Shanghai Gamma Hospital

Shanghai, China

Shanghai Gamma Hospital

Shanghai, China
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Deibert C.P.,University of Pittsburgh | Ahluwalia M.S.,Cleveland Clinic | Sheehan J.P.,University of Virginia | Link M.J.,Mayo Medical School | And 8 more authors.
Journal of Neuro-Oncology | Year: 2013

To retrospectively evaluate the clinical benefit and imaging response of bevacizumab when used to treat refractory adverse radiation effects (ARE) after stereotactic radiosurgery. Twenty-nine patients with brain tumors or vascular malformations developed clinical and/or imaging evidence of ARE after SRS and were treated using bevacizumab. Patients received an average dose of 7.4 mg/kg over a mean of 5.7 weeks at a median of 16 months following SRS. Initial diagnosis, SRS dose, bevacizumab treatment protocols, magnetic resonance imaging T2/FLAIR and T1 paramagnetic contrast enhanced edema volumes were compared before and after bevacizumab administration. Ninety percent (18/20) with clinically symptomatic ARE had neurological improvement after bevacizumab therapy. Twenty-six patients had a decrease of 62 % of T2/FLAIR volumes and a 50 % decrease in magnetic resonance imaging intravenous contrast enhancement volumes. Two patients showed progression of the T2/FLAIR and contrast enhancement volumes. One patient had progression of post-Gd-enhancement but regression of T2/FLAIR volume. Symptoms recurred in 11 of the 20 patients after discontinuing therapy. Patients who experienced a return of enhancement received a lower marginal dose during SRS. Our experience provides additional evidence that bevacizumab reduces both symptoms and reactive imaging changes in patients with ARE. After SRS, refractory ARE unresponsive to initial corticosteroids or other agents may benefit from a bevacizumab trial. The necessary duration and optimum dose of therapy is unknown and provides a further impetus to conduct a prospective trial. © 2013 Springer Science+Business Media New York.


Tang X.,Shanghai Gamma Hospital | Wu H.,Shanghai Gamma Hospital | Wang B.,Shanghai Gamma Hospital | Wang B.,Fudan University | And 10 more authors.
Acta Neurochirurgica | Year: 2015

Background: Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients. Methods: From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25–76) years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.2 ± 8.2 cm3 (range, 1–41 cm3). A mean marginal dose of 13.3 Gy (range, 8–15 Gy) was directed to the 49 %–64 % isodose line (mean 53 %). Results: Of the 53 tumors, 6 (11 %) were classified as intrasellar type. Eight (15 %) were parasellar type and the other 39 cases(74 %) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2–67 months) and 34 months (range, 2–73 months), respectively. The tumor control rate was 100 %. The mean tumor volume reduction was 79.5 % (range, 16.5 %–100 %) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2 % tumor volume reduction (range, 16.5 %–89.2 %). Twenty-nine cases (55 %) showed a >80 % tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed. Conclusions: Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment. © 2015, Springer-Verlag Wien.


Gao W.,Shanghai Gamma Hospital | Wang Y.,Shanghai Gamma Hospital | Sheng X.-F.,Shanghai Gamma Hospital | Ni C.-X.,Shanghai Gamma Hospital
Tumor | Year: 2012

Objective: To prospectively evaluate the side-effect and outcomes of nimotuzumab combined with reirradiation in patients with recurrent high-grade glioma. Methods: Ten patients with recurrent high-grade glioma recruited between October 2008 and March 2011 were reirradiated with conventional fractionation. The interval between initial radiation therapy and reirradiation was 7-42 months (the median time was 20 months). The irradiation dose was 40-51 Gy (18-27 fx) for 26-40 d [the median dose was 48 Gy (24 fx ) for 35d]. Intravenous injection of nimotuzumab was used weekly during radiation therapy for 3-6 weeks. The toxicities and short responses were recorded. The overall survival and the progression-free survival were calculated. Results: The acute adverse reactions were gradesI-II headache, digestive system side effects, and aggravation of the neurologic dysfunction, but they were all relieved after symptomatic treatment. The toxicity of more than grade III was not observed. The radiation-induced brain necrosis was found in three patients. Of the 10 patients, 3 had partial response, 6 had stable disease, and 1 had progressive disease. The Karnofsky performance status score was increased, unchanged and decreased in 4, 4 and 2 patients, respectively. The median time to progression was 6.5 months. The 6-month and 1-year progression-free survival rates were 60% and 20%, respectively. The median overall survival was 11.5 months. The 6-month and 1-year overall survival rates were 80% and 50%, respectively. Conclusion: The preliminary results demonstrate that nimotuzumab combined with reirradiation for recurrent high-grade glioma appears to be effective and safe. The further follow-up is required to determine the long-term outcomes. Copyright © 2012 by TUMOR.


PubMed | Shanghai Gamma Hospital
Type: | Journal: Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie | Year: 2016

Glioma is a malignant cancer with high mortality. A key prognostic factor of glioma is radiosensitivity. It has also been known that microRNAs (miR) significantly contribute to the development of glioma. miR-132 has been previously reported to inhibit tumor growth in some cancers, but not well studied in glioma. It is necessary to understand the association between miR-132 and glioma, including miR-132 expression in glioma, effects of miR-132 on cancer metastasis and radiosensitivity, and the involved molecular mechanism. We first explored the expression levels of miR-132 in human normal and glioma tissues, then correlated the expression levels with different stages of glioma. Utilizing human glioma U87 cells, lentiviral transduction technique, luciferase reporter assay, wound healing assay, transwell invasion assay and clonogenic assay, we investigated the effects of hepatic leukemia factor (HLF), miR-132 and TTK protein kinase (TTK) on cancer cell viability, proliferation, migration, invasion and radiosensitivity. The expression of miR-132 was low in human glioma tissues, and the downregulated expression was associated with advanced glioma grades. HLF directly bound to the BS1 site of miR-132 promoter to enhance the expression of miR-132. HLF-mediated miR-132 was able to directly target and inhibit a downstream factor TTK, which had an oncogenic role. Overexpression of TTK could reverse the inhibitory effects of either miR-132 or HLF on cancer cell proliferation, metastasis and radioresistance. TTK acts as an oncogene in glioma. HLF-mediated miR-132 directly suppresses TTK expression, thus exerting inhibitory effects on cancer cell proliferation, metastasis and radioresistance.


PubMed | Shanghai Gamma Hospital
Type: Journal Article | Journal: Acta neurochirurgica | Year: 2015

Cavernous sinus hemangiomas (CaSHs) are rare vascular lesions in the cavernous sinus(CS). Gamma Knife radiosurgery (GKS) provides a treatment modality alternative to microsurgery. This study was conducted to describe a new classification of CaSHs based on their magnetic resonance (MR) imaging findings and determine the efficacy and safety of GKS in a large series of CaSH patients.From April 2007 to November 2012, 53 patients harboring CaSHs were treated using Leksell Gamma Knife model C (before April 2012) or Perfexion (from May 2012 ) at the Gamma Knife Center of Huashan Hospital. Of the 53 patients, 15 with definitive histopathologic diagnoses after surgery, 38 were diagnosed based on their MR imaging findings. There were 15 male and 38 female patients with a mean age of 52 (range, 25-76)years old. The characteristics of MR images of CaSHs were their extremely high homogeneous intensity on T2-weighted and FLAIR images: as bright as cerebrospinal fluid signal. According to the relationship between the carotid line and their location, CaSHs were classified into three types: the intrasellar, parasellar and mixed type. The mean volume of the tumors was 13.28.2 cm(3) (range, 1-41 cm(3)). A mean marginal dose of 13.3 Gy (range, 8-15 Gy) was directed to the 49%-64% isodose line (mean 53%).Of the 53 tumors, 6 (11%) were classified as intrasellar type. Eight (15%) were parasellar type and the other 39 cases(74%) mixed type. The mean radiological and clinical follow-up time of this study was 24 (range, 2-67 months) and 34 months (range, 2-73 months), respectively. The tumor control rate was 100%. The mean tumor volume reduction was 79.5% (range, 16.5%-100%) compared with the pre-GKS volume. Six months after GKS, MR imaging revealed an average of 60.2% tumor volume reduction (range, 16.5%-89.2%). Twenty-nine cases (55%) showed a >80% tumor volume decrease. Neurologically, only two of these patients showed clinical deterioration, and 33 patients demonstrated an obvious improvement in ocular or endocrine disorders. At last follow-up, there were no more complications related to GKS, and none of the tumors progressed.Our study showed that GKS is a useful and safe therapeutic method for CaSHs as both a primary and adjuvant treatment. The new classification of CaSHs may help predict their clinical course during tumor development and treatment response after GKS. Further studies with long-term follow-up and larger numbers of cases are necessary to optimize the treatment conditions and verify the benefit of this treatment.

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