Progress in Neuro-Oncology
Online ISSN : 2187-0551
Print ISSN : 1880-0742
ISSN-L : 1880-0742
Volume 21, Issue 3
Displaying 1-10 of 10 articles from this issue
  • Takanori Ohnishi
    2014 Volume 21 Issue 3 Pages 1-13
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
    Goal of malignant glioma surgery is to maximally resect the tumor with minimum neurological dysfunction, giving the patients a chance to survive much longer with keeping good quality of life. When malignant gliomas are located in eloquent cortical areas (EA) such as motor and language cortices, multi-modal assistant systems for surgery are essential to carry out the glioma surgery with maximal resection and minimal neurological deficit. These systems include image-guided navigation, photodynamic tumor detection, and functional monitoring including awake surgery. In the image-guided navigation, various devices have been introduced into the navigation system to perform a real-time navigation that enables to correct displacement of structures induced by brain shift. In addition to US-linked navigation, intraoperative MRI has become available to update the images of MRI and DTI. Photodynamic detection with 5-ALA has highly contributed to resect tumors to the maximal extent.However, a novel quantitative method to detect the fluorescence in the surrounding tumor cells will be needed to overcome tumor invasion. Functional monitoring such as cortical and subcortical stimulation is essential to maintain the important neurological functions including motor and language activity. Recently, subcortical stimulation with the navigation of fiber tractography has been widely used to more exactly detect the location of subcortical neuronal fibers. With using these multi-modal assistant systems, we operated on 74 patients with GBM, including 25 patients in EA. Extent of resection and postoperative KPS in patients with EA GBM did not differ from those in patients with non-EA GBM. The EA-GBM patients also showed overall survival as long as the non-EA-GBM patients.
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  • Toshihiko Kuroiwa
    2014 Volume 21 Issue 3 Pages 14-21
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
    Malignant glioma is extremely difficult to treat because of its invasiveness and obscure borders between the tumor and surrounding brain, which are due to a mixture of tumor cells and nerve tissue in the area around the tumor. For surgical removal of malignant glioma, it is important to at least confirm the area of the main mass which is rich in tumor cells. Many methods including frozen section during operation, pre- and intra-operative imaging diagnosis, and navigation system are used for this purpose. Photodynamic diagnosis or photodynamic detection (PDD) is a method that uses various fluorescent dyes such as fluorescein sodium (FS), indocyanine green (ICG), 5-aminofluorescein-albumin conjugate, hematoporphyrin derivatives including porfimer sodium and 5-aminolevulinic acid (5-ALA), and mono-L-aspartyl chlorin e6 (Npe6). We utilize FS and ICG which leak from the tumor vessels due to the breakdown of the blood-brain barrier. The other dyes are selectively incorporated into the brain tumor cells. 5-ALA, an endogenous substance, is the most commonly used dye because it can be orally administered and is relatively safe. While 5-ALA itself does not produce fluorescence, it is metabolized in the cells to protoporphyrin IX producing red fluorescence.Dyes incorporated into the tumor cells are also used for photodynamic therapy (PDT). At present, however, Npe6 is the only dye approved for PDT against brain tumors in Japan.
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  • Akira Gomi
    2014 Volume 21 Issue 3 Pages 22-32
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
    Recently molecular classifications of pediatric brain tumors, especially medulloblastoma, ependymoma and diffuse intrinsic pontine gliomas (DIPG), have progressed. Various molecular targeting agents have also been developed. We need to knownot only standard therapies but also various therapeutic options according to the novel information. Here we reviewed recent progresses in chemotherapy in medulloblastoma, ependymoma and DIPG, including molecular subtyping.
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  • Makoto Shibuya
    2014 Volume 21 Issue 3 Pages 33-41
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
    Meningiomas are the most common intracranial primary neoplasm. Although most meningiomas are benign with a slow-growing behavior, some subtypes are associated with a high risk of recurrence and short survival times. Recent advances of technologies related to the clinical, histological, and molecular diversity of this common but heterogenous tumor are being reviewed.
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  • Akira Matsumura
    2014 Volume 21 Issue 3 Pages 42-44
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
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  • Toshihiko Wakabayashi
    2014 Volume 21 Issue 3 Pages 45-50
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
    Gliomas account for approximately 30% of all brain tumors and are thus the most common primary tumors of the central nervous system (CNS). High-grade (WHO grades III and IV) malignant gliomas, especially glioblastoma (GBM), the most common glioma in adults, kills patients within a median time span of a year after diagnosis despite treatment with aggressive surgical resection, chemotherapy, and radiotherapy. In Japan, alkylating agents such as 1- (4-amino-2-methyl-5-pyridiminyl) methyl-3- (2-chloroethyl) -3-nitrosourea (ACNU) and methyl-6-[3- (2-chloroethyl) -3-nitrosoureido] -6-deoxy-alpha-D-glucopyranoside (MCNU) have been used to treatmalignant gliomas for a long time, however, this treatment offered few clinical benefits.Temozolomide (TMZ; Temodal®), an oral alkylating agent, has been demonstrated to possess antitumor activity against malignant gliomas, with minimal additional toxicity; furthermore, in a previous study, treatment with this agent significantly prolonged the median survival time. In 2006, TMZ was certified as the treatment agent for malignant gliomas by the National Ministry of Health and Welfare of Japan. And it is now used as the first-line therapy. However, its clinical outcomes depend on the O6-methylguanine-DNA methyltransferase (MGMT) status, and MGMT modification is one of the key factors to obtain greater clinical benefits in the future.TMZ and other antitumor drugs, especially anti VEGF antibody (Avascin®) and/or BCNU wafer (Gliadel®) combination therapy have been aggressively tried for the treatment of gliomas. Some of them were also observed in an experimental animal model and moved to the clinical trials. These studies suggested that TMZ with other antitumor drugs combination therapy might further improve the clinical outcome in malignant gliomas as compared to TMZ plus radiation therapy.Based upon all these data shown previously, there are now going into the next step to perform the phase II to III clinical study for further improvement against malignant brain tumors.
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  • Editorial Committee for Neuro-Oncology Brush-up Tests for Neurosurgica ...
    2014 Volume 21 Issue 3 Pages 51-56
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
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  • 2014 Volume 21 Issue 3 Pages 57-58
    Published: December 25, 2014
    Released on J-STAGE: December 26, 2014
    JOURNAL FREE ACCESS
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