Radiosurgery/stereotactic radiotherapy in the therapeutical concept for skull base meningiomas.

OBJECTIVE: Microsurgical resection is still the treatment of choice for skull base meningiomas. But the risk of postoperative neurological deficits is high, and in many of these cases complete tumor removal cannot be achieved. Therefore recurrences are even more probable. Stereotactically guided radiation therapy - radiosurgery (RS) or stereotactic radiotherapy (SRT) - offers an additional or alternate treatment option for those patients. We evaluated local control rates, symptomatology, and toxicity. PATIENTS AND METHODS: 224 patients were treated with stereotactically guided radiation techniques in two departments between 1997 and 2003. 129 of 224 had recurrences after 1 to 3 prior tumor resections and 95 of 224 were treated with SRT/RS alone. 87.9% of cases had benign, 7.8% had atypical and 4.3% had malignant meningiomas. RS was only applied in 11 cases. Tumor volumes ranged from 0.16 ccm to 3.56 ccm. The other 213 patients had larger tumor volumes of up to 135 ccm or a meningioma close to optical structures. Therefore 183 cases were treated with SRT in normal fractions of 1.8-2 Gy in single doses up to 60 Gy. Hypofractionated SRT with single fraction doses of 5 or 4 Gy was applied in 30 cases. Follow-up data were available in 181 skull base meningiomas and the progression-free and overall survival rates, the toxicity and symptomatology were evaluated. RESULTS: The median follow-up was 36 months. The overall survival and the progression-free survival rates for 5 years were 92.9%, and 96.9%, respectively. Two tumor progressions have occurred to date but further follow up is required. Tumor volumes (TV) had shrunk about by 19.7% at 6 months (p<0.0001) and by 23.2% at 12 months (p<0.01) after SRT/RS. In 95.6% the symptoms had improved or were stable. Clinically significant acute toxicity (grade III) was seen in only 1 case (2.7%). Some patients developed late toxicity: 8.8% had grade I, 4.4% had grade II and 1.1% had grade III. No other neurological deficits occurred during follow-up. CONCLUSION: SRT and RS offer an additional or alternative treatment option with a high efficacy and few side effects for the tumor control of skull base meningiomas. An individual and interdisciplinary decision respecting treatment is needed for each patient. In cases of large TV (>4 ccm), tumors adjacent to critical structures (<2 mm) or in high-risk patients the use of SRT offers greater benefits.

[Prevalence and risk factors in the population of Graz (Austrian Stroke Prevention Study)]. / Prävalenz von Risikofaktoren in der Grazer Bevölkerung (Austrian Stroke Prevention Study).

The Austrian Stroke Prevention Study recruited 1960 randomly selected subjects aged 50 to 75 years during a 3-year period of enrollment. The response rate of the study was 32.4%. A telephone interview with 200 randomly selected non-responders yielded no differences to responders regarding the frequency of major vascular risk factors known to the subjects. Besides demographics, the study assessed arterial hypertension, diabetes mellitus, cardiac disease, smoking, a complete lipid status including the apolipoprotein-E genotype, serum fibrinogen and anticardiolipin antibodies as well as various natural antioxidants such as vitamins A, C, E and beta-carotene. Arterial hypertension, diabetes mellitus, cardiac disease and hypercholesterolemia > 200 mg/dl were strikingly common and occurred in 38%, 7.6%, 32% and 76%, respectively. Suboptimal plasma concentrations of vitamin A, E, and beta-carotene were noted in 77.2%, 56.1% and in 53.2% of study participants. The rate of treatment of major risk factors known to the subjects prior to study entry were 60.3% and 70% for arterial hypertension and diabetes mellitus, but only 37.1% and 6.3% for cardiac disease and hypercholesterolemia > 250 mg/dl. Diet was commonly used to treat diabetes but was almost neglected in the treatment of other vascular risk factors. These data provide an orientation on the prevalence of risk factors and the use of primary preventive measures for stroke treatment in our community.

Chronic Lyme disease with an expansive granulomatous lesion in the cerebellopontine angle.

Expansive granulomatous lesions in the posterior cranial fossa are rare and have not been reported in conjunction with Lyme disease. We report a patient with verified Borrelia burgdorferi infection who developed a tumor in the cerebellopontine angle. Rapid growth of the tumor led to signs of cerebral compression and to hydrocephalus. Surgical intervention was required despite florid meningitis. The histological examination showed inflammatory, nonspecific granulation tissue. The origin of this tissue is almost certainly causally related to the B. burgdorferi infection. Signs of inflammation resolved rapidly after subtotal resection. The clinical, radiological, and biochemical course is documented. This is the first report of an expansive cerebral lesion in the chronic phase of Lyme disease.

[Percutaneous radiotherapy for thyroid gland carcinoma]. / Ergebnisse der perkutanen Strahlentherapie bei Schilddrüsenkarzinomen.

Prognostically relevant factors as well as indications for percutaneous radiotherapy are analysed by the hand of a retrospective analysis of therapeutic results in 86 patients that were exposed a percutaneous radiotherapy because of a thyroid carcinoma at the Clinic and Policlinic of the Medical Academy Erfurt during the period 1972 to 1982. The 5-years-survivals of 83% for patients with differentiated carcinoma and 22% for patients with dedifferentiated carcinoma prove the influence of tumor histology on prognosis of the disease. Next to it the locoregional tumor spreading at beginning of therapy rendered prognostically relevant. The 5-years-survival was 83% in tumor stages T1-3N0M0. With metastatic infiltration into lymph-nodes of the neck the 5-years-survival decreased to 57%, with spreading of the primary tumor beyond organ borders to 23.5%. The postoperative percutaneous radiotherapy should be applied in all cases of metastatic infiltration of lymph-nodes. In large, inoperable tumors the percutaneous radiotherapy is the solely possible palliative measure that should be applied both in differentiated and also in anaplastic carcinomas in spite of infaust prognosis.

Primary malignant histiocytosis of the brain: a clinical, radiological and morphological study with cytological and immunohistochemical demonstration of atypical histiocytes.

Clinical, radiological and morphological findings in the case of a 79-year-old patient with a primary malignant histiocytosis of the brain are reported. The tumor was exclusively situated in the brain as proven by autopsy and was spreading on the inside of the lateral ventricles. The demonstration of atypical histiocytic cells in the CSF and the immunohistochemical demonstration of lysozyme, alpha 1-antitrypsin and alpha 1-antichymotrypsin which are typical for histiocytes, underline the histiocytic origin of the tumor.

Carcinomatous meningeosis as exclusive metastasizing pattern in a malignant thymoma.

In a 57-year-old male patient meningitic symptoms occurred. CSF cytology exhibited carcinoma cells, thus establishing the diagnosis of carcinomatous meningeosis. The primary site of the tumor or metastases were not detected intra vitam. The autopsy revealed a malignant thymoma with an exclusive metastatic participation of the leptomeninges except for some few regional lymph nodes. Cerebral metastases of malignant thymoma is an extremely rare condition.