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Luque L, Skogen K, MacIntosh BJ, Emblem KE, Larsson C, Bouget D, Helland RH, Reinertsen I, Solheim O, Schellhorn T, Vardal J, Mireles EEM, Vik-Mo EO, Bjørnerud A. Standardized evaluation of the extent of resection in glioblastoma with automated early post-operative segmentation. FRONTIERS IN RADIOLOGY 2024; 4:1357341. [PMID: 38840717 PMCID: PMC11150796 DOI: 10.3389/fradi.2024.1357341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024]
Abstract
Standard treatment of patients with glioblastoma includes surgical resection of the tumor. The extent of resection (EOR) achieved during surgery significantly impacts prognosis and is used to stratify patients in clinical trials. In this study, we developed a U-Net-based deep-learning model to segment contrast-enhancing tumor on post-operative MRI exams taken within 72 h of resection surgery and used these segmentations to classify the EOR as either maximal or submaximal. The model was trained on 122 multiparametric MRI scans from our institution and achieved a mean Dice score of 0.52 ± 0.03 on an external dataset (n = 248), a performance -on par with the interrater agreement between expert annotators as reported in literature. We obtained an EOR classification precision/recall of 0.72/0.78 on the internal test dataset (n = 462) and 0.90/0.87 on the external dataset. Furthermore, Kaplan-Meier curves were used to compare the overall survival between patients with maximal and submaximal resection in the internal test dataset, as determined by either clinicians or the model. There was no significant difference between the survival predictions using the model's and clinical EOR classification. We find that the proposed segmentation model is capable of reliably classifying the EOR of glioblastoma tumors on early post-operative MRI scans. Moreover, we show that stratification of patients based on the model's predictions offers at least the same prognostic value as when done by clinicians.
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Affiliation(s)
- Lidia Luque
- Computational Radiology and Artificial Intelligence (CRAI), Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Karoline Skogen
- Department of Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Bradley J. MacIntosh
- Computational Radiology and Artificial Intelligence (CRAI), Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sandra E Black Centre for Brain Resilience and Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Kyrre E. Emblem
- Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christopher Larsson
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - David Bouget
- Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Ragnhild Holden Helland
- Department of Health Research, SINTEF Digital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ingerid Reinertsen
- Department of Health Research, SINTEF Digital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ole Solheim
- Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Till Schellhorn
- Computational Radiology and Artificial Intelligence (CRAI), Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Jonas Vardal
- Department of Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Eduardo E. M. Mireles
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Einar O. Vik-Mo
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Atle Bjørnerud
- Computational Radiology and Artificial Intelligence (CRAI), Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Physics and Computational Radiology, Clinic for Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
- Center for Lifespan Changes in Brain and Cognition, University of Oslo, Oslo, Norway
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2
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Wu O, Clift GW, Hilliard S, Ip M. Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review. J Med Radiat Sci 2023; 70:479-490. [PMID: 37434551 PMCID: PMC10715358 DOI: 10.1002/jmrs.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 07/02/2023] [Indexed: 07/13/2023] Open
Abstract
Brain tumours are the most common solid neoplasm in children, posing a significant challenge in oncology due to the limited range of treatment. Intraoperative magnetic resonance imaging (iMRI) has recently emerged to aid surgical intervention in neurosurgery resection with the potential to delineate tumour boundaries. This narrative literature review aimed to provide an updated evaluation of the clinical implementation of iMRI in paediatric neurosurgical resection, with an emphasis on the extent of brain tumour resection, patient outcomes and its drawbacks. Databases including MEDLINE, PubMed, Scopus and Web of Science were used to investigate this topic with key terms: paediatric, brain tumour, and iMRI. Exclusion criteria included literature comprised of adult populations and the use of iMRI in neurosurgery in the absence of brain tumours. The limited body of research evaluating the clinical implementation of iMRI in paediatric cohorts has been predominantly positive. Current evidence demonstrates the potential for iMRI use to increase rates of gross total resection (GTR), assess the extent of resection, and improve patient outcomes, such as progression-free survival. Limitations regarding the use of iMRI include prolonged operation times and complications associated with head immobilisation devices. iMRI has the potential to aid in the achievement of maximal brain tumour resection in paediatric patients. Future prospective randomised controlled trials are necessary to determine the clinical significance and benefits of using iMRI during neurosurgical resection for clinical management of brain neoplasms in children.
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Affiliation(s)
- Olivia Wu
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Georgina Williamson Clift
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Sonia Hilliard
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
| | - Miranda Ip
- Discipline of Medical Radiation Sciences, Sydney School of Health SciencesThe University of SydneySydneyNew South WalesAustralia
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3
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Peritumor Edema Serves as an Independent Predictive Factor of Recurrence Patterns and Recurrence-Free Survival for High-Grade Glioma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9547166. [PMID: 35936378 PMCID: PMC9348930 DOI: 10.1155/2022/9547166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/01/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Objective. This study is aimed at analyzing the factors affecting the recurrence patterns and recurrence-free survival (RFS) of high-grade gliomas (HGG). Methods. Eligible patients admitted to the Affiliated Hospital of Xuzhou Medical University were selected. Subsequently, the effects of some clinical data including age, gender, WHO pathological grades, tumor site, tumor size, clinical treatments, and peritumoral edema (PTE) area and molecular markers (Ki-67, MGMT, IDH-1, and p53) on HGG patients’ recurrence patterns and RFS were analyzed. Results. A total number of 77 patients were enrolled into this study. After analyzing all the cases, it was determined that tumor size and tumor site had a significant influence on the recurrent patterns of HGG, and PTE was an independent predict factor of recurrence patterns. Specifically, when the PTE was mild (<1 cm), the recurrence pattern tended to be local; in contrast, HGG was more likely to progress to marginal recurrence and distant recurrence. Furthermore, age and PTE were significantly associated with RFS; the median RFS of the population with
(23.60 months) was obviously longer than the population with
(5.00 months). Conclusions. PTE is an independent predictor of recurrence patterns and RFS for HGG. Therefore, preoperative identification of PTE in HGG patients is crucially important, which is helpful to accurately estimate the recurrence pattern and RFS.
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Aftahy AK, Barz M, Lange N, Baumgart L, Thunstedt C, Eller MA, Wiestler B, Bernhardt D, Combs SE, Jost PJ, Delbridge C, Liesche-Starnecker F, Meyer B, Gempt J. The Impact of Postoperative Tumor Burden on Patients With Brain Metastases. Front Oncol 2022; 12:869764. [PMID: 35600394 PMCID: PMC9114705 DOI: 10.3389/fonc.2022.869764] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background Brain metastases were considered to be well-defined lesions, but recent research points to infiltrating behavior. Impact of postoperative residual tumor burden (RTB) and extent of resection are still not defined enough. Patients and Methods Adult patients with surgery of brain metastases between April 2007 and January 2020 were analyzed. Early postoperative MRI (<72 h) was used to segment RTB. Survival analysis was performed and cutoff values for RTB were revealed. Separate (subgroup) analyses regarding postoperative radiotherapy, age, and histopathological entities were performed. Results A total of 704 patients were included. Complete cytoreduction was achieved in 487/704 (69.2%) patients, median preoperative tumor burden was 12.4 cm3 (IQR 5.2–25.8 cm3), median RTB was 0.14 cm3 (IQR 0.0–2.05 cm3), and median postoperative tumor volume of the targeted BM was 0.0 cm3 (IQR 0.0–0.1 cm3). Median overall survival was 6 months (IQR 2–18). In multivariate analysis, preoperative KPSS (HR 0.981982, 95% CI, 0.9761–0.9873, p < 0.001), age (HR 1.012363; 95% CI, 1.0043–1.0205, p = 0.0026), and preoperative (HR 1.004906; 95% CI, 1.0003–1.0095, p = 0.00362) and postoperative tumor burden (HR 1.017983; 95% CI; 1.0058–1.0303, p = 0.0036) were significant. Maximally selected log rank statistics showed a significant cutoff for RTB of 1.78 cm3 (p = 0.0022) for all and 0.28 cm3 (p = 0.0047) for targeted metastasis and cutoff for the age of 67 years (p < 0.001). (Stereotactic) Radiotherapy had a significant impact on survival (p < 0.001). Conclusions RTB is a strong predictor for survival. Maximal cytoreduction, as confirmed by postoperative MRI, should be achieved whenever possible, regardless of type of postoperative radiotherapy.
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Affiliation(s)
- Amir Kaywan Aftahy
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Melanie Barz
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Nicole Lange
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Lea Baumgart
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Cem Thunstedt
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Mario Antonio Eller
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum Munich, Munich, Germany
| | - Philipp J Jost
- III. Medical Department of Hematology and Oncology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.,Clinical Division of Oncology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Claire Delbridge
- Department of Neuropathology, Institute of Pathology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Friederike Liesche-Starnecker
- Department of Neuropathology, Institute of Pathology, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, School of Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
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5
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Malik DG, Rath TJ, Urcuyo Acevedo JC, Canoll PD, Swanson KR, Boxerman JL, Quarles CC, Schmainda KM, Burns TC, Hu LS. Advanced MRI Protocols to Discriminate Glioma From Treatment Effects: State of the Art and Future Directions. FRONTIERS IN RADIOLOGY 2022; 2:809373. [PMID: 37492687 PMCID: PMC10365126 DOI: 10.3389/fradi.2022.809373] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/01/2022] [Indexed: 07/27/2023]
Abstract
In the follow-up treatment of high-grade gliomas (HGGs), differentiating true tumor progression from treatment-related effects, such as pseudoprogression and radiation necrosis, presents an ongoing clinical challenge. Conventional MRI with and without intravenous contrast serves as the clinical benchmark for the posttreatment surveillance imaging of HGG. However, many advanced imaging techniques have shown promise in helping better delineate the findings in indeterminate scenarios, as posttreatment effects can often mimic true tumor progression on conventional imaging. These challenges are further confounded by the histologic admixture that can commonly occur between tumor growth and treatment-related effects within the posttreatment bed. This review discusses the current practices in the surveillance imaging of HGG and the role of advanced imaging techniques, including perfusion MRI and metabolic MRI.
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Affiliation(s)
- Dania G. Malik
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - Tanya J. Rath
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
| | - Javier C. Urcuyo Acevedo
- Mathematical Neurooncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, United States
| | - Peter D. Canoll
- Departments of Pathology and Cell Biology, Columbia University, New York, NY, United States
| | - Kristin R. Swanson
- Mathematical Neurooncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, United States
| | - Jerrold L. Boxerman
- Department of Diagnostic Imaging, Brown University, Providence, RI, United States
| | - C. Chad Quarles
- Department of Neuroimaging Research & Barrow Neuroimaging Innovation Center, Barrow Neurologic Institute, Phoenix, AZ, United States
| | - Kathleen M. Schmainda
- Department of Biophysics & Radiology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Terry C. Burns
- Departments of Neurologic Surgery and Neuroscience, Mayo Clinic, Rochester, MN, United States
| | - Leland S. Hu
- Department of Radiology, Mayo Clinic, Phoenix, AZ, United States
- Mathematical Neurooncology Lab, Precision Neurotherapeutics Innovation Program, Mayo Clinic, Phoenix, AZ, United States
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6
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Fuentes AM, Ansari D, Burch TG, Mehta AI. Use of intraoperative MRI for resection of intracranial tumors: A nationwide analysis of short-term outcomes. J Clin Neurosci 2022; 99:152-157. [PMID: 35279588 DOI: 10.1016/j.jocn.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/22/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recent evidence supports the use of intraoperative MRI (iMRI) during resection of intracranial tumors due to its demonstrated efficacy and clinical benefit. Though many single-center investigations have been conducted, larger nationwide outcomes have yet to be characterized. METHODS We used the American College of Surgeons National Surgical Quality Improvement Program database to examine baseline characteristics and 30-day postoperative outcomes among patients undergoing craniotomy for tumor resection with and without iMRI. Comparisons between outcomes were accomplished after propensity matching using chi-square tests for categorical variables and Welch two-sample t-tests for continuous variables. RESULTS A total of 38,003 patients met inclusion criteria. Of this population, 54 (0.1%) received iMRI, while 37,949 (99.9%) did not receive iMRI. After propensity score matching, the resulting groups consisted of an iMRI group (n = 54) and a matched non-iMRI group (n = 54). Procedures involving iMRI were associated with significantly increased operation length compared to those without (p < 0.01). Length of hospital stay was higher in patients without iMRI, with this difference trending towards significance (p = 0.05) in the unmatched comparison. Patients undergoing craniotomy without iMRI had a higher rate of readmission (p = 0.04). There was no significant difference in occurrence of other adverse events between the two patient groups. CONCLUSION Despite increasing operative length, iMRI is not associated with higher infection rate and may have a clinical benefit associated with reducing readmissions and a trend towards reducing inpatient length of stay. Additional nationwide analyses including more iMRI patients would provide further insight into the strength of these findings.
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Affiliation(s)
- Angelica M Fuentes
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Darius Ansari
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Taylor G Burch
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Ankit I Mehta
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Matsumae M, Nishiyama J, Kuroda K. Intraoperative MR Imaging during Glioma Resection. Magn Reson Med Sci 2022; 21:148-167. [PMID: 34880193 PMCID: PMC9199972 DOI: 10.2463/mrms.rev.2021-0116] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/11/2021] [Indexed: 11/09/2022] Open
Abstract
One of the major issues in the surgical treatment of gliomas is the concern about maximizing the extent of resection while minimizing neurological impairment. Thus, surgical planning by carefully observing the relationship between the glioma infiltration area and eloquent area of the connecting fibers is crucial. Neurosurgeons usually detect an eloquent area by functional MRI and identify a connecting fiber by diffusion tensor imaging. However, during surgery, the accuracy of neuronavigation can be decreased due to brain shift, but the positional information may be updated by intraoperative MRI and the next steps can be planned accordingly. In addition, various intraoperative modalities may be used to guide surgery, including neurophysiological monitoring that provides real-time information (e.g., awake surgery, motor-evoked potentials, and sensory evoked potential); photodynamic diagnosis, which can identify high-grade glioma cells; and other imaging techniques that provide anatomical information during the surgery. In this review, we present the historical and current context of the intraoperative MRI and some related approaches for an audience active in the technical, clinical, and research areas of radiology, as well as mention important aspects regarding safety and types of devices.
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Affiliation(s)
- Mitsunori Matsumae
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Nishiyama
- Department of Neurosurgery, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Kagayaki Kuroda
- Department of Human and Information Sciences, School of Information Science and Technology, Tokai University, Hiratsuka, Kanagawa, Japan
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8
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Deora H, Ferini G, Garg K, Narayanan MDK, Umana GE. Evaluating the Impact of Intraoperative MRI in Neuro-Oncology by Scientometric Analysis. Life (Basel) 2022; 12:life12020175. [PMID: 35207463 PMCID: PMC8877236 DOI: 10.3390/life12020175] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Objective—Intraoperative Magnetic Resonance Imaging (IOMRI) guided surgery has revolutionized neurosurgery and has especially impacted the field of Neuro-Oncology, with randomized controlled trails demonstrating improved resection, fewer postoperative deficits and enhanced survival rates. Bibliometric analysis allows for analysing chronological trends and measuring the impact and directions of research in a particular field. To the authors’ knowledge, this is the first Bibliometric analysis conducted on IOMRI. (2) Methods—a title specific search of the Web of Science database was executed using the keywords ‘intraoperative MRI’, ‘intraoperative magnetic resonance imaging’, and “IOMRI’ on 23rd April 2021. Results—663 articles met the inclusion criteria and were included in the final analysis. In addition, the 100 most cited were analysed as well. Among these 100 articles, 76 were original research papers, while 14 others were review articles. Amongst all the authors, Ganslandt contributed the maximum number of articles, with USA being the largest single source of these articles, followed by Germany. Interestingly, a shift of trends from “Image guided surgery’ and ‘accuracy’ in the early 2000s to ‘extent of resection’, ‘impact’, and ‘survival’ in the later years was noted. (3) Conclusions—IOMRI has now become an integral part of neurosurgery, especially in neuro-oncology. Focus has now shifted from implementation to refinement of technique in the form of functional and oncological outcomes. Therefore, future research in this direction is imperative and will be of more impact that in any other sub-field related to IOMRI.
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Affiliation(s)
- Harsh Deora
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore 560029, India;
| | | | - Kanwaljeet Garg
- Department of Neurosurgery, All-India Institute of Medical Sciences, New Delhi 110029, India
- Correspondence:
| | | | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma and Gamma-Knife Center, Cannizzaro Hospital, 95126 Catania, Italy;
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9
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Guo P, Wang P, Yasarla R, Zhou J, Patel VM, Jiang S. Anatomic and Molecular MR Image Synthesis Using Confidence Guided CNNs. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:2832-2844. [PMID: 33351754 PMCID: PMC8543492 DOI: 10.1109/tmi.2020.3046460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Data-driven automatic approaches have demonstrated their great potential in resolving various clinical diagnostic dilemmas in neuro-oncology, especially with the help of standard anatomic and advanced molecular MR images. However, data quantity and quality remain a key determinant, and a significant limit of the potential applications. In our previous work, we explored the synthesis of anatomic and molecular MR image networks (SAMR) in patients with post-treatment malignant gliomas. In this work, we extend this through a confidence-guided SAMR (CG-SAMR) that synthesizes data from lesion contour information to multi-modal MR images, including T1-weighted ( [Formula: see text]), gadolinium enhanced [Formula: see text] (Gd- [Formula: see text]), T2-weighted ( [Formula: see text]), and fluid-attenuated inversion recovery ( FLAIR ), as well as the molecular amide proton transfer-weighted ( [Formula: see text]) sequence. We introduce a module that guides the synthesis based on a confidence measure of the intermediate results. Furthermore, we extend the proposed architecture to allow training using unpaired data. Extensive experiments on real clinical data demonstrate that the proposed model can perform better than current the state-of-the-art synthesis methods. Our code is available at https://github.com/guopengf/CG-SAMR.
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10
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Han M, Xing H, Chen L, Cui M, Zhang Y, Qi L, Jin M, Yang Y, Gao C, Gao Z, Xing X, Huang W. Efficient antiglioblastoma therapy in mice through doxorubicin-loaded nanomicelles modified using a novel brain-targeted RVG-15 peptide. J Drug Target 2021; 29:1016-1028. [PMID: 33825602 DOI: 10.1080/1061186x.2021.1912053] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Glioblastoma (GBM) is an aggressive malignancy and therapeutic options are limited due to the presence of the blood-brain barrier (BBB). RVG-29, a 29-amino-acid polypeptide derived from the rabies virus glycoprotein (RVG), has excellent brain-targeted capacity across the BBB. We reduced the size of this peptide to get a15-amino-acid polypeptide (RVG-15), while retaining its brain-targeted capacity across the BBB. First, we synthesized a novel nanocarrier RVG-15-PEG2000-DSPE. Next, DOX-loaded polymeric micelles (DOX RVG-15-PMs) were prepared in an electrostatic interaction-dependent manner. Finally, we evaluated its antitumor benefits in vitro at the cellular level and in vivo using an in situ tumour-bearing mouse model. MALDI-TOF-MS and FTIR spectra confirmed the successful synthesis of the novel nanocarrier. The prepared DOX RVG-15-PMs displayed even size distribution, a high entrapment efficiency and satisfactory in vitro release behaviour. In vitro blank RVG-15-PMs were excellent, safe and highly biocompatible as drug delivery carriers. DOX-loaded micelles were easily taken up by C6 cells and could effectively inhibit cancer development and metastasis. In vivo, DOX RVG-15-PMs delayed weight loss, prevented cancer cell metastasis and accelerated cancer cell apoptosis in tumour-bearing mice. Our novel brain-targeted nanocarrier is highly feasible, while DOX RVG-15-PMs exert significant antiglioma effects, both in vitro and in vivo.
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Affiliation(s)
- Mingfeng Han
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Liqing Chen
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minhu Cui
- Yanbian University Hospital, Jilin, China
| | - Yingying Zhang
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingling Qi
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingji Jin
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Yang
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Chunsheng Gao
- State Key Laboratory of Toxicology and Medical Countermeasures, Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Zhonggao Gao
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuezhong Xing
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Huang
- Department of Pharmaceutics, State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kiesel B, Freund J, Reichert D, Wadiura L, Erkkilae MT, Woehrer A, Hervey-Jumper S, Berger MS, Widhalm G. 5-ALA in Suspected Low-Grade Gliomas: Current Role, Limitations, and New Approaches. Front Oncol 2021; 11:699301. [PMID: 34395266 PMCID: PMC8362830 DOI: 10.3389/fonc.2021.699301] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Radiologically suspected low-grade gliomas (LGG) represent a special challenge for the neurosurgeon during surgery due to their histopathological heterogeneity and indefinite tumor margin. Therefore, new techniques are required to overcome these current surgical drawbacks. Intraoperative visualization of brain tumors with assistance of 5-aminolevulinic acid (5-ALA) induced protoporphyrin IX (PpIX) fluorescence is one of the major advancements in the neurosurgical field in the last decades. Initially, this technique was exclusively applied for fluorescence-guided surgery of high-grade glioma (HGG). In the last years, the use of 5-ALA was also extended to other indications such as radiologically suspected LGG. Here, we discuss the current role of 5-ALA for intraoperative visualization of focal malignant transformation within suspected LGG. Furthermore, we discuss the current limitations of the 5-ALA technology in pure LGG which usually cannot be visualized by visible fluorescence. Finally, we introduce new approaches based on fluorescence technology for improved detection of pure LGG tissue such as spectroscopic PpIX quantification fluorescence lifetime imaging of PpIX and confocal microscopy to optimize surgery.
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Affiliation(s)
- Barbara Kiesel
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Julia Freund
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - David Reichert
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory OPTRAMED, Medical University of Vienna, Vienna, Austria
| | - Lisa Wadiura
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Mikael T Erkkilae
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Adelheid Woehrer
- Department of Neurology, Institute for Neuropathology and Neurochemistry, Medical University of Vienna, Vienna, Austria
| | - Shawn Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California San Francisco (UCSF), San Francisco, CA, United States
| | - Georg Widhalm
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
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12
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Rykkje AM, Li D, Skjøth-Rasmussen J, Larsen VA, Nielsen MB, Hansen AE, Carlsen JF. Surgically Induced Contrast Enhancements on Intraoperative and Early Postoperative MRI Following High-Grade Glioma Surgery: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11081344. [PMID: 34441279 PMCID: PMC8392564 DOI: 10.3390/diagnostics11081344] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
For the radiological assessment of resection of high-grade gliomas, a 72-h diagnostic window is recommended to limit surgically induced contrast enhancements. However, such enhancements may occur earlier than 72 h post-surgery. This systematic review aimed to assess the evidence on the timing of the postsurgical MRI. PubMed, Embase, Web of Science and Cochrane were searched following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles describing surgically induced contrast enhancements on MRI after resection for high-grade gliomas were included and analysed. The frequency of different contrast enhancement patterns on intraoperative MRI (iMRI) and early postoperative MRI (epMRI) was recorded. The search resulted in 1443 studies after removing duplicates, and a total of 12 studies were chosen for final review. Surgically induced contrast enhancements were reported at all time points after surgery, including on iMRI, but their type and frequency vary. Thin linear contrast enhancements were commonly found to be surgically induced and were less frequently recorded on postoperative days 1 and 2. This suggests that the optimal time to scan may be at or before this time. However, the evidence is limited, and higher-quality studies using larger and consecutively sampled populations are needed.
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Affiliation(s)
- Alexander Malcolm Rykkje
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Correspondence:
| | - Dana Li
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jane Skjøth-Rasmussen
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Vibeke Andrée Larsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jonathan Frederik Carlsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (D.L.); (V.A.L.); (M.B.N.); (A.E.H.); (J.F.C.)
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13
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Chan HW, Uff C, Chakraborty A, Dorward N, Bamber JC. Clinical Application of Shear Wave Elastography for Assisting Brain Tumor Resection. Front Oncol 2021; 11:619286. [PMID: 33732645 PMCID: PMC7956956 DOI: 10.3389/fonc.2021.619286] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022] Open
Abstract
Background The clinical outcomes for brain tumor resection have been shown to be significantly improved with increased extent of resection. To achieve this, neurosurgeons employ different intra-operative tools to improve the extent of resection of brain tumors, including ultrasound, CT, and MRI. Young’s modulus (YM) of brain tumors have been shown to be different from normal brain but the accuracy of SWE in assisting brain tumor resection has not been reported. Aims To determine the accuracy of SWE in detecting brain tumor residual using post-operative MRI scan as “gold standard”. Methods Thirty-four patients (aged 1–62 years, M:F = 15:20) with brain tumors were recruited into the study. The intraoperative SWE scans were performed using Aixplorer® (SuperSonic Imagine, France) using a sector transducer (SE12-3) and a linear transducer (SL15-4) with a bandwidth of 3 to 12 MHz and 4 to 15 MHz, respectively, using the SWE mode. The scans were performed prior, during and after brain tumor resection. The presence of residual tumor was determined by the surgeon, ultrasound (US) B-mode and SWE. This was compared with the presence of residual tumor on post-operative MRI scan. Results The YM of the brain tumors correlated significantly with surgeons’ findings (ρ = 0.845, p < 0.001). The sensitivities of residual tumor detection by the surgeon, US B-mode and SWE were 36%, 73%, and 94%, respectively, while their specificities were 100%, 63%, and 77%, respectively. There was no significant difference between detection of residual tumor by SWE, US B-mode, and MRI. SWE and MRI were significantly better than the surgeon’s detection of residual tumor (p = 0.001 and p < 0.001, respectively). Conclusions SWE had a higher sensitivity in detecting residual tumor than the surgeons (94% vs. 36%). However, the surgeons had a higher specificity than SWE (100% vs. 77%). Therefore, using SWE in combination with surgeon’s opinion may optimize the detection of residual tumor, and hence improve the extent of brain tumor resection.
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Affiliation(s)
- Huan Wee Chan
- Joint Department of Physics, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, United Kingdom.,Neurosurgery Department, Southampton General Hospital, Southampton, United Kingdom
| | - Christopher Uff
- Neurosurgery Department, Royal London Hospital, London, United Kingdom
| | - Aabir Chakraborty
- Neurosurgery Department, Southampton General Hospital, Southampton, United Kingdom
| | - Neil Dorward
- Neurosurgery Department, The National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Jeffrey Colin Bamber
- Joint Department of Physics, Institute of Cancer Research and the Royal Marsden Hospital, Sutton, United Kingdom
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14
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Reis J, Stahl R, Zimmermann H, Ruf V, Thon N, Kunz M, Liebig T, Forbrig R. Advanced MRI Findings in Medulloblastomas: Relationship to Genetic Subtypes, Histopathology, and Immunohistochemistry. J Neuroimaging 2021; 31:306-316. [PMID: 33465267 DOI: 10.1111/jon.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/06/2020] [Accepted: 12/24/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE For diagnosis of medulloblastoma, the updated World Health Organization classification now demands for genetic typing, defining more precisely the tumor biology, therapy, and prognosis. We investigated potential associations between magnetic resonance imaging (MRI) parameters including apparent diffusion coefficient (ADC) and neuropathologic features of medulloblastoma, focusing on genetic subtypes. METHODS This study was a retrospective single-center analysis of 32 patients (eight females, median age = 9 years [range, 1-57], mean 12.6 ± 11.3) from 2012 to 2019. Genetic subtypes (wingless [WNT]; sonic hedgehog [SHH]; non-WNT/non-SHH), histopathology, immunohistochemistry (p53, Ki67), and the following MRI parameters were correlated: tumor volume, location (midline, pontocerebellar, and cerebellar hemisphere), edema, hydrocephalus, metastatic disease (presence/absence and each), contrast-enhancement (minor, moderate, and distinct), cysts (none, small, and large), hemorrhage (none, minor, and major), and ADCmean . The ADCmean was calculated using manually set regions of interest within the solid tumor. Statistics comprised univariate and multivariate testing. RESULTS Out of 32 tumors, three tumors were WNT activated (9.4%), 13 (40.6%) SHH activated, and 16 (50.0%) non-WNT/non-SHH. Hemispherical location (n = 7/8, P = .003) and presence of edema (8/8; P < .001, specificity 100%, positive predictive value 100%) were significantly associated with SHH activation. The combined parameter "no edema + no metastatic disease + cysts" significantly discriminated WNT-activated from SHH-activated medulloblastoma (P = .036). ADCmean (10-6 mm2 /s) was 484 for WNT-activated, 566 for SHH-activated, and 624 for non-WNT/non-SHH subtypes (P = .080). A significant negative correlation was found between ADCmean and Ki67 (r = -.364, P = .040). CONCLUSION MRI analysis enabled noninvasive differentiation of SHH-activated medulloblastoma. ADC alone was not reliable for genetic characterization, but associated with tumor proliferation rate.
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Affiliation(s)
- Jonas Reis
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Robert Stahl
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Hanna Zimmermann
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Viktoria Ruf
- Department of Neuropathology, University Hospital, LMU Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
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15
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Kerschbaumer J, Pinggera D, Holzner B, Delazer M, Bodner T, Karner E, Dostal L, Kvitsaridze I, Minasch D, Thomé C, Seiz-Rosenhagen M, Nevinny-Stickel M, Freyschlag CF. Sector Irradiation vs. Whole Brain Irradiation After Resection of Singular Brain Metastasis-A Prospective Randomized Monocentric Trial. Front Oncol 2020; 10:591884. [PMID: 33330076 PMCID: PMC7732624 DOI: 10.3389/fonc.2020.591884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/29/2020] [Indexed: 12/03/2022] Open
Abstract
To minimize recurrence following resection of a cerebral metastasis, whole-brain irradiation therapy (WBRT) has been established as the adjuvant standard of care. With prolonged overall survival in cancer patients, deleterious effects of WBRT gain relevance. Sector irradiation (SR) aims to spare uninvolved brain tissue by applying the irradiation to the resection cavity and the tumor bed. 40 were randomized to receive either WBRT (n = 18) or SR (n = 22) following resection of a singular brain metastasis. Local tumor control was satisfactory in both groups. Recurrence was observed earlier in the SR (median 3 months, 1–6) than in the WBRT cohort (median 8 months, 7–9) (HR, 0.63; 95% CI, 0.03–10.62). Seventeen patients experienced a distant intracranial recurrence. Most relapses (n = 15) occurred in the SR cohort, whereas only two patients in the WBRT group had new distant tumor manifestation (HR, 6.59; 95% CI, 1.71–11.49; p = 0.002). Median overall survival (OS) was 15.5 months (range: 1–61) with longer OS in the SR group (16 months, 1–61) than in the WBRT group (13 months, 3–52), without statistical significance (HR, 0.55; 95% CI, 0.69–3.64). Concerning neurocognition, patients in the SR group improved in the follow-up assessments, while this was not observed in the WBRT group. There were positive signals in terms of QOL within the SR group, but no significant differences in the global QLQ and QLQ-C30 summary scores were found. Our results indicate comparable efficacy of SR in terms of local control, with better maintenance of neurocognitive function. Unsurprisingly, more distant intracranial relapses occurred. Clinical Trial Registration:ClinicalTrials.gov, identifier NCT01667640.
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Affiliation(s)
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Holzner
- University Clinic for Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Bodner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elfriede Karner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Lucie Dostal
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Irma Kvitsaridze
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Danijela Minasch
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neurosurgery, Klinikum Memmingen, Memmingen, Germany
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
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16
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Booth TC, Luis A, Brazil L, Thompson G, Daniel RA, Shuaib H, Ashkan K, Pandey A. Glioblastoma post-operative imaging in neuro-oncology: current UK practice (GIN CUP study). Eur Radiol 2020; 31:2933-2943. [PMID: 33151394 PMCID: PMC8043861 DOI: 10.1007/s00330-020-07387-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES MRI remains the preferred imaging investigation for glioblastoma. Appropriate and timely neuroimaging in the follow-up period is considered to be important in making management decisions. There is a paucity of evidence-based information in current UK, European and international guidelines regarding the optimal timing and type of neuroimaging following initial neurosurgical treatment. This study assessed the current imaging practices amongst UK neuro-oncology centres, thus providing baseline data and informing future practice. METHODS The lead neuro-oncologist, neuroradiologist and neurosurgeon from every UK neuro-oncology centre were invited to complete an online survey. Participants were asked about current and ideal imaging practices following initial treatment. RESULTS Ninety-two participants from all 31 neuro-oncology centres completed the survey (100% response rate). Most centres routinely performed an early post-operative MRI (87%, 27/31), whereas only a third performed a pre-radiotherapy MRI (32%, 10/31). The number and timing of scans routinely performed during adjuvant TMZ treatment varied widely between centres. At the end of the adjuvant period, most centres performed an MRI (71%, 22/31), followed by monitoring scans at 3 monthly intervals (81%, 25/31). Additional short-interval imaging was carried out in cases of possible pseudoprogression in most centres (71%, 22/31). Routine use of advanced imaging was infrequent; however, the addition of advanced sequences was the most popular suggestion for ideal imaging practice, followed by changes in the timing of EPMRI. CONCLUSION Variations in neuroimaging practices exist after initial glioblastoma treatment within the UK. Multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment. KEY POINTS • Variations in imaging practices exist in the frequency, timing and type of interval neuroimaging after initial treatment of glioblastoma within the UK. • Large, multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment.
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Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK. .,Department of Neuroradiology Ruskin Wing, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Neuroradiology, National Hospital For Neurology and Neurosrgery, London, WC1N 3BG, UK
| | - Lucy Brazil
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Gerry Thompson
- Centre for Clinical Brain Sciences, Edinburgh, EH16 4SB, UK
| | - Rachel A Daniel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Haris Shuaib
- Department of Medical Physics, Guy's & St. Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Anmol Pandey
- Faculty of Life Sciences and Medicine, King's College London Strand, London, WC2R 2LS, UK
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17
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Gabrovsky N, Laleva M, Poptodorov G, Velinov N, Kamenova M, Kaneva R, Gabrovsky S. Impact of surgical treatment on the performance status of patients with high-grade gliomas. Neurol Res 2020; 42:1074-1079. [PMID: 32892718 DOI: 10.1080/01616412.2020.1802147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of our study is to evaluate the impact of neurosurgical operative treatment on the performance status assessed by the Karnofsky Performance Scale (KPS) in patients with HGG for the first, for the second intervention and for the different age groups. METHODS A group of 425 patients operated consecutively for high-grade gliomas were included in this study. The performance status was evaluated preoperatively and 15 days postoperatively with the KPS. Analyses for the different histological grade, tumor locations and age groups divided by decades have been made. RESULTS The initial, preoperative KPS score for patients with grade III tumor was 77.65 and for grade IV - 71.35. Following the first operation mean KPS has a statistically significant increase and reaches 82.24 and 78.41, respectively. The improvement of the performance status after the first operation was significant for all relevant age groups, including the sixth, seventh and eighth decades. Although the obtained mean KPS scores after the second operation did not show improvement there was also no clear evidence for worsening in this group of patients (n = 100) and the negative results obtained were not statistically significant. CONCLUSION According to our study, the first operation has a beneficial effect on the performance status in patients with HGG. The results for the second operation are more ambiguous, but there is no clear evidence for worsening of the KPS score after the second intervention. These results were relevant for all age groups, so we may expect amelioration in the performance status even in older patients.
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Affiliation(s)
- Nikolay Gabrovsky
- Department of Neurosurgery, University Hospital Pirogov , Sofia, Bulgaria
| | - Maria Laleva
- Department of Neurosurgery, University Hospital Pirogov , Sofia, Bulgaria
| | - George Poptodorov
- Department of Neurosurgery, University Hospital Pirogov , Sofia, Bulgaria
| | - Nikolay Velinov
- Department of Neurosurgery, University Hospital Pirogov , Sofia, Bulgaria
| | | | - Radka Kaneva
- Molecular Medicine Center, Medical University of Sofia , Sofia, Bulgaria
| | - Stefan Gabrovsky
- Department of Neurosurgery, University Hospital Pirogov , Sofia, Bulgaria
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18
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Tsitlakidis A, Aifantis EC, Kritis A, Tsingotjidou AS, Cheva A, Selviaridis P, Foroglou N. Mechanical properties of human glioma. Neurol Res 2020; 42:1018-1026. [PMID: 32705967 DOI: 10.1080/01616412.2020.1796381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Brain gliomas represent some of the most aggressive tumors encountered by modern medicine and, despite major efforts to optimize early diagnosis and treatment, the prognosis remains poor. Due to the complex structure of the brain and the unique mechanical properties of the extracellular matrix, gliomas invade and expand into the brain parenchyma, along white matter tracts and within perivascular spaces, usually sparing normal vessels. Different methods have been developed to study the mechanical properties of gliomas in a wide range of scales, from cells and the microscale to tissues and the macroscale. In this review, the current view on glioma mechanics is presented and the methods used to determine glioma mechanical properties are outlined. Their principles and current state of affairs are discussed.
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Affiliation(s)
- Abraham Tsitlakidis
- First Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Elias C Aifantis
- Laboratory of Mechanics and Materials, Polytechnic School, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Aristeidis Kritis
- Laboratory of Physiology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Anastasia S Tsingotjidou
- Laboratory of Anatomy, Histology and Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Panagiotis Selviaridis
- First Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
| | - Nicolas Foroglou
- First Department of Neurosurgery, AHEPA University Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece
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19
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Jakola AS, Sagberg LM, Gulati S, Solheim O. Advancements in predicting outcomes in patients with glioma: a surgical perspective. Expert Rev Anticancer Ther 2020; 20:167-177. [PMID: 32114857 DOI: 10.1080/14737140.2020.1735367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Diffuse glioma is a challenging neurosurgical entity. Although surgery does not provide a cure, it may greatly influence survival, brain function, and quality of life. Surgical treatment is by nature highly personalized and outcome prediction is very complex. To engage and succeed in this balancing act it is important to make best use of the information available to the neurosurgeon.Areas covered: This narrative review provides an update on advancements in predicting outcomes in patients with glioma that are relevant to neurosurgeons.Expert opinion: The classical 'gut feeling' is notoriously unreliable and better prediction strategies for patients with glioma are warranted. There are numerous tools readily available for the neurosurgeon in predicting tumor biology and survival. Predicting extent of resection, functional outcome, and quality of life remains difficult. Although machine-learning approaches are currently not readily available in daily clinical practice, there are several ongoing efforts with the use of big data sets that are likely to create new prediction models and refine the existing models.
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Affiliation(s)
- Asgeir Store Jakola
- Department of Clinical Neuroscience, Institute of Physiology and Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway
| | - Lisa Millgård Sagberg
- Department of Neurosurgery, St.Olavs Hospital, Trondheim, Norway.,Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Sasha Gulati
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,Department of Neurosurgery, St.Olavs Hospital, Trondheim, Norway
| | - Ole Solheim
- Department of Neuromedicine and Movement Science, NTNU, Trondheim, Norway.,Department of Neurosurgery, St.Olavs Hospital, Trondheim, Norway
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20
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Dimou J, Beland B, Kelly J. Supramaximal resection: A systematic review of its safety, efficacy and feasibility in glioblastoma. J Clin Neurosci 2019; 72:328-334. [PMID: 31864830 DOI: 10.1016/j.jocn.2019.12.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/01/2019] [Indexed: 02/03/2023]
Abstract
The philosophy of 'supramaximal resection' (SMR) beyond the T1-enhanced margin holds some potential in glioblastoma surgery, but the quality of available literature has not been elucidated. A systematic review of published studies of SMR in glioblastoma surgery was performed. Articles were sought in MEDLINE, EMBASE, Scopus and Cochrane Central Register for Clinical Trials. The search items were grouped into three themes; supramaximal resection, glioblastoma and outcomes. Cases were included wherein the initial extent of resection was described as exceeding gross total resection, that is to say, beyond the area of T1-enhancement on MRI. Only newly diagnosed glioblastoma was considered. Articles containing primary patient data, including outcome data, were included; reviews, editorials, descriptive articles and systematic reviews were excluded. Subsequently, 1123 unique articles were initially retrieved. After screening article titles and abstracts for relevance to SMR in glioblastoma, seven articles remained, and were all included post-full text review. No randomized controlled trials were discovered. Almost all studies were of Level 4 quality, according to Oxford Center for Evidence-Based Medicine guidelines. The included articles yielded a total of 2019 surgically treated glioblastoma patients, 13.5% of whom underwent SMR. Preliminary results suggest SMR of glioblastoma positively impacts overall and progression free survival. However, the contemporaneous literature supporting glioblastoma SMR is of low quality, with neither anatomical nor radiographic definitional consensus for what constitutes SMR. Prospective studies of larger pooled populations with standardized technical, radiological and outcome measures in designated centers would help minimize bias and validate SMR in appropriately selected glioblastoma patients.
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Affiliation(s)
- James Dimou
- Division of Neurosurgery, University of Calgary, Alberta, Canada.
| | - Benjamin Beland
- Division of Neurosurgery, University of Calgary, Alberta, Canada
| | - John Kelly
- Division of Neurosurgery, University of Calgary, Alberta, Canada
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Kim SH, Cho KH, Choi SH, Kim TM, Park CK, Park SH, Won JK, Kim IH, Lee ST. Prognostic Predictions for Patients with Glioblastoma after Standard Treatment: Application of Contrast Leakage Information from DSC-MRI within Nonenhancing FLAIR High-Signal-Intensity Lesions. AJNR Am J Neuroradiol 2019; 40:2052-2058. [PMID: 31727756 DOI: 10.3174/ajnr.a6297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/16/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Attempts have been made to quantify the microvascular leakiness of glioblastomas and use it as an imaging biomarker to predict the prognosis of the tumor. The purpose of our study was to evaluate whether the extraction fraction value from DSC-MR imaging within nonenhancing FLAIR hyperintense lesions was a better prognostic imaging biomarker than dynamic contrast-enhanced MR imaging parameters for patients with glioblastoma. MATERIALS AND METHODS A total of 102 patients with glioblastoma who received a preoperative dynamic contrast-enhanced MR imaging and DSC-MR imaging were included in this retrospective study. Patients were classified into the progression (n = 87) or nonprogression (n = 15) groups at 24 months after surgery. We extracted the means and 95th percentile values for the contrast leakage information parameters from both modalities within the nonenhancing FLAIR high-signal-intensity lesions. RESULTS The extraction fraction 95th percentile value was higher in the progression-free survival group of >24 months than at ≤24 months. The median progression-free survival of the group with an extraction fraction 95th percentile value of >13.32 was 17 months, whereas that of the group of ≤13.32 was 12 months. In addition, it was an independent predictor variable for progression-free survival in the patients regardless of their ages and genetic information. CONCLUSIONS The extraction fraction 95th percentile value was the only independent parameter for prognostic prediction in patients with glioblastoma among the contrast leakage information, which has no statistically significant correlations with the DCE-MR imaging parameters.
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Affiliation(s)
- S H Kim
- From the Departments of Radiology (S.H.K., K.H.C., S.H.C.)
| | - K H Cho
- From the Departments of Radiology (S.H.K., K.H.C., S.H.C.)
| | - S H Choi
- From the Departments of Radiology (S.H.K., K.H.C., S.H.C.)
- Center for Nanoparticle Research (S.H.C.), Institute for Basic Science, Seoul, Korea
- School of Chemical and Biological Engineering (S.H.C.), Seoul National University, Seoul, Korea
| | - T M Kim
- Departments of Internal Medicine (T.M.K.)
| | - C K Park
- Department of Neurosurgery (C.K.P.), Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - I H Kim
- Radiation Oncology (I.H.K.), Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - S T Lee
- Neurology (S.T.L.), Seoul National University College of Medicine, Seoul, Korea
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Certo F, Stummer W, Farah JO, Freyschlag C, Visocchi M, Morrone A, Altieri R, Toccaceli G, Peschillo S, Thomè C, Jenkinson M, Barbagallo G. Supramarginal resection of glioblastoma: 5-ALA fluorescence, combined intraoperative strategies and correlation with survival. J Neurosurg Sci 2019; 63:625-632. [PMID: 31355623 DOI: 10.23736/s0390-5616.19.04787-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Glioblastoma treatment requires a multidisciplinary approach involving oncologists, radiotherapists and surgeons. Surgery constitutes the initial step of the therapeutic strategy and its efficacy is dependent on the extent of resection (EOR). Over the last decade, the goal of surgical treatment was the resection of the contrast enhancement on T1 MRI, defined as gross-total resection (GTR). More recently, an increasing number of studies reports a positive impact on survival parameters of a more aggressive surgical strategy aiming to resect all peri-tumoral infiltrated areas. These areas are histologically characterized by the presence of pathological cells infiltrating normal white matter and surround the neoplastic core of glioblastoma identified by gadolinium enhancement in T1-weighted MR. Intuitively, the major risk of the so called supramarginal resection is related to the possibility of resecting functionally eloquent brain tissue. Several strategies have been proposed to maximize the safety of resection and minimize the occurrence of postoperative functional deficits. The aim of this review was to focus on the clinical impact of supramarginal resection of glioblastomas, highlighting the role of image-guided surgery combined with neuromonitoring to increase surgical safety and efficacy. EVIDENCE ACQUISITION The MEDLINE database has been queried for the literature research. EVIDENCE SYNTHESIS Ten studies matched the inclusion criteria, reporting a global number of 3221 patients. CONCLUSIONS The current evidence suggests a positive correlation between a more extensive resection based on FLAIR abnormal areas and overall survival.
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Affiliation(s)
- Francesco Certo
- Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy - .,Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy -
| | - Walter Stummer
- Department of Neurosurgery, University Hospital of Münster, Münster, Germany
| | - Jibril O Farah
- The Walton Centre for Neurology and Neurosurgery, Liverpool, UK
| | - Christian Freyschlag
- Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria
| | | | - Antonio Morrone
- Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy
| | - Roberto Altieri
- Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy
| | - Giada Toccaceli
- Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy
| | - Simone Peschillo
- Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy.,Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
| | - Claudius Thomè
- Department of Neurosurgery, Medizinische Universität Innsbruck, Innsbruck, Austria
| | | | - Giuseppe Barbagallo
- Department of Neurological Surgery, G. Rodolico Polyclinic University Hospital, Catania, Italy.,Interdisciplinary Research Center on Brain Tumors Diagnosis and Treatment, University of Catania, Catania, Italy
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Villanueva KG, Rea ND, Krieger MD. Novel Surgical and Radiologic Risk Factors for Progression or Recurrence of Pediatric Pilocytic Astrocytoma. Pediatr Neurosurg 2019; 54:375-385. [PMID: 31593969 DOI: 10.1159/000503110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pilocytic astrocytomas (PA) are a common, benign childhood tumor known for their slow growth rates and excellent prognosis. The aim of our study was to characterize patient, tumor, and imaging-related risk factors for recurrence and progression of disease. METHODS We identified 116 patients with PA who underwent surgery at our institution between 2000 and 2015. Data were collected retrospectively from the clinical charts. RESULTS The mean age at resection was 7 ± 5 years (range 0.5-31) and mean follow-up was 6 ± 3 years. Initial resection was complete in 33 patients (29%), subtotal in 78 patients (67%), and biopsy in 5 patients (4%). A total of 45/116 (40%) patients experienced either recurrence or progression after initial resection with a mean time to recurrence or progression of 2.2 years. Bivariate analysis identified subtotal resection, tumor location, age at diagnosis, and imaging features (i.e., T2 invasion, exophytic component, hemorrhage, and solid tumors) as factors significantly associated with recurrence or progression (p < 0.05). Conversely, PAs that were completely resected, predominately cystic, and located in the cerebellum were significantly associated with no recurrence or progression (p < 0.05). Multivariate regression analysis narrowed down 4 robust risk factors: extent of resection, T2 invasion, predominantly solid lesions, and presence of an exophytic component (p < 0.05). CONCLUSION Total surgical removal of PA has been the most important prognostic factor for the clinical course of PA. Our study reveals additional risk factors for the recurrence or progression of disease: tumor invasion, solid composition, and tumors with an exophytic component.
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Affiliation(s)
- Karie G Villanueva
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Nolan D Rea
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA,
| | - Mark D Krieger
- Division of Neurosurgery, Children's Hospital Los Angeles, Los Angeles, California, USA
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Nakashima T, Hatano N, Kanamori F, Muraoka S, Kawabata T, Takasu S, Watanabe T, Kojima T, Nagatani T, Seki Y. Tumor Volume Decrease via Feeder Occlusion for Treating a Large, Firm Trigone Meningioma. NMC Case Rep J 2017; 5:9-14. [PMID: 29354332 PMCID: PMC5767480 DOI: 10.2176/nmccrj.cr.2017-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/28/2017] [Indexed: 12/18/2022] Open
Abstract
Trigone meningiomas are considered a surgical challenge, as they tend to be considerably large and hypervascularized at the time of presentation. We experienced a case of a large and very hard trigone meningioma that was effectively treated using initial microsurgical feeder occlusion followed by surgery in stages. A 19-year-old woman who presented with loss of consciousness was referred to our hospital for surgical treatment of a brain tumor. Radiological findings were compatible with a left ventricular trigone meningioma extending laterally in proximity to the Sylvian fissure. At initial surgery using the transsylvian approach, main feeders originating from the anterior and lateral posterior choroidal arteries were occluded at the inferior horn; however, only a small section of the tumor could initially be removed because of its firmness. Over time, feeder occlusion resulted in tumor necrosis and a 20% decrease in its diameter; the mass effect was alleviated within 1 year. The residual meningioma was then totally excised in staged surgical procedures after resection became more feasible owing to ischemia-induced partial softening of the tumor. When a trigone meningioma is large and very hard, initial microsurgical feeder occlusion in the inferior horn can be a safe and effective option, and can lead to necrosis, volume decrease, and partial softening of the residual tumor to allow for its staged surgical excision.
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Affiliation(s)
- Takuma Nakashima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norikazu Hatano
- Department of Stroke Medicine, Kawashima Hospital, Nagoya, Aichi, Japan
| | - Fumiaki Kanamori
- Department of Neurosurgery, Tosei General Hospital, Seto, Aichi, Japan
| | - Shinsuke Muraoka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Teppei Kawabata
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Syuntaro Takasu
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tadashi Watanabe
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Takao Kojima
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Tetsuya Nagatani
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yukio Seki
- Department of Neurosurgery, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan
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Li P, Qian R, Niu C, Fu X. Impact of intraoperative MRI-guided resection on resection and survival in patient with gliomas: a meta-analysis. Curr Med Res Opin 2017; 33:621-630. [PMID: 28008781 DOI: 10.1080/03007995.2016.1275935] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study addressed the benefit of intraoperative magnetic resonance imaging (iMRI) compared with conventional neuronavigation-guided resection in patients with gliomas. RESEARCH DESIGN AND METHODS The Medline, PubMed, Cochrane, and Google Scholar databases were searched up to 26 September 2015. Randomized controlled trials (RCTs), two-arm prospective studies, and retrospective studies in patients with glioblastoma/glioma who had received surgical treatment were included. MAIN OUTCOME MEASURES The primary outcome measures were the extent of tumor resection and tumor size reduction for using iMRI-guided or conventional neuronavigation-guided neurosurgery. Secondary outcomes included impact of surgery on 6 month progression-free survival (PFS), 12 month overall survival (OS) rates and surgical duration. RESULTS We found that iMRI was associated with greater rate of gross total resection (rGTR) compared with conventional neuronavigation procedures (3.16, 95% confidence interval [CI] 2.07-4.83, P < .001). We found no difference between the two neuronavigation approaches in extent of resection (EOR), tumor size reduction, or time required for surgery (P values ≥.065). Intraoperative MRI was associated with a higher rate of progression-free survival (PFS) compared with conventional neuronavigation (odds ratio, 1.84; 95% CI 1.15-2.95; P = .012), but the rate of overall survival (OS) between groups was similar (P = .799). Limitations of the study included the fact that data from non-RCTs was used, the small study population, and heterogeneity of outcomes across studies. CONCLUSIONS Our findings indicate that iMRI more frequently resulted in more complete resections leading to improved PFS in patients with malignant gliomas.
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Affiliation(s)
- Ping Li
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
- b Department of Neurosurgery , South branch of Anhui Provincial Hospital, Anhui Provincial Cardiovascular and Cerebrovascular Hospital , Hefei , Anhui 230001 , P.R. China
| | - Ruobing Qian
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
| | - Chaoshi Niu
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
| | - Xianming Fu
- a Department of Neurosurgery , Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province Key Laboratory of Brain Function and Brain Disease , Hefei , Anhui , P.R. China
- b Department of Neurosurgery , South branch of Anhui Provincial Hospital, Anhui Provincial Cardiovascular and Cerebrovascular Hospital , Hefei , Anhui 230001 , P.R. China
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Volumetric Analysis Using Low-Field Intraoperative Magnetic Resonance Imaging for 168 Newly Diagnosed Supratentorial Glioblastomas: Effects of Extent of Resection and Residual Tumor Volume on Survival and Recurrence. World Neurosurg 2017; 98:73-80. [DOI: 10.1016/j.wneu.2016.10.109] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 11/18/2022]
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Czarnek N, Clark K, Peters KB, Mazurowski MA. Algorithmic three-dimensional analysis of tumor shape in MRI improves prognosis of survival in glioblastoma: a multi-institutional study. J Neurooncol 2017; 132:55-62. [DOI: 10.1007/s11060-016-2359-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/23/2016] [Indexed: 12/18/2022]
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Majós C, Cos M, Castañer S, Pons A, Gil M, Fernández-Coello A, Macià M, Bruna J, Aguilera C. Preradiotherapy MR Imaging: A Prospective Pilot Study of the Usefulness of Performing an MR Examination Shortly before Radiation Therapy in Patients with Glioblastoma. AJNR Am J Neuroradiol 2016; 37:2224-2230. [PMID: 27609621 DOI: 10.3174/ajnr.a4917] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 07/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Current protocols in patients with glioblastoma include performing an MR examination shortly after surgery and then 2-6 weeks after ending concomitant chemoradiotherapy. The assessment of this first postradiotherapy examination is challenging because the pseudoprogression phenomenon may appear. The aim of this study was to explore if performing an MR examination shortly before radiation therapy (preradiotherapy MR imaging) could improve the radiologic assessment of patients with glioblastoma. MATERIALS AND METHODS A preradiotherapy MR imaging examination was prospectively performed before the start of radiation therapy in 28 consecutive patients with glioblastoma who had undergone surgical resection. Tumor response to chemoradiotherapy was assessed twice: with the early postoperative MR examination as baseline and with the preradiotherapy MR imaging examination as baseline. In addition, tumor growth in the preradiotherapy MR imaging examination was evaluated, and its correlation with patient survival was assessed with Kaplan-Meier analysis and Cox regression. RESULTS Tumor progression after radiation therapy was found in 16 patients, corresponding to pseudoprogression in 7 of them (44%). Four assessments of pseudoprogression switched to partial response or stable disease when preradiotherapy MR imaging was the baseline examination, and the ratio of pseudoprogression was reduced to 25% (3 of 12). Significant differences in survival were found when patients were stratified according to the pattern of tumor growth on preradiotherapy MR imaging (median overall survival "no-growth," 837 days; "focal-growth," 582 days; "global-growth," 344 days; P = .001). CONCLUSIONS Performing a preradiotherapy MR imaging examination may improve the clinical management of patients with glioblastoma by reducing the ratio of pseudoprogression assessments and providing prognostic information.
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Affiliation(s)
- C Majós
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
- Centro de Investigación Red en Bioingeniería, Biomateriales y Nanomedicina (C.M., C.A.), Cerdanyola del Vallès, Spain
| | - M Cos
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
| | - S Castañer
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
| | - A Pons
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
| | - M Gil
- Medical Oncology, Institut Català d'Oncologia L'Hospitalet (M.G.)
| | | | - M Macià
- Radiotherapy Oncology, Institut Català d'Oncologia L'Hospitalet (M.M.)
| | - J Bruna
- Neurology (J.B.), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
- Institut d'Investigació Biomèdica de Bellvitge, IDIBELL (J.B.), L'Hospitalet de Llobregat, Spain
| | - C Aguilera
- From the Departments of Radiology, Institut de Diagnòstic per la Imatge (C.M., M.C., S.C., A.P., C.A.)
- Centro de Investigación Red en Bioingeniería, Biomateriales y Nanomedicina (C.M., C.A.), Cerdanyola del Vallès, Spain
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Jermyn M, Desroches J, Mercier J, Tremblay MA, St-Arnaud K, Guiot MC, Petrecca K, Leblond F. Neural networks improve brain cancer detection with Raman spectroscopy in the presence of operating room light artifacts. JOURNAL OF BIOMEDICAL OPTICS 2016; 21:94002. [PMID: 27604560 DOI: 10.1117/1.jbo.21.9.094002] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/18/2016] [Indexed: 05/20/2023]
Abstract
Invasive brain cancer cells cannot be visualized during surgery and so they are often not removed. These residual cancer cells give rise to recurrences. <italic<In vivo</italic< Raman spectroscopy can detect these invasive cancer cells in patients with grade 2 to 4 gliomas. The robustness of this Raman signal can be dampened by spectral artifacts generated by lights in the operating room. We found that artificial neural networks (ANNs) can overcome these spectral artifacts using nonparametric and adaptive models to detect complex nonlinear spectral characteristics. Coupling ANN with Raman spectroscopy simplifies the intraoperative use of Raman spectroscopy by limiting changes required to the standard neurosurgical workflow. The ability to detect invasive brain cancer under these conditions may reduce residual cancer remaining after surgery and improve patient survival.
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Affiliation(s)
- Michael Jermyn
- McGill University, Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, 3801 University Street, Montreal, Quebec H3A 2B4, CanadabPolytechnique Montreal, Department of Engineering Physics, CP 6079, Succ. Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Joannie Desroches
- Polytechnique Montreal, Department of Engineering Physics, CP 6079, Succ. Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Jeanne Mercier
- Polytechnique Montreal, Department of Engineering Physics, CP 6079, Succ. Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Marie-Andrée Tremblay
- Polytechnique Montreal, Department of Engineering Physics, CP 6079, Succ. Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Karl St-Arnaud
- Polytechnique Montreal, Department of Engineering Physics, CP 6079, Succ. Centre-Ville, Montreal, Quebec H3C 3A7, Canada
| | - Marie-Christine Guiot
- McGill University, Division of Neuropathology, Department of Pathology, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
| | - Kevin Petrecca
- McGill University, Montreal Neurological Institute and Hospital, Department of Neurology and Neurosurgery, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
| | - Frederic Leblond
- Polytechnique Montreal, Department of Engineering Physics, CP 6079, Succ. Centre-Ville, Montreal, Quebec H3C 3A7, CanadadCentre de Recherche du Centre Hospitalier de l'Université de Montréal, 900 rue Saint-Denis, H2X 0A9 Quebec, Canada
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Resection of C6 gliomas in rats with the aid of the waterjet technique. Clin Neurol Neurosurg 2016; 146:57-63. [PMID: 27152467 DOI: 10.1016/j.clineuro.2016.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 04/08/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES While clinically the safety and efficacy of waterjet resection of brain tumors have been shown, evidence that waterjet dissection improves tumor resection radicality in comparison with conventional techniques is still missing. In the present study, resection radicality and tumor-free long-term survival of both techniques were evaluated in a C6-glioma model. MATERIAL AND METHODS Fifty-thousand C6-glioma cells were stereotactically transplanted in the left frontal lobe of 100 male Sprague-Dawley rats. After MRI-scanning for evaluation of tumor extension, microsurgical tumor resection was performed with conventional techniques (n=50) or with the waterjet dissector at pressures of 6bar (n=50). Twenty-five animals of each group were sacrificed after surgery for histological analysis. For analysis of survival after tumor resection, twenty-five animals of each group were followed-up to analyze tumor-free survival using the Kaplan Meier method. RESULTS In the waterjet group, the resection cavity was free of C6-tumor cells in 10/25 (40%) rats showing a trend (p=0.3) towards better resection radicality compared to the rats that were treated conventionally (7/10; 28%). R1-resection with up to 250C6 cells/object slice was found in 14/25 (56%) rats after waterjet dissection compared to 6/25 (24%) rats treated conventionally showing significance (p<0.01). Probability of survival was 38% after 2 weeks and 20% after 6 months in the waterjet group compared to 30% and 16% respectively in the conventional group. Diffuse tumor cell spreading with possible influence on survival was shown in 47/50 rats. CONCLUSION In this experimental model, waterjet tumor resection did reveal significantly better resection radicality compared to the conventional technique. Although a direct transfer of these results to human glioma surgery is prohibited, the waterjet technique might contribute to the best possible resection radicality in human gliomas. Nevertheless, tumor cell spreading remains a major problem. Further studies have to address that the surgical results - in deed - improve the postoperative outcome.
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Schär RT, Fiechter M, Z'Graggen WJ, Söll N, Krejci V, Wiest R, Raabe A, Beck J. No Routine Postoperative Head CT following Elective Craniotomy--A Paradigm Shift? PLoS One 2016; 11:e0153499. [PMID: 27077906 PMCID: PMC4831779 DOI: 10.1371/journal.pone.0153499] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 03/29/2016] [Indexed: 12/16/2022] Open
Abstract
Introduction Patient management following elective cranial surgery often includes routine postoperative computed tomography (CT). We analyzed whether a regime of early extubation and close neurological monitoring without routine CT is safe, and compared the rate of postoperative emergency neurosurgical intervention with published data. Methods Four hundred ninety-two patients were prospectively analyzed; 360 had supra- and 132 had infratentorial lesions. Extubation within one hour after skin closure was aimed for in all cases. CT was performed within 48 hours only in cases of unexpected neurological findings. Results Four-hundred sixty-nine of the 492 patients (95.3%) were extubated within one hour, 20 (4.1%) within 3 hours, and three (0.6%) within 3 to 10 hours. Emergency CT within 48 hours was performed for 43/492 (8.7%) cases. Rate of recraniotomy within 48 hours for patients with postoperative hemorrhage was 0.8% (n = 4), and 0.8% (n = 4) required placement of an external ventricular drain (EVD). Of 469 patients extubated within one hour, 3 required recraniotomy and 2 required EVD placements. Of 23 patients with delayed extubation, 1 recraniotomy and 2 EVDs were required. Failure to extubate within one hour was associated with a significantly higher risk of surgical intervention within 48 hours (rate 13.0%, p = 0.004, odds ratio 13.9, 95% confidence interval [3.11–62.37]). Discussion Early extubation combined with close neurological monitoring is safe and omits the need for routine postoperative CT. Patients not extubated within one hour do need early CT, since they had a significantly increased risk of requiring emergency neurosurgical intervention. Trial Registration ClinicalTrials.gov NCT01987648
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Affiliation(s)
- Ralph T. Schär
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Fiechter
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Werner J. Z'Graggen
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicole Söll
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vladimir Krejci
- Department of Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Department of Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- * E-mail:
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Ahmadi R, Campos B, Haux D, Rieke J, Beigel B, Unterberg A. Assessing perioperative complications associated with use of intraoperative magnetic resonance imaging during glioma surgery – a single centre experience with 516 cases. Br J Neurosurg 2016; 30:397-400. [DOI: 10.3109/02688697.2016.1161726] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bette S, Kaesmacher J, Huber T, Delbridge C, Ringel F, Boeckh-Behrens T, Meyer B, Zimmer C, Kirschke JS, Gempt J. Value of Early Postoperative FLAIR Volume Dynamic in Glioma with No or Minimal Enhancement. World Neurosurg 2016; 91:548-559.e1. [PMID: 27004759 DOI: 10.1016/j.wneu.2016.03.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/11/2016] [Accepted: 03/12/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The evaluation of postoperative magnetic resonance imaging (MRI) in glioma with no or minimal enhancement is controversial because the evaluation of residual tumor volume can be biased. The purpose of this study was to clarify the value of early postoperative and 3-month MRI regarding its validity in predicting recurrent disease. METHODS For this retrospective, single-center study, overall fluid attenuated inversion recovery (FLAIR) volumes (early postoperative [<48 hours] and 3-month MRI including FLAIR and T1-weighted sequences with and without contrast agent) of 99 patients were assessed using manual segmentation. FLAIR volume dynamic over the first 3 months after surgery and its effect on disease recurrence were evaluated while considering histopathologic features. RESULTS Overall FLAIR-hyperintense volume significantly decreased between early postoperative and 3-month follow-up MRIs (P < 0.001). Early FLAIR volume increase had a high positive predictive value for overall disease recurrence after resection (85.71% [95%-CI: 62.64-96.24]). Early FLAIR volume dynamic (P < 0.001), isocitrate dehydrogenase 1/2 status (P = 0.002), and preoperative Karnofsky Performance Status (P = 0.012) were observed as independent factors for progression-free survival in multivariate analysis. CONCLUSION Early postoperative FLAIR volume assessment in gliomas with no or minimal enhancement is susceptible to a systematic overestimation of residual tumors. Nevertheless, early FLAIR volume dynamic is an independent factor for tumor recurrence that should be evaluated in order timely adapt surveillance and therapy regimens accordingly.
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Affiliation(s)
- Stefanie Bette
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Johannes Kaesmacher
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Thomas Huber
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claire Delbridge
- Department of Neuropathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Florian Ringel
- Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Boeckh-Behrens
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Meyer
- Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jens Gempt
- Department of Neurorsurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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The influence of intraoperative resection control modalities on survival following gross total resection of glioblastoma. Neurosurg Rev 2016; 39:401-9. [PMID: 26860420 DOI: 10.1007/s10143-015-0698-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 09/25/2015] [Accepted: 10/31/2015] [Indexed: 10/22/2022]
Abstract
The purpose of the present study is to analyze the impact of intraoperative resection control modalities on overall survival (OS) and progression-free survival (PFS) following gross total resection (GTR) of glioblastoma. We analyzed data of 76 glioblastoma patients (30f, mean age 57.4 ± 11.6 years) operated at our institution between 2009 and 2012. Patients were only included if GTR was achieved as judged by early postoperative high-field MRI. Intraoperative technical resection control modalities comprised intraoperative ultrasound (ioUS, n = 48), intraoperative low-field MRI (ioMRI, n = 22), and a control group without either modality (n = 11). The primary endpoint of our study was OS, and the secondary endpoint was PFS-both analyzed in Kaplan-Meier plots and Cox proportional hazards models. Median OS in all 76 glioblastoma patients after GTR was 20.4 months (95 % confidence interval (CI) 18.5-29.0)-median OS in patients where GTR was achieved using ioUS was prolonged (21.9 months) compared to those without ioUS usage (18.8 months). A multiple Cox model adjusting for age, preop Karnofsky performance status, tumor volume, and the use of 5-aminolevulinic acid showed a beneficial effect of ioUS use, and the estimated hazard ratio was 0.63 (95 % CI 0.31-1.2, p = 0.18) in favor of ioUS, however not reaching statistical significance. A similar effect was found for PFS (hazard ratio 0.59, p = 0.072). GTR of glioblastoma performed with ioUS guidance was associated with prolonged OS and PFS. IoUS should be compared to other resection control devices in larger patient cohorts.
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Guyotat J, Pallud J, Armoiry X, Pavlov V, Metellus P. 5-Aminolevulinic Acid-Protoporphyrin IX Fluorescence-Guided Surgery of High-Grade Gliomas: A Systematic Review. Adv Tech Stand Neurosurg 2016:61-90. [PMID: 26508406 DOI: 10.1007/978-3-319-21359-0_3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The current first-line treatment of malignant gliomas consists in surgical resection (if possible) as large as possible. The existing tools don't permit to identify the limits of tumor infiltration, which goes beyond the zone of contrast enhancement on MRI. The fluorescence-guided malignant gliomas surgery was started 15 years ago and had become a standard of care in many countries. The technique is based on fluorescent molecule revelation using the filters, positioned within the surgical microscope. The fluorophore, protoporphyrin IX (PpIX), is converted in tumoral cells from 5-aminolevulinic acid (5-ALA), given orally before surgery. Many studies have shown that the ratio of gross total resections was higher if the fluorescence technique was used. The fluorescence signal intensity is correlated to the cell density and the PpIX concentration. The current method has a very high specificity but still lower sensibility, particularly regarding the zones with poor tumoral infiltration. This book reviews the principles of the technique and the results (extent of resection and survival).
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Affiliation(s)
- Jacques Guyotat
- Department of Neurosurgery, Neurological Hospital, Lyon, France.
| | - Johan Pallud
- Department of Neurosurgery, Sainte Anne Hospital, Paris, France.
- Paris Descartes University, Paris, France.
| | - Xavier Armoiry
- Délégation à la recherche clinique et à l'innovation, cellule innovation Hospices Civils de, Lyon, France.
| | - Vladislav Pavlov
- Department of Neurosurgery, Neurological Hospital, Lyon, France.
| | - Philippe Metellus
- Department of Neurosurgery, Timone Hospital, Marseille, France.
- University Aix Marseille, Marseille, France.
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Abstract
Neurosurgical intervention remains the first step in effective glioma management. Mounting evidence suggests that cytoreduction for low- and high-grade gliomas is associated with a survival benefit. Beyond conventional neurosurgical principles, an array of techniques have been refined in recent years to maximize the effect of the neurosurgical oncologist and facilitate the impact of subsequent adjuvant therapy. With intraoperative mapping techniques, aggressive microsurgical resection can be safely pursued even when tumors occupy essential functional pathways. Other adjunct techniques, such as intraoperative magnetic resonance imaging, intraoperative ultrasonography, and fluorescence-guided surgery, can be valuable tools to safely reduce the tumor burden of low- and high-grade gliomas. Taken together, this collection of surgical strategies has pushed glioma extent of resection towards the level of cellular resolution.
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Affiliation(s)
- Colin Watts
- Department of Clinical Neurosciences, Division of Neurosurgery, University of Cambridge, Cambridge, UK.
| | - Nader Sanai
- Barrow Brain Tumor Research Center, Barrow Neurological Institute, Phoenix, AZ, USA
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Masuda Y, Ishikawa E, Yamamoto T, Matsuda M, Akutsu H, Kohzuki H, Nakai K, Okamoto E, Takano S, Masumoto T, Matsumura A. Early Postoperative Expansion of Parenchymal High-intensity Areas on T2-weighted Imaging Predicts Delayed Cerebral Edema Caused by Carmustine Wafer Implantation in Patients with High-grade Glioma. Magn Reson Med Sci 2015; 15:299-307. [PMID: 26726015 PMCID: PMC5608126 DOI: 10.2463/mrms.mp.2015-0054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Carmustine (BCNU) wafer (Gliadel® Wafer) implantation after tumor resection is an approved treatment for high-grade glioma (HGG). These wafers change various characteristics on early postoperative magnetic resonance imaging (ep-MRI) including slight expansion of high-intensity areas on T2-weighted imaging (ep-T2-HIAs) into adjacent parenchyma without restricted diffusivity. We assessed the frequency of the ep-T2-HIAs after BCNU wafer implantation in HGG patients. Moreover, we focused on ep-T2-HIA expansion and its relation to delayed cerebral edema. Methods: Twenty-five consecutive HGG patients who underwent BCNU wafer implantation were assessed. First, patients were divided into ep-T2-HIA and non-ep-T2-HIA groups, and the incidence of delayed adverse effects was compared between the two groups. Subsequently, the patients were divided into delayed edema and non-delayed edema groups, and pre-, intra-, and postoperative data were compared between the two groups. Results: The ep-T2-HIA expansion and the delayed edema were evident in 9 cases (36%) and 12 cases (48%), respectively. In comparison of the ep-T2-HIA and non-ep-T2-HIA groups, delayed edema was the only delayed adverse effect associated with ep-T2-HIA expansion (P = 0.004). Univariate analysis showed a significantly higher ratio of delayed edema in the subgroups with maximal diameter of removed cavity ≤40 mm (P = 0.047) and the ep-T2-HIA expansion in comparison of the delayed edema and non-delayed edema groups. Multivariate analysis showed that the ep-T2-HIA expansion was the only independent factor associated with delayed edema (P = 0.021). Conclusion: In BCNU wafer implantation cases, ep-T2-HIA expansion was a predictive factor for delayed cerebral edema.
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Affiliation(s)
- Yosuke Masuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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Shields LBE, Shelton BJ, Shearer AJ, Chen L, Sun DA, Parsons S, Bourne TD, LaRocca R, Spalding AC. Dexamethasone administration during definitive radiation and temozolomide renders a poor prognosis in a retrospective analysis of newly diagnosed glioblastoma patients. Radiat Oncol 2015; 10:222. [PMID: 26520780 PMCID: PMC4628380 DOI: 10.1186/s13014-015-0527-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/19/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Dexamethasone (DXM) is commonly used in the management of cerebral edema in patients diagnosed with glioblastoma multiforme (GBM). Bevacizumab (BEV) is FDA-approved for the progression or recurrence of GBM but has not been shown to improve survival when given for newly diagnosed patients concurrently with radiation (RT) and temozolomide (TMZ). Both DXM and BEV reduce cerebral edema, however, DXM has been shown to induce cytokine cascades which could interfere with cytotoxic therapy. We investigated whether DXM would reduce survival of GBM patients in the setting of concurrent TMZ and BEV administration. METHODS We reviewed the treatment of all 73 patients with GBM who received definitive therapy at our institution from 2005 to 2013 with RT (60 Gy) delivered with concurrent daily TMZ (75 mg/m(2)). Of these, 34 patients also were treated with concurrent BEV (10 mg/kg every two weeks). Patients received adjuvant therapy (TMZ or TMZ/Bev) until either progression, discontinuation due to toxicity, or 12 months after radiation completion. All patients who had GBM progression with TMZ were offered BEV for salvage therapy, with 19 (56 %) receiving BEV. RESULTS With a median follow-up of 15.6 months, 67 (91.8 %) patients were deceased. The OS for the entire cohort was 15.9 months, while the PFS was 7.7 months. The extent of resection was a prognostic indicator for OS (p = .0044). The median survival following gross tumor resection (GTR) was 22.5 months, subtotal resection (STR) was 14.9 months, and biopsy was 12.1 months. The addition of BEV to TMZ with RT was borderline significantly associated with increased PFS (9.4 vs. 5.1 months, p = 0.0574) although was not significantly associated with OS (18.1 vs. 15.3 months respectively, p = 0.3064). In patients receiving TMZ, DXM use concurrent with RT was a poor prognostic indicator of both OS (12.7 vs. 22.6 months, p = 0.003) and PFS (3.6 vs. 8.4 months, p <0.0001). DXM did not reduce OS in patients who received TMZ and BEV concurrently with RT (22.9 vs 22.8 months, p = 0.4818). On multivariable analysis, DXM use predicted an unfavorable OS hazard ratio (HR) = 1.72, p = 0.045). CONCLUSIONS Our results with TMZ, BEV, and RT are similar to previous studies in terms of PFS and OS. DXM use during RT with concurrent TMZ correlated with reduced OS and PFS unless BEV was administered.
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Affiliation(s)
- Lisa B E Shields
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA. .,The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA.
| | - Brent J Shelton
- The Markey Cancer Center, University of Kentucky School of Medicine, Lexington, KY, USA.
| | - Andrew J Shearer
- The Markey Cancer Center, University of Kentucky School of Medicine, Lexington, KY, USA.
| | - Li Chen
- The Markey Cancer Center, University of Kentucky School of Medicine, Lexington, KY, USA.
| | - David A Sun
- Norton Neuroscience Institute, Norton Healthcare, Louisville, KY, USA. .,The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA.
| | - Sarah Parsons
- The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA. .,The Norton Cancer Institute, Norton Healthcare, Louisville, KY, USA.
| | - T David Bourne
- The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA.
| | - Renato LaRocca
- The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA. .,The Norton Cancer Institute, Norton Healthcare, Louisville, KY, USA.
| | - Aaron C Spalding
- The Brain Tumor Center, Norton Healthcare, Louisville, KY, USA. .,The Norton Cancer Institute, Norton Healthcare, Louisville, KY, USA. .,The Norton Cancer Institute Radiation Center, 676 S. Floyd St., Suite 100, Louisville, KY, 40202, USA.
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Lee EK, Choi SH, Yun TJ, Kang KM, Kim TM, Lee SH, Park CK, Park SH, Kim IH. Prediction of Response to Concurrent Chemoradiotherapy with Temozolomide in Glioblastoma: Application of Immediate Post-Operative Dynamic Susceptibility Contrast and Diffusion-Weighted MR Imaging. Korean J Radiol 2015; 16:1341-8. [PMID: 26576125 PMCID: PMC4644757 DOI: 10.3348/kjr.2015.16.6.1341] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 07/22/2015] [Indexed: 11/15/2022] Open
Abstract
Objective To determine whether histogram values of the normalized apparent diffusion coefficient (nADC) and normalized cerebral blood volume (nCBV) maps obtained in contrast-enhancing lesions detected on immediate post-operative MR imaging can be used to predict the patient response to concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ). Materials and Methods Twenty-four patients with GBM who had shown measurable contrast enhancement on immediate post-operative MR imaging and had subsequently undergone CCRT with TMZ were retrospectively analyzed. The corresponding histogram parameters of nCBV and nADC maps for measurable contrast-enhancing lesions were calculated. Patient groups with progression (n = 11) and non-progression (n = 13) at one year after the operation were identified, and the histogram parameters were compared between the two groups. Receiver operating characteristic (ROC) analysis was used to determine the best cutoff value for predicting progression. Progression-free survival (PFS) was determined with the Kaplan-Meier method and the log-rank test. Results The 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033). ROC analysis showed that the best cutoff value for predicting progression after CCRT was 5.537 (sensitivity and specificity were 72.7% and 76.9%, respectively). The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026). Conclusion The nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.
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Affiliation(s)
- Eun Kyoung Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea. ; Center for Nanoparticle Research, Institute for Basic Science, and School of Chemical and Biological Engineering, Seoul National University, Seoul 08826, Korea
| | - Tae Jin Yun
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Tae Min Kim
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Se-Hoon Lee
- Department of Internal Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Cancer Research Institute, Seoul National University College of Medicine, Seoul 03080, Korea
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Kamp MA, Rapp M, Bühner J, Slotty PJ, Reichelt D, Sadat H, Dibué-Adjei M, Steiger HJ, Turowski B, Sabel M. Early postoperative magnet resonance tomography after resection of cerebral metastases. Acta Neurochir (Wien) 2015; 157:1573-80. [PMID: 26156037 DOI: 10.1007/s00701-015-2479-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 06/12/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND In contrast to malignant gliomas, the impact of an early postoperative MRI after surgery of cerebral metastasis is still unclear. The present study analyses early MRI-based postoperative resection controls and incidence of in-brain progression in 116 patients suffering from 130 cerebral metastases. METHODS The extent of surgical resection was verified by an early postoperative contrast-enhanced 1.5-T MRI within 72 h after surgery of cerebral metastases and correlated with in-brain progression, leptomeningeal carcinomatosis, and progression-free survival. RESULTS MRI confirmed complete resection was seen in 80 out of 130 metastases (61.5 %). In 24 metastases (18.5 %), no final decision on degree of resection could be made. Residual tumor was seen in 26 cases (20 %). Local in-brain progression was observed in 40 of 130 (30.8 %) cases. The incidence of in-brain progression significantly correlated with dural contact of the metastasis (p < 0.05) and residual tumor on early postoperative MRI (p < 0.0001). The odds ratio for local recurrence with residual tumor is 8.2-fold compared to no residual tumor. CONCLUSIONS Residual tumor after metastasis extirpation was shown in nearly 20 % of patients by an early postoperative MRI and significantly correlated with local in-brain progression. Furthermore, dural contact of cerebral metastases was identified as a risk factor for local recurrence. Further studies are mandatory to clearly identify the incidence of incomplete resections of cerebral metastases and their oncologic impact. An early postoperative MRI after resection of cerebral metastases is recommended as residual tumor promotes local recurrence.
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Affiliation(s)
- Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstraße 5, Düsseldorf, Germany,
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Chan M, Lux J, Nishimura T, Akiyoshi K, Almutairi A. Long-Lasting and Efficient Tumor Imaging Using a High Relaxivity Polysaccharide Nanogel Magnetic Resonance Imaging Contrast Agent. Biomacromolecules 2015; 16:2964-71. [DOI: 10.1021/acs.biomac.5b00867] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | - Tomoki Nishimura
- Department
of Polymer Chemistry, Graduate School of Engineering, Kyoto University, Katsura, Nishikyo-ku, Kyoto 615-8510, Japan
- Japan
Science and Technology Agency (JST), The Exploratory Research for
Advanced Technology (ERATO), Bionanotransporter Project, Katsura Int’tech Center, Katsura, Nishikyo-ku, Kyoto 615-8530, Japan
| | - Kazunari Akiyoshi
- Department
of Polymer Chemistry, Graduate School of Engineering, Kyoto University, Katsura, Nishikyo-ku, Kyoto 615-8510, Japan
- Japan
Science and Technology Agency (JST), The Exploratory Research for
Advanced Technology (ERATO), Bionanotransporter Project, Katsura Int’tech Center, Katsura, Nishikyo-ku, Kyoto 615-8530, Japan
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Tang W, Wang X, Chen Y, Zhang J, Chen Y, Lin Z. CXCL12 and CXCR4 as predictive biomarkers of glioma recurrence pattern after total resection. ACTA ACUST UNITED AC 2015; 63:190-8. [PMID: 26277915 DOI: 10.1016/j.patbio.2015.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/15/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE OF THE STUDY Previous studies have shown that the pattern of recurrence for glioma is related to the direction of glioma cell invasion. Recent studies demonstrated that the CXCL12/CXCR4 signaling pathway mediates cellular invasion in glioma. Therefore, in this study, we investigated the possible relationship between CXCL12/CXCR4 expression and recurrence pattern in glioma. PATIENTS AND METHODS Immunohistochemical techniques were used to assess CXCL12/CXCR4 expression in 42 glioma tissues following total resection. According to magnetic resonance imaging (MRI) of gliomas, the recurrence pattern was classified as close or distant pattern. The relationship between recurrence pattern and CXCL12/CXCR4 expression were initially examined by Chi-squared analysis. The prognostic significance of CXCL12 and CXCR4 was determined by log-rank tests and COX proportional hazards model. RESULTS CXCL12 was expressed mainly in vascular endothelial cells and CXCR4 was expressed mainly in tumor cells. The recurrence pattern was significantly related to the expression level of CXCL12 in vascular endothelial cells (P=0.002) and CXCR4 in tumor cells (P=0.004). However, CXCL12 and CXCR4 were not independent prognostic factors for progression-free survival or overall survival in glioma patients. CONCLUSION The glioma recurrence pattern is related to CXCL12 expression levels in vascular endothelial cells and CXCR4 expression levels in tumor cells; thus, implicating the CXCL12/CXCR4 signaling pathway as a potential target for glioma therapy.
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Affiliation(s)
- W Tang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Cazhong Road, Fuzhou, Fujian, China
| | - X Wang
- Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Y Chen
- Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - J Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Cazhong Road, Fuzhou, Fujian, China
| | - Y Chen
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Cazhong Road, Fuzhou, Fujian, China
| | - Z Lin
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Cazhong Road, Fuzhou, Fujian, China; Department of Neurosurgery, Beijing Sanbo Brain Hospital, 50 Xiangshanyikesong Road, Haidian District, Beijing, China.
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Early post-operative magnetic resonance imaging in glioblastoma: correlation among radiological findings and overall survival in 60 patients. Eur Radiol 2015; 26:1048-55. [PMID: 26188660 DOI: 10.1007/s00330-015-3914-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 06/15/2015] [Accepted: 07/01/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To evaluate early post-operative magnetic resonance (EPMR) as a prognostic tool after resection of glioblastoma. METHODS Sixty EPMR examinations were evaluated for perioperative infarct, tumour growth between diagnosis and EPMR, contrast enhancement pattern, and extent of resection (EOR). The EOR was approached with the subjective evaluation of radiologists and by quantifying volumes. These parameters were tested as predictors of survival using the Kaplan-Meier method. RESULTS Contrast enhancement was found in 59 patients (59/60; 98 %). Showing a thin-linear pattern of enhancement was the most favourable finding. Patients with this pattern survived longer than patients with thick-linear (median overall survival (OS) thin-linear=609 days; thick-linear=432 days; P = .023) or nodular (median OS = 318 days; P = .001) enhancements. The subjective evaluation of the EOR performed better than its quantification. Patients survived longer when resection was total (median OS total resection=609 days; subtotal=371 days; P = .001). When resection was subtotal, patients survived longer if it was superior to 95 % (median OS resection superior to 95 %=559 days; inferior to 95 %=256 days; P = .034). CONCLUSIONS EPMR provides valuable prognostic information after surgical resection of glioblastomas. A thin-linear pattern of contrast enhancement is the most favourable finding. Further prognostic stratification may be obtained by assessing the EOR. KEY POINTS • Some kind of contrast enhancement may be found in most EPMR examinations. • Thin-linear enhancements in the EPMR may be considered benign findings. • The EOR evaluated in the EPMR may stratify prognostic groups of patients. • The subjective evaluation of the EOR performs slightly better than its quantification.
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Abstract
OPINION STATEMENT Treatment of patients with high-grade glioma (HGG) should begin with thorough evaluation by a specialized multidisciplinary team to determine whether or not the patient is appropriate for surgery, chemotherapy and radiotherapy. Particular attention should be paid to the performance status and neurological function. Surgery is the first step in therapeutic intervention. Patients undergo either biopsy, debulking surgery or maximal resection depending on the anatomical location of the tumour and the patient's clinical condition. Extent of resection has a prognostic value. In patients who are 'fit for surgery', the aim is to remove all contrast-enhancing tumour without causing neurological deficit. If microsurgical resection is not feasible, then a biopsy, either open or stereotactic, should be performed to confirm high-grade glioma diagnosis and to perform molecular genetic analyses (MGMT methylation status, loss of heterozygosity in 1p/19q, IDH1 status) as this has treatment implications. Over the past decade, much glioma research has focussed on novel surgical approaches to improve long-term outcomes. The evidence to support the benefit of maximizing extent of resection is growing. Advances in neurosurgical techniques allow safer, more aggressive surgery to maximize tumour resection whilst minimizing neurological deficit. Surgical adjuncts including advanced neuronavigation, intraoperative magnetic resonance imaging, high-frequency ultrasonography, fluorescence-guided microsurgery using intraoperative fluorescence, functional mapping of motor and language pathways, and locally delivered therapies are extending the armamentarium of the neurosurgeon to provide patients with the best outcome. Operating on elderly patients and those with recurrent disease, although controversial, is becoming more common due to emerging neurosurgical approaches. Here, we discuss the emerging surgical techniques and comment on the future of HGG surgery.
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Affiliation(s)
- Fahid Tariq Rasul
- Department of Clinical Neurosciences, Brain Repair Centre, University of Cambridge, ED Adrian Building, Forvie Site, Robinson Way, Cambridge, CB2 0PY, UK,
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Díez Valle R, Tejada Solis S. To what extent will 5-aminolevulinic acid change the face of malignant glioma surgery? CNS Oncol 2015; 4:265-72. [PMID: 26118538 DOI: 10.2217/cns.15.10] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Glioma surgery is an essential part of glioma management; however, fully achieving the goal of surgery has been uncommon. The goal of surgery is 'maximal safe resection' with the accepted target for maximal being complete resection of the contrast-enhancing tumor. This ideal result was obtained in less than 30% of cases in centers of excellence until a few years ago. The development of fluorescence-guided surgery using 5-aminolevulinic acid has initiated a radical change. Over the past 5 years, various groups have published rates of complete resection of the enhancing tumor that exceed 80%. In the coming years, as the use of the technology expands, complete resection should become a common, predictable result at many centers. Consequently, adjuvant therapies that benefit from resection could play a bigger role, resection could be incorporated as a variable in randomized trials and distant recurrence might become a more common problem.
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Affiliation(s)
- Ricardo Díez Valle
- Department of Neurosurgery, Clínica Universidad de Navarra, Navarre, Spain
| | - Sonia Tejada Solis
- Department of Neurosurgery, Clínica Universidad de Navarra, Navarre, Spain
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Olubiyi OI, Ozdemir A, Incekara F, Tie Y, Dolati P, Hsu L, Santagata S, Chen Z, Rigolo L, Golby AJ. Intraoperative Magnetic Resonance Imaging in Intracranial Glioma Resection: A Single-Center, Retrospective Blinded Volumetric Study. World Neurosurg 2015; 84:528-36. [PMID: 25937354 DOI: 10.1016/j.wneu.2015.04.044] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intraoperative magnetic resonance imaging (IoMRI) was devised to overcome brain shifts during craniotomies. Yet, the acceptance of IoMRI is limited. OBJECTIVE To evaluate impact of IoMRI on intracranial glioma resection outcome including overall patient survival. METHODS A retrospective review of records was performed on a cohort of 164 consecutive patients who underwent resection surgery for newly diagnosed intracranial gliomas either with or without IoMRI technology performed by 2 neurosurgeons in our center. Patient follow-up was at least 5 years. Extent of resection (EOR) was calculated using pre- and postoperative contrast-enhanced and T2-weighted MR-images. Adjusted analysis was performed to compare gross total resection (GTR), EOR, permanent surgery-associated neurologic deficit, and overall survival between the 2 groups. RESULTS Overall median EOR was 92.1%, and 97.45% with IoMRI use and 89.9% without IoMRI, with crude (unadjusted) P < 0.005. GTR was achieved in 49.3% of IoMRI cases, versus in only 21.4% of no-IoMRI cases, P < 0.001. GTR achieved was more with the use of IoMRI among gliomas located in both eloquent and noneloquent brain areas, P = 0.017 and <0.001, respectively. Permanent surgery-associated neurologic deficit was not (statistically) more significant with no-IoMRI, P = 0.284 (13.8% vs. 6.7%). In addition, the IoMRI group had better 5-year overall survival, P < 0.001. CONCLUSION This study shows that the use of IoMRI was associated with greater rates of EOR and GTR, and better overall 5-year survival in both eloquent brain areas located and non-eloquent brain areas located gliomas, with no increased risk of neurologic complication.
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Affiliation(s)
- Olutayo Ibukunolu Olubiyi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Aysegul Ozdemir
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Haseki Training and Research Hospital, Cad. Fatih, Istanbul, Turkey
| | - Fatih Incekara
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Erasmus Medical Center Rotterdam, Netherlands
| | - Yanmei Tie
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Parviz Dolati
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Liangge Hsu
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Zhenrui Chen
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Jinling Hospital, Southern Medical University, Nanjing, Jiangsu, China
| | - Laura Rigolo
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexandra J Golby
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Geßler F, Dützmann S, Quick J, Tizi K, Voigt MA, Mutlak H, Vatter H, Seifert V, Senft C. Is postoperative imaging mandatory after meningioma removal? Results of a prospective study. PLoS One 2015; 10:e0124534. [PMID: 25915782 PMCID: PMC4411043 DOI: 10.1371/journal.pone.0124534] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background Routine postoperative imaging (PI) following surgery for intracranial meningiomas is common practice in most neurosurgical departments. The purpose of this study was to determine the role of routine PI and its impact on clinical decision making after resection of meningioma. Methods Patient and tumor characteristics, details of radiographic scans, symptoms and alteration of treatment courses were prospectively collected for patients undergoing removal of a supratentorial meningioma of the convexity, falx, tentorium, or lateral sphenoid wing at the authors’ institution between January 1st, 2010 and March 31st, 2012. Patients with infratentorial manifestations or meningiomas of the skull base known to be surgically difficult (e.g. olfactory groove, petroclival, medial sphenoid wing) were not included. Maximum tumor diameter was divided into groups of < 3cm (small), 3 to 6 cm (medium), and > 6 cm (large). Results 206 patients with meningiomas were operated between January 2010 and March 2012. Of these, 113 patients met the inclusion criteria and were analyzed in this study. 83 patients (73.5%) did not present new neurological deficits, whereas 30 patients (26.5%) became clinically symptomatic. Symptomatic patients had a change in treatment after PI in 21 cases (70%), while PI was without consequence in 9 patients (30%). PI did not result in a change of treatment in all asymptomatic patients (p<0.001) irrespective of tumor size (p<0.001) or localization (p<0.001). Conclusions PI is mandatory for clinically symptomatic patients but it is safe to waive it in clinically asymptomatic patients, even if the meningioma was large in size.
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Affiliation(s)
- Florian Geßler
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
- * E-mail:
| | - Stephan Dützmann
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Johanna Quick
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Karima Tizi
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Melanie Alexandra Voigt
- Institute of Neuroradiology, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Haitham Mutlak
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Volker Seifert
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe-University, Schleusenweg 2–16, 60528, Frankfurt, Germany
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Abstract
Neurosurgical oncology for intrinsic glioma is evolving rapidly. It must be patient-centered, consultant-led and research-orientated. The value of specialist neurosurgical engagement is becoming more widely recognized. Detailed evaluation tailored to each patient is essential before the surgical admission, in conjunction with clinical oncology input. Medical optimization, collation of magnetic resonance datasets for preoperative planning and providing an informed explanation of the proposed management and its alternatives are all part of the neurosurgeon's remit. Meticulous microsurgical technique during surgery utilizing modern neuronavigation and physiological monitoring are integral components of the specialist armamentarium. A clear understanding of the rationale for surgical intervention, including its place alongside radiotherapy and chemotherapy, informs surgical decision-making. Recognition and understanding of these issues are driving the evolution of neurosurgical management of high-grade glioma. New challenges are emerging and need to be critically evaluated in robustly designed clinical trials.
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Affiliation(s)
- Colin Watts
- University of Cambridge Department of Clinical Neurosciences, Division of Neurosurgery, Box 167 Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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