PubMed Health⌕ Search

Biomedical subjects

David W Andrews

Publications and source records attributed to David W Andrews.

At least 37 records · Page 2Linked to original sources

Novel targeting signals mediate the sorting of different isoforms of the tail-anchored membrane protein cytochrome b5 to either endoplasmic reticulum or mitochondria.

Tail-anchored membrane proteins are a class of proteins that are targeted posttranslationally to various organelles and integrated by a single segment of hydrophobic amino acids located near the C terminus. Although the localization of tail-anchored proteins in specific subcellular compartments in plant cells is essential for their biological function, the molecular targeting signals responsible for sorting these proteins are not well defined. Here, we describe the biogenesis of four closely related tung (Aleurites fordii) cytochrome b5 isoforms (Cb5-A, -B, -C, and -D), which are small tail-anchored proteins that play an essential role in many cellular processes, including lipid biosynthesis. Using a combination of in vivo and in vitro assays, we show that Cb5-A, -B, and -C are targeted exclusively to the endoplasmic reticulum (ER), whereas Cb5-D is targeted specifically to mitochondrial outer membranes. Comprehensive mutational analyses of ER and mitochondrial Cb5s revealed that their C termini, including transmembrane domains (TMD) and tail regions, contained several unique physicochemical and sequence-specific characteristics that defined organelle-specific targeting motifs. Mitochondrial targeting of Cb5 was mediated by a combination of hydrophilic amino acids along one face of the TMD, an enrichment of branched beta-carbon-containing residues in the medial portion of the TMD, and a dibasic -R-R/K/H-x motif in the C-terminal tail. By contrast, ER targeting of Cb5 depended primarily upon the overall length and hydrophobicity of the TMD, although an -R/H-x-Y/F- motif in the tail was also a targeting determinant. Collectively, the results presented provide significant insight into the early biogenetic events required for entry of tail-anchored proteins into either the ER or mitochondrial targeting pathways.

Aleurites↗

Bcl-2 homodimerization involves two distinct binding surfaces, a topographic arrangement that provides an effective mechanism for Bcl-2 to capture activated Bax.

The homo- and heterodimerization of Bcl-2 family proteins is important for transduction and integration of apoptotic signals and control of the permeability of mitochondria and endoplasmic reticulum membranes. Here we mapped the interface of the Bcl-2 homodimer in a cell-free system using site-specific photocross-linking. Bcl-2 homodimer-specific photoadducts were detected from 11 of 17 sites studied. When modeled into the structure of Bcl-2 core, the interface is composed of two distinct surfaces: an acceptor surface that includes the hydrophobic groove made by helices 2 and 8 and the loop connecting helices 4 and 5 and a donor surface that is made by helices 1-4 and the loop connecting helices 2 and 3. The two binding surfaces are on separate faces of the three-dimensional structure, explaining the formation of Bcl-2 homodimers, homo-oligomers, and Bcl-2/Bax hetero-oligomers. We show that in vitro the Bcl-2 dimer can still interact with activated Bax as a larger oligomer. However, formation of a Bax/Bcl-2 heterodimer is favored, since this interaction inhibits Bcl-2 homodimerization. Our data support a simple model mechanism by which Bcl-2 interacts with activated Bax during apoptosis in an effective manner to neutralize the proapoptotic activity of Bax.

Apoptosis↗

Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.

BACKGROUND: Brain metastases occur in up to 40% of all patients with systemic cancer. We aimed to assess whether stereotactic radiosurgery provided any therapeutic benefit in a randomised multi-institutional trial directed by the Radiation Therapy Oncology Group (RTOG). METHODS: Patients with one to three newly diagnosed brain metastases were randomly allocated either whole brain radiation therapy (WBRT) or WBRT followed by stereotactic radiosurgery boost. Patients were stratified by number of metastases and status of extracranial disease. Primary outcome was survival; secondary outcomes were tumour response and local rates, overall intracranial recurrence rates, cause of death, and performance measurements. FINDINGS: From January, 1996, to June, 2001, we enrolled 333 patients from 55 participating RTOG institutions--167 were assigned WBRT and stereotactic radiosurgery and 164 were allocated WBRT alone. Univariate analysis showed that there was a survival advantage in the WBRT and stereotactic radiosurgery group for patients with a single brain metastasis (median survival time 6.5 vs 4.9 months, p=0.0393). Patients in the stereotactic surgery group were more likely to have a stable or improved Karnofsky Performance Status (KPS) score at 6 months' follow-up than were patients allocated WBRT alone (43% vs 27%, respectively; p=0.03). By multivariate analysis, survival improved in patients with an RPA class 1 (p<0.0001) or a favourable histological status (p=0.0121). INTERPRETATION: WBRT and stereotactic boost treatment improved functional autonomy (KPS) for all patients and survival for patients with a single unresectable brain metastasis. WBRT and stereotactic radiosurgery should, therefore, be standard treatment for patients with a single unresectable brain metastasis and considered for patients with two or three brain metastases.

Adult↗

During apoptosis bcl-2 changes membrane topology at both the endoplasmic reticulum and mitochondria.

In healthy cells the antiapoptotic protein Bcl-2 adopts a topology typical of tail-anchored proteins with only the hydrophobic carboxyl terminus inserted into the membrane, as shown by labeling cell lysates with a membrane-impermeant sulfhydryl-specific reagent. Induction of apoptosis in cells triggered a change in the conformation of Bcl-2 such that cysteine 158 near the base of helix 5 inserted into the lipid bilayer of both endoplasmic reticulum and mitochondria where it was protected from labeling. Addition of a peptide corresponding to the BH3 domain of the proapoptotic protein Bim to cell lysates triggered a similar conformational change in Bcl-2, demonstrating that preexisting, membrane-bound Bcl-2 proteins change topology.

Animals↗

There is more to life and death than mitochondria: Bcl-2 proteins at the endoplasmic reticulum.

Proteins of the Bcl-2 family are important regulators of cell fate. The role of these proteins in controlling mitochondrial apoptotic processes has been extensively investigated, although exact molecular mechanisms are incompletely understood. However, mounting evidence indicates that these proteins also function at the endoplasmic reticulum and other locations within the cell. Both pro- and anti-apoptotic Bcl-2 family members can regulate endoplasmic reticulum calcium, cellular pH and endoplasmic reticulum resident proteins. In this review, we discuss the activities and potential targets of Bcl-2 family members at the endoplasmic reticulum and other cellular locations.

Animals↗

Gliosarcoma arising from an anaplastic ependymoma: a case report of a rare entity.

We report the first case of a gliosarcoma arising from an anaplastic ependymoma and the second case of gliosarcoma arising from any type of ependymal neoplasm. The patient was a 48-year-old woman with a solid and cystic, peripherally enhancing, 7-cm right frontal mass lesion. Histologically, the lesion displayed characteristics of anaplastic ependymoma (grade III, World Health Organization scale). The tumor recurred despite multiple cycles of postoperative radiation and chemotherapy. After the fourth recurrence, the tumor displayed a biphasic pattern of differentiation. The first pattern was similar to the original anaplastic ependymoma, whereas there was a second new sarcomatous pattern resembling fibrosarcoma that was admixed with and overrunning the ependymal component. The spectrum of gliosarcoma is therefore expanded to include not only astrocytic and oligodendroglial components but ependymal components as well.

Brain Neoplasms↗

Membrane-bound fatty acid desaturases are inserted co-translationally into the ER and contain different ER retrieval motifs at their carboxy termini.

Fatty acid desaturases (FADs) play a prominent role in plant lipid metabolism and are located in various subcellular compartments, including the endoplasmic reticulum (ER). To investigate the biogenesis of ER-localized membrane-bound FADs, we characterized the mechanisms responsible for insertion of Arabidopsis FAD2 and Brassica FAD3 into ER membranes and determined the molecular signals that maintain their ER residency. Using in vitro transcription/translation reactions with ER-derived microsomes, we show that both FAD2 and FAD3 are efficiently integrated into membranes by a co-translational, translocon-mediated pathway. We also demonstrate that while the C-terminus of FAD3 (-KSKIN) contains a functional prototypic dilysine ER retrieval motif, FAD2 contains a novel C-terminal aromatic amino acid-containing sequence (-YNNKL) that is both necessary and sufficient for maintaining localization in the ER. Co-expression of a membrane-bound reporter protein containing the FAD2 C-terminus with a dominant-negative mutant of ADP-ribosylation factor (Arf)1 abolished transient localization of the reporter protein in the Golgi, indicating that the FAD2 peptide signal acts as an ER retrieval motif. Mutational analysis of the FAD2 ER retrieval signal revealed a sequence-specific motif consisting of Phi-X-X-K/R/D/E-Phi-COOH, where -Phi- are large hydrophobic amino acid residues. Interestingly, this aromatic motif was present in a variety of other known and putative ER membrane proteins, including cytochrome P450 and the peroxisomal biogenesis factor Pex10p. Taken together, these data describe the insertion and retrieval mechanisms of FADs and define a new ER localization signal in plants that is responsible for the retrieval of escaped membrane proteins back to the ER.

Amino Acid Sequence↗

Fractionated stereotactic radiotherapy for the treatment of large arteriovenous malformations with or without previous partial embolization.

OBJECTIVE: Despite the success of stereotactic radiosurgery, large inoperable arteriovenous malformations (AVMs) of 14 cm(3) or more have remained largely refractory to stereotactic radiosurgery, with much lower obliteration rates. We review treatment of large AVMs either previously untreated or partially obliterated by embolization with fractionated stereotactic radiotherapy (FSR) regimens using a dedicated linear accelerator (LINAC). METHODS: Before treatment, all patients were discussed at a multidisciplinary radiosurgery board and found to be suitable for FSR. All patients were evaluated for pre-embolization. Those who had feeding pedicles amenable to glue embolization were treated. LINAC technique involved acquisition of a stereotactic angiogram in a relocatable frame that was also used for head localization during treatment. The FSR technique involved the use of six 7-Gy fractions delivered on alternate days over a 2-week period, and this was subsequently dropped to 5-Gy fractions after late complications in one of seven patients treated with 7-Gy fractions. Treatments were based exclusively on digitized biplanar stereotactic angiographic data. We used a Varian 600SR LINAC (Varian Medical Systems, Inc., Palo Alto, CA) and XKnife treatment planning software (Radionics, Inc., Burlington, MA). In most cases, one isocenter was used, and conformality was established by non-coplanar arc beam shaping and differential beam weighting. RESULTS: Thirty patients with large AVMs were treated between January 1995 and August 1998. Seven patients were treated with 42-Gy/7-Gy fractions, with one patient lost to follow-up and the remaining six with previous partial embolization. Twenty-three patients were treated with 30-Gy/5-Gy fractions, with two patients lost to follow-up and three who died as a result of unrelated causes. Of 18 evaluable patients, 8 had previous partial embolization. Mean AVM volumes at FSR treatment were 23.8 and 14.5 cm(3), respectively, for the 42-Gy/7-Gy fraction and 30-Gy/5-Gy fraction groups. After embolization, 18 patients still had AVM niduses of 14 cm(3) or more: 6 in the 7-Gy cohort and 12 in the 5-Gy cohort. For patients with at least 5-year follow-up, angiographically documented AVM obliteration rates were 83% for the 42-Gy/7-Gy fraction group, with a mean latency of 108 weeks (5 of 6 evaluable patients), and 22% for the 30-Gy/5-Gy fraction group, with an average latency of 191 weeks (4 of 18 evaluable patients) (P = 0.018). For AVMs that remained at 14 cm(3) or more after embolization (5 of 6 patients), the obliteration rate remained 80% (4 of 5 patients) for the 7-Gy cohort and dropped to 9% for the 5-Gy cohort. A cumulative hazard plot revealed a 7.2-fold greater likelihood of obliteration with the 42-Gy/7-Gy fraction protocol (P = 0.0001), which increased to a 17-fold greater likelihood for postembolization AVMs of 14 cm(3) or more (P = 0.003). CONCLUSION: FSR achieves obliteration for AVMs at a threshold dose, including large residual niduses after embolization. With significant treatment-related morbidities, further investigation warrants a need for better three-dimensional target definition with higher dose conformality.

Adult↗

Photodamage to multiple Bcl-xL isoforms by photodynamic therapy with the phthalocyanine photosensitizer Pc 4.

The antiapoptotic oncoprotein Bcl-2 is now a recognized phototarget of photodynamic therapy (PDT) with the phthalocyanine Pc 4 and with other mitochondrion-targeting photosensitizers. Photodamage, observed on Western blots as the loss of the native 26-kDa Bcl-2 protein, is PDT dose dependent and occurs in multiple cell lines, in the cold, and immediately upon photoirradiation. In our initial study, no photochemical damage was observed to Bcl-xL, in spite of its similarity in size, sequence, location and function to Bcl-2. The original study used a commercial anti-Bcl-xS/L antibody. We have revisited this issue by examining Western blots developed using one of three epitope-specific anti-Bcl-xL antibodies from commercial sources, a polyclonal antibody generated to the entire protein, as well as the antibody used previously. All five Bcl-xL antibodies recognized bacterially expressed Bcl-xL, but not Bcl-2, whereas an anti-Bcl-2 antibody recognized Bcl-2 and not Bcl-xL. All five Bcl-xL antibodies recognized at least one protein migrating at approximately 30 kDa; two of the antibodies recognized an additional band, migrating at approximately 33 or approximately 24 kDa. We now observe Pc 4-PDT-induced photodamage to all Bcl-xL-related proteins, except the 33-kDa species, in several human cancer cell lines. The results indicate that, in addition to the expected quantitative differences that may reflect exposure of individual epitopes, the antibodies also detect proteins of different apparent molecular weights that may be distinct isoforms or post-translationally modified forms of Bcl-xL. No evidence for PDT-induced phosphorylation or degradation was observed. Bcl-xL localized to mitochondria was considerably more sensitive to photodamage than was Bcl-xL in the cytosol, indicating that as previously found for Bcl-2, Bcl-xL must be membrane localized to be photosensitive.

Blotting, Western↗

Interaction with a membrane surface triggers a reversible conformational change in Bax normally associated with induction of apoptosis.

The Bcl-2 family member Bax is an apoptosis-promoting protein that normally resides in an inactive state within the cytoplasm of healthy cells. Upon induction of apoptosis by diverse stimuli, Bax undergoes a conformational change and translocates to mitochondria, where it oligomerizes and forms pores that allow the release of cytochrome c and other cytotoxic factors. Protein-protein interactions between Bax and other Bcl-2 family members are strongly implicated in Bax activation, but a compelling case has recently been made for the involvement of lipids in this process as well. Here we report that purified Bax undergoes a reversible conformational change upon incubation with lipid vesicles in the absence of other proteins. This Bax-liposome interaction does not depend on a specific lipid composition. Changes in Bax conformation were observed by immunoprecipitation with the conformation-specific antibody 6A7, circular dichroism spectroscopy, and differential scanning calorimetry. Although liposomes induced Bax to become 6A7-reactive (a feature normally associated with the onset of apoptosis), the protein did not insert into membranes, become oligomeric, or form pores, clearly indicating that other triggers are required for Bax to achieve its final pro-apoptotic state. Indeed, the lipid-induced Bax conformational change is shown to be required for tBid-induced Bax oligomerization and pore formation, putting it upstream of tBid activity in this molecular pathway to Bax activation. These data demonstrate that Bax is sensitized to activation by transient interaction with lipid membrane surfaces and provide evidence that Bax activation proceeds in a stepwise fashion, with multiple triggers and potential levels of regulation.

Apoptosis↗

The beta-subunit of the signal recognition particle receptor is a novel GTP-binding protein without intrinsic GTPase activity.

The beta-subunit of the signal recognition particle receptor (SRbeta), a member of the Ras family of small molecular weight GTPases, is involved in the targeting of nascent polypeptide chains to the protein translocation machinery in the endoplasmic reticulum membrane. We purified SRbeta from an expressing strain of Escherichia coli and investigated the properties of the isolated GTPase. We find that, unlike other Ras family GTPases, most SRbeta purifies bound to GTP, and SRbeta-bound GTP is not easily exchanged with solution GTP. SRbeta possesses no detectable GTPase activity. Although a stable interaction between SRbeta and ribosomes is observed, SRbeta is not stimulated to hydrolyze GTP when incubated with ribosomes or ribosome-nascent chains. A GTPase mutant harboring a mutation in a region predicted to be functionally important, based on observations made in related GTPases, binds GTP with faster kinetics and appears to be a less stable protein but otherwise displays similar properties to the wild-type SRbeta GTPase. Our results demonstrate that as an isolated GTPase, SRbeta functions differently from the Arf- and Ras-type GTPases that it is most closely related to by sequence.

Animals↗

Cyclooxygenase-2 (COX-2) and epidermal growth factor receptor (EGFR) expression in human pituitary macroadenomas.

Macroadenomas are tumors of the pituitary gland and are considered almost to be always benign and curable. The clinical manifestations of a pituitary tumor depend on the hormone secreted by the tumor as well as on the pattern of tumor growth within the sella turcica. Current trends attempt to target new molecular markers that also may serve as potential therapeutic targets. Cyclooxygenase-2 (COX-2) and epidermal growth factor receptor (EGFR) are upregulated in a number of epithelial tumors. No published reports exist about expression of COX-2 in pituitary macroadenomas, and only a few reports with differing results exist concerning EGFR expression in pituitary macroadenomas. This study sought to determine whether a relationship exists between COX-2 and EGFR expression and pituitary macroadenomas. Thirty specimens of pituitary macroadenomas were evaluated after being identified in the surgical pathology database of Thomas Jefferson University Hospital. The hematoxylin and eosin-stained slides were reviewed, and the representative paraffin blocks containing the index case were chosen and immunohistochemically stained for COX-2 and EGFR expression. The COX-2 and EGFR-stained slides were reviewed and an immunohistochemical score was calculated and analyzed. The pituitary macroadenomas were classified on the basis of hormone expression: none (nonsecreting), minor (nondominant, plurihormonal), single (dominant nonplurihormonal), or plurihormonal (dominant plurihormonal). The hormonal classification was then analyzed for association with COX-2 expression. COX-2 expression was significantly associated with plurihormonal pituitary macroadenomas (p value 0.03). COX-2 expression was significantly associated with expression of luteinizing hormone (p value 0.007) and with expression of thyroid-stimulating hormone (TSH) (p value 0.04). Additionally, COX-2 expression was significantly associated with single-hormone of pituitary adenoma (p value 0.049). The expression of COX-2 in 100% of the normal autopsy pituitary glands establishes an additional central nervous system location of COX-2 expression. EGFR was not expressed in any of the pituitary macroadenomas. The expression of COX-2 in plurihormonal pituitary macroadenomas, particularly those secreting TSH, may be a potential target for treatment in addition to surgical and/or radiotherapy treatment in these benign but clinically significant tumors. COX-2 is expressed in normal autopsy pituitary tissue.

Adenoma↗

Cyclooxygenase-2 (COX-2) expression in human meningioma as a function of tumor grade.

Meningiomas are one of the most frequent central nervous system tumors, with an annual incidence in the United States of approximately 2.5 per 100,000 people. An intense interest exists in evaluating new molecular markers that may serve as potential therapeutic targets. Cyclooxygenase-2 (COX-2) is upregulated in a number of epithelial tumors, but to date, there are no published reports about the expression of COX-2 in meningioma. This study evaluated a possible relationship between COX-2 expression and malignant progression of meningioma. Eighty-three specimens of meningioma from the surgical pathology database of Thomas Jefferson University Hospital were evaluated. The hematoxylin and eosin (H&E)-stained slides were reviewed, and representative paraffin-embedded tissue sections containing the index cases were chosen and immunohistochemically stained for COX-2 expression. The H&E-stained sections of the individual tumors were classified according to the 1993 and 2000 World Health Organization (WHO) criteria for grading of meningiomas. The COX-2-stained slides were then reviewed and an immunohistochemical score was calculated and analyzed for statistical significance. The association between tumor grade and COX-2 expression is highly significant using the WHO-1993 grading criteria, (p = 0.012). Tumors with a more aggressive phenotype (benign --> atypical --> malignant) are associated with increasingly higher levels of COX-2. Using the 2000 WHO classification system, however, the association between tumor classification and COX-2 expression was not significant (p = 0.17), although the overwhelming percentage of tumors expressed COX-2. The association of COX-2 and meningioma is unique and represents a potential area for therapeutic intervention with selective COX-2 inhibitors, either as adjunct or in combination with radiation therapy.

Antineoplastic Agents↗

Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: analysis of 225 consecutive surgical cases with antecedent historical control at one institution.

OBJECTIVE: Recent neurosurgical literature reflects rapidly evolving, technically enhanced methods that promise to improve neurosurgical outcomes. We review our experience with computer image guidance, linear or sigmoid incisions after minimal shaving, and liquid wound dressing with 2-octyl cyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) for tumor craniotomy or craniectomy in our attempt to optimize craniotomy or craniectomy for tumor. METHODS: After institutional review board approval, we retrospectively reviewed patients who underwent craniotomy or craniectomy for tumor with or without the combination of techniques specified above. A prior cohort of patients who underwent craniotomy or craniectomy with traditional techniques served as a retrospective basis of comparison. Analysis included in- and outpatient chart reviews, which included the operative notes, pathology reports, discharge summaries, outpatient office records, and intraoperative nursing records. Data were entered into a statistical spreadsheet for analysis and comparison. RESULTS: A total of 225 consecutive patients underwent a combination of less invasive techniques from July 2000 through October 2001. These patients were matched with 225 patients in a standard neurosurgical cohort that included patients who underwent operations from July 1994 through July 2000. Age, tumor type, radiation, reoperation rate, tumor location, and extent of resection were comparable for both groups. The overall wound complication rate was significantly lower in the minimally invasive group when compared with the control cohort of patients (0.9% versus 6.2%; P = 0.0298), even for early follow-up (0.9% versus 3.5%; P = 0.0427). Pedicle flap design was a variable that was significantly associated with wound complication. CONCLUSION: Modern neurosurgical techniques are beneficial for patients undergoing craniotomy or craniectomy for tumor and seem to be superior to standard techniques. Although the study is multifactorial and retrospective, this conclusion is further supported by the enhanced self-image patients have during the postoperative period.

Adult↗

Toward conceptual development and empirical measurement of global risk indicators in the lives of court-involved youth.

This paper reports work related to the conceptual development and empirical use of global risk indicators meant to measure rapidly and reliably potential threats to the overall development and well-being of adolescents in the juvenile justice system. The development of these indicators and initial data regarding their use with court involved samples are presented. Analysis of data gathered from a sample containing 248 families of adolescents who participated in a family-based diversion program identified a seven-factor structure that corresponded to theoretically derived dimensions of risk in domains associated with prior offenses, family/parenting, education/work, peers, substance use, personality/behavior problems, and attitudes/orientation. Analysis of data gathered from a second sample containing 373 families of adolescents who came into contact with the intake/diversion department of a county juvenile court confirmed the original seven factors of the battery and generated support for an eighth dimension composed of items that reflected leisure activities. The use of these global risk indicators are discussed as part of a practical and effective assessment battery for professionals working with court-involved youth and their families.

Adolescent↗

Protein origami for beginners.

In the October issue of Molecular Cell, Kowarik et al. examine cotranslational translocation and folding during the synthesis of secretory and integral membrane proteins. Their results suggest that these potentially competing processes are regulated in surprising ways and reveal novel insights into the mechanisms by which proteins are assembled into membranes.

Cell Membrane↗

Fractionated stereotactic radiotherapy for the treatment of optic nerve sheath meningiomas: preliminary observations of 33 optic nerves in 30 patients with historical comparison to observation with or without prior surgery.

OBJECTIVE: We investigated the safety and efficacy of stereotactic radiotherapy as an alternative therapy to surgical resection for optic nerve sheath meningiomas (ONSMs). METHODS: Thirty patients and 33 optic nerves with ONSMs were treated with conventional fractionated stereotactic radiotherapy treatment (CF-SRT) between July 1996 and May 2001 with the use of a 6-MeV LINAC designed for and dedicated to radiosurgery. The LINAC technique involved daily CF-SRT involving a relocatable frame, an average of three isocenters, and high-radiation dose conformality established by noncoplanar arc beam shaping and differential beam weighting. The patients who were treated with CF-SRT were followed clinically with serial visual fields and radiographically with both magnetic resonance imaging and functional (111)In-octreotide single-photon emission computed tomography. The results of treatment were compared with a historical control group of ONSM patients who were either observed or treated surgically and then observed. RESULTS: Our study population comprised 18 women and 12 men with a median age of 44 years (age range, 20-76 yr). The median isosurface radiation dose was 51 Gy (dose range, 50-54.0 Gy), and the median clinical follow-up time was 89 weeks (range, 9-284 wk). Of 22 optic nerves with vision before CF-SRT, 20 nerves (92%) demonstrated preserved vision, and 42% manifested improvement in visual acuity and/or visual field at follow-up. Comparison of our patients with a historical control group revealed preserved vision in only 16% of patients in a comparable period of observation, along with a 150% greater probability of visual improvement. Four patients (13%) had posttreatment morbidities, including visual loss (two patients), optic neuritis (one patient), and transient orbital pain (one patient). On magnetic resonance imaging studies, there was no evidence of tumor progression or recurrence in all patients, including tumor volume reductions noted in four patients. All six patients monitored with (111)In-octreotide scintigraphy demonstrated significant decreases in tumor activity after CF-SRT. CONCLUSION: To date, this article describes the largest reported series of ONSMs. Although longer follow-up is necessary, we think that CF-SRT represents a safe alternative to surgery and offers a higher likelihood of preserved or improved vision in patients with ONSM. Our analysis suggests that CF-SRT is also preferable to observation. Functional (111)In-octreotide single-photon emission computed tomographic scintigraphy provides a useful technique for the assessment of tumor control that complements serial posttreatment magnetic resonance imaging in patients with ONSMs.

Adult↗