Postoperative recurrence and the role of adjuvant chemotherapy in patients with pulmonary large-cell neuroendocrine carcinoma

ObjectivesThe prognosis for patients with large-cell neuroendocrine carcinoma is generally very poor. In this study, we describe the clinical features of recurrent tumors of large-cell neuroendocrine carcinoma and discuss the role of adjuvant chemotherapy and management of recurrence in patients with large-cell neuroendocrine carcinoma.MethodsWe retrospectively analyzed clinical data from 79 patients and evaluated the prognosis of patients with platinum-based adjuvant chemotherapy, recurrence patterns, patient response to chemotherapy or radiation therapy, and prognosis in patients who experienced relapse.ResultsOf 72 patients, 36 had confirmed recurrent tumors upon follow-up examinations. Of those with recurrent tumors, 33 patients (91.7%) had their first recurrent tumors within 3 years. Patients who underwent platinum-based adjuvant chemotherapy had a significantly lower rate of tumor recurrence and a higher rate of disease-free survival than those who had non–platinum-based adjuvant chemotherapy or no adjuvant chemotherapy. Multivariate analyses revealed that platinum-based adjuvant chemotherapy, pathologic stage, and the presence of second cancer are independent prognostic factors. Three patients with limited resection of the primary tumor had poor prognosis with recurrence. Postoperatively, 11 of the 36 patients without recurrence (30.6%) had metachronous second primary cancers, of which 4 patients had more than 1 site.ConclusionsPatients with large-cell neuroendocrine carcinoma had frequent recurrence following resection of the primary tumor, and those without recurrence often developed metachronous second primary cancers. Platinum-based adjuvant chemotherapy after surgery may be useful for preventing recurrence in patients with large-cell neuroendocrine carcinoma

A prospective compound screening contest identified broader inhibitors for Sirtuin 1

Potential inhibitors of a target biomolecule, NAD-dependent deacetylase Sirtuin 1, were identified by a contest-based approach, in which participants were asked to propose a prioritized list of 400 compounds from a designated compound library containing 2.5 million compounds using in silico methods and scoring. Our aim was to identify target enzyme inhibitors and to benchmark computer-aided drug discovery methods under the same experimental conditions. Collecting compound lists derived from various methods is advantageous for aggregating compounds with structurally diversified properties compared with the use of a single method. The inhibitory action on Sirtuin 1 of approximately half of the proposed compounds was experimentally accessed. Ultimately, seven structurally diverse compounds were identified

The Role of C-11 Methionine PET for Non-invasive Grading Between Oligodendroglial Tumor and Other Brain Tumors

PURPOSE: Several studies have shown that the prognosis of oligodendroglial tumor is dependent on their histological grade. C-11 methionine (MET) PET imaging is one of sensitive techniques for visualizing primary brain tumors. The aim of this study was to evaluate the relationship between the uptake of MET and histopathologic grading especially based on oligodendroglial tumor versus other brain tumors.METHOD AND MATERIALS: Cerebral uptake of MET was determined in 30 patients with histologically proven gliomas (22 male patients and 9 female patients: meanage,46.9y; range, 14-75y). Grade I, II, III and IV lesions based on WHO grading class were 3,10,9, and 8 lesions, respectively. There were 3 oligodendroglioma (grade II) and 1 anaplastic oligodendroglioma (grade III) in our cases. Ecat Exact HR+ PET scanner and Biograph DUO PET/CT were used for imaging in this study. A semiquantitative methionine uptake ratio (TNR; Tumor to normal tissue ratio) was correlated with tumor grade. RESULTS: There was a significant difference in TNR between grade III and IV lesions, but no significant difference between grade II and III in whole cases. In oligodendroglial tumors, 3 grade II lesions tended to show higher TNR than a grade III lesion. There was a significant difference in TNR between grade II and III lesions except oligodendroglial tumors from the cases. Oligodendroglioma might represent different metabolic demand for MET uptake from the other gliomas. CONCLUSION: MET PET was sensitive for histopathologic grading of gliomas except oligodedroglial tumors. We must pay much attention to primary staging of oligodendroglial tumors using MET PET. CLINICAL RELEVANCE/APPLICATION: Non-invasive grading technique for oligodendroglial tumor and other brain tumors using methionine PET94rd Scientific Assembly and Annual Meetin

Operation of a P300-based brain-computer interface by patients with spinocerebellar ataxia

Objective: We investigated the efficacy of a P300-based brain-computer interface (BCI) for patients with spinocerebellar ataxia (SCA), which is often accompanied by cerebellar impairment. Methods: Eight patients with SCA and eight age- and gender-matched healthy controls were instructed to input Japanese hiragana characters using the P300-based BCI with green/blue flicker. All patients depended on some assistance in their daily lives (modified Rankin scale: mean 3.5). The chief symptom was cerebellar ataxia; no cognitive deterioration was present. A region-based, two-step P300-based BCI was used. During the P300 task, eight-channel EEG data were recorded, and a linear discriminant analysis distinguished the target from other nontarget regions of the matrix. Results: The mean online accuracy in BCI operation was 82.9% for patients with SCA and 83.2% for controls; no significant difference was detected. Conclusion: The P300-based BCI was operated successfully not only by healthy controls but also by individuals with SCA. Significance: These results suggest that the P300-based BCI may be applicable for patients with SCA. Keywords: BCI, BMI, P300, Visual stimuli, Spinocerebellar ataxi

Glucose and Methionine Uptake by Rat Brain Tumor Treated with Prodrug-Activated Gene Therapy

The effect of aciclovier(ACV) on the metabolism of rat 9I-gliosarcoma cells expressing the herpes simples virus-thymidine kinase gene was studied using 2-deoxy-2-[18F]fluoro-D-glucose(FDG) and L-[methyl-11C]methionine. Though the average weight of the tumors treated with ACV was significantly lower than that of the saline-injected control group, FDG and methionine uptake per weight of tumor tissue was not different between the two groups. This result exhibits a striking contrast to the metabolic pattern observed after radiation therapy, suggesting the different pathways regarding tumor cell death between the therapies

Discrimination between low-grade oligodendrogliomas and diffuse astrocytoma with the aid of 11C-methionine positron emission tomography.

OBJECT: The diagnostic usefulness of (11)C-methionine PET scans in gliomas is still controversial. The authors investigated the clinical significance of (11)C-methionine PET findings in preoperative diagnosis of histological type and grade.\nMETHODS: The tissue uptake of (11)C-methionine was assessed using PET in 70 patients with histologically confirmed intracerebral gliomas. The ratio of maximum standard uptake values in tumor areas to the mean standard uptake values in the contralateral normal brain tissue (tumor/normal tissue [T/N] ratio) was calculated and correlated with tumor type, histological grade, contrast enhancement on MR imaging, Ki 67 labeling index, and 1p/19q status.\nRESULTS: The T/N ratio was significantly increased as tumor grade advanced in astrocytic tumors (WHO Grade II vs Grade III, p = 0.0011; Grade III vs Grade IV, p = 0.0007). Among Grade II gliomas, the mean T/N ratio was significantly higher in oligodendroglial tumors than in diffuse astrocytomas (DAs) (p < 0.0001). All T/N ratios for oligodendroglial tumors were &#8805; 1.46, and those for DA were consistently < 1.46, with the exception of 2 cases of gemistocytic astrocytoma. The Ki 67 labeling index significantly correlated with T/N ratio in astrocytic tumors, but not in oligodendrogliomas. Oligodendroglial tumors without 1p/19q deletion had a significantly higher T/N ratio than those with the codeletion. In combination with Gd-enhanced MR imaging, 67% of nonenhanced tumors with a T/N ratio of &#8805; 1.46 were proved to be Grade II oligodendrogliomas.\nCONCLUSIONS: These results clearly show that (11)C-methionine PET T/N ratios in Grade II oligodendrogliomas were higher than those in DAs independently of their proliferative activity. This information contributes to preoperative differential diagnoses of histological type, especially in suspected low-grade gliomas

Transclival clipping for giant vertebral artery aneurysm: A case report

Background: Endovascular treatment often achieves complete obliteration of VA giant aneurysm; however, retreatmentmay be required because of late recanalization. We report a case of giant VA aneurysm that showedregrowth after endovascular treatment and was treated with VA clipping using the endoscopic endonasaltransclival approach.Case description: A 47-year-old man with chief complaint of ataxia underwent endovascular treatment of giantVA aneurysm. One year later, he needed additional treatment to regrowth of the aneurysm. We were not able toaccomplish aneurysmectomy via the transcondylar fossa approach because of difficulty in achieving hemostasisand ended with partial thrombectomy. Digital subtraction angiography (DSA) performed after 4 months revealedcoil compaction and distal flow due to recanalization. Right VA elongation and position of anterior spinal artery(ASA), these factors made possible for us to perform transclival approach to VA. Despite the limited indicationsfor its use, endonasal endoscopic transclival clipping may be effective in limited anatomical cases.Conclusion: We report the use of endonasal endoscopic transclival clipping for giant VA aneurysm. This endonasalendoscopic treatment may be an optional alternative in only limited cases depending upon the anatomicallocation of the lesion because of limitations of vascular control and the inability to visualize the field in thepresence of major bleeding. For treatment of progressive giant VA aneurysm, it is very important to avoidoptimistic strategy for giant VA aneurysm initially