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Sae-Huang M, Smith LC, Usher I, Hill CS. Cystic glioblastoma: A systematic review and meta-analysis of characteristics and outcomes. BRAIN & SPINE 2022; 2:101692. [PMID: 36605383 PMCID: PMC9808441 DOI: 10.1016/j.bas.2022.101692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 11/11/2022] [Indexed: 11/22/2022]
Abstract
Introduction Cystic glioblastoma is a well-recognised clinical entity but the characteristics and role of these cystic components in determining clinical outcome remains poorly understood. Research question To determine whether (1) there is a prognostic significance to a glioblastoma having a cystic component and (2) whether the presence of cyst, and its prognosis relative to non-cystic glioblastoma, relates to patient demographics and other tumour characteristics. Material & methods A systematic review and meta-analysis was conducted in accordance to PRISMA guidelines. Articles with histological and/or radiological diagnosis of cystic glioblastoma that reported on survival outcome and/or characteristics of cystic glioblastomas mentioned were included. Meta-analysis was performed and presented using random effect model. Results Twenty studies met the inclusion criteria, and nine studies were included in the meta-analysis (374 glioblastoma patients with cystic components and 2477 glioblastoma patients without cystic components above 18 years of age). Search result did not yield any Level I evidence. There is statistically significant survival benefit in cystic over non-cystic glioblastomas (HR = 0.81, 95%CI 0.70-0.93, p = 0.004, I2 = 50%). Studies reported younger average patient age, larger tumor size and slower tumor growth velocity in cystic glioblastoma. No significant difference in gender ratio and IDH-1 and MGMT methylation status between cystic and non-cystic glioblastoma were reported. Discussion & conclusion Presence of cyst in glioblastoma tumor is associated with improved overall survival outcome. Etiology of cystic entities and why they might confer survival benefits remained to be determined, and future studies examining how to best treat cystic glioblastomas would be clinically valuable.
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Affiliation(s)
- Morrakot Sae-Huang
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK,Department of Neurosurgery, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, UK
| | - Luke Christopher Smith
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| | - Inga Usher
- Cancer Biology Division, The UCL Cancer Institute, University College London, London, WC1E 6DD, UK
| | - Ciaran Scott Hill
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK,Cancer Biology Division, The UCL Cancer Institute, University College London, London, WC1E 6DD, UK,Corresponding author. The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
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Abstract
Craniopharyngioma (CP) is an intracranial benign tumor that behaves aggressively due to its location, infiltration of the surrounding nervous tissue and high capacity for recurrence. Treatment of choice is surgery followed or not by radiotherapy. Recent advances in molecular biology techniques and the better understanding of the genetic alterations of the two histological types of CP have open new therapeutic perspectives with targeted drugs. Adamantinomatous CP (ACP) is associated with activating mutations of the CTNNB1 gene. Such mutations are accompanied by intracellular accumulation of β-catenin, an oncogenic protein that activates the intracellular Wnt/ β-catenin signaling pathway, which regulates the transcription of genes involved in cell proliferation. Therefore, the use of molecular therapies directed against the activation of the Wnt/ β-catenin pathway could be an attractive and promising therapeutic option in the management of ACPs. On the other hand, papillary CP (PCP) is associated with activating mutations in the BRAF gene. This gene encodes a BRAF protein that plays an important role in the intracellular mitogen-activated protein kinase (MAPK) signaling pathway, which also regulates cell proliferation. The use of BRAF inhibitors either in monotherapy or in combination with mitogen-activated protein kinase (MEK) inhibitors has demonstrated therapeutic efficacy in isolated clinical cases of relapsed PCPs. A preliminary report of a recent phase II clinical trial has shown a therapeutic response in 93.7% of patients with BRAF V600E -mutated PCP, with an 85% reduction in tumor size. In the present review we comment on the efficacy and safety of the different drugs being used in patients with PCP.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana (IDIPHISA), Calle Manuel de Falla 1, 28222, Madrid, Spain.
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Radiographic markers of breast cancer brain metastases: relation to clinical characteristics and postoperative outcome. Acta Neurochir (Wien) 2022; 164:439-449. [PMID: 34677686 PMCID: PMC8854251 DOI: 10.1007/s00701-021-05026-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/09/2021] [Indexed: 12/24/2022]
Abstract
Objective Occurrence of brain metastases BM is associated with poor prognosis in patients with breast cancer (BC). Magnetic resonance imaging (MRI) is the standard of care in the diagnosis of BM and determines further treatment strategy. The aim of the present study was to evaluate the association between the radiographic markers of BCBM on MRI with other patients’ characteristics and overall survival (OS). Methods We included 88 female patients who underwent BCBM surgery in our institution from 2008 to 2019. Data on demographic, clinical, and histopathological characteristics of the patients and postoperative survival were collected from the electronic health records. Radiographic features of BM were assessed upon the preoperative MRI. Univariable and multivariable analyses were performed. Results The median OS was 17 months. Of all evaluated radiographic markers of BCBM, only the presence of necrosis was independently associated with OS (14.5 vs 22.5 months, p = 0.027). In turn, intra-tumoral necrosis was more often in individuals with shorter time interval between BC and BM diagnosis (< 3 years, p = 0.035) and preoperative leukocytosis (p = 0.022). Moreover, dural affection of BM was more common in individuals with positive human epidermal growth factor receptor 2 status (p = 0.015) and supratentorial BM location (p = 0.024). Conclusion Intra-tumoral necrosis demonstrated significant association with OS after BM surgery in patients with BC. The radiographic pattern of BM on the preoperative MRI depends on certain tumor and clinical characteristics of patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-05026-4.
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Stefini R, Peron S, Lacamera A, Cividini A, Fiaschi P, Sicuri GM. The positive effects of surgery on symptomatic stereotactic radiation-induced peritumoral brain edema: A report of three cases. Surg Neurol Int 2021; 12:358. [PMID: 34345498 PMCID: PMC8326067 DOI: 10.25259/sni_111_2021] [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: 02/05/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022] Open
Abstract
Background Peritumoral brain edema is an uncommon but life-threatening side effect of brain tumors radiosurgery. Medical therapy usually alleviates symptoms until edema spontaneously disappears. However, when peritumoral brain edema endangers the patient's life or medical therapy fails to guarantee an acceptable quality of life, surgery might be considered. Case Description Our report focuses on three patients who developed extensive peritumoral brain edema after radiosurgery. Two were affected by vestibular schwannomas and one by a skull-base meningioma. Peritumoral brain edema worsened despite maximal medical therapy in all cases; therefore, surgical removal of the radiated lesion was carried out. In the first patient, surgery was overdue and resulted in a fatal outcome. On the other hand, in the latter two cases surgery was quickly effective. In all three cases, an unmanageable brain swelling was not found at surgery. Conclusion Surgical removal of brain tumors previously treated with radiosurgery was safe and effective in resolving shortly peritumoral brain edema. This solution should be considered in patients who do not respond to medical therapy and before worsening of clinical conditions. Interestingly, the expected brain swelling was not confirmed intraoperatively. In our experience, this magnetic resonance finding should not be considered a criterion to delay surgery.
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Affiliation(s)
- Roberto Stefini
- Department of Neurosurgery, ASST Ovest Milanese, Legnano, Milano, Italy
| | - Stefano Peron
- Department of Neurosurgery, ASST Ovest Milanese, Legnano, Milano, Italy
| | - Alessandro Lacamera
- Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Andrea Cividini
- Department of Neurosurgery, ASST Ovest Milanese, Legnano, Milano, Italy
| | - Pietro Fiaschi
- Department of Neurosurgery, San Martino IST University Hospital, Genova, Italy
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Yamasaki F, Kolakshyapati M, Takano M, Yonezawa U, Nishibuchi I, Imano N, Taguchi A, Onishi S, Amatya VJ, Takeshima Y, Nagata Y, Kurisu K, Sugiyama K. Effect of bevacizumab against cystic components of brain tumors. Cancer Med 2019; 8:6519-6527. [PMID: 31498567 PMCID: PMC6825995 DOI: 10.1002/cam4.2537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 12/23/2022] Open
Abstract
Background Bevacizumab improves symptoms via reducing the peritumoral edema and/or normalizing blood brain barrier, and occasionally via reducing the tumor size. However, the effect against active cystic components has not been documented yet. Materials and Methods Between 2008 and 2018, 139 patients with primary or metastatic brain tumors were treated with bevacizumab (BEV) in our institution. The images and symptoms before and after administration of BEV were examined, and changes in size of cysts were evaluated as follows: CR (complete disappearance), PR (reduction by ≥50%), MR (reduction by ≥25%), SD (size change <25%), PD (increase by ≥25%). The effect of BEV on tumor itself was determined according to Response Assessment in Neuro‐Oncology criteria. Results Of the 139 patients, 21 (15.1%) had cystic components. The best responses of cysts to BEV treatment were as follows: CR 6, PR 7, MR 4, SD 4. The group of patients with progressively increasing cysts prior to BEV treatment had significant cyst size reduction compared to stable cyst size groups, at initial imaging after BEV (mean 62.6% vs 22.5%, P = .0055) and at best response timing (mean 76.3% vs 32.8%, P = .0050). Patients with cysts showed significant improvement in symptoms after the treatment with BEV compared to patients without cysts (P = .0033). However, response rate was not different between patients with or without cysts. Overall survival after starting BEV was not different between glioblastoma patients with or without cysts. Conclusion Bevacizumab is effective against progressively increasing cysts. Although cysts reduction effect and tumor response and/or overall survival are independent, BEV may be effective in patients who are symptomatic due to cyst enlargement.
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Affiliation(s)
- Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ikuno Nishibuchi
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuki Imano
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shumpei Onishi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University Hospital, Hiroshima, Japan
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