Friday, March 30, 2012

Diagnostic Hope For Children's Cancer Following Discovery Of Genetic Abnormality

A chromosomal abnormality in children with a deadly form of brain cancer is linked with a poorer chance of survival, clinician scientists at The University of Nottingham have discovered...





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Seizure Control for Patients Undergoing Meningioma Surgery

Publication year: 2012
Source:World Neurosurgery
Kaisorn L. Chaichana, Courtney Pendleton, Hasan Zaidi, Alessandro Olivi, Jon D. Weingart, Gary L. Gallia, Michael Lim, Henry Brem, Alfredo Quinones-Hinojosa
Objective Seizures are common among patients with meningiomas and are a significant cause of morbidity and poor quality of life. The factors associated with the onset of seizures as well as factors associated with seizure control remains poorly understood. Methods Adult patients who underwent primary resection of a supratentorial World Health Organization grade I meningioma at a single institution between 1996 and 2006 were retrospectively reviewed. Multivariate logistical regression analysis was used to identify associations with pre-operative seizures, and multivariate proportional hazards regression analyses were used to identify associations with prolonged seizure control following surgical resection. Results Of the 626 patients in this series, 84 (13%) presented with seizures. The factors independently associated with pre-operative seizures were: Karnofsky performance score (KPS) ≤ 80 (p<0.0001), absence of headaches (p=0.0006), and vasogenic edema (p=0.007). At 48-months post-operatively, 90% were Engel Class I, 3% were Class II, 0% were Class III, and 7% were Class IV. The factors independently associated with decreased seizure control following surgical resection were: uncontrolled pre-operative seizures (p=0.04), parasagittal tumors (p=0.03), and tumors along the sphenoid wing (p=0.05). The association between seizure recurrence and tumor recurrence trended towards but did not achieve statistical significance (p=0.11). Conclusion With the widespread availability of various neuro-imaging modalities, there will be increased detection of intracranial meningiomas. The identification and consideration of factors associated with seizure onset and prolonged seizure control may help guide treatment strategies aimed at improving the quality of life for patients with meningiomas.






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Monday, March 26, 2012

Surgical management of ventral and ventrolateral foramen magnum meningiomas: report on a 64-case ser

Abstract  
Foramen magnum meningioma poses a challenge for neurosurgeons. Prognosis has generally improved with diagnostic and surgical advances over the past two decades; however, it may ultimately depend more on the surgeon's ability to tailor the approach and interpret intraoperative risks in single cases. The series comprised 64 patients operated on for ventral and ventrolateral foramen magnum meningioma. All patients underwent preoperative magnetic resonance imaging and received surgery via the dorsolateral route, rendering the series homogeneous in neuroradiological workup and surgical treatment. Particular to this series was that the majority of patients were of advanced age (n = 29; age, >65 years), had serious functional impairment (n = 30, Karnofski score <70), and large tumors (mean diameter, 3.5 cm). Total tumor removal was achieved in 52 (81 %) patients; operative mortality was nil. Early outcome varied depending on difficulties encountered at surgery (cranial nerve position and type of involvement in particular) and type of preoperative dysfunction. Long-tract signs and cerebellar deficits improved in 74 and 77 % of cases, respectively, but only 27 % of cranial nerve deficits did so. Surgical complications most often involved the cranial nerves: cranial nerve impairment, especially of the 9th through the 12th cranial nerves, due to stretching or encasement was noted in 44 cases. At final outcome assessment, two thirds of the cranial nerve deficits cleared, and all but two patients returned to a normal productive life. One patient was reoperated on during the follow-up period. Foramen magnum meningiomas behave like clival or spinal tumors depending on their prevalent extension. A dorsolateral approach tailored to tumor position and extension and meticulous surgical technique allow for definitive control of surgical complications. Scrupulous postoperative care may prevent dysphagia, a major persistent complication of surgery. Long-term observation of indolent tumor behavior at follow-up suggests that incomplete resection may be a viable surgical treatment option.

  • Content Type Journal Article
  • Category Original Article
  • Pages 1-10
  • DOI 10.1007/s10143-012-0381-6
  • Authors
    • Andrea Talacchi, Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy
    • Antonio Biroli, Institute of Neurosurgery, University Hospital, Verona, Italy
    • Christian Soda, Institute of Neurosurgery, University Hospital, Verona, Italy
    • Barbara Masotto, Institute of Neurosurgery, University Hospital, Verona, Italy
    • Albino Bricolo, Section of Neurosurgery, Department of Neuroscience, University of Verona, Verona, Italy





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Mutations Detected Within A Brain Tumor Using Non-Invasive Imaging

Researchers at Winship Cancer Institute have developed a technique for detecting an "oncometabolite," a chemical produced by some brain tumors' warped metabolism, via non-invasive imaging. Their approach could allow doctors to know not only that a brain tumor is there, but also that it carries a particular genetic mutation...





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Sunday, March 25, 2012

Stereotactic endoscopic resection and surgical management of a subependymal giant cell astrocytoma

Journal of Neurosurgery: Pediatrics, Volume 9, Issue 4, Page 417-420, April 2012.
Subependymal giant cell astrocytomas (SEGAs) are benign tumors, most commonly associated with tuberous sclerosis complex (TSC). Arising from the lateral ependymal surface, these tumors may obstruct one or both foramina of Monro, resulting in hydrocephalus and often requiring treatment. Although interhemispheric-transcallosal and transcortical-transventricular approaches have been the standard methods for resecting these tumors, advances in neuroendoscopic techniques have expanded SEGAs as a potential target for endoscopic resection. The authors present a case of an endoscopically resected SEGA with stereotactic guidance in a 4-year-old girl with TSC. A gross-total resection of an enlarging SEGA was achieved. This represents one of the early case reports of endoscopically resected SEGAs. Although recent advances in medical treatment for SEGAs with mammalian target of rapamycin (mTOR) pathway inhibitors have shown promising initial results, the long-term safety and efficacy of mTOR inhibitors has yet to be determined. The propensity of these tumors to cause obstructive hydrocephalus requires that a surgical option remain. Neuroendoscopic approaches may allow a safe and effective technique.





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Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-7, Ahead of Print.
Object Postoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery. Methods The authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage. Results In 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m2, p = 0.006). Multivariate analyses indicate that for every 5-kg/m2 increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10–2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak. Conclusions Elevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m2 have meticulous sellar reconstruction at surgery and close monitoring postoperatively.





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Morbidity profile following aggressive resection of parietal lobe gliomas

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-5, Ahead of Print.
Object The impact of parietal lobe gliomas is typically studied in the context of parietal lobe syndromes. However, critical language pathways traverse the parietal lobe and are susceptible during tumor resection. The authors of this study reviewed their experience with parietal gliomas to characterize the impact of resection and the morbidity associated with language. Methods The study population included adults who had undergone resection of parietal gliomas of all grades. Tumor location was identified according to a proposed classification system for parietal region gliomas. Low- and high-grade tumors were volumetrically analyzed using FLAIR and T1-weighted contrast-enhanced MR imaging. Results One hundred nineteen patients with parietal gliomas were identified—34 with low-grade gliomas and 85 with high-grade gliomas. The median patient age was 45 years, and most patients (53) presented with seizures, whereas only 4 patients had an appreciable parietal lobe syndrome. The median preoperative tumor volume was 31.3 cm3, the median extent of resection was 96%, and the median postoperative tumor volume was 0.9 cm3. Surprisingly, the most common early postoperative neurological deficit was dysphasia (16 patients), not weakness (12 patients), sensory deficits (14 patients), or parietal lobe syndrome (10 patients). A proposed parietal glioma classification system, based on surgical anatomy, was predictive of language deficits. Conclusions This is the largest reported experience with parietal lobe gliomas. The findings suggested that parietal language pathways are compromised at a surprisingly high rate. The proposed parietal glioma classification system is predictive of postoperative morbidity associated with language and can assist with preoperative planning. Taken together, these data emphasize the value of identifying language pathways when operating within the parietal lobe.





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The CareGiver Oncology Quality of Life questionnaire (CarGOQoL): Development and validation of an in

Publication year: 2012
Source:European Journal of Cancer, Volume 48, Issue 6
Patricia Minaya, Karine Baumstarck, Julie Berbis, Anthony Goncalves, Fabrice Barlesi, Gérard Michel, Sébastien Salas, Olivier Chinot, Jean-Jacques Grob, Jean François Seitz, Franck Bladou, Audrey Clement, Julien Mancini, Marie-Claude Simeoni, Pascal Auquier
Purpose The study objective was to validate a specific quality of life (QoL) questionnaire for caregivers of cancer patients, the CareGiver Oncology Quality of Life questionnaire (CarGOQoL), based on the exclusive points of view of the caregivers. Materials and methods A 75-item questionnaire generated from content analysis of interviews with caregivers was self-completed by 837 caregivers of cancer patients. In addition to sociodemographic data and patient characteristics, self-reported questionnaires assessing QoL, burden, coping and social support were collected. Psychometric properties combined methods relying on both classical test theory and item response theory. Results The final 29 items selected assessed 10 dimensions: psychological well-being, burden, relationship with health care, administration and finances, coping, physical well-being, self-esteem, leisure time, social support and private life; they were isolated from principal component analysis explaining 73% of the total variance. The missing data and the floor effects were low. Some ceiling effects were found for B (34%). Cronbach's alpha coefficients ranged from 0.72 to 0.89, except private life (PL) (0.55). Unidimensionality of the scales was confirmed by Rasch analyses. Correlations with other instruments confirmed the isolated content and significant links were found with respect to patient's characteristics. Reproducibility and sensitivity to change were found satisfactory. Conclusion The CarGOQoL could provide a reliable and valid measure of caregivers of cancer patients' QoL which are key-actors in the provision of health care.






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Thursday, March 22, 2012

Glioblastoma with an oligodendroglioma component: distinct clinical behavior, genetic alterations, a

Glioblastomas (GBMs) containing foci that resemble oligodendroglioma are defined as GBM with oligodendroglioma component (GBMO). However, whether GBMO is a distinct clinicopathological variant of GBM or merely represents a divergent pattern of differentiation remains controversial. We investigated 219 consecutive primary GBMs, of which 40 (18.3%) were confirmed as GBMOs. The clinical features and genetic profiles of the GBMOs were analyzed and compared with the conventional GBMs. The GBMO group showed more frequent tumor-related seizures (P= .027), higher frequency of IDH1 mutation (31% vs. <5%, P= .015), lower MGMT expression (P= .016), and longer survival (19.0 vs. 13.2 months; P= .022). In multivariate Cox regression analyses, presence of an oligodendroglioma component was predictive of longer survival (P= .001), but the extent of the oligodendroglial component appeared not to be linked to prognosis (P= .664). The codeletions of 1p/19q, somewhat surprisingly, were infrequent (<5%) in both GBMO and conventional GBM. In addition, the response to aggressive therapy differed: the GBMO group had no survival advantage associated with aggressive treatment protocols, whereas a clear treatment effect was observed in the conventional GBM group. Collectively, the clinical behavior and genetic alterations of GBMO thus differs from those of conventional GBM. Presence of an oligodendroglial component may therefore be a useful classification and stratification variable in therapeutic trials of GBMs.






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Wednesday, March 21, 2012

Enhancing life after cancer in diverse communities

Abstract

BACKGROUND:

Although large numbers of cancer survivors exist in every community, including minority communities, there is a significant gap in knowledge about best practices for these patients.

METHODS:

The Community Networks Program, funded by the National Cancer Institute Center to Reduce Cancer Health Disparities, has developed and tested unique services for these communities. These programs have used community-based participatory research techniques under a framework of diffusion of innovation and communications theory.

RESULTS:

This article describes some specifically tailored interventions that may be useful to a wide range of providers working with the underserved.

CONCLUSIONS:

Enhancing life after cancer can be achieved in underserved communities by supplementing local resources. Cancer 2012;. © 2012 American Cancer Society.






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Aspirin, Cancer Mortality, and Risk for Distant Metastases

Three new meta-analyses show that aspirin can reduce the long-term risk for cancer death and lower the risk for distant metastasis.
Medscape Medical News





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The Role of Avastin in the Management of Recurrent Glioblastoma

Glioblastoma multiforme is a malignant primary brain tumor for which no cure has been developed. However, with aggressive surgical resection, radiation, and the advent of temozolomide, the overall survival of patients with glioblastomas has improved significantly. Despite this multimodal treatment, glioblastoma invariably recurs. Although treatment options for glioblastoma recurrence are limited, one promising therapy is bevacizumab (Avastin). The role of Avastin in the management of recurrent glioblastomas is reviewed.





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Management of Multifocal and Multicentric Gliomas

The diffuse nature of gliomas has long confounded attempts at achieving a definitive cure. The advent of computed tomography and magnetic resonance imaging made it increasingly apparent that gliomas could have a multifocal or multicentric appearance. Treating these tumors is the summit of an already daunting challenge, because the obstacles that must be surmounted to treat gliomas in general, namely, their heterogeneity, diffuse nature, and ability to insidiously invade normal brain, are more conspicuous in this subset of tumors.





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Temozolomide and Other Potential Agents for the Treatment of Glioblastoma Multiforme

This article provides historical and recent perspectives related to the use of temozolomide for the treatment of glioblastoma multiforme. Temozolomide has quickly become part of the standard of care for the modern treatment of stage IV glioblastoma multiforme since its approval in 2005. Yet despite its improvements from previous therapies, median survival remains approximately 15 months, with a 2-year survival rate of 8% to 26%. The mechanism of action of this chemotherapeutic agent, conferred advantages and limitations, treatment resistance and rescue, and potential targets of future research are discussed.





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Tuesday, March 20, 2012

Viral Gene Therapy For The Future

Brain-tumor cells that are infected with a cancer-killing virus release a protein "alarm bell" that warns other tumor cells of the impending infection and enables them to mount a defense against the virus, according to a study led by researchers at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James)...





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Microsurgical treatment of spinal epidermoid and dermoid cysts in the lumbosacral region

Publication year: 2012
Source:Journal of Clinical Neuroscience
Hui Liu, Jian-Ning Zhang, Tao Zhu
The aim of this study was to evaluate the characteristics and surgical outcome of spinal epidermoid and dermoid cysts in the lumbosacral spine. We reviewed 26 patients with spinal epidermoid and dermoid cysts (15 epidermoid and 11 dermoid) treated between October 2000 and December 2010. The latter 15 patients of this series underwent neurophysiological monitoring during surgery. Gross total resection of the tumour was achieved in 46.2% of patients, and 53.8% underwent subtotal resection. In 14 patients, the tumour capsule adhered so tightly to the neural structures that a section of the capsule remained in situ. After surgery, the Japanese Orthopaedic Association score improved in 80.8% of patients, remained stable in 15.4%, and declined in 3.8%. The average follow-up period was 53months. Three patients developed recurrence of the tumour and 20 patients resumed a normal working life. Microsurgical techniques and intraoperative neurophysiological monitoring are practical and reliable methods for radical removal of spinal epidermoid and dermoid cysts that involve the conus medullaris and cauda equina.






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Surgical Management of Cranial Base Metastases

BACKGROUND: Cranial base metastases (CBM) are rare and have received limited attention in the medical literature. Questions remain regarding the role of surgery, if any, in the management of these tumors. OBJECTIVE: To report surgical outcomes in a consecutive series of patients with CBM and to better define the role of surgery in their management. METHODS: Twenty-seven patients with CBM underwent surgery between 1996 and 2009 at MD Anderson Cancer Center. A retrospective review of their prospectively collected data was performed after obtaining institutional review board approval. The median patient age was 52 years. The most common pathology was renal cell carcinoma (6 patients). Surgical indications were worsening neurological deficit, disfiguring mass, and the need for a diagnosis. RESULTS: Gross total resection was achieved in 59% of the cases. The median survival was 11.4 months. The median progression-free survival was 5.8 months. A Karnofsky Performance Scale score less than 90, dural invasion, and brain invasion were associated with a shorter survival. Seven patients were neurologically intact preoperatively; all of them remained intact after surgery. Among all patients with preoperative neurological deficit, 11 remained stable, 7 improved, and 2 had worsening of their deficit postoperatively. CONCLUSION: The goal of surgery for CBM is to provide symptom relief and to preserve functional status in well-selected cases. Patient selection is critical because the surgery is usually palliative, and only a minority of patients are surgical candidates. Radiation therapy remains the management option of choice for the majority of patients.





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Quantitative Assessment of Heterogeneity in Tumor Metabolism Using FDG-PET

Purpose: [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) images are usually quantitatively analyzed in "whole-tumor" volumes of interest. Also parameters determined with dynamic PET acquisitions, such as the Patlak glucose metabolic rate (MRglc) and pharmacokinetic rate constants of two-tissue compartment modeling, are most often derived per lesion. We propose segmentation of tumors to determine tumor heterogeneity, potentially useful for dose-painting in radiotherapy and elucidating mechanisms of FDG uptake.Methods and Materials: In 41 patients with 104 lesions, dynamic FDG-PET was performed. On MRglc images, tumors were segmented in quartiles of background subtracted maximum MRglc (0%–25%, 25%–50%, 50%–75%, and 75%–100%). Pharmacokinetic analysis was performed using an irreversible two-tissue compartment model in the three segments with highest MRglc to determine the rate constants of FDG metabolism.Results: From the highest to the lowest quartile, significant decreases of uptake (K1), washout (k2), and phosphorylation (k3) rate constants were seen with significant increases in tissue blood volume fraction (Vb).Conclusions: Tumor regions with highest MRglc are characterized by high cellular uptake and phosphorylation rate constants with relatively low blood volume fractions. In regions with less metabolic activity, the blood volume fraction increases and cellular uptake, washout, and phosphorylation rate constants decrease. These results support the hypothesis that regional tumor glucose phosphorylation rate is not dependent on the transport of nutrients (i.e., FDG) to the tumor.





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Prognostic value of gross tumor volume delineated by FDG-PET-CT based radiotherapy treatment plannin

Background: We aimed to assess whether gross tumor volume (GTV) determined by fusion of contrast-enhanced computerized tomography (CT) and 18F-fluoro-deoxy-D-glucose positron emission tomography-CT (FDG-PET-CT) based radiotherapy planning could predict outcomes, namely overall survival (OS), local-regional progression-free survival (LRPFS), and progression-free survival (PFS) in cases with locally advanced pancreas cancer (LAPC) treated with definitive concurrent chemoradiotherapy. Methods: A total of 30 patients with histological proof of LAPC underwent 50.4 Gy (1.8 Gy/28 fractions) of radiotherapy concurrent with continuously infused 5-FU followed by 4 to 6 courses of maintenance gemcitabine. Target volume delineations were performed on FDG-PET-CT-based RTP. Patients were stratified into 2 groups: GTV lesser (GTVL) versus greater (GTVG) than cut off value determined by receiver operating characteristic (ROC) analysis, and compared in terms of OS, LRPFS and PFS. Results: Median GTV delineated according to the FDG-PET-CT data was 100.0 cm3. Cut off GTV value determined from ROC curves was 91.1 cm3. At a median follow up of 11.2 months, median OS, LRPFS and PFS for the entire population were 10.3, 7.8 and 5.7 months, respectively. Median OS, LRPFS and PFS for GTVL and GTVG cohorts were 16.3 vs. 9.5 (p = 0.005), 11.0 vs. 6.0 (p = 0.013), and 9.0 vs. 4.8 months (p = 0.008), respectively. Conclusions: The superior OS, LRPFS and PFS observed in GTVL patients over GTVG ones suggests a potential for FDG-PET-CT-defined GTV size in predicting outcomes of LAPC patients treated with definitive C-CRT, which needs to be validated by further studies with larger cohorts.





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Wednesday, March 14, 2012

A reduced risk of Alzheimer's disease in those who survive cancer

In a linked population based cohort study (doi:10.1136/bmj.e1442), Driver and colleagues report that older adults who survived cancer had a lower risk of developing Alzheimer's disease than those who...





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When a Patient is Ready to Talk About Death, but a Medical Student is Not

The woman sitting across from me is eighty-one years old. I am sitting on her couch, not a straight-backed chair, and she is reclining on her sofa, not a hospital bed. I wear a sweater and leggings; I left my white coat at home. She offers me something to drink.

It is my first time doing a patient home visit. The purpose was to step outside the hospital snapshot and paint a fuller picture of a patient s life: her family and support network, any physical or socioeconomic barriers to health, and how illness has affected her life.

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Assessment of intra-observer variability in measurement of high-grade brain tumors

Abstract  
A 25% increase in bidimensional products (BPs) of tumor diameter has been used as a criterion for brain tumor progression. We studied intra-observer variability in measurements of BPs. Ten patients with contrast-enhancing glioblastoma multiforme underwent baseline and follow-up MR imaging. Seven observers measured BPs in various planes. Differences in BPs between scans were expressed as a percentage of baseline. This calculation was performed for both readings of the baseline and follow-up scans. Differences between change from baseline to follow-up on each reading (termed D values) were calculated for each reader (total of 196 D values). Median D value in each plane was calculated for each reader. Range of D values was 12.36–33.64% in axial plane (average 10.63%), 12.18–38.62% in coronal plane (average 26.84%) and 15.12–35.48% in sagittal plane (average 26.11%). Across all planes, 88 (45%) D values were >25%. When all imaging planes for any single observation were combined, in 76% of cases, at least one D value of >25% was seen. Based on the high degree of intra-observer variability, tumor measurements producing an increase in BP of >25% can routinely be obtained solely by chance.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-7
  • DOI 10.1007/s11060-012-0843-2
  • Authors
    • James M. Provenzale, Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA
    • Michael C. Mancini, Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA





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Congruence of primary brain tumor patient and caregiver symptom report

Abstract

BACKGROUND:

Evaluating the severity of symptoms in patients with primary brain tumors (PBTs) is important in clinical care and research but may be difficult due to patient neurocognitive (NC) impairment. This study was conducted to evaluate the congruence of symptom reporting in patient and caregiver dyads, examining potential impact of NC impairment and Karnofsky performance status (KPS).

METHODS:

PBT patients undergoing NC testing and their caregivers were included in this study. These dyads (paired patient and caregiver group) completed the MD Anderson Symptom Inventory-Brain Tumor Module prior to testing, and impairment was categorized based on NC test scores. Concordance and equivalency was then assessed using Bland-Altman analysis and 2 one-sided techniques.

RESULTS:

A total of 115 dyads participated. Median patient and caregiver age was 49 and 51 years, respectively, and 63% of patients were male (73% female caregivers). Most patients had a good KPS (≥90, 66%) but were classified as NC impaired (58%). Caregiver's report of patient symptoms are congruent to the self-report of the patient. Equivalency between patient and caregiver report were found using prespecified confidence intervals. KPS group (good, ≥90; poor, ≤80) comparisons of equivalency indicated no significant differences in symptoms and interference reporting between dyads (good = 0.49, P > .05; and poor = 0.3, P > .05) overall, but there was a tendency for higher report by caregivers if the patients had a poor KPS.

CONCLUSIONS:

Caregivers of PBT patients have similar assessments of symptom severity (highly congruent) with patient self-report regardless of NC function or KPS. These findings suggest that caregivers may serve as proxy report of symptoms for primary brain tumor patients. Cancer 2012. © 2012 American Cancer Society.






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Monday, March 12, 2012

Brain Cancer Blood Vessels Not Substantially Tumor-Derived

Johns Hopkins scientists have published laboratory data refuting studies that suggest blood vessels that form within brain cancers are largely made up of cancer cells. The theory of cancer-based blood vessels calls into question the use and value of anticancer drugs that target these blood vessels, including bevacizumab (Avastin)...





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Sunday, March 11, 2012

Biopsies from one tumour have more genetic differences than similarities, finds study

Taking a single biopsy from just one part of a tumour may fail to provide a full picture of its genetic landscape, indicates the first study to analyse the full genome in different regions of the...





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Mobile phone use and glioma risk: comparison of epidemiological study results with incidence trends

Objective In view of mobile phone exposure being classified as a possible human carcinogen by the International Agency for Research on Cancer (IARC), we determined the compatibility of two recent...





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APG101 Pase II Trial With Glioblastoma Patients - Meets Primary Endpoint

Apogenix GmbH, a biopharmaceutical company, has announced that APG101, designed for the 2nd line treatment of glioblastoma multiforme (GBM), has met its primary endpoint 6 months after the follow-up of the last treated patient...





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MRI findings in patients with central neurocytomas with special reference to differential diagnosis

Publication year: 2012
Source:Journal of Clinical Neuroscience
Tadaaki Niiro, Hiroshi Tokimura, Ryosuke Hanaya, Hirofumi Hirano, Yoshihiko Fukukura, Kazuhiko Sugiyma, Kuniki Eguchi, Kaoru Kurisu, Hiroyuki Yoshioka, Kazunori Arita
We retrospectively evaluated 12 patients with histologically verified central neurocytoma (CN) to identify the MRI characteristics associated with this tumour. All tumours had heterogeneous signal intensity in their solid components and seven had a "soap bubble" or spongy appearance. Spicules were identified at the tumour periphery interfacing with the lateral ventricular walls. These spicules were formed by walls of multiple cysts of medium size. Undulation of the lateral ventricular wall attached to the tumour capsule was seen in nine patients. These spicules and undulations resulted in a "scalloping" appearance. In a diagnostic experiment to test the differential diagnosis of CN from other neoplasms near the foramen of Monro, the identification of scalloping made a greater contribution to the specificity and accuracy of the diagnosis than the soap bubble appearance. Thus, recognition of multiple cystic interfaces between the solid part of the tumour and the lateral ventricular wall on MRI may contribute to a correct preoperative diagnosis of CN.






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Saturday, March 10, 2012

1P19Q loss but not IDH1 mutations influences WHO grade II gliomas spontaneous growth

Abstract  
Mutations at the codon 132 in the isocitrate dehydrogenase 1 (IDH1) gene occur early, with a high frequency, in World Health Organization (WHO) grade II gliomas. We investigated the impact of IDH1 mutations on spontaneous glioma growth rate, known to be an early prognostic factor.The mean tumor diameter was assessed on the first MRI performed at diagnosis and on a second MRI, performed immediately before surgery, in a series of 64 WHO grade II gliomas. The patients did not undergo treatment before surgery. Because of a frequent association, we jointly analyzed the 1p19q co-deletion and IDH1 mutations effects on tumor velocity of diameter expansion (mm/year) during preoperative spontaneous growth period. 1p19q co-deletion had a significant slowing effect (p = 0.0133) on tumor growth estimated at −1.7760 ± 0.711 mm/year (95% CI −3.154, −0.366), whereas IDH1 mutations estimated effect of +0.036 ± 0.833 mm/year (95% CI −1.668; +1.596) was not significant (p = 0.9654). Our results provide first evidence that IDH1 mutations are not significantly involved in tumor growth rate. By contrast, we confirm that 1p19q co-deletion decreases growth velocity.

  • Content Type Journal Article
  • Category Laboratory Investigation
  • Pages 1-7
  • DOI 10.1007/s11060-012-0831-6
  • Authors
    • Catherine Gozé, Laboratoire de Biologie Cellulaire et Hormonale CHU de Montpellier, 371 Avenue Doyen Giraud, 34295 Montpellier Cedex 5, France
    • Charlotte Bezzina, Laboratoire de Biologie Cellulaire et Hormonale CHU de Montpellier, 371 Avenue Doyen Giraud, 34295 Montpellier Cedex 5, France
    • Eric Gozé, CIRAD, UPR SCA, 34398 Montpellier, France
    • Valérie Rigau, Centre des Collections Biologiques Hospitalières de Montpellier (CCBH-M), CHU de Montpellier, 34295 Montpellier Cedex 5, France
    • Thierry Maudelonde, Laboratoire de Biologie Cellulaire et Hormonale CHU de Montpellier, 371 Avenue Doyen Giraud, 34295 Montpellier Cedex 5, France
    • Luc Bauchet, INSERM U1051 Institut des Neurosciences de Montpellier, 80 rue Augustin Fliche, BP 74103 34291, Montpellier Cedex 5, France
    • Hugues Duffau, INSERM U1051 Institut des Neurosciences de Montpellier, 80 rue Augustin Fliche, BP 74103 34291, Montpellier Cedex 5, France





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Investigation of cognitive impairments in people with brain tumors

Abstract  
Study of brain tumors (BT) has revealed the importance of cognitive and behavioral assessment to clinical care and prognosis. This paper overviews recent literature, focusing on the main points of interest and current methods, providing recommendations for advancing research. Histological aspects, disease progression, treatment-related neurotoxicity, and co-morbidities determine the cognitive patterns of BT. Mental slowing with prominent executive and memory compromise usually mark the advanced phases of disease, whereas normal cognitive performance or subtle behavioral symptoms characterize the early disease course, irrespective of tumor location. Neurocognitive assessment may indicate brain damage in otherwise neurologically normal patients, explain pathological behavior, and provide reliable measures of outcome, contributing to improving the management of patients. Scarce attention has been devoted to social cognitive deficits which are expected to impair autonomy and relationships. Interest in non-pharmacological treatment of cognitive impairment is a growing area although methodological difficulties persist. Homogeneous patient populations, longitudinal study designs including baseline evaluations, and measurement of the lowest and highest levels of cognitive performance seem indispensable to advancing the study of the cognitive and behavioral changes provoked by BT. Future investigations are also expected to clarify the clinical significance of such changes, their effect on quality of life, and the efficacy of specific rehabilitation treatments.

  • Content Type Journal Article
  • Category Baseline Neuropsychological Investigations and Batteries
  • Pages 1-7
  • DOI 10.1007/s11060-012-0815-6
  • Authors
    • Anna Rita Giovagnoli, Laboratory of Cognitive and Behavioral Neurology, Fondazione IRCCS Istituto Neurologico "C. Besta", Milano, Italy





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Immunohistochemical detection of IDH1 mutation, p53, and internexin as prognostic factors of glial t

Abstract  
Isocitrate dehydrogenase 1 (IDH1) mutations, which are early and frequent genetic alterations in astrocytomas, oligodendrogliomas, oligoastrocytomas, and secondary glioblastomas, are specific to arginine 132 (R132). Recently, we established monoclonal antibodies (mAbs) against IDH1 mutations: anti-IDH1-R132H and anti-IDH1-R132S. However, the importance of immunohistochemistry using the combination of those mAbs has not been elucidated. For this study, 164 cases of glioma were evaluated immunohistochemically for IDH1 mutations (R132H and R132S) using anti-IDH1 mAbs (HMab-1 and SMab-1). IDH1 mutation was detected, respectively, in 9.7%, 63.6%, 51.7%, and 77.8% of primary grade IV, secondary grade IV, grade III, and grade II gliomas. For each grade of glioma, prognostic factors for progression-free survival and overall survival were evaluated using clinical and pathological parameters in addition to IDH1 immunohistochemistry. IDH1 mutation, p53 overexpression, and internexin expression, as evaluated using immunohistochemistry with clinical parameters such as degree of surgical removal and preoperative Karnofsky Performance Status (KPS), might be of greater prognostic significance than histological grading alone in grade III as well as IDH1 mutation in grade IV gliomas.

  • Content Type Journal Article
  • Category Laboratory Investigation
  • Pages 1-13
  • DOI 10.1007/s11060-012-0837-0
  • Authors
    • Shingo Takano, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan
    • Yukinari Kato, Molecular Tumor Marker Research Team, Yamagata University Global COE Program, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, 990-9585 Yamagata, Japan
    • Tetsuya Yamamoto, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan
    • Mika Kato Kaneko, Molecular Tumor Marker Research Team, Yamagata University Global COE Program, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, 990-9585 Yamagata, Japan
    • Eiichi Ishikawa, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan
    • Yuta Tsujimoto, Molecular Tumor Marker Research Team, Yamagata University Global COE Program, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, 990-9585 Yamagata, Japan
    • Masahide Matsuda, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan
    • Kei Nakai, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan
    • Ryo Yanagiya, Molecular Tumor Marker Research Team, Yamagata University Global COE Program, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, 990-9585 Yamagata, Japan
    • Shunpei Morita, Molecular Tumor Marker Research Team, Yamagata University Global COE Program, Yamagata University Faculty of Medicine, 2-2-2 Iida-nishi, 990-9585 Yamagata, Japan
    • Koji Tsuboi, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan
    • Akira Matsumura, Department of Neurological Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, 305-8575 Ibaraki, Tsukuba, Japan





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Wednesday, March 7, 2012

Cancer Seen Killing 1.3 Million EU Citizens in 2012

Almost 1.3 million people will die of cancer in the European Union this year, but death rates from the disease are on a steady decline, according to new research released on Wednesday.
Source: Reuters Health





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Tuesday, March 6, 2012

Management Plan For Brain Tumor Patients Changed By PET Tracer

Imaging amino acid transporters with positron emission tomography/computed tomography (PET/CT) has been shown to significantly alter intended management plans for patients with brain tumors, according to research in the March issue of The Journal of Nuclear Medicine...





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Patient advocates' role in clinical trials

Abstract

BACKGROUND:

Patient advocates are increasingly involved in cooperative group trials, single-institution cancer programs, and peer-review of research applications. The purpose of this study was to evaluate the role and value of patient advocates from the perspective of Cancer and Leukemia Group B (CALGB) advocates and investigators.

METHODS:

An online survey was sent to current and past (within 5 years) patient advocates and investigators.

RESULTS.

Response rates were 72.7% (16 of 22) for advocates and 56.4% (102 of 181) for investigators. Patient advocates were more likely than investigators to report the following: the clinical trial process benefited from advocate involvement on committees (100% of advocates vs 72.1% of investigators; P < .05), advocates contribute to protocol development (92.8% vs 33.8%, respectively; P < .001), the cultural appropriateness of protocols (21.4% vs 10.4%, respectively; P < .05), advocates assist with patient accrual (78.6% vs 23.4%, respectively; P < .001), and advocates add value to concept development and protocol review (100% vs 63.2%, respectively; P < .001). Over half of advocates and investigators reported gaps in patient advocate knowledge and suggested that additional clinical trials training was needed. To improve clinical trials, advocates suggested their earlier involvement in protocol development and increased support from investigators. CALGB investigators recommended improving patient advocate selection and communication skills training:

CONCLUSIONS:

The majority of patient advocates and investigators perceived benefits from advocate involvement in the clinical trials process; patient advocates placed more value on their role than investigators. The current results indicated that strategies to improve advocacy training and advocate-investigator communication may further enhance the role of patient advocates, and future studies that clarify the role of advocates in the prioritization and development of protocol, consent, and education materials, and on patient accrual, are warranted. Cancer 2012;. © 2012 American Cancer Society.






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Potential New Target To Counteract Brain Tumor Resistance To Therapy

Persistent protein expression may explain why tumors return after therapy in glioblastoma patients, according to a study published in the Journal of Experimental Medicine. Current therapy for glioblastoma, the most prevalent malignant brain tumor in adults, includes targeting a protein called VEGF, which promotes the growth of blood vessels to the tumor...





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Thursday, March 1, 2012

Intraoperative DTI and brain mapping for surgery of neoplasm of the motor cortex and the corticospin

Abstract  
We report our preliminary series of patients treated for lesions involving the motor cortex and the corticospinal tract in BrainSuite, with intraoperative MRI, tractography and "neuronavigated" electrophysiological cortical and subcortical mapping. An exact localization of the cortical and subcortical functional areas is mandatory for executing surgery of intra-parenchymal neoplasm involving the motor cortex and the corticospinal tract. Nowadays modern technology offers a variety of tools to reduce as much as possible postoperative deficits during surgery of cerebral eloquent areas. From December 2008 and June 2010, 18 patients underwent functional surgery, for neoplasm involving the motor cortex and/or the subcortical pathway, in BrainSuite. Our preliminary series include 14 gliomas and 4 metastases; Table 1 summarizes all of the data. We included in this series patients with complete removal of lesions of eloquent areas with an average distance from the corticospinal tract of 4 mm. Six neoplasms were considered in contact and/or involving the motor cortex, while in 18 cases (100%) the tumour involved eloquent areas concerning the corticospinal tract. All of the patients underwent complete removal of the lesion as subsequently demonstrated by intraoperative postsurgical MRI. Our series highlights the good integration and the high compatibility between BrainSUITE with 1.5 T intraoperative magnetic field and neurophysiological monitoring. We strongly believe that intraoperative MRI with DTI allows us to treat complex surgery tumours that without its auxilium we would not be able to deal with.
Table 1 Summary of intraoperative data

Case

Name

Age

Sex

Histology

Surgical risk

Resection

Distance from tract

Distance of MEP (mm)

Immediate outcome

Quality of life

Recovery

1

A. M.

68

M

Low grade

Tract

Complete

In contact

0

Improved

Excellent

Immediate

2

B. S.

39

F

Metastasis

Tract

Complete

7 mm

7

Unchanged

Excellent

Immediate

3

C. M.

77

M

Glioma

Tract

Complete

In contact

0

Improved

Excellent

Immediate

4

D. C.

67

M

Glioma

Tract

Complete

In contact

0

Unchanged

Excellent

Immediate

5

D. M. N.

42

M

Metastasis

Tract/cortex

Complete

In contact

5

Improved

Excellent

Immediate

6

F. V.

66

F

Glioma

Tract

Complete

15 mm

15

Unchanged

Excellent

Immediate

7

P. A.

37

M

Oligodendroglioma

Tract/cortex

Complete

In contact

2

Mild paresis

Excellent

3 months

8

S. M.

65

F

Low grade

Tract/cortex

Complete

In contact

0

Unchanged

Excellent

Immediate

9

M. L.

66

F

Glioma

Tract

Complete

4 mm

4

Improved

Excellent

Immediate

10

R. G.

40

F

Glioma

Tract

Complete

12 mm

12

Improved

Excellent

Immediate

11

Q. A.

26

M

Glioma

Tract

Complete

6 mm

6

Improved

Excellent

Immediate

12

A. G.

68

F

Glioma

Tract

Complete

8 mm

8

Improved

Excellent

Immediate

13

P. C.

50

F

Glioma

Tract

Complete

In contact

2

Improved

Excellent

Immediate

14

P. I.

50

M

Metastasis

Tract/cortex

Complete

In contact

0

Unchanged

Excellent

Immediate

15

C. A.

75

F

Glioma

Tract

Complete

In contact

2

Improved

Optimum

Immediate

16

C. L.

76

M

Glioma

Tract

Complete

In contact

0

Unchanged

Optimum

Immediate

17

R. A.

54

F

Glioma

Tract/cortex

Complete

In contact

0

Improved

Excellent

Immediate

18

D. N.

43

M

Metastasis

Tract/cortex

Complete

In contact

0

Monoparesis

Excellent

1 month

  • Content Type Journal Article
  • Category Original Article
  • Pages 1-12
  • DOI 10.1007/s10143-012-0373-6
  • Authors
    • Giancarlo D'Andrea, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy
    • Albina Angelini, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy
    • Andrea Romano, S Andrea Hospital, Institute of Neuroradiology, University of Rome "La Sapienza", Rome, Italy
    • Antonio Di Lauro, S Andrea Hospital, Institute of Anesthesiology, University of Rome "La Sapienza", Rome, Italy
    • Giovanni Sessa, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy
    • Alessandro Bozzao, S Andrea Hospital, Institute of Neuroradiology, University of Rome "La Sapienza", Rome, Italy
    • Luigi Ferrante, S Andrea Hospital, Institute of Neurosurgery, University of Rome "La Sapienza", V. Raineri 27, 00151 Rome, Italy





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