Journal of neuro-oncology
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Journal of neuro-oncology · Nov 2011
Clinical TrialPostoperative seizure in high grade glioma patients treated with BCNU wafers. A mono-institutional experience.
Anticonvulsant therapy is usually recommended before surgery in all patients affected by high grade glioma who are planned to be treated with Carmustine 1,3-bis [2 chloroetyl]-1-nitrosurea, or BCNU) wafers. In fact, phase III studies have reported a risk of seizures higher than 30% in this group of patients. The aim of the study was the evaluation of rate type time of occurrence of seizures in BCNU-treated patients in the postoperative period as well as the investigation into possible risk factors for seizure occurrence in this population. ⋯ Patients with a sub-therapeutic level of AED at the seventh day after surgery presented a higher seizure occurrence [P = 0.02; OR = 11 (1,5;79,8)]. In our experience, postoperative seizures in BCNU-treated patients were less frequent than expected. Careful patient selection and postoperative monitoring could probably play a role in order to decrease seizure occurrence.
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Journal of neuro-oncology · Nov 2011
Assessment of MGMT promoter methylation status in pleomorphic xanthoastrocytoma.
Although pleomorphic xanthoastrocytoma (PXA) is currently designed as a grade II glioma according to the WHO classification, a significant percentage of the tumors undergo malignant progression. In this study, the MGMT methylation status was examined in 11 PXA patients to determine if a biologic rationale exists to support the use of temozolomide (TMZ) for treatment of aggressive PXA. There were 9 cases of PXA grade II and 2 cases of PXA with anaplastic features. ⋯ In contrast, other cases, including PXAs with anaplastic features, were unmethylated. In addition, a tumor recurrence was found to be unmethylated. Thus, MGMT promoter methylation is not frequent in PXA and our results raise doubts about the benefits of treating indistinctly aggressive PXA with TMZ.
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Journal of neuro-oncology · Sep 2011
Gamma knife stereotactic radiosurgery for the management of incidentally-identified brain metastasis from non-small cell lung cancer.
Initial staging workup of non-small cell lung cancer (NSCLC) patients has led to increased identification of incidental brain metastases in patients who otherwise have minimal or no neurologic symptoms. We present our experience treating these metastases with stereotactic radiosurgery (SRS) alone and compare outcomes to those of patients with brain metastases treated with other strategies. We queried our neuro-oncology and radiation oncology databases for patients with incidentally-identified NSCLC brain metastases treated with upfront SRS alone between 1997 and 2006. ⋯ Survival was not statistically different from similar patients treated with whole brain radiotherapy (WBRT) (P = 0.98), WBRT + Surgery (P = 0.07) or WBRT + SRS (P = 0.62). Patients with incidentally-identified NSCLC brain metastases treated with SRS alone may achieve a survival rate comparable to patients managed with other standard therapeutic modalities. Our findings suggest that SRS alone may be a viable therapeutic option for patients with incidentally-discovered NSCLC brain metastases.
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Journal of neuro-oncology · Sep 2011
Hydroxyurea for recurrent surgery and radiation refractory meningioma: a retrospective case series.
Hydroxyurea (HU), an orally administered chemotherapy, has become the de facto standard therapeutic agent in patients with surgically and radiation refractory meningiomas based on a limited literature. A retrospective case series of 60 patients with recurrent WHO grade 1 meningioma treated with HU following progression after surgery and radiotherapy was conducted with primary study objective progression free survival (PFS) at 6- and 12-months. Sixty patients (45 women; 15 men: median age 61.5 years, range 26-88) with recurrent meningioma were treated with HU (1000 mg/m(2)/day orally divided twice per day; one cycle operationally defined as 4-weeks of daily HU). ⋯ The overall PFS was 10% (median PFS 2.0 months). The majority of patients (80%) following progression on HU were subsequently treated on an investigational trial. In this retrospective case series, HU though generally well tolerated and convenient, appeared to have very limited activity which raises questions of what constitutes effective salvage therapy and indicates an unmet need for alternative treatments for recurrent meningiomas.
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Journal of neuro-oncology · Aug 2011
Case ReportsSpinal cord anaplastic oligodendroglioma with 1p deletion: report of a relapsing case treated with temozolomide.
Primary spinal cord oligodendroglial tumor is very rare, and in only one patient with spinal cord oligodendroglioma has a deletion of chromosome 1p/19q been reported. We present the case of an 18-year-old girl, who had one-year lower back pain and one-month lower limb weakness. Magnetic resonance images of the spinal cord showed an intramedullary mass from level T8 to T10, which was then radically removed. ⋯ The most recent MRI of brain and spinal cord showed postoperative changes without evidence of tumor recurrence of the spine and oligodendrogliomatosis along the cerebral-spinal axis. To our knowledge, this is the first report of a recurrent anaplastic oligodendroglioma with 1p deletion occurring in the spinal cord. It is also the first case of the patient with recurrent intramedullary anaplastic oligodendroglioma who had a significant clinical improvement and complete imaging remission after subtotal resection then treatment with temozolomide chemotherapy.