Wednesday, May 30, 2012

Costs of multidisciplinary teams in cancer are small in relation to benefits

To see evidence that multidisciplinary teams are effective in cancer is a relief, given the effort required to implement them.1 Whether their efficacy derives from surgical specialisation or the...





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Sunday, May 27, 2012

Prognostic Indexes for Brain Metastases: Which Is the Most Powerful?

Purpose: The purpose of the present study was to compare the prognostic indexes (PIs) of patients with brain metastases (BMs) treated with whole brain radiotherapy (WBRT) using an artificial neural network. This analysis is important, because it evaluates the prognostic power of each PI to guide clinical decision-making and outcomes research.Methods and Materials: A retrospective prognostic study was conducted of 412 patients with BMs who underwent WBRT between April 1998 and March 2010. The eligibility criteria for patients included having undergone WBRT or WBRT plus neurosurgery. The data were analyzed using the artificial neural network. The input neural data consisted of all prognostic factors included in the 5 PIs (recursive partitioning analysis, graded prognostic assessment [GPA], basic score for BMs, Rotterdam score, and Germany score). The data set was randomly divided into 300 training and 112 testing examples for survival prediction. All 5 PIs were compared using our database of 412 patients with BMs. The sensibility of the 5 indexes to predict survival according to their input variables was determined statistically using receiver operating characteristic curves. The importance of each variable from each PI was subsequently evaluated.Results: The overall 1-, 2-, and 3-year survival rate was 22%, 10.2%, and 5.1%, respectively. All classes of PIs were significantly associated with survival (recursive partitioning analysis, P < .0001; GPA, P < .0001; basic score for BMs, P = .002; Rotterdam score, P = .001; and Germany score, P < .0001). Comparing the areas under the curves, the GPA was statistically most sensitive in predicting survival (GPA, 86%; recursive partitioning analysis, 81%; basic score for BMs, 79%; Rotterdam, 73%; and Germany score, 77%; P < .001). Among the variables included in each PI, the performance status and presence of extracranial metastases were the most important factors.Conclusion: A variety of prognostic models describe the survival of patients with BMs to a more or less satisfactory degree. Among the 5 PIs evaluated in the present study, GPA was the most powerful in predicting survival. Additional studies should include emerging biologic prognostic factors to improve the sensibility of these PIs.





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Quality Assessment in Oncology

The movement to improve healthcare quality has led to a need for carefully designed quality indicators that accurately reflect the quality of care. Many different measures have been proposed and continue to be developed by governmental agencies and accrediting bodies. However, given the inherent differences in the delivery of care among medical specialties, the same indicators will not be valid across all of them. Specifically, oncology is a field in which it can be difficult to develop quality indicators, because the effectiveness of an oncologic intervention is often not immediately apparent, and the multidisciplinary nature of the field necessarily involves many different specialties. Existing and emerging comparative effectiveness data are helping to guide evidence-based practice, and the increasing availability of these data provides the opportunity to identify key structure and process measures that predict for quality outcomes. The increasing emphasis on quality and efficiency will continue to compel the medical profession to identify appropriate quality measures to facilitate quality improvement efforts and to guide accreditation, credentialing, and reimbursement. Given the wide-reaching implications of quality metrics, it is essential that they be developed and implemented with scientific rigor. The aims of the present report were to review the current state of quality assessment in oncology, identify existing indicators with the best evidence to support their implementation, and propose a framework for identifying and refining measures most indicative of true quality in oncologic care.





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Why can't I know I have cancer, then do nothing?

Prostate screening is truly a situation in which ignorance is bliss. Knowing you have cancer and not being able to do anything about it could cause mental turmoil.





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Wednesday, May 23, 2012

Potential risk factors for incident glioblastoma multiforme: the Honolulu Heart Program and Honolulu

Abstract  
Glioblastoma multiforme (GBM) is the most common adult primary malignant brain tumor. Ninety percent of adult GBM patients die within 24 months after diagnosis. The etiology of GBM is unknown. The Honolulu Heart Program (HHP) and Honolulu-Asia Aging Study (HAAS) are prospective, cohort studies of cardiovascular and neurodegenerative disease based on 8,006 Japanese–American men followed since 1965. The Japan Hawaii Cancer Study provides data on incident cancer cases in the HHP/HAAS cohort. We used data from these studies to obtain epidemiologic information about GBM. GBM cases were identified by searching the 1965–1998 databases using International Classification of Diseases (ICD-9) codes. Nine histologically confirmed GBM cases, 58–80 years old, were identified. The incidence rate was 6.2/100,000 person–years. Records of each case were reviewed. Selected variables from the first three examinations (1965–1968; 1968–1970; 1971–1974) were used to identify potential candidate GBM risk factors. A multivariate Cox proportional hazards model showed sugar intake and occupational exposure to carbon tetrachloride were independently and significantly associated with development of GBM.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-7
  • DOI 10.1007/s11060-012-0895-3
  • Authors
    • James S. Nelson, Pacific Health Research Institute, Honolulu, HI, USA
    • Cecil M. Burchfiel, Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
    • Desta Fekedulegn, Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
    • Michael E. Andrew, Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA





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Saturday, May 19, 2012

[Correspondence] Neurological disorders in the 11th revision of the International Classification of

The WHO International Classification of Diseases (ICD) provides a taxonomy of nearly all known human diseases, based on the best available evidence. The ICD is the international standard for diagnostic classification and ensures comparable reporting of health data and the homogenous compilation of national morbidity and mortality statistics. All 194 member states of WHO have agreed to use the ICD. Since its foundation in 1948, WHO has been responsible for the listing and organisation of diseases and their periodic revision in the ICD, including the chapter entitled Diseases of the Nervous System.





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Long-term Seizure Control Outcomes After Resection of Gangliogliomas

BACKGROUND: Gangliogliomas are rare glioneuronal tumors that typically cause refractory seizures during the first 3 decades of life. OBJECTIVE: To determine the prognosticators of seizure outcome after surgery for ganglioglioma. METHODS: We reviewed the cases of 66 patients who underwent resection of gangliogliomas at the University of California, San Francisco. Demographic, seizure history, and operative data were examined for statistical association with postoperative seizure outcomes. RESULTS: Of the 66 patients who underwent surgical resection of ganglioglioma, 49 patients (74%) presented with a history of seizures. Of those 49 patients, 50% presented with intractable epilepsy. Temporal lobe gangliogliomas were present in 76% of the patients who presented with a history of seizures. Electrocorticography was performed on 35% of the patients, and of those patients, 82% underwent extended lesionectomy to remove abnormally epileptogenic extralesional tissue. The median follow-up duration was 6.9 years, during which tumor progression occurred in 38% of patients who underwent subtotal resection and in 8% of patients who underwent gross total resection (P = .02). Overall, 85% of patients were seizure free (International League Against Epilepsy class I or II) 5 years after surgery. Subtotal resection was associated with poor seizure outcomes 1 year after resection (odds ratio = 14.6; 95% confidence interval = 2.4-87.7): rates of seizure freedom were 54% after subtotal resection, 96% after gross total resection, and 93% after gross total resection with intraoperative electrocorticography-guided extended lesionectomy. CONCLUSION: We report excellent long-term seizure control outcomes after surgery for gangliogliomas. Intraoperative electrocorticography may be a useful adjunct for guiding extended resection in certain pharmacoresistant epilepsy patients with gangliogliomas. Subtotal resection is associated with higher rates of tumor progression and nonoptimal seizure outcomes. ABBREVIATIONS: AED, antiepileptic drug ECoG, electrocorticography GTR, gross total resection ILAE, International League Against Epilepsy STR, subtotal resection





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Current Surgical Outcomes for Cranial Base Chordomas: Cohort Study of 95 Patients

BACKGROUND: Chordomas of the skull base are locally aggressive neoplasms for which maximal surgical resection confers prolonged survival. OBJECTIVE: To present the largest consecutive surgical series of cranial base chordomas to date, including complications, functional outcome, and overall (OS) and recurrence-free survival (RFS) in early and late eras of our experience. METHODS: From 1988 to 2011, 95 patients with cranial base chordomas were treated, including 56 patients from 1988 to 1999 and 39 from 2000 to 2011. Mean age and average follow-up were 42.6 ± 16.8 years and 38.3 ± 38.5 months, respectively. A historically controlled study design was implemented comparing both eras with respect to 5-year OS, RFS, Karnofsky performance scale at last-follow-up, and complications. RESULTS: Mean 5-year OS and RFS for the entire cohort was 74% ± 6% and 56% ± 8%, respectively. Complete resection rates were similar between groups (68% and 74%, respectively; P = .494). In the 2000 to 2011 era, overall (26%), cranial nerve (10%), vascular (3%), and systemic (0%) complications were less frequent than in the 1988 to 1999 era. Patients in the 2000 to 2011 era were 1.50 times more likely to have a Karnofsky performance scale ≥70 than in the 1988 to 1999 era (95% confidence interval 1.15-1.94; P = .003). There was no significant difference in 5-year RFS between the 1988 to 1999 and 2000 to 2011 eras. Five-year OS was higher in the 2000 to 2011 era (93% ± 6% vs 64% ± 8% for the 1988-1999 era; P = .012). CONCLUSION: Aggressive surgical resection implementing contemporary skull base approaches can be performed with an acceptable complication profile with preservation of functional status, while conferring a similar OS and RFS. ABBREVIATIONS: KPS, Karnofsky performance scale OS, overall survival RFS, recurrence-free survival





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Wednesday, May 16, 2012

Glioblastoma multiforme and cerebral cavernous malformations: intersection of pathophysiologic pathw

Publication year: 2012
Source:Journal of Clinical Neuroscience, Volume 19, Issue 6
Matthew K. Mian, Brian V. Nahed, Brian P. Walcott, Christopher S. Ogilvy, William T. Curry
Cerebral cavernous malformations (CCM) are known to occur in both sporadic and familial forms. To date, there has been no identified association of CCM with glioblastoma multiforme. We present a 69-year-old woman with a 14year history of multiple CCM who developed progressive aphasia. She had no radiation exposure and had only undergone a single computed tomography scan in her entire life. MRI demonstrated irregular gadolinium enhancement in the area of a prior stable CCM, suspicious for a high grade tumor. Stereotactic biopsy revealed a glioblastoma multiforme. This is a unique case of glioblastoma multiforme arising from the "site" of a known CCM. We review the literature on the genetics of cavernous malformations and propose a mechanism for the tumorigenic potential of these vascular malformations.






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A single institution experience of the incidence of extracranial metastasis in glioma

Publication year: 2012
Source:Journal of Clinical Neuroscience
Sekhar Amitendu, Siu Kei David Mak, Ling Ji Min, Wai Hoe Ng
Glioblastoma multiforme (GBM) is the most common and aggressive subtype of all gliomas. The prognosis is poor but despite the aggressiveness of the tumour, extracranial metastasis of glioma is rare. Most documented cases of extracranial metastases of GBM involve leptomeningeal spread to the spine. In this clinical study we aim to review the incidence and location of extracranial metastasis of glioma from the Brain Tumor Database of the National Neuroscience Institute of Singapore, between September 2004 to October 2009. Four of 148 patients (2.7%) were identified, one of whom had pleomorphic xanthoastrocytoma (PXA) with scalp and spinal metastasis, suggestive of haematogenous rather than cerebrospinal fluid spread that has been described elsewhere. To our knowledge, there has been no published report of PXA with scalp metastasis or vertebral metastasis.






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Saturday, May 12, 2012

Anamnesis ( apps iPhone and iPad) English and Portuguese

 
Anamnesis is a universal app to help with anamnesis information gathering and storage. With a simple and practical layout, the app allows physicians, medicine students, nurses, and other healthcare professionals to annotate the most pertinent data regarding the clinical history and physical examination of the patient.The app intends to ease the life of professionals that many times have to annotate the anamnesis in a paper to later copy it into a medical record. With Anamnesis, the annotation can be done directly into the device and will remain stored to be later reviewed by the professional anywhere and anytime he wants.Aside from that, the app also has an Anamnesis Guide that explains the key concepts for understanding the anamnesis, allowing the professional to review pertinent information whenever he wants. Main features:
•Allows collection and reviewing of anamnesis anywhere
•Simple, easy-to-use layout
•Guide to review clinical examination topics
•Multiple exams per patient, sorted by date
•Describe and illustrate with images (from the camera or photo library) many exams (Thorax X-Ray, ECG, Computed Tomography, Magnetic Resonance, Anatomopathological)
•Allows annotation of every possible anamnesis information (General Information, Clinical History, Physical Examination, Laboratory Tests, List of Problems, Surgeries and Procedures…)
•Export to PDF and send to e-mail
•Universal app
•Economy of paper
As a Launching special, Anamnesis will cost just $4.99 until end of May.
Anamnesis can be downloaded directly from App Store


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Friday, May 11, 2012

Radiosurgery to the Postoperative Surgical Cavity: Who Needs Evidence?

There is a growing interest in adjuvant radiosurgery after resection of hematogenous brain metastases. This is exemplified by the approximately 1000 cases reported in mainly retrospective series. These cases fall into four paradigms: adjuvant radiosurgery as an alternative to whole-brain radiotherapy (WBRT), radiosurgery neoadjuvant to the surgical resection, radiosurgery as an intensification of adjuvant WBRT, and adjuvant radiosurgery for patients having failed prior WBRT. These procedures seem well tolerated, with an approximate 5% risk of radiation necrosis. Although crude local control rates for each strategy seem improved over surgery alone, multiple biases make comparisons with standard WBRT difficult without prospective data. Because evidence lags behind clinical practice, an upcoming intergroup trial will aim to clarify the value of the most common tumor bed radiosurgery strategy by randomizing oligometastatic patients between adjuvant WBRT and adjuvant radiosurgery.





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Wednesday, May 9, 2012

Hospital deaths are on decline, but change is slow, says new report

The number of people dying at home rose in the past five years, while hospital deaths declined, show the latest figures on care at the end of life in England.The latest report from the NHS's National...





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Sunday, May 6, 2012

Cervical spine metastases: techniques for anterior reconstruction and stabilization

Abstract  
The surgical management of cervical spine metastases continues to evolve and improve. The authors provide an overview of the various techniques for anterior reconstruction and stabilization of the subaxial cervical spine after corpectomy for spinal metastases. Vertebral body reconstruction can be accomplished using a variety of materials such as bone autograft/allograft, polymethylmethacrylate, interbody spacers, and/or cages with or without supplemental anterior cervical plating. In some instances, posterior instrumentation is needed for additional stabilization.

  • Content Type Journal Article
  • Category Review
  • Pages 1-13
  • DOI 10.1007/s10143-012-0388-z
  • Authors
    • Christina M. Sayama, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA
    • Meic H. Schmidt, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA
    • Erica F. Bisson, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA





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Thursday, May 3, 2012

Atypical and anaplastic meningiomas treated with bevacizumab

Abstract  
Atypical and anaplastic (WHO Grades II and III) meningiomas are aggressive tumors, and patients often progress despite surgery and radiation. There is no known effective chemotherapeutic option for these patients. Meningiomas have a high expression of vascular endothelial growth factor receptor (VEGFR). We sought to retrospectively study the activity of bevacizumab, which is an anti-angiogenic agent targeting the VEGF pathway in these tumors. This is a retrospective review of WHO Grade II and III meningiomas treated at four institutions, selecting only those patients who received bevacizumab. We analyzed radiographic response according to standard RANO criteria, progression-free survival (PFS) and overall survival from the initiation of bevacizumab therapy using Kaplan–Meier statistics. We identified 15 patients across four institutions who carried a diagnosis of atypical or anaplastic meningioma and were treated with bevacizumab. Best radiographic response was stable disease. MR perfusion studies showed decreased tumor blood volume in one patient. Three patients developed non-fatal intratumoral hemorrhage. Median PFS was 26 weeks (95 % CI, 10–29 weeks). Six month PFS rate was 43.8 % (95 % CI, 15.7–69.1 %). Bevacizumab was well-tolerated in our patients, and may be considered in patients who have exhausted radiation and surgical options. Prospective studies are required to define the safety and efficacy of bevacizumab in atypical and anaplastic meningiomas.

  • Content Type Journal Article
  • Category Clinical Study
  • Pages 1-7
  • DOI 10.1007/s11060-012-0886-4
  • Authors
    • Lakshmi Nayak, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
    • Fabio M. Iwamoto, Neuro-Oncology Branch, National Institutes of Health, National Cancer Institute, Bethesda, MD, USA
    • Jeremy D. Rudnick, Department of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
    • Andrew D. Norden, Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, University of Pittsburgh, Boston, MA, USA
    • Eudocia Quant Lee, Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, University of Pittsburgh, Boston, MA, USA
    • Jan Drappatz, Center for Neuro-Oncology, Dana Farber/Brigham and Women's Cancer Center, University of Pittsburgh, Boston, MA, USA
    • Antonio Omuro, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
    • Thomas J. Kaley, Department of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA





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Efficacy of clinically relevant temozolomide dosing schemes in glioblastoma cancer stem cell lines

Abstract  
The effectiveness of temozolomide (TMZ) dosing schemes and the "rechallenge" of recurrent glioblastoma (GBM) with TMZ are controversial. We therefore compared the efficacy of different TMZ dosing schemes against GBM cancer stem cell (CSC) lines in vitro. In O6-methyl-guanidine-methyl-transferase (MGMT)-negative CSC lines, all schedules (1 day on/27 days off, 5 days on/23 days off, 7 days on/7 days off, 21 days on/7 days off, continuous low-dose TMZ) depleted clonogenic cells. In TMZ-resistant CSC lines, the 7 days on/7 days off scheme showed higher toxicity as compared with the other schemes. However, clinically feasible concentrations remained ineffective in highly resistant CSC lines. In addition, none of the schedules induced long-term depletion of clonogenic cells even at the highest concentrations (up to 250 μM). After sublethal TMZ treatment for 5 days, TMZ rechallenge of recovering CSC lines remained effective. Our data advocate CSC lines as in vitro model to address clinical questions. Using this model, our data suggest the effectiveness of TMZ in MGMT-negative CSC lines and support the concept of TMZ rechallenge. The 7 days on/7 days off scheme consistently showed the best activity of all schedules in TMZ-resistant CSC lines.

  • Content Type Journal Article
  • Category Laboratory Investigation
  • Pages 1-8
  • DOI 10.1007/s11060-012-0878-4
  • Authors
    • Dagmar Beier, Department of Neurology and JARA Brain, Hospital Medical School, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
    • Beate Schriefer, Department of Neurology, Medical School, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany
    • Konstantin Brawanski, Department of Neurology, Medical School, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany
    • Peter Hau, Department of Neurology, Medical School, University of Regensburg, Universitätsstrasse 84, 93053 Regensburg, Germany
    • Joachim Weis, Department of Neuropathology, Medical School, RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
    • Jörg B. Schulz, Department of Neurology and JARA Brain, Hospital Medical School, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
    • Christoph P. Beier, Department of Neurology and JARA Brain, Hospital Medical School, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany





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New Clues To How Brain Cancer Cells Migrate And Invade

Researchers have discovered that a protein that transports sodium, potassium and chloride may hold clues to how glioblastoma, the most common and deadliest type of brain cancer, moves and invades nearby healthy brain tissue...





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Wednesday, May 2, 2012

[Cancer and Society] Coffee: the science and art of moderation

I was drinking my usual flask of ginger and ginseng tea on the train to work recently when I was approached by a salesperson promoting a brand of organic coffee imported from Mexico. The coffee was claimed to have medicinal properties, including, of course, the now obligatory anticancer effects. The notion that coffee is perhaps now "good for you" surprised me. WHO classifies coffee as a group 2B carcinogen (albeit in reference to only certain cancers), which is the same designation ascribed to mobile phones.





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