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Fred H Hochberg - One of the best experts on this subject based on the ideXlab platform.
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clinical relevance of consolidation radiotherapy and other main therapeutic issues in primary central nervous system Lymphomas treated with upfront high dose methotrexate
International Journal of Radiation Oncology Biology Physics, 2001Co-Authors: Michele Reni, Jeanyves Blay, Andres J M Ferreri, Nandita Guhathakurta, Stefania Delloro, Pierre Biron, Fred H HochbergAbstract:Abstract Purpose: To evaluate the optimal dose of methotrexate (MTX) and the efficacy of other drugs, intrathecal chemotherapy (CHT), and radiotherapy (RT) in primary Brain Lymphomas. Methods and Materials: Two hundred eighty-eight immunocompetent patients with histologically documented, previously untreated primary Brain Lymphomas, receiving CHT containing high-dose MTX (≥1 g/m 2 ) with or without RT were selected from 19 prospective series. The impact on survival of the MTX dose ( 2 vs.≥3 g/m 2 ), the main drugs, intrathecal CHT, and combination CHT (mono-CHT vs. poly-CHT) was assessed, according to the intention-to-treat principle. The role of post-CHT irradiation (immediate vs. delayed RT) was evaluated in 119 patients with a complete response to CHT. The whole Brain and tumor bed dose ( Results: No difference in overall survival (OS) was detected between mono-CHT and combination CHT ( p = 0.38). MTX ≥3 g/m 2 ( p = 0.04), thiotepa ( p = 0.03), and intrathecal CHT ( p = 0.03) improved the OS, and nitrosoureas ( p = 0.01) correlated with a worse survival. In multivariate analysis, limited to patients receiving MTX ≥3 g/m 2 , only the addition of cytarabine improved the OS; nitrosoureas reduced MTX efficacy. Of the 119 complete responders, 70 received immediate RT. A RT dose of ≥40 Gy to the whole Brain or tumor bed did not improve OS. The 3-year OS was similar between the immediate and delayed RT groups. In multivariate analysis, RT delay had no negative impact on survival. Conclusions: MTX ≥3 g/m 2 seems to improve survival in primary Brain Lymphoma patients. The efficacy of additional drugs, except for cytarabine, remains unproved. Randomized trials are needed to confirm that RT withdrawal yields no detrimental effect in complete responders.
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Clinical aspects of Brain tumor
Curr Opin Neurol, 1997Co-Authors: D M Damek, Fred H HochbergAbstract:New approaches to treating patients with malignant Brain tumors use advanced magnetic resonance and positron imaging. Clinical protocols to treat oligodendroglial-containing tumors, Brain Lymphoma or primitive neuroectodermal tumor make use of systemic administration of drugs before irradiation. Chemotherapy directed into tumor is provided for recurrent glioblastoma as is reoperation and the use of stereotactic radiosurgical boosts.
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The therapy of primary Brain Lymphoma
Journal of Neuro-Oncology, 1991Co-Authors: Fred H Hochberg, Jay S. Loeffler, Michael PradosAbstract:Recommendations regarding the current therapy of primary Brain Lymphoma (NHL-CNS) take into account the occurrence of this tumor in immunocompetent and immumosuppressed hosts. Immunohistochemical evaluation of biopsy material or spinal fluid provides the diagnosis in 90% of patients. For the immunocompetent, pre-irradiation intra-venous or intra-arterial chemotherapy with Methotrexate alone or in combination with other agents is provided to treat tumor within multiple Brain sites. Subarachnoid deposits are treated with Methotrexate by intrathecal administration. Radiation is provided after chemotherapy and for the treatment of vitreal/retinal deposits or symptomatic lesions within the spinal axis. The therapy of recurrent NHL-CNS makes use of intravenous Methotrexate or high dose Cytosine Arabinoside. Immunosuppressed patients respond to reduction of immunosuppressive medication. The therapy of NHL-CNS in the AIDS patient makes use of corticosteroids followed by cranial irradiation. A discussion of emerging trends in the therapy of NHL-CNS in the AIDS and non-AIDS population is provided.
Jeanyves Blay - One of the best experts on this subject based on the ideXlab platform.
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primary cns Lymphoma with intraocular involvement international pcnsl collaborative group report
Neurology, 2008Co-Authors: S A Grimm, Tali Siegal, Colin A Mccannel, Antonio Omuro, A J M Ferreri, Jeanyves Blay, Edward A Neuwelt, Tracy T Batchelor, Kristoph Jahnke, Tamara ShenkierAbstract:Objective: To describe the demographics, diagnostic details, therapeutic management, and outcome in patients with primary CNS Lymphoma (PCNSL) with ocular involvement. Methods: A retrospective study of 221 patients was assembled from 16 centers in seven countries. Only HIV-negative, immunocompetent patients with Brain and ocular Lymphoma were included; none had systemic Lymphoma. Results: Median age at diagnosis was 60. Fifty-seven percent were women. Median Eastern Cooperative Oncology Group performance status was 2. Ocular disturbance and behavioral/cognitive changes were the most common presenting symptoms. Diagnosis of Lymphoma was made by Brain biopsy (147), vitrectomy (65), or CSF cytology (11). Diagnosis of intraocular Lymphoma was made by vitrectomy/choroidal/retinal biopsy (90) or clinical ophthalmic examination (141). CSF cytology was positive in 23%. Treatment information was available for 176 patients. A total of 102 received dedicated ocular therapy (ocular radiotherapy 79, intravitreal methotrexate 22, and both 1) in addition to treatment for their Brain Lymphoma. Sixty-nine percent progressed at a median of 13 months; sites of progression included Brain 52%, eyes 19%, Brain and eyes 12%, and systemic 2%. Patients treated with local ocular therapy did not have a statistically significant decreased risk of failing in the eyes ( p = 0.7). Median progression free survival and overall survival for the entire cohort were 18 and 31 months. Conclusion: This is the largest reported series of primary CNS Lymphoma (PCNSL) with intraocular involvement. Progression free and overall survival was similar to that reported with PCNSL. Dedicated ocular therapy improved disease control but did not affect overall survival.
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clinical relevance of consolidation radiotherapy and other main therapeutic issues in primary central nervous system Lymphomas treated with upfront high dose methotrexate
International Journal of Radiation Oncology Biology Physics, 2001Co-Authors: Michele Reni, Jeanyves Blay, Andres J M Ferreri, Nandita Guhathakurta, Stefania Delloro, Pierre Biron, Fred H HochbergAbstract:Abstract Purpose: To evaluate the optimal dose of methotrexate (MTX) and the efficacy of other drugs, intrathecal chemotherapy (CHT), and radiotherapy (RT) in primary Brain Lymphomas. Methods and Materials: Two hundred eighty-eight immunocompetent patients with histologically documented, previously untreated primary Brain Lymphomas, receiving CHT containing high-dose MTX (≥1 g/m 2 ) with or without RT were selected from 19 prospective series. The impact on survival of the MTX dose ( 2 vs.≥3 g/m 2 ), the main drugs, intrathecal CHT, and combination CHT (mono-CHT vs. poly-CHT) was assessed, according to the intention-to-treat principle. The role of post-CHT irradiation (immediate vs. delayed RT) was evaluated in 119 patients with a complete response to CHT. The whole Brain and tumor bed dose ( Results: No difference in overall survival (OS) was detected between mono-CHT and combination CHT ( p = 0.38). MTX ≥3 g/m 2 ( p = 0.04), thiotepa ( p = 0.03), and intrathecal CHT ( p = 0.03) improved the OS, and nitrosoureas ( p = 0.01) correlated with a worse survival. In multivariate analysis, limited to patients receiving MTX ≥3 g/m 2 , only the addition of cytarabine improved the OS; nitrosoureas reduced MTX efficacy. Of the 119 complete responders, 70 received immediate RT. A RT dose of ≥40 Gy to the whole Brain or tumor bed did not improve OS. The 3-year OS was similar between the immediate and delayed RT groups. In multivariate analysis, RT delay had no negative impact on survival. Conclusions: MTX ≥3 g/m 2 seems to improve survival in primary Brain Lymphoma patients. The efficacy of additional drugs, except for cytarabine, remains unproved. Randomized trials are needed to confirm that RT withdrawal yields no detrimental effect in complete responders.
Tamara Shenkier - One of the best experts on this subject based on the ideXlab platform.
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primary cns Lymphoma with intraocular involvement international pcnsl collaborative group report
Neurology, 2008Co-Authors: S A Grimm, Tali Siegal, Colin A Mccannel, Antonio Omuro, A J M Ferreri, Jeanyves Blay, Edward A Neuwelt, Tracy T Batchelor, Kristoph Jahnke, Tamara ShenkierAbstract:Objective: To describe the demographics, diagnostic details, therapeutic management, and outcome in patients with primary CNS Lymphoma (PCNSL) with ocular involvement. Methods: A retrospective study of 221 patients was assembled from 16 centers in seven countries. Only HIV-negative, immunocompetent patients with Brain and ocular Lymphoma were included; none had systemic Lymphoma. Results: Median age at diagnosis was 60. Fifty-seven percent were women. Median Eastern Cooperative Oncology Group performance status was 2. Ocular disturbance and behavioral/cognitive changes were the most common presenting symptoms. Diagnosis of Lymphoma was made by Brain biopsy (147), vitrectomy (65), or CSF cytology (11). Diagnosis of intraocular Lymphoma was made by vitrectomy/choroidal/retinal biopsy (90) or clinical ophthalmic examination (141). CSF cytology was positive in 23%. Treatment information was available for 176 patients. A total of 102 received dedicated ocular therapy (ocular radiotherapy 79, intravitreal methotrexate 22, and both 1) in addition to treatment for their Brain Lymphoma. Sixty-nine percent progressed at a median of 13 months; sites of progression included Brain 52%, eyes 19%, Brain and eyes 12%, and systemic 2%. Patients treated with local ocular therapy did not have a statistically significant decreased risk of failing in the eyes ( p = 0.7). Median progression free survival and overall survival for the entire cohort were 18 and 31 months. Conclusion: This is the largest reported series of primary CNS Lymphoma (PCNSL) with intraocular involvement. Progression free and overall survival was similar to that reported with PCNSL. Dedicated ocular therapy improved disease control but did not affect overall survival.
Julia Bohlius - One of the best experts on this subject based on the ideXlab platform.
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Incidence and risk factors of HIV-associated non-Hodgkin-lymophma in the era combined anti-retroviral therapy. A European multi-cohort study
Infectious Agents and Cancer, 2009Co-Authors: Julia BohliusAbstract:not on cART was 519 (95% CI 448 to 602) per 100,000 person-years compared to 229 (95% CI 208 to 252) per 100,000 person-years in those on cART. The incidence of Primary Brain Lymphoma was 56.7 (95% CI 36 to 89) per 100,000 person-years in patients not on CART and 24 (95% CI 18 to 33) per 100,000 person years in patients on cART. The incidence of systemic Non-Hodgkin Lymphoma other than Primary Brain Lymphoma was 463 (95% CI 395 to 541) per 100,000 in patients not on cART and 205 (95% CI 185 to 227) per 100,000 person years in patients on cART. In cART naive patients the risk for NHL
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Incidence and risk factors of HIV-related non-Hodgkin's Lymphoma in the era of combination antiretroviral therapy: a European multicohort study.
Antiviral Therapy, 2009Co-Authors: Julia Bohlius, Kurt Schmidlin, Dominique Costagliola, Gerd Fätkenheuer, Margaret May, Ana Maria Caro-murillo, Amanda Mocroft, Fabrice Bonnet, Gary Clifford, Anastasia KarafoulidouAbstract:BACKGROUND: Incidence and risk factors of HIV-associated non-Hodgkin's Lymphoma (NHL) are not well defined in the era of combination antiretroviral therapy (cART). METHODS: A total of 56,305 adult HIV type-1 (HIV-1)-infected patients who started cART in 1 of 22 prospective studies in Europe were included. Weibull random effects models were used to estimate hazard ratios (HRs) for developing systemic NHL and included CD4(+) T-cell counts and viral load as time-updated variables. RESULTS: During the 212,042 person-years of follow-up, 521 patients were diagnosed with systemic NHL and 62 with primary Brain Lymphoma (PBL). The incidence rate of systemic NHL was 463 per 100,000 person-years not on cART and 205 per 100,000 person-years in treated patients for a rate ratio of 0.44 (95% confidence interval [CI] 0.37-0.53). The corresponding incidence rates of PBL were 57 and 24 per 100,000 person-years (rate ratio 0.43, 95% CI 0.25-0.73). Suppression of HIV-1 replication on cART (HR 0.60, 95% CI 0.44-0.81, comparing < or =500 with 10,000-99,999 copies/ml) and increases in CD4(+) T-cell counts (HR 0.30, 0.22-0.42, comparing > or =350 with 100-199 cells/microl) were protective; a history of Kaposi's sarcoma (HR 1.70, 1.08-2.68, compared to no history of AIDS), transmission through sex between men (HR 1.57, 1.19-2.08, compared with heterosexual transmission) and older age (HR 3.71, 2.37-5.80, comparing > or =50 with 16-29 years) were risk factors for systemic NHL. CONCLUSIONS: The incidence rates of both systemic NHL and PBL were substantially reduced in patients on cART. Timely initiation of therapy is key to the prevention of NHL in the era of cART.
Ortrun Gündisch - One of the best experts on this subject based on the ideXlab platform.
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Accuracy of stereotactic Brain tumor biopsy: comparison of the histologic findings in biopsy cylinders and resected tumor tissue.
Neurosurgical review, 1991Co-Authors: Wolfgang Feiden, U. Steude, Karl Bise, Ortrun GündischAbstract:Appropriate treatment for intracranial mass lesions depends upon accurate morphological diagnosis. In 47 of 360 patients the findings in stereotactically obtained tissue cylinders were compared with tumor resection (n=38) or autopsy (n=9) tissue material to define the accuracy of our stereotactic biopsy method. These biopsies were performed using the LEKSELL CT stereotactic frame and a spiral needle which procured about 10-mm-long tissue cylinders. Usually, three to four successive biopsy specimens were taken along the target trajectory placed through the whole lesion and its margins according to the CT imagings. Final morphological diagnosis was exclusively based on the histological findings of permanent paraffin sections. In 42 cases (89%), the histological results in biopsy and resection/autopsy tissue were identical, including mainly cases of low and high grade gliomas as well as some Brain Lymphomas, metastases, and cases of inflammatory Brain lesions (aspergillosis, toxoplasmosis). In 3 patients with a diagnosis of Brain Lymphoma and low grade glioma on the basis of the surgical specimens, stereotactic biopsy revealed only unspecific reactive tissue changes. In two cases of the early part of the study, sampling errors occurred. This study provides evidence for the high diagnostic accuracy of the established stereotactic biopsy method which is characterized by representative tissue sampling and histological processing of the specimens.