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Nandoliya KR, Thirunavu V, Ellis E, Dixit K, Tate MC, Drumm MR, Templer JW. Pre-operative predictors of post-operative seizure control in low-grade glioma: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:94. [PMID: 38411788 DOI: 10.1007/s10143-024-02329-9] [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: 08/09/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
As many as 80% of low-grade gliomas (LGGs) present with seizures, negatively impacting quality of life. While seizures are associated with gliomas regardless of grade, the importance of minimizing impact of seizures for patients with low grade tumors cannot be understated given the prolonged survival period in this population. The objective of this systematic review and meta-analysis was to summarize existing literature and identify factors associated with post-operative seizure control (defined as Engel I classification) in patients with LGGs, with a focus on pre-operative factors. Patient data extracted include tumor location and histology, pre-operative anti-seizure medication use, extent of resection (EOR), adjuvant treatment, pre-operative seizure type, duration, and frequency, and post-operative Engel classification. A random-effects model was used to calculate the effects of EOR, pre-operative seizure duration, adjuvant radiation, and adjuvant chemotherapy on post-operative seizure control. The effect of tumor location and histology on post-operative Engel I classification was determined using contingency analyses. Thirteen studies including 1628 patients with seizures were included in the systematic review. On meta-analyses, Engel I classification was associated with pre-operative seizure type (OR = 0.79 (0.63-0.99), p = 0.0385, focal versus generalized), frontal lobe LGGs (OR = 1.5 (1.1-2.0), p = 0.0195), and EOR (OR (95% CI) = 4.5 (2.3-6.7), p < 0.0001 gross-total versus subtotal). Pre-operative seizure duration less than one year, adjuvant radiation, adjuvant chemotherapy, and tumor histology were not associated with achieving Engel I classification. In addition to the known effects of EOR, Engel I classification is less likely to be achieved in patients with focal pre-operative seizures and more likely to be achieved in patients with frontal lobe LGGs.
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Affiliation(s)
- Khizar R Nandoliya
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Vineeth Thirunavu
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Erin Ellis
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Karan Dixit
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA
| | - Matthew C Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Michael R Drumm
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jessica W Templer
- Department of Neurology, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair Street, Suite 20-100, Chicago, IL, 60611, USA.
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Current Trends in Neurosurgical Management of Adult Diffuse Low-Grade Gliomas in Canada. Can J Neurol Sci 2023; 50:278-281. [PMID: 35510291 DOI: 10.1017/cjn.2022.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is considerable variability in the management of diffuse low-grade gliomas (LGGs). To characterize treatment paradigms, a survey of Canadian neurosurgeons was performed with forty neurosurgeons responding. Their responses show that the management of patients with LGGs has evolved in the past decade and findings from the RTOG9802 trial have been integrated into the practice of Canadian neurosurgeons. Most respondents stated that the patient selection and treatment strategy advocated by the RTOG9802 trial needs further evaluation. Overall, there is a trend toward more aggressive surgical resections, and future investigations will have to more accurately stratify patient risk profiles.
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Deacu M, Popescu S, Docu Axelerad A, Topliceanu TS, Aschie M, Bosoteanu M, Cozaru GC, Cretu AM, Voda RI, Orasanu CI. Prognostic Factors of Low-Grade Gliomas in Adults. Curr Oncol 2022; 29:7327-7342. [PMID: 36290853 PMCID: PMC9600247 DOI: 10.3390/curroncol29100576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/22/2022] Open
Abstract
Adult low-grade gliomas are a rare and aggressive pathology of the central nervous system. Some of their characteristics contribute to the patient's life expectancy and to their management. This study aimed to characterize and identify the main prognostic factors of low-grade gliomas. The six-year retrospective study statistically analyzed the demographic, imaging, and morphogenetic characteristics of the patient group through appropriate parameters. Immunohistochemical tests were performed: IDH1, Ki-67, p53, and Nestin, as well as FISH tests on the CDKN2A gene and 1p/19q codeletion. The pathology was prevalent in females, with patients having an average age of 56.31 years. The average tumor volume was 41.61 cm3, producing a midline shift with an average of 7.5 mm. Its displacement had a negative impact on survival. The presence of a residual tumor resulted in decreased survival and is an independent risk factor for mortality. Positivity for p53 identified a low survival rate. CDKN2A mutations were an independent risk factor for mortality. We identified that a negative prognosis is influenced by the association of epilepsy with headache, tumor volume, and immunoreactivity to IDH1 and p53. Independent factors associated with mortality were midline shift, presence of tumor residue, and CDKN2A gene deletions and amplifications.
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Affiliation(s)
- Mariana Deacu
- Clinical Service of Pathology, Departments of Pathology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
| | - Steliana Popescu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Radiology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
| | - Any Docu Axelerad
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Department of Neurology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
| | - Theodor Sebastian Topliceanu
- Center for Research and Development of the Morphological and Genetic Studyies of Malignant Pathology (CEDMOG), Ovidius University of Constanta, 900591 Constanta, Romania
| | - Mariana Aschie
- Clinical Service of Pathology, Departments of Pathology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
- Academy of Medical Sciences of Romania, 030167 Bucharest, Romania
| | - Madalina Bosoteanu
- Clinical Service of Pathology, Departments of Pathology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania
| | - Georgeta Camelia Cozaru
- Center for Research and Development of the Morphological and Genetic Studyies of Malignant Pathology (CEDMOG), Ovidius University of Constanta, 900591 Constanta, Romania
- Clinical Service of Pathology, Departments of Genetics, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
| | - Ana Maria Cretu
- Clinical Service of Pathology, Departments of Pathology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studyies of Malignant Pathology (CEDMOG), Ovidius University of Constanta, 900591 Constanta, Romania
| | - Raluca Ioana Voda
- Clinical Service of Pathology, Departments of Pathology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studyies of Malignant Pathology (CEDMOG), Ovidius University of Constanta, 900591 Constanta, Romania
| | - Cristian Ionut Orasanu
- Clinical Service of Pathology, Departments of Pathology, Sfantul Apostol Andrei Emergency County Hospital, 900591 Constanta, Romania
- Center for Research and Development of the Morphological and Genetic Studyies of Malignant Pathology (CEDMOG), Ovidius University of Constanta, 900591 Constanta, Romania
- Correspondence: ; Tel.: +40-72-281-4037
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Motomura K, Ohka F, Aoki K, Saito R. Supratotal Resection of Gliomas With Awake Brain Mapping: Maximal Tumor Resection Preserving Motor, Language, and Neurocognitive Functions. Front Neurol 2022; 13:874826. [PMID: 35645972 PMCID: PMC9133877 DOI: 10.3389/fneur.2022.874826] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/15/2022] [Indexed: 11/13/2022] Open
Abstract
Gliomas are a category of infiltrating glial neoplasms that are often located within or near the eloquent areas involved in motor, language, and neurocognitive functions. Surgical resection being the first-line treatment for gliomas, plays a crucial role in patient outcome. The role of the extent of resection (EOR) was evaluated, and we reported significant correlations between a higher EOR and better clinical prognosis of gliomas. However, recurrence is inevitable, even after aggressive tumor removal. Thus, efforts have been made to achieve extended tumor resection beyond contrast-enhanced mass lesions in magnetic resonance imaging (MRI)-defined areas, a process known as supratotal resection. Since it has been reported that tumor cells invade beyond regions visible as abnormal areas on MRI, imaging underestimates the true spatial extent of tumors. Furthermore, tumor cells have the potential to spread 10–20 mm away from the MRI-verified tumor boundary. The primary goal of supratotal resection is to maximize EOR and prolong the progression-free and overall survival of patients with gliomas. The available data, as well as our own work, clearly show that supratotal resection of gliomas is a feasible technique that has improved with the aid of awake functional mapping using intraoperative direct electrical stimulation. Awake brain mapping has enabled neurosurgeons achieve supratotal resection with favorable motor, language, and neurocognitive outcomes, ensuring a better quality of life in patients with gliomas.
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Robe PA, Rados M, Spliet WG, Hoff RG, Gosselaar P, Broekman MLD, van Zandvoort MJ, Seute T, Snijders TJ. Early Surgery Prolongs Professional Activity in IDH Mutant Low-Grade Glioma Patients: A Policy Change Analysis. Front Oncol 2022; 12:851803. [PMID: 35356212 PMCID: PMC8959843 DOI: 10.3389/fonc.2022.851803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/04/2022] [Indexed: 12/14/2022] Open
Abstract
Background Until 2015, Dutch guidelines recommended follow-up and biopsy rather than surgery as initial care for suspected low-grade gliomas (LGG). Given evidence that surgery could extend patient survival, our center stopped following this guideline on January 1, 2010 and opted for early maximal safe resection of LGG. The effects of early surgery on the ability of patients to work remains little documented. Methods A total of 104 patients operated on at our center between January 2000 and April 2013 and diagnosed with the WHO 2016 grade 2 astrocytoma, IDH mutant or oligodendroglioma, IDH mutant and deleted 1p19q were included. The clinical characteristics, survival, and work history of patients operated on before or after January 2010 were obtained from the patients' records and compared. The minimal follow-up was 8 years. Results As per policy change, the interval between radiological diagnosis and first surgery decreased significantly after 2010. Likewise, before 2010, 25.8% of tumors were initially biopsied, 51.6% were resected under anesthesia, and 22.5% under awake conditions versus 14.3%, 23.8%, and 61.9% after this date (p < 0.001). The severity of permanent postoperative neurological deficits decreased after 2010. In total, 82.5% of the patients returned to work postoperatively before 2010 versus 100% after 2010. The postoperative control of epilepsy increased significantly after 2010 (74.4% vs. 47.9%). The median time from diagnosis to a definitive incapacity to work increased by more than 2 years after 2010 (88.7 vs. 62.2 months). Conclusion A policy shift towards early aggressive surgical treatment of IDH mutant LGG is safe and prolongs the patients' ability to work.
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Affiliation(s)
- Pierre A Robe
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matea Rados
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Wim G Spliet
- Department of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Reinier G Hoff
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Peter Gosselaar
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marike L D Broekman
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Martine J van Zandvoort
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands.,Departement of Clinical Neuropsychology, University of Utrecht, Utrecht, Netherlands
| | - Tatjana Seute
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tom J Snijders
- University Medical Center (UMC) Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, Netherlands
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Motomura K, Chalise L, Ohka F, Aoki K, Tanahashi K, Hirano M, Nishikawa T, Yamaguchi J, Shimizu H, Wakabayashi T, Saito R. Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping. J Neurooncol 2021; 153:361-372. [PMID: 34009509 DOI: 10.1007/s11060-021-03776-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with grade II and III gliomas (GII/III-gliomas) who underwent awake brain mapping. METHODS We retrospectively analyzed 126 patients with GII/III-gliomas in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020. RESULTS EOR cut-off values for improved progression-free survival (PFS) were determined by a receiver operator characteristic (ROC) analysis of 5-year PFS. The ROC for EOR showed a cut-off value of ≥ 85.3%. The median PFS rate of patients with GII/III-gliomas in the group with an EOR ≥ 100%, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 90% (n = 52; MS, 43.1 months; 95% CI 37.7-48.5 months; p = 0.03). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR ≥ 100%, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI 19.9-51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI 22.3-59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. CONCLUSIONS The present study demonstrates a significant association between tumor EOR and survival in patients with GII/III gliomas. The EOR cut-off value for 5-year PFS was ≥ 85.3%. It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.
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Affiliation(s)
- Kazuya Motomura
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Lushun Chalise
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kosuke Aoki
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Masaki Hirano
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomohide Nishikawa
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Junya Yamaguchi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Hiroyuki Shimizu
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Ryuta Saito
- Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Liu S, Liu X, Zhuang W. Prognostic Factors Associated With Survival in Patients With Diffuse Astrocytoma. Front Surg 2021; 8:712350. [PMID: 34722621 PMCID: PMC8554054 DOI: 10.3389/fsurg.2021.712350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/17/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Diffuse astrocytoma (DA) is a rare disease with inadequately understood epidemiological characteristics and prognosis. Identification of the factors associated with the survival in DA patients is therefore necessary. In this study, we aim to investigate the clinicopathological characteristics of DA to delineate factors influencing the survival of DA. Methods: A population-based cohort study was conducted, utilizing prospectively extracted data from the Surveillance, Epidemiology and End Results (SEER) database. Patients with histological diagnosis of DA in the SEER database from 1973 to 2017 were included. Results: A total of 799 participants with DA were included, consisting of 95.9% fibrillary astrocytoma and 4.1% protoplasmic variants. The average age of participants was 41.9 years, with 57.2% being male. The majority of the population was white (87.5%). More than half (53.9%) of the patients were married. DA arose mostly in the cerebrum (63.8%). Around 71.6% of the population had received surgical treatment. The overall 1-, 3-, 5-, and 10-year survival rate were 73.7, 55.2, 49.4, and 37.6%, respectively. Kaplan-Meier analysis showed that age at diagnosis, marital status, primary tumor site, tumor size, and surgery was possibly associated with cancer-specific survival (CSS) (p < 0.05). Multivariate Cox proportional hazard analysis indicated that surgery was a protective factor whereas older age, larger tumor size, and tumor in the brainstem were harmful factors for patients with DA. Moreover, a nomogram predicting 5- and 10-year survival probability for DA was developed. Conclusions: Age, primary tumor site, tumor size, and surgery were associated with the survival of patients with DA.
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Dhawan S, Patil CG, Chen C, Venteicher AS. Early versus delayed postoperative radiotherapy for treatment of low-grade gliomas. Cochrane Database Syst Rev 2020; 1:CD009229. [PMID: 31958162 PMCID: PMC6984627 DOI: 10.1002/14651858.cd009229.pub3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This is an update of the review originally published in 2011 and first updated in 2015. In most people with low-grade gliomas (LGG), the primary treatment regimen remains a combination of surgery followed by postoperative radiotherapy. However, the optimal timing of radiotherapy is controversial. It is unclear whether to use radiotherapy in the early postoperative period, or whether radiotherapy should be delayed until tumour progression occurs. OBJECTIVES To assess the effects of early postoperative radiotherapy versus radiotherapy delayed until tumour progression for low-grade intracranial gliomas in people who had initial biopsy or surgical resection. SEARCH METHODS Original searches were run up to September 2014. An updated literature search from September 2014 through November 2019 was performed on the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 11), MEDLINE via Ovid (September 2014 to November week 2 2019), and Embase via Ovid (September 2014 to 2019 week 46) to identify trials for inclusion in this Cochrane review update. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared early versus delayed radiotherapy following biopsy or surgical resection for the treatment of people with newly diagnosed intracranial LGG (astrocytoma, oligodendroglioma, mixed oligoastrocytoma, astroblastoma, xanthoastrocytoma, or ganglioglioma). Radiotherapy may include conformal external beam radiotherapy (EBRT) with linear accelerator or cobalt-60 sources, intensity-modulated radiotherapy (IMRT), or stereotactic radiosurgery (SRS). DATA COLLECTION AND ANALYSIS Three review authors independently assessed the trials for inclusion and risk of bias, and extracted study data. We resolved any differences between review authors by discussion. Adverse effects were also extracted from the study report. We performed meta-analyses using a random-effects model with inverse variance weighting. MAIN RESULTS We included one large, multi-institutional, prospective RCT, involving 311 participants; the risk of bias in this study was unclear. This study found that early postoperative radiotherapy was associated with an increase in time to progression compared to observation (and delayed radiotherapy upon disease progression) for people with LGG but did not significantly improve overall survival (OS). The median progression-free survival (PFS) was 5.3 years in the early radiotherapy group and 3.4 years in the delayed radiotherapy group (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.45 to 0.77; P < 0.0001; 311 participants; 1 trial; low-quality evidence). The median OS in the early radiotherapy group was 7.4 years, while the delayed radiotherapy group experienced a median overall survival of 7.2 years (HR 0.97, 95% CI 0.71 to 1.33; P = 0.872; 311 participants; 1 trial; low-quality evidence). The total dose of radiotherapy given was 54 Gy; five fractions of 1.8 Gy per week were given for six weeks. Adverse effects following radiotherapy consisted of skin reactions, otitis media, mild headache, nausea, and vomiting. Rescue therapy was provided to 65% of the participants randomised to delayed radiotherapy. People in both cohorts who were free from tumour progression showed no differences in cognitive deficit, focal deficit, performance status, and headache after one year. However, participants randomised to the early radiotherapy group experienced significantly fewer seizures than participants in the delayed postoperative radiotherapy group at one year (25% versus 41%, P = 0.0329, respectively). AUTHORS' CONCLUSIONS Given the high risk of bias in the included study, the results of this analysis must be interpreted with caution. Early radiation therapy was associated with the following adverse effects: skin reactions, otitis media, mild headache, nausea, and vomiting. People with LGG who underwent early radiotherapy showed an increase in time to progression compared with people who were observed and had radiotherapy at the time of progression. There was no significant difference in overall survival between people who had early versus delayed radiotherapy; however, this finding may be due to the effectiveness of rescue therapy with radiation in the control arm. People who underwent early radiation had better seizure control at one year than people who underwent delayed radiation. There were no cases of radiation-induced malignant transformation of LGG. However, it remained unclear whether there were differences in memory, executive function, cognitive function, or quality of life between the two groups since these measures were not evaluated.
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Affiliation(s)
- Sanjay Dhawan
- University of MinnesotaDepartment of Neurosurgery420 Delaware St. SE, D429 MayoMinneapolisMinnesotaUSA55455
| | - Chirag G Patil
- Maxine Dunitz Neurosurgical InstituteDepartment of NeurosurgeryCedars‐Sinai Medical Center8631 West Third Street, Suite 800ELos AngelesCAUSA90048
| | - Clark Chen
- University of MinnesotaDepartment of Neurosurgery420 Delaware St. SE, D429 MayoMinneapolisMinnesotaUSA55455
| | - Andrew S Venteicher
- University of MinnesotaDepartment of Neurosurgery420 Delaware St. SE, D429 MayoMinneapolisMinnesotaUSA55455
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Wang T, Yang Y, Xu X, Niu X, Yang R, Gao T, Kong L, Mao Q, Qiu Y. An Integrative Survival Analysis for Multicentric Low-Grade Glioma. World Neurosurg 2019; 134:e189-e195. [PMID: 31605855 DOI: 10.1016/j.wneu.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to perform a survival analysis of patients with multicentric low-grade gliomas (MLGGs) and to assess the influence of various prognostic factors on progression-free survival (PFS) and overall survival. METHODS A literature search on Web of Science and PubMed was performed for literature in English published from 1963 to September 2018. Detailed information including demographics, clinical characteristics, treatments, critical events, and time to events for survival analysis were extracted from the included articles. RESULTS A total of 36 cases from published articles were selected for analysis. Univariate analysis showed that age (<31 years or ≥31 years), grade (pure low grade/low and high grade) and glioma type (astrocytoma/oligodendroglioma) had a significant relationship with PFS. Cox regression analysis showed that tumor grade was an independent prognostic factor for PFS. No factors correlated with overall survival. CONCLUSIONS This integrative analysis of MLGGs patients revealed that age younger than 31 years, pure MLGG, and oligodendroglioma were significantly associated with improved PFS, and pure MLGGs was an independent prognostic factors for PFS.
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Affiliation(s)
- Tianwei Wang
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yanping Yang
- Department of Neurosurgery, Xi'an Central Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Xiaoke Xu
- Department of Neurology, Xi'an Children's Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Xiaodong Niu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Renhao Yang
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting Gao
- Department of Neurology, Xi'an Children's Hospital, Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Lin Kong
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yongming Qiu
- Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
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Zhao YY, Chen SH, Hao Z, Zhu HX, Xing ZL, Li MH. A Nomogram for Predicting Individual Prognosis of Patients with Low-Grade Glioma. World Neurosurg 2019; 130:e605-e612. [DOI: 10.1016/j.wneu.2019.06.169] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 01/25/2023]
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Tang S, Liao J, Long Y. Comparative assessment of the efficacy of gross total versus subtotal total resection in patients with glioma: A meta-analysis. Int J Surg 2019; 63:90-97. [DOI: 10.1016/j.ijsu.2019.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/25/2019] [Accepted: 02/02/2019] [Indexed: 12/31/2022]
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Matsko DE, Zrelov AA, Ulitin AY, Matsko MV, Skliar SS, Baksheeva AO, Imyanitov EN. [Gemistocytic astrocytomas]. Arkh Patol 2019; 80:27-38. [PMID: 30059069 DOI: 10.17116/patol201880427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Gemistocytic astrocytomas (GA) are a variant of diffuse astrocytomas GII (WHO, 2016). Like all diffuse astrocytomas, GA recur with time, which is often accompanied by malignant degeneretion into the anaplastic astrocytoma GIII or to the secondary glioblastoma GIV. However, the progression-free survival and overall survival in patients with GA is less than in patients with diffuse astrocytomas. Given that this group of patients, according to the WHO classification (2016), is classified as GII, patients with GA usually do not receive comprehensive treatment. We have conducted a thorough analysis of research on this problem for the period from 1956 to 2017. Differences in the histological pattern, immunohistochemical and molecular-genetic profiles, survival of patients with GA and diffuse astrocytomas GII are shown there. A clinical case of a patient with transformation of a diffuse astrocytoma in GA (GIII) and then into a secondary glioblastoma is presented.
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Affiliation(s)
- D E Matsko
- Polenov's neurosurgery institute - the branch of V.A. Almazov National Medical Research Centre, Saint-Petersburg, Russia; Saint-Petersburg Clinical Research Center Specialized Types of Medical Care, Saint-Petersburg, Russia; Saint-Petersburg State University, Saint-Petersburg, Russia; Saint-Petersburg Medico-Social Institute, Saint-Petersburg, Russia
| | - A A Zrelov
- Polenov's neurosurgery institute - the branch of V.A. Almazov National Medical Research Centre, Saint-Petersburg, Russia; North-Western State Medical University n. a. I.I. Mechnikov, Saint-Petersburg, Russia
| | - A Yu Ulitin
- Polenov's neurosurgery institute - the branch of V.A. Almazov National Medical Research Centre, Saint-Petersburg, Russia; North-Western State Medical University n. a. I.I. Mechnikov, Saint-Petersburg, Russia
| | - M V Matsko
- Polenov's neurosurgery institute - the branch of V.A. Almazov National Medical Research Centre, Saint-Petersburg, Russia; Saint-Petersburg Clinical Research Center Specialized Types of Medical Care, Saint-Petersburg, Russia; Saint-Petersburg State University, Saint-Petersburg, Russia; Saint-Petersburg Medico-Social Institute, Saint-Petersburg, Russia
| | - S S Skliar
- Polenov's neurosurgery institute - the branch of V.A. Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - A O Baksheeva
- Polenov's neurosurgery institute - the branch of V.A. Almazov National Medical Research Centre, Saint-Petersburg, Russia; North-Western State Medical University n. a. I.I. Mechnikov, Saint-Petersburg, Russia
| | - E N Imyanitov
- Saint-Petersburg Clinical Research Center Specialized Types of Medical Care, Saint-Petersburg, Russia; Saint-Petersburg State University, Saint-Petersburg, Russia; North-Western State Medical University n. a. I.I. Mechnikov, Saint-Petersburg, Russia; N.N. Petrov National Medical Research Centre of Oncology, Saint-Petersburg, Russia
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13
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Yang K, Nath S, Koziarz A, Badhiwala JH, Ghayur H, Sourour M, Catana D, Nassiri F, Alotaibi MB, Kameda-Smith M, Manoranjan B, Aref MH, Mansouri A, Singh S, Almenawer SA. Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:e762-e775. [DOI: 10.1016/j.wneu.2018.08.163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
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14
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Mahato D, De Biase G, Ruiz-Garcia HJ, Grover S, Rosenfeld S, Quiñones-Hinojosa A, Trifiletti DM. Impact of facility type and volume on post-surgical outcomes following diagnosis of WHO grade II glioma. J Clin Neurosci 2018; 58:34-41. [DOI: 10.1016/j.jocn.2018.10.078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 10/14/2018] [Indexed: 01/13/2023]
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15
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Hervey-Jumper SL, Berger MS. Evidence for Improving Outcome Through Extent of Resection. Neurosurg Clin N Am 2018; 30:85-93. [PMID: 30470408 DOI: 10.1016/j.nec.2018.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Surgical resection plays a central role in the management of gliomas however many tumors are within areas resulting in sensorimotor and cognitive consequences. This article reviews the evidence in support of extent of resection to improve survival, symptom management, and time to malignant transformation in low-grade gliomas. The authors summarize the evolving literature regarding the role of maximal safe resection in light of WHO subclassification of low-grade gliomas. Long lasting neurological deficits following glioma resection may hinder both survival and quality of life. New insights into glioma related central nervous system plasticity impact both surgical planning and timing of interventions.
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Affiliation(s)
- Shawn L Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, 513 Parnassus Avenue, Health Sciences East Suite 814, San Francisco, CA 94143-0112, USA.
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Avenue, M779, San Francisco, CA 94143-0112, USA
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16
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Brown TJ, Bota DA, van Den Bent MJ, Brown PD, Maher E, Aregawi D, Liau LM, Buckner JC, Weller M, Berger MS, Glantz M. Management of low-grade glioma: a systematic review and meta-analysis. Neurooncol Pract 2018; 6:249-258. [PMID: 31386075 DOI: 10.1093/nop/npy034] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Optimum management of low-grade gliomas remains controversial, and widespread practice variation exists. This evidence-based meta-analysis evaluates the association of extent of resection, radiation, and chemotherapy with mortality and progression-free survival at 2, 5, and 10 years in patients with low-grade glioma. Methods A quantitative systematic review was performed. Inclusion criteria included controlled trials of newly diagnosed low-grade (World Health Organization Grades I and II) gliomas in adults. Eligible studies were identified, assigned a level of evidence for every endpoint considered, and analyzed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The relative risk of mortality and of progression at 2, 5, and 10 years was calculated for patients undergoing resection (gross total, subtotal, or biopsy), radiation, or chemotherapy. Results Gross total resection was significantly associated with decreased mortality and likelihood of progression at all time points compared to subtotal resection. Early radiation was not associated with decreased mortality; however, progression-free survival was better at 5 years compared to patients receiving delayed or no radiation. Chemotherapy was associated with decreased mortality at 5 and 10 years in the high-quality literature. Progression-free survival was better at 5 and 10 years compared to patients who did not receive chemotherapy. In patients with isocitrate dehydrogenase 1 gene (IDH1) R132H mutations receiving chemotherapy, progression-free survival was better at 2 and 5 years than in patients with IDH1 wild-type gliomas. Conclusions Results from this review, the first to quantify differences in outcome associated with surgery, radiation, and chemotherapy in patients with low-grade gliomas, can be used to inform evidence-based management and future clinical trials.
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Affiliation(s)
- Timothy J Brown
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Daniela A Bota
- Department of Neurology, University of California Irvine, USA.,Department of Neurological Surgery, University of California Irvine, USA
| | | | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elizabeth Maher
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Dawit Aregawi
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Oncology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Linda M Liau
- Department of Neurological Surgery, University of California Los Angeles, USA
| | | | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Switzerland
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco, USA
| | - Michael Glantz
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.,Department of Oncology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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17
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Motomura K, Chalise L, Ohka F, Aoki K, Tanahashi K, Hirano M, Nishikawa T, Wakabayashi T, Natsume A. Supratotal Resection of Diffuse Frontal Lower Grade Gliomas with Awake Brain Mapping, Preserving Motor, Language, and Neurocognitive Functions. World Neurosurg 2018; 119:30-39. [PMID: 30075269 DOI: 10.1016/j.wneu.2018.07.193] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/21/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Extended margin tumor resection beyond the abnormal area detected by magnetic resonance imaging, defined as supratotal resection, could improve the outcomes of patients with lower grade gliomas (LGGs). The aim of the present study was to assess the surgical outcomes of awake brain mapping to achieve supratotal resection with determination of the normal brain tissue boundaries beyond the tumor of frontal LGGs, in both dominant and nondominant hemispheres. METHODS We analyzed the data from 9 patients with diffuse frontal LGGs who had undergone supratotal resection with awake surgery from January 2016 to November 2017. RESULTS The frontal aslant tract was identified as the functional boundary in 4 of 5 left frontal tumor cases (80%). Working memory impairments during dorsolateral prefrontal cortex stimulation with digit span and/or visual N-back tasks were detected in all 4 patients (100%) with right-frontal tumor. The neurocognitive outcomes were significantly improved after surgery, as shown by the mean Wechsler adult intelligence scale III scores for verbal intelligence quotient (P = 0.04) and verbal comprehension (P = 0.03) and the mean Wechsler memory scale-revised scores for generalized memory (P = 0.04) and delayed recall (P = 0.04). CONCLUSIONS The results of the present study have provided evidence that awake mapping can enable the preservation of higher neurocognitive function, including working memory and spatial cognition in patients with nondominant right frontal tumors. Despite the small number of cases, our findings suggest the surgical benefit of awake surgery for supratotal resection of diffuse frontal LGGs.
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Affiliation(s)
- Kazuya Motomura
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan.
| | - Lushun Chalise
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Kosuke Aoki
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Kuniaki Tanahashi
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Masaki Hirano
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | - Tomohide Nishikawa
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
| | | | - Atsushi Natsume
- Department of Neurosurgery, Nagoya University School of Medicine, Nagoya, Japan
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18
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Abstract
Detailed brain imaging studies discover gliomas incidentally before clinical symptoms or signs show. These tumors represent an early stage in the natural history of gliomas. Left untreated, they are likely to progress to a symptomatic stage and transform to malignant gliomas. A greater extent of resection delays the onset of malignant transformation and prolongs patient survival. Because incidental gliomas are typically smaller and less likely to be in eloquent brain locations, there is a strong case for early surgical intervention to maximize resection and improve outcomes. This article discusses developments in the surgical management of low-grade gliomas.
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Affiliation(s)
- Imran Noorani
- Department of Neurological Surgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013, USA; Department of Neurosurgery, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0QQ, UK
| | - Nader Sanai
- Department of Neurological Surgery, Barrow Neurological Institute, Saint Joseph's Hospital and Medical Center, 350 W Thomas Rd, Phoenix, AZ 85013, USA.
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19
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Al-Tamimi YZ, Palin MS, Patankar T, MacMullen-Price J, O'Hara DJ, Loughrey C, Chakrabarty A, Ismail A, Roberts P, Duffau H, Goodden JR, Chumas PD. Low-Grade Glioma with Foci of Early Transformation Does Not Necessarily Require Adjuvant Therapy After Radical Surgical Resection. World Neurosurg 2018; 110:e346-e354. [DOI: 10.1016/j.wneu.2017.10.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/29/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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20
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Xia L, Fang C, Chen G, Sun C. Relationship between the extent of resection and the survival of patients with low-grade gliomas: a systematic review and meta-analysis. BMC Cancer 2018; 18:48. [PMID: 29306321 PMCID: PMC5756328 DOI: 10.1186/s12885-017-3909-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical resection is necessary to conduct a pathological biopsy and to achieve a reduction of intracranial pressure in low-grade gliomas patients. This study aimed to determine whether a greater extent of resection would increase the overall 5-year and 10-year survival of patients with low-grade gliomas. METHODS The studies addressing relationship between the extent of resection and the prognosis of low-grade gliomas updated until March 2017 were systematically searched in two databases (Pubmed and EMBASE). The relationships among categorical variables were analyzed using an odds ratio (OR) and a95% confidence interval (CI). Significance was established using CIs at a level of 95% or P < 0.05. Funnel plot was used to detect the publication bias. RESULTS Twenty articles (a total of 2128 patients) were identified. The meta-analysis showed that the 5-year (Odds ratio (OR), 3.90;95% Confidence Interval (CI), 2.79~5.45; P < 0.01; Z = 7.95) and 10-year OS (OR, 7.91; 95%CI, 5.12~12.22; P < 0.01; Z = 9.33) associated with gross total resection (GTR) were higher than those associated with subtotal resection (STR). Similarly, as compared with biopsy(BX), the 5-year and 10-year OS were higher after either GTR (5-year: OR, 5.43; 95%CI, 3.57~8.26; P < 0.01; Z = Z = 7.9; 10-year: OR, 10.17; 95%CI, 4.02~25.71; P < 0.00001; Z = 4.9) or STR (5-year: OR, 2.59; 95%CI, 1.81~ - 3.71; P < 0.00001; Z = 5.19; 10-year: OR, 2.21; 95%CI, 1.164.25; P = 0.02; Z = 2.39). CONCLUSIONS Our research found that a greater extent of resection could significantly increase the OS of patients with low-grade gliomas.
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Affiliation(s)
- Liang Xia
- Department of Neurosurgery, Zhejiang Cancer Hospital, 1 ban shan east Road, Hangzhou, Zhejiang Province, 310022, China
| | - Chenyan Fang
- Zhejiang Cancer Hospital, Zhejiang Chinese medical university, Hangzhou, Zhejiang Province, 210022, China
| | - Gao Chen
- Department of Neurosurgery, The second affiliated hospital of Zhejiang University, Hangzhou, Zhejiang Province, 310000, China.
| | - Caixing Sun
- Department of Neurosurgery, Zhejiang Cancer Hospital, 1 ban shan east Road, Hangzhou, Zhejiang Province, 310022, China.
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21
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Altieri R, Hirono S, Duffau H, Ducati A, Fontanella MM, La Rocca G, Melcarne A, Panciani PP, Spena G, Garbossa D. Natural history of de novo high grade glioma: first description of growth parabola. J Neurosurg Sci 2017; 64:399-403. [PMID: 28748908 DOI: 10.23736/s0390-5616.17.04067-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Etiopathogenesis and physiopathology of gliomas are largely unknown. Recently, many authors have proved a strict correlation between the velocity of diametric expansion (VDE) on the magnetic resonance imaging (MRI) and the biological behavior of these tumors, especially in low grade gliomas (LGGs). Unfortunately, natural history of High Grade Gliomas (HGGs) has not been well clarified because of its fast progression, late diagnoses and early surgical intervention. We describe, for the first time to our knowledge, the case of asymptomatic patient with an incidentally discovered de novo HGG with a total of 17 months of follow-up. A male patient was referred to our consultation for routinely follow-up after meningioma resection 5 years before. He underwent MRI every year without any neuroradiological alterations. A new MRI image presented a non-enhancing lesion in the right temporal lobe with 3.55 cm of mean tumor diameter (MTD) and 35.6 mm/year of VDE. After two months interval, the lesion had 3.97 cm of MTD and 27.8 mm/year of VDE. Although we have strongly suggested surgical resection, patient have delayed the operation for personal issues. After other 3 months, the tumor showed enhancement with 4.5 of MTD and 17.4 mm/year of VDE. We speculate that the descending parabola is due to initial mass effect and hypoxia of the tumor core. We also underline the crucial role of the VDE determining, in order to predict the nature of the lesion and address the most effective treatment for each patient.
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Affiliation(s)
- Roberto Altieri
- Unit of Neurosurgery, Città della Salute e della Scienza, University of Turin, Turin, Italy -
| | - Seiichiro Hirono
- Department of Neurosurgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Alessandro Ducati
- Unit of Neurosurgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Marco M Fontanella
- Unit of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy
| | - Giuseppe La Rocca
- Unit of Neurosurgery, School of Medicine, Sacred Heart Catholic University, Rome, Italy
| | - Antonio Melcarne
- Unit of Neurosurgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pier P Panciani
- Unit of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy
| | - Giannantonio Spena
- Unit of Neurosurgery, Spedali Civili and University of Brescia, Brescia, Italy
| | - Diego Garbossa
- Unit of Neurosurgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
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22
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D’Amico RS, Englander ZK, Canoll P, Bruce JN. Extent of Resection in Glioma–A Review of the Cutting Edge. World Neurosurg 2017; 103:538-549. [DOI: 10.1016/j.wneu.2017.04.041] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/03/2017] [Accepted: 04/06/2017] [Indexed: 11/29/2022]
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23
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Eseonu CI, Eguia F, ReFaey K, Garcia O, Rodriguez FJ, Chaichana K, Quinones-Hinojosa A. Comparative volumetric analysis of the extent of resection of molecularly and histologically distinct low grade gliomas and its role on survival. J Neurooncol 2017; 134:65-74. [PMID: 28527004 DOI: 10.1007/s11060-017-2486-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Abstract
The authors investigate the role of extent of resection (EOR) and genetic markers on patient outcome and survival for LGGs. We conducted a retrospective cohort between 2005 and 2015, of 109 adult patients who underwent surgery for a LGG by a single surgeon. Volumetric computations of MRI studies were conducted to evaluate the EOR, and genetic markers (IDH1, 1p/19q co-deletion, and p53) were assessed and their effects on survival and neurological outcome were evaluated. The median EOR was 88.1%. Permanent postoperative neurological deficits were seen in 4.6% of patients. EOR was a significant predictor for both overall survival (OS) (hazard ratio [HR] = 0.979, 95% CI 0.961-0.980, p = 0.029) and progression free survival (PFS) (HR = 0.982, 95% CI 0.968-0.997, p = 0.018). Malignant progression free survival (MPFS) was predicted by the 1p/19q co-deletion (HR = 0.148, 95% CI 0.019-1.148, p = 0.048). Patients with EOR of 100% had a significantly better OS than EOR less than 90% (p = 0.038). Patients with an EOR of at least 76% had a better OS than EOR less than 76% (p = 0.025). Patients with an EOR of at least 71% had a better PFS than EOR less than 71% (p = 0.030). Preoperative tumor volume was found to have significant association with EOR (R2 = 0.049, p = 0.031). Increased EOR is associated with improved OS and PFS survival outcomes, while 1p/19q co-deletion provides improved MPFS. Understanding both surgical resections and molecular markers of the tumor are important for effective management of LGG patients.
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Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Francisco Eguia
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Oscar Garcia
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | | | - Kaisorn Chaichana
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA
| | - Alfredo Quinones-Hinojosa
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, MD, USA. .,Brain Tumor Stem Cell Laboratory, Department of Neurologic Surgery, Mayo Clinic, Florida, 4500 San Pablo Rd. S, Jacksonville, FL, 32224, USA.
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24
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Jiang B, Chaichana K, Veeravagu A, Chang SD, Black KL, Patil CG. Biopsy versus resection for the management of low-grade gliomas. Cochrane Database Syst Rev 2017; 4:CD009319. [PMID: 28447767 PMCID: PMC6478300 DOI: 10.1002/14651858.cd009319.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in 2013, Issue 4.Low-grade gliomas (LGG) constitute a class of slow-growing primary brain neoplasms. Patients with clinically and radiographically suspected LGG have two initial surgical options, biopsy or resection. Biopsy can provide a histological diagnosis with minimal risk but does not offer a direct treatment. Resection may have additional benefits such as increasing survival and delaying recurrence, but is associated with a higher risk for surgical morbidity. There remains controversy about the role of biopsy versus resection and the relative clinical outcomes for the management of LGG. OBJECTIVES To assess the clinical effectiveness of biopsy compared to surgical resection in patients with a new lesion suspected to be a LGG. SEARCH METHODS The following electronic databases were searched in 2012 for the first version of the review: Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 11), MEDLINE (1950 to November week 3 2012), Embase (1980 to Week 46 2012). For this updated version, the following electronic databases were searched: Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 5), MEDLINE (Nov 2012 to June week 3 2016), Embase (Nov 2012 to 2016 week 26). All relevant articles were identified on PubMed and by using the 'related articles' feature. We also searched unpublished and grey literature including ISRCTN-metaRegister of Controled Trials, Physicians Data Query and ClinicalTrials.gov for ongoing trials. SELECTION CRITERIA We planned to include patients of any age with a suspected intracranial LGG receiving biopsy or resection within a randomized clinical trial (RCT) or controlled clinical trial (CCT). Patients with prior resections, radiation therapy, or chemotherapy for LGG were excluded. Outcome measures included overall survival (OS), progression-free survival (PFS), functionally independent survival (FIS), adverse events, symptom control, and quality of life (QoL). DATA COLLECTION AND ANALYSIS A total of 1375 updated citations were searched and critically analyzed for relevance. This was undertaken independently by two review authors. The original electronic database searches yielded a total of 2764 citations. In total, 4139 citations have been critically analyzed for this updated review. MAIN RESULTS No new RCTs of biopsy or resection for LGG were identified. No additional ineligible non-randomized studies (NRS) were included in this updated review. Twenty other ineligible studies were previously retrieved for further analysis despite not meeting the pre-specified criteria. Ten studies were retrospective or were literature reviews. Three studies were prospective, however they were limited to tumor recurrence and volumetric analysis and extent of resection. One study was a population-based parallel cohort in Norway, but not an RCT. Four studies were RCTs, however patients were randomized with respect to varying radiotherapy regimens to assess timing and dose of radiation. One RCT was on high-grade gliomas (HGGs) and not LGG. Finally, one RCT evaluated diffusion tensor imaging (DTI)-based neuro-navigation for surgical resection. AUTHORS' CONCLUSIONS Since the last version of this review, no new studies have been identified for inclusion and currently there are no RCTs or CCTs available on which to base definitive clinical decisions. Therefore, physicians must approach each case individually and weigh the risks and benefits of each intervention until further evidence is available. Some retrospective studies and non-randomized prospective studies do seem to suggest improved OS and seizure control correlating to higher extent of resection. Future research could focus on RCTs to determine outcomes benefits for biopsy versus resection.
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Affiliation(s)
- Bowen Jiang
- Neurosurgery, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, Maryland, USA, 21287
| | - Kaisorn Chaichana
- Neurosurgery, Johns Hopkins Hospital, 1800 Orleans Street, Baltimore, Maryland, USA, 21287
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford School of Medicine, 679 Oxford Ave, Palo Alto, CA, USA, 94306
| | - Steven D Chang
- Department of Neurosurgery, Stanford School of Medicine, 679 Oxford Ave, Palo Alto, CA, USA, 94306
| | - Keith L Black
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA, USA, 90048
| | - Chirag G Patil
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Cedars-Sinai Medical Center, 8631 West Third Street, Suite 800E, Los Angeles, CA, USA, 90048
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25
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Wijnenga MMJ, Mattni T, French PJ, Rutten GJ, Leenstra S, Kloet F, Taphoorn MJB, van den Bent MJ, Dirven CMF, van Veelen ML, Vincent AJPE. Does early resection of presumed low-grade glioma improve survival? A clinical perspective. J Neurooncol 2017; 133:137-146. [PMID: 28401374 PMCID: PMC5495869 DOI: 10.1007/s11060-017-2418-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/08/2017] [Indexed: 12/31/2022]
Abstract
Early resection is standard of care for presumed low-grade gliomas. This is based on studies including only tumors that were post-surgically confirmed as low-grade glioma. Unfortunately this does not represent the clinicians’ situation wherein he/she has to deal with a lesion on MRI that is suspect for low-grade glioma (i.e. without prior knowledge on the histological diagnosis). We therefore aimed to determine the optimal initial strategy for patients with a lesion suspect for low-grade glioma, but not histologically proven yet. We retrospectively identified 150 patients with a resectable presumed low-grade-glioma and who were otherwise in good clinical condition. In this cohort we compared overall survival between three types of initital treatment strategy: a wait-and-scan approach (n = 38), early resection (n = 83), or biopsy for histopathological verification (n = 29). In multivariate analysis, no difference was observed in overall survival for early resection compared to wait-and-scan: hazard ratio of 0.92 (95% CI 0.43–2.01; p = 0.85). However, biopsy strategy showed a shorter overall survival compared to wait-and-scan: hazard ratio of 2.69 (95% CI 1.19–6.06; p = 0.02). In this cohort we failed to confirm superiority of early resection over a wait-and-scan approach in terms of overall survival, though longer follow-up is required for final conclusion. Biopsy was associated with shorter overall survival.
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Affiliation(s)
- Maarten M J Wijnenga
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
| | - Tariq Mattni
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Pim J French
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Geert-Jan Rutten
- Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Sieger Leenstra
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.,Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Fred Kloet
- Department of Neurosurgery, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Centre, The Hague, The Netherlands
| | - Martin J van den Bent
- Department of Neuro-Oncology, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Marie-Lise van Veelen
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Erasmus MC Cancer Institute, Wytemaweg 80, 3015CN, Rotterdam, The Netherlands.
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Aiello KA, Alter O. Platform-Independent Genome-Wide Pattern of DNA Copy-Number Alterations Predicting Astrocytoma Survival and Response to Treatment Revealed by the GSVD Formulated as a Comparative Spectral Decomposition. PLoS One 2016; 11:e0164546. [PMID: 27798635 PMCID: PMC5087864 DOI: 10.1371/journal.pone.0164546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 09/27/2016] [Indexed: 01/07/2023] Open
Abstract
We use the generalized singular value decomposition (GSVD), formulated as a comparative spectral decomposition, to model patient-matched grades III and II, i.e., lower-grade astrocytoma (LGA) brain tumor and normal DNA copy-number profiles. A genome-wide tumor-exclusive pattern of DNA copy-number alterations (CNAs) is revealed, encompassed in that previously uncovered in glioblastoma (GBM), i.e., grade IV astrocytoma, where GBM-specific CNAs encode for enhanced opportunities for transformation and proliferation via growth and developmental signaling pathways in GBM relative to LGA. The GSVD separates the LGA pattern from other sources of biological and experimental variation, common to both, or exclusive to one of the tumor and normal datasets. We find, first, and computationally validate, that the LGA pattern is correlated with a patient's survival and response to treatment. Second, the GBM pattern identifies among the LGA patients a subtype, statistically indistinguishable from that among the GBM patients, where the CNA genotype is correlated with an approximately one-year survival phenotype. Third, cross-platform classification of the Affymetrix-measured LGA and GBM profiles by using the Agilent-derived GBM pattern shows that the GBM pattern is a platform-independent predictor of astrocytoma outcome. Statistically, the pattern is a better predictor (corresponding to greater median survival time difference, proportional hazard ratio, and concordance index) than the patient's age and the tumor's grade, which are the best indicators of astrocytoma currently in clinical use, and laboratory tests. The pattern is also statistically independent of these indicators, and, combined with either one, is an even better predictor of astrocytoma outcome. Recurring DNA CNAs have been observed in astrocytoma tumors' genomes for decades, however, copy-number subtypes that are predictive of patients' outcomes were not identified before. This is despite the growing number of datasets recording different aspects of the disease, and due to an existing fundamental need for mathematical frameworks that can simultaneously find similarities and dissimilarities across the datasets. This illustrates the ability of comparative spectral decompositions to find what other methods miss.
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Affiliation(s)
- Katherine A. Aiello
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, United States of America
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Orly Alter
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, United States of America
- Department of Bioengineering, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah, United States of America
- Department of Human Genetics, University of Utah, Salt Lake City, Utah, United States of America
- * E-mail:
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27
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Koekkoek JAF, Dirven L, Taphoorn MJB. The withdrawal of antiepileptic drugs in patients with low-grade and anaplastic glioma. Expert Rev Neurother 2016; 17:193-202. [PMID: 27484737 DOI: 10.1080/14737175.2016.1219250] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The withdrawal of antiepileptic drugs (AEDs) in World Health Organization (WHO) grade II-III glioma patients with epilepsy is controversial, as the presence of a symptomatic lesion is often related to an increased risk of seizure relapse. However, some glioma patients may achieve long-term seizure freedom after antitumor treatment, raising questions about the necessity to continue AEDs, particularly when patients experience serious drug side effects. Areas covered: In this review, we show the evidence in the literature from 1990-2016 for AED withdrawal in glioma patients. We put this issue into the context of risk factors for developing seizures in glioma, adverse effects of AEDs, seizure outcome after antitumor treatment, and outcome after AED withdrawal in patients with non-brain tumor related epilepsy. Expert commentary: There is currently scarce evidence of the feasibility of AED withdrawal in glioma patients. AED withdrawal could be considered in patients with grade II-III glioma with a favorable prognosis, who have achieved stable disease and long-term seizure freedom. The potential benefits of AED withdrawal need to be carefully weighed against the presumed risk of seizure recurrence in a shared decision-making process by both the clinical physician and the patient.
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Affiliation(s)
- Johan A F Koekkoek
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands.,b Department of Neurology , Medical Center Haaglanden , The Hague , The Netherlands
| | - Linda Dirven
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands
| | - Martin J B Taphoorn
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands.,b Department of Neurology , Medical Center Haaglanden , The Hague , The Netherlands
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28
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Rønning PA, Helseth E, Meling TR, Johannesen TB. The effect of pregnancy on survival in a low-grade glioma cohort. J Neurosurg 2016; 125:393-400. [DOI: 10.3171/2015.6.jns15985] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The impact of pregnancy on survival in female patients with low-grade glioma (LGG) is unknown and controversial. The authors designed a retrospective cohort study on prospectively collected registry data to assess the influence of pregnancy and child delivery on the survival of female patients with LGG.
METHODS
In Norway, the reporting of all births and cancer diagnoses to the Medical Birth Registry of Norway (MBRN) and the Cancer Registry of Norway (CRN), respectively, is compulsory by law. Furthermore, every individual has a unique 11-digit identification number. The CRN was searched to identify all female patients with a histologically confirmed diagnosis of World Health Organization (WHO) Grade II astrocytoma, oligoastrocytoma, oligodendroglioma, or pilocytic astrocytoma who were 16–40 years of age at the time of diagnosis during the period from January 1, 1970, to December 31, 2008. Obstetrical information was obtained from the MBRN for each patient. The effect of pregnancy on survival was evaluated using a Cox model with parity as a time-dependent variable.
RESULTS
The authors identified 65 patients who gave birth to 95 children after an LGG diagnosis. They also identified 281 patients who did not give birth after an LGG diagnosis. The median survival was 14.3 years (95% CI 11.7–20.6 years) for the entire study population. The effect of pregnancy was insignificant in the multivariate model (HR 0.71, 95% CI 0.35–1.42).
CONCLUSIONS
Pregnancy does not seem to have an impact on the survival of female patients with LGG.
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Affiliation(s)
- Pål A. Rønning
- 1Department of Neurosurgery, Oslo University Hospital; and
| | - Eirik Helseth
- 1Department of Neurosurgery, Oslo University Hospital; and
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29
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Cabrera S, Edelstein K, Mason WP, Tartaglia MC. Assessing behavioral syndromes in patients with brain tumors using the frontal systems behavior scale (FrSBe). Neurooncol Pract 2016; 3:113-119. [PMID: 31386079 PMCID: PMC6668266 DOI: 10.1093/nop/npv055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Personality changes following brain tumors may be due to disruption of frontal-subcortical networks. The relation between personality changes and tumor parameters such as volumes of the surgical cavity, residual tumor, or nonspecific white matter abnormalities is unknown. In this study we examined the relation between these tumor parameters and abnormal behaviors typically associated with frontal lobe dysfunction. METHODS Thirty-one patients with intracranial tumors who completed the Frontal Systems Behavior Scale (FrSBe) during clinical neuropsychological assessment and had a solitary, well-delimited brain lesion on MRI within 3 months of that assessment were included. Tumor parameters were manually segmented using OsiriX. Nonparametric statistics were used to determine the relationship between tumor parameters and frontal behavioral dysfunction as measured by FrSBe scores. RESULTS Patients reported significantly more behavior problems after tumor diagnosis. Tumor cavity volume was correlated with self-reported Executive Dysfunction (rho = 0.450, P = .047), and there was a trend in the relationship with self-reported Apathy (rho = 0.438, P = .053). Nonspecific white matter abnormality volume was also correlated with self-reported Apathy (rho = 0.810, P = .01). There were no correlations between FrSBe scores and residual tumor volume or summed volumes of tumor-related parameters. CONCLUSION Our results suggest that tumor parameters have differential effects on behaviors associated with frontal-subcortical networks and corroborate the high frequency of behavioral dysfunction in brain tumor patients. Examination of these relationships in a prospective trial is warranted to establish incidence, prevalence, risk factors, and consequences of behavioral disturbances in brain tumor patients.
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Affiliation(s)
- Sergio Cabrera
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Kim Edelstein
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Warren P. Mason
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
| | - Maria Carmela Tartaglia
- Memory Clinic, Toronto Western
Hospital, 399 Bathurst St, Toronto M5T 2S8,
Canada (S.C., M.C.T.); Pencer Brain Tumor
Centre, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., K.E., W.P.M.); Department of Psychosocial
Oncology & Palliative Care, Princess
Margaret Cancer Centre, 610 University Ave, Toronto M5G
2M9, Canada (K.E.); Department of Hematology
Oncology, Princess Margaret Cancer
Centre, 610 University Ave, Toronto M5G 2M9,
Canada (S.C., W.P.M.); Department of Neurology,
University of Toronto,
Toronto, Canada (S.C., W.P.M., M.C.T.);
Department of Psychiatry, University of Toronto, Toronto,
Canada (K.E.); Tanz Centre for Research in Neurodegenerative
Disease, University of Toronto,
Toronto, Canada (M.C.T.)
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30
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Hervey-Jumper SL, Berger MS. Maximizing safe resection of low- and high-grade glioma. J Neurooncol 2016; 130:269-282. [PMID: 27174197 DOI: 10.1007/s11060-016-2110-4] [Citation(s) in RCA: 304] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 03/23/2016] [Indexed: 10/21/2022]
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31
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Khalilov VS, Kholin AA, Medvedeva NA, Vasiliev IG, Rasskazchikova IV, Ismailova RR, Kislyakov AN, Demushkina AA, Alikhanov AA. [MRI-characteristics of epileptogenic supratentorial brain tumors in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:56-63. [PMID: 26977627 DOI: 10.17116/jnevro20161161156-63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To analyze MR-images in patients with symptomatic epilepsy associated with the brain tumor. MATERIAL AND METHODS MRI results of 52 patients with symptomatic epilepsy operated for tumors of supratentorial localization were analyzed. The most epileptogenic tumors with atypical MRI signs and subtle clinical presentation were identified. All patients with tumors were operated using different methods of surgical intervention. RESULTS Dysembryoplastic neuroepithelial tumors (DNET), diffuse astrocytomas (DA) and gangliogliomas (GG) were the most frequent epileptogenic tumors. In all the cases of DNET and in 4 patients with GG, epileptic seizures were the first, and in 4 of 5 cases of DIO were the only clinical sign of tumor presence. In DNET, DA and GG, there was an iso- or hypointensive signal on T1 WI and a signal varying in intensity from moderate to hyperintense in T2 and FLAIR WI, while in cases with DNET and GG, no mass effect and perifocal edema was practically seen. The so-called «spume-like» (multicystic) structure was most clearly observed in FLAIR WI. No significant changes in the dimensions of the DNET and GG were identified. The combination of DNET with focal cortical dysplasia was noted in one case. In DA, it was difficult to distinguish the perifocal edema from tumorous tissue and normal brain tissues, and the growth potential of malformation was slow. CONCLUSION Epileptogenic tumors can imitate the x-ray characteristics of each other, and mimicry to gangliogliomas, oligodendrogliomas and astrocytomas Gr I, II, and others. They are the most frequent causes of symptomatic focal epilepsy. The presence of these malformations is necessary to exclude first of all in all cases of pharmacoresistant epilepsy.
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Affiliation(s)
- V S Khalilov
- FGBUZ 'Tsentral'naja detskaja klinicheskaja bol'nitsa' FMBA Rossii, Moskva
| | - A A Kholin
- GBOU VPO 'Rossijskij natsional'nyj issledovatel'skij meditsinskij universitet im. N.I. Pirogova' Minzdrava RF, Moskva; FGBU 'Rossijskaja detskaja klinicheskaja bol'nitsa' Minzdrava RF, Moskva
| | - N A Medvedeva
- FGBUZ 'Tsentral'naja detskaja klinicheskaja bol'nitsa' FMBA Rossii, Moskva
| | - I G Vasiliev
- FGBU 'Rossijskaja detskaja klinicheskaja bol'nitsa' Minzdrava RF, Moskva
| | - I V Rasskazchikova
- FGBU 'Rossijskaja detskaja klinicheskaja bol'nitsa' Minzdrava RF, Moskva
| | - R R Ismailova
- GBOU VPO 'Rossijskij natsional'nyj issledovatel'skij meditsinskij universitet im. N.I. Pirogova' Minzdrava RF, Moskva
| | - A N Kislyakov
- FGBU 'Morozovskaja detskaja gorodskaja klinicheskaja bol'nitsa' Departamenta zdravoohranenija Moskvy, Moskva
| | - A A Demushkina
- FGBU 'Rossijskaja detskaja klinicheskaja bol'nitsa' Minzdrava RF, Moskva
| | - A A Alikhanov
- FGBU 'Rossijskaja detskaja klinicheskaja bol'nitsa' Minzdrava RF, Moskva
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Zadeh G, Khan OH, Vogelbaum M, Schiff D. Much debated controversies of diffuse low-grade gliomas. Neuro Oncol 2016; 17:323-6. [PMID: 26114668 PMCID: PMC4483107 DOI: 10.1093/neuonc/nou368] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Gelareh Zadeh
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (G.Z., O.H.K.); Division of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (M.V.); Division of Neuro-Oncology, University of Virginia Medical Center, Charlottesville, Virginia (D.S.)
| | - Osaama H Khan
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (G.Z., O.H.K.); Division of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (M.V.); Division of Neuro-Oncology, University of Virginia Medical Center, Charlottesville, Virginia (D.S.)
| | - Michael Vogelbaum
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (G.Z., O.H.K.); Division of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (M.V.); Division of Neuro-Oncology, University of Virginia Medical Center, Charlottesville, Virginia (D.S.)
| | - David Schiff
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada (G.Z., O.H.K.); Division of Neurosurgery, Cleveland Clinic, Cleveland, Ohio (M.V.); Division of Neuro-Oncology, University of Virginia Medical Center, Charlottesville, Virginia (D.S.)
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Berger MS, Hervey-Jumper S, Wick W. Astrocytic gliomas WHO grades II and III. HANDBOOK OF CLINICAL NEUROLOGY 2016; 134:345-60. [PMID: 26948365 DOI: 10.1016/b978-0-12-802997-8.00021-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
World Health Organization grades II and III lower-grade astrocytomas are a challenging area in neuro-oncology. One the one hand, for proper diagnosis, the analysis of molecular factors, especially mutation status of isocitrate dehydrogenase and 1p/19q status in the tumor status needs to be done in addition to classical neuropathology. Further, the high clinical and prognostic value of a maximal safe resection requires a profound knowledge of presurgical diagnosis and surgical as well as imaging techniques to ensure optimal outcome for patients. Also medical treatment may be more intensive than previously believed, with randomized trials providing evidence for a benefit in overall survival by combined chemoradiation versus radiation alone. A critical problem concerns the considerable undesirable effects of therapeutic interventions on long-term health-related quality of life, cognitive and functional outcome as well as future developments in this still difficult disease that will need to be addressed in future trials.
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Affiliation(s)
- Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, CA, USA.
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, Taubman Health Center, Ann Arbor, MI, USA
| | - Wolfgang Wick
- Department of Neurooncology, University Clinic of Heidelberg, Heidelberg, Germany
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Abstract
Primary CNS tumors consist of a diverse group of neoplasms originating from various cell types in the CNS. Brain tumors are the most common solid malignancy in children under the age of 15 years and the second leading cause of cancer death after leukemia. The most common brain neoplasms in children differ consistently from those in older age groups. Pediatric brain tumors demonstrate distinct patterns of occurrence and biologic behavior according to sex, age, and race. This chapter highlights the imaging features of the most common tumors that affect the child's CNS (brain and spinal cord).
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Affiliation(s)
- Andre D Furtado
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA.
| | - Ashok Panigrahy
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Charles R Fitz
- Department of Radiology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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35
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Abstract
Neurosurgical intervention remains the first step in effective glioma management. Mounting evidence suggests that cytoreduction for low- and high-grade gliomas is associated with a survival benefit. Beyond conventional neurosurgical principles, an array of techniques have been refined in recent years to maximize the effect of the neurosurgical oncologist and facilitate the impact of subsequent adjuvant therapy. With intraoperative mapping techniques, aggressive microsurgical resection can be safely pursued even when tumors occupy essential functional pathways. Other adjunct techniques, such as intraoperative magnetic resonance imaging, intraoperative ultrasonography, and fluorescence-guided surgery, can be valuable tools to safely reduce the tumor burden of low- and high-grade gliomas. Taken together, this collection of surgical strategies has pushed glioma extent of resection towards the level of cellular resolution.
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Affiliation(s)
- Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
| | - Nader Sanai
- Barrow Brain Tumor Research Center, Barrow Neurological Institute, Phoenix, AZ, USA
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36
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Aghi MK, Nahed BV, Sloan AE, Ryken TC, Kalkanis SN, Olson JJ. The role of surgery in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline. J Neurooncol 2015; 125:503-30. [PMID: 26530265 DOI: 10.1007/s11060-015-1867-1] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
Abstract
QUESTION Should patients with imaging suggestive of low grade glioma (LGG) undergo observation versus treatment involving a surgical procedure? TARGET POPULATION These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma). RECOMMENDATIONS Surgical resection is recommended over observation to improve overall survival for patients with diffuse low-grade glioma (Level III) although observation has no negative impact on cognitive performance and quality of life (Level II). QUESTION What is the impact of extent of resection on progression free survival (PFS) or overall survival (OS) in LGG patients? TARGET POPULATION These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma). RECOMMENDATIONS IMPACT OF EXTENT OF RESECTION ON PFS: LEVEL II It is recommended that GTR or STR be accomplished instead of biopsy alone when safe and feasible so as to decrease the frequency of tumor progression recognizing that the rate of progression after GTR is fairly high. IMPACT OF EXTENT OF RESECTION ON OS LEVEL III Greater extent of resection can improve OS in LGG patients. QUESTION What tools are available to increase extent of resection in LGG patients? TARGET POPULATION These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma). RECOMMENDATIONS INTRAOPERATIVE MRI DURING SURGERY: LEVEL III The use of intraoperative MRI should be considered as a method of increasing the extent of resection of LGGs. QUESTION What is the impact of surgical resection on seizure control and accuracy of pathology in low grade glioma patients? TARGET POPULATION These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma). RECOMMENDATIONS SURGICAL RESECTION AND SEIZURE CONTROL: LEVEL III After taking into account the patient's clinical status and tumor location, gross total resection is recommended for patients with diffuse LGG as a way to achieve more favorable seizure control. ACCURACY OF DIAGNOSIS LEVEL III Taking into account the patient's clinical status and tumor location, surgical resection should be carried out to maximize the chance of accurate diagnosis. QUESTION What tools can improve the safety of surgery for LGGs in eloquent locations? TARGET POPULATION These recommendations apply to adults with imaging suggestive of a WHO grade 2 glioma (oligodendroglioma, astrocytoma, or oligo-astrocytoma). RECOMMENDATIONS PREOPERATIVE IMAGING: LEVEL III It is recommended that preoperative functional MRI and diffusion tensor imaging be utilized in the appropriate clinical setting to improve functional outcome after surgery for LGG. INTRAOPERATIVE MAPPING OF TUMORS IN ELOQUENT AREAS LEVEL III Intraoperative mapping is recommended for patients with diffuse LGGs in eloquent locations compared to patients with non-eloquently located diffuse LGGs as a way of preserving function.
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Affiliation(s)
- Manish K Aghi
- Department of Neurosurgery, University of California, 505 Parnassus Avenue, Room M779, San Francisco, CA, 94143-0112, USA.
| | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew E Sloan
- Department of Neurosurgery, University Hospitals, Cleveland, OH, USA
| | - Timothy C Ryken
- Department of Neurosurgery, Kansas University Medical Center, Kansas City, KS, USA
| | - Steven N Kalkanis
- Department of Neurosurgery, Henry Ford Health System, Detroit, MI, USA
| | - Jeffrey J Olson
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
Epilepsy develops in more than 70-90% of oligodendroglial tumors and represents a favorable indicator for long-term survival if present as the first clinical sign. Presence of IDH1 mutation is frequently associated with seizures in oligodendrogliomas, next to alterations of glutamate and GABA metabolism in the origin of glioma-associated epilepsy. Treatment by surgery or radiotherapy results in seizure freedom in about two-thirds of patients, and chemotherapy to a seizure reduction in about 50%. Symptomatic anticonvulsive therapy with levetiracetam and valproic acid as monotherapy are both evidence-based drugs for the partial epilepsies, and their effective use in brain tumors is supported by a large amount of additional data. Pharmacoresistance against anticonvulsants is more prevalent among oligodendrogliomas, occurring in about 40% despite polytherapy with two anticonvulsants or more. Toxic signs of anticonvulsants in brain tumors involve cognition, bone marrow and skin. Previous neurosurgery, radiation therapy or chemotherapy add to the risks of cognitive dysfunction.
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Affiliation(s)
- Melissa Kerkhof
- Department of Neurology, Medical Center The Hague, The Netherlands
| | - Christa Benit
- Department of Neurology, Medical Center The Hague, The Netherlands
| | | | - Charles J Vecht
- Service Neurologie Mazarin, GH Pitié-Salpêtrière, Paris, France
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Khan OH, Mason W, Kongkham PN, Bernstein M, Zadeh G. Neurosurgical management of adult diffuse low grade gliomas in Canada: a multi-center survey. J Neurooncol 2015; 126:137-149. [PMID: 26454818 PMCID: PMC4683163 DOI: 10.1007/s11060-015-1949-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 10/05/2015] [Indexed: 11/21/2022]
Abstract
Adult diffuse low-grade gliomas are slow growing, World Health Organization grade II lesions with insidious onset and ultimate anaplastic transformation. The timing of surgery remains controversial with polarized practices continuing to govern patient management. As a result, the management of these patients is variable. The goal of this questionnaire was to evaluate practice patterns in Canada. An online invitation for a questionnaire including diagnostic, preoperative, perioperative, and postoperative parameters and three cases with magnetic resonance imaging data with questions to various treatment options in these patients was sent to practicing neurosurgeons and trainees. Survey was sent to 356 email addresses with 87 (24.7 %) responses collected. The range of years of practice was less than 10 years 36 % (n = 23), 11–20 years 28 % (n = 18), over 21 years 37 % (n = 24). Twenty-two neurosurgery students of various years of training completed the survey. 94 % (n = 47) of surgeons and trainees (n = 20) believe that we do not know the “right treatment”. 90 % of surgeons do not obtain formal preoperative neurocognitive assessments. 21 % (n = 13) of surgeons and 23 % of trainees (n = 5) perform a biopsy upon first presentation. A gross total resection was believed to increase progression free survival (surgeons: 75 %, n = 46; trainees: 95 %, n = 21) and to increase overall survival (surgeons: 64 %, n = 39, trainees: 68 %, n = 15). Intraoperative MRI was only used by 8 % of surgeons. Awake craniotomy was the procedure of choice for eloquent tumors by 80 % (n = 48) of surgeons and 100 % of trainees. Of those surgeons who perform awake craniotomy 93 % perform cortical stimulation and 38 % performed subcortical stimulation. Using the aid of three hypothetical cases with progressive complexities in tumor eloquence there was a trend for younger surgeons to operate earlier, and use awake craniotomy to obtain greater extent of resection with the aid of cortical stimulation when compared to senior surgeons who still more often preferred a “wait-and-see” approach. Despite the limitations of an online survey study, it has offered insights into the variability in surgeon practice patterns in Canada and the need for a consensus on the workup and surgical management of this disease.
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Affiliation(s)
- Osaama H Khan
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
| | - Warren Mason
- Princess Margaret Hospital, 610 University Avenue Suite 18-717, Toronto, ON, M5G 2M9, Canada
| | - Paul N Kongkham
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Mark Bernstein
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
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Hervey-Jumper SL, Li J, Lau D, Molinaro AM, Perry DW, Meng L, Berger MS. Awake craniotomy to maximize glioma resection: methods and technical nuances over a 27-year period. J Neurosurg 2015; 123:325-39. [DOI: 10.3171/2014.10.jns141520] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Awake craniotomy is currently a useful surgical approach to help identify and preserve functional areas during cortical and subcortical tumor resections. Methodologies have evolved over time to maximize patient safety and minimize morbidity using this technique. The goal of this study is to analyze a single surgeon's experience and the evolving methodology of awake language and sensorimotor mapping for glioma surgery.
METHODS
The authors retrospectively studied patients undergoing awake brain tumor surgery between 1986 and 2014. Operations for the initial 248 patients (1986–1997) were completed at the University of Washington, and the subsequent surgeries in 611 patients (1997–2014) were completed at the University of California, San Francisco. Perioperative risk factors and complications were assessed using the latter 611 cases.
RESULTS
The median patient age was 42 years (range 13–84 years). Sixty percent of patients had Karnofsky Performance Status (KPS) scores of 90–100, and 40% had KPS scores less than 80. Fifty-five percent of patients underwent surgery for high-grade gliomas, 42% for low-grade gliomas, 1% for metastatic lesions, and 2% for other lesions (cortical dysplasia, encephalitis, necrosis, abscess, and hemangioma). The majority of patients were in American Society of Anesthesiologists (ASA) Class 1 or 2 (mild systemic disease); however, patients with severe systemic disease were not excluded from awake brain tumor surgery and represented 15% of study participants. Laryngeal mask airway was used in 8 patients (1%) and was most commonly used for large vascular tumors with more than 2 cm of mass effect. The most common sedation regimen was propofol plus remifentanil (54%); however, 42% of patients required an adjustment to the initial sedation regimen before skin incision due to patient intolerance. Mannitol was used in 54% of cases. Twelve percent of patients were active smokers at the time of surgery, which did not impact completion of the intraoperative mapping procedure. Stimulation-induced seizures occurred in 3% of patients and were rapidly terminated with ice-cold Ringer's solution. Preoperative seizure history and tumor location were associated with an increased incidence of stimulation-induced seizures. Mapping was aborted in 3 cases (0.5%) due to intraoperative seizures (2 cases) and patient emotional intolerance (1 case). The overall perioperative complication rate was 10%.
CONCLUSIONS
Based on the current best practice described here and developed from multiple regimens used over a 27-year period, it is concluded that awake brain tumor surgery can be safely performed with extremely low complication and failure rates regardless of ASA classification; body mass index; smoking status; psychiatric or emotional history; seizure frequency and duration; and tumor site, size, and pathology.
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Affiliation(s)
| | - Jing Li
- Departments of 1Neurological Surgery and
| | - Darryl Lau
- Departments of 1Neurological Surgery and
| | | | - David W. Perry
- 2Surgical Neurophysiology, University of California, San Francisco, California
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Abstract
PURPOSE OF REVIEW The primary treatment of low-grade gliomas is still claimed to lack robust supporting evidence. Yet, several investigations were performed in the last 2 decades. To critically review these studies could help in further clarifying the role of surgery aimed at maximal resection. RECENT FINDINGS Despite the lack of randomized clinical trials hampering the performance of appropriate meta-analyses, the increasing amount of evidence pointed toward an aggressive surgical strategy to low-grade glioma. Low-grade glioma surgery has to be performed with the appropriate armamentarium, which is the availability of intraoperative stimulation mapping, especially for those lesions occurring in cortical and subcortical eloquent sites. SUMMARY According to the recently published guidelines, surgical treatment has been increasingly recognized as the initial therapeutic act of choice for patients diagnosed with a presumed low-grade glioma, given that total resection can improve seizure control, progression-free survival and overall survival, while reducing the risk of malignant transformation and preserving patients' functional status.
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Dong X, Noorbakhsh A, Hirshman BR, Zhou T, Tang JA, Chang DC, Carter BS, Chen CC. Survival trends of grade I, II, and III astrocytoma patients and associated clinical practice patterns between 1999 and 2010: A SEER-based analysis. Neurooncol Pract 2015; 3:29-38. [PMID: 31579519 DOI: 10.1093/nop/npv016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Indexed: 11/13/2022] Open
Abstract
Background The survival trends and the patterns of clinical practice pertaining to radiation therapy and surgical resection for WHO grade I, II, and III astrocytoma patients remain poorly characterized. Methods Using the Surveillance, Epidemiology and End Results (SEER) database, we identified 2497 grade I, 4113 grade II, and 2755 grade III astrocytomas during the period of 1999-2010. Time-trend analyses were performed for overall survival, radiation treatment (RT), and the extent of surgical resection (EOR). Results While overall survival of grade I astrocytoma patients remained unchanged during the study period, we observed improved overall survival for grade II and III astrocytoma patients (Tarone-Ware P < .05). The median survival increased from 44 to 57 months and from 15 to 24 months for grade II and III astrocytoma patients, respectively. The differences in survival remained significant after adjusting for pertinent variables including age, ethnicity, marital status, sex, tumor size, tumor location, EOR, and RT status. The pattern of clinical practice in terms of EOR for grade II and III astrocytoma patients did not change significantly during this study period. However, there was decreased RT utilization as treatment for grade II astrocytoma patients after 2005. Conclusion Results from the SEER database indicate that there were improvements in the overall survival of grade II and III astrocytoma patients over the past decade. Analysis of the clinical practice patterns identified potential opportunities for impacting the clinical course of these patients.
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Affiliation(s)
- Xuezhi Dong
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Abraham Noorbakhsh
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Brian R Hirshman
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Tianzan Zhou
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Jessica A Tang
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - David C Chang
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Bob S Carter
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
| | - Clark C Chen
- School of Medicine, University of California, San Diego, 9500 Gilman Drive, La Jolla, California 92093 (X.D., A.N., B.R.H., T.Z., J.A.T.); Division of Neurological Surgery, University of California, San Diego, 200 West Arbor Drive #8893, San Diego, California 92103 (B.S.C., C.C.C.); Department of Surgery, University of California, San Diego, 200 West Arbor Drive #8220, San Diego, California 92103 (D.C.C.)
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Sarmiento JM, Venteicher AS, Patil CG. Early versus delayed postoperative radiotherapy for treatment of low-grade gliomas. Cochrane Database Syst Rev 2015; 6:CD009229. [PMID: 26118544 PMCID: PMC4506130 DOI: 10.1002/14651858.cd009229.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND In most people with low-grade gliomas (LGG), the primary treatment regimen remains a combination of surgery followed by postoperative radiotherapy. However, the optimal timing of radiotherapy is controversial. It is unclear whether to use radiotherapy in the early postoperative period, or whether radiotherapy should be delayed until tumour progression occurs. OBJECTIVES To assess the effects of early postoperative radiotherapy versus radiotherapy delayed until tumour progression for low-grade intracranial gliomas in people who had initial biopsy or surgical resection. SEARCH METHODS We searched up to September 2014 the following electronic databases: the Cochrane Register of Controlled Trials (CENTRAL, Issue 8, 2014), MEDLINE (1948 to Aug week 3, 2014), and EMBASE (1980 to Aug week 3, 2014) to identify trials for inclusion in this Cochrane review. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared early versus delayed radiotherapy following biopsy or surgical resection for the treatment of people with newly diagnosed intracranial LGG (astrocytoma, oligodendroglioma, mixed oligoastrocytoma, astroblastoma, xanthoastrocytoma, or ganglioglioma). Radiotherapy may include conformal external beam radiotherapy (EBRT) with linear accelerator or cobalt-60 sources, intensity-modulated radiotherapy (IMRT), or stereotactic radiosurgery (SRS). DATA COLLECTION AND ANALYSIS Three review authors independently assessed the trials for inclusion and risk of bias, and extracted study data. We resolved any differences between review authors by discussion. Adverse effects were also extracted from the study report. We performed meta-analyses using a random-effects model with inverse variance weighting. MAIN RESULTS We included one large, multi-institutional, prospective RCT, involving 311 participants; the risk of bias in this study was unclear. This study found that early postoperative radiotherapy is associated with an increase in time to progression compared to observation (and delayed radiotherapy upon disease progression) for people with LGG but does not significantly improve overall survival (OS). The median progression-free survival (PFS) was 5.3 years in the early radiotherapy group and 3.4 years in the delayed radiotherapy group (hazard ratio (HR) 0.59, 95% confidence interval (CI) 0.45 to 0.77; P value < 0.0001; 311 participants; 1 trail; low quality evidence). The median OS in the early radiotherapy group was 7.4 years, while the delayed radiotherapy group experienced a median overall survival of 7.2 years (HR 0.97, 95% CI 0.71 to 1.33; P value = 0.872; 311 participants; 1 trail; low quality evidence). The total dose of radiotherapy given was 54 Gy; five fractions of 1.8 Gy per week were given for six weeks. Adverse effects following radiotherapy consisted of skin reactions, otitis media, mild headache, nausea, and vomiting. Rescue therapy was provided to 65% of the participants randomised to delayed radiotherapy. People in both cohorts who were free from tumour progression showed no differences in cognitive deficit, focal deficit, performance status, and headache after one year. However, participants randomised to the early radiotherapy group experienced significantly fewer seizures than participants in the delayed postoperative radiotherapy group at one year (25% versus 41%, P value = 0.0329, respectively). AUTHORS' CONCLUSIONS Given the high risk of bias in the included study, the results of this analysis must be interpreted with caution. Early radiation therapy was associated with the following adverse effects: skin reactions, otitis media, mild headache, nausea, and vomiting. People with LGG who undergo early radiotherapy showed an increase in time to progression compared with people who were observed and had radiotherapy at the time of progression. There was no significant difference in overall survival between people who had early versus delayed radiotherapy; however, this finding may be due to the effectiveness of rescue therapy with radiation in the control arm. People who underwent early radiation had better seizure control at one year than people who underwent delayed radiation. There were no cases of radiation-induced malignant transformation of LGG. However, it remains unclear whether there are differences in memory, executive function, cognitive function, or quality of life between the two groups since these measures were not evaluated.
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Affiliation(s)
- J Manuel Sarmiento
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew S Venteicher
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Chirag G Patil
- Department of Neurosurgery, Maxine Dunitz Neurosurgical Institute, Los Angeles, CA, USA
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Hathout L, Pope WB, Lai A, Nghiemphu PL, Cloughesy TF, Ellingson BM. Radial expansion rates and tumor growth kinetics predict malignant transformation in contrast-enhancing low-grade diffuse astrocytoma. CNS Oncol 2015; 4:247-56. [PMID: 26095141 DOI: 10.2217/cns.15.16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Contrast-enhancing low-grade diffuse astrocytomas are an understudied, aggressive subtype at increased risk because of few radiographic indications of malignant transformation. In the current study, we tested whether tumor growth kinetics could identify tumors that undergo malignant transformation to higher grades. METHODS Thirty patients with untreated diffuse astrocytomas (WHO II) that underwent tumor progression were enrolled. Contrast-enhancing and T2 hyperintense tumor regions were segmented and the radius of tumor at two time points leading to progression was estimated. Radial expansion rates were used to estimate proliferation and invasion rates using a biomathematical model. RESULTS Radial expansion rates for both contrast-enhancing (p = 0.0040) and T2 hyperintense regions (p = 0.0016) were significantly higher in WHO II-IV tumors compared with nontransformers. Similarly, model estimates showed a significantly higher proliferation (p = 0.0324) and invasion rate (p = 0.0050) in WHO II-IV tumors compared with nontransformers. CONCLUSION Tumor growth kinetics can identify contrast-enhancing diffuse astrocytomas undergoing malignant transformation.
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Affiliation(s)
- Leith Hathout
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.,Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA
| | - Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, 924 Westwood Boulevard, Suite 615, Los Angeles, CA 90024, USA.,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.,Department of Biomedical Physics, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA.,Department of Bioengineering, Henry Samueli School of Engineering & Applied Science, University of California Los Angeles, Los Angeles, CA 90095, USA
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Hollon T, Hervey-Jumper SL, Sagher O, Orringer DA. Advances in the Surgical Management of Low-Grade Glioma. Semin Radiat Oncol 2015; 25:181-8. [PMID: 26050588 DOI: 10.1016/j.semradonc.2015.02.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Over the past 2 decades, extent of resection has emerged as a significant prognostic factor in patients with low-grade gliomas (LGGs). Greater extent of resection has been shown to improve overall survival, progression-free survival, and time to malignant transformation. The operative goal in most LGG cases is to maximize extent of resection, while avoiding postoperative neurologic deficits. Several advanced surgical techniques have been developed in an attempt to better achieve maximal safe resection. Intraoperative magnetic resonance imaging, fluorescence-guided surgery, intraoperative functional pathway mapping, and neuronavigation are some of the most commonly used techniques with multiple studies to support their efficacy in glioma surgery. By using these techniques either alone or in combination, patients harboring LGGs have a better prognosis with less surgical morbidity following tumor resection.
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Affiliation(s)
- Todd Hollon
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
| | | | - Oren Sagher
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI
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Bagley JH, Babu R, Friedman AH, Adamson C. Improved survival in the largest national cohort of adults with cerebellar versus supratentorial low-grade astrocytomas. Neurosurg Focus 2015; 34:E7. [PMID: 23373452 DOI: 10.3171/2012.12.focus12343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Low-grade gliomas (LGGs) are indolent tumors that have the potential to dedifferentiate into malignant high-grade tumors. Recent studies have demonstrated that cerebellar low-grade tumors have a better prognosis than supratentorial tumors, although no study has focused on the risk factors for poor prognosis in cerebellar LGGs in adults. The authors of the current study aimed to address both of these concerns by using a large cohort derived from a national cancer registry and a smaller cohort derived from their institution's experience. METHODS Adults with diagnosed Grade I and Grade II gliomas of the cerebellum were identified in the Surveillance, Epidemiology, and End Results (SEER) database. Multivariate Cox proportional hazard models were used to predict rates of survival, and the log-rank test was applied to evaluate differences in Kaplan-Meier survival curves. An institutional cohort was created by isolating all patients whose surgical pathology revealed an LGG of the cerebellum. Excluded from analysis were patients in whom a glioma was first diagnosed under the age of 18 years and those whose tumors could not be definitively determined to arise from the cerebellum. Results Data from the local cohort (11 patients) demonstrated that the most common presenting symptom was headache, which occurred in more than 70% of the cohort. Approximately half of the patients in this cohort had symptomatic improvement after treatment. RESULTS from the SEER cohort (166 patients) revealed that adults with Grade I gliomas were slightly younger than those with Grade II tumors (p < 0.01), but no other demographic differences were observed. Patients with Grade I tumors were twice as likely to undergo gross-total resection (54% vs 21%), and those with Grade II gliomas were much more likely to receive postoperative radiation (3% vs 48%). Five-year survival was greater in the patients with Grade I gliomas than in those with Grade II lesions (91% vs 70%). Multivariate analysis revealed that an age ≥ 40 years (HR 7.30, 95% CI 3.55-15.0, p < 0.0001) and Grade II tumors (HR 2.76, 95% CI 1.12-6.84, p = 0.028) were risk factors for death, whereas female sex was protective (HR 0.28, 95% CI 0.14-0.59, p < 0.001). Log-rank tests revealed that a cerebellar location was protective (p < 0.0001), but this relationship was only true for Grade II tumors (p < 0.0001). Survival in patients with Grade I gliomas was not different based on the various lesion locations (p = 0.21). CONCLUSIONS Taken together, adults with cerebellar WHO Grade I and II astrocytomas have a much more favorable survival curve than those with similar supratentorial tumors. Research demonstrates that the primary driver of this phenomenon is the improved survival in patients with cerebellar Grade II gliomas.
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Affiliation(s)
- Jacob H Bagley
- Division of Neurosurgery, Department of Surgery, Duke university Medical Center, North Carolina 27710, USA
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Abstract
Surgical resection, with the goal of maximal tumor removal, is now standard of care for the overwhelming majority of newly diagnosed gliomas. In order to achieve this goal while minimizing the risk of postoperative neurologic deficits, intraoperative brain mapping remains the gold standard. Recent advances in technical aspects of preoperative and intraoperative brain mapping, as well as our understanding of the functional anatomy of the human brain with respect to language, movement, sensation, and cognition, particularly at the subcortical level, have improved our ability to safely perform aggressive resective surgeries in eloquent areas. In this chapter, the functional anatomy of the human brain relevant to intrinsic tumor resection is reviewed. In addition, general principles governing surgical management of patients are highlighted, with a particular emphasis on awake brain mapping.
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Affiliation(s)
- Matthew C Tate
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 North Saint Clair Street Suite 2210, 60611, Chicago, IL, USA,
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Mohammadi AM, Sullivan TB, Barnett GH, Recinos V, Angelov L, Kamian K, Vogelbaum MA. Use of high-field intraoperative magnetic resonance imaging to enhance the extent of resection of enhancing and nonenhancing gliomas. Neurosurgery 2014; 74:339-48; discussion 349; quiz 349-50. [PMID: 24368543 DOI: 10.1227/neu.0000000000000278] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (IoMRI) is used to improve the extent of resection of brain tumors. Most previous studies evaluating the utility of IoMRI have focused on enhancing tumors. OBJECTIVE To report our experience with the use of high-field IoMRI (1.5 T) for both enhancing and nonenhancing gliomas. METHODS An institutional review board-approved retrospective review was performed of 102 consecutive glioma patients (104 surgeries, 2010-2012). Pre-, intra-, and postoperative tumor volumes were assessed. Analysis was performed with the use of volumetric T2 images in 43 nonenhancing and 13 minimally enhancing tumors and with postcontrast volumetric magnetization-prepared rapid gradient-echo images in 48 enhancing tumors. RESULTS In 58 cases, preoperative imaging showed tumors likely to be amenable to complete resection. Intraoperative electrocorticography was performed in 32 surgeries, and 14 cases resulted in intended subtotal resection of tumors due to involvement of deep functional structures. No further resection (complete resection before IoMRI) was required in 25 surgeries, and IoMRI showed residual tumor in 79 patients. Of these, 25 surgeries did not proceed to further resection (9 due to electrocorticography findings, 14 due to tumor in deep functional areas, and 2 due to surgeon choice). Additional resection that was performed in 54 patients resulted in a final median residual tumor volume of 0.21 mL (0.6%). In 79 patients amenable to complete resection, the intraoperative median residual tumor volume for the T2 group was higher than for the magnetization-prepared rapid gradient-echo group (1.088 mL vs 0.437 mL; P = .049), whereas the postoperative median residual tumor volume was not statistically significantly different between groups. CONCLUSION IoMRI enhances the extent of resection, particularly for nonenhancing gliomas.
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Affiliation(s)
- Alireza Mohammad Mohammadi
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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Ho VK, Reijneveld JC, Enting RH, Bienfait HP, Robe P, Baumert BG, Visser O. Changing incidence and improved survival of gliomas. Eur J Cancer 2014; 50:2309-18. [DOI: 10.1016/j.ejca.2014.05.019] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/21/2014] [Accepted: 05/21/2014] [Indexed: 01/05/2023]
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Murphy M, Parney IF. Clinical trials in neurosurgical oncology. J Neurooncol 2014; 119:569-76. [PMID: 25106866 DOI: 10.1007/s11060-014-1569-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 07/23/2014] [Indexed: 10/24/2022]
Abstract
Brain tumors such as diffuse infiltrating gliomas continue to represent a major clinical challenge. Overall survival for patients diagnosed with glioblastoma, the most common primary brain tumor, remains less than 2 years despite intensive multimodal therapy with surgery, radiation, and chemotherapy. However, advances have been made in standard therapies and novel treatments that are showing great potential. These advances reflect careful study performed in the context of clinical trials. Neurosurgeons have played and will continue to play key parts in these studies. In this manuscript, we review clinical trials in neuro-oncology from a neurosurgical point of view and discuss potential roles for neurosurgeons in advancing glioma therapy in the future.
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Affiliation(s)
- Meghan Murphy
- Department of Neurological Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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