Delayed Effects of Therapeutic Brain Irradiation

The challenges of long-term treatment outcomes in adults with malignant gliomas

Malignant gliomas are among the most devastating tumors, with survival only one to three years after diagnosis even with the best of treatments. For this reason, long-term follow-up has not been established. Patients who do survive have significant disabilities, which compromise patient and family quality of life (QOL). Side effects from a brain tumor are dependent on the location of the tumor in the brain and can cause significant cognitive, emotional, and social effects on patients and families. Surgical treatment options also are dependent on the location of the tumor in the brain, and some sites remain inoperable (e.g., brain stem, motor strip). Radiation therapy continues to remain the mainstay of treatment for this patient population. The advent of newer technologies in radiation and chemotherapy and the development of novel treatments have increased survival. As survival increases, QOL issues become more important to patients and families. Impairment, disability, and handicap are measurements of QOL used by healthcare professionals. A multitude of studies has produced evidence regarding the impact of tumor location and size on QOL, whereas other studies have demonstrated the effects that various treatment modalities have on QOL. Few studies actually have provided insight into the everyday consequences that tumors pose on patients. Understanding the significance and causes of these impairments, disabilities, and handicaps will assist oncology nurses in caring for this special population.

Rehabilitation of persons with central nervous system tumors

A tumor that affects the central nervous system can have a dramatic impact on the individual affected, as well as his or her family and friends. The tumor, regardless of extent or location, may affect the physical, social, vocational, and emotional capabilities of the individual. Basic aspects of rehabilitation for patients with tumors affecting the brain and spinal cord are reviewed in this article. The authors have found that the same principles of neurorehabilitation applied to persons with traumatic brain injury, stroke, and traumatic spinal cord injury are equally appropriate for persons with brain and spinal cord tumors. These principles include the prevention of medical complications; the treatment of medical problems such as pain, spasticity, and neuropathic bowel and bladder; and the improvement of patients' mobility and activities of daily living. Rehabilitation specialists can help prevent complications, maximize function, and improve the quality of life for patients with central nervous system tumors.

Functional outcome of inpatient rehabilitation in persons with brain tumors

OBJECTIVE

To document functional outcome in persons with brain tumors undergoing inpatient rehabilitation and to compare outcomes with a group of traumatically brain injured patients.

DESIGN

Retrospective, descriptive, and case-matched.

SETTING

A free-standing inpatient brain injury rehabilitation unit.

PARTICIPANTS

Forty consecutive patients with a variety of tumor types (40% were either glioblastoma multiforme or meningioma) and a mean age of 53.1 (SD 15.4) years. Sixty percent were men, 25% had recurrent tumors, and 15% had metastatic disease. Also, 40 patients with traumatic brain injury (TBI) matched for age, gender, and admission functional status.

MAIN OUTCOME MEASURES

Change in Functional Independence Measure (FIM) scores, length of rehabilitation stay (LOS), and discharge disposition.

RESULTS

The mean LOS for the tumor group was 17.8 (SD 9.9) days, mean FIM gain was 25.4 (SD 20.1) points, and 82.5% were discharged home. No demographic or tumor characteristic was statistically significant in predicting functional outcome at discharge, but greater gains were seen for persons with the diagnosis of meningioma, those with left-sided cerebral lesions, and those not receiving radiation therapy. TBI patients made statistically significant greater gains in total FIM change (34.6 vs 25.4), self-care (12.3 vs 8.5), and social cognition (5.2 vs 3.6). However, FIM efficiency and LOS were not statistically different between the TBI and tumor groups (1.9 vs 1.5 FIM points/day and 22.1 vs 17.8 days, respectively).

CONCLUSIONS

Daily functional gains made by persons with brain tumor undergoing rehabilitation were similar to those made by a group of persons with TBI matched by age, gender, and admission functional status. Further research should use larger samples and address the impact of psychosocial and team factors on LOS and discharge disposition.

Posterior fossa tumors in children: a case study

Brain tumors are the second most common malignancy to occur during childhood and the posterior fossa is the most common region of the brain affected. Diagnosis and treatment are complex and challenging. Once a child suffering from a posterior fossa tumor is identified, a multidisciplinary team must be assembled to provide comprehensive care through all phases of treatment. The nursing staff is vital to this team because they are often the individuals who coordinate services involved in the care of the child with a posterior fossa tumor. This case study illustrates the phases of diagnosis and treatment of a child with a medulloblastoma and highlights critical care nursing challenges. Following the case study presentation, a summary describes posterior fossa tumors including epidemiology, pathophysiology, clinical manifestations, and outcome. The case study is integrated throughout this review to highlight key issues for critical care nurses to explore.

Severe spatial navigation deficit in the Morris water maze after single high dose of neonatal x-ray irradiation in the rat

Ambiguous spatial behavior deficits induced in adult rats by different types of dentate gyrus lesions were examined by subjecting neonatal rats to x-ray irradiation, which reduces the granule cell population in fascia dentata without affecting the number of hilar neurons and pyramidal cells of Ammon's horn. Three- to six-month-old irradiated and intact male Long-Evans rats were tested in the Morris water maze. Four experiments were done. (i) Rats were trained to find an invisible escape platform, when started from any of four equidistant points at the circumference of the pool. (ii) The same rats then were trained to find a visible platform in the same pool. Poor performance of irradiated rats in both experiments suggested a visual deficit. (iii) Navigation in the absence of visual cues was studied in other rats trained in total darkness to find the escape platform under conditions of fixed start-fixed goal geometry. (iv) Contribution of nonvisual allocentric cues and egocentric path integration mechanisms to spatial performance of the above rats was tested in darkness after rotating both the start and goal positions by 90 degrees clockwise. Impairment of irradiated rats in Exp. 3 and 4 and histological examination of their brains support the conclusion that 60-70% reduction of granule cells in the dorsal hippocampus causes significant deterioration in both allocentric and egocentric orientation.