1
|
Ius T, Montemurro N, Lombardi G, Berardinelli J, Romano A, Barresi V, Cerretti G, Guarnera A, Tel A, Cavallo LM, Pasqualetti F, Feletti A. Decoding the puzzle: A multidisciplinary systematic review of adult brainstem glioma. Crit Rev Oncol Hematol 2024; 196:104261. [PMID: 38395241 DOI: 10.1016/j.critrevonc.2024.104261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 02/25/2024] Open
Abstract
Adult brainstem gliomas (BSGs) are a group of rare central nervous system tumors with varying prognoses and controversial standard treatment strategies. To provide an overview of current trends, a systematic review using the PRISMA guidelines, Class of evidence (CE) and strength of recommendation (SR), was conducted. The review identified 27 studies. Surgery was found to have a positive impact on survival, particularly for focal lesions with CE II SR C. Stereotactic image-guided biopsy was recommended when resective surgery was not feasible with CE II and SR B. The role of systemic treatments remains unclear. Eight studies provided molecular biology data. This review gathers crucial literature on diagnosis and management of adult BSGs. It provides evidence-based guidance with updated recommendations for diagnosing and treating, taking into account recent molecular and genetic advancements. The importance of brain biopsy is emphasized to optimize treatment using emerging genetic-molecular findings and explore potential targeted therapies.
Collapse
Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department University Hospital of Udine, Italy.
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Andrea Romano
- Department of Neuroradiology, NESMOS S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Valeria Barresi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giulia Cerretti
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Alessia Guarnera
- Department of Neuroradiology, NESMOS S. Andrea Hospital, University Sapienza, Rome, Italy
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department University Hospital of Udine, Italy
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Francesco Pasqualetti
- Division of Radiation Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, Italy
| |
Collapse
|
2
|
Weiß L, Roth F, Rea-Ludmann P, Rosenstock T, Picht T, Vajkoczy P, Zdunczyk A. NTMS based tractography and segmental diffusion analysis in patients with brainstem gliomas: Risk stratification and clinical potential. BRAIN & SPINE 2024; 4:102753. [PMID: 38510608 PMCID: PMC10951762 DOI: 10.1016/j.bas.2024.102753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 03/22/2024]
Abstract
Introduction Surgery on the brainstem level is associated with a high-risk of postoperative morbidity. Recently, we have introduced the combination of navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging (DTI) tractography to define functionally relevant motor fibers tracts on the brainstem level to support operative planning and risk stratification in brainstem cavernomas. Research question Evaluate this method and assess it's clinical impact for the surgery of brainstem gliomas. Material and methods Patients with brainstem gliomas were examined preoperatively with motor nTMS and DTI tractography. A fractional anisotropy (FA) value of 75% of the individual FA threshold (FAT) was used to track descending corticospinal (CST) and -bulbar tracts (CBT). The distance between the tumor and the somatotopic tracts (hand, leg, face) was measured and diffusion parameters were correlated to the patients' outcome. Results 12 patients were enrolled in this study, of which 6 underwent surgical resection, 5 received a stereotactic biopsy and 1 patient received conservative treatment. In all patients nTMS mapping and somatotopic tractography were performed successfully. Low FA values correlated with clinical symptoms revealing tract alteration by the tumor (p = 0.049). A tumor-tract distance (TTD) above 2 mm was the critical limit to achieve a safe complete tumor resection. Discussion and conclusion nTMS based DTI tractography combined with local diffusion analysis is a valuable tool for preoperative visualization and functional assessment of relevant motor fiber tracts, improving planning of safe entry corridors and perioperative risk stratification in brainstem gliomas tumors. This technique allows for customized treatment strategy to maximize patients' safety.
Collapse
Affiliation(s)
- Lion Weiß
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Fabia Roth
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Pierre Rea-Ludmann
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Tizian Rosenstock
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
- Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Germany
| | - Thomas Picht
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
- Cluster of Excellence Matters of Activity. Image Space Material, Humboldt Universität zu Berlin, Germany
| | - Peter Vajkoczy
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| | - Anna Zdunczyk
- Charité – Universitätsmedizin Berlin, Department of Neurosurgery, Germany
| |
Collapse
|
3
|
Gavryushin AV, Khukhlaeva EA, Veselkov AA, Pronin IN, Konovalov AN. [Primary tumors of the brain stem. State of the problem]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2024; 88:98-104. [PMID: 38549416 DOI: 10.17116/neiro20248802198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Primary brainstem gliomas are still poorly studied in neurooncology. This concept includes tumors with different histological and genetic features, as well as variable clinical course and outcomes. Nevertheless, treatment implies radiotherapy without a clear idea of morphological substrate of disease in 80% of cases. Small number of studies and insufficient data on histological and genetic nature of brainstem tumors complicate clear diagnostic and treatment algorithms. This review provides current information regarding primary glial brainstem tumors. Appropriate problems and objectives are highlighted. The purpose of the review is to provide a comprehensive and updated understanding of the current state of brainstem glial tumors and to identify areas requiring further study for improvement of diagnosis and treatment of these diseases. Brainstem tumors are an understudied problem with small amount of data that complicates optimal treatment strategies. Further researches and histological verification are required to develop new methods of therapy, especially for diffuse forms of neoplasms.
Collapse
Affiliation(s)
- A V Gavryushin
- Burdenko Neurosurgical Center, Moscow, Russia
- National Medical Research Center for Pediatric Hematology, Oncology and Immunology named after Dmitry Rogachev, Moscow, Russia
| | | | | | - I N Pronin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | |
Collapse
|
4
|
Ius T, Lombardi G, Baiano C, Berardinelli J, Romano A, Montemurro N, Cavallo LM, Pasqualetti F, Feletti A. Surgical Management of Adult Brainstem Gliomas: A Systematic Review and Meta-Analysis. Curr Oncol 2023; 30:9772-9785. [PMID: 37999129 PMCID: PMC10670486 DOI: 10.3390/curroncol30110709] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/25/2023] Open
Abstract
The present review aims to investigate the survival and functional outcomes in adult high-grade brainstem gliomas (BGSs) by comparing data from resective surgery and biopsy. MEDLINE, EMBASE and Cochrane Library were screened to conduct a systematic review of the literature, according to the PRISMA statement. Analysis was limited to articles including patients older than 18 years of age and those published from 1990 to September 2022. Case reports, review articles, meta-analyses, abstracts, reports of aggregated data, and reports on multimodal therapy where surgery was not the primary treatment were excluded. The ROBINS-I tool was applied to evaluate the risk of bias. Six studies were ultimately considered for the meta-analysis. The resective group was composed of 213 subjects and the bioptic group comprised 125. The analysis demonstrated a survival benefit in those patients in which an extensive resection was possible (STR HR 0.59 (95% CI 0.42, 0.82)) (GTR HR 0.63 (95% CI 0.43, 0.92)). Although surgical resection is associated with increased survival, the significantly higher complication rate makes it difficult to recommend surgery instead of biopsy for BSGs. Future investigations combining volumetric data and molecular profiles could add important data to better define the proper indication between resection and biopsy.
Collapse
Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, 33100 Udine, Italy;
| | - Giuseppe Lombardi
- Department of Oncology 1, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy;
| | - Cinzia Baiano
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.B.); (L.M.C.)
| | - Jacopo Berardinelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.B.); (L.M.C.)
| | - Andrea Romano
- Department of Neuroradiology, NESMOS S.Andrea Hospital, University Sapienza, 00189 Rome, Italy;
| | - Nicola Montemurro
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana, 56123 Pisa, Italy;
| | - Luigi Maria Cavallo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy; (C.B.); (L.M.C.)
| | | | - Alberto Feletti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Institute of Neurosurgery, University of Verona, 37129 Verona, Italy;
| |
Collapse
|
5
|
Guarnera A, Romano A, Moltoni G, Ius T, Palizzi S, Romano A, Bagatto D, Minniti G, Bozzao A. The Role of Advanced MRI Sequences in the Diagnosis and Follow-Up of Adult Brainstem Gliomas: A Neuroradiological Review. Tomography 2023; 9:1526-1537. [PMID: 37624115 PMCID: PMC10457939 DOI: 10.3390/tomography9040122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/26/2023] Open
Abstract
The 2021 WHO (World Health Organization) classification of brain tumors incorporated the rapid advances in the molecular, genetic, and pathogenesis understanding of brain tumor pathogenesis, behavior, and treatment response. It revolutionized brain tumor classification by placing great emphasis on molecular types and completely splitting adult-type and pediatric-type diffuse gliomas. Brainstem gliomas (BSGs) are the leading primary tumors of the brainstem, although they are quite uncommon in adults compared with the pediatric population, representing less than 2% of adult gliomas. Surgery is not always the treatment of choice since resection is rarely feasible and does not improve overall survival, and biopsies are not generally performed since the location is treacherous. Therefore, MRI (Magnetic Resonance Imaging) without and with gadolinium administration represents the optimal noninvasive radiological technique to suggest brainstem gliomas diagnosis, plan a multidisciplinary treatment and for follow-up evaluations. The MRI protocol encompasses morphological sequences as well as functional and advanced sequences, such as DWI/ADC (Diffusion-Weighted Imaging/Apparent Diffusion Coefficient), DTI (Diffusion Tensor Imaging), PWI (Perfusion-Weighted Imaging), and MRS (Magnetic Resonance Spectroscopy), which improve the accuracy of the diagnosis of BSGs by adding substantial information regarding the cellularity, the infiltrative behavior toward the v fiber tracts, the vascularity, and the molecular changes. Brainstem gliomas have been divided into four categories on the basis of their MRI radiological appearance, including diffuse intrinsic low-grade gliomas, enhancing malignant gliomas, localized tectal gliomas, and other forms. The aim of our review is to provide insight into the role of advanced MRI sequences in the diagnosis and follow-up of adult brainstem gliomas.
Collapse
Affiliation(s)
- Alessia Guarnera
- Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (A.R.); (G.M.); (S.P.); (A.R.); (A.B.)
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (A.R.); (G.M.); (S.P.); (A.R.); (A.B.)
| | - Giulia Moltoni
- Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (A.R.); (G.M.); (S.P.); (A.R.); (A.B.)
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children’s Hospital, Piazza Sant’Onofrio 4, 00165 Rome, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy;
| | - Serena Palizzi
- Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (A.R.); (G.M.); (S.P.); (A.R.); (A.B.)
| | - Allegra Romano
- Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (A.R.); (G.M.); (S.P.); (A.R.); (A.B.)
| | - Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging, University Hospital of Udine, Piazzale Santa Maria della Misericordia 15, 33100 Udine, Italy;
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Division of Radiotherapy, La Sapienza University of Rome, 00161 Rome, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Alessandro Bozzao
- Neuroradiology Unit, NESMOS Department Sant’Andrea Hospital, La Sapienza University of Rome, Via di Grottarossa, 1035-1039, 00189 Rome, Italy; (A.R.); (G.M.); (S.P.); (A.R.); (A.B.)
| |
Collapse
|
6
|
Aleid AM, Alaethan MH, Alsaati AA, Alhejji MH, Ali Alkathem J. Medullary brainstem gliomas in an adult: A rare case report and challenging tumor. Surg Neurol Int 2023; 14:190. [PMID: 37404499 PMCID: PMC10316255 DOI: 10.25259/sni_189_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/10/2023] [Indexed: 07/06/2023] Open
Abstract
Background Medullary brainstem lesions are rare tumors that are challenging to treat due to their location in the brainstem, which controls vital functions such as breathing, heart rate, and blood pressure. While the most common subtype is the aggressive diffuse intrinsic pontine glioma, other subtypes exist, including focal brainstem gliomas and cervicomedullary gliomas. The prognosis for patients with brainstem gliomas is generally poor, and treatment options are limited. Early detection and treatment are crucial to improve outcomes for patients with these tumors. Case Description In this case report, the authors describe a 28-year-old male from Saudi Arabia who presented with headaches and vomiting. Imaging studies and clinical examination revealed a high-grade astrocytoma medullary brainstem lesion. The patient underwent radiation therapy and chemotherapy, effectively controlling tumor growth and improving his quality of life. However, a residual tumor remained, and the patient underwent neurosurgery to resect the remaining tumor was successful in removing the tumor, and the patient showed significant improvement in his symptoms and overall health. Conclusion This case highlights the importance of early detection and treatment of medullary brainstem lesions. While radiation therapy and chemotherapy are primary treatment options, neurosurgery may be necessary to resect residual tumors. In addition, cultural and social factors may need to be considered in managing these tumors in Saudi Arabia.
Collapse
Affiliation(s)
| | | | | | - Murtadah Hassan Alhejji
- Department of Radiology, King Saud bin Abdulaziz University – Health Science, Ahsa, Saudi Arabia
| | | |
Collapse
|
7
|
Bishnoi I, Midha R, Singh K, Garg S, Jain P. Adult Brainstem Astroblastoma: Unusual Presentation of a Rare Tumor. Asian J Neurosurg 2023; 18:396-399. [PMID: 37397046 PMCID: PMC10313440 DOI: 10.1055/s-0043-1769892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Astroblastoma is a rare tumor, which is mostly found in pediatric population. Due to scarcity of literature, the data about treatment is lacking. We are reporting case of brainstem astroblastoma in an adult female. A 45-year-old lady presented with complaint of headache, vertigo, vomiting, and nasal regurgitation for 3 months. On examination, she had weak gag, left hemiparesis. Magnetic resonance imaging brain reported medulla oblongata mass, dorsally exophytic. She underwent suboccipital craniotomy and decompression of mass. Histopathology confirmed diagnosis of astroblastoma. She underwent radiotherapy and recovered well. Brainstem astroblastoma is an extremely rare entity. The surgical resection is possible due to well-defined plane. For best outcome, maximum resection and radiation are indicated.
Collapse
Affiliation(s)
- Ishu Bishnoi
- Neurosurgery Department, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Rahul Midha
- Anesthesia Department, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Karandeep Singh
- Pathology Department, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Swapnil Garg
- Surgery Department, Maharaja Agrasen Medical College, Agroha, Haryana, India
| | - Payal Jain
- Anesthesia Department, Maharaja Agrasen Medical College, Agroha, Haryana, India
| |
Collapse
|
8
|
Lasica N, Arnautovic K, Tadanori T, Vulekovic P, Kozic D. An integrative survival analysis and a systematic review of the cerebellopontine angle glioblastomas. Sci Rep 2023; 13:4442. [PMID: 36932101 PMCID: PMC10023706 DOI: 10.1038/s41598-023-30677-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
Glioblastomas presenting topographically at the cerebellopontine angle (CPA) are exceedingly rare. Given the specific anatomical considerations and their rarity, overall survival (OS) and management are not discussed in detail. The authors performed an integrative survival analysis of CPA glioblastomas. A literature search of PubMed, Scopus, and Web of Science databases was performed per PRISMA guidelines. Patient data including demographics, clinical features, neuroimaging, management, follow-up, and OS were extracted. The mean age was 39 ± 26.2 years. The mean OS was 8.9 months. Kaplan-Meier log-rank test and univariate Cox proportional-hazards model identified hydrocephalus (log-rank, p = 0.034; HR 0.34; 95% CI 0.12-0.94; p = 0.038), chemotherapy (log-rank, p < 0.005; HR 5.66; 95% CI 1.53-20.88; p = 0.009), and radiotherapy (log-rank, p < 0.0001; HR 12.01; 95% CI 3.44-41.89; p < 0.001) as factors influencing OS. Hydrocephalus (HR 3.57; 95% CI 1.07-11.1; p = 0.038) and no adjuvant radiotherapy (HR 0.12; 95% CI 0.02-0.59; p < 0.01) remained prognostic on multivariable analysis with fourfold and twofold higher risk for the time-related onset of death, respectively. This should be considered when assessing the risk-to-benefit ratio for patients undergoing surgery for CPA glioblastoma.
Collapse
Affiliation(s)
- Nebojsa Lasica
- Clinic of Neurosurgery, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia.
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
| | - Kenan Arnautovic
- Semmes Murphey Clinic, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Tomita Tadanori
- Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Petar Vulekovic
- Clinic of Neurosurgery, University Clinical Center of Vojvodina, Hajduk Veljkova 1-9, 21000, Novi Sad, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Dusko Kozic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Center for Diagnostic Imaging, Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
| |
Collapse
|
9
|
Zhang D, Li H, Jia W. Exploration of the prognostic value of the resection of adult brainstem high-grade glioma based on competing risk model, propensity score matching, and conditional survival rate. Neurol Sci 2023; 44:1755-1764. [PMID: 36604383 PMCID: PMC10102064 DOI: 10.1007/s10072-022-06557-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Adult brainstem high-grade glioma (HGG) is a refractory disease, and the treatment strategy of resection is still controversial. OBJECTIVE To investigate the prognostic value of brainstem HGG resection in adults. METHODS We collected 126,386 samples from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2016, and screened 973 patients diagnosed with adult brainstem HGG, who were in turn, grouped into 899 cases of non-resections and 74 cases of resections. Competing risk models were used to screen independent prognostic factors. Propensity score matching (PSM) was performed to reduce the influence of confounding factors. Conditional survival (CS) rate was considered to evaluate the changes in overall survival (OS) and disease-specific survival (DSS) of patients with HGG over time. RESULTS Based on the competing risk model and PSM, univariate analysis showed that age ≥ 45 years and male gender were poor prognostic factors for adult brainstem HGG. No previous history of glioma was a beneficial factor. Multivariate analysis revealed only the absence of a history of glioma to be a favorable prognostic factor. Considering the CS rate of the resection group, after the patient had survived for 3 years, the OS and DSS remained unchanged at 100% during the fourth and fifth years, whereas in the non-resection group, the OS and DSS of the patients were 82% and 74%, respectively. CONCLUSION Adult brainstem HGG resection has a poor prognosis in the early stage; however, patients have a potentially significant survival benefit after 3 years of survival.
Collapse
Affiliation(s)
- Dainan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Haiming Li
- Henan Provincial Key Laboratory of Neurorestoratology, The First Affiliated Hospital of Xinxiang Medical University, Wei Hui, China
| | - Wang Jia
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| |
Collapse
|
10
|
Malaizé H, Laigle-Donadey F, Riche M, Marijon P, Mokhtari K, Bielle F, Tran S, Nichelli L, Beccaria K, Idbaih A, Hoang-Xuan K, Touat M, Carpentier A, Mathon B. Roles and outcomes of stereotactic biopsy for adult patients with brainstem lesion. J Neurooncol 2022; 160:159-170. [PMID: 36083426 DOI: 10.1007/s11060-022-04129-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This study aimed to assess the benefit-risk ratio by determining diagnostic yield and safety of brainstem biopsies in adult patients. The secondary objectives were (i) to compare brainstem biopsy safety and postbiopsy patients' outcomes and survival with those of patients biopsied for a brain or cerebellar lesion, and (ii) to assess the impact of brainstem biopsy on final diagnosis and further therapeutic management. METHODS Among 1784 stereotactic biopsies performed in adult patients at a tertiary center between April 2009 and October 2020, we retrospectively examined 50 consecutive brainstem biopsies. We compared variables regarding diagnostic yield, safety and post-biopsy outcomes between brainstem biopsy patients and brain/cerebellum biopsy patients. RESULTS Brainstem biopsy led to a diagnosis in 86% of patients (94.6% in patients with suspected tumor). Lesion contrast enhancement on imaging was the sole predictor of obtaining a diagnosis. Rates of symptomatic complications and mortality were significantly higher in brainstem biopsy patients compared to brain/cerebellum biopsy patients (20% vs 0%; p < 0.001 and 6% vs 0%; p = 0.01, respectively). Transfrontal trajectory and prebiopsy swallowing disorders were predictors of brainstem biopsy-related symptomatic complications. Brainstem biopsy findings led to diagnostic change in 22% of patients. CONCLUSIONS Stereotactic biopsy in adult patients with brainstem lesion has a high diagnostic yield. Although stereotactic brainstem biopsy is associated with more functional and fatal complications than biopsies targeting the brain/cerebellum, its safety profile appears acceptable. Thus, the benefit-risk ratio of stereotactic biopsy in patients with brainstem lesion is favorable but should nevertheless be carefully weighted on a case-by-case basis.
Collapse
Affiliation(s)
- Henri Malaizé
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Florence Laigle-Donadey
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Maximilien Riche
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Pauline Marijon
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Karima Mokhtari
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France.,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France
| | - Franck Bielle
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France.,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France
| | - Suzanne Tran
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France.,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France
| | - Lucia Nichelli
- Department of Neuropathology, Sorbonne University, APHP, La Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Kevin Beccaria
- Department of Pediatric Neurosurgery, University of Paris Cité, APHP, Necker - Enfants Malades Hospital, 75015, Paris, France
| | - Ahmed Idbaih
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Khê Hoang-Xuan
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Mehdi Touat
- Department of Neurology, Sorbonne University, INSERM, CNRS, UMR S 1127, Paris Brain Institute, ICM, APHP, La Pitié-Salpêtrière Hospital, 2 - Mazarin, 75013, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France
| | - Bertrand Mathon
- Department of Neurosurgery, la Pitié-Salpêtrière University Hospital, 47-83, Boulevard de L'Hôpital, 75651, Paris Cedex 13, France. .,Paris Brain Institute, ICM, INSERM U 1127, CNRS, UMR 7225, Sorbonne University, UMRS 1127, Paris, France.
| | | |
Collapse
|
11
|
Wang Y, Pan C, Xie M, Zuo P, Li X, Gu G, Li T, Jiang Z, Wu Z, Zhang J, Zhang L. Adult diffuse intrinsic pontine glioma: clinical, radiological, pathological, molecular features, and treatments of 96 patients. J Neurosurg 2022; 137:1628-1638. [PMID: 35395636 DOI: 10.3171/2022.2.jns211920] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/07/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Unlike its pediatric counterpart, adult diffuse intrinsic pontine glioma (DIPG) remains largely unelucidated. In this study, the authors examined the clinical, radiological, pathological, molecular, and clinical aspects of 96 adult DIPGs. METHODS The National Brain Tumor Registry of China (April 2013-December 2019) was used to collect data on radiologically diagnosed adult DIPG patients. Survival analysis was conducted using Kaplan-Meier curves and univariate and multivariate Cox regression. The chi-square test/Wilcoxon rank-sum test and multivariable logistic regression were used to examine the clinical and radiological characteristics of patients with long-term survival (LTS). Interaction analyses between clinical factors were also conducted. RESULTS The median age at symptom onset was 33.5 years, and the median duration of symptoms was 4.5 months. The frequencies of H3K27M and IDH1 mutations were 37.2% and 26.5%, respectively. All adult DIPG patients had a median overall survival (OS) of 19.5 months, with 1-, 2-, and 3-year survival rates of 67.0%, 42.8%, and 36.0%, respectively. The median OS of 40 patients who did not undergo treatment was 13.4 months. Patients with H3K27M-mutant tumors had a poorer prognosis than those with IDH-mutant tumors (p < 0.001) and H3K27M(-)/IDH-wild-type tumors (p = 0.002), with a median OS of 11.4 months. The median OSs of patients with H3K27M-mutant tumors who received treatment and those who did not were 13.8 months and 7.5 months, respectively (p = 0.016). Among patients with and without a pathological diagnosis, H3K27M mutation (p < 0.001) and contrast enhancement on MRI (p = 0.003), respectively, imparted a worse prognosis. Treatments were the predictive factor for patients with H3K27M-mutant tumors (p = 0.038), whereas contrast enhancement on MRI was the prognostic factor for the H3K27M(-) group (p = 0.038). In addition, H3K27M mutation and treatment were significant predictors for patients with symptom duration ≤ 4 months (H3K27M, p = 0.020; treatment, p = 0.014) and tumors with no contrast enhancement (H3K27M, p = 0.003; treatment, p = 0.042). Patients with LTS were less likely to have cranial nerve palsy (p = 0.002) and contrast enhancement on MRI at diagnosis (p = 0.022). CONCLUSIONS It is recommended that all adult DIPG patients undergo genomic testing for H3K27M and IDH mutations. Despite the low prevalence, additional study is needed to better characterize the efficacy of various treatment modalities in adults with DIPG.
Collapse
Affiliation(s)
- Yi Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Changcun Pan
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingguo Xie
- 2Department of Neurosurgery, Sanbo Brain Hospital, Beijing, China
| | - Pengcheng Zuo
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaoou Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guocan Gu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhuang Jiang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhen Wu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Junting Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liwei Zhang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,3China National Clinical Research Center for Neurological Diseases, Beijing, China; and.,4Beijing Key Laboratory of Brain Tumor, Beijing, China
| |
Collapse
|
12
|
Sano K, Matsuda KI, Kawanami K, Kanemura Y, Ohe R, Sonoda Y. Malignant Progression of an IDH Mutant Brainstem Glioma in Adult. NMC Case Rep J 2022; 8:301-307. [PMID: 35079479 PMCID: PMC8769401 DOI: 10.2176/nmccrj.cr.2020-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Brain stem gliomas (BSG) in adults are rare and less aggressive than those in children. However, the molecular profile of adult BSG cases has not been well characterized. We report a case of adult BSG with isocitrate dehydrogenase (IDH) mutation. A 43-year-old male was admitted to our hospital with diplopia and right-sided hypesthesia. An open biopsy led to the tumor being diagnosed as a diffuse astrocytoma. Immunohistochemically, the tumor was positive for IDH1 R132H, but negative for H3K27M. The patient received 54 Gy of local radiotherapy and adjuvant temozolomide, which resulted in the size of the lesion decreasing significantly. At 56 months after the initial diagnosis, the patient was referred to our hospital with a severe headache and ataxia. Magnetic resonance imaging (MRI) revealed a contrast-enhanced lesion in the brain stem, which extended into the left cerebellar hemisphere and brainstem. Partial tumor removal was performed, and a pathological examination revealed the features of glioblastoma. Immunohistochemically, the tumor was positive for IDH1 R132H and p53 and negative for ATRX. To the best of our knowledge, there are few reports about adult case of brain stem astrocytoma to be confirmed via histological and molecular examinations of the primary and recurrent tumor. We exhibit detailed pathological and molecular findings which resembles to IDH mutant supratentorial diffuse astrocytic tumors.
Collapse
Affiliation(s)
- Kenshi Sano
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Ken-Ichiro Matsuda
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Kanako Kawanami
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Yonehiro Kanemura
- Department of Biomedical Research and Innovation, Institute for Clinical Research, National Hospital Organization Osaka National Hospital, Osaka, Osaka, Japan
| | - Rintaro Ohe
- Department of Pathological Diagnostics, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| |
Collapse
|
13
|
Li Y, Beeraka NM, Guo W, Lei Y, Hu Q, Guo L, Fan R, Liu J, Sui A. Prognosis of Patients With Brainstem Glioblastoma Based on "age, surgery and radiotherapy": A SEER Database Analysis. Technol Cancer Res Treat 2022; 21:15330338221082760. [PMID: 35311589 PMCID: PMC8941692 DOI: 10.1177/15330338221082760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary brainstem glioma is a rare tumor with a dismal prognosis that poses significant treatment challenges. The purpose of the current study is to identify and determine prognostic factors associated with survival in high-grade brainstem glioma patients. Methods: We gathered the data from the SEER database for the duration of years from 1973 to 2016 to examine the survival of patients particularly reported with the high-grade brainstem glioma and subsequently ascertained the potential impact of demographic features, tumor, and clinical characteristics on the overall survival of these patients. The survival patterns were assessed using Kaplan-Meier curves and Cox proportional hazards models. Propensity score matching (PSM) analysis was performed between patients with or without radiation therapy based on age and surgical resection to investigate the effect of radiotherapy on overall survival (OS). Results: A total 232 patient's data were obtained from the SEER database and included in this study. The median overall survival was 8 months. Kaplan-Meier survival analysis delineated that the patients who were in younger age (P = .001) and underwent surgery (P = .001) exhibited typically a better prognosis. Among 232 patients, a total of 204 patients were categorized as radiotherapy group (RG) received radiation therapy whereas 28 patients were considered as nonradiotherapy group (NRG), who were not receiving radiotherapy. Radiotherapy was associated with an improvement in the overall survival without statistical significance (P = .104). PSM was performed between RG and NRG based on age and surgical resection. After the PSM, 56 patients were included. Overall Survival was significantly different between both groups (P = .038). Conclusion: Furthermore, the patients with high-grade brain glioma who received "both radiotherapy and chemotherapy" exhibited significantly longer survival compared to the patients who received chemotherapy alone. Multivariate analysis showed that treatment with surgery and radiotherapy were considered as the independent prognostic factors (P < .05).
Collapse
Affiliation(s)
- Yitong Li
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Narasimha M Beeraka
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.,Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Academy of Higher Education and Research (JSS AHER), JSS Medical college, Mysuru, Karnataka, India
| | - Wenchang Guo
- Department of Neurosurgery, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yuying Lei
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Qilu Hu
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Litao Guo
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ruitai Fan
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqi Liu
- Department of Human Anatomy, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Aixia Sui
- Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei, China
| |
Collapse
|
14
|
Prognostic factors in adult brainstem glioma: a tertiary care center analysis and review of the literature. J Neurol 2021; 269:1574-1590. [PMID: 34342680 PMCID: PMC8857120 DOI: 10.1007/s00415-021-10725-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/24/2022]
Abstract
Introduction Adult brainstem gliomas (BSGs) are rare central nervous system tumours characterized by a highly heterogeneous clinical course. Median survival times range from 11 to 84 months. Beyond surgery, no treatment standard has been established. We investigated clinical and radiological data to assess prognostic features providing support for treatment decisions. Methods 34 BSG patients treated between 2000 and 2019 and aged ≥ 18 years at the time of diagnosis were retrospectively identified from the databases of the two largest Austrian Neuro-Oncology centres. Clinical data including baseline characteristics, clinical disease course, applied therapies, the outcome as well as neuroradiological and neuropathological findings were gathered and analysed. The tumour apparent diffusion coefficient (ADC), volumetry of contrast-enhancing and non-contrast-enhancing lesions were determined on magnetic resonance imaging scans performed at diagnosis. Results The median age at diagnosis was 38.5 years (range 18–71 years). Tumour progression occurred in 26/34 (76.5%) patients after a median follow up time of 19 months (range 0.9–236.2). Median overall survival (OS) and progression-free survival (PFS) was 24.1 months (range 0.9–236.2; 95% CI 18.1–30.1) and 14.5 months (range 0.7–178.5; 95% CI 5.1–23.9), respectively. Low-performance status, high body mass index (BMI) at diagnosis and WHO grading were associated with shorter PFS and OS at univariate analysis (p < 0.05, log rank test, respectively). ADC values below the median were significantly associated with shorter OS (14.9 vs 44.2 months, p = 0.018). Conclusion ECOG, BMI, WHO grade and ADC values were associated with the survival prognosis of BSG patients and should be included in the prognostic assessment.
Collapse
|
15
|
Dudoit T, Balossier A, Reyes-Botero G, Laigle-Donadey F, Emery E, Blond S, Carluer L, Lechapt-Zalcman E, Delattre JY, Guillamo JS. Adult brainstem glioma presenting with isolated persistent hemifacial spasm or facial nerve palsy. Rev Neurol (Paris) 2021; 177:1276-1282. [PMID: 34272066 DOI: 10.1016/j.neurol.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/22/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022]
Abstract
OBJECT Adult brainstem gliomas are a rare group of heterogeneous brain tumors. Classical clinical presentation includes progressive impairment of cranial nerves associated with long tract signs. The prognosis and response to treatment are poor; nevertheless, some patients do have a long survival. The objective of this study was to describe a series of patients with an isolated persistent hemifacial spasm and/or facial nerve palsy as the presenting symptom of a brainstem glioma. METHODS Fourteen patients from 3 French hospitals (Paris, Caen, Lille) were included. Clinical and radiological features and overall survival were retrospectively analyzed. A review of the literature of similar cases was performed. RESULTS Mean age at diagnosis was 35 years (range 19-57 years). Mean duration of facial nerve involvement before diagnosis was 17 months (range 1-48 months). Tumors were characterized on MRI by a lateralized location in the pons, a T1-weighted hyposignal, a T2-weighted hypersignal and no contrast enhancement after Gadolinium injection except for 2 cases. Biopsies were performed in 10 cases and showed 8 low-grade and 2 high-grade gliomas. All the patients were initially treated with radiotherapy and 6 patients with chemotherapy after progression. Eleven patients died from tumor progression. Median survival time was 90 months. CONCLUSIONS Adult brainstem gliomas revealed by a progressive isolated involvement of the facial nerve seem to have particular clinico-radiological features of slow progressive tumors and may be associated with long patient survival.
Collapse
Affiliation(s)
- T Dudoit
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France
| | - A Balossier
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France
| | - G Reyes-Botero
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - F Laigle-Donadey
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - E Emery
- Service de neurochirurgie, CHU de Caen, 14000 Caen, France; Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France
| | - S Blond
- Service de neurochirurgie, CHRU de Lille, 59037 Lille, France
| | - L Carluer
- Service de neurologie, CHU de Caen, 14000 Caen, France
| | | | - J-Y Delattre
- Service de neurologie Mazarin, groupe hospitalier Pitié-Salpêtrière, université Pierre et Marie Curie-Paris 6, AP-HP, Paris, France
| | - J-S Guillamo
- Université de Caen Basse-Normandie, UFR de Médecine, 14000 Caen, France; Service de neurologie, CHU de Caen, 14000 Caen, France; Service de neurologie, CHU de Nîmes, 30029 Nîmes, France.
| |
Collapse
|
16
|
Liu Z, Feng S, Li J, Cao H, Huang J, Fan F, Cheng L, Liu Z, Cheng Q. The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma. Front Oncol 2021; 11:566972. [PMID: 33842307 PMCID: PMC8027112 DOI: 10.3389/fonc.2021.566972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose The role of surgical resection in the treatment of brainstem glioma (BSG) is poorly understood. For pediatric low-grade (LGBSG) group, several monocentric small-scale retrospective studies reported contradictory conclusions. And there was no clinical study focused on surgical resection for adult or pediatric high-grade (HG) patient groups. This study aims to illustrate whether surgical resection and adjuvant therapy provide survival benefits for patients with histologically confirmed BSG. Patients and Methods This retrospective cohort study included 529 patients with histologically confirmed BSG in Surveillance Epidemiology and End Results (SEER) database from 2006-2015. Patients were divided into four groups by age and World Health Organization (WHO) grade. Kaplan-Meier curves of CSS were plotted by different treatment options to compare the survival probability. Univariate and multivariable analyses were then conducted to determine the prognosis effects of surgical resection and adjuvant therapy on cancer specific survival (CSS). All analyses were done in four different groups separately. Results The final sample included 529 patients. The entire study population was divided into groups of pediatric LG (n=236, 44.6%), pediatric HG (n=37, 7.0%), adult LG (n=204, 38.6%) and adult HG (n=52, 9.8%). 52.7% (n=144) of pediatric patients had pilocytic astrocytoma and 45.3% (n=116) of adult patients had ependymoma. Pediatric LGBSG group had the highest gross total resection (GTR) rate (61.4%) and 5-year CSS rate (88.6%). Kaplan-Meier curves of pediatric LGBSG group revealed that patients treated with GTR had significantly better survival probability (P=0.033). Multivariable analysis identified GTR as independently significant predictor for prolonged CSS in pediatric LGBSG group (HR0.29, 95%CI 0.11-0.78, P=0.015); Surgical resection showed no relation to CSS in other patient groups. Kaplan-Meier curves of adult HGBSG group showed that patients treated with both RT and CT in adult HGBSG group had the best survival probability (P=0.02). However, multivariable analysis showed the combination of radiotherapy (RT) and chemotherapy (CT) was not significantly related to better CSS in adult HGBSG group (HR0.35, 95%CI 0.11-1.09, P=0.070). Adjuvant therapy didn’t associate with better CSS in other patient groups. Conclusion Pediatric LGBSG group had the highest GTR rate and the most favorable clinical outcome. GTR can provide significant survival benefits for pediatric LGBSG group.
Collapse
Affiliation(s)
- Zhuoyi Liu
- Department of Anesthesiology, Xiangya Hospital, Center South University, Changsha, China.,Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Songshan Feng
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Molecular Radiation Oncology of Hunan Province, Changsha, China
| | - Jing Li
- Department of Rehabilitation, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Cao
- Department of Psychiatry, The Second People's Hospital of Hunan Province, The Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jun Huang
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fan Fan
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Center for Medical Genetics & Hunan Provincial Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Li Cheng
- Department of Emergency, Fengyang County Hospital of Traditional Chinese Medicine, Fengyang, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
17
|
Ovenden C, O'Donohoe T, Santoreneos S. Ventrally exophytic pontine mass in a patient with dysarthria, dysphagia and diplopia: Answer. J Clin Neurosci 2021; 86:310-311. [PMID: 33509681 DOI: 10.1016/j.jocn.2021.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Christopher Ovenden
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Thomas O'Donohoe
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Stephen Santoreneos
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
18
|
Faulkner H, Arnaout O, Hoshide R, Young IM, Yeung JT, Sughrue ME, Teo C. The Surgical Resection of Brainstem Glioma: Outcomes and Prognostic Factors. World Neurosurg 2020; 146:e639-e650. [PMID: 33152495 DOI: 10.1016/j.wneu.2020.10.147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of brainstem glioma remains controversial, with increasing evidence supporting surgical resection as the primary treatment for a select subgroup of tumors. However, there remains no consensus on the specific benefits and risks, the selection of surgical candidates, and prognostic factors that may further refine surgical indications. METHODS A retrospective single-surgeon chart review was performed for all patients who underwent surgical treatment for radiographically suspected brainstem glioma between 2000 and 2017. Preoperative and postoperative radiographic evaluations on magnetic resonance imaging were conducted. Survival outcomes were collected, and machine-learning techniques were used for multivariate analysis. RESULTS Seventy-seven patients with surgical treatment of brainstem glioma were identified, with a median age of 9 years (range, 0-58 years). The cohort included 64% low-grade (I and II) and 36% high-grade (III and IV) tumors. For all patients, the 1-year and 5-year overall survival were 76.4% and 62.3%, respectively. Transient neurologic deficit was present in 34% of cases, and permanent deficit in a further 29%. CONCLUSIONS The radical surgical resection of brainstem gliomas can be performed with acceptable risk in well-selected cases and likely confers survival advantage for what is otherwise a rapidly and universally fatal disease. Various radiographic features are useful during patient selection and may guide treatment selection.
Collapse
Affiliation(s)
- Harrison Faulkner
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia; Faculty of Medicine, The University of New South Wales Sydney, New South Wales, Australia
| | - Omar Arnaout
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
| | - Reid Hoshide
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia; Department of Neurosurgery, University of California - San Diego, San Diego, California, USA
| | - Isabella M Young
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia
| | - Jacky T Yeung
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia
| | - Michael E Sughrue
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia.
| | - Charles Teo
- The Centre for Minimally Invasive Neurosurgery, Sydney, New South Wales, Australia
| |
Collapse
|
19
|
Rigamonti A, Simonetti G, Silvani A, Rudà R, Franchino F, Villani V, Pace A, Merli R, Servida M, Picca A, Berzero G, Cerase A, Chiarotti I, Spena G, Salmaggi A. Adult brainstem glioma: a multicentre retrospective analysis of 47 Italian patients. Neurol Sci 2020; 42:1879-1886. [PMID: 32954462 DOI: 10.1007/s10072-020-04725-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Adult brainstem gliomas are rare primary brain tumours with heterogeneous clinical course. The low frequency of these tumours makes it difficult to achieve high-quality evidence regarding prognostic factors, adequate therapeutic approach and outcome in such patients. METHODS In this retrospective study, we analysed clinical, radiological, molecular, prognostic and therapeutic factors in a series of 47 histologically proven adult brainstem gliomas recruited over a 20-year period (1998-2018). RESULTS Twenty-two patients were male, 25 female with median age of 39 years. The tumour involved one brainstem segment in 20 cases and 2 or more segments in 27. Contrast enhancement was reported in 28 cases. Surgical procedures included biopsy in 26 cases and partial/total resection in the remaining 21. Histological diagnosis was of low-grade glioma in 23 patients, high-grade glioma in 22 and non-diagnostic in 2 cases. Data regarding molecular biology were available for 22 patients. Median overall survival was 35 months, in particular 16 months in high-grade glioma and 84 months in low-grade glioma. At univariate analysis, tumour grade was the only factor with a statistically significant impact on survival time (p = 0,003), whereas younger age, better performance status and total/subtotal resection showed a trend to more prolonged survival. This study also confirms safety of biopsy/surgery in adult brainstem glioma patients and shows a clear trend to a more frequent assessment of molecular biology data. CONCLUSIONS Further prospective multicentre efforts, and hopefully clinical trials, are necessary to improve outcome in this neglected glioma patient population.
Collapse
Affiliation(s)
- Andrea Rigamonti
- Neurosciences Department, Neurology Unit, Ospedale A. Manzoni, ASST Lecco, Via Dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Giorgia Simonetti
- Clinical Neurooncology Unit, Neurooncology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Antonio Silvani
- Clinical Neurooncology Unit, Neurooncology Department, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Federica Franchino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Veronica Villani
- Neurooncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Andrea Pace
- Neurooncology Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | | | - Maura Servida
- Department of Neurology, ASST Ovest Milanese - Legnano Hospital, Legnano, Italy
| | - Alberto Picca
- Neurooncology Unit, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Giulia Berzero
- Neurooncology Unit, IRCCS C. Mondino Foundation, Pavia, Italy
| | - Alfonso Cerase
- Unit of Neuroimaging - Diagnostic and Functional Neuroradiology Department of Neurological and Human Movement Sciences "Santa Maria alle Scotte", NHS & University General Hospital, Tuscany, Siena, Italy
| | - Ivano Chiarotti
- Unit of Neuroimaging - Diagnostic and Functional Neuroradiology Department of Neurological and Human Movement Sciences "Santa Maria alle Scotte", NHS & University General Hospital, Tuscany, Siena, Italy
| | - Giannantonio Spena
- Neurosciences Department, Neurology Unit, Ospedale A. Manzoni, ASST Lecco, Via Dell'Eremo 9/11, 23900, Lecco, Italy
| | - Andrea Salmaggi
- Neurosciences Department, Neurology Unit, Ospedale A. Manzoni, ASST Lecco, Via Dell'Eremo 9/11, 23900, Lecco, Italy
| | | |
Collapse
|
20
|
Hersh DS, Kumar R, Moore KA, Smith LGF, Tinkle CL, Chiang J, Patay Z, Gajjar A, Choudhri AF, Lee-Diaz JA, Vaughn B, Klimo P. Safety and efficacy of brainstem biopsy in children and young adults. J Neurosurg Pediatr 2020; 26:552-562. [PMID: 32736346 DOI: 10.3171/2020.4.peds2092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Biopsies of brainstem lesions are performed to establish a diagnosis in the setting of an atypical clinical or radiological presentation, or to facilitate molecular studies. A better understanding of the safety and diagnostic yield of brainstem biopsies would help guide appropriate patient selection. METHODS All patients who underwent biopsy of a brainstem lesion during the period from January 2011 to June 2019 were reviewed. Demographic, radiological, surgical, and outcome data were collected. RESULTS A total of 58 patients underwent 65 brainstem biopsies during the study period. Overall, the median age was 7.6 years (IQR 3.9-14.2 years). Twenty-two of the 65 biopsies (34%) were open, 42 (65%) were stereotactic, and 1 was endoscopic. In 3 cases (5%), a ventriculoperitoneal shunt was placed, and in 9 cases (14%), a posterior fossa decompression was performed during the same operative session as the biopsy. An intraoperative MRI (iMRI) was performed in 28 cases (43%). In 3 of these cases (11%), the biopsy was off target and additional samples were obtained during the same procedure. New neurological deficits were noted in 5 cases (8%), including sensory deficits, ophthalmoparesis/nystagmus, facial weakness, and hearing loss; these deficits persisted in 2 cases and were transient in 3 cases. A pseudomeningocele occurred in 1 patient; no patients developed a CSF leak or infection. In 8 cases (13%) an additional procedure was needed to obtain a diagnosis. CONCLUSIONS Brainstem biopsies are safe and effective. Target selection and approach should be a collaborative effort. iMRI can be used to assess biopsy accuracy in real time, thereby allowing any adjustment if necessary.
Collapse
Affiliation(s)
- David S Hersh
- 1Division of Neurosurgery, Connecticut Children's, Hartford.,2Department of Surgery, UConn School of Medicine, Farmington, Connecticut
| | - Rahul Kumar
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Kenneth A Moore
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Luke G F Smith
- 4Department of Neurosurgery, The Ohio State University, Columbus, Ohio; Departments of
| | | | | | | | - Amar Gajjar
- 8Division of Neuro-oncology, St. Jude Children's Research Hospital, Memphis
| | - Asim F Choudhri
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,9Department of Radiology, University of Tennessee Health Science Center, Memphis.,10Division of Neuroradiology, Le Bonheur Neuroscience Institute, Memphis.,11Le Bonheur Children's Hospital, Memphis; and
| | - Jorge A Lee-Diaz
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,9Department of Radiology, University of Tennessee Health Science Center, Memphis.,10Division of Neuroradiology, Le Bonheur Neuroscience Institute, Memphis.,11Le Bonheur Children's Hospital, Memphis; and
| | | | - Paul Klimo
- 3Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,11Le Bonheur Children's Hospital, Memphis; and.,12Semmes Murphey, Memphis, Tennessee
| |
Collapse
|
21
|
Liu Z, Feng S, Li J, Cao H, Huang J, Fan F, Cheng L, Liu Z, Cheng Q. The Epidemiological Characteristics and Prognostic Factors of Low-Grade Brainstem Glioma: A Real-World Study of Pediatric and Adult Patients. Front Oncol 2020; 10:391. [PMID: 32328455 PMCID: PMC7160332 DOI: 10.3389/fonc.2020.00391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/05/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: Our current understanding of low-grade brainstem glioma (LGBSG) is still limited. This study aimed to conduct a large-scale population-based real-world study to understand the epidemiological characteristics of LGBSG and determine the predictive factors of cancer-specific survival (CSS) and overall survival (OS) of LGBSG patients. Patients and Methods: We used Surveillance Epidemiology and End Results database to conduct this study of patients with histologically confirmed LGBSG. Patient demographics, tumor characteristics, and treatment options were compared between pediatric and adult patients. Univariate and multivariate analyses were employed to determine prognostic factors of CSS and OS. Kaplan–Meier curve and decision tree were used to confirm the prognostic factors. All variables were further identified by L1-penalized (Lasso) regression and then a nomogram was established to predict the 5- and 8-year CSS and OS rate. The precision of the nomogram was evaluated by calibration plots, Harrell's concordance index, and time-dependent receiver operating characteristic curve. The clinical use of nomogram was estimated by decision curve analysis. Results: A cohort of 305 patients with LGBSG, including 165 pediatric and 140 adult patients, was analyzed. Adult and pediatric patients showed different patterns concerning tumor size, tumor extension, adjuvant therapy, and survival rate. Univariate analysis revealed that pediatric group, gross total resection (GTR), World Health Organization grade II, radiotherapy, extension to ventricular system, and diffuse astrocytic and oligodendroglial tumor (DAOT) were significantly associated with CSS. Multivariate analysis showed that pediatric group, metastasis, ventricular system involvement, and DAOT were independently associated with CSS. The prognostic factors were further confirmed by Kaplan–Meier curve and decision tree. Kaplan–Meier curve also showed that adjuvant therapy added no benefits in patients with GTR and non-GTR. In addition, the nomogram was developed and the C-index of internal validation for CSS was 0.87 (95% CI, 0.78–0.96). Conclusion: This study shows that pediatric and adult patients have different tumor characteristics, treatment options, and survival rate. Pediatric group, DAOT, ventricular system involvement, and metastasis were identified as independent prognostic factors for CSS by multivariate analysis. Adjuvant therapy showed no benefits on CSS in patients with GTR and non-GTR. The nomogram was discriminative and clinically useful.
Collapse
Affiliation(s)
- Zhuoyi Liu
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Songshan Feng
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Rehabilitation, Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Cao
- Department of Psychiatry, The Second People's Hospital of Hunan Province, The Hospital of Hunan University of Chinese Medicine, Changsha, China
| | - Jun Huang
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fan Fan
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Center for Medical Genetics and Hunan Provincial Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Li Cheng
- Department of Emergency, Fengyang County Hospital of Traditional Chinese Medicine, Fengyang, China
| | - Zhixiong Liu
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Quan Cheng
- Department of Neurosurgery, Xiangya Hospital, Center South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
22
|
Climans SA, Ramos RC, Laperriere N, Bernstein M, Mason WP. Outcomes of presumed malignant glioma treated without pathological confirmation: a retrospective, single-center analysis. Neurooncol Pract 2020; 7:446-452. [PMID: 33282325 DOI: 10.1093/nop/npaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Tissue diagnosis is essential in the usual management of high-grade glioma. In rare circumstances, due to patient preference, performance status, comorbidities, or tumor location, biopsy is not feasible. Sometimes a biopsy is nondiagnostic. Many neuro-oncology clinics have patients like this, but these patients' outcomes and responses to treatment are not known. Methods We retrospectively reviewed records from adult patients diagnosed with presumed high-grade glioma of the brain without definitive pathology, diagnosed between 2004 and 2016. We recorded several clinical variables including date of first diagnostic imaging and date of death. Results We identified 61 patients and subclassified them to brainstem glioma (n = 32), supratentorial presumed glioblastoma (n = 24), presumed thalamic diffuse midline glioma (n = 2), gliomatosis cerebri (n = 2), and cerebellar glioma (n = 1). Most brainstem glioma patients had no biopsy because of tumor location. Supratentorial presumed glioblastoma patients had no biopsy predominantly because of comorbidities. Median survival, from first diagnostic imaging, was 3.2 months (95% CI: 2.9 to 6.3 months) in the supratentorial glioblastoma group and 18.5 months (95% CI: 13.0 to 44.1 months) in the brainstem group. Treatment with radiation or chemotherapy did not alter the median survival of the supratentorial glioblastoma group (hazard ratio 1.41, uncorrected P = .5). Conclusions Patients with imaging diagnoses of high-grade glioma have similar, if not worse, survival than those with pathological confirmation. Based on these uncontrolled data, it is unclear how effective radiation or chemotherapy is in this population.
Collapse
Affiliation(s)
- Seth Andrew Climans
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Ronald Cepe Ramos
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Normand Laperriere
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Mark Bernstein
- Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Warren P Mason
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| |
Collapse
|
23
|
The role of radiation and chemotherapy in adult patients with high-grade brainstem gliomas: results from the National Cancer Database. J Neurooncol 2019; 146:303-310. [PMID: 31873874 DOI: 10.1007/s11060-019-03374-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Surgical resection of high-grade brainstem gliomas is challenging and treatment mostly involves radiation and chemotherapy. In this study, we utilized registry data to determine prognostic features and impact of chemotherapy and radiation on overall survival. METHODS The National Cancer Database was queried from 2006 to 2015 for adult cases with histologically confirmed high-grade brainstem glioma. Covariates including patient demographics, comorbidities, tumor characteristics and treatment parameters were captured. Multivariable Cox proportional hazards regression was performed to identify predictors of survival. RESULTS A total of 422 patients were analyzed. Most patients (66.6%) underwent postoperative radiation with chemotherapy, 9.2% underwent radiation alone, while the remaining had no postoperative treatment (24.2%). Overall median survival was 9.8 months (95% CI 8.8-12). Survival was longer (p < 0.001) in the radiation + chemotherapy group (median: 14.2 months, 95% CI 11.7-17.1) compared to radiation alone (median: 5.7 months, 95% CI 3.7-12) and no postoperative treatment (median: 1.8 months, 95% CI 1.4-4) groups. In multivariable analysis, increasing age was associated with worse survival (HR: 1.87, 95% CI 1.47-2.37, p < 0.001), whereas radiation + chemotherapy was associated with lower mortality compared to radiation alone (HR: 0.67, 95% CI 0.46-0.98, p = 0.038). In subgroup analysis, postoperative chemotherapy with radiation was associated with significant survival benefit compared to radiation alone for grade IV (HR: 0.46, 95% CI 0.28-0.76, p = 0.003), but not for grade III tumors (HR: 0.87, 95% CI 0.48-1.58, p = 0.65). CONCLUSION Analysis from a national registry illustrated the effectiveness of radiation with chemotherapy for adult patients with high-grade brainstem gliomas, particularly grade IV. Further research should identify specific patient profiles and molecular subgroups that are more likely to benefit from multimodality therapy.
Collapse
|
24
|
Laigle-Donadey F, Duran-Peña A. Gliomi del tronco cerebrale dell’adulto. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
25
|
Yu D, Han G, Liu H, Gao L, Verma V. Treatment of adult brainstem glioma with combined antiangiogenic therapy: a case report and literature review. Onco Targets Ther 2019; 12:1333-1339. [PMID: 30863099 PMCID: PMC6388961 DOI: 10.2147/ott.s195783] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Adult brainstem gliomas belong to a rare and heterogeneous group of brain tumors. The overall prognosis is poor; therapeutic options are limited, given the resistance to radiotherapy and the unclear role of chemotherapy/antiangiogenic therapy. Apatinib, a tyrosine kinase inhibitor that selectively inhibits the vascular endothelial growth factor receptor and mildly inhibits c-Kit, PDGFR-β, RET, and c-SRC, has been reported to show efficacy among some patients with malignant supratentorial gliomas. However, its effect on brainstem glioma has not been reported so far. Herein, a 66-year-old man with brainstem anaplastic astrocytoma isocitrate dehydrogenase (IDH) wild type was treated initially with combined radiotherapy, temozolomide, and apatinib. The patient achieved a complete response by MRI and continues to have an ongoing progression-free survival of over 8 months. To our knowledge, this is the first case report using apatinib to treat brainstem IDH wild-type anaplastic astrocytoma, displaying an excellent outcome. We also summarize cases of adult brainstem glioma treated with antiangiogenic therapy. Experiences using various regimens may improve understanding of this rare disease, and thus help physicians to seek more effective treatments for these patients.
Collapse
Affiliation(s)
- Dongdong Yu
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, Wuhan, Hubei Province, P.R. China,
| | - Huali Liu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
| | - Likun Gao
- Department of Pathology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA
| |
Collapse
|
26
|
Rosen A, Anderson V, Bercovici E, Laperriere N, D'Souza R. Brainstem gliomas in pregnancy: a systematic review†. J Matern Fetal Neonatal Med 2019; 33:2841-2851. [PMID: 30563399 DOI: 10.1080/14767058.2018.1560410] [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] [Indexed: 10/27/2022]
Abstract
Introduction: Although brainstem gliomas are a rare group of neoplasias, when they affect pregnant women, there can be challenges with diagnosis and management. This study describes a case of brainstem glioma diagnosed in pregnancy and systematically reviews the literature on brainstem gliomas in pregnancy to provide guidance for management.Material and methods: We searched five databases from inception until October 2016 using subject headings and keywords related to pregnancy and brainstem glioma, and included original research articles that described pregnancy outcomes in women with brainstem glioma. Data extraction and quality assessment using the Joanna Briggs Institute Critical Appraisal Checklist for case reports were performed in duplicate. Outcomes were reported as proportions. The study protocol was registered with the Prospero International Prospective Register of Systematic Reviews (CRD42017060196).Results: We screened 2737 titles and abstracts, and 89 full-texts. Twelve articles describing 17 pregnancies in 16 women were included in the analysis. The median gestational age at presentation was 23 weeks. All but one case presented with neurologic deficit. Magnetic resonance (MRI) imaging conclusively diagnosed all cases. Surgical tumor resection (n = 4) and radiation therapy (n = 3) were successfully undertaken during pregnancy. There were no reported sequelae of maternal oncological management on neonatal wellbeing. Maternal mortality was high (8/16, 50%) both during (n = 5) and within 4 weeks (n = 3) of pregnancy. Pregnancy losses included one pregnancy termination and four miscarriages (associated with maternal mortality). Of the 12 live-born babies, five were premature. Two of these were the result of spontaneous preterm labor and three were delivered prematurely to facilitate glioma management. There was one case of fetal growth restriction.Conclusions: Although the symptoms of brainstem gliomas often mimic those commonly encountered in pregnancy, neurologic deficits warrant urgent investigation. MRI is the diagnostic modality of choice in pregnancy. Brainstem gliomas are associated with high maternal mortality and appropriate management, including surgical tumor resection and radiation therapy, should not be delayed on account of pregnancy. Pregnancy outcomes are favorable although there is a risk of preterm birth.Key messageBrainstem gliomas are associated with high maternal mortality and timely diagnosis using magnetic resonance imaging and treatment including surgical resection and radiation therapy should not be delayed during pregnancy. Pregnancy outcomes are generally favorable except for risk of preterm birth.
Collapse
Affiliation(s)
- Adam Rosen
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada.,Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Eduard Bercovici
- Division of Neurology, Department of Medicine, Toronto Western Hospital, Krembil Neuroscience Centre, University of Toronto, Toronto, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
27
|
Chen X, Dong D, Pan C, Xu C, Sun Y, Geng Y, Kong L, Xiao X, Zhao Z, Zhou W, Huang L, Song Y, Zhang L. Identification of Grade-associated MicroRNAs in Brainstem Gliomas Based on Microarray Data. J Cancer 2018; 9:4463-4476. [PMID: 30519352 PMCID: PMC6277643 DOI: 10.7150/jca.26417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/01/2018] [Indexed: 12/19/2022] Open
Abstract
Gliomas arising in the brainstem are rare tumours that are difficult to surgically resect, and the microRNAs (miRNAs) and signalling pathways associated with brainstem gliomas (BSGs) are largely unknown. To identify grade-associated miRNAs in BSGs, a microarray analysis of 10 low-grade and 15 high-grade BSGs was performed in this study. Differentially expressed miRNAs (DE-miRNAs) were identified, and the functional DE-miRNAs were selected. The potential target genes and enriched pathways were analysed, and a target gene-associated protein-protein interaction (PPI) network was generated. Grade-associated functional DE-miRNAs were confirmed by real-time quantitative PCR. First, 28 functional DE-miRNAs, including 13 upregulated miRNAs and 15 downregulated miRNAs, were identified. Second, 2546 target genes that were involved in BSG-related pathways, such as signalling pathways regulating the pluripotency of stem cells, the AMPK signalling pathway, the HIF-1 signalling pathway, the PI3K-Akt signalling pathway, the Wnt signalling pathway and the Hippo signalling pathway, were screened. Third, PHLPP2 and VEGFA were identified as hub genes in the PPI network. Last, we found that hsa-miR-34a-5p inhibits BSG cell invasion in vitro. In summary, using integrated bioinformatics analysis, we have identified the potential target genes and pathways of grade-associated functional DE-miRNAs in BSGs, which could improve the accuracy of prognostic evaluation. Furthermore, these hub genes and pathways could be therapeutic targets for the treatment of BSGs.
Collapse
Affiliation(s)
- Xin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Dezuo Dong
- Department of Radiation Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, Beijing, 100142, China
| | - Changcun Pan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Cheng Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Yu Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Yibo Geng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Lu Kong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Xiong Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| | - Zitong Zhao
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Zhou
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Lijie Huang
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yongmei Song
- State Key Laboratory of Molecular Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing, 100050, China
| |
Collapse
|
28
|
Majchrzak K, Bobek-Billewicz B, Hebda A, Majchrzak H, Ładziński P, Krawczyk L. Surgical treatment and prognosis of adult patients with brainstem gliomas. Neurol Neurochir Pol 2018; 52:623-633. [PMID: 30213445 DOI: 10.1016/j.pjnns.2018.08.008] [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: 11/21/2016] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 10/28/2022]
Abstract
The paper presents 47 adult patients who were surgically treated due to brainstem gliomas. Thirteen patients presented with contrast-enhancing Grades III and IV gliomas, according to the WHO classification, 13 patients with contrast-enhancing tumours originating from the glial cells (Grade I; WHO classification), 9 patients with diffuse gliomas, 5 patients with tectal brainstem gliomas and 7 patients with exophytic brainstem gliomas. During the surgical procedure, neuronavigation and the diffusion tensor tractography (DTI) of the corticospinal tract were used with the examination of motor evoked potentials (MEPs) and somatosensory evoked potentials (SSEPs) with direct stimulation of the fundus of the fourth brain ventricle in order to define the localization of the nuclei of nerves VII, IX, X and XII. Cerebellar dysfunction, damage to cranial nerves and dysphagia were the most frequent postoperative sequelae which were also the most difficult to resolve. The Karnofsky score established preoperatively and the extent of tumour resection were the factors affecting the prognosis. The mean time of progression-free survival (14 months) and the mean survival time after surgery (20 months) were the shortest for malignant brainstem gliomas. In the group with tectal brainstem gliomas, no cases of progression were found and none of the patients died during the follow-up. Some patients were professionally active. Partial resection of diffuse brainstem gliomas did not prolong the mean survival above 5 years. However, some patients survived over 5 years in good condition.
Collapse
Affiliation(s)
- Krzysztof Majchrzak
- Department and Clinical Ward of Neurosurgery in Sosnowiec, Medical University of Silesia, Katowice, Poland.
| | - Barbara Bobek-Billewicz
- Department of Radio-diagnostics, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Anna Hebda
- Department of Radio-diagnostics, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Henryk Majchrzak
- Department and Clinical Ward of Neurosurgery in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Piotr Ładziński
- Department and Clinical Ward of Neurosurgery in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Lech Krawczyk
- Department of Anaesthesiology and Intensive Care in Sosnowiec, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
29
|
Fernandes Cabral DT, Zenonos GA, Nuñez M, Celtikci P, Snyderman C, Wang E, Gardner PA, Fernandez-Miranda JC. Endoscopic Endonasal Transclival Approach for Resection of a Pontine Glioma: Surgical Planning, Surgical Anatomy, and Technique. Oper Neurosurg (Hagerstown) 2018. [DOI: 10.1093/ons/opy005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The endoscopic endonasal approach (EEA) has been proposed as a potential alternative for ventral brainstem lesions. The surgical anatomy, feasibility, and limitations of the EEA for intrinsic brainstem lesions are still poorly understood.
OBJECTIVE
To describe the surgical planning, anatomy, and technique of an intrinsic pontine glioma operated via EEA.
METHODS
Six-human brainstems were prepared for white matter microdissection. Ten healthy subjects were studied with high-definition fiber tractography (HDFT). A 56-yr-old female with right-hemiparesis underwent EEA for an exophytic pontine glioma. Pre- and postoperative HDFTs were implemented.
RESULTS
The corticospinal tracts (CSTs) are the most eloquent fibers in the ventral brainstem. At the pons, CSTs run between the pontine nuclei and the middle cerebellar peduncle (MCP). At the lower medulla, the pyramidal decussation leaves no room for safe ventral access. In our illustrative case, preoperative HDFT showed left-CST displaced posteromedially and partially disrupted, right-CST posteriorly displaced, and MCP severely disrupted. A transclival exposure was performed achieving a complete resection of the exophytic component with residual intra-axial tumor. Immediately postop, patient developed new left-side abducens nerve palsy and worse right-hemiparesis. Ten days postop, her strength returned to baseline. HDFT showed preservation and trajectory restoration of the CSTs.
CONCLUSION
The EEA provides direct access to the ventral brainstem, overcoming the limitations of lateral approaches. For intrinsic pathology, HDFT helps choosing the most appropriate surgical route/boundaries for safer resection. Further experience is needed to determine the indications and limitations of this approach that should be performed by neurosurgeons with high-level expertise in EEA.
Collapse
Affiliation(s)
- David T Fernandes Cabral
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Georgios A Zenonos
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Maximiliano Nuñez
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Pinar Celtikci
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Carl Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Eric Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
30
|
Moharamzad Y, Sanei Taheri M, Niaghi F, Shobeiri E. Brainstem glioma: Prediction of histopathologic grade based on conventional MR imaging. Neuroradiol J 2017; 31:10-17. [PMID: 29148317 DOI: 10.1177/1971400917743099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years). A binary logistic regression analysis was used to explore associations between MRI features and histopathological grade of the BSG. Results Binary logistic regression revealed that necrosis (adjusted odds ratio (OR) = 16.07; 95% confidence interval (CI) = 3.20 to 80.52; p = 0.001) and inhomogeneous contrast enhancement (adjusted OR = 8.04; 95% CI = 1.73 to 37.41; p = 0.008) as significant predictors of high-grade BSG. The equation (Nagelkerke R2 = 0.575) is Logit ( p high-grade BSG) = (2.77 × necrosis) + (2.08 × heterogeneous contrast enhancement) - 3.13. Sensitivity and specificity values were respectively 66.7% and 96.0% for necrosis and 85.7% and 65.9% for inhomogeneous contrast-enhancing lesions. In the pediatric age group, only inhomogeneous contrast enhancement (adjusted OR = 40; 95% CI = 3.95 to 445.73; p = 0.002) was a significant predictor for high-grade BSG. Conclusion Conventional MR imaging features such as necrosis and inhomogeneous contrast enhancement in adults and heterogeneous contrast enhancement in children suggest high-grade BSG.
Collapse
Affiliation(s)
- Yashar Moharamzad
- 1 School of Medicine, 48464 Kermanshah University of Medical Sciences , Kermanshah, Iran
| | - Morteza Sanei Taheri
- 2 Department of Radiology, Shohada Hospital, 48486 Shahid Beheshti University of Medical Sciences , Iran
| | - Farhad Niaghi
- 2 Department of Radiology, Shohada Hospital, 48486 Shahid Beheshti University of Medical Sciences , Iran
| | - Elham Shobeiri
- 1 School of Medicine, 48464 Kermanshah University of Medical Sciences , Kermanshah, Iran
| |
Collapse
|
31
|
Tan ZR, Long XY, Yang ZQ, Huang J, Hu QY, Yang HD, Li GL. Younger age at surgery and lesser seizure frequency as prognostic factors for favorable seizure-related outcome after glioma resection in adults. Oncotarget 2017; 8:93444-93449. [PMID: 29212163 PMCID: PMC5706809 DOI: 10.18632/oncotarget.18726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/11/2017] [Indexed: 11/25/2022] Open
Abstract
The identification of variables predictive of good seizure control following surgical tumor resection in adult glioma patients with tumor-related epilepsy would greatly benefit treatment decisions. Therefore, we analyzed the clinical data of adult patients with tumor-related epilepsy who underwent tumor resection at our institute between November 2011 and August 2013. Patients were divided into seizure-free (Engel Ia) and unfavorable outcome groups (Engel Ib-IV), and potential prognostic factors were analyzed. Of 90 patients, 61 (68%) had a favorable outcome at an average of 3 years after surgery. Our analyses indicated that younger age at surgery (P=0.048) and rare seizure frequency (P=0.006) were associated with significantly more favorable postoperative seizure-related outcomes. In conclusion, younger age at surgery and lesser seizure frequency were independent predictors of favorable epileptic seizure control after glioma resection in adults. Thus, early surgical resection is necessary for achieving favorable seizure outcome.
Collapse
Affiliation(s)
- Zhe-Ren Tan
- Department of Neurology, Xiangya Hospital, The Central South University, Changsha 410008, China
| | - Xiao-Yan Long
- Department of Neurology, Xiangya Hospital, The Central South University, Changsha 410008, China
| | - Zhi-Quan Yang
- Department of Neurosurgery, Xiangya Hospital, The Central South University, Changsha 410008, China
| | - Jun Huang
- Department of Neurosurgery, Xiangya Hospital, The Central South University, Changsha 410008, China
| | | | | | - Guo-Liang Li
- Department of Neurology, Xiangya Hospital, The Central South University, Changsha 410008, China
| |
Collapse
|
32
|
Phuong PC, Hung NQ, Ngoc TB, Rades D, Khoa MT. Rotating Gamma System Irradiation: A Promising Treatment for Low-grade Brainstem Gliomas. In Vivo 2017; 31:957-960. [PMID: 28882965 PMCID: PMC5656872 DOI: 10.21873/invivo.11153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 06/21/2017] [Accepted: 07/03/2017] [Indexed: 01/07/2023]
Abstract
AIM To evaluate the role of rotating gamma system (RGS) radiosurgery for low-grade brainstem gliomas. PATIENTS AND METHODS Thirty-seven patients undergoing RGS radiosurgery at the Bach Mai Hospital Hanoi for low-grade brainstem glioma were included in this prospective interventional study. The median RGS dose was 12 Gy (range=8-16 Gy). Endpoints included response to RGS radiosurgery given as change in glioma size (maximum diameter), survival and adverse events. Follow-up was performed for 36 months. Three dose-groups (<13, 13-14 and >14 Gy) were compared for survival. RESULTS Mean glioma size decreased from 1.87 cm before RGS irradiation to 1.15 cm at 36 months. Mean survival was 39.5 months. Mean survival after <13, 13-14 and >14 Gy were 22.7, 66.7 and 49 months, respectively (p<0.05). Adverse events, mainly reduced appetite, sleep disturbances, headache and edema, were not associated with RGS dose and were easily managed. CONCLUSION RGS radiosurgery led to promising results with acceptable toxicity in patients with low-grade brainstem gliomas.
Collapse
Affiliation(s)
- Pham Cam Phuong
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Nguyen Quang Hung
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Tran Bao Ngoc
- Department of Oncology, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Nuclear Medicine, Ha Noi Medical University, Hanoi, Vietnam
| | - Mai Trong Khoa
- The Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam
- Department of Nuclear Medicine, Ha Noi Medical University, Hanoi, Vietnam
| |
Collapse
|
33
|
Zhang YS, Pan CC, Zhang P, Dai B, Tang J, Wu Z, Zhang JT, Zhang LW. Prognostic indicators of adult medullary gliomas after microsurgical treatment - A retrospective analysis of 54 patients. J Clin Neurosci 2017; 44:122-127. [PMID: 28711295 DOI: 10.1016/j.jocn.2017.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 04/13/2017] [Accepted: 05/21/2017] [Indexed: 10/19/2022]
Abstract
Due to the low incidence of medullary gliomas, the special location, and the function of the gliomas in the medulla oblongata, microsurgical treatment is still challenging for neurosurgeons. The aim of this study was to observe the effect of microsurgical treatment of adult medullary gliomas and to explore the prognostic factors after treatment. The clinical data from 54 patients with adult medullary gliomas who received microsurgical treatment at Beijing Tiantan Hospital (China) from April 2008 to April 2014 was retrospectively analyzed. The factors affecting their prognosis were analyzed with log-rank univariate analysis. The factors that affected prognosis included age, gender, duration of preoperative symptoms, Karnofsky Performance Scale (KPS) score, World Health Organization (WHO) grade, extent of tumor resection, and postoperative complications. Those with statistical significance in the univariate analysis were entered into a multivariate Cox regression analysis. WHO grading showed 7 cases of grade I, 30 cases of grade II, 14 cases of grade III, and 3 cases of grade IV tumors. Univariable analysis showed that postoperative nasogastric feeding (P=0.031), WHO pathological grade (P=0.018), extent of resection (P=0.016), and preoperative involvement of ≥3 cranial nerves (CNs) (P=0.014) affected overall survival. The WHO pathological grade of the tumor was an independent risk factor for prognosis. In conclusion, the WHO pathological grade of the tumor was an important prognostic indicator.
Collapse
Affiliation(s)
- Yi-Song Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Chang-Cun Pan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Bin Dai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Jie Tang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Tiantanxili 6, Dongcheng District, Beijing 100050, China; China National Clinical Research Center for Neurological Disease, Tiantanxili 6, Dongcheng District, Beijing 100050, China.
| |
Collapse
|
34
|
Abstract
Brainstem gliomas are not nearly as common in adults as they are in children. They are likely the final common consequence not of a single disease process but of several. They can be difficult to diagnose, and are challenging to treat. Clinical studies of this diagnosis are few and generally small. Because of these factors, our understanding of the biology of adult brainstem glioma is incomplete. However, the knowledge base is growing and progress is being made. In this article, we review the current state of knowledge for brainstem glioma in adults and identify key areas for which additional information is required.
Collapse
Affiliation(s)
- Jethro Hu
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Santosh Kesari
- Department of Translational Neuro-Oncology and Neurotherapeutics, John Wayne Cancer Institute, Pacific Neuroscience Institute, Providence Saint John's Health Center , Santa Monica, CA , USA
| |
Collapse
|
35
|
Eisele SC, Reardon DA. Adult brainstem gliomas. Cancer 2016; 122:2799-809. [PMID: 27327773 DOI: 10.1002/cncr.29920] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 01/17/2023]
Abstract
Brainstem gliomas in adults are a rare and heterogeneous group of brain tumors that vary with regard to underlying pathology, radiographic appearance, clinical course and prognosis. Diffuse intrinsic pontine gliomas represent the most common subtype. Although still considered aggressive and most often lethal, these brain tumors are associated with a more insidious clinical course and more favorable prognosis compared to the highly aggressive form in children. Treatment options for patients with brainstem gliomas still are limited and insufficiently studied. A better understanding of the pathobiology of these tumors will be crucial for the development of more specific and effective therapies. Cancer 2016. © 2016 American Cancer Society. Cancer 2016;122:2799-2809. © 2016 American Cancer Society.
Collapse
Affiliation(s)
- Sylvia C Eisele
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | - David A Reardon
- Center for Neuro-Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| |
Collapse
|
36
|
High-Grade Glioma of the Ventrolateral Medulla in an Adult: Case Presentation and Discussion of Surgical Considerations. Case Rep Neurol Med 2016; 2016:6813089. [PMID: 27242937 PMCID: PMC4875976 DOI: 10.1155/2016/6813089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/03/2016] [Indexed: 11/17/2022] Open
Abstract
Background. High-grade gliomas of the brainstem are rare in adults and are particularly rare in the anterolateral medulla. We describe an illustrative case and discuss the diagnostic and treatment issues associated with a tumor in this location, including differential diagnosis, anatomical considerations for options for surgical management, multimodality treatment, and prognosis. Case Description. A 69-year-old woman presented with a 3-week history of progressive right lower extremity weakness. She underwent an open biopsy via a far lateral approach with partial condylectomy, which revealed a glioblastoma. Concurrent temozolomide and radiation were completed; however, she elected to stop her chemotherapy after 5.5 weeks of treatment. She succumbed to her disease 11 months after diagnosis. Conclusions. Biopsy can be performed relatively safely to provide definitive diagnosis to guide treatment, but long-term prognosis is poor.
Collapse
|
37
|
Yoshida K, Sulaiman NS, Miyawaki D, Ejima Y, Nishimura H, Ishihara T, Matsuo Y, Nishikawa R, Sasayama T, Hayakawa A, Kohmura E, Sasaki R. Radiotherapy for brainstem gliomas in children and adults: A single-institution experience and literature review. Asia Pac J Clin Oncol 2016; 13:e153-e160. [DOI: 10.1111/ajco.12451] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/10/2015] [Accepted: 11/25/2015] [Indexed: 01/30/2023]
Affiliation(s)
- Kenji Yoshida
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Nor Shazrina Sulaiman
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yasuo Ejima
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Hideki Nishimura
- Department of Radiation Oncology; Kobe Minimally Invasive Cancer Center; Kobe Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yoshiro Matsuo
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ryo Nishikawa
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Takashi Sasayama
- Department of Neurosurgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - Akira Hayakawa
- Department of Pediatrics; Kobe University Graduate School of Medicine; Kobe Japan
| | - Eiji Kohmura
- Department of Neurosurgery; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology; Kobe University Graduate School of Medicine; Kobe Japan
| |
Collapse
|
38
|
Uekawa K, Nakamura H, Shinojima N, Takezaki T, Yano S, Kuratsu JI. Adult Diffuse Astrocytoma in the Medulla Oblongata: Molecular Biological Analyses Including H3F3A Mutation of Histone H3.3. NMC Case Rep J 2016; 3:29-33. [PMID: 28663993 PMCID: PMC5386147 DOI: 10.2176/nmccrj.cr.2015-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 06/18/2015] [Indexed: 12/05/2022] Open
Abstract
Unlike in children, brain stem gliomas in adult are rare and still poorly understood. In addition, most adult brain stem gliomas result predominantly in the pons and are less often found in the medulla oblongata. Here, we report a case of an adult glioma in the medulla oblongata and its molecular biological features. A 46-year-old male presented with gait disturbance, paresthesia, and dysphagia. Magnetic resonance imaging (MRI) showed a diffuse hyper-intensive lesion in the medulla oblongata on a T2-weighted image without gadolinium contrast enhancement. We performed an open biopsy and the lesion was pathologically diagnosed as a diffuse astrocytoma. Molecular biological analyses revealed the absence of histone H3.3 mutation (H3F3A K27M), and presence of methylation of O-6-methylguanine-DNA methyltransferase (MGMT) promoter and a mutation in isocitrate dehydrogenase 1 (IDH-1). The patient received local radiotherapy and temozolomide chemotherapy. The patient’s symptoms were ameliorated, and MRI showed no tumor growth at 6 months after the initial treatment. Biopsy for brain stem lesions is generally thought to have risk of complications, but if performed minimally, it is useful to diagnose and determine treatment strategy. Obtaining patient characteristics and molecular biological features will provide insight towards therapeutic treatment for adult brain stem gliomas.
Collapse
Affiliation(s)
- Ken Uekawa
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Tatsuya Takezaki
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Shigetoshi Yano
- Department of Neurosurgery, Kumamoto University School of Medicine
| | - Jun-ichi Kuratsu
- Department of Neurosurgery, Kumamoto University School of Medicine
| |
Collapse
|
39
|
Barnard ZR, Drazin D, Bannykh SI, Rudnick JD, Chu RM. Adult Brainstem Glioblastoma Multiforme: Long-term Survivor. Cureus 2015; 7:e434. [PMID: 26848423 PMCID: PMC4727952 DOI: 10.7759/cureus.434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Adult, malignant brainstem gliomas are rare entities that often cause treatment conundrums due to the difficulty of surgical resection and, therefore, the absence of pathological diagnosis. This leads to a reliance on radiological imaging for diagnosis, which can often be unreliable. These shortcomings have made the treatment of brainstem gliomas challenging with unpredictable outcomes. The mainstay of treatment consists of chemotherapy and radiation; however, recurrence is inevitable. Predicting outcomes has been the major difficulty in treating these patients as adult malignant brainstem gliomas Grade II have a median survival between five to seven years while Grades III and IV are between 10-17 months (with some studies showing significantly longer survival in Grade III). Here, we present the case of a patient with the pathologic diagnosis of a right brachium pontis glioblastoma who had a remarkable survival of 73 months, whereas the expected median survival for these patients is 10-17 months.
Collapse
Affiliation(s)
| | | | | | | | - Ray M Chu
- Neurosurgery, Cedars-Sinai Medical Center
| |
Collapse
|
40
|
Theeler BJ, Ellezam B, Melguizo-Gavilanes I, de Groot JF, Mahajan A, Aldape KD, Bruner JM, Puduvalli VK. Adult brainstem gliomas: Correlation of clinical and molecular features. J Neurol Sci 2015; 353:92-7. [PMID: 25934342 PMCID: PMC4782610 DOI: 10.1016/j.jns.2015.04.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/17/2015] [Accepted: 04/10/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Brainstem gliomas are rare in adults and overall have superior survival outcomes compared to pediatric brainstem gliomas. PATIENTS AND METHODS We conducted a retrospective data and tissue analysis of all adult patients (≥ 18 years old) with World Health Organization (WHO) Grade II, III, and IV brainstem gliomas in the University of Texas MD Anderson Cancer Center institutional database from 1990 to 2012. RESULTS We identified 143 cases in adults ages 18 and over. There were 28 glioblastomas, 43 anaplastic astrocytomas, 15 diffuse astrocytomas, and 11 gliomas not otherwise specified, and in 46 cases the diagnosis was made radiographically. 128 (89.5%) cases were classified radiographically as diffuse and of the focal tumors, 9 of the 15 were WHO Grade III or IV tumors. Increasing tumor grade and contrast enhancement were associated with significantly reduced overall survival. The median overall survival for the entire cohort was 32.1 months similar to previously published studies. Two of 25 grade II and III tumors, and 1 of 17 glioblastomas had IDH1 mutations on immunohistochemical testing. Nine cases had sufficient tissue for mutation profiling, 1 case had a BRAF V600E mutation and 2 had 2 PIK3CA mutations. CONCLUSIONS Survival outcomes for adult WHO Grade II to IV brainstem gliomas were similar to supratentorial IDH1 wild-type tumors of similar grade and histology. Potentially actionable mutations can be identified from small biopsy samples in a subset of adult brainstem gliomas.
Collapse
Affiliation(s)
- Brett J Theeler
- Department of Neurology and John P. Murtha Cancer Center, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, United States.
| | - Benjamin Ellezam
- Department of Pathology, CHU Sainte-Justine, Universite de Montreal, 3175 Cote-Ste-Catherine Rd, Montreal, Quebec H3TIC5, Canada
| | - Isaac Melguizo-Gavilanes
- Neuro-Oncology Associates at Baylor Charles A. Sammons Cancer Center, 3410 Worth Street, Suite 820, Dallas, TX 75246, United States
| | - John F de Groot
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit Number: 431, Houston, TX 77030, United States
| | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
| | - Kenneth D Aldape
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
| | - Janet M Bruner
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, United States
| | - Vinay K Puduvalli
- Division of Neuro-oncology, The Ohio State University Comprehensive Cancer Center, 320 W 10th Avenue, Starling Loving Hall Suite M410, Columbus, OH 43210, United States
| |
Collapse
|
41
|
Narita Y, Shibui S. Trends and outcomes in the treatment of gliomas based on data during 2001-2004 from the Brain Tumor Registry of Japan. Neurol Med Chir (Tokyo) 2015; 55:286-95. [PMID: 25797780 PMCID: PMC4628175 DOI: 10.2176/nmc.ra.2014-0348] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The committee of Brain Tumor Registry of Japan (BTRJ) was founded in 1973 and conducts surveys and analyses of incidence, therapeutic methods, and treatment outcomes of primary and metastatic brain tumors with the cooperation of the Japan Neurosurgical Society members. Newly diagnosed 3,000-4,000 primary brain tumors and 600-1,000 brain metastases patients were enrolled in each year. This report describes the trends and treatment outcomes of gliomas from BTRJ volume 13, including 13,431 patients with primary brain tumors who newly started treatment from 2001 to 2004. Data from 382 diffuse astrocytomas (DAs), 121 oligodendrogliomas (OLs), 90 oligoastrocytomas (OAs), 513 anaplastic astrocytomas (AAs), 126 anaplastic oligodendrogliomas (AOs), 106 anaplastic oligoastrocytomas (AOAs), and 1,489 glioblastomas (GBMs) were analyzed for overall survival (OS) and progression free survival (PFS) depending on age, symptoms, Karnofsky performance status, location of the tumor, extent of resection (EOR), initial radiotherapy and chemotherapy. The 5-year PFS rates of the patients with DA, OL+OA, AA, AO+AOA, and GBM were 57.0%, 74.6%, 28.7%, 54.0%, and 9.2%, and the 5-year OS rates were 75.0%, 90.0%, 41.1%, 68.2%, and 10.1%, respectively. Higher EOR≥75% in DA and OL+OA and that ≥50% in AA, AO+AOA, and GBM significantly prolonged OS. Complications and cause of death were also reported. BTRJ had been edited for all the patients, researchers, and especially for clinicians at bedside to give useful information about brain tumors and to contribute to the advances in brain tumor treatment. This report revealed various clinical problematic issues pertaining to the diagnosis and treatment of gliomas.
Collapse
Affiliation(s)
- Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | | | | |
Collapse
|
42
|
Breshears JD, Ivan ME, Cotter JA, Bollen AW, Theodosopoulos PV, Berger MS. Primary glioblastoma of the trigeminal nerve root entry zone: case report. J Neurosurg 2015; 122:78-81. [PMID: 25380115 DOI: 10.3171/2014.10.jns14449] [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] [Indexed: 11/06/2022]
Abstract
Gliomas of the cranial nerve root entry zone are rare clinical entities. There have been 11 reported cases in the literature, including only 2 glioblastomas. The authors report the case of a 67-year-old man who presented with isolated facial numbness and was found to have a glioblastoma involving the trigeminal nerve root entry zone. After biopsy the patient completed treatment with conformal radiation and concomitant temozolomide, and at 23 weeks after surgery he demonstrated symptom progression despite the treatment described. This is the first reported case of a glioblastoma of the trigeminal nerve root entry zone.
Collapse
|
43
|
Imaging of adult brainstem gliomas. Eur J Radiol 2015; 84:709-20. [PMID: 25641008 DOI: 10.1016/j.ejrad.2014.12.025] [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: 10/06/2014] [Revised: 12/22/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
Abstract
Brainstem gliomas (BSGs) are uncommon in adults accounting for about 2% of all intracranial neoplasms. They are often phenotypically low-grade as compared to their more common paediatric counterparts. Since brainstem biopsies are rarely performed, these tumours are commonly classified according to their MR imaging characteristics into 4 subgroups: (a) diffuse intrinsic low-grade gliomas, (b) enhancing malignant gliomas, (c) focal tectal gliomas and (d) exophytic gliomas/other subtypes. The prognosis and treatment is variable for the different types and is almost similar to adult supratentorial gliomas. Radiotherapy (RT) with adjuvant chemotherapy is the standard treatment of diffuse low-grade and malignant BSGs, whereas, surgical resection is limited to the exophytic subtypes. Review of previous literature shows that the detailed imaging of adult BSGs has not received significant attention. This review illustrates in detail the imaging features of adult BSGs using conventional and advanced MR techniques like diffusion weighted imaging (DWI), diffusion tensor imaging (DTI), MR perfusion weighted imaging (PWI), MR spectroscopy (MRS), as well as 18F-fluoro-ethyl-tyrosine positron emission tomography (18F-FET/PET). We have discussed the pertinent differences between childhood and adult BSGs, imaging mimics, prognostic factors and briefly reviewed the treatment options of these tumours.
Collapse
|
44
|
Bayoumi Y, Sabbagh AJ, Mohamed R, ElShokhaiby UM, Maklad AM, Tunio MA, Balbaid AAO. Clinicopathological features and treatment outcomes of brain stem gliomas in Saudi population. World J Clin Oncol 2014; 5:1060-1067. [PMID: 25493242 PMCID: PMC4259933 DOI: 10.5306/wjco.v5.i5.1060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 04/16/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze experiences to identify treatment outcomes and prognostic factors in a Saudi population.
METHODS: Medical records of patients with brainstem gliomas treated from July 2001 to December 2012 were reviewed to identify treatment outcomes of surgery, radiation therapy and chemotherapy and associated prognostic factors in a Saudi population.
RESULTS: We analyzed 49 brain stem glioma (BSG) patients from July 2001 to December 2012; 31 of them were males (63.3%) with a median age of 12.6 years (range: 8-64 mo). Twenty-two patients (44.9%) had diffuse intrinsic pontine gliomas (DIPG) and 15 (30.6%) presented with focal/tectal BSG. Histopathology was available in 30 patients (61.2%). Median survival time for the whole cohort was 1.5 years. One and two year OS rates were 51.1% and 41.9% respectively. Two year OS rates for focal/tectal, dorsally exophytic, cervicomedullary and DIPG tumors were 60%, 33.3%, 33.3% and 13.6% respectively (P < 0.0001). Significant prognostic factors related to OS were age at diagnosis (worse for > 18 years) P = 0.01, KPS < 70 P = 0.02, duration of symptoms (< 60 d) P = 0.002, histology (better for favorable) P = 0.002, surgery (maximal resection) P = 0.002, and concurrent chemotherapy with radiation therapy in DIPG (better if given) P = 0.01.
CONCLUSION: BSG, especially the DIPG subgroup, had a dismal prognosis, needing more aggressive neurosurgical, radiation and chemotherapy techniques, while focal and tectal tumors were found to have a better prognosis.
Collapse
|
45
|
Dey M, Lin Y, Melkonian S, Lam S. Prognostic factors and survival in primary adult high grade brainstem astrocytoma: A population based study from 1973–2008. J Clin Neurosci 2014; 21:1298-303. [DOI: 10.1016/j.jocn.2013.12.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
|
46
|
Chourmouzi D, Papadopoulou E, Konstantinidis M, Syrris V, Kouskouras K, Haritanti A, Karkavelas G, Drevelegas A. Manifestations of pilocytic astrocytoma: a pictorial review. Insights Imaging 2014; 5:387-402. [PMID: 24789122 PMCID: PMC4035491 DOI: 10.1007/s13244-014-0328-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Pilocytic astrocytoma can be challenging to diagnose. METHODS Its clinical presentations can differ, directly related to its size and location, and are relatively unreliable. Similarly, imaging findings also vary with the location of the pilocytic astrocytoma. RESULTS This review provides an overview of the different imaging findings regarding pilocytic astrocytomas using both conventional and advanced magnetic resonance imaging sequences according to tumour location; the findings are strongly related to the tumour's tendency to infiltrate surrounding structures, being able to carry out gross total resection, and finally the prognosis. CONCLUSIONS Knowledge of these imaging manifestations of pilocytic astrocytoma may be helpful to arrive at an accurate diagnosis. TEACHING POINTS • To recognise the various imaging findings of pilocytic astrocytoma on both conventional and advanced magnetic resonance imaging sequences. • To identify the characteristic imaging findings according to tumour location. • To discuss the relevant differential diagnoses of pilocytic astrocytoma in each tumour location.
Collapse
Affiliation(s)
- Danai Chourmouzi
- Department of Radiology, Interbalcan Medical Centre, Thessaloniki, Greece,
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Babu R, Kranz PG, Agarwal V, McLendon RE, Thomas S, Friedman AH, Bigner DD, Adamson C. Malignant brainstem gliomas in adults: clinicopathological characteristics and prognostic factors. J Neurooncol 2014; 119:177-85. [PMID: 24838419 DOI: 10.1007/s11060-014-1471-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 04/30/2014] [Indexed: 10/25/2022]
Abstract
Adult malignant brainstem gliomas (BSGs) are poorly characterized due to their relative rarity. We have examined histopathologically confirmed cases of adult malignant BSGs to better characterize the patient and tumor features and outcomes, including the natural history, presentation, imaging, molecular characteristics, prognostic factors, and appropriate treatments. A total of 34 patients were identified, consisting of 22 anaplastic astrocytomas (AAs) and 12 glioblastomas (GBMs). The overall median survival for all patients was 25.8 months, with patients having GBMs experiencing significantly worse survival (12.1 vs. 77.0 months, p = 0.0011). The majority of tumors revealed immunoreactivity for EGFR (93.3 %) and MGMT (64.7 %). Most tumors also exhibited chromosomal abnormalities affecting the loci of epidermal growth factor receptor (92.9 %), MET (100 %), PTEN (61.5 %), and 9p21 (80 %). AAs more commonly appeared diffusely enhancing (50.0 vs. 27.3 %) or diffusely nonenhancing (25.0 vs. 0.0 %), while GBMs were more likely to exhibit focal enhancement (54.6 vs. 10.0 %). Multivariate analysis revealed confirmed histopathology for GBM to significantly affect survival (HR 4.80; 95 % CI 1.86-12.4; p = 0.0012). In conclusion, adult malignant BSGs have an overall poor prognosis, with GBM tumors faring significantly worse than AAs. As AAs and GBMs have differing imaging characteristics, tissue diagnosis may be necessary to accurately determine patient prognosis and identify molecular characteristics which may aid in the treatment of these aggressive tumors.
Collapse
Affiliation(s)
- Ranjith Babu
- Division of Neurosurgery, Department of Surgery, Duke University Medical Center, 2624, Durham, NC, 27710, USA
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Manoj N, Arivazhagan A, Bhat DI, Arvinda HR, Mahadevan A, Santosh V, Devi BI, Sampath S, Chandramouli BA. Stereotactic biopsy of brainstem lesions: Techniques, efficacy, safety, and disease variation between adults and children: A single institutional series and review. J Neurosci Rural Pract 2014; 5:32-9. [PMID: 24741247 PMCID: PMC3985354 DOI: 10.4103/0976-3147.127869] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Stereotactic biopsy of brainstem lesions have been performed with varying indications, with most of the literature reporting on children. MATERIALS AND METHODS The present study retrospectively analyzed all cases that underwent stereotactic biopsy for brainstem lesion in both adult and pediatric population between 1994 and 2009 in a single tertiary neurosurgical center. The clinical and radiological features, technique of the procedure, morbidity, diagnostic accuracy, spectrum of diagnosis, and variations in adult and pediatric population were analyzed. RESULTS Eighty-two patients were included in the study. Computed tomography (CT) was used as guidance in 73 (38 children and 35 adults) patients and magnetic resonance imaging (MRI) in 9 (3 children and 6 adults). The biopsy was performed in a procedure room under local anesthesia in most adults, while children required sedation. Glioblastoma comprised 29.3% of all pathologies in children, compared with only 4.9% of the pathologies in adult population (P = 0.007). Tuberculosis was the next major diagnosis (9.8%). In 12 patients, initial biopsy was inconclusive. Following a repeat biopsy in 5 of these patients, a diagnosis was possible for 75/82 (91.5%) patients by STB. The location of the target, the choice of entry, the radiological characteristic of the lesion, enhancement pattern, and age group did not significantly correlate with the occurrence of inconclusive biopsy. Permanent complications occurred in two patients (2.4%). There was no mortality in this series. CONCLUSION Stereotactic biopsy has an important role in brainstem lesions, more significantly in adults, due to wider pathological spectrum. It can be performed safely under local anesthesia through a twist drill craniostomy in most of the adults.
Collapse
Affiliation(s)
- N Manoj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - D I Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - H R Arvinda
- Department of Neuro Imaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - A Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - V Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - S Sampath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - B A Chandramouli
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| |
Collapse
|
49
|
Hundsberger T, Tonder M, Hottinger A, Brügge D, Roelcke U, Putora PM, Stupp R, Weller M. Clinical management and outcome of histologically verified adult brainstem gliomas in Switzerland: a retrospective analysis of 21 patients. J Neurooncol 2014; 118:321-328. [PMID: 24736829 DOI: 10.1007/s11060-014-1434-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 03/31/2014] [Indexed: 12/25/2022]
Abstract
Because of low incidence, mixed study populations and paucity of clinical and histological data, the management of adult brainstem gliomas (BSGs) remains non-standardized. We here describe characteristics, treatment and outcome of patients with exclusively histologically confirmed adult BSGs. A retrospective chart review of adults (age >18 years) was conducted. BSG was defined as a glial tumor located in the midbrain, pons or medulla. Characteristics, management and outcome were analyzed. Twenty one patients (17 males; median age 41 years) were diagnosed between 2004 and 2012 by biopsy (n = 15), partial (n = 4) or complete resection (n = 2). Diagnoses were glioblastoma (WHO grade IV, n = 6), anaplastic astrocytoma (WHO grade III, n = 7), diffuse astrocytoma (WHO grade II, n = 6) and pilocytic astrocytoma (WHO grade I, n = 2). Diffuse gliomas were mainly located in the pons and frequently showed MRI contrast enhancement. Endophytic growth was common (16 vs. 5). Postoperative therapy in low-grade (WHO grade I/II) and high-grade gliomas (WHO grade III/IV) consisted of radiotherapy alone (three in each group), radiochemotherapy (2 vs. 6), chemotherapy alone (0 vs. 2) or no postoperative therapy (3 vs. 1). Median PFS (24.1 vs. 5.8 months; log-rank, p = 0.009) and mOS (30.5 vs. 11.5 months; log-rank, p = 0.028) was significantly better in WHO grade II than in WHO grade III/IV tumors. Second-line therapy considerably varied. Histologically verification of adult BSGs is feasible and has an impact on postoperative treatment. Low-grade gliomas can simple be followed or treated with radiotherapy alone. Radiochemotherapy with temozolomide can safely be prescribed for high-grade gliomas without additional CNS toxicities.
Collapse
Affiliation(s)
- Thomas Hundsberger
- Department of Neurology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.
- Department of Hematology and Oncology, Cantonal Hospital St. Gallen, Rorschacherstr. 95, 9007, St. Gallen, Switzerland.
| | - Michaela Tonder
- Department of Neurology, and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Hottinger
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Detlef Brügge
- Department of Radiation Oncology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Ulrich Roelcke
- Department of Neurology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Paul Martin Putora
- Department of Radiation Oncology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Roger Stupp
- Department of Oncology, and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, and Brain Tumor Center, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
50
|
Reithmeier T, Kuzeawu A, Hentschel B, Loeffler M, Trippel M, Nikkhah G. Retrospective analysis of 104 histologically proven adult brainstem gliomas: clinical symptoms, therapeutic approaches and prognostic factors. BMC Cancer 2014; 14:115. [PMID: 24555482 PMCID: PMC3975961 DOI: 10.1186/1471-2407-14-115] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 02/12/2014] [Indexed: 11/26/2022] Open
Abstract
Background Adult brainstem gliomas are rare primary brain tumors (<2% of gliomas). The goal of this study was to analyze clinical, prognostic and therapeutic factors in a large series of histologically proven brainstem gliomas. Methods Between 1997 and 2007, 104 patients with a histologically proven brainstem glioma were retrospectively analyzed. Data about clinical course of disease, neuropathological findings and therapeutic approaches were analyzed. Results The median age at diagnosis was 41 years (range 18-89 years), median KPS before any operative procedure was 80 (range 20-100) and median survival for the whole cohort was 18.8 months. Histopathological examinations revealed 16 grade I, 31 grade II, 42 grade III and 14 grade IV gliomas. Grading was not possible in 1 patient. Therapeutic concepts differed according to the histopathology of the disease. Median overall survival for grade II tumors was 26.4 months, for grade III tumors 12.9 months and for grade IV tumors 9.8 months. On multivariate analysis the relative risk to die increased with a KPS ≤ 70 by factor 6.7, with grade III/IV gliomas by the factor 1.8 and for age ≥ 40 by the factor 1.7. External beam radiation reduced the risk to die by factor 0.4. Conclusion Adult brainstem gliomas present with a wide variety of neurological symptoms and postoperative radiation remains the cornerstone of therapy with no proven benefit of adding chemotherapy. Low KPS, age ≥ 40 and higher tumor grade have a negative impact on overall survival.
Collapse
Affiliation(s)
- Thomas Reithmeier
- Department of Neurosurgery, Schwabing Academic Teaching Hospital, Munich, Germany.
| | | | | | | | | | | |
Collapse
|