Brain Oncology Biology, diagnosis and therapy: An international meeting on brain oncology, Rennes, France, September 4–5, 1986, held under the auspices of the Ministry of National Education, the University of Rennes and the Regional Hospital Rennes

427 Pages·1987·17.37 MB·English

by  C. C. Tijssen (auth.)

BRAIN ONCOLOGY
DEVELOPMENTS IN ONCOLOGY
Recent volumes
M.P. Hacker, E.B. Double and I. Krakoff, eds., Platinum Coordination Complexes in Cancer Chemo
therapy. ISBN 0-89838-619-5
M.J. van Zwieten, The Rat as Animal Model in Breast Cancer Research: A Histopathological Study of
Radiation-and Hormone-Induced Rat Mammary Tumors.
ISBN 0-89838-624-1
B. Lowenberg and A. Hagenbeek, eds., Minimal Residual Disease in Acute Leukemia.
ISBN 0-89838-630-6
I. van der Waal and G.B. Snow, eds., Oral Oncology. ISBN 0-89838-631-4
BW. Hancock and A.H. Ward, eds., Immunological Aspects of Cancer. ISBN 0-89838-664-0
K.Y. Honn and B.F. Sloane, Hemostatic Mechanisms and Metastasis. ISBN 0-89838-667-5
K.R. Harrap, W. Davis and A.H. Calvert, eds., Cancer Chemotherapy and Selective Drug Development.
ISBN 0-89838-673-X
C1.H. van de Velde and P.H. Sugarbaker, eds., Liver Metastasis. ISBN 0-89838-648-5
D.1. Ruiter, K. Welvaart and S. Ferrone, eds., Cutaneous Melanoma and Precursor Lesions.
ISBN 0-89838-689-6
S.B. Howell, ed., Intra-arterial and Intracavitary Cancer Chemotherapy. ISBN 0-89838-691-8
D.L. Kisner and J.E Smyth, eds., Interferon Alpha-2: Pre-Clinical and Clinical Evaluation.
ISBN 0-89838-701-9
P. Furmanski, J.C Hager and M.A. Rich, eds., RNA Tumor Viruses, Oncogenes, Human Cancer and
Aids: On the Frontiers of Understanding. ISBN 0-89838-703-5
J. Talmadge, 1.1. Fidler and R.K. Oldham, Screening for Biological Response Modifiers: Methods and
Rationale. ISBN 0-89838-712-4
J.C Bottino, RW. Opfell and EM. Muggia, eds., Liver Cancer. ISBN 0-89838-713-2
P.K. Pattengale, R.J. Lukes and CR. Taylor, Lymphoproliferative Diseases: Pathogenesis, Diagnosis,
Therapy. ISBN 0-89838-725-6
E Cavalli, G. Bonadonna and M. Rozencweig, eds., Malignant Lymphomas and Hodgkin's Disease:
Experimental and Therapeutic Advances. ISBN 0-89838-727-2
L. Baker, E Valeriote and V. Ratanatharathorn, eds., Biology and Therapy of Acute Leukemia.
ISBN 0-89838-728-0
J. Russo, ed., Immunocytochemistry in Tumor Diagnosis. ISBN 0-89838-737-X
R.L. Ceriani, ed., Monoclonal Antibodies and Breast Cancer. ISBN 0-89838-739-6
D.E. Peterson, G.E. Elias and S.T. Son is, eds., Head and Neck Management of the Cancer Patient.
ISBN 0-89838-747-7
D.M. Green, Diagnosis and Management of Malignant Solid Tumors in Infants and Children.
ISBN 0-89838-750-7
K.A. Foon and A.C Morgan, Jr., eds., Monoclonal Antibody Therapy of Human Cancer.
ISBN 0-89838-754-X
1.G. McVie, W. Bakker, Sj.Sc. Wagenaar and D. Carney, eds., Clinical and Experimental Pathology of
Lung Cancer. ISBN 0-89838-764-7
KY Honn, W.E. Powers and B.E Sloane, eds., Mechanisms of Cancer Metastasis. ISBN 0-89838-765-5
K. Lapis, L.A. Liotta and A.s. Rabson, eds., Biochemistry and Molecular Genetics of Cancer Metasta
sis. ISBN 0-89838-785-X
A . .l. Mastromarino, ed., Biology and Treatment of Colorectal Cancer Metastasis. ISBN 0-89838-786-8
M.A. Rich, 1.C Hager and 1. Taylor-Papadimitriou, eds., Breast Cancer: Origins, Detection and Treat
ment. ISBN 0-89838-792-2
D.G. Poplack, L. Massimo and P. Cornaglia-Ferraris, eds., The Rol~ of Pharmacology in Pediatric
Oncology. ISBN 0-89838-795-7
A. Hagenbeek and B. Lowenberg, eds., Minimal Residual Disease in Acute Leukemia 1986.
ISBN 0-89838-799-Y.
EM. Muggia and M. R"zencweig, eds., Clinical Evaluations of Anti-Tumor Therapy.
ISBN 0-89838-803-1
EA. Valeriote and L. Baker, eds., Biochemical Modulation of Anticancer Agents: Experimental and
Clinical Approaches. ISBN 0-89838-827-9
B.A. Stoll, ed., Pointers to Cancer Prognosis. ISBN 0-89838-841-4
K.H. Hollmann and J.M. Verley, eds., New Frontiers in Mammary Pathology 1986. ISBN 0-89838-852-X
D.J. Ruiter, G.J. Fleuren and S.O. Warnaar, eds., Application of Monoclonal Antibodies in Tumor
Pathology. ISBN 0-89838-853-8
M. Chatel, F. Darcel and J. Pecker, eds., Brain Oncology. ISBN 0-89838-954-2
Brain Oncology
Biology, diagnosis and therapy
An international meeting on brain oncology, Rennes, France,
September 4-5, 1986, held under the auspices of the Ministry of National
Education, the University of Rennes and the Regional Hospital Rennes
edited by
M. Chatel
Department of Neurology,
University of Rennes, France
F. Darcel
Department of Neuropathology,
University of Rennes, France
J. Peeker
Department of Neurosurgery,
University of Rennes, France
With the collaboration of· Y. Adam, M. Carsin, 1. Faivre, Y. Guegan, G. Guy,
M. lan, A. lavalet and 1.M. Scarabin
1987 MARTINUS NIJHOFF PUBLISHERS
a member of the KLUWER ACADEMIC PUBLISHERS GROUP
DORDRECHT / BOSTON / LANCASTER
We wish to thank the PREUSS FOUNDATION for BRAIN TUMOR
RESEARCH of SAN DIEGO, California, for their generous financial support
in publishing this book.
Distributors
for the United States and Canada: Kluwer Academic Publishers, P.O. Box 358,
Accord Station, Hingham, MA 02018-0358, USA
for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited,
Falcon House, Queen Square, Lancaster LAI lRN, UK
for all other countries: Kluwer Academic Publishers Group, Distribution Center,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
International Meeting on Brain Oncology (1986 : Rennes,
France)
Brain oncology.
(Developments in oncology)
Includes index.
1. Brain--Cancer--Congresses. I. Chatel, M. (Marcel)
II. lJarcel, F. (Fran~oise) III. Peeker, J. (Jean)
IV. France. Ministere de I'education nationale.
v. Universite de Rennes. VI. Centre hospitalier regional
de Rennes. VII. Title. VIII. Series. lDNLM: 1. Brain
Neoplasms--congresses. Wi DE998 I WL 358 I583 1986J
RC280.B7I544 1986 616.99'481 87-14154
ISBN-13: 978-94-010-8003-3 e-ISBN: 978-94-009-3347-7
DOl: 10.1007/978-94-009-3347-7
Copyright
© 1987 by Martinus Nijhoff Publishers, Dordrecht.
Softcover reprint of the hardcover 1st Edition 1987
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Martinus Nijhoff Publishers, P.O. Box 163, 3300 AD Dordrecht,
The Netherlands.
PREFACE
The International Meeting on Brain Oncology in Rennes was organised in honor of Jean Pecker, to
pay tribute to his contribution to the development of neurological sciences and to take stock of the
current state of knowledge on brain tumors, a domain in which the role of neurosurgery has been
and will continue to be primordial.
During the two-day conference, the major themes of brain oncology studies, both fundamental and
clinical, were examined: oncogenesis, tumoral markers and immunology, metabolic and diagnosis
imaging, prognostic factors and therapeutic strategies.
The large number and high quality of participations resulted in a genuinely synthetic view of current
advances in research, of which this book presents the essentials.
We have attempted both to preserve the richness of scientific exchanges which occurred and to
publish a great many oral and poster communications. The book respects the organization of
conference sessions, and thus reflects the importance accorded to glial tumor studies.
This may seem disproportionate given their frequency of occurrence in proportion to total numbers
of intracranial tumor processes, but their gravity and quasi-total resistance to current therapeutic
methods are ample justification. Moreover, this is the domain in which hopes of progress are
beginning to appear, and it is becoming possible to envisage treatment based on recently established
fundamental knowledge.
Obviously these are only hopes as yet, since control of oncogene expression and immunity processes
of gliomas are still not really feasible; neither have therapies using monoclonal antibodies, the
« suicidal enzymes» of polyamine metabolism or hormone receptor modulators yet given the results
which experimental data seem to warrant; nonetheless the continuation of new attempts based on
ever-growing knowledge of tumor biology represents the sole available route to progress. The
conference was planned as a landmark along this route; this book is intended simply to prolong and
widen its impact.
We should like to express our thanks to all those, authors, researchers and scientific personalities,
who honored us by replying to our invitation, participating in the conference, presenting their work
and contributing to the publication of this book.
M.CHATEL
EDITORIAL
In presenting the work of the International Meeting on Brain Oncology held in Rennes, I wonder
what could be the underlying philosophy to this preface. In other words, what can we expect from it?
Should the author justify the holding of the meeting and the choice of the topics; should he try to
synthesize the views expressed. Should he pinpoint the importance of the achievements or on the
contrary, should he point out the grey areas still existing and which could become future subjects for
other studies, for other meetings? And last but not least, should he leave aside his role as rapporteur
and show his concern through his daily work on each case?
The answer to these questions becomes more difficult when researchers from different fields take
part in the meeting. The table of contents might seem confusing for the reader. Undoubtedly he will
find the usual chapters together with pathology, biology, medical imaging, therapy. Nonetheless it is
odd to talk at the same time of such different lesions such as benign or malign gliomas,
meningiomas, lymphomas.
It so happens that neuro-oncology must by its own essence, deal exhaustively with the different
varieties of brain tumors. The complexity of the problems justifies this kind of encounter meeting
ground for experts from different fields. The goal is not to verify the birth of a new speciality
neuro-oncology; less still to give it an official stamp, but rather to show that in order to cure the
brain tumors pooling of the knowledge is essential.
Presently, two main approaches can be identified:
- that of fundamental studies carried out in laboratories, anatomical, pathological, biological,
immunological, genetical, physical etc. The notions of oncogenesis, resistance of the subject to the
tumor, chemical sensitivity or chemical resistance and so on are related to the studies on general
carcinology.
- that of studies on patients and for physicians, neurologists, neurosurgeons, neuroradiologists,
the problem being the very nature of the brain which requires a very precise diagnosis concerning the
localization. The search for a tissue diagnosis before any therapeutic decision is taken and the need
to take into account the functional integrity of the brain.
It could be argued that there is nothing new or at least nothing revolutionary in this approach.
Nevertheless it is true that the ever increasing knowledge and possibilities in different fields might
lead to harmful attitudes. Laboratory searchers could be tempted by a too wide comprehension of
the phenomena; on the other hand the physician is compelled to judge case by case. One of the
lessons which could be drawn from the Rennes meeting is the need to set up at the level of each
hospital concerned with the treatment of brain tumors an interdisciplinary working group interested
both in the follow up of research in different fields and in the study, case by case, of the decisions
concerning each patient.
The experience gained in Rennes allows us to draw some conclusions:
- the gap between the diagnostic and therapeutic methods has widened during the last twenty
years: the medical imaging methods, the present wide use of stereotaxic biopsies, a better knowledge
of tumoral markers, the possibilities offered by monoclonal antibodies permit us to avoid a biased
pathological classification and to choose the best possible treatment taking into account the need
for the functional integrity of the brain. On the contrary the range of treatments does not evolve but
slowly: surgery thanks to the pre and intra-operat ory explorations, less and less dangerous for a
healthy brain and backed up by more efficacious reanimation techniques open new vistas but
simultaneously realizes its limitations every time that the oncological problem prevails.
Radiotherapy tries also to limit itself to the lesion sparing the necrosis of the healthy tissue, aiming
VIII
after the relative failure of the interstitial irradiation, at the multibeam irradiation under stereotaxic
conditions. New administration methods as well as the utilization of radio sensitizers attempt to
reduce the pain and the length of the treatment but do not improve the results. Chemotherapy tries
new drugs every day, thanks not only to a follow up of clinical results but also to in vitro trials in cell
cultures and to tolerance and effectiveness tests on induced tumors in animals.
For man, the problems are heightened by the blood brain barrier; preparatory infusions of
antiedematous or more and more focalised intra arterial administration could help to solve the
problems. Here again there is hope that monoclonal antibodies behave as guided vehicles towards
the tumor.
It is easy to verify that the therapeutical pattern of brain tumors has lately grealty advanced and
therefore it will do so in the future. Tumors can no longer be divided into two groups: amenable to
surgery or not.
Indeed the majority of extra-parenchymatous tumors fall almost exclusively in the realm of surgery.
But a better knowledge of their induction and growth factors will give perhaps a role to some
pharmacological agents such as the progesterone inhibitors. On the contrary few tumors which
seemingly would have been excluded from any surgical possibility can nevertheless be removed
today; for instance some MRI identified brain stem tumors.
For most of the intra parenchymatous tumors, surgery, radiotherapy, and chemotherapy are jointly
utilised; not surprisingly several participants have coined the neologism of « multimodal therapies ».
But one day we may well be witnesses to other choices than the three fold « surgery -radiotherapy
-chemotherapy», thanks to further knowledge of the tumor induction factors and the relationship
between the tumor and the host.
The lasting pessimism - unfortunately justified - of the physicians at facing therapeutical results
in certain varieties of tumors, specially high grade gliomas, is nowadays tempered by the
researchers: They open the door for the future: hope calms the medical and surgical team spirits and
reflects itself on the quality of the management of the patient.
J. PECKER
CONTRIBUTORS
M. BAMBERG, Westdeutsches Tumor Zentrum Universitat
55 Hufelandstr. 4300 ESSEN, R.F.A.
David BATEMAN, Wessex Neurological Center, General Hospital
Shirley 777222, SOUHTAMPTON, U.K.
Julianne BEHNKE
Von Bar Strasse 8
D 3400 GOTTINGEN, R.F.A.
Mohammed BEN HASSEL, Centre Eugene Marquis, C.H.R.
Rue H. Le-Guilloux 35033 RENNES, FRANCE.
Alim Louis BENABID
Departement de Biophysique, C.H.U.
La Tronche 38700, GRENOBLE, FRANCE.
Sandra H. BIGNER
Laboratory of Neuropathology, Duke University Med. Center
B.O. Box 3156, DURHAM, North Carolina, U.S.A.
Ulrich BOGDAHN, Department of Neuroradiologie, University Wurzburg
II Joseph Schneider Str., 8700 WURZBURG, R.F.A.
Jurgen BOHL, Abt. Neuropathologie, Institut J. Gutenberg
I Lengenbeckstrasse, 6500 MA YENCE, R.F.A.
Robert BRADFORD Department of Neurological Surgery, Institute of Neurology
Gough Cooper Queen Square, WClB 3BG, LONDRES, U.K.
Philippe BRET, Hopital Neurologique
B.P., Lyon Montchat, 69394 LYON CEDEX 3, FRANCE.
Giovanni BROGGI, Istituto Neurologico C. Besta
II Via Celoria, 20133 MILANO, ITALY.
Jacques BROTCHI, Service de Neurochirurgie, Hopital Erasme
808 Rte de Lennik, B 1070 BRUXELLES, BELGIUM.
Jean-Marie BRUCHER, Unite de Neuropathologie
Universite de Louvain, 52 avo Emile Mounier, B 1200 BRUXELLES, BELGIUM.
Volker BUDACH, Sreahlenklinik Westdeutsches Tumor Zentrum Universitat
55 Hufelandstr., 4300 ESSEN, R.F.A. .
Roberto BUONAGUIDI, Institute of Neurosurgery, University of Pisa
57 Spedali S. Chiara, 56600 PISA, ITA LIA.
Marcel CHATEL, Service de Neurologie, C.H.U.
Hopital de Ponchaillou, 35000 RENNES, FRANCE.
Kyung CHO, Brain Tumor Research Center, University of California
94143 SAN FRANCISCO, California, U.S.A.
Hughes B. COAKHAM, Neurosurgery, Bristol Medical Center
BSI6 ILE, BRISTOL, U.K.
E.V. COLAPINTO, Department of Pathology Duke, University Medal Center
P.O. Box 3156 27710 DURHAM, North Carolina, U.S.A.
Jean-Paul CONSTANS, Service de Neurochirurgie, Centre Hospitalier Sainte-Anne
I rue Cabanis, 75674 PARIS, FRANCE.
x RENNES, 4-5 SEPTEMBRE 1986 -IMBO/JIOC
Franr;:oise DARCEL, Laboratoire de Neuropathologie, C.H.U.
H6pital de Ponchaillou, 35000 RENNES, FRANCE.
John DARLING, Department of Neurological Surgery,
Institute of Neurology, Queen Square, WC IN 3BG, LONDRES, U.K.
Stephen J. De ARMOND, Laboratory of Neuropathology
U.C.S.F. Parnassus, 94143 SAN FRANCISCO, California, U.S.A.
Jean-Michel DERLON, Service de Neurochirurgie
Centre Hospitalier C6te-de-Nacre, 14033 CAEN, FRANCE.
Franr;:ois DUBOIS, Service de Neurologie
H6pital B, 59037 LILLE, FRANCE.
Vittorio Aldo FASANO, Institute of Neurosurgery
University of Turin, 15 Via Cherasco, 10126 TURINO, ITALY.
Kazuhisa FUJISA W A, Department of Neurosurgery
Fujita Gakuen Health University School of Medicine, 470 11 TOYOAKE AI CHI JAPAN.
Daniel GEDOUIN, Centre Regional de Lutte contre Ie Cancer
Rue Henri-Le-Guilloux, 35000 RENNES, FRANCE.
Yvon GUEGAN, Service de Neurochirurgie, C.H.U.
Rue H.-Le-Guilloux, 35033 RENNES, FRANCE.
Jorge HILDEBRAND, Service de Neurologie
H6pital Erasme, 808 Route de Lennik, 1070 BRUXELLES, BELGIUM.
Alfred HORACZEK, Klinik Neurochirurgie
18-20 Wahringer Gurtel, A 1090 VIENNE, AUSTRIA.
Jose IGLESIAS ROZAS, Abt fur Neurochirurgie
RudolfVirchows-Krankenhaus, I Augustenburger Platz, 1000 BERLIN 65, R.F.A.
Bernard IRTHUM, Service de Neurochirurgie,
H6pital Fontmaure, 63400 CHAMALIERES, FRANCE.
Roberto KNERICH, Department of Surgery, Neurosurgical section
Policlinico S. Matteo, 27100 PAVIA, ITALY.
Ivan KRIVOSIC, Laboratoire de Neuropathologie
H6pital B LILLE, 59037 LILLE, FRANCE.
F. LABROUSSE, Laboratoire d'Anatomo-Cytologie
H6pital Sainte-Anne, I, rue Cabanis, 75014 PARIS, FRANCE.
Bernard LECHEVA LIER, Laboratoire de Neuropathologie
H6pital C6te-de-Nacre, 14040 CAEN, FRANCE.
Laurence LE MOYEC, Laboratoire de Biophysique
Faculte de Medecine, Av du Pr. Leon-Bernard, 35000 RENNES, FRANCE.
Edouard LEG ALL, Service de Pediatrie
C.H.U., Pontchaillou, 35033 RENNES, FRANCE.
G. LUCCARELLI, Istituto di Patologia
Universita Degli Studi, 31 Via Mangiagalli, 20133 MILANO, ITALY.
Jean-Philippe MAIRE, Service de Neurochirurgie
H6pital St-Andre, I, rue Jean-Burguet, 33075 BORDEAUX, FRANCE.
Thomas-Marc MARKWALDER, Service Neurochirurgie
H6pital de l'Ile, 61 Seidenberggasschen, 3010 MURIIBERNE SWITZERLAND.
CONTRIBUTORS XI
Sylvia MIESCHER, Laboratoire d'Oncologie
Institut Ludwig C.H.U.V., lOll LAUSANNE, SWITZERLAND.
Fran~ois MIKOL, Fondation Rotchshild
25 Rue Manin, 75019 PARIS, FRANCE.
Jacqueline MIKOL, Laboratoire d'Anatomie Pathologique
Hopital Lariboisiere, 2 Rue Ambroise-Pare, 75475 PARIS, FRANCE.
Richard MOSER, Anderson Hospital and Tumor Institute
6723 Bertner Avenue, 77030 HOUSTON, Texas, U.S.A.
Mikael MOSSKIN, Department of Neuroradiology
Karolinska Hospital, S 10401 STOCKHOLM, SWEDEN.
Jacques-Philippe MOULlNOUX, Laboratoire d'Histologie
Faculte de Medecine, 35033 RENNES, FRANCE.
H.F.V. NEWMAN Clinical Oncology Medical Research Council Centre
Hill Road, CB2 20H, CAMBRIDGE, U.K.
Maria PAMUCKA, Department of Radiotherapy
Hospital Opole, 66a Katowicka, 45060 OPOLE, POLOGNE.
Jean PECKER, Service de Neurochirurgie
C.H.U. Ponchaillou, 35033 RENNES, FRANCE.
Serge PRIER, Service de Neurologie
Hopital Beaujon, 100 Avenue du General-Leclerc, 92110 CLlCHY, FRANCE.
Veronique QUEMENER, Laboratoire d'Histo1ogie
Faculte de Medecine, 35033 RENNES, FRANCE.
Burckhard RAMA, Neurochirurgie Klinik der Universitat
40 Rob. Koch Str., D 3400 GOTTINGEN, R.F.A.
C. REMY, Departement de Biophysique
C.H.U. La Tronche, 38700 GRENOBLE, FRANCE.
Norbert ROOSEN, Neurochirurgische Univ. Klinik
5 Moorenstrasse, 4000 DUSSELDORF 1, R.F.A.
Alain ROUGIER, Service de Neurochirurgie
C.H.U. Pellegrin Tripode, Place Ameli-Raba-Leonie, 33076 BORDEAUX, FRANCE.
Lucien J. RUBINSTEIN, Laboratory of Neuropathology
University of Virginia, 22908 CHARLOTTESVILLE, Virginia, U.S.A.
Keiji SHIMIZU, Department of Neurosurgery
Osaka University Medical School, 1-1-50 Fukushima, Fukushima-ku 553 OSAKA, JAPAN.
Paolo SIMI, Department of Pediatrics
University of Pisa, 57 Via Roma, 56100 PISA, ITALY.
Umberto SIMI, Service of Istology
Spedali Santa Chiara, 57 Via Roma, 56100 PISA, ITALlA.
David J. STEWART, Ontario Cancer Treatment Center
Ottawa General Hospital, 50 I Smyth Rd, KIN 8L6 OTTA WA, Ontario, CANADA.
Martienne TARDY, Unite 282 INSERM
Hopital Henri-Mondor, 69 Avenue Gabriel-Peri, 94010 PARIS, FRANCE.
Jacques THERON, Neuroradiologie
C.H.U. Cote-de-Nacre, 14040 CAEN, FRANCE.
David G.T. THOMAS, Neurological Surgery
Institute of Neurology, Queen Square, WC IN 3BG, LONDRES U.K.