The lost art of localization: Franc Ingraham's legacy in pediatric neurosurgery.

The authors describe an 8-year-old girl who underwent emergency posterior fossa surgery for resection of a large cerebellar astrocytoma in November 1939. The surgery was carried out by Franc D. Ingraham at Boston Children's Hospital a decade after he established the first pediatric neurosurgical service in the world at the same institution. Four years later the tumor recurred and the patient underwent repeat resection followed by external-beam radiation therapy. The pathological diagnosis by Sidney Farber was fibrillary astrocytoma. The young girl is currently a healthy, functional 82-year-old woman. The authors believe that this 74-year follow-up represents one of the longest in history, if not the longest, of a patient undergoing resection of a brain tumor. A recent MRI study shows postoperative changes with no evidence of residual or recurrent tumor. The original block tissue specimen had been preserved. It was restained and examined, revealing the pathological diagnosis to be juvenile pilocytic astrocytoma. The case is analyzed in the context of Ingraham's powerful and lasting impact on the field of pediatric neurosurgery.

Advanced and relapsed/refractory Hodgkin lymphoma: what has been achieved during the last 50 years.

During the last 50 years there has been great progress in understanding the biology of Hodgkin disease, which is now called Hodgkin lymphoma (HL), since it has been definitely shown to be a lymphoid neoplasm and its B-cell origin has been documented in the vast majority of cases. Progress in biology has also resulted in the identification of numerous biological prognostic factors, which may facilitate the definition of high-risk groups of patients and provide guidance for individualized therapy. Unfortunately, biological prognostic factors have not been incorporated in prognostic models applicable in everyday practice and need prospective validation. More importantly, during the last 50 years, advanced stage HL has been transformed from a rather incurable into a highly curable disease. Chemotherapy has gradually improved in terms of efficacy. MOPP was replaced by the more efficacious and less toxic ABVD regimen, but higher cure rates with BEACOPP-escalated have come at the expense of increased toxicity. Better risk stratification, probably based on early, interim positron emission tomography (PET) evaluation, may in the near future better identify those patients who really need intensified chemotherapy. Furthermore, the intensification of chemotherapy and the optimal use of PET at the end of chemotherapy have already minimized the use of radiotherapy in advanced disease, thus reducing the risk of long-term complications. Relapsed and refractory disease has also been rendered curable in almost half of the patients with the advent of effective salvage regimens, and, mainly, autologous stem cell transplantation. Furthermore, better understanding of the biology of HL has permitted the development of targeted therapy. Anti-CD30 targeting with brentuximab vedotin (BV) was the first targeted therapy to be approved for relapsed/refractory HL, either after autologous stem cell transplantation (auto-SCF) failure or after failure of two regimens in patients who were not candidates for transplant. Hopefully, the determination of the optimal role and timing of BV treatment and the development and approval of other targeted compounds will further improve the outcome of advanced stage as well as relapsed/refractory HL.

[Oncologic "second-look" today]. / Il "second look" oncologico oggi.

The Wangensteen's proposal of the SLL is far from us, not only chronologically but, what is more meaningful, technologically. Radiology, with its digestive tract barium meal or enema, was at his time the only mean entrusted for the instrumental study of the patient, and the medical oncology was at its very dawn. The Wangensteen's purpose was to discover with a SLL the recurrence (metastasis or relapse) of the neoplastic disease after a first demolitive surgical approach, not waiting its late clinical evidence. And this on the conviction that also the recurrent neoplastic disease can be again successfully treated by surgery when early detected. Many facts have happened since the 50's, and if it is by now demonstrated true that also the neoplastic recurrence can be successfully treated by surgery--naturally for particular neoplasms and in particular localization--it is equally true that diagnostic possibilities have widely evolved permitting the non invasive detection and localization of neoplastic recurrences with remarkable accuracy. Thence the renewed possibility of a reinterventional surgery.