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Lanman TA, Cao TQ, Miller JJ, Nagpal S. Ready to INDIGO: Vorasidenib Ushers in the Era of Isocitrate Dehydrogenase Inhibition in Low-Grade Glioma. Int J Radiat Oncol Biol Phys 2024; 118:334-336. [PMID: 38220256 DOI: 10.1016/j.ijrobp.2023.10.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Tyler A Lanman
- Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Toni Q Cao
- Department of Neurology, Stanford University, Palo Alto, California
| | - Julie J Miller
- Pappas Center for Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Seema Nagpal
- Department of Neurology, Stanford University, Palo Alto, California.
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2
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Bhatia A, Moreno R, Reiner AS, Nandakumar S, Walch HS, Malani R, Panageas KS, Mellinghoff IK, Bale TA, Young RJ. Tumor Volume Growth as Surrogate Endpoint in IDH-mt Glioma-Response. Clin Cancer Res 2024; 30:639. [PMID: 38298142 DOI: 10.1158/1078-0432.ccr-23-3603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Ankush Bhatia
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Raquel Moreno
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anne S Reiner
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Subhiksha Nandakumar
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Henry S Walch
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rachna Malani
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ingo K Mellinghoff
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tejus A Bale
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Robert J Young
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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3
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Mandonnet E. Tumor Volume Growth as Surrogate Endpoint in IDH-mt Glioma-Letter. Clin Cancer Res 2024; 30:638. [PMID: 38298141 DOI: 10.1158/1078-0432.ccr-23-3444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, 2 rue Ambroise Paré, Paris, France
- Frontlab, CNRS UMR 7225, INSERM U1127, Paris Brain Institute (ICM), Paris, France
- Université de Paris Cité, Paris, France
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4
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Erkan B, Demir S, Akpinar E, Akkurt TS, Tanriverdi O, Gunaldi O. A rare tumor in the sellar region: ganglioglioma, a case report and a general overview. Childs Nerv Syst 2023; 39:3621-3626. [PMID: 37432397 DOI: 10.1007/s00381-023-06073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Gangliogliomas are rare mixed neuronal-glial tumors of the central nervous system, accounting for less than 2% of intracranial tumors. CASE DESCRIPTION This report presents a rare case of ganglioglioma in the sellar region of a 3-year-old and 5-month-old pediatric patient. The patient underwent surgical intervention initially through a transnasal transsphenoidal approach and subsequently through a transcranial pterional craniotomy approach. Subsequently, radiotherapy and chemotherapy were administered for residual tumor tissue. The purpose of this report is to highlight the presence of ganglioglioma as a distinct diagnosis in sellar region tumors, discuss the surgical, radiotherapy, and/or chemotherapy treatment options for sellar region gangliogliomas based on the literature, and contribute the patient's follow-up and treatment outcomes to the existing literature. CONCLUSION Complete tumor resection may not be feasible in sellar region gangliogliomas, especially in pediatric cases, due to endocrinological and vision-related complications. In cases where complete resection is not possible, radiotherapy and/or chemotherapy may be considered. However, the optimal treatment approach has not yet been established, and further research is needed.
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Affiliation(s)
- Buruc Erkan
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Suat Demir
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ebubekir Akpinar
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Tuce Soylemez Akkurt
- Department of Pathology, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Osman Tanriverdi
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Omur Gunaldi
- Department of Neurosurgery, Health Science University, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
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Delobel T, Ayala-Hernández LE, Bosque JJ, Pérez-Beteta J, Chulián S, García-Ferrer M, Piñero P, Schucht P, Murek M, Pérez-García VM. Overcoming chemotherapy resistance in low-grade gliomas: A computational approach. PLoS Comput Biol 2023; 19:e1011208. [PMID: 37983271 PMCID: PMC10695391 DOI: 10.1371/journal.pcbi.1011208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/04/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
Low-grade gliomas are primary brain tumors that arise from glial cells and are usually treated with temozolomide (TMZ) as a chemotherapeutic option. They are often incurable, but patients have a prolonged survival. One of the shortcomings of the treatment is that patients eventually develop drug resistance. Recent findings show that persisters, cells that enter a dormancy state to resist treatment, play an important role in the development of resistance to TMZ. In this study we constructed a mathematical model of low-grade glioma response to TMZ incorporating a persister population. The model was able to describe the volumetric longitudinal dynamics, observed in routine FLAIR 3D sequences, of low-grade glioma patients acquiring TMZ resistance. We used the model to explore different TMZ administration protocols, first on virtual clones of real patients and afterwards on virtual patients preserving the relationships between parameters of real patients. In silico clinical trials showed that resistance development was deferred by protocols in which individual doses are administered after rest periods, rather than the 28-days cycle standard protocol. This led to median survival gains in virtual patients of more than 15 months when using resting periods between two and three weeks and agreed with recent experimental observations in animal models. Additionally, we tested adaptive variations of these new protocols, what showed a potential reduction in toxicity, but no survival gain. Our computational results highlight the need of further clinical trials that could obtain better results from treatment with TMZ in low grade gliomas.
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Affiliation(s)
- Thibault Delobel
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
- Sorbonne Université, Paris, France
| | - Luis E. Ayala-Hernández
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
- Departamento de Ciencias Exactas y Tecnología Centro Universitario de los Lagos, Universidad de Guadalajara, Lagos de Moreno, Mexico
| | - Jesús J. Bosque
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
| | - Julián Pérez-Beteta
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
| | - Salvador Chulián
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
- Department of Mathematics, Universidad de Cádiz, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Hospital Universitario Puerta del Mar, Cádiz, Spain
| | | | - Pilar Piñero
- Department of Radiology, Virgen del Rocío University Hospital, Seville, Spain
| | - Philippe Schucht
- Department of Neurosurgery, Inselspital Bern and University Hospital, Bern, Switzerland
| | - Michael Murek
- Department of Neurosurgery, Inselspital Bern and University Hospital, Bern, Switzerland
| | - Víctor M. Pérez-García
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), University of Castilla-La Mancha, Ciudad Real, Spain
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Bursi M, Rizzo C, Barberis M, Poisson I, Lehman-Che J, Adle-Biassette H, Froelich S, Mandonnet E. Oncological, cognitive, and employment outcomes in a series of patients with IDH-mutated glioma resected following neoadjuvant chemotherapy. Acta Neurochir (Wien) 2023; 165:2461-2471. [PMID: 37482554 DOI: 10.1007/s00701-023-05711-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/30/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Maximal safe tumor resection is the first line of treatment for IDH-mutated gliomas. However, when upfront surgical resection is deemed unsatisfactory due to tumor size and location, chemotherapy could represent an interesting alternative for reducing glioma extension and allowing for a safer and more efficient removal. METHODS We performed a retrospective study (June 2011 to December 2021) on patients with IDH-mutated gliomas undergoing chemotherapy with a neoadjuvant intent, followed by surgical excision in awake conditions. MRI-imaging follow-up was conducted every 3-6 months. Neuropsychological assessments (NPSA) were performed for all patients before surgery, during post-operative period, and at later follow-up, and patients were periodically interviewed about their clinical and job status. RESULTS We included 6 patients who underwent awake surgery after neoadjuvant chemotherapy (temozolomide in 5 cases, PCV in 1 case) for an IDH-mutated glioma (3 oligodendrogliomas and 3 astrocytomas). Median tumor volume reduction was 47%, allowing for complete resection in one patient, subtotal resection in 4 patients, and partial resection in 1 patient. No major adverse effects were observed under chemotherapy. At the 4 months NPSA, a worsening of flexibility was observed in 2 patients (verbal fluencies in one case and trail making test in the other). Three out of the four patients working full time before procedure resumed their job full time, after a 7 to 10 months delay. CONCLUSION Neoadjuvant chemotherapy followed by maximal safe resection can be offered to patients affected by IDH-mutated gliomas for whom upfront surgery would be inadequate. More studies are necessary given the limited size of our sample.
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Affiliation(s)
- Marco Bursi
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris, France
| | - Claudia Rizzo
- Department of Medical Oncology, Groupe Hospitalier Privé Ambroise Paré - Hartmann, Paris, France
| | - Marion Barberis
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris, France
| | - Isabelle Poisson
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris, France
| | - Jacqueline Lehman-Che
- Université de Paris Cité, Paris, France
- Department of Molecular Biology, Saint-Louis Hospital, 2 rue Ambroise Paré, 75010, Paris, France
| | - Homa Adle-Biassette
- Université de Paris Cité, Paris, France
- Department of Histopathology, Lariboisière Hospital, AP-HP, Paris, France
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris, France
- Université de Paris Cité, Paris, France
| | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, AP-HP, Paris, France.
- Université de Paris Cité, Paris, France.
- Frontlab, Paris Brain Institute, CNRS UMR 7225, INSERM U1127, Paris, France.
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7
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Hou Z, Hu J, Liu X, Yan Z, Zhang K, Fang S, Jiang T, Wang Y. Decision system for extent of resection in WHO grade 3 gliomas: a Chinese Glioma Genome Atlas database analysis. J Neurooncol 2023; 164:461-471. [PMID: 37668945 DOI: 10.1007/s11060-023-04420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Extensive surgical resection has been found to be associated with longer survival in patients with gliomas, but the interactive prognostic value of molecular pathology of the surgical resection is unclear. This study evaluated the impact of molecular pathology and clinical characteristics on the surgical benefit in WHO grade 3 IDH-mutant gliomas. METHODS Clinical and pathological information of 246 patients with WHO grade 3 IDH-mutant gliomas were collected from the Chinese Glioma Genome Atlas database (2006-2020). The role of the extent of resection on overall survival, stratified by molecular pathology and clinical characteristics, was investigated. We then assessed prognostic factors using a univariate log-rank test and multivariate Cox proportional hazards model in the subgroups. RESULTS The extent of resection was an independent prognostic factor in the entire cohort, even when adjusted for molecular pathology. Gross total resection was found to be associated with longer survival in all patients and in the astrocytoma group but not in the oligodendroglioma group. Compared with subtotal resections, gross total resections resulted in a longer survival time for astrocytoma patients aged ≤ 45 years. However, there was no survival benefit from total resection in patients with astrocytoma aged > 45 years. CONCLUSIONS Extensive resection benefits only a proportion of patients with WHO grade 3 IDH-mutant gliomas. Younger patients with astrocytomas had survival benefits from extensive resection. In addition to clinical characteristics (especially age), molecular pathology impacted prognosis in patients with gliomas. Our findings provide guiding information to neurosurgeons while planning surgeries.
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Affiliation(s)
- Ziming Hou
- Department of Neurosurgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jie Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Area A, Nansihuanxi Road, Fengtai District, Beijing, 100070, China
| | - Xing Liu
- Beijing Neurosurgical Institute, Capital Medical University, #119 Area B, Nansihuanxi Road, Fengtai District, Beijing, 100070, China
| | - Zeya Yan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Area A, Nansihuanxi Road, Fengtai District, Beijing, 100070, China
| | - Kenan Zhang
- Beijing Neurosurgical Institute, Capital Medical University, #119 Area B, Nansihuanxi Road, Fengtai District, Beijing, 100070, China
| | - Shengyu Fang
- Beijing Neurosurgical Institute, Capital Medical University, #119 Area B, Nansihuanxi Road, Fengtai District, Beijing, 100070, China.
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Area A, Nansihuanxi Road, Fengtai District, Beijing, 100070, China
- Beijing Neurosurgical Institute, Capital Medical University, #119 Area B, Nansihuanxi Road, Fengtai District, Beijing, 100070, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, #119 Area A, Nansihuanxi Road, Fengtai District, Beijing, 100070, China.
- Beijing Neurosurgical Institute, Capital Medical University, #119 Area B, Nansihuanxi Road, Fengtai District, Beijing, 100070, China.
- Chinese Institute for Brain Research, Beijing, China.
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8
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Tuohy K, Ba DM, Bhanja D, Leslie D, Liu G, Mansouri A. Early costs and complications of first-line low-grade glioma treatment using a large national database: Limitations and future perspectives. Front Surg 2023; 10:1001741. [PMID: 36816005 PMCID: PMC9935584 DOI: 10.3389/fsurg.2023.1001741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Diffuse Low-grade gliomas (DLGG, WHO Grade II) are a heterogenous group of tumors comprising 13-16% of glial tumors. While maximal safe resection is endorsed as the best approach to DLGG, compared to more conservative interventions like stereotactic biopsy, the added costs and risks have not been systematically evaluated. The purpose of this study was to better understand the complication rates and costs associated with each intervention. Methods A retrospective cohort study using data from the IBM Watson Health MarketScan® Commercial Claims and Encounters database was conducted, using the International Classification of Diseases, Ninth Revision (ICD-9) codes corresponding to DLGG (2005-2014). Current Procedure Terminology, 4th Edition (CPT-4) codes were used to differentiate resection and biopsy cohorts. Inverse weighting by the propensity score was used to balance baseline potential confounders (age, sex, pre-op seizure, geographic region, year, Charleston Comorbidity Index). Complication rates, hospital mortality, readmission, and costs were compared between groups. Results We identified 5,784 and 3,635 patients undergoing resection and biopsy, respectively, for initial DLGG management. Resection was associated with greater 30-day complications (29.17% vs. 26.34%; p < 0.05). However, this association became non-significant after inverse propensity weighting (adjusted odds ratio = 1.09; 0.98-1.20). There was no statistically significant difference in unadjusted, 30-day hospital mortality (p = 0.06) or re-admission (p = 0.52). Resection was associated with higher 90-day total costs (p < 0.0001) and drug costs (p < 0.0001). Biopsy was associated with greater index procedure costs (p < 0.0001). Long-term outcomes and evaluation of DLGG subtypes was not possible given limitations in the metrics recorded in MarketScan and lack of specificity in the ICD coding system. Conclusion Resection was not associated with an increase in the adjusted complication rate after balancing for baseline prognostic factors. Total costs and drug costs were higher with resection of DLGG, but the index procedure costs were higher for biopsy. This data should help to facilitate prospective health economic analyses in the future to understand the cost-effectiveness, and impact on quality of life, for DLGG interventions. However, the use of large national databases for studying long-term outcomes in DLGG management should be discouraged until there is greater specificity in the ICD coding system for DLGG subtypes.
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Affiliation(s)
- Kyle Tuohy
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, United States,Correspondence: Kyle Tuohy
| | - Djibril M. Ba
- Department of Public Health Sciences, Penn State University, University park, PA, United States,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, United States
| | - Debarati Bhanja
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, United States
| | - Douglas Leslie
- Department of Public Health Sciences, Penn State University, University park, PA, United States,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, United States
| | - Guodong Liu
- Department of Public Health Sciences, Penn State University, University park, PA, United States,Center for Applied Studies in Health Economics (CASHE), Penn State College of Medicine, Hershey, PA, United States
| | - Alireza Mansouri
- Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, United States,Penn State Cancer Institute, Penn State Hershey Medical Center, Hershey, PA, United States
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Zhang L, Pan H, Liu Z, Gao J, Xu X, Wang L, Wang J, Tang Y, Cao X, Kan Y, Wen Z, Chen J, Huang D, Chen S, Li Y. Multicenter clinical radiomics-integrated model based on [ 18F]FDG PET and multi-modal MRI predict ATRX mutation status in IDH-mutant lower-grade gliomas. Eur Radiol 2023; 33:872-883. [PMID: 35984514 DOI: 10.1007/s00330-022-09043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/23/2022] [Accepted: 07/01/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To develop a clinical radiomics-integrated model based on 18 F-fluorodeoxyglucose positron emission tomography ([18F]FDG PET) and multi-modal MRI for predicting alpha thalassemia/mental retardation X-linked (ATRX) mutation status of IDH-mutant lower-grade gliomas (LGGs). METHODS One hundred and two patients (47 ATRX mutant-type, 55 ATRX wild-type) diagnosed with IDH-mutant LGGs (CNS WHO grades 1 and 2) were retrospectively enrolled. A total of 5540 radiomics features were extracted from structural MR (sMR) images (contrast-enhanced T1-weighted imaging, CE-T1WI; T2-weighted imaging, and T2WI), functional MR (fMR) images (apparent diffusion coefficient, ADC; cerebral blood volume, CBV), and metabolic PET images ([18F]FDG PET). The random forest algorithm was used to establish a clinical radiomics-integrated model, integrating the optimal multi-modal radiomics model with three clinical parameters. The predictive effectiveness of the models was evaluated by receiver operating characteristic (ROC) and decision curve analysis (DCA). RESULTS The optimal multi-modal model incorporated sMR (CE-T1WI), fMR (ADC), and metabolic ([18F]FDG) images ([18F]FDG PET+ADC+ CE-T1WI) with the area under curves (AUCs) in the training and test groups of 0.971 and 0.962, respectively. The clinical radiomics-integrated model, incorporating [18F]FDG PET+ADC+CE-T1WI, three clinical parameters (KPS, SFSD, and ATGR), showed the best predictive effectiveness in the training and test groups (0.987 and 0.975, respectively). CONCLUSIONS The clinical radiomics-integrated model with metabolic, structural, and functional information based on [18F]FDG PET and multi-modal MRI achieved promising performance for predicting the ATRX mutation status of IDH-mutant LGGs. KEY POINTS • The clinical radiomics-integrated model based on [18F]FDG PET and multi-modal MRI achieved promising performance for predicting ATRX mutation status in LGGs. • The study investigated the value of multicenter clinical radiomics-integrated model based on [18F]FDG PET and multi-modal MRI in LGGs regarding ATRX mutation status prediction. • The integrated model provided structural, functional, and metabolic information simultaneously and demonstrated with satisfactory calibration and discrimination in the training and test groups (0.987 and 0.975, respectively).
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Affiliation(s)
- Liqiang Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Hongyu Pan
- College of Computer & Information Science, Southwest University, Chongqing, 400715, China
| | - Zhi Liu
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Jueni Gao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xinyi Xu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Linlin Wang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yi Tang
- Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
| | - Xu Cao
- School of Medical and Life Sciences Chengdu University of Traditional Chinese Medicine, Chengdu, 610032, China
| | - Yubo Kan
- Department of Nuclear Medicine, United Medical Imaging Center, Chongqing, 400038, China
| | - Zhipeng Wen
- Department of Radiology, Sichuan Cancer Hospital, Chengdu, 610042, China
| | - Jianjun Chen
- Department of Nuclear Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Dingde Huang
- Department of Nuclear Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Shanxiong Chen
- College of Computer & Information Science, Southwest University, Chongqing, 400715, China.
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Gatto L, Franceschi E, Tosoni A, Nunno VD, Bartolini S, Brandes AA. Hypermutation as a potential predictive biomarker of immunotherapy efficacy in high-grade gliomas: a broken dream? Immunotherapy 2022; 14:799-813. [PMID: 35670093 DOI: 10.2217/imt-2021-0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A high tumor mutational burden and mismatch repair deficiency are observed in 'hypermutated' high-grade gliomas (HGGs); however, the molecular characterization of this distinct subtype and whether it predicts the response to immune checkpoint inhibitors (ICIs) are largely unknown. Pembrolizumab is a valid therapeutic option for the treatment of hypermutated cancers of diverse origin, but only a few clinical trials have explored the activity of ICIs in hypermutated HGGs. HGGs appear to differ from other cancers, likely due to the prevalence of subclonal versus clonal neoantigens, which are unable to elicit an immune response with ICIs. The main aim of this review is to summarize the current knowledge on hypermutation in HGGs, focusing on the broken promises of tumor mutational burden and mismatch repair deficiency as potential biomarkers of response to ICIs.
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Affiliation(s)
- Lidia Gatto
- Department of Oncology, AUSL Bologna, Bologna, Italy
| | - Enrico Franceschi
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alicia Tosoni
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | | | - Stefania Bartolini
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Alba Ariela Brandes
- Nervous System Medical Oncology Department, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Abstract
Abstract
Purpose
Gliomas, the most common primary brain tumours, have recently been re-classified incorporating molecular aspects with important clinical, prognostic, and predictive implications. Concurrently, the reprogramming of metabolism, altering intracellular and extracellular metabolites affecting gene expression, differentiation, and the tumour microenvironment, is increasingly being studied, and alterations in metabolic pathways are becoming hallmarks of cancer. Magnetic resonance spectroscopy (MRS) is a complementary, non-invasive technique capable of quantifying multiple metabolites. The aim of this review focuses on the methodology and analysis techniques in proton MRS (1H MRS), including a brief look at X-nuclei MRS, and on its perspectives for diagnostic and prognostic biomarkers in gliomas in both clinical practice and preclinical research.
Methods
PubMed literature research was performed cross-linking the following key words: glioma, MRS, brain, in-vivo, human, animal model, clinical, pre-clinical, techniques, sequences, 1H, X-nuclei, Artificial Intelligence (AI), hyperpolarization.
Results
We selected clinical works (n = 51), preclinical studies (n = 35) and AI MRS application papers (n = 15) published within the last two decades. The methodological papers (n = 62) were taken into account since the technique first description.
Conclusions
Given the development of treatments targeting specific cancer metabolic pathways, MRS could play a key role in allowing non-invasive assessment for patient diagnosis and stratification, predicting and monitoring treatment responses and prognosis. The characterization of gliomas through MRS will benefit of a wide synergy among scientists and clinicians of different specialties within the context of new translational competences. Head coils, MRI hardware and post-processing analysis progress, advances in research, experts’ consensus recommendations and specific professionalizing programs will make the technique increasingly trustworthy, responsive, accessible.
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Monocentric evaluation of Ki-67 labeling index in combination with a modified RPA score as a prognostic factor for survival in IDH-wildtype glioblastoma patients treated with radiochemotherapy. Strahlenther Onkol 2022; 198:892-906. [PMID: 35612598 PMCID: PMC9515058 DOI: 10.1007/s00066-022-01959-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 04/24/2022] [Indexed: 11/05/2022]
Abstract
Purpose The prognosis for glioblastoma patients remains dismal despite intensive research on better treatment options. Molecular and immunohistochemical markers are increasingly being investigated as understanding of their role in disease progression grows. O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation has been shown to have prognostic and therapeutic relevance for glioblastoma patients. Other markers implicated in tumor formation and/or malignancy are p53, Alpha thalassemia/mental retardation syndrome X-linked (ATRX), Epidermal Growth Factor Receptor splice variant III (EGFRvIII), and Ki-67, with loss of nuclear ATRX expression and lower Ki-67 index being associated with prolonged survival. For p53 and EGFRvIII the data are contradictory. Our aim was to investigate the markers mentioned above regarding progression-free (PFS) and overall survival (OS) to evaluate their viability as independent prognostic markers for our patient collective. Methods In this retrospective study, we collected data on patients undergoing radiotherapy due to isocitrate dehydrogenase (IDH) wildtype glioblastoma at a single university hospital between 2014 and 2020. Results Our findings confirm Ki-67 labeling index ≤ 20% as an independent prognostic factor for prolonged PFS as well as MGMT promoter methylation for both prolonged PFS and OS, in consideration of age and Eastern Cooperative Oncology Group (ECOG) status, chemotherapy treatment, and total radiation dose for PFS as well as additionally sex, resection status, and receipt of treatment for progression or recurrence for OS. Additionally, Ki-67 labeling index ≤ 20% showed a significant correlation with prolonged OS in univariate analysis. Modification of the recursive partitioning analysis (RPA) score to include Ki-67 labeling index resulted in a classification with the possible ability to distinguish long-term-survivors from patients with unfavorable prognosis. Conclusion MGMT promoter methylation and Ki-67 labeling index were independent predictors of survival in our collective. We see further studies pooling patient collectives to reach larger patient numbers concerning Ki-67 labeling index as being warranted. Supplementary Information The online version of this article (10.1007/s00066-022-01959-6) contains supplementary material, which is available to authorized users.
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Blonski M, Obara T, Brzenczek C, Pouget C, Dillier C, Meyer M, Lavigne L, Forthoffer N, Broussois A, Gauchotte G, Baron MH, Rech F, Mézières S, Gaudeau Y, Verger A, Vogin G, Anxionnat R, Moureaux JM, Taillandier L. Initial PCV Chemotherapy Followed by Radiotherapy Is Associated With a Prolonged Response But Late Neurotoxicity in 20 Diffuse Low-Grade Glioma Patients. Front Oncol 2022; 12:827897. [PMID: 35311144 PMCID: PMC8931287 DOI: 10.3389/fonc.2022.827897] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundStudy RTOG 9802 in high-risk diffuse low-grade gliomas (DLGGs) showed the potential synergistic effect on survival of the procarbazine, CCNU, and vincristine (PCV) radiotherapy (RT) combination. Limited data on long-term neurocognitive impact and quality of life (QoL) have yet been reported.Patients and MethodsWe described a monocentric series of patients treated at first line by the combination of PCV immediately followed by RT between January 01, 1982 and January 01, 2017. Radiological data were collected and included volume, velocity of diametric expansion (VDE), and MRI aspects. Long-term neurocognitive and QoL were analyzed.ResultsTwenty patients fulfilled the eligibility criteria. The median response rate was 65.1% (range, 9.6%–99%) at the time of maximal VDE decrease corresponding to a median volume reduction of 79.7 cm3 (range, 3.1 to 174.2 cm3), which occurred after a median period of 7.2 years (range, 0.3–21.9) after the end of RT. An ongoing negative VDE was measured in 13/16 patients after the end of RT, with a median duration of 6.7 years (range, 9 months–21.9 years). The median follow-up since radiological diagnosis was 17.5 years (range, 4.8 to 29.5). Estimated median survival was 17.4 years (95% CI: 12; NR). After a long-term follow-up, substantial neurotoxicity was noticed with dementia in six progression-free patients (30%), leading to ventriculo-peritoneal shunt procedures in three, and premature death in five. Thirteen patients (65%) were unable to work with disability status. Successive longitudinal neurocognitive assessments for living patients showed verbal episodic memory deterioration.ConclusionsPCV-RT combination seems to have not only an oncological synergy but also a long-term neurotoxic synergy to consider before initial therapeutic decision.
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Affiliation(s)
- Marie Blonski
- Department of Neurology, Neurooncology Unit, CHRU, Nancy, France
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
- *Correspondence: Marie Blonski,
| | - Tiphaine Obara
- Department of Neurology, Neurooncology Unit, CHRU, Nancy, France
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
| | - Cyril Brzenczek
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
| | - Celso Pouget
- Department of Pathology, CHRU, Nancy, France
- Centre de ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | - Céline Dillier
- Department of Neurology, Neurooncology Unit, CHRU, Nancy, France
| | - Mylène Meyer
- Department of Neurology, Neurooncology Unit, CHRU, Nancy, France
| | - Laura Lavigne
- Department of Neurology, Neurooncology Unit, CHRU, Nancy, France
| | | | | | - Guillaume Gauchotte
- Department of Pathology, CHRU, Nancy, France
- Centre de ressources Biologiques, BB-0033-00035, CHRU, Nancy, France
| | | | - Fabien Rech
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
- Department of Neurosurgery, CHRU, Nancy, France
| | - Sophie Mézières
- Department of Mathematics, Elie Cartan Institute, Nancy, France
- INRIA Biology, Genetics and Statistics, Nancy, France
| | - Yann Gaudeau
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU, Nancy, France
- IADI, INSERM U1254, Université de Lorraine, Vandoeuvre-lès Nancy, France
| | - Guillaume Vogin
- Department of Radiation Therapy, Baclesse Radiation Therapy Center, Esch/Alzette, Luxembourg
- UMR 7635 CNRS, IMoPA Biopole Lorraine University Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - Jean-Marie Moureaux
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
| | - Luc Taillandier
- Department of Neurology, Neurooncology Unit, CHRU, Nancy, France
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès Nancy, France
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Jo J, van den Bent MJ, Nabors B, Wen PY, Schiff D. Surveillance imaging frequency in adult patients with lower-grade (WHO Grade 2 and 3) gliomas. Neuro Oncol 2022; 24:1035-1047. [PMID: 35137214 PMCID: PMC9248400 DOI: 10.1093/neuonc/noac031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
With improved outcome following aggressive treatment in patients with grade 2 and 3 IDH-mutant (IDHmt), 1p/19q codeleted oligodendroglioma and IDHmt, non-codeleted astrocytoma, prolonged surveillance is desirable for early detection of tumor growth and malignant transformation. Current National Comprehensive Cancer Network (NCCN) guidelines provide imaging follow-up recommendations based on molecular classification of lower-grade gliomas, although individualized imaging guidelines based on treatments received and after tumor recurrence are not clearly specified. Other available guidelines have yet to incorporate the molecular biomarkers that inform the WHO classification of gliomas, and in some cases do not adequately consider current knowledge on IDHmt glioma growth rate and recurrence patterns. Moreover, these guidelines also do not provide specific recommendations for concerning clinical symptoms or radiographic findings warranting imaging studies out of prespecified intervals. Focusing on molecularly defined grade 2 and 3 IDHmt astrocytomas and oligodendrogliomas, we review current knowledge of tumor growth rates and time to tumor progression for each tumor type and propose a range of recommended MRI surveillance intervals for both the newly diagnosed and recurrent tumor setting. Additionally, we summarize situations in which imaging is advisable outside of these intervals.
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Affiliation(s)
- Jasmin Jo
- Department of Internal Medicine, Division of Hematology and Oncology, East Carolina University, Greenville, North Carolina, USA
| | - Martin J van den Bent
- Department of Neuro-Oncology/Neurology, Erasmus MC Cancer Institute, Erasmus MC University Medical Center, Rotterdam, Netherland
| | - Burt Nabors
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women’s Cancer Center; Division of Neuro-Oncology, Department of Neurology, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - David Schiff
- Corresponding Author: David Schiff, MD, University of Virginia Neuro-Oncology Center, Box 800432 Charlottesville, VA 22908-0432, USA ()
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15
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Li G, Li L, Li Y, Qian Z, Wu F, He Y, Jiang H, Li R, Wang D, Zhai Y, Wang Z, Jiang T, Zhang J, Zhang W. An MRI radiomics approach to predict survival and tumour-infiltrating macrophages in gliomas. Brain 2022; 145:1151-1161. [PMID: 35136934 PMCID: PMC9050568 DOI: 10.1093/brain/awab340] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/15/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023] Open
Abstract
Preoperative MRI is one of the most important clinical results for the diagnosis and treatment of glioma patients. The objective of this study was to construct a stable and validatable preoperative T2-weighted MRI-based radiomics model for predicting the survival of gliomas. A total of 652 glioma patients across three independent cohorts were covered in this study including their preoperative T2-weighted MRI images, RNA-seq and clinical data. Radiomic features (1731) were extracted from preoperative T2-weighted MRI images of 167 gliomas (discovery cohort) collected from Beijing Tiantan Hospital and then used to develop a radiomics prediction model through a machine learning-based method. The performance of the radiomics prediction model was validated in two independent cohorts including 261 gliomas from the The Cancer Genomae Atlas database (external validation cohort) and 224 gliomas collected in the prospective study from Beijing Tiantan Hospital (prospective validation cohort). RNA-seq data of gliomas from discovery and external validation cohorts were applied to establish the relationship between biological function and the key radiomics features, which were further validated by single-cell sequencing and immunohistochemical staining. The 14 radiomic features-based prediction model was constructed from preoperative T2-weighted MRI images in the discovery cohort, and showed highly robust predictive power for overall survival of gliomas in external and prospective validation cohorts. The radiomic features in the prediction model were associated with immune response, especially tumour macrophage infiltration. The preoperative T2-weighted MRI radiomics prediction model can stably predict the survival of glioma patients and assist in preoperatively assessing the extent of macrophage infiltration in glioma tumours.
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Affiliation(s)
- Guanzhang Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Lin Li
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zenghui Qian
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Fan Wu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Yufei He
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Haoyu Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Renpeng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Di Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - You Zhai
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
| | - Zhiliang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.,Chinese Glioma Genome Atlas Network and Asian Glioma Genome Atlas Network, Beijing, China
| | - Jing Zhang
- Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Engineering Medicine, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100083, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.,Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China.,China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.,Chinese Glioma Genome Atlas Network and Asian Glioma Genome Atlas Network, Beijing, China
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16
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Hou Z, Zhang K, Liu X, Fang S, Li L, Wang Y, Jiang T. Molecular subtype impacts surgical resection in low-grade gliomas: A Chinese Glioma Genome Atlas database analysis. Cancer Lett 2021; 522:14-21. [PMID: 34517083 DOI: 10.1016/j.canlet.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/29/2021] [Accepted: 09/06/2021] [Indexed: 10/20/2022]
Abstract
Surgeons have considered extending the resection margins for better outcomes in gliomas, but have not considered molecular pathology. We investigated the impact of molecular pathology on the surgical benefit in gliomas. Herein, we collected the clinical and pathological information of 449 patients with glioma from the Chinese Glioma Genome Atlas database, and enrolled those who underwent surgical resection. We measured the impact of the extent of resection on survival time in subgroups classified by clinical characteristics. We found that gross total resection (GTR) was associated with longer survival times in the entire cohort, and each of the three molecular subtypes. Even after age stratification, there was no survival benefit from GTR in those with a Karnofsky performance score (KPS) ≤ 80. In patients aged >45 years with a KPS >80, extensive resection resulted in longer survival times in isocitrate dehydrogenase-mutated astrocytomas. Additionally, GTR was associated with longer overall survival times in patients aged ≤45 years with a KPS >80. In conclusion, extensive resection does not always prolong survival in patients with glioma. Along with clinical characteristics, molecular pathology positively impacts survival in gliomas. Neurosurgeons may consider our findings when planning surgery in the future.
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Affiliation(s)
- Ziming Hou
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kenan Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xing Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shengyu Fang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Lianwang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yinyan Wang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Chinese Institute for Brain Research, Beijing, China.
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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17
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Kha QH, Le VH, Hung TNK, Le NQK. Development and Validation of an Efficient MRI Radiomics Signature for Improving the Predictive Performance of 1p/19q Co-Deletion in Lower-Grade Gliomas. Cancers (Basel) 2021; 13:cancers13215398. [PMID: 34771562 PMCID: PMC8582370 DOI: 10.3390/cancers13215398] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022] Open
Abstract
Simple Summary Low-grade gliomas (LGG) with the 1p/19q co-deletion mutation have been proven to have a better survival prognosis and response to treatment than individuals without the mutation. Identifying this mutation has a vital role in managing LGG patients; however, the current diagnostic gold standard, including the brain-tissue biopsy or the surgical resection of the tumor, remains highly invasive and time-consuming. We proposed a model based on the eXtreme Gradient Boosting (XGBoost) classifier to detect 1p/19q co-deletion mutation using non-invasive medical images. The performance of our model achieved 87% and 82.8% accuracy on the training and external test set, respectively. Significantly, the prediction was based on only seven optimal wavelet radiomics features extracted from brain Magnetic Resonance (MR) images. We believe that this model can address clinicians in the rapid diagnosis of clinical 1p/19q co-deletion mutation, thereby improving the treatment prognosis of LGG patients. Abstract The prognosis and treatment plans for patients diagnosed with low-grade gliomas (LGGs) may significantly be improved if there is evidence of chromosome 1p/19q co-deletion mutation. Many studies proved that the codeletion status of 1p/19q enhances the sensitivity of the tumor to different types of therapeutics. However, the current clinical gold standard of detecting this chromosomal mutation remains invasive and poses implicit risks to patients. Radiomics features derived from medical images have been used as a new approach for non-invasive diagnosis and clinical decisions. This study proposed an eXtreme Gradient Boosting (XGBoost)-based model to predict the 1p/19q codeletion status in a binary classification task. We trained our model on the public database extracted from The Cancer Imaging Archive (TCIA), including 159 LGG patients with 1p/19q co-deletion mutation status. The XGBoost was the baseline algorithm, and we combined the SHapley Additive exPlanations (SHAP) analysis to select the seven most optimal radiomics features to build the final predictive model. Our final model achieved an accuracy of 87% and 82.8% on the training set and external test set, respectively. With seven wavelet radiomics features, our XGBoost-based model can identify the 1p/19q codeletion status in LGG-diagnosed patients for better management and address the drawbacks of invasive gold-standard tests in clinical practice.
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Affiliation(s)
- Quang-Hien Kha
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (Q.-H.K.); (V.-H.L.); (T.N.K.H.)
| | - Viet-Huan Le
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (Q.-H.K.); (V.-H.L.); (T.N.K.H.)
- Department of Thoracic Surgery, Khanh Hoa General Hospital, Nha Trang City 65000, Vietnam
| | - Truong Nguyen Khanh Hung
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (Q.-H.K.); (V.-H.L.); (T.N.K.H.)
- Department of Orthopedic and Trauma, Cho Ray Hospital, Ho Chi Minh City 70000, Vietnam
| | - Nguyen Quoc Khanh Le
- International Master/Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan; (Q.-H.K.); (V.-H.L.); (T.N.K.H.)
- Professional Master Program in Artificial Intelligence in Medicine, College of Medicine, Taipei Medical University, Taipei 106, Taiwan
- Research Center for Artificial Intelligence in Medicine, Taipei Medical University, Taipei 106, Taiwan
- Translational Imaging Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
- Correspondence: ; Tel.: +886-02-663-82736-1992
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Optimal Combinations of Chemotherapy and Radiotherapy in Low-Grade Gliomas: A Mathematical Approach. J Pers Med 2021; 11:jpm11101036. [PMID: 34683177 PMCID: PMC8537400 DOI: 10.3390/jpm11101036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 12/16/2022] Open
Abstract
Low-grade gliomas (LGGs) are brain tumors characterized by their slow growth and infiltrative nature. Treatment options for these tumors are surgery, radiation therapy and chemotherapy. The optimal use of radiation therapy and chemotherapy is still under study. In this paper, we construct a mathematical model of LGG response to combinations of chemotherapy, specifically to the alkylating agent temozolomide and radiation therapy. Patient-specific parameters were obtained from longitudinal imaging data of the response of real LGG patients. Computer simulations showed that concurrent cycles of radiation therapy and temozolomide could provide the best therapeutic efficacy in-silico for the patients included in the study. The patient cohort was extended computationally to a set of 3000 virtual patients. This virtual cohort was subject to an in-silico trial in which matching the doses of radiotherapy to those of temozolomide in the first five days of each cycle improved overall survival over concomitant radio-chemotherapy according to RTOG 0424. Thus, the proposed treatment schedule could be investigated in a clinical setting to improve combination treatments in LGGs with substantial survival benefits.
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Adenis L, Plaszczynski S, Grammaticos B, Pallud J, Badoual M. The Effect of Radiotherapy on Diffuse Low-Grade Gliomas Evolution: Confronting Theory with Clinical Data. J Pers Med 2021; 11:jpm11080818. [PMID: 34442462 PMCID: PMC8401413 DOI: 10.3390/jpm11080818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
Diffuse low-grade gliomas are slowly growing tumors that always recur after treatment. In this paper, we revisit the modeling of the evolution of the tumor radius before and after the radiotherapy process and propose a novel model that is simple yet biologically motivated and that remedies some shortcomings of previously proposed ones. We confront this with clinical data consisting of time series of tumor radii from 43 patient records by using a stochastic optimization technique and obtain very good fits in all cases. Since our model describes the evolution of a tumor from the very first glioma cell, it gives access to the possible age of the tumor. Using the technique of profile likelihood to extract all of the information from the data, we build confidence intervals for the tumor birth age and confirm the fact that low-grade gliomas seem to appear in the late teenage years. Moreover, an approximate analytical expression of the temporal evolution of the tumor radius allows us to explain the correlations observed in the data.
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Affiliation(s)
- Léo Adenis
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
| | - Stéphane Plaszczynski
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
- Correspondence:
| | - Basile Grammaticos
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris, Sainte-Anne Hospital, 75014 Paris, France;
- Université de Paris, Sorbonne Paris Cité, 75014 Paris, France
- Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, 75014 Paris, France
| | - Mathilde Badoual
- CNRS/IN2P3, IJCLab, Université Paris-Saclay, 91405 Orsay, France; (L.A.); (B.G.); (M.B.)
- IJCLab, Université de Paris, 91405 Orsay, France
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20
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From Laboratory Studies to Clinical Trials: Temozolomide Use in IDH-Mutant Gliomas. Cells 2021; 10:cells10051225. [PMID: 34067729 PMCID: PMC8157002 DOI: 10.3390/cells10051225] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/07/2021] [Accepted: 05/07/2021] [Indexed: 12/11/2022] Open
Abstract
In this review, we discuss the use of the alkylating agent temozolomide (TMZ) in the treatment of IDH-mutant gliomas. We describe the challenges associated with TMZ in clinical (drug resistance and tumor recurrence) and preclinical settings (variabilities associated with in vitro models) in treating IDH-mutant glioma. Lastly, we summarize the emerging therapeutic targets that can potentially be used in combination with TMZ.
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21
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Roux A, Tauziede-Espariat A, Zanello M, Peeters S, Zah-Bi G, Parraga E, Edjlali M, Lechapt E, Shor N, Bellu L, Berzero G, Dormont D, Dezamis E, Chretien F, Oppenheim C, Sanson M, Varlet P, Capelle L, Dhermain F, Pallud J. Imaging growth as a predictor of grade of malignancy and aggressiveness of IDH-mutant and 1p/19q-codeleted oligodendrogliomas in adults. Neuro Oncol 2021; 22:993-1005. [PMID: 32025725 DOI: 10.1093/neuonc/noaa022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND We quantified the spontaneous imaging growth rate of oligodendrogliomas. We assessed whether (i) it discriminates between World Health Organization (WHO) grade II and grade III oligodendrogliomas, and (ii) grade III oligodendrogliomas with neo-angiogenesis are associated with more fast growth rates (≥8 mm/y). METHODS This work employed a retrospective bicentric cohort study (2010-2016) of adult patients harboring a newly diagnosed supratentorial oligodendroglioma, isocitrate dehydrogenase (IDH) mutant and 1p/19q codeleted (WHO 2016 classification), with a minimum of 2 available MRIs before any treatment (minimum 6-week interval) to measure the spontaneous tumor growth rate. RESULTS We included 108 patients (age 44.7 ± 14.1 y, 60 males). The tumor growth rate was higher in grade III oligodendrogliomas with neo-angiogenesis (n = 37, median 10.4 mm/y, mean 10.0 ± 6.9) than in grade III oligodendrogliomas with increased mitosis count only (cutoff ≥6 mitoses, n = 18, median 3.9 mm/y, mean 4.5 ± 3.2; P = 0.004), and higher than in grade II oligodendrogliomas (n = 53, median 2.3 mm/y, mean 2.8 ± 2.2; P < 0.001). There was increased prevalence of fast tumor growth rates in grade III oligodendrogliomas with neo-angiogenesis (54.1%) compared with grade III oligodendrogliomas with increased mitosis count only (11.1%; P < 0.001), and in grade II oligodendrogliomas (0.0%; P < 0.001). The tumor growth rate trends did not differ between centers (P = 0.121). Neo-angiogenesis (P < 0.001) and mitosis count at ≥9 (P = 0.013) were independently associated with tumor growth rates ≥8 mm/year. A tumor growth rate ≥8 mm/year was the only predictor independently associated with shorter progression-free survival (P = 0.041). CONCLUSIONS The spontaneous tumor growth rate recapitulates oligodendroglioma aggressiveness, permits identification of grade III oligodendrogliomas preoperatively when ≥8 mm/year, and questions the grading by mitosis count.
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Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Arnault Tauziede-Espariat
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU-Sainte-Anne Hospital, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Gilles Zah-Bi
- Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Eduardo Parraga
- Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Myriam Edjlali
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuroradiology, GHU-Sainte-Anne Hospital, Paris, France
| | - Emmanuèle Lechapt
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU-Sainte-Anne Hospital, Paris, France
| | - Natalia Shor
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Luisa Bellu
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - Giulia Berzero
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - Didier Dormont
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Fabrice Chretien
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU-Sainte-Anne Hospital, Paris, France
- Laboratory of Experimental Neuropathology, Pasteur Institute, Paris, France
| | - Catherine Oppenheim
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuroradiology, GHU-Sainte-Anne Hospital, Paris, France
| | - Marc Sanson
- Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU-Sainte-Anne Hospital, Paris, France
| | - Laurent Capelle
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Johan Pallud
- Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France
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22
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Dono A, Ballester LY, Primdahl D, Esquenazi Y, Bhatia A. IDH-Mutant Low-grade Glioma: Advances in Molecular Diagnosis, Management, and Future Directions. Curr Oncol Rep 2021; 23:20. [PMID: 33492489 DOI: 10.1007/s11912-020-01006-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW IDH-mutant low-grade gliomas (LGG) have emerged as a distinct clinical and molecular entity with unique treatment considerations. Here, we review updates in IDH-mutant LGG diagnosis and classification, imaging biomarkers, therapies, and neurocognitive and patient-reported outcomes. RECENT FINDINGS CDKN2A/B homozygous deletion in IDH-mutant astrocytoma is associated with shorter survival, similar to WHO grade 4. The T2-FLAIR mismatch, a highly specific but insensitive sign, is diagnostic of IDH-mutant astrocytoma. Maximal safe resection is currently indicated in all LGG cases. Radiotherapy with subsequent PCV (procarbazine, lomustine, vincristine) provides longer overall survival compared to radiotherapy alone. Temozolomide in place of PCV is reasonable, but high-level evidence is still lacking. LGG adjuvant treatment has important quality of life and neurocognitive side effects that should be considered. Although incurable, IDH-mutant LGG have a favorable survival compared to IDH-WT glioma. Recent advances in molecular-based classification, imaging, and targeted therapies will hopefully improve survival and quality of life.
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Affiliation(s)
- Antonio Dono
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center, 6431 Fannin Street, MSB 3.000, Houston, TX, 77030, USA.,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA
| | - Leomar Y Ballester
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center, 6431 Fannin Street, MSB 3.000, Houston, TX, 77030, USA.,Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center, 6431 Fannin St., MSB 2.136, Houston, TX, 77030, USA.,Memorial Hermann Health System, Houston, TX, USA
| | - Ditte Primdahl
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, USA
| | - Yoshua Esquenazi
- Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center, 6431 Fannin Street, MSB 3.000, Houston, TX, 77030, USA.,Memorial Hermann Health System, Houston, TX, USA.,Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA
| | - Ankush Bhatia
- Memorial Hermann Health System, Houston, TX, USA. .,Department of Neurology, The University of Texas Health Science Center at Houston - McGovern Medical School, 6410 Fannin Street, Suite # 1014, Houston, TX, 77030, USA.
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23
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Is chemotherapy alone an option as initial treatment for low-grade oligodendrogliomas? Curr Opin Neurol 2020; 33:707-715. [DOI: 10.1097/wco.0000000000000866] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Darlix A, Rigau V, Duffau H. Neoformazioni intracraniche: gliomi di grado II. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44227-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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25
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Pallud J. Early and maximal safe functional-based resection improves both survival and seizure control in adult diffuse low-grade glioma patients. Neurooncol Pract 2020; 7:576-577. [DOI: 10.1093/nop/npaa027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Inserm, U1266, IMA-Brain, Centre Psychiatrie et Neurosciences, Paris, France
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26
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Schiff D, Van den Bent M, Vogelbaum MA, Wick W, Miller CR, Taphoorn M, Pope W, Brown PD, Platten M, Jalali R, Armstrong T, Wen PY. Recent developments and future directions in adult lower-grade gliomas: Society for Neuro-Oncology (SNO) and European Association of Neuro-Oncology (EANO) consensus. Neuro Oncol 2020; 21:837-853. [PMID: 30753579 DOI: 10.1093/neuonc/noz033] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The finding that most grades II and III gliomas harbor isocitrate dehydrogenase (IDH) mutations conveying a relatively favorable and fairly similar prognosis in both tumor grades highlights that these tumors represent a fundamentally different entity from IDH wild-type gliomas exemplified in most glioblastoma. Herein we review the most recent developments in molecular neuropathology leading to reclassification of these tumors based upon IDH and 1p/19q status, as well as the potential roles of methylation profiling and deletional analysis of cyclin-dependent kinase inhibitor 2A and 2B. We discuss the epidemiology, clinical manifestations, benefit of surgical resection, and neuroimaging features of lower-grade gliomas as they relate to molecular subtype, including advanced imaging techniques such as 2-hydroxyglutarate magnetic resonance spectroscopy and amino acid PET scanning. Recent, ongoing, and planned studies of radiation therapy and both cytotoxic and targeted chemotherapies are summarized, including both small molecule and immunotherapy approaches specifically targeting the mutant IDH protein.
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Affiliation(s)
- David Schiff
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Martin Van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Wolfgang Wick
- Divison of Neuro-Oncology, German Cancer Research Center, Heidelberg, Germany
| | - C Ryan Miller
- Pathology and Lab Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Martin Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Whitney Pope
- Section of Neuroradiology, UCLA, Los Angeles, California
| | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael Platten
- Department of Neurology, Mannheim University Hospital, Mannheim, Germany
| | | | - Terri Armstrong
- Neuro-Oncology Branch, National Institute of Health, Bethesda, Maryland
| | - Patrick Y Wen
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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27
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Fogh SE, Boreta L, Nakamura JL, Johnson DR, Chi AS, Kurz SC. Neuro-Oncology Practice Clinical Debate: Early treatment or observation for patients with newly diagnosed oligodendroglioma and small-volume residual disease. Neurooncol Pract 2020; 8:11-17. [PMID: 33664965 DOI: 10.1093/nop/npaa037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Advances in treatment of oligodendroglioma represent arguably the most significant recent development in the treatment of brain tumors, with multiple clinical trials demonstrating that median survival is approximately doubled in patients with World Health Organization grade II and III 1p/19q codeleted gliomas (ie, oligodendrogliomas) treated with procarbazine, lomustine, vincristine chemotherapy and radiation vs radiation alone. However, chemoradiotherapy itself is not without morbidity, including both short-term toxicities primarily related to chemotherapy and longer-term cognitive issues likely due to radiation. Patients and physicians both desire maximally effective therapy with minimal toxicity, and it remains unclear whether some patients with macroscopic residual disease after surgery can safely delay therapy, to avoid or delay toxicity, while simultaneously preserving the full benefits of treatment. In this article, experts in the field discuss the rationale for the approaches of up-front treatment with chemoradiotherapy and initial observation, respectively.
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Affiliation(s)
- Shannon E Fogh
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Lauren Boreta
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Jean L Nakamura
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | | | | | - Sylvia C Kurz
- Department of Hematology and Medical Oncology, New York University, New York, NY, USA
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28
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Association of tumor growth rates with molecular biomarker status: a longitudinal study of high-grade glioma. Aging (Albany NY) 2020; 12:7908-7926. [PMID: 32388499 PMCID: PMC7244074 DOI: 10.18632/aging.103110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/31/2020] [Indexed: 12/15/2022]
Abstract
To determine the association of molecular biomarkers with tumor growth in patients with high-grade gliomas (HGGs), the tumor growth rates and molecular biomarker status in 109 patients with HGGs were evaluated. Mean tumor diameter was assessed on at least two pre-surgical T2-weighted and contrast-enhancement T1-weighted magnetic resonance images (MRIs). Tumor growth rates were calculated based on tumor volume and diameter using various methods. The association of biomarkers with increased or decreased tumor growth was calculated using linear mixed-effects models. HGGs exhibited rapid growth rates, with an equivalent volume doubling time of 63.4 days and an equivalent velocity of diameter expansion of 51.6 mm/year. The WHO grade was an independent clinical factor of eVDEs. TERT promoter mutation C250T and MGMT promoter methylation was significantly associated with tumor growth in univariable analysis but not in multivariable analysis. Molecular groups of IDH1, TERT, and 1p/19q and IDH1 and MGMT were independently associated with tumor growth. In addition, tumor enhanced area had a faster growth rate than a tumor entity in incomplete enhanced HGGs (p = 0.006). Our findings provide crucial information for the prediction of preoperative tumor growth in HGGs, and aided in the decision making for aggressive resection and adjuvant treatment strategies.
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29
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Dimou J, Kelly J. The biological and clinical basis for early referral of low grade glioma patients to a surgical neuro-oncologist. J Clin Neurosci 2020; 78:20-29. [PMID: 32381393 DOI: 10.1016/j.jocn.2020.04.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 03/24/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022]
Abstract
The discovery of IDH1/2 (isocitrate dehydrogenase) mutation in large scale, genomewide mutational analyses of gliomas has led to profound developments in understanding tumourigenesis, and restructuring of the classification of both high and low grade gliomas. Owing to this progress made in the recognition of molecular markers which predict tumour behavior and treatment response, the increasing importance of adjuvant treatments such as chemo- and radiotherapy, and the tremendous advances in surgical technique and intraoperative monitoring which have facilitated superior extents of resection whilst preserving neurological functioning and quality of life, contemporary management of low grade glioma (LGG) has switched from a passive, observant approach to a more active, interventional one. Furthermore, this has implications for the manner in which patients with incidentally discovered and/or asymptomatic LGG are managed, and this review of the biological behaviour of LGG, as well as its clinical investigation and management, should act as a timely reminder to all clinicians of the importance of referring LGG patients early to a surgical neuro-oncologist who is not only familiar and acquainted with the vagaries of this disease process, but who, in addition, is devoted to delivering care to these patients with the support of a multi-disciplinary clinical decision-making unit, comprising medical neuro-oncologists, radiation oncologists and allied health professionals.
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Affiliation(s)
- James Dimou
- Department of Neurosurgery, University of Calgary, Alberta, Canada.
| | - John Kelly
- Department of Neurosurgery, University of Calgary, Alberta, Canada
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30
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Zhang S, William C. Educational Case: Histologic and Molecular Features of Diffuse Gliomas. Acad Pathol 2020; 7:2374289520914021. [PMID: 32284966 PMCID: PMC7133074 DOI: 10.1177/2374289520914021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 01/13/2020] [Accepted: 02/22/2020] [Indexed: 11/23/2022] Open
Abstract
The following fictional cases are intended as a learning tool within the Pathology Competencies for Medical Education (PCME), a set of national standards for teaching pathology. These are divided into three basic competencies: Disease Mechanisms and Processes, Organ System Pathology, and Diagnostic Medicine and Therapeutic Pathology. For additional information, and a full list of learning objectives for all three competencies, seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Sarah Zhang
- NYU Langone Medical Center, New York, NY, USA
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31
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Liu Q, Wang K, Huang R, Tong X, Jiang T, Wang J, Yang P. A novel DNA damage response signature of IDH-mutant grade II and grade III astrocytoma at transcriptional level. J Cancer Res Clin Oncol 2020; 146:579-591. [PMID: 32060643 DOI: 10.1007/s00432-020-03132-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/11/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The WHO classification for IDH-mutant grade II and grade III astrocytoma may not be as prognostically meaningful as expected. We aimed to develop a novel classification system based on the DNA damage response signature. METHODS We developed the gene signature of DNA damage response with 115 samples from The Cancer Genome Atlas (TCGA) database. The dataset from Chinese Glioma Genome Atlas (CGGA) database with 41 samples was used as the validation set. Lasso Cox regression model was applied for selection of the best signature. Gene set enrichment analysis (GSEA) and gene ontology (GO) analysis were implemented to reveal its biological phenotype. RESULTS A two-gene DNA damage response signature (RAD18, MSH2) was developed using the lasso Cox regression model based on the TCGA dataset. Its prognostic efficiency was validated in the CGGA cohort. The result of Cox regression analysis showed that the signature has a better predictive accuracy than the WHO grade. The risk score was an independent prognostic factor for the overall survival of the IDH-mutant grade II and grade III astrocytoma. GSEA and GO analysis confirmed enhanced processes related to DNA damage response in high-risk group. CONCLUSION We developed a two-gene signature which can effectively predict the prognosis of patients with IDH-mutant grade II and grade III astrocytoma. It suggests a novel classification of astrocytoma with better prognostic accuracy based on the expression of DNA damage response genes.
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Affiliation(s)
- Qi Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kuanyu Wang
- Gamma Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruoyu Huang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xuezhi Tong
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jiangfei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Pei Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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32
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Belciug S. Oncologist at work. Artif Intell Cancer 2020. [DOI: 10.1016/b978-0-12-820201-2.00005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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33
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Choi S, Yu Y, Grimmer MR, Wahl M, Chang SM, Costello JF. Temozolomide-associated hypermutation in gliomas. Neuro Oncol 2019; 20:1300-1309. [PMID: 29452419 DOI: 10.1093/neuonc/noy016] [Citation(s) in RCA: 118] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Low-grade gliomas cause considerable morbidity and most will recur after initial therapy. At recurrence, low-grade gliomas can undergo transformation to high-grade gliomas (grade III or grade IV), which are associated with worse prognosis. Temozolomide (TMZ) provides survival benefit in patients with glioblastomas, but its value in patients with low-grade gliomas is less clear. A subset of TMZ-treated, isocitrate dehydrogenase‒mutant, low-grade astrocytomas recur as more malignant tumors with thousands of de novo, coding mutations bearing a signature of TMZ-induced hypermutation. Preliminary studies raise the hypothesis that TMZ-induced hypermutation may contribute to malignant transformation, although with highly variable latency. On the other hand, hypermutated gliomas have radically altered genomes that present new opportunities for therapeutic intervention. In light of these findings and the immunotherapy clinical trials they inspired, how do patients and providers approach the risks and benefits of TMZ therapy? This review discusses what is known about the mechanisms and consequences of TMZ-induced hypermutation and outstanding questions regarding its clinical significance.
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Affiliation(s)
- Serah Choi
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Yao Yu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Matthew R Grimmer
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Michael Wahl
- Samaritan Pastega Regional Cancer Center, Corvallis, Oregon
| | - Susan M Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
| | - Joseph F Costello
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California
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34
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van der Voort SR, Incekara F, Wijnenga MM, Kapas G, Gardeniers M, Schouten JW, Starmans MP, Nandoe Tewarie R, Lycklama GJ, French PJ, Dubbink HJ, van den Bent MJ, Vincent AJ, Niessen WJ, Klein S, Smits M. Predicting the 1p/19q Codeletion Status of Presumed Low-Grade Glioma with an Externally Validated Machine Learning Algorithm. Clin Cancer Res 2019; 25:7455-7462. [DOI: 10.1158/1078-0432.ccr-19-1127] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/12/2019] [Accepted: 09/06/2019] [Indexed: 11/16/2022]
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35
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Pérez-García VM, Ayala-Hernández LE, Belmonte-Beitia J, Schucht P, Murek M, Raabe A, Sepúlveda J. Computational design of improved standardized chemotherapy protocols for grade II oligodendrogliomas. PLoS Comput Biol 2019; 15:e1006778. [PMID: 31306418 PMCID: PMC6629055 DOI: 10.1371/journal.pcbi.1006778] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 06/24/2019] [Indexed: 11/18/2022] Open
Abstract
Here we put forward a mathematical model describing the response of low-grade (WHO grade II) oligodendrogliomas (LGO) to temozolomide (TMZ). The model describes the longitudinal volumetric dynamics of tumor response to TMZ of a cohort of 11 LGO patients treated with TMZ. After finding patient-specific parameters, different therapeutic strategies were tried computationally on the 'in-silico twins' of those patients. Chemotherapy schedules with larger-than-standard rest periods between consecutive cycles had either the same or better long-term efficacy than the standard 28-day cycles. The results were confirmed in a large trial of 2000 virtual patients. These long-cycle schemes would also have reduced toxicity and defer the appearance of resistances. On the basis of those results, a combination scheme consisting of five induction TMZ cycles given monthly plus 12 maintenance cycles given every three months was found to provide substantial survival benefits for the in-silico twins of the 11 LGO patients (median 5.69 years, range: 0.67 to 68.45 years) and in a large virtual trial including 2000 patients. We used 220 sets of experiments in-silico to show that a clinical trial incorporating 100 patients per arm (standard intensive treatment versus 5 + 12 scheme) could demonstrate the superiority of the novel scheme after a follow-up period of 10 years. Thus, the proposed treatment plan could be the basis for a standardized TMZ treatment for LGO patients with survival benefits.
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Affiliation(s)
- Víctor M. Pérez-García
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Avda. Camilo José Cela, 3, 13071 Ciudad Real, Spain
| | - Luis E. Ayala-Hernández
- Departamento de Ciencias Exactas y Tecnología Centro Universitario de los Lagos, Universidad de Guadalajara, Lagos de Moreno, Mexico
| | - Juan Belmonte-Beitia
- Department of Mathematics, Mathematical Oncology Laboratory (MOLAB), Universidad de Castilla-La Mancha, Avda. Camilo José Cela, 3, 13071 Ciudad Real, Spain
| | - Philippe Schucht
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Michael Murek
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Andreas Raabe
- Universitätsklinik für Neurochirurgie, Bern University Hospital, CH-3010 Bern, Switzerland
| | - Juan Sepúlveda
- Oncology Unit, Hospital 12 de Octubre, Avda. de Córdoba s/n, 28041 Madrid, Spain
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36
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Darlix A, Mandonnet E, Freyschlag CF, Pinggera D, Forster MT, Voss M, Steinbach J, Loughrey C, Goodden J, Banna G, Di Blasi C, Foroglou N, Hottinger AF, Baron MH, Pallud J, Duffau H, Rutten GJ, Almairac F, Fontaine D, Taillandier L, Pessanha Viegas C, Albuquerque L, von Campe G, Urbanic-Purkart T, Blonski M. Chemotherapy and diffuse low-grade gliomas: a survey within the European Low-Grade Glioma Network. Neurooncol Pract 2019; 6:264-273. [PMID: 31386080 PMCID: PMC6660823 DOI: 10.1093/nop/npy051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Diffuse low-grade gliomas (DLGGs) are rare and incurable tumors. Whereas maximal safe, functional-based surgical resection is the first-line treatment, the timing and choice of further treatments (chemotherapy, radiation therapy, or combined treatments) remain controversial. METHODS An online survey on the management of DLGG patients was sent to 28 expert centers from the European Low-Grade Glioma Network (ELGGN) in May 2015. It contained 40 specific questions addressing the modalities of use of chemotherapy in these patients. RESULTS The survey demonstrated a significant heterogeneity in practice regarding the initial management of DLGG patients and the use of chemotherapy. Interestingly, radiation therapy combined with the procarbazine, CCNU (lomustine), and vincristine regimen has not imposed itself as the gold-standard treatment after surgery, despite the results of the Radiation Therapy Oncology Group 9802 study. Temozolomide is largely used as first-line treatment after surgical resection for high-risk DLGG patients, or at progression. CONCLUSIONS The heterogeneity in the management of patients with DLGG demonstrates that many questions regarding the postoperative strategy and the use of chemotherapy remain unanswered. Our survey reveals a high recruitment potential within the ELGGN for retrospective or prospective studies to generate new data regarding these issues.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut du Cancer de Montpellier, University of Montpellier, France
| | | | | | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Austria
| | | | - Martin Voss
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | - Joachim Steinbach
- Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Frankfurt, Germany
| | | | - John Goodden
- Leeds General Infirmary and North East Paediatric Neuroscience Network, Leeds, United Kingdom
| | - Giuseppe Banna
- Department of Neurosurgery and Gammaknife, Cannizzaro General Hospital, Catania, Italy
| | - Concetta Di Blasi
- Department of Neurosurgery and Gammaknife, Cannizzaro General Hospital, Catania, Italy
| | - Nicolas Foroglou
- Aristotle University of Thessaloniki, Department of Neurosurgery, AHEPA University Hospital, Greece
| | - Andreas F Hottinger
- Departments of Clinical Neurosciences and Oncology, Centre Hospitalier Universitaire Vaudois and Lausanne University, Switzerland
| | | | - Johan Pallud
- Department of Neurosurgery, Sainte-Anne Hospital, Paris, France, and Paris Descartes University, Sorbonne Paris Cité, France
| | - Hugues Duffau
- Inserm, U894, IMA-Brain, Centre de Psychiatrie et Neurosciences, Paris, France
- Department of Neurosurgery, Montpellier University Hospital, France
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands
| | - Fabien Almairac
- Department of Neurosurgery, University Hospital of Nice, France
| | - Denys Fontaine
- Department of Neurosurgery, University Hospital of Nice, France
| | - Luc Taillandier
- Department of Neurooncology, Nancy Neurological Hospital, France
| | | | | | - Gord von Campe
- Department of Neurosurgery, Medical University of Graz, Austria
| | | | - Marie Blonski
- Department of Neurooncology, Nancy Neurological Hospital, France
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Smits A, Jakola AS. Clinical Presentation, Natural History, and Prognosis of Diffuse Low-Grade Gliomas. Neurosurg Clin N Am 2019; 30:35-42. [DOI: 10.1016/j.nec.2018.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Jooma R, Waqas M, Khan I. Diffuse Low-Grade Glioma - Changing Concepts in Diagnosis and Management: A Review. Asian J Neurosurg 2019; 14:356-363. [PMID: 31143247 PMCID: PMC6516028 DOI: 10.4103/ajns.ajns_24_18] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Though diffuse low-grade gliomas (dLGGs) represent only 15% of gliomas, they have been receiving increasing attention in the past decade. Significant advances in knowledge of the natural history and clinical diversity have been documented, and an improved pathological classification of gliomas that integrates histological features with molecular markers has been issued by the WHO. Advances in the radiological assessment of dLGG, particularly new magnetic resonance imaging scanning sequences, allow improved diagnostic and prognostic information. The management paradigms are evolving from “wait and watch” of the past to more active interventional therapy to obviate the risk of malignant transformation. New surgical technologies allow more aggressive surgical resections with a reduction of morbidity. Many reports suggest the association of gross total resection with longer overall survival and progression-free survival in addition to better seizure control. The literature also shows the use of chemotherapeutics and radiation therapy as important adjuncts to surgery. The goals of management have has been increasing survival with increasing stress on quality of life. Our review highlights the recent advances in the molecular diagnosis and management of dLGG with trends toward multidisciplinary and multimodality management of dLGG with an aim to surgically resect the primary disease, followed by chemoradiation in cases of progressive or recurrent disease.
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Affiliation(s)
- Rashid Jooma
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Waqas
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
| | - Inamullah Khan
- Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan
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Liu X, Li Y, Qian Z, Sun Z, Xu K, Wang K, Liu S, Fan X, Li S, Zhang Z, Jiang T, Wang Y. A radiomic signature as a non-invasive predictor of progression-free survival in patients with lower-grade gliomas. NEUROIMAGE-CLINICAL 2018; 20:1070-1077. [PMID: 30366279 PMCID: PMC6202688 DOI: 10.1016/j.nicl.2018.10.014] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 08/16/2018] [Accepted: 10/15/2018] [Indexed: 12/20/2022]
Abstract
Objective The aim of this study was to develop a radiomics signature for prediction of progression-free survival (PFS) in lower-grade gliomas and to investigate the genetic background behind the radiomics signature. Methods In this retrospective study, training (n = 216) and validation (n = 84) cohorts were collected from the Chinese Glioma Genome Atlas and the Cancer Genome Atlas, respectively. For each patient, a total of 431 radiomics features were extracted from preoperative T2-weighted magnetic resonance images. A radiomics signature was generated in the training cohort, and its prognostic value was evaluated in both the training and validation cohorts. The genetic characteristics of the group with high-risk scores were identified by radiogenomic analysis, and a nomogram was established for prediction of PFS. Results There was a significant association between the radiomics signature (including 9 screened radiomics features) and PFS, which was independent of other clinicopathologic factors in both the training (P < 0.001, multivariable Cox regression) and validation (P = 0.045, multivariable Cox regression) cohorts. Radiogenomic analysis revealed that the radiomics signature was associated with the immune response, programmed cell death, cell proliferation, and vasculature development. A nomogram established using the radiomics signature and clinicopathologic risk factors demonstrated high accuracy and good calibration for prediction of PFS in both the training (C-index, 0.684) and validation (C-index, 0.823) cohorts. Conclusions PFS can be predicted non-invasively in patients with LGGs by a group of radiomics features that could reflect the biological processes of these tumors. We developed a non-invasive model for the prediction of PFS in patients with lower-grade gliomas. We further revealed the biological processes underlying the radiomic signature by using comprehensive radiogenomic analysis. PFS of lower-grade gliomas could be predicted effectively based on the radiomics model.
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Affiliation(s)
- Xing Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yiming Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zenghui Qian
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhiyan Sun
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kaibin Xu
- Chinese Academy of Sciences, Institute of Automation, Beijing, China
| | - Kai Wang
- Department of Nuclear Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shaowu Li
- Neurological Imaging Center, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Youssef I, Lee A, Garay EL, Becker DJ, Schreiber D. Patterns of care and outcomes of postoperative radiation for low-grade gliomas in United States hospitals. J Clin Neurosci 2018; 58:124-129. [PMID: 30287250 DOI: 10.1016/j.jocn.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 01/30/2023]
Abstract
It is unclear whether there is a survival benefit with postoperative radiation for low-grade gliomas deemed to be high-risk. We sought to analyze patterns of care and outcomes of radiation use. We accessed the National Cancer Database to identify patients with WHO grade II oligodendroglioma or astrocytoma between 2010 and 2012. Multivariable logistic regression was used to identify predictors of radiation use and multivariable Cox regression was used to identify covariables associated with differences in survival. There were 1952 patients included in this study, of which 518 (26.5%) received postoperative radiation. The majority had oligodendroglioma histology (n = 1121, 57.4%) compared to astrocytoma (n = 831, 42.6%). There were 1626 patients who were either ≥40 years old or underwent a subtotal resection ("high-risk"), and from these 495 (30.4%) received postoperative radiation. On multivariable logistic regression treatment at an academic facility (OR 0.72) was associated with a lower likelihood of receiving postoperative radiation. Astrocytoma histology (OR 2.08), age ≥40 years (OR 2.23), tumor size ≥6 cm (OR 1.64), subtotal resection (OR 1.55), and chemotherapy use (OR 3.93) were associated with an increased likelihood of postoperative radiation. On multivariable analysis, astrocytoma histology (HR 3.49, p < 0.001) and receipt of radiation (HR 2.06, p < 0.001) were associated with worse overall survival. GTR (HR 0.51, p = 0.001) was associated with improved overall survival. Patients treated in United States hospitals are not routinely referred for postoperative radiation for high-risk, low-grade gliomas. Patients who received radiation did not do better than those who did not receive radiation.
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Affiliation(s)
- Irini Youssef
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anna Lee
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.
| | - Elizabeth L Garay
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Daniel J Becker
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - David Schreiber
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA; Summit Medical Group at MD Anderson Cancer Center, Berkeley Heights, NJ, USA
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41
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Garcia CR, Slone SA, Pittman T, St. Clair WH, Lightner DD, Villano JL. Comprehensive evaluation of treatment and outcomes of low-grade diffuse gliomas. PLoS One 2018; 13:e0203639. [PMID: 30235224 PMCID: PMC6147430 DOI: 10.1371/journal.pone.0203639] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/26/2018] [Indexed: 01/31/2023] Open
Abstract
Background Low-grade gliomas affect younger adults and carry a favorable prognosis. They include a variety of biological features affecting clinical behavior and treatment. Having no guidelines on treatment established, we aim to describe clinical and treatment patterns of low-grade gliomas across the largest cancer database in the United States. Methods We analyzed the National Cancer Database from 2004 to 2015, for adult patients with a diagnosis of World Health Organization grade II diffuse glioma. Results We analyzed 13,621 cases with median age of 41 years. Over 56% were male, 88.4% were white, 6.1% were black, and 7.6% Hispanic. The most common primary site location was the cerebrum (79.9%). Overall, 72.2% received surgery, 36.0% radiation, and 27.3% chemotherapy. Treatment combinations included surgery only (41.5%), chemotherapy + surgery (6.6%), chemotherapy only (3.1%), radiation + chemotherapy + surgery (10.7%), radiation + surgery (11.5%), radiation only (6.1%), and radiotherapy + chemotherapy (6.7%). Radiation was more common in treatment of elderly patients, 1p/19q co-deletion (37.3% versus 24.3%, p<0.01), and tumors with midline location. Median survival was 11 years with younger age, 1p/19q co-deletion, and cerebrum location offered survival advantage. Conclusions Tumor location, 1p/19q co-deletion, and age were the main determinants of treatment received and survival, likely reflecting tumor biology differences. Any form of treatment was preferred over watchful waiting in the majority of the patients (86.1% versus 8.1%). Survival of low-grade gliomas is higher than previously reported in the majority of clinical trials and population-based analyses. Our analysis provides a real world estimation of treatment decisions, use of molecular data, and outcomes.
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Affiliation(s)
- Catherine R. Garcia
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Stacey A. Slone
- Division on Cancer Biostatistics, University of Kentucky, Lexington, Kentucky, United States of America
| | - Thomas Pittman
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, United States of America
| | - William H. St. Clair
- Department of Radiation Oncology, University of Kentucky, Lexington, Kentucky, United States of America
| | - Donita D. Lightner
- Department of Neurology, University of Kentucky, Lexington, Kentucky, United States of America
| | - John L. Villano
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Neurology, University of Kentucky, Lexington, Kentucky, United States of America
- Department of Medicine, University of Kentucky, Lexington, Kentucky, United States of America
- * E-mail:
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42
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Abstract
PURPOSE OF REVIEW Low-grade gliomas present vexing management issues for neuro-oncologists. The relatively long survival compared to other brain tumors makes consideration of treatment toxicity, and thus timing of potentially damaging interventions such as surgery, radiation, and chemotherapy, crucial. Moreover, the rarity of these tumors makes clinical trials to ascertain optimal care challenging. RECENT FINDINGS The discovery that most low-grade gliomas harbor isocitrate dehydrogenase (IDH) mutations that confer a favorable prognosis has improved diagnosis and risk stratification of these tumors. Although Level 1 evidence is still lacking, increasing data support the concept of maximal safe tumor debulking as a first step in tumor management. Preliminary results from a large randomized trial suggest chemotherapy is of comparable effectiveness to radiation therapy for one molecular subtype of low-grade glioma. Importantly, however, the final results of a phase 3 trial comparing radiation with or without procarbazine, CCNU (lomustine), and vincristine (PCV) chemotherapy indicate a large survival advantage to combined chemotherapy and radiation, raising questions about using chemotherapy alone as an initial treatment strategy. SUMMARY While the combination of radiation and PCV provides the best proven overall survival with low-grade gliomas, important questions remain. These include whether the better-tolerated temozolomide is as effective as PCV in conjunction with radiation therapy and whether the use of initial chemotherapy as a strategy to defer the potential delayed cognitive toxicity associated with radiation will yield acceptable survival results with a favorable toxicity profile.
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43
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Abdallah MB, Blonski M, Wantz-Mezieres S, Gaudeau Y, Taillandier L, Moureaux JM, Darlix A, de Champfleur NM, Duffau H. Data-Driven Predictive Models of Diffuse Low-Grade Gliomas Under Chemotherapy. IEEE J Biomed Health Inform 2018; 23:38-46. [PMID: 29993901 DOI: 10.1109/jbhi.2018.2834159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Diffuse low-grade gliomas (DLGG) are brain tumors of young adults. They affect the quality of life of the inflicted patients and, if untreated, they evolve into higher grade tumors where the patient's life is at risk. Therapeutic management of DLGGs includes chemotherapy, and tumor diameter is particularly important for the follow-up of DLGG evolution. In fact, the main clinical basis for deciding whether to continue chemotherapy is tumor diameter growth rate. In order to reliably assist the doctors in selecting the most appropriate time to stop treatment, we propose a novel clinical decision support system. Based on two mathematical models, one linear and one exponential, we are able to predict the evolution of tumor diameter under Temozolomide chemotherapy as a first treatment and thus offer a prognosis on when to end it. We present the results of an implementation of these models on a database of 42 patients from Nancy and Montpellier University Hospitals. In this database, 38 patients followed the linear model and four patients followed the exponential model. From a training data set of a minimal size of five, we are able to predict the next tumor diameter with high accuracy. Thanks to the corresponding prediction interval, it is possible to check if the new observation corresponds to the predicted diameter. If the observed diameter is within the prediction interval, the clinician is notified that the trend is within a normal range. Otherwise, the practitioner is alerted of a significant change in tumor diameter.
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Li Y, Liu X, Qian Z, Sun Z, Xu K, Wang K, Fan X, Zhang Z, Li S, Wang Y, Jiang T. Genotype prediction of ATRX mutation in lower-grade gliomas using an MRI radiomics signature. Eur Radiol 2018; 28:2960-2968. [DOI: 10.1007/s00330-017-5267-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 11/25/2017] [Accepted: 12/20/2017] [Indexed: 12/24/2022]
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Zapotocky M, Ramaswamy V, Lassaletta A, Bouffet E. Adolescents and young adults with brain tumors in the context of molecular advances in neuro-oncology. Pediatr Blood Cancer 2018; 65. [PMID: 29049858 DOI: 10.1002/pbc.26861] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 09/21/2017] [Accepted: 09/22/2017] [Indexed: 12/26/2022]
Abstract
Adolescents and young adults (AYA) comprise a specific group of oncology patients with a distinct biological and epidemiological spectrum of central nervous system neoplasms. It has been well documented that they differ clinically, especially in relation to prognosis and chemotherapy tolerance; however, the underlying reasons for this are unclear. Recent advances in the genomics of both childhood and adult brain tumors have provided new explanations and insights into the previously described age-dependent heterogeneity. Herein, we summarize the current state of the AYA population in neuro-oncology, specifically how biological advances can help personalize therapy for this unique group of patients.
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Affiliation(s)
- Michal Zapotocky
- Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical School, Charles University, Prague, Czech Republic.,Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Vijay Ramaswamy
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Alvaro Lassaletta
- Pediatric Hematology Oncology Department, Hospital Niño Jesús, Madrid, Spain
| | - Eric Bouffet
- Division of Hematology/Oncology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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46
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Mandonnet E, Duffau H. An attempt to conceptualize the individual onco-functional balance: Why a standardized treatment is an illusion for diffuse low-grade glioma patients. Crit Rev Oncol Hematol 2017; 122:83-91. [PMID: 29458793 DOI: 10.1016/j.critrevonc.2017.12.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/19/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
In the era of evidence-based medicine, clinicians aim to establish standards of care from randomized studies. Following, personalized medicine has emerged, as new individualized biomarkers could help to predict sensitivity to specific treatment. In this paper, we show that, for diffuse low-grade glioma, some specificities - dual goal of both survival and functional gain, long duration of the disease with multistep treatments, multiparametric evaluation of the onco-functional balance of each treatment modality - call for a change of paradigm. After summarizing how to weight the benefits and risks of surgery, chemotherapy and radiotherapy, we show that the overall efficacy of a treatment modality cannot be assessed per se, as it depends on its integration in the whole sequence. Then, we revisit the notion of personalized medicine: instead of decision-making based solely on molecular profile, we plead for a recursive algorithm, allowing a dynamic evaluation of the onco-functional balance, integrating many individual characteristics of the patient's tumor and brain function.
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Affiliation(s)
- Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, APHP, Paris, France; University Paris 7, Paris, France; Institut du Cerveau de la Moelle (ICM), Paris, France.
| | - Hugues Duffau
- Department of Neurosurgery, Hôpital Gui de Chauliac, Montpellier Medical University Center, Montpellier, France; Institute of Neuroscience of Montpellier, INSERM U1051, Montpellier, France; University of Montpellier, Montpellier, France
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47
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Izquierdo C, Alentorn A, Idbaih A, Simó M, Kaloshi G, Ricard D, Barritault M, Meyronet D, Bruna J, Honnorat J, Delattre JY, Ducray F. Long-term impact of temozolomide on 1p/19q-codeleted low-grade glioma growth kinetics. J Neurooncol 2017; 136:533-539. [PMID: 29143276 DOI: 10.1007/s11060-017-2677-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/11/2017] [Indexed: 10/18/2022]
Abstract
Although upfront temozolomide (TMZ) has been widely-used to treat 1p/19q-codeleted diffuse low-grade gliomas (LGG), its long-term impact on the growth kinetics of these tumors has not been determined. Based on serial magnetic resonance images we retrospectively evaluated the evolution of the mean tumor diameter (MTD) in 36 progressive 1p/19q-codeleted LGG treated with upfront TMZ. After TMZ onset, all but two patients (94.4%) presented a progressive MTD decrease that lasted for a median duration of 23 months (range 3-114). In 10 patients (27%) MTD regrowth occurred during TMZ treatment and in 22 patients (66%) after TMZ discontinuation. In these patients, median time to MTD regrowth after TMZ discontinuation was 12 months (range 1-88). The rate of MTD regrowth at 3 and 5 years after TMZ onset was 77 and 94%, respectively. Time to tumor progression (TTP) based on volumetric analysis was shorter than TTP based on Response Assessment in Neuro-Oncology (RANO) bidimensional criteria (23 vs. 35 months, p = 0.05) and shorter than time to next oncological treatment (23 vs. 46 months, p = 0.001). In 10 patients (27%), absence of volumetric analysis led to continue TMZ for a median of 10 cycles after MTD had started to regrow. Volumetric analysis is important to precisely assess chemotherapy efficacy in 1p/19q-codeleted LGG, identify early tumor progression and avoid futile chemotherapy continuation. In the present series, although some long-lasting volumetric responses were observed, most tumors resumed their growth within 3 years after TMZ onset.
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Affiliation(s)
- C Izquierdo
- Service de Neuro-Oncologie, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Bvd Pinel, 69394, Lyon Cedex, France.,Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Av. Gran vía de l'Hospitalet, 199-203, 08907, l'Hospitalet de Llobregat, Barcelona, Spain
| | - A Alentorn
- Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - A Idbaih
- Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - M Simó
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Av. Gran vía de l'Hospitalet, 199-203, 08907, l'Hospitalet de Llobregat, Barcelona, Spain
| | - G Kaloshi
- Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - D Ricard
- Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Service de Neurologie, HIA du Val-de-Grâce, 74 Bvd de Port-Royal, 75005, Paris, France.,École du Val-de-Grâce, 1, place Alphonse-Laveran, 75005, Paris, France.,Cognac-G UMR-MD4 8257, Service de Santé des Armées, Université Paris Descartes, 74, Bvd de Port-Royal, 75005, Paris, France
| | - M Barritault
- Service d'anatomopathologie, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Bvd Pinel, 69394, Lyon Cedex, France.,Université Claude Bernard Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - D Meyronet
- Service d'anatomopathologie, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Bvd Pinel, 69394, Lyon Cedex, France.,Université Claude Bernard Lyon 1, Lyon, France.,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France
| | - J Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-ICO L'Hospitalet-IDIBELL, Av. Gran vía de l'Hospitalet, 199-203, 08907, l'Hospitalet de Llobregat, Barcelona, Spain
| | - J Honnorat
- Service de Neuro-Oncologie, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Bvd Pinel, 69394, Lyon Cedex, France.,Université Claude Bernard Lyon 1, Lyon, France.,Institut NeuroMyoGene, INSERM 1217/CNRS 5310, Université de Lyon, Lyon, France
| | - J Y Delattre
- Service de Neurologie 2-Mazarin, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, 75013, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, 75013, Paris, France
| | - F Ducray
- Service de Neuro-Oncologie, Groupe Hospitalier Est, Hospices Civils de Lyon, 59 Bvd Pinel, 69394, Lyon Cedex, France. .,Université Claude Bernard Lyon 1, Lyon, France. .,Department of Cancer Cell Plasticity, Cancer Research Centre of Lyon, INSERM U1052, CNRS UMR5286, Lyon, France.
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SEOM clinical guideline of diagnosis and management of low-grade glioma (2017). Clin Transl Oncol 2017; 20:3-15. [PMID: 29124520 PMCID: PMC5785601 DOI: 10.1007/s12094-017-1790-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 10/26/2017] [Indexed: 11/09/2022]
Abstract
Diffuse infiltrating low-grade gliomas include oligodendrogliomas
and astrocytomas, and account for about 5% of all primary brain tumors. Treatment strategies for these low-grade gliomas in adults have recently changed. The 2016 World Health Organization (WHO) classification has updated the definition of these tumors to include their molecular characterization, including the presence of isocitrate dehydrogenase (IDH) mutation and 1p/19p codeletion. In this new classification, the histologic subtype of grade II-mixed oligoastrocytoma has also been eliminated. The precise optimal management of patients with low-grade glioma after resection remains to be determined. The risk–benefit ratio of adjuvant treatment must be weighed for each individual.
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Li Y, Qian Z, Xu K, Wang K, Fan X, Li S, Jiang T, Liu X, Wang Y. MRI features predict p53 status in lower-grade gliomas via a machine-learning approach. NEUROIMAGE-CLINICAL 2017. [PMID: 29527478 PMCID: PMC5842645 DOI: 10.1016/j.nicl.2017.10.030] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background P53 mutation status is a pivotal biomarker for gliomas. Here, we developed a machine-learning model to predict p53 status in lower-grade gliomas based on radiomic features extracted from conventional magnetic resonance (MR) images. Methods Preoperative MR images were retrospectively obtained from 272 patients with primary grade II/III gliomas. The patients were randomly allocated in a 2:1 ratio to a training (n = 180) or validation (n = 92) set. A total of 431 radiomic features were extracted from each patient. The lest absolute shrinkage and selection operator (LASSO) method was used for feature selection and radiomic signature construction. Subsequently, a machine-learning model to predict p53 status was established using the selected features and a Support Vector Machine classifier. The predictive performance of all individual features and the model was calculated using receiver operating characteristic curves in both the training and validation sets. Results The p53-related radiomic signature was built using the LASSO algorithm; this procedure consisted of four first-order statistics or related wavelet features (including Maximum, Median, Minimum, and Uniformity), a shape and size-based feature (Spherical Disproportion), and ten textural features or related wavelet features (including Correlation, Run Percentage, and Sum Entropy). The prediction accuracies based on the area under the curve were 89.6% in the training set and 76.3% in the validation set, which were better than individual features. Conclusions These results demonstrate that MR image texture features are predictive of p53 mutation status in lower-grade gliomas. Thus, our procedure can be conveniently used to facilitate presurgical molecular pathological diagnosis. We established a p53-related radiomic signature in lower-grade gliomas based on LASSO algorithm. We developed a machine-learning model using the radiomic signature and a support vector machine. P53 mutation status of lower-grade gliomas was predicted effectively based on our machine-learning model.
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Affiliation(s)
- Yiming Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Zenghui Qian
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kaibin Xu
- Chinese Academy of Sciences, Institute of Automation, Beijing, China
| | - Kai Wang
- Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shaowu Li
- Neurological Imaging Center, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tao Jiang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Xing Liu
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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50
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MRI features can predict EGFR expression in lower grade gliomas: A voxel-based radiomic analysis. Eur Radiol 2017; 28:356-362. [PMID: 28755054 DOI: 10.1007/s00330-017-4964-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/05/2017] [Accepted: 06/23/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify the magnetic resonance imaging (MRI) features associated with epidermal growth factor (EGFR) expression level in lower grade gliomas using radiomic analysis. METHODS 270 lower grade glioma patients with known EGFR expression status were randomly assigned into training (n=200) and validation (n=70) sets, and were subjected to feature extraction. Using a logistic regression model, a signature of MRI features was identified to be predictive of the EGFR expression level in lower grade gliomas in the training set, and the accuracy of prediction was assessed in the validation set. RESULTS A signature of 41 MRI features achieved accuracies of 82.5% (area under the curve [AUC] = 0.90) in the training set and 90.0% (AUC = 0.95) in the validation set. This radiomic signature consisted of 25 first-order statistics or related wavelet features (including range, standard deviation, uniformity, variance), one shape and size-based feature (spherical disproportion), and 15 textural features or related wavelet features (including sum variance, sum entropy, run percentage). CONCLUSIONS A radiomic signature allowing for the prediction of the EGFR expression level in patients with lower grade glioma was identified, suggesting that using tumour-derived radiological features for predicting genomic information is feasible. KEY POINTS • EGFR expression status is an important biomarker for gliomas. • EGFR in lower grade gliomas could be predicted using radiogenomic analysis. • A logistic regression model is an efficient approach for analysing radiomic features.
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