Saturday, November 29, 2014

Clinical Outcome and Quality of Life After Treatment of Patients with Central Neurocytoma

Neurosurgery Clinics of North America

Central neurocytoma (CN) is an uncommon, deep-seated tumor of the central nervous system. Optimal treatment strategies and long-term outcomes are not well established. The mainstay of initial treatment CN is total surgical resection whenever possible; however, CNs cannot be resected completely in more than half of patients. Advances in alternative and adjuvant treatments and their role in the treatment of CN is becoming significant. This article provides an overview of the clinical outcomes of various treatment modalities, recent advances, and recommendations for the treatment of CN, emphasizing functional outcomes and the quality of life.

Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00102-8/abstract?rss=yes

A Report on Quality and Safety Education for Radiation Oncology Residents

International Journal of Radiation Oncology * Biology * Physics

In 2010, ASTRO proposed a Target Safely plan, which includes expanding educational training programs. Special courses on quality and safety as well as adding the additional content to existing educational programs was specifically recommended in the 6-point plan (1). This report describes the design, deployment, and initial attendee feedback on a quality and safety mini-course for medical and physics radiation oncology residents.

Original Article: http://www.redjournal.org/article/S0360-3016(14)03691-8/abstract?rss=yes

Wednesday, November 26, 2014

[Articles] Tumour genomic and microenvironmental heterogeneity for integrated prediction of 5-year biochemical recurrence of prostate cancer: a retrospective cohort study

The Lancet Oncology

This is the first study of cancer outcome to integrate DNA-based and microenvironment-based failure indices to predict patient outcome. Patients exhibiting these aggressive features after biopsy should be entered into treatment intensification trials.

Original Article: http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)71021-6/abstract?rss=yes

Cerebral Performance Category at Hospital Discharge Predicts Long-Term Survival of Cardiac Arrest Survivors Receiving Targeted Temperature Management*

Critical Care Medicine - Most Popular Articles

Objective: Despite recent advancements in post–cardiac arrest resuscitation, the optimal measurement of postarrest outcome remains unclear. We hypothesized that Cerebral Performance Category score can predict the long-term outcome of postarrest survivors who received targeted temperature management during their postarrest hospital care. Design: Retrospective chart review. Setting: Two academic medical centers from May 2005 to December 2012. Patients: The medical records of 2,417 out-of-hospital and in-hospital patients post cardiac arrest were reviewed to identify 140 of 582 survivors who received targeted temperature management. Interventions: None. Measurements and Main Results: The Cerebral Performance Category scores at hospital discharge were determined by three independent abstractors. The 1-month, 6-month, and 12-month survival of these patients was determined by reviewing hospital records and querying the Social Security Death Index and by follow-up telephone calls. The association of unadjusted long-term survival and adjusted survival with Cerebral Performance Category was calculated. Of the 2,417 patients who were identified to have undergone cardiac arrest, 24.1% (582/2,417) were successfully resuscitated, of whom 24.1% (140/582) received postarrest targeted temperature management. Overall, 42.9% of patients (60/140) were discharged with Cerebral Performance Category 1, 27.1% (38/140) with Cerebral Performance Category 2, 18.6% (26/140) with Cerebral Performance Category 3, and 11.4% (16/140) with Cerebral Performance Category 4. Cerebral Performance Category 1 survivors had the highest long-term survival followed by Cerebral Performance Categories 2 and 3, with Cerebral Performance Category 4 having the lowest long-term survival (p < 0.001, log-rank test). We found that Cerebral Performance Category 3 (hazard ratio = 3.62, p < 0.05) and Cerebral Performance Category 4 (hazard ratio = 12.73, p < 0.001) remained associated with worse survival after adjusting for age, gender, race, shockable rhythm, time to targeted temperature management initiation, total duration of resuscitation, withdrawal of care, and location of arrest. Conclusion: Patients with different Cerebral Performance Category scores at discharge have significantly different survival trajectories. Favorable Cerebral Performance Category at hospital discharge predicts better long-term outcomes of survivors of cardiac arrest who received targeted temperature management than those with less favorable Cerebral Performance Category scores.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2014/12000/Cerebral_Performance_Category_at_Hospital.13.aspx

Cognitive function and social attainment in adult survivors of retinoblastoma: A report from the St. Jude Lifetime Cohort Study

Cancer

BACKGROUND

Retinoblastoma has a 5-year survival rate exceeding 95%, yet little is known about long-term functional outcomes for these patients.

METHODS

Sixty-nine adult survivors of retinoblastoma (mean age, 33 years; mean years post-diagnosis, 31) who had enrolled in the St. Jude Lifetime Cohort Study completed clinical cognitive evaluations and questionnaires assessing adult social attainment. Scores on all cognitive measures were converted to z-scores (M = 0, SD = 1) using age-adjusted normative data. Multivariable linear regression analyses, adjusted for age at diagnosis and disease laterality, were used to examine associations between disease and treatment exposures and cognitive outcomes.

RESULTS

Retinoblastoma survivors performed within normative expectations across most cognitive domains. In multivariable models, adjusted for disease laterality, survivors diagnosed at ≤1 year of age performed significantly better on measures of short-term verbal memory (β = 0.87, P<.01), long-term verbal memory (β = 0.66, P = .02), verbal learning (β = 0.67, P = .02), and verbal reasoning abilities (β = 0.79, P<.01) compared with survivors diagnosed at >1 year of age. In multivariable models, restricted to bilateral survivors and adjusted for age at diagnosis, whole brain radiation exposure was significantly associated with poorer performance on tasks of short-term verbal memory (β = −0.003, P = .03) and long-term verbal memory (β = −0.003, P = .01). Reported social attainment was consistent with adult developmental expectations.

CONCLUSIONS

Adult survivors of retinoblastoma demonstrate few cognitive or social attainment deficits decades following diagnosis and treatment. Findings suggest the potential for neural reorganization following early insult to the visual system as well as vulnerability of the developing brain to low dose radiation exposure. Early intervention and rehabilitation will be important for these patients. Cancer 2014. © 2014 American Cancer Society.

Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28924

Monday, November 24, 2014

TV APARECIDA | Tumor cerebral: conheça as causas e os tratamentos!

Santa Receita | Tumor cerebral: conheça as causas e os tratamentos! - 24 de Novembro de 2014

TV APARECIDA

Check out this video on YouTube:

http://youtu.be/QV8B_yWwVOc

Saturday, November 22, 2014

“Potential Therapy Found for Incurable Pediatric Brain Tumor,” Robert H. Lurie Comprehensive Cancer Center at Northwestern University

"Potential Therapy Found for Incurable Pediatric Brain Tumor," Robert H. Lurie Comprehensive Cancer Center at Northwestern University

National Comprehensive Cancer Network

Northwestern Medicine scientists have discovered a new potential drug therapy for a rare, incurable pediatric brain tumor by targeting a genetic mutation found in children with the cancer. By inhibiting the tumor-forming consequences of the mutation using an experimental drug called GSKJ4, they delayed tumor growth and prolonged survival in mice with pediatric brainstem glioma. Robert H. Lurie Comprehensive Cancer Center at Northwestern University is one of the 25 NCCN Member Institutions....

Original Article: http://www.feinberg.northwestern.edu/news/2014/11/Hashizume-pediatric-tumor-therapy.html

How Doctors Determine the Moment of Death [Excerpt]

Scientific American: Mind and Brain

The definition of death is hazy but important for medical decisions, explains Harvard neurologist Allan Ropper in the new book Reaching Down the Rabbit Hole

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/how-doctors-determine-the-moment-of-death-excerpt/

Facial Nerve Preservation Surgery for Koos Grade 3 and 4 Vestibular Schwannomas

Neurosurgery - Most Popular Articles

BACKGROUND: Facial nerve preservation surgery for large vestibular schwannomas is a novel strategy for maintaining normal nerve function by allowing residual tumor adherent to this nerve or root-entry zone. OBJECTIVE: To report, in a retrospective study, outcomes for large Koos grade 3 and 4 vestibular schwannomas. METHODS: After surgical treatment for vestibular schwannomas in 52 patients (2004-2013), outcomes included extent of resection, postoperative hearing, and facial nerve function. Extent of resection defined as gross total, near total, or subtotal were 7 (39%), 3 (17%), and 8 (44%) in 18 patients after retrosigmoid approaches, respectively, and 10 (29.5%), 9 (26.5%), and 15 (44%) for 34 patients after translabyrinthine approaches, respectively. RESULTS: Hearing was preserved in 1 (20%) of 5 gross total, 0 of 2 near-total, and 1 (33%) of 3 subtotal resections. Good long-term facial nerve function (House-Brackmann grades of I and II) was achieved in 16 of 17 gross total (94%), 11 of 12 near-total (92%), and 21 of 23 subtotal (91%) resections. Long-term tumor control was 100% for gross total, 92% for near-total, and 83% for subtotal resections. Postoperative radiation therapy was delivered to 9 subtotal resection patients and 1 near-total resection patient. Follow-up averaged 33 months. CONCLUSION: Our findings support facial nerve preservation surgery in becoming the new standard for acoustic neuroma treatment. Maximizing resection and close postoperative radiographic follow-up enable early identification of tumors that will progress to radiosurgical treatment. This sequential approach can lead to combined optimal facial nerve function and effective tumor control rates. ABBREVIATIONS: GTR, gross total resection NTR, near-total resection STR, subtotal resection

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/12000/Facial_Nerve_Preservation_Surgery_for_Koos_Grade_3.17.aspx

Thursday, November 20, 2014

Neurosurgery Internet TV Show Friday 5 pm EST

Greetings

Here is the promo video for the 2nd weekly "Neurosurgery Internet TV" show

with George Mendes MD, Brazilian Neurosurgeon, who is currently in France doing a Senior Clinical Fellowship at Dupuytren University Hospital.

http://youtu.be/viAw84KncRY

George is going to speak about Hybrid vascular neurosurgery- dual training open and endovascular methods

There will be a panel including Julio Pereira MD, Neurosurgeon from Sao Paulo, who will be moderator.

You can watch at

www.Neurosurgical.TV

can tweet, comments, and questions, LIVE, at 5 pm EST Friday.

And if anyone has an idea for a presentation, we welcome ideas, etc.

John Bennett MD

for Julio Pereira MD

Wednesday, November 19, 2014

Bullets and Brain - Andrew Wilner MD Neurologist talks about his book

Check out this video on YouTube:

http://youtu.be/gHhzbwWCmJk

Neurosurgery App (FREE)

https://itunes.apple.com/br/app/neurosurgery-app/id587505622?l=en&mt=8

https://play.google.com/store/apps/details?id=com.sodavirtual.neurosurgery

DESCRIPTION

Latest news, researches and blog about Neurology, Neuroscience and Neurosurgery.
To provide neurosurgeons with the most timely comprehensive and relevant clinical information to improve patient care.
The mission of Neurosurgery blog is to facilitate the equitable, global dissemination of high-quality health research; to promote international dialogue and collaboration on health issues; to improve clinical practice; and to expand and deepen the understanding of health and health care.

http://www.neurosurgic.com/index.php?option=com_myblog&show=neurosurgery-app-free-.html&Itemid=337

Why do we need to have so many meetings?

Scientific American: Mind and Brain

These days my calendar is a source of stress. My morning routine of reviewing my appointments for the day during my commute often leaves me dreading the coming workday—and frantically looking...

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/blog/post/why-do-we-need-to-have-so-many-meetings/

Evaluation of permanent alopecia in pediatric medulloblastoma patients treated with proton radiation

Radiation Oncology

Background: To precisely calculate skin dose and thus to evaluate the relationship between the skin dose and permanent alopecia for pediatric medulloblastoma patients treated with proton beams. Methods: The dosimetry and alopecia outcomes of 12 children with medulloblastoma (ages 4-15 years) comprise the study cohort. Permanent alopecia was assessed and graded after completion of the entire therapy. Skin threshold doses of permanent alopecia were calculated based on the skin dose from the craniospinal irradiation (CSI) plan using the concept of generalized equivalent uniform dose (gEUD) and accounting for chemotherapy intensity. Monte Carlo simulations were employed to accurately assess uncertainties due to beam range prediction and secondary particles. Results: Increasing the dose of the CSI field or the dose given by the boost field to the posterior fossa increased total skin dose delivered in that region. It was found that permanent alopecia could be correlated with CSI dose with a threshold of about 21?Gy (relative biological effectiveness, RBE) with high dose chemotherapy and 30?Gy(RBE) with conventional chemotherapy. Conclusions: Our results based on 12 patients provide a relationship between the skin dose and permanent alopecia for pediatric medulloblastoma patients treated with protons. The alopecia risk as assessed with gEUD could be predicted based on the treatment plan information.

Original Article: http://www.ro-journal.com/content/9/1/220

Monday, November 17, 2014

Long-Term Cell Phone Use Linked to Brain Tumor Risk

Medscape NeurologyHeadlines

The most recent study results show that the risk for glioma triples with long-term exposure to radiofrequency electromagnetic fields emitted by wireless phones.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/834888?src=rss

The Impact of Adjuvant Radiation Therapy for High-Grade Gliomas by Histology in the United States Population

Neurosurgery Blog

The Impact of Adjuvant Radiation Therapy for High-Grade Gliomas by Histology in the United States Population

International Journal of Radiation Oncology * Biology * Physics

To compare the survival impact of adjuvant external beam radiation therapy (RT) for malignant gliomas of glioblastoma (GBM), anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), and mixed anaplastic oligoastrocytoma (AOA) histology.

Original Article: http://www.redjournal.org/article/S0360-3016(14)03558-5/abstract?rss=yes

The post The Impact of Adjuvant Radiation Therapy for High-Grade Gliomas by Histology in the United States Population appeared first on NEUROSURGERY BLOG.

Original Article: http://neurocirurgiabr.com/the-impact-of-adjuvant-radiation-therapy-for-high-grade-gliomas-by-histology-in-the-united-states-population/?utm_source=rss&utm_medium=rss&utm_campaign=the-impact-of-adjuvant-radiation-therapy-for-high-grade-gliomas-by-histology-in-the-united-states-population

Rede Vida: Dalcides Biscalquin entrevista Júlio Pereira

Neurosurgery Blog

Programa Tribuna Independente (Rede Vida) entrevista: Júlio Pereira – Neurocirurgião e Escritor

Clique para assistir:

https://www.youtube.com/watch?v=FJ2emgzMt2E&list=UUC1_Drela_P4MAW8pPcdjSw

The post Rede Vida: Dalcides Biscalquin entrevista Júlio Pereira appeared first on NEUROSURGERY BLOG.

Original Article: http://neurocirurgiabr.com/rede-vida-dalcides-biscalquin-entrevista-julio-pereira/?utm_source=rss&utm_medium=rss&utm_campaign=rede-vida-dalcides-biscalquin-entrevista-julio-pereira

Practice changing mature results of RTOG study 9802: another positive PCV trial makes adjuvant chemotherapy part of standard of care in low-grade glioma

Neuro-Oncology - current issue

The long-term follow-up of the RTOG 9802 trial that compared 54 Gy of radiotherapy (RT) with the same RT followed by adjuvant procarbazine, CCNU, and vincristine (PCV) chemotherapy in high-risk low-grade glioma shows a major increase in survival after adjuvant PCV chemotherapy. Median overall survival increased from 7.8 years to 13.3 years, with a hazard ratio of death of 0.59 (log rank: P = .002). This increase in survival was observed despite the fact that 77% of patients who progressed after RT alone received salvage chemotherapy. With this outcome, RT + PCV is now to be considered standard of care for low-grade glioma requiring postsurgical adjuvant treatment. Unfortunately, studies on molecular correlates associated with response are still lacking. This is now the third trial showing benefit from the addition of PCV to RT in grade II or III diffuse glioma. The optimal parameter for selecting patients for adjuvant PCV has not yet been fully elucidated, but several candidate markers have so far emerged. It is still unclear whether temozolomide can replace PCV and whether initial management with chemotherapy only is a safe initial treatment. Potentially, that may adversely affect overall survival, but concerns for delayed RT-induced neurotoxicity may limit acceptance of early RT in patients with expected long term survival. The current evidence supports that in future trials, grades II and III tumors with similar molecular backgrounds should be combined, and trials should focus on molecular glial subtype regardless of grade.

Original Article: http://neuro-oncology.oxfordjournals.org/cgi/content/short/16/12/1570?rss=1

Wednesday, November 12, 2014

Cancer Patients in Hospice Face Less Aggressive Treatment

Cancer: MedlinePlus

More health care strategies and costs seen for non-hospice patients at end of life

Source: HealthDay

Original Article: http://www.nlm.nih.gov/medlineplus/news/fullstory_149392.html

Printed NCCN Guidelines for Patients Now Available through Amazon.com

National Comprehensive Cancer Network

Printed NCCN Guidelines for Patients® available for order on Amazon.com for Breast (Stages 0 - IV), Colon, and Pancreatic Cancers; Malignant Pleural Mesothelioma; Melanoma; Multiple Myeloma; and Soft Tissue Sarcoma. FORT WASHINGTON, PA - The National Comprehensive Cancer Network® (NCCN®), with the support of the NCCN Foundation®, announces the availability of printed versions of the NCCN Guidelines for Patients® for order on Amazon.com for the following cancer types: Breast (Stages 0 - IV), C...

Original Article: http://www.nccn.org/about/news/newsinfo.aspx?NewsID=456

Evolution, current status, and way forward for the Asian Oceanian Association of Neurology

Neurology recent issues

The Asian and Oceanian Association of Neurology (AOAN) was established in 1961¹ with the primary aim of promoting neurologic advancement via the exchange of ideas for the development of education programs in neurology. Another major aim of the association is to encourage scientific research geared toward neurologic diseases that are a major health burden in the Asian-Oceanian countries. Charles Poser (World Federation of Neurology [WFN]) and Shigeo Okinaka (Japan) were pivotal in the development of this association and the inaugural Asian Oceanian Congress of Neurology (AOCN) was held in Nippon Teshi Center, October 7–10, 1962, under the leadership of Professor Okinaka. Since then, various countries have hosted the AOCN (table). The 14th AOCN took place in Macao, China, March 2–5, 2014.

Original Article: http://www.neurology.org/cgi/content/short/83/20/1853?rss=1

Education in medical billing benefits both neurology trainees and academic departments

Neurology recent issues

The objective of residency training is to produce physicians who can function independently within their chosen subspecialty and practice environment. Skills in the business of medicine, such as clinical billing, are widely applicable in academic and private practices but are not commonly addressed during formal medical education. Residency and fellowship training include limited exposure to medical billing, but our academic department's performance of these skills was inadequate: in 56% of trainee-generated outpatient notes, documentation was insufficient to sustain the chosen billing level. We developed a curriculum to improve the accuracy of documentation and coding and introduced practice changes to address our largest sources of error. In parallel, we developed tools that increased the speed and efficiency of documentation. Over 15 months, we progressively eliminated note devaluation, increased the mean level billed by trainees to nearly match that of attending physicians, and increased outpatient revenue by $34,313/trainee/year. Our experience suggests that inclusion of billing education topics into the formal medical curriculum benefits both academic medical centers and trainees.

Original Article: http://www.neurology.org/cgi/content/short/83/20/1856?rss=1

Tuesday, November 11, 2014

Neurosurgical.tv - 1st show nov 15

www.neurosurgical.tv

http://www.youtube.com/watch?v=IA5n8BbXNvg&sns=em

Sunday, November 9, 2014

Enhancing Brain Lesions after Endovascular Treatment of Aneurysms

AJNR Blog

Fellows' Journal Club

October 2014

(2 of 3)

These authors present MR images in 7 patients who developed enhancing lesions after endovascular therapy for intracranial aneurysms, 3 of which were symptomatic. The number of lesions increased in 2, was stable in 1, decreased in 3, and disappeared in 1 patient. The authorsput forward that the imaging and clinical characteristics suggested a foreign body reaction. They found no correlation to a specific device, but a possible source may be the generic hydrophilic coating.

EIC signature

Summary

Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We present 7 patients from 5 different institutions that developed MR imaging–enhancing brain lesions after endovascular therapy of aneurysms, detected after a median time of 63 days. The number of lesions ranged from 4–46 (median of 10.5), sized 2–20 mm, and were mostly in the same vascular territory used for access. Three patients presented with symptoms attributable to these lesions. After a median follow-up of 21.5 months, the number of lesions increased in 2, was stable in 1, decreased in 3, and disappeared in 1. The imaging and clinical characteristics suggested a foreign body reaction. We could find no correlation to a specific device, but a possible source may be the generic hydrophilic coating.

Full text

The post Enhancing Brain Lesions after Endovascular Treatment of Aneurysms appeared first on AJNR Blog.

Original Article: http://www.ajnrblog.org/2014/11/08/enhancing-brain-lesions-endovascular-treatment-aneurysms/

Saturday, November 8, 2014

Hariane Fonseca recebe Julio Pereira Neurocirurgião e Escritor no Pgm Temperando o Papo

Conversa sobre Tumor Cerebral: Hariane Fonseca recebe Julio Pereira Neurocirurgião e Escritor no Pgm Temperando o Papo

Check out this video on YouTube:

http://youtu.be/8rvwdI2oxCQ

Potential to predict when breast cancers will spread to the brain

Neurology News & Neuroscience News from Medical News Today

Scientists have found a pattern of genetic 'switches' - chemical marks that turn genes on or off - that are linked to breast cancer's spread to the brain, according to research presented at the...

Original Article: http://www.medicalnewstoday.com/releases/284944.php

The Impact of Adjuvant Radiation Therapy for High-Grade Gliomas by Histology in the United States Population

International Journal of Radiation Oncology * Biology * Physics

Thursday, November 6, 2014

Feasibility of extreme dose escalation for glioblastoma multiforme using 4¿ radiotherapy

Radiation Oncology

Background: Glioblastoma multiforme (GBM) frequently recurs at the same location after radiotherapy. Further dose escalation using conventional methods is limited by normal tissue tolerance. 4? non-coplanar radiotherapy has recently emerged as a new potential method to deliver highly conformal radiation dose using the C-arm linacs. We aim to study the feasibility of very substantial GBM dose escalation while maintaining normal tissue tolerance using 4?. Methods: 11 GBM patients previously treated with volumetric modulated arc therapy (VMAT/RapidArc) on the NovalisTxTM platform to a prescription dose of either 59.4?Gy or 60?Gy were included. All patients were replanned with 30 non-coplanar beams using a 4? radiotherapy platform, which inverse optimizes both beam angles and fluence maps. Four different prescriptions were used including original prescription dose and PTV (4?PTVPD), 100?Gy to the PTV and GTV (4?PTV100Gy), 100?Gy to the GTV only while maintaining prescription dose to the rest of the PTV (4?GTV100Gy), and a 5?mm margin expansion plan (4?PTVPD+5mm). OARs included in the study are the normal brain (brain ? PTV), brainstem, chiasm, spinal cord, eyes, lenses, optical nerves, and cochleae. Results: The 4? plans resulted in superior dose gradient indices, as indicated by >20% reduction in the R50, compared to the clinical plans. Among all of the 4? cases, when compared to the clinical plans, the maximum and mean doses were significantly reduced (p??0.05) for all of the non-brain OARs. Both the 4?PTVPD and 4? GTV100GYplans reduced the mean normal brain mean doses. Conclusions: 4? non-coplanar radiotherapy substantially increases the dose gradient outside of the PTV and better spares critical organs. Dose escalation to 100?Gy to the GTV or additional margin expansion while meeting clinical critical organ dose constraints is feasible. 100?Gy to the PTV result in higher normal brain doses but may be tolerated when delivered in proportionally increased treatment fractions. Therefore, 4? non-coplanar radiotherapy on C-arm gantry may provide an accessible tool to improve the outcome of GBM radiotherapy through extreme dose escalation.

Original Article: http://www.ro-journal.com/content/9/1/239

Long-term outcomes of adjuvant radiotherapy after surgical resection of central neurocytoma

Radiation Oncology

Background and purposeThe role of adjuvant radiotherapy for central neurocytomas (CNs) is not clear. Therefore, we aimed to examine the clinical outcomes of treating histologically confirmed CNs with adjuvant RT after surgical resection.Material and methodsSixty-three CN patients were retrospectively evaluated: 24 patients underwent gross total resection (GTR); 28, subtotal resection (STR); 9, partial resection (PR), and 2, biopsy (Bx). They underwent adjuvant RT after surgery (median dose, 54?Gy). Results: The median follow-up was 69?months (15?129 months). The 5-year overall survival (OS) and 5-year progression-free survival (PFS) were 94.4% and 95% after GTR?+?RT, 96.4% and 100% after STR?+?RT, and 100% and 90.9% after PR?+?RT. Only three patients had tumor recurrence: at the primary site at 30 and 24?months in two GTR?+?PR patients, and dissemination to the spinal cord at 75?months in one STR?+?RT patient. Thirty-eight (63.3%) patients experienced late neurotoxicity (28, grade 1; 7, grade 2; 3, grade 3). Short-term memory impairment was the most common toxicity. Conclusions: RT after incomplete resection (IR) led to OS and PFS comparable to those for GTR. Considering the excellent outcomes and limited late toxicity, adjuvant RT maybe a good option for CN patients who undergo IR.

Original Article: http://www.ro-journal.com/content/9/1/242