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Harris G, Jones S, Pinkham MB, Lion KM, Ownsworth T. Reliability and validity of the telephone-based version of the Montgomery-Asberg depression rating scale for assessing depression in individuals with primary brain tumour. Disabil Rehabil 2024; 46:1158-1166. [PMID: 37021336 DOI: 10.1080/09638288.2023.2191015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/09/2023] [Indexed: 04/07/2023]
Abstract
This study aimed to examine interrater reliability and construct validity of the Montgomery-Asberg Depression Rating Scale (MADRS) semi-structured interview for assessing depression in adults with a primary brain tumour. Fifty adults with a primary brain tumour (mean age = 45.86, SD = 12.48) reporting at least mild distress (Distress Thermometer [DT] ≥ 4) were recruited from a multidisciplinary brain tumour clinic and administered a telephone-based cognitive screener, MADRS, Depression Anxiety Stress Scales (DASS) depression subscale and Generalised Anxiety Disorder-7 (GAD-7). Audiotaped interviews were transcribed and then scored by two independent raters. Interrater reliability for the MADRS total score was excellent (ICC = 0.98) and ranged from good to excellent (ICC = 0.83-0.96) for MADRS items. The MADRS total score was significantly associated with the DT, DASS depression, and GAD-7 (r = 0.50-0.76, p < 0.001), thus providing evidence of construct validity. Individuals with poorer cognitive function reported higher levels of depression. The findings provide psychometric support for the MADRS as a semi-structured interview for assessing depression after brain tumour. Further research investigating the sensitivity and specificity of the MADRS is recommended.
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Affiliation(s)
- Georgia Harris
- School of Applied Psychology, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Stephanie Jones
- School of Applied Psychology, Griffith University, Queensland, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Queensland, Australia
- Department of Radiation Oncology, Princess Alexandra Hospital, Queensland, Australia
| | - Katarzyna M Lion
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Tamara Ownsworth
- School of Applied Psychology, Griffith University, Queensland, Australia
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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2
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Lion KM, Pike KE, Dhillon HM, Koh ES, Pinkham MB, Shaw J, Halkett GKB, Ownsworth T. Access to psychosocial support for people with brain tumor and family members: Healthcare professional perspectives. Psychooncology 2023. [PMID: 37084182 DOI: 10.1002/pon.6142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Ongoing access to psychosocial support is important to maintain the well-being of people with brain tumor (PwBT) and their families; yet, there is limited knowledge of psychosocial care access. This qualitative study aimed to develop an understanding of psychosocial support pathways specific to PwBT from the perspectives of Australian healthcare professionals. METHODS Semi-structured interviews were conducted with 21 healthcare professionals working in hospital and community services supporting PwBT and their family members. Transcribed interviews were coded and analyzed thematically. RESULTS The three major themes identified were: (1) Challenges in fitting people into the care system within existing pathways; (2) Benefits of longer-term care coordination and interdisciplinary connections; and (3) Brain tumor affects the whole family. Despite established psychosocial care pathways, service access varied and lacked continuity for individuals with lower-grade glioma and benign tumors across the illness trajectory. CONCLUSIONS Healthcare professionals recognize the need for improved access to care coordination and multidisciplinary psychosocial care tailored to the varying needs of PwBT and their families.
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Affiliation(s)
- Katarzyna M Lion
- School of Applied Psychology & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Kerryn E Pike
- School of Applied Psychology & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Griffith Centre for Mental Health, Griffith University, Nathan, Queensland, Australia
- School of Psychology & Public Health & John Richards Centre for Rural Ageing Research La Trobe University, Victoria, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology & Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Eng-Siew Koh
- South Western Sydney Clinical School, University of New South Wales, Faculty of Medicine, Sydney, New South Wales, Australia
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Mark B Pinkham
- School of Medicine, University of Queensland, Saint Lucia, Queensland, Australia
- Department of Radiation Oncology, Princess Alexandra Hospital, Saint Lucia, Queensland, Australia
| | - Joanne Shaw
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia
| | - Georgia K B Halkett
- Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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3
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Tamara O, Katarzyna L, Ursula M SD, Kerryn P, Eng-Siew K, Georgia Kb H, Mark B P, Raymond J C, Haryana D. Scoping the psychological support practices of Australian health professionals working with people with primary brain tumor and their families Short heading: psychological support for brain tumor. Psychooncology 2022; 31:1313-1321. [PMID: 35332965 PMCID: PMC9543201 DOI: 10.1002/pon.5929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/04/2022] [Accepted: 03/19/2022] [Indexed: 11/12/2022]
Abstract
Objectives This study aimed to scope the psychological support practices of Australian health professionals providing supportive care to adults with primary brain tumor. Method Health professionals from multidisciplinary organizations and cancer support services completed an online survey focused on psychological support for people with brain tumor (PwBT) and family members, and perceived barriers or gaps in support provision. Results 107 professionals, mainly from psychology (45%), nursing (20%), and social work (10%) backgrounds, completed the survey. Scope of practice differed according to discipline, with psychologists and nurses most likely to screen for psychological distress (71%–76%), and psychologists more typically providing at least one psychological support session (78%). Psychologists were more likely to screen for cognitive impairment (31%), whereas nurses and social workers more commonly provided family‐based support (62%–73%). Psychological support was more frequently provided in the long‐term management phase (78%) than early post‐diagnosis/treatment (45%). System‐level barriers to accessing psychological support were most frequently identified, which included limited resources and funding, insufficient staff time, lengthy waitlists and costs, poor service coordination, and lack of staff with brain tumor‐specific training. Conclusions The provision of psychological support for PwBT varies according to discipline, setting and management phase. Further research on different models of psychosocial care is needed to inform strategies to address organizational and policy factors impacting professionals' scope of practice.
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Affiliation(s)
- Ownsworth Tamara
- School of Applied Psychology & The Hopkins Centre, Menzies Health Institute QueenslandGriffith University, Queensland, Australia
| | - Lion Katarzyna
- School of Applied Psychology & The Hopkins Centre, Menzies Health Institute QueenslandGriffith University, Queensland, Australia
| | - Sansom-Daly Ursula M
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia.,Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, 2031, Australia.,Sydney Youth Cancer Service, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, NSW, 2031, Australia
| | - Pike Kerryn
- School of Psychology & Public Health & John Richards Centre for Rural Ageing Research, La Trobe University, Victoria, Australia
| | - Koh Eng-Siew
- South Western Sydney Clinical School, University of New South Wales, Faculty of Medicine, NSW.,Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Australia.,Ingham Institute for Applied Medical Research, Liverpool, Australia
| | - Halkett Georgia Kb
- Curtin School of Nursing, Faculty of Health Sciences, Curtin University, WA
| | - Pinkham Mark B
- School of Medicine, University of Queensland, QLD.,Department of Radiation Oncology, Princess Alexandra Hospital, QLD
| | - Chan Raymond J
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA
| | - Dhillon Haryana
- School of Psychology, Psycho-Oncology Cooperative Research Group, Faculty of Science, University of Sydney, NSW.,School of Psychology, Centre for Medical Psychology & Evidence-based Decision-making, Faculty of Science, University of Sydney, NSW
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4
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Cubis L, Ownsworth T, Pinkham MB, Foote M, Green H, Chambers S. "Hey, I'm still here!": Maintaining, managing and rebuilding social connections after brain tumour. Neuropsychol Rehabil 2022; 33:454-479. [PMID: 35168498 DOI: 10.1080/09602011.2022.2028640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
It is well recognized that social networks can buffer the adverse effects of chronic illness on psychological wellbeing. However, the functional impairments associated with brain tumour often affect social participation, which may reduce people's capacity to draw upon their social capital for support. This qualitative phenomenological study aimed to understand how brain tumour influences people's ability to manage, maintain, and rebuild their social networks. Participants were 20 individuals (65% female) aged 22-69 years with diverse types of primary brain tumour (50% high grade or malignant) who were on average 35 months post-diagnosis. Two semi-structured interviews, conducted three months apart, comprised a Social Identity Mapping exercise and questions exploring changes in social groups since diagnosis. Two overarching and interrelated themes emerged: engaging and connecting and then versus now. An interplay of barriers, facilitators and strategies influenced people's ability to engage and connect with their social groups, which in turn influenced whether they experienced stability; maintenance and expansion; loss and rebuilding; or loss and shrinkage of their social networks over time. These novel findings highlight the need to develop interventions that specifically focus on enhancing individuals' abilities to maintain or rebuild their social networks.
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Affiliation(s)
- Lee Cubis
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia.,Summer Foundation Ltd, Melbourne, Australia
| | - Tamara Ownsworth
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
| | - Mark B Pinkham
- Princess Alexandra Hospital, University of Queensland, Woolloongabba, Australia
| | - Matthew Foote
- Princess Alexandra Hospital, University of Queensland, Woolloongabba, Australia
| | - Heather Green
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia
| | - Suzanne Chambers
- School of Applied Psychology and The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Mt Gravatt, Australia.,Faculty of Health, University of Technology Sydney, Sydney, Australia
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5
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Su C, Chen X, Liu C, Li S, Jiang J, Qin Y, Zhang S. T2-FLAIR, DWI and DKI radiomics satisfactorily predicts histological grade and Ki-67 proliferation index in gliomas. Am J Transl Res 2021; 13:9182-9194. [PMID: 34540034 PMCID: PMC8430185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To build highly predictive performance models for glioma stratification with radiomics features from non-invasive MRI. METHODS T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) imaging, diffusion-weighted MRI and diffusion kurtosis imaging were retrospectively collected for 139 glioma cases (2 with grade I, 67 with grade II, 36 with grade III and 34 with grade IV disease). Multi-parameter maps, including the apparent diffusion coefficient (ADC), mean diffusion coefficient (Dmean), fractional anisotropy (FA), and mean kurtosis (MK), were co-registered to T2-FLAIR, and 431 radiomics features for each were extracted within manually segmented tumour regions. Partial correlation analysis revealed correlations between radiomics features and glioma stratification factors (tumour grades and Ki-67 LI). Predictive models were built with adjusted-imbalanced logistic regression. RESULTS MK radiomics features were more closely correlated with glioma stratification than other modalities analysed. The maximum R in MK was 0.52 for tumour grade and 0.56 for Ki-67 index (compared with 0.36 and 0.34 in FA, and 0.43 and 0.37 in ADC, and 0.48 and 0.42 in T2-FLAIR). The best predictive models for grade II vs. III, grade II vs. IV, low-grade vs. high-grade gliomas and positive vs. highly positive Ki-67 LI were obtained by combining multi-parameter MR radiomics features with AUCs of 0.858, 0.966, 0.853 and 0.870, respectively. However, for grade III vs. IV gliomas, the model obtained from MK radiomics features achieved the highest AUC (0.947), with excellent sensitivity and specificity. CONCLUSION Compared with the other modalities, MK showed closer correlations with tumour grade and Ki-67 LI. Combined radiomics models integrating multi-parameter MRI allow for the generation of highly predictive models for glioma stratification.
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Affiliation(s)
- Changliang Su
- Department of Medical Imaging, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer MedicineGuangzhou 510060, China
| | - Xiaowei Chen
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Chenxia Liu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Shihui Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Jingjing Jiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Yuanyun Qin
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
| | - Shun Zhang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhan, Hubei, China
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Rogers JL, Vera E, Acquaye A, Briceno N, Jammula V, King AL, Leeper H, Quezado MM, Gonzalez Alarcon J, Boris L, Burton E, Celiku O, Choi A, Christ A, Crandon S, Grajkowska E, Leggiero N, Lollo N, Penas-Prado M, Reyes J, Siegel C, Theeler BJ, Timmer M, Wall K, Wu J, Aldape K, Gilbert MR, Armstrong TS. Living with a central nervous system (CNS) tumor: findings on long-term survivorship from the NIH Natural History Study. Neurooncol Pract 2021; 8:460-474. [PMID: 34277024 DOI: 10.1093/nop/npab022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Primary central nervous system (CNS) tumors are often associated with high symptom burden and a poor prognosis from the time of diagnosis. The purpose of this study is to describe patient-reported outcomes (PRO) data from long-term survivors (LTS; ≥5-year survival post-diagnosis). Methods Clinical/treatment/molecular characteristics and PROs (symptom burden/interference (MDASI-BT/SP), perceived cognition (Neuro-QoL), anxiety/depression (PROMIS), and general health status (EQ-5D-3L)) were collected on 248 adult LTS between 9/2016 and 8/2019. Descriptive statistics and regression analysis were used to report results. Results Participants had a median age of 47 years (19-82) and were primarily White (83%) males (51%) with high-grade tumors (59%) and few mutations. Forty-two percent of the 222 brain tumor LTS reported no moderate-to-severe symptoms, whereas 45% reported three or more; most common symptoms were fatigue (40%), difficulty remembering (29%), and drowsiness (28%). Among spine tumor LTS (n = 42), nearly half reported moderate-to-severe weakness, pain, fatigue, and numbness/tingling, with 72% experiencing activity-related interference. Severe anxiety, depression, and cognitive symptoms were reported in up to 23% of the sample. Brain tumor LTS at higher risk for severe symptoms were more likely to be young, unemployed, and have poor KPS (Karnofsky Performance Status), whereas high symptom-risk spinal cord tumor LTS had poor KPS and received any tumor treatment. Conclusions Findings indicate LTS fall into distinct cohorts with no significant symptoms or very high symptom burden, regardless of tumor grade or mutational profile. These LTS data demonstrate the need for survivorship care programs and future studies to explore the symptom trajectory of all CNS tumor patients for prevention and early interventions.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Varna Jammula
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amanda L King
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Heather Leeper
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Martha M Quezado
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Javier Gonzalez Alarcon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa Boris
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Eric Burton
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Orieta Celiku
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anna Choi
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alexa Christ
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sonja Crandon
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | | | - Nicole Lollo
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Christine Siegel
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Brett J Theeler
- Department of Neurology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Michael Timmer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kathleen Wall
- Leidos Biomedical Research, Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, Maryland, USA
| | - Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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7
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Irfan N, Samuel E, Rafi Ranjha F, Waheed A, Abu Bakar M, Usman S, Butt S, Rashid A, Yousaf I. Toxicity Profile of Procarbazine Lomustine and Vincristine Chemotherapy in Low-Grade Glioma - Retrospective Review. Cureus 2020; 12:e11070. [PMID: 33224664 PMCID: PMC7676953 DOI: 10.7759/cureus.11070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background The role of Procarbazine Lomustine and Vincristine (PCV) chemotherapy is already established in terms of improving survival in low-grade glioma (LGG). This improved survival has led to the increasing administration of PCV to LGG patients over the past years. However, like other chemotherapies, serious hematological and non-hematological toxicities may occur. The purpose of this study was to evaluate the toxicity profile of PCV and its clinical relevance in our practice. Materials and Methods We reviewed 63 patients of LGG retrospectively who received chemotherapy PCV between January 2015 and January 2018 at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore. Results Significant hematological toxicity as grade 3 anemia, thrombocytopenia, and neutropenia occurred in 19%, 27%, and 46% respectively with PCV. Other toxicities such as neurotoxicity, vomiting and derangement of liver enzymes occurred in 3.2%, 19%, and 19% respectively. Patients who were on concurrent anticonvulsants had no increase in PCV toxicity. Survival was not impacted by hematological toxicities up to grade 3. Conclusion PCV chemotherapy is associated with major hematological, hepatic, and clinical toxicities (vomiting, constipation, and neuropathy). Hematological toxicities influenced the course of treatment in terms of delays and interruptions.
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Affiliation(s)
- Nabia Irfan
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Eileen Samuel
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Fajar Rafi Ranjha
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Asmara Waheed
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Muhammad Abu Bakar
- Biostatistics and Epidemiology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Sadaf Usman
- Clinical Oncology, Colchester General Hospital, Colchester, GBR
| | - Sumera Butt
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Asma Rashid
- Clinical and Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Irfan Yousaf
- Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
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8
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Mobark NA, Alharbi M, Alhabeeb L, AlMubarak L, Alaljelaify R, AlSaeed M, Almutairi A, Alqubaishi F, Ahmad M, Al-Banyan A, Alotabi FE, Barakeh D, AlZahrani M, Al-Khalidi H, Ajlan A, Ramkissoon LA, Ramkissoon SH, Abedalthagafi M. Clinical management and genomic profiling of pediatric low-grade gliomas in Saudi Arabia. PLoS One 2020; 15:e0228356. [PMID: 31995621 PMCID: PMC6988947 DOI: 10.1371/journal.pone.0228356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/13/2020] [Indexed: 01/22/2023] Open
Abstract
Pediatric Low Grade Gliomas (PLGGs) display heterogeneity regarding morphology, genomic drivers and clinical outcomes. The treatment modality dictates the outcome and optimizing patient management can be challenging. In this study, we profiled a targeted panel of cancer-related genes in 37 Saudi Arabian patients with pLGGs to identify genetic abnormalities that can inform prognostic and therapeutic decision-making. We detected genetic alterations (GAs) in 97% (36/37) of cases, averaging 2.51 single nucleotide variations (SNVs) and 0.91 gene fusions per patient. The KIAA1549-BRAF fusion was the most common alteration (21/37 patients) followed by AFAP1-NTRK2 (2/37) and TBLXR-PI3KCA (2/37) fusions that were observed at much lower frequencies. The most frequently mutated) genes were NOTCH1-3 (7/37), ATM (4/37), RAD51C (3/37), RNF43 (3/37), SLX4 (3/37) and NF1 (3/37). Interestingly, we identified a GOPC-ROS1 fusion in an 8-year-old patient whose tumor lacked BRAF alterations and histologically classified as low grade glioma. The patient underwent gross total resection (GTR). The patient is currently disease free. To our knowledge this is the first report of GOPC-ROS1 fusion in PLGG. Taken together, we reveal the genetic characteristics of pLGG patients can enhance diagnostics and therapeutic decisions. In addition, we identified a GOPC-ROS1 fusion that may be a biomarker for pLGG.
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Affiliation(s)
- Nahla A. Mobark
- Department of Paediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Musa Alharbi
- Department of Paediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Lamees Alhabeeb
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Latifa AlMubarak
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Rasha Alaljelaify
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Mariam AlSaeed
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Amal Almutairi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Fatmah Alqubaishi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Maqsood Ahmad
- Department of Neuroscience, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ayman Al-Banyan
- Department of Neuroscience, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Fahad E. Alotabi
- Department of Neuroscience, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Duna Barakeh
- Department of Pathology, King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Malak AlZahrani
- Department of Pathology, King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Hisham Al-Khalidi
- Department of Pathology, King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrazag Ajlan
- Department of Pathology, King Khalid Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Lori A. Ramkissoon
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Shakti H. Ramkissoon
- Wake Forest Comprehensive Cancer Center and Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- Foundation Medicine Inc., Morrisville, NC, United States of America
| | - Malak Abedalthagafi
- Genomics Research Department, Saudi Human Genome Project, King Fahad Medical City and King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
- * E-mail:
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9
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Chhabra A, Schneider C, Chowdhary M, Diwanji TP, Mohindra P, Mishra MV. How Histopathologic Tumor Extent and Patterns of Recurrence Data Inform the Development of Radiation Therapy Treatment Volumes in Solid Malignancies. Semin Radiat Oncol 2018; 28:218-237. [PMID: 29933882 DOI: 10.1016/j.semradonc.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The ability to deliver highly conformal radiation therapy using intensity-modulated radiation therapy and particle therapy provides for new opportunities to improve patient outcomes by reducing treatment-related morbidities following radiation therapy. By reducing the volume of normal tissue exposed to radiation therapy (RT), while also allowing for the opportunity to escalate the dose of RT delivered to the tumor, use of conformal RT delivery should also provide the possibility of expanding the therapeutic index of radiotherapy. However, the ability to safely and confidently deliver conformal RT is largely dependent on our ability to clearly define the clinical target volume for radiation therapy, which requires an in-depth knowledge of histopathologic extent of different tumor types, as well as patterns of recurrence data. In this article, we provide a comprehensive review of the histopathologic and radiographic data that provide the basis for evidence-based guidelines for clinical tumor volume delineation.
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Affiliation(s)
- Arpit Chhabra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Craig Schneider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University, Chicago, IL
| | - Tejan P Diwanji
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
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10
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Jutras G, Bélanger K, Letarte N, Adam JP, Roberge D, Lemieux B, Lemieux-Blanchard É, Masucci L, Ménard C, Bahary JP, Moumdjian R, Berthelet F, Florescu M. Procarbazine, lomustine and vincristine toxicity in low-grade gliomas. ACTA ACUST UNITED AC 2018; 25:e33-e39. [PMID: 29507493 DOI: 10.3747/co.25.3680] [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] [Indexed: 12/12/2022]
Abstract
Background Procarbazine, lomustine, and vincristine (pcv) significantly improve survival outcomes in lgg (low-grade gliomas). Administration of pcv to lgg patients increased tremendously over the past years as it went from 2 patients per year between 2005 and 2012 to 23 patients in 2015 only in our centre. However, serious hematological and non-hematological adverse events may occur. The purpose of this study was to evaluate the toxicity of pcv and its clinical relevance in our practice. Methods We retrospectively reviewed the charts of 57 patients with lgg who received pcv at the Centre hospitalier de l'Université de Montréal between 1 January 2005 and 27 July 2016. Results Procarbazine, lomustine, and vincristine were associated with severe hematological toxicity as clinically significant grade 3 anemia, neutropenia, and thrombocytopenia occurred in 7%, 10%, and 28% of patients, respectively. Other frequent adverse events such as the increase of liver enzymes, cutaneous rash, neurotoxicity, and vomiting occurred in 65%, 26%, 60%, and 40% of patients, respectively. Patients with prophylactic trimethoprim/sulfamethoxazole had more grade 3 hematological toxicity with pcv, especially anemia (p = 0.040) and thrombocytopenia (p = 0.003) but we found no increase in pcv toxicity in patients on concurrent anticonvulsants. Patients with grade 3 neutropenia had a significantly lower survival (median survival 44.0 months vs. 114.0 months, p = 0.001). Patients who were given pcv at diagnosis had more grade 3 anemia than those who received it at subsequent lines of treatment (p = 0.042). Conclusion Procarbazine, lomustine, and vincristine increase survival in lgg but were also associated with major hematologic, hepatic, neurologic, and cutaneous toxicity. Anti-Pneumocystis jiroveci pneumonia (pjp) prophylaxis, but not anticonvulsants, enhances hematologic toxicity.
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Affiliation(s)
- G Jutras
- Faculty of Medicine, Université de Montréal, Montréal, QC
| | - K Bélanger
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - N Letarte
- Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC.,Faculty of Pharmacy, University of Montreal, Montreal, QC; and.,Department of Pharmacy at chum, Montréal, QC
| | - J-P Adam
- Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC.,Department of Pharmacy at chum, Montréal, QC
| | - D Roberge
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - B Lemieux
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - É Lemieux-Blanchard
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - L Masucci
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - C Ménard
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - J P Bahary
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - R Moumdjian
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - F Berthelet
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
| | - M Florescu
- Faculty of Medicine, Université de Montréal, Montréal, QC.,Centre hospitalier de l'Université de Montréal, Notre-Dame Hospital, Montréal, QC
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11
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Abdullah A, Entezami P, Halpin L, Feldmeier J, Mrak RE, Gaudin D. Protoplasmic astrocytoma with multifocal involvement: case report and radiological findings. BJR Case Rep 2015; 1:20150057. [PMID: 30363198 PMCID: PMC6159139 DOI: 10.1259/bjrcr.20150057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/05/2015] [Accepted: 05/07/2015] [Indexed: 12/04/2022] Open
Abstract
Protoplasmic astrocytomas are a poorly characterized and extremely rare subtype of astrocytoma. We describe the CT, MR and 18F-fludeoxyglucose positron emission tomography (FDG-PET) findings of a multifocal protoplasmic astrocytoma in a 29-year-old male with neurological deficits. He was initially diagnosed with neurosarcoidosis based on imaging. MRI demonstrated intraparenchymal lesions involving the right temporal lobe and cerebellum. These appeared as extremely hyperintense signals on T2 weighted imaging and as homogeneous enhancements with a small non-enhancing cystic component on contrast-enhanced MR. Diffuse post-contrast enhancement of the craniospinal meninges was also noted. Post-radiation therapy PET-CT demonstrated a highly FDG-avid tumour in the right temporal lobe and left cerebellum. To our knowledge, a multifocal form of protoplasmic astrocytoma in an adult patient has not been previously described.
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Affiliation(s)
- A Abdullah
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - P Entezami
- Division of Neurosurgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - L Halpin
- Department of Radiology, University of Toledo Medical Center, Toledo, OH, USA
| | - J Feldmeier
- Department of Radiation Oncology, University of Toledo Medical Center, Toledo, OH, USA
| | - R E Mrak
- Department of Pathology, University of Toledo Medical Center, Toledo, OH, USA
| | - D Gaudin
- Division of Neurosurgery, Department of Surgery, University of Toledo Medical Center, Toledo, OH, USA
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