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Bianchi F, Ceccarelli GM, Tamburrini G. Surgery for pediatric low-grade gliomas within the vermis. Childs Nerv Syst 2024:10.1007/s00381-024-06545-y. [PMID: 39046475 DOI: 10.1007/s00381-024-06545-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 07/16/2024] [Indexed: 07/25/2024]
Abstract
Pediatric low-grade gliomas (pLGGs) in the cerebellar vermis present unique challenges due to their intricate anatomical location and potential impact on critical neurological functions. Surgical intervention remains a cornerstone in the management of these tumors, aiming to achieve maximal tumor resection while preserving neurological function. In this review, the authors will discuss anatomical consideration and will explore current surgical techniques and strategies employed in the treatment of cerebellar vermis pLGGs such as the midline and lateral suboccipital approaches, as well as endoscopic-assisted technique. Additionally, we will emphasize the importance of intraoperative neurophysiological monitoring (IONM) in ensuring safe and effective tumor resection. Overall, this review provides insights into the neurosurgical approach of pLGGs in the cerebellar vermis.
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Affiliation(s)
- Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
| | | | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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2
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Xu S, Yang W, Luo Y, Wang X, Li Y, Meng X, Zhang Y, Zeng H, Huang B. A novel MRI feature, the cut green pepper sign, can help differentiate a suprasellar pilocytic astrocytoma from an adamantinomatous craniopharyngioma. BMC Med Imaging 2023; 23:191. [PMID: 37985972 PMCID: PMC10662486 DOI: 10.1186/s12880-023-01132-0] [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: 04/11/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVE There are no specific magnetic resonance imaging (MRI) features that distinguish pilocytic astrocytoma (PA) from adamantinomatous craniopharyngioma (ACP). In this study we compared the frequency of a novel enhancement characteristic on MRI (called the cut green pepper sign) in PA and ACP. METHODS Consecutive patients with PA (n = 24) and ACP (n = 36) in the suprasellar region were included in the analysis. The cut green pepper sign was evaluated on post-contrast T1WI images independently by 2 neuroradiologists who were unaware of the pathologic diagnosis. The frequency of cut green pepper sign in PA and ACP was compared with Fisher's exact test. RESULTS The cut green pepper sign was identified in 50% (12/24) of patients with PA, and 5.6% (2/36) with ACP. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the cut green pepper sign for diagnosing PA were 50%, 94.4%, 85.7% and 73.9%, respectively. There was a statistically significant difference in the age of patients with PA with and without the cut green pepper sign (12.3 ± 9.2 years vs. 5.5 ± 4.4 years, p = 0.035). CONCLUSION The novel cut green pepper sign can help distinguish suprasellar PA from ACP on MRI.
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Affiliation(s)
- Shumin Xu
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, 518000, China
| | - Wanqun Yang
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 514000, China
| | - Yi Luo
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, 518000, China
| | - Xiaoyu Wang
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, 518000, China
| | - Yaowen Li
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, 518000, China
| | - Xianlei Meng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, 518000, China
| | - Yuze Zhang
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 514000, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, 518000, China.
| | - Biao Huang
- Department of Radiology, Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 514000, China.
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3
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Modrzejewska M, Olejnik-Wojciechowska J, Roszyk A, Szychot E, Konczak TD, Szemitko M, Peregud-Pogorzelski JW. Optic Pathway Gliomas in Pediatric Population-Current Approach in Diagnosis and Management: Literature Review. J Clin Med 2023; 12:6709. [PMID: 37959175 PMCID: PMC10649937 DOI: 10.3390/jcm12216709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/05/2023] [Accepted: 10/17/2023] [Indexed: 11/15/2023] Open
Abstract
In this paper, the authors present a clinical picture of the diagnosis and current treatment regimens of optic pathway glioma in the pediatric population, with an emphasis on the role of an ophthalmic diagnosis in the differentiation and monitoring of lesions. Glioma is the most common optic nerve tumor in children. MATERIAL Articles in PubMed, Scholar and Website were reviewed, taking into account current standards of management related to sporadic or NF1-related optic glioma, epidemiology, location, course of the disease, clinical manifestations, histological types of the tumor, genetic predisposition, diagnostic ophthalmic tests currently applicable in therapeutic monitoring of the tumor, neurological diagnosis, therapeutic management and prognosis. The importance of current screening recommendations, in line with standards, was emphasized. RESULTS Glioma occurs in children most often in the first decade of life. Initially, they may be asymptomatic, and clinically ophthalmic changes are associated with the organ of vision or with systemic changes. Gliomas associated with the NF1 mutation have a better prognosis for sporadic gliomas. Diagnosis includes radiological imaging methods/MRI/ophthalmology/OCT and visual acuity log MAR assessment. The basis of treatment is clinical observation. In the case of disease progression, surgical treatment, chemotherapy and targeted therapy are used. CONCLUSION Further research into novel techniques for detecting gliomas would allow for early monitoring of the disease.
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Affiliation(s)
- Monika Modrzejewska
- II Department of Ophthalmology, Pomeranian Medical University, Al. Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Joanna Olejnik-Wojciechowska
- Scientific Students Association of Ophtalmology, II Department of Ophthalmology, Pomeranian Medical University, Szczecin Unia Lubelska 1 Street, 71-252 Szczecin, Poland
| | - Agnieszka Roszyk
- Scientific Students Association of Ophtalmology, II Department of Ophthalmology, Pomeranian Medical University, Szczecin Unia Lubelska 1 Street, 71-252 Szczecin, Poland
| | - Elwira Szychot
- Department of Paediatrics, Oncology and Paediatric Immunology, Pomeranian Medical University, 71-252 Szczecin, Poland
- Department of Paediatric Onclogy, Great Ormond Street Hospital for Children, London WC1N 1LE, UK
| | - Tomasz Dariusz Konczak
- Department of Paediatrics, Oncology and Paediatric Immunology, Pomeranian Medical University, 71-252 Szczecin, Poland
| | - Marcin Szemitko
- Department of Intervantional Radiology, Pomerian Medical University, 70-111 Szczecin, Poland
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4
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Tomita Y, Hibler EA, Suruga Y, Ishida J, Fujii K, Satomi K, Ichimura K, Hirotsune N, Date I, Tanaka Y, Otani Y. Age is a major determinant for poor prognosis in patients with pilocytic astrocytoma: a SEER population study. Clin Exp Med 2023; 23:2301-2309. [PMID: 36063258 DOI: 10.1007/s10238-022-00882-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/26/2022] [Indexed: 01/08/2023]
Abstract
Background Pilocytic astrocytomas (PAs) are central nervous system tumors with variable prognosis and poorly understood risk factors. Little evidence exists regarding the effect of age on mortality in PA. Therefore, we conducted a thorough characterization of PA in the US. Methods We queried the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2018 to extract age-adjusted incidence rate (AAIR), age-adjusted mortality rate (AAMR), and survival data on PA. The age group comparisons for each measure varied depending on available SEER data. We compared trends in AAIR and AAMR by two age groups (children, 0-19 years; adults, 20 + years) and by sex. The cumulative incidence function and the Fine-Gray competing risk model were applied by 0-19, 20-39, 40-59, and 60 + years of age groups. Results This study included 5211 incident PA and 462 PA-specific deaths between 2000 and 2018. Trends in AAIRs and AAMRs were almost constant between 2000 and 2018. Average AAIRs had a sharp peak in 1-4 years of age groups, whereas AAMRs had a gradual peak in 80-84 years of age groups. Age groups, tumor location, and race/ethnicity were significantly associated with PA-specific death, whereas only age was associated with other cause of deaths. Conclusions Trends in AAIRs and AAMRs were constant regardless of age. PAs in older populations, especially over 60 years old, have higher incidence of death than those in younger populations.
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Affiliation(s)
- Yusuke Tomita
- Department of Neurosurgery and Neuroendovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, 730-8518, Japan
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Elizabeth A Hibler
- Division of Epidemiology, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yasuki Suruga
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Joji Ishida
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Kentaro Fujii
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Kaishi Satomi
- Department of Pathology, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichi Ichimura
- Department of Brain Diseases Translational Research, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Nobuyuki Hirotsune
- Department of Neurosurgery and Neuroendovascular Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, 730-8518, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan
| | - Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA.
| | - Yoshihiro Otani
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, 700-8558, Japan.
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Muto J, Murata H, Shigekawa S, Mitsuhara T, Umebayashi D, Kanematsu R, Joko M, Inoue T, Inoue T, Endo T, Hirose Y. Clinical Characteristics and Long-term Outcomes of Spinal Pilocytic Astrocytomas: A Multicenter Retrospective Study by the Neurospinal Society of Japan. Neurospine 2023; 20:774-782. [PMID: 37798969 PMCID: PMC10562249 DOI: 10.14245/ns.2346450.225] [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: 04/12/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE The characteristics, imaging features, long-term surgical outcomes, and recurrence rates of primary spinal pilocytic astrocytomas (PAs) have not been clarified owing to their rarity and limited reports. Thus, this study aimed to analyze the clinical presentation, radiological features, pathological findings, and long-term outcomes of spinal PAs. METHODS Eighteen patients with spinal PAs who were surgically treated between 2009 and 2020 at 58 institutions were included in this retrospective multicenter study. Patient data, including demographics, radiographic features, treatment modalities, and long-term outcomes, were evaluated. RESULTS Among the 18 consecutive patients identified, 11 were women and 7 were men; the mean age at presentation was 31 years (3-73 years). Most PAs were located eccentrically, were solid or heterogeneous in appearance (cystic and solid), and had unclear margins. Gross total resection (GTR), subtotal resection (STR), partial resection (PR), and biopsy were performed in 28%, 33%, 33%, and 5% of cases, respectively. During a follow-up period of 65 ± 49 months, 4 patients developed a recurrence; however, the recurrence-free survival did not differ significantly between the GTR and non-GTR (STR, PR, and biopsy) groups. CONCLUSION Primary spinal PAs are rare and present as eccentric and intermixed cystic and solid intramedullary cervical tumors. The imaging features of spinal PAs are nonspecific, and a definitive diagnosis requires pathological support. Surgical resection with prevention of neurological deterioration can serve as the first-line treatment; however, the resection rate does not affect recurrence-free survival. Investigation of relevant molecular biomarkers is required to elucidate the regrowth risk and prognostic factors.
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Affiliation(s)
- Jun Muto
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Hidetoshi Murata
- Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama, Japan
| | | | | | - Daisuke Umebayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryo Kanematsu
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
| | - Masahiro Joko
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Tatsushi Inoue
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - Tomoo Inoue
- Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku Medical and Phamaceutical University, Sendai, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
| | - for the Investigators of Intramedullary Spinal Cord Tumors in the Neurospinal Society of Japan
- Department of Neurosurgery, Fujita Health University, Aichi, Japan
- Department of Neurosurgery, St. Marianna University School of Medicine, Yokohama, Japan
- Department of Neurosurgery, Ehime University, Ehime, Japan
- Department of Neurosurgery, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Spinal Disorders Center, Fujieda Heisei Memorial Hospital, Shizuoka, Japan
- Department of Neurosurgery, Saitama Red Cross Hospital, Saitama, Japan
- Department of Neurosurgery, Tohoku Medical and Phamaceutical University, Sendai, Japan
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6
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Wang R, Cui J, Diao Y, Jin C, Chen Y, Lv X, Li X. Risk factor analysis and nomogram establishment and verification of brain astrocytoma patients based on SEER database. Sci Rep 2023; 13:7754. [PMID: 37173353 PMCID: PMC10182035 DOI: 10.1038/s41598-023-33537-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/14/2023] [Indexed: 05/15/2023] Open
Abstract
Astrocytoma is a common brain tumor that can occur in any part of the central nervous system. This tumor is extremely harmful to patients, and there are no clear studies on the risk factors for astrocytoma of the brain. This study was conducted based on the SEER database to determine the risk factors affecting the survival of patients with astrocytoma of the brain. Patients diagnosed with brain astrocytoma in the SEER database from 2004 to 2015 were screened by inclusion exclusion criteria. Final screened brain astrocytoma patients were classified into low grade and high grade according to WHO classification. The risk factors affecting the survival of patients with low-grade and high-grade brain astrocytoma were analyzed by univariate Kaplan-Meier curves and log-rank tests, individually. Secondly, the data were randomly divided into training set and validation set according to the ratio of 7:3, and the training set data were analyzed by univariate and multivariate Cox regression, and the risk factors affecting the survival of patients were screened and nomogram was established to predict the survival rates of patients at 3 years and 5 years. The area under the ROC curve (AUC value), C-index, and Calibration curve are used to evaluate the sensitivity and calibration of the model. Univariate Kaplan-Meier survival curve and log-rank test showed that the risk factors affecting the prognosis of patients with low-grade astrocytoma included Age, Primary site, Tumor histological type, Grade, Tumor size, Extension, Surgery, Radiation, Chemotherapy and Tumor number; risk factors affecting the prognosis of patients with high-grade astrocytoma include Age, Primary site, Tumor histological type, Tumor size, Extension, Laterality, Surgery, Radiation, Chemotherapy and Tumor number. Through Cox regression, independent risk factors of patients with two grades were screened separately, and nomograms of risk factors for low-grade and high-grade astrocytoma were successfully established to predict the survival rate of patients at 3 and 5 years. The AUC values of low-grade astrocytoma training set patients were 0.829 and 0.801, and the C-index was 0.818 (95% CI 0.779, 0.857). The AUC values of patients in the validation set were 0.902, 0.829, and the C-index was 0.774 (95% CI 0.758, 0.790), respectively. The AUC values of high-grade astrocytoma training set patients were 0.814 and 0.806, the C-index was 0.774 (95% CI 0.758, 0.790), the AUC values of patients in the validation set were 0.802 and 0.823, and the C-index was 0.766 (95% CI 0.752, 0.780), respectively, and the calibration curves of the two levels of training set and validation set were well fitted. This study used data from the SEER database to identify risk factors affecting the survival prognosis of patients with brain astrocytoma, which can provide some guidance for clinicians.
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Affiliation(s)
- Ruiqi Wang
- Department of Epidemiology and Health Statistics, Dalian Medical University, 9 Lvshun South Road, Liaoning Dalian, 116044, China
| | - Jiaxue Cui
- Department of Epidemiology and Health Statistics, Dalian Medical University, 9 Lvshun South Road, Liaoning Dalian, 116044, China
| | - Yizhuo Diao
- Department of Epidemiology and Health Statistics, Dalian Medical University, 9 Lvshun South Road, Liaoning Dalian, 116044, China
| | - Chenxin Jin
- Department of Epidemiology and Health Statistics, Dalian Medical University, 9 Lvshun South Road, Liaoning Dalian, 116044, China
| | - Yongxing Chen
- Department of Epidemiology and Health Statistics, Dalian Medical University, 9 Lvshun South Road, Liaoning Dalian, 116044, China
| | - Xiupeng Lv
- Department of Radiation Oncology, First Affiliated Hospital, Dalian Medical University, Dalian Liaoning, 116044, China.
| | - Xiaofeng Li
- Department of Epidemiology and Health Statistics, Dalian Medical University, 9 Lvshun South Road, Liaoning Dalian, 116044, China.
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Kim JW, Phi JH, Kim SK, Lee JH, Park SH, Won JK, Choi JY, Kang HJ, Park CK. Comparison of the clinical features and treatment outcomes of pilocytic astrocytoma in pediatric and adult patients. Childs Nerv Syst 2023; 39:583-591. [PMID: 36662276 DOI: 10.1007/s00381-023-05839-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE Pilocytic astrocytoma is a slow-growing tumor that predominantly develops in children, but has a broad age spectrum. A notable characteristic of pilocytic astrocytoma is that the tumor arises in diverse locations and the clinical course is not always benign. Therefore, it is necessary to elucidate the clinical spectrum of the disease and analyze the relevant prognostic factors. METHODS Demographic and treatment-related factors were retrospectively reviewed in a cohort of 254 patients with histologically confirmed pilocytic astrocytoma. Clinical features were compared between the pediatric group (N = 208; age < 18 years) and the adult group (N = 46; age ≥ 18 years). Cox regression analysis was performed to identify relevant prognostic factors. RESULTS There was no difference in progression-free survival (PFS) between the pediatric and adult groups (p = 0.36); however, patients under 8 years of age exhibited worse PFS (p < 0.01). Leptomeningeal seeding at diagnosis and pilomyxoid histology was observed only in pediatric patients. In the pediatric group, nine patients experienced recurrence after complete resection. Increasing age (hazard ratio (HR) = 0.89, p < 0.01) and adjuvant therapy (HR = 0.32, p < 0.01) were protective factors against tumor progression. In the adult group, no progression occurred after complete resection. Age and adjuvant therapy were not significant factors in the adult group. CONCLUSION Pilocytic astrocytoma presents with a diverse clinical spectrum. Complete resection is of utmost importance, and appropriate adjuvant treatment is recommended if complete resection cannot be achieved. Children with younger age are associated with more aggressive tumors, and recurrence may occur even after complete resection.
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Affiliation(s)
- Joo Whan Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea.
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, 03080, Seoul, Republic of Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Kyung Won
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
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Willman M, Willman J, Figg J, Dioso E, Sriram S, Olowofela B, Chacko K, Hernandez J, Lucke-Wold B. Update for astrocytomas: medical and surgical management considerations. EXPLORATION OF NEUROSCIENCE 2023; 2:1-26. [PMID: 36935776 PMCID: PMC10019464 DOI: 10.37349/en.2023.00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/10/2022] [Indexed: 02/25/2023]
Abstract
Astrocytomas include a wide range of tumors with unique mutations and varying grades of malignancy. These tumors all originate from the astrocyte, a star-shaped glial cell that plays a major role in supporting functions of the central nervous system (CNS), including blood-brain barrier (BBB) development and maintenance, water and ion regulation, influencing neuronal synaptogenesis, and stimulating the immunological response. In terms of epidemiology, glioblastoma (GB), the most common and malignant astrocytoma, generally occur with higher rates in Australia, Western Europe, and Canada, with the lowest rates in Southeast Asia. Additionally, significantly higher rates of GB are observed in males and non-Hispanic whites. It has been suggested that higher levels of testosterone observed in biological males may account for the increased rates of GB. Hereditary syndromes such as Cowden, Lynch, Turcot, Li-Fraumeni, and neurofibromatosis type 1 have been linked to increased rates of astrocytoma development. While there are a number of specific gene mutations that may influence malignancy or be targeted in astrocytoma treatment, O 6-methylguanine-DNA methyltransferase (MGMT) gene function is an important predictor of astrocytoma response to chemotherapeutic agent temozolomide (TMZ). TMZ for primary and bevacizumab in the setting of recurrent tumor formation are two of the main chemotherapeutic agents currently approved in the treatment of astrocytomas. While stereotactic radiosurgery (SRS) has debatable implications for increased survival in comparison to whole-brain radiotherapy (WBRT), SRS demonstrates increased precision with reduced radiation toxicity. When considering surgical resection of astrocytoma, the extent of resection (EoR) is taken into consideration. Subtotal resection (STR) spares the margins of the T1 enhanced magnetic resonance imaging (MRI) region, gross total resection (GTR) includes the margins, and supramaximal resection (SMR) extends beyond the margin of the T1 and into the T2 region. Surgical resection, radiation, and chemotherapy are integral components of astrocytoma treatment.
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Affiliation(s)
- Matthew Willman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jonathan Willman
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - John Figg
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Emma Dioso
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Sai Sriram
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Bankole Olowofela
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Kevin Chacko
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Jairo Hernandez
- College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, USA
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9
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Shi Z, Yang C, Xu X, Wu W, Jiang D, Yan D. Plasma metabolite profiles identify pediatric medulloblastoma and other brain cancer. Anal Bioanal Chem 2023; 415:471-480. [PMID: 36369592 DOI: 10.1007/s00216-022-04427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/11/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022]
Abstract
Medulloblastoma is a malignancy of the central nervous system that occurs most frequently in childhood and is often difficult to diagnose due to its similarities to conventional imaging findings for other pediatric intracranial tumors such as astrocytomas and ependymomas. The purpose of this study was to identify new metabolites and differential metabolic pathways by analyzing the significantly different metabolites present in the plasma of children with medulloblastoma in comparison with those with other intracranial tumors. Plasma was collected from 37 children with medulloblastoma and 34 children with other intracranial tumors. Targeted and non-targeted metabolomics based on ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) analyses were performed to determine metabolic changes in pediatric medulloblastomas versus other intracranial tumors. Based on multivariate statistical analysis and regression models, we identified differential metabolites in the plasma and investigated different metabolic pathways. A total of 61 differential metabolites in the plasma of children with medulloblastoma were identified by non-targeted metabolomics analysis. In addition, targeted metabolomics analysis identified four differential amino acids, thus allowing us to establish a diagnostic model for children with medulloblastoma. Metabolic pathway analysis showed that there were significant differences in patients with medulloblastoma in terms of glycerophospholipid and α-linolenic acid metabolism pathways as well as several amino acid metabolism pathways (phenylalanine, tyrosine, and tryptophan biosynthesis). We identified differential profiles of key plasma metabolites between children with medulloblastoma and other forms of intracranial tumor, thus providing a basis for identifying early diagnostic markers of medulloblastoma and new therapeutic targets and strategies.
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Affiliation(s)
- Zhengyuan Shi
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Clinical Rational Drug Use, Beijing, People's Republic of China
| | - Chunjing Yang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Clinical Rational Drug Use, Beijing, People's Republic of China
| | - Xiqiao Xu
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Clinical Rational Drug Use, Beijing, People's Republic of China
| | - Wanshui Wu
- Department of Pediatrics, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Dechun Jiang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing, People's Republic of China.,Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Clinical Rational Drug Use, Beijing, People's Republic of China
| | - Dan Yan
- Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Clinical Rational Drug Use, Beijing, People's Republic of China. .,Beijing Institute of Clinical Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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10
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Ferriastuti DW, Fauziah D, Fatmariyanti S. A case report of pilocytic astrocytoma mimicking meningioma on imaging. Radiol Case Rep 2022; 17:3797-3800. [PMID: 35965926 PMCID: PMC9364054 DOI: 10.1016/j.radcr.2022.07.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 11/25/2022] Open
Abstract
Pilocytic astrocytoma (PA) is categorized as grade I gliomas with a good prognosis. Although PA mostly occurs in the cerebellum, it also can occur in the orbital and mostly presents as a cystic tumor with a mural nodule. PA often presents in the second decade of life, with 75% occurring under the age of 20 years. This case report describes a 10-year-old boy presented a left eye tumor for over 3 years. MRI examination showed unrestricted intraconal lesions in the optic nerve, visible from the optic canal to the anterior with well-defined borders. The excised tumor specimen depicted a nodular tumor tissue, measuring 35 × 28 × 20 mm, weighing 11 grams, solid with gray and white. The microscopic examination showed a classical biphasic pattern including combinations of loose glial tissue and compact pyloid tissue. Hispathology result revealed a pilocytic astrocytoma.
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Affiliation(s)
- Dr. Widiana Ferriastuti
- Department of Radiology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia
- Corresponding author.
| | - Dyah Fauziah
- Department of Radiology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia
| | - Susy Fatmariyanti
- Department of Radiology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia
- Department of Opthalmology, Faculty of Medicine, Universitas Airlangga / Dr. Soetomo General and Academic Hospital, Surabaya, Indonesia
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11
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Salari N, Fatahian R, Kazeminia M, Hosseinian-Far A, Shohaimi S, Mohammadi M. Patients' Survival with Astrocytoma After Treatment: a Systematic Review and Meta-analysis of Clinical Trial Studies. Indian J Surg Oncol 2022; 13:329-342. [PMID: 35782798 PMCID: PMC9240140 DOI: 10.1007/s13193-022-01533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/19/2022] [Indexed: 11/28/2022] Open
Abstract
About half of the brain tumours are primary and the rest are metastatic. The impact of each of these treatments alone or together on the prognosis of patients with astrocytoma tumours, especially low-grade astrocytoma, is unclear which may pose many challenges in the decision-making of surgeons and patients. Considering the importance of patient's outcomes with astrocytoma and lack of general statistics, this study aimed to determine the survival of patients with high-grade astrocytoma and low-grade astrocytoma after treatments. This study follows a systematic review and a meta-analysis approach. Following a systematic review and meta-analysis method, articles dated from 1982 to March 2020 were extracted from Embase, ScienceDirect, Scopus, PubMed and Web of Science (WoS) international databases. Random effects model was used for analysis, and heterogeneity of studies was investigated considering the I 2 index. Data were analysed using the Comprehensive Meta-Analysis software (version 2). According to a meta-analysis of studies, the mean overall survival in patients with high-grade astrocytoma was 31.9 ± 2.7 months, for 2-year survival, 38.1% (95% CI: 27.5-50.1%) and for 5-year survival was 28.6% (95% CI: 24.1-33.4%). Mean overall survival in patients with low-grade astrocytoma was 64.8 ± 7.4 months, for 2-year survival was 74.3% (95% CI: 32.6-94.5%) and for 5-year survival was 74.4% (95% CI: 57.9-86%). The highest mean for survival in patients with high-grade astrocytoma and in chemotherapy and radiation therapy treatments was 45.2 ± 5.2 months, and also the highest mean for survival in patients with low-grade astrocytoma in surgical treatment was 71.4 ± 8.8 months. The results of this study show that the average survival in patients with low-grade astrocytoma is high following the treatment, and in high-grade astrocytoma, there will be the highest survival rate, if the surgical treatment is combined with chemotherapy and radiation therapy. This study summarizes retrospective studies up to 2020 to evaluate the prognosis and survival of patients with brain astrocytoma tumours, and the results of this meta-analysis can be of interest to surgeons and specialists in this field.
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Affiliation(s)
- Nader Salari
- Department of Biostatistics, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Fatahian
- Department of Neurosurgery, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Kazeminia
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Amin Hosseinian-Far
- Department of Business Systems & Operations, University of Northampton, Northampton, UK
| | - Shamarina Shohaimi
- Department of Biology, Faculty of Science, University Putra Malaysia, Serdang, Selangor Malaysia
| | - Masoud Mohammadi
- Cellular and Molecular Research Center, Gerash University of Medical Sciences, Gerash , Iran
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12
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Shin I, Park YW, Ahn SS, Kim J, Chang JH, Kim SH, Lee SK. Clinical factors and conventional MRI may independently predict progression-free survival and overall survival in adult pilocytic astrocytomas. Neuroradiology 2022; 64:1529-1537. [PMID: 35112217 DOI: 10.1007/s00234-021-02872-y] [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: 10/04/2021] [Accepted: 11/29/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Pilocytic astrocytoma (PA) is rare in adults, and only limited knowledge on the clinical course and prognosis has been available. The combination of clinical information and comprehensive imaging parameters could be used for accurate prognostic stratification in adult PA patients. This study was conducted to predict the prognostic factors from clinical information and conventional magnetic resonance imaging (MRI) features in adult PAs. METHODS A total of 56 adult PA patients were enrolled in the institutional cohort. Clinical characteristics including age, sex, anaplastic PA, presence of neurofibromatosis type 1, Karnofsky performance status, extent of resection, and postoperative treatment were collected. MRI characteristics including major axis length, tumor location, presence of the typical 'cystic mass with enhancing mural nodule appearance', proportion of enhancing tumor, the proportion of edema, conspicuity of the nonenhancing margin, and presence of a cyst were evaluated. Univariable and multivariable Cox proportional hazard modeling were performed. RESULTS The 5-year progression-free survival (PFS) and overall survival (OS) rates were 83.9% and 91.l%, respectively. On univariable analysis, older age, larger proportion of edema, and poor definition of nonenhancing margin were predictors of shorter PFS and OS, respectively (all Ps < .05). On multivariable analysis, older age (hazard ratio [HR] = 1.04, P = .014; HR = 1.14, P = .030) and poor definition of nonenhancing margin (HR = 3.66, P = .027; HR = 24.30, P = .024) were independent variables for shorter PFS and OS, respectively. CONCLUSION Age and the margin of the nonenhancing part of the tumor may be useful biomarkers for predicting the outcome in adult PAs.
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Affiliation(s)
- Ilah Shin
- Department of Radiology, Ansan Hospital, Korea University, College of Medicine, Seoul, Korea
| | - Yae Won Park
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
| | - Sung Soo Ahn
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Jinna Kim
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Koo Lee
- Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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13
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Yang S, Yang X, Wang H, Gu Y, Feng J, Qin X, Feng C, Li Y, Liu L, Fan G, Liao X, He S. Development and Validation of a Personalized Prognostic Prediction Model for Patients With Spinal Cord Astrocytoma. Front Med (Lausanne) 2022; 8:802471. [PMID: 35118095 PMCID: PMC8804494 DOI: 10.3389/fmed.2021.802471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe study aimed to investigate the prognostic factors of spinal cord astrocytoma (SCA) and establish a nomogram prognostic model for the management of patients with SCA.MethodsPatients diagnosed with SCA between 1975 and 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and randomly divided into training and testing datasets (7:3). The primary outcomes of this study were overall survival (OS) and cancer-specific survival (CSS). Cox hazard proportional regression model was used to identify the prognostic factors of patients with SCA in the training dataset and feature importance was obtained. Based on the independent prognostic factors, nomograms were established for prognostic prediction. Calibration curves, concordance index (C-index), and time-dependent receiver operating characteristic (ROC) curves were used to evaluate the calibration and discrimination of the nomogram model, while Kaplan-Meier (KM) survival curves and decision curve analyses (DCA) were used to evaluate the clinical utility. Web-based online calculators were further developed to achieve clinical practicability.ResultsA total of 818 patients with SCA were included in this study, with an average age of 30.84 ± 21.97 years and an average follow-up time of 117.57 ± 113.51 months. Cox regression indicated that primary site surgery, age, insurance, histologic type, tumor extension, WHO grade, chemotherapy, and post-operation radiotherapy (PRT) were independent prognostic factors for OS. While primary site surgery, insurance, tumor extension, PRT, histologic type, WHO grade, and chemotherapy were independent prognostic factors for CSS. For OS prediction, the calibration curves in the training and testing dataset illustrated good calibration, with C-indexes of 0.783 and 0.769. The area under the curves (AUCs) of 5-year survival prediction were 0.82 and 0.843, while 10-year survival predictions were 0.849 and 0.881, for training and testing datasets, respectively. Moreover, the DCA demonstrated good clinical net benefit. The prediction performances of nomograms were verified to be superior to that of single indicators, and the prediction performance of nomograms for CSS is also excellent.ConclusionsNomograms for patients with SCA prognosis prediction demonstrated good calibration, discrimination, and clinical utility. This result might benefit clinical decision-making and patient management for SCA. Before further use, more extensive external validation is required for the established web-based online calculators.
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Affiliation(s)
- Sheng Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Xun Yang
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Orthopedics, The First Affiliated Hospital, Shenzhen University, Shenzhen, China
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Huiwen Wang
- Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuelin Gu
- Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Ministry of Education, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Behavioral and Cognitive Neuroscience Center, Fudan University, Shanghai, China
| | - Jingjing Feng
- The First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xianfeng Qin
- College of Artificial Intelligence, Guangxi University for Nationalities, Nanning, China
| | - Chaobo Feng
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Yufeng Li
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Lijun Liu
- Department of Orthopedics, The First Affiliated Hospital, Shenzhen University, Shenzhen, China
- Shenzhen Second People's Hospital, Shenzhen, China
| | - Guoxin Fan
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
- Department of Pain Medicine, Shenzhen Municipal Key Laboratory for Pain Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- *Correspondence: Guoxin Fan
| | - Xiang Liao
- National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
- Department of Pain Medicine, Shenzhen Municipal Key Laboratory for Pain Medicine, The 6th Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, China
- Xiang Liao
| | - Shisheng He
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
- Shisheng He
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14
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Comparison of adult and pediatric pilocytic astrocytomas using competing risk analysis: A population-based study. Clin Neurol Neurosurg 2021; 212:107084. [PMID: 34875553 DOI: 10.1016/j.clineuro.2021.107084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 11/19/2021] [Accepted: 11/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pilocytic astrocytoma(PA) is a relatively benign tumor occurring primarily in the pediatric population. Comparison of characteristics and survival of this tumor between adult and pediatric patients in a single, population-based study is yet to be performed. OBJECTIVE We aimed to directly compare the characteristics and survival of pilocytic astrocytoma between pediatric and adult patients in a single, population-based study. METHODS We utilized the SEER database using data from 1983 to 2016. All patients with histologically confirmed, intracranial pilocytic astrocytoma were included and divided into a pediatric(age<18 years) or adult group. Due to lower risk of tumor-specific-mortality, we utilized a competing risk analysis to account for mortality from other causes. Univariable and multivariable competing risk analysis(CRA) was performed, and sub-distribution hazard ratio(SHR) or adjusted SHR(aSHR) was reported. RESULTS A total of 4357 patients comprised the final cohort, with 3014(69.2%) pediatric patients. As compared to the pediatric group, adult patients were predominantly White(p < 0.01), with PA less likely fully resected(p = 0.01), smaller tumor size(p < 0.01), and were less often located in the cerebellum(p < 0.01). Multivariable CRA revealed a worse prognosis for the adult group(p < 0.01), regional or distal extension(p < 0.01), and non-cerebellar locations including frontal(p < 0.01), parietal(p < 0.01), ventricular(p < 0.01) or brainstem(p < 0.01). Improved prognosis was seen with more recent year-of-diagnosis(2003-2016, p = 0.03), gross-total/total resection(p < 0.01), and biopsy only patients(p = 0.02). CONCLUSIONS Pilocytic astrocytomas in adult patients have a worse prognosis than pediatric patients. Cumulative incidence of cancer-specific-mortality is higher in adults when adjusted for other factors. PAs with regional or distal extension and non-cerebellar locations carry worse outcomes. Surgery remains an effective treatment and GTR/TR should be achieved when possible.
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15
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Clinical characteristics and long-term surgical outcomes of spinal pilocytic astrocytoma: a report of twenty cases. Acta Neurochir (Wien) 2021; 163:3005-3013. [PMID: 33037477 DOI: 10.1007/s00701-020-04606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Primary spinal pilocytic astrocytoma (PA) is an extremely rare low-grade astrocytoma with unclear natural history. The demographic characteristics, imaging features, and long-term surgical outcomes have not been clarified due to low prevalence and limited reports. METHODS A retrospective review within a single institution between 2004 and 2018 of all patients with pathologically proven PA was conducted. Patient data including demographics, radiographic features, treatment modalities, and long-term outcomes were evaluated. RESULTS Twenty consecutive patients were identified, and 16 (80%) were male patients, with a mean age at presentation of 29 ± 13 years. The lesion was primarily located in cervical (n = 10, 50%), thoracic (n = 7, 35%), cervico-thoracic junction (n = 2), and lumbar level (n = 1, 5%). The tumor had a mean extension of 4 ± 2 (1-7) vertebral segments. Most PAs were located eccentrically (n = 16, 80%), with most being heterogeneous in appearance (cystic and solid) or purely cystic (n = 14, 70%), and had unclear margins (n = 16, 80%). Eleven patients (55%) had associated syringomyelia. Gross total resection (GTR) was achieved in 11 (55%) patients, and subtotal resection (STR) in 9 (45%). During a mean follow-up of 104 ± 56 months, 2 patients died and recurrence was found in 4 patients (20%), translating to a mean progression-free survival of 21 ± 11 months. CONCLUSION Primary spinal PA is a rare entity with acceptable progression-free survival if treated appropriately. Surgical resection may provide reasonable prolongation of survival, and GTR should be achieved if possible. A close follow-up is recommended especially for residual lesions, and a further in-depth investigation of molecular biomarkers is needed to stratify risk and prognostic factors.
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16
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Zhang M, Chen T, Zhong Y. Demographic and prognostic factors of optic nerve astrocytoma: a retrospective study of surveillance, epidemiology, and end results (SEER). BMC Cancer 2021; 21:976. [PMID: 34461852 PMCID: PMC8406908 DOI: 10.1186/s12885-021-08719-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022] Open
Abstract
Background Optic nerve astrocytomas (ONAs) are neurological neoplasms in the central nervous system (CNS), and they have the highest incidence rate among all the tumor types in the visual pathway. In this study, we conducted a Surveillance, Epidemiology, and End Results (SEER) -based research to explore the demographic, survival, and prognostic factors of patients diagnosed with ONAs. Methods Utilizing the SEER database, we retrospectively evaluated data of patients diagnosed with ONAs of all ages from 1984 to 2016. We used the Student’s t distribution to test variables of patients and various characteristics, and Kaplan-Meier curve to illustrate overall survival (OS) with 95.0% confidence intervals (CIs). We also performed univariate and multivariate analyses to evaluate various variables’ validity on overall survival. Results A total of 1004 cases were analyzed, and revealed that age (P<0.001, hazard ratio (HR) = 8.830, 95% CI: 4.088–19.073), tumor grade (P<0.001, HR = 1.927, 95% CI: 1.516–2.450), diagnostic confirmation (P<0.001, HR = 2.444, 95% CI: 1.632–3.660), and histology type (P = 0.046, HR = 1.563, 95% CI: 1.008–2.424) of the tumor were associated with decreased survival. Conclusions From this large, comparative study of ONAs, we found that younger age may be considered as a protective indicator, while high-grade astrocytic tumors have a worse prognosis. We also found that diagnostic confirmation and tumor grade were independent prognostic factors in this patient population.
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Affiliation(s)
- Mingui Zhang
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.,Department of Ophthalmology, Massachusetts Eye and Ear Infirmary / Schepens Eye Research Institute, Harvard University, Boston, MA, 02114, USA
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Shanghai, China
| | - Yisheng Zhong
- Department of Ophthalmology, Ruijin Hospital Affiliated Medical School, Shanghai Jiaotong University, 197 Ruijin Er Road, Shanghai, 200025, China.
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17
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Khan K, Luther E, Morrell AA, Tan SK, Eichberg DG, Shah AH, Lu VM, Gultekin SH, Morcos JJ. Recurrent adult pilocytic astrocytoma presenting with intraventricular and leptomeningeal spread. Surg Neurol Int 2021; 12:359. [PMID: 34345499 PMCID: PMC8326142 DOI: 10.25259/sni_423_2021] [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: 04/27/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background Infratentorial pilocytic astrocytomas are uncommon tumors in adulthood but are thought to be prognostically similar to their pediatric counterparts with excellent overall survival following gross total resection. However, given the relative rarity of these tumors, no management guidelines exist for recurrent adult pilocytic astrocytomas (APAs). This lack of consensus is especially problematic for inoperable recurrences or those with aggressive features concerning for malignant transformation. Case Description In 2017, a 26-year-old female presented with headaches, nausea, vomiting, and blurry vision. A brain magnetic resonance imaging (MRI) demonstrated a large, well-circumscribed mass within the fourth ventricle causing obstructive hydrocephalus. She underwent near-total resection through a midline suboccipital transtonsillar approach. Pathology demonstrated a World Health Organization Grade 1 pilocytic astrocytoma. Despite initial improvement in her symptoms, she developed worsening headaches and lethargy 10 months after surgery and repeat MRI demonstrated recurrent tumor within the entire ventricular system and the subarachnoid spaces of the left cerebellopontine angle suggesting leptomeningeal spread. Due to the unresectable nature of the recurrence, the patient declined any further intervention and succumbed to her disease 6 months later. Conclusion We present the first case of a recurrent APA presenting with intraventricular and leptomeningeal spread. Although thought to be a benign neoplasm, close interval follow-up with serial imaging is of essential, especially in those patients with known residual tumor, to prevent aggressive recurrences such as this.
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Affiliation(s)
- Khadeja Khan
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Evan Luther
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Alexis A Morrell
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Sze Kiat Tan
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Daniel G Eichberg
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Ashish H Shah
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Victor M Lu
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Sakir H Gultekin
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
| | - Jacques J Morcos
- Department of Pathology, University of Miami Miller School of Medicine, Miami, Florida, United States.,Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, United States
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18
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Zilli T, Dolcemascolo V, Passone E, Maieron M, De Colle MC, Skrap M, Ius T, Liguoro I, Venchiarutti M, Cogo P, Tomasino B. A multimodal approach to the study of children treated for posterior fossa tumor: A review of the literature and a pilot study. Clin Neurol Neurosurg 2021; 207:106819. [PMID: 34274656 DOI: 10.1016/j.clineuro.2021.106819] [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: 05/03/2021] [Revised: 06/24/2021] [Accepted: 07/02/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aims of the present study were: (1) to review the literature on long-lasting cognitive sequelae in children treated for Posterior Fossa Tumor and (2) to investigate anatomic functional relations in a case series of 7 children treated for PFT using magnetic resonance imaging (MRI) post-processing methods. METHODS We retrospectively analyzed MRIs of children who underwent complete surgical resection of PFT and performed extensive neuropsychological evaluation. Tumor, ventricular volumes, and VPS insertion site were drawn on T1 volumetric MRI scans and normalized to a pediatric template. Children showed worse performances on tasks tapping executive functions, memory, visuo-motor precision, and expressive language. RESULTS Volumes of interest related to these functions showed a maximum overlap on the left vermis and the lateral ventricle enlargement, except for impaired narrative fluency -which was associated with left lateral ventricle enlargement- and narrative memory -which was related to the right vermis and the enlarged fourth ventricle. CONCLUSION Results suggest that anatomic functional relations in children treated for PFT are related to a combination of different pathophysiological factors.
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Affiliation(s)
- Tiziana Zilli
- Scientific Institute Eugenio Medea, Via della Bontà n. 7, 33078 San Vito al Tagliamento, PN, Italy.
| | - Valentina Dolcemascolo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Eva Passone
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Marta Maieron
- Department of Medical Physics, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Maria Cristina De Colle
- Department of Neuroradiology, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Miran Skrap
- Department of Neurosurgery, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Tamara Ius
- Department of Neurosurgery, University Hospital of Udine, P.le S.M. della Misericordia 15, 33100, Italy
| | - Ilaria Liguoro
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Martina Venchiarutti
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy; Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, P.le L.A. Scuro 10, 37134, Italy
| | - Paola Cogo
- Division of Pediatrics, Department of Medicine, University Hospital of Udine, Piazzale S.M. della Misericordia 15, 33100, Italy
| | - Barbara Tomasino
- Scientific Institute Eugenio Medea, Via della Bontà n. 7, 33078 San Vito al Tagliamento, PN, Italy
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19
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Typical Pediatric Brain Tumors Occurring in Adults-Differences in Management and Outcome. Biomedicines 2021; 9:biomedicines9040356. [PMID: 33808415 PMCID: PMC8066180 DOI: 10.3390/biomedicines9040356] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Adult brain tumors mostly distinguish themselves from their pediatric counterparts. However, some typical pediatric brain tumors also occur in adults. The aim of this review is to describe the differences between classification, treatment, and outcome of medulloblastoma, pilocytic astrocytoma, and craniopharyngioma in adults and children. Medulloblastoma is a WHO IV posterior fossa tumor, divided into four different molecular subgroups, namely sonic hedgehog (SHH), wingless (WNT), Group 3, and Group 4. They show a different age-specific distribution, creating specific outcome patterns, with a 5-year overall survival of 25–83% in adults and 50–90% in children. Pilocytic astrocytoma, a WHO I tumor, mostly found in the supratentorial brain in adults, occurs in the cerebellum in children. Complete resection improves prognosis, and 5-year overall survival is around 85% in adults and >90% in children. Craniopharyngioma typically occurs in the sellar compartment leading to endocrine or visual field deficits by invasion of the surrounding structures. Treatment aims for a gross total resection in adults, while in children, preservation of the hypothalamus is of paramount importance to ensure endocrine development during puberty. Five-year overall survival is approximately 90%. Most treatment regimens for these tumors stem from pediatric trials and are translated to adults. Treatment is warranted in an interdisciplinary setting specialized in pediatric and adult brain tumors.
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Racial and ethnic disparities among children with primary central nervous system tumors in the US. J Neurooncol 2021; 152:451-466. [PMID: 33774801 DOI: 10.1007/s11060-021-03738-2] [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: 12/15/2020] [Accepted: 03/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Primary central nervous system (CNS) tumors are among the most common and lethal types of cancer in children. However, the existence of health disparities in CNS tumors by race or ethnicity remains poorly understood. This systematic review sought to determine whether racial and ethnic disparities in incidence, healthcare access, and survival exist among pediatric patients diagnosed with CNS tumors. METHODS A search of MEDLINE, Embase, CINAHL, Web of Science, and Scopus was conducted. Inclusion criteria selected for studies published between January 1, 2005 and July 15, 2020 that focused on pediatric populations in the US, evaluated for potential differences based on racial or ethnic backgrounds, and focused on CNS tumors. A standardized study form was used to collect study information, population of interest, research design, and quality of analysis, sample size, participant demographics, pathology evaluated, and incidence or outcomes observed. RESULTS A total of 30 studies were inlcuded. Studies suggest White children may be more likely to be diagnosed with a CNS tumor and Hispanic children to present with advanced-stage disease and have worse outcomes. The degree of influence derived from socioeconomic factors is unclear. This review was limited by few available studies that included race and ethnicity as a variable, the overlap in databases used, and unclear categorization of race and ethnicity. CONCLUSIONS This review identified notable and at times contradicting variations in racial/ethnic disparities among children with CNS tumors, suggesting that the extent of these disparities remains largely unknown and prompts further research to improve health equity.
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Zhang L, Zhang B, Dou Z, Wu J, Iranmanesh Y, Jiang B, Sun C, Zhang J. Immune Checkpoint-Associated Locations of Diffuse Gliomas Comparing Pediatric With Adult Patients Based on Voxel-Wise Analysis. Front Immunol 2021; 12:582594. [PMID: 33815356 PMCID: PMC8010651 DOI: 10.3389/fimmu.2021.582594] [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: 07/12/2020] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
Objective: Pediatric diffuse gliomas (pDGs) are relatively rare and molecularly distinct from pediatric pilocytic astrocytoma and adult DGs. Immunotherapy is a promising therapeutic strategy, requiring a deep understanding of tumor immune profiles. The spatial locations of brain tumors might be related to the molecular profiles. We aimed to analyze the relationship between the immune checkpoint molecules with the locations of DGs comparing pediatric with adult patients. Method: We studied 20 pDGs patients (age ≤ 21 years old), and 20 paired adult patients according to gender and histological types selected from 641 adult patients with DGs. Immune checkpoint molecules including B7-H3, CD47, and PD-L1, as well as tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs), were manifested by immunohistochemical staining. Expression difference analyses and Spearman's correlation were performed. MRI data were voxel-wise normalized, segmented, and analyzed by Fisher's exact test to construct the tumor frequency and p value heatmaps. Survival analyses were conducted by Log-rank tests. Result: The median age of pediatric patients was 16 years. 55% and 30% of patients were WHO II and III grades, respectively. The left frontal lobe and right cerebellum were the statistically significant locations for pDGs, while the anterior horn of ventricles for adult DGs. A potential association between the expression of PD-L1 and TAMs was found in pDGs (p = 0.002, R = 0.670). The right posterior external capsule and the lateral side of the anterior horn of the left ventricle were predominant locations for the adult patients with high expression of B7-H3 and low expression of PD-L1 compared to pediatric ones, respectively. Pediatric patients showed significantly improved overall survival compared with adults. The prognostic roles of immune checkpoint molecules and TILs/TAMs were not significantly different between the two groups. Conclusion: Immune checkpoint-associated locations of diffuse gliomas comparing pediatric with adult patients could be helpful for the immunotherapy decisions and design of clinical trials.
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Affiliation(s)
- Li Zhang
- Department of Oncology, Daqing Oilfield General Hospital, Daqing, China
| | - Buyi Zhang
- Department of Pathology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhangqi Dou
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jiawei Wu
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yasaman Iranmanesh
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Biao Jiang
- Department of Radiology, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Chongran Sun
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Jianmin Zhang
- Department of Neurosurgery, School of Medicine, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Candido MF, Baldissera GC, Medeiros M, Umezawa K, Brassesco MS. NF-кB inhibition by DHMEQ: in vitro antiproliferative effects on pilocytic astrocytoma and concise review of the current literature. Childs Nerv Syst 2020; 36:2675-2684. [PMID: 32385563 DOI: 10.1007/s00381-020-04625-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Pilocytic astrocytoma (PA) is the most common brain tumor that affects the pediatric population. Even though PA is benign and treatment only involves surgery, recurrent or unresectable tumors require chemo- and radiotherapy. Besides BRAF, CDKN2A, or IDH mutations, the hyperactivation of the nuclear factor NF-κB contributes to tumor growth and survival. METHODS In the present study, we used publicly available data for the in silico analysis of NF-κB subunits (RELA, RELB, REL, NF-κB1, and NF-κB2) expression in PA samples. Besides, in vitro assays were performed to evaluate proliferation, migration, cell death, on the PA cell line Res286 comparing to human primary astrocytes. Sensitization to radiation therapy and temozolomide (TMZ) was also assayed. RESULTS Our results showed that all the members of the NF-kB family are upregulated in PA datasets compared to normal brain tissues. Moreover, DHMEQ treatment significantly reduced cell growth and motility, while sensitized cells to ionizing radiation and TMZ, as previously seen in high-grade gliomas. CONCLUSIONS This drug presents a potential application in clinical practice for the treatment of recurrent or inoperable PA. Moreover, its use might assist adjuvant chemotherapy and reduce irradiation doses to avoid toxicity to the surrounding tissues.
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Affiliation(s)
- M F Candido
- Department of Cell and Molecular Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - G C Baldissera
- Regional Blood Center of Ribeirão Preto, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - M Medeiros
- Department of Cell and Molecular Biology, Ribeirão Preto Medical School, University of São Paulo, Ribeirao Preto, São Paulo, Brazil
| | - K Umezawa
- Department of Molecular Target Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - María Sol Brassesco
- Departamento de Biologia, FFCLRP-USP, Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirao Preto, SP, CEP 14040-901, Brazil.
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