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Lunde CE, Dudek MR, Talbert CA, Sieberg CB, Silva KE, Papadelis C, Ullrich NJ, Manley PE, Moulton EA. The long-term impact of cerebellar tumor resection on executive functioning, anxiety, and fear of pain: A mixed methodology pilot study. APPLIED NEUROPSYCHOLOGY. CHILD 2024:1-11. [PMID: 38604218 DOI: 10.1080/21622965.2024.2337208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
This pilot study investigated the long-term impact of a surgery-only treatment (no exposure to other treatments, such as chemotherapy and radiation) for pediatric cerebellar low-grade gliomas on executive function, anxiety, and fear of pain (FOP) beliefs. Twelve patients who underwent surgical glioma resection during childhood (surgery age was 4-16 years, study visit age was 10-28 years), and 12 pain-free controls matched for age, sex, race, and handedness were tested. The spatial extent of resection was precisely mapped using magnetic resonance imaging (MRI). Executive function, anxiety, and FOP were assessed using validated self-report age-appropriate questionnaires for children and adults. Structured clinical interviews at a post-surgery follow-up visit were completed (average: 89 months, range: 20-99). No significant differences in FOP (FOPQ-C t[14 = 1.81, p = 0.09; FOPQ-III t[4] = 0.29, p = 0.79), executive function scores (BRIEF t[20] = 0.30, p = 0.28), or anxiety scores (MASC t[16] = 0.19, p = 0.85; MAQ t[4] = 1.80, p = 0.15) were found in pediatric or adult patients compared to pain-free controls. Clinical interviews mainly categorized pediatric patients as not anxious. One participant reported mild/subclinical anxiety, and one had moderate clinical anxiety. Neither psychologists nor patients endorsed impairments to executive functioning, anxiety, or FOP. Our pilot results suggest that pediatric cerebellar tumor survivors treated with surgery-only have favorable long-term functioning related to these themes. While these results are promising, they will need to be replicated in a larger patient sample.
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Affiliation(s)
- Claire E Lunde
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, USA
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Nuffield Department of Women's and Reproductive Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Madison R Dudek
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| | - Cameron A Talbert
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| | - Christine B Sieberg
- Biobehavioral Pain Innovations Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, Massachusetts, USA
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Center for Health Outcomes & Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Adolescent & Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Katie E Silva
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, Texas, USA
- Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nicole J Ullrich
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Peter E Manley
- Department of Hematology/Oncology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Moulton
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Brain and Eye Pain Imaging Lab, Department of Anesthesiology, Critical Care and Pain Medicine, Boston, Massachusetts, USA
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Meel M, Jindal A, Kumar M, Mathur K, Singh A. IDH1, ATRX, p53, and Ki67 Expression in Glioblastoma patients: Their Clinical and Prognostic Significance-A Prospective Study. Asian J Neurosurg 2024; 19:14-20. [PMID: 38751398 PMCID: PMC11093636 DOI: 10.1055/s-0042-1750783] [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] [Indexed: 05/18/2024] Open
Abstract
Context Glioblastoma multiforme (GBM) is a malignant and aggressive primary brain tumor with a poor prognosis. This adverse prognosis is due to the tumor's tendency for advancement and recurrence caused by highly intrusive nature of the persisting GBM cells that actively escape from the main tumor mass into the surrounding normal brain tissue. On the basis of biomarker illustration, it can be classified into molecular subgroups. Aims (1) To determine the expression of IDH1, ATRX, p53, and Ki67 by immunohistochemistry, in a cohort of GBMs. (2) To determine whether altered protein expression of any of these growth-control genes in GBM will show association with patient survival. (3) To establish prognostically distinct molecular subgroups of GBM, irrespective of histopathological diagnosis. Results In this prospective observational study, 35 histologically diagnosed cases of glioblastoma were enrolled. The mean age at the time of presentation was 43.46 ± 17.25 years with a male:female ratio of 1.3:1. Of the 35 cases, microvascular proliferation was seen in 23 cases. Large foci of necrosis (>50%) were seen in 10 cases and 27 cases had mitotic count ≥ 5/high power field (HPF). Of 35 cases, 5 (14.3%) cases showed IDH1 immunopositivity and 30 (85.7%) cases were negative for IDH1. ATRX was retained in 24 (68.6%) cases, while it was lost in 11 (31.4%) cases. The p53 immunoexpression was seen in 31 (88.6%) cases, whereas p53 was negative in 4 (11.4%) cases. The overall median survival (OS) was 6 months. In two protein pairs, the three compositions were IDH1-/p53+ (74.3%), ATRX +/IDH1- (62.9%), and ATRX +/p53+ (57.1%). Combined three-protein immunohistochemical analysis revealed five different molecular variants. Also, 8.6% (3/35) of the samples had aberrant protein expression of all three proteins, i.e., ATRX-/p53 +/IDH1 + , while 11.4% (4/35) were wild-type protein expression group, i.e., ATRX +/p53-/IDH1-. Conclusion In patients with single protein expression, Kaplan-Meier survival analysis showed statistically better OS in IDH1 mutant glioblastomas. In cases with double protein pairs, IDH1/p53 revealed statistically significant association with better median OS. The survival analysis of patients with IDH1/ATRX/p53 protein combinations also denoted a better OS. Hence, GBM can be grouped into prognostically relevant subgroups using these protein expression signatures individually, as well as the combined protein expression signatures.
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Affiliation(s)
- Mukta Meel
- Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
| | - Arpita Jindal
- Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
| | - Mukesh Kumar
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Kusum Mathur
- Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
| | - Ashok Singh
- Department of Pathology, SMS Medical College, Jaipur, Rajasthan, India
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Das K, Maurya V, Datta A, Singh M, Pal L, Misra S, Bhaisora K, Srivastava A, Jaiswal A, Behari S. Spinal metastasis from pediatric supratentorial glioblastoma: Is it the price of an extended survival? An interesting case and review of literature. J Pediatr Neurosci 2023. [DOI: 10.4103/jpn.jpn_95_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
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Contrast Enhancement Patterns in Pediatric Glioblastomas. J Comput Assist Tomogr 2023; 47:115-120. [PMID: 36112052 DOI: 10.1097/rct.0000000000001379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Brain tumors are the most common cause of cancer-related deaths among the pediatric population. Among these, pediatric glioblastomas (GBMs) comprise 2.9% of all central nervous system tumors and have a poor prognosis. The purpose of this study is to determine whether the imaging findings can be a prognostic factor for survival in children with GBMs. MATERIALS AND METHODS The imaging studies and clinical data from 64 pediatric patients with pathology-proven GBMs were evaluated. Contrast enhancement patterns were classified into focal, ring-like, and diffuse, based on preoperative postcontrast T1-weighted magnetic resonance images. We used the Kaplan-Meier method and Cox proportional hazard regression to evaluate the prognostic value of imaging findings. RESULTS Patients with ring-enhanced GBMs who underwent gross total resection or subtotal resection were found to have a significantly shorter progression-free survival ( P = 0.03) comparing with other enhancing and nonenhancing glioblastomas. CONCLUSIONS In this study, we analyzed survival factors in children with pediatric glioblastomas. In the group of patients who underwent gross total resection or subtotal resection, those patients with focal-enhanced GBMs had significantly longer progression-free survival ( P = 0.03) than did those with other types of enhancing GBMs (diffuse and ring-like).
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A Signature of Three microRNAs Is a Potential Diagnostic Biomarker for Glioblastoma. IRANIAN BIOMEDICAL JOURNAL 2022; 26:301-12. [PMID: 35490305 PMCID: PMC9432466 DOI: 10.52547/ibj.3671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background: Glioblastoma is the most common primary malignant neoplasm of the central nervous system. Despite progress in diagnosis and treatment, glioblastoma still has a poor prognosis. This study aimed to examine whether a signature of three candidate miRNAs (i.e. hsa-let-7c-5p, hsa-miR-206-5p, and hsa-miR-1909-5p) can be used as a diagnostic biomarker for distinguishing glioblastoma from healthy brain tissues. Methods: In this study, 50 FFPE glioblastoma tissue samples and 50 healthy tissue samples adjacent to tumor were included. The expression of each candidate miRNA (i.e. hsa-let-7c-5p, hsa-miR-206-5p, and hsa-miR-1909-5p) was measured using RT-qPCR. To show the roles of each miRNA and their biological effects on glioblastoma development and clinicopathological characteristics, in silico tools were used. ROC curves were performed to assess the diagnostic accuracy of each miRNA. Results: Based on the results, hsa-let-7c-5p and hsa-miR-206-5p were downregulated, while hsa-miR-1909-5p was upregulated in glioblastoma tumors compared to healthy samples. No association was detected between the expression of each candidate miRNA and sex. Except for hsa-let-7c-5p, other miRNAs did not correlate with age status. ROC curve analysis indicated that the signature of candidate miRNAs is a potential biomarker distinguishing between glioblastoma and healthy samples. Only hsa-miR-206-5p suggested the association with poor prognosis in glioblastoma patients. Conclusion: Our findings revealed that the signature of three miRNAs is capable of distinguishing glioblastoma tumor and healthy tissues. These results are beneficial for the clinical management of glioblastoma patients.
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The Current State of Radiotherapy for Pediatric Brain Tumors: An Overview of Post-Radiotherapy Neurocognitive Decline and Outcomes. J Pers Med 2022; 12:jpm12071050. [PMID: 35887547 PMCID: PMC9315742 DOI: 10.3390/jpm12071050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Tumors of the central nervous system are the most common solid malignancies diagnosed in children. While common, they are also found to have some of the lowest survival rates of all malignancies. Treatment of childhood brain tumors often consists of operative gross total resection with adjuvant chemotherapy or radiotherapy. The current body of literature is largely inconclusive regarding the overall benefit of adjuvant chemo- or radiotherapy. However, it is known that both are associated with conditions that lower the quality of life in children who undergo those treatments. Chemotherapy is often associated with nausea, emesis, significant fatigue, immunosuppression, and alopecia. While radiotherapy can be effective for achieving local control, it is associated with late effects such as endocrine dysfunction, secondary malignancy, and neurocognitive decline. Advancements in radiotherapy grant both an increase in lifetime survival and an increased lifetime for survivors to contend with these late effects. In this review, the authors examined all the published literature, analyzing the results of clinical trials, case series, and technical notes on patients undergoing radiotherapy for the treatment of tumors of the central nervous system with a focus on neurocognitive decline and survival outcomes.
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Chaulagain D, Smolanka V, Smolanka A, Munakomi S. The Impact of Extent of Resection on the Prognosis of Glioblastoma Multiforme: A Systematic Review and Meta-analysis. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose:
To investigate the predictor factors of mortality describing the prognosis of primary surgical resection of Glioblastoma Multiforme (GBM).
Materials and Methods:
A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 12th September 2021. All statistical analysis was conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result were reported in the Hazards Ratio (HR) and corresponding 95% Confidence interval (CI).
Result:
Twenty-three cohort studies were selected for meta-analysis. There was statistically significant effect of extent of resection on prognosis of surgery in GBM patients (HR= 0.90 [0.86, 0.95]; p< 0.0001; I2= 96%), male gender (HR= 1.19 [1.06, 1.34]; p= 0.002; I2= 0%) and decrease Karnofsky Performance Status (HR= 0.97 [0.95, 0.99]; p= 0.003; I2= 90%). Age and tumor volume was also analyzed in the study.
Conclusion:
The results of our meta-analysis suggested that age, gender, pre-operative KPS score and extent of resection have significant effects on the post-surgical mortality rate, therefore, these factors can be used significant predictor of mortality in GBM patients.
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Kinoshita T, Yano H, Nakayama N, Suzui N, Iida T, Endo S, Yasue S, Ozeki M, Kobayashi K, Miyazaki T, Iwama T. Pediatric Giant Cell Glioblastoma Presenting with Intracranial Dissemination at Diagnosis: A Case Report. NMC Case Rep J 2022; 8:151-157. [PMID: 35079457 PMCID: PMC8769385 DOI: 10.2176/nmccrj.cr.2020-0138] [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] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Giant cell glioblastoma (GCG) is a rare subtype of glioblastoma multiforme (GBM), and it often occurs in younger patients; however, its onset in children is extremely noticeable. A 7-year-old girl presented with a headache and restlessness. A giant tumor that was 7 cm in diameter was found by magnetic resonance imaging (MRI) in the left frontal lobe with intracranial dissemination. Because the tumor had extended to the lateral ventricles and occluded the foramen of Monro causing hydrocephalus, she underwent ventricular drainage and neuro-endoscopic biopsy from the left posterior horn of the lateral ventricle. The initial pathological diagnosis was an atypical teratoid/rhabdoid tumor (AT/RT). When the dissemination subsided after the first chemotherapy with vincristine, doxorubicin, and cyclophosphamide, she underwent the first tumor resection via a left frontal transcortical approach. After surgery, the second chemotherapy with ifosfamide, cisplatin, and etoposide was not effective for the residual tumor and intracranial dissemination. The second surgery via a transcallosal approach achieved nearly total resection leading to an improvement of the hydrocephalus. The definitive pathological diagnosis was GCG. Despite chemo-radiation therapy, the dissemination in the basal cistern reappeared and the hydrocephalus worsened. She was obliged to receive a ventriculo-peritoneal (VP) shunt and palliative care at home; however, her poor condition prevented her discharge. Ten months after admission, she died of tumor progression. The peritoneal dissemination was demonstrated by cytology of ascites. In conclusion, although unusual, pediatric GCG may be disseminated at diagnosis, in which case both tumor and hydrocephalus control need to be considered.
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Affiliation(s)
- Takamasa Kinoshita
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Hirohito Yano
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan.,Chubu Medical Center for Prolonged Traumatic Brain Dysfunction, Kizawa Memorial Hospital, Minokamo, Gifu, Japan
| | - Noriyuki Nakayama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Natsuko Suzui
- Department of Pathology, Gifu University Hospital, Gifu, Gifu, Japan
| | - Tomohiro Iida
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Saori Endo
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Shiho Yasue
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
| | | | | | - Toru Iwama
- Department of Neurosurgery, Gifu University Graduate School of Medicine, Gifu, Gifu, Japan
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Li L, Chen J, Ming Y, Li B, Fu R, Duan D, Li Z, Ni R, Wang X, Zhou Y, Zhang L. The Application of Peptides in Glioma: a Novel Tool for Therapy. Curr Pharm Biotechnol 2021; 23:620-633. [PMID: 34182908 DOI: 10.2174/1389201022666210628114042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Glioma is the most aggressive and lethal tumor of the central nervous system. Owing to the cellular heterogeneity, the invasiveness, and blood-brain barrier (BBB), current therapeutic approaches, such as chemotherapy and radiotherapy, are poorly to obtain great anti-tumor efficacy. However, peptides, a novel type of therapeutic agent, displayed excellent ability in the tumor, which becomes a new molecule for glioma treatment. METHOD We review the current knowledge on peptides for the treatment of glioma through a PubMed-based literature search. RESULTS In the treatment of glioma, peptides can be used as (i) decoration on the surface of the delivery system, facilitating the distribution and accumulation of the anti-tumor drug in the target site;(ii) anti-tumor active molecules, inhibiting the growth of glioma and reducing solid tumor volume; (iii) immune-stimulating factor, and activating immune cells in the tumor microenvironment or recruiting immune cells to the tumor for breaking out the immunosuppression by glioma cells. CONCLUSION The application of peptides has revolutionized the treatment of glioma, which is based on targeting, penetrating, anti-tumor activities, and immunostimulatory. Moreover, better outcomes have been discovered in combining different kinds of peptides rather than a single one. Until now, more and more preclinical studies have been developed with multifarious peptides, which show promising results in vitro or vivo with the model of glioma.
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Affiliation(s)
- Li Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Jianhong Chen
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yue Ming
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Bin Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ruoqiu Fu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Dongyu Duan
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Ziwei Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Rui Ni
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Xianfeng Wang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yueling Zhou
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Lin Zhang
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
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Jiao Y, Wang M, Liu X, Wang J, Wang Z, Luo W, Yu Y, Sun H. Clinical Features and Prognostic Factors of Pediatric Glioblastoma: Report of 38 Cases. World Neurosurg 2021; 153:e105-e111. [PMID: 34129988 DOI: 10.1016/j.wneu.2021.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To better characterize children with glioblastoma, assess outcomes, and identify prognostic factors associated with overall survival and progression-free survival in a relatively large cohort from a single institution. METHODS For this retrospective review, 38 pediatric patients with a diagnosis of glioblastoma who were treated at The First Affiliated Hospital of Zhengzhou University between January 2015 and January 2020 were selected. Clinical and pathological characteristics, imaging, treatment, and survival variables were compared. RESULTS There were 24 boys and 14 girls with a median age of 11.5 years (range, 3-18 years). All patients underwent surgery, with gross total resection in 16 and subtotal resection in 22. Of patients, 18 received radiation combined with chemotherapy, 6 received radiation or chemotherapy alone, and 14 did not receive any adjuvant therapy. Contrast-enhanced magnetic resonance imaging of 21 patients showed rim enhancement, while heterogeneous enhancement was shown on imaging of the other 17 patients. Tumors were observed in hemispheric locations in 19 cases and in central locations in the others. Median overall survival was 10.5 months with a median progression-free survival of 6 months. Extent of resection, adjuvant therapy, and original site of tumor were identified as independent predictors for progression-free survival and overall survival on multivariate analysis. There were significant differences in prognosis among different enhancement characteristics; patients with rim-enhancing tumors had a better prognosis. CONCLUSIONS Pediatric glioblastoma carries a dismal prognosis. Maximum safe resection followed by adjuvant radiation with chemotherapy is considered standard treatment. Better outcomes are associated with hemispheric tumor locations and rim enhancement on magnetic resonance imaging.
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Affiliation(s)
- Yang Jiao
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xueyou Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junkuan Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zeming Wang
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenzheng Luo
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yang Yu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongwei Sun
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Singla AK, Madan R, Gupta K, Goyal S, Kumar N, Sahoo SK, Uppal DK, Ahuja CK. Clinical behaviour and outcome in pediatric glioblastoma: current scenario. Radiat Oncol J 2021; 39:72-77. [PMID: 33794576 PMCID: PMC8024182 DOI: 10.3857/roj.2020.00591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/22/2020] [Indexed: 11/08/2022] Open
Abstract
Pediatric glioblastoma (pGBM) is a rare entity accounting for only approximately 3% of all childhood brain tumors. Treatment guidelines for pGBM have been extrapolated from those in adult glioblastoma. Rarity of pGBM and underrepresentation of pediatric population in major studies precludes from defining the ideal treatment protocol for these patients. Maximum safe resection is performed in most of the cases followed by postoperative radiotherapy in children over 3 years of age. Benefit of temozolomide is unclear in these patients. Here, we present the clinicopathological details and outcome of six pGBM patients treated at our institute in 2018–2019.
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Affiliation(s)
- Aditya Kumar Singla
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Madan
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shikha Goyal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Narendra Kumar
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushant Kumar Sahoo
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak K Uppal
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag K Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Alimohammadi E, Bagheri SR, Delfani N, Safari-Faramani R, Janatolmakan M. Pediatric Non–Brain Stem High-Grade Glioma: A Single-Center Experience. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1712067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Abstract
Background Pediatric high-grade gliomas (PHGGs) consist of a heterogeneous class of central nervous system (CNS) neoplasms with a poor prognosis. We aimed to present our 10-year experience in the management of children with high-grade glioma focusing on patients’ survival and related factors.
Methods All pediatric patients with high- grade glioma (HGG) who were admitted to our center between May 2009 and May 2018 were investigated. Overall survival (OS) was calculated from the time of diagnosis until the day of death. The impact of suggested variables on survival was evaluated using the univariate and multivariate analyses.
Results There were 41 children with non–brain stem high-grade glioma (NBSHGG). The mean OS of patients was 21.24 ± 10.16 months. The extent of resection (p = 0.002, hazard ratio [HR] = 4.84), the grade of the tumor (p = 0.017, HR = 4.36), and temozolomide (TMZ) therapy (p = 0.038, HR = 3.57) were the independent predictors of OS in children with NBSHGG. Age, gender, tumor location, and size of tumor were not associated with the survival of these patients.
Conclusion HGGs are uncommon pediatric tumors with an aggressive nature and a poor prognosis. Our results revealed that in NBSHGG cases, children with maximal safe tumor resection and children that received temozolomide therapy as well as children with grade III of the tumor had higher survival.
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Affiliation(s)
- Ehsan Alimohammadi
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Department of Neurosurgery, Kermanshah University of Medical Sciences, Imam Reza Hospital, Kermanshah, Iran
| | - Nasrin Delfani
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Roya Safari-Faramani
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Janatolmakan
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Dhoot AS, Just C, Bursztyn LL. Paraneoplastic Ophthalmoplegia as the Presenting Sign of Paediatric Glioblastoma Multiforme: A Case Report. Neuroophthalmology 2020; 45:397-402. [PMID: 34720271 DOI: 10.1080/01658107.2020.1817098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Glioblastoma multiforme (GBM) is an aggressive glioma that is infrequently diagnosed in the paediatric population. GBM and other primary brain tumours have rarely been associated with paraneoplastic syndromes. We report an unusual case of an 8-year-old boy presenting with an inability to abduct his left eye and almost complete ophthalmoplegia of his right eye, prior to any radiological evidence of GBM. This is the first documented case of paediatric GBM presenting with bilateral asymmetric ophthalmoplegia.
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Affiliation(s)
- Arjan S Dhoot
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Caroline Just
- Department of Clinical Neurological Sciences, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lulu Lcd Bursztyn
- Department of Clinical Neurological Sciences, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada.,Department of Ophthalmology, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Bone Morphogenetic Protein 4 Targeting Glioma Stem-Like Cells for Malignant Glioma Treatment: Latest Advances and Implications for Clinical Application. Cancers (Basel) 2020; 12:cancers12020516. [PMID: 32102285 PMCID: PMC7072475 DOI: 10.3390/cancers12020516] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022] Open
Abstract
Malignant gliomas are heterogeneous neoplasms. Glioma stem-like cells (GSCs) are undifferentiated and self-renewing cells that develop and maintain these tumors. These cells are the main population that resist current therapies. Genomic and epigenomic analyses has identified various molecular subtypes. Bone morphogenetic protein 4 (BMP4) reduces the number of GSCs through differentiation and induction of apoptosis, thus increasing therapeutic sensitivity. However, the short half-life of BMP4 impedes its clinical application. We previously reviewed BMP4 signaling in central nervous system development and glioma tumorigenesis and its potential as a treatment target in human gliomas. Recent advances in understanding both adult and pediatric malignant gliomas highlight critical roles of BMP4 signaling pathways in the regulation of tumor biology, and indicates its potential as a therapeutic molecule. Furthermore, significant progress has been made on synthesizing BMP4 biocompatible delivery materials, which can bind to and markedly extend BMP4 half-life. Here, we review current research associated with BMP4 in brain tumors, with an emphasis on pediatric malignant gliomas. We also summarize BMP4 delivery strategies, highlighting biocompatible BMP4 binding peptide amphiphile nanostructures as promising novel delivery platforms for treatment of these devastating tumors.
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Muhammed A, Gaber MS, Elbeltagy M, El Hemaly A, Taha H, Refaat A, Zaghluol MS. Risk stratification of pediatric high-grade glioma: a newly proposed prognostic score. Childs Nerv Syst 2019; 35:2355-2362. [PMID: 31218465 DOI: 10.1007/s00381-019-04257-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/07/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-grade glioma (HGG) is a clinical challenge. Radiation Therapy Oncology Group Recursive Partitioning Analysis (RTOG-RPA) for HGG remains the standard for assessing the prognosis of adult HGG. This study assesses the validity of the RTOG-RPA to be applied to pediatric HGG. METHODS A retrospective study was conducted on 59 pediatric HGG treated in the Children's Cancer Hospital, Egypt (CCHE) between 2007 and 2016. Several factors were studied as predictors for the disease survival, including age, gender, increased intracranial hypertension, tumor characteristics and pathology, CSF seeding, performance status, post-surgical residual, and radiation dose. The statistically significant results were integrated into a Cox-regression model to develop a prognostic risk score. RESULTS Kaplan-Meier statistics identified 13 factors that impacted the overall survival. However, Cox model showed that the histological grade IV [HR 14.2, 95%CI; (3.5-57), P < 0.0001], thalamic infiltration [HR 8.7; 95%CI; (2.9-25.9), P < 0.0001], PS ≥ 60 [HR 0.317; 95%CI; (0.13-0.776); P = 0.012], and maximum tumor dimension > 3.3 cm [HR 10.2; 95%CI; (1.58-65.89); P = 0.015] were the independent variables that predicted the overall survival. A risk score was proposed based on the presence of one or more of these factors. The median OS for the low risk (score 0-1), the intermediate-low risk (score 2), the intermediate-high risk (score 3), and the high risk (score 4) were 40, 18.5, 9.5, and 2.5 months, respectively, (P < 0.0001). CONCLUSION The proposed model and risk score could stratify pediatric patients as the RTOG-RPA do for the adults.
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Affiliation(s)
- Amr Muhammed
- Department of Clinical Oncology and Nuclear Medicine, Sohag University Hospital, Sohag, Egypt.
| | - Mohamed S Gaber
- Department of Clinical Oncology and Nuclear Medicine, Sohag University Hospital, Sohag, Egypt
| | - Mohamed Elbeltagy
- Department of Neurosurgery Children's Cancer Hospital, Egypt and Faculty of Medicine Cairo University, Cairo, Egypt
| | - Ahmed El Hemaly
- Department of Pediatric Oncology, National Cancer Institute, Cairo University and Children Cancer Hospital (CCHE), Cairo, Egypt
| | - Hala Taha
- Department of Pathology, National Cancer Institute, Cairo University and Children Cancer Hospital (CCHE), Cairo, Egypt
| | - Amal Refaat
- Radio-diagnosis Department, National Cancer Institute & Children's Cancer Hospital, Cairo, Egypt
| | - Mohamed S Zaghluol
- Department of Radiation Oncology, National Cancer Institute, Cairo University and Children Cancer Hospital (CCHE), Cairo, Egypt
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Solanki C, Sadana D, Arimappamagan A, Rao KVLN, Rajeswaran J, Subbakrishna DK, Santosh V, Pandey P. Impairments in Quality of Life and Cognitive Functions in Long-term Survivors of Glioblastoma. J Neurosci Rural Pract 2019; 8:228-235. [PMID: 28479798 PMCID: PMC5402490 DOI: 10.4103/0976-3147.203829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The incidence of long-term survival in glioblastoma (GBM), i.e., >3 years, ranges from 3% to 5%. Although extensive research is performed in novel therapies for prolonging survival, there is a scarcity of research focusing on the impact of tumor and treatment on cognitive, psychological, and social status of survivors. This study is an attempt to look into this poorly addressed important issue. MATERIALS AND METHODS Nine patients (six adults and three children) with GBM who had survived >3 years were included in the study. The quality of life (QOL) functions were assessed with the World Health Organization QOL Questionnaire BREF questionnaire. The neuropsychological assessment was done using the National Institute of Mental Health and Neurosciences neuropsychology battery for adults and children. The scores were compared with normative data. RESULTS The physical and psychological health-related QOL of long-term GBM survivors were affected considerably due to fatigue, poor quality of sleep, inability to concentrate, presence of depression, financial burden with impaired personal and social relationships (P < 0.05). Different domains of cognitions such as motor speed (P = 0.0173), mental speed (P = 0.0022), sustained attention (P = 0.0001), long-term memory (P = 0.0431), mental flexibility (P < 0.05), and planning and executive functions (P < 0.05) were significantly impaired affecting personal, social, and professional lives. CONCLUSION The health-related QOL and cognition are significantly impaired in GBM long-term survivors. As the incidence of long-term survival is very less, there is a need for larger multicenter studies to come up with definitive results, which in turn can help in formatting the rehabilitative and support programs for these patients.
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Affiliation(s)
- Chirag Solanki
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Divya Sadana
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - K V L N Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jamuna Rajeswaran
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - D K Subbakrishna
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Paritosh Pandey
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Uppar AM, Sugur H, Prabhuraj AR, Rao MB, Devi BI, Sampath S, Arivazhagan A, Santosh V. H3K27M, IDH1, and ATRX expression in pediatric GBM and their clinical and prognostic significance. Childs Nerv Syst 2019; 35:1537-1545. [PMID: 31152217 DOI: 10.1007/s00381-019-04222-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 05/23/2019] [Indexed: 01/21/2023]
Abstract
PURPOSE Pediatric glioblastoma (pGBM) tumors have been identified as an entity distinct and different from the adult variety of GBM not only with respect to pathogenesis, genetics, and molecular alterations but also in clinical outcomes and overall survival. This study aims to evaluate the immunohistochemical profile of molecular markers in pediatric GBM and correlate them with clinical features and prognosis. MATERIALS AND METHODS We retrospectively analyzed 29 pGBMs (age range 3 to 18 years), operated at our institute between 2009 and 2014, and evaluated their clinical and histopathological features along with the immunohistochemical expression of clinically relevant molecular markers: H3K27M, p53, ATRX, and IDH1 (R132H), and correlated their expression with clinical features. We further assessed the prognostic value of these markers in our cohort of patients. RESULTS The median overall survival (OS) of the cohort was 6.00 ± 0.882 months. The mean overall survival was 7.571 ± 1.118 months which was lower than in most studies. Preoperative Karnofsky Performance Score (KPS), extent of surgical resection, and adjuvant radiotherapy were found to be the clinical factors strongly influencing median survival (p < 0.05). Loss of ATRX expression was predominantly noted in hemispheric tumors (84%), while p53 staining was maximum in thalamic tumors (8 out of 9 cases). H3K27M mutant protein expression was noted in 8/9 thalamic tumors and 5/7 tumors in the brain stem-cerebellar-peduncular region. Patients with tumors showing H3K27M immunopositivity had the worst prognosis with a mean OS of 5 months ± 0.832 months, as against patients with H3K27M-immunonegative tumors, which was 10.143 ± 1.866 months(p = 0.006). Other markers like p53, ATRX, and IDH1 did not influence the prognosis in this patient cohort. ATRX loss of expression was associated with a better OS, with a trend to significance, and such an association has not been reported earlier. CONCLUSIONS Ours is one among the few studies from India describing the clinical parameters and evaluating the key immunohistochemical markers in pGBM and deriving their prognostic significance. The study reiterates the poor prognostic significance of H3K27M immunopositivity.
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Affiliation(s)
- Alok Mohan Uppar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
| | - Harsha Sugur
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
| | - A R Prabhuraj
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
| | - M Bhaskara Rao
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
| | - B Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
| | - S Sampath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
| | - A Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India.
| | - Vani Santosh
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Hosur Road, Bangalore, 560029, India
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Boudaouara O, Charfi S, Bahri M, Daoud J, Boudawara MZ, Gouiaa N, Sellami Boudawara T. Pediatric high grade gliomas: Clinico-pathological profile, therapeutic approaches and factors affecting overall survival. Neurochirurgie 2019; 65:63-68. [PMID: 30922839 DOI: 10.1016/j.neuchi.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 01/19/2019] [Accepted: 03/09/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Pediatric high grade gliomas are rare tumors of the central nervous system. Treatment is multidisciplinary, comprising surgical excision followed by radiotherapy and/or chemotherapy. OBJECTIVES describe these tumors' characteristics as seen in our institution, and identify factors associated with better overall survival. PATIENTS AND METHODS We conducted a retrospective study of 30 cases of pediatric high grade glioma treated consecutively in our institution over a 20-year period. Brainstem tumors and patients aged more than 22years were excluded. Univariate analysis was conducted to determine factors associated with better overall survival. RESULTS The series comprised 30 pediatric high grade gliomas: 27 glioblastomas and 3 anaplastic astrocytomas. The sex ratio was 1.7. Mean age was 13years. Tumors were mainly located in the cerebral hemispheres (63.3%). Median tumor size was 5cm. Glioblastomas were subdivided into 26 cases of classical subtype (96.3%) and 1 case of epithelioid subtype (3.7%). Surgical strategy consisted in tumor resection in 24 cases (80%). Twenty-one patients (70%) received postoperative radiotherapy. Therapeutic response at end of treatment was complete in 7 cases (23.3%). Postoperative radiation therapy and complete treatment response were significantly associated with improved overall survival in all high grade gliomas and also specifically in glioblastomas (P<0.001 and P=0.005, respectively). CONCLUSION Our results suggest that postoperative radiotherapy and complete treatment response are predictive factors for better overall survival in pediatric high grade glioma.
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Affiliation(s)
- O Boudaouara
- Laboratoire d'anatomie et de cytologie pathologique, CHU Habib Bourguiba, route Aïn km 0.5, 3029 Sfax, Tunisia.
| | - S Charfi
- Laboratoire d'anatomie et de cytologie pathologique, CHU Habib Bourguiba, route Aïn km 0.5, 3029 Sfax, Tunisia
| | - M Bahri
- Service de radiothérapie, CHU Habib Bourguiba, 3029 Sfax, Tunisia
| | - J Daoud
- Service de radiothérapie, CHU Habib Bourguiba, 3029 Sfax, Tunisia
| | - M Z Boudawara
- Service de neurochirurgie, CHU Habib Bourguiba, 3029 Sfax, Tunisia
| | - N Gouiaa
- Laboratoire d'anatomie et de cytologie pathologique, CHU Habib Bourguiba, route Aïn km 0.5, 3029 Sfax, Tunisia
| | - T Sellami Boudawara
- Laboratoire d'anatomie et de cytologie pathologique, CHU Habib Bourguiba, route Aïn km 0.5, 3029 Sfax, Tunisia
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Sattiraju A, Mintz A. Pericytes in Glioblastomas: Multifaceted Role Within Tumor Microenvironments and Potential for Therapeutic Interventions. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1147:65-91. [PMID: 31147872 DOI: 10.1007/978-3-030-16908-4_2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Glioblastoma (GBM) is an aggressive and lethal disease that often results in a poor prognosis. Unlike most solid tumors, GBM is characterized by diffuse infiltrating margins, extensive angiogenesis, hypoxia, necrosis, and clonal heterogeneity. Recurrent disease is an unavoidable consequence for many patients as standard treatment options such as surgery, radiotherapy, and chemotherapy have proven to be insufficient in causing long-term survival benefits. Systemic delivery of promising drugs is hindered due to the blood-brain barrier and non-uniform perfusion within GBM tissue. In recent years, many investigations have highlighted the role of GBM stem cells (GSCs) and their microenvironment in the initiation and maintenance of tumor tissue. Preclinical and early clinical studies to target GSCs and microenvironmental components are currently underway. Of these strategies, immunotherapy using checkpoint inhibitors and redirected cytotoxic T cells have shown promising results in early investigations. But, GBM microenvironment is heterogenous and recent investigations have shown cell populations within this microenvironment to be plastic. These studies underline the importance of identifying the role of and targeting multiple cell populations within the GBM microenvironment which could have a synergistic effect when combined with novel therapies. Pericytes are multipotent perivascular cells that play a vital role within the GBM microenvironment by assisting in tumor initiation, survival, and progression. Due to their role in regulating the blood-brain barrier permeability, promoting angiogenesis, tumor growth, clearing extracellular matrix for infiltrating GBM cells and in helping GBM cells evade immune surveillance, pericytes could be ideal therapeutic targets for stymieing or exploiting their role within the GBM microenvironment. This chapter will introduce hallmarks of GBM and elaborate on the contributions of pericytes to these hallmarks by examining recent findings. In addition, the chapter also highlights the therapeutic value of targeting pericytes, while discussing conventional and novel GBM therapies and obstacles to their efficacy.
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Affiliation(s)
- Anirudh Sattiraju
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Akiva Mintz
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA.
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Abstract
The detection of glioblastoma (GBM) in biofluids offers potential advantages over existing paradigms for the diagnosis and therapeutic monitoring of glial tumors. Biofluid-based detection of GBM focuses on detecting tumor-specific biomarkers in the blood and CSF. Current clinical research concentrates on studying 3 distinct tumor-related elements: extracellular macromolecules, extracellular vesicles, and circulating tumor cells. Investigations into these 3 biological classifications span the range of locales for tumor-specific biomarker discovery, and combined, have the potential to significantly impact GBM diagnosis, monitoring for treatment response, and surveillance for recurrence. This review highlights the recent advancements in the development of biomarkers and their efficacy for the detection of GBM.
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Malignant Gliomas as Second Neoplasms in Pediatric Cancer Survivors: Neuropathological Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4596812. [PMID: 29805974 PMCID: PMC5899852 DOI: 10.1155/2018/4596812] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/02/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022]
Abstract
This study presents a unique series of malignant supratentorial gliomas in children previously cured from non-CNS primary cancer. On neuroimaging these tumors were not specific, so the patients were suspected of cerebral recurrence of their primary neoplasm: leukemia in four children and sarcoma in one child. Histologically, the group contained four glioblastomas and one anaplastic astrocytoma. Three patients underwent neurosurgical resection, while the other two underwent stereotactic diagnostic biopsy only. Despite combined oncological treatment, four children died during 20 months, and only one glioblastoma patient continued to live for another twelve years. Microscopically, the neoplasms consisted of small cells with some morphologic features of astrocytic lineage, having scanty or prominent processes. Microvascular proliferation and focal or diffuse necrosis were encountered in four cases. The GFAP reactivity in neoplastic cells was low or nil, together with the expression of Olig2, vimentin, and nestin. In two cases a subpopulation of synaptophysin-positive cells was present. Molecular immunohistochemical profiling revealed the expression of phosphorylated forms of PI3Kp110 and AKT, in parallel to a strong PTEN and p53 positivity. The tumors were of IDH1R132H-wild type and immunoreactive for ATRX, HER3, and EGFR. Secondary malignant gliomas in pediatric cancer survivors pose a diagnostic challenge. The present study shows that these tumors are of IDH wild type, PI3K/AKT-activated, having no PTEN and EGFR mutations. Therefore, the biopsy of brain tumors in such patients is crucial both for accurate diagnosis and material preservation for molecular typing.
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Demir MK, Yapıcıer O, Ozturk OC, Aslan M. Posterior Third Ventricular Glioblastoma with Primary Leptomeningeal Metastasis in a Child. Pediatr Neurosurg 2018; 53:205-208. [PMID: 29316549 DOI: 10.1159/000485922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Hospital, Istanbul, Turkey
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Tan AP, Mankad K. Intraventricular Glioblastoma Multiforme in A Child with L2-Hydroxyglutaric Aciduria. World Neurosurg 2017; 110:288-290. [PMID: 29183865 DOI: 10.1016/j.wneu.2017.11.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/15/2017] [Accepted: 11/17/2017] [Indexed: 11/27/2022]
Abstract
L2-hydroxyglutaric aciduria (L2-HGA) is a rare neurometabolic disease characterized by accumulation of L2-hydroxyglutarate (L2-HG), a potential oncometabolite resulting in significant lifetime risk for cerebral tumors. Herein, we present a case of intraventricular glioblastoma multiforme (GBM) in a 16-year-old child with L2-HGA who presented with rapid functional decline and persistent vomiting. The tumor was completely resected, and the patient remained well at 2-year follow-up. Clinicians should be aware of the usual insidious nature of the disease. Rapid deterioration is unusual and should raise the suspicion of tumor development. This case also illustrates the importance of surveillance neuroimaging in patients with L2-HGA. To the best of our knowledge, only 1 case of GBM has been reported and it was sited in the temporal lobe, unlike the unusual intraventricular location in our case.
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Affiliation(s)
- Ai Peng Tan
- Department of Diagnostic Radiology, National University Health System, Singapore, Singapore.
| | - Kshitij Mankad
- Department of Neuroradiology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
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Lam S, Lin Y, Zinn P, Su J, Pan IW. Patient and treatment factors associated with survival among pediatric glioblastoma patients: A Surveillance, Epidemiology, and End Results study. J Clin Neurosci 2017; 47:285-293. [PMID: 29102237 DOI: 10.1016/j.jocn.2017.10.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
Glioblastoma (GBM) is a rare malignancy in children. The United States Surveillance, Epidemiology, and End Results (SEER) database allows large-scale analyses of clinical characteristics and prognostic features. We used it to study patients aged <20 years with histologically confirmed GBM (2000-2010) and examined the relationship between patient demographics, tumor characteristics, patterns of treatment, and outcomes. The primary outcome was disease-specific survival. 302 subjects were identified, with median age 11 years. Median follow-up was 32 months (95% CI 27-39). 34.4% had gross total resection (GTR). 61% underwent radiation after surgery (17% of subjects <3 years, 67% of those aged 4-19 years). Median survival and 2-year survival rates were 20 months and 46.9%, respectively. In multivariate analyses, age, tumor location, extent of resection, and year of diagnosis were significantly associated with the primary outcome. Compared to those aged 0-4 years, subjects aged 5-9 years and 10-14 years had higher risk of mortality. Infratentorial tumor location (HR 2.0, 95% CI 1.2-3.3, p = 0.007) and subtotal resection (HR 2.04, 95% CI 1.4-3.0, p < 0.001) were associated with increased mortality. Later year of diagnosis was significantly associated with decreased risk of death (HR 0.93, 95% CI 0.9-0.99, p = 0.031). There was no association between sex, race, region, or tumor size and the primary outcome. Repeat analyses examining all-cause mortality identified the same risk factors as for CNS cancer-specific mortality. Younger age, supratentorial location, GTR, and later year of diagnosis were associated with improved survival.
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Affiliation(s)
- Sandi Lam
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Neurosurgery, Houston, TX, USA.
| | - Yimo Lin
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Neurosurgery, Houston, TX, USA
| | - Pascal Zinn
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Neurosurgery, Houston, TX, USA
| | - Jack Su
- Baylor College of Medicine, Department of Pediatrics, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Hematology/Oncology, Houston, TX, USA
| | - I-Wen Pan
- Baylor College of Medicine, Department of Neurosurgery, Houston, TX, USA; Texas Children's Hospital, Division of Pediatric Neurosurgery, Houston, TX, USA
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Immanuel V, Kingsley PA, Negi P, Isaacs R, Grewal SS. Variegated Colors of Pediatric Glioblastoma Multiforme: What to Expect? Rare Tumors 2017; 9:6552. [PMID: 28975017 PMCID: PMC5617915 DOI: 10.4081/rt.2017.6552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/07/2016] [Accepted: 08/17/2016] [Indexed: 12/21/2022] Open
Abstract
Malignant gliomas account for 35-45% of primary brain tumors; among these glioblastoma multiforme (GBM) is the most common adult brain tumor constituting approximately 85%. Its incidence is quite less in the pediatric population and treatment of these patients is particularly challenging. Exposure to ionizing radiation is the only environmental factor found to have any significant association with GBM. Several genetic alterations associated with GBM in adults have been well documented such as epidermal growth factor receptor amplification, overexpression of mouse double minute 2 homolog also known as E3 ubiquitin-protein ligase, Phosphatase and tensin homolog gene mutation, loss of heterozygosity of chromosome 10p and isocitrate dehydrogenase-1 mutation. However, data on genetic mutations in pediatric GBM is still lacking. Exophytic brain stem gliomas are rare tumors and are usually associated with a poor prognosis. The most effective treatment in achieving long-term survival in such patients, is surgical excision of the tumor and then chemoradiotherapy followed by adjuvant chemotherapy by temozolomide. This schedule is the standard treatment for GBM patients. In view of the rarity of pediatric GBM, we report here a case of pontine GBM in a 5-year-old girl.
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Affiliation(s)
- Vivek Immanuel
- Departments of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Pamela A Kingsley
- Departments of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Preety Negi
- Departments of Radiotherapy, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Roma Isaacs
- Departments of Pathology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Sarvpreet S Grewal
- Departments of Neurosurgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Extent of surgical resection and adjuvant temozolomide improves survival in pediatric GBM: a single center experience. Childs Nerv Syst 2017; 33:951-956. [PMID: 28424876 DOI: 10.1007/s00381-017-3381-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 03/09/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pediatric glioblastoma (pGBM) is an uncommon entity. The importance of concurrent and adjuvant temozolomide is not known in this subset of patients. METHODS We retrospectively analyzed our database between 2000 and 2015. All patients were treated with maximally safe surgical resection. This was followed by a uniform treatment schedule of post-operative radiation with concurrent daily temozolomide at 75 mg/m2. Radiation dose was 60 Gy in 30 fractions planned by 3-dimensional conformal radiotherapy. Concurrent and adjuvant temozolomide was used in all patients treated after 2007. Four weeks later, adjuvant temozolomide was started at 150 mg/m2, day 1 to 5 every 28 days and escalated to 200 mg/m2 from the second cycle onwards if well tolerated. Log-rank test was used to compare survival distribution. The data was analyzed using SPSS (version 16). RESULTS Fifty-one patients were analyzed. Median age was 14 years (range: 5 to 21 years). Thirty-five males and 16 females were noted. Median symptom duration was 4 months. Twenty-eight patients underwent a gross total resection (GTR) while 17 underwent a subtotal resection; six patients underwent decompression. Thirty-three patients received concurrent chemotherapy while 27 received adjuvant chemotherapy. Median progression-free survival (PFS) was 15.1 months. One- and 3-year PFS was 54.4% and 3-year PFS was 24.6.7%. The median overall survival was 17.4 months. In univariate analysis survival was better for gross total resection (17.4 months vs. 11.5 months; p = 0.037), and significance maintained after multivariate analysis p = 0.026, HR 3.069, 95% CI 1.14-8.23. In univariate analysis, survival was better for patients receiving temozolomide but did not achieve significance. However, in multivariate analysis, use of temozolomide was associated with significantly improved survival p = 0.036, HR 3.315, 95% CI 1.07-10.19. CONCLUSIONS GTR improves survival significantly in pGBM. Adjuvant temozolomide may improve survival in pGBM.
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Kim AV, Khachatryan VA. [Intraoperative fluorescence diagnosis using 5-aminolevulinic acid in surgical treatment of children with recurrent neuroepithelial tumors]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2017; 81:51-57. [PMID: 28291213 DOI: 10.17116/neiro201780751-57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze the efficacy and safety of 5-aminolevulinic acid for intraoperative fluorescence diagnosis (FD) during repeated surgery for recurrent neuroepithelial tumors (NETs) in children. MATERIAL AND METHODS We performed a retrospective analysis of the results of recurrent NET resection in 13 children aged from 3 to 17 years in the period between December 2013 and May 2015. The source of 5-ALA was a drug "Alasens" that was administered at a dose of 20 mg/kg of body weight 4 h before the beginning of tumor resection. A visual scale was used to evaluate the fluorescence intensity. The drug was used with the informed consent of the child's parents and approval of the Polenov Neurosurgical Institute ethics committee. All patients underwent complex clinical and introscopic examination in the pre- and postoperative periods and a repeated histological tumor examination. RESULTS There was no fluorescence in 4 cases (Gr I in 2 cases; Gr II in 2 cases). Grade 1 fluorescence (Gr II) was observed in one case, and grade 2-3 fluorescence was observed in the remaining 8 patients. Total and subtotal tumor resection was achieved in 11 (84.6%) of 13 patients. There were no clinically significant adverse effects. A transient increase in transaminases was observed in 2 patients. Two girls had an elevated photosensitivity to light for two days. CONCLUSION FD is a safe technique in childhood and can improve intraoperative detection of NET during its repeated growth as well as differentiate the tumor from pathological tissues of non-tumorous nature, which increases completeness of blastomatous tissue removal. However, the character and intensity of fluorescence may change in recurrent NETs. Further research is required to investigate the FD effectiveness in various age patients with tumors of a different histological structure and malignancy in the case of both primary and recurrent lesions.
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Affiliation(s)
- A V Kim
- Polenov Neurosurgical Institute, Branch of the Almazov Federal North-West Medical Research Centre, Saint-Petersburg, Russia
| | - V A Khachatryan
- Polenov Neurosurgical Institute, Branch of the Almazov Federal North-West Medical Research Centre, Saint-Petersburg, Russia
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Kameda M, Otani Y, Ichikawa T, Shimada A, Ichimura K, Date I. Congenital Glioblastoma with Distinct Clinical and Molecular Characteristics: Case Reports and a Literature Review. World Neurosurg 2017; 101:817.e5-817.e14. [PMID: 28214639 DOI: 10.1016/j.wneu.2017.02.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The molecular diagnosis of brain tumors is important in classifying tumors and determining appropriate treatment. Congenital glioblastoma multiforme (GBM) is a rare tumor that occurs in infants, and the prognosis is poor. Approximately 60 patients diagnosed with congenital GBM have been reported. However, few reports have conducted molecular analyses of congenital GBM. CASE DESCRIPTION We describe 2 congenital GBM patients treated in our hospital, and report results of immunohistochemistry, fluorescent in situ hybridization (FISH), direct sequencing, and methylation analyses. Surgery was performed on both patients at 2 months old, and the cases were diagnosed as glioblastoma. Immunohistochemical staining, FISH, and direct sequencing were positive for glial fibrillary acidic protein and ATRX, partially positive for p53, showed no alteration of isocitrate dehydrogenase 1 R132H, H3F3A, HIST1H3B, and BRAF, and indicated no codeletion of 1p and 19q. Methylation analysis of 1 patient identified copy number aberrations of 4 genes: deletions of CDK6 and CDKN2A/B, and a fusion of MET. One patient received chemotherapy consisting of ranimustine, interferon-beta, carboplatin, and etoposide, whereas the other patient received chemotherapy with the modified Children's Cancer Group study-9921 protocol. Residual tumors in both patients were decreased, and they achieved 18-year- and 9-month progression-free survival, respectively. In addition, we reviewed 65 previously reported congenital GBM patients, and found they have better prognosis than pediatric and adult GBM, and long-term survival can be expected. CONCLUSIONS Congenital GBM demonstrates clinical and molecular characteristics that are different from those of pediatric or adult GBM.
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Affiliation(s)
- Masahiro Kameda
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Otani
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomotsugu Ichikawa
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Akira Shimada
- Department of Pediatrics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Institute, Tokyo, Japan
| | - Isao Date
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Zamora C, Huisman TA, Izbudak I. Supratentorial Tumors in Pediatric Patients. Neuroimaging Clin N Am 2017; 27:39-67. [DOI: 10.1016/j.nic.2016.08.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Zhu X, McDowell MM, Newman WC, Mason GE, Greene S, Tamber MS. Severe cerebral edema following nivolumab treatment for pediatric glioblastoma: case report. J Neurosurg Pediatr 2017; 19:249-253. [PMID: 27858578 DOI: 10.3171/2016.8.peds16326] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Nivolumab is an immune checkpoint inhibitor (ICI) currently undergoing Phase III clinical trials for the treatment of glioblastoma. The authors present the case of a 10-year-old girl with glioblastoma treated with nivolumab under compassionate-use guidelines. After the first dose of nivolumab the patient developed hemiparesis, cerebral edema, and significant midline shift due to severe tumor necrosis. She was managed using intravenous dexamethasone and discharged on a dexamethasone taper. The patient's condition rapidly deteriorated after the second dose of nivolumab, demonstrating hemiplegia, seizures, and eventually unresponsiveness with a fixed and dilated left pupil. Computed tomography of her brain revealed malignant cerebral edema requiring emergency decompressive hemicraniectomy. Repeat imaging demonstrated increased size of the lesion, reflecting immune-mediated inflammation and tumor necrosis. The patient remained densely hemiplegic, but became progressively more interactive and was ultimately extubated. She resumed nivolumab several weeks later, but again her condition deteriorated with headache, vomiting, swelling at the craniectomy site, and limited right-sided facial movement following the sixth dose. MRI demonstrated severe midline shift and uncal herniation despite her craniectomy. Her condition gradually declined, and she died several days later under "do not resuscitate/do not intubate" orders. To the authors' knowledge, this represents the first case of malignant cerebral edema requiring operative intervention following nivolumab treatment for glioblastoma in a pediatric patient.
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Affiliation(s)
- Xiao Zhu
- Department of Neurological Surgery, and
| | | | | | - Gary E Mason
- Division of Pediatric Hematology/Oncology, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania
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Prasad VB, Rajesh A, Purohit AK, Uppin MS. A rare case of congenital glioblastoma with atypical presentation in an eleven month-old infant: Case report with review of literature. Asian J Neurosurg 2017; 12:72-74. [PMID: 28413539 PMCID: PMC5379811 DOI: 10.4103/1793-5482.145103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumor in adults. The occurrence of this entity in infants is a rarity and portends a uniform dismal prognosis and survival in spite of all the latest available management options. The authors herein report a case of a GBM in an 11 month-old infant with tumor involving predominantly the left temporal and frontal regions who expired 10 weeks after tumor decompression. Literature and available management options have been reviewed in the context of the presented case.
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Affiliation(s)
- Vangala Bramha Prasad
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Alugolu Rajesh
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Aniruddh Kumar Purohit
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
| | - Megha Shantveer Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India
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de Andrade PV, Andrade AF, de Paula Queiroz RG, Scrideli CA, Tone LG, Valera ET. The histone deacetylase inhibitor PCI-24781 as a putative radiosensitizer in pediatric glioblastoma cell lines. Cancer Cell Int 2016; 16:31. [PMID: 27095947 PMCID: PMC4835828 DOI: 10.1186/s12935-016-0306-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/07/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Glioblastoma (GBM) is considered to be one of the most aggressive tumors of the central nervous system (CNS). Even with the use of modern treatment protocols, the prognosis remains reserved, with children with GBM having a mean survival of 12-15 months. METHODS In the present study we investigated the potential radiosensitizing effect of PCI-24781, a potent pan-histone deacetylase inhibitor (HDACi), on the SF188 and KNS42 cell lines of pediatric GBM. Cell proliferation rates, clonogenicity and apoptosis were compared in the presence and absence of treatment with PCI-24781. We also compared the clonogenicity rates of the irradiated SF188 and KNS42 cell lines with or without previous treatment with PCI-24781 at the doses of 0.25-16 μM. In addition, we investigated the effects of PCI-24781 on the expression of some of the main proteins responsible for the repair of double-strand DNA breaks caused by irradiation. RESULTS The inhibitor blocked cell proliferation, induced death by apoptosis and reduced the colony forming capacity of the cell lines, both of them showing a significant decrease of colony formation at all irradiation doses. The expression of the Rad51 protein, important for the homologous recombination (HR) repair pathway, and of the DNA-PKcs, Ku70 and Ku86 proteins, important for the non-homologous end joining (NHEJ) repair pathway, was more reduced when the irradiated cell line was previously treated with PCI-24781 than when it was treated exclusively with radiotherapy. CONCLUSIONS These findings demonstrate that HDACi PCI-24781 has a radiosensitizing profile that compromises the repair of double-strand DNA breaks in cells of pediatric GBM treated with radiotherapy.
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Affiliation(s)
- Pamela Viani de Andrade
- Department of Pediatrics, Ribeirão Preto Medical School, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, University of São Paulo, 7º andar. Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil
| | - Augusto Faria Andrade
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil
| | - Rosane Gomes de Paula Queiroz
- Department of Pediatrics, Ribeirão Preto Medical School, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, University of São Paulo, 7º andar. Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil
| | - Carlos Alberto Scrideli
- Department of Pediatrics, Ribeirão Preto Medical School, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, University of São Paulo, 7º andar. Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil
| | - Luiz Gonzaga Tone
- Department of Pediatrics, Ribeirão Preto Medical School, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, University of São Paulo, 7º andar. Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil ; Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil
| | - Elvis Terci Valera
- Department of Pediatrics, Ribeirão Preto Medical School, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP, University of São Paulo, 7º andar. Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, SP CEP 14048-900 Brazil
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Adams H, Adams HHH, Jackson C, Rincon-Torroella J, Jallo GI, Quiñones-Hinojosa A. Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis. Childs Nerv Syst 2016; 32:493-503. [PMID: 26767842 DOI: 10.1007/s00381-015-3006-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/23/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE The benefit of radical resections for glioblastoma patients remains a source of contention in the literature. Few studies have been conducted in pediatric patients, and it is becoming increasingly evident that data regarding adult glioblastoma (GB) patients cannot be generalized to pediatric patients affected by this neoplasm. A comparative effectiveness study is performed for different extent of resection (EOR) groups in the largest cohort of pediatric GB (pGB) patients. METHODS The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used to identify pGB patients from 1988 through 2009. Multivariate- and multiple propensity score (mPS)-adjusted analyses were used to determine the effect of gross total resection (GTR), partial resection (PR), and biopsy (Bx) on overall survival. Survival prospects were summarized using direct adjusted survival curves. RESULTS A total of 342 pGB patients were identified, and 35.4 % of patients received a GTR, 28.8 % PR, 17.3 % Bx, and 17.0 % did not undergo surgery. In our cohort, a median overall survival of 12 months was observed with 1-, 2-, and 5-year survival rates of 51.7, 28.3, and 15.7 %, respectively. EOR was a predictor of survival in both the multivariate- (P < 0.001) and mPS-adjusted model (P < 0.001). Compared to the GTR group, a higher mortality rate was observed in patients who underwent a PR (HR 1.50; 95 % CI, 1.02-2.21) or Bx (HR 1.87; 95 % CI, 1.18-2.98). There were no significant differences in (adjusted) mortality risk between the PR and Bx groups. CONCLUSION Our study suggests that GTR is independently associated with improved survival for pediatric patients with glioblastoma.
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Affiliation(s)
- Hadie Adams
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Hieab H H Adams
- Division of Neuro-Epidemiology, Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Christina Jackson
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA
| | - Jordina Rincon-Torroella
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA
| | - George I Jallo
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA
| | - Alfredo Quiñones-Hinojosa
- Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.
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High-grade glioma in children and adolescents: a single-center experience. Childs Nerv Syst 2016; 32:291-7. [PMID: 26679932 DOI: 10.1007/s00381-015-2980-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 12/04/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE The aim of this study was to report the outcome in children with high-grade astrocytoma outside the brain stem and spinal cord that were treated at a single center. MATERIALS AND METHODS The study included 26 patients with anaplastic astrocytoma and 37 patients with glioblastoma; all patients were aged ≤18 years. At initial diagnosis, 18 of the patients with glioblastoma received only temozolomide (TMZ), 14 received other chemotherapies, and 5 did not receive any chemotherapy. Among the patients with anaplastic astrocytoma, 9 received TMZ, 9 received other chemotherapy regimens, and 8 patients did not receive any chemotherapy. The median radiotherapy dose in all patients was 60 Gy. RESULTS Median age of the patients was 12.5 years. Median overall survival was 20 months and mean progression-free survival was 4.7-11.3 months (median: 8 months) in all patients. Patients with a Karnofsky performance score (KPS) ≥70 had median overall survival of 32 months, versus 7 months in those with a KPS < 70. Patients aged <15 years had median survival of 38 months, versus 16 months in those aged 15-18 years. Patients with anaplastic astrocytoma that received TMZ, other chemotherapy regimens, and no chemotherapy had median survival of 21 months, 132 months, and 11 months, respectively. Patients with glioblastoma that received TMZ, other chemotherapy regimens, and no chemotherapy had median survival of 32 months, 12 months, and 8 months, respectively. CONCLUSION In the present study, patients with anaplastic astrocytoma treated with chemotherapy protocols other than TMZ had the longest OS; however, in the glioblastoma group, OS was 32 months in those treated with standard TMZ and 12 months in those treated with other protocols (P = 0.493). Although TMZ is less toxic than PCV, it was not shown to be superior.
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Abstract
PURPOSE The aim of this study was to evaluate characteristics of childhood glioblastoma multiforme, effectiveness of treatment modalities, and detect factors related to outcome. METHODS A detailed analysis was performed on a series of 15 patients treated between 2000 and 2013, based on their clinical, radiologic, pathologic, treatment, and follow-up data. RESULTS Median survival time of children with glioblastoma was 13.5 months. One- and 2-year overall survival probabilities were 66.7 and 20 %, respectively. There were no significant differences in survival based on patients' gender, age, disease presentation with or without epileptic seizures, signs/symptoms of increased intracranial pressure, or tumor location. The presence of neurological deficit initially, as well as prior to radiotherapy, which was quantified by neurologic function score (NFS), had an impact on overall survival. Children with NFS 0 lived longer compared to others (p = 0.001). Survival of children that underwent gross total resection was longer than that of children that underwent subtotal resection (p = 0.030). Mean survival time of children with gross total resection was 73.5 months, compared to 13 months in children with subtotal resection. There was no significant correlation between outcome and type of radiotherapy. In four patients with gigantocellular glioblastoma, we found no evidence of a better prognosis. Two long-term survivors were recorded. Both of them underwent gross total resection and were assigned a NFS 0. CONCLUSIONS Gross total resection is essential for longer overall survival among pediatric patients with glioblastoma and offers a possibility for long-term survival. Severity of neurologic symptoms quantified by NFS can be considered as a potential predictor of outcome.
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Makale M, Kesari S. Cell Phones and Glioma Risk: An Update. Neurooncol Pract 2015. [DOI: 10.1093/nop/npv045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Mallick S, Gandhi AK, Joshi NP, Kumar A, Puri T, Sharma DN, Haresh KP, Gupta S, Julka PK, Rath GK, Sarkar C. Outcomes of pediatric glioblastoma treated with adjuvant chemoradiation with temozolomide and correlation with prognostic factors. Indian J Med Paediatr Oncol 2015; 36:99-104. [PMID: 26157286 PMCID: PMC4477385 DOI: 10.4103/0971-5851.158838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Pediatric glioblastoma (pGBM) patients are underrepresented in major trials for this disease. We aimed to explore the outcome of pGBM patients treated with concurrent and adjuvant temozolomide (TMZ). Materials and Methods: 23 patients of pGBM treated from 2004 to 2010 were included in this retrospective analysis. Adjuvant therapy included conformal radiation 60 gray at 2 gray/fraction daily over 6 weeks with concurrent TMZ 75 mg/m2 followed by six cycles of adjuvant TMZ 150-200 mg/m2 (day 1-5) every 4 weeks. Kaplan-Meier estimates of overall survival (OS) were determined. Univariate analysis with log-rank test was used to determine the impact of prognostic variables on survival. Results: Median age at presentation was 11.5 years (range: 7-19 years) and M:F ratio was 15:8. All patients underwent maximal safe surgical resection; 13 gross total resection and 10 sub-total resection. At a median follow-up of 18 months (range: 2.1-126 months), the estimated median OS was 41.9 months. The estimated median OS for patients receiving only concurrent TMZ was 8 months while that for patients receiving concurrent and adjuvant TMZ was 41.9 months (P = 0.081). Estimated median OS for patients who did not complete six cycles of adjuvant TMZ was 9.5 months versus not reached for those who completed at least six cycles (P = 0.0005). Other prognostic factors did not correlate with survival. Conclusions: Our study shows the benefit of TMZ for pGBM patients. Both concurrent and adjuvant TMZ seem to be important for superior OS in this group of patients.
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Affiliation(s)
- Supriya Mallick
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajeet Kumar Gandhi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil P Joshi
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anupam Kumar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Tarun Puri
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Kunhi Parambath Haresh
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Subhash Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Pramod Kumar Julka
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Goura Kisor Rath
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Chitra Sarkar
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Ryzhova MV, Shishkina LV. [Molecular methods in diagnosis of poorly differentiated malignant brain tumors in children]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2015; 79:10-20. [PMID: 26146040 DOI: 10.17116/neiro201579210-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The histological diagnosis of malignant brain tumors in children is a complex process. In some cases, glioblastoma, primitive neuroectodermal tumor of the central nervous system, and atypical teratoid/rhabdoid tumor have a histological type similar to that of small blue round cell malignant tumor. Despite the similar histology, biological properties and approaches to treatment, these neoplasms are completely different and require their own treatment protocols. We retrospectively reviewed the most malignant types of childhood tumors and analyzed our own experience to propose a diagnostic algorithm for intracerebral small blue round cell malignant tumors in children based on the use of immunohistochemistry and fluorescence in situ hybridization.
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Affiliation(s)
- M V Ryzhova
- Burdenko Neurosurgical Institute, Moscow, Russia
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Walston S, Hamstra DA, Oh K, Woods G, Guiou M, Olshefski RS, Chakravarti A, Williams TM. A multi-institutional experience in pediatric high-grade glioma. Front Oncol 2015; 5:28. [PMID: 25741472 PMCID: PMC4332307 DOI: 10.3389/fonc.2015.00028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 01/27/2015] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Pediatric high-grade gliomas are rare tumors with poor outcomes and incompletely defined management. We conducted a multi-institutional retrospective study to evaluate association of clinical, pathologic, and treatment characteristics with outcomes. MATERIALS AND METHODS Fifty-one patients treated from 1984 to 2008 at the Ohio State University or University of Michigan were included. Histologic subgroups were compared. Log-rank and stepwise Cox proportional hazard modeling were used to analyze progression-free survival (PFS) and overall survival (OS) within the whole group, grade III subgroup, grade IV subgroup, and sub-total resection/biopsy subgroup. RESULTS Median OS was 27.6 months. Grade III histology, complete tumor resection, and cerebral tumor location correlated with improved PFS and OS. Temozolomide use and chemotherapy after radiotherapy or chemoradiation (CRT) were associated with better PFS while seizure at presentation was associated with better OS. In multivariate analysis, complete resection and chemotherapy following radiotherapy or CRT were independent predictors for improved PFS and OS. For grade III and IV subgroups, complete resection was associated with improved OS (grade III) and seizure presentation was associated with improved OS (grade IV). In the incompletely resection subgroup, temozolomide use and concurrent CRT independently correlated with improved PFS, while higher radiation dose (≥59.4 Gy) and adjuvant chemotherapy were independently associated with improved OS. DISCUSSION Total resection and receiving chemotherapy adjuvant to radiation or CRT are most closely associated with improved PFS and OS. For higher risk incompletely resected patients, temozolomide use and treatment intensification with concurrent CRT, adjuvant chemotherapy, and higher radiation dose were associated with improved outcomes.
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Affiliation(s)
- Steve Walston
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Daniel A Hamstra
- Department of Radiation Oncology, University of Michigan Health System , Ann Arbor, MI , USA
| | - Kevin Oh
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Gary Woods
- Department of Hematology-Oncology, Nationwide Children's Hospital , Columbus, OH , USA
| | - Michael Guiou
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Randal S Olshefski
- Department of Hematology-Oncology, Nationwide Children's Hospital , Columbus, OH , USA
| | - Arnab Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Terence M Williams
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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Gielen GH, Gessi M, Buttarelli FR, Baldi C, Hammes J, zur Muehlen A, Doerner E, Denkhaus D, Warmuth-Metz M, Giangaspero F, Lauriola L, von Bueren AO, Kramm CM, Waha A, Pietsch T. Genetic Analysis of Diffuse High-Grade Astrocytomas in Infancy Defines a Novel Molecular Entity. Brain Pathol 2014; 25:409-17. [PMID: 25231549 DOI: 10.1111/bpa.12210] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 09/12/2014] [Indexed: 12/24/2022] Open
Abstract
Pediatric high-grade gliomas are considered to be different when compared to adult high-grade gliomas in their pathogenesis and biological behavior. Recently, common genetic alterations, including mutations in the H3F3A/ATRX/DAXX pathway, have been described in approximately 30% of the pediatric cases. However, only few cases of infant high-grade gliomas have been analyzed so far. We investigated the molecular features of 35 infants with diffuse high-grade astrocytomas, including 8 anaplastic astrocytomas [World Health Organization (WHO) grade III] and 27 glioblastomas (WHO grade IV) by immunohistochemistry, multiplex ligation probe-dependent amplification (MLPA), pyrosequencing of glioma-associated genes and molecular inversion probe (MIP) assay. MIP and MLPA analyses showed that chromosomal alterations are significantly less frequent in infants compared with high-grade gliomas in older children and adults. We only identified H3F3A K27M in 2 of 34 cases (5.9%), with both tumors located in the posterior fossa. PDGFRA amplifications were absent, and CDKN2A loss could be observed only in two cases. Conversely, 1q gain (22.7%) and 6q loss (18.2%) were identified in a subgroup of tumors. Loss of SNORD located on chromosome 14q32 was observed in 27.3% of the infant tumors, a focal copy number change not previously described in gliomas. Our findings indicate that infant high-grade gliomas appear to represent a distinct genetic entity suggesting a different pathogenesis and biological behavior.
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Affiliation(s)
- Gerrit H Gielen
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Marco Gessi
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Francesca R Buttarelli
- Department of Neurology and Psychiatry, University of Rome "La Sapienza", Pozzilli, Italy
| | - Caterina Baldi
- Department of Neurology and Psychiatry, University of Rome "La Sapienza", Pozzilli, Italy
| | - Jennifer Hammes
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Anja zur Muehlen
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Evelyn Doerner
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Dorota Denkhaus
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | | | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, University of Rome "La Sapienza", Pozzilli, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | | | - André O von Bueren
- Division of Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Christof M Kramm
- Division of Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Andreas Waha
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology, University of Bonn Medical Center, Bonn, Germany
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Stummer W, Rodrigues F, Schucht P, Preuss M, Wiewrodt D, Nestler U, Stein M, Artero JMC, Platania N, Skjøth-Rasmussen J, Puppa AD, Caird J, Cortnum S, Eljamel S, Ewald C, González-García L, Martin AJ, Melada A, Peraud A, Brentrup A, Santarius T, Steiner HH. Predicting the "usefulness" of 5-ALA-derived tumor fluorescence for fluorescence-guided resections in pediatric brain tumors: a European survey. Acta Neurochir (Wien) 2014; 156:2315-24. [PMID: 25248327 PMCID: PMC4232748 DOI: 10.1007/s00701-014-2234-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 09/05/2014] [Indexed: 10/26/2022]
Abstract
BACKGROUND Five-aminolevulinic acid (Gliolan, medac, Wedel, Germany, 5-ALA) is approved for fluorescence-guided resections of adult malignant gliomas. Case reports indicate that 5-ALA can be used for children, yet no prospective study has been conducted as of yet. As a basis for a study, we conducted a survey among certified European Gliolan users to collect data on their experiences with children. METHODS Information on patient characteristics, MRI characteristics of tumors, histology, fluorescence qualities, and outcomes were requested. Surgeons were further asked to indicate whether fluorescence was "useful", i.e., leading to changes in surgical strategy or identification of residual tumor. Recursive partitioning analysis (RPA) was used for defining cohorts with high or low likelihoods for useful fluorescence. RESULTS Data on 78 patients <18 years of age were submitted by 20 centers. Fluorescence was found useful in 12 of 14 glioblastomas (85 %), four of five anaplastic astrocytomas (60 %), and eight of ten ependymomas grades II and III (80 %). Fluorescence was found inconsistently useful in PNETs (three of seven; 43 %), gangliogliomas (two of five; 40 %), medulloblastomas (two of eight, 25 %) and pilocytic astrocytomas (two of 13; 15 %). RPA of pre-operative factors showed tumors with supratentorial location, strong contrast enhancement and first operation to have a likelihood of useful fluorescence of 64.3 %, as opposed to infratentorial tumors with first surgery (23.1 %). CONCLUSIONS Our survey demonstrates 5-ALA as being used in pediatric brain tumors. 5-ALA may be especially useful for contrast-enhancing supratentorial tumors. These data indicate controlled studies to be necessary and also provide a basis for planning such a study.
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Jung TY, Lee JY, Kim DS, Park HJ, Kim CY, Ra YS, Lee MJ, Kim SH, Baek HJ, Kim IH, Park KD, Kim SK. Pediatric supratentorial high-grade glioma: multicenter retrospective observational study of the Korean Society for Pediatric Neuro-Oncology. J Neurooncol 2014; 121:413-9. [PMID: 25366367 DOI: 10.1007/s11060-014-1653-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/26/2014] [Indexed: 01/05/2023]
Abstract
We analyzed the prognostic factors of Korean pediatric patients with supratentorial high-grade glioma (HGG). Between 1997 and 2011, 62 patients with 34 glioblastomas and 28 anaplastic gliomas were surgically operated at nine institutions. The male-to-female ratio was 33 to 29 and the median age was 12 years (range 1-18). The prognostic significance of tumor location, extent of removal, pathologic grade, treatment method, and pattern of recurrence was analyzed. The median progression-free survival (PFS) and overall survival (OS) were 9.3 (± 0.8) and 17.8 (± 1.9) months, respectively. Glioblastoma and anaplastic glioma showed OSs of 15.9 (± 1.3) and 19.6 (± 2.4) months, respectively. Based on the univariate analysis, gross total removal (GTR) and initial combined chemoradiotherapy improved PFS (p = 0.012 and p = 0.003) and OS (p = 0.030 and p = 0.013), respectively. Cerebrospinal fluid (CSF) dissemination showed poor OS (p = 0.001). Based on the multivariate analysis, GTR and initial combined chemoradiotherapy resulted in an improved PFS [(hazard ratio 0.360; 95 % CI 0.177-0.733; p = 0.005) and (hazard ratio 0.458; 95 % CI 0.230-0.911; p = 0.026), respectively]. GTR, initial combined chemoradiotherapy, and no CSF seeding resulted in an improved OS [(hazard ratio 0.417; 95 % CI 0.201-0.861; p = 0.018), (hazard ratio 0.406; 95 % CI 0.206-0.800; p = 0.009), and (hazard ratio 0.288; 95 % CI 0.148-0.563; p = 0.000), respectively]. No significant difference in PFS and OS was observed between glioblastoma and anaplastic glioma. CSF dissemination was observed in 22 patients (35.5 %) during total follow-up. Pediatric anaplastic glioma showed poor survival, similarly to glioblastoma. GTR and initial combined chemoradiotherapy were associated with improved survival.
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Affiliation(s)
- Tae-Young Jung
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Gwangju, South Korea
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Vasen HFA, Ghorbanoghli Z, Bourdeaut F, Cabaret O, Caron O, Duval A, Entz-Werle N, Goldberg Y, Ilencikova D, Kratz CP, Lavoine N, Loeffen J, Menko FH, Muleris M, Sebille G, Colas C, Burkhardt B, Brugieres L, Wimmer K. Guidelines for surveillance of individuals with constitutional mismatch repair-deficiency proposed by the European Consortium "Care for CMMR-D" (C4CMMR-D). J Med Genet 2014; 51:283-93. [PMID: 24556086 DOI: 10.1136/jmedgenet-2013-102238] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Lynch syndrome (LS) is an autosomal dominant disorder caused by a defect in one of the DNA mismatch repair genes: MLH1, MSH2, MSH6 and PMS2. In the last 15 years, an increasing number of patients have been described with biallelic mismatch repair gene mutations causing a syndrome referred to as 'constitutional mismatch repair-deficiency' (CMMR-D). The spectrum of cancers observed in this syndrome differs from that found in LS, as about half develop brain tumours, around half develop digestive tract cancers and a third develop haematological malignancies. Brain tumours and haematological malignancies are mainly diagnosed in the first decade of life, and colorectal cancer (CRC) and small bowel cancer in the second and third decades of life. Surveillance for CRC in patients with LS is very effective. Therefore, an important question is whether surveillance for the most common CMMR-D-associated cancers will also be effective. Recently, a new European consortium was established with the aim of improving care for patients with CMMR-D. At a workshop of this group held in Paris in June 2013, one of the issues addressed was the development of surveillance guidelines. In 1968, criteria were proposed by WHO that should be met prior to the implementation of screening programmes. These criteria were used to assess surveillance in CMMR-D. The evaluation showed that surveillance for CRC is the only part of the programme that largely complies with the WHO criteria. The values of all other suggested screening protocols are unknown. In particular, it is questionable whether surveillance for haematological malignancies improves the already favourable outcome for patients with these tumours. Based on the available knowledge and the discussions at the workshop, the European consortium proposed a surveillance protocol. Prospective collection of all results of the surveillance is needed to evaluate the effectiveness of the programme.
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Affiliation(s)
- H F A Vasen
- Department of Gastroenterology & Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Preuß M, Renner C, Krupp W, Christiansen H, Fischer L, Merkenschlager A, Kieß W, Müller W, Manzo N, Meixensberger J, Nestler U. The use of 5-aminolevulinic acid fluorescence guidance in resection of pediatric brain tumors. Childs Nerv Syst 2013; 29:1263-7. [PMID: 23708867 DOI: 10.1007/s00381-013-2159-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 05/11/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Whereas in the adult population 5-Aminolevulinic acid (5-ALA) fluorescence guidance has been widely accepted for improving the extent of tumor resection, the application in children remains an off-label use. Even though most pediatric study protocols require a complete resection for improving outcome parameters, only few pediatric patients have been operated with fluorescence guidance, and it remains questionable, whether and which pediatric tumors show useful fluorescence. We present casuistic reports of application of 5-ALA in children collected from three different neurosurgical departments. PATIENTS AND METHODS In children with suspected malignant intracerebral tumor or recurrence, individual informed consent was obtained in each case from the parents. 5-ALA was administered according to the adult protocol, with 20 mg/kg, 2 h before induction of anesthesia. We retrospectively analyzed 18 patients (13 male, 5 female; age 3-18 years), using the intraoperative neurosurgical protocol, the postoperative MRI results, and the follow-up clinical examinations. RESULTS The use of 5-ALA fluorescence guidance proved to be safe in our group of pediatric patients. Fluorescence guidance was most useful for recurrent glioblastoma resection. Medulloblastoma tissue displayed fluorescence only inconsistently, and most pilocytic astrocytoma remained without staining. Ganglioglioma showed partial staining in the central tumor areas, without allowing the use for circumferent resection. CONCLUSION The off-label use of 5-ALA fluorescence guidance in pediatric patients appears to be most useful in recurrent high-grade gliomas. Fluorescence accumulation in other pediatric brain tumor entities is not predictable and should be evaluated in future clinical studies before being integrated into the current treatment protocols.
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Affiliation(s)
- M Preuß
- Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
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Tomaselli S, Galeano F, Massimi L, Di Rocco C, Lauriola L, Mastronuzzi A, Locatelli F, Gallo A. ADAR2 editing activity in newly diagnosed versus relapsed pediatric high-grade astrocytomas. BMC Cancer 2013; 13:255. [PMID: 23697632 PMCID: PMC3663793 DOI: 10.1186/1471-2407-13-255] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 05/08/2013] [Indexed: 01/12/2023] Open
Abstract
Background High-grade (WHO grade III and IV) astrocytomas are aggressive malignant brain tumors affecting humans with a high risk of recurrence in both children and adults. To date, limited information is available on the genetic and molecular alterations important in the onset and progression of pediatric high-grade astrocytomas and, even less, on the prognostic factors that influence long-term outcome in children with recurrence. A-to-I RNA editing is an essential post-transcriptional mechanism that can alter the nucleotide sequence of several RNAs and is mediated by the ADAR enzymes. ADAR2 editing activity is particularly important in mammalian brain and is impaired in both adult and pediatric high-grade astrocytomas. Moreover, we have recently shown that the recovered ADAR2 activity in high-grade astrocytomas inhibits in vivo tumor growth. The aim of the present study is to investigate whether changes may occur in ADAR2-mediated RNA editing profiles of relapsed high-grade astrocytomas compared to their respective specimens collected at diagnosis, in four pediatric patients. Methods Total RNAs extracted from all tumor samples and controls were tested for RNA editing levels (by direct sequencing on cDNA pools) and for ADAR2 mRNA expression (by qRT-PCR). Results A significant loss of ADAR2-editing activity was observed in the newly diagnosed and recurrent astrocytomas in comparison to normal brain. Surprisingly, we found a substantial rescue of ADAR2 editing activity in the relapsed tumor of the only patient showing prolonged survival. Conclusions High-grade astrocytomas display a generalized loss of ADAR2-mediated RNA editing at both diagnosis and relapse. However, a peculiar Case, in complete remission of disease, displayed a total rescue of RNA editing at relapse, intriguingly suggesting ADAR2 activity/expression as a possible marker for long-term survival of patients with high-grade astrocytomas.
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Affiliation(s)
- Sara Tomaselli
- Laboratory of RNA Editing, Department of Pediatric Haematology/Oncology, Bambino Gesù Children's Hospital, IRCCS, Piazza S, Onofrio 4, Rome 00165, Italy
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Treatment of children with glioblastoma with conformal radiation, temozolomide, and bevacizumab as adjuncts to surgical resection. J Pediatr Hematol Oncol 2013; 35:e123-6. [PMID: 23425999 DOI: 10.1097/mph.0b013e318282cd7f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Prognosis for children with glioblastoma is unacceptably poor. Modest improvements in progression-free survival were seen in adults with glioblastoma by combining temozolomide and bevacizumab with conformal radiation. We retrospectively reviewed 3 cases of glioblastoma in children treated using upfront bevacizumab and temozolomide during radiation, followed by 12 cycles of maintenance therapy. All patients completed therapy with minimal toxicity and no delays in treatment. Two patients remain disease free at 38 and 49 months from diagnosis. One patient recurred 14 months off therapy and currently receives salvage therapy 48 months from diagnosis. These results support further investigation of this regimen.
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Friedman GK, Raborn J, Kelly VM, Cassady KA, Markert JM, Gillespie GY. Pediatric glioma stem cells: biologic strategies for oncolytic HSV virotherapy. Front Oncol 2013; 3:28. [PMID: 23450706 PMCID: PMC3584319 DOI: 10.3389/fonc.2013.00028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/04/2013] [Indexed: 01/17/2023] Open
Abstract
While glioblastoma multiforme (GBM) is the most common adult malignant brain tumor, GBMs in childhood represent less than 10% of pediatric malignant brain tumors and are phenotypically and molecularly distinct from adult GBMs. Similar to adult patients, outcomes for children with high-grade gliomas (HGGs) remain poor. Furthermore, the significant morbidity and mortality yielded by pediatric GBM is compounded by neurotoxicity for the developing brain caused by current therapies. Poor outcomes have been attributed to a subpopulation of chemotherapy and radiotherapy resistant cells, termed “glioma stem cells” (GSCs), “glioma progenitor cells,” or “glioma-initiating cells,” which have the ability to initiate and maintain the tumor and to repopulate the recurring tumor after conventional therapy. Future innovative therapies for pediatric HGG must be able to eradicate these therapy-resistant GSCs. Oncolytic herpes simplex viruses (oHSV), genetically engineered to be safe for normal cells and to express diverse foreign anti-tumor therapeutic genes, have been demonstrated in preclinical studies to infect and kill GSCs and tumor cells equally while sparing normal brain cells. In this review, we discuss the unique aspects of pediatric GSCs, including markers to identify them, the microenvironment they reside in, signaling pathways that regulate them, mechanisms of cellular resistance, and approaches to target GSCs, with a focus on the promising therapeutic, genetically engineered oHSV.
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Affiliation(s)
- Gregory K Friedman
- Brain Tumor Research Program, Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama at Birmingham Birmingham, AL, USA
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Das KK, Mehrotra A, Nair AP, Kumar S, Srivastava AK, Sahu RN, Kumar R. Pediatric glioblastoma: clinico-radiological profile and factors affecting the outcome. Childs Nerv Syst 2012; 28:2055-62. [PMID: 22903238 DOI: 10.1007/s00381-012-1890-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/03/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Glioblastoma in the pediatric age group is relatively rare. As a result, it has been difficult to deduce any consistent clinico-radiological and pathological profiles on these patients. Also, the prognostic factors affecting the survival in pediatric glioblastoma are not as well defined as in adults. PATIENTS AND METHODS In this retrospective series, 65 pediatric patients (age ≤ 18 years) from January 1995 to December 2011 with histopathologically proven diagnosis of intracranial glioblastoma were studied. Clinico-radiological, pathological, treatment, and follow-up data were collected. Progression-free and overall survivals were assessed using the Kaplan-Meier method. RESULTS The male-to-female ratio was 2.6:1 with a mean age of 13.29 ± 4.53 years (range 2-18 years). Headache with or without vomiting (n = 51, 78 %), followed by seizures (n = 42, 65 %), and focal deficits (n = 31, 47 %) were the leading symptoms. Forty-nine (75 %) patients had tumors located superficially, whereas there were 16 patients with deeply located glioblastomas (25 %). Gross total tumor excision was achieved in 43 (66 %) patients, while the remaining patients had incomplete excision (n = 22, 34 %). Mean follow-up was 17.7 months (range 1.5-119 months). The median progression-free and overall survivals were 10 and 20 months, respectively. Extent of resection was found to be the independent predictor of survival (p value = 0.002). CONCLUSION Pediatric glioblastomas are associated with longer progression-free as well as overall survivals. Extent of tumor resection is the strongest predictor of survival in pediatric glioblastoma. Hence, an aggressive surgical resection may fetch a better outcome in children with glioblastoma.
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Affiliation(s)
- Kuntal Kanti Das
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Yang T, Temkin N, Barber J, Geyer JR, Leary S, Browd S, Ojemann JG, Ellenbogen RG. Gross total resection correlates with long-term survival in pediatric patients with glioblastoma. World Neurosurg 2012; 79:537-44. [PMID: 23017588 DOI: 10.1016/j.wneu.2012.09.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Revised: 04/02/2012] [Accepted: 09/18/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Glioblastoma is a rare central nervous system neoplasm in pediatric patients. Few studies focused exclusively on this disease in this population. Available literature suggests that this disease behaves differently between pediatric and adult patients. We set out to study patients younger than 18 years of age, carrying the diagnosis of glioblastoma not of the brainstem, their clinical characteristics and clinical factors associated with clinical outcome. METHODS Thirty-seven pediatric patients with the diagnosis of glioblastoma not of the brainstem, who were treated in our institution from 1982-2011, were identified and studied retrospectively. RESULTS All patients underwent surgical intervention. Seventeen patients (45.9%) had gross total resection (GTR). Thirteen patients (35.1%) had subtotal resection and seven (18.9%) had biopsy. After surgery, 35 patients received radiation therapy (94.6%) and 34 patients (91.9%) received chemotherapy (various agents depending on the institutional protocols established at the time of treatment and family choice). Median follow-up time was 17.5 months, ranging from 0.5-186 months. The median overall survival is 18.7 months (95% confidence interval 15.7-21.8 months). The survival rate at 1, 2, and 5 years is 63.9%, 44.5%, and 17.6%, respectively. The median overall survival for patients with GTR is 45.1 months (95% confidence interval 27.5-62.8 months), 8.7 or 11.5 months for patients with subtotal resection or biopsy, respectively. GTR was accomplished only in patients with superficially located tumors. CONCLUSIONS GTR significantly associates with long-term survival in our population of pediatric patients with glioblastoma not of the brainstem.
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Affiliation(s)
- Tong Yang
- Department of Neurosurgery, School of Public Health, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA.
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Joo JD, Chang JH, Kim JH, Hong YK, Kim YH, Kim CY. Temozolomide during and after Radiotherapy for Newly Diagnosed Glioblastomas : A Prospective Multicenter Study of Korean Patients. J Korean Neurosurg Soc 2012; 52:92-7. [PMID: 23091665 PMCID: PMC3467382 DOI: 10.3340/jkns.2012.52.2.92] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Revised: 05/07/2012] [Accepted: 08/17/2012] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study was performed to determine the safety and outcome of concurrent chemoradiotherapy (CCRT) and adjuvant chemotherapy with temozolomide for Korean patients with a newly diagnosed glioblastoma. METHODS Patients were recruited from four institutions between 2004 and 2007. The patients received fractionated focal irradiation in daily fractions of 2 Gy given 5 days per week for 6 weeks and daily temozolomide, followed by 6 cycles of adjuvant temozolomide. The primary endpoint was overall survival (OS) and the secondary endpoints were progression-free survival (PFS), response, and safety. RESULTS A total of 103 patients were enrolled in this study. Ninety-six patients (93%) completed the CCRT and 54 patients (52%) received 6 cycles of adjuvant temozolomide. The response rate was 73% (53/73) and the tumor control rate was 92% (67/73). Of the 96 patients who completed the CCRT, the median OS was 18.0 months and the 1- and 2-year OS rates were 74 and 38%, respectively. The median PFS was 10.0 months and the 1- and 2-year PFS rates were 33 and 16%, respectively. The only significant prognostic factor of survival was the extent of surgical resection (p<0.05). CCRT resulted in grade 3 or 4 hematologic toxic effects in 8% of patients. No opportunistic infections were noted. CONCLUSION This study is the first prospective multi-institutional report of CCRT and adjuvant chemotherapy with temozolomide for patients with a newly diagnosed glioblastoma in Korea. The current protocol may prolong the survival of Korean patients with a glioblastoma and may be tolerable in terms of toxicity.
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Affiliation(s)
- Jin-Deok Joo
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
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