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Dogra S, Zagzag D, Young M, Golfinos J, Orringer D, Jain R. Long-Term Follow-up of Multinodular and Vacuolating Neuronal Tumors and Implications for Surveillance Imaging. AJNR Am J Neuroradiol 2023; 44:1032-1038. [PMID: 37500290 PMCID: PMC10494952 DOI: 10.3174/ajnr.a7946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND PURPOSE Most multinodular and vacuolating neuronal tumors (MVNTs) are diagnosed and followed radiologically without any change across time. There are no surveillance guidelines or quantitative volumetric assessments of these tumors. We evaluated MVNT volumes during long follow-up periods using segmentation tools with the aim of quantitative assessment. MATERIALS AND METHODS All patients with MVNTs in a brain MR imaging report in our system were reviewed. Patients with only 1 brain MR imaging or in whom MVNT was not clearly the most likely diagnosis were excluded. All MVNTs were manually segmented. For all follow-up examinations, absolute and percentage volume change from immediately prior and initial examinations were calculated. RESULTS Forty-eight patients (32 women; median age, 50.5 years at first scanning) underwent 158 brain MRIs. The median duration between the first and last scan was 15.6 months (interquartile range, 5.7-29.6 months; maximum, 6.4 years) and between consecutive scans, it was 6.7 months (interquartile range, 3.3-12.4 months; maximum, 4.9 years). Pearson correlation coefficients between days since immediately prior scan versus absolute and percentage volume change from immediately prior scan were r = 0.05 (P = .60) and r = 0.07 (P = .45), respectively. For the relationship between days since the first scan versus absolute and percentage volume change from the first scan, values were r = -0.06 (P = .53) and r = -0.04 (P = .67), respectively. CONCLUSIONS MVNT segmentation across follow-up brain MR imaging examinations did not demonstrate significant volume differences, suggesting that these tumors do not enlarge with time. Hence, frequent surveillance imaging of newly diagnosed MVNTs may not be necessary.
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Affiliation(s)
- S Dogra
- From the Department of Radiology (S.D., M.Y., R.J.), New York University Grossman School of Medicine, New York, New York
| | - D Zagzag
- Department of Pathology (D.Z.), New York University Grossman School of Medicine, New York, New York
| | - M Young
- From the Department of Radiology (S.D., M.Y., R.J.), New York University Grossman School of Medicine, New York, New York
| | - J Golfinos
- Department of Neurosurgery (J.G., D.O., R.J.), New York University Grossman School of Medicine, New York, New York
| | - D Orringer
- Department of Neurosurgery (J.G., D.O., R.J.), New York University Grossman School of Medicine, New York, New York
| | - R Jain
- From the Department of Radiology (S.D., M.Y., R.J.), New York University Grossman School of Medicine, New York, New York
- Department of Neurosurgery (J.G., D.O., R.J.), New York University Grossman School of Medicine, New York, New York
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Goldberg H, Ajaj R, Cáceres JOH, Berlin A, Chandrasekar T, Klaassen Z, Wallis CJD, Ahmad AE, Leao R, Petrella AR, Kachura JR, Fleshner N, Matthew A, Finelli A, Jewett MAS, Hamilton RJ. Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass. Urol Oncol 2020; 38:603.e17-603.e25. [PMID: 32253117 DOI: 10.1016/j.urolonc.2020.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 12/28/2019] [Accepted: 02/11/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To compare the psychological distress throughout several predefined disease time points in patients younger than 70 with small renal masses (SRMs) treated with either active surveillance (AS) or ablative/surgical therapy. METHODS Using the Edmonton Symptom Assessment System - revised (ESAS-r) questionnaire, we focused on psychological distress symptoms in all consecutive patients with an SRM between 2014 and 2017. We further evaluated the psychological distress sub-score (PDSS) of ESAS-r, consisting of the sum scores of anxiety, depression, and well-being. PDSS of patients treated with AS or ablation/surgery were compared at 4 distinct time points (before and after diagnosis, after a biopsy is performed, and at last follow-up). Multivariable linear regression models were performed to assess factors associated with worse PDSS (1-point score increase). RESULTS We examined 477 patients, of whom 217 and 260 were treated with AS and surgery/ablation, respectively. Similar ESAS-r and PDSS scores were shown at all predefined disease time points except following an SRM biopsy and at last, follow-up, where AS-treated patients with a biopsy-proven malignancy had significantly worse PDSS (11.4 vs. 6.1, P = 0.035), and (13.2 vs. 5.4, P = 0.004), respectively. At last follow-up, multivariable linear models demonstrated that a biopsy-proven malignancy (B = 2.630, 95% CI 0.024-5.236, P = 0.048) and AS strategy (B = 6.499, 95% CI 2.340-10.658, P = 0.002) were associated with worse PDSS in all patients, and in those who underwent a biopsy, respectively. CONCLUSIONS Offering standardized psychological supportive care may be required for patients younger than 70 years on AS for SRM, especially for those with a biopsy-proven tumor.
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Affiliation(s)
- Hanan Goldberg
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Rami Ajaj
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jaime Omar Herrera Cáceres
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alejandro Berlin
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Techna Institute, University Health Network, Toronto, ON, Canada
| | - Thenappan Chandrasekar
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Zachary Klaassen
- Division of Urology, Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA; Georgia Cancer Center, Augusta, GA
| | - Christopher J D Wallis
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ardalan E Ahmad
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ricardo Leao
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anika R Petrella
- Departments of Surgery and Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R Kachura
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Neil Fleshner
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Matthew
- Departments of Surgery and Supportive Care, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antonio Finelli
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael A S Jewett
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Robert J Hamilton
- Urology Division, Surgical Oncology Department, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
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Thurin E, Corell A, Gulati S, Smits A, Henriksson R, Bartek J, Salvesen Ø, Jakola AS. Return to work following meningioma surgery: a Swedish nationwide registry-based matched cohort study. Neurooncol Pract 2019; 7:320-328. [PMID: 32528713 PMCID: PMC7274187 DOI: 10.1093/nop/npz066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Background Meningioma is the most common primary intracranial tumor. It is usually slow growing and benign, and surgery is the main treatment modality. There are limited data on return to work following meningioma surgery. The objective of this study was to determine the patterns of sick-leave rate prior to surgery, and up to 2 years after, in patients compared to matched controls. Methods Data on patients ages 18 to 60 years with histologically verified intracranial meningioma between 2009 and 2015 were identified in the Swedish Brain Tumor Registry (SBTR) and linked to 3 national registries after 5 matched controls were assigned to each patient. Results We analyzed 956 patients and 4765 controls. One year prior to surgery, 79% of meningioma patients and 86% of controls were working (P < .001). The proportion of patients at work 2 years after surgery was 57%, in contrast to 84% of controls (P < .001). Statistically significant negative predictors for return to work in patients 2 years after surgery were high (vs low) tumor grade, previous history of depression, amount of sick leave in the year preceding surgery, and surgically acquired neurological deficits. Conclusion There is a considerable risk for long term sick leave 2 years after meningioma surgery. Neurological impairment following surgery was a modifiable risk factor increasing the risk for long-term sick leave. More effective treatment of depression may facilitate return to work in this patient group.
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Affiliation(s)
- Erik Thurin
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Sweden
| | - Alba Corell
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sasha Gulati
- Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim
| | - Anja Smits
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neuroscience, Neurology, Uppsala University, Sweden
| | - Roger Henriksson
- Department of Radiation Science and Oncology, University Hospital, Umeå, Sweden
| | - J Bartek
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Neuroscience and Department of Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark
| | - Øyvind Salvesen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim
| | - Asgeir Store Jakola
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Sweden.,Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neurosurgery, St. Olav's University Hospital, Trondheim, Norway
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A pilot study: application of hemoglobin and cortisol levels, and a memory test to evaluate the quality of life of breast cancer patients on chemotherapy. Int J Biol Markers 2013; 28:e348-56. [PMID: 24338719 DOI: 10.5301/jbm.5000053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Short-term memory (STM) decline in breast cancer patients resulting from chemotherapy was evaluated by means of blood biomarkers, a questionnaire, and a computerized STM test. METHODS This study was conducted from January 2013 to June 2013, recruiting 90 subjects: 30 breast cancer patients beginning the 3rd of 4th cycles of docetaxel and cyclophosphamide chemotherapy, 30 recovered patients (who completed 4 cycles of docetaxel for a minimum of 6 months), and 30 healthy subjects (disease-free females). The levels of hemoglobin, red and white blood cells, and cortisol in serum, and a computerized STM test were analyzed to estimate the effects of chemotherapy on STM. A questionnaire was given to all subjects to assess quality of life. RESULTS Statistically significant differences were observed for the blood parameters (hemoglobin, red and white blood cells, and cortisol levels) between healthy and on-treatment subjects (respectively 13.47 ± 0.96 g/dL vs 5.37 ± 0.38 g/dL, 4.58 ± 0.41 10(12)/L vs 2.07 ± 0.13 10(12)/L, and 6.15 ± 1.03 10(9)/L vs 0.86 ± 0.41 10(9)/L). Scores of the STM test were significantly lower for patients compared to healthy subjects. As indicated by the results of the questionnaire, breast cancer patients had a higher tendency to forget than healthy controls (X(2)=3.15; p<0.0001) and recovered subjects (X(2)=3.15; p<0.0001). CONCLUSION We found depleted levels of hemoglobin, red and white blood cells as a result of chemotherapy, and elevated levels of stress correlated with poor performances in the computerized STM test. A higher cortisol level might be an important precursor of STM deterioration. Monitoring cortisol would be beneficial for evaluating the quality of life of breast cancer patients on chemotherapy.
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