Friday, November 11, 2011

Adrenocorticotropic Hormone-Producing Pituitary Carcinoma with Intracranial Metastases

Publication year: 2011
Source: World Neurosurgery, Available online 10 November 2011
Bhavin R. Shastri, Anil Nanda, Marjorie Fowler, Steven N. Levine
BackgroundPituitary carcinomas are rare and challenging clinical entities. Because of the paucity of cases, there is limited information in the literature on how best to diagnose and treat pituitary carcinomas.MethodsWe review the literature and describe a woman who presented with an adrenocorticotropic hormone (ACTH)-secreting pituitary macroadenoma that later evolved into a carcinoma with intracranial metastases.ResultsA 39-year-old woman presented at age 27 with classic findings of Cushing's syndrome and a pituitary macroadenoma. Her initial treatment was transsphenoidal surgery, during which we confirmed an ACTH-secreting pituitary neoplasm. For 5 years, she was asymptomatic before her first recurrence. During the next 6 years, she underwent four transsphenoidal surgeries and two craniotomies. After each surgery, there was some reduction in the size of the macroadenoma but the residual tumor mass would rapidly enlarge. Immunochemical staining was positive for ACTH, and a stain for Ki-67 antigen showed a high mitotic index. Eleven years after her initial presentation, magnetic resonance imaging revealed bilateral hippocampal and tempero-occipital masses. The patient's health continued to deteriorate, largely from complications of severe hypercortisolemia, and she died from sepsis. At postmortem, the hippocampus and tempero-occipital lobe masses proved to be a pituitary tumor with positive ACTH staining.ConclusionsPituitary carcinomas are rare, may present many years after diagnosis of a primary pituitary adenoma, and should be suspected in patients with persistent or recurrent disease. Reliable histopathologic ways to distinguish between carcinoma and adenoma are difficult because the features of hypercellularity, nuclear pleomorphism, and mitotic figures are not always helpful.





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Stereotactic Biopsy with Electrical Monitoring for Deep-Seated Brain Tumors

Publication year: 2011
Source: World Neurosurgery, Available online 10 November 2011
Hiroshi Ooba, Tatsuya Abe, Yasutomo Momii, Minoru Fujiki
OBJECTIVE:The stereotactic biopsy is widely integrated into clinical practice as an efficient and safe procedure for histologic diagnoses. However, the surgical risk increases when the lesions are close to the eloquence of the adjacent brain. The present report describes two patients with deep-seated brain tumors who underwent a stereotactic biopsy with electrical monitoring and demonstrates the importance of this technique.METHODS:The tentative target and trajectory were determined on a stereotactic map from the Schaltenbrand and Wahren atlas. A Cosman–Roberts–Wells stereotactic frame was applied to the patient. Electrical recording along a single trajectory was used to identify the circumscribed neuronal structures, and electrical simulation was administered to the target. The biopsy point was decided when no adverse events were observed with a low electric current level.RESULTS:A 34-year-old male patient with anaplastic astrocytoma in the putamen and thalamus and an 81-year-old female patient with malignant lymphoma in the midbrain underwent stereotactic biopsies with electrical monitoring. The biopsies were successfully performed without any resulting neurologic deficits.CONCLUSIONS:This report describes two patients with deep-seated brain tumors who underwent stereotactic biopsies with electrical recording and stimulation. The electrical monitoring appears to be a useful technique to complement the ordinary image-guided biopsy.





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Thursday, November 10, 2011

MiRNA expression patterns predict survival in glioblastoma

Background: In order to define new prognostic subgroups in patients with glioblastoma a miRNA screen (> 1000 miRNAs) from paraffin tissues followed by a bio-mathematical analysis was performed. Methods: 35 glioblastoma patients treated between 7/2005 - 8/2008 at a single institution with surgery and postoperative radio(chemo)therapy were included in this retrospective analysis. For microarray analysis the febit biochip "Geniom(R) Biochip MPEA homo-sapiens" was used. Total RNA was isolated from FFPE tissue sections and 1100 different miRNAs were analyzed. Results: It was possible to define a distinct miRNA expression pattern allowing for a separation of distinct prognostic subgroups. The defined miRNA pattern was significantly associated with early death versus long-term survival (split at 450 days) (p = 0.01). The pattern and the prognostic power were both independent of the MGMT status. Conclusions: At present, this is the first dataset defining a prognostic role of miRNA expression patterns in patients with glioblastoma. Having defined such a pattern, a prospective validation of this observation is required.





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In Childhood Cancer, Basic Biology Offers Clues To Better Treatments

By studying tumor biology at the molecular level, researchers are gaining a deeper understanding of drug resistance and how to avoid it by designing pediatric cancer treatments tailored to specific mutations in a child's DNA. In a fruitful collaboration, pediatric oncologists and biochemists are targeting neuroblastoma, an often-deadly childhood cancer of the peripheral nervous system...





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Wednesday, November 9, 2011

Predicting the risk of chemotherapy toxicity in older patients: The Chemotherapy Risk Assessment Sca

Abstract

BACKGROUND:

Tools are lacking to assess the individual risk of severe toxicity from chemotherapy. Such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve.

METHODS:

The authors conducted a prospective, multicentric study of patients aged ≥70 years who were starting chemotherapy. Grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity according to version 3.0 of the Common Terminology Criteria for Adverse Events was defined as severe. Twenty-four parameters were assessed. Toxicity of the regimen (Chemotox) was adjusted using an index to estimate the average per-patient risk of chemotherapy toxicity (the MAX2 index). In total, 562 patients were accrued, and 518 patients were evaluable and were split randomly (2:1 ratio) into a derivation cohort and a validation cohort.

RESULTS:

Severe toxicity was observed in 64% of patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score was constructed along 2 subscores: H toxicity and NH toxicity. Predictors of H toxicity were lymphocytes, aspartate aminotransferase level, Instrumental Activities of Daily Living score, lactate dehydrogenase level, diastolic blood pressure, and Chemotox. The best model included the 4 latter predictors (risk categories: low, 7%; medium-low, 23%; medium-high, 54%; and high, 100%, respectively; Ptrend < .001). Predictors of NH toxicity were hemoglobin, creatinine clearance, albumin, self-rated health, Eastern Cooperative Oncology Group performance, Mini-Mental Status score, Mini-Nutritional Assessment score, and Chemotox. The 4 latter predictors provided the best model (risk categories: 33%, 46%, 67%, and 93%, respectively; Ptrend < .001). The combined risk categories were 50%, 58%, 77%, and 79%, respectively; Ptrend < .001). Bootstrap internal validation and independent sample validation demonstrated stable risk categorization and Ptrend < .001.

CONCLUSIONS:

The CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined score. To the authors' knowledge, this is the first score systematically integrating both chemotherapy and patient risk for older patients and has a potential for future clinical application. Cancer 2011. © 2011 American Cancer Society.






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Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among pati

Abstract

BACKGROUND:

Xerostomia (dry mouth) after head/neck radiation is a common problem among cancer patients, and available treatments are of little benefit. The objective of this trial was to determine whether acupuncture can prevent xerostomia among head/neck patients undergoing radiotherapy.

METHODS:

A randomized, controlled trial among patients with nasopharyngeal carcinoma was conducted comparing acupuncture to standard care. Participants were treated at Fudan University Shanghai Cancer Center, Shanghai, China. Forty patients were randomized to acupuncture treatment and 46 to standard care. Patients were treated 3×/wk on the same days they received radiotherapy. Subjective measures included the Xerostomia Questionnaire and MD Anderson Symptom Inventory-Head and Neck (MDASI-HN). Objective measures were unstimulated and stimulated whole salivary flow rates. Patients were followed for 6 months after the end of radiotherapy.

RESULTS:

Xerostomia Questionnaire scores for acupuncture were statistically significantly lower than for controls starting in week 3 through the 6 months (P = .003 at week3, all other P < .0001), with clinically significant differences as follows: week 11, relative risk (RR) 0.63 (95% confidence interval [CI], 0.45-0.87); 6 months, RR 0.38 (95% CI, 0.19-0.76). Similar findings were seen for MDASI-HN scores. Group differences emerged as early as 3 weeks into treatment for saliva (unstimulated whole salivary flow rate, P = .0004), with greater saliva flow in the acupuncture group at week 7 (unstimulated whole salivary flow rate, P < .0001; stimulated whole salivary flow rate, P = .002) and 11 (unstimulated whole salivary flow rate, P < .02; stimulated whole salivary flow rate, P < .03) and at 6 months (stimulated whole salivary flow rate, P < .003).

CONCLUSIONS:

Acupuncture given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life. Cancer 2011. © 2011 American Cancer Society.






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Salvage gamma knife stereotactic radiosurgery followed by bevacizumab for recurrent glioblastoma mul

Abstract  
We evaluated the efficacy and safety of gamma knife stereotactic radiosurgery (GKSR) followed by bevacizumab combined with chemotherapy in 11 patients with recurrent glioblastoma multiforme who experienced tumor progression despite aggressive initial multi-modality treatment. Our experience included eight male and three female patients. The median patient age at GKSR was 62 years (range 46–72 years). At the time of GKSR, seven patients had a first recurrence and four had two or more recurrences. The median interval from the initial diagnosis until GKSR was 17 months (range 5–34.5 months). The median tumor volume was 13.6 cm3 (range 1.2–45.1 cm3) and the median margin dose of GKSR was 16 Gy (range 13–18 Gy). Following GKSR, bevacizumab was administrated with irinotecan in nine patients and with temozolomide in one patient. One patient was treated with bevacizumab monotherapy. The treatment outcomes were compared to 44 case-matched controls who underwent GKSR without additional bevacizumab. At a median of 13.7 months (range 4.6–28.3 months) after radiosurgery, tumor progression was evident in seven patients. The median progression-free survival (PFS) was 15 months (95% confidential interval (CI), 6.5–23.3 months). Six-month and 1-year PFS rates were 73 and 55%, respectively. The median overall survival (OS) from GKSR was 18 months (95% CI, 10.1–25.7 months) and 1-year OS rate was 73%. One patient (9%) experienced grade III toxicity and one patient (9%) had major adverse radiation effects. Compared with patients who did not receive bevacizumab, the patients who received bevacizumab had significantly prolonged PFS (15 months vs. 7 months, P = 0.035) and OS (18 months vs. 12 months, P = 0.005), and were less likely to develop an adverse radiation effect (9 vs. 46%, P = 0.037). The combination of salvage GKSR followed by bevacizumab added potential benefit and little additional risk in a small group of patients with progressive glioblastoma. Further experience is needed to define the efficacy and long-term toxicity with this strategy.

  • Content Type Journal Article
  • Category Clinical Study - Patient Study
  • Pages 1-11
  • DOI 10.1007/s11060-011-0744-9
  • Authors
    • Kyung-Jae Park, Department of Neurosurgery, College of Medicine, Korea University, Seoul, Korea
    • Hideyuki Kano, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
    • Aditya Iyer, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
    • Xiaomin Liu, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
    • Ajay Niranjan, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
    • John C. Flickinger, Departments of Radiation Oncology, Center for Image-Guided Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
    • Frank S. Lieberman, Departments of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
    • L. Dade Lunsford, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA
    • Douglas Kondziolka, Departments of Neurological Surgery, Center for Image-Guided Neurosurgery, University of Pittsburgh, Suite B-400, UPMC Presbyterian, 200 Lothrop Street, Pittsburgh, PA 15213, USA





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Tuesday, November 8, 2011

USPSTF Updates Skin Cancer Prevention Counseling Guidelines

To reduce risk for skin cancer, the USPSTF recommends counseling fair skinned persons aged 10-24 years to minimize exposure to UV radiation.
Medscape Medical News





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Sunday, November 6, 2011

Mechanism Discovered In Brain Cancer Responsible For Neuron Death

Researchers from Virginia Commonwealth University Massey Cancer Center and the VCU Institute of Molecular Medicine have discovered a mechanism by which glioblastoma multiforme (GBM), the most common form of brain cancer, promotes the loss of function or death of neurons, a process known as neurodegeneration...





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Saturday, November 5, 2011

Glioblastoma survival in the United States before and during the temozolomide era

Abstract  
The standard-of-care treatment for newly diagnosed glioblastoma changed in 2005, when radiation therapy plus temozolomide chemotherapy replaced radiation therapy alone. It is not yet clear how this change in treatment has influenced patient survival in routine clinical practice, or if a survival benefit extends to patients older than those enrolled in the trial. Data from the Surveillance, Epidemiology, and End Results (SEER) Program was analyzed to compare survival of adult glioblastoma patients diagnosed from 2000–2003 to patients diagnosed from 2005–2008, in order to evaluate pre-temozolomide and post-temozolomide periods. The Kaplan–Meier method and Cox proportional hazards models were used. 6,673 patients with glioblastoma diagnosed from 2000–2003 and 7,259 patients diagnosed from 2005–2008 were identified. Median survival times of all patients diagnosed in the 2000–2003 and 2005–2008 periods were 8.1 and 9.7 months, respectively. Amongst patients treated with surgery and a radiation-containing regimen, median survival was 12.0 months in 2000–2003 and 14.2 months in 2005–2008. In the temozolomide era, median survival times ranged from a high of 31.9 months in patients age 20–29 to a low of 5.6 months in patients age 80 and older. The survival of patients with newly diagnosed glioblastoma improved from 2000–2003 to 2005–2008, likely due to temozolomide use. However, median survival time after glioblastoma diagnosis in the SEER population remains well under one year, largely driven by poor prognosis in elderly patients.

  • Content Type Journal Article
  • Category Clinical Study - Patient Study
  • Pages 1-6
  • DOI 10.1007/s11060-011-0749-4
  • Authors
    • Derek R. Johnson, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
    • Brian Patrick O'Neill, Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA





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