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Zhu Q, Jiang H, Cui Y, Ren X, Li M, Zhang X, Li H, Shen S, Li M, Lin S. Intratumoral calcification: not only a diagnostic but also a prognostic indicator in oligodendrogliomas. Eur Radiol 2024; 34:3674-3685. [PMID: 37968476 DOI: 10.1007/s00330-023-10405-9] [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: 04/30/2023] [Revised: 09/07/2023] [Accepted: 09/18/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVE Calcification is a hallmark characteristic of oligodendroglioma (ODG) that may be used as a diagnostic factor, but its prognostic implications remain unclear. This study aimed to investigate the features of calcified ODGs and to evaluate the differences in survival between patients with calcified and noncalcified ODGs. METHODS We retrospectively reviewed the records of 305 consecutive patients who were diagnosed with IDH-mutant, 1p/19q codeleted ODG at our institution from July 2009 to August 2020. Patients with intratumoral calcification were identified. The clinical, radiologic, and molecular features of the patients in the calcified group and noncalcified group were recorded. Univariate and multivariate analyses were performed to identify prognostic factors. RESULTS Of the 305 patients, 112 (36.7%) were confirmed to have intratumoral calcification. Compared to ODGs without calcification, ODGs with calcifications had a larger tumor diameter; lower degree of resection; higher tumor grade; higher MGMT methylation level; higher Ki-67 index; and higher rates of midline crossing, enhancement, cyst, and 1q/19p copolysomy, and patients with calcification were more likely to receive chemoradiotherapy. ODGs with T2 hypointense calcification had a higher Hounsfield unit (HU) value on CT scans, and a lower degree of resection. Patients with T2 hypointense calcification ODGs had a shorter survival than those with non-hypointense calcification ODGs. ODGs with calcification and cysts showed a higher Ki-67 index, tumor grade, and enhanced rate, and the patients had an unfavorable overall survival (OS). Calcification was found to be a negative prognostic factor for both progression-free survival (PFS) and OS by univariate analysis, which was confirmed by the Cox proportional hazard model. CONCLUSIONS Calcification is a useful negative prognostic factor for PFS and OS in patients with ODGs and could therefore be helpful in guiding personalized treatment and predicting patient prognosis. CLINICAL RELEVANCE STATEMENT Calcification can serve as an independent prognostic factor for patients with oligodendroglioma and shows a vital role in guiding individualized treatment. KEY POINTS • Intratumoral calcification is an independent negative prognostic risk factor for progression-free survival and overall survival in oligodendroglioma patients. • Calcifications in oligodendroglioma can be divided into hypointense and non-hypointense subtypes based on T2-weighted imaging, and patients with T2-hypointense calcification oligodendrogliomas have worse prognosis. • Calcification concurrent with cysts indicates a more aggressive phenotype of oligodendrogliomas and a significantly reduced survival rate.
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Affiliation(s)
- Qinghui Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haihui Jiang
- Department of Neurosurgery, Peking University Third Hospital, Peking University, #49 Huayuan North Road, Haidian District, Beijing, 100191, China.
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaokang Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haoyi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shaoping Shen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, #119 Fanyang Road, Fengtai District, Beijing, 100070, China.
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Mubarak F, Khandwala K, Shamim SM, Qureshi MB. Multifocal oligodendroglioma with callosal and brainstem involvement. Surg Neurol Int 2022; 13:442. [DOI: 10.25259/sni_589_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/30/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Oligodendrogliomas are generally low-grade glial neoplasms commonly occurring in a cortical or subcortical location and frequently contain coarse calcifications. Tumors with 1p and 19q codeletions behave atypically and are more likely to have ill-defined margins and tend to have calcification. Very rarely, diffuse pattern and gliomatosis type of infiltrative nature of oligodendrogliomas have been described in sporadic case reports.
Case Description:
In this article, we present a case of a 31-year-old male who had diffuse multifocal oligodendroglioma with rare features of extensive callosal and brainstem involvement on imaging.
Conclusion:
Rare cases of oligodendrocytic gliomatosis cerebri or oligodendrogliomatosis with diffuse white matter spread of these tumors usually lead to a detrimental course of neurological status and a poor prognosis in these patients.
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Affiliation(s)
- Fatima Mubarak
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan,
| | - Kumail Khandwala
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan,
| | - Shahzad M. Shamim
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan,
| | - Madiha Bilal Qureshi
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Li C, Liu Z, Zhang X, Wang H, Friedman GK, Ding Q, Zhao X, Li H, Kim K, Yu X, Burt Nabors L, Han X, Zhao R. Generation of chromosome 1p/19q co-deletion by CRISPR/Cas9-guided genomic editing. Neurooncol Adv 2022; 4:vdac131. [PMID: 36225650 PMCID: PMC9547542 DOI: 10.1093/noajnl/vdac131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Chromosomal translocation has been detected in many human cancers including gliomas and is considered a driving force in tumorigenesis. Co-deletion of chromosome arms 1p and 19q is a hallmark for oligodendrogliomas. On the molecular level, 1p/19q co-deletion results from t(1;19)(q10;p10), which leads to the concomitant formation of a hybrid chromosome containing the 1q and 19p arms. A method to generate 1p/19q co-deletion is lacking, which hinders the investigation of how 1p/19q co-deletion contributes to gliomagenesis. Methods We hypothesized that chromosomal translocation, such as t(1;19)(q10;p10) resulting in the 1p/19q co-deletion, may be induced by simultaneously introducing DNA double-strand breaks (DSBs) into chromosomes 1p and 19q using CRISPR/Cas9. We developed a CRISPR/Cas9-based strategy to induce t(1;19)(q10;p10) and droplet digital PCR (ddPCR) assays to detect the hybrid 1q/19p and 1p/19q chromosomes. Results After translocation induction, we detected both 1p/19q and 1q/19p hybrid chromosomes by PCR amplification of the junction regions in HEK 293T, and U-251 and LN-229 glioblastoma cells. Sequencing analyses of the PCR products confirmed DNA sequences matching both chromosomes 1 and 19. Furthermore, the 1p/19q hybrid chromosome was rapidly lost in all tested cell lines. The 1q/19p hybrid chromosome also become undetectable over time likely due to cell survival disadvantage. Conclusion We demonstrated that t(1;19)(q10;p10) may be induced by CRISPR/Cas9-mediated genomic editing. This method represents an important step toward engineering the 1p/19q co-deletion to model oligodendrogliomas. This method may also be generalizable to engineering other cancer-relevant translocations, which may facilitate the understanding of translocation roles in cancer progression.
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Affiliation(s)
- Chao Li
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, AL 35294, USA
| | - Zhong Liu
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, AL 35294, USA
| | - Xiaoxia Zhang
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, AL 35294, USA
- Department of Genetics, University of Alabama at Birmingham, AL 35294, USA
| | - Huafeng Wang
- Department of Neurology, University of Alabama at Birmingham, AL 35294, USA
| | - Gregory K Friedman
- Department of Pediatrics, Division of Hematology/Oncology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Qiang Ding
- Department of Anesthesiology and Perioperative Medicine & Molecular and Translational Biomedicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Xinyang Zhao
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, AL 35294, USA
| | - Hu Li
- Department of Molecular Pharmacology & Experimental Therapeutics, Center for Individualized Medicine, Mayo Clinic College of Medicine, Rochester, MN 55904, USA
| | - Kitai Kim
- Human Stem Cell & Genome Engineering Center and Department of Biological Chemistry, University of California, Los Angeles, CA 90095, USA
| | - Xi Yu
- Clinical Oncology Center, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, China
| | - L Burt Nabors
- Department of Neurology, University of Alabama at Birmingham, AL 35294, USA
| | - Xiaosi Han
- Department of Neurology, University of Alabama at Birmingham, AL 35294, USA
| | - Rui Zhao
- Department of Biochemistry and Molecular Genetics, University of Alabama at Birmingham, AL 35294, USA
- Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
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Human IDH mutant 1p/19q co-deleted gliomas have low tumor acidity as evidenced by molecular MRI and PET: a retrospective study. Sci Rep 2020; 10:11922. [PMID: 32681084 PMCID: PMC7367867 DOI: 10.1038/s41598-020-68733-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/01/2020] [Indexed: 01/19/2023] Open
Abstract
Co-deletion of 1p/19q is a hallmark of oligodendroglioma and predicts better survival. However, little is understood about its metabolic characteristics. In this study, we aimed to explore the extracellular acidity of WHO grade II and III gliomas associated with 1p/19q co-deletion. We included 76 glioma patients who received amine chemical exchange saturation transfer (CEST) imaging at 3 T. Magnetic transfer ratio asymmetry (MTRasym) at 3.0 ppm was used as the pH-sensitive CEST biomarker, with higher MTRasym indicating lower pH. To control for the confounder factors, T2 relaxometry and l-6-18F-fluoro-3,4-dihydroxyphenylalnine (18F-FDOPA) PET data were collected in a subset of patients. We found a significantly lower MTRasym in 1p/19q co-deleted gliomas (co-deleted, 1.17% ± 0.32%; non-co-deleted, 1.72% ± 0.41%, P = 1.13 × 10−7), while FDOPA (P = 0.92) and T2 (P = 0.61) were not significantly affected. Receiver operating characteristic analysis confirmed that MTRasym could discriminate co-deletion status with an area under the curve of 0.85. In analysis of covariance, 1p/19q co-deletion status was the only significant contributor to the variability in MTRasym when controlling for age and FDOPA (P = 2.91 × 10−3) or T2 (P = 8.03 × 10−6). In conclusion, 1p/19q co-deleted gliomas were less acidic, which may be related to better prognosis. Amine CEST-MRI may serve as a non-invasive biomarker for identifying 1p/19q co-deletion status.
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Colip C, Oztek MA, Lo S, Yuh W, Fink J. Updates in the Neuoroimaging and WHO Classification of Primary CNS Gliomas: A Review of Current Terminology, Diagnosis, and Clinical Relevance From a Radiologic Prospective. Top Magn Reson Imaging 2019; 28:73-84. [PMID: 31022050 DOI: 10.1097/rmr.0000000000000195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
As new advances in the genomics and imaging of CNS tumors continues to evolve, a standardized system for classification is increasingly essential to diagnosis and management. The molecular markers introduced in the 2016 WHO classification of CNS tumors bring both practical and conceptual advances to the characterization of gliomas, strengthening the prognostic and predictive value of terminology while shedding light on the underlying mechanisms that drive biologic behavior. The purpose of this article is to provide a succinct overview of primary intracranial gliomas from a neuroradiologic prospective and according to the 5th edition WHO classification that was revised in 2016. An update of the molecular markers pertinent to defining the major lineages of brain gliomas will be provided, followed by discussion of the terminology, grading and imaging features associated with individual entities. Neuroradiologists should be aware of the key genomic and radiomic features of common brain gliomas, and familiar with an integrated approach to their diagnosis and grading.
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Affiliation(s)
- Charles Colip
- University of Washington Medical Center, Department of Radiology, Seattle, WA
| | - Murat Alp Oztek
- University of Washington Medical Center, Department of Radiology, Seattle, WA
| | - Simon Lo
- University of Washington Medical Center, Department of Radiation Oncology, Seattle, WA
| | - Willam Yuh
- University of Washington Medical Center, Department of Radiology, Seattle, WA
| | - James Fink
- University of Washington Medical Center, Department of Radiology, Seattle, WA
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ABT-888 restores sensitivity in temozolomide resistant glioma cells and xenografts. PLoS One 2018; 13:e0202860. [PMID: 30153289 PMCID: PMC6112648 DOI: 10.1371/journal.pone.0202860] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/12/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Temozolomide (TMZ) is active against glioblastomas (GBM) in which the O6-methylguanine-DNA methyltransferase (MGMT) gene is silenced. However, even in responsive cases, its beneficial effect is undermined by the emergence of drug resistance. Here, we tested whether inhibition of poly (ADP-ribose) polymerase-1 and -2 (PARP) enhanced the effectiveness of TMZ. METHODS Using patient derived brain tumor initiating cells (BTICs) and orthotopic xenografts as models of newly diagnosed and recurrent high-grade glioma, we assessed the effects of TMZ, ABT-888, and the combination of TMZ and ABT-888 on the viability of BTICs and survival of tumor-bearing mice. We also studied DNA damage repair, checkpoint protein phosphorylation, and DNA replication in mismatch repair (MMR) deficient cells treated with TMZ and TMZ plus ABT-888. RESULTS Cells and xenografts derived from newly diagnosed MGMT methylated high-grade gliomas were sensitive to TMZ while those derived from unmethylated and recurrent gliomas were typically resistant. ABT-888 had no effect on the viability of BTICs or tumor bearing mice, but co-treatment with TMZ restored sensitivity in resistant cells and xenografts from newly diagnosed unmethylated gliomas and recurrent gliomas with MSH6 mutations. In contrast, the addition of ABT-888 to TMZ had little sensitizing effect on cells and xenografts derived from newly diagnosed methylated gliomas. In a model of acquired TMZ resistance mediated by loss of MMR gene MSH6, re-sensitization to TMZ by ABT-888 was accompanied by persistent DNA strand breaks, re-engagement of checkpoint kinase signaling, and interruption of DNA synthesis. CONCLUSION In laboratory models, the addition of ABT-888 to TMZ overcame resistance to TMZ.
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7
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Naveed MA, Goyal P, Malhotra A, Liu X, Gupta S, Mangla M, Mangla R. Grading of oligodendroglial tumors of the brain with apparent diffusion coefficient, magnetic resonance spectroscopy, and dynamic susceptibility contrast imaging. Neuroradiol J 2018; 31:379-385. [PMID: 29469659 DOI: 10.1177/1971400918757217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose We explored whether advanced magnetic resonance (MR) imaging techniques could grade oligodendrogliomas. Methods Forty patients (age 9-61 years) with oligodendroglial tumors were selected. There were 23 patients with World Health Organization grade II (group 1) and 17 patients with grade III (group 2) tumors. Apparent diffusion coefficient (ADC) maps were calculated by b values of 0 and 1000 s/mm2. Dynamic susceptibility contrast (DSC) images were obtained during the first pass of a bolus of gadolinium-based contrast. These data were post-processed and cerebral blood volume (CBV) maps and permeability (PS) were calculated. MR spectroscopy was acquired after drawing a region of interest on the tumor using two-dimensional chemical shift imaging. Statistical analysis was performed using SPSS software. Results When the rPSmax was combined with the rCBVmax, there was a significant difference between the two groups ( p ≤ 0.03) with area under the curve of 0.742 (95% CI: 0.412-0.904). rCBV, rADC, choline/creatine, and choline/NAA alone were able to differentiate between the two groups; however, they did not show any statistical difference with p values of ≤ 0.121, ≤ 0.722, and ≤ 0.582, respectively. A CBV PS product threshold of 0.53 provided a sensitivity of 80% and a specificity of 83.3% in detection of grade III tumors. Conclusion Combined rCBVmax and rPSmax can be utilized to grade oligodendrogliomas. ADC values, relative cerebral blood volume (rCBV), and MR spectroscopy alone can be utilized to differentiate between the two groups of oligodendrogliomas but without statistical significance.
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Affiliation(s)
| | - Pradeep Goyal
- 2 Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | - Xiang Liu
- 4 Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Sonali Gupta
- 5 Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA
| | | | - Rajiv Mangla
- 1 Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
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Maiguel Carrizosa CE, Sanchez Paez MG, Martinez Amado A, Gonzalez Gutierrez A, Garcia Ardila ME. Spinal metastases of two different grade oligodendrogliomas: a case report and review of literature. JOURNAL OF SPINE SURGERY 2017; 3:468-474. [PMID: 29057359 DOI: 10.21037/jss.2017.06.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Oligodendrogliomas (OGD) are glial tumors, together with mixed oligoastrocytoma constituting 5-20% of all gliomas, which occur predominantly in younger populations and are managed with surgery and chemotherapy with good long-term prognosis after treatment and additionally present with low rates of metastases. We present the case of a 46-year-old patient with intracranial right frontal subcortical OGD [World Health Organisation (WHO) grade II] managed at the Neurosurgery Department in Foscal Clinic, Floridablanca, Colombia. Two years after brain surgery the patient presents with neurological symptomatology suggestive of spinal cord compression and is found to have a neoplastic lesion with extra medullary compressive strength on the conus medullary and wrapping all of the roots with the final report of pathology and immunohistochemistry indicating: OGD (WHO grade III), this lesion was the only one found, the brain studies shows any residual tumor or recurrence in the primary tumor site.
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Abstract
Primary brain tumors, most commonly gliomas, are histopathologically typed and graded as World Health Organization (WHO) grades I-IV according to increasing degrees of malignancy. These grades provide prognostic information and guidance on treatment such as radiation therapy and chemotherapy after surgery. Despite the confirmed value of the WHO grading system, results of a multitude of studies and prospective interventional trials now indicate that tumors with identical morphologic criteria can have highly different outcomes. Molecular markers can allow subtypes of tumors of the same morphologic type and WHO grade to be distinguished and are, therefore, of great interest in personalization of brain tumor treatment. Recent genomic-wide studies have resulted in a far more comprehensive understanding of the genomic alterations in gliomas and provide suggestions for a new molecularly based classification. Magnetic resonance (MR) imaging phenotypes can serve as noninvasive surrogates for tumor genotypes and can provide important information for diagnosis, prognosis, and, eventually, personalized treatment. The newly emerged field of radiogenomics allows specific MR imaging phenotypes to be linked with gene expression profiles. In this article, the authors review the conventional and advanced imaging features of three tumoral genotypes with prognostic and therapeutic consequences: (a) isocitrate dehydrogenase mutation; (b) the combined loss of the short arm of chromosome 1 and the long arm of chromosome 19, or 1p19q codeletion; and (c) methylguanine methyltransferase promoter methylation. © RSNA, 2017.
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Affiliation(s)
- Marion Smits
- From the Department of Radiology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands (M.S.); and Brain Tumor Center, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
| | - Martin J van den Bent
- From the Department of Radiology, Erasmus MC University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, the Netherlands (M.S.); and Brain Tumor Center, Erasmus MC Cancer Center, Rotterdam, the Netherlands (M.J.v.d.B.)
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Mesti T, Ocvirk J. Malignant gliomas: old and new systemic treatment approaches. Radiol Oncol 2016; 50:129-38. [PMID: 27247544 PMCID: PMC4852970 DOI: 10.1515/raon-2015-0003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 09/29/2014] [Indexed: 12/15/2022] Open
Abstract
Background Malignant (high-grade) gliomas are rapidly progressive brain tumours with very high morbidity and mortality. Until recently, treatment options for patients with malignant gliomas were limited and mainly the same for all subtypes of malignant gliomas. The treatment included surgery and radiotherapy. Chemotherapy used as an adjuvant treatment or at recurrence had a marginal role. Conclusions Nowadays, the treatment of malignant gliomas requires a multidisciplinary approach. The treatment includes surgery, radiotherapy and chemotherapy. The chosen approach is more complex and individually adjusted. By that, the effect on the survival and quality of life is notable higher.
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Affiliation(s)
- Tanja Mesti
- Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Sathornsumetee S, Cheunsuchon P, Sangruchi T. High Carbonic Anhydrase-9 Expression Identifies a Subset of 1p/19q Co-Deletion and Favorable Prognosis in Oligodendroglioma. World Neurosurg 2016; 91:518-523.e1. [PMID: 26960282 DOI: 10.1016/j.wneu.2016.02.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the relationship between 3 hypoxic markers, carbonic anhydrase-9 (CA-9), hypoxia-inducible factor (HIF)-1α, and HIF-2α and the traditional genetic markers, deletions of chromosomes 1p and 19q and Isocitrate dehydrogenase 1 (IDH1) R132H mutation in oligodendrogliomas. METHODS Thirty-one oligodendrogliomas (27 World Health Organization Grade [WHO] II and 4 WHO Grade III) were processed into tissue microarray. Fluorescence in situ hybridization was exploited to detect chromosome deletion, whereas immunohistochemistry was performed to assess IDH1R132H mutation, CA-9, HIF-1α, and HIF-2α expression. RESULTS The frequencies of 1p/19q co-deletion and IDH1 R132H mutation were 68% and 71%, respectively. High expression of CA-9 was observed in 42% and was associated with longer survival (P = 0.04) in WHO Grade II oligodendroglioma. High CA-9 expression also identified 62% of 1p/19q-codeleted oligodendroglioma (P = 0.001). In addition, all tumors with high CA-9 expression displayed 1p/19q-codeletion. HIF-1α and HIF-2α provided no additional prognostic value for survival. CONCLUSIONS High expression of CA-9, a marker for hypoxia and acidosis, is associated with favorable prognosis in oligodendroglioma. In addition, it may serve as a simple screening test for 1p/19q co-deletion if validated in larger cohorts.
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Affiliation(s)
- Sith Sathornsumetee
- Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; NANOTEC-Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Pornsuk Cheunsuchon
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Tumtip Sangruchi
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Abstract
Oligodendroglioma are glial tumours, predominantly occurring in adults. Their hallmark molecular feature is codeletion of the 1p and 19q chromosome arms, which is not only of diagnostic but also of prognostic and predictive relevance. On imaging, these tumours characteristically show calcification, and they have a cortical–subcortical location, most commonly in the frontal lobe. Owing to their superficial location, there may be focal thinning or remodelling of the overlying skull. In contrast to other low-grade gliomas, minimal to moderate enhancement is commonly seen and perfusion may be moderately increased. This complicates differentiation from high-grade, anaplastic oligodendroglioma, in which enhancement and increased perfusion are also common. New enhancement in a previously non-enhancing, untreated tumour, however, is suggestive of malignant transformation, as is high growth rate. MR spectroscopy may further aid in the differentiation between low- and high-grade oligodendroglioma. A relatively common feature of recurrent disease is leptomeningeal dissemination, but extraneural spread is rare. Tumours with the 1p/19q codeletion more commonly show heterogeneous signal intensity, particularly on T2 weighted imaging; calcifications; an indistinct margin; and mildly increased perfusion and metabolism than 1p/19q intact tumours. For the initial diagnosis of oligodendroglioma, MRI and CT are complementary; MRI is superior to CT in assessing tumour extent and cortical involvement, whereas CT is most sensitive to calcification. Advanced and functional imaging techniques may aid in grading and assessing the molecular genotype as well as in differentiating between tumour recurrence and radiation necrosis, but so far no unequivocal method or combination of methods is available.
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Affiliation(s)
- Marion Smits
- Department of Radiology, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands
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Dong X, Noorbakhsh A, Hirshman BR, Zhou T, Tang JA, Chang DC, Carter BS, Chen CC. Survival trends of grade I, II, and III astrocytoma patients and associated clinical practice patterns between 1999 and 2010: A SEER-based analysis. Neurooncol Pract 2015; 3:29-38. [PMID: 31579519 DOI: 10.1093/nop/npv016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
Background The survival trends and the patterns of clinical practice pertaining to radiation therapy and surgical resection for WHO grade I, II, and III astrocytoma patients remain poorly characterized. Methods Using the Surveillance, Epidemiology and End Results (SEER) database, we identified 2497 grade I, 4113 grade II, and 2755 grade III astrocytomas during the period of 1999-2010. Time-trend analyses were performed for overall survival, radiation treatment (RT), and the extent of surgical resection (EOR). Results While overall survival of grade I astrocytoma patients remained unchanged during the study period, we observed improved overall survival for grade II and III astrocytoma patients (Tarone-Ware P < .05). The median survival increased from 44 to 57 months and from 15 to 24 months for grade II and III astrocytoma patients, respectively. The differences in survival remained significant after adjusting for pertinent variables including age, ethnicity, marital status, sex, tumor size, tumor location, EOR, and RT status. The pattern of clinical practice in terms of EOR for grade II and III astrocytoma patients did not change significantly during this study period. However, there was decreased RT utilization as treatment for grade II astrocytoma patients after 2005. Conclusion Results from the SEER database indicate that there were improvements in the overall survival of grade II and III astrocytoma patients over the past decade. Analysis of the clinical practice patterns identified potential opportunities for impacting the clinical course of these patients.
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Affiliation(s)
- Xuezhi Dong
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Abraham Noorbakhsh
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Brian R Hirshman
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Tianzan Zhou
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Jessica A Tang
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - David C Chang
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Bob S Carter
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Clark C Chen
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
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Ducray F, Dehais C, Delattre JY. An overview of current and future treatment options for adults anaplastic oligodendroglial tumors. Expert Opin Orphan Drugs 2014. [DOI: 10.1517/21678707.2014.928617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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15
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Sizoo EM, Pasman HRW, Dirven L, Marosi C, Grisold W, Stockhammer G, Egeter J, Grant R, Chang S, Heimans JJ, Deliens L, Reijneveld JC, Taphoorn MJB. The end-of-life phase of high-grade glioma patients: a systematic review. Support Care Cancer 2013; 22:847-57. [PMID: 24337718 DOI: 10.1007/s00520-013-2088-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/26/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND High-grade gliomas (HGG) are rare and incurable; yet, these neoplasms result in a disproportionate share of cancer morbidity and mortality. Treatment of HGG patients is directed not merely towards prolonging life but also towards quality of life, which becomes the major goal in the end of life (EOL). The latter has received increasing attention over the last decade. METHODS We reviewed the literature related to the EOL phase of HGG patients from 1966 up to April 2012. Articles were retrieved from PubMed, Embase, Cinahl, PsycINFO and Cochrane database. We then selected papers for analysis using pre-determined inclusion criteria and subtracted information on the topics of interest. RESULTS The search yielded 695 articles, of which 17 were classified eligible for analysis according to pre-defined inclusion criteria. Reviewed topics were symptoms and signs, quality of life and quality of dying, caregiver burden, organization and location of palliative care, supportive treatment, and EOL decision making. Nearly all identified studies were observational, with only two non-randomized intervention studies. Symptom burden is high in the EOL phase and affects the quality of life of both patient and carer. Palliative care services are more intensively used compared to other cancer patients. Cognitive deficits increase as the disease progresses, hampering communication and decision making. CONCLUSION The EOL phase of HGG is substantially different from other patient groups, and more clinical studies in HGG on supportive medication, advance care planning and decision making are required. The organization of care, development of guidelines and interventions to decrease caregiver burden in the EOL phase are critical as well.
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Affiliation(s)
- Eefje M Sizoo
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands,
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16
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Besse A, Sana J, Fadrus P, Slaby O. MicroRNAs involved in chemo- and radioresistance of high-grade gliomas. Tumour Biol 2013; 34:1969-78. [PMID: 23568705 DOI: 10.1007/s13277-013-0772-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 03/22/2013] [Indexed: 11/28/2022] Open
Abstract
High-grade gliomas (HGGs) are malignant primary brain tumors of glial cell origin. Despite optimal course of treatment, including maximal surgical resection followed by adjuvant chemo- and/or radiotherapy, the prognosis still remains poor. The main reason is the commonly occurring chemo- and radioresistance of these tumors. In recent years, several signaling pathways, especially PI3K/AKT and ATM/CHK2/p53, have been linked to the resistance of gliomas. Moreover, additional studies have shown that these pathways are significantly regulated by microRNAs (miRNAs), short endogenous RNA molecules that modulate gene expression and control many biological processes including apoptosis, proliferation, cell cycle, invasivity, and angiogenesis. MiRNAs are not only highly deregulated in gliomas, their expression signatures have also been shown to predict prognosis and therapy response. Therefore, they present promising biomarkers and therapeutic targets that might overcome the resistance to treatment and improve prognosis of glioma patients. In this review, we summarize the current knowledge of the functional role of miRNAs in gliomas resistance to chemo- and radiotherapy.
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Affiliation(s)
- Andrej Besse
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Zluty kopec 7, 656 53, Brno, Czech Republic
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17
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Long-term response in high-grade optic glioma treated with medically induced hypothyroidism and carboplatin. Anticancer Drugs 2013; 24:315-23. [DOI: 10.1097/cad.0b013e32835c7a47] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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18
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Xu T, Qin R, Zhou J, Yan Y, Lu Y, Zhang X, Fu D, Lv Z, Li W, Xia C, Hu G, Ding X, Chen J. High bone sialoprotein (BSP) expression correlates with increased tumor grade and predicts a poorer prognosis of high-grade glioma patients. PLoS One 2012; 7:e48415. [PMID: 23119009 PMCID: PMC3485236 DOI: 10.1371/journal.pone.0048415] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Accepted: 09/25/2012] [Indexed: 01/02/2023] Open
Abstract
Objectives To investigate the expression and prognostic value of bone sialoprotein (BSP) in glioma patients. Methods We determined the expression of BSP using real-time RT-PCR and immunohistochemistry in tissue microarrays containing 15 normal brain and 270 glioma samples. Cumulative survival was calculated by the Kaplan-Meier method and analyzed by the log-rank test. Univariate and multivariate analyses were performed by the stepwise forward Cox regression model. Results Both BSP mRNA and protein levels were significantly elevated in high-grade glioma tissues compared with those of normal brain and low-grade glioma tissues, and BSP expression positively correlated with tumor grade (P<0.001). Univariate and multivariate analysis showed high BSP expression was an independent prognostic factor for a shorter progression-free survival (PFS) and overall survival (OS) in both grade III and grade IV glioma patients [hazard ratio (HR) = 2.549 and 3.154 for grade III glioma, and HR = 1.637 and 1.574 for grade IV glioma, respectively]. Patients with low BSP expression had a significantly longer median OS and PFS than those with high BSP expression. Small extent of resection and lineage of astrocyte served as independent risk factors of both shorter PFS and OS in grade III glioma patients; GBM patients without O6-methylguanine (O6-meG) DNA methyltransferase (MGMT) methylation and Karnofsky performance score (KPS) less than 70 points were related to poor prognosis. Lack of radiotherapy related to shorter OS but not affect PFS in both grade III and grade IV glioma patients. Conclusion High BSP expression occurs in a significant subset of high-grade glioma patients and predicts a poorer outcome. The study identifies a potentially useful molecular marker for the categorization and targeted therapy of gliomas.
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Affiliation(s)
- Tao Xu
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rong Qin
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jinxu Zhou
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yong Yan
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yicheng Lu
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaoping Zhang
- Department of Nuclear Medicine, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
- The Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences/Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Da Fu
- Department of Nuclear Medicine, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
- The Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences/Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhongwei Lv
- Department of Nuclear Medicine, Shanghai 10th People’s Hospital, Tongji University School of Medicine, Shanghai, China
- The Key Laboratory of Stem Cell Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences/Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Weiqing Li
- Department of Pathology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chunyan Xia
- Department of Pathology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Guohan Hu
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xuehua Ding
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Juxiang Chen
- Department of Neurosurgery, Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
- * E-mail:
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Intraventricular localization of an anaplastic oligodedendroglioma: a rare event. Can J Neurol Sci 2012; 39:649-51. [PMID: 22931708 DOI: 10.1017/s0317167100015407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Reardon DA, Herndon JE, Peters K, Desjardins A, Coan A, Lou E, Sumrall A, Turner S, Sathornsumetee S, Rich JN, Boulton S, Lipp ES, Friedman HS, Vredenburgh JJ. Outcome after bevacizumab clinical trial therapy among recurrent grade III malignant glioma patients. J Neurooncol 2011; 107:213-21. [PMID: 21997879 DOI: 10.1007/s11060-011-0740-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/03/2011] [Indexed: 12/23/2022]
Abstract
Although outcome following bevacizumab among recurrent grade IV malignant glioma patients is documented as poor by several analyses, outcome for recurrent grade III patients following bevacizumab therapy has not been specifically evaluated. We performed a pooled analysis of 96 recurrent grade III malignant glioma patients enrolled on three consecutive phase II bevacizumab salvage trials to evaluate overall outcome following bevacizumab trial discontinuation. Outcome on the three bevacizumab trials, which included similar eligibility, treatment and assessment criteria, was comparable. Forty-nine patients who progressed on bevacizumab trial therapy and remained alive for at least 30 days elected to receive additional therapy. These patients achieved a median PFS-6 and OS of 30.6% (95% CI: 18.4, 43.6) and 10.3 months (95% CI: 5.2, 11.7), respectively. Among patients who continued bevacizumab therapy (n = 23) after study progression, PFS-6 and median OS were 39.1% (95% CI: 19.9, 58.0) and 9.2 months (95% CI: 5.2, 13.6), respectively, compared to 23.1% (95% CI: 9.4, 40.3; P = 0.51) and 10.3 months (95% CI: 2.5, 14.4; P = 0.91) for patients who initiated non-bevacizumab containing therapy (n = 26). Outcome after discontinuation of bevacizumab therapy for recurrent grade III malignant glioma patients is associated with improved outcome compared to historical data for recurrent grade IV malignant glioma patients. Salvage therapies following bevacizumab failure have modest activity for grade III malignant glioma patients that is independent of further bevacizumab continuation.
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Affiliation(s)
- David A Reardon
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, SW-460F, Boston, MA 02215, USA.
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Abstract
Multiple vascular patterns are presented in tumors of the central nervous system (CNS), including microvascular hyperplasia, branching capillaries, numerous capillaries without definite pattern, hyalinized vessels, and angiomatous area. These vascular patterns play important roles in pathological diagnosis of brain tumors. Because of insufficient recognition of the significance of the various vascular patterns, only a few of them have been applied in pathological diagnosis, leading to missed diagnosis and diagnostic errors. Microvascular hyperplasia can present in multiple brain tumors but display different diagnostic values. Otherwise, varied brain tumors characterized by branching capillaries or vascular pattern mimicking branching capillaries should be given careful consideration. Therefore, a familiarity of these tumors and their vascular pattern is essential for general pathologists. This study reviews the value of various kinds of vascular patterns for pathological diagnosis of brain tumors, constructs a framework for better understanding, and provides a novel perspective for general pathologists.
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Affiliation(s)
- Jing Zhou
- Department of Pathology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
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Abstract
Although uncommon, anaplastic oligodendrogliomas (AODs) are important to recognize, as they have unique molecular, histologic, and clinical features. Patients with new seizures or new focal neurologic deficits should be referred for brain MRI with contrast. If the MRI suggests a malignant glioma, maximal feasible tumor resection is advised for accurate diagnosis and for relief of tumor-related neurologic symptoms. Radiation therapy (XRT) is the most commonly prescribed postsurgical therapy for patients with AODs. The role and timing of adjuvant chemotherapy are less clear. Tumor responses to PCV (the combination of procarbazine, lomustine, and vincristine) and to temozolomide have been documented in patients with AODs. However, two prospective phase 3 trials in patients with newly diagnosed AOD have shown no difference in overall survival when PCV is added to XRT. Ongoing trials investigating the benefit of temozolomide plus XRT in patients with newly diagnosed AOD will inform about the value of this common practice. The recognition that 1p19q codeletion is a marker of oligodendroglial differentiation and the subsequent prospective confirmation of this marker's importance in predicting better prognosis have been critical discoveries. Tumors with intermediate oligodendroglial features or mixed astrocytic features should be referred for 1p19q assessment. Identification of 1p19q status is also required in clinical trials for patients with AOD, given the association of 1p19q codeletion with improved response to therapies and overall prognosis. There are not yet sufficient data to guide individual treatment planning based on 1p19q status, but several planned and ongoing trials will address this issue. Unfortunately, AOD remains a terminal brain cancer even with maximal therapies. As more therapeutic options become available and the full significance of molecular markers is understood, 1p19q and other markers are expected to help guide optimal antitumor therapies, and it is hoped that survival and function will improve for all patients with AOD.
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Affiliation(s)
- Jaishri Blakeley
- Jaishri Blakeley, MD Brain Cancer Program, Johns Hopkins University, Cancer Research Building 2, 1550 Orleans, Suite 1M16, Baltimore, MD 21231, USA.
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Fischer I, Aldape K. Molecular tools: biology, prognosis, and therapeutic triage. Neuroimaging Clin N Am 2010; 20:273-82. [PMID: 20708546 DOI: 10.1016/j.nic.2010.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Diffuse gliomas in adults continue to have a dismal prognosis with the current standard therapeutic methods, including maximal surgical resection, radiation, and chemotherapy. The pathogenesis of adult glioma is complex, involving the loss of function of tumor suppressor genes and activation of oncogenes, which are involved in a network of interconnected signaling pathways. Through activation of these pathways, characteristics of malignant gliomas, including uncontrolled proliferation and growth, invasion, and angiogenesis, are driven. Evolving therapeutic approaches are focused on specifically targeting these genetic lesions. This content gives an overview of the current knowledge about the pathogenesis of adult diffuse gliomas, emphasizing new targeted treatment approaches.
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Affiliation(s)
- Ingeborg Fischer
- Department of Pathology, Unit 085, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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Abstract
BACKGROUND Oliogodendrogliomas are brain tumours composed of the cells resembling oligodendrocytes. They represent the third most common glial tumour, comprising 2.5% of all primary brain tumours and 5-20% of all gliomas. CONCLUSIONS Oligodendroglial tumours with 1p and 19q loss demonstrate a better overall prognosis due to more indolent clinical behaviour and higher sensitivity to treatment. Additionally, 1p and 19q loss is a marker of clinical utility, helping to assess tumour sensitivity to chemotherapy and harbouring the potential for improving the diagnosis and survival of oligodendroglioma patients as well as future clinical practice.
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Abstract
A better understanding of gliomas biology is now leading to a combined histo-molecular classification of these tumors. In anaplastic gliomas ongoing studies depend on 1p/19q codeletion status and in glioblastomas on MGMT methylation status. Advanced brain tumor imaging elicits a better identification of gliomas evolutive potential of. In low-grade gliomas, the importance of maximal resection and the role of chemotherapy are being increasingly recognized. In anaplastic gliomas, phase III studies have clarified the respective roles of chemotherapy and radiotherapy. In glioblastomas concomitant chemoradiotherapy is the standard. Most targeted therapies, namely anti-EGFR therapies have failed to demonstrate efficacy but anti-angiogenics are promising. The aim of this review is to discuss the main advances in adults' gliomas biology, imaging and treatment.
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Shirai K, Suzuki Y, Okamoto M, Wakatsuki M, Noda SE, Takahashi T, Ishiuchi S, Hasegawa M, Nakazato Y, Nakano T. Influence of histological subtype on survival after combined therapy of surgery and radiation in WHO grade 3 glioma. JOURNAL OF RADIATION RESEARCH 2010; 51:589-594. [PMID: 20921826 DOI: 10.1269/jrr.10055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
World Health Organization (WHO) grade 3 glioma is one of the common brain tumors and has three main histological subtypes, including anaplastic astrocytoma (AA), anaplastic oligoastrocytoma (AOA) and anaplastic oligodendroglioma (AO). However, most previous studies have considered AOA and AO as one group because of the difficult differential diagnosis between AOA and AO. Therefore the prognostic difference among patients with these histological subtypes has been unclear. In this study, 68 patients with histologically proven WHO grade 3 glioma, consecutively received postoperative radiotherapy at the Gunma University Hospital, Japan, between 1983 and 2005, were investigated to assess the impact of histological subtype on the survival. The number of AA, AOA and AO patients was 41, 16 and 11, respectively. The mean and median follow-up periods were 72 and 48 months, respectively. The number of patients treated with gross total resection, partial resection and biopsy was 14, 38 and 16, respectively. The mean and median radiation doses were 58 ± 5 Gy and 60 Gy, respectively. The 5-year overall survival rates of AA, AOA and AO were 21%, 38% and 80%, and median survival period were 16 months, 58 months and not reached, respectively. Univariate analysis showed that the histological subtype (P < 0.01) and extent of surgery (P < 0.01) were significant prognostic factors for survival. Selective comparison showed that overall survival of patients with AA was significantly worse than for those with AOA (P = 0.01) and AO (P < 0.01). The overall survival of patients with AO was better than for those with AOA; however, the difference was not statistically significant (P = 0.14). Multivariate analysis demonstrated that histological subtype, age and extent of surgery were the significant independent variable for survival (P < 0.01, P < 0.01 and P = 0.04). In our study, histological subtype was one of the most important prognostic factors of WHO grade 3 glioma.
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Affiliation(s)
- Katsuyuki Shirai
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Guillaume DJ, Doolittle ND, Gahramanov S, Hedrick NA, Delashaw JB, Neuwelt EA. Intra-arterial chemotherapy with osmotic blood-brain barrier disruption for aggressive oligodendroglial tumors: results of a phase I study. Neurosurgery 2009; 66:48-58; discussion 58. [PMID: 20023537 DOI: 10.1227/01.neu.0000363152.37594.f7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Refractory anaplastic oligodendroglioma and oligoastrocytoma tumors are challenging to treat. This trial primarily evaluated toxicity and estimated the maximum tolerated dose of intra-arterial (IA) melphalan, IA carboplatin, and intravenous (IV) etoposide phosphate in conjunction with blood-brain barrier disruption in these tumors. The secondary measure was efficacy. METHODS Thirteen patients with temozolomide-refractory anaplastic oligodendroglioma (11 patients) or oligoastrocytoma (2 patients) underwent blood-brain barrier disruption with carboplatin (IA, 200 mg/m(2)/d), etoposide phosphate (IV, 200 mg/m(2)/d), and melphalan (IA, dose escalation) every 4 weeks, for up to 1 year. Patients underwent melphalan dose escalation (4, 8, 12, 16, and 20 mg/m(2)/d) until the maximum tolerated dose (1 level below that producing grade 4 toxicity) was determined. Toxicity and efficacy were assessed. RESULTS Two of 4 patients receiving IA melphalan at 8 mg/m(2)/d developed grade 4 thrombocytopenia; thus, the melphalan maximum tolerated dose was 4 mg/m/d. Adverse events included asymptomatic subintimal tear (1 patient) and grade 4 thrombocytopenia (3 patients). Two patients demonstrated complete response, 3 had partial responses, 5 demonstrated stable disease, and 3 progressed. Median overall progression-free survival was 11 months. Patients with complete or partial response demonstrated deletion of chromosomes 1p and 19q. In the 5 patients with stable disease, 2 demonstrated 1p and 19q deletion, and 3 demonstrated 19q deletion only. CONCLUSION In patients with anaplastic oligodendroglioma or oligoastrocytoma tumors in whom temozolomide treatment has failed, osmotic blood-brain barrier disruption with IA carboplatin, IV etoposide phosphate, and IA melphalan (4 mg/m(2)/d for 2 days) shows acceptable toxicity and encouraging efficacy, especially in patients demonstrating 1p and/or 19q deletion.
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Affiliation(s)
- Daniel J Guillaume
- Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon, USA
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Park CK, Lee SH, Han JH, Kim CY, Kim DW, Paek SH, Kim DG, Heo DS, Kim IH, Jung HW. Recursive partitioning analysis of prognostic factors in WHO grade III glioma patients treated with radiotherapy or radiotherapy plus chemotherapy. BMC Cancer 2009; 9:450. [PMID: 20017960 PMCID: PMC2806410 DOI: 10.1186/1471-2407-9-450] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 12/18/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the hierarchical risk groups for the estimated survival of WHO grade III glioma patients using recursive partitioning analysis (RPA). To our knowledge, this is the first study to address the results of RPA specifically for WHO grade III gliomas. METHODS A total of 133 patients with anaplastic astrocytoma (AA, n = 56), anaplastic oligodendroglioma (AO, n = 67), or anaplastic oligoastrocytoma (AOA, n = 10) were included in the study. These patients were treated with either radiotherapy alone or radiotherapy followed by PCV chemotherapy after surgery. Five prognostic factors, including histological subsets, age, performance status, extent of resection, and treatment modality were incorporated into the RPA. The final nodes of RPA were grouped according to their survival times, and the Kaplan-Meier graphs are presented as the final set of prognostic groups. RESULTS Four risk groups were defined based on the clinical prognostic factors excluding age, and split variables were all incorporated into the RPA. Survival analysis showed significant differences in mean survival between the different groups: 163.4 months (95% CI: 144.9-182.0), 109.5 months (86.7-132.4), 66.6 months (50.8-82.4), and 27.7 months (16.3-39.0), respectively, from the lowest to the highest risk group (p = 0.00). CONCLUSION The present study shows that RPA grouping with clinical prognostic factors can successfully predict the survival of patients with WHO grade III glioma.
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Affiliation(s)
- Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University, Seoul 110-744, Korea.
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Abstract
Gliomas are the most common primary brain tumors. Despite the implementation of therapeutic strategies, these tumors remain fatal. The recent advances in the field of stem cell biology, cell signaling, genomics, bio-informatics and genetic model systems have led to a better understanding of gliomas biology. These advances are facilitating the establishment of a more precise, molecular-based, classification of gliomas and are leading to new therapeutic strategies directed against the key molecular events implicated in gliomas oncogenesis.
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Affiliation(s)
- Patrick Y Wen
- Division of Neuro-Oncology, Department of Neurology, Dana-Farber[corrected]/Brigham and Women's Hospital, Boston, MA 02115, USA.
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