151
|
Wang F, Su H, Lin R, Chakroun RW, Monroe MK, Wang Z, Porter M, Cui H. Supramolecular Tubustecan Hydrogel as Chemotherapeutic Carrier to Improve Tumor Penetration and Local Treatment Efficacy. ACS NANO 2020; 14:10083-10094. [PMID: 32806082 DOI: 10.1021/acsnano.0c03286] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Local chemotherapy is a clinically proven strategy in treating malignant brain tumors. Its benefits, however, are largely limited by the rapid release and clearance of therapeutic agents and the inability to penetrate through tumor tissues. We report here on a supramolecular tubustecan (TT) hydrogel as both a therapeutic and drug carrier that enables long-term, sustained drug release and improved tumor tissue penetration. Covalent linkage of a tissue penetrating cyclic peptide to two camptothecin drug units creates a TT prodrug amphiphile that can associate into tubular supramolecular polymers and subsequently form a well-defined sphere-shaped hydrogel after injection into tumor tissues. The hollow nature of the resultant tubular assemblies allows for encapsulation of doxorubicin or curcumin for combination therapy. Our in vitro and in vivo studies reveal that these dual drug-bearing supramolecular hydrogels enhance tumor retention and penetration, serving as a local therapeutic depot for potent tumor regression, inhibition of tumor metastasis and recurrence, and mitigation of the off-target side effects.
Collapse
Affiliation(s)
- Feihu Wang
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Hao Su
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Ran Lin
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Rami W Chakroun
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Maya K Monroe
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Zongyuan Wang
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Michael Porter
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
| | - Honggang Cui
- Department of Chemical and Biomolecular Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, Maryland 21218, United States
- Institute for NanoBiotechnology (INBT), Johns Hopkins University, Baltimore, Maryland 21218, United States
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
- Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, United States
| |
Collapse
|
152
|
Scherer M, Ahmeti H, Roder C, Gessler F, Jungk C, Pala A, Mayer B, Senft C, Tatagiba M, Synowitz M, Wirtz CR, Unterberg AW, Coburger J. Surgery for Diffuse WHO Grade II Gliomas: Volumetric Analysis of a Multicenter Retrospective Cohort From the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery 2020; 86:E64-E74. [PMID: 31574147 DOI: 10.1093/neuros/nyz397] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In diffuse WHO grade II gliomas (LGG), the extent of resection (EOR) required to achieve significant survival benefits remains elusive. OBJECTIVE To evaluate the association of residual volume (RV) and EOR with progression-free survival (PFS) or overall survival (OS) in LGG in a retrospective, multicenter series by the German study group of intraoperative MRI (GeSGIM). METHODS Consecutive cases were retrospectively assessed from 5 centers. Tumors were volumetrically quantified before and after surgery, and clinical data were analyzed, including IDH mutations and neurologic deficits. Kaplan-Meier estimates, accelerated failure time models (AFT), and multivariate Cox regression models were calculated to identify determinants of survival. RESULTS A total of 140 cases were analyzed. Gross total resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (P = .009). A significant survival disadvantage was evident even for small (>0-5 ml) residuals and increased for moderate (>5-20 ml) and large remnants (>20 ml) P = .001). Accordingly, PFS increased continuously for 20% incremental steps of EOR (P < .001). AFT models supported the notion of a continuous association of RV and EOR with PFS. Multivariate Cox regression models confirmed RV (P = .01) and EOR (P = .005) as continuous prognosticators of PFS. Univariate analysis showed significant associations of RV and EOR with OS. CONCLUSION Our data support the hypothesis of a continuous relationship of RV and EOR with survival for LGG with superiority seen for GTR. Hence, GTR should be achieved whenever safely feasible, and resections should be maximized whenever tumor has to be left behind to spare function.
Collapse
Affiliation(s)
- Moritz Scherer
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Hajrulla Ahmeti
- Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
| | - Constantin Roder
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Florian Gessler
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Christine Jungk
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Christian Senft
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
| | | | | | - Jan Coburger
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| |
Collapse
|
153
|
Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ. Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 2020; 22:1073-1113. [PMID: 32328653 PMCID: PMC7594557 DOI: 10.1093/neuonc/noaa106] [Citation(s) in RCA: 594] [Impact Index Per Article: 148.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Glioblastomas are the most common form of malignant primary brain tumor and an important cause of morbidity and mortality. In recent years there have been important advances in understanding the molecular pathogenesis and biology of these tumors, but this has not translated into significantly improved outcomes for patients. In this consensus review from the Society for Neuro-Oncology (SNO) and the European Association of Neuro-Oncology (EANO), the current management of isocitrate dehydrogenase wildtype (IDHwt) glioblastomas will be discussed. In addition, novel therapies such as targeted molecular therapies, agents targeting DNA damage response and metabolism, immunotherapies, and viral therapies will be reviewed, as well as the current challenges and future directions for research.
Collapse
Affiliation(s)
- Patrick Y Wen
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Eudocia Quant Lee
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Brian M Alexander
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jill S Barnholtz-Sloan
- Case Western Reserve University School of Medicine and University Hospitals of Cleveland, Cleveland, Ohio, USA
| | - Floris P Barthel
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Tracy T Batchelor
- Department of Neurology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School
| | - Ranjit S Bindra
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Susan M Chang
- University of California San Francisco, San Francisco, California, USA
| | - E Antonio Chiocca
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy F Cloughesy
- David Geffen School of Medicine, Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
| | - John F DeGroot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Monika E Hegi
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Craig Horbinski
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Raymond Y Huang
- Division of Neuroradiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew B Lassman
- Department of Neurology and Herbert Irving Comprehensive Cancer Center, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Emilie Le Rhun
- University of Lille, Inserm, Neuro-oncology, General and Stereotaxic Neurosurgery service, University Hospital of Lille, Lille, France; Breast Cancer Department, Oscar Lambret Center, Lille, France and Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Ingo K Mellinghoff
- Department of Neurology and Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - David Nathanson
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University, Heidelberg, Germany
| | - Matthias Preusser
- Division of Oncology, Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière – Charles Foix, Service de Neurologie 2-Mazarin, Paris, France
| | - David Schiff
- University of Virginia School of Medicine, Division of Neuro-Oncology, Department of Neurology, University of Virginia, Charlottesville, Virginia, USA
| | - Susan C Short
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Martin J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague and Department of Neurology, Leiden University Medical Center, the Netherlands
| | | | - Jonathan Tsang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, University of California Los Angeles, Los Angeles, California, USA
| | - Roel G W Verhaak
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
| | - Andreas von Deimling
- Neuropathology and Clinical Cooperation Unit Neuropathology, University Heidelberg and German Cancer Center, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology and Neuro-oncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Gelareh Zadeh
- MacFeeters Hamilton Centre for Neuro-Oncology Research, Princess Margaret Cancer Centre, Toronto, Canada
| | - David A Reardon
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth D Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | | |
Collapse
|
154
|
Optimizing the onco-functional balance in supratentorial brain tumour surgery: A single institution's initial experience with intraoperative cortico-subcortical mapping and monitoring in Singapore. J Clin Neurosci 2020; 79:224-230. [PMID: 33070901 DOI: 10.1016/j.jocn.2020.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/04/2020] [Accepted: 07/11/2020] [Indexed: 11/23/2022]
Abstract
Intraoperative cortical mapping provides functional information that permits the safe and maximal resection of supratentorial lesions infiltrating the so-called eloquent cortex or subcortical white matter tracts. Primary and secondary brain tumours located in eloquent cortex can render surgical treatment ineffective if it results in new or worsening neurology. A cohort of forty-six consecutive patients with supratentorial tumours of variable pathology involving eloquent cortical regions and aided with intraoperative neurophysiology were included for retrospective analysis at a single-centre tertiary institution. Intraoperative neurophysiological data has been related to immediate post-operative neurologic status as well as 3-month follow-up in patients that underwent awake or asleep surgical resection. Patients that experienced new or worsening neurologic symptoms post-operatively demonstrated a high incidence of recovery at 3-months. Those without new neurologic symptoms post-operatively demonstrated little to no worsening at 3-months. Our study explored the extent to which cortical mapping permitted safe surgical resection whilst preserving neurologic function. To the authors' knowledge this is the first documented case series in Singapore that has incorporated a systematic and individually tailored multimodal workflow to cortico-subcortical mapping and monitoring for the safe resection of infiltrative lesions of the supratentorial region.
Collapse
|
155
|
ReFaey K, Chaichana KL, Feyissa AM, Vivas-Buitrago T, Brinkmann BH, Middlebrooks EH, McKay JH, Lankford DJ, Tripathi S, Bojaxhi E, Roth GE, Tatum WO, Quiñones-Hinojosa A. A 360° electronic device for recording high-resolution intraoperative electrocorticography of the brain during awake craniotomy. J Neurosurg 2020; 133:443-450. [PMID: 31277069 DOI: 10.3171/2019.4.jns19261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Epilepsy is common among patients with supratentorial brain tumors; approximately 40%-70% of patients with glioma develop brain tumor-related epilepsy (BTRE). Intraoperative localization of the epileptogenic zone during surgical tumor resection (real-time data) may improve intervention techniques in patients with lesional epilepsy, including BTRE. Accurate localization of the epileptogenic signals requires electrodes with high-density spatial organization that must be placed on the cortical surface during surgery. The authors investigated a 360° high-density ring-shaped cortical electrode assembly device, called the "circular grid," that allows for simultaneous tumor resection and real-time electrophysiology data recording from the brain surface. METHODS The authors collected data from 99 patients who underwent awake craniotomy from January 2008 to December 2018 (29 patients with the circular grid and 70 patients with strip electrodes), of whom 50 patients were matched-pair analyzed (25 patients with the circular grid and 25 patients with strip electrodes). Multiple variables were then retrospectively assessed to determine if utilization of this device provides more accurate real-time data and improves patient outcomes. RESULTS Matched-pair analysis showed higher extent of resection (p = 0.03) and a shorter transient motor recovery period during the hospitalization course (by approximately 6.6 days, p ≤ 0.05) in the circular grid patients. Postoperative versus preoperative Karnofsky Performance Scale (KPS) score difference/drop was greater for the strip electrode patients (p = 0.007). No significant difference in postoperative seizures between the 2 groups was present (p = 0.80). CONCLUSIONS The circular grid is a safe, feasible tool that grants direct access to the cortical surgical surface for tissue resection while simultaneously monitoring electrical activity. Application of the circular grid to different brain pathologies may improve intraoperative epileptogenic detection accuracy and functional outcomes, while decreasing postoperative complications.
Collapse
Affiliation(s)
| | | | | | | | - Benjamin H Brinkmann
- Departments of3Neurology and
- 4Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | | | | | | | - Shashwat Tripathi
- 6Department of Mathematics, University of Texas at Austin, Austin, Texas; and
| | - Elird Bojaxhi
- 7Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida
| | | | | | | |
Collapse
|
156
|
Birch JL, Coull BJ, Spender LC, Watt C, Willison A, Syed N, Chalmers AJ, Hossain-Ibrahim MK, Inman GJ. Multifaceted transforming growth factor-beta (TGFβ) signalling in glioblastoma. Cell Signal 2020; 72:109638. [PMID: 32320860 DOI: 10.1016/j.cellsig.2020.109638] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022]
Abstract
Glioblastoma (GBM) is an aggressive and devastating primary brain cancer which responds very poorly to treatment. The average survival time of patients is only 14-15 months from diagnosis so there is a clear and unmet need for the development of novel targeted therapies to improve patient outcomes. The multifunctional cytokine TGFβ plays fundamental roles in development, adult tissue homeostasis, tissue wound repair and immune responses. Dysfunction of TGFβ signalling has been implicated in both the development and progression of many tumour types including GBM, thereby potentially providing an actionable target for its treatment. This review will examine TGFβ signalling mechanisms and their role in the development and progression of GBM. The targeting of TGFβ signalling using a variety of approaches including the TGFβ binding protein Decorin will be highlighted as attractive therapeutic strategies.
Collapse
Affiliation(s)
| | - Barry J Coull
- Division of Cellular and Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Lindsay C Spender
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Courtney Watt
- Division of Cellular and Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Alice Willison
- Division of Cellular and Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Nelofer Syed
- The John Fulcher Molecular Neuro-Oncology Laboratory, Division of Brain Sciences, Imperial College London, London, UK
| | | | - M Kismet Hossain-Ibrahim
- Division of Cellular and Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK; Department of Neurosurgery, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - Gareth J Inman
- CRUK Beatson Institute, Glasgow, UK; Division of Cellular and Molecular Medicine, School of Medicine, University of Dundee, Dundee, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
| |
Collapse
|
157
|
Tejada Solís S, Plans Ahicart G, Iglesias Lozano I, de Quintana Schmidt C, Fernández Coello A, Hostalot Panisello C, Ley Urzaiz L, García Romero JC, Díez Valle R, González Sánchez J, Duque S. Glioblastoma treatment guidelines: Consensus by the Spanish Society of Neurosurgery Tumor Section. Neurocirugia (Astur) 2020; 31:289-298. [PMID: 32690400 DOI: 10.1016/j.neucir.2020.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/20/2020] [Accepted: 06/03/2020] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Glioblastoma (GBM) treatment starts in most patients with surgery, either resection surgery or biopsy, to reach a histology diagnose. Multidisciplinar team, including specialists in brain tumors diagnose and treatment, must make an individualize assessment to get the maximum benefit of the available treatments. MATERIAL AND METHODS Experts in each GBM treatment field have briefly described it based in their experience and the reviewed of the literature. RESULTS Each area has been summarized and the consensus of the brain tumor group has been included at the end. CONCLUSIONS GBM are aggressive tumors with a dismal prognosis, however accurate treatments can improve overall survival and quality of life. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case.
Collapse
Affiliation(s)
- Sonia Tejada Solís
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - Gerard Plans Ahicart
- Departamento de Neurocirugía, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - Irene Iglesias Lozano
- Departamento de Neurocirugía, Hospital Universitario Puerta del Mar, Barcelona, España
| | | | - Alejandro Fernández Coello
- Departamento de Neurocirugía, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | | | - Luis Ley Urzaiz
- Departamento de Neurocirugía, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Ricardo Díez Valle
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - Josep González Sánchez
- Departamento de Neurocirugía, Hospital Clínic y Provincial de Barcelona, Barcelona, España
| | - Sara Duque
- Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Majadahonda (Madrid), España
| |
Collapse
|
158
|
Qian J, Herman MG, Brinkmann DH, Laack NN, Kemp BJ, Hunt CH, Lowe V, Pafundi DH. Prediction of MGMT Status for Glioblastoma Patients Using Radiomics Feature Extraction From 18F-DOPA-PET Imaging. Int J Radiat Oncol Biol Phys 2020; 108:1339-1346. [PMID: 32634544 DOI: 10.1016/j.ijrobp.2020.06.073] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/15/2020] [Accepted: 06/28/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Methylation of the O6-methylguanine methyltransferase (MGMT) gene promoter is associated with improved treatment response and survival in patients with glioblastoma (GB), but the necessary pathologic specimen can be nondiagnostic. In this study, we assessed whether radiomics features from pretreatment 18F-DOPA positron emission tomography (PET) imaging could be used to predict pathologic MGMT status. METHODS AND MATERIALS This study included 86 patients with newly diagnosed GB, split into 3 groups (training, validating, and predicting). We performed a radiomics analysis on 18F-DOPA PET images by extracting features from 2 tumor-based contours: a "Gold" contour of all abnormal uptake per expert nuclear medicine physician and a high-grade glioma (HGG) contour based on a tumor-to-normal hemispheric ratio >2.0, representing the most aggressive components. Feature selection was performed by comparing the weighted feature importance and filtering with bivariate analysis. Optimization of model parameters was explored using grid search with selected features. The stability of the model with increasing input features was also investigated for model robustness. The model predictions were then applied by comparing the overall survival probability of the patients with GB and unknown MGMT status versus those with known MGMT status. RESULTS A radiomics signature was constructed to predict MGMT methylation status. Using features extracted from HGG contour alone with a random forest model, we achieved 80% ± 10% accuracy for 95% confidence level in predicting MGMT status. The prediction accuracy was not improved with the addition of the Gold contour or with more input features. The model was applied to the patients with unknown MGMT methylation status. The prediction results are consistent with what is expected using overall survival as a surrogate. CONCLUSIONS This study suggests that 3 features from radiomics modeling of 18F-DOPA PET imaging can predict MGMT methylation status with reasonable accuracy. These results could provide valuable therapeutic guidance for patients in whom MGMT testing is inconclusive or nondiagnostic.
Collapse
Affiliation(s)
- Jing Qian
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley J Kemp
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| | | | - Val Lowe
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota
| | - Deanna H Pafundi
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida.
| |
Collapse
|
159
|
Tan AC, Ashley DM, López GY, Malinzak M, Friedman HS, Khasraw M. Management of glioblastoma: State of the art and future directions. CA Cancer J Clin 2020; 70:299-312. [PMID: 32478924 DOI: 10.3322/caac.21613] [Citation(s) in RCA: 947] [Impact Index Per Article: 236.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/05/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
Glioblastoma is the most common malignant primary brain tumor. Overall, the prognosis for patients with this disease is poor, with a median survival of <2 years. There is a slight predominance in males, and incidence increases with age. The standard approach to therapy in the newly diagnosed setting includes surgery followed by concurrent radiotherapy with temozolomide and further adjuvant temozolomide. Tumor-treating fields, delivering low-intensity alternating electric fields, can also be given concurrently with adjuvant temozolomide. At recurrence, there is no standard of care; however, surgery, radiotherapy, and systemic therapy with chemotherapy or bevacizumab are all potential options, depending on the patient's circumstances. Supportive and palliative care remain important considerations throughout the disease course in the multimodality approach to management. The recently revised classification of glioblastoma based on molecular profiling, notably isocitrate dehydrogenase (IDH) mutation status, is a result of enhanced understanding of the underlying pathogenesis of disease. There is a clear need for better therapeutic options, and there have been substantial efforts exploring immunotherapy and precision oncology approaches. In contrast to other solid tumors, however, biological factors, such as the blood-brain barrier and the unique tumor and immune microenvironment, represent significant challenges in the development of novel therapies. Innovative clinical trial designs with biomarker-enrichment strategies are needed to ultimately improve the outcome of patients with glioblastoma.
Collapse
Affiliation(s)
- Aaron C Tan
- Division of Medical Oncology, National Cancer Center Singapore, Singapore
| | - David M Ashley
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA
| | - Giselle Y López
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Michael Malinzak
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Henry S Friedman
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA
| | - Mustafa Khasraw
- The Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA
| |
Collapse
|
160
|
Suarez-Meade P, Marenco-Hillembrand L, Prevatt C, Murguia-Fuentes R, Mohamed A, Alsaeed T, Lehrer EJ, Brigham T, Ruiz-Garcia H, Sabsevitz D, Middlebrooks EH, Bechtle PS, Quinones-Hinojosa A, Chaichana KL. Awake vs. asleep motor mapping for glioma resection: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162:1709-1720. [PMID: 32388682 DOI: 10.1007/s00701-020-04357-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Intraoperative stimulation (IS) mapping has become the preferred standard treatment for eloquent tumors as it permits a more accurate identification of functional areas, allowing surgeons to achieve higher extents of resection (EOR) and decrease postoperative morbidity. For lesions adjacent to the perirolandic area and descending motor tracts, mapping can be done with both awake craniotomy (AC) and under general anesthesia (GA). OBJECTIVE We aimed to determine which anesthetic protocol-AC vs. GA-provides better patient outcomes by comparing EOR and postoperative morbidity for surgeries using IS mapping in gliomas located near or in motor areas of the brain. METHODS A systematic literature search was carried out to identify relevant studies from 1983 to 2019. Seven databases were screened. A total of 2351 glioma patients from 17 studies were analyzed. RESULTS A random-effects meta-analysis revealed a trend towards a higher mean EOR in AC [90.1% (95% C.I. 85.8-93.8)] than with GA [81.7% (95% C.I. 72.4-89.7)] (p = 0.06). Neurological deficits were divided by timing and severity for analysis. There was no significant difference in early neurological deficits [20.9% (95% C.I. 4.1-45.0) vs. 25.4% (95% C.I. 13.6-39.2)] (p = 0.74), late neurological deficits [17.1% (95% C.I. 0.0-50.0) vs. 3.8% (95% C.I. 1.1-7.6)] (p = 0.06), or in non-severe [28.4% (95% C.I. 0.0-88.5) vs. 20.1% (95% C.I. 7.1-32.2)] (p = 0.72), and severe morbidity [2.6% (95% C.I. 0.0-15.5) vs. 4.5% (95% C.I. 1.1-9.6)] (p = 0.89) between patients who underwent AC versus GA, respectively. CONCLUSION Mapping during resection of gliomas located in or near the perirolandic area and descending motor tracts can be safely carried out with both AC and GA.
Collapse
Affiliation(s)
- Paola Suarez-Meade
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Lina Marenco-Hillembrand
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Calder Prevatt
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ricardo Murguia-Fuentes
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Alea Mohamed
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Thannon Alsaeed
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tara Brigham
- Mayo Clinic Libraries, Mayo Clinic, Jacksonville, FL, USA
| | - Henry Ruiz-Garcia
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - David Sabsevitz
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Perry S Bechtle
- Anesthesiology Department, Mayo Clinic, Jacksonville, FL, USA
| | | | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
| |
Collapse
|
161
|
Exploiting Cancer's Tactics to Make Cancer a Manageable Chronic Disease. Cancers (Basel) 2020; 12:cancers12061649. [PMID: 32580319 PMCID: PMC7352192 DOI: 10.3390/cancers12061649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
The history of modern oncology started around eighty years ago with the introduction of cytotoxic agents such as nitrogen mustard into the clinic, followed by multi-agent chemotherapy protocols. Early success in radiation therapy in Hodgkin lymphoma gave birth to the introduction of radiation therapy into different cancer treatment protocols. Along with better understanding of cancer biology, we developed drugs targeting cancer-related cellular and genetic aberrancies. Discovery of the crucial role of vasculature in maintenance, survival, and growth of a tumor opened the way to the development of anti-angiogenic agents. A better understanding of T-cell regulatory pathways advanced immunotherapy. Awareness of stem-like cancer cells and their role in cancer metastasis and local recurrence led to the development of drugs targeting them. At the same time, sequential and rapidly accelerating advances in imaging and surgical technology have markedly increased our ability to safely remove ≥90% of tumor cells. While we have advanced our ability to kill cells from multiple directions, we have still failed to stop most types of cancer from recurring. Here we analyze the tactics employed in cancer evolution; namely, chromosomal instability (CIN), intra-tumoral heterogeneity (ITH), and cancer-specific metabolism. These tactics govern the resistance to current cancer therapeutics. It is time to focus on maximally delaying the time to recurrence, with drugs that target these fundamental tactics of cancer evolution. Understanding the control of CIN and the optimal state of ITH as the most important tactics in cancer evolution could facilitate the development of improved cancer therapeutic strategies designed to transform cancer into a manageable chronic disease.
Collapse
|
162
|
ReFaey K, Tripathi S, Bhargav AG, Grewal SS, Middlebrooks EH, Sabsevitz DS, Jentoft M, Brunner P, Wu A, Tatum WO, Ritaccio A, Chaichana KL, Quinones-Hinojosa A. Potential differences between monolingual and bilingual patients in approach and outcome after awake brain surgery. J Neurooncol 2020; 148:587-598. [PMID: 32524393 DOI: 10.1007/s11060-020-03554-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION 20.8% of the United States population and 67% of the European population speak two or more languages. Intraoperative different languages, mapping, and localization are crucial. This investigation aims to address three questions between BL and ML patients: (1) Are there differences in complications (i.e. seizures) and DECS techniques during intra-operative brain mapping? (2) Is EOR different? and (3) Are there differences in the recovery pattern post-surgery? METHODS Data from 56 patients that underwent left-sided awake craniotomy for tumors infiltrating possible dominant hemisphere language areas from September 2016 to June 2019 were identified and analyzed in this study; 14 BL and 42 ML control patients. Patient demographics, education level, and the age of language acquisition were documented and evaluated. fMRI was performed on all participants. RESULTS 0 (0%) BL and 3 (7%) ML experienced intraoperative seizures (P = 0.73). BL patients received a higher direct DECS current in comparison to the ML patients (average = 4.7, 3.8, respectively, P = 0.03). The extent of resection was higher in ML patients in comparison to the BL patients (80.9 vs. 64.8, respectively, P = 0.04). The post-operative KPS scores were higher in BL patients in comparison to ML patients (84.3, 77.4, respectively, P = 0.03). BL showed lower drop in post-operative KPS in comparison to ML patients (- 4.3, - 8.7, respectively, P = 0.03). CONCLUSION We show that BL patients have a lower incidence of intra-operative seizures, lower EOR, higher post-operative KPS and tolerate higher DECS current, in comparison to ML patients.
Collapse
Affiliation(s)
- Karim ReFaey
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Shashwat Tripathi
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Mathematics, University of Texas at Austin, Austin, TX, USA
| | - Adip G Bhargav
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN, USA
| | - Sanjeet S Grewal
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Erik H Middlebrooks
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - David S Sabsevitz
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Psychology, Mayo Clinic, Jacksonville, FL, USA
| | - Mark Jentoft
- Department of Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Peter Brunner
- Albany Medical College, Albany, NY, USA.,National Center for Adaptive Neurotechnologies, Albany, NY, USA
| | - Adela Wu
- Department of Neurologic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | | | | | - Alfredo Quinones-Hinojosa
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA. .,Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, 4500 San Pablo Rd. S, FloridaJacksonville, FL, 32224, USA.
| |
Collapse
|
163
|
Postoperative outcomes following glioblastoma resection using a robot-assisted digital surgical exoscope: a case series. J Neurooncol 2020; 148:519-527. [PMID: 32519286 DOI: 10.1007/s11060-020-03543-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/22/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Maximal extent of resection (EOR) of glioblastoma (GBM) is associated with greater progression free survival (PFS) and improved patient outcomes. Recently, a novel surgical system has been developed that includes a 2D, robotically-controlled exoscope and brain tractography display. The purpose of this study was to assess outcomes in a series of patients with GBM undergoing resections using this surgical exoscope. METHODS A retrospective review was conducted for robotic exoscope assisted GBM resections between 2017 and 2019. EOR was computed from volumetric analyses of pre- and post-operative MRIs. Demographics, pathology/MGMT status, imaging, treatment, and outcomes data were collected. The relationship between these perioperative variables and discharge disposition as well as progression-free survival (PFS) was explored. RESULTS A total of 26 patients with GBM (median age = 57 years) met inclusion criteria, comprising a total of 28 cases. Of these, 22 (79%) tumors were in eloquent regions, most commonly in the frontal lobe (14 cases, 50%). The median pre- and post-operative volumes were 24.0 cc and 1.3 cc, respectively. The median extent of resection for the cohort was 94.8%, with 86% achieving 6-month PFS. The most common neurological complication was a motor deficit followed by sensory loss, while 8 patients (29%) were symptom-free. CONCLUSIONS The robotic exoscope is safe and effective for patients undergoing GBM surgery, with a majority achieving large-volume resections. These patients experienced complication profiles similar to those undergoing treatment with the traditional microscope. Further studies are needed to assess direct comparisons between exoscope and microscope-assisted GBM resection.
Collapse
|
164
|
De Barros A, Attal J, Roques M, Nicolau J, Sol JC, Charni S, Cohen-Jonathan-Moyal E, Roux FE. Glioblastoma survival is better analyzed on preradiotherapy MRI than on postoperative MRI residual volumes: A retrospective observational study. Clin Neurol Neurosurg 2020; 196:105972. [PMID: 32512407 DOI: 10.1016/j.clineuro.2020.105972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/09/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Establishing an overall survival prognosis for resected glioblastoma during routine postoperative management remains a challenge. The aim of our single-center study was to assess the usefulness of basing survival analyses on preradiotherapy MRI (PRMR) rather than on postoperative MRI (POMR). PATIENTS AND METHODS A retrospective review was undertaken of 75 patients with glioblastoma treated at our institute. We collected overall survival and MRI volumetric data. We analyzed two types of volumetric data: residual tumor volume and extent of resection. Overall survival rates were compared according to these two types of volumetric data, calculated on either POMR or PRMR and according to the presence or absence of residual enhancement. RESULTS Analysis of volumetric data revealed progression of some residual tumors between POMR and PRMR. Kaplan-Meier analysis of the correlations between extent of resection, residual tumor volume, and overall survival revealed significant differences between POMR and PRMR data. Both MRI scans indicated a difference between the complete resection subgroup and the incomplete resection subgroup, as median overall survival was longer in patients with complete resection. However, differences were significant for PRMR (25.3 vs. 15.5, p = 0.012), but not for POMR (21.3 vs. 15.8 months, p = 0.145). With a residual tumor volume cut-off value of 3 cm3, Kaplan-Meier survival analysis revealed non-significant differences on POMR (p = 0.323) compared with PRMR (p = 0.007). CONCLUSION Survival in patients with resected glioblastoma was more accurately predicted by volumetric data acquired with PRMR. Differences in predicted survival between the POMR and PRMR groups can be attributed to changes in tumor behavior before adjuvant therapy.
Collapse
Affiliation(s)
- Amaury De Barros
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France.
| | - Justine Attal
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France
| | - Margaux Roques
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Neuroradiology Department, Toulouse University Hospital, Toulouse, France
| | - Julien Nicolau
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France
| | - Jean-Christophe Sol
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France
| | - Saloua Charni
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France
| | - Elizabeth Cohen-Jonathan-Moyal
- Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse-Oncopôle, 1 Avenue Irène Joliot-Curie, 31059, Toulouse, France; INSERM U1037, Centre de Recherche contre le Cancer de Toulouse, 1 avenue Irène Joliot-Curie, Toulouse Cedex, 31059, France
| | - Franck-Emmanuel Roux
- Pôle Neuroscience (Neurochirurgie), Toulouse University Hospital, Toulouse, France; Université Paul Sabatier, Toulouse III, 118 route de Narbonne, Toulouse, 31062, France; CNRS UMR5549 Brain and Cognition (Cerco), Hôpital Purpan, Toulouse, France
| |
Collapse
|
165
|
Müller DMJ, Robe PAJT, Eijgelaar RS, Witte MG, Visser M, de Munck JC, Broekman MLD, Seute T, Hendrikse J, Noske DP, Vandertop WP, Barkhof F, Kouwenhoven MCM, Mandonnet E, Berger MS, De Witt Hamer PC. Comparing Glioblastoma Surgery Decisions Between Teams Using Brain Maps of Tumor Locations, Biopsies, and Resections. JCO Clin Cancer Inform 2020; 3:1-12. [PMID: 30673344 PMCID: PMC6873995 DOI: 10.1200/cci.18.00089] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The aim of glioblastoma surgery is to maximize the extent of resection while preserving functional integrity, which depends on the location within the brain. A standard to compare these decisions is lacking. We present a volumetric voxel-wise method for direct comparison between two multidisciplinary teams of glioblastoma surgery decisions throughout the brain. Methods Adults undergoing first-time glioblastoma surgery from 2012 to 2013 performed by two neuro-oncologic teams were included. Patients had had a diagnostic biopsy or resection. Preoperative tumors and postoperative residues were segmented on magnetic resonance imaging in three dimensions and registered to standard brain space. Voxel-wise probability maps of tumor location, biopsy, and resection were constructed for each team to compare patient referral bias, indication variation, and treatment variation. To evaluate the quality of care, subgroups of differentially resected brain regions were analyzed for survival and functional outcome. Results One team included 101 patients, and the other included 174; 91 tumors were biopsied, and 181 were resected. Patient characteristics were largely comparable between teams. Distributions of tumor locations were dissimilar, suggesting referral bias. Distributions of biopsies were similar, suggesting absence of indication variation. Differentially resected regions were identified in the anterior limb of the right internal capsule and the right caudate nucleus, indicating treatment variation. Patients with (n = 12) and without (n = 6) surgical removal in these regions had similar overall survival and similar permanent neurologic deficits. Conclusion Probability maps of tumor location, biopsy, and resection provide additional information that can inform surgical decision making across multidisciplinary teams for patients with glioblastoma.
Collapse
Affiliation(s)
| | | | | | - Marnix G Witte
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Martin Visser
- University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan C de Munck
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Tatjana Seute
- University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - David P Noske
- Vrije Universiteit Medical Center, Amsterdam, the Netherlands
| | | | - Frederik Barkhof
- University Medical Center Utrecht, Utrecht, the Netherlands.,University College London, London, United Kingdom
| | | | | | | | | |
Collapse
|
166
|
Ponnapalli SP, Bradley MW, Devine K, Bowen J, Coppens SE, Leraas KM, Milash BA, Li F, Luo H, Qiu S, Wu K, Yang H, Wittwer CT, Palmer CA, Jensen RL, Gastier-Foster JM, Hanson HA, Barnholtz-Sloan JS, Alter O. Retrospective clinical trial experimentally validates glioblastoma genome-wide pattern of DNA copy-number alterations predictor of survival. APL Bioeng 2020; 4:026106. [PMID: 32478280 PMCID: PMC7229984 DOI: 10.1063/1.5142559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Modeling of genomic profiles from the Cancer Genome Atlas (TCGA) by using recently developed mathematical frameworks has associated a genome-wide pattern of DNA copy-number alterations with a shorter, roughly one-year, median survival time in glioblastoma (GBM) patients. Here, to experimentally test this relationship, we whole-genome sequenced DNA from tumor samples of patients. We show that the patients represent the U.S. adult GBM population in terms of most normal and disease phenotypes. Intratumor heterogeneity affects ≈ 11 % and profiling technology and reference human genome specifics affect <1% of the classifications of the tumors by the pattern, where experimental batch effects normally reduce the reproducibility, i.e., precision, of classifications based upon between one to a few hundred genomic loci by >30%. With a 2.25-year Kaplan-Meier median survival difference, a 3.5 univariate Cox hazard ratio, and a 0.78 concordance index, i.e., accuracy, the pattern predicts survival better than and independent of age at diagnosis, which has been the best indicator since 1950. The prognostic classification by the pattern may, therefore, help to manage GBM pseudoprogression. The diagnostic classification may help drugs progress to regulatory approval. The therapeutic predictions, of previously unrecognized targets that are correlated with survival, may lead to new drugs. Other methods missed this relationship in the roughly 3B-nucleotide genomes of the small, order of magnitude of 100, patient cohorts, e.g., from TCGA. Previous attempts to associate GBM genotypes with patient phenotypes were unsuccessful. This is a proof of principle that the frameworks are uniquely suitable for discovering clinically actionable genotype-phenotype relationships.
Collapse
Affiliation(s)
- Sri Priya Ponnapalli
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah 84112, USA
| | | | - Karen Devine
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
| | - Jay Bowen
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Sara E. Coppens
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Kristen M. Leraas
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA
| | - Brett A. Milash
- Center for High-Performance Computing, University of Utah, Salt Lake City, Utah 84112, USA
| | - Fuqiang Li
- Beijing Genomics Institute (BGI) -Shenzhen, Shenzhen, Guangdong 518083, China
| | - Huijuan Luo
- Beijing Genomics Institute (BGI) -Shenzhen, Shenzhen, Guangdong 518083, China
| | - Shi Qiu
- BGI-Americas, Cambridge, Massachusetts 02142, USA
| | | | | | - Carl T. Wittwer
- Department of Pathology, University of Utah, Salt Lake City, Utah 84112, USA
| | | | | | | | | | - Jill S. Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA
| | - Orly Alter
- Author to whom correspondence should be addressed:
| |
Collapse
|
167
|
Di L, Heath RN, Shah AH, Sanjurjo AD, Eichberg DG, Luther EM, de la Fuente MI, Komotar RJ, Ivan ME. Resection versus biopsy in the treatment of multifocal glioblastoma: a weighted survival analysis. J Neurooncol 2020; 148:155-164. [PMID: 32394325 DOI: 10.1007/s11060-020-03508-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECT Diffuse tumor invasion in multifocal/multicentric GBM (mGBM) often foreshadows poor survival outcome. The correlation between extent of resection in gliomas and patient outcome is well described. The objective of this study was to assess the effect of gross total resection compared to biopsy for mGBM on patient overall survival and progression free survival. METHODS Thirty-four patients with mGBM received either biopsy or resection of their largest enhancing lesion from 2011 to 2019. Relevant demographic, peri-operative, and radiographic data were collected. Tumor burden and extent of resection was assessed through measurement of pre-operative and post-operative contrast-enhancing volume. An adjusted Kaplan-Meier survival analysis was conducted using inverse probability of treatment weighting (IPTW) to account for the covariates of age, number of lesions, satellite tumor volume, total pre-operative tumor volume, degree of spread, and location. RESULTS Thirty-four patients were identified with sixteen (47.1%) and eighteen (52.9%) patients receiving resection and biopsy respectively. Patients receiving resection exhibited greater median overall survival but not progression free survival compared to biopsy on IPTW analysis (p = 0.026, p = 0.411). Greater than or equal to 85% extent of resection was significantly associated with increased median overall survival (p = 0.016). CONCLUSION Overall, our study suggests that resection of the largest contrast-enhancing lesion may provide a survival benefit. Our volumetric analysis suggests that a greater degree of resection results in improved survival. Employing IPTW analysis, we sought to control for selection bias in our retrospective analysis. Thus, aggressive surgical treatment of mGBM may offer improved outcomes. Further clinical trials are needed.
Collapse
Affiliation(s)
- Long Di
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA.
| | - Rainya N Heath
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA
| | - Alexander D Sanjurjo
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA
| | - Evan M Luther
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA
| | - Macarena I de la Fuente
- Department of Neurology, University of Miami School of Medicine, 1120 NW 14th St, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL, 33136, USA
| | - Michael E Ivan
- Department of Neurological Surgery, University of Miami School of Medicine, 1095 NW 14th Terr, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, Miami, FL, 33136, USA
| |
Collapse
|
168
|
Impact of Early Reoperation on the Prognosis of Patients Operated on for Glioblastoma. World Neurosurg 2020; 139:e592-e600. [PMID: 32330620 DOI: 10.1016/j.wneu.2020.04.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The prognosis for patients with glioblastoma depends particularly on the degree of tumor resection. Patients with tumor remnants in postsurgical magnetic resonance imaging (<72 hours) may benefit from early reoperation. We present our results concerning the impact on overall survival (OS) and progression-free survival (PFS) of reoperation in patients who have already undergone surgery for glioblastoma. METHODS This study included all patients who had undergone surgery for glioblastoma with control magnetic resonance imaging, who received adjuvant therapy as per the Stupp protocol, with a minimum follow-up of 24 months. We recorded the number of complete resections, partial resections, and early reoperations. We determined the impact on OS and PFS of the early reoperations and the functional status. We considered complete resection when the volume of the residual tumor was 0 cm3. RESULTS A total of 112 patients were diagnosed with glioblastoma between March 2014 and March 2017. The study included 58 patients who fulfilled all the inclusion criteria. Complete resection was achieved in 24 patients (41.4%) and partial resection in 34 (58.6%). Of these 34 patients, 11 (32.35%) underwent early reoperation. The final result was complete resection in 58.62% of the patients. In the patients who underwent reoperation, OS and PFS were 30.3 months and 16.6 months compared with 12.7 months and 6.75 months in those without reoperation (P = 0.013 and P = 0.012). The functional prognosis was similar between the 2 groups. CONCLUSIONS Early reoperation in patients with residual tumor improved OS and PFS without increasing the number of complications compared with the patients who did not undergo reoperation.
Collapse
|
169
|
Brehmer S, Grimm MA, Förster A, Seiz-Rosenhagen M, Welzel G, Stieler F, Wenz F, Groden C, Mai S, Hänggi D, Giordano FA. Study Protocol: Early Stereotactic Gamma Knife Radiosurgery to Residual Tumor After Surgery of Newly Diagnosed Glioblastoma (Gamma-GBM). Neurosurgery 2020; 84:1133-1137. [PMID: 29688510 DOI: 10.1093/neuros/nyy156] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common malignant brain tumor in adult patients. Tumor recurrence commonly occurs around the resection cavity, especially after subtotal resection (STR). Consequently, the extent of resection correlates with overall survival (OS), suggesting that depletion of postoperative tumor remnants will improve outcome. OBJECTIVE To assess safety and efficacy of adding stereotactic radiosurgery (SRS) to the standard treatment of GBM in patients with postoperative residual tumor. METHODS Gamma-GBM is a single center, open-label, prospective, single arm, phase II study that includes patients with newly diagnosed GBM (intraoperative via frozen sections) who underwent STR (residual tumor will be identified by native and contrast enhanced T1-weighted magnetic resonance imaging scans). All patients will receive SRS with 15 Gy (prescribed to the 50% isodose enclosing all areas of residual tumor) early (within 24-72 h) after surgery. Thereafter, all patients undergo standard-of-care therapy for GBM (radiochemotherapy with 60 Gy external beam radiotherapy [EBRT] plus concomitant temozolomide and 6 cycles of adjuvant temozolomide chemotherapy). The primary outcome is median progression-free survival, secondary outcomes are median OS, occurrence of radiation induced acute (<3 wk), early delayed (<3 mo), and late (>3 mo post-SRS) neurotoxicity and incidence of symptomatic radionecrosis. EXPECTED OUTCOMES We expect to detect efficacy and safety signals by the immediate application of SRS to standard-of-care therapy in newly diagnosed GBM. DISCUSSION Early postoperative SRS to areas of residual tumor could bridge the therapeutic gap between surgery and adjuvant therapies.
Collapse
Affiliation(s)
- Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Mario Alexander Grimm
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Uni-versity Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Grit Welzel
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Florian Stieler
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, Uni-versity Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Sabine Mai
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Frank Anton Giordano
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| |
Collapse
|
170
|
Papageorgiou GI, Razis ED. CNS Tumors in Adolescents and Young Adults: The Need for a Holistic Specialized Approach. JCO Oncol Pract 2020; 16:155-162. [DOI: 10.1200/jop.18.00767] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
CNS tumors are one of the most common causes of cancer-related death in the 15- to 39-year-old age group. The management of adolescents and young adults (AYAs) who are diagnosed with brain tumors presents unique endocrine, developmental, and psychosocial issues. AYAs are frequently diagnosed late, after a prolonged period of misdiagnosis. The epidemiology, biology, prognosis, and overall management of these tumors differ from those of both older and younger age groups. AYAs are usually in a transitional phase in their lives, and brain tumors in this age group carry a better prognosis than in older adults; thus, special attention should be paid to survivorship care. Fertility and other treatment-related sequelae that affect the quality of life, as well as the increased risk of secondary malignancies in long-term survivors, are such examples. Although most AYAs are managed by adult or, to a lesser extent pediatric, oncologists, a multidisciplinary approach in the setting of specialized centers with increased participation in clinical trials is preferable. End-of-life and palliative care remain an unmet need for these patients, because most physicians lack the training to discuss such issues with young patients.
Collapse
|
171
|
Behling F, Barrantes-Freer A, Behnes CL, Stockhammer F, Rohde V, Adel-Horowski A, Rodríguez-Villagra OA, Barboza MA, Brück W, Lehmann U, Stadelmann C, Hartmann C. Expression of Olig2, Nestin, NogoA and AQP4 have no impact on overall survival in IDH-wildtype glioblastoma. PLoS One 2020; 15:e0229274. [PMID: 32160197 PMCID: PMC7065747 DOI: 10.1371/journal.pone.0229274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Abstract
Despite many years of research efforts and clinical trials the prognosis of patients diagnosed with glioblastoma remains very poor. The oligodendrocyte transcription factor 2 (Olig2) was identified as a marker for glioma stem cells, which are believed to be responsible for glioma recurrence and therapy resistance. In this retrospective analysis we assessed the prognostic value of oligodendroglial and glioma stem cell markers in 113 IDH-wildtype glioblastomas. Immunohistochemical staining for Olig2, NogoA, AQP4 and Nestin was performed in combination with sequencing of IDH1 and IDH2 as well as promotor methylation analysis of the MGMT gene. Even though differences in overall survival according to Olig2 expression were observed, univariate and multivariate survival analysis did not reveal a firm significant prognostic impact of Olig2, NogoA, AQP4 or Nestin expression. Additionally, no differences in the expression of these markers depending on clinical status, age or gender were found. The established independent prognostic factors age<65, Karnofsky Performance Status> = 70 and methylated MGMT gene promoter were significant in the multivariate analysis. In conclusion expression of oligodendroglial and glioma stem cell markers do not have an independent prognostic effect in IDH-wildtype glioblastoma.
Collapse
Affiliation(s)
- Felix Behling
- Institute of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
- Department of Neurosurgery, University Hospital Tuebingen, Tuebingen, Germany
- Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital Tuebingen, Tuebingen, Germany
| | - Alonso Barrantes-Freer
- Institute of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
- Department of Neuropathology, Leipzig University Medicine, Leipzig, Germany
| | - Carl Ludwig Behnes
- Institute of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Florian Stockhammer
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Antonia Adel-Horowski
- Department of Neurosurgery, University Medical Center Goettingen, Goettingen, Germany
| | - Odir Antonio Rodríguez-Villagra
- Neuroscience Research Center, University of Costa Rica, San José, Costa Rica
- Institute for Psychological Research, University of Costa Rica, San José, Costa Rica
| | - Miguel Angel Barboza
- Neurosciences Department, Hospital Dr. Rafael A. Calderón Guardia, CCSS, University of Costa Rica, San José, Costa Rica
| | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Ulrich Lehmann
- Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Christine Stadelmann
- Institute of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Christian Hartmann
- Department of Neuropathology, Institute of Pathology, Hannover Medical School, Hannover, Germany
- * E-mail:
| |
Collapse
|
172
|
Katsevman GA, Turner RC, Urhie O, Voelker JL, Bhatia S. Utility of sodium fluorescein for achieving resection targets in glioblastoma: increased gross- or near-total resections and prolonged survival. J Neurosurg 2020; 132:914-920. [PMID: 30738388 DOI: 10.3171/2018.10.jns181174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 10/04/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE It is commonly reported that achieving gross-total resection of contrast-enhancing areas in patients with glioblastoma (GBM) improves overall survival. Efforts to achieve an improved resection have included the use of both imaging and pharmacological adjuvants. The authors sought to investigate the role of sodium fluorescein in improving the rates of gross-total resection of GBM and to assess whether patients undergoing resection with fluorescein have improved survival compared to patients undergoing resection without fluorescein. METHODS A retrospective chart review was performed on 57 consecutive patients undergoing 64 surgeries with sodium fluorescein to treat newly diagnosed or recurrent GBMs from May 2014 to June 2017 at a teaching institution. Outcomes were compared to those in patients with GBMs who underwent resection without fluorescein. RESULTS Complete or near-total (≥ 98%) resection was achieved in 73% (47/64) of fluorescein cases. Of 42 cases thought not to be amenable to complete resection, 10 procedures (24%) resulted in gross-total resection and 15 (36%) resulted in near-total resection following the use of sodium fluorescein. No patients developed any local or systemic side effects after fluorescein injection. Patients undergoing resection with sodium fluorescein, compared to the non-fluorescein-treated group, had increased rates of gross- or near-total resection (73% vs 53%, respectively; p < 0.05) as well as improved median survival (78 weeks vs 60 weeks, respectively; p < 0.360). CONCLUSIONS This study is the largest case series to date demonstrating the beneficial effect of utilizing sodium fluorescein as an adjunct in GBM resection. Sodium fluorescein facilitated resection in cases in which it was employed, including dominant-side resections particularly near speech and motor regions. The cohort of patients in which sodium fluorescein was utilized had statistically significantly increased rates of gross- or near-total resection. Additionally, the fluorescein group demonstrated prolonged median survival, although this was not statistically significant. This work demonstrates the promise of an affordable and easy-to-implement strategy for improving rates of total resection of contrast-enhancing areas in patients with GBM.
Collapse
Affiliation(s)
| | | | - Ogaga Urhie
- 2West Virginia University School of Medicine, Morgantown, West Virginia
| | | | | |
Collapse
|
173
|
Multi-modality imaging assisted fluorescence-guided resection of glioblastoma: Case report. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2019.100593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
174
|
Ius T, Pignotti F, Della Pepa GM, La Rocca G, Somma T, Isola M, Battistella C, Gaudino S, Polano M, Dal Bo M, Bagatto D, Pegolo E, Chiesa S, Arcicasa M, Olivi A, Skrap M, Sabatino G. A Novel Comprehensive Clinical Stratification Model to Refine Prognosis of Glioblastoma Patients Undergoing Surgical Resection. Cancers (Basel) 2020; 12:E386. [PMID: 32046132 PMCID: PMC7072471 DOI: 10.3390/cancers12020386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Despite recent discoveries in genetics and molecular fields, glioblastoma (GBM) prognosis still remains unfavorable with less than 10% of patients alive 5 years after diagnosis. Numerous studies have focused on the research of biological biomarkers to stratify GBM patients. We addressed this issue in our study by using clinical/molecular and image data, which is generally available to Neurosurgical Departments in order to create a prognostic score that can be useful to stratify GBM patients undergoing surgical resection. By using the random forest approach [CART analysis (classification and regression tree)] on Survival time data of 465 cases, we developed a new prediction score resulting in 10 groups based on extent of resection (EOR), age, tumor volumetric features, intraoperative protocols and tumor molecular classes. The resulting tree was trimmed according to similarities in the relative hazard ratios amongst groups, giving rise to a 5-group classification tree. These 5 groups were different in terms of overall survival (OS) (p < 0.000). The score performance in predicting death was defined by a Harrell's c-index of 0.79 (95% confidence interval [0.76-0.81]). The proposed score could be useful in a clinical setting to refine the prognosis of GBM patients after surgery and prior to postoperative treatment.
Collapse
Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Fabrizio Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (F.P.); (G.S.); (G.L.R.)
| | | | - Giuseppe La Rocca
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (F.P.); (G.S.); (G.L.R.)
- Institute of Neurosurgery, Catholic University, 00168 Rome, Italy; (G.M.D.P.); (A.O.)
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy;
| | - Miriam Isola
- Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (M.I.); (C.B.)
| | - Claudio Battistella
- Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (M.I.); (C.B.)
| | - Simona Gaudino
- Institute of radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Maurizio Polano
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (M.P.); (M.D.B.)
| | - Michele Dal Bo
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (M.P.); (M.D.B.)
| | - Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging ASUIUD Udine, 33100 Udine, Italy;
| | - Enrico Pegolo
- Institute of Pathology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Silvia Chiesa
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Mauro Arcicasa
- Department of Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy;
| | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University, 00168 Rome, Italy; (G.M.D.P.); (A.O.)
| | - Miran Skrap
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Giovanni Sabatino
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (F.P.); (G.S.); (G.L.R.)
- Institute of Neurosurgery, Catholic University, 00168 Rome, Italy; (G.M.D.P.); (A.O.)
| |
Collapse
|
175
|
Ius T, Pignotti F, Della Pepa GM, Bagatto D, Isola M, Battistella C, Gaudino S, Pegolo E, Chiesa S, Arcicasa M, La Rocca G, Olivi A, Skrap M, Sabatino G. Glioblastoma: from volumetric analysis to molecular predictors. J Neurosurg Sci 2020; 66:173-186. [PMID: 32031360 DOI: 10.23736/s0390-5616.20.04850-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite decades of therapeutic and molecular refinements, the prognosis of patients with glioblastoma (GBM) still remains unfavorable. Integrative clinical studies allow a better understanding of the natural evolution of GBM. To assess independent predictors of overall survival (OS) and progression free survival (PFS) clinical, surgical, molecular and radiological variables were evaluated. A novel preoperative volumetric magnetic resonance imaging (MRI) index for tumor prognosis in GBM patients was investigated. METHODS A cohort of 195 cases of patients operated for newly GBM were analyzed. Extent of tumoral resection (EOR), tumor growth pattern, expressed by preoperative volumetric ΔT1-T2 MRI index, molecular markers such as O6-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase 1/2 (IDH1/2) mutation, were analyzed. Analysis of survival was done using Cox-proportional hazard models. RESULTS The 1-, 2- years estimated OS and PFS rate for the whole population were 61% and 27%, 38% and 17%, respectively. A better survival rate, both in terms of survival and tumor progression, was observed in patient with higher EOR (p=0.000), younger age (p=0.000), MGMT methylation status (p=0.001) and lower preoperative ΔT1-T2 MRI index (p=0.004). Regarding the tumor growth pattern a cut-off value of 0.75 was found to discriminate patient with different prognosis. Patients with a preoperative ΔT1-T2 MRI index <0.75 had a 1-year estimated OS of 67%, otherwise patients with a preoperative ΔT1-T2 MRI index >0.75 hada 1-year estimated OS of 34%. CONCLUSIONS In this investigation longer survival is associated with younger age, EOR, promoter methylation of MGMT and preoperative tumor volumetric features expressed by ΔT1-T2 MRI index. The preoperative ΔT1-T2 MRI index could be a promising prognostic factor potentially useful in GBM management. Future investigations based on multiparametric MRI data and next generation sequences analysis, may better clarify this result.
Collapse
Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy -
| | | | | | - Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging ASUIUD Udine, Italy
| | - Miriam Isola
- Department of Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Claudio Battistella
- Department of Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Simona Gaudino
- Institute of Radiology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Enrico Pegolo
- Institute of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Silvia Chiesa
- Institute of Radiotherapy, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Miran Skrap
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Catholic University, Rome, Italy.,Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| |
Collapse
|
176
|
The role of tailored intraoperative neurophysiological monitoring in glioma surgery: a single institute experience. J Neurooncol 2020; 146:459-467. [PMID: 32020476 DOI: 10.1007/s11060-019-03347-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 11/15/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Glioma surgery near the functional area is still a dilemma. Intraoperative neurophysiologic monitoring (IONM) and functional mapping can play a role to maximize the extent of resection (EOR), while minimizing the risk of sequelae. We herein review the utility of tailored intraoperative mapping and monitoring in patients undergoing glioma surgery in our institute. METHODS Patients were divided into two groups on the basis of application tailored IONM (group A, 2013-2017, n = 53) or not (group B, 2008-2012, n = 49) between January 2008 and December 2017. The setup, tailored IONM protocols, surgery, and clinical results of all patients with eloquent glioma were analyzed with the EOR, functionality scores, overall survival (OS) and progression-free survival (PFS) retrospectively. RESULTS The 102 patients were considered eligible for analysis. High grade and low grade gliomas accounted for 73 (72%) and 29 (28%) cases, respectively. There was a positive association between the application of neuromonitor and post-operative functional preservation, but no significant statistical differences over the EOR, OS and PFS between the two groups. CONCLUSIONS In our experience, tailored intraoperative functional mapping provides an effective neurological function preservation. Routine implementation of neurophysiological monitoring with adequate pre-operative planning and intraoperative teamwork in eloquent glioma can get more satisfied functional preservation. Due to the maturation and experience of our IONM team may also be the variation factor, prospective studies with a more prominent sample and proper multivariate analysis will be expected to determine the real benefit.
Collapse
|
177
|
Woodroffe RW, Zanaty M, Soni N, Mott SL, Helland LC, Pasha A, Maley J, Dhungana N, Jones KA, Monga V, Greenlee JDW. Survival after reoperation for recurrent glioblastoma. J Clin Neurosci 2020; 73:118-124. [PMID: 31987636 DOI: 10.1016/j.jocn.2020.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 11/30/2019] [Accepted: 01/04/2020] [Indexed: 10/25/2022]
Abstract
Determining which patients will benefit from reoperation for recurrent glioblastoma remains difficult and the impact of the volume of FLAIR signal hyperintensity is not well known. The primary purpose of this study is to analyze the impact of preoperative volume of FLAIR hyperintensity on prognosis. 37 patients who underwent a reoperation for recurrent glioblastoma after initial gross total resection followed by standard chemoradiation were retrospectively reviewed. Volumetric analysis of preoperative MR images from the initial and second surgery was performed and correlated with clinical data. Survival probabilities were estimated using the Kaplan-Meier method and Cox regression to assess the effect of risk factors on time to reoperation (TTR), progression-free survival (PFS) after reoperation, and overall survival (OS). The volumes of FLAIR signal hyperintensity prior to the initial surgery and reoperation were not associated with prognosis. TTR and OS were significantly affected by the preoperative enhancement volume at the initial surgery, with increasing volumes yielding poorer prognosis. Patients with tumor in critical/eloquent areas were found to have a worse prognosis. Median TTR was 11 months, median PFS after reoperation was 3 months, and OS in patients undergoing a reoperation was 21 months. The results suggest FLAIR signal change seen in patients with glioblastoma does not influence time to reoperation, progression-free survival, or overall survival. These findings suggest the amount of FLAIR signal change should not greatly influence a surgeon's decision to perform a second surgical resection compare to other factors, and when appropriate, aggressive surgical intervention should be considered.
Collapse
Affiliation(s)
- Royce W Woodroffe
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Neetu Soni
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Logan C Helland
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Arham Pasha
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Joan Maley
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Neha Dhungana
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Karra A Jones
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Varun Monga
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| |
Collapse
|
178
|
Navarro-Bonnet J, Suarez-Meade P, Brown DA, Chaichana KL, Quinones-Hinojosa A. Following the light in glioma surgery: a comparison of sodium fluorescein and 5-aminolevulinic acid as surgical adjuncts in glioma resection. J Neurosurg Sci 2020; 63:633-647. [PMID: 31961116 DOI: 10.23736/s0390-5616.19.04745-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Gliomas are molecularly complex neoplasms and require a multidisciplinary approach to treatment. Maximal safe resection is often the initial goal of treatment and extent of resection (EOR) is an important prognostic factor correlating with both progression-free-survival (PFS) and overall survival (OS). Postoperative patient outcome is also a critical and independent prognosticator and high EOR must not be achieved at the expense of good functional outcome. Several intraoperative adjuvant techniques have been developed to help the surgeon push the boundaries of EOR while maintaining safety. Fluorescence-guided surgery for brain tumors is a contemporary adjuvant technique that allows for intraoperative delineation of diseased and normal brain thus improving maximal safe resection. The most extensively used fluorophores are 5-aminolevulinic acid (5-ALA) and sodium fluorescein (SFL). These fluorophores have different spectrophotometric properties, mechanisms of action and considerations for use. Both have demonstrated utility in neurosurgical oncology. They are safe and both are FDA approved for use as surgical adjuncts during resection of primary CNS neoplasms although they have been used with varying success for other tumor types. When combined with other surgical adjuvant strategies such as neuronavigation, intraoperative ultrasound, intraoperative MRI, awake resection and/or electrophysiological mapping/monitoring, fluorescence-guided resection appears to further improve resection quality in regard to EOR and safety. In this article, we review the current knowledge related to both fluorophores for brain tumor resection, their benefits, and pitfalls, as well as the major advantages associated with their use. We also briefly review additional fluorophores in early clinical development. Fluorescence-guided surgery is a novel surgical adjuvant which allows for real-time delineation of neoplastic tissues. The most widely used fluorophores are 5-ALA and SFL. They are safe compounds and there is a large body of evidence suggesting improvement in EOR when these are employed. There are nuances to the use of each; the fluorescence intensity is dose-dependent in either case and the sensitivity and specificity for various tumors vary widely. Additional prospective studies will be necessary to parse the impact of this technique and these fluorophores on survival metrics.
Collapse
Affiliation(s)
- Jorge Navarro-Bonnet
- Department of Neurosurgery, Medica Sur Clinical Foundation, Mexico City, Mexico - .,Faculty of Health Sciences, Anahuac University, Mexico City, Mexico -
| | | | | | | | | |
Collapse
|
179
|
Calhoun MA, Cui Y, Elliott EE, Mo X, Otero JJ, Winter JO. MicroRNA-mRNA Interactions at Low Levels of Compressive Solid Stress Implicate mir-548 in Increased Glioblastoma Cell Motility. Sci Rep 2020; 10:311. [PMID: 31941933 PMCID: PMC6962377 DOI: 10.1038/s41598-019-56983-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/16/2019] [Indexed: 01/07/2023] Open
Abstract
Glioblastoma (GBM) is an astrocytic brain tumor with median survival times of <15 months, primarily as a result of high infiltrative potential and development of resistance to therapy (i.e., surgical resection, chemoradiotherapy). A prominent feature of the GBM microenvironment is compressive solid stress (CSS) caused by uninhibited tumor growth within the confined skull. Here, we utilized a mechanical compression model to apply CSS (<115 Pa) to well-characterized LN229 and U251 GBM cell lines and measured their motility, morphology, and transcriptomic response. Whereas both cell lines displayed a peak in migration at 23 Pa, cells displayed differential response to CSS with either minimal (i.e., U251) or large changes in motility (i.e., LN229). Increased migration of LN229 cells was also correlated to increased cell elongation. These changes were tied to epigenetic signaling associated with increased migration and decreases in proliferation predicted via Ingenuity® Pathway Analysis (IPA), characteristics associated with tumor aggressiveness. miRNA-mRNA interaction analysis revealed strong influence of the miR548 family (i.e., mir-548aj, mir-548az, mir-548t) on differential signaling induced by CSS, suggesting potential targets for pharmaceutical intervention that may improve patient outcomes.
Collapse
Affiliation(s)
- Mark A Calhoun
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Yixiao Cui
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Eileen E Elliott
- William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA
| | - Xiaokui Mo
- Center for Biostatistics and Bioinformatics, The Ohio State University, Columbus, OH, USA
| | - Jose J Otero
- Department of Pathology, The Ohio State University, Columbus, OH, USA
| | - Jessica O Winter
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA. .,William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH, USA.
| |
Collapse
|
180
|
Whiting BB, Lee BS, Mahadev V, Borghei-Razavi H, Ahuja S, Jia X, Mohammadi AM, Barnett GH, Angelov L, Rajan S, Avitsian R, Vogelbaum MA. Combined use of minimal access craniotomy, intraoperative magnetic resonance imaging, and awake functional mapping for the resection of gliomas in 61 patients. J Neurosurg 2020; 132:159-167. [PMID: 30684941 DOI: 10.3171/2018.9.jns181802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 09/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Current management of gliomas involves a multidisciplinary approach, including a combination of maximal safe resection, radiotherapy, and chemotherapy. The use of intraoperative MRI (iMRI) helps to maximize extent of resection (EOR), and use of awake functional mapping supports preservation of eloquent areas of the brain. This study reports on the combined use of these surgical adjuncts. METHODS The authors performed a retrospective review of patients with gliomas who underwent minimal access craniotomy in their iMRI suite (IMRIS) with awake functional mapping between 2010 and 2017. Patient demographics, tumor characteristics, intraoperative and postoperative adverse events, and treatment details were obtained. Volumetric analysis of preoperative tumor volume as well as intraoperative and postoperative residual volumes was performed. RESULTS A total of 61 patients requiring 62 tumor resections met the inclusion criteria. Of the tumors resected, 45.9% were WHO grade I or II and 54.1% were WHO grade III or IV. Intraoperative neurophysiological monitoring modalities included speech alone in 23 cases (37.1%), motor alone in 24 (38.7%), and both speech and motor in 15 (24.2%). Intraoperative MRI demonstrated residual tumor in 48 cases (77.4%), 41 (85.4%) of whom underwent further resection. Median EOR on iMRI and postoperative MRI was 86.0% and 98.5%, respectively, with a mean difference of 10% and a median difference of 10.5% (p < 0.001). Seventeen of 62 cases achieved an increased EOR > 15% related to use of iMRI. Seventeen (60.7%) of 28 low-grade gliomas and 10 (30.3%) of 33 high-grade gliomas achieved complete resection. Significant intraoperative events included at least temporary new or worsened speech alteration in 7 of 38 cases who underwent speech mapping (18.4%), new or worsened weakness in 7 of 39 cases who underwent motor mapping (18.0%), numbness in 2 cases (3.2%), agitation in 2 (3.2%), and seizures in 2 (3.2%). Among the patients with new intraoperative deficits, 2 had residual speech difficulty, and 2 had weakness postoperatively, which improved to baseline strength by 6 months. CONCLUSIONS In this retrospective case series, the combined use of iMRI and awake functional mapping was demonstrated to be safe and feasible. This combined approach allows one to achieve the dual goals of maximal tumor removal and minimal functional consequences in patients undergoing glioma resection.
Collapse
Affiliation(s)
- Benjamin B Whiting
- 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland
| | - Bryan S Lee
- 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland
| | - Vaidehi Mahadev
- 3School of Medicine, Northeast Ohio Medical University, Rootstown
| | - Hamid Borghei-Razavi
- 4Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| | - Sanchit Ahuja
- 5Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland; and
| | - Xuefei Jia
- 6Quantitative Health Sciences, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alireza M Mohammadi
- 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland
- 4Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| | - Gene H Barnett
- 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland
- 4Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| | - Lilyana Angelov
- 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland
- 4Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| | - Shobana Rajan
- 5Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland; and
| | - Rafi Avitsian
- 5Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland; and
| | - Michael A Vogelbaum
- 1Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland
- 2Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland
- 4Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland
| |
Collapse
|
181
|
Kim G, Kim M, Lee Y, Byun JW, Hwang DW, Lee M. Systemic delivery of microRNA-21 antisense oligonucleotides to the brain using T7-peptide decorated exosomes. J Control Release 2019; 317:273-281. [PMID: 31730913 DOI: 10.1016/j.jconrel.2019.11.009] [Citation(s) in RCA: 161] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 11/03/2019] [Accepted: 11/11/2019] [Indexed: 01/24/2023]
Abstract
Antisense miRNA oligonucleotides against miR-21 (AMO-21) have a therapeutic potential for treatment of glioblastoma. However, glioblastoma-targeted delivery through systemic injection requires development of an efficient targeting carrier. For this purpose, a glioblastoma-targeting carrier was developed using the T7 peptide and exosomes. The transferrin receptor is overexpressed on the surface of glioblastoma cells, and T7 is a transferrin receptor-binding peptide. A T7 peptide-decorated exosome (T7-exo) was produced by incorporation of T7 into the exosome membrane as a fusion protein of T7 and Lamp2b. As a control, rabies virus glycoprotein (RVG) peptide targeting brain neuron cells was incorporated into the exosome membrane. AMO-21 was loaded into the exosomes by electroporation. In vitro studies of AMO-21 delivery showed that T7-exo had a higher delivery efficiency to C6 glioblastoma cells than unmodified exosome (Unmod-exo) and RVG-decorated exosome (RVG-exo). For in vivo delivery studies, T7-exo with AMO-21 was delivered into intracranial glioblastoma rat models by intravenous injection through the tail vein. The results showed that T7-exo delivered AMO-21 into the brain more efficiently than Unmod-exo and RVG-exo. In addition, delivery of AMO-21 using T7-exo reduced the miR-21 level in the glioblastoma efficiently. Reduction of miR-21 by AMO-21 induced the expression of PDCD4 and PTEN in tumors, resulting in reduction of tumor sizes. Taken together, these findings indicate that T7-exo is an efficient carrier of AMO-21 into the glioblastoma and may be useful in development of glioblastoma therapy.
Collapse
Affiliation(s)
- Gyeungyun Kim
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Minkyung Kim
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Youngki Lee
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea
| | - Jung Woo Byun
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Do Won Hwang
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea.
| | - Minhyung Lee
- Department of Bioengineering, College of Engineering, Hanyang University, Seoul 04763, Republic of Korea.
| |
Collapse
|
182
|
Ellingson BM, Abrey LE, Garcia J, Chinot O, Wick W, Saran F, Nishikawa R, Henriksson R, Mason WP, Harris RJ, Leu K, Woodworth DC, Mehta A, Raymond C, Chakhoyan A, Pope WB, Cloughesy TF. Post-chemoradiation volumetric response predicts survival in newly diagnosed glioblastoma treated with radiation, temozolomide, and bevacizumab or placebo. Neuro Oncol 2019; 20:1525-1535. [PMID: 29897562 DOI: 10.1093/neuonc/noy064] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background In the current study we used contrast-enhanced T1 subtraction maps to test whether early changes in enhancing tumor volume are prognostic for overall survival (OS) in newly diagnosed glioblastoma (GBM) patients treated with chemoradiation with or without bevacizumab (BV). Methods Seven hundred ninety-eight patients (404 BV and 394 placebo) with newly diagnosed GBM in the AVAglio trial (NCT00943826) had baseline MRI scans available, while 337 BV-treated and 269 placebo-treated patients had >4 MRI scans for response evaluation. The volume of contrast-enhancing tumor was quantified and used for subsequent analyses. Results A decrease in tumor volume during chemoradiation was associated with a longer OS in the placebo group (hazard ratio [HR] = 1.578, P < 0.0001) but not BV-treated group (HR = 1.135, P = 0.4889). Results showed a higher OS in patients on the placebo arm with a sustained decrease in tumor volume using a post-chemoradiation baseline (HR = 1.692, P = 0.0005), and a trend toward longer OS was seen in BV-treated patients (HR = 1.264, P = 0.0724). Multivariable Cox regression confirmed that sustained response or stable disease was prognostic for OS (HR = 0.7509, P = 0.0127) when accounting for age (P = 0.0002), KPS (P = 0.1516), postsurgical tumor volume (P < 0.0001), O6-methylguanine-DNA methyltransferase status (P < 0.0001), and treatment type (P = 0.7637) using the post-chemoradiation baseline. Conclusions The post-chemoradiation timepoint is a better baseline for evaluating efficacy in newly diagnosed GBM. Early progression during the maintenance phase is consequential in predicting OS, supporting the use of progression-free survival rates as a meaningful surrogate for GBM.
Collapse
Affiliation(s)
- Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,UCLA Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | | | - Olivier Chinot
- Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, Marseille, France
| | - Wolfgang Wick
- Clinical Cooperation Unit Neuro-oncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Frank Saran
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Roger Henriksson
- Regional Cancer Center Stockholm, Stockholm, Sweden and Umeå University, Umeå, Sweden
| | | | - Robert J Harris
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,MedQIA, LLC, Los Angeles, California, USA
| | - Kevin Leu
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California, USA
| | - Davis C Woodworth
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Physics and Biology in Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Arnav Mehta
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Ararat Chakhoyan
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Timothy F Cloughesy
- UCLA Brain Research Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
183
|
Ellingson BM, Abrey LE, Nelson SJ, Kaufmann TJ, Garcia J, Chinot O, Saran F, Nishikawa R, Henriksson R, Mason WP, Wick W, Butowski N, Ligon KL, Gerstner ER, Colman H, de Groot J, Chang S, Mellinghoff I, Young RJ, Alexander BM, Colen R, Taylor JW, Arrillaga-Romany I, Mehta A, Huang RY, Pope WB, Reardon D, Batchelor T, Prados M, Galanis E, Wen PY, Cloughesy TF. Validation of postoperative residual contrast-enhancing tumor volume as an independent prognostic factor for overall survival in newly diagnosed glioblastoma. Neuro Oncol 2019; 20:1240-1250. [PMID: 29660006 DOI: 10.1093/neuonc/noy053] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background In the current study, we pooled imaging data in newly diagnosed glioblastoma (GBM) patients from international multicenter clinical trials, single institution databases, and multicenter clinical trial consortiums to identify the relationship between postoperative residual enhancing tumor volume and overall survival (OS). Methods Data from 1511 newly diagnosed GBM patients from 5 data sources were included in the current study: (i) a single institution database from UCLA (N = 398; Discovery); (ii) patients from the Ben and Cathy Ivy Foundation for Early Phase Clinical Trials Network Radiogenomics Database (N = 262 from 8 centers; Confirmation); (iii) the chemoradiation placebo arm from an international phase III trial (AVAglio; N = 394 from 120 locations in 23 countries; Validation); (iv) the experimental arm from AVAglio examining chemoradiation plus bevacizumab (N = 404 from 120 locations in 23 countries; Exploratory Set 1); and (v) an Alliance (N0874) phase I/II trial of vorinostat plus chemoradiation (N = 53; Exploratory Set 2). Postsurgical, residual enhancing disease was quantified using T1 subtraction maps. Multivariate Cox regression models were used to determine influence of clinical variables, O6-methylguanine-DNA methyltransferase (MGMT) status, and residual tumor volume on OS. Results A log-linear relationship was observed between postoperative, residual enhancing tumor volume and OS in newly diagnosed GBM treated with standard chemoradiation. Postoperative tumor volume is a prognostic factor for OS (P < 0.01), regardless of therapy, age, and MGMT promoter methylation status. Conclusion Postsurgical, residual contrast-enhancing disease significantly negatively influences survival in patients with newly diagnosed GBM treated with chemoradiation with or without concomitant experimental therapy.
Collapse
Affiliation(s)
- Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | | | - Sarah J Nelson
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, California, USA
| | | | | | - Olivier Chinot
- Aix-Marseille University, AP-HM, Service de Neuro-Oncologie, CHU Timone, Marseille, France
| | - Frank Saran
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Roger Henriksson
- Regional Cancer Center Stockholm, Stockholm, Sweden and Umeå University, Umeå, Sweden
| | | | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Nicholas Butowski
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Keith L Ligon
- Department of Oncologic Pathology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Howard Colman
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, USA
| | - John de Groot
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan Chang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | | | - Robert J Young
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Brian M Alexander
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rivka Colen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jennie W Taylor
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | | | - Arnav Mehta
- UCLA Brain Tumor Imaging Laboratory, Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles (UCLA), Los Angeles, California, USA.,Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Raymond Y Huang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - David Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Tracy Batchelor
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
| | - Michael Prados
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Evanthia Galanis
- Department of Molecular Medicine, Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
184
|
Roux A, Roca P, Edjlali M, Sato K, Zanello M, Dezamis E, Gori P, Lion S, Fleury A, Dhermain F, Meder JF, Chrétien F, Lechapt E, Varlet P, Oppenheim C, Pallud J. MRI Atlas of IDH Wild-Type Supratentorial Glioblastoma: Probabilistic Maps of Phenotype, Management, and Outcomes. Radiology 2019; 293:633-643. [PMID: 31592732 DOI: 10.1148/radiol.2019190491] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Tumor location is a main prognostic parameter in patients with glioblastoma. Probabilistic MRI-based brain atlases specifying the probability of tumor location associated with important demographic, clinical, histomolecular, and management data are lacking for isocitrate dehydrogenase (IDH) wild-type glioblastomas. Purpose To correlate glioblastoma location with clinical phenotype, surgical management, and outcomes by using a probabilistic analysis in a three-dimensional (3D) MRI-based atlas. Materials and Methods This retrospective study included all adults surgically treated for newly diagnosed IDH wild-type supratentorial glioblastoma in a tertiary adult surgical neuro-oncology center (2006-2016). Semiautomated tumor segmentation and spatial normalization procedures to build a 3D MRI-based atlas were validated. The authors performed probabilistic analyses by using voxel-based lesion symptom mapping technology. The Liebermeister test was used for binary data, and the generalized linear model was used for continuous data. Results A total of 392 patients (mean age, 61 years ± 13; 233 men) were evaluated. The authors identified the preferential location of glioblastomas according to subventricular zone, age, sex, clinical presentation, revised Radiation Therapy Oncology Group-Recursive Partitioning Analysis class, Karnofsky performance status, O6-methylguanine DNA methyltransferase promoter methylation status, surgical management, and survival. The superficial location distant from the eloquent area was more likely associated with a preserved functional status at diagnosis (348 of 392 patients [89%], P < .05), a large surgical resection (173 of 392 patients [44%], P < .05), and prolonged overall survival (163 of 334 patients [49%], P < .05). In contrast, deep location and location within eloquent brain areas were more likely associated with an impaired functional status at diagnosis (44 of 392 patients [11%], P < .05), a neurologic deficit (282 of 392 patients [72%], P < .05), treatment with biopsy only (183 of 392 patients [47%], P < .05), and shortened overall survival (171 of 334 patients [51%], P < .05). Conclusion The authors identified the preferential location of isocitrate dehydrogenase wild-type glioblastomas according to parameters of interest and provided an image-based integration of multimodal information impacting survival results. This suggests the role of glioblastoma location as a surrogate and multimodal parameter integrating several known prognostic factors. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Huang in this issue.
Collapse
Affiliation(s)
- Alexandre Roux
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Pauline Roca
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Myriam Edjlali
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Kanako Sato
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Marc Zanello
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Edouard Dezamis
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Pietro Gori
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Stéphanie Lion
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Ariane Fleury
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Frédéric Dhermain
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Jean-François Meder
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Fabrice Chrétien
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Emmanuèle Lechapt
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Pascale Varlet
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Catherine Oppenheim
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| | - Johan Pallud
- From the Department of Neurosurgery, Sainte-Anne Hospital, Paris, France (A.R., M.Z., E.D., J.P.); Paris Descartes University, Sorbonne Paris Cité, Paris, France (A.R., P.R., M.E., M.Z., J.F.M., F.C., E.L., P.V., C.O., J.P.); UMR 1266 INSERM, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France (A.R., P.R., M.E., K.S., M.Z., P.G., S.L., A.F., J.F.M., P.V., C.O., J.P.); Department of Neuroradiology, Sainte-Anne Hospital, Paris, France (M.E., J.F.M., C.O.); Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan (K.S.); LTCI, Telecom ParisTech, Paris, France (P.G.); Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France (F.D.); and Department of Neuropathology, Sainte-Anne Hospital, Paris, France (F.C., E.L., P.V.)
| |
Collapse
|
185
|
Bassaganyas-Vancells C, Roldán P, González JJ, Ferrés A, García S, Culebras D, Hoyos J, Reyes L, Torales J, Enseñat J. Combined Use of 5-Aminolevulinic Acid and Intraoperative Low-Field Magnetic Resonance Imaging in High-Grade Glioma Surgery. World Neurosurg 2019; 130:e206-e212. [DOI: 10.1016/j.wneu.2019.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/15/2022]
|
186
|
Bouchart C, Trépant AL, Hein M, Van Gestel D, Demetter P. Prognostic impact of glioblastoma stem cell markers OLIG2 and CCND2. Cancer Med 2019; 9:1069-1078. [PMID: 31568682 PMCID: PMC6997071 DOI: 10.1002/cam4.2592] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/06/2019] [Accepted: 09/16/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Glioblastoma (GBM) is the most common and lethal malignant brain tumor in adults. Glioma stem cells (GSCs) are implicated in this poor prognosis and in radio(chemo‐)resistance. We have previously demonstrated that among potentially highly specific GSC markers oligodendrocyte lineage transcription factor 2 (OLIG2) appears to be the most specific and cyclin D2 (CCND2) the only one related to cell cycle regulation. The purpose of this work was to investigate the clinical significance and the evolution of OLIG2 and CCND2 protein expression in GBM. Methods and results Immunohistochemical expression analysis of Olig2 and Ccnd2 was carried out on a cohort of human paired GBM samples comparing initial resections with local recurrent tumors after radiation therapy (RT) alone or radio‐chemotherapy with temozolomide (RT‐TMZ). Uni‐ and multivariate logistic regression analysis revealed that significant risk factors predicting early mortality (<12 months) are: subtotal surgery for recurrence, time to recurrence <6 months, Ccnd2 nuclear expression at initial surgery ≥30%, and Olig2 nuclear expression <30% at second surgery after RT alone and RT‐TMZ. Conclusions We demonstrated that patients for whom nuclear expression of Olig2 becomes low (<30%) after adjuvant treatments have a significantly shorter time to recurrence and survival reflecting most probably a proneural to mesenchymal transition of the GSCs population. We also highlighted the fact that at initial surgery, high nuclear expression (≥30%) of CCND2, a G1/S regulator specific of GSCs, has a prognostic value and is associated with early mortality (<12 months).
Collapse
Affiliation(s)
- Christelle Bouchart
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne-Laure Trépant
- Department of Pathology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Matthieu Hein
- Department of Psychiatry and Sleep Laboratory, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation-Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Pieter Demetter
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
187
|
De Witt Hamer PC, Ho VKY, Zwinderman AH, Ackermans L, Ardon H, Boomstra S, Bouwknegt W, van den Brink WA, Dirven CM, van der Gaag NA, van der Veer O, Idema AJS, Kloet A, Koopmans J, Ter Laan M, Verstegen MJT, Wagemakers M, Robe PAJT. Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery. J Neurooncol 2019; 144:313-323. [PMID: 31236819 PMCID: PMC6700042 DOI: 10.1007/s11060-019-03229-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. METHODS Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. RESULTS Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34-3.26, P = 0.001), and not with academic setting, nor with case volume. CONCLUSIONS Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors.
Collapse
Affiliation(s)
- Philip C De Witt Hamer
- Department of Neurosurgery, Neurosurgical Center Amsterdam, Location VU Medical Center, Amsterdam, The Netherlands.
- Department of Neurosurgery, Amsterdam University Medical Centers, Location VU Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Vincent K Y Ho
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hilko Ardon
- Department of Neurosurgery, St Elisabeth Hospital, Tilburg, The Netherlands
| | - Sytske Boomstra
- Department of Neurosurgery, Medical Spectrum Twente, Enschede, The Netherlands
| | - Wim Bouwknegt
- Department of Neurosurgery, Medical Center Slotervaart, Amsterdam, The Netherlands
| | | | - Clemens M Dirven
- Department of Neurosurgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Niels A van der Gaag
- HAGA Teaching Hospital, The Hague, The Netherlands
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Albert J S Idema
- Department of Neurosurgery, Northwest Clinics, Alkmaar, The Netherlands
| | - Alfred Kloet
- Department of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands
| | - Jan Koopmans
- Department of Neurosurgery, Martini Hospital, Groningen, The Netherlands
| | - Mark Ter Laan
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Pierre A J T Robe
- Department of Neurology & Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
188
|
Reliability of intraoperative ultrasound in detecting tumor residual after brain diffuse glioma surgery: a systematic review and meta-analysis. Neurosurg Rev 2019; 43:1221-1233. [PMID: 31410683 DOI: 10.1007/s10143-019-01160-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/28/2019] [Accepted: 08/05/2019] [Indexed: 12/11/2022]
Abstract
Intraoperative ultrasonography (iUS) is considered an accurate, safe, and cost-effective tool to estimate the extent of resection of both high-grade (HGG) and low-grade (DLGG) diffuse gliomas (DGs). However, it is currently missing an evidence-based assessment of iUS diagnostic accuracy in DGs surgery. The objective of review is to perform a systematic review and meta-analysis of the diagnostic performance of iUS in detecting tumor residue after DGs resection. A comprehensive literature search for studies published through October 2018 was performed according to PRISMA-DTA and STARD 2015 guidelines, using the following algorithm: ("ultrasound" OR "ultrasonography" OR "ultra-so*" OR "echo*" OR "eco*") AND ("brain" OR "nervous") AND ("tumor" OR "tumour" OR "lesion" OR "mass" OR "glio*" OR "GBM") AND ("surgery" OR "surgical" OR "microsurg*" OR "neurosurg*"). Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), and diagnostic odds ratio (DOR) of iUS in DGs were calculated. A subgroup analysis for HGGs and DLGGs was also conducted. Thirteen studies were included in the systematic review (665 DGs). Ten articles (409 DGs) were selected for the meta-analysis with the following results: sensitivity 72.2%, specificity 93.5%, LR- 0.29, LR+ 3, and DOR 9.67. Heterogeneity among studies was non-significant. Subgroup analysis demonstrates a better diagnostic performance of iUS for DLGGs compared with HGGs. iUS is an effective technique in assessing DGs resection. No significant differences are seen regarding iUS modality and transducer characteristics. Its diagnostic performance is higher in DLGGs than HGGs and could be worsened by previous treatments, surgical artifacts, and small tumor residue volumes.
Collapse
|
189
|
Peng C, Sun T, Vykhodtseva N, Power C, Zhang Y, Mcdannold N, Porter T. Intracranial Non-thermal Ablation Mediated by Transcranial Focused Ultrasound and Phase-Shift Nanoemulsions. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2104-2117. [PMID: 31101446 PMCID: PMC6591088 DOI: 10.1016/j.ultrasmedbio.2019.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 03/18/2019] [Accepted: 04/07/2019] [Indexed: 05/09/2023]
Abstract
High intensity focused ultrasound (HIFU) mechanical ablation is an emerging technique for non-invasive transcranial surgery. Lesions are created by driving inertial cavitation in tissue, which requires significantly less peak pressure and time-averaged power compared with traditional thermal ablation. The utility of mechanical ablation could be extended to the brain provided the pressure threshold for inertial cavitation can be reduced. In this study, the utility of perfluorobutane (PFB)-based phase-shift nanoemulsions (PSNEs) for lowering the inertial cavitation threshold and enabling focal mechanical ablation in the brain was investigated. We successfully achieved vaporization of PFB-based PSNEs at 1.8 MPa with a 740 kHz focused transducer with a pulsed sonication protocol (duty cycle = 1.5%, 10 min sonication) within intact CD-1 mice brains. Evidence is provided showing that a single bolus injection of PSNEs could be used to initiate and sustain inertial cavitation in cerebrovasculature for at least 10 min. Histologic analysis of brain slices after HIFU exposure revealed ischemic and hemorrhagic lesions with dimensions that were comparable to the focal zone of the transducer. These results suggest that PFB-based PSNEs may be used to significantly reduce the inertial cavitation threshold in the cerebrovasculature and, when combined with transcranial focused ultrasound, enable focal intracranial mechanical ablation.
Collapse
Affiliation(s)
- Chenguang Peng
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
| | - Tao Sun
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natalia Vykhodtseva
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Chanikarn Power
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yongzhi Zhang
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nathan Mcdannold
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tyrone Porter
- Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| |
Collapse
|
190
|
Molecular and Clinical Insights into the Invasive Capacity of Glioblastoma Cells. JOURNAL OF ONCOLOGY 2019; 2019:1740763. [PMID: 31467533 PMCID: PMC6699388 DOI: 10.1155/2019/1740763] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/01/2019] [Accepted: 07/07/2019] [Indexed: 12/22/2022]
Abstract
The invasive capacity of GBM is one of the key tumoral features associated with treatment resistance, recurrence, and poor overall survival. The molecular machinery underlying GBM invasiveness comprises an intricate network of signaling pathways and interactions with the extracellular matrix and host cells. Among them, PI3k/Akt, Wnt, Hedgehog, and NFkB play a crucial role in the cellular processes related to invasion. A better understanding of these pathways could potentially help in developing new therapeutic approaches with better outcomes. Nevertheless, despite significant advances made over the last decade on these molecular and cellular mechanisms, they have not been translated into the clinical practice. Moreover, targeting the infiltrative tumor and its significance regarding outcome is still a major clinical challenge. For instance, the pre- and intraoperative methods used to identify the infiltrative tumor are limited when trying to accurately define the tumor boundaries and the burden of tumor cells in the infiltrated parenchyma. Besides, the impact of treating the infiltrative tumor remains unclear. Here we aim to highlight the molecular and clinical hallmarks of invasion in GBM.
Collapse
|
191
|
Juarez-Chambi RM, Kut C, Rico-Jimenez JJ, Chaichana KL, Xi J, Campos-Delgado DU, Rodriguez FJ, Quinones-Hinojosa A, Li X, Jo JA. AI-Assisted In Situ Detection of Human Glioma Infiltration Using a Novel Computational Method for Optical Coherence Tomography. Clin Cancer Res 2019; 25:6329-6338. [PMID: 31315883 DOI: 10.1158/1078-0432.ccr-19-0854] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE In glioma surgery, it is critical to maximize tumor resection without compromising adjacent noncancerous brain tissue. Optical coherence tomography (OCT) is a noninvasive, label-free, real-time, high-resolution imaging modality that has been explored for glioma infiltration detection. Here, we report a novel artificial intelligence (AI)-assisted method for automated, real-time, in situ detection of glioma infiltration at high spatial resolution.Experimental Design: Volumetric OCT datasets were intraoperatively obtained from resected brain tissue specimens of 21 patients with glioma tumors of different stages and labeled as either noncancerous or glioma-infiltrated on the basis of histopathology evaluation of the tissue specimens (gold standard). Labeled OCT images from 12 patients were used as the training dataset to develop the AI-assisted OCT-based method for automated detection of glioma-infiltrated brain tissue. Unlabeled OCT images from the other 9 patients were used as the validation dataset to quantify the method detection performance. RESULTS Our method achieved excellent levels of sensitivity (∼100%) and specificity (∼85%) for detecting glioma-infiltrated tissue with high spatial resolution (16 μm laterally) and processing speed (∼100,020 OCT A-lines/second). CONCLUSIONS Previous methods for OCT-based detection of glioma-infiltrated brain tissue rely on estimating the tissue optical attenuation coefficient from the OCT signal, which requires sacrificing spatial resolution to increase signal quality, and performing systematic calibration procedures using tissue phantoms. By overcoming these major challenges, our AI-assisted method will enable implementing practical OCT-guided surgical tools for continuous, real-time, and accurate intraoperative detection of glioma-infiltrated brain tissue, facilitating maximal glioma resection and superior surgical outcomes for patients with glioma.
Collapse
Affiliation(s)
| | - Carmen Kut
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Jose J Rico-Jimenez
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas
| | | | - Jiefeng Xi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Daniel U Campos-Delgado
- Facultad de Ciencias, Universidad Autónoma de San Luis de Potosí, San Luis de Potosí, Mexico
| | - Fausto J Rodriguez
- Division of Neuropathology, Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | | | - Xingde Li
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Javier A Jo
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, Oklahoma.
| |
Collapse
|
192
|
Kozielski KL, Ruiz-Valls A, Tzeng SY, Guerrero-Cázares H, Rui Y, Li Y, Vaughan HJ, Gionet-Gonzales M, Vantucci C, Kim J, Schiapparelli P, Al-Kharboosh R, Quiñones-Hinojosa A, Green JJ. Cancer-selective nanoparticles for combinatorial siRNA delivery to primary human GBM in vitro and in vivo. Biomaterials 2019; 209:79-87. [PMID: 31026613 PMCID: PMC7122460 DOI: 10.1016/j.biomaterials.2019.04.020] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/24/2019] [Accepted: 04/11/2019] [Indexed: 01/15/2023]
Abstract
Novel treatments for glioblastoma (GBM) are urgently needed, particularly those which can simultaneously target GBM cells' ability to grow and migrate. Herein, we describe a synthetic, bioreducible, biodegradable polymer that can package and deliver hundreds of siRNA molecules into a single nanoparticle, facilitating combination therapy against multiple GBM-promoting targets. We demonstrate that siRNA delivery with these polymeric nanoparticles is cancer-selective, thereby avoiding potential side effects in healthy cells. We show that we can deliver siRNAs targeting several anti-GBM genes (Robo1, YAP1, NKCC1, EGFR, and survivin) simultaneously and within the same nanoparticles. Robo1 (roundabout homolog 1) siRNA delivery by biodegradable particles was found to trigger GBM cell death, as did non-viral delivery of NKCC1, EGFR, and survivin siRNA. Most importantly, combining several anti-GBM siRNAs into a nanoparticle formulation leads to high GBM cell death, reduces GBM migration in vitro, and reduces tumor burden over time following intratumoral administration. We show that certain genes, like survivin and EGFR, are important for GBM survival, while NKCC1, is more crucial for cancer cell migration. This represents a powerful platform technology with the potential to serve as a multimodal therapeutic for cancer.
Collapse
Affiliation(s)
- Kristen L Kozielski
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA; Max Planck Institute for Intelligent Systems, Heisenbergstr. 3, Stuttgart, 70569, Germany
| | - Alejandro Ruiz-Valls
- Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Stephany Y Tzeng
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Hugo Guerrero-Cázares
- Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Yuan Rui
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Yuxin Li
- Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA
| | - Hannah J Vaughan
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Marissa Gionet-Gonzales
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Casey Vantucci
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Jayoung Kim
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA
| | - Paula Schiapparelli
- Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Rawan Al-Kharboosh
- Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 32224, USA
| | - Alfredo Quiñones-Hinojosa
- Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Jordan J Green
- Department of Biomedical Engineering, Translational Tissue Engineering Center, And Institute for NanoBioTechnology, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA; Departments of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, 21231, USA; Department of Materials Science and Engineering, Department of Chemical and Biomolecular Engineering, Department of Ophthalmology, The Sidney Kimmel Comprehensive Cancer, And the Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Johns Hopkins School of Medicine, Baltimore, MD, 21231, USA.
| |
Collapse
|
193
|
Temporal Glioblastoma Mimicking Basal Ganglia Invasion: Distinguishing Removable and Unremovable Tumors. World Neurosurg 2019; 130:e213-e221. [PMID: 31252080 DOI: 10.1016/j.wneu.2019.06.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Maximal safe resection prolongs the survival of patients with glioblastoma (GB). However, whether total resection of the enhanced lesion is pursued or abandoned depends on preoperative judgments based on the findings of magnetic resonance imaging (MRI). Anatomically, medial temporal tumor tends to invade toward the temporal stem, insula, and basal ganglia, representing tumor with high surgical risk. In the present study, we describe the key radiologic features of medial temporal GB to achieve extent of resection. METHODS We reviewed all GB cases located in the temporal lobe (tGB) treated between April 2013 and March 2018 at Kitasato University Hospital. On the basis of MRI, tGB was simply classified into 3 groups: medial tGB and nonmedial tGB, and medial tGB was further subdivided into invading type and mimicking type. We focused on the resectability of medial tGB. RESULTS Twenty-seven patients with tGB were identified. Twenty were included in the nonmedial tGB, and 7 were in the medial tGB. All medial tGB seemed to invade into the basal ganglia and/or the lenticulostriate arteries, but detailed examination revealed 2 types of tumor, invading type (3 cases) and mimicking type (4 cases). The invading type had true involvement of the basal ganglia and/or lenticulostriate arteries, whereas the mimicking type had no involvement of these structures. This new classification is highly effective, as the former is unresectable, but the latter is totally resectable. CONCLUSIONS Medial tGB is a challenging tumor for maximal safe resection, so our classification will help to identify cases of removable medial tGB.
Collapse
|
194
|
Sun N, Zhao L, Zhu J, Li Y, Song N, Xing Y, Qiao W, Huang H, Zhao J. 131I-labeled polyethylenimine-entrapped gold nanoparticles for targeted tumor SPECT/CT imaging and radionuclide therapy. Int J Nanomedicine 2019; 14:4367-4381. [PMID: 31354266 PMCID: PMC6580422 DOI: 10.2147/ijn.s203259] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/14/2019] [Indexed: 01/02/2023] Open
Abstract
Purpose: Polyethylenimine (PEI) has been widely used as a versatile template to develop multifunctional nanosystems for disease diagnosis and treatment. In this study, we manufactured iodine-131 (131I)-labeled PEI-entrapped gold nanoparticles (Au PENPs) as a novel nanoprobe for single-photon emission computed tomography/computed tomography (SPECT/CT) imaging and radionuclide therapy. Materials and methods: PEI was PEGylated and sequentially conjugated with Buthus martensii Karsch chlorotoxin (BmK CT, a tumor-specific ligand which can selectively bind to MMP2), 3-(4'-hydroxyphenyl)propionic acid-OSu (HPAO), and fluorescein isothiocyanate to form the multifunctional PEI template for entrapment of Au NPs. Then, the PEI surface was radiolabeled with 131I via HPAO to produce the novel nanoprobe (BmK CT-Au PENPs-131I). Results: The synthesized multifunctional Au PENPs before and after 131I radiolabeling were well-characterized as follows: structure, X-ray attenuation coefficient, colloid stability, cytocompatibility, and radiochemical stability in vitro. Furthermore, BmK CT-Au PENPs-131I were suitable for targeted SPECT/CT imaging and radionuclide therapy of tumor cells in vitro and in a xenograft tumor model in vivo. Conclusion: The developed multifunctional Au PENPs are a promising theranostic platform for targeted imaging and treatment of different MMP2-overexpressing tumors.
Collapse
Affiliation(s)
- Na Sun
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| | - Lingzhou Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| | - Jingyi Zhu
- State Key Laboratory of Material-Oriented Chemical Engineering, School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing211816, People’s Republic of China
| | - Yujie Li
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| | - Ningning Song
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| | - Yan Xing
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| | - Wenli Qiao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| | - He Huang
- State Key Laboratory of Material-Oriented Chemical Engineering, School of Pharmaceutical Sciences, Nanjing Tech University, Nanjing211816, People’s Republic of China
| | - Jinhua Zhao
- Department of Nuclear Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200080, People’s Republic of China
| |
Collapse
|
195
|
Feyissa AM, Worrell GA, Tatum WO, Chaichana KL, Jentoft ME, Guerrero Cazares H, Ertekin-Taner N, Rosenfeld SS, ReFaey K, Quinones-Hinojosa A. Potential influence of IDH1 mutation and MGMT gene promoter methylation on glioma-related preoperative seizures and postoperative seizure control. Seizure 2019; 69:283-289. [PMID: 31141785 DOI: 10.1016/j.seizure.2019.05.018] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 04/21/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To examine the occurrence of glioma-related preoperative seizures (GPS) and post-operative seizure control (PSC) with respect to patients characteristics including five commonly tested tumor molecular markers (TMMs). METHODS A single-center retrospective cohort study of patients with glioma evaluated at the Mayo Clinic, Florida between 2016 and 2018. RESULTS 68 adult patients (mean age = 51-years, 45-males) were included. 46 patients had GPS. 57 patients underwent intra-operative electrocorticography during awake craniotomy-assisted glioma resection. All patients underwent glioma resection (53, gross-total resection) with histologies of pilocytic astrocytoma (n = 2), diffuse astrocytoma (n = 4), oligodendroglioma (n = 14), anaplastic astrocytoma (n = 16), anaplastic oligodendroglioma (n = 1), and glioblastoma (n = 31). 31 (67%) patients had PSC (median follow-up = 14.5 months; IQR = 7-16.5 months). IDH1 mutation (IDH1mut) was present in 32, ARTX retention in 53, MGMT gene promotor methylation in 15, 1p/19q co-deletion in 15, and over-expression of p53 in 19 patients. Patients with IDH1mut were more likely to have GPS (p = 0.037) and PSC (p = 0.035) compared to patients with IDH1 wild-type. Patients with MGMT gene promoter methylation were also likely to have PSC (p = 0.032). GPS or PSC did not differ by age, sex, extent of surgery, glioma grade, location, and histopathological subtype, p53 expression, ARTX retention, or 1p/19q co-deletion status. CONCLUSIONS GPS and PSC may be associated with IDH1 mutation and MGMT gene promoter methylation status but not other glioma characteristics including tumor grade, location, or histopathology. Prospective studies with larger sample size are needed to clarify the exact mechanisms of GPS and PSC by the various TMMs to identify new treatment targets.
Collapse
Affiliation(s)
- Anteneh M Feyissa
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Gregory A Worrell
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States; Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States.
| | - William O Tatum
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Kaisorn L Chaichana
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Mark E Jentoft
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Hugo Guerrero Cazares
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Nileufer Ertekin-Taner
- Department of Neurology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Steven S Rosenfeld
- Department of Hematology/Oncology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | - Karim ReFaey
- Department of Pathology, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, United States.
| | | |
Collapse
|
196
|
Wu DF, He W, Lin S, Han B, Zee CS. Using Real-Time Fusion Imaging Constructed from Contrast-Enhanced Ultrasonography and Magnetic Resonance Imaging for High-Grade Glioma in Neurosurgery. World Neurosurg 2019; 125:e98-e109. [DOI: 10.1016/j.wneu.2018.12.215] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 12/26/2018] [Accepted: 12/28/2018] [Indexed: 01/20/2023]
|
197
|
Overall survival and progression-free survival in patients with primary brain tumors after treatment: is the outcome of [ 18F] FDOPA PET a prognostic factor in these patients? Ann Nucl Med 2019; 33:471-480. [PMID: 30949937 DOI: 10.1007/s12149-019-01355-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022]
Abstract
AIM To investigate the progression-free survival (PFS) and the overall survival (OS) in a population affected by primary brain tumors (PBT) evaluated by [18F]-L-dihydroxyphenylalanine ([18F] FDOPA) positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS 133 subjects with PBT (65 women and 68 men, mean age 45 ± 10 years old) underwent 18F FDOPA PET/CT after treatment. Of them, 68 (51.2%) were Grade II, 34 (25.5%) were Grade III and 31 (23.3%) were Grade IV. PET/CT was scored as positive or negative and standardized uptake value ratio (SUVr) was calculated as the ratio between SUVmax of the lesion vs. that of the background. Patients have been observed for a mean of 24 months. RESULTS The outcome of [18F] FDOPA PET/CT scan was significantly related to the OS and PFS in Grade II gliomas. In Grade II PBT, the OS proportions at 24 months were 100% in subjects with a negative PET/CT scan and 82% in those with a positive scan. Gehan-Breslow-Wilcoxon test showed a significant difference in the OS curves (P = 0.03) and the hazard-ratio was equal to 5.1 (95% CI of ratio 1.1-23.88). As for PFS, the proportion at 24 months was 90% in subjects with a negative PET/CT scan and 58% in those with a positive scan. Gehan-Breslow-Wilcoxon test showed a significant difference in the OS curves (P = 0.007) and the hazard-ratio was equal to 4.1 (95% CI of ratio 1.3-8). We did not find any significant relationship between PET outcome and OS and PFS in Grade III and IV PBT. CONCLUSIONS A positive [18F] FDOPA PET/CT scan is related to a poor OS and PFS in subjects with low-grade PBT. This imaging modality could be considered as a prognostic factor in these subjects.
Collapse
|
198
|
Tamura M, Sato I, Maruyama T, Ohshima K, Mangin JF, Nitta M, Saito T, Yamada H, Minami S, Masamune K, Kawamata T, Iseki H, Muragaki Y. Integrated datasets of normalized brain with functional localization using intra-operative electrical stimulation. Int J Comput Assist Radiol Surg 2019; 14:2109-2122. [PMID: 30955195 DOI: 10.1007/s11548-019-01957-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 04/01/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to transform brain mapping data into a digitized intra-operative MRI and integrated brain function dataset for predictive glioma surgery considering tumor resection volume, as well as the intra-operative and postoperative complication rates. METHODS Brain function data were transformed into digitized localizations on a normalized brain using a modified electric stimulus probe after brain mapping. This normalized brain image with functional information was then projected onto individual patient's brain images including predictive brain function data. RESULTS Log data were successfully acquired using a medical device integrated into intra-operative MR images, and digitized brain function was converted to a normalized brain data format in 13 cases. For the electrical stimulation positions in which patients showed speech arrest (SA), speech impairment (SI), motor and sensory responses during cortical mapping processes in awake craniotomy, the data were tagged, and the testing task and electric current for the stimulus were recorded. There were 13 SA, 7 SI, 8 motor and 4 sensory responses (32 responses) in total. After evaluation of transformation accuracy in 3 subjects, the first transformation from intra- to pre-operative MRI using non-rigid registration was calculated as 2.6 ± 1.5 and 2.1 ± 0.9 mm, examining neighboring sulci on the electro-stimulator position and the cortex surface near each tumor, respectively; the second transformation from pre-operative to normalized brain was 1.7 ± 0.8 and 1.4 ± 0.5 mm, respectively, representing acceptable accuracy. CONCLUSION This image integration and transformation method for brain normalization should facilitate practical intra-operative brain mapping. In the future, this method may be helpful for pre-operatively or intra-operatively predicting brain function.
Collapse
Affiliation(s)
- Manabu Tamura
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. .,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Ikuma Sato
- Faculty of System Information Science Engineering, Future University Hakodate, 116-2 Kamedanakano-cho, Hakodate City, Hokkaido, 041-8655, Japan
| | - Takashi Maruyama
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Kazuma Ohshima
- Faculty of System Information Science Engineering, Future University Hakodate, 116-2 Kamedanakano-cho, Hakodate City, Hokkaido, 041-8655, Japan
| | - Jean-François Mangin
- The Computer Assisted Neuroimaging Laboratory, Neurospin, Biomedical Imaging Institute, CEA, Centre d'études de Saclay, 91191, Gif-Sur-Yvette, France
| | - Masayuki Nitta
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Taiichi Saito
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroyuki Yamada
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shinji Minami
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Ken Masamune
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hiroshi Iseki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yoshihiro Muragaki
- Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women's Medical University, 8-1 (TWIns) Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
199
|
Blomstergren A, Rydelius A, Abul-Kasim K, Lätt J, Sundgren PC, Bengzon J. Evaluation of reproducibility in MRI quantitative volumetric assessment and its role in the prediction of overall survival and progression-free survival in glioblastoma. Acta Radiol 2019; 60:516-525. [PMID: 29966430 DOI: 10.1177/0284185118786060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Residual tumor volume (RTV) and extent of resection (EOR) have previously been shown to affect survival in glioblastoma (GB) patients. Quantitative radiological assessment (QRA) of these factors could potentially affect clinical decision-making in the postoperative period. PURPOSE The first aim was to evaluate the reproducibility of different volume estimation methods of RTV and EOR by comparing QRA with subjective visual estimation and with objective volume estimations. The second aim was to clarify whether QRA of RTV and EOR would provide accuracy in predicting progression-free survival (PFS) and overall survival (OS) in GB patients. MATERIAL AND METHODS Seventy GB patients were studied retrospectively. Reproducibility of QRA was compared to conventional visual analysis. Intra-rater agreement between two repeated measurements of 25 patients was calculated. QRA for RTV and EOR was made for the entire study population. Survival analysis was performed by multivariate cox-regression analysis. RESULTS QRA of RTV and EOR gave superior intra-rater agreement compared to subjective evaluation. Multivariate survival analysis showed prognostic significance on 18 months PFS (hazard ratio [HR] = 0.44, P = 0.003) and OS (HR = 0.42, P = 0.012) at RTV < 1.6 mL and with EOR > 96% on PFS (HR = 2.152, P = 0.005) but not on OS (HR = 1.92, P = 0.053). CONCLUSION QRA of tumor volumes is more robust compared to standard evaluation methods. Since EOR and RTV are correlated to the prognosis in GB, quantitative analysis of tumor volumes could aid decision-making and patient management postoperatively.
Collapse
Affiliation(s)
- Adam Blomstergren
- Department of Clinical Sciences, Division of Neurosurgery, Lund University and Region Skåne, Lund, Sweden
| | - Anna Rydelius
- Department of Clinical Sciences, Division of Neurology, Lund University, Lund, Sweden
| | - Kasim Abul-Kasim
- Centre for Imaging and Function, Section of Neuroradiology, SUS Malmö, Lund University, Malmö, Sweden
| | - Jimmy Lätt
- Centre for Imaging and Function, SUS, Lund University, Lund, Sweden
| | - Pia C Sundgren
- Centre for Imaging and Function, SUS, Lund University, Lund, Sweden
- Department of Clinical Sciences, Division of Radiology, Lund University, Lund, Sweden
| | - Johan Bengzon
- Department of Clinical Sciences, Division of Neurosurgery, Lund University and Region Skåne, Lund, Sweden
- Stem Cell Center, BMC B10, Lund University, Lund, Sweden
| |
Collapse
|
200
|
Krivoshapkin AL, Sergeev GS, Gaytan AS, Kalneus LE, Kurbatov VP, Abdullaev OA, Salim N, Bulanov DV, Simonovich AE. Automated Volumetric Analysis of Postoperative Magnetic Resonance Imaging Predicts Survival in Patients with Glioblastoma. World Neurosurg 2019; 126:e1510-e1517. [PMID: 30910753 DOI: 10.1016/j.wneu.2019.03.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glioblastomas (GBMs) are primary brain tumors that are very difficult to treat. Magnetic resonance imaging (MRI) is the reference tool for diagnosis, postoperative control, and follow-up of GBM. The MRI tumor contrast enhancement part serves as a target for surgery. However, there are controversial data about the influence of pre- and postoperative tumor volumetric MRI parameters on overall survival (OS). METHODS Data of 57 patients with GBM were analyzed retrospectively. All patients had maximum safe resection and standard adjuvant treatment. All patients underwent 1.5-T MRI with contrast in the first 24 hours postoperatively. The data of pre- and postoperative volumetric parameters were analyzed using the original software. RESULTS Correlation analysis between the postoperative volume of the tumor contrast enhancement part and the patient's OS revealed a significant level (on the Chaddock scale) of inverse correlation. Residual tumor volume associated with OS of >6 months was determined as <2.5 cm3. The mortality risk in the first 6 months after tumor resection is 3.4 times higher when the tumor remnant is >2.5 cm3 (risk ratio, 3.4; P = 0.0002). CONCLUSIONS The volume of MRI contrast-enhancing GBM remnants after surgery, automatically measured by the software, was a significant predictor for early postoperative progression and death.
Collapse
Affiliation(s)
- Alexey L Krivoshapkin
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia.
| | - Gleb S Sergeev
- Neurosurgical Department, European Medical Center, Moscow, Russia
| | - Alekey S Gaytan
- Neurosurgical Department, European Medical Center, Moscow, Russia
| | - Leonid E Kalneus
- Physics Department, Novosibirsk State University, Novosibirsk, Russia
| | | | - Orkhan A Abdullaev
- Department of Neurosurgery, Novosibirsk State Medical University, Novosibirsk, Russia
| | - Nidal Salim
- Radiotherapy Center, European Medical Center, Moscow, Russia
| | | | | |
Collapse
|