Journal of neuro-oncology
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Journal of neuro-oncology · May 2012
The superiority of conservative resection and adjuvant radiation for craniopharyngiomas.
The purpose of this study is to evaluate the roles of resection extent and adjuvant radiation in the treatment of craniopharyngiomas. We reviewed the records of 122 patients ages 11-52 years who received primary treatment for craniopharyngioma between 1980 and 2009 at the University of California, San Francisco (UCSF). Primary endpoints were progression free survival (PFS) and overall survival (OS). ⋯ STR was associated with significantly shortened OS compared to STR + RT (p = 0.050) and trended to shorter OS compared to GTR (p = 0.066). GTR was associated with significantly greater risk of developing DI (56.3 vs. 13.3% with STR + XRT, p < 0.001) and panhypopituitarism (54.8 vs. 26.7% with STR + XRT, p = 0.014). In conclusion, for patients with craniopharyngioma, STR + RT may provide superior clinical outcome, achieving better disease control than STR and limiting side effects associated with aggressive surgical resection.
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Journal of neuro-oncology · May 2012
Dose dense 1 week on/1 week off temozolomide in recurrent glioma: a retrospective study.
Alternative temozolomide regimens have been proposed to overcome O(6)-methylguanine-DNA methyltransferase mediated resistance. We investigated the efficacy and tolerability of 1 week on/1 week off temozolomide (ddTMZ) regimen in a cohort of patients treated with ddTMZ between 2005 and 2011 for the progression of a glioblastoma during or after chemo-radiation with temozolomide or a recurrence of another type of glioma after radiotherapy and at least one line of chemotherapy. Patients received ddTMZ at 100-150 mg/m(2)/d (days 1-7 and 15-21 in cycles of 28-days). ⋯ Four out of the 12 evaluable patients with a recurrent WHO grade 2 or 3 oligodendroglioma or oligo-astrocytoma with combined 1p and 19q loss had an objective response; PFS-6 in these patients was 62%. This study indicates that ddTMZ is safe and effective in recurrent glioma, despite previous temozolomide and/or nitrosourea chemotherapy. Our data do not suggest superior efficacy of this schedule as compared to the standard day 1-5 every 4 weeks schedule.
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Journal of neuro-oncology · May 2012
Significance of target location relative to the depth from the brain surface and high-dose irradiated volume in the development of brain radionecrosis after micromultileaf collimator-based stereotactic radiosurgery for brain metastases.
The objective of this study was to investigate the factors that potentially lead to brain radionecrosis (RN) after micromultileaf collimator-based stereotactic radiosurgery (SRS) for brain metastases. We retrospectively evaluated 131 lesions with a minimum follow-up of 6 months, 43.5% of which received prior whole-brain radiotherapy (WBRT). The three-tiered location grade (LG) was defined, as follows, for each target by considering mainly the depth from the brain surface: grade 1 (superficial), involving the region at a depth of ≤5 mm from the brain surface; grade 2 (deep), located at a depth of >5 mm from the brain surface; and grade 3 (central), located in the brainstem, cerebellar peduncle, diencephalon, or basal ganglion. ⋯ For the WBRT cases, the cutoff values of V15 Gy were 5.61 and 5.20 cm(3) for S-RN and both RN, respectively. In addition to the IIDV data, LG helps predict the risk of RN. High-dose IIDV, V22 Gy, was also significantly correlated with RN, particularly for patients treated with SRS alone.
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Journal of neuro-oncology · May 2012
Characterization and outcomes of optic nerve gliomas: a population-based analysis.
Optic nerve gliomas (ONG) are rare astrocytic neoplasms. A paucity of literature exists on the epidemiology and outcomes of ONG. Here, we present a series of 445 cases of ONG obtained from the Surveillance, epidemiology and end results (SEER) database. ⋯ Age at diagnosis, receipt of radiation therapy, and extent of surgical resection were not significantly correlated with overall survival. In conclusion, ONG are rare tumors seen predominantly in children. The overall prognosis of high-grade tumors remains poor in all age groups despite multi-modality treatment.
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Journal of neuro-oncology · May 2012
Comparative StudyRisk of ischemia in glioma surgery: comparison of first and repeat procedures.
The role of repeat resection in the multimodal treatment of gliomas is unclear. Repeat surgery theoretically carries a higher risk of inducing neurological deficits, which might even out any advantage of cytoreduction. We sought to determine whether the occurrence of perioperative infarction is higher for repeat surgery than for first surgery, and sought to identify factors associated with the occurrence of postoperative infarction. ⋯ There was no difference between first and repeat surgery with regard to the occurrence of new DWI lesions (27.7 vs. 21.3%, P = 0.77) or neurological deficits (10.0 vs. 10.6%, P = 1.0). Tumor location in the insula, operculum, and temporal lobe was found to be significantly associated with the occurrence of new DWI lesions. We conclude that repeat surgery should not be withheld as a treatment option for patients with recurrent gliomas for fear of a higher risk of postoperative infarction or new neurologic deficit than the first surgery.