Biomedical subjects

W J Berghorn

Publications and source records attributed to W J Berghorn.

4 recordsLinked to original sources

PubMed1997

Collins' law. Prediction of recurrence or cure in childhood medulloblastoma?

Collins' law, known as period of risk for recurrence (PRR), has been discussed as a reliable scheme for the prediction of recurrence or cure of embryonal tumours including medulloblastomas. The PRR is defined as the age at diagnosis plus 9 months of gestation. According to Collins' law, a patient who has no clinical evidence of recurrence within this time period is considered cured. We have applied this system to 66 patients (age range from 0 to 47 years) who underwent surgery for medulloblastoma at a single center between 1975 and 1990. Three patients in whom a recurrence could not be verified died within 6 months. Eight patients (12.1%, age range from 1 to 14 years) survived the PRR without relapse and are free of risk for recurrence according to Collins' law. Of the remaining 55 patients, 35 showed a relapse within the PRR with a mean latency of 18 months (0-78); Twenty patients are alive with no recurrence as yet, but are still within the PRR Three patients had non-recurrent benign brain tumours not connected to the initial tumours with a mean latency of 10 (8-14) years after medulloblastoma surgery. Thus, all our patients fulfilled the criteria for Collins' law. In conclusion, a patient's risk for medulloblastoma recurrence is significantly higher before than after the completion of the PRR. Therefore, the PRR is a helpful prognostic parameter that provides additional information about the risk of medulloblastoma recurrence. A medulloblastoma cure cannot be presumed with certainty by Collins' law because relapses after the PRR have been reported in other studies (1.4% of the cases). Intracranial lesions detected after a long follow-up might be radiotherapeutically induced second tumours.

Adolescent↗

PubMed1995

Staging, scoring and grading of medulloblastoma. A postoperative prognosis predicting system based on the cases of a single institute.

Although recently survival of some medulloblastoma patients increased remarkably, it remains a serious diagnosis in others. In order to predict the postoperative prognosis in patients treated for medulloblastoma, a new staging, scoring and grading system was developed. Sixty-six patients operated on microsurgically between 1975 and 1990 at a single neurosurgical center were fully followed-up. No patient was excluded due to a poor postoperative course. Completion of commonly used radiotherapy protocols was attempted in all patients. Survival of patients was evaluated by the Kaplan-Meier method. The following 5 parameters were selected to define subgroups: patients' age, tumour location and histology, degree of resection and presence or absence of metastases. Patients older than 10 years had a better prognosis than individuals aged 10 or less (p < 0.01), patients with lateral tumours had a better prognosis than patients with midline tumours with brain stem infiltration (p < 0.05), patients with complete tumour resection had a more favourable prognosis than individuals with subtotal (p < 0.01) or partial resection (p < 0.001), patients without metastases at the time of diagnosis had a better prognosis than individuals without such evidence (p < 0.001), patients with the desmoplastic tumour variant had a better prognosis than patients with classical tumour histology (p < 0.01). According to the prognosis of a distinct subgroup, scoring points were distributed which correlated with the degree of inter-subgroup significances. The sum of a single patient's scoring points was called the total score. Based on this score, three groups of prognosis were distinguished.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Secondary manifestation of medulloblastoma: metastases and local recurrences in 66 patients.

Although primary treatment of medulloblastoma is now successful in a high percentage of patients, its secondary manifestations still bear a poor prognosis. Thorough studies of secondary manifestations are therefore pivotal to plan therapeutic approaches for the long-term management of medulloblastoma. Here we describe the incidence of secondary tumour manifestations in 66 patients of a single centre who underwent surgery for medulloblastoma between 1975 and 1990. No patient was excluded due to a poor postoperative course. Thirty-five patients showed evidence of secondary tumour growth. Of these, 17 suffered from local recurrence, and 27 developed metastastatic disease. The median latencies for secondary manifestations were 25 months for local recurrence (n = 17), 11 months for spinal metastases (n = 10), 15 months for supratentorial metastases (n = 8), 8 months for subleptomeningeal dissemination (n = 6), and 23 months for systemic metastases (n = 8). Two patients developed primary metastatic spread to the posterior fossa. Of 8 patients with supratentorial metastases, 6 developed fronto-basal lesions. In our patients, 89% of secondary lesions occurred within less than 3 years after primary diagnosis. 85% of patients with extra-axial tumour spread had been treated with a permanent shunt. Radical tumour resection and radiotherapy with 30 Gy to the neuraxis and 20 Gy boost to the posterior fossa was an important prognostic factor in this series. Patients with additional chemotherapy did not benefit significantly from this treatment. We conclude that optimal management of the primary lesions should aim at (i) total resection, (ii) avoid permanent shunting, and (iii) completion of the radiotherapy with inclusion of the medial frontobasal cisterns in the radiotherapeutic regimen. Our analysis suggests that adequate postoperative screening programmes should consist of 3-monthly scans of the neuraxis in the first three postoperative years and 6-monthly scans thereafter.

Adolescent↗

PubMed1988

[Brain injuries].

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Brain Edema↗