Lisa M DeAngelis

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..Emerging data support the validity of this approach, and the development of more efficacious chemotherapeutic regimens has been the focus of recent research...

..Consequently, patients are often treated with chemotherapy alone, and WBRT is deferred until relapse...

..Aggressive therapy should be offered to select patients irrespective of advanced age...

..This study was a pilot project to assess the safety and efficacy of carboxypeptidase G2 (CPG2) rescue from high-dose (HD) methotrexate (MTX) in patients with recurrent cerebral lymphoma...

..This review summarizes the literature regarding the treatment of PCNSL in immunocompetent patients...

..Nevertheless, some patients, particularly those with leukemia, lymphoma, and breast cancer, respond and a substantial minority will be alive one to two years after diagnosis...

..Consequently, the role of radiotherapy remains to be clarified in newly diagnosed younger patients with PCNSL...

..Cranial irradiation alone rarely results in long-term disease control or prolonged survival. We prospectively studied the use of combination chemotherapy plus cranial irradiation in newly diagnosed patients with PCNSL...

..This treatment strategy affords long-term disease control to a subset of patients with newly diagnosed anaplastic oligodendroglioma without evidence of delayed neurotoxicity or myelodysplasia...

..01), and frontal lobe predominance (P < .05). Limited level 1 evidence is currently available to guide treatment decisions, and ongoing phase III trials will be critical to understanding the optimal therapy...

..4, P< .0001). Longitudinal increases in serum YKL-40 are associated with increased risk of death in patients with glioblastomas and anaplastic gliomas. YKL-40 is also a putative indicator of disease status in these patients...

..Combined CT + RT led to longer disease control and survival than did CT or RT alone in cases with no 1p19q deletion. Ongoing trials will address these issues prospectively...

..001). Single-agent activity of erlotinib is minimal for recurrent MGs and marginally beneficial following RT for NP GBM patients. Development of rash in cycle 1 correlates with survival in patients with NP GBM after RT...

..CONCLUSIONS: Treatment-induced leukoencephalopathy is not a late delayed consequence of neurotoxic treatment but can be seen very early in some patients. Vascular disease may be a component of this white matter injury...

..Therefore, a retrospective study was conducted to assess the impact of consolidation treatment after a CR to initial induction chemotherapy on disease control and survival...

..Changes in serum MMP-9 were not associated with survival in the anaplastic glioma cohort. Serum MMP-9 showed no utility in determining glioma disease status and was not a clinically relevant prognostic marker of survival...

..Cognitive dysfunction was more prevalent in PCNSL survivors treated with WBRT + HD-MTX compared with patients treated with HD-MTX alone...

..To evaluate YKL-40 and MMP-9 proteins as tumor biomarkers in serum samples from patients with primary central nervous system lymphoma (PCNSL)...

..51). Similarly, there were no differences in response rates or overall survival according to MTX AUC, suggesting that intra-patient dose escalation to increase MTX exposure is unnecessary when our regimen is utilized...

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..The goal of this randomized phase II study was to evaluate two different temozolomide regimens in the adjuvant treatment of newly diagnosed GBM...

..The objective of the current study was to identify factors associated with the receipt and type of treatment in a population-based cohort of older PCNSL patients...

..This has important implications for further development of this drug in the treatment of MG as well as the optimal management of patients with other malignancies such as NSCLC who are on enzyme-inducing drugs...

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..7 years from diagnosis (range: 0.9-11.5 years). Long-term survivors remain rare, but are found across all age groups despite multiple recurrences; clinically significant delayed complications of treatment are common...

..First relapse and neurotoxicity within 2 years of diagnosis seem to be critical for predicting long-term outcomes...

..A retrospective review was carried out to assess the impact of whole brain radiotherapy (WBRT), intrathecal therapy (IT), and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on outcomes...

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..Long-term persistence of the PCNSL clone was observed in one patient. Patients with late relapses have a good response to salvage therapy and prolonged survival...

..Capecitabine may achieve a CR and provide long-term control in patients with both leptomeningeal and parenchymal CNS metastases from breast cancer...

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..To assess the safety and efficacy of intensive methotrexate-based chemotherapy followed by high-dose chemotherapy (HDT) with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma (PCNSL)...

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..The objectives of this study were to characterize the immunophenotypes of PCNSL samples and to determine their utility in predicting clinical outcomes...

..There was no significant cognitive decline up to 24 months post-chemotherapy and reduced-dose WBRT in this group of PCNSL patients, however, difficulties in Verbal Memory and Motor speed persisted over the follow-up period...

..The few published studies examining adverse treatment effects on cognition revealed conflicting results...

..MRI findings were typical, but CSF white blood cell count was normal in four patients and one had negative CSF testing, suggesting that CSF results may be misleading in this population...

..We obtained prospective longitudinal serum samples from patients with gliomas to determine whether YKL-40 or MMP-9 could be used as serum markers...

..For older patients, it appears to be reasonable to defer whole brain radiotherapy in an effort to minimize treatment-related neurotoxicity...

..Using a case-controlled retrospective study, matching patients treated with HD-MTX with or without IT-MTX, we found no difference in survival, disease control, or neurotoxicity...

..Median overall survival was 2 months (range 2 days to 3.6 years) after VP shunt placement, but there was no procedure-related mortality. The prognosis of LM remained poor, but VP shunt can be an effective palliative tool when required...

..Patients whose ocular disease was identified and treated before CNS progression had a significantly improved survival...

..We describe five patients with long-term primary CNS lymphoma who were diagnosed with retinopathy several years after treatment with chemotherapy and WBRT...

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..This data suggests that FDG-PET imaging in PCNSL is useful and may have a role in response assessment...

..Other organs such as liver, lung, and kidneys were spared. Necrotizing vasculopathy is a novel entity that should be considered in the differential diagnosis of PCNSL...

..Here, we demonstrate selective sensitivity of glioma-specific EGFR mutants to ATP-site competitive EGFR kinase inhibitors that target the inactive conformation of the catalytic domain...

..Prior exposure to VEGFR-TKIs may not preclude response to BEV, but sensitivity to BEV may be lower following more robust VEGFR inhibition...

..This review summarizes the literature regarding the treatment of PCNSL in immunocompetent patients...

..Although results from clinical trials suggest progress in the treatment of PCNSL, survival improvements are not reflected in this population-based cohort...

..Primary brain tumor patients are at increased risk for stroke from disease and treatment-specific mechanisms...

..Patients often have complete responses but relapses are common. We characterized the MR spectra of PCNSL patients, correlated MRSI with MRI and evaluated whether early recurrence could be detected by MRSI...

..Only one of our six patients suffered minor bleeding as a complication of rTPA. Acute stroke in patients with cancer may be treated with rTPA, and active cancer should not be considered an absolute contraindication to rTPA use...

..The current treatment options are discussed. Although advances have been made, the optimal treatment for primary ocular lymphoma remains to be identified..

..Patients with recurrent brain metastases can also benefit from additional treatment, including all the modalities available at diagnosis...

..Body FDG PET may be an important noninvasive adjunct to conventional PCNSL staging, and its utility should be evaluated prospectively...

..We hope that these guidelines will improve communication among investigators and comparability among clinical trials in a way that will allow us to develop better therapies for patients...

..However, the optical treatment approach is still unclear and therapy can be associated with long-term neurotoxicity. Current research focuses on maximizing survival while minimizing neurologic sequelae...

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..This review will discuss the common complications of both established and novel agents used to treat cancer...

..Unfortunately, even when effective in other types of neuropathic pain, anti-depressants and anticonvulsants have not yet proven effective for treating the symptoms of CIPN...

..This combined regimen prolongs patient survival, but also carries a substantial risk for delayed neurotoxicity particularly in the elderly. However, cognitive outcome evaluations have not been included in most clinical trials...

..We reviewed the records of children who developed a brain abscess during treatment of a malignancy to define the clinical characteristics, prognosis, and management of these patients...

..To evaluate an integrated battery of preoperative functional magnetic resonance imaging (fMRI) tasks developed to identify cortical areas associated with tactile, motor, language, and visual functions...

..The reported protocol was designed to optimize and enhance the chemotherapeutic component of treatment...

..While better definitive strategies are investigated, physicians must remember to optimize the use of supportive therapies to ameliorate symptoms and maintain quality of life...

..This article reviews the epidemiology, clinical features, treatment, and prognosis of brain metastases from system malignancies...

..All patients underwent radiation therapy, and three received chemotherapy. Complete response was achieved in 100% of patients, but three developed systemic relapse...

..Convulsive status epilepticus may cause reversible neuroimaging abnormalities. These cortical changes have been reported rarely in association with nonconvulsive status epilepticus...

..The prognosis of T-cell PCNSL may be worse than that of comparable B-cell tumors...

..Accurate diagnosis is essential; neuroimaging often is suggestive of a primary brain tumor and should initiate surgical intervention so that histopathology can be obtained early and appropriate treatment instituted...

..Autopsy studies reveal that most primary CNS lymphomas (PCNSL) extensively infiltrate the brain. To date, there has been no correlation of autopsy findings with a modern neuroimaging assessment of tumor burden...

..Combining inducers of DTD and cytochrome b5 reductase with bioreductive agents may be a potential therapeutic strategy for glioblastoma...

..Outcome was primarily determined by the underlying malignancy and the patient's neurologic condition...

..However, patterns of relapse, prognosis, and outcome of further therapy after bevacizumab failure have not been studied systematically...

..In this article, the authors review the standard treatment for upfront and recurrent PCNSL...

..Our patient had a rapidly deteriorating course with recurrent strokes despite numerous anti-platelet and anti-coagulant agents, and was only responsive to chemotherapy aimed at the underlying cancer...

..SUMMARY: Topics covered in detail include central nervous system prophylaxis, leptomeningeal metastasis, and common hematologic complications affecting the brain. The findings aid in the clinical management of patients with leukemia...

..At recurrence, ependymoma is notoriously refractory to therapy and the prognosis is poor. In recurrent glioblastoma, encouraging responses with bevacizumab have been observed...

..To analyze the risk factors, presentation, etiologies, and outcomes of adult cancer patients with intracranial hemorrhage (IH)...

..The diagnostic gold standard has been CSF cytology, but MRI is now used routinely for diagnosis. Diagnosis and prognosis of LM has not been studied in the MRI era...

..Because tipifarnib undergoes extensive hepatic metabolism, MTD is doubled in patients on EIAEDs. The population included 67 patients with glioblastoma multiforme (GBM) and an exploratory group of 22 patients with anaplastic glioma (AG)...

..Laboratory and clinical data suggest that the anti-angiogenic agent, thalidomide, if combined with cytotoxic agents, may be effective against recurrent glioblastoma multiforme (GBM)...

..Phase II: To determine the therapeutic efficacy of imatinib...

..CONCLUSION: GBMs may be a late complication of radiation treatment for pediatric brain tumors. If further radiotherapy is not a therapeutic option, chemotherapy may result in prolonged survival...

..7 months. This combination merits further study and provides a reasonable therapeutic alternative for older patients with progressive PCNSL...

..The study was also intended to assess whether temozolomide affects the conversion of irinotecan to SN-38...

..Earlier assessments of progression status also predicted survival and may be incorporated in the design of future clinical trials...

..028). Despite improved treatment for both diseases over the past decade, survival remains dismal in this cohort of Medicare/Medicaid beneficiaries with HIV-related PCNSL. These results may not apply to the general HIV population...

..g. only anaplastic astrocytomas). When taken together with the results of a similar randomized trial, prophylactic anticonvulsants are unlikely to be effective or useful in brain tumour patients who have not had a seizure...

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