Months For Grade Research Articles

Timing and characteristics of radiation pneumonitis after stereotactic body radiotherapy for peripherally located stage I lung cancer.

This study was conducted to determine the timing and characteristics of radiation pneumonitis (RP) associated with stereotactic body radiotherapy (SBRT) for stage I lung cancer. Two hundred thirty-one patients treated with SBRT using 52 Gy in 4 fractions were identified. Control rate, RP incidence rate, and predictive factors and timing of RP were evaluated retrospectively. The 3-year overall survival and local control rates were 80.7 and 92.0 %, respectively. The grade ≥2 RP rate was 13.0 %; no grade 4-5 RP occurred. The most statistically significant predictive factor of grade ≥2 RP was V10. The median intervals to first graphical appearance were 4.2 and 2.5 months for grade 1 and grade 2-3 RP, respectively. Median intervals to maximum radiological density change were 6.0 and 4.6 months for grade 1 and grade 2-3 RP, respectively. A significantly different interval to first graphical appearance between grade 1 and grade 2-3 RP was observed; no significantly different interval to maximum radiological density change was noted. The first graphical appearance of grade ≥2 RP was earlier than that of grade 1 RP, although the timing of maximum radiological density change was not significantly different.

MS-19 * LONG-TERM OUTCOMES FOR PATIENTS WITH INTRACRANIAL MENINGIOMAS: A SINGLE-INSTITUTION RETROSPECTIVE ANALYSIS

While meningiomas represent the most common intracranial tumor, limited long-term outcome data are available. We analyzed clinical features and outcomes for all patients with intracranial meningiomas treated with radiotherapy at Duke University Medical Center between 1/1/1992 and 10/31/2013 by retrospective chart review. 237 patients were identified (median age 52; female:male 2:1); of these, 32 (14%) were diagnosed by imaging only. Median follow-up was 92 months (range 4-401) with follow-up >12 and 20 years for 88 and 22 patients, respectively. Histologic WHO grade distribution was 52% grade I, 15% grade II, 7% grade III, and 26% unknown. Patients received one or more of the following treatments: surgery (78%), stereotactic radiosurgery (26%), fractionated radiotherapy (84%), and/or systemic therapy (18%). Median overall survival (OS) and progression-free survival (PFS) were 383 and 113 months, respectively. Median OS was 389 months for grade I, 383 months for unknown grade, not reached for grade II, and 120 months for grade III (p 5%) was associated with shorter OS (median 174 months versus 383 months for grade I/unknown grade with low or unknown proliferation index). The median PFS for grade I, II, and III was 113, 45 and 39 months, respectively (p < 0.0001). 50% of patients (117) were treated for recurrent or progressive disease. Median OS after first treatment for recurrence was 327 months for grade I, not reached for grade II, 80 months for grade III, and 117 months for unknown grade (p = 0.003). Given the prolonged survival, frequent recurrences well past initial treatment, and the apparent efficacy of salvage therapy, meningioma patients should be observed systematically long after diagnosis.

ED-30 * MULTI-CENTER RETROSPECTIVE COHORT STUDY OF ADULT INTRACRANIAL EPENDYMOMA: BRAIN TUMOR REGISTRY OF JAPAN 2001-2004

OBJECTIVE: Intracranial ependymoma is a rare brain tumor in adults. The standard treatments comprise of aggressive resection and radiotherapy, although only a few contemporary studies have evaluated their prognostic values. The objective of this study is to analyze clinical data from Brain Tumor Registry of Japan for assessing prognostic factors in adult intracranial ependymoma. MATERIALS AND METHODS: Seventy-six adult patients of intracranial ependymoma treated at 31 hospitals between 2001 and 2004 were included in the study. Subependymoma was excluded. Clinical data collected prospectively were retrospectively analyzed. RESULTS: The median age was 45 years (range,18-85), and the median KPS score was 80 (range,40-90). Infratentorial and multiple tumors were noted in 40 and 4 cases, respectively. Forty-five cases were classified as WHO grade 2 and 29 cases as grade 3. Grade 3 tumors were significantly associated with low KPS score, supratentorial tumor, large tumor diameter, and seizure onset compared to grade 2 tumors. All the grade 3 tumors except one were treated with radiotherapy and/or chemotherapy, while only 18 were treated with radiotherapy among 45 grade 2 tumors. With a median follow-up of 40 months, 5-year overall survival (OS) was 98% for grade 2 and 46% for grade 3; the median OS was not reached for grade 2 and 44 months for grade 3. Five-year progression-free survival (PFS) was 85% for grade 2 and 33% for grade 3; the median PFS was not reached for grade 2 and 21 months for grade 3. Multivariate analyses revealed that WHO grade (P = 0.009), complete resection (P = 0.002), and KPS score (P = 0.02) were associated with OS and that WHO grade (P = 0.02) and complete resection (P = 0.003) with PFS. CONCLUSION: WHO grade 3 ependymoma more often presents as a supratentorial mass provoking seizure than grade 2. WHO grade and complete resection were independent prognostic factors in adult intracranial ependymoma.

Prognostic value of histologic grading for feline mammary carcinoma: a retrospective survival analysis.

Feline mammary carcinoma is highly malignant and generally associated with a poor prognosis, although studies suggest the range of survival times in affected cats is broad. Histologic grading of these tumors is achieved using the Elston and Ellis system, originally developed for human breast cancer. In cats, however, classification using this method has variable prognostic value. Therefore, objectives of this study were (1) to evaluate the Elston and Ellis grading system for feline mammary carcinoma in a predominantly spayed population and (2) to determine whether modification of this system or development of a novel system improved the prognostic value of histologic grading. Survey data and histologic features for 108 carcinomas from 97 cats were analyzed with respect to overall survival. Elston and Ellis grading failed to correlate significantly with overall survival. Using multivariable analysis, lymphovascular invasion, nuclear form, and mitotic count each demonstrated independent prognostic significance (P = .008, <.001, and .004, respectively). Modifications of the Elston and Ellis system and a novel grading system were proposed based on these results; all showed significant correlation with overall survival (P < .001). Median survival times were 27, 29, or 31 months for grade I; 14, 12, or 14 months for grade II; and 13, 5, or 8 months for grade III carcinomas using the mitotic-modified Elston and Ellis, the revised Elston and Ellis, or the novel grading system, respectively. Based on this retrospective study, adoption of the species-specific systems as proposed here may improve the prognostic value of histologic grading for feline mammary carcinoma.

Principles of Surgery for Malignant Astrocytomas

Malignant astrocytomas constitute the most aggressive and common primary tumors of the central nervous system. The standard treatment protocol for these tumors involves maximum safe surgical resection with adjuvant chemoradiotherapy. Despite numerous advances in surgical techniques and adjuncts, as well as the ongoing renaissance in the genetic and molecular characterization of these tumors, malignant astrocytomas continue to be associated with poor prognosis, with median overall survival averaging 15 months for grade IV astrocytomas after standard-of-care treatment. In this article, the goals, principles, techniques, prognostic factors, and modern outcomes of malignant astrocytoma surgery are reviewed. Particular attention is paid to contemporary methods of neuronavigation and functional mapping, the prognostic significance of the extent of resection, surgically delivered adjunctive therapies, and future avenues of research.

The prevalence of vasomotor and psychological symptoms in prostate cancer patients receiving hormonal therapy: Results from a single-institution experience.

283 Background: Hormonal therapy is an important therapeutic modality in both early and metastatic prostate cancer. Whilst the long term effects of androgen deprivation (AD) have been extensively studied, little attention has focussed on assessing short-term vasomotor and psychological effects and the resulting impact of quality of life (QoL) in prostate cancer, relying on data mainly extrapolated from breast cancer patients. This prospective study sought to assess these effects and identify any predictive factors. Methods: Data from 200 consecutive prostate cancer patients were collected from January 2010 to August 2013. A self-reported questionnaire was employed to objectively assess a variety of vasomotor and psychological symptoms, graded from 1 no toxicity, 2 mild, 3 moderate to 4 severe toxicity. Other parameters including height, weight, Body Surface Area (BSA), Body Mass Index (BMI), duration and type of hormonal therapy were also recorded. Results: 181 patients were fully evaluable, with a median age of 75 (IQR 70.5-80). 166 received an LHRH analogue,11 maximum androgen blockade, and 4 received anti-androgens only. 33 (18.2%) of patients reported no toxicity, with 76 (42%), 55 (30%) and 17 (9.4%) experiencing mild, moderate and severe (debilitating) symptoms respectively. The commonest debilitating symptoms were vasomotor: drenching sweats (82%), and hot flashes (82%), which usually coexisted, and less commonly psychological: sleep disturbances (18%) and tiredness (12%). Age (median: 77 vs. 74 yrs), weight (median: 79.8 vs. 84.4), and BMI (median: 26.6 vs. 28.3) significantly predicted between those with grade 1/2 and grade 3/4 symptoms, (p=0.0007, 0.02, 0.02). A non-significant trend was observed with increasing duration of hormonal treatment and toxicity (median: 5, 7, 9.5 and 12 months for Grade 1-4, respectively, p=0.07). Conclusions: The short term side-effect profile of hormonal therapy for prostate cancer is generally favourable, though debilitating predominantly vasomotor symptoms can occur in a significant minority of cases. Increasing age, weight, and BMI may be predictive of toxicity.

Adverse Events Associated with Postsurgery of Early‐Stage Oral Cancer in a Phase III Surgical Trial

Objectives: 1) Investigate the adverse events (AEs) associated with surgery for early-stage oral cancer. 2) Characterize surgical procedure and its related AEs. Methods: Based on the National Institute of Health/National Cancer Institute Common Terminology Criteria for Adverse Events (v4.0), patient self-reported AEs post-surgery in a pan-Canadian multi-center phase III randomized controlled surgical trial (the COOLS trial) were captured during the follow-up visits. Results: From September 2010 to January 2013, 228 eligible patients were recruited and received surgeries, including tumor excision, and/or free flap or neck dissection. Among these, 188 (82%) patients had at least 3 months follow-up with an average of 24.8±19 months. There were 83 types and 593 counts of AEs from 148 (79%) patients. The most occurring AEs were oral pain (146 patients) and oral dysesthesia (64 patients). Thirty patients (20%) presented with prolonged oral pain (≥3 months) with an average duration of 6.5±10.5 months for Grade I and 2.0±5.6 months for Grade 2 or greater (77 patients). The average duration of oral dysethesia was 18.6±16.4 months with 52 (80%) over 3 months. Univariate analysis had shown that neck dissection and longer surgery time have significant impact on the reported Grade 2 oral pain ( P = 0.03 for both). Interestingly, excision type [cold knife (9%) vs. electric knife/laser (23%)] had significant effect on experiencing prolonged post-surgical oral pain (P = 0.01). Conclusions: Post-surgical AEs surveillance is critical to understand the factors impacting patients’ quality of life. Concurrent neck dissection has impacts on patients’ experience in prolonged post-surgical oral pain.

Evaluation of the WHO 2010 Grading and AJCC/UICC Staging Systems in Prognostic Behavior of Intestinal Neuroendocrine Tumors

BackgroundThe increasing incidence and heterogeneous behavior of intestinal neuroendocrine tumors (iNETs) pose a clinicopathological challenge. Our goal was to decribe the prognostic value of the new WHO 2010 grading and the AJCC/UICC TNM staging systems for iNETs. Moreover, outcomes of patients treated with somatostatin analogs were assessed.MethodsWe collected epidemiological and clinicopathological data from 93 patients with histologically proven iNETs including progression and survival outcomes. The WHO 2010 grading and the AJCC/UICC TNM staging systems were applied for all cases. RECIST criteria were used to define progression. Kaplan-Meier analyses for progression free survival (PFS) and overall survival (OS) were performed.ResultsMean follow-up was 58.6 months (4–213 months). WHO 2010 grading yielded PFS and disease-specific OS of 125.0 and 165.8 months for grade 1 (G1), 100.0 and 144.2 months for G2 and 15.0 and 15.8 months for G3 tumors (p = 0.004 and p = 0.001). Using AJCC staging, patients with stage I and II tumors had no progression and no deaths. Stage III and IV patients demonstrated PFS of 138.4 and 84.7 months (p = 0.003) and disease-specific OS of 210.0 and 112.8 months (p = 0.017). AJCC staging also provided informative PFS (91.2 vs. 50.0 months, p = 0.004) and OS (112.3 vs. 80.0 months, p = 0.005) measures with somatostatin analog use in stage IV patients.ConclusionOur findings underscore the complementarity of WHO 2010 and AJCC classifications in providing better estimates of iNETS disease outcomes and extend the evidence for somatostatin analog benefit in patients with metastatic disease.

Spinal cord ependymomas and myxopapillary ependymomas in the first 2 decades of life: a clinicopathological and immunohistochemical characterization of 19 cases

Primary spinal cord ependymomas (EPNs) are rare in children, comprising classical WHO Grade II and III tumors and Grade I myxopapillary ependymomas (MEPNs). Despite their benign histology, recurrences and neural-axis dissemination have been reported in up to 33% MEPNs in the pediatric population. Treatment options beyond resection are limited, and little is known about their tumorigenesis. The purpose of this study was to explore the tumor biology and outcomes in a consecutive series of pediatric patients treated at a single institution. The authors performed a retrospective clinicopathological review of 19 patients at a tertiary referral children's hospital for resection of a spinal cord ependymoma. The population included 8 patients with a pathological diagnosis of MEPN and 11 patients with a pathological diagnosis of spinal EPN (10 cases were Grade II and 1 case was Grade III). The upregulation of the following genes HOXB13, NEFL, PDGFRα, EGFR, EPHB3, AQP1, and JAGGED 1 was studied by immunohistochemistry from archived paraffin-embedded tumor samples of the entire cohort to compare the expression in MEPN versus EPN. Gross-total resection was achieved in 75% of patients presenting with MEPNs and in 100% of those with EPNs. The average follow-up period was 79 months for the MEPN subset and 53 months for Grade II/III EPNs. Overall survival for both subsets was 100%. However, event-free survival was only 50% for patients with MEPNs. Of note, in all cases involving MEPNs that recurred, the patients had undergone gross-total resection on initial surgery. In contrast, there were no tumor recurrences in patients with EPNs. Immunohistochemistry revealed no significant differences in protein expression between the two tumor types with the exception of EPHB3, which demonstrates a tendency to be positive in MEPNs (6 reactive tumors of 9) rather than in EPN (2 reactive tumors of 10). The authors' experience shows that, following a gross-total resection, MEPNs are more likely to recur than their higher-grade counterpart, EPNs. This supports the recommendation for close long-term radiological follow-up of pediatric patients with MEPNs to monitor for recurrence, despite the tumor's low-grade histological feature. No significant difference in the protein expression of HOXB13, NEFL, PDGFRα, EGFR, EPHB3, AQP1, and JAGGED 1 was present in this selected cohort of pediatric patients.

Volumetric Response Evaluation after Intensity Modulated Radiotherapy in Patients with Supratentorial Gliomas

Radiotherapy is frequently indicated to treat cerebral gliomas. Accurate response evaluation after radiotherapy is essential to determine the efficacy of treatment. We retrospectively analyzed the volumetric tumor response after simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in patients with gliomas. Thirty-five patients (Grade II, 7 patients; Grade III, 12; and Grade IV, 16) were treated with SIB-IMRT with a median total dose of 55.9 Gy/26 fractions for Grade II and 60 Gy/25 fractions for Grade III-IV tumors. Tumor responses were evaluated for enhancing volume on post-gadolinium T1-weighted images (Vgd) and hyper-intensity volume on T2-weighted FLAIR images (V(fl)) on serial MRIs. With the median follow-up of 24.0 months, overall response rates (RRs) were 57% for V(gd) and 51% for V(fl). Tumor grade was predictive of response favoring the lower grade in Vfl with RRs of 86% for Grade II, 75% for Grade III, and 19% for Grade IV tumors (p = 0.004). Time to 50% or greater volume reduction (T50) in Vgd was 8 months for grade III. The T50 in V(fl) was approximately 24 months both for Grade II and III tumors. Majority of Grade IV tumors continued to progress and never reached the T50 in Vgd or Vfl. Responders survived longer than non-responders for V(gd) and V(fl). Volume response after radiotherapy was dependent upon tumor grade and time. LGGs are very responsive to radiotherapy with the RRs of 86% in V(fl). The response of Vfl is more protracted compared to V(gd). Further investigation is needed to determine the clinical significance of volumetric response evaluation.

A Clinical Study of 211 Cases of Idiopathic Sudden Sensorineural Hearing Loss

We investigated 211 inpatients in our hospital who underwent treatment within 2 weeks of the onset of idiopathic sudden sensorineural hearing loss over an eight year-period (January 2003 to December 2010). Some prognostic factors analyzed in this study were as follows; age, sex, side, smoking, the initial averaged five-frequency hearing level, grade, vestibular symptom, complications such as diabetes mellitus (DM) and hypertension (HT), and the period to fixation of hearing level. The ages of patients ranged from 10 to 85 years (median 56.5 yr). Males and females accounted for 106 and 105 cases, respectively. The sides of hearing impairment were 105 in the right, 105 in the left and 1 in the bilateral ears. The smoking rate of our cases was lower than that of the general population as reported by the Ministry of Health, Labour and Welfare. The main hearing types were horizontal and deaf before treatment, and high-frequency impairment and normal hearing after treatment. The overall results of the treatment showed 87 (41.0%) patients with a complete recovery, 53 (25.0%) with a marked improvement, 40 (18.9%) with some improvement and 32 (15.1%) with no change. Hearing improvement of 4000 Hz was worse than those of 250, 500 and 1000 Hz. Hearing improvement was good in the valley and low tone senseorineural hearing loss types, on the other hand, it was worst in the deaf type. Hearing improvement of Grade 4 was worse than those of Grade 1, 2 and 3. Smoking and DM had no influence on the prognosis. The complete recovery rate of those over 60 years of age was worse than in those under 60 years of age. The prognoses of patients with vestibular symptom and HT were worse than those without them. Important prognostic factors strongly related to the complete recovery rate were the presence of vertigo and the grade of initial hearing level as determined by multiple logistic regression analyses. The period to fixation of hearing level in Grade 4 was prolonged as compared with those of Grade 1, 2 and 3. We recommend to follow up for two weeks in Grade 1, two months in Grade 2 and 3, and six months in Grade 4 to obtain an accurate evaluation of hearing improvement.

Dropping out: Why are students leaving junior high in China's poor rural areas?

Despite requirements of and support for universal education up to grade 9, there are concerning reports that poor rural areas in China suffer from high and maybe even rising dropout rates. Although aggregated statistics from the Ministry of Education show almost universal compliance with the 9-year compulsory education law, there have been few independent, survey-based studies regarding dropout rates in China. Between 2009 and 2010 we surveyed over 7800 grade 7, 8, and 9 students from 46 randomly selected junior high schools in four counties in two provinces in North and Northwest China to measure the dropout rate. We also used the survey data to examine factors correlated with dropping out, such as the opportunity cost of going to school, household poverty, and poor academic performance. According to the study's findings, drop out rates between grade 7 and grade 8 reached 5.7% and dropout rates between grade 8 and grade 9 reached 9.0%. In sum, among the total number of students attending junior high school during the first month of the first term of grade 7, 14.2% had left school by the first month of grade 9. Dropout rates were even higher for students that were older, from poorer families (and families in which the parents were not healthy), or were performing more poorly academically. We conclude that although the government's policy of reducing tuition and fees for junior high students may be necessary, it is not sufficient to solve the dropout problem.

Abstract 675: Effects of PBN and OKN007 in rodent glioma models assessed by 1H MR spectroscopy

Abstract Gliomas are the most common and lethal primary brain tumors in the adult, with a median survival time of 12 to 15 months for grade IV gliomas, glioblastoma multiforme. PBN and OKN007 are nitrones which have demonstrated beneficial effects in many aging diseases. In this study, we evaluated the anti-tumor effects of PBN or OKN007 in several rodent glioma models (C6, RG2, and GL261) by assessing metabolite alterations with magnetic resonance spectroscopy (MRS). PBN or OKN007 was administered in drinking water prior to or post tumor formation. MRI and short echo time, single-voxel point-resolved spectroscopy (PRESS) were obtained to assess tumor morphology and metabolites, respectively, following therapy. Major metabolite ratios (Choline, N-acetyl aspartate (NAA), Lipid (methylene), and Lipid (methyl), all compared to Creatine) were assessed. Nitrones induced tumor metabolism changes that resulted in restoring major metabolite ratios close to their normal levels, in the glioma regression phase. Nitrones treatment decreased the Lipid (methylene) to Creatine ratio significantly, which can be a useful marker for evaluation of the efficacy of the treatments, and was found to be related with the reduction of necrosis. OKN007 was more effective than PBN when administered post-tumor formation in the C6 glioma model. OKN007 was able to inhibit angiogenic factors (VEGF, bFGF and HGF) and induce apoptosis (indicated by an increase of the apoptotic marker m30) in C6 gliomas, which might be potential mechanisms that are involved in the anti-glioma effects. In conclusion, OKN007 and PBN are effective in inhibiting the growth of several experimental gliomas and may be considered as potential therapeutics for a clinical trial in human gliomas. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 675. doi:10.1158/1538-7445.AM2011-675

Reirradiation of Large-Volume Recurrent Glioma With Pulsed Reduced-Dose-Rate Radiotherapy

Pulsed reduced-dose-rate radiotherapy (PRDR) is a reirradiation technique that reduces the effective dose rate and increases the treatment time, allowing sublethal damage repair during irradiation. A total of 103 patients with recurrent glioma underwent reirradiation using PRDR (86 considered to have Grade 4 at PRDR). PRDR was delivered using a series of 0.2-Gy pulses at 3-min intervals, creating an apparent dose rate of 0.0667 Gy/min to a median dose of 50 Gy (range, 20-60) delivered in 1.8-2.0-Gy fractions. The mean treatment volume was 403.5±189.4 cm3 according to T2-weighted magnetic resonance imaging and a 2-cm margin. For the initial or upgraded Grade 4 cohort (n=86), the median interval from the first irradiation to PRDR was 14 months. Patients undergoing PRDR within 14 months of the first irradiation (n=43) had a median survival of 21 weeks. Those treated ≥14 months after radiotherapy had a median survival of 28 weeks (n=43; p=0.004 and HR=1.82 with a 95% CI ranging from 1.25 to 3.10). These data compared favorably to historical data sets, because only 16% of the patients were treated at first relapse (with 46% treated at the second relapse, 32% at the third or fourth relapse, and 4% at the fourth or fifth relapse). The median survival since diagnosis and retreatment was 6.3 years and 11.4 months for low-grade, 4.1 years and 5.6 months for Grade 3, and 1.6 years and 5.1 months for Grade 4 tumors, respectively, according to the initial histologic findings. Multivariate analysis revealed age at the initial diagnosis, initial low-grade disease, and Karnofsky performance score of ≥80 to be significant predictors of survival after initiation of PRDR. PRDR allowed for safe retreatment of larger volumes to high doses with palliative benefit.

Impact of school readiness program interventions on children's learning in Cambodia

To reduce the high repetition rates in early years of primary school, the government of Cambodia piloted a school readiness program (SRP) in the first two months of Grade 1 of primary school. This study examines whether such intervention has effects on students’ immediate acquisition of school readiness skills as well as students’ longer term achievement of formal curriculum. The study finds that children who participated in SRP outperform children that did not participate in both outcomes, controlling for pretest score and background variables. The findings suggest that the intervention may be one alternative model to preschools in countries where access to pre-primary education is limited.

Early diagnostic and endoscopic dilatation for the treatment of acquired upper airway stenosis after intubation in children

Background Upper airway stenosis (UAS) after endotracheal intubation is a common problem in children. Most literature refers to a surgical treatment for these lesions. Laryngotracheal reconstruction and cricotracheal resection are used for low- and high-grade stenosis, but decannulation is not always possible immediately after surgery. Purpose The aim of this study was to verify the feasibility and results of endoscopic dilatations for treatment of subglottic stenosis. Method The study encompassed a 12-year retrospective analysis of patients treated for UAS in a tertiary center. All children were symptomatic at the time of the endoscopic diagnosis. The stenosis was graded according to the Myer-Cotton criteria. Endoscopic dilatation was initiated immediately after the diagnosis. Children with grade IV stenosis underwent surgery. Results Children with tracheal stenosis and no involvement of the subglottic area did not respond to endoscopic dilatations and underwent surgery. There were 45 children with grade I stenosis, 12 with grade II, 7 with grade III, and 4 with grade IV lesions. Patients with grade I, II, and III stenosis were all treated by endoscopic dilatations alone and were decannulated when asymptomatic. The average time for decannulation was 18.90 ± 26.07 months for grade I, 32.5 ± 27.08 months for grade II, and 27.57 ± 20.60 months for grade III stenosis ( P < .01, for grade II vs grade III). Conclusion Grade I, II, and III subglottic stenoses can be safely managed by early endoscopic dilatations with a high rate of success and low rate of morbidity but require a significantly long period of treatment.

Clinical course of 735 children and adolescents with primary vesicoureteral reflux

The purpose of this retrospective cohort study was to report the clinical course of children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR and were systematically followed in a single tertiary renal unit. Patients were followed up for a mean time of 76 months (6 months to 411 months). The events of interest were reflux resolution, renal damage, urinary tract infection (UTI), chronic kidney disease (CKD), and hypertension. Survival analysis was performed in order to evaluate reflux resolution and CKD. Renal damage was detected at admission in 319 patients (43.4%). Continuous low-dose antibiotic prophylaxis was administered to 624 patients (91.2%); 499 (73%) patients subsequently had no UTI or fewer than three episodes. The median time of persistence of reflux according to Kaplan-Meier analysis was 38 months for grade I/II [95% confidence interval (95% CI), 33-43], 98 months for grade III (95% CI, 78.5-105), and 156 months for grade IV/V (95% CI, 122-189). Twenty patients (3%) developed hypertension. It was estimated that the probability of CKD was 5% at 10 years after diagnosis of VUR; for children diagnosed after 1990 the probability of CKD was only 2%. Renal function impairment occurred in patients with severe bilateral reflux or in patients with contralateral renal hypoplasia. There has been an improvement of prognosis for patients diagnosed in the past 15 years.

Efficacy of Fractionated Stereotactic Reirradiation in Recurrent Gliomas: Long-Term Results in 172 Patients Treated in a Single Institution

To evaluate the efficacy of fractionated stereotactic radiotherapy (FSRT) performed as reirradiation in 172 patients with recurrent low- and high-grade gliomas. Between 1990 and 2004, 172 patients with recurrent gliomas were treated with FSRT as reirradiation in a single institution. Seventy-one patients suffered from WHO grade 2 gliomas. WHO grade 3 gliomas were diagnosed in 42 patients, and 59 patients were diagnosed with glioblastoma multiforme (GBM). The median time between primary radiotherapy and reirradiation was 10 months for GBM, 32 months for WHO grade 3 tumors, and 48 months for grade 2 astrocytomas. FSRT was performed with a median dose of 36 Gy in a median fractionation of 5 x 2 Gy/wk. Median overall survival after primary diagnosis was 21 months for patients with GBM, 50 months for patients with WHO grade 3 gliomas, and 111 months for patients with WHO grade 2 gliomas. Histologic grading was the strongest predictor for overall survival, together with the extent of neurosurgical resection and age at primary diagnosis. Median survival after reirradiation was 8 months for patients with GBM, 16 months for patients with grade 3 tumors, and 22 months for patients with low-grade gliomas. Only time to progression and histology were significant in influencing survival after reirradiation. Progression-free survival after FSRT was 5 months for GBM, 8 months for WHO grade 3 tumors, and 12 months for low-grade gliomas. FSRT is well tolerated and may be effective in patients with recurrent gliomas. Prospective studies are warranted for further evaluation.

Résultats de la série sainte-anne –– lyon de 318 oligodendrogliomes intracrâniens de l’adulte

Incidence of cerebral oligodendrogliomas is increasing because of better recognition made possible by improved classifications. We studied a homogeneous series using the Sainte-Anne grading scale in order to better understanding the history of these tumors with or without treatment and to assess prognosis and associated factors. A retrospective series of 318 adult patients with oligodendroglioma (OLG) treated at Hôpital Sainte-Anne, Paris (SA) and Hôpital Neurologique, Lyons (L) between 1984 and 2003 was analyzed: 182 grade A OLG (SA + L), 136 grade B among which a homogenous series of 98 (SA) were included. For grade A: age at diagnosis ranged from 21 to 70 (mean: 41), sex ratio was 1.28. For grade B: age at diagnosis ranged from 12 to 75 (mean: 45.5), sex-ratio was 1.58. The main first symptoms were: epilepsy (A: 91.5%; B: 76%), intracranial hypertension (A: 7.9%; B: 14.6%), neurological deficit (A: 5.1%; B: 17.7%). The most frequent locations were: frontal, insular and central for both A and B. Mean size was 55 mm for grade A, 62 mm for B. Calcifications were found in 20% of A, 48.5% of B. No tumor was enhanced on imaging (CT/MRI) in grade A, all but 7 in grade B. All patients underwent surgery either for biopsy (A: 47.2%; B: 53%), or removal which was partial (A: 26.4% vs B: 19.4%) or extended (A: 36.3% vs B: 37.8%). Fifty-six patients underwent 2 procedures and 12 three procedures. Radiotherapy was performed in 76.9% of grade A, and 91% of B patients, in the immediate postoperative period for 71% A and 82.7% B. Chemotherapy was delivered for 36% of grade A (in the event of transformation to grade B or failure of radiotherapy) and 67.5% of B patients. Among grade A tumors, 38% transformed into grade B within a mean delay of 51 months with a mean follow-up of 78 months. Median survival was 136 months for grade A and 52 for grade B. Survival at 5, 10 and 15 was 75.5%, 51% and 22.4% for grade A vs 45.2%, 31.3% and 0% for grade B respectively. In univariate and multivariate analysis, grade A survival was associated with age at diagnosis, tumor size, large removal and response to radiotherapy. Grade B survival was associated with age at diagnosis, wide removal and sharply defined limits of the tumor on imaging. Analysis of both published data and this series underlines many prognostic parameters. It shows that OLG are heterogeneous tumors even in each grade (A and B). Treatment should consequently progress towards more targeted procedures for patients mainly with postoperative radiotherapy and chemotherapy.

Hypofractionated stereotactic re-irradiation: treatment option in recurrent malignant glioma.

BackgroundHypofractionated stereotactic radiotherapy (HFSRT) is one salvage treatment option in previously irradiated patients with recurrent malignant glioma. We analyzed the results of HFSRT and prognostic factors in a single-institution series.MethodsBetween 1997 and 2003, 19 patients with recurrent malignant glioma (14 glioblastoma on most recent histology, 5 anaplastic astrocytoma) were treated with HFSRT. The median interval from post-operative radiotherapy to HFSRT was 19 (range 3–116) months, the median daily single dose 5 (4–10) Gy, the median total dose 30 (20–30) Gy and the median planning target volume 15 (4–70) ml.ResultsThe median overall survival (OS) was 9.3 (1.9-77.6+) months from the time of HFSRT, 15.4 months for grade III and 7.9 months for grade IV tumors (p = 0.029, log-rank test). Two patients were alive at 34.6 and 77.6 months. OS was longer after a total dose of 30 Gy (11.1 months) than after total doses of <30 Gy (7.4 months; p = 0.051). Of five (26%) reoperations, none was performed for presumed or histologically predominant radiation necrosis. Median time to tumor progression after HFSRT on imaging was 4.9 months (1.3 to 37.3) months.ConclusionHFSRT with conservative total doses of no more than 30 Gy is safe and leads to similar OS times as more aggressive treatment schemes. In individual patients, HFSRT in combination with other salvage treatment modalities, was associated with long-term survival.