Tuesday, September 30, 2014

Stereotactic radiosurgery alone for small cell lung cancer: a neurocognitive benefit?

Stereotactic radiosurgery alone for small cell lung cancer: a neurocognitive benefit?
Radiation Oncology

Yomo and Hayashi reported results of stereotactic radiosurgery alone for brain metastases from small cell lung cancer. This strategy aims to avoid the neurocognitive effects of whole-brain radiation therapy. However, radiosurgery alone increases the risk of distant intracranial relapse, which can independently worsen cognition. This concern is heightened in histologies like small cell with high predilection for intracranial spread. The majority of study patients developed new brain disease, suggesting radiosurgery alone may not be an optimal strategy for preserving neurocognitive function in this population. We suggest whole-brain radiation therapy should remain the standard of care for small cell lung cancer.

Original Article: http://www.ro-journal.com/content/9/1/218

Monday, September 29, 2014

Pearls & Oy-sters: Anorexia and emaciation in patients with cerebellar hemangioblastoma

Pearls & Oy-sters: Anorexia and emaciation in patients with cerebellar hemangioblastoma
Neurology current issue

Anorexia and emaciation result from various conditions, including digestive diseases, metabolic disorders, chronic inflammation, chronic infections, malignancies, and psychiatric problems. Intracranial tumors can also cause a reduction in food intake, thus mimicking anorexia nervosa, through various mechanisms. Fourth ventricular tumors, particularly hemangioblastomas, can cause prolonged appetite loss and extreme body weight loss, without any apparent focal neurologic deficits.



Original Article: http://www.neurology.org/cgi/content/short/83/14/1298?rss=1

Friday, September 26, 2014

Too Many People Die In Hospital Instead of Home. Here?s Why.

Too Many People Die In Hospital Instead of Home. Here?s Why.
MedPage Today Neurology

(MedPage Today) -- Local customs are the reason that so many terminally ill patients spend their final days -- or hours -- in a hospital.

Original Article: http://www.medpagetoday.com/Geriatrics/GeneralGeriatrics/47795

Bevacizumab and glioblastoma: Scientific review, newly reported updates, and ongoing controversies

Bevacizumab and glioblastoma: Scientific review, newly reported updates, and ongoing controversies
Cancer

Anti-angiogenic therapy for glioblastoma has been in the spotlight for several years, as researchers and clinicians strive to find agents with meaningful efficacy against glioblastoma. Bevacizumab in particular, in the second half of the last decade, became the most significant breakthrough in anti-glioblastoma therapy since temozolomide. Optimism for bevacizumab has been somewhat challenged given recent clinical trials that have raised questions regarding its clinical effectiveness, the optimal timing of its use and the validity of endpoints, among other issues. In addition, uncertainty has recently arisen regarding the effects of bevacizumab on quality of life and neurocognitive function, two key clinical endpoints of unquestionable significance among glioblastoma patients. In this review, we highlight these controversies and other recent work related to bevacizumab for glioblastoma. Cancer 2014. © 2014 American Cancer Society.



Original Article: http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1002/cncr.28935

Tuesday, September 23, 2014

Gamma Knife Radiosurgery for Cerebellopontine Angle Meningiomas: A Multicenter Study

Gamma Knife Radiosurgery for Cerebellopontine Angle Meningiomas: A Multicenter Study
Neurosurgery - Most Popular Articles

imageBACKGROUND: Resection of cerebellopontine angle (CPA) meningiomas may result in significant neurological morbidity. Radiosurgery offers a minimally invasive alternative to surgery. OBJECTIVE: To evaluate, in a multicenter cohort study, the outcomes of patients harboring CPA meningiomas who underwent Gamma Knife radiosurgery (GKRS). METHODS: From 7 institutions participating in the North American Gamma Knife Consortium, 177 patients with benign CPA meningiomas treated with GKRS and at least 6 months radiologic follow-up were included for analysis. The mean age was 59 years and 84% were female. Dizziness or imbalance (48%) and cranial nerve (CN) VIII dysfunction (45%) were the most common presenting symptoms. The median tumor volume and prescription dose were 3.6 cc and 13 Gy, respectively. The mean radiologic and clinical follow-up durations were 47 and 46 months, respectively. Multivariate regression analyses were performed to identify the predictors of tumor progression and neurological deterioration. RESULTS: The actuarial rates of progression-free survival at 5 and 10 years were 93% and 77%, respectively. Male sex (P = .014), prior fractionated radiation therapy (P = .010), and ataxia at presentation (P = .002) were independent predictors of tumor progression. Symptomatic adverse radiation effects and permanent neurological deterioration were observed in 1.1% and 9% of patients, respectively. Facial spasms at presentation (P = .007) and lower maximal dose (P = .011) were independently associated with neurological deterioration. CONCLUSION: GKRS is an effective therapy for CPA meningiomas. Depending on the patient and tumor characteristics, radiosurgery can be an adjuvant treatment to initial surgical resection or a standalone procedure that obviates the need for resection in most patients. ABBREVIATIONS: ARE, adverse radiation effect CN, cranial nerve CPA, cerebellopontine angle EBRT, external beam radiation therapy GKRS, Gamma Knife radiosurgery IAC, internal auditory canal NAGKC, North American Gamma knife Consortium PFS, progression-free survival SRS, stereotactic radiosurgery WHO, World Health Organization

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2014/10000/Gamma_Knife_Radiosurgery_for_Cerebellopontine.19.aspx

Multimodal Treatment of Pain

Multimodal Treatment of Pain
Neurosurgery Clinics of North America

Chronic pain is a complex disorder with extensive overlap in sensory and limbic pathways. It needs systemic therapy in addition to focused local treatment. This article discusses treatment modalities other than surgical and interventional approaches and also discusses the literature regarding these treatment modalities, including pharmacotherapy, physical and occupational therapy, psychological approaches including cognitive behavior therapy, and other adjunctive treatments like yoga and tai chi.

Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00078-3/abstract?rss=yes

Saturday, September 20, 2014

Intraventricular tumor presenting as progressive supranuclear palsy-like phenotype

Intraventricular tumor presenting as progressive supranuclear palsy-like phenotype
Neurology recent issues

A 70-year-old woman presented with a 2-year history of progressive difficulty in walking with frequent falls. Neurologic examination showed postural instability with backward falls, vertical supranuclear gaze palsy with normal vestibular-ocular reflex, rigidity, and pyramidal signs in the right limbs. There was no clinical response to levodopa. Laboratory serologic tests had normal results. MRI displayed midbrain compression and dislocation caused by a large tumor in the left lateral ventricle (figure). Dopamine transporter SPECT showed normal striatal binding. The patient died before neurosurgery could be performed; there was no autopsy. Brain tumors should be considered in the diagnostic workup1 of progressive supranuclear palsy–like phenotypes.



Original Article: http://www.neurology.org/cgi/content/short/83/10/948?rss=1

Long term results after fractionated stereotactic radiotherapy (FSRT) in patients with craniopharyngioma: maximal tumor control with minimal side effects

Long term results after fractionated stereotactic radiotherapy (FSRT) in patients with craniopharyngioma: maximal tumor control with minimal side effects
Radiation Oncology

Purpose: There are already numerous reports about high local control rates in patients with craniopharyngioma but there are only few studies with follow up times of more than 10 years. This study is an analysis of long term control, tumor response and side effects after fractionated stereotactic radiotherapy (FSRT) for patients with craniopharyngioma.Patients and methods: 55 patients who were treated with FSRT for craniopharyngioma were analyzed. Median age was 37 years (range 6-70 years), among them eight children < 18 years. Radiotherapy (RT) was indicated for progressive disease after neurosurgical resection or postoperatively after repeated resection or partial resection. A median dose of 52.2 Gy (50 - 57.6 Gy) was applied with typical dose per fraction of 1.8 Gy five times per week. The regular follow up examinations comprised in addition to contrast enhanced MRI scans thorough physical examinations and clinical evaluation. Results: During median follow up of 128 months (2 - 276 months) local control rate was 95.3% after 5 years, 92.1% after 10 years and 88.1% after 20 years. Overall survival after 10 years was 83.3% and after 20 years 67.8% whereby none of the deaths were directly attributed to craniopharyngioma. Overall treatment was tolerated well with almost no severe acute or chronic side effects. One patient developed complete anosmia, another one's initially impaired vision deteriorated further. In 83.6% of the cases with radiological follow up a regression of irradiated tumor residues was monitored, in 7 cases complete response was achieved. 44 patients presented themselves initially with endocrinologic dysfunction none of them showed signs of further deterioration during follow up. No secondary malignancies were observed. Conclusion: Long term results for patients with craniopharyngioma after stereotactic radiotherapy are with respect to low treatment related side effects as well as to local control and overall survival excellent.

Original Article: http://www.ro-journal.com/content/9/1/203

A new prognostic instrument to predict the probability of developing new cerebral metastases after radiosurgery alone

A new prognostic instrument to predict the probability of developing new cerebral metastases after radiosurgery alone
Radiation Oncology

Background: Addition of whole-brain irradiation (WBI) to radiosurgery for treatment of few cerebral metastases is controversial. This study aimed to create an instrument that estimates the probability of developing new cerebral metastases after radiosurgery to facilitate the decision regarding additional WBI. Methods: Nine characteristics were investigated for associations with the development of new cerebral metastases including radiosurgery dose (dose equivalent to <20 Gy vs. 20 Gy vs. >20 Gy for tumor cell kill, prescribed to the 73-90% isodose level), age (<=60 vs. >=61 years), gender, Eastern Cooperative Oncology Group performance score (0-1 vs. 2), primary tumor type (breast cancer vs. non-small lung cancer vs. malignant melanoma vs. others), number/size of cerebral metastases (1 lesion <15 mm vs. 1 lesion >=15 mm vs. 2 or 3 lesions), location of the cerebral metastases (supratentorial alone vs. infratentorial +/- supratentorial), extra-cerebra metastases (no vs. yes) and time between first diagnosis of the primary tumor and radiosurgery (<=15 vs. >15 months). Results: Number of cerebral metastases (p = 0.002), primary tumor type (p = 0.10) and extra-cerebral metastases (p = 0.06) showed significant associations with development of new cerebral metastases or a trend, and were integrated into the predictive instrument. Scoring points were calculated from 6-months freedom from new cerebral metastases rates. Three groups were formed, group I (16-17 points, N = 47), group II (18-20 points, N = 120) and group III (21-22 points, N = 47). Six-month rates of freedom from new cerebral metastases were 36%, 65% and 80%, respectively (p < 0.001). Corresponding rates at 12 months were 27%, 44% and 71%, respectively. Conclusion: This new instrument enables the physician to estimate the probability of developing new cerebral metastases after radiosurgery alone. Patients of groups I and II appear good candidates for additional WBI in addition to radiosurgery, whereas patients of group III may not require WBI in addition to radiosurgery.

Original Article: http://www.ro-journal.com/content/9/1/215