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Frontal glioblastoma multiforme may be biologically distinct from non-frontal and multilobar tumors. J Clin Neurosci 2016; 34:128-132. [PMID: 27593971 DOI: 10.1016/j.jocn.2016.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/20/2016] [Indexed: 11/21/2022]
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain tumor in adults and carries a grim prognosis. Lobar GBM, notably those localized to the frontal lobe, are generally more amenable to complete surgical resection, and may carry a better prognosis. The biology of differently localized GBM has been reported scarcely in terms of prognostic markers, including isocitrate dehydrogenase 1 (IDH1) mutation and O(6)-methylguanine-methyltransferase (MGMT) methylation. To our knowledge, there has been no evaluation in the literature of different proliferation indexes in different GBM locations in the brain. We performed a retrospective evaluation of our prospectively collected database to assess the rate of IDH1 positivity, MGMT methylation and Ki67 index for GBM located in the frontal lobes alone, lobar GBM in other supra-tentorial lobes and multilobar GBM. IDH1 mutated tumors were localized in the frontal lobes in 50.0%, whereas only 20.3% of IDH1 wild-type tumors were localized in the frontal lobe (p=0.006); MGMT methylated tumors were localized in the frontal lobe in 32.0% of the cases. Only 13.75% of the MGMT unmethylated tumors were localized to the frontal lobe (p=0.005); Tumors with higher Ki67 proliferation index were more likely to be localized in the frontal lobe (40.6% vs. 19.5%, p=0.019). This is the largest cohort of GBM assessed for these purposes in the literature. Frontal lobe GBMs may be intrinsically biologically distinct from GBM in other lobes and from multilobar tumors.
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302
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Hathout L, Ellingson B, Pope W. Modeling the efficacy of the extent of surgical resection in the setting of radiation therapy for glioblastoma. Cancer Sci 2016; 107:1110-6. [PMID: 27240229 PMCID: PMC4982585 DOI: 10.1111/cas.12979] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/24/2016] [Accepted: 05/27/2016] [Indexed: 01/22/2023] Open
Abstract
Standard therapy for glioblastoma (GBM) includes maximal surgical resection and radiation therapy. While it is established that radiation therapy provides the greatest survival benefit of standard treatment modalities, the impact of the extent of surgical resection (EOR) on patient outcome remains highly controversial. While some studies describe no correlation between EOR and patient survival even up to total resection, others propose either qualitative (partial versus subtotal versus complete resection) or quantitative EOR thresholds, below which there is no correlation with survival. This work uses a mathematical model in the form of a reaction–diffusion partial differential equation to simulate tumor growth and treatment with radiation therapy and surgical resection based on tumor‐specific rates of diffusion and proliferation. Simulation of 36 tumors across a wide spectrum of diffusion and proliferation rates suggests that while partial or subtotal resections generally do not provide a survival advantage, complete resection significantly improves patient outcomes. Furthermore, our model predicts a tumor‐specific quantitative threshold below which EOR has no effect on patient survival and demonstrates that this threshold increases with tumor aggressiveness, particularly with the rate of proliferation. Thus, this model may serve as an aid for determining both when surgical resection is indicated as well as the surgical margins necessary to provide clinically significant improvements in patient survival. In addition, by assigning relative benefits to radiation and surgical resection based on tumor invasiveness and proliferation, this model confirms that (with the exception of the least aggressive tumors) the survival benefit of radiation therapy exceeds that of surgical resection.
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Affiliation(s)
| | - Benjamin Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, California, USA.,Department of Bioengineering, Henry Samueli School of Engineering and Applied Science, University of California Los Angeles, Los Angeles, California, USA
| | - Whitney Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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303
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Barnett GH, Voigt JD, Alhuwalia MS. A Systematic Review and Meta-Analysis of Studies Examining the Use of Brain Laser Interstitial Thermal Therapy versus Craniotomy for the Treatment of High-Grade Tumors in or near Areas of Eloquence: An Examination of the Extent of Resection and Major Complication Rates Associated with Each Type of Surgery. Stereotact Funct Neurosurg 2016; 94:164-73. [PMID: 27322392 DOI: 10.1159/000446247] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/18/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND The extent of resection (EOR) of high-grade gliomas (WHO grade III or IV) in or near areas of eloquence is associated with overall patient survival, but with higher major neurocognitive complications. METHODS A systematic review and meta-analysis was undertaken of the peer-reviewed literature in order to identify studies which examined EOR or extent of ablation (EOA) and major complications (defined as neurocognitive or functional complications which last >3 months duration after surgery) associated with either brain laser interstitial thermal therapy (LITT) or open craniotomy in high-grade tumors in or near areas of eloquence. RESULTS Eight studies on brain LITT (n = 79 patients) and 12 craniotomy studies (n = 1,036 patients) were identified which examined either/both EOR/EOA and complications. Meta-analysis demonstrated an EOA/EOR of 85.4 ± 10.6% with brain LITT versus 77.0 ± 40% with craniotomy (mean difference: 8%; 95% CI: 2-15; p = 0.01; inverse variance, random effects model). Meta-analysis of proportions of major complications for each individual therapy demonstrated major complications of 5.7% (95% CI: 1.8-11.6) and 13.8% (95% CI: 10.3-17.9) for LITT and craniotomy, respectively. CONCLUSION In patients presenting with high-grade gliomas in or near areas of eloquence, early results demonstrate that brain LITT may be a viable surgical alternative.
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Affiliation(s)
- Gene H Barnett
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Ridgewood, N.J., USA
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304
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Smith CL, Kilic O, Schiapparelli P, Guerrero-Cazares H, Kim DH, Sedora-Roman NI, Gupta S, O'Donnell T, Chaichana KL, Rodriguez FJ, Abbadi S, Park J, Quiñones-Hinojosa A, Levchenko A. Migration Phenotype of Brain-Cancer Cells Predicts Patient Outcomes. Cell Rep 2016; 15:2616-24. [PMID: 27292647 DOI: 10.1016/j.celrep.2016.05.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 02/24/2016] [Accepted: 05/09/2016] [Indexed: 01/11/2023] Open
Abstract
Glioblastoma multiforme is a heterogeneous and infiltrative cancer with dismal prognosis. Studying the migratory behavior of tumor-derived cell populations can be informative, but it places a high premium on the precision of in vitro methods and the relevance of in vivo conditions. In particular, the analysis of 2D cell migration may not reflect invasion into 3D extracellular matrices in vivo. Here, we describe a method that allows time-resolved studies of primary cell migration with single-cell resolution on a fibrillar surface that closely mimics in vivo 3D migration. We used this platform to screen 14 patient-derived glioblastoma samples. We observed that the migratory phenotype of a subset of cells in response to platelet-derived growth factor was highly predictive of tumor location and recurrence in the clinic. Therefore, migratory phenotypic classifiers analyzed at the single-cell level in a patient-specific way can provide high diagnostic and prognostic value for invasive cancers.
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Affiliation(s)
- Chris L Smith
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Onur Kilic
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Paula Schiapparelli
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Hugo Guerrero-Cazares
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Deok-Ho Kim
- Department of Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Neda I Sedora-Roman
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Saksham Gupta
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Thomas O'Donnell
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Kaisorn L Chaichana
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - Sara Abbadi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
| | - JinSeok Park
- Department of Biomedical Engineering and Yale Systems Biology Institute, Yale University, New Haven, CT 06516, USA
| | | | - Andre Levchenko
- Department of Biomedical Engineering and Yale Systems Biology Institute, Yale University, New Haven, CT 06516, USA.
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305
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Goldman DA, Panageas KS. Letter to the Editor: Biases in estimation of overall survival in patients who underwent repeat resection of glioblastoma. J Neurosurg 2016; 125:519-22. [PMID: 27257842 DOI: 10.3171/2015.11.jns152515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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306
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Fekete B, Werlenius K, Örndal C, Rydenhag B. Prognostic factors for glioblastoma patients--a clinical population-based study. Acta Neurol Scand 2016; 133:434-41. [PMID: 26358197 DOI: 10.1111/ane.12481] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To address in a retrospective and population-based study prognostic factors for survival time after diagnosis and surgery for glioblastoma multiforme (GBM). MATERIAL AND METHODS During the study period, 430 patients were identified at the multidisciplinary team conferences as newly diagnosed GBM, 201 of these were considered not to benefit from surgery, and thus, a total of 229 consecutive adult patients with GBM were operated between January 2004 and December 2008 at Sahlgrenska University Hospital and were retrospectively analyzed. Potential predictors of survival were statistically analyzed using Poisson regression models. RESULTS Median survival was 0.73 years. Multivariable analysis showed the following factors to positively influence survival: younger age at surgery, secondary tumor genesis, unifocal tumor location (vs multifocal), resection (vs biopsy only), radiotherapy, and combination of radiotherapy and chemotherapy. CONCLUSION This population-based study supports the importance of surgery instead of biopsy only, followed by radiotherapy and chemotherapy, a finding which has also been stated in earlier non-population-based reports. However, it is obvious that the solution is not just surgical radicality followed by optimal oncological treatment. It is of great importance to seek further subclassifications, biomarkers, and new treatment modalities to make a significant change in survival for individuals.
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Affiliation(s)
- B. Fekete
- Department of Clinical Neuroscience and Rehabilitation; The Sahlgrenska Academy; Institute of Neuroscience and Physiology; University of Göteborg; Göteborg Sweden
| | - K. Werlenius
- Department of Oncology; Sahlgrenska University Hospital; The Sahlgrenska Academy; University of Göteborg; Göteborg Sweden
| | - C. Örndal
- Department of Pathology; Sahlgrenska University Hospital; The Sahlgrenska Academy; University of Göteborg; Göteborg Sweden
| | - B. Rydenhag
- Department of Clinical Neuroscience and Rehabilitation; The Sahlgrenska Academy; Institute of Neuroscience and Physiology; University of Göteborg; Göteborg Sweden
- Department of Neurosurgery; Sahlgrenska University Hospital; The Sahlgrenska Academy; University of Göteborg; Göteborg Sweden
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307
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Abstract
INTRODUCTION Despite substantial improvements in standards of care, the most common aggressive pediatric and adult high-grade gliomas (HGG) carry uniformly fatal diagnoses due to unique treatment limitations, high recurrence rates and the absence of effective treatments following recurrence. Recent advancements in our understanding of the pathophysiology, genetics and epigenetics as well as mechanisms of immune surveillance during gliomagenesis have created new knowledge to design more effective and target-directed therapies to improve patient outcomes. AREAS COVERED In this review, the authors discuss the critical genetic, epigenetic and immunologic aberrations found in gliomas that appear rational and promising for therapeutic developments in the presence and future. The current state of the latest therapeutic developments including tumor-specific targeted drug therapies, metabolic targeting, epigenetic modulation and immunotherapy are summarized and suggestions for future directions are offered. Furthermore, they highlight contemporary issues related to the clinical development, such as challenges in clinical trials and toxicities. EXPERT OPINION The commitment to understanding the process of gliomagenesis has created a catalogue of aberrations that depict multiple mechanisms underlying this disease, many of which are suitable to therapeutic inhibition and are currently tested in clinical trials. Thus, future treatment endeavors will employ multiple treatment modalities that target disparate tumor characteristics personalized to the patient's individual tumor.
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Affiliation(s)
- Verena Staedtke
- a Department of Neurology , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - Ren-Yuan Bai
- b Department of Neurosurgery , Johns Hopkins Medical Institutions , Baltimore , MD , USA
| | - John Laterra
- a Department of Neurology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,c Department of Oncology , Johns Hopkins Medical Institutions , Baltimore , MD , USA.,d Department of Neuroscience , Johns Hopkins Medical Institutions , Baltimore , MD , USA
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308
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Su H, Zhang P, Cheetham AG, Koo JM, Lin R, Masood A, Schiapparelli P, Quiñones-Hinojosa A, Cui H. Supramolecular Crafting of Self-Assembling Camptothecin Prodrugs with Enhanced Efficacy against Primary Cancer Cells. Theranostics 2016; 6:1065-74. [PMID: 27217839 PMCID: PMC4876630 DOI: 10.7150/thno.15420] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/21/2016] [Indexed: 12/01/2022] Open
Abstract
Chemical modification of small molecule hydrophobic drugs is a clinically proven strategy to devise prodrugs with enhanced treatment efficacy. While this prodrug strategy improves the parent drug's water solubility and pharmacokinetic profile, it typically compromises the drug's potency against cancer cells due to the retarded drug release rate and reduced cellular uptake efficiency. Here we report on the supramolecular design of self-assembling prodrugs (SAPD) with much improved water solubility while maintaining high potency against cancer cells. We found that camptothecin (CPT) prodrugs created by conjugating two CPT molecules onto a hydrophilic segment can associate into filamentous nanostructures in water. Our results suggest that these SAPD exhibit much greater efficacy against primary brain cancer cells relative to that of irinotecan, a clinically used CPT prodrug. We believe these findings open a new avenue for rational design of supramolecular prodrugs for cancer treatment.
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Affiliation(s)
- Hao Su
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
| | - Pengcheng Zhang
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
| | - Andrew G Cheetham
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
| | - Jin Mo Koo
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
| | - Ran Lin
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
| | - Asad Masood
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
| | - Paula Schiapparelli
- 2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, United States
| | - Alfredo Quiñones-Hinojosa
- 2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, United States
- 4. Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
| | - Honggang Cui
- 1. Department of Chemical and Biomolecular Engineering, and Institute for NanoBioTechnology, The Johns Hopkins University, 3400 North Charles Street, Baltimore, Maryland 21218 United States
- 3. Center for Nanomedicine, The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 400 North Broadway, Baltimore, Maryland 21231, United States
- 4. Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, United States
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309
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Ohtaki S, Wanibuchi M, Kataoka-Sasaki Y, Sasaki M, Oka S, Noshiro S, Akiyama Y, Mikami T, Mikuni N, Kocsis JD, Honmou O. ACTC1 as an invasion and prognosis marker in glioma. J Neurosurg 2016; 126:467-475. [PMID: 27081897 DOI: 10.3171/2016.1.jns152075] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Glioma is a major class of brain tumors, and glioblastoma (GBM) is the most aggressive and malignant type. The nature of tumor invasion makes surgical removal difficult, which results in remote recurrence. The present study focused on glioma invasion and investigated the expression of actin, alpha cardiac muscle 1 (ACTC1), which is 1 of 6 actin families implicated in cell motility. METHODS mRNA expression of ACTC1 expression was analyzed using quantitative real-time polymerase chain reaction (qRT-PCR) in 47 formalin-fixed, paraffin-embedded glioma tissues that were graded according to WHO criteria: Grade I (n = 4); Grade II (n = 12); Grade III (n = 6); and Grade IV (n = 25). Survival was analyzed using the Kaplan-Meier method. The relationships between ACTC1 expression and clinical features such as radiological findings at the time of diagnosis and recurrence, patient age, Karnofsky Performance Scale status (KPS), and the MIB-1 index were evaluated. RESULTS The incidence of ACTC1 expression as a qualitative assessment gradually increased according to WHO grade. The hazard ratio for the median overall survival (mOS) of the patients with ACTC1-positive high-grade gliomas as compared with the ACTC1-negative group was 2.96 (95% CI, 1.03-8.56). The mOS was 6.28 years in the ACTC1-negative group and 1.26 years in the positive group (p = 0.037). In GBM patients, the hazard ratio for mOS in the ACTC1-positive GBMs as compared with the ACTC1-negative group was 2.86 (95% CI 0.97-8.45). mOS was 3.20 years for patients with ACTC1-negative GBMs and 1.08 years for patients with ACTC1-positive GBMs (p = 0.048). By the radiological findings, 42.9% of ACTC1-positive GBM patients demonstrated invasion toward the contralateral cerebral hemisphere at the time of diagnosis, although no invasion was observed in ACTC1-negative GBM patients (p = 0.013). The recurrence rate of GBM was 87.5% in the ACTC1-positive group; in contrast, none of the ACTC1-negative patients demonstrated distant recurrence (0.007). No remarkable relationship was demonstrated among ACTC1 expression and patient age, KPS, and the MIB-1 index. CONCLUSIONS ACTC1 may serve as a novel independent prognostic and invasion marker in GBM.
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Affiliation(s)
- Shunya Ohtaki
- Departments of 1 Neurosurgery and.,Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masahiko Wanibuchi
- Departments of 1 Neurosurgery and.,Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuko Kataoka-Sasaki
- Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Masanori Sasaki
- Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.,Department of Neurology, Yale University School of Medicine, New Haven; and.,Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Shinichi Oka
- Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shouhei Noshiro
- Departments of 1 Neurosurgery and.,Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | | | - Takeshi Mikami
- Departments of 1 Neurosurgery and.,Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | | | - Jeffery D Kocsis
- Department of Neurology, Yale University School of Medicine, New Haven; and.,Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Osamu Honmou
- Neural Regenerative Medicine, Research Institute for Frontier Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.,Department of Neurology, Yale University School of Medicine, New Haven; and.,Center for Neuroscience and Regeneration Research, VA Connecticut Healthcare System, West Haven, Connecticut
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310
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Pessina F, Navarria P, Cozzi L, Ascolese AM, Simonelli M, Santoro A, Tomatis S, Riva M, Fava E, Scorsetti M, Bello L. Value of Surgical Resection in Patients with Newly Diagnosed Grade III Glioma Treated in a Multimodal Approach: Surgery, Chemotherapy and Radiotherapy. Ann Surg Oncol 2016; 23:3040-6. [DOI: 10.1245/s10434-016-5222-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Indexed: 11/18/2022]
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311
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McCrea HJ, Bander ED, Venn RA, Reiner AS, Iorgulescu JB, Puchi LA, Schaefer PM, Cederquist G, Greenfield JP. Sex, Age, Anatomic Location, and Extent of Resection Influence Outcomes in Children With High-grade Glioma. Neurosurgery 2016; 77:443-52; discussion 452-3. [PMID: 26083157 DOI: 10.1227/neu.0000000000000845] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Survival duration and prognostic factors in adult high-grade glioma have been comprehensively analyzed, but less is known about factors contributing to overall survival (OS) and progression-free survival (PFS) in pediatric patients. OBJECTIVE To identify these factors in the pediatric population. METHODS We retrospectively reviewed institutional databases evaluating all patients ≤21 years with high-grade glioma treated between 1988 and 2010. Kaplan-Meier curves and log-rank statistics were used to compare groups univariately. Multivariate analyses were completed using Cox proportional hazards regression models. RESULTS Ninety-seven patients were identified with a median age of 11 years. Median OS was 1.7 years, and median PFS was 272 days. Location was significant for OS (P < .001). Patients with gross total resection (GTR) had a median OS of 3.4 years vs 1.6 years for subtotal resection and 1.3 years for biopsy patients (P < .001). Female patients had improved OS (P = .01). Female patients with GTR had a mean OS of 8.1 years vs 2.4 years for male patients with GTR and 1.4 years for all other female patients and male patients (P = .001). PFS favored patients ≤3 and ≥13 years and females (P = .003 and .001). CONCLUSION OS was significantly correlated with the location of the tumor and the extent of resection. GTR significantly improved overall survival for both glioblastoma multiforme and anaplastic astrocytoma patients, and female patients showed a much larger survival benefit from GTR than male patients.
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Affiliation(s)
- Heather J McCrea
- *Department of Neurological Surgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York; ‡Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York; §Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York; ¶Children's Brain Tumor Project, New York, New York
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312
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Kut C, Chaichana KL, Xi J, Raza SM, Ye X, McVeigh ER, Rodriguez FJ, Quiñones-Hinojosa A, Li X. Detection of human brain cancer infiltration ex vivo and in vivo using quantitative optical coherence tomography. Sci Transl Med 2016; 7:292ra100. [PMID: 26084803 DOI: 10.1126/scitranslmed.3010611] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
More complete brain cancer resection can prolong survival and delay recurrence. However, it is challenging to distinguish cancer from noncancer tissues intraoperatively, especially at the transitional, infiltrative zones. This is especially critical in eloquent regions (for example, speech and motor areas). This study tested the feasibility of label-free, quantitative optical coherence tomography (OCT) for differentiating cancer from noncancer in human brain tissues. Fresh ex vivo human brain tissues were obtained from 32 patients with grade II to IV brain cancer and 5 patients with noncancer brain pathologies. On the basis of volumetric OCT imaging data, pathologically confirmed brain cancer tissues (both high- and low-grade) had significantly lower optical attenuation values at both cancer core and infiltrated zones when compared with noncancer white matter, and OCT achieved high sensitivity and specificity at an attenuation threshold of 5.5 mm(-1) for brain cancer patients. We also used this attenuation threshold to confirm the intraoperative feasibility of performing in vivo OCT-guided surgery using a murine model harboring human brain cancer. Our OCT system was capable of processing and displaying a color-coded optical property map in real time at a rate of 110 to 215 frames per second, or 1.2 to 2.4 s for an 8- to 16-mm(3) tissue volume, thus providing direct visual cues for cancer versus noncancer areas. Our study demonstrates the translational and practical potential of OCT in differentiating cancer from noncancer tissue. Its intraoperative use may facilitate safe and extensive resection of infiltrative brain cancers and consequently lead to improved outcomes when compared with current clinical standards.
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Affiliation(s)
- Carmen Kut
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD 21205, USA
| | | | - Jiefeng Xi
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD 21205, USA
| | - Shaan M Raza
- Department of Neurosurgery, Johns Hopkins, Baltimore, MD 21287, USA
| | - Xiaobu Ye
- Department of Neurosurgery, Johns Hopkins, Baltimore, MD 21287, USA
| | - Elliot R McVeigh
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD 21205, USA
| | | | | | - Xingde Li
- Department of Biomedical Engineering, Johns Hopkins, Baltimore, MD 21205, USA.
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313
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Voigt JD, Barnett G. The value of using a brain laser interstitial thermal therapy (LITT) system in patients presenting with high grade gliomas where maximal safe resection may not be feasible. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2016; 14:6. [PMID: 27006643 PMCID: PMC4802786 DOI: 10.1186/s12962-016-0055-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 03/11/2016] [Indexed: 12/04/2022] Open
Abstract
Background The objective of this analysis was to determine the value (incremental cost/increment benefit) of a brain LITT system versus employing current surgical options recommended by NCCN guidelines, specifically open resection (i.e. craniotomy) methods or biopsy (collectively termed CURRENT TREATMENTS) in patients where maximal safe resection may not be feasible. As has been demonstrated in the literature, extent of resection/ablation with minimal complications are independently related to overall survival. Methods A cost effectiveness analysis from a societal perspective was employed using TreeAge Pro 2014 software. Direct costs (using national average Medicare reimbursement amounts), outcomes (overall survival), and value [defined as increment cost/incremental survival—evaluated as cost/life year gained (LYG)] were evaluated. Sensitivity analysis was also performed to determine which variables had the largest effect on incremental costs and outcomes. Results In the base case, the overall survival was improved with brain LITT versus CURRENT TREATMENTS by 3.07 months at an additional cost of $7508 (or $29,340/LYG). This amount was significantly less than the current international threshold value for $32,575/LYG and considerably less than the US threshold value of $50,000/LYG. This incremental cost may also qualify under NICE criteria for end of life therapies. In sensitivity analysis: As percent local recurrence GBM increased; cost of DRG25/26 increased; percent GTR increased; and gliadel use increased—the value of brain LITT improved. Additionally, in those patients where a biopsy is the only option, brain LITT extended life by 7 months. Conclusions Brain LITT should be considered a viable option for treatment of high grade gliomas as it improves survival at a cost which appears to be of good value to society. This incremental cost is less than the international and US thresholds for good value.
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Affiliation(s)
| | - Gene Barnett
- The Rose Ella Burkhardt Chair in Neurosurgical Oncology, The Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, The Cleveland Clinic S73, 9500 Euclid Avenue, Cleveland, OH 44195 USA ; Department of Neurological Surgery, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center Cleveland Clinic Neurological Institute, The Cleveland Clinic, S73, 9500 Euclid Avenue, Cleveland, OH 44195 USA
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314
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Survival in glioblastoma: a review on the impact of treatment modalities. Clin Transl Oncol 2016; 18:1062-1071. [PMID: 26960561 DOI: 10.1007/s12094-016-1497-x] [Citation(s) in RCA: 421] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/27/2016] [Indexed: 12/17/2022]
Abstract
Glioblastoma (GBM) is the most common and lethal tumor of the central nervous system. The natural history of treated GBM remains very poor with 5-year survival rates of 5 %. Survival has not significantly improved over the last decades. Currently, the best that can be offered is a modest 14-month overall median survival in patients undergoing maximum safe resection plus adjuvant chemoradiotherapy. Prognostic factors involved in survival include age, performance status, grade, specific markers (MGMT methylation, mutation of IDH1, IDH2 or TERT, 1p19q codeletion, overexpression of EGFR, etc.) and, likely, the extent of resection. Certain adjuncts to surgery, especially cortical mapping and 5-ALA fluorescence, favor higher rates of gross total resection with apparent positive impact on survival. Recurrent tumors can be offered re-intervention, participation in clinical trials, anti-angiogenic agent or local electric field therapy, without an evident impact on survival. Molecular-targeted therapies, immunotherapy and gene therapy are promising tools currently under research.
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315
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Teixidor P, Arráez MÁ, Villalba G, Garcia R, Tardáguila M, González JJ, Rimbau J, Vidal X, Montané E. Safety and Efficacy of 5-Aminolevulinic Acid for High Grade Glioma in Usual Clinical Practice: A Prospective Cohort Study. PLoS One 2016; 11:e0149244. [PMID: 26885645 PMCID: PMC4757411 DOI: 10.1371/journal.pone.0149244] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 01/28/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND During the last decade, the use of 5-aminolevulinic acid (5-ALA) has been steadily increasing in neurosurgery. The study's main objectives were to prospectively evaluate the effectiveness and safety of 5-ALA when used in clinical practice setting on high-grade gliomas' patients. METHODS National, multicenter and prospective observational study. INCLUSION CRITERIA authorized conditions of use of 5-ALA. EXCLUSION CRITERIA contraindication to 5-ALA, inoperable or partial resected tumors, pregnancy and children. Epidemiological, clinical, laboratory, radiological, and safety data were collected. Effectiveness was assessed using complete resection of the tumor, and progression-free and overall survival probabilities. RESULTS Between May 2010 and September 2014, 85 patients treated with 5-ALA were included, and 77 were suitable for the effectiveness analysis. Complete resection was achieved in 41 patients (54%). Surgeons considered suboptimal the fluorescence of 5-ALA in 40% of the patients assessed. The median duration of follow-up was 12.3 months. The progression-free survival probability at 6 months was 58%. The median duration overall survival was 14.2 months. Progression tumor risk factors were grade of glioma, age and resection degree; and death risk factors were grade of glioma and gender. No severe adverse effects were reported. At one month after surgery, new or increased neurological morbidity was 6.5%. Hepatic enzymes were frequently increased within the first month after surgery; however, they subsequently normalized, and this was found to have no clinical significance. CONCLUSION In clinical practice, the 5-ALA showed a good safety profile, but the benefits related to 5-ALA have not been yet clearly shown. The improved differentiation expected by fluorescence between normal and tumor cerebral tissue was suboptimal in a relevant number of patients; in addition, the expected higher degree of resection was lower than in clinical trials as well as incomplete resection was not identified as a prognostic factor risk for death. Because optimal fluorescence was correlated to higher complete resection rate, further research is needed to identify patients (or tumors) with more surgery benefits when using the 5-ALA.
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Affiliation(s)
- Pilar Teixidor
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | - Glòria Villalba
- Department of Neurosurgery, Hospital del Mar, Barcelona, Spain
| | - Roser Garcia
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Manel Tardáguila
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan José González
- Department of Neurosurgery, Hospital Clínic I Provincial de Barcelona, Barcelona, Spain
| | - Jordi Rimbau
- Department of Neurosurgery, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xavier Vidal
- Fundació Institut Català de Farmacologia, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Montané
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
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316
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Gzell CE, Wheeler HR, McCloud P, Kastelan M, Back M. Small increases in enhancement on MRI may predict survival post radiotherapy in patients with glioblastoma. J Neurooncol 2016; 128:67-74. [PMID: 26879084 DOI: 10.1007/s11060-016-2074-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 02/10/2016] [Indexed: 11/30/2022]
Abstract
To assess impact of volumetric changes in tumour volume post chemoradiotherapy in glioblastoma. Patients managed with chemoradiotherapy between 2008 and 2011 were included. Patients with incomplete MRI sets were excluded. Analyses were performed on post-operative MRI, and MRIs at 1 month (M+1), 3 months (M+3), 5 months (M+5), 7 months (M+7), and 12 months (M+12) post completion of RT. RANO definitions of response were used for all techniques. Modified RANO criteria and two volumetric analysis techniques were used. The two volumetric analysis techniques involved utility of the Eclipse treatment planning software to calculate the volume of delineated tissue: surgical cavity plus all surrounding enhancement (Volumetric) versus surrounding enhancement only (Rim). Retrospective analysis of 49 patients with median survival of 18.4 months. Using Volumetric analysis the difference in MS for patients who had a <5 % increase versus ≥5 % at M+3 was 23.1 versus 15.1 months (p = 0.006), and M+5 was 26.3 versus 15.1 months (p = 0.006). For patients who were classified as progressive disease using modified RANO criteria at M+1 and M+3 there was a difference in MS compared with those who were not (M+1: 13.1 vs. 19.4 months, p = 0.017, M+3: 13.2 vs. 20.1 months, p = 0.096). An increase in the volume of cavity and enhancement of ≥5 % at M+3 and M+5 post RT was associated with reduced survival, suggesting that increases in radiological abnormality of <25 % may predict survival.
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Affiliation(s)
- Cecelia Elizabeth Gzell
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. .,Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia. .,Genesis Cancer Care, Level A, 438 Victoria Street, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - Helen R Wheeler
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.,Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia
| | - Philip McCloud
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Marina Kastelan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia
| | - Michael Back
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.,Northern Sydney Clinical School, Sydney University Medical School, Sydney, NSW, 2065, Australia
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317
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Suchorska B, Weller M, Tabatabai G, Senft C, Hau P, Sabel MC, Herrlinger U, Ketter R, Schlegel U, Marosi C, Reifenberger G, Wick W, Tonn JC, Wirsching HG. Complete resection of contrast-enhancing tumor volume is associated with improved survival in recurrent glioblastoma-results from the DIRECTOR trial. Neuro Oncol 2016; 18:549-56. [PMID: 26823503 DOI: 10.1093/neuonc/nov326] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 12/21/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The role of reoperation for recurrent glioblastoma (GBM) remains unclear. Prospective studies are lacking. Here, we studied the association of clinical outcome with extent of resection upon surgery for recurrent GBM in the patient cohort of DIRECTOR, a prospective randomized multicenter trial comparing 2 dose-intensified temozolomide regimens at recurrence of GBM. METHODS We analyzed prospectively collected clinical and imaging data from the DIRECTOR cohort (N = 105). Volumetric analysis was performed on gadolinium contrast-enhanced MRI as well as fluid attenuated inversion recovery/T2 MRI and correlated with PFS after initial progression (PFS2) and post-recurrence survival (PRS). Quality of life was monitored by the EORTC QLQ-C30 and QLQ-BN20 questionnaires at 8-week intervals. RESULTS Seventy-one patients received surgery at first recurrence. Prognostic factors, including age, MGMT promoter methylation, and Karnofsky performance score, were balanced between patients with and without reoperation. Outcome in patients with versus without surgery at recurrence was similar for PFS2 (2.0 mo vs 1.9 mo, P = .360) and PRS (11.4 mo vs 9.8 mo, P = .633). Among reoperated patients, post-surgery imaging was available in 59 cases. In these patients, complete resection of contrast-enhancing tumor (N = 40) versus residual detection of contrast enhancement (N = 19) was associated with improved PRS (12.9 mo [95% CI: 11.5-18.2] vs 6.5 mo [95% CI: 3.6-9.9], P < .001) and better quality of life. Incomplete tumor resection was associated with inferior PRS compared with patients who did not undergo surgery (6.5 vs 9.8 mo, P = .052). Quality of life was similar in these 2 groups. CONCLUSION Surgery at first recurrence of GBM improves outcome if complete resection of contrast-enhancing tumor is achieved.
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Affiliation(s)
- Bogdana Suchorska
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Michael Weller
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Ghazaleh Tabatabai
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Christian Senft
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Peter Hau
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Michael C Sabel
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Ulrich Herrlinger
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Ralf Ketter
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Uwe Schlegel
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Christine Marosi
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Guido Reifenberger
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Wolfgang Wick
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Jörg C Tonn
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
| | - Hans-Georg Wirsching
- Department of Neurosurgery, Ludwig-Maximilians University Munich, Munich, Germany (B.S., J.C.T.); Department of Neurology, University Hospital Zurich, Zurich, Switzerland (M.W., G.T., H.-G.W.); Department of Neurology, University Hospital Tübingen, Tübingen, Germany (G.T.); Department of Neurosurgery, University Hospital Frankfurt, Frankfurt am Main, Germany (C.S.); Department of Neurology, University Hospital Regensburg, Regensburg, Germany (P.H.); Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany (M.C.S.); Department of Neurology, University Hospital Bonn, Bonn, Germany (U.H.); Department of Neurosurgery, University Hospital Saarland, Homburg/Saar, Germany (R.K.); Department of Neurology, Knappschaftskrankenhaus Bochum, Bochum, Germany (U.S.); Department of Oncology, Vienna General Hospital, Vienna, Austria (C.M.); Institute of Neuropathology, University Hospital Düsseldorf, Düsseldorf, Germany (G.R.); Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany (W.W.)
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Dahlrot RH, Poulsen FR, Nguyen NNTT, Kristensen BW, Hansen S, Holm NV. Trends in tumors in the central nervous system in elderly in Denmark, 2008-2012. Acta Oncol 2016; 55 Suppl 1:91-7. [PMID: 26781160 DOI: 10.3109/0284186x.2015.1115123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tumors in the central nervous system (CNS) comprise a heterogeneous group of tumors with different treatment strategies and prognoses. Current treatment regimens are based on studies on patients mainly younger than 70 years. The aim of the present study was to analyze and describe trends in incidence, mortality, prevalence, and relative survival in Denmark from 1980 to 2012 focusing on patients older than 70 years. MATERIAL AND METHODS Tumors in the CNS were defined as ICD-10 codes C70-72, D32-33 and D42-43. Data with comparable data on cancer incidence, mortality, prevalence and relative survival derived from the NORDCAN database were delivered from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS During the period 1980-2012 the number of patients with CNS tumors increased from 603 to 1378 patients. The increase is seen mainly in the elderly patients, and especially in women aged 84-89 and 90 + at the time of diagnosis. During the same time period, the mortality rates increased within all age groups, most significantly in patients aged 70 years or older. This may reflect an increased focus on and identification of these patients. Noteworthy; the number of patients living with a CNS tumor increased from 2952 in 1980 to 12 147 patients in 2010. CONCLUSION This study suggests that the current treatment strategies in general may have improved survival in patients with CNS tumors, but in order to improve survival further in the increasing group of elderly patients more knowledge about treatment of these patients is needed.
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Affiliation(s)
- Rikke H Dahlrot
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Frantz R Poulsen
- b Department of Neurosurgery , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Nina N T T Nguyen
- c Department of Radiology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Bjarne W Kristensen
- d Department of Pathology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Steinbjørn Hansen
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
| | - Niels V Holm
- a Department of Oncology , Odense University Hospital, Institute of Clinical Research, University of Southern Denmark , Odense , Denmark
- e The Danish Twin Registry, University of Southern Denmark , Denmark
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Paldor I, Drummond KJ, Awad M, Sufaro YZ, Kaye AH. Is a wake-up call in order? Review of the evidence for awake craniotomy. J Clin Neurosci 2016; 23:1-7. [DOI: 10.1016/j.jocn.2015.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 11/21/2015] [Indexed: 10/22/2022]
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320
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Jackson C, Westphal M, Quiñones-Hinojosa A. Complications of glioma surgery. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:201-18. [PMID: 26948356 DOI: 10.1016/b978-0-12-802997-8.00012-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Even with current advances in adjunctive therapies, including radiation, chemotherapy, and various clinical trials of gene therapy and immunotherapy, surgical resection remains one of the most effective treatment for intra-axial gliomas. Survival in these patients has been shown to be related to the extent of resection. In some cases, it can provide cures of long-term remission; in others, it can provide disease control when combined with the above adjunctive treatments. However, surgical resection carries its own risks and complications. These complications can be broadly divided into neurologic, regional, and systemic, including direct cortical and vascular injury, surgical wound complications, and postsurgical medical complications. Certain patient characteristics, including Karnofsky performance status score (KPS) and pathology of the tumor, have been shown to have an impact on the risk of postsurgical complications. Advancement in preoperative and intraoperative adjunct technology such as cortical mapping and navigation has improved the surgeon's ability to safely and maximally resect the tumors. It is therefore important to understand the perioperative complications after craniotomy and tumor resection and factors affecting morbidity and mortality in order for surgeons to optimally select and counsel patients who will benefit the most from surgical resection. This chapter will focus on the complications associated with craniotomy for intrinsic glioma and ways of avoiding these events.
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Affiliation(s)
- Christina Jackson
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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321
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Dev A, Srivastava AK, Choudhury SR, Karmakar S. Nano-curcumin influences blue light photodynamic therapy for restraining glioblastoma stem cells growth. RSC Adv 2016. [DOI: 10.1039/c6ra20269a] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nano-curcumin based blue light photodynamic therapy has therapeutic potential in the arsenal of glioblastoma cancer stem cells recurrence.
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Affiliation(s)
- A. Dev
- Institute of Nano Science and Technology
- Mohali
- India
| | | | | | - S. Karmakar
- Institute of Nano Science and Technology
- Mohali
- India
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322
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De la Garza-Ramos R, Kerezoudis P, Tamargo RJ, Brem H, Huang J, Bydon M. Surgical complications following malignant brain tumor surgery: An analysis of 2002-2011 data. Clin Neurol Neurosurg 2015; 140:6-10. [PMID: 26615463 DOI: 10.1016/j.clineuro.2015.11.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 11/08/2015] [Accepted: 11/09/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To estimate the incidence of surgical complications and associated in-hospital morbidity and mortality following surgery for malignant brain tumors. PATIENTS AND METHODS The Nationwide Inpatient Sample (NIS) database was queried from 2002 to 2011. All adult patients who underwent elective brain surgery for a malignant brain tumor were included. Surgical complications included wrong side surgery, retention of a foreign object, iatrogenic stroke, meningitis, hemorrhage/hematoma complicating a procedure, and neurological complications. A regression model was conducted to estimate the odds ratios (OR) with their 95% confidence intervals (95% CI) of in-hospital mortality for each surgical complication. RESULTS A total of 16,530 admissions were analyzed, with 601 (36.2 events per 1000 cases) surgical complications occurring in 567 patients. Over the examined 10-year period, the overall incidence of surgical complications did not change (P=0.061) except for iatrogenic strokes, which increased in incidence from 14.1 to 19.8 events per 1000 between 2002 and 2011 (P=0.023). Patients who developed a surgical complication had significantly longer lengths of stay, total hospital costs, and higher rates of other complications. Patients who experienced an iatrogenic stroke had a significantly increased risk of mortality (OR 9.6; 95% 6.3-14.8) and so were patients with a hemorrhage/hematoma (OR 3.3; 95% CI 1.6-6.6). CONCLUSION In this study of an administrative database, patients undergoing surgery for a malignant brain tumor who suffered from a surgical complication had significantly longer lengths of stay, total hospital charges, and complication rates. Having a surgical complication was also an independent risk factor for in-hospital mortality. Nonetheless, it is unclear whether all surgical complications were clinically relevant, and further research is encouraged.
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Affiliation(s)
| | | | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohamad Bydon
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
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323
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Predictors of survival and effect of short (40 Gy) or standard-course (60 Gy) irradiation plus concomitant temozolomide in elderly patients with glioblastoma: a multicenter retrospective study of AINO (Italian Association of Neuro-Oncology). J Neurooncol 2015; 125:359-67. [PMID: 26423801 DOI: 10.1007/s11060-015-1923-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
Abstract
The efficacy of temozolomide (TMZ) plus radiation therapy (RT) in elderly patients with glioblastoma is unclear. We performed a large multicenter retrospective study to analyze prognostic factors and clinical outcome in these patients. Inclusion criteria were age ≥65 years, newly histologically confirmed glioblastoma, ECOG PS 0-2, adjuvant treatment with RT plus TMZ. We enrolled 237 patients; the average age was 71 and ECOG PS was 0-1 in 196 patients; gross total resection was performed in 174 cases. MGMT was analyzed in 151 persons and was methylated in 56 %. IDH1 was assessed in 100 patients and was mutated in 6 %. Seventy-one patients were treated with RT 40 Gy and 166 with RT 60 Gy. Progression-free survival and overall survival (OS) were 11.3 and 17.3 months, respectively. Overall survival was 19.4 vs 13.8 months for patients treated with RT 60 Gy and 40 Gy (p = 0.02); OS was 17.7 versus 16.1 months for patients treated with gross total resection vs partial surgery (p = 0.02); OS was 21.2 versus 13.6 months for methylated and unmethylated MGMT (p < 0.001). On multivariate analysis, gross total resection, RT 60 Gy, methylated MGMT and ECOG PS 0-1 were independent predictors of longer survival. Twenty-five patients (10 %) had grade 3-4 haematological toxicity during the concomitant treatment. We showed that, in elderly patients in good clinical condition treated with concomitant treatment, standard-course irradiation might be more effective than short-course irradiation. Methylated MGMT remains the most important prognostic factor.
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324
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Chen L, Chaichana KL, Kleinberg L, Ye X, Quinones-Hinojosa A, Redmond K. Glioblastoma recurrence patterns near neural stem cell regions. Radiother Oncol 2015; 116:294-300. [PMID: 26276527 DOI: 10.1016/j.radonc.2015.07.032] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 07/14/2015] [Accepted: 07/25/2015] [Indexed: 12/14/2022]
Abstract
PURPOSE Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood-brain barrier breakdown. METHODS 102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern. RESULTS 49 of 102 (48.0%, 95% CI: 0.386-0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100%) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8%, 95% CI: 0.565-0.804) recurred contacting NRs. In total, 86/102 (84.3%, 95% CI: 0.760-0.901) recurrent GBM contacted NRs compared with 49/102 (48%, 95% CI: 0.386-0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1%, 95% CI: 0.195-0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6%, 95% CI: 0.212-0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2%, 95% CI: 0.0655-0.248) initially non-contacting recurred out of the radiation treatment field (p=0.0315, Odds ratio: 3.19, 95% CI: 1.18-8.62). CONCLUSIONS GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.
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Affiliation(s)
- Linda Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, United States
| | - Kaisorn L Chaichana
- Department of Neurosurgery and Oncology, The Johns Hopkins University, Baltimore, United States
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, United States
| | - Xiaobu Ye
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University, Baltimore, United States
| | - Alfredo Quinones-Hinojosa
- Department of Neurosurgery and Oncology, The Johns Hopkins University, Baltimore, United States; Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University, Baltimore, United States.
| | - Kristin Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University, Baltimore, United States.
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Young RM, Jamshidi A, Davis G, Sherman JH. Current trends in the surgical management and treatment of adult glioblastoma. ANNALS OF TRANSLATIONAL MEDICINE 2015. [PMID: 26207249 DOI: 10.3978/j.issn.2305-5839.2015.05.10] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This manuscript discusses the current surgical management of glioblastoma. This paper highlights the common pathophysiology attributes of glioblastoma, surgical options for diagnosis/treatment, current thoughts of extent of resection (EOR) of tumor, and post-operative (neo)adjuvant treatment. Glioblastoma is not a disease that can be cured with surgery alone, however safely performed maximal surgical resection is shown to significantly increase progression free and overall survival while maximizing quality of life. Upon invariable tumor recurrence, re-resection also is shown to impact survival in a select group of patients. As adjuvant therapy continues to improve survival, the role of surgical resection in the treatment of glioblastoma looks to be further defined.
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Affiliation(s)
- Richard M Young
- Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA
| | - Aria Jamshidi
- Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA
| | - Gregory Davis
- Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA
| | - Jonathan H Sherman
- Department of Neurological Surgery, George Washington University Medical Center, Washington, DC 20037, USA
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326
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Lemée JM, Clavreul A, Menei P. Intratumoral heterogeneity in glioblastoma: don't forget the peritumoral brain zone. Neuro Oncol 2015. [PMID: 26203067 DOI: 10.1093/neuonc/nov119] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Glioblastoma (GB) is the most frequent and aggressive primary tumor of the central nervous system. Prognosis remains poor despite ongoing progress. In cases where the gadolinium-enhanced portion of the GB is completely resected, 90% of recurrences occur at the margin of surgical resection in the macroscopically normal peritumoral brain zone (PBZ). Intratumoral heterogeneity in GB is currently a hot topic in neuro-oncology, and the GB PBZ may be involved in this phenomenon. Indeed, this region, which possesses specific properties, has been less studied than the core of the GB tumor. The high rate of local recurrence in the PBZ and the limited success of targeted therapies against GB demonstrate the need for a better understanding of the PBZ. We present here a review of the literature on the GB PBZ, focusing on its radiological, cellular, and molecular characteristics. We discuss how intraoperative analysis of the PBZ is important for the optimization of surgical resection and the development of targeted therapies against GB.
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Affiliation(s)
- Jean-Michel Lemée
- Department of Neurosurgery, University Hospital of Angers, Angers, France (J.-M.L., A.C., P.M.); INSERM U1066, "Micro- et nano-médecine biomimétiques", Angers, France (J.-M.L., A.C., P.M.)
| | - Anne Clavreul
- Department of Neurosurgery, University Hospital of Angers, Angers, France (J.-M.L., A.C., P.M.); INSERM U1066, "Micro- et nano-médecine biomimétiques", Angers, France (J.-M.L., A.C., P.M.)
| | - Philippe Menei
- Department of Neurosurgery, University Hospital of Angers, Angers, France (J.-M.L., A.C., P.M.); INSERM U1066, "Micro- et nano-médecine biomimétiques", Angers, France (J.-M.L., A.C., P.M.)
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327
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Delivery of local therapeutics to the brain: working toward advancing treatment for malignant gliomas. Ther Deliv 2015; 6:353-69. [PMID: 25853310 DOI: 10.4155/tde.14.114] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Malignant gliomas, including glioblastoma and anaplastic astrocytomas, are characterized by their propensity to invade surrounding brain parenchyma, making curative resection difficult. These tumors typically recur within two centimeters of the resection cavity even after gross total removal. As a result, there has been an emphasis on developing therapeutics aimed at achieving local disease control. In this review, we will summarize the current developments in the delivery of local therapeutics, namely direct injection, convection-enhanced delivery and implantation of drug-loaded polymers, as well as the application of these therapeutics in future methods including microchip drug delivery and local gene therapy.
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328
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Surgery for Glioblastoma: Impact of the Combined Use of 5-Aminolevulinic Acid and Intraoperative MRI on Extent of Resection and Survival. PLoS One 2015; 10:e0131872. [PMID: 26115409 PMCID: PMC4482740 DOI: 10.1371/journal.pone.0131872] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/08/2015] [Indexed: 01/01/2023] Open
Abstract
Background There is rising evidence that in glioblastoma(GBM) surgery an increase of extent of resection(EoR) leads to an increase of patient’s survival. Based on histopathological assessments tumor depiction of Gd-DTPA enhancement and 5-aminolevulinic-acid-fluorescence(5-ALA) might be synergistic for intraoperative resection control. Objective To assess impact of additional use of 5-ALA in intraoperative MRI(iMRI) assisted surgery of GBMs on extent of resection(EoR), progression free survival(PFS) and overall survival(OS). Methods We prospectively enrolled 33 patients with GBMs eligible for gross-total-resection(GTR) and performed a combined approach using 5-ALA and iMRI. As a control group, we performed a retrospective matched pair assessment, based on 144 patients with iMRI-assisted surgery. Matching criteria were, MGMT promotor methylation, recurrent surgery, eloquent location, tumor size and age. Only patients with an intended GTR and primary GBMs were included. We calculated Kaplan Mayer estimates to compare OS and PFS using the Log-Rank-Test. We used the T-test to compare volumetric results of EoR and the Chi-Square-Test to compare new permanent neurological deficits(nPND) and general complications between the two groups. Results Median follow up was 31 months. No significant differences between both groups were found concerning the matching criteria. GTR was achieved significantly more often (p <0.010) using 5-ALA&iMRI (100%) compared to iMRI alone(82%). Mean EoR was significantly(p<0.004) higher in 5-ALA&iMRI-group(99.7%) than in iMRI-alone-group(97.4%) Rate of complications did not differ significantly between groups(21% iMRI-group,27%5-ALA&iMRI-group,p<0.518). nPND were found in 6% in both groups. Median PFS (6mo resp.;p<0.309) and median OS(iMRI:17mo;5-ALA&iMRI-group:18mo;p<0.708)) were not significantly different between both groups. Conclusion We found a significant increase of EoR when combining 5-ALA&iMRI compared to use of iMRI alone. Maximizing EoR did not lead to an increase of complications or neurological deficits if used with neurophysiological monitoring in eloquent lesions. No final conclusion can be drawn whether a further increase of EoR benefits patient’s progression free survival and overall survival.
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Warram JM, de Boer E, Korb M, Hartman Y, Kovar J, Markert JM, Gillespie GY, Rosenthal EL. Fluorescence-guided resection of experimental malignant glioma using cetuximab-IRDye 800CW. Br J Neurosurg 2015; 29:850-8. [PMID: 26073144 DOI: 10.3109/02688697.2015.1056090] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The standard treatment for glioblastoma multiforme (GBM) remains maximal safe surgical resection. Here, we evaluated the ability of a systemically administered antibody-dye probe conjugate (cetuximab-IRDye 800CW) to provide sufficient fluorescent contrast for surgical resection of disease in both subcutaneous and orthotopic animal models of GBM. Multiple luciferase-positive GBM cell lines (D-54MG, U-87MG, and U-251MG; n = 5) were implanted in mouse flank and tumors were fluorescently imaged daily using a closed-field near-infrared (NIR) system after cetuximab-IRDye 800CW systemic administration. Orthotopic models were also generated (n = 5), and tumor resection was performed under white light and fluorescence guidance using an FDA-approved wide-field NIR imaging system. Residual tumor was monitored using luciferase imaging. Immunohistochemistry was performed to characterize tumor fluorescence, epidermal growth factor receptor (EGFR) expression, and vessel density. Daily imaging of tumors revealed an average tumor-to-background (TBR) of 4.5 for U-87MG, 4.1 for D-54MG, and 3.7 for U-251MG. Fluorescence intensity within the tumors peaked on day-1 after cetuximab-IRDye 800CW administration, however the TBR increased over time in two of the three cell lines. For the orthotopic model, TBR on surgery day ranged from 19 to 23 during wide-field, intraoperative imaging. Surgical resection under white light on day 3 after cetuximab-IRDye 800CW resulted in an average 41% reduction in luciferase signal while fluorescence-guided resection using wide-field NIR imaging resulted in a significantly (P = 0.001) greater reduction in luciferase signal (87%). Reduction of luciferase signal was found to correlate (R (2) = 0.99) with reduction in fluorescence intensity. Fluorescence intensity was found to correlate (P < 0.05) with EGFR expression in D-54MG and U-251MG tumor types but not U-87MG. However, tumor fluorescence was found to correlate with vessel density for the U-87MG tumors. Here we show systemic administration of cetuximab-IRDye 800CW in combination with wide-field NIR imaging provided robust and specific fluorescence contrast for successful localization of disease in subcutaneous and orthotopic animal models of GBM.
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Affiliation(s)
- Jason M Warram
- a Department of Surgery , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - Esther de Boer
- a Department of Surgery , University of Alabama at Birmingham , Birmingham, Alabama , USA.,d Department of Surgery , University Medical Center Groningen, University of Groningen , the Netherlands
| | - Melissa Korb
- a Department of Surgery , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - Yolanda Hartman
- a Department of Surgery , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - Joy Kovar
- c LI-COR Biosciences , Lincoln, Nebraska , USA
| | - James M Markert
- b Department of Neurosurgery , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - G Yancey Gillespie
- b Department of Neurosurgery , University of Alabama at Birmingham , Birmingham, Alabama , USA
| | - Eben L Rosenthal
- a Department of Surgery , University of Alabama at Birmingham , Birmingham, Alabama , USA
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Noell S, Feigl GC, Naros G, Barking S, Tatagiba M, Ritz R. Experiences in surgery of primary malignant brain tumours in the primary sensori-motor cortex practical recommendations and results of a single institution. Clin Neurol Neurosurg 2015; 136:41-50. [PMID: 26056811 DOI: 10.1016/j.clineuro.2015.05.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Tumour resection in the Rolandic region is a challenge. Aim of this study is to review a series of patients malignant glioma surgery in the Rolandic region which was performed by combinations of neuronavigation, sonography, 5-aminolevulinic acid fluorescence guided (5-ALA) surgery and intraoperative electrophysiological monitoring (IOM). METHODS 29 patients suffering malignant gliomas in the motor cortex (17) and sensory cortex (12) were analyzed with respect to functional outcome and grade of resections. RESULTS Improvement of motor function was seen in 41.5% one week after surgery, 41.5% were stable, only 17% deteriorated. After three months patients had an improvement of motor function in 56%, of Karnofsky Score (KPS) 27% and sensory function was improved in 8%. Deterioration of motor function was seen in 16%, in sensory function 4% and in KPS 28% after three months. 25% showed no residual tumour in early post surgical contrast enhanced MRI. 10% had less than 2% residual tumour and 15% had 2-5% residual tumour. CONCLUSIONS Preoperative functional neuroimaging, neuronavigation for planning the surgical approach and resection margins, intraoperative sonography and 5-ALA guided surgery in combination with the application of IOM shows that functional outcome and total to subtotal resection of malignant glioma in the Rolandic region is feasible.
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Affiliation(s)
- Susan Noell
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Guenther C Feigl
- Department of Neurosurgery, Bamberg Hospital, Huger Straße 80, 96049 Bamberg, Germany
| | - Georgios Naros
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Susanne Barking
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany
| | - Rainer Ritz
- Department of Neurosurgery, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany; Department of Neurosurgery, Philipps University Marburg, Baldingerstraße, 35043 Marburg, Germany.
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331
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Chaichana KL, Kone L, Bettegowda C, Weingart JD, Olivi A, Lim M, Quinones-Hinojosa A, Gallia GL, Brem H. Risk of surgical site infection in 401 consecutive patients with glioblastoma with and without carmustine wafer implantation. Neurol Res 2015; 37:717-26. [PMID: 25916669 DOI: 10.1179/1743132815y.0000000042] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Patients with glioblastoma (GBM) have an inherently shortened survival because of their disease. It has been recently shown that carmustine wafers in addition to other therapies (surgery, temozolomide, and radiation) can further extend survival. There is concern, however, that these therapies may increase infection risk. The goals of this study were to calculate the incidence of postoperative infection, evaluate if carmustine wafers changes the risk of infection and identify factors independently associated with an infection following GBM surgery. METHODS All patients who underwent non-biopsy, surgical resection of an intracranial GBM from 2007 to 2011 at a single institution were retrospectively reviewed. Stepwise multivariate proportional hazards regression analysis was used to identify factors associated with infection, including the use of carmustine wafers. Variables with P < 0.05 were considered statistically significant. RESULTS Four hundred and one patients underwent resection of an intracranial GBM during the reviewed period, and 21 (5%) patients developed an infection at a median time of 40 [28-286] days following surgery. The incidence of infection was not higher in patients who had carmustine wafers, and this remained true in multivariate analyses to account for differences in treatment cohorts. The factors that remained significantly associated with an increased risk of infection were prior surgery [RR (95% CI); 2.026 (1.473-4.428), P = 0.01], diabetes mellitus [RR (95% CI); 6.090 (1.380-9.354)], P = 0.02], and increasing duration of hospital stay [RR (95% CI); 1.048 (1.006-1.078); P = 0.02], where the greatest risk occurred with hospital stays > 5 days [RR (95% CI); 3.904 (1.003-11.620), P = 0.05]. DISCUSSION These findings may help guide treatment regimens aimed at minimizing infection for patients with GBM.
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Chou YC, Chang MY, Wang MJ, Harnod T, Hung CH, Lee HT, Shen CC, Chung JG. PEITC induces apoptosis of Human Brain Glioblastoma GBM8401 Cells through the extrinsic- and intrinsic -signaling pathways. Neurochem Int 2015; 81:32-40. [PMID: 25582659 DOI: 10.1016/j.neuint.2015.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/18/2014] [Accepted: 01/06/2015] [Indexed: 11/16/2022]
Abstract
Glioblastoma is the most common and most aggressive primary brain malignancy. The multimodality treatments for this tumor including surgery, radiotherapy, and chemotherapy, are still not completely satisfied. Phenethyl isothiocyanate (PEITC), one member of the isothiocyanate family, has been shown to induce apoptosis in many human cancer cells. In this study, we investigate the pro-apoptotic effects caused by PETIC in human brain glioblastoma multiforme GBM 8401 cells. In our data, PEITC induced the cell morphological changes and decreased the cell viability of GBM8401 cells in a dose- and time-dependent manner. Moreover, the analysis of cell cycle distribution detected by flow cytometry showed that PEITC induced significantly sub-G1 phase (apoptotic population) in GBM 8401 cells. In addition, PEITC promoted the production of reactive oxygen species (ROS) and increase in [Ca2+]I, but decreased the mitochondrial membrane potential (ΔΨm) in treated cells. PEITC also induced caspases activities in GBM 8401 cells. Results from Western blot analysis indicated that PEITC promoted Fas, FasL, FADD, TRAIL, caspase-8, -9, -3, increased the pro-apoptotic protein (Bax, Bid and Bak), and inhibited the anti-apoptotic proteins (Bcl-2 and Bcl-xl) in GBM 8401 cells. Furthermore, PEITC promoted the release of cytochrome c, AIF and Endo G. GADD153, GRP 78, XBP-1 and IRE-1α, Calpain I and II in GBM 8401 cells. PEITC also promoted the expression of associated protein with endoplasmic reticulum (ER) stress. PEITC induces apoptosis through the extrinsic (death receptor) pathway, dysfunction of mitochondria, ROS induced ER stress, intrinsic (mitochondrial) pathway in GBM 8401 cells. The possible molecular mechanisms and signaling pathways of the anti-cancer properties of PEITC for human brain glioblastoma cells were postulated.
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Affiliation(s)
- Yu-Cheng Chou
- Division of Neurosurgical Oncology, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan; Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan; School of Medicine, National Defense Medical Center, Taipei 114, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taiwan
| | - Meng-Ya Chang
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Mei-Jen Wang
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Tomor Harnod
- Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and College of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Chih-Huang Hung
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Hsu-Tung Lee
- Division of Neurosurgical Oncology, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 114, Taiwan
| | - Chiung-Chyi Shen
- Division of Minimally Invasive Skull Base Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Jing-Gung Chung
- Departments of Biological Science and Technology, China Medical University, Taichung 404, Taiwan; Department of Biotechnology, Asia University, Taichung 413, Taiwan.
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Characterizing the peritumoral brain zone in glioblastoma: a multidisciplinary analysis. J Neurooncol 2015; 122:53-61. [PMID: 25559687 DOI: 10.1007/s11060-014-1695-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/20/2014] [Indexed: 10/24/2022]
Abstract
Glioblastoma (GB) is the most frequent and aggressive type of primary brain tumor. Recurrences are mostly located at the margin of the resection cavity in the peritumoral brain zone (PBZ). Although it is widely believed that infiltrative tumor cells in this zone are responsible for GB recurrence, few studies have examined this zone. In this study, we analyzed PBZ left after surgery with a variety of techniques including radiology, histopathology, flow cytometry, genomic, transcriptomic, proteomic, and primary cell cultures. The resulting PBZ profiles were compared with those of the GB tumor zone and normal brain samples to identify characteristics specific to the PBZ. We found that tumor cell infiltration detected by standard histological analysis was present in almost one third of PBZ taken from an area that was considered normal both on standard MRI and by the neurosurgeon under an operating microscope. The panel of techniques used in this study show that the PBZ, similar to the tumor zone itself, is characterized by substantial inter-patient heterogeneity, which makes it difficult to identify representative markers. Nevertheless, we identified specific alterations in the PBZ such as the presence of selected tumor clones and stromal cells with tumorigenic and angiogenic properties. The study of GB-PBZ is a growing field of interest and this region needs to be characterized further. This will facilitate the development of new, targeted therapies for patients with GB and the development of approaches to refine the per-operative evaluation of the PBZ to optimize the surgical resection of the tumor.
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334
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Polyzoidis S, Tuazon J, Brazil L, Beaney R, Al-Sarraj ST, Doey L, Logan J, Hurwitz V, Jarosz J, Bhangoo R, Gullan R, Mijovic A, Richardson M, Farzaneh F, Ashkan K. Active dendritic cell immunotherapy for glioblastoma: Current status and challenges. Br J Neurosurg 2014; 29:197-205. [PMID: 25541743 DOI: 10.3109/02688697.2014.994473] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Dendritic cell (DC) immunotherapy is developing as a promising treatment modality for patients with glioblastoma multiforme (GBM). The aim of this article is to review the data from clinical trials and prospective studies evaluating the safety and efficacy of DC vaccines for newly diagnosed (ND)- and recurrent (Rec)-GBM and for other high-grade gliomas (HGGs). By searching all major databases we identified and reviewed twenty-two (n=22) such studies, twenty (n=20) of which were phase I and II trials, one was a pilot study towards a phase I/II trial and one was a prospective study. GBM patients were exclusively recruited in 12/22 studies, while 10/22 studies enrolled patients with any diagnosis of a HGG. In 7/22 studies GBM was newly diagnosed. In the vast majority of studies the vaccine was injected subcutaneously or intradermally and consisted of mature DCs pulsed with tumour lysate or peptides. Median overall survival ranged between 16.0 and 38.4 months for ND-GBM and between 9.6 and 35.9 months for Rec-GBM. Vaccine-related side effects were in general mild (grade I and II), with serious adverse events (grade III, IV and V) reported only rarely. DC immunotherapy therefore appears to have the potential to increase the overall survival in patients with HGG, with an acceptable side effect profile. The findings will require confirmation by the ongoing and future phase III trials.
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335
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Hypoxia-cultured human adipose-derived mesenchymal stem cells are non-oncogenic and have enhanced viability, motility, and tropism to brain cancer. Cell Death Dis 2014; 5:e1567. [PMID: 25501828 PMCID: PMC4649837 DOI: 10.1038/cddis.2014.521] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/30/2014] [Accepted: 10/06/2014] [Indexed: 02/07/2023]
Abstract
Adult human adipose-derived mesenchymal stem cells (hAMSCs) are multipotent cells, which are abundant, easily collected, and bypass the ethical concerns that plague embryonic stem cells. Their utility and accessibility have led to the rapid development of clinical investigations to explore their autologous and allogeneic cellular-based regenerative potential, tissue preservation capabilities, anti-inflammatory properties, and anticancer properties, among others. hAMSCs are typically cultured under ambient conditions with 21% oxygen. However, physiologically, hAMSCs exist in an environment of much lower oxygen tension. Furthermore, hAMSCs cultured in standard conditions have shown limited proliferative and migratory capabilities, as well as limited viability. This study investigated the effects hypoxic culture conditions have on primary intraoperatively derived hAMSCs. hAMSCs cultured under hypoxia (hAMSCs-H) remained multipotent, capable of differentiation into osteogenic, chondrogenic, and adipogenic lineages. In addition, hAMSCs-H grew faster and exhibited less cell death. Furthermore, hAMSCs-H had greater motility than normoxia-cultured hAMSCs and exhibited greater homing ability to glioblastoma (GBM) derived from brain tumor-initiating cells from our patients in vitro and in vivo. Importantly, hAMSCs-H did not transform into tumor-associated fibroblasts in vitro and were not tumorigenic in vivo. Rather, hAMSCs-H promoted the differentiation of brain cancer cells in vitro and in vivo. These findings suggest an alternative culturing technique that can enhance the function of hAMSCs, which may be necessary for their use in the treatment of various pathologies including stroke, myocardial infarction, amyotrophic lateral sclerosis, and GBM.
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336
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The Value of Extent of Resection of Glioblastomas: Clinical Evidence and Current Approach. Curr Neurol Neurosci Rep 2014; 15:517. [DOI: 10.1007/s11910-014-0517-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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337
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Solheim O, Gulati S, Jakola AS. Glioblastoma resection: in search of a threshold between worthwhile and futile. Neuro Oncol 2014; 16:610-1. [PMID: 24637551 DOI: 10.1093/neuonc/not312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway (O.S.); National Centre for Ultrasound and Image Guided Therapy, Trondheim, Norway (S.G.); MI Lab, Norwegian University of Science and Technology, Trondheim, Norway (A.S.J.)
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338
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Grabowski MM, Recinos PF, Nowacki AS, Schroeder JL, Angelov L, Barnett GH, Vogelbaum MA. Residual tumor volume versus extent of resection: predictors of survival after surgery for glioblastoma. J Neurosurg 2014; 121:1115-23. [DOI: 10.3171/2014.7.jns132449] [Citation(s) in RCA: 238] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The impact of extent of resection (EOR) on survival for patients with glioblastoma (GBM) continues to be a point of debate despite multiple studies demonstrating that increasing EOR likely extends survival for these patients. In addition, contrast-enhancing residual tumor volume (CE-RTV) alone has rarely been analyzed quantitatively to determine if it is a predictor of outcome. The purpose of this study was to evaluate the effect of CE-RTV and T2/FLAIR residual volume (T2/F-RV) on overall survival.
Methods
A retrospective review of 128 patients who underwent primary resection of supratentorial GBM followed by standard radiation/chemotherapy was undertaken utilizing quantitative, volumetric analysis of pre- and postoperative MR images. The results were compared with clinical data obtained from the patients' medical records.
Results
At analysis, 8% of patients were alive, and no patients were lost to follow-up. The overall median survival was 13.8 months, with a median Karnofsky Performance Scale (KPS) score of 90 at presentation. The median contrast-enhancing preoperative tumor volume (CE-PTV) was 29.0 cm3, and CE-RTV was 1.2 cm3, equating to a 95.8% median EOR. The median T2/F-RV was 36.8 cm3. CE-PTV, CE-RTV, T2/F-RV, and EOR were all statistically significant predictors of survival when controlling for age and KPS score. A statistically significant benefit in survival was seen with a CE-RTV less than 2 cm3 or an EOR greater than 98%. Evaluation of the volumetric analysis methodology was performed by observers of varying degrees of experience—an attending neurosurgeon, a fellow, and a medical student. Both the medical student and fellow recorded correlation coefficients of 0.98 when compared with the attending surgeon's measured volumes of CE-PTV, while for CE-RTV, correlation coefficients of 0.67 and 0.71 (medical student and fellow, respectively) were obtained.
Conclusions
CE-RTV and EOR were found to be significant predictors of survival after GBM resection. CERTV was the more significant predictor of survival compared with EOR, suggesting that the volume of residual contrast-enhancing tumor may be a more accurate and meaningful reflection of the pathobiology of GBM.
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Affiliation(s)
| | - Pablo F. Recinos
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
| | - Amy S. Nowacki
- 2Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Jason L. Schroeder
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
| | - Lilyana Angelov
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
| | - Gene H. Barnett
- 1Brain Tumor and Neuro-Oncology Center and Department of Neurosurgery, and
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339
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The future of glioblastoma therapy: synergism of standard of care and immunotherapy. Cancers (Basel) 2014; 6:1953-85. [PMID: 25268164 PMCID: PMC4276952 DOI: 10.3390/cancers6041953] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/05/2014] [Accepted: 09/03/2014] [Indexed: 12/18/2022] Open
Abstract
The current standard of care for glioblastoma (GBM) is maximal surgical resection with adjuvant radiotherapy and temozolomide (TMZ). As the 5-year survival with GBM remains at a dismal <10%, novel therapies are needed. Immunotherapies such as the dendritic cell (DC) vaccine, heat shock protein vaccines, and epidermal growth factor receptor (EGFRvIII) vaccines have shown encouraging results in clinical trials, and have demonstrated synergistic effects with conventional therapeutics resulting in ongoing phase III trials. Chemoradiation has been shown to have synergistic effects when used in combination with immunotherapy. Cytotoxic ionizing radiation is known to trigger pro-inflammatory signaling cascades and immune activation secondary to cell death, which can then be exploited by immunotherapies. The future of GBM therapeutics will involve finding the place for immunotherapy in the current treatment regimen with a focus on developing strategies. Here, we review current GBM therapy and the evidence for combination of immune checkpoint inhibitors, DC and peptide vaccines with the current standard of care.
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340
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Uckermann O, Galli R, Tamosaityte S, Leipnitz E, Geiger KD, Schackert G, Koch E, Steiner G, Kirsch M. Label-free delineation of brain tumors by coherent anti-Stokes Raman scattering microscopy in an orthotopic mouse model and human glioblastoma. PLoS One 2014; 9:e107115. [PMID: 25198698 PMCID: PMC4159970 DOI: 10.1371/journal.pone.0107115] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/05/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Coherent anti-Stokes Raman scattering (CARS) microscopy provides fine resolution imaging and displays morphochemical properties of unstained tissue. Here, we evaluated this technique to delineate and identify brain tumors. METHODS Different human tumors (glioblastoma, brain metastases of melanoma and breast cancer) were induced in an orthotopic mouse model. Cryosections were investigated by CARS imaging tuned to probe C-H molecular vibrations, thereby addressing the lipid content of the sample. Raman microspectroscopy was used as reference. Histopathology provided information about the tumor's localization, cell proliferation and vascularization. RESULTS The morphochemical contrast of CARS images enabled identifying brain tumors irrespective of the tumor type and properties: All tumors were characterized by a lower CARS signal intensity than the normal parenchyma. On this basis, tumor borders and infiltrations could be identified with cellular resolution. Quantitative analysis revealed that the tumor-related reduction of CARS signal intensity was more pronounced in glioblastoma than in metastases. Raman spectroscopy enabled relating the CARS intensity variation to the decline of total lipid content in the tumors. The analysis of the immunohistochemical stainings revealed no correlation between tumor-induced cytological changes and the extent of CARS signal intensity reductions. The results were confirmed on samples of human glioblastoma. CONCLUSIONS CARS imaging enables label-free, rapid and objective identification of primary and secondary brain tumors. Therefore, it is a potential tool for diagnostic neuropathology as well as for intraoperative tumor delineation.
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Affiliation(s)
- Ortrud Uckermann
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Roberta Galli
- Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sandra Tamosaityte
- Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elke Leipnitz
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Kathrin D. Geiger
- Neuropathology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Schackert
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Edmund Koch
- Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gerald Steiner
- Clinical Sensoring and Monitoring, Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- * E-mail: (GS); (MK)
| | - Matthias Kirsch
- Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- * E-mail: (GS); (MK)
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341
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Chaichana KL, Jusue-Torres I, Lemos AM, Gokaslan A, Cabrera-Aldana EE, Ashary A, Olivi A, Quinones-Hinojosa A. The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors? J Neurooncol 2014; 120:625-34. [PMID: 25193022 DOI: 10.1007/s11060-014-1597-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/23/2014] [Indexed: 11/24/2022]
Abstract
A subset of patients with glioblastoma (GBM) have butterfly GBM (bGBM) that involve both cerebral hemispheres by crossing the corpus callosum. The prognoses, as well as the effectiveness of surgery and adjuvant therapy, are unclear because studies are few and limited. The goals of this study were to: (1) determine if bGBM have worse outcomes than patients with non-bGBM, (2) determine if surgery is more effective than biopsy, and (3) identify factors independently associated with improved outcomes for these patients. Adult patients who underwent surgery for a newly diagnosed primary GBM at an academic tertiary-care institution between 2007 and 2012 were retrospectively reviewed and tumors were volumetrically measured. Of the 336 patients with newly diagnosed GBM who were operated on, 48 (14 %) presented with bGBM, where 29 (60 %) and 19 (40 %) underwent surgical resection and biopsy, respectively. In multivariate analysis, a bGBM was independently associated with poorer survival [HR (95 % CI) 1.848 (1.250-2.685), p < 0.003]. In matched-pair analysis, patients who underwent surgical resection had improved median survival than biopsy patients (7.0 vs. 3.5 months, p = 0.03). In multivariate analysis, increasing percent resection [HR (95 % CI) 0.987 (0.977-0.997), p = 0.01], radiation [HR (95 % CI) 0.431 (0.225-0.812), p = 0.009], and temozolomide [HR (95 % CI) 0.413 (0.212-0. 784), p = 0.007] were each independently associated with prolonged survival among patients with bGBM. This present study shows that while patients with bGBM have poorer prognoses compared to non-bGBM, these patients can also benefit from aggressive treatments including debulking surgery, maximal safe surgical resection, temozolomide chemotherapy, and radiation therapy.
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Affiliation(s)
- Kaisorn L Chaichana
- Department of Neurosurgery, Neuro-Oncology Outcomes Laboratory, The Johns Hopkins Hospital, Johns Hopkins University, 1800 Orleans Street, Zayed 6007B, Baltimore, MD, 21202, USA,
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342
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Bauchet L, Zouaoui S, Darlix A, Menjot de Champfleur N, Ferreira E, Fabbro M, Kerr C, Taillandier L. Assessment and treatment relevance in elderly glioblastoma patients. Neuro Oncol 2014; 16:1459-68. [PMID: 24792440 DOI: 10.1093/neuonc/nou063] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Glioblastoma (GBM) is the most common malignant primary brain tumor. Its incidence continues to increase in the elderly because the older segment of the population is growing faster than any other age group. Most clinical studies exclude elderly patients, and "standards of care" do not exist for GBM patients aged >70 years. We review epidemiology, tumor biology/molecular factors, prognostic factors (clinical, imaging data, therapeutics), and their assessments as well as classic and specific endpoints plus recent and ongoing clinical trials for elderly GBM patients. This work includes perspectives and personal opinions on this topic. Although there are no standards of care for elderly GBM patients, we can hypothesize that (i) Karnofsky performance status (KPS), probably after steroid treatment, is one of the most important clinical factors for determining our oncological strategy; (ii) resection is superior to biopsy, at least in selected patients (depending on location of the tumor and associated comorbidities); (iii) specific schedules of radiotherapy yield a modest but significant improvement; (iv) temozolomide has an acceptable tolerance, even when KPS <70, and could be proposed for methylated elderly GBM patients; and (v) the addition of concomitant temozolomide to radiotherapy has not yet been validated but shows promising results in some studies, yet the optimal schedule of radiotherapy remains to be determined. In the future, specific assessments (geriatric, imaging, biology) and use of new endpoints (quality of life and toxicity measures) will aid clinicians in determining the balance of potential benefits and risks of each oncological strategy.
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Affiliation(s)
- Luc Bauchet
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Sonia Zouaoui
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Amélie Darlix
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Nicolas Menjot de Champfleur
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Ernestine Ferreira
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Michel Fabbro
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Christine Kerr
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
| | - Luc Taillandier
- Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi - Gui de Chauliac, Montpellier, France (L.B., S.Z.); French Brain Tumor DataBase, ICM, Montpellier, France (L.B., S.Z., A.D.); Department of Neuroradiology, CHU, Montpellier, France (N.M. deC.); Department of Geriatrics, CHU, Montpellier, France (E.F.); Department of Medical Oncology, ICM, Montpellier, France (A.D., M.F.); Department of Radiation Oncology, ICM, Montpellier, France (C.K.); Department of Neurology, CHU, Poitiers, France (L.T.)
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343
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5-Aminolevulinic acid fluorescence in high grade glioma surgery: surgical outcome, intraoperative findings, and fluorescence patterns. BIOMED RESEARCH INTERNATIONAL 2014; 2014:232561. [PMID: 24804203 PMCID: PMC3997860 DOI: 10.1155/2014/232561] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/10/2014] [Indexed: 11/18/2022]
Abstract
Background. 5-Aminolevulinic acid (5-ALA) fluorescence is a validated technique for resection of high grade gliomas (HGG); the aim of this study was to evaluate the surgical outcome and the intraoperative findings in a consecutive series of patients. Methods. Clinical and surgical data from patients affected by HGG who underwent surgery guided by 5-ALA fluorescence at our Department between June 2011 and February 2014 were retrospectively evaluated. Surgical outcome was evaluated by assessing the resection rate as gross total resection (GTR) > 98% and GTR > 90%. We finally stratified data for recurrent surgery, tumor location, tumor size, and tumor grade (IV versus III grade sec. WHO). Results. 94 patients were finally enrolled. Overall GTR > 98% and GTR > 90% was achieved in 93% and 100% of patients. Extent of resection (GTR > 98%) was dependent on tumor location, tumor grade (P < 0.05), and tumor size (P < 0.05). In 43% of patients the boundaries of fluorescent tissue exceeded those of tumoral tissue detected by neuronavigation, more frequently in larger (57%) (P < 0.01) and recurrent (60%) tumors. Conclusions. 5-ALA fluorescence in HGG surgery enables a GTR in 100% of cases even if selection of patients remains a main bias. Recurrent surgery, and location, size, and tumor grade can predict both the surgical outcome and the intraoperative findings.
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344
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Sarkar S, Yong VW. The battle for the brain: Brain tumor-initiating cells vs. microglia/macrophages. Oncoimmunology 2014; 3:e28047. [PMID: 25340004 PMCID: PMC4203533 DOI: 10.4161/onci.28047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 01/29/2014] [Indexed: 11/19/2022] Open
Abstract
Brain tumor-initiating cells (BTICs) become less tumorigenic when co-cultured with microglia/macrophages (M/Ms) isolated from subjects not affected by glioma, but not when exposed to the M/Ms of glioma patients. Microglial cells and macrophages from glioma patients, however, can be reactivated by non-toxic doses of amphotericin B to curb the growth of BTICs in vitro and in vivo.
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Affiliation(s)
- Susobhan Sarkar
- Hotchkiss Brain Institute and Department of Clinical Neurosciences; University of Calgary; Calgary, Canada
| | - V Wee Yong
- Hotchkiss Brain Institute and Department of Clinical Neurosciences; University of Calgary; Calgary, Canada
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