1
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Hunter H, Qin E, Wallingford A, Hyon A, Patel A. Neurorehabilitation for Adults with Brain and Spine Tumors. Semin Neurol 2024; 44:64-73. [PMID: 38049116 DOI: 10.1055/s-0043-1777407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Central nervous system (CNS) malignancies (i.e. brain and spine tumors) and their treatments can result in a multitude of neurologic deficits. Patients with CNS malignancies experience physical, cognitive, and psychosocial sequelae that can impact their mobility and quality of life. Neurorehabilitation can play a critical role in maintaining independence, preventing disability, and optimizing safety with activities of daily living. This review provides an overview of the neurorehabilitation approaches for patients with CNS malignancies, neurologic impairments frequently treated, and rehabilitation interventions in various health care settings. In addition, we will highlight rehabilitative outcomes between patients with nononcologic neurologic conditions compared to brain and spine tumors. Finally, we address medical challenges that may impact rehabilitation care in these medically complex cancer patients.
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Affiliation(s)
- Hanna Hunter
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Evelyn Qin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Allison Wallingford
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - April Hyon
- Department of Rehabilitation Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Amar Patel
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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2
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Fanfarillo F, Ferraguti G, Lucarelli M, Francati S, Barbato C, Minni A, Ceccanti M, Tarani L, Petrella C, Fiore M. The Impact of ROS and NGF in the Gliomagenesis and their Emerging Implications in the Glioma Treatment. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:449-462. [PMID: 37016521 DOI: 10.2174/1871527322666230403105438] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/19/2022] [Accepted: 02/01/2023] [Indexed: 04/06/2023]
Abstract
Reactive oxygen species (ROS) are highly reactive molecules derived from molecular oxygen (O2). ROS sources can be endogenous, such as cellular organelles and inflammatory cells, or exogenous, such as ionizing radiation, alcohol, food, tobacco, chemotherapeutical agents and infectious agents. Oxidative stress results in damage of several cellular structures (lipids, proteins, lipoproteins, and DNA) and is implicated in various disease states such as atherosclerosis, diabetes, cancer, neurodegeneration, and aging. A large body of studies showed that ROS plays an important role in carcinogenesis. Indeed, increased production of ROS causes accumulation in DNA damage leading to tumorigenesis. Various investigations demonstrated the involvement of ROS in gliomagenesis. The most common type of primary intracranial tumor in adults is represented by glioma. Furthermore, there is growing attention on the role of the Nerve Growth Factor (NGF) in brain tumor pathogenesis. NGF is a growth factor belonging to the family of neurotrophins. It is involved in neuronal differentiation, proliferation and survival. Studies were conducted to investigate NGF pathogenesis's role as a pro- or anti-tumoral factor in brain tumors. It has been observed that NGF can induce both differentiation and proliferation in cells. The involvement of NGF in the pathogenesis of brain tumors leads to the hypothesis of a possible implication of NGF in new therapeutic strategies. Recent studies have focused on the role of neurotrophin receptors as potential targets in glioma therapy. This review provides an updated overview of the role of ROS and NGF in gliomagenesis and their emerging role in glioma treatment.
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Affiliation(s)
| | - Giampiero Ferraguti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Lucarelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Silvia Francati
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Minni
- Department of Sensory Organs, Sapienza University of Rome, Rome, Italy
| | - Mauro Ceccanti
- SITAC, Società Italiana per il Trattamento dell'Alcolismo e le sue Complicanze, Rome, Italy
| | - Luigi Tarani
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Carla Petrella
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
| | - Marco Fiore
- Institute of Biochemistry and Cell Biology, IBBC-CNR, Rome, Italy
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3
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Rhee JY, Strander S, Podgurski A, Chiu D, Brizzi K, Forst DA. Palliative Care in Neuro-oncology: an Update. Curr Neurol Neurosci Rep 2023; 23:645-656. [PMID: 37751050 DOI: 10.1007/s11910-023-01301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW While the benefits of palliative care for patients with cancer are well established, palliative care in neuro-oncology is still in its early stages. However, in recent years, there has been increasing attention drawn to the need for better palliative care for patients with brain tumors. RECENT FINDINGS There is a growing body of literature demonstrating the high symptom burden and significant supportive care and information needs of these patients and their caregivers. In the area of caregiver needs, the last 3 years has seen a more rapid growth in recognizing and characterizing these needs. However, there remains a knowledge gap regarding the optimal means of addressing these needs. In this article, we outline important recent advances in the literature on palliative care for patients with brain tumors and highlight areas in need of greater attention and investigation.
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Affiliation(s)
- John Y Rhee
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA.
- Department of Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Alyx Podgurski
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
| | - Daniel Chiu
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
- Department of Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah A Forst
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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4
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Haq Khan ZU, Khan TM, Khan A, Shah NS, Muhammad N, Tahir K, Iqbal J, Rahim A, Khasim S, Ahmad I, Shabbir K, Gul NS, Wu J. Brief review: Applications of nanocomposite in electrochemical sensor and drugs delivery. Front Chem 2023; 11:1152217. [PMID: 37007050 PMCID: PMC10060975 DOI: 10.3389/fchem.2023.1152217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
The recent advancement of nanoparticles (NPs) holds significant potential for treating various ailments. NPs are employed as drug carriers for diseases like cancer because of their small size and increased stability. In addition, they have several desirable properties that make them ideal for treating bone cancer, including high stability, specificity, higher sensitivity, and efficacy. Furthermore, they might be taken into account to permit the precise drug release from the matrix. Drug delivery systems for cancer treatment have progressed to include nanocomposites, metallic NPs, dendrimers, and liposomes. Materials’ mechanical strength, hardness, electrical and thermal conductivity, and electrochemical sensors are significantly improved using nanoparticles (NPs). New sensing devices, drug delivery systems, electrochemical sensors, and biosensors can all benefit considerably from the NPs’ exceptional physical and chemical capabilities. Nanotechnology is discussed in this article from a variety of angles, including its recent applications in the medical sciences for the effective treatment of bone cancers and its potential as a promising option for treating other complex health anomalies via the use of anti-tumour therapy, radiotherapy, the delivery of proteins, antibiotics, and vaccines, and other methods. This also brings to light the role that model simulations can play in diagnosing and treating bone cancer, an area where Nanomedicine has recently been formulated. There has been a recent uptick in using nanotechnology to treat conditions affecting the skeleton. Consequently, it will pave the door for more effective utilization of cutting-edge technology, including electrochemical sensors and biosensors, and improved therapeutic outcomes.
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Affiliation(s)
- Zia Ul Haq Khan
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari, Pakistan
- *Correspondence: Zia Ul Haq Khan, ; Noor Shad Gul,
| | - Taj Malook Khan
- Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
| | - Amjad Khan
- Department of Zoology, University of Lakki Marwat, Lakki Marwat, Pakistan
| | - Noor Samad Shah
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Nawshad Muhammad
- Department of Dental Materials, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Kamran Tahir
- Institute of Chemical Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - Jibran Iqbal
- College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Abdur Rahim
- Department of Chemistry, COMSATS University Islamabad, Islamabad, Pakistan
| | - Syed Khasim
- Nanotechnology Research Unit, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia
- Department of Physics, Faculty of Science, University of Tabuk, Tabuk, Saudi Arabia
| | - Iftikhar Ahmad
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Khadija Shabbir
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari, Pakistan
| | - Noor Shad Gul
- Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
- *Correspondence: Zia Ul Haq Khan, ; Noor Shad Gul,
| | - Jianbo Wu
- Drug Discovery Research Center, Southwest Medical University, Luzhou, China
- Department of Pharmacology, Laboratory of Cardiovascular Pharmacology, The School of Pharmacy, Southwest Medical University, Luzhou, China
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Wang LM, Englander ZK, Miller ML, Bruce JN. Malignant Glioma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:1-30. [PMID: 37452933 DOI: 10.1007/978-3-031-23705-8_1] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
This chapter provides a comprehensive overview of malignant gliomas, the most common primary brain tumor in adults. These tumors are varied in their cellular origin, genetic profile, and morphology under the microscope, but together they share some of the most dismal prognoses of all neoplasms in the body. Although there is currently no cure for malignant glioma, persistent efforts to improve outcomes in patients with these tumors have led to modest increases in survival, and researchers worldwide continue to strive toward a deeper understanding of the factors that influence glioma development and response to treatment. In addition to well-established epidemiology, clinical manifestations, and common histopathologic and radiologic features of malignant gliomas, this section considers recent advances in molecular biology that have led to a more nuanced understanding of the genetic changes that characterize the different types of malignant glioma, as well as their implications for treatment. Beyond the traditional classification of malignant gliomas based on histopathological features, this chapter incorporates the World Health Organization's 2016 criteria for the classification of brain tumors, with special focus on disease-defining genetic alterations and newly established subcategories of malignant glioma that were previously unidentifiable based on microscopic examination alone. Traditional therapeutic modalities that form the cornerstone of treatment for malignant glioma, such as aggressive surgical resection followed by adjuvant chemotherapy and radiation therapy, and the studies that support their efficacy are reviewed in detail. This provides a foundation for additional discussion of novel therapeutic methods such as immunotherapy and convection-enhanced delivery, as well as new techniques for enhancing extent of resection such as fluorescence-guided surgery.
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Affiliation(s)
- Linda M Wang
- Columbia University Irving Medical Center, New York, NY, 10032, USA
| | | | - Michael L Miller
- Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.
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6
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Mukerjee N, Maitra S, Roy S, Modak S, Hasan MM, Chakraborty B, Ghosh A, Ghosh A, Kamal MA, Dey A, Ashraf GM, Malik S, Rahman MH, Alghamdi BS, Abuzenadah AM, Alexiou A. Treatments against Polymorphosal discrepancies in Glioblastoma Multiforme. Metab Brain Dis 2023; 38:61-68. [PMID: 36149588 DOI: 10.1007/s11011-022-01082-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/30/2022] [Indexed: 02/03/2023]
Abstract
Glioblastoma (GB) are aggressive tumors that obstruct normal brain function. While the skull cannot expand in response to cancer growth, the growing pressure in the brain is generally the first sign. It can produce more frequent headaches, unexplained nausea or vomiting, blurred peripheral vision, double vision, a loss of feeling or movement in an arm or leg, and difficulty speaking and concentrating; all depend on the tumor's location. GB can also cause vascular thrombi, damaging endothelial cells and leading to red blood cell leakage. Latest studies have revealed the role of single nucleotide polymorphisms (SNPs) in developing and spreading cancers such as GB and breast cancer. Many discovered SNPs are associated with GB, particularly in great abundance in the promoter region, creating polygenetic vulnerability to glioma. This study aims to compile a list of some of the most frequent and significant SNPs implicated with GB formation and proliferation.
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Affiliation(s)
- Nobendu Mukerjee
- Department of Microbiology, Ramakrishna Mission Vivekananda Centenary College, Rahara, Khardah, West Bengal, Kolkata, 700118, India.
- Department of Science and Engineering, Novel Global Community Educational Foundation, Hebersham, NSW, 2770, Australia.
| | - Swastika Maitra
- Department of Microbiology, Adamas University, Kolkata, 700126, West Bengal, India
| | - Subhradeep Roy
- Department of Microbiology, Ramakrishna Mission Vivekananda Centenary College, Rahara, Khardah, West Bengal, Kolkata, 700118, India
| | - Shaswata Modak
- Department of Microbiology, Ramakrishna Mission Vivekananda Centenary College, Rahara, Khardah, West Bengal, Kolkata, 700118, India
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Biswajit Chakraborty
- Department of Biochemistry and Biophysics, University of Kalyani Nadia, Kalyani, West Bengal, India
| | - Arabinda Ghosh
- Microbiology Division, Department of Botany, Gauhati University, Guwahati, Assam, India
| | - Asmita Ghosh
- Department of Biochemistry, McGill University, Montreal, Canada
| | - Mohammad Amjad Kamal
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka, Bangladesh
- Enzymoics, Novel Global Community Educational Foundation, 7 Peterlee place, Habersham , NSW, 2770, Australia
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, West Bengal, India
| | - Ghulam Md Ashraf
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Sumira Malik
- Amity Institute of Biotechnology, Amity University Jharkhand, Ranchi, Jharkhand, 834001, India
| | - Md Habibur Rahman
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Gangwon-do, Wonju, 26426, Korea
| | - Badrah S Alghamdi
- Pre-Clinical Research Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
- Department of Physiology, Neuroscience Unit, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Adel Mohammad Abuzenadah
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
- Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Athanasios Alexiou
- Novel Global Community Educational Foundation, Hebersham, NSW, 2770, Australia.
- AFNP Med, 1030, Vienna, Austria.
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7
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Keats MR, Grandy SA, Blanchard C, Fowles JR, Neyedli HF, Weeks AC, MacNeil MV. The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e37709. [PMID: 35507403 PMCID: PMC9118089 DOI: 10.2196/37709] [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: 03/03/2022] [Revised: 03/17/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
Background Glioblastoma is the most common primary brain malignancy in adults, accounting for approximately 48% of all brain tumors. Standard treatment includes radiation and temozolomide chemotherapy. Glioblastomas are highly vascular and can cause vasogenic brain edema and mass effect, which can worsen the neurologic symptoms associated with the disease. The steroid dexamethasone (DEX) is the treatment of choice to reduce vasogenic edema and intracranial pressure associated with glioblastoma. However high-dose DEX or long-term use can result in muscle myopathy in 10%-60% of glioblastoma patients, significantly reducing functional fitness and quality of life (QOL). There is a wealth of evidence to support the use of exercise as an adjuvant therapy to improve functional ability as well as help manage treatment-related symptoms. Specifically, resistance training has been shown to increase muscle mass, strength, and functional fitness in aging adults and several cancer populations. Although studies are limited, research has shown that exercise is safe and feasible in glioblastoma populations. However, it is not clear whether resistance training can be successfully used in glioblastoma to prevent or mitigate steroid-induced muscle myopathy and associated loss of function. Objective The primary purpose of this study is to establish whether an individualized circuit-based program will reduce steroid-induced muscle myopathy, as indicated by maintained or improved functional fitness for patients on active treatment and receiving steroids. Methods This is a 2-armed, randomized controlled trial with repeated measures. We will recruit 38 adult (≥18 years) patients diagnosed with either primary or secondary glioblastoma who are scheduled to receive standard radiation and concurrent and adjuvant temozolomide chemotherapy postsurgical debulking and received any dose of DEX through the neurooncology clinic and the Nova Scotia Health Cancer Center. Patients will be randomly allocated to a standard of care waitlist control group or standard of care + circuit-based resistance training exercise group. The exercise group will receive a 12-week individualized, group and home-based exercise program. The control group will be advised to maintain an active lifestyle. The primary outcome, muscle myopathy (functional fitness), will be assessed using the Short Physical Performance Battery and hand grip strength. Secondary outcome measures will include body composition, cardiorespiratory fitness, physical activity, QOL, fatigue, and cognitive function. All measures will be assessed pre- and postintervention. Participant accrual, exercise adherence, and safety will be assessed throughout the study. Results This study has been funded by the Canadian Cancer Society Atlantic Cancer Research Grant and the J.D. Irving Limited–Excellence in Cancer Research Fund (grant number 707182). The protocol was approved by the Nova Scotia Health and Acadia University’s Research Ethics Boards. Enrollment is anticipated to begin in March 2022. Conclusions This study will inform how individualized circuit-based resistance training may improve functional independence and overall QOL of glioblastoma patients. Trial Registration ClinicalTrails.gov NCT05116137; https://www.clinicaltrials.gov/ct2/show/NCT05116137 International Registered Report Identifier (IRRID) DERR1-10.2196/37709
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Affiliation(s)
- Melanie R Keats
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Scott A Grandy
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.,Beatrice Hunter Cancer Research Institute, Halifax, NS, Canada
| | - Christopher Blanchard
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Heather F Neyedli
- Division of Kinesiology, School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Adrienne C Weeks
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Mary V MacNeil
- Division of Medical Oncology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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8
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Koning ASCAM, Satoer DD, Vinkers CH, Zamanipoor Najafabadi AH, Biermasz NR, Nandoe Tewarie RDS, Moojen WA, van Rossum EFC, Dirven CMF, Pereira AM, van Furth WR, Meijer OC. The DEXA-CORT trial: study protocol of a randomised placebo-controlled trial of hydrocortisone in patients with brain tumour on the prevention of neuropsychiatric adverse effects caused by perioperative dexamethasone. BMJ Open 2021; 11:e054405. [PMID: 37057711 PMCID: PMC8719188 DOI: 10.1136/bmjopen-2021-054405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
IntroductionThe synthetic glucocorticoid dexamethasone can induce serious neuropsychiatric adverse effects. Dexamethasone activates the glucocorticoid receptor (GR) but, unlike endogenous cortisol, not the mineralocorticoid receptor (MR). Moreover, dexamethasone suppresses cortisol production, thereby eliminating its MR binding. Consequently, GR overactivation combined with MR underactivation may contribute to the neuropsychiatric adverse effects of dexamethasone. The DEXA-CORT trial aims to reactivate the MR using cortisol to reduce neuropsychiatric adverse effects of dexamethasone treatment.Methods and analysisThe DEXA-CORT study is a multicentre, randomised, double-blind, placebo-controlled trial in adult patients who undergo elective brain tumour resection treated perioperatively with high doses of dexamethasone to minimise cerebral oedema. 180 patients are randomised between treatment with either two times per day 10 mg hydrocortisone or placebo during dexamethasone treatment. The primary study outcome is the difference in proportion of patients scoring ≥3 points on at least one of the Brief Psychiatric Rating Scale (BPRS) questions 5 days postoperatively or earlier at discharge. Secondary outcomes are neuropsychiatric symptoms, quality of sleep, health-related quality of life and neurocognitive functioning at several time points postoperatively. Furthermore, neuropsychiatric history, serious adverse events, prescribed (psychiatric) medication and referrals or evaluations of psychiatrist/psychologist and laboratory measurements are assessed.Ethics and disseminationThe study protocol has been approved by the Medical Research Ethics Committee of the Leiden University Medical Center, and by the Dutch competent authority, and by the Institutional Review Boards of the participating sites. It is an investigator-initiated study with financial support by The Netherlands Organisation for Health Research and Development (ZonMw) and the Dutch Brain Foundation. Results of the study will be submitted for publication in a peer-reviewed journal.Trial registration numberNL6726 (Netherlands Trial Register); open for patient inclusion. EudraCT number 2017-003705-17.
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Affiliation(s)
- Anne-Sophie C A M Koning
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Djaina D Satoer
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christiaan H Vinkers
- Department of Psychiatry (GGZ inGeest), Amsterdam UMC (location VUmc), Vrije University, Amsterdam Public Health and Amsterdam Neuroscience Research Institutes, Amsterdam, The Netherlands
- Department of Anatomy and Neurosciences, Amsterdam UMC (location VUmc), Vrije University, Amsterdam, The Netherlands
| | - Amir H Zamanipoor Najafabadi
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague, The Netherlands
| | - Nienke R Biermasz
- Department of Medicine, Division of Endocrinology, and Centre for Endocrine Tumors Leiden (CETL), Leiden University Medical Center, Leiden, The Netherlands
| | - Rishi D S Nandoe Tewarie
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague, The Netherlands
| | - Wouter A Moojen
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague, The Netherlands
| | - Elisabeth F C van Rossum
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alberto M Pereira
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter R van Furth
- Department of Neurosurgery, University Neurosurgical Center Holland, Leiden University Medical Center, Haaglanden Medical Center and Haga Teaching Hospitals, Leiden and The Hague, The Netherlands
| | - Onno C Meijer
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
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9
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Ma HK, Bebawy JF. Albumin Use in Brain-injured and Neurosurgical Patients: Concepts, Indications, and Controversies. J Neurosurg Anesthesiol 2021; 33:293-299. [PMID: 31929351 DOI: 10.1097/ana.0000000000000674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/09/2019] [Indexed: 11/25/2022]
Abstract
Human albumin has been used extensively for decades as a nonwhole blood plasma replacement fluid in the perioperative and critical care setting. Its potential advantages as a highly effective volume expander must be weighed, however, against its potential harm for patients in the context of various neurological states and for various neurosurgical interventions. This narrative review explores the physiological considerations of intravenous human albumin as a replacement fluid and examines the extant clinical evidence for and against its use within the various facets of modern neuroanesthesia and neurocritical care practice.
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Affiliation(s)
- Heung Kan Ma
- Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Easwaran TP, Lancki N, Henriquez M, Vortmeyer AO, Barbaro NM, Scholtens DM, Ahmed AU, Dey M. Molecular Classification of Gliomas is Associated with Seizure Control: A Retrospective Analysis. Neuromolecular Med 2021; 23:315-326. [PMID: 33206320 PMCID: PMC8128931 DOI: 10.1007/s12017-020-08624-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/08/2020] [Indexed: 01/18/2023]
Abstract
Classically, histologic grading of gliomas has been used to predict seizure association, with low-grade gliomas associated with an increased incidence of seizures compared to high-grade gliomas. In 2016, WHO reclassified gliomas based on histology and molecular characteristics. We sought to determine whether molecular classification of gliomas is associated with preoperative seizure presentation and/or post-operative seizure control across multiple glioma subtypes. All gliomas operated at our institution from 2007 to 2017 were identified based on ICD 9 and 10 billing codes and were retrospectively assessed for molecular classification of the IDH1 mutation, and 1p/19q codeletion. Logistic regression models were performed to assess associations of seizures at presentation as well as post-operative seizures with IDH status and the new WHO integrated classification. Our study included 376 patients: 82 IDH mutant and 294 IDH wildtype. The presence of IDH mutation was associated with seizures at presentation [OR 3.135 (1.818-5.404), p < 0.001]. IDH-mutant glioblastomas presented with seizures less often than other IDH-mutant glioma subtypes grade II and III [OR 0.104 (0.032-0.340), p < 0.001]. IDH-mutant tumors were associated with worse post-operative seizure outcomes, demonstrated by Engel Class [OR 2.666 (1.592-4.464), p < 0.001]. IDH mutation in gliomas is associated with an increased risk of seizure development and worse post-operative seizure control, in all grades except for GBM.
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Affiliation(s)
- Teresa P Easwaran
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicola Lancki
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mario Henriquez
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue CSC K3/803, Madison, WI, 53792, USA
| | - Alexander O Vortmeyer
- Department of Pathology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas M Barbaro
- Department of Neurosurgery, Dell Medical School, The University of Texas, Austin, TX, USA
| | - Denise M Scholtens
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Atique U Ahmed
- Department of Neurosurgery and Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mahua Dey
- Department of Neurosurgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue CSC K3/803, Madison, WI, 53792, USA.
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11
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Hardy J, Haywood A, Rickett K, Sallnow L, Good P. Practice review: Evidence-based quality use of corticosteroids in the palliative care of patients with advanced cancer. Palliat Med 2021; 35:461-472. [PMID: 33499759 DOI: 10.1177/0269216320986717] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It would be unusual for a patient with advanced cancer not to be prescribed corticosteroids at some stage of their disease course for a variety of specific and non-specific indications. AIM The aim of this practice review was to provide a pragmatic overview of the evidence supporting current practice and to identify areas in which further research is indicated. DESIGN A 'state-of-the-art' review approach was used to examine the evidence supporting the use of corticosteroids for the management of cancer-related complications and in symptom control, in the context of known risks and harms to inform quality use of this medicine. We developed 'Do', 'Do not', and 'Don't know' recommendations based on current literature and identified areas for future investigation and research. DATA SOURCES We searched MEDLINE, EMBASE and the Cochrane library from inception to 14th October 2020. Our initial search limited to reviews, reviews of reviews, randomised controlled trials (RCTs) and controlled trials was supplemented by supporting literature as appropriate. RESULTS Evidence to support common practice in the use of corticosteroids is lacking for most indications. This is in the context of strong evidence for the potential for significant toxicity and poor quality use of medicine. CONCLUSION Guidelines recommending the widespread use of corticosteroids should acknowledge the poor evidence base supporting much current dogma. Quality research is essential not only to define the role of corticosteroids in this context but to ensure good prescribing practice.
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Affiliation(s)
- Janet Hardy
- Mater Health, Brisbane, SEQ, Australia.,Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia
| | - Alison Haywood
- Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia.,School of Pharmacy and Pharmacology, Griffith University, Gold Coast, QLD, Australia
| | - Kirsty Rickett
- University of Queensland Library - Mater Misericordiae Hospital, Brisbane, QLD, Australia
| | - Libby Sallnow
- St Christopher's Hospice and UCL Marie Curie Palliative Care Department, London, UK.,St Vincent's Private Hospital Brisbane, Brisbane, QLD, Australia
| | - Phillip Good
- Mater Health, Brisbane, SEQ, Australia.,Mater Research Institute - University of Queensland (UQ), Brisbane, QLD, Australia.,St Vincent's Private Hospital Brisbane, Brisbane, QLD, Australia
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12
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Abstract
The clinical presentation of glioblastomas is varied, and definitive diagnosis requires pathologic examination and study of the tissue. Management of glioblastomas includes surgery and adjuvant chemotherapy and radiotherapy, with surgery playing an important role in the prognosis of these patients. Awake craniotomy plays a crucial role in tumors in or adjacent to eloquent areas, allowing surgeons to maximize resection, while minimizing iatrogenic deficits. However, the prognosis remains dismal. This article presents the perioperative management of patients with glioblastoma including tools and surgical adjuncts to maximize extent of resection and minimize poor outcomes.
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13
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Abstract
OPINION STATEMENT Corticosteroids have been essential in the management of brain tumor patients for decades, primarily for the treatment of peritumoral cerebral edema and its associated neurologic deficits. Dexamethasone is the drug of choice with standard practice being administration up to four times per day, however, because of its long biologic half-life and high potency, once or twice a day dosing is likely adequate in patients without elevated intracranial pressure. The length of corticosteroid treatment should be limited to the shortest period of time to minimize the risk of potential toxicities that can significantly affect quality of life, as well as to avoid a possible detrimental impact on survival in high-grade glioma patients and abrogation of the effect of immunotherapy. Agents such as bevacizumab should be considered in patients who are unable to wean completely off of steroids as well as those who have symptomatic edema and are on immunotherapy. Several other agents have been studied without much success. An increased understanding of the complex pathophysiology of peritumoral vasogenic edema is critically needed to discover new agents that are safer and more effective.
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14
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Zhang X, Zhang W, Mao XG, Cao WD, Zhen HN, Hu SJ. Malignant Intracranial High Grade Glioma and Current Treatment Strategy. Curr Cancer Drug Targets 2020; 19:101-108. [PMID: 29848277 DOI: 10.2174/1568009618666180530090922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/06/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022]
Abstract
Malignant high-grade glioma (HGG) is the most common and extremely fatal type of primary intracranial tumor. These tumors recurred within 2 to 3 cm of the primary region of tumor resection in the majority of cases. Furthermore, the blood-brain barrier significantly limited the access of many systemically administered chemotherapeutics to the tumor, pointing towards a stringent need for new therapeutic patterns. Therefore, targeting therapy using local drug delivery for HGG becomes a priority for the development of novel therapeutic strategies. The main objectives to the effective use of chemotherapy for HGG include the drug delivery to the tumor region and the infusion of chemotherapeutic agents into the vascular supply of a tumor directly, which could improve the pharmacokinetic profile by enhancing drug delivery to the neoplasm tissue. Herein, we reviewed clinical and molecular features, different methods of chemotherapy application in HGGs, especially the existing and promising targeting therapies using local drug delivery for HGG which could effectively inhibit tumor invasion, proliferation and recurrence of HGG to combat the deadly disease. Undoubtedly, novel chemical medicines targeting these HGG may represent one of the most important directions in the Neuro-oncology.
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Affiliation(s)
- Xiang Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Wei Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Xing-Gang Mao
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Wei-Dong Cao
- Department of Neurosurgery, Navy General Hospital, PLA, Beijing, 100048, China
| | - Hai-Ning Zhen
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
| | - Shi-Jie Hu
- Department of Neuro-oncology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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15
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Mahmoud BS, AlAmri AH, McConville C. Polymeric Nanoparticles for the Treatment of Malignant Gliomas. Cancers (Basel) 2020; 12:E175. [PMID: 31936740 PMCID: PMC7017235 DOI: 10.3390/cancers12010175] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/19/2019] [Accepted: 01/06/2020] [Indexed: 12/24/2022] Open
Abstract
Malignant gliomas are one of the deadliest forms of brain cancer and despite advancements in treatment, patient prognosis remains poor, with an average survival of 15 months. Treatment using conventional chemotherapy does not deliver the required drug dose to the tumour site, owing to insufficient blood brain barrier (BBB) penetration, especially by hydrophilic drugs. Additionally, low molecular weight drugs cannot achieve specific accumulation in cancerous tissues and are characterized by a short circulation half-life. Nanoparticles can be designed to cross the BBB and deliver their drugs within the brain, thus improving their effectiveness for treatment when compared to administration of the free drug. The efficacy of nanoparticles can be enhanced by surface PEGylation to allow more specificity towards tumour receptors. This review will provide an overview of the different therapeutic strategies for the treatment of malignant gliomas, risk factors entailing them as well as the latest developments for brain drug delivery. It will also address the potential of polymeric nanoparticles in the treatment of malignant gliomas, including the importance of their coating and functionalization on their ability to cross the BBB and the chemistry underlying that.
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Affiliation(s)
- Basant Salah Mahmoud
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK; (B.S.M.); or
- Hormones Department, Medical Research Division, National Research Centre, El Buhouth St., Dokki, Cairo 12622, Egypt
| | - Ali Hamod AlAmri
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK; (B.S.M.); or
- College of Pharmacy, King Khalid University, Abha 62585, Saudi Arabia
| | - Christopher McConville
- College of Medical and Dental Sciences, School of Pharmacy, University of Birmingham, Birmingham B15 2TT, UK; (B.S.M.); or
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16
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Optimización del manejo del paciente neuroquirúrgico en Medicina Intensiva. Med Intensiva 2019; 43:489-496. [DOI: 10.1016/j.medin.2019.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/18/2019] [Accepted: 02/21/2019] [Indexed: 01/26/2023]
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17
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Cenciarini M, Valentino M, Belia S, Sforna L, Rosa P, Ronchetti S, D'Adamo MC, Pessia M. Dexamethasone in Glioblastoma Multiforme Therapy: Mechanisms and Controversies. Front Mol Neurosci 2019; 12:65. [PMID: 30983966 PMCID: PMC6449729 DOI: 10.3389/fnmol.2019.00065] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 02/26/2019] [Indexed: 12/25/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and malignant of the glial tumors. The world-wide estimates of new cases and deaths annually are remarkable, making GBM a crucial public health issue. Despite the combination of radical surgery, radio and chemotherapy prognosis is extremely poor (median survival is approximately 1 year). Thus, current therapeutic interventions are highly unsatisfactory. For many years, GBM-induced brain oedema and inflammation have been widely treated with dexamethasone (DEX), a synthetic glucocorticoid (GC). A number of studies have reported that DEX also inhibits GBM cell proliferation and migration. Nevertheless, recent controversial results provided by different laboratories have challenged the widely accepted dogma concerning DEX therapy for GBM. Here, we have reviewed the main clinical features and genetic and epigenetic abnormalities underlying GBM. Finally, we analyzed current notions and concerns related to DEX effects on cerebral oedema, cancer cell proliferation and migration and clinical outcome.
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Affiliation(s)
- Marta Cenciarini
- Section of Physiology and Biochemistry, Department of Experimental Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Mario Valentino
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Silvia Belia
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia, Italy
| | - Luigi Sforna
- Section of Physiology and Biochemistry, Department of Experimental Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo Rosa
- Department of Medical-Surgical Sciences and Biotechnologies, University of Rome "Sapienza", Polo Pontino, Latina, Italy
| | - Simona Ronchetti
- Section of Pharmacology, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
| | - Maria Cristina D'Adamo
- Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Mauro Pessia
- Section of Physiology and Biochemistry, Department of Experimental Medicine, University of Perugia School of Medicine, Perugia, Italy.,Department of Physiology and Biochemistry, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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18
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Incidence of Dural Venous Sinus Thrombosis in Patients with Glioblastoma and Its Implications. World Neurosurg 2019; 125:e189-e197. [PMID: 30684707 DOI: 10.1016/j.wneu.2019.01.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Glioblastoma (GBM) is associated with increased risk of developing dural venous sinus thrombosis (DVST), which often goes undiagnosed as symptoms are readily attributed to tumor. The purpose of this study was to investigate the incidence of DVST, potential predictive features on imaging, complications, its effect on survival, and time of greatest risk for developing DVST. METHODS A retrospective search of patients with GBM who had surgery followed by chemotherapy and/or radiation therapy between 2009 and 2015 at our institution was performed. Magnetic resonance imaging studies of the brain were reviewed on volumetric postgadolinium T1-weighted sequences for DVST. Tumors were characterized using the Visually Accessible REMBRANDT (Repository for Molecular Brain Neoplasia Data) Images classification, and identified thromboses were tracked for propagation, regression, or resolution. Statistical analyses were directed at identifying clinical predictors and survival differences between the DVST and no-DVST groups. RESULTS In total, 163 cases totaling 1637 scans, were reviewed; 12 patients (7.4%) developed DVST, of whom 11 presented with thrombus before any treatment. Tumor invasion of dural sinuses and greater T1/fluid-attenuated inversion recovery ratios were significantly associated with thrombus development (P = 0.02 and P = 0.02, respectively). In patients who developed DVST, thrombosis was more likely to develop ipsilateral to tumor side (P = 0.01) and was associated with a greater likelihood of developing extracranial venous thromboembolism (P = 0.012). There were no venous infarcts and no significant difference in survival between groups (P = 0.83). CONCLUSIONS Patients with GBM have increased risk of developing DVST, independent of surgical treatment or chemoradiation. DVST presence does not affect survival. Tumor invasion of dural sinuses and greater T1/fluid-attenuated inversion recovery ratio on preoperative imaging were the most significant predictors of DVST development.
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19
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Coppens R, Yang J, Ghosh S, Gill J, Chambers C, Easaw JC. Evaluation of laboratory disturbance risk when adding low-dose cotrimoxazole for PJP prophylaxis to regimens of high-grade glioma patients taking RAAS inhibitors. J Oncol Pharm Pract 2018; 25:1366-1373. [PMID: 30124122 DOI: 10.1177/1078155218792985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cotrimoxazole is associated with the development of hyponatremia, hyperkalemia and elevated serum creatinine, especially when combined with inhibitors of the renin-angiotensin-aldosterone system (RAAS). Pneumocystis jirovecii pneumonia (PJP) prophylaxis is the standard of care for high-grade glioma (HGG) patients receiving temozolomide concurrently with radiotherapy, low-dose cotrimoxazole being the preferred agent. Many of these patients are also taking renin-angiotensin-aldosterone system inhibitors, however the risk of significant laboratory disturbance in these patients remains undescribed. OBJECTIVE We evaluated whether high-grade glioma patients taking renin-angiotensin-aldosterone system inhibitors receiving low-dose cotrimoxazole for Pneumocystis jirovecii pneumonia prophylaxis are at additional risk of laboratory disturbances in comparison with their non-renin-angiotensin-aldosterone system counterparts. METHODS We conducted a retrospective chart review of adult neuro-oncology patients treated for WHO Grade III or IV glioma between 2013 and 2016. Patient serum Na, K, creatinine, and eGFR were compared (renin-angiotensin-aldosterone system vs. non-renin-angiotensin-aldosterone system) using the chi-square test. Binary logistic regression analysis was then performed to account for differences between cohorts. RESULTS Of 63 patients (35 non-renin-angiotensin-aldosterone system, 28 renin-angiotensin-aldosterone system), patients in the renin-angiotensin-aldosterone system cohort were more likely to experience a laboratory disturbance (odds ratio=3.17, p = 0.03). Overall, these disturbances were moderate, but were slightly more common and slightly more severe in the renin-angiotensin-aldosterone system cohort. CONCLUSION Adding low-dose cotrimoxazole for Pneumocystis jirovecii pneumonia prophylaxis to the regimens of patients with high-grade glioma taking renin-angiotensin-aldosterone system inhibitors increases the risk of laboratory disturbances. While these are generally moderate, some patients are at risk of significant electrolyte abnormalities requiring intervention.
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Affiliation(s)
| | | | | | - John Gill
- 2 Alberta Health Services, Calgary, Canada
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20
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Ebeling M, Lüdemann W, Frisius J, Karst M, Schedel I, Gerganov V, Samii A, Fahlbusch R. Venous thromboembolic complications with and without intermittent intraoperative and postoperative pneumatic compression in patients with glioblastoma multiforme using intraoperative magnetic resonance imaging. A retrospective study. Neurochirurgie 2018; 64:161-165. [PMID: 29859696 DOI: 10.1016/j.neuchi.2018.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 02/14/2018] [Accepted: 04/13/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of intraoperative and postoperative intermittent pneumatic compression (IPC) as a method used to decrease the incidence of deep venous thrombosis (DVT), in comparison to the standard use of graduated compression stockings, low-molecular weight heparin (LMWH) and physiotherapy during the hospital stay. All patients in this study underwent intracranial surgery for glioblastoma multiforme (GBM) using intraoperative magnetic resonance imaging (MRI) guidance. PATIENTS AND METHODS We performed a single center retrospective study of a cohort of 153 patients who underwent surgery for GBM aided by intraoperative MRI from October of 2009 to January of 2015 at the International Neuroscience Institute (INI), Hannover, Germany. Out of all patients, 75 in comparison to 78 were operated with and without the additional use of IPC, respectively. Both groups received graduated compression stockings, LMWH and physiotherapy postoperatively as a basic thromboprophylaxis. Postoperatively the patients were screened for DVT by Doppler ultrasonography of the limbs and pulmonary embolism (PE) by CT-scan of the chest. RESULTS DVTs were found in 6 patients with IPC and in 3 patients without IPC. The incidence of developing DVTs was therefore not significantly increased with the application of IPC from 3.9% to 8% (P-value: 0.33). No statistically significant differences were found in the probability of occurrence of pulmonary embolism (PE) with a reduction from 2.6% to 1.3% (P-value: 0.59). CONCLUSION Our results demonstrate, that the surgical intervention and the subsequent patient immobilization, as well as the thromboprophylactic techniques used have a relatively low influence on the occurrence of thromboembolic complications than we expected. Our findings might be attributed to the overall low number of these complications in a glioblastoma multiforme patient population expected to be at a high risk for coagulopathy. In other words, in order to produce statistically significant results, we would need to increase the patient cohort. By doing so we may better detect a positive therapeutic effect. Alternatively, because of the multitude of possible complex risk-factors leading to coagulopathy in a glioblastoma patient population it might be the case that IPC has little or no effect and that there is a different underlying mechanism responsible for the observed coagulopathy.
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Affiliation(s)
- M Ebeling
- Hanover Medical School, Hanover, Carl-Neuberg-Straße 1, 30625 Hanover, Germany.
| | - W Lüdemann
- Department of Neurosurgery, Helios Klinik, Hildesheim, Senator-Braun-Allee 33, 31135 Hildesheim, Germany.
| | - J Frisius
- Department of Anesthesiology, International Neuroscience Institute, Hanover, Rudolf-Pichlmayr-Straße 4, 30625 Hanover, Germany
| | - M Karst
- Department of Anesthesiology, Hanover Medical School, Hanover, Carl-Neuberg-Straße 1, 30625 Hanover, Germany.
| | - I Schedel
- Department of Internal Medicine, Hanover Medical School, Hanover, Germany, Carl-Neuberg-Straße 1, 30625 Hanover, Germany
| | - V Gerganov
- Department of Neurosurgery, International Neuroscience Institute, Hanover, Rudolf-Pichlmayr-Straße 4, 30625 Hanover, Germany
| | - A Samii
- Department of Neurosurgery, International Neuroscience Institute, Hanover, Rudolf-Pichlmayr-Straße 4, 30625 Hanover, Germany
| | - R Fahlbusch
- Department of Neurosurgery, International Neuroscience Institute, Hanover, Rudolf-Pichlmayr-Straße 4, 30625 Hanover, Germany
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21
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Abstract
Patients with brain tumor exhibit wide-ranging prognoses and functional implications of their disease and treatments. In general, the supportive care needs of patients with brain tumor, including disabling effects, have been recognized to be high. This review (1) briefly summarizes brain tumor types, treatments, and prognostic information for the rehabilitation clinician; (2) reviews evidence for rehabilitation, including acute inpatient rehabilitation and cognitive rehabilitation, and the approaches to selected common symptom and medical management issues; and (3) examines emerging data about survivorship, such as employment, community integration, and fitness.
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Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
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22
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Noh T, Walbert T. Brain metastasis: clinical manifestations, symptom management, and palliative care. HANDBOOK OF CLINICAL NEUROLOGY 2018; 149:75-88. [PMID: 29307363 DOI: 10.1016/b978-0-12-811161-1.00006-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Patients who have brain metastases can suffer from a medley of symptoms, including headaches, seizures, cognitive impairment, fatigue, and focal deficits. As therapies have evolved, so has the management of these symptoms as patients survive longer. This chapter focuses on the clinical presentation of brain metastases, the treatment of those symptoms, and palliation in end-of-life management. Brain metastases are the most common cerebral malignancy. They can present with various symptoms, which can have significant impact on patients' quality of life throughout the course of their disease. Most of these symptoms are related to direct brain compression from the tumor or from edema. The location of the metastases will determine the focal deficits incurred and most patients will be on a course of steroids tapered according to their clinical status. The chapter includes a list of potential side-effects and considerations for management. Palliative care is an essential and important part of approaching patients with metastases. Early and clear communication about end-of-life decision making is encouraged with multiple easily accessible tools. For patients near the end of life, comfort is the ultimate goal in providing a good quality of life.
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Affiliation(s)
- Thomas Noh
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States
| | - Tobias Walbert
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, United States; Department of Neurology, Henry Ford Health System, Detroit, MI, United States.
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23
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Radiation Therapy in High-Grade Gliomas. Radiat Oncol 2018. [DOI: 10.1007/978-3-319-52619-5_3-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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24
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Antic D, Jelicic J, Vukovic V, Nikolovski S, Mihaljevic B. Venous thromboembolic events in lymphoma patients: Actual relationships between epidemiology, mechanisms, clinical profile and treatment. Blood Rev 2017; 32:144-158. [PMID: 29126566 DOI: 10.1016/j.blre.2017.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 10/15/2017] [Accepted: 10/27/2017] [Indexed: 02/08/2023]
Abstract
Venous thromboembolic events (VTE) are an underestimated health problem in patients with lymphoma. Many factors contribute to the pathogenesis of thromboembolism and the interplay between various mechanisms that provoke VTE is still poorly understood. The identification of parameters that are associated with an increased risk of VTE in lymphoma patients led to the creation of several risk-assessment models. The models that evaluate potential VTE risk in lymphoma patients in particular are quite limited, and have to be validated in larger study populations. Furthermore, the VTE prophylaxis in lymphoma patients is largely underused, despite the incidence of VTE. The lack of adequate guidelines for the prophylaxis and treatment of VTE in lymphoma patients, together with a cautious approach due to an increased risk of bleeding, demands great efforts to ensure the implementation of current knowledge in order to reduce the incidence and complications of VTE in lymphoma patients.
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Affiliation(s)
- Darko Antic
- Clinic for Hematology, Clinical Centre Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia.
| | - Jelena Jelicic
- Clinic for Hematology, Clinical Centre Serbia, Belgrade, Serbia
| | - Vojin Vukovic
- Clinic for Hematology, Clinical Centre Serbia, Belgrade, Serbia
| | | | - Biljana Mihaljevic
- Clinic for Hematology, Clinical Centre Serbia, Belgrade, Serbia; Medical Faculty, University of Belgrade, Belgrade, Serbia
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25
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Gazzeri R, Galarza M, Conti C, De Bonis C. Incidence of thromboembolic events after use of gelatin-thrombin-based hemostatic matrix during intracranial tumor surgery. Neurosurg Rev 2017; 41:303-310. [DOI: 10.1007/s10143-017-0856-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 03/27/2017] [Accepted: 04/13/2017] [Indexed: 01/22/2023]
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26
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Abstract
Patients with brain tumors and systemic malignancies are subject to diverse neurologic complications that require urgent evaluation and treatment. These neurologic conditions are commonly due to the tumor's direct effects on the nervous system, such as cerebral edema, increased intracranial pressure, seizures, spinal cord compression, and leptomeningeal metastases. In addition, neurologic complications can develop as a result of thrombocytopenia, coagulopathy, hyperviscosity syndromes, infection, immune-related disorders, and adverse effects of treatment. Patients may present with typical disease syndromes. However, it is not uncommon for patients to have more subtle, nonlocalizing manifestations, such as alteration of mental status, that could be attributed to other systemic, nonneurologic complications. Furthermore, neurologic complications are at times the initial manifestations of an undiagnosed malignancy. Therefore a high index of suspicion is essential for rapid assessment and management. Timely intervention may prolong survival and improve quality of life. In this chapter, we will discuss the common neuro-oncologic emergencies, including epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment.
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Affiliation(s)
- J T Jo
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA
| | - D Schiff
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA.
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27
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Wang B, Li H, Yao Q, Zhang Y, Zhu X, Xia T, Wang J, Li G, Li X, Ni S. Local in vitro delivery of rapamycin from electrospun PEO/PDLLA nanofibers for glioblastoma treatment. Biomed Pharmacother 2016; 83:1345-1352. [PMID: 27580454 DOI: 10.1016/j.biopha.2016.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 01/28/2023] Open
Abstract
Rapamycin, a mammalian target of rapamycin inhibitor and anti-proliferative agent, is used to treat glioma and other malignancies, but its effectiveness is limited by the fact that it cannot be delivered in a targeted manner to the site of the tumor. To address this issue, we fabricated a mesh via electrospinning using two biodegradable materials, poly(lactic acid) (PLA) and polyethylene oxide (PEO) as a carrier for rapamycin delivery to the tumor. Nanofiber diameter decreased with increasing PLA concentration in the mixed solution. Scanning electron microscopy analysis revealed the smooth and uniform surface morphology of hybrid fibers. Fourier transform infrared spectroscopy analysis demonstrated that rapamycin was encapsulated in the polymer solution; encapsulation efficiency was high and stable over the range of drug concentrations from 0.5-2wt%. A correlation was observed between sustained release of the drug in vitro and cytotoxicity in cultured glioma cells. These results indicate that the PEO/poly(d,l-lactic acid) nanofiber mesh can be used as a targeted delivery system for rapamycin that can limit side effects and prevent locoregional recurrence following surgical resection of glioma.
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Affiliation(s)
- Benlin Wang
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Haoyuan Li
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Qingyu Yao
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Yulin Zhang
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Xiaodong Zhu
- Affiliated Hospital of Jining Medical University, Jining 272000, China
| | - Tongliang Xia
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Jian Wang
- Brain Science Research Institute, Shandong University, Jinan 250012, China; Department of Biomedicine, University of Bergen, Jonas Lies Vei 91, 5009 Bergen, Norway
| | - Gang Li
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China; Brain Science Research Institute, Shandong University, Jinan 250012, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China; Brain Science Research Institute, Shandong University, Jinan 250012, China
| | - Shilei Ni
- Department of Neurosurgery, Qilu Hospital, Shandong University, Jinan 250012, China.
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Lee CY, Lai HY, Chiu A, Chan SH, Hsiao LP, Lee ST. The effects of antiepileptic drugs on the growth of glioblastoma cell lines. J Neurooncol 2016; 127:445-53. [PMID: 26758059 PMCID: PMC4835521 DOI: 10.1007/s11060-016-2056-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/30/2015] [Indexed: 11/30/2022]
Abstract
To determine the effects of antiepileptic drug compounds on glioblastoma cellular growth, we exposed glioblastoma cell lines to select antiepileptic drugs. The effects of selected antiepileptic drugs on glioblastoma cells were measured by MTT assay. For compounds showing significant inhibition, cell cycle analysis was performed. Statistical analysis was performed using SPSS. The antiepileptic compounds selected for screening included carbamazepine, ethosuximide, gabapentin, lamotrigine, levetiracetam, magnesium sulfate, oxcarbazepine, phenytoin, primidone, tiagabine, topiramate, valproic acid, and vigabatrin. Dexamethasone and temozolomide were used as a negative and positive control respectively. Our results showed temozolomide and oxcarbazepine significantly inhibited glioblastoma cell growth and reached IC50 at therapeutic concentrations. The other antiepileptic drugs screened were unable to reach IC50 at therapeutic concentrations. The metabolites of oxcarbazepine were also unable to reach IC50. Dexamethasone, ethosuximide, levetiracetam, and vigabatrin showed some growth enhancement though they did not reach statistical significance. The growth enhancement effects of ethosuximide, levetiracetam, and vigabatrin found in the study may indicate that these compounds should not be used for prophylaxis or short term treatment of epilepsy in glioblastoma. While valproic acid and oxcarbazepine were effective, the required dose of valproic acid was far above that used for the treatment of epilepsy and the metabolites of oxcarbazepine failed to reach significant growth inhibition ruling out the use of oral oxcarbazepine or valproic acid as monotherapy in glioblastoma. The possibility of using these compounds as local treatment is a future area of study.
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Affiliation(s)
- Ching-Yi Lee
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan
| | - Hung-Yi Lai
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan
| | - Angela Chiu
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan
| | - She-Hung Chan
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan
| | - Ling-Ping Hsiao
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan
| | - Shih-Tseng Lee
- Department of Neurosurgery, Chang-Gung Memorial Hospital, Chang-Gung University College of Medicine, 5 Fu-Shing Street, 333, Kweishan, Taoyuan, Taiwan.
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Markovic-Bozic J, Karpe B, Potocnik I, Jerin A, Vranic A, Novak-Jankovic V. Effect of propofol and sevoflurane on the inflammatory response of patients undergoing craniotomy. BMC Anesthesiol 2016; 16:18. [PMID: 27001425 PMCID: PMC4802874 DOI: 10.1186/s12871-016-0182-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/24/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The purpose of this randomised, single-centre study was to prospectively investigate the impact of anaesthetic techniques for craniotomy on the release of cytokines IL-6, IL-8, IL-10, and to determine whether intravenous anaesthesia compared to inhalational anaesthesia attenuates the inflammatory response. METHODS The study enroled 40 patients undergoing craniotomy, allocated into two equal groups to receive either sevoflurane (n = 20) or propofol (n = 20) in conjunction with remifentanil and rocuronium. The lungs were ventilated mechanically to maintain normocapnia. Remifentanil infusion was adjusted according to the degree of surgical manipulation and increased when mean arterial pressure and the heart rate increased by more than 30 % from baseline. The depth of anaesthesia was adjusted to maintain a bispectral index (BIS) of 40-60. Invasive haemodynamic monitoring was used. Serum levels of IL-6, IL-8 and IL-10 were measured before surgery and anaesthesia, during tumour removal, at the end of surgery, and at 24 and 48 h after surgery. Postoperative complications (pain, vomiting, changes in blood pressure, infection and pulmonary, cardiovascular and neurological events) were monitored during the first 15 days after surgery. RESULTS Compared with patients anaesthetised with sevoflurane, patients who received propofol had higher levels of IL-10 (p = 0.0001) and lower IL-6/IL-10 concentration ratio during and at the end of surgery (p = 0.0001). Both groups showed only a minor response of IL- 8 during and at the end of the surgery (p = 0.57). CONCLUSIONS Patients who received propofol had higher levels of IL-10 during surgery. Neither sevoflurane nor propofol had any significant impact on the occurrence of postoperative complications. Our findings should incite future studies to prove a potential medically important anti-inflammatory role of propofol in neuroanaesthesia. CLINICAL TRIAL REGISTRATION Identified as NCT02229201 at www.clinicaltrials.gov.
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Affiliation(s)
- Jasmina Markovic-Bozic
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, SI-1000 Slovenia
| | - Blaz Karpe
- Faculty of Natural Science and Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Iztok Potocnik
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, SI-1000 Slovenia
| | - Ales Jerin
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Andrej Vranic
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Service de Neurochirurgie, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Vesna Novak-Jankovic
- Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Zaloska 7, Ljubljana, SI-1000 Slovenia
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Abstract
Disabling sequelae occur in a majority of patients diagnosed with brain tumor, including glioma, such as cognitive deficits, weakness, and visual perceptual changes. Often, multiple impairments are present concurrently. Healthcare staff must be aware of the "biographic disruption" the patient with glioma has experienced. While prognostic considerations factor into rehabilitation goals and expectations, regardless of prognosis the treatment team must offer cohesive support, facilitating hope, function, and quality of life. Awareness of family and caregiver concerns plays an important role in the overall care. Inpatient rehabilitation, especially after surgical resection, has been shown to result in functional improvement and homegoing rates on a par with individuals with other neurologic conditions, such as stroke or traumatic brain injury. Community integration comprises a significant element of life satisfaction, as has been shown in childhood glioma survivors. Employment is often affected by the glioma diagnosis, but may be ameliorated, when appropriate, by addressing modifiable factors such as depression, fatigue, or sleep disturbance, or by workplace accommodations. Further research is needed into many facets of rehabilitation in the setting of glioma, including establishing better care models for consistently identifying and addressing functional limitations in this population, measuring outcomes of various levels of rehabilitation care, identifying optimal physical activity strategies, delineating the long-term effects of rehabilitation interventions, and exploring impact of rehabilitation interventions on caregiver burden. The effective elements of cognitive rehabilitation, including transition of cognitive strategies to everyday living, need to be better defined.
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Affiliation(s)
- Mary Vargo
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | | | - Pär Salander
- Department of Social Work, Umeå University, Umeå, Sweden
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Dautricourt S, Marzloff V, Dollfus S. Meningiomatosis revealed by a major depressive syndrome. BMJ Case Rep 2015; 2015:bcr-2015-211909. [PMID: 26688430 DOI: 10.1136/bcr-2015-211909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Depressive symptoms may be the only expression of brain tumours. Thus, it is challenging to suspect a brain tumour when patients with depression have a normal neurological examination. We illustrate this by a case report regarding a meningiomatosis revealed by a treatment-resistant depressive syndrome that improved after surgery. This case highlights the importance of identifying signs of brain tumour in patients with depression. Although there is no consensus about whether brain imaging is indicated for depressive syndromes, it should be performed, particularly in late onset of depressive syndrome (after 50 years of age), treatment-resistant depression or in apathy with a reduced emotional response or without dysphoric manifestations.
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Affiliation(s)
| | | | - Sonia Dollfus
- CHU Caen, Caen, France UNICAEN, Université de Caen, 14000, France, Caen, France
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Ma Y, Tang N, Thompson RC, Mobley BC, Clark SW, Sarkaria JN, Wang J. InsR/IGF1R Pathway Mediates Resistance to EGFR Inhibitors in Glioblastoma. Clin Cancer Res 2015; 22:1767-76. [PMID: 26561558 DOI: 10.1158/1078-0432.ccr-15-1677] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/23/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE Aberrant activation of EGFR is a hallmark of glioblastoma. However, EGFR inhibitors exhibit at best modest efficacy in glioblastoma. This is in sharp contrast with the observations in EGFR-mutant lung cancer. We examined whether activation of functionally redundant receptor tyrosine kinases (RTKs) conferred resistance to EGFR inhibitors in glioblastoma. EXPERIMENTAL DESIGN We collected a panel of patient-derived glioblastoma xenograft (PDX) lines that maintained expression of wild-type or mutant EGFR in serial xenotransplantation and tissue cultures. Using this physiologically relevant platform, we tested the abilities of several RTK ligands to protect glioblastoma cells against an EGFR inhibitor, gefitinib. Based on the screening results, we further developed a combination therapy cotargeting EGFR and insulin receptor (InsR)/insulin-like growth factor 1 receptor (IGF1R). RESULTS Insulin and IGF1 induced significant protection against gefitinib in the majority of EGFR-dependent PDX lines with one exception that did not express InsR or IGF1R. Blockade of the InsR/IGF1R pathway synergistically improved sensitivity to gefitinib or dacomitinib. Gefitinib alone effectively attenuated EGFR activities and the downstream MEK/ERK pathway. However, repression of AKT and induction of apoptosis required concurrent inhibition of both EGFR and InsR/IGF1R. A combination of gefitinib and OSI-906, a dual InsR/IGF1R inhibitor, was more effective than either agent alone to treat subcutaneous glioblastoma xenograft tumors. CONCLUSIONS Our results suggest that activation of the InsR/IGF1R pathway confers resistance to EGFR inhibitors in EGFR-dependent glioblastoma through AKT regulation. Concurrent blockade of these two pathways holds promise to treat EGFR-dependent glioblastoma.
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Affiliation(s)
- Yufang Ma
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nan Tang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Reid C Thompson
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bret C Mobley
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven W Clark
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jann N Sarkaria
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jialiang Wang
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Department of Cancer Biology, Vanderbilt University Medical Center, Nashville, Tennessee. Department of Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Predictors of Venous Thromboembolism in Patients with Glioblastoma. Pathol Oncol Res 2015; 22:311-6. [DOI: 10.1007/s12253-015-0008-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 11/04/2015] [Indexed: 10/22/2022]
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Thomas AA, Carver A. Essential competencies in palliative medicine for neuro-oncologists. Neurooncol Pract 2015; 2:151-157. [PMID: 31386098 PMCID: PMC6668271 DOI: 10.1093/nop/npv011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Indexed: 01/27/2023] Open
Abstract
Palliative care is an approach to practicing medicine that addresses symptom management, alleviation of pain, assessment of psychosocial and spiritual distress or suffering, and practical support for patients and their caregivers with a goal of improving quality of life for patients with serious and life-threatening illnesses. Although palliative care has gained acceptance as an important part of comprehensive cancer care at the end of life, early integration of palliative care is less common. Patients with high-grade malignant gliomas have an invariably poor prognosis and high morbidity. With short survival times and complex neurological and systemic symptoms, these patients require palliative care from the time of diagnosis. In this review, we highlight the palliative care needs of neuro-oncology patients at diagnosis, during treatment, and at the end of life. We identify some of the barriers to incorporation of palliative care in standard neuro-oncology practice and equate competency in neuro-oncology with competency in the basic tenets of palliative medicine.
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Affiliation(s)
- Alissa A Thomas
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan Carver
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
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Khoury MN, Missios S, Edwin N, Sakruti S, Barnett G, Stevens G, Peereboom DM, Khorana AA, Ahluwalia MS. Intracranial hemorrhage in setting of glioblastoma with venous thromboembolism. Neurooncol Pract 2015; 3:87-96. [PMID: 31386010 DOI: 10.1093/nop/npv028] [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: 04/28/2015] [Indexed: 02/02/2023] Open
Abstract
Background Venous thromboembolism (VTE) is a complication of glioblastoma. Anticoagulating patients with glioblastoma carries a theoretical risk of intracranial hemorrhage (ICH). Methods We performed a retrospective cohort study of consecutive glioblastoma patients (2007-2013) diagnosed with VTE. Results The study population comprised of 523 glioblastoma patients of whom 173 (33%) had VTE events. Seventeen (10%) had ICH: 6 (35%) subdural hematomas and 11 (65%) intratumoral hemorrhages. In total, 4 patients with ICH required neurosurgical intervention. Enhancement in the area of subsequent intratumoral hemorrhage was noted in 9 of 10 with available pre-ICH scans. Multivariable regression did not show associations between ICH and tumor enhancement diameter or use of vascular-endothelial-growth-factor inhibitor. Fifteen (16%) patients receiving anticoagulation had ICH compared with 2 (2.6%) not receiving anticoagulation (P = .005). The method of anticoagulation was not associated with development of ICH. Median survival times from nondistal VTE diagnosis to death were 8.0 and 3.5 months (P = .05) in patients receiving anticoagulation and those not on anticoagulation, respectively. Conclusion Patients with glioblastoma and VTE on anticoagulation have increased incidence of ICH. However, development of ICH was not associated with lower median survival from time of VTE. Intratumoral hemorrhage occurred within the enhancing portion of tumor; however, no relationship was identified between the development of ICH and (i) the median diameter of enhancement or (ii) type of anticoagulant used. However, patients with absence of enhancing tumor did not have intratumoral bleed, suggesting gross total resection may limit this adverse outcome. It is appropriate to initiate anticoagulation in glioblastoma patients with VTEs.
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Affiliation(s)
- Michael Nabil Khoury
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Symeon Missios
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Natasha Edwin
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Susmita Sakruti
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Gene Barnett
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Glen Stevens
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - David M Peereboom
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Alok A Khorana
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
| | - Manmeet S Ahluwalia
- Department of Neurooncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, Florida (M.N.K.); Department of Oncological Sciences, University of South Florida, Tampa, Florida (M.N.K.); Department of Neurosurgery, Louisiana State University, 1501 Kings Hwy, Shreveport, Louisiana (S.M.); Department of Internal Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (N.E.); Department of Hematology/Oncology, University Hospital, 11100 Euclid Avenue, Cleveland, Ohio (S.S.); Department of Neurosurgery,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B.); Department of Neurology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.S.); Department of Hematology and Oncology,Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (D.M.P., A.A.K., M.S.A.); Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio (G.B., G.S., D.M.P., M.S.A.)
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Depot delivery of dexamethasone and cediranib for the treatment of brain tumor associated edema in an intracranial rat glioma model. J Control Release 2015; 217:183-90. [PMID: 26285064 DOI: 10.1016/j.jconrel.2015.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 08/03/2015] [Accepted: 08/13/2015] [Indexed: 11/22/2022]
Abstract
Treatments of brain tumor associated edema with systemically delivered dexamethasone, the standard of care, and cediranib, a novel anti-edema agent, are associated with systemic toxicities in brain tumor patients. A tunable, reservoir-based drug delivery device was developed to investigate the effects of delivering dexamethasone and cediranib locally in the brain in an intracranial 9L gliosarcoma rat model. Reproducible, sustained releases of both dexamethasone and solid dispersion of cediranib in polyvinylpyrrolidone (AZD/PVP) from these devices were achieved. The water-soluble AZD/PVP, which exhibited similar bioactivity as cediranib, was developed to enhance the release of cediranib from the device. Local and systemic administration of both dexamethasone and cediranib was equally efficacious in alleviating edema but had no effect on tumor growth. Edema reduction led to modest but significant improvement in survival. Local delivery of dexamethasone prevented dexamethasone-induced weight loss, an adverse effect seen in animals treated with systemic dexamethasone. Local deliveries of dexamethasone and cediranib via these devices used only 2.36% and 0.21% of the systemic doses respectively, but achieved similar efficacy as systemic drug deliveries without the side effects associated with systemic administration. Other therapeutic agents targeting brain tumor can be delivered locally in the brain to provide similar improved treatment outcomes.
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Managing Disease and Therapy-Related Complications in Patients with Central Nervous System Tumors. Curr Treat Options Oncol 2015; 16:38. [DOI: 10.1007/s11864-015-0357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Gong Y, Ma Y, Sinyuk M, Loganathan S, Thompson RC, Sarkaria JN, Chen W, Lathia JD, Mobley BC, Clark SW, Wang J. Insulin-mediated signaling promotes proliferation and survival of glioblastoma through Akt activation. Neuro Oncol 2015; 18:48-57. [PMID: 26136493 DOI: 10.1093/neuonc/nov096] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 05/07/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Metabolic complications such as obesity, hyperglycemia, and type 2 diabetes are associated with poor outcomes in patients with glioblastoma. To control peritumoral edema, use of chronic high-dose steroids in glioblastoma patients is common, which can result in de novo diabetic symptoms. These metabolic complications may affect tumors via profound mechanisms, including activation of insulin receptor (InsR) and the related insulin-like growth factor 1 receptor (IGF1R) in malignant cells. METHODS In the present study, we assessed expression of InsR in glioblastoma surgical specimens and glioblastoma response to insulin at physiologically relevant concentrations. We further determined whether genetic or pharmacological targeting of InsR affected oncogenic functions of glioblastoma in vitro and in vivo. RESULTS We showed that InsR was commonly expressed in glioblastoma surgical specimens and xenograft tumor lines, with mitogenic isoform-A predominating. Insulin at physiologically relevant concentrations promoted glioblastoma cell growth and survival, potentially via Akt activation. Depletion of InsR impaired cellular functions and repressed orthotopic tumor growth. The absence of InsR compromised downstream Akt activity, but yet stimulated IGF1R expression. Targeting both InsR and IGF1R with dual kinase inhibitors resulted in effective blockade of downstream signaling, loss of cell viability, and repression of xenograft tumor growth. CONCLUSIONS Taken together, our work suggests that glioblastoma is sensitive to the mitogenic functions of insulin, thus significant insulin exposure imposes risks to glioblastoma patients. Additionally, dual inhibition of InsR and IGF1R exhibits promise for treating glioblastoma.
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Affiliation(s)
- Yuanying Gong
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Yufang Ma
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Maksim Sinyuk
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Sudan Loganathan
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Reid C Thompson
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Jann N Sarkaria
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Wenbiao Chen
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Justin D Lathia
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Bret C Mobley
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Stephen W Clark
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
| | - Jialiang Wang
- Department of Neurological Surgery (Y.G., Y.M., R.C.T., S.W.C., J.W.), Department of Molecular Physiology and Biophysics (W.C.), Department of Neurology (S.W.C.), Department of Pathology, Microbiology and Immunology (B.C.M.), and Department of Cancer Biology and Department of Pharmacology, Vanderbilt University, Nashville, Tennessee (J.W.); Department of Cellular and Molecular Medicine, Cleveland Clinic, Cleveland, Ohio (M.S., J.D.L.); Department of Neuroscience and Pharmacology, Meharry Medical College, Nashville, Tennessee (S.L.); Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (J.N.S.)
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Berg AK, Buckner JC, Galanis E, Jaeckle KA, Ames MM, Reid JM. Quantification of the impact of enzyme-inducing antiepileptic drugs on irinotecan pharmacokinetics and SN-38 exposure. J Clin Pharmacol 2015; 55:1303-12. [PMID: 25975718 DOI: 10.1002/jcph.543] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 05/11/2015] [Indexed: 01/25/2023]
Abstract
The population pharmacokinetic model reported here was developed using data from 2 phase 2 trials of irinotecan for treatment of malignant glioma to quantify the impact of concomitant therapy with enzyme-inducing antiepileptic drugs (EIAEDs) on irinotecan pharmacokinetics. Patients received weekly irinotecan doses of 100 to 400 mg/m(2) , and plasma samples were collected and analyzed for irinotecan and its APC, SN-38, and SN-38G metabolites. Nonlinear mixed-effects modeling was employed for population pharmacokinetic analysis. Concomitant therapy with phenytoin, phenobarbital, or carbamazepine increased the clearances of irinotecan, SN-38, and SN-38G but not APC. SN-38 clearance was 2-fold higher with concomitant EIAED use, resulting in 40% lower SN-38 exposure. Evaluation of additional covariates revealed no clinically relevant effects of sex or concomitant corticosteroid use. The population pharmacokinetic model suggests that a 1.7-fold increase in irinotecan dose may compensate for decreases in SN-38 exposure in the presence of concomitant EIAEDs. Although slightly more conservative, this dose adjustment is consistent with those recommended based on increases in the maximally tolerated dose for malignant glioma patients receiving EIAEDs and may be an appropriate starting point for further investigation when extrapolating to other cancer types or alternative regimens.
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Affiliation(s)
- Alexander K Berg
- Department of Clinical Pharmacology, Upsher-Smith Laboratories Inc., Maple Grove, MN, USA
| | - Jan C Buckner
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| | | | - Kurt A Jaeckle
- Department of Neurology, Mayo Clinic, Jacksonville, MN, USA
| | - Matthew M Ames
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Joel M Reid
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.,Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
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Yu LJ, Wall BA, Chen S. The current management of brain metastasis in melanoma: a focus on riluzole. Expert Rev Neurother 2015; 15:779-92. [PMID: 26092602 DOI: 10.1586/14737175.2015.1055321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Brain metastasis is a common endpoint in human malignant melanoma, and the prognosis for patients remains poor despite advancements in therapy. Current treatment for melanoma metastatic to the brain is grouped into those providing symptomatic relief such as corticosteroids and antiepileptic agents, to those that are disease modifying. Related to the latter group, recent studies have demonstrated that aberrant glutamate signaling plays a role in the transformation and maintenance of various cancer types, including melanoma. Glutamate secretion from these and surrounding cells have been found to stimulate regulatory pathways that control tumor growth, proliferation and survival in vitro and in vivo. The antiglutamatergic actions of an inhibitor of glutamate release, riluzole, have been detected by its ability to clear glutamate from the synapse, and it has been shown to inhibit glutamate release rather than directly inhibiting glutamate receptors. Preclinical studies have demonstrated the ability of riluzole to act as a radiosensitizing agent in melanoma. The effect of riluzole on downstream glutamatergic signaling has pointed to cross talk between the metabotropic G-protein-coupled glutamate receptors implicated in a subset of human melanomas with other signaling pathways, including apoptotic, angiogenic, ROS and cell invasion mechanisms, thus establishing its potential to be further explored in combination therapy regimens for both primary human melanoma and melanoma metastatic to the brain.
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Affiliation(s)
- Lumeng J Yu
- Susan Lehman Cullman Laboratory for Cancer Research, Ernest Mario School of Pharmacy, Rutgers, the State University, Piscataway, NJ, 08854, USA
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Alifieris C, Trafalis DT. Glioblastoma multiforme: Pathogenesis and treatment. Pharmacol Ther 2015; 152:63-82. [PMID: 25944528 DOI: 10.1016/j.pharmthera.2015.05.005] [Citation(s) in RCA: 496] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/28/2015] [Indexed: 12/12/2022]
Abstract
Each year, about 5-6 cases out of 100,000 people are diagnosed with primary malignant brain tumors, of which about 80% are malignant gliomas (MGs). Glioblastoma multiforme (GBM) accounts for more than half of MG cases. They are associated with high morbidity and mortality. Despite current multimodality treatment efforts including maximal surgical resection if feasible, followed by a combination of radiotherapy and/or chemotherapy, the median survival is short: only about 15months. A deeper understanding of the pathogenesis of these tumors has presented opportunities for newer therapies to evolve and an expectation of better control of this disease. Lately, efforts have been made to investigate tumor resistance, which results from complex alternate signaling pathways, the existence of glioma stem-cells, the influence of the blood-brain barrier as well as the expression of 0(6)-methylguanine-DNA methyltransferase. In this paper, we review up-to-date information on MGs treatment including current approaches, novel drug-delivering strategies, molecular targeted agents and immunomodulative treatments, and discuss future treatment perspectives.
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Affiliation(s)
| | - Dimitrios T Trafalis
- Laboratory of Pharmacology, Medical School, University of Athens, Athens, Greece.
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Schiff D, Lee EQ, Nayak L, Norden AD, Reardon DA, Wen PY. Medical management of brain tumors and the sequelae of treatment. Neuro Oncol 2015; 17:488-504. [PMID: 25358508 PMCID: PMC4483077 DOI: 10.1093/neuonc/nou304] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 09/28/2014] [Indexed: 12/11/2022] Open
Abstract
Patients with malignant brain tumors are prone to complications that negatively impact their quality of life and sometimes their overall survival as well. Tumors may directly provoke seizures, hypercoagulable states with resultant venous thromboembolism, and mood and cognitive disorders. Antitumor treatments and supportive therapies also produce side effects. In this review, we discuss major aspects of supportive care for patients with malignant brain tumors, with particular attention to management of seizures, venous thromboembolism, corticosteroids and their complications, chemotherapy including bevacizumab, and fatigue, mood, and cognitive dysfunction.
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Affiliation(s)
| | - Eudocia Q. Lee
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - Lakshmi Nayak
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - Andrew D. Norden
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - David A. Reardon
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
| | - Patrick Y. Wen
- Neuro-Oncology Center, University of Virginia Medical Center, Charlottesville, Virginia (D.S.); Center for Neuro-Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (E.Q.L., L.N., A.D.N., D.A.R., P.Y.W.)
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Brandes AA, Bartolotti M, Tosoni A, Poggi R, Franceschi E. Practical management of bevacizumab-related toxicities in glioblastoma. Oncologist 2015; 20:166-75. [PMID: 25568148 DOI: 10.1634/theoncologist.2014-0330] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bevacizumab, currently an option for treatment of different types of tumors including glioblastoma, has a peculiar toxicity profile related to its antiangiogenic effect. Because some bevacizumab-related adverse events can be life threatening, it is important to identify risk factors and to establish treatment protocols to minimize treatment-related morbidity and mortality. In glioblastoma patients, the risk of developing certain side effects, such as gastrointestinal perforation, venous thromboembolism, and intracranial hemorrhages, is slightly higher than in patients treated with bevacizumab for other tumor types. We performed a systematic review of the side effects of bevacizumab and their incidence, causal mechanisms, and available treatments. Finally, we identified risk factors and proposed preventive and therapeutic measures for these adverse events.
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Affiliation(s)
- Alba A Brandes
- Department of Medical Oncology, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Marco Bartolotti
- 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
| | - Rosalba Poggi
- Department of Medical Oncology, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Enrico Franceschi
- Department of Medical Oncology, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Bologna, Italy
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Hansen A, Rosenbek Minet LK, Søgaard K, Jarden JO. The effect of an interdisciplinary rehabilitation intervention comparing HRQoL, symptom burden and physical function among patients with primary glioma: an RCT study protocol. BMJ Open 2014; 4:e005490. [PMID: 25280804 PMCID: PMC4187655 DOI: 10.1136/bmjopen-2014-005490] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Gliomas are among the biggest challenges in neurological and oncology rehabilitation and optimising treatment is of major clinical importance in this population. Although inpatient rehabilitation among glioma patients' results in improved functional measures, rehabilitation efforts are still not emphasised in this patient group and the literature lacks studies investigating the impact of outpatient rehabilitation. METHOD This protocol describes a randomised 6-week parallel group rehabilitation study investigating an outpatient interdisciplinary rehabilitation programme. The intervention consists of 6 weeks intensive physiotherapy as groups exercise in conjunction with 0-6 weeks of individual occupational therapy if a need is present. The aim of this study is to describe the design of the upcoming randomised control trial (RCT). The results of the RCT will add to the growing body of literature investigating the potential role of exercise as a supportive therapeutic intervention for a patient with cancer. ETHICS AND DISSEMINATION The project is approved by the Regional Scientific Ethical Committees for Southern Denmark under Project-ID: (S-20140108) and by the Danish Data Protection Agency (J. no.2008-58-0035). Dissemination will occur through presentation and findings will be published in peer-reviewed journals. The key strength of this study is its randomised design and it is the first study to investigate a standardised outpatient interdisciplinary rehabilitation programme among patients with glioma. A potential limitation is the uncertainty and risk of side effects to the concomitant treatment, which enhances the risk of dropout. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Identifier NCT02221986.
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Affiliation(s)
- Anders Hansen
- Rehabilitation Unit, Odense University Hospital, Odense, Fyn, Denmark
| | | | - Karen Søgaard
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jens Ole Jarden
- Department of Neurology, Herlev University Hospital, University of Copenhagen, Copenhagen, Denmark
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Sayegh ET, Fakurnejad S, Oh T, Bloch O, Parsa AT. Anticonvulsant prophylaxis for brain tumor surgery: determining the current best available evidence. J Neurosurg 2014; 121:1139-47. [PMID: 25170671 DOI: 10.3171/2014.7.jns132829] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients who undergo craniotomy for brain tumor resection are prone to experiencing seizures, which can have debilitating medical, neurological, and psychosocial effects. A controversial issue in neurosurgery is the common practice of administering perioperative anticonvulsant prophylaxis to these patients despite a paucity of supporting data in the literature. The foreseeable benefits of this strategy must be balanced against potential adverse effects and interactions with critical medications such as chemotherapeutic agents and corticosteroids. Multiple disparate metaanalyses have been published on this topic but have not been applied into clinical practice, and, instead, personal preference frequently determines practice patterns in this area of management. Therefore, to select the current best available evidence to guide clinical decision making, the literature was evaluated to identify meta-analyses that investigated the efficacy and/or safety of anticonvulsant prophylaxis in this patient population. Six meta-analyses published between 1996 and 2011 were included in the present study. The Quality of Reporting of Meta-analyses and Oxman-Guyatt methodological quality assessment tools were used to score these meta-analyses, and the Jadad decision algorithm was applied to determine the highest-quality meta-analysis. According to this analysis, 2 metaanalyses were deemed to be the current best available evidence, both of which conclude that prophylactic treatment does not improve seizure control in these patients. Therefore, this management strategy should not be routinely used.
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Affiliation(s)
- Eli T Sayegh
- Department of Neurological Surgery, Northwestern University, Chicago, Illinois
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Kostaras X, Cusano F, Kline GA, Roa W, Easaw J. Use of dexamethasone in patients with high-grade glioma: a clinical practice guideline. ACTA ACUST UNITED AC 2014; 21:e493-503. [PMID: 24940109 DOI: 10.3747/co.21.1769] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Dexamethasone is the corticosteroid most commonly used for the management of vasogenic edema and increased intracranial pressure in patients with brain tumours. It is also used after surgery (before embarking on radiotherapy), particularly in patients whose tumours exert significant mass effect. Few prospective clinical trials have set out to determine the optimal dose and schedule for dexamethasone in patients with primary brain tumours, and subsequently, fewer clinical practice guideline recommendations have been formulated. METHODS A review of the scientific literature published to November 2012 considered all publications that addressed dexamethasone use in adult patients with brain tumours. Evidence was selected and reviewed by a working group comprising 3 clinicians and 1 methodologist. The resulting draft guideline underwent internal review by members of the Alberta Provincial cns Tumour Team, and feedback was incorporated into the final version of the guideline. RECOMMENDATIONS Based on the evidence available to date, the Alberta Provincial cns Tumour Team makes these recommendations: Treatment with dexamethasone is recommended for symptom relief in adult patients with primary high-grade glioma and cerebral edema.After surgery, a maximum dose of 16 mg daily, administered in 4 equal doses, is recommended for symptomatic patients. This protocol should ideally be started by the neurosurgeon.A rapid dexamethasone tapering schedule should be considered where appropriate.Patients who have high-grade tumours, are symptomatic, or have poor life expectancy, can be maintained on a 0.5-1.0 mg dose of dexamethasone daily.Side effects with dexamethasone are common, and they increase in frequency and severity with increased dose and duration of therapy. Patients should be carefully monitored for endocrine, muscular, skeletal, gastrointestinal, psychiatric, and hematologic complications, and for infections and other general side effects.
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Affiliation(s)
- X Kostaras
- Guideline Utilization Resource Unit, Alberta Health Services, CancerControl Alberta, Calgary, AB
| | - F Cusano
- Department of Pharmacy, Tom Baker Cancer Centre, Calgary, AB
| | - G A Kline
- Division of Endocrinology and Metabolism, Faculty of Medicine, University of Calgary, Calgary, AB
| | - W Roa
- Department of Oncology, Cross Cancer Institute, Edmonton' AB
| | - J Easaw
- Department of Oncology, Tom Baker Cancer Centre, Calgary, AB
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Gehring K, Aaronson NK, Taphoorn MJ, Sitskoorn MM. Interventions for cognitive deficits in patients with a brain tumor: an update. Expert Rev Anticancer Ther 2014; 10:1779-95. [DOI: 10.1586/era.10.163] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Samlowski WE, Jensen RL, Shrieve DC. Multimodality management of brain metastases in metastatic melanoma patients. Expert Rev Anticancer Ther 2014; 7:1699-705. [DOI: 10.1586/14737140.7.12.1699] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Strowd RE, Knovich MA, Lesser GJ. The therapeutic management of bleeding and thrombotic disorders complicating CNS malignancies. Curr Treat Options Oncol 2013; 13:451-64. [PMID: 22829388 DOI: 10.1007/s11864-012-0207-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT Patients with central nervous system (CNS) malignancies have a substantial risk for developing both thrombotic and bleeding disorders. The risk of venous thromboembolism (VTE) is substantially higher in these patients, both in the perioperative period and throughout their disease course. Patients with CNS malignancy harbor a latent hypercoagulability, which predisposes to VTE, as do postoperative immobility, hemiparesis, and other factors. The management of VTE in these patients is complex, given the significant morbidity and mortality associated with intratumoral hemorrhage. In the past, the perceived risk of intracranial hemorrhage limited the use of anticoagulation for the management of VTE with many favoring nonpharmacologic methods for prophylaxis and treatment. Inferior vena cava (IVC) filters have since lost favor at many centers given significant complications, which appear to be more frequent in patients with CNS malignancy. Recent studies have demonstrated safe and efficacious use of anticoagulation in these patients with a low incidence of intracranial hemorrhage. Treatment of established VTE is now recommended in this population with many centers favoring low-molecular-weight heparin (LMWH) versus oral warfarin for short- or long-term treatment. We advocate a multimodality approach utilizing compression stockings, intermittent compression devices, and heparin in the perioperative setting as the best proven method to reduce the risk of VTE. In the absence of a strict contraindication to systemic anticoagulation, such as previous intracranial hemorrhage or profound thrombocytopenia, we recommend LMWH in patients with newly diagnosed VTE and a CNS malignancy.
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Affiliation(s)
- Roy E Strowd
- Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, Box 2409, NC 27157, USA.
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Recurrent headaches in an older man without other neurologic symptoms. JAAPA 2013; 26:36, 39-40. [DOI: 10.1097/01720610-201305000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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