Spinal cord astrocytoma: pathological and treatment considerations

1995 ◽  
Vol 83 (4) ◽  
pp. 590-595 ◽  
Author(s):  
Kern J. Minehan ◽  
Edward G. Shaw ◽  
Bernd W. Scheithauer ◽  
Dean L. Davis ◽  
Burton M. Onofrio
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Survival Rate ◽  
Pilocytic Astrocytoma ◽  
Histological Type ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Fibrillary Astrocytoma ◽  
Fine Print

✓ Seventy-nine patients underwent surgery, with or without radiation therapy, for astrocytoma of the spinal cord. There were 43 tumors (54%) classified as pilocytic astrocytoma and 25 (32%) as diffuse fibrillary astrocytoma. Eleven tumors (14%) could not be classified other than as astrocytoma, “type not otherwise specified.” The 10-year overall survival rate for all 79 patients was 50% but significantly differed by histological type: 81% for patients with pilocytic astrocytoma compared to 15% for those with diffuse fibrillary astrocytoma. Tumor grade by the Kernohan, et al., or St. Anne—Mayo methods was also a significant predictor of survival in patients with diffuse fibrillary astrocytoma. The extent of surgical resection (biopsy vs. subtotal resection vs. gross total resection) did not significantly impact survival among patients with pilocytic or nonpilocytic astrocytomas of the spinal cord, although there was a trend toward poorer survival in patients undergoing some degree of resection as opposed to biopsy. Postoperative radiation therapy improved survival but did so more for diffuse fibrillary astrocytoma than pilocytic astrocytoma. In this series, histological type was the most significant predictor of survival in patients with astrocytoma of the spinal cord. The survival rate was highest in patients who underwent biopsy followed by postoperative radiation therapy.

Surgical experience with chromophobe adenomas of the pituitary gland

1971 ◽  
Vol 34 (6) ◽  
pp. 726-729 ◽  
Author(s):  
Bronson S. Ray ◽  
Russell H. Patterson
Keyword(s):  
Radiation Therapy ◽  
Pituitary Gland ◽  
Operative Mortality ◽  
Postoperative Radiation ◽  
Surgical Experience ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Chromophobe Adenoma ◽  
First Time ◽  
Fine Print

✓ Between 1950 and 1969, 165 operations were performed on 146 patients for the treatment of chromophobe adenoma of the pituitary gland unassociated with either acromegaly or Cushing's syndrome. The over-all operative mortality was 1.2%, and no deaths occurred in 138 cases operated on for the first time. In 106 of the patients who had not received prior treatment, vision was improved in 80% of cases and returned to normal in 50%. In the group of patients whose initial treatment was surgery, postoperative radiation therapy was administered in one-half of the cases. The rate of recurrence was 8% in those who received radiation and 22% in those who did not. Recurrence of symptoms within less than 1 year often was due to a hemorrhagic cyst which could be treated better by reoperation than by radiation therapy.

Results of surgical treatment for growth hormone-secreting pituitary adenomas

1993 ◽  
Vol 79 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Dudley H. Davis ◽  
Edward R. Laws ◽  
Duane M. Ilstrup ◽  
James K. Speed ◽  
Michela Caruso ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Radiation Therapy ◽  
Hormone Level ◽  
Growth Hormone Level ◽  
Surgical Excision ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Prior Surgery ◽  
Fine Print

✓ The results of surgical therapy for acromegaly were reviewed in a series of 175 patients treated between 1972 and 1983. Patients with prior surgery or radiation therapy were excluded from the study. Postoperative radiation therapy was given to 54 patients. The criterion of achieving a postoperative basal or glucose-suppressed growth hormone level of 2 ng/ml or less was used to indicate remission. Utilizing the most recently available growth hormone determinations, 90 (51.7%) of 174 patients were in remission. The actuarial probability of remission at 1 and 5 years after surgery was 48.8% and 62.7%, respectively. Tumor size and the preoperative basal growth hormone level were correlated with outcome. Surgical excision of a pituitary adenoma is the most effective therapy currently available for acromegaly.

Primary leiomyosarcoma of the dura mater

1988 ◽  
Vol 68 (2) ◽  
pp. 308-311 ◽  
Author(s):  
Akio Asai ◽  
Hisashi Yamada ◽  
Sadayoshi Murata ◽  
Akira Matsuno ◽  
Kazuo Tsutsumi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Complete Remission ◽  
Dura Mater ◽  
Rare Case ◽  
Postoperative Radiation ◽  
Electron Microscopic ◽  
Postoperative Radiation Therapy ◽  
Content Type ◽  
Microscopic Features ◽  
Fine Print

✓ A rare case of leiomyosarcoma arising from the dura mater is presented. A definite histological diagnosis was based on the electron microscopic features. Extensive removal of the tumor and postoperative radiation therapy resulted in complete remission. The etiology and the origin of this tumor are discussed.

Treatment of Mixed Tumors of the Kidney in Childhood, by Robert E. Gross, MD, and Edward B. D. Neuhauser, MD,Pediatrics, 1950;6:843–852

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 209-210
Author(s):  
Judson Randolph
Keyword(s):  
Radiation Therapy ◽  
Survival Rate ◽  
Wilms Tumor ◽  
Preoperative Radiation ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Children's Hospital ◽  
Tumor Bed ◽  
Operative Removal ◽  
Children’S Hospital

This fundamental paper by a surgeon, Dr Gross, and a radiologist and radiotherapist, Dr Neuhauser, cleaned up the existing information and conflicting results of therapy for Wilms' tumor through 1947. There is a careful review of literature, comments about existing suggestions of preoperative radiation versus postoperative radiation versus radiation only and versus surgery without radiation. The authors then carefully analyze the experience at Boston Children's Hospital over the period from 1914 to 1947. This material is carefully broken down into three periods, 1914 to 1930, 1931 to 1939, and 1940 to 1947. During period I, 1914 to 1930, 27 cases of Wilms' tumor were seen and four cures were obtained for a survival rate of 14.9%. Beginning in 1931, under the able leadership of Dr William E. Ladd, a vigorous approach to the surgery for children with Wilms' tumor was undertaken. The program consisted of a wide transabdominal incision rather than the more classic approach to kidney surgery by a flank incision. This surgical exposure allowed prompt identification and control of the renal vessels and removal, in most cases, of the entire tumor and kidney mass without rupture of the encapsulated tumor. Additionally, Dr. Ladd insisted on careful fluid and blood replacement before and during surgery and a meticulous approach to the anesthestic management of the child undergoing surgery. In previous experience at Boston Children's and other reported centers, there had been a large number of intraoperative deaths. After 1932, there were no deaths from the surgery at Children's Hospital in Boston. In the 1931 to 1939 experience, 31 patients were operated on and ten cures were achieved for a survival rate of 32.2%. Beginning in 1940, Dr Gross and Dr Neuhauser instituted a program of immediate surgery and postoperative radiation to the bed of the tumor. Thirty-eight children were so treated with a survival rate of 47.3%. This group of patients was subsequently followed for 2½ years so that cures, recurrences, and deaths could be accurately reported. This patient material also emphasized that babies in the first 12 months of life had a far better outlook than did older subjects. The authors also emphasized that if recurrences were to occur, they were usually evident within 9 months after operative removal and radiation therapy. Postoperative radiation therapy was given in daily doses of 200r alternately using three portals, anteriorly, laterally, and posteriorly over the tumor bed reaching a total of 4000 to 5000r using a 200KV machine.

Role of Radiation Therapy in the Treatment of Cerebral Oligodendroglioma: An Analysis of 57 Cases and a Literature Review

Neurosurgery ◽  
1983 ◽  
Vol 13 (5) ◽  
pp. 499-503 ◽  
Author(s):  
Peter D. Reedy ◽  
Janet W. Bay ◽  
Joseph F. Hahn
Keyword(s):  
Radiation Therapy ◽  
Survival Rate ◽  
Literature Review ◽  
Cleveland Clinic ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy

Abstract Fifty-seven cases of histologically confirmed cerebral oligodendroglioma treated at the Cleveland Clinic between 1950 and 1980 were reviewed. No difference in the 5-year survival rate was seen in patients treated with postoperative radiation therapy vs. operation alone. These data are compared to previously published series with special emphasis on the role of radiation therapy.

Improved survival with the use of adjuvant chemotherapy in the treatment of medulloblastoma

1991 ◽  
Vol 74 (3) ◽  
pp. 433-440 ◽  
Author(s):  
Roger J. Packer ◽  
Leslie N. Sutton ◽  
Joel W. Goldwein ◽  
Giorgio Perilongo ◽  
Greta Bunin ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Survival Rate ◽  
Adjuvant Chemotherapy ◽  
Disease Free Survival ◽  
Free Survival ◽  
Content Type ◽  
Poor Risk ◽  
Standard Risk ◽  
Disease Free ◽  
Fine Print

✓ Between 1975 and 1989, 108 children with newly diagnosed medulloblastoma/primitive neuroectodermal tumor (MB/PNET) of the posterior fossa were treated at the authors' institution. The patients were managed uniformly, and treatment included aggressive surgical resections, postoperative staging evaluations for extent of disease, and craniospinal radiation therapy with a local boost. Beginning in 1983, children with MB/PNET were prospectively assigned to risk groups; those with “standard-risk” MB/PNET were treated with radiation therapy alone, while those in the “poor-risk” group received similar radiation therapy plus adjuvant chemotherapy with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU), vineristine, and cisplatin. The 5-year actuarial disease-free survival rate for all patients treated between 1975 and 1982 was 68%, and 73% when patients who died within 2 weeks after operation were excluded. This survival rate was statistically better for patients treated after 1982 (82%) compared to those treated between 1975 and 1982 (49%) (p < 0.004). There was no difference in disease-free survival rates over time for children with standard-risk factors; however, there was a significant difference in the 5-year survival rate for poor-risk patients treated prior to 1982 (35%) compared to those treated later (87%) (p < 0.001). For the group as a whole, a younger age at diagnosis correlated with a poorer survival rate; however, this relationship between age and outcome was significant only for children treated before 1983 (p < 0.001). These results demonstrated an encouraging survival rate for children with MB/PNET, especially those treated with aggressive surgical resection followed by both radiation therapy and chemotherapy. The results strongly suggest that chemotherapy has a role for some, and possibly all, children with MB/PNET.

Surgical Technique and Outcomes in the Treatment of Spinal Cord Ependymomas: Part II: Myxopapillary Ependymoma

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. ons90-ons94 ◽  
Author(s):  
Elisa J Kucia ◽  
Peter H Maughan ◽  
Udaya K Kakarla ◽  
Nicholas C Bambakidis ◽  
Robert F Spetzler
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Myxopapillary Ependymoma ◽  
Postoperative Radiation ◽  
Total Resection ◽  
Postoperative Radiation Therapy ◽  
Duration Of Symptoms

Abstract BACKGROUND: Myxopapillary ependymomas usually occur in the filum terminale of the spinal cord. OBJECTIVE: This report summarizes our experience treating myxopapillary ependymomas. METHODS: The records of 34 patients (14 men, 20 women; mean age 45.5 years; age range, 14-88 years) who underwent resection of a myxopapillary ependymoma between 1983 and 2006 were reviewed for age, sex, tumor location, symptoms at diagnosis, duration of symptoms, treatment before presentation, extent of surgical resection, adjuvant therapy, length of follow-up, evidence of recurrence, and complications. Neurological examinations performed at presentation, immediately after surgery, and last follow-up were graded according to the McCormick grading scale. RESULTS: The average duration of symptoms before diagnosis was 22.2 months. The most common symptom was pain followed by weakness, bowel/bladder symptoms, and numbness. The rate of gross total resection was 80%. All patients with a subtotal resection (20%) underwent postoperative radiation therapy. Presentation and outcomes of patients who underwent subtotal resection followed by radiation therapy were compared with those who underwent gross total resection. There was no significant difference in neurological grade between the groups at presentation or final follow-up. The overall recurrence rate was 10% (3/34 patients). CONCLUSION: The goal of surgical treatment of myxopapillary ependymomas is resection to the greatest extent possible with preservation of function. In cases of subtotal resection, postoperative radiation therapy may improve outcome. If neurological function is maintained at treatment, these indolent lesions allow years of good function.

De novo development of a cavernous malformation of the spinal cord following spinal axis radiation

1999 ◽  
Vol 90 (2) ◽  
pp. 234-238 ◽  
Author(s):  
J. Nozipo Maraire ◽  
Saleem I. Abdulrauf ◽  
Scott Berger ◽  
Jonathan Knisely ◽  
Issam A. Awad
Keyword(s):  
Spinal Cord ◽  
Radiation Therapy ◽  
De Novo ◽  
Pathological Examination ◽  
High Dose ◽  
Mr Image ◽  
Lower Extremity Weakness ◽  
Cavernous Malformations ◽  
Content Type ◽  
Fine Print

✓ Analysis of recent reports has suggested that cavernous malformations (CMs) of the brain may have an acquired pathogenesis and a dynamic pathophysiological composition, with documented appearance of new lesions in familial cases and following radiotherapy. The authors report the first case of demonstrated de novo formation of an intramedullary CM following spinal radiation therapy. A 17 year-old boy presented with diabetes insipidus and delayed puberty. Evaluation of endocrine levels revealed hypopituitarism, and magnetic resonance (MR) imaging demonstrated an infundibular mass. The patient underwent a pterional craniotomy and removal of an infundibular germinoma. The MR image of the spine demonstrated normal results. The patient received craniospinal radiation therapy and did well. He presented 5 years later with acute onset of back pain, lower-extremity weakness and numbness, and difficulty with urination. An MR image obtained of the spine revealed an intramedullary T-7 lesion; its signal characteristics were consistent with a CM. The patient was initially managed conservatively but developed progressive myelopathy and partial Brown—Séquard syndrome. Although he received high-dose steroids and bed rest, his symptoms worsened. He underwent a costotransversectomy and excision of a hemorrhagic vascular lesion via an anterolateral myelotomy. Pathological examination confirmed features of a CM. The patient has done well and was walking without assistance within 4 weeks of surgery. De novo genesis of CMs may be associated with prior radiation therapy to the spinal cord.

Factors associated with survival in patients with meningioma

1998 ◽  
Vol 88 (5) ◽  
pp. 831-839 ◽  
Author(s):  
Bridget J. McCarthy ◽  
Faith G. Davis ◽  
Sally Freels ◽  
Tanya S. Surawicz ◽  
Denise M. Damek ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
Survival Rate ◽  
Proportional Hazards Model ◽  
Malignant Tumors ◽  
Age At Diagnosis ◽  
Benign Tumors ◽  
Content Type ◽  
Cancer Data ◽  
Fine Print

Object. To explore factors affecting the survival rate in patients with meningiomas, the authors used the National Cancer Data Base (NCDB), which includes tumors from approximately 1000 hospitals participating in the American College of Surgeons tumor registry program. Methods. Analysis included over 9000 cases diagnosed from 1985 to 1988 and 1990 to 1992. Survival estimates were computed and prognostic factors were identified using a proportional hazards model. The overall 5-year survival rate was 69% and it declined with patient age. This rate was 81% in patients aged 21 to 64 years and 56% for patients 65 years of age or older. When patients were grouped by the histological type of their tumors, those with benign tumors had an overall 5-year survival rate of 70%, whereas the overall 5-year survival rates in patients with atypical and malignant meningiomas were 75% and 55%, respectively. Prognostic factors for benign tumors included age at diagnosis, tumor size, whether treated surgically, hospital type, and radiation therapy; for malignant tumors, the prognostic factors included: age at diagnosis, whether treated surgically, and radiation therapy. These factors were statistically significant. The 5-year rate for recurrence of symptoms (regardless of the method of treatment) was 19.2% for those with benign tumors and 32.4% for those with malignant tumors. In patients whose benign tumor had been completely removed, the 5-year rate of tumor recurrence was 20.5%. Conclusions. Although not population-based, the NCDB has the potential for providing pertinent information regarding patient characteristics and methods of treatment for benign, as well as malignant, brain tumors.

Complex cervical spine neoplastic disease: reconstruction after surgery by using a vascularized fibular strut graft

1999 ◽  
Vol 90 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Neill M. Wright ◽  
Bruce A. Kaufman ◽  
Bruce H. Haughey ◽  
Carl Lauryssen
Keyword(s):  
Cervical Spine ◽  
Radical Resection ◽  
Neoplastic Disease ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Strut Graft ◽  
Content Type ◽  
Posterior Arthrodesis ◽  
Fibular Strut ◽  
Fine Print

✓ The authors report a case of an aggressive chordoma in the cervical spine of a 15-year-old girl who underwent radical resection followed by reconstruction using an anterior vascularized fibular strut graft and posterior arthrodesis prior to receiving immediate postoperative radiation therapy. The patient had successful graft incorporation 4 months postoperatively. The authors review the advantages of using vascularized fibular strut grafts for the treatment of multilevel cervical spine neoplastic disease and discuss the theoretical advantages of using vascularized grafts that tolerate therapeutic levels of radiation.

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