Radiocirurgia

Abstract Survival outcomes and patterns of care for brain tumor patients in the USA Veterans population have not been previously published and the extent of variation in outcomes between Veterans and the rest of the USA is currently unknown. The Veterans healthcare administration (VA) provides comprehensive care to Veterans and their families and maintains the Veterans affairs central cancer registry (VACCR). This was a retrospective review of microscopically-confirmed, supratentorial glioblastoma multiforme in male Veterans actively followed by the VACCR; survival was analyzed and compared to a national cohort from the surveillance, epidemiology and end results program. We analyzed 1,219 Veterans with glioblastomas diagnosed between 1997 and 2006. Median survival was 6.5 months and 1, 2, and 5 years survival rates were 26.8, 5.4, and 0.5%, respectively. Patients receiving all three treatment modalities (surgical resection, radiotherapy, and chemotherapy) did best; these findings remained true among patients aged 70 and older such that these patients had an overall survival similar to those age <70. A comparable national cohort had longer median survival (9.0 months) and greater 1, 2, and 5 years survival rates (37.8, 12.8, and 4.1%) than the VA cohort. Survival and patterns of care are presented for the first time for Veterans with glioblastoma multiforme. In conclusion, we found that more aggressive therapy was associated with better survival, even among elderly Veterans and whether compared overall or by age group, VA patients showed decreased survival relative to a national cohort. We believe this potential disparity warrants further investigation.

• Content Type Journal Article
• Category Clinical Study – Patient Study
• Pages 1-9
• DOI 10.1007/s11060-011-0702-6
• Authors
  • Robert T. Arrigo, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA
  • Maxwell Boakye, Outcomes Research Lab, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA
  • Stephen L. Skirboll, Outcomes Research Lab, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, USA

• Journal Journal of Neuro-Oncology
• Online ISSN 1573-7373
• Print ISSN 0167-594X

http://www.springerlink.com/content/b641m682321l14u0/

Abstract

BACKGROUND:

Survival after a glioblastoma multiforme (GBM) diagnosis remained static during the several decades before 1999. We hypothesized that the progressive increase in temozolomide use for GBM treatment that began in 1999 in the United States would be paralleled by a corresponding improvement in survival.

METHODS:

We included 19,674 GBM cases, ages 20 years or greater, diagnosed 1993 to 2007 in the population-based Surveillance, Epidemiology, and End Results Program database. We used proportional hazards models to calculate calendar period hazard ratios (HR) and 95% confidence intervals (CI), adjusted for demographic covariates. We compared survival across periods using the Kaplan-Meier method.

RESULTS:

Starting with cases diagnosed in 1999 to 2001, we observed a progressive decrease in HRs compared with cases diagnosed in 1993 to 1995. The multivariate-adjusted HR for 2005 to 2007 versus 1993 to 1995 was 0.69 (95% CI, 0.65-0.72). Age-stratified analyses revealed that this progressive decrease occurred in all age groups except 80+ years. Two-year survival increased from 7% among cases diagnosed in 1993 to 1995 and 1996 to 1998 to 9% among cases diagnosed in 1999 to 2001, 13% in 2002 to 2004, and 17% in 2005 to 2007. The disparity in survival between young and old patients increased in the temozolomide era, with 2-year survival of 39% among cases diagnosed at ages 20 to 44 years and 1% among cases diagnosed at 80+ years in 2005 to 2007.

CONCLUSIONS:

We observed a modest, but meaningful, population-based survival improvement for GBM patients in the United States. Widespread adoption of temozolomide represents the most likely explanation, although other treatment advances, such as increased extent of surgical resection, also may have played a role. Cancer 2011;. © 2011 American Cancer Society.

http://dx.doi.org/10.1002%2Fcncr.26494

Abstract Thalidomide and procarbazine have demonstrated single agent activity against malignant gliomas (MG). We evaluated the combination of thalidomide and procarbazine with a single arm phase II trial in adults with recurrent or progressive MG. Procarbazine was given at a dose of 250 mg/m2/d × 5day q 28 days. Thalidomide was administered at a dose of 200 mg/day continuously. Intrapatient dose escalation of thalidomide was attempted (increase by 100 mg/day weekly as tolerated) to a maximum of 800 mg/day. The primary outcome was tumor response, assessed by MRI and CT. Secondary outcomes were progression free survival (PFS), overall survival (OS) and toxicity. In addition, quality of life questionnaires were performed at baseline and prior to each odd cycle in all treated patients. Eighteen patients (median age of 50) were accrued and received a total of 36 cycles (median 2) of therapy. The median maximum thalidomide dose achieved was 400 mg (range 0–800). No complete or partial responses were seen. One patient (6%) experienced stable disease, fourteen (78%) progressed as best response and three (17%) were not evaluable for response. Median time to progression was 2.1 months (95% CI, 1.5–2.5). Seventeen patients have died (one patient lost to follow-up after progression); median survival from enrollment was 7.6 months (95% CI, 3.5–9.4). Grade 3/4 drug related toxicity was minimal. Quality of life diminished over time. The combination of thalidomide and procarbazine demonstrated no efficacy in this trial.

• Content Type Journal Article
• Category Clinical Study – Patient Study
• Pages 1-7
• DOI 10.1007/s11060-011-0698-y
• Authors
  • Jimmy Ruiz, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Doug Case, Biostatistical Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Gina Enevold, Radiation Oncology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Robin Rosdhal, Radiation Oncology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Stephen B. Tatter, Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Thomas L. Ellis, Neurosurgery, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Richard P. McQuellon, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Kevin P. McMullen, Radiation Oncology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Volker W. Stieber, Radiation Oncology, Forsyth Medical Center, Winston-Salem, NC 27157, USA
  • Edward G. Shaw, Radiation Oncology, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA
  • Glenn J. Lesser, Section on Hematology and Oncology, Department of Internal Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157, USA

• Journal Journal of Neuro-Oncology
• Online ISSN 1573-7373
• Print ISSN 0167-594X

http://www.springerlink.com/content/crn5h70821u10407/

Publication year: 2011
Source: Journal of Clinical Neuroscience, In Press, Corrected Proof, Available online 24 August 2011
Ruth A., Mitchell , Joshua Mingsheng, Ye , Simone, Mandelstam , Patrick, Lo
Gliomatosis cerebri (GC) is an uncommon brain tumour defined as a diffuse neoplastic glial cell infiltration of the brain, involving more than two cerebral lobes and, occasionally, the infratentorial structures or the spinal cord. GC of the oligodendroglial phenotype is extremely rare, especially in the paediatric setting. We describe an unusual case of oligodendroglial GC diagnosed in a 16-year-old boy with Ollier disease. To our knowledge this is the first case of GC reported in a child with Ollier disease.

http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=IRSSCONTENT&_method=citationSearch&_piikey=S0967586811003031&_version=1&md5=73ce1317a5b2659b6f1822d4c85c690c

Abstract Diffuse WHO grade II (GIIG) may be unresectable when involving critical structures. To assess the feasibility and functional tolerance (cognition and quality of life) of an original therapeutic strategy combining neoadjuvant chemotherapy followed by surgical resection for initially inoperable GIIG. Ten patients underwent Temozolomide for unresectable GIIG, as initial treatment or at recurrence after previous partial resection, due to invasion of eloquent areas or bi-hemispheric diffusion preventing a total/subtotal removal. Functional outcome after both treatments was assessed, with evaluation of seven cognitive domains. Chemotherapy induced tumor shrinkage (median volume decrease 38.9%) in ipsilateral functional areas in six patients and in the contralateral hemisphere in four. Only four patients had a 1p19q codeletion. The tumor shrinkage made possible the resection (mean extent of resection 93.3%, 9 total or subtotal removals) of initially inoperable tumors. Postoperatively, three patients had no deficits, while verbal episodic memory and executive functions were slightly impaired in seven patients. However, global quality of life was roughly preserved on the EORTC QLQ C30 + BN 20 (median score: 66.7%). Role functioning score was relatively reduced (median score: 66.7%) whereas KPS was preserved (median score: 90, range 80–100). Seven patients became seizure-free while three improved. This combined treatment is feasible, efficient (surgery made possible by neoadjuvant chemotherapy) and well-tolerated (preservation of quality of life, no serious cognitive disturbances). Cognitive deficits seem mostly related to tumor location. Because KPS is not reliable enough, a detailed neuropsychological assessment should be systematically performed in GIIG.

• Content Type Journal Article
• Pages 1-14
• DOI 10.1007/s11060-011-0670-x
• Authors
  • Marie Blonski, Division of Neuro-Oncology, Department of Neurology, Nancy University Hospital, Nancy, France
  • Luc Taillandier, Division of Neuro-Oncology, Department of Neurology, Nancy University Hospital, Nancy, France
  • Guillaume Herbet, Department of Neurology, Montpellier University Hospital, Montpellier, France
  • Igor Lima Maldonado, Department of Neurosurgery, Montpellier University Hospital, Montpellier, France
  • Patrick Beauchesne, Division of Neuro-Oncology, Department of Neurology, Nancy University Hospital, Nancy, France
  • Michel Fabbro, Department of Oncology, Val D’Aurelle Center for Cancer Treatment, Montpellier, France
  • Chantal Campello, Department of Neurology, Montpellier-Nîmes University Hospital, Nîmes, France
  • Catherine Gozé, National Institute for Health and Medical Research (INSERM)—U1051 Laboratory, Institute for Neurosciences of Montpellier, Montpellier University Hospital, Montpellier, France
  • Valérie Rigau, Cytology and Anatomical Pathology Laboratory, Montpellier University Hospital, Montpellier, France
  • Sylvie Moritz-Gasser, Department of Neurology, Montpellier University Hospital, Montpellier, France
  • Christine Kerr, Department of Radiotherapy, Val D’Aurelle Center for Cancer Treatment, Montpellier, France
  • Roberta Rudà, Division of Neuro-Oncology, Departments of Neurosciences and Oncology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
  • Riccardo Soffietti, Division of Neuro-Oncology, Departments of Neurosciences and Oncology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
  • Luc Bauchet, Department of Neurosurgery, Montpellier University Hospital, Montpellier, France
  • Hugues Duffau, Department of Neurosurgery, Montpellier University Hospital, Montpellier, France

• Journal Journal of Neuro-Oncology
• Online ISSN 1573-7373
• Print ISSN 0167-594X

http://www.springerlink.com/content/b7l0x534638597m6/

Abstract

Purpose

This retrospective study was done to better understand the conditions for which stereotactic radiosurgery (SRS) for glioblastoma may be efficacious.

Methods

Between 2000 and 2007, 33 patients with a pathological diagnosis of glioblastoma received SRS with the Novalis®Shaped Beam Radiosurgery system. Eighteen patients (54%) underwent salvage SRS for recurrence while 15 (45%) patients received upfront SRS following standard fractionated RT for newly diagnosed glioblastoma.

Results

There were no RTOG grade >2 acute side effects. The median survival after SRS was 6.7 months (range 1.4 – 74.7). There was no significant difference in overall survival (from the time of initial diagnosis) with respect to the timing of SRS (p = 0.2). There was significantly better progression free survival in patients treated with SRS as consolidation versus at the time of recurrence (p = 0.04). The majority of patients failed within or at the margin of the SRS treatment volume (21/26 evaluable for recurrence).

Conclusion

SRS is well tolerated in the treatment of glioblastoma. As there was no difference in survival whether SRS is delivered upfront or at recurrence, the treatment for each patient should be individualized. Future studies are needed to identify patients most likely to respond to SRS.

http://www.ro-journal.com/content/4/1/11

A discovery by scientists at Duke University Medical Center and Johns Hopkins University could increase the chances for an effective combination of drug therapy to treat the second most common type of brain tumor. For years scientists have been looking for the primary cancer genes involved in the development of oligodendrogliomas…

http://www.medicalnewstoday.com/releases/232319.php

Purpose: To analyze the pathology, outcomes, and prognostic factors in patients with high-grade glioma undergoing reoperation after radiotherapy (RT).Methods and Materials: Fifty-one patients with World Health Organization Grade 3–4 glioma underwent reoperation after prior RT. The median dose of prior RT was 60 Gy, and 84% received chemotherapy as part of their initial treatment. Estimation of the percentage of necrosis and recurrent tumor in each reoperation specimen was performed. Pathology was classified as RT necrosis if ≥80% of the specimen was necrotic and as tumor recurrence if ≥20% was tumor. Predictors of survival were analyzed using log–rank comparisons and Cox proportional hazards regression.Results: The median interval between the completion of RT and reoperation was 6.7 months (range, 1–59 months). Pathologic analysis showed RT necrosis in 27% and recurrence in 73% of cases. Thirteen patients required a reoperation for uncontrolled symptoms. Among them, 1 patient (8%) had pathology showing RT necrosis, and 12 (92%) had tumor recurrence. Median survival after reoperation was longer for patients with RT necrosis (21.8 months vs. 7.0 months, p = 0.047). In 7 patients with Grade 4 tumors treated with temozolomide-based chemoradiation with RT necrosis, median survival from diagnosis and reoperation were 30.2 months and 21.8 months, respectively.Conclusions: Patients with RT necrosis at reoperation have improved survival compared with patients with tumor recurrence. Future efforts to intensify local therapy and increase local tumor control in patients with high-grade glioma seem warranted.

http://www.redjournal.org/article/PIIS0360301610006875/abstract?rss=yes

Journal of Neurosurgery, Volume 115, Issue 1, Page 3-8, July 2011.

Nader Sanai, M.D., Mei-Yin Polley, Ph.D., Michael W. McDermott, M.D., Andrew T. Parsa, M.D., Ph.D., and Mitchel S. Berger, M.D.

Object

The value of extent of resection (EOR) in improving survival in patients with glioblastoma multiforme (GBM) remains controversial. Specifically, it is unclear what proportion of contrast-enhancing tumor must be resected for a survival advantage and how much survival improves beyond this threshold. The authors attempt to define these values for the patient with newly diagnosed GBM in the modern neurosurgical era.

Methods

The authors identified 500 consecutive newly diagnosed patients with supratentorial GBM treated at the University of California, San Francisco between 1997 and 2009. Clinical, radiographic, and outcome parameters were measured for each case, including MR imaging–based volumetric tumor analysis.

Results

The patients had a median age of 60 years and presented with a median Karnofsky Performance Scale (KPS) score of 80. The mean clinical follow-up period was 15.3 months, and no patient was unaccounted for. All patients underwent resection followed by chemotherapy and radiation therapy. The median postoperative tumor volume was 2.3 cm3, equating to a 96% EOR. The median overall survival was 12.2 months. Using Cox proportional hazards analysis, age, KPS score, and EOR were predictive of survival (p < 0.0001). A significant survival advantage was seen with as little as 78% EOR, and stepwise improvement in survival was evident even in the 95%–100% EOR range. A recursive partitioning analysis validated these findings and provided additional risk stratification parameters related to age, EOR, and tumor burden.

Conclusions

For patients with newly diagnosed GBMs, aggressive EOR equates to improvement in overall survival, even at the highest levels of resection. Interestingly, subtotal resections as low as 78% also correspond to a survival benefit.

http://thejns.org/doi/abs/10.3171/2011.2.JNS10998?ai=ru&mi=0&af=R