Cases reported "Glioblastoma"

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1/16. thalidomide-induced toxic epidermal necrolysis.

    Toxic epidermal necrolysis (TEN) is a severe dermatologic disorder associated with mortality of up to 30%. Withdrawal of the causative agent is crucial in its management. Although thalidomide-induced dermatologic disorders rarely were reported before thalidomide was administered to patients positive for the human immunodeficiency virus, hypersensitivity reactions including rash are the agent's major dose-limiting toxicities in this population. As it is prescribed for other immunosuppressed patients, such as those with malignancies, the frequency of dermatologic reactions (including TEN) may increase. A 62-year-old woman developed TEN after approximately 5 weeks of thalidomide therapy for the treatment of a glioblastoma.
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2/16. Long survival and therapeutic responses in patients with histologically disparate high-grade gliomas demonstrating chromosome 1p loss.

    OBJECT: Allelic loss of chromosome 1p is a powerful predictor of tumor chemosensitivity and prolonged survival in patients with anaplastic oligodendrogliomas. Chromosome 1p loss also occurs in astrocytic and oligoastrocytic gliomas, although less commonly than in pure oligodendroglial tumors. This observation raises the possibility investigated in this study that chromosome 1p loss might also provide prognostic information for patients with high-grade gliomas with astrocytic components. methods: The authors report on seven patients with high-grade gliomas composed of either pure astrocytic or mixed astrocytic-oligodendroglial phenotypes, who had remarkable neuroradiological responses to therapy or unexpectedly long survivals. All of the tumors from these seven patients demonstrated chromosome 1p loss, whereas other genetic alterations characteristic of high-grade gliomas (p53 gene mutations, EGFR gene amplification, chromosome 10 loss, chromosome 19q loss, or CDKN2A/p16 deletions) were only found in occasional cases. The authors also assessed the frequency of chromosome 1p loss in a series of anonymous high-grade astrocytoma samples obtained from a tumor bank and demonstrate that this genetic change is uncommon, occurring in only 10% of cases. CONCLUSIONS: Although any prognostic importance of chromosome 1p loss in astrocytic or mixed astrocytic-oligodendroglial gliomas can only be determined in larger and prospective series, these findings raise the possibility that some high-grade gliomas with chromosome 1p loss, in addition to pure anaplastic oligodendrogliomas, may follow a more favorable clinical course.
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3/16. Planning of hyperthermic treatment for malignant glioma using computer simulation.

    Interstitial hyperthermia was applied using a radiofrequency generator in the treatment of four malignant glioma patients who had especially deep seated brain tumours or were at high risk. Prior to heating tumours, treatment planning based on an accurate prediction of temperature distribution is essential. The present paper introduces a novel treatment planning method and discusses its clinical efficacy. The two-dimensional finite element method was used for simulation of temperature distribution, which was calculated using the bioheat transfer equation. This technique was applied to plan treatment. temperature was measured at two points during heating and these values were compared with those estimated by the simulation. In addition, the area of the contrast enhanced (CE) rim on the pre-heating computed tomography (CT) image was compared with the low density area of the CE rim on the post-heating CT image, which was obtained within 2 months after heating. The optimal position and number of radiofrequency (RF) electrodes to include the outside of the CE rim in the simulated area above 42 degrees C contour could be easily determined using this planning system in all cases. The temperature estimated by the simulation was in good agreement with the actual values obtained (within 0.4 degrees C). The post-heating CT image revealed that the hyperthermic procedure described herein achieved more than an 80% low density area within the CE rim in all cases (mean 86.0%). These results demonstrate that this novel treatment planning method may prove to be a clinically valuable tool in the treatment of malignant glioma with RF electrodes.
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4/16. radiation necrosis and brain edema association with CyberKnife treatment.

    The CyberKnife (CK) is a frameless and image guided robotic controlled instrument for stereotactic irradiation. The authors studied CK treatment of glioma and glioblastoma, and analyzed frequency and risk factors of radiation necrosis. Of 61 patients with glioma and glioblastoma treated with CyberKnife, four patients showed symptomatic radiation necrosis. All of these patients were treated with stereotactic radiotherapy, varying from 3 to 6 fractions without previous radiation therapy. Two patients required necrotomy through craniotomy. Two patients were treated conservatively. Our four patients with radiation necrosis were not specific in terms of tumor volume and dose delivery. glioma cells invade the normal brain tissue and over-radiation to this intermingling area is one of the risk factors for injury to normal endothelial cells. The homogeneity of the maximum dose area is an important factor to reduce over radiation to the normal brain parenchyma. The dose volume effect has been discussed in terms of risk factor; however, the number of fractions and dose per fraction should be considered to avoid radiation necrosis. We consider that conformal treatment with inverse algorism, fractionated stereotactic radiotherapy and precise anatomic targeting reduce the risk of radiation necrosis.
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5/16. glioblastoma multiforme and the meningeal syndrome.

    Brain tumors rarely may produce acute steile meningitis (the meningeal syndrome) resulting from the spillage of blood, lipid products of tumor necrosis, or malignant cells into the cerebrospinal fluid (CSF). The frequency of the associated meningeal syndrome is a function of tumor type and of the tproximity of tumor necrosis to the ventricles. The meningeal syndromes of lipid-induced chemical inflammation are seen most commonly with epidermoids, craniopharyngiomas, and infarcted pituitary adenomas. I report a patient with the rare association of the meningeal syndrome with glioblastoma multiforme. The lipid irritants of glioblastomas and craniopharyngiomas are similar chemically and can be detected in the CSF. The anti-inflammatory and immunosuppressant properties of steroids provide a rational basis for their efficacy in treatment of the syndrome.
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6/16. Stereotactic hyperthermia for brain tumors.

    We have developed a localized hyperthermia system using computed tomography-stereotactic surgery as malignant brain tumor therapy. In an experimental study, the temperature in the area of the cat brain within 20 mm from a radiofrequency electrode reached more than 43.7 degrees C. Intravenous administration of MCNU during hyperthermia caused a significant increase of MCNU content in the heated brain as compared with a control brain. In the clinical study, localized radiofrequent hyperthermia using stereotactic surgery was performed on 7 malignant deep-seated gliomas and 21 metastatic brain tumors. Especially, combination therapy of stereotactic hyperthermia and chemotherapy was effective treatment for gliomas less than 30 mm deep in the brain.
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7/16. Extracranial metastases of glioblastoma multiforme confirmed by electron microscopy.

    A case of glioblastoma multiforme which metastasized to the pleura and the lymph nodes of the neck is described. The metastases were detected during the life of the patient. The glial nature of the metastases was confirmed by electronmicriscopic demonstration of typical 90-100 angstrom wide glial fibrils occupying the tumor cell cytoplasm. Electronmicroscopy is recommended to prove the astrocytic nature of a metastatic glioblastoma multiforme. A review of the literature of histologically documented extracranial metastases of glioblastoma multiforme reveals an increase in frequency in recent years. Increased efforts at detection and documentation or an increase in occurrence caused by new methods of treatment are the two possible explanations for this trend.
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8/16. Stereotactic localization (with computerized tomographic scanning), biopsy, and radiofrequency treatment of deep brain lesions.

    In eight patients stereotactic biopsy of deep brain lesions was performed. Adequate tissue was obtained, and the information helped considerably in planning further therapy. No significant complications occurred in these patients. In three of the cases, the stereotactic coordinates were determined from the computerized tomographic (CT) scan. In one patient, after biopsy, stereotactic radiofrequency (RF) lesions in the tumor resulted in temporary improvement.
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9/16. Microwave hyperthermia for brain tumors.

    Twelve patients with malignant brain tumors who had failed to respond to conventional therapies were treated with thermotherapy. Hyperthermic temperatures (approximately 43 degrees C) were induced in the tumors using microwaves at a frequency of 2450 MHz that were guided into the tumors by one or more semirigid coaxial applicators. These applicators fit into 16 gauge tubes or needles and can be inserted into the brain with minimal damage to healthy tissues. During each treatment, the tumors were maintained at hyperthermic temperatures for 1 hour. Several treatments spaced a few days apart were usually administered. The procedure used for producing hyperthermia in brain tumors with microwaves proved to be safe and could be repeated several times without producing toxic effects. Objective tumor responses were obtained in 75% of the patients (decrease in tumor size, 3 patients; slowing of tumor growth, 2 patients; necrosis of tumor tissues verified by pathological examination, 4 patients). Favorable clinical responses were observed in 75% of the patients (rapid decrease in intractable headaches, 5 patients; improvements in clinical deficits, 4 patients). Also, in all patients, the microwave power required to heat for a given time or a given volume decreased during most of the thermotherapy sessions, possibly because of heat damage to the tumor vasculature. Our results, taken together with the results of other investigators, indicate that thermotherapy is a promising modality for treating malignant brain tumors, either as the sole therapy or in combination with radiotherapy and chemotherapy. The next logical steps would be Phase I/II type trials of subjects whose disease is less advanced than the disease of patients treated in the current series of investigations.
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10/16. subarachnoid hemorrhage from brain tumors in childhood.

    Six children are reported in whom subarachnoid hemorrhage was an initial symptom of brain tumor. In our neurosurgical clinics, this represented 3.6% of pediatric brain tumors and showed a frequency equal to aneurysmal rupture among nontraumatic subarachnoid hemorrhage of children. In pediatric patients, hemorrhages from brain tumors occur predominantly in the posterior fossa. The medulloblastoma, which had been believed to bleed rarely, is now realized to be a common source of tumor hemorrhages in such cases. The introduction of CT scan facilitates early recognition of hemorrhagic stroke from brain tumors and prompt management for acute intracranial hypertension and brainstem dysfunction. Although the patients achieve favorable recovery from their initial catastrophic condition, the ultimate prognosis, in the majority of cases, is still rather poor because such hemorrhages usually develop from a malignant tumor. The present and other recent reports indicate that the incidence of hemorrhagic stroke from brain tumors in pediatric patients is much higher than has been thought and is an important cause of subarachnoid hemorrhage in this age group.
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