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M J Taphoorn

Publications and source records attributed to M J Taphoorn.

At least 19 recordsLinked to original sources
PubMed2001

Neurobehavioral status and health-related quality of life in newly diagnosed high-grade glioma patients.

PURPOSE: To evaluate the health-related quality of life (HRQOL) and cognitive functioning of high-grade glioma patients in the postneurosurgical period. PATIENTS AND METHODS: The HRQOL, as assessed by the Short-Form Health Survey-36, tumor-specific symptoms, and objective and subjective neuropsychologic functioning, of 68 newly diagnosed glioma patients were compared with that of 50 patients with non-small-cell lung cancer (NSCLC) and to age- and sex-matched healthy controls. The association between tumor lateralization, extent of resection, and use of medication, and the HRQOL outcomes was also investigated. RESULTS: The HRQOL of the two patient groups was similar but significantly lower than that of the healthy controls. Glioma patients reported significantly more neurologic symptoms and poorer objective and subjective neuropsychologic functioning than the NSCLC patients. Using healthy controls as the reference group, cognitive impairment assessed at the individual patient level was observed in all glioma patients and 52% of the NSCLC patients. Poor performance on timed tasks in the glioma group could be attributed, in large part, to visual and motor deficits. Tumor lateralization was found to affect neuropsychologic functioning in a predictable manner. The extent of resection was not related significantly to neuropsychologic functioning. Corticosteroid use was associated with better recognition memory, whereas antiepileptic drug use was correlated negatively with working memory capacity. CONCLUSION: The general HRQOL of glioma patients is similar to that of patients with NSCLC. However, they suffer from a number of condition-specific neurologic and neuropsychologic problems that have a significant impact on their daily lives in the postsurgical period, before treatment with radiotherapy.

Attention↗
PubMed2001

Temozolomide chemotherapy in recurrent oligodendroglioma.

The authors determined the tolerance, response rate, and duration of recurrent anaplastic oligodendroglioma in 30 patients to temozolomide given orally at 150 to 200 mg/m2 on days 1 through 5 in cycles of 28 days. Nine patients responded: 7 of 27 patients (26%) treated with temozolomide after prior PCV chemotherapy and 2 of 3 chemotherapy-naive patients (both complete response). Median time to progression in responding patients was 13 months. Temozolomide shows promise and has an acceptable safety profile in recurrent anaplastic oligodendroglial tumors. Patients not responding to PCV may respond to temozolomide.

Adult↗
PubMed2001

[Brain tumor or stroke?].

Sometimes, the clinical presentation of a brain tumour mimics that of stroke or vice versa, as exemplified in the following three patients. In a 73-year-old patient the initial clinical picture was compatible with a brachial plexus lesion, as the weakness in his right hand appeared to have a traumatic, and not a central nervous system related, cause. When he experienced a focal seizure, the CT scan of the brain revealed a lesion in the motor cortex. This was presumed to be an infarction due to the lack of mass effect and the absence of contrast enhancement. Shortly afterwards the patient deteriorated and a follow-up scan revealed a large contrast-enhancing lesion. During surgery this proved to be a glioblastoma multiforme. A 76-year-old man was suffering from a progressive neurological deficit. An MRI scan of the brain revealed a contrast-enhancing lesion and a chest X-ray revealed an asymptomatic lung tumour; the diagnosis 'brain metastasis' was made. The surgeon removed the lung tumour, which proved to be a carcinoma. Later, when the patient was referred to the neurosurgeon for extirpation of the presumed brain metastasis, the MRI scan revealed that the lesion had decreased in size and no longer exhibited contrast enhancement. The metastasis proved to be an infarction. A 53-year-old man presented with sudden loss of consciousness due to a haemorrhage in the occipital lobe. An angiogram did not reveal a vascular malformation and during surgery no abnormal tissue was seen. The patient almost made a complete recovery. However, several months later he developed an elevated intracranial pressure due to a large occipital high-grade glioma, which had caused the original haemorrhage.

Aged↗
PubMed2001

Cognitive status and quality of life in patients with suspected versus proven low-grade gliomas.

BACKGROUND: The preferred management of patients with suspected low-grade gliomas (S-LGG) remains controversial. The benefits of resection or radiotherapy early in the course of the disease have not been proven in terms of survival. Little is known about the effects of early therapy on quality of life (QOL) and cognitive status. The authors compared functional status, QOL, and cognitive status of patients suspected of having a LGG, in whom treatment was deferred, and patients with proven LGG (P-LGG), who underwent early surgery. METHODS: The authors recruited 24 patients suspected of having an LGG. These patients were matched with 24 patients with a histologically proven LGG and healthy control subjects for educational level, handedness, age, and gender. The two patient groups were also matched for tumor laterality, use of anticonvulsants, and interval between diagnosis and testing. Functional status was determined in both patient groups. QOL and cognitive status were compared between the three groups. RESULTS: Matching criteria and functional status did not differ significantly between groups. Both patient groups scored worse on QOL scales than healthy control subjects. Unoperated patients with S-LGG scored better on most items than patients with P-LGG. Cognitive status was worse in both groups than in healthy control subjects, but, again, patients with S-LGG performed better than patients with P-LGG. CONCLUSION: These data suggest that a wait-and-see policy in patients with S-LGG has no negative effect on cognitive performance and QOL.

Adolescent↗
PubMed2001

PCV chemotherapy for recurrent glioblastoma multiforme.

The authors evaluated response, time to progression (TTP), survival, prognostic factors, and toxicity in 63 patients with a recurrent glioblastoma multiforme treated with procarbazine, lomustine, and vincristine (PCV) chemotherapy. Complete and partial response was observed in two (3%) and five patients (8%). In 16 patients (25%), stable disease was observed. Median TTP and survival were 13 and 33 weeks. Age < 40 years and Karnofsky Performance Status > or = 90 were associated with longer TTP and survival. PCV treatment was generally well tolerated.

Adult↗
PubMed2001

White matter lesions and encephalopathy in patients treated for primary central nervous system lymphoma.

A retrospective analysis of the clinical presentations and neuroimaging characteristics of 33 patients with a primary central nervous system lymphoma (PCNL) who received cranial radiotherapy was performed to assess incidence of and risk factors for radiation-induced encephalopathy. CT and MRI scans were revised by a neurologist and a radiologist in conference. White matter abnormalities before and after radiotherapy on the last scan before recurrence were quantified according to a semi-quantitative scale. All available medical records were retrieved and reviewed with respect to demographic and tumor-related variables, treatment modalities, disease-free and overall survival and clinical symptoms and signs of encephalopathy. CT and MRI scans showed severe white matter lesions in 75% of 20 patients and in 86% of patients aged more than 60 years. Forty percent of patients presented with new clinical signs of cognitive impairment a median of 14.5 months after initial diagnosis (8.5 months after radiotherapy). The risk of white matter lesions appeared greater in patients aged >60 (RR 1.2, 95% CI = 0.8-2.0), in patients with prior white matter lesions (RR 1.3, 95% CI = 0.8-2.1) and in patients with multifocal cerebral lymphoma (RR 1.5, 95% CI = 1.0-2.1). In conclusion, the risk of white matter lesions and clinical symptoms and signs of encephalopathy is high in patients treated by radiotherapy for PCNL. The risk appears to be greatest in older patients, patients with multifocal tumor and in those with prior white matter lesions on CT or MRI.

Adult↗
PubMed2001

Multiple cysts in the cerebral white matter: a rare complication of whole brain radiation therapy.

We describe a patient with multiple cysts in the cerebral white matter, several years after whole brain radiation therapy (WBRT) for a solitary cerebellar metastasis of a lung carcinoma. MR images of the brain show diffuse white matter changes, 1 year after radiation, and cyst formation in the white matter, starting 3.5 years later. We conclude that cysts in the cerebral white matter can be a late stage of white matter damage after whole brain radiation therapy in long-term survivors with brain metastases.

Adenocarcinoma↗
PubMed2000

[Children with craniopharyngioma, a 'benign' brain tumor with a high morbidity].

The craniopharyngioma is a histologically benign tumour, mainly occurring in childhood. Neurosurgical treatment, in some of these patients in combination with external radiotherapy, results in a fair prognosis for children with craniopharyngioma. However, the central localisation of this tumour in the brain, damage of surrounding structures due to tumour growth, as well as the adverse effects of treatment will result in substantial morbidity in many patients. The first patient, a 13-year-old boy, presented with symptoms and signs of increased intracranial pressure. Following operation he was treated with radiotherapy, and up to 4 years after the operation there was no tumour recurrence. However, he experienced endocrine, visual, hypothalamic and intellectual disturbances due to the disease and its treatment. The second patient, a 6-year-old girl, presented with hydrocephalus due to the tumour, but also had growth retardation. After operation and radiotherapy, she had visual, endocrine, and intellectual dysfunction, but there were no signs of tumor recurrence. The third patient, an 12-year-old boy, already had growth retardation several years before he presented with neurological dysfunction. He received no postoperative radiation, as all tumour tissue could be removed. He had visual, hypothalamic, endocrine and intellectual disturbances but until nearly 6 years after the operation, there was no tumour recurrence. The morbidity due to the tumour and its treatment has a negative impact on the patient's quality of life. A multidisciplinary treatment and follow-up of these children cannot avoid this morbidity but may result in a timely observation of problems and thereby prevent unnecessary damage.

Adolescent↗
PubMed2000

Angiogenesis in malignant primary and metastatic brain tumors.

Patients with malignant primary and metastatic brain tumors have a poor prognosis, despite developments in diagnostic and therapeutic modalities. Therefore in the past decade a search for new therapeutic possibilities has started. The inhibition of angiogenesis, the sprouting of new capillaries from preexisting vasculature, which is an absolute requirement for the growth of tumors beyond a size of a few cubic millimeters, is one of the most promising approaches with which to influence tumor growth. This review focuses on the critical role of angiogenesis in the development of normal brain and the blood-brain barrier. We discuss the importance of angiogenesis in the formation of malignant brain tumors and in bloodbrain barrier function in these tumors and possible consequences of altered blood-brain barrier properties for antiangiogenic therapy. Furthermore, results of current clinical trials with antiangiogenic drugs are reviewed, and clinical perspectives of antiangiogenic therapy in malignant brain tumors are outlined.

Angiogenesis Inhibitors↗
PubMed2000

A phase II study of paclitaxel in chemonaïve patients with recurrent high-grade glioma.

BACKGROUND: The prognosis of malignant gliomas remains poor. In recurrent disease, chemotherapy can be considered. PATIENTS AND METHODS: In this phase II study we determined the anti-tumour efficacy of paclitaxel 200 mg/m2 in a three-hour intravenous infusion every three weeks in chemonaïve patients with recurrent high-grade glioma in terms of response, survival, and quality of life. RESULTS: In 17 patients (14 glioblastoma multiforme, 3 anaplastic astrocytoma) 69 paclitaxel cycles were administered. Partial or complete responses were not observed. Stable disease for four to six months was observed in five patients (29%). Median time to progression and median survival were two and 10 months, respectively. Toxicity due to paclitaxel was as to be expected and minor in most cases. Quality of life and mood estimates appeared rather stable over time. CONCLUSIONS: We conclude that three-weekly 200 mg/m2 paclitaxel chemotherapy for patients with recurrent high-grade gliomas did not lead to major complications or adverse effects on quality of life and mood. However, this therapy is of only very limited value in terms of response and survival in such patients.

Adult↗
PubMed2000

Cryptic von Hippel-Lindau disease: germline mutations in patients with haemangioblastoma only.

OBJECTIVES: Central nervous system haemangioblastoma (HAB) is a major feature of von Hippel-Lindau (VHL) disease, and it is estimated that about 30% of HAB patients have VHL disease. Consequently, it is widely recommended that sporadic HAB patients are screened for clinical and radiological features of VHL disease because of the risk of multiple tumours. We investigated the frequency of VHL germline mutations in patients with HAB only with no clinical or radiological evidence of VHL disease to define the role of molecular genetic analysis in the management of such patients. METHODS: Eighty four patients with a single HAB (23 Dutch, 61 UK) and four with multiple HAB (two Dutch, two UK) were studied by direct sequencing of the coding region and quantitative Southern blotting. RESULTS: A VHL germline mutation was found in three of 69 (4.3%) single HAB patients aged 50 years or less (three of 84 (3.6%) total single HAB patients). A germline VHL mutation was detected in a 44 year old woman with a solitary cerebellar HAB, as well as in four clinically unaffected close relatives, and in two single HAB cases presenting at the ages of 29 and 36 years. Germline VHL mutations were detected in two of four cases with multiple HAB. CONCLUSIONS: Early detection of VHL disease is important to reduce morbidity and mortality and therefore we recommend that, in addition to conventional clinical and radiological investigations, VHL gene mutation analysis should be offered to all HAB patients younger than 50 years. HAB patients aged >50 years will have a lower a priori risk of VHL disease and further data are required to evaluate the role of routine molecular genetic investigations in late onset HAB cases. The failure to detect germline VHL mutations in some patients with multiple HAB may indicate the presence of somatic mosaicism or additional HAB susceptibility genes.

Adolescent↗
PubMed1999

A simple mouse model for leptomeningeal metastases and repeated intrathecal therapy.

Leptomeningeal metastases occur in 0.8-8% of cancer patients. Despite recent developments in cancer therapy, survival of these patients is usually less than six months. Here, we describe an easy and reproducible mouse model of leptomeningeal metastases through intracisternal injection of B16F-10 murine melanoma cells, with histological characteristics comparable with human leptomeningeal metastases. After intracisternal injection of a recombinant adenoviral vector containing the LacZ gene, we found transfected cells in ependymal and subependymal cells throughout the brain, but not in parenchymal cells. Intracisternal injection of adenoviral vector, preceded by daily intracisternal injections with saline, did not result in a decreased vector delivery. After a single intracisternal injection, gene expression persisted for at least a month in immunodeficient mice, without apparent toxicity or decrease in intensity. The results of this study show the facility of a mouse model for leptomeningeal metastases as well as repeated intrathecal drug delivery.

Adenoviridae↗
PubMed1998

Response rate and prognostic factors of recurrent oligodendroglioma treated with procarbazine, CCNU, and vincristine chemotherapy. Dutch Neuro-oncology Group.

OBJECTIVES: To determine the response rate and factors correlated with response of oligodendroglial tumors to procarbazine, lomustine (CCNU), and vincristine (PCV) chemotherapy. DESIGN: Retrospective, observational multicenter study. METHODS: Patients treated with PCV or intensified PCV chemotherapy for a recurrent oligodendroglial tumor after surgery and radiation therapy with measurable disease were retrospectively evaluated for response. A 50% reduction in cross-sectional enhancing tumor area was considered a partial response. Stabilized or responding patients received six cycles of PCV unless unacceptable toxicity occurred. RESULTS: Fifty-two patients were included; median time to progression (MTP) for the entire group was 10 months. In 17% of patients a complete response (MTP, 25 months) was obtained, and in 46% a partial response (MTP, 12 months) was obtained. Median overall survival was 20 months. Although treatment was discontinued for toxicity in seven patients, it was generally well tolerated. The intensified PCV regimen was more toxic. Patients initially presenting with seizures and patients with tumor necrosis in histologic specimens had a better response rate in contrast to patients who had their first relapse within 1 year of first treatment (surgery and radiation therapy). CONCLUSIONS: Oligodendroglial tumors are chemosensitive, but most patients will have relapsed after 12 to 16 months. New studies must aim at improving initial treatment and second-line chemotherapy.

Adolescent↗
PubMed1998

Bilateral temporal lobe necrosis after radiotherapy: confounding SPECT results.

A patient with seizures and a contrast-enhancing temporal lesion after radiation therapy for a chondrosarcoma of the nasal septum is described. To differentiate between radiation necrosis and recurrent tumor, thallium-201 (201Tl) SPECT was used. 201Tl SPECT revealed high local accumulation suggesting tumor growth; however, pathologic examination demonstrated focal necrosis with reactive changes but without tumor. The 201Tl SPECT findings in this patient demonstrate a possible diagnostic pitfall in differentiating recurrent tumor from radiation necrosis.

Bone Neoplasms↗
PubMed1997

[Neurological presentation of non-Hodgkin lymphoma: a diagnostic problem].

In two patients, men aged 69 and 38 years, neurological signs were the first presenting symptoms of systemic non-Hodgkin's lymphoma (NHL). This presentation is uncommon. The patients had focal neurological deficit and elevated serum lactate dehydrogenase (LDH) activity. Neurological manifestations of NHL may be caused by extradural lymphoma or by diffuse leptomeningeal metastasis (meningitis lymphomatosa). A third patient, a woman of 48, had a third form of nervous system involvement, primary cerebral NHL, which is not a metastatic sequel to systemic NHL. Primary neurological presentation of NHL may be difficult to diagnose, particularly in case of prior treatment with corticosteroids.

Adult↗
PubMed1997

Quantitative computer-assisted analysis vs. visual estimation of MR imaging response of brain metastases to radiotherapy.

Using both quantitative computer-assisted analysis and visual estimation the MR imaging response of brain metastases to whole-brain radiotherapy (WBRT) was prospectively studied in 49 patients. Compared to the computer-assisted analysis, the precision of the visual estimation (by two readers in conference) of tumor response was determined. Also the radiological response was related to the clinical response. Six weeks after WBRT follow-up MR was performed in 27 of 49 patients. Of the remaining 22 patients without follow-up MR, 9 had died or deteriorated due to neurologic decline. In four patients (15%) tumor increase was demonstrated by computer-assisted analysis; in the other 23 patients tumor remained stable (15%) or decreased (70%). In 11 of the 27 patients, a second follow-up MR was obtained 26 wk after WBRT demonstrating tumor increase in seven patients (64%). Complete discordance between both assessment methods was noticed in only 4 of 38 MR scans (27 scans 6 wk after WBRT and 11 scans 26 wk after WBRT) with small quantitative changes in tumor volume. In 26 of 38 (68%) observations 6 and 26 wk after WBRT, there was a positive correlation between change in tumor volume and change in the Neurologic Status. Visual estimation analysis seems an appropriate method of routine therapy monitoring in individual patients with brain metastases. The computer-assisted analysis should be considered if precise response monitoring becomes critical.

Adult↗