Journal of neuro-oncology
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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
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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Gliosarcoma is a variant of glioblastoma (GBM) with both glial and mesenchymal differentiation. The genetic profile of gliosarcoma is similar to that of primary GBM, except for rare EGFR amplification. However, little is known about O6-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase (IDH) 1/2 mutations in gliosarcomas. ⋯ Patients who underwent gross total resection (GTR) during first surgery had better survival (mean overall survival 18.1 vs. 9.04 months; P = 0.0543). In multivariate analysis, GTR and/or gamma knife surgery at recurrence was the independent favorable prognostic factor (P = 0.0003). In conclusion, MGMT methylation and IDH1 mutation are rare events in gliosarcomas, and only aggressive and repetitive local control seems to be effective in treatment of gliosarcoma.
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Journal of neuro-oncology · May 2012
ReviewEmerging techniques in the minimally invasive treatment and management of thoracic spine tumors.
Over the past decade, the development and refinement of minimally invasive spine surgery techniques has lead to procedures with the potential to minimize iatrogenic and post-operative sequelae that may occur during the surgical treatment of various pathologies. In a similar manner, parallel advances in other current treatment technologies have led to the development of other minimally invasive treatments of spinal malignancies. These advances include percutaneous techniques for vertebral reconstruction, including vertebroplasty and kyphoplasty, the development of safe and effective spinal radiosurgery, and minimal-access spinal surgical procedures that allow surgeons to safely decompress and reconstruct the anterior spinal column. ⋯ The author's describe how these emerging treatment options are significantly expanding the options open to clinicians in the treatment of thoracic spinal column malignancies. Specific illustrative case examples are provided. The development of these techniques has the potential to improve clinical outcomes, limit surgical morbidity, and also improve the safety and efficiency of treatment pathways.
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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.