1
|
Hong B, Lalk M, Wiese B, Merten R, Heissler HE, Raab P, Hartmann C, Krauss JK. Primary and secondary gliosarcoma: differences in treatment and outcome. Br J Neurosurg 2024; 38:332-339. [PMID: 33538191 DOI: 10.1080/02688697.2021.1872773] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION There are only few studies comparing differences in the outcome of primary versus secondary gliosarcoma. This study aimed to review the outcome and survival of patients with primary or secondary gliosarcoma following surgical resection and adjuvant treatment. The data were also matched with data of patients with primary and secondary glioblastoma (GBM). PATIENTS AND METHODS Treatment histories of 10 patients with primary gliosarcoma and 10 patients with secondary gliosarcoma were analysed and compared. Additionally, data of 20 patients with primary and 20 patients with secondary GBM were analysed and compared. All patients underwent surgical resection of the tumour in our department. Follow-up data, progression-free survival (PFS), and median overall survival (mOS) were evaluated. RESULTS The median PFS in patients with primary gliosarcoma was significantly higher than in patients with secondary gliosarcoma (p = 0.037). The 6-month PFS rates were 80.0% in patients with primary and 30.0% in patients with secondary gliosarcoma. Upon recurrence, five patients with primary gliosarcoma and four patients with secondary gliosarcoma underwent repeat surgical resection. The mOS of patients with primary gliosarcoma was significantly higher than that of patients with secondary gliosarcoma (p = 0.031). The percentage of patients surviving at 1-year/2-year follow-up in primary gliosarcoma was 70%/20%, while it was only 10%/10% in secondary gliosarcoma. When PFS and mOS of primary gliosarcoma was compared to primary GBM, there were no statistically differences (p = 0.509; p = 0.435). The PFS and mOS of secondary gliosarcoma and secondary GBM were also comparable (p = 0.290 and p = 0.390). CONCLUSION Patients with primary gliosarcoma have a higher PFS and mOS compared to those with secondary gliosarcoma. In the case of tumour recurrence, patients with secondary gliosarcoma harbour an unfavourable prognosis with limited further options. The outcome of patients with primary or secondary gliosarcoma is comparable to that of patients with primary or secondary GBM.
Collapse
Affiliation(s)
- Bujung Hong
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Department of Neurosurgery, Brandenburg Medical School, Helios Medical Center, Bad Saarow, Germany
| | - Michael Lalk
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Bettina Wiese
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Roland Merten
- Department of Radiation Oncology, Hannover Medical School, Hannover, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Peter Raab
- Institute of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Christian Hartmann
- Department for Neuropathology, Institute for Pathology, Hannover Medical School, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| |
Collapse
|
2
|
Kosianova А, Pak O, Bryukhovetskiy I. Regulation of cancer stem cells and immunotherapy of glioblastoma (Review). Biomed Rep 2024; 20:24. [PMID: 38170016 PMCID: PMC10758921 DOI: 10.3892/br.2023.1712] [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: 09/06/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
Glioblastoma (GB) is one of the most adverse diagnoses in oncology. Complex current treatment results in a median survival of 15 months. Resistance to treatment is associated with the presence of cancer stem cells (CSCs). The present review aimed to analyze the mechanisms of CSC plasticity, showing the particular role of β-catenin in regulating vital functions of CSCs, and to describe the molecular mechanisms of Wnt-independent increase of β-catenin levels, which is influenced by the local microenvironment of CSCs. The present review also analyzed the reasons for the low effectiveness of using medication in the regulation of CSCs, and proposed the development of immunotherapy scenarios with tumor cell vaccines, containing heterogenous cancer cells able of producing a multidirectional antineoplastic immune response. Additionally, the possibility of managing lymphopenia by transplanting hematopoietic stem cells from a healthy sibling and using clofazimine or other repurposed drugs that reduce β-catenin concentration in CSCs was discussed in the present study.
Collapse
Affiliation(s)
- Аleksandra Kosianova
- Medical Center, School of Medicine and Life Science, Far Eastern Federal University, Vladivostok 690091, Russian Federation
| | - Oleg Pak
- Medical Center, School of Medicine and Life Science, Far Eastern Federal University, Vladivostok 690091, Russian Federation
| | - Igor Bryukhovetskiy
- Medical Center, School of Medicine and Life Science, Far Eastern Federal University, Vladivostok 690091, Russian Federation
| |
Collapse
|
3
|
Wang R, Li Q, Chu X, Li N, Liang H, He F. Sequencing and Bioinformatics analysis of lncRNA/circRNA-miRNA-mRNA in Glioblastoma multiforme. Metab Brain Dis 2023; 38:2289-2300. [PMID: 37389689 DOI: 10.1007/s11011-023-01256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
Evidence suggests that non-coding RNAs have a role in glioblastoma multiforme (GBM), although the regulatory mechanisms controlled by competing endogenous RNAs (ceRNAs) in GBM are still poorly understood and infrequently described. This research extensively analyzed circRNA, lncRNA, miRNA, and mRNA expression changes in GBM patients. RNA-sequencing analyses were conducted to investigate differentially expressed genes (DEGs), lncRNAs (DELs), miRNAs (DEMs), and circRNAs (DECs) in the GBM. In this study, researchers found that GBM patients and healthy controls differed in the presence of 1224 DECs, 1406 DELs, 229 DEMs, and 2740 DEGs. PPI network analysis demonstrated that CEACAM5, CXCL17, FAM83A, TMPRSS4, and GGPRC5A were hub genes and enriched in modules. Then a ceRNA network was constructed with 8 circRNA, 7 lncRNAs, 16 miRNAs, and 17 mRNAs. Overall, the ceRNA interaction axes that were found may prove to be pivotal therapeutic targets for treating GBM.
Collapse
Affiliation(s)
- Renjie Wang
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China
- Department of Neurosurgery, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China
| | - Qi Li
- Tianjin Hospital, Tianjin University, Tianjin, 300050, China
| | - Xiaolei Chu
- Tianjin Hospital, Tianjin University, Tianjin, 300050, China
| | - Nan Li
- Department of Neurosurgery, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China
| | - Haiqian Liang
- Department of Neurosurgery, Characteristic Medical Center of Chinese People's Armed Police Force, Tianjin, 300162, China.
| | - Feng He
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, 300072, China.
| |
Collapse
|
4
|
Vaz-Salgado MA, Villamayor M, Albarrán V, Alía V, Sotoca P, Chamorro J, Rosero D, Barrill AM, Martín M, Fernandez E, Gutierrez JA, Rojas-Medina LM, Ley L. Recurrent Glioblastoma: A Review of the Treatment Options. Cancers (Basel) 2023; 15:4279. [PMID: 37686553 PMCID: PMC10487236 DOI: 10.3390/cancers15174279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/14/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Glioblastoma is a disease with a poor prognosis. Multiple efforts have been made to improve the long-term outcome, but the 5-year survival rate is still 5-10%. Recurrence of the disease is the usual way of progression. In this situation, there is no standard treatment. Different treatment options can be considered. Among them would be reoperation or reirradiation. There are different studies that have assessed the impact on survival and the selection of patients who may benefit most from these strategies. Chemotherapy treatments have also been considered in several studies, mainly with alkylating agents, with data mostly from phase II studies. On the other hand, multiple studies have been carried out with target-directed treatments. Bevacizumab, a monoclonal antibody with anti-angiogenic activity, has demonstrated activity in several studies, and the FDA has approved it for this indication. Several other TKI drugs have been evaluated in this setting, but no clear benefit has been demonstrated. Immunotherapy treatments have been shown to be effective in other types of tumors, and several studies have evaluated their efficacy in this disease, both immune checkpoint inhibitors, oncolytic viruses, and vaccines. This paper reviews data from different studies that have evaluated the efficacy of different forms of relapsed glioblastoma.
Collapse
Affiliation(s)
- Maria Angeles Vaz-Salgado
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - María Villamayor
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Víctor Albarrán
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Víctor Alía
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Pilar Sotoca
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Jesús Chamorro
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Diana Rosero
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Ana M. Barrill
- Medical Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.V.); (V.A.); (V.A.); (P.S.); (J.C.); (D.R.); (A.M.B.)
| | - Mercedes Martín
- Radiotherapy Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.M.); (E.F.)
| | - Eva Fernandez
- Radiotherapy Oncology Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (M.M.); (E.F.)
| | - José Antonio Gutierrez
- Neurosurgery Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (J.A.G.); (L.M.R.-M.); (L.L.)
| | - Luis Mariano Rojas-Medina
- Neurosurgery Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (J.A.G.); (L.M.R.-M.); (L.L.)
| | - Luis Ley
- Neurosurgery Department, Ramon y Cajal University Hospital, 28034 Madrid, Spain; (J.A.G.); (L.M.R.-M.); (L.L.)
| |
Collapse
|
5
|
Zhao W, Sun X, Shi L, Cai SZ, Ma ZR. Discovery of novel analogs of KHS101 as transforming acidic coiled coil containing protein 3 (TACC3) inhibitors for the treatment of glioblastoma. Eur J Med Chem 2022; 244:114874. [DOI: 10.1016/j.ejmech.2022.114874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
|
6
|
Leone A, Colamaria A, Fochi NP, Sacco M, Landriscina M, Parbonetti G, de Notaris M, Coppola G, De Santis E, Giordano G, Carbone F. Recurrent Glioblastoma Treatment: State of the Art and Future Perspectives in the Precision Medicine Era. Biomedicines 2022; 10:biomedicines10081927. [PMID: 36009473 PMCID: PMC9405902 DOI: 10.3390/biomedicines10081927] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/20/2022] Open
Abstract
Current treatment guidelines for the management of recurrent glioblastoma (rGBM) are far from definitive, and the prognosis remains dismal. Despite recent advancements in the pharmacological and surgical fields, numerous doubts persist concerning the optimal strategy that clinicians should adopt for patients who fail the first lines of treatment and present signs of progressive disease. With most recurrences being located within the margins of the previously resected lesion, a comprehensive molecular and genetic profiling of rGBM revealed substantial differences compared with newly diagnosed disease. In the present comprehensive review, we sought to examine the current treatment guidelines and the new perspectives that polarize the field of neuro-oncology, strictly focusing on progressive disease. For this purpose, updated PRISMA guidelines were followed to search for pivotal studies and clinical trials published in the last five years. A total of 125 articles discussing locoregional management, radiotherapy, chemotherapy, and immunotherapy strategies were included in our analysis, and salient findings were critically summarized. In addition, an in-depth description of the molecular profile of rGBM and its distinctive characteristics is provided. Finally, we integrate the above-mentioned evidence with the current guidelines published by international societies, including AANS/CNS, EANO, AIOM, and NCCN.
Collapse
Affiliation(s)
- Augusto Leone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, Germany
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany
| | | | - Nicola Pio Fochi
- Department of Neurosurgery, University of Foggia, 71122 Foggia, Italy
| | - Matteo Sacco
- Department of Neurosurgery, Riuniti Hospital, 71122 Foggia, Italy
| | - Matteo Landriscina
- Unit of Medical
Oncology and Biomolecular Therapy, Department of Medical and Surgical
Sciences, University of Foggia, 71122 Foggia, Italy
| | | | - Matteo de Notaris
- Department of Neurosurgery, “Rummo” Hospital, 82100 Benevento, Italy
| | - Giulia Coppola
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, 00185 Roma, Italy
| | - Elena De Santis
- Department of Anatomical Histological Forensic Medicine and Orthopedic Sciences, Sapienza University of Rome, 00185 Roma, Italy
| | - Guido Giordano
- Unit of Medical
Oncology and Biomolecular Therapy, Department of Medical and Surgical
Sciences, University of Foggia, 71122 Foggia, Italy
- Correspondence:
| | - Francesco Carbone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, 76133 Karlsruhe, Germany
- Department of Neurosurgery, University of Foggia, 71122 Foggia, Italy
| |
Collapse
|
7
|
Sorensen von Essen H, Stacey D, Dahl Steffensen K, Guldager R, Rom Poulsen F, Piil K. Decisional needs of patients with recurrent high-grade glioma and their families. Neurooncol Pract 2022; 9:402-410. [PMID: 36127893 PMCID: PMC9476966 DOI: 10.1093/nop/npac046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background High-grade gliomas are aggressive and life-threatening brain tumors. At the time of recurrence, the patients and their families need to decide on future treatment. None of the treatment options are curative, and tradeoffs between benefits and harms must be made. This study aimed to explore the patients’ and family members’ decisional needs when making the decision. Methods We performed semi-structured individual interviews with patients and family members to explore their experiences during the decision making. A phenomenological hermeneutical analysis was conducted. Results A total of 15 patients and 14 family members aged 22-79 years participated in the study. Most of the family members were partners to the patient. The findings were centered around three interrelated and concurrently occurring themes: (I) A patient- and family-centered decision making, including the subtheme of being a supportive family member; (II) Balanced information and a trustful professional encounter; and (III) The value of hope. We found that both the patients and family members preferred to be involved in the decision making and that a trustful relationship with the surgeon, balanced and tailored information, and sufficient time to make the decision were essential. The experience of hope had a significant influence on patients’ decisions. Conclusion This study found that patient and family involvement, balanced information, and hope were the primary decisional needs of patients and family members at the time of recurrent high-grade glioma. Patients and family members can have different decisional needs, making individual needs assessment essential to decisional support.
Collapse
Affiliation(s)
- Helle Sorensen von Essen
- Department of Neurosurgery, Odense University Hospital , Odense , Denmark
- Clinical Institute and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark , Odense , Denmark
| | - Dawn Stacey
- Center for Shared Decision Making, Region of Southern Denmark , Vejle , Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
- School of Nursing and Ottawa Hospital Research Institute, University of Ottawa , Ottawa, Ontario , Canada
| | - Karina Dahl Steffensen
- Center for Shared Decision Making, Region of Southern Denmark , Vejle , Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark , Odense , Denmark
| | - Rikke Guldager
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet , Copenhagen , Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital , Odense , Denmark
- Clinical Institute and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark , Odense , Denmark
| | - Karin Piil
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital , Copenhagen , Denmark
- Department of Public Health, Aarhus University , Aarhus C , Denmark
| |
Collapse
|
8
|
Survival after reoperation for recurrent glioblastoma multiforme: A prospective study. Surg Oncol 2022; 42:101771. [DOI: 10.1016/j.suronc.2022.101771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/28/2022] [Accepted: 04/10/2022] [Indexed: 11/22/2022]
|
9
|
Seyfrid M, Maich WT, Shaikh VM, Tatari N, Upreti D, Piyasena D, Subapanditha M, Savage N, McKenna D, Mikolajewicz N, Han H, Chokshi C, Kuhlmann L, Khoo A, Salim SK, Archibong-Bassey B, Gwynne W, Brown K, Murtaza N, Bakhshinyan D, Vora P, Venugopal C, Moffat J, Kislinger T, Singh S. CD70 as an actionable immunotherapeutic target in recurrent glioblastoma and its microenvironment. J Immunother Cancer 2022; 10:e003289. [PMID: 35017149 PMCID: PMC8753449 DOI: 10.1136/jitc-2021-003289] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Glioblastoma (GBM) patients suffer from a dismal prognosis, with standard of care therapy inevitably leading to therapy-resistant recurrent tumors. The presence of cancer stem cells (CSCs) drives the extensive heterogeneity seen in GBM, prompting the need for novel therapies specifically targeting this subset of tumor-driving cells. Here, we identify CD70 as a potential therapeutic target for recurrent GBM CSCs. EXPERIMENTAL DESIGN In the current study, we identified the relevance and functional influence of CD70 on primary and recurrent GBM cells, and further define its function using established stem cell assays. We use CD70 knockdown studies, subsequent RNAseq pathway analysis, and in vivo xenotransplantation to validate CD70's role in GBM. Next, we developed and tested an anti-CD70 chimeric antigen receptor (CAR)-T therapy, which we validated in vitro and in vivo using our established preclinical model of human GBM. Lastly, we explored the importance of CD70 in the tumor immune microenvironment (TIME) by assessing the presence of its receptor, CD27, in immune infiltrates derived from freshly resected GBM tumor samples. RESULTS CD70 expression is elevated in recurrent GBM and CD70 knockdown reduces tumorigenicity in vitro and in vivo. CD70 CAR-T therapy significantly improves prognosis in vivo. We also found CD27 to be present on the cell surface of multiple relevant GBM TIME cell populations, notably putative M1 macrophages and CD4 T cells. CONCLUSION CD70 plays a key role in recurrent GBM cell aggressiveness and maintenance. Immunotherapeutic targeting of CD70 significantly improves survival in animal models and the CD70/CD27 axis may be a viable polytherapeutic avenue to co-target both GBM and its TIME.
Collapse
Affiliation(s)
- Mathieu Seyfrid
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - William Thomas Maich
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Nazanin Tatari
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Deepak Upreti
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Deween Piyasena
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Minomi Subapanditha
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Neil Savage
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dillon McKenna
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Nicholas Mikolajewicz
- Department of Molecular Genetics - Donnelly Centre, University of Toronto, Toronto, Ontario, Canada
| | - Hong Han
- Department of Molecular Genetics - Donnelly Centre, University of Toronto, Toronto, Ontario, Canada
| | - Chirayu Chokshi
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Kuhlmann
- Department of Medical Biophysics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Amanda Khoo
- Department of Medical Biophysics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Sabra Khalid Salim
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - William Gwynne
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kevin Brown
- Department of Molecular Genetics - Donnelly Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nadeem Murtaza
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David Bakhshinyan
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Parvez Vora
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Chitra Venugopal
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jason Moffat
- Department of Molecular Genetics - Donnelly Centre, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Kislinger
- Department of Medical Biophysics, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Sheila Singh
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
10
|
Raspagliesi L, D'Ammando A, Gionso M, Sheybani ND, Lopes MB, Moore D, Allen S, Gatesman J, Porto E, Timbie K, Franzini A, Di Meco F, Sheehan J, Xu Z, Prada F. Intracranial Sonodynamic Therapy With 5-Aminolevulinic Acid and Sodium Fluorescein: Safety Study in a Porcine Model. Front Oncol 2021; 11:679989. [PMID: 34235081 PMCID: PMC8256685 DOI: 10.3389/fonc.2021.679989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 02/02/2023] Open
Abstract
Background Sonodynamic therapy (SDT) is an emerging ultrasound-based treatment modality for malignant gliomas which combines ultrasound with sonosensitizers to produce a localized cytotoxic and modulatory effect. Tumor-specificity of the treatment is achieved by the selective extravasation and accumulation of sonosensitizers in the tumor-bearing regions. The aim of this study is to demonstrate the safety of low-intensity ultrasonic irradiation of healthy brain tissue after the administration of FDA-approved sonosensitizers used for SDT in experimental studies in an in vivo large animal model. Methods In vivo safety of fluorescein (Na-Fl)- and 5 aminolevulinic acid (5-ALA)-mediated low-intensity ultrasound irradiation of healthy brain parenchyma was assessed in two sets of four healthy swine brains, using the magnetic resonance imaging (MRI)-guided Insightec ExAblate 4000 220 kHz system. After administration of the sonosensitizers, a wide fronto-parietal craniotomy was performed in pig skulls to allow transmission of ultrasonic beams. Sonication was performed on different spots within the thalamus and periventricular white matter with continuous thermal monitoring. Sonication-related effects were investigated with MRI and histological analysis. Results Post-treatment MRI images acquired within one hour following the last sonication, on day one, and day seven did not visualize any sign of brain damage. On histopathology, no signs of necrosis or apoptosis attributable to the ultrasonic treatments were shown in target areas. Conclusions The results of the present study suggest that either Na-FL or 5-ALA-mediated sonodynamic therapies under MRI-guidance with the current acoustic parameters are safe towards healthy brain tissue in a large in vivo model. These results further support growing interest in clinical translation of sonodynamic therapy for intracranial gliomas and other brain tumors.
Collapse
Affiliation(s)
- Luca Raspagliesi
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio D'Ammando
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Natasha D Sheybani
- Division of Oncology, Department of Medicine, Stanford Cancer Institute, Stanford University, Stanford, CA, United States
| | - Maria-Beatriz Lopes
- Department of Pathology, University of Virginia, Charlottesville, VA, United States
| | - David Moore
- Focused Ultrasound Foundation, Charlottesville, VA, United States
| | - Steven Allen
- Department of Biomedical Engineering, University of Virginia, Charlottesville, VA, United States
| | - Jeremy Gatesman
- Center for Comparative Medicine, University of Virginia, Charlottesville, VA, United States
| | - Edoardo Porto
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Kelsie Timbie
- Focused Ultrasound Foundation, Charlottesville, VA, United States
| | - Andrea Franzini
- Department of Neurosurgery, Humanitas Clinical and Research Center, Milan, Italy
| | - Francesco Di Meco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy.,Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Jason Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Francesco Prada
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.,Focused Ultrasound Foundation, Charlottesville, VA, United States.,Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States.,Acoustic Neuroimaging and Therapy Laboratory, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| |
Collapse
|
11
|
Patel M, Au K, Davis FG, Easaw JC, Mehta V, Broad R, Chow MMC, Hockley A, Kaderali Z, Magro E, Nataraj A, Scholtes F, Chagnon M, Gevry G, Raymond J, Darsaut TE. Clinical Uncertainty and Equipoise in the Management of Recurrent Glioblastoma. Am J Clin Oncol 2021; 44:258-263. [PMID: 33782334 DOI: 10.1097/coc.0000000000000812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A significant proportion of glioblastoma (GBM) patients are considered for repeat resection, but evidence regarding best management remains elusive. Our aim was to measure the degree of clinical uncertainty regarding reoperation for patients with recurrent GBM. METHODS We first performed a systematic review of agreement studies examining the question of repeat resection for recurrent GBM. An electronic portfolio of 37 pathologically confirmed recurrent GBM patients including pertinent magnetic resonance images and clinical information was assembled. To measure clinical uncertainty, 26 neurosurgeons from various countries, training backgrounds, and years' experience were asked to select best management (repeat surgery, other nonsurgical management, or conservative), confidence in recommended management, and whether they would include the patient in a randomized trial comparing surgery with nonsurgical options. Agreement was evaluated using κ statistics. RESULTS The literature review did not reveal previous agreement studies examining the question. In our study, agreement regarding best management of recurrent GBM was slight, even when management options were dichotomized (repeat surgery vs. other options; κ=0.198 [95% confidence interval: 0.133-0.276]). Country of practice, years' experience, and training background did not change results. Disagreement and clinical uncertainty were more pronounced within clinicians with (κ=0.167 [0.055-0.314]) than clinicians without neuro-oncology fellowship training (κ=0.601 [0.556-0.646]). A majority (51%) of responders were willing to include the patient in a randomized trial comparing repeat surgery with nonsurgical alternatives in 26/37 (69%) of cases. CONCLUSION There is sufficient uncertainty and equipoise regarding the question of reoperation for patients with recurrent glioblastoma to support the need for a randomized controlled trial.
Collapse
Affiliation(s)
- Mukt Patel
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | - Karolyn Au
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | | | - Jacob C Easaw
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB
| | - Vivek Mehta
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | - Robert Broad
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | - Michael M C Chow
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | - Aaron Hockley
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | - Zul Kaderali
- Section of Neurosurgery, GB1-Health Sciences Centre, Winnipeg, MB, Canada
| | - Elsa Magro
- Neurosurgery service, CHU Cavale Blanche, INSERM UMR 1101 LaTIM, Boulevard Tanguy-Prigent Brest, France
| | - Andrew Nataraj
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| | | | - Miguel Chagnon
- Department of Mathematics and Statistics, André-Aisenstadt Pavillon (AA-5190)
| | - Guylaine Gevry
- Department of Radiology, Centre Hospitalier of University of Montreal (CHUM), Montreal, QC, Canada
| | - Jean Raymond
- Department of Radiology, Centre Hospitalier of University of Montreal (CHUM), Montreal, QC, Canada
| | - Tim E Darsaut
- Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Centre
| |
Collapse
|
12
|
Zhao M, Fu X, Zhang Z, Ma L, Wang X, Li X. Gamma Knife Radiosurgery for High-Grade Gliomas: Single-Center Experience of Six Years in China. Stereotact Funct Neurosurg 2021; 99:181-186. [PMID: 33756470 DOI: 10.1159/000509782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/22/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of Gamma Knife radiosurgery (GKRS) as a salvage therapy for high-grade glioma in our center. METHODS A total of 167 patients with malignant glioma were treated with GKRS in our Gamma Knife Center between January 2013 and December 2017; 140 patients (85 males and 55 females) were followed up and enrolled in our study. A single lesion was found in 110 cases, and multiple lesions were found in 30 cases; 108 cases received a single therapy, and in 32 cases, at least 2 GKRSs were performed. The median tumor volume was 13.5 cm3. The mean radiation dosage was 14.35 Gy (range, 6-18 Gy). MRI was performed regularly. The RANO criteria and Cox analysis were used to evaluate the therapeutic efficiency. RESULTS Follow-up MRI showed the local control rate was 61.4% at 3 months after GKRS, 25.0% at 6 months, and 7.1% at 12 months. The mean and median progression-free survival (PFS) periods were 8.6 (95% CI, 6.3-11.0) and 4 (95% CI, 3.5-4.5) (range, 1-60) months, respectively. The overall survival (OS) after GKRS was 3-62 months, with a mean of 16.7 (95% CI, 14.6-18.9) months, and the median survival was 13 (95% CI, 12.1-13.9) months. The 1-, 2-, and 5-year survival rates were 51.4, 10.0, and 2.9%, respectively. No severe complications occurred. Cox regression showed that glioma pathology was closely related to prognosis (p < 0.05). The Karnofsky Performance Score had little influence on PFS (p > 0.05) but influenced OS significantly (p < 0.05). CONCLUSION GKRS can be used to effectively treat malignant brain glioma and can therefore be used as an alternative treatment option.
Collapse
Affiliation(s)
- Ming Zhao
- Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China,
| | - Xiangping Fu
- Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhiwen Zhang
- Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liang Ma
- Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xiaopeng Wang
- Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xuexiu Li
- Department of Neurosurgery, Fourth Medical Center, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
13
|
Patel KS, Everson RG, Yao J, Raymond C, Goldman J, Schlossman J, Tsung J, Tan C, Pope WB, Ji MS, Nguyen NT, Lai A, Nghiemphu PL, Liau LM, Cloughesy TF, Ellingson BM. Diffusion Magnetic Resonance Imaging Phenotypes Predict Overall Survival Benefit From Bevacizumab or Surgery in Recurrent Glioblastoma With Large Tumor Burden. Neurosurgery 2021; 87:931-938. [PMID: 32365185 DOI: 10.1093/neuros/nyaa135] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/02/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diffusion magnetic resonance (MR) characteristics are a predictive imaging biomarker for survival benefit in recurrent glioblastoma treated with anti-vascular endothelial growth factor (VEGF) therapy; however, its use in large volume recurrence has not been evaluated. OBJECTIVE To determine if diffusion MR characteristics can predict survival outcomes in patients with large volume recurrent glioblastoma treated with bevacizumab or repeat resection. METHODS A total of 32 patients with large volume (>20 cc or > 3.4 cm diameter) recurrent glioblastoma treated with bevacizumab and 35 patients treated with repeat surgery were included. Pretreatment tumor volume and apparent diffusion coefficient (ADC) histogram analysis were used to phenotype patients as having high (>1.24 μm2/ms) or low (<1.24 μm2/ms) ADCL, the mean value of the lower peak in a double Gaussian model of the ADC histogram within the contrast enhancing tumor. RESULTS In bevacizumab and surgical cohorts, volume was correlated with overall survival (Bevacizumab: P = .009, HR = 1.02; Surgical: P = .006, HR = 0.96). ADCL was an independent predictor of survival in the bevacizumab cohort (P = .049, HR = 0.44), but not the surgical cohort (P = .273, HR = 0.67). There was a survival advantage of surgery over bevacizumab in patients with low ADCL (P = .036, HR = 0.43) but not in patients with high ADCL (P = .284, HR = 0.69). CONCLUSION Pretreatment diffusion MR imaging is an independent predictive biomarker for overall survival in recurrent glioblastoma with a large tumor burden. Large tumors with low ADCL have a survival benefit when treated with surgical resection, whereas large tumors with high ADCL may be best managed with bevacizumab.
Collapse
Affiliation(s)
- Kunal S Patel
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Richard G Everson
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jingwen Yao
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jodi Goldman
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jacob Schlossman
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Joseph Tsung
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Caleb Tan
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Whitney B Pope
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Matthew S Ji
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Nhung T Nguyen
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Albert Lai
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Phioanh L Nghiemphu
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| |
Collapse
|
14
|
Sacko O, Benouaich-Amiel A, Brandicourt P, Niaré M, Charni S, Cavandoli C, Brauge D, Catalaa I, Brenner A, Moyal ECJ, Roux FE. The Impact of Surgery on the Survival of Patients with Recurrent Glioblastoma. Asian J Neurosurg 2021; 16:1-7. [PMID: 34211860 PMCID: PMC8202372 DOI: 10.4103/ajns.ajns_180_20] [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: 04/27/2020] [Revised: 06/06/2020] [Accepted: 09/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objective: The purpose of this study was to investigate the possible benefit of repeat surgery on overall survival for patients with recurrent glioblastoma multiforme (GBM). Methods: We performed a retrospective analysis of data from patients who presented with recurrent GBM over a 5-year period (n = 157), comparing baseline characteristics and survival for patients who had at least 1 new tumor resection followed by chemotherapy (reoperation group, n = 59) and those who received medical treatment only (no-reoperation group, n = 98) for recurrence. Results: The baseline characteristics of the two groups differed in terms of WHO performance status (better in the reoperation group), mean age (60 years in the reoperation group vs. 65 years in the no-reoperation group), mean interval to recurrence (3 months later in the reoperation group than in the no-reoperation group) and more gross total resections in the reoperation group. Nevertheless, the patients in the reoperation group had a higher rate [32.8%] of sensorimotor deficits than those of the no-reoperation group [14.2]. There was no significant difference in sex; tumor localization, side, or extent; MGMT status; MIB-1 labeling index; or Karnofsky Performance Status [KPS] score. After adjustment for age, the WHO performance status, interval of recurrence, and extent of resection at the first operation, multivariate analysis showed that median survival was significantly better in the reoperation group than in the no-reoperation group (22.9 vs. 14.61 months, P < 0.05). After a total of 69 repeat operations in 59 patients (10 had 2 repeat surgeries), we noted 13 temporary and 20 permanent adverse postoperative events, yielding a permanent complication rate of 28.99% (20/69). There was also a statistically significant (P = 0.029, Student's t-test) decrease in the mean KPS score after reoperation (mean preoperative KPS score of 89.34 vs. mean postoperative score of 84.91). Conclusion: Our retrospective study suggests that repeat surgery may be beneficial for patients with GBM recurrence who have good functional status (WHO performance status 0 and 1), although the potential benefits must be weighed against the risk of permanent complications, which occurred in almost 30% of the patients who underwent repeat resection in this series.
Collapse
Affiliation(s)
- Oumar Sacko
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France
| | - Alexandra Benouaich-Amiel
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France
| | - Pierre Brandicourt
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France
| | - Mahamadou Niaré
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France.,CNRS (Centre Recherche et Cognition), Toulouse, France
| | - Saloua Charni
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France.,CNRS (Centre Recherche et Cognition), Toulouse, France
| | - Clarissa Cavandoli
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France
| | - David Brauge
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France
| | - Isabelle Catalaa
- Neuroradiologie, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France
| | - Adam Brenner
- Western University of Health Sciences, Pomona, USA
| | | | - Franck-Emmanuel Roux
- Pôle Neurosciences, Neurochirurgie, PPR, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Université Paul-Sabatier, Toulouse, France.,CNRS (Centre Recherche et Cognition), Toulouse, France
| |
Collapse
|
15
|
Neville IS, Dos Santos AG, Almeida CC, Abaurre LB, Wayhs SY, Feher O, Teixeira MJ, Lepski G. Reoperation for recurrent glioblastomas: What to expect? Surg Neurol Int 2021; 12:42. [PMID: 33598358 PMCID: PMC7881499 DOI: 10.25259/sni_538_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/17/2020] [Indexed: 12/27/2022] Open
Abstract
Background: The current standard treatment for glioblastoma (GBM) is maximal safe surgical resection followed by radiation and chemotherapy. Unfortunately, the disease will invariably recur even with the best treatment. Although the literature suggests some advantages in reoperating patients harboring GBM, controversy remains. Here, we asked whether reoperation is an efficacious treatment strategy for GBM, and under which circumstances, it confers a better prognosis. Methods: We retrospectively reviewed 286 consecutive cases of newly diagnosed GBM in a single university hospital from 2008 to 2015. We evaluated clinical and epidemiological parameters possibly influencing overall survival (OS) by multivariate Cox regression analysis. OS was calculated using the Kaplan–Meier method in patients submitted to one or two surgical procedures. Finally, the survival curves were fitted with the Weibull model, and survival rates at 6, 12, and 24 months were estimated. Results: The reoperated group survived significantly longer (n = 63, OS = 20.0 ± 2.3 vs. 11.4 ± 1.0 months, P < 0.0001). Second, the multivariate analysis revealed an association between survival and number of surgeries, initial Karnofsky Performance Status, and age (all P < 0.001). Survival estimates according to the Weibull regression model revealed higher survival probabilities for reoperation compared with one operation at 6 months (83.74 ± 3.42 vs. 63.56 ± 3.59, respectively), 12 months (64.00 ± 4.85 vs. 37.53 ± 3.52), and 24 months (32.53 ± 4.78 vs. 12.02 ± 2.36). Conclusion: Our data support the indication of reoperation for GBM, especially for younger patients with good functional status. Under these circumstances, survival can be doubled at 12 and 24 months.
Collapse
Affiliation(s)
| | | | | | | | - Samia Yasin Wayhs
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Olavo Feher
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas
| | | | - Guilherme Lepski
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| |
Collapse
|
16
|
Sorensen von Essen H, Piil K, Dahl Steffensen K, Rom Poulsen F. Shared decision making in high-grade glioma patients-a systematic review. Neurooncol Pract 2020; 7:589-598. [PMID: 33304599 PMCID: PMC7716176 DOI: 10.1093/nop/npaa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Shared decision making (SDM) has proven to be a valuable approach in different patient populations when treatment decisions are called for. Along the disease trajectory of high-grade glioma (HGG), patients are presented with a series of treatment decisions. At the same time, HGG patients often experience cognitive deterioration and reduced decision-making capacity. This study aimed to review the current knowledge about shared decision making from the perspective of the HGG patient. Methods Systematic searches were performed in MEDLINE, CINAHL, PsycINFO, and EMBASE. Studies were reviewed against the inclusion criteria and assessed for methodological quality. Descriptive data from the included studies were extracted and a narrative synthesis of the findings was performed. Results The searches resulted in 5051 original records. Four studies involving 178 HGG patients fulfilled the inclusion criteria. The narrative synthesis revealed that most HGG patients in the included studies appreciated an SDM approach and that sufficient information and involvement increased patients’ emotional well-being. The use of a patient decision aid showed the potential to increase knowledge, decrease uncertainty, and affect the treatment decision making of HGG patients. Conclusion The results indicate that many HGG patients prefer an SDM approach and that SDM can lead patients toward improved emotional well-being. The evidence is weak, however, and firm conclusions and practice guidelines concerning SDM in HGG patients cannot be made. Future research is warranted to improve decision support for HGG patients.
Collapse
Affiliation(s)
- Helle Sorensen von Essen
- Department of Neurosurgery, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark, Odense C, Denmark
| | - Karin Piil
- Department of Oncology 5074, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Karina Dahl Steffensen
- Department of Oncology, Lillebaelt University Hospital of Southern Denmark, Vejle, Denmark.,Center for Shared Decision Making, Region of Southern Denmark, Vejle, Denmark.,Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Frantz Rom Poulsen
- Department of Neurosurgery, Odense University Hospital, Odense C, Denmark.,Department of Clinical Research and BRIDGE (Brain Research-Interdisciplinary Guided Excellence), University of Southern Denmark, Odense C, Denmark
| |
Collapse
|
17
|
Delgado-Fernández J, Frade-Porto N, Blasco G, González-Tarno P, Gil-Simoes R, Li ZQ, Rivas PP, de Sola RG. Does reintervention improve survival in recurrent glioblastoma? Facing a temporal bias in the literature. Acta Neurochir (Wien) 2020; 162:1967-1975. [PMID: 32556522 DOI: 10.1007/s00701-020-04432-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Glioblastoma (GBM) is the most frequent intraaxial malignant brain tumour, in which recurrence management is a frequent and demanding issue. Recently, reintervention has emerged as a useful tool for treatment. However, some new evidence has shown that most of the articles published could have overestimated its effects. We aimed to analyse the effect on survival of reintervention considering it as a time-dependent variable and to compare it with classic statistical analysis. METHODS We performed a retrospective study with GBM patients between 2007 and 2017. We compared the overall survival (OS) between reintervention and non-reintervention groups with time-dependent statistical methods (Simon-Makuch and landmarking methods and time-dependent multivariable Cox analysis) and compared them with those obtained with non-dependent time variable analysis. RESULTS A total of 183 patients were included in the analysis and 44 of them were reoperated. The standard analysis with Kaplan-Meier and multivariable Cox regression of the cohort showed an OS of 22.2 months (95% CI 12.56-16.06) in the reintervention group and 11.8 months (95% CI 9.87-13.67) in the non-reintervention group (p < .001); and an HR 0.649 (95% CI 0.434-0.97 p = .035) for reintervention, demonstrating an increase in OS. However, time-dependent analysis with the Simon-Makuch test and the landmarking method showed that the relationship was not consistent, as this increase in OS was not significant. Moreover, time-dependent multivariable Cox analysis did not show that reintervention improved OS in our cohort (HR 0.997 95% CI 0.976-1.018 p = 0.75). CONCLUSIONS There has been a temporal bias in the literature that has led to an overestimation of the positive effect of reintervention in recurrent GBM. However, reintervention could still be useful in some selected patients, who should be individualized according to prognostic factors related to the patient, biology of the tumour, and characteristics of surgical procedure.
Collapse
Affiliation(s)
- Juan Delgado-Fernández
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba S/N, 28041, Madrid, Spain.
| | - Natalia Frade-Porto
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Guillermo Blasco
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Patricia González-Tarno
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Zhi-Qiang Li
- Department of Neurosurgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Paloma Pulido Rivas
- Division of Neurosurgery, Department of Surgery, University Hospital La Princesa, Madrid, Spain
| | - Rafael García de Sola
- Innovation in Neurosurgery, Department of Neurosurgery, Hospital del Rosario, Universidad Autonoma de Madrid, Madrid, Spain
| |
Collapse
|
18
|
He X, Liu M, Zhang M, Sequeiros RB, Xu Y, Wang L, Liu C, Wang Q, Zhang K, Li C. A novel three-dimensional template combined with MR-guided 125I brachytherapy for recurrent glioblastoma. Radiat Oncol 2020; 15:146. [PMID: 32513276 PMCID: PMC7282063 DOI: 10.1186/s13014-020-01586-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background At present, the treatment of recurrent glioblastoma is extremely challenging. In this study, we used a novel three-dimensional non-coplanar template (3DNPT) combined with open MR to guide 125I seed implantation for recurrent glioblastoma. The aim of this study was to evaluate the feasibility, accuracy, and effectiveness of this technique. Methods Twenty-four patients of recurrent glioblastoma underwent 3DNPT with open MR-guided 125I brachytherapy from August 2017 to January 2019. Preoperative treatment plan and 3DNPT were made according to enhanced isovoxel T1-weighted MR images. 125I seeds were implanted using 3DNPT and 1.0-T open MR imaging guidance. Dosimetry verification was performed after brachytherapy based on postoperative CT/MR fusion images. Preoperative and postoperative dosimetry parameters of D90, V100, V200, conformity index (CI), external index (EI) were compared. The objective response rate (ORR) at 6 months and 1-year survival rate were calculated. Median overall survival (OS) measured from the date of brachytherapy was estimated by Kaplan-Meier method. Results There were no significant differences between preoperative and postoperative dosimetry parameters of D90, V100, V200, CI, EI (P > 0.05). The ORR at 6 months was 75.0%. The 1-year survival rate was 58.3%. Median OS was 12.9 months. One case of small amount of epidural hemorrhage occurred during the procedure. There were 3 cases of symptomatic brain edema after brachytherapy treatment, including grade three toxicity in 1 case and grade two toxicity in 2 cases. The three patients were treated with corticosteroid for 2 to 4 weeks. The clinical symptoms related to brain edema were significantly alleviated thereafter. Conclusions 3DNPT combined with open MR-guided 125I brachytherapy for circumscribed recurrent glioblastoma is feasible, effective, and with low risk of complications. Postoperative dosimetry matched the preoperative treatment plan. The described method can be used as a novel implantation technique for 125I brachytherapy in the treatment of recurrent gliomas. Trial registration The study was approved by the Institutional Review Board of Shandong Provincial Hospital Affiliated to Shandong University (NSFC:NO.2017–058), registered 1st July 2017.
Collapse
Affiliation(s)
- Xiangmeng He
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Ming Liu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Menglong Zhang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | | | - Yujun Xu
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Ligang Wang
- Department of Medical Imaging and Interventional Radiology, Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, People's Republic of China
| | - Chao Liu
- Department of Tumor Minimally Invasive, Tai'an Central Hospital, Tai'an, Shandong, People's Republic of China
| | - Qingwen Wang
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China
| | - Kai Zhang
- Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China
| | - Chengli Li
- Department of Interventional MRI, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, Shandong Key Laboratory of Advanced Medical Imaging Technology and Application, Jinan, Shandong, People's Republic of China.
| |
Collapse
|
19
|
Gawley M, Almond L, Daniel S, Lastakchi S, Kaur S, Detta A, Cruickshank G, Miller R, Hingtgen S, Sheets K, McConville C. Development and in vivo evaluation of Irinotecan-loaded Drug Eluting Seeds (iDES) for the localised treatment of recurrent glioblastoma multiforme. J Control Release 2020; 324:1-16. [PMID: 32407745 DOI: 10.1016/j.jconrel.2020.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/01/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022]
Abstract
Glioblastoma multiforme (GBM) is impossible to fully remove surgically and almost always recurs at the borders of the resection cavity, while systemic delivery of therapeutic drug levels to the brain tumour is limited by the blood-brain barrier. This research describes the development of a novel formulation of Irinotecan-loaded Drug Eluting Seeds (iDES) for insertion into the margin of the GBM resection cavity to provide a sustained high local dose with reduced systemic toxicities. We used primary GBM cells from both the tumour core and Brain Around the Tumour tissue from recurrent GBM patients to demonstrate that irinotecan is more effective than temozolomide. Irinotecan had a 75% response rate, while only 50% responded to temozolomide. With temozolomide the cell viability was never below 80% whereas irinotecan achieved cell viabilities of less than 44%. The iDES were manufactured using a hot melt extrusion process with accurate irinotecan drug loadings and the same cytotoxicity as unformulated irinotecan. The iDES released irinotecan in a sustained fashion for up to 7 days. However, only the 30, 40 and 50% w/w loaded iDES formulations released the 300 to 1000 μg of irinotecan needed to be effective in vivo. The 30 and 40% w/w iDES formulations containing 10% plasticizer and either 60 or 50% PLGA prolonged survival from 27 to 70 days in a GBM xenograft mouse resection model with no sign of tumour recurrence. The 30% w/w iDES formulations showed equivalent toxicity to a placebo in non-tumour bearing mice. This innovative drug delivery approach could transform the treatment of recurrent GBM patients by improving survival and reducing toxicity.
Collapse
Affiliation(s)
- Matthew Gawley
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Lorna Almond
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Senam Daniel
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Sarah Lastakchi
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Sharnjit Kaur
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom
| | - Allah Detta
- Department of Neurosurgery, University Hospitals Birmingham, NHS Foundation Trust, United Kingdom
| | - Garth Cruickshank
- Department of Neurosurgery, University Hospitals Birmingham, NHS Foundation Trust, United Kingdom
| | - Ryan Miller
- Division of Neuropathology, Department of Pathology and Laboratory Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Departments of Neurology and Pharmacology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Shawn Hingtgen
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kevin Sheets
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Christopher McConville
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, United Kingdom.
| |
Collapse
|
20
|
Bilmin K, Kujawska T, Grieb P. Sonodynamic Therapy for Gliomas. Perspectives and Prospects of Selective Sonosensitization of Glioma Cells. Cells 2019; 8:E1428. [PMID: 31766152 PMCID: PMC6912826 DOI: 10.3390/cells8111428] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022] Open
Abstract
Malignant glial tumors (gliomas) are the second (after cerebral stroke) cause of death from diseases of the central nervous system. The current routine therapy, involving a combination of tumor resection, radio-, and chemo-therapy, only modestly improves survival. Sonodynamic therapy (SDT) has been broadly defined as a synergistic effect of sonication applied in combination with substances referred to as "sonosensitizers". The current review focuses on the possibility of the use of tumor-seeking sonosensitizers, in particular 5-aminolevulinic acid, to control recurring gliomas. In this application, SDT employs a principle similar to that of the more widely-known photodynamic therapy of superficially located cancers, the difference being the use of ultrasound instead of light to deliver the energy necessary to eliminate the sensitized malignant cells. The ability of ultrasound to penetrate brain tissues makes it possible to reach deeply localized intracranial tumors such as gliomas. The major potential advantage of this variant of SDT is its relative non-invasiveness and possibility of repeated application. Until now, there have been no clinical data regarding the efficacy and safety of such treatment for malignant gliomas, but the preclinical data are encouraging.
Collapse
Affiliation(s)
- Krzysztof Bilmin
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland;
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University, 01-938 Warsaw, Poland
| | - Tamara Kujawska
- Institute of Fundamental Technological Research, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| | - Paweł Grieb
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland;
| |
Collapse
|
21
|
Zattra CM, Zhang DY, Broggi M, Velz J, Vasella F, Seggewiss D, Schiavolin S, Bozinov O, Krayenbühl N, Sarnthein J, Ferroli P, Regli L, Stienen MN. Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes. J Neurooncol 2018; 142:49-57. [PMID: 30474767 PMCID: PMC6399174 DOI: 10.1007/s11060-018-03058-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 11/21/2018] [Indexed: 11/28/2022]
Abstract
Purpose Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations. Methods Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG). Results 463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases. Conclusions Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process. Electronic supplementary material The online version of this article (10.1007/s11060-018-03058-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Costanza Maria Zattra
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - David Y Zhang
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Morgan Broggi
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Julia Velz
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Flavio Vasella
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Dominik Seggewiss
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Silvia Schiavolin
- Public Health and Disability Unit, Department of Neurology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Niklaus Krayenbühl
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Johannes Sarnthein
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Paolo Ferroli
- Neurosurgical Unit 2, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Martin N Stienen
- Department of Neurosurgery, University Hospital Zurich and Clinical Neuroscience Center, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| |
Collapse
|
22
|
Hong B, Banan R, Christians A, Nakamura M, Lalk M, Lehmann U, Hartmann C, Krauss JK. Cerebellar glioblastoma: a clinical series with contemporary molecular analysis. Acta Neurochir (Wien) 2018; 160:2237-2248. [PMID: 30203362 DOI: 10.1007/s00701-018-3673-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Glioblastomas (GBM) are localized in only less than 1% of patients in the cerebellum. Therefore, tumor characteristics, survival, and the efficacy of therapies are not yet well defined. The present study aims to characterize the molecular features of cerebellar GBM (GBMc) in 8 patients treated with contemporary modality in our institution. METHODS Patients' treatment history, progression-free survival (PFS), and overall survival (OS) were analyzed. All histopathological specimens were re-investigated. EGFR amplification was determined by FISH, H3F3A, and HIST1H3B mutation status and MGMT promoter methylation after bisulfite treatment by pyrosequencing and BRAF V600E by pyrosequencing and immunohistochemistry. TERT promoter mutations were analyzed by Sanger sequencing, CDKN2A/B deletions by digital PCR. The expression of IDH1 R132H, ATRX, and p53 was determined through immunohistochemistry. RESULTS Six adults and two children (mean age 36 years) underwent tumor resection via medial or lateral suboccipital craniotomy. The median overall survival (mOS) of the adult patients was 7 months. GBMc from two children demonstrated a H3F3A K27M mutation. One of these also harbored a BRAF V600E mutation and has already had a PFS of 74 months. Mutated IDH1 R132H protein was expressed in 2 GBM from adult patients with previous supratentorial anaplastic astrocytoma. One patient carried a TERT promoter mutation. Another patient initially presented with a thalamic pilocytic astrocytoma. The cerebellar tumor revealed neither a BRAF V600E nor a H3F3A mutation but a homozygous CDKN2A/B deletion. CONCLUSIONS GBM located in the cerebellum can be found in all age groups. We provide novel molecular genetic data on these rare tumors. Mutated IDH1 R132H protein and H3F3A K27M mutations indicate that a substantial number of GBMc are "metastatic" or "diaschismatic" lesions. Mutation of BRAF V600E may have a stronger biological significance than H3F3A K27M alterations. In a subset of patients, GBM may arise primarily as a distinct entity in the cerebellum.
Collapse
|
23
|
Affiliation(s)
- Nicole A Shonka
- University of Nebraska Medical Center and Fred and Pamela Buffett Cancer Center, Omaha, NE
| | - Michele R Aizenberg
- University of Nebraska Medical Center and Fred and Pamela Buffett Cancer Center, Omaha, NE
| |
Collapse
|
24
|
Re-irradiation of recurrent glioblastoma as part of a sequential multimodality treatment concept. Clin Transl Oncol 2018; 21:582-587. [PMID: 30284233 DOI: 10.1007/s12094-018-1957-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/14/2018] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this retrospective study was to evaluate survival outcomes in well-performing, mainly, young patients receiving a sequence of all available therapeutic options for relapsed glioblastoma, including re-irradiation. METHODS We performed a retrospective analysis of 27 patients irradiated twice for glioblastoma between 2008 and 2016. In the first line, all had surgical treatment of the tumor followed by radiotherapy with a total dose of 60 Gy and temozolomide. All re-irradiated patients were treated with a total dose of 36 Gy in 12 fractions. The endpoints were death from glioblastoma or any cause, and toxicity after re-irradiation. RESULTS The median follow-up of survivors was 35.6 months. At the time of analysis, 25 patients had died. The median time between first and second radiotherapy was 18.9 months (6.1-58.4). Re-irradiation was performed at different time points of first, second and third progression. The median overall survival after first diagnosis was 39.2 months. Five years after first surgery, nearly 20% of the patients were alive. CONCLUSION Carefully planned re-irradiation of the brain is a safe therapy for recurrent glioblastoma. Younger and well-performing patients benefit from all available therapy options. Every patient should be discussed in a multidisciplinary setting at each time point of tumor progression. Further prospective studies are needed to define the optimal time, dose and volume of re-irradiation.
Collapse
|
25
|
Zygogianni A, Protopapa M, Kougioumtzopoulou A, Simopoulou F, Nikoloudi S, Kouloulias V. From imaging to biology of glioblastoma: new clinical oncology perspectives to the problem of local recurrence. Clin Transl Oncol 2018; 20:989-1003. [PMID: 29335830 DOI: 10.1007/s12094-018-1831-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022]
Abstract
GBM is one of the most common and aggressive brain tumors. Surgery and adjuvant chemoradiation have succeeded in providing a survival benefit. Although most patients will eventually experience local recurrence, the means to fight recurrence are limited and prognosis remains poor. In a disease where local control remains the major challenge, few trials have addressed the efficacy of local treatments, either surgery or radiation therapy. The present article reviews recent advances in the biology, imaging and biomarker science of GBM as well as the current treatment status of GBM, providing new perspectives to the problem of local recurrence.
Collapse
Affiliation(s)
- A Zygogianni
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - M Protopapa
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - A Kougioumtzopoulou
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Greece
| | - F Simopoulou
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - S Nikoloudi
- Radiotherapy Unit, 1st Department of Radiology, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - V Kouloulias
- Radiotherapy Unit, 2nd Department of Radiology, Medical School, ATTIKON University Hospital, National and Kapodistrian University of Athens, Rimini 1, 12462, Chaidari, Greece.
| |
Collapse
|