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El-Khouly FE, Veldhuijzen van Zanten SEM, Santa-Maria Lopez V, Hendrikse NH, Kaspers GJL, Loizos G, Sumerauer D, Nysom K, Pruunsild K, Pentikainen V, Thorarinsdottir HK, Rutkauskiene G, Calvagna V, Drogosiewicz M, Dragomir M, Deak L, Kitanovski L, von Bueren AO, Kebudi R, Slavc I, Jacobs S, Jadrijevic-Cvrlje F, Entz-Werle N, Grill J, Kattamis A, Hauser P, Pears J, Biassoni V, Massimino M, Lopez Aguilar E, Torsvik IK, Joao Gil-da-Costa M, Kumirova E, Cruz-Martinez O, Holm S, Bailey S, Hayden T, Thomale UW, Janssens GOR, Kramm CM, van Vuurden DG. Diagnostics and treatment of diffuse intrinsic pontine glioma: where do we stand? J Neurooncol 2019; 145:177-184. [PMID: 31522324 PMCID: PMC6775536 DOI: 10.1007/s11060-019-03287-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 09/05/2019] [Indexed: 01/31/2023]
Abstract
Introduction Diffuse intrinsic pontine glioma (DIPG) is a rare clinically, neuro-radiologically, and molecularly defined malignancy of the brainstem with a median overall survival of approximately 11 months. Our aim is to evaluate the current tendency for its treatment in Europe in order to develop (inter)national consensus guidelines. Methods Healthcare professionals specialized in DIPG were asked to fill in an online survey with questions regarding usual treatment strategies at diagnosis and at disease progression in their countries and/or their centers, respectively. Results Seventy-four healthcare professionals responded to the survey, of which 87.8% were pediatric oncologists. Only 13.5% of the respondents biopsy all of their patients, 41.9% biopsy their patients infrequently. More than half of the respondents (54.1%) treated their patients with radiotherapy only at diagnosis, whereas 44.6% preferred radiotherapy combined with chemotherapy. When the disease progresses, treatment strategies became even more diverse, and the tendency for no treatment increased from 1.4% at diagnosis to 77.0% after second progression. 36.5% of the healthcare professionals treat children younger than 3 years differently than older children at diagnosis. This percentage decreased, when the disease progresses. Most of the participants (51.4%) included less than 25% of their patients in clinical trials. Conclusion This survey demonstrates a large heterogeneity of treatment regimens, especially at disease progression. We emphasize the need for international consensus guidelines for the treatment of DIPG, possible by more collaborative clinical trials. Electronic supplementary material The online version of this article (10.1007/s11060-019-03287-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fatma E El-Khouly
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.
- Department of Pediatric Oncology/Hematology, Amsterdam UMC, location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Sophie E M Veldhuijzen van Zanten
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Vicente Santa-Maria Lopez
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, St Joan de Déu Children´s Hospital, Barcelona, Spain
| | - N Harry Hendrikse
- Department of Clinical Pharmacology & Pharmacy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gertjan J L Kaspers
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - G Loizos
- Pediatric Oncology-Hematology Clinic, Archbishop Makarios III Hospital, Nicosia, Cyprus
| | - David Sumerauer
- Department of Pediatric Hematology and Oncology, 2nd Faculty of Medicine, University Hospital Motol, Charles University, Prague, Czech Republic
| | - Karsten Nysom
- Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Kaie Pruunsild
- Department of Hematology and Oncology, Tallinn Children's Hospital, Tallinn, Estonia
| | - Virve Pentikainen
- Division of Hematology-Oncology and Stem Cell Transplantation, Children's Hospital, Helsinki University Hospital, Helsinki, Finland
| | | | - Giedre Rutkauskiene
- Department of Pediatric Oncology and Hematology, Hospital of Lithuanian University of Health Sciences Kaunas Clinic, Kaunas, Lithuania
| | | | | | - Monica Dragomir
- Department of Pediatric Oncology, Oncology Institute Professor Doctor Alexandru Trestioreanu, Bucharest, Romania
| | - Ladislav Deak
- Department of Pediatric Oncology/Hematology, Children University Hospital, Kosice, Slovakia
| | - Lidija Kitanovski
- Division of Hemato-Oncology, Department of Pediatrics, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Andre O von Bueren
- Pediatric Oncology and Hematology, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland
| | - Rejin Kebudi
- Pediatric Hematology-Oncology, Cerrahpasa Medical Faculty & Oncology Institute, Istanbul University, Istanbul, Turkey
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | | | | | - Natacha Entz-Werle
- CHRU Hautepierre Strasbourg, Service de Pédiatrie Onco-Hématologie, Strasbourg, France
| | - Jacques Grill
- Département de Cancérologie de l'enfant et de l'adoloscent, CLCC Institut Gustave Roussy, Villejuif, France
| | - Antonis Kattamis
- First Department of Pediatrics, 'Aghia Sofia' Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Hauser
- Second Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Jane Pears
- Department of Pediatric Oncology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Enrique Lopez Aguilar
- Hospital de Pediatría, Centro Médico National Siglo XXI, Instituto Mexicano del Seguro Social, Jefatura de Servicio de Oncologia, Distrito Federal, Mexico
| | - Ingrid K Torsvik
- Division of Oncology/Hematology, Department of Pediatrics, Haukeland University Hospital, Mons, Norway
| | - Maria Joao Gil-da-Costa
- Pediatric Hematology and Oncology Division, University Hospital S. João Alameda Hernani Monteiro, Porto, Portugal
| | - Ella Kumirova
- Department of Neurooncology, Federal Research and Clinical Centre of Pediatric Hematology, Oncology and Immunology (FRC-PHOI), Moscow, Russia
| | - Ofelia Cruz-Martinez
- Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, St Joan de Déu Children´s Hospital, Barcelona, Spain
| | - Stefan Holm
- Department of Pediatric Hematology and Oncology, Department of Woman and Child Health, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Bailey
- Great North Children's Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Ulrich W Thomale
- Pediatric Neurosurgery, Charité University Medical Center Berlin, Berlin, Germany
| | - Geert O R Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Geottingen, Göttingen, Germany
| | - Dannis G van Vuurden
- Pediatric Oncology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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152
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Alvi MA, Ida CM, Paolini MA, Kerezoudis P, Meyer J, Barr Fritcher EG, Goncalves S, Meyer FB, Bydon M, Raghunathan A. Spinal cord high-grade infiltrating gliomas in adults: clinico-pathological and molecular evaluation. Mod Pathol 2019; 32:1236-1243. [PMID: 31028365 DOI: 10.1038/s41379-019-0271-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/15/2022]
Abstract
Primary high-grade infiltrating gliomas of the spinal cord are rare, with prior series including limited numbers of cases and reporting poor outcomes. Additionally, the molecular profile of high-grade infiltrating gliomas of the spinal cord has not been well characterized. We identified 13 adult patients whose surgery had been performed at our institution over a 26-year-period. Radiologically, nine cases harbored regions of post-contrast enhancement. Existing slides were reviewed, and when sufficient tissue was available, immunohistochemical stains (IDH1-R132H, H3-K27M, H3K27-me3, ATRX, p53 and BRAF-V600E), and a targeted 150-gene neuro-oncology next-generation sequencing panel were performed. The 13 patients included 11 men and 2 women with a median age of 38 years (range = 18-69). Histologically, all were consistent with an infiltrating astrocytoma corresponding to 2016 WHO grades III (n = 5) and IV (n = 8). By immunohistochemistry, six cases were positive for H3K27M, all showing concomitant loss of H3K27-me3. Next-generation sequencing was successfully performed in ten cases. Next-generation sequencing studies were successfully performed in four of the cases positive for H3K27M by immunohistochemistry, and all were confirmed as H3F3A K27M-mutant. Additional recurrent mutations identified included those of TERT promoter (n = 3), TP53 (n = 5), PPM1D (n = 3), NF1 (n = 3), ATRX (n = 2), and PIK3CA (n = 2). No HIST1H3B, HIST1H3C, IDH1, IDH2, or BRAF mutations were detected. Ten patients have died since first surgery, with a median survival of 13 months and 1 year of 46%. Median survival was 48.5 months for H3K27M-positive cases, compared to 1 month for those with TERT promoter mutation and 77 months for those harboring neither (p = 0.019). Median survival for cases with TP53 mutations was 11.5 months and for those with PPM1D mutations was 84 months. Our findings suggest that high-grade infiltrating gliomas of the spinal cord in adults represent a heterogeneous group of tumors, with variable outcomes possibly related to their molecular profiles.
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Affiliation(s)
- Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, 55902, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Cristiane M Ida
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Michael A Paolini
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, 55902, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Jenna Meyer
- Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, 84105, Israel
| | - Emily G Barr Fritcher
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Sandy Goncalves
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, 55902, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Frederic B Meyer
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Mohammed Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, 55902, USA.,Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55902, USA
| | - Aditya Raghunathan
- Department of Laboratory Medicine & Pathology, Mayo Clinic, Rochester, MN, 55902, USA.
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153
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Dufour C, Perbet R, Leblond P, Vasseur R, Stechly L, Pierache A, Reyns N, Touzet G, Le Rhun E, Vinchon M, Maurage CA, Escande F, Renaud F. Identification of prognostic markers in diffuse midline gliomas H3K27M-mutant. Brain Pathol 2019; 30:179-190. [PMID: 31348837 DOI: 10.1111/bpa.12768] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/18/2019] [Indexed: 12/19/2022] Open
Abstract
Pediatric diffuse midline gliomas are devastating diseases. Among them, diffuse midline gliomas H3K27M-mutant are associated with worse prognosis. However, recent studies have highlighted significant differences in clinical behavior and biological alterations within this specific subgroup. In this context, simple markers are needed to refine the prognosis of diffuse midline gliomas H3K27M-mutant and guide the clinical management of patients. The aims of this study were (i) to describe the molecular, immunohistochemical and, especially, chromosomal features of a cohort of diffuse midline gliomas and (ii) to focus on H3K27M-mutant tumors to identify new prognostic markers. Patients were retrospectively selected from 2001 to 2017. Tumor samples were analyzed by immunohistochemistry (including H3K27me3, EGFR, c-MET and p53), next-generation sequencing and comparative genomic hybridization array. Forty-nine patients were included in the study. The median age at diagnosis was 9 years, and the median overall survival (OS) was 9.4 months. H3F3A or HIST1H3B mutations were identified in 80% of the samples. Within the H3K27M-mutant tumors, PDGFRA amplification, loss of 17p and a complex chromosomal profile were significantly associated with worse survival. Three prognostic markers were identified in diffuse midline gliomas H3K27M-mutant: PDGFRA amplification, loss of 17p and a complex chromosomal profile. These markers are easy to detect in daily practice and should be considered to refine the prognosis of this entity.
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Affiliation(s)
- Charlotte Dufour
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, F-59000, France
| | - Romain Perbet
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, F-59000, France.,Univ Lille, Inserm, UMR 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, F-59000, France
| | - Pierre Leblond
- Department of Paediatric Oncology, Centre Oscar Lambret, Lille, F-59000, France
| | - Romain Vasseur
- Univ Lille, Inserm, UMR 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, F-59000, France
| | - Laurence Stechly
- Department of Biochemistry and Molecular Biology, Centre de Biologie Pathologie, Lille University Hospital, Lille, F-59000, France
| | - Adeline Pierache
- Department of Biostatistics and Data Management, Lille University Hospital, Lille, F-59000, France
| | - Nicolas Reyns
- Department of Stereotactic Neurosurgery, Lille University Hospital, Lille, F-59000, France
| | - Gustavo Touzet
- Department of Stereotactic Neurosurgery, Lille University Hospital, Lille, F-59000, France
| | - Emilie Le Rhun
- Univ Lille, Inserm, U-1192, Lille, F-59000, France.,Department of Neuro-Oncology and Neurosurgery, Lille University Hospital, Lille, F-59000, France.,Department of Neurology, Breast Cancer, Centre Oscar Lambret, Lille, F-59000, France
| | - Matthieu Vinchon
- Department of Paediatric Neurosurgery, Lille University Hospital, Lille, F-59000, France
| | - Claude-Alain Maurage
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, F-59000, France.,Univ Lille, Inserm, UMR 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, F-59000, France
| | - Fabienne Escande
- Department of Biochemistry and Molecular Biology, Centre de Biologie Pathologie, Lille University Hospital, Lille, F-59000, France
| | - Florence Renaud
- Institute of Pathology, Centre de Biologie Pathologie, Lille University Hospital, Lille, F-59000, France.,Univ Lille, Inserm, UMR 1172 - JPARC - Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer, Lille, F-59000, France
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154
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Kristensen BW, Priesterbach-Ackley LP, Petersen JK, Wesseling P. Molecular pathology of tumors of the central nervous system. Ann Oncol 2019; 30:1265-1278. [PMID: 31124566 PMCID: PMC6683853 DOI: 10.1093/annonc/mdz164] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Since the update of the 4th edition of the WHO Classification of Central Nervous System (CNS) Tumors published in 2016, particular molecular characteristics are part of the definition of a subset of these neoplasms. This combined 'histo-molecular' approach allows for a much more precise diagnosis of especially diffuse gliomas and embryonal CNS tumors. This review provides an update of the most important diagnostic and prognostic markers for state-of-the-art diagnosis of primary CNS tumors. Defining molecular markers for diffuse gliomas are IDH1/IDH2 mutations, 1p/19q codeletion and mutations in histone H3 genes. Medulloblastomas, the most frequent embryonal CNS tumors, are divided into four molecularly defined groups according to the WHO 2016 Classification: wingless/integrated (WNT) signaling pathway activated, sonic hedgehog (SHH) signaling pathway activated and tumor protein p53 gene (TP53)-mutant, SHH-activated and TP53-wildtype, and non-WNT/non-SHH-activated. Molecular characteristics are also important for the diagnosis of several other CNS tumors, such as RELA fusion-positive subtype of ependymoma, atypical teratoid rhabdoid tumor (AT/RT), embryonal tumor with multilayered rosettes, and solitary fibrous tumor/hemangiopericytoma. Immunohistochemistry is a helpful alternative for further molecular characterization of several of these tumors. Additionally, genome-wide methylation profiling is a very promising new tool in CNS tumor diagnostics. Much progress has thus been made by translating the most relevant molecular knowledge into a more precise clinical diagnosis of CNS tumors. Hopefully, this will enable more specific and more effective therapeutic approaches for the patients suffering from these tumors.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/pharmacology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/antagonists & inhibitors
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Brain/pathology
- Brain Neoplasms/diagnosis
- Brain Neoplasms/drug therapy
- Brain Neoplasms/genetics
- Brain Neoplasms/mortality
- DNA Methylation
- Drug Resistance, Neoplasm/genetics
- Gene Expression Regulation, Neoplastic/drug effects
- Glioma/diagnosis
- Glioma/drug therapy
- Glioma/genetics
- Glioma/mortality
- Humans
- Immunohistochemistry
- Molecular Targeted Therapy/methods
- Mutation
- Neoplasms, Germ Cell and Embryonal/diagnosis
- Neoplasms, Germ Cell and Embryonal/drug therapy
- Neoplasms, Germ Cell and Embryonal/genetics
- Neoplasms, Germ Cell and Embryonal/mortality
- Prognosis
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- B W Kristensen
- Department of Pathology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | | | - J K Petersen
- Department of Pathology, Odense University Hospital, Odense; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - P Wesseling
- Department of Pathology, University Medical Center Utrecht, Utrecht; Princess Máxima Center for Pediatric Oncology, Utrecht; Department of Pathology, Amsterdam University Medical Centers/VU Medical Center, Amsterdam, The Netherlands.
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155
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He P, Chen W, Qiu XX, Xi YB, Guan H, Xia J. A Rare High-Grade Glioma with a Histone H3 K27M Mutation in the Hypothalamus of an Adult Patient. World Neurosurg 2019; 128:527-531. [PMID: 31048046 DOI: 10.1016/j.wneu.2019.04.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/19/2019] [Accepted: 04/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Diffuse midline glioma H3 K27M mutant is a new tumor entity described in the revised 2016 World Health Organization classification. It is most frequently observed in children and develops in midline structures, including the brainstem, thalamus, and spine. We describe a rare diffuse midline glioma with an H3 K27M mutation arising in the hypothalamus of an adult. CASE DESCRIPTION A 27-year-old woman was admitted to our department complaining of amenorrhea, polydipsia, and diuresis for the previous 3 months, and headache and lethargy for approximately 10 days. Computed tomography scan showed an oval isodense solid mass extending from the pituitary toward the suprasellar cistern. A gadolinium-enhanced magnetic resonance imaging (MRI) showed a strongly heterogeneous enhanced solid lesion and nonenhanced cystic lesion. The patient underwent surgery and chemoradiotherapy with temozolomide. Histologic and immunohistochemical analyses revealed H3 K27M-mutant diffuse midline glioma. The patient underwent another resection for a recurrent tumor 5 months after the first surgery. Three months after the second operation, the patient relapsed, with MRI revealing spinal cord and meningeal metastases; she died shortly afterward. CONCLUSIONS Diffuse midline glioma with an H3 K27M mutation occurring in the hypothalamus of an adult is rare but should be considered in differential diagnoses. Because histone H3 K27M mutations are associated with aggressive clinical behavior and poor prognosis, molecular analyses should be used to determine the clinical and histopathologic features of such tumors. This will contribute to developing targeted drugs and gene therapy going forward.
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Affiliation(s)
- Pin He
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China
| | - Wei Chen
- Department of Radiology, Tongji Hospital, Tongji University School of Medicine, Shanghai, China; Department of Radiology, Pingshan District People's Hospital, Hubei University of Medicine, Shenzhen, Guangdong, China
| | - Xi Xiong Qiu
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China
| | - Yi Bin Xi
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Hong Guan
- Department of Pathology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China
| | - Jun Xia
- Department of Radiology, The First Affiliated Hospital of Shenzhen University, Health Science Center, Shenzhen, China; Shenzhen Second People's Hospital, Shenzhen, China.
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156
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Nakano Y, Yamasaki K, Sakamoto H, Matsusaka Y, Kunihiro N, Fukushima H, Inoue T, Honda-Kitahara M, Hara J, Yoshida A, Ichimura K. A long-term survivor of pediatric midline glioma with H3F3A K27M and BRAF V600E double mutations. Brain Tumor Pathol 2019; 36:162-168. [PMID: 31254135 DOI: 10.1007/s10014-019-00347-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
We report a case of 2-year-old female with lateral ventricular glioma harboring both H3F3A K27M and BRAF V600E mutations. By the methylation analysis, the tumor was classified as a diffuse midline glioma H3 K27M mutant, WHO grade IV. However, the tumor was pathologically low-grade and likely localized rather than diffusely infiltrating. Further, the patient has survived more than 8 years after gross total resection of the tumor. Whereas both H3F3A K27M and BRAF V600E have been reported as poor prognostic markers in pediatric glioma, our case, along with several other reported cases, suggests that the coexistence of these two mutations might not indicate poor prognosis. The case emphasizes the importance of comprehensive assessment based on pathological, genetic and clinical findings and calls for further investigations of non-diffuse glioma with H3F3A K27M and glioma with H3F3A K27M and BRAF V600E.
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Affiliation(s)
- Yoshiko Nakano
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan.
| | - Kai Yamasaki
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.,Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Hiroaki Sakamoto
- Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Yasuhiro Matsusaka
- Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Noritsugu Kunihiro
- Department of Pediatric Neurosurgery, Osaka City General Hospital, Osaka, Japan
| | - Hiroko Fukushima
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Mai Honda-Kitahara
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Junichi Hara
- Department of Pediatric Hematology/Oncology, Osaka City General Hospital, Osaka, Japan
| | - Akihiko Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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157
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Kotecha R, Mehta MP, Chang EL, Brown PD, Suh JH, Lo SS, Das S, Samawi HH, Keith J, Perry J, Sahgal A. Updates in the management of intradural spinal cord tumors: a radiation oncology focus. Neuro Oncol 2019; 21:707-718. [PMID: 30977511 PMCID: PMC6556849 DOI: 10.1093/neuonc/noz014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Primary spinal cord tumors represent a hetereogeneous group of central nervous system malignancies whose management is complex given the relatively uncommon nature of the disease and variety of tumor subtypes, functional neurologic deficits from the tumor, and potential morbidities associated with definitive treatment. Advances in neuroimaging; integration of diagnostic, prognostic, and predictive molecular testing into tumor classification; and developments in neurosurgical techniques have refined the current role of radiotherapy in the multimodal management of patients with primary spinal cord tumors, and corroborated the need for prospective, multidisciplinary discussion and treatment decision making. Radiotherapeutic technological advances have dramatically improved the entire continuum from treatment planning to treatment delivery, and the development of stereotactic radiosurgery and proton radiotherapy provides new radiotherapy options for patients treated in the definitive, adjuvant, or salvage setting. The objective of this comprehensive review is to provide a contemporary overview of the management of primary intradural spinal cord tumors, with a focus on radiotherapy.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Eric L Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California, USA
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - John H Suh
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Taussig Cancer Institute, Cleveland, Ohio, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Sunit Das
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Haider H Samawi
- Division of Hematology/Oncology, St Michael’s Hospital, Toronto, Ontario, Canada
| | - Julia Keith
- Department of Anatomical Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - James Perry
- Department of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW This review summarizes recent advances in the molecular classification of adult gliomas. RECENT FINDINGS According to the 2016 WHO classification, five main molecular subgroups of adult diffuse gliomas can be distinguished based on the 1p/19q codeletion, isocitrate dehydrogenase (IDH), and histone H3.3 mutation status. In the future, this classification may be further refined based on the integration of additional biomarkers, in particular CDKN2A/B homozygous deletion in IDH-mutant astrocytomas, TERT promoter mutations, EGFR amplification, chromosome 7 gain and chromosome 10 loss in IDH-wildtype astrocytomas, and FGFR1 mutations in midline gliomas. Histone H3.3 G34R/V defines a distinct subgroup of hemispheric IDH-wildtype high-grade gliomas occurring in young patients and FGFR gene fusions characterize a subgroup of IDH-wildtype glioblastomas that could benefit from specific treatment approaches. RNA sequencing may identify targetable gene fusions in circumscribed gliomas lacking classical BRAF alterations. In chordoid gliomas, recurrent PRKCA mutations could serve as a new diagnostic marker. Among comprehensive molecular analysis methods, DNA methylation profiling appears as a particularly powerful approach to identify new molecular subgroups of gliomas and to classify difficult cases. SUMMARY The classification of adult gliomas may be improved by the integration of additional biomarkers and/or by comprehensive molecular analysis, in particular DNA methylation profiling. The most relevant approach, however, remains to be established.
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159
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Goodarzi A, Thaci B, Toussi A, Karnati T, Kim K, Fragoso R. Glioblastoma Multiforme of the Conus Medullaris—Management Strategies and Complications. World Neurosurg 2019; 124:101-109. [PMID: 30639501 DOI: 10.1016/j.wneu.2018.12.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/27/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
Abstract
Primary spinal glioblastoma multiforme (GBM) of the conus medullaris is a rare and devastating pathologic entity. The presenting symptoms commonly include progressive neurologic deficits in the lower extremities, bowel and bladder dysfunction, and low back pain. Histologically, these tumors have high-grade features similar to their intracranial counterparts. However, recent advancements in the field of molecular oncology have been beginning to elucidate a unique molecular blueprint for these spinal gliomas. Given the lack of standardized treatment strategies, we have presented our institutional experience in treating a small series of patients with conus medullaris GBM and have reviewed the reported data on the relevant molecular markers, management strategies, and complication avoidance for this malignant pathologic entity.
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Affiliation(s)
- Amir Goodarzi
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA.
| | - Bart Thaci
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Atrin Toussi
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Tejas Karnati
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Kee Kim
- Department of Neurological Surgery, University of California, Davis, School of Medicine, Sacramento, California, USA
| | - Ruben Fragoso
- Department of Radiation-Oncology, University of California, Davis, School of Medicine, Sacramento, California, USA
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160
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Role of Radiation Therapy in the Management of Diffuse Intrinsic Pontine Glioma: A Systematic Review. Adv Radiat Oncol 2019; 4:520-531. [PMID: 31360809 PMCID: PMC6639749 DOI: 10.1016/j.adro.2019.03.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/20/2019] [Indexed: 01/05/2023] Open
Abstract
Purpose Diffuse intrinsic pontine glioma (DIPG) is the most aggressive primary pediatric brain tumor, with <10% of children surviving 2 years. Radiation therapy (RT) remains the mainstay of treatment, but there is a great clinical need for improvements and advancements in treatment strategies. The aim of this systematic review was to identify all available studies in which RT was used to treat patients with DIPG. Methods and Materials A literature search for studies published up to March 10, 2018 was conducted using the PubMed database. We identified 384 articles using search items “diffuse intrinsic pontine glioma” and 221 articles using search items “diffuse brainstem glioma radiotherapy.” Included studies were prospective and retrospective series that reported outcomes of DIPG treatment with RT. Results We identified 49 studies (1286 patients) using upfront conventionally fractionated RT, 5 studies (92 patients) using hypofractionated RT, and 8 studies (348 patients) using hyperfractionated RT. The mean median overall survival (OS) was 12.0 months, 10.2 months, and 7.9 months in patients who received conventional, hyperfractionated, and hypofractionated RT regimens, respectively. Patients undergoing radiosensitizing therapy had a mean median OS of 11.5 months, and patients who did not receive concomitant systemic therapy had an OS of 9.4 months. In patients who received salvage RT, the mean median OS from initial diagnosis was 16.3 months. Conclusions As one of the largest systematic reviews examining RT for DIPG, this report may serve as a useful tool to help clinicians choose the most appropriate treatment approach, while also providing a platform for future investigations into the utility of RT and systemic therapy.
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161
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Liu Y, Zhang Y, Hua W, Li Z, Wu B, Liu W. Clinical and Molecular Characteristics of Thalamic Gliomas: Retrospective Report of 26 Cases. World Neurosurg 2019; 126:e1169-e1182. [PMID: 30885860 DOI: 10.1016/j.wneu.2019.03.061] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Thalamic glioma is a type of midline glioma with poor outcomes. In the present study, we investigated the clinical and molecular features of thalamic gliomas in Chinese patients. METHODS The data from 26 patients with thalamic glioma who had undergone surgery at Shanghai Huashan Hospital from January 2011 to August 2015 were retrospectively analyzed. Various clinical and molecular factors were evaluated to explore their effects on prognosis. H3K27M mutation status and its association with relevant molecular factors were also investigated. RESULTS The mean age of the patients was 38.88 years, and no significant difference was found in sex. The most common initial symptoms were headaches (38.46%; 10 of 26) and motor deficits (30.77%; 8 of 26). The H3K27M mutation was identified in 12 patients, and mutant thalamic glioma showed less frequent O-6-methylguanine DNA methyltransferase (MGMT) promoter methylation compared with the wild-type group (P = 0.015; χ1 test). Multivariate analysis showed that the H3K27M mutation was an independent unfavorable prognostic factor for overall survival. MGMT promoter unmethylation and the TP53 mutation were identified as negative prognostic factors for progression-free survival. CONCLUSIONS Our results revealed the clinical and molecular characteristics of thalamic glioma in China. Our data have shown the absence of MGMT promoter methylation in H3K27M mutant thalamic glioma, validating it as a hallmark of H3K27M mutant gliomas. In addition, H3K27M mutation was identified as the sole unfavorable prognostic factor on overall survival. MGMT promoter unmethylation and TP53 mutation were identified as independent prognostic factors for progression-free survival.
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Affiliation(s)
- Yikui Liu
- Department of Neurosurgery, Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Yi Zhang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
| | - Wei Hua
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiqi Li
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Biwu Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenli Liu
- GenomiCare Biotechnology Company, Shanghai, China
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162
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Schreck KC, Ranjan S, Skorupan N, Bettegowda C, Eberhart CG, Ames HM, Holdhoff M. Incidence and clinicopathologic features of H3 K27M mutations in adults with radiographically-determined midline gliomas. J Neurooncol 2019; 143:87-93. [PMID: 30864101 PMCID: PMC6482123 DOI: 10.1007/s11060-019-03134-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/22/2019] [Indexed: 12/30/2022]
Abstract
Purpose H3 K27 mutations, most commonly in H3F3A, are common in diffuse midline glioma. The exact frequency of these mutations in adults with gliomas in the midline location is unknown. This study was conducted to define the incidence of H3 K27M mutations in this location and to compare clinicopathological features with those of patients who do not harbor this mutation. Methods Consecutive glioma cases from 2007 to 2017 were screened for gliomas in the midline location. Immunohistochemistry was performed on all available tissue for mutations of H3 K27M, IDH1, and ARTX. Results Of 850 gliomas screened, 163 cases had midline glioma on MRI. Sufficient FFPE tissue was available for 123 cases (75%). H3 K27M mutation was identified in 18 of 123 cases (15%). All except one H3 K27M-mutant tumors were WHO grade III or IV on histology, while non-mutant tumors encompassed all four grades. The most common midline locations for H3 K27M-mutated tumors were midbrain (2/3; 67%), pons (4/11; 36%), and cerebellum (6/24; 25%). As compared to H3 K27M-wildtype tumors, there were no differences in age at diagnosis, sex, tumor grade, contrast enhancement on MRI, extent of resection, or treatment received. In this cohort, median survival was longer for patients with H3 K27M-mutated tumors (n = 18; 17.6 months) compared with high-grade wildtype tumors (n = 74; 7.7 months, p = 0.03). Conclusions H3 K27M mutations are common in midline gliomas in adults and can present in all midline locations. Survival comparison between H3 K27M-mutant and wildtype midline gliomas suggests that survival may be similar or possibly improved if the mutation is present.
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Affiliation(s)
- Karisa C. Schreck
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 201 North Broadway, Viragh Building, 9th floor, Post Box 3, Baltimore, MD 21287 USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Surabhi Ranjan
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 201 North Broadway, Viragh Building, 9th floor, Post Box 3, Baltimore, MD 21287 USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Nebojša Skorupan
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 201 North Broadway, Viragh Building, 9th floor, Post Box 3, Baltimore, MD 21287 USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Chetan Bettegowda
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 201 North Broadway, Viragh Building, 9th floor, Post Box 3, Baltimore, MD 21287 USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Charles G. Eberhart
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Heather M. Ames
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD USA
| | - Matthias Holdhoff
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 201 North Broadway, Viragh Building, 9th floor, Post Box 3, Baltimore, MD 21287 USA
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD USA
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163
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Lu VM, Alvi MA, McDonald KL, Daniels DJ. Impact of the H3K27M mutation on survival in pediatric high-grade glioma: a systematic review and meta-analysis. J Neurosurg Pediatr 2019; 23:308-316. [PMID: 30544362 DOI: 10.3171/2018.9.peds18419] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/06/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Pediatric high-grade gliomas (pHGGs), including diffuse intrinsic pontine glioma, present a prognostic challenge given their lethality and rarity. A substitution mutation of lysine for methionine at position 27 in histone H3 (H3K27M) has been shown to be highly specific to these tumors. Data are accumulating regarding the poor outcomes of patients with these tumors; however, the quantification of pooled outcomes has yet to be done, which could assist in prioritizing management. The aim of this study was to quantitatively pool data in the current literature on the H3K27M mutation as an independent prognostic factor in pHGG. METHODS Searches of seven electronic databases from their inception to March 2018 were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were extracted and pooled using a meta-analysis of proportions. Meta-regression was used to identify potential sources of heterogeneity. RESULTS Six observational studies satisfied the selection criteria for inclusion. They reported the survival outcomes of a pooled cohort of 474 pHGG patients, with 258 (54%) and 216 (46%) patients positive and negative, respectively, for the H3K27M mutation. Overall, the presence of the mutation was independently and significantly associated with a worse prognosis (HR 3.630, p < 0.001). Overall survival was significantly shorter (by 2.300 years; p = 0.008) when the H3K27M mutation was present in pHGG. Meta-regression did not identify any study covariates of heterogeneous concern. CONCLUSIONS According to the current literature, pHGG patients positive for the H3K27M mutation are more than 3 times more susceptible to succumbing to this disease by more than 2 years, compared to patients negative for the mutation. More robust outcome data are required to improve our quantitative understanding of this pathological entity in order to assist in prioritizing clinical management. Future larger prospective studies are required to overcome inherent biases in the current literature to validate the quantitative findings of this study. ABBREVIATIONS CI = confidence interval; GRADE = Grades of Recommendation Assessment, Development and Evaluation; HR = hazard ratio; MD = mean difference; NOS = Newcastle-Ottawa Scale; OS = overall survival; pHGG = pediatric high-grade glioma; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RE = random effects.
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Affiliation(s)
- Victor M Lu
- 1Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia; and
| | - Mohammed A Alvi
- 2Department of Neurologic Surgery and
- 3Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Kerrie L McDonald
- 1Prince of Wales Clinical School, The University of New South Wales, Sydney, Australia; and
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164
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H3 K27M Mutations in Thalamic Pilocytic Astrocytomas with Anaplasia. World Neurosurg 2019; 124:87-92. [PMID: 30639498 DOI: 10.1016/j.wneu.2018.12.147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The revised WHO classification of central nervous system tumors, published in 2016, has recognized the H3 K27M mutation as a critical genetic signature defining a new group of infiltrative astrocytomas designated "diffuse midline glioma, H3 K27M mutant". Although the majority of H3 K27M mutations arise in the setting of diffusely infiltrative tumors, there are rare reports of compact tumors with low-grade histologic features harboring this mutation. The prevalence and clinical significance of this mutation in pilocytic astrocytomas remain unclear. CASE DESCRIPTION We report two young adult patients with H3 K27M-mutated thalamic pilocytic astrocytomas who presented to medical attention with symptomatic hydrocephalus requiring urgent intervention. We present our experience with this unusual tumor and recommend a treatment paradigm of maximal safe surgical resection followed by chemotherapy and radiation. CONCLUSIONS Stereotactic biopsies may undergrade some adult thalamic pilocytic astrocytomas. Thus, we recommend that all of these tumors be evaluated for the H3 K27M mutation. Further, we believe that H3 K27M-mutant thalamic pilocytic astrocytomas require aggressive multi-modality treatment and that these treatments should be guided by the molecular findings, as opposed to the histologic ones.
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165
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Ebrahimi A, Skardelly M, Schuhmann MU, Ebinger M, Reuss D, Neumann M, Tabatabai G, Kohlhof-Meinecke P, Schittenhelm J. High frequency of H3 K27M mutations in adult midline gliomas. J Cancer Res Clin Oncol 2019; 145:839-850. [PMID: 30610375 DOI: 10.1007/s00432-018-02836-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/27/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Diffuse midline gliomas, H3 K27M-mutant were introduced as a new grade IV entity in WHO classification of tumors 2016. These tumors occur often in pediatric patients and show an adverse prognosis with a median survival less than a year. Most of the studies on these tumors, previously known as pediatric diffuse intrinsic pontine glioma, are on pediatric patients and its significance in adult patients is likely underestimated. METHODS We studied 165 cases of brain tumors of midline localization initially diagnosed as diffuse astrocytomas, oligodendrogliomas, pilocytic astrocytomas, supependymomas, ependymomas and medulloblastomas in patients with an age range of 2-85. RESULTS We identified 41 diffuse midline gliomas according WHO 2016, including 12 pediatric and 29 adult cases, among them two cases with histological features of low grade tumors: pilocytic astrocytoma and subependymoma. 49% (20/41) of the patients were above 30 years old by the first tumor manifestation including 29% (11/41) above 54 that signifies a broader age spectrum as previously reported. Our study confirms that H3 K27M mutations are associated with a poorer prognosis in pediatric patients compared to wild-type tumors, while in adult patients these mutations do not influence the survival significantly. The pattern of tumor growth was different in pediatric compared to adult patients; a diffuse growth along the brain axis was more evident in adult compared to pediatric patients (24% vs. 15%). CONCLUSION H3 K27M mutations are frequent in adult midline gliomas and have a prognostic role similar to H3 K27M wild-type high-grade tumors.
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Affiliation(s)
- Azadeh Ebrahimi
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany. .,Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany. .,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany. .,Department of Neuropathology, Institute of Pathology, University Hospital of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany.
| | - Marco Skardelly
- Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany.,Interdisciplinary Division of Neurooncology, Departments of Vascular Neurology and Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany.,Laboratory for Clinical and Experimental Neurooncology, Hertie-Institute for Clinical Brain Research, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Martin U Schuhmann
- Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany
| | - Martin Ebinger
- Department of General Pediatrics, Hematology/Oncology, University Children's Hospital, 72076, Tuebingen, Germany
| | - David Reuss
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, University Hospital of Heidelberg, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Manuela Neumann
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neurooncology, Departments of Vascular Neurology and Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany.,Laboratory for Clinical and Experimental Neurooncology, Hertie-Institute for Clinical Brain Research, Tuebingen, Germany.,Center for Personalized Medicine, Eberhard Karls University of Tuebingen, Tuebingen, Germany.,German Consortium for Translational Cancer Research (DKTK), DKFZ Partner Site Tuebingen, Tuebingen, Germany.,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | | | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, 72076, Tuebingen, Germany. .,Center for CNS Tumors, Comprehensive Cancer Center Tuebingen-Stuttgart, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany.
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166
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Khalid SI, Kelly R, Adogwa O, Carlton A, Tam E, Naqvi S, Kushkuley J, Ahmad S, Woodward J, Khanna R, Davison M, Munoz L, Byrne R. Pediatric Brainstem Gliomas: A Retrospective Study of 180 Patients from the SEER Database. Pediatr Neurosurg 2019; 54:151-164. [PMID: 30947221 DOI: 10.1159/000497440] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 02/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Large population-based studies are needed to assess the epidemiology and survival risk factors associated with pediatric brainstem gliomas. This retrospective study explores factors that may influence survival in this population. METHODS Utilizing the SEER database, the authors retrospectively assessed survival in histologically confirmed brainstem gliomas in patients aged 17 and younger. Survival was described with Kaplan-Meyer curves and multivariate regression analysis. RESULTS This analysis of 180 cases showed that age (hazard ratio [HR] 1.04, 95% CI 0.96-1.14, p = 0.34), non-white race (HR 1.00, 95% CI 0.35-2.85 p > 0.99), distant or invasive extension of the tumor (HR 0.4, 95% CI 0.08-2.53, p = 0.37), and radiation therapy (HR 1.27, 95% CI 0.52-3.11, p = 0.61) were not associated with decreased survival. High-grade tumor status (HR 8.64, 95% CI 3.49-21.41, p < 0.001) was associated with decreased survival. Partial resection (HR 0.11, 95% CI 0.04-0.30, p < 0.001) and gross-total resection (HR 0.03, 95% CI 0.01-0.14, p < 0.001) were associated with improved survival. CONCLUSIONS High-grade brainstem gliomas have a worse prognosis. Early diagnosis and surgery appear to be associated with improved survival, while the role of radiation is unclear.
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Affiliation(s)
- Syed I Khalid
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Kelly
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Owoicho Adogwa
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA,
| | - Adam Carlton
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, USA
| | - Edric Tam
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
| | - Salik Naqvi
- College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Jacob Kushkuley
- Department of PA Studies, MGH Institute of Health Professions, Charlestown, Massachusetts, USA
| | - Shahjehan Ahmad
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Josha Woodward
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Ryan Khanna
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark Davison
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Lorenzo Munoz
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Richard Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA
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Grill J, Debily MA, Varlet P, Plessier A, Le Dret L, Beccaria K, Puget S, Castel D. The dark matter of diffuse intrinsic pontine gliomas: an update. Expert Opin Orphan Drugs 2018. [DOI: 10.1080/21678707.2019.1560262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jacques Grill
- Equipe Nouvelles Thérapeutiques Anticancéreuses, Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Université Paris-Saclay, Villejuif cedex, France
- Departement de Cancerologie de l’Enfant et de l’Adolescent, Gustave Roussy, Villejuif cedex, France
| | - Marie-Anne Debily
- Equipe Nouvelles Thérapeutiques Anticancéreuses, Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Université Paris-Saclay, Villejuif cedex, France
- Department Master Biologie et Sante, Universite Evry Val d'Essonne, Evry cedex, France
| | - Pascale Varlet
- Service de Neuropathologie, Hôpital Sainte-Anne, Paris cedex, France
| | - Alexandre Plessier
- Equipe Nouvelles Thérapeutiques Anticancéreuses, Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Université Paris-Saclay, Villejuif cedex, France
| | - Ludivine Le Dret
- Equipe Nouvelles Thérapeutiques Anticancéreuses, Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Université Paris-Saclay, Villejuif cedex, France
| | - Kevin Beccaria
- Departement de Cancerologie de l’Enfant et de l’Adolescent, Gustave Roussy, Villejuif cedex, France
- Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Paris cedex, France
| | - Stéphanie Puget
- Service de Neurochirurgie Pédiatrique, Hôpital Necker - Enfants Malades, Paris cedex, France
| | - David Castel
- Equipe Nouvelles Thérapeutiques Anticancéreuses, Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Université Paris-Saclay, Villejuif cedex, France
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Castel D, Philippe C, Kergrohen T, Sill M, Merlevede J, Barret E, Puget S, Sainte-Rose C, Kramm CM, Jones C, Varlet P, Pfister SM, Grill J, Jones DTW, Debily MA. Transcriptomic and epigenetic profiling of 'diffuse midline gliomas, H3 K27M-mutant' discriminate two subgroups based on the type of histone H3 mutated and not supratentorial or infratentorial location. Acta Neuropathol Commun 2018; 6:117. [PMID: 30396367 PMCID: PMC6219253 DOI: 10.1186/s40478-018-0614-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 01/18/2023] Open
Abstract
Diffuse midline glioma (DMG), H3 K27M-mutant, is a new entity in the updated WHO classification grouping together diffuse intrinsic pontine gliomas and infiltrating glial neoplasms of the midline harboring the same canonical mutation at the Lysine 27 of the histones H3 tail.Two hundred and fifteen patients younger than 18 years old with centrally-reviewed pediatric high-grade gliomas (pHGG) were included in this study. Comprehensive transcriptomic (n = 140) and methylation (n = 80) profiling was performed depending on the material available, in order to assess the biological uniqueness of this new entity compared to other midline and hemispheric pHGG.Tumor classification based on gene expression (GE) data highlighted the similarity of K27M DMG independently of their location along the midline. T-distributed Stochastic Neighbor Embedding (tSNE) analysis of methylation profiling confirms the discrimination of DMG from other well defined supratentorial tumor subgroups. Patients with diffuse intrinsic pontine gliomas (DIPG) and thalamic DMG exhibited a similarly poor prognosis (11.1 and 10.8 months median overall survival, respectively). Interestingly, H3.1-K27M and H3.3-K27M primary tumor samples could be distinguished based both on their GE and DNA methylation profiles, suggesting that they might arise from a different precursor or from a different epigenetic reorganization.These differences in DNA methylation profiles were conserved in glioma stem-like cell culture models of DIPG which mimicked their corresponding primary tumor. ChIP-seq profiling of H3K27me3 in these models indicate that H3.3-K27M mutated DIPG stem cells exhibit higher levels of H3K27 trimethylation which are correlated with fewer genes expressed by RNAseq. When considering the global distribution of the H3K27me3 mark, we observed that intergenic regions were more trimethylated in the H3.3-K27M mutated cells compared to the H3.1-K27M mutated ones.H3 K27M-mutant DMG represent a homogenous group of neoplasms compared to other pediatric gliomas that could be further separated based on the type of histone H3 variant mutated and their respective epigenetic landscapes. As these characteristics drive different phenotypes, these findings may have important implication for the design of future trials in these specific types of neoplasms.
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Affiliation(s)
- David Castel
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France.
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut de Cancérologie Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, 114 rue Édouard Vaillant, 94805, Villejuif Cedex, France.
| | - Cathy Philippe
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
- NeuroSpin/UNATI, CEA, Université Paris-Saclay, Gif-sur-Yvette, France
| | - Thomas Kergrohen
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut de Cancérologie Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, 114 rue Édouard Vaillant, 94805, Villejuif Cedex, France
| | - Martin Sill
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Jane Merlevede
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
| | - Emilie Barret
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
| | - Stéphanie Puget
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Université Paris V Descartes, Sorbonne Paris Cité, Paris, France
| | - Christian Sainte-Rose
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Université Paris V Descartes, Sorbonne Paris Cité, Paris, France
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Goettingen, Goettingen, Germany
| | - Chris Jones
- Divisions of Molecular Pathology and Cancer Therapeutics, The Institute of Cancer Research, Sutton, Surrey, UK
| | - Pascale Varlet
- Department of Neuropathology, Hôpital Sainte-Anne, Université Paris V Descartes, Sorbonne Paris Cité, Paris, France
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology (B062), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jacques Grill
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France
- Département de Cancérologie de l'Enfant et de l'Adolescent, Institut de Cancérologie Gustave Roussy, Université Paris-Sud, Université Paris-Saclay, 114 rue Édouard Vaillant, 94805, Villejuif Cedex, France
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Pediatric Glioma Research Group, German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Marie-Anne Debily
- UMR8203,Vectorologie et Nouvelles Thérapies Anticancéreuses, CNRS, Gustave Roussy, Univ. Paris-Sud, Université Paris-Saclay, 94805, Villejuif, France.
- Université Evry, Université Paris-Saclay, 91057, Evry Cedex, France.
- Univ. Evry, Université Paris-Saclay, 91057, Evry Cedex, France.
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169
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Velz J, Neidert MC, Struckmann K, Hackius M, Germans M, Bozinov O, Rushing E. A Rare Case of Diffuse Midline Glioma, H3 K27M Mutant, of the Spinal Cord Mimicking Meningitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s42399-018-0007-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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170
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Testa U, Castelli G, Pelosi E. Genetic Abnormalities, Clonal Evolution, and Cancer Stem Cells of Brain Tumors. Med Sci (Basel) 2018; 6:E85. [PMID: 30279357 PMCID: PMC6313628 DOI: 10.3390/medsci6040085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023] Open
Abstract
Brain tumors are highly heterogeneous and have been classified by the World Health Organization in various histological and molecular subtypes. Gliomas have been classified as ranging from low-grade astrocytomas and oligodendrogliomas to high-grade astrocytomas or glioblastomas. These tumors are characterized by a peculiar pattern of genetic alterations. Pediatric high-grade gliomas are histologically indistinguishable from adult glioblastomas, but they are considered distinct from adult glioblastomas because they possess a different spectrum of driver mutations (genes encoding histones H3.3 and H3.1). Medulloblastomas, the most frequent pediatric brain tumors, are considered to be of embryonic derivation and are currently subdivided into distinct subgroups depending on histological features and genetic profiling. There is emerging evidence that brain tumors are maintained by a special neural or glial stem cell-like population that self-renews and gives rise to differentiated progeny. In many instances, the prognosis of the majority of brain tumors remains negative and there is hope that the new acquisition of information on the molecular and cellular bases of these tumors will be translated in the development of new, more active treatments.
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Affiliation(s)
- Ugo Testa
- Department of Oncology, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Germana Castelli
- Department of Oncology, Istituto Superiore di Sanità, 00161 Rome, Italy.
| | - Elvira Pelosi
- Department of Oncology, Istituto Superiore di Sanità, 00161 Rome, Italy.
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171
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Yi S, Choi S, Kim SH. In Reply: Impact of H3.3 K27M Mutation on Prognosis and Survival of Grade IV Spinal Cord Glioma on the Basis of New 2016 WHO Health Organization Classification of the Central Nervous System. Neurosurgery 2018; 83:E195-E197. [PMID: 31222270 DOI: 10.1093/neuros/nyy348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Seong Yi
- Department of Neurosurgery Spine and Spinal Cord Institute Yonsei University College of Medicine Seoul, Republic of Korea
| | - Sunkyu Choi
- Department of Neurosurgery Spine and Spinal Cord Institute Yonsei University College of Medicine Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology Yonsei University College of Medicine Seoul, Republic of Korea
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172
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Lu VM, Alvi MA, Daniels DJ. Letter: Impact of H3.3 K27M Mutation on Prognosis and Survival of Grade IV Spinal Cord Glioma on the Basis of New 2016 World Health Organization Classification of the Central Nervous System. Neurosurgery 2018; 83:E193-E194. [DOI: 10.1093/neuros/nyy347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Victor M Lu
- Cure Brain Cancer Neuro-oncology Laboratory Prince of Wales Clinical School The University of New South Wales Sydney, Australia
| | - Mohammed A Alvi
- Department of Neurologic Surgery The Mayo Clinic Rochester, Minnesota
| | - David J Daniels
- Department of Neurologic Surgery The Mayo Clinic Rochester, Minnesota
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173
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H3 K27M-mutant gliomas in adults vs. children share similar histological features and adverse prognosis. Clin Neuropathol 2018; 37 (2018):53-63. [PMID: 29393845 PMCID: PMC5822176 DOI: 10.5414/np301085] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 12/17/2022] Open
Abstract
Background:H3 K27M mutation was originally described in pediatric diffuse intrinsic pontine gliomas (DIPGs), but has been recently recognized to occur also in adult midline diffuse gliomas, as well as midline tumors with other morphologies, including gangliogliomas (GGs), anaplastic GGs, pilocytic astrocytomas (PAs), and posterior fossa ependymomas. In a few patients with H3 K27M-mutant tumors with these alternate morphologies, longer survival has been reported, making grading difficult for the neuropathologist. Few series compare tumors in adult vs. pediatric cohorts; we report our 4-year experience. Materials and methods: Text Word database searches using “H3 K27M” in reports generated between January 2013 and November 10, 2017 were used to identify patients. Clinical and histological features as well as survival were evaluated for each case. Results: 28 H3 K27M-mutant tumors were identified, with equal numbers of adults (13) vs. children (15). For adults, mean and median age was 52 years (range = 27 – 81 years), 2 decades older than a recently-published adult series. Tumors involved thalamic (adult = 7; pediatric = 7), spinal cord (adult = 4; pediatric = 2), pons (adult = 1; pediatric = 6), and hypothalamic (n = 1) sites. Other morphologies at presentation included pure GG (n = 3, pediatric) and PA (n = 1, adult). One adult and 1 pediatric patient each presented with leptomeningeal dissemination or developed leptomeningeal dissemination within 1 year after diagnosis, with transformation from PA or GG histology to glioblastoma. Mean survival was 9.3 (adults) vs. 8.9 (pediatric) months. Patients with tumors of other morphologies (GG, PA) did not enjoy extended survival. Conclusion:H3 K27M-mutant tumors can affect patients at advanced ages, may show leptomeningeal dissemination at time of presentation, and “pure” GG or PA morphology is not rare. Regardless of patient age or tumor morphology, patients fare equally poorly.
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174
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Lapointe S, Perry A, Butowski NA. Primary brain tumours in adults. Lancet 2018; 392:432-446. [PMID: 30060998 DOI: 10.1016/s0140-6736(18)30990-5] [Citation(s) in RCA: 809] [Impact Index Per Article: 134.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/05/2018] [Accepted: 04/23/2018] [Indexed: 12/11/2022]
Abstract
Primary CNS tumours refer to a heterogeneous group of tumours arising from cells within the CNS, and can be benign or malignant. Malignant primary brain tumours remain among the most difficult cancers to treat, with a 5 year overall survival no greater than 35%. The most common malignant primary brain tumours in adults are gliomas. Recent advances in molecular biology have improved understanding of glioma pathogenesis, and several clinically significant genetic alterations have been described. A number of these (IDH, 1p/19q codeletion, H3 Lys27Met, and RELA-fusion) are now combined with histology in the revised 2016 WHO classification of CNS tumours. It is likely that understanding such molecular alterations will contribute to the diagnosis, grading, and treatment of brain tumours. This progress in genomics, along with significant advances in cancer and CNS immunology, has defined a new era in neuro-oncology and holds promise for diagntic and therapeutic improvement. The challenge at present is to translate these advances into effective treatments. Current efforts are focused on developing molecular targeted therapies, immunotherapies, gene therapies, and novel drug-delivery technologies. Results with single-agent therapies have been disappointing so far, and combination therapies seem to be required to achieve a broad and durable antitumour response. Biomarker-targeted clinical trials could improve efficiencies of therapeutic development.
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Affiliation(s)
- Sarah Lapointe
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Arie Perry
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, CA, USA
| | - Nicholas A Butowski
- Department of Neurological Surgery, University of California, San Francisco, CA, USA.
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175
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H3 K27M–mutant diffuse midline gliomas in different anatomical locations. Hum Pathol 2018; 78:89-96. [DOI: 10.1016/j.humpath.2018.04.015] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 11/21/2022]
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176
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A suggestion to introduce the diagnosis of "diffuse midline glioma of the pons, H3 K27 wildtype (WHO grade IV)". Acta Neuropathol 2018; 136:171-173. [PMID: 29785560 DOI: 10.1007/s00401-018-1863-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/06/2018] [Accepted: 05/07/2018] [Indexed: 10/16/2022]
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177
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Mackay A, Burford A, Molinari V, Jones DTW, Izquierdo E, Brouwer-Visser J, Giangaspero F, Haberler C, Pietsch T, Jacques TS, Figarella-Branger D, Rodriguez D, Morgan PS, Raman P, Waanders AJ, Resnick AC, Massimino M, Garrè ML, Smith H, Capper D, Pfister SM, Würdinger T, Tam R, Garcia J, Thakur MD, Vassal G, Grill J, Jaspan T, Varlet P, Jones C. Molecular, Pathological, Radiological, and Immune Profiling of Non-brainstem Pediatric High-Grade Glioma from the HERBY Phase II Randomized Trial. Cancer Cell 2018; 33:829-842.e5. [PMID: 29763623 PMCID: PMC5956280 DOI: 10.1016/j.ccell.2018.04.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/28/2018] [Accepted: 04/10/2018] [Indexed: 12/30/2022]
Abstract
The HERBY trial was a phase II open-label, randomized, multicenter trial evaluating bevacizumab (BEV) in addition to temozolomide/radiotherapy in patients with newly diagnosed non-brainstem high-grade glioma (HGG) between the ages of 3 and 18 years. We carried out comprehensive molecular analysis integrated with pathology, radiology, and immune profiling. In post-hoc subgroup analysis, hypermutator tumors (mismatch repair deficiency and somatic POLE/POLD1 mutations) and those biologically resembling pleomorphic xanthoastrocytoma ([PXA]-like, driven by BRAF_V600E or NF1 mutation) had significantly more CD8+ tumor-infiltrating lymphocytes, and longer survival with the addition of BEV. Histone H3 subgroups (hemispheric G34R/V and midline K27M) had a worse outcome and were immune cold. Future clinical trials will need to take into account the diversity represented by the term "HGG" in the pediatric population.
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Affiliation(s)
- Alan Mackay
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - Anna Burford
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - Valeria Molinari
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany; Division of Paediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Elisa Izquierdo
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK
| | | | - Felice Giangaspero
- Department of Radiology, Oncology and Anatomic-Pathology Sciences, Sapienza University, Rome, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Christine Haberler
- Institute of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Torsten Pietsch
- DGNN Brain Tumor Reference Center, Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Thomas S Jacques
- UCL Great Ormond Street Institute of Child Health, London, UK; Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | | | | | | | - Pichai Raman
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Angela J Waanders
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Adam C Resnick
- The Center for Data Driven Discovery in Biomedicine (D(3)b), Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | | | - Helen Smith
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - David Capper
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany; Berlin Institute of Health, Institute of Neuropathology, Berlin, Germany; Department of Neuropathology, University Hospital Heidelberg and Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany; Division of Paediatric Neuro-oncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Hematology and Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Würdinger
- Department of Neurosurgery, Brain Tumor Center Amsterdam, VU Medical Center, Amsterdam, the Netherlands
| | | | | | | | - Gilles Vassal
- Pediatric and Adolescent Oncology and Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Jacques Grill
- Pediatric and Adolescent Oncology and Unite Mixte de Recherche 8203 du Centre National de la Recherche Scientifique, Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Tim Jaspan
- Nottingham University Hospitals, Nottingham, UK
| | - Pascale Varlet
- Sainte-Anne Hospital, Paris-Descartes University, Paris, France
| | - Chris Jones
- Division of Molecular Pathology, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, Surrey SM2 5NG, UK.
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Abstract
Recent advances in molecular pathology have reshaped the practice of brain tumor diagnostics. The classification of gliomas has been restructured with the discovery of isocitrate dehydrogenase (IDH) 1/2 mutations in the vast majority of lower grade infiltrating gliomas and secondary glioblastomas (GBM), with IDH-mutant astrocytomas further characterized by TP53 and ATRX mutations. Whole-arm 1p/19q codeletion in conjunction with IDH mutations now define oligodendrogliomas, which are also enriched for CIC, FUBP1, PI3K, NOTCH1, and TERT-p mutations. IDH-wild-type (wt) infiltrating astrocytomas are mostly primary GBMs and are characterized by EGFR, PTEN, TP53, NF1, RB1, PDGFRA, and CDKN2A/B alterations, TERT-p mutations, and characteristic copy number alterations including gains of chromosome 7 and losses of 10. Other clinically and genetically distinct infiltrating astrocytomas include the aggressive H3K27M-mutant midline gliomas, and smaller subsets that occur in the setting of NF1 or have BRAF V600E mutations. Low-grade pediatric gliomas are both genetically and biologically distinct from their adult counterparts and often harbor a single driver event often involving BRAF, FGFR1, or MYB/MYBL1 genes. Large scale genomic and epigenomic analyses have identified distinct subgroups of ependymomas tightly linked to tumor location and clinical behavior. The diagnosis of embryonal neoplasms also integrates molecular testing: (I) 4 molecularly defined, biologically distinct subtypes of medulloblastomas are now recognized; (II) 3 histologic entities have now been reclassified under a diagnosis of "embryonal tumor with multilayered rosettes (ETMR), C19MC-altered"; and (III) atypical teratoid/rhabdoid tumors (AT/RT) now require SMARCB1 (INI1) or SMARCA4 (BRG1) alterations for their diagnosis. We discuss the practical use of contemporary biomarkers for an integrative diagnosis of central nervous system neoplasia.
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