The Japan Society for Neuro-Oncology guideline on the diagnosis and treatment of central nervous system germ cell tumors.

Primary CNS germ cell tumors (GCTs) are rare neoplasms predominantly observed in the pediatric and young adult populations. In line with the hypothesis that the primordial germ cell is the cell-of-origin, histopathological examinations for this pathology involve a diverse range of components mirroring the embryogenic developmental dimensions. Chemotherapy and radiotherapy are the mainstays of treatment, with surgery having a limited role for diagnosis and debulking of residual tissue after treatment. While better management has been achieved over recent decades by modifying radiation coverage and selecting appropriate chemotherapy, standardization of treatment remains challenging, partly due to the low volume of cases encountered in each institution. As the incidence is higher in East Asia, including Japan, the Japan Society for Neuro-Oncology established a multidisciplinary task force to create an evidence-based guideline for CNS GCTs. This guideline provides recommendations for multiple dimensions of clinical management for CNS GCTs, with particular focus on diagnostic measures including serum markers, treatment algorithms including surgery, radiotherapy, and chemotherapy, and under-investigated but important areas such as treatment for recurrent cases, long-term follow-up protocols, and long-term sequelae. This guideline serves the purpose of helping healthcare professionals keep up to date with current knowledge and standards of management for patients with this rare disease in daily clinical practice, as well as driving future translational and clinical research by recognizing unmet needs concerning this tumor.

Noninvasive and quantitative evaluation of movement disorder disability using an infrared depth sensor.

Cerebellar ataxia and Parkinson's disease are neurodegenerative disorders clinically characterized by motor disabilities including gait disturbance. This study aimed to investigate the usefulness of an infrared depth sensor device to quantitatively evaluate gait disturbances in patients with movement disorders. 25 ataxic, 25 Parkinson's disease, and 25 control subjects were enrolled and evaluated their walk. Stride length, feet interval, gait rhythm, and a ratio of the actual walking route length to the linear distance between the start and goal points (A/L ratio) were assessed and compared. Outcome correlations with clinical scales were also analyzed. The average stride length was shorter in ataxic subjects or Parkinson's disease subjects than in control subjects. The average feet interval was larger in ataxic subjects than in control subjects. The stride length coefficient of variation (CV), gait rhythm CV, and average and standard deviations of the A/L ratio were larger in ataxic or Parkinson's disease subjects than in control subjects. Ataxic subjects exhibited significant positive correlations between the CV of stride length or average feet interval and scale for the assessment and rating of ataxia scores or international cooperative ataxia rating scale scores. Parkinson's disease subjects exhibited a significant correlation between the average stride length, CV of stride length, or standard deviation of A/L ratio and unified Parkinson's disease rating scale score. The device used in this study differentiated the characteristics of gait disturbance in each movement disorder and quantitatively evaluated ataxia or Parkinson's disease severity, indicating its potential clinical utility across applications.

[Radiation therapy for brain tumors].

Brain tumors respond differently to treatment with surgery plus radiotherapy or radiotherapy alone, combined with or without chemotherapy, because they are characterized by subtypes with different histologies. Since the development of diagnostic radiology, such as computed tomography (CT) and magnetic resonance imaging (MRI), brain tumors have been easier to demonstrate and can be found at earlier stages than in the conventional situation. Furthermore, highly technical devices and equipment for radiation therapy have been developed and installed for clinical use, especially with multileaf collimator (MLC) and treatment planning systems. In the field of radiotherapy for brain tumors, it has been possible to use more precise treatment planning with conformal radiotherapy, three-dimensional treatment planning, and stereotactic radiotherapy. Dose escalation studies and the modified fractionation schedule of radiotherapy can also be designed by analyzing biological data and applying hypofractionated intensity-modulated radiotherapy (IMRT) to radioresistant tumors such as glioblastoma multiforme and anaplastic astrocytoma. Future investigation may be useful to determine which fraction size is likely to be optimal for these malignant gliomas when highly conformal radiotherapy is used in adjuvant treatment. These technological developments and newly designed radiosensitizing agents will improve local control rates and survival times, thereby enhancing the quality of life in patients suffering from various kinds of brain tumors.