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Yassin A, Al-Mistarehi AH, Tremont-Lukats IW, El-Salem K, Shawagfeh A, Al-Hafez B, Levine N. Acute diffuse cerebral vasospasm as a complication of endoscopic resection of a colloid cyst: a case report. Br J Neurosurg 2023; 37:1362-1366. [PMID: 32955376 DOI: 10.1080/02688697.2020.1820946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Endoscopic resection can be used for removing colloid cysts as a substitute for open craniotomy. Cerebral vasospasm, a possible complication of the craniotomy procedure, has not been reported as a complication of endoscopic removal of colloid cysts. CASE DESCRIPTION A 58-year-old man developed the worst headache of his life. The CT and MRI showed a 1.3 cm midline third ventricular cyst at the level of the foramen of Monro, consistent with a colloid cyst. The patient elected to undergo an endoscopic resection of the colloid cyst. The image-guided frameless stereotactic endoscopic colloid cyst resection proceeded without events. Postoperative MRI showed a gross total resection. The patient continued to improve until post-operative day #9 when he experienced an episode of slurred speech and several episodes of legs buckling. An MRI did not show a stroke. A CT angiogram showed diffuse vasospasm, including the basilar artery and bilateral middle cerebral arteries, when compared to the patient's preoperative MRA. The patient's antihypertensive medications were stopped. The patient was started on Nimodipine, 60 mg every 4 hours, and triple H therapy (Hypertension, Hypervolemia, and Hemodilution) was applied. His blood pressure rose and his neurologic exam improved over several days. The patient returned to his baseline in 14 days without any neurological deficits. To our knowledge, this is the first case report of a patient undergoing endoscopic colloid cyst resection that was complicated by diffuse cerebral vasospasm. CONCLUSIONS We report the first case of acute, transient cerebral vasospasm following endoscopic resection of a colloid cyst.
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Affiliation(s)
- Ahmed Yassin
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Abdel-Hameed Al-Mistarehi
- Department of Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ivo W Tremont-Lukats
- Department of Neurosurgery and the Kenneth R. Peak Brain and Pituitary Treatment Center, Houston Methodist Hospital, Houston, TX, USA
| | - Khalid El-Salem
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ahmad Shawagfeh
- Plummer Movement Disorders Center, Baylor Scott and White Clinics, Temple, TX, USA
| | - Baraa Al-Hafez
- Department of Neurosurgery, University of Texas, Memorial Hermann Southeast Hospital, 18955 Memorial N, Humble, TX, USA
| | - Nicholas Levine
- Department of Neurosurgery, University of California San Francisco, 155 N Fresno St, Fresno, CA, USA
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2
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Arbona-Haddad E, Tremont-Lukats IW, Gogia B, Rai PK. COVID-19 encephalopathy, Bayes rule, and a plea for case-control studies. Ann Clin Transl Neurol 2021; 8:723-725. [PMID: 33512092 PMCID: PMC7951100 DOI: 10.1002/acn3.51288] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Esther Arbona-Haddad
- Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Ivo W Tremont-Lukats
- Kenneth R. Peak Brain and Pituitary Tumor Center, Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Bhanu Gogia
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Prashant K Rai
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, USA
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3
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Stocksdale B, Nagpal S, Hixson JD, Johnson DR, Rai P, Shivaprasad A, Tremont-Lukats IW. Neuro-Oncology Practice Clinical Debate: long-term antiepileptic drug prophylaxis in patients with glioma. Neurooncol Pract 2020; 7:583-588. [PMID: 33312673 DOI: 10.1093/nop/npaa026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Patients with primary brain tumors often experience seizures, which can be the presenting symptom or occur for the first time at any point along the illness trajectory. In addition to causing morbidity, seizures negatively affect independence and quality of life in other ways, for example, by leading to loss of driving privileges. Long-term therapy with antiepileptic drugs (AEDs) is the standard of care in brain tumor patients with seizures, but the role of prophylactic AEDs in seizure-naive patients remains controversial. In this article, experts in the field discuss the issues of AED efficacy and toxicity, and explain their differing recommendations for routine use of prophylactic AEDs.
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Affiliation(s)
- Brian Stocksdale
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Seema Nagpal
- Department of Neurology, Stanford University, California
| | - John D Hixson
- Department of Neurology, University of California San Francisco
| | | | - Prashant Rai
- Department of Neurology, The University of Texas Medical Branch at Galveston
| | - Akhil Shivaprasad
- Stanley H. Appel Department of Neurology, Houston Methodist Hospital, Texas
| | - Ivo W Tremont-Lukats
- Kenneth R. Peak Brain and Pituitary Tumor Center, Houston Methodist Hospital, Texas.,Department of Neurosurgery, Houston Methodist Hospital, Texas
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4
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Rai P, Gogia B, Tremont-Lukats IW. Epileptic discharges in acutely ill patients investigated for SARS-CoV-2/COVID-19 and the absence of evidence. Epilepsia Open 2020; 5:616-617. [PMID: 33230489 PMCID: PMC7675313 DOI: 10.1002/epi4.12435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 08/19/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Bhanu Gogia
- Department of Neurology UTMB Galveston TX USA
| | - Ivo W Tremont-Lukats
- Kenneth R. Peak Brain and Pituitary Tumor Center Houston Methodist Hospital Houston TX USA
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5
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Tremont-Lukats IW, Teh BS. Lomustine and temozolomide for newly diagnosed glioblastoma with methylated MGMT promoter: Lessons from the CeTeG/NOA-09 trial. Transl Cancer Res 2019; 8:S589-S591. [PMID: 35117137 PMCID: PMC8798802 DOI: 10.21037/tcr.2019.06.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/20/2019] [Indexed: 11/06/2022]
Affiliation(s)
- Ivo W Tremont-Lukats
- The Kenneth R. Peak Center for Pituitary and Brain Tumors, Houston Methodist Hospital, Houston, TX, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Cancer Center and Research Institute, Houston, TX, USA
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Abstract
BACKGROUND Lidocaine, mexiletine, tocainide, and flecainide are local anesthetics which give an analgesic effect when administered orally or parenterally. Early reports described the use of intravenous lidocaine or procaine to relieve cancer and postoperative pain. Interest reappeared decades later when patient series and clinical trials reported that parenteral lidocaine and its oral analogs tocainide, mexiletine, and flecainide relieved neuropathic pain in some patients. With the recent publication of clinical trials with high quality standards, we have reviewed the use of systemic lidocaine and its oral analogs in neuropathic pain to update our knowledge, to measure their benefit and harm, and to better define their role in therapy. OBJECTIVES To evaluate pain relief and adverse effect rates between systemic local anesthetic-type drugs and other control interventions. SEARCH METHODS We searched MEDLINE (1966 through 15 May 2004), EMBASE (January 1980 to December 2002), Cancer Lit (through 15 December 2002), Cochrane Central Register of Controlled Trials (2nd Quarter, 2004), System for Information on Grey Literature in Europe (SIGLE), and LILACS, from January 1966 through March 2001. We also hand searched conference proceedings, textbooks, original articles and reviews. SELECTION CRITERIA We included trials with random allocation, that were double blinded, with a parallel or crossover design. The control intervention was a placebo or an analgesic drug for neuropathic pain from any cause. DATA COLLECTION AND ANALYSIS We collected efficacy and safety data from all published and unpublished trials. We calculated combined effect sizes using continuous and binary data for pain relief and adverse effects as primary and secondary outcome measurements, respectively. MAIN RESULTS Thirty-two controlled clinical trials met the selection criteria; two were duplicate articles. The treatment drugs were intravenous lidocaine (16 trials), mexiletine (12 trials), lidocaine plus mexiletine sequentially (one trial), and tocainide (one trial). Twenty-one trials were crossover studies, and nine were parallel. Lidocaine and mexiletine were superior to placebo [weighted mean difference (WMD) = -11; 95% CI: -15 to -7; P < 0.00001], and limited data showed no difference in efficacy (WMD = -0.6; 95% CI: -7 to 6), or adverse effects versus carbamazepine, amantadine, gabapentin or morphine. In these trials, systemic local anesthetics were safe, with no deaths or life-threatening toxicities. Sensitivity analysis identified data distribution in three trials as a probable source of heterogeneity. There was no publication bias. AUTHORS' CONCLUSIONS Lidocaine and oral analogs were safe drugs in controlled clinical trials for neuropathic pain, were better than placebo, and were as effective as other analgesics. Future trials should enroll specific diseases and test novel lidocaine analogs with better toxicity profiles. More emphasis is necessary on outcomes measuring patient satisfaction to assess if statistically significant pain relief is clinically meaningful.
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Sinicrope KD, Barata P, Walker J, Tremont-Lukats IW, Groves M, Loghin M, Seligman C, Ferguson S, Weathers SP, Penas-Prado M, Kamiya-Matsuoka C, Harrison R, Tummala S, Trevino CR, Peinado S, Murthy RK, Seyedeh D, de Groot J, O’Brien B. LPTO-09. INTRATHECAL TOPOTECAN FOR LEPTOMENINGEAL METASTASIS IN SOLID TUMORS: THE MD ANDERSON EXPERIENCE. Neurooncol Adv 2019. [PMCID: PMC7213302 DOI: 10.1093/noajnl/vdz014.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: Leptomeningeal metastasis (LM) is a devastating complication of cancer resulting in progressive neurologic decline. Although intrathecal (IT) methotrexate and cytarabine are commonly used for solid tumor LM, we routinely use IT topotecan due to previously demonstrated similar efficacy and modest side effect profile. We report updated data on our experience. METHODS: We reviewed clinical records of patients with solid tumor LM treated with IT topotecan at MD Anderson Cancer Center from 2008–2018. Patient characteristics and course were summarized by descriptive statistics. Overall survival (OS) was estimated with Kaplan-Meier, and the association of KPS with OS evaluated with log-rank test. RESULTS: 138 patients were treated with IT topotecan. The median age was 54 years (range, 22–76), 81% were female. Breast cancer (62%) was the most common primary, then lung (21%), melanoma (4%). Median time from primary diagnosis to LM was 3.4 (range, 0.07–25.2) years. LM was diagnosed by CSF cytology alone in 8 (6%), MRI alone in 21 (15%), CSF+MRI in 108 (78%). Patients most commonly presented with headache (39%) or sensory changes (18%), and had a median KPS of 80 (range, 60–100). 66% had prior/concurrent brain metastasis. 71 patients (52%) received WBRT following LM diagnosis. 41% had adverse effects, most commonly nausea/vomiting (22%) and headache (20%). The majority were grade 1 (63%); 7 were grade 4 (2 Ommaya malfunctions and 5 infections). Patients received a median of 9 (range, 1–79) doses, most stopped due to CNS progression (42%). Median OS was 6.5 months (95% CI 4.7, 7.8). OS was 3.8 mos with KPS ≤70, vs. 7.5 mos with KPS >70 (p< 0.001). CONCLUSIONS: IT topotecan has a modest side effect profile. Patients with higher functional status at diagnosis had significantly better survival. This study supports the continued use of IT topotecan as a well-tolerated option for LM.
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8
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Maraka S, Groves MD, Mammoser AG, Melguizo-Gavilanes I, Conrad CA, Tremont-Lukats IW, Loghin ME, O'Brien BJ, Puduvalli VK, Sulman EP, Hess KR, Aldape KD, Gilbert MR, de Groot JF, Alfred Yung WK, Penas-Prado M. Phase 1 lead-in to a phase 2 factorial study of temozolomide plus memantine, mefloquine, and metformin as postradiation adjuvant therapy for newly diagnosed glioblastoma. Cancer 2018; 125:424-433. [PMID: 30359477 DOI: 10.1002/cncr.31811] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/15/2018] [Accepted: 09/17/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Repurposed memantine, mefloquine, and metformin have putative anticancer activity. The objective of this phase 1 study was to determine the maximum tolerated doses (MTDs) of combinations of these agents with temozolomide (TMZ). METHODS Adults with newly diagnosed glioblastoma who completed chemoradiation were eligible. The patients were assigned to receive doublet, triplet, or quadruplet therapy with TMZ combined with mefloquine, memantine, and/or metformin. Dose-limiting toxicities (DLTs) were determined, using a 3 + 3 study design. RESULTS Of 85 enrolled patients, 4 did not complete cycle 1 (the DLT observation period) for nontoxicity reasons, and 81 were evaluable for DLT. The MTDs for doublet therapy were memantine 20 mg twice daily, mefloquine 250 mg 3 times weekly, and metformin 850 mg twice daily. For triplet therapy, the MTDs were memantine 10 mg twice daily, mefloquine 250 mg 3 times weekly, and metformin 850 mg twice daily. For quadruplet therapy, the MTDs were memantine 10 mg twice daily, mefloquine 250 mg 3 times weekly, and metformin 500 mg twice daily. DLTs included dizziness (memantine) and gastrointestinal effects (metformin). Lymphopenia was the most common adverse event (66%). From study entry, the median survival was 21 months, and the 2-year survival rate was 43%. CONCLUSIONS Memantine, mefloquine, and metformin can be combined safely with TMZ in patients with newly diagnosed glioblastoma.
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Affiliation(s)
- Stefania Maraka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Morris D Groves
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aaron G Mammoser
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Charles A Conrad
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ivo W Tremont-Lukats
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monica E Loghin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara J O'Brien
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinay K Puduvalli
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erik P Sulman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth R Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth D Aldape
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark R Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John F de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - W K Alfred Yung
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marta Penas-Prado
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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Lewis GD, Rivera AL, Tremont-Lukats IW, Ballester-Fuentes LY, Zhang YJ, Teh BS. GBM skin metastasis: a case report and review of the literature. CNS Oncol 2017; 6:203-209. [PMID: 28718312 PMCID: PMC6009214 DOI: 10.2217/cns-2016-0042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/20/2017] [Indexed: 12/11/2022] Open
Abstract
Glioblastoma (GBM) is the most common type of malignant tumor found in the brain, and acts very aggressively by quickly and diffusely infiltrating the surrounding brain parenchyma. Despite its aggressive nature, GBM is rarely found to spread extracranially and develop distant metastases. The most common sites of these rare metastases are the lungs, pleura and cervical lymph nodes. There are also a few case reports of skin metastasis. We present the clinical, imaging and pathologic features of a case of a GBM with metastasis to the soft tissue scar and skin near the original craniotomy site. In addition, we discuss the details of this case in the context of the previously reported literature.
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Affiliation(s)
- Gary D Lewis
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
- Department of Radiation Oncology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA
| | - Andreana L Rivera
- Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Ivo W Tremont-Lukats
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA
- Kenneth R. Peak Center for Brain & Pituitary Tumors, Houston, TX 77030, USA
| | | | - Yi Jonathan Zhang
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA
- Kenneth R. Peak Center for Brain & Pituitary Tumors, Houston, TX 77030, USA
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX 77030, USA
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10
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Raizer JJ, Giglio P, Hu J, Groves M, Merrell R, Conrad C, Phuphanich S, Puduvalli VK, Loghin M, Paleologos N, Yuan Y, Liu D, Rademaker A, Yung WK, Vaillant B, Rudnick J, Chamberlain M, Vick N, Grimm S, Tremont-Lukats IW, De Groot J, Aldape K, Gilbert MR. A phase II study of bevacizumab and erlotinib after radiation and temozolomide in MGMT unmethylated GBM patients. J Neurooncol 2016; 126:185-192. [PMID: 26476729 DOI: 10.1007/s11060-015-1958-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
Abstract
Survival for glioblastoma (GBM) patients with an unmethyated MGMT promoter in their tumor is generally worse than methylated MGMT tumors, as temozolomide (TMZ) response is limited. How to better treat patients with unmethylated MGMT is unknown. We performed a trial combining erlotinib and bevacizumab in unmethylated GBM patients after completion of radiation (RT) and TMZ. GBM patients with an unmethylated MGMT promoter were trial eligible. Patient received standard RT (60 Gy) and TMZ (75 mg/m2 × 6 weeks) after surgical resection of their tumor. After completion of RT they started erlotinib 150 mg daily and bevacizumab 10 mg/kg every 2 weeks until progression. Imaging evaluations occurred every 8 weeks. The primary endpoint was overall survival. Of the 48 unmethylated patients enrolled, 46 were evaluable (29 men and 17 women); median age was 55.5 years (29-75) and median KPS was 90 (70-100). All patients completed RT with TMZ. The median number of cycles (1 cycle was 4 weeks) was 8 (2-47). Forty-one patients either progressed or died with a median progression free survival of 9.2 months. At a follow up of 33 months the median overall survival was 13.2 months. There were no unexpected toxicities and most observed toxicities were categorized as CTC grade 1 or 2. The combination of erlotinib and bevacizumab is tolerable but did not meet our primary endpoint of increasing survival. Importantly, more trials are needed to find better therapies for GBM patients with an unmethylated MGMT promoter.
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Affiliation(s)
- J J Raizer
- Department of Neurology, Northwestern University, 710 North Lake Shore Drive, Abbott Hall, Room 1123, Chicago, IL, 60611, USA.
| | - P Giglio
- James Cancer Hospital, Ohio State University, Columbus, OH, USA
| | - J Hu
- Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - M Groves
- Austin Brain Tumor Center, Austin, USA
| | - R Merrell
- Department of Neurology, NorthShore University Health System, Evanston, USA
| | - C Conrad
- Austin Brain Tumor Center, Austin, USA
| | - S Phuphanich
- Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - V K Puduvalli
- James Cancer Hospital, Ohio State University, Columbus, OH, USA
| | - M Loghin
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - N Paleologos
- Department of Neurology, Rush University Medical Center, Chicago, USA
| | - Y Yuan
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - D Liu
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Rademaker
- Department of Preventive Medicine, Northwestern University, Chicago, USA
| | - W K Yung
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - B Vaillant
- Dell Medical School, The University of Texas, Austin, USA
| | - J Rudnick
- Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - M Chamberlain
- Department of Neurology, University of Washington, Seattle, USA
| | - N Vick
- Department of Neurology, NorthShore University Health System, Evanston, USA
| | - S Grimm
- Department of Neurology, Northwestern University, 710 North Lake Shore Drive, Abbott Hall, Room 1123, Chicago, IL, 60611, USA
| | - I W Tremont-Lukats
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - J De Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - K Aldape
- Department of Pathology, Princess Margaret Cancer Centre, Toronto, Canada
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11
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Affiliation(s)
- Nibal Rizk
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston
| | | | - Ivo W Tremont-Lukats
- Department of Neuro-oncology, University of Texas MD Anderson Cancer Center, Houston
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12
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Bittar J, Kamiya-Matsuoka C, Barata PC, Lee-Kim SH, Olar A, Tremont-Lukats IW. Corticosteroid sensitivity in gliomatosis cerebri delays diagnosis. Pract Neurol 2015; 15:309-11. [PMID: 25922538 DOI: 10.1136/practneurol-2015-001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Jan Bittar
- Department of Neuro-Oncology, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Pedro C Barata
- Department of Neuro-Oncology, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Soo-Hyun Lee-Kim
- Department of Neuro-Oncology, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Adriana Olar
- Department of Pathology, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Ivo W Tremont-Lukats
- Department of Neuro-Oncology, The University of Texas-M.D. Anderson Cancer Center, Houston, Texas, USA
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13
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Abstract
Sinking skin flap syndrome (SSFS) is a rare neurological complication in patients with traumatic haemorrhage, stroke or cerebral oedema who undergo decompressive craniectomy to relieve increased intracranial pressure. Hallmark of SSFS is the sinking of the scalp to a plane lower than the edges of the skull defect in the setting of neurological deterioration. Our objective is to report that SSFS can present after small craniotomy without cerebral cortex compression and to share our diagnostic/therapeutic approach. A 62-year-old woman with a glioblastoma developed SSFS after a small craniectomy and tumour resection without cerebral cortex compression but a decrease in the surgical cavity volume. Brain MRI showed decreased size of the surgical cavity. Interestingly, the patient also developed posterior reversible encephalopathy syndrome (PRES). This case highlights an atypical presentation of SSFS and the possible association with PRES. It also illustrates how an early cranioplasty can successfully reverse SSFS.
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Affiliation(s)
| | - Sheetal Shroff
- Department of Neuro-oncology, MDACC, Houston, Texas, USA
| | | | | | - Mark R Gilbert
- Department of Neuro-oncology, MDACC, Houston, Texas, USA
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14
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Mandel JJ, Olar A, Aldape KD, Tremont-Lukats IW. Lambrolizumab induced central nervous system (CNS) toxicity. J Neurol Sci 2014; 344:229-31. [PMID: 24980937 DOI: 10.1016/j.jns.2014.06.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 05/30/2014] [Accepted: 06/12/2014] [Indexed: 01/19/2023]
Affiliation(s)
- Jacob J Mandel
- The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, 1515 Holcombe Blvd Unit 431, Houston, TX 77030-4009, United States; The University of Texas MD Anderson Cancer Center, Department of Pathology, 1515 Holcombe Blvd, Houston, TX 77030-4009, United States.
| | - Adriana Olar
- The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, 1515 Holcombe Blvd Unit 431, Houston, TX 77030-4009, United States; The University of Texas MD Anderson Cancer Center, Department of Pathology, 1515 Holcombe Blvd, Houston, TX 77030-4009, United States
| | - Kenneth D Aldape
- The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, 1515 Holcombe Blvd Unit 431, Houston, TX 77030-4009, United States; The University of Texas MD Anderson Cancer Center, Department of Pathology, 1515 Holcombe Blvd, Houston, TX 77030-4009, United States
| | - Ivo W Tremont-Lukats
- The University of Texas MD Anderson Cancer Center, Department of Neuro-Oncology, 1515 Holcombe Blvd Unit 431, Houston, TX 77030-4009, United States; The University of Texas MD Anderson Cancer Center, Department of Pathology, 1515 Holcombe Blvd, Houston, TX 77030-4009, United States
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Shroff S, Shroff GS, Yust-Katz S, Olar A, Tummala S, Tremont-Lukats IW. The CT halo sign in invasive aspergillosis. Clin Case Rep 2014; 2:113-4. [PMID: 25356263 PMCID: PMC4184607 DOI: 10.1002/ccr3.67] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/11/2014] [Accepted: 02/20/2014] [Indexed: 11/07/2022] Open
Abstract
KEY CLINICAL MESSAGE In immunocompromised patients, the pulmonary computed tomography halo sign is highly suggestive of angioinvasive aspergillosis. Early recognition may be life-saving.
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Affiliation(s)
- Sheetal Shroff
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center Houston, Texas, 77030
| | - Girish S Shroff
- Department of Radiology, The University of Texas Medical School at Houston Houston, Texas, 77030
| | - Shlomit Yust-Katz
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center Houston, Texas, 77030
| | - Adriana Olar
- Department of Pathology, The University of Texas MD Anderson Cancer Center Houston, Texas, 77030
| | - Sudhakar Tummala
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center Houston, Texas, 77030
| | - Ivo W Tremont-Lukats
- Department of Neuro-oncology, The University of Texas MD Anderson Cancer Center Houston, Texas, 77030
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Kamiya-Matsuoka C, Blas-Boria D, Williams MD, Garciarena P, Tummala S, Tremont-Lukats IW. N-type calcium channel antibody-mediated paraneoplastic limbic encephalitis: a diagnostic challenge. J Neurol Sci 2014; 338:188-90. [PMID: 24462122 DOI: 10.1016/j.jns.2014.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/26/2013] [Accepted: 01/02/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The etiology of encephalitis presents a diagnostic challenge and often remains a mystery. However, current technological advances using antibodies can enable a definitive diagnosis in cases that would previously have been suspected to be idiopathic or viral encephalitis. Our objective is to show that tonsil neuroendocrine carcinoma can present initially as limbic encephalitis mediated by N-type calcium channel antibodies and to highlight the diagnostic confusion before cancer detection. METHODS We report a rare case of neuroendocrine cancer presenting as limbic encephalopathy, Lambert-Eaton myasthenic syndrome and neuropathy. The patient was diagnosed and treated at The University of Texas MD Anderson Cancer Center in November 2011. RESULTS Paraneoplastic limbic encephalitis was diagnosed based on clinical presentation of seizures, short-term memory loss, retrograde amnesia, disorientation, distractibility, and abulia; on the exclusion of brain metastases, CNS infection, stroke, metabolic or nutritional deficits, or medication-related events; and on CSF results with inflammatory findings and an abnormal electroencephalography study that showed seizure activity in the left temporal lobe. Serum paraneoplastic panel was positive for P/Q-type calcium channel antibody and N-type calcium channel antibody. Magnetic resonance imaging of brain was unremarkable. CONCLUSION This case highlights limbic encephalitis as an atypical presentation of neuroendocrine cancer. It also illustrates how treatment of the underlying cancer can reverse limbic encephalitis and Lambert-Eaton myasthenic syndrome in a neuroendocrine carcinoma patient even before the paraneoplastic panel becomes negative.
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Affiliation(s)
- Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - David Blas-Boria
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pedro Garciarena
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ivo W Tremont-Lukats
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Gilbert MR, Dignam JJ, Armstrong TS, Wefel JS, Blumenthal DT, Vogelbaum MA, Colman H, Chakravarti A, Pugh S, Won M, Jeraj R, Brown PD, Jaeckle KA, Schiff D, Stieber VW, Brachman DG, Werner-Wasik M, Tremont-Lukats IW, Sulman EP, Aldape KD, Curran WJ, Mehta MP. A randomized trial of bevacizumab for newly diagnosed glioblastoma. N Engl J Med 2014; 370:699-708. [PMID: 24552317 PMCID: PMC4201043 DOI: 10.1056/nejmoa1308573] [Citation(s) in RCA: 1906] [Impact Index Per Article: 190.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Concurrent treatment with temozolomide and radiotherapy followed by maintenance temozolomide is the standard of care for patients with newly diagnosed glioblastoma. Bevacizumab, a humanized monoclonal antibody against vascular endothelial growth factor A, is currently approved for recurrent glioblastoma. Whether the addition of bevacizumab would improve survival among patients with newly diagnosed glioblastoma is not known. METHODS In this randomized, double-blind, placebo-controlled trial, we treated adults who had centrally confirmed glioblastoma with radiotherapy (60 Gy) and daily temozolomide. Treatment with bevacizumab or placebo began during week 4 of radiotherapy and was continued for up to 12 cycles of maintenance chemotherapy. At disease progression, the assigned treatment was revealed, and bevacizumab therapy could be initiated or continued. The trial was designed to detect a 25% reduction in the risk of death and a 30% reduction in the risk of progression or death, the two coprimary end points, with the addition of bevacizumab. RESULTS A total of 978 patients were registered, and 637 underwent randomization. There was no significant difference in the duration of overall survival between the bevacizumab group and the placebo group (median, 15.7 and 16.1 months, respectively; hazard ratio for death in the bevacizumab group, 1.13). Progression-free survival was longer in the bevacizumab group (10.7 months vs. 7.3 months; hazard ratio for progression or death, 0.79). There were modest increases in rates of hypertension, thromboembolic events, intestinal perforation, and neutropenia in the bevacizumab group. Over time, an increased symptom burden, a worse quality of life, and a decline in neurocognitive function were more frequent in the bevacizumab group. CONCLUSIONS First-line use of bevacizumab did not improve overall survival in patients with newly diagnosed glioblastoma. Progression-free survival was prolonged but did not reach the prespecified improvement target. (Funded by the National Cancer Institute; ClinicalTrials.gov number, NCT00884741.).
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Affiliation(s)
- Mark R Gilbert
- From the University of Texas M.D. Anderson Cancer Center (M.R.G., T.S.A., J.S.W., P.D.B., I.W.T.-L., E.P.S., K.D.A.) and the University of Texas Health Science Center School of Nursing (T.S.A.), Houston; American College of Radiology (J.J.D., S.P., M.W.) and Thomas Jefferson University (M.W.-W.) - both in Philadelphia; the University of Chicago, Chicago (J.J.D.); Tel-Aviv Medical Center, Tel Aviv, Israel (D.T.B.); Cleveland Clinic, Cleveland (M.A.V.); the University of Utah, Salt Lake City (H.C.); Ohio State University, Columbus (A.C.); University of Wisconsin, Madison (R.J.); Mayo Clinic, Jacksonville, FL (K.A.J.); University of Virginia, Charlottesville (D.S.); Southeast Cancer Control Consortium, Winston-Salem, NC (V.W.S.); Barrow Neurologic Institute, Phoenix, AZ (D.G.B.); Emory University, Atlanta (W.J.C.); and the University of Maryland, Baltimore (M.P.M.)
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Tremont-Lukats IW. The toxicity of chemotherapy and radiotherapy on the central nervous system. J Support Oncol 2012; 10:142. [PMID: 22542044 DOI: 10.1016/j.suponc.2012.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/05/2012] [Indexed: 05/31/2023]
Affiliation(s)
- Ivo W Tremont-Lukats
- Neuro-Oncology Department, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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Tremont-Lukats IW, Garciarena P, Juarbe R, El-Abassi RN. The immune inflammatory reconstitution syndrome and central nervous system toxoplasmosis. Ann Intern Med 2009; 150:656-7. [PMID: 19414855 DOI: 10.7326/0003-4819-150-9-200905050-00025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Abstract
BACKGROUND Seizures can present at any time before or after diagnosis of a brain tumor. The risk of seizures varies by tumor type and its location in the brain. For a long time we believed that preventing seizures with antiepileptic drugs (seizure prophylaxis) was effective and necessary, but the supporting evidence was little and mixed. Such evidence was the basis for previous reviews to conclude that seizure prophylaxis was ineffective in people with brain tumors. OBJECTIVES To estimate the effectiveness of seizure prophylaxis in people with brain tumors, and to estimate the adverse event rates in the identified clinical trials. SEARCH STRATEGY A search strategy that included free-text and MeSH terms in LILACS, EMBASE, PubMed, CENTRAL, and The Cochrane Library (1966 to 2007). SELECTION CRITERIA Controlled clinical trials with random allocation, blinded or unblinded, and placebo or observation in the control groups. DATA COLLECTION AND ANALYSIS We screened the articles, extracted the data, and rated the validity of each trial to assess the risk of bias. Our primary outcome was the occurrence of a first seizure. The secondary outcome was adverse events. We pooled the aggregate data for each outcome into a random-effects model meta-analysis using the relative risk (RR). For adverse events, we also included the number needed to harm (NNH) using the absolute risk increase to compute the NNH. MAIN RESULTS There was no difference between the treatment interventions and the control groups in preventing a first seizure in participants with brain tumors. The risk of an adverse event was higher for those on antiepileptic drugs than for participants not on antiepileptic drugs (NNH 3; RR 6.10, 95% CI 1.10 to 34.63; P = 0.046). AUTHORS' CONCLUSIONS The evidence is neutral, neither for nor against seizure prophylaxis, in people with brain tumors. These conclusions apply only for the antiepileptic drugs phenytoin, phenobarbital, and divalproex sodium. The decision to start an antiepileptic drug for seizure prophylaxis is ultimately guided by assessment of individual risk factors and careful discussion with patients.
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Affiliation(s)
- I W Tremont-Lukats
- Louisiana State University, Neurology, 1111 Medical Center Boulevard, Suite S-750, Marrero, Louisiana 77072, USA.
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Tremont-Lukats IW, Bruera E, González-Barboteo J. Neurokinin-1 receptor antagonists for prevention of chemotherapy-related nausea and vomiting in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2007. [DOI: 10.1002/14651858.cd006844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Groves MD, Puduvalli VK, Chang SM, Conrad CA, Gilbert MR, Tremont-Lukats IW, Liu TJ, Peterson P, Schiff D, Cloughesy TF, Wen PY, Greenberg H, Abrey LE, DeAngelis LM, Hess KR, Lamborn KR, Prados MD, Yung WKA. A North American brain tumor consortium (NABTC 99-04) phase II trial of temozolomide plus thalidomide for recurrent glioblastoma multiforme. J Neurooncol 2006; 81:271-7. [PMID: 17031561 DOI: 10.1007/s11060-006-9225-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Accepted: 07/20/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Laboratory and clinical data suggest that the anti-angiogenic agent, thalidomide, if combined with cytotoxic agents, may be effective against recurrent glioblastoma multiforme (GBM). OBJECTIVES To determine 6-month progression-free survival (6PFS) and toxicity of temozolomide plus thalidomide in adults with recurrent GBM. PATIENTS AND METHODS Eligible patients had recurrent GBM after surgery, radiotherapy, and/or adjuvant chemotherapy. Temozolomide was given at 150-200 mg/m(2)/day on days 1-5 of each 28-day cycle. Thalidomide was given orally at 400 mg at bedtime (days 1-28) and increased to 1,200 mg as tolerated. Patients were evaluated with magnetic resonance imaging scans every 56 days. The study was designed to detect an increase of the historical 6PFS for GBM from 10 to 30%. RESULTS Forty-four patients were enrolled, 43 were evaluable for efficacy and safety. The study population included 15 women, 29 men; median age was 53 years (range 32-84); median Karnofsky performance status was 80% (range 60-100%). Thirty-six (82%) patients were chemotherapy-naïve. There were 57 reports of toxicity of grade 3 or greater. Non-fatal grade 3-4 granulocytopenia occurred in 15 patients (34%). The objective response rate was 7%. The estimated probability of being progression-free at 6 months with this therapy is 24% [95% confidence interval (C.I.) 12-38%]. The median time to progression is 15 weeks (95% C.I. 10-20 weeks). There was no observed correlation between serum levels of vascular endothelial growth factor, basic fibroblast growth factor, and IL-8 and the 6PFS outcome. CONCLUSION This drug combination was reasonably safe, but with little indication of improvement compared to temozolomide alone.
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Affiliation(s)
- Morris D Groves
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1400 Holcombe, 431, Houston, TX, 77030, USA.
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Tremont-Lukats IW, Hutson PR, Backonja MM. A randomized, double-masked, placebo-controlled pilot trial of extended IV lidocaine infusion for relief of ongoing neuropathic pain. Clin J Pain 2006; 22:266-71. [PMID: 16514327 DOI: 10.1097/01.ajp.0000169673.57062.40] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the dose-response effect and safety of IV lidocaine at different dose infusion rates on spontaneous ongoing neuropathic pain. METHODS In this double-masked, placebo-controlled, parallel study conducted in an outpatient clinical research center, patients with peripheral neuropathic pain received a 6-hour infusion of three doses (1, 3, and 5 mg/kg) of lidocaine or placebo. The main outcome measure was relief of pain intensity (percentage pain intensity difference [PID %]). Other measures were responder rate, adverse events, and correlation between lidocaine levels and PID %. RESULTS There was a significant difference in the median PID % between the group treated with lidocaine 5 mg/kg/h (-34.60) and the placebo group (-11.96, P=0.012). Such effect began 4 hours after the onset of treatment and lasted until the end of the study. Lidocaine at lower infusion rates was no better than placebo in relieving pain. A modest but significant correlation was found between methylethylglycinexylidide (MEGX) levels and pain relief (R=0.60). There were no serious adverse events, but in two patients lidocaine was stopped prematurely. CONCLUSIONS Lidocaine at 5 mg/kg/h was more effective than placebo at relieving neuropathic pain. The effect started 4 hours after the onset of treatment and continued for at least 4 hours after the end of the infusion. Additional research is needed using higher infusion rates with larger sample sizes to confirm these results and to explore the role of MEGX in the relief of neuropathic pain.
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Affiliation(s)
- Ivo W Tremont-Lukats
- Department of Neurology, University of Wisconsin-Madison, Madison, WI 53792, USA
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Tremont-Lukats IW, Challapalli V, McNicol ED, Lau J, Carr DB. Systemic administration of local anesthetics to relieve neuropathic pain: a systematic review and meta-analysis. Anesth Analg 2005; 101:1738-1749. [PMID: 16301253 DOI: 10.1213/01.ane.0000186348.86792.38] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We reviewed randomized controlled trials to determine the efficacy and safety of systemically administered local anesthetics compared with placebo or active drugs. Of 41 retrieved studies, 27 trials of diverse quality were included in the systematic review. Ten lidocaine and nine mexiletine trials had data suitable for meta-analysis (n = 706 patients total). Lidocaine (most commonly 5 mg/kg IV over 30-60 min) and mexiletine (median dose, 600 mg daily) were superior to placebo (weighted mean difference on a 0-100 mm pain intensity visual analog scale = -10.60; 95% confidence interval: -14.52 to -6.68; P < 0.00001) and equal to morphine, gabapentin, amitriptyline, and amantadine (weighted mean difference = -0.60; 95% confidence interval: -6.96 to 5.75) for neuropathic pain. The therapeutic benefit was more consistent for peripheral pain (trauma, diabetes) and central pain. The most common adverse effects of lidocaine and mexiletine were drowsiness, fatigue, nausea, and dizziness. The adverse event rate for systemically administered local anesthetics was more than for placebo but equivalent to morphine, amitriptyline, or gabapentin (odds ratio: 1.23; 95% confidence interval: 0.22 to 6.90). Lidocaine and mexiletine produced no major adverse events in controlled clinical trials, were superior to placebo to relieve neuropathic pain, and were as effective as other analgesics used for this condition.
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Affiliation(s)
- Ivo W Tremont-Lukats
- *Department of Neurology, Medical University of South Carolina, Charleston, SC; †Department of Anesthesiology and Critical Care, University of Chicago Hospitals, Chicago, IL; ‡Department of Anesthesiology, and §Institute for Clinical Research and Health Policy Studies Tufts-New England Medical Center, Boston, MA
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Boeve BF, Tremont-Lukats IW, Waclawik AJ, Murrell JR, Hermann B, Jack CR, Shiung MM, Smith GE, Nair AR, Lindor N, Koppikar V, Ghetti B. Longitudinal characterization of two siblings with frontotemporal dementia and parkinsonism linked to chromosome 17 associated with the S305N tau mutation. Brain 2005; 128:752-72. [PMID: 15615814 DOI: 10.1093/brain/awh356] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The background to this study began with the reporting of two Japanese kindreds with the S305N tau mutation. Although the pathological findings in the autopsied cases were well characterized, only limited ante-mortem data were presented. In this study, longitudinal characterization was carried out in two siblings of European ancestry found to have frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17) through comprehensive neurobehavioural examinations and other scales at approximate 6-month intervals. Scales included the Mini-Mental State Examination, Short Test of Mental Status, modified motor subtest of the Unified Parkinson's Disease Rating Scale, detailed neuropsychological testing, and the Neuropsychiatric Inventory. Changes in whole-brain volume and ventricular volume were measured from serial MRI studies. All members of the kindred underwent molecular genetic analyses to elucidate the mechanism of inheritance. The missense mutation in tau, S305N, was detected in the proband (onset age 30), who has undergone serial evaluations for almost 4 years. Her older sister (onset age 36) was subsequently found to have the same mutation, and has undergone serial evaluations for 2 years. This mutation is absent in both parents and the only other sibling, and non-paternity was excluded by additional analyses. The siblings have exhibited cognitive and behavioural features typical of FTDP-17, which have proved challenging to manage despite aggressive pharmacological and behavioural therapies. The proband's sister has demonstrated an atypical profile of impairment on neuropsychological testing. Both siblings have developed striking atrophy of the anterior part of temporal lobes and moderate atrophy of the dorsolateral and orbitofrontal cortical regions, which in both cases is relatively symmetrical. The annualized changes in whole-brain volume and ventricular volume, respectively, were -35.2 ml/year (3.23% decrease per year) and +20.75 ml/year (16.93% increase per year) for the proband, and -30.75 ml/year (2.77% decrease per year) and +5.01 ml/year (3.11% increase per year) for the proband's sister. In conclusion, the mutation in these siblings may have arisen during oogenesis in the mother and probably represents germline mosaicism. Although both patients have exhibited the typical cognitive and behavioural features of FTDP-17, one patient is exhibiting an atypical neuropsychological profile. Also, despite a similar topographic pattern of progressive atrophy on MRI, the rates of change in whole-brain volume and ventricular volume between the two patients are quite different. These findings have implications for future drug trial development in FTDP-17 and the sporadic tauopathies.
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Affiliation(s)
- Bradley F Boeve
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, MN 55905, USA.
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Abstract
Neoplastic meningitis (NM) is a major challenge for the neuro-oncologist as it constitutes a relatively common clinical problem in systemic and central nervous system cancers, and is very difficult to treat. NM portends a significant worsening in prognosis. Chemotherapeutic treatment options are limited, and not particularly effective. We report two cases of NM from breast carcinoma and a third with esophageal carcinoma, which responded to treatment with capecitabine, an oral prodrug for 5-flurouracil. We believe capecitabine warrants further investigation in patients with NM. In some patients, its use may result in clinical and radiographic tumor responses, improved quality of life, and possibly increased survival.
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Affiliation(s)
- Pierre Giglio
- Neuro-Oncology Department, University of Texas--M.D. Anderson Cancer Center, TX 77030, USA
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Tremont-Lukats IW, Bobustuc G, Lagos GK, Lolas K, Kyritsis AP, Puduvalli VK. Brain metastasis from prostate carcinoma: The M. D. Anderson Cancer Center experience. Cancer 2003; 98:363-8. [PMID: 12872358 DOI: 10.1002/cncr.11522] [Citation(s) in RCA: 171] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The objective of this study was to estimate the incidence and describe distribution, clinical presentation, and prognosis of brain metastases in patients with prostate carcinoma who were seen at The University of Texas M. D. Anderson Cancer Center (MDACC). METHODS The authors reviewed the charts of 16,280 patients with prostate carcinoma in the MDACC patient data base. Of 131 patients with craniospinal metastases confirmed by neuroimaging (n=53 patients) or autopsy (n=78 patients), 103 of 16,280 patients (0.63%) had parenchymal metastases. RESULTS The median patient age at diagnosis was 64 years (range, 16-85 years). The median interval from the diagnosis of prostate carcinoma to the detection of brain metastasis was 35 months for patients with adenocarcinoma and 48 months for patients with small cell carcinoma (SCC). Confusion, headache, and memory deficits were the most frequent initial symptoms. Eighty-six percent of patients had single lesions, and 14% of patients had > or = 2 lesions. Metastases were supratentorial in 81 of 103 patients (76%), infratentorial in 22 of 103 patients (21%), and both supratentorial and infratentorial in 3 of 103 patients (3%). SCC and cribriform subtypes were more likely than adenocarcinoma to metastasize to the brain (relative risk, 20.36; 95% confidence interval, 9.91-41.84). Regardless of histology, the median survival in untreated patients was 1 month compared with 3.5 months in patients who were treated with radiotherapy. Patients who underwent stereotactic radiosurgery (n=5 patients) had a longer median survival (9 months). Survival was not affected by supratentorial or infratentorial location of metastases. CONCLUSIONS Brain metastasis from prostate carcinoma is a rare, terminal event with death in <1 year frequently due to advanced, systemic disease. The majority of metastases were single and supratentorial. The most common clinical presentation was nonfocal neurologic symptoms related to intracranial hypertension. A better understanding of the biology of prostate carcinoma will help clarify the basis for its metastasis to the brain.
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Affiliation(s)
- Ivo W Tremont-Lukats
- Department of Neuro-Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA
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Abstract
BACKGROUND We are witnessing the development of new treatment modalities for primary brain tumors. An area under intense investigation is the use of small molecules targeting intracellular signaling pathways that interfere with growth, invasion, and metastasis of high-grade gliomas. METHODS We review clinical trials of small molecules in adults with brain tumors. This search included electronic databases, specialty journals, textbooks, proceedings, and Web sites of the National Cancer Institute and other cooperative brain tumor groups in Europe and the United States. RESULTS Several drugs with the ability to down-regulate the growth and invasion of malignant gliomas are at various stages of testing. Most of these focus on interfering with oncogenic and tumor survival pathways. Examples include inhibitors of tyrosine kinases, farnesyltransferases, and matrix metalloproteinases. These molecules are at different stages of testing, and a conclusive picture of which drug is most effective, either alone or in combination, needs better definition. The metalloproteinase inhibitor marimastat with temozolomide has given the best results to date in phase II trials, increasing the rate of 6-month progression-free survival for recurrent glioblastoma multiforme and anaplastic gliomas. CONCLUSIONS As our understanding of the biology of gliomas increases and new drugs targeting specific molecular pathways enter well-designed cooperative trials, the control and prognosis of these tumors should improve.
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Affiliation(s)
- Ivo W Tremont-Lukats
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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Tremont-Lukats IW, Fuller GN, Ribalta T, Giglio P, Groves MD. Paraneoplastic chorea: Case autopsy confirmation study with. Neuro Oncol 2002. [DOI: 10.1215/s1522851701000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Tremont-Lukats IW, Fuller GN, Ribalta T, Giglio P, Groves MD. Paraneoplastic chorea: case study with autopsy confirmation. Neuro Oncol 2002; 4:192-5. [PMID: 12084350 PMCID: PMC1920638 DOI: 10.1093/neuonc/4.3.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2001] [Accepted: 03/12/2002] [Indexed: 11/13/2022] Open
Abstract
A 67-year-old man presented with a 7-month history of insidiously progressive chorea, ataxia, and vertigo. Neurologic examination revealed deficits referable to the basal nuclei, cerebellar vermis, and vestibular nuclei. Small-cell lung cancer was diagnosed by fine-needle biopsy of a parahilar mass. After chemotherapy, the patient's chorea worsened. Anti-Hu antibodies were present in serum and cerebrospinal fluid. Microscopic examination of the brain at autopsy revealed diffuse perivascular lymphocytic infiltrates, microglial activation, and neuronophagia throughout the neuraxis, including the brainstem, cerebellum, lenticular nuclei, striatum, and cerebral cortex. Prominent loss of Purkinje cells was seen in the cerebellar vermis and hemispheres to a lesser degree. Chorea is extremely rare as a paraneoplastic manifestation of cancer. The florid presentation and the positive findings contrasted with an unremarkable MRI of the brain. This case illustrates the preeminence of symptoms and signs over negative MRI findings in paraneoplastic encephalitis.
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Affiliation(s)
- Ivo W Tremont-Lukats
- Neuro-Oncology Department, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Abstract
Neuropathic pain, a form of chronic pain caused by injury to or disease of the peripheral or central nervous system, is a formidable therapeutic challenge to clinicians because it does not respond well to traditional pain therapies. Our knowledge about the pathogenesis of neuropathic pain has grown significantly over last 2 decades. Basic research with animal and human models of neuropathic pain has shown that a number of pathophysiological and biochemical changes take place in the nervous system as a result of an insult. This property of the nervous system to adapt morphologically and functionally to external stimuli is known as neuroplasticity and plays a crucial role in the onset and maintenance of pain symptoms. Many similarities between the pathophysiological phenomena observed in some epilepsy models and in neuropathic pain models justify the rational for use of anticonvulsant drugs in the symptomatic management of neuropathic pain disorders. Carbamazepine, the first anticonvulsant studied in clinical trials, probably alleviates pain by decreasing conductance in Na+ channels and inhibiting ectopic discharges. Results from clinical trials have been positive in the treatment of trigeminal neuralgia, painful diabetic neuropathy and postherpetic neuralgia. The availability of newer anticonvulsants tested in higher quality clinical trials has marked a new era in the treatment of neuropathic pain. Gabapentin has the most clearly demonstrated analgesic effect for the treatment of neuropathic pain, specifically for treatment of painful diabetic neuropathy and postherpetic neuralgia. Based on the positive results of these studies and its favourable adverse effect profile, gabapentin should be considered the first choice of therapy for neuropathic pain. Evidence for the efficacy of phenytoin as an antinociceptive agent is, at best, weak to modest. Lamotrigine has good potential to modulate and control neuropathic pain, as shown in 2 controlled clinical trials, although another randomised trial showed no effect. There is potential for phenobarbital, clonazepam, valproic acid, topiramate, pregabalin and tiagabine to have antihyperalgesic and antinociceptive activities based on result in animal models of neuropathic pain, but the efficacy of these drugs in the treatment of human neuropathic pain has not yet been fully determined in clinical trials. The role of anticonvulsant drugs in the treatment of neuropathic pain is evolving and has been clearly demonstrated with gabapentin and carbamazepine. Further advances in our understanding of the mechanisms underlying neuropathic pain syndromes and well-designed clinical trials should further the opportunities to establish the role of anticonvulsants in the treatment of neuropathic pain.
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Tremont-Lukats IW, Teixeira GM, Hernández DE. Primitive reflexes in a case-control study of patients with advanced human immunodeficiency virus type 1. J Neurol 1999; 246:540-3. [PMID: 10463353 DOI: 10.1007/s004150050400] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study estimated the frequency of nine primitive reflexes (PR) and assessed their possible clinical value in a group of patients with acquired immunodeficiency syndrome. We studied 78 patients with human inmunodeficiency type 1 (HIV-1) infection in WHO clinical stage 3 or 4 and 81 matched seronegative controls. All participants were examined using a standardized neurological examination and the Mini-Mental State Examination. Cognitive impairment and PR was found in 36% of patients but in none of the controls (P<0.0001; logistic regression odds ratio: 14.7). Overall, PR were 2-36 times more frequent in patients with HIV-1 infection. This association was stronger for the glabellar, snout, Rossolimo, and digital signs. At least two PR were observed in 92% of patients vs. 8% of controls (P<0.0001; 95% confidence interval: 68%-100%; logistic regression odds ratio: 10.8). These data support the association of PR with cognitive decline in patients with advanced HIV-1 infection without overt neurological disease. Larger follow-up studies with multivariate techniques are needed to identify which PRs are useful as indicators of HIV-1-associated cognitive/motor complex and minor neurocognitive disorders.
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Affiliation(s)
- I W Tremont-Lukats
- Department of Neurology, University of Wisconsin Hospital and Clinics, Madison 53792-5132, USA.
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Tremont-Lukats IW, Teixeira GM, Hernández DE. [Nine primitive reflexes in patients with acquired immunodeficiency syndrome (AIDS). Results of a case-control study]. GAC MED MEX 1999; 135:101-6. [PMID: 10327745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
This study estimated the frequency and assessed the clinical value of nine primitive reflexes (PR) in 78 AIDS cases, comparing them with 81 matched, seronegative controls. All subjects were evaluated with a standardized neurologic examination that included a Mini-Mental State Exam (MMSE). Fifty-six percent had cognitive impairment and PR. Overall, PR were 2-36 times more frequent in cases. Such association was univariately stronger for the glabellar, snout, and Rossolimo signs. Ninety-two percent of cases had > or = 2 PR vs. 8% of controls, who had up to 2 PR (p < 0.0001; 95 CI: 68% to 100%). We were able isolate or show opportunistic pathogens in CSF of 4 out of 43 cases. This study supports the association of PR to cognitive decline in patients with AIDS. Larger, long term follow-up studies with multivariate analysis in Latin America are needed to identify the PR that can serve as reliable indicators of human immunodeficiency virus type 1 (HIV-1)-associated cognitive/motor complex.
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Tremont-Lukats IW, Serbanescu R, Teixeira GM, Iriza E, Hernández DE, Schneider C. Multivariate analysis of primitive reflexes in patients with human immunodeficiency virus type-1 infection and neurocognitive dysfunction. Ital J Neurol Sci 1999; 20:17-22. [PMID: 10933480 DOI: 10.1007/s100720050005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To prove that primitive reflexes are independent markers of symptomatic human immunodeficiency virus type-1 (HIV-1) infection, a case-control study was carried out in a tertiary care, university teaching hospital. Thirty HIV-1-positive symptomatic cases, 30 seropositive asymptomatic controls and 30 HIV-1 seronegative controls consented to participate and were selected consecutively. A single examiner blinded to serostatus administered the Mini-Mental State Exam and a structured neurological exam to each participant. Up to 45% of cases had cognitive impairment. The occurrence of neurologic signs between seropositive cases and seropositive controls was similar, but the number of primitive reflexes was significantly higher in cases (P < 0.001). By multivariate discriminant analysis, all primitive reflexes but two correctly classified 83.3% of all participants (P = 0.0013). The model had a positive predictive value of 97% when motor, mood, and cognitive symptoms were added (P = 0.0001). Primitive reflexes were independent predictors of HIV-1 serostatus, especially for those with cognitive dysfunction. Primitive reflexes should be included in future case definitions of HIV-1-related neurocognitive disorders.
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Affiliation(s)
- I W Tremont-Lukats
- Department of Neurology, University of Wisconsin Hospital and Clinics, 53792, USA
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Tremont-Lukats IW, Teixeira GM. Cervical cancer decreasing, but not everywhere. Lancet 1997; 350:449. [PMID: 9259688 DOI: 10.1016/s0140-6736(05)64183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Tremont-Lukats IW, Avila JL, Hernández D, Vásquez J, Teixeira GM, Rojas M. Antibody levels against alpha-galactosyl epitopes in sera of patients with squamous intraepithelial lesions and early invasive cervical carcinoma. Gynecol Oncol 1997; 64:207-12. [PMID: 9038265 DOI: 10.1006/gyno.1996.4558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We measured serum levels of anti-Gal(alpha 1-->3)Gal and anti-Gal(alpha 1-->2)Gal antibodies in 89 and 91 women, respectively, by using ELISA. These patients had cervical intraepithelial neoplasia (CIN) grades 1 to 3 and early invasive cervical carcinoma (ICC). Our objective was to compare anti-alpha-galactosyl antibody levels among them and with those of normal controls. High levels of anti-Gal(alpha 1-->2)Gal antibodies were detected in 22% of patients (P = 0.006). The mean level was 1.6 times greater than that of controls, without difference among subgroups. Thirty percent of patients had abnormally high anti-Gal levels (P = 0.001). Mean levels were twofold greater than the mean control value. Subsets with human papillomavirus/CIN 1 and CIN 2-3 had high immunoreactivity (P = 0.004). Both antibodies showed a significant correlation (r = 0.53, P < 0.00001). We conclude that 22 to 30% of patients with CIN 1-3 showed significantly high levels of anti-alpha-galactosyl antibodies. This seroreactivity might be related to the abnormal expression of alpha-galactosyl residues at some point of the natural history of human papillomavirus infection of the uterine cervix, suggesting an active immune response by natural antibodies against this virus. Further studies are needed to determine whether anti-alpha-galactosyl antibodies confer protection in human papillomavirus infection.
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Affiliation(s)
- I W Tremont-Lukats
- Instituto Oncológico Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela
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Tremont-Lukats IW, Teixeira GM, Vásquez J, Hernández D. Validity of colposcopy to identify and grade squamous intraepithelial lesions among Venezuelan women. EUR J GYNAECOL ONCOL 1997; 18:57-60. [PMID: 9061326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
To assess the validity of colposcopy to correctly detect and grade squamous intraepithelial lesions (SIL) in Venezuelan women, we did a prospective, nonrandomized and cross sectional study on patients referred with low-grade and high-grade SIL. After a second cervical smear, they were colposcopically evaluated and biopsied. The outcome measures were interobserver variation, sensitivity, specificity, and predictive values. Ninety-nine patients were evaluable. Colposcopy had poor agreement with repeat cervical smears, and moderate to good agreement with conization biopsy (kappa = 0.55; 95% C.I.: 0.45 to 0.65), with a sensitivity of 0.87, a specificity of 0.69, a positive predictive value of 0.85 and a negative predictive value of 0.71 for high-grade SIL. The criterion of colposcopic vascular atypias was accurate enough to detect and grade SIL, showing good agreement with histopathology. Because of the disparity of results in previous reports, only a carefully designed, randomized study will settle this question.
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Affiliation(s)
- I W Tremont-Lukats
- Servicio de Medicina Oncológica, Instituto Oncológico Luis Razetti, Universidad Central de Venezuela, Caracas, Venezuela
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Tremont-Lukats IW, Teixeira GM. Comparison of Granisetron, ondansetron, and tropisetron in the prophylaxis of acute nausea and vomiting induced by cisplatin for the treatment of head and neck cancer. A randomized controlled trial. Cancer 1996; 78:2450-3. [PMID: 8941020 DOI: 10.1002/(sici)1097-0142(19961201)78:11<2450::aid-cncr29>3.0.co;2-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Tremont-Lukats IW, Avila JL, Tapia F, Hernández D, Cáceres-Dittmar G, Rojas M. Abnormal expression of galactosyl(alpha 1-->3) galactose epitopes in squamous cells of the uterine cervix infected by human papillomavirus. Pathobiology 1996; 64:239-46. [PMID: 9068006 DOI: 10.1159/000164054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
This study describes the presence of alpha-galactosyl epitopes on 12 cervical biopsy samples with features of human papillomavirus infection (HPV) and different stages of cervical intraepithelial neoplasia. An avidin-biotin-peroxidase assay with a monoclonal antibody recognizing gal(alpha 1-->3)gal residues was strongly positive in 5 of 12 cases. None of the controls stained (p = 0.02). Immunostaining was intense in the areas with the highest viral load (koilocytes and keratinocytes) and absent in malignant foci. Immunostaining was also absent in normal exo- and endocervical epithelium of 12 controls with no features of HPV infection. A faint background staining in cases and controls was evident, but similar. These initial findings suggest that alpha-galactosyl epitopes are expressed in cervical squamous cells infected with HPV, turning them vulnerable to lysis by natural anti-alpha-galactosyl antibodies.
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Affiliation(s)
- I W Tremont-Lukats
- Medical Oncology Section, University of Wisconsin Hospital and Clinics, Madison, USA
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