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CNS Oncology

Konstantin Brawanski, Gero Brockhoff, Peter Hau, Arabel Vollmann-Zwerenz, Christian Freyschlag, Annette Lohmeier, Markus J Riemenschneider, Claudius Thomé, Alexander Brawanski, Martin A Proescholdt
AIM: Recently, D,L-methadone has been put forward as adjuvant treatment in glioblastoma (GBM). METHODS: We analyzed the μ-opioid receptor expression in a set of GBM cell lines and investigated the efficacy of D,L-methadone alone and in combination with temozolomide (TMZ). Results & conclusion: Expression of the μ-opioid receptor was similar in the tested cell lines. High concentrations of D,L-methadone induced apoptosis in all cell lines and showed treatment interaction with TMZ...
June 19, 2018: CNS Oncology
Andrea Wasilewski, Nimish Mohile
BACKGROUND: Adult pilocytic astrocytomas are rare and highly vascular tumors. AIM: We hypothesized that they may be uniquely responsive to bevacizumab (BEV). PATIENTS: We present four adult patients with pathologically diagnosed WHO grade I pilocytic astrocytoma who had robust and durable responses to BEV at time of recurrence. Three patients developed radiographic changes on MRI, consistent with progressive disease based on response assessment in neuro-oncology criteria...
April 9, 2018: CNS Oncology
Tine Rosenberg, Charlotte Aaberg-Jessen, Stine Asferg Petterson, Bjarne Winther Kristensen
AIM: To investigate the time profile of hypoxia and stem cell markers in glioblastoma spheroids of known molecular subtype. MATERIALS & METHODS: Patient-derived glioblastoma spheroids were cultured up to 7 days in either 2% or 21% oxygen. Levels of proliferation (Ki-67), hypoxia (HIF-1α, CA9 and VEGF) and stem cell markers (CD133, nestin and musashi-1) were investigated by immunohistochemistry. RESULTS: Hypoxia markers as well as CD133 and partially nestin increased in long-term hypoxia...
April 2018: CNS Oncology
Rimas V Lukas, Ryan T Merrell
Pleomorphic xanthoastrocytomas can be very resistant to treatment if they progress after standard therapy with surgery and radiation. We present the case of a patient with a multiply recurrent pleomorphic xanthoastrocytoma which demonstrated a sustained partial response to a combination regimen of the BRAF inhibitor vemurafenib and tumor treating fields. The regimen proved tolerable and efficacious in this case.
April 2018: CNS Oncology
Zehra Pınar Koç, Pelin Özcan Kara, Ahmet Dağtekin
AIM:  F-18 fluorodeoxyglucose (FDG) PET/CT has several advantages in diagnosis of cancer of unknown primary with reported incremental diagnostic value. In this study, we evaluated the patients who were presented with multiple brain metastasis and unknown primary tumor. MATERIALS & METHODS: 31 patients (17 males, 14 females; mean: 56.1 ± 14.22 years old) with diagnosis of brain metastasis according to histopathology and/or MRI were included into this retrospective study...
April 2018: CNS Oncology
Emily C Merfeld, Sonika Dahiya, Stephanie M Perkins
AIM: To evaluate the use of chemotherapy and radiation, and their outcomes for patients with astroblastoma. PATIENTS & METHODS: This is a retrospective review of patients extracted from the National Cancer Database. We investigated overall survival (OS) using Kaplan-Meier curves. Cox proportional hazards models were used to correlate OS with risk variables and treatments. RESULTS: OS at 5 years was 79.5%. Patients with high-grade tumors were more likely to receive chemotherapy and radiation...
April 2018: CNS Oncology
Vijay M Patil, Nikhil Pande, Arun Chandrasekharan, Chandrakanth M, Raees Tonse, Rahul Krishnatry, Jayant S Goda, Hollis Dsouza, Dilip Harindran Vallathol, Santam Chakraborty, Tejpal Gupta, Rakesh Jalali
AIM: This study was designed with a primary objective to study the rate of agreement in treatment plan and decisions between video follow-up (VF) and conventional clinic follow-up (CF). PATIENTS & METHODS: Adult patients with intermediate- to high-grade glioma on adjuvant temozolomide (TMZ) with facilities for live video call were invited to participate in the study. RESULTS: The concurrence in decision of administering TMZ between VF and CF was 100% (p < 0...
April 2018: CNS Oncology
Shamsudini Hashi, Courtney Rory Goodwin, Ali Karim Ahmed, Daniel M Sciubba
Extranodal lymphoma of the spine is often a late manifestation of systemic disease, and may result in symptoms of pain, neurologic compromise or spinal instability. Symptomatic relief is generally achieved by radiotherapy alone, but is not sufficient in addressing spinal instability. The indications for surgery remain controversial, but may be required for spinal stabilization, or refractory disease. Currently, there is a lack of studies that compare the indications and clinical outcomes of patients receiving surgical and nonsurgical management of spinal extranodal lymphoma...
April 2018: CNS Oncology
Jason T Pham, Ronald C Kim, Anna Nguyen, Daniela Bota, Xiao-Tang Kong, Sumeet Vadera, Frank Hsu, Jose A Carrillo
Meningiomas have been implicated as the most common primary intracranial tumor to contain tumor-to-tumor metastasis. In the following two case reports, we describe cases of adenocarcinoma and breast carcinoma that metastasized into an intracranial meningioma. The first patient was a 64-year-old man presenting to the emergency department with seizures and loss of consciousness. After a left frontal mass resection, pathology reported a heterogeneous mass consisting of a meningioma and a metastatic adenocarcinoma component...
April 2018: CNS Oncology
Kirsty J Martin-McGill, Nisaharan Srikandarajah, Anthony G Marson, Catrin Tudur Smith, Michael D Jenkinson
AIM: We performed a systematic review of the evidence for effectiveness and acceptability of different ketogenic diets (KDs) in the therapeutic management of gliomas. METHODS: The search strategy included searches of seven electronic databases. Data extraction and quality assessment were undertaken independently by two authors. RESULTS: No randomized clinical trials were identified. Six studies (n = 39) met the eligibility criteria for this review - all were case series or reports and therefore at high risk of bias...
April 2018: CNS Oncology
Victor A Levin, Sandra E Ictech, Kenneth R Hess
This review covers the literature between 1989 and 2007 on studies relevant to the neuro-oncology usage of eflornithine (α-difluoromethylornithine), an oral agent that irreversibly inhibits the enzyme ornithine decarboxylase. It covers the use of eflornithine, alone or in combination, to treat high-grade gliomas. In addition, we provide an update on overall survival from The University of Texas MD Anderson Cancer Center Community Clinical Oncology Program and Clinical Trials Data Office that demonstrates a meaningful benefit in overall survival for eflornithine as a single agent and in combination with nitrosourea-based therapies for anaplastic gliomas...
April 2018: CNS Oncology
Kevin O Lillehei, Steven N Kalkanis, Linda M Liau, Dellann Elliott Mydland, Jeffrey Olson, Nina A Paleologos, Timothy Ryken, Tania Johnson, Evan Scullin
Implantation of biodegradable wafers impregnated with carmustine (BCNU) is one of the few chemotherapeutic modalities that have been evaluated in Phase III trials and approved by the US FDA for treatment of newly diagnosed high-grade glioma and recurrent glioblastoma. Enrolling up to 500 patients for 3-year follow-up at over 30 sites, the prospective Vigilant ObservatIon of GlIadeL WAfer ImplaNT (VIGILANT) registry (NCT02684838) will evaluate BCNU wafers for treatment of CNS malignancies in contemporary practice and in the new era of molecular tumor analysis...
April 2018: CNS Oncology
Cheng-Hung Tai, Cheng-Chia Wu, Mark E Hwang, Anurag Saraf, Christopher Grubb, Ashish Jani, Matthew E Lapa, Jacquelyn I S Andrews, Steven R Isaacson, Adam M Sonabend, Sameer A Sheth, Guy M McKhann, Michael B Sisti, Jeffrey N Bruce, Simon K Cheng, Eileen P Connolly, Tony Jc Wang
AIM: The number of breast cancer brain metastases is a prognostic clinical variable in the modified graded prognostic assessment (GPA) Index for breast cancer. PATIENTS & METHODS: We retrospectively gathered data from 127 breast cancer patients who underwent radiation therapy for brain metastasis. Patients were stratified by both breast GPA and modified breast GPA scores, and survival was determined using the Kaplan-Meier curves and Cox proportional hazards model...
January 2018: CNS Oncology
Romulus Emmanuel H Cruz, Ranhel C De Roxas, Carmela Concepcion A Sales-Callangan, Roland Dominic G Jamora
Widespread primary spinal oligodendrogliomas are a rare variety of tumors that usually affect children. Currently, there are only two adult cases reported worldwide. We report the first case of primary holocord oligodendroglioma with intracranial extension in a young adult female. The patient presented with a 4-month history of fluctuating hemiparesis of the left upper extremity eventually becoming quadriplegic after 1 month. Imaging findings revealed a contrast-enhancing holocord neoplasm spanning from the cervical region to the conus medullaris and with extension to the lower medulla...
January 2018: CNS Oncology
Alissa Thomas, Marc Rosenblum, Sasan Karimi, Lisa M DeAngelis, Antonio Omuro, Thomas J Kaley
Interpretation of MRI abnormalities in patients with malignant gliomas (MG) treated with bevacizumab is challenging. Recent reports describe quantitative analyses of diffusion-weighted imaging abnormalities not available in standard clinical settings, to differentiate tumor recurrence from treatment necrosis. We retrospectively reviewed bevacizumab treated MG patients who underwent surgery or autopsy to correlate radiographic recurrence patterns with pathologic findings. 32 patients with MG (26 glioblastoma, three anaplastic astrocytoma and three anaplastic oligodendroglioma) were identified...
January 2018: CNS Oncology
Mehdi Benna, Nesrine Mejri, Manel Mabrouk, Houda El Benna, Soumaya Labidi, Nouha Daoud, Hamouda Boussen
AIM: We reported anatomo-clinical features of brain metastases (BMs) collected in a Tunisian medical oncology department. PATIENTS & METHODS: We retrospectively identified all cases of BM within a cohort of 7055 patients, treated for a histologically confirmed nonhematological cancer between 2000 and 2016. Data about age, sex and primary tumor were collected. RESULTS: Incidence was 1.9% and mean age was 54 years with a 1.24 sex ratio...
January 2018: CNS Oncology
Victor M Lu, Kerrie L McDonald
In recent years, de novo missense structural mutations in the IDH1 gene of arginine at site 132 (R132) have become a standard for diagnostication and prognostication in glioma management. As our clinical understanding of this mutation grows, so too does the number of mutation subtypes reported in the literature. By synergizing current knowledge of IDH1 activity in glioma with the emerging evidence of different enzyme kinetics between R132 IDH1 mutation subtypes, the translational potential in improving glioma management based on mutated IDH1 subtype in glioma is described...
January 2018: CNS Oncology
Hao-Wen Sim, Erin R Morgan, Warren P Mason
High-grade gliomas, including glioblastoma, are the most common malignant brain tumors in adults. Despite intensive efforts to develop new therapies for these diseases, treatment options remain limited and prognosis is poor. Recently, there have been important advances in our understanding of the molecular basis of glioma, leading to refinements in our diagnostic and management approach. There is new evidence to guide the treatment of elderly patients. A multitude of new agents have been investigated, including targeted therapies, immunotherapeutics and tumor-treating fields...
January 2018: CNS Oncology
Ajay Patel, Homan Mohammadi, Tuo Dong, Kevin Ren-Yeh Shiue, Douglas Frye, Yi Le, Shaheryar Ansari, Gordon A Watson, James C Miller, Tim Lautenschlaeger
Brainstem metastases offer a unique challenge in cancer treatment, yet stereotactic radiosurgery (SRS) has proven to be an effective modality in treating these tumors. This report discusses the clinical outcomes of patients with brainstem metastases treated at Indiana University with Gamma Knife (GK) radiosurgery from 2008 to 2016. 19 brainstem metastases from 14 patients who had follow-up brain imaging were identified. Median tumor volume was 0.04 cc (range: 0.01-2.0 cc). Median prescribed dose was 17...
January 2018: CNS Oncology
Bénédicte Durand, Fahed Zairi, Thomas Boulanger, Jacques Bonneterre, Laurent Mortier, Emilie Le Rhun
Therapeutic options of leptomeningeal metastases include intra-cerebrospinal fluid (CSF) chemotherapy. Among intra-CSF agents, liposomal cytarabine has advantages but can induce specific toxicities. A BRAF-V600E-mutated melanoma leptomeningeal metastases patient, treated by dabrafenib and liposomal cytarabine, presented after the first injection of liposomal cytarabine with hyperthermia and headaches. Despite sterile CSF/blood analyses, extended intravenous antibiotics were given and the second injection was delayed...
October 2017: CNS Oncology
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