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Duffau H. White Matter Tracts and Diffuse Lower-Grade Gliomas: The Pivotal Role of Myelin Plasticity in the Tumor Pathogenesis, Infiltration Patterns, Functional Consequences and Therapeutic Management. Front Oncol 2022; 12:855587. [PMID: 35311104 PMCID: PMC8924360 DOI: 10.3389/fonc.2022.855587] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 02/14/2022] [Indexed: 12/18/2022] Open
Abstract
For many decades, interactions between diffuse lower-grade glioma (LGG) and brain connectome were neglected. However, the neoplasm progression is intimately linked to its environment, especially the white matter (WM) tracts and their myelin status. First, while the etiopathogenesis of LGG is unclear, this tumor seems to appear during the adolescence, and it is mostly located within anterior and associative cerebral areas. Because these structures correspond to those which were myelinated later in the brain maturation process, WM myelination could play a role in the development of LGG. Second, WM fibers and the myelin characteristics also participate in LGG diffusion, since glioma cells migrate along the subcortical pathways, especially when exhibiting a demyelinated phenotype, which may result in a large invasion of the parenchyma. Third, such a migratory pattern can induce functional (neurological, cognitive and behavioral) disturbances, because myelinated WM tracts represent the main limitation of neuroplastic potential. These parameters are critical for tailoring an individualized therapeutic strategy, both (i) regarding the timing of active treatment(s) which must be proposed earlier, before a too wide glioma infiltration along the WM bundles, (ii) and regarding the anatomic extent of surgical resection and irradiation, which should take account of the subcortical connectivity. Therefore, the new science of connectomics must be integrated in LGG management, based upon an improved understanding of the interplay across glioma dissemination within WM and reactional neural networks reconfiguration, in order to optimize long-term oncological and functional outcomes. To this end, mechanisms of activity-dependent myelin plasticity should be better investigated.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.,Team "Plasticity of Central Nervous System, Stem Cells and Glial Tumors", Institute of Functional Genomics, National Institute for Health and Medical Research (INSERM) U1191, University of Montpellier, Montpellier, France
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2
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Jain R, Johnson DR, Patel SH, Castillo M, Smits M, van den Bent MJ, Chi AS, Cahill DP. "Real world" use of a highly reliable imaging sign: "T2-FLAIR mismatch" for identification of IDH mutant astrocytomas. Neuro Oncol 2021; 22:936-943. [PMID: 32064507 DOI: 10.1093/neuonc/noaa041] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AbstractThe T2-FLAIR (fluid attenuated inversion recovery) mismatch sign is an easily detectable imaging sign on routine clinical MRI studies that suggests diagnosis of isocitrate dehydrogenase (IDH)-mutant 1p/19q non-codeleted gliomas. Multiple independent studies show that the T2-FLAIR mismatch sign has near-perfect specificity, but low sensitivity for diagnosing IDH-mutant astrocytomas. Thus, the T2-FLAIR mismatch sign represents a non-invasive radiogenomic diagnostic finding with potential clinical impact. Recently, false positive cases have been reported, many related to variable application of the sign's imaging criteria and differences in image acquisition, as well as to differences in the included patient populations. Here we summarize the imaging criteria for the T2-FLAIR mismatch sign, review similarities and differences between the multiple validation studies, outline strategies to optimize its clinical use, and discuss potential opportunities to refine imaging criteria in order to maximize its impact in glioma diagnostics.
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Affiliation(s)
- Rajan Jain
- Departments of Radiology and Neurosurgery, New York University Langone Health, New York, New York, USA
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sohil H Patel
- Department of Radiology, University of Virginia Health, Charlottesville, Virginia, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | | | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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3
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Ismail M, Hill V, Statsevych V, Mason E, Correa R, Prasanna P, Singh G, Bera K, Thawani R, Ahluwalia M, Madabhushi A, Tiwari P. Can Tumor Location on Pre-treatment MRI Predict Likelihood of Pseudo-Progression vs. Tumor Recurrence in Glioblastoma?-A Feasibility Study. Front Comput Neurosci 2021; 14:563439. [PMID: 33381018 PMCID: PMC7767991 DOI: 10.3389/fncom.2020.563439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/19/2020] [Indexed: 11/14/2022] Open
Abstract
A significant challenge in Glioblastoma (GBM) management is identifying pseudo-progression (PsP), a benign radiation-induced effect, from tumor recurrence, on routine imaging following conventional treatment. Previous studies have linked tumor lobar presence and laterality to GBM outcomes, suggesting that disease etiology and progression in GBM may be impacted by tumor location. Hence, in this feasibility study, we seek to investigate the following question: Can tumor location on treatment-naïve MRI provide early cues regarding likelihood of a patient developing pseudo-progression vs. tumor recurrence? In this study, 74 pre-treatment Glioblastoma MRI scans with PsP (33) and tumor recurrence (41) were analyzed. First, enhancing lesion on Gd-T1w MRI and peri-lesional hyperintensities on T2w/FLAIR were segmented by experts and then registered to a brain atlas. Using patients from the two phenotypes, we construct two atlases by quantifying frequency of occurrence of enhancing lesion and peri-lesion hyperintensities, by averaging voxel intensities across the population. Analysis of differential involvement was then performed to compute voxel-wise significant differences (p-value < 0.05) across the atlases. Statistically significant clusters were finally mapped to a structural atlas to provide anatomic localization of their location. Our results demonstrate that patients with tumor recurrence showed prominence of their initial tumor in the parietal lobe, while patients with PsP showed a multi-focal distribution of the initial tumor in the frontal and temporal lobes, insula, and putamen. These preliminary results suggest that lateralization of pre-treatment lesions toward certain anatomical areas of the brain may allow to provide early cues regarding assessing likelihood of occurrence of pseudo-progression from tumor recurrence on MRI scans.
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Affiliation(s)
- Marwa Ismail
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Virginia Hill
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States.,Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Volodymyr Statsevych
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Evan Mason
- Department of Neuroradiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Ramon Correa
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Prateek Prasanna
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, NY, United States
| | - Gagandeep Singh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.,Maimonides Medical Center, New York, NY, United States
| | - Rajat Thawani
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Manmeet Ahluwalia
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH, United States
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, United States
| | - Pallavi Tiwari
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
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4
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Gaps and Doubts in Search to Recognize Glioblastoma Cellular Origin and Tumor Initiating Cells. JOURNAL OF ONCOLOGY 2020; 2020:6783627. [PMID: 32774372 PMCID: PMC7396023 DOI: 10.1155/2020/6783627] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/22/2020] [Accepted: 06/13/2020] [Indexed: 12/20/2022]
Abstract
Cellular origin of glioblastoma (GB) is constantly discussed and remains a controversial subject. Unfortunately, neurobiologists are not consistent in defining neural stem cells (NSC) complicating this issue even further. Nevertheless, some suggestions referring to GB origin can be proposed based on comparing GB to central nervous system (CNS) cells. Firstly, GB cells show in vitro differentiation pattern similar to GFAP positive neural cells, rather than classical (GFAP negative) NSC. GB cells in primary cultures become senescent in vitro, similar to GFAP positive neural progenitors, whereas classical NSC proliferate in vitro infinitely. Classical NSC apoptosis triggered by introduction of IDH1R132H undermines hypothesis stating that IDH-mutant (secondary) GB origins from these NSC. Analysis of biological role of typical IDH-wildtype (primary) GB oncogene such as EGFRvIII also favors GFAP positive cells rather than classical NSC as source of GB. Single-cell NGS and single-cell transcriptomics also suggest that GFAP positive cells are GB origin. Considering the above-mentioned and other discussed in articles data, we suggest that GFAP positive cells (astrocytes, radial glia, or GFAP positive neural progenitors) are more likely to be source of GB than classical GFAP negative NSC, and further in vitro assays should be focused on these cells. It is highly possible that several populations of tumor initiating cells (TIC) exist within GB, adjusting their phenotype and even genotype to various environmental conditions including applied therapy and periodically going through different TIC states as well as non-TIC state. This adjustment is driven by changes in number and types of amplicons. The existence of various populations of TIC would enable creating neoplastic foci in different environments and increase tumor aggressiveness.
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5
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Latini F, Fahlström M, Hesselager G, Zetterling M, Ryttlefors M. Differences in the preferential location and invasiveness of diffuse low-grade gliomas and their impact on outcome. Cancer Med 2020; 9:5446-5458. [PMID: 32537906 PMCID: PMC7402839 DOI: 10.1002/cam4.3216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background Low‐grade gliomas (LGGs) are primary diffuse slow‐growing brain tumors derived from glial cells. The management of these tumors is dependent on their location, which often harbors eloquent areas. We retrospectively recorded the location of diffuse gliomas to identify whether specific differences exist between the histological types. Methods We analyzed 102 patients with previous histological diagnosis of WHO‐II astrocytomas (62) and WHO‐II oligodendrogliomas (40) according to WHO‐2016 classification. MRI sequences (T2‐FLAIR) were used for tumor volume segmentation and to create a frequency map of their locations within the Montreal Neurological Institute (MNI) space. The Brain‐Grid (BG) system (standardized radiological tool of intersected lines according to anatomical landmarks) was created and merged with a tractography atlas for infiltration analysis. Results Astrocytomas frequently infiltrated association and projection white matter pathways within fronto‐temporo‐insular regions on the left side. Oligodendrogliomas infiltrated larger white matter networks (association‐commissural‐projection) of the frontal lobe bilaterally. A critical number of infiltrated BG voxels (7 for astrocytomas, 10 for oligodendrogliomas) significantly predicted shorter overall survival (OS) in both groups. Bilateral tumor extension in astrocytomas and preoperative tumor volume in oligodendrogliomas were independent prognostic factors for shorter OS. Conclusions Astrocytomas and oligodendrogliomas differ in preferential location, and this has an impact on the type and the extent of white matter involvement. The number of BG voxels infiltrated reflected different tumor invasiveness and its impact on OS in both groups. All this new information may be valuable in neurosurgical oncology to classify and plan treatment for patients with diffuse gliomas.
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Affiliation(s)
- Francesco Latini
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Markus Fahlström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Göran Hesselager
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Maria Zetterling
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mats Ryttlefors
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
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6
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Skjulsvik AJ, Bø HK, Jakola AS, Berntsen EM, Bø LE, Reinertsen I, Myrmel KS, Sjåvik K, Åberg K, Berg T, Dai HY, Kloster R, Torp SH, Solheim O. Is the anatomical distribution of low-grade gliomas linked to regions of gliogenesis? J Neurooncol 2020; 147:147-157. [PMID: 31983026 PMCID: PMC7075820 DOI: 10.1007/s11060-020-03409-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/20/2020] [Indexed: 12/02/2022]
Abstract
INTRODUCTION According to the stem cell theory, two neurogenic niches in the adult human brain may harbor cells that initiate the formation of gliomas: The larger subventricular zone (SVZ) and the subgranular zone (SGZ) in the hippocampus. We wanted to explore whether defining molecular markers in low-grade gliomas (LGG; WHO grade II) are related to distance to the neurogenic niches. METHODS Patients treated at two Norwegian university hospitals with population-based referral were included. Eligible patients had histopathological verified supratentorial low-grade glioma. IDH mutational status and 1p19q co-deletion status was retrospectively assessed. 159 patients were included, and semi-automatic tumor segmentation was done from pre-treatment T2-weighted (T2W) or Fluid-Attenuated Inversion Recovery (FLAIR) images. 3D maps showing the anatomical distribution of the tumors were then created for each of the three molecular subtypes (IDH mutated/1p19q co-deleted, IDH mutated and IDH wild-type). Both distance from tumor center and tumor border to the neurogenic niches were recorded. RESULTS In this population-based cohort of previously untreated low-grade gliomas, we found that low-grade gliomas are more often found closer to the SVZ than the SGZ, but IDH wild-type tumors are more often found near SGZ. CONCLUSION Our study suggests that the stem cell origin of IDH wild-type and IDH mutated low-grade gliomas may be different.
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Affiliation(s)
- Anne Jarstein Skjulsvik
- Department of Pathology, St. Olavs University Hospital, Trondheim, Norway
- Departments of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Hans Kristian Bø
- Department of Diagnostic Imaging, Nordland Hospital Trust, Bodø, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Asgeir Store Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neuroscience and Movement Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Erik Magnus Berntsen
- Department of Circulation and Medical Imaging, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Radiology and Nuclear Medicine, St. Olavs University Hospital, Olav Kyrres Gate, 7006 Trondheim, Norway
| | - Lars Eirik Bø
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | | | | | - Kristin Sjåvik
- Department of Neurosurgery, University Hospital of North Norway, Tromsö, Norway
| | - Kristin Åberg
- Department of Clinical Pathology, University Hospital of North Norway, Tromsö, Norway
| | - Thomas Berg
- Department of Clinical Pathology, University Hospital of North Norway, Tromsö, Norway
| | - Hong Yan Dai
- Department of Pathology, St. Olavs University Hospital, Trondheim, Norway
| | - Roar Kloster
- Department of Neurosurgery, University Hospital of North Norway, Tromsö, Norway
| | - Sverre Helge Torp
- Department of Pathology, St. Olavs University Hospital, Trondheim, Norway
- Departments of Clinical and Molecular Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs University Hospital, Olav Kyrres Gate, 7006 Trondheim, Norway
- Department of Neuroscience and Movement Medicine, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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8
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Wijnenga MMJ, van der Voort SR, French PJ, Klein S, Dubbink HJ, Dinjens WNM, Atmodimedjo PN, de Groot M, Kros JM, Schouten JW, Dirven CMF, Vincent AJPE, Smits M, van den Bent MJ. Differences in spatial distribution between WHO 2016 low-grade glioma molecular subgroups. Neurooncol Adv 2019; 1:vdz001. [PMID: 33889844 PMCID: PMC8051437 DOI: 10.1093/noajnl/vdz001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Several studies reported a correlation between anatomic location and genetic background of low-grade gliomas (LGGs). As such, tumor location may contribute to presurgical clinical decision-making. Our purpose was to visualize and compare the spatial distribution of different WHO 2016 gliomas, frequently aberrated single genes and DNA copy number alterations within subgroups, and groups of postoperative tumor volume. Methods Adult grade II glioma patients (WHO 2016 classified) diagnosed between 2003 and 2016 were included. Tumor volume and location were assessed with semi-automatic software. All volumes of interest were mapped to a standard reference brain. Location heatmaps were created for each WHO 2016 glioma subgroup, frequently aberrated single genes and copy numbers (CNVs), as well as heatmaps according to groups of postoperative tumor volume. Differences between subgroups were determined using voxelwise permutation testing. Results A total of 110 IDH mutated astrocytoma patients, 92 IDH mutated and 1p19q co-deleted oligodendroglioma patients, and 22 IDH wild-type astrocytoma patients were included. We identified small regions in which specific molecular subtypes occurred more frequently. IDH-mutated LGGs were more frequently located in the frontal lobes and IDH wild-type tumors more frequently in the basal ganglia of the right hemisphere. We found no localizations of significant difference for single genes/CNVs in subgroups, except for loss of 9p in oligodendrogliomas with a predilection for the left parietal lobes. More extensive resections in LGG were associated with frontal locations. Conclusions WHO low-grade glioma subgroups show differences in spatial distribution. Our data may contribute to presurgical clinical decision-making in LGG patients.
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Affiliation(s)
- Maarten M J Wijnenga
- Department of Neurology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Pim J French
- Department of Neurology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Winand N M Dinjens
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Peggy N Atmodimedjo
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marius de Groot
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - Johan M Kros
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost W Schouten
- Department of Neurosurgery, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neurology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Deshpande RP, Y B V K C, Panigrahi M, Babu PP. Prognostic Significance of Anatomic Origin and Evaluation of Survival Statistics of Astrocytoma Patients-a Tertiary Experience. Indian J Surg Oncol 2018; 10:55-60. [PMID: 30948873 DOI: 10.1007/s13193-018-0820-0] [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] [Received: 04/24/2018] [Accepted: 10/17/2018] [Indexed: 11/30/2022] Open
Abstract
Astrocytoma constitutes the most noted malignancies of the central nervous system with worse clinical outcomes in grade IV astrocytoma or glioblastoma multiforme. Owing to poor clinical outcomes with existing therapeutic regime, there is a need to revisit the initial course of treatment. Statistical information of clinicopathological parameters could be used to understand the spread of disease and, in turn, to formulate updated treatment management. In the present study, we have seen anatomic distribution of astrocytoma subtypes in a group of 479 patients and correlated it with survival outcomes. Anatomic location was confirmed by MRI (magnetic resonance imaging) images. A registry of patients was maintained with clinicopathological details as tumor type, location, age/sex, and survival after surgery. We have observed overall survival particulars in patients diagnosed with astrocytoma. Our findings highlight that in total cases, tumor location was anatomically dominated by frontal and temporal lobes. Survival analysis in high-grade (grade III, p = 0.03; grade IV, p = 0.01) astrocytic tumors confirms poor outcomes with temporal, parietal, and occipital location as compared to frontal lobe. Overall survival study demonstrates glioblastoma multiforme (GBM) was associated with worse prognosis as compared to astrocytoma subtypes (p < 0.0001). In high-grade astrocytomas, anaplastic astrocytoma was found with 34 months of median survival age while 14 months in the case of patients with glioblastoma multiforme. In conclusion, we report dismal prognosis in parietal, temporal, and occipital lobes in grade II, grade III, and grade IV astrocytoma patients. Among astrocytoma subtypes, patients with glioblastoma multiforme were associated with worse survival outcomes. We uniquely feature the survival of astrocytoma patients for the first time and observe GBM patients have slightly longer survival.
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Affiliation(s)
- Ravindra Pramod Deshpande
- 1Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana State 500046 India
| | | | - Manas Panigrahi
- 2Krishna Institute of Medical Sciences, Secunderabad, Telangana State India
| | - Phanithi Prakash Babu
- 1Department of Biotechnology and Bioinformatics, School of Life Sciences, University of Hyderabad, Hyderabad, Telangana State 500046 India
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Zetterling M, Berhane L, Alafuzoff I, Jakola AS, Smits A. Prognostic markers for survival in patients with oligodendroglial tumors; a single-institution review of 214 cases. PLoS One 2017; 12:e0188419. [PMID: 29186201 PMCID: PMC5706698 DOI: 10.1371/journal.pone.0188419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background In the 2016 WHO classification, the diagnosis of oligodendroglioma has been restricted to IDH mutated, 1p19q codeleted tumors (IDHmut-codel). IDHmut oligoastrocytoma is now classified either as oligodendroglioma or astrocytoma based on presence of 1p19q codeletion. There is growing evidence that this molecular classification more closely reflects patient outcome. Due to the strong association between IDHmut-codel with oligodendroglial morphology, the additional impact of these markers on prognostic accuracy is largely unknown. Our aim was to assess the prognostic impact of IDHmut-codel in an unselected cohort of morphologically classified oligodendroglial tumors. Methods We performed a retrospective chart review of oligodendroglial tumors (WHO grade II and III) operated since 1983. A total of 214 tumors were included, and molecular information was available for 96 tumors. The prognostic impact of IDHmut-codel together with clinical parameters was analyzed by multivariate Cox regression. Results IDHmut-codel was registered in 64 tumors while for 150 tumors the molecular profile was negative for IDHmut-codel, unknown or incomplete. Comparison between the two groups showed that patients with IDHmut-codel tumors were younger (42 vs. 48 years), had more frequent frontal tumor location (48 vs. 33%) and presented more often with seizures (72 vs. 51%) and no signs of neurological impairment (14 vs. 30%) than patients harboring tumors with unknown or incomplete molecular profile. Multivariate survival analysis identified young age (HR 1.78 ≥ 40 years), the absence of neurological deficits or personality changes (HR 0.57), frontal tumor location (HR 0.64) and the presence of IDHmut-codel (HR 0.50) as independent predictors for longer survival, whereas tumor grade was not. Conclusion In this unselected single-institution cohort, the presence of IDHmut-codel was associated with more beneficial clinical parameters and was identified as an independent prognostic factor. We conclude that the classical oligodendroglioma genotype provides additional prognostic data beyond clinical characteristics, morphology and tumor grade.
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Affiliation(s)
- Maria Zetterling
- Department of Neuroscience, Neurosurgery, Uppsala University, University Hospital, Uppsala, Sweden
- * E-mail:
| | - Luwam Berhane
- Department of Neuroscience, Neurology, Uppsala University, University Hospital, Uppsala, Sweden
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Experimental and clinical Oncology, Uppsala University, University Hospital, Uppsala, Sweden
| | - Asgeir S. Jakola
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Neurosurgery, St.Olavs Hospital, Trondheim, Norway
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University, University Hospital, Uppsala, Sweden
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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11
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Darlix A, Deverdun J, Menjot de Champfleur N, Castan F, Zouaoui S, Rigau V, Fabbro M, Yordanova Y, Le Bars E, Bauchet L, Gozé C, Duffau H. IDH mutation and 1p19q codeletion distinguish two radiological patterns of diffuse low-grade gliomas. J Neurooncol 2017; 133:37-45. [PMID: 28434111 DOI: 10.1007/s11060-017-2421-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 04/09/2017] [Indexed: 02/06/2023]
Abstract
Diffuse low-grade gliomas (DLGG) prognosis is variable, depending on several factors, including the isocitrate dehydrogenase (IDH) mutation and the 1p19q codeletion. A few studies suggested associations between these parameters and tumor radiological characteristics including topography. Our aim was analyzing the correlations between the IDH and 1p19q statuses and the tumor intracerebral distribution (at the lobar and voxel levels), volume, and borders. We conducted a retrospective, monocentric study on a consecutive series of 198 DLGG patients. The IDH and 1p19q statuses were recorded. The pre-treatment magnetic resonance FLAIR imagings were reviewed for determination of lobar topography, tumor volume, and characterisation of tumor borders (sharp or indistinct). We conducted a voxel-based lesion-symptom mapping analysis to investigate the correlations between the IDH and 1p19q statuses and topography at the voxel level. The IDH mutation and 1p19q statuses were correlated with the tumor topography defined using lobar anatomy (p < 0.001 and p = 0.004, respectively). Frontal tumors were more frequently IDH-mutant (87.1 vs. 57.4%) and 1p19q codeleted (45.2 vs. 17.0%) than temporo-insular lesions. At the voxel level, these associations were not found. Tumors with sharp borders were more frequently IDH-mutant (p = 0.001) while tumors with indistinct borders were more frequently IDH wild-type and 1p19q non-codeleted (p < 0.001). Larger tumors at diagnosis (possibly linked to a slower growth rate) were more frequently IDH-mutant (p < 0.001). IDH wild-type, 1p19q non-codeleted temporo-insular tumors are distinct from IDH-mutant, 1p19q codeleted frontal tumors. Further studies are needed to determine whether the therapeutic strategy should be adapted to each pattern.
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Affiliation(s)
- Amélie Darlix
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM) - Val d'Aurelle, 208 Rue des Apothicaires, 34298, Montpellier, France. .,INSERM U1051, Montpellier Neurosciences Institute, 80 Avenue Augustin Fliche, 34091, Montpellier, France.
| | - Jérémy Deverdun
- Department of Neuroradiology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | | | - Florence Castan
- Biometrics Unit, Institut Régional du Cancer de Montpellier (ICM) - Val d'Aurelle, 208 Rue des Apothicaires, 34298, Montpellier, France
| | - Sonia Zouaoui
- Department of Epidemiology, French Brain Tumor Database, GNOLR, Registre des Tumeurs de l'Hérault, Institut Régional du Cancer de Montpellier (ICM) - Val d'Aurelle, 208 Rue des Apothicaires, 34298, Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Valérie Rigau
- Department of Pathology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Michel Fabbro
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier (ICM) - Val d'Aurelle, 208 Rue des Apothicaires, 34298, Montpellier, France
| | - Yordanka Yordanova
- INSERM U1051, Montpellier Neurosciences Institute, 80 Avenue Augustin Fliche, 34091, Montpellier, France.,Department of Neurosurgery, Percy Military Hospital, 101 Avenue Henri Barbusse, 92140, Clamart, France
| | - Emmanuelle Le Bars
- Department of Neuroradiology, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Luc Bauchet
- INSERM U1051, Montpellier Neurosciences Institute, 80 Avenue Augustin Fliche, 34091, Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - Catherine Gozé
- INSERM U1051, Montpellier Neurosciences Institute, 80 Avenue Augustin Fliche, 34091, Montpellier, France.,Laboratory of Cellular and Tumoral Biology, Biopathology Department, Arnaud de Villeneuve Hospital, 371 Avenue du Doyen Gaston Giraud, 34090, Montpellier, France
| | - Hugues Duffau
- INSERM U1051, Montpellier Neurosciences Institute, 80 Avenue Augustin Fliche, 34091, Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, 80 Avenue Augustin Fliche, 34090, Montpellier, France
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12
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Johnson DR, Diehn FE, Giannini C, Jenkins RB, Jenkins SM, Parney IF, Kaufmann TJ. Genetically Defined Oligodendroglioma Is Characterized by Indistinct Tumor Borders at MRI. AJNR Am J Neuroradiol 2017; 38:678-684. [PMID: 28126746 DOI: 10.3174/ajnr.a5070] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/10/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In 2016, the World Health Organization revised the brain tumor classification, making IDH mutation and 1p/19q codeletion the defining features of oligodendroglioma. To determine whether imaging characteristics previously associated with oligodendroglial tumors are still applicable, we evaluated the MR imaging features of genetically defined oligodendrogliomas. MATERIALS AND METHODS One hundred forty-eight adult patients with untreated World Health Organization grade II and III infiltrating gliomas with histologic oligodendroglial morphology, known 1p/19q status, and at least 1 preoperative MR imaging were retrospectively identified. The association of 1p/19q codeletion with tumor imaging characteristics and ADC values was evaluated. RESULTS Ninety of 148 (61%) patients had 1p/19q codeleted tumors, corresponding to genetically defined oligodendroglioma, and 58/148 (39%) did not show 1p/19q codeletion, corresponding to astrocytic tumors. Eighty-three of 90 (92%) genetically defined oligodendrogliomas had noncircumscribed borders, compared with 26/58 (45%) non-1p/19q codeleted tumors with at least partial histologic oligodendroglial morphology (P < .0001). Eighty-nine of 90 (99%) oligodendrogliomas were heterogeneous on T1- and/or T2-weighted imaging. In patients with available ADC values, a lower mean ADC value predicted 1p/19q codeletion (P = .0005). CONCLUSIONS Imaging characteristics of World Health Organization 2016 genetically defined oligodendrogliomas differ from the previously considered characteristics of morphologically defined oligodendrogliomas. We found that genetically defined oligodendrogliomas were commonly poorly circumscribed and were almost always heterogeneous in signal intensity.
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Affiliation(s)
- D R Johnson
- From the Departments of Radiology (D.R.J., F.E.D., T.J.K.)
| | - F E Diehn
- From the Departments of Radiology (D.R.J., F.E.D., T.J.K.)
| | | | | | | | - I F Parney
- Neurosurgery (I.F.P.), Mayo Clinic, Rochester, Minnesota
| | - T J Kaufmann
- From the Departments of Radiology (D.R.J., F.E.D., T.J.K.)
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13
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The etiopathogenesis of diffuse low-grade gliomas. Crit Rev Oncol Hematol 2016; 109:51-62. [PMID: 28010898 DOI: 10.1016/j.critrevonc.2016.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022] Open
Abstract
The origins of diffuse low-grade gliomas (DLGG) are unknown. Beyond some limited data on their temporal and cellular origins, the mechanisms and risk factors involved are poorly known. First, based on strong relationships between DLGG development and the eloquence of brain regions frequently invaded by these tumors, we propose a "functional theory" to explain the origin of DLGG. Second, the biological pathways involved in DLGG genesis may differ according to tumor location (anatomo-molecular correlations). The cellular and molecular mechanisms of such "molecular theory" will be reviewed. Third, the geographical distribution of diffuse WHO grade II-III gliomas within populations is heterogeneous, suggesting possible environmental risk factors. We will discuss this "environmental theory". Finally, we will summarize the current knowledge on genetic susceptibility in gliomas ("genetic predisposition theory"). These crucial issues illustrate the close relationships between the pathophysiology of gliomagenesis, the anatomo-functional organization of the brain, and personalized management of DLGG patients.
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14
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Iwadate Y, Shinozaki N, Matsutani T, Uchino Y, Saeki N. Molecular imaging of 1p/19q deletion in oligodendroglial tumours with 11C-methionine positron emission tomography. J Neurol Neurosurg Psychiatry 2016; 87:1016-21. [PMID: 26848169 PMCID: PMC5013113 DOI: 10.1136/jnnp-2015-311516] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/30/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chromosome 1p/19q deletion is an established prognostic and predictive marker in the WHO grade III oligodendroglial tumours (OT). To estimate the genetic status preoperatively, the authors investigated the correlation between the uptake of (11)C-methionine in positron emission tomography (PET) and the 1p/19q status in grades II and III OT. METHODS We retrospectively reviewed 144 patients with gliomas who received (11)C-methionine PET. 66 cases with grades II-III oligodendrogliomas or oligoastrocytomas underwent fluorescence in situ hybridisation to determine the 1p/19q status. The tissue uptake of (11)C-methionine was expressed as the ratio of the maximum standardised uptake value (SUVmax) in tumour areas to the mean SUV (SUVmean) in the contralateral normal brain (tumour-to-normal tissue (T/N) ratio). RESULTS The T/N ratio in (11)C-methionine PET was significantly higher in grade III OT than in grade II tumours. The mean T/N ratio of the grade II tumours without 1p/19q deletion was significantly higher than that of the grade II tumours with 1p/19q deletion (mean 2.67 vs 1.94, respectively; p=0.0457). In grade III tumours, the mean T/N ratio of the tumours without 1p/19q deletion was also significantly higher than that of the tumours with 1p/19q deletion (mean 4.83 vs 3.49, respectively; p=0.0261). The rate of IDH1 mutation was lower and the rate of contrast enhancement on MRIs was higher in the 1p/19q non-deleted OT than those with 1p/19q deletion, which may contribute to the high T/N ratio. CONCLUSIONS Among suspected OT, (11)C-methionine PET may help us preoperatively discriminate tumours with and without 1p/19q deletion.
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Affiliation(s)
- Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Natsuki Shinozaki
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan Department of Neurosurgery, Narita Red-Cross Hospital, Chiba, Japan
| | - Tomoo Matsutani
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Uchino
- Chiba Medical Center for Prolonged Traumatic Brain Dysfunction, Chiba, Japan National Institute of Radiological Science, Chiba, Japan
| | - Naokatsu Saeki
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
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15
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Zetterling M, Roodakker KR, Berntsson SG, Edqvist PH, Latini F, Landtblom AM, Pontén F, Alafuzoff I, Larsson EM, Smits A. Extension of diffuse low-grade gliomas beyond radiological borders as shown by the coregistration of histopathological and magnetic resonance imaging data. J Neurosurg 2016; 125:1155-1166. [PMID: 26918468 DOI: 10.3171/2015.10.jns15583] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Magnetic resonance imaging tends to underestimate the extent of diffuse low-grade gliomas (DLGGs). With the aim of studying the presence of tumor cells outside the radiological border, the authors developed a method of correlating MRI findings with histological data in patients with suspected DLGGs in whom en bloc resections were performed. METHODS Five patients with suspected DLGG suitable for en bloc resection were recruited from an ongoing prospective study. Sections of the entire tumor were immunostained with antibodies against mutated IDH1 protein (IDH1-R132H). Magnetic resonance images were coregistered with corresponding IDH1 images. The growth pattern of tumor cells in white and gray matter was assessed in comparison with signal changes on corresponding MRI slices. RESULTS Neuropathological assessment revealed DLGG in 4 patients and progression to WHO Grade III glioma in 1 patient. The tumor core consisted of a high density of IDH1-R132H-positive tumor cells and was located in both gray and white matter. Tumor cells infiltrated along the peripheral fibers of the white matter tracts. In all cases, tumor cells were found outside the radiological tumor border delineated on T2-FLAIR MRI sequences. CONCLUSIONS The authors present a new method for the coregistration of histological and radiological characteristics of en bloc-removed infiltrative brain tumors that discloses tumor invasion at the radiological tumor borders. This technique can be applied to evaluate the sensitivity of alternative imaging methods to detect scattered tumor cells at tumor borders. Accurate methods for detection of infiltrative tumor cells will improve the possibility of performing radical tumor resection. In future studies, the method could also be used for in vivo studies of tumor invasion.
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Affiliation(s)
- Maria Zetterling
- Department of Neuroscience, Neurosurgery, Uppsala University.,Department of Neurosurgery, Uppsala University Hospital
| | | | - Shala Ghaderi Berntsson
- Department of Neuroscience, Neurology, Uppsala University.,Department of Neurology, Uppsala University Hospital
| | - Per-Henrik Edqvist
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University
| | | | - Anne-Marie Landtblom
- Department of Neuroscience, Neurology, Uppsala University.,Department of Neurology, Uppsala University Hospital.,Center for Medical Image Science and Visualization, Linköpings University, Linköping, Sweden; and
| | - Fredrik Pontén
- Department of Immunology, Genetics and Pathology and Science for Life Laboratory, Uppsala University
| | - Irina Alafuzoff
- Department of Immunology, Genetics and Pathology, Uppsala University.,Department of Pathology and Cytology, Uppsala University Hospital
| | - Elna-Marie Larsson
- Department of Surgical Sciences, Radiology, Uppsala University.,Department of Radiology, Uppsala University Hospital, Uppsala
| | - Anja Smits
- Department of Neuroscience, Neurology, Uppsala University.,Department of Neurology, Uppsala University Hospital.,Danish Epilepsy Center, Dianalund, Denmark
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16
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Identifying the association between contrast enhancement pattern, surgical resection, and prognosis in anaplastic glioma patients. Neuroradiology 2016; 58:367-74. [PMID: 26795126 DOI: 10.1007/s00234-016-1640-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Contrast enhancement observable on magnetic resonance (MR) images reflects the destructive features of malignant gliomas. This study aimed to investigate the relationship between radiologic patterns of tumor enhancement, extent of resection, and prognosis in patients with anaplastic gliomas (AGs). METHODS Clinical data from 268 patients with histologically confirmed AGs were retrospectively analyzed. Contrast enhancement patterns were classified based on preoperative T1-contrast MR images. Univariate and multivariate analyses were performed to evaluate the prognostic value of MR enhancement patterns on progression-free survival (PFS) and overall survival (OS). RESULTS The pattern of tumor contrast enhancement was associated with the extent of surgical resection in AGs. A gross total resection was more likely to be achieved for AGs with focal enhancement than those with diffuse (p = 0.001) or ring-like (p = 0.024) enhancement. Additionally, patients with focal-enhanced AGs had a significantly longer PFS and OS than those with diffuse (log-rank, p = 0.025 and p = 0.031, respectively) or ring-like (log-rank, p = 0.008 and p = 0.011, respectively) enhanced AGs. Furthermore, multivariate analysis identified the pattern of tumor enhancement as a significant predictor of PFS (p = 0.016, hazard ratio [HR] = 1.485) and OS (p = 0.030, HR = 1.446). CONCLUSION Our results suggested that the contrast enhancement pattern on preoperative MR images was associated with the extent of resection and predictive of survival outcomes in AG patients.
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17
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Parisot S, Darlix A, Baumann C, Zouaoui S, Yordanova Y, Blonski M, Rigau V, Chemouny S, Taillandier L, Bauchet L, Duffau H, Paragios N. A Probabilistic Atlas of Diffuse WHO Grade II Glioma Locations in the Brain. PLoS One 2016; 11:e0144200. [PMID: 26751577 PMCID: PMC4709135 DOI: 10.1371/journal.pone.0144200] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/13/2015] [Indexed: 11/18/2022] Open
Abstract
Diffuse WHO grade II gliomas are diffusively infiltrative brain tumors characterized by an unavoidable anaplastic transformation. Their management is strongly dependent on their location in the brain due to interactions with functional regions and potential differences in molecular biology. In this paper, we present the construction of a probabilistic atlas mapping the preferential locations of diffuse WHO grade II gliomas in the brain. This is carried out through a sparse graph whose nodes correspond to clusters of tumors clustered together based on their spatial proximity. The interest of such an atlas is illustrated via two applications. The first one correlates tumor location with the patient's age via a statistical analysis, highlighting the interest of the atlas for studying the origins and behavior of the tumors. The second exploits the fact that the tumors have preferential locations for automatic segmentation. Through a coupled decomposed Markov Random Field model, the atlas guides the segmentation process, and characterizes which preferential location the tumor belongs to and consequently which behavior it could be associated to. Leave-one-out cross validation experiments on a large database highlight the robustness of the graph, and yield promising segmentation results.
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Affiliation(s)
- Sarah Parisot
- Center for Visual Computing, Ecole Centrale Paris, Chatenay Malabry, France
- INRIA, Galen Team, Saclay-Ile-de-France Center, Chatenay Malabry, France
- Intrasense SAS, Montpellier, France
| | - Amélie Darlix
- INSERM U1051, Montpellier Neurosciences Institute, University Hospital, Montpellier, France
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
| | - Cédric Baumann
- Department of Clinical Epidemiology and Evaluation, University Hospital, Nancy, France
| | - Sonia Zouaoui
- Department of Epidemiology, Groupe de Neuro-Oncologie du Languedoc-Roussillon, Registre des Tumeurs de l’Hérault, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
| | | | - Marie Blonski
- Neuro-oncology Unit, Department of Neurology, University Hospital, Hôpital Central, Nancy, France
| | - Valérie Rigau
- Department of Pathology, University Hospital, Hôpital Gui de Chauliac, Montpellier, France
| | | | - Luc Taillandier
- Neuro-oncology Unit, Department of Neurology, University Hospital, Hôpital Central, Nancy, France
| | - Luc Bauchet
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
- Department of Neurosurgery, University Hospital, Hôpital Gui de Chauliac, Montpellier, France
| | - Hugues Duffau
- Department of Medical Oncology, Institut Régional du Cancer de Montpellier - Val d’Aurelle, Montpellier, France
- Department of Neurosurgery, University Hospital, Hôpital Gui de Chauliac, Montpellier, France
| | - Nikos Paragios
- Center for Visual Computing, Ecole Centrale Paris, Chatenay Malabry, France
- INRIA, Galen Team, Saclay-Ile-de-France Center, Chatenay Malabry, France
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18
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TERT promoter mutations in primary central nervous system lymphoma are associated with spatial distribution in the splenium. Acta Neuropathol 2015. [PMID: 26195323 DOI: 10.1007/s00401-015-1461-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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19
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Oslobanu A, Florian S. Anatomic locations in high grade glioma. ROMANIAN NEUROSURGERY 2015. [DOI: 10.1515/romneu-2015-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The treatment options and prognosis in gliomas could be determined by anatomic topographic location, beside different subtypes of glioma. The aim of this study is to find if any correlation between anatomical location of a glioma and the different subtypes of high grade glioma exist, and if this differences exists, does this influence the treatment options in terms of surgery. To do this, a representative group of 318 adults with high grade glioma was used. The most frequent subtypes of high grade glioma were glioblastoma (76,1%) followed by anaplastic astrocytomas (19,1%), anaplastic oligodendrogliomas (2,2), anaplastic ependymomas (1,2%), anaplastic oligoastrocytomas (0,9%), and anaplastic oligoastrocyomas (0,3%). The most frequent locations of gliomas were in the right frontal lobe in 11,95% of the cases, followed by left frontal in 9,12%, left temporal in 9,12%, right parietal in 8,18%, left parietal in 6,60%, right temporal in 5,66% for one lobe location. For multiple lobe locations the left fronto-parietal and left temporo-parietal (5,03%) were the most frequent locations. Deep-seated locations were present in 1,56% of the cases, and brain stem location was in 3,46%. No significant difference was observed between left or right predominence. Regarding the results among different subtypes of high grade glioma we noted that the anaplastic astrocytomas were more frequently located at the right frontal lobe in 18,03% compare to left frontal and left parietal lobe in 9,83%. In glioblastoma we found no significant differences in anatomical location as seen in anaplastic astrocytomas. These data results from our study could affect the therapeutic strategy regarding the extent of tumors resection.
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20
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Wang YY, Wang K, Li SW, Wang JF, Ma J, Jiang T, Dai JP. Patterns of Tumor Contrast Enhancement Predict the Prognosis of Anaplastic Gliomas with IDH1 Mutation. AJNR Am J Neuroradiol 2015; 36:2023-9. [PMID: 26316565 DOI: 10.3174/ajnr.a4407] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE It is proposed that isocitrate dehydrogenase 1 (IDH1) mutation predicts the outcome in patients with high-grade glioma. In addition, contrast enhancement on preoperative MR imaging reflects tumor biologic features. Patients with anaplastic glioma with the IDH1 mutation were evaluated by using MR imaging to determine whether tumor enhancement is a prognostic factor and can be used to predict survival. MATERIALS AND METHODS A cohort of 216 patients with histologically confirmed anaplastic glioma was reviewed retrospectively. Tumor contrast-enhancement patterns were classified on the basis of preoperative T1 contrast MR images. Tumor IDH1 status was examined by using RNA sequencing. We used univariate analysis and the multivariate Cox model to evaluate the prognostic value of the IDH1 mutation and tumor contrast-enhancement pattern for progression-free survival and overall survival. RESULTS In all 216 patients, IDH1 mutation was associated with longer progression-free survival (P = .004, hazard ratio = 0.439) and overall survival (P = .002, hazard ratio = 0.406). For patients with IDH1 mutant anaplastic glioma, the absence of contrast enhancement was associated with longer progression-free survival (P = .038, hazard ratio = 0.473) and overall survival (P = .043, hazard ratio = 0.436). Furthermore, we were able to stratify the progression-free survival and overall survival of patients with IDH1 mutation by using the tumor contrast-enhancement patterns (P = .022 and 0.029, respectively; log-rank). CONCLUSIONS Tumor enhancement on postcontrast MR imaging is a valuable prognostic factor for patients with anaplastic glioma and IDH1 mutation. Furthermore, the contrast-enhancement patterns could potentially be used to stratify the survival outcome of such patients.
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Affiliation(s)
- Y Y Wang
- From the Departments of Neurosurgery (Y.Y.W., J.F.W., T.J.) Beijing Neurosurgical Institute (Y.Y.W., T.J., J.P.D.), Capital Medical University, Beijing, China
| | - K Wang
- Neuroradiology (K.W., S.W.L., J.M., J.P.D.), Beijing Tian Tan Hospital
| | - S W Li
- Neuroradiology (K.W., S.W.L., J.M., J.P.D.), Beijing Tian Tan Hospital
| | - J F Wang
- From the Departments of Neurosurgery (Y.Y.W., J.F.W., T.J.)
| | - J Ma
- Neuroradiology (K.W., S.W.L., J.M., J.P.D.), Beijing Tian Tan Hospital
| | - T Jiang
- From the Departments of Neurosurgery (Y.Y.W., J.F.W., T.J.) Beijing Neurosurgical Institute (Y.Y.W., T.J., J.P.D.), Capital Medical University, Beijing, China Center for Brain Tumor (T.J.), Beijing Institute for Brain Disorders, Beijing, China.
| | - J P Dai
- Neuroradiology (K.W., S.W.L., J.M., J.P.D.), Beijing Tian Tan Hospital Beijing Neurosurgical Institute (Y.Y.W., T.J., J.P.D.), Capital Medical University, Beijing, China
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21
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Alentorn A, Duran-Peña A, Pingle SC, Piccioni DE, Idbaih A, Kesari S. Molecular profiling of gliomas: potential therapeutic implications. Expert Rev Anticancer Ther 2015; 15:955-62. [PMID: 26118895 DOI: 10.1586/14737140.2015.1062368] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gliomas are the most common primary malignant brain tumor. Over the last decade, significant advances have been made in the molecular characterization of this tumor group, identifying predictive biomarkers or molecular actionable targets, and paving the way to molecular-based targeted therapies. This personalized therapeutic approach is effective and illustrated in the present review. Among many molecular abnormalities, BRAF mutation and mTOR activation in pilocytic astrocytomas and subependymal giant cell astrocytomas are actionable targets sensitive to vemurafenib and everolimus, respectively. Chromosome arms 1p/19q co-deletion and IDH mutational status are pivotal in driving delivery of early procarbazine, lomustine and vincristine chemotherapy in anaplastic oligodendroglial tumors. Although consensus to assess MGMT promoter methylation is not reached yet, it may be useful in predicting resistance to temozolomide in elderly patients.
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Affiliation(s)
- Agusti Alentorn
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de neurologie 2-Mazarin, Paris, France
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22
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Cordier D, Gozé C, Schädelin S, Rigau V, Mariani L, Duffau H. A better surgical resectability of WHO grade II gliomas is independent of favorable molecular markers. J Neurooncol 2014; 121:185-93. [PMID: 25261925 DOI: 10.1007/s11060-014-1623-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/21/2014] [Indexed: 12/23/2022]
Abstract
A higher extent of resection (EOR) in WHO grade II gliomas (GIIG) is correlated with longer survival. However, the molecular markers also feature prognostic relevance. Here, we examined whether maximal EOR was related to the genetic profile. We retrospectively investigated the predictive value of 1p19q, IDH1, 53 expression and Ki67 index for the EOR in 200 consecutive GIIGs (2007-2013). Data were modeled in a linear model. The analysis was performed with two statistical methods (arcsin-sqrt and Beta-regression model with logit link). There was no deletion 1p19q in 118 cases, codeletion 1p19q (57 cases), single deletion 1p (4 cases) or19q (16 cases). 155 patients had a mutation of IDH1. p53 was graded in 4 degrees (0:92 cases, 1:52 cases, 2:31 cases, 3:8 cases). Mean Ki67 index was 5.2 % (range 1-20 %). Mean preoperative tumor volume was 60.8 cm(3) (range 3.3-250 cm(3)) and mean EOR was 0.917 (range 0.574-1). The statistical analysis was significant for a lower EOR in patients with codeletion 1p19q (OR 0.738, p = 0.0463) and with a single deletion 19q (OR 0.641, p = 0.0168). There was no significant correlation between IDH1 or p53 and the EOR. Higher Ki67 was marginally associated with higher EOR (p = 0.0603). The study demonstrates in a large cohort of GIIG that a higher EOR is not attributable to favorable genetic markers. This original result supports maximal surgical resection as an important therapeutic factor per se to optimize prognosis, independently of the molecular pattern.
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Affiliation(s)
- Dominik Cordier
- Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 Av Augustin Fliche, 34295, Montpellier, France
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Abstract
Oligodendrogliomas are an important adult form of diffuse gliomas with a distinctive clinical and genetic profile. Histologically similar tumors occurring rarely in children are incompletely characterized. We studied 50 patients with oligodendrogliomas (median age at diagnosis 8 y, range 7 mo to 20 y). Tumors resembling dysembryoplastic neuroepithelial tumors or pilocytic astrocytomas or those having a "mixed" histology were excluded. Tumors at first diagnosis were low grade (n=38) or anaplastic (n=12). Histologic features included uniform round cells with perinuclear halos (100%), secondary structures (predominantly perineuronal satellitosis) (90%), calcifications (46%), and microcysts (44%). Sequential surgical specimens were obtained in 8 low-grade oligodendroglioma patients, with only 1 progressing to anaplasia. Studies for 1p19q performed in 40 cases demonstrated intact 1p19q loci in 29 (73%), 1p19q codeletion in 10 (25%), and 1p deletion with intact 19q in 1 (2%). Except for 2 young patients (3 and 11 y of age), patients with 1p19q codeletion were older than 16 years at diagnosis. Mutant IDH1 (R132H) protein immunohistochemistry was positive in 4 (of 22) (18%) cases, 3 of which also had 1p19q codeletion, whereas 1p19q status was not available on the fourth case. There was a nonsignificant trend for worse overall survival in grade III tumors, but no significant association with age, extent of resection, or 1p19q status. In summary, oligodendrogliomas with classic histology occur in the pediatric population but lack 1p19q codeletion and IDH1 (R132H) mutations in most instances. They are predominantly low grade, recur/clinically progress in a subset, but demonstrate a relatively low frequency of histologic progression.
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Qi S, Yu L, Li H, Ou Y, Qiu X, Ding Y, Han H, Zhang X. Isocitrate dehydrogenase mutation is associated with tumor location and magnetic resonance imaging characteristics in astrocytic neoplasms. Oncol Lett 2014; 7:1895-1902. [PMID: 24932255 PMCID: PMC4049752 DOI: 10.3892/ol.2014.2013] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/11/2014] [Indexed: 01/08/2023] Open
Abstract
The molecular subsets of glioma behave in biologically distinct ways. The present study detected isocitrate dehydrogenase (IDH) 1 and IDH2 mutations in glioma to analyze whether IDH-mutated gliomas are situated in certain preferential areas and to investigate their correlation with magnetic resonance imaging (MRI) characteristics. A series of 193 patients with astrocytic neoplasms (111 diffuse and 82 anaplastic astrocytomas), grouped according to prelabeled anatomical structures and the risk of surgery, were retrospectively reviewed for IDH1 and IDH2 mutations to compare the tumor location and MRI features. A total of 111 IDH1 mutations at codon 132 (57.5%) and six IDH2 mutations at codon 172 (3.1%) were detected. The IDH1/2 mutations were found to predict longer survival, independent of the histological type in this series of patients. The IDH-mutated gliomas were predominantly located in a single lobe, such as the frontal lobe, temporal lobe or cerebellum and rarely in the diencephalon or brain stem. Furthermore, according to the risk of surgery, the IDH-mutated tumors were rarely located in the high-risk regions of the brain, where surgery exhibits a high mortality rate intraoperatively and postoperatively. In addition, gliomas with IDH mutations were significantly more likely to exhibit a unilateral pattern of growth, sharp tumor margins, homogeneous signal intensity and less contrast enhancement on MRI. The results of the current study suggested that the prolonged survival of patients with IDH-mutated gliomas is primarily due to a less aggressive biological behavior according to tumor site and MRI features.
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Affiliation(s)
- Songtao Qi
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Lei Yu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Hezhen Li
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yanghui Ou
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xiaoyu Qiu
- Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yanqing Ding
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Huixia Han
- Department of Pathology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xuelin Zhang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Nishiyama Y, Sasaki H, Nagahisa S, Adachi K, Hayashi T, Yoshida K, Kawase T, Hattori N, Murayama K, Abe M, Hasegawa M, Hirose Y. Radiological features of supratentorial gliomas are associated with their genetic aberrations. Neurosurg Rev 2013; 37:291-9; discussion 299-300. [DOI: 10.1007/s10143-013-0515-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 07/28/2013] [Indexed: 01/04/2023]
Affiliation(s)
- Yuya Nishiyama
- Department of Neurosurgery, School of Medicine, Fujita Health University, Toyoake, Japan,
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Reyes-Botero G, Dehais C, Idbaih A, Martin-Duverneuil N, Lahutte M, Carpentier C, Letouzé E, Chinot O, Loiseau H, Honnorat J, Ramirez C, Moyal E, Figarella-Branger D, Ducray F. Contrast enhancement in 1p/19q-codeleted anaplastic oligodendrogliomas is associated with 9p loss, genomic instability, and angiogenic gene expression. Neuro Oncol 2013; 16:662-70. [PMID: 24353325 DOI: 10.1093/neuonc/not235] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aim of this study was to correlate MRI features and molecular characteristics in anaplastic oligodendrogliomas (AOs). METHODS The MRI characteristics of 50 AO patients enrolled in the French national network for high-grade oligodendroglial tumors were analyzed. The genomic profiles and IDH mutational statuses were assessed using high-resolution single-nucleotide polymorphism arrays and direct sequencing, respectively. The gene expression profiles of 25 1p/19q-codeleted AOs were studied on Affymetrix expression arrays. RESULTS Most of the cases were frontal lobe contrast-enhanced tumors (52%), but the radiological presentations of these cases were heterogeneous, ranging from low-grade glioma-like aspects (26%) to glioblastoma-like aspects (22%). The 1p/19q codeletion (n = 39) was associated with locations in the frontal lobe (P = .001), with heterogeneous intratumoral signal intensities (P = .003) and with no or nonmeasurable contrast enhancements (P = .01). The IDH wild-type AOs (n = 7) more frequently displayed ringlike contrast enhancements (P = .03) and were more frequently located outside of the frontal lobe (P = .01). However, no specific imaging pattern could be identified for the 1p/19q-codeleted AO or the IDH-mutated AO. Within the 1p/19q-codeleted AO, the contrast enhancement was associated with larger tumor volumes (P = .001), chromosome 9p loss and CDKN2A loss (P = .006), genomic instability (P = .03), and angiogenesis-related gene expression (P < .001), particularly for vascular endothelial growth factor A and angiopoietin 2. CONCLUSION In AOs, the 1p/19q codeletion and the IDH mutation are associated with preferential (but not with specific) imaging characteristics. Within 1p/19q-codeleted AO, imaging heterogeneity is related to additional molecular alterations, especially chromosome 9p loss, which is associated with contrast enhancement and larger tumor volume.
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Affiliation(s)
- German Reyes-Botero
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France (G.R.B., C.D., A.I.); Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière, Paris, France (A.I., C.C.); AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neuro-radiologie, Paris, France (N.M.-D.); Service de Santé des Armées, Hôpital d'Instruction des Armées, Paris, France (M.L.); Programme Carte d'Identité des Tumeurs, Ligue Nationale Contre le Cancer, Paris, France (E.L.); AP-HM, Hôpital de la Timone, Service de Neuro-Oncologie, Marseille , France (O.C.); CHU Bordeaux, Hôpital Pellegrin, Service de Neurochirurgie, Bordeaux, France (H.L.); Hospices Civils de Lyon, Hôpital Pierre Wertheimer, Service de Neuro-Oncologie, Bron, France (J.H., F.D.); INSERM U1028, CNRS UMR5292, Bron, France (J.H., F.D.); CHU Lille, Hôpital Roger Salengro, Clinique de Neurochirurgie, Lille, France (C.R.); Institut Claudius Regaud, Département de Radiothérapie, Toulouse, France (E.M.); AP-HM, Hôpital de la Timone, Service d'Anatomie Pathologique et de Neuropathologie, Marseille, France (D.F.-B.); Université de la Méditerranée, Aix-Marseille, Faculté de Médecine La Timone, Marseille, France (D.F.B.)
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Duffau H. The Rationale to Perform Early Resection in Incidental Diffuse Low-Grade Glioma: Toward a “Preventive Surgical Neurooncology”. World Neurosurg 2013; 80:e115-7. [DOI: 10.1016/j.wneu.2012.06.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 06/21/2012] [Indexed: 12/27/2022]
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Capelle L, Fontaine D, Mandonnet E, Taillandier L, Golmard JL, Bauchet L, Pallud J, Peruzzi P, Baron MH, Kujas M, Guyotat J, Guillevin R, Frenay M, Taillibert S, Colin P, Rigau V, Vandenbos F, Pinelli C, Duffau H, _ _. Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases. J Neurosurg 2013; 118:1157-68. [PMID: 23495881 DOI: 10.3171/2013.1.jns121] [Citation(s) in RCA: 276] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The spontaneous prognostic factors and optimal therapeutic strategy for WHO Grade II gliomas (GIIGs) have yet to be unanimously defined. Specifically, the role of resection is still debated, most notably because the actual amount of resection has seldom been assessed.
Methods
Cases of GIIGs treated before December 2007 were extracted from a multicenter database retrospectively collected since January 1985 and prospectively collected since 1996. Inclusion criteria were a patient age ≥ 18 years at diagnosis, histological diagnosis of WHO GIIG, and MRI evaluation of tumor volume at diagnosis and after initial surgery. One thousand ninety-seven lesions were included in the analysis. The mean follow-up was 7.4 years since radiological diagnosis. Factors significant in a univariate analysis (with a p value ≤ 0.1) were included in the multivariate Cox proportional hazard regression model analysis.
Results
At the time of radiological diagnosis, independent spontaneous factors of a poor prognosis were an age ≥ 55 years, an impaired functional status, a tumor location in a nonfrontal area, and, most of all, a larger tumor size. When the study starting point was set at the time of first treatment, independent favorable prognostic factors were limited to a smaller tumor size, an epileptic symptomatology, and a greater extent of resection.
Conclusions
This large series with its volumetric assessment refines the prognostic value of previously stressed clinical and radiological parameters and highlights the importance of tumor size and location. The results support additional arguments in favor of the predominant role of resection, in accordance with recently reported experiences.
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Affiliation(s)
| | | | | | | | | | | | - Johan Pallud
- 7Department of Neurosurgery, Centre Hospitalier Sainte-Anne, Paris
| | - Philippe Peruzzi
- 8Department of Neurosurgery, Centre Hospitalier Universitaire de Reims
| | - Marie Hélène Baron
- 9Department of Radiotherapy, Centre Hospitalier Universitaire de Besançon
| | | | - Jacques Guyotat
- 11Department of Neurosurgery, Centre Hospitalier Universitaire de Lyon
| | | | - Marc Frenay
- 13Centre Anti-Cancéreux Antoine Lacassagne, Nice; and
| | | | | | - Valérie Rigau
- 16Neuropathology, Centre Hospitalier Universitaire de Montpellier
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Gozé C, Mansour L, Rigau V, Duffau H. Distinct IDH1/IDH2 mutation profiles in purely insular versus paralimbic WHO Grade II gliomas. J Neurosurg 2013; 118:866-72. [PMID: 23330999 DOI: 10.3171/2012.11.jns121100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The molecular profile of diffuse WHO Grade II gliomas involving the insular lobe, with a possible impact on outcome, is controversial. The authors undertook this study to investigate a possible difference of molecular patterns between purely insular Grade II gliomas and paralimbic Grade II gliomas that involve both the insular lobe and the frontal and/or temporal structures. METHODS From a consecutive series of 47 patients who underwent resection of a Grade II glioma invading the insula, 2 subgroups were identified. The first subgroup included 11 patients with a purely insular tumor. The second subgroup included 36 patients with a paralimbic Grade II glioma also involving the frontal and/or temporal lobe. The authors searched systematically for TP53 mutations, 1p19q codeletion, and IDH1/IDH2 mutations. RESULTS There was no significant difference between the 2 subgroups with respect to 1p19q codeletion or TP53 mutations rates. Conversely, IDH1/IDH2 mutations were found in all 11 (100%) of the insular Grade II gliomas but only 20 (55%) of 36 paralimbic Grade II gliomas (p = 0.008). Ten (28%) of the 36 patients in the paralimbic tumor group experienced a malignant transformation, and 6 of them died; whereas neither transformation nor death occurred in the insular tumor group (trend toward significance, p = 0.088). CONCLUSIONS These findings demonstrate for the first time distinct IDH1/IDH2 and consequently distinct "triplenegative" patterns in purely insular versus paralimbic Grade II gliomas. Such findings could explain discrepancies reported in the literature, because insular and paralimbic gliomas have not been separated in previous reports. These results may enable physicians to refine the management of Grade II gliomas involving the insula according to the presence or lack of invasion of the frontal and/or temporal areas.
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Affiliation(s)
- Catherine Gozé
- Hormone and Cell Biology Laboratory, Hôpital Arnaud de Villeneuve, Montpellier University Medical Center, Montpellier, France.
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Abstract
Glioblastoma is the most frequent and malignant brain tumor. The vast majority of glioblastomas (~90%) develop rapidly de novo in elderly patients, without clinical or histologic evidence of a less malignant precursor lesion (primary glioblastomas). Secondary glioblastomas progress from low-grade diffuse astrocytoma or anaplastic astrocytoma. They manifest in younger patients, have a lesser degree of necrosis, are preferentially located in the frontal lobe, and carry a significantly better prognosis. Histologically, primary and secondary glioblastomas are largely indistinguishable, but they differ in their genetic and epigenetic profiles. Decisive genetic signposts of secondary glioblastoma are IDH1 mutations, which are absent in primary glioblastomas and which are associated with a hypermethylation phenotype. IDH1 mutations are the earliest detectable genetic alteration in precursor low-grade diffuse astrocytomas and in oligodendrogliomas, indicating that these tumors are derived from neural precursor cells that differ from those of primary glioblastomas. In this review, we summarize epidemiologic, clinical, histopathologic, genetic, and expression features of primary and secondary glioblastomas and the biologic consequences of IDH1 mutations. We conclude that this genetic alteration is a definitive diagnostic molecular marker of secondary glioblastomas and more reliable and objective than clinical criteria. Despite a similar histologic appearance, primary and secondary glioblastomas are distinct tumor entities that originate from different precursor cells and may require different therapeutic approaches.
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Affiliation(s)
- Hiroko Ohgaki
- Molecular Pathology Section, International Agency for Research on Cancer, Lyon, France.
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Walker C, Baborie A, Crooks D, Wilkins S, Jenkinson MD. Biology, genetics and imaging of glial cell tumours. Br J Radiol 2012; 84 Spec No 2:S90-106. [PMID: 22433833 DOI: 10.1259/bjr/23430927] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Despite advances in therapy, gliomas remain associated with poor prognosis. Clinical advances will be achieved through molecularly targeted biological therapies, for which knowledge of molecular genetic and gene expression characteristics in relation to histopathology and in vivo imaging are essential. Recent research supports the molecular classification of gliomas based on genetic alterations or gene expression profiles, and imaging data supports the concept that molecular subtypes of glioma may be distinguished through non-invasive anatomical, physiological and metabolic imaging techniques, suggesting differences in the baseline biology of genetic subtypes of infiltrating glioma. Furthermore, MRI signatures are now being associated with complex gene expression profiles and cellular signalling pathways through genome-wide microarray studies using samples obtained by image guidance which may be co-registered with clinical imaging. In this review we describe the pathobiology, molecular pathogenesis, stem cells and imaging characteristics of gliomas with emphasis on astrocytomas and oligodendroglial neoplasms.
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Affiliation(s)
- C Walker
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
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Keogh BP, Henson JW. Clinical Manifestations and Diagnostic Imaging of Brain Tumors. Hematol Oncol Clin North Am 2012; 26:733-55. [DOI: 10.1016/j.hoc.2012.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Duffau H. Awake surgery for incidental WHO grade II gliomas involving eloquent areas. Acta Neurochir (Wien) 2012; 154:575-84; discussion 584. [PMID: 22139145 DOI: 10.1007/s00701-011-1216-x] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 10/24/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND WHO grade II glioma (G2G) is a pre-malignant tumor, usually revealed by seizures in young patients living normal lives. G2G grows constantly and will inevitably become anaplastic. Surgical resection significantly increases the overall survival by delaying malignant transformation. Recently, a similar natural history was demonstrated in a patient with incidental G2G, with continuous growth and risk of anaplasia. Here, the aim was to study for the first time the functional results and extent of resection in a prospective series of patients who underwent resection for incidental G2G within eloquent areas. METHOD G2G involving functional regions in the left dominant hemisphere was incidentally diagnosed in 11 asymptomatic patients. Resection was achieved in all cases after demonstration of a volumetric increase on serial MRIs. Intraoperative awake mapping was performed in the 11 patients. FINDINGS There were no cases of mortality or permanent postoperative deficit. A subtotal, total or even "supratotal" resection was achieved in the 11 cases, with no partial resections. All patients resumed normal social and professional lives, with no seizures (KPS 100). Due to slow tumor re-growth in three patients with subtotal resection, adjuvant chemotherapy was administrated in two cases and radiotherapy in one. With a mean follow-up of 40 months since surgery, there was no anaplastic transformation. CONCLUSION These results show that surgery can be considered in incidental G2G, even in critical areas, with a minimal risk and optimal resection, thanks to intraoperative mapping. Such findings raise the question of an early detection.
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Affiliation(s)
- Hugues Duffau
- Department of Neurosurgery, Gui de Chauliac Hospital, CHU Montpellier, Montpellier University Medical Center, France.
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Ren X, Cui X, Lin S, Wang J, Jiang Z, Sui D, Li J, Wang Z. Co-deletion of chromosome 1p/19q and IDH1/2 mutation in glioma subsets of brain tumors in Chinese patients. PLoS One 2012; 7:e32764. [PMID: 22427879 PMCID: PMC3299680 DOI: 10.1371/journal.pone.0032764] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/02/2012] [Indexed: 11/21/2022] Open
Abstract
Objective To characterize co-deletion of chromosome 1p/19q and IDH1/2 mutation in Chinese brain tumor patients and to assess their associations with clinical features. Methods In a series of 528 patients with gliomas, pathological and radiological materials were reviewed. Pathological constituents of tumor subsets, incidences of 1p/19q co-deletion and IDH1/2 mutation in gliomas by regions and sides in the brain were analyzed. Results Overall, 1p and 19q was detected in 339 patients by FISH method while the sequence of IDH1/2 was determined in 280 patients. Gliomas of frontal, temporal and insular origin had significantly different pathological constituents of tumor subsets (P<0.001). Gliomas of frontal origin had significantly higher incidence of 1p/19q co-deletion (50.4%) and IDH1/2 mutation (73.5%) than those of non-frontal origin (27.0% and 48.5%, respectively) (P<0.001), while gliomas of temporal origin had significantly lower incidence of 1p/19q co-deletion (23.9%) and IDH1/2 mutation (41.7%) than those of non-temporal origin (39.9% and 63.2%, respectively) (P = 0.013 and P = 0.003, respectively). Subgroup analysis confirmed these findings in oligoastrocytic and oligodendroglial tumors, respectively. Although the difference of 1p/19q co-deletion was not statistically significant in temporal oligodendroglial tumors, the trend was marginally significant (P = 0.082). However, gliomas from different sides of the brain did not show significant different pathological constituents, incidences of 1p/19q co-deletion or IDH1/2 mutation. Conclusion Preferential distribution of pathological subsets, 1p/19q co-deletion and IDH1/2 mutation were confirmed in some brain regions in Chinese glioma patients, implying their distinctive tumor genesis and predictive value for prognosis.
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Affiliation(s)
- Xiaohui Ren
- Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
| | - Xiangli Cui
- Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
| | - Song Lin
- Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
- * E-mail:
| | - Junmei Wang
- Beijing Neurosurgical Institute, Beijing, China
| | - Zhongli Jiang
- Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
| | - Dali Sui
- Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
| | - Jing Li
- Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China
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36
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Lai A, Kharbanda S, Pope WB, Tran A, Solis OE, Peale F, Forrest WF, Pujara K, Carrillo JA, Pandita A, Ellingson BM, Bowers CW, Soriano RH, Schmidt NO, Mohan S, Yong WH, Seshagiri S, Modrusan Z, Jiang Z, Aldape KD, Mischel PS, Liau LM, Escovedo CJ, Chen W, Nghiemphu PL, James CD, Prados MD, Westphal M, Lamszus K, Cloughesy T, Phillips HS. Evidence for sequenced molecular evolution of IDH1 mutant glioblastoma from a distinct cell of origin. J Clin Oncol 2011; 29:4482-90. [PMID: 22025148 DOI: 10.1200/jco.2010.33.8715] [Citation(s) in RCA: 330] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Mutation in isocitrate dehydrogenase 1 (IDH1) at R132 (IDH1(R132MUT)) is frequent in low-grade diffuse gliomas and, within glioblastoma (GBM), has been proposed as a marker for GBMs that arise by transformation from lower-grade gliomas, regardless of clinical history. To determine how GBMs arising with IDH1(R132MUT) differ from other GBMs, we undertook a comprehensive comparison of patients presenting clinically with primary GBM as a function of IDH1(R132) mutation status. PATIENTS AND METHODS In all, 618 treatment-naive primary GBMs and 235 lower-grade diffuse gliomas were sequenced for IDH1(R132) and analyzed for demographic, radiographic, anatomic, histologic, genomic, epigenetic, and transcriptional characteristics. RESULTS Investigation revealed a constellation of features that distinguishes IDH1(R132MUT) GBMs from other GBMs (including frontal location and lesser extent of contrast enhancement and necrosis), relates them to lower-grade IDH1(R132MUT) gliomas, and supports the concept that IDH1(R132MUT) gliomas arise from a neural precursor population that is spatially and temporally restricted in the brain. The observed patterns of DNA sequence, methylation, and copy number alterations support a model of ordered molecular evolution of IDH1(R132MUT) GBM in which the appearance of mutant IDH1 protein is an initial event, followed by production of p53 mutant protein, and finally by copy number alterations of PTEN and EGFR. CONCLUSION Although histologically similar, GBMs arising with and without IDH1(R132MUT) appear to represent distinct disease entities that arise from separate cell types of origin as the result of largely nonoverlapping sets of molecular events. Optimal clinical management should account for the distinction between these GBM disease subtypes.
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Affiliation(s)
- Albert Lai
- David Geffen School of Medicine at theUniversity of California at Los Angeles, Los Angeles, CA, USA
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Occipital WHO grade II gliomas: oncological, surgical and functional considerations. Acta Neurochir (Wien) 2011; 153:1907-17; discussion 1917. [PMID: 21842441 DOI: 10.1007/s00701-011-1125-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/01/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Diffuse WHO grade II glioma (GIIG) involving the occipital lobe is a rare entity. Its surgical resection remains controversial as it implies inducing a permanent visual deficit. For the first time to our knowledge, we report a consecutive surgical series of patients who underwent an occipital lobectomy for an LGG invading visual structures. METHOD Six right-handed patients harboring a GIIG revealed by seizures (normal examination except a quadrantanopsia in one case) and located within the occipital lobe (4 left and 2 right tumors) were submitted to surgery. Before making this decision, the benefit-to-risk ratio of the resection was extensively discussed with the patient and his/her family, especially concerning the price to pay to remove the tumor, that is, to voluntarily generate a permanent hemianopsia. All the procedures were performed under awake condition using intraoperative electrostimulation, in order to pursue the resection until sensory-motor and/or language structures were encountered. FINDINGS An extensive occipital lobectomy was achieved in the six patients, with identification and preservation of sensory-motor pathways in the two cases with a right tumor and detection of language pathways in the four cases with a left tumor. The mean extent of resection was 93% (range: 91-100%). All patients experienced an expected postoperative deficit of the visual field (homonymous hemianopsia). Nonetheless, the six patients resumed a normal social and professional life (KPS at 90 in the 6 cases) with a mean follow-up of 58 months (range: 3-147 months)--with adjuvant treatment in three cases (in addition to a reoperation in two of them). CONCLUSIONS Our findings suggest that, despite a definitive hemianopsia, an extensive surgical resection can be considered in the rare cases of occipital GIIG involving the primary visual structures, with patients able to maintain a normal life--except regarding the medico-legal problem of driving.
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Vergani F, Martino J, Gozé C, Rigau V, Duffau H. World Health Organization Grade II Gliomas and Subventricular Zone: Anatomic, Genetic, and Clinical Considerations. Neurosurgery 2011; 68:1293-8; discussion 1298-9. [PMID: 21273932 DOI: 10.1227/neu.0b013e31820b522a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Recent studies suggest a possible origin of human gliomas from subventricular zone (SVZ) stem cells.
OBJECTIVE:
To evaluate the relationship of World Health Organization grade II gliomas (GIIGs) with the SVZ and to investigate the presence of different genetic patterns, depending on their relationship with the SVZ.
METHODS:
Forty-three consecutive patients were operated on for GIIG. Preoperative fluid-attenuated inversion recovery-weighted magnetic resonance images were reviewed to assess the presence of cortical involvement and the relationship between gliomas and the SVZ. Patients were divided into 2 groups: group 1, tumors in contact with the SVZ; and group 2, tumors not in contact with the SVZ. Preoperative and postoperative tumor volumes were calculated. Genetic analysis was performed to study 1p19q allelic loss.
RESULTS:
Twenty-four patients were in group 1 and 19 in group 2. All tumors were in contact with the cortex. Preoperative volume was significantly larger in group 1 than in group 2 (P = .003). The proportion of total and subtotal resections was higher in group 2 (P = .01). Insular tumors never showed 1p19q codeletions. Noninsular tumors exhibited a significantly different incidence of complete 1p19q codeletion, with allelic loss more common in group 1 (P = .03).
CONCLUSION:
GIIGs showed a constant relationship with the cortex and a larger volume when they came in contact with the ventricles. A distinct genetic pattern was found in noninsular SVZ GIIGs. This parameter can be considered for therapeutic management.
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Affiliation(s)
- Francesco Vergani
- Department of Neurosurgery, The Newcastle Upon Tyne Hospitals, Newcastle, United Kingdom
| | - Juan Martino
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Cantabria, Spain
| | - Catherine Gozé
- Laboratoire de Biologie Cellulaire et Hormonale, Hôpital Arnaud de Villeneuve, Montpellier, France
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute of Neurosciences of Montpellier, Hôpital Saint Eloi, Montpellier, France
| | - Valérie Rigau
- Departments of Neuropathology, Hôpital Gui de Chauliac, Montpellier, France
| | - Hugues Duffau
- Team “Plasticity of Central Nervous System, Stem Cells and Glial Tumors,” INSERM U1051, Institute of Neurosciences of Montpellier, Hôpital Saint Eloi, Montpellier, France
- Departments of Neurosurgery, Hôpital Gui de Chauliac, Montpellier, France
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Absence of IDH mutation identifies a novel radiologic and molecular subtype of WHO grade II gliomas with dismal prognosis. Acta Neuropathol 2010; 120:719-29. [PMID: 21080178 DOI: 10.1007/s00401-010-0777-8] [Citation(s) in RCA: 218] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/03/2010] [Accepted: 11/04/2010] [Indexed: 01/22/2023]
Abstract
The phenotypic heterogeneity of low-grade gliomas (LGGs) is still inconsistently explained by known molecular abnormalities in patients treated according to the present standards of care. IDH1 codon 132 and IDH2 codon 172 sequencing was performed in a series of 47 LGGs and correlated with clinical presentation, MR imaging characteristics, genomic profile and outcome. A total of 38 IDH1 mutations at codon 132 and 2 IDH2 mutations at codon 172 were found, including 35 R132H (87.5%), 2 R132C (5.0%), 1 R132S (2.5%) and 2 R172 M (5%). The IDH mutations were significantly associated with 1p19q deleted genotype (P = 0.031) and p53 expression (P = 0.014). The presence (vs. absence) of IDH mutations was associated with a better outcome (5-year survival rate, 93% vs. 51%, respectively, P = 0.000001). After adjustment for age, tumor location and size, radiologic infiltration pattern and extent of surgery, multivariate analysis confirmed that IDH mutations was an independent favorable prognostic factor (hazard ratio = 40.9; 95% CI, 2.89-578.49, P = 0.006). Furthermore, we showed that patients with IDH-nonmutated tumors were significantly older (P = 0.020) and that these tumors involved significantly more frequently the insula (P = 0.004), were larger in size (>6 cm, P = 0.047), displayed an infiltrative pattern on MRI (P = 0.007) and were all p53 negative with no 1p19q deletion (P < 10⁻⁶). The absence of IDH mutations in LGGs identifies a novel entity of LGGs with distinctive location, infiltrative behavior, specific molecular alterations, and dismal outcome. These findings could significantly modify the LGG classification and may represent a new tool to guide patient-tailored therapy.
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40
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Jansen M, Yip S, Louis DN. Molecular pathology in adult gliomas: diagnostic, prognostic, and predictive markers. Lancet Neurol 2010; 9:717-26. [PMID: 20610347 DOI: 10.1016/s1474-4422(10)70105-8] [Citation(s) in RCA: 176] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Over the past 10 years, there has been an increasing use of molecular markers in the assessment and management of adult malignant gliomas. Some molecular signatures are used diagnostically to help pathologists classify tumours, whereas others are used to estimate prognosis for patients. Most crucial, however, are those markers that are used to predict response to certain therapies, thereby directing clinicians to a particular treatment while avoiding other potentially deleterious therapies. Recently, large-scale genome-wide surveys have been used to identify new biomarkers that have been rapidly developed as diagnostic and prognostic tools. Given these developments, the pace of discovery of new molecular assays will quicken to facilitate personalised medicine in the setting of malignant glioma.
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Affiliation(s)
- Michael Jansen
- Pathology Service, Massachusetts General Hospital, Boston, MA 02114, USA
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Kouwenhoven MCM, Gorlia T, Kros JM, Ibdaih A, Brandes AA, Bromberg JEC, Mokhtari K, van Duinen SG, Teepen JL, Wesseling P, Vandenbos F, Grisold W, Sipos L, Mirimanoff R, Vecht CJ, Allgeier A, Lacombe D, van den Bent MJ. Molecular analysis of anaplastic oligodendroglial tumors in a prospective randomized study: A report from EORTC study 26951. Neuro Oncol 2010; 11:737-46. [PMID: 19224764 DOI: 10.1215/15228517-2009-011] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Recent studies have shown that the clinical outcome of anaplastic oligodendroglial tumors is variable, but also that the histological diagnosis is subject to interobserver variation. We investigated whether the assessment of 1p/19q codeletion, polysomy of chromosome 7, epidermal growth factor receptor (EGFR) gene amplification (EGFR(amp)), and loss of chromosome 10 or 10q offers additional prognostic information to the histological diagnosis and would allow molecular subtyping. For this study, we used the clinical data and tumor samples of the patients included in multicenter prospective phase III European Organisation for Research and Treatment of Cancer (EORTC) study 26951 on the effects of adjuvant procarbazine, chloroethyl cyclohexylnitrosourea (lomustine), and vincristine chemotherapy in anaplastic oligodendroglial tumors. Fluorescence in situ hybridization was used to assess copy number aberrations of chromosome 1p, 19q, 7, 10, and 10q and EGFR. Three different analyses were performed: on all included patients based on local pathology diagnosis, on the patients with confirmed anaplastic oligodendroglial tumors on central pathology review, and on this latter group but after excluding anaplastic oligoastrocytoma (AOA) with necrosis. As a reference set for glioblastoma multiforme (GBM), patients from the prospective randomized phase III study on GBM (EORTC 26981) were used as a benchmark. In 257 of 368 patients, central pathology review confirmed the presence of an anaplastic oligodendroglial tumor. Tumors with combined 1p and 19q loss (1p(loss)19q(loss)) were histopathologically diagnosed as anaplastic oligodendroglioma, were more frequently located in the frontal lobe, and had a better outcome. Anaplastic oligodendroglial tumors with EGFR(amp) were more frequently AOA, were more often localized outside the frontal lobe, and had a survival similar to that for GBM. Survival of patients with AOA harboring necrosis was in a similar range as for GBM, while patients with AOA with only endothelial proliferation had better overall survival. In univariate analyses, all molecular factors except loss of 10q were of prognostic significance, but on multivariate analysis a histopathological diagnosis of AOA, necrosis, and 1p(loss)19q(loss) remained independent prognostic factors. AOA tumors with necrosis are to be considered WHO grade IV tumors (GBM). Of all molecular markers analyzed in this study, especially loss of 1p/19q carried prognostic significance, while the others contributed little prognostic value to classical histology.
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Affiliation(s)
- Mathilde C M Kouwenhoven
- Department of Neurology, Daniel den Hoed Cancer Center, Erasmus University Hospital, Rotterdam, The Netherlands
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42
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Wu A, Aldape K, Lang FF. High rate of deletion of chromosomes 1p and 19q in insular oligodendroglial tumors. J Neurooncol 2009; 99:57-64. [PMID: 20035368 DOI: 10.1007/s11060-009-0100-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Accepted: 12/14/2009] [Indexed: 11/30/2022]
Abstract
It has been reported recently that oligodendroglial tumors arising in the insula rarely harbor co-deletions of chromosomes 1p and 19q, a molecular signature which is associated with a good prognosis and increased responsiveness to radiation and chemotherapy compared with tumors in which 1p and/or 19q is intact. In the context of this claim, we analyzed a series of insular oligodendroglial tumors in order to determine the frequency of 1p/19q co-deletion in tumors arising in this region. We identified 14 insular cases operated on after 2003 in which testing for losses of 1p and 19q was performed. Of these cases, co-deletion of 1p and 19q occurred in eight (57%). Four (50%) of eight oligodendrogliomas and four (67%) of six oligoastrocytomas demonstrated 1p/19q co-deletions. Seven of the eight tumors with co-deletion of 1p/19q were WHO grade II gliomas. There were no statistical differences between tumors with 1p/19q co-deletion compared to those with 1p and/or 19q intact in terms of age, preoperative KPS, presenting symptoms, left versus right lateralization, tumor location (purely insular versus extension into frontal or temporal lobe), preoperative tumor size. There was a preponderance of females in the co-deletion group, and a greater average extent of resection. In contradistinction to previous reports, loss of 1p/19q occurs commonly in insular oligodendroglial tumors. With respect to 1p/19q, insular gliomas do not appear to be distinct from gliomas arising elsewhere in the brain.
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Affiliation(s)
- Adam Wu
- The Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Box 442, Houston, TX 77030, USA
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43
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Huang L, Jiang T, Yuan F, Li GL, Cui Y, Liu EZ, Wang ZC. Correlation of chromosomes 1p and 19q status and expressions of O6-methylguanine DNA methyltransferase (MGMT), p53 and Ki-67 in diffuse gliomas of World Health Organization (WHO) grades II and III: a clinicopathological study. Neuropathol Appl Neurobiol 2008; 35:367-379. [PMID: 19019173 DOI: 10.1111/j.1365-2990.2008.01002.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS The objective of the present study was to verify the correlation of chromosomes 1p and 19q status and expressions of O(6)-methylguanine DNA methyltransferase (MGMT), p53 and Ki-67 in diffuse gliomas of World Health Organization grades II and III. METHODS A series of 146 diffuse gliomas, including 45 oligodendrogliomas, 42 oligoastrocytomas and 59 astrocytomas, were analysed by denaturing high-performance liquid chromatography for 1p and 19q status and by immunohistochemistry for MGMT, p53 and Ki-67 expression patterns. The molecular alterations were then correlated with clinicopathological characteristics and with each other. RESULTS Loss of heterozygosity (LOH) on 1p, combined LOH on 1p and 19q, low MGMT expression and high Ki-67 expression were associated with oligodendroglial tumours, whereas high p53 expression was associated with astrocytic and mixed tumours. LOH on 1p and low MGMT expression were associated with grade II oligodendroglial tumours, whereas high expressions of p53 and Ki-67 were associated with grade III oligodendroglial tumours. In addition, high Ki-67 expression was associated with grade III astrocytomas. LOH on 1p and LOH on 19q were associated with nontemporal oligodendroglial tumours. Nonrandom associations were found between LOH on 1p and LOH on 19q, MGMT expression and p53 expression, and MGMT expression and Ki-67 expression, whereas mutual exclusions were found between LOH on 1p and 19q and p53 expression, and LOH on 1p and Ki-67 expression. CONCLUSIONS The present study revealed significant interrelationships of the investigated molecular alterations and clinicopathological characteristics in diffuse gliomas of World Health Organization grades II and III, which support a promising role of molecular markers in the diagnostic assessment of these neoplasms.
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Affiliation(s)
- L Huang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing.,Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, and
| | - T Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing
| | - F Yuan
- Beijing Neurosurgical Institute, Beijing, China
| | - G-L Li
- Beijing Neurosurgical Institute, Beijing, China
| | - Y Cui
- Beijing Neurosurgical Institute, Beijing, China
| | - E-Z Liu
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, and
| | - Z-C Wang
- Beijing Neurosurgical Institute, Beijing, China
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Huang L, Jiang T, Yuan F, Li GL, Liu EZ, Wang ZC. Correlations between molecular profile and tumor location in Chinese patients with oligodendroglial tumors. Clin Neurol Neurosurg 2008; 110:1020-4. [PMID: 18845382 DOI: 10.1016/j.clineuro.2008.06.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 05/20/2008] [Accepted: 06/27/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate possible correlations between molecular alterations and tumor location in Chinese patients with oligodendroglial tumors. METHODS A series of 105 gliomas, including 42 oligoastrocytomas, and two control groups of 28 oligodendrogliomas and 35 astrocytomas, were retrospectively reviewed. In each case, the radiologic picture and loss of heterozygosity (LOH) on chromosome 1p and 19q detected by denaturing high-performance liquid chromatography (DHPLC) were analyzed. Correlations between molecular profile and tumor location were made by chi-square and Fisher's exact tests. RESULTS Oligodendroglial tumors located in the nontemporal lobes were significantly more likely to have combination of LOH 1p and LOH 19q than tumors arising in the insula, temporal lobe, and temporal with another lobe (p=0.001). Subgroup analysis confirmed this finding in oligodendrogliomas (p=0.006), but the difference did not reach significance in the oligoastrocytoma group, although the trend was similar (p=0.067). In contrast to the oligodendroglial tumors, we detected no association between molecular alterations and location for diffuse astrocytomas. CONCLUSION We conclude that molecular subsets of oligodendroglial tumors may arise preferentially in certain lobes of the brain, with tumors having LOH 1p and LOH 19q occurring most frequently in the nontemporal lobes. These findings suggest that molecular subsets of oligodendroglial tumors may arise from site-specific precursor cells, which has provided some information for the current management of these neoplasms in China.
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Affiliation(s)
- L Huang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, PR China
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45
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Lack of complete 1p19q deletion in a consecutive series of 12 WHO grade II gliomas involving the insula: a marker of worse prognosis? J Neurooncol 2008; 91:1-5. [DOI: 10.1007/s11060-008-9680-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Accepted: 08/04/2008] [Indexed: 11/25/2022]
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46
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Fontaine D, Vandenbos F, Lebrun C, Paquis V, Frenay M. [Diagnostic and prognostic values of 1p and 19q deletions in adult gliomas: critical review of the literature and implications in daily clinical practice]. Rev Neurol (Paris) 2008; 164:595-604. [PMID: 18565359 DOI: 10.1016/j.neurol.2008.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Revised: 04/08/2008] [Accepted: 04/09/2008] [Indexed: 11/17/2022]
Abstract
Losses of chromosomes 1p and 19q are deemed correlated with diagnosis of oligodendroglioma, higher chemosensitivity and better prognosis. We reviewed the literature to evaluate the usefulness of these correlations in daily clinical practice. The rates of deletions relative to histology (WHO classifications) were extracted from 33 studies, including 2666 patients. The 1p deletions and 1p19q codeletion mean rates were respectively 65.4 and 63.3% in oligodendrogliomas, 28.7 and 21.6% in oligoastrocytomas, 13.2 and 7.5% in astrocytomas, 11.6 and 2.9% in glioblastomas. The presence of 1p deletion and 1p19q codeletion were strongly correlated with the histological diagnosis corresponding to oligodendroglioma. Calculation of specificity, sensitivity, predictive positive values and false negative rates suggests that presence of deletion 1p or codeletion represents a strong argument in favor of the diagnosis of oligodendroglioma. However, considering the high false negative rate, absence of such deletions does not rule out the diagnosis. In grade 3 oligodendroglial tumors, the probability of responding to chemotherapy, and the duration of response, were higher when codeletions were present. This suggests that, in these tumors, the presence of codeletion is a strong argument in favor of adjuvant chemotherapy. However, chemotherapy should not be systematically excluded when codeletions are absent, as the chances of response are about 33% in this situation. Data concerning low-grade gliomas were more controversial. Oligodendroglial tumors with 1p deletion or 1p19q codeletion seemed to have a better prognosis, as five-year survival rates were 50% higher than in tumors without deletion. This might be explained by the correlation between 1p deletion and other identified prognosis factors: (1) higher chemosensitivity, (2) tumor location more frequently in the frontal lobe, leading to better resection and lower risk of neurological deficit, (3) slower growth rate, (4) higher risk of epilepsy, leading to an early detection.
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Affiliation(s)
- D Fontaine
- Service de neurochirurgie, hôpital Pasteur, CHU de Nice, UNSA, 30, avenue de la Voie-Romaine, 06000 Nice, France.
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Molecular diagnostic testing in malignant gliomas: a practical update on predictive markers. J Neuropathol Exp Neurol 2008; 67:1-15. [PMID: 18091559 DOI: 10.1097/nen.0b013e31815f65fb] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Advances in understanding the molecular underpinnings of cancer and in molecular diagnostic technologies have changed the clinical practice of oncologic pathology. The development of targeted therapies against specific molecular alterations in cancer further portends changes in the role of the pathology laboratory to guide such custom therapies. To reconcile the flood of scientific discoveries in this area, the promises of highly touted novel therapeutics, and the practicality of applying this knowledge to the day-to-day practice of clinical neuropathology, the present review highlights the operative differences between diagnostic, predictive, and prognostic markers, and discusses issues surrounding the transition of prospective biomarkers to routine laboratory implementation. This review focuses on 3 predictive molecular markers that are either in clinical use or are contemplated for use in the evaluation of malignant gliomas: assessment of 1p/19q loss in oligodendroglial tumors, examination of O6-methylguanine DNA methyltransferase promoter methylation status in glioblastomas, and molecular dissection of the epidermal growth factor receptor-phosphatidylinositol 3-kinase pathway in glioblastomas. Implementation of such predictive markers is not straightforward and requires critical review of the available literature and attention to practical laboratory, compliance, financial, and clinical management issues.
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Larjavaara S, Mäntylä R, Salminen T, Haapasalo H, Raitanen J, Jääskeläinen J, Auvinen A. Incidence of gliomas by anatomic location. Neuro Oncol 2007; 9:319-25. [PMID: 17522333 PMCID: PMC1907421 DOI: 10.1215/15228517-2007-016] [Citation(s) in RCA: 197] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The anatomic location of a glioma influences prognosis and treatment options. The aim of our study was to describe the distribution of gliomas in different anatomic areas of the brain. A representative population-based sample of 331 adults with glioma was used for preliminary analyses. The anatomic locations for 89 patients from a single center were analyzed in more detail from radiologic imaging and recorded on a three-dimensional 1 x 1 x 1-cm grid. The age-standardized incidence rate of gliomas was 4.7 per 100,000 person-years. The most frequent subtypes were glioblastoma (47%) and grade II-III astrocytoma (23%), followed by oligodendroglioma and mixed glioma. The gliomas were located in the frontal lobe in 40% of the cases, temporal in 29%, parietal in 14%, and occipital lobe in 3%, with 14% in the deeper structures. The difference in distribution between lobes remained after adjustment for their tissue volume: the tumor:volume ratio was 4.5 for frontal, 4.8 for temporal, and 2.3 for parietal relative to the occipital lobe. The area with the densest occurrence was the anterior subcortical brain. Statistically significant spatial clustering was found in the three-dimensional analysis. No differences in location were found among glioblastoma, diffuse astrocytoma, and oligodendroglioma. Our results demonstrate considerable heterogeneity in the anatomic distribution of gliomas within the brain.
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Affiliation(s)
- Suvi Larjavaara
- Tampere School of Public Health, University of Tampere, FIN-33016 Tampere, Finland.
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Huijsmans R, Damen J, van der Linden H, Hermans M. Single nucleotide polymorphism profiling assay to confirm the identity of human tissues. J Mol Diagn 2007; 9:205-13. [PMID: 17384212 PMCID: PMC1867440 DOI: 10.2353/jmoldx.2007.060059] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To identify issues of sample mix-ups, various molecular techniques are currently used. These techniques, however, are time consuming and require experience and/or DNA sequencing equipment or have a relatively high risk of errors because of contamination. Therefore, a quick and straightforward single nucleotide polymorphism (SNP) profiling assay was developed to link human tissues to a source. SNPs are common sequence variations in the human genome, and each individual has a unique combination of these nucleotide variations. Using potentially mislabeled paraffin-embedded tissues, DNA was extracted and SNP profiles were determined by real-time polymerase chain reaction analysis of the purified DNA using a selection of 10 commercially available SNP amplification assays. These profiles were compared with profiles of the supposed owners. All issues (34 in total) of potential sample mix-ups during the last 3 years were adequately solved, with six cases described here. The SNP profiling assay provides a quick (within 24 hours), easy, and reliable way to link human samples to a source, without polymerase chain reaction postprocessing. The chance for two randomly chosen individuals to have an identical profile is 1 in 18,000. Solving potential sample mix-ups will secure downstream evaluations and critical decisions concerning the patients involved.
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Affiliation(s)
- Ronald Huijsmans
- Multidisciplinary Laboratory of Molecular Diagnostics, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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50
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Dehais C, Laigle-Donadey F, Marie Y, Kujas M, Lejeune J, Benouaich-Amiel A, Pedretti M, Polivka M, Xuan KH, Thillet J, Delattre JY, Sanson M. Prognostic stratification of patients with anaplastic gliomas according to genetic profile. Cancer 2006; 107:1891-7. [PMID: 16986124 DOI: 10.1002/cncr.22211] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is a need to improve the current, controversial, and poorly reproducible classification of anaplastic gliomas, which represent a highly heterogeneous entity in terms of survival. METHODS The impact of the most common genetic alterations on survival was investigated based on 156 anaplastic gliomas: Among the patients who were included, the gender ratio was 1.32, the median age was 45.5 years (range, 20-83 years), and the median Karnofsky performance status was 70 (range, 40-100). Genetic analysis included a search for loss of heterozygosity (LOH) on chromosomes 1p and 19q; amplification of chromosomes 9p and 10q and of the epidermal growth factor receptor (EGFR), cyclin-dependent kinase 4 (CDK4) and mouse double-minute (MDM2) genes; and p53 expression. RESULTS The median survival was 33.5 months, and the median progression-free survival was 15.8 months. In a univariate analysis, LOH on 1p and 19q was correlated with longer survival, whereas p53 expression, LOH on 9p, LOH on 10q, amplified EGFR, and deleted CDKN2A were correlated with shorter survival. LOH on 1p and 19q were associated with oligodendrogliomas, LOH on 10q was related to EGFR amplification, and LOH on 1p and 19q was mutually exclusive with EGFR amplification and LOH on 10q. In a multivariate analysis, the significant prognostic factors were age, histology, LOH on 1p and 19q, and P16/CDKN2A deletion. Recursive partitioning analysis (RPA) divided the whole group hierarchically into 3 distinct prognostic subgroups: Group A with 1p19q codeletion (median survival, 98 months), Group B with EGFR amplification (median survival, 17 months), and Group CC (median survival, 31 months), providing a basis for a genetically based prognostic subclassification for patients with Grade III gliomas. CONCLUSIONS The search for 1p19q codeletion and EGFR receptor amplification provides a simple, clinically relevant prognostic subclassification of grade III gliomas.
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Affiliation(s)
- Caroline Dehais
- INSERM U711, Biologie des Interactions Neurones et Glie, Paris, France
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