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n3:25404928
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n2:RelevantPaper n2:ReferencePaper n2:CitationPaper
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introduction
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One series noted promising results with use of thioTEPA (>>1<<), while another suggested that Palliative Care may be preferable to intrathecal chemotherapy (2).
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One series noted promising results with use of thioTEPA (1), while another suggested that Palliative Care may be preferable to intrathecal chemotherapy (>>2<<). One case report suggested that liposomal cytarabine may be of value, with a reported time to progression (TTP) of 6 months (3). In cases, where LM is present at the time of first diagnosis, the use of radiation and temozolomide has been
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One case report suggested that liposomal cytarabine may be of value, with a reported time to progression (TTP) of 6 months (>>3<<). In cases, where LM is present at the time of first diagnosis, the use of radiation and temozolomide has been advocated (4).
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In cases, where LM is present at the time of first diagnosis, the use of radiation and temozolomide has been advocated (>>4<<).
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materials and methods
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It has been proposed that ependymoma shares a common precursor with glial tumors (>>5<<). On reflection, we decided to focus the review on adult patients with grade III and IV tumors in order to minimize heterogeneity.
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results
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While this is a widely employed and relatively simple test, methylation-specific PCR remains the “gold standard” when available (>>13<<).
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The high proportion of macrophages in most samples obtained by lumbar puncture is notable, a finding more classically associated with intracerebral hemorrhage and with fungal infections of the CSF (>>14<<).
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n3:3343052
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Of those receiving temozolomide, the standard Stupp protocol was used in 14 (>>15<<). Another patient received a “dose dense” regimen of 75 mg/m2 daily. In one patient, information on the type of chemotherapy was not available. No effect of systemic chemotherapy could be demonstrated on OS or TTP.
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discussion
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Two similarly sized series have reported results of use of intrathecal chemotherapy for this condition (>>1<<, 2). These, along with an earlier series, are summarized in Table 5. It is striking that the median OS time in the earliest series, from 1980, is better than our current series, yet only one patient received treatment [with i.
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Two similarly sized series have reported results of use of intrathecal chemotherapy for this condition (1, >>2<<). These, along with an earlier series, are summarized in Table 5. It is striking that the median OS time in the earliest series, from 1980, is better than our current series, yet only one patient received treatment [with i.
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chemotherapy (>>16<<)]. However, in this latter 4 of 12 patients were diagnosed only at autopsy, whereas all of ours had symptoms or signs leading to diagnosis ante mortem.
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typemPFSmOSDardis (current)3471564428liposomal cytarabine/MTX4.910.2Chamberlain (>>2<<)18447261100MTX ⇒ Ara-C ⇒ thioTEPA33.5Witham et al. (1)14643671100thioTEPANA10Yung et al. (16)1275008MTX +
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typemPFSmOSDardis (current)3471564428liposomal cytarabine/MTX4.910.2Chamberlain (2)18447261100MTX ⇒ Ara-C ⇒ thioTEPA33.5Witham et al. (>>1<<)14643671100thioTEPANA10Yung et al. (16)1275008MTX +
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typemPFSmOSDardis (current)3471564428liposomal cytarabine/MTX4.910.2Chamberlain (2)18447261100MTX ⇒ Ara-C ⇒ thioTEPA33.5Witham et al. (1)14643671100thioTEPANA10Yung et al. (>>16<<)1275008MTX +
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This finding is in keeping with the series from Witham et al. (>>1<<), which also reported a shorter survival for those with GBM.
n2:mentions
n3:10506724
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Reported cases of spinal metastases from GBM in this setting have already been the subject of a review [n = 24 (>>17<<)]. In 37 patients with available survival data, the mean survival time was reported to be 3.7 months (range 0.1–12).
n2:mentions
n3:22958073
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In the series from Lawton et al. (>>17<<), chemotherapy was used in 14% of cases, with radiotherapy in 77%.
n2:mentions
n3:22958073
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In keeping with earlier series focusing on those with dissemination to the spinal cord, all of our cases had a clear source of communication with CSF (>>18<<). Also consistent with data presented in this series, patients with spinal cord involvement experienced a relatively short time to further progression (median 2.4 months in our 7 patients).
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n3:21887390
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Another review, (n = 19), focusing on spinal metastases reported a mean OS time of 4.5 months, also shorter than in our series (>>19<<).
n2:mentions
n3:20549302
Subject Item
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Radiation with temozolomide has been advocated as the treatment of choice in cases where LM is present at the time of first diagnosis (>>4<<). This was based on a review of 15 cases. One patient survived 22 months from diagnosis with this treatment.
n2:mentions
n3:22024443
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In the case of GBM, rates of 2–3% have been reported (>>20<<, 21). However, symptomatic LM may occur in up to 19% of cases of GBM involving the cerebellum (22).
n2:mentions
n3:185169
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In the case of GBM, rates of 2–3% have been reported (20, >>21<<). However, symptomatic LM may occur in up to 19% of cases of GBM involving the cerebellum (22).
n2:mentions
n3:2358840
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However, symptomatic LM may occur in up to 19% of cases of GBM involving the cerebellum (>>22<<). We estimate that our institution sees c. 60 cases of newly diagnosed GBM per year. Thus per our calculations, over 10 years c. 3.8% of patients experienced this complication, which is broadly in agreement with the above figures.
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n3:21643841
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However, the rate of LM in gliomas may be underestimated as autopsy series report rates in the range of 20–25% (>>16<<, 23, 24). It is likely that we are underestimating the true rate, as no autopsies were performed the patients in our series.
n2:mentions
n3:6260012
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However, the rate of LM in gliomas may be underestimated as autopsy series report rates in the range of 20–25% (16, >>23<<, 24). It is likely that we are underestimating the true rate, as no autopsies were performed the patients in our series.
n2:mentions
n3:2172859
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However, the rate of LM in gliomas may be underestimated as autopsy series report rates in the range of 20–25% (16, 23, >>24<<). It is likely that we are underestimating the true rate, as no autopsies were performed the patients in our series.
n2:mentions
n3:2797391
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One series where all patients underwent autopsy reported ante mortem diagnosis in only 8 of 12 patients (>>16<<). Generally speaking, the rate of autopsy appears to be falling over time: for example in the USA this decreased from 19 to 9% over the period 1972–2007 (25).
n2:mentions
n3:6260012
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In one series of 12 such patients, 10 showed evidence of hydrocephalus (>>16<<). Interestingly, in a series of 7 patients with communicating hydrocephalus in the context of GBM, none showed MRI changes typical of LM (26).
n2:mentions
n3:6260012
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Interestingly, in a series of 7 patients with communicating hydrocephalus in the context of GBM, none showed MRI changes typical of LM (>>26<<). In this latter series CSF cytology was generally normal, although protein was typically elevated. The authors suggest that initial post-operative radiation may cause fibrosis of the arachnoid granulations leading to blockages by protein
n2:mentions
n3:21905801
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Intractable nausea/vomiting should lead to a high degree of suspicion of LM (>>27<<). We only had three patients with disease affecting the 4th ventricle; two presented with nausea.
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According to at least one case report, FDG-PET may also be useful in this setting (>>28<<).
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n3:21394504
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This may be formally assessed using a radioisotope as per (>>29<<) although we are not routinely implementing this technique.
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treatment described in the series by Chamberlain (>>2<<) were much higher than in our series with 12 of 18 developing aseptic meningitis.
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By contrast, Witham et al. (>>1<<) suggest their results are promising and that i.t.
n2:mentions
n3:10506724
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Regarding liposomal cytarabine, while no definite benefit can be attributed to its use our series, at least one case report shows some evidence of benefit and it is generally well tolerated (>>3<<). The reported TTP of 6 months in the cited case is similar to that of five patients in our series receiving this treatment, who had a median TTP of 4.4 months.
n2:mentions
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Such an approach has already been shown to be practical for intravenous antibiotics (>>30<<).
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