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[PMID]:28463155
[Au] Autor:Nanda RH; Ganju RG; Schreibmann E; Chen Z; Zhang C; Jegadeesh N; Cassidy R; Deng C; Eaton BR; Esiashvili N
[Ad] Endereço:Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia. Electronic address: rhazari@emory.edu.
[Ti] Título:Correlation of Acute and Late Brainstem Toxicities With Dose-Volume Data for Pediatric Patients With Posterior Fossa Malignancies.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):360-366, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Radiation-induced brainstem toxicity after treatment of pediatric posterior fossa malignancies is incompletely understood, especially in the era of intensity modulated radiation therapy (IMRT). The rates of, and predictive factors for, brainstem toxicity after photon RT for posterior fossa tumors were examined. METHODS AND MATERIALS: After institutional review board approval, 60 pediatric patients treated at our institution for nonmetastatic infratentorial ependymoma and medulloblastoma with IMRT were included in the present analysis. Dosimetric variables, including the mean and maximum dose to the brainstem, the dose to 10% to 90% of the brainstem (in 10% increments), and the volume of the brainstem receiving 40, 45, 50, and 55 Gy were recorded for each patient. Acute (onset within 3 months) and late (>3 months of RT completion) RT-induced brainstem toxicities with clinical and radiographic correlates were scored using Common Terminology Criteria for Adverse Events, version 4.0. RESULTS: Patients aged 1.4 to 21.8 years underwent IMRT or volumetric arc therapy postoperatively to the posterior fossa or tumor bed. At a median clinical follow-up period of 2.8 years, 14 patients had developed symptomatic brainstem toxicity (crude incidence 23.3%). No correlation was found between the dosimetric variables examined and brainstem toxicity. Vascular injury or ischemia showed a strong trend toward predicting brainstem toxicity (P=.054). Patients with grade 3 to 5 brainstem toxicity had undergone treatment to significant volumes of the posterior fossa. CONCLUSION: The results of the present series demonstrate a low, but not negligible, risk of brainstem radiation necrosis for pediatric patients with posterior fossa malignancies treated with IMRT. No specific dose-volume correlations were identified; however, modern treatment volumes might help limit the incidence of severe toxicity. Additional work investigating inherent biologic sensitivity might also provide further insight into this clinical problem.
[Mh] Termos MeSH primário: Tronco Encefálico/efeitos da radiação
Neoplasias Cerebelares/radioterapia
Ependimoma/radioterapia
Neoplasias Infratentoriais/radioterapia
Meduloblastoma/radioterapia
Lesões por Radiação/patologia
Radioterapia de Intensidade Modulada/efeitos adversos
[Mh] Termos MeSH secundário: Doença Aguda
Adolescente
Tronco Encefálico/patologia
Neoplasias Cerebelares/patologia
Neoplasias Cerebelares/cirurgia
Criança
Pré-Escolar
Ependimoma/patologia
Ependimoma/cirurgia
Feminino
Seguimentos
Seres Humanos
Lactente
Neoplasias Infratentoriais/patologia
Neoplasias Infratentoriais/cirurgia
Masculino
Meduloblastoma/patologia
Meduloblastoma/cirurgia
Necrose/etiologia
Dosagem Radioterapêutica
Radioterapia de Intensidade Modulada/métodos
Fatores de Tempo
Carga Tumoral
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:28863455
[Au] Autor:Amani V; Donson AM; Lummus SC; Prince EW; Griesinger AM; Witt DA; Hankinson TC; Handler MH; Dorris K; Vibhakar R; Foreman NK; Hoffman LM
[Ad] Endereço:Morgan Adams Foundation Pediatric Brain Tumor Research Program; Department of Pathology; and Department of Neurosurgery, University of Colorado Anschutz Medical Campus; and Children's Hospital Colorado, Aurora, Colorado.
[Ti] Título:Characterization of 2 Novel Ependymoma Cell Lines With Chromosome 1q Gain Derived From Posterior Fossa Tumors of Childhood.
[So] Source:J Neuropathol Exp Neurol;76(7):595-604, 2017 Jul 01.
[Is] ISSN:1554-6578
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Ependymoma (EPN) is a common brain tumor of childhood that, despite standard surgery and radiation therapy, has a relapse rate of 50%. Clinical trials have been unsuccessful in improving outcome by addition of chemotherapy, and identification of novel therapeutics has been hampered by a lack of in vitro and in vivo models. We describe 2 unique EPN cell lines (811 and 928) derived from recurrent intracranial metastases. Both cell lines harbor the high-risk chromosome 1q gain (1q+) and a derivative chromosome 6, and both are classified as molecular group A according to transcriptomic analysis. Transcriptional enrichment of extracellular matrix-related genes was a common signature of corresponding primary tumors and cell lines in both monolayer and 3D formats. EPN cell lines, when cultured in 3D format, clustered closer to the primary tumors with better fidelity of EPN-specific transcripts than when grown as a monolayer. Additionally, 3D culture revealed ependymal rosette formation and cilia-related ontologies, similar to in situ tumors. Our data confirm the validity of the 811 and 928 cell lines as representative models of intracranial, posterior fossa 1q+ EPN, which holds potential to advance translational science for patients affected by this tumor.
[Mh] Termos MeSH primário: Linhagem Celular Tumoral/patologia
Aberrações Cromossômicas
Cromossomos Humanos Par 1/genética
Ependimoma/patologia
Neoplasias Infratentoriais/genética
Neoplasias Infratentoriais/patologia
[Mh] Termos MeSH secundário: Criança
Análise Citogenética
Proteínas de Ligação a DNA/metabolismo
Ependimoma/genética
Perfilação da Expressão Gênica
Proteína Glial Fibrilar Ácida/metabolismo
Seres Humanos
Imagem Tridimensional
Antígeno Ki-67/metabolismo
Masculino
Análise em Microsséries
Microscopia Confocal
Mucina-1/metabolismo
Proteínas Nucleares/metabolismo
Receptores de HIV/metabolismo
Fatores de Transcrição/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (C9orf24 protein, human); 0 (DNA-Binding Proteins); 0 (Glial Fibrillary Acidic Protein); 0 (Ki-67 Antigen); 0 (Mucin-1); 0 (Nef receptor); 0 (Nuclear Proteins); 0 (Receptors, HIV); 0 (Transcription Factors)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170914
[Lr] Data última revisão:
170914
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170903
[St] Status:MEDLINE
[do] DOI:10.1093/jnen/nlx040


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[PMID]:28602925
[Au] Autor:Choque-Velasquez J; Colasanti R; Resendiz-Nieves JC; Jahromi BR; Kozyrev DA; Thiarawat P; Hernesniemi J
[Ad] Endereço:Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland. Electronic address: johchove@hotmail.com.
[Ti] Título:Supracerebellar Infratentorial Paramedian Approach in Helsinki Neurosurgery: Cornerstones of a Safe and Effective Route to the Pineal Region.
[So] Source:World Neurosurg;105:534-542, 2017 Sep.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The supracerebellar infratentorial (SCIT) paramedian approach in sitting position represents one of the most used surgical routes for dealing with pineal region lesions. The purpose of this study is to determine the cornerstones to perform this approach in a simple, safe, and effective way, so that it could be easily reproduced in other neurosurgical centers, particularly in those with modest resources. METHODS: We reviewed and analyzed the surgical videos of 24 pineal region lesions that were operated on through an SCIT approach between June 2012 and October 2015. The SCIT approach may be divided into 3 main steps: 1) skin-muscle incision; 2) craniotomy; and 3) dura opening and access to the pineal region. RESULTS: Complete lesion removal was accomplished in 23 cases, and subtotal removal was accomplished in 1 case. The pineal region was effectively and safely reached through the SCIT approach in the sitting position with a mean time of 14 minutes, using a basic set of microsurgical instruments. Cornerstones and potential delaying events were carefully recorded for each of the 3 main steps of the approach. Moreover, we present in a short video a step-by-step guide to perform the SCIT approach in a fast and safe way. CONCLUSIONS: A correct application of microsurgical principles may allow to safely and rapidly perform the SCIT approach, therefore offering an effective and relatively atraumatic route for dealing with pineal region lesions.
[Mh] Termos MeSH primário: Cerebelo/cirurgia
Neoplasias Infratentoriais/cirurgia
Microcirurgia/métodos
Procedimentos Neurocirúrgicos/métodos
Glândula Pineal/cirurgia
Pinealoma/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Cerebelo/diagnóstico por imagem
Criança
Pré-Escolar
Feminino
Seres Humanos
Neoplasias Infratentoriais/diagnóstico por imagem
Masculino
Meia-Idade
Posicionamento do Paciente/métodos
Glândula Pineal/diagnóstico por imagem
Pinealoma/diagnóstico por imagem
Estudos Retrospectivos
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170613
[St] Status:MEDLINE


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[PMID]:28291428
[Au] Autor:Dewan MC; Lim J; Shannon CN; Wellons JC
[Ad] Endereço:Division of Pediatric Neurosurgery, Department of Neurological Surgery, Vanderbilt University Medical School, Nashville, Tennessee.
[Ti] Título:The durability of endoscopic third ventriculostomy and ventriculoperitoneal shunts in children with hydrocephalus following posterior fossa tumor resection: a systematic review and time-to-failure analysis.
[So] Source:J Neurosurg Pediatr;19(5):578-584, 2017 May.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Up to one-third of patients with a posterior fossa brain tumor (PFBT) will experience persistent hydrocephalus mandating permanent CSF diversion. The optimal hydrocephalus treatment modality is unknown; the authors sought to compare the durability between endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) therapy in the pediatric population. METHODS The authors conducted a systematic review of articles indexed in PubMed between 1986 and 2016 describing ETV and/or VPS treatment success/failure and time-to-failure rate in patients < 19 years of age with hydrocephalus related to a PFBT. Additionally, the authors conducted a retrospective review of their institutional series of PFBT patients requiring CSF diversion. Patient data from the systematic review and from the institutional series were aggregated and a time-to-failure analysis was performed comparing ETV and VPS using the Kaplan-Meier method. RESULTS A total of 408 patients were included from 12 studies and the authors' institutional series: 284 who underwent ETV and 124 who underwent VPS placement. The analysis included uncontrolled studies with variable method and timing of CSF diversion and were subject to surgeon bias. No significant differences between cohorts were observed with regard to age, sex, tumor grade or histology, metastatic status, or extent of resection. The cumulative failure rate of ETV was 21%, whereas that of VPS surgery was 29% (p = 0.105). The median time to failure was earlier for ETV than for VPS surgery (0.82 [IQR 0.2-1.8] vs 4.7 months [IQR 0.3-5.7], p = 0.03). Initially the ETV survival curve dropped sharply and then stabilized around 2 months. The VPS curve fell gradually but eventually crossed below the ETV curve at 5.7 months. Overall, a significant survival advantage was not demonstrated for one procedure over the other (p = 0.21, log-rank). However, postoperative complications were higher following VPS (31%) than ETV (17%) (p = 0.012). CONCLUSIONS ETV failure occurred sooner than VPS failure, but long-term treatment durability may be higher for ETV. Complications occurred more commonly with VPS than with ETV. Limited clinical conclusions are drawn using this methodology; the optimal treatment for PFBT-related hydrocephalus warrants investigation through prospective studies.
[Mh] Termos MeSH primário: Hidrocefalia/cirurgia
Neoplasias Infratentoriais/cirurgia
Neuroendoscopia
Complicações Pós-Operatórias/cirurgia
Derivação Ventriculoperitoneal
Ventriculostomia
[Mh] Termos MeSH secundário: Criança
Análise de Falha de Equipamento
Seres Humanos
Hidrocefalia/etiologia
Complicações Pós-Operatórias/etiologia
Terceiro Ventrículo/cirurgia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1705
[Cu] Atualização por classe:170526
[Lr] Data última revisão:
170526
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170315
[St] Status:MEDLINE
[do] DOI:10.3171/2017.1.PEDS16536


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[PMID]:28232638
[Au] Autor:Valvi S; Ziegler DS
[Ad] Endereço:Princess Margaret Hospital for Children, Perth, Western Australia, Australia; santosh.valvi@health.wa.gov.au.
[Ti] Título:Ganglioglioma Arising From Desmoplastic Medulloblastoma: A Case Report and Review of Literature.
[So] Source:Pediatrics;139(3), 2017 Mar.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We describe a case of medulloblastoma maturating into ganglioglioma during therapy. A 10-month-old boy was diagnosed with a desmoplastic medulloblastoma and was treated with gross total resection followed by induction chemotherapy. A recurrence in the tumor bed during therapy was managed with focal radiation therapy and consolidation chemotherapy. After further progression, the recurrent tumor was resected completely. The histopathology revealed a benign ganglioglioma with no residual medulloblastoma. This case raises the possibility that a malignant medulloblastoma can differentiate into a benign tumor and suggests that differentiation therapy may have value in the treatment of medulloblastoma.
[Mh] Termos MeSH primário: Neoplasias Cerebelares/patologia
Ganglioglioma/patologia
Neoplasias Infratentoriais/patologia
Meduloblastoma/patologia
Segunda Neoplasia Primária/patologia
[Mh] Termos MeSH secundário: Criança
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170628
[Lr] Data última revisão:
170628
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170225
[St] Status:MEDLINE


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[PMID]:28187964
[Au] Autor:Li MD; Forkert ND; Kundu P; Ambler C; Lober RM; Burns TC; Barnes PD; Gibbs IC; Grant GA; Fisher PG; Cheshier SH; Campen CJ; Monje M; Yeom KW
[Ad] Endereço:Department of Radiology, Lucile Packard Children's Hospital, Stanford University, Stanford, CA.
[Ti] Título:Brain Perfusion and Diffusion Abnormalities in Children Treated for Posterior Fossa Brain Tumors.
[So] Source:J Pediatr;185:173-180.e3, 2017 Jun.
[Is] ISSN:1097-6833
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To compare cerebral perfusion and diffusion in survivors of childhood posterior fossa brain tumor with neurologically normal controls and correlate differences with cognitive dysfunction. STUDY DESIGN: We analyzed retrospectively arterial spin-labeled cerebral blood flow (CBF) and apparent diffusion coefficient (ADC) in 21 patients with medulloblastoma (MB), 18 patients with pilocytic astrocytoma (PA), and 64 neurologically normal children. We generated ANCOVA models to evaluate treatment effects on the cerebral cortex, thalamus, caudate, putamen, globus pallidus, hippocampus, amygdala, nucleus accumbens, and cerebral white matter at time points an average of 5.7 years after original diagnosis. A retrospective review of patient charts identified 12 patients with neurocognitive data and in whom the relationship between IQ and magnetic resonance imaging variables was assessed for each brain structure. RESULTS: Patients with MB (all treated with surgery, chemotherapy, and radiation) had significantly lower global CBF relative to controls (10%-23% lower, varying by anatomic region, all adjusted P?
[Mh] Termos MeSH primário: Encéfalo/patologia
Circulação Cerebrovascular/fisiologia
Neoplasias Infratentoriais/fisiopatologia
[Mh] Termos MeSH secundário: Adolescente
Astrocitoma/fisiopatologia
Astrocitoma/terapia
Encéfalo/diagnóstico por imagem
Estudos de Casos e Controles
Criança
Pré-Escolar
Estudos Transversais
Feminino
Seres Humanos
Neoplasias Infratentoriais/terapia
Imagem por Ressonância Magnética
Masculino
Meduloblastoma/fisiopatologia
Meduloblastoma/terapia
Testes Neuropsicológicos
Fluxo Sanguíneo Regional/fisiologia
Estudos Retrospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170212
[St] Status:MEDLINE


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[PMID]:28179177
[Au] Autor:Onishi S; Hirose T; Takayasu T; Nosaka R; Kolakshyapati M; Saito T; Akiyama Y; Sugiyama K; Kurisu K; Yamasaki F
[Ad] Endereço:Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Minami-ku, Hiroshima-city, Hiroshima, Japan.
[Ti] Título:Advantage of High b Value Diffusion-Weighted Imaging for Differentiation of Hemangioblastoma from Brain Metastases in Posterior Fossa.
[So] Source:World Neurosurg;101:643-650, 2017 May.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: It is sometimes difficult to make a differential diagnosis between brain metastases and hemangioblastomas in the posterior fossa. We assessed whether high b value diffusion-weighted image (DWI) at b = 4000 could differentiate these tumors. METHODS: We acquired DWI at 3-T magnetic resonance imaging with b = 1000 and b = 4000 seconds/mm in histologically confirmed 12 patients of hemangioblastoma without von Hippel-Lindau disease and 16 patients with brain metastases originating at the posterior fossa. Apparent diffusion coefficient (ADC) values were measured by manually placing regions of interest on ADC maps at the site of enhanced tumor confirmed on contrast-enhanced T1- weighed image. ADC was expressed as the minimum (ADC ), mean (ADC ), and maximum (ADC ) values. RESULTS: All the ADC values of hemangioblastomas were statistically higher than those of metastatic tumor in both b = 1000 and b = 4000 (P < 0.0001 in ADC , ADC , and ADC ; Mann-Whitney U test). With the cutoff value at 0.6 × 10 mm /second, the positive predictive value of ADC at b = 4000 was higher than that of ADC at b = 1000 (100% vs. 89.3%, logistic analysis) to differentiate hemangioblastomas from brain metastases. Moreover, we studied the pathologic subtype of hemangioblastoma and confirmed that ADCs (b = 4000 ) of cellular subtype were statistically lower than those of reticular subtype (P = 0.03; Mann-Whitney U test). CONCLUSIONS: High b value DWI reflects diffusion more accurately than does regular b value. Our results showed that ADC calculation by high b value (b = 4000) DWI at 3-T magnetic resonance imaging is clinically useful for differentiating hemangioblastomas from brain metastases.
[Mh] Termos MeSH primário: Neoplasias Cerebelares/diagnóstico por imagem
Imagem de Difusão por Ressonância Magnética/métodos
Hemangioblastoma/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Neoplasias Encefálicas/diagnóstico por imagem
Neoplasias Encefálicas/cirurgia
Neoplasias Cerebelares/cirurgia
Diagnóstico Diferencial
Imagem de Difusão por Ressonância Magnética/normas
Feminino
Hemangioblastoma/cirurgia
Seres Humanos
Neoplasias Infratentoriais/diagnóstico por imagem
Neoplasias Infratentoriais/cirurgia
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170210
[St] Status:MEDLINE


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[PMID]:28137902
[Au] Autor:Gama I; Almeida L
[Ad] Endereço:Ophthalmology Department, University Hospital Santa Maria, North Lisbon Hospital Center, Lisbon, Portugal.
[Ti] Título:Lhermitte-Duclos disease associated to Cowden syndrome: de novo diagnosis and management of these extremely rare syndromes in a patient.
[So] Source:BMJ Case Rep;2017, 2017 Jan 30.
[Is] ISSN:1757-790X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:A 36-year-old woman, with history of cutaneous papilomatosis and thyroid carcinoma presented with headache, transitory visual blurring and nausea. Funduscopy showed papilloedema. MRI showed a tumour of the right cerebellar hemisphere with a striated, tigroid pattern, typical of Lhermitte-Duclos disease (LDD). Significant clinical and perimetric improvements were noted after surgery and the follow-up did not reveal recurrences of the tumour. LDD is an extremely rare differential diagnosis of posterior fossa tumours. LDD and the history of thyroid carcinoma permitted us to diagnose Cowden syndrome (CS). We present a clinical case that supports the possibility of performing a preoperative diagnosis of LDD based on MRI features. We review the diagnosis and management of LDD and CS. This report highlights the importance of excluding CS after LDD diagnosis, of monitoring the optic nerve postoperatively using optical coherence tomography and of prompt treatment that can potentially prevent visual function loss.
[Mh] Termos MeSH primário: Ganglioneuroma/diagnóstico por imagem
Síndrome do Hamartoma Múltiplo/diagnóstico
Neoplasias Infratentoriais/diagnóstico por imagem
Papiledema/diagnóstico
[Mh] Termos MeSH secundário: Adulto
Feminino
Ganglioneuroma/complicações
Síndrome do Hamartoma Múltiplo/complicações
Seres Humanos
Neoplasias Infratentoriais/complicações
Imagem por Ressonância Magnética
Nervo Óptico/diagnóstico por imagem
Papiledema/etiologia
Papiloma/complicações
Doenças Raras
Neoplasias Cutâneas/complicações
Neoplasias da Glândula Tireoide/complicações
Tomografia de Coerência Óptica
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170306
[Lr] Data última revisão:
170306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170201
[St] Status:MEDLINE


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[PMID]:27986346
[Au] Autor:Giantsoudi D; Adams J; MacDonald SM; Paganetti H
[Ad] Endereço:Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: dgiantsoudi@mgh.harvard.edu.
[Ti] Título:Proton Treatment Techniques for Posterior Fossa Tumors: Consequences for Linear Energy Transfer and Dose-Volume Parameters for the Brainstem and Organs at Risk.
[So] Source:Int J Radiat Oncol Biol Phys;97(2):401-410, 2017 Feb 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: In proton therapy of posterior fossa tumors, at least partial inclusion of the brainstem in the target is necessary because of its proximity to the tumor and required margins. Additionally, the preferred beam geometry results in directing the field distal edge toward this critical structure, raising concerns for brainstem toxicity. Some treatment techniques place the beam's distal edge within the brainstem (dose-sparing techniques), and others avoid elevated linear energy transfer (LET) of the proton field by placing the distal edge beyond it (LET-sparing techniques). Hybrid approaches are also being used. We examine the dosimetric efficacy of these techniques, accounting for LET-dependent and dose-dependent variable relative biologic effectiveness (RBE) distributions. METHODS: Six techniques were applied in ependymoma cases: (a) 3-field dose-sparing; (b) 3-field LET-sparing; (c) 2-field dose-sparing, wide angles; (d) 2-field LET-sparing, wide angles; (e) 2-field LET-sparing, steep angles; and (f) 2-field LET-sparing with feathered distal end. Monte Carlo calculated dose, LET, and RBE-weighted dose distributions were compared. RESULTS: Decreased LET values in the brainstem by LET-sparing techniques were accompanied by higher, not statistically significant, median dose: 53.6 Gy(RBE), 53.4 Gy(RBE), and 54.3 Gy(RBE) for techniques (b), (d), and (e) versus 52.1 Gy(RBE) for technique (a). Accounting for variable RBE distributions, the brainstem volume receiving at least 55 Gy(RBE) increased from 72.5% for technique (a) to 80.3% for (b) (P<.01) and from 70.7% for technique (c) to 77.6% for (d) (P<.01). Less than 2%, but statistically significant, decrease in maximum variable RBE-weighted brainstem dose was observed for the LET-sparing techniques compared with the corresponding dose-sparing (P=.03 and .004). CONCLUSIONS: Extending the proton range beyond the brainstem to reduce LET results in clinically comparable maximum radiobiologic effective dose to this sensitive structure. However this method significantly increasing the brainstem volume receiving RBE-weighted dose higher than 55 Gy(RBE) with possible consequences based on known dose-volume parameters for increased toxicity.
[Mh] Termos MeSH primário: Tronco Encefálico/efeitos da radiação
Ependimoma/radioterapia
Neoplasias Infratentoriais/radioterapia
Transferência Linear de Energia
Órgãos em Risco/efeitos da radiação
Terapia com Prótons/métodos
[Mh] Termos MeSH secundário: Algoritmos
Tronco Encefálico/diagnóstico por imagem
Relação Dose-Resposta à Radiação
Ependimoma/diagnóstico por imagem
Seres Humanos
Neoplasias Infratentoriais/diagnóstico por imagem
Método de Monte Carlo
Tratamentos com Preservação do Órgão/efeitos adversos
Tratamentos com Preservação do Órgão/métodos
Órgãos em Risco/diagnóstico por imagem
Terapia com Prótons/efeitos adversos
Radiometria/métodos
Planejamento da Radioterapia Assistida por Computador/métodos
Eficiência Biológica Relativa
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161218
[St] Status:MEDLINE


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[PMID]:27936528
[Au] Autor:Gupta K; Karthigeyan M; Salunke P
[Ti] Título:Infratentorial ganglioglioma mimicking pilocytic astrocytoma.
[So] Source:Clin Neuropathol;36 (2017)(2):78-82, 2017 Mar/Apr.
[Is] ISSN:0722-5091
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Majority of tumors arising in posterior fossa in children are pilocytic astrocytoma. However, a small subset of these have a neuronal component that may either be admixed throughout with the glial component or may be segregated to one or two regions within the glial element. Interestingly, the radiological features of this subgroup are also distinctive, showing midline location, frequent cyst formation, hemorrhage, and circumscribed nature. Taken together, both radiological and pathological features can fairly predict the subgroup categorization within infratentorial gangliogliomas (GG), as has been recently elucidated. Moreover, these are characterized by distinct molecular abnormalities that are therapeutically targetable, making their recognition critical. We describe an example of infratentorial tumor with its radiology and morphological features distinct enough to place it under the category of GG, group II or pilocytic astrocytoma with gangliocytic differentiation.
.
[Mh] Termos MeSH primário: Astrocitoma/diagnóstico
Diagnóstico Diferencial
Ganglioglioma/diagnóstico
Neoplasias Infratentoriais/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Astrocitoma/patologia
Biomarcadores Tumorais/análise
Feminino
Ganglioglioma/patologia
Seres Humanos
Imuno-Histoquímica
Neoplasias Infratentoriais/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers, Tumor)
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170320
[Lr] Data última revisão:
170320
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161213
[St] Status:MEDLINE
[do] DOI:10.5414/NP300974



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