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Fairclough S, Chumas P, Goodden J, Maguire M, Mathew RK. Motor seizures confer overall survival benefit in who grade 2 glioma. Epilepsia 2024; 65:1679-1686. [PMID: 38506645 DOI: 10.1111/epi.17956] [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: 11/02/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The prevalence of epilepsy in World Health Organization (WHO) grade 2 glioma is high, with seizures being the presenting symptom in 60%-90%. We explore the epidemiology of seizures in this patient population in a regional neurosurgical center. METHODS Electronic health records of patients with histologically-proven WHO grade 2 glioma (n = 228) were reviewed between 1997 and 2021, with data collected including patient demographics, epilepsy prevalence, and seizure semiology. The influence of seizure type on overall survival was calculated using a Cox proportional hazards model. RESULTS Overall, 197 of 228 patients (86.4%) were diagnosed with epilepsy-either at presentation or during the course of their disease. Male patients were more likely than female patients to be diagnosed with epilepsy (91.1% vs 77.1%, p = .003) and, in those with epilepsy, more likely to experience at least one focal to bilateral tonic-clonic seizure (69.4% vs 54.1%, p = .05). Patients with left-sided tumors were twice as likely to have experienced a focal to bilateral tonic-clonic seizure (p = .02, odds ratio [OR] = .47). Predominantly experiencing seizures with motor activity appeared to confer better overall survival, with a 65% decrease in the risk of death 10 years post diagnosis (hazard ratio [HR] = .35, p = .02). This is despite accounting for previously described prognostic markers including tumor histology/genetics, time from diagnosis to surgery, and the extent of tumor resection. SIGNIFICANCE Motor seizure activity is a frequent feature in WHO grade 2 glioma and appears to confer a survival benefit regardless of histology or surgical factors. Seizures due to dominant hemisphere tumors may be more likely to propagate and cause bilateral tonic-clonic activity.
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Affiliation(s)
- Sam Fairclough
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - John Goodden
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
| | - Melissa Maguire
- Adult Neurology, Leeds Teaching Hospitals, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Ryan K Mathew
- School of Medicine, University of Leeds, Leeds, UK
- Department of Neurosurgery, Leeds Teaching Hospitals, Leeds, UK
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2
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Vaz-Salgado MÁ, García BC, Pérez IF, Munárriz BJ, Domarco PS, González AH, Villar MV, Caro RL, Delgado MLV, Sánchez JMS. SEOM-GEINO clinical guidelines for grade 2 gliomas (2023). Clin Transl Oncol 2024:10.1007/s12094-024-03456-x. [PMID: 38662171 DOI: 10.1007/s12094-024-03456-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] [Accepted: 03/08/2024] [Indexed: 04/26/2024]
Abstract
The 2021 World Health Organization (WHO) classification has updated the definition of grade 2 gliomas and the presence of isocitrate dehydrogenase (IDH) mutation has been deemed the cornerstone of diagnosis. Though slow-growing and having a low proliferative index, grade 2 gliomas are incurable by surgery and complementary treatments are vital to improving prognosis. This guideline provides recommendations on the multidisciplinary treatment of grade 2 astrocytomas and oligodendrogliomas based on the best evidence available.
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Affiliation(s)
- María Ángeles Vaz-Salgado
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (Irycis) CIBERONC, Madrid, Spain.
| | - Belén Cigarral García
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Isaura Fernández Pérez
- Medical Oncology Department, Hospital Alvaro Cunqueiro-Complejo Hospitalario Universitario de Vigo, Pontevedra, Spain
| | | | - Paula Sampedro Domarco
- Medical Oncology Department, Complexo Hospitalario Universitario de Ourense (CHUO), Orense, Spain
| | - Ainhoa Hernández González
- Medical Oncology Department, Hospital Germans Trias I Pujol(ICO)-Badalona, Instituto Catalán de Oncología, Barcelona, Spain
| | - María Vieito Villar
- Medical Oncology Department, Hospital Universitario Vall D'Hebron, Barcelona, Spain
| | - Raquel Luque Caro
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitaria Ibs.Granada, Granada, Spain
| | | | - Juan Manuel Sepúlveda Sánchez
- Neuro-Oncology Unit, HM Universitario Sanchinarro-CIOCC, Madrid, Spain.
- Medical Oncology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación 12 de Octubre (I+12), Madrid, Spain.
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3
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Lucke-Wold B, Rangwala BS, Shafique MA, Siddiq MA, Mustafa MS, Danish F, Nasrullah RMU, Zainab N, Haseeb A. Focus on current and emerging treatment options for glioma: A comprehensive review. World J Clin Oncol 2024; 15:482-495. [PMID: 38689623 PMCID: PMC11056857 DOI: 10.5306/wjco.v15.i4.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/22/2024] [Accepted: 02/28/2024] [Indexed: 04/22/2024] Open
Abstract
This comprehensive review delves into the current updates and challenges associated with the management of low-grade gliomas (LGG), the predominant primary tumors in the central nervous system. With a general incidence rate of 5.81 per 100000, gliomas pose a significant global concern, necessitating advancements in treatment techniques to reduce mortality and morbidity. This review places a particular focus on immunotherapies, discussing promising agents such as Zotiraciclib and Lerapolturev. Zotiraciclib, a CDK9 inhibitor, has demonstrated efficacy in glioblastoma treatment in preclinical and clinical studies, showing its potential as a therapeutic breakthrough. Lerapolturev, a viral immunotherapy, induces inflammation in glioblastoma and displays positive outcomes in both adult and pediatric patients. Exploration of immunotherapy extends to Pembrolizumab, Nivolumab, and Entrectinib, revealing the challenges and variabilities in patient responses. Despite promising preclinical data, the monoclonal antibody Depatuxizumab has proven ineffective in glioblastoma treatment, emphasizing the critical need to understand resistance mechanisms. The review also covers the success of radiation therapy in pediatric LGG, with evolving techniques, such as proton therapy, showing potential improvements in patient quality of life. Surgical treatment is discussed in the context of achieving a balance between preserving the patient's quality of life and attaining gross total resection, with the extent of surgical resection significantly influencing the survival outcomes. In addition to advancements in cancer vaccine development, this review highlights the evolving landscape of LGG treatment, emphasizing a shift toward personalized and targeted therapies. Ongoing research is essential for refining strategies and enhancing outcomes in the management of LGG.
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Affiliation(s)
- Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
| | | | | | - Mohammad Arham Siddiq
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Fnu Danish
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Noor Zainab
- Department of Neurosurgery, Army Medical College, Rawalpindi 46000, Pakistan
| | - Abdul Haseeb
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi 75510, Pakistan
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4
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Nandoliya KR, Thirunavu V, Ellis E, Dixit K, Tate MC, Drumm MR, Templer JW. Pre-operative predictors of post-operative seizure control in low-grade glioma: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:94. [PMID: 38411788 DOI: 10.1007/s10143-024-02329-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
As many as 80% of low-grade gliomas (LGGs) present with seizures, negatively impacting quality of life. While seizures are associated with gliomas regardless of grade, the importance of minimizing impact of seizures for patients with low grade tumors cannot be understated given the prolonged survival period in this population. The objective of this systematic review and meta-analysis was to summarize existing literature and identify factors associated with post-operative seizure control (defined as Engel I classification) in patients with LGGs, with a focus on pre-operative factors. Patient data extracted include tumor location and histology, pre-operative anti-seizure medication use, extent of resection (EOR), adjuvant treatment, pre-operative seizure type, duration, and frequency, and post-operative Engel classification. A random-effects model was used to calculate the effects of EOR, pre-operative seizure duration, adjuvant radiation, and adjuvant chemotherapy on post-operative seizure control. The effect of tumor location and histology on post-operative Engel I classification was determined using contingency analyses. Thirteen studies including 1628 patients with seizures were included in the systematic review. On meta-analyses, Engel I classification was associated with pre-operative seizure type (OR = 0.79 (0.63-0.99), p = 0.0385, focal versus generalized), frontal lobe LGGs (OR = 1.5 (1.1-2.0), p = 0.0195), and EOR (OR (95% CI) = 4.5 (2.3-6.7), p < 0.0001 gross-total versus subtotal). Pre-operative seizure duration less than one year, adjuvant radiation, adjuvant chemotherapy, and tumor histology were not associated with achieving Engel I classification. In addition to the known effects of EOR, Engel I classification is less likely to be achieved in patients with focal pre-operative seizures and more likely to be achieved in patients with frontal lobe LGGs.
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Affiliation(s)
- Khizar R Nandoliya
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Erin Ellis
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Karan Dixit
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Michael R Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica W Templer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA.
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de la Fuente MI. Adult-type Diffuse Gliomas. Continuum (Minneap Minn) 2023; 29:1662-1679. [PMID: 38085893 DOI: 10.1212/con.0000000000001352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE This article highlights key aspects of the diagnosis and management of adult-type diffuse gliomas, including glioblastomas and IDH-mutant gliomas relevant to the daily practice of the general neurologist. LATEST DEVELOPMENTS The advances in molecular characterization of gliomas have translated into more accurate prognostication and tumor classification. Gliomas previously categorized by histological appearance solely as astrocytomas or oligodendrogliomas are now also defined by molecular features. Furthermore, ongoing clinical trials have incorporated these advances to tailor more effective treatments for specific glioma subtypes. ESSENTIAL POINTS Despite recent insights into the molecular aspects of gliomas, these tumors remain incurable. Care for patients with these complex tumors requires a multidisciplinary team in which the general neurologist has an important role. Efforts focus on translating the latest data into more effective therapies that can prolong survival.
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6
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Kokkinos V, Chatzisotiriou A, Seimenis I. Functional Magnetic Resonance Imaging and Diffusion Tensor Imaging-Tractography in Resective Brain Surgery: Lesion Coverage Strategies and Patient Outcomes. Brain Sci 2023; 13:1574. [PMID: 38002534 PMCID: PMC10670090 DOI: 10.3390/brainsci13111574] [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: 09/26/2023] [Revised: 11/04/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Diffusion tensor imaging (DTI)-tractography and functional magnetic resonance imaging (fMRI) have dynamically entered the presurgical evaluation context of brain surgery during the past decades, providing novel perspectives in surgical planning and lesion access approaches. However, their application in the presurgical setting requires significant time and effort and increased costs, thereby raising questions regarding efficiency and best use. In this work, we set out to evaluate DTI-tractography and combined fMRI/DTI-tractography during intra-operative neuronavigation in resective brain surgery using lesion-related preoperative neurological deficit (PND) outcomes as metrics. We retrospectively reviewed medical records of 252 consecutive patients admitted for brain surgery. Standard anatomical neuroimaging protocols were performed in 127 patients, 69 patients had additional DTI-tractography, and 56 had combined DTI-tractography/fMRI. fMRI procedures involved language, motor, somatic sensory, sensorimotor and visual mapping. DTI-tractography involved fiber tracking of the motor, sensory, language and visual pathways. At 1 month postoperatively, DTI-tractography patients were more likely to present either improvement or preservation of PNDs (p = 0.004 and p = 0.007, respectively). At 6 months, combined DTI-tractography/fMRI patients were more likely to experience complete PND resolution (p < 0.001). Low-grade lesion patients (N = 102) with combined DTI-tractography/fMRI were more likely to experience complete resolution of PNDs at 1 and 6 months (p = 0.001 and p < 0.001, respectively). High-grade lesion patients (N = 140) with combined DTI-tractography/fMRI were more likely to have PNDs resolved at 6 months (p = 0.005). Patients with motor symptoms (N = 80) were more likely to experience complete remission of PNDs at 6 months with DTI-tractography or combined DTI-tractography/fMRI (p = 0.008 and p = 0.004, respectively), without significant difference between the two imaging protocols (p = 1). Patients with sensory symptoms (N = 44) were more likely to experience complete PND remission at 6 months with combined DTI-tractography/fMRI (p = 0.004). The intraoperative neuroimaging modality did not have a significant effect in patients with preoperative seizures (N = 47). Lack of PND worsening was observed at 6 month follow-up in patients with combined DTI-tractography/fMRI. Our results strongly support the combined use of DTI-tractography and fMRI in patients undergoing resective brain surgery for improving their postoperative clinical profile.
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Affiliation(s)
- Vasileios Kokkinos
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02215, USA
| | | | - Ioannis Seimenis
- Department of Medicine, School of Health Sciences, Democritus University of Thrace, 387479 Alexandroupolis, Greece;
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7
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Zhu E, Shi W, Chen Z, Wang J, Ai P, Wang X, Zhu M, Xu Z, Xu L, Sun X, Liu J, Xu X, Shan D. Reasoning and causal inference regarding surgical options for patients with low-grade gliomas using machine learning: A SEER-based study. Cancer Med 2023; 12:20878-20891. [PMID: 37929878 PMCID: PMC10709720 DOI: 10.1002/cam4.6666] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/17/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Due to the heterogeneity of low-grade gliomas (LGGs), the lack of randomized control trials, and strong clinical evidence, the effect of the extent of resection (EOR) is currently controversial. AIM To determine the best choice between subtotal resection (STR) and gross-total resection (GTR) for individual patients and to identify features that are potentially relevant to treatment heterogeneity. METHODS Patients were enrolled from the SEER database. We used a novel DL approach to make treatment recommendations for patients with LGG. We also made causal inference of the average treatment effect (ATE) of GTR compared with STR. RESULTS The patients were divided into the Consis. and In-consis. groups based on whether their actual treatment and model recommendations were consistent. Better brain cancer-specific survival (BCSS) outcomes in the Consis. group was observed. Overall, we also identified two subgroups that showed strong heterogeneity in response to GTR. By interpreting the models, we identified numerous variables that may be related to treatment heterogeneity. CONCLUSIONS This is the first study to infer the individual treatment effect, make treatment recommendation, and guide surgical options through deep learning approach in LGG research. Through causal inference, we found that heterogeneous responses to STR and GTR exist in patients with LGG. Visualization of the model yielded several factors that contribute to treatment heterogeneity, which are worthy of further discussion.
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Affiliation(s)
- Enzhao Zhu
- School of MedicineTongji UniversityShanghaiChina
| | - Weizhong Shi
- Shanghai Hospital Development CenterShanghaiChina
| | - Zhihao Chen
- School of BusinessEast China University of Science and TechnologyShanghaiChina
| | - Jiayi Wang
- School of MedicineTongji UniversityShanghaiChina
| | - Pu Ai
- School of MedicineTongji UniversityShanghaiChina
| | - Xiao Wang
- School of MedicineTongji UniversityShanghaiChina
| | - Min Zhu
- Department of Computer Science and Technology, School of Electronics and Information EngineeringTongji UniversityShanghaiChina
| | - Ziqin Xu
- Department of Industrial Engineering and Operations ResearchColumbia UniversityNew YorkNew YorkUSA
| | - Lingxiao Xu
- School of MedicineTongji UniversityShanghaiChina
| | - Xueyi Sun
- School of Ocean and Earth ScienceTongji UniversityShanghaiChina
| | - Jingyu Liu
- School of Ocean and Earth ScienceTongji UniversityShanghaiChina
| | - Xuetong Xu
- College of Civil EngineeringTongji UniversityShanghaiChina
| | - Dan Shan
- Regenerative Medicine Institute, School of MedicineNational University of IrelandGalwayIreland
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8
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Tejada Solís S, González Sánchez J, Iglesias Lozano I, Plans Ahicart G, Pérez Núñez A, Meana Carballo L, Gil Salú JL, Fernández Coello A, García Romero JC, Rodríguez de Lope Llorca A, García Duque S, Díez Valle R, Narros Giménez JL, Prat Acín R. Low grade gliomas guide-lines elaborated by the tumor section of Spanish Society of Neurosurgery. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:139-152. [PMID: 36446721 DOI: 10.1016/j.neucie.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/20/2022] [Accepted: 08/01/2022] [Indexed: 05/06/2023]
Abstract
Adult low-grade gliomas (Low Grade Gliomas, LGG) are tumors that originate from the glial cells of the brain and whose management involves great controversy, starting from the diagnosis, to the treatment and subsequent follow-up. For this reason, the Tumor Group of the Spanish Society of Neurosurgery (GT-SENEC) has held a consensus meeting, in which the most relevant neurosurgical issues have been discussed, reaching recommendations based on the best scientific evidence. In order to obtain the maximum benefit from these treatments, an individualised assessment of each patient should be made by a multidisciplinary team. Experts in each LGG treatment field have briefly described it based in their experience and the reviewed of the literature. Each area has been summarized and focused on the best published evidence. LGG have been surrounded by treatment controversy, although during the last years more accurate data has been published in order to reach treatment consensus. Neurosurgeons must know treatment options, indications and risks to participate actively in the decision making and to offer the best surgical treatment in every case.
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Affiliation(s)
- Sonia Tejada Solís
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain.
| | - Josep González Sánchez
- Departamento de Neurocirugía, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Irene Iglesias Lozano
- Departamento de Neurocirugía, Hospital Universitario Puerta del Mar, Cádiz, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Gerard Plans Ahicart
- Departamento de Neurocirugía, Hospital Universitari Bellvitge, Barcelona, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Angel Pérez Núñez
- Departamento de Neurocirugía, Hospital Universitario 12 de Octubre, Madrid, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Leonor Meana Carballo
- Departamento de Neurocirugía, Centro Médico de Asturias, Oviedo, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Jose Luis Gil Salú
- Departamento de Neurocirugía, Hospital Universitario Puerta del Mar, Cádiz, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Alejandro Fernández Coello
- Departamento de Neurocirugía, Hospital Universitari Bellvitge, Barcelona, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Juan Carlos García Romero
- Departamento de Neurocirugía, Hospital Virgen del Rocío, Sevilla, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Angel Rodríguez de Lope Llorca
- Departamento de Neurocirugía, Hospital Virgen de la Salud, Toledo, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Sara García Duque
- Departamento de Neurocirugía, Hospital Universitario La Fe, Valencia, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Ricardo Díez Valle
- Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Jose Luis Narros Giménez
- Departamento de Neurocirugía, Hospital Virgen del Rocío, Sevilla, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
| | - Ricardo Prat Acín
- Departamento de Neurocirugía, Hospital Universitario La Fe, Valencia, Spain; Departamento de Neurocirugía, Hospital Universitario HM Montepríncipe, Madrid, Spain
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Dao Trong P, Kilian S, Jesser J, Reuss D, Aras FK, Von Deimling A, Herold-Mende C, Unterberg A, Jungk C. Risk Estimation in Non-Enhancing Glioma: Introducing a Clinical Score. Cancers (Basel) 2023; 15:cancers15092503. [PMID: 37173969 PMCID: PMC10177456 DOI: 10.3390/cancers15092503] [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: 03/04/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The preoperative grading of non-enhancing glioma (NEG) remains challenging. Herein, we analyzed clinical and magnetic resonance imaging (MRI) features to predict malignancy in NEG according to the 2021 WHO classification and developed a clinical score, facilitating risk estimation. A discovery cohort (2012-2017, n = 72) was analyzed for MRI and clinical features (T2/FLAIR mismatch sign, subventricular zone (SVZ) involvement, tumor volume, growth rate, age, Pignatti score, and symptoms). Despite a "low-grade" appearance on MRI, 81% of patients were classified as WHO grade 3 or 4. Malignancy was then stratified by: (1) WHO grade (WHO grade 2 vs. WHO grade 3 + 4) and (2) molecular criteria (IDHmut WHO grade 2 + 3 vs. IDHwt glioblastoma + IDHmut astrocytoma WHO grade 4). Age, Pignatti score, SVZ involvement, and T2/FLAIR mismatch sign predicted malignancy only when considering molecular criteria, including IDH mutation and CDKN2A/B deletion status. A multivariate regression confirmed age and T2/FLAIR mismatch sign as independent predictors (p = 0.0009; p = 0.011). A "risk estimation in non-enhancing glioma" (RENEG) score was derived and tested in a validation cohort (2018-2019, n = 40), yielding a higher predictive value than the Pignatti score or the T2/FLAIR mismatch sign (AUC of receiver operating characteristics = 0.89). The prevalence of malignant glioma was high in this series of NEGs, supporting an upfront diagnosis and treatment approach. A clinical score with robust test performance was developed that identifies patients at risk for malignancy.
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Affiliation(s)
- Philip Dao Trong
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Samuel Kilian
- Institute of Medical Biometry, Heidelberg University, 69120 Heidelberg, Germany
| | - Jessica Jesser
- Department of Neuroradiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - David Reuss
- Division of Neuropathology, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), CCU Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Fuat Kaan Aras
- Division of Neuropathology, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas Von Deimling
- Division of Neuropathology, Institute of Pathology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), CCU Neuropathology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Christel Herold-Mende
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany
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10
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Kreatsoulas D, Damante M, Gruber M, Duru O, Elder JB. Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review. Cancers (Basel) 2023; 15:cancers15092493. [PMID: 37173957 PMCID: PMC10177219 DOI: 10.3390/cancers15092493] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Low-grade gliomas (LGGs) are optimally treated with up-front maximal safe surgical resection, typically defined as maximizing the extent of tumor resection while minimizing neurologic risks of surgery. Supratotal resection of LGG may improve outcomes beyond gross total resection by removing tumor cells invading beyond the tumor border as defined on MRI. However, the evidence regarding supratotal resection of LGG, in terms of impact on clinical outcomes, such as overall survival and neurologic morbidities, remains unclear. Authors independently searched the PubMed, Medline, Ovid, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for studies evaluating overall survival, time to progression, seizure outcomes, and postoperative neurologic and medical complications of supratotal resection/FLAIRectomy of WHO-defined LGGs. Papers in languages other than English, lacking full-text availability, evaluating supratotal resection of WHO-defined high-grade gliomas only, and nonhuman studies were excluded. After literature search, reference screening, and initial exclusions, 65 studies were screened for relevancy, of which 23 were evaluated via full-text review, and 10 were ultimately included in the final evidence review. Studies were evaluated for quality using the MINORS criteria. After data extraction, a total of 1301 LGG patients were included in the analysis, with 377 (29.0%) undergoing supratotal resection. The main measured outcomes were extent of resection, pre- and postoperative neurological deficits, seizure control, adjuvant treatment, neuropsychological outcomes, ability to return to work, progression-free survival, and overall survival. Overall, low- to moderate-quality evidence was supportive of aggressive, functional boundary-based resection of LGGs due to improvements in progression-free survival and seizure control. The published literature provides a moderate amount of low-quality evidence supporting supratotal surgical resection along functional boundaries for low-grade glioma. Among patients included in this analysis, the occurrence of postoperative neurological deficits was low, and nearly all patients recovered within 3 to 6 months after surgery. Notably, the surgical centers represented in this analysis have significant experience in glioma surgery in general, and supratotal resection specifically. In this setting, supratotal surgical resection along functional boundaries appears to be appropriate for both symptomatic and asymptomatic low-grade glioma patients. Larger clinical studies are needed to better define the role of supratotal resection in LGG.
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Affiliation(s)
- Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Maxwell Gruber
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Olivia Duru
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - James Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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11
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Alshiekh Nasany R, de la Fuente MI. Therapies for IDH-Mutant Gliomas. Curr Neurol Neurosci Rep 2023; 23:225-233. [PMID: 37060388 PMCID: PMC10182950 DOI: 10.1007/s11910-023-01265-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE OF REVIEW Isocitrate dehydrogenase (IDH) mutant gliomas are a distinct type of primary brain tumors with unique characteristics, behavior, and disease outcomes. This article provides a review of standard of care treatment options and innovative, therapeutic approaches that are currently under investigation for these tumors. RECENT FINDINGS Extensive pre-clinical data and a variety of clinical studies support targeting IDH mutations in glioma using different mechanisms, which include direct inhibition and immunotherapies that target metabolic and epigenomic vulnerabilities caused by these mutations. IDH mutations have been recognized as an oncogenic driver in gliomas for more than a decade and as a positive prognostic factor influencing the research for new therapeutic methods including IDH inhibitors, DNA repair inhibitors, and immunotherapy.
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Affiliation(s)
| | - Macarena Ines de la Fuente
- Sylvester Comprehensive Cancer Center and Department of Neurology, 1120 NW 14th Street, Miami, FL, 33136, USA.
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12
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Hervey-Jumper SL, Zhang Y, Phillips JJ, Morshed RA, Young JS, McCoy L, Lafontaine M, Luks T, Ammanuel S, Kakaizada S, Egladyous A, Gogos A, Villanueva-Meyer J, Shai A, Warrier G, Rice T, Crane J, Wrensch M, Wiencke JK, Daras M, Oberheim Bush NA, Taylor JW, Butowski N, Clarke J, Chang S, Chang E, Aghi M, Theodosopoulos P, McDermott M, Jakola AS, Kavouridis VK, Nawabi N, Solheim O, Smith T, Berger MS, Molinaro AM. Interactive Effects of Molecular, Therapeutic, and Patient Factors on Outcome of Diffuse Low-Grade Glioma. J Clin Oncol 2023; 41:2029-2042. [PMID: 36599113 PMCID: PMC10082290 DOI: 10.1200/jco.21.02929] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/18/2022] [Accepted: 11/14/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE In patients with diffuse low-grade glioma (LGG), the extent of surgical tumor resection (EOR) has a controversial role, in part because a randomized clinical trial with different levels of EOR is not feasible. METHODS In a 20-year retrospective cohort of 392 patients with IDH-mutant grade 2 glioma, we analyzed the combined effects of volumetric EOR and molecular and clinical factors on overall survival (OS) and progression-free survival by recursive partitioning analysis. The OS results were validated in two external cohorts (n = 365). Propensity score analysis of the combined cohorts (n = 757) was used to mimic a randomized clinical trial with varying levels of EOR. RESULTS Recursive partitioning analysis identified three survival risk groups. Median OS was shortest in two subsets of patients with astrocytoma: those with postoperative tumor volume (TV) > 4.6 mL and those with preoperative TV > 43.1 mL and postoperative TV ≤ 4.6 mL. Intermediate OS was seen in patients with astrocytoma who had chemotherapy with preoperative TV ≤ 43.1 mL and postoperative TV ≤ 4.6 mL in addition to oligodendroglioma patients with either preoperative TV > 43.1 mL and residual TV ≤ 4.6 mL or postoperative residual volume > 4.6 mL. Longest OS was seen in astrocytoma patients with preoperative TV ≤ 43.1 mL and postoperative TV ≤ 4.6 mL who received no chemotherapy and oligodendroglioma patients with preoperative TV ≤ 43.1 mL and postoperative TV ≤ 4.6 mL. EOR ≥ 75% improved survival outcomes, as shown by propensity score analysis. CONCLUSION Across both subtypes of LGG, EOR beginning at 75% improves OS while beginning at 80% improves progression-free survival. Nonetheless, maximal resection with preservation of neurological function remains the treatment goal. Our findings have implications for surgical strategies for LGGs, particularly oligodendroglioma.
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Affiliation(s)
- Shawn L. Hervey-Jumper
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Yalan Zhang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Joanna J. Phillips
- Department of Pathology, University of California, San Francisco, San Francisco, CA
| | - Ramin A. Morshed
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Jacob S. Young
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Lucie McCoy
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Marisa Lafontaine
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Tracy Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Simon Ammanuel
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Sofia Kakaizada
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Andrew Egladyous
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Andrew Gogos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Javier Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Anny Shai
- Department of Pathology, University of California, San Francisco, San Francisco, CA
| | - Gayathri Warrier
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Terri Rice
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Jason Crane
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA
| | - Margaret Wrensch
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - John K. Wiencke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Mariza Daras
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Nancy Ann Oberheim Bush
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Jennie W. Taylor
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Nicholas Butowski
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Jennifer Clarke
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Susan Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Edward Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Manish Aghi
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Philip Theodosopoulos
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Michael McDermott
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Asgeir S. Jakola
- Department of Neurological Surgery, St Olavs University Hospital, Trondheim, Norway
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Noah Nawabi
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Ole Solheim
- Department of Neurological Surgery, St Olavs University Hospital, Trondheim, Norway
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Timothy Smith
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, MA
| | - Mitchel S. Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
| | - Annette M. Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA
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13
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Anbunesan SN, Alfonso-Garcia A, Zhou X, Bec J, Lee HS, Jin LW, Bloch O, Marcu L. Intraoperative detection of IDH-mutant glioma using fluorescence lifetime imaging. JOURNAL OF BIOPHOTONICS 2023; 16:e202200291. [PMID: 36510639 PMCID: PMC10522274 DOI: 10.1002/jbio.202200291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Identifying isocitrate dehydrogenase (IDH)-mutation and glioma subtype during surgery instead of days later can aid in modifying tumor resection strategies for better survival outcomes. We report intraoperative identification of IDH-mutant glioma (N = 12 patients) with a clinically compatible fluorescence lifetime imaging (FLIm) device (excitation: 355 nm; emission spectral bands: 390/40 nm, 470/28 nm, 542/50 nm). The fluorescence-derived parameters were analyzed to study the optical contrast between IDH-mutant tumors and surrounding brain tissue. IDH-mutant oligodendrogliomas exhibited shorter lifetimes (3.3 ± 0.1 ns) than IDH-mutant astrocytomas (4.1 ± 0.1 ns). Both IDH-mutant glioma subtypes had shorter lifetimes than white matter (4.6 ± 0.4 ns) but had comparable lifetimes to cortex. Lifetimes also increased with malignancy grade within IDH-mutant oligodendrogliomas (grade 2: 2.96 ± 0.08 ns, grade 3: 3.4 ± 0.3 ns) but not within IDH-mutant astrocytomas. The current results support the feasibility of FLIm as a surgical adjuvant for identifying IDH-mutant glioma tissue.
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Affiliation(s)
- Silvia Noble Anbunesan
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Alba Alfonso-Garcia
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Xiangnan Zhou
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Julien Bec
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
| | - Han Sung Lee
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Lee-Way Jin
- Department of Pathology and Laboratory Medicine, University of California Davis, Sacramento, California, USA
| | - Orin Bloch
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California Davis, Davis, California, USA
- Department of Neurological Surgery, University of California Davis, Sacramento, California, USA
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14
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Trinder SM, McKay C, Power P, Topp M, Chan B, Valvi S, McCowage G, Govender D, Kirby M, Ziegler DS, Manoharan N, Hassall T, Kellie S, Heath J, Alvaro F, Wood P, Laughton S, Tsui K, Dodgshun A, Eisenstat DD, Endersby R, Luen SJ, Koh ES, Sim HW, Kong B, Gottardo NG, Whittle JR, Khuong-Quang DA, Hansford JR. BRAF-mediated brain tumors in adults and children: A review and the Australian and New Zealand experience. Front Oncol 2023; 13:1154246. [PMID: 37124503 PMCID: PMC10140567 DOI: 10.3389/fonc.2023.1154246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/13/2023] [Indexed: 05/02/2023] Open
Abstract
The mitogen-activated protein kinase (MAPK) pathway signaling pathway is one of the most commonly mutated pathways in human cancers. In particular, BRAF alterations result in constitutive activation of the rapidly accelerating fibrosarcoma-extracellular signal-regulated kinase-MAPK significant pathway, leading to cellular proliferation, survival, and dedifferentiation. The role of BRAF mutations in oncogenesis and tumorigenesis has spurred the development of targeted agents, which have been successful in treating many adult cancers. Despite advances in other cancer types, the morbidity and survival outcomes of patients with glioma have remained relatively stagnant. Recently, there has been recognition that MAPK dysregulation is almost universally present in paediatric and adult gliomas. These findings, accompanying broad molecular characterization of gliomas, has aided prognostication and offered opportunities for clinical trials testing targeted agents. The use of targeted therapies in this disease represents a paradigm shift, although the biochemical complexities has resulted in unexpected challenges in the development of effective BRAF inhibitors. Despite these challenges, there are promising data to support the use of BRAF inhibitors alone and in combination with MEK inhibitors for patients with both low-grade and high-grade glioma across age groups. Safety and efficacy data demonstrate that many of the toxicities of these targeted agents are tolerable while offering objective responses. Newer clinical trials will examine the use of these therapies in the upfront setting. Appropriate duration of therapy and durability of response remains unclear in the glioma patient cohort. Longitudinal efficacy and toxicity data are needed. Furthermore, access to these medications remains challenging outside of clinical trials in Australia and New Zealand. Compassionate access is limited, and advocacy for mechanism of action-based drug approval is ongoing.
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Affiliation(s)
- Sarah M. Trinder
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Campbell McKay
- Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, VIC, Australia
| | - Phoebe Power
- Sydney Children’s Hospital, Children’s Cancer Institute, University of New South Wales, Randwick, NSW, Australia
- School of Women’s and Children’s Health, University of New South Wales, Randwick, NSW, Australia
| | - Monique Topp
- Department of Medical Oncology, Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - Bosco Chan
- Michael Rice Cancer Centre, Women’s and Children’s Hospital, North Adelaide, SA, Australia
| | - Santosh Valvi
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children’s Hospital, Nedlands, WA, Australia
| | - Geoffrey McCowage
- Department of Oncology, Children’s Hospital at Westmead, Sydney, NSW, Australia
- Australasian Children’s Cancer Trials, Clayton, VIC, Australia
| | - Dinisha Govender
- Department of Oncology, Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Maria Kirby
- Michael Rice Cancer Centre, Women’s and Children’s Hospital, North Adelaide, SA, Australia
| | - David S. Ziegler
- Sydney Children’s Hospital, Children’s Cancer Institute, University of New South Wales, Randwick, NSW, Australia
- Children’s Cancer Institute, Lowy Cancer Research Centre, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine and Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Neevika Manoharan
- Sydney Children’s Hospital, Children’s Cancer Institute, University of New South Wales, Randwick, NSW, Australia
- School of Clinical Medicine, University of New South Wales (UNSW) Medicine and Health, University of New South Wales (UNSW) Sydney, Sydney, NSW, Australia
| | - Tim Hassall
- Queensland Children’s Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Stewart Kellie
- Westmead Children’s Hospital, University of Sydney, Westmead, NSW, Australia
| | - John Heath
- Department of Pediatric Oncology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Frank Alvaro
- Department of Pediatric Oncology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Paul Wood
- Monash Medical Centre, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephen Laughton
- Starship Blood and Cancer Centre, Starship Children’s Hospital, Auckland, New Zealand
| | - Karen Tsui
- Starship Blood and Cancer Centre, Starship Children’s Hospital, Auckland, New Zealand
| | - Andrew Dodgshun
- Children’s Haematology/Oncology Centre, Christchurch Hospital, Christchurch, New Zealand
| | - David D. Eisenstat
- Children’s Cancer Centre, Royal Children’s Hospital, Melbourne, VIC, Australia
- Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Raelene Endersby
- Brain Tumour Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, Nedlands, WA, Australia
- Centre for Child Health Research, University of Western Australia, Perth, WA, Australia
| | - Stephen J. Luen
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Eng-Siew Koh
- Department of Radiation Oncology, Liverpool and Macarther Cancer Therapy Centres, Liverpool, NSW, Australia
- Department of Medicine, University of New South Wales, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Hao-Wen Sim
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, Sydney, NSW, Australia
- Department of Medical Oncology, Chris O’Brien Lifehouse, Sydney, NSW, Australia
| | - Benjamin Kong
- National Health and Medical Research Council (NHMRC) Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Nicholas G. Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children’s Hospital, Nedlands, WA, Australia
- Brain Tumour Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, Nedlands, WA, Australia
| | - James R. Whittle
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | | | - Jordan R. Hansford
- Michael Rice Cancer Centre, Women’s and Children’s Hospital, North Adelaide, SA, Australia
- South Australian Health and Medical Research Institute South Australia, Adelaide, SA, Australia
- South Australia ImmunoGENomics Cancer Institute, University of Adelaide, Adelaide, SA, Australia
- *Correspondence: Jordan R. Hansford,
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15
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Wu PB, Filley AC, Miller ML, Bruce JN. Benign Glioma. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:31-71. [PMID: 37452934 DOI: 10.1007/978-3-031-23705-8_2] [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: 07/18/2023]
Abstract
Benign glioma broadly refers to a heterogeneous group of slow-growing glial tumors with low proliferative rates and a more indolent clinical course. These tumors may also be described as "low-grade" glioma (LGG) and are classified as WHO grade I or II lesions according to the Classification of Tumors of the Central Nervous System (CNS) (Louis et al. in Acta Neuropathol 114:97-109, 2007). Advances in molecular genetics have improved understanding of glioma tumorigenesis, leading to the identification of common mutation profiles with significant treatment and prognostic implications. The most recent WHO 2016 classification system has introduced several notable changes in the way that gliomas are diagnosed, with a new emphasis on molecular features as key factors in differentiation (Wesseling and Capper in Neuropathol Appl Neurobiol 44:139-150, 2018). Benign gliomas have a predilection for younger patients and are among the most frequently diagnosed tumors in children and young adults (Ostrom et al. in Neuro Oncol 22:iv1-iv96, 2020). These tumors can be separated into two clinically distinct subgroups. The first group is of focal, well-circumscribed lesions that notably are not associated with an increased risk of malignant transformation. Primarily diagnosed in pediatric patients, these WHO grade I tumors may be cured with surgical resection alone (Sturm et al. in J Clin Oncol 35:2370-2377, 2017). Recurrence rates are low, and the prognosis for these patients is excellent (Ostrom et al. in Neuro Oncol 22:iv1-iv96, 2020). Diffuse gliomas are WHO grade II lesions with a more infiltrative pattern of growth and high propensity for recurrence. These tumors are primarily diagnosed in young adult patients, and classically present with seizures (Pallud et al. Brain 137:449-462, 2014). The term "benign" is a misnomer in many cases, as the natural history of these tumors is with malignant transformation and recurrence as grade III or grade IV tumors (Jooma et al. in J Neurosurg 14:356-363, 2019). For all LGG, surgery with maximal safe resection is the treatment of choice for both primary and recurrent tumors. The goal of surgery should be for gross total resection (GTR), as complete tumor removal is associated with higher rates of tumor control and seizure freedom. Chemotherapy and radiation therapy (RT), while not typically a component of first-line treatment in most cases, may be employed as adjunctive therapy in high-risk or recurrent tumors and in some select cases. The prognosis of benign gliomas varies widely; non-infiltrative tumor subtypes generally have an excellent prognosis, while diffusely infiltrative tumors, although slow-growing, are eventually fatal (Sturm et al. in J Clin Oncol 35:2370-2377, 2017). This chapter reviews the shared and unique individual features of the benign glioma including diffuse glioma, pilocytic astrocytoma and pilomyxoid astrocytoma (PMA), subependymal giant cell astrocytoma (SEGA), pleomorphic xanthoastrocytoma (PXA), subependymoma (SE), angiocentric glioma (AG), and chordoid glioma (CG). Also discussed is ganglioglioma (GG), a mixed neuronal-glial tumor that represents a notable diagnosis in the differential for other LGG (Wesseling and Capper 2018). Ependymomas of the brain and spinal cord, including major histologic subtypes, are discussed in other chapters.
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Affiliation(s)
- Peter B Wu
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, UCLA, Los Angeles, USA
| | - Anna C Filley
- Department of Neurosurgery, Columbia University Medical Center, New York, USA
| | - Michael L Miller
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, USA
| | - Jeffrey N Bruce
- Department of Neurosurgery, Columbia University Medical Center, New York, USA.
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16
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Fults DW. Commentary: Occurrence, Risk Factors, and Consequences of Postoperative Ischemia After Glioma Resection: A Retrospective Study. Neurosurgery 2023; 92:e5-e6. [PMID: 36170171 DOI: 10.1227/neu.0000000000002173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/25/2022] Open
Affiliation(s)
- Daniel W Fults
- Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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17
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Wang Y, Zhang J, Luo C, Yao Y, Qin G, Wu J. Predictive models and survival analysis of postoperative mental health disturbances in adult glioma patients. Front Oncol 2023; 13:1153455. [PMID: 37152011 PMCID: PMC10160603 DOI: 10.3389/fonc.2023.1153455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background and Objectives Patients with primary malignant brain tumors may experience mental health disturbances that can significantly affect their daily life. This study aims to identify risk factors and generate predictive models for postoperative mental health disturbances (PMHDs) in adult glioma patients in accordance with different clinical periods; additionally, survival analyses will be performed. Methods This longitudinal cohort study included 2,243 adult patients (age at diagnosis ≥ 18 years) with nonrecurrent glioma who were pathologically diagnosed and had undergone initial surgical resection. Six indicators of distress, sadness, fear, irritability, mood and enjoyment of life, ranging from 0-10, were selected to assess PMHDs in glioma patients in the third month after surgery, mainly referring to the M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT). Factor analysis (FA) was applied on these indicators to divide participants into PMHD and control groups based on composite factor scores. Survival analyses were performed, and separate logistic regression models were formulated for preoperative and postoperative factors predicting PMHDs. Results A total of 2,243 adult glioma patients were included in this study. Based on factor analysis results, 300 glioma patients had PMHDs in the third postoperative month, and the remaining 1,943 were controls. Candidate predictors for PMHDs in the preoperative model were associated with age, clinical symptoms (intracranial space-occupying lesion, muscle weakness and memory deterioration), and tumor location (corpus callosum, basal ganglia and brainstem), whereas age, clinical symptoms (nausea and memory deterioration), tumor location (basal ganglia and brainstem), hospitalization days, WHO grade 4, postoperative chemotherapy or radiotherapy and postoperative Karnofsky Performance Scale (KPS) served as important factors in the postoperative model. In addition, the median overall survival (OS) time for glioma patients with PMHDs was 19 months, compared to 13 months for glioblastoma, IDH-wild type (GBM) patients with PMHDs. Conclusion The risk factors for PMHDs were identified. These findings may provide new insights into predicting the probability of PMHD occurrence in glioma patients in addition to aiding effective early intervention and improving prognosis based on different clinical stages.
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Affiliation(s)
- Yi Wang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Jie Zhang
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute, Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai Municipal Health Commission, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Chen Luo
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute, Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai Municipal Health Commission, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
| | - Ye Yao
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
- *Correspondence: Ye Yao, ; Jinsong Wu,
| | - Guoyou Qin
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety of Ministry of Education, Fudan University, Shanghai, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Neurosurgical Institute, Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai Municipal Health Commission, Shanghai, China
- Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration, Science and Technology Commission of Shanghai Municipality, Shanghai, China
- *Correspondence: Ye Yao, ; Jinsong Wu,
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18
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Yao S, Yang R, Du C, Jiang C, Wang Y, Peng C, Bai H. Maximal safe resection of diffuse lower grade gliomas primarily within central lobe using cortical/subcortical direct electrical stimulation under awake craniotomy. Front Oncol 2023; 13:1089139. [PMID: 36895476 PMCID: PMC9990258 DOI: 10.3389/fonc.2023.1089139] [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: 11/03/2022] [Accepted: 02/07/2023] [Indexed: 02/23/2023] Open
Abstract
Background Diffuse lower-grade glioma (DLGG) in the central lobe is a challenge for safe resection procedures. To improve the extent of resection and reduce the risk of postoperative neurological deficits, we performed an awake craniotomy with cortical-subcortical direct electrical stimulation (DES) mapping for patients with DLGG located primarily within the central lobe. We investigated the outcomes of cortical-subcortical brain mapping using DES in an awake craniotomy for central lobe DLGG resection. Methods We performed a retrospective analysis of clinical data of a cohort of consecutively treated patients from February 2017 to August 2021 with diffuse lower-grade gliomas located primarily within the central lobe. All patients underwent awake craniotomy with DES for cortical and subcortical mapping of eloquent brain areas, neuronavigation, and/or ultrasound to identify tumor location. Tumors were removed according to functional boundaries. Maximum safe tumor resection was the surgical objective for all patients. Results Thirteen patients underwent 15 awake craniotomies with intraoperative mapping of eloquent cortices and subcortical fibers using DES. Maximum safe tumor resection was achieved according to functional boundaries in all patients. The pre-operative tumor volumes ranged from 4.3 cm3 to 137.3 cm3 (median 19.2 cm3). The mean extent of tumor resection was 94.6%, with eight cases (53.3%) achieving total resection, four (26.7%) subtotal and three (20.0%) partial. The mean tumor residue was 1.2 cm3. All patients experienced early postoperative neurological deficits or worsening conditions. Three patients (20.0%) experienced late postoperative neurological deficits at the 3-month follow-up, including one moderate and two mild neurological deficits. None of the patients experienced late onset severe neurological impairments post-operatively. Ten patients with 12 tumor resections (80.0%) had resumed activities of daily living at the 3-month follow-up. Among 14 patients with pre-operative epilepsy, 12 (85.7%) were seizure-free after treatment with antiepileptic drugs 7 days after surgery up to the last follow-up. Conclusions DLGG located primarily in the central lobe deemed inoperable can be safely resected using awake craniotomy with intraoperative DES without severe permanent neurological sequelae. Patients experienced an improved quality of life in terms of seizure control.
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Affiliation(s)
- Shujing Yao
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Ruixin Yang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Chenggang Du
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Yang Wang
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Chongqi Peng
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
| | - Hongmin Bai
- Department of Neurosurgery, General Hospital of Southern Theater Command of PLA, Guangzhou, China
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19
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Giantini-Larsen AM, Pannullo S, Juthani RG. Challenges in the Diagnosis and Management of Low-Grade Gliomas. World Neurosurg 2022; 166:313-320. [PMID: 36192863 DOI: 10.1016/j.wneu.2022.06.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/14/2022] [Indexed: 12/15/2022]
Abstract
Low-grade gliomas are clinically challenging entities. Patients with these tumors tend to be relatively young at presentation, and lesions are often incidental findings or are identified because the patient presents with a seizure. Rapidly emerging and evolving molecular classifications of gliomas have influenced treatment paradigms. Importantly, low-grade gliomas can be classified on the basis of IDH mutation status, whereby low-grade astrocytomas harbor the IDH mutation, while oligodendrogliomas are defined by both IDH mutant status and 1p/19q co-deletion. Given the importance of molecular classification for diagnosis, treatment planning, and prognostication, tissue samples are necessary for proper management. Literature supports improved overall survival and outcomes with increased extent of resection for low-grade glioma. Awake craniotomies and resection of insular low-grade gliomas both have been demonstrated as safe and improve outcomes for patients with lesions located in eloquent areas. Given the younger age at diagnosis of these lesions compared with higher-grade gliomas, fertility, fertility preservation, and potential malignant transformation should be discussed with patients of childbearing age.
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Affiliation(s)
- Alexandra M Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
| | - Susan Pannullo
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
| | - Rupa Gopalan Juthani
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA.
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20
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Brenner S, Hartzendorf S, Vogt P, Maier E, Etminan N, Jung E, Wick W, Sahm F, Winkler F, Ratliff M. Progression Patterns in Non-Contrast-Enhancing Gliomas Support Brain Tumor Responsiveness to Surgical Lesions. Pathol Oncol Res 2022; 28:1610268. [PMID: 35706996 PMCID: PMC9189286 DOI: 10.3389/pore.2022.1610268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/05/2022] [Indexed: 11/13/2022]
Abstract
Purpose: The overall benefit of surgical treatments for patients with glioma is undisputed. We have shown preclinically that brain tumor cells form a network that is capable of detecting damage to the tumor, and repair itself. The aim of this study was to determine whether a similar mechanism might contribute to local recurrence in the clinical setting. Methods: We evaluated tumor progression patterns of 24 initially non-contrast-enhancing gliomas that were partially resected or biopsied. We measured the distance between the new contrast enhancement developing over time, and prior surgical lesioning, and evaluated tumor network changes in response to sequential resections by quantifying tumor cells and tumor networks with specific stainings against IDH1-R132H. Results: We found that new contrast enhancement appeared within the residual, non-enhancing tumor mass in 21/24 patients (87.5%). The location of new contrast enhancement within the residual tumor region was non-random; it occurred adjacent to the wall of the resection cavity in 12/21 patients (57.1%). Interestingly, the density of the glioma cell network increased in all patient tumors between initial resection or biopsy and recurrence. In line with the histological and radiological malignization, Ki67 expression increased from initial to final resections in 14/17 cases. Conclusion: The non-random distribution of glioma malignization in patients and unidirectional increase of anatomical tumor networks after surgical procedures provides evidence that surgical lesions, in the presence of residual tumor cells, can stimulate local tumor progression and tumor cell network formation. This argues for the development of intraoperative treatments increasing the benefits from surgical resection by specifically disrupting the mechanisms of local recurrence, particularly tumor cell network functionality.
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Affiliation(s)
- Steffen Brenner
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sebastian Hartzendorf
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philip Vogt
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Elena Maier
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
| | - Erik Jung
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, University of Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Frank Winkler
- Neurology Clinic and National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Miriam Ratliff
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.,Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
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21
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Pradhan A, Mozaffari K, Ghodrati F, Everson RG, Yang I. Modern surgical management of incidental gliomas. J Neurooncol 2022; 159:81-94. [PMID: 35704158 PMCID: PMC9325816 DOI: 10.1007/s11060-022-04045-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/23/2022] [Indexed: 11/19/2022]
Abstract
Purpose Gliomas are the most common primary tumors of the central nervous system and are categorized by the World Health Organization into either low-grade (grades 1 and 2) or high-grade (grades 3 and 4) gliomas. A subset of patients with glioma may experience no tumor-related symptoms and be incidentally diagnosed. These incidental low-grade gliomas (iLGG) maintain controversial treatment course despite scientific advancements. Here we highlight the recent advancements in classification, neuroimaging, and surgical management of these tumors. Methods A review of the literature was performed. The authors created five subtopics of focus: histological criteria, diagnostic imaging, surgical advancements, correlation of surgical resection and survival outcomes, and clinical implications. Conclusions Alternating studies suggest that these tumors may experience higher mutational rates than their counterparts. Significant progress in management of gliomas, regardless of the grade, has been made through modern neurosurgical treatment modalities, diagnostic neuroimaging, and a better understanding of the genetic composition of these tumors. An optimal treatment approach for patients with newly diagnosed iLGG remains ill-defined despite multiple studies arguing in favor of safe maximal resection. Our review emphasizes the not so benign nature of incidental low grade glioma and further supports the need for future studies to evaluate survival outcomes following surgical resection.
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Affiliation(s)
- Anjali Pradhan
- Departments of Neurosurgery, University of California, Los Angeles, Los Angeles, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Khashayar Mozaffari
- Departments of Neurosurgery, University of California, Los Angeles, Los Angeles, USA
| | - Farinaz Ghodrati
- Departments of Neurosurgery, University of California, Los Angeles, Los Angeles, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Richard G Everson
- Departments of Neurosurgery, University of California, Los Angeles, Los Angeles, USA.,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, USA.,The Lundquist Institute, University of California, Los Angeles, Los Angeles, USA.,Harbor-UCLA Medical Center, University of California, Los Angeles, Los Angeles, USA.,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Isaac Yang
- Departments of Neurosurgery, University of California, Los Angeles, Los Angeles, USA. .,Radiation Oncology, University of California, Los Angeles, Los Angeles, USA. .,Head and Neck Surgery, University of California, Los Angeles, Los Angeles, USA. .,Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, USA. .,The Lundquist Institute, University of California, Los Angeles, Los Angeles, USA. .,Harbor-UCLA Medical Center, University of California, Los Angeles, Los Angeles, USA. .,David Geffen School of Medicine, Los Angeles (UCLA), Los Angeles, CA, USA.
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22
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Yeo KK, Alexandrescu S, Cotter JA, Vogelzang J, Bhave V, Li MM, Ji J, Benhamida JK, Rosenblum MK, Bale TA, Bouvier N, Kaneva K, Rosenberg T, Lim-Fat MJ, Ghosh H, Martinez M, Aguilera D, Smith A, Goldman S, Diamond EL, Gavrilovic I, MacDonald TJ, Wood MD, Nazemi KJ, Truong A, Cluster A, Ligon KL, Cole K, Bi WL, Margol AS, Karajannis MA, Wright KD. Multi-institutional study of the frequency, genomic landscape, and outcome of IDH-mutant glioma in pediatrics. Neuro Oncol 2022; 25:199-210. [PMID: 35604410 PMCID: PMC9825351 DOI: 10.1093/neuonc/noac132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The incidence and biology of IDH1/2 mutations in pediatric gliomas are unclear. Notably, current treatment approaches by pediatric and adult providers vary significantly. We describe the frequency and clinical outcomes of IDH1/2-mutant gliomas in pediatrics. METHODS We performed a multi-institutional analysis of the frequency of pediatric IDH1/2-mutant gliomas, identified by next-generation sequencing (NGS). In parallel, we retrospectively reviewed pediatric IDH1/2-mutant gliomas, analyzing clinico-genomic features, treatment approaches, and outcomes. RESULTS Incidence: Among 851 patients with pediatric glioma who underwent NGS, we identified 78 with IDH1/2 mutations. Among patients 0-9 and 10-21 years old, 2/378 (0.5%) and 76/473 (16.1%) had IDH1/2-mutant tumors, respectively. Frequency of IDH mutations was similar between low-grade glioma (52/570, 9.1%) and high-grade glioma (25/277, 9.0%). Four tumors were graded as intermediate histologically, with one IDH1 mutation. Outcome: Seventy-six patients with IDH1/2-mutant glioma had outcome data available. Eighty-four percent of patients with low-grade glioma (LGG) were managed observantly without additional therapy. For low-grade astrocytoma, 5-year progression-free survival (PFS) was 42.9% (95%CI:20.3-63.8) and, despite excellent short-term overall survival (OS), numerous disease-related deaths after year 10 were reported. Patients with high-grade astrocytoma had a 5-year PFS/OS of 36.8% (95%CI:8.8-66.4) and 84% (95%CI:50.1-95.6), respectively. Patients with oligodendroglioma had excellent OS. CONCLUSIONS A subset of pediatric gliomas is driven by IDH1/2 mutations, with a higher rate among adolescents. The majority of patients underwent upfront observant management without adjuvant therapy. Findings suggest that the natural history of pediatric IDH1/2-mutant glioma may be similar to that of adults, though additional studies are needed.
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Affiliation(s)
- Kee Kiat Yeo
- Corresponding Author: Kee Kiat Yeo, MD, Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, 450 Brookline Ave, Boston, MA 02215, USA ()
| | | | | | - Jayne Vogelzang
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, MA, USA
| | | | - Marilyn M Li
- Division of Genomic Diagnostics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jianling Ji
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles, Los Angeles, CA,USA
| | - Jamal K Benhamida
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc K Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tejus A Bale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nancy Bouvier
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kristiyana Kaneva
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, USA,Tempus Labs, Inc., Chicago, IL, USA
| | - Tom Rosenberg
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
| | - Mary Jane Lim-Fat
- Department of Medical Oncology, Dana-Farber/Brigham and Women’s Hospital Cancer Center, Boston, MA, USA
| | - Hia Ghosh
- Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Migdalia Martinez
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Dolly Aguilera
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Amy Smith
- Department of Pediatrics, Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Stewart Goldman
- Department of Child Health, Phoenix Children’s Hospital, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Igor Gavrilovic
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tobey J MacDonald
- Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew D Wood
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Kellie J Nazemi
- Department of Pediatrics, Doernbecher Children’s Hospital, Portland, OR, USA
| | - AiLien Truong
- Department of Pediatrics, Doernbecher Children’s Hospital, Portland, OR, USA
| | - Andrew Cluster
- Department of Pediatrics, St. Louis Children’s Hospital, St. Louis, MO, USA
| | - Keith L Ligon
- Department of Pathology, Dana-Farber/Brigham and Women’s Hospital Cancer Center, Boston, MA, USA
| | - Kristina Cole
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Ashley S Margol
- Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Karen D Wright
- Department of Pediatric Oncology, Dana-Farber/Boston Children’s Cancer and Blood Disorder Center, Boston, MA, USA,Harvard Medical School, Boston, MA, USA
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23
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Motomura K, Ohka F, Aoki K, Saito R. Supratotal Resection of Gliomas With Awake Brain Mapping: Maximal Tumor Resection Preserving Motor, Language, and Neurocognitive Functions. Front Neurol 2022; 13:874826. [PMID: 35645972 PMCID: PMC9133877 DOI: 10.3389/fneur.2022.874826] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Gliomas are a category of infiltrating glial neoplasms that are often located within or near the eloquent areas involved in motor, language, and neurocognitive functions. Surgical resection being the first-line treatment for gliomas, plays a crucial role in patient outcome. The role of the extent of resection (EOR) was evaluated, and we reported significant correlations between a higher EOR and better clinical prognosis of gliomas. However, recurrence is inevitable, even after aggressive tumor removal. Thus, efforts have been made to achieve extended tumor resection beyond contrast-enhanced mass lesions in magnetic resonance imaging (MRI)-defined areas, a process known as supratotal resection. Since it has been reported that tumor cells invade beyond regions visible as abnormal areas on MRI, imaging underestimates the true spatial extent of tumors. Furthermore, tumor cells have the potential to spread 10–20 mm away from the MRI-verified tumor boundary. The primary goal of supratotal resection is to maximize EOR and prolong the progression-free and overall survival of patients with gliomas. The available data, as well as our own work, clearly show that supratotal resection of gliomas is a feasible technique that has improved with the aid of awake functional mapping using intraoperative direct electrical stimulation. Awake brain mapping has enabled neurosurgeons achieve supratotal resection with favorable motor, language, and neurocognitive outcomes, ensuring a better quality of life in patients with gliomas.
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24
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Metz G, Jayamanne D, Wheeler H, Wong M, Cook R, Little N, Parkinson J, Kastelan M, Brown C, Back M. Large tumour volume reduction of IDH-mutated anaplastic glioma involving the insular region following radiotherapy. BMC Neurol 2022; 22:24. [PMID: 35027006 PMCID: PMC8756697 DOI: 10.1186/s12883-021-02548-3] [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: 06/07/2021] [Accepted: 12/23/2021] [Indexed: 11/17/2022] Open
Abstract
Background The impact of near-total resection of IDH-mutated anaplastic glioma (IDHmutAG) is well-established but there remains uncertainty of benefit in tumours of the insular cortex where the extent of safe resection may be limited. This study aimed to assess tumour volume reduction in patients following IMRT and impact of residual post-surgical volume. Methods and materials Patients with IDHmutAG involving insular cortex managed with IMRT from 2008 to 2019 had baseline patient, tumour and treatment factors recorded. Volumetric assessment of residual disease on MRI was performed at baseline, month+ 3 and month+ 12 post-IMRT. Potential prognostic factors were analysed for tumour reduction and relapse-free survival, and assessed by log-rank and Cox regression analyses. Results Thirty two patients with IDHmutAG of the insular cortex were managed with median follow-up post-IMRT of 67.2 months. Pathology was anaplastic astrocytoma (AAmut) in 20, and anaplastic oligodendroglioma (AOD) in 12 patients. Median pre-IMRT volume on T1 and T2Flair was 24.3cm3 and 52.2cm3. Twenty-seven patients were alive with 5-year relapse-free survival of 80%. There was a median 67 and 64% reduction from baseline occurring at 3 months post-IMRT for T1 and T2Flair respectively; and subsequent median 78 and 73% at 12 months. At 12 months AOD patients had median 83% T1 volume reduction compared to 63% in AAmut (p < 0.01). There was no difference on T2Flair volume (p = 0.64). No other pathological factors influenced volume reduction at 12 months. No factors were associated with relapse-free survival including baseline T1 (p = 0.52) and T2Flair (p = 0.93) volume. Conclusion IMRT provides large tumour volume reduction in IDHmutAG of the insular cortex. While maximal safe debulking remains standard of care when feasible, this patient cohort reported no significant negative impact of residual disease volume on relapse-free survival.
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Affiliation(s)
- Gabrielle Metz
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.
| | - Dasantha Jayamanne
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Genesis Cancer Care, Sydney, Australia
| | - Helen Wheeler
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Matthew Wong
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - Raymond Cook
- The Brain Cancer Group, Sydney, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Nicholas Little
- Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Jonathon Parkinson
- The Brain Cancer Group, Sydney, Australia.,Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia
| | - Marina Kastelan
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,The Brain Cancer Group, Sydney, Australia
| | - Chris Brown
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia.,Genesis Cancer Care, Sydney, Australia.,The Brain Cancer Group, Sydney, Australia.,Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
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25
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Rudà R, Bruno F, Ius T, Silvani A, Minniti G, Pace A, Lombardi G, Bertero L, Pizzolitto S, Pollo B, Conti Nibali M, Pellerino A, Migliore E, Skrap M, Bello L, Soffietti R. IDH wild-type grade 2 diffuse astrocytomas: prognostic factors and impact of treatments within molecular subgroups. Neuro Oncol 2021; 24:809-820. [PMID: 34651653 DOI: 10.1093/neuonc/noab239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Prognostic factors and role of treatments are not well known in isocitrate dehydrogenase (IDH) wild-type (wt) grade 2 astrocytomas. The aim of this study was to define in these tumours clinical features, molecular characteristics and prognostic factors, with particular focus on molecular subgroups defined by cIMPACT-NOW update 3. METHODS We analysed 120 patients with confirmed diagnosis of grade 2 IDHwt astrocytoma according to WHO 2016, collected from 7 Italian centres between 1999 and 2017. RESULTS Median PFS and OS of the whole cohort were 18.9 and 32.6 months. Patients older than 40 years and patients with modest contrast enhancement on MRI had a shorter PFS and OS. Gross total resection yielded superior PFS and OS over non-gross total resection. PFS and OS of patients with either pTERT mutation or EGRF amplification were significantly shorter. The prognostic value of age, contrast enhancement on MRI and extent of surgery was different within the molecular subgroups. Gross total resection was associated with increased PFS (not reached versus 14 months, p = 0.023) and OS (117.9 versus 20 months, p = 0.023) in patients without EGFR amplification, and with increased OS in those without pTERT mutation (NR vs 53.7 months, p = 0.05). Conversely, for patients with EGFR amplification or pTERT mutation, gross total resection did not yield a significant survival benefit. CONCLUSION Patients without EGFR amplification and pTERT mutation could be observed after gross total resection.
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Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy.,Department of Neurology, Castelfranco Veneto and Brain Tumor Board Treviso Hospital, Italy
| | - Francesco Bruno
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Tamara Ius
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Antonio Silvani
- Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University Hospital, Siena, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, Regina Elena National Cancer Institute, Rome, Italy
| | | | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Italy
| | - Stefano Pizzolitto
- Department of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Bianca Pollo
- Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Conti Nibali
- Neurosurgical Oncology Division, Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Alessia Pellerino
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
| | - Enrica Migliore
- Unit of Cancer Epidemiology (CPO Piemonte), University of Turin, Turin, Italy
| | - Miran Skrap
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Division, Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy
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26
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Yeung JT, Taylor HM, Nicholas PJ, Young IM, Jiang I, Doyen S, Sughrue ME, Teo C. Using Quicktome for Intracerebral Surgery: Early Retrospective Study and Proof of Concept. World Neurosurg 2021; 154:e734-e742. [PMID: 34358688 DOI: 10.1016/j.wneu.2021.07.127] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Neurosurgeons have limited tools in their armamentarium to visualize critical brain networks during surgical planning. Quicktome was designed using machine-learning to generate robust visualization of important brain networks that can be used with standard neuronavigation to minimize those deficits. We sought to see whether Quicktome could help localize important cerebral networks and tracts during intracerebral surgery. METHODS We report on all patients who underwent keyhole intracranial surgery with available Quicktome-enabled neuronavigation. We retrospectively analyzed the locations of the lesions and determined functional networks at risks, including chief executive network, default mode network, salience, corticospinal/sensorimotor, language, neglect, and visual networks. We report on the postoperative neurologic outcomes of the patients and retrospectively determined whether the outcomes could be explained by Quicktome's functional localizations. RESULTS Fifteen high-risk patients underwent craniotomies for intra-axial tumors, with the exception of one meningioma and one case of leukoencephalopathy. Eight patients were male. The median age was 49.6 years. Quicktome was readily integrated in our existing navigation system in every case. New postoperative neurologic deficits occurred in 8 patients. All new deficits, except for one resulting from a postoperative stroke, were expected and could be explained by preoperative findings by Quicktome. In addition, in those who did not have new neurologic deficits, Quicktome offered explanations for their outcomes. CONCLUSIONS Quicktome helps to visualize complex functional connectomic networks and tracts by seamlessly integrating into existing neuronavigation platforms. The added information may assist in reducing neurological deficits and offer explanations for postsurgical outcomes.
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Affiliation(s)
- Jacky T Yeung
- Centre for Minimally Invasive Neurosurgery, Randwick, NSW, Australia
| | | | | | | | - Ivy Jiang
- Omniscient Neurotechnology, Sydney, Australia
| | | | | | - Charles Teo
- Centre for Minimally Invasive Neurosurgery, Randwick, NSW, Australia; Omniscient Neurotechnology, Sydney, Australia
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Kiesel B, Freund J, Reichert D, Wadiura L, Erkkilae MT, Woehrer A, Hervey-Jumper S, Berger MS, Widhalm G. 5-ALA in Suspected Low-Grade Gliomas: Current Role, Limitations, and New Approaches. Front Oncol 2021; 11:699301. [PMID: 34395266 PMCID: PMC8362830 DOI: 10.3389/fonc.2021.699301] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Radiologically suspected low-grade gliomas (LGG) represent a special challenge for the neurosurgeon during surgery due to their histopathological heterogeneity and indefinite tumor margin. Therefore, new techniques are required to overcome these current surgical drawbacks. Intraoperative visualization of brain tumors with assistance of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence is one of the major advancements in the neurosurgical field in the last decades. Initially, this technique was exclusively applied for fluorescence-guided surgery of high-grade glioma (HGG). In the last years, the use of 5-ALA was also extended to other indications such as radiologically suspected LGG. Here, we discuss the current role of 5-ALA for intraoperative visualization of focal malignant transformation within suspected LGG. Furthermore, we discuss the current limitations of the 5-ALA technology in pure LGG which usually cannot be visualized by visible fluorescence. Finally, we introduce new approaches based on fluorescence technology for improved detection of pure LGG tissue such as spectroscopic PpIX quantification fluorescence lifetime imaging of PpIX and confocal microscopy to optimize surgery.
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Affiliation(s)
- Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Julia Freund
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - David Reichert
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Vienna, Austria
| | - Lisa Wadiura
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Mikael T Erkkilae
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Department of Neurology, Institute for Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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Zhao X, Sun Y, Sun X, Li J, Shi X, Liang Z, Ma Y, Zhang X. AEG-1 Knockdown Sensitizes Glioma Cells to Radiation Through Impairing Homologous Recombination Via Targeting RFC5. DNA Cell Biol 2021; 40:895-905. [PMID: 34042508 DOI: 10.1089/dna.2020.6287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Radiotherapy is the most important adjuvant treatment for glioma; however, radioresistance is the major cause for inevitable recurrence and poor survival of glioma patients. Thus, this study aims to investigate the effect of astrocyte elevated gene-1 (AEG-1) on the radiosensitivity of glioma cells. Immunohistochemistry assay found that AEG-1 was generally overexpressed in glioma tissues and was correlated with poor clinicopathological features of glioma patients. AEG-1 knockdown inhibited proliferation of glioma cells. And γ-H2AX foci assay, colony formation assay, and flow cytometry analysis demonstrated that AEG-1 depletion enhanced radiosensitivity and promoted apoptosis as well as cell cycle arrest in G2 phase of glioma cells treated by ionizing radiation. Moreover, replication factor C5 (RFC5) was screened as the target of AEG-1 by using Affymetrix human gene expression array, and RFC5 expression was downregulated in AEG-1 knockdown glioma cells. Mechanistically, AEG-1 knockdown impaired homologous recombination repair activity induced by radiation through inhibiting RFC5 expression. Furthermore, the Kaplan-Meier analysis and multivariate Cox regression analysis indicated that high levels of AEG-1 and RFC5 were related to poor prognosis of glioma patients treated with radiotherapy. Taken together, our findings indicate that AEG-1 may serve as a reliable radiosensitizing target for glioma radiotherapy.
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Affiliation(s)
- Xu Zhao
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuchen Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xuanzi Sun
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Li
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaobo Shi
- Department of Radiation Oncology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhinan Liang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yuan Ma
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xiaozhi Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Rossi M, Gay L, Ambrogi F, Conti Nibali M, Sciortino T, Puglisi G, Leonetti A, Mocellini C, Caroli M, Cordera S, Simonelli M, Pessina F, Navarria P, Pace A, Soffietti R, Rudà R, Riva M, Bello L. Association of supratotal resection with progression-free survival, malignant transformation, and overall survival in lower-grade gliomas. Neuro Oncol 2021; 23:812-826. [PMID: 33049063 DOI: 10.1093/neuonc/noaa225] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Supratotal resection is advocated in lower-grade gliomas (LGGs) based on theoretical advantages but with limited verification of functional risk and data on oncological outcomes. We assessed the association of supratotal resection in molecularly defined LGGs with oncological outcomes. METHODS Included were 460 presumptive LGGs; 404 resected; 347 were LGGs, 319 isocitrate dehydrogenase (IDH)-mutated, 28 wildtype. All patients had clinical, imaging, and molecular data. Resection aimed at supratotal resection without any patient or tumor a priori selection. The association of extent of resection (EOR), categorized on volumetric fluid attenuated inversion recovery images as residual tumor volume, along with postsurgical management with progression-free survival (PFS), malignant (M)PFS, and overall survival (OS) assessed by univariate, multivariate, and propensity score analysis. The study mainly focused on IDH-mutated LGGs, the "typical LGGs." RESULTS Median follow-up was 6.8 years (interquartile range, 5-8). Out of 319 IDH-mutated LGGs, 190 (59.6%) progressed, median PFS: 4.7 years (95% CI: 4-5.3). Total and supratotal resection obtained in 39% and 35% of patients with IDH1-mutated tumors. In IDH-mutated tumors, most patients in the partial/subtotal group progressed, 82.4% in total, only 6 (5.4%) in supratotal. Median PFS was 29 months (95% CI: 25-36) in subtotal, 46 months (95% CI: 38-48) in total, while at 92 months, PFS in supratotal was 94.0%. There was no association with molecular subtypes and grade. At random forest analysis, PFS strongly associated with EOR, radiotherapy, and previous treatment. In the propensity score analysis, EOR associated with PFS (hazard ratio, 0.03; 95% CI: 0.01-0.13). MPFS occurred in 32.1% of subtotal total groups; 1 event in supratotal. EOR, grade III, previous treatment correlated to MPFS. At random forest analysis, OS associated with EOR as well. CONCLUSIONS Supratotal resection strongly associated with PFS, MPFS, and OS in LGGs, regardless of molecular subtypes and grade, right from the beginning of clinical presentation.
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Affiliation(s)
- Marco Rossi
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Lorenzo Gay
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Federico Ambrogi
- Laboratory of Medical Statistics, Biometry and Epidemiology "G.A.Maccararo," Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Marco Conti Nibali
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Tommaso Sciortino
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Guglielmo Puglisi
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Antonella Leonetti
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Cristina Mocellini
- Neuro-oncologia, Divisione di Neurologia, Ospedale Santa Croce e Carle, Cuneo, Italy
| | - Manuela Caroli
- Neurochirurgia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
| | - Susanna Cordera
- Neuro-oncologia, Divisione di Neurologia, Ospedale Regionale Parini, Aosta, Italy
| | - Matteo Simonelli
- Humanitas Cancer Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy
| | - Federico Pessina
- Humanitas Cancer Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy
| | - Piera Navarria
- Humanitas Cancer Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy
| | - Andrea Pace
- Neuro-Oncologia, Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - Riccardo Soffietti
- Neuro-Oncologia, Città della Salute e della Scienza, Università di Torino, Torino, Italy
| | - Roberta Rudà
- Neuro-Oncologia, Città della Salute e della Scienza, Università di Torino, Torino, Italy
| | - Marco Riva
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
| | - Lorenzo Bello
- Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.,IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
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Motomura K, Chalise L, Ohka F, Aoki K, Tanahashi K, Hirano M, Nishikawa T, Yamaguchi J, Shimizu H, Wakabayashi T, Saito R. Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping. J Neurooncol 2021; 153:361-372. [PMID: 34009509 DOI: 10.1007/s11060-021-03776-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with grade II and III gliomas (GII/III-gliomas) who underwent awake brain mapping. METHODS We retrospectively analyzed 126 patients with GII/III-gliomas in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020. RESULTS EOR cut-off values for improved progression-free survival (PFS) were determined by a receiver operator characteristic (ROC) analysis of 5-year PFS. The ROC for EOR showed a cut-off value of ≥ 85.3%. The median PFS rate of patients with GII/III-gliomas in the group with an EOR ≥ 100%, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 90% (n = 52; MS, 43.1 months; 95% CI 37.7-48.5 months; p = 0.03). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR ≥ 100%, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI 19.9-51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI 22.3-59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. CONCLUSIONS The present study demonstrates a significant association between tumor EOR and survival in patients with GII/III gliomas. The EOR cut-off value for 5-year PFS was ≥ 85.3%. It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.
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Affiliation(s)
- Kazuya Motomura
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Lushun Chalise
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kosuke Aoki
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masaki Hirano
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomohide Nishikawa
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Junya Yamaguchi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Shimizu
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Microsurgical resection of fronto-temporo-insular gliomas in the non-dominant hemisphere, under general anesthesia using adjunct intraoperative MRI and no cortical and subcortical mapping: a series of 20 consecutive patients. Sci Rep 2021; 11:6994. [PMID: 33772073 PMCID: PMC7997967 DOI: 10.1038/s41598-021-86165-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/23/2021] [Indexed: 12/18/2022] Open
Abstract
Fronto-temporo-insular (FTI) gliomas continue to represent a surgical challenge despite numerous technical advances. Some authors advocate for surgery in awake condition even for non-dominant hemisphere FTI, due to risk of sociocognitive impairment. Here, we report outcomes in a series of patients operated using intraoperative magnetic resonance imaging (IoMRI) guided surgery under general anesthesia, using no cortical or subcortical mapping. We evaluated the extent of resection, functional and neuropsychological outcomes after IoMRI guided surgery under general anesthesia of FTI gliomas located in the non-dominant hemisphere. Twenty patients underwent FTI glioma resection using IoMRI in asleep condition. Seventeen tumors were de novo, three were recurrences. Tumor WHO grades were II:12, III:4, IV:4. Patients were evaluated before and after microsurgical resection, clinically, neuropsychologically (i.e., social cognition) and by volumetric MR measures (T1G+ for enhancing tumors, FLAIR for non-enhancing). Fourteen (70%) patients benefited from a second IoMRI. The median age was 33.5 years (range 24–56). Seizure was the inaugural symptom in 71% of patients. The median preoperative volume was 64.5 cm3 (min 9.9, max 211). Fourteen (70%) patients underwent two IoMRI. The final median EOR was 92% (range 69–100). The median postoperative residual tumor volume (RTV) was 4.3 cm3 (range 0–38.2). A vast majority of residual tumors were located in the posterior part of the insula. Early postoperative clinical events (during hospital stay) were three transient left hemiparesis (which lasted less than 48 h) and one prolonged left brachio-facial hemiparesis. Sixty percent of patients were free of any symptom at discharge. The median Karnofsky Performance Score was of 90 both at discharge and at 3 months. No significant neuropsychological impairment was reported, excepting empathy distinction in less than 40% of patients. After surgery, 45% of patients could go back to work. In our experience and using IoMRI as an adjunct, microsurgical resection of non-dominant FTI gliomas under general anesthesia is safe. Final median EOR was 92%, with a vast majority of residual tumors located in the posterior insular part. Patients experienced minor neurological and neuropsychological morbidity. Moreover, neuropsychological evaluation reported a high preservation of sociocognitive abilities. Solely empathy seemed to be impaired in some patients.
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Low-Grade Glioma Case Series: Lessons Learned from an Evolving 10-Year Single-Institution Multidisciplinary Team Practice. World Neurosurg 2021; 151:e47-e57. [PMID: 33781942 DOI: 10.1016/j.wneu.2021.03.101] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/20/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low-grade gliomas are a heterogeneous group with significant changes in their management during the last decade. OBJECTIVE To assess how our multidisciplinary team approach to the management of low-grade glioma has evolved over the past 10 years and its implications for outcomes. METHODS Retrospective single-center cohort study of adult patients with a pathologically confirmed diagnosis of World Health Organization grade II glioma between 2009 and 2018. Demographic, clinical, and pathologic data were collected. RESULTS Ninety-five patients were included. There was a statistically significant difference in the surgical approach, with more patients having gross total resection (45.7% vs. 18.4%) and fewer patients having a biopsy (21.8% vs. 49.0%) (P = 0.002) after 2014. There was a significantly better overall survival after 2014 (<2014, 16.3%; ≥2014, 0 deaths; P = 0.010) measured at the mean time of follow-up. The use of adjuvant chemotherapy (P = 0.045) and radiotherapy (P = 0.001) significantly decreased after 2014. A subgroup analysis showed that the impact of extent of surgical resection was the greatest for survival in the 1p19q noncodeleted tumors (P = 0.029) and for seizure outcomes in the 1p19q codeleted group (P = 0.018). There was no statistically significant increase in neurologic disability with more radical surgery, incorporating intraoperative neuromonitoring, as measured by modified Rankin Scale score (P > 0.05). CONCLUSIONS More radical surgery was associated with increased survival, less need for postoperative adjuvant therapy and better seizure control, without significant morbidity. Molecular markers are useful tools for stratification of benefits after such surgery.
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Redjal N, Venteicher AS, Dang D, Sloan A, Kessler RA, Baron RR, Hadjipanayis CG, Chen CC, Ziu M, Olson JJ, Nahed BV. Guidelines in the management of CNS tumors. J Neurooncol 2021; 151:345-359. [PMID: 33611702 DOI: 10.1007/s11060-020-03530-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Evidence-based, clinical practice guidelines in the management of central nervous system tumors (CNS) continue to be developed and updated through the work of the Joint Section on Tumors of the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS). METHODS The guidelines are created using the most current and clinically relevant evidence using systematic methodologies, which classify available data and provide recommendations for clinical practice. CONCLUSION This update summarizes the Tumor Section Guidelines developed over the last five years for non-functioning pituitary adenomas, low grade gliomas, vestibular schwannomas, and metastatic brain tumors.
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Affiliation(s)
- Navid Redjal
- Department of Neurosurgery, Capital Institute for Neurosciences, Two Capital Way, Pennington, NJ, 08534, USA.
| | - Andrew S Venteicher
- Center for Pituitary and Skull Base Surgery, Department of Neurosurgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Danielle Dang
- Inova Neuroscience and Spine Institute, 3300 Gallows Rd, Falls Church, VA, 22042, USA
| | - Andrew Sloan
- Department of Neurosurgery, Case Western Reserve University, Cleveland, OH, USA
| | - Remi A Kessler
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rebecca R Baron
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Clark C Chen
- Center for Pituitary and Skull Base Surgery, Department of Neurosurgery, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Mateo Ziu
- Inova Neuroscience and Spine Institute, 3300 Gallows Rd, Falls Church, VA, 22042, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University, Atlanta, GA, USA
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
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Rogers CM, Jones PS, Weinberg JS. Intraoperative MRI for Brain Tumors. J Neurooncol 2021; 151:479-490. [PMID: 33611714 DOI: 10.1007/s11060-020-03667-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/23/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The use of intraoperative imaging has been a critical tool in the neurosurgeon's armamentarium and is of particular benefit during tumor surgery. This article summarizes the history of its development, implementation, clinical experience and future directions. METHODS We reviewed the literature focusing on the development and clinical experience with intraoperative MRI. Utilizing the authors' personal experience as well as evidence from the literature, we present an overview of the utility of MRI during neurosurgery. RESULTS In the 1990s, the first description of using a low field MRI in the operating room was published describing the additional benefit provided by improved resolution of MRI as compared to ultrasound. Since then, implementation has varied in magnetic field strength and in configuration from floor mounted to ceiling mounted units as well as those that are accessible to the operating room for use during surgery and via an outpatient entrance to use for diagnostic imaging. The experience shows utility of this technique for increasing extent of resection for low and high grade tumors as well as preventing injury to important structures while incorporating techniques such as intraoperative monitoring. CONCLUSION This article reviews the history of intraoperative MRI and presents a review of the literature revealing the successful implementation of this technology and benefits noted for the patient and the surgeon.
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Affiliation(s)
- Cara Marie Rogers
- Department of Neurosurgery, Virginia Tech Carilion, Roanoke, VA, USA
| | - Pamela S Jones
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Stålnacke M, Bergenheim T, Sjöberg RL. Neuropsychological Function and Quality of Life after Resection of Suspected Lower-Grade Glioma in the Face Primary Motor Area. J Clin Med 2021; 10:jcm10040580. [PMID: 33557128 PMCID: PMC7913783 DOI: 10.3390/jcm10040580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
The negative side effects of neurosurgical resection of the lower third of the primary motor cortex (M1) are often described as relatively mild. However, detailed descriptions of how these resections affect neurocognitive function, speech, mental health and quality of life (QoL) are sparse. In the present study, seven patients with suspected lower-grade glioma (WHO II-III) in the inferior M1 were assessed for facial motor function, cognitive function, anxiety and QoL before and after awake surgical resections. The main finding was that after surgery, six of the seven patients experienced a mild facial motor dysfunction, mainly affecting the mouth, tongue and throat. At the group level, we were also able to observe a significant postoperative decline in maximum verbal speed, whereas no negative effects on measures of word production (i.e., verbal fluency) were seen. Self-reported QoL data suggest that some patients experienced increased social isolation postoperatively but do not lend support to the interpretation that this was caused by direct neurological side effects of the surgery. The results appear to support the general notion that awake surgery in the lower M1 can be performed safely and with postoperative deficits that are most often perceived by the patient as tolerable.
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Motomura K, Chalise L, Shimizu H, Yamaguchi J, Nishikawa T, Ohka F, Aoki K, Tanahashi K, Hirano M, Wakabayashi T, Natsume A. Intraoperative seizure outcome of levetiracetam combined with perampanel therapy in patients with glioma undergoing awake brain surgery. J Neurosurg 2021; 135:998-1007. [PMID: 33482638 DOI: 10.3171/2020.8.jns201400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of levetiracetam (LEV) combined with perampanel (PER) therapy for intraoperative seizure treatment to determine whether a combination of LEV and PER can aid in the prevention of intraoperative intractable seizures during awake surgery. METHODS The authors performed a retrospective cohort study in 78 consecutive patients with glioma who underwent awake surgery using intraoperative direct electrical stimulation mapping. To prevent intraoperative seizures, 50 patients were treated with the antiepileptic drug LEV only (LEV group) from January 2017 to January 2019, while the remaining 28 patients were treated with LEV plus PER (LEV + PER group) between March 2019 and January 2020. LEV (1000-3000 mg) and/or PER (2-4 mg) were administered before the surgery. RESULTS Preoperative seizures with International League Against Epilepsy (ILAE) class II-VI occurred in 44% of the patients in the LEV group and in 35.7% of patients in the LEV + PER group, with no significant difference between groups (p = 0.319). Total intraoperative seizures occurred in 18 patients (36.0%) in the LEV therapy group and in 2 patients (7.1%) in the LEV + PER group (p = 0.009). Of these, there were no patients (0%) with intractable seizures in the LEV + PER group. Regarding factors that influence intraoperative seizures in glioma patients during awake brain surgery, multivariate logistic regression models revealed that the occurrence of intraoperative seizures was significantly related to the involvement of motor-related regions (positive vs negative, HR 6.98, 95% CI 1.71-28.56, p = 0.007), preoperative seizure (ILAE class II-VI vs ILAE class I, HR 4.44, 95% CI 1.22-16.11, p = 0.024), and LEV + PER group (positive vs negative, HR 0.07, 95% CI 0.01-0.44, p = 0.005). Treatment-related adverse effects were rare and mild, including sleepiness, tiredness, and dizziness in both treatment groups. CONCLUSIONS This study demonstrates that LEV + PER therapy is significantly associated with a lower risk of intraoperative seizures compared with LEV therapy alone in patients with glioma during awake brain mapping. These findings will help neurosurgeons conduct safe and reliable awake surgeries and reduce the rate of intraoperative intractable seizures during such procedures.
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Watson J, Romagna A, Ballhausen H, Niyazi M, Lietke S, Siller S, Belka C, Thon N, Nachbichler SB. Long-term outcome of stereotactic brachytherapy with temporary Iodine-125 seeds in patients with WHO grade II gliomas. Radiat Oncol 2020; 15:275. [PMID: 33298103 PMCID: PMC7724805 DOI: 10.1186/s13014-020-01719-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This long-term retrospective analysis aimed to investigate the outcome and toxicity profile of stereotactic brachytherapy (SBT) in selected low-grade gliomas WHO grade II (LGGII) in a large patient series. METHODS This analysis comprised 106 consecutive patients who received SBT with temporary Iodine-125 seeds for histologically verified LGGII at the University of Munich between March 1997 and July 2011. Investigation included clinical characteristics, technical aspects of SBT, the application of other treatments, outcome analyses including malignization rates, and prognostic factors with special focus on molecular biomarkers. RESULTS For the entire study population, the 5- and 10-years overall survival (OS) rates were 79% and 62%, respectively, with a median follow-up of 115.9 months. No prognostic factors could be identified. Interstitial radiotherapy was applied in 51 cases as first-line treatment with a median number of two seeds (range 1-5), and a median total implanted activity of 21.8 mCi (range 4.2-43.4). The reference dose average was 54.0 Gy. Five- and ten-years OS and progression-free survival rates after SBT were 72% and 43%, and 40% and 23%, respectively, with a median follow-up of 86.7 months. The procedure-related mortality rate was zero, although an overall complication rate of 16% was registered. Patients with complications had a significantly larger tumor volume (p = 0.029). CONCLUSION SBT is a minimally invasive treatment modality with a favorable outcome and toxicity profile. It is both an alternative primary treatment method as well as an adjunct to open tumor resection in selected low-grade gliomas.
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Affiliation(s)
- Juliana Watson
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Alexander Romagna
- Department of Neurosurgery, München Klinik Bogenhausen, Munich, Germany
- Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Hendrik Ballhausen
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Lietke
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Siller
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Silke Birgit Nachbichler
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Obara T, Blonski M, Brzenczek C, Mézières S, Gaudeau Y, Pouget C, Gauchotte G, Verger A, Vogin G, Moureaux JM, Duffau H, Rech F, Taillandier L. Adult Diffuse Low-Grade Gliomas: 35-Year Experience at the Nancy France Neurooncology Unit. Front Oncol 2020; 10:574679. [PMID: 33194684 PMCID: PMC7656991 DOI: 10.3389/fonc.2020.574679] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/20/2020] [Indexed: 01/14/2023] Open
Abstract
Background To report survival, spontaneous prognostic factors, and treatment efficacy in a French monocentric cohort of diffuse low-grade glioma (DLGG) patients over 35 years of follow-up. Methods A monocentric retrospective study of 339 patients diagnosed with a new DLGG between 01/01/1982 and 01/01/2017 was created. Inclusion criteria were patient age ≥18 years at diagnosis and histological diagnosis of WHO grade II glioma (according to 1993, 2007, and 2016 WHO classifications). The survival parameters were estimated using the Kaplan-Meier method with a 95% confidence interval. Differences in survival were tested for statistical significance by the log-rank test. Factors were considered significant when p ≤ 0.1 and p ≤ 0.05 in the univariate and multivariate analyses, respectively. Results A total of 339 patients were included with a median follow-up of 8.7 years. The Kaplan-Meier median overall survival was 15.7 years. At the time of radiological diagnosis, Karnofsky Performance Status score and initial tumor volume were significant independent prognostic factors. Oncological prognostic factors were the extent of resection for patients who underwent surgery and the timing of radiotherapy for those concerned. In this study, patients who had delayed radiotherapy (provided remaining low grade) did not have worse survival compared with patients who had early radiotherapy. The functional capabilities of the patients were preserved enough so that they could remain independent during at least three quarters of the follow-up. Conclusion This large monocentric series spread over a long time clarifies the effects of different therapeutic strategies and their combination in the management of DLGG.
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Affiliation(s)
- Tiphaine Obara
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France.,Neurology Departement, Neurooncology Unit, CHRU, Nancy, France
| | - Marie Blonski
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France.,Neurology Departement, Neurooncology Unit, CHRU, Nancy, France
| | - Cyril Brzenczek
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Sophie Mézières
- Department of Mathematics, Elie Cartan Institute, Nancy, France.,INRIA Biology, Genetics and Statistics, Nancy, France
| | - Yann Gaudeau
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Celso Pouget
- Department of Pathology, CHRU, Nancy, France.,Centre de Ressources Biologiques, BB-0033-00035, CHRU Nancy, France
| | - Guillaume Gauchotte
- Department of Pathology, CHRU, Nancy, France.,Centre de Ressources Biologiques, BB-0033-00035, CHRU Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, France.,IADI, INSERM U1254, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Guillaume Vogin
- UMR 7365 CNRS, IMoPA Biopole Lorraine University Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France.,Department of Radiation Therapy, Baclese Radiation Therapy Centre, Esch/Alzette, Luxembourg
| | - Jean-Marie Moureaux
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Hugues Duffau
- Department of Neurosurgery, Montpellier University Medical Center, Gui de Chauliac Hospital, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", U1051 Laboratory, National Institute for Health and Medical Research (INSERM), Institute for Neurosciences of Montpellier, Montpellier University Medical Center, Montpellier, France
| | - Fabien Rech
- Department of Neurosurgery, CHRU, Nancy, France
| | - Luc Taillandier
- Centre de Recherche en Automatique Nancy France - UMR 7039 - BioSiS Department, Faculty of Medicine, Université de Lorraine, Vandoeuvre-lès-Nancy, France.,Neurology Departement, Neurooncology Unit, CHRU, Nancy, France
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Li G, Wu F, Zeng F, Zhai Y, Feng Y, Chang Y, Wang D, Jiang T, Zhang W. A novel DNA repair-related nomogram predicts survival in low-grade gliomas. CNS Neurosci Ther 2020; 27:186-195. [PMID: 33063446 PMCID: PMC7816205 DOI: 10.1111/cns.13464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/20/2020] [Accepted: 09/26/2020] [Indexed: 12/17/2022] Open
Abstract
Aims We aimed to create a tumor recurrent‐based prediction model to predict recurrence and survival in patients with low‐grade glioma. Methods This study enrolled 291 patients (188 in the training group and 103 in the validation group) with clinicopathological information and transcriptome sequencing data. LASSO‐COX algorithm was applied to shrink predictive factor size and build a predictive recurrent signature. GO, KEGG, and GSVA analyses were performed for function annotations of the recurrent signature. The calibration curves and C‐Index were assessed to evaluate the nomogram's performance. Results This study found that DNA repair functions of tumor cells were significantly enriched in recurrent low‐grade gliomas. A predictive recurrent signature, built by the LASSO‐COX algorithm, was significantly associated with overall survival and progression‐free survival in low‐grade gliomas. Moreover, function annotations analysis of the predictive recurrent signature exhibited that the signature was associated with DNA repair functions. The nomogram, combining the predictive recurrent signature and clinical prognostic predictors, showed powerful prognostic ability in the training and validation groups. Conclusion An individualized prediction model was created to predict 1‐, 2‐, 3‐, 5‐, and 10‐year survival and recurrent rate of patients with low‐grade glioma, which may serve as a potential tool to guide postoperative individualized care.
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Affiliation(s)
- Guanzhang Li
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Fan Wu
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Fan Zeng
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - You Zhai
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuemei Feng
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yuanhao Chang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Di Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tao Jiang
- Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA), Asian Glioma Genome Atlas Network (AGGA)
| | - Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Chinese Glioma Genome Atlas Network (CGGA), Asian Glioma Genome Atlas Network (AGGA)
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40
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Vetrano IG, Broggi M, Acerbi F. Commentary: Symptomatic Primary Tethered Optic Chiasm: Technical Case Report. Oper Neurosurg (Hagerstown) 2020; 19:E446-E447. [PMID: 32442271 DOI: 10.1093/ons/opaa146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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41
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Wu A. Overview of Modern Surgical Management of Central Nervous System Tumors: North American Experience. CURRENT CANCER THERAPY REVIEWS 2020. [DOI: 10.2174/1573394715666190212112842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A wide variety of neoplasms can affect the central nervous system. Surgical management
is impacted by tumor biology and anatomic location. In this review, an overview is presented
of common and clinically significant CNS tumor types based on anatomic location.
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Affiliation(s)
- Adam Wu
- University of Saskatchewan, Saskatoon, Saskatchewan, SK, Canada
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42
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Grant R, Dowswell T, Tomlinson E, Brennan PM, Walter FM, Ben-Shlomo Y, Hunt DW, Bulbeck H, Kernohan A, Robinson T, Lawrie TA. Interventions to reduce the time to diagnosis of brain tumours. Cochrane Database Syst Rev 2020; 9:CD013564. [PMID: 32901926 PMCID: PMC8082957 DOI: 10.1002/14651858.cd013564.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.
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Affiliation(s)
- Robin Grant
- Edinburgh Centre for Neuro-Oncology (ECNO), Western General Hospital, Edinburgh, UK
| | - Therese Dowswell
- C/o Cochrane Pregnancy and Childbirth Group, Department of Women's and Children's Health, The University of Liverpool, Liverpool, UK
| | - Eve Tomlinson
- Cochrane Gynaecological, Neuro-oncology and Orphan Cancers, 1st Floor Education Centre, Royal United Hospital, Bath, UK
| | - Paul M Brennan
- Translational Neurosurgery Department, Western General Hospital, Edinburgh, UK
| | - Fiona M Walter
- Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Yoav Ben-Shlomo
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - David William Hunt
- Foundation School/Dept of Clinical and Experimental Medicine, Royal Surrey County Hospital/University of Surrey, Guildford, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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43
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Heiland DH, Ohle R, Cipriani D, Franco P, Delev D, Behriger SP, Kellner E, Petrova G, Neidert N, Mader I, Nuñez MF, Urbach H, Sankowski R, Beck J, Schnell O. Characterization of longitudinal transformation of T2-hyperintensity in oligodendroglioma. BMC Cancer 2020; 20:818. [PMID: 32854646 PMCID: PMC7450792 DOI: 10.1186/s12885-020-07290-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Oligodendroglioma (ODG) are CNS resistant tumors characterized by their unique molecular signature, namely a combined deletion of 1p and 19q simultaneously to an IDH1/2 mutation. These tumors have a more favorable clinical outcome compared to other gliomas and a long-time survival that ranges between 10 and 20 years. However, during the course of the disease, multiple recurrences occur and the optimal treatment at each stage of the disease remains unclear. Here we report a retrospective longitudinal observation study of 836 MRI examinations in 44 ODG patients. METHODS We quantified the volume of T2-hyperintensity to compute growth behavior in dependence of different treatment modalities, using various computational models. RESULTS The identified growth pattern revealed dynamic changes, which were found to be patient-specific an did not correlate with clinical parameter or therapeutic interventions. Further, we showed that, surgical resection is beneficial for overall survival regardless the WHO grad or timepoint of surgery. To improve overall survival, an extent of resection above 50% is required. Multiple resections do not generally improve overall survival, except a greater extent of resection than in previous surgeries was achieved. CONCLUSIONS Our data aids to improve the interpretation of MRI images in clinical practice.
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Affiliation(s)
- Dieter H Heiland
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany. .,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany. .,Medical Faculty, Freiburg University, Freiburg, Germany.
| | - Robin Ohle
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Debora Cipriani
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Pamela Franco
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Daniel Delev
- Department of Neurosurgery, University of Aachen, Aachen, Germany
| | - Simon P Behriger
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Gergana Petrova
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Nicolas Neidert
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Irina Mader
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik, Vogtareuth, Germany
| | - Mateo Fariña Nuñez
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Horst Urbach
- Medical Faculty, Freiburg University, Freiburg, Germany.,Department of Neuroradiology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Roman Sankowski
- Medical Faculty, Freiburg University, Freiburg, Germany.,Institute of Neuropathology, Medical Center - University of Freiburg, Freiburg, Germany.,Berta-Ottenstein-Programme for Clinician Scientists Medical Center, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
| | - Oliver Schnell
- Translational NeuroOncology Research Group, Medical Center, University of Freiburg, Freiburg, Germany.,Department of Neurosurgery, Medical Center, University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.,Medical Faculty, Freiburg University, Freiburg, Germany
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Scherer M, Ahmeti H, Roder C, Gessler F, Jungk C, Pala A, Mayer B, Senft C, Tatagiba M, Synowitz M, Wirtz CR, Unterberg AW, Coburger J. Surgery for Diffuse WHO Grade II Gliomas: Volumetric Analysis of a Multicenter Retrospective Cohort From the German Study Group for Intraoperative Magnetic Resonance Imaging. Neurosurgery 2020; 86:E64-E74. [PMID: 31574147 DOI: 10.1093/neuros/nyz397] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/18/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In diffuse WHO grade II gliomas (LGG), the extent of resection (EOR) required to achieve significant survival benefits remains elusive. OBJECTIVE To evaluate the association of residual volume (RV) and EOR with progression-free survival (PFS) or overall survival (OS) in LGG in a retrospective, multicenter series by the German study group of intraoperative MRI (GeSGIM). METHODS Consecutive cases were retrospectively assessed from 5 centers. Tumors were volumetrically quantified before and after surgery, and clinical data were analyzed, including IDH mutations and neurologic deficits. Kaplan-Meier estimates, accelerated failure time models (AFT), and multivariate Cox regression models were calculated to identify determinants of survival. RESULTS A total of 140 cases were analyzed. Gross total resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (P = .009). A significant survival disadvantage was evident even for small (>0-5 ml) residuals and increased for moderate (>5-20 ml) and large remnants (>20 ml) P = .001). Accordingly, PFS increased continuously for 20% incremental steps of EOR (P < .001). AFT models supported the notion of a continuous association of RV and EOR with PFS. Multivariate Cox regression models confirmed RV (P = .01) and EOR (P = .005) as continuous prognosticators of PFS. Univariate analysis showed significant associations of RV and EOR with OS. CONCLUSION Our data support the hypothesis of a continuous relationship of RV and EOR with survival for LGG with superiority seen for GTR. Hence, GTR should be achieved whenever safely feasible, and resections should be maximized whenever tumor has to be left behind to spare function.
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Affiliation(s)
- Moritz Scherer
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Hajrulla Ahmeti
- Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
| | - Constantin Roder
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Florian Gessler
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Christine Jungk
- Department of Neurosurgery, University of Heidelberg, Heidelberg, Germany
| | - Andrej Pala
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Christian Senft
- Department of Neurosurgery, University of Frankfurt, Frankfurt, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Michael Synowitz
- Department of Neurosurgery, University of Schleswig-Holstein, Kiel, Germany
| | | | | | - Jan Coburger
- Department of Neurosurgery, University of Ulm, Günzburg, Germany
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Young JS, Gogos AJ, Morshed RA, Hervey-Jumper SL, Berger MS. Molecular characteristics of diffuse lower grade gliomas: what neurosurgeons need to know. Acta Neurochir (Wien) 2020; 162:1929-1939. [PMID: 32472378 DOI: 10.1007/s00701-020-04426-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/21/2020] [Indexed: 01/03/2023]
Abstract
The importance of genomic information in intrinsic brain tumors is highlighted in the World Health Organization (WHO) 2016 classification of gliomas, which now incorporates both phenotype and genotype data to assign a diagnosis. By using genetic markers to both categorize tumors and advise patients on prognosis, this classification system has minimized the risk of tissue sampling error, improved diagnostic accuracy, and reduced inter-rater variability. In the neurosurgical community, it is critical to understand the role genetics plays in tumor biology, what certain mutations mean for the patient's prognosis and adjuvant treatment, and how to interpret the results of sequencing data that are generated following tumor resection. In this review, we examine the critical role of genetics for diagnosis and prognosis and highlight the importance of tumor genetics for neurosurgeons caring for patients with diffuse lower grade gliomas.
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Affiliation(s)
- Jacob S Young
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
| | - Andrew J Gogos
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Ramin A Morshed
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Shawn L Hervey-Jumper
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
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Suarez-Meade P, Marenco-Hillembrand L, Prevatt C, Murguia-Fuentes R, Mohamed A, Alsaeed T, Lehrer EJ, Brigham T, Ruiz-Garcia H, Sabsevitz D, Middlebrooks EH, Bechtle PS, Quinones-Hinojosa A, Chaichana KL. Awake vs. asleep motor mapping for glioma resection: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162:1709-1720. [PMID: 32388682 DOI: 10.1007/s00701-020-04357-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Intraoperative stimulation (IS) mapping has become the preferred standard treatment for eloquent tumors as it permits a more accurate identification of functional areas, allowing surgeons to achieve higher extents of resection (EOR) and decrease postoperative morbidity. For lesions adjacent to the perirolandic area and descending motor tracts, mapping can be done with both awake craniotomy (AC) and under general anesthesia (GA). OBJECTIVE We aimed to determine which anesthetic protocol-AC vs. GA-provides better patient outcomes by comparing EOR and postoperative morbidity for surgeries using IS mapping in gliomas located near or in motor areas of the brain. METHODS A systematic literature search was carried out to identify relevant studies from 1983 to 2019. Seven databases were screened. A total of 2351 glioma patients from 17 studies were analyzed. RESULTS A random-effects meta-analysis revealed a trend towards a higher mean EOR in AC [90.1% (95% C.I. 85.8-93.8)] than with GA [81.7% (95% C.I. 72.4-89.7)] (p = 0.06). Neurological deficits were divided by timing and severity for analysis. There was no significant difference in early neurological deficits [20.9% (95% C.I. 4.1-45.0) vs. 25.4% (95% C.I. 13.6-39.2)] (p = 0.74), late neurological deficits [17.1% (95% C.I. 0.0-50.0) vs. 3.8% (95% C.I. 1.1-7.6)] (p = 0.06), or in non-severe [28.4% (95% C.I. 0.0-88.5) vs. 20.1% (95% C.I. 7.1-32.2)] (p = 0.72), and severe morbidity [2.6% (95% C.I. 0.0-15.5) vs. 4.5% (95% C.I. 1.1-9.6)] (p = 0.89) between patients who underwent AC versus GA, respectively. CONCLUSION Mapping during resection of gliomas located in or near the perirolandic area and descending motor tracts can be safely carried out with both AC and GA.
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Affiliation(s)
- Paola Suarez-Meade
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Lina Marenco-Hillembrand
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Calder Prevatt
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Ricardo Murguia-Fuentes
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Alea Mohamed
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Thannon Alsaeed
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tara Brigham
- Mayo Clinic Libraries, Mayo Clinic, Jacksonville, FL, USA
| | - Henry Ruiz-Garcia
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - David Sabsevitz
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Perry S Bechtle
- Anesthesiology Department, Mayo Clinic, Jacksonville, FL, USA
| | | | - Kaisorn L Chaichana
- Department of Neurological Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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Verburg N, de Witt Hamer PC. State-of-the-art imaging for glioma surgery. Neurosurg Rev 2020; 44:1331-1343. [PMID: 32607869 PMCID: PMC8121714 DOI: 10.1007/s10143-020-01337-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 11/29/2022]
Abstract
Diffuse gliomas are infiltrative primary brain tumors with a poor prognosis despite multimodal treatment. Maximum safe resection is recommended whenever feasible. The extent of resection (EOR) is positively correlated with survival. Identification of glioma tissue during surgery is difficult due to its diffuse nature. Therefore, glioma resection is imaging-guided, making the choice for imaging technique an important aspect of glioma surgery. The current standard for resection guidance in non-enhancing gliomas is T2 weighted or T2w-fluid attenuation inversion recovery magnetic resonance imaging (MRI), and in enhancing gliomas T1-weighted MRI with a gadolinium-based contrast agent. Other MRI sequences, like magnetic resonance spectroscopy, imaging modalities, such as positron emission tomography, as well as intraoperative imaging techniques, including the use of fluorescence, are also available for the guidance of glioma resection. The neurosurgeon’s goal is to find the balance between maximizing the EOR and preserving brain functions since surgery-induced neurological deficits result in lower quality of life and shortened survival. This requires localization of important brain functions and white matter tracts to aid the pre-operative planning and surgical decision-making. Visualization of brain functions and white matter tracts is possible with functional MRI, diffusion tensor imaging, magnetoencephalography, and navigated transcranial magnetic stimulation. In this review, we discuss the current available imaging techniques for the guidance of glioma resection and the localization of brain functions and white matter tracts.
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Affiliation(s)
- Niels Verburg
- Department of Neurosurgery and Cancer Center Amsterdam, Amsterdam UMC location VU University Medical Center, Amsterdam, The Netherlands. .,Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Brain Tumor Imaging Laboratory, University of Cambridge, Addenbrooke's Hospital, Hill Rd, Cambridge, CB2 0QQ, UK.
| | - Philip C de Witt Hamer
- Department of Neurosurgery and Cancer Center Amsterdam, Amsterdam UMC location VU University Medical Center, Amsterdam, The Netherlands
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Shee K, Chambers M, Hughes EG, Almiron DA, Deharvengt SJ, Green D, Lefferts JA, Andrew AS, Hickey WF, Tsongalis GJ. Molecular genetic profiling reveals novel association between FLT3 mutation and survival in glioma. J Neurooncol 2020; 148:473-480. [PMID: 32583303 DOI: 10.1007/s11060-020-03567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Recent molecular characterization of gliomas has uncovered somatic gene variation and DNA methylation changes that are associated with etiology, prognosis, and therapeutic response. Here we describe genomic profiling of gliomas assessed for associations between genetic mutations and patient outcomes, including overall survival (OS) and recurrence-free survival (RFS). METHODS Mutations in a 50-gene cancer panel, 1p19q co-deletion, and MGMT promoter methylation (MGMT methylation) status were obtained from tumor tissue of 293 glioma patients. Multivariable regression models for overall survival (OS) and recurrence-free survival (RFS) were constructed for MGMT methylation, 1p19q co-deletion, and gene mutations controlling for age, treatment status, and WHO grade. RESULTS Mutational profiles of gliomas significantly differed based on WHO Grade, such as high prevalence of BRAF V600E, IDH1, and PTEN mutations in WHO Grade I, II/III, and IV tumors, respectively. In multivariate regression analysis, MGMT methylation and IDH1 mutations were significantly associated with improved OS (HR = 0.44, p = 0.0004 and HR = 0.21, p = 0.007, respectively), while FLT3 and TP53 mutations were significantly associated with poorer OS (HR = 19.46, p < 0.0001 and HR = 1.67, p = 0.014, respectively). MGMT methylation and IDH1 mutations were the only significant alterations associated with improved RFS in the model (HR = 0.42, p < 0.0001 and HR = 0.37, p = 0.002, respectively). These factors were then included in a combined model, which significantly exceeded the predictive value of the base model alone (age, surgery, radiation, chemo, grade) (likelihood ratio test OS p = 1.64 × 10-8 and RFS p = 3.80 × 10-7). CONCLUSIONS This study highlights the genomic landscape of gliomas in a single-institution cohort and identifies a novel association between FLT3 mutation and OS in gliomas.
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Affiliation(s)
- Kevin Shee
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany.
| | - Meagan Chambers
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany
| | - Edward G Hughes
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 03756, Lebanon, NH, Germany
| | | | - Sophie J Deharvengt
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 03756, Lebanon, NH, Germany
| | - Donald Green
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 03756, Lebanon, NH, Germany
| | - Joel A Lefferts
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 03756, Lebanon, NH, Germany
| | - Angeline S Andrew
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany.,Department of Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, Germany
| | - William F Hickey
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany.,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 03756, Lebanon, NH, Germany
| | - Gregory J Tsongalis
- Geisel School of Medicine At Dartmouth, Hanover, NH, Germany. .,Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, 03756, Lebanon, NH, Germany.
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Kudulaiti N, Qiu T, Lu J, Zhang H, Zhang Z, Guan Y, Zhuang D, Wu J. Combination of Magnetic Resonance Spectroscopy and ¹¹C-Methionine Positron Emission Tomography for the Accurate Diagnosis of Non-Enhancing Supratentorial Glioma. Korean J Radiol 2020; 20:967-975. [PMID: 31132822 PMCID: PMC6536785 DOI: 10.3348/kjr.2018.0690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/28/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate whether the combination of magnetic resonance spectroscopy (MRS) and ¹¹C-methionine positron emission tomography (¹¹C-MET PET) could increase accurate diagnostic sensitivity for non-enhancing supratentorial gliomas. MATERIALS AND METHODS Between February 2012 and December 2017, 109 patients with non-enhanced supratentorial lesions on contrast-enhanced MRI were enrolled. Each patient underwent MRS and ¹¹C-MET PET before treatment. A lesion was considered to be a glioma when either the MRS or ¹¹C-MET PET results reached the diagnostic threshold. The radiological diagnosis was compared with the pathological diagnosis or medical diagnostic criteria. RESULTS The sensitivity and specificity were 60.0% and 50.0% for MRS and 75.8% and 50.0% for ¹¹C-MET PET, respectively. Upon combining the two modalities, the sensitivity and specificity of the imaging-based diagnosis prior to surgery reached 89.5% and 42.9%, respectively. Statistically significant differences in the sensitivities were observed between the combined and individual approaches (MRS alone, 89.5% vs. 60.0%, p < 0.001; ¹¹C-MET PET alone, 89.5% vs. 75.8%, p = 0.001). However, no significant differences in specificity were observed between the combined and individual modalities. CONCLUSION The combination of MRS and ¹¹C-MET PET findings significantly increases accurate diagnostic sensitivity for non-enhancing supratentorial gliomas without significantly lowering the specificity. This finding suggests the potential of the combined MRS and ¹¹C-MET PET approach in clinical applications.
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Affiliation(s)
- Nijiati Kudulaiti
- Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tianming Qiu
- Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junfeng Lu
- Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Huiwei Zhang
- PET Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhengwei Zhang
- PET Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yihui Guan
- PET Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dongxiao Zhuang
- Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jinsong Wu
- Department of Neurologic Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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50
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Latini F, Fahlström M, Hesselager G, Zetterling M, Ryttlefors M. Differences in the preferential location and invasiveness of diffuse low-grade gliomas and their impact on outcome. Cancer Med 2020; 9:5446-5458. [PMID: 32537906 PMCID: PMC7402839 DOI: 10.1002/cam4.3216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Low‐grade gliomas (LGGs) are primary diffuse slow‐growing brain tumors derived from glial cells. The management of these tumors is dependent on their location, which often harbors eloquent areas. We retrospectively recorded the location of diffuse gliomas to identify whether specific differences exist between the histological types. Methods We analyzed 102 patients with previous histological diagnosis of WHO‐II astrocytomas (62) and WHO‐II oligodendrogliomas (40) according to WHO‐2016 classification. MRI sequences (T2‐FLAIR) were used for tumor volume segmentation and to create a frequency map of their locations within the Montreal Neurological Institute (MNI) space. The Brain‐Grid (BG) system (standardized radiological tool of intersected lines according to anatomical landmarks) was created and merged with a tractography atlas for infiltration analysis. Results Astrocytomas frequently infiltrated association and projection white matter pathways within fronto‐temporo‐insular regions on the left side. Oligodendrogliomas infiltrated larger white matter networks (association‐commissural‐projection) of the frontal lobe bilaterally. A critical number of infiltrated BG voxels (7 for astrocytomas, 10 for oligodendrogliomas) significantly predicted shorter overall survival (OS) in both groups. Bilateral tumor extension in astrocytomas and preoperative tumor volume in oligodendrogliomas were independent prognostic factors for shorter OS. Conclusions Astrocytomas and oligodendrogliomas differ in preferential location, and this has an impact on the type and the extent of white matter involvement. The number of BG voxels infiltrated reflected different tumor invasiveness and its impact on OS in both groups. All this new information may be valuable in neurosurgical oncology to classify and plan treatment for patients with diffuse gliomas.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Göran Hesselager
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Maria Zetterling
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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