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1. Greenberg HS, Chamberlain MC, Glantz MJ, Wang S: Adult medulloblastoma: multiagent chemotherapy. Neuro Oncol; 2001 01;3(1):29-34
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  • [Title] Adult medulloblastoma: multiagent chemotherapy.
  • In this study, the records of 17 adult patients with medulloblastoma treated with craniospinal radiation and 1 of 2 multiagent chemotherapy protocols were reviewed for progression-free survival, overall survival, and toxicity, and the patients were compared with each other and with similarly treated children and adults.
  • Seventeen medulloblastoma patients (11 female, 6 male) with a median age of 23 years (range, 18-47 years) were treated with surgery, craniospinal radiation (CSRT) plus local boost, and 1 of 2 adjuvant chemotherapy regimens.
  • All tumors were infratentorial (10 in 4th ventricle and 7 in left or right hemisphere).
  • Other relapse sites included the leptomeninges (5), bone (1), and brain (1).
  • Two patients relapsed during chemotherapy and 6 relapsed after completing all therapy at 18, 18, 26, 30, 40, and 48 months.
  • Toxicity during the Packer protocol was moderately severe, with only 1 of 10 patients able to complete all therapy.
  • Two patients had severe abdominal pain during CSRT + vincristine, and 5 had peripheral neuropathy during vincristine therapy.
  • The POG and Packer protocols did not have a statistically significant difference in relapse-free or overall survival because of the small sample size.
  • To know whether adding adjuvant chemotherapy to craniospinal radiation in adult therapy increases relapse-free and overall survival, we must await the results of a larger randomized controlled clinical trial.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Infratentorial Neoplasms / drug therapy. Medulloblastoma / drug therapy
  • [MeSH-minor] Abdominal Pain / chemically induced. Adolescent. Adult. Cerebrospinal Fluid Shunts. Chemotherapy, Adjuvant. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy. Cranial Irradiation. Cyclophosphamide / administration & dosage. Cyclophosphamide / adverse effects. Disease-Free Survival. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Gastrointestinal Diseases / chemically induced. Hearing Loss, Sensorineural / chemically induced. Hematologic Diseases / chemically induced. Humans. Life Tables. Lomustine / administration & dosage. Lomustine / adverse effects. Male. Neoplasm Invasiveness. Neoplasm Recurrence, Local. Peripheral Nervous System Diseases / chemically induced. Radiotherapy, Adjuvant. Retrospective Studies. Survival Analysis. Vincristine / administration & dosage. Vincristine / adverse effects

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  • (PMID = 11305414.001).
  • [ISSN] 1522-8517
  • [Journal-full-title] Neuro-oncology
  • [ISO-abbreviation] Neuro-oncology
  • [Language] eng
  • [Publication-type] Comparative Study; Evaluation Studies; Journal Article; Review
  • [Publication-country] England
  • [Chemical-registry-number] 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 7BRF0Z81KG / Lomustine; 8N3DW7272P / Cyclophosphamide; Q20Q21Q62J / Cisplatin
  • [Number-of-references] 15
  • [Other-IDs] NLM/ PMC1920599
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2. Fouladi M, Hunt DL, Pollack IF, Dueckers G, Burger PC, Becker LE, Yates AJ, Gilles FH, Davis RL, Boyett JM, Finlay JL: Outcome of children with centrally reviewed low-grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high-grade glioma study CCG-945. Cancer; 2003 Sep 15;98(6):1243-52
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  • [Title] Outcome of children with centrally reviewed low-grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high-grade glioma study CCG-945.
  • BACKGROUND: The objectives of the current study were to determine the outcome of children who were treated with chemotherapy and radiotherapy on the Children's Cancer Group (CCG) high-grade glioma protocol (CCG-945) who were diagnosed with low-grade gliomas on post hoc central pathologic review and to identify clinical and biologic features associated with prognosis.
  • Patients older than 24 months with intracranial lesions were assigned randomly to receive either lomustine, vincristine, and prednisone (control regimen) or the 8-drugs-in-1-day regimen (experimental regimen); younger patients and those with primary spinal cord tumors were assigned nonrandomly to the experimental regimen.
  • Significantly poorer 5-year PFS was seen in children younger than 24 months, those with fibrillary astrocytoma, and those with posterior fossa tumors.
  • Patients demonstrated a modest improvement in PFS but no improvement in OS compared with children with low-grade gliomas who were treated with contemporary chemotherapy-alone approaches.
  • CONCLUSIONS: The current report calls attention to the importance of central pathologic review in large multiinstitutional trials of children with gliomas and suggests that aggressive front-line combined chemoradiotherapy does not confer a survival advantage in this highly selected population of patients.
  • [MeSH-major] Brain Neoplasms / therapy. Glioma / therapy
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Child. Child, Preschool. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Infant. Infant, Newborn. Lomustine / administration & dosage. Male. Prednisolone / administration & dosage. Prognosis. Treatment Outcome. Vincristine / administration & dosage

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  • [Copyright] Copyright 2003 American Cancer Society.DOI 10.1002/cncr.11637
  • (PMID = 12973849.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA13539; United States / NCI NIH HHS / CA / CA21765; United States / NINDS NIH HHS / NS / NS01810; United States / NINDS NIH HHS / NS / NS37704
  • [Publication-type] Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 5J49Q6B70F / Vincristine; 7BRF0Z81KG / Lomustine; 9PHQ9Y1OLM / Prednisolone
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3. Puget S, Boddaert N, Viguier D, Kieffer V, Bulteau C, Garnett M, Callu D, Sainte-Rose C, Kalifa C, Dellatolas G, Grill J: Injuries to inferior vermis and dentate nuclei predict poor neurological and neuropsychological outcome in children with malignant posterior fossa tumors. Cancer; 2009 Mar 15;115(6):1338-47

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  • [Title] Injuries to inferior vermis and dentate nuclei predict poor neurological and neuropsychological outcome in children with malignant posterior fossa tumors.
  • BACKGROUND: Children treated for a malignant posterior fossa tumor (PFT) are at risk of intellectual impairment.
  • Its severity is not explained by age and radiotherapy alone.
  • METHODS: Sixty-one consecutive children (mean age, 6.0 years) treated for a malignant PFT with surgery, chemotherapy, and radiotherapy underwent a detailed neuropsychological evaluation, including a full-scale intelligence quotient (FSIQ), on average 5.6 years after the diagnosis.
  • The neurological examination was recorded 1 month after surgery and at the time of the neuropsychological evaluation.
  • Cerebellar and brain injuries were scored based on the magnetic resonance imaging (MRI).
  • [MeSH-major] Cerebellar Neoplasms / complications. Cerebellar Neoplasms / therapy. Cerebellar Nuclei / injuries. Cognition Disorders / etiology. Infratentorial Neoplasms / complications. Infratentorial Neoplasms / therapy. Intelligence. Motor Skills

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  • [Copyright] Copyright (c) 2009 American Cancer Society.
  • (PMID = 19195041.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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4. Douglas JG, Barker JL, Ellenbogen RG, Geyer JR: Concurrent chemotherapy and reduced-dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average-risk medulloblastoma: efficacy and patterns of failure. Int J Radiat Oncol Biol Phys; 2004 Mar 15;58(4):1161-4
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  • [Title] Concurrent chemotherapy and reduced-dose cranial spinal irradiation followed by conformal posterior fossa tumor bed boost for average-risk medulloblastoma: efficacy and patterns of failure.
  • PURPOSE: To review the efficacy and patterns of failure in average-risk medulloblastoma patients treated with concurrent chemotherapy and reduced-dose cranial spinal irradiation and a conformal tumor bed boost.
  • METHODS AND MATERIALS: Thirty-three patients with average risk (defined as < or =1.5 cm(2) of residual tumor after resection, age >3 years, and no involvement of the cerebrospinal fluid or spine [M0]) medulloblastoma were diagnosed at our institution between January 1994 and December 2001.
  • They were enrolled in an institutional pilot protocol consisting of concurrent chemotherapy (vincristine), reduced-dose cranial spinal irradiation (2340 cGy), a conformal primary tumor bed boost (3240 cGy), followed by eight cycles of chemotherapy (vincristine, cisplatin, and lomustine or cyclophosphamide).
  • RESULTS: The 5-year estimated disease-free survival rate, as determined by Kaplan-Meier plots, was 86% (+/-12.6%, 95% confidence interval).
  • The 5-year estimated disease-free posterior fossa control and primary tumor bed control rates were both 94% (+/-8.2%, 95% confidence interval).
  • The patterns of failure included 2 patients with distant central nervous system failure only, 1 patient who developed local primary tumor bed failure, posterior fossa failure, and diffuse leptomeningeal spread simultaneously, and 1 patient with failure in the high-dose, primary tumor bed field.
  • No patient experienced isolated posterior fossa failure outside the high-dose boost region.
  • CONCLUSION: The treatment of average-risk medulloblastoma with chemotherapy, reduced-dose cranial spinal irradiation, and a conformal tumor bed boost results in survival rates and local control rates comparable to those in contemporary studies.
  • A reduction in the amount of posterior fossa treated to the high dose is possible.
  • [MeSH-major] Infratentorial Neoplasms / drug therapy. Infratentorial Neoplasms / radiotherapy. Medulloblastoma / drug therapy. Medulloblastoma / radiotherapy. Radiotherapy, Conformal
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Confidence Intervals. Cranial Irradiation / methods. Female. Humans. Male. Pilot Projects

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  • (PMID = 15001259.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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5. Massimino M, Gandola L, Giangaspero F, Sandri A, Valagussa P, Perilongo G, Garrè ML, Ricardi U, Forni M, Genitori L, Scarzello G, Spreafico F, Barra S, Mascarin M, Pollo B, Gardiman M, Cama A, Navarria P, Brisigotti M, Collini P, Balter R, Fidani P, Stefanelli M, Burnelli R, Potepan P, Podda M, Sotti G, Madon E, AIEOP Pediatric Neuro-Oncology Group: Hyperfractionated radiotherapy and chemotherapy for childhood ependymoma: final results of the first prospective AIEOP (Associazione Italiana di Ematologia-Oncologia Pediatrica) study. Int J Radiat Oncol Biol Phys; 2004 Apr 1;58(5):1336-45
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  • [Title] Hyperfractionated radiotherapy and chemotherapy for childhood ependymoma: final results of the first prospective AIEOP (Associazione Italiana di Ematologia-Oncologia Pediatrica) study.
  • (1) focal hyperfractionated radiotherapy (HFRT) if with no evidence of disease (NED), or (2) 4 courses with VEC followed by HFRT for residual disease (ED).
  • HFRT dose was 70.4 Gy (1.1 Gy/fraction b.i.d.
  • RESULTS: Sixty-three consecutive children were enrolled: 46 NED, 17 ED; the tumor was infratentorial in 47 and supratentorial in 16, with spinal metastasis in 1.
  • Of NED patients, 35 of 46 have been treated with HFRT; 8 received conventionally fractionated radiotherapy, and 3 received no treatment.
  • Of the 17 ED patients, 9 received VEC + HFRT; violations due to postsurgical morbidity were as follows: HFRT only (2), conventionally fractionated radiotherapy (3) + VEC (2), and no therapy (1).
  • CONCLUSIONS: HFRT, despite the high total dose adopted, did not change the prognosis of childhood ependymoma as compared to historical series: New radiotherapeutic approaches are needed to improve local control.
  • Future ependymoma strategies should consider grading when stratifying treatment indications.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / drug therapy. Brain Neoplasms / radiotherapy. Ependymoma / drug therapy. Ependymoma / radiotherapy
  • [MeSH-minor] Adolescent. Adult. Chemotherapy, Adjuvant. Child. Child, Preschool. Cyclophosphamide / administration & dosage. Dose Fractionation. Etoposide / administration & dosage. Feasibility Studies. Humans. Infratentorial Neoplasms / drug therapy. Infratentorial Neoplasms / radiotherapy. Infratentorial Neoplasms / surgery. Patient Compliance. Prospective Studies. Radiotherapy, Adjuvant. Supratentorial Neoplasms / drug therapy. Supratentorial Neoplasms / radiotherapy. Supratentorial Neoplasms / surgery. Survival Analysis. Vincristine / administration & dosage

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  • (PMID = 15050308.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide
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6. Massimino M, Gandola L, Spreafico F, Biassoni V, Luksch R, Collini P, Solero CN, Simonetti F, Pignoli E, Cefalo G, Poggi G, Modena P, Mariani L, Potepan P, Podda M, Casanova M, Pecori E, Acerno S, Ferrari A, Terenziani M, Meazza C, Polastri D, Ravagnani F, Fossati-Bellani F: No salvage using high-dose chemotherapy plus/minus reirradiation for relapsing previously irradiated medulloblastoma. Int J Radiat Oncol Biol Phys; 2009 Apr 1;73(5):1358-63
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  • [Title] No salvage using high-dose chemotherapy plus/minus reirradiation for relapsing previously irradiated medulloblastoma.
  • PURPOSE: Myeloablative regimens were frequently used for medulloblastoma relapsing after craniospinal irradiation (CSI): in 1997-2002, we used repeated surgery, standard-dose and myeloablative chemotherapy, and reirradiation.
  • Hematopoietic precursor mobilization followed high-dose etoposide or high-dose cyclophosphamide or cisplatin/etoposide therapy.
  • After the overall chemotherapy program, reirradiation was prescribed when possible.
  • RESULTS: Seventeen patients were treated: previous treatment included CSI of 19.5-36 Gy with posterior fossa/tumor boost and chemotherapy in 16 patients.
  • Relapse sites included leptomeninges in 9 patients, spine in 4 patients, posterior fossa in 3 patients, and brain in 1 patient.
  • Twelve of 14 patients with assessable tumor had an objective response after reinduction; 2 experienced progression and were not given the myeloablative courses.
  • Additional relapses appeared in 13 patients continuing the treatment.
  • CONCLUSIONS: Despite responses being obtained and ample use of surgery and reirradiation, second-line therapy with myeloablative schedules was not curative, barring a few exceptions.
  • A salvage therapy for medulloblastoma after CSI still needs to be sought.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Cerebellar Neoplasms. Medulloblastoma. Neoplasm Recurrence, Local. Salvage Therapy
  • [MeSH-minor] Adolescent. Carboplatin / administration & dosage. Carboplatin / adverse effects. Child. Child, Preschool. Cisplatin / administration & dosage. Cisplatin / adverse effects. Combined Modality Therapy / methods. Cyclophosphamide / administration & dosage. Cyclophosphamide / adverse effects. Disease-Free Survival. Drug Administration Schedule. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Granulocyte Colony-Stimulating Factor / administration & dosage. Humans. Male. Methotrexate / administration & dosage. Methotrexate / adverse effects. Radiotherapy Dosage. Remission Induction / methods. Thiotepa / administration & dosage. Thiotepa / adverse effects. Vincristine / administration & dosage. Vincristine / adverse effects. Young Adult

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  • (PMID = 19019566.001).
  • [ISSN] 1879-355X
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 143011-72-7 / Granulocyte Colony-Stimulating Factor; 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; 905Z5W3GKH / Thiotepa; BG3F62OND5 / Carboplatin; Q20Q21Q62J / Cisplatin; YL5FZ2Y5U1 / Methotrexate
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7. Badhe PB, Chauhan PP, Mehta NK: Brainstem gliomas--a clinicopathological study of 45 cases with p53 immunohistochemistry. Indian J Cancer; 2004 Oct-Dec;41(4):170-4
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  • BACKGROUND: Brainstem tumors represent 10% of central nervous system tumors, accounting for 30% of pediatric posterior fossa tumors.
  • AIMS: The aim of this study was to clinicopathologically correlate 45 cases of brain stem gliomas and determine the occurrence and prognostic significance of p53 expression.
  • MATERIALS AND METHOD: 45 cases of brain stem gliomas encountered during a 19-year period.
  • The WHO brain tumor classification and Stroink's CT classification were applied.
  • Grade II astrocytomas were treated with excision and radiotherapy, while grade III and IV tumors were treated with radiotherapy and chemotherapy (CCNU).
  • The outcome was better in patients who were treated surgically. p53 is a frequently mutated gene in brain stem astrocytomas.
  • [MeSH-major] Biomarkers, Tumor / metabolism. Brain Stem Neoplasms / metabolism. Glioma / metabolism. Tumor Suppressor Protein p53 / metabolism

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  • (PMID = 15659871.001).
  • [ISSN] 0019-509X
  • [Journal-full-title] Indian journal of cancer
  • [ISO-abbreviation] Indian J Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] India
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 0 / Tumor Suppressor Protein p53
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8. Sato I, Higuchi A, Yanagisawa T, Mukasa A, Ida K, Sawamura Y, Sugiyama K, Saito N, Kumabe T, Terasaki M, Nishikawa R, Ishida Y, Kamibeppu K: Development of the Japanese version of the Pediatric Quality of Life Inventory Brain Tumor Module. Health Qual Life Outcomes; 2010;8:38
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  • [Title] Development of the Japanese version of the Pediatric Quality of Life Inventory Brain Tumor Module.
  • The PedsQL Brain Tumor Module is comprised of six scales: Cognitive Problems, Pain and Hurt, Movement and Balance, Procedural Anxiety, Nausea, and Worry.
  • In the present study, we developed the Japanese version of the PedsQL Brain Tumor Module and investigated its feasibility, reliability, and validity among Japanese children and their parents.
  • Participants were recruited from 6 hospitals in Japan and the Children's Cancer Association of Japan, and questionnaires were completed by 137 children with brain tumors and 166 parents.
  • Feasibility of the questionnaire was determined based on the amount of time required to complete the form and the percentage of missing values.
  • Known-groups validity was described with regard to whole brain irradiation, developmental impairment, infratentorial tumors, paresis, and concurrent chemotherapy.
  • Evaluation of known-groups validity confirmed that the Cognitive Problems scale was sensitive for developmental impairment, the Movement and Balance scale for infratentorial tumors or paresis, and the Nausea scale for a patient currently undergoing chemotherapy.
  • CONCLUSIONS: The Japanese version of the PedsQL Brain Tumor Module is suitable for assessing health-related quality of life in children with brain tumors in clinical trials and research studies.
  • [MeSH-major] Brain Neoplasms. Quality of Life. Surveys and Questionnaires

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  • (PMID = 20398254.001).
  • [ISSN] 1477-7525
  • [Journal-full-title] Health and quality of life outcomes
  • [ISO-abbreviation] Health Qual Life Outcomes
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Validation Studies
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC2873593
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9. Sandberg DI, Crandall KM, Petito CK, Padgett KR, Landrum J, Babino D, He D, Solano J, Gonzalez-Brito M, Kuluz JW: Chemotherapy administration directly into the fourth ventricle in a new piglet model. Laboratory Investigation. J Neurosurg Pediatr; 2008 May;1(5):373-80
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  • [Title] Chemotherapy administration directly into the fourth ventricle in a new piglet model. Laboratory Investigation.
  • OBJECT: The authors hypothesized that chemotherapy infusions directly into the fourth ventricle may potentially play a role in treating malignant posterior fossa tumors.
  • METHODS: A closed-tip silicone lumbar drain catheter was inserted into the fourth ventricle via a posterior fossa craniectomy and 5 daily infusions of etoposide (0.5 mg in 5 animals) or normal saline (in 2 animals) were instilled.

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  • (PMID = 18447671.001).
  • [ISSN] 1933-0707
  • [Journal-full-title] Journal of neurosurgery. Pediatrics
  • [ISO-abbreviation] J Neurosurg Pediatr
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Phytogenic; 6PLQ3CP4P3 / Etoposide
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10. Sainte-Rose C, Cinalli G, Roux FE, Maixner R, Chumas PD, Mansour M, Carpentier A, Bourgeois M, Zerah M, Pierre-Kahn A, Renier D: Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg; 2001 Nov;95(5):791-7
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  • [Title] Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy.
  • OBJECT: The authors undertook a study to evaluate the effectiveness of endoscopic third ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children.
  • METHODS: Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hĵpital Necker-Enfants Malades in Paris.
  • The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic third ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary third ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission.
  • There were no significant differences between patients in Group A or B with respect to the following variables: age at presentation, evidence of metastatic disease, extent of tumor resection, or follow-up duration.
  • Ultimately, there were only four patients (6%) in Group A compared with 22 patients (26.8%) in Group B (p = 0.001) in whom progressive hydrocephalus required treatment following removal of the posterior fossa tumor.
  • The other six patients (7.3%) were treated by endoscopic third ventriculostomy after tumor resection.
  • In three patients who required placement of CSF shunts several episodes of shunt malfunction occurred that were ultimately managed by endoscopic third ventriculostomy and definitive removal of the shunt.
  • CONCLUSIONS: Third ventriculostomy is feasible even in the presence of posterior fossa tumors (including brainstem tumors).
  • When performed prior to posterior fossa surgery, it significantly reduces the incidence of postoperative hydrocephalus.
  • The procedure provides a valid alternative to placement of a permanent shunt in cases in which hydrocephalus develops following posterior fossa surgery, and it may negate the need for the shunt in cases in which the shunt malfunctions.
  • Furthermore, in patients in whom CSF has caused spread of the tumor at presentation, third ventriculostomy allows chemotherapy to be undertaken prior to tumor excision by controlling hydrocephalus.
  • Although the authors acknowledge that the routine application of third ventriculostomy in selected patients results in a proportion of patients undergoing an "unnecessary" procedure, they believe that because patients' postoperative courses are less complicated and because the incidence of morbidity is low and the success rate is high in those patients with severe hydrocephalus that further investigation of this protocol is warranted.
  • [MeSH-major] Brain Neoplasms / complications. Endoscopy. Hydrocephalus / etiology. Hydrocephalus / surgery. Third Ventricle / surgery. Ventriculostomy
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Cranial Fossa, Posterior. Humans. Infant. Postoperative Complications


11. Rønning C, Sundet K, Due-Tønnessen B, Lundar T, Helseth E: Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood. Pediatr Neurosurg; 2005 Jan-Feb;41(1):15-21
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  • [Title] Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood.
  • Traditionally, the cerebral hemispheres have been regarded as the region of the brain responsible for cognitive functions, while the cerebellum has been considered to be primarily involved in motor functions.
  • The aim of this study was to determine the neuropsychological profile of young adults treated for a posterior fossa tumor in childhood and look for possible support for the presence of the so-called 'cerebellar cognitive affective syndrome' in these patients.
  • The medulloblastoma group (n = 11) had been treated with surgery followed by radiotherapy and chemotherapy (mean age at surgery was 6.1 years and mean age at neuropsychological testing was 23.1 years).
  • No significant correlation between age at time of treatment and grade of neuropsychological impairment was found in the astrocytoma group, though there was a tendency that young age at time of treatment correlated with better outcome on IQ measures.
  • For this group, young age at time of treatment indicated a worse outcome.
  • CONCLUSIONS: Persistent cognitive dysfunction was detected in patients treated for posterior fossa medulloblastoma and cerebellar astrocytoma.
  • Follow-up of all patients treated for posterior fossa tumor in childhood should include an extensive neuropsychological testing at regular intervals.
  • [MeSH-major] Astrocytoma / surgery. Cerebellar Neoplasms / surgery. Cerebellum / physiopathology. Cerebellum / surgery. Cognition Disorders / etiology. Medulloblastoma / surgery

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  • [Copyright] Copyright 2005 S. Karger AG, Basel.
  • (PMID = 15886508.001).
  • [ISSN] 1016-2291
  • [Journal-full-title] Pediatric neurosurgery
  • [ISO-abbreviation] Pediatr Neurosurg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Switzerland
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12. Cohen KJ, Broniscer A, Glod J: Pediatric glial tumors. Curr Treat Options Oncol; 2001 Dec;2(6):529-36
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  • [Title] Pediatric glial tumors.
  • Glial neoplasms in children comprise many heterogeneous tumors that include pilocytic and fibrillary astrocytomas, ependymomas, and the diffuse intrinsic pontine gliomas.
  • In contrast to adults, most of whom present with high-grade fibrillary neoplasms, alternate histologies represent most cases seen in the pediatric setting.
  • In addition, although most adult gliomas are supratentorial in location, in pediatrics infratentorial tumors (posterior fossa and brain stem) predominate.
  • We discuss three specific tumors: diffuse intrinsic pontine gliomas; pilocytic astrocytomas; and ependymomas.
  • Maximal surgical resection is the mainstay of therapy for both pilocytic astrocytomas and ependymomas.
  • Failure to achieve an optimal resection often results in progression and the need for further therapy for patients with pilocytic astrocytomas, and is ultimately fatal in most children with subtotally resected ependymomas.
  • Surgical resection has no role in the treatment of pontine gliomas.
  • Focal radiation therapy is included routinely in the treatment of ependymomas, and it has been shown to improve event-free survival.
  • This therapy also is used in the treatment of pontine gliomas because radiation treatment appears to slow inevitable tumor progression.
  • Radiation therapy in pilocytic astrocytomas is generally reserved for patients who progress after an initial surgical resection or for those patients with midline tumors; these patients are poor candidates for aggressive surgical resection.
  • The role of chemotherapy in these tumors is in evolution.
  • Chemotherapy for pilocytic astrocytomas, particularly in young children (for whom radiation therapy is avoided), appears to be effective in the treatment of a subset of patients.
  • Up-front chemotherapy is generally reserved for the youngest children who present with ependymoma.
  • In the recurrence setting, chemotherapy has shown some activity, although this approach is never curative.
  • Despite the application of various chemotherapeutics and other biologic agents, none of these therapies has improved the prognosis for patients with the uniformly lethal pontine glioma.
  • [MeSH-major] Brain Neoplasms / therapy. Glioma / therapy
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Astrocytoma / mortality. Astrocytoma / therapy. Cerebrospinal Fluid Shunts. Chemotherapy, Adjuvant. Child. Child, Preschool. Combined Modality Therapy. Cranial Irradiation. Craniotomy. Disease Progression. Ependymoma / mortality. Ependymoma / therapy. Epidemiologic Methods. Humans. Hydrocephalus / etiology. Hydrocephalus / surgery. Infant. Infratentorial Neoplasms / mortality. Infratentorial Neoplasms / therapy. Palliative Care. Pons. Prognosis. Radiotherapy, Adjuvant. Treatment Outcome

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  • (PMID = 12057098.001).
  • [ISSN] 1527-2729
  • [Journal-full-title] Current treatment options in oncology
  • [ISO-abbreviation] Curr Treat Options Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 30
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13. Szathmari A, Thiesse P, Galand-desmé S, Mottolese C, Bret P, Jouanneau E, Guyotat J, Lion-François L, Frappaz D: Correlation between pre- or postoperative MRI findings and cerebellar sequelae in patients with medulloblastomas. Pediatr Blood Cancer; 2010 Dec 15;55(7):1310-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • We investigated whether pre-operative and delayed post-operative MRI may correlate with such sequelae.
  • MATERIAL AND METHODS: The data of 31 patients in continuous complete remission after removal of medulloblastoma, irradiation and chemotherapy, were retrospectively reviewed.
  • Magnetic Resonance Imaging (MRI) was analyzed for the following items: preoperative MRI (ratio of the surface of the tumor/posterior fossa, presence of ventricular dilatation or tonsilar hernia, involvement of the dentate nucleus) and delayed post-operative MRI (amount of cerebellar parenchyma removed, degree of cerebellar atrophy, presence of T1 hypointense regions in remaining cerebellar area and removal of region containing dentate nucleus).
  • RESULTS: On preoperative MRI, the ratio of the surface of the tumor/posterior fossa and the presence of tonsilar hernia were significantly correlated with long-term sequelae on speech (respectively P = 0.027 and P = 0.05).
  • Hypointense T1 territory in remaining cerebellar parenchyma significantly correlated with immediate post-operative cerebellar syndrome (P = 0.01) and showed a tendency for post-operative mutism (P = 0.087) but was not correlated with any long-term sequelae.
  • [MeSH-major] Cerebellar Neoplasms / surgery. Magnetic Resonance Imaging. Medulloblastoma / surgery. Postoperative Complications
  • [MeSH-minor] Adolescent. Adult. Atrophy. Cerebellum / pathology. Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Infant. Intracranial Hypertension / etiology. Intracranial Hypertension / pathology. Male. Young Adult

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  • (PMID = 20981689.001).
  • [ISSN] 1545-5017
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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14. Boguszewicz L, Blamek S, Sokół M: Pattern recognition methods in (1)H MRS monitoring in vivo of normal appearing cerebellar tissue after treatment of posterior fossa tumors. Acta Neurochir Suppl; 2010;106:171-5

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Pattern recognition methods in (1)H MRS monitoring in vivo of normal appearing cerebellar tissue after treatment of posterior fossa tumors.
  • The objective of this study was to investigate the metabolic responses of normal appearing cerebellar tissue after posterior fossa tumor treatment, and to identify characteristics of the particular treatment method.
  • Moreover, this work examined the metabolic alterations of normal appearing tissue induced by a particular tumor state including resection, stagnation, progression, and recurrence.
  • The studied group consisted of 29 patients treated for posterior fossa tumors.
  • All of them were irradiated with a total dose of 54 Gy at 1.8 Gy/fraction (median values).
  • In addition, 13 underwent chemotherapy, 25 underwent total tumor resection, 18 were tumor-free in control examinations, 5 had a stable disease, and tumor progression or recurrence was observed in 2 and 4 cases, respectively.
  • The 69 spectra, acquired using a MRI/MRS 2T system, were analyzed using Partial Least Squares Discriminant Analysis (PLS-DA) with orthogonal signal correction (OSC) spectral filtering.
  • Patients treated with chemotherapy showed an elevated band between 1.15-1.75 and 2.7-3.0 ppm and had decreases in the remaining parts of the spectra.
  • Increases in lactate and decreases in the remaining metabolites were characteristic for the tumor progression/recurrence group.
  • Pattern recognition methods coupled with MRS revealed significant treatment-dependent alterations in normal appearing cerebellar tissue, as well as metabolic changes induced by tumor progression/recurrence.
  • [MeSH-major] Cerebellum / pathology. Infratentorial Neoplasms / pathology. Infratentorial Neoplasms / physiopathology. Magnetic Resonance Spectroscopy / methods. Pattern Recognition, Physiological / physiology
  • [MeSH-minor] Adolescent. Combined Modality Therapy. Electrons. Female. Humans. Magnetic Resonance Imaging / methods. Male. Multivariate Analysis. Neuropsychological Tests. Radiotherapy Dosage

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  • (PMID = 19812943.001).
  • [ISSN] 0065-1419
  • [Journal-full-title] Acta neurochirurgica. Supplement
  • [ISO-abbreviation] Acta Neurochir. Suppl.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Austria
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15. Schoch B, Konczak J, Dimitrova A, Gizewski ER, Wieland R, Timmann D: Impact of surgery and adjuvant therapy on balance function in children and adolescents with cerebellar tumors. Neuropediatrics; 2006 Dec;37(6):350-8

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Impact of surgery and adjuvant therapy on balance function in children and adolescents with cerebellar tumors.
  • OBJECTIVES: This study examined the effects of posterior fossa tumor surgery and concomitant irradiation and/or chemotherapy on the long-term recovery of balance function in children and adolescent patients.
  • SUBJECTS AND METHODS: 22 patients, treated during childhood for a benign (n = 14) or malignant cerebellar tumor (n = 8), were examined in chronic state (mean latency between surgery and testing: 7.7 years, range 3 - 17 years).
  • RESULTS: Comparing the balance function of (i) children with or without affected cerebellar nuclei and (ii) children with and without adjuvant chemotherapy and/or radiotherapy revealed that damage to the cerebellar nuclei had more impact on neurological impairment than concomitant tumor therapy.
  • Chemotherapy with its neurological side effect was associated with enhanced postural sway in only two children with malignant tumors.
  • CONCLUSIONS: The study results indicate that the sparing of the deep cerebellar nuclei had the greatest impact on the recovery of balance function in pediatric patients treated for both a benign or malignant cerebellar tumor.
  • [MeSH-major] Cerebellar Neoplasms / surgery. Postural Balance
  • [MeSH-minor] Adolescent. Cerebellar Nuclei / drug effects. Cerebellar Nuclei / pathology. Cerebellar Nuclei / radiation effects. Cerebellar Nuclei / surgery. Cerebellum / drug effects. Cerebellum / radiation effects. Cerebellum / surgery. Chemotherapy, Adjuvant. Child. Child, Preschool. Combined Modality Therapy. Cranial Irradiation. Female. Follow-Up Studies. Humans. Image Processing, Computer-Assisted. Infant. Magnetic Resonance Imaging. Male. Neurologic Examination / drug effects. Postoperative Complications / diagnosis. Postoperative Complications / pathology. Radiotherapy, Adjuvant

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  • (PMID = 17357037.001).
  • [ISSN] 0174-304X
  • [Journal-full-title] Neuropediatrics
  • [ISO-abbreviation] Neuropediatrics
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
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16. López-Aguilar E, Sepúlveda-Vildósola AC, Rivera-Márquez H, Cerecedo-Díaz F, Hernández-Contreras I, Ramón-García G, Diegopérez-Ramírez J, Santacruz-Castillo E: Preirradiation ifosfamide, carboplatin, and etoposide for the treatment of anaplastic astrocytomas and glioblastoma multiforme: a phase II study. Arch Med Res; 2000 Mar-Apr;31(2):186-90
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  • [Title] Preirradiation ifosfamide, carboplatin, and etoposide for the treatment of anaplastic astrocytomas and glioblastoma multiforme: a phase II study.
  • BACKGROUND: Central nervous system (CNS) tumors are the second most common pediatric tumors.
  • Astrocytomas represent 35% of all CNS tumors in children.
  • Traditional treatment of anaplastic astrocytoma (AA) and glioblastoma multiforme (GM) consisting of surgery-radiotherapy-chemotherapy with nitrosoureas has resulted in a survival rate of 26% at 1 year.
  • Neoadjuvant chemotherapy has proven good results in the treatment of other solid tumors.
  • Chemotherapy with ifosfamide, carboplatin, and etoposide (ICE) permits synergism among the different drugs and sensitizes the tumor to radiotherapy.
  • Our objective was to evaluate the efficacy, security, and survival rate of postoperative chemotherapy with ICE in pediatric patients with AA or GM.
  • We evaluated 11 children with AA or GM who had received no prior treatment.
  • A magnetic resonance image (MRI) study of the tumor was made after surgery to evaluate residual tumor and routine laboratory analysis.
  • Chemotherapy with carboplatin, ifosfamide and etoposide was given every 3 weeks for four courses.
  • Each patient then received hyperfractionated radiotherapy and a final MRI was done at the end of the treatment.
  • Supratentorial and infratentorial tumors had a good response to chemotherapy.
  • Brainstem tumors had an initial response after two courses and then increased in size.
  • AA was the tumor with the greatest reduction of residual tumor after treatment.
  • CONCLUSIONS: Postoperative chemotherapy with ICE reduces the tumor size and increases the survival rate of pediatric patients with malignant astrocytomas with minimal toxicity.
  • Brainstem responded poorly to treatment.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Astrocytoma / drug therapy. Brain Neoplasms / drug therapy. Cranial Irradiation. Glioblastoma / drug therapy. Premedication. Radiotherapy, Adjuvant
  • [MeSH-minor] Adolescent. Carboplatin / administration & dosage. Child. Child, Preschool. Combined Modality Therapy. Disease-Free Survival. Etoposide / administration & dosage. Female. Humans. Ifosfamide / administration & dosage. Life Tables. Male. Mesna / administration & dosage. Prospective Studies. Survival Analysis. Survival Rate. Treatment Outcome

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  • (PMID = 10880725.001).
  • [ISSN] 0188-4409
  • [Journal-full-title] Archives of medical research
  • [ISO-abbreviation] Arch. Med. Res.
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase II; Journal Article
  • [Publication-country] MEXICO
  • [Chemical-registry-number] 6PLQ3CP4P3 / Etoposide; BG3F62OND5 / Carboplatin; NR7O1405Q9 / Mesna; UM20QQM95Y / Ifosfamide; ICE protocol 5
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17. Ciurea AV, Coman T, Tascu A, Ionescu V: Intradural dermoid tumor of the posterior fossa in a child with diastematobulbia. Surg Neurol; 2005 Jun;63(6):571-5; discussion 575
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  • [Title] Intradural dermoid tumor of the posterior fossa in a child with diastematobulbia.
  • Dermoid tumors (DTs) are rare lesions and represent 0.3% of all intracranial tumors.
  • More than 50% of these tumors are diagnosed in childhood or early adolescence.
  • Authors report an intradural DT of the posterior fossa in a child aged 4 years, possibly originating in the brainstem in which the diastematobulbia was detected postoperatively.
  • The only curative treatment in DT is the total removal of the lesion.
  • The surgical intervention is particularly related to the DT type.
  • Diastematobulbia associated with DT and the origin of the DT in the brainstem is discussed based on the literature.
  • [MeSH-major] Brain Stem / abnormalities. Brain Stem / pathology. Brain Stem Neoplasms / complications. Dermoid Cyst / complications. Infratentorial Neoplasms / complications. Nervous System Malformations / complications. Neural Tube Defects / complications
  • [MeSH-minor] Cerebellar Diseases / etiology. Cerebellar Diseases / pathology. Cerebellar Diseases / radiography. Child, Preschool. Cranial Nerve Diseases / etiology. Cranial Nerve Diseases / pathology. Cranial Nerve Diseases / radiography. Headache / etiology. Headache / pathology. Headache / radiography. Humans. Magnetic Resonance Imaging. Male. Meningitis, Aseptic / etiology. Meningitis, Aseptic / pathology. Meningitis, Aseptic / radiography. Neurosurgical Procedures. Predictive Value of Tests. Tomography, X-Ray Computed. Treatment Outcome

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  • (PMID = 15936393.001).
  • [ISSN] 0090-3019
  • [Journal-full-title] Surgical neurology
  • [ISO-abbreviation] Surg Neurol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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18. Kieffer-Renaux V, Viguier D, Raquin MA, Laurent-Vannier A, Habrand JL, Dellatolas G, Kalifa C, Hartmann O, Grill J: Therapeutic schedules influence the pattern of intellectual decline after irradiation of posterior fossa tumors. Pediatr Blood Cancer; 2005 Nov;45(6):814-9
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  • [Title] Therapeutic schedules influence the pattern of intellectual decline after irradiation of posterior fossa tumors.
  • BACKGROUND: To evaluate intellectual decline in children with posterior fossa (PF) tumors treated with different therapeutic protocols.
  • PROCEDURE: Forty children had a complete neuropsychological evaluation prospectively twice, at least 6 months year (y) after the end of their treatment.
  • Patients were classified into four groups according to treatment schedules: Group 1 (n = 7) PF radiotherapy (PFRT) alone at 50 Gy; Group 2 (n = 13) reduced-dose cranio-spinal irradiation (CSI) at 25 Gy with a PF boost; Group 3 (n = 9) standard CSI at 35 Gy and a PF boost; and Group 4 (n = 11) high-dose chemotherapy with stem cell support followed by PFRT at 50 Gy.
  • A FSIQ decline was observed in all treatment groups except Group 1 (P = 0.005).
  • The differences in FSIQ observed initially between the four treatment groups persisted at the second evaluation.
  • CONCLUSIONS: This study shows that FSIQ continues to decline more than 4 years after the diagnosis but this yearly decline seems to decrease with time from diagnosis.
  • Therapeutic schedules influence the magnitude of this decline.
  • [MeSH-major] Cognition Disorders / etiology. Infratentorial Neoplasms / complications. Infratentorial Neoplasms / radiotherapy. Intelligence / radiation effects. Radiotherapy / adverse effects
  • [MeSH-minor] Adolescent. Adult. Appointments and Schedules. Child. Child, Preschool. Combined Modality Therapy. Dose-Response Relationship, Radiation. Female. Follow-Up Studies. Humans. Infant. Intelligence Tests. Male. Time Factors

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  • [Copyright] (c) 2005 Wiley-Liss, Inc.
  • (PMID = 15924360.001).
  • [ISSN] 1545-5009
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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19. Bertolone SJ, Yates AJ, Boyett JM, Wallace D, Finlay JL, Children's Cancer Group: Combined modality therapy for poorly differentiated gliomas of the posterior fossa in children: a Children's Cancer Group report. J Neurooncol; 2003 May;63(1):49-54
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  • [Title] Combined modality therapy for poorly differentiated gliomas of the posterior fossa in children: a Children's Cancer Group report.
  • PURPOSE: To study the effectiveness of combined chemotherapy and radiotherapy for children with high-grade astrocytomas of the posterior fossa.
  • Sixteen children were randomly assigned to one of two chemotherapy regimens, vincristine, lomustine, and prednisone or '8-in-1', using the same involved-field irradiation in both.
  • Six infants received 8-in-1 chemotherapy before involved-field irradiation.
  • RESULTS: Twenty-two patients with an institutional diagnosis high-grade posterior fossa tumors received chemotherapy and/or irradiation.
  • Overall survival for confirmed high-grade astrocytoma of the posterior fossa was approximately 36 +/- 13% at 5 years for the children (n = 11) and 25 +/- 15% at 5 years for the infants (n = 4).
  • CONCLUSIONS: Involved-field irradiation with chemotherapy appeared to prevent extraneural and subarachnoid metastases.
  • We also confirmed the rarity of the tumor (6% of patients registered).
  • Further Phase III trials are necessary to improve survival in this aggressive tumor.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Astrocytoma / drug therapy. Astrocytoma / radiotherapy. Cerebellar Neoplasms / drug therapy. Cerebellar Neoplasms / radiotherapy
  • [MeSH-minor] Adolescent. Cell Differentiation / drug effects. Child. Child, Preschool. Combined Modality Therapy. Disease-Free Survival. Female. Humans. Infant. Lomustine / administration & dosage. Male. Neoplasm Recurrence, Local. Prednisone / administration & dosage. Survival Rate. Treatment Failure. Vincristine / administration & dosage

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  • (PMID = 12814254.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA21765
  • [Publication-type] Clinical Trial; Clinical Trial, Phase III; Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 5J49Q6B70F / Vincristine; 7BRF0Z81KG / Lomustine; VB0R961HZT / Prednisone
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20. Bozić B, Rotim K, Kogler A, Broz R, Krpina H, Cupić H, Radić J: Cerebellar glioblastoma in the elderly--case report. Acta Clin Croat; 2009 Jun;48(2):175-8
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  • Computed tomography scan revealed a posterior fossa tumor of 34 x 33 x 52 mm in size, with hydrocephalus.
  • The patient presented with posterior fossa symptoms, ataxia, nausea and vomiting.
  • When the patient's condition improved, suboccipital median craniectomy was performed and the tumor was removed.
  • Postoperative treatment included radiotherapy and temozolomide chemotherapy.
  • [MeSH-major] Cerebellar Neoplasms. Glioblastoma

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  • (PMID = 19928418.001).
  • [ISSN] 0353-9466
  • [Journal-full-title] Acta clinica Croatica
  • [ISO-abbreviation] Acta Clin Croat
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Croatia
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21. Al-Hussain TO, Dababo MA: Posterior fossa tumor in a 2 year-old girl. Brain Pathol; 2009 Apr;19(2):343-6

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Posterior fossa tumor in a 2 year-old girl.
  • We report a case of a 2 year-old girl who presented with three weeks' history of deterioration of walking, then became unable to walk and later she developed projectile vomiting.
  • Radiological studies showed an enhancing mass in the posterior fossa extending from the cerebellum to the roof of the fourth ventricle.
  • The tumor was diagnosed as an embryonal tumor with abundant neuropil and true rosettes (ETANTR).
  • The tumor cells in the neuroblastic component were diffusely positive for synaptophysin and CD56, with scattered positive cells for glial fibrillary acidic protein.
  • Our patient developed recurrent disease 6 months after resection and chemotherapy.
  • ETANTR is a very rare aggressive embryonal CNS tumor that combines features of neuroblastoma and ependymoblastoma.
  • [MeSH-major] Infratentorial Neoplasms / pathology. Neoplasms, Germ Cell and Embryonal / pathology

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  • (PMID = 19291003.001).
  • [ISSN] 1750-3639
  • [Journal-full-title] Brain pathology (Zurich, Switzerland)
  • [ISO-abbreviation] Brain Pathol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Switzerland
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22. Shankar A, Chacko G, Chacko AG: Intratumoral abscess: an unusual complication of ventriculoperitoneal shunt infection. Childs Nerv Syst; 2004 Mar;20(3):204-6
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • INTRODUCTION: Ventriculoperitoneal shunts were routinely used in the past in children with posterior fossa tumors and hydrocephalus.
  • CASE REPORT: This report highlights a previously unencountered phenomenon of a pyogenic abscess forming within a posterior fossa ependymoma as a result of shunt infection.
  • Only a partial excision of the tumor was possible, as the inflammatory response caused by the abscess had obliterated tissue planes.
  • [MeSH-major] Brain Abscess / diagnosis. Cerebellar Neoplasms / diagnosis. Ependymoma / diagnosis. Gram-Negative Bacterial Infections / diagnosis. Hydrocephalus / surgery. Postoperative Complications / diagnosis. Prosthesis-Related Infections / diagnosis. Skull Base Neoplasms / diagnosis. Ventriculoperitoneal Shunt / adverse effects
  • [MeSH-minor] Amikacin / therapeutic use. Cefotaxime / therapeutic use. Child, Preschool. Combined Modality Therapy. Cranial Fossa, Posterior / pathology. Cranial Fossa, Posterior / surgery. Cranial Irradiation. Drug Therapy, Combination / therapeutic use. Humans. Male. Neoplasm, Residual / diagnosis. Neoplasm, Residual / radiotherapy. Radiotherapy, Adjuvant

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  • (PMID = 14747956.001).
  • [ISSN] 0256-7040
  • [Journal-full-title] Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
  • [ISO-abbreviation] Childs Nerv Syst
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 84319SGC3C / Amikacin; N2GI8B1GK7 / Cefotaxime
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23. Jaing TH, Wang HS, Tsay PK, Tseng CK, Jung SM, Lin KL, Lui TN: Multivariate analysis of clinical prognostic factors in children with intracranial ependymomas. J Neurooncol; 2004 Jul;68(3):255-61

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Our retrospective series included 15 with supratentorial and 28 with infratentorial tumors.
  • Radiotherapy was done in 31 patients and chemotherapy in 13.
  • The median survival time was 30 months, and 5-year overall survival and progression-free survival rates were 53.9% and 45.9%, respectively.
  • By tumor site: supratentorial, 56.6% and 50.9%; infratentorial, 52.3% and 42.5%.
  • Only one of 15 patients with supratentorial tumors developed isolated spinal metastasis.
  • [MeSH-major] Ependymoma / diagnosis. Infratentorial Neoplasms / diagnosis. Neoplasm Recurrence, Local / diagnosis. Supratentorial Neoplasms / diagnosis

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  • (PMID = 15332330.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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24. Chen KS, Hung PC, Wang HS, Jung SM, Ng SH: Medulloblastoma or cerebellar dysplastic gangliocytoma (Lhermitte-Duclos disease)? Pediatr Neurol; 2002 Nov;27(5):404-6
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  • [Title] Medulloblastoma or cerebellar dysplastic gangliocytoma (Lhermitte-Duclos disease)?
  • Dysplastic cerebellar gangliocytoma is a rare benign tumor associated with specific neuroimaging findings of abnormal laminated or folial pattern in the posterior fossa.
  • In patients with a posterior fossa tumor suggestive of a dysplastic gangliocytoma on neuroimaging studies, a pathologic confirmation is necessary.
  • [MeSH-minor] Diagnosis, Differential. Drug Therapy. Gadolinium. Humans. Infant. Magnetic Resonance Imaging. Male. Neoplasm, Residual / surgery. Reoperation. Tomography, X-Ray Computed


25. Massimino M, Giardini R, Cefalo G, Simonetti F, Pollo B, Giombini S, Tesoro-Tess JD, Ponzoni M, Patriarca C: Intravascular lymphomatosis (IL) in a child mimicking a posterior fossa tumor. J Neurooncol; 2001 Jan;51(1):47-50

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Intravascular lymphomatosis (IL) in a child mimicking a posterior fossa tumor.
  • SS, a 13-year-old girl, was admitted to a Neurosurgery Unit because of endocranic hypertension, where, after CT and MRI documenting a IV ventricle 3 cm diameter tumor, she was submitted to complete tumor excision: extemporary diagnosis was suggestive of medulloblastoma.
  • Whole CNS MRI did not give evidence of residual or metastatic disease while CSF cytology showed only pleiocytosis.
  • Treatment was started according to our ongoing protocol for medulloblastoma with pre-radiation chemotherapy.
  • Before delivering radiotherapy (RT), upon review of histologic specimens, the definitive diagnosis of IL B-phenotype was made.
  • The girl was re-admitted and, after a complete re-staging, chemotherapy was intensified according to our schedule for high-grade B-cell lymphoma and CNS was irradiated up to a total dose of 25 Gy.
  • The case here reported is unique for age, tumor presentation, and, so far, favourable outcome, in spite of the delayed histological diagnosis.
  • [MeSH-major] Cerebellar Neoplasms / diagnosis. Lymphoma, B-Cell / diagnosis. Medulloblastoma / diagnosis. Vascular Neoplasms / diagnosis
  • [MeSH-minor] Adolescent. Cranial Fossa, Posterior. Female. Humans. Magnetic Resonance Imaging

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  • (PMID = 11349880.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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26. Hilden JM, Meerbaum S, Burger P, Finlay J, Janss A, Scheithauer BW, Walter AW, Rorke LB, Biegel JA: Central nervous system atypical teratoid/rhabdoid tumor: results of therapy in children enrolled in a registry. J Clin Oncol; 2004 Jul 15;22(14):2877-84
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Central nervous system atypical teratoid/rhabdoid tumor: results of therapy in children enrolled in a registry.
  • PURPOSE: Atypical teratoid/rhabdoid tumor (AT/RT) of the CNS is an extremely rare and aggressive tumor of early childhood.
  • The poor outcome with conventional infant brain tumor therapy has resulted in a lack of clear treatment guidelines.
  • A registry has been established to create an outcomes database and to facilitate biology studies for this tumor.
  • Nine patients (21%) had disseminated disease at diagnosis.
  • Sixteen tumors were infratentorial; 26 were supratentorial.
  • Primary therapy included chemotherapy in all patients, radiotherapy in 13 patients (31%), stem-cell rescue in 13 patients (31%), and intrathecal chemotherapy in 16 patients (38%).
  • Recurrent or progressive disease was reported in nine and 19 patients, respectively.
  • Twenty-seven patients (64%) are dead of disease (3 to 62 months from diagnosis) and one patient died of toxicity.
  • Fourteen patients (33%) show no evidence of disease (9.5 to 96 months from diagnosis).
  • CONCLUSION: Aggressive therapy has prolonged the natural history in a subset of children.
  • [MeSH-major] Central Nervous System Neoplasms / therapy. Registries. Rhabdoid Tumor / therapy. Teratoma / therapy
  • [MeSH-minor] Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Infant. Male. Survival Analysis. Treatment Outcome

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  • (PMID = 15254056.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA 46274
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
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27. Koeller KK, Rushing EJ: From the archives of the AFIP: medulloblastoma: a comprehensive review with radiologic-pathologic correlation. Radiographics; 2003 Nov-Dec;23(6):1613-37
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Medulloblastoma is the most common pediatric central nervous system malignancy and the most common primary tumor of the posterior fossa in children.
  • This highly malignant neoplasm occurs more frequently in males and usually before 10 years of age.
  • Clinical symptoms and signs are generally brief, typically less than 3 months in duration, and reflect the strong predilection of this tumor to arise within the cerebellum, most often in the vermis.
  • Although much less common, the disease may also occur in adults, usually in the 3rd and 4th decades of life.
  • Surgical resection, radiation therapy, and chemotherapy have substantially lowered the mortality associated with this tumor, with 5-year survival rates now commonly well above 50%.
  • Still, both dissemination at the time of diagnosis and recurrence remain obstacles in achieving a cure.
  • The tumor has characteristic hyperattenuation on unenhanced computed tomographic scans that reflects the high nuclear-cytoplasmic ratio seen at histologic analysis.
  • The tumor typically appears heterogeneous on images, findings that are related to cyst formation, hemorrhage, and calcification and that are even more pronounced with magnetic resonance (MR) imaging.
  • Evidence of leptomeningeal metastatic spread is present in 33% of all cases at the time of diagnosis and is well evaluated with contrast-enhanced MR imaging of the brain and the spine.
  • With continued research, treatment of these common neoplasms should improve, perhaps even achieving a cure in the future.
  • [MeSH-major] Cerebellar Neoplasms / radiography. Magnetic Resonance Imaging. Medulloblastoma / radiography. Tomography, X-Ray Computed
  • [MeSH-minor] Adolescent. Adult. Aged. Child. Child, Preschool. Female. Humans. Infant. Male. Meninges / pathology. Middle Aged. Neoplasm Invasiveness. Prognosis. Survival Rate

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  • (PMID = 14615567.001).
  • [ISSN] 1527-1323
  • [Journal-full-title] Radiographics : a review publication of the Radiological Society of North America, Inc
  • [ISO-abbreviation] Radiographics
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 102
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28. Lutz RJ, Warren K, Balis F, Patronas N, Dedrick RL: Mixing during intravertebral arterial infusions in an in vitro model. J Neurooncol; 2002 Jun;58(2):95-106
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  • Regional delivery of drugs can offer a pharmacokinetic advantage in the treatment of localized tumors.
  • One method of regional delivery is by intra-arterial infusion into the basilar/vertebral artery network that provides local access to infratentorial tumors, which are frequent locations of childhood brain cancers.
  • Proper delivery of drug by infused solutions requires adequate mixing of the infusate at the site of infusion within the artery lumen.
  • Our mixing studies with an in vitro model of the vertebral artery network indicate that streaming of drug solution is likely to occur at low, steady infusion rates of 2 ml/min.
  • Streaming leads to maldistribution of drug to distal perfused brain regions and may result in toxic levels in some regions while concurrently yielding subtherapeutic levels in adjacent regions.
  • According to our model findings, distribution to both brain hemispheres is not likely following infusion into a single vertebral artery even if the infusate is well-mixed at the infusion site.
  • Careful thought and planning of the methods of intravertebral drug infusions for treating posterior fossa tumors are required to assure proper distribution of the drug to the desired tissue regions.
  • Improper delivery may be responsible for some noted toxicities or for failure of the treatments.
  • [MeSH-major] Antineoplastic Agents / administration & dosage. Brain Neoplasms / drug therapy. Infusions, Intra-Arterial. Models, Cardiovascular. Vertebral Artery
  • [MeSH-minor] Brain / metabolism. Cranial Fossa, Posterior. Humans

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  • (PMID = 12164691.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents
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29. Robertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, Dias MS, Allen JC, Children's Oncology Group: Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children's Oncology Group. J Neurosurg; 2006 Dec;105(6 Suppl):444-51
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  • OBJECT: Cerebellar mutism syndrome (CMS) is a unique postoperative syndrome typically arising 1 to 2 days after resection of a midline posterior fossa tumor; it consists of diminished speech progressing to mutism, emotional lability, hypotonia, and ataxia.
  • METHODS: The authors incorporated a CMS questionnaire in two large clinical trials (Children's Cancer Group [CCG] 9931, treatment for high-risk medulloblastoma/primitive neuroectodermal tumor; and CCG/Pediatric Oncology Group [POG] A9961, treatment for average-risk medulloblastoma) to prospectively survey for incidence, severity, and possible causes of CMS in children with newly diagnosed medulloblastoma.
  • CONCLUSIONS: Nearly one quarter of patients who underwent resection of a medulloblastoma developed symptoms of CMS, of which 92% were judged to be of moderate or severe intensity.
  • Brainstem invasion by tumor was the only risk factor that correlated positively with CMS occurrence; there was a negative correlation with cerebellar hemisphere tumor location.
  • [MeSH-major] Cerebellar Neoplasms / epidemiology. Cerebellar Neoplasms / surgery. Medulloblastoma / epidemiology. Medulloblastoma / surgery. Mutism / epidemiology. Postoperative Complications / epidemiology
  • [MeSH-minor] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Incidence. Infant. Male. Neuroectodermal Tumors, Primitive / drug therapy. Neuroectodermal Tumors, Primitive / epidemiology. Neuroectodermal Tumors, Primitive / surgery. Prognosis. Prospective Studies. Risk Factors. Severity of Illness Index

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  • [CommentIn] J Neurosurg Pediatr. 2008 Mar;1(3):262 [18352776.001]
  • (PMID = 17184075.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / U10 CA 98543
  • [Publication-type] Clinical Trial, Phase II; Clinical Trial, Phase III; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural
  • [Publication-country] United States
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30. Schmidt MH, Meyer GA, Reichert KW, Cheng J, Krouwer HG, Ozker K, Whelan HT: Evaluation of photodynamic therapy near functional brain tissue in patients with recurrent brain tumors. J Neurooncol; 2004 Mar-Apr;67(1-2):201-7
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  • [Title] Evaluation of photodynamic therapy near functional brain tissue in patients with recurrent brain tumors.
  • INTRODUCTION: Photodynamic therapy (PDT) involves the selective retention of a photosensitizer that upon activation with light mediates tumor cell destruction via the production of singlet oxygen.
  • This study evaluates the toxicity of PDT and a new light-delivery device based on light-emitting diode (LED) technology in selected patients with brain tumors.
  • METHODS: Twenty patients with recurrent malignant brain tumors received 22 treatments with PDT.
  • Sixteen tumors were supratentorial and four tumors were infratentorial.
  • Laser and LED arrays were used to deliver 100 J cm(-2) of light to the sensitized tumors.
  • Quantitative analysis of toxicity and time to progression was performed.
  • RESULTS: Two patients had toxicity consisting of ataxia and facial weakness after treatment with interstitial fibers.
  • BPD did not result in additional toxicity.
  • PDT in the posterior fossa or near eloquent brain was tolerated using the LED or laser-balloon adapter.
  • All patients had tumor responses as documented by MRI scan and the mean time to tumor progression after PDT was 67 weeks.
  • CONCLUSION: PDT with LED balloon adapters (also tunable dye laser) has acceptable toxicity in brain tumor patients.
  • [MeSH-major] Antineoplastic Agents / adverse effects. Brain Neoplasms / drug therapy. Dihematoporphyrin Ether / adverse effects. Photochemotherapy
  • [MeSH-minor] Adolescent. Adult. Child. Humans. Infant. Lasers. Magnetic Resonance Imaging. Middle Aged. Photosensitizing Agents / adverse effects. Tissue Distribution

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  • (PMID = 15072468.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Grant] United States / NCRR NIH HHS / RR / M01 RR00058
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Photosensitizing Agents; 97067-70-4 / Dihematoporphyrin Ether
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31. Yazigi-Rivard L, Masserot C, Lachenaud J, Diebold-Pressac I, Aprahamian A, Avran D, Doz F: [Childhood medulloblastoma]. Arch Pediatr; 2008 Dec;15(12):1794-804
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  • [Transliterated title] Le médulloblastome de l'enfant.
  • Medulloblastoma is one of the most common malignant childhood brain tumors.
  • It is a primitive neuroectodermal tumor (PNET) and predominantly arises in the cerebellum and 4th ventricle.
  • Most often intracranial hypertension reveals the disease typically with headache and vomiting.
  • However, the frequent atypical presentation should not delay neuroradiological investigations.
  • Brain and spinal MRI can establish the diagnosis of posterior fossa tumor and define the extent of the disease.
  • Histologic examination of the tumor confirms the diagnosis of medulloblastoma.
  • Patients are classified into 2 risk groups: standard-risk medulloblastoma, defined by nonmetastatic disease treated by total or subtotal tumor resection; and high-risk patients who have disseminated disease and/or residual disease.
  • Tumor molecular genetic findings allow the use of emerging prognostic factors and may ultimately contribute to the development of targeted therapy.
  • Current treatment in the oldest children combines surgical resection followed by radiotherapy and chemotherapy.
  • Treatment in younger patients is as much as possible restricted to surgery and chemotherapy.
  • However, long-term sequelae after treatment for medulloblastoma remain frequent and the detection and treatment of those sequelae is an essential part of the follow-up of the patients.
  • [MeSH-major] Cerebellar Neoplasms. Medulloblastoma
  • [MeSH-minor] Age Factors. Child. Child, Preschool. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Magnetic Resonance Imaging. Male. Meta-Analysis as Topic. Neoplasm Metastasis. Neoplasms, Second Primary / etiology. Prognosis. Prospective Studies. Radiotherapy / adverse effects. Radiotherapy Dosage. Randomized Controlled Trials as Topic. Risk Factors. Treatment Outcome

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  • (PMID = 18995998.001).
  • [ISSN] 0929-693X
  • [Journal-full-title] Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
  • [ISO-abbreviation] Arch Pediatr
  • [Language] fre
  • [Publication-type] Comparative Study; English Abstract; Journal Article; Review
  • [Publication-country] France
  • [Number-of-references] 52
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32. Wolfe-Christensen C, Mullins LL, Scott JG, McNall-Knapp RY: Persistent psychosocial problems in children who develop posterior fossa syndrome after medulloblastoma resection. Pediatr Blood Cancer; 2007 Oct 15;49(5):723-6
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  • [Title] Persistent psychosocial problems in children who develop posterior fossa syndrome after medulloblastoma resection.
  • PURPOSE: Posterior fossa syndrome (PFS) occurs in approximately 20% of patients after resection of a tumor from the posterior fossa.
  • We assessed whether the development of PFS is associated with increased risk for emotional, behavioral, and social problems after the cessation of cancer treatment.
  • All participants were survivors of childhood medulloblastoma and had been treated with surgical resection of the tumor, craniospinal radiation, +/- chemotherapy, and had comprehensive neuropsychological evaluations 1-2 years post-treatment.
  • RESULTS: Children who developed PFS were significantly more likely to exhibit obsessive-compulsive type (i.e., perfectionistic) behaviors, withdrawal behaviors, social problems, and internalizing problems (all P < 0.05) than those who did not develop PFS.
  • Additionally, children with PFS were more likely to evidence anxious-shy behaviors, attention problems, and somatic complaints, although these differences were not statistically significant.
  • CONCLUSION: Results from the current preliminary study suggest that PFS may place children at increased risk for emotional, behavioral, and social problems long after completion of their cancer treatment.
  • [MeSH-major] Brain Neoplasms / complications. Child Behavior Disorders / etiology. Medulloblastoma / surgery
  • [MeSH-minor] Adolescent. Child. Combined Modality Therapy. Data Collection. Humans. Postoperative Complications / psychology. Retrospective Studies. Survivors

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  • [Copyright] (c) 2007 Wiley-Liss, Inc.
  • (PMID = 17066468.001).
  • [ISSN] 1545-5009
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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33. Berger A, Sadeh M, Tzur G, Shuper IA, Kornreich L, Inbar D, Cohen IJ, Michowiz S, Yaniv I, Constantini S, Vakil E: Motor and non-motor sequence learning in children and adolescents with cerebellar damage. J Int Neuropsychol Soc; 2005 Jul;11(4):482-7
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  • Cerebellar involvement in motor and non-motor sequence learning was examined with serial reaction time tasks (SRT).
  • Our sample consisted of 8 children and adolescents who had undergone surgical removal of a benign posterior fossa tumor (PFT) during childhood.
  • None of them had undergone chemotherapy or cranial radiation therapy (CRT).
  • The children were tested not earlier than 2.5 years after surgery (M = 5.9 years), enabling brain plasticity and recovery of functions.
  • The PFT group was not impaired in the implicit learning of sequences, as reflected in their performance in blocks with a repeated sequence, both before and after a random block.
  • [MeSH-major] Cerebellar Diseases / physiopathology. Psychomotor Performance / physiology. Reaction Time / physiology. Serial Learning / physiology
  • [MeSH-minor] Adolescent. Analysis of Variance. Child. Female. Functional Laterality / physiology. Humans. Magnetic Resonance Imaging / methods. Male. Neuropsychological Tests. Practice (Psychology). Recovery of Function. Time Factors

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  • (PMID = 16209429.001).
  • [ISSN] 1355-6177
  • [Journal-full-title] Journal of the International Neuropsychological Society : JINS
  • [ISO-abbreviation] J Int Neuropsychol Soc
  • [Language] eng
  • [Publication-type] Clinical Trial; Comparative Study; Journal Article
  • [Publication-country] England
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34. Palmér L, Nordborg C, Steneryd K, Aman P, Kyllerman M: Large-cell medulloblastoma in Aicardi syndrome. Case report and literature review. Neuropediatrics; 2004 Oct;35(5):307-11
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  • An eight-year-old girl with Aicardi syndrome (AIC) developed signs of increased intracranial pressure.
  • A clinical and radiological investigation revealed a tumor in the posterior fossa, which was resected.
  • Eight months later, she died of a local recurrence, despite treatment with chemotherapy and radiotherapy according to a PNET protocol.
  • In addition to the growth of a large-cell medulloblastoma at the location of the primary tumor and the meningeal spread of the tumor, the autopsy revealed major cortical and subcortical malformations of the brain.
  • Various benign (e.g., plexus papillomas) and malignant tumors (angiosarcoma, embryonic carcinoma, and hepatoblastoma) have been reported in connection with Aicardi syndrome.
  • A genetic analysis of AIC suggests that the mutation is localized on the distal part of the short arm of the X chromosome, an area that may be of importance for tumor development.
  • This is the first report of a primary malignant brain tumor -- large-cell medulloblastoma -- in a patient with Aicardi syndrome.
  • [MeSH-major] Agenesis of Corpus Callosum. Cerebellar Neoplasms / etiology. Choroid Diseases / complications. Medulloblastoma / etiology. Retinal Diseases / complications. Spasm / complications


35. Germanwala AV, Mai JC, Tomycz ND, Niranjan A, Flickinger JC, Kondziolka D, Lunsford LD: Boost Gamma Knife surgery during multimodality management of adult medulloblastoma. J Neurosurg; 2008 Feb;108(2):204-9
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  • METHODS: The authors performed a retrospective analysis of 12 adult patients with histologically proven medulloblastoma or supratentorial primitive neuroectodermal tumor who between February 1991 and December 2004 underwent >or=1 sessions of GKS for posttreatment residual or recurrent tumors (6 tumors in each group).
  • Nine patients also received systemic chemotherapy.
  • Stereotactic radiosurgery was applied to residual and recurrent posterior fossa tumor as well as to foci of intracranial medulloblastoma metastases.
  • The median time interval from initial diagnosis and resection to the first GKS treatment was 24 months (range 2-37 months).
  • The mean GKS-treated tumor volume was 9.4 cm3 (range 0.5-39 cm3).
  • RESULTS: Following adjunctive radiosurgery, 5 patients had no evidence of tumor on magnetic resonance (MR) imaging, 3 patients had stable tumor burden on MR imaging, and 4 patients had evidence of tumor progression locally with or without intracranial metastases.
  • All patients with tumor progression died.
  • The majority of patients who achieved tumor eradication (80%) and tumor stabilization (67%) after GKS had residual tumor as the reason for their referral for GKS.
  • The best outcomes were attained in patients with residual disease who were younger, had smaller tumor volumes, had no evidence of metastatic disease, and had received higher cumulative GKS doses.
  • CONCLUSIONS: Single or multiple GKS sessions were a well-tolerated, feasible, and effective adjunctive treatment for posterior fossa residual or recurrent medulloblastoma as well as intracranial metastatic medulloblastoma in adult patients.
  • [MeSH-major] Cerebellar Neoplasms / surgery. Medulloblastoma / surgery. Neoadjuvant Therapy. Radiosurgery / methods
  • [MeSH-minor] Adult. Age Factors. Chemotherapy, Adjuvant. Cranial Irradiation. Disease Progression. Female. Follow-Up Studies. Humans. Magnetic Resonance Imaging. Male. Middle Aged. Neoplasm Recurrence, Local / radiotherapy. Neoplasm Recurrence, Local / surgery. Neoplasm, Residual. Neuroectodermal Tumors / radiotherapy. Neuroectodermal Tumors / surgery. Remission Induction. Retrospective Studies. Spine / radiation effects. Supratentorial Neoplasms / radiotherapy. Supratentorial Neoplasms / surgery. Survival Rate. Time Factors. Treatment Outcome

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  • (PMID = 18240913.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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36. Odame I, Duckworth J, Talsma D, Beaumont L, Furlong W, Webber C, Barr R: Osteopenia, physical activity and health-related quality of life in survivors of brain tumors treated in childhood. Pediatr Blood Cancer; 2006 Mar;46(3):357-62
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  • [Title] Osteopenia, physical activity and health-related quality of life in survivors of brain tumors treated in childhood.
  • BACKGROUND: Osteopenia has been reported in children surviving acute lymphoblastic leukemia and brain tumors, apparently as a consequence of therapy.
  • In order to explore that possibility, we examined survivors of brain tumors treated with and without radiation in childhood to investigate associations between radiation, osteopenia, physical activity, health status and overall health-related quality of life (HRQL).
  • PROCEDURE: Subjects were survivors of posterior fossa tumors (astrocytoma or medulloblastoma) or optic glioma, < 18 years of age at diagnosis and > 1 year off treatment.
  • Of the 25 patients, 12 (48%) received radiation therapy (R group) while 13 received no radiation (NR group).
  • Growth hormone (GH) deficiency had been detected in three subjects, one had completed GH therapy while two were still on hormone replacement.
  • CONCLUSIONS: This pilot study demonstrates that in survivors of brain tumors treated in childhood, radiation therapy is associated with significant loss of bone mineral.
  • [MeSH-major] Bone Diseases, Metabolic / drug therapy. Brain Neoplasms. Growth Hormone / therapeutic use. Hormone Replacement Therapy. Motor Activity. Quality of Life

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  • (PMID = 16035080.001).
  • [ISSN] 1545-5009
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 9002-72-6 / Growth Hormone
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37. Krishnamoorthy P, Freeman C, Bernstein ML, Lawrence S, Rodd C: Osteopenia in children who have undergone posterior fossa or craniospinal irradiation for brain tumors. Arch Pediatr Adolesc Med; 2004 May;158(5):491-6
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  • [Title] Osteopenia in children who have undergone posterior fossa or craniospinal irradiation for brain tumors.
  • OBJECTIVES: To determine lumbar spine and total body bone mineral density (BMD) in pediatric patients who have undergone cranial or craniospinal irradiation for posterior fossa tumors, specifically medulloblastoma and ependymoma and to analyze the association between degree of osteopenia and factors that may affect BMD.
  • All 19 underwent craniospinal radiotherapy plus a boost to the posterior fossa (mean +/- SD of 5410 +/- 130 rad [54.1 +/- 1.3 Gy] to the posterior fossa, mean +/- SD of 3470 +/- 460 rad [34.7 +/- 4.6 Gy] to the whole brain and spinal axis), and 8 of 19 underwent chemotherapy.
  • The remaining 5 patients had ependymoma and underwent irradiation to the posterior fossa only (mean +/- SD of 5680 +/- 720 rad [56.8 +/- 7.2 Gy]).
  • Therefore, there were 3 treatment groups: craniospinal irradiation and chemotherapy, only craniospinal irradiation, and only posterior fossa irradiation.
  • Bone mineral studies were performed a mean +/- SD of 5.42 +/- 3.23 years after therapy.
  • CONCLUSIONS: Children who have undergone irradiation for posterior fossa tumors have diminished total body and lumbar spine BMD, as compared with those of the general population.
  • This reduction was similar within all 3 treatment groups, which suggests that chemotherapy did not play a major role and that localized irradiation may have systemic effects.
  • [MeSH-major] Bone Density / radiation effects. Bone Diseases, Metabolic / etiology. Ependymoma / radiotherapy. Infratentorial Neoplasms / radiotherapy. Medulloblastoma / radiotherapy

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  • (PMID = 15123484.001).
  • [ISSN] 1072-4710
  • [Journal-full-title] Archives of pediatrics & adolescent medicine
  • [ISO-abbreviation] Arch Pediatr Adolesc Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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38. Sandberg DI, Solano J, Petito CK, Mian A, Mou C, Koru-Sengul T, Gonzalez-Brito M, Padgett KR, Luqman A, Buitrago JC, Alam F, Wilkerson JR, Crandall KM, Kuluz JW: Safety and pharmacokinetic analysis of methotrexate administered directly into the fourth ventricle in a piglet model. J Neurooncol; 2010 Dec;100(3):397-406
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  • We have developed a piglet model to assess chemotherapy administration directly into the fourth ventricle as a potential treatment for medulloblastoma and other malignant posterior fossa tumors.
  • Safety was assessed by neurological examination, 4.7 T MRI, and post-mortem pathological analysis.
  • MTX levels in serum and cerebrospinal fluid (CSF) were measured, and area under the concentration-time curve (AUC) was calculated for CSF samples.
  • Statistically significant differences between fourth ventricle and lumbar AUC were detected at peaks (P = 0.01) and at all collection time points (P = 0.01) but not at troughs (P = 0.36).
  • [MeSH-major] Enzyme Inhibitors / administration & dosage. Enzyme Inhibitors / pharmacokinetics. Fourth Ventricle / drug effects. Methotrexate / administration & dosage. Methotrexate / pharmacokinetics
  • [MeSH-minor] Animals. Area Under Curve. Cell Count / methods. Magnetic Resonance Imaging / methods. Models, Animal. Swine. Time Factors

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  • (PMID = 20440538.001).
  • [ISSN] 1573-7373
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Enzyme Inhibitors; YL5FZ2Y5U1 / Methotrexate
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39. McLean TW: Medulloblastomas and central nervous system primitive neuroectodermal tumors. Curr Treat Options Oncol; 2003 Dec;4(6):499-508
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  • [Title] Medulloblastomas and central nervous system primitive neuroectodermal tumors.
  • Significant advances in the treatment of medulloblastoma and primitive neuroectodermal tumors have been made in the past three decades.
  • Maximal surgical resection is a mainstay of therapy.
  • However, unlike many other central nervous system neoplasms, medulloblastoma and primitive neuroectodermal tumors are radiation and chemotherapy responsive.
  • Despite this response, the prognosis for patients with these tumors remains variable and is relatively poor in infants and patients with metastatic disease.
  • These tumors most commonly arise in children, thus most clinical trials emphasize the reduction of long-term sequelae, in addition to improving survival.
  • If a patient is ineligible or declines consent/assent for a clinical trial, the best current treatment approach is surgical resection, followed by radiation therapy (except for children younger than 3 years) with weekly vincristine.
  • For high-risk patients, 36 Gy of craniospinal irradiation should be delivered plus a boost of 19.8 Gy to the posterior fossa/primary tumor bed and sites of bulk metastatic disease.
  • For average-risk patients, the craniospinal irradiation dose may be lowered to 23.4 Gy plus 32.4 Gy to the posterior fossa/tumor bed.
  • After radiation therapy, intensive multimodal chemotherapy should be used for all patients.
  • [MeSH-major] Central Nervous System Neoplasms / therapy. Cerebellar Neoplasms / therapy. Medulloblastoma / therapy. Neuroectodermal Tumors, Primitive / therapy
  • [MeSH-minor] Antineoplastic Agents / administration & dosage. Antineoplastic Agents / therapeutic use. Cisplatin / administration & dosage. Cisplatin / therapeutic use. Cyclophosphamide / administration & dosage. Cyclophosphamide / therapeutic use. Emergency Medical Services. Etoposide / administration & dosage. Etoposide / therapeutic use. Humans. Life Style. Lomustine / administration & dosage. Lomustine / therapeutic use. Neurosurgical Procedures. Radiotherapy. Self-Help Groups. Social Support. Spinal Puncture. Vincristine / administration & dosage. Vincristine / therapeutic use

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  • Hazardous Substances Data Bank. ETOPOSIDE .
  • Hazardous Substances Data Bank. CYCLOPHOSPHAMIDE .
  • Hazardous Substances Data Bank. VINCRISTINE .
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  • (PMID = 14585230.001).
  • [ISSN] 1527-2729
  • [Journal-full-title] Current treatment options in oncology
  • [ISO-abbreviation] Curr Treat Options Oncol
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 7BRF0Z81KG / Lomustine; 8N3DW7272P / Cyclophosphamide; Q20Q21Q62J / Cisplatin
  • [Number-of-references] 38
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40. Pascual Castroviejo I, Pascual Pascual S, Velázquez Fragua R, Viaño J, Garcia Segura JM: [Brain stem tumors associated with neurofibromatosis type 1. Presentation of 20 infantile patients]. Neurologia; 2007 Dec;22(10):846-52
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  • [Title] [Brain stem tumors associated with neurofibromatosis type 1. Presentation of 20 infantile patients].
  • [Transliterated title] Tumores de tronco cerebral asociados con neurofibromatosis tipo 1. Presentación de 20 pacientes infantiles.
  • OBJECTIVE: To describe the clinical and imaging findings of 20 patients (12 women and 8 men) with brain stem tumors associated with neurofibromatosis type 1 (NF1).
  • PATIENTS AND METHODS: All patients were first time studied before 11 years old.
  • Thirteen of the 20 patients (65 %) also had optic pathway tumor.
  • Brain stem tumor identification occurred at the same time as NF1 in the patients who were studied by MR at the time of the first consult.
  • RESULTS: Brain stem identification occurred at the same time as that of the NF1 in patients who were studied by MR from the beginning.
  • Diffuse or localized medullary enlargement was the most frequent MR imaging and appeared in 13 patients (65%), followed by the tumor that involved all brain stem (pontine and medullary areas) that appeared in 6 patients (30 %).
  • In the last group, one tumor showed extension through brain stem and medial cerebellar parts, another was located in the aqueduct and in the periaqueductal areas and showed slow progressive growth, and one third patient had a tumor with aggressive signs in the SMR study.
  • Another patient had an aggressive tumor that involved the left optic nerve, chiasm, mesencephalon and upper right pontine areas.
  • The histological study of the tumoral biopsic tissue of the two last patients showed astrocitoma degree 1 (benign tumor).
  • The two aggressive tumors were treated with radiotheraphy and chemotherapy and they are still alive 4 and 7 years respectively after treatment.
  • The rest of patients did not receive treatment.
  • Only one of the 20 patients died, although it was due to a malignant chiasmatic tumor, that had been treated twenty years before, and not by the brain stem tumor.
  • CONCLUSIONS: In NF1, brain stem tumors are the most frequent tumors of the posterior fossa and the second most frequent of the central nervous system (CNS).
  • MR and SMR are necessary to a correct identification of the tumor in some patients.
  • Most of these tumors are benign.
  • [MeSH-major] Brain Neoplasms / complications. Brain Neoplasms / diagnosis. Brain Stem. Magnetic Resonance Imaging. Magnetic Resonance Spectroscopy. Neurofibromatosis 1 / complications


41. Karami KJ, Poulik J, Rabah R, Krass J, Sood S: Simultaneous choroid plexus carcinoma and pilocytic astrocytoma in a pediatric patient. J Neurosurg Pediatr; 2010 Jan;5(1):104-12
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  • Simultaneous primary brain tumors in pediatric patients without prior chemotherapy or radiotherapy, phacomatosis, or known familial history are a rare occurrence.
  • Magnetic resonance imaging studies revealed diffuse heterogeneously enhancing left intraventricular and posterior fossa tumors initially believed most consistent with multicentric choroid plexus carcinomas.
  • A multiple staged resection was carried out for each tumor and gross-total resection was achieved.
  • Upon gross inspection intraoperatively as well as postoperative histological analysis, 2 distinct simultaneous tumors were identified: choroid plexus carcinoma and pilocytic astrocytoma.
  • To the authors' knowledge this is the first case report published identifying 2 distinct tumor types with similar radiological appearances in a pediatric patient with no prior history of radiotherapy, chemotherapy, or phacomatosis.
  • [MeSH-major] Astrocytoma / diagnosis. Astrocytoma / surgery. Cerebral Ventricle Neoplasms / diagnosis. Cerebral Ventricle Neoplasms / surgery. Choroid Plexus Neoplasms / diagnosis. Choroid Plexus Neoplasms / surgery. Fourth Ventricle / surgery. Lateral Ventricles / surgery. Magnetic Resonance Imaging. Neoplasms, Multiple Primary / diagnosis. Neoplasms, Multiple Primary / surgery. Neuronavigation. Thalamus / surgery. Tomography, X-Ray Computed


42. Zacharoulis S, Ji L, Pollack IF, Duffner P, Geyer R, Grill J, Schild S, Jaing TH, Massimino M, Finlay J, Sposto R: Metastatic ependymoma: a multi-institutional retrospective analysis of prognostic factors. Pediatr Blood Cancer; 2008 Feb;50(2):231-5
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  • PROCEDURE: Data regarding diagnosis, treatment and follow-up for 40 patients from eight institutional cohorts were collected.
  • RESULTS: Twenty-nine (72%) patients were less than 36 months of age at the time of diagnosis, 28% were females, and 90% of the patients had posterior fossa tumors.
  • Gross total resection (GTR) of the primary tumor was achieved in 16 patients (40%).
  • Adjuvant therapy was variable and included craniospinal irradiation (CSRT), chemotherapy, and chemotherapy with focal irradiation.
  • The 5-year event free survival (EFS) and overall survival (OS) from the time of diagnosis were 29% (+/-7%) and 43% (+/-8%), respectively.
  • Patients with GTR achieved a 5-year EFS of 35% and OS of 59%, compared to a 5-year EFS of 25% and OS of 32% for patients who did not achieve GTR (P = 0.12 for EFS, P = 0.03 for OS).
  • [MeSH-major] Brain Neoplasms / pathology. Ependymoma / pathology. Ependymoma / secondary
  • [MeSH-minor] Child. Child, Preschool. Disease-Free Survival. Female. Humans. Infant. Infant, Newborn. Kaplan-Meier Estimate. Male. Neoplasm Metastasis. Proportional Hazards Models. Retrospective Studies

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  • [Copyright] (c) 2007 Wiley-Liss, Inc.
  • (PMID = 17610266.001).
  • [ISSN] 1545-5017
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study
  • [Publication-country] United States
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43. Khan RB, Onar A: Seizure recurrence and risk factors after antiepilepsy drug withdrawal in children with brain tumors. Epilepsia; 2006 Feb;47(2):375-9
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  • [Title] Seizure recurrence and risk factors after antiepilepsy drug withdrawal in children with brain tumors.
  • PURPOSE: To study seizure outcome after antiepilepsy drug (AED) withdrawal in brain tumor patients and to analyze risk factors for seizure recurrence.
  • METHODS: Brain tumor patients with seizures and at least one attempt at AED discontinuation were identified from the hospital database and neurology clinic records.
  • RESULTS: Sixty-two patients discontinued AEDs at a median time of 5.6 years from the first seizure (range, 1.2-19.6 years).
  • Median time since AED withdrawal was 2.3 years (range, 0.4-15.1 years).
  • Seizures recurred in 17 (27%) patients within a median time of 0.8 years (range, 0.06-7.7 years).
  • More than one tumor resection and whole-brain radiation treatment (WBRT) were associated with seizure recurrence, whereas posterior fossa tumor location was correlated with reduced seizure recurrence risk.
  • At seizure recurrence, control was easily reestablished in 10 patients with AED reinstitution and after dose adjustment in five; two patients with poor drug compliance continue to have seizures.
  • In 48 patients who had an EEG before AED withdrawal, spikes or slow waves did not correlate with seizure recurrence.
  • WBRT and multiple tumor resections seem to be associated with an increased hazard for seizure recurrence.
  • [MeSH-major] Anticonvulsants / adverse effects. Brain Neoplasms / complications. Epilepsy / drug therapy. Epilepsy / etiology. Substance Withdrawal Syndrome / etiology
  • [MeSH-minor] Adolescent. Brain Mapping. Child. Child, Preschool. Electroencephalography. Humans. Infratentorial Neoplasms / complications. Infratentorial Neoplasms / radiotherapy. Infratentorial Neoplasms / surgery. Proportional Hazards Models. Recurrence. Risk Factors. Time Factors. Treatment Outcome. Treatment Refusal

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  • (PMID = 16499763.001).
  • [ISSN] 0013-9580
  • [Journal-full-title] Epilepsia
  • [ISO-abbreviation] Epilepsia
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Anticonvulsants
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