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Chaturvedi A, Sadashiva N, Shukla D, Konar S, Krishna U, Beniwal M, Rao S, Santosh V, Saini J, Vazhayil V, Prabhuraj AR, Pruthi N, Arimappamagan A. Thalamic H3K27M altered diffuse midline gliomas: Clinicopathological and outcome analysis. Clin Neurol Neurosurg 2024; 244:108449. [PMID: 39053322 DOI: 10.1016/j.clineuro.2024.108449] [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: 05/16/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
INTRODUCTION Diffuse midline glioma (DMG) is a relatively new entity which was introduced in the fourth edition of the WHO classification of CNS tumours in 2016 and later underwent revision in 2021. It is an infiltrative glioma arising from midline structures, viz., thalamus, spine, and brainstem. Current literature on DMG is based majorly on brainstem lesions, and DMGs arising elsewhere remain unexplored. In our study, we have discussed our experience with thalamic DMGs. METHODOLOGY This is a retrospective observational study of all patients with histopathologically proven DMG H3K27M altered, arising in the thalamus from 2018 to 2022. Clinical, neuroimaging, and pathology were re-reviewed, and prognostic factors for 3 months, 6 months, and overall survival (OS) were analyzed for all patients. RESULTS There were 89 patients- 64 adults and 25 pediatric patients with thalamic DMG. The median age at presentation was 24 years. Raised ICP followed by limb weakness were the most common presenting complaints. Stereotactic biopsy was performed in 64 (71.9 %) patients and surgical decompression in 25 (28.1 %) patients. CSF diversion was required in 53 (59.6 %) patients. Median survival was 8 months in adults and 7 months in pediatric (p-value: 0.51). Raised ICP and TP53 mutation were prognostic factors in pediatric population. Radiotherapy with or without chemotherapy improved survival (p-value- <0.01). CONCLUSION Thalamic DMGs have a poor prognosis which is comparable to brainstem DMGs. Radiotherapy improves survival in these patients. However, the disease remains an enigma and further work delving into its molecular characterization should be encouraged.
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Affiliation(s)
- Aprajita Chaturvedi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Nishanth Sadashiva
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Dhaval Shukla
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Subhas Konar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Uday Krishna
- Consultant Radiation Oncology, Apollo Proton Cancer Center, Chennai, India
| | - Manish Beniwal
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Shilpa Rao
- Department Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Vani Santosh
- Department Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Vikas Vazhayil
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - A R Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India
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Hayashi N, Fukai J, Nakatogawa H, Kawaji H, Yoshioka E, Kodama Y, Nakajo K, Uda T, Naito K, Kijima N, Okita Y, Kagawa N, Takahashi Y, Hashimoto N, Arita H, Takano K, Sakamoto D, Iida T, Arakawa Y, Kawauchi T, Sonoda Y, Mitobe Y, Ishibashi K, Matsuda M, Achiha T, Tomita T, Nonaka M, Hara K, Takebe N, Tsuzuki T, Nakajima Y, Ohue S, Nakajima N, Watanabe A, Inoue A, Umegaki M, Kanematsu D, Katsuma A, Sumida M, Shofuda T, Mano M, Kinoshita M, Mori K, Nakao N, Kanemura Y. Neuroradiological, genetic and clinical characteristics of histone H3 K27-mutant diffuse midline gliomas in the Kansai Molecular Diagnosis Network for CNS Tumors (Kansai Network): multicenter retrospective cohort. Acta Neuropathol Commun 2024; 12:120. [PMID: 39061104 PMCID: PMC11282756 DOI: 10.1186/s40478-024-01808-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 05/27/2024] [Indexed: 07/28/2024] Open
Abstract
This study aims to elucidate the clinical and molecular characteristics, treatment outcomes and prognostic factors of patients with histone H3 K27-mutant diffuse midline glioma. We retrospectively analyzed 93 patients with diffuse midline glioma (47 thalamus, 24 brainstem, 12 spinal cord and 10 other midline locations) treated at 24 affiliated hospitals in the Kansai Molecular Diagnosis Network for CNS Tumors. Considering the term "midline" areas, which had been confused in previous reports, we classified four midline locations based on previous reports and anatomical findings. Clinical and molecular characteristics of the study cohort included: age 4-78 years, female sex (41%), lower-grade histology (56%), preoperative Karnofsky performance status (KPS) scores ≥ 80 (49%), resection (36%), adjuvant radiation plus chemotherapy (83%), temozolomide therapy (76%), bevacizumab therapy (42%), HIST1H3B p.K27M mutation (2%), TERT promoter mutation (3%), MGMT promoter methylation (9%), BRAF p.V600E mutation (1%), FGFR1 mutation (14%) and EGFR mutation (3%). Median progression-free and overall survival time was 9.9 ± 1.0 (7.9-11.9, 95% CI) and 16.6 ± 1.4 (13.9-19.3, 95% CI) months, respectively. Female sex, preoperative KPS score ≥ 80, adjuvant radiation + temozolomide and radiation ≥ 50 Gy were associated with favorable prognosis. Female sex and preoperative KPS score ≥ 80 were identified as independent good prognostic factors. This study demonstrated the current state of clinical practice for patients with diffuse midline glioma and molecular analyses of diffuse midline glioma in real-world settings. Further investigation in a larger population would contribute to better understanding of the pathology of diffuse midline glioma.
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Affiliation(s)
- Nobuhide Hayashi
- Department of Neurosurgery, Wakayama Rosai Hospital, Kinomoto 93-1, Wakayama City, Wakayama, 640-8505, Japan.
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan.
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan.
| | - Junya Fukai
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan.
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan.
| | - Hirokazu Nakatogawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Pediatric Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Hiroshi Kawaji
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, 430-8558, Japan
| | - Ema Yoshioka
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Yoshinori Kodama
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Kosuke Nakajo
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Takehiro Uda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Kentaro Naito
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Metropolitan University Graduate School of Medicine, Osaka City, Osaka, 545-8585, Japan
| | - Noriyuki Kijima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yoshiko Okita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Naoki Kagawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, 565-0871, Japan
| | - Yoshinobu Takahashi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, School of Medical Science, Kyoto Prefectural University Graduate, Kyoto City, Kyoto, 602-8566, Japan
| | - Naoya Hashimoto
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, School of Medical Science, Kyoto Prefectural University Graduate, Kyoto City, Kyoto, 602-8566, Japan
| | - Hideyuki Arita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Koji Takano
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
| | - Daisuke Sakamoto
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tomoko Iida
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshiki Arakawa
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto City, Kyoto, 606-8507, Japan
| | - Takeshi Kawauchi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka Red Cross Hospital, Osaka City, Osaka, 543-8555, Japan
| | - Yukihiko Sonoda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata City, Yamagata, 990-8560, Japan
| | - Yuta Mitobe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata City, Yamagata, 990-8560, Japan
| | - Kenichi Ishibashi
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka City General Hospital, Osaka City, Osaka, 534-0021, Japan
| | - Masahide Matsuda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Takamune Achiha
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kansai Rosai Hospital, Amagasaki, Hyogo, 660-8511, Japan
| | - Takahiro Tomita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama City, Toyama, 930-0194, Japan
| | - Masahiro Nonaka
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kansai Medical University, Hirakata, Osaka, 573-1191, Japan
| | - Keijiro Hara
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima City, Tokushima, 770-8501, Japan
| | - Noriyoshi Takebe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Medical Research Institute, Tazuke Kofukai Foundation, Kitano Hospital, Osaka City, Osaka, 530-8480, Japan
| | - Takashi Tsuzuki
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, 593-8304, Japan
| | - Yoshikazu Nakajima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Sakai City Medical Center, Sakai, Osaka, 593-8304, Japan
- Department of Neurosurgery, Kobe Tokushukai Hospital, Kobe, Hyogo, 655-0017, Japan
| | - Shiro Ohue
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, 790-0024, Japan
| | - Nobuyuki Nakajima
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Tokyo Medical University, Tokyo, 160-0023, Japan
| | - Akira Watanabe
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Kindai University Nara Hospital, Ikoma, Nara, 630-0293, Japan
| | - Akihiro Inoue
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Ehime, 791-0295, Japan
| | - Masao Umegaki
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, 564-8567, Japan
| | - Daisuke Kanematsu
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Asako Katsuma
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Miho Sumida
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Tomoko Shofuda
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Stem Cell Research, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Masayuki Mano
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Central Laboratory and Surgical Pathology, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
| | - Manabu Kinoshita
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka City, Osaka, 541-8567, Japan
- Department of Neurosurgery, Asahikawa Medical University, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kanji Mori
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, Yao Municipal Hospital, Yao, Osaka, 581-0069, Japan
| | - Naoyuki Nakao
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Department of Neurological Surgery, School of Medicine, Wakayama Medical University, Kimiidera 811-1, Wakayama City, Wakayama, 641-8510, Japan
| | - Yonehiro Kanemura
- Kansai Molecular Diagnosis Network for CNS Tumors, Osaka City, Osaka, 540-0006, Japan
- Division of Molecular Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
- Division of Regenerative Medicine, Department of Biomedical Research and Innovation, Institute for Clinical Research, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
- Department of Neurosurgery, NHO Osaka National Hospital, Osaka City, Osaka, 540-0006, Japan
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Roach JT, Riviere-Cazaux C, Wells BA, Boop FA, Daniels DJ. Epigenetics to clinicopathological features: a bibliometric analysis of H3 G34-mutant diffuse hemispheric glioma literature. Childs Nerv Syst 2024; 40:2009-2017. [PMID: 38613587 DOI: 10.1007/s00381-024-06395-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/03/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE Pediatric-type diffuse high-grade gliomas are the leading cause of cancer-related morbidity and mortality in children. More than 30% of diffuse hemispheric gliomas (DHG) in adolescents harbor histone H3 G34 mutations and are recognized by the World Health Organization as a distinct tumor entity. By reporting bibliometric characteristics of the most cited publications on H3 G34-mutant DHG (H3 G34 DHG), we provide an overview of emerging literature and speculate where future research efforts may lead. METHODS One hundred fourteen publications discussing H3 G34 DHG were identified, categorized as basic science (BSc), clinical (CL), or review (R), and ranked by citation number. Various bibliometric parameters were summarized, and a comparison between article types was performed. RESULTS Articles within this study represent principal investigators from 15 countries and were published across 63 journals between 2012 and 2024, with 36.84% of articles originating in the United States. Overall median values were as follows: citation count, 20 (range, 0-2591), number of authors, 9 (range, 2-78), and year of publication, 2020 (range, 2012-2024). Among the top ten most cited articles, BSc articles accounted for all ten reports. Compared to CL and R articles, BSc articles were published in journals with higher impact factors. CONCLUSION We establish variability in bibliometric parameters for the most cited publications on H3 G34 DHG. Our findings demonstrate a paucity of high-impact and highly cited CL reports and acknowledge an unmet need to intersect basic mechanism with clinical data to inform novel therapeutic approaches.
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Affiliation(s)
- Jordan T Roach
- Department of Developmental Neurobiology, Division of Brain Tumor Research, St. Jude Children's Research Hospital, Memphis, TN, USA.
- Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Cecile Riviere-Cazaux
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
- Mayo Clinic Graduate School of Biomedical Sciences, Rochester, MN, USA
| | | | - Frederick A Boop
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, TN, USA
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David J Daniels
- Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA
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Williamson C, Williamson S, Jiang R, Sudmeier L, Esiashvili N, Eaton BR. The impact of radiation therapy variables on pediatric high-grade glioma outcomes: A National Cancer Database analysis. Pediatr Blood Cancer 2024; 71:e30751. [PMID: 37937991 DOI: 10.1002/pbc.30751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/23/2023] [Accepted: 10/17/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE The purpose of this analysis is to report patterns of care for pediatric patients with high-grade glioma (pHGG) and evaluate the impact of radiotherapy (RT) variables on outcomes using the National Cancer Database (NCDB). METHODS Eligibility criteria included age < 22 years, histologically diagnosed WHO grade III-IV gliomas treated with ≥50 Gy and < 76 Gy RT between 2004 and 2013, and RT initiation within 90 days of diagnosis. RT variables including RT dose, RT timing, and RT modality were analyzed along with baseline demographic, tumor, and treatment variables to assess the impact on overall survival. RESULTS A total of 498 pHGG patients were included. The median age was 15 years (range, 0-21), common diagnoses were astrocytoma (55%) and glioblastoma (30%), 73.5% underwent surgical resection and 90.2% received chemotherapy. The median RT dose was 59.4 Gy (SD 2.9 Gy) starting at a median of 4.4 weeks from diagnosis (SD 2.5 weeks). Fourteen patients were treated with proton therapy. Median follow-up was 19.6 months with 1- and 3-year overall survival of 78.4% and 40.4%, respectively. On multivariable analysis, female gender, older age, and RT delay of ≥6 weeks were significantly associated with a lower rate of death; glioblastoma histology, no surgical resection/biopsy only, and earlier RT initiation < 6 weeks from diagnosis were associated with a higher rate of death. There was no relationship between RT dose or proton versus photon therapy and overall survival. CONCLUSIONS Outcomes for pHGG are poor. There was no benefit to early RT timing when RT is initiated within 90 days of diagnosis or higher RT dose in this dataset.
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Affiliation(s)
- Christopher Williamson
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Shayla Williamson
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Renjian Jiang
- Department of Biostatistics and Bioinformatics, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Lisa Sudmeier
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
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Nguyen AV, Soto JM, Gonzalez SM, Murillo J, Trumble ER, Shan FY, Huang JH. H3G34-Mutant Gliomas-A Review of Molecular Pathogenesis and Therapeutic Options. Biomedicines 2023; 11:2002. [PMID: 37509641 PMCID: PMC10377039 DOI: 10.3390/biomedicines11072002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The 2021 World Health Organization Classification of Tumors of the Central Nervous System reflected advances in understanding of the roles of oncohistones in gliomagenesis with the introduction of the H3.3-G34R/V mutant glioma to the already recognized H3-K27M altered glioma, which represent the diagnoses of pediatric-type diffuse hemispheric glioma and diffuse midline glioma, respectively. Despite advances in research regarding these disease entities, the prognosis remains poor. While many studies and clinical trials focus on H3-K27M-altered-glioma patients, those with H3.3-G34R/V mutant gliomas represent a particularly understudied population. Thus, we sought to review the current knowledge regarding the molecular mechanisms underpinning the gliomagenesis of H3.3-G34R/V mutant gliomas and the diagnosis, treatment, long-term outcomes, and possible future therapeutics.
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Affiliation(s)
- Anthony V Nguyen
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
| | - Jose M Soto
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
| | - Sarah-Marie Gonzalez
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
| | - Jennifer Murillo
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
- Department of Neurology, Baylor Scott and White Medical Center, Temple, TX 76508, USA
| | - Eric R Trumble
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
| | - Frank Y Shan
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
- Department of Pathology, Baylor Scott and White Medical Center, Temple, TX 76508, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott and White Medical Center, Temple, TX 76508, USA
- Department of Surgery, Texas A&M University College of Medicine, Temple, TX 76508, USA
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Lasocki A, Abdalla G, Chow G, Thust SC. Imaging features associated with H3 K27-altered and H3 G34-mutant gliomas: a narrative systematic review. Cancer Imaging 2022; 22:63. [DOI: 10.1186/s40644-022-00500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/23/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Advances in molecular diagnostics accomplished the discovery of two malignant glioma entities harboring alterations in the H3 histone: diffuse midline glioma, H3 K27-altered and diffuse hemispheric glioma, H3 G34-mutant. Radiogenomics research, which aims to correlate tumor imaging features with genotypes, has not comprehensively examined histone-altered gliomas (HAG). The aim of this research was to synthesize the current published data on imaging features associated with HAG.
Methods
A systematic search was performed in March 2022 using PubMed and the Cochrane Library, identifying studies on the imaging features associated with H3 K27-altered and/or H3 G34-mutant gliomas.
Results
Forty-seven studies fulfilled the inclusion criteria, the majority on H3 K27-altered gliomas. Just under half (21/47) were case reports or short series, the remainder being diagnostic accuracy studies. Despite heterogeneous methodology, some themes emerged. In particular, enhancement of H3 K27M-altered gliomas is variable and can be less than expected given their highly malignant behavior. Low apparent diffusion coefficient values have been suggested as a biomarker of H3 K27-alteration, but high values do not exclude this genotype. Promising correlations between high relative cerebral blood volume values and H3 K27-alteration require further validation. Limited data on H3 G34-mutant gliomas suggest some morphologic overlap with 1p/19q-codeleted oligodendrogliomas.
Conclusions
The existing data are limited, especially for H3 G34-mutant gliomas and artificial intelligence techniques. Current evidence indicates that imaging-based predictions of HAG are insufficient to replace histological assessment. In particular, H3 K27-altered gliomas should be considered when occurring in typical midline locations irrespective of enhancement characteristics.
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Rodriguez D, Calmon R, Aliaga ES, Warren D, Warmuth-Metz M, Jones C, Mackay A, Varlet P, Le Deley MC, Hargrave D, Cañete A, Massimino M, Azizi AA, Saran F, Zahlmann G, Garcia J, Vassal G, Grill J, Peet A, Dineen RA, Morgan PS, Jaspan T. MRI and Molecular Characterization of Pediatric High-Grade Midline Thalamic Gliomas: The HERBY Phase II Trial. Radiology 2022; 304:174-182. [DOI: 10.1148/radiol.211464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hohm A, Karremann M, Gielen GH, Pietsch T, Warmuth-Metz M, Vandergrift LA, Bison B, Stock A, Hoffmann M, Pham M, Kramm CM, Nowak J. Magnetic Resonance Imaging Characteristics of Molecular Subgroups in Pediatric H3 K27M Mutant Diffuse Midline Glioma. Clin Neuroradiol 2021; 32:249-258. [PMID: 34919158 PMCID: PMC8894220 DOI: 10.1007/s00062-021-01120-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/28/2021] [Indexed: 11/28/2022]
Abstract
Purpose Recent research identified histone H3 K27M mutations to be associated with a dismal prognosis in pediatric diffuse midline glioma (pDMG); however, data on detailed MRI characteristics with respect to H3 K27 mutation status and molecular subgroups (H3.1 and H3.3 K27M mutations) are limited. Methods Standardized magnetic resonance imaging (MRI) parameters and epidemiologic data of 68 pDMG patients (age <18 years) were retrospectively reviewed and compared in a) H3 K27M mutant versus H3 K27 wildtype (WT) tumors and b) H3.1 versus H3.3 K27M mutant tumors. Results Intracranial gliomas (n = 58) showed heterogeneous phenotypes with isointense to hyperintense signal in T2-weighted images and frequent contrast enhancement. Hemorrhage and necrosis may be present. Comparing H3 K27M mutant to WT tumors, there were significant differences in the following parameters: i) tumor localization (p = 0.001), ii) T2 signal intensity (p = 0.021), and iii) T1 signal homogeneity (p = 0.02). No significant imaging differences were found in any parameter between H3.1 and H3.3 K27M mutant tumors; however, H3.1 mutant tumors occurred at a younger age (p = 0.004). Considering spinal gliomas (n = 10) there were no significant imaging differences between the analyzed molecular groups. Conclusion With this study, we are the first to provide detailed MR imaging data on H3 K27M mutant pDMG with respect to molecular subgroup status in a large patient cohort. Our findings may support diagnosis and future targeted therapeutic trials of pDMG within the framework of the radiogenomics concept. Supplementary Information The online version of this article (10.1007/s00062-021-01120-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annika Hohm
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
- Current address: Division of Pediatric Stem Cell Transplantation and Immunology, University Children's Medical Clinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Karremann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gerrit H Gielen
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Monika Warmuth-Metz
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Lindsey A Vandergrift
- Departments of Radiology and Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Brigitte Bison
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Current address: Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Department of Neuroradiology, University Augsburg, Faculty of Medicine, Augsburg, Germany
| | - Annika Stock
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Marion Hoffmann
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Mirko Pham
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes Nowak
- Neuroradiological Reference Center for the Pediatric Brain Tumor (HIT) Studies of the German Society of Pediatric Oncology and Hematology, Würzburg University Hospital, Würzburg, Germany.
- Department of Neuroradiology, Würzburg University Hospital, Würzburg, Germany.
- SRH Poliklinik Gera GmbH, Radiology Gotha, Gotha, Germany.
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9
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Kazarian E, Marks A, Cui J, Darbinyan A, Tong E, Mueller S, Cha S, Aboian MS. Topographic correlates of driver mutations and endogenous gene expression in pediatric diffuse midline gliomas and hemispheric high-grade gliomas. Sci Rep 2021; 11:14377. [PMID: 34257334 PMCID: PMC8277861 DOI: 10.1038/s41598-021-92943-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/15/2021] [Indexed: 11/09/2022] Open
Abstract
We evaluate the topographic distribution of diffuse midline gliomas and hemispheric high-grade gliomas in children with respect to their normal gene expression patterns and pathologic driver mutation patterns. We identified 19 pediatric patients with diffuse midline or high-grade glioma with preoperative MRI from tumor board review. 7 of these had 500 gene panel mutation testing, 11 patients had 50 gene panel mutation testing and one 343 gene panel testing from a separate institution were included as validation set. Tumor imaging features and gene expression patterns were analyzed using Allen Brain Atlas. Twelve patients had diffuse midline gliomas and seven had hemispheric high-grade gliomas. Three diffuse midline gliomas had the K27M mutation in the tail of histone H3 protein. All patients undergoing 500 gene panel testing had additional mutations, the most common being in ACVR1, PPM1D, and p53. Hemispheric high-grade gliomas had either TP53 or IDH1 mutation and diffuse midline gliomas had H3 K27M-mutation. Gene expression analysis in normal brains demonstrated that genes mutated in diffuse midline gliomas had higher expression along midline structures as compared to the cerebral hemispheres. Our study suggests that topographic location of pediatric diffuse midline gliomas and hemispheric high-grade gliomas correlates with driver mutations of tumor to the endogenous gene expression in that location. This correlation suggests that cellular state that is required for increased gene expression predisposes that location to mutations and defines the driver mutations within tumors that arise from that region.
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Affiliation(s)
- Eve Kazarian
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Asher Marks
- Department of Pediatric Hematology & Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Jin Cui
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Armine Darbinyan
- Department of Neuropathology, Yale School of Medicine, New Haven, CT, USA
| | - Elizabeth Tong
- Department of Radiology, , University of California, San Francisco, San Francisco, USA
| | - Sabine Mueller
- Division of Pediatric Hematology & Oncology, Department of Pediatrics, University of California, San Francisco, San Francisco, USA.,Department of Neurological Surgery, University of California, San Francisco, San Francisco, USA.,Department of Neurology, University of California, San Francisco, San Francisco, USA
| | - Soonmee Cha
- Department of Radiology, , University of California, San Francisco, San Francisco, USA
| | - Mariam S Aboian
- Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
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10
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Dorfer C, Czech T, Gojo J, Hosmann A, Peyrl A, Azizi AA, Kasprian G, Dieckmann K, Filbin MG, Haberler C, Roessler K, Slavc I. Infiltrative gliomas of the thalamus in children: the role of surgery in the era of H3 K27M mutant midline gliomas. Acta Neurochir (Wien) 2021; 163:2025-2035. [PMID: 33090244 PMCID: PMC8195935 DOI: 10.1007/s00701-020-04589-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/16/2020] [Indexed: 12/28/2022]
Abstract
Background The role of surgery in the management of pediatric non-pilocytic infiltrative thalamic gliomas needs to be revisited specifically with regard to molecularly defined subtypes. Methods A retrospective review of a consecutive series of children operated on a thalamic tumor between 1992 and May 2018 was performed. Neuroimaging data were reviewed for localization and extent of resection; pathology was re-reviewed according to the current WHO classification, including assessment of histone H3 K27 mutational status. Results Forty-nine patients with a thalamic tumor aged < 18 years at diagnosis were identified. Twenty-five patients (51%) had a non-pilocytic infiltrative glioma, of which the H3 K27M status was available in 22. Fourteen patients were diagnosed as diffuse midline glioma (DMG) H3 K27M mutant. There was no statistically significant difference in survival between patients harboring the H3 K27M mutation and wildtype. Resection (“any resection > 50%” vs “biopsy”) and histological tumor grade (“°II” vs “°III+°IV”) were statistically significant predictors of survival (univariate: p = 0.044 and p = 0.013, respectively). These results remained significant on multivariate analysis (HR 0.371/p = 0.048, HR 9.433/p = 0.035). Conclusion We advocate to still consider an attempt at maximal safe resection in the multidisciplinary treatment of unilateral thalamic non-pilocytic gliomas irrespective of their H3 K27-mutational status.
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Affiliation(s)
- Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria.
| | - Johannes Gojo
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
| | - Andreas Peyrl
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Amedeo A Azizi
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gregor Kasprian
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Mariella G Filbin
- Department of Pediatric Oncology, Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Christine Haberler
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karl Roessler
- Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Comprehensive Cancer Center-CCC CNS Unit, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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11
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Chauhan RS, Kulanthaivelu K, Kathrani N, Kotwal A, Bhat MD, Saini J, Prasad C, Chakrabarti D, Santosh V, Uppar AM, Srinivas D. Prediction of H3K27M mutation status of diffuse midline gliomas using MRI features. J Neuroimaging 2021; 31:1201-1210. [PMID: 34189806 DOI: 10.1111/jon.12905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/18/2021] [Accepted: 06/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND PURPOSE Presurgical prediction of H3K27M mutation in diffuse midline gliomas (DMGs) on MRI is desirable. The purpose of this study is to elaborate conventional MRI (cMRI) features of H3K27M-mutant DMGs and identify features that could discriminate them from wild-type (WT) DMGs. METHODS CMRI features of 123 patients with DMG were evaluated conforming to the institutional research protocols. Multimodality MRI was performed on 1.5 or 3.0 Tesla MR Scanners with imaging protocol, including T1-weighted (w), T2w, fluid-attenuated inversion recovery, diffusion-weighted, susceptibility-weighted, and postcontrast T1w sequences. Pertinent cMRI features were annotated along the lines of Visually AcceSAble Rembrandt Images features, and Intra Tumoral Susceptibility Signal score (ITSS) was evaluated. R software was used for statistical analysis. RESULTS Sixty-one DMGs were H3K27M-mutant (mutant DMGs). The patients in the H3K27M-mutant DMG group were younger compared to the WT-DMG group (mean age 24.13 ± 13.13 years vs. 35.79±18.74 years) (p = 0.016). The two groups differed on five cMRI features--(1) enhancement quality (p = 0.032), (2) thickness of enhancing margin (p = 0.05), (3) proportion of edema (p = 0.002), (4) definition of noncontrast-enhancing tumor (NCET) margin (p = 0.001), and (5) cortical invasion (p = 0.037). The mutant DMGs showed greater enhancement and greater thickness of enhancing margin, while the WT DMGs exhibited significantly larger edema proportion with poorly defined NCET margins and cortical invasion. ITSS was not significantly different among the groups. CONCLUSION CMRI features like enhancement quality, the thickness of the enhancing margin, proportion of edema, definition of NCET margin, and cortical invasion can discriminate between the H3K27M-mutant and WT DMGs.
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Affiliation(s)
- Richa Singh Chauhan
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Nihar Kathrani
- Consultant Interventionalist, Paras Hospital, Gurugram, India
| | - Abhishek Kotwal
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Maya Dattatraya Bhat
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Chandrajit Prasad
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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12
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Izquierdo E, Proszek P, Pericoli G, Temelso S, Clarke M, Carvalho DM, Mackay A, Marshall LV, Carceller F, Hargrave D, Lannering B, Pavelka Z, Bailey S, Entz-Werle N, Grill J, Vassal G, Rodriguez D, Morgan PS, Jaspan T, Mastronuzzi A, Vinci M, Hubank M, Jones C. Droplet digital PCR-based detection of circulating tumor DNA from pediatric high grade and diffuse midline glioma patients. Neurooncol Adv 2021; 3:vdab013. [PMID: 34169282 PMCID: PMC8218704 DOI: 10.1093/noajnl/vdab013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of liquid biopsy is of potential high importance for children with high grade (HGG) and diffuse midline gliomas (DMG), particularly where surgical procedures are limited, and invasive biopsy sampling not without risk. To date, however, the evidence that detection of cell-free DNA (cfDNA) or circulating tumor DNA (ctDNA) could provide useful information for these patients has been limited, or contradictory. METHODS We optimized droplet digital PCR (ddPCR) assays for the detection of common somatic mutations observed in pediatric HGG/DMG, and applied them to liquid biopsies from plasma, serum, cerebrospinal fluid (CSF), and cystic fluid collected from 32 patients. RESULTS Although detectable in all biomaterial types, ctDNA presented at significantly higher levels in CSF compared to plasma and/or serum. When applied to a cohort of 127 plasma specimens from 41 patients collected from 2011 to 2018 as part of a randomized clinical trial in pediatric non-brainstem HGG/DMG, ctDNA profiling by ddPCR was of limited use due to the small volumes (mean = 0.49 mL) available. In anecdotal cases where sufficient material was available, cfDNA concentration correlated with disease progression in two examples each of poor response in H3F3A_K27M-mutant DMG, and longer survival times in hemispheric BRAF_V600E-mutant cases. CONCLUSION Tumor-specific DNA alterations are more readily detected in CSF than plasma. Although we demonstrate the potential of the approach to assessing tumor burden, our results highlight the necessity for adequate sample collection and approach to improve detection if plasma samples are to be used.
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Affiliation(s)
- Elisa Izquierdo
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Paula Proszek
- Molecular Diagnostics, Royal Marsden Hospital NHS Trust, Sutton, UK
| | - Giulia Pericoli
- Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital-IRCCS, Rome, Italy
| | - Sara Temelso
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Matthew Clarke
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Diana M Carvalho
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Alan Mackay
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Lynley V Marshall
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
- Children & Young People’s Unit, Royal Marsden Hospital NHS Trust, Sutton, UK
| | - Fernando Carceller
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
- Children & Young People’s Unit, Royal Marsden Hospital NHS Trust, Sutton, UK
| | - Darren Hargrave
- Department of Haematology and Oncology, UCL Great Ormond Street Institute for Child Health, London, UK
| | - Birgitta Lannering
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children’s Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Zdenek Pavelka
- Department of Pediatric Oncology, University Hospital Brno – Children’s Hospital, Brno, Czechia
| | - Simon Bailey
- Department of Paediatric Oncology, Great North Children’s Hospital, Newcastle University Center for Cancer, Newcastle upon Tyne, UK
| | - Natacha Entz-Werle
- Pediatric Onco-Hematology Department, University Hospital of Strasbourg, Strasbourg, France
- UMR CNRS 7021, Laboratory Bioimaging and Pathologies, Tumoral Signaling and Therapeutic Targets team, Faculty of Pharmacy, Illkirch, France
| | - Jacques Grill
- Pediatric and Adolescent Oncology and INSERM Unit U981, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy and Paris Saclay University, Villejuif, France
| | - Gilles Vassal
- Pediatric and Adolescent Oncology and INSERM Unit U981, Team Genomics and Oncogenesis of Pediatric Brain Tumors, Gustave Roussy and Paris Saclay University, Villejuif, France
| | - Daniel Rodriguez
- Medical Physics and Clinical Engineering, Nottingham University Hospital Trust Nottingham University Hospital Trust, Nottingham, UK
| | - Paul S Morgan
- Medical Physics and Clinical Engineering, Nottingham University Hospital Trust Nottingham University Hospital Trust, Nottingham, UK
| | - Tim Jaspan
- Department of Radiology, Nottingham University Hospital Trust, Nottingham University Hospital Trust, Nottingham, UK
| | - Angela Mastronuzzi
- Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital-IRCCS, Rome, Italy
| | - Mara Vinci
- Department of Onco-haematology, Cell and Gene Therapy, Bambino Gesù Children’s Hospital-IRCCS, Rome, Italy
| | - Michael Hubank
- Molecular Diagnostics, Royal Marsden Hospital NHS Trust, Sutton, UK
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
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13
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Erker C, Tamrazi B, Poussaint TY, Mueller S, Mata-Mbemba D, Franceschi E, Brandes AA, Rao A, Haworth KB, Wen PY, Goldman S, Vezina G, MacDonald TJ, Dunkel IJ, Morgan PS, Jaspan T, Prados MD, Warren KE. Response assessment in paediatric high-grade glioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group. Lancet Oncol 2020; 21:e317-e329. [PMID: 32502458 DOI: 10.1016/s1470-2045(20)30173-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/05/2020] [Accepted: 03/12/2020] [Indexed: 12/27/2022]
Abstract
Response criteria for paediatric high-grade glioma vary historically and across different cooperative groups. The Response Assessment in Neuro-Oncology working group developed response criteria for adult high-grade glioma, but these were not created to meet the unique challenges in children with the disease. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group, consisting of an international panel of paediatric and adult neuro-oncologists, clinicians, radiologists, radiation oncologists, and neurosurgeons, was established to address issues and unique challenges in assessing response in children with CNS tumours. We established a subcommittee to develop response assessment criteria for paediatric high-grade glioma. Current practice and literature were reviewed to identify major challenges in assessing the response of paediatric high-grade gliomas to various treatments. For areas in which scientific investigation was scarce, consensus was reached through an iterative process. RAPNO response assessment recommendations include the use of MRI of the brain and the spine, assessment of clinical status, and the use of corticosteroids or antiangiogenics. Imaging standards for brain and spine are defined. Compared with the recommendations for the management of adult high-grade glioma, for paediatrics there is inclusion of diffusion-weighted imaging and a higher reliance on T2-weighted fluid-attenuated inversion recovery. Consensus recommendations and response definitions have been established and, similar to other RAPNO recommendations, prospective validation in clinical trials is warranted.
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Affiliation(s)
- Craig Erker
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Dalhousie University and IWK Health Centre, Halifax, NS, Canada.
| | - Benita Tamrazi
- Department of Radiology, Keck School of Medicine, University of Southern California and Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Tina Y Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Sabine Mueller
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA; Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA; Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Daddy Mata-Mbemba
- Department of Diagnostic Imaging, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| | - Enrico Franceschi
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Arvind Rao
- Departments of Computational Medicine and Bioinformatics and Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kellie B Haworth
- Division of Neuro-Oncology, Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Patrick Y Wen
- Center For Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Stewart Goldman
- Department of Haematology, Oncology, Neuro-Oncology, and Stem Cell Transplantation, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gilbert Vezina
- Department of Radiology, Children's National Medical Center, Washington, DC, USA
| | - Tobey J MacDonald
- Department of Pediatrics, Aflac Cancer and Blood Disorders Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Ira J Dunkel
- Department of Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul S Morgan
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Tim Jaspan
- Department of Radiology, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, UK
| | - Michael D Prados
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana- Farber/Boston Children's Cancer and Blood Disorders Center, Dana-Farber Cancer Institute, Boston, MA, USA
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