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Ependymoma are rare glial neoplasm, it rarely metastasize outside the central nervous system. We present a case of anaplastic ependymoma with extraneural metastases with review of literature. A ten-year-old male child presented with anaplastic ependymoma of choroid plexus and treated with craniospinal radiotherapy in 1998. He had intracranial recurrence in 2004, confirmed by biopsy. He was given adjuvant chemotherapy in form of PCV. At 10 months after completion of chemotherapy, he developed extracranial scalp metastasis and so was treated with palliative local radiation therapy to the scalp metastasis and systemic chemotherapy with oral Etoposide. Scalp metastasis completely disappeared and ataxia improved. After five cycles of chemotherapy, the patient had progression of disease in form of scalp and cervical lymph node metastasis confirmed by fine needle aspiration cytology, biopsy and immunohistochemistry. He was given salvage chemotherapy (carboplatin + ifosfamide + etoposide) at 3-weekly. He had partial response and was still on chemotherapy till May 2007.

The aims of the study were to review the patients with choroid plexus tumor (CPT) treated in Slovenia between 1972-1999, to calculate the incidence of CPTs, and to evaluate treatment results in respect to tumor histology and mode of therapy. Cancer Registry of Slovenia database was used for patientś identification. Histological specimens and medical records were reviewed. Twelve patients (7 females, 5 males), 0.8-43 years old (median 6.1 years; <15 years: 10/12,83%) with CPT, representing 0.36% of all intracranial tumors registered during the period under study, were identified. Considering children less than 15 years old only, the corresponding percentage was 3.69. There were eight papillomas (CPPs) and four carcinomas (CPCs) with no difference in age distribution between the groups. Of seven patients with gross tumor resection in CPP group, one patient died of postoperative meningitis and one had local recurrence 1.6 years after surgery; the latter is disease-free 17.9 years after re-operation. One patient with macroscopic residue after surgery is alive and asymptomatic after 16.5 years. In the CPC-group, only the patient who received adjuvant BEP chemotherapy and craniospinal irradiation following incomplete surgery is alive with no signs of disease after 6.5 years. Ten-year disease-specific survival for all CPTs and for CPP subgroup was 73% and 100%, respectively. In Slovenia, CPTs represent 0.36% of intracranial tumors. In children, the incidence is 3.69%. CPPs are twice as frequent as CPCs. In CPPs, the treatment of choice is surgery alone. After incomplete surgery, wait-and-see policy seems to be justified. For CPCs, adjuvant multiagent chemotherapy and craniospinal radiotherapy following surgery should be considered.

Background: Metastatic tumors to the brain presenting exclusively in the choroid plexus are exceedingly rare. These events are frequently associated with renal cell carcinoma (RCC), of which all reported cases have been solitary lesions., Methods: The authors present the unusual case of a patient with metastatic RCC who developed bilateral tumors of the choroid plexus. These tumors, one of which was confirmed to be metastatic RCC by histologic analysis, were treated over a 5-year period with a combination of interventions, including surgical resection, stereotactic radiosurgery, and chemotherapy, in conjunction with continual radiological monitoring., Findings: Follow-up over a 5-year period demonstrated good control of the patient's intracranial disease and very little neurologic sequelae., Interpretation: This strategy was successful in keeping the patient in good health with minimal neurological symptoms, despite the bilateral nature of the disease and its generally poor prognosis.

Brain tumors are the most common solid neoplasms in the pediatric population. Each year in the United States, approximately 1500 to 2000 children are affected by one of these tumors. About 50% of pediatric brain tumors are malignant. Nonmalignant pediatric brain tumors comprise an eclectic group of pathologic entities that have fascinating clinical features. Many of these tumors demonstrate a favorable prognosis. In this report, we review the epidemiology, histopathology, genetics, clinical presentation, neuroimaging, and treatment of the common nonmalignant pediatric brain tumors, including low grade astrocytomas (such as cerebellar astrocytoma and optic pathway glioma), subependymal giant cell astrocytomas, central neurocytomas, dysembryoplastic neuroepithelial tumor, choroid plexus papilloma, and craniopharyngioma. Advances in the therapeutic management of patients with these tumors have considerably improved their prognosis.

Choroid plexus tumours are rare epithelial brain tumours and limited information is available regarding their biology and the best treatment. A meta-analysis was done to determine prognostic factors and the influence of various treatment modalities. A thorough review of the medical literature (1966-1998) revealed 566 well-documented choroid plexus tumours. These were entered into a database, which was analysed to determine prognostic factors and treatment modalities. Most patients with a supratentorial tumour were children, while the most common sites in adults were the fourth ventricle and the cerebellar pontine angle. Cerebellar pontine angle tumours were more frequently benign. Histology was the most important prognostic factor, as one, five, and 10-year projected survival rates were 90, 81, and 77% in choroid plexus-papilloma (n=353) compared to only 71, 41, and 35% in choroid plexus-carcinoma respectively (P<0.0005). Surgery was prognostically relevant for both choroid plexus-papilloma (P=0.0005) and choroid plexus-carcinoma (P=0.0001). Radiotherapy was associated with significantly better survival in choroid plexus-carcinomas. Eight of 22 documented choroid plexus-carcinomas responded to chemotherapy. Relapse after primary treatment was a poor prognostic factor in choroid plexus-carcinoma patients but not in choroid plexus-papilloma patients. Treatment of choroid plexus tumours should start with radical surgical resection. This should be followed by adjuvant treatment in case of choroid plexus-carcinoma, and a "wait and see" approach in choroid plexus-papilloma., (Copyright 2002 Cancer Research UK)

Introduction and Objective: Tumors of the choroid plexus are rare tumors of neuro ectodermal origin, accounting for less 1% of intracranial tumors in all ages. Most cases present in children less than 2 years of age. These tumors have been classified according to histopathological criteria into papilloma and carcinoma., Development: We review the epidemiological, clinical, neuropathological details, neuroradiological aspects and treatment of choroid plexus tumors., Conclusions: Choroid plexus tumors may present with overt intracranial hypertension with or without focal neurological signs. In the adult population, headaches are the most commonly encountered symptom. The CT characteristics of CPT are well characterized. On non enhanced studies the tumor appears as a smooth or lobulated mass, hyperdense in relation to surrounding brain parenchyma. With intravenous contrast, there is marked, homogeneous enhancement. With MRI these tumors showed an iso intensity in T1 weighted images and iso hypo intensity in T2 weighted images, with marked enhancement after gadolinium. The treatment of choice is total surgical excision with minimal damage to the surrounding neural elements. For carcinomas, adjuvant treatment in the form of chemotherapy supplemented by radiation therapy in older children.

Choroid plexus tumors are rare intraventricular papillary neoplasms derived from choroid plexus epithelium, which account for only between 0.4-0.6% of all intracranial and 2-3% of pediatric neoplasms. Plexus papillomas outnumber choroid plexus carcinomas by a ratio of 5:1 and around 80% of choroid plexus carcinomas arise in children. Plexus tumors are most common in the lateral and fourth ventricles; while 80% of lateral ventricle tumors present in children, fourth ventricle tumors are evenly distributed in all age groups. Clinically, choroid plexus tumors tend to cause hydrocephalus and increased intracranial pressure. Histologically, choroid plexus papillomas correspond to WHO grade I, choroid plexus carcinomas to WHO grade III. Immunohistochemically, cytokeratins and vimentin are expressed by virtually all choroid plexus papillomas and most choroid plexus carcinomas while transthyretin and S-100 protein are present in 80-90% of cases, less frequently, though, in choroid plexus carcinomas. Glial fibrillary acidic protein can be found focally in about 25-55% of choroid plexus papillomas and 20% of choroid plexus carcinomas. The mean Ki67/MIB1 labeling index for choroid plexus papillomas is 1.9%, for choroid plexus carcinomas 13. 8%. Choroid plexus papillomas typically show hyperdiploidy with gains particularly on chromosomes 7, 9, 12, 15, 17, and 18 while one choroid plexus carcinoma showed rearrangements of chromosomes 7p11-12, 9q11-12, 15q22, and 19q13.4. Choroid plexus papillomas can usually be cured by surgery alone with a 5-year survival rate of up to 100% with occasional recurrences while choroid plexus carcinomas grow more rapidly and have a less favorable outcome with a 5-year survival rate of 26-40%., (Copyright 2001 Wiley-Liss, Inc.)

A number of recent studies have indicated that T cells can be stimulated to attack transplanted brain tumors in rodent models. As IL-12 has been shown to activate cytotoxic T cell responses, we tested the idea that it might stimulate a T cell response against endogenous brain tumors that arise in SV40 large T Ag transgenic mice (SV11). SV11 mice develop tumors of the choroid plexus, a specialization of the ependymal lining of the brain ventricles. They are a particularly relevant model of human disease, because they are immunocompetent but immunologically tolerant of the tumors. SV11 mice were treated with recombinant murine IL-12 for 10 days. Tumors grew more slowly than in control treated mice, and in some cases were reduced in size, as assessed by magnetic resonance imaging before and after treatment. At the end of treatment, tumors, but not brain parenchyma, exhibited extensive infiltration of activated CD8(+) and CD4(+) T cells. Tumors also showed a reduction in vascular density. Mice treated with IL-12 lived significantly longer than control mice. Tumors that progressed were nearly devoid of T cells, indicating that the T cell response was not sustained. In addition, some mice that had a substantial tumor burden at the beginning of treatment displayed evidence of immunosuppression, which might be related to TGF-ss2 detected in tumors. We conclude that IL-12 treatment can initiate an anti-tumor response even against endogenously arising brain tumors, but factors that will allow a sustained and more effective anti-tumor response need to be determined.

Objective: Tumours of the choroid plexus are rare tumours of neuro-ectodermal origin, accounting for less than 1% of all intracranial tumours. Most cases present in children less than 2 years of age. While choroid plexus carcinomas (CPC) are reported to have an extremely poor prognosis, choroid plexus papillomas (CPP) are generally regarded as benign tumours with a very favourable long-term outcome. Management dilemmas are associated with the choice of surgical procedure, tumour vascularity, the treatment of hydrocephalus and the value of adjuvant therapy. The objective of this study was to review our experience with this rare tumour over a 20-year period., Methods: Patients were identified from the Great Ormond Street Neurosurgical Brain Tumour Database. Over a 20-year period (1979-1999), 34 children were identified with a choroid plexus tumour. There were 25 cases of CPP and 9 cases of CPC. A retrospective review of case notes, radiological imaging, operation reports and pathology was performed., Results: The median age at presentation was 17 months (1-138) for CPP and 13 months (2-102) for CPC. There was no sex difference for CPP. However, 8 of the 9 CPCs were male (89%). A complete surgical resection was achieved in all 25 cases of CPP and in 3 cases of CPC (33%). The median survival for CPPs was 75.5 months (2-228), with a median follow-up of 73.5 months (2-228). The median survival for CPCs was 6 months (1-90), with a median follow-up of 6 months (1-90)., Conclusion: With modern neurosurgical practise, a cure should be the aim for all children with CPP. There is no evidence that adjuvant therapy has any role in the primary management of these children. However, CPC still has an extremely poor prognosis, and the efficacy of adjuvant therapy remains to be established., (Copyright 2000 S. Karger AG, Basel)

Background: Small retinal and choroidal tumors situated near the optic nerve or macula, such as retinoblastomas and malignant melanomas, as well as various other anomalies, in particular vascular malformations, may successfully be treated by photocoagulation. Model assumptions geared towards maximizing efficiency and minimizing undesirable side effects are forwarded, and the most important parameters subserving photothermal destruction, such as radiation field and thermal energy, analyzed. The influence exerted by physical traits of various tissues involved are also considered., Methods: The model approximations presented are based on classical radiation and absorption laws, as well as on the scattering properties of the various tissues implicated, these being considered as a function of wavelength and their relevance to the photodestructive task at hand. Particular attention is paid to the rate processes and reaction kinetics of irradiated proteins., Conclusions: Radiation sources emitting in the near-infrared range of the electromagnetic spectrum, such as the diode (810 nm) and the cw Nd:YAG (1064 nm) lasers, are optimal for the treatment of tumors and large, voluminous entities (such as Hippel-Lindau angiomas), owing to the good tissue penetration properties of their light. Those emitting in the shorter wavelength range, such as the argon ion (488 and 514 nm) and first harmonic--mode Nd:YAG (532 nm) lasers, are not suitable for such tasks, but they are ideal for the destruction of fine sanguinous structures, within which their light is strongly absorbed but through which it penetrates poorly. For the treatment of large anomalous structures, a combined short/long wavelength--strategy should also be considered as a viable alternative. Such a "wavelength mixture" is emitted by the xenon high pressure lamp of the once renowned Meyer-Schwickerath light coagulator. The precision and safety of photothermal destruction methods depend, in the first approximation, upon the details of the pulse energy deposition (wavelength, pulse height and duration, pulse dynamics, mode composition, focussing), the choice of which is determined by the optical and thermal constants of the irradiated tissues. Higher pulse energies will, of course, be more effective in destroying neoplastic cells, but the risk of producing undesired collateral heat damage will also increase concomitantly. Until we can ascertain the physical properties of the pathological tissues treated with certainty, we will hardly be able to achieve more than an approximation of an ideal treatment strategy. But with increasing developments in in vivo-diagnostic techniques, we expect that this goal will be attainable in the not too distant future.

Purpose: Choroid plexus tumors (CPT) are rare childhood neoplasms. The relatively small number of reported cases and the controversies surrounding the clinical and pathological classification of these tumors have made it difficult to define a standard of care for these patients. Our intention is to contribute to the body of knowledge of these tumors and further define the role of adjuvant therapy., Methods and Materials: We performed a retrospective review of 14 children with choroid plexus neoplasms referred to St. Jude Children's Research Hospital between October 1985 and December 1987. Ten patients had choroid plexus carcinoma (CPC) based on pathologic criteria and evidence of brain invasion at surgery or leptomeningeal disease (M+); 4 patients had choroid plexus papilloma (CPP). Patients with CPP were initially treated with surgery alone whereas patients with CPC were generally treated with postoperative therapy that included chemotherapy (CT) and/or craniospinal irradiation (CSI) with a focal boost to the primary site. For most patients CT consisted of combinations of cyclophosphamide, etoposide, vincristine, and a platinum agent. The median CSI dose was 35.2 Gy (range 24-46.2 Gy). The median primary site dose was 55.2 Gy (range 49.6-64 Gy)., Results: Seven of the 10 CPC cases presented with leptomeningeal dissemination; two of these patients have succumbed to disease. Of the 3 patients with M0 status, all are alive with no evidence of disease (NED). The medial time to relapse from the time of surgery was 5.3 mo (range 3-25 mo). Seven CPC patients were treated with gross total resection (GTR). Three of these patients (2 M0, 1 M+) received CT without CSI and are currently NED (27, 69, and 60 mo respectively). One M+ patient progressed on CT and has stable disease after CSI (6 mo), one (M0) received CT and CSI and is NED (120 mo), one (M+) is currently on CT with objective response (3 mo) and one (M+) died of progressive disease (24.5 mo) despite CT and CSI. Three patients with CPC had subtotal resection (STR). One of these patients (M+) received CT and CSI and is NED (23 mo), one (M0) had an elective second resection GTR alone and is currently NED (153 mo), and one (M+) developed progressive disease (13.5 mo) while on CT and died despite CSI. Among the 4 CPP patients, GTR was performed in two; both were NED at 54 and 81 mo. Two patients with CPP (one with focal atypia) were treated with STR initially; both transformed to CPC at 7 and 27 mo, respectively. Both were currently NED following salvage with (1) GTR and CSI alone (98 mo) or (2) STR, CT, and CSI (62 mo). Six of the 12 survivors in this series had significant neuropsychological sequelae., Conclusion: The prognosis of CPP is good for patients treated with GTR. Malignant transformation occurred in 2 CPP patients with less than GTR. Patients with localized CPC who undergo GTR have had a favorable outcome with the addition of chemotherapy or irradiation. CSI may not be routinely indicated in M0 children following GTR. There is evidence that salvage with radiation therapy may be successful following progression on chemotherapy. For patients treated with STR, the use of CT and CSI appears to be necessary.

Bispecific antibodies capable of simultaneously binding a tumor surface antigen and the T-cell receptor/CD3 complex are capable of inducing polyclonal immune effector cells to destroy targeted tumor cells. Bispecific antibody immunotherapies have shown some promise against tumors of hematopoietic origin such as lymphomas, but use of bispecific antibodies for the treatment of solid tumors has been less fully explored. To test the preclinical potential of bispecific antibody therapy against an endogenously arising solid brain tumor, we have utilized a novel variation of conventional bispecific antibodies, referred to as bispecific ligand-antibody conjugates, to target choroid plexus tumors. The bispecific ligand-antibody conjugate described in this study is a chemical conjugate between an anti-CD3 monoclonal antibody (MAb) and folic acid, the ligand for a high-affinity surface receptor expressed on the surface of choroid plexus tumors. SV11 mice transgenic for SV40 large T antigen and its promoter develop solid choroid plexus tumors in the brain. We demonstrate that choroid plexus tumor cells are susceptible in vitro to cytolysis mediated by cytotoxic T cells in the presence of the bispecific ligand-antibody conjugate in a folate-inhibitable manner. Adoptive immunotherapy studies demonstrate the potential benefits of the bispecific ligand-antibody conjugate in vivo. The bispecific conjugate is capable of retaining adoptively transferred T lymphocytes specifically within tumor tissue for periods of up to at least 1 week. Further, following intracerebro-ventricular injection of bispecific conjugate and splenocytes containing activated cytotoxic T cells, T cells were observed to penetrate to interior regions of the tumor. A single treatment of adoptively delivered activated effectors and bispecific conjugate into the brain ventricles was insufficient to produce significant increases in survival of SV11 mice, but repeated treatment through indwelling cannulas prolonged survival of animals treated with activated effectors and bispecific ligand-antibody conjugate compared to animals treated with activated effectors or saline alone. Our results demonstrate that the SV11 model may be useful for preclinical evaluation and optimization of bispecific ligand-antibody conjugate treatments of solid tumors.

High-affinity receptors expressed on the surface of some tumors can be exploited by chemically conjugating the ligand for the receptor and an antibody against immune effector cells, thus redirecting their cytolytic potential against the tumor. Ovarian carcinomas and some brain tumors express the high-affinity folate receptor (FR). In this report, a transgenic mouse model that generates endogenously arising choroid plexus tumors was used to show that folate/anti-T-cell receptor antibody conjugates can direct infiltration of T cells into solid brain tumor masses. An engineered single-chain Fv form of the anti-T-cell receptor antibody KJ16 was conjugated with folate, to produce a bispecific agent that was substantially smaller than most previously characterized bispecific antibodies. Folate conjugation to the antibody increased T-cell infiltration into the tumors by 10- to 20-fold, and significantly prolonged survival of the mice.

Choroid plexus carcinoma is a rare intracranial neoplasm, affecting mainly very young children. The most common site of origin is within one of the lateral ventricles. The diagnosis of choroid plexus carcinoma is based on histological examination. Frequently subarachnoid seeding occurs and investigation at diagnosis should include examination of the cerebrospinal fluid and magnetic resonance imaging of the spinal cord. Extraneural metastases are rare. Prognosis for long-term survival ameliorates. Total surgical resection of the tumor should be attempted. Both radiotherapy and chemotherapy are used as adjuvant therapies for primary tumors. No clear difference in effectiveness of these therapies could be found. However craniospinal irradiation seems to be more effective when leptomeningeal seeding is present.

Choroid plexus carcinoma are tumors arising from epithelial cells of the choroid plexus. They distinguish from the benign choroid plexus papilloma because of their invasive capacity and cellular pleomorphism. This is a rare neoplasm and only infrequently occurs in adults. We report three cases of choroid plexus carcinoma, two women of 61 and 58 years old and a third one a child of 3 years old. We performed a review of the literature with special attention to the epidemiologic, histologic, clinic and therapeutic issues.

Carcinomas of the plexus choroideus (PCC) represent the rare malignant variety of plexus choroideus papillomas and take a particularly unfavourable course. Tumors of the plexus choroideus account for about 2-4% of all primary brain tumors in children and 0.5% of those in adults. The PCC is more frequent in children than in adults; the authors found reports on 72 cases of PCC in children and on 16 cases in adults. In most cases the PCC is located in the lateral ventricles. The symptoms caused by PCC are non specific and appear as those of increased intracranial pressure (on the basis of hydrocephalus hypersecretorius and/or occlusivus). As the nature of the tumor cannot be identified by means of medical imaging, the diagnosis is usually set up histologically. Prognosis is poor for patients treated only by surgery, which in most cases has been performed as subtotal resection of the tumor. So the necessity for an oncological strategy combining surgery and 'adjuvant' therapy arises. The authors report the application of such a strategy in the case of a three-year-old boy with a PCC of the left lateral ventricle. After nearly four years of remission, the boy died of meningeosis carcinomatosa. This course underlines the malignancy of this tumor; even after years the poor prognosis can still be diminished by the spread of meningeal metastases. In a survey of the case reports published in literature the patients' data, their therapy and the outcome are demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

The reversal of diastolic cerebral blood flow has been regarded as a characteristic waveform of brain death and a useful confirming sign. We report 2 patients who had diastolic flow reversal but survived. One, a 1-month-old boy with status epilepticus, had reversal of diastolic cerebral blood flow detected by Doppler ultrasound soon after admission. Reversal disappeared after medical management for increased intracranial pressure and seizure control. He recovered without sequelae. The other, a 6-month-old girl with choroid plexus papilloma, had reversal of diastolic flow during abrupt clinical deterioration. Emergent surgical removal of the tumor was performed and she survived with hemiparesis and psychomotor retardation. Our patients demonstrated that even in the presence of diastolic reversal of cerebral blood flow, prompt and effective treatment can avoid a fatal outcome.

Choroid plexus carcinoma (CPC) is a rare tumor with usually severe prognosis, whose optimal treatment has not yet been established. The exact role of complete surgical resection, chemotherapy, and radiotherapy has been debated but not clarified. We report one girl with CPC diagnosed at age 3 months and apparently cured with minimal surgical resection, chemotherapy, and delayed irradiation. At the age of 8 years, she is well, with minor psychomotor retardation and growth hormone deficiency as the only sequelae.

Carcinoma of the choroid plexus (CCP) is a rare tumor of the central nervous system which occurs more frequently in patients under 3 years of age. We report 10 cases of CCP in children. There were 5 males and 5 females, aged 5 to 84 months at diagnosis (median 32 months). Eight CCP were located in the lateral ventricle and 2 in the fourth ventricle. All patients underwent initial surgery, with complete resection in 5 cases. Postoperative treatment included radiotherapy alone in 4 patients, chemotherapy alone in 4, both in 1 patient, and no further treatment in one patient. Six patients remain in first continuous complete remission with a follow-up of 12 to 156 months (mean 34 months). Five of these six patients had a complete surgical resection of their tumor and 4 of them received chemotherapy alone. A comparison with the series in the literature suggests that total resection of the tumors is the major prognostic factor for survival. Recourse to additional treatments to prevent local relapses and CNS dissemination seems necessary. In our opinion, radiotherapy should be avoided as far as possible because of its deleterious effect in very young children. As some of the long term survivors did not receive radiation treatment, we conclude that CCP can be treated post operatively using chemotherapy protocols designed for infants with malignant brain tumors.

The presentation, growth patterns, and response to therapy of 11 consecutive children with choroid plexus carcinomas were analyzed, and the results were compared with the outcome reported in other series. Patients were a median of 26 months of age at diagnosis. Two patients had thalamic tumors, one had a posterior fossa primary, and the rest had ventricular lesions. Five of 11 (45%) children remain in continuous progression-free remission a median of 48 months from diagnosis. Four of the five in continuous remission had a "gross total" surgical resection, and only one received radiation therapy. Five of six patients with subtotal resections relapsed despite postoperative treatment with radiation therapy (three) and chemotherapy (one). The response to treatment with radiation therapy or chemotherapy at relapse was disappointing, with only one child (treated with etoposide) responding. In combination with other series, 11 of 14 children had prolonged progression-free survival after gross total resection (only two of whom received adjuvant therapy) compared with two of 20 after less than total resections, independent of the type of adjuvant therapy given. Adjuvant therapy for children with choroid plexus carcinomas is of unproven benefit, and this must be considered when analyzing innovative treatment trials for such children, especially for those with totally resected tumors. Patients with partially resected lesions fare poorly with present forms of treatment.

A retrospective study of 86 dogs with brain tumors was undertaken. Sixty-nine dogs had histologic confirmation of tumor type, whereas the remaining 17 dogs had CT evidence of a brain tumor. All dogs had neurologic abnormalities. Seven dogs received no treatment, 38 dogs received only symptomatic treatment, and 41 dogs received some form of definitive treatment, in addition to medical management. Types of definitive treatment included surgery, cobalt-60 radiation, whole-body hyperthermia, 125I implants, and chemotherapy, alone or in combination. The factor that was most associated with survival duration was mode of therapy. Those dogs who were treated with cobalt-60 radiation, with or without other combinations of therapy, lived significantly longer than dogs who received surgery (+/- 125I implants), or dogs who received symptomatic treatment (P = 0.01 and P less than 0.001, respectively). After statistic adjustment for treatment, multiplicity of brain involvement (solitary vs. multiple) provided prognostic information with respect to survival (P = 0.001), with dogs who had a solitary site of involvement having a better prognosis. After further adjustment, initial neurologic dysfunction (mild/moderate vs. severe) showed significance as prognostic variable (P = 0.005). Both the mild and moderate groups had a more favorable prognosis compared with dogs who had severe initial neurologic impairment. The median survival time for the 86 dogs was 1.0 month (range: 1 day-42.4 mo). Median survival times of dogs receiving: 1) no therapy or only symptomatic therapy, 2) surgery (+/- 125I), or 3) cobalt-60 radiation (+/- hyperthermia, +/- surgery) were 0.2, 0.9, and 4.9 months, respectively.