Radiocirurgia

Abstract In 1991, a prospective phase II trial was initiated to evaluate the efficacy of treatment for adults with medulloblastoma (MB). After surgery, patients were staged with a neuroradiologic examination of the brain and neuroaxis and by cerebrospinal fluid cytology. All patients received three cycles of upfront cisplatinum (cisplatinum) and etoposide (VP16) chemotherapy followed by cranio-spinal radiation therapy. The current article reports on the long-term results from that trial. After a median follow-up of 14.9 years, among a total of 28 adults with MB, the overall progression-free survival and overall survival (OS) rates at 5 years were 57.6 and 80%, respectively. The median OS for the whole group of patients was 11.3 years. The observed toxicity was mainly hematological, with leukopenia and thrombocytopenia (16% of grades 3 and 4). In summary, in our small series of patients, the role of combination administration of CDDP + VP16 started before the initiation of radiotherapy in reducing recurrences, particularly distant recurrences, remains unclear. To know whether adding chemotherapy to craniospinal radiation in adult therapy increases relapse-free and overall survival, we must await the results of a larger randomized controlled clinical trial.

• Content Type Journal Article
• Category Clinical Study – Patient Study
• Pages 1-6
• DOI 10.1007/s11060-011-0696-0
• Authors
  • A. Silvani, Department of Neuro-oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • P. Gaviani, Department of Neuro-oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • E. Lamperti, Department of Neuro-oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • A. Botturi, Department of Neuro-oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • F. DiMeco, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • A. Franzini, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • P. Ferroli, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • L. Fariselli, Department of Radiotherapy, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • I. Milanesi, Department of Radiotherapy, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • A. Erbetta, Department of Neuro-radiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • B. Pollo, Department of Neuro-pathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
  • A. Salmaggi, Department of Neuro-oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy

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

http://www.springerlink.com/content/98l7078431854025/

Abstract Previous studies of chordoma have focused on either surgery, radiotherapy, or particular tumor locations. This paper reviewed the outcomes of surgery and proton radiotherapy with various tumor locations. Between 2001 and 2008, 40 patients with chordomas of the skull base and cervical spine had surgery at our hospital. Most patients received proton therapy. Their clinical course was reviewed. Age, sex, tumor location, timing of surgery, extent of resection, and chondroid appearance were evaluated in regard to the progression-free survival (PFS) and overall survival (OS). The primary surgery (PS) group was analyzed independently. The extensive resection rate was 42.5%. Permanent neurological morbidity was seen in 3.8%. Radiotherapy was performed in 75% and the mean dose was 68.9 cobalt gray equivalents. The median follow-up was 56.5 months. The 5-year PFS and OS rates were 70% and 83.4%, respectively. Metastasis was seen in 12.5%. The tumor location at the cranio-cervical junction (CCJ) was associated with a lower PFS (P = 0.007). In the PS group, a younger age and the CCJ location were related to a lower PFS (P = 0.008 and P < 0.001, respectively). The CCJ location was also related to a lower OS (P = 0.043) and it was more common in young patients (P = 0.002). Among the survivors, the median of the last Karnofsky Performance Scale score was 80 with 25.7% of patients experiencing an increase and 11.4% experiencing a decrease. Multimodal surgery and proton therapy thus improved the chordoma treatment. The CCJ location and a younger age are risks for disease progression.

• Content Type Journal Article
• Category Original Article
• Pages 1-13
• DOI 10.1007/s10143-011-0334-5
• Authors
  • Muneyoshi Yasuda, Department of Neurosurgery, Lariboisiere Hospital (AP-HP), Paris, France
  • Damien Bresson, Department of Neurosurgery, Lariboisiere Hospital (AP-HP), Paris, France
  • Salvatore Chibbaro, Department of Neurosurgery, Lariboisiere Hospital (AP-HP), Paris, France
  • Jan F. Cornelius, Department of Neurosurgery, Lariboisiere Hospital (AP-HP), Paris, France
  • Marc Polivka, Department of Pathology, Lariboisiere Hospital (AP-HP), Paris, France
  • Loic Feuvret, Department of Radiotherapy, Pitie Salpetriere Hospital (AP-HP), Paris, France
  • Masakazu Takayasu, Department of Neurosurgery, Aichi Medical University, Nagakute, Aichi 480-1195, Japan
  • Bernard George, Department of Neurosurgery, Lariboisiere Hospital (AP-HP), Paris, France

• Journal Neurosurgical Review
• Online ISSN 1437-2320
• Print ISSN 0344-5607

http://www.springerlink.com/content/e8647573q8pg5h05/

Journal of Neurosurgery: Pediatrics, Volume 8, Issue 3, Page 246-250, September 2011.

Maura Massimino, M.D., Carlo Lazzaro Solero, M.D., Maria Luisa Garrè, M.D., Veronica Biassoni, M.D., Armando Cama, M.D., Lorenzo Genitori, M.D., Concezio Di Rocco, M.D., Iacopo Sardi, M.D., Elisabetta Viscardi, M.D., Piergiorgio Modena, Ph.D., Paolo Potepan, M.D., Salvina Barra, M.D., Giovanni Scarzello, M.D., Ercole Galassi, M.D., Felice Giangaspero, M.D., Manila Antonelli, M.D., and Lorenza Gandola, M.D.

Object

Complete ependymoma resection ensures a better prognosis for children with this tumor, but the complete excision of infratentorial ependymomas involves serious risks. Second-look surgery for tumor remnants may be less harmful and enable complete removal. There is a potential, although still unclear, role for neoadjuvant chemotherapy in preparation for further surgery.

Methods

Since 1994, the authors have adopted two successive protocols for intracranial ependymoma, both including a phase of adjuvant chemotherapy for children with surgical tumor remnants with a plan for potential second-look surgery before radiotherapy.

Results

In the first protocol, 9 of 63 children underwent further surgery, and 6 became tumor free with no additional sequelae. Their prognosis for progression-free survival and freedom from local relapse was comparable to that of children who were operated on only once. In the second protocol, efforts were made to achieve complete resection and 29 of 110 patients underwent reoperations: 9 after the first surgery, 17 after chemotherapy, and 3 soon after radiotherapy. Fourteen of the 29 patients became tumor free, 1 of them with worsening neurological symptoms. The outcome of the 66 patients who became tumor free after 1 operation was compared with that of the 14 who became tumor free after reoperation. The 3-year progression-free survival of the 66 patients compared with the 14 other patients was 71.4% ± 6.9% and 90% ± 9.5%, respectively; the 3-year freedom from local relapse was 84.7% ± 5.9% and 90% ± 9.5%, respectively; and the 3-year overall survival was 85.9% ± 5.4% and 87.5% ± 11.7%, respectively.

Conclusions

Second-look surgery proved feasible with no major morbidity, and results improved with time. Local tumor control was comparable in patients undergoing 1 or more resections.

http://thejns.org/doi/abs/10.3171/2011.6.PEDS1142?ai=3f6&mi=3ba5z2&af=R

Abstract Central nervous system (CNS) lesions that are discovered incidentally when imaging children for problems that were unrelated to the detected lesion pose a dilemma to physicians. Because there are few data on the outcome of such cases, we retrospectively reviewed the clinical course of a group of children followed at our institution with brain lesions found incidentally on neuro-imaging. A database of all children with brain lesions followed at the University of Rochester medical center from 2000 to 2010 was reviewed. Data were obtained regarding presentation, magnetic resonance imaging (MRI) features, treatment, progression-free survival, and overall survival of children with brain lesions found incidentally. Of the 244 children with brain lesions seen over this time period, 21 (8.6%) were found to have incidentally discovered brain lesions. Of these 21 children, 12 (57%) underwent surgical resection of their brain lesions. Ten patients (48%) had symptoms considered to be unassociated with the detected lesion. Lesions were found in the cerebellum (n = 7, 33%), midline (n = 5, 24%), and cerebrum (n = 9, 43%). All lesions were ≤5 cm in diameter. Eight patients (38%) had surgery at presentation, one because of imaging features suspicious for a posterior fossae ependymoma, and the seven others because of location in the posterior fossae or brain stem. Of the remaining 13 patients, five had progression of disease on serial MRI scans: four underwent surgery and the fifth was monitored and remained stable after the initial progression stabilized. Nine of the ten patients (90%) with posterior fossae lesions underwent surgery, while only three of 11 with supratentorial lesions underwent surgery (27%) (P = 0.006). The progression free survival was 94% at 12 months (95% CI 65–99%) and 71% at 24 months (95% CI 39–88%). At a median follow-up of 32 months, the overall survival was 100%. Incidentally detected CNS lesions are usually small. The outcome for children with such lesions is excellent. Close monitoring of these patients with serial MRIs may be a safe alternative to immediate biopsy and/or resection for select patients.

• Content Type Journal Article
• Category Clinical Study – Patient Study
• Pages 1-6
• DOI 10.1007/s11060-011-0695-1
• Authors
  • Amy-Lee Bredlau, University of Rochester, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA
  • Louis S. Constine, University of Rochester, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA
  • Howard J. Silberstein, University of Rochester, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA
  • Michael T. Milano, University of Rochester, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA
  • David N. Korones, University of Rochester, 601 Elmwood Avenue, Box 777, Rochester, NY 14642, USA

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

http://www.springerlink.com/content/p765745108600k23/

Abstract Plasma cell granuloma (PCG) is an uncommon non-neoplastic mass lesion of unknown etiology. It is characterized by a polyclonal proliferation of chronic inflammatory cells, mostly mature plasma and other mononuclear cells. PCGs arising in the central nervous system are particularly rare. We report two additional cases of intracranial PCG exclusively involving the brain parenchyma. A 47 year-old woman, presenting with partial motor seizures and fluent aphasia, underwent complete excision of a well-demarcated, enhancing left parietal mass. The second patient was a 56 year-old man presenting with headaches and right-sided weakness who underwent stereotactic biopsy of an ill-defined, heterogeneously enhancing lesion in the left basal ganglia. Immunohistochemical analysis of surgical specimens showed polyclonal plasma cells and mature lymphocytes but no etiological agent. A histopathologic diagnosis of intracranial PCG was made in both cases. PCG should be part of the differential diagnosis of enhancing mass lesions of the brain. The etiology and natural history of these tumor-like lesions is not fully understood. Complete surgical excision appears to be curative. Lesions where total resection is not possible may benefit from adjuvant treatment including corticosteroids and possibly radiation therapy.

• Content Type Journal Article
• Pages 1-11
• DOI 10.1007/s11060-011-0667-5
• Authors
  • Preeti Puntambekar, Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
  • Sunitha Santhakumar, Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
  • William J. Kupsky, Department of Pathology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
  • Alexandros Tselis, Department of Neurology, Wayne State University, Detroit Medical Center, Detroit, MI, USA
  • Sandeep Mittal, Karmanos Cancer Institute, Detroit, MI, USA

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

http://www.springerlink.com/content/g71g3576v7822003/

Abstract Medulloblastoma (MB) occurs infrequently in adult patients and standard treatment is still controversial. We report our long-term, single-institution experience of adult MB and a review of the literature. We analysed adult patients with histologically proved MB treated by postoperative radiotherapy. Primary endpoints were local control (LC), disease-free survival (DFS), and overall survival (OS). Acute toxicity was reported according to CTC-NCI score vers. 3.0 and specific neuropsychological assessment analysis was performed to define late brain toxicity. From 1990–2008, 13 patients were treated by craniospinal (CSI, 12/13) or cranial irradiation (1/13, because of bad clinical conditions). Median follow up was 101 months (64–218). Complete radiological response was observed in 12/13 patients and a partial response in 1/13. Ten-year LC, OS, and DFS were 91, 76, and 84%, respectively. Two patients died because of local and spinal progression after 13 and 62 months. Acute G3 haematological toxicity (RTOG score) was observed for one patient only. The neuropsychological analysis did not reveal late toxicity related to brain radiotherapy. This experience confirms the efficacy and safety of radiotherapy in adult MB patients, resulting in very interesting 10-year LC and OS.

• Content Type Journal Article
• Pages 1-9
• DOI 10.1007/s11060-011-0665-7
• Authors
  • M. Balducci, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • S. Chiesa, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • D. Chieffo, Neurosurgery Institute, Catholic University of Rome, 00168 Rome, Italy
  • S. Manfrida, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • N. Dinapoli, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • A. Fiorentino, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • F. Miccichè, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • V. Frascino, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • C. Anile, Neurosurgery Institute, Catholic University of Rome, 00168 Rome, Italy
  • V. Valentini, Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168 Rome, Italy
  • B. De Bari, AO Spedali Civili, Istituto del Radio “O. Alberti”, Università degli Studi di Brescia, Piazzale Spedali Civili, 1, 25123 Brescia, Italy

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

http://www.springerlink.com/content/m132l3x775008p1k/

Journal of Neurosurgery, Volume 0, Issue 0, Page 1-12, Ahead of Print.

Salvatore Di Maio, M.D.C.M., F.R.C.S.C., Nancy Temkin, Ph.D., Dinesh Ramanathan, M.D., and Laligam N. Sekhar, M.D.

Object

The role of surgery and adjuvant radiation therapy for cranial base chordomas is not well established. This meta-analysis measures the relationship of complete resection and type of adjuvant radiation therapy to 5-year progression-free survival (PFS) and overall survival (OS) of cranial base chordomas.

Methods

A systematic MEDLINE search (1999–present) yielded 23 observational studies and 807 patients who fit inclusion criteria. The following analyses were performed: 1) Kaplan-Meier 5-year PFS and OS compared based on the extent of resection and type of adjuvant radiation therapy using the log-rank method; 2) a random-effects model comparing 5-year PFS with complete or incomplete resection; and 3) paired z-test comparisons of weighted average 5-year OS and PFS grouped by type of adjuvant radiation therapy.

Results

The weighted average follow-up was 53.6 months. The weighted average 5-year PFS and OS were 50.8% and 78.4%, respectively. Complete resection conferred a higher 5-year PFS than incomplete resection from the random effects model (mean difference in PFS 20.7%; 95% CI 6.57%–34.91%). Patients with incomplete resection were 3.83 times more likely to experience a recurrence (95% CI 1.63–9.00) and 5.85 times more likely to die (95% CI 1.40–24.5) at 5 years versus patients with complete resection. There was no difference in 5-year OS by type of adjuvant radiation, although 5-year PFS was lower in patients receiving Gamma Knife surgery relative to carbon ion radiotherapy (p = 0.042) on paired z-test. No survival difference occurred between radiation therapy techniques on Kaplan-Meier analysis of compiled patient data.

Conclusions

Patients with complete resection of cranial base chordomas have a prolonged 5-year PFS and OS. Adjuvant proton-beam, carbon ion, and modern fractionated photon radiation therapy techniques offered a similar rate of PFS and OS at 5 years.

http://thejns.org/doi/abs/10.3171/2011.7.JNS11355?ai=ru&mi=0&af=R

BACKGROUND: Although considered slow-growing, low-grade malignancies, chordomas are locally aggressive and destructive tumors with high recurrence rates. OBJECTIVE: To assess patient survival, tumor control, complications, and selected variables that predict outcome in patients who underwent Gamma Knife stereotactic radiosurgery (SRS) as primary, adjuvant, or salvage management for chordomas of the skull base. METHODS: Six participating centers of the North American Gamma Knife Consortium identified 71 patients who underwent SRS for chordoma. The median patient age was 45 years (range, 7-80 years). The median SRS target volume was 7.1 cm3 (range, 0.9-109 cm3), and median margin dose was 15.0 Gy (range, 9-25 Gy). RESULTS: At a median follow-up of 5 years (range, 0.6-14 years) after SRS, 23 patients died of tumor progression. The 5-year actuarial overall survival after SRS was 80% for the entire group, 93% for the no prior fractionated radiation therapy (RT) group (n = 50), and 43% for the prior RT group (n = 21). Younger age, longer interval between initial diagnosis and SRS, no prior RT, < 2 cranial nerve deficits, and smaller total tumor volume were significantly associated with longer patient survival. The 5-year treated tumor control rate after SRS was 66% for the entire group, 69% for the no prior RT group, and 62% for the prior RT group. Older age, recurrent group, prior RT, and larger tumor volume were significantly associated with worse tumor control. CONCLUSION: Stereotactic radiosurgery is a potent treatment option for small sized chordomas, especially in younger patients and as part of a multipronged attack that includes surgical resection when possible.

http://journals.lww.com/neurosurgery/Fulltext/2011/02000/Stereotactic_Radiosurgery_for_Chordoma__A_Report.20.aspx

Gamma knife radiosurgery for cavernous sinus plasmacytoma in a patient with breast cancer history.

Peker S, Abacioğlu U, Bayrakli F, Kiliç T, Pamir MN (2005) Surg Neurol. 63 (2), 174-6; discussion 176-7.

Multiple myeloma (MM) presentation with cerebral mass lesion is unusual. Gamma knife radiosurgery for plasmacytoma has not been reported so far.

http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&retmode=ref&id=15680666