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Biomedical subjects

W R Shapiro

Publications and source records attributed to W R Shapiro.

At least 73 records · Page 4Linked to original sources
PubMed1984

Local blood-to-tissue transport in Walker 256 metastatic brain tumors.

Local blood-to-tissue transfer constants (K) in metastatic Walker 256 (WL-256) brain tumors produced by the intracarotid artery injection of WL-256 tumor cells in rats were measured using 14C-alpha-aminoisobutyric acid and quantitative autoradiography. Small compact and diffuse infiltrative intraparenchymal tumors had values of K similar to that of contralateral nontumorous brain tissue. Medium and large tumors, meningeal metastases and intraventricular tumors had higher K values (5 to 30 fold) than contralateral nontumorous brain tissue indicating that intraparenchymal tumor size and location in meningeal and choroidal tissue influence the permeability of tumor capillaries. The local intratumor values of K varied considerably in these tumors and this variability of K correlated to only a few specific histopathologic features of the tumors. The value of K abruptly decreased at the tumor-brain interface when this interface was sharply defined, indicating that the metastatic tumors have only a small effect on the permeability of adjacent brain capillaries. Low blood-to-tumor transport of water soluble drugs will significantly affect drug concentrations in the tumor and the tumor-drug exposure.

Aminoisobutyric Acids↗
PubMed1984

Neurological complications of antineoplastic therapy.

Increasingly vigorous chemotherapy of cancer including primary and metastatic central nervous system disease has resulted in prolonged good-quality survival. However, there has been an associated increase in neurotoxicity from both radiation therapy and chemotherapy. All classes of chemotherapeutic agents contain drugs that are potentially neurotoxic, often only at high doses. Mechlorethamine, the first nitrogen mustard, is not neurotoxic at conventional dosage, but at high doses, it may produce both an acute and a delayed encephalopathy. Methotrexate administered intrathecally often induces reversible aseptic meningitis, but chronic administration, either intrathecally or high-dose intravenously, may produce fatal leukoencephalopathy. 5-Fluorouracil at high dosage may cause cerebellar ataxia, but may also do so at low dosage when combined with thymidine infusions. Cytosine arabinoside at high dosage may also produce cerebellar ataxia. Vincristine produces a peripheral neuropathy, and less commonly causes both autonomic and cranial neuropathy. The enzyme L-asparaginase can produce a dose-related reversible encephalopathy. BCNU, now the mainstay of glioma chemotherapy, may combine with radiation to produce long-term cerebral atrophy. Both intracarotid and high-dose intravenous BCNU administration may cause encephalopathy. Several other chemotherapeutic agents have also been reported to cause neurotoxicity under certain circumstances.

Adrenal Cortex Hormones↗
PubMed1983

Effects of frontal lobe lesions on hypothesis sampling during concept formation.

Thirty-two subjects with unilateral cerebral tumors were assessed for the use of hypotheses and cognitive strategies during a visual discrimination task. Subjects with frontal lobe lesions attained fewer concepts and used fewer appropriate hypotheses than subjects with tumors confined to the posterior hemisphere, although there was no difference in total hypotheses used. Lose-stay errors were committed with greater frequency among patients with frontal lobe lesions, although not all subjects with frontal lobe tumors exhibited this error tendency. The results of hypothesis sampling and a second visual discrimination transfer task suggested that the frontal lobe deficit was related to difficulty in attending to multiple cues and in monitoring feedback to segregate relevant from irrelevant sources of information.

Adult↗
PubMed1983

Comparisons of carmustine, procarbazine, and high-dose methylprednisolone as additions to surgery and radiotherapy for the treatment of malignant glioma.

Within 3 weeks of definitive surgery, 609 patients with histologically demonstrated, supratentorial malignant glioma were randomized to receive, in addition to 6000 rads of radiotherapy, one of four treatment regimens: carmustine (BCNU), high-dose methylprednisolone, procarbazine, or BCNU plus high-dose methylprednisolone. We analyzed the data for the total randomized population and for the 527 patients (87% with glioblastoma multiforme) in whom the initial protocol specifications were met (the valid study group). Significantly longer survival was experienced by patients receiving procarbazine or BCNU alone compared to those receiving only high-dose methylprednisolone. No other pairwise comparisons demonstrated differences significant at the 0.05 level. However, the combination of BCNU plus high-dose methylprednisolone tended to be less effective than BCNU alone in patients with poor prognosis. This study indicates that BCNU and procarbazine are moderately useful agents in conjunction with radiotherapy for patients with malignant glioma. In addition, future protocols may allow use of corticosteroids in conventional dosages for treating cerebral edema and controlling symptoms; conclusions based on survival as the endpoint are unlikely to be affected by administering steroids at somewhat greater than the usual dose. More effective regimens for the treatment of malignant glioma should be sought.

Adolescent↗
PubMed1983

Serum and cerebrospinal fluid distribution of 5-methyltetrahydrofolate after intravenous calcium leucovorin and intra-Ommaya methotrexate administration in patients with meningeal carcinomatosis.

Serum and cerebrospinal fluid (CSF) concentrations of citrovorum factor (CF) and 5-methyltetrahydrofolic acid (5-MTHFA) were measured after i.v. infusion of leucovorin (50 or 100 mg/sq m) in seven patients undergoing treatment for meningeal carcinomatosis by intra-Ommaya reservoir injection of methotrexate (MTX). Serum CF levels rapidly rose after leucovorin administration as did 5-MTHFA, its conversion product. A small amount of CF entered the CSF, but peak CSF 5-MTHFA increased about 10-fold. The concentration X time (C X t) of additional 5-MTHFA in the CSF was greater [114.4 +/- 36.1 (S.E.) microgram/ml X min] after 100-mg/sq m doses of leucovorin than after 50 mg/sq m [14.2 +/- 4.3 micrograms/ml X min] (p less than 0.05). The CSF MTX concentration exceeded CSF 5-MTHFA by 2 to 3 logs throughout the 48 hr of observation, while serum 5-MTHFA and CF exceeded serum MTX by 0.5 to 2 logs. This study demonstrates that leucovorin administered i.v. to patients receiving intra-Ommaya MTX does not increase CSF concentrations of "rescue" folate above those of CSF MTX and are unlikely to interfere with MTX action against meningeal tumor. On the other hand, i.v. leucovorin does permit serum "rescue" folate to operate, thus reducing the systemic toxicity that may follow intraventricular administration of MTX.

Aged↗
PubMed1982

Heterogeneous chemosensitivities of subpopulations of human glioma cells in culture.

Six karyotypically distinct clonal cell lines isolated from each of two freshly resected human malignant gliomas were examined for heterogeneity of morphology, in vitro growth rate, and chemosensitivity to 1,3-bis(2-chloroethyl)-1-nitrosourea and cis-diamminedichloroplatinum (II). Each clone was identified karyotypically as having come from the parent tumor. The karyotypic deviations were primarily numerical; chromosome numbers ranged from hypodiploid to near-tetraploid. Three morphological types were recognized: astrocyte-like; squamous-like; and fibroblast-like. The growth rates differed among the clones; the doubling times ranged from 48 to 84 hr in those from one tumor and from 72 to 252 hr in the other. Chemosensitivity was measured by cytotoxicity and/or colony-forming assay. In both assays and in both tumors, heterogeneity of chemosensitivity response to both drugs was demonstrated among the different clones from the same tumor. Dose-response curves from some clones differed statistically (log-probit analysis) from those of others, and when the curves were parallel, their 50% effective doses often differed. For the cytotoxicity assay, the 50% effective doses of BCNU ranged from 43 to 94 microgram/ml and for cis-diamminedichloroplatinum (II), from 29 to 340 microgram/ml. For the colony-forming assay, the 50% effective doses of 1,3-bis(2-chloroethyl)-1-nitrosourea ranged from 4.5 to 7.0 microgram/ml and for cis-diamminedichloroplatinum (II), from 0.35 to 1.40 microgram/ml. No correlation was evident between the chromosome number, morphology, growth rates, or chemosensitivities of the clones. These results identified heterogeneity of chemosensitivity among cellular subpopulations in human malignant gliomas.

Carmustine↗
PubMed1981

Xenograft of human malignant glial tumors into brains of nude mice. A histopatholgical study.

Sixteen of 21 human malignant glial tumors were successfully heterotransplanted into the brains of nude mice, and one other was transplanted into the brain after prior subcutaneous heterotransplantation. Most xenografts grew preferentially as diffusely infiltrating tumors within hemispheric white matter, generally sparing cortex and deep gray matter. The heterogeneity of most in vivo human tumors gave way to a tumor of generally uniform cell type while growing in nude mice. From six human tumors, all glioblastomas, there emerged histologic patterns or cell forms that were not evident in the original tumor. Tumors from 15 patients were treated with standard chemotherapeutic agents while growing in nude mouse brains. The most common morphologic change induced in tumors by several agents was a distinctive giant cell change characterized by large bizarre nuclei and abundant cytoplasm. It is concluded that the human brain-tumor-nude-mouse xenograft model offers morphological parallels with the clinical situation, but selects for growth only some of the many subpopulations of the human tumor. Such selection imposes restriction on the clinical inferences that may be drawn from this model.

Animals↗
PubMed1981

Regional blood flow, capillary permeability, and glucose utilization in two brain tumor models: preliminary observations and pharmacokinetic implications.

Regional quantitative autoradiographic measurements of blood flow, capillary permeability, and glucose utilization were made in rats harboring an intracerebral Walker 256 metastatic tumor or a well-differentiated oligodendroglioma. Distinct differences were observed between the two brain tumor models; regional differences within the metastatic tumor appeared to be partly related to tumor size. The pharmacokinetic implications of these physiological measurements with respect to drug delivery to tumor tissue are discussed. The interrelationship of commonly used parameters to quantitate transport across the blood-brain barrier--permeability coefficient, permeability-surface area product, transfer constant, extraction fraction, equilibrium half-time, and blood flow--and their relevance to effective brain tumor chemotherapy are demonstrated.

Animals↗
PubMed1980

Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery.

Within three weeks of definitive surgical intervention, 467 patients with histologically proved malignant glioma were randomized to receive one of four treatment regimens: semustine (MeCCNU), radiotherapy, carmustine (BCNU) plus radiotherapy, or semustine plus radiotherapy. We analyzed the data for the total randomized population and for the 358 patients in whom the initial protocol specifications were met (the valid study group). Observed toxicity included acceptable skin reactions secondary to radiotherapy and reversible leukopenia and thrombocytopenia due to chemotherapy. Radiotherapy used alone or in combination with a nitrosourea significantly improved survival in comparison with semustine alone. The group receiving carmustine plus radiotherapy had the best survival, but the difference in survival between the groups receiving carmustine plus radiotherapy and semustine plus radiotherapy was not statistically significant. The combination of carmustine plus radiotherapy produced a modest benefit in long-term (18-month) survival as compared with radiotherapy alone, although the difference between survival curves was not significiant at the 0.05 level. This study suggests that it is best to use radiotherapy in the post-surgical treatment of malignant glioma and to continue the search for an effective chemotherapeutic regimen to use in addition to radiotherapy.

Aged↗
PubMed1980

Meningeal gliomatosis: a review of 12 cases.

Diffuse or multifocal invasion of the leptomeninges by malignant glioma (meningeal gliomatosis) is believed to be rare. From 1971 through 1977, 11 of 52 patients with intracranial malignant gliomas examined at autopsy were found to have meningeal gliomatosis, and 1 additional patient was diagnosed clinically without autopsy (12 cases total). Eight of the 12 patients were diagnosed antemortem with positive cerebrospinal fluid (CSF) cytology, while the other 4 patients were diagnosed at autopsy only. All 11 autopsied patients had multifocal or diffuse meningeal tumor distant from the primary site; 8 patients had spinal subarachnoid seeding with tumor encroachment of cauda equina and spinal nerve roots, and 9 patients had tumor invasion into the lateral ventricles. Three patients had symptomatic spinal cord compression at the thoracic or lumbar level, and 10 patients had hydrocephalus. These 12 patients with meningeal gliomatosis were compared with the other 41 autopsied malignant glioma patients without the complication (controls); the patients with meningeal gliomatosis were significantly younger (mean age, 40 versus 57 years; p less than 0.005). Patients with meningeal gliomatosis lived somewhat longer (median, 49 weeks) compared to controls (35 weeks), but the difference was not statistically significant. With the advance of chemotherapy, patients with malignant glioma are living longer and the incidence of meningeal gliomatosis may rise. The diagnosis of meningeal gliomatosis can be suspected, especially if hydrocephalus is present, and can often be confirmed by CSF cytology.

Adolescent↗