פרופסור עפר מרימסקי
מומחה באונקולוגיה קלינית וקרינתית
מעורבות מוחית בסרטן
2. Oncology. 2000 Apr;58(3):210-4.
Primary sarcomas of the central nervous system.
Merimsky O(1), Lepechoux C, Terrier P, Vanel D, Delord JP, LeCesne A.
(1)Unit of Bone and Soft Tissue Sarcomas, Department of Medicine, Institut Gustav
Roussy, Villejuif, France. firstname.lastname@example.org
The medical files of 14 patients with primary brain and spine sarcomas were
retrospectively reviewed. Ten patients had primary brain sarcomas and 4 primary
spinal sarcomas. The tumors probably originated in the brain substance or blood
vessels, in the meninges or in the inner aspect of the skull. The spinal tumors
originated in the nerve roots of the cauda equina and in the spinal substance or
blood vessels. The most common type was angiosarcoma. Removal of the brain tumors
was performed in 95% of the patients. Radiotherapy was delivered to 6 patients
with brain sarcomas and to all patients with primary spinal sarcomas. Metastatic
disease to the lung or pleural effusion was evident in 2 patients who underwent
total removal of their tumors followed by radiation therapy.
Copyright 2000 S. Karger AG, Basel
PMID: 10765122 [PubMed - indexed for MEDLINE]
4. Am J Clin Oncol. 1996 Aug;19(4):363-7.
Malignant melanoma of the head and neck. Clinical and immunological
Merimsky O(1), Fishman P, Feldman I, Shafir R, Rapaport Y, Sheonfeld Y, Chaitchik
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Israel.
Prolonged exposure to sun for long periods during most of the year has led to an
increase in the frequency of malignant melanoma in Israel, especially for head
and neck (H&N) melanoma. H & N melanoma is found in males more than in females
and diagnosed when already locally advanced. The disease-free interval between
treatment of the primary lesion and recurrence of the disease correlated with the
patient's age and the depth of invasion according to Breslow. A higher recurrence
rate correlated with male gender, location in the scalp, and the stage of the
disease. Metastatic disease involved the lungs, liver, and brain and responded
poorly to systemic therapy. Improved survival was related to female gender, early
stage of the disease, low Breslow thickness, and location of the primary lesion
elsewhere than the scalp. Immunologically, we found that the titers of
antimelanoma antibodies in patients with metastatic disease originating in the
area of the head and neck were higher than the titer in disease-free H & N
melanoma patients (p = 0.05). Moreover, patients with metastatic H & N melanoma
had a higher titer of antityrosinase antibodies compared with healthy subjects.
These two types of antibodies might be used as markers for disease progression in
H & N melanoma. The more aggressive character of H & N melanoma was not reflected
by different titers of antimelanoma antibodies nor by antityrosinase antibodies
in patients with H & N versus non-H & N melanoma.
PMID: 8677905 [PubMed - indexed for MEDLINE]
5. Am J Clin Oncol. 1996 Feb;19(1):49-53.
Computed tomography features of cerebral spread of malignant melanoma.
Reider-Groswasser I(1), Merimsky O, Karminsky N, Chaitchik S.
(1)Department of Radiology, Tel-Aviv Sourasky Medical Center, Ichilov Hospital,
Sackler Faculty of Medicine, Tel-Aviv University, Israel.
The CT features of cerebral involvement by metastatic malignant melanoma are
described in 28 patients. The most common locations of the primary lesion were
the trunk and lower limbs. There was a high incidence of extracerebral metastasis
at the time of diagnosis of cerebral involvement. Headache and behavioral changes
were the most frequent presenting symptoms; 7% of patients with asymptomatic. The
cerebral metastases were classified by size (< 1 cm, 1-4 cm, > 4 cm), with more
than half measuring 1-4 cm. The larger lesions usually occurred singly.
Peritumoral edema was detected in 89% of patients, hemorrhage in 19%, pressure
signs on the ventricles in 37%, midline deviation in 15%, and leptomeningeal
spread in 11%. No correlation was noted between size of tumor and other
radiological features. Unilateral involvement was documented in 44% of cases. In
the majority of patients the metastases were located at the periphery of the
brain, mostly in the temporal and parietal lobes. Neuroimaging studies of the
brain in asymptomatic patients with malignant melanoma may reveal occult
metastases and influence the choice of treatment.
PMID: 8554036 [PubMed - indexed for MEDLINE]
6. Melanoma Res. 1992 Dec;2(5-6):401-6.
Fotemustine--an advance in the treatment of metastatic malignant melanoma.
Merimsky O(1), Inbar M, Gerard B, Chaitchik S.
(1)Department of Oncology, Ichilov Hospital, Tel-Aviv, Israel.
Although chemotherapy has been generally of limited clinical benefit in the
treatment of metastatic malignant melanoma (MMM), fotemustine (FM) is a newly
developed drug which is active against this disease. Twenty-four patients with
histologically proven MMM were treated with fotemustine, with or without
dacarbazine (DITC) according to different phase II trials. In the first schedule,
three patients received FM alone on days 1, 8, 15 followed by a 5-week rest
period. The second schedule consisted of FM administered on days 1 and 8
alternating with DTIC on days 15 and 16, followed by a 5-week rest period (19
patients). The third schedule, given to two patients, consisted of DTIC followed
4 h later by FM. The overall response rate was 8.3%. Response in those who were
treated with alternating drugs, included one partial response (PR) in the brain
which lasted 4 months, and one PR in brain metastases with complete response (CR)
in lymph nodes for 4 months. Clinical and radiological evidence of regression was
observed mainly in brain metastases (22.2%), reflecting the intracerebral
activity of the drug. It seems that fotemustine is superior to any other drug
currently available in the treatment of these metastases.
PMID: 1292787 [PubMed - indexed for MEDLINE]
7. Melanoma Res. 1992 Dec;2(5-6):385-91.
Cerebral metastatic melanoma: correlation between clinical and CT findings.
Merimsky O(1), Reider-Groswasser I, Inbar M, Kovner F, Chaitchik S.
(1)Department of Oncology, Ichilov Hospital, Tel-Aviv Sourasky Medical Center,
Thirty patients with malignant melanoma and cerebral metastases confirmed by CT
were studied. Metastases were classified according to their size: < or = 1 cm
(group A), 1.1-4 cm (group B), and > 4 cm (group C), in order to assess the
clinical course of the disease and predict the response to treatment with
fotemustine. Group B lesions were the most common, independent of the site of the
primary tumour, except for patients with rectal melanoma. Group C metastases were
least common and were usually solitary. Asymptomatic patients usually had group A
metastases, whereas those with non-specific complaints, hemisyndrome or
neurobehavioural changes usually had group B metastases. The time from diagnosis
of the primary tumour to discovery of disease in the CNS was significantly longer
for those who had group A lesions, compared with those who had groups B or C
lesions (P < 0.0001). Solitary lesions usually belonged to groups B or C, whereas
multiple lesions belonged mainly to groups A or B. All the responders to
fotemustine has mainly cortical, group A or group B lesions. Patients with group
C lesions or leptomeningeal spread did not respond to fotemustine. Our findings
suggest an association between the size of the cerebral metastatic lesion from
malignant melanoma and clinical parameters characteristic of tumour behaviour.
PMID: 1292786 [PubMed - indexed for MEDLINE]
8. Acta Neurol Scand. 1992 Nov;86(5):521-5.
Encephalopathy in ifosfamide-treated patients.
Merimsky O(1), Reider-Groswasser I, Wigler N, Chaitchik S.
(1)Department of Oncology, Ichilov Hospital, Sourasky Medical Center, Tel-Aviv
Acute encephalopathy following treatment with ifosfamide and mesna was observed
in 5 (4 women and 1 men) of 28 patients (17.8%), with advanced sarcoma, lymphoma
or ovarian carcinoma. This appeared within 2 to 7 days following the first dose
of ifosfamide treatment, and included mental status changes, urinary
incontinence, weakness, seizure activity, altered consciousness and psychiatric
manifestations. Three cases were fatal, while two patients recovered completely.
Brain CT and morphometric studies were normal in all the patients. Associated
findings were myelosuppression, renal failure and electrolyte alterations.
PMID: 1481635 [PubMed - indexed for MEDLINE]
9. Mol Biother. 1992 Sep;4(3):135-8.
Our experience with interferon alpha: metastatic malignant melanoma.
Merimsky O(1), Chaitchik S.
(1)Department of Oncology, Ichilov Hospital, Tel Aviv Sourasky Medical Center,
Interferon-alpha and dacarbazine combination is a milestone in the treatment of
metastatic malignant melanoma. Objective response rate ranged from 3% to 25%. Our
phase II study included 34 patients; the overall response was 29.4%. Median time
of survival of the responders was significantly longer than that of the
nonresponders. Nine of the 34 patients had previously progressed on interleukin-2
(IL-2) and dacarbazine treatment, or had been withdrawn because of unacceptable
toxicity. Two patients (22.2%) achieved partial responses. There seemed to be no
cross-resistance between the two biologic response modifiers. Successful
treatment of melanoma patients by interferon resulted in complete disappearance
of all extracerebral lesions, but left the brain vulnerable to involvement by
metastases, and was frequently a site of relapse. Brain irradiation is suggested
by several investigators to prevent cerebral involvement. Ongoing protocols are
an adjuvant treatment for high-risk patients and combination of interferon-alpha,
IL-2, dacarbazine and cisplatinum for metastatic melanoma after failure of
PMID: 1445667 [PubMed - indexed for MEDLINE]
10. Anticancer Drugs. 1992 Aug;3(4):371-3.
Cortical blindness--a catastrophic side effect of vincristine.
Merimsky O(1), Loewenstein A, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Medical Center, Israel.
The term 'cortical blindness' indicates loss of sight due to bilateral lesions of
the occipital lobes. It is a rare, but severe, side effect of chemotherapeutic
agents. Cortical blindness was diagnosed in a 67 year old woman with
leiomyosarcoma of the large bowel, treated by vincristine-containing
chemotherapy. Cortical blindness without focal neurological signs and with two
repeated normal brain computed tomography scans, in which there was no structural
damage to the occipital lobes, suggests a metabolic or toxic reaction as a cause
in our patients. The temporal relationship between vincristine treatment and
cortical blindness implicates vincristine as the possible causative agent for
this catastrophic phenomenon.
PMID: 1421432 [PubMed - indexed for MEDLINE]
11. J Neurooncol. 1992 Feb;12(2):137-40.
Brain metastases of malignant melanoma in interferon complete responders:
clinical and radiological observations.
Merimsky O(1), Inbar M, Reider-Groswasser I, Chaitchik S.
(1)Department of Oncology, Ichilov Hospital, Israel.
Three patients with metastatic malignant melanoma, 2 of whom were males with
primary lesion on the shoulder, and a female with primary lesion on the ankle,
with Clark's level III-IV, completely responded to interferon-DTIC, but failed in
the brain. Radiologically, all the lesions were peripheral in location, and none
showed any bleeding tendency. Clinically, these lesions seemed to be resistant to
radiotherapy, chemotherapy or steroid treatment, and were the cause of death
after a very short survival period. Interferon apparently is inactive against
melanoma brain metastases, but does cause CNS symptoms. Because CNS metastases
are sometimes the sole site of clinical relapse, and are frequently disabling,
prophylactic cranial irradiation (PCI) needs to be studied in high risk patients.
PMID: 1560259 [PubMed - indexed for MEDLINE]
12. Am J Clin Oncol. 1992 Feb;15(1):84-6.
Fotemustine and DTIC combination in patients with disseminated malignant
Merimsky O(1), Inbar M, Chaitchik S.
(1)Department of Oncology, Ichilov Hospital, Tel-Aviv, Israel.
Seventeen patients with histologically proven melanoma and measurable metastatic
disease received 7-week cycles of fotemustine 100 mg/m2/day on days 1 and 8, and
decarbazine (DTIC) 500 mg/m2/day on days 15 and 16, in a prospective open study,
to assess the efficacy of fotemustine-DTIC combination. Response rate was 11.7%:
one partial response (PR) in brain for 4.5 months, and one PR in brain and lymph
nodes for 4 months. There was also one (5.8%) minimal response (MR) in brain,
stomach, and lymph nodes for 8 months, and three (17.6%) patients with stable
disease. Survival of responders was significantly superior to nonresponders.
There was no response in brain without response in extracerebral sites. Toxicity
was generally mild and well tolerated by all the patients. Fotemustine-DTIC
showed some activity against metastatic melanoma, and should be further
PMID: 1550085 [PubMed - indexed for MEDLINE]
13. Cancer Chemother Pharmacol. 1992;29(4):329-30.
Interferon-related cortical blindness.
Merimsky O(1), Nisipeanu P, Loewenstein A, Reider-Groswasser I, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Medical Center, Israel.
The term cortical blindness indicates loss of sight due to bilateral lesions in
the occipital lobes. It is a rare but severe side effect produced by
chemotherapeutic agents. Cortical blindness was diagnosed in a 75-year-old man
who had been treated with alpha-interferon for metastatic renal-cell carcinoma.
The absence of focal neurological signs and of abnormal findings as determined by
two repeated computed tomography (CT) scans of the brain, which excluded
structural damage to the occipital lobes, suggest that metabolic or toxic
reactions may have caused the cortical blindness diagnosed in our patient. The
temporal relationship between the treatment with alpha-interferon and the
development of cortical blindness indicates that this substance may have been the
causative agent for this phenomenon.
PMID: 1537083 [PubMed - indexed for MEDLINE]
14. Tumori. 1991 Aug 31;77(4):361-2.
Interferon-related leukoencephalopathy in a patient with renal cell carcinoma.
Merimsky O(1), Reider I, Merimsky E, Chaitchik S.
(1)Department of Oncology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University,
A 75-year-old patient with metastatic renal cell carcinoma was treated with
recombinant interferon alpha-C and thereafter developed a neurologic syndrome of
dementia, ataxia, confusional state, loss of concentration ability and cortical
blindness. CT scan findings were compatible with leukoencephalopathy, which is
reported as being a toxic effect of interferon.
PMID: 1746062 [PubMed - indexed for MEDLINE]
15. Eur J Cancer. 1991;27(9):1188-9.
Ifosfamide-related acute encephalopathy: clinical and radiological aspects.
Merimsky O, Inbar M, Reider-Groswasser I, Scharf M, Chaitchik S.
PMID: 1835639 [PubMed - indexed for MEDLINE]
16. Eur J Cancer. 1991;27(8):1066.
Fotemustine with or without dacarbazine for brain metastases of malignant
Merimsky O, Inbar M, Reider-Groswasser I, Chaitchik S.
PMID: 1832900 [PubMed - indexed for MEDLINE]
17. Isr J Med Sci. 1990 Sep;26(9):520-4.
Pregnancy and cavernous sinus involvement in a patient with primary non-Hodgkin's
lymphoma of bone.
Merimsky O(1), Reider I, Rahmani R, Chaitchik S.
(1)Department of Oncology, Sourasky Tel Aviv Medical Center, Ichilov, Israel.
PMID: 2228565 [PubMed - indexed for MEDLINE]
18. Eur J Cancer. 1990;26(5):596-600.
Interferon-related mental deterioration and behavioral changes in patients with
renal cell carcinoma.
Merimsky O(1), Reider-Groswasser I, Inbar M, Chaitchik S.
(1)Department of Oncology, Tel Aviv Sourasky Center, Ichilov Hospital, Israel.
Five out of 38 patients (13%) with metastatic renal cell carcinoma had mental
deterioration 3 weeks to 13 months after the start of treatment with recombinant
interferon alpha-C. Metastatic spread to the brain, paraneoplastic effect of the
tumor on the central nervous system and other causes of dementia were excluded.
Computed tomography of the brain in these patients was normal and the width of
the cerebral sulci and ventricles did not correlate with the severity of
dementia. Specific patterns of atrophy were not seen. General deterioration,
assessed by the change in Karnofsky performance status, was associated with
dementia. The dementia may have been caused by a neurotoxic effect of interferon.
PMID: 2144747 [PubMed - indexed for MEDLINE]