Precision radiotherapy for hemangiopericytomas of the central nervous system

Abstract

Objective Sleepiness at the wheel is a major risk factor for traffic accidents. Because of the potential medical and legal implications, in this study, we evaluated the correlation between subjective and objective measures of sleepiness and driving performances in patients suffering from excessive daytime sleepiness. Methods Thirty‐eight untreated sleep apnea patients (mean age ± standard deviation, 51 ± 9 years; mean apnea–hypopnea index ± standard deviation, 41 ± 25), and 14 healthy control subjects (mean age ± standard deviation, 46 ± 9 years) were included in the study. Nocturnal polysomnography, mean sleep latency as measured by four 40‐minute Maintenance of Wakefulness Test (MWT) trials, Epworth Sleepiness Scale, Karolinska Sleepiness Scale, and the number of inappropriate line crossings during a 90‐minute real‐life driving session were analyzed. Results The number of inappropriate line crossings correlated with MWT scores (Spearman's P: r = −0.339; p < 0.05), Karolinska Sleepiness Scale scores measured at halfway in total driving distance (P: r = 0.367; p < 0.01), and Epworth Sleepiness Scale (P: r = 0.389; p < 0.01). We found a significant difference in the number of inappropriate line crossings among the four groups defined by MWT scores (very sleepy [0–19 minutes], sleepy [20–33 minutes], alert [34–40 minutes], and controls) (Kruskal–Wallis test: H = 11.319; p < 0.01). Very sleepy and sleepy patients had more inappropriate line crossings than the control drivers (p < 0.05). Interpretation In addition to subjective sleepiness scales, the MWT can be used to assess driving ability in untreated sleep apnea patients. Ann Neurol 2008

Surgical management of primary spinal hemangiopericytomas: an institutional case series and review of the literature

“…The 5-, 10-, and 15-year recurrence rates for irradiated tumors were 38, 64, and 80 %, respectively. The effective radiation dose is quoted by most studies to be [50 Gy [17][18][19][21][22][23][24]. In a recent systematic review of 563 intracranial HPCs cases (277 had follow-up data), Rutkowski et al [25] reported that patients receiving [50 Gy of radiation had worse survival outcomes (median Table 2 Cases of hemangiopericytoma of the spine described in present and previous reports survival 4 vs. 18.6 years, p \ 0.01).…”

Hemangiopericytoma of cervicothoracic spine: a case report and literature review.

“…Some investigators have recommended that postoperative radiotherapy should be implemented to control the residual tumor (11,13,14,19,52,55). In fact, adjuvant radiotherapy has been shown to be effective in controlling HPC (11,13,14,19,30,55). However, the evidence of its efficacy has been mainly based on small retrospective studies.…”

“…They were first described by Stout and Murray in 1942 (47). HPCs may occur anywhere in the human body but the most common locations are the extremities, pelvis, the retroperitoneum, and the head and neck areas (11). They are rarely found in the central nervous system and account for approximately 2% to 4% of all primary meningeal tumors (19,33).…”

“…HPCs in the spine may involve the structures of the vertebra and the spinal canal, including the extradural and intradural space. Our search of the literature showed that 140 cases of HPC in the spine had been reported (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(49)(50)(51)(52)(53)(54)(55)(56), and 64 cases were extradural (2, 4-6, 8-10, 15, 20-22, 24, 25, 27, 28, 31, 32, 34, 35, 37, 40-42, 44-46, 49, 51, 53-55) (Table I). Here we present a case of primary HPC invasion in the cervicothoracic spine, as well as presenting a review of the literature.…”

F18‑fluorodeoxyglucose positron emission tomography/computed tomography for bone hemangiopericytoma

“…Most of HPC are in soft tissues and can be reclassified as a fibroblastic neoplasm similar to a solitary fibrous tumors (2)(3)(4). The most common sites of HPC are the lower extremities, followed by the pelvis and head and neck (5,6). HPC has non-specific image features and clinical manifestations.…”