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Richard Mair, Kevin Morris, Ian Scott and Thomas A. Carroll

that for WHO Grade II (atypical) meningiomas, that is, ≥ 4 mitotic cells per 10 hpf and/or 3 or more of the following: increased cellularity, small cells, necrosis, prominent nucleoli, and sheeting. 12 A further revision in 2007 included brain invasion in an otherwise Grade I tumor as an additional criterion for a WHO Grade II lesion. 26 The 2000 WHO grading system has enabled a more objective comparison—of published outcomes, for example—and also permits pooling of data between neuroscience centers. Postoperative radiotherapy is frequently given for WHO Grade II

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Hilary P. Bagshaw, Lindsay M. Burt, Randy L. Jensen, Gita Suneja, Cheryl A. Palmer, William T. Couldwell and Dennis C. Shrieve

guidelines regarding recommendations for patients whose tumors display an atypical pathology are not definitive, suggesting that postoperative radiotherapy can be considered in appropriate cases ( https://www.nccn.org/professionals/physician_gls/f_guidelines.asp#site ). Retrospective data from single institutions suggest that adjuvant radiotherapy may be beneficial, 2 , 11 , 12 , 19 , 24 , 25 and a Phase II trial to further delineate optimal treatment is ongoing ( https://clinicaltrials.gov/ct2/show/NCT00895622 ). To investigate the role of adjuvant radiotherapy in this

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Troy Dawley, Zaker Rana, Hussam Abou-Al-Shaar, Anuj Goenka and Michael Schulder

these patients are 53% and 0%, respectively. 8 Treatment options for patients with atypical meningiomas include observation, resection, and radiotherapy (RT), in the form of stereotactic radiosurgery (SRS), fractionated radiotherapy (FRT), or a combination of the above. Considerations for treatment options include local mass effect, neurological symptoms, and perilesional edema. Following gross-total resection (GTR), observation or adjuvant RT is recommended and is the topic of the ongoing prospective trial NRG-BN003, in which patients are treated with adjuvant RT to

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Kanna K. Gnanalingham, Aabir Chakraborty, Malcolm Galloway, Tamas Revesz and Michael Powell

T he role of radiotherapy is well established in the treatment of pituitary adenomas. It is principally used to reduce the rate of tumor recurrence in cases of incompletely excised nonsecreting adenomas and is selected as an adjunct to surgery and medical therapy in cases of secreting pituitary tumors. 1, 4 Secondary neoplasms, including meningiomas, gliomas, and sarcomas, are rare complications that occur following radiotherapy for pituitary adenoma. 1 The occurrence of a fibrosarcoma is more widely reported than that of an osteosarcoma. We describe the

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Lilie L. Lin, Issam El Naqa, Jeffrey R. Leonard, Tae Sung Park, Abby S. Hollander, Jeff M. Michalski and David B. Mansur

C raniopharyngiomas are benign brain tumors that result from an abnormal overgrowth of remnants of the Rathke pouch. These lesions account for ∼ 6–10% of all intracranial tumors in children. 1 There is a bimodal age distribution for this lesion with peak incidence in children 5–14 years of age, and in adults >50 years. The optimal extent of surgery and timing of radiotherapy have been extensively debated. Although GTR can be achieved in 43–76% of patients, it may also result in significant long-term complications including panhypopituitarism, diabetes

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Teresa Meier, J. Michael Hazenfield, Saulius Girnius, Matthew Hagen, Ronald E. Warnick and Jordan Kharofa

include surgery or radiotherapy, is often directed at the local process. Central nervous system amyloidomas are rare with only a few dozen cases reported in the literature, and although treatment data are sparse, a majority of these lesions have been treated with resection. 3 While radiotherapy has been documented as a primary treatment for amyloidoma of the lung, the present case is the first reported instance of focal radiotherapy for CNS amyloidoma. Case Report History and Examination A 54-year-old female presented with multiple episodes of emesis, intractable

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Jee-Soo Jang and Sang-Ho Lee

P ercutaneous vertebroplasty involves the injection of PMMA, under fluoroscopic guidance, into a vertebra to strengthen it and prevent further collapse. This procedure has been proposed for use in cases involving painful vertebral hemangiomas, spinal tumors, and osteoporotic compression fractures of the VBs. 1, 3, 4, 6–9, 11, 13, 14, 19 The management of metastatic spinal tumors not associated with neurological deficit includes radiotherapy alone and a combination of surgery and radiotherapy for tumor suppression, pain reduction, and spinal stabilization

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John M. Buatti and William A. Friedman

procedures. These lesions are highly curable with radiotherapy, although debate continues about the dosage, the use of craniospinal radiotherapy, and the role of adjuvant chemotherapy. 23 Placement of a VP shunt is frequently used to alleviate hydrocephalus in these patients. The small but well-documented incidence of poor outcomes associated with shunt-disseminated metastasis led us to try temporary ventricular drainage and emergency radiotherapy as an alternative. Clinical Material and Methods Between April 1996 and April 1998, five patients with intracranial

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Ricardo J. Komotar, J. Bryan Iorgulescu, Daniel M. S. Raper, Eric C. Holland, Kathryn Beal, Mark H. Bilsky, Cameron W. Brennan, Viviane Tabar, Jonathan H. Sherman, Yoshiya Yamada and Philip H. Gutin

A typical meningiomas are reported to account for 20%–35% of all meningiomas and represent an intermediate subtype between benign and anaplastic meningiomas in the WHO classification. 5 , 39 , 40 , 47 Although benign meningiomas (WHO Grade I) are generally slow growing and have a low recurrence rate after GTR, 28 , 44 atypical meningiomas are more locally aggressive and demonstrate more rapid tumor progression, with 5-year recurrence rates of approximately 40% in the literature in the absence of postoperative radiotherapy. 8 , 20 , 34 , 39 Atypical

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Carlos A. Bagley, Markus J. Bookland, Jonathan A. Pindrik, Tolga Ozmen, Ziya L. Gokaslan, Jean-Paul Wolinsky and Timothy F. Witham

. 5 , 18 In the coming years, the development of effective treatments for these symptoms will be important in ensuring a better quality of life for a growing population of patients with advanced oncological disease. 5 Current treatment strategies for metastatic spinal tumors center around focused radiotherapy and excision. 2 , 5 Although radiotherapy is a widely used first-line therapy for spinal metastasis, there exists no animal model in the literature to date that approximates this therapy. Given the current usefulness of radiotherapy in treating spinal