Letters to the Editor

offered to each question (no complaints, mild complaints, severe complaints). Totally 243 (35) combinations of health condition exist. The outcome is EQ-5D score (dimensions of QoL), which has the values from 0 to 1 (0 – the worst health condition and 1 – the best health condition). Subjective indicator includes visual analogous scale (the value of 100 – the best health condition, the value of 0 – the worst health condition). The respondent marks his subjectively perceived health condition at the thermometer scale. The outcome is EQ-5D VAS (a subjective health condition), which has the values from 0 to 100. The metastatic breast cancer patients in a program of palliative cancer care were tested while hospitalized at the Department of Clinical Oncology. The filling in the generic EuroQol Questionnaire EQ-5D was voluntary and anonymous. The HRQoL among metastatic breast cancer patients was on very low level. The mean EQ-5D score (dimension of QoL) was 55%. The mean EQ-5D VAS (subjective health condition) was 59.2%. The mean EQ-5D score in group of healthy females was 78.4% and the mean EQ-5D VAS was 85% (both QoL parameters showed very good

HRQoL). The statistical evaluation not presents statistically significant dependence of EQ-5D score and EQ-5D VAS on age, number of associated diseases and type of palliative cancer care. Ladislav Slovacek Department of Clinical Oncology and Radiation Therapy, Charles University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic For Correspondence: Dr. Ladislav Slovacek, Department of Clinical Oncology and Radiation Therapy, Charles University Hospital and Faculty of Medicine Hradec Kralove, Sokolska 581, Hradec Kralove, Czech Republic. E-mail: [email protected]

REFERENCE 1.

Wani SQ, Khan T, Teeli AM, Khan NA, Wani SY; Ashfaq-ul-Hassan. Quality of life assessment in survivors of breast cancer. J Cancer Res Ther 2012;8:272-6.

Severe intracranial hypertension mimics intracranial hypotension radiologically Access this article online Website: www.cancerjournal.net www.cancerjournal.net

Quick Response Code:

DOI: 10.4103/0973-1482.126491

PMID: 24518740

Sir, We report a case of lung cancer in a 55-year-old female who presented with progressive headache since past 3 months. She had vomiting, unsteady gait, and drowsiness since the past month. There was no fever or other neurological deficits. Brain magnetic resonance imaging (MRI) disclosed diffuse dural thickening with vivid contrast enhancement, slit ventricles, and tonsilar herniation [Figure 1], which were typical signs of intracranial hypotension.[1] However, the venous sinuses were irregular and collapsed with an engorged superior ophthalmic vein (SOV) [Figure 2]. Fundoscopy was performed and bilateral papilledema were noticed. Lumbar puncture revealed high opening pressure above 400 mm H2O. Diffused bony metastasis with dura involvement was diagnosed. Diffused pachymeningeal enhancement and brain descend are typical image characteristics for intracranial hypotension. Patients usually present with headache, especially orthostatic type. However, multiple diseases will present as pachymeningeal enhancement including transient postoperative changes, neoplasm, metastatic disease, secondary central nervous 756

a

b

Figure 1: Postgadolinium T1 weighted image axial view (a) and midline sagittal view (b) showed diffused pachymeningeal enhancement, slit ventricles, and tonsilar herniation

Figure 2: MR venography disclose irregular and collapsed venous sinus. Engorged superior opththalmic vein is seen (arrow)

Journal of Cancer Research and Therapeutics - October-December 2013 - Volume 9 - Issue 4

Letters to the Editor

system (CNS) lymphoma, and granulomatous disease.[2,3] Careful survey of clinical history and analyzing other imaging findings are crucial for correct diagnosis. Neoplasm or metastasis disease involving the dura matter may be focal or diffused.[2,3] The intracranial pressure is usually increased. Small venous sinuses and engorged SOV demonstrated by using MR venography could give us a hint for elevated intracranial pressure. Hsin Tung1, Chieh-Lin Jerry Teng2, Hung-Chieh Chen3,4 Section of Neurology, 2Division of Haematology/Medical Oncology, Department of Medicine, 3Department of Radiology, Taichung Veterans General Hospital, Taichung, 4Department of Radiology, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China

For correspondence: Dr. Hung-Chieh Chen,No. 160, Sec. 3, Chung-Kang Rd., Taichung, Taiwan, Republic of China 40705. E-mail: [email protected]

REFERENCES 1. 2.

1

3.

Sainani NI, Lawande MA, Pungavkar SA, Desai M, Patkar DP, Mohanty PH. Spontaneous intracranial hypotension: A study of six cases with MR findings and literature review. Australas Radiol 2006;50:419-23. Grabarz D, Bezjak A, Bordeleau L. Treating dural metastases mimicking intracranial hypotension. J Support Oncol 2007;5:423-4. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007;27:525-51.

Neurocognitive functioning in patients of high-grade gliomas Access this article online Website: www.cancerjournal.net www.cancerjournal.net

Quick Response Code:

DOI: 10.4103/0973-1482.126493

PMID: 24518741

Sir, I read with great interest the article by authors Anand, et al., devoted to the issue of neurotoxicity in patients of high-grade gliomas treated with conformal radiation and temozolomide.[1] I would like this original work added to their own experience with neurocognitive functioning assessment in patients of glioblastoma multiforme (GBM). It is know that GBM belongs to the most aggressive brain tumors with limited therapeutic options. In the clinical presentation often dominate the mental changes (memory loss, impaired speech, changes in personality, and temperament). Our pilot study was local, prospective. and longitudinal. From the January 1, 2009 to the June 30, 2010, the evaluation of neurocognitive functioning had been performed in 11 patients with GBM (9 women, 2 men) with a mean age of 56.8 years (age range 45-72). Four patients underwent total resection of GBM, subtotal resection was performed in five patients and two patients had stereobiopsy. The localization of GBM was in six patients in the frontal lobe, in two patients in frontotemporal area, in two patients in frontoparietal area and in one patient in parieto-occipital area. All patients underwent postoperative external-beam radiotherapy with a 25 mm margin at a dose of 50 Gy in 25 fractions and a boost to the tumor with a 15 mm margin at a dose of 10 Gy in five fractions with chemotherapy of temozolomide at dose 75 mg/ m2. The assessment of neurocognitive functions was performed by clinical neuropsychologist using the methods sensitive for cognitive deficit. We used one complex screening method (ACE-R), two graphomotoric tests (TMT, ROCF), two verbal tests (DS, VFT),

and one computer-administered test (CPT). The total examination time took about 1 hour. The schedule of examination during the pilot study was following: (1) before radiotherapy with chemotherapy (performed in all 11 patients), (2) immediately after radiotherapy with chemotherapy (performed in 7 patients), (3) 1 month from finishing the adjuvant treatment (performed in 5 patients), (4) 3 months after finishing the adjuvant treatment (performed in 1 patient, (5) 6 months after finishing the treatment (performed in 1 patient). Due to the rapid progression of glioblastoma multiforme and related alterations of somatic and mental status, only one patient underwent the whole planned schedule of examinations. In our pilot project, we detect a big variability in cognitive functions in the first assessment (before radiotherapy). The reason of this variability is with high probability associated with different way and invasiveness of selected neurosurgery intervention. Patients, who underwent the most radical neurosurgery, had the worst results. The average score in ACE-R test in a group of four patients with complete resection was 75.5 points, in group of five patients with partial or subtotal resection 84.1 points and in group of two patients with stereobiopsy 87.8 points. For any similar monitoring of patients in the future, it would be appropriate to implement the first neuropsychological assessment before the surgery. This would then allow to distinguish the negative impact of radiotherapy with/without chemotherapy from the traumatic impact of neurosurgical intervention. The different impact or combination of above mentioned factors is, together with tumor progression and localization of GBM, a reason of different progress of cognitive functions during the follow up period. To monitor developments and changes in cognitive functions in patients with GBM, the following battery of neuropsychological tests has shown helpful information: Addenbrooke's Cognitive Examination, Trail Making Test, Rey-Osterrieth Complex Figure, and Verbal Fluency Test. It seems that this battery of neuropsychological tests is suitable for repeated long-term monitoring of cognitive function in cancer patients undergoing radiotherapy of brain.

Journal of Cancer Research and Therapeutics - October-December 2013 - Volume 9 - Issue 4

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