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CLIN-EPIDEMIOLOGY

ABSTRACT: Although most children treated for acute lymphoblastic leukemia (ALL) survive, the noncognitive neurologic sequelae of ALL treatment are inadequately described, and most reported studies utilize self-administered questionnaires. We undertook a prospective, IRB-approved, cross-sectional study to define neurologic morbidity in ALL survivors who were more than 5 years from diagnosis. An investigator administered the questionnaire and disability scales, and a board-certified neurologist performed a quantitative neurologic examination. The PedMIDAS tool was completed to determine headache-related disability. The International Headache Society criteria were applied to classify headache type. Of 375 long-term survivors available, 162 consented and participated in the study. There were no significant differences in clinical or biological features between participants and non-participants. Headache was reported by 76 (47%) of the 162 patients: 34 of 70 (49%) girls and 42 of the 92 boys (46%). Median time from onset of the first headache episode was 5.7 years (0.1-18 years), and median age at headache onset was 9.5 years (3.1-27 years). Migraine was diagnosed in 46 survivors (61%), and 25 experienced one or more aura. Episodic tension-type headache was present in 39 (51%) patients, and 17 patients (22%) experienced both migraine and tension-type headaches. Chronic daily headaches were present in 12 survivors (8 with migraine and 4 with tension-type headache). Among survivors with headache, 13 (17%) reported a frequent need to interrupt activities, 36 (47%) occasionally restricted activity, and 27 (36%) did not restrict activity during a headache episode. More than two-thirds (67%) had never seen a physician for headache, and only 8% had visited the hospital emergency room over the last year. PedMIDAS scores revealed no headache-related disability in 42 (55%) patients, mild disability in 22 (29%) patients, and moderate disability in 12 (16%) patients. In conclusion, migraine and tension-type headaches are common in ALL survivors, affect both sexes equally, and in general cause relatively little morbidity.

SUBMITTER: Khan R

PROVIDER: S-EPMC3488775 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Project description:Skull base tumors are challenging lesions for neurosurgeons, but these cannot always be removed via surgical resection. Helical tomotherapy (HT) delivers small beamlets of photons in continuous rotational treatment arcs and has an advantage of soft-tissue verification using computed tomography. We present our experience with HT for skull base tumors when the tumors were not accessible via surgery or recurred after surgery. From December 2005 to October 2010, 60 patients underwent HT for brain tumors. Among them, 13 patients had skull base tumors; four patients had petroclival meningiomas; two patients had cerebellopontine angle (CPA) meningiomas; two patients had acoustic schwannomas; one patient had foramen magnum meningioma; one patient had sphenoid meningioma; one patient had cavernous meningioma; one patient had jugular foramen meningioma; and one patient had clival meninigioma. Eight patients (62%) underwent surgery before HT. The target size ranged from 0.55 to 141.86 cm3 (median 3.85 cm3), and the target dose ranged from 9 to 57 Gy in 1-31 fractions (median 25 Gy in 5 fractions). The median follow-up period was 11 months. The results of HT for skull base tumors are described in Table 1. Twelve patients (92%) had favorable radiologic response. Six patients (46%) had partial response, and another six patients (46%) had stable disease after HT. One patient with CPA meningioma (case 11) had disease progression and underwent a second surgery. One patient with acoustic schwannoma (case 8) had transient radiation-induced changes on the cerebellum, but other patients did not have radiation-induced complications. HT is a useful treatment modality for skull base tumors when surgical access is not possible, and HT is well tolerated by patients with skull base tumors. PURPOSE: A breast cancer-specific graded prognostic assessment (GPA) was developed to better estimate prognosis for breast cancer patients with brain metastases. This GPA was further refined by adding genetic subtype on the basis of a retrospective, multi-institutional analysis. We sought to externally validate this breast-cancer GPA via an independent, large, multi-institutional data set. MATERIALS AND METHODS: Between 1993 and 2012, 275 women from two institutions who had breast cancer metastases to the brain and complete information available to assign breast-GPA (age, Karnofsky Performance Score, and genetic subtype of luminal A or B, HER2, or basal) were evaluated. Median overall survival (OS) with 95% confidence interval (95% CI) was calculated for each breast-GPA group. Differences between groups were tested using the log-rank test. RESULTS: Of the 275 women, 208 (76%) are deceased. The median OS was 11.5 months (95% CI 8.4, 12.9). The median OS by GPA scores of 0-1.0, 1.5-2.0, 2.5-3.0, 3.5-4.0 were 3.9 (n = 46), 8.0 (n = 88), 13.8 (n = 95), and 17.6 (n = 46) months, respectively (p < 0.0001). These results compared favorably with those of Sperduto et al.: median OS of 3.4 (n = 23), 7.7 (n = 104), 15.1 (n = 140), and 25.3 (n = 133) months, respectively. Genetic subtype was associated with OS, with luminal A and B, HER2, and basal subtypes having a median OS of 12.5 (n = 81), 16.2 (n = 66), 14.9 (n = 34), and 5.8 months (n = 94), respectively (p < 0.0001). CONCLUSIONS: In this cohort of women, the breast-GPA incorporating genetic subtype demonstrated wide variation in prognosis according to GPA score and tumor subtype, in a manner similar to the original report. This analysis validates the prognostic value of including genetic subtype in the breast-GPA, which has been shown to have superior predictive power compared with tumor subtype alone.

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CLIN-EPIDEMIOLOGY

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