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  Most popular articles (Since June 26, 2018)

 
 
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ABHIJIT GUHA ORATION, ISNOCON 2018
Extent of resection in glioblastoma – Where to draw the line?
Raymond Sawaya
January-December 2018, 1(1):11-13
DOI:10.4103/IJNO.IJNO_9_18  
  833 128 -
ORIGINAL ARTICLES
Antiepileptic drug usage in neuro-oncology: A practice survey
Amrita Parhi, Tejpal Gupta
January-June 2019, 2(1):17-23
DOI:10.4103/IJNO.IJNO_3_19  
Purpose: Despite the lack of high-quality evidence, anti-epileptic drugs (AEDs) are very commonly prescribed for seizure prophylaxis in patients with brain tumors even without prior history of seizures. We sought to review the current practices of prescribing AEDs among neuro-oncology health-care professionals. Materials and Methods: An e-mail with online link to a 15-item questionnaire regarding AED prophylaxis was sent to members of major academic societies representing the Indian Neuro-Oncology Community to assess the prevalent patterns of practice. Results: The online survey was completed by 318 of 3320 health-care professionals that were mailed for an overall response rate of 9.6%. Majority (68.9%) of respondents were radiation oncologists followed by neurosurgeons (22.9%) and medical oncologists/neurologists (8.2%). The practice setting spanned across the health-care spectrum, and over 75% reported having ≥ 5-year of experience in managing patients with brain tumors. Even for seizure-naïve patients, 65.1% of respondents routinely prescribed prophylactic AEDs with significant variability in the duration of such prophylaxis. Levetiracetam was the most preferred AED (60%) followed by phenytoin (35%) in the survey. Most respondents believed that tumor type, histological grade, and anatomic location influenced the risk of seizures. Despite widespread use in clinical practice, only 27.3% of the respondents strongly believed that prophylactic AEDs significantly reduced the risk of seizures. Over 93% of respondents agreed that a large randomized controlled trial would better inform therapeutic decision-making regarding AED prophylaxis. Conclusions: This survey of the Indian Neuro-Oncology Community demonstrates widespread variability in the frequency and duration of AED prophylaxis in seizure-naive brain tumor patients in contemporary practice.
  783 133 -
REVIEW ARTICLES
Understanding the brain tumor microenvironment: Considerations to applying systems biology and immunotherapy
Tiffany M Juarez, Jose A Carrillo, Achal A Achrol, Matthew P Salomon, Diego M Marzese, James H Park, Nitin S Baliga, Santosh Kesari
January-December 2018, 1(1):25-33
DOI:10.4103/IJNO.IJNO_11_18  
Patients with malignant brain cancers such as glioblastoma and brain metastases (BM) represent a population with a large unmet medical need, and a multitude of drugs have failed over decades. The current treatment modalities include surgery, radiation, and chemotherapy; yet, the median survival of patients with gliomas and BM remains abysmally low at 15 months and 2–14 months, respectively. In addition, standard treatments cause debilitating motor and neurological deficits. The paucity of effective therapies, despite intense investigation over the past several decades, represents inherent challenges to treating brain cancer and the critical knowledge gap in understanding tumor sensitivity, drug delivery, and microenvironmental shifts. Recently, immunotherapy has shown tremendous efficacy in melanoma and other cancers but has yet to revolutionize the treatment of brain cancers. However, as immunotherapy holds the promise of specifically targeting and eliminating tumor cells while sparing normal brain cells, innovative methods for investigating immunotherapy for brain cancer are essential for optimizing patient response. In this review, we will summarize the key issues and how a systems biology approach can help decipher this complexity and lead to better understanding and therapeutic targeting of the brain cancers.
  764 109 -
EDITORIALS
Glioma surgery: The art and science
Aliasgar V Moiyadi
January-December 2018, 1(1):6-10
DOI:10.4103/IJNO.IJNO_5_18  
Surgery for gliomas has been dogged by controversy for decades. The need for radical resections and the extent of such resections has been a subject of many debates. The all-elusive cure coupled with the complex biology of the disease feeds this pessimism. However, advances in technology and integration of adjuncts into the operating room, along with the evolution of specialist training in this field, has seen improving outcomes documented in the ever-increasing scientific literature. This commentary provides an overview of this evolution and the status of contemporary glioma surgery.
  746 112 -
Indian society of neuro-oncology: Travails and triumphs
Rakesh Jalali, Pankaj Kumar Panda
January-December 2018, 1(1):3-5
DOI:10.4103/IJNO.IJNO_10_18  
  721 131 -
REVIEW ARTICLES
Challenges in glioblastoma biology and implications in personalized therapy
Divya Kumari Singh, Abir Mondal, Anjali Shiras
January-December 2018, 1(1):17-24
DOI:10.4103/IJNO.IJNO_7_18  
Glioblastoma is one of the most dreaded tumors of the central nervous system. The tumors show poor prognosis with patients showing a median survival of only 12–15 months despite all the treatment regimens. Recent studies have contributed a lot to our understanding of the pathogenesis of this disease and have suggested the presence of glioma stem cell (GSC) population as drivers of tumor growth. The GSCs are also considered responsible for tumor recurrence leading to treatment failure. It is thus increasingly becoming important to understand the biology of this tumor and effectively classify these tumors based on genetic mutations. Advancement in diagnosis to uncover the stages of tumor development and customize treatment modalities would increase chances for better responsiveness to various treatments and help us witness positive outcomes. These altogether could help in improving the survival of patients and their quality of life. An urgent need to find better ways of diagnosis could be achieved by combining our knowledge of basic science with advanced technologies. This review summarizes the past and present status of glioma biology, their classification and pathogenesis. It highlights the current pitfalls in clinical treatment and recent advances in diagnostics which could have clinical implications in near future.
  718 85 -
ORIGINAL ARTICLES
Extraneuraxial metastases from medulloblastoma: Single-institution outcome analyses
Tejpal Gupta, Archya Dasgupta, Sridhar Epari, Neelam Shirsat, Girish Chinnaswamy, Rahul Krishnatry, Godajayant Sastri, Rakesh Jalali
January-December 2018, 1(1):46-52
DOI:10.4103/IJNO.IJNO_6_18  
Introduction: Novel biological insights have led to consensus classification of medulloblastoma into four distinct molecular subgroups. It is widely accepted that medulloblastomas have a higher propensity for extraneuraxial metastases (ENM) compared to other primary brain tumors. We sought to review our own institutional experience of ENM from medulloblastoma. Materials and Methods: Patients with a histological diagnosis of medulloblastoma and ENM were identified from institutional neuro-oncology database. Patient-, disease-, and treatment-related details were retrieved by retrospective review of medical case records. Results: A total of 573 patients with medulloblastoma were registered from 2005 to 2016, of which 13 patients were detected with ENM. Median age of our study cohort was 17 years (range: 3–25 years) at index diagnosis. Ten (77%) patients had desmoplastic medulloblastoma, while 3 (23%) patients had large-cell/anaplastic histology. Five of 7 (71%) patients with known molecular subgroup affiliation belonged to sonic hedgehog subgroup, while the remaining two (29%) were subgroup 3 medulloblastoma. The median time to development of ENM was 13 months (range: 2–72 months) with common sites being bone (77%), bone marrow (62%), and lymph nodes (46%). Median overall survival after diagnosis of ENM was 2 months (range: 1–25 months) with 1-year survival probability of 23%. Patients with desmoplastic medulloblastoma had longer median overall survival compared to anaplastic histology (4.5 months vs. 1 month; P = 0.07). None of the other putative prognostic factors such as age at ENM, concurrent central nervous system involvement, visceral metastases, or time to relapse impacted overall survival. Conclusions: ENM from medulloblastoma, although rare, is frequently associated with desmoplastic histology. Bone, bone marrow, and lymph nodes are the most common sites of extraneuraxial involvement. Survival outcomes remain universally poor mandating the testing of newer agents and/or novel molecularly targeted therapies.
  689 92 -
Clinicians view and practice pattern on the use of stereotactic radiosurgery in brain metastases: A survey among Indian radiation oncologists
Kazi Sazzad Manir, Anindya Mukherjee, Debanti Banerjee, Abhishek Basu, Swapnendu Basu, Sourav Guha
January-December 2018, 1(1):40-45
DOI:10.4103/IJNO.IJNO_3_18  
Context: Due to increased incidence of late neurotoxicities associated with whole-brain radiotherapy (WBRT), the idea of treating limited brain metastasis (BM) (1–4) only with stereotactic radiosurgery (SRS) has become an interesting topic. Due to lack of SRS facilities, there is a major disagreement in the use of SRS in BMs. Aims: In our study, we tried to find out views and practice patterns of the Indian radiation oncologists (RO) on the use of SRS in BMs. Setting and Design: This is an internet-based, cross-sectional survey among ROs. Materials and Methods: Online questionnaires were sent to 411 RO through an online survey portal (SurveyMonkey®). Responses were analyzed. Results: Among which, 24.6% (101) responded completely. 39.6% were from teaching hospitals and 49.4% (48) were had <5 years of postspecialization experiences. About 38% (36) treats 30–100 BMs cases/month. Among the respondents who have SRS facilities (25.8%), only 26.1% use SRS routinely for BMs. Majorities (39.7%) have <3-year experiences. In oligometastases (1-4), 56.1% still practice WBRT only, though 57.6% feel that WBRT followed by SRS boost is the ideal treatment. 30.2% RO feels that local control is most important outcome determining factor for single metastasis, 40.9% RO feels the best modality is SRS alone. For treating >5 metastases, 92.1% ROs practice WBRT only. Conclusions: This is probably the first study on practice patterns of SRS in India if not the world. Major discordance exists between practice patterns and views on SRS use among RO in India. Majority do not practice SRS due to lack of facilities.
  701 68 -
Early initiation of radiotherapy in patients diagnosed with gliomas: A retrospective analysis of patient in a single institution a tertiary care center
Anusheel Munshi, Shaleen Agrawal, Sandeep Vaishya, Rana Patir, Rakesh Gupta, Biplab Sarkar, Tharmar Ganesh, Bidhu K Mohanti
January-June 2019, 2(1):12-16
DOI:10.4103/IJNO.IJNO_1_19  
Objective: Evaluation of effect of interval between surgery to adjuvant radiotherapy (Sx-ART) start and its early tolerance in glioma patients. Method: A retrospective study of 155 adult glioma patients (WHO Grade II-IV) who underwent adjuvant radiotherapy (ART) post-surgery with confirmed histopathology was done in our institution from Sept, 2012 to May,2017. Results were analysed in 3 parts: Sx-ART interval, ART schedule, ART course tolerance. Results: Sx-ART interval ranged from 1-8wks. Seventy-eight percent (121/155) patients started ART within 4wks of surgery, 30/155(19.4%) started within 2wks and 89/155 (57.4%) within 3wks of surgery. ART schedule was conventional fractionation (CF) in 121 (78%) while 34/155 (22%) patients received hypofractionated (HF) course. CF schedules varied between 54Gy-61Gy in 28-33 fractions and HF ranged 50Gy-55Gy in 20-25 fractions. Duration of ART ranged 24-50 days (median 41days). Sixty-five percent (101/155) patients completed ART <6wks and 147/155 (95%) <7wks. Seventy-eight percent (121/155) patients had concurrent Temozolomide (TMZ) including 28/34 (82%) HF patients. ART course interruption was recorded in 11/155 (7%) patients. Interruptions for Sx-ART interval <3wks & >3wks was 3 & 8 patients respectively. None had Grade 3/4 skin reactions or post-treatment scar infection/gaping at ART conclusion. Conclusion: Early start of ART in this analysis showed no difference in tolerance to radiotherapy, including patients receiving HF radiotherapy or concomitant temozolomide. Decrease in time interval from surgery to start of radiotherapy may improve compliance to radiotherapy and reduce overall duration of treatment time (ODT). Long term data of such approaches to reduce ODT and its effect on disease free and overall survival require future studies.
  636 121 -
EDITORIALS
Ushering in a new era: The IJNO
Dattatraya Muzumdar
January-December 2018, 1(1):1-2
DOI:10.4103/IJNO.IJNO_12_18  
  646 102 -
ORIGINAL ARTICLES
Multiple primary intracranial tumors with diverse histological origin
Harish Naik, Vernon Velho
January-December 2018, 1(1):34-39
DOI:10.4103/IJNO.IJNO_2_18  
Context: Most primary intracranial neoplasms occur as solitary lesions. Presence of multiple intracranial tumours with different histological origin in same individual or even collision tumours is exceedingly rare. Aims: With the advancement in neuroimaging techniques, more such synchronous tumours are being identified. The most common combination identified till date is meningioma associated with glioma. Our understanding of multiple, dissimilar intracranial tumours will gradually improve as more cases are identified, reported and studied. The explanations for the simultaneous occurrence of different primary intracranial tumours in the absence of phacomatoses or prior radiation exposure are at present hypothetical, and these tumours could be simply coincidental. Material and Methods: We present here a series of four cases who had multiple intracranial tumours of different histological origin and were managed successfully. None of our patients had received radiation in the past or had any family history of phakomatoses. Conclusions: Simultaneous occurrence of histologically different primary braintumours is rare, and its preoperative diagnosis is still challenging. Syndromic association should be ruled out in patients of histologically different multiple brain tumours. Most common primary brain tumour associated with other histologically different brain tumours is meningioma. Thorough clinical and imaging studies are mandatory in these cases to provide optimal treatment.
  677 71 -
PRESIDENTIAL ORATION, ISNOCON 2018
Milestones in neuropathology: Bridging morphology with molecules
Vani Santosh
January-December 2018, 1(1):14-16
DOI:10.4103/IJNO.IJNO_13_18  
  643 103 -
EDITORIAL
World Health Organization 2016 update on classification of central nervous system tumors: The road ahead
Dattatraya Muzumdar
January-June 2019, 2(1):1-2
DOI:10.4103/2590-2652.259560  
  563 144 -
CASE REPORT
A rare cerebellopontine angle neurothekeoma
Kartik Manoj Multani, Anandh Balasubramaniam, M Sharath Kumar, Pooja Chavali
January-December 2018, 1(1):53-55
DOI:10.4103/IJNO.IJNO_4_18  
Neurothekeomas are benign, predominantly cutaneous tumors originating from the nerve sheath seen mostly in the first three decades with predilection to female gender. This is the second case in world literature describing neurothekeoma in the cerebellopontine angle (CPA). This patient was a 27-year-old female who presented to us with right-sided CPA neurothekeoma. Intraoperatively, the tumor showed no obvious attachments from the surrounding nerves, arachnoid, and brain tissue, and gross total resection was achieved. The tumor cells were strongly positive for S100 and focally for glial fibrillary acidic protein and were negative for epithelial membrane antigen, cytokeratin, and synaptophysin. More literature inputs along with long-term follow-up data are needed for this rare entity to form a uniform treatment protocol.
  578 63 -
ORIGINAL ARTICLES
Simultaneously occurring tumors with acoustic schwannomas without phakomatoses – A case series of nine patients and review of literature
Dattatraya P Muzumdar, Sonal Jain, Abhidha Shah, Atul Goel
January-June 2019, 2(1):7-11
DOI:10.4103/IJNO.IJNO_8_18  
Introduction: Primary brain tumors of different histological types developing spontaneously together is a rare event; the incidence being 0.3% of all brain tumors. Acoustic schwannomas form the majority (about 70%–80%) of all cerebellopontine angle tumors. The most common association found is meningioma and acoustic schwannoma occurring in the same cerebellopontine angle region. Excluding phakomatoses, other neurocutaneous syndromes, and previous irradiation; the simultaneous occurrence of different primary brain tumors with acoustic schwannoma is rare. Methodology: We report the largest single institute case series, 9 patients of simultaneously occurring primary tumors with acoustic schwannomas over the last 25 years (1990–2015). All these patients were operated for both the tumors. The classification, pathogenesis, and surgical strategy of such tumors are discussed in light of current literature. Results: There were five males and four females in the study population aged from 30-60 years. There were five patients with spatially distant co-existing tumors. Transient facial paresis was noticed in three patients. They had significant improvement within six months. Conclusion: Simultaneously occurring tumors need appropriate planning and surgical strategy for ensuring good outcome and long-term prognosis.
  511 103 -
REVIEW ARTICLE
Management of optic pathway gliomas: Role of magnetic resonance imaging with diffusion-tensor imaging tractography in planning surgical resection
Manas Panigrahi, Chirag Patel, Y B. V K. Chandrasekhar, Sudhindra Vooturi
January-June 2019, 2(1):3-6
DOI:10.4103/IJNO.IJNO_4_19  
Optic pathway gliomas (OPGs) are histological low grade but widely infiltrative tumors that arise along the optic nerves, optic chiasm, tracts, diencephalic structures, and white matter radiations to the visual cortex. When OPGs progress, management strategies may differ between pre-chiasmatic and chiasmatic lesions. Radiation therapy is often utilized as the primary treatment modality, but it is typically postponed till the age of 5–7 years because of the potential for late risks such as endocrinopathy, vasculopathy, and cognitive decline. No definitive studies establish the superiority of one specific chemotherapeutic agent over others. However, a favorable side effect profile is often opted for. Surgery is considered in patients with (1) single nerve is involved, (2) progressive and disfiguring proptosis, (3) blindness, and (4) significant mass effect or hydrocephalus. Encouragingly, diffusion-tensor imaging (DTI) has emerged as a useful tool for the assessment of white matter structures, including the visual pathways. We report an interim analysis of 14 patients with OPG, at our center, a tertiary referral center. We report that magnetic resonance imaging (MRI)-DTI studies provided additional information about visual fiber arrangement in relationship to the tumor that was not evident by conventional MRI methods.
  488 98 -
PAPERS ABSTRACTS
Papers Abstracts

January-June 2019, 2(1):30-74
DOI:10.4103/2590-2652.259561  
  502 57 -
CASE REPORTS
Ganglioneuroblastoma of the paracavernous region
Kanika Bansal, Sandeep Vaishya, Rakesh K Gupta, Sunita Ahlawat, Anusheel Munshi
January-June 2019, 2(1):24-26
DOI:10.4103/IJNO.IJNO_2_19  
Brain tumors commonly seen in the third decade of life are germinomas, medulloblastomas, and gliomas. A 21-year-old male presented with an extra-axial mass lesion in the right paracavernous and cerebellopontine region of the brain. Postoperative histopathology was ganglioneuroblastoma (GNB). We present the first report of GNB of this region of the brain along with a literature review of the past cases.
  392 45 -
Neuroendocrine variant of carcinoma of the prostate
RB Nerli, Shridhar C Ghagane, K Shankar, Rafat Jamadar K, Sushant Deole, Neeraj S Dixit, Murigendra B Hiremath
January-June 2019, 2(1):27-29
DOI:10.4103/IJNO.IJNO_14_18  
Alterations in the differentiation pathway of prostate cancer can be seen in a small proportion of patients, giving rise to a neuroendocrine (NE) variant. Such tumors possess a number of biologic characteristics unique to NE tumors that can also arise from other organs. Rapidly growing disease with the following clinical characteristics such as pelvic masses, visceral involvement, osteolytic metastasis with hypercalcemia, and brain metastasis should prompt evaluation for the NE variant. We report a case of NE variant of prostatic carcinoma presenting in an elderly male and rapidly progressing to metastasize even the brain.
  306 41 -
POSTER ABSTRACTS
Poster Abstracts

January-June 2019, 2(1):75-86
DOI:10.4103/2590-2652.259562  
  264 49 -