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Xie Y, Zaccagna F, Rundo L, Testa C, Zhu R, Tonon C, Lodi R, Manners DN. IMPA-Net: Interpretable Multi-Part Attention Network for Trustworthy Brain Tumor Classification from MRI. Diagnostics (Basel) 2024; 14:997. [PMID: 38786294 PMCID: PMC11119919 DOI: 10.3390/diagnostics14100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
Deep learning (DL) networks have shown attractive performance in medical image processing tasks such as brain tumor classification. However, they are often criticized as mysterious "black boxes". The opaqueness of the model and the reasoning process make it difficult for health workers to decide whether to trust the prediction outcomes. In this study, we develop an interpretable multi-part attention network (IMPA-Net) for brain tumor classification to enhance the interpretability and trustworthiness of classification outcomes. The proposed model not only predicts the tumor grade but also provides a global explanation for the model interpretability and a local explanation as justification for the proffered prediction. Global explanation is represented as a group of feature patterns that the model learns to distinguish high-grade glioma (HGG) and low-grade glioma (LGG) classes. Local explanation interprets the reasoning process of an individual prediction by calculating the similarity between the prototypical parts of the image and a group of pre-learned task-related features. Experiments conducted on the BraTS2017 dataset demonstrate that IMPA-Net is a verifiable model for the classification task. A percentage of 86% of feature patterns were assessed by two radiologists to be valid for representing task-relevant medical features. The model shows a classification accuracy of 92.12%, of which 81.17% were evaluated as trustworthy based on local explanations. Our interpretable model is a trustworthy model that can be used for decision aids for glioma classification. Compared with black-box CNNs, it allows health workers and patients to understand the reasoning process and trust the prediction outcomes.
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Affiliation(s)
- Yuting Xie
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (C.T.); (R.L.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - Fulvio Zaccagna
- Department of Imaging, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0SL, UK;
- Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - Leonardo Rundo
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, 84084 Fisciano, Italy;
| | - Claudia Testa
- INFN Bologna Division, Viale C. Berti Pichat, 6/2, 40127 Bologna, Italy
- Department of Physics and Astronomy, University of Bologna, 40127 Bologna, Italy
| | - Ruifeng Zhu
- Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia, 41125 Modena, Italy;
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (C.T.); (R.L.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40126 Bologna, Italy; (Y.X.); (C.T.); (R.L.)
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - David Neil Manners
- Functional and Molecular Neuroimaging Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139 Bologna, Italy
- Department for Life Quality Studies, University of Bologna, 40126 Bologna, Italy
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Li X, Yang C, Guo C, Li Q, Peng C, Zhang H. Temperature-Switch-Controlled Second Harmonic Mode Sensor for Brain-Tissue Detection. SENSORS (BASEL, SWITZERLAND) 2024; 24:3065. [PMID: 38793918 PMCID: PMC11124983 DOI: 10.3390/s24103065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
Identifying brain-tissue types holds significant research value in the biomedical field of non-contact brain-tissue measurement applications. In this paper, a layered metastructure is proposed, and the second harmonic generation (SHG) in a multilayer metastructure is derived using the transfer matrix method. With the SHG conversion efficiency (CE) as the measurement signal, the refractive index ranges that can be distinguished are 1.23~1.31 refractive index unit (RIU) and 1.38~1.44 RIU, with sensitivities of 0.8597 RIU-1 and 1.2967 RIU-1, respectively. It can distinguish various brain tissues, including gray matter, white matter, and low-grade glioma, achieving the function of a second harmonic mode sensor (SHMS). Furthermore, temperature has a significant impact on the SHG CE, which can be used to define the switch signal indicating whether the SHMS is functioning properly. When the temperature range is 291.4~307.9 Kelvin (K), the temperature switch is in the "open" state, and the optimal SHG CE is higher than 0.298%, indicating that the SHMS is in the working state. For other temperature ranges, the SHG CE will decrease significantly, indicating that the temperature switch is in the "off" state, and the SHMS is not working. By stimulating temperature and using the response of SHG CE, the temperature-switch function is achieved, providing a new approach for temperature-controlled second harmonic detection.
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Affiliation(s)
| | | | | | | | | | - Haifeng Zhang
- College of Electronic and Optical Engineering & College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, Nanjing 210023, China; (X.L.)
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3
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Lucke-Wold B, Rangwala BS, Shafique MA, Siddiq MA, Mustafa MS, Danish F, Nasrullah RMU, Zainab N, Haseeb A. Focus on current and emerging treatment options for glioma: A comprehensive review. World J Clin Oncol 2024; 15:482-495. [PMID: 38689623 PMCID: PMC11056857 DOI: 10.5306/wjco.v15.i4.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/22/2024] [Accepted: 02/28/2024] [Indexed: 04/22/2024] Open
Abstract
This comprehensive review delves into the current updates and challenges associated with the management of low-grade gliomas (LGG), the predominant primary tumors in the central nervous system. With a general incidence rate of 5.81 per 100000, gliomas pose a significant global concern, necessitating advancements in treatment techniques to reduce mortality and morbidity. This review places a particular focus on immunotherapies, discussing promising agents such as Zotiraciclib and Lerapolturev. Zotiraciclib, a CDK9 inhibitor, has demonstrated efficacy in glioblastoma treatment in preclinical and clinical studies, showing its potential as a therapeutic breakthrough. Lerapolturev, a viral immunotherapy, induces inflammation in glioblastoma and displays positive outcomes in both adult and pediatric patients. Exploration of immunotherapy extends to Pembrolizumab, Nivolumab, and Entrectinib, revealing the challenges and variabilities in patient responses. Despite promising preclinical data, the monoclonal antibody Depatuxizumab has proven ineffective in glioblastoma treatment, emphasizing the critical need to understand resistance mechanisms. The review also covers the success of radiation therapy in pediatric LGG, with evolving techniques, such as proton therapy, showing potential improvements in patient quality of life. Surgical treatment is discussed in the context of achieving a balance between preserving the patient's quality of life and attaining gross total resection, with the extent of surgical resection significantly influencing the survival outcomes. In addition to advancements in cancer vaccine development, this review highlights the evolving landscape of LGG treatment, emphasizing a shift toward personalized and targeted therapies. Ongoing research is essential for refining strategies and enhancing outcomes in the management of LGG.
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Affiliation(s)
- Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32608, United States
| | | | | | - Mohammad Arham Siddiq
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Fnu Danish
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi 75510, Pakistan
| | | | - Noor Zainab
- Department of Neurosurgery, Army Medical College, Rawalpindi 46000, Pakistan
| | - Abdul Haseeb
- Department of Neurosurgery, Jinnah Sindh Medical University, Karachi 75510, Pakistan
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Mohammed S, Kurtek S, Bharath K, Rao A, Baladandayuthapani V. Tumor radiogenomics in gliomas with Bayesian layered variable selection. Med Image Anal 2023; 90:102964. [PMID: 37797481 PMCID: PMC10653647 DOI: 10.1016/j.media.2023.102964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/09/2022] [Accepted: 07/03/2023] [Indexed: 10/07/2023]
Abstract
We propose a statistical framework to analyze radiological magnetic resonance imaging (MRI) and genomic data to identify the underlying radiogenomic associations in lower grade gliomas (LGG). We devise a novel imaging phenotype by dividing the tumor region into concentric spherical layers that mimics the tumor evolution process. MRI data within each layer is represented by voxel-intensity-based probability density functions which capture the complete information about tumor heterogeneity. Under a Riemannian-geometric framework these densities are mapped to a vector of principal component scores which act as imaging phenotypes. Subsequently, we build Bayesian variable selection models for each layer with the imaging phenotypes as the response and the genomic markers as predictors. Our novel hierarchical prior formulation incorporates the interior-to-exterior structure of the layers, and the correlation between the genomic markers. We employ a computationally-efficient Expectation-Maximization-based strategy for estimation. Simulation studies demonstrate the superior performance of our approach compared to other approaches. With a focus on the cancer driver genes in LGG, we discuss some biologically relevant findings. Genes implicated with survival and oncogenesis are identified as being associated with the spherical layers, which could potentially serve as early-stage diagnostic markers for disease monitoring, prior to routine invasive approaches. We provide a R package that can be used to deploy our framework to identify radiogenomic associations.
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Affiliation(s)
- Shariq Mohammed
- Department of Biostatistics, Boston University, 801 Massachusetts Ave, Boston, MA 02118, United States; Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48103, United States; Department of Computational Medicine and Bioinformatics, University of Michigan, 100 Washtenaw Avenue, Ann Arbor, MI 48109, United States.
| | - Sebastian Kurtek
- Department of Statistics, The Ohio State University, 1958 Neil Avenue, Columbus, OH 43210, United States
| | - Karthik Bharath
- School of Mathematical Sciences, University Park, Nottingham, NG7 2RD, United Kingdom
| | - Arvind Rao
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48103, United States; Department of Computational Medicine and Bioinformatics, University of Michigan, 100 Washtenaw Avenue, Ann Arbor, MI 48109, United States; Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, United States
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van Coevorden-van Loon EMP, Horemans HHLD, Heijenbrok-Kal MH, van den Berg-Emons RJG, Rozenberg R, Vincent AJPE, Ribbers GM, van den Bent MJ. Physical fitness and its association with fatigue in patients with low-grade glioma. Disabil Rehabil 2023; 45:3323-3329. [PMID: 36148487 DOI: 10.1080/09638288.2022.2125084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate physical fitness and its association with fatigue in patients with low grade glioma (LGG). METHODS Cross-sectional study. Muscle strength was measured with a digital dynamometer, cardiorespiratory fitness (peak oxygen uptake (VO2peak), maximal workload (MWL)) by cardiopulmonary-exercise-testing, and fatigue by using the Multidimensional Fatigue Inventory. RESULTS Thirty patients were included, mean age of 44.1 (SD11.2) years, and 67% were men, 31.2 (SD18) months post-diagnosis. Muscle strength (p < 0.01), and cardiorespiratory fitness (VO2peak, MWL) (p < 0.01) were significantly decreased compared to predicted values based on age and gender. Thirty percent of the patients experienced severe physical fatigue, and severe mental fatigue was reported in 57% of the patients. Cardiorespiratory fitness showed weak to moderate (r - 0.46 to r - 0.52) but significant (p < 0.01) correlations with physical fatigue, not with mental and general fatigue. Muscle strength was not associated with fatigue. A lower VO2peak was independently associated with a higher level of physical fatigue, adjusted for Karnofsky Performance Status (R2 0.40). CONCLUSIONS Physical fitness (muscle strength, cardiorespiratory fitness) is reduced in patients with LLG, and a lower level of cardiorespiratory fitness (VO2peak) is independently associated with a higher level of experienced physical fatigue. Trials to explore the benefit of exercise programs to improve cardiorespiratory fitness and, consequently, fatigue are warranted.Implications for rehabilitationPhysical fitness (muscle strength and cardiorespiratory fitness) is reduced in patients with low-grade glioma.Patients with low-grade glioma should be screened for fatigue with the multidimensional fatigue inventory, to differentiate between mental and physical fatigue.Patients with low-grade glioma with severe physical fatigue should be screened for reduced physical fitness, especially cardiorespiratory fitness by objective cardiopulmonary-exercise-testing.Rehabilitation exercise programs to improve cardiorespiratory fitness and, consequently, (physical) fatigue could be warranted in patients with low-grade glioma.
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Affiliation(s)
- Ellen M P van Coevorden-van Loon
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation, Revant Rehabilitation, Goes, The Netherlands
| | - Herwin H L D Horemans
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert Rozenberg
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arnaud J P E Vincent
- The Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Alshiekh Nasany R, de la Fuente MI. Therapies for IDH-Mutant Gliomas. Curr Neurol Neurosci Rep 2023; 23:225-233. [PMID: 37060388 PMCID: PMC10182950 DOI: 10.1007/s11910-023-01265-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/16/2023]
Abstract
PURPOSE OF REVIEW Isocitrate dehydrogenase (IDH) mutant gliomas are a distinct type of primary brain tumors with unique characteristics, behavior, and disease outcomes. This article provides a review of standard of care treatment options and innovative, therapeutic approaches that are currently under investigation for these tumors. RECENT FINDINGS Extensive pre-clinical data and a variety of clinical studies support targeting IDH mutations in glioma using different mechanisms, which include direct inhibition and immunotherapies that target metabolic and epigenomic vulnerabilities caused by these mutations. IDH mutations have been recognized as an oncogenic driver in gliomas for more than a decade and as a positive prognostic factor influencing the research for new therapeutic methods including IDH inhibitors, DNA repair inhibitors, and immunotherapy.
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Affiliation(s)
| | - Macarena Ines de la Fuente
- Sylvester Comprehensive Cancer Center and Department of Neurology, 1120 NW 14th Street, Miami, FL, 33136, USA.
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7
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Rajendran S, Hu Y, Canella A, Peterson C, Gross A, Cam M, Nazzaro M, Haffey A, Serin-Harmanci A, Distefano R, Nigita G, Wang W, Kreatsoulas D, Li Z, Sepeda JA, Sas A, Hester ME, Miller KE, Elemento O, Roberts RD, Holland EC, Rao G, Mardis ER, Rajappa P. Single-cell RNA sequencing reveals immunosuppressive myeloid cell diversity during malignant progression in a murine model of glioma. Cell Rep 2023; 42:112197. [PMID: 36871221 DOI: 10.1016/j.celrep.2023.112197] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/22/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Recent studies have shown the importance of the dynamic tumor microenvironment (TME) in high-grade gliomas (HGGs). In particular, myeloid cells are known to mediate immunosuppression in glioma; however, it is still unclear if myeloid cells play a role in low-grade glioma (LGG) malignant progression. Here, we investigate the cellular heterogeneity of the TME using single-cell RNA sequencing in a murine glioma model that recapitulates the malignant progression of LGG to HGG. LGGs show increased infiltrating CD4+ and CD8+ T cells and natural killer (NK) cells in the TME, whereas HGGs abrogate this infiltration. Our study identifies distinct macrophage clusters in the TME that show an immune-activated phenotype in LGG but then evolve to an immunosuppressive state in HGG. We identify CD74 and macrophage migration inhibition factor (MIF) as potential targets for these distinct macrophage populations. Targeting these intra-tumoral macrophages in the LGG stage may attenuate their immunosuppressive properties and impair malignant progression.
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Affiliation(s)
- Sakthi Rajendran
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Yang Hu
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Alessandro Canella
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Clayton Peterson
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amy Gross
- Center for Childhood Cancer and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Maren Cam
- Center for Childhood Cancer and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Matthew Nazzaro
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Abigail Haffey
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Rosario Distefano
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Giovanni Nigita
- Department of Cancer Biology and Genetics, Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Wesley Wang
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Zihai Li
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Jesse A Sepeda
- Department of Neurology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University, Columbus, OH, USA
| | - Andrew Sas
- Department of Neurology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University, Columbus, OH, USA
| | - Mark E Hester
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Neurology, College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Katherine E Miller
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Olivier Elemento
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | - Ryan D Roberts
- Center for Childhood Cancer and Blood Diseases, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Eric C Holland
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Ganesh Rao
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Elaine R Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Prajwal Rajappa
- The Steve and Cindy Rasmussen Institute for Genomic Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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Yahanda AT, Rich KM, Dacey RG, Zipfel GJ, Dunn GP, Dowling JL, Smyth MD, Leuthardt EC, Limbrick DD, Honeycutt J, Sutherland GR, Jensen RL, Evans J, Chicoine MR. Survival After Resection of Newly-Diagnosed Intracranial Grade II Ependymomas: An Initial Multicenter Analysis and the Logistics of Intraoperative Magnetic Resonance Imaging. World Neurosurg 2022; 167:e757-e769. [PMID: 36028106 DOI: 10.1016/j.wneu.2022.08.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To identify factors, including the use of intraoperative magnetic resonance imaging (iMRI), impacting overall survival (OS) and progression-free survival (PFS) after resections of newly diagnosed intracranial grade II ependymomas performed across 4 different institutions. METHODS Analyses of a multicenter mixed retrospective/prospective database assessed the impact of patient, treatment, and tumor characteristics on OS and PFS. iMRI workflow and logistics were also outlined. RESULTS Forty-three patients were identified (mean age 25.4 years, mean follow-up 52.8 months). The mean OS was 52.8 ± 44.7 months. Univariate analyses failed to identify prognostic factors associated with OS, likely due to relatively shorter follow-up time for this less aggressive glioma subtype. The mean PFS was 43.7 ± 39.8 months. Multivariate analyses demonstrated that gross-total resection was associated with prolonged PFS compared to both subtotal resection (STR) (P = 0.005) and near-total resection (P = 0.01). Infratentorial location was associated with improved PFS compared to supratentorial location (P = 0.04). Log-rank analyses of Kaplan-Meier survival curves showed that increasing extent of resection (EOR) led to improved OS specifically for supratentorial tumors (P = 0.02) and improved PFS for all tumors (P < 0.001). Thirty cases (69.8%) utilized iMRI, of which 12 (27.9%) involved additional resection after iMRI. Of these, 8/12 (66.7%) resulted in gross-total resection, while 2/12 (16.7%) were near-total resection and 2/12 (16.7%) were subtotal resection. iMRI was not an independent prognosticator of PFS (P = 0.72). CONCLUSIONS Greater EOR and infratentorial location were associated with increased PFS for grade II ependymomas. Greater EOR was associated with longer OS only for supratentorial tumors. A longer follow-up is needed to establish prognostic factors for this cohort, including use of iMRI.
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Affiliation(s)
- Alexander T Yahanda
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA.
| | - Keith M Rich
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Ralph G Dacey
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Gavin P Dunn
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Joshua L Dowling
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Matthew D Smyth
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Eric C Leuthardt
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - David D Limbrick
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - John Honeycutt
- Department of Neurological Surgery, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Garnette R Sutherland
- Department of Neurological Surgery, University of Calgary School of Medicine, Calgary, Alberta, Canada
| | - Randy L Jensen
- Department of Neurological Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John Evans
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Michael R Chicoine
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Lin W, Ou G, Zhao W. Mutational profiling of low-grade gliomas identifies prognosis and immunotherapy-related biomarkers and tumour immune microenvironment characteristics. J Cell Mol Med 2021; 25:10111-10125. [PMID: 34597473 PMCID: PMC8572778 DOI: 10.1111/jcmm.16947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 02/05/2023] Open
Abstract
Low-grade glioma (LGG) is a heterogeneous tumour with the median survival rate less than 10 years. Therefore, it is urgent to develop efficient immunotherapy strategies of LGG. In this study, we analysed mutation profiles based on the data of 510 LGG patients from the Cancer Genome Atlas (TCGA) database and investigated the prognostic value of mutated genes and evaluate their immune infiltration. Tumor Immune Dysfunction and Exclusion (TIDE) algorithm was used to indicate the characteristics of gliomas that respond to immune checkpoint blockade (ICB) therapy. Univariate and multivariate cox regression analysis was performed to identify indicators to construct the nomogram model. 485 (95.47%) of 508 LGG samples showed gene mutation, and 9 mutated genes were significantly related to overall survival (OS), among which 6 mutated genes were significantly correlated with OS between mutation and wildtypes. Immune infiltration and immune score analyses revealed that these six mutated genes were significantly associated with tumour immune microenvironment in LGG. The response of LGG with different characteristics to ICB was evaluated by TIDE algorithm. Finally, CIC gene was screened through both univariate and multivariate Cox regression analyses, and the nomogram model was established to determine the potential prognostic value of CIC in LGG. Our study provides comprehensive analysis of mutated genes in LGG, supporting modulation of mutated genes in the management of LGG.
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Affiliation(s)
- Wen‐wen Lin
- Center for NeuroscienceShantou University Medical CollegeShantouGuangdongChina
| | - Guan‐yong Ou
- Center for NeuroscienceShantou University Medical CollegeShantouGuangdongChina
| | - Wei‐jiang Zhao
- Center for NeuroscienceShantou University Medical CollegeShantouGuangdongChina
- Cell biology department, Wuxi School of MedicineJiangnan UniversityWuxi, JiangsuChina
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10
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Rodrigues AJ, Jin MC, Wu A, Bhambhvani HP, Li G, Grant GA. Risk of secondary neoplasms after external-beam radiation therapy treatment of pediatric low-grade gliomas: a SEER analysis, 1973-2015. J Neurosurg Pediatr 2021; 28:306-314. [PMID: 34144522 DOI: 10.3171/2021.1.peds20859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although past studies have associated external-beam radiation therapy (EBRT) with higher incidences of secondary neoplasms (SNs), its effect on SN development from pediatric low-grade gliomas (LGGs), defined as WHO grade I and II gliomas of astrocytic or oligodendrocytic origin, is not well understood. Utilizing a national cancer registry, the authors sought to characterize the risk of SN development after EBRT treatment of pediatric LGG. METHODS A total of 1245 pediatric patient (aged 0-17 years) records from 1973 to 2015 were assembled from the Surveillance, Epidemiology, and End Results (SEER) database. Univariable and multivariable subdistribution hazard regression models were used to evaluate the prognostic impact of demographic, tumor, and treatment-related covariates. Propensity score matching was used to balance baseline characteristics. Cumulative incidence analyses measured the time to, and rate of, SN development, stratified by receipt of EBRT and controlled for competing mortality risk. The Fine and Gray semiparametric model was used to estimate future SN risk in EBRT- and non-EBRT-treated pediatric patients. RESULTS In this study, 366 patients received EBRT and 879 did not. Forty-six patients developed SNs after an LGG diagnosis, and 27 of these patients received EBRT (OR 3.61, 95% CI 1.90-6.95; p < 0.001). For patients alive 30 years from the initial LGG diagnosis, the absolute risk of SN development in the EBRT-treated cohort was 12.61% (95% CI 8.31-13.00) compared with 4.99% (95% CI 4.38-12.23) in the non-EBRT-treated cohort (p = 0.013). Cumulative incidence curves that were adjusted for competing events still demonstrated higher rates of SN development in the EBRT-treated patients with LGGs. After matching across available covariates and again adjusting for the competing risk of mortality, a clear association between EBRT and SN development remained (subhazard ratio 2.26, 95% CI 1.21-4.20; p = 0.010). CONCLUSIONS Radiation therapy was associated with an increased risk of future SNs for pediatric patients surviving LGGs. These data suggest that the long-term implications of EBRT should be considered when making treatment decisions for this patient population.
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Nuessle NC, Behling F, Tabatabai G, Castaneda Vega S, Schittenhelm J, Ernemann U, Klose U, Hempel JM. ADC-Based Stratification of Molecular Glioma Subtypes Using High b-Value Diffusion-Weighted Imaging. J Clin Med 2021; 10:3451. [PMID: 34441747 PMCID: PMC8397197 DOI: 10.3390/jcm10163451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/02/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To investigate the diagnostic performance of in vivo ADC-based stratification of integrated molecular glioma grades. MATERIALS AND METHODS Ninety-seven patients with histopathologically confirmed glioma were evaluated retrospectively. All patients underwent pre-interventional MRI-examination including diffusion-weighted imaging (DWI) with implemented b-values of 500, 1000, 1500, 2000, and 2500 s/mm2. Apparent Diffusion Coefficient (ADC), Mean Kurtosis (MK), and Mean Diffusivity (MD) maps were generated. The average values were compared among the molecular glioma subgroups of IDH-mutant and IDH-wildtype astrocytoma, and 1p/19q-codeleted oligodendroglioma. One-way ANOVA with post-hoc Games-Howell correction compared average ADC, MD, and MK values between molecular glioma groups. A Receiver Operating Characteristic (ROC) analysis determined the area under the curve (AUC). RESULTS Two b-value-dependent ADC-based evaluations presented statistically significant differences between the three molecular glioma sub-groups (p < 0.001, respectively). CONCLUSIONS High-b-value ADC from preoperative DWI may be used to stratify integrated molecular glioma subgroups and save time compared to diffusion kurtosis imaging. Higher b-values of up to 2500 s/mm2 may present an important step towards increasing diagnostic accuracy compared to standard DWI protocol.
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Affiliation(s)
- Nils C. Nuessle
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, 72076 Tübingen, Germany; (U.E.); (U.K.); (J.-M.H.)
| | - Felix Behling
- Department of Neurosurgery, University Hospital Tübingen, Eberhard Karls University, 72076 Tübingen, Germany;
- Departments of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University, 72076 Tübingen, Germany;
| | - Ghazaleh Tabatabai
- Departments of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University, 72076 Tübingen, Germany;
| | - Salvador Castaneda Vega
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, University Hospital Tübingen, Eberhard Karls University, 72076 Tübingen, Germany;
| | - Jens Schittenhelm
- Department of Pathology and Neuropathology, University Hospital Tübingen, Institute of Neuropathology, Eberhard Karls University, 72076 Tübingen, Germany;
| | - Ulrike Ernemann
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, 72076 Tübingen, Germany; (U.E.); (U.K.); (J.-M.H.)
| | - Uwe Klose
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, 72076 Tübingen, Germany; (U.E.); (U.K.); (J.-M.H.)
| | - Johann-Martin Hempel
- Department of Neuroradiology, University Hospital Tübingen, Eberhard Karls University, 72076 Tübingen, Germany; (U.E.); (U.K.); (J.-M.H.)
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Witteler J, Schild SE, Rades D. Clinical Prognostic Factors for Local Control and Survival After Irradiation of Grade II Gliomas. In Vivo 2021; 34:3719-3722. [PMID: 33144489 DOI: 10.21873/invivo.12220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/06/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Personalized treatment for low-grade gliomas likely improves patient outcomes. This study aimed to identify predictors of local control and survival. PATIENTS AND METHODS Twenty-five patients irradiated for grade II gliomas were retrospectively analyzed. Irradiation was performed after biopsy (n=6) or incomplete resection (n=19). Nineteen patients received additional chemotherapy. Eight factors were analyzed, namely the number of glioma sites, cumulative maximum diameter, radiotherapy technique, Karnofsky performance score (KPS), gender, age, resection and chemotherapy. RESULTS On univariate analysis, trends for associations with local control were found for cumulative maximum diameter ≤43 mm (p=0.087) and age ≤45 years (p=0.065). In the Cox regression analysis, cumulative maximum diameter maintained significance (p=0.046). On univariate analysis, KPS 90-100 (p=0.039) and female gender (p=0.022) were significantly associated with better survival. In the Cox regression analysis, both KPS (p=0.039) and gender (p=0.016) were significant. CONCLUSION Independent predictors of local control and survival were identified that can contribute to better treatment personalization.
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Affiliation(s)
- Jaspar Witteler
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Glioma-Specific Diffusion Signature in Diffusion Kurtosis Imaging. J Clin Med 2021; 10:jcm10112325. [PMID: 34073442 PMCID: PMC8199055 DOI: 10.3390/jcm10112325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose: This study aimed to assess the relationship between mean kurtosis (MK) and mean diffusivity (MD) values from whole-brain diffusion kurtosis imaging (DKI) parametric maps in preoperative magnetic resonance (MR) images from 2016 World Health Organization Classification of Tumors of the Central Nervous System integrated glioma groups. Methods: Seventy-seven patients with histopathologically confirmed treatment-naïve glioma were retrospectively assessed between 1 August 2013 and 30 October 2017. The area on scatter plots with a specific combination of MK and MD values, not occurring in the healthy brain, was labeled, and the corresponding voxels were visualized on the fluid-attenuated inversion recovery (FLAIR) images. Reversely, the labeled voxels were compared to those of the manually segmented tumor volume, and the Dice similarity coefficient was used to investigate their spatial overlap. Results: A specific combination of MK and MD values in whole-brain DKI maps, visualized on a two-dimensional scatter plot, exclusively occurs in glioma tissue including the perifocal infiltrative zone and is absent in tissue of the normal brain or from other intracranial compartments. Conclusions: A unique diffusion signature with a specific combination of MK and MD values from whole-brain DKI can identify diffuse glioma without any previous segmentation. This feature might influence artificial intelligence algorithms for automatic tumor segmentation and provide new aspects of tumor heterogeneity.
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Rana R, Joon S, Chauhan K, Rathi V, Ganguly NK, Kumari C, Yadav DK. Role of Extracellular Vesicles in Glioma Progression: Deciphering Cellular Biological Processes to Clinical Applications. Curr Top Med Chem 2021; 21:696-704. [PMID: 33292136 DOI: 10.2174/1568026620666201207100139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/07/2020] [Accepted: 08/09/2020] [Indexed: 11/22/2022]
Abstract
Glioma predominantly targets glial cells in the brain and spinal cord. There are grade I, II, III, and IV gliomas with anaplastic astrocytoma and glioblastoma multiforme as the most severe forms of the disease. Current diagnostic methods are limited in their data acquisition and interpretation, markedly affecting treatment modalities, and patient outcomes. Circulating extracellular vesicles (EVs) or "magic bullets" contain bioactive signature molecules such as DNA, RNA, proteins, lipids, and metabolites. These secretory "smart probes" participate in myriad cellular activities, including glioma progression. EVs are released by all cell populations and may serve as novel diagnostic biomarkers and efficient nano-vehicles in the targeted delivery of encapsulated therapeutics. The present review describes the potential of EV-based biomarkers for glioma management.
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Affiliation(s)
- Rashmi Rana
- Department of Research, Sir Ganga Ram Hospital, New Delhi-110060, India
| | - Shikha Joon
- Department of Research, Sir Ganga Ram Hospital, New Delhi-110060, India
| | - Kirti Chauhan
- Department of Research, Sir Ganga Ram Hospital, New Delhi-110060, India
| | - Vaishnavi Rathi
- Department of Research, Sir Ganga Ram Hospital, New Delhi-110060, India
| | | | - Chandni Kumari
- Gachon Institute of Pharmaceutical Science and Department of Pharmacy, College of Pharmacy, Gachon University, Incheon, Korea
| | - Dharmendra Kumar Yadav
- Gachon Institute of Pharmaceutical Science and Department of Pharmacy, College of Pharmacy, Gachon University, Incheon, Korea
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Sarma S, Khonglah Y, Mishra J, Kakati A, Phukan P. Gliomas - An experience based on molecular markers. J Family Med Prim Care 2021; 10:1341-1346. [PMID: 34041176 PMCID: PMC8140246 DOI: 10.4103/jfmpc.jfmpc_1963_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/05/2020] [Accepted: 01/01/2021] [Indexed: 11/04/2022] Open
Abstract
Background Gliomas account for 45% of all intracranial tumors. Newer technologies have allowed deeper genetic and epigenetic analysis leading to the discovery of IDH (Isocitrate dehydrogenase) mutations and their association with ATRX (alpha-thalassemia/mental retardation syndrome X-linked) and p53, for better diagnosis and prognosis. In this study, we analysed their expression and correlated with various clinicopathological parameters. A follow up to prognosticate gliomas based on the molecular findings is also attempted. Materials and Method During last 5 years both retrospective and prospective cases were included in the study. Immunohistochemistry for IDH1, ATRX, and p53 was done and reported based on intensity and percentage of tumor cells expressing the markers. Results A total of 53 cases of gliomas were included, excluding primary glioblastomas and ependymomas. The patient's age ranged from 10 to 53 years. The male to female ratio was 1.3:1. IDH1 positivity was seen in 88% of diffuse astrocytoma, 80% of anaplastic astrocytoma, 90% of oligodendroglioma, 60% of anaplastic oligodendroglioma, and 54% of glioblastoma. A significant association was seen between positive IDH1 expression and low-grade gliomas (p = 0.028). A combined analysis of expression of IDH1 and ATRX versus IDH1, ATRX, and p53 with WHO grade showed a statistically significant association. A follow-up of 32 patients was available. Out of 24 IDH1+ (positive) cases, 22 patients had a median survival of 21.5 months (92%). Out of 8 IDH1- (negative) cases, 5 had a median survival of 15.8 months (62%). Conclusion Gliomas expressing IDH1 mutation show improved survival of patients. Combined analysis of IDH1, ATRX, and p53 has diagnostic and prognostic significance. For routine cases of gliomas, a combination of IDH1 and ATRX are sufficient; however, the use of p53 is recommended for further prognostication and for possible targeted therapy in the future.
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Affiliation(s)
- Susmita Sarma
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Yookarin Khonglah
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Jaya Mishra
- Department of Pathology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Arindom Kakati
- Department of Neurosurgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Pranjal Phukan
- Department of Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
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Finch A, Solomou G, Wykes V, Pohl U, Bardella C, Watts C. Advances in Research of Adult Gliomas. Int J Mol Sci 2021; 22:ijms22020924. [PMID: 33477674 PMCID: PMC7831916 DOI: 10.3390/ijms22020924] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 01/03/2023] Open
Abstract
Diffuse gliomas are the most frequent brain tumours, representing 75% of all primary malignant brain tumours in adults. Because of their locally aggressive behaviour and the fact that they cannot be cured by current therapies, they represent one of the most devastating cancers. The present review summarises recent advances in our understanding of glioma development and progression by use of various in vitro and in vivo models, as well as more complex techniques including cultures of 3D organoids and organotypic slices. We discuss the progress that has been made in understanding glioma heterogeneity, alteration in gene expression and DNA methylation, as well as advances in various in silico models. Lastly current treatment options and future clinical trials, which aim to improve early diagnosis and disease monitoring, are also discussed.
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Affiliation(s)
- Alina Finch
- Institute of Cancer Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.F.); (G.S.); (V.W.)
| | - Georgios Solomou
- Institute of Cancer Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.F.); (G.S.); (V.W.)
- School of Medicine, Keele University, Staffordshire ST5 5NL, UK
| | - Victoria Wykes
- Institute of Cancer Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.F.); (G.S.); (V.W.)
- Department of Neurosurgery, University Hospital Birmingham, Birmingham B15 2WB, UK
| | - Ute Pohl
- Department of Cellular Pathology, University Hospital Birmingham, Birmingham B15 2WB, UK;
| | - Chiara Bardella
- Institute of Cancer Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.F.); (G.S.); (V.W.)
- Correspondence: (C.B.); (C.W.)
| | - Colin Watts
- Institute of Cancer Genomic Sciences, University of Birmingham, Birmingham B15 2TT, UK; (A.F.); (G.S.); (V.W.)
- Department of Neurosurgery, University Hospital Birmingham, Birmingham B15 2WB, UK
- Correspondence: (C.B.); (C.W.)
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Evaluating survival in subjects with astrocytic brain tumors by dynamic susceptibility-weighted perfusion MR imaging. PLoS One 2021; 16:e0244275. [PMID: 33406116 PMCID: PMC7787526 DOI: 10.1371/journal.pone.0244275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 12/07/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose Studies have evaluated the application of perfusion MR for predicting survival in patients with astrocytic brain tumors, but few of them statistically adjust their results to reflect the impact of the variability of treatment administered in the patients. Our aim was to analyze the association between the perfusion values and overall survival time, with adjustment for various clinical factors, including initial treatments and follow-up treatments. Materials and methods This study consisted of 51 patients with astrocytic brain tumors who underwent perfusion-weighted MRI with MultiHance® at a dose of 0.1 mmol/kg prior to initial surgery. We measured the mean rCBV, the 5% & 10% maximum rCBV, and the variation of rCBV in the tumors. Comparisons were made between patients with and without 2-year survival using two-sample t-test or Wilcoxon rank-sum test for the continuous data, or chi-square and Fisher exact tests for categorical data. The multivariate cox-proportional hazard regression was fit to evaluate the association between rCBV and overall survival time, with adjustment for clinical factors. Results Patients who survived less than 2 years after diagnosis had a higher mean and maximum rCBV and a larger variation of rCBV. After adjusting for clinical factors including therapeutic measures, we found no significant association of overall survival time within 2 years with any of these rCBV values. Conclusions Although patients who survived less than 2 years had a higher mean and maximum rCBV and a larger variation of rCBV, rCBV itself may not be used independently for predicting 2-year survival of patients with astrocytic brain tumors.
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18
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Ghaffari-Rafi A, Ghaffari-Rafi S, Leon-Rojas J. Role of Temozolomide Regimen on Survival Outcomes in Molecularly Stratified WHO Grade II Gliomas: A Systematic Review. Asian J Neurosurg 2021; 16:14-23. [PMID: 34211862 PMCID: PMC8202389 DOI: 10.4103/ajns.ajns_186_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/23/2020] [Accepted: 09/27/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE/INTRODUCTION Although a critical chemotherapeutic, temozolomide's optimal regimen for 2016 World Health Organization (WHO) Grade II gliomas remains elusive, hence there is utility in not only cataloging survival outcomes of Grade II glioma subtypes against the background of temozolomide regimens, but also quantifying differences in progression-free survival (PFS) and overall survival (OS). MATERIALS AND METHODS A systematic review of MEDLINE, Embase, and Cochrane Central Register of Controlled Trails was conducted by using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Handbook of Systemic Reviews of Interventions. RESULTS Each molecular subtype of WHO Grade II glioma had a different temozolomide regimen identified as optimal in prolonging PFS and OS. For PFS, with temozolomide, the 25th, 50th, and 75th percentiles, were as follows (in months), respectively-A-wt II: 6.90, 12.95, and 19.95; A-mt II: 34.45, 36.01, and 39.60; OD II: 37.90, 46.00, and 55.03 (P = 0.016). For OS, the first quartile (25%), median (50%), third quartile (75%), were respectively identified (in months-A-wt II: 21.6 (median; n = 1); A-mt II: 60.6, 85.2, and 109.8; OD II: 86.1, 96.2, and 106.3 (P = 0.37). CONCLUSION For each tumor molecular subtype, a different temozolomide regimen was identified as optimal for prolonging PFS and OS. Furthermore, regardless of temozolomide regimen, A-wt II had a significantly shorter PFS than A-mt II and OD-II. Overall, the data can provide useful prognostic insight to patients when making critical treatment decisions. Moreover, by cataloging and assessing survival outcomes per temozolomide regimen, such may facilitate future clinical trial design.
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Affiliation(s)
- Arash Ghaffari-Rafi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii, USA
| | - Shadeh Ghaffari-Rafi
- Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jose Leon-Rojas
- Universidad Internacional del Ecuador, Escuela de Medicina, Quito, Ecuador
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Yahanda AT, Patel B, Shah AS, Cahill DP, Sutherland G, Honeycutt J, Jensen RL, Rich KM, Dowling JL, Limbrick DD, Dacey RG, Kim AH, Leuthardt EC, Dunn GP, Zipfel GJ, Leonard JR, Smyth MD, Shah MV, Abram SR, Evans J, Chicoine MR. Impact of Intraoperative Magnetic Resonance Imaging and Other Factors on Surgical Outcomes for Newly Diagnosed Grade II Astrocytomas and Oligodendrogliomas: A Multicenter Study. Neurosurgery 2020; 88:63-73. [DOI: 10.1093/neuros/nyaa320] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/24/2020] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas.
OBJECTIVE
To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas.
METHODS
Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS.
RESULTS
A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances.
CONCLUSION
EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.
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Affiliation(s)
- Alexander T Yahanda
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Bhuvic Patel
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Amar S Shah
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Daniel P Cahill
- Department of Neurological Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Garnette Sutherland
- Department of Neurological Surgery, University of Calgary School of Medicine, Calgary, Canada
| | - John Honeycutt
- Department of Neurological Surgery, Cook Children's Medical Center, Fort Worth, Texas
| | - Randy L Jensen
- Department of Neurological Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keith M Rich
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Joshua L Dowling
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - David D Limbrick
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Ralph G Dacey
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Albert H Kim
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Gavin P Dunn
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Jeffrey R Leonard
- Department of Neurological Surgery, Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew D Smyth
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Mitesh V Shah
- Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - Steven R Abram
- Department of Neurological Surgery, St. Thomas Hospital, Nashville, Tennessee
| | - John Evans
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
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20
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Cao LJ, Xie HT, Chu ZX, Ma Y, Wang MM, Shi Z. Tubeimoside‑1 induces apoptosis in human glioma U251 cells by suppressing PI3K/Akt‑mediated signaling pathways. Mol Med Rep 2020; 22:1527-1535. [PMID: 32627020 PMCID: PMC7339596 DOI: 10.3892/mmr.2020.11224] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 05/12/2020] [Indexed: 12/15/2022] Open
Abstract
Tubeimoside-1 (TBMS1), a traditional Chinese herb extracted from Bolbostemma paniculatum (Maxim.), induces apoptosis in a number of human cancer cell lines. TBMS1 has been reported to induce apoptosis in human glioma cells, however the mechanism remains to be elucidated. The present study explored TBMS1-induced PI3K/Akt-related pathways in human glioma cells. The human glioma U251 and the human astrocyte (HA) cell lines were treated with various concentrations of TBMS1. MTT assays were conducted to analyze cell viability. Cell cycle distribution and the rate of apoptosis were assessed using flow cytometry. BrdU incorporation and Hoechst 33342 staining were performed to analyze the cell cycle and apoptosis, respectively. Western blotting was performed to investigate protein expression levels. The results demonstrated that TBMS1 reduced cell viability in human glioma cells U251 by suppressing Akt phosphorylation. Subsequently, TBMS1 inhibited DNA synthesis and induced G2/M phase arrest by targeting the PI3K/Akt/p21 and the cyclin-dependent kinase 1/cyclin B1 signaling cascades. In addition, TBMS1 triggered apoptosis via the PI3K/Akt-mediated Bcl-2 signaling pathway. These results demonstrated that TBMS1 prevented the progression of gliomas via the PI3K/Akt-dependent pathway, which provided a theoretical basis for in vivo studies to use TBMS1 as potential therapy for the prevention of cancer.
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Affiliation(s)
- Li-Juan Cao
- Department of Pediatrics, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia Autonomous Region 028007, P.R. China
| | - Hai-Tang Xie
- Department of Pediatrics, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia Autonomous Region 028007, P.R. China
| | - Zhong-Xia Chu
- Department of Pediatrics, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia Autonomous Region 028007, P.R. China
| | - Yue Ma
- Department of Pediatrics, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia Autonomous Region 028007, P.R. China
| | - Ming-Ming Wang
- Department of Pediatrics, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia Autonomous Region 028007, P.R. China
| | - Zhuang Shi
- Department of Mongolian Medicine Hand Foot Surgery, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, Inner Mongolia Autonomous Region 028007, P.R. China
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21
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Li J, Liu S, Qin Y, Zhang Y, Wang N, Liu H. High-order radiomics features based on T2 FLAIR MRI predict multiple glioma immunohistochemical features: A more precise and personalized gliomas management. PLoS One 2020; 15:e0227703. [PMID: 31968004 PMCID: PMC6975558 DOI: 10.1371/journal.pone.0227703] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To investigate the performance of high-order radiomics features and models based on T2-weighted fluid-attenuated inversion recovery (T2 FLAIR) in predicting the immunohistochemical biomarkers of glioma, in order to execute a non-invasive, more precise and personalized glioma disease management. Methods 51 pathologically confirmed gliomas patients committed in our hospital from March 2015 to June 2018 were retrospective analysis, and Ki-67, vimentin, S-100 and CD34 immunohistochemical data were collected. The volumes of interest (VOIs) were manually sketched and the radiomics features were extracted. Feature reduction was performed by ANOVA+ Mann-Whiney, spearman correlation analysis, least absolute shrinkage and selection operator (LASSO) and Gradient descent algorithm (GBDT). SMOTE technique was used to solve the data bias between two groups. Comprehensive binary logistic regression models were established. Area under the ROC curves (AUC), sensitivity, specificity and accuracy were used to evaluate the predict performance of models. Models reliability were decided according to the standard net benefit of the decision curves. Results Four clusters of significant features were screened out and four predicting models were constructed. AUC of Ki-67, S-100, vimentin and CD34 models were 0.713, 0.923, 0.854 and 0.745, respectively. The sensitivities were 0.692, 0.893, 0.875 and 0.556, respectively. The specificities were: 0.667, 0.905, 0.722, and 0.875, with accuracy of 0.660, 0.898, 0.738, and 0.667, respectively. According to the decision curves, the Ki-67, S-100 and vimentin models had reference values. Conclusion The radiomics features based on T2 FLAIR can potentially predict the Ki-67, S-100, vimentin and CD34 expression. Radiomics model were expected to be a computer-intelligent, non-invasive, accurate and personalized management method for gliomas.
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Affiliation(s)
- Jing Li
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- Department of Radiology, Tangshan Women and Children’s Hospital, Tangshan, Hebei, China
| | - Siyun Liu
- Life Science, GE Healthcare, Beijing, China
| | - Ying Qin
- Life Science, GE Healthcare, Beijing, China
| | - Yan Zhang
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ning Wang
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Huaijun Liu
- Department of Radiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
- * E-mail:
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22
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Faulkner JW, Wilshire CE. Mapping eloquent cortex: A voxel-based lesion-symptom mapping study of core speech production capacities in brain tumour patients. BRAIN AND LANGUAGE 2020; 200:104710. [PMID: 31739187 DOI: 10.1016/j.bandl.2019.104710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/21/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
This study used voxel-based lesion-symptom mapping to examine the cortical and white matter regions associated with language production impairments in a sample of 63 preoperative tumour patients. We identified four cognitive functions considered crucial for spoken language production: semantic-to-lexical mapping (selecting the appropriate lexical label for the intended concept); phonological encoding (retrieving the word's phonological form); articulatory-motor planning (programming the articulatory motor movements); and goal-driven language selection (exerting top-down control over the words selected for production). Each participant received a score estimating their competence on each function. We then mapped the region(s) where pathology was significantly associated with low scores. For semantic-to-lexical mapping, the critical map encompassed portions of the left posterior middle and inferior temporal gyri, extending into posterior fusiform gyrus, overlapping substantially with the territory of the inferior longitudinal fasciculus. For phonological encoding, the map encompassed the left inferior parietal lobe and posterior middle temporal gyrus, overlapping with the territory of the inferior longitudinal and posterior arcuate fasciculi. For articulatory-motor planning, the map encompassed parts of the left frontal pole, frontal operculum, and inferior frontal gyrus, and overlapped with the territory of the frontal aslant tract. Finally, the map for goal-driven language selection encompassed the left frontal pole and the anterior cingulate cortex. We compare our findings with those from other neuropsychological samples, and conclude that the study of tumour patients offers evidence that complements that available from other populations.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Victoria University of Wellington, New Zealand
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23
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Ghaffari-Rafi A, Samandouras G. Effect of Treatment Modalities on Progression-Free Survival and Overall Survival in Molecularly Subtyped World Health Organization Grade II Diffuse Gliomas: A Systematic Review. World Neurosurg 2020; 133:366-380.e2. [DOI: 10.1016/j.wneu.2019.08.111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 12/20/2022]
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24
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Rebsamen M, Knecht U, Reyes M, Wiest R, Meier R, McKinley R. Divide and Conquer: Stratifying Training Data by Tumor Grade Improves Deep Learning-Based Brain Tumor Segmentation. Front Neurosci 2019; 13:1182. [PMID: 31749678 PMCID: PMC6848279 DOI: 10.3389/fnins.2019.01182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/18/2019] [Indexed: 11/13/2022] Open
Abstract
It is a general assumption in deep learning that more training data leads to better performance, and that models will learn to generalize well across heterogeneous input data as long as that variety is represented in the training set. Segmentation of brain tumors is a well-investigated topic in medical image computing, owing primarily to the availability of a large publicly-available dataset arising from the long-running yearly Multimodal Brain Tumor Segmentation (BraTS) challenge. Research efforts and publications addressing this dataset focus predominantly on technical improvements of model architectures and less on properties of the underlying data. Using the dataset and the method ranked third in the BraTS 2018 challenge, we performed experiments to examine the impact of tumor type on segmentation performance. We propose to stratify the training dataset into high-grade glioma (HGG) and low-grade glioma (LGG) subjects and train two separate models. Although we observed only minor gains in overall mean dice scores by this stratification, examining case-wise rankings of individual subjects revealed statistically significant improvements. Compared to a baseline model trained on both HGG and LGG cases, two separately trained models led to better performance in 64.9% of cases (p < 0.0001) for the tumor core. An analysis of subjects which did not profit from stratified training revealed that cases were missegmented which had poor image quality, or which presented clinically particularly challenging cases (e.g., underrepresented subtypes such as IDH1-mutant tumors), underlining the importance of such latent variables in the context of tumor segmentation. In summary, we found that segmentation models trained on the BraTS 2018 dataset, stratified according to tumor type, lead to a significant increase in segmentation performance. Furthermore, we demonstrated that this gain in segmentation performance is evident in the case-wise ranking of individual subjects but not in summary statistics. We conclude that it may be useful to consider the segmentation of brain tumors of different types or grades as separate tasks, rather than developing one tool to segment them all. Consequently, making this information available for the test data should be considered, potentially leading to a more clinically relevant BraTS competition.
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Affiliation(s)
- Michael Rebsamen
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Urspeter Knecht
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Mauricio Reyes
- Healthcare Imaging A.I. Lab, Insel Data Science Center, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Raphael Meier
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Richard McKinley
- Support Center for Advanced Neuroimaging (SCAN), University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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25
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Liu X, Tian W, Kolar B, Johnson MD, Milano MT, Jiang H, Lin S, Li D, Mohile NA, Li YM, Walter KA, Ekholm S, Wang HZ. The correlation of fractional anisotropy parameters with Ki-67 index, and the clinical implication in grading of non-enhancing gliomas and neuronal-glial tumors. Magn Reson Imaging 2019; 65:129-135. [PMID: 31644925 DOI: 10.1016/j.mri.2019.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the correlation between the FA parameters and Ki-67 labeling index, and their diagnostic performance in grading supratentorial non-enhancing gliomas and neuronal-glial tumors (GNGT). METHODS This institutional review board-approved, Health Insurance Portability and Accountability (HIPAA) compliant retrospective study enrolled 35 patients, including 19 with low grade GNGT and 16 with high grade GNGT. The mean FA, maximal FA and mean maximal FA values derived from diffusion tensor imaging were measured. The correlation between the FA parameters and the Ki-67 labeling index was assessed by Spearman rank test. The receiver operating characteristic curve analysis and multivariate logistic regression analysis were performed to detect the optimal imaging parameters in grading GNGT. RESULTS The three FA parameters of low grade GNGT were significantly lower than the high grade GNGT (p < 0.001). The mean FA, maximal FA and mean maximal FA had significant positive correlation with Ki-67 labeling index (p = 0.001, p < 0.001, p < 0.001 respectively). The maximal FA showed a higher sensitivity and specificity in grading of non-enhancing GNGT with specificity of 78.9%, sensitivity of 100.0%, respectively. CONCLUSIONS The FA parameters correlated with Ki-67 labeling index, and were useful surrogates in preoperative grading supratentorial non-enhancing GNGT.
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Affiliation(s)
- Xiang Liu
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
| | - Wei Tian
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Balasubramanya Kolar
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Mahlon D Johnson
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Beijing, China
| | - Dongmei Li
- Clinical and Translational Research and Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Nimish A Mohile
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Yan M Li
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Kevin A Walter
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA
| | - Sven Ekholm
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Henry Z Wang
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
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26
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Kinslow CJ, Garton ALA, Rae AI, Marcus LP, Adams CM, McKhann GM, Sisti MB, Connolly ES, Bruce JN, Neugut AI, Sonabend AM, Canoll P, Cheng SK, Wang TJC. Extent of resection and survival for oligodendroglioma: a U.S. population-based study. J Neurooncol 2019; 144:591-601. [PMID: 31407129 DOI: 10.1007/s11060-019-03261-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 08/03/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND National guidelines recommend maximal safe resection of low-grade and high-grade oligodendrogliomas. However, there is no level 1 evidence to support these guidelines, and recent retrospective studies on the topic have yielded mixed results. OBJECTIVE To assess the association between extent of resection (EOR) and survival for oligodendrogliomas in the general U.S. POPULATION METHODS Cases diagnosed between 2004 and 2013 were selected from the Surveillance, Epidemiology, and End-Results (SEER) Program and retrospectively analyzed for treatment, prognostic factors, and survival times. Cases that did not undergo tumor de-bulking surgery (e.g. no surgery or biopsy alone) were compared to subtotal resection (resection) and gross-total resection (GTR). The primary end-points were overall survival (OS) and cause-specific survival (CSS). An external validation cohort with 1p/19q-codeleted tumors was creating using the TCGA and GSE16011 datasets. RESULTS 3135 Cases were included in the final analysis. The 75% survival time (75ST) and 5-year survival rates were 47 months and 70.8%, respectively. Subtotal resection (STR, 75ST = 50 months) and GTR (75ST = 61 months) were associated with improved survival times compared to cases that did not undergo surgical debulking (75ST = 20 months, P < 0.001 for both), with reduced hazard ratios (HRs) after controlling for other factors (HR 0.81 [0.68-0.97] and HR 0.65 [0.54-0.79], respectively). GTR was associated with improved OS in both low-grade and anaplastic oligodendroglioma subgroups (HR 0.74 [0.58-0.95], HR 0.60 [0.44-0.82], respectively) while STR fell short of significance in the subgroup analysis. All findings were corroborated by multivariable analysis of CSS and externally validated in a cohort of patients with 1p19q-codeleted tumors. CONCLUSION Greater EOR is associated with improved survival in oligodendrogliomas. Our findings in this U.S. population-based cohort support national guidelines.
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Affiliation(s)
- Connor J Kinslow
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA
| | - Andrew L A Garton
- Department of Neurological Surgery, NewYork-Presbyterian Hospital / Weill Cornell Medical Center, 525 E 68th Street, New York, NY, 10065, USA
| | - Ali I Rae
- Department of Neurological Surgery, Oregon Health & Sciences University, 3181 SW Sam Jackson Pkwy, Portland, OR, 97239, USA
| | - Logan P Marcus
- Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA
| | - Christopher M Adams
- Division of Biostatistics, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, New York, NY, 10032, USA
| | - Guy M McKhann
- Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Michael B Sisti
- Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - E Sander Connolly
- Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Alfred I Neugut
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.,Department of Epidemiology, Mailman School of Public Health, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 722 West 168th St, New York, NY, 10032, USA
| | - Adam M Sonabend
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA
| | - Peter Canoll
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.,Departments of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St. Nicholas Ave Rm.1001, New York, NY, 10032, USA
| | - Simon K Cheng
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA
| | - Tony J C Wang
- Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA.
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27
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Karschnia P, Barbiero FJ, Schwaiblmair MH, Kaulen LD, Piepmeier JM, Huttner AJ, Becker KP, Fulbright RK, Baehring JM. Leptomeningeal dissemination of low-grade neuroepithelial CNS tumors in adults: a 15-year experience. Neurooncol Pract 2019; 7:118-126. [PMID: 32257290 DOI: 10.1093/nop/npz020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Leptomeningeal dissemination (LD) in adults is an exceedingly rare complication of low-grade neuroepithelial CNS tumors (LGNs). We aimed to determine relative incidence, clinical presentation, and predictors of outcome. Methods We searched the quality control database of the Section of Neuro-Oncology, Yale Cancer Center, for patients with LGN (WHO grade I/II) seen between 2002 and 2017. For cases complicated by LD, we recorded demographics, clinical signs, histopathological diagnosis, and imaging findings. A comprehensive literature review was performed. Results Eleven consecutive patients with LD were identified, representing 2.3% of individuals with LGN seen at our institution between 2002 and 2017 (n = 475). Ependymoma was the predominant histological entity. Mean time interval from diagnosis of LGN to LD was 38.6 ± 10 months. Symptoms were mostly attributed to communicating hydrocephalus. Tumor deposits of LD were either nodular or linear with variable enhancement (nonenhancing lesions in 4 of 11 patients). Localized (surgery, radiosurgery, involved-field, or craniospinal radiation therapy) or systemic treatments (chemotherapy) were provided. All patients progressed radiographically. Median overall survival after LD was 102 months. Survival was prolonged when a combination of localized and systemic therapies was administered (188.5 vs 25.5 months; P = .03). Demographics and tumor spectrum reported in the literature were similar to our cohort. Conclusions LD is a rare complication of LGNs. A high level of suspicion is required for timely diagnosis as early symptoms are nonspecific and commonly do not occur until years after initial tumor diagnosis. Repeated aggressive treatment appears to be beneficial in improving survival.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Frank J Barbiero
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | | | - Leon D Kaulen
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Joseph M Piepmeier
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Anita J Huttner
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Kevin P Becker
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Robert K Fulbright
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Joachim M Baehring
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.,Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
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28
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Abstract
Advances in genome sequencing have elucidated the genetics of low-grade glioma. Available evidence indicates a neomorphic mutation in isocitrate dehydrogenase (IDH) initiates gliomagenesis. Mutant IDH produces the oncometabolite 2-hydroxyglutarate, which inhibits enzymes that demethylate genomic DNA and histones. Recent findings by the authors and others suggest the ensuing hypermethylation alters chromatin conformation and the transcription factor landscape in brain progenitor cells, leading to a block in differentiation and tumor initiation. Work in preclinical models has identified selective metabolic and molecular vulnerabilities of low-grade glioma. These new concepts will trigger a wave of innovative clinical trials in the near future.
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Affiliation(s)
- Devin Bready
- Department of Neurosurgery, NYU School of Medicine, 530 First Avenue, Skirball 8R, New York, NY 10016, USA
| | - Dimitris G Placantonakis
- Department of Neurosurgery, Kimmel Center for Stem Cell Biology, Laura and Isaac Perlmutter Cancer Center, Neuroscience Institute, Brain Tumor Center, NYU School of Medicine, 530 First Avenue, Skirball 8R, New York, NY 10016, USA.
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29
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Youssef I, Lee A, Garay EL, Becker DJ, Schreiber D. Patterns of care and outcomes of postoperative radiation for low-grade gliomas in United States hospitals. J Clin Neurosci 2018; 58:124-129. [PMID: 30287250 DOI: 10.1016/j.jocn.2018.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 09/03/2018] [Accepted: 09/24/2018] [Indexed: 01/30/2023]
Abstract
It is unclear whether there is a survival benefit with postoperative radiation for low-grade gliomas deemed to be high-risk. We sought to analyze patterns of care and outcomes of radiation use. We accessed the National Cancer Database to identify patients with WHO grade II oligodendroglioma or astrocytoma between 2010 and 2012. Multivariable logistic regression was used to identify predictors of radiation use and multivariable Cox regression was used to identify covariables associated with differences in survival. There were 1952 patients included in this study, of which 518 (26.5%) received postoperative radiation. The majority had oligodendroglioma histology (n = 1121, 57.4%) compared to astrocytoma (n = 831, 42.6%). There were 1626 patients who were either ≥40 years old or underwent a subtotal resection ("high-risk"), and from these 495 (30.4%) received postoperative radiation. On multivariable logistic regression treatment at an academic facility (OR 0.72) was associated with a lower likelihood of receiving postoperative radiation. Astrocytoma histology (OR 2.08), age ≥40 years (OR 2.23), tumor size ≥6 cm (OR 1.64), subtotal resection (OR 1.55), and chemotherapy use (OR 3.93) were associated with an increased likelihood of postoperative radiation. On multivariable analysis, astrocytoma histology (HR 3.49, p < 0.001) and receipt of radiation (HR 2.06, p < 0.001) were associated with worse overall survival. GTR (HR 0.51, p = 0.001) was associated with improved overall survival. Patients treated in United States hospitals are not routinely referred for postoperative radiation for high-risk, low-grade gliomas. Patients who received radiation did not do better than those who did not receive radiation.
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Affiliation(s)
- Irini Youssef
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anna Lee
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA.
| | - Elizabeth L Garay
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA
| | - Daniel J Becker
- Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - David Schreiber
- Department of Radiation Oncology, SUNY Downstate Medical Center, Brooklyn, NY, USA; Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, USA; Summit Medical Group at MD Anderson Cancer Center, Berkeley Heights, NJ, USA
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30
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Margol AS, Yeo KK, Xia C, Onar A, Robison NJ, Freyer DR, Dhall G. A comparative analysis of clinicopathological features and survival among early adolescents/young adults and children with low-grade glioma: a report from the Children's Oncology Group. J Neurooncol 2018; 140:575-582. [PMID: 30173409 DOI: 10.1007/s11060-018-2983-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/14/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND For several types of cancer, biological differences and outcome disparities have been documented in adolescents/young adults (AYAs, 15-39 years old) versus children. This study compared clinicopathological features and survival between younger AYAs and children with low-grade glioma (LGG), a common brain tumor among AYAs. METHODS This was a secondary analysis of Children's Oncology Group legacy study CCG-9891/POG-9130, which enrolled participants 0-21 years of age with newly-diagnosed LGG treated with surgery alone. For analysis, participants were categorized as children (0-14 years old) or early AYAs (eAYAs, 15-21 years old) and compared on demographics, clinical presentation, tumor characteristics, surgical outcomes, progression-free survival (PFS) and overall survival (OS). RESULTS Among 468 children and 50 eAYAs, more eAYAs presented with seizures (34.0% vs. 19.2%; p = 0.015), without other significant differences in clinicopathological features. 5-year PFS rates for children and eAYA were 80.2% (95% confidence interval [95% CI], 76.1-83.7) and 83.0% (95% CI 68.8-91.1), respectively; 5-year OS rates were 97.3% (95% CI 95.2-98.5) and 95.4% (95% CI 82.7-98.8), respectively. Multivariable analysis including all participants showed presence of residual tumor to be an independent predictor of PFS (< 1.5 cm3, hazard ratio [HR] 5.93 [95% CI 3.45-10.18]) and (≥ 1.5 cm3, HR 8.38 [95% CI 4.75-14.79]) (p < 0.001), while midline-chiasmatic location (HR 9.69 [95% CI 3.05-30.75], p < 0.001) and non-pilocytic astrocytoma histology (HR 6.77 [95% CI 2.35-19.49], p < 0.001) were independent predictors of OS. CONCLUSION Unlike several other cancers, LGG has similar presenting features and survival for both eAYAs and children. This support continuing a unified treatment approach and enrollment of eAYAs in pediatric clinical trials for LGGs.
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Affiliation(s)
- Ashley S Margol
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA. .,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Kee Kiat Yeo
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Caihong Xia
- Children's Oncology Group, Monrovia, CA, USA
| | - Arzu Onar
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nathan J Robison
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - David R Freyer
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Girish Dhall
- Children's Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, 4650 Sunset Boulevard, MS #54, Los Angeles, CA, 90027-6016, USA.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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31
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Bao S, Watanabe Y, Takahashi H, Tanaka H, Arisawa A, Matsuo C, Wu R, Fujimoto Y, Tomiyama N. Differentiating between Glioblastoma and Primary CNS Lymphoma Using Combined Whole-tumor Histogram Analysis of the Normalized Cerebral Blood Volume and the Apparent Diffusion Coefficient. Magn Reson Med Sci 2018; 18:53-61. [PMID: 29848919 PMCID: PMC6326759 DOI: 10.2463/mrms.mp.2017-0135] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose: This study aimed to determine whether whole-tumor histogram analysis of normalized cerebral blood volume (nCBV) and apparent diffusion coefficient (ADC) for contrast-enhancing lesions can be used to differentiate between glioblastoma (GBM) and primary central nervous system lymphoma (PCNSL). Methods: From 20 patients, 9 with PCNSL and 11 with GBM without any hemorrhagic lesions, underwent MRI, including diffusion-weighted imaging and dynamic susceptibility contrast perfusion-weighted imaging before surgery. Histogram analysis of nCBV and ADC from whole-tumor voxels in contrast-enhancing lesions was performed. An unpaired t-test was used to compare the mean values for each type of tumor. A multivariate logistic regression model (LRM) was performed to classify GBM and PCNSL using the best parameters of ADC and nCBV. Results: All nCBV histogram parameters of GBMs were larger than those of PCNSLs, but only average nCBV was statistically significant after Bonferroni correction. Meanwhile, ADC histogram parameters were also larger in GBM compared to those in PCNSL, but these differences were not statistically significant. According to receiver operating characteristic curve analysis, the nCBV average and ADC 25th percentile demonstrated the largest area under the curve with values of 0.869 and 0.838, respectively. The LRM combining these two parameters differentiated between GBM and PCNSL with a higher area under the curve value (Logit (P) = −21.12 + 10.00 × ADC 25th percentile (10−3 mm2/s) + 5.420 × nCBV mean, P < 0.001). Conclusion: Our results suggest that whole-tumor histogram analysis of nCBV and ADC combined can be a valuable objective diagnostic method for differentiating between GBM and PCNSL.
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Affiliation(s)
- Shixing Bao
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Yoshiyuki Watanabe
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Hiroto Takahashi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Hisashi Tanaka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Atsuko Arisawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Chisato Matsuo
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Rongli Wu
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
| | - Yasunori Fujimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine
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32
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Yang CA, Huang HY, Lin CL, Chang JG. G6PD as a predictive marker for glioma risk, prognosis and chemosensitivity. J Neurooncol 2018; 139:661-670. [DOI: 10.1007/s11060-018-2911-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/19/2018] [Indexed: 12/13/2022]
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Wang R, Deng D, Shao N, Xu Y, Xue L, Peng Y, Liu Y, Zhi F. Evodiamine activates cellular apoptosis through suppressing PI3K/AKT and activating MAPK in glioma. Onco Targets Ther 2018. [PMID: 29535541 PMCID: PMC5841348 DOI: 10.2147/ott.s155275] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Glioblastoma multiforme (GBM) is the most malignant primary tumor of the central nervous system and is associated with a very poor prognosis. No further improvements in outcomes have been reported since radiotherapy-temozolomide therapy was introduced. Therefore, developing new agents to treat GBM is important. Aim This study aimed to evaluate the anti-tumor effect of evodiamine (Evo) on GBM cells, and to determine the underlying mechanisms involved. Results According to MTT assay results, Evo significantly inhibited the cell proliferation in a time- and dose-dependent manner. Fluorescence microscopy and flow cytometry analyses revealed that Evo induced cell apoptosis in a concentration-dependent manner. Moreover, Evo induced reactive oxygen species (ROS) production and mitochondrial membrane potential (MMP) disruption. Finally, Evo induced apoptosis in cancer cells by suppressing PI3K/AKT signaling and inducing MAPK phosphorylation (p38 and JNK, but not ERK) to regulate apoptotic proteins (Bax, Bcl-2, Cytochrome c, Caspase-3, and PARP). Conclusion In summary, Evo inhibits cell proliferation by inducing cellular apoptosis via suppressing PI3K/AKT and activating MAPK in GBM; these results indicate that Evo may be regarded as a new approach for GBM treatment.
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Affiliation(s)
- Rong Wang
- Department of Neurosurgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China.,Modern Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Danni Deng
- Modern Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Naiyuan Shao
- Department of Neurosurgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yuan Xu
- Modern Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Lian Xue
- Modern Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Ya Peng
- Department of Neurosurgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yatian Liu
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu, China
| | - Feng Zhi
- Department of Neurosurgery, The First People's Hospital of Changzhou, Changzhou, Jiangsu, China.,Modern Medical Research Center, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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34
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Hempel JM, Schittenhelm J, Klose U, Bender B, Bier G, Skardelly M, Tabatabai G, Castaneda Vega S, Ernemann U, Brendle C. In Vivo Molecular Profiling of Human Glioma. Clin Neuroradiol 2018; 29:479-491. [DOI: 10.1007/s00062-018-0676-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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35
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Celtikci P, Fernandes-Cabral DT, Yeh FC, Panesar SS, Fernandez-Miranda JC. Generalized q-sampling imaging fiber tractography reveals displacement and infiltration of fiber tracts in low-grade gliomas. Neuroradiology 2018; 60:267-280. [PMID: 29372286 DOI: 10.1007/s00234-018-1985-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 01/16/2018] [Indexed: 01/12/2023]
Abstract
PURPOSE Low-grade gliomas (LGGs) are slow growing brain tumors that often cause displacement and/or infiltration of the surrounding white matter pathways. Differentiation between infiltration and displacement of fiber tracts remains a challenge. Currently, there is no reliable noninvasive imaging method capable of revealing such white matter alteration patterns. We employed quantitative anisotropy (QA) derived from generalized q-sampling imaging (GQI) to identify patterns of fiber tract alterations by LGGs. METHODS Sixteen patients with a neuropathological diagnosis of LGG (WHO grade II) were enrolled. Peritumoral fiber tracts underwent qualitative and quantitative evaluation. Contralateral hemisphere counterparts were used for comparison. Tracts were qualitatively classified as unaffected, displaced, infiltrated or displaced, and infiltrated at once. The average QA of whole tract (W), peritumoral tract segment (S), and their ratio (S/W) were obtained and compared to the healthy side for quantitative evaluation. RESULTS Qualitative analysis revealed 9 (13.8%) unaffected, 24 (36.9%) displaced, 13 (20%) infiltrated, and 19 (29.2%) tracts with a combination of displacement and infiltration. There were no disrupted tracts. There was a significant increase in S/W ratio among displaced tracts in the pre-operative scans in comparison with the contralateral side. QA values of peritumoral tract segments (S) were significantly lower in infiltrated tracts. CONCLUSION WHO grade II LGGs might displace, infiltrate, or cause a combination of displacement and infiltration of WM tracts. QA derived from GQI provides valuable information that helps to differentiate infiltration from displacement. Anisotropy changes correlate with qualitative alterations, which may serve as a potential biomarker of fiber tract integrity.
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Affiliation(s)
- Pinar Celtikci
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA, 15213, USA
| | - David T Fernandes-Cabral
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA, 15213, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA, 15213, USA
| | - Sandip S Panesar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA, 15213, USA
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St., Suite B-400, Pittsburgh, PA, 15213, USA.
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36
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Automatic Brain Tumor Grading from MRI Data Using Convolutional Neural Networks and Quality Assessment. UNDERSTANDING AND INTERPRETING MACHINE LEARNING IN MEDICAL IMAGE COMPUTING APPLICATIONS 2018. [DOI: 10.1007/978-3-030-02628-8_12] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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37
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Impact of WHO 2016 update of brain tumor classification, molecular markers and clinical outcomes in pleomorphic xanthoastrocytoma. J Neurooncol 2017; 136:343-350. [DOI: 10.1007/s11060-017-2658-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/27/2017] [Indexed: 10/18/2022]
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38
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Zhang J, Chen YS, Li YP, Zhu ZQ, Liu JM, Guo CC, Yang QY, Wang XL, Rao YH, Mao Q, Li WY, Ma L, Yang YQ, Xiao SY. Postoperative functional status in patients with supratentorial superficial low-grade glioma. World J Surg Oncol 2017; 15:186. [PMID: 29041974 PMCID: PMC5645899 DOI: 10.1186/s12957-017-1237-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/20/2017] [Indexed: 02/05/2023] Open
Abstract
Background We investigated the functional status of adult supratentorial superficial low-grade glioma (ASS-LGG) after surgery and analyzed its relevant factors to guide the therapeutic strategy and improve the life quality of these patients. Methods Clinical materials from January 2008 to December 2010 in 104 adults with ASS-LGG were analyzed retrospectively. The follow-up period ranged from 6 months to 1.5 years. The logistic regression was used to evaluate the preoperative and postoperative variation of functional status in patients to disclose the relevant factors affecting postoperative functional status, such as age, gender, the duration of symptom, size and location of the tumor, hemisphere, resection degree, and tumor pathologic grade and preoperative Karnofsky performance status (Pre-KPS). Results Four out of nine candidate factors are related to the postoperative functional status. They are age less than 40 years, the size of tumor less than 5 cm in diameter, tumor located in the right hemisphere, and limited resection of tumor in the eloquent area. Conclusions It seems more meaningful to evaluate the functional status of the patients with ASS-LGG on the basis of these clinical features, involving age, tumor size, location, and extent of resection.
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Affiliation(s)
- Ji Zhang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - Yin Sheng Chen
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - You-Ping Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zheng-Quan Zhu
- Department of Neurosurgery, Tumor Hospital Affiliated of Xinjiang Medical University, Xinshi District, Ürümqi, Xinjiang, China
| | - Jian-Min Liu
- Department of Neurosurgery, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Cheng-Cheng Guo
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - Qun-Ying Yang
- Department of Neurosurgery, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng East Road, Guangzhou, 510060, China
| | - Xiao-Li Wang
- Department of General Surgery, Shang Jin Nan Fu Hospital, West China Hospital, Sichuan University, Cheng du, Sichuang, China
| | - Ying-Hua Rao
- Department of Neurosurgery, Guangzhou Baiyun District People's Hospital, Guangzhou, China
| | - Qing Mao
- Department of General Surgery, West China Hospital of Sichuan University, Cheng du, Sichuang, China
| | - Wen-Yan Li
- Department of Neurosurgery, Affiliated Hospital of Guiyang Medical College, Guiyang, Guizhou Province, China
| | - Lu Ma
- Department of General Surgery, West China Hospital of Sichuan University, Cheng du, Sichuang, China
| | - Yun Qiang Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Shi-Yin Xiao
- Department of Neurosurgery, The second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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39
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Hempel JM, Schittenhelm J, Brendle C, Bender B, Bier G, Skardelly M, Tabatabai G, Castaneda Vega S, Ernemann U, Klose U. Histogram analysis of diffusion kurtosis imaging estimates for in vivo assessment of 2016 WHO glioma grades: A cross-sectional observational study. Eur J Radiol 2017; 95:202-211. [PMID: 28987669 DOI: 10.1016/j.ejrad.2017.08.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/19/2017] [Accepted: 08/07/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE To assess the diagnostic performance of histogram analysis of diffusion kurtosis imaging (DKI) maps for in vivo assessment of the 2016 World Health Organization Classification of Tumors of the Central Nervous System (2016 CNS WHO) integrated glioma grades. MATERIALS AND METHODS Seventy-seven patients with histopathologically-confirmed glioma who provided written informed consent were retrospectively assessed between 01/2014 and 03/2017 from a prospective trial approved by the local institutional review board. Ten histogram parameters of mean kurtosis (MK) and mean diffusivity (MD) metrics from DKI were independently assessed by two blinded physicians from a volume of interest around the entire solid tumor. One-way ANOVA was used to compare MK and MD histogram parameter values between 2016 CNS WHO-based tumor grades. Receiver operating characteristic analysis was performed on MK and MD histogram parameters for significant results. RESULTS The 25th, 50th, 75th, and 90th percentiles of MK and average MK showed significant differences between IDH1/2wild-type gliomas, IDH1/2mutated gliomas, and oligodendrogliomas with chromosome 1p/19q loss of heterozygosity and IDH1/2mutation (p<0.001). The 50th, 75th, and 90th percentiles showed a slightly higher diagnostic performance (area under the curve (AUC) range; 0.868-0.991) than average MK (AUC range; 0.855-0.988) in classifying glioma according to the integrated approach of 2016 CNS WHO. CONCLUSIONS Histogram analysis of DKI can stratify gliomas according to the integrated approach of 2016 CNS WHO. The 50th (median), 75th, and the 90th percentiles showed the highest diagnostic performance. However, the average MK is also robust and feasible in routine clinical practice.
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Affiliation(s)
| | - Jens Schittenhelm
- Institute of Neuropathology, Department of Pathology and Neuropathology, Eberhard Karls University, Tübingen, Germany
| | - Cornelia Brendle
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
| | - Benjamin Bender
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
| | - Georg Bier
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
| | - Marco Skardelly
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| | - Ghazaleh Tabatabai
- Centre of Neurooncology, Comprehensive Cancer Center Tübingen-Stuttgart, Eberhard Karls University, Tübingen, Germany
| | - Salvador Castaneda Vega
- Werner Siemens Imaging Center, Department of Preclinical Imaging and Radiopharmacy, Eberhard Karls University, Tübingen, Germany
| | - Ulrike Ernemann
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
| | - Uwe Klose
- Department of Neuroradiology, Eberhard Karls University, Tübingen, Germany
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40
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Bogdańska MU, Bodnar M, Piotrowska MJ, Murek M, Schucht P, Beck J, Martínez-González A, Pérez-García VM. A mathematical model describes the malignant transformation of low grade gliomas: Prognostic implications. PLoS One 2017; 12:e0179999. [PMID: 28763450 PMCID: PMC5538650 DOI: 10.1371/journal.pone.0179999] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/07/2017] [Indexed: 01/28/2023] Open
Abstract
Gliomas are the most frequent type of primary brain tumours. Low grade gliomas (LGGs, WHO grade II gliomas) may grow very slowly for the long periods of time, however they inevitably cause death due to the phenomenon known as the malignant transformation. This refers to the transition of LGGs to more aggressive forms of high grade gliomas (HGGs, WHO grade III and IV gliomas). In this paper we propose a mathematical model describing the spatio-temporal transition of LGGs into HGGs. Our modelling approach is based on two cellular populations with transitions between them being driven by the tumour microenvironment transformation occurring when the tumour cell density grows beyond a critical level. We show that the proposed model describes real patient data well. We discuss the relationship between patient prognosis and model parameters. We approximate tumour radius and velocity before malignant transformation as well as estimate the onset of this process.
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Affiliation(s)
- Magdalena U. Bogdańska
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
- Departamento de Matemáticas, Universidad de Castilla-La Mancha, Ciudad Real, Spain
| | - Marek Bodnar
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Monika J. Piotrowska
- Faculty of Mathematics, Informatics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Michael Murek
- Universitätsklinik für Neurochirurgie, Bern University Hospital, Bern, Switzerland
| | - Philippe Schucht
- Universitätsklinik für Neurochirurgie, Bern University Hospital, Bern, Switzerland
| | - Jürgen Beck
- Universitätsklinik für Neurochirurgie, Bern University Hospital, Bern, Switzerland
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Persaud-Sharma D, Burns J, Trangle J, Moulik S. Disparities in Brain Cancer in the United States: A Literature Review of Gliomas. ACTA ACUST UNITED AC 2017; 5:medsci5030016. [PMID: 29099032 PMCID: PMC5635804 DOI: 10.3390/medsci5030016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 11/24/2022]
Abstract
In the human body, the central regulatory system of homeostasis is maintained by the brain. Its complexity is mesmerizing and many of its functions are largely uncharted. Unfortunately, its functionality is often impaired through neoplastic growths, like gliomas, which are devastating to patients and their families. Annually, gliomas are the most common primary brain tumours affecting over 20,000 people in the United States. However, despite their status as the third most common cause of cancer related death for individuals between ages 20 and 39, the aetiology of gliomas remains unknown. This paper aims to review the latest information regarding the 2016 World Health Organization (WHO) 4th edition classifications of gliomas, their malignant effects, and disparities within these classifications, as well as identify areas for further research. These suggestions for future inquiry may contribute to a better understanding of the pathology of these cancers enabling improvement in prevention, screening, and treatment.
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Affiliation(s)
- Dharam Persaud-Sharma
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
| | - Joseph Burns
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
| | - Jeran Trangle
- Florida International University, Herbert Wertheim College of Medicine, Miami, FL 33199, USA.
| | - Sabyasachi Moulik
- Florida International University, Herbert Wertheim College of Medicine, Department of Cellular Biology and Pharmacology, Miami, FL 33199, USA.
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42
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Zhang C, de Smith AJ, Smirnov IV, Wiencke JK, Wiemels JL, Witte JS, Walsh KM. Non-additive and epistatic effects of HLA polymorphisms contributing to risk of adult glioma. J Neurooncol 2017; 135:237-244. [PMID: 28721485 DOI: 10.1007/s11060-017-2569-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/13/2017] [Indexed: 01/15/2023]
Abstract
Although genome-wide association studies have identified several susceptibility loci for adult glioma, little is known regarding the potential contribution of genetic variation in the human leukocyte antigen (HLA) region to glioma risk. HLA associations have been reported for various malignancies, with many studies investigating selected candidate HLA polymorphisms. However, no systematic analysis has been conducted in glioma patients, and no investigation into potential non-additive effects has been described. We conducted comprehensive genetic analyses of HLA variants among 1746 adult glioma patients and 2312 controls of European-ancestry from the GliomaScan Consortium. Genotype data were generated with the Illumina 660-Quad array, and we imputed HLA alleles using a reference panel of 5225 individuals in the Type 1 Diabetes Genetics Consortium who underwent high-resolution HLA typing via next-generation sequencing. Case-control comparisons were adjusted for population stratification using ancestry-informative principal components. Because alleles in different loci across the HLA region are linked, we created multigene haplotypes consisting of the genes DRB1, DQA1, and DQB1. Although none of the haplotypes were associated with glioma in additive models, inclusion of a dominance term significantly improved the model for multigene haplotype HLA-DRB1*1501-DQA1*0102-DQB1*0602 (P = 0.002). Heterozygous carriers of the haplotype had an increased risk of glioma [odds ratio (OR) 1.23; 95% confidence interval (CI) 1.01-1.49], while homozygous carriers were at decreased risk compared with non-carriers (OR 0.64; 95% CI 0.40-1.01). Our results suggest that the DRB1*1501-DQA1*0102-DQB1*0602 haplotype may contribute to the risk of glioma in a non-additive manner, with the positive dominance effect partly explained by an epistatic interaction with HLA-DRB1*0401-DQA1*0301-DQB1*0301.
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Affiliation(s)
- Chenan Zhang
- Division of Neuroepidemiology, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94158, USA. .,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA.
| | - Adam J de Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Ivan V Smirnov
- Division of Neuroepidemiology, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - John K Wiencke
- Division of Neuroepidemiology, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Joseph L Wiemels
- Division of Neuroepidemiology, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94158, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - John S Witte
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA
| | - Kyle M Walsh
- Division of Neuroepidemiology, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, 94158, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, 94158, USA.,Division of Neuro-epidemiology, Department of Neurosurgery, Duke University, Durham, NC, 27710, USA
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Catanese A, Malacario F, Cirillo L, Toni F, Zenesini C, Casolino D, Bacci A, Agati R. Application of intravoxel incoherent motion (IVIM) magnetic resonance imaging in the evaluation of primitive brain tumours. Neuroradiol J 2017. [PMID: 28643545 DOI: 10.1177/1971400917693025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intravoxel incoherent motion is a potential non-invasive diagnostic tool in brain tumours, without any clear guidelines for its evaluation yet. In our study, we compare intravoxel incoherent motion with dynamic susceptibility contrast magnetic resonance imaging in the quantification of tumour tissue blood perfusion in 28 patients affected by brain tumours, highlighting the issues encountered during the acquisition set-up and post-processing steps. Intravoxel incoherent motion is a new imaging tool and an alternative technique to dynamic susceptibility contrast-magnetic resonance imaging which is of considerable interest at present. This is partly because it does not require the use of a contrast agent and relies on the intrinsic properties of motion in the capillaries of the spins. Compared to dynamic susceptibility contrast-magnetic resonance imaging, the intravoxel incoherent motion technique is also characterised by better resolution because the gadolinium-based contrast agent bolus used in the standard technique results in a variation by more than 50% of the signal coming from the brain. Finally, intravoxel incoherent motion is more sensitive to the incoherent motion that originates from small capillary vessels, while the dynamic susceptibility contrast signal is also contaminated by the input from larger arteries and veins, which may result in an overestimation of the blood volume. Although there are limitations due to the heterogeneity of the sample considered in our study, intravoxel incoherent motion has been shown to be an accurate noninvasive radiological biomarker, useful to distinguish between low and high grade glial tumours.
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Affiliation(s)
- A Catanese
- 1 Department of Radiology, University of Bologna, S. Orsola Hospital, Bologna Italy
| | - F Malacario
- 2 Department of Radiology, University of Naples Federico II, Italy
| | - L Cirillo
- 3 Department of Neuroradiology, Institute of Neurological Sciences of Bologna, Italy
| | - F Toni
- 3 Department of Neuroradiology, Institute of Neurological Sciences of Bologna, Italy
| | - C Zenesini
- 4 Unit of Epidemiology and Biostatistic, Institute of Neurological Sciences of Bologna, Italy
| | - D Casolino
- 5 MTS Medical Technology Solutions, Italy
| | - A Bacci
- 3 Department of Neuroradiology, Institute of Neurological Sciences of Bologna, Italy
| | - R Agati
- 3 Department of Neuroradiology, Institute of Neurological Sciences of Bologna, Italy
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44
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Henares-Molina A, Benzekry S, Lara PC, García-Rojo M, Pérez-García VM, Martínez-González A. Non-standard radiotherapy fractionations delay the time to malignant transformation of low-grade gliomas. PLoS One 2017; 12:e0178552. [PMID: 28570587 PMCID: PMC5453550 DOI: 10.1371/journal.pone.0178552] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/15/2017] [Indexed: 12/15/2022] Open
Abstract
Grade II gliomas are slowly growing primary brain tumors that affect mostly young patients. Cytotoxic therapies (radiotherapy and/or chemotherapy) are used initially only for patients having a bad prognosis. These therapies are planned following the “maximum dose in minimum time” principle, i. e. the same schedule used for high-grade brain tumors in spite of their very different behavior. These tumors transform after a variable time into high-grade gliomas, which significantly decreases the patient’s life expectancy. In this paper we study mathematical models describing the growth of grade II gliomas in response to radiotherapy. We find that protracted metronomic fractionations, i.e. therapeutical schedules enlarging the time interval between low-dose radiotherapy fractions, may lead to a better tumor control without an increase in toxicity. Other non-standard fractionations such as protracted or hypoprotracted schemes may also be beneficial. The potential survival improvement depends on the tumor’s proliferation rate and can be even of the order of years. A conservative metronomic scheme, still being a suboptimal treatment, delays the time to malignant progression by at least one year when compared to the standard scheme.
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Affiliation(s)
- Araceli Henares-Molina
- Department of Mathematics, University of Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Sebastien Benzekry
- INRIA Bordeaux Sud-Ouest, team MONC, Institut de Mathematiques de Bordeaux, Bordeaux, Nouvelle-Aquitaine, France
| | - Pedro C Lara
- Department of Radiation Oncology, Negrín Las Palmas University Hospital, Las Palmas GC, Canarias, Spain
| | - Marcial García-Rojo
- Department of Pathology, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, Spain
| | - Víctor M Pérez-García
- Department of Mathematics, University of Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
| | - Alicia Martínez-González
- Department of Mathematics, University of Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
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45
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van Coevorden-van Loon EMP, Coomans MB, Heijenbrok-Kal MH, Ribbers GM, van den Bent MJ. Fatigue in patients with low grade glioma: systematic evaluation of assessment and prevalence. J Neurooncol 2017; 133:237-246. [PMID: 28540668 PMCID: PMC5529493 DOI: 10.1007/s11060-017-2454-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/27/2017] [Indexed: 01/03/2023]
Abstract
Fatigue is the most prevalent and disabling symptom in cancer patients. Yet, scientific literature on this topic is scarce and reports disparate results. This study systematically reviews how fatigue is assessed in patients with low-grade glioma and evaluates its prevalence in LGG patients. A systematic literature search was performed in PubMed, Embase and PsychINFO for articles reporting on fatigue in patients with LGG. Two reviewers independently extracted data from selected articles. Inclusion criteria were: (1) patients with suspected or confirmed LGG; (2) fatigue was assessed as primary or secondary outcome measure; (3) age≥ 18 years; (4) full-length article written in English or Dutch. In total, 19 articles were selected, including 971 patients. Seven self-assessment instruments were identified. Prevalence rates ranged from 39 to 77%. Fatigue was found to be a common side effect of treatment. The prevalence rates ranged from 20 to 76% when fatigue was reported as a mild or moderate side effect and fatigue was prevalent in 4% when reported as a severe side effect. Fatigue is a common problem in LGG patients that warrants more therapeutic and scientific attention. Gaining deeper insight in the underlying mechanisms of fatigue is essential in targeting therapy to individual patients.
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Affiliation(s)
- Ellen M P van Coevorden-van Loon
- Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, PO Box 23181, 3001 KD, Rotterdam, The Netherlands. .,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Marijke B Coomans
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Majanka H Heijenbrok-Kal
- Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, PO Box 23181, 3001 KD, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Gerard M Ribbers
- Rotterdam Neurorehabilitation Research (RoNeRes), Rijndam Rehabilitation Center, PO Box 23181, 3001 KD, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neurology/Neuro-oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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46
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Metabolic Profiling of IDH Mutation and Malignant Progression in Infiltrating Glioma. Sci Rep 2017; 7:44792. [PMID: 28327577 PMCID: PMC5361089 DOI: 10.1038/srep44792] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 02/14/2017] [Indexed: 01/04/2023] Open
Abstract
Infiltrating low grade gliomas (LGGs) are heterogeneous in their behavior and the strategies used for clinical management are highly variable. A key factor in clinical decision-making is that patients with mutations in the isocitrate dehydrogenase 1 and 2 (IDH1/2) oncogenes are more likely to have a favorable outcome and be sensitive to treatment. Because of their relatively long overall median survival, more aggressive treatments are typically reserved for patients that have undergone malignant progression (MP) to an anaplastic glioma or secondary glioblastoma (GBM). In the current study, ex vivo metabolic profiles of image-guided tissue samples obtained from patients with newly diagnosed and recurrent LGG were investigated using proton high-resolution magic angle spinning spectroscopy (1H HR-MAS). Distinct spectral profiles were observed for lesions with IDH-mutated genotypes, between astrocytoma and oligodendroglioma histologies, as well as for tumors that had undergone MP. Levels of 2-hydroxyglutarate (2HG) were correlated with increased mitotic activity, axonal disruption, vascular neoplasia, and with several brain metabolites including the choline species, glutamate, glutathione, and GABA. The information obtained in this study may be used to develop strategies for in vivo characterization of infiltrative glioma, in order to improve disease stratification and to assist in monitoring response to therapy.
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47
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Neill E, Luks T, Dayal M, Phillips JJ, Perry A, Jalbert LE, Cha S, Molinaro A, Chang SM, Nelson SJ. Quantitative multi-modal MR imaging as a non-invasive prognostic tool for patients with recurrent low-grade glioma. J Neurooncol 2017; 132:171-179. [PMID: 28124178 DOI: 10.1007/s11060-016-2355-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
Low-grade gliomas can vary widely in disease course and therefore patient outcome. While current characterization relies on both histological and molecular analysis of tissue resected during surgery, there remains high variability within glioma subtypes in terms of response to treatment and outcome. In this study we hypothesized that parameters obtained from magnetic resonance data would be associated with progression-free survival for patients with recurrent low-grade glioma. The values considered were derived from the analysis of anatomic imaging, diffusion weighted imaging, and 1H magnetic resonance spectroscopic imaging data. Metrics obtained from diffusion and spectroscopic imaging presented strong prognostic capability within the entire population as well as when restricted to astrocytomas, but demonstrated more limited efficacy in the oligodendrogliomas. The results indicate that multi-parametric imaging data may be applied as a non-invasive means of assessing prognosis and may contribute to developing personalized treatment plans for patients with recurrent low-grade glioma.
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Affiliation(s)
- Evan Neill
- Department of Radiology, University of California San Francisco, San Francisco,, CA, 94143, USA
| | - Tracy Luks
- Department of Radiology, University of California San Francisco, San Francisco,, CA, 94143, USA.
| | - Manisha Dayal
- Department of Radiology, University of California San Francisco, San Francisco,, CA, 94143, USA
| | - Joanna J Phillips
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Arie Perry
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Llewellyn E Jalbert
- Department of Radiology, University of California San Francisco, San Francisco,, CA, 94143, USA
| | - Soonmee Cha
- Department of Radiology, University of California San Francisco, San Francisco,, CA, 94143, USA
| | - Annette Molinaro
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Susan M Chang
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Sarah J Nelson
- Department of Radiology, University of California San Francisco, San Francisco,, CA, 94143, USA
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48
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Sengupta S, Voloschin A. Redefining Management of Adult Low-Grade Gliomas. J Oncol Pract 2016; 12:1244-1245. [PMID: 27943688 DOI: 10.1200/jop.2016.019174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Soma Sengupta
- Winship Cancer Institute, Emory University Hospital, Atlanta, GA
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49
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Turki S, Mardassi A, Nefzaoui S, Hachicha A, Rhouma SB. [Brain stem glioma: a rare cause of central vertigo in adults]. Pan Afr Med J 2016; 25:135. [PMID: 28292097 PMCID: PMC5326053 DOI: 10.11604/pamj.2016.25.135.10669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 10/17/2016] [Indexed: 11/15/2022] Open
Abstract
Unlike children, brainstem gliomas in adults are rare and represent a heterogeneous group of tumors: often low grade tumors having a better prognosis. These tumors are a rare cause of central vertigo in adults. The treatment of diffuse gliomas is based on radiation therapy. We here report the case of a 35-year old female patient with low grade brainstem glioma revealed by balance disorders, in order to highlight the different clinical, paraclinical and radiological aspects of this disease as well as the therapeutic tools and the progressive methods.
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Affiliation(s)
- Senda Turki
- Service ORL, Hôpital FSI,Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Ali Mardassi
- Service ORL, Hôpital FSI,Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Safa Nefzaoui
- Service ORL, Hôpital FSI,Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Amani Hachicha
- Service ORL, Hôpital FSI,Faculté de Médecine de Tunis, Université Tunis El Manar
| | - Sofiène Ben Rhouma
- Service ORL, Hôpital FSI,Faculté de Médecine de Tunis, Université Tunis El Manar
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50
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Ji YB, Oh SJ, Kang SG, Heo J, Kim SH, Choi Y, Song S, Son HY, Kim SH, Lee JH, Haam SJ, Huh YM, Chang JH, Joo C, Suh JS. Terahertz reflectometry imaging for low and high grade gliomas. Sci Rep 2016; 6:36040. [PMID: 27782153 PMCID: PMC5080552 DOI: 10.1038/srep36040] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/10/2016] [Indexed: 01/02/2023] Open
Abstract
Gross total resection (GTR) of glioma is critical for improving the survival rate of glioma patients. One of the greatest challenges for achieving GTR is the difficulty in discriminating low grade tumor or peritumor regions that have an intact blood brain barrier (BBB) from normal brain tissues and delineating glioma margins during surgery. Here we present a highly sensitive, label-free terahertz reflectometry imaging (TRI) that overcomes current key limitations for intraoperative detection of World Health Organization (WHO) grade II (low grade), and grade III and IV (high grade) gliomas. We demonstrate that TRI provides tumor discrimination and delineation of tumor margins in brain tissues with high sensitivity on the basis of Hematoxylin and eosin (H&E) stained image. TRI may help neurosurgeons to remove gliomas completely by providing visualization of tumor margins in WHO grade II, III, and IV gliomas without contrast agents, and hence, improve patient outcomes.
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Affiliation(s)
- Young Bin Ji
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Jae Oh
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Brain Tumor Center, Brain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung Heo
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hoon Kim
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Applied Electromagnetic Wave Research Center, Korea Electrotechnology Research Institute, Ansan, Republic of Korea
| | - Yuna Choi
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungri Song
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Hye Young Son
- Severance Biomedical Science Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Hyun Lee
- Department of Neurosurgery, Brain Tumor Center, Brain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Joo Haam
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong Min Huh
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Hee Chang
- Department of Neurosurgery, Brain Tumor Center, Brain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chulmin Joo
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Jin-Suck Suh
- YUHS-KRIBB Medical Convergence Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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