Brain and Spinal Cord Tumours
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Latest Research Publications
Childhood Brain Tumours
Pituitary Tumours
Primary CNS Lymphoma
Acoustic Neuroma
Neuro-oncology (specialty)

Information Patients and the Public (15 links)

Information for Health Professionals / Researchers (24 links)

Latest Research Publications

This list of publications is regularly updated (Source: PubMed).

Roci E, Cakani B, Brace G, et al.
Platinum-based chemotherapy in recurrent high-grade glioma patients: retrospective study.
Med Arch. 2014; 68(2):140-3 [PubMed] Related Publications
INTRODUCTION: To investigate the efficacy of platinum-based chemotherapy in patients with recurrent high-grade glioma (HGG) who had received previous alkylating line of chemotherapy.
MATERIAL AND METHODS: Case notes of patients who had received chemotherapy with carboplatin or cysplatin for recurrent HGG between June 2006 and July 2012 were reviewed. Baseline characteristics and outcomes after treatment were recorded.
RESULTS: Forty-eight patients received carboplatin/cysplatin as second line chemotherapy for recurrent HGG (grade III n = 6; grade IV n = 42). The median number of cycles completed was 4. Fifteen patients (28%) had at least minor response, 22 (49%) had stable disease and 11 (23%) had progressive disease. Six month progression-free survival was 30% (52% in patients with grade III glioma and 18% in patients with grade IV glioma). The median time to disease progression from the first treatment with platinum drug was 3.2 months. The median survival was 8 months (10 months for patients with grade III glioma and 7 months for patients with grade IV glioma). Among patients with either stable disease or a partial response, the median survival was 12 months compared with 3 months in patients with progressive disease. No survival or response rate differences were noted regarding the type of previous chemotherapy, nitrosoureas or temozolomide.
CONCLUSIONS: Single-agent carboplatin/cysplatin has modest activity in patients with recurrent HGG previously treated with one line of chemotherapy, nitrosoureas or temozolomide. Despite the improvement of median survival of patients achieving stable disease or a partial response to treatment, more effective regimens are required for this patient population.

Related: Carboplatin Cisplatin

Patel AP, Tirosh I, Trombetta JJ, et al.
Single-cell RNA-seq highlights intratumoral heterogeneity in primary glioblastoma.
Science. 2014; 344(6190):1396-401 [PubMed] Related Publications
Human cancers are complex ecosystems composed of cells with distinct phenotypes, genotypes, and epigenetic states, but current models do not adequately reflect tumor composition in patients. We used single-cell RNA sequencing (RNA-seq) to profile 430 cells from five primary glioblastomas, which we found to be inherently variable in their expression of diverse transcriptional programs related to oncogenic signaling, proliferation, complement/immune response, and hypoxia. We also observed a continuum of stemness-related expression states that enabled us to identify putative regulators of stemness in vivo. Finally, we show that established glioblastoma subtype classifiers are variably expressed across individual cells within a tumor and demonstrate the potential prognostic implications of such intratumoral heterogeneity. Thus, we reveal previously unappreciated heterogeneity in diverse regulatory programs central to glioblastoma biology, prognosis, and therapy.

Pendse AA, Edgerly CH, Fedoriw Y
Hemolytic anemia and metastatic carcinoma: case report and literature review.
Lab Med. 2014; 45(2):132-5 [PubMed] Related Publications
Hemolytic anemia can complicate the development of a variety of solid tumors and hematologic malignancies. Although patients may have an established diagnosis with documented metastases, microangiopathic hemolytic anemia (MAHA) can be a presenting feature of an occult malignancy. Prompt diagnosis is essential because conditions that mimic the symptoms of MAHA, including thrombotic thrombocytopenic purpura, have different prognoses and therapeutic options. Although the exact pathogenesis is not yet delineated, we present herein a case of cancer-associated MAHA and discuss the known pathways that can contribute to the initiation and propagation of hemolytic anemia in patients with cancer. The patient is a 69-year-old woman with breast carcinoma that had metastasized to her rectum, urinary bladder, and brain. She eventually developed progressive decline in her functional status, with intermittent epistaxis and melena. The results of laboratory studies revealed hemolytic anemia and thrombocytopenia; results of a bone-marrow biopsy confirmed the involvement by metastatic carcinoma. The patient received red blood cell and platelet transfusions and was discharged to hospice care after clinical stabilization. She died soon thereafter.

Related: Breast Cancer

Syeda T, Hashim AS, Rizvi HA, Hadi SM
Pre- and post-operative values of serum CRP in patients undergoing surgery for brain tumour.
J Pak Med Assoc. 2014; 64(3):271-4 [PubMed] Related Publications
OBJECTIVE: To determine the concentration of C-reactive protein in pre- and post-operative serum samples of brain tumour patients in order to detect the potential risks of post-operative infections.
METHODS: Serum C-reactive protein was measured on pre- and post-operative Day 1, Day 2 and Day 7 in 18 patients who underwent surgery for brain tumours. The study was performed at the Neurosurgical Ward, Jinnah Postgraduate Medical Centre, Karachi, from May 2007 to April 2008. Mean pre-operative patients and control values were compared using Mann-Whitney or Wilcoxon tests for comparing between pre- and post-operative values. P-value was considered significant at < 0.05.
RESULTS: Five (27.7%) of the 18 pre-operative patients had elevated serum concentrations i.e. > 5.0 mg/L but no statistically significant difference was found when compared with healthy controls, with mean 4.4 +/- 6.6 and 0.9 +/- 0.7, respectively. Significantly raised serum concentrations were observed in all post-operative samples when compared with pre-operative samples. Serum CRP concentrations significantly increased post-operatively on Day 1, with mean value of 102.9 +/- 82.0 mg/L (p < 0.0005), and further increased on Day 2 with mean value of 166.9 +/- 128.1 mg/L (p < 0.0005), but declined on Day 7, with mean value of 42.7 +/- 63.6 mg/L (p < 0.005).
CONCLUSION: Pre-operative serum C-reactive protein concentrations of 28% of the patients were elevated, suggesting an association with brain tumours. Post-operative serum concentrations were significantly higher than those noted before the surgery. Absence of a fall of concentration from peak value on post-operative Day 2 or a secondary rise from post-operative Day 7 could be alarming for inter-current infection.

Related: Childhood Brain Tumours Childhood Brain Tumors

Frankel TL, Bamboat ZM, Ariyan C, et al.
Predicting the development of brain metastases in patients with local/regional melanoma.
J Surg Oncol. 2014; 109(8):770-4 [PubMed] Related Publications
BACKGROUND: The brain is a common site of recurrence in melanoma patients. Brain recurrence may present as a seizure, hemorrhage, or death. We sought to determine predictors of brain metastases in patients with primary and regional melanoma in order to facilitate targeted screening.
METHODS: Prospectively maintained databases were used to identify patients treated for local or regional melanoma who developed stage IV melanoma with and without brain metastasis at initial recurrence. One hundred twenty patients were identified with brain relapse and compared to 487 patients without brain recurrence.
RESULTS: On univariate analysis, patients with brain metastases were younger (55 vs. 59yrs, P = 0.04) but did not differ in primary site (head and neck 23% vs. 21%, P = 0.20). Brain metastasis patients had thinner primaries (mean 3.4 vs. 4.5 mm, P = 0.01). There were no other pathologic differences including ulceration (55% vs. 53%, P = 0.75), mitoses (7 vs.7.5, P = 0.61) or histologic subtype. Younger age and decreased Breslow thickness were independently associated with brain metastases at stage IV recurrence (OR = 1.10 P = 0.01 and OR = 1.02 P = 0.02, respectively).
CONCLUSIONS: Our analysis, the largest to date, demonstrates that thinner Breslow depth and younger age were associated with brain recurrence at first presentation with Stage IV disease.

Related: Skin Cancer

Tang Y, Dundamadappa SK, Thangasamy S, et al.
Correlation of apparent diffusion coefficient with Ki-67 proliferation index in grading meningioma.
AJR Am J Roentgenol. 2014; 202(6):1303-8 [PubMed] Related Publications
OBJECTIVE: A noninvasive method to predict aggressiveness of high-grade meningiomas would be desirable because it would help anticipate tumor recurrence and improve tumor management and the treatment outcomes. The Ki-67 protein is a marker of tumor proliferation, and apparent diffusion coefficient (ADC) is related to tumor cellularity. Therefore, we sought to determine whether there is a statistically significant correlation between ADC and Ki-67 values in meningiomas and whether ADC values can differentiate various meningioma subtypes.
MATERIALS AND METHODS: MRI examinations and histopathology of 68 surgically treated meningiomas were retrospectively reviewed. Mean ADC values were derived from diffusion imaging. Correlation coefficients were calculated for mean ADC and Ki-67 proliferation index values using linear regression. An independent unpaired Student t test was used to compare the ADC and Ki-67 proliferation index values from low-grade and more aggressive meningiomas.
RESULTS: A statistically significant inverse correlation was found between ADC and Ki-67 proliferation index for low-grade and aggressive meningiomas (r(2) = -0.33, p = 0.0039). ADC values (± SD) of low-grade meningiomas (0.84 ± 0.14 × 10(-3) mm(2)/s) and aggressive (atypical or anaplastic) meningiomas (0.75 ± 0.03 × 10(-3) mm(2)/s) were significantly different (p = 0.0495). Using an ADC cutoff value of 0.70 × 10(-3) mm(2)/s, the sensitivity for diagnosing aggressive meningiomas was 29%, specificity was 94%, positive predictive value was 67%, and negative predictive value was 75%.
CONCLUSION: ADC values correlate inversely with Ki-67 proliferation index and help differentiate low-grade from aggressive meningiomas.

Related: MKI67

Kondo Y, Katsushima K, Ohka F, et al.
Epigenetic dysregulation in glioma.
Cancer Sci. 2014; 105(4):363-9 [PubMed] Related Publications
Given that treatment options for patients with glioblastoma are limited, much effort has been made to clarify the underlying mechanisms of gliomagenesis. Recent genome-wide genomic and epigenomic analyses have revealed that mutations in epigenetic modifiers occur frequently in gliomas and that dysregulation of epigenetic mechanisms is closely associated with glioma formation. Given that epigenetic changes are reversible, understanding the epigenetic abnormalities that arise in gliomagenesis might be key to developing more effective treatment strategies for glioma. In this review, we focus on the recent advancements in epigenetic research with respect to gliomas, consider how epigenetic mechanisms dynamically regulate tumor cells, including the cancer stem cell population, and discuss perspectives and challenges for glioma treatment in the near future.

Duebgen M, Martinez-Quintanilla J, Tamura K, et al.
Stem cells loaded with multimechanistic oncolytic herpes simplex virus variants for brain tumor therapy.
J Natl Cancer Inst. 2014; 106(6):dju090 [PubMed] Related Publications
BACKGROUND: The current treatment regimen for malignant glioblastoma multiforme (GBM) is tumor resection followed by chemotherapy and radiation therapy. Despite the proven safety of oncolytic herpes simplex virus (oHSV) in clinical trials for GBMs, its efficacy is suboptimal mainly because of insufficient viral spread after tumor resection.
METHODS: Human mesenchymal stem cells (MSC) were loaded with oHSV (MSC-oHSV), and their fate was explored by real-time imaging in vitro and in vivo. Using novel diagnostic and armed oHSV mutants and real-time multimodality imaging, the efficacy of MSC-oHSV and its proapoptotic variant, oHSV-TRAIL encapsulated in biocompatible synthetic extracellular matrix (sECM), was tested in different mouse GBM models, which more accurately reflect the current clinical settings of malignant, resistant, and resected tumors. All statistical tests were two-sided.
RESULTS: MSC-oHSVs effectively produce oHSV progeny, which results in killing of GBMs in vitro and in vivo mediated by a dynamic process of oHSV infection and tumor destruction. sECM-encapsulated MSC-oHSVs result in statistically significant increased anti-GBM efficacy compared with direct injection of purified oHSV in a preclinical model of GBM resection, resulting in prolonged median survival in mice (P < .001 with Gehan-Breslow-Wilcoxin test). To supersede resistant tumors, MSC loaded with oHSV-TRAIL effectively induce apoptosis-mediated killing and prolonged median survival in mice bearing oHSV- and TRAIL-resistant GBM in vitro (P < .001 with χ(2) contingency test).
CONCLUSIONS: Human MSC loaded with different oHSV variants provide a platform to translate oncolytic virus therapies to clinics in a broad spectrum of GBMs after resection and could also have direct implications in different cancer types.

Gessi M, Moneim YA, Hammes J, et al.
FGFR1 mutations in Rosette-forming glioneuronal tumors of the fourth ventricle.
J Neuropathol Exp Neurol. 2014; 73(6):580-4 [PubMed] Related Publications
Rosette-forming glioneuronal tumors (RGNTs) are rare glioneuronal tumors of the fourth ventricle region that preferentially affect young adults. Despite their histologic similarity with pilocytic astrocytomas (PAs), RGNTs do not harbor KIAA1549-BRAF fusions or BRAF mutations, which represent the most common genetic alteration in PAs. Recently, mutations affecting the hotspot codons Asn546 and Lys656 of fibroblast growth factor receptor 1 (FGFR1) have been described in PAs. They are considered to be the most frequent mechanism of mitogen-activated protein kinase activation, alternative to KIAA1549-BRAF fusion and BRAF mutations. To uncover possible molecular similarities between RGNTs and PAs, we performed a mutational study of FGFR1 in 8 RGNTs. An FGFR1 N546K mutation and an FGFR1 K656E mutation were found in the tumors of 2 patients. Notably, the patient with an FGFR1 K656E mutated RGNT had undergone a resection of a diencephalic pilocytic astrocytoma with pilomyxoid features 5 years before the discovery of the fourth ventricle tumor; the mutational analysis uncovered the presence of the same FGFR1 K656E mutation in the diencephalic tumor. These results indicate that, in addition to histologic similarities, at least a subgroup of RGNTs may show close molecular relationships with PAs. Whether FGFR1 mutated RGNTs represent a specific subset of this rare tumor entity remains to be determined.

Related: MKI67 FGFR1 gene

Giannini C, Dogan A, Salomão DR
CNS lymphoma: a practical diagnostic approach.
J Neuropathol Exp Neurol. 2014; 73(6):478-94 [PubMed] Related Publications
The concept and understanding of central nervous system (CNS) lymphoma have greatly evolved in the past few years. Better characterization of a number of lymphoproliferative neoplasms through clinical, immunophenotyping, and molecular studies is reflected in a much more complex WHO Classification of Tumours of Hematopoietic and Lymphoid Tissue. The term "primary CNS lymphoma" is now restricted to primary diffuse large B-cell lymphoma confined to the CNS (and/or to the eye) that occurs in immunocompetent patients. Many other lymphoma subtypes, some of which are primary or exclusive to the CNS, such as lymphomas of the dura and immunodeficiency-associated lymphomas, are excluded from this definition. We describe the clinical and morphologic features of a diverse group of lymphomas occurring in the CNS, including primary CNS lymphoma, primary vitreoretinal lymphoma, lymphomatosis cerebri, Epstein-Barr virus-associated lymphoproliferative disorders, low-grade B-cell lymphoma, T-cell lymphoma, anaplastic large cell lymphoma, intravascular large B-cell lymphoma, and Hodgkin lymphoma. The purpose of this review is to provide a practical approach to the diagnosis of an often-challenging entity, focusing on how to maximize the use of small tissue biopsies and prevent diagnostic traps, which we have encountered with similar cases. Clinical, radiologic, and histologic examples are presented.

Lacouture ME, Davis ME, Elzinga G, et al.
Characterization and management of dermatologic adverse events with the NovoTTF-100A System, a novel anti-mitotic electric field device for the treatment of recurrent glioblastoma.
Semin Oncol. 2014; 41 Suppl 4:S1-14 [PubMed] Related Publications
The NovoTTF-100A System (NovoTTF™ Therapy, Novocure Inc.) is a device that delivers alternating electric fields (TTFields) to tumor cells and interferes with mitosis. It is approved for use as monotherapy for the treatment of recurrent glioblastoma (rGB). TTFields are delivered through insulated transducer arrays applied onto the shaved scalp and connected to a battery-operated field generator. The occurrence of dermatologic adverse events (dAEs) is primarily due to the continuous contact between the array-related components and the scalp for periods of 3-4 days (together with other risk factors). These dAEs may include allergic and irritant dermatitis, mechanical lesions, ulcers, and skin infection. The incidence of dAEs in the phase III trial (n = 116) was 16% (2% grade 2, 0% grade 3/4); the post-marketing surveillance program (n = 570) revealed 156 (21.8%) dAEs with some patients reporting more than one event. Prophylactic strategies for dAEs include proper shaving and cleansing of the scalp and array relocation. Treatment-based strategies are AE-specific and include topical or oral antibiotics, topical corticosteroids, and isolation of affected skin areas from adhesives and pressure. The addition of skin care strategies to the NovoTTF-100A System use will maximize adherence to therapy while maintaining quality of life, all of which contribute to the therapeutic benefit of NovoTTF Therapy in rGB.

Hernán Martínez J, Figueroa-Núñez C, Mansilla-Letelier P, et al.
Young female with acromegaloid features and pituitary macroadenoma: what is your diagnosis?
Bol Asoc Med P R. 2014; 106(1):49-53 [PubMed] Related Publications
Pseudoacromegaly is a extremely rare condition previously described and characterized by acromegaloid changes, tissue overgrowth, without elevations in insulin-like growth factor or growth hormone as seen in Acromegaly. We present the case of a young female seen initially with acromegaloid features and a pituitary microadenoma. After work-up the patient was diagnosed as insulin-mediated pseudoacromegaly. Only a few cases of pseudoacromegaly has been reported and should always be considered when evaluating patients for acromegaloid features with negative biochemical and hormonal levels.

Related: Pituitary Tumors Breast cancer in pregnancy

Kraft Roverea R, Dagnonia C, Gomes de Oliveiraa G, Sapellia J
Meningeal melanocytoma: case report and literature review.
Bol Asoc Med P R. 2014; 106(1):30-2 [PubMed] Related Publications
We report a case of a 54-year-old female with progressive chronic pain in lower extremity, paraplegia and loss of function of the anal sphincter. MRI revealed an expansive solid intradural and intramedullar lesion located at the T6 to T9 levels. Histology of the lesion showed melanocytes with the results of immunohistochemistry consistent with a melanocytoma. Melanocytic tumors are rare tumors which present a diagnostic and management challenge for the modern neurosurgeon and neuro-oncologist since MRI and CT features are non-specific and there is scant data to standardise best strategic therapy.

Related: Melanoma

Han B, Lai H, Xie R, et al.
Identification of glioma cancer-alerted gene markers based on a diagnostic outcome correlation analysis preferential approach.
Int J Data Min Bioinform. 2014; 9(1):67-88 [PubMed] Related Publications
Identifying glioma cancer-alerted genetic markers through analysis of microarray data allows us to detect tumours at the genome-wide level. To this end, we propose to identify glioma gene markers based primarily on their correlation with the glioma diagnostic outcomes, rather than merely on the classification quality or differential expression levels, as it is not the classification or expression level per se that is crucial, but the selection of biologically relevant biomarkers is the most important issue. With the help of singular value decomposition, microarray data are decomposed and the eigenvectors corresponding to the biological effect of diagnostic outcomes are identified. Genes that play important roles in determining this biological effect are thus detected. Therefore, genes are essentially identified in terms of their strength of association with diagnostic outcomes. Monte Carlo simulations are then used to fine tune the selected gene set in terms of classification accuracy. Experiments show that the proposed method achieves better classification accuracies and is data sets independent. Graph-based statistical analysis showed that the selected genes have close relationships with glioma diagnostic outcomes. Further biological database and literature study confirms that the identified genes are biologically relevant.

Ohtakara K, Ohe N, Iwama T, Hoshi H
Early manifestation of communicating hydrocephalus after fractionated stereotactic radiotherapy for aggressive giant atypical prolactinoma.
Anticancer Res. 2014; 34(5):2509-15 [PubMed] Related Publications
Aggressive giant invasive pituitary adenomas refractory to standard surgical or medical treatment remain a genuine challenge. In addition, communicating hydrocephalus (CH) attributed to malabsorption of cerebrospinal fluid (CSF) developing after radiotherapy for pituitary adenomas has not been previously reported. Herein, we describe the case of a 48-year-old male presenting with a giant atypical prolactinoma refractory to previous therapies, including pharmacotherapy and repetitive surgery. He underwent image-guided fractionated stereotactic radiotherapy in 28 fractions, resulting in early manifestation of CH associated with undisputed, both radiological and hormonal response. He recovered well after a shunt placement, with otherwise favorable consequences such as sustained tumor regression, decreasing prolactin level, and retained visual function for a 22-month follow-up. Fractionated stereotactic radiotherapy would provide a viable treatment alternative for these refractory cases, while caution should be exercised regarding the possibility of iatrogenic CH.

Related: Pituitary Tumors

Rades D, Weber A, Karstens JH, et al.
Number of extraspinal organs with metastases: a prognostic factor of survival in patients with metastatic spinal cord compression (MSCC) from non-small cell lung cancer (NSCLC).
Anticancer Res. 2014; 34(5):2503-7 [PubMed] Related Publications
BACKGROUND/AIM: In patients irradiated for MSCC from NSCLC, the number of extraspinal organs involved by metastases was investigated for associations with survival.
PATIENTS AND METHODS: The data of 131 patients irradiated with 10×3 Gy in two weeks for MSCC were evaluated. The number of involved extraspinal organs plus eight other factors were retrospectively analyzed.
RESULTS: The 6-month survival rates were 72%, 57%, 20%, and 11% for the involvement of 0, 1, 2, and ≥3 extraspinal organs, respectively (p<0.001). On multivariate analysis, the number of involved extraspinal organs remained significant (risk ratio 1.60; 95% CI 1.28-2.00; p<0.001). Gender (p=0.028), ECOG performance score (p=0.001), histology (p=0.014), ambulatory status (p=0.002), and time to developing motor deficits (p=0.041) were also independent prognostic factors for survival.
CONCLUSION: The number of extraspinal organs with metastases is an independent prognostic factor for the survival of NSCLC patients presenting with MSCC and should be considered in future studies.

Related: Lung Cancer

Evers JN, Schild SE, Segedin B, et al.
A new score predicting survival prognosis after whole-brain radiotherapy alone for brain metastases in elderly patients.
Anticancer Res. 2014; 34(5):2455-8 [PubMed] Related Publications
BACKGROUND/AIM: Elderly patients represent an important subgroup of patients with brain metastases. A survival score has been developed specifically for these patients.
PATIENTS AND METHODS: A total of 544 elderly patients (aged ≥65 years) receiving whole-brain radiotherapy alone were divided into a test (n=272) and a validation group (n=272). In the multivariate analysis of the test group, survival was significantly associated with gender, performance status, and number of organs involved by extracranial metastases. These factors were included in the score. Total scores representing the sum of the three factor scores were 3-13 points. Four prognostic groups were formed.
RESULTS: The 6-month survival rates were 2% for those with 3-6 points, 17% for those with 7-9 points, 56% for those with 10-12 points and 90% for those with 13 points in the test group (p<0.001), and 4%, 21%, 50% and 86%, respectively, in the validation group (p<0.001).
CONCLUSION: This score is reproducible and helps estimate the survival prognosis of elderly patients with brain metastasis.

Kilbourn KJ, Aferzon J, Menon M
Isolated brain metastasis in cholangiocarcinoma: a case report and review of literature.
Conn Med. 2014; 78(3):161-2 [PubMed] Related Publications
Cholangiocarcinoma is a rare malignancyinvolvingthe epithelium of the intrahepatic and extrahepatic bile ducts associated with high mortality usually from systemic recurrence. Isolated brain metastases occur rarely in this malignancy. We found three previous reports on this subject in our review of literature which had a varied presentation. We present the case report of a patient presenting with an isolated brain metastases and we present a review of the literature concerning this diagnosis.

Related: Extra-Hepatic Bile duct cancer (cholangiocarcinoma)

Gronych J, Pfister SM, Jones DT
Connect four with glioblastoma stem cell factors.
Cell. 2014; 157(3):525-7 [PubMed] Related Publications
Hierarchical cell state models, wherein a few stem-like tumor-propagating cells repopulate the tumor after therapy, are often invoked in cancer. Suvà et al. demonstrate a plastic developmental hierarchy in glioma cell populations by characterizing the epigenetic states of phenotypically distinct cells and identifying four factors sufficient to reprogram differentiated cells into a tumorigenic stem-like state.

van der Vossen S, Schepers VP, Berkelbach van der Sprenkel JW, et al.
Cognitive and emotional problems in patients after cerebral meningioma surgery.
J Rehabil Med. 2014; 46(5):430-7 [PubMed] Related Publications
OBJECTIVES: To determine long-term cognitive complaints and symptoms of depression or anxiety in patients following surgery for a cerebral meningioma, and to examine factors associated with these outcomes.
DESIGN: Cross-sectional study.
PATIENTS: Patients operated on for a cerebral meningioma in the University Medical Center Utrecht, The Netherlands, between 2007 and 2009.
METHODS: Clinical data were retrieved from medical files. Patients completed a postal questionnaire. Cognitive complaints were measured with the Cognitive Failures Questionnaire. A score above 43.5 was defined as presence of cognitive complaints. Anxiety and depressive symptoms were measured with the Hospital Anxiety and Depression Scale, and were considered present if the scale score was ≥ 8.
RESULTS: The response rate was 76% (n = 136). Mean time after operation was 32.6 months (standard deviation 10.6 months). Overall, 40% of patients experienced cognitive and/or emotional problems. Thirty-one patients (23%) experienced cognitive complaints, 39 (29%) showed anxiety, and 31 (23%) showed depressive symptoms. Country of birth and previous depression/burn-out were the most important factors. Scores on all outcome measures were related to each other.
CONCLUSION: Forty percent of patients experienced cognitive or emotional problems following surgery for a cerebral meningioma. Screening for these problems is therefore important in order to provide patients with the care they require as soon as possible.

Katsenos S, Nikolopoulou M
Intramedullary thoracic spinal metastasis from small-cell lung cancer.
Monaldi Arch Chest Dis. 2013 Sep-Dec; 79(3-4):140-2 [PubMed] Related Publications
Lung cancer with intramedullary spinal cord metastasis (ISCM) is a rare event exhibiting dismal prognosis. In the present paper, we describe a 74-year-old male who developed bilateral leg weakness with associated backache and non-productive cough. Chest imaging evaluation demonstrated pronounced bilateral mediastinal lymphadenopathy and a nodular opacity in the right lower lobe. The patient was diagnosed with small cell lung cancer through bronchoscopic procedures. Magnetic resonance imaging of the spinal cord with contrast-enhancement revealed an intramedullary lesion consistent with metastasis at the T5-T6 level. Despite chemotherapy and thoracic spine radiotherapy, he eventually succumbed to the disease 3 months after diagnosis. A brief overview of the current literature is also provided laying emphasis on the therapeutic strategies of this unusual extrathoracic metastatic disease.

Related: Lung Cancer

Zimmermann S, Dziadziuszko R, Peters S
Indications and limitations of chemotherapy and targeted agents in non-small cell lung cancer brain metastases.
Cancer Treat Rev. 2014; 40(6):716-22 [PubMed] Related Publications
Lung cancer is characterized by the highest incidence of solid tumor-related brain metastases, which are reported with a growing incidence during the last decade. Prognostic assessment may help to identify subgroups of patients that could benefit from more aggressive therapy of metastatic disease, in particular when central nervous system is involved. The recent sub-classification of non-small cell lung cancer (NSCLC) into molecularly-defined "oncogene-addicted" tumors, the emergence of effective targeted treatments in molecularly defined patient subsets, global improvement of advanced NSCLC survival as well as the availability of refined new radiotherapy techniques are likely to impact on outcomes of patients with brain dissemination. The present review focuses on key evidence and research strategies for systemic treatment of patients with central nervous system involvement in non-small cell lung cancer.

Related: Lung Cancer EGFR Erlotinib (Tarceva) Gefitinib (Iressa)

Fatehi D, Baral TN, Abulrob A
In vivo imaging of brain cancer using epidermal growth factor single domain antibody bioconjugated to near-infrared quantum dots.
J Nanosci Nanotechnol. 2014; 14(7):5355-62 [PubMed] Related Publications
Diagnosis of glioblastoma multiform (GBM) with MRI lacks molecular information and requires a biopsy for pathologic confirmation. The EGFRvIII, is a constitutively active mutant of the EGF receptor, identified in a high percentage of brain cancers and associated with increased invasiveness and resistance, making it a good target to improve imaging and diagnosis. The present study shows that conjugation of near-infrared quantum dot (Qd800) to an anti-EGFRvIII single domain antibody, made of the variable region with an extra cysteine for site-specific conjugation (EG2-Cys), increased its internalization in U87MG-EGFRvIII cells in vitro compared to Qd800 conjugated with the Fc region of the antibody (EG2-hFc) or unconjugated. EG2-Cys also improved the contrast in Near-Infrared Imaging of mice bearing orthotopic glioblastoma. The increased accumulation was confirmed by fluorescence microscopy of brain sections. The specificity of EG2-Cys in brain tumor expressing the EGFRvIII mutant receptor may provide an accurate less invasive diagnosis and determine the level of tumor aggressiveness and resistance.

Related: Monoclonal Antibodies

Carmignani M, Volpe AR, Aldea M, et al.
Glioblastoma stem cells: a new target for metformin and arsenic trioxide.
J Biol Regul Homeost Agents. 2014 Jan-Mar; 28(1):1-15 [PubMed] Related Publications
The high malignancy of glioblastoma has been recently attributed to the presence, within the tumor, of glioblastoma stem cells (GSC) poorly responsive to chemo- and radiotherapy. Here, the potential employment of metformin and arsenic trioxide (ATO) in glioblastoma therapy is discussed focusing on their effects on GSC. Metformin exerts anticancer effects by primarily blocking the pivotal LKB1/AMPK/mTOR/S6K1 pathway-dependent cell growth, induces selective lethal effects on GSC by impairing the GSC-initiating spherogenesis and inhibits the proliferation of CD133+ cells, while having a low or null effect on differentiated glioblastoma cells and normal human stem cells. Metformin and ATO induce autophagy and apoptosis in glioma cells by inhibiting and stimulating the PI3K/Akt and the mitogen-activated protein kinase pathways, respectively. Both drugs promote differentiation of GSC into non-tumorigenic cells. In this regard, metformin acts via activation of the AMPK-FOXO3 axis, whereas ATO blocks the interleukin 6-induced promotion of STAT3 phosphorylation. Blood-brain barrier, easily crossed by metformin but not by ATO, undergoes important glioblastoma-induced alterations that increase its permeability, thus allowing ATO to distribute more into the glioblastoma bulk than in the normal brain parenchyma. A prompt clinical assessment of metformin and ATO in glioblastoma patients would represent a valid attempt to improve their survival.

Pierce T, Kranz PG, Roth C, et al.
Use of apparent diffusion coefficient values for diagnosis of pediatric posterior fossa tumors.
Neuroradiol J. 2014; 27(2):233-44 [PubMed] Related Publications
We prospectively compared the ability of neuroradiologists to diagnose medulloblastoma with novice raters using only apparent diffusion coefficient (ADC) values measured on ADC maps. One hundred and three pediatric patients with pre-operative magnetic resonance imaging scans showing a posterior fossa tumor with histological verification were retrospectively identified from a ten-year period at a tertiary care medical center. A single observer measured the lowest ADC values in all tumors to determine the mean minimum ADC (ADCmin) value that provided greatest accuracy in distinguishing medulloblastomas from other tumors, which was determined to be 0.66×10(-3) mm(2)/s. Imaging studies, including ADC maps, from 90 patients were provided to two neuroradiologists, who provided a diagnosis, which was later dichotomized as medulloblastoma or other. Two medical students measured ADCmin within tumors and those with ADCmin < 0.66×10(-3) mm(2)/s were recorded as medulloblastoma; any other value was recorded as other. Diagnostic accuracy was measured. ADCmin values allowed a correct identification of lesions as either medulloblastoma or other in 91% of cases. After diagnoses by the two neuroradiologists were categorized as either medulloblastoma or other, their diagnoses were correct in 90% and 84% of cases, respectively. In 19 cases, at least one neuroradiologist was incorrect; the addition of ADC values to clinical interpretation would have allowed a correct diagnosis in 63% of such cases. Diagnostic accuracy based on ADC values by medical students was comparable to that of subspecialty-trained neuroradiologists. Our findings suggest that the addition of ADC values to standard film interpretation may improve the diagnostic rate for these tumors.

Related: Childhood Astrocytoma Childhood Brain Tumours Childhood Brain Tumors Childhood Ependymoma Childhood Medulloblastoma / PNET

Eluvathingal Muttikkal TJ, Raghavan P
Spontaneous regression and recurrence of a tumefactive perivascular space.
Neuroradiol J. 2014; 27(2):195-202 [PubMed] Related Publications
Perivascular spaces can occasionally appear mass-like (tumefactive or giant perivascular space), and can be associated with clinical symptoms. Spontaneous regression of a tumefactive perivascular space is a very rare phenomenon with only two reported cases in the English medical literature. Spontaneous regression of a tumefactive perivascular space along with resolution of clinical symptoms, followed by spontaneous recurrence associated with symptom recurrence is an extremely rare occurrence, which to the best of our knowledge, has not been reported in the medical literature. We describe a case of spontaneous regression of a tumefactive perivascular space, three years after its initial detection, followed by spontaneous recurrence after two years.

Prontera A, Puzzolante A, Carpeggiani P, Pavesi G
Symptomatic anterior cerebral artery vasospasm after brainstem hemangioblastoma resection. A case report.
Neuroradiol J. 2014; 27(2):186-90 [PubMed] Related Publications
Diffuse cerebral vasospasm is a rare complication after brain tumour resection as opposed to that following an aneurysmal subarachnoid haemorrhage. Sellar tumours are among the most common pathologies and locations associated with this complication. Removal of posterior cranial fossa lesions is uncommonly associated with vasospasm, with only nine reported cases. We describe a case of diffuse symptomatic vasospasm mainly involving the right anterior cerebral artery, angiographically confirmed, after resection of a haemangioblastoma of the medulla in an adult patient with von Hippel-Lindau disease. The possible pathogenesis of this phenomenon is discussed.

Guarnieri G, Tecame M, Izzo R, et al.
Multisegmental diffuse intradural extramedullary ependymoma. An extremely rare case.
Neuroradiol J. 2014; 27(2):179-85 [PubMed] Related Publications
Ependymoma has been described typically as an intramedullary tumour derived from ependymal cells with a predominance in women in the fifth decade of life. Pain is the most frequent symptom. Intradural extramedullary presentation is rarely described and almost always as a unique lesion. We describe a 53-year-old man with multi-segmental diffuse intradural extramedullary ependymoma with progressive lower leg hypoesthesia with regular motility. The patient's neurologic condition improved after surgery.

Alzahrani A, Alassiri A, Kashgari A, et al.
Extraneural metastasis of an ependymoma: a rare occurrence.
Neuroradiol J. 2014; 27(2):175-8 [PubMed] Related Publications
Extraneural metastases of ependymoma are very rare, and have been reported in the lungs, lymph nodes, pleura, mediastinum, liver, diaphragmatic muscle, and bone. We describe the radiological findings of pathologically proven lung metastases from an anaplastic ependymoma. The tumor which arose in the posterior fossa was first diagnosed in 2007 when first surgical resection was performed outside our institute. Multiple operations were performed after that due to tumor relapse. Multiple lung nodules were discovered incidentally during a VP shunt survey. Biopsy from the lung nodules displayed identical histomorphology to the primary brain tumor.

Rispoli R, Conti C, Celli P, et al.
Neural stem cells and glioblastoma.
Neuroradiol J. 2014; 27(2):169-74 [PubMed] Related Publications
Glioblastoma multiforme represents one of the most common brain cancers with a rather heterogeneous cellular composition, as indicated by the term "multiforme". Recent reports have described the isolation and identification of cancer neural stem cells from human adult glioblastoma multiforme, which possess the capacity to establish, sustain, and expand these tumours, even under the challenging settings posed by serial transplantation experiments. Our study focused on the distribution of neural cancer stem cells inside the tumour. The study is divided into three phases: removal of tumoral specimens in different areas of the tumour (centre, periphery, marginal zone) in an operative room equipped with a 1.5 T scanner; isolation and characterization of neural cancer stem cells from human adult glioblastoma multiforme; identification of neural cancer stem cell distribution inside the tumour.

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