Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: an assessment of clinical potential.

The purpose of this analysis was to assess the potential of BNCT, with L-boronophenylalanine (L-BPA), as first line radiotherapy for glioblastoma multiforme (GBM). The survival of patients with newly diagnosed GBM from a phase II BNCT study was compared with those from the two arms of a phase III study with conventional radiotherapy (RT) vs. RT plus concomitant and adjuvant medication with temozolomide (TMZ).

Boron neutron capture therapy for newly diagnosed glioblastoma multiforme: an assessment of clinical potential.

The purpose of this study was to assess the potential of boron neutron capture therapy (BNCT), with a 6-h infusion of the boron carrier l-boronophenylalanine as a fructose preparation (BPA-f), as first-line radiotherapy for newly diagnosed glioblastoma multiforme (GBM). Patient survival data from a Phase II study using BNCT were compared with retrospective data from the two arms of a Phase III study using conventional radiotherapy (RT) in the reference arm and using RT plus concomitant and adjuvant medication with temozolomide (TMZ) in the experimental arm, and were also compared with small subgroups of these patients for whom the methylation status of the MGMT (O(6)-methylguanine-DNA methyltransferase) DNA repair gene was known. Differences in the baseline characteristics, salvage therapy after recurrence and levels of severe adverse events were also considered.

Boron Neutron Capture Therapy for glioblastoma multiforme: advantage of prolonged infusion of BPA-f.

Objectives: To assess possible improved efficacy of Boron Neutron Capture Therapy (BNCT) for glioblastoma multiforme (GBM) using prolonged infusion and a correspondingly higher dose of l-boronophenylalanine, as the fructose complex (BPA-f).

Materials And Methods: The benefit of prolonged infusion was analyzed by comparing the results from a Phase II study using 6 h infusion of BPA-f with those obtained from a Phase I/II study using 2 h of infusion. Median survival time (MST) from diagnosis, patient baseline characteristics, salvage treatment and severe adverse events were considered in the comparison.

An investigation of boron neutron capture therapy for recurrent glioblastoma multiforme.

Objectives - To explore the use of boron neutron capture therapy (BNCT) for patients with glioblastoma multiforme (GBM), recurring after surgery and conventional radiotherapy (photon radiotherapy). Materials and Methods - Boron uptake in recurrent GBM was measured for four patients. Twelve patients were subsequently treated by BNCT with boronophenylalanine-fructose (900 mg/kg body weight), administered by intravenous infusion for 6 h.

Neuropathological postmortem evaluation of BNCT for GBM.

Background: Thirty patients with glioblastoma multiforme (GBM) were treated by boron neutron capture therapy (BNCT) at the Studsvik facility in Sweden, in a clinical trial exploring a procedure in which 900 mg p-boronophenylalanine (BPA) per kilo body weight was infused in 6 h.

Objective: The present study was designed to assess tumor efficacy and radiation damage to the brain for the seven patients in the Studsvik trial that were available for postmortem neuropathological examination.

Method: Whole brain slices containing the initial tumor site and other regions showing pathological changes were chosen for microscopy and selected areas were studied by immunological methods.

BNCT for recurrent intracranial meningeal tumours - case reports.

Objectives: The investigation was designed to explore the efficacy of boron neutron capture therapy (BNCT) as treatment for recurrent intracranial meningeal tumours.

Materials And Methods: Three patients with meningeal tumours, recurring after initial surgery, radiation therapy and several reoperations, were evaluated for treatment with BNCT by determination of the accumulation of boronophenylalanine fructose (BPA-F) in tumour and in surrounding tissue. Two of these patients were subsequently treated by BNCT.

Fractionated, stereotactic proton beam treatment of cerebral arteriovenous malformations.

Objectives: To evaluate the therapeutic efficiency and adverse effects of stereotactic proton beam treatment of cerebral arteriovenous malformations (AVM).

Material And Methods: Twenty-six patients treated in Uppsala during 1991-97 were included (men = 14, women = 12; mean age = 39, range = 23-64). The nidus volumes ranged from 0.

Boron neutron capture therapy for glioblastoma multiforme: clinical studies in Sweden.

A boron neutron capture therapy (BNCT) facility has been constructed at Studsvik, Sweden. It includes two filter/moderator configurations. One of the resulting neutron beams has been optimized for clinical irradiations with a filter/moderator system that allows easy variation of the neutron spectrum from the thermal to the epithermal energy range.

Stereotactic irradiation of skull base meningiomas with high energy protons.

Nineteen patients with inextirpable skull base meningioma with involvement of neurovascular structures were given irradiation with a 180 MeV proton beam at the The Svedberg Laboratory, Uppsala, Sweden. The patients were treated seated in a fixed position with a stereotactic approach. Titanium-markers to the outer table served for identification and verification of the target positioning for dose planning and irradiation.

Differences in radiosensitivity between brain, small and large arteriovenous malformations. A tentative explanation of the incongruent results of radiotherapy.

Intriguing differences in the results of brain arteriovenous malformation (AVM) therapy with ionizing radiation are reported in the literature, i.e. AVMs obliterate at different time intervals from the initiation of radiotherapy although presenting with similar nidus volumes that are treated with the same radiation dose.

Hidden compartments in AVMs--a new concept.

Purpose: The concept of hidden compartments in cerebral arteriovenous malformations (AVMs), which is hereby launched, offers a new explanation for the neurosurgical and neuroradiological controversies concerning patients with AVMs.

Material And Methods: Three patients who were considered completely cured of their AVMs, subsequently developed new areas of malformed vessels as revealed by later angiograms.

Results: These 3 cases support our hidden compartment hypothesis and are reported on here, illustrated with relevant angiograms.

Warning leak and management outcome in aneurysmal subarachnoid hemorrhage.

The impact of warning leaks on management results in patients with aneurysmal subarachnoid hemorrhage (SAH) was evaluated in this prospective study. In a consecutive series of 422 patients with aneurysmal SAH, 84 patients (19.9%) had an episode suggesting a warning leak; 34 (40.

Activation PET scanning in pretreatment evaluation of patients with cerebral tumours or vascular lesions in or close to the sensorimotor cortex.

Treatment of tumours and vascular lesions in or close to eloquent cortex may inflict neurological deficits. Intra-operative mapping procedures have been used for many decades in efforts to minimize neurological sequelae. The possibility for non-invasive pre-operative brain mapping has emerged with the advent of positron emission tomography (PET).

The immunorejection of neoplasia in a theoretical model.

A theoretical model is presented based on the idea that the immune system of a patient with a tumour can cross-react against transplanted normal foreign cells as well as against the patient's own neoplastic cells, thereby rejecting both. This hypothesis is shown in a diagram, the potential use of which is discussed.

Endovascular treatment of a spinal arteriovenous malformation in a 21-month-old boy.

Reports of spinal arteriovenous malformations in children are rare. This case report describes a 21-month-old boy whose first symptom was attacks of abdominal pain, followed gradually by neurological symptoms. The diagnosis was made using magnetic resonance imaging and spinal angiography, and the patient was successfully treated with embolization.

Patient positioning for fractionated precision radiation treatment of targets in the head using fiducial markers.

When irradiating targets in the brain, an accurately localised dose is often needed. One crucial moment to achieve this is the positioning of the patient. We have developed a positioning method where the patient is immobilised with a bite block and a head mould, and where the position of the target is determined by X-ray imaging of fiducial markers that are placed in the patient's skull.

Cellular differentiation: a theory based on simulation with computer graphics.

Rules are outlined in order to construct graphically a computer model that deals with cell growth, multiplication and differentiation. The process starts with a multicoloured stem cell and the end product will be differentiated cells represented by different colours. Various biological processes and neoplastic transformation can also be simulated.

Doctors' versus patients' evaluation of results after neurosurgery.

A comparison between doctors' and patients' judgements of results after treatment for various neurosurgical conditions has been made. Ninety consecutive patients (41 women and 49 men) treated for trauma, vascular diseases, tumours, pain, and malformations were included in the study. The physicians responsible for the treatment and the patients rated the result of the therapeutic efforts (operative or nonoperative) independently from each other on a five grade scale at the time for discharge.

Nimodipine treatment of selected good-risk patients with subarachnoid hemorrhage: no significant difference between present and historical results.

Eighty-four patients were treated early with nimodipine intravenously, and thereafter orally, up to 21 days after aneurysmal subarachnoid hemorrhage. Thirty-nine patients in the nimodipine-treated group were carefully selected to be compared with similar patients from a historical control group (114 patients) conventionally treated. The causes of poor results were clinically identified as follows: delayed ischemic deterioration (DID), rebleeding, complications of surgery, or not defined.

Malignant prolactinoma with multiple intracranial metastases studied with positron emission tomography.

A rare case of a patient with multiple intracranial metastases from a prolactin-secreting pituitary neoplasm is described. At the age of 14 years, the patient had been operated on for a sellar tumor; he presented 12 years later with severe headache, at which time computed tomographic and magnetic resonance imaging scans revealed multiple intracranial metastases. Histopathology examination showed pituitary neoplastic cells with positive immunostaining for prolactin.

Prognostic evaluation before operative extirpation and radiotherapy of solitary brain metastasis.

This is a retrospective study of 134 patients operated on for solitary brain metastasis at the University Hospital in Uppsala, Sweden between 1963 and 1982. All the patients underwent postoperative radiation therapy. A statistical evaluation of different prognostic factors was made in order to create a prognostic model, a so-called risk profile, to be used for future patients.

Treatment of spinal cord injuries in the thoracolumbar region.

Forty patients with spinal cord injuries in the thoracolumbar region were studied. Clinical and experimental data support the conservative approach. In some patients acute stabilisation is needed and in a few patients operative decompression may be considered.

Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy.

One hundred and fourteen patients were admitted to our department for evaluation of their cervical spondylogenetic symptoms, including local cervical pain, radiculopathy and myelopathy. This retrospective study gives the results, expressed as improved, unchanged or worse, of anterior surgery, posterior surgery and conservative treatment. Local cervical pain improved in about half of the patients, without any difference between the groups.