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Refining the Intraoperative Identification of Suspected High-Grade Glioma Using a Surgical Fluorescence Biomarker: GALA BIDD Study Report. J Pers Med 2023; 13:jpm13030514. [PMID: 36983696 PMCID: PMC10058333 DOI: 10.3390/jpm13030514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023] Open
Abstract
Background. Improving intraoperative accuracy with a validated surgical biomarker is important because identifying high-grade areas within a glioma will aid neurosurgical decision-making and sampling. Methods. We designed a multicentre, prospective surgical cohort study (GALA-BIDD) to validate the presence of visible fluorescence as a pragmatic intraoperative surgical biomarker of suspected high-grade disease within a tumour mass in patients undergoing 5-aminolevulinic acid (5-ALA) fluorescence-guided cytoreductive surgery. Results. A total of 106 patients with a suspected high-grade glioma or malignant transformation of a low-grade glioma were enrolled. Among the 99 patients who received 5-ALA, 89 patients were eligible to assess the correlation of fluorescence with diagnosis as per protocol. Of these 89, 81 patients had visible fluorescence at surgery, and 8 patients had no fluorescence. A total of 80 out of 81 fluorescent patients were diagnosed as high-grade gliomas on postoperative central review with 1 low-grade glioma case. Among the eight patients given 5-ALA who did not show any visible fluorescence, none were high-grade gliomas, and all were low-grade gliomas. Of the seven patients suspected radiologically of malignant transformation of low-grade gliomas and with visible fluorescence at surgery, six were diagnosed with high-grade gliomas, and one had no tissue collected. Conclusion. In patients where there is clinical suspicion, visible 5-ALA fluorescence has clinical utility as an intraoperative surgical biomarker of high-grade gliomas and can aid surgical decision-making and sampling. Further studies assessing the use of 5-ALA to assess malignant transformation in all diffuse gliomas may be valuable.
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Duffau H. A Personalized Longitudinal Strategy in Low-Grade Glioma Patients: Predicting Oncological and Neural Interindividual Variability and Its Changes over Years to Think One Step Ahead. J Pers Med 2022; 12:jpm12101621. [PMID: 36294760 PMCID: PMC9604939 DOI: 10.3390/jpm12101621] [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: 08/28/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Diffuse low-grade glioma (LGG) is a rare cerebral cancer, mostly involving young adults with an active life at diagnosis. If left untreated, LGG widely invades the brain and becomes malignant, generating neurological worsening and ultimately death. Early and repeat treatments for this incurable tumor, including maximal connectome-based surgical resection(s) in awake patients, enable postponement of malignant transformation while preserving quality of life owing to constant neural network reconfiguration. Due to considerable interindividual variability in terms of LGG course and consecutive cerebral reorganization, a multistage longitudinal strategy should be tailored accordingly in each patient. It is crucial to predict how the glioma will progress (changes in growth rate and pattern of migration, genetic mutation, etc.) and how the brain will adapt (changes in patterns of spatiotemporal redistribution, possible functional consequences such as epilepsy or cognitive decline, etc.). The goal is to anticipate therapeutic management, remaining one step ahead in order to select the optimal (re-)treatment(s) (some of them possibly kept in reserve), at the appropriate time(s) in the evolution of this chronic disease, before malignization and clinical worsening. Here, predictive tumoral and non-tumoral factors, and their ever-changing interactions, are reviewed to guide individual decisions in advance based on patient-specific markers, for the treatment of LGG.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av. Augustin Fliche, 34295 Montpellier, France; ; Tel.: +33-4-67-33-66-12; Fax: +33-4-67-33-69-12
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors”, National Institute for Health and Medical Research (INSERM), U1191 Laboratory, Institute of Functional Genomics, University of Montpellier, 34091 Montpellier, France
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Balana C, Vaz MA, Manuel Sepúlveda J, Mesia C, Del Barco S, Pineda E, Muñoz-Langa J, Estival A, de Las Peñas R, Fuster J, Gironés R, Navarro LM, Gil-Gil M, Alonso M, Herrero A, Peralta S, Olier C, Perez-Segura P, Covela M, Martinez-García M, Berrocal A, Gallego O, Luque R, Perez-Martín FJ, Esteve A, Munne N, Domenech M, Villa S, Sanz C, Carrato C. A phase II randomized, multicenter, open-label trial of continuing adjuvant temozolomide beyond 6 cycles in patients with glioblastoma (GEINO 14-01). Neuro Oncol 2021; 22:1851-1861. [PMID: 32328662 DOI: 10.1093/neuonc/noaa107] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Standard treatment for glioblastoma is radiation with concomitant and adjuvant temozolomide for 6 cycles, although the optimal number of cycles of adjuvant temozolomide has long been a subject of debate. We performed a phase II randomized trial investigating whether extending adjuvant temozolomide for more than 6 cycles improved outcome. METHODS Glioblastoma patients treated at 20 Spanish hospitals who had not progressed after 6 cycles of adjuvant temozolomide were centrally randomized to stop (control arm) or continue (experimental arm) temozolomide up to a total of 12 cycles at the same doses they were receiving in cycle 6. Patients were stratified by MGMT methylation and measurable disease. The primary endpoint was differences in 6-month progression-free survival (PFS). Secondary endpoints were PFS, overall survival (OS), and safety (Clinicaltrials.gov NCT02209948). RESULTS From August 2014 to November 2018, 166 patients were screened, 7 of whom were ineligible. Seventy-nine patients were included in the stop arm and 80 in the experimental arm. All patients were included in the analyses of outcomes and of safety. There were no differences in 6-month PFS (control 55.7%; experimental 61.3%), PFS, or OS between arms. MGMT methylation and absence of measurable disease were independent factors of better outcome. Patients in the experimental arm had more lymphopenia (P < 0.001), thrombocytopenia (P < 0.001), and nausea and vomiting (P = 0.001). CONCLUSIONS Continuing temozolomide after 6 adjuvant cycles is associated with greater toxicity but confers no additional benefit in 6-month PFS. KEY POINTS 1. Extending adjuvant temozolomide to 12 cycles did not improve 6-month PFS.2. Extending adjuvant temozolomide did not improve PFS or OS in any patient subset.3. Extending adjuvant temozolomide was linked to increased toxicities.
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Affiliation(s)
- Carmen Balana
- Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain.,Applied Research Group in Oncology (B-ARGO) from the Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | | | | | - Carlos Mesia
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain
| | - Sonia Del Barco
- Medical Oncology Service, Institut Català d'Oncologia Girona, Girona, Spain
| | - Estela Pineda
- Medical Oncology Service, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Jose Muñoz-Langa
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | - Anna Estival
- Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain.,Applied Research Group in Oncology (B-ARGO) from the Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Ramón de Las Peñas
- Medical Oncology Service, Hospital Provincial de Castellón, Castellón, Spain
| | - Jose Fuster
- Medical Oncology Service, Hospital Son Espases, Palma De Mallorca, Spain
| | - Regina Gironés
- Medical Oncology Service, Hospital Universitario La Fe, Valencia, Spain
| | | | - Miguel Gil-Gil
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat, Spain
| | - Miriam Alonso
- Medical Oncology Service, Hospital Virgen del Rocio, Sevilla, Spain
| | - Ana Herrero
- Medical Oncology Service, Hospital Miguel Servet, Zaragoza, Spain
| | - Sergio Peralta
- Medical Oncology Service, Hospital Sant Joan de Reus, Reus, Spain
| | - Clara Olier
- Medical Oncology Service, Fundación Alcorcón, Madrid, Spain
| | - Pedro Perez-Segura
- Medical Oncology Service, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Maria Covela
- Medical Oncology Service, Hospital Lucus Agusti, Lugo, Spain
| | | | - Alfonso Berrocal
- Medical Oncology Service, Hospital General Universitario de Valencia, Valencia, Spain
| | - Oscar Gallego
- Medical Oncology Service, Hospital de Sant Pau, Barcelona, Spain
| | - Raquel Luque
- Medical Oncology Service, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Franciso Javier Perez-Martín
- Medical Oncology Service, Institut Català d'Oncologia, Hospitalet de Llobregat, Spain.,Bellvitge Biomedical Research Institute (IDIBELL) Hospitalet de Llobregat, Spain
| | - Anna Esteve
- Applied Research Group in Oncology (B-ARGO) from the Institut Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Nuria Munne
- Pathology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marta Domenech
- Medical Oncology Service, Institut Català d'Oncologia, Badalona, Spain
| | - Salvador Villa
- Radiation Therapy Oncology Service, Institut Català d'Oncologia, Badalona, Spain
| | - Carolina Sanz
- Pathology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Cristina Carrato
- Pathology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Tong Y, Ye L, Li S, Zhao F, Ying J, Qu Y, Li J, Mu D. The association of 6 variants of 8q24 and the risk of glioma: A meta-analysis. Medicine (Baltimore) 2019; 98:e16205. [PMID: 31277128 PMCID: PMC6635291 DOI: 10.1097/md.0000000000016205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
With the advances in sequencing technologies and genome-wide association studies (GWAS), several inherited variants that increase glioma risk have been identified. Ten studies including 8818 cases and 17,551 controls were collected to conduct a meta-analysis to evaluate the associations between 6 variants in 8q24 and glioma risk. Of the 6 variants located in 8q24, 2 have strong significant associations with the risk of glioma, including rs4295627 (P = .003, odds ratio [OR] = 1.21), rs55705857 (P = 2.31 × 10, OR = 3.54). In particular, both homozygous GG (P = 1.91 × 10, OR1 = 2.01) and heterozygous GT (P = 7.75 × 10, OR2 = 1.35) genotypes of rs4295627 were associated with glioma risk. Further studies are needed to explore the role of the 8q24 variants involved in the etiology of glioma.
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Affiliation(s)
- Yu Tong
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Lv Ye
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Shiping Li
- Chendu Gaoxin-Daan Medical Laboratory Co Ltd Pathology Lab, China
| | - Fengyan Zhao
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Junjie Ying
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Yi Qu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Jinhui Li
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Dezhi Mu
- Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan Province
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