bluuebunny/crossref_metadata_2025 huggingface dataset:
Cognitive Impairment and Seizures in Patients with Lacunar Strokes
Authors: Reuck Jacques De ,   Former Chairman, Department of Neurology and Former Director, PET Centre, Ghent University, Belgium
Published: October 2015

Lacunar strokes are mainly related to cerebral microangiopathy and to the presence of leukoaraiosis. Cognitive impairment is frequently linked to the presence of lacunes and white matter changes. The cognitive impairment consists mainly of disturbances of executive functions sometimes leading to dementia. It is mainly due to interruption of the frontal-subcortical neuronal circuits. Seizures are also observed in patients with lacunes and white matter changes. Although lacunes cannot be considered as the cause of the seizures, there is a relationship between the occurrence of cognitive impairment and seizures. Repeated seizures promote further cognitive decline. However, the development of dementia in patients with late-onset epilepsy is most probably not directly due to the lacunes but rather due to Alzheimer's disease or to cortical cerebrovascular lesions. The development of lacunes should only be the aggravating factor for the cognitive decline as demonstrated in the Nun study.
Autoimmune Encephalitis
Authors: Leypoldt Frank , Wandinger Klaus-Peter , Bien Christian G , Dalmau Josep ,   Post doctoral Research Fellow, Catalan Institution for Research and Advanced Studies (ICREA), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; Junior Attending Physician, Department of Neurology, University Medical Centre Hamburg-Eppendorf, Germany,   Attending Physician, Institute of Clinical Chemistry; Attending Physician, Department of Neurology, University Medical-Centre Schleswig-Holstein Campus Lübeck, Germany,   Head of Department, Epilepsy Centre Bethel, Mara-Clinic Bethel, Bielefeld, Germany,   Post doctoral Research Fellow, Catalan Institution for Research and Advanced Studies (ICREA), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
Published: October 2015

The term autoimmune encephalitis is used to describe a group of disorders characterised by symptoms of limbic and extra-limbic dysfunction occurring in association with antibodies against synaptic antigens and proteins localised on the neuronal cell surface. In recent years there has been a rapidly expanding knowledge of these syndromes resulting in a shift in clinical paradigms and new insights into pathogenic mechanisms. Since many patients respond well to immunosuppressive treatment, the recognition of these disorders is of utmost importance. In general, there are no brain-imaging modalities or biomarkers specific of these disorders other than the demonstration of the neuronal antibodies. A disease classification based on these antibodies provides information on prognosis and paraneoplastic aetiology. This article focuses on recent clinical advances, newly characterised antibodies and treatment approaches to these disorders.
Biological Agents for Chronic Inflammatory Demyelinating Polyradiculoneuropathy
Authors: Stübgen Joerg-Patrick ,   Professor of Clinical Neurology/Attending Neurologist, Department of Neurology and Neuroscience, Weill Cornell Medical College/New York Presbyterian Hospital, US
Published: October 2015

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a term for a group of acquired, immune-mediated inflammatory demyelinating disorders of the peripheral nervous system. Most patients with CIDP respond to ‘first-line’ therapy with intravenous immunoglobulin (IVIG), plasmapheresis and/or corticosteroids. ‘Conventional’ immunosuppressive drugs are of no proven benefit. Biological agents directed at key aspects of the CIDP immunopathogenic pathway have gained increasing attention due to the unpredictable efficacy and overall health risks of non-targeted immunosuppressive drugs. Presently, there exists insufficient clinical experience with biological therapy to allow specific treatment recommendations for CIDP. The challenge remains to identify drug-naïve or treatment-resistant CIDP patients who will most likely respond to targeted immunotherapy.
The Role of Neuromuscular Ultrasound in the Diagnostic of the Chronic Inflammatory Demyelinating Polyneuropathy
Authors: Kerasnoudis Antonios ,   Neurologist, Department of Neurology, St Josef-Hospital, Ruhr University, Germany
Published: October 2015

Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common acquired immune-mediated inflammatory disorder of the peripheral nervous system. The diagnosis is based in classic cases, on the distribution pattern of the neurological semiology and pathological changes of nerve conduction studies (NCS). However, in cases with subtle clinical presentation, an extended diagnostic workup may be needed (cerebrospinal fluid examination, laboratory tests, nerve biopsy). NCS remain fundamental for the diagnosis, follow-up and measurement of response to immunetreatment in CIDP. However, new challenges arose on how best to acquire a static and dynamic imaging of the peripheral nerves, with the aim of providing a holistic approach to the nerve impairment. According to the literature, neuromuscular ultrasound is able to detect in cases of CIDP thickened or swollen roots, peripheral nerves or brachial plexus, findings that are consistent with ongoing inflammation. This review provides a timely update on the nerve ultrasound findings of CIDP and future possibilities of neuromuscular ultrasound are also discussed.
The International Multiple Sclerosis Clinic – A Virtual Tour of Best Practice Multiple Sclerosis Nursing
Authors: Duddy Martin , Olsson Tomas , Sastre-Garriga Jaume , Munk Marion R , Thomas Del , Gertz Andrea , McGarvey Stephen ,   Consultant Neurologist, Neurology Department, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK,   Professor of Neurology, Karolinska Institute, Stockholm, Sweden,   Neurologist and Deputy Director, Multiple Sclerosis Centre of Catalonia, Vall d’Hebron University Hospital, Barcelona, Spain,   Lecturer and Ophthalmologist, Department of Ophthalmology and Optometry, Medical University of Vienna, Austria,   MS Specialist Nurse, Multiple Sclerosis Specialist Nursing Service, Wye Valley NHS Trust, Gaol Street Health Clinic, Hereford, UK,   MS Nurse Consultant, Neuro-Service GmbH, Langgöns, Germany,   Solutions in Mind, Richmond Hill, Canada
Published: October 2015

Multiple sclerosis (MS), a progressive inflammatory and neurodegenerative disease of the central nervous system, is one of the most common causes of neurological disability in adults. The efficacy of disease-modifying therapies is improving and more oral medications are becoming available. These treatments have effects that include limiting chronic inflammatory damage, reducing the frequency of relapses, delaying disease progression and controlling symptoms. Most of these medications, however, can only delay disease progression and some have side effects that increase the burden of disease. The need for close monitoring varies between drugs and in the treatment-decision process, it is important to discuss the benefit–risk profile with the patient and to take account of the long-term nature of this disease. MS nurses have a pivotal role in the patient management and are important in ensuring compliance with treatment. The 2012 ‘MS International Clinic’ at Barcelona gathered MS nursing professionals from 26 countries and offered a singular opportunity to review the pathophysiology of the disease and discuss the benefits and limitations of current treatment options. The MS International Clinic also aimed to strengthen the role of the MS nurse in symptom management and patient support and to share best nursing practices.
Symptomatic Treatment in Multiple Sclerosis
Authors: Bigi Sandra , Yeh E Ann ,   Clinical Research Fellow, MS and Demyelinating Disorders Program, Hospital for Sick Children, University of Toronto, Ontario, Canada,   Associate Professor of Pediatrics (Neurology), University of Toronto; Director, Pediatric MS and Demyelinating Disorders Program, Director, Pediatric Neurology Training Program, Associate Scientist, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
Published: October 2015

Multiple sclerosis (MS) is a progressive and disabling neurodegenerative disease that primarily affects young adults. Despite significant therapeutic advances in the prevention of relapses, individuals with MS experience a variety of symptoms, most notably fatigue, spasticity, depression, gait and balance difficulties and sexual dysfunction. These symptoms may interfere with activities of daily living and have a negative impact on quality of life. This review discusses treatment options for these symptoms.
Pseudobulbar Affect – A Disabling but Under-recognised Consequence of Neurological Disease and Brain Injury
Authors: Cummings Jeffrey , Gilbart James , Andersen Grethe ,   Professor and Director, Lou Ruvo Center for Brain Health, Camille and Larry Ruvo Chair for Brain Health, Cleveland Clinic, Las Vegas, Nevada, US,   Senior Medical Writer, Touch Medical Media, London, UK,   Professor, Danish Stroke Centre, Aarhus University Hospital, Aarhus, Denmark
Published: October 2015

Pseudobulbar affect (PBA) is a condition associated with common neurological diseases or brain injury that manifests as uncontrollable and inappropriate outbursts of laughter or crying. PBA exacts a severe burden on the patient and care-givers in terms of reduced social functioning and often results in the patient’s isolation. The pathophysiology of PBA is incompletely understood, but symptoms are thought to result from damage to neural pathways associated with motor functioning and emotional processing. Data suggest that PBA is under-recognised by neurologists and psychiatrists and many cases go unrecognised or misdiagnosed. PBA has been successfully treated with psychoactive drugs, including antidepressants, but these do not have regulatory approval for use in this indication. A combination of dextromethorphan hydrobromide and quinidine sulphate (DM/Q) has demonstrated significant efficacy in reducing PBA symptoms and a favourable safety profile in a series of clinical trials and in regular clinical use. With the availability of an effective treatment for PBA symptoms, it becomes even more pressing to detect the condition so that patients can receive appropriate treatment.
The Impact of Restless Legs Syndrome/ Willis–Ekbom Disorder on Quality of Life
Authors: Kalloo Aadi , Gamaldo Charlene E , Kwan Anthony B , Salas Rachel E ,   BA Candidate, Department of Neuroscience, Johns Hopkins University,   Associate Professor, Department of Neurology, Sleep Division, Johns Hopkins University School of Medicine,   BA, Department of Neuroscience, Johns Hopkins University,   Assistant Professor, Department of Neurology, Sleep Division, Johns Hopkins University School of Medicine, Baltimore, Maryland, US
Published: October 2015

Restless legs syndrome (RLS), also known as Willis–Ekbom Disorder (WED), is a condition associated with nocturnal sensorimotor symptoms that can result in significant sleep disruption. RLS is a prevalent condition, affecting an estimated 3.9–14.3 % of the US population. Despite the most recently reported prevalence studies, many experts in the field still believe RLS is a generally underdiagnosed condition. RLS can negatively affect a patient’s quality of life (QoL) across several domains, such as daytime sleepiness, decreased general health, decreased immune function, stress and mood. Of those patients with moderate-to-severe symptoms that require treatment, the currently available therapeutic options (e.g. iron supplements, dopamine agonists, benzodiazepines, opioids and anticonvulsants) can also come with adverse side effects that can further impact QoL. The purpose of this article is to examine the QoL deficits experienced by RLS patients.
Cell-Based Therapeutic Strategies in Multiple Sclerosis
Authors: Rossman Ian , Cohen Jeffrey A ,   Child Neurology Fellow, Cleveland Clinic Center for Pediatric Neuroscience,   Professor, Cleveland Clinic Lerner College of Medicine and Director, Experimental Therapeutics Program, Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, US
Published: October 2015

Multiple sclerosis (MS) is an immune-mediated disease in which acute inflammatory demyelination leads to axonal injury and neurodegeneration, and is manifested clinically by relapsing–remitting neurological deficits superimposed on chronic accumulation of disability. MS treatments are largely immunomodulatory with little, if any, effect on neurodegeneration. Mesenchymal stem cells MSCs) are pluripotent cells derived from adult tissues with intrinsic anti-inflammatory and repair-promoting properties. They cross the blood–brain barrier and target perivascular spaces, which are the sites of inflammatory cell infiltration in MS.In vitro, MSCs can be purified and expanded, labelled for post-transplant tracking and be manipulated to express surface receptors or neurotrophic factors for central nervous system (CNS) targeting or neuroprotection, respectively. Animal models of MS, traumatic CNS injury and neurodegenerative diseases demonstrate clinical and pathological benefits following MSC transplantation. Potentially, MSCs can be used to treat MS patients at various disease stages, which is the current focus of ongoing phase I/II clinical trials at multiple centres.
A Novel Electronic Application of Patient-reported Outcomes in Multiple Sclerosis – Meeting the Necessary Challenge of Assessing Quality of Life and Outcomes in Daily Clinical Practice
Authors: Exell Simon , Thristan Mark , Dangond Fernando , Marhardt Kurt , Krohe Meaghan St Charles , Turner-Bowker Diane M ,   Program Lead Rebif, Global Clinical Development Center, EMD Serono, Inc., Rockland, Massachusetts, US,   Manager, Business Analysis, EMD Serono, Inc., Rockland, Massachusetts, US,   Head, US Medical Affairs, Neurodegenerative Diseases, EMD Serono, Inc., Rockland, Massachusetts, US,   Medical Affairs Director, Headquarter Medical Affairs Neurodegenerative Diseases, Merck Gesellschaft mbH, Vienna, Austria,   Scientist, eResearch Technology, Inc. (ERT), Pittsburgh, Pennsylvania,   Senior Scientist, eResearch Technology, Inc. (ERT), Pittsburgh, Pennsylvania, US
Published: October 2015

Multiple sclerosis (MS) has a substantial negative impact on health-related quality of life. Clinical assessments often do not include standardised, routine assessment of MS impact from the patient perspective, and communication between healthcare practitioners (HCPs) and patients can be lacking. Thus, there is a need for patient-reported outcome (PRO) measures to encourage patient–HCP communication, to help inform HCPs of matters important to patients and to aid both patients and HCPs in managing the disease. MSdialog is a web- and mobile-based software application that works with auto-injector devices and electronic autoinjectors, including the RebiSmart® 2.0 device (a handheld electronic Rebif® auto-injector with wireless data transmission capabilities, CE marked and available worldwide [excluding the US]) to collect and store real-time, point-of-administration adherence, clinician-reported outcomes and PRO data. MSdialog may provide a practical solution to support patient-proactive engagements and self-management, patient-centred care and participatory decision-making in clinical practice.
A New Approach in Neurorehabilitation – The Role of the Mirror Neuron System
Authors: Blessin Juliane , Hamzei Farsin ,   Physiotherapist, Section Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany,   Professor, Section Neurological Rehabilitation, Hans Berger Department of Neurology, Jena University Hospital, Jena, Moritz Klinik, Bad Klosterlausnitz and Centre for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
Published: October 2015

Even in nations with well-established comprehensive strategy with the aim to achieve full coverage to rehabilitation, half of the stroke patients remain dependent on activities of daily living (ADL) 3 months post stroke. Therefore, in the last few years part of the scientific community is increasingly focusing on development of innovative therapeutic concepts to increase effectiveness of stroke rehabilitation. In the following article we discuss a new approach in recovery of stroke patients with the use of a mirror. A mirror is positioned orthogonally in front of a patient. The less-affected arm is moved while the patient is observing this movement in the mirror. The illusion is created that he affected arm is moving. Despite the enthusiastic response that mirror therapy has received, not every stroke patient benefits from mirror therapy. This circumstance reflects that an individualised therapy approach is necessary for an effective rehabilitation regime of stroke patients.
Long-term Cardiac Monitoring for Detection of Occult Atrial Fibrillation – A Tool to Prevent Secondary Stroke in Cryptogenic Stroke Patients
Authors: Berrouschot Joerg ,   Head, Department of Neurology, Clinic Altenburger Land, Altenburg, Germany
Published: October 2015

Stroke kills or disables millions of people every year. If the cause of a stroke is known, it is often possible to reduce the risk of a second stroke by appropriate patient management. However, up to a third of all ischaemic strokes remain cryptogenic, with no identified cause. Many of these strokes are suspected to be due to atrial fibrillation (AF), which is difficult to diagnose accurately. Small, leadless, insertable cardiac monitors (ICMs) gather data over three years, making them superior to other monitoring methods. The current review surveys the substantial supporting clinical data for the ICM Reveal XT, including the recently completed CRYSTAL-AF randomised clinical trial. The results consistently report previously undiagnosed AF in around 30 % of patients with cryptogenic stroke. ICM-provided data have direct consequences, as patients with AF-related stroke are indicated for protective oral anticoagulant therapies. Thus, ICMs will be important in the management of cryptogenic stroke, identifying and enabling patients with AF to receive life-saving therapies.
Neuroplasticity – Basis for Lifelong Learning
Authors: Kesselring Jürg ,   Head of the Department of Neurology and Neurorehabilitation, Rehabilitation Centre Valens, Switzerland
Published: October 2015

Neuroplasticity is the continuous adaptation of synaptic networks to the requirements from internal external environment. It is the basis of learning. Neurorehabilitation is its clinical application.
Meta-analysis of Placebo-controlled Clinical Trials of Safinamide and Entacapone as Add-on Therapy to Levodopa in the Treatment of Parkinson’s Disease
Authors: Schnitker Jörg , Müller Thomas ,   Institut für angewandte Statistik GmbH, Bielefeld, Germany,   Department of Neurology, St Joseph Hospital Berlin-Weißensee, Berlin, Germany
Published: October 2015

Chronic levodopa (L-dopa) treatment of Parkinson’s disease (PD) patients is sooner or later associated with the onset of motor complications, for example wearing off and dyskinesia. PD patients with motor complications usually require the addition of further PD drugs to reduce these L-dopa side effects and enhance its efficacy. Entacapone is an available catechol-O-methyltransferase (COMT) inhibitor, which was extensively investigated as add-on to L-dopa/dopadecarboxylase inhibitor (DDCI) application in PD patients. Safinamide, a watersoluble, orally active a-aminoamide derivative, which modulates dopaminergic and glutamatergic neurotransmission with a unique dual mechanism of action, has been studied in two placebo-controlled clinical trials as add-on therapy to L-dopa in fluctuating PD patients. To date, there are no head-to-head clinical trials comparing the efficacy of safinamide and entacapone in the clinic. The aim of this meta-analysis was to determine effect sizes of safinamide and entacapone as add-on treatment to L-dopa in fluctuating PD patients. A systematic search of the literature on entacapone trials up to the end of September 2014 was first conducted on the MEDLINE and EMBASE databases in order to identify appropriate studies. Definition criteria for inclusion were prospective, randomised, placebocontrolled and double-blinded trials on the efficacy and safety of entacapone or safinamide in fluctuating L-dopa-treated PD patients. Four studies for entacapone and two trials on safinamide were considered. Data from the safinamide trials were provided by Zambon and therefore safinamide’ was not used as a search term. Safinamide and entacapone treatment was comparable in terms of the main efficacy variables (offtime, percentageontime, Unified Parkinson’s Disease Rating Scale). Significant advantages in favour of safinamide were shown in terms of the total incidence of adverse events (AEs) in comparison to placebo, the study discontinuation due to AEs and deaths and in the risk differences of the AEs versus placebo, particularly for nausea, vomiting, diarrhoea, dizziness, urine abnormality and shortness of breath. The odds ratio (OR) of 0.907 for any AE corresponds to an overall AE rate of 68.7 % for safinamide whereas the OR of 2.089 to an overall AE rate of 84.4 % for entacapone.
Importance and Benefits of Patient Registries for Duchenne Muscular Dystrophy
Authors: Schreiber-Katz Olivia ,   Resident Physician, Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians-University of Munich, Munich, Germany
Published: October 2015

Rare diseases represent a special challenge for the translation of new therapies into patient care. Duchenne muscular dystrophy (DMD) is a rare childhood-onset muscular dystrophy; curative treatment is not yet available. However, new therapies are emerging to fight this devastating disease. In order to establish an infrastructure to improve data harmonisation, knowledge on the disease, public awareness, industrial interest and trial readiness, patient registries are an indispensable resource. This article provides a short overview on their importance and benefits towards improving diagnosis and care.
A Retrospective Study on Patients with Guillain-Barré Syndrome Treated with Therapeutic Plasma Exchange and Other Treatment Options  A Centre’s Experience
Authors: Kozanoglu Ilknur , Deniz Yerdelen , Buyukkurt Nurhilal , Yeral Mahmut , Boga Can , Ozdogu Hakan ,   Associate Professor of Physiology, Baskent University Adana Research and Training Center, Therapeutic Apheresis Unit, Turkey,   Baskent University Medical Faculty Department of Physiology, Ankara, Turkey,   Professor of Neurology, Baskent University Medical Faculty Department of Neurology, Ankara, Turkey,   Medical Doctor of Hematology,   Associate Professor of Hematology,   Professor of Hematology, Baskent University Medical Faculty, Department of Hematology, Ankara, Turkey,   Professor of Hematology, Baskent University Medical Faculty, Department of Hematology, Ankara, Turkey
Published: October 2015

Therapeutic plasma exchange (TPE) has been shown to hasten recovery in Guillain-Barré syndrome (GBS). In this study, the objective was to show the outcome of disability grade in a retrospective analysis of data of clinical experience of TPE using the COBE Spectra Apheresis system and other treatment options in selected patients from a series of 56 patients with GBS at a single treatment centre in Turkey. Ten patients had the acute motor axonal neuropathy (AMAN) subtype; 46 had the acute inflammatory demyelinating polyneuropathy (AIDP) subtype of GBS. Three hundred and eighteen TPE procedures were performed taking 2 to 3 hours: in 6.3 % of them a peripheral catheter was used; in 93.7 % of them a central catheter was used. Replacement fluids were fresh frozen plasma (FFP), lactated Ringers solution or 3 % hydroxyethyl starch (HES). Among the patients, 12 (21.4 %) who had severe disease course received additional treatment to TPE - this was intravenous immunoglobulin (IVIG) in 11 patients. One patient was treated with steroids after rheumatology consultation due to another autoimmune disease. After 2 weeks, the mean GBS disability scores had significantly decreased from 3.75±0.48 to 2.44±0.96 (p=0.0001) and mean Medical Research Council (MRC) muscle strength scores significantly increased from 2.07±0.89 to 3.54±0.88 (p=0.0001). No difference in efficacy was observed between AMAN and AIDP subtypes. Adverse events occurred in 20 procedures (6.3 %) of TPE and were mostly transient hypocalcaemia and allergic reactions that did not necessitate treatment discontinuation. Difficulty in venous access was observed in 3.14 % of procedures. TPE using the COBE Spectra Apheresis system provides effective treatment of GBS with an acceptable safety profile using various replacement fluids and is an essential part of disease management. Although the benefit is controversial, other treatment options may be applied as an additional therapy in selected patients.
The Application of Clinical, Electrophysiological and Nerve Ultrasound Parameters in Distinguishing Acute-onset Chronic from Acute Inflammatory Demyelinating Polyneuropathy
Authors: Kerasnoudis Antonios , Pitarokoili Kallia , Gold Ralf , Yoon Min-Suk ,   Neurologist, Department of Neurology, St Luke Hospital Thessaloniki, Greece,   Neurologist, Department of Neurology, St Josef Hospital, Ruhr-University of Bochum, Germany,   President, German Society of Neurology; Professor of Neurology, Head of the Neurological Department, St Josef Hospital, Ruhr-University of Bochum, Germany,   Neurologist, Department of Neurology, St Josef Hospital, Ruhr-University of Bochum, Germany
Published: October 2015

History-taking and nerve conduction studies are fundamental for the diagnosis and assessment of the severity of acute (AIDP) or chronic inflammatory demyelinating polyneuropathy (CIDP). The diagnostic challenge of distinguishing these two immune-mediated subacute polyradiculoneuropathies remains high, as intravenous immunoglobulin and steroids exert short-term clinical improvement in the majority of the CIDP cases, whereas steroids have no effect on AIDP patients. Accordingly, the precise classification of subacute polyradiculoneuropathies significantly affects the early application of steroids in CIDP. This review aims to give a timely update on the application of clinical, electrophysiological and nerve ultrasound parameters in distinguishing subacute CIDP from AIDP.
Interventional Radiology in Skeletal Metastasis
Authors: De Anirban , Rennie Winston ,   Specialist Registrar in Radiology,   Consultant Radiologist, University Hospitals of Leicester NHS Trust
Published: October 2015

Metastasis is the most common cancer of the bone. These lesions cause significant pain and morbidity. Palliative treatment has been the mainstay in managing these patients. However, the introduction of minimally invasive techniques and the concept of filling metastatic bone lesions with acrylic cement has revolutionised the management of these patients. Such techniques are usually performed under conscious sedation, thus reducing the risks of general anaesthesia in this group of patients, who are often unfit for major surgery. This article presents a review of the different intervention techniques performed by the radiologist in patients with skeletal metastasis. We have reviewed the techniques of vertebroplasty, acetabuloplasty, sacroplasty and some of the different ablation procedures.
Locoregional Therapy in Breast Cancer
Authors: Livi Lorenzo ,   Researcher, Radiotherapy Unit, University of Florence
Published: October 2015

Breast cancer is the most common cancer in women. In 2004, estimates were that about 215,990 women and approximately 1,500 men in the US would be diagnosed with invasive breast cancer. Surgery and radiotherapy, either alone or combined, remain the most effective techniques to treat cancer. Surgical procedures have been clearly defined by several randomised clinical trials that demonstrated equivalent survival with breast-conservation surgery combined with radiotherapy versus mastectomy. In the last few years, in order to avoid the risk of lymphoedema caused by axillary dissection, in patients free from axillary lymph node metastases sentinel lymph node biopsy has been widely accepted as a standard of care. The use of whole-breast irradiation with or without a boost is the standard of care at present. The value of adding nodal irradiation to the breast irradiation is unproven. Local control is influenced not only by treatment modalities but also by screening programmes, allowing the possibility of identifying smaller and smaller lesions. Nowadays, local control for breast cancer is a fundamental part of treatment. The surgical approach is tailored towards conservation of the breast and good-looking cosmesis, while radiotherapy is tailored towards reduction of treated volume to reduce damage and to spare time and cost.
Therapeutic Armamentarium in Metastatic Colorectal Cancer
Authors: Macarulla Teresa , Markman Ben , Tabernero Josep ,   Physician,   Fellow,   Head, Gastrointestinal Tumours and Phase 1 Unit, Medical Oncology Department, Vall d–Hebron University Hospital, Barcelona
Published: October 2015

Colorectal cancer is one of the most frequently diagnosed malignancies in both men and women and, despite recent advances, the prognosis in the metastatic setting remains poor. In the last decade the introduction of new chemotherapeutic agents has improved the median overall survival of these patients. The demonstration that deregulation and/or activation of selected kinase proteins are common phenomena in patients with colon cancer has prompted the development of new biologic therapies targeting such proteins. Further, inhibition of the angiogenesis process can result in efficacy advantage. To date, three targeted therapies have been approved for the treatment of patients with metastatic colorectal cancer: bevacizumab, cetuximab and panitumumab. New treatments directed against other molecular targets are being developed in order to improve these results.
The Role of Imaging in Advanced Endometrial Carcinoma
Authors: Addley Helen , Sala Evis ,   Registrar,   Lecturer, and Honorary Consultant, Department of Radiology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust
Published: October 2015

Imaging in endometrial carcinoma has many roles. It is used in the initial assessment of symptomatic patients for demonstration of abnormal endometrial thickness. Once the histological diagnosis of endometrial carcinoma is confirmed, imaging can accurately stage the tumour, facilitating surgical and oncological treatment planning. This article will review the different imaging techniques available and their roles in staging, treatment selection and follow-up of patients with endometrial carcinoma.
Antifungal Treatment in the Blood and Marrow Transplant Setting — Perspectives from Clinical Experience
Authors: Transplantation Marrow ,   Held in Vienna, Austria, 2124 March 2010
Published: October 2015

Invasive fungal disease (IFD) is a major threat to the success of haematopoietic stem cell transplantation (HSCT), especially in the modern era of reduced-intensity conditioning regimens and wide range of donor sources. Changing fungal epidemiology and mortality rates of 8090% for certain pathogens1 are adding to the challenge for haematologists and oncologists. Against this background, speakers at the symposium ‘Antifungal treatment in the bone marrow transplant (BMT) setting: Perspectives from clinical experience’, held during the 36th Annual Meeting of the European Group for Blood and Marrow Transplantation in Vienna, Austria on 2124 March 2010, presented data showing the impact of recent epidemiological and clinical IFD studies on everyday practice in Europe and the US.
Myelodysplastic Syndromes in the Elderly — A Prominent Medical Concern with Significant Effects on Healthcare Systems
Authors: Ria Roberto , Moschetta Michele , Reale Antonia , Vacca Angelo ,   University Researcher, Internal Medicine, University of Bari,   Visiting Scientist, Department of Oncology, Mario Negri Institute for Pharmalogical Research,   Fellow of Collaborative Research, Department of Biochemical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari,   Full Professor of Internal Medicine and Director, Unit of Clinical Immunology, University of Bari Medical School
Published: October 2015

Myelodysplastic syndromes (MDS) represent one of the most challenging health-related problems in the elderly. As the population continues to age, MDS will become a more prominent medical problem with a significant effect on healthcare systems. MDS are characterised by dysplastic morphology in the bone marrow in association with ineffective haematopoiesis; there are various pathophysiological causes of these diseases, including genetic abnormalities within myeloid progenitors, altered epigenetics and changes in the bone marrow microenvironment. There is uncertainty about how to diagnose patients who may benefit from a specific treatment; in fact, MDS probably constitute several molecularly distinct entities that share common changes in blood and bone marrow. The International Prognostic Scoring System (IPSS) is a useful tool to guide treatment decisions, but revisions of the original IPSS are under way as it fails to consider many aspects of the treatment of MDS patients, especially in elderly patients. This article examines treatment goals, options and directions when treating elderly MDS patients. Furthermore, it explores how treatment has evolved according to new survival data and how various therapies are contributing to improve the survival rate.
Budesonide versus Placebo in a High-risk Population with Screen-detected Lung Nodules
Authors: Lazzeroni Matteo , Veronesi Giulia , Bonanni Bernardo ,   Medical Oncology Resident, Division of Cancer Prevention and Genetics,   Director, Lung Cancer Early Detection Unit, Department of Thoracic Surgery,   Director, Division of Cancer Prevention and Genetics, European Institute of Oncology
Published: October 2015

Screening computed tomography (CT) enables the detection of small peripheral lung nodules. The nature of these nodules is uncertain, but it seems reasonable that some of them, in particular non-solid nodules, could represent pre-cancerous lesions. A previous trial showed a reduction in the size of peripheral nodules by inhaled budesonide in subjects with bronchial dysplasia. We tested inhaled budesonide 800μg or placebo twice daily in a randomised, double-blind, placebo-controlled phase IIb trial, which enrolled 202 current and former smokers with stable CT-detected lung nodules. The primary end-point was the one-year change in target nodule size in a per-subject analysis. Treatment was well tolerated and >80% of participants received at least 50% of total drug dose. Initial observations seem to show a promising effect on non-solid target nodules in individuals at high risk of lung cancer. As non-solid nodules may represent precursors of adenocarcinoma, further investigations in this population are warranted.
Local Control of Metastatic Spinal Cord Compression Following Radiotherapy
Authors: Rades Dirk , Schild Steven E ,   Vice Chairman, and Full Professor of Radiation Oncology, Department of Radiation Oncology, University of Lubeck,   Chairman, and Professor, Department of Radiation Oncology, Mayo Clinic Arizona
Published: October 2015

Radiotherapy (RT) alone is the most frequently applied treatment modality for metastatic spinal cord compression (MSCC). Short-course RT (overall treatment time one week or less) provides a similar functional outcome to longer programmes. Therefore, short-course RT should be seriously considered for many MSCC patients, especially for those with a poor survival prognosis. By contrast, a considerable proportion of MSCC patients live long enough to experience a local recurrence of MSCC in the previously irradiated area of the spinal cord. Long-course RT (30–40Gy in two to four weeks) results in significantly better local control than short-course RT and should therefore be administered to patients with a more favourable survival prognosis. Survival can be estimated with a newly developed scoring system. If re-irradiation is required, a second course of RT can be safely administered in most cases after primary short-course RT. After primary long-course RT, re-irradiation should optimally be performed with high-precision techniques in order to reduce the risk of radiation-related myelopathy.
Novel Strategies to Improve the Efficacy of Anticancer Agents in Human Colorectal Carcinoma
Authors: Maddalena Francesca , Piscazzi Annamaria , Esposito Franca , Landriscina Matteo ,   PhD Student, Experimental Oncology, University of Foggia School of Medicine,   Post-doctoral Fellow, Laboratory of Molecular Medicine, Department of Medical Sciences, University of Foggia,   Full Professor of Biochemistry, University of Naples Federico II School of Medicine,   Assistant Professor, Clinical Oncology, University of Foggia School of Medicine
Published: October 2015

Colorectal cancer is one of the leading causes of cancer deaths worldwide. For decades, 5-fluorouracil has been the only effective chemotherapeutic agent for the treatment of this disease. Lately, the addition of irinotecan and oxaliplatin to standard 5-fluorouracil-based chemotherapy has improved not only response rates but also overall survival. Intense efforts have also focused on identifying novel agents targeting specific growth factor receptors, such as epidermal growth factor receptor 1 (EGFR1), which is over-expressed in a number of solid tumours of ectodermal origin, including colon adenocarcinoma, or mediators of angiogenesis, such as vascular endothelial growth factor (VEGF). Some of these molecular-targeted agents (i.e. the anti-EGFR1 monoclonal antibodies cetuximab and panitumumab, and the anti-VEGF monoclonal antibody bevacizumab) can be safely and effectively used in combination with conventional chemotherapy in colorectal cancer patients. However, recent evidence suggests that anti-EGFR1 antibodies are ineffective in tumours bearing the oncogenic activation of signalling pathways downstream of the EGFR1. Therefore, in spite of these advances, there is still a strong need for more effective and well-tolerated therapies for the management of human colorectal carcinoma. With such a perspective, this review addresses some of the critical issues under evaluation in either pre-clinical studies or clinical trials and focuses on innovative strategies for the rational combination of anticancer drugs in order to improve the synergism between traditional chemotherapeutics and novel molecular-targeted agents. Based on the evidence that colorectal cancer is characterised by the activation of survival signals responsible for protecting cells from the cytotoxic effects of anticancer agents, we discuss the role of the TNF-receptor-associated protein 1 (TRAP1)/heat shock protein 90 (HSP90) anti-apoptotic pathway, which is involved in drug resistance and may became a novel potential molecular target to improve the efficacy of drug therapies in human colorectal carcinoma.
Treatment of Hepatocellular Carcinoma – Integrating Loco-regional and Molecular-targeted Therapies
Authors: Lencioni Riccardo ,   Associate Professor of Radiology, and Head, Division of Diagnostic Imaging and Intervention, Department of Liver Transplantation, Hepatology and Infectious Diseases, University of Pisa School of Medicine
Published: October 2015

The treatment of hepatocellular carcinoma (HCC) is rapidly evolving as loco-regional and systemic therapies continue to improve. Image-guided radiofrequency (RF) ablation is established as the treatment of choice for patients with early-stage HCC when transplantation or resection are precluded. Recent refinements to technique have substantially increased the ability of RF ablation to achieve sustained complete response of target tumours in properly selected patients, and new alternate thermal and non-thermal methods for local tumour treatment are currently under investigation. Transarterial chemo-embolisation (TACE) is the standard of care for patients with multinodular disease at the intermediate stage. The introduction of drug-eluting beads, which enhance drug delivery to the tumour and reduce systemic exposure, appears to improve anticancer activity and the safety profile of TACE compared with conventional regimens. Despite these advances, the long-term outcomes of patients treated with loco-regional therapies remain unsatisfactory because of the high rate of tumour recurrence. The introduction of molecular-targeted therapies that inhibit tumour proliferation and angiogenesis has opened new prospects in this regard. Clinical trials focused on combining interventional treatment with systemically active drugs are ongoing. The outcomes of such studies are eagerly awaited, as they have the potential to revolutionise the treatment of HCC.
The European Organisation for Research and Treatment of Cancer Imaging Programme
Authors: Bean John , Flament Jocelyne , Ruyskart Pascal , Meunier Françoise ,   European Organisation for Research and Treatment of Cancer,   European Organisation for Research and Treatment of Cancer,   European Organisation for Research and Treatment of Cancer,   European Organisation for Research and Treatment of Cancer
Published: October 2015

The European Organisation for Research and Treatment of Cancer (EORTC), an international organisation under Belgian law, develops, conducts, co-ordinates and stimulates translational and clinical research in Europe aimed at improving the management of cancer and related problems by increasing survival and also improving patient quality of life. Imaging is now playing an increasingly important role in the treatment of cancer, and in order to further its mission to improve the standard of cancer treatment through the testing of more effective therapeutic strategies, the EORTC has initiated a cancer imaging programme. The objectives of this programme are to build an image exchange platform for cancer clinical trials, create an EORTC Imaging Group, network with stakeholders in cancer imaging, stimulate the integration of imaging components into EORTC studies, participate in major EU initiatives and link up with US co-operative groups. The EORTC is dedicated to improving the quality and consistency of evaluation of cancer treatment within its clinical trials through the incorporation of imaging technologies used for treatment definition for radiotherapy, staging, prediction and evaluation of response, or pathology.
The Neurogenic Component of Cutaneous Toxicities Induced by Chemotherapy — New Solutions
Authors: Chanez Jean-François ,   Head, Scientific Department, Evolife Laboratoires
Published: October 2015

Most chemotherapies cause cutaneous side effects. Docetaxel entered the therapeutic arsenal in the 1990s; while undeniably a sign of progress, it can also cause cutaneous side effects. Other chemotherapeutic drugs can induce secondary cutaneous effects, such as acneiform rash, handfoot syndrome or mucositis. Hair loss, reversible or not, and nail disorders are also well-known deleterious effects encountered with several drugs used in oncology. Furthermore, the development of new targeted therapies is contributing to an increased frequency of these undesirable effects. New products that take into account the neurogenic phenomena implicated in the local inflammatory response to chemotherapy are required to offer new alternative care for various cutaneous and muco-cutaneous side effects.
Surgical Treatment of Pancreatic Cancer
Authors: Bergenfeldt Magnus , Andrén-Sandberg Åke ,   Associate Professor of Surgery, Department of Surgical Gastroenterology, Herlev Hospital,   Professor of Surgery, Department of Surgery, Karolinska University Hospital
Published: October 2015

Surgical resection offers the only hope for cure of pancreatic carcinoma. Pancreaticoduodenectomy (Whipples operation) is the standard procedure for cancer in the right hemipancreas, while resection of the pancreatic tail is used for left-sided pancreatic cancer. Total pancreatomy is used for diffuse/multifocal disease, but has severe metabolic consequences. This article summarises recent advances in the field. Today, pancreatic resection has a post-operative mortality rate of a few per cent and the long-term outcome after curative resection has improved: a median survival of 1224 months and a five-year survival of 1020% can be expected. Various technical modifications of Whipples operation have been described, but generally they do not outperform the original procedure. More complex procedures including vascular resection and/or extended lymphadenectomy can also be performed safely today, but generally they do not result in a better outcome. Although surgery is crucial for the treatment of pancreatic cancer, it has become obvious that pancreatic cancer can only rarely be cured by surgery alone; therefore, recent advances in adjuvant oncological therapy are discussed.
Endocrine Complications in Children Treated for Medulloblastoma or Ependymoma using Radiation Therapy – Outcomes in the Computed Tomography Planning Era
Authors: Urbach Stacey L , Laperriere Normand , Bartels Ute ,   Assistant Professor, Department of Paediatrics, Division of Endocrinology, The Hospital for Sick Children,   Associate Professor, Department of Radiation Oncology, Princess Margaret Hospital, Toronto,   Assistant Professor, Department of Paediatrics, Division of Haematology/Oncology, The Hospital for Sick Children
Published: October 2015

Radiation therapy is an integral part of the treatment of paediatric patients with medulloblastoma and ependymoma. With newer surgical techniques and adjuvant chemotherapy regimens, recurrence-free survival rates have improved dramatically. Unfortunately, improved survival has come at the cost of significant late effects, including endocrine dysfunction. Prior to the 1990s, radiation fields were planned using 2D X-rays, exposing large volumes of healthy tissue to harmful radiation. Over the past two decades, radiation oncologists have increasingly applied 3D computed tomography scans to radiation therapy planning. By shaping target fields more precisely, higher doses of radiation may be delivered directly to the tumour while limiting exposure to healthy tissues and reducing side effects. The objective of this article is to review recent evidence about late endocrine effects among survivors of childhood medulloblastoma and ependymoma who received radiation therapy and to assess whether the introduction of 3D radiation planning techniques has affected the prevalence of these effects. Patients treated for medulloblastoma with current doses of craniospinal radiation continue to be at high risk of growth hormone deficiency and primary hypothyroidism, even when conformal radiation is used to deliver posterior fossa radiation. Patients with ependymoma who are treated with focal radiation alone, however, demonstrate fewer late endocrine effects.
The Clinical Pharmacology of Anastrozole
Authors: Bao Ting , Rudek Michelle A ,   Assistant Professor, University of Maryland Marlene and Stewart Greenebaum Cancer Center, University of Maryland School of Medicine,   Laboratory Scientist, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine
Published: October 2015

Anastrozole is a potent non-steroidal aromatase inhibitor that selectively inhibits aromatase. It is the first aromatase inhibitor approved by the US Food and Drug Administration as an adjuvant hormonal therapy in early-stage breast cancer. With most patients needing to take anastrozole for two to five years, it is important for physicians to understand the clinical pharmacology of anastrozole. Anastrozole has excellent oral bioavailability and is widely distributed throughout the body. It is extensively metabolised by the liver, with a half-life of 4050 hours. Anastrozole is primarily excreted through the faecal route. Steady-state concentrations are achieved after seven days of once-daily administration. The standard dosage of anastrozole is 1mg/day orally. No dose adjustments are necessary based on hepatic or renal dysfunction. No significant drugdrug interaction has been reported with anastrozole use. This article is to summarise the existing knowledge of the pharmacokinetics of anastrozole.