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Results for “CEREBELLAR NEOPLASMS”

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At least 127 records · Page 7Linked to original sources

PubMed1975

The role of radiation therapy in the treatment of astrocytomas.

One hundred forty-seven patients with astrocytoma were treated between 1942 and 1967. There were 25 postoperative deaths. The 14 patients in whom the tumor was thought tohave been completely removed were not irradiated and all survived 5 years or longer. Seventy-one of the 108 patients with imcompletely excised lesions received radiation therapy. The 5-year survival rate for those with imcomplete resection alone was 19%, compared to 46% when irradiation was given. Based on observations up to 20 years, after incomplete removal postoperative irradiation significally prolonged useful life and may have lead to permanent control in some. There was no evidence of radiation damage. Most of these tumors were fibrillary astrocytomas, and the results apply particularly to this histologic type. Only 1 of 11 patients with gemistocytic astrocytoma survivied 5 years. The survival rate for Grade i tumors was appreciably greater than for Grade iilesions; in both grades, it was improved by irradiation.

Adolescent↗

PubMed1977

Multiple primary tumors of the brain including a medulloblastoma in the cerebellum.

A case of multiple primary tumors in a 12-year-old girl is described. The tumors included a right optic nerve glioma, a pilocytic astrocytoma in the right globus pallidus, a ganglioglioma in the left globus pallidus and a medulloblastoma in the cerebellum. To our knowledge no such case has been reported so far in literature.

Astrocytoma↗

PubMed1978

Primary malignant melanoma of the cerebellum: a case with metastases outside the nervous system.

A case of primary intracranial melanoma in a 65-year-old female is described. A complete postmortem examination revealed multiple metastases in the liver, and eliminated the possibility of an extraneural primary melanoma. A review of the literature confirmed that such cases are highly exceptional, and that an exhaustive autopsy including particularly the eyes is indispensable to substantiate the diagnosis. When these conditions are fulfilled, there is no reason not to consider the eventuality of visceral deposits from a primary melanoma of the central nervous system.

Aged↗

PubMed1978

Central nervous system involvement by ovarian carcinoma: a complication of prolonged survivial with metastatic disease.

Six patients with epithelial ovarian cancer had clinical diagnoses of central nervous system (CNS) metastases during a four-year period. A thorough review of the literature shows that involvement of the CNS by ovarian cancer is a rare phenomenon. Four of the six patients developed parenchymal brain metastases whereas carcinomatous meningitis was detected in the other two. These patients were younger and survived longer from initial diagnosis than the majority of women with ovarian cancer. Five of the six patients had previously received chemotherapy and had developed metastatic spread to extraperitoneal sites. Following extensive surgical resection, chemotherapy may provide intraperitoneal and systemic control, thereby extending survival and permitting occult CNS metastases to become apparent.

Adenocarcinoma↗

PubMed1978

Multifocal pontine lesions in cancer patients treated with chemotherapy and CNS radiotherapy.

Multifocal pontine lesions were found at postmortem examination in four patients with various types of malignancy. The patients had undergone extensive evaluation and treatment with multiple chemotherapy regimens as well as radiotherapy to the central nervous system. The histologic character and striking anatomic distribution of the pontine lesions are described and their possible pathogenesis discussed.

Adolescent↗

PubMed1981

Systemic metastases from medulloblastoma: report of two cases and review of the literature.

The clinical and pathologic data from two cases of medulloblastoma with systemic metastases, and 101 previously reported cases were evaluated to define better the clinical presentation and natural history. Patients ranged in age from six months to 48 years, with a mean of 13 years; two thirds of the patients were male. Ventricular shunts had been inserted in 20% of the patients. Systemic metastases occurred on an average of two years after the diagnosis of the primary tumor in patients without shunts, but only 1.3 years in patients with shunts. Fifty-nine percent of the patients were known to have experienced recurrence or spread of medulloblastoma within the central nervous system by the time systemic metastases appeared. Ninety percent showed radiologic evidence of bone metastases, of which 60% were osteoblastic. Bones most frequently involved were pelvis, femur and vertebrae; pain was the most common initial symptom. At autopsy, lymph node metastases were found in 65% and liver metastases were found in 28% of all cases in addition to bone metastases in 82%. Lung metastases occurred in 9% of the patients without shunts, compared with 30% of patients with shunts. The average survival was seven months after the appearance of systemic metastases for patients both with and without shunts. Approximately 5% of patients with medulloblastoma may be expected to develop systemic metastases. This development is associated with increased morbidity and a shortened life expectancy.

Adolescent↗

PubMed1984

Radiation-induced intracranial neoplasms. A report of three possible cases.

The pathologic findings are described in three patients who developed second intracranial neoplasms after irradiation for central nervous system malignancy. The second neoplasms were an astrocytoma, an ependymoma, and multiple meningiomas. All were histologically different from the first neoplasms and appeared in the field of irradiation between 3 and 15 years later. It is suggested that therapeutic irradiation was a causative factor in the development of these tumors.

Adult↗

PubMed1984

Follow-up of children with brain tumors.

One hundred two patients were evaluated for late effects of brain tumor in childhood by a medical record review and follow-up questionnaire. The patients had survived brain tumor for 5 to 47 years (median, 18 years). Among 30 patients who had received brain irradiation, 3 were successfully treated for second neoplasms that developed within the radiotherapy field 11, 16, and 29, years later, respectively. Moderate or severe functional deficits were present in 24 patients (24%), more commonly among those treated before 2 years of age and among those with cerebral astrocytoma. The other 78 patients (76%) had mild or no gross deficits, and all but 1 of them were attending school or were employed. Twenty-one patients in the series reported a total of 41 offspring, none of whom had cancer or mental retardation. Although markedly diverse performance levels were found among the 102 long-term survivors of childhood brain tumors, the majority had an acceptable quality of life.

Adolescent↗

PubMed1985

Tumor markers and cytologic features of cerebrospinal fluid.

Tumor markers are useful in establishing the diagnosis of certain central nervous system tumors, especially germinal tumors of the pineal region. They are not sufficiently specific to be able to replace biopsy for exact diagnosis. They may also be useful for monitoring of therapy, as an indicator of recurrence of the tumor. Cerebrospinal fluid cytology is not generally useful in establishing a specific histologic diagnosis, especially in children, but can help to monitor therapy and predict tumor recurrence. More extensive studies are needed in both areas to define more precisely the role of markers and cytologic studies.

Brain Neoplasms↗

PubMed1985

The value of surveillance testing in childhood brain tumors.

Follow-up procedures in children with brain tumors are designed to confirm tumor response to initial therapy, identify recurrence or progression at the time of potential secondary treatment, and establish the patterns of failure. Serial use of neurologic examinations and computerized tomography scans are outlined for all tumor types. Tumors capable of subarachnoid metastasis (medulloblastoma, ependymomas, pineal/suprasellar germ cell tumors, and pineoblastoma) require periodic assessment of the neuraxis by cerebrospinal fluid (CSF) cytology and myelography to establish the frequency of subclinical meningeal seeding in study settings. Serial analysis of specific biochemical markers for medulloblastoma (CSF polyamines) and germ cell tumors (serum and CSF alpha-fetoprotein and beta-human chorionic gonadotropin) are suggested. Serial evoked potentials in brain stem gliomas are recommended.

Astrocytoma↗

PubMed1985

Revision of the World Health Organization classification of brain tumors for childhood brain tumors.

A classification for childhood brain tumors based upon revision of nomenclature of all brain tumors published by the World Health Organization (WHO) in 1979 is proposed. Applicability of the WHO classification scheme was tested in a combined study of the clinical and pathologic features of approximately 3300 brain tumors in children. It was found to be adequate for many of the neoplasms but unsuitable for a significant proportion, including a number of complex cerebral tumors for which there was no appropriate name. Nomenclature of poorly differentiated or densely cellular neuroepithelial tumors was simplified to reflect the current state of knowledge of neuroembryology and neuro-oncology, although the Committee members recognized that such a proposal would likely perpetuate the long-standing and continuing controversy relative to the nature and origin of these neoplasms.

Brain Neoplasms↗

PubMed1986

Advances in pediatric radiotherapy in the last ten years and future proposals.

Advances made can be divided into five main categories. Firstly, the problem of geographic miss which has been reduced by delivering effective radiation doses with greater precision. This has been accomplished with more sophisticated diagnostic and therapeutic equipment, immobilization techniques and computerized treatment planning. Second is the recognition of the interplay of radiation and chemotherapy on normal tissue tolerance and local tumor control. This interaction has necessitated reduction in both dose and volume of irradiation. Third is the use of wide field irradiation as a systemic treatment. Fourthly, the utilization of cooperative group trials to define the role of irradiation. Finally, with the improvement in survival has come the recognition of late effects of irradiation in the growing child and the means of reducing such effects. The current role of radiation therapy in childhood malignancies is summarized, controversies are identified, and future prospects explored.

Brain Neoplasms↗

PubMed1986

Recent developments in pediatric neuro-oncology.

Although brain tumors represent the second most common malignancy in childhood, there are only 1200 to 1500 children diagnosed with brain tumors each year in the US. Approximately 50% of these children are treated at university or cancer treatment centers. Thus, therapeutic trials by default rather than design have been restricted to small numbers of patients. Information on histopathologic groupings, incidence of various tumor types according to age, general treatment trends and survival statistics are available from the Surveillance, Epidemiology, and End Results (SEER) registries of the National Cancer Institute. Although survivals in brain tumor cancers are worse than in other forms of childhood cancer, treatment advances in surgery, radiation and chemotherapy have significantly improved survivals in at least one brain tumor of childhood, medulloblastoma. Ironically, this treatment may have significant long-term adverse effects on intellect, endocrine function, and on the development of second malignancies. Prompt recognition of these delayed effects is of clinical importance, as some effects are amenable to treatment and others may be prevented by careful monitoring of drug and radiation administration.

Adolescent↗

PubMed1987

Radiation-induced neoplasms of the brain.

The histopathology of two patients with radiation-induced neoplasms of the brain following therapeutic irradiation for intracranial malignancies is described. The second neoplasms were an atypical meningioma and a polymorphous cell sarcoma, respectively. They occurred 12 and 23 years after irradiation (4000 rad), within the original field of irradiation. In both cases, the radiation-induced tumors were histologically distinct from the initial medulloblastomas. Both patients were retreated with local irradiation using permanent implantation of radioactive iodine-125 seeds.

Adult↗

PubMed1993

A phase II evaluation of thiotepa in pediatric central nervous system malignancies.

BACKGROUND: Both thiotepa and its active metabolite, tepa, efficiently cross the blood-brain barrier. After intravenous administration, the cerebrospinal fluid concentrations achieved are nearly identical to those in plasma. This provides a strong rationale for testing this agent against brain tumors. METHODS: Sixty pediatric patients with recurrent primary brain tumors were treated on a multiinstitutional Phase II study of intravenous thiotepa at a dose of 65 mg/m2 administered every 3 weeks. This dose is the result of a prior pediatric Phase I trial and is significantly higher than those previously recommended. RESULTS: Three of 13 assessable patients with medulloblastoma had partial responses lasting 22, 25, and 54 weeks. Although no objective responses were observed in 16 assessable patients with malignant gliomas and 14 with brain stem gliomas, 5 of 16 and 4 of 14 patients in these respective strata had prolonged periods of stable disease (SD) lasting from 12 to more than 33 weeks. Nine assessable patients with ependymoma had no objective response, but two had SD, both for more than 33 weeks. Myelosuppression was the principle toxic effect encountered and appeared to be more severe in patients who had received prior craniospinal radiation therapy or nitrosourea therapy. CONCLUSIONS: By conventional Phase II criteria, thiotepa appears to have activity in medulloblastoma. Based on several patients with prolonged SD, it also may possess some limited activity in brain stem and malignant gliomas. The steep in vitro dose-response curve of thiotepa and the long durations of response or SD observed with the dose reported here suggest that moderate-dose to high-dose thiotepa with cytokine support or autologous bone marrow rescue may be associated with an improved response rate to this agent.

Adolescent↗

PubMed1993

In vivo metabolism of childhood posterior fossa tumors and primitive neuroectodermal tumors before and after treatment.

BACKGROUND: Despite an increasing interest in the clinical application of positron emission tomography (PET) in tumors of the adult patient as a diagnostic and prognostic tool, only a few studies have been concerned with the usefulness of PET with [18F]2-deoxy-2-fluoro-D-glucose (FDG) in childhood tumors. METHODS: Fifteen children and young adults (0.5-26.0 years of age) with histologically confirmed brain tumors were studied with PET and FDG. Seven children with medulloblastoma (n = 5) or primitive neuroectodermal tumor (PNET) (n = 2) underwent repeated PET studies during their therapy. The other eight children with medulloblastoma (n = 5) or astrocytoma (n = 3) were studied only once before initiation of treatment. A close clinical follow-up was performed in every case. RESULTS: Comparison of local glucose metabolic rates obtained in the various tumor lesions revealed that the mean rates found in medulloblastomas (mean glucose metabolic rate, 42.8 +/- 14.03 mumol/100 g/min) were twice as high as the rates measured in either PNET (17.3 +/- 4.5 mumol/100g/min) or infratentorial gliomas (21.8 +/- 4.2 mumol/100g/min). The high metabolism of medulloblastomas enabled the observer to identify the tumor more easily and to clearly separate it from the surrounding unaffected brain tissue. In the seven patients with follow-up PET studies during therapy, decreasing or increasing ratios of tumor-to-white matter metabolic rate were not only commensurate with neuroradiologically defined tumor reduction or growth, but also corresponded to the duration of initial clinical improvement. CONCLUSIONS: These preliminary results suggest that PET with FDG may be a useful tool to evaluate metabolic activity of pediatric brain tumors over time and to assess response to treatment.

Adolescent↗

PubMed1994

The impact of perioperative factors on subsequent intelligence quotient deficits in children treated for medulloblastoma/posterior fossa primitive neuroectodermal tumors.

BACKGROUND: Despite success in treating children with medulloblastoma/posterior fossa primitive neuroectodermal tumor (PF PNET), some children survive with significant neurocognitive sequelae. This study was performed to understand better the significance of perioperative factors on subsequent full scale intelligence quotient (FSIQ) deterioration in these children. METHODS: Twenty-eight children who underwent prospective and serial neurocognitive testing were studied. All children underwent surgery followed by radiotherapy with or without chemotherapy between 1983 and 1987 for medulloblastoma/PF PNET and were disease free when this study was conducted. IQ testing was performed before surgery and after the completion of radiation therapy. The clinical courses of the patients were correlated with changes in the corresponding intelligence quotients of each child. Factors correlating with neurocognitive declines were examined by chi-square or Fisher exact test analysis. Differences in mean IQs were examined by the t test. Factors found to be significant were analyzed by exact logistic regression analysis. RESULTS: The presence of adverse factors such as neurologic deficits, meningitis, or shunt infections, or the need for repeat surgery was correlated significantly with IQ deficits after treatment. Of the subset of children with one or more of these factors, 13 of 16 (81%) sustained decreases in FSIQ; 7 of 16 (43.8%) had decreases of 20 points of more. In contrast, only 3 of 12 (25%) of the children without the factors sustained FSIQ decreases, and no child sustained a decrease of more than 13 points. The mean FSIQ change after treatment in the group with factors was -15.7 (95% confidence interval [CI]: -24.0, -8.4), and the median was -18. The mean FSIQ change in the group without factors was 4.8 (95% CI: -0.5, 10.1), and the median was 5. The difference in mean FSIQ change between the two groups was significant (P < 0.0001). On univariate analysis, both the presence of adverse factors and an age less than six years correlated with neurocognitive deficit. On regression analysis, only the presence of adverse factors was significant (odds ratio 11.53; 95% CI, 1.65-116.58; P = 0.009), whereas age was not (P = 0.27). CONCLUSIONS: Perioperative events or complications may account for some of the neurocognitive deterioration seen in these children after treatment, especially in the very young. The occurrence of these factors is associated with a significantly greater risk of IQ deterioration. Studies of the neurocognitive effects of treatment for children with medulloblastoma/PF PNET should include an analysis of these postoperative factors.

Adolescent↗

PubMed1999

Neurocognitive deficits in medulloblastoma survivors and white matter loss.

Although previous studies have documented a significant risk of intellectual loss after treatment for childhood medulloblastoma (MED), the pathophysiology underlying this process is poorly understood. The purpose of this study was to test the hypotheses that (1) patients treated for MED in childhood have reduced volumes of normal white matter (NWM) related to their treatment with craniospinal irradiation with or without chemotherapy, and (2) deficits in NWM among patients surviving MED can at least partially explain deficits in their intellectual performance. Eighteen pediatric patients previously treated for MED were matched on the basis of age at the time of evaluation to 18 patients previously treated for low-grade posterior fossa tumors with surgery alone (mean difference, 3.7 months). Evaluations were conducted with age-appropriate neurocognitive testing and quantitative magnetic resonance imaging by using a novel automated segmentation and classification algorithm constructed from a hybrid neural network. Patients treated for MED had significantly less NWM (p < 0.01) and significantly lower Full-Scale IQ values than those treated for low-grade tumors (mean, 82.1 vs 92.9). In addition, NWM had a positive and statistically significant association with Full-Scale IQ among the patients treated for MED. We conclude that irradiation- or chemotherapy-induced destruction of NWM can at least partially explain intellectual and academic achievement deficits among MED survivors.

Adolescent↗