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   Table of Contents - Current issue
Coverpage
July-December 2019
Volume 2 | Issue 2
Page Nos. 87-142

Online since Friday, January 10, 2020

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EDITORIALS  

Adjuncts in glial tumor management: Optimizing strategy p. 87
Dattatraya Muzumdar
DOI:10.4103/2590-2652.275537  
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Management of suprasellar tumors in the era of endoscopic surgery: Presidential Oration 2019 p. 89
Suresh K Sankhla
DOI:10.4103/IJNO.IJNO_18_19  
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Robotic surgery, proton therapy, and targeted therapy – Are these the way forward in oncology? p. 97
Anusheel Munshi, Khushboo Rastogi
DOI:10.4103/IJNO.IJNO_19_19  
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ORIGINAL ARTICLES Top

Gamma knife-based stereotactic radiosurgery boost after whole-brain radiotherapy in patients with up to three brain metastases: Effects on survival, functional independence, and neurocognitive function p. 101
Sankalp Singh, Arti Sarin, Manoj Semwal, Sharad Bhatnagar, Maneet Gill, Shweta Sharma
DOI:10.4103/IJNO.IJNO_14_19  
Background: Brain metastases are a major cause of mortality and morbidity in cancer patients and are seen as a terminal event in the natural course of disease. Whole-brain radiotherapy (WBRT) has remained the most commonly used treatment for multiple metastases. Although it provides symptomatic relief, the effects have low durability and local failure is common. Stereotactic radiosurgery (SRS) techniques such as Gamma Knife have been shown to be as effective as surgery in control of limited (1–3) metastases. Aim: The aim of this is to study the role of SRS boost after WBRT in patients of 1–3 brain metastases. Objective: (1) To compare the survival of patients with 1–3 brain metastases treated with WBRT with versus without SRS boost. (2) To compare the duration of functional independence (FI) and normal neurocognitive function (NNF) posttreatment in the patients belonging to the two groups. Materials and Methods: Twenty-six patients with 1–3 brain metastases received WBRT to a dose of 30 Gy in 10 fractions. Half the patients (13) were also given an SRS boost of 16–20 Gy by the Gamma Knife technique. All patients were followed up at twelve weekly intervals for a period of 9 months and assessed for survival, FI (Karnofsky Performance Status Score (KPS) >60%) and NNF (Hindi Mental Status Examination Score >24). Results: At 9 months, the median survival in the SRS boost group was 27 weeks compared to 22 weeks in the no boost group. The mean duration of FI and NNF was 24 and 12 weeks in the boost and nonboost groups, respectively. The differences between two groups were not statistically significant. Conclusions: Although results are not significant, a definite trend toward improvement in median survival, FI, and neurocognitive function in patients who received an SRS boost after WBRT is seen.
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STAT6 immunohistochemical expression in meningeal-based tumors: Diagnostic of solitary fibrous tumor/hemangiopericytomas p. 112
Ayushi Sahay, Vinayak Kadam, Aliasgar Moyiadi, Tejpal Gupta, Jayant Sastri Goda, Prakash Shetty, Rakesh Jalali, Epari Sridhar
DOI:10.4103/IJNO.IJNO_9_19  
Background: Updated 2016 WHO classification of central nervous system tumors has unified solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) as a single entity (SFT/HPC), Grading from I to III, in view of common genetic alteration namely fusion of NAB2 and STAT6 genes. Aim: This study aims to evaluate the role of STAT6 immunohistochemical expression in a cohort of meningeal-based tumors and its correlation with other pathological parameters. Materials and Methods: Sixty-two meningeal-based tumors were studied including 40 HPC/SFT (1 Grade I, 29 Grade II and 10 Grade III), 14 meningiomas (2 Grade I, 10 Grade II, 2 anaplastic meningiomas), three meningeal sarcoma, and five cases with features suspicious for SFT/HPC. The expression pattern of STAT6 and other histological findings were noted. Results: Nuclear or nuclear + cytoplasmic STAT6 positivity was seen in 40/40SFT/HPC (100%), diffuse in 30 and focal in 10 cases. Only 1/14 cases of meningioma (7.1%) showed weak nuclear positivity. All cases of meningiomas and 2/3 cases of meningeal sarcoma showed cytoplasmic positivity. Of the five suspicious HPC cases, four showed diffuse strong nuclear STAT6 positivity, based on which they were confirmed as HPC. Interestingly, of the 40 STAT6 positive SFT/HPC, five showed epithelial differentiation (AE1/AE3 and/or epithelial membrane antigen [EMA]). CD34 was negative in 4/36 SFT/HPC. CD34 was focally positive in 3/5 suspicious HPC cases, two of which were focally EMA positive as well, and both cases showed nuclear STAT6 positivity. BCl2 was negative in 5/27 SFT/HPC, all of which were nuclear STAT6 positive. Conclusions: Nuclear expression of STAT6 can serve as a highly sensitive and specific adjunctive diagnostic marker for meningeal-based SFT/HPC, especially in cases with nonconventional histology and immunohistochemical profile, where meningioma or high-grade meningeal sarcoma forms a diagnostic dilemma.
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Prognostic evaluation of patients with metastatic spinal tumors using modified Tokuhashi's score: A retrospective study p. 119
Aiman Mohammed, Monica Malik Irukulla, Syed Fayaz Ahmed, Deepthi Valiyaveettil
DOI:10.4103/IJNO.IJNO_16_19  
Introduction: Tokuhashi's scoring has been used as a presurgical tool for prediction of survival in patients with spinal metastases (SM). It evaluates prognostic factors such as performance status, number of extraspinal bone metastasis, metastasis to visceral organs, site of primary, and neurological status that determine the survival in these patients. To the best of our knowledge, only limited studies are available to use this scoring system to determine survival outcomes in patients with SMs undergoing palliative radiotherapy. Aim: The purpose of our study was to determine the patient characteristics and usefulness of modified Tokuhashi's score in determining survival in patients with SM. Methods: This is a retrospective study of patients who underwent radiotherapy for SM from January 2013 to December 2017. Results: Seventy patients with SM from solid tumors were included in the study. The male to female ratio was 1.3:1. The median ageat diagnosis of SM was 50 years. The median survival was 7 months. The modified Tokuhashi's score ranged from 0 to 13, and the mean score was 6. In our study, 46 belonged to the poor prognostic group, 20 belonged to the moderate prognostic group, and 4 patients belongedto good prognostic group with a median survival of 4.8, 13.5, and 28 months, respectively. There was a statistical significance in the difference in survival in three prognostic groups. Conclusion: Our study confirms the usefulness of modified Tokuhashi's score in determining the survival outcomes in patients with metastatic spinal tumors.
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CASE REPORTS Top

An unusual occurrence of melanotic neuroectodermal tumor of infancy with malignant features p. 124
Shilpa Rao, Pooja Chavali, Gaurav Tyagi, Amey Savardekar, Jitender Saini, Anita Mahadevan
DOI:10.4103/IJNO.IJNO_17_19  
Melanotic neuroectodermal tumor of infancy (MNTI) is a rare, commonly benign, congenital pigmented neoplasm that originates from the neural crest. In contrast to peripheral MNTI usually found in the maxilla, cerebral MNTI has a much worse outcome. We report a case of intracranial MNTI with malignant features in a 2-year-old child. The clinical, radiological, histological, and immunohistochemical findings are described, and the published data on this rare entity are reviewed.
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Three-Dimensional Conformal focal radiotherapy (30 Gy in 5 fractions) – An useful substitute for Stereotactic radiosurgery In Brain oligometastases: A Single-institutional Case Series p. 128
Jyotirup Goswami, Suman Mallik, Kazi Sazzad Manir, Sayan Das, Arijit Sen, Monidipa Mondal, Bipasha Pal, Suresh Das, Soura Palit, Papai Sarkar
DOI:10.4103/IJNO.IJNO_15_19  
Stereotactic Radiosurgery/Radiotherapy (SRS/SRT) or neurosurgery is the standard of care for brain oligometastases (≤4 in number). SRS/SRT is only applicable for highly selected patients due to stringent size criteria (≤4 cm) and unavailability of this advanced technology in majority radiation centers in India. Hypofractionated focal 3-dimensional conformal radiotherapy (30 Gy in 5 fractions in 5 consecutive days) represents an attractive clinical alternative to SRS/SRT. In our series, we report dosimetric and clinical outcomes of nine patients (single brain metastatic foci, median size 3.4 cm). Radiotherapy was planned using coplanar and noncoplanar beams, conventional 1 cm multileaf collimators, and 3-mm planning target volume margins on a 6 MV linear accelerator. We were able to achieve sharp-dose falloff and excellent clinical outcome in our short follow-up. This protocol seems to be a feasible and well-tolerated alternative to SRS/SRT. We have designed a long-term Phase III prospective study to validate this regimen in larger population (ineligible for SRS/SRT).
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Primary central nervous lymphoma of cerebellopontine angle germinal center type: Report of a rare case p. 131
Venkateswarao Kommu, Rachanakehra , Sudha S Murthy, Krishnamohan Mallavarapu, Tasneem Rushdi, Rashmi Sudhir
DOI:10.4103/IJNO.IJNO_7_19  
Lymphoma of the central nervous system is uncommon, accounting for approximately 0.2-2% of all brain tumors. Primary lymphoma of the cerebellopontine angle (CPA) is rare in the central nervous system. Computed tomography (CT) and magnetic resonance imaging (MRI) reliably describe the typical features of vestibular schwannomas and meningiomas. In various types of cerebellopontine angle mass lesions lymphoma should be considered one of the differential diagnosis. To our knowledge, there have only been 20 cases reported worldwide so far.
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Paraneoplastic Miller-Fisher syndrome associated with splenic lymphoma p. 135
Victoria Ros-Castello, Arantxa Sanchez-Sanchez, Ana Gomez-Lopez, Elena Natera-Villalba, Nuria Garcia-Barragan, Javier Buisan-Catevilla, Iñigo Corral-Corral
DOI:10.4103/IJNO.IJNO_6_19  
Paraneoplastic neurologic syndromes (PNSs) are infrequently associated with lymphoma. Manifestations of lymphoma-associated PNS include both central and peripheral nervous systems. We report the case of a patient with Miller-Fisher syndrome (MFS) and a final diagnosis of splenic lymphoma whose neurological symptoms improved only after surgery and chemotherapy. Our report outlines the importance of suspecting a paraneoplastic etiology in patients with MFS and no response to conventional therapies.
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LETTERS TO EDITOR Top

Cerebellopontine angle neurothekeoma (nerve sheath myxoma): An overview p. 137
Jamir Pitton Rissardo, Ana Leticia Fornari Caprara
DOI:10.4103/IJNO.IJNO_13_19  
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Is there any difference in response to treatment between radiotherapy techniques in Cushing's disease? p. 139
Yasemin Benderli Cihan
DOI:10.4103/IJNO.IJNO_8_19  
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Does BRAF V600E mutation change the treatment in craniopharyngioma? p. 141
Yasemin Benderli Cihan
DOI:10.4103/IJNO.IJNO_11_19  
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