Journal of neuro-oncology
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Journal of neuro-oncology · Dec 2009
Prospective assessment of quality of life in adult patients with primary brain tumors in routine neurooncology practice.
The aim of this article is to evaluate and assess the impact of various factors on quality of life (QOL) in adult patients with primary brain tumors seen consecutively in routine neurooncology practice. Two hundred and fifty-seven adult patients, after undergoing surgical intervention and histologically proven primary brain neoplasms were registered in the NeuroOncology Clinic at our centre during 1 full calendar year. The study included detailed neurological assessment, evaluation of QOL using EORTC questionnaire (QLQ-30) and specific Brain Cancer module (BN 20). ⋯ Type of surgery (biopsy/complete excision) (p = 0.284) and site of tumor (p = 0.309) did not show any impact on QOL score. Patients with primary brain tumours before starting adjuvant therapy have relatively low baseline quality of life scores, especially in lower economic and literacy strata. Patients with malignant tumors and poor performance status had significantly lower QOL scores even before starting adjuvant treatment.
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Journal of neuro-oncology · Nov 2009
Case ReportsNeurolymphomatosis: a rare metastatic complication of diffuse large B-Cell lymphoma.
To report the occurrence of neurolymphomatosis in a patient with previously treated systemic diffuse B-cell lymphoma (DLBCL). A case report. University medical center. ⋯ High-dose methotrexate and involved-field radiotherapy. Neurolymphomatosis, although rare, is increasingly recognized with peripheral and central nervous system MRI. Treatment remains unsatisfactory as treatment with methotrexate-based chemotherapy and irradiation is only partially effective.
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Journal of neuro-oncology · Nov 2009
Non-PEGylated liposomes for convection-enhanced delivery of topotecan and gadodiamide in malignant glioma: initial experience.
Convection-enhanced delivery (CED) of highly stable PEGylated liposomes encapsulating chemotherapeutic drugs has previously been effective against malignant glioma xenografts. We have developed a novel, convectable non-PEGylated liposomal formulation that can be used to encapsulate both the topoisomerase I inhibitor topotecan (topoCED) and paramagnetic gadodiamide (gadoCED), providing an ideal basis for real-time monitoring of drug distribution. Tissue retention of topoCED following single CED administration was significantly improved relative to free topotecan. ⋯ In a U87MG intracranial rat xenograft model, a two-dose CED regimen of topoCED co-infused with gadoCED greatly increased median overall survival at dose levels of 0.5 mg/ml (29.5 days) and 1.0 mg/ml (33.0 days) vs. control (20.0 days; P < 0.0001 for both comparisons). TopoCED at higher concentrations (1.6 mg/ml) co-infused with gadoCED showed no evidence of histopathological changes attributable to either agent. The positive results of tissue pharmacokinetics, co-convection, cytotoxicity, efficacy, and lack of toxicity of topoCED in a clinically meaningful dose range, combined with an ideal matched-liposome paramagnetic agent, gadoCED, implicates further clinical applications of this therapy in the treatment of malignant glioma.
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Journal of neuro-oncology · Aug 2009
Glioma grading: sensitivity, specificity, positive and negative predictive values of diffusion and perfusion imaging.
The purpose of our study was to determine the statistical significance of thresholds of relative cerebral blood volume (rCBV), apparent diffusion coefficient (ADC) and ADC ratios in grading cerebral gliomas. ⋯ Combining PWI and DWI with conventional MR imaging increases the accuracy of pre-operative imaging grading of glial neoplasms. The rCBV measurements had the most superior diagnostic performance in predicting glioma grade. Absolute ADC values or ADC ratios were also helpful in preoperative grading of gliomas. Threshold values can be used in a clinical setting to evaluate tumors preoperatively for histologic grade and provide a means for guiding treatment and predicting postoperative patient outcome.
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Journal of neuro-oncology · Jul 2009
Review Case ReportsCerebral astroblastoma: analysis of six cases and critical review of treatment options.
Astroblastoma is one of the rarest tumors of the central nervous system (CNS), and its classification, histogenesis, diagnosis and therapeutic management are still being debated. The typical histopathological appearance is the perivascular, astroblastic pseudorosette, which is however present in other CNS tumors. To clarify the clinical, radiological, histopathological, prognostic and therapeutic characteristics, which have been treated only recently and are not well established yet due to the rarity of this tumor, six cases of histologically proven astroblastoma were retrospectively analyzed in light of more pertinent literature and paying special attention to therapeutic remarks. ⋯ The role of chemotherapy is still very debatable. We propose an aggressive standardized treatment for those lesions that meet anaplastic criteria, owing to their postulated glial origin and the propensity to have aggressive courses, and we advocate the use of a safe adjuvant chemotherapeutic regimen with TMZ, used concomitantly and subsequently to radiotherapy, especially for the high-grade astroblastoma cases. Multicenter studies, taking into account molecular biological findings, are necessary to define a common therapeutic strategy for astroblastomas.