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Boelders SM, De Baene W, Postma E, Gehring K, Ong LL. Predicting Cognitive Functioning for Patients with a High-Grade Glioma: Evaluating Different Representations of Tumor Location in a Common Space. Neuroinformatics 2024:10.1007/s12021-024-09671-9. [PMID: 38900230 DOI: 10.1007/s12021-024-09671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Cognitive functioning is increasingly considered when making treatment decisions for patients with a brain tumor in view of a personalized onco-functional balance. Ideally, one can predict cognitive functioning of individual patients to make treatment decisions considering this balance. To make accurate predictions, an informative representation of tumor location is pivotal, yet comparisons of representations are lacking. Therefore, this study compares brain atlases and principal component analysis (PCA) to represent voxel-wise tumor location. Pre-operative cognitive functioning was predicted for 246 patients with a high-grade glioma across eight cognitive tests while using different representations of voxel-wise tumor location as predictors. Voxel-wise tumor location was represented using 13 different frequently-used population average atlases, 13 randomly generated atlases, and 13 representations based on PCA. ElasticNet predictions were compared between representations and against a model solely using tumor volume. Preoperative cognitive functioning could only partly be predicted from tumor location. Performances of different representations were largely similar. Population average atlases did not result in better predictions compared to random atlases. PCA-based representation did not clearly outperform other representations, although summary metrics indicated that PCA-based representations performed somewhat better in our sample. Representations with more regions or components resulted in less accurate predictions. Population average atlases possibly cannot distinguish between functionally distinct areas when applied to patients with a glioma. This stresses the need to develop and validate methods for individual parcellations in the presence of lesions. Future studies may test if the observed small advantage of PCA-based representations generalizes to other data.
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Affiliation(s)
- S M Boelders
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
- Department of Cognitive Sciences and AI, Tilburg University, Tilburg, The Netherlands
| | - W De Baene
- Department of Cognitive Neuropsychology, Tilburg University Tilburg, Warandelaan 2, P. O. Box 90153, Tilburg, 5000 LE, The Netherlands
| | - E Postma
- Department of Cognitive Sciences and AI, Tilburg University, Tilburg, The Netherlands
| | - K Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands.
- Department of Cognitive Neuropsychology, Tilburg University Tilburg, Warandelaan 2, P. O. Box 90153, Tilburg, 5000 LE, The Netherlands.
| | - L L Ong
- Department of Cognitive Sciences and AI, Tilburg University, Tilburg, The Netherlands
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2
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Röttgering JG, Varkevisser TMCK, Gorter M, Belgers V, De Witt Hamer PC, Reijneveld JC, Klein M, Blanken TF, Douw L. Symptom networks in glioma patients: understanding the multidimensionality of symptoms and quality of life. J Cancer Surviv 2024; 18:1032-1041. [PMID: 36922442 PMCID: PMC11082018 DOI: 10.1007/s11764-023-01355-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To comprehend the complex relationship between symptoms and health-related quality of life (HRQoL) in patients with diffuse glioma, we applied symptom network analysis to identify patterns of associations between depression, cognition, brain tumor-related symptoms, and HRQoL. Additionally, we aimed to compare global strength between symptom networks to understand if symptoms are more tightly connected in different subgroups of patients. METHODS We included 256 patients and stratified the sample based on disease status (preoperative vs. postoperative), tumor grade (grade II vs. III/IV), and fatigue status (non-fatigued vs. fatigued). For each subgroup of patients, we constructed a symptom network. In these six networks, each node represented a validated subscale of a questionnaire and an edge represented a partial correlation between two nodes. We statistically compared global strength between networks. RESULTS Across the six networks, nodes were highly correlated: fatigue severity, depression, and social functioning in particular. We found no differences in GS between the networks based on disease characteristics. However, global strength was lower in the non-fatigued network compared to the fatigued network (5.51 vs. 7.49, p < 0.001). CONCLUSIONS Symptoms and HRQoL are highly interrelated in patients with glioma. Interestingly, nodes in the network of fatigued patients were more tightly connected compared to non-fatigued patients. IMPLICATIONS FOR CANCER SURVIVORS We introduce symptom networks as a method to understand the multidimensionality of symptoms in glioma. We find a clear association between multiple symptoms and HRQoL, which underlines the need for integrative symptom management targeting fatigue in particular.
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Affiliation(s)
- J G Röttgering
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands.
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Psychology, Boelelaan 1117, Amsterdam, The Netherlands.
| | - T M C K Varkevisser
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, The Netherlands
| | - M Gorter
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, The Netherlands
| | - V Belgers
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Neurology, Boelelaan 1117, Amsterdam, The Netherlands
| | - P C De Witt Hamer
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Neurosurgery, Boelelaan 1117, Amsterdam, The Netherlands
| | - J C Reijneveld
- Department of Neurology, SEIN, Heemstede, The Netherlands
| | - M Klein
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Medical Psychology, Boelelaan 1117, Amsterdam, The Netherlands
| | - T F Blanken
- Department of Psychological Methods, University of Amsterdam, 1018 WT, Amsterdam, The Netherlands
| | - L Douw
- Cancer Center Amsterdam, Brain Tumor Center, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Boelelaan 1117, Amsterdam, The Netherlands
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3
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Noll KR, Bradshaw M, Sheppard D, Wefel JS. Perioperative Neurocognitive Function in Glioma Surgery. Curr Oncol Rep 2024; 26:466-476. [PMID: 38573439 DOI: 10.1007/s11912-024-01522-9] [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] [Accepted: 03/22/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW This review provides a concise overview of the recent literature regarding preoperative and postoperative neurocognitive functioning (NCF) in patients with glioma. Brief discussion also covers contemporary intraoperative brain mapping work, with a focus on potential influence of mapping upon NCF outcomes following awake surgery. RECENT FINDINGS Most patients with glioma exhibit preoperative NCF impairment, with severity varying by germ line and tumoral genetics, tumor grade, and lesion location, among other characteristics. Literature regarding postoperative NCF changes is mixed, though numerous studies indicate a majority of patients exhibit immediate and short-term worsening. This is often followed by recovery over several months; however, a substantial portion of patients harbor persisting declines. Decline appears related to surgically-induced structural and functional brain alterations, both local and distal to the tumor and resection cavity. Importantly, NCF decline may be mitigated to some extent by intraoperative brain mapping, including mapping of both language-mediated and nonverbal functions. Research regarding perioperative NCF in patients with glioma has flourished over recent years. While this has increased our understanding of contributors to NCF and risk of decline associated with surgical intervention, more work is needed to better preserve NCF throughout the disease course.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA.
| | - Mariana Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
| | - David Sheppard
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX, 77030, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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4
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Zhang K, Yang T, Xia Y, Guo X, Chen W, Wang L, Li J, Wu J, Xiao Z, Zhang X, Jiang W, Xu D, Guo S, Wang Y, Shi Y, Liu D, Li Y, Wang Y, Xing H, Liang T, Niu P, Wang H, Liu Q, Jin S, Qu T, Li H, Zhang Y, Ma W, Wang Y. Molecular Determinants of Neurocognitive Deficits in Glioma: Based on 2021 WHO Classification. J Mol Neurosci 2024; 74:17. [PMID: 38315329 PMCID: PMC10844410 DOI: 10.1007/s12031-023-02173-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/05/2023] [Indexed: 02/07/2024]
Abstract
Cognitive impairment is a common feature among patients with diffuse glioma. The objective of the study is to investigate the relationship between preoperative cognitive function and clinical as well as molecular factors, firstly based on the new 2021 World Health Organization's updated classification of central nervous system tumors. A total of 110 diffuse glioma patients enrolled underwent preoperative cognitive assessments using the Mini-Mental State Examination and Montreal Cognitive Assessment. Clinical information was collected from medical records, and gene sequencing was performed to analyze the 18 most influenced genes. The differences in cognitive function between patients with and without glioblastoma were compared under both the 2016 and 2021 WHO classification of tumors of the central nervous system to assess their effect of differentiation on cognition. The study found that age, tumor location, and glioblastoma had significant differences in cognitive function. Several genetic alterations were significantly correlated with cognition. Especially, IDH, CIC, and ATRX are positively correlated with several cognitive domains, while most other genes are negatively correlated. For most focused genes, patients with a low number of genetic alterations tended to have better cognitive function. Our study suggested that, in addition to clinical characteristics such as age, histological type, and tumor location, molecular characteristics play a crucial role in cognitive function. Further research into the mechanisms by which tumors affect brain function is expected to enhance the quality of life for glioma patients. This study highlights the importance of considering both clinical and molecular factors in the management of glioma patients to improve cognitive outcomes.
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Affiliation(s)
- Kun Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tianrui Yang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yu Xia
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xiaopeng Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wenlin Chen
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Lijun Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Junlin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiaming Wu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Zhiyuan Xiao
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wenwen Jiang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Dongrui Xu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Siying Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- School of Medicine, Tsinghua University, Beijing, 100730, China
| | - Yaning Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yixin Shi
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Delin Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yilin Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuekun Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hao Xing
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tingyu Liang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Pei Niu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hai Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qianshu Liu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Shanmu Jin
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Tian Qu
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Huanzhang Li
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yi Zhang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Wenbin Ma
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yu Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Zimmermann MLM, Breedt LC, Centeno EGZ, Reijneveld JC, Santos FAN, Stam CJ, van Lingen MR, Schoonheim MM, Hillebrand A, Douw L. The relationship between pathological brain activity and functional network connectivity in glioma patients. J Neurooncol 2024; 166:523-533. [PMID: 38308803 PMCID: PMC10876827 DOI: 10.1007/s11060-024-04577-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/17/2024] [Indexed: 02/05/2024]
Abstract
PURPOSE Glioma is associated with pathologically high (peri)tumoral brain activity, which relates to faster progression. Functional connectivity is disturbed locally and throughout the entire brain, associating with symptomatology. We, therefore, investigated how local activity and network measures relate to better understand how the intricate relationship between the tumor and the rest of the brain may impact disease and symptom progression. METHODS We obtained magnetoencephalography in 84 de novo glioma patients and 61 matched healthy controls. The offset of the power spectrum, a proxy of neuronal activity, was calculated for 210 cortical regions. We calculated patients' regional deviations in delta, theta and lower alpha network connectivity as compared to controls, using two network measures: clustering coefficient (local connectivity) and eigenvector centrality (integrative connectivity). We then tested group differences in activity and connectivity between (peri)tumoral, contralateral homologue regions, and the rest of the brain. We also correlated regional offset to connectivity. RESULTS As expected, patients' (peri)tumoral activity was pathologically high, and patients showed higher clustering and lower centrality than controls. At the group-level, regionally high activity related to high clustering in controls and patients alike. However, within-patient analyses revealed negative associations between regional deviations in brain activity and clustering, such that pathologically high activity coincided with low network clustering, while regions with 'normal' activity levels showed high network clustering. CONCLUSION Our results indicate that pathological activity and connectivity co-localize in a complex manner in glioma. This insight is relevant to our understanding of disease progression and cognitive symptomatology.
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Affiliation(s)
- Mona L M Zimmermann
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Lucas C Breedt
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Eduarda G Z Centeno
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
| | - Jaap C Reijneveld
- Department of Neurology, Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Fernando A N Santos
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Dutch Institute for Emergent Phenomena (DIEP), Institute for Advanced Studies, University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Clinical Neurophysiology and MEG Center, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marike R van Lingen
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Amsterdam Neuroscience, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Clinical Neurophysiology and MEG Center, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Douw
- Anatomy and Neurosciences, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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6
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Cai S, Liang Y, Wang Y, Fan Z, Qi Z, Liu Y, Chen F, Jiang C, Shi Z, Wang L, Zhang L. Shared and malignancy-specific functional plasticity of dynamic brain properties for patients with left frontal glioma. Cereb Cortex 2024; 34:bhad445. [PMID: 38011109 DOI: 10.1093/cercor/bhad445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
The time-varying brain activity may parallel the disease progression of cerebral glioma. Assessment of brain dynamics would better characterize the pathological profile of glioma and the relevant functional remodeling. This study aims to investigate the dynamic properties of functional networks based on sliding-window approach for patients with left frontal glioma. The generalized functional plasticity due to glioma was characterized by reduced dynamic amplitude of low-frequency fluctuation of somatosensory networks, reduced dynamic functional connectivity between homotopic regions mainly involving dorsal attention network and subcortical nuclei, and enhanced subcortical dynamic functional connectivity. Malignancy-specific functional remodeling featured a chaotic modification of dynamic amplitude of low-frequency fluctuation and dynamic functional connectivity for low-grade gliomas, and attenuated dynamic functional connectivity of the intrahemispheric cortico-subcortical connections and reduced dynamic amplitude of low-frequency fluctuation of the bilateral caudate for high-grade gliomas. Network dynamic activity was clustered into four distinct configuration states. The occurrence and dwell time of the weakly connected state were reduced in patients' brains. Support vector machine model combined with predictive dynamic features achieved an averaged accuracy of 87.9% in distinguishing low- and high-grade gliomas. In conclusion, dynamic network properties are highly predictive of the malignant grade of gliomas, thus could serve as new biomarkers for disease characterization.
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Affiliation(s)
- Siqi Cai
- Paul. C. Lauterbur Research Centers for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yuchao Liang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 10070, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 10070, China
| | - Zhen Fan
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - Yufei Liu
- Department of Neurosurgery, Shenzhen Second People's Hospital, Shenzhen, Guangdong 518025, China
| | - Fanfan Chen
- Department of Neurosurgery, Shenzhen Second People's Hospital, Shenzhen, Guangdong 518025, China
| | - Chunxiang Jiang
- Paul. C. Lauterbur Research Centers for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
| | - Zhifeng Shi
- Department of Neurosurgery, Huashan Hospital of Fudan University, Shanghai 200040, China
| | - Lei Wang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing 10070, China
| | - Lijuan Zhang
- Paul. C. Lauterbur Research Centers for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China
- University of Chinese Academy of Sciences, Beijing 100049, China
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7
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Maas DA, Douw L. Multiscale network neuroscience in neuro-oncology: How tumors, brain networks, and behavior connect across scales. Neurooncol Pract 2023; 10:506-517. [PMID: 38026586 PMCID: PMC10666814 DOI: 10.1093/nop/npad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Network neuroscience refers to the investigation of brain networks across different spatial and temporal scales, and has become a leading framework to understand the biology and functioning of the brain. In neuro-oncology, the study of brain networks has revealed many insights into the structure and function of cells, circuits, and the entire brain, and their association with both functional status (e.g., cognition) and survival. This review connects network findings from different scales of investigation, with the combined aim of informing neuro-oncological healthcare professionals on this exciting new field and also delineating the promising avenues for future translational and clinical research that may allow for application of network methods in neuro-oncological care.
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Affiliation(s)
- Dorien A Maas
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Linda Douw
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Amsterdam, The Netherlands
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8
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Ladisich B, Rampp S, Trinka E, Weisz N, Schwartz C, Kraus T, Sherif C, Marhold F, Demarchi G. Network topology in brain tumor patients with and without structural epilepsy: a prospective MEG study. Ther Adv Neurol Disord 2023; 16:17562864231190298. [PMID: 37655227 PMCID: PMC10467269 DOI: 10.1177/17562864231190298] [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: 12/22/2022] [Accepted: 07/07/2023] [Indexed: 09/02/2023] Open
Abstract
Background It was proposed that network topology is altered in brain tumor patients. However, there is no consensus on the pattern of these changes and evidence on potential drivers is lacking. Objectives We aimed to characterize neurooncological patients' network topology by analyzing glial brain tumors (GBTs) and brain metastases (BMs) with respect to the presence of structural epilepsy. Methods Network topology derived from resting state magnetoencephalography was compared between (1) patients and controls, (2) GBTs and BMs, and (3) patients with (PSEs) and without structural epilepsy (PNSEs). Eligible patients were investigated from February 2019 to March 2021. We calculated whole brain (WB) connectivity in six frequency bands, network topological parameters (node degree, average shortest path length, local clustering coefficient) and performed a stratification, where differences in power were identified. For data analysis, we used Fieldtrip, Brain Connectivity MATLAB toolboxes, and in-house built scripts. Results We included 41 patients (21 men), with a mean age of 60.1 years (range 23-82), of those were: GBTs (n = 23), BMs (n = 14), and other histologies (n = 4). Statistical analysis revealed a significantly decreased WB node degree in patients versus controls in every frequency range at the corrected level (p1-30Hz = 0.002, pγ = 0.002, pβ = 0.002, pα = 0.002, pθ = 0.024, and pδ = 0.002). At the descriptive level, we found a significant augmentation for WB local clustering coefficient (p1-30Hz = 0.031, pδ = 0.013) in patients compared to controls, which did not persist the false discovery rate correction. No differences regarding networks of GBTs compared to BMs were identified. However, we found a significant increase in WB local clustering coefficient (pθ = 0.048) and decrease in WB node degree (pα = 0.039) in PSEs versus PNSEs at the uncorrected level. Conclusion Our data suggest that network topology is altered in brain tumor patients. Histology per se might not, however, tumor-related epilepsy seems to influence the brain's functional network. Longitudinal studies and analysis of possible confounders are required to substantiate these findings.
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Affiliation(s)
- Barbara Ladisich
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Department of Neurosurgery, University Hospital St. Poelten, Dunant-Platz 1, St Polten 3100 Austria
- Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Stefan Rampp
- Department of Neurosurgery, Department of Neuroradiology, University Hospital Erlangen, Germany
- Department of Neurosurgery, University Hospital Halle (Saale), Germany
| | - Eugen Trinka
- Department of Neurology, Center for Cognitive Neuroscience Salzburg, Member of the European Reference Network, EpiCARE, Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
- Karl Landsteiner Institute of Neurorehabilitation and Space Neurology, Salzburg, Austria
| | - Nathan Weisz
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Center for Cognitive Neuroscience & Department of Psychology, Paris Lodron University, Salzburg, Austria
| | - Christoph Schwartz
- Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Theo Kraus
- Institute of Pathology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Camillo Sherif
- Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Franz Marhold
- Department of Neurosurgery, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Krems an der Donau, Austria
| | - Gianpaolo Demarchi
- Neuroscience Institute, Christian Doppler University Hospital, Salzburg, Austria
- Center for Cognitive Neuroscience & Department of Psychology, Paris Lodron University, Salzburg, Austria
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9
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Huisman TAGM, Patel R, Kralik S, Desai NK, Meoded A, Chen K, Weiner HL, Curry DJ, Lequin M, Kranendonk M, Orman G, Jallo G. Advances in Imaging Modalities for Pediatric Brain and Spinal Cord Tumors. Pediatr Neurosurg 2023; 58:240-258. [PMID: 37604135 DOI: 10.1159/000531998] [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: 05/20/2022] [Accepted: 07/05/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Neuroimaging has evolved from anatomical imaging toward a multi-modality comprehensive anatomical and functional imaging in the past decades, important functional data like perfusion-weighted imaging, permeability imaging, diffusion-weighted imaging (DWI), and diffusion tensor imaging (DTI), tractography, metabolic imaging, connectomics, event-related functional imaging, resting state functional imaging, and much more is now being offered. SUMMARY Precision diagnostics has proven to be essential for precision treatment. Many minimal invasive techniques have been developed, taking advantage of digital subtraction angiography and interventional neuroradiology. Furthermore, intraoperative CT and/or MRI and more recently MR-guided focused ultrasound have complemented the diagnostic and therapeutic armamentarium. KEY MESSAGES In the current manuscript, we discuss standard imaging sequences including advanced techniques like DWI, DTI, susceptibility-weighted imaging, and 1H magnetic resonance spectroscopy, various perfusion weighted imaging approaches including arterial spin labeling, dynamic contrast enhanced imaging, and dynamic susceptibility contrast imaging. Pre-, intra, and postoperative surgical imaging including visualize imaging will be discussed. The value of connectomics will be presented for its value in neuro-oncology. Minimal invasive therapeutic possibilities of interventional neuroradiology and image-guided laser ablation and MR-guided high-intensity-focused ultrasound will be presented for treatment of pediatric brain and spinal cord tumors. Finally, a comprehensive review of spinal cord tumors and matching neuropathology has been included.
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Affiliation(s)
- Thierry A G M Huisman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Rajan Patel
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Stephen Kralik
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Nilesh K Desai
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Avner Meoded
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Karen Chen
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Howard L Weiner
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel J Curry
- Division of Pediatric Neurosurgery, Department of Surgery, Texas Children's Hospital and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Maarten Lequin
- Department of Radiology, Wilhelmina Children's Hospital and Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mariette Kranendonk
- Department of Pathobiology, Princess Maxima Center for Pediatric Oncology University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gunes Orman
- Divisions of Neuroradiology and Interventional Radiology, Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA,
| | - George Jallo
- Department of Neurosurgery, Institute for Brain Protection Sciences, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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10
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van Lingen MR, Breedt LC, Geurts JJG, Hillebrand A, Klein M, Kouwenhoven MCM, Kulik SD, Reijneveld JC, Stam CJ, De Witt Hamer PC, Zimmermann MLM, Santos FAN, Douw L. The longitudinal relation between executive functioning and multilayer network topology in glioma patients. Brain Imaging Behav 2023; 17:425-435. [PMID: 37067658 PMCID: PMC10435610 DOI: 10.1007/s11682-023-00770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/18/2023]
Abstract
Many patients with glioma, primary brain tumors, suffer from poorly understood executive functioning deficits before and/or after tumor resection. We aimed to test whether frontoparietal network centrality of multilayer networks, allowing for integration across multiple frequencies, relates to and predicts executive functioning in glioma. Patients with glioma (n = 37) underwent resting-state magnetoencephalography and neuropsychological tests assessing word fluency, inhibition, and set shifting before (T1) and one year after tumor resection (T2). We constructed binary multilayer networks comprising six layers, with each layer representing frequency-specific functional connectivity between source-localized time series of 78 cortical regions. Average frontoparietal network multilayer eigenvector centrality, a measure for network integration, was calculated at both time points. Regression analyses were used to investigate associations with executive functioning. At T1, lower multilayer integration (p = 0.017) and epilepsy (p = 0.006) associated with poorer set shifting (adj. R2 = 0.269). Decreasing multilayer integration (p = 0.022) and not undergoing chemotherapy at T2 (p = 0.004) related to deteriorating set shifting over time (adj. R2 = 0.283). No significant associations were found for word fluency or inhibition, nor did T1 multilayer integration predict changes in executive functioning. As expected, our results establish multilayer integration of the frontoparietal network as a cross-sectional and longitudinal correlate of executive functioning in glioma patients. However, multilayer integration did not predict postoperative changes in executive functioning, which together with the fact that this correlate is also found in health and other diseases, limits its specific clinical relevance in glioma.
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Affiliation(s)
- Marike R van Lingen
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - Lucas C Breedt
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
| | - Arjan Hillebrand
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Martin Klein
- Department of Medical Psychology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Mathilde C M Kouwenhoven
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Shanna D Kulik
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
| | - Jaap C Reijneveld
- Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Philip C De Witt Hamer
- Department of Neurosurgery, Amsterdam UMC location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Mona L M Zimmermann
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Fernando A N Santos
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands
- Institute of Advanced Studies, University of Amsterdam, Amsterdam, the Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, de Boelelaan 1108, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, the Netherlands.
- Amsterdam Neuroscience, Systems & Network Neurosciences, Amsterdam, the Netherlands.
- Cancer Center Amsterdam, Amsterdam, the Netherlands.
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11
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Soffietti R, Pellerino A, Bruno F, Mauro A, Rudà R. Neurotoxicity from Old and New Radiation Treatments for Brain Tumors. Int J Mol Sci 2023; 24:10669. [PMID: 37445846 DOI: 10.3390/ijms241310669] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Research regarding the mechanisms of brain damage following radiation treatments for brain tumors has increased over the years, thus providing a deeper insight into the pathobiological mechanisms and suggesting new approaches to minimize this damage. This review has discussed the different factors that are known to influence the risk of damage to the brain (mainly cognitive disturbances) from radiation. These include patient and tumor characteristics, the use of whole-brain radiotherapy versus particle therapy (protons, carbon ions), and stereotactic radiotherapy in various modalities. Additionally, biological mechanisms behind neuroprotection have been elucidated.
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Affiliation(s)
- Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science University Hospital, 10126 Turin, Italy
| | - Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science University Hospital, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science University Hospital, 10126 Turin, Italy
| | - Alessandro Mauro
- Department of Neuroscience "Rita Levi Montalcini", University of Turin and City of Health and Science University Hospital, 10126 Turin, Italy
- I.R.C.C.S. Istituto Auxologico Italiano, Division of Neurology and Neuro-Rehabilitation, San Giuseppe Hospital, 28824 Piancavallo, Italy
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science University Hospital, 10126 Turin, Italy
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12
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Skufca Smrdel AC, Podlesek A, Skoblar Vidmar M, Markovic J, Jereb J, Okorn MK, Smrdel U. Cognitive functioning in a cohort of high-grade glioma patients. Radiol Oncol 2023; 57:201-210. [PMID: 37341199 DOI: 10.2478/raon-2023-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 12/31/2022] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND High grade gliomas are associated with cognitive problems. The aim of the study was to investigate cognitive functioning in a cohort of patients with high grade glioma, according to isocitrate dehydrogenase (IDH) and methyl guanine methyl transferase (MGMT) status and other clinical characteristics. PATIENTS AND METHODS The patients with the high-grade glioma treated in Slovenia in given period of time were included in study. Postoperatively they completed neuropsychological assessment consisting of Slovenian Verbal Learning Test, Slovenian Controlled Oral Word Association Test, Trail Making Test Part A and B and self-evaluation questionnaire. We analysed results (z-scores and dichotomized results) also according to IDH mutation and MGMT methylation. We examined differences between groups using T-test, Mann-Whitney U, χ2 and Kendall's Tau tests. RESULTS Out of 275 patients in the cohort, we included 90. Forty-six percent of patients were unable to participate due to poor performance status and other conditions related to tumour. Patients with the IDH mutation were younger, with better performance status, larger proportions of grade III tumours and MGMT methylation. In this group cognitive functioning is significantly better in the domains of immediate recall, short delayed recall and delayed recall, and in the fields of executive functioning and recognition. There were no differences in cognitive functioning in regard to MGMT status. Grade III tumours were associated with more frequent MGMT methylation. Self-assessment proved week tool, associated only with immediate recall. CONCLUSIONS We found no differences in cognitive functioning according to MGMT status, but cognition was better when IDH mutation was present. In a cohort study of patients with high-grade glioma, almost half were unable to participate in a study, which points to an overrepresentation of patients with better cognitive functioning in the research.
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Affiliation(s)
- Andreja Cirila Skufca Smrdel
- Department of Psycho-Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Department of Psychology, Faculty of Arts, University of Ljubljana, Slovenia
| | - Anja Podlesek
- Department of Psychology, Faculty of Arts, University of Ljubljana, Slovenia
| | - Marija Skoblar Vidmar
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
| | - Jana Markovic
- Department of Psycho-Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Jana Jereb
- Department of Psycho-Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Uros Smrdel
- Division of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Slovenia
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13
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Cognitive issues in patients with IDH mutant gliomas: from neuroscience to clinical neuropsychology. J Neurooncol 2023; 162:525-533. [PMID: 36940053 DOI: 10.1007/s11060-023-04289-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The understanding of cognitive symptoms in patients with IDH-Mutant gliomas (IDH-Mut) is rapidly developing. In this article, we summarize the neuroscientific knowledge base regarding the influence of IDH-Mut tumors and their treatment on cognition and provide guidance regarding the management of these symptoms in patients. METHODS We performed a review of peer reviewed publications relevant to IDH-Mut glioma and cognitive outcomes and provide an overview of the literature as well as a case example to clarify management strategies. RESULTS At the time of presentation, patients with IDH-Mut gliomas have a favorable cognitive profile as compared with those with IDH-wild type (WT) tumors. The relatively low cognitive burden may reflect the slower growth rate of IDH-Mut tumors, which is less disruptive to both local and widespread neural networks. Human connectomic research using a variety of modalities has demonstrated relatively preserved network efficiency in patients with IDH-Mut gliomas as compared with IDH-WT tumors. Risk of cognitive decline from surgery can potentially be mitigated by careful integration of intra-operative mapping. Longer term cognitive risks of tumor treatment, including chemotherapy and radiation, are best managed by instituting neuropsychological assessment as part of the long-term care of patients with IDH-Mutant glioma. A specific timeline for such integrative care is provided. CONCLUSIONS Given the relative recency of the IDH-mutation based classification of gliomas, as well as the long time course of this disease, a thoughtful and comprehensive strategy to studying patient outcomes and devising methods of cognitive risk reduction is required.
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14
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Hardy SJ, Finkelstein AJ, Tivarus M, Culakova E, Mohile N, Weber M, Lin E, Zhong J, Usuki K, Schifitto G, Milano M, Janelsins-Benton MC. Cognitive and neuroimaging outcomes in individuals with benign and low-grade brain tumours receiving radiotherapy: a protocol for a prospective cohort study. BMJ Open 2023; 13:e066458. [PMID: 36792323 PMCID: PMC9933762 DOI: 10.1136/bmjopen-2022-066458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Radiation-induced cognitive decline (RICD) occurs in 50%-90% of adult patients 6 months post-treatment. In patients with low-grade and benign tumours with long expected survival, this is of paramount importance. Despite advances in radiation therapy (RT) treatment delivery, better understanding of structures important for RICD is necessary to improve cognitive outcomes. We hypothesise that RT may affect network topology and microstructural integrity on MRI prior to any gross anatomical or apparent cognitive changes. In this longitudinal cohort study, we aim to determine the effects of RT on brain structural and functional integrity and cognition. METHODS AND ANALYSIS This study will enroll patients with benign and low-grade brain tumours receiving partial brain radiotherapy. Patients will receive either hypofractionated (>2 Gy/fraction) or conventionally fractionated (1.8-2 Gy/fraction) RT. All participants will be followed for 12 months, with MRIs conducted pre-RT and 6-month and 12 month post-RT, along with a battery of neurocognitive tests and questionnaires. The study was initiated in late 2018 and will continue enrolling through 2024 with final follow-ups completing in 2025. The neurocognitive battery assesses visual and verbal memory, attention, executive function, processing speed and emotional cognition. MRI protocols incorporate diffusion tensor imaging and resting state fMRI to assess structural connectivity and functional connectivity, respectively. We will estimate the association between radiation dose, imaging metrics and cognitive outcomes. ETHICS AND DISSEMINATION This study has been approved by the Research Subjects Review Board at the University of Rochester (STUDY00001512: Cognitive changes in patients receiving partial brain radiation). All results will be published in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT04390906.
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Affiliation(s)
- Sara J Hardy
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Alan J Finkelstein
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
- Center for Advanced Brain Imaging and Neurophysiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Madalina Tivarus
- Center for Advanced Brain Imaging and Neurophysiology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Nimish Mohile
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
| | - Miriam Weber
- Department of Neurology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York, USA
| | - Edward Lin
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Jianhui Zhong
- Department of Biomedical Engineering, University of Rochester, Rochester, New York, USA
- Center for Advanced Brain Imaging and Neurophysiology, University of Rochester Medical Center, Rochester, New York, USA
| | - Kenneth Usuki
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Giovanni Schifitto
- Department of Neurology, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Michael Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - M C Janelsins-Benton
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
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15
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Tariq R, Hussain N, Baqai MWS. Factors affecting cognitive functions of patients with high-grade gliomas: a systematic review. Neurol Sci 2023; 44:1917-1929. [PMID: 36773209 DOI: 10.1007/s10072-023-06673-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Gliomas make up approximately 26.5% of all primary CNS tumors and 80.7% of malignant tumors. They are classified according to histology, location, and genetics. Grade III and IV gliomas are considered high-grade gliomas (HGGs). The cognitive signs and symptoms are attributed to mass defects depending on location, growth rapidity, and edema. Our purpose is to review the cognitive status of patients diagnosed with HGGs; the effect of treatments including surgical resection, radiotherapy, and chemotherapy; and the predictors of the cognitive status. METHODS We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines as a template for the methodology. A comprehensive literature search was performed from three databases (PubMed, ScienceDirect, and Cochrane Library) for clinical trials and longitudinal studies on patients diagnosed with HGGs assessing their cognitive status. RESULTS Thirteen studies were selected among which 9 assessed cognitive function before and after treatment. One assessed the consistency of cognitive complaints and objective cognitive functioning. Three reported factors affecting disease progression and cognitive status. Most HGG patients have impairment in at least one cognitive domain. Treatments including surgical resection or radio-chemotherapy did not impair cognitive status. DISCUSSION The cognitive status could be used to assess sub-clinical tumor progression. Factors correlated to cognitive status were tumor location, edema, and grade. Patient characteristics correlated were pre-operative epilepsy, corticosteroid use, and age at the time of diagnosis. CONCLUSION Assessment of the cognitive status of HGG patients indicates sub-clinical tumor progression and may be used to assess treatment outcomes.
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Affiliation(s)
- Rabeet Tariq
- Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Nowal Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Samuel N, Harmsen IE, Ding MYR, Sarica C, Vetkas A, Wong C, Lawton V, Yang A, Rowland NC, Kalia SK, Valiante T, Wennberg R, Zadeh G, Kongkham P, Kalyvas A, Lozano AM. Investigation of neurophysiologic and functional connectivity changes following glioma resection using magnetoencephalography. Neurooncol Adv 2023; 5:vdad091. [PMID: 37547265 PMCID: PMC10403751 DOI: 10.1093/noajnl/vdad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background In patients with glioma, clinical manifestations of neural network disruption include behavioral changes, cognitive decline, and seizures. However, the extent of network recovery following surgery remains unclear. The aim of this study was to characterize the neurophysiologic and functional connectivity changes following glioma surgery using magnetoencephalography (MEG). Methods Ten patients with newly diagnosed intra-axial brain tumors undergoing surgical resection were enrolled in the study and completed at least two MEG recordings (pre-operative and immediate post-operative). An additional post-operative recording 6-8 weeks following surgery was obtained for six patients. Resting-state MEG recordings from 28 healthy controls were used for network-based comparisons. MEG data processing involved artifact suppression, high-pass filtering, and source localization. Functional connectivity between parcellated brain regions was estimated using coherence values from 116 virtual channels. Statistical analysis involved standard parametric tests. Results Distinct alterations in spectral power following tumor resection were observed, with at least three frequency bands affected across all study subjects. Tumor location-related changes were observed in specific frequency bands unique to each patient. Recovery of regional functional connectivity occurred following glioma resection, as determined by local coherence normalization. Changes in inter-regional functional connectivity were mapped across the brain, with comparable changes in low to mid gamma-associated functional connectivity noted in four patients. Conclusion Our findings provide a framework for future studies to examine other network changes in glioma patients. We demonstrate an intrinsic capacity for neural network regeneration in the post-operative setting. Further work should be aimed at correlating neurophysiologic changes with individual patients' clinical outcomes.
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Affiliation(s)
- Nardin Samuel
- Corresponding Author: Andres M. Lozano, OC, MD, PhD, FRCSC, FRSC, FCAHS, University Professor and Alan and Susan Chair in Neurosurgery, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, West Wing 4-431, Toronto, ON, Canada M5T 2S8 ()
| | | | - Mandy Yi Rong Ding
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Can Sarica
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Artur Vetkas
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Christine Wong
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Vanessa Lawton
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Andrew Yang
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathan C Rowland
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Murray Center for Research on Parkinson’s Disease and Related Disorders, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Suneil K Kalia
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Taufik Valiante
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
| | - Richard Wennberg
- Mitchell Goldhar MEG Unit, University Health Network, Toronto, Canada
- Toronto Western Hospital, Division of Neurology, University Health Network, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Paul Kongkham
- Toronto Western Hospital, Division of Neurosurgery, University Health Network, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Forster MT, Hug M, Geissler M, Voss M, Weber K, Hoelter MC, Seifert V, Czabanka M, Steinbach JP. Outcome and characteristics of patients with adult grade 4 diffuse gliomas changing sites of treatment. J Cancer Res Clin Oncol 2023; 149:111-119. [PMID: 36348019 PMCID: PMC9889416 DOI: 10.1007/s00432-022-04439-7] [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: 08/14/2022] [Accepted: 10/18/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE With increasing patient self-empowerment and participation in decision making, we hypothesized that patients with adult-type diffuse gliomas, CNS WHO grade 4 who change sites of treatment differ from patients being entirely treated in one neuro-oncological center. METHODS Prospectively collected data from all diffuse glioma grade 4 patients who underwent treatment in our neuro-oncological center between 2012 and 2018 were retrospectively examined for differences between patients having initially been diagnosed and/or treated elsewhere (External Group) and patients having entirely been treated in our neuro-oncological center (Internal Group). Additionally, a matched-pair analysis was performed to adjust for possible confounders. RESULTS A total of 616 patients was analyzed. Patients from the External Group (n = 78) were significantly younger, more frequently suffered from IDH-mutant astrocytoma grade 4, had a greater extent of tumor resection, more frequently underwent adjuvant therapy and experienced longer overall survival (all p < 0.001). However, after matching these patients to patients of the Internal Group considering IDH mutations, extent of resection, adjuvant therapy, age and gender, no difference in patients' overall survival was observed anymore. CONCLUSION The present study demonstrates that mobile diffuse glioma grade 4 patients stand out from a comprehensive diffuse glioma grade 4 patient cohort due to their favorable prognostic characteristics. However, changing treatment sites did not result in survival benefit over similar patients being entirely taken care of within one neuro-oncological institution. These results underline the importance of treatment and molecular markers in glioma disease for patients' self-empowerment, including changing treatment sites according to patients' needs and wishes.
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Affiliation(s)
- Marie-Therese Forster
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Marion Hug
- Department of Neurology, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
| | - Maximilian Geissler
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
| | - Martin Voss
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany ,Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
| | - Katharina Weber
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany ,Neurological Institute (Edinger Institute), Goethe University Hospital, Heinrich-Hoffmann-Str. 7, 60528 Frankfurt am Main, Germany ,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Maya Christina Hoelter
- Department of Neuroradiology, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany ,University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Joachim P. Steinbach
- University Cancer Center Frankfurt (UCT), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany ,Dr. Senckenberg Institute of Neurooncology, Goethe University Hospital, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany ,German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
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18
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Numan T, Breedt LC, Maciel BDAPC, Kulik SD, Derks J, Schoonheim MM, Klein M, de Witt Hamer PC, Miller JJ, Gerstner ER, Stufflebeam SM, Hillebrand A, Stam CJ, Geurts JJG, Reijneveld JC, Douw L. Regional healthy brain activity, glioma occurrence and symptomatology. Brain 2022; 145:3654-3665. [PMID: 36130310 PMCID: PMC9586543 DOI: 10.1093/brain/awac180] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/22/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
It is unclear why exactly gliomas show preferential occurrence in certain brain areas. Increased spiking activity around gliomas leads to faster tumour growth in animal models, while higher non-invasively measured brain activity is related to shorter survival in patients. However, it is unknown how regional intrinsic brain activity, as measured in healthy controls, relates to glioma occurrence. We first investigated whether gliomas occur more frequently in regions with intrinsically higher brain activity. Second, we explored whether intrinsic cortical activity at individual patients’ tumour locations relates to tumour and patient characteristics. Across three cross-sectional cohorts, 413 patients were included. Individual tumour masks were created. Intrinsic regional brain activity was assessed through resting-state magnetoencephalography acquired in healthy controls and source-localized to 210 cortical brain regions. Brain activity was operationalized as: (i) broadband power; and (ii) offset of the aperiodic component of the power spectrum, which both reflect neuronal spiking of the underlying neuronal population. We additionally assessed (iii) the slope of the aperiodic component of the power spectrum, which is thought to reflect the neuronal excitation/inhibition ratio. First, correlation coefficients were calculated between group-level regional glioma occurrence, as obtained by concatenating tumour masks across patients, and group-averaged regional intrinsic brain activity. Second, intrinsic brain activity at specific tumour locations was calculated by overlaying patients’ individual tumour masks with regional intrinsic brain activity of the controls and was associated with tumour and patient characteristics. As proposed, glioma preferentially occurred in brain regions characterized by higher intrinsic brain activity in controls as reflected by higher offset. Second, intrinsic brain activity at patients’ individual tumour locations differed according to glioma subtype and performance status: the most malignant isocitrate dehydrogenase-wild-type glioblastoma patients had the lowest excitation/inhibition ratio at their individual tumour locations as compared to isocitrate dehydrogenase-mutant, 1p/19q-codeleted glioma patients, while a lower excitation/inhibition ratio related to poorer Karnofsky Performance Status, particularly in codeleted glioma patients. In conclusion, gliomas more frequently occur in cortical brain regions with intrinsically higher activity levels, suggesting that more active regions are more vulnerable to glioma development. Moreover, indices of healthy, intrinsic excitation/inhibition ratio at patients’ individual tumour locations may capture both tumour biology and patients’ performance status. These findings contribute to our understanding of the complex and bidirectional relationship between normal brain functioning and glioma growth, which is at the core of the relatively new field of ‘cancer neuroscience’.
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Affiliation(s)
- Tianne Numan
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands
| | - Lucas C Breedt
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands
| | - Bernardo de A P C Maciel
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands
| | - Shanna D Kulik
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands
| | - Jolanda Derks
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands
| | - Martin Klein
- Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Department of Medical Psychology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Philip C de Witt Hamer
- Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Department of Neurosurgery, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Julie J Miller
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Elizabeth R Gerstner
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Steven M Stufflebeam
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands
| | - Jaap C Reijneveld
- Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Department of Neurology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Department of Neurology, Stichting Epilepsie Instellingen Nederland, Heemstede 2103 SW, The Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam 1081 HV, The Netherlands.,Cancer Center Amsterdam, Imaging and Biomarkers, Brain Tumor Center Amsterdam, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam 1081 HV, The Netherlands.,Amsterdam Neuroscience, Brain Imaging, Amsterdam 1081 HV, The Netherlands.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA
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19
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Guarracino I, Pauletto G, Ius T, Palese F, Skrap M, Tomasino B. Presurgical cognitive status in patients with low-grade glioma and epilepsy: Testing the effects of seizures, antiseizure medications, and tumor localization. Brain Behav 2022; 12:e2560. [PMID: 35377547 PMCID: PMC9120733 DOI: 10.1002/brb3.2560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/18/2022] [Accepted: 03/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Low-grade gliomas (LGGs) are frequently associated with epilepsy. There are few studies addressing the impact of seizures, antiseizure medications (ASMs), and lesion localization on presurgery cognitive functioning. METHODS We tested the relation between the above-mentioned variables in a continuous series of 73 young patients (mean age 38.3 years ± 11.7) affected by LGGs and epilepsy. The anatomical areas, involved in this sample, were the left insula with surrounding cortical and subcortical areas, the right precentral gyrus/rolandic operculum, and the white matter and cortical regions beneath. RESULTS Patients' presurgery cognitive status was within the normal range, with borderline performance for some tasks. We tested whether lower scores were related with lesion or with epilepsy-related factors. Multiple regression identified variables that predict test scores. The Token test score was predicted by a model (p = .0078) containing the DT2T1 MRI, corrected for seizure features. Object naming performance was predicted by a model (p = .0113) containing the localization, the DT2T1 MRI, corrected for sex, EEG, and onset. Verbal fluency score was predicted by a model (p = .0056) containing the localization and the DT2T1 MRI, corrected for AEDs and EEG. Working memory score was predicted by a model (p = .0117) containing Engel class, the DT2T1 MRI, corrected for sex. Clock drawing score was predicted by a model (p < .0001) containing the Engel class, AEDs, and EEG. TMT A score was predicted by a model (p = .0022) containing localization, corrected for EEG. TMT B-A score was predicted by a model (p = .0373) containing localization. Voxel Lesion Symptom Mapping analyses carried out on patients' lesion volumes confirmed that patients' level of performance correlated with lesion-related variables. CONCLUSION This preliminary study indicates that the presurgical level of performance for language tasks and for cognitive flexibility and shifting is mainly predicted by lesion-related variables, working memory by both lesion and epilepsy-related variables. Epilepsy clinical and instrumental characteristics predicted performance for visuospatial planning.
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Affiliation(s)
- Ilaria Guarracino
- Polo FVG, San Vito al Tagliamento, PN, Scientific Institute IRCCS "Eugenio Medea,", Italy
| | - Giada Pauletto
- Unità Operativa di Neurologia, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Tamara Ius
- Unità Operativa di Neurochirurgia, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Francesca Palese
- Servizio di Igiene e Sanità Pubblica Dipartimento di Prevenzione, San Daniele del Friuli, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Miran Skrap
- Unità Operativa di Neurochirurgia, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - Barbara Tomasino
- Polo FVG, San Vito al Tagliamento, PN, Scientific Institute IRCCS "Eugenio Medea,", Italy
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20
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Chen Z, Ye N, Teng C, Li X. Alternations and Applications of the Structural and Functional Connectome in Gliomas: A Mini-Review. Front Neurosci 2022; 16:856808. [PMID: 35478847 PMCID: PMC9035851 DOI: 10.3389/fnins.2022.856808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/28/2022] [Indexed: 12/12/2022] Open
Abstract
In the central nervous system, gliomas are the most common, but complex primary tumors. Genome-based molecular and clinical studies have revealed different classifications and subtypes of gliomas. Neuroradiological approaches have non-invasively provided a macroscopic view for surgical resection and therapeutic effects. The connectome is a structural map of a physical object, the brain, which raises issues of spatial scale and definition, and it is calculated through diffusion magnetic resonance imaging (MRI) and functional MRI. In this study, we reviewed the basic principles and attributes of the structural and functional connectome, followed by the alternations of connectomes and their influences on glioma. To extend the applications of connectome, we demonstrated that a series of multi-center projects still need to be conducted to systemically investigate the connectome and the structural–functional coupling of glioma. Additionally, the brain–computer interface based on accurate connectome could provide more precise structural and functional data, which are significant for surgery and postoperative recovery. Besides, integrating the data from different sources, including connectome and other omics information, and their processing with artificial intelligence, together with validated biological and clinical findings will be significant for the development of a personalized surgical strategy.
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Affiliation(s)
- Ziyan Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Ningrong Ye
- Department of Neurosurgery, Xiangya Hospital, Central South University, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
| | - Chubei Teng
- Department of Neurosurgery, Xiangya Hospital, Central South University, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
- Department of Neurosurgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Hunan, China
- Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Xuejun Li,
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21
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van Kessel E, Krijnen EA, IJpelaar S, Wajer IMCH, Ruis C, Seute T, De Vos FYFL, Verhoeff JJC, Robe PA, van Zandvoort MJE, Snijders TJ. Complications, compliance and undertreatment do not explain the relationship between cognition and survival in diffuse glioma patients. Neurooncol Pract 2022; 9:284-298. [PMID: 35855455 PMCID: PMC9290897 DOI: 10.1093/nop/npac027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Cognitive deficits occur in all different grades of glioma. In a recent study, we found these deficits to be independently, and possibly causally, related to survival in diffuse gliomas. In this study, we investigated whether the relationship between cognition and survival was mediated by three different factors: undertreatment, complications of treatment, and compliance. We hypothesized that patients with cognitive impairment may undergo less intensive treatment, be less compliant, and suffer more from complications, resulting in shortened survival for cognitively impaired patients. Methods In a retrospective cohort study of patients undergoing awake craniotomy between operative neuropsychological assessments in five cognitive domains. We used Structural Equation Modeling to perform mediation analyses. Mediation analyses are analyses to evaluate whether a variable is a factor in the causal chain, referred to as an intermediate factor. Results In total 254 patients were included, of whom 111 patients were LGG patients and 143 were HGG patients. The most frequently impaired domain was memory (37.8% ≤–2 SD) in HGG and attention and executive functioning in LGG (33.3≤–1.5 SD). We confirmed the significant association between different cognitive domains and survival. These associations could not be explained by one of the aforementioned intermediate factors. Conclusions This suggests that other mechanisms should be involved in the relation between cognition and survival. Hypothetically, cognitive functioning can act as a marker for diffuse infiltration of the tumor or cognitive functioning and survival could be determined by overlapping germline and somatic tumoral molecular-genetic factors.
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Affiliation(s)
- Emma van Kessel
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Eva A Krijnen
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Suzanne IJpelaar
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Irene M C Huenges Wajer
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Experimental Psychology, Heidelberglaan, Utrecht, The Netherlands
| | - Carla Ruis
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Experimental Psychology, Heidelberglaan, Utrecht, The Netherlands
| | - Tatjana Seute
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Filip Y F L De Vos
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Medical Oncology, Utrecht, The Netherlands
| | - Joost J C Verhoeff
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Radiation Oncology, Utrecht, The Netherlands
| | - Pierre A Robe
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
| | - Martine J E van Zandvoort
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
- Helmholtz Institute, Utrecht University, Experimental Psychology, Heidelberglaan, Utrecht, The Netherlands
| | - Tom J Snijders
- University Medical Center Utrecht/UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, Utrecht, The Netherlands
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22
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Luks TL, Villanueva-Meyer JE, Weyer-Jamora C, Gehring K, Jakary A, Hervey-Jumper SL, Braunstein SE, Bracci PM, Brie MS, Smith EM, Chang SM, Taylor JW. T2 FLAIR Hyperintensity Volume Is Associated With Cognitive Function and Quality of Life in Clinically Stable Patients With Lower Grade Gliomas. Front Neurol 2022; 12:769345. [PMID: 35153976 PMCID: PMC8831734 DOI: 10.3389/fneur.2021.769345] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/20/2021] [Indexed: 01/03/2023] Open
Abstract
Survival outcomes for patients with lower grade gliomas (LrGG) continue to improve. However, damage caused both by tumor growth and by the consequences of treatment often leads to significantly impaired cognitive function and quality of life (QoL). While neuropsychological testing is not routine, serial clinical MRIs are standard of care for patients with LrGG. Thus, having a greater understanding of MRI indicators of cognitive and QoL impairment risk could be beneficial to patients and clinicians. In this work we sought to test the hypothesis that in clinically stable LrGG patients, T2 FLAIR hyperintensity volumes at the time of cognitive assessment are associated with impairments of cognitive function and QoL and could be used to help identify patients for cognitive and QoL assessments and interventions. We performed anatomical MR imaging, cognitive testing and QoL assessments cross-sectionally in 30 clinically stable grade 2 and 3 glioma patients with subjective cognitive concerns who were 6 or more months post-treatment. Larger post-surgical T2 FLAIR volume at testing was significantly associated with lower cognitive performance, while pre-surgical tumor volume was not. Older patients had lower cognitive performance than younger patients, even after accounting for normal age-related declines in performance. Patients with Astrocytoma, IDH mutant LrGGs were more likely to show lower cognitive performance than patients with Oligodendroglioma, IDH mutant 1p19q co-deleted LrGGs. Previous treatment with combined radiation and chemotherapy was associated with poorer self-reported QoL, including self-reported cognitive function. This study demonstrates the importance of appreciating that LrGG patients may experience impairments in cognitive function and QoL over their disease course, including during periods of otherwise sustained clinical stability. Imaging factors can be helpful in identifying vulnerable patients who would benefit from cognitive assessment and rehabilitation.
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Affiliation(s)
- Tracy L. Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Tracy L. Luks
| | - Javier E. Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Christina Weyer-Jamora
- Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Karin Gehring
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, Netherlands
- Department of Cognitive Neuropsychology, Tilburg University, Tilburg, Netherlands
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Shawn L. Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Steve E. Braunstein
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, United States
| | - Paige M. Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Melissa S. Brie
- Zuckerberg San Francisco General Hospital, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Ellen M. Smith
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Susan M. Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Jennie W. Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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23
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Wolthuis N, Satoer D, Veenstra W, Smits M, Wagemakers M, Vincent A, Bastiaanse R, Cherian PJ, Bosma I. Resting-State Electroencephalography Functional Connectivity Networks Relate to Pre- and Postoperative Language Functioning in Low-Grade Glioma and Meningioma Patients. Front Neurosci 2021; 15:785969. [PMID: 34955732 PMCID: PMC8693574 DOI: 10.3389/fnins.2021.785969] [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: 09/29/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Preservation of language functioning in patients undergoing brain tumor surgery is essential because language impairments negatively impact the quality of life. Brain tumor patients have alterations in functional connectivity (FC), the extent to which brain areas functionally interact. We studied FC networks in relation to language functioning in glioma and meningioma patients. Method: Patients with a low-grade glioma (N = 15) or meningioma (N = 10) infiltrating into/pressing on the language-dominant hemisphere underwent extensive language testing before and 1 year after surgery. Resting-state EEG was registered preoperatively, postoperatively (glioma patients only), and once in healthy individuals. After analyzing FC in theta and alpha frequency bands, weighted networks and Minimum Spanning Trees were quantified by various network measures. Results: Pre-operative FC network characteristics did not differ between glioma patients and healthy individuals. However, hub presence and higher local and global FC are associated with poorer language functioning before surgery in glioma patients and predict worse language performance at 1 year after surgery. For meningioma patients, a greater small worldness was related to worse language performance and hub presence; better average clustering and global integration were predictive of worse outcome on language function 1 year after surgery. The average eccentricity, diameter and tree hierarchy seem to be the network metrics with the more pronounced relation to language performance. Discussion: In this exploratory study, we demonstrated that preoperative FC networks are informative for pre- and postoperative language functioning in glioma patients and to a lesser extent in meningioma patients.
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Affiliation(s)
- Nienke Wolthuis
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands
| | - Djaina Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wencke Veenstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marion Smits
- Department of Radiology & Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.,Brain Tumour Centre, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Michiel Wagemakers
- Department of Neurosurgery, University Medical Center Groningen, Groningen, Netherlands
| | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Roelien Bastiaanse
- Center for Language and Cognition Groningen, University of Groningen, Groningen, Netherlands.,National Research University Higher School of Economics, Moscow, Russia
| | - Perumpillichira J Cherian
- Department of Neurology, University Medical Center Rotterdam, Rotterdam, Netherlands.,Division of Neurology, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Ingeborg Bosma
- Department of Neurology, University Medical Center Groningen, Groningen, Netherlands
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24
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Noll K, King AL, Dirven L, Armstrong TS, Taphoorn MJB, Wefel JS. Neurocognition and Health-Related Quality of Life Among Patients with Brain Tumors. Hematol Oncol Clin North Am 2021; 36:269-282. [PMID: 34711455 DOI: 10.1016/j.hoc.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patients with brain tumors experience great symptom burden across various domains of functioning, with associated decreases in health-related quality of life and general well-being. Impaired neurocognitive functioning is among the primary concerns of these patients. Unfortunately, most patients will experience such impairment at some point in the disease. However, impaired neurocognitive functioning, symptom burden, and well-being vary according numerous patient-, tumor-, and treatment-related factors. Recent work has furthered our understanding of these contributors to patient functioning and health-related quality of life and also points to various potential targets for prevention and intervention strategies, though more efficacious treatments remain needed.
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Affiliation(s)
- Kyle Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA
| | - Amanda L King
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Road, Building 82, Room 214, Bethesda, MD 20892, USA
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands; Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, the Netherlands
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 82, Room 201, Bethesda, MD 20892, USA
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, the Netherlands; Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, the Netherlands
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 431, Houston, TX 77030, USA.
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25
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Haldbo-Classen L, Amidi A, Wu LM, Lukacova S, Oettingen G, Lassen-Ramshad Y, Zachariae R, Kallehauge JF, Høyer M. Associations between patient-reported outcomes and radiation dose in patients treated with radiation therapy for primary brain tumours. Clin Transl Radiat Oncol 2021; 31:86-92. [PMID: 34693039 PMCID: PMC8515293 DOI: 10.1016/j.ctro.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022] Open
Abstract
Higher radiation doses to the brain may negatively affect quality of life. Higher radiation doses to the brain may negatively affect patient-reported cognition. Patients with fatigue had received higher dose to certain areas in the brain.
Aim This study aimed to explore associations between radiation dose and patient-reported outcomes in patients with a primary non-glioblastoma brain tumour treated with radiation therapy (RT), with a focus on health-related quality-of-life (HRQoL) and self-reported cognitive function. Methods In this cross-sectional study, 78 patients who had received RT for a non-glioblastoma primary brain tumour, underwent neuropsychological testing and completed questionnaires on HRQoL, cognitive function, fatigue, depression, anxiety and perceived stress. The study explores the association between HRQoL scores, self-reported cognitive function and radiation doses to total brain, brainstem, hippocampus, thalamus, temporal lobes and frontal lobes. In addition, we examined correlations between neuropsychological test scores and self-reported cognitive function. Results The median time between RT and testing was 4.6 years (range 1–9 years). Patients who had received high mean radiation doses to the total brain had low HRQoL scores (Cohen’s d = 0.50, p = 0.04), brainstem (d = 0.65, p = 0.01) and hippocampus (d = 0.66, p = 0.01). High mean doses to the total brain were also associated with low scores on self-reported cognitive functioning (Cohen’s d = 0.64, p = 0.02), brainstem (d = 0.55, p = 0.03), hippocampus (d = 0.76, p < 0.01), temporal lobes (d = 0.70, p < 0.01) and thalamus (d = 0.64, p = 0.01). Self-reported cognitive function correlated well with neuropsychological test scores (correlation range 0.27–0.54.) Conclusions High radiation doses to specific brain structures may be associated with impaired HRQoL and self-reported cognitive function with potentially negative implications to patients’ daily lives. Patient-reported outcomes of treatment-related side-effects and their associations with radiation doses to the brain and its sub-structures may provide important information on radiation tolerance to the brain and sub-structures.
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Affiliation(s)
- L Haldbo-Classen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A Amidi
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| | - L M Wu
- Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Denmark.,Aarhus Institute of Advanced Studies, Aarhus University, Denmark
| | - S Lukacova
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - G Oettingen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Y Lassen-Ramshad
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - R Zachariae
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Unit for Psychooncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
| | - J F Kallehauge
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - M Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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26
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Numan T, Kulik SD, Moraal B, Reijneveld JC, Stam CJ, de Witt Hamer PC, Derks J, Bruynzeel AME, van Linde ME, Wesseling P, Kouwenhoven MCM, Klein M, Würdinger T, Barkhof F, Geurts JJG, Hillebrand A, Douw L. Non-invasively measured brain activity and radiological progression in diffuse glioma. Sci Rep 2021; 11:18990. [PMID: 34556701 PMCID: PMC8460818 DOI: 10.1038/s41598-021-97818-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/20/2021] [Indexed: 01/25/2023] Open
Abstract
Non-invasively measured brain activity is related to progression-free survival in glioma patients, suggesting its potential as a marker of glioma progression. We therefore assessed the relationship between brain activity and increasing tumor volumes on routine clinical magnetic resonance imaging (MRI) in glioma patients. Postoperative magnetoencephalography (MEG) was recorded in 45 diffuse glioma patients. Brain activity was estimated using three measures (absolute broadband power, offset and slope) calculated at three spatial levels: global average, averaged across the peritumoral areas, and averaged across the homologues of these peritumoral areas in the contralateral hemisphere. Tumors were segmented on MRI. Changes in tumor volume between the two scans surrounding the MEG were calculated and correlated with brain activity. Brain activity was compared between patient groups classified into having increasing or stable tumor volume. Results show that brain activity was significantly increased in the tumor hemisphere in general, and in peritumoral regions specifically. However, none of the measures and spatial levels of brain activity correlated with changes in tumor volume, nor did they differ between patients with increasing versus stable tumor volumes. Longitudinal studies in more homogeneous subgroups of glioma patients are necessary to further explore the clinical potential of non-invasively measured brain activity.
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Affiliation(s)
- T Numan
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, O
- 2 building 13W09, De Boelelaan 1108, 1081 HV, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S D Kulik
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, O
- 2 building 13W09, De Boelelaan 1108, 1081 HV, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - B Moraal
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J C Reijneveld
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C J Stam
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P C de Witt Hamer
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Derks
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, O
- 2 building 13W09, De Boelelaan 1108, 1081 HV, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - A M E Bruynzeel
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Radiotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M E van Linde
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Wesseling
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M C M Kouwenhoven
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Klein
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - T Würdinger
- Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurosurgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - J J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, O
- 2 building 13W09, De Boelelaan 1108, 1081 HV, Amsterdam, The Netherlands
| | - A Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L Douw
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, O
- 2 building 13W09, De Boelelaan 1108, 1081 HV, Amsterdam, The Netherlands. .,Brain Tumor Center Amsterdam, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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27
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Li L, Li G, Fang S, Zhang K, Huang R, Wang Y, Zhang C, Li Y, Zhang W, Zhang Z, Jin Q, Zhou D, Fan X, Jiang T. New-Onset Postoperative Seizures in Patients With Diffuse Gliomas: A Risk Assessment Analysis. Front Neurol 2021; 12:682535. [PMID: 34220689 PMCID: PMC8250134 DOI: 10.3389/fneur.2021.682535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Glioma-related epilepsy (GRE) is the most common presenting sign of patients with diffuse glioma. According to clinical experience, new-onset postoperative seizures can be observed even in patients without preoperative GRE. The current study mainly aimed to explore the risk factors of new-onset postoperative seizures in those patients. In addition, the prognostic value of new-onset postoperative seizures was also discussed. Methods: Data of 313 patients without GRE were retrospectively reviewed. Chi-square test or Fisher's exact test were first performed to compare categorical variables between patients with new-onset postoperative seizures and those without. Subsequently, binary logistic regression analysis was conduct to further assess risk factors of new-onset postoperative seizures. Kaplan-Meier and Cox analysis were used to investigate the prognostic value of new-onset postoperative seizures for progression-free survival (PFS) and overall survival (OS). Results: Patients with low-grade tumors (p = 0.006), isocitrate dehydrogenase 1 (IDH1) mutation (p = 0.040) or low Ki-67 expression (p = 0.005) showed a higher incidence of new-onset postoperative seizures. IDH1 mutation was identified as the only independent predictor for new-onset postoperative seizures (OR, 2.075; 95% CI, 1.051–4.098; p = 0.035). Additionally, new-onset postoperative seizure occurrence was demonstrated as an independent predicter of prolonged OS (OR, 0.574; 95% CI, 0.335–0.983; p = 0.043), while younger age, gross total resection, low-grade and IDH1 mutation were independently correlated with prolonged OS and PFS. Conclusions: IDH1 mutation is an independent predictor for new-onset postoperative seizures in patients without preoperative GRE. Moreover, new-onset postoperative seizures can independently predict prolonged OS in those patients. The results of the current study can contribute to improving the individualized management of diffuse glioma.
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Affiliation(s)
- Lianwang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Guanzhang Li
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Shengyu Fang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Kenan Zhang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ruoyu Huang
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yinyan Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chuanbao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Jin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dabiao Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing Fan
- Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,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.,Research Units of Accurate Diagnosis and Treatment of Brain Tumors and Translational Medicine, Chinese Academy of Medical Sciences, Beijing, China
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28
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Derks J, Kulik SD, Numan T, de Witt Hamer PC, Noske DP, Klein M, Geurts JJG, Reijneveld JC, Stam CJ, Schoonheim MM, Hillebrand A, Douw L. Understanding Global Brain Network Alterations in Glioma Patients. Brain Connect 2021; 11:865-874. [PMID: 33947274 DOI: 10.1089/brain.2020.0801] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Introduction: Glioma patients show increased global brain network clustering related to poorer cognition and epilepsy. However, it is unclear whether this increase is spatially widespread, localized in the (peri)tumor region only, or decreases with distance from the tumor. Materials and Methods: Weighted global and local brain network clustering was determined in 71 glioma patients and 53 controls by using magnetoencephalography. Tumor clustering was determined by averaging local clustering of regions overlapping with the tumor, and vice versa for non-tumor regions. Euclidean distance was determined from the tumor centroid to the centroids of other regions. Results: Patients showed higher global clustering compared with controls. Clustering of tumor and non-tumor regions did not differ, and local clustering was not associated with distance from the tumor. Post hoc analyses revealed that in the patient group, tumors were located more often in regions with higher clustering in controls, but it seemed that tumors of patients with high global clustering were located more often in regions with lower clustering in controls. Conclusions: Glioma patients show non-local network disturbances. Tumors of patients with high global clustering may have a preferred localization, namely regions with lower clustering in controls, suggesting that tumor localization relates to the extent of network disruption. Impact statement This work uses the innovative framework of network neuroscience to investigate functional connectivity patterns associated with brain tumors. Glioma (primary brain tumor) patients experience cognitive deficits and epileptic seizures, which have been related to brain network alterations. This study shows that glioma patients have a spatially widespread increase in global network clustering, which cannot be attributed to local effects of the tumor. Moreover, tumors occur more often in brain regions with higher network clustering in controls. This study emphasizes the global character of network alterations in glioma patients and suggests that preferred tumor locations are characterized by particular network profiles.
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Affiliation(s)
- Jolanda Derks
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Shanna D Kulik
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tianne Numan
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Philip C de Witt Hamer
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurosurgery, Overarching Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - David P Noske
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurosurgery, Overarching Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin Klein
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Psychology, and Overarching Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Overarching Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging/Massachusetts General Hospital, Charlestown, Massachusetts, USA
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29
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Butterbrod E, Sitskoorn M, Bakker M, Jakobs B, Fleischeuer R, Roijers J, Rutten G, Gehring K. The APOE ε4 allele in relation to pre- and postsurgical cognitive functioning of patients with primary brain tumors. Eur J Neurol 2021; 28:1665-1676. [PMID: 33342004 PMCID: PMC8247965 DOI: 10.1111/ene.14693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Recent studies suggest a relationship between the APOE ε4 allele and cognitive outcome in patients treated for malignant brain tumors. Still, longitudinal investigations that include a pretreatment cognitive assessment are lacking and APOE's effects in patients with benign tumors are understudied. This study investigated presurgical cognitive performance and postsurgical change in ε4-carrying and non-carrying patients with glioma and meningioma. METHODS Neuropsychological test scores (CNS Vital Signs battery [seven measures], Digit Span Forward/Backward, Letter Fluency test) were obtained as part of a prospective study in which patients with meningioma and glioma underwent cognitive assessment 1 day before (T0, n = 505) and 3 (T3, n = 418) and 12 months after (T12, n = 167) surgery. APOE isoforms were identified retrospectively. ε4 carriers and non-carriers were compared with regard to pretreatment cognitive performance on the group and individual level. Changes in performances over time were compared with longitudinal mixed model analysis in the total sample and the subgroup receiving adjuvant treatment. RESULTS Carriers and non-carriers did not differ with regard to pretreatment performance. No significant main effect of ε4 carrier status or interaction between time (T0-T12) and carrier status was found on any of the tests in the whole sample nor in the sample receiving adjuvant treatment. CONCLUSIONS This study found no evidence of increased vulnerability for pretreatment cognitive dysfunction or cognitive decline within 1 year after surgery in APOE ε4-carrying meningioma and glioma patients. Investigations that include larger samples at longer-term follow-up are recommended to investigate potential late treatment effects.
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Affiliation(s)
- Elke Butterbrod
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgThe Netherlands
| | - Margriet Sitskoorn
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgThe Netherlands
| | - Marjan Bakker
- Department of Methodology and StatisticsTilburg UniversityTilburgThe Netherlands
| | - Bernadette Jakobs
- Department of Laboratory MedicineElisabeth‐Tweesteden HospitalTilburgThe Netherlands
| | - Ruth Fleischeuer
- Clinical Pathology LaboratoryElisabeth‐Tweesteden HospitalTilburgThe Netherlands
| | - Janine Roijers
- Department of Laboratory MedicineElisabeth‐Tweesteden HospitalTilburgThe Netherlands
| | - Geert‐Jan Rutten
- Department of NeurosurgeryElisabeth‐Tweesteden HospitalTilburgThe Netherlands
| | - Karin Gehring
- Department of Cognitive NeuropsychologyTilburg UniversityTilburgThe Netherlands
- Department of NeurosurgeryElisabeth‐Tweesteden HospitalTilburgThe Netherlands
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30
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Impaired neurocognitive function in glioma patients: from pathophysiology to novel intervention strategies. Curr Opin Neurol 2020; 33:716-722. [PMID: 33009006 DOI: 10.1097/wco.0000000000000865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This review succinctly summarizes the recent literature regarding etiological contributors to impaired neurocognitive function (NCF) in adult patients with glioma. A brief overview of intervention and prevention strategies is also provided. RECENT FINDINGS A majority of patients with glioma exhibit NCF deficits, most frequently in memory and executive functioning. Impairments are often disabling and associated with reduced quality of life and survival. Cause is multifactorial and includes the tumour itself, treatments received and associated comorbidities. Although modern techniques such as brain mapping, dosing modifications and prophylactic medication aim to improve the NCF outcomes following neurosurgical resection and radiation therapy, a sizeable proportion of patients continue to evidence treatment-related NCF declines related to adverse effects to both local and distributed cerebral networks. Numerous patient and tumour characteristics, including genetic markers and sociodemographic factors, influence the pattern and severity of NCF impairment. Some rehabilitative and pharmacologic approaches show promise in mitigating NCF impairment in this population, though benefits are somewhat modest and larger scale intervention studies are needed. SUMMARY Research regarding NCF in patients with glioma has dramatically proliferated, providing insights into the mechanisms underlying impaired NCF and pointing to potential interventions, though further work is needed.
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31
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Bunevicius A, Miller J, Parsons M. Isocitrate Dehydrogenase, Patient-Reported Outcomes, and Cognitive Functioning of Glioma Patients: a Systematic Review. Curr Oncol Rep 2020; 22:120. [PMID: 32965568 DOI: 10.1007/s11912-020-00978-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Isocitrate dehydrogenase (IDH) mutation status has important prognostic implications in glioma patients, with IDH wild-type (IDH-WT) gliomas being associated with worse prognosis and shorter survival when compared with IDH mutant (IDH-mut) gliomas. Optimization of quality of life is a priority in the management of glioma patients. The goal of this systematic review was to identify studies that explored the association of IDH mutation status with patient-reported outcomes (PROs) and cognitive functioning of glioma patients. RECENT FINDINGS Studies that evaluated the association of IDH mutation status with PROs and/or cognitive functioning of glioma patients were identified from the Pubmed/MEDLINE, Clarivate analytics, and Google Scholar databases. Eight studies (7 journal articles and 2 conference abstracts) with a total of 658 low-grade glioma and high-grade glioma patients investigated the association of cognitive functioning and/or QoL with IDH status. IDH-WT status was associated with greater cognitive impairment relative to IDH-Mut status in three studies, while one study did not find the association between IDH status and perioperative cognitive functioning. One study reported worse postoperative cognitive functioning patients with IDH-WT vs. IDH-mut gliomas. In one study, IDH-WT status was linked to greater impairment on physical and communication functioning after surgery. IDH-WT gliomas are associated with greater cognitive burden than IDH-Mut tumors. The association of IDH status with QoL remains less clear. Assessment of IDH status should be considered when evaluating QoL and cognitive complaints of glioma patients. Further studies linking glioma molecular phenotypes with PROs and cognitive functioning are encouraged.
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Affiliation(s)
- Adomas Bunevicius
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.
- Department of Neurosurgery, University of Virginia, 1 Hospital Dr., Charlottesville, VA, 22903, USA.
| | - Julie Miller
- Harvard Medical School, Boston, MA, USA
- Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Parsons
- Harvard Medical School, Boston, MA, USA
- Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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32
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Reilly JM, Gundersen AI, Silver JK, Tan CO, Knowlton SE. A Comparison of Functional Outcomes between Patients Admitted to Inpatient Rehabilitation after Initial Diagnosis Versus Recurrence of Glioblastoma Multiforme. PM R 2020; 12:975-983. [PMID: 32281244 DOI: 10.1002/pmrj.12379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/25/2020] [Accepted: 03/27/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prior studies of inpatient rehabilitation of patients with brain tumor demonstrate similar functional gains as compared to other rehabilitation populations. There are few studies specifically examining the rehabilitation of patients with glioblastoma. OBJECTIVE To compare functional outcomes between matched patients admitted to acute inpatient rehabilitation after initial diagnosis of glioblastoma (iGBM) and after diagnosis of recurrent glioblastoma (rGBM). DESIGN A retrospective, case-matched study using descriptive statistics compared demographic information and functional outcomes as designated by the Functional Independence Measure (FIM) score. SETTING A single, freestanding inpatient rehabilitation hospital. PATIENTS Over a 20-month period, 25 patients with iGBM were matched with 25 patients admitted to an inpatient rehabilitation facility with rGBM by the following criteria: (1) side of lesion (left/right hemisphere), (2) admission total FIM score within 10 points, (3) age within 10 years, and (4) gender. Nineteen of the 25 patients in each group were matched meeting all criteria, and 6 of the 25 patients were matched meeting three out of four criteria. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The primary outcome measures were differences in functional outcomes as measured by FIM scores. RESULTS There were no statistically significant differences (P < .05) between the groups in mean admission FIM scores, discharge FIM scores, FIM gains, and FIM efficiencies. There were no statistically significant differences in the development of complications during acute rehabilitation and transfer rate to acute care hospital. Sixty-four percent of patients in both groups were able to be discharged home. CONCLUSIONS This study demonstrated no statistically significant differences in functional outcomes between matched patients admitted with iGBM compared to rGBM. Further studies are indicated to examine the rehabilitation outcomes of patients with rGBM in inpatient rehabilitation.
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Affiliation(s)
- Julia M Reilly
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Alexandra I Gundersen
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Massachusetts General Hospital, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Can Ozan Tan
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Research Institute, Spaulding Rehabilitation Hospital, Boston, MA, USA.,Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sasha E Knowlton
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital, Charlestown, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
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33
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Belgers V, Numan T, Kulik SD, Hillebrand A, de Witt Hamer PC, Geurts JJG, Reijneveld JC, Wesseling P, Klein M, Derks J, Douw L. Postoperative oscillatory brain activity as an add-on prognostic marker in diffuse glioma. J Neurooncol 2020; 147:49-58. [PMID: 31953611 PMCID: PMC7075827 DOI: 10.1007/s11060-019-03386-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022]
Abstract
Introduction Progression-free survival (PFS) in glioma patients varies widely, even when stratifying for known predictors (i.e. age, molecular tumor subtype, presence of epilepsy, tumor grade and Karnofsky performance status). Neuronal activity has been shown to accelerate tumor growth in an animal model, suggesting that brain activity may be valuable as a PFS predictor. We investigated whether postoperative oscillatory brain activity, assessed by resting-state magnetoencephalography is of additional value when predicting PFS in glioma patients. Methods We included 27 patients with grade II–IV gliomas. Each patient’s oscillatory brain activity was estimated by calculating broadband power (0.5–48 Hz) in 56 epochs of 3.27 s and averaged over 78 cortical regions of the Automated Anatomical Labeling atlas. Cox proportional hazard analysis was performed to test the predictive value of broadband power towards PFS, adjusting for known predictors by backward elimination. Results Higher broadband power predicted shorter PFS after adjusting for known prognostic factors (n = 27; HR 2.56 (95% confidence interval (CI) 1.15–5.70); p = 0.022). Post-hoc univariate analysis showed that higher broadband power also predicted shorter overall survival (OS; n = 38; HR 1.88 (95% CI 1.00–3.54); p = 0.038). Conclusions Our findings suggest that postoperative broadband power is of additional value in predicting PFS beyond already known predictors. Electronic supplementary material The online version of this article (10.1007/s11060-019-03386-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vera Belgers
- Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Tianne Numan
- Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Shanna D Kulik
- Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Arjan Hillebrand
- Clinical Neurophysiology and MEG Center, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Philip C de Witt Hamer
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Neurosurgery, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Jeroen J G Geurts
- Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Jaap C Reijneveld
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Neurology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Pieter Wesseling
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Pathology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Martin Klein
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Medical Psychology, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Jolanda Derks
- Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands
| | - Linda Douw
- Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, Netherlands.
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 149 13th street, Charlestown, MA, USA.
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Zhang L. Glioma characterization based on magnetic resonance imaging: Challenge overview and future perspective. GLIOMA 2020. [DOI: 10.4103/glioma.glioma_9_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wang Q, Zhang L, Cui Y, Zhang C, Chen H, Gu J, Qian J, Luo C. Increased RLIP76 expression in IDH1 wild‑type glioblastoma multiforme is associated with worse prognosis. Oncol Rep 2019; 43:188-200. [PMID: 31746408 PMCID: PMC6908935 DOI: 10.3892/or.2019.7394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/25/2019] [Indexed: 12/16/2022] Open
Abstract
Mutation of the isocitrate dehydrogenase (IDH) gene is regarded a novel indicator for the prognosis of patients with glioma. However, the role of the IDH1 gene mutations in carcinogenesis and the mechanisms underlying their function in glioblastoma multiforme (GBM) remain unknown. The present study aimed to determine whether the association of RLIP76 with the different IDH1 mutational status could serve as a putative biomarker for improving disease prognosis. Quantitative PCR, western blotting and immunohistochemical staining assays were used to investigate the expression levels of RLIP76 in 124 patients with GBM with different IDH1 mutational status. In addition, the association between RLIP76 expression, IDH1 mutational status and clinicopathological characteristics was investigated. The effects of RLIP76 expression and IDH1 mutational status on cell proliferation, cell apoptosis, and cell signaling were examined by Cell Counting Kit-8, flow cytometry and western blot assays, respectively. The data demonstrated that IDH1 wild-type (IDH1Wt) patients with low RLIP76 expression exhibited improved overall and progression-free survival. This effect was not observed in patients with IDH1 mutant (IDH1Mut) GBM. In vitro assays demonstrated that knockdown of IDH1 or overexpression of the IDH1 R132H mutation suppressed cell proliferation and promoted cell apoptosis in U87 glioma cells. Mechanistic studies further indicated that although the IDH1 R132H mutant phenotype exhibited similar antitumor effects on GBM cells as those observed with the IDH1 knockdown, it acted via a different mechanism with regard to the regulation of the apoptosis signaling pathway. IDH1 R132H mutant cells promoted p53-induced apoptosis, while the IDH1 knockdown inhibited the RLIP76-dependent apoptotic pathway in glioma cells. The findings of the present study provided insight to the contribution of IDH1 mutation in the development of GBM and indicated that RLIP76 may be considered as a prognostic biomarker of IDH1Wt GBM.
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Affiliation(s)
- Qi Wang
- Department of Neurosurgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
| | - Lei Zhang
- Department of Neurosurgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
| | - Yong Cui
- Department of Neurosurgery, The 411 Hospital of People's Liberty Army, Shanghai 200081, P.R. China
| | - Chi Zhang
- Department of Neurosurgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
| | - Huairui Chen
- Department of Neurosurgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
| | - Juan Gu
- Department of Operating Room, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200092, P.R. China
| | - Jun Qian
- Department of Neurosurgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
| | - Chun Luo
- Department of Neurosurgery, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, P.R. China
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Derks J, Kulik S, Wesseling P, Numan T, Hillebrand A, van Dellen E, de Witt Hamer PC, Geurts JJG, Reijneveld JC, Stam CJ, Klein M, Douw L. Understanding cognitive functioning in glioma patients: The relevance of IDH-mutation status and functional connectivity. Brain Behav 2019; 9:e01204. [PMID: 30809977 PMCID: PMC6456787 DOI: 10.1002/brb3.1204] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 11/15/2018] [Accepted: 12/11/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Cognitive deficits occur frequently in diffuse glioma patients, but are limitedly understood. An important marker for survival in these patients is isocitrate dehydrogenase (IDH) mutation (IDH-mut). Patients with IDH-mut glioma have a better prognosis but more often suffer from epilepsy than patients with IDH-wildtype (IDH-wt) glioma, who are generally older and more often have cognitive deficits. We investigated whether global brain functional connectivity differs between patients with IDH-mut and IDH-wt glioma, and whether this measure reflects variations in cognitive functioning in these subpopulations beyond the associated differences in age and presence of epilepsy. METHODS We recorded magnetoencephalography and tested cognitive functioning in 54 diffuse glioma patients (31 IDH-mut, 23 IDH-wt). Global functional connectivity between 78 atlas regions spanning the entire cortex was calculated in two frequency bands (theta and alpha). Group differences in global functional connectivity were tested, as was their association with cognitive functioning, controlling for age, education, and presence of epilepsy. RESULTS Patients with IDH-wt glioma had lower functional connectivity in the alpha band than patients with IDH-mut glioma (p = 0.040, corrected for age and presence of epilepsy). Lower alpha band functional connectivity was associated with poorer cognitive performance (p < 0.034), corrected for age, education, and presence of epilepsy. CONCLUSION Global functional connectivity is lower in patients with IDH-wt diffuse glioma compared to patients with IDH-mut diffuse glioma. Moreover, having lower functional alpha connectivity relates to poorer cognitive performance in patients with diffuse glioma, regardless of age, education, and presence of epilepsy.
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Affiliation(s)
- Jolanda Derks
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.,VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Shanna Kulik
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.,VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Pieter Wesseling
- VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.,Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Pathology, Princess Máxima Center for Pediatric Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tianne Numan
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.,VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Brain Center Rudolf Magnus, Utrecht, The Netherlands
| | - Philip C de Witt Hamer
- VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.,Department of Neurosurgery, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Jeroen J G Geurts
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Jaap C Reijneveld
- VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Department of Clinical Neurophysiology and MEG Center, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Klein
- VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.,Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Linda Douw
- Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.,VUmc CCA Brain Tumor Center Amsterdam, Amsterdam, The Netherlands.,Athinoula A. Martinos Center for Biomedical Imaging/Massachusetts General Hospital, Charlestown, Massachusetts
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