Partial Tumor Removal Research Articles

Partial Surgical Removal of Growth Hormone-Secreting Pituitary Tumors Enhances the Response to Somatostatin Analogs in Acromegaly

Partial Surgical Removal of Growth Hormone-Secreting Pituitary Tumors Enhances the Response to Somatostatin Analogs in Acromegaly

Continued Growth and Recidivation of Vestibular Schwannomas

The problems of recidivating and continued growing of vestibular schwannomas are considered on material from 336 observations of patients. There were 25 (7.4%) tumors of clinical stage III and 311 (92.6%) of stage IV. Total removal of tumor was made in 262 (78.0%) cases, subtotal removal in 42 (12.5%) cases, and partial removal in 32 (9.5%) cases. Facial nerve was preserved in 245 (72.9%) cases. Postoperative mortality amounted to 2.7% (9) cases. Thirty (8.9%) patients were reoperated. Eighteen (6.9%) patients had recidivation after total removal of neurinomas, 5 (11.9%) patients after subtotal removal. Average time of the observation was 49.9 months and 24.6 months, respectively. Continuing growth of tumors after their partial removal was noted in 7 (21.9%) cases. Malignancy of schwannomas was the reason for recidivating in two cases. The residual part of the tumors' capsule, usually left on the brainstem or facial nerve at subtotal removal of tumors, was a reason for recidivation only in 1 (3.6%) case. Total removal of recidivating tumor was made in 12 (40.0%) cases, subtotal in 7 (23.3%) cases, and partial in 11 (36.7%) cases. We noted that in all cases of recidivating or continued growth of vestibular schwannomas, patients endured the repeated surgical procedure very well. We conclude that one of the ways to reduce postoperative mortality must be an expansion of the evidence to partial removal of tumor in cases accompanying with somatic pathology and to subtotal removal in cases with difficult tumor capsule microdissection from the brainstem and facial nerve.

Partial Surgical Removal of Growth Hormone-Secreting Pituitary Tumors Enhances the Response to Somatostatin Analogs in Acromegaly

Surgery is a cornerstone in the treatment of acromegaly, but its efficacy in large, invasive tumors is scant. The objective of this study was to investigate whether partial surgical removal of GH-secreting pituitary tumors enhances the response rate to somatostatin analogs (SSA; sc octreotide, slow-release octreotide, and lanreotide). This was a multicenter, open, retrospective study. The study was performed at university hospitals. Eighty-six patients (42 women and 44 men; age, 42 +/- 14 yr) with acromegaly were studied. Patients underwent two courses of octreotide, lanreotide, or slow-release octreotide treatments before and after surgery of at least 6 months. The main outcome measure was normal IGF-I levels for age. Presurgical SSA treatment significantly decreased GH and IGF-I levels in all patients. GH levels were less than 2.5 microg/liter in 12 patients (14%); IGF-I levels normalized in nine (10%). After surgery, GH and IGF-I levels further decreased in all patients; tumor removal was greater than 75% in 50 (58%), 50.1-75% in 21 (24%), 25.1-50% in 10 (12%), and less than 25% in five patients (6%). Preoperatively, pituitary function was impaired in 12 patients (14%). Postsurgical SSA treatment lowered GH levels to less than 2.5 microg/liter in 49 (56%) and normalized IGF-I levels in 48 patients (55%). The success rate was significantly increased compared with that before surgery (P < 0.0001). GH (r = -0.48; P < 0.0001) and IGF-I levels (r = -0.38; P = 0.0003) after postsurgery SSA treatment correlated with the amount of tumor surgically removed. After surgery, pituitary function was impaired in 28 patients (32.6%) and was improved in 12 patients (13.9%). The cumulative prevalence of pituitary deficiency did not change during the study (normal function from 40 to 42%; deficiency from 60 to 58%). Surgical tumor removal (>75%) enhances the response to SSAs without impairing pituitary function. Our data indicate that surgical debulking has a significant place in the treatment algorithm of acromegaly.

Craniopharyngiomas in children: Turkey experience

Craniopharyngiomas are the most frequently encountered suprasellar tumors in children. Although they have a benign histology, total resection without morbidity is very difficult. We aimed to review the results of pediatric craniopharyngioma patients treated in eight institutions in Turkey. There were 51 boys and 36 girls, ranging in age from 20 months to 18 years (mean 10.2 years). The most frequent symptom was headache, followed by visual disturbances. Hydrocephalus was seen most frequently in tumors greater than 4 cm in size (P=0.002). Hydrocephalus was associated with the decreased gross total resection (P=0.043). The recurrence (28%) was significantly higher in patients with subtotal and partial tumor removal (P=0.010). Bad outcome was significantly associated with tumor dimension (P=0.039); the greater the tumor dimension, the worse the outcome. Outcome was significantly better in patients older than 10 years (P=0.032). Gender, tumor type and location, presence of hydrocephalus and calcification, histological type of craniopharyngioma, and surgical approach did not have a significant effect on the outcome. The treatment should be individualized and a multidisciplinary approach should be used. The goal of surgery should be gross total removal without mortality and with acceptable morbidity.

Meningiomas de la base de cráneo. Un sistema predictivo para conocer las posibilidades de su extirpación y pronóstico

The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1 degrees which skull base meningiomas can be total or partially removed, and 2 degrees their surgical outcome. Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1 degrees total vs partial tumor resection and 2 degrees with patients outcome according to the degree of tumour removal. From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98.3% (p< 0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96.5% ( p=0.001). Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83.3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70.6% (p=0.001). Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42.9% (p<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001). We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.

Clinical results of proton beam therapy for skull base chordoma

To evaluate clinical results of proton beam therapy for patients with skull base chordoma. Thirteen patients with skull base chordoma who were treated with proton beams with or without X-rays at the University of Tsukuba between 1989 and 2000 were retrospectively reviewed. A median total tumor dose of 72.0 Gy (range, 63.0-95.0 Gy) was delivered. The patients were followed for a median period of 69.3 months (range, 14.6-123.4 months). The 5-year local control rate was 46.0%. Cause-specific, overall, and disease-free survival rates at 5 years were 72.2%, 66.7%, and 42.2%, respectively. The local control rate was higher, without statistical significance, for those with preoperative tumors <30 mL. Partial or subtotal tumor removal did not yield better local control rates than for patients who underwent biopsy only as the latest surgery. Proton beam therapy is effective for patients with skull base chordoma, especially for those with small tumors. For a patient with a tumor of <30 mL with no prior treatment, biopsy without tumor removal seems to be appropriate before proton beam therapy.

Radiotherapy (RT) and concomitant and adjuvant temozolomide (TMZ) versus radiotherapy alone for newly diagnosed glioblastoma (GBM): Overall results and recursive partitioning analysis (RPA) of a phase III randomized trial of the EORTC brain tumor and radiotherapy groups and the NCIC clinical trial group

The standard initial treatment for patients with GBM after biopsy or surgical resection is post-operative radiotherapy. Chemotherapy was shown to have only a minimal impact on outcome. In a previous phase II trial, we have suggested that adding TMZ to RT might improve survival (Stupp et al. JCO 20:1375–1382, 2002). In EORTC 26981/22981 NCIC CE3 we compared the efficacy of concomitant and adjuvant TMZ and RT to RT alone. Patients with newly diagnosed and histologically proven GBM (WHO grade IV), PS (WHO) 0–2, age 18–70 were eligible. The randomization was between standard RT (60 Gy in 30 daily fractions of 2 Gy, with a GTV-CTV margin of 2–3 cm), versus the same RT with concomitant TMZ (75 mg/m2 daily 7d/week for 35–42 d), followed by up to 6 cycles of adjuvant TMZ (150–200 mg/m2, daily × 5 d, q 28 d). Patients were stratified for institution, age, PS and extent of surgery. Primary endpoint was overall survival (OS) and secondary endpoints were progression free survival (PFS), quality of life and full toxicity profile. Pathology was centrally reviewed and quality control for RT was assessed by individual case reviews. Between July 2000 and March 2002, a total of 573 patients were randomized by 85 institutions. Sixteen percent of patients had a biopsy only, and 84 % had either partial (44 %) or complete (40 %) surgical tumor removal. Median age was 56 years (19–70.5), 63 % were male. PS was 0, 1 and 2 in 39 %, 48 % and 13 % of patients respectively. There was no difference in the prognostic factors between the two treatment arms. RT was delivered as prescribed in 93 % of patients, concomitant TMZ was administered without interruption in 76 % and temporarily interrupted in 11 %. Adjuvant TMZ was given to 76 % of patients and 36 % completed all 6 cycles. With a median follow-up of 2 years, 436 patients have died, 241 (84 %) in the control (RT only) arm and 195 (68 %) in the experimental (RT/TMZ) arm. Median survival was 12 months (95% c.i. 11.2–13.2) in the RT arm and 15 months (95% c.i. 13.6–16.8) in the RT/TMZ arm (p < .0001), and 2 year survivals were 8 % (95% c.i. 4–12 %) and 26 % (95% c.i. 20–32 %), respectively (p < .0001). The difference between the two treatment arms remained statistically significant in RPA classes III-V. Additional results and detailed analysis of prognostic classes will be presented. Concomitant and adjuvant TMZ/RT significantly improves overall survival compared to RT alone in newly diagnosed glioblastoma, regardless of the prognostic class

Growing Teratoma Syndrome in a Patient With a Non-germinomatous Germ Cell Tumor in the Neurohypophysis-Case Report-

A 16-year-old woman presented with a non-germinomatous germ cell tumor in the neurohypophysis manifesting as progressive visual disturbance, amenorrhea, hydrodipsia, and polyuria. Her serum alpha-fetoprotein and human chorionic gonadotropin levels were elevated. She experienced sudden, rapid visual deterioration and underwent emergency partial tumor removal to decompress the optic nerves. Her vision subsequently improved. Histological examination of the surgical specimens confirmed immature teratoma. She received chemotherapy (ifosphamide 900 mg/m2, cisplatin 20 mg/m2, etoposide 60 mg/m2) for 5 consecutive days. Although the tumor marker levels decreased remarkably, her vision again declined rapidly due to enlargement of the tumor after the first course of chemotherapy. A second radical operation resulted in vision improvement. The tumor specimen showed only mature teratoma elements. This phenomenon, called the growing teratoma syndrome, is very rare in intracranial non-germinomatous germ cell tumors.

Autologous glioma cell vaccine admixed with interleukin-4 gene transfected fibroblasts in the treatment of recurrent glioblastoma: preliminary observations in a patient with a favorable response to therapy

We designed a phase I clinical trial of vaccinations with autologous glioma cells expressing transgene-derived interleukin-4 (IL-4), and treated one patient with a right temporal lobe recurrent glioblastoma. This 62-year-old man underwent craniotomy and partial tumor removal, at which time autologous tumor cells were obtained for vaccine preparation. After confirming the patient's cellular immune function by skin test, two cycles of vaccination with irradiated autologous glioma cells admixed with gene transfected fibroblasts were given intradermally. The patient demonstrated no evidence of allergic encephalitis throughout this course. Immunohistochemistry with biopsy samples taken from the vaccine sites demonstrated that the infiltration level of CD4, CD8 and CD1a positive cells increased proportionally to the amount of IL-4 produced at the each site, suggesting that there was local immune response induced at the vaccine site. While it is premature to assess effectiveness of the vaccine, this initial patient's course suggested a transient response to the vaccine, and he survived 10 months after treatment.

頚静脈球型グロムス腫ようの２例

The clinical results in two patients with glomus tumor recently treated in our department are reported. The first case involved a mixed type of glomus tympanicum tumor and glomus jugulare tumor, while the second case showed glomus jugulotympanicum tumor. These were both classified as class C1 according to Fisch's classification. Both cases were treated surgically by an infratemporal fossa approach. Preoperative embolization diminished bleeding. The first case underwent partial tumor removal with postoperative radiotherapy using a γ-knife. The second case underwent total tumor removal.

Neurological outcome following laminectomy in spinal metastases.

Retrospective outcome measurement study. Patients suffering from malignant tumour disease and metastases to the spine develop a variety of clinical complaints including radicular symptoms and/or spinal cord compression syndromes. Palliative decompressive laminectomy with total or partial tumour resection is an acknowledged method of treatment, despite controversy. The Department of Neurosurgery of the University of Vienna. Patients suffering from metastases with predominant infiltration of the dorsal epidural parts, or patients who could not be operated on via an anterior approach, were included. Eighty-four patients who met these criteria underwent decompressive laminectomy with total or partial tumour removal. The study analyzed motor function, pain relief and continence in a 2- and 4-month post-operative follow-up. According to the criteria of motor performance, 20% of the patients had been mobile pre-operatively. In the immediate post-operative period 45%, after 2 months 33% and after 4 months 26%, were considered mobile. None of the paraplegic patients showed functional improvement. The median survival time was 6.5 months. Pre-operatively, 56% of the patients had shown continence dysfunction. Post-operatively, 38%, and after 2 months 46% of the patients, developed continence disorders. A significant reduction in analgesic medication was also observed in the post-operative period. In our series, palliative laminectomy with total or subtotal tumour reduction in patients with malignant spinal metastatic disease resulted in amelioration of motor function, pain and continence and therefore improved the patients' quality of life. The improvement in quality of life shows that this method is a valuable option in neurosurgical therapy, except for cases with pre-operative paraplegia. However, in patients with severe pre-operative paraparesis, the authors recommend laminectomy only in very exceptional cases, because of the poor post-operative neurological results.

Hypervascular vestibular schwannomas

BACKGROUND Vestibular schwannoma (VS) is usually hypovascular and can be resected totally without major morbidity. Resection of the more uncommon hypervascular VS is complicated by excessive tumor bleeding. We have attempted to clarify the clinical characteristics and management of hypervascular VS. METHODS Surgical reports and videos of 78 patients with unilateral VS (5 hypervascular, 73 nonhypervascular) were retrospectively reviewed and clinical characteristics, radiological findings, and case management were compared. RESULTS Hypervascular VS presented at a younger age than nonhypervascular VS (29 ± 12 vs. 52 ± 16 years old) ( p < 0.01). Magnetic resonance imaging (MRI) showed that hypervascular VS was solid, without tumor cyst, and significantly larger than nonhypervascular VS ( p < 0.05). The surface of hypervascular VS consistently showed multiple flow voids representing large draining veins. The characteristic angiographical findings of hypervascular VS were extensive tumor vessels, tumor stains, and early filling of draining veins; vertebrobasilar arteries supplied hypervascular VS. A multi-stage surgical approach was used since torrential tumor bleeding in the first surgery interfered with resection, resulting in partial tumor removal. Angiography before the second surgery showed much reduced tumor vascularity, bleeding was much reduced, and tumor was resected with less difficulty. In this approach, all 5 hypervascular VS were resected totally (1 case) or near-totally (4 cases) without major morbidity. CONCLUSIONS Hypervascular VS, a solid and large tumor, presents at an earlier age. Although angiography provides characteristic findings, MRI can confirm the diagnosis of a hypervascular VS by showing multiple flow-voids on the tumor surface. Since partial tumor removal (first surgery) extensively reduces tumor vascularity and intraoperative tumor bleeding considerably, hypervascular VS should be managed by a multi-staged surgical approach.

Outcome of Postoperative Intratumoral Bleomycin Injection for Cystic Craniopharyngioma

Total excision is a treatment of choice in preventing the relapse of craniopharyngioma, but for tumors involving an extensive area, it is often associated with an increased risk of complications. We have performed a partial or subtotal tumor removal followed by repeated injection of bleomycin into the remaining tumor through a subcutaneous reservoir as postoperative adjuvant therapy. A retrospective review of clinical, radiological, and surgical data was performed for 10 patients (5 males and 5 females; age, 3-65 yr; follow-up duration, 12-79 months) with cystic craniopharyngiomas. The measurements of lactate dehydrogenase (LDH) level at each aspiration were performed. The shrinkage and/or stabilization of tumor was initially noted in all cases. The recurrence of tumor was seen in 4 cases (40%). The decreased or increased level of LDH was interpreted as tumor shrinkage or recurrence, respectively. The transient toxic reactions were observed in 3 patients (30%). Our study demonstrates that postoperative bleo-mycin injection for cystic craniopharyngioma, although does not appear to eradicate the tumor, decreases and stabilizes the tumor size, when used as an adjuvant therapy in young patients.

Intracranial Dural Metastasis of Mediastinal Seminoma

A 24-year-old male presented with a rare intracranial dural metastasis from a mediastinal germ cell tumor infiltrating the superior vena cava, pericardium, ascending aorta, and lung. Routine chest radiography incidentally revealed the abnormal mediastinum, which was partially resected after median sternotomy, followed by radiotherapy. One year after the radiotherapy, magnetic resonance imaging revealed a right parasagittal tumor mimicking a meningioma. Partial tumor removal was performed. Two cycles of chemotherapy with carboplatin and etoposide were then performed, and the residual tumor almost completely disappeared. The histological diagnosis of both the mediastinal and intracranial tumors was pure seminoma. Sections of metastatic tumor revealed several thick fibrous septa and numerous epithelioid granulomas infiltrated by plasma cells, intermingled between the clusters of tumor cells. Follow up of patients apparently in remission from mediastinal seminoma without evidence of advanced or recurrent disease at other sites is recommended.

Neuroendoscopic approach to tectal tumors: a consecutive series.

The authors report a consecutive series of 10 patients who presented with signs and symptoms caused by tectal tumors. Clinical findings, radiographic features, neuroendoscopic management strategies, and histological findings are reported and discussed. Since January 1990, 11 neuroendoscopic procedures were performed in 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months-11 years), and a retrospective study was conducted in which case notes, radiological findings, operative notes, and histopathological findings were assessed. Magnetic resonance (MR) imaging was performed, and the images were used to classify patients into three groups: those with hypertrophy of the tectum in whom isointensity appeared on T1-weighted images (Group 1); those with a tectal tumor occupying the cerebral aqueduct in whom decreased signal intensity appeared on T1-weighted images, as well as no enhancement after gadolinium administration (Group 2); and those with a tectal tumor in whom mixed signal intensity and conspicuous evidence of contrast enhancement appeared on T1-weighted images (Group 3). The results of histological examination were consistent with MR imaging features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocytoma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydrocephalus. One patient in Group 3 underwent radiotherapy and subsequent partial tumor removal under neuroendoscopic guidance. Thereafter, the tumor remained in decline. All patients had normal intellectual status after undergoing surgery in which a neuroendoscope was used. Neuroendoscopic procedures can provide histological diagnosis, define the tumor-midbrain interrelationship, and be highly effective in treating obstructive hydrocephalus and in removing tectal tumors. This procedure may receive clinical application as a new management strategy for tectal glioma.

Endoscopic mucosal resection (EMR): results and prognostic factors in 21 patients.

The aim of this study was to evaluate the efficacy of endoscopic mucosectomy (EM), and to present our experience with the endoscopic removal of superficial tumors of the gastrointestinal tract. A total of 21 patients were included in the study (16 men, 5 women), between September 1995 and May 1997. In 16 cases the site of the lesions was an esophageal carcinoma, in two cases a gastric carcinoma, and in three cases a sessile polyp of the duodenum with severe dysplasia. Surgery was not recommended for the patients with esophageal or gastric tumors (on account of cardiac disease, cirrhosis or poor health). All patients underwent an endoscopic ultrasound (EUS) examination. The lesions were classified as usT1N0 in 20 cases, and usT0N0 in one case, according to the pretreatment EUS findings. We used the technique of polypectomy after submucosal injection of 10-15 ml of saline serum. Complications were encountered in 2/21 patients (9.5 %). Bleeding occurred in one case, but hemostasis was achieved endoscopically. In the other case, the patient presented with a thoracic pain and was treated by morphine injection. Endoscopic resection was considered to be complete in 19/21 patients (90.4%). In the other two cases, both involving esophageal tumors, histologic examination indicated only a partial tumor removal. However, these two patients had survived with negative EUS and endoscopic biopsy findings at 18 and 22 months later, respectively. None of the patients whose resections were considered complete presented with local recurrence, but three patients developed another superficial esophageal cancer, which was also treated by endoscopic mucosal resection (EMR). The mean follow-up was 20 months. EMR is a safe and efficient treatment of early gastrointestinal tumors. The development of high-frequency EUS probes may further improve the results of this technique in the future.

Fractionated irradiation of cerebellopontine angle neurinoma: 12 years' experience of the Bordeaux University Hospital Center

To evaluate retrospectively the long-term results of fractionated radiation therapy (RT) in cerebello-pontine angle neurinomas (CPA). From January 1986 to October 1995, 29 patients with stage III and IV neurinomas were treated with external fractionated RT. One patient was irradiated on both sides and indications for RT were as follows: (1) general contraindications for surgery (16 patients); (2) hearing preservation in bilateral neurinomas after controlateral tumor exeresis (six patients); (3) partial tumor removal (five patients); and, (4) non-surgical recurrence (three patients). A three to four fields technique with coplanar static beams and conformal cerobend blocks was used; doses were calculated on a 95 to 98% isodoses and were given five days a week for a median total dose of 51 Gy (1.8 Gy/fraction). Most patients were irradiated with 6 to 10 MV photons). Median follow-up was 66 months (seven to 120 months). Seven patients died, two with progressive disease, five from non-tumoral causes. Tumor shrinkage was observed in 13 patients (43.3%), stable disease in 14 (46.6%), and tumor progression in three. Two patients underwent total tumor removal after RT (one stable and one growing tumor). Hearing was preserved in four out of six patients. No patient experienced facial or trigeminal neuropathy. Fractionated RT is a well tolerated and efficacious treatment of large non-surgical CPA neurinomas.

Neuroendoscopic approach to tectal tumors: a consecutive series

The authors report a consecutive series of 10 patients who presented with signs and symptoms caused by tectal tumors. Clinical findings, radiographic features, neuroendoscopic management strategies, and histological findings are reported and discussed. Since January 1990, 11 neuroendoscopic procedures were performed in 10 patients who harbored tectal tumors. The patients were followed for an average of 5 years (range 2 months to 12 years), and a retrospective study was conducted in which case notes, radiological findings, operative notes, and histopathological findings were assessed. Magnetic resonance (MR) imaging was performed, and the images were used to classify patients into three groups: those with hypertrophy of the tectum in whom isointensity appeared on T1-weighted images (Group 1); those with a tectal tumor occupying the cerebral aqueduct in whom decreased signal intensity appeared on T1-weighted images, as well as no enhancement after gadolinium administration (Group 2); and those with a tectal tumor in whom mixed signal intensity appeared on T1-weighted images and conspicuous evidence of contrast enhancement (Group 3). The results of histological examination were consistent with MR imaging features: in Group 1, glial tissue or gliosis; in Group 2, benign astrocytoma; and in Group 3, malignant astrocytoma. Cerebrospinal fluid diversion was the only surgical treatment that provided relief from obstructive hydrocephalus. One patient in Group 3 underwent radiotherapy and subsequent partial tumor removal under neuroendoscopic guidance. Thereafter, the tumor remained in decline. All patients had normal intellectual status after undergoing surgery in which a neuroendoscope was used. Neuroendoscopic procedures can provide histological diagnosis, define the tumor-midbrain interrelationship, and be highly effective in treating obstructive hydrocephalus and in removing tectal tumors. This procedure may receive clinical application as a new management strategy for tectal glioma.

Gangliogliomas: experience with 34 patients and review of the literature.

Ganglioglioma is an uncommon central nervous system tumor. The role of adjuvant postoperative radiation therapy is undefined. The authors retrospectively reviewed the clinicopathologic features and results of therapy for 34 patients with ganglioglioma treated at the University of California at Los Angeles. There were 18 women and 16 men. Median age was 18 years. Twenty-five tumors were low grade. Twenty-one patients underwent gross total resection. Three patients received adjuvant radiotherapy. The 4-year actuarial progression free and overall survival rates were 67% and 75%, respectively. The median time to progression was 14 months and all relapses were local. Factors significantly influencing progression-free or overall survival according to univariate analysis included degree of resection and tumor grade. Survival and relapse were not significantly influenced by any factor according to multivariate analysis. The progression-free survivals after gross total resection of low- and high-grade tumors were 78% and 75%, respectively. Respective rates after subtotal resection were 63% and 25%. Review of the literature demonstrates no role for radiotherapy after total resection of ganglioglioma or after partial removal of low-grade tumor. Radiation therapy appears to reduce the relapse rate after partial removal of high-grade lesions. A dose in excess of 5,000 cGy is necessary for ganglioglioma.

Trail receptor expression and trail-mediated apoptosis in human colon carcinoma cell lines

The aim of this study is to evaluate the efficacy of the endoscopic mucosectomy (EM) and to present our experience with the endoscopic removal of superficial tumors of the GI tract. Patients and methods: 30 patients were included in the study (21 men and 9 women) between September 1995 and January 1997. The site of the lesion was in 8 cases an esophageal carcinoma (7 squamous cell, 1 adenocarcinoma), in 2 cases a gastric carcinoma, in 1 case a sessile polyp of the duodenum with in situ carcinoma, in 9 cases a flat colonic polyp (5 adenocarcinoma and 4 polyps with severe dysplasia) and in 10 cases a rectal tumor (3 adenocarcinoma and 7 villous tumors with in situ carcinoma). The mean size of the lesion was 17 mm (range: 5-40 mm). Surgery wasn't recommended for the patients with esophageal, gastric and rectal tumors (cardiac disease, cirrhosis or bad health condition). An endoscopic ultrasound examination (EUS) was performed in 23130 patients. The pretherapeutic EUS classified the lesion as T1N0 in 20 cases and TON0 in 3 cases. We used the technique of polypectomy after submucosal injection of 10-15 ml of saline serum. Results: complications occurred in 4•30 patients (13%). Bleeding occurred in 3 cases during resection tumor (1 esophagus and 2 rectal tumors) but hemostasis was achieved using the coagulation electrode or adrenaline injection. In the other case, the patient presented a thoracic pain treated by morphine injection. The endoscopic resection was considered as complete in 25130 of cases (83,3%). In 5 cases, the histology examination concluded to a partial tumor removal (2 esophagus lesions, 2 colonic tumors and 1 rectal villous tumor). Surgery was performed in the 2 colonic and in the rectal tumors and the pathologic examination of the resected specimen founded residual T1 tumor in 2 cases and no tumor in 1 case. The 2 patients with the esophageal cancer partially resected were alive with negative EUS and endoscopic biopsy respectively 12 and 14 months later. Only one of the 25 patients considered as a complete resection has presented a local recurrence (small tumor of the caecum). The mean follow-up of the patients was 10 months (range: 6-24). Two patients were dead at the end of the study of intercurrent diseases. Conclusion: 24/30 patients (80%) benefited from this non invasive treatment. Based on the development of high frequency EUS probe, the results of this technique will increase in the future.