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SpanishInterstitial chemotherapy for malignant glioma: Future prospects in the era of multimodal therapy
Date of publication: 13-Feb-2015
Abstract
The advent of interstitial chemotherapy has significantly increased therapeutic options for patients with malignant glioma. Interstitial chemotherapy can deliver high concentrations of chemotherapeutic agents, directly at the site of the brain tumor while bypassing systemic toxicities. Gliadel, a locally implanted polymer that releases the alkylating agent carmustine, given alone and in combination with various other antitumor and resistance modifying therapies, has significantly increased the median survival for patients with malignant glioma. Convection enhanced delivery, a technique used to directly infuse drugs into brain tissue, has shown promise for the delivery of immunotoxins, monoclonal antibodies, and chemotherapeutic agents. Preclinical studies include delivery of chemotherapeutic and immunomodulating agents by polymer and microchips. Interstitial chemotherapy was shown to maximize local efficacy and is an important strategy for the efficacy of any multimodal approach.
Treatment of Gliomas: How did we get here?
Date of publication: 13-Feb-2015
Abstract
Over the past 30 years, the treatment of gliomas has become more multi-modality with clinical trials demonstrating that adjuvant chemo-radiation following surgery improves survival of patients. Unfortunately, this advance in therapeutic intervention has had a modest impact on patient survival, with only a 3–6 month improvement in survival during this time period. In this review, we discuss the progress made in each key aspect of glioma treatment; chemotherapy, surgery and radiation therapy. We present key clinical trials that were used as basis for current management guidelines for patients with gliomas. Ultimately, it is clear that future treatments of patients with gliomas will entail specific chronologic combinations of these three modalities in personalized regimens designed for individual patient tumor sub-type.
Personalized Medicine for Gliomas
Date of publication: 13-Feb-2015
Abstract
Personalized medicine for cancer entails tailoring therapy for each patient based on unique features of the patient's tumor; physiologic, molecular, genetic and epigenetic. Our ability to molecularly characterize tumor cells has increased dramatically and shown that there are significant differences between samples from patients with the same tumor type. Given this extensive variability in mutations and pathways driving tumors in patients, seeking a single bullet is an unrealistic approach for achieving a cure. In glioblastoma multiforme (GBM), the most common adult brain tumor, this inter-tumoral heterogeneity is further complicated by intra-tumoral heterogeneity within the tumor. This suggests that for personalized therapy to work for GBMs, pharmacologic agents would not only be tailored to target the differences from patient to patient but also the clonal diversity within each patient's tumor. In this review, we provide a historical perspective on clinical trials for cancer. We also discuss the current state of molecular biology and immunology based strategies for personalized therapies for glioblastoma multiforme.
Commentary: Utility of the O-Arm in spinal surgery
Date of publication: 30-Dec-2014
Background:More studies report the intraoperative benefits vs. risks of utilizing the O-Arm in performing pedicle screw insertion in spinal surgery.
K-Wire fracture during minimally invasive transforaminal lumbar interbody fusion: Report of six cases and recommendations for avoidance and management
Date of publication: 30-Dec-2014
Background:Although rare, minimally invasive spine techniques do have the risk of intraoperative device failure. Kirschner wire (K-wire) fractures during minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) have not been previously reported. This report focuses on the incidence of k-wire fractures following MI-TLIF and describes techniques to help avoid and treat these fractures when they occur.
A blast from the past!: The value of adding single slice magnetic resonance myelography sequence to magnetic resonance imaging of the spine; a flashback to the conventional myelography of the past
Date of publication: 30-Dec-2014
Background:The study was undertaken to determine whether a single slice magnetic resonance (MR) myelogram sequence improves the interpretation and diagnostic yield for magnetic resonance imaging (MRI) of the spine.
Public awareness of the bone morphogenic protein controversy: Evidence from news publications
Date of publication: 30-Dec-2014
Background:Use of recombinant human bone morphogenic protein-2 (rhBMP-2) in spinal fusion has seen a tremendous increase. Public awareness of rhBMP-2 and its complications has not been assessed. The authors studied published news media articles to analyze information provided to the public on this bone graft substitute.
Cervical laminoforaminotomy for radiculopathy: Symptomatic and functional outcomes in a large cohort with long-term follow-up
Date of publication: 30-Dec-2014
Background:The efficacy and safety of cervical laminoforaminotomy (FOR) in the treatment of cervical radiculopathy has been demonstrated in several series with follow-up less than a decade. However, there is little data analyzing the relative effectiveness of FOR for radiculopathy due to soft disc versus osteophyte disease. In the present study, we review our experience with FOR in a single-center cohort, with long-term follow-up.
Anterior transarticular screw fixation as a conventional operation for rigid stabilization
Date of publication: 30-Dec-2014
Background:Anterior transarticular screw (ATS) fixation is a useful surgical option for atlantoaxial (AA) stabilization. This report presents a revised ATS method for AA fusion.
Intraoperative neuro-monitoring corner editorial: The need for preoperative sep and mep baselines in spinal surgery: Why can’t we and our monitoring colleagues get this right?
Date of publication: 30-Dec-2014
Background:The majority of spinal surgeons now utilize intraoperative neurophysiological monitoring (IONM) during spinal procedures to limit the risk of inadvertent injury. Nevertheless, probably the most frequent error is the failure of the surgeon and IONM to obtain adequate preoperative baselines (e.g. before intubation or positioning).
