1
|
Bruno F, Pellerino A, Conti Nibali M, Pronello E, Cofano F, Rossi M, Levis M, Bertero L, Soffietti R, Cassoni P, Garbossa D, Bello L, Rudà R. Association of Clinical, Tumor, and Treatment Characteristics With Seizure Control in Patients With IDH1/2-Mutant Lower-Grade Glioma. Neurology 2024; 102:e209352. [PMID: 38684041 DOI: 10.1212/wnl.0000000000209352] [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: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with IDH1/2-mutant lower-grade glioma have a high frequency of seizures. We aimed to investigate the correlations between seizures and tumor/patient characteristics and the impact of surgery and adjuvant treatments (AT) on seizure control along the disease trajectory. METHODS We retrospectively included patients with IDH1/2-mutant lower-grade glioma who underwent surgery at the neurosurgery divisions of the University of Turin and Milan and were treated at the Division of Neuro-Oncology of Turin. Inclusion criteria were a diagnosis according to the 2021 WHO Classification and presentation with seizures; exclusion criteria were presence of CDKN2A/B homozygous deletion, intense/ring contrast enhancement on MRI at presentation, and small tissue biopsy. We evaluated seizure freedom for 2 months after surgery, 6 months from starting observation or AT, at recurrence, and for 6 months after treatments of recurrence. RESULTS We included 150 patients. There were 77 (51%) and 31 (21%) patients with IDH-mutant/1p19q-codeleted grade 2 and 3 oligodendroglioma and 30 (20%) and 12 (8%) with IDH-mutant grade 2 and 3 astrocytoma, respectively. Total resection was accomplished in 68 (45%). Seventy-five patients (50%) received AT while the remaining 75 were observed with MRI. After 6 months after AT, 28 of 29 patients (96.5%) displayed seizure reduction, 5 of 28 (18%) being seizure-free. 66 of 124 patients (53%) had seizures at recurrence. After 6 months after second-line treatments, 60 of 66 patients (91%) had seizure reduction, 11 (17%) being seizure-free. In multivariable analyses, grade 3 histology positively correlated with seizure freedom at 2 months after surgery (OR 3.5, 1.4-8.9, p = 0.008), 6 months after AT (OR 9.0, 1.5-54.9, p = 0.017), and 6 months after treatment of recurrence (OR 4.9, 1.5-16.5, p = 0.009). Adjuvant radiotherapy reduced seizures at recurrence in a univariate analysis (OR 0.14, 0.03-0.7, p = 0.020). Patients with seizure freedom after surgery and AT displayed longer progression-free survival (PFS) (65, 24.5-105, vs 48 months, 32-63.5, p = 0.037). DISCUSSION This study analyzed seizure control in patients with IDH1/2-mutant lower-grade glioma across multiple time points. Grade 3 correlated with better seizure control throughout the entire disease trajectory, and seizure freedom after surgery and AT correlated with a longer PFS regardless of tumor grade. These results could serve as an external control arm in clinical trials evaluating the efficacy on seizures of antitumor agents in patients with IDH-mutant lower-grade glioma.
Collapse
Affiliation(s)
- Francesco Bruno
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Alessia Pellerino
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Marco Conti Nibali
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Edoardo Pronello
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Fabio Cofano
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Marco Rossi
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Mario Levis
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Luca Bertero
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Riccardo Soffietti
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Paola Cassoni
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Diego Garbossa
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Lorenzo Bello
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Roberta Rudà
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| |
Collapse
|
3
|
Rudà R, Angileri FF, Ius T, Silvani A, Sarubbo S, Solari A, Castellano A, Falini A, Pollo B, Del Basso De Caro M, Papagno C, Minniti G, De Paula U, Navarria P, Nicolato A, Salmaggi A, Pace A, Fabi A, Caffo M, Lombardi G, Carapella CM, Spena G, Iacoangeli M, Fontanella M, Germanò AF, Olivi A, Bello L, Esposito V, Skrap M, Soffietti R. Italian consensus and recommendations on diagnosis and treatment of low-grade gliomas. An intersociety (SINch/AINO/SIN) document. J Neurosurg Sci 2020; 64:313-334. [PMID: 32347684 DOI: 10.23736/s0390-5616.20.04982-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In 2018, the SINch (Italian Society of Neurosurgery) Neuro-Oncology Section, AINO (Italian Association of Neuro-Oncology) and SIN (Italian Association of Neurology) Neuro-Oncology Section formed a collaborative Task Force to look at the diagnosis and treatment of low-grade gliomas (LGGs). The Task Force included neurologists, neurosurgeons, neuro-oncologists, pathologists, radiologists, radiation oncologists, medical oncologists, a neuropsychologist and a methodologist. For operational purposes, the Task Force was divided into five Working Groups: diagnosis, surgical treatment, adjuvant treatments, supportive therapies, and follow-up. The resulting guidance document is based on the available evidence and provides recommendations on diagnosis and treatment of LGG patients, considering all aspects of patient care along their disease trajectory.
Collapse
Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Filippo F Angileri
- Section of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, 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
| | - Silvio Sarubbo
- Department of Neurosurgery, Structural and Functional Connectivity Lab Project, "S. Chiara" Hospital, Trento, Italy
| | - Alessandra Solari
- Unit of Neuroepidemiology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonella Castellano
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Falini
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Bianca Pollo
- Section of Oncologic Neuropathology, Division of Neurology V - Neuropathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Costanza Papagno
- Center of Neurocognitive Rehabilitation (CeRiN), Interdepartmental Center of Mind/Brain, University of Trento, Trento, Italy.,Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Minniti
- Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, Policlinico Le Scotte, University of Siena, Siena, Italy
| | - Ugo De Paula
- Unit of Radiotherapy, San Giovanni-Addolorata Hospital, Rome, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy
| | - Antonio Nicolato
- Unit of Stereotaxic Neurosurgery, Department of Neurosciences, Hospital Trust of Verona, Verona, Italy
| | - Andrea Salmaggi
- Neurology Unit, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Andrea Pace
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maria Caffo
- Section of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Lombardi
- Unit of Oncology 1, Department of Oncology, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | | | - Giannantonio Spena
- Neurosurgery Unit, Department of Neurosciences, A. Manzoni Hospital, Lecco, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Marche Polytechnic University, Umberto I General University Hospital, Ancona, Italy
| | - Marco Fontanella
- Division of Neurosurgery, Department of Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Antonino F Germanò
- Section of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Alessandro Olivi
- Neurosurgery Unit, Department of Neurosciences, Università Cattolica del Sacro Cuore, Fondazione Policlinico "A. Gemelli", Rome, Italy
| | - Lorenzo Bello
- Unit of Oncologic Neurosurgery, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Vincenzo Esposito
- Sapienza University, Rome, Italy.,Giampaolo Cantore Department of Neurosurgery, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Miran Skrap
- Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Riccardo Soffietti
- Department of Neuro-Oncology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | | |
Collapse
|