specificity of the target tumor. To the best of our knowledge, this is the first report on the specific detection of target tumors by mAb-conjugated SPIO using clinical 1.5-Tesla MRI. Our observations provide clues for reliable active targeting using mAb-conjugated SPIO in clinical applications.

image





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Monday, February 6, 2012

Brain Tumor Eradication And Prolonged Survival

Tocagen Inc. has announced the publication of data showing the company's investigational treatment for high grade glioma eradicates brain tumors and provides a dramatic survival benefit in mouse models of glioblastoma...





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Saturday, February 4, 2012

Crocodile tears syndrome after vestibular schwannoma surgery

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-5, Ahead of Print.
Object Crocodile tears syndrome (CTS) is a lacrimal hypersecretion disorder characterized by excessive tearing with gustatory stimulation while eating, drinking, or smelling food. Surgeons tend to overlook CTS after vestibular schwannoma (VS) surgery because its symptoms are less obvious compared with facial paralysis. The authors aim to elucidate the precise incidence and the detailed natural course of CTS after VS surgery. Methods This study included 128 consecutive patients with unilateral VSs resected via a retrosigmoid, lateral suboccipital approach. Clinical information on the patients was obtained by retrospective chart review. The presence of, time of onset of, and recovery of patients from CTS were obtained from the chart or evaluated from the most recent outpatient visit. Results A total of 14 patients (10.9%) developed CTS. Motor function of the facial nerve at discharge was statistically related to the occurrence of CTS (p < 0.001). The odds ratio of House-Brackmann Grade 4 compared with Grade 1 was 86.4 (p < 0.001). A bimodal distribution of CTS onset was observed, with a mean onset of 6.1 ± 4.0 months after resection. The CTS improved in 10 patients (71%) at various intervals, whereas CTS resolved in only 7 patients (50%) at a mean interval of 10.9 ± 7.9 months. The mean interval to recovery in the early-onset group was 9.7 ± 7.9 months, and it was 18 months in the late-onset group; the mean is given ± SD throughout. Conclusions The occurrence of CTS following VS surgery was more common than expected; however, a surgical procedure intended to protect the functioning of the facial nerve appears to be conducive to reduction of the occurrence of CTS. To reduce the distress caused by CTS, all patients should be given sufficient information and provide their informed consent prior to surgery.





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Friday, February 3, 2012

Training can help GPs provide a better death for patients

GPs need better training to boost their confidence in talking about death to patients and to improve care at the end of life, says new research published by the coalition Dying Matters.The coalition,...





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Thursday, February 2, 2012

Is the prognosis of stage 4s neuroblastoma in patients 12 months of age and older really excellent?

Publication year: 2012
Source: European Journal of Cancer, Available online 1 February 2012
Tomoko Iehara, Eiso Hiyama, Tatsuro Tajiri, Akihiro Yoneda, Minoru Hamazaki, ...
PurposeIn the International Neuroblastoma Risk Group (INRG) classification system, stage 4s was changed into stage MS in children less than 18 months of age. Stage MS is defined as a metastatic disease with skin, liver and bone marrow, similar to INSS stage 4s. To evaluate the outcome of stage 4s cases in patients 12 months of age and over and to determine the appropriate treatment strategy.MethodWe performed a retrospective review of 3834 patients registered with the Japanese Society of Pediatric Oncology and Japanese Society of Pediatric Surgeons between 1980 and 1998.ResultsThe rates of stage 4s patients were 10.7%, 6.3% and 3.3% in patients of ⩽11 months of age, from ⩾12 to ⩽17 months of age, ⩾18 months of age, respectively. The 5 year event-free survival rates were 89.4%, 100% and 53.1%, respectively. The rates ofMYCNamplification and unfavourable histology were smaller in stage 4s groups than stage 4 groups in all ages.ConclusionIn the children 12 months of age and older, stage 4s cases are markedly different from stage 4 cases in regard to the clinical features and prognosis. The prognosis of stage 4s cases from ⩾12 to ⩽17 months of age is excellent. The concept of stage MS appears to be appropriate.





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Wednesday, February 1, 2012

MGMT promoter hypermethylation and its associations with genetic alterations in a series of 350 brai

Abstract  
MGMT (O 6-methylguanine-DNA methyltransferase) promoter hypermethylation is a helpful prognostic marker for chemotherapy of gliomas, although with some controversy for low-grade tumors. The objective of this study was to retrospectively investigate MGMT promoter hypermethylation status for a series of 350 human brain tumors, including 275 gliomas of different malignancy grade, 21 glioblastoma multiforme (GBM) cell lines, and 75 non-glial tumors. The analysis was performed by methylation-specific PCR and capillary electrophoresis. MGMT expression at the protein level was also evaluated by both immunohistochemistry (IHC) and western blotting analysis. Associations of MGMT hypermethylation with IDH1/IDH2 mutations, EGFR amplification, TP53 mutations, and 1p/19q co-deletion, and the prognostic significance of these, were investigated for the gliomas. MGMT promoter hypermethylation was identified in 37.8% of gliomas, but was not present in non-glial tumors, with the exception of one primitive neuroectodermal tumor (PNET). The frequency was similar for all the astrocytic gliomas, with no correlation with histological grade. Significantly higher values were obtained for oligodendrogliomas. MGMT promoter hypermethylation was significantly associated with IDH1/IDH2 mutations (P = 0.0207) in grade II–III tumors, whereas it had a borderline association with 1p deletion (P = 0.0538) in oligodendrogliomas. No other association was found. Significant correlation of MGMT hypermethylation with MGMT protein expression was identified by IHC in GBMs and oligodendrogliomas (P = 0.0001), but not by western blotting. A positive correlation between MGMT protein expression, as detected by either IHC or western blotting, was also observed. The latter was consistent with MGMT promoter hypermethylation status in GBM cell lines. In low-grade gliomas, MGMT hypermethylation, but not MGMT protein expression, was associated with a trend, only, toward better survival, in contrast with GBMs, for which it had favorable prognostic significance.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-15
  • DOI 10.1007/s11060-011-0787-y
  • Authors
    • Marta Mellai, Neuro-bio-oncology Center, Policlinico di Monza Foundation, Via Pietro Micca, 29–13100, Vercelli, Italy
    • Oriana Monzeglio, Neuro-bio-oncology Center, Policlinico di Monza Foundation, Via Pietro Micca, 29–13100, Vercelli, Italy
    • Angela Piazzi, Department of Medical Sciences, University of Piemonte Orientale, Novara, Italy
    • Valentina Caldera, Neuro-bio-oncology Center, Policlinico di Monza Foundation, Via Pietro Micca, 29–13100, Vercelli, Italy
    • Laura Annovazzi, Neuro-bio-oncology Center, Policlinico di Monza Foundation, Via Pietro Micca, 29–13100, Vercelli, Italy
    • Paola Cassoni, Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy
    • Guido Valente, Department of Clinical and Experimental Medicine, University of Piemonte Orientale, Novara, Italy
    • Susanna Cordera, Department of Neurology, Ospedale Regionale, Aosta, Italy
    • Cristina Mocellini, Department of Neurology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
    • Davide Schiffer, Neuro-bio-oncology Center, Policlinico di Monza Foundation, Via Pietro Micca, 29–13100, Vercelli, Italy





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Risk of haemorrhagic and ischaemic stroke in patients with cancer: A nationwide follow-up study from

Publication year: 2012
Source: European Journal of Cancer, Available online 30 January 2012
Bengt Zöller, Jianguang Ji, Jan Sundquist, Kristina Sundquist
BackgroundStroke is common in cancer patients, but risk estimates for different cancer sites/types have not been determined. The aim of this nationwide study was to examine whether there is an association between cancer and first hospitalisation for haemorrhagic or ischaemic stroke.MethodsAll 820,491 individuals in Sweden with a diagnosis of cancer between 1st January 1987 and 31st December 2008 were followed for first hospitalisation for haemorrhagic or ischaemic stroke. The reference population was the total population of Sweden without cancer. Standardised incidence ratios (SIRs) for haemorrhagic and ischaemic strokes were calculated.ResultsOverall risk of haemorrhagic stroke and ischaemic stroke during the first 6 months after diagnosis of cancer was 2.2 (95% confidence interval (CI) = 2.0–2.3) and 1.6 (CI = 1.5–1.6), respectively. For 18 and 20 of the 34 cancers studied, respectively, risk of haemorrhagic and ischaemic strokes was increased. Overall stroke risk decreased rapidly, but remained elevated, even 10+ years after diagnosis of cancer 1.2 (CI = 1.1–1.3) for haemorrhagic stroke and 1.1 (CI = 1.1–1.2) for ischaemic stroke. The risk of stroke was highest during the first 6 months after diagnosis of cancer of the nervous system (29 (CI = 25–34) for haemorrhagic stroke and 4.1 (CI = 3.4–4.8) for ischaemic stroke)) or leukaemia (13 (CI = 10–16) for haemorrhagic stroke and 3.0 (CI = 2.5–3.7) for ischaemic stroke)). Metastasis was associated with an increased risk of haemorrhagic stroke 2.2 (CI = 1.8–2.7) and ischaemic stroke 1.5 (CI = 1.3–1.7).InterpretationSeveral cancer sites/types are associated with an increased risk of haemorrhagic and ischaemic strokes.





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[Review] Chordoma: current concepts, management, and future directions

Chordoma is a rare bone cancer that is aggressive, locally invasive, and has a poor prognosis. Chordomas are thought to arise from transformed remnants of notochord and have a predilection for the axial skeleton, with the most common sites being the sacrum, skull base, and spine. The gold standard treatment for chordomas of the mobile spine and sacrum is en-bloc excision with wide margins and postoperative external-beam radiation therapy. Treatment of clival chordomas is unique from other locations with an enhanced emphasis on preservation of neurological function, typified by a general paradigm of maximally safe cytoreductive surgery and advanced radiation delivery techniques.





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Physical activity for cancer survivors

In 2008, more than 12 million people worldwide were diagnosed with cancer (http://globocan.iarc.fr/). Because of improvements in early diagnosis and the introduction of more aggressive treatments...





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