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Topel G, Dirilenoğlu F, Sevin İE, Kahraman A. Ependymomas of the spinal region in adults: Clinical and pathological features and MYCN expression levels in spinal ependymomas and myxopapillary ependymomas. Ann Diagn Pathol 2024; 70:152299. [PMID: 38555652 DOI: 10.1016/j.anndiagpath.2024.152299] [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: 03/02/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Ependymomas (EPNs) of the spinal region are a heterogeneous group of tumors that account for 17.6 % in adults. Four types have been recognized: subependymoma, spinal ependymoma (Sp-EPN), myxopapillary ependymoma (MPE), and Sp-EPN-MYCN amplified, each with distinct histopathological and molecular features. METHODS This study investigated the clinical and pathological characteristics and MYCN expression levels of 35 Sp-EPN and MPE cases diagnosed at a tertiary university hospital over a decade-long period. RESULTS Twenty-five cases were Sp-EPN and 10 cases were MPE, and were graded as WHO grade 2, except for 1 Sp-EPN case with grade 3 features. The most common symptoms were lower back pain and difficulty in walking. Radiology showed different tumor sizes and locations along the spinal cord, with MPEs exclusively in the lumbosacral region. Surgery was the main treatment, and gross total resection was achieved in all cases except for one. Immunohistochemistry showed low Ki-67 proliferation indices in all cases, and no MYCN expression. During follow-up, 3 (8.6 %) cases recurred and/or metastasized and 5 cases (14.3 %) died. No significant difference was found in disease-free survival or overall survival between Sp-EPN and MPE cases. However, 3 cases with grade 2 histology demonstrated recurrence and/or metastasis, despite the lack of MYCN expression. CONCLUSION Our results underscore the multifactorial nature of tumor aggressiveness in EPNs of the spinal region. This study enhances our knowledge of the clinical and pathological features of Sp-EPNs and MPEs and highlights the need for better diagnostic and prognostic markers in these rare tumors.
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Affiliation(s)
- Gözde Topel
- Department of Pathology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Türkiye
| | - Fikret Dirilenoğlu
- Department of Pathology, Faculty of Medicine, Near East University, Nicosia, Cyprus.
| | - İsmail Ertan Sevin
- Department of Neurosurgery, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Türkiye
| | - Aslı Kahraman
- Department of Pathology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Izmir, Türkiye
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Akinduro OO, Ghaith AK, Loizos M, Lopez AO, Goyal A, de Macêdo Filho L, Ghanem M, Jarrah R, Moniz Garcia DP, Abode-Iyamah K, Kalani MA, Chen SG, Krauss WE, Clarke MJ, Bydon M, Quiñones-Hinojosa A. What Factors Predict the Development of Neurologic Deficits Following Resection of Intramedullary Spinal Cord Tumors: A Multi-Center Study. World Neurosurg 2024; 182:e34-e44. [PMID: 37952880 DOI: 10.1016/j.wneu.2023.11.010] [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: 07/12/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Intramedullary spinal cord tumors are challenging to resect, and their postoperative neurological outcomes are often difficult to predict, with few studies assessing this outcome. METHODS We reviewed the medical records of all patients surgically treated for Intramedullary spinal cord tumors at our multisite tertiary care institution (Mayo Clinic Arizona, Mayo Clinic Florida, Mayo Clinic Rochester) between June 2002 and May 2020. Variables that were significant in the univariate analyses were included in a multivariate logistic regression. "MissForest" operating on the Random Forest algorithm, was used for data imputation, and K-prototype was used for data clustering. Heatmaps were added to show correlations between postoperative neurological deficit and all other included variables. Shapley Additive exPlanations were implemented to understand each feature's importance. RESULTS Our query resulted in 315 patients, with 160 meeting the inclusion criteria. There were 53 patients with astrocytoma, 66 with ependymoma, and 41 with hemangioblastoma. The mean age (standard deviation) was 42.3 (17.5), and 48.1% of patients were women (n = 77/160). Multivariate analysis revealed that pathologic grade >3 (OR = 1.55; CI = [0.67, 3.58], P = 0.046 predicted a new neurological deficit. Random Forest algorithm (supervised machine learning) found age, use of neuromonitoring, histology of the tumor, performing a midline myelotomy, and tumor location to be the most important predictors of new postoperative neurological deficits. CONCLUSIONS Tumor grade/histology, age, use of neuromonitoring, and myelotomy type appeared to be most predictive of postoperative neurological deficits. These results can be used to better inform patients of perioperative risk.
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Affiliation(s)
| | - Abdul Karim Ghaith
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaelides Loizos
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Anshit Goyal
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Marc Ghanem
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ryan Jarrah
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Maziyar A Kalani
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Florida, USA
| | - Selby G Chen
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - William E Krauss
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Michelle J Clarke
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Dibas M, Ghozy S, Morsy S, Abbas AS, Alkahtani S, Bin-Jumah M, Abdel-Daim MM. Novel nomograms predicting overall and cancer-specific survival of malignant ependymoma patients: a population-based study. J Neurosurg Sci 2023; 67:93-102. [PMID: 32972115 DOI: 10.23736/s0390-5616.20.05033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Malignant ependymomas are rare cancerous tumors that are associated with increased morbidity and mortality in the affected patients. Lately, there has been a lot of controversy about the correct way to manage and predict the survival outcome of these patients. We aim in this retrospective cohort study to develop novel nomograms that can better predict the overall survival (OS) and cancer-specific survival (CSS) of these patients. METHODS This is a retrospective cohort study that was conducted through the Surveillance, Epidemiology, and End Results databases (SEER) between 1998 and 2016. Patients were excluded if they had an unknown diagnosis, unknown cause of death or those with survival duration less than a month. We used penalized regression models with the highest time-dependent area under the ROC curve (AUC) and most stable calibrations to construct the nomograms. By searching the SEER database and applying the eligibility criteria, we identified 3391 patients for the final analysis. RESULTS Nine penalized regression models were developed of which two models including adaptive elastic-net was selected for both OS and CSS. The model incorporated age, sex, year of diagnosis, site, race, radiation, chemotherapy, surgery, and type for the construction of nomograms. We aimed in this population-based cohort study to develop novel prediction tools that can help physicians estimate the survival of malignant ependymoma patients and provide better care. CONCLUSIONS Our nomograms appear to have high accuracy and applicability, which we hope that can predict the survival and improve the treatment and prognosis of these patients.
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Affiliation(s)
- Mahmoud Dibas
- College of Medicine, Sulaiman Al Rajhi Colleges, Al Bukayriyah, Saudi Arabia
| | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Department of Neurosurgery, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Sara Morsy
- Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Saad Alkahtani
- Department of Zoology, Science College, King Saud University, Riyadh, Saudi Arabia
| | - May Bin-Jumah
- Department of Biology, Faculty of Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mohamed M Abdel-Daim
- Department of Zoology, College of Sciences, King Saud University, Riyadh, Saudi Arabia - .,Department of Pharmacology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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Abstract
PURPOSE OF REVIEW To review state of art and relevant advances in the molecular genetics and management of ependymomas of children and adults. RECENT FINDINGS Ependymomas may occur either in the brain or in the spinal cord. Compared with intracranial ependymomas, spinal ependymomas are less frequent and exhibit a better prognosis. The new WHO classification of CNS tumors of 2021 has subdivided ependymomas into different histomolecular subgroups with different outcome. The majority of studies have shown a major impact of extent of resection; thus, a complete resection must be performed, whenever possible, at first surgery or at reoperation. Conformal radiotherapy is recommended for grade 3 or incompletely resected grade II tumors. Proton therapy is increasingly employed especially in children to reduce the risk of neurocognitive and endocrine sequelae. Craniospinal irradiation is reserved for metastatic disease. Chemotherapy is not useful as primary treatment and is commonly employed as salvage treatment for patients failing surgery and radiotherapy. Standard treatments are still the mainstay of treatment: the discovery of new druggable pathways will hopefully increase the therapeutic armamentarium in the near future.
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Affiliation(s)
- Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Alessia Pellerino
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
| | - Riccardo Soffietti
- Division of Neuro-Oncology, Department of Neuroscience “Rita Levi Montalcini”, University of Turin, Via Cherasco 15, 10126 Turin, Italy
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Jia Z, Yan Y, Wang J, Yang H, Zhan H, Chen Q, He Y, Huang C, Hu Y. Development and validation of prognostic nomogram in ependymoma: A retrospective analysis of the SEER database. Cancer Med 2021; 10:6140-6148. [PMID: 34342153 PMCID: PMC8419756 DOI: 10.1002/cam4.4151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background The prognostic factors for survival in patients with ependymoma (EPN) remain controversial. The aim of this study was to establish a prognostic model for 5‐ and 10‐year survival probability nomograms for patients with EPN. Methods Clinical data from the Surveillance, Epidemiology, and End Results (SEER) database were used for patients diagnosed with ependymoma between 2000 and 2018 and were randomized 7:3 into a development set and a validation set. Factors significantly associated with prognosis were screened out using the least absolute shrinkage and selection operator (LASSO) regression. The calibration chart and consistency index (C‐index) are used to evaluate the discrimination and consistency of the prediction model. Decision curve analysis (DCA) was used to further evaluate the established model. Finally, prognostic factors selected by LASSO regression were evaluated using Kaplan–Meier (KM) survival curves. Results A total of 3820 patients were included in the prognostic model. Seven survival predictors were obtained by LASSO regression screening, including age, gender, morphology, location, size, laterality, and resection. The prognostic model of the nomogram showed moderate discriminative ability in the development group and the validation group, with a C‐index of 0.642 and 0.615, respectively. In the development set and validation set survival curves, the prognosis index of high risk was less effective than low risk (p < 0.001). Conclusions Our nomograms may play an important role in predicting 5 and 10‐year outcomes for patients with ependymoma. This will help assist clinicians in personalized medicine.
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Affiliation(s)
- Zetian Jia
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yaqi Yan
- Department of Cardiology, The First Hospital of Handan of Hebei Province, Handan, People's Republic of China
| | - Jiuxin Wang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - He Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Haihua Zhan
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Qian Chen
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Yawei He
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
| | - Changyu Huang
- Department of Gastrointestinal Surgery, Xianyang First People's Hospital, Xianyang, People's Republic of China
| | - Yuhua Hu
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China
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Varrassi M, Bellisari FC, De Donato MC, Tommasino E, Di Sibio A, Bruno F, Di Vitantonio H, Splendiani A, Di Cesare E, Masciocchi C. Intracranial ependymomas: The role of advanced neuroimaging in diagnosis and management. Neuroradiol J 2021; 34:80-92. [PMID: 33525963 DOI: 10.1177/1971400921990770] [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: 11/15/2022] Open
Abstract
Intracranial ependymomas represent a rare subgroup of glial tumours, showing a wide variety of imaging characteristics, often representing a challenging diagnosis for neuroradiologists. Here, we review the most recent scientific Literature on intracranial ependymomas, highlighting the most characteristic computed tomography and magnetic resonance imaging features of these neoplasms, along with epidemiologic data, recent classification aspects, clinical presentation and conventional therapeutic strategies. In addition, we report an illustrative case of an 18-year-old girl presenting with an intracranial supratentorial, anaplastic ependymoma, with the aim of contributing to the existing knowledge and comprehension of this rare tumour.
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Affiliation(s)
| | | | | | - Emanuele Tommasino
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | | | - Federico Bruno
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | | | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Science, University of L'Aquila, Italy
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Rauschenbach L. Spinal Cord Tumor Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1226:97-109. [PMID: 32030679 DOI: 10.1007/978-3-030-36214-0_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intramedullary spinal cord tumors (IMSCT) are rare entities for which there currently exist no standardized treatment paradigms. Consequently, patients usually receive treatment modalities that were established for intracerebral tumors; these approaches, however, typically result in functional impairment, recurrent tumor growth, and short overall survival. There is a distinct lack of promising research efforts in this field, which raises questions about whether spinal cord tumor microenvironment (TME) might promote the development, progression, and treatment resistance of IMSCT. In this review, we aim to examine spinal cord biology, compare spinal cord and brain microenvironments, and discuss mutual interactions between IMSCT and TME. Manipulating these pathways may provide new treatment approaches for future patient groups.
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Affiliation(s)
- Laurèl Rauschenbach
- Department of Neurosurgery, University Hospital Essen, Essen, Germany. .,DKFZ Division of Translational Neuro-Oncology at the West German Cancer Center (WTZ), German Cancer Consortium (DKTK) Partner Site, University Hospital Essen, Essen, Germany.
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8
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Deng X, Zhang X, Yang L, Lu X, Fang J, Yu L, Li D, Sheng H, Yin B, Zhang N, Lin J. Personalizing age-specific survival prediction and risk stratification in intracranial grade II/III ependymoma. Cancer Med 2019; 9:615-625. [PMID: 31793749 PMCID: PMC6970043 DOI: 10.1002/cam4.2753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Models for estimation of survival rates of patients with intracranial grade II/III ependymoma (EPN) are scarce. Considering the heterogeneity in prognostic factors between pediatric and adult patients, we aimed to develop age-specific nomograms for predicting 3-, 5-, and 8-year survival for these patients. METHODS A total of 1390 cases (667 children; 723 adults) of intracranial grade II/III EPNs diagnosed between 1988 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database for our study. Univariable and multivariable Cox analyses were employed to identify independent prognostic predictors. Age-specific nomograms were developed based on the results of multivariate Cox analyses. We also evaluated the performance of these predictive models by concordance index, calibration curves, time-dependent receiver operating characteristic curves, and decision curve analyses. RESULTS Considerable heterogeneity in prognostic factors was highlighted between pediatric and adult patients. Age, sex, tumor grade, surgery treatment and radiotherapy were identified as significant predictors of overall survival for children, and age, tumor grade, tumor size, surgery treatment, and marital status for adult. Based on these factors, age-specific nomogram models were established and internally validated. These models exhibited favorable discrimination and calibration characteristics. Nomogram-based risk classification systems were also constructed to facilitate risk stratification in EPNs for optimization of clinical management. CONCLUSIONS We developed the first nomograms and corresponding risk classification systems for predicting survival in patients with intracranial grade II/III EPN. These easily used tools can assist oncologists in making accurate survival evaluation.
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Affiliation(s)
- Xiangyang Deng
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaojia Zhang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Yang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiangqi Lu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junhao Fang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lisheng Yu
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dandong Li
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hansong Sheng
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bo Yin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nu Zhang
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian Lin
- Department of Neurosurgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Sun XY, Wang W, Zhang TT, Kong C, Sun SY, Guo MC, Ding JZ, Lu SB. Factors associated with postoperative outcomes in patients with intramedullary Grade II ependymomas: A Systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e16185. [PMID: 31232977 PMCID: PMC6637017 DOI: 10.1097/md.0000000000016185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Most of the previous studies combined all types of intramedullary ependymomas without providing accurate pathological subtypes. In addition, it was very difficult to evaluate the factors associated with postoperative outcomes of patients with different pathological subtypes of intramedullary Grade II ependymomas by traditional meta-analysis. This study evaluated the factors related with postoperative outcomes of patients with intramedullary Grade II ependymomas. METHODS Individual patient data analysis was performed using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The search included articles published up to April 2018 with no lower date limit on the search results. The topics were intramedullary Grade II ependymomas. Progression-free survival (PFS) and overall survival (OS) were analyzed by Kaplan-Meier survival analysis (log-rank test). The level of significance was set at P < .05. RESULTS A total of 21 studies with 70 patients were included in this article. PFS of patients who underwent total resection was much longer than the PFS of those who received subtotal resection (P < .001). Patients who received adjuvant therapy (P = .005) or radiotherapy and chemotherapy (P < .001) seemed to have shorter PFS than others; PFS of patients who had cerebrospinal fluid disease dissemination (P = .022) or scoliosis (P = .001) were significantly shorter than others. OS of cellular ependymoma patients was less than giant cell ependymoma patients (P < .001). CONCLUSIONS PFS of patients who received total resection was much longer than those who received subtotal resection. Patients treated with adjuvant therapy or radiotherapy and chemotherapy appeared to have shorter PFS than others; PFS of patients with cerebrospinal fluid disease dissemination or scoliosis were significantly shorter than others. Cellular ependymomas would have better OS than giant cell ependymoma. However, giant cell ependymoma patients might have the worst OS.
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Affiliation(s)
- Xiang-Yao Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Tong-Tong Zhang
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- Capital Medical University
- Department of Orthopaedics, ChuiYangLiu Hospital Affiliated to Tsinghua University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
| | - Si-Yuan Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Ma-Chao Guo
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Jun-Zhe Ding
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
- Capital Medical University
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University
- National Clinical Research Center for Geriatric Diseases
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Butt E, Alyami S, Nageeti T, Saeed M, AlQuthami K, Bouazzaoui A, Athar M, Abduljaleel Z, Al-Allaf F, Taher M. Mutation profiling of anaplastic ependymoma grade III by Ion Proton next generation DNA sequencing. F1000Res 2019; 8:613. [PMID: 32612806 PMCID: PMC7317822 DOI: 10.12688/f1000research.18721.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Ependymomas are glial tumors derived from differentiated ependymal cells. In contrast to other types of brain tumors, histological grading is not a good prognostic marker for these tumors. In order to determine genomic changes in an anaplastic ependymoma, we analyzed its mutation patterns by next generation sequencing (NGS). Methods: Tumor DNA was sequenced using an Ion PI v3 chip on Ion Proton instrument and the data were analyzed by Ion Reporter 5.6. Results: NGS analysis identified 19 variants, of which four were previously reported missense variants; c.395G>A in IDH1, c.1173A>G in PIK3CA, c.1416A>T in KDR and c.215C>G in TP53. The frequencies of the three missense mutations ( PIK3CA c.1173A>G, KDR c.1416A>T, TP53, c.215C>G) were high, suggesting that these are germline variants, whereas the IDH1 variant frequency was low (4.81%). However, based on its FATHMM score of 0.94, only the IDH1 variant is pathogenic; other variants TP53, PIK3CA and KDR had FATHMM scores of 0.22, 0.56 and 0.07, respectively. Eight synonymous mutations were found in FGFR3, PDGFRA, EGFR, RET, HRAS, FLT3, APC and SMAD4 genes. The mutation in FLT3 p.(Val592Val) was the only novel variant found. Additionally, two known intronic variants in KDR were found and intronic variants were also found in ERBB4 and PIK3CA. A known splice site mutation at an acceptor site in FLT3, a 3'-UTR variant in the CSF1R gene and a 5'_UTR variant in the SMARCB1 gene were also identified. The p-values were below 0.00001 for all variants and the average coverage for all variants was around 2000x. Conclusions: In this grade III ependymoma, one novel synonymous mutation and one deleterious missense mutation is reported. Many of the variants reported here have not been detected in ependymal tumors by NGS analysis previously and we therefore report these variants in brain tissue for the first time.
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Affiliation(s)
- Ejaz Butt
- Histopathology Division, Al-Noor Specialty Hospital, Makkah, Makkah, Saudi Arabia
- Histopathology Department, Amna Inayat Medical College, Sheikhupura, Punjab, Pakistan
| | - Sabra Alyami
- Department of Medical Genetics, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Tahani Nageeti
- Department of Radiation Oncology, King Abdullah Medical City, Makkah, Makkah, Saudi Arabia
| | - Muhammad Saeed
- Faculty of Medicine, Umm-Al-Qura University and Al-Noor Specialty Hospital, Makkah, Makkah, Saudi Arabia
| | - Khalid AlQuthami
- Department of Laboratory Medicine and Blood Bank, Al-Noor Specialty Hospital, Makkah, Makkah, Saudi Arabia
| | - Abdellatif Bouazzaoui
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Mohammad Athar
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Zainularifeen Abduljaleel
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Faisal Al-Allaf
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Mohiuddin Taher
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
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Butt E, Alyami S, Nageeti T, Saeed M, AlQuthami K, Bouazzaoui A, Athar M, Abduljaleel Z, Al-Allaf F, Taher M. Mutation profiling of anaplastic ependymoma grade III by Ion Proton next generation DNA sequencing. F1000Res 2019; 8:613. [PMID: 32612806 PMCID: PMC7317822 DOI: 10.12688/f1000research.18721.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 03/30/2024] Open
Abstract
Background: Ependymomas are glial tumors derived from differentiated ependymal cells. In contrast to other types of brain tumors, histological grading is not a good prognostic marker for these tumors. In order to determine genomic changes in an anaplastic ependymoma, we analyzed its mutation patterns by next generation sequencing (NGS). Methods: Tumor DNA was sequenced using an Ion PI v3 chip on Ion Proton instrument and the data were analyzed by Ion Reporter 5.6. Results: NGS analysis identified 19 variants, of which four were previously reported missense variants; c.395G>A in IDH1, c.1173A>G in PIK3CA, c.1416A>T in KDR and c.215C>G in TP53. The frequencies of the three missense mutations ( PIK3CA c.1173A>G, KDR c.1416A>T, TP53, c.215C>G) were high, suggesting that these are germline variants, whereas the IDH1 variant frequency was low (4.81%). However, based on its FATHMM score of 0.94, only the IDH1 variant is pathogenic; other variants TP53, PIK3CA and KDR had FATHMM scores of 0.22, 0.56 and 0.07, respectively. Eight synonymous mutations were found in FGFR3, PDGFRA, EGFR, RET, HRAS, FLT3, APC and SMAD4 genes. The mutation in FLT3 p.(Val592Val) was the only novel variant found. Additionally, two known intronic variants in KDR were found and intronic variants were also found in ERBB4 and PIK3CA. A known splice site mutation at an acceptor site in FLT3, a 3'-UTR variant in the CSF1R gene and a 5'_UTR variant in the SMARCB1 gene were also identified. The p-values were below 0.00001 for all variants and the average coverage for all variants was around 2000x. Conclusions: In this grade III ependymoma, one novel synonymous mutation and one deleterious missense mutation is reported. Many of the variants reported here have not been detected in ependymal tumors by NGS analysis previously and we therefore report these variants in brain tissue for the first time.
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Affiliation(s)
- Ejaz Butt
- Histopathology Division, Al-Noor Specialty Hospital, Makkah, Makkah, Saudi Arabia
- Histopathology Department, Amna Inayat Medical College, Sheikhupura, Punjab, Pakistan
| | - Sabra Alyami
- Department of Medical Genetics, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Tahani Nageeti
- Department of Radiation Oncology, King Abdullah Medical City, Makkah, Makkah, Saudi Arabia
| | - Muhammad Saeed
- Faculty of Medicine, Umm-Al-Qura University and Al-Noor Specialty Hospital, Makkah, Makkah, Saudi Arabia
| | - Khalid AlQuthami
- Department of Laboratory Medicine and Blood Bank, Al-Noor Specialty Hospital, Makkah, Makkah, Saudi Arabia
| | - Abdellatif Bouazzaoui
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Mohammad Athar
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Zainularifeen Abduljaleel
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Faisal Al-Allaf
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
| | - Mohiuddin Taher
- Department of Medical Genetics and Science and Technology Unit, Umm-Al-Qura University, Makkah, Makkah, Saudi Arabia
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Fukuoka K, Kanemura Y, Shofuda T, Fukushima S, Yamashita S, Narushima D, Kato M, Honda-Kitahara M, Ichikawa H, Kohno T, Sasaki A, Hirato J, Hirose T, Komori T, Satomi K, Yoshida A, Yamasaki K, Nakano Y, Takada A, Nakamura T, Takami H, Matsushita Y, Suzuki T, Nakamura H, Makino K, Sonoda Y, Saito R, Tominaga T, Matsusaka Y, Kobayashi K, Nagane M, Furuta T, Nakada M, Narita Y, Hirose Y, Ohba S, Wada A, Shimizu K, Kurozumi K, Date I, Fukai J, Miyairi Y, Kagawa N, Kawamura A, Yoshida M, Nishida N, Wataya T, Yamaoka M, Tsuyuguchi N, Uda T, Takahashi M, Nakano Y, Akai T, Izumoto S, Nonaka M, Yoshifuji K, Kodama Y, Mano M, Ozawa T, Ramaswamy V, Taylor MD, Ushijima T, Shibui S, Yamasaki M, Arai H, Sakamoto H, Nishikawa R, Ichimura K. Significance of molecular classification of ependymomas: C11orf95-RELA fusion-negative supratentorial ependymomas are a heterogeneous group of tumors. Acta Neuropathol Commun 2018; 6:134. [PMID: 30514397 PMCID: PMC6278135 DOI: 10.1186/s40478-018-0630-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 11/03/2018] [Indexed: 11/10/2022] Open
Abstract
Extensive molecular analyses of ependymal tumors have revealed that supratentorial and posterior fossa ependymomas have distinct molecular profiles and are likely to be different diseases. The presence of C11orf95-RELA fusion genes in a subset of supratentorial ependymomas (ST-EPN) indicated the existence of molecular subgroups. However, the pathogenesis of RELA fusion-negative ependymomas remains elusive. To investigate the molecular pathogenesis of these tumors and validate the molecular classification of ependymal tumors, we conducted thorough molecular analyses of 113 locally diagnosed ependymal tumors from 107 patients in the Japan Pediatric Molecular Neuro-Oncology Group. All tumors were histopathologically reviewed and 12 tumors were re-classified as non-ependymomas. A combination of RT-PCR, FISH, and RNA sequencing identified RELA fusion in 19 of 29 histologically verified ST-EPN cases, whereas another case was diagnosed as ependymoma RELA fusion-positive via the methylation classifier (68.9%). Among the 9 RELA fusion-negative ST-EPN cases, either the YAP1 fusion, BCOR tandem duplication, EP300-BCORL1 fusion, or FOXO1-STK24 fusion was detected in single cases. Methylation classification did not identify a consistent molecular class within this group. Genome-wide methylation profiling successfully sub-classified posterior fossa ependymoma (PF-EPN) into PF-EPN-A (PFA) and PF-EPN-B (PFB). A multivariate analysis using Cox regression confirmed that PFA was the sole molecular marker which was independently associated with patient survival. A clinically applicable pyrosequencing assay was developed to determine the PFB subgroup with 100% specificity using the methylation status of 3 genes, CRIP1, DRD4 and LBX2. Our results emphasized the significance of molecular classification in the diagnosis of ependymomas. RELA fusion-negative ST-EPN appear to be a heterogeneous group of tumors that do not fall into any of the existing molecular subgroups and are unlikely to form a single category.
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13
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Sun XY, Kong C, Lu SB, Sun SY, Guo MC, Ding JZ. Survival outcomes and prognostic factors of patients with intramedullary Grade II ependymomas after surgical treatments. J Clin Neurosci 2018; 57:136-142. [PMID: 30146401 DOI: 10.1016/j.jocn.2018.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 05/23/2018] [Accepted: 08/08/2018] [Indexed: 12/12/2022]
Abstract
This study evaluated survival outcomes of patients with intramedullary Grade II ependymomas and identify prognostic factors. Electronic searches of PubMed, EMBASE, OVID, the Cochrane Central Register of Controlled Trials were performed to identify trials according to the Cochrane Collaboration guidelines. The objects were intramedullary Grade II ependymoma according to 2007 WHO classification. Kaplan-Meier survival analysis with log-rank test was used to analyze progressive free survival (PFS) and overall survival (OS). Cox proportional hazard model was utilized for multivariate analysis with hazard ratio (HR) and 95% confidence interval (CI) calculated. P values <0.05 were considered statistically significant. A total of 28 studies including 138 cases of intramedullary Grade II ependymomas were retrieved. Patients who were classified as cellular ependymomas or papillary ependymomas had higher risks of progression than those who possessed typical Grade II ependymomas. Patients who were treated with adjuvant therapy had a higher risk of progression than those without adjuvant therapy. OS of patients with giant cell ependymoma was significantly shorter than those with typical Grade II ependymoma. Patients who had cellular or papillary subtype, adjuvant therapy would have a shorter estimated value of progression-free time and a higher risk of progression than typical Grade II ependymomas. Giant cell ependymoma patients would have a higher risk of fatality than those with typical Grade II ependymomas. Definite pathology type and appropriate treatments were foundations of intramedullary Grade II ependymomas' managements.
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Affiliation(s)
- Xiang-Yao Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China.
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China.
| | - Si-Yuan Sun
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
| | - Ma-Chao Guo
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
| | - Jun-Zhe Ding
- Department of Orthopedics, Xuanwu Hospital Capital Medical University, China; National Clinical Research Center for Geriatric Diseases, China; Capital Medical University, China
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Abstract
PURPOSE OF REVIEW This article describes the most common pediatric brain tumors and highlights recent developments in their diagnosis and treatment strategies. RECENT FINDINGS We are in the midst of a molecular era for pediatric brain tumors. Genetic and epigenetic profiling of tumors has impacted their diagnosis, allowing for the subgrouping of heterogeneous tumor groups and leading to the complete renaming of some tumor types. These advances are reflected in the new 2016 World Health Organization classification. For example, primitive neuroectodermal tumors have been completely eliminated and replaced by subgroups defined by the absence or presence of specific chromosomal amplification. Medulloblastomas, diffuse astrocytomas, and ependymomas now have specific subtypes that are based on defining molecular features. More recent epigenetic-based subgrouping of atypical teratoid/rhabdoid tumors have not yet made it into the official classification system, but will surely have an impact on how these tumors are regarded in future preclinical and clinical trials. SUMMARY Genetic and epigenetic data are changing how pediatric brain tumors are diagnosed, are leading to new guidelines for how treatment outcome analyses can be organized, and are offering molecular targets that can be used for the development of novel therapies.
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15
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Lillard JC, Venable GT, Khan NR, Tatevossian RG, Dalton J, Vaughn BN, Klimo P. Pediatric Supratentorial Ependymoma: Surgical, Clinical, and Molecular Analysis. Neurosurgery 2018; 85:41-49. [DOI: 10.1093/neuros/nyy239] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/09/2018] [Indexed: 12/31/2022] Open
Abstract
Abstract
BACKGROUND
Pediatric supratentorial ependymomas (SEs) have distinct molecular and behavioral differences from their infratentorial counterparts.
OBJECTIVE
To present our experience with pediatric SEs over a 24-yr period.
METHODS
Clinical, operative, and radiographic information was abstracted retrospectively. Our primary outcomes were progression-free survival (PFS) and overall survival (OS). Detection of C11orf95-RELA rearrangement was performed using interphase fluorescence in situ hybridization (iFISH).
RESULTS
Seventy-three patients were identified (41 female, 32 male); median age was 6.7 yrs (range, 1 mo-18.8 yr); median follow-up was 8.3 yrs (range, 2.0-26.3). Fifty-eight (79.5%) of 73 patients underwent gross total resection (GTR); no patient with subtotal resection had greater than 1 cm3 of residual tumor; 42 patients (57.5%) experienced subsequent disease progression with 17 patients ultimately dying of their disease. Median PFS was 3.7 yrs. Molecular analysis was available for 51 patients (70%). On bivariate analysis, PFS and OS were not statistically affected by age, tumor grade, or extent of resection, although there was a clinically significant trend for the latter in favor of aggressive resection on PFS (P = .061). Children with RELA fusion had significantly higher PFS (P = .013) than those without, although there was no difference in OS when compared with those with no C11orf95-RELA fusion or C11orf95 gene rearrangement alone.
CONCLUSION
In our series, GTR may be associated with better PFS, but did not impact OS. Surprisingly, RELA fusion was not found to be a negative prognostic factor, raising the possibility that the deleterious effects may be overcome by aggressive resection.
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Affiliation(s)
- Jock C Lillard
- College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Garrett T Venable
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Nickalus R Khan
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ruth G Tatevossian
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James Dalton
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | | | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Le Bonheur Children's Hospital, Memphis, Tennessee
- Semmes Murphey, Memphis, Tennessee
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16
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Wang Y, Cai R, Wang R, Wang C, Chen C. Outcome predictors in the management of intramedullary classic ependymoma: An integrative survival analysis. Medicine (Baltimore) 2018; 97:e10870. [PMID: 29879023 PMCID: PMC5999504 DOI: 10.1097/md.0000000000010870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
UNLABELLED This is a retrospective study.The aim of this study was to illustrate the survival outcomes of patients with classic ependymoma (CE) and identify potential prognostic factors.CE is the most common category of spinal ependymomas, but few published studies have discussed predictors of the survival outcome.A Boolean search of the PubMed, Embase, and OVID databases was conducted by 2 investigators independently. The objects were intramedullary grade II ependymoma according to 2007 WHO classification. Univariate Kaplan-Meier analysis and Log-Rank tests were performed to identify variables associated with progression-free survival (PFS) or overall survival (OS). Multivariate Cox regression was performed to assess hazard ratios (HRs) with 95% confidence intervals (95% CIs). Statistical analysis was performed by SPSS version 23.0 (IBM Corp.) with statistical significance defined as P < .05.A total of 35 studies were identified, including 169 cases of CE. The mean follow-up time across cases was 64.2 ± 51.5 months. Univariate analysis showed that patients who had undergone total resection (TR) had better PFS and OS than those with subtotal resection (STR) and biopsy (P = .002, P = .004, respectively). Within either univariate or multivariate analysis (P = .000, P = .07, respectively), histological type was an independent prognostic factor for PFS of CE [papillary type: HR 0.002, 95% CI (0.000-0.073), P = .001, tanycytic type: HR 0.010, 95% CI (0.000-0.218), P = .003].It was the first integrative analysis of CE to elucidate the correlation between kinds of factors and prognostic outcomes. Definite histological type and safely TR were foundation of CE's management. LEVEL OF EVIDENCE 4.
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17
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Abstract
Recent advances in molecular pathology have reshaped the practice of brain tumor diagnostics. The classification of gliomas has been restructured with the discovery of isocitrate dehydrogenase (IDH) 1/2 mutations in the vast majority of lower grade infiltrating gliomas and secondary glioblastomas (GBM), with IDH-mutant astrocytomas further characterized by TP53 and ATRX mutations. Whole-arm 1p/19q codeletion in conjunction with IDH mutations now define oligodendrogliomas, which are also enriched for CIC, FUBP1, PI3K, NOTCH1, and TERT-p mutations. IDH-wild-type (wt) infiltrating astrocytomas are mostly primary GBMs and are characterized by EGFR, PTEN, TP53, NF1, RB1, PDGFRA, and CDKN2A/B alterations, TERT-p mutations, and characteristic copy number alterations including gains of chromosome 7 and losses of 10. Other clinically and genetically distinct infiltrating astrocytomas include the aggressive H3K27M-mutant midline gliomas, and smaller subsets that occur in the setting of NF1 or have BRAF V600E mutations. Low-grade pediatric gliomas are both genetically and biologically distinct from their adult counterparts and often harbor a single driver event often involving BRAF, FGFR1, or MYB/MYBL1 genes. Large scale genomic and epigenomic analyses have identified distinct subgroups of ependymomas tightly linked to tumor location and clinical behavior. The diagnosis of embryonal neoplasms also integrates molecular testing: (I) 4 molecularly defined, biologically distinct subtypes of medulloblastomas are now recognized; (II) 3 histologic entities have now been reclassified under a diagnosis of "embryonal tumor with multilayered rosettes (ETMR), C19MC-altered"; and (III) atypical teratoid/rhabdoid tumors (AT/RT) now require SMARCB1 (INI1) or SMARCA4 (BRG1) alterations for their diagnosis. We discuss the practical use of contemporary biomarkers for an integrative diagnosis of central nervous system neoplasia.
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18
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Rudà R, Reifenberger G, Frappaz D, Pfister SM, Laprie A, Santarius T, Roth P, Tonn JC, Soffietti R, Weller M, Moyal ECJ. EANO guidelines for the diagnosis and treatment of ependymal tumors. Neuro Oncol 2018; 20:445-456. [PMID: 29194500 PMCID: PMC5909649 DOI: 10.1093/neuonc/nox166] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Ependymal tumors are rare CNS tumors and may occur at any age, but their proportion among primary brain tumors is highest in children and young adults. Thus, the level of evidence of diagnostic and therapeutic interventions is higher in the pediatric compared with the adult patient population.The diagnosis and disease staging is performed by craniospinal MRI. Tumor classification is achieved by histological and molecular diagnostic assessment of tissue specimens according to the World Health Organization (WHO) classification 2016. Surgery is the crucial initial treatment in both children and adults. In pediatric patients with intracranial ependymomas of WHO grades II or III, surgery is followed by local radiotherapy regardless of residual tumor volume. In adults, radiotherapy is employed in patients with anaplastic ependymoma WHO grade III, and in case of incomplete resection of WHO grade II ependymoma. Chemotherapy alone is reserved for young children <12 months and for adults with recurrent disease when further surgery and irradiation are no longer feasible. A gross total resection is the mainstay of treatment in spinal ependymomas, and radiotherapy is reserved for incompletely resected tumors. Nine subgroups of ependymal tumors across different anatomical compartments (supratentorial, posterior fossa, spinal) and patient ages have been identified with distinct genetic and epigenetic alterations, and with distinct outcomes. These findings may lead to more precise diagnostic and prognostic assessments, molecular subgroup-adapted therapies, and eventually new recommendations pending validation in prospective studies.
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Affiliation(s)
- Roberta Rudà
- Department of Neuro-Oncology, University of Turin and City of Health and Science University Hospital, Turin, Italy
| | - Guido Reifenberger
- Institute of Neuropathology, Medical Faculty, Heinrich Heine University Düsseldorf and German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, Düsseldorf, Germany
| | - Didier Frappaz
- Département de Neuro-Oncologie, Centre Léon-Bérard, Institut d’Hématologie et Oncologie Pédiatrique et Adulte, Lyon, France
| | - Stefan M Pfister
- Division of Pediatric Neuro-oncology, German Cancer Research Center, DKTK, Heidelberg, Germany and Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anne Laprie
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | | | - Patrick Roth
- Department of Neurology and Brain Tumor Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Joerg Christian Tonn
- Department of Neurosurgery Ludwig-Maximilians-Universität and DKTK partner site, University of Munich, Munich, Germany
| | - Riccardo Soffietti
- Department of Neuro-Oncology, University of Turin and City of Health and Science University Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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19
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Malgulwar PB, Nambirajan A, Pathak P, Faruq M, Rajeshwari M, Singh M, Suri V, Sarkar C, Sharma MC. C11orf95-RELA fusions and upregulated NF-KB signalling characterise a subset of aggressive supratentorial ependymomas that express L1CAM and nestin. J Neurooncol 2018; 138:29-39. [PMID: 29354850 DOI: 10.1007/s11060-018-2767-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 01/14/2018] [Indexed: 12/16/2022]
Abstract
Ependymomas (EPN) show site specific genetic alterations and a recent DNA methylation profiling study identified nine molecular subgroups. C11orf95-RELA and YAP1 fusions characterise the RELA and YAP1 molecular subgroups, respectively, of supratentorial (ST)-EPNs. Current guidelines recommend molecular subgrouping over histological grade for accurate prognostication. Clinicopathological features of ST-EPNs in correlation with C11orf95-RELA and YAP1 fusions have been assessed in only few studies. We aimed to study these fusions in EPNs, and identify diagnostic and prognostic markers. qRT-PCR and Sanger Sequencing for the detection of C11orf95-RELA, YAP1-MAMLD1 and YAP1-FAM118B fusion transcripts, gene expression analysis for NFKB1, and immunohistochemistry for p53, MIB-1, nestin, VEGF, and L1CAM were performed. 88 EPNs (10-Grade I and 78-Grade II/III) from all sites were included. RELA fusions were unique to Grade II/III ST-EPNs, detected in 81.4% (22/27) and 18.5% (5/27) of pediatric and adult ST-EPNs respectively. ST-EPNs harbouring RELA fusions showed frequent grade III histology (81.5%), clear cell morphology (70.3%), upregulated NFKB1 expression, MIB-1 labelling indices (LI) ≥ 10% (77.8%), and immunopositivity for nestin (95.7%), VEGF (72%), L1CAM (79%), and p53 (64%). Presence of RELA fusions, L1CAM immunopositivity and MIB-1 LI ≥ 10% associated with poor outcome. L1CAM showed 81% concordance with RELA fusions. YAP1-MAMLD1 fusion was identified in a single RELA fusion negative adult anaplastic ST-EPN. RELA fusions are frequent in ST-EPNs and associate with poor outcome. L1CAM is a surrogate immunohistochemical marker. RELA fusion positive ST-EPNs strongly express nestin indicating increased stemness. Further evaluation of the interactions between NFKB and stem cell pathways is warranted.
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Affiliation(s)
- Prit Benny Malgulwar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Pankaj Pathak
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mohammed Faruq
- Genomics and Molecular Medicine Unit, Institute of Genomics and Integrative Biology-Council of Scientific and Industrial Research (IGIB-CSIR), New Delhi, India
| | - Madhu Rajeshwari
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Mehar Chand Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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20
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Choudhri AF, Siddiqui A, Klimo P. Pediatric Cerebellar Tumors: Emerging Imaging Techniques and Advances in Understanding of Genetic Features. Magn Reson Imaging Clin N Am 2017; 24:811-821. [PMID: 27742118 DOI: 10.1016/j.mric.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cerebellar tumors are the most common group of solid tumors in children. MR imaging provides an important role in characterization of these lesions, surgical planning, and postsurgical surveillance. Preoperative imaging can help predict the histologic subtype of tumors, which can provide guidance for surgical planning. Beyond histology, pediatric brain tumors are undergoing new classification schemes based on genetic features. Intraoperative MR imaging has emerged as an important tool in the surgical management of pediatric brain tumors. Effective understanding of the imaging features of pediatric cerebellar tumors can benefit communication with neurosurgeons and neuro-oncologists and can improve patient management.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Department of Ophthalmology, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA.
| | - Adeel Siddiqui
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Division of Neurosurgery, St. Jude's Children's Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Semmes Murphey Neurologic & Spine Institute, 6325 Humphreys Boulevard, Memphis, TN 38120, USA
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21
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Virág J, Haberler C, Baksa G, Piurkó V, Hegedüs Z, Reiniger L, Bálint K, Chocholous M, Kiss A, Lotz G, Glasz T, Schaff Z, Garami M, Hegedűs B. Region Specific Differences of Claudin-5 Expression in Pediatric Intracranial Ependymomas: Potential Prognostic Role in Supratentorial Cases. Pathol Oncol Res 2017; 23:245-252. [PMID: 27395057 PMCID: PMC5371650 DOI: 10.1007/s12253-016-0084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/28/2016] [Indexed: 10/26/2022]
Abstract
Ependymomas are common pediatric brain tumors that originate from the ependyma and characterized by poor prognosis due to frequent recurrence. However, the current WHO grading system fails to accurately predict outcome. In a retrospective study, we analyzed 54 intracranial pediatric ependymomas and found a significantly higher overall survival in supratentorial cases when compared to infratentorial tumors. Next we performed region-specific immunohistochemical analysis of the ependyma in neonatal and adult ependyma from the central canal of spinal cord to the choroid plexus of lateral ventricles for components of cell-cell junctions including cadherins, claudins and occludin. We found robust claudin-5 expression in the choroid plexus epithelia but not in other compartments of the ependyma. Ultrastructural studies demonstrated distinct regional differences in cell-cell junction organization. Surprisingly, we found that 9 out of 20 supratentorial but not infratentorial ependymomas expressed high levels of the brain endothelial tight junction component claudin-5 in tumor cells. Importantly, we observed an increased overall survival in claudin-5 expressing supratentorial ependymoma. Our data indicates that claudin-5 expressing ependymomas may follow a distinct course of disease. The assessment of claudin-5 expression in ependymoma has the potential to become a useful prognostic marker in this pediatric malignancy.
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Affiliation(s)
- József Virág
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Christine Haberler
- Institute of Neuropathology, Medical University of Vienna, Vienna, Austria
| | - Gábor Baksa
- 1st Department of Anatomy, Semmelweis University, Budapest, Hungary
| | - Violetta Piurkó
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Zita Hegedüs
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Lilla Reiniger
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
- MTA-SE NAP, Brain Metastasis Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary
| | - Katalin Bálint
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Monika Chocholous
- Department of Pediatrics, Medical University of Vienna, Vienna, Austria
| | - András Kiss
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Gábor Lotz
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Tibor Glasz
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Zsuzsa Schaff
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Miklós Garami
- 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Balázs Hegedűs
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary.
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
- Molecular Oncology Research Group, Hungarian Academy of Sciences - Semmelweis University, Budapest, Hungary.
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Abstract
Over the past 150 years since Virchow's initial characterization of ependymoma, incredible efforts have been made in the classification of these tumors and in the care of pediatric patients with this disease. While the advent of modern neurosurgery and the optimization of radiation have provided significant gains, a more complex but incomplete picture of pediatric ependymomas has begun to form through a combination of international collaborations and detailed genetic and histologic characterizations. This review includes and synthesizes the clinical understanding of pediatric ependymoma and their developing molecular insight into what is truly a family of malignancies in which distinct members require different surgical approaches, radiation plans, and targeted therapies.
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Affiliation(s)
- Nicholas A Vitanza
- Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Stanford University, Palo Alto, CA, USA
| | - Sonia Partap
- Division of Child Neurology, Department of Neurology, Lucile Packard Children's Hospital at Stanford, Stanford University, Palo Alto, CA, USA
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23
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LeBlanc AK, Mazcko C, Brown DE, Koehler JW, Miller AD, Miller CR, Bentley RT, Packer RA, Breen M, Boudreau CE, Levine JM, Simpson RM, Halsey C, Kisseberth W, Rossmeisl JH, Dickinson PJ, Fan TM, Corps K, Aldape K, Puduvalli V, Pluhar GE, Gilbert MR. Creation of an NCI comparative brain tumor consortium: informing the translation of new knowledge from canine to human brain tumor patients. Neuro Oncol 2016; 18:1209-18. [PMID: 27179361 PMCID: PMC4999002 DOI: 10.1093/neuonc/now051] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/27/2016] [Indexed: 12/14/2022] Open
Abstract
On September 14-15, 2015, a meeting of clinicians and investigators in the fields of veterinary and human neuro-oncology, clinical trials, neuropathology, and drug development was convened at the National Institutes of Health campus in Bethesda, Maryland. This meeting served as the inaugural event launching a new consortium focused on improving the knowledge, development of, and access to naturally occurring canine brain cancer, specifically glioma, as a model for human disease. Within the meeting, a SWOT (strengths, weaknesses, opportunities, and threats) assessment was undertaken to critically evaluate the role that naturally occurring canine brain tumors could have in advancing this aspect of comparative oncology aimed at improving outcomes for dogs and human beings. A summary of this meeting and subsequent discussion are provided to inform the scientific and clinical community of the potential for this initiative. Canine and human comparisons represent an unprecedented opportunity to complement conventional brain tumor research paradigms, addressing a devastating disease for which innovative diagnostic and treatment strategies are clearly needed.
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Affiliation(s)
- Amy K LeBlanc
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Christina Mazcko
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Diane E Brown
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Jennifer W Koehler
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Andrew D Miller
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - C Ryan Miller
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - R Timothy Bentley
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Rebecca A Packer
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Matthew Breen
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - C Elizabeth Boudreau
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Jonathan M Levine
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - R Mark Simpson
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Charles Halsey
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - William Kisseberth
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - John H Rossmeisl
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Peter J Dickinson
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Timothy M Fan
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Kara Corps
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Kenneth Aldape
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Vinay Puduvalli
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - G Elizabeth Pluhar
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
| | - Mark R Gilbert
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (A.K.L, C.M.); American Kennel Club Canine Health Foundation, Raleigh, North Carolina (D.E.B); Department of Pathobiology, College of Veterinary Medicine, Auburn University, Auburn, Alabama (J.W.K); Department of Biomedical Sciences, Section of Anatomic Pathology, Cornell University College of Veterinary Medicine, Ithaca, New York (A.D.M); Departments of Pathology and Laboratory Medicine and Neurology, Lineberger Comprehensive Cancer Center and Neuroscience Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina (C.R.M); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana (R.T.B); Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado , (R.A.P); Department of Molecular Biomedical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (M.B.); Department of Small Animal Clinical Sciences, Texas A&M University, College Station, Texas (J.M.L, C.E.B); Laboratory of Cancer Biology and Genetics, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland (R.M.S, C.H.); Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio , (W.K.); Veterinary and Comparative Neuro-Oncology Laboratory, Department of Small Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia (J.H.R); Department of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, California (P.J.D); Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois (T.M.F); National Institute of Neurological Disorders and Stroke and National Cancer Institute, Bethesda, Maryland (K.C., M.R.G); De
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24
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Araki A, Chocholous M, Gojo J, Dorfer C, Czech T, Heinzl H, Dieckmann K, Ambros IM, Ambros PF, Slavc I, Haberler C. Chromosome 1q gain and tenascin-C expression are candidate markers to define different risk groups in pediatric posterior fossa ependymoma. Acta Neuropathol Commun 2016; 4:88. [PMID: 27550150 PMCID: PMC4994287 DOI: 10.1186/s40478-016-0349-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/18/2016] [Indexed: 12/11/2022] Open
Abstract
Intracranial classic (WHO grade II) and anaplastic (WHO grade III) ependymomas are among the most common tumors in pediatric patients and have due to frequent recurrences and late relapses a relatively poor outcome. The impact of histopathological grading on patient outcome is controversial and therefore, molecular prognostic and predictive markers are needed to improve patient outcome. To date, the most promising candidate marker is chromosome 1q gain, which has been associated in independent studies with adverse outcome. Furthermore, gene expression and methylation profiles revealed distinct molecular subgroups in the supratentorial and posterior fossa (PF) compartment and Laminin alpha-2 (LAMA2) and Neural Epidermal Growth Factor Like-2 (NELL2) were suggested as surrogate markers for the two PF subgroups PF-EPN-A and PF-EPN-B. PF-EPN-A tumors were also characterized by tenascin-C (TNC) expression and tenascin-C has been suggested as candidate gene on 9q, involved in tumor progression. Therefore, we have analyzed the status of chromosome 1q, TNC, LAMA2, and NELL2 expression in a series of pediatric PF ependymomas in terms of their frequency, associations among themselves, and clinical parameters, as well as their prognostic impact. We confirm the negative prognostic impact of 1q gain and TNC expression and could classify PF ependymomas by these two markers into three molecular subgroups. Tumors with combined 1q gain and TNC expression had the poorest, tumors without 1q gain and TNC expression had a favorable and TNC positive 1q non-gained cases had an intermediate outcome. We found also differences in age and tumor grade in the three subgroups and thus, provide evidence that PF pediatric ependymomas can be divided by chromosome 1q status and TNC expression in three molecular subgroups with distinct clinico-pathological features. These analyses require only few amounts of tumor tissue, are broadly available in the routine clinical neuropathological setting and thus, could be used in further therapy trials to optimize treatment of ependymoma patients.
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25
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Abedalthagafi MS, Wu MP, Merrill PH, Du Z, Woo T, Sheu SH, Hurwitz S, Ligon KL, Santagata S. Decreased FOXJ1 expression and its ciliogenesis programme in aggressive ependymoma and choroid plexus tumours. J Pathol 2016; 238:584-97. [PMID: 26690880 DOI: 10.1002/path.4682] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 11/12/2015] [Accepted: 12/10/2015] [Indexed: 12/21/2022]
Abstract
Well-differentiated human cancers share transcriptional programmes with the normal tissue counterparts from which they arise. These programmes broadly influence cell behaviour and function and are integral modulators of malignancy. Here, we show that the master regulator of motile ciliogenesis, FOXJ1, is highly expressed in cells along the ventricular surface of the human brain. Strong expression is present in cells of the ependyma and the choroid plexus as well as in a subset of cells residing in the subventricular zone. Expression of FOXJ1 and its transcriptional programme is maintained in many well-differentiated human tumours that arise along the ventricle, including low-grade ependymal tumours and choroid plexus papillomas. Anaplastic ependymomas as well as choroid plexus carcinomas show decreased FOXJ1 expression and its associated ciliogenesis programme genes. In ependymomas and choroid plexus tumours, reduced expression of FOXJ1 and its ciliogenesis programme are markers of poor outcome and are therefore useful biomarkers for assessing these tumours. Transitions in ciliogenesis define distinct differentiation states in ependymal and choroid plexus tumours with important implications for patient care. Copyright © 2015 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Malak S Abedalthagafi
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia.,King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia.,Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael P Wu
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Parker H Merrill
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ziming Du
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Terri Woo
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shu-Hsien Sheu
- Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shelley Hurwitz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith L Ligon
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Division of Neuropathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA, USA
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26
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Choudhri AF, Siddiqui A, Klimo P. Pediatric Cerebellar Tumors: Emerging Imaging Techniques and Advances in Understanding of Genetic Features. Neuroimaging Clin N Am 2016; 26:459-69. [PMID: 27423803 DOI: 10.1016/j.nic.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cerebellar tumors are the most common group of solid tumors in children. MR imaging provides an important role in characterization of these lesions, surgical planning, and postsurgical surveillance. Preoperative imaging can help predict the histologic subtype of tumors, which can provide guidance for surgical planning. Beyond histology, pediatric brain tumors are undergoing new classification schemes based on genetic features. Intraoperative MR imaging has emerged as an important tool in the surgical management of pediatric brain tumors. Effective understanding of the imaging features of pediatric cerebellar tumors can benefit communication with neurosurgeons and neuro-oncologists and can improve patient management.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Department of Ophthalmology, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA.
| | - Adeel Siddiqui
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Division of Neurosurgery, St. Jude's Children's Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Semmes Murphey Neurologic & Spine Institute, 6325 Humphreys Boulevard, Memphis, TN 38120, USA
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27
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Theeler BJ, Gilbert MR. Investigating therapies in ependymoma. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1191347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Brett J. Theeler
- Department of Neurology, Walter Reed National Military Medical Center, Neurology and John P. Murtha Cancer Center, Bethesda, MD, USA
| | - Mark R. Gilbert
- Neuro-Oncology Branch, National Institutes of Health, Bethesda, MD, USA
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28
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Celano E, Salehani A, Malcolm JG, Reinertsen E, Hadjipanayis CG. Spinal cord ependymoma: a review of the literature and case series of ten patients. J Neurooncol 2016; 128:377-86. [PMID: 27154165 DOI: 10.1007/s11060-016-2135-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 05/01/2016] [Indexed: 02/06/2023]
Abstract
Spinal cord ependymoma (SCE) is a rare tumor that is most commonly low-grade. Complete surgical resection has been established as first-line treatment and can be curative. However, SCEs tend to recur when complete tumor resection is not possible. Evidence supporting the use of adjuvant radiation and chemotherapy is not definitive. We review the most recent literature on SCE covering a comprehensive range of topics spanning the biology, presentation, clinical management, and outcomes. In addition, we present a case series of ten SCE patients with the goal of contributing to existing knowledge of this rare disease.
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Affiliation(s)
- Emma Celano
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Erik Reinertsen
- Emory University School of Medicine, Atlanta, GA, USA.,Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Constantinos G Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Philips Ambulatory Care Center, 10 Union Square, 5th Floor, Suite 5E, New York, NY, 10003, USA.
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29
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Wu J, Armstrong TS, Gilbert MR. Biology and management of ependymomas. Neuro Oncol 2016; 18:902-13. [PMID: 27022130 DOI: 10.1093/neuonc/now016] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022] Open
Abstract
Ependymomas are rare primary tumors of the central nervous system in children and adults that comprise histologically similar but genetically distinct subgroups. The tumor biology is typically more associated with the site of origin rather than being age-specific. Genetically distinct subgroups have been identified by genomic studies based on locations in classic grade II and III ependymomas. They are supratentorial ependymomas with C11orf95-RELA fusion or YAP1 fusion, infratentorial ependymomas with or without a hypermethylated phenotype (CIMP), and spinal cord ependymomas. Myxopapillary ependymomas and subependymomas have different biology than ependymomas with typical WHO grade II or III histology. Surgery and radiotherapy are the mainstays of treatment, while the role of chemotherapy has not yet been established. An in-depth understanding of tumor biology, developing reliable animal models that accurately reflect tumor molecule features, and high throughput drug screening are essential for developing new therapies. Collaborative efforts between scientists, physicians, and advocacy groups will enhance the translation of laboratory findings into clinical trials. Improvements in disease control underscore the need to incorporate assessment and management of patients' symptoms to ensure that treatment advances translate into improvement in quality of life.
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Affiliation(s)
- Jing Wu
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland (J.W., M.R.G.); Department of Family Health, University of Texas Health Science Center at Houston, Houston, Texas (T.S.A.)
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30
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Evaluation of chromosome 1q gain in intracranial ependymomas. J Neurooncol 2016; 127:271-8. [PMID: 26725097 DOI: 10.1007/s11060-015-2047-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 12/25/2015] [Indexed: 10/22/2022]
Abstract
Ependymomas are relatively uncommon gliomas with poor prognosis despite recent advances in neurooncology. Molecular pathogenesis of ependymomas is not extensively studied. Lack of correlation of histological grade with patient outcome has directed attention towards identification of molecular alterations as novel prognostic markers. Recently, 1q gain has emerged as a potential prognostic marker, associated with decreased survival, especially in posterior fossa, high grade tumors. Cases of intracranial ependymomas were retrieved. Tumors were graded using objective criteria to supplement WHO grading. Fluorescence in situ hybridization for 1q gain was performed on formalin-fixed paraffin embedded sections. Eighty-one intracranial ependymomas were analyzed. Pediatric (76%) and infratentorial (70%) ependymomas constituted the majority. 1q gain was seen in 27 cases (33%), was equally frequent in children (34%) and adults (32%), supratentorial (37%) and infratentorial (32%) location, grade II (33%) and III (25%) tumors. Recurrence was noted in 24 cases and death in 7 cases with 5-year progression-free and overall-survival rates of 37% and 80%, respectively. Grade II tumors had a better survival than grade III tumors; histopathological grade was the only prognostically significant marker. 1q gain had no prognostic significance. 1q gain is frequent in ependymomas in Indian patients, seen across all ages, sites and grades, and thus is likely an early event in pathogenesis. The prognostic value of 1q gain, remains uncertain, and multicentric pooling of data is required. A histopathological grading system using objective criteria correlates well with patient outcome and can serve as an economical option for prognostication of ependymomas.
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Dorfer C, Tonn J, Rutka JT. Ependymoma: a heterogeneous tumor of uncertain origin and limited therapeutic options. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:417-431. [PMID: 26948369 DOI: 10.1016/b978-0-12-802997-8.00025-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Ependymomas are tumors that typically occur with an age-based site preference, with adults harboring supratentorial and spinal tumors and pediatric tumors being mainly in the posterior fossa. Despite their similar histologic appearance, the prognosis varies significantly by age and tumor location, with a better prognosis in increasing age. The mainstay of treatment remains surgical excision with or without radiation therapy as the tumor biology is poorly understood and chemotherapy is generally considered to be ineffective. More recently, molecular biology data have increased our understanding of the genetic and epigenetic changes that drive these tumors, but still it will take a lot of effort to find effective chemotherapeutic regimens. Currently, we are trying to define a subset of tumors, for which radiation therapy can be avoided.
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Affiliation(s)
- Christian Dorfer
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada; Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Joerg Tonn
- Department of Neurosurgery, University Clinic of Ludwig-Maximilians-University Munich-Großhadern, Munich, Germany
| | - James T Rutka
- Division of Neurosurgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.
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Gupta K, Salunke P. Understanding Ependymoma Oncogenesis: an Update on Recent Molecular Advances and Current Perspectives. Mol Neurobiol 2015; 54:15-21. [PMID: 26712502 DOI: 10.1007/s12035-015-9646-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 12/16/2015] [Indexed: 01/12/2023]
Abstract
Remarkable progress has been made in the last decade in understanding the biology and oncogenesis of this relatively rare childhood brain tumor-the ependymoma. Surgery and irradiation are the mainstays of therapeutic options; chemotherapy is yet to predictably affect outcome, and its role is currently being explored in several clinical trials. While WHO scores this tumor into three grades, grading of ependymoma into grade II and grade III is controversial because of its elusive histological criteria where no cut-offs have been defined for mitoses or percentage of tumor depicting increased cellularity. Grading remains unreliable in predicting outcome in several instances. There is a compelling need to integrate the molecular biomarkers highlighted in several studies over the past decade into patient risk stratification to help in better predicting the clinical outcome and to design effective tailored therapy. Genomic and transcriptomic studies lately have defined distinct molecular subgroups within ependymoma arising at three anatomic compartments-supratentorial, posterior fossa, and spinal cord. Review of pertinent literature on several seminal studies that have established a paradigm shift in understanding the oncogenesis of ependymoma has been carried out. The outcome, impact, and clinical relevance of these studies are also discussed. The review provides an update on progress and recent advances in understanding the biology and oncogenesis of ependymoma. The establishment of robust subgroups which are demographically, clinically, and molecularly distinct will provide new avenues for further refinement of therapeutic strategies.
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Affiliation(s)
- Kirti Gupta
- Neuropathology fellowship (St Jude, Memphis), Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Pravin Salunke
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Raybaud C, Ramaswamy V, Taylor MD, Laughlin S. Posterior fossa tumors in children: developmental anatomy and diagnostic imaging. Childs Nerv Syst 2015; 31:1661-76. [PMID: 26351220 DOI: 10.1007/s00381-015-2834-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 07/10/2015] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Modern understanding of the relation between the mutated cancer stem cell and its site of origin and of its interaction with the tissue environment is enhancing the importance of developmental anatomy in the diagnostic assessment of posterior fossa tumors in children. The aim of this review is to show how MR imaging can improve on the exact identification of the tumors in the brainstem and in the vicinity of the fourth ventricle in children, using both structural imaging data and a precise topographical assessment guided by the developmental anatomy. RESULTS The development of the hindbrain results from complex processes of brainstem segmentation, ventro-dorsal patterning, multiple germinative zones, and diverse migration pathways of the neural progenitors. Depending on their origin in the brainstem, gliomas may be infiltrative or not, as well as overwhelmingly malignant (pons), or mostly benign (cervicomedullary, medullo-pontine tegmental, gliomas of the cerebellar peduncles). In the vicinity of the fourth ventricles, the prognosis of the medulloblastomas (MB) correlates the molecular subtyping as well as the site of origin: WNT MB develop from the Wnt-expressing lower rhombic lip and have a good prognosis; SHH MB develop from the Shh-modulated cerebellar cortex with an intermediate prognosis (dependent on age); recurrences are local mostly. The poor prognosis group 3 MB is radiologically heterogeneous: some tumors present classic features but are juxtaventricular (rather than intraventricular); others have highly malignant features with a small principal tumor and an early dissemination. Group 4 MB has classic features, but characteristically usually does not enhance; dissemination is common. Although there is as yet no clear molecular subgrouping of the ependymomas, their sites of origin and their development can be clearly categorized, as most develop in an exophytic way from the ventricular surface of the medulla in clearly specific locations: the obex region with expansion in the cistern magna, or the lateral recess region with expansion in the CPA and prepontine cisterns (cerebellar ependymomas, and still more intra-brainstem ependymomas are rare). Finally, almost all cerebellar gliomas are pilocytic astrocytomas. CONCLUSIONS A developmental and anatomic approach to the posterior fossa tumors in children (together with diffusion imaging data) provides a reliable pre-surgical identification of the tumor and of its aggressiveness.
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Affiliation(s)
- Charles Raybaud
- Pediatric Neuroradiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada.
| | - Vijay Ramaswamy
- Neurooncology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Michael D Taylor
- Neurosurgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Suzanne Laughlin
- Pediatric Neuroradiology, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G1X8, Canada
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Abstract
OBJECT
Ependymomas of the filum terminale provide specific surgical challenges due to their often enormous size, contact with nerve roots of the cauda equina and conus, and potential for subarachnoid dissemination. This study presents treatment results for these tumors over a 30-year period.
METHODS
Among 1447 patients with tumors of the spinal canal treated between 1980 and 2014, 618 patients presented with extramedullary tumors. Of these, 42 patients (25 males, 17 females) demonstrated a myxopapillary ependymoma in the lumbosacral region. Thirty-four patients underwent 36 operations for 39 such tumors. The mean patient age was 38 ± 14 years (range 11−73 years), with an average clinical history of 37 ± 67 months. Patients were followed through outpatient visits and questionnaires, with a mean follow-up of 10 years (127 ± 100 months). Twenty-seven operations were performed to treat de novo tumors and the remainder were undertaken on recurrent tumors. Short-term results were determined for individual symptoms, and tumor recurrence rates were calculated with Kaplan-Meier statistical analyses.
RESULTS
Subarachnoid dissemination was observed in 11 patients and was related to previous surgery in 9 patients and associated with extensive tumors in 2 patients. Gross-total resections (GTR) were achieved in 28 operations (77.7%) and subtotal resections in the remainder. Subtotal resections were restricted to unencapsulated ependymomas (61.5%). Radiotherapy was employed after 6 operations on unencapsulated tumors, with 5 of these also demonstrating subarachnoid seeding. Permanent surgical morbidity affected 3 patients who experienced permanent worsening of bladder function, while 7 patients showed no postoperative changes, and the remaining 26 operations were followed by improvements. Long-term outcome depended on the amount of resection and the presence of a tumor capsule. Eight of 9 tumor recurrences affected unencapsulated tumors, of which 3 had undergone GTR. The overall recurrence rates were 6.6%, 19.0%, and 37.0% after 1, 10, and 20 years, respectively. For unencapsulated ependymomas, the corresponding rates were 15.6%, 32.5%, and 66.2% after 1, 10, and 20 years, respectively, with significantly lower rates of 9.1% after 10 and 20 years for encapsulated tumors. Postoperative radiotherapy tended to prolong the recurrence-free interval for patients with unencapsulated tumors. Five patient deaths occurred during follow-up, of which 2 deaths were tumor related and occurred at 216 and 287 months after surgery.
CONCLUSION
Extramedullary ependymomas are slow-growing tumors in the lumbosacral region, sometimes with an indolent course for long periods of time. Despite their delicate location and often enormous size, surgical morbidity in experienced hands is low, with good chances for postoperative clinical improvements and very low recurrence rates after GTR for encapsulated tumors. The role of postoperative radiotherapy remains controversial. Radiotherapy may be considered after incomplete resections of unencapsulated tumors and/or for patients with subarachnoid dissemination.
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Nambirajan A, Sharma MC, Gupta RK, Suri V, Singh M, Sarkar C. Study of stem cell marker nestin and its correlation with vascular endothelial growth factor and microvascular density in ependymomas. Neuropathol Appl Neurobiol 2015; 40:714-25. [PMID: 24224478 DOI: 10.1111/nan.12097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 11/08/2013] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ependymomas are relatively rare glial tumours, whose pathogenesis is not well elucidated. They are enigmatic tumours that show site-specific differences in their biological behaviour. Recent studies have hypothesized that ependymoma cancer stem cells (CSCs) are derived from radial glia and express stem cell markers such as nestin, which is associated with a poor prognosis. CSCs reside in 'vascular niches', where endothelial cells and molecular signals like vascular endothelial growth factor (VEGF) play an important role in their survival. Studies analysing VEGF expression in ependymomas showed that ependymal vascular proliferation is less sensitive to induction by VEGF, questioning the possible beneficial effect of anti-VEGF therapy in ependymomas. We aimed to study nestin and VEGF immunoexpression in ependymomas, correlate them with clinicopathological parameters and reveal a role for VEGF in ependymomas that extends beyond the context of tumour angiogenesis. METHODS We analysed 126 cases of ependymomas of different grades and locations for nestin and VEGF immunoexpression. Endothelial cells were labelled with CD34. Vascular patterns and microvascular density was determined. RESULTS Nestin and VEGF expression in tumour cells were more frequent in supratentorial tumours [89% (33/37) and 65% (24/37) respectively], and were associated with a significantly poor progression-free survival (PFS). VEGF expression did not reveal any correlation with necrosis or bizarre vascular patterns. CONCLUSIONS Supratentorial location is an independent predictor of a poor PFS. Significant coexpression of nestin and VEGF suggests that latter possibly augments stem cell survival. Thus, anti-VEGF therapy may be a good option in future for nestin immunopositive ependymomas.
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Affiliation(s)
- Aruna Nambirajan
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Prognostic marker analysis in pediatric intracranial ependymomas. J Neurooncol 2015; 122:255-61. [DOI: 10.1007/s11060-014-1711-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 12/26/2014] [Indexed: 01/13/2023]
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Kitchen WJ, Pizer B, Pettorini B, Husband D, Mallucci C, Jenkinson MD. Paediatric intracranial anaplastic ependymoma: the role of multiple surgical resections for disease relapse in maintaining quality of life and prolonged survival. Pediatr Neurosurg 2015; 50:68-72. [PMID: 25871983 DOI: 10.1159/000380856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 02/01/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Ependymoma is the third most common intracranial glioma in children. The treatment of choice for these tumours remains gross total resection followed by radiotherapy. There are two principal histological subtypes, namely classic (∼70%) and anaplastic (∼30%) ependymoma. CASE We present the case of a 12-year-old girl with an anaplastic ependymoma of the left temporal lobe. She underwent initial image-guided resection following biopsy. A postoperative MRI showed a macroscopic resection. She subsequently relapsed and indeed had 11 local and distant relapses managed by 12 separate craniotomies and tumour resection, 4 courses of radiotherapy and chemotherapy. CONCLUSION For patients with multiple relapses, surgery should be considered primarily to re-resect any symptomatic lesion. This case demonstrates that multiple tumour resections can be undertaken with limited morbidity for the patient and with maintenance of quality of life. Repeated focal irradiation can also be used to control the disease with limited morbidity.
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Vera-Bolanos E, Aldape K, Yuan Y, Wu J, Wani K, Necesito-Reyes MJ, Colman H, Dhall G, Lieberman FS, Metellus P, Mikkelsen T, Omuro A, Partap S, Prados M, Robins HI, Soffietti R, Wu J, Gilbert MR, Armstrong TS. Clinical course and progression-free survival of adult intracranial and spinal ependymoma patients. Neuro Oncol 2014; 17:440-7. [PMID: 25121770 DOI: 10.1093/neuonc/nou162] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 07/09/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Ependymomas are rare CNS tumors. Previous studies describing the clinical course of ependymoma patients were restricted to small sample sizes, often with patients at a specific institution. METHODS Clinically annotated ependymoma tissue samples from 19 institutions were centrally reviewed. Patients were all adults aged 18 years or older at the time of diagnosis. Potential prognostic clinical factors identified on univariate analysis were included in a multivariate Cox proportional hazards model with backwards selection to model progression-free survival. RESULTS The 282 adult ependymoma patients were equally male and female with a mean age of 43 years (range, 18-80y) at diagnosis. The majority were grade II (78%) with the tumor grade for 20 cases being reclassified on central review (half to higher grade). Tumor locations were spine (46%), infratentorial (35%), and supratentorial (19%). Tumor recurrence occurred in 26% (n = 74) of patients with a median time to progression of 14 years. A multivariate Cox proportional hazards model identified supratentorial location (P < .01), grade III (anaplastic; P < .01), and subtotal resection, followed or not by radiation (P < .01), as significantly increasing risk of early progression. CONCLUSIONS We report findings from an ongoing, multicenter collaboration from a collection of clinically annotated adult ependymoma tumor samples demonstrating distinct predictors of progression-free survival. This unique resource provides the opportunity to better define the clinical course of ependymoma for clinical and translational studies.
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Affiliation(s)
- Elizabeth Vera-Bolanos
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Kenneth Aldape
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Ying Yuan
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Jimin Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Khalida Wani
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Mary Jo Necesito-Reyes
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Howard Colman
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Girish Dhall
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Frank S Lieberman
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Philippe Metellus
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Tom Mikkelsen
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Antonio Omuro
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Sonia Partap
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Michael Prados
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - H Ian Robins
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Riccardo Soffietti
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Jing Wu
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Mark R Gilbert
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
| | - Terri S Armstrong
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (E.V.-B., M.R.G.); Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (K.A., K.W.); Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (Y.Y., J.W.); Office of Multicenter Clinical Research, The University of Texas M.D. Anderson Cancer Center, Houston, Texas (M.J.N.-R.); Department of Neurosurgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (H.C.); Division of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California (G.D.); Departments of Neurology and Medicine (Medical Oncology), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (F.S.L.); Department of Neurosurgery, Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, Marseille, France (P.M.); Departments of Neurology & Neurosurgery, Henry Ford Hospital, Detroit, Michigan (T.M.); Department of Neurology, Memorial-Sloan Kettering Cancer Center, New York, New York (A.O.); Department of Neurology, Stanford University & Lucile Packard Children's Hospital, Palo Alto, California (S.P.); Department of Neuro-Oncology, UCSF Helen Diller Comprehensive Cancer Center, San Francisco, California (M.P.); Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin (H.I.R.); Department of Neuroscience, University San Giovanni Battista Hospital, Turin, Italy (R.S.); Department of Neurosurgery, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina (J.W.); Department of Family Health, School of Nursing, The University of Texas Health Science Center-Houston, Houston, Texas (T.S.A.); CERN Foundation, Dayton, Ohio
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