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  • 1
    Electronic Resource
    Electronic Resource
    The Status of Stereotactic Radiosurgery for Cerebral Metastases in 1998 (1998)
    Springer
    Journal of radiosurgery 1 (1998), S. 17-30 
    Details
    ISSN: 1573-8752
    Keywords: Brain metastases ; prognostic factors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The last decade has witnessed an exponential proliferation of radiosurgery facilities in the United States and around the globe, and consequently, several tens of thousands of patients have undergone this procedure for a variety of intracranial and skull-base abnormalities. Since brain metastases represent the most common intracranial neoplasm, these have become a common target for radiosurgery. We present a review paper summarizing the major issues surrounding the management of brain metastases as well as an English-language literature review of 20 independent reports, using either γ-knife or linear accelerator-based radiosurgery, with 〉1250 patients and 〉2100 lesions available for analysis. Variable reporting in the studies precludes a definitive analysis and comparison of all factors in a rigorous statistical fashion, but the composite data reveal an average local control rate of 83% and a median survival of 9.6 months, which are comparable to those in recent surgical reports. Prognostic factors for survival are beginning to be unraveled, and the most important ones appear to be the presence of fewer than three lesions, controlled extracranial disease, and Karnofsky performance score. The exact impact of dose has not been clarified, but a dose–response relationship, especially for ≥18 Gy, is emerging. The role of whole-brain radiotherapy remains unresolved; it may enhance local control but does not convincingly improve survival and, in some series, is associated with an increased risk of late complications, which appear to be less than 5% on average. The concerns regarding chronic steroid dependance and increased intracranial edema do not appear to be a common problem. With such a large base of uncontrolled evidence, this is an opportune time for conducting and completing randomized trials to validate these observations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/B:JORA.0000010873.43368.21
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  • 2
    Electronic Resource
    Electronic Resource
    On “Stereotactic Radiosurgery for Patients with Single Brain Metastasis” (Cho et al., This Issue) (1998)
    Springer
    Journal of radiosurgery 1 (1998), S. 87-88 
    Details
    ISSN: 1573-8752
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/B:JORA.0000010891.20360.b3
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  • 3
    Electronic Resource
    Electronic Resource
    Recurrent Malignant Gliomas Treated with Radiosurgery (1999)
    Springer
    Journal of radiosurgery 2 (1999), S. 119-125 
    Details
    ISSN: 1573-8752
    Keywords: Radiosurgery ; malignant glioma ; surgery ; brachytherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The inability to control malignant glioma results in a high incidence of local failure and poor survival. Focal therapy such as radiosurgery permits delivery of a high dose of radiation with moderate toxicity. This report summarizes the outcome of patients with recurrent malignant glioma treated with radiosurgery at University of Wisconsin Hospital, between January 1989 and December 1997, when 30 patients were treated radiosurgically. All patients had undergone and failed external beam radiotherapy (median dose of 59.4 Gy) prior to radiosurgery. All recurrences were detected by clinical deterioration and confirmed by radiographic progression. No patient was treated for radiographic progression only in the context of a screening protocol. Eight out of 30 patients underwent subtotal resection prior to radiosurgery and 3 received chemotherapy along with radiosurgery. Radiosurgery was delivered in a single fraction using a modified linear accelerator. The median tumor volume was 7.2 cm3 (range 0.42–35.1 cm3) and the median minimal tumor dose was 12 Gy at the 50–80% isodose line. Median follow-up is 70 months. The median overall survival is 8 months; the 1- and 2-year survival rates are 20% and 9%, respectively. For patients with an initial diagnosis of non-glioblastoma, the median survival is 11 months and for those with glioblastoma the median survival is 7 months. The median progression-free survival is 4 months for the entire cohort, 5 months for nonglioblastoma, and 3 months for glioblastoma. The 1-year actuarial reoperation rate after radio-surgery is 7.6%. Radiosurgery for recurrent malignant glioma may improve short-term survival for selected patients with a lower reoperation rate than brachytherapy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1022969211720
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  • 4
    Electronic Resource
    Electronic Resource
    Comparison of Methods for Response Analysis of Central Nervous System Neoplasms (1999)
    Springer
    Journal of radiosurgery 2 (1999), S. 153-161 
    Details
    ISSN: 1573-8752
    Keywords: Brain metastases ; glioblastoma multiforme ; bidimensional product ; tridimensional product ; volume
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The primary objective of this study is to determine whether the conventionally utilized “gold standard” methodology of bidimensional product is reproducible for the purpose of ascertaining response to treatment in CNS neoplasms. Secondary objectives include testing of volumetric methods for response analysis and examining the variability due to tumor pathology, observer, and other factors. Twenty-five patients with brain metastases (evaluated by serial CT) and 16 patients with glioblastoma multiforme (evaluated by serial MRI) were the subjects of this study. The images were reviewed independently by 5 observers and analyzed subjectively, bidimensionally, tridimensionally, and volumetrically, using an NIH-developed software tool, NIH Image. Volume proved to be the most precise measurement technique. Interobserver reproducibility for volume measurements was superior to that of all other methods tested, with the range of correlation coefficients being: bidimensional product = .88–.98, area = .94–.99, tridimensional product = .75–.99, and volume = .96–1.00. Misclassification in tumor response rates was lowest for volume measurements (mean = .23, range = .20–.27) and highest for bidimensional product (mean = .39, range = .34–.44). Volume derived from CT or MRI is a more precise measure of tumor size, yielding consistently lower misclassification rates than traditional bidimensional product or cross-sectional area. This superiority holds irrespective of pathology, tumor size, or observer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1022970730375
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  • 5
    Electronic Resource
    Electronic Resource
    Meningeal hemangiopericytoma: defining the role for radiation therapy (1992)
    Springer
    Journal of neuro-oncology 14 (1992), S. 277-287 
    Details
    ISSN: 1573-7373
    Keywords: hemangiopericytoma ; meningeal hemangiopericytoma ; radiation oncology ; brain neoplasms
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Meningeal hemangiopericytoma is a rare neoplasm arising from perivascular pericytes. Accounting for 〈 1% of all brain tumors, these neoplasms are characterized by a high local recurrence rate and metastatic potential. Meningeal hemangiopericytoma occur most frequently during the fifth decade of life, with an almost equal sex incidence. To evaluate and define the role for primary, postoperative, or palliative radiotherapy in meningeal hemangiopericytoma, data were gathered from our own tumor registry and compiled with an extensive analysis of published series and case reports. This analysis reveals a 90%, 9 year actuarial risk for local recurrence following surgical resection only. Interestingly, less than 33% of these recurrences were noted within the first five years, which may account for the false assumption that these tumors are highly curable with surgical resection only. Radiation therapy appears to reduce this local recurrence rate, prolonging disease-free and overall survival. Radiation responses are dose dependent, with 〉 50 Gray providing superior long-term disease-free survival. Meningeal hemangiopericytoma are characterized by a slow, but progressive radiographic response to ionizing radiation, not unlike other radiated, highly vascular brain lesions, such as arteriovenous malformations. A retrospective review of clinical demographics, sites of meningeal origin, radiographic and pathologic findings and the role of chemotherapy is also presented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00172604
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  • 6
    Electronic Resource
    Electronic Resource
    Acute changes in glucose uptake after treatment: the effects of carmustine (BCNU) on human glioblastoma multiforme (1993)
    Springer
    Journal of neuro-oncology 15 (1993), S. 57-66 
    Details
    ISSN: 1573-7373
    Keywords: glioblastoma ; tumor metabolism ; positron emission tomography ; chemotherapy ; prognosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Sequential positron emission tomographic scans with [18F]-2-fluorodeoxyglucose (PET-FDG) were performed on 6 patients with glioblastoma multiforme who were treated with adjuvant BCNU. Scans were acquired before and 24 hours after BCNU. All patients had prior brain irradiation. Ratios between the maximal tumor FDG uptake and the contralateral white matter FDG uptake, the glucose uptake ratio, were determined. Percent changes in the glucose uptake ratio between the baseline scan and the 24 hour post-treatment scan were of prognostic significance. Patients with the largest percent changes in FDG uptake had the shortest survival. In contrast, neither the baseline glucose uptake ratio nor the visual tumor grade accurately predicted length of survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01050264
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  • 7
    Electronic Resource
    Electronic Resource
    The potential of topoisomerase I inhibitors in the treatment of CNS malignancies: report of a synergistic effect between topotecan and radiation (1996)
    Springer
    Journal of neuro-oncology 30 (1996), S. 1-6 
    Details
    ISSN: 1573-7373
    Keywords: glioma ; radiosensitizers ; topoisomerase I ; topotecan
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Despite innovations in imaging, surgery, and radiation therapy, local failure remains the principle clinical problem in most CNS malignancies. To date, chemotherapy has not made a major impact in the treatment of most adult CNS tumors. The inroads made by chemotherapy in pediatric CNS malignancies suggest that novel drugs, or drug combinations, may improve therapy. Topoisomerase I (Topo I) inhibitors are a relatively new group of chemotherapy drugs with a novel mechanism of action. Drugs in this group currently undergoing clinical trials are the Camptothecin analogues Topotecan, CPT-11, and 9-aminocamptothecin. There is substantial preclinical and some clinical evidence to suggest that these drugs could be useful in the treatment of CNS malignancies. Preclinical studies with the water soluble Topo I inhibitor, Topotecan, demonstrate antineoplastic activity in a variety of CNS malignancies. In addition, Topotecan has good CNS penetration in primates, and recent preliminary phase I and II clinical trials of Topotecan in pediatric and adult CNS malignancies have been promising. In this paper, we describe the unique mechanism of action, antineoplastic activity, and radiosensitizing properties of Topo I inhibitors. We present the first report demonstrating potentiation of radiation lethality by Topotecan in a human glioma (1354) cell line. The dose enhancement ratio was 3.2 at 10% survival. Thus, there is evidence to suggest that Topo I inhibitors may be beneficial in the treatment of CNS neoplasms on the basis of their antineoplastic activity alone, as well as their radiosensitizing effects. Two clinical trials which utilize concurrent Topotecan and radiation in the treatment of pediatric and adult CNS malignancies are discussed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00177437
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  • 8
    Electronic Resource
    Electronic Resource
    A Phase II Study of Preradiation Chemotherapy Followed by External Beam Radiotherapy for the Treatment of Patients with Newly Diagnosed Glioblastoma Multiforme: An Eastern Cooperative Oncology Group Study (E2393) (2000)
    Springer
    Journal of neuro-oncology 47 (2000), S. 145-152 
    Details
    ISSN: 1573-7373
    Keywords: glioblastoma multiforme ; chemotherapy ; radiotherapy ; phase II trial
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Recent publications support the use of preradiation chemotherapy in the treatment of selected primary brain tumors. In the pediatric population, this treatment strategy often delays radiotherapy and may improve the outcome in patients. This manuscript describes the use of a preradiation chemotherapy approach for adult patients with newly diagnosed glioblastoma multiforme. The main objective of this trial was to determine the feasibility of delivering up to 3 monthly cycles of a 72 h continuous simultaneous intravenous infusion of BCNU (40 mg/m2/day) and cisplatin (40 mg/m2/day). Patients were evaluated for tumor response or progression after each cycle. Following the completion of the chemotherapy treatments or evidence of tumor progression, patients underwent external beam radiotherapy. A dose of 45 Gy was delivered to the pretreatment tumor volume plus surrounding edema and a margin of 3.0 cm. An additional 14.4 Gy was delivered to the preoperative volume plus a 2 cm margin. Fifty patients were enrolled, 47 were eligible and analyzable. Overall, 79% of patients were able to complete at least 2 cycles of treatment, exceeding the predefined measure of feasibility. One patient achieved a complete response, 10 patients a partial response and 18 patients had stable disease at completion of the chemotherapy treatments. Twenty-four patients experienced grade 4 toxicity, mostly hematologic. All patients were able to undergo radiotherapy following chemotherapy. These results indicate that a preradiation strategy is feasible. Although responses to the chemotherapy were seen, a phase III trial is needed to determine whether this approach provides an advantage over standard treatment; such a phase III trial has been undertaken by ECOG.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1006402123397
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