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Clarke JJ, Halkett GKB, McDougall E, Dhillon HM, Lobb E, Phillips JL, Hudson P, Nowak AK. What do carers of people with high-grade glioma perceive could improve their preparedness to care, and what additional support do they require? Neurooncol Pract 2024; 11:296-306. [PMID: 38737602 PMCID: PMC11085844 DOI: 10.1093/nop/npae015] [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] [Indexed: 05/14/2024] Open
Abstract
Background Concerning levels of stress, strain, and poorer mental health are observed in family carers of patients diagnosed with high-grade glioma (HGG). Understanding the reported unmet needs of these carers will enable future interventions to address such needs to improve their preparedness for care and well-being. In this secondary analysis, we aimed to explore: (i) what carers of people with HGG perceive could improve their preparedness to care; and (ii) what needs carers reported they required additional support with. Methods Responses from 188 carers of patients with HGG participating in a randomized controlled trial of the Care-IS intervention were analyzed to identify reported unmet needs. Of this larger sample, 92 participants answered a qualitative question seeking to identify perceived unmet needs in carer preparedness over 12 months. These responses comprised the data for the current secondary analysis. Content analysis was used to analyze the qualitative data and observe trends across participant responses. Results Five overarching themes were identified: carer needs, providing emotional and practical care, coping with uncertainty, coping with the consequences of illness progression, and processing and supporting end-of-life care. Notably, the content analysis identified differences in response numbers between groups in the Care-IS trial, particularly with the control group having more needs regarding illness progression and end-of-life care. Conclusions Future interventions aimed at improving the well-being and preparedness of carers of people with HGG should consider providing better support centered on carer needs, their changed circumstances, living with uncertainty, and care transition.
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Affiliation(s)
- James J Clarke
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Faculty of Health Sciences, Curtin School of Population Health/Curtin EnAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Haryana M Dhillon
- Faculty of Science, Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-based Decision-making, Sydney, Australia
| | - Elizabeth Lobb
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane L Phillips
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
- End of LIfe Research Department, Vrije University Brussels, Brussels, Belgium
| | - Anna K Nowak
- University of Western Australia, Crawley, Western Australia, Australia
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Foglar M, Aumiller M, Bochmann K, Buchner A, El Fahim M, Quach S, Sroka R, Stepp H, Thon N, Forbrig R, Rühm A. Interstitial Photodynamic Therapy of Glioblastomas: A Long-Term Follow-up Analysis of Survival and Volumetric MRI Data. Cancers (Basel) 2023; 15:cancers15092603. [PMID: 37174068 PMCID: PMC10177153 DOI: 10.3390/cancers15092603] [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: 02/06/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND The treatment of glioblastomas, the most common primary malignant brain tumors, with a devastating survival perspective, remains a major challenge in medicine. Among the recently explored therapeutic approaches, 5-aminolevulinic acid (5-ALA)-mediated interstitial photodynamic therapy (iPDT) has shown promising results. METHODS A total of 16 patients suffering from de novo glioblastomas and undergoing iPDT as their primary treatment were retrospectively analyzed regarding survival and the characteristic tissue regions discernible in the MRI data before treatment and during follow-up. These regions were segmented at different stages and were analyzed, especially regarding their relation to survival. RESULTS In comparison to the reference cohorts treated with other therapies, the iPDT cohort showed a significantly prolonged progression-free survival (PFS) and overall survival (OS). A total of 10 of 16 patients experienced prolonged OS (≥ 24 months). The dominant prognosis-affecting factor was the MGMT promoter methylation status (methylated: median PFS of 35.7 months and median OS of 43.9 months) (unmethylated: median PFS of 8.3 months and median OS of 15.0 months) (combined: median PFS of 16.4 months and median OS of 28.0 months). Several parameters with a known prognostic relevance to survival after standard treatment were not found to be relevant to this iPDT cohort, such as the necrosis-tumor ratio, tumor volume, and posttreatment contrast enhancement. After iPDT, a characteristic structure (iPDT remnant) appeared in the MRI data in the former tumor area. CONCLUSIONS In this study, iPDT showed its potential as a treatment option for glioblastomas, with a large fraction of patients having prolonged OS. Parameters of prognostic relevance could be derived from the patient characteristics and MRI data, but they may partially need to be interpreted differently compared to the standard of care.
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Affiliation(s)
- Marco Foglar
- Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Maximilian Aumiller
- Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Katja Bochmann
- Max Planck Institute for Psychiatry, Max Planck Society, 80804 Munich, Germany
- Institute of Neuroradiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Mohamed El Fahim
- Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Ronald Sroka
- Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Herbert Stepp
- Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, 81377 Munich, Germany
| | - Adrian Rühm
- Laser-Forschungslabor, LIFE Center, University Hospital, LMU Munich, 81377 Munich, Germany
- Department of Urology, University Hospital, LMU Munich, 81377 Munich, Germany
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3
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Determining the Research Priorities for Adult Primary Brain Tumours in Australia and New Zealand: A Delphi Study with Consumers, Health Professionals, and Researchers. Curr Oncol 2022; 29:9928-9955. [PMID: 36547195 PMCID: PMC9777470 DOI: 10.3390/curroncol29120781] [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: 11/09/2022] [Revised: 12/08/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas.
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4
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Maksoud S. The DNA Double-Strand Break Repair in Glioma: Molecular Players and Therapeutic Strategies. Mol Neurobiol 2022; 59:5326-5365. [PMID: 35696013 DOI: 10.1007/s12035-022-02915-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/05/2022] [Indexed: 12/12/2022]
Abstract
Gliomas are the most frequent type of tumor in the central nervous system, which exhibit properties that make their treatment difficult, such as cellular infiltration, heterogeneity, and the presence of stem-like cells responsible for tumor recurrence. The response of this type of tumor to chemoradiotherapy is poor, possibly due to a higher repair activity of the genetic material, among other causes. The DNA double-strand breaks are an important type of lesion to the genetic material, which have the potential to trigger processes of cell death or cause gene aberrations that could promote tumorigenesis. This review describes how the different cellular elements regulate the formation of DNA double-strand breaks and their repair in gliomas, discussing the therapeutic potential of the induction of this type of lesion and the suppression of its repair as a control mechanism of brain tumorigenesis.
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Affiliation(s)
- Semer Maksoud
- Experimental Therapeutics and Molecular Imaging Unit, Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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5
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Identification of ubiquitin-specific protease 32 as an oncogene in glioblastoma and the underlying mechanisms. Sci Rep 2022; 12:6445. [PMID: 35440702 PMCID: PMC9018837 DOI: 10.1038/s41598-022-09497-y] [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] [Received: 10/26/2021] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Glioblastoma (GBM) patients present poor prognosis. Deubiquitination by deubiquitinating enzymes (DUBs) is a critical process in cancer progression. Ubiquitin-specific proteases (USPs) constitute the largest sub-family of DUBs. Evaluate the role of USP32 in GBM progression and provide a potential target for GBM treatment. Clinical significance of USP32 was investigated using Gene Expression Omnibus databases. Effects of USP32 on cell growth and metastasis were studied in vitro and in vivo. Differentially expressive genes between USP32-knockdown U-87 MG cells and negative control cells were detected using RNA sequencing and used for Gene Ontology and Kyoto Encyclopedia of Genes and Genomic pathway enrichment analyses. Finally, RT-qPCR was used to validate the divergent expression of genes involved in the enriched pathways. USP32 was upregulated in GBM patients, being correlated to poor prognosis. USP32 downregulation inhibited cell growth and metastasis in vitro. Furthermore, USP32 knockdown inhibited tumorigenesis in vivo. In addition, UPS32 was identified as a crucial regulator in different pathways including cell cycle, cellular senescence, DNA replication, base excision repair, and mismatch repair pathways. USP32 acts as an oncogene in GBM through regulating several biological processes/pathways. It could be a potential target for GBM treatment.
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Owens MR, Nguyen S, Karsy M. Utility of Administrative Databases and Big Data on Understanding Glioma Treatment—A Systematic Review. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1742333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Background Gliomas are a heterogeneous group of tumors where large multicenter clinical and genetic studies have become increasingly popular in their understanding. We reviewed and analyzed the findings from large databases in gliomas, seeking to understand clinically relevant information.
Methods A systematic review was performed for gliomas studied using large administrative databases up to January 2020 (e.g., National Inpatient Sample [NIS], National Surgical Quality Improvement Program [NSQIP], and Surveillance, Epidemiology, and End Results Program [SEER], National Cancer Database [NCDB], and others).
Results Out of 390 screened studies, 122 were analyzed. Studies included a wide range of gliomas including low- and high-grade gliomas. The SEER database (n = 83) was the most used database followed by NCDB (n = 28). The most common pathologies included glioblastoma multiforme (GBM) (n = 67), with the next category including mixes of grades II to IV glioma (n = 31). Common study themes involved evaluation of descriptive epidemiological trends, prognostic factors, comparison of different pathologies, and evaluation of outcome trends over time. Persistent health care disparities in patient outcomes were frequently seen depending on race, marital status, insurance status, hospital volume, and location, which did not change over time. Most studies showed improvement in survival because of advances in surgical and adjuvant treatments.
Conclusions This study helps summarize the use of clinical administrative databases in gliomas research, informing on socioeconomic issues, surgical outcomes, and adjuvant treatments over time on a national level. Large databases allow for some study questions that would not be possible with single institution data; however, limitations remain in data curation, analysis, and reporting methods.
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Affiliation(s)
- Monica-Rae Owens
- Department of Neurosurgery, University of Utah, Utah, United States
| | - Sarah Nguyen
- Department of Neurosurgery, University of Utah, Utah, United States
| | - Michael Karsy
- University of Utah Health Care, University of Utah Health Hospitals and Clinics, Utah, United States
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Lin Z, Wen M, Yu E, Lin X, Wang H, Chen J, Yao C, Zhang H, Ru J, Wang K, Zhang Y, Huang L, Zhuge Q, Yang S. ANXA1 as a Prognostic and Immune Microenvironmental Marker for Gliomas Based on Transcriptomic Analysis and Experimental Validation. Front Cell Dev Biol 2021; 9:659080. [PMID: 34422796 PMCID: PMC8371204 DOI: 10.3389/fcell.2021.659080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/16/2021] [Indexed: 01/17/2023] Open
Abstract
The tumor microenvironment (TME) plays an important role in the growth and invasion of glioma. This study aimed to analyze the composition of the immune microenvironment in glioma samples and analyze the important differentially expressed genes to identify novel immune-targeted therapy for glioma. We downloaded transcriptomic data of 669 glioma samples from The Cancer Genome Atlas database. CIBERSORT and ESTIMATE methods were used to calculate the proportion of tumor-infiltrating immune cells and ratio of immune and stromal components in the TME. The differentially expressed genes (DEGs) were screened by comparing the genes expressed by both stromal and immune cells. Annexin A1 (ANXA1) was determined to be an important prognostic indicator through the common overlap of univariate Cox regression analysis and protein–protein interaction network analysis. The proportion of tumor-infiltrating immune cells, calculated by CIBERSORT algorithm, had a significant difference in distribution among the high and low ANXA1 expression groups, indicating that ANXA1 could be an important immune marker of TME. Furthermore, ANXA1 level was positively correlated with the histopathological factors and negatively related to the survival of glioma patients based on the analysis of multiple databases. Finally, in vitro experiments verified that antagonizing ANXA1 expression promoted cell apoptosis and inhibited the invasion and migration capacities of glioma cells. Therefore, ANXA1 due to its immune-related functions, can be an important prognostic indicator and immune microenvironmental marker for gliomas. Further studies are warranted to confirm ANXA1 as a potential immunotherapeutic target for gliomas.
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Affiliation(s)
- Zhongxiao Lin
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Min Wen
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Neurosurgery, School of Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Enxing Yu
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao Lin
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hua Wang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jiayu Chen
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - ChaoJie Yao
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hengli Zhang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junnan Ru
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kankai Wang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ying Zhang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lijie Huang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qichuan Zhuge
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Su Yang
- Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, Department of Neurosurgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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8
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Maksoud S. The Role of the Ubiquitin Proteasome System in Glioma: Analysis Emphasizing the Main Molecular Players and Therapeutic Strategies Identified in Glioblastoma Multiforme. Mol Neurobiol 2021; 58:3252-3269. [PMID: 33665742 PMCID: PMC8260465 DOI: 10.1007/s12035-021-02339-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
Gliomas constitute the most frequent tumors of the brain. High-grade gliomas are characterized by a poor prognosis caused by a set of attributes making treatment difficult, such as heterogeneity and cell infiltration. Additionally, there is a subgroup of glioma cells with properties similar to those of stem cells responsible for tumor recurrence after treatment. Since proteasomal degradation regulates multiple cellular processes, any mutation causing disturbances in the function or expression of its elements can lead to various disorders such as cancer. Several studies have focused on protein degradation modulation as a mechanism of glioma control. The ubiquitin proteasome system is the main mechanism of cellular proteolysis that regulates different events, intervening in pathological processes with exacerbating or suppressive effects on diseases. This review analyzes the role of proteasomal degradation in gliomas, emphasizing the elements of this system that modulate different cellular mechanisms in tumors and discussing the potential of distinct compounds controlling brain tumorigenesis through the proteasomal pathway.
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Affiliation(s)
- Semer Maksoud
- Experimental Therapeutics and Molecular Imaging Unit, Department of Neurology, Neuro-Oncology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
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9
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Seyfried TN, Shivane AG, Kalamian M, Maroon JC, Mukherjee P, Zuccoli G. Ketogenic Metabolic Therapy, Without Chemo or Radiation, for the Long-Term Management of IDH1-Mutant Glioblastoma: An 80-Month Follow-Up Case Report. Front Nutr 2021; 8:682243. [PMID: 34136522 PMCID: PMC8200410 DOI: 10.3389/fnut.2021.682243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Successful treatment of glioblastoma (GBM) remains futile despite decades of intense research. GBM is similar to most other malignant cancers in requiring glucose and glutamine for growth, regardless of histological or genetic heterogeneity. Ketogenic metabolic therapy (KMT) is a non-toxic nutritional intervention for cancer management. We report the case of a 32-year-old man who presented in 2014 with seizures and a right frontal lobe tumor on MRI. The tumor cells were immunoreactive with antibodies to the IDH1 (R132H) mutation, P53 (patchy), MIB-1 index (4–6%), and absent ATRX protein expression. DNA analysis showed no evidence of methylation of the MGMT gene promoter. The presence of prominent microvascular proliferation and areas of necrosis were consistent with an IDH-mutant glioblastoma (WHO Grade 4). Methods: The patient refused standard of care (SOC) and steroid medication after initial diagnosis, but was knowledgeable and self-motivated enough to consume a low-carbohydrate ketogenic diet consisting mostly of saturated fats, minimal vegetables, and a variety of meats. The patient used the glucose ketone index calculator to maintain his Glucose Ketone Index (GKI) near 2.0 without body weight loss. Results: The tumor continued to grow slowly without expected vasogenic edema until 2017, when the patient opted for surgical debulking. The enhancing area, centered in the inferior frontal gyrus, was surgically excised. The pathology specimen confirmed IDH1-mutant GBM. Following surgery, the patient continued with a self-administered ketogenic diet to maintain low GKI values, indicative of therapeutic ketosis. At the time of this report (May 2021), the patient remains alive with a good quality of life, except for occasional seizures. MRI continues to show slow interval progression of the tumor. Conclusion: This is the first report of confirmed IDH1-mutant GBM treated with KMT and surgical debulking without chemo- or radiotherapy. The long-term survival of this patient, now at 80 months, could be due in part to a therapeutic metabolic synergy between KMT and the IDH1 mutation that simultaneously target the glycolysis and glutaminolysis pathways that are essential for GBM growth. Further studies are needed to determine if this non-toxic therapeutic strategy could be effective in providing long-term management for other GBM patients with or without IDH mutations.
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Affiliation(s)
- Thomas N Seyfried
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Aditya G Shivane
- Department of Cellular and Anatomical Pathology, University Hospital Plymouth National Health Service (NHS) Trust, Plymouth, United Kingdom
| | | | - Joseph C Maroon
- Department of Neurosurgery, Medical Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Purna Mukherjee
- Biology Department, Boston College, Chestnut Hill, MA, United States
| | - Giulio Zuccoli
- Department of Radiology, St. Christopher Hospital for Children, Drexel University School of Medicine, Philadelphia, PA, United States
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10
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Zhao N, Wang F, Ahmed S, Liu K, Zhang C, Cathcart SJ, DiMaio DJ, Punsoni M, Guan B, Zhou P, Wang S, Batra SK, Bronich T, Hei TK, Lin C, Zhang C. Androgen Receptor, Although Not a Specific Marker For, Is a Novel Target to Suppress Glioma Stem Cells as a Therapeutic Strategy for Glioblastoma. Front Oncol 2021; 11:616625. [PMID: 34094902 PMCID: PMC8175980 DOI: 10.3389/fonc.2021.616625] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 04/23/2021] [Indexed: 11/13/2022] Open
Abstract
Targeting androgen receptor (AR) has been shown to be promising in treating glioblastoma (GBM) in cell culture and flank implant models but the mechanisms remain unclear. AR antagonists including enzalutamide are available for treating prostate cancer patients in clinic and can pass the blood-brain barrier, thus are potentially good candidates for GBM treatment but have not been tested in GBM orthotopically. Our current studies confirmed that in patients, a majority of GBM tumors overexpress AR in both genders. Enzalutamide inhibited the proliferation of GBM cells both in vitro and in vivo. Although confocal microscopy demonstrated that AR is expressed but not specifically in glioma cancer stem cells (CSCs) (CD133+), enzalutamide treatment significantly decreased CSC population in cultured monolayer cells and spheroids, suppressed tumor sphere-forming capacity of GBM cells, and downregulated CSC gene expression at mRNA and protein levels in a dose- and time-dependent manner. We have, for the first time, demonstrated that enzalutamide treatment decreased the density of CSCs in vivo and improved survival in an orthotopic GBM mouse model. We conclude that AR antagonists potently target glioma CSCs in addition to suppressing the overall proliferation of GBM cells as a mechanism supporting their repurposing for clinical applications treating GBM.
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Affiliation(s)
- Nan Zhao
- Department of Radiation Oncology, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Fei Wang
- Department of Radiation Oncology, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Shaheen Ahmed
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Kan Liu
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Chi Zhang
- School of Biological Sciences, University of Nebraska-Lincoln, Lincoln, NE, United States
| | - Sahara J Cathcart
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Dominick J DiMaio
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Michael Punsoni
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Bingjie Guan
- Department of Radiation Oncology, Union Hospital of Fujian Medical University, Fuzhou, China
| | - Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Shuo Wang
- Department of Radiation Oncology, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, College of Medicine, Eppley Institute for Research in Cancer, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tatiana Bronich
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, NE, United States
| | - Tom K Hei
- Center for Radiological Research, College of Physicians and Surgeons, Columbia University, New York, NY, United States
| | - Chi Lin
- Department of Radiation Oncology, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Chi Zhang
- Department of Radiation Oncology, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
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11
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Kang H, Lee J, Ji SY, Choi SW, Kim KM, Lee JH, Lee ST, Won JK, Kim TM, Choi SH, Park SH, Moon KS, Kim CY, Yoo H, Nam DH, Kim JH, Kim Y, Park CK. Radiological assessment schedule for 1p/19q-codeleted gliomas during the surveillance period using parametric modeling. Neurooncol Adv 2021; 3:vdab069. [PMID: 34286277 PMCID: PMC8284622 DOI: 10.1093/noajnl/vdab069] [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] [Indexed: 12/03/2022] Open
Abstract
Background There have been no evidence-based guidelines on the optimal schedule for the radiological assessment of 1p/19q-codeleted glioma. This study aimed to recommend an appropriate radiological evaluation schedule for 1p/19q-codeleted glioma during the surveillance period through parametric modeling of the progression-free survival (PFS) curve. Methods A total of 234 patients with 1p/19q-codeleted glioma (137 grade II and 97 grade III) who completed regular treatment were retrospectively reviewed. The patients were stratified into each layered progression risk group by recursive partitioning analysis. A piecewise exponential model was used to standardize the PFS curves. The cutoff value of the progression rate among the remaining progression-free patients was set to 10% at each scan. Results Progression risk stratification resulted in 3 groups. The optimal magnetic resonance imaging (MRI) interval for patients without a residual tumor was every 91.2 weeks until 720 weeks after the end of regular treatment following the latent period for 15 weeks. For patients with a residual tumor after the completion of adjuvant radiotherapy followed by chemotherapy, the optimal MRI interval was every 37.5 weeks until week 90 and every 132.8 weeks until week 361, while it was every 33.6 weeks until week 210 and every 14.4 weeks until week 495 for patients with a residual tumor after surgery only or surgery followed by radiotherapy only. Conclusions The optimal radiological follow-up schedule for each progression risk stratification of 1p/19q-codeleted glioma can be established from the parametric modeling of PFS.
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Affiliation(s)
- Ho Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jongjin Lee
- Department of Statistics, Seoul National University, Seoul, Korea
| | - So Young Ji
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung Won Choi
- Department of Neurosurgery, Sungkyunkwan University, School of Medicine, Samsung Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Min Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hong Choi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Statistics, Seoul National University, Seoul, Korea.,Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.,Department of Neurosurgery, Sungkyunkwan University, School of Medicine, Samsung Medical Center, Seoul, Korea.,Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea.,Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea.,Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-Sub Moon
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Science, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Korea
| | - Chae-Yong Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heon Yoo
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Do-Hyun Nam
- Department of Neurosurgery, Sungkyunkwan University, School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jeong Hoon Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yongdai Kim
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Ji SY, Lee J, Lee JH, Lee ST, Won JK, Kim JW, Kim YH, Kim TM, Choi SH, Park SH, Kim Y, Park CK. Radiological assessment schedule for high-grade glioma patients during the surveillance period using parametric modeling. Neuro Oncol 2021; 23:837-847. [PMID: 33130858 DOI: 10.1093/neuonc/noaa250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND An optimal radiological surveillance plan is crucial for high-grade glioma (HGG) patients, which is determined arbitrarily in daily clinical practice. We propose the radiological assessment schedule using a parametric model of standardized progression-free survival (PFS) curves. METHODS A total of 277 HGG patients (178 glioblastoma [GBM] and 99 anaplastic astrocytoma [AA]) from a single institute who completed the standard treatment protocol were enrolled in this cohort study and retrospectively analyzed. The patients were stratified into each layered risk group by genetic signatures and residual mass or through recursive partitioning analysis. PFS curves were estimated using the piecewise exponential survival model. The criterion of a 10% progression rate among the remaining patients at each observation period was used to determine the optimal radiological assessment time point. RESULTS The optimal follow-up intervals for MRI evaluations of isocitrate dehydrogenase (IDH) wild-type GBM was every 7.4 weeks until 120 weeks after the end of standard treatment, followed by a 22-week inflection period and every 27.6 weeks thereafter. For the IDH mutated GBM, scans every 13.2 weeks until 151 weeks are recommended. The optimal follow-up intervals were every 22.8 weeks for IDH wild-type AA, and 41.2 weeks for IDH mutated AA until 241 weeks. Tailored radiological assessment schedules were suggested for each layered risk group of the GBM and the AA patients. CONCLUSIONS The optimal schedule of radiological assessments for each layered risk group of patients with HGG could be determined from the parametric model of PFS.
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Affiliation(s)
- So Young Ji
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Jongjin Lee
- Department of Statistics, Seoul National University
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital
| | - Jae Kyung Won
- Department of Pathology, Seoul National University Hospital
| | - Jin Wook Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Yong Hwy Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital
| | | | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital
| | - Yongdai Kim
- Department of Statistics, Seoul National University
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine
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Carr CM, Benson JC, DeLone DR, Diehn FE, Kim DK, Merrell KW, Nagelschneider AA, Madhavan AA, Johnson DR. Intracranial long-term complications of radiation therapy: an image-based review. Neuroradiology 2021; 63:471-482. [PMID: 33392738 DOI: 10.1007/s00234-020-02621-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Radiation therapy is commonly utilized in the majority of solid cancers and many hematologic malignancies and other disorders. While it has an undeniably major role in improving cancer survival, radiation therapy has long been recognized to have various negative effects, ranging from mild to severe. In this manuscript, we review several intracranial manifestations of therapeutic radiation, with particular attention to those that may be encountered by radiologists. METHODS We conducted an extensive literature review of known complications of intracranial radiation therapy. Based on this review, we selected complications that had salient, recognizable imaging findings. We searched our imaging database for illustrative examples of these complications, focusing only on patients who had a history of intracranial radiation therapy. We then selected cases that best exemplified expected imaging findings in these entities. RESULTS Based on our initial literature search and imaging database review, we selected cases of radiation-induced meningioma, radiation-induced glioma, cavernous malformation, enlarging perivascular spaces, leukoencephalopathy, stroke-like migraine after radiation therapy, Moyamoya syndrome, radiation necrosis, radiation-induced labyrinthitis, optic neuropathy, and retinopathy. Although retinopathy is not typically apparent on imaging, it has been included given its clinical overlap with optic neuropathy. CONCLUSIONS We describe the clinical and imaging features of selected sequelae of intracranial radiation therapy, with a focus on those most relevant to practicing radiologists. Knowledge of these complications and their imaging findings is important, because radiologists play a key role in early detection of these entities.
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Affiliation(s)
- Carrie M Carr
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - John C Benson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David R DeLone
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Felix E Diehn
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Dong Kun Kim
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Alex A Nagelschneider
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ajay A Madhavan
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Öztürk M. Ege Üniversitesi Hastanesinde glioblastomaların epidemiyolojik ve sağ kalım özellikleri. EGE TIP DERGISI 2019. [DOI: 10.19161/etd.668263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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15
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Duwa R, Emami F, Lee S, Jeong JH, Yook S. Polymeric and lipid-based drug delivery systems for treatment of glioblastoma multiforme. J IND ENG CHEM 2019. [DOI: 10.1016/j.jiec.2019.06.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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16
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Guzauskas GF, Pollom EL, Stieber VW, Wang BCM, Garrison LP. Tumor treating fields and maintenance temozolomide for newly-diagnosed glioblastoma: a cost-effectiveness study. J Med Econ 2019; 22:1006-1013. [PMID: 31050315 DOI: 10.1080/13696998.2019.1614933] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose: The EF-14 trial demonstrated that adding tumor treating fields (TTFields) to maintenance temozolomide (TMZ) significantly extends progression-free survival (PFS) and overall survival (OS) for newly-diagnosed glioblastoma (GBM) patients. This study assessed the cost-effectiveness of TTFields and TMZ for newly-diagnosed GBM from the US healthcare system perspective. Methods and materials: Outcomes for newly-diagnosed GBM patients were estimated over a lifetime horizon using an area under the curve model with three states: stable disease, progressive disease, or death. The survival model integrated the 5-year EF-14 trial results with long-term GBM epidemiology data and US background mortality rates. Adverse event rates were derived from the EF-14 trial data. Utility values to determine quality-adjusted life-years, adverse event costs, and supportive care costs were obtained from published literature. A 3% discount rate was applied to future costs and outcomes. One-way and probabilistic sensitivity analyses were performed to assess result uncertainty due to parameter variability. Results: Treatment with TTFields and TMZ was estimated to result in a mean increase in survival of 1.25 life years (95% credible range [CR] = 0.89-1.67) and 0.96 quality-adjusted life years (QALYs) (95% CR = 0.67-1.30) compared to treatment with TMZ alone. The incremental total cost was $188,637 (95% CR = $145,324-$225,330). The incremental cost-effectiveness ratio (ICER) was $150,452 per life year gained and $197,336 per QALY gained. The model was most sensitive to changes in the cost of TTFields treatment. Conclusions: Adding TTFields to maintenance TMZ resulted in a substantial increase in the estimated mean lifetime survival and quality-adjusted survival for newly-diagnosed GBM patients. Treatment with TTFields can be considered cost-effective within the reported range of willingness-to-pay thresholds in the US.
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Affiliation(s)
- Gregory F Guzauskas
- Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington , Seattle , WA , USA
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University , Stanford , CA , USA
| | - Volker W Stieber
- Department of Radiation Oncology, Novant Health Forsyth Medical Center , Winston-Salem , NC , USA
| | | | - Louis P Garrison
- Department of Pharmacy, The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington , Seattle , WA , USA
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17
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Tumor-treating fields induce autophagy by blocking the Akt2/miR29b axis in glioblastoma cells. Oncogene 2019; 38:6630-6646. [DOI: 10.1038/s41388-019-0882-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 05/09/2019] [Accepted: 06/22/2019] [Indexed: 01/07/2023]
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18
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Johnston SK, Whitmire P, Massey SC, Kumthekar P, Porter AB, Raghunand N, Gonzalez-Cuyar LF, Mrugala MM, Hawkins-Daarud A, Jackson PR, Hu LS, Sarkaria JN, Wang L, Gatenby RA, Egan KM, Canoll P, Swanson KR. ENvironmental Dynamics Underlying Responsive Extreme Survivors (ENDURES) of Glioblastoma: A Multidisciplinary Team-based, Multifactorial Analytical Approach. Am J Clin Oncol 2019; 42:655-661. [PMID: 31343422 PMCID: PMC7416695 DOI: 10.1097/coc.0000000000000564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although glioblastoma (GBM) is a fatal primary brain cancer with short median survival of 15 months, a small number of patients survive >5 years after diagnosis; they are known as extreme survivors (ES). Because of their rarity, very little is known about what differentiates these outliers from other patients with GBM. For the purpose of identifying unknown drivers of extreme survivorship in GBM, the ENDURES consortium (ENvironmental Dynamics Underlying Responsive Extreme Survivors of GBM) was developed. This consortium is a multicenter collaborative network of investigators focused on the integration of multiple types of clinical data and the creation of patient-specific models of tumor growth informed by radiographic and histologic parameters. Leveraging our combined resources, the goals of the ENDURES consortium are 2-fold: (1) to build a curated, searchable, multilayered repository housing clinical and outcome data on a large cohort of ES patients with GBM; and (2) to leverage the ENDURES repository for new insights into tumor behavior and novel targets for prolonging survival for all patients with GBM. In this article, the authors review the available literature and discuss what is already known about ES. The authors then describe the creation of their consortium and some preliminary results.
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Affiliation(s)
- Sandra K. Johnston
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
- Department of Radiology, University of Washington, Seattle, WA
| | - Paula Whitmire
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Susan Christine Massey
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Priya Kumthekar
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | | | - Luis F. Gonzalez-Cuyar
- Department of Pathology, Neuropathology Division, University of Washington Medical Center, Seattle, WA
| | | | - Andrea Hawkins-Daarud
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Pamela R. Jackson
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, AZ
| | | | - Lei Wang
- Departments of Radiology & Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert A. Gatenby
- Cancer Biology and Evolution Program, Moffitt Cancer Center, Tampa, FL
| | | | - Peter Canoll
- Division of Neuropathology, Department of Pathology and Cell Biology, Columbia University School of Medicine, New York, NY
| | - Kristin R. Swanson
- Mathematical Neuro-Oncology Laboratory, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ
- Department of Neurosurgery, Mayo Clinic, Phoenix, AZ
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ
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Molinaro AM, Taylor JW, Wiencke JK, Wrensch MR. Genetic and molecular epidemiology of adult diffuse glioma. Nat Rev Neurol 2019; 15:405-417. [PMID: 31227792 PMCID: PMC7286557 DOI: 10.1038/s41582-019-0220-2] [Citation(s) in RCA: 402] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2019] [Indexed: 12/24/2022]
Abstract
The WHO 2007 glioma classification system (based primarily on tumour histology) resulted in considerable interobserver variability and substantial variation in patient survival within grades. Furthermore, few risk factors for glioma were known. Discoveries over the past decade have deepened our understanding of the molecular alterations underlying glioma and have led to the identification of numerous genetic risk factors. The advances in molecular characterization of glioma have reframed our understanding of its biology and led to the development of a new classification system for glioma. The WHO 2016 classification system comprises five glioma subtypes, categorized by both tumour morphology and molecular genetic information, which led to reduced misclassification and improved consistency of outcomes within glioma subtypes. To date, 25 risk loci for glioma have been identified and several rare inherited mutations that might cause glioma in some families have been discovered. This Review focuses on the two dominant trends in glioma science: the characterization of diagnostic and prognostic tumour markers and the identification of genetic and other risk factors. An overview of the many challenges still facing glioma researchers is also included.
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Affiliation(s)
- Annette M Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
| | - Jennie W Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - John K Wiencke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA, USA
| | - Margaret R Wrensch
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Institute of Human Genetics, University of California, San Francisco, San Francisco, CA, USA
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20
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Development and external validation of a nomogram for predicting the conditional probability of survival after D2 lymphadenectomy for gastric cancer: A multicentre study. Eur J Surg Oncol 2019; 45:1934-1942. [PMID: 31027946 DOI: 10.1016/j.ejso.2019.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/22/2019] [Accepted: 04/01/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Previous studies have elucidated that on average, long-term cancer survivors have better prognoses than newly diagnosed individuals. This study aimed to devise a nomogram to predict the conditional probability of cancer-specific survival (CPCS) in gastric cancer (GC) patients after D2 lymphadenectomy. METHODS Clinicopathological data for 2,596 GC patients who underwent D2 lymphadenectomy in an Eastern institution (the training cohort) were retrospectively analysed. Cancer-specific survival (CSS) was predicted using Cox regression models. A nomogram was constructed to predict CPCS at 3 and 5 years post-gastrectomy. Two external validations were performed using a cohort of 2,198 Chinese patients and a cohort of 504 Italian patients. RESULTS In the training cohort, the 5-year CPCS was 59.2% immediately post-gastrectomy and increased to 68.8%, 79.7%, and 88.8% at 1, 2, and 3 years post-gastrectomy, respectively. Multivariate Cox regression analyses showed that age; tumour site, size and invasion depth; numbers of examined and metastatic lymph nodes; and surgical margins were independent prognostic factors of CSS (all P < 0.05) and formed the nomogram predictor variables. Internal validation showed that the conditional nomogram exhibited good discrimination ability at 3 and 5 years post-gastrectomy (concordance index, 0.794 and 0.789, respectively). External validation showed a 3- and 5-year concordance index of 0.788 and 0.785, respectively, in the Chinese cohort, and 0.792 and 0.787, respectively, in the Italian cohort. Calibration of the nomogram predicted that survival corresponded closely with actual survival. CONCLUSIONS we developed a robust nomogram to predict CPCS after D2 lymphadenectomy for GC based on survival duration.
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Sirven-Villaros L, Bourg V, Suissa L, Mondot L, Almairac F, Fontaine D, Paquis P, Burel-VandenBos F, Frenay M, Thomas P, Lebrun-Frenay C. Bevacizumab: Is the lower the better for glioblastoma patients in progression? Bull Cancer 2018; 105:1135-1146. [DOI: 10.1016/j.bulcan.2018.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
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Halkett GKB, Lobb EA, Miller L, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Nowak AK. Feasibility Testing and Refinement of a Supportive Educational Intervention for Carers of Patients with High-Grade Glioma - a Pilot Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:967-975. [PMID: 28190236 DOI: 10.1007/s13187-017-1175-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this pilot study was to test the feasibility and acceptability of a family carer intervention for carers of patients with high-grade glioma (HGG). The intervention consisted of: (1) an initial telephone assessment of carer needs; (2) a personalised tabbed resource file; (3) nurse-led home visit; and (4) ongoing telephone support. Two consumer representatives reviewed the intervention resources. The intervention was then piloted with participants who were the primary carer for patients undergoing treatment for HGG in Western Australia. Two consumers provided feedback on the resource, and 10 carers participated in the pilot. Positive feedback was received about the resource manual and intervention. Suggestions were also made for changes which were implemented into the trial. The surveys were shortened based on feedback. Participants identified a large range of issues during nursing assessments which would not otherwise be identified or addressed for carers receiving routine care. As a result of providing the intervention, the nurse was able to make referrals to address needs that were identified. This pilot study enabled us to refine and test the Care-IS intervention and test the feasibility and acceptability of proposed survey instruments. We were also able to estimate recruitment and retention and the overall study timeline required for the randomised controlled trial we are now conducting. It has also demonstrated the role of the nurse who delivered the intervention and allowed us to refine communication and referral pathways.
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Affiliation(s)
- Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales, Australia
- School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
- Department of Health WA, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Thérèse Shaw
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne King
- Department of Health WA, WA Cancer and Palliative Care Network, Perth, Western Australia, Australia
| | - Jenny Clarke
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia
| | | | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Medicine, University of Western Australia, Nedlands, Western Australia, Australia
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Guzauskas GF, Salzberg M, Wang BC. Estimated lifetime survival benefit of tumor treating fields and temozolomide for newly diagnosed glioblastoma patients. CNS Oncol 2018; 7:CNS23. [PMID: 30124334 PMCID: PMC6200060 DOI: 10.2217/cns-2018-0010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Aim: To estimate the mean lifetime survival benefit, an essential component of health economic evaluations in oncology, of adding tumor treating fields (TTFields) to maintenance temozolomide (TMZ) for newly diagnosed glioblastoma patients. Methods: We integrated EF-14 trial data with glioblastoma epidemiology data. The model provided for an evidence-based approach to estimate lifetime survival for the material number of EF-14 trial patients still alive at 5 years. Results & conclusion: Patients treated with TTFields and TMZ had an incremental mean lifetime survival of 1.8 years (TTFields/TMZ: 4.2 vs TMZ alone: 2.4). Patients alive at year 2 after starting TTFields had a 20.7% probability of surviving to year 10. The results presented here provide the required incremental survival benefit necessary for a future assessment of the incremental cost–effectiveness of TTFields.
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Affiliation(s)
| | - Marc Salzberg
- Tufts Center for the Study of Drug Development, Tufts University, Boston, MA 02111, USA
| | - Bruce Cm Wang
- Department of Pharmacy, University of Washington, Seattle, WA 98195, USA.,Elysia Group, LLC, New York, NY 10017, USA
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Tykocki T, Eltayeb M. Ten-year survival in glioblastoma. A systematic review. J Clin Neurosci 2018; 54:7-13. [PMID: 29801989 DOI: 10.1016/j.jocn.2018.05.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 04/09/2018] [Accepted: 05/17/2018] [Indexed: 02/07/2023]
Abstract
Glioblastoma (GBM) is among the most deadly neoplasms associated with one of the worst 5-year overall survival (OS) rates among all human cancers. The aim of this systematic review is to present all cases with OS of a decade or more and to perform a descriptive analysis of the group. This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. A comprehensive search for relevant articles was performed on PubMed, Embase and Google Scholar for a period until June 10, 2016, using the following search words: glioblastoma multiforme, glioblastoma, GBM, long-term survival/survivors. Reports containing cases with the long-term survival of 10 years or longer were included in the review. The search produced 36 studies with 162 cases published in the years 1950-2014. The rate of long survivors in the cohort studied was established 0.76%. Mean age at diagnosis, OS and PFS were 31.1 ± 11.1, 15.9 ± 6.3, 11.9 ± 5.6 years respectively. Total and subtotal resections were found in 82 and 58 patients respectively. Nine cases received a biopsy alone. No statistical differences were found in a comparison of PFS, OS and age between total and subtotal resection groups. A regression analysis showed a significant correlation between PFS and OS, with an inverse relationship stated between age at diagnosis and OS. The 10-year survival rate in the cohort studied with GBM was estimated 0.71%. OS was positively correlated with the length of PFS and inversely related with age at diagnosis.
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Affiliation(s)
- Tomasz Tykocki
- Department of Neurosurgery, Western Hospital in Grodzisk Mazowiecki, Poland.
| | - Mohamed Eltayeb
- Royal Victoria Infirmary, NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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Zhong Q, Chen QY, Li P, Xie JW, Wang JB, Lin JX, Lu J, Cao LL, Lin M, Tu RH, Zheng CH, Huang CM. Prediction of Conditional Probability of Survival After Surgery for Gastric Cancer: A Study Based on Eastern and Western Large Data Sets. Surgery 2018; 163:1307-1316. [PMID: 29685636 DOI: 10.1016/j.surg.2018.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/27/2018] [Accepted: 02/06/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND The dynamic prognosis of patients who have undergone curative surgery for gastric cancer has yet to be reported. Our objective was to devise an accurate tool for predicting the conditional probability of survival for these patients. METHODS We analyzed 11,551 gastric cancer patients from the Surveillance, Epidemiology, and End Results database. Two-thirds of the patients were selected randomly for the development set and one-third for the validation set. Two nomograms were constructed to predict the conditional probability of overall survival and the conditional probability of disease-specific survival, using conditional survival methods. We then applied these nomograms to the 4,001 patients in the database from Fujian Medical University Union Hospital, Fuzhou, China, one of the most active Chinese institutes. RESULTS The 5-year conditional probability of overall survival of the patients was 41.6% immediately after resection and increased to 52.8%, 68.2%, and 80.4% at 1, 2, and 3 years after gastrectomy. The 5-year conditional probability of disease-specific survival "increased" from 48.9% at the time of gastrectomy to 59.8%, 74.7%, and 85.5% for patients surviving 1, 2, and 3 years, respectively. Sex; race; age; depth of tumor invasion; lymph node metastasis; and tumor size, site, and grade were associated with overall survival and disease-specific survival (P <.05). Within the Surveillance, Epidemiology, and End Results validation set, the accuracy of the conditional probability of overall survival nomogram was 0.77, 0.81, 0.82, and 0.82 at 1, 3, 5, and 10 years after gastrectomy, respectively. Within the other validation set from the Fujian Medical University Union Hospital (n = 4,001), the accuracy of the conditional probability of overall survival nomogram was 0.76, 0.79, 0.77, and 0.77 at 1, 3, 5, and 10 years, respectively. The accuracy of the conditional probability of disease-specific survival model was also favorable. The calibration curve demonstrated good agreement between the predicted and observed survival rates. CONCLUSION Based on the large Eastern and Western data sets, we developed and validated the first conditional nomogram for prediction of conditional probability of survival for patients with gastric cancer to allow consideration of the duration of survivorship.
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Affiliation(s)
- Qing Zhong
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ru-Hong Tu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
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Franceschi E, Tosoni A, Minichillo S, Depenni R, Paccapelo A, Bartolini S, Michiara M, Pavesi G, Urbini B, Crisi G, Cavallo MA, Tosatto L, Dazzi C, Biasini C, Pasini G, Balestrini D, Zanelli F, Ramponi V, Fioravanti A, Giombelli E, De Biase D, Baruzzi A, Brandes AA. The Prognostic Roles of Gender and O6-Methylguanine-DNA Methyltransferase Methylation Status in Glioblastoma Patients: The Female Power. World Neurosurg 2018; 112:e342-e347. [PMID: 29337169 DOI: 10.1016/j.wneu.2018.01.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. METHODS We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. RESULTS A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. CONCLUSIONS Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alicia Tosoni
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Santino Minichillo
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Roberta Depenni
- Department of Oncology, Hematology, and Respiratory Diseases, University Hospital of Modena, Modena, Italy
| | - Alexandro Paccapelo
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Stefania Bartolini
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Maria Michiara
- Department of Medical Oncology, University Hospital of Parma, Parma, Italy
| | - Giacomo Pavesi
- Department of Neurosurgery, Agostino-Estense Hospital, Modena, Italy; Department of Oncology and Hematology, Romagnolo Scientific Institute for the Study and Treatment of Tumors-IRCCS, Cesena, Italy
| | - Benedetta Urbini
- Clinical Oncology Unit, St. Anna University Hospital, Ferrara, Italy
| | - Girolamo Crisi
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Michele A Cavallo
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Italy
| | - Claudio Dazzi
- Department of Oncology and Hematology, General Hospital, Ravenna, Italy
| | - Claudia Biasini
- Department of Oncology and Hematology, Oncology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giuseppe Pasini
- Department of Medical Oncology, Infermi Hospital, Rimini, Italy
| | | | - Francesca Zanelli
- Department of Oncology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Vania Ramponi
- Department of Neurosurgery, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Ermanno Giombelli
- Department of Special Surgeries, Unit of Neurosurgery, University Hospital of Parma, Parma, Italy
| | - Dario De Biase
- Molecular Diagnostic Unit, Department of Pharmacy and Biotechnology, USL Company of Bologna, University of Bologna, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Sciences, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy.
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Zhu P, Du XL, Lu G, Zhu JJ. Survival benefit of glioblastoma patients after FDA approval of temozolomide concomitant with radiation and bevacizumab: A population-based study. Oncotarget 2018; 8:44015-44031. [PMID: 28467795 PMCID: PMC5546458 DOI: 10.18632/oncotarget.17054] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/20/2017] [Indexed: 11/25/2022] Open
Abstract
Few population-based analyses have investigated survival change in glioblastoma multiforme (GBM) patients treated with concomitant radiotherapy-temozolomide (RT-TMZ) and adjuvant temozolomide (TMZ) and then bevacizumab (BEV) after Food and Drug Administration (FDA) approval, respectively. We aimed to explore the effects on survival with RT-TMZ, adjuvant TMZ and BEV in general GBM population based on the Surveillance, Epidemiology, and End Results (SEER) and Texas Cancer Registry (TCR) databases. A total of 28933 GBM patients from SEER (N = 24578) and TCR (N = 4355) between January 2000 and December 2013 were included. Patients were grouped into three calendar periods based on date of diagnosis: pre-RT-TMZ and pre-BEV (1/2000-2/2005, P1), post-RT-TMZ and pre-BEV (3/2005-4/2009, P2), and post-RT-TMZ and post-BEV (5/2009-12/2013, P3). The association between calendar period of diagnosis and survival was analyzed in SEER and TCR, separately, by the Kaplan-Meier method and Cox proportional hazards model. We found a significant increase in median overall survival (OS) across the three periods in both populations. In multivariate models, the risk of death was significantly reduced during P2 and further decreased in P3, which remained unchanged after stratification. Comparison and validation analysis were performed in the combined dataset, and consistent results were observed. We conclude that the OS of GBM patients in a "real-world" setting has been steadily improved from January 2000 to December 2013, which likely resulted from the administrations of TMZ concomitant with RT and adjuvant TMZ for newly diagnosed GBM and then BEV for recurrent GBM after respective FDA approval.
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Affiliation(s)
- Ping Zhu
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Houston, TX 77030, USA.,The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, and Memorial Hermann at Texas Medical Center, Houston, TX 77030, USA
| | - Xianglin L Du
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth), School of Public Health, Houston, TX 77030, USA
| | - Guangrong Lu
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, and Memorial Hermann at Texas Medical Center, Houston, TX 77030, USA
| | - Jay-Jiguang Zhu
- The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, and Memorial Hermann at Texas Medical Center, Houston, TX 77030, USA
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Yuan Y, Ross J, Shi Q, Davis FG. Conditional survival after a diagnosis of malignant brain tumour in Canada: 2000-2008. ACTA ACUST UNITED AC 2017; 24:e341-e347. [PMID: 29089803 DOI: 10.3747/co.24.3579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND "Conditional survival probability" is defined as the probability that a patient will survive an additional time, given that the patient has already survived a defined period of time after diagnosis. Such estimates might be more relevant for clinicians and patients during post-diagnosis care, because survival probability projections are based on the patient's survival to date. Here, we provides the first population-based estimates of conditional survival probabilities by histology for brain cancer in Canada. METHODS Canadian Cancer Registry data were accessed for patients diagnosed with primary brain cancers during 2000-2008. Kaplan-Meier survival probabilities were estimated by histology. Conditional survival probabilities at 6 months (short-term, denoted scs) and 2 years (long-term, denoted lcs) were derived from the Kaplan-Meier survival estimates for a range of time periods. RESULTS Among the 20,875 patients who met the study criteria, scs increased by a margin of 16-18 percentage points from 6-month survivors to 2-year survivors for the three most aggressive brain cancers. The lcs for 2-year survivors was 66% or greater for all tumour groups except glioblastoma. The lcs for 4-year survivors was 62% or greater for all histologies. For glioblastoma and diffuse astrocytoma, the lcs increased each year after diagnosis. For all other histologies, the lcs first increased and then plateaued from 2 years after diagnosis. The lcs and scs both worsened with increasing older age at diagnosis. SUMMARY We report histologically specific conditional survival probabilities that can have value for clinicians practicing in Canada as they plan the course of follow-up for individual patients with brain cancer.
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Affiliation(s)
- Y Yuan
- School of Public Health, University of Alberta, Edmonton, AB
| | - J Ross
- School of Public Health, University of Alberta, Edmonton, AB
| | - Q Shi
- School of Public Health, University of Alberta, Edmonton, AB
| | - F G Davis
- School of Public Health, University of Alberta, Edmonton, AB
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30
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Parikh NS, Burch JE, Kamel H, DeAngelis LM, Navi BB. Recurrent Thromboembolic Events after Ischemic Stroke in Patients with Primary Brain Tumors. J Stroke Cerebrovasc Dis 2017. [PMID: 28647417 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Stroke mechanisms and the risk of recurrent thromboembolism are incompletely understood in patients with primary brain tumors. We sought to better delineate these important clinical features. METHODS We performed a retrospective cohort study of adults with primary brain tumors diagnosed with magnetic resonance imaging-confirmed acute ischemic stroke at the Memorial Sloan Kettering Cancer Center from 2005 to 2015. Study neurologists collected data on patients' cancer history, stroke risk factors, treatments, and outcomes. Stroke mechanisms were adjudicated by consensus. The primary outcome was recurrent thromboembolism (arterial or venous) and the secondary outcome was recurrent ischemic stroke. Kaplan-Meier statistics were used to calculate cumulative outcome rates, and Cox hazards analysis was used to evaluate the association between potential risk factors and outcomes. RESULTS We identified 83 patients with primary brain tumors and symptomatic acute ischemic stroke. Median survival after index stroke was 2.2 years (interquartile range, .5-7.0). Tumors were mostly gliomas (72%) and meningiomas (13%). Most strokes were from unconventional mechanisms, particularly radiation vasculopathy (36%) and surgical manipulation (18%). Small- or large-vessel disease or cardioembolism caused 13% of strokes, whereas 29% were cryptogenic. Cumulative recurrent thromboembolism rates were 11% at 30 days, 17% at 180 days, and 27% at 365 days, whereas cumulative recurrent stroke rates were 5% at 30 days, 11% at 180 days, and 13% at 365 days. We found no significant predictors of outcomes. CONCLUSION Patients with primary brain tumors generally develop strokes from rare mechanisms, and their risk of recurrent thromboembolism, including stroke, is high.
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Affiliation(s)
- Neal S Parikh
- Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Jaclyn E Burch
- Department of Neurology, Weill Cornell Medicine, New York, New York
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, New York; Clinical and Translational Neuroscience Unit, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York
| | - Lisa M DeAngelis
- Department of Neurology, Weill Cornell Medicine, New York, New York; Clinical and Translational Neuroscience Unit, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Babak B Navi
- Department of Neurology, Weill Cornell Medicine, New York, New York; Clinical and Translational Neuroscience Unit, Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York; Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York.
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CK2-An Emerging Target for Neurological and Psychiatric Disorders. Pharmaceuticals (Basel) 2017; 10:ph10010007. [PMID: 28067771 PMCID: PMC5374411 DOI: 10.3390/ph10010007] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 12/20/2016] [Accepted: 12/30/2016] [Indexed: 12/16/2022] Open
Abstract
Protein kinase CK2 has received a surge of attention in recent years due to the evidence of its overexpression in a variety of solid tumors and multiple myelomas as well as its participation in cell survival pathways. CK2 is also upregulated in the most prevalent and aggressive cancer of brain tissue, glioblastoma multiforme, and in preclinical models, pharmacological inhibition of the kinase has proven successful in reducing tumor size and animal mortality. CK2 is highly expressed in the mammalian brain and has many bona fide substrates that are crucial in neuronal or glial homeostasis and signaling processes across synapses. Full and conditional CK2 knockout mice have further elucidated the importance of CK2 in brain development, neuronal activity, and behavior. This review will discuss recent advances in the field that point to CK2 as a regulator of neuronal functions and as a potential novel target to treat neurological and psychiatric disorders.
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32
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Farber SH, Elsamadicy AA, Atik AF, Suryadevara CM, Chongsathidkiet P, Fecci PE, Sampson JH. The Safety of available immunotherapy for the treatment of glioblastoma. Expert Opin Drug Saf 2017; 16:277-287. [PMID: 27989218 DOI: 10.1080/14740338.2017.1273898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. Current standard of care involves maximal surgical resection combined with adjuvant chemoradiation. Growing support exists for a role of immunotherapy in treating these tumors with the goal of targeted cytotoxicity. Here we review data on the safety for current immunotherapies being tested in GBM. Areas covered: Safety data from published clinical trials, including ongoing clinical trials were reviewed. Immunotherapeutic classes currently under investigation in GBM include various vaccination strategies, adoptive T cell immunotherapy, immune checkpoint blockade, monoclonal antibodies, and cytokine therapies. Trials include children, adolescents, and adults with either primary or recurrent GBM. Expert opinion: Based on the reviewed clinical trials, the current immunotherapies targeting GBM are safe and well-tolerated with minimal toxicities which should be noted. However, the gains in patient survival have been modest. A safe and well-tolerated combinatory immunotherapeutic approach may be essential for optimal efficacy towards GBM.
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Affiliation(s)
- S Harrison Farber
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA
| | - Aladine A Elsamadicy
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA
| | - Ahmet Fatih Atik
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA
| | - Carter M Suryadevara
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA.,c Department of Pathology , Duke University Medical Center , Durham , NC , USA
| | - Pakawat Chongsathidkiet
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA.,c Department of Pathology , Duke University Medical Center , Durham , NC , USA
| | - Peter E Fecci
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA.,c Department of Pathology , Duke University Medical Center , Durham , NC , USA
| | - John H Sampson
- a Duke Brain Tumor Immunotherapy Program, Department of Neurosurgery , Duke University Medical Center , Durham , NC , USA.,b The Preston Robert Tisch Brain Tumor Center , Duke University Medical Center , Durham , NC , USA.,c Department of Pathology , Duke University Medical Center , Durham , NC , USA
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Ganbold, MD M, Harada, MD, PhD M, Khashbat, MD, PhD D, Abe, MD, PhD T, Kageji, MD, PhD T, Nagahiro, MD, PhD S. Differences In High-Intensity Signal Volume Between Arterial Spin Labeling And Contrast-Enhanced T1-Weighted Imaging May Be Useful For Differentiating Glioblastoma From Brain Metastasis. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:58-63. [DOI: 10.2152/jmi.64.58] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mungunbagana Ganbold, MD
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Masafumi Harada, MD, PhD
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Delgerdalai Khashbat, MD, PhD
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | - Takashi Abe, MD, PhD
- Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School
| | | | - Shinji Nagahiro, MD, PhD
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School
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Halkett GKB, Lobb EA, Shaw T, Sinclair MM, Miller L, Hovey E, Nowak AK. Distress and psychological morbidity do not reduce over time in carers of patients with high-grade glioma. Support Care Cancer 2016; 25:887-893. [DOI: 10.1007/s00520-016-3478-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022]
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Chaddad A, Desrosiers C, Hassan L, Tanougast C. A quantitative study of shape descriptors from glioblastoma multiforme phenotypes for predicting survival outcome. Br J Radiol 2016; 89:20160575. [PMID: 27781499 DOI: 10.1259/bjr.20160575] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Predicting the survival outcome of patients with glioblastoma multiforme (GBM) is of key importance to clinicians for selecting the optimal course of treatment. The goal of this study was to evaluate the usefulness of geometric shape features, extracted from MR images, as a potential non-invasive way to characterize GBM tumours and predict the overall survival times of patients with GBM. METHODS The data of 40 patients with GBM were obtained from the Cancer Genome Atlas and Cancer Imaging Archive. The T1 weighted post-contrast and fluid-attenuated inversion-recovery volumes of patients were co-registered and segmented into delineate regions corresponding to three GBM phenotypes: necrosis, active tumour and oedema/invasion. A set of two-dimensional shape features were then extracted slicewise from each phenotype region and combined over slices to describe the three-dimensional shape of these phenotypes. Thereafter, a Kruskal-Wallis test was employed to identify shape features with significantly different distributions across phenotypes. Moreover, a Kaplan-Meier analysis was performed to find features strongly associated with GBM survival. Finally, a multivariate analysis based on the random forest model was used for predicting the survival group of patients with GBM. RESULTS Our analysis using the Kruskal-Wallis test showed that all but one shape feature had statistically significant differences across phenotypes, with p-value < 0.05, following Holm-Bonferroni correction, justifying the analysis of GBM tumour shapes on a per-phenotype basis. Furthermore, the survival analysis based on the Kaplan-Meier estimator identified three features derived from necrotic regions (i.e. Eccentricity, Extent and Solidity) that were significantly correlated with overall survival (corrected p-value < 0.05; hazard ratios between 1.68 and 1.87). In the multivariate analysis, features from necrotic regions gave the highest accuracy in predicting the survival group of patients, with a mean area under the receiver-operating characteristic curve (AUC) of 63.85%. Combining the features of all three phenotypes increased the mean AUC to 66.99%, suggesting that shape features from different phenotypes can be used in a synergic manner to predict GBM survival. CONCLUSION Results show that shape features, in particular those extracted from necrotic regions, can be used effectively to characterize GBM tumours and predict the overall survival of patients with GBM. Advances in knowledge: Simple volumetric features have been largely used to characterize the different phenotypes of a GBM tumour (i.e. active tumour, oedema and necrosis). This study extends previous work by considering a wide range of shape features, extracted in different phenotypes, for the prediction of survival in patients with GBM.
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Affiliation(s)
- Ahmad Chaddad
- 1 Laboratory for Imagery, Vision and Artificial Intelligence, University of Québec, École de Technologie Supérieure, Montréal, QC, Canada.,2 Laboratory of Conception, Optimization and Modeling of Systems, University of Lorraine, Metz, Lorraine, France
| | - Christian Desrosiers
- 1 Laboratory for Imagery, Vision and Artificial Intelligence, University of Québec, École de Technologie Supérieure, Montréal, QC, Canada
| | - Lama Hassan
- 1 Laboratory for Imagery, Vision and Artificial Intelligence, University of Québec, École de Technologie Supérieure, Montréal, QC, Canada.,2 Laboratory of Conception, Optimization and Modeling of Systems, University of Lorraine, Metz, Lorraine, France
| | - Camel Tanougast
- 2 Laboratory of Conception, Optimization and Modeling of Systems, University of Lorraine, Metz, Lorraine, France
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Fukui T, Okasaka T, Kawaguchi K, Fukumoto K, Nakamura S, Hakiri S, Ozeki N, Yokoi K. Conditional Survival After Surgical Intervention in Patients With Non-Small Cell Lung Cancer. Ann Thorac Surg 2016; 101:1877-82. [DOI: 10.1016/j.athoracsur.2015.11.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/28/2015] [Accepted: 11/30/2015] [Indexed: 12/24/2022]
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Conditional survival after diagnosis with malignant brain and central nervous system tumor in the United States, 1995-2012. J Neurooncol 2016; 128:419-29. [PMID: 27095247 DOI: 10.1007/s11060-016-2127-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/07/2016] [Indexed: 12/21/2022]
Abstract
General population-based survival statistics for primary malignant brain or other central nervous system (CNS) tumors do not provide accurate estimations of prognosis for individuals who have survived for a significant period of time. For these persons, the use of conditional survival percentages provides more accurate information to estimate potential outcomes. Using information from the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) program from 1995 to 2012, conditional survival percentages were calculated for 1 or 5 years of additional survival for all primary malignant brain and CNS tumors overall and by gender, race, ethnicity and age. Rates were calculated to include 1, 2, 3, 4, 5, 10 and 15 years post diagnosis. Conditional survival was also calculated in intervals from 1995-2004 to 2005-2012, to examine the potential effect that the introduction of new treatment protocols may have had on survival rates. The percentage of patients surviving one or five additional years varied by histology, age at diagnosis, gender, race and ethnicity. Younger persons (age <15 years at diagnosis) had higher conditional survival percentages for all histologies as compared to all histologies in older patients (age ≥15 years at diagnosis). The longer the amount of time post-diagnosis of a malignant brain or other CNS tumor, the higher the conditional survival. Younger persons at diagnosis had the highest conditional survival irrespective of histology. Use of conditional survival rates provides relevant additional information for patients and their families, as well as for clinicians and researchers, and helps with understanding prognosis.
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Khosla D. Concurrent therapy to enhance radiotherapeutic outcomes in glioblastoma. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:54. [PMID: 26904576 DOI: 10.3978/j.issn.2305-5839.2016.01.25] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Glioblastoma is one of the most fatal and incurable human cancers characterized by nuclear atypia, mitotic activity, intense microvascular proliferation and necrosis. The current standard of care includes maximal safe surgical resection followed by radiation therapy (RT) with concurrent and adjuvant temozolomide (TMZ). The prognosis remains poor with median survival of 14.6 months with RT plus TMZ. Majority will have a recurrence within 2 years from diagnosis despite adequate treatment. Radiosensitizers, radiotherapy dose escalation and altered fractionation have failed to improve outcome. The molecular biology of glioblastoma is complex and poses treatment challenges. High rate of mutation, genotypic and phenotypic heterogeneity, rapid development of resistance, existence of blood-brain barrier (BBB), multiple intracellular and intercellular signalling pathways, over-expression of growth factor receptors, angiogenesis and antigenic diversity renders the tumor cells differentially susceptible to various treatment modalities. Thus, the treatment strategies require personalised or individualized approach based on the characteristics of tumor. Several targeted agents have been evaluated in clinical trials but the results have been modest despite these advancements. This review summarizes the current standard of care, results of concurrent chemoradiation trials, evolving innovative treatments that use targeted therapy with standard chemoradiation or RT alone, outcome of various recent trials and future outlook.
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Affiliation(s)
- Divya Khosla
- Department of Radiotherapy and Oncology, Government Medical College & Hospital, Chandigarh 160030, India
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Halkett GKB, Lobb EA, Miller L, Phillips JL, Shaw T, Moorin R, Long A, King A, Clarke J, Fewster S, Hudson P, Agar M, Nowak AK. Protocol for the Care-IS Trial: a randomised controlled trial of a supportive educational intervention for carers of patients with high-grade glioma (HGG). BMJ Open 2015; 5:e009477. [PMID: 26503395 PMCID: PMC4636639 DOI: 10.1136/bmjopen-2015-009477] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/11/2015] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION High-grade glioma (HGG) is a rapidly progressive and debilitating disease. Primary carers experience significant levels of distress which impacts on their experience of caregiving, the quality of care received and the community in terms of the increased reliance on healthcare due to the potential development of complicated grief. This paper describes the protocol for testing the efficacy and feasibility of an intervention for primary carers of patients with HGG in order to improve preparedness to care and reduce carer distress. METHODS Randomised controlled trial. The target population is carers of patients with HGG who are undergoing combined chemoradiotherapy. The intervention consists of 4 components: (1) initial telephone assessment of unmet needs of the carer, (2) tailoring of a personalised resource folder, (3) home visit, (4) ongoing monthly telephone contact and support for 12 months. The control arm will receive usual care. PRIMARY HYPOTHESIS This intervention will improve preparedness for caring and reduce carer psychological distress. SECONDARY HYPOTHESIS This intervention will reduce carer unmet needs. The longer term aim of the intervention is to reduce patient healthcare resource utilisation and, by doing so, reduce costs. Assessments will be obtained at baseline, 8 weeks post intervention, then 4, 6 and 12 months. Participants will also complete a healthcare utilisation checklist and proxy performance status which will be assessed at baseline and monthly. 240 carers will be recruited. The sample size is 180. Multilevel mixed effects regression models will be applied to test the effect of the intervention. ETHICS Ethics approval has been gained from Curtin University and the participating sites. DISSEMINATION Results will be reported in international peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registration (ACTRN)12612001147875.
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Affiliation(s)
- Georgia K B Halkett
- Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University, Bentley, Perth, Western Australia, Australia
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales, Australia School of Medicine, The University of Notre Dame, Sydney, New South Wales, Australia
| | - Lisa Miller
- Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Health WA, WA Cancer and Palliative Carer Network, Perth, Western Australia, Australia
| | - Jane L Phillips
- Faculty of Health, Centre for Cardiovascular and Chronic Care, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Thérése Shaw
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Western Australia, Australia School of Population Health, The University of Western Australia, Perth, Western Australia, Australia Department of Research, Silver Chain Group, Perth, Western Australia, Australia
| | - Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anne King
- Department of Health WA, WA Cancer and Palliative Carer Network, Perth, Western Australia, Australia
| | - Jenny Clarke
- Faculty of Health Sciences, School of Nursing and Midwifery, Curtin University, Bentley, Perth, Western Australia, Australia
| | | | - Peter Hudson
- Centre for Palliative Care St Vincent's Hospital Melbourne, Victoria, Australia Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, United Kingdom
| | - Meera Agar
- Department of Palliative Care, Braeside Hospital, Prairiewood, New South Wales, Australia
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia, Australia
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Long A, Halkett GKB, Lobb EA, Shaw T, Hovey E, Nowak AK. Carers of patients with high-grade glioma report high levels of distress, unmet needs, and psychological morbidity during patient chemoradiotherapy. Neurooncol Pract 2015; 3:105-112. [PMID: 31386072 DOI: 10.1093/nop/npv039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Indexed: 11/14/2022] Open
Abstract
Background Few studies have explored the unmet needs of carers of people with high-grade glioma. We aimed to determine carers' levels of distress during treatment, understand their support needs and explore predictors of distress. Methods Carers of people with high-grade glioma undergoing chemoradiotherapy were recruited to this prospective, longitudinal cohort study. Carers completed the validated Supportive Care Needs Survey, Brain Tumour Specific Supportive Care Needs Scale, Distress Thermometer (DT), and General Health Questionnaire (GHQ-12). Questionnaires were administered during patients' chemoradiotherapy and 3 and 6 months later. Results We recruited 118 carers who were mainly female (72%) and caring for spouse (82%). The mean age was 53 years (SD = 13.6; range, 21-89). Thirty-one percent of carers reported moderate distress (DT score 5-6/10) and 31% reported extreme distress (score 7-10/10) during combined chemoradiotherapy. Carer distress was associated with adverse GHQ scores (r = 0.61, P < .001). Seventy-two percent reported a negative financial impact of caring and 51% of those previously working full-time had taken leave or reduced working hours. The top 5 moderate/high unmet needs were: accessing prognostic information; accessing financial support and government benefits; accessible hospital parking; impact of caring on usual life; reducing stress in the patients' life. Conclusion Carers reported substantial distress, and high distress levels were correlated with greater psychological impact and increased self-reporting of unmet needs. Future research should focus on interventions that aid in reducing carer distress.
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Affiliation(s)
- Anne Long
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Georgia K B Halkett
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Elizabeth A Lobb
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Thérèse Shaw
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Elizabeth Hovey
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
| | - Anna K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia (A.L., A.K.N.); School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Bentley, Western Australia (G.K.B.H.); Calvary Health Care Kogarah and Cunningham Centre for Palliative Care, Sydney, New South Wales (E.A.L.); School of Medicine, The University of Notre Dame, Sydney, New South Wales (E.A.L.); Telethon Kids Institute, Perth, Western Australia (T.S.); Department of Medical Oncology, Prince of Wales Hospital, Sydney, New South Wales (E.H.); Department of Medicine, University of New South Wales, Sydney, New South Wales (E.H.); School of Medicine and Pharmacology, University of Western Australia, Nedlands, Western Australia (A.K.N.)
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Interferon-β Modulates the Innate Immune Response against Glioblastoma Initiating Cells. PLoS One 2015; 10:e0139603. [PMID: 26441059 PMCID: PMC4595134 DOI: 10.1371/journal.pone.0139603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/14/2015] [Indexed: 01/16/2023] Open
Abstract
Immunotherapy targeting glioblastoma initiating cells (GIC) is considered a promising strategy. However, GIC are prone to evade immune response and there is a need for potent adjuvants. IFN-β might enhance the immune response and here we define its net effect on the innate immunogenicity of GIC. The transcriptomes of GIC treated with IFN-β and controls were assessed by microarray-based expression profiling for altered expression of immune regulatory genes. Several genes involved in adaptive and innate immune responses were regulated by IFN-β. We validated these results using reverse transcription (RT)-PCR and flow cytometry for corresponding protein levels. The up-regulation of the NK cell inhibitory molecules HLA-E and MHC class I was balanced by immune stimulating effects including the up-regulation of nectin-2. In 3 out of 5 GIC lines tested we found a net immune stimulating effect of IFN-β in cytotoxicity assays using NKL cells as effectors. IFN-β therefore warrants further investigation as an adjuvant for immunotherapy targeting GIC.
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Yang G, Jones TL, Howe FA, Barrick TR. Morphometric model for discrimination between glioblastoma multiforme and solitary metastasis using three-dimensional shape analysis. Magn Reson Med 2015; 75:2505-16. [PMID: 26173745 DOI: 10.1002/mrm.25845] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/28/2015] [Accepted: 06/23/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE Glioblastoma multiforme (GBM) and brain metastasis (MET) are the most common intra-axial brain neoplasms in adults and often pose a diagnostic dilemma using standard clinical MRI. These tumor types require different oncological and surgical management, which subsequently influence prognosis and clinical outcome. METHODS Here, we hypothesize that GBM and MET possess different three-dimensional (3D) morphological attributes based on their physical characteristics. A 3D morphological analysis was applied on the tumor surface defined by our diffusion tensor imaging (DTI) segmentation technique. It segments the DTI data into clusters representing different isotropic and anisotropic water diffusion characteristics, from which a distinct surface boundary between healthy and pathological tissue was identified. Morphometric features of shape index and curvedness were then computed for each tumor surface and used to build a morphometric model of GBM and MET pathology with the goal of developing a tumor classification method based on shape characteristics. RESULTS Our 3D morphometric method was applied on 48 untreated brain tumor patients. Cross-validation resulted in a 95.8% accuracy classification with only two shape features needed and that can be objectively derived from quantitative imaging methods. CONCLUSION The proposed 3D morphometric analysis framework can be applied to distinguish GBMs from solitary METs. Magn Reson Med 75:2505-2516, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Guang Yang
- Neuroscience Research Centre, Cardiovascular and Cell Sciences Institute, St. George's, University of London, London, United Kingdom
| | - Timothy L Jones
- Neuroscience Research Centre, Cardiovascular and Cell Sciences Institute, St. George's, University of London, London, United Kingdom
| | - Franklyn A Howe
- Neuroscience Research Centre, Cardiovascular and Cell Sciences Institute, St. George's, University of London, London, United Kingdom
| | - Thomas R Barrick
- Neuroscience Research Centre, Cardiovascular and Cell Sciences Institute, St. George's, University of London, London, United Kingdom
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Amelot A, De Cremoux P, Quillien V, Polivka M, Adle-Biassette H, Lehmann-Che J, Françoise L, Carpentier AF, George B, Mandonnet E, Froelich S. IDH-Mutation Is a Weak Predictor of Long-Term Survival in Glioblastoma Patients. PLoS One 2015; 10:e0130596. [PMID: 26158269 PMCID: PMC4497660 DOI: 10.1371/journal.pone.0130596] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 05/21/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND A very small proportion of patients diagnosed with glioblastoma (GBM) survive more than 3 years. Isocitrate dehydrogenase 1 or 2 (IDH1/2) mutations define a small subgroup of GBM patients with favourable prognosis. However, it remains controversial whether long-term survivors (LTS) are found among those IDH1/2 mutated patients. METHODS We retrospectively analyzed 207 GBM patients followed at Lariboisière Hospital (Paris) between 2005 and 2010. Clinical parameters were obtained from medical records. Mutations of IDH1/2 were analyzed in these patients, by immunohistochemistry for the R132H mutation of IDH1 and by high-resolution melting-curve analysis, followed by Sanger sequencing for IDH1 and IDH2 exon 4 mutations. Mutation rates in LTS and non-LTS groups were compared by Chi square Pearson test. RESULTS Seventeen patients with survival >3 years were identified (8.2% of the total series). The median overall survival in long-term survivors was 4.6 years. Subgroup analysis found that the median age at diagnosis was significantly higher for non long-term survivors (non-LTS) compared to LTS (60 versus 51 years, p <0.03). The difference in the rate of IDH mutation between non-LTS and LTS was statistically not significant (1.16% versus 5.9%, p = 0.144). Among LTS, 10 out of 16 tumors presented a methylation of MGMT promoter. CONCLUSIONS This study confirms that long-term survival in GBM patients is if at all only weakly correlated to IDH-mutation.
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Affiliation(s)
- Aymeric Amelot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
| | - Patricia De Cremoux
- Assistance Publique-Hôpitaux de Paris (AP-HP), St-Louis Hospital, Department of Biochemistry, Molecular Oncology Unit, Paris, France
| | - Véronique Quillien
- Département de Biologie, Centre Eugène Marquis, CS 44229, Rue de la Bataille Flandres Dunkerque, 35042, Rennes Cedex, France
| | - Marc Polivka
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of pathology, Paris, France
| | - Homa Adle-Biassette
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of pathology, Paris, France
| | - Jacqueline Lehmann-Che
- Assistance Publique-Hôpitaux de Paris (AP-HP), St-Louis Hospital, Department of Biochemistry, Molecular Oncology Unit, Paris, France
| | - Laurence Françoise
- Assistance Publique-Hôpitaux de Paris (AP-HP), St-Louis Hospital, Department of Biochemistry, Molecular Oncology Unit, Paris, France
| | - Antoine F. Carpentier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Avicennes Hospital, Department of Neurology, Bobigny, France
| | - Bernard George
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Emmanuel Mandonnet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
- IMNC, UMR 8165, Orsay, France
| | - Sébastien Froelich
- Assistance Publique-Hôpitaux de Paris (AP-HP), Lariboisière Hospital, Department of Neurosurgery, Paris, France
- University Paris Diderot, Sorbonne Paris Cité, Paris, France
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Abstract
Gliomas are the most common type of primary intracranial tumors. Some glioma subtypes cause significant mortality and morbidity that are disproportionate to their relatively rare incidence. A very small proportion of glioma cases can be attributed to inherited genetic disorders. Many potential risk factors for glioma have been studied to date, but few provide explanation for the number of brain tumors identified. The most significant of these factors includes increased risk due to exposure to ionizing radiation, and decreased risk with history of allergy or atopic disease. The potential effect of exposure to cellular phones has been studied extensively, but the results remain inconclusive. Recent genomic analyses, using the genome-wide association study (GWAS) design, have identified several inherited risk variants that are associated with increased glioma risk. The following chapter provides an overview of the current state of research in the epidemiology of intracranial glioma.
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Duchman KR, Gao Y, Miller BJ. Prognostic factors for survival in patients with Ewing's sarcoma using the surveillance, epidemiology, and end results (SEER) program database. Cancer Epidemiol 2015; 39:189-95. [PMID: 25595632 DOI: 10.1016/j.canep.2014.12.012] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/22/2014] [Accepted: 12/26/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND The current study aims to determine cause-specific survival in patients with Ewing's sarcoma while reporting clinical risk factors for survival. METHODS The Surveillance, Epidemiology, and End Results (SEER) Program database was used to identify patients with osseous Ewing's sarcoma from 1991 to 2010. Patient, tumor, and socioeconomic variables were analyzed to determine prognostic factors for survival. RESULTS There were 1163 patients with Ewing's sarcoma identified in the SEER Program database. The 10-year cause-specific survival for patients with non-metastatic disease at diagnosis was 66.8% and 28.1% for patients with metastatic disease. Black patients demonstrated reduced survival at 10 years with an increased frequency of metastatic disease at diagnosis as compared to patients of other race, while Hispanic patients more frequently presented with tumor size>10cm. Univariate analysis revealed that metastatic disease at presentation, tumor size>10cm, axial tumor location, patient age≥20 years, black race, and male sex were associated with decreased cause-specific survival at 10 years. Metastatic disease at presentation, axial tumor location, tumor size>10cm, and age≥20 years remained significant in the multivariate analysis. CONCLUSIONS Patients with Ewing's sarcoma have decreased cause-specific survival at 10 years when metastatic at presentation, axial tumor location, tumor size>10cm, and patient age≥20 years.
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Affiliation(s)
- Kyle R Duchman
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA.
| | - Yubo Gao
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA.
| | - Benjamin J Miller
- Department of Orthopaedics and Rehabilitation, University of Iowa, 200 Hawkins Drive, 01015 JPP, Iowa City, IA 52242, USA.
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Abstract
Despite the growing number of preclinical and clinical trials focused on immunotherapy for the treatment of malignant gliomas, the prognosis for this disease remains grim. Cancer immunotherapy seeks to recruit an effective immune response to eliminate tumor cells. To date, cancer vaccines have shown only limited effectiveness because of our incomplete understanding of the necessary effector cells and mechanisms that yield efficient tumor clearance. CD8+ T cell cytotoxic activity has long been proposed as the primary effector function necessary for tumor regression. However, there is increasing evidence that indicates that components of the immune system other than CD8+ T cells play important roles in tumor eradication and control. The following review should provide an understanding of the mechanisms involved in an effective antitumor response to guide future therapeutic designs. The information provided suggests an alternate means of effective tumor clearance in malignant glioma to the canonical CD8+ cytotoxic T cell mechanism.
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Affiliation(s)
- G. Elizabeth Pluhar
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN. 55108
| | - Christopher A. Pennell
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN. 55445
| | - Michael R. Olin
- Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, MN. 55445
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Yamazoe T, Koizumi S, Yamasaki T, Amano S, Tokuyama T, Namba H. Potent tumor tropism of induced pluripotent stem cells and induced pluripotent stem cell-derived neural stem cells in the mouse intracerebral glioma model. Int J Oncol 2014; 46:147-52. [PMID: 25310640 DOI: 10.3892/ijo.2014.2702] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/12/2014] [Indexed: 11/05/2022] Open
Abstract
Although neural and mesenchymal stem cells have been well-known to have a strong glioma tropism, this activity in induced pluripotent stem cells (iPSCs) has not yet been fully studied. In the present study, we tested tumor tropic activity of mouse iPSCs and neural stem cells derived from the iPSC (iPS-NSCs) using in vitro Matrigel invasion chamber assay and in vivo mouse intracranial tumor model. Both iPSC and iPS-NSC had a similar potent in vitro tropism for glioma conditioned media. The migrated iPSCs to the gliomas kept expressing Nanog-GFP gene, suggesting no neuronal or glial differentiation. iPSCs or iPS-NSCs labeled with 5-bromo-2-deoxyuridine were intracranially implanted in the contralateral hemisphere to the GL261 glioma cell implantation in the allogeneic C57BL/6 mouse. Active migration of both stem cells was observed 7 days after implantation. Again, the iPSCs located in the tumor area expressed Nanog-GFP gene, suggesting that the migrated cells were still iPSCs. These findings demonstrated that both iPSCs and iPS-NSCs had potent glioma tropism and could be candidates as vehicles in stem cell-based glioma therapy.
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Affiliation(s)
- Tomohiro Yamazoe
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Shinichiro Koizumi
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Tomohiro Yamasaki
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Shinji Amano
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Tsutomu Tokuyama
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hiroki Namba
- Department of Neurosurgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
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Yang G, Jones TL, Barrick TR, Howe FA. Discrimination between glioblastoma multiforme and solitary metastasis using morphological features derived from the p:q tensor decomposition of diffusion tensor imaging. NMR IN BIOMEDICINE 2014; 27:1103-1111. [PMID: 25066520 DOI: 10.1002/nbm.3163] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/04/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Abstract
The management and treatment of high-grade glioblastoma multiforme (GBM) and solitary metastasis (MET) are very different and influence the prognosis and subsequent clinical outcomes. In the case of a solitary MET, diagnosis using conventional radiology can be equivocal. Currently, a definitive diagnosis is based on histopathological analysis on a biopsy sample. Here, we present a computerised decision support framework for discrimination between GBM and solitary MET using MRI, which includes: (i) a semi-automatic segmentation method based on diffusion tensor imaging; (ii) two-dimensional morphological feature extraction and selection; and (iii) a pattern recognition module for automated tumour classification. Ground truth was provided by histopathological analysis from pre-treatment stereotactic biopsy or at surgical resection. Our two-dimensional morphological analysis outperforms previous methods with high cross-validation accuracy of 97.9% and area under the receiver operating characteristic curve of 0.975 using a neural networks-based classifier.
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Affiliation(s)
- Guang Yang
- Neuroscience Research Centre, Cardiovascular and Cell Sciences Institute, St. George's, University of London, London, UK
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Bi WL, Beroukhim R. Beating the odds: extreme long-term survival with glioblastoma. Neuro Oncol 2014; 16:1159-60. [PMID: 25096192 DOI: 10.1093/neuonc/nou166] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Wenya Linda Bi
- Departments of Cancer Biology and Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (W.L.B.)Departments of Medicine and Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (R.B.)
| | - Rameen Beroukhim
- Departments of Cancer Biology and Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts (W.L.B.)Departments of Medicine and Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts (R.B.)
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