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Mantziaris G, Diamond J, Pikis S, El Hefnawi FM, Al Sideiri G, Coupé FL, Mathieu D, Lee CC, May J, Liščák R, Peker S, Samanci Y, Niranjan A, Lunsford LD, Sheehan JP. Radiological and clinical outcomes of stereotactic radiosurgery for gangliogliomas: an international multicenter study. J Neurosurg 2022; 137:1248-1253. [PMID: 35334469 DOI: 10.3171/2022.2.jns212813] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The optimal treatment for recurrent and residual gangliogliomas remains unclear. The aim of this study was to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) in the management of patients with recurrent or residual intracranial ganglioglioma. METHODS This retrospective multicenter study involved patients managed with SRS for ganglioglioma. The study endpoints included local tumor control and tumor- or SRS-related neurological morbidity following treatment. Factors associated with tumor progression and neurological morbidity were also analyzed. RESULTS The cohort included 20 patients (11 males [55%]) with a median age of 24.5 (IQR 14) years who had been managed with SRS for ganglioglioma. Five-year radiological progression-free survival was 85.6%. After SRS, 2 patients (10%) experienced transient neurological deterioration. At a median clinical follow-up of 88.5 (IQR 112.5) months, 1 patient (5%) experienced seizure worsening and 1 (5%) required further resection of the tumor because of radiological progression. No mortality was noted in this series. CONCLUSIONS SRS appears to be a safe and effective treatment option for surgically inaccessible, recurrent, and residual gangliogliomas. In this series, the 5-year progression-free survival rate after SRS was 85.6%. Gross-total resection remains the primary treatment of choice for patients with newly diagnosed or recurrent ganglioglioma. SRS may be considered for patients unfit for surgery and those with surgically inaccessible newly diagnosed, residual, and recurrent lesions.
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Affiliation(s)
- Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Joshua Diamond
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | | | | | - François-Louis Coupé
- 3Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - David Mathieu
- 3Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jaromir May
- 5Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Roman Liščák
- 5Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Selcuk Peker
- 6Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey; and
| | - Yavuz Samanci
- 6Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey; and
| | - Ajay Niranjan
- 7Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - L Dade Lunsford
- 7Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Safavi-Abbasi S, Di Rocco F, Chantra K, Feigl GC, El-Shawarby A, Samii A, Samii M. Posterior cranial fossa gangliogliomas. Skull Base 2011; 17:253-64. [PMID: 18174926 DOI: 10.1055/s-2007-984486] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ganglioglioma (GG) is an uncommon primary lesion of the central nervous system that is typically located supratentorially. There are only a few reports of GG arising from the cerebellum. To the best of our knowledge this is the first case of a cerebellar GG with supratentorial extension and a longstanding history before its recognition. In fact, this 29-year-old male presented with an 11-year history of intermittent headaches. A cranial computerized tomography (CT) performed at the onset of his complaints failed to reveal the tumor. After a particularly longstanding cephalalgic episode, the patient underwent a new CT scan that was also negative. However, magnetic resonance (MR) imaging of the brain revealed a space-occupying lesion in the right cerebellar hemisphere with extension to the level of the superior colliculi and pineal recess. The tumor was partially removed through a midline suboccipital craniotomy and supracerebellar approach. Pathological examination of the tumor showed composition of atypical ganglion cells and astrocytes, indicating the diagnosis of cerebellar GG. At last follow-up, 24 months after surgery, the patient reported a marked improvement of his clinical condition with significant reduction of intensity and frequency of the headache. The present report illustrates how cerebellar GG may remain undetectable by CT and may therefore present with a longstanding history and nonspecific signs and symptoms. MR investigation can lead to the proper diagnosis. Even after partial removal the prognosis remains good and remission of the symptoms may be achieved. In this article, we review the literature and summarize the current understanding of infratentorial GGs.
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Affiliation(s)
- Sam Safavi-Abbasi
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Bondiau PY, Fauchon F, Jadaud E, Paquis P. [Radiotherapy in adult glioblastomas]. Neurochirurgie 2010; 56:486-90. [PMID: 20869090 DOI: 10.1016/j.neuchi.2010.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/15/2010] [Indexed: 10/19/2022]
Abstract
Radiation therapy is a treatment of malignant gliomas in adults. It improves survival rates, whether used alone, in addition to surgery, or in combination with chemotherapy. Three-dimensional imaging techniques, image fusion, and conformational radiotherapy are optimizing treatment plans for the treatment of these tumors and are sparing healthy tissue. After a review of the physical and biological bases of ionizing radiation, we present the techniques, results, side effects, and results of irradiation of glioblastomas.
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Affiliation(s)
- P-Y Bondiau
- Centre Antoine-Lacassagne, 33, avenue de Valombrose, 06100 Nice, France.
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Kang TW, Kim ST, Byun HS, Jeon P, Kim K, Kim H, Lee JII. Morphological and functional MRI, MRS, perfusion and diffusion changes after radiosurgery of brain metastasis. Eur J Radiol 2009; 72:370-80. [DOI: 10.1016/j.ejrad.2008.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Revised: 08/11/2008] [Accepted: 08/11/2008] [Indexed: 10/21/2022]
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Histological changes after single high-dose irradiation for squamous cell carcinoma arising from a burn scar. Med Oncol 2009; 27:86-90. [DOI: 10.1007/s12032-009-9176-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 01/29/2009] [Indexed: 12/14/2022]
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Perry A, Schmidt RE. Cancer therapy-associated CNS neuropathology: an update and review of the literature. Acta Neuropathol 2006; 111:197-212. [PMID: 16463065 DOI: 10.1007/s00401-005-0023-y] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 12/08/2005] [Accepted: 12/09/2005] [Indexed: 01/28/2023]
Abstract
Standard therapeutic options for brain tumors include surgery, radiation, and chemotherapy. Unfortunately, these same therapies pose risks of neurotoxicity, the most common long-term complications being radiation necrosis, chemotherapy-associated leukoencephalopathy, and secondary neoplasms. These side effects remain difficult to predict, but are associated with risk factors that include patient age, therapeutic modality and dosage, genetic background, and idiosyncratic predispositions. Experimental treatments designed to enhance efficacy and to minimize neurotoxicity include molecularly targeted, genetic, stem cell, and immune therapies. Newer modifications in radiation and drug delivery include stereotactic radiosurgery, interstitial therapy such as intracavitary brachytherapy and gliadel wafer placement, 3D conformal radiation, boron neutron capture therapy, radiosensitizers, blood-brain barrier disrupting agents, and convection enhanced delivery. Toxicities associated with these newer modalities have yet to be fully investigated and documented. Additionally, a number of recently implemented radiographic techniques such as PET and SPECT imaging have enhanced the ability to distinguish recurrent tumor from radiation necrosis. Nevertheless, post-therapeutic brain biopsies and autopsies remain the gold standard for assessing neurotoxicity, therapeutic efficacy, tumor progression, and the development of secondary neoplasms. At the same time, treatment-associated changes such as tumor necrosis, vasculopathy, inflammation, and cytologic atypia can pose significant diagnostic pitfalls, particularly if the pathologist is not provided a detailed therapeutic history. Therefore, it is critical to recognize the full spectrum of cancer therapy-associated neuropathology, the topic of the current review.
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Affiliation(s)
- Arie Perry
- Division of Neuropathology, Washington University School of Medicine, St. Louis, MO 63110-1093, USA.
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Murillo TP, Sandquist C, Jacobs PM, Nesbit G, Manninger S, Neuwelt EA. Imaging brain tumors with ferumoxtran-10, a nanoparticle magnetic resonance contrast agent. ACTA ACUST UNITED AC 2005. [DOI: 10.2217/14750708.2.6.871] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kamitani H, Hirano N, Takigawa H, Yokota M, Miyata H, Ohama E, Watanabe T. Attenuation of vascularity by preoperative radiosurgery facilitates total removal of a hypervascular hemangioblastoma at the cerebello-pontine angle: case report. ACTA ACUST UNITED AC 2004; 62:238-43; discussion 243-4. [PMID: 15336869 DOI: 10.1016/j.surneu.2003.09.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2003] [Accepted: 09/23/2003] [Indexed: 11/23/2022]
Abstract
BACKGROUND The surgical removal of solid, large, and deep-seated hemangioblastomas remains challenging because it is difficult to control bleeding during the procedure. We used preoperative radiosurgery in a solid, highly vascular hemangioblastoma at the left cerebello-pontine angle and present our angiographic, operative, and histologic findings. CASE DESCRIPTION A 37-year-old paraplegic woman with multiple hemangioblastomas was re-admitted to our clinic with cerebellar ataxia 6 years after resection of a tumor at the fourth ventricle. A vertebral artery angiogram revealed that the 3.5 cm diameter hemangioblastoma at the left cerebello-pontine angle was highly vascular and fed by the left anterior inferior cerebellar artery and posterior inferior cerebellar artery. Nine months before surgical removal it was treated with stereotactic radiosurgery (gamma knife, margin dose 28 Gy) to inhibit tumor progression and to reduce its vascularity. The tumor was totally removed via the left lateral suboccipital approach; bleeding was well controlled and there were no complications. Pathologic examination of the content of the excised tumor revealed coagulation necrosis with hyaline degeneration of the tumor vessels, resulting in a marked decrease in its vascularity. CONCLUSION Preoperative radiosurgery led to a marked reduction in the vascularity of this hypervascular hemangioblastoma and was useful for controlling bleeding from the tumor during resection. We succeeded to remove the vascular-rich hemangioblastma after the intentional preoperative radiosurgery. The pathologic changes induced by radiotherapy were confirmed by operative finding.
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Affiliation(s)
- Hideki Kamitani
- Department of Neurosurgery, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Yonago, Tottori, Japan
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Shinoda J, Yano H, Ando H, Ohe N, Sakai N, Saio M, Shimokawa K. Radiological response and histological changes in malignant astrocytic tumors after stereotactic radiosurgery. Brain Tumor Pathol 2003; 19:83-92. [PMID: 12622138 DOI: 10.1007/bf02478932] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Stereotactic radiosurgery is an encouraging approach to deliver higher doses of radiation boost for malignant gliomas safely and precisely. The purpose of this study was to investigate the radiation response and histological changes of malignant astrocytic tumors after stereotactic linac radiosurgery (SLRS). We studied an autopsy case of recurrent glioblastoma multiforme (GBM) and two surgical cases with gross total removal of recurrent GBM and anaplastic astrocytoma transformed from fibrillary astrocytoma treated with SLRS. Destructive changes, such as the disappearance of viable cells, coagulation necrosis, and fibrinoid degeneration of vascular walls, were observed in the center of the target of SLRS, which showed histologically similar radiobiological reactions to well-known delayed central nervous system radiation necrosis caused by conventional radiotherapy. The region showing such radiation necrosis was within the area irradiated with approximately 15-20Gy or more by SLRS; however, dense viable tumor cells remained in the periphery that was irradiated with less than 15Gy. In a comparative immunohistochemical study of the tumors before and after SLRS, neither MIB-1 and p53 labeling indices nor immunoreactivity for GFAP represented any persistent tendencies. There were very few TUNEL-positive cells in either tumor before and after SLRS. These results showed that radiosurgery for malignant gliomas leads to earlier radiation necrosis than conventional radiation and that it is useful in eradicating tumor cells in the center of the target. However, some viable tumor cells may remain in the periphery irradiated with an insufficient dose for cell death and may be partly transformed in character by DNA damage due to radiation. Proton magnetic resonance spectroscopy (MRS) was suggested to characterize the radiation response in radiosurgery tumor targets for correlation with histological findings.
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Affiliation(s)
- Jun Shinoda
- Department of Neurosurgery, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu 500-8705, Japan.
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