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1. Levin VA, Lamborn K, Wara W, Davis R, Edwards M, Rabbitt J, Malec M, Prados MD: Phase II study of 6-thioguanine, procarbazine, dibromodulcitol, lomustine, and vincristine chemotherapy with radiotherapy for treating malignant glioma in children. Neuro Oncol; 2000 01;2(1):22-8
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  • [Title] Phase II study of 6-thioguanine, procarbazine, dibromodulcitol, lomustine, and vincristine chemotherapy with radiotherapy for treating malignant glioma in children.
  • We conducted a single-arm phase II study to evaluate the efficacy and safety of radiotherapy combined with 6-thioguanine, procarbazine, dibromodulcitol, lomustine, and vincristine (TPDCV) chemotherapy for treating malignant astrocytoma in children and anaplastic ependymoma in patients of all ages.
  • Between 1984 and 1992, 42 patients who had malignant astrocytomas (glioblastomas multiforme, anaplastic astrocytomas, or mixed anaplastic oligoastrocytomas) were treated with TPDCV chemotherapy and radiation therapy.
  • Cranial radiation averaged 58 Gy.
  • TPDCV chemotherapy was given for 1 year or until progression.
  • Between 1989 and 1991, 17 patients with malignant ependymoma were treated with TPDCV chemotherapy and craniospinal radiation.
  • Radiation was given at an average dose of 54 Gy to the tumor, 28 Gy to the whole brain, and 31 Gy to the spinal axis.
  • TPDCV chemotherapy was given for 1 year or until tumor progressed.
  • Of the patients with glioblastoma multiforme, 13 of 17 died; the median time to progression was 49 weeks, and median survival was 85 weeks.
  • Of the patients with nonglioblastoma malignant astrocytoma, 14 of 25 died; the median time to progression was 224 weeks.
  • For the patients with ependymoma, 11 of 17 died with a median time to progression of 141 weeks.
  • The median follow-up for the eight who survive was 469 weeks.
  • Nine patients died with a median survival of 183 weeks.
  • The combination of TPDCV and radiotherapy has activity against childhood anaplastic astrocytoma, glioblastoma multiforme, and anaplastic ependymoma.
  • The results of this study for children with glioblastoma were comparable to results in the literature, while the results for children with anaplastic astrocytoma appeared better than most reports.
  • The combination of TPDCV chemotherapy and radiation therapy for anaplastic ependymomas appears to be active and at least as good as published reports using radiation therapy alone.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / drug therapy. Brain Neoplasms / radiotherapy. Glioma / drug therapy. Glioma / radiotherapy. Lomustine / therapeutic use. Mitolactol / therapeutic use. Procarbazine / therapeutic use. Thioguanine / therapeutic use. Vincristine / therapeutic use
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Male. Survival Analysis. Treatment Outcome

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  • (PMID = 11302250.001).
  • [ISSN] 1522-8517
  • [Journal-full-title] Neuro-oncology
  • [ISO-abbreviation] Neuro-oncology
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA13525
  • [Publication-type] Clinical Trial; Clinical Trial, Phase II; Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] England
  • [Chemical-registry-number] 35S93Y190K / Procarbazine; 5J49Q6B70F / Vincristine; 7BRF0Z81KG / Lomustine; FTK8U1GZNX / Thioguanine; LJ2P1SIK8Y / Mitolactol; TPDCV protocol
  • [Other-IDs] NLM/ PMC1920700
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2. Kumar P, Rastogi N, Jain M, Chhabra P: Extraneural metastases in anaplastic ependymoma. J Cancer Res Ther; 2007 Apr-Jun;3(2):102-4
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  • [Title] Extraneural metastases in anaplastic ependymoma.
  • Ependymoma are rare glial neoplasm, it rarely metastasize outside the central nervous system.
  • We present a case of anaplastic ependymoma with extraneural metastases with review of literature.
  • A ten-year-old male child presented with anaplastic ependymoma of choroid plexus and treated with craniospinal radiotherapy in 1998.
  • He was given adjuvant chemotherapy in form of PCV.
  • At 10 months after completion of chemotherapy, he developed extracranial scalp metastasis and so was treated with palliative local radiation therapy to the scalp metastasis and systemic chemotherapy with oral Etoposide.
  • After five cycles of chemotherapy, the patient had progression of disease in form of scalp and cervical lymph node metastasis confirmed by fine needle aspiration cytology, biopsy and immunohistochemistry.
  • He was given salvage chemotherapy (carboplatin + ifosfamide + etoposide) at 3-weekly.
  • He had partial response and was still on chemotherapy till May 2007.
  • [MeSH-major] Choroid Plexus Neoplasms / pathology. Ependymoma / secondary. Scalp / pathology. Skin Neoplasms / secondary

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  • (PMID = 17998733.001).
  • [ISSN] 1998-4138
  • [Journal-full-title] Journal of cancer research and therapeutics
  • [ISO-abbreviation] J Cancer Res Ther
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] India
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3. Oshiro S, Tsugu H, Komatsu F, Ohmura T, Ohta M, Sakamoto S, Fukushima T, Inoue T: Efficacy of temozolomide treatment in patients with high-grade glioma. Anticancer Res; 2009 Mar;29(3):911-7
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  • [Title] Efficacy of temozolomide treatment in patients with high-grade glioma.
  • BACKGROUND: Numerous studies have reported the clinical efficacy of temozolomide (TMZ) treatment for high-grade glioma, but information on Japanese populations has been limited.
  • This study assessed the safety and early outcomes of TMZ treatment, with or without combination therapy.
  • PATIENTS AND METHODS: The subjects comprised ten patients with high-grade glioma [glioblastoma multiforme (GBM), n=3, gliosarcoma (GS), n=1, anaplastic oligodendroglioma (AO), n=3, anaplastic mixed oligoastrocytoma (AOA), n=1, and anaplastic ependymoma (AE), n=2].
  • All the patients were initially treated with conventional radiotherapy following surgical resection with or without adjuvant chemotherapy.
  • As second- or third-line chemotherapy, patients received TMZ for recurrence or tumor progression.
  • As combination therapy, the local administration of tumor necrosis factor-alpha and the addition of carboplatin and etoposide were included for three patients during the course of oral TMZ treatment.
  • RESULTS: Partial response (PR) to TMZ therapy was achieved by four out of the ten patients (objective response rate, 40%), while three patients displayed stable disease (SD) and three showed disease progression (PD).
  • One of the patients receiving combination therapy has continued to show shrinkage of the relapsed tumor.
  • Despite prior radio- and chemotherapy, most patients experienced only grade 1-2 hematotoxicity that was well-controlled by conservative therapy.
  • CONCLUSION: TMZ chemotherapy is effective for the treatment of high-grade glioma in some patients without serious toxicity.
  • Assessing the true efficacy of TMZ will require a larger study with comparison of long-term outcomes between other agents or combined therapeutic modalities.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / drug therapy. Glioblastoma / drug therapy. Gliosarcoma / drug therapy. Oligodendroglioma / drug therapy
  • [MeSH-minor] Adult. Aged. Carboplatin / administration & dosage. Chemotherapy, Adjuvant. Combined Modality Therapy. Dacarbazine / administration & dosage. Dacarbazine / analogs & derivatives. Etoposide / administration & dosage. Female. Humans. Magnetic Resonance Imaging. Male. Middle Aged. Prognosis. Treatment Outcome. Tumor Necrosis Factor-alpha / therapeutic use

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  • (PMID = 19414327.001).
  • [ISSN] 0250-7005
  • [Journal-full-title] Anticancer research
  • [ISO-abbreviation] Anticancer Res.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Tumor Necrosis Factor-alpha; 6PLQ3CP4P3 / Etoposide; 7GR28W0FJI / Dacarbazine; 85622-93-1 / temozolomide; BG3F62OND5 / Carboplatin
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4. Green RM, Cloughesy TF, Stupp R, DeAngelis LM, Woyshner EA, Ney DE, Lassman AB: Bevacizumab for recurrent ependymoma. Neurology; 2009 Nov 17;73(20):1677-80
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  • [Title] Bevacizumab for recurrent ependymoma.
  • BACKGROUND: Ependymoma is a rare type of glioma, representing 5% of all CNS malignancies.
  • Radiotherapy (RT) is commonly administered, but there is no standard chemotherapy.
  • At recurrence, ependymoma is notoriously refractory to therapy and the prognosis is poor.
  • METHODS: In this Institutional Review Board-approved study, we retrospectively analyzed the records of 8 adult patients treated for recurrent ependymoma and anaplastic ependymoma with bevacizumab containing chemotherapy regimens.
  • We determined radiographic response (Macdonald criteria), median time to progression (TTP), and median overall survival (OS; Kaplan-Meier method).
  • RESULTS: There were 4 men and 4 women with a median age of 40 years (range, 20-65).
  • Prior treatment included surgery (n = 8), RT (8), temozolomide (5), and carboplatin (4).
  • Bevacizumab (5-15 mg/kg every 2-3 weeks) was administered alone (2) or concurrently with cytotoxic chemotherapy including irinotecan (3), carboplatin (2), or temozolomide (1).
  • Median TTP was 6.4 months (95% confidence interval 1.4-7.4) and median OS was 9.4 months (95% confidence interval 7.0-not reached), with a median follow-up of 5.2 months among 5 surviving patients (63%).

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  • (PMID = 19917990.001).
  • [ISSN] 1526-632X
  • [Journal-full-title] Neurology
  • [ISO-abbreviation] Neurology
  • [Language] ENG
  • [Grant] United States / NCI NIH HHS / CA / UO1 CA-105663-01
  • [Publication-type] Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Angiogenesis Inhibitors; 0 / Antibodies, Monoclonal; 0 / Antibodies, Monoclonal, Humanized; 2S9ZZM9Q9V / Bevacizumab
  • [Other-IDs] NLM/ PMC2788805
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5. Merchant TE, Li C, Xiong X, Kun LE, Boop FA, Sanford RA: Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study. Lancet Oncol; 2009 Mar;10(3):258-66
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  • [Title] Conformal radiotherapy after surgery for paediatric ependymoma: a prospective study.
  • BACKGROUND: Therapy for ependymoma includes aggressive surgical intervention and radiotherapy administered by use of methods that keep the risk of side-effects to a minimum.
  • We extended this treatment approach to include children under the age of 3 years with the aim of improving tumour control.
  • METHODS: Between July 11, 1997, and Nov 18, 2007, 153 paediatric patients (median age 2.9 years [range 0.9-22.9 months]) with localised ependymoma were treated.
  • 85 patients had anaplastic ependymoma; the tumours of 122 were located in the infratentorial region, and 35 had received previous chemotherapy.
  • Patients received conformal radiotherapy after definitive surgery (125 patients had undergone gross total, 17 near total, and 11 subtotal resection).
  • Doses of 59.4 Gy (n=131) or 54.0 Gy (n=22) were prescribed to a 10 mm margin around the target volume.
  • Variables considered included tumour grade, tumour location, ethnic origin, sex, age when undergoing conformal radiotherapy, total radiotherapy dose, number of surgical procedures, surgery extent, and preradiotherapy chemotherapy.
  • In the 107 patients treated with immediate postoperative conformal radiotherapy (without delay or chemotherapy), 7-year local control, EFS, and overall survival were 88.7% (77.9-99.5), 76.9% (63.4-90.4), and 85.0% (74.2-95.8), respectively; the cumulative incidence of local and distant failure were 12.6% (5.1-20.1), and 8.6% (2.8-14.3), respectively.
  • The incidence of secondary malignant brain tumour at 7 years was 2.3% (0-5.6) and brainstem necrosis 1.6% (0-4.0).
  • Overall survival was affected by tumour grade (anaplastic vs differentiated: HR 3.98 [95% CI 1.51-10.48]; p=0.0052), extent of resection (gross total vs near total or subtotal: 0.16 [0.07-0.37]; p<0.0001), and ethnic origin (non-white vs white: 3.0 [1.21-7.44]; p=0.018).
  • EFS was affected by tumour grade (anaplastic vs differentiated: 2.52 [1.2705.01]; p=0.008), extent of resection (gross total vs near total or subtotal: 0.20 [0.11-0.39]; p<0.0001]), and sex (male vs female: 2.19 [1.03-4.66]; p=0.042).
  • Distant recurrence was only affected by tumour grade (anaplastic vs differentiated: 4.1 [1.2-14.0]; p=0.017).
  • INTERPRETATION: Treatment of ependymoma should include surgery with the aim of gross-total resection and conformal, high-dose, postoperative irradiation.
  • Future trials might consider treatment stratification based on sex and age.
  • [MeSH-major] Brain Neoplasms / therapy. Ependymoma / therapy. Radiotherapy, Conformal / methods
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Infant. Male. Prospective Studies. Treatment Failure

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  • (PMID = 19274783.001).
  • [ISSN] 1474-5488
  • [Journal-full-title] The Lancet. Oncology
  • [ISO-abbreviation] Lancet Oncol.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / P30 CA021765
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] England
  • [Other-IDs] NLM/ NIHMS429992; NLM/ PMC3615425
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6. Timmermann B, Kortmann RD, Kühl J, Meisner C, Slavc I, Pietsch T, Bamberg M: Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91. Int J Radiat Oncol Biol Phys; 2000 Jan 15;46(2):287-95

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Combined postoperative irradiation and chemotherapy for anaplastic ependymomas in childhood: results of the German prospective trials HIT 88/89 and HIT 91.
  • PURPOSE: To evaluate the outcome in children with anaplastic ependymomas after surgery, irradiation, and chemotherapy; and to identify prognostic factors for survival.
  • METHODS AND MATERIALS: Fifty-five children (n = 27 girls, 28 boys; median age at diagnosis, 6.2 years) with newly diagnosed anaplastic ependymomas were treated in the multicenter, prospective trials HIT 88/89 and HIT 91.
  • All patients received chemotherapy before (n = 40) or after irradiation (n = 15).
  • The irradiation volume encompassed either the neuraxis followed by a boost to the primary tumor site (n = 40) or the tumor region only (n = 13).
  • The median time to disease progression was 45 months.
  • The only significant prognostic factor was the extent of resection (estimated progression-free survival [EPFS] after 3 years was 83.3% after complete resection and 38.5% after incomplete resection) and the presence of metastases at the time of diagnosis (0% vs. 65.8% 3-year EPFS in localized tumors).
  • Age, sex, tumor site, mode of chemotherapy, and irradiation volume did not influence survival.
  • CONCLUSIONS: Treatment centers should be meticulous about surgery and diagnostic workup.
  • Because the primary tumor region is the predominant site of failure it is important to intensify local treatment.
  • The role of adjuvant chemotherapy requires further study.
  • [MeSH-major] Ependymoma / drug therapy. Ependymoma / radiotherapy. Infratentorial Neoplasms / drug therapy. Infratentorial Neoplasms / radiotherapy. Supratentorial Neoplasms / drug therapy. Supratentorial Neoplasms / radiotherapy
  • [MeSH-minor] Adolescent. Austria. Child. Child, Preschool. Combined Modality Therapy. Disease Progression. Disease-Free Survival. Female. Germany. Humans. Male. Prospective Studies. Radiotherapy Dosage. Survival Rate

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  • (PMID = 10661334.001).
  • [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] Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial
  • [Publication-country] UNITED STATES
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7. Sardi I, Sanzo M, Giordano F, Sandri A, Mussa F, Donati PA, Genitori L: Intracavitary chemotherapy (Gliadel) and oral low-dose etoposide for recurrent anaplastic ependymoma. Oncol Rep; 2008 May;19(5):1219-23
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  • [Title] Intracavitary chemotherapy (Gliadel) and oral low-dose etoposide for recurrent anaplastic ependymoma.
  • Anaplastic ependymoma is associated with a higher incidence of tumor recurrence and its prognosis still remains unsatisfactory.
  • Consolidated therapy for ependymoma includes surgery followed by focal radiotherapy when resection is incomplete.
  • In the case of relapse treatment, options are limited especially for patients who have already received radiotherapy.
  • We sought to establish the feasibility of administering low-dose oral etoposide (50 mg/m(2)/day for 21 days) in combination with the implantation of intracavitary carmustine (BCNU) wafers (Gliadel) at the gross total resection for achieving synergistic treatment in three children affected by recurrent anaplastic ependymoma.
  • The therapy was tolerated safely and well in all patients without any post-surgery complications.
  • This multimodal approach was not effective for the treatment of refractory anaplastic ependymoma and further studies are required in order to define the role of the combination of multidrug systemic chemotherapy with BCNU wafer implantation in children with high-risk brain tumors.
  • [MeSH-major] Biocompatible Materials. Brain / pathology. Brain Neoplasms / drug therapy. Decanoic Acids / therapeutic use. Ependymoma / drug therapy. Etoposide / administration & dosage. Polyesters / therapeutic use

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  • (PMID = 18425379.001).
  • [ISSN] 1021-335X
  • [Journal-full-title] Oncology reports
  • [ISO-abbreviation] Oncol. Rep.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Greece
  • [Chemical-registry-number] 0 / Antineoplastic Agents, Phytogenic; 0 / Biocompatible Materials; 0 / Decanoic Acids; 0 / Polyesters; 6PLQ3CP4P3 / Etoposide; 90409-78-2 / decanedioic acid-4,4'-(1,3-propanediylbis(oxy))bis(benzoic acid) copolymer; U68WG3173Y / Carmustine
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8. Kanamori M, Kumabe T, Saito R, Yamashita Y, Sonoda Y, Tominaga T: [The safety of combination chemotherapy with ifosfamide, cisplatin, and etoposide (ICE): single-institution retrospective review of 108 cases]. No Shinkei Geka; 2010 Nov;38(11):997-1005
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  • [Title] [The safety of combination chemotherapy with ifosfamide, cisplatin, and etoposide (ICE): single-institution retrospective review of 108 cases].
  • PURPOSE: The adverse effects of combination chemotherapy of ifosfamide, cisplatin, and etoposide (ICE) were evaluated in the treatment of various intracranial brain tumors.
  • The histological diagnosis was newly diagnosed or recurrent germ cell tumor in 45 cases, medulloblastoma in 19, primitive neuroectodermal tumor (PNET) in 7, anaplastic ependymoma in 6, recurrent glioblastoma in 13, and others in 18 cases.
  • Patients received 1-8 cycles of ICE chemotherapy with or without radiation therapy.
  • 3.0 (CTCAE v3.0) grade 4 neutropenia, anemia, and thrombocytopenia occurred in 81.4%, 14.8%, and 35.2% of patients, respectively.
  • The proportion of ICE cycles associated with CTCAE v3.0 grade 4 neutropenia, transfusion of platelets, and elevated AST/ALT significantly decreased after enforcement of dose reduction criteria.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / adverse effects. Brain Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Agents / administration & dosage. Antineoplastic Agents / adverse effects. Antineoplastic Agents, Alkylating / administration & dosage. Antineoplastic Agents, Alkylating / adverse effects. Antineoplastic Agents, Phytogenic / administration & dosage. Antineoplastic Agents, Phytogenic / adverse effects. Child. Child, Preschool. Cisplatin / administration & dosage. Cisplatin / adverse effects. Ependymoma / drug therapy. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Glioblastoma / drug therapy. Hematologic Diseases / chemically induced. Humans. Ifosfamide / administration & dosage. Ifosfamide / adverse effects. Infant. Male. Medulloblastoma / drug therapy. Middle Aged. Neoplasms, Germ Cell and Embryonal / drug therapy. Neuroectodermal Tumors, Primitive / drug therapy. Retrospective Studies

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  • (PMID = 21081811.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Alkylating; 0 / Antineoplastic Agents, Phytogenic; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; UM20QQM95Y / Ifosfamide
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9. Jennings MT, Cmelak A, Johnson MD, Moots PL, Pais R, Shyr Y: Differential responsiveness among "high risk" pediatric brain tumors in a pilot study of dose-intensive induction chemotherapy. Pediatr Blood Cancer; 2004 Jul;43(1):46-54
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Differential responsiveness among "high risk" pediatric brain tumors in a pilot study of dose-intensive induction chemotherapy.
  • BACKGROUND: These factors have been predictive for progressive disease on therapy (PDOT) among pediatric brain tumors: >1.5 cm(2) unresectable tumor, glioblastoma, supratentorial primitive neuroectodermal tumor, and metastatic medulloblastoma (MBL).
  • Maintenance chemotherapy consisted of eight cycles of carboplatin, etoposide, and vincristine.
  • RESULTS: Twenty newly diagnosed patients [nine primitive neuroectodermal tumors/MBL, one choroid plexus carcinoma, eight malignant gliomas, and two anaplastic ependymomas] were treated.
  • Ten patients, who required neuraxis irradiation, constituted the "PNET" group.
  • Induction chemotherapy produced partial and minor responses (MRs) among 5/10.
  • Their estimated median progression free survival was 6.9 months (P = 0.035 relative to the PNET) with a median survival of 10.7 months (P = 0.04).
  • Expression of the biologic factors was similar between both groups and did not correlate with diagnosis or response.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / drug therapy. Glioma / drug therapy. Neuroectodermal Tumors, Primitive / drug therapy
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Cisplatin / administration & dosage. Cyclophosphamide / administration & dosage. Disease-Free Survival. Dose Fractionation. Etoposide / administration & dosage. Female. Humans. Male. Neoadjuvant Therapy. Pilot Projects. Statistics, Nonparametric. Survival Rate. Vincristine / administration & dosage

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  • [Copyright] Copyright 2004 Wiley-Liss, Inc.
  • (PMID = 15170889.001).
  • [ISSN] 1545-5009
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 5J49Q6B70F / Vincristine; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; Q20Q21Q62J / Cisplatin
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10. Valera ET, Machado HR, Santos AC, de Oliveira RS, Araújo D, Neder L, Tone LG: The use of neoadjuvant chemotherapy to achieve complete surgical resection in recurring supratentorial anaplastic ependymoma. Childs Nerv Syst; 2005 Mar;21(3):230-3
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  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] The use of neoadjuvant chemotherapy to achieve complete surgical resection in recurring supratentorial anaplastic ependymoma.
  • INTRODUCTION: Ependymoma is a central nervous system neoplasm that is often managed with surgery and radiotherapy.
  • The benefits of chemotherapy in treating this tumor remain poorly defined.
  • CASE REPORT: The use of a platinum-based chemotherapy as a neoadjuvant treatment to permit complete surgical resection of a supratentorial anaplastic ependymoma recurring for the third time is described.
  • DISCUSSION: This paper also discusses the possible use of chemotherapy as a strategy that may allow tumor shrinkage and ease tumor resection in giant recurring ependymomas.
  • [MeSH-major] Combined Modality Therapy. Ependymoma / therapy. Neoadjuvant Therapy. Supratentorial Neoplasms / therapy
  • [MeSH-minor] Child. Humans. Magnetic Resonance Imaging / methods. Male. Treatment Outcome

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  • [Cites] Childs Nerv Syst. 1998 Aug;14(8):357-61 [9753400.001]
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  • (PMID = 15338180.001).
  • [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
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11. Ray SK, Patel SJ, Welsh CT, Wilford GG, Hogan EL, Banik NL: Molecular evidence of apoptotic death in malignant brain tumors including glioblastoma multiforme: upregulation of calpain and caspase-3. J Neurosci Res; 2002 Jul 15;69(2):197-206
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  • [Title] Molecular evidence of apoptotic death in malignant brain tumors including glioblastoma multiforme: upregulation of calpain and caspase-3.
  • To identify the role of apoptosis in brain tumor cell death, we investigated macromolecular (RNA and protein) synthesis and activity in the central to peripheral region of benign [desmoplastic infantile ganglioglioma (DIG) and transitional meningioma (TMG)] and malignant [ependymoma (END), anaplastic astrocytoma (APA), and glioblastoma multiforme (GBM)] brain tumors derived from five patients who had not received previously radiotherapy or chemotherapy.
  • Normal brain tissue (NBT) served as control.
  • RT-PCR analysis of tumor tissues covering central to peripheral regions detected mRNA overexpression of pro-apoptotic gene bax in malignant tumors, indicating a commitment to apoptosis.
  • Agarose gel electrophoresis detected a mixture of random and internucleosomal DNA fragmentation in malignant brain tumors.
  • Overexpression of pro-apoptotic bax, upregulation of calpain and caspase-3, and occurrence of internucleosomal DNA fragmentation are now presented indicating that one mechanism of cell death in malignant brain tumors is apoptosis, and that enhancement of this process therapeutically may promote decreased tumor growth.

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  • [Copyright] Copyright 2002 Wiley-Liss, Inc.
  • (PMID = 12111801.001).
  • [ISSN] 0360-4012
  • [Journal-full-title] Journal of neuroscience research
  • [ISO-abbreviation] J. Neurosci. Res.
  • [Language] eng
  • [Grant] United States / NINDS NIH HHS / NS / NS-31622; United States / NINDS NIH HHS / NS / NS-38146; United States / NINDS NIH HHS / NS / NS-41088
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / BAX protein, human; 0 / Calcium-Binding Proteins; 0 / Proto-Oncogene Proteins; 0 / Proto-Oncogene Proteins c-bcl-2; 0 / RNA, Messenger; 0 / bcl-2-Associated X Protein; 79079-11-1 / calpastatin; EC 3.4.22.- / CASP3 protein, human; EC 3.4.22.- / CASP9 protein, human; EC 3.4.22.- / Calpain; EC 3.4.22.- / Caspase 3; EC 3.4.22.- / Caspase 9; EC 3.4.22.- / Caspases
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12. Agaoglu FY, Ayan I, Dizdar Y, Kebudi R, Gorgun O, Darendeliler E: Ependymal tumors in childhood. Pediatr Blood Cancer; 2005 Sep;45(3):298-303
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  • [Title] Ependymal tumors in childhood.
  • BACKGROUND: Ependymal tumors are classified as ependymoma (benign or low grade) versus anaplastic ependymoma (malignant or high grade).
  • Ependymomas represent 5-10% of intracranial neoplasm in children.
  • In this study, demographic data and the treatment results of pediatric patients with ependymal tumors, treated in a single institute, is reported.
  • PATIENTS AND METHODS: Between 1989 and 2001, 40 (22 M/18 F) previously untreated patients with a median age of 5.5 years (3 months-15 years), of histologically proven ependymal tumors (except ependymoblastomas) were referred to the Institute of Oncology, University of Istanbul.
  • Histologic subgroups were 18 ependymomas (43.6%), and 22 anaplastic ependymomas (56.4%).
  • Total tumor resection was performed in 20 patients (50%), subtotal in 18 patients (45%), and biopsy only in 2 patients (5%).
  • Postoperative treatment consisted of regional (8 patients) or craniospinal (CSI) (9 patients) radiotherapy (RT) in patients with ependymoma; regional (7 patients) or CSI RT (14 patients) with chemotherapy (ChT) in patients with anaplastic ependymoma; ChT only (1 patient) in patients less than 3 years of age.
  • The standard technique for posterior fossa irradiation was parallel-opposed lateral fields and total dose was 45-54 Gy.
  • Patients who were treated between June 1991 and July 1994, received regimen B, which included two courses of postoperative "VEC" (vincristine, etoposide, cisplatin) ChT, administered every 3 weeks, followed by RT applied with low dose concomitant cisplatin used as a radiosensitizer.
  • Median time for progression or relapse was 24.3 months and there were 19 patients (43.6%) with relapse or progression.
  • CONCLUSIONS: The majority of complete responders were patients who had total tumor removal.
  • Treatment failure occurred mainly within the first 2 years, and outcome was dismal for patients who relapsed or had progressive disease.
  • The median age at diagnosis is 6 years in our patient group; younger children (less than 3 years old) have less favorable outcome.
  • [MeSH-major] Brain Neoplasms. Ependymoma

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  • [Copyright] (c) 2004 Wiley-Liss, Inc.
  • (PMID = 15770637.001).
  • [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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13. Beuthien-Baumann B, Hahn G, Winkler C, Heubner G: Differentiation between recurrent tumor and radiation necrosis in a child with anaplastic ependymoma after chemotherapy and radiation therapy. Strahlenther Onkol; 2003 Dec;179(12):819-22
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  • [Title] Differentiation between recurrent tumor and radiation necrosis in a child with anaplastic ependymoma after chemotherapy and radiation therapy.
  • BACKGROUND: In patients after treatment for malignant brain tumors, a clear distinction between tumor recurrence and radiation necrosis can be challenging.
  • This case report describes the diagnostic workup in a child with anaplastic ependymoma and inconclusive MRI (magnetic resonance imaging) and PET (positron emission tomography) findings.
  • CASE REPORT: 1.5 years after resection, hyperfractionated radiotherapy and chemotherapy of an anaplastic ependymoma in the right parietal region, the cranial MRI of an 11-year-old girl showed multiple small contrast-enhanced lesions in the frontal cortex.
  • In the following months, these lesions increased in number and size and neurologic symptoms developed.
  • Although not typical, this result was suspicious of tumor seeding, the more since the lesions appeared in gray matter areas outside the high-dose-rate irradiation field.
  • A biopsy, performed 6 months later when the clinical appearance worsened, showed no tumor tissue.
  • FDG PET, performed after the size and number of the lesions had increased, showed no intensely increased glucose metabolism, a high-grade recurrent tumor was therefore very unlikely.
  • CONCLUSION: The final interpretation of the lesions was multiple focal radiation necrosis based on perfusion abnormalities after chemotherapy and conformal hyperfractionated radiotherapy, probably due to an individually enhanced vulnerability of the cerebral vessels.
  • [MeSH-major] Brain Diseases / etiology. Brain Neoplasms / radiotherapy. Ependymoma / radiotherapy. Magnetic Resonance Imaging. Necrosis. Neoplasm Recurrence, Local / diagnosis. Radiation Injuries / diagnosis. Radiotherapy / adverse effects. Tomography, Emission-Computed
  • [MeSH-minor] Biopsy. Brain / pathology. Child. Combined Modality Therapy. Diagnosis, Differential. Dose Fractionation. Female. Follow-Up Studies. Humans. Radiotherapy Dosage. Radiotherapy, Conformal. Time Factors


14. Krishnamurthy S, Powers SK, Witmer P, Brown T: Optimal light dose for interstitial photodynamic therapy in treatment for malignant brain tumors. Lasers Surg Med; 2000;27(3):224-34

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Optimal light dose for interstitial photodynamic therapy in treatment for malignant brain tumors.
  • BACKGROUND AND OBJECTIVE: The primary goal was to determine the maximal tolerable light dose that can be administered to patients undergoing multifiber interstitial photodynamic therapy (PDT) of malignant brain tumors at a fixed dose of photosensitizer.
  • STUDY DESIGN/MATERIALS AND METHODS: Eighteen patients (12 glioblastomas, 5 anaplastic astrocytoma, and 1 malignant ependymoma) were included in this study.
  • The total light dose delivered to the tumor was divided into three groups of six patients each: 1,500-3,700 J, 3,700-4,400 J, and 4,400-5,900 J.
  • Glioblastomas recurred more often than anaplastic astrocytomas.
  • Patients with anaplastic astrocytomas survived (mean, 493 days) longer than patients with glioblastomas (mean, 116.5 days) after PDT.
  • CONCLUSIONS: Increasing the total light dose delivered to the tumor increases the odds of having a permanent neurologic deficit but does not increase survival or time to tumor progression.
  • Recurrent anaplastic astrocytomas tend to do better than recurrent glioblastomas with PDT.
  • [MeSH-major] Glioma / drug therapy. Hematoporphyrin Photoradiation / methods. Laser Therapy. Supratentorial Neoplasms / drug therapy
  • [MeSH-minor] Adult. Aged. Dihematoporphyrin Ether / administration & dosage. Disease-Free Survival. Dose-Response Relationship, Radiation. Humans. Middle Aged. Neoplasm Recurrence, Local. Photochemotherapy. Photosensitizing Agents. Stereotaxic Techniques. Survival Analysis. Treatment Outcome

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  • [Copyright] Copyright 2000 Wiley-Liss, Inc.
  • (PMID = 11013384.001).
  • [ISSN] 0196-8092
  • [Journal-full-title] Lasers in surgery and medicine
  • [ISO-abbreviation] Lasers Surg Med
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Photosensitizing Agents; 97067-70-4 / Dihematoporphyrin Ether
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15. Mora J, Cruz O, Parareda A, Guillen A, Puy R, Massaguer S, de Torres C, Garcia G, Costa JM: Treatment of childhood glial tumors with cisplatin and irinotecan. J Clin Oncol; 2009 May 20;27(15_suppl):10062

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Treatment of childhood glial tumors with cisplatin and irinotecan.
  • After a pilot study suggesting that irinotecan/cisplatin (I/C) may be effective in children (Mora et al, Neuro Oncol 2007), we initiated a phase II prospective trial with the aim of avoiding radiation therapy for low grade's (LG) and improve outcome for high grade's (HG).
  • METHODS: The indication for adjuvant therapy was based upon histology, the extent of surgical resection, and the presence of clinical or neuroradiological signs of progression.
  • RESULTS: From January 2004 to December 2007, 30 children aged 6 months to 17 years were treated, 21 at diagnosis, 7 at progression and 2 at relapse.
  • Fourteen tumors were WHO grades I-II gliomas (LGG), 10 grade III (6 gliomas, 2 anaplastic ependymomas and 2 AT/RT), and 6 had no biopsy (3 brainstem (BST) and 3 optic-pathway tumors (OPT)).
  • Two patients had type-1 neurofibromatosis and OPT.
  • Prior to the I/C regimen, gross total resection was performed in 7 and biopsy in 14 tumors; 9 patients received chemotherapy and 5 radiotherapy.
  • All but 6 patients, 2 because of C allergy and 4 BST because of progression, completed the protocol, with no grade 3-4 side effects.
  • With a median follow-up of 25 months, 14 (47%) patients had a complete/partial response (7 out of 10 HG), 10 (40%) had stable disease (8 out of 14 LG), and 6 (20%) progressed (all BST).

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  • (PMID = 27962497.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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16. Green RM, Cloughesy T, Stupp R, DeAngelis LM, Woyshner EA, Ney DE, Lassman AB: Bevacizumab for recurrent ependymoma. J Clin Oncol; 2009 May 20;27(15_suppl):2060

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Bevacizumab for recurrent ependymoma.
  • : 2060 Background: Ependymoma is a rare type of glioma, representing less than 5% of brain tumors in adults.
  • Radiotherapy (RT) is commonly administered, but there is no standard chemotherapy.
  • At recurrence ependymoma is notoriously refractory to therapy and the prognosis is poor.
  • Therefore, we treated patients with recurrent ependymoma and anaplastic ependymoma with bevacizumab containing chemotherapy regimens.
  • METHODS: We retrospectively identified adults treated for recurrent ependymoma and anaplastic ependymoma with bevacizumab containing chemotherapy regimens.
  • We determined radiographic response (Macdonald criteria) and estimated median time to progression (TTP) and overall survival (OS) by the Kaplan-Meier method.
  • RESULTS: There were six patients, four women and two men, with a median age of 29 years (range, 20-65).
  • Prior treatment included RT in all and temozolomide in four.
  • Median TTP and OS were 6.5 (95% CI: 2.7-10.2) and 9.4 (95% CI: 6.3-12.6) months, respectively, with a median follow up of 18.7 months for the two surviving patients.
  • CONCLUSIONS: Bevacizuamb has efficacy in the treatment of recurrent ependymoma.

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  • (PMID = 27964675.001).
  • [ISSN] 1527-7755
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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17. Geis T, Peters O, Friedrich M, Dränert E, Wolff JE: Intratumoral methotrexate kinetics in a patient with intracranial anaplastic ependymoma. Pediatr Blood Cancer; 2004 Jul;43(1):78-80
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  • [Title] Intratumoral methotrexate kinetics in a patient with intracranial anaplastic ependymoma.
  • Little is known about intratumoral anticancer drug concentration in childhood brain tumors.
  • We were able to measure methotrexate (MTX) tumor concentrations directly in a cystic anaplastic ependymoma.
  • Cyst fluid was obtained by puncture of a subgaleal Rickham reservoir connected to a catheter in the tumor cyst.
  • Maximum MTX concentrations in tumor and CSF were found at the end of MTX infusion.
  • Twenty-four hour after MTX infusion the mean tumor concentration was significantly higher than in the serum indicating MTX retention and accumulation in the tumor cyst.
  • An AUC(tumor)/AUC(serum) ratio of 1.95 was obtained.
  • In response to the applied multiagent chemotherapy the clinical condition of our patient improved and the tumor showed partial response on MRI.
  • Cystic ependymomas might benefit from high dose MTX especially because of drug retention in the tumor cyst.
  • [MeSH-major] Antimetabolites, Antineoplastic / pharmacokinetics. Brain Neoplasms / drug therapy. Ependymoma / drug therapy. Methotrexate / pharmacokinetics
  • [MeSH-minor] Female. Humans. Infant. Tissue Distribution

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  • [Copyright] Copyright 2004 Wiley-Liss, Inc.
  • (PMID = 15170895.001).
  • [ISSN] 1545-5009
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; YL5FZ2Y5U1 / Methotrexate
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18. Buccoliero AM, Castiglione F, Rossi Degl'Innocenti D, Paglierani M, Maio V, Gheri CF, Garbini F, Moncini D, Taddei A, Sardi I, Sanzo M, Giordano F, Mussa F, Genitori L, Taddei GL: O6-Methylguanine-DNA-methyltransferase in recurring anaplastic ependymomas: PCR and immunohistochemistry. J Chemother; 2008 Apr;20(2):263-8
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  • [Title] O6-Methylguanine-DNA-methyltransferase in recurring anaplastic ependymomas: PCR and immunohistochemistry.
  • Ependymomas are the third most common brain tumor in children.
  • There are no convincing data on an effective role for chemotherapy.
  • We evaluated the MGMT gene promoter methylation and the immunohistochemical MGMT protein expression in 12 recurrent anaplastic ependymomas affecting children.
  • Our purpose was to investigate the molecular rationale of the administration of alkylating agents to children affected by recurrent anaplastic ependymomas.
  • All ependymomas lacked MGMT promoter hypermethylation and 9 (75%) showed high MGMT protein expression (>50% tumoral cells).
  • These results may indicate MGMT as a factor of chemoresistance to alkylating drugs in anaplastic ependymomas and support the uncertainties regarding the actual benefit of chemotherapy for patients with anaplastic ependymomas.
  • [MeSH-major] Brain Neoplasms / enzymology. DNA Modification Methylases / biosynthesis. DNA Repair Enzymes / biosynthesis. Ependymoma / enzymology. Neoplasm Recurrence, Local / enzymology. Tumor Suppressor Proteins / biosynthesis
  • [MeSH-minor] Adolescent. Anaplasia. Child. Child, Preschool. DNA Methylation. Drug Resistance, Neoplasm. Female. Humans. Immunohistochemistry. Male. Polymerase Chain Reaction. Promoter Regions, Genetic

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  • (PMID = 18467255.001).
  • [ISSN] 1973-9478
  • [Journal-full-title] Journal of chemotherapy (Florence, Italy)
  • [ISO-abbreviation] J Chemother
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Italy
  • [Chemical-registry-number] 0 / Tumor Suppressor Proteins; EC 2.1.1.- / DNA Modification Methylases; EC 2.1.1.63 / MGMT protein, human; EC 6.5.1.- / DNA Repair Enzymes
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19. Merchant TE, Jenkins JJ, Burger PC, Sanford RA, Sherwood SH, Jones-Wallace D, Heideman RL, Thompson SJ, Helton KJ, Kun LE: Influence of tumor grade on time to progression after irradiation for localized ependymoma in children. Int J Radiat Oncol Biol Phys; 2002 May 01;53(1):52-7
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  • [Title] Influence of tumor grade on time to progression after irradiation for localized ependymoma in children.
  • PURPOSE: To investigate the influence of histologic grade on progression-free survival (PFS) after irradiation (RT) for pediatric patients with localized ependymoma.
  • METHODS AND MATERIALS: Fifty patients with localized ependymoma (median age 3.6 years, range 1-18 years at the time of RT) were treated with RT between December 1982 and June 1999.
  • Anaplastic features were identified in 14 of 50 patients.
  • The median dose to the primary site was 54 Gy.
  • Of the 50 patients, 23 received pre-RT chemotherapy.
  • RESULTS: Thirty-nine patients were alive at a median follow-up of 46 months (range 21-214) from diagnosis.
  • Progression occurred in 16 patients (12 local and 4 local and distant), with a median time to failure of 21.2 months (range 4.6-65.0).
  • The tumor grade significantly influenced the PFS after RT (p < 0.0005).
  • The estimated 3-year PFS rate was 28% +/- 14% for patients with anaplastic ependymoma compared with 84% +/- 8% for patients with differentiated ependymoma.
  • These results remained significant when corrected for age at diagnosis (<3 years), pre-RT chemotherapy, and extent of resection.
  • Patients who received pre-RT chemotherapy had an inferior 3-year PFS estimate after RT (49 +/- 12%) compared with those who did not (84% +/- 10%; p = 0.056).
  • Anaplastic ependymoma was found more frequently in the supratentorial brain (p = 0.002).
  • Six of 12 patients with supratentorial tumor developed recurrence; recurrence was restricted to patients with anaplastic ependymoma.
  • CONCLUSION: Tumor grade influences outcome for patients with ependymoma independent of other factors and should be considered in the design and analysis of prospective trials involving pediatric patients treated with RT.
  • Chemotherapy before RT influences the PFS and overall survival after RT.
  • The effect is more pronounced when progression occurs during chemotherapy.
  • [MeSH-major] Brain Neoplasms / pathology. Brain Neoplasms / radiotherapy. Ependymoma / pathology. Ependymoma / radiotherapy
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Combined Modality Therapy. Disease Progression. Disease-Free Survival. Female. Humans. Infant. Male. Radiotherapy Dosage. Retrospective Studies. Supratentorial Neoplasms / drug therapy. Supratentorial Neoplasms / pathology. Supratentorial Neoplasms / radiotherapy. Treatment Outcome

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  • (PMID = 12007941.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / R25 CA023944; United States / NCI NIH HHS / CA / P30 CA 21765
  • [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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20. Timmermann B, Kortmann RD, Kühl J, Rutkowski S, Dieckmann K, Meisner C, Bamberg M: Role of radiotherapy in anaplastic ependymoma in children under age of 3 years: results of the prospective German brain tumor trials HIT-SKK 87 and 92. Radiother Oncol; 2005 Dec;77(3):278-85
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  • [Title] Role of radiotherapy in anaplastic ependymoma in children under age of 3 years: results of the prospective German brain tumor trials HIT-SKK 87 and 92.
  • BACKGROUND AND PURPOSE: To evaluate the outcome of very young children with anaplastic ependymoma after delayed or omitted radiotherapy (RT).
  • MATERIALS AND METHODS: Children under age of 3 years with anaplastic ependymoma were enrolled in the HIT-SKK 87 trial from 1987.
  • After surgery, low-risk patients (R0, M0) received maintenance chemotherapy until elective RT at age of three.
  • In high-risk patients (R+, M+) intensive induction chemotherapy was followed by maintenance chemotherapy and subsequently delayed RT.
  • In the HIT-SKK 92, trial MTX-based chemotherapy was applied.
  • RESULTS: Thirty-four children with anaplastic ependymoma were eligible (age 1.0-33.0 months).
  • All children received chemotherapy.
  • Preventive RT after chemotherapy was given in nine, and salvage RT in 12 children.
  • Positive impact on survival was observed in children with higher age, M0-stage, complete resection, and treatment with radiotherapy.
  • CONCLUSION: Delaying RT jeopardizes survival even after intensive chemotherapy.
  • Predominant site of failure is the primary tumor site.
  • [MeSH-major] Brain Neoplasms / radiotherapy. Ependymoma / radiotherapy
  • [MeSH-minor] Age Factors. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child, Preschool. Female. Humans. Infant. Infant, Newborn. Male. Methotrexate / administration & dosage. Prospective Studies. Risk Factors. Salvage Therapy. Survival Analysis. Time Factors. Treatment Outcome


21. Reni M: Guidelines for the treatment of adult intra-cranial grade II-III ependymal tumours. Forum (Genova); 2003;13(1):90-8

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  • [Title] Guidelines for the treatment of adult intra-cranial grade II-III ependymal tumours.
  • Intra-cranial ependymal tumours are very rare in the adult population, so most of reported series are retrospective, include also paediatric patients and have limited statistical power due to the small number of cases.
  • As a consequence, universally accepted prognostic factors and therapeutic guidelines are lacking.
  • The addition of postoperative chemotherapy with lomustine, vincristine and prednisone to cranio-spinal irradiation did not improve survival with respect to RT alone in a randomised phase III trial of children with infratentorial ependymoma.
  • Different chemotherapy regimens have been tested in children with ependymoma or anaplastic ependymoma yielding comparable results to those reported for patients receiving RT alone.
  • Thus far, there is no proof that the addition of chemotherapy to RT improves the outcome and adjuvant chemotherapy should be confined to investigational controlled clinical trials.

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  • (PMID = 14732890.001).
  • [ISSN] 1970-0008
  • [Journal-full-title] Forum (Genoa, Italy)
  • [ISO-abbreviation] Forum (Genova)
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Italy
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22. Behling E, Birbe R, Veznadaroglu E, Andrews DW, Flanders A, Kenyon LC: Gliosarcoma arising from an anaplastic ependymoma: a case report of a rare entity. Hum Pathol; 2004 Apr;35(4):512-6
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  • [Title] Gliosarcoma arising from an anaplastic ependymoma: a case report of a rare entity.
  • We report the first case of a gliosarcoma arising from an anaplastic ependymoma and the second case of gliosarcoma arising from any type of ependymal neoplasm.
  • The patient was a 48-year-old woman with a solid and cystic, peripherally enhancing, 7-cm right frontal mass lesion.
  • Histologically, the lesion displayed characteristics of anaplastic ependymoma (grade III, World Health Organization scale).
  • The tumor recurred despite multiple cycles of postoperative radiation and chemotherapy.
  • After the fourth recurrence, the tumor displayed a biphasic pattern of differentiation.
  • The first pattern was similar to the original anaplastic ependymoma, whereas there was a second new sarcomatous pattern resembling fibrosarcoma that was admixed with and overrunning the ependymal component.
  • The spectrum of gliosarcoma is therefore expanded to include not only astrocytic and oligodendroglial components but ependymal components as well.
  • [MeSH-major] Brain Neoplasms / pathology. Ependymoma / pathology. Gliosarcoma / pathology. Neoplasms, Multiple Primary / pathology. Neoplasms, Radiation-Induced / pathology
  • [MeSH-minor] Female. Glial Fibrillary Acidic Protein / metabolism. Humans. Immunohistochemistry. Magnetic Resonance Imaging. Middle Aged. Neoplasm Recurrence, Local / metabolism. Neoplasm Recurrence, Local / pathology


23. Kano H, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD: Outcome predictors for intracranial ependymoma radiosurgery. Neurosurgery; 2009 Feb;64(2):279-87; discussion 287-8
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  • [Title] Outcome predictors for intracranial ependymoma radiosurgery.
  • OBJECTIVE: To develop outcome predictors after stereotactic radiosurgery (SRS) in patients with intracranial ependymomas who had received previous fractionated radiation therapy, we compared tumor control, survival, and complications with tumor grade, volume, age of patients, and imaging characteristics.
  • METHODS: We retrospectively reviewed records of 39 consecutive ependymoma patients who underwent SRS for 56 tumors.
  • All patients had previous surgical resection of their ependymomas followed by radiotherapy, and 14 patients underwent previous chemotherapy.
  • Twenty-five patients had low-grade ependymomas (34 tumors), and 14 patients had anaplastic ependymomas (22 tumors).
  • The median radiosurgery target volume was 3.6 cm (range, 0.1-36.8 cm), and the median margin dose was 15.0 Gy (range, 10-22 Gy).
  • The progression-free survival rates after SRS at 1, 3, and 5 years were 81.6, 45.8, and 45.8%, respectively, for all grades of ependymomas.
  • Lower histological tumor grade was not significantly associated with better progression-free survival (P = 0.725).
  • Factors associated with an improved progression-free survival included smaller tumor volume and homogeneous tumor contrast enhancement in low-grade ependymomas.
  • CONCLUSION: SRS provides another management option for patients with residual or recurrent ependymomas that have failed surgery and radiation therapy.
  • [MeSH-major] Brain Neoplasms / epidemiology. Brain Neoplasms / surgery. Ependymoma / epidemiology. Ependymoma / surgery. Neoplasm Recurrence, Local / epidemiology. Neoplasm Recurrence, Local / prevention & control. Outcome Assessment (Health Care) / methods. Radiosurgery / statistics & numerical data
  • [MeSH-minor] Adolescent. Adult. Aged. Child. Child, Preschool. Female. Humans. Incidence. Male. Middle Aged. Pennsylvania / epidemiology. Retrospective Studies. Risk Assessment / methods. Risk Factors. Treatment Outcome. Young Adult

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  • (PMID = 19190457.001).
  • [ISSN] 1524-4040
  • [Journal-full-title] Neurosurgery
  • [ISO-abbreviation] Neurosurgery
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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24. Sasajima T, Takahashi M, Kinouchi H, Suzuki A, Mizoi K: [Therapeutic results of eight patients with intracranial ependymomas]. No To Shinkei; 2003 Mar;55(3):233-40
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  • [Title] [Therapeutic results of eight patients with intracranial ependymomas].
  • Between 1985 and 2001, eight patients with intracranial ependymomas underwent surgery at our hospital.
  • The cases included six infratentorial ependymomas, one supratentorial ependymoma and one supratentorial anaplastic ependymoma.
  • Infratentorial ependymomas were classified according to origin and extension.
  • The lateral type tumors originated from the lateral part of the fourth ventricle in four cases.
  • The midfloor type tumors originated from the inferior half of the fourth ventricular floor in two cases.
  • The three totally resected tumors were the lateral type tumors.
  • The remaining one case with the lateral type tumor underwent nearly total resection of the tumor, since the tumor involved lower cranial nerves.
  • All patients with the midfloor type tumors underwent incomplete resections of the tumors, because the tumors infiltrated into brain stem.
  • In intracranial ependymomas, all four patients with total resections have been alive, whereas three of four patients with incomplete resections have died.
  • The mean survival time of all patients with intracranial ependymomas was 127 months from the time of the initial surgery.
  • The mean survival time of the patients with tumors showing MIB-1 index > or = 10% (n = 4), was 30 months.
  • The extent of the resection, the age of the patients and MIB-1 index are important factors in the outcome in patients with intracranial ependymomas.
  • Two representative children aged less than 3 years with the midfloor type tumors were presented.
  • In a patient treated with conventional radiation and chemotherapy, residual tumor repeatedly enlarged within 12 months despite several resections of the tumor.
  • In contrast, the other patient received multidisciplinary treatment including Linac stereotactic radiotherapy (SRT) with a marginal dose of 27 Gy in 9 fractions, have been still alive for 45 months after the initial resection.
  • The residual tumor slightly decreased in size and remained stable without evident growth 12 months after SRT.
  • SRT may provide good local control for patients with intracranial ependymomas and have a favorable impact on survival.
  • [MeSH-major] Brain Neoplasms / surgery. Ependymoma / surgery
  • [MeSH-minor] Adolescent. Adult. Child, Preschool. Female. Humans. Infant. Male. Middle Aged. Prognosis. Supratentorial Neoplasms / mortality. Supratentorial Neoplasms / surgery. Survival. Treatment Outcome

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  • (PMID = 12728504.001).
  • [ISSN] 0006-8969
  • [Journal-full-title] Nō to shinkei = Brain and nerve
  • [ISO-abbreviation] No To Shinkei
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Japan
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25. Benesch M, Weber-Mzell D, Gerber NU, von Hoff K, Deinlein F, Krauss J, Warmuth-Metz M, Kortmann RD, Pietsch T, Driever PH, Quehenberger F, Urban C, Rutkowski S: Ependymoma of the spinal cord in children and adolescents: a retrospective series from the HIT database. J Neurosurg Pediatr; 2010 Aug;6(2):137-44
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  • [Title] Ependymoma of the spinal cord in children and adolescents: a retrospective series from the HIT database.
  • OBJECT: Reports on spinal cord ependymoma in children are rare.
  • The aim of this study was to evaluate the clinical spectrum, treatment, and outcome of children with primary ependymoma of the spinal cord who were registered in the database of the pediatric German brain tumor studies Hirntumor (HIT) '91 and HIT 2000.
  • METHODS: Between 1991 and 2007, 29 patients (12 male and 17 female, median age at diagnosis 13.6 years) with primary spinal cord ependymoma (myxopapillary ependymoma WHO Grade I, II, and III tumors in 6, 17, and 6 patients, respectively) were identified.
  • Four patients had neurofibromatosis Type 2.
  • RESULTS: With a median follow-up of 4.2 years (range 0.48-15 years), 28 patients (96.6%) were alive.
  • Seven patients (24.1%) developed progressive disease or relapse, 2 after gross-total resection (GTR) and 5 after incomplete resection or biopsy.
  • One patient with anaplastic ependymoma (WHO Grade III) died 65 months after diagnosis of disease progression.
  • Primary adjuvant treatment (radiotherapy, chemotherapy, or both) was used in 8 (50%) of 16 patients following GTR and in 9 (82%) of 11 patients who underwent less than a GTR.
  • Progression-free survival at 5 years is 84.4% (95% CI 50%-96%) for patients following GTR compared with 57.1% (95% CI 25%-69%) for patients who achieved a less than GTR (p = 0.088, log-rank test).
  • A high relapse incidence (4 of 6) was observed among patients with myxopapillary ependymoma.
  • CONCLUSIONS: Gross-total resection is the mainstay of treatment for patients with primary spinal cord ependymoma and may be achieved in about 50% of the patients using modern surgical techniques.
  • Primary adjuvant treatment was commonly used in children with spinal cord ependymoma irrespective of the extent of resection or tumor grade.
  • The impact of adjuvant treatment on progression-free and overall survival has to be investigated in a prospective trial.
  • [MeSH-major] Ependymoma / surgery. Spinal Cord Neoplasms / surgery
  • [MeSH-minor] Adolescent. Austria. Biopsy. Chemotherapy, Adjuvant. Child. Combined Modality Therapy. Disability Evaluation. Disease Progression. Female. Follow-Up Studies. Germany. Humans. Male. Neurofibromatosis 2 / diagnosis. Neurofibromatosis 2 / drug therapy. Neurofibromatosis 2 / pathology. Neurofibromatosis 2 / radiotherapy. Neurofibromatosis 2 / surgery. Postoperative Complications / diagnosis. Postoperative Complications / mortality. Prospective Studies. Radiotherapy, Adjuvant. Registries. Survival Rate

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  • (PMID = 20672934.001).
  • [ISSN] 1933-0715
  • [Journal-full-title] Journal of neurosurgery. Pediatrics
  • [ISO-abbreviation] J Neurosurg Pediatr
  • [Language] eng
  • [Publication-type] Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
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26. Reni M, Gatta G, Mazza E, Vecht C: Ependymoma. Crit Rev Oncol Hematol; 2007 Jul;63(1):81-9
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  • [Title] Ependymoma.
  • Ependymomas are rare tumours of neuroectodermal origin classified as myxopapillary ependymoma and subependymoma (grade I), ependymoma (grade II) and anaplastic ependymoma (grade III).
  • Age <40 years and extent of surgery appear related to better prognosis, while the role of other prognostic factors, such as tumour grade and tumour site are equivocal.
  • This emphasizes the role of surgery as the standard treatment.
  • Postoperative radiotherapy is indicated in high-grade ependymomas, and is recommended in low-grade ependymomas after subtotal or incomplete resection (confirmed by postoperative MR).
  • Recommended dose to involved fields is 45-54 Gy for low-grade (grade II) and 54-60 Gy for high-grade ependymomas (grade III).
  • There is no proof that postoperative chemotherapy improves the outcome.
  • At recurrence, platinum-, nitrosourea- or temozolomide-based chemotherapy can be administered, although there is no evidence of efficacy.
  • [MeSH-major] Brain Neoplasms / pathology. Ependymoma / pathology. Infratentorial Neoplasms / pathology. Spinal Cord Neoplasms / pathology
  • [MeSH-minor] Age Distribution. Female. Glial Fibrillary Acidic Protein / metabolism. Humans. Incidence. Male. Neoplasm Recurrence, Local. Neoplasm Staging. Prognosis. Risk Factors. Sex Factors. Survival Analysis

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  • (PMID = 17482475.001).
  • [ISSN] 1040-8428
  • [Journal-full-title] Critical reviews in oncology/hematology
  • [ISO-abbreviation] Crit. Rev. Oncol. Hematol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] Ireland
  • [Chemical-registry-number] 0 / Glial Fibrillary Acidic Protein
  • [Number-of-references] 100
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27. Spagnoli D, Tomei G, Ceccarelli G, Grimoldi N, Lanterna A, Bello L, Sinisi MM, De Santis A, Villani RM: Combined treatment of fourth ventricle ependymomas: report of 26 cases. Surg Neurol; 2000 Jul;54(1):19-26; discussion 26
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  • [Title] Combined treatment of fourth ventricle ependymomas: report of 26 cases.
  • BACKGROUND: This study investigated the relevance of prognostic factors and the impact of histological features in posterior fossa ependymoma.
  • METHODS: The charts of 26 patients (aged 1-59 years, mean 20.6 years; 11 adults) with posterior fossa ependymoma operated on between January 1983 and December 1994 were reviewed and patients followed up (mean: 93 months).
  • One patient (3.8%) developed respiratory complications and died.
  • Four children first received chemotherapy and then radiotherapy only when at least 3 years old.
  • Eleven patients (42%) received radiotherapy and subsequently chemotherapy.
  • CONCLUSIONS: This review suggests that a) younger patients (</= 6 years), despite multimodality treatment, have a poor prognosis;.
  • b) the microanatomical location of the tumor (lateral recess, roof, and floor) influences the extent of tumor removal (p < 0.05);.
  • e) histological classification (WHO) does not reflect different survival rates between ependymomas and anaplastic ependymomas (p = 0.082).
  • [MeSH-major] Brain Neoplasms. Ependymoma. Fourth Ventricle / surgery
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child. Child, Preschool. Combined Modality Therapy. Cranial Fossa, Posterior / radiation effects. Cranial Fossa, Posterior / surgery. Female. Follow-Up Studies. Humans. Infant. Male. Middle Aged. Radiotherapy Dosage. Retrospective Studies. Survival Rate. Treatment Outcome

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  • (PMID = 11024503.001).
  • [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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28. Niazi TN, Jensen EM, Jensen RL: WHO Grade II and III supratentorial hemispheric ependymomas in adults: case series and review of treatment options. J Neurooncol; 2009 Feb;91(3):323-8
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  • [Title] WHO Grade II and III supratentorial hemispheric ependymomas in adults: case series and review of treatment options.
  • Supratentorial ependymomas and their anaplastic variants are relatively uncommon central nervous system neoplasms that afflict both adults and children.
  • Whereas the treatment algorithm in the pediatric population is well established, however, treatment in the adult population is less defined.
  • In our case series of three adult patients with supratentorial ependymomas, two patients had tumors of WHO Grade III (anaplastic variant) and one had tumor of WHO Grade II.
  • Additional radiation therapy was administered in the Grade III patients.
  • Twenty-four-month follow-up in case 1 yielded no tumor recurrence and no requirement of adjuvant chemotherapy.
  • In case 2, tumor recurred with leptomeningeal gliomatosis by 6 months.
  • Addition of platinum-based chemotherapy did not improve long-term survival; the patient succumbed to the disease after 14 months.
  • In case 3 (WHO Grade II), no radiation therapy was required.
  • Tumor did not recur during the 42-month follow-up.
  • In our experience, gross total resection was achieved in all patients with hemispheric supratentorial WHO Grade II or Grade III ependymomas with additional radiation therapy for Grade III variants.
  • The role of chemotherapy is still uncertain but may be necessary in younger patients who may have tumors that behave more like the pediatric ependymomas.
  • [MeSH-major] Brain Neoplasms / pathology. Brain Neoplasms / therapy. Ependymoma / pathology. Ependymoma / therapy. Frontal Lobe / pathology. Functional Laterality

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  • (PMID = 18974933.001).
  • [ISSN] 1573-7373
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 18
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29. Shuangshoti S, Rushing EJ, Mena H, Olsen C, Sandberg GD: Supratentorial extraventricular ependymal neoplasms: a clinicopathologic study of 32 patients. Cancer; 2005 Jun 15;103(12):2598-605
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  • [Title] Supratentorial extraventricular ependymal neoplasms: a clinicopathologic study of 32 patients.
  • BACKGROUND: Published research on the clinicopathologic features of extraventricular ependymal neoplasms of the cerebral hemispheres has been scant.
  • RESULTS: Among these 32 cases were 2 subependymomas, 19 ependymomas, and 11 anaplastic ependymomas.
  • The left cerebral hemisphere was 1.5 times more commonly involved.
  • Ki-67 proliferation index paralleled tumor grade.
  • Immunoreactivity for p53 protein was observed in the 2 cases of subependymoma, in 10 of 11 anaplastic ependymomas, and in 6 of 17 ependymomas.
  • Flow cytometry performed in 27 tumors revealed diploidy in 20 cases and aneuploidy in 4 cases (3 anaplastic and 1 classic ependymomas), with S-phase fraction ranging from 0.2-9.7.
  • Eleven subjects were additionally treated with radiotherapy, and 3 with chemotherapy.
  • CONCLUSIONS: The results of the current study suggest that there is no significant relation between histopathology, Ki-67 proliferation index, p53 immunolabeling, tumor ploidy, and biologic behavior.
  • [MeSH-major] Brain Neoplasms / pathology. Cerebral Ventricle Neoplasms / pathology. Ependymoma / pathology. Glioma, Subependymal / pathology. Supratentorial Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Aged. Cell Proliferation. Child. Child, Preschool. Female. Flow Cytometry. Humans. Infant. Ki-67 Antigen / metabolism. Male. Middle Aged. Ploidies. Prognosis. S Phase. Tumor Suppressor Protein p53

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  • [Copyright] Published 2005 by the American Cancer Society.
  • (PMID = 15861411.001).
  • [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
  • [Chemical-registry-number] 0 / Ki-67 Antigen; 0 / Tumor Suppressor Protein p53
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30. Kano T, Ikota H, Wada H, Iwasa S, Kurosaki S: A case of an anaplastic ependymoma with gliosarcomatous components. Brain Tumor Pathol; 2009;26(1):11-7
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  • [Title] A case of an anaplastic ependymoma with gliosarcomatous components.
  • A 29-year-old woman presented with a severe headache.
  • Computed tomography revealed a large cystic lesion with a mural nodule-like mass homogeneously enhanced with contrast medium in the right cerebellum.
  • The tumor was removed, and pathological studies revealed a cerebellar astrocytoma corresponding to World Health Organization grade II.
  • When she was 35 years old, or 6 years after the surgery, magnetic resonance imaging revealed a recurrence of the tumor in the right cerebellum, and subtotal removal of the recurrent tumor was performed.
  • Pathological studies revealed a mixed glioblastoma multiforme and anaplastic ependymoma.
  • Chemotherapy (Paraplatin and VePeside-S) and focal radiation therapy at 60 Gy were administered following surgery.
  • Thereafter, at 39 years of age, or 4 years after radiation therapy, magnetic resonance imaging again revealed a recurrence of the tumor, which was heterogeneously enhanced with gadoliniumdiethylenetriamine pentaacetic acid in the right cerebellum.
  • Subtotal removal of the tumor was performed; pathological studies revealed an anaplastic ependymoma with sarcomatous components.
  • [MeSH-major] Cerebellar Neoplasms / pathology. Ependymoma / pathology. Gliosarcoma / pathology
  • [MeSH-minor] Adult. Astrocytoma / pathology. Astrocytoma / surgery. Female. Glial Fibrillary Acidic Protein / metabolism. Headache / etiology. Humans. Immunohistochemistry. Magnetic Resonance Imaging. Neoplasm Recurrence, Local. Paraffin Embedding. Tomography, X-Ray Computed

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  • (PMID = 19408092.001).
  • [ISSN] 1861-387X
  • [Journal-full-title] Brain tumor pathology
  • [ISO-abbreviation] Brain Tumor Pathol
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Glial Fibrillary Acidic Protein
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31. Rostomily RC, Halligan J, Geyer R, Stelzer K, Lindsley K, Berger MS: Permanent low-activity (125)I seed placement for the treatment of pediatric brain tumors: preliminary experience. Pediatr Neurosurg; 2001 Apr;34(4):198-205
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  • [Title] Permanent low-activity (125)I seed placement for the treatment of pediatric brain tumors: preliminary experience.
  • Although external beam radiation therapy is effective in the treatment of many pediatric brain neoplasms its use in this patient population has been associated with the development of significant cognitive and endocrine dysfunction and is severely limited as an option in previously irradiated patients.
  • Therefore, we have adopted a strategy for management of residual microscopic disease by implantation of low-activity (125)I seeds in the tumor bed at the time of surgery.
  • Six patients aged 2-14 years with recurrent tumors including two supratentorial primitive neuroectodermal tumors (n = 2), one medulloblastoma, one malignant ependymoma (n = 1), glioblastoma (n = 1) and one pleomorphic xanthoastrocytoma were implanted at the time of reoperation.
  • A total of 11-126 seeds were implanted resulting in total doses of 16-21.8 Gy (after theoretical infinite time) at a depth of 5 mm from the implanted resection bed.
  • Five patients had prior external beam radiation while the other patient (2 years old at initial diagnosis) progressed after surgery and chemotherapy.
  • Two patients had lasting local tumor control.
  • One patient is alive at 390 weeks of follow-up and another who died of distant failure at 366 weeks had no recurrence on MRI at 333 weeks' follow-up.
  • These results suggest that the use of permanent low-activity (125)I seeds as an adjunct to surgery can provide good local tumor control and is a suitable treatment option for pediatric patients.
  • [MeSH-major] Brachytherapy / adverse effects. Brain Neoplasms / radiotherapy. Iodine Radioisotopes / pharmacokinetics. Iodine Radioisotopes / therapeutic use
  • [MeSH-minor] Adolescent. Brain / metabolism. Brain / pathology. Child. Child, Preschool. Drug Implants. Female. Humans. Magnetic Resonance Imaging. Male. Neoplasm Recurrence, Local. Radiotherapy Dosage. Treatment Outcome

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  • [Copyright] Copyright 2001 S. Karger AG, Basel
  • (PMID = 11359113.001).
  • [ISSN] 1016-2291
  • [Journal-full-title] Pediatric neurosurgery
  • [ISO-abbreviation] Pediatr Neurosurg
  • [Language] eng
  • [Grant] United States / PHS HHS / / 2T 32-N07144
  • [Publication-type] Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] Switzerland
  • [Chemical-registry-number] 0 / Drug Implants; 0 / Iodine Radioisotopes
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32. Gilbert MR, Ruda R, Soffietti R: Ependymomas in adults. Curr Neurol Neurosci Rep; 2010 May;10(3):240-7
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  • [Title] Ependymomas in adults.
  • Ependymomas are rare primary central nervous system tumors in adults.
  • They occur most commonly in the spinal cord, where histopathologic evaluation is critical to differentiate the grade I myxopapillary ependymoma from the grade II ependymoma or grade III anaplastic ependymoma.
  • Brain ependymomas are either grade II or III.
  • Treatment for all grades and types includes maximum surgical resection.
  • For myxopapillary ependymoma, complete removal while maintaining capsule integrity may be curative.
  • Some grade II ependymomas may be observed carefully after imaging confirms complete resection, but grade III tumors require adjuvant radiation treatment.
  • Radiation commonly is given to the region of tumor, except in cases in which there is imaging or cerebrospinal fluid evidence of tumor dissemination.
  • Chemotherapy has not been studied extensively, although most reports suggest only modest benefit.
  • Ongoing laboratory studies have uncovered important signal transduction pathways that may be better therapeutic targets, leading to the development of clinical trials using targeted agents.
  • [MeSH-major] Central Nervous System Neoplasms. Ependymoma

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  • (PMID = 20425040.001).
  • [ISSN] 1534-6293
  • [Journal-full-title] Current neurology and neuroscience reports
  • [ISO-abbreviation] Curr Neurol Neurosci Rep
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 62
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33. Barut F, Kandemir NO, Ozdamar SO, Gul S, Bektas S, Gun BD, Bahadir B: Gliosarcoma with chondroblastic osteosarcomatous differentation: report of two case with clinicopathologic and immunohistochemical features. Turk Neurosurg; 2009 Oct;19(4):417-22
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  • Gliosarcoma is a rare tumor of the central nervous system characterized by a biphasic histological pattern.
  • CASE 1: A 52- year-old male patient underwent parietal craniotomy due to anaplastic ependymoma.
  • The case had radiotherapy and chemotherapy postoperatively.
  • After the first operation, additional resections were performed for tumor because of recurrences at the fourth, seventh and tenth months.
  • The patient died after the last tumor resection.
  • Histopathologic examination of the postmortem biopsy revealed neoplasm displaying a biphasic morphologic pattern including both gliomatous and sarcomatous components.
  • CASE 2: The case was a 69-year-old male patient with a right frontal lobe mass histologically diagnosed as gliosarcoma displaying sarcomatous and glial components.
  • We report two cases with an extremely rare histopathological diagnosis of "gliosarcoma with features of chondroblastic osteosarcoma".
  • [MeSH-minor] Aged. Biopsy. Cell Differentiation. Ependymoma / pathology. Ependymoma / surgery. Fatal Outcome. Humans. Immunohistochemistry. Magnetic Resonance Imaging. Male. Middle Aged. Neoplasm Recurrence, Local / pathology

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  • (PMID = 19847765.001).
  • [ISSN] 1019-5149
  • [Journal-full-title] Turkish neurosurgery
  • [ISO-abbreviation] Turk Neurosurg
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Turkey
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34. Nagai H, Yamasaki T, Yamamoto Y, Takada D, Miyazaki T, Sugimoto K, Matsumoto Y, Akiyama Y, Moritake K: [Evaluation of brain tumors by simultaneous dual isotope SPECT with 201Tl-chloride and 99mTc-MIBI]. No Shinkei Geka; 2004 Oct;32(10):1029-37
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  • Single photon emission computed tomography (SPECT) is useful for detecting brain tumors.
  • In this study, we evaluated the utility of simultaneous dual SPECT with 201Tl-Chloride (Tl) and 99mTc-MIBI (MIBI) for diagnosis of brain tumors.
  • We evaluated 20 cases, including 2 glioblastomas, 7 anaplastic astrocytomas, 2 oligodendrogliomas, 2 anaplastic ependymomas, 2 medulloblastomas, 2 meningiomas, 1 malignant meningioma, 1 pituitary adenoma, and 1 craniopharyngioma.
  • There were no correlations between tumor volume and T/N ratio for the two (ER-Tl; r = 0.0095, DR-TI; r = 0.0050, ER-MIBI; r = 0.036, DR-MIBI; r = 0.254).
  • We discuss the difference in the mechanism of accumulation of two tracers and the significance of simultaneous dual SPECT using them for the differential diagnosis of pituitary tumors, regrowth of oligodendrogliomas, and multidrug resistance of chemotherapy.
  • Dual SPECT with Tl and MIBI appears to be useful for the diagnosis of brain tumor.
  • [MeSH-minor] Adenoma / radionuclide imaging. Adult. Aged. Child. Diagnosis, Differential. Female. Humans. Male. Middle Aged. Pituitary Neoplasms / radionuclide imaging. Thallium. Tomography, Emission-Computed, Single-Photon / methods

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  • (PMID = 15529789.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Radiopharmaceuticals; 0 / Thallium Radioisotopes; 7791-12-0 / thallium chloride; 971Z4W1S09 / Technetium Tc 99m Sestamibi; AD84R52XLF / Thallium
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35. Kano H, Yang HC, Kondziolka D, Niranjan A, Arai Y, Flickinger JC, Lunsford LD: Stereotactic radiosurgery for pediatric recurrent intracranial ependymomas. J Neurosurg Pediatr; 2010 Nov;6(5):417-23
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  • [Title] Stereotactic radiosurgery for pediatric recurrent intracranial ependymomas.
  • OBJECT: To evaluate the role of stereotactic radiosurgery (SRS) in patients with recurrent or residual intracranial ependymomas after resection and fractionated radiation therapy (RT), the authors assessed overall survival, distant tumor relapse, progression-free survival (PFS), and complications.
  • METHODS: The authors retrospectively reviewed the records of 21 children with ependymomas who underwent SRS for 32 tumors.
  • There were 17 boys and 4 girls with a median age of 6.9 years (range 2.9-17.2 years) in the patient population.
  • All patients underwent resection of an ependymoma followed by cranial or neuraxis (if spinal metastases was confirmed) RT.
  • Eleven patients had adjuvant chemotherapy.
  • Twelve patients had low-grade ependymomas (17 tumors), and 9 patients had anaplastic ependymomas (15 tumors).
  • The median radiosurgical target volume was 2.2 cm(3) (range 0.1-21.4 cm(3)), and the median dose to the tumor margin was 15 Gy (range 9-22 Gy).
  • RESULTS: Follow-up imaging demonstrated therapeutic control in 23 (72%) of 32 tumors at a mean follow-up period of 27.6 months (range 6.1-72.8 months).
  • Factors associated with a longer PFS included patients without spinal metastases (p = 0.033) and tumor volumes < 2.2 cm(3) (median tumor volume 2.2 cm(3), p = 0.029).
  • The distant tumor relapse rate despite RT and SRS was 33.6%, 41.0%, and 80.3% at 1, 2, and 3 years, respectively.
  • Factors associated with a higher rate of distant tumor relapse included patients who had spinal metastases before RT (p = 0.037), a fourth ventricle tumor location (p = 0.002), and an RT to SRS interval < 18 months (p = 0.015).
  • Adverse radiation effects developed in 2 patients (9.5%).
  • CONCLUSIONS: Stereotactic radiosurgery offers an additional option beyond repeat surgery or RT in pediatric patients with residual or recurrent ependymomas after initial management.
  • [MeSH-major] Brain Neoplasms / surgery. Ependymoma / surgery. Neoplasm Recurrence, Local / surgery. Neoplasm, Residual / surgery. Radiosurgery
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Combined Modality Therapy. Cranial Irradiation. Disease-Free Survival. Dose Fractionation. Female. Humans. Kaplan-Meier Estimate. Male. Radiotherapy, Adjuvant. Reoperation. Retrospective Studies

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  • (PMID = 21039163.001).
  • [ISSN] 1933-0715
  • [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
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36. Murakami M, Kuratsu J, Takeshima H, Soyama N, Shinojima N, Ushio Y: Spinal seeding of anaplastic ependymoma mimicking fungal meningitis. A case report and review of the literature. J Neurosurg Sci; 2000 Mar;44(1):46-51; discussion 51-2
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  • [Title] Spinal seeding of anaplastic ependymoma mimicking fungal meningitis. A case report and review of the literature.
  • METHODS AND RESULTS: A 19-year-old woman gradually developed increased intracranial hypertension.
  • It was totally removed and histologically diagnosed as an anaplastic ependymoma.
  • Radiation- and chemotherapy were administered postoperatively.
  • The patient reported low back pain 5 months after the surgical treatment.
  • MRI disclosed neither spinal dissemination nor tumor recurrence at the primary site.
  • Lumbar puncture was performed and the cerebrospinal fluid (CSF) was found to have an extremely low glucose level (5 mg/dl); no tumor cells were identified.
  • A slight degree of inflammation and low-grade fever were recorded.
  • A tentative diagnosis of fungal meningitis was made and anti-fungal therapy was administered transventricularly and transvenously.
  • Sequential CSF studies showed that the glucose level remained extremely low, it even decreased to 0 mg/dl Eight months after the surgical treatment, MRI with Gd-DTPA revealed marked subarachnoid enhancement in both intracranial and spinal areas.
  • An open biopsy was performed and a histological diagnosis of intracranial and spinal seeding of the anaplastic ependymoma was returned.
  • CONCLUSIONS: We report a patient with intracranial and spinal seeding of an anaplastic ependymoma that mimicked fungal meningitis.
  • We discuss the difficulty of obtaining a differential diagnosis in this case and describe the mechanism of the decreased CSF glucose level.
  • [MeSH-major] Ependymoma / diagnosis. Meningeal Neoplasms / diagnosis. Meningitis, Fungal / diagnosis. Neoplasm Seeding


37. Lin YH, Huang CI, Wong TT, Chen MH, Shiau CY, Wang LW, Ming-Tak Ho D, Yen SH: Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy. J Neurooncol; 2005 Jan;71(2):205-10

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  • [Title] Treatment of spinal cord ependymomas by surgery with or without postoperative radiotherapy.
  • PURPOSE: To evaluate the effectiveness of complete resection and postoperative radiotherapy in spinal cord ependymomas.
  • METHODS AND MATERIALS: We conducted a retrospective study over 20 patients (13 males and 7 females) with histologically confirmed spinal cord ependymomas between July 1985 and April 2001.
  • Among them, 13 patients had ependymomas, 6 had myxopapillary ependymomas, and 1 had anaplastic ependymoma.
  • All patients received radical surgery for tumor removal with 13 patients achieving complete resection and 7 incomplete resection due to technical difficulty.
  • Among those with incomplete resection, 6 patients received postoperative radiotherapy to tumor bed and only one patient with anaplastic ependymoma received surgery alone.
  • The total tumor dose ranged from 50 to 60 Gy.
  • The median survival time of all patients was 109 months, with 104 months in the complete resection alone group and 135 months in the incomplete resection with postoperative radiotherapy group.
  • One patient with anaplastic ependymoma and no postoperative radiotherapy developed leptomeningeal seeding 9 months after surgery.
  • Salvage therapy of radiotherapy and chemotherapy maintained normal neurological functions.
  • The patient expired 34 months from the initial diagnosis due to progression of leptomeningeal seeding.
  • CONCLUSION: Complete resection alone in spinal cord ependymoma can achieve excellent local control and survival.
  • Local radiotherapy with 50-60 Gy is effective and safe.
  • [MeSH-major] Ependymoma / radiotherapy. Ependymoma / surgery. Spinal Cord Neoplasms / radiotherapy. Spinal Cord Neoplasms / surgery
  • [MeSH-minor] Adult. Aged. Child. Combined Modality Therapy. Female. Humans. Male. Middle Aged. Neoplasm Recurrence, Local / therapy. Nervous System / physiopathology. Retrospective Studies. Salvage Therapy. Survival Analysis. Treatment Outcome

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  • (PMID = 15690140.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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38. Okcu MF, Selvan M, Wang LE, Stout L, Erana R, Airewele G, Adatto P, Hess K, Ali-Osman F, Groves M, Yung AW, Levin VA, Wei Q, Bondy M: Glutathione S-transferase polymorphisms and survival in primary malignant glioma. Clin Cancer Res; 2004 Apr 15;10(8):2618-25
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  • [Title] Glutathione S-transferase polymorphisms and survival in primary malignant glioma.
  • PURPOSE: The purpose of this research was to investigate the relationship between glutathione S-transferase (GST) polymorphisms and survival, and chemotherapy-related toxicity in 278 glioma patients.
  • RESULTS: For patients with anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic oligoastrocytoma, and anaplastic ependymoma (n = 78), patients with GSTP1*A/*A-M1 null genotype survived longer than did the rest of the group (median survival "not achieved," and 41 months, respectively; P = 0.06).
  • Among patients treated with nitrosoureas (n = 108), those with GSTP1*A/*A and GSTM1 null genotype were 5.7 times (95% confidence interval, 0.9-37.4) more likely to experience an adverse event secondary to chemotherapy, compared with the others.
  • CONCLUSIONS: In patients with anaplastic astrocytoma, anaplastic oligodendroglioma, and anaplastic oligoastrocytoma, combination of germ-line GSTP1*A/*A and GSTM1 null genotype confers a survival advantage.
  • Patients with this genotype also have an increased risk of adverse events secondary to chemotherapy that primarily comprised nitrosourea alkylating agents.
  • [MeSH-minor] Adult. Astrocytoma / genetics. Ependymoma / genetics. Female. Genotype. Glutathione S-Transferase pi. Humans. Logistic Models. Male. Middle Aged. Neoplasm Metastasis. Oligodendroglioma / genetics. Polymerase Chain Reaction. Polymorphism, Restriction Fragment Length. Proportional Hazards Models. Time Factors. Treatment Outcome

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  • (PMID = 15102663.001).
  • [ISSN] 1078-0432
  • [Journal-full-title] Clinical cancer research : an official journal of the American Association for Cancer Research
  • [ISO-abbreviation] Clin. Cancer Res.
  • [Language] eng
  • [Grant] United States / NCI NIH HHS / CA / CA70917
  • [Publication-type] Journal Article; Research Support, U.S. Gov't, P.H.S.
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Isoenzymes; EC 2.5.1.- / glutathione S-transferase T1; EC 2.5.1.18 / GSTP1 protein, human; EC 2.5.1.18 / Glutathione S-Transferase pi; EC 2.5.1.18 / Glutathione Transferase; EC 2.5.1.18 / glutathione S-transferase M1
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39. Patel R, Shervington L, Lea R, Shervington A: Epigenetic silencing of telomerase and a non-alkylating agent as a novel therapeutic approach for glioma. Brain Res; 2008 Jan 10;1188:173-81
Hazardous Substances Data Bank. TAXOL .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Epigenetic silencing of telomerase and a non-alkylating agent as a novel therapeutic approach for glioma.
  • While treatment with 5azadC downregulated hTERT and upregulated MGMT expression in two glioma cell lines, there was no change in the expression of these two genes in the normal cell line.
  • However, cell viability was reduced as a result of 5azadC treatment in all three cell lines.
  • 5azadC treatment reduced telomerase expression and activity and subsequently enhanced chemosensitivity towards cisplatin, taxol and tamoxifen but not with the alkylating agents temozolomide (TMZ), carmustine and chlorambucil.
  • To further evaluate the effect of these findings, the level of hTERT and MGMT expression was measured in a recurrent anaplastic ependymoma, seven glioblastoma and two normal brain tissues.
  • While four of eight gliomas and one of the normal tissues expressed MGMT, hTERT was expressed in all gliomas but not in the normal brain tissue.
  • Results of this study suggest that taxol together with 5azadC may be a good therapeutic combination for glioma.
  • In addition, the work on cell lines can be repeated on tissues utilizing hTERT as the therapeutic target for demethylation using 5azadC in glioma.
  • [MeSH-major] Azacitidine / analogs & derivatives. Brain Neoplasms / drug therapy. Brain Neoplasms / genetics. Gene Silencing / drug effects. Glioma / drug therapy. Glioma / genetics. Telomerase / genetics
  • [MeSH-minor] Antimetabolites, Antineoplastic / pharmacology. Antimetabolites, Antineoplastic / therapeutic use. Antineoplastic Agents, Phytogenic / pharmacology. Antineoplastic Agents, Phytogenic / therapeutic use. Antineoplastic Combined Chemotherapy Protocols / pharmacology. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Cell Aging / drug effects. Cell Aging / genetics. Cell Line, Tumor. DNA Methylation / drug effects. Dose-Response Relationship, Drug. Down-Regulation / drug effects. Down-Regulation / genetics. Drug Resistance, Neoplasm / drug effects. Drug Resistance, Neoplasm / genetics. Gene Expression Regulation, Enzymologic / drug effects. Gene Expression Regulation, Enzymologic / genetics. Gene Expression Regulation, Neoplastic / drug effects. Gene Expression Regulation, Neoplastic / genetics. Humans. Methyltransferases / antagonists & inhibitors. Methyltransferases / metabolism. Paclitaxel / pharmacology. Paclitaxel / therapeutic use. RNA, Messenger / drug effects. RNA, Messenger / metabolism

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  • (PMID = 18021753.001).
  • [ISSN] 0006-8993
  • [Journal-full-title] Brain research
  • [ISO-abbreviation] Brain Res.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Antineoplastic Agents, Phytogenic; 0 / RNA, Messenger; 776B62CQ27 / decitabine; EC 2.1.1.- / Methyltransferases; EC 2.7.7.49 / Telomerase; M801H13NRU / Azacitidine; P88XT4IS4D / Paclitaxel
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40. Benesch M, Siegler N, Hoff Kv, Lassay L, Kropshofer G, Müller H, Sommer C, Rutkowski S, Fleischhack G, Urban C: Safety and toxicity of intrathecal liposomal cytarabine (Depocyte) in children and adolescents with recurrent or refractory brain tumors: a multi-institutional retrospective study. Anticancer Drugs; 2009 Oct;20(9):794-9
Hazardous Substances Data Bank. CYTARABINE .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • Nineteen heavily pretreated patients (males, n = 14; females, n = 5; median age at diagnosis 8.5 years; range, 1.4-22 years) were given intrathecal liposomal cytarabine on a compassionate use basis for recurrent refractory medulloblastoma (n = 12), mixed germ cell tumor (n = 2), central nervous system primitive neuroectodermal tumors of the pons (n = 1), anaplastic ependymoma (n = 1), anaplastic oligodendroglioma (n = 1), atypical teratoid rhabdoid tumor (n = 1), or rhabdoid papillary meningioma (n = 1).
  • Duration of treatment ranged from (1/2) to 10 months.
  • Eleven patients (57.9%) did not show any side effects, whereas eight patients (42.1%) developed side effects related to either chemical arachnoiditis (n = 4) or neurological progression (n = 2).
  • Less typical treatment-related symptoms (e.g. lethargy, ataxia, and slurred speech) were observed in two patients.
  • Treatment with intrathecal liposomal cytarabine was discontinued twice because of side effects.
  • [MeSH-major] Antimetabolites, Antineoplastic / adverse effects. Brain Neoplasms / drug therapy. Cytarabine / administration & dosage. Cytarabine / adverse effects
  • [MeSH-minor] Adolescent. Child. Child, Preschool. Compassionate Use Trials. Delayed-Action Preparations. Drug Resistance, Neoplasm. Female. Humans. Infant. Injections, Spinal. Liposomes / administration & dosage. Male. Retrospective Studies. Salvage Therapy. Young Adult

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  • (PMID = 19617818.001).
  • [ISSN] 1473-5741
  • [Journal-full-title] Anti-cancer drugs
  • [ISO-abbreviation] Anticancer Drugs
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article; Multicenter Study
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Delayed-Action Preparations; 0 / Liposomes; 04079A1RDZ / Cytarabine
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41. Kortmann RD, Timmermann B, Rutkowski S, Bamberg M: Re: B. Beuthien-Baumann, et al. Differentiation between recurrent tumor and radiation necrosis in a child with anaplastic ependymoma after chemotherapy and radiation therapy. Strahlenther Onkol 2003;179:819-22. Strahlenther Onkol; 2004 Apr;180(4):245
MedlinePlus Health Information. consumer health - Radiation Therapy.

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Re: B. Beuthien-Baumann, et al. Differentiation between recurrent tumor and radiation necrosis in a child with anaplastic ependymoma after chemotherapy and radiation therapy. Strahlenther Onkol 2003;179:819-22.
  • [MeSH-major] Brain Neoplasms / radiotherapy. Ependymoma / radiotherapy. Necrosis. Neoplasm Recurrence, Local / diagnosis. Radiation Injuries / diagnosis. Radiotherapy / adverse effects
  • [MeSH-minor] Brain / pathology. Child. Combined Modality Therapy. Diagnosis, Differential. Dose Fractionation. Humans. Radiotherapy Dosage. Tomography, Emission-Computed






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