Pre-operative chemoradiotherapy (CRT) is a preferable treatment option for patients with locally advanced rectal cancer. However, few data are available regarding pre-operative CRT for locally advanced colon cancer. Here, we describe two cases of successful treatment with pre-operative CRT and establish evidence supporting this treatment option in patients with locally advanced colon cancer. In the first case, a 65-year-old woman was diagnosed with ascending colon cancer with duodenal invasion. In the second case, a 63-year-old man was diagnosed with a colonic-duodenal fistula due to transverse colon cancer invasion. These case reports will help to establish a treatment consensus for pre-operative CRT in patients with locally advanced colon cancer.
Aged ; Chemoradiotherapy ; Colon ; Colon, Ascending ; Colon, Transverse ; Colonic Neoplasms ; Consensus ; Female ; Fistula ; Humans ; Middle Aged ; Rectal Neoplasms

BACKGROUND: In this study, we investigated the effects of reduced-dose craniospinal radiotherapy (CSRT) followed by tandem high-dose chemotherapy (HDCT) with autologous stem cell rescue (ASCR) in children with a newly diagnosed high-risk medulloblastoma (MB) or supratentorial primitive neuroectodermal tumor (sPNET). METHODS: Between March 2005 and April 2007, patients older than 3 years with a newly diagnosed high-risk MB or sPNET were enrolled. The patients received two cycles of pre-RT chemotherapy consisting of cisplatin, etoposide, vincristine, and cyclophosphamide (cycle A), and carboplatin, etoposide, vincristine, and ifosphamide (cycle B), followed by CSRT with 23.4 Gy and local RT with 30.6 Gy. After four cycles of post-RT chemotherapy (cycles A, B, A, and B), tandem double HDCT with ASCR was performed. RESULTS: A total of 13 patients (MB=11, sPNET=2) were enrolled. Of these, one patient progressed, one patient died of septic shock after the second cycle of B, and one patient relapsed after the third cycle of B. The 3-year event-free survival (EFS) rate of the patients intended for HDCT was 76.9%, whereas the 3-year EFS rate of the patients who received HDCT was 100%. No treatment-related mortality occurred during HDCT. CONCLUSION: Although the follow-up period was short and the patient cohort was small in size, the results of this study are encouraging. The limited toxicity and favorable EFS rate observed in children treated with reduced-dose CSRT followed by HDCT and ASCR warrant further exploration in a larger study population.
Carboplatin ; Child ; Cisplatin ; Cohort Studies ; Cyclophosphamide ; Disease-Free Survival ; Etoposide ; Follow-Up Studies ; Humans ; Medulloblastoma ; Neuroectodermal Tumors, Primitive ; Shock, Septic ; Stem Cells ; Vincristine

OBJECTIVE: Revascularization is an effective treatment for the ischemic symptom of moyamoya disease. Indirect revascularization is also effective. Magnetic resonance angiography (MRA) has the ability for collateral formation that is equivalent to conventional angiography. This study analyzed the results of indirect revascularization by MRA. METHODS: A total of 25 patients underwent bilateral EDAS for the management of moyamoya disease. All patients underwent MRA after surgery more than 24 months later. The collateral formation was graded as Good, Fair, and Poor. The clinical outcome was assessed as Excellent, Good, Fair, and Poor. RESULTS: Good collateral formation was 32 sides of the EDAS, and fair was 18. An excellent clinical outcome was obtained in 15 patients, Good in 8, Fair in 1, and Poor in 1. There was a significant correlation between the preoperative symptom, gender, and the clinical outcome. CONCLUSION: In the management of ischemic moyamoya disease, indirect revascularization has been the golden standard with remarkably low morbidity and mortality. Moreover, and MRA can replace conventional angiography in the follow-up of moyamoya patients.
Angiography ; Follow-Up Studies* ; Humans ; Magnetic Resonance Angiography* ; Mortality ; Moyamoya Disease*

OBJECTIVE: Classically, single photon emission tomography is known to be the reference standard for evaluating the hemodynamic status of patients with moyamoya disease. Recently, T2-weighted perfusion magnetic resonance(MR) imaging has been found to be effective in estimating cerebral hemodynamics in moyamoya disease. We aim to assess the utility of perfusion-weighted MR imaging for evaluating hemodynamic status of moyamoya disease. METHODS: The subjects were fourteen moyamoya patients(mean age: 7.21yrs) who were admitted at our hospital between Sep. 2001 to Sep 2003. Four normal children were used for control group. Perfusion MR imaging was performed before any treatment by using a T2-weighted contrast material-enhanced technique. Relative cerebral blood volume(rCBV) and time to peak enhancement(TTP) maps were calculated. Relative ratios of rCBV and TTP in the anterior cerebral artery(ACA), middle cerebral artery(MCA) and basal ganglia were measured and compared with those of the posterior cerebral artery(PCA) in each cerebral hemispheres. Using this data, we analysed the hemodynamic aspect of pediatric moyamoya disease patients in regarding to the age, Suzuki stage, signal change in FLAIR MR imaging, and hemispheres inducing symptoms. RESULTS: The mean rCBV ratio of ACA, MCA did not differ between normal children and moyamoya patients. However the significant TTP delay was observed at ACA, MCA territories (mean = 2.3071 sec, 1.2089 sec, respectively, p < 0.0001). As the Suzuki stage of patients is advanced, rCBV ratio is decreased and TTP differences increased. CONCLUSION: Perfusion MR can be applied for evaluating preoperative cerebral hemodynamic status of moyamoya patients. Furthermore, perfusion MR imaging can be used for determine which hemisphere should be treated, first.
Basal Ganglia ; Cerebrum ; Child ; Hemodynamics* ; Humans ; Magnetic Resonance Angiography* ; Magnetic Resonance Imaging ; Moyamoya Disease ; Perfusion*

PURPOSE: Firstly, to analyze factors in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma. Secondly, to explore an effective salvage treatment for these relapses. MATERIALS AND METHODS: Two patients who had high-risk disease (T3bM1, T3bM3) were treated with combined chemoradiotherapy. CT-simulation based radiation-treatment planning (RTP) was performed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. RESULTS: Review of radiotherapy portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume. When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. CONCLUSION: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.
Brain ; Chemoradiotherapy ; Craniospinal Irradiation ; Humans ; Medulloblastoma* ; Optic Nerve ; Radiotherapy ; Recurrence*

OBJECTIVE: The aim of this study is to compare the frequency of postoperative epilepsies of patients with chronic as opposed to recent onset epilepsy due to glial tumors in the frontal or temporal lobe with the hypothesis that patients with chronic epilepsy do worse. METHODS: We compared the clinical and diagnostic characteristics of the patients(n=73) who had seizures preoperatively to those of the patients(n=153) who did not. Among those who have had seizures preoperatively, we compared those(n=32, chronic seizure group) who had seizures a year or more prior to surgery to those(n=41, acute seizure group) who had seizures within a year prior to surgery. RESULTS: Among the various factors, the frequency of benign pathology and favorable neurological state were higher in seizure group than in non-seizure group(p<0.05). Complex partial seizure and low-grade tumors were frequent in chronic seizure group, whereas simple partial seizure and high-grade tumors were frequent in acute seizure group. Seizure-free rate was significantly higher in acute seizure group than in chronic one(p<0.05). Also, the difference of seizure control rate between surgical strategies were statistically significant(p<0.05). CONCLUSION: This study indicates that preoperative seizure durations and frequencies have a close relationship with the frequency of postoperative epilepsy of glial tumors. A longer lapse may allow the formation of epileptogenic foci, leading to chronic epilepsy, and eventually having a negative effect on the prognosis of the patients. Factors including histopathological characteristics of the tumor, its location, seizure duration/frequency, and semiology should be taken account of deciding on surgical strategies.
Brain Neoplasms ; Epilepsy* ; Glioma ; Humans ; Pathology ; Prognosis ; Seizures ; Temporal Lobe

OBJECTIVE: This study is designed to investigate the association of tumorigenesis with DNA repair gene, N-methylpurine-DNA-glycosylase(MPG) in astrocytic tumors. METHODS: MPG mRNA expression and localization in the 30 astrocytic tumors and 7 tumor-adjacent brain tissues was examined by reverse transcriptase-polymerase chain reaction(RT-PCR) and RNA in situ hybridization. Expression and intracellular localization of MPG protein was determined by immunohistochemistry. Statistical analysis was performed by ANOVA with a p value<0.05 considered statistically significant. RESULTS: MPG mRNA expression in RT-PCR was significantly higher in grade IV tumor tissues than in brain tissues adjacent to tumor or in grade II-III astrocytic tumor tissues(p<0.05). MPG mRNA in in situ hybridization was detected both in brain tissues adjacent to tumor and in astrocytic tumor tissues, regardless of the tumor grades. However, MPG protein localization in immunohistochemical study was detected only in the nucleus of all tumor tissues. In brain tissues adjacent to tumor, immunohistochemical study for MPG was not stained both in the nucleus and in cytoplasm. CONCLUSION: These results suggest MPG's role in human astrocytic tumors and raise the possibility that the increased mRNA level and intracellular localization could be associated with astrocytic tumorigenesis. Further studies about control of MPG gene expression in astrocytic tumors are warranted.
Brain ; Carcinogenesis ; Cytoplasm ; DNA Repair* ; DNA* ; Gene Expression ; Humans ; Immunohistochemistry ; In Situ Hybridization ; RNA ; RNA, Messenger

The authors report below a clinical study of 23 patients bearing 31 primary central nervous system lymphomas diagnosed between January 1985 and December 1994. The cohort included 13 men and 10 women whose mean age was 46 years, ranging from 28 to 61 years. No patient had antecedent of human immunodeficiency virus positivity but one had a past history of rheumatoid arthritis. The duration of symptom was less than 8 weeks in 52% of the patients. Symptom groups included increased intracranial pressure(78%), focal neurological decificit(52%), neuropsychiatric symptoms(43%), and seizures(13%). The histopathologcal diagnosies were done in 19 cases(10 cases by resective surgery, 9 cases by open or stereotactic biopsy). The others were diagnosed by the typical clinical course such as rapid disappearance of lesions after steroid therapy, and/or radiological findings. Histological subtypes(National Cancer Institute Working Formulation) was confirmed in 8 patients including 3 cases of diffuse larger cell type. Phenotype was determined in 7 patients: 4 were B-cell type and 3 were T-cell type. One patient committed suicide during the radiation therapy and was therefore excluded from the survival analysis. All but two patients received radiation therapy. Five patients received chemotherapy. The over-all Kaplan-Meier survival rate was 46% at 2 years and 15.5% at 5 years. On univariate analysis, statistically significant prognostic factor associated with survival was not found but the higher Karnofsky score and single lesion were found to be favorable to the long-term survival. In the statistical analysis of the patients who received radiation therapy, surgical resection did not significantly influence the survival.
Arthritis, Rheumatoid ; B-Lymphocytes ; Brain Neoplasms ; Central Nervous System* ; Cohort Studies ; Drug Therapy ; Female ; HIV ; Humans ; Lymphoma ; Male ; Phenotype ; Suicide ; Survival Rate ; T-Lymphocytes

A non-isotopic in situ hybridization method with biotin-labelled oligonucleotide probes was used to examine growth hormone(GH) and prolactin(PRL) gene expression in 32 patients with pituitary adenomas; 13 were prolactinomas, 8 GH secreting adenomas, and 11 mixed GH and PRL secreting adenomas.Positive immunostaining for GH was found in all patients with GH secreting adenomas, and mixed GH and PRL secreting adenomas. Positive immunostaining for PRL was found in all patients with prolactinomas and 9(81.8%) of 11 mixed GH and PRL secreting adenomas, 5(62.5%) of 8 GH secreting adenomas. Immunohistochemistry revealed that 13 were lactotrope adenomas, 5 somatotrope adenomas, and 14 GH and PRL cell adenomas.In situ hybridization revealed that GH mRNA expression was found in all the patients with somatotrope adenomas and GH and PRL cell adenomas, and 6(46.1%) of 13 lactotrope adenomas. PRL mRNA expression was 100% in lactotrope and GH and PRL cell adenomas, and 4(80.0%) of 5 somatotrope adenomas.The patients with a clinical diagnosis of acromegaly had detectable PRL mRNA in their neoplasm and it is suggested that the PRL cells in the adenomas did not result from dedifferentiation, but from the neoplastic stimulus for some mixed tumors probably occurred in cells previously committed to produce PRL and GH. In lactotrope adenomas, the PRL cells of the patients without expression of GH mRNA may be arised from cells programmed to secrete PRL or precussor PRL cells rather than from mixed GH-PRL cells. The finding that some patients produced mRNA detectable by in situ hybridization, but no hormone detectable by immunohistochemistry within tumor was suggested of a silent adenoma.These observations indicated that in situ hybridization studies may improve the classification of pituitary adenomas and may provide a precise knowledge of the biology of these neoplasms.
Acromegaly ; Adenoma ; Biology ; Classification ; Diagnosis ; Gene Expression ; Human Growth Hormone ; Humans ; Immunohistochemistry ; In Situ Hybridization ; Methods ; Oligonucleotide Probes ; Pituitary Neoplasms ; Prolactin ; Prolactinoma ; RNA, Messenger

Radiotherapy is a standard postoperative treatment for various cerebral neoplasms. Howewr, radiation has the potential to produce severe injury to normal brain tissue in and around the tumor bed. The authors encountered 7 patients with delayed cerebral necrosis. These unacceptable complication prompted us to analyze cases with such a complication particularly in regard to the differential diagnosis between the recurrence of the tumor and radiation necrosis of the brain. This article summarizes factors related to the radiation necrosis, including clinical observations and treatment.
Brain Injuries ; Brain* ; Diagnosis, Differential ; Humans ; Necrosis* ; Radiotherapy ; Recurrence