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Wu Y, Walker EV, Yuan Y. Regional Variability in Survival for Patients Diagnosed with Selected Central Nervous System Tumours in Canada. Curr Oncol 2024; 31:3073-3085. [PMID: 38920718 PMCID: PMC11203179 DOI: 10.3390/curroncol31060234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/25/2024] [Accepted: 05/28/2024] [Indexed: 06/27/2024] Open
Abstract
Canada's decentralized healthcare system may lead to regional disparities in survival among Canadians diagnosed with central nervous system (CNS) tumours. We identified 50,670 patients diagnosed with a first-ever primary CNS tumour between 2008 and 2017 with follow-up until 31 December 2017. We selected the four highest incidence histologies and used proportional hazard regression to estimate hazard ratios (HRs) for five regions (British Columbia, Prairie Provinces, Ontario, Atlantic Provinces and the Territories), adjusting for sex, tumour behaviour and patient age. Ontario had the best survival profile for all histologies investigated. The Atlantic Provinces had the highest HR for glioblastoma (HR = 1.26, 95% CI: 1.18-1.35) and malignant glioma not otherwise specified (NOS) (Overall: HR = 1.87, 95% CI:1.43-2.43; Pediatric population: HR = 2.86, 95% CI: 1.28-6.39). For meningioma, the Territories had the highest HR (HR = 2.44, 95% CI: 1.09-5.45) followed by the Prairie Provinces (HR = 1.52, 95% CI: 1.38-1.67). For malignant unclassified tumours, the highest HRs were in British Columbia (HR = 1.45, 95% CI: 1.22-1.71) and the Atlantic Provinces (HR = 1.40, 95% CI: 1.13-1.74). There are regional differences in the survival of CNS patients at the population level for all four specific histological types of CNS tumours investigated. Factors contributing to these observed regional survival differences are unknown and warrant further investigation.
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Affiliation(s)
- Yifan Wu
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.W.); (E.V.W.)
| | - Emily V. Walker
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.W.); (E.V.W.)
- Precision Analytics, Cancer Research & Analytics, Cancer Care Alberta, Alberta Health Services, Edmonton, AB T5J 3C6, Canada
| | - Yan Yuan
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada; (Y.W.); (E.V.W.)
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de Melo SM, Marta GN, Latorraca CDOC, Martins CB, Efthimiou O, Riera R. Hypofractionated radiotherapy for newly diagnosed elderly glioblastoma patients: A systematic review and network meta-analysis. PLoS One 2021; 16:e0257384. [PMID: 34735442 PMCID: PMC8568110 DOI: 10.1371/journal.pone.0257384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate different hypofractionated radiotherapy (HRT) regimens for newly diagnosed elderly glioblastoma (GBM) patients. METHODS We performed a systematic review with network meta-analysis (NMA), including searches on CENTRAL, Medline, EMBASE, CINAHL, clinical trial databases and manual search. Only randomized clinical trials (RCTs) were included. Primary outcomes: overall survival (OS) and adverse events (AE). Secondary outcomes: progression-free-survival (PFS) and quality of life (QoL). We used the Cochrane Risk of Bias (RoB) table for assessing individual studies and CINeMA for evaluating the certainty of the final body of evidence. RESULTS Four RCTs (499 patients) were included. For OS, the estimates from NMA did not provide strong evidence of a difference between the HRTs: 40 Gray (Gy) versus 45 Gy (HR: 0.89; CI 95%: 0.42, 1.91); 34 Gy versus 45 Gy (HR: 0.85; CI 95% 0.43, 1.70); 25 Gy versus 45 Gy (HR: 0.81; CI 95% 0.32, 2.02); 34 Gy versus 40 Gy (HR: 0.95; CI 95% 0.57, 1.61); and 25 Gy versus 34 Gy (HR: 0.95; CI 95% 0.46, 1.97). We performed qualitative synthesis for AE and QoL due to data scarcity and clinical heterogeneity among studies. The four studies reported a similar QoL (assessed by different methods) between arms. One RCT reported grade ≥ 3 AE, with no evidence of a difference between arms. PFS was reported in one study (25 Gy versus 40 Gy), with no evidence of a difference between arms. CONCLUSION This review found no evidence of a difference between the evaluated HRTs for efficacy and safety.
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Affiliation(s)
- Suely Maymone de Melo
- Neuro-Oncology–Hospital do Coração de Sao Paulo, Sao Paulo, Brazil
- Evidence-Based Medicine Post-graduation Program, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
- Department of Neurosurgery Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
- * E-mail: (SMM)
| | | | | | - Camila Bertini Martins
- Department of Preventive Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicin—Universität Bern, Bern, Switzerland
| | - Rachel Riera
- Discpline of Evidence-based Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), Sao Paulo, Brazil
- Center of Health Technology Assessment—Hospital Sírio-Libanês, Sao Paulo, Brazil
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Ahangar-Sirous R, Poudineh M, Ansari A, Nili A, Dana SMMA, Nasiri Z, Hosseini ZS, Karami D, Mokhtari M, Deravi N. Pharmacotherapeutic Potential of Garlic in Age-Related Neurological Disorders. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:377-398. [PMID: 34579639 DOI: 10.2174/1871527320666210927101257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/24/2021] [Accepted: 06/24/2021] [Indexed: 12/26/2022]
Abstract
Age-related neurological disorders [ANDs] involve neurodegenerative diseases [NDDs] such as Alzheimer's disease [AD], the most frequent kind of dementia in elderly people, and Parkinson's disease [PD], and also other disorders like epilepsy and migraine. Although ANDs are multifactorial, Aging is a principal risk factor for them. The common and most main pathologic features among ANDs are inflammation, oxidative stress, and misfolded proteins accumulation. Since failing brains caused by ANDs impose a notable burden on public health and their incidence is increasing, a lot of works has been done to overcome them. Garlic, Allium sativum, has been used for different medical purposes globally and more than thousands of publications have reported its health benefits. Garlic and aged garlic extract are considered potent anti-inflammatory and antioxidants agents and can have remarkable neuroprotective effects. This review is aimed to summarize knowledge on the pharmacotherapeutic potential of garlic and its components in ANDs.
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Affiliation(s)
| | | | - Arina Ansari
- Student Research Committee, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd. Iran
| | - Ali Nili
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord. Iran
| | | | - Zahra Nasiri
- Student's Research Committee, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | | | - Dariush Karami
- Student's Research Committee, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran. Iran
| | - Melika Mokhtari
- Student Research Committee, Dental Faculty, Tehran Medical Sciences, Islamic Azad University, Tehran. Iran
| | - Niloofar Deravi
- Student's Research Committee, School of medicine, Shahid Beheshti University of Medical Sciences, Tehran. Iran
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Clinical characteristics and risk factors of perioperative outcomes in elderly patients with intracranial tumors. Neurosurg Rev 2019; 44:389-400. [PMID: 31848767 DOI: 10.1007/s10143-019-01217-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/13/2019] [Accepted: 11/21/2019] [Indexed: 01/21/2023]
Abstract
We aimed to study the clinical and radiological characteristics of intracranial tumors and explore the possible predictive value of these characteristics in relation to perioperative outcomes in elderly patients. We retrospectively identified 1535 elderly patients (aged 65 years and older) with intracranial tumors who underwent surgical resection between 2014 and 2018 in Beijing Tiantan Hospital. Factors associated with an increased risk of unfavorable perioperative performance and complications were investigated. Meningiomas were the most common tumors in the cohort (43.26%). The overall risk of perioperative death was 0.59%, and 42.80% of patients were discharged with unfavorable performance (Karnofsky Performance Scale [KPS] score ≤ 70). Of all patients, 39.22% had one or more complications after surgical resection. Aggressive surgery significantly lowered the rate of unfavorable perioperative outcomes (P = 0.000) with no increase in postoperative complications (P = 0.153), but it failed to be an independent predictor for perioperative outcomes in the multivariate analysis. Low performance status at admission (KPS ≤ 70) was independently associated with both unfavorable perioperative performance (P = 0.000) and complications (P = 0.000). In addition to the histopathological patterns of tumors, low performance status at admission is an independent predictor for both unfavorable perioperative performance and the occurrence of complications in elderly patients with intracranial tumors who have undergone surgical resections. However, age is not associated with perioperative outcomes in elderly patients.
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Villani V, Tanzilli A, Telera SM, Terrenato I, Vidiri A, Fabi A, Zucchella C, Carapella CM, Marucci L, Casini B, Carosi M, Oppido PM, Pace A. Comorbidities in elderly patients with glioblastoma: a field-practice study. Future Oncol 2019; 15:841-850. [DOI: 10.2217/fon-2018-0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim: This single-center study evaluated the effect of comorbidities on progression-free and overall survival in elderly patients with glioblastoma multiforme (GBM). Patients & methods: Comorbid conditions were identified in each patient with the modified version of the cumulative illness rating scale (CIRS). Results: Total of 118 patients with GBM were enrolled. An age of >75 years at diagnosis, high CIRS, comorbidity index and performance status play a predictive role on survival. Conclusion: Comorbidities play an important prognostic role in elderly patients with GBM, a factor too often neglected in clinical practice. If the prognostic role of comorbidity measured by CIRS on outcome will be confirmed, it would be interesting to add it in the algorithm for treatment choice in elderly GBM patients.
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Affiliation(s)
- Veronica Villani
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonio Tanzilli
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Stefano M Telera
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonello Vidiri
- Service of Neuroradiology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Chiara Zucchella
- Neurology Unit, ‘Azienda Ospedaliera Universitaria Integrata’ Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Carmine M Carapella
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Laura Marucci
- Radiotherapy Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Beatrice Casini
- Division of Neuropathology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Mariantonia Carosi
- Division of Neuropathology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Piero M Oppido
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Cheng K, Montgomery D, Feng Y, Steel R, Liao H, McLaren DB, Erridge SC, McLaughlin S, Nailon WH. Identifying radiotherapy target volumes in brain cancer by image analysis. Healthc Technol Lett 2015; 2:123-8. [PMID: 26609418 DOI: 10.1049/htl.2015.0014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/04/2015] [Accepted: 08/11/2015] [Indexed: 11/20/2022] Open
Abstract
To establish the optimal radiotherapy fields for treating brain cancer patients, the tumour volume is often outlined on magnetic resonance (MR) images, where the tumour is clearly visible, and mapped onto computerised tomography images used for radiotherapy planning. This process requires considerable clinical experience and is time consuming, which will continue to increase as more complex image sequences are used in this process. Here, the potential of image analysis techniques for automatically identifying the radiation target volume on MR images, and thereby assisting clinicians with this difficult task, was investigated. A gradient-based level set approach was applied on the MR images of five patients with grades II, III and IV malignant cerebral glioma. The relationship between the target volumes produced by image analysis and those produced by a radiation oncologist was also investigated. The contours produced by image analysis were compared with the contours produced by an oncologist and used for treatment. In 93% of cases, the Dice similarity coefficient was found to be between 60 and 80%. This feasibility study demonstrates that image analysis has the potential for automatic outlining in the management of brain cancer patients, however, more testing and validation on a much larger patient cohort is required.
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Affiliation(s)
- Kun Cheng
- Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK
| | - Dean Montgomery
- Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK
| | - Yang Feng
- Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK
| | - Robin Steel
- Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK
| | - Hanqing Liao
- Department of Electrical Engineering and Electronics , University of Liverpool , Liverpool L69 3GQ , UK
| | - Duncan B McLaren
- Department of Clinical Oncology , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK
| | - Sara C Erridge
- Department of Clinical Oncology , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK
| | - Stephen McLaughlin
- School of Engineering and Physical Sciences , Heriot Watt University , David Brewster Building, Edinburgh EH14 4AS , UK
| | - William H Nailon
- Department of Oncology Physics , Edinburgh Cancer Centre, Western General Hospital , Crewe Road South, Edinburgh EH4 2XU , UK ; School of Engineering , University of Edinburgh , King's Buildings, Mayfield Road, Edinburgh EH9 3JL , UK
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Tsang D, Khan L, Perry J, Soliman H, Sahgal A, Keith J, Mainprize T, Das S, Zhang L, Tsao M. Survival Outcomes in Elderly Patients with Glioblastoma. Clin Oncol (R Coll Radiol) 2015; 27:176-83. [DOI: 10.1016/j.clon.2014.11.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/19/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
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Watts C, Price SJ, Santarius T. Current concepts in the surgical management of glioma patients. Clin Oncol (R Coll Radiol) 2014; 26:385-94. [PMID: 24882149 DOI: 10.1016/j.clon.2014.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/01/2014] [Indexed: 12/16/2022]
Abstract
The scientific basis for the surgical management of patients with glioma is rapidly evolving. The infiltrative nature of these cancers precludes a surgical cure, but despite this, cytoreductive surgery remains central to high-quality patient care. In addition to tissue sampling for accurate histopathological diagnosis and molecular genetic characterisation, clinical benefit from decompression of space-occupying lesions and microsurgical cytoreduction has been reported in patients with different grades of glioma. By integrating advanced surgical techniques with molecular genetic characterisation of the disease and targeted radiotherapy and chemotherapy, it is possible to construct a programme of personalised surgical therapy throughout the patient journey. The goal of therapeutic packages tailored to each patient is to optimise patient safety and clinical outcome and must be delivered in a multidisciplinary setting. Here we review the current concepts that underlie surgical subspecialisation in the management of patients with glioma.
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Affiliation(s)
- C Watts
- University of Cambridge, Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK; Department of Clinical Neurosciences, Cambridge Centre for Brain Repair, University of Cambridge, Cambridge, UK.
| | - S J Price
- University of Cambridge, Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - T Santarius
- University of Cambridge, Department of Clinical Neurosciences, Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
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Burnet N. Developments in the Management of Central Nervous System Tumours. Clin Oncol (R Coll Radiol) 2014; 26:361-3. [DOI: 10.1016/j.clon.2014.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 11/28/2022]
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