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Gotohda K, Uchino A, Suzuki T, Mishima K, Homma T, Miyama Y, Baba Y. Acute subdural hematoma caused by hemorrhagic falx meningioma: A case report and review of the literature. Radiol Case Rep 2024; 19:2804-2811. [PMID: 38689814 PMCID: PMC11059303 DOI: 10.1016/j.radcr.2024.03.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/16/2024] [Accepted: 03/22/2024] [Indexed: 05/02/2024] Open
Abstract
We herein report a case of acute subdural hematoma caused by hemorrhagic falx meningioma. The patient was a 64-year-old woman with no significant medical history or prior history of trauma. She experienced a sudden onset of headache and weakness in her extremities. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed a mass lesion with intratumoral hemorrhage or faint calcification along the left side of the fronto-parietal cerebral falx. There was also a linear lesion at the left side of the falx, suggesting acute subdural hematoma. MRI was performed again on the eleventh day. On precontrast T1-weighted images, intratumoral hemorrhage and widespread left subdural hematoma were shown as high intensity. On postcontrast T1-weighted images, the tumor showed heterogeneous enhancement with a dural tail sign on the falx, indicative of a falx meningioma. She underwent surgical resection, and the histological subtype was transitional meningioma. Nine cases of hemorrhagic falx meningioma associated with acute subdural hematoma have been reported. If not limited to the site of occurrence, there have been 59 reported cases overall. In our investigation, the incidence of hemorrhage is higher in the convexity and lower in the skull base. It is higher for fibrous, angiomatous, and metaplastic subtypes and lower for meningothelial subtype. The location and histological subtype might be risk factors for meningioma associated with subdural hematoma. Further accumulation of cases will be necessary to establish the cause of bleeding.
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Affiliation(s)
- Kohei Gotohda
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan
| | - Akira Uchino
- Department of Radiology, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa Sayama, Saitama 350-1305, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan
| | - Taku Homma
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan
| | - Yu Miyama
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane Hidaka, Saitama 350-1298, Japan
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Ishizawa K, Adachi JI, Tamaru JI, Nishikawa R, Mishima K, Sasaki A. Neuropil-like islands are a possible pathogenetic link between glioblastoma and gangliocytoma/ganglioglioma in a case of synchronous bilateral brain tumors. Neuropathology 2024; 44:126-134. [PMID: 37641451 DOI: 10.1111/neup.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
Neuropil-like islands (NIs) are a histologic hallmark of glioneuronal tumors with neuropil-like islands (GTNIs), but GTNIs are presently not considered a homogeneous entity. The essence of GTNI is likely its glial component, and NIs are now considered aberrant neuronal differentiation or metaplasia. The case we report herein is a 41-year-old woman who was synchronously affected by two brain tumors: one was a glioblastoma (glioblastoma multiforme, GBM), of isocitrate dehydrogenase (IDH)-wild type, with NIs in the left parietal lobe, and the other was histologically a composite gangliocytoma (GC)/anaplastic ganglioglioma (GG) with NIs in the right medial temporal lobe. While both tumors were genetically wild type for IDH, histone H3, and v-raf murine sarcoma viral oncogene homolog B1 (BRAF), the former tumor, but not the latter, was mutated for telomerase reverse transcriptase promoter gene (TERT). A recent systematic study using DNA methylation profiling and next-generation sequencing showed that anaplastic GG separate into other WHO tumor types, including IDH-wild-type GBM. It suggested a diagnostic scheme where an anaplastic GG is likely an IDH-wild-type GBM if it is a BRAF wild type, IDH wild type, and TERT promoter mutant tumor. The likely scenario in this patient is that the GBM results from the progression of GC/anaplastic GG due to the superimposed TERT promoter mutation and the propagation of newly generated GBM cells in the contralateral hemisphere. A systematic analysis using DNA methylation profiling and next-generation sequencing was not available in this study, but the common presence of NIs histologically noted in the two tumors could support this scenario. Although a sufficient volume of molecular and genetic testing is sine qua non for the accurate understanding of brain tumors, the importance of histologic observation cannot be overemphasized.
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Affiliation(s)
- Keisuke Ishizawa
- Department of Pathology, Saitama Medical University, Moroyama, Japan
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Jun-Ichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama, Japan
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Ehara T, Suzuki T, Mizuno R, Shirahata M, Mishima K, Homma T. Rapidly Progressing Intramedullary Spinal Cord Abscess: A Case Report. NMC Case Rep J 2024; 11:43-47. [PMID: 38454915 PMCID: PMC10917654 DOI: 10.2176/jns-nmc.2023-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/05/2023] [Indexed: 03/09/2024] Open
Abstract
Intramedullary spinal cord abscess is a rare and severe infectious disease characterized by devastating neurological deficits. We report a case of cervical intramedullary spinal cord abscess in a 74-year-old diabetic male with a 3-day history of neck pain and weakness in the right lower extremity. Magnetic resonance imaging revealed a ring-shaped contrast lesion in C3-C6 of the cervical spinal cord with extensive edema. Further, 1 day after admission, he became comatose (Glasgow Coma Scale E1VtM1), and a computed tomography head scan revealed hydrocephalus. Despite emergency ventricular drainage, the patient's level of consciousness remained unchanged. Magnetic resonance imaging performed 1 day after surgery revealed bilateral intracranial extension of the abscess into the thalamus and caudate nucleus. The patient died 19 days after admission. Our report is the first case of extensive brain abscess development over a short period. Based on our experience, prompt administration of antibiotics and emergency abscess drainage of the cervical cord (and ventricular drainage, if necessary) are recommended in cases of neurological deterioration in patients with cervical intramedullary spinal cord abscess.
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Affiliation(s)
- Takuro Ehara
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Reina Mizuno
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Taku Homma
- Department of Pathology, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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Mishima K, Tsuji T, Kodama K, Hayashida H, Kikuchi K, Okuno S, Ochi K, Hiraoka D, Ishimura D, Mizuki S. Сarotid artery ultrasonography for diagnosis and monitoring of cervical and intracranial large vessel vasculitis in a patient with systemic lupus erythematosus and Sjögren syndrome. QJM 2024; 117:63-65. [PMID: 37788134 DOI: 10.1093/qjmed/hcad223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- K Mishima
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - T Tsuji
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - K Kodama
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - H Hayashida
- Department of Neurology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - K Kikuchi
- Department of Radiology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - S Okuno
- Department of Ophthalmology, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - K Ochi
- Clinical Training Center, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - D Hiraoka
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - D Ishimura
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - S Mizuki
- Center for Rheumatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
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On J, Natsumeda M, Takahashi H, Koyama A, Shibuma S, Shibata N, Watanabe J, Saito S, Kanemaru Y, Tsukamoto Y, Okada M, Ogura R, Eda T, Tada M, Shimizu H, Adachi JI, Mishima K, Nishikawa R, Kakita A, Oishi M. Reliable detection of genetic alterations in cyst fluid DNA for the diagnosis of brain tumors. J Neurooncol 2024; 166:273-282. [PMID: 38227143 DOI: 10.1007/s11060-023-04555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 12/26/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE Liquid biopsy of cyst fluid in brain tumors has not been extensively studied to date. The present study was performed to see whether diagnostic genetic alterations found in brain tumor tissue DNA could also be detected in cell-free DNA (cfDNA) of cyst fluid in cystic brain tumors. METHODS Cyst fluid was obtained from 22 patients undergoing surgery for a cystic brain tumor with confirmed genetic alterations in tumor DNA. Pathological diagnoses based on WHO 2021 classification and diagnostic alterations in the tumor DNA, such as IDH1 R132H and TERT promoter mutation for oligodendrogliomas, were detected by Sanger sequencing. The same alterations were analyzed by both droplet digital PCR (ddPCR) and Sanger sequencing in cyst fluid cfDNA. Additionally, multiplex ligation-dependent probe amplification (MLPA) assays were performed to assess 1p/19q status, presence of CDKN2A loss, PTEN loss and EGFR amplification, to assess whether differentiating between astrocytomas and oligodendrogliomas and grading is possible from cyst fluid cfDNA. RESULTS Twenty-five genetic alterations were found in 22 tumor samples. All (100%) alterations were detected in cyst fluid cfDNA by ddPCR. Twenty of the 25 (80%) alterations were also detected by Sanger sequencing of cyst fluid cfDNA. Variant allele frequency (VAF) in cyst fluid cfDNA was comparable to that of tumor DNA (R = 0.62, Pearson's correlation). MLPA was feasible in 11 out of 17 (65%) diffuse gliomas, with close correlation of results between tumor DNA and cyst fluid cfDNA. CONCLUSION Cell-free DNA obtained from cyst fluid in cystic brain tumors is a reliable alternative to tumor DNA when diagnosing brain tumors.
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Affiliation(s)
- Jotaro On
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan.
- Advanced Treatment of Neurological Diseases Branch, Brain Research Institute, Niigata University, Niigata, Japan.
| | - Haruhiko Takahashi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akihide Koyama
- Department of Legal Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Satoshi Shibuma
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Nao Shibata
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jun Watanabe
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Shoji Saito
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yu Kanemaru
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yoshihiro Tsukamoto
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Masayasu Okada
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Ryosuke Ogura
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Takeyoshi Eda
- Division of Pharmacy, Medical and Dental Hospital, Niigata University, Niigata, Japan
| | - Mari Tada
- Department of Pathology, Brain Research Institute, Niigata, Japan
| | - Hiroshi Shimizu
- Department of Pathology, Brain Research Institute, Niigata, Japan
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
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Yonezawa H, Narita Y, Nagane M, Mishima K, Terui Y, Arakawa Y, Asai K, Fukuhara N, Sugiyama K, Shinojima N, Aoi A, Nishikawa R. Three-year follow-up analysis of phase 1/2 study on tirabrutinib in patients with relapsed or refractory primary central nervous system lymphoma. Neurooncol Adv 2024; 6:vdae037. [PMID: 38690230 PMCID: PMC11059299 DOI: 10.1093/noajnl/vdae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Background The ONO-4059-02 phase 1/2 study showed favorable efficacy and acceptable safety profile of tirabrutinib, a second-generation Bruton's tyrosine kinase inhibitor, for relapsed/refractory primary central nervous system lymphoma (PCNSL). Here, we report the long-term efficacy and safety after a 3-year follow-up. Methods Eligible patients were aged ≥ 20 years with histologically diagnosed PCNSL and KPS of ≥ 70. Patients received oral tirabrutinib once daily at 320 or 480 mg, or 480 mg under fasted conditions. Results Between October 19, 2017, and June 13, 2019, 44 patients were enrolled: 33 and 9 had relapsed and refractory, respectively. The 320, 480, and 480 mg fasted groups included 20, 7, and 17 patients, respectively. The median follow-up was 37.1 months. The overall response rate was 63.6% (95% CI: 47.8-77.6) with complete response (CR), unconfirmed CR, and partial response in 9, 7, and 12 patients, respectively. The median duration of response (DOR) was 9.2 months, with a DOR rate of 19.8%; the median progression-free survival (PFS) and median overall survival (OS) were 2.9 months and not reached, respectively, with PFS and OS rates of 13.9% and 56.7%, respectively. Adverse events occurred in 38 patients (86.4%): grade ≥ 3 in 23 (52.3%) including 1 patient with grade 5 events. KPS and quality of life (QoL) scores were well maintained among patients receiving long-term treatment. Conclusions The results demonstrated the long-term clinical benefit of tirabrutinib, with deep and durable response in a subset of patients and acceptable safety profile, while KPS and QoL scores were maintained.
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Affiliation(s)
- Hajime Yonezawa
- Department of Neurosurgery, Kagoshima University Hospital, Kagoshima, Kagoshima, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yasuhito Terui
- Department of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Kyoto, Japan
| | - Katsunori Asai
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Noriko Fukuhara
- Department of Hematology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University Hospital, Hiroshima, Hiroshima, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Kumamoto, Japan
| | - Arata Aoi
- Department of Clinical Development, Ono Pharmaceutical Co., Ltd., Osaka, Osaka, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Mizuno R, Sasaki A, Suzuki T, Adachi JI, Shirahata M, Nishikawa R, Mishima K. Successful Treatment of a CNS Tumor with BCOR Internal Tandem Duplication: A Case Report. NMC Case Rep J 2023; 10:343-348. [PMID: 38249434 PMCID: PMC10796265 DOI: 10.2176/jns-nmc.2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/14/2023] [Indexed: 01/23/2024] Open
Abstract
A central nervous system (CNS) tumor with BCL-6 co-repressor (BCOR) internal tandem duplication (CNS tumor with BCOR ITD) is a rare tumor classified as an embryonal tumor by the World Health Organization classification (5th edition), and the prognosis is generally poor. A successfully treated case is reported, and its treatment is discussed. A five-year-old boy presented with a one-month history of headache and vomiting. Magnetic resonance imaging showed a well-demarcated, left-frontal tumor without perifocal edema. The patient underwent complete resection without a neurological deficit. Anti-BCOR antibody showed strong immunoreactivity in tumor nuclei, and the tumor was diagnosed as a CNS tumor with BCOR ITD. The patient received craniospinal irradiation (CSI) comprising 23.4 Gy, followed by a boost to the primary site to a total dose of 30.6 Gy in daily fractions of 1.8 Gy. The chemotherapy comprised four cycles of vincristine, cyclophosphamide, and cisplatin with peripheral blood stem cell rescue. The clinical course was uneventful throughout the treatment, the tumor has not recurred for four years, and no neurological impairment was reported. CSI and multiagent chemotherapy were effective for a CNS tumor with BCOR ITD.
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Affiliation(s)
- Reina Mizuno
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama International Medical Center, Hidaka, Saitama, Japan
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Okamoto N, Mineta S, Mishima K, Fujiyama Y, Wakabayashi T, Fujita S, Sakamoto J, Wakabayashi G. Comparison of short-term outcomes of robotic and laparoscopic transabdominal peritoneal repair for unilateral inguinal hernia: a propensity-score matched analysis. Hernia 2023; 27:1131-1138. [PMID: 36595086 DOI: 10.1007/s10029-022-02730-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE This study aimed to compare perioperative outcomes of robotic and laparoscopic transabdominal peritoneal repair (TAPP) for unilateral inguinal hernia. METHODS This single institutional retrospective cohort study used de-identified data of patients who underwent robotic TAPP (R-TAPP) or laparoscopic TAPP (L-TAPP) for unilateral inguinal hernia between January 1, 2016 and October 31, 2021. Two cohorts were propensity matched, and data were analyzed. The learning curve was evaluated in the R-TAPP group. RESULTS Among 938 patients analyzed, 704 were included. After propensity-score matching, 80 patients were included in each group. The difference in operative time between R-TAPP and L-TAPP groups was 10 min (99.5 and 89.5 min, p = 0.087); however, console/laparoscopic time was similar (67 and 66 min, p = 0.71). The dissection time for medial-type hernia in the R-TAPP group was marginally shorter than that in the L-TAPP group (17 and 27 min, p = 0.056); however, there was no difference for lateral-type hernia (38.5 and 40 min p = 0.37). Perioperative variables, including estimated blood loss, postoperative hospital stay, and postoperative pain, had no significant difference, and chronic pain, which needed medication or intervention, was not observed in each group. The number of cases needed to achieve plateau performance was 7-10 in the R-TAPP group. CONCLUSION This study suggests that R-TAPP was safely introduced, and its perioperative outcomes were not inferior to those of L-TAPP. A shorter dissection time for medial-type hernia might be due to the robot's advantages, and a fast-learning curve could help with the early standardization of the procedure.
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Affiliation(s)
- N Okamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan.
| | - S Mineta
- Department of Surgery, Chiba Tokusyukai Hospital, Funabashi, Japan
| | - K Mishima
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Y Fujiyama
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - T Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - S Fujita
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - J Sakamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - G Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
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Suzuki T, Shirahata M, Adachi JI, Mishima K, Nishikawa R. Clinical significance and pitfalls of human chorionic gonadotropin-related tumor markers for intracranial germinomas. Childs Nerv Syst 2023; 39:901-907. [PMID: 36745216 DOI: 10.1007/s00381-023-05856-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/22/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Measuring serum and cerebrospinal fluid human chorionic gonadotropin (hCG) is essential for the diagnosis of intracranial germ cell tumors. There are three types of hCG-related markers in clinical use: hCGβ, intact hCG, and total hCG. The best marker for the diagnosis of intracranial germ cell tumors, especially germinoma, is currently unknown. This study aimed to evaluate the usefulness of these hCG-related markers. METHODS We investigated 19 serum samples obtained from 6 patients with histologically diagnosed germinoma treated in our institute. Serum hCGβ, intact hCG, and total hCG values were measured before, during, and after treatment. Samples with hCG values above the lower limits were considered positive. RESULTS The positivity rates of serum hCGβ, intact hCG, and total hCG were 6% (1/17), 47% (7/15), and 42% (8/19), respectively, with the latter two having significantly higher positivity rates than hCGβ (p = 0.041). Both intact and total hCGs showed similar values. The median values of hCGβ, intact hCG, and total hCG before treatment were 0.1 ng/mL, 4.6 mIU/mL, and 4.5 mIU/mL, respectively. CONCLUSION Serum intact and total hCGs have higher detection rates than hCGβ in patients with germinoma using available commercial measurement tools.
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Affiliation(s)
- Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan.
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka City, Saitama, 350-1298, Japan
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Take Y, Shirahata M, Sakai J, Kubota Y, Suzuki T, Adachi JI, Maesaki S, Mishima K, Nishikawa R. Miliary Tuberculosis during R-MPV Therapy in an Elderly Patient with Primary Central Nerve System Lymphoma: A Case Report. Case Rep Oncol 2023; 16:1054-1059. [PMID: 37900802 PMCID: PMC10601709 DOI: 10.1159/000530711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/12/2023] [Indexed: 10/31/2023] Open
Abstract
Most elderly patients with tuberculosis (TB) have previously been infected with Mycobacterium tuberculosis, which remains dormant in the body for decades and may reactivate when their immunity declines due to underlying diseases. Elderly cancer patients are at a high risk for TB, and the treatment of TB reactivation in these patients is challenging. Among cancer patients, the incidence of TB reactivation is the highest in lymphoma patients. However, the impact of chemotherapy on TB reactivation in lymphoma patients is unknown. We report the case of an immunocompetent elderly patient with primary central nervous system lymphoma (PCNSL) having no prior history of TB, who developed miliary TB during multiagent chemotherapy consisting of rituximab, high-dose methotrexate, procarbazine, and vincristine (R-MPV therapy). Retrospectively, the chest computed tomography showed calcification of the pleura, suggesting that the patient had a latent tuberculosis infection (LTBI) and developed miliary TB from the reactivation of TB triggered by the R-MPV therapy. Our case emphasizes that when chemotherapy is administered to patients with PCNSL, interferon-gamma release assay (IGRA) should be performed if there are findings on chest examination suggestive of LTBI, such as pleural calcification, and if IGRA is positive, chemotherapy should be given concurrently with LTBI treatment.
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Affiliation(s)
- Yushiro Take
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun Sakai
- Department of Infectious Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Yuichi Kubota
- Department of Neurosurgery, TMG Asaka Medical Center, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Jun-ichi Adachi
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Shigefumi Maesaki
- Department of Infectious Diseases, Saitama Medical University Hospital, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neurosurgery/Neuro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
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11
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Arakawa Y, Narita Y, Nagane M, Mishima K, Terui Y, Yonezawa H, Asai K, Fukuhara N, Sugiyama K, Shinojima N, Aoi A, Nishikawa R. Karnofsky Performance Status and quality of life in patients with relapsed or refractory primary CNS lymphoma from a phase I/II study of tirabrutinib. Neurooncol Adv 2023; 5:vdad109. [PMID: 37744697 PMCID: PMC10517093 DOI: 10.1093/noajnl/vdad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background Tirabrutinib, a second-generation inhibitor of Bruton's tyrosine kinase, was approved in March 2020 for the treatment of relapsed or refractory primary central nervous system lymphoma (r/r PCNSL) based on phase I/II studies in Japan. We previously reported the overall response rate and safety profile. We describe Karnofsky Performance Status (KPS) and the quality of life (QoL) in patients with r/r PCNSL receiving tirabrutinib based on more than 1-year follow-up data. Methods Patients with r/r PCNSL, age ≥20 years, and KPS ≥70 were treated with tirabrutinib once daily at a dose of 320, 480, or 480 mg under fasted conditions. QoL was assessed using questionnaires issued by the European Organization for Research and Treatment of Cancer (EORTC), namely EORTC QLQ-C30, EORTC QLQ-BN20, and EuroQol 5 dimensions 3-level (EQ-5D-3L) along with KPS. Results Forty-four patients (mean age, 60 years [range 29-86]) were enrolled. The median follow-up period was 14.9 months (range, 1.4-27.7). The median KPS of the patients at baseline was 80.0 (range, 70-100), and this remained constant during the treatment. The global health status/QoL in the QLQ-C30 showed significant improvements from baseline through cycles 3-17 and remained relatively constant thereafter until cycle 23. Improvements were also seen in emotional functioning and constipation in the QLQ-C30 segments. Other items of QLQ-C30 and QLQ-BN20, EQ-5D visual analog scales, and EQ-5D index were maintained during the treatment. Conclusions Tirabrutinib generally maintains KPS and QoL scores with some improvements in specific QoL items in patients with r/r PCNSL.
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Affiliation(s)
- Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhito Terui
- Department of Hematology and Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hajime Yonezawa
- Department of Neurosurgery, Kagoshima University Hospital, Kagoshima, Japan
| | - Katsunori Asai
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Arata Aoi
- Ono Pharmaceutical Co, Ltd, Osaka, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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12
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Ohno M, Kitanaka C, Miyakita Y, Tanaka S, Takahashi M, Yanagisawa S, Sonoda Y, Matsuda K, Mishima K, Suzuki T, Shirahara M, Ishikawa E, Ohashi K, Nagane M, Narita Y. ACT-19 A REPORT OF PHASE I PART OF PHASE I/II STUDY OF MAINTENANCE THERAPY WITH METFORMIN AND TEMOZOLOMIDE FOR GLIOBLASTOMA. Neurooncol Adv 2022. [DOI: 10.1093/noajnl/vdac167.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Abstract
Background
Glioblastoma (GBM) is an aggressive primary brain tumor with poor prognosis. One strategy for overcoming resistance is developing a new therapy targeting the cancer stem/initiating cells. We have shown that the antidiabetic drug metformin (MF) can induce differentiation of stem-like glioma-initiating cells and suppress tumor formation through AMPK-FOXO3 activation. We conducted a phase I/II study to examine the clinical effect of MF combined with standard maintenance temozolomide (TMZ). Here, we report the result of phase I part and the current status of phase II part.
Patients and Methods
Patients between 20 and 74 years of age with supratentorial GBM histologically diagnosed according to the World Health Organization 2016 classification were eligible. MF dose-escalation was planned using a 3 + 3 design. Dose-limiting toxicities (DLTs) were assessed during the first 6 weeks after MF initiation.
Results
Between February 2021 and January 2022, the first three patients were treated with 1,500 mg/day MF and the next four patients were treated with 2,250 mg/day MF, which is the maximum dose approved in Japan. The median age of the patients was 41 years. Three tumors (42.9 %) were IDH1/2 mutants and 4 (57.1 %) were IDH1/2 wild-types. No DLTs were observed. The most common adverse effects were appetite loss, nausea, and diarrhea, which were observed in three patients. All of them were manageable, with grade 1 or 2. Only one grade 3 seizure was reported, which was likely related to the tumor. Two patients experienced tumor progression at 6.0 and 6.1 months, and one died 12.2 months after initial surgery. The other five patients remained stable at the last follow-up.
Conclusion
MF dose of up to 2,250 mg/day combined with maintenance TMZ appeared to be well tolerated, and we proceeded to phase II study with 2,250 mg/day MF.
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Affiliation(s)
- Makoto Ohno
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Chifumi Kitanaka
- Department of Molecular Cancer Science, Faculty of Medicine, Yamagata University
| | - Yasuji Miyakita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Shunsuke Yanagisawa
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Yukihiko Sonoda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University
| | - Kenichiro Matsuda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University
| | - Mitsuaki Shirahara
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Ken Ohashi
- Department of General Internal Medicine, National Cancer Center Hospital
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
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Mishima K, Tkahashi N, Shirahata M, Suzuki T, Mizuno R, Adachi J, Ozawa T. ML-8 HIGH-DOSE CHEMOTHERAPY SUPPORTED BY AN AUTOLOGOUS STEM CELL TRANSPLANT IN RELAPSED PRIMARY CNS LYMPHOMA. Neurooncol Adv 2022. [PMCID: PMC9719349 DOI: 10.1093/noajnl/vdac167.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Abstract
Background
Many patients with primary CNS lymphoma (PCNSL) relapse despite complete response (CR) after initial therapy. Relapsed PCNSL (rPCNSL) has a poor prognosis, and no adequate standard of treatment has been established. Autologous stem cell transplant (ASCT)-assisted high-dose chemotherapy (HDC) for rPCNSL is a promising treatment option, as is thiotepa (TT), which has been used in malignant lymphoma as a treatment option for PCNSL. In March 2020, TT was approved in Japan as a pre-treatment for ASCT in malignant lymphoma. TBC, TT with busulfan and cyclophosphamide, and BCNU+TT are used in Europe and the US, but treatment-related mortality (TRM) has been reported in about 10% of patients. The regimen approved in Japan is Buslufan-TT(BuTT) therapy in combination with busulfan, which differs from TBC in dosage, and there is little information on efficacy and safety for rPCNSL. In our hospital, we have introduced BuTT therapy for rPCNSL in patients under 65 years of age. In this report, we describe our experience with this treatment. Subjects: Five patients with rPCNSL since May 2021, age <66 years, PS 0-2, are included in this study.
Methods
After obtaining CR with (R)MPV therapy after relapse, peripheral blood stem cells were harvested after administration of G-CSF and plerixafor, pretreated with BuTT therapy (Bu: 3.2 mg/kg, Day-8, -7, -6, -5: TT: 5 mg/kg, Day-4, -3) and transplanted on Day 0.
Results
Adverse events of Grade 3 or higher were abdominal pain in 2 cases, diarrhea in 1 case, pharyngitis in 2 cases, sepsis in 1 case, and pleuritis in 1 case, but all recovered, and no TRM was observed. All five patients are currently alive without recurrence.
Conclusion
HDC/ASCT is expected to be a curative treatment for rPCNSL. Future issues include the establishment of an upper age limit for the indication.
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Affiliation(s)
- Kazuhiko Mishima
- Department of Neuro-Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University , Saitama , Japan
| | - Naoki Tkahashi
- Department of Hematology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University , Saitama , Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University , Saitama , Japan
| | - Reina Mizuno
- Department of Neuro-Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University , Saitama , Japan
| | - Junichi Adachi
- Department of Neuro-Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University , Saitama , Japan
| | - Tastuya Ozawa
- Department of Neuro-Oncology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University , Saitama , Japan
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14
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Adachi JI, Mishima K, Nishikawa R. BIOM-30. ANALYSIS OF GLIOMA-RELATED GENES USING A BREAKTHROUGH AMPLIFICATION TECHNIQUE FOR CELL-FREE DNA IN CEREBROSPINAL FLUID. Neuro Oncol 2022. [PMCID: PMC9660519 DOI: 10.1093/neuonc/noac209.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
In the pathological classification of brain tumors, newly revised in 2021, molecular genetic analysis of gliomas has become more important for diagnosis and understanding of the pathogenesis of the disease. Gliomas are prone to recurrence and malignant progression, and collecting tumor tissue during every genetic analysis is highly invasive. Therefore, techniques have been developed to analyze tumor-derived circulating cell-free DNA (ccfDNA) in the cerebrospinal fluid as a substitute for tissue collection. However, the amount of ccfDNA derived from the cerebrospinal fluid is extremely small and the number of cases for whom genetic analysis is possible is currently limited. In this study, we attempted to establish an efficient method for the integrated analysis of glioma-related genes by in vitro amplification of cerebrospinal fluid-derived ccfDNA from glioma patients and a highly sensitive assay.
METHODS
Tumor-derived ccfDNA was extracted and purified from 1 ml of cerebrospinal fluid obtained by lumbar puncture using the Maxwell RSC instrument in five glioma cases. Hot spots of mutations in IDH1 and H3F3A genes were analyzed by high resolution melting (HRM), TERT mutation by droplet digital PCR, MGMT promoter methylation by methylation-specific HRM, and chromosome 1p/19q loss by multiplex ligation-dependent probe amplification. For samples in which the amount of ccfDNA was too small to analyze, DNA was amplified approximately 500-fold by DNA polymerase using the GenomiPhi kit and analyzed by the same assay method.
RESULTS AND CONCLUSIONS
Although two of the five cases required amplification with the GenomiPhi kit, it was possible to analyze all cases for glioma-related genes as described above. Although the amount of ccfDNA obtained from low-grade gliomas and gliomas that are not in contact with the ventricles or subarachnoid space is small, this amplification method may increase the possibility of liquid biopsy using cerebrospinal fluid.
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Affiliation(s)
- Jun-ichi Adachi
- Department of Neuro-Oncology, Saitama Medical University International Medical Center , Hidaka , Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology, Saitama Medical University International Medical Center , Hidaka , Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology, Saitama Medical University International Medical Center , Hidaka , Japan
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15
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Mishima K, Nishikawa R, Narita Y, Mizusawa J, Sumi M, Koga T, Sasaki N, Kinoshita M, Nagane M, Arakawa Y, Yoshimoto K, Shibahara I, Shinojima N, Asano K, Tsurubuchi T, Sasaki H, Asai A, Sasayama T, Momii Y, Sasaki A, Nakamura S, Kojima M, Tamaru J, Tsuchiya K, Gomyo M, Abe K, Natsumeda M, Yamasaki F, Katayama H, Fukuda H. Randomized phase III study of high-dose methotrexate and whole-brain radiotherapy with/without temozolomide for newly diagnosed primary CNS lymphoma: JCOG1114C. Neuro Oncol 2022; 25:687-698. [PMID: 36334050 PMCID: PMC10076938 DOI: 10.1093/neuonc/noac246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The goal was to determine whether the addition of temozolomide (TMZ) to the standard treatment of high-dose methotrexate (HD-MTX) and whole-brain radiotherapy (WBRT) for primary central nervous system lymphoma (PCNSL) improves survival. METHODS An open-label, randomized, phase III trial was conducted in Japan, enrolling immunocompetent patients aged 20-70 years with histologically confirmed, newly diagnosed PCNSL. After administration of HD-MTX, patients were randomly assigned to receive WBRT (30 Gy) ± 10 Gy boost (arm A) or WBRT ± boost with concomitant and maintenance TMZ for two years (arm B). The primary endpoint was overall survival (OS). RESULTS Between September 29, 2014 and October 15, 2018, 134 patients were enrolled, of whom 122 were randomly assigned and analyzed. At the planned interim analysis, two-year OS was 86.8% (95% confidence interval [CI]: 72.5-94.0%) in arm A and 71.4% (56.0-82.2%) in arm B. The hazard ratio was 2.18 (95% CI: 0.95 to 4.98), with the predicted probability of showing the superiority of arm B at the final analysis estimated to be 1.3%. The study was terminated early due to futility. O 6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status was measured in 115 tumors, and it was neither prognostic nor predictive of TMZ response. CONCLUSIONS This study failed to demonstrate the benefit of concomitant and maintenance TMZ in newly diagnosed PCNSL.
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Affiliation(s)
- Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital
| | - Minako Sumi
- Radiation Oncology Department, Cancer Institute Hospital
| | - Tomoyuki Koga
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center.,Department of Neurosurgery, Faculty of Medicine, The University of Tokyo
| | - Nobuyoshi Sasaki
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka International Cancer Institute
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine
| | - Koji Yoshimoto
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Graduate School of Medicine
| | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine
| | - Yasutomo Momii
- Department of Neurosurgery, Oita University Faculty of Medicine
| | | | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Masaru Kojima
- Department of Anatomical and Surgical Pathology, Dokkyo University School of Medicine
| | - Junichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University
| | - Kazuhiro Tsuchiya
- Department of Radiology, Saitama Medical Center, Saitama Medical University
| | - Miho Gomyo
- Department of Radiology, Kyorin University Faculty of Medicine
| | - Kayoko Abe
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, University of Niigata
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital
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16
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Ohno M, Kitanaka C, Miyakita Y, Tanaka S, Sonoda Y, Mishima K, Ishikawa E, Takahashi M, Yanagisawa S, Ohashi K, Nagane M, Narita Y. Metformin with Temozolomide for Newly Diagnosed Glioblastoma: Results of Phase I Study and a Brief Review of Relevant Studies. Cancers (Basel) 2022; 14:cancers14174222. [PMID: 36077758 PMCID: PMC9454846 DOI: 10.3390/cancers14174222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/22/2022] [Accepted: 08/23/2022] [Indexed: 11/16/2022] Open
Abstract
Glioblastoma (GBM) inevitably recurs due to a resistance to current standard therapy. We showed that the antidiabetic drug metformin (MF) can induce the differentiation of stem-like glioma-initiating cells and suppress tumor formation through AMPK-FOXO3 activation. In this study, we design a phase I/II study to examine the clinical effect of MF. We aim to determine a recommended phase II MF dose with maintenance temozolomide (TMZ) in patients with newly diagnosed GBM who completed standard concomitant radiotherapy and TMZ. MF dose-escalation was planned using a 3 + 3 design. Dose-limiting toxicities (DLTs) were assessed during the first six weeks after MF initiation. Three patients were treated with 1500 mg/day MF and four patients were treated with 2250 mg/day MF between February 2021 and January 2022. No DLTs were observed. The most common adverse effects were appetite loss, nausea, and diarrhea, all of which were manageable. Two patients experienced tumor progression at 6.0 and 6.1 months, and one died 12.2 months after initial surgery. The other five patients remained stable at the last follow-up session. The MF dose of up to 2250 mg/day combined with maintenance TMZ appeared to be well tolerated, and we proceeded to a phase II study with 2250 mg/day MF.
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Affiliation(s)
- Makoto Ohno
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Chifumi Kitanaka
- Department of Molecular Cancer Science, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Yasuji Miyakita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shota Tanaka
- Department of Neurosurgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yukihiko Sonoda
- Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Hidaka 350-1298, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba 350-8576, Japan
| | - Masamichi Takahashi
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shunsuke Yanagisawa
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Ken Ohashi
- Department of General Internal Medicine, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Mitaka 181-8611, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
- Correspondence: ; Tel.: +81-3-3542-2511
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17
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Mizuno R, Homma T, Adachi JI, Mishima K, Suzuki T, Shirahata M, Nishikawa R, Atushi S. True anaplastic oligoastrocytoma with dual genotype: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 4:CASE22146. [PMID: 36046704 PMCID: PMC9301343 DOI: 10.3171/case22146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND The revised fourth edition of the World Health Organization classification of central nervous system tumors was published in 2016. Based on this classification, one of the infiltrating glioma entities named “oligoastrocytoma/anaplastic oligoastrocytoma” is discouraged. It is proposed that these mixed gliomas should be classified as diffuse astrocytoma/anaplastic astrocytoma or oligodendroglioma/anaplastic oligodendroglioma when analyzing their genetic alteration. OBSERVATIONS A 78-year-old female underwent brain computed tomography (CT) because of a traffic accident. Cranial CT revealed a brain tumor in the left temporoparietal lobe; therefore, she was hospitalized. She underwent awake craniotomy. After the operation, she was treated with only local radiotherapy; the authors could not prescribe temozolomide, because she had had levetiracetam-induced pancytopenia. The remaining tumor neuroradiologically disappeared, and she was alive 40 months after the operation without tumor recurrence. LESSONS Histopathologically, this tumor was diagnosed as an anaplastic oligoastrocytoma with a distinct dual phenotype of astrocytoma and oligodendroglioma components. Genetically, these two components revealed astrocytoma and oligodendroglioma genotypes, respectively. Therefore, the authors considered the integrated diagnosis of the temporal tumor as a true anaplastic oligoastrocytoma with a dual genotype. Interestingly, this case also included an area composed of spindle to oval neoplastic cells that revealed intermediate genetic alterations between astrocytomas and oligodendrogliomas.
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Affiliation(s)
| | - Taku Homma
- Pathology, Saitama International Medical Center, Saitama, Japan; and
| | | | | | | | | | | | - Sasaki Atushi
- Department of Pathology, Hospital of Saitama Medical University, Saitama, Japan
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18
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Uchida E, Sasaki A, Shirahata M, Suzuki T, Adachi JI, Mishima K, Yasuda M, Fujimaki T, Ichimura K, Nishikawa R. Role of proliferative marker index and KBTBD4 mutation in the pathological diagnosis of pineal parenchymal tumors. Brain Tumor Pathol 2022; 39:130-138. [PMID: 35000018 DOI: 10.1007/s10014-021-00421-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 12/01/2021] [Indexed: 12/19/2022]
Abstract
Pineal parenchymal tumors (PPTs) are clinically rare and a biopsy is often required for a definitive diagnosis. To improve the accuracy of histological assessment of PPTs, we examined the proliferative capacity of PPT cells and investigated DICER1 expression and KBTBD4 mutations. This study included 19 cases of PPTs [3 pineocytomas (PCs), 10 PPTs of intermediate differentiation (PPTID), and 6 pineoblastomas (PBs)]. Immunohistochemistry for Ki-67, PHH3, and DICER1, as well as Sanger sequencing analysis for KBTBD4 mutations, was performed using formalin-fixed paraffin-embedded tissue specimens that were resected during surgery. Tumor cell proliferation was quantified using an image analysis software. For the PHH3 and MIB-1 indices, a significant difference was observed between the PPTIDs and PBs (P < 0.05). Loss of DICER1 was not specific for PB; 0/3 PCs (0.0%), 2/9 PPTIDs (22.2%), and 2/4 PBs (50.0%). KBTBD4 mutations were detected in 1/3 PCs (33.3%), 6/9 PPTIDs (66.7%), and 0/4 PBs (0.0%). Thus, combined application of the proliferative marker index and KBTBD4 mutation analysis may be useful for the differential diagnosis of PPTs. Furthermore, detection of KBTBD4 mutations using Sanger sequencing analysis may support the diagnosis of PPTID.
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Affiliation(s)
- Eita Uchida
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan. .,Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan.
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama-machi, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takamitsu Fujimaki
- Department of Neurosurgery, Saitama Medical University, Moroyama-machi, Saitama, Japan
| | - Koichi Ichimura
- Division of Brain Tumor Translational Research, National Cancer Center Research Institute, Chuo-ku, Tokyo, Japan.,Department of Brain Disease Translational Research, Juntendo University Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Mishima K, Mitsuaki S, Adachi J, Suzuki T, Uchida E, Nishikawa R. ML-10 Tirabrutinib, a second-generation BTK inhibitor in relapsed and refractory primary CNS lymphoma: A single institute study. Neurooncol Adv 2021. [PMCID: PMC8664626 DOI: 10.1093/noajnl/vdab159.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: The prognosis of relapsed and refractory (r/r) primary CNS lymphoma (PCNSL) is poor, and the development of new therapeutic agents is desirable. Comprehensive genetic analysis of PCNSL has shown that MYD88 and CD79B are frequently mutated and are oncogenic drivers, suggesting that Bruton’s tyrosine kinase (BTK), which is located downstream of MYD88 and CD79B, may be a reasonable therapeutic target. Tirabrutinib is a second-generation oral BTK inhibitor recently approved in Japan for the treatment of r/r PCNSL. In this study, we evaluated the efficacy and safety of tiraburtinib treatment of r/r PCNSL at Saitama Medical University. MATERIAL AND METHODS: Eighteen patients with r/r PCNSL to HD-MTX-based regimens were treated with 480 mg tiraburtinib daily under fasting conditions until disease progression. RESULTS: The median age was 63.5 years, and the median KPS was 70. Nine patients (50%) achieved a CR, 2 (11%) had a partial response, 3 (17%) had stable disease, and 4 (22%) had progressive disease. After a median follow-up of 17.3 months, the median progression-free survival was 7.9 months, and the median overall survival was 23.6 months. There were four cases of long-term treatment lasting more than one year. Grade 3 or higher adverse events were observed in 1 case of maculopapular rash, 1 case of cardiac failure, 1 case of neutropenia, and 1 case of lymphopenia. CONCLUSION: Tiraburtinib can be administered relatively safely to patients with relapsed or refractory PCNSL, and a certain degree of efficacy can be expected. Which patients can be treated with tiraburtinib over the long term, when can stop tirabrutinib treatment for patients with long-term CR, and the mechanism of tiraburtinib resistance needs to be determined.
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Affiliation(s)
- Kazuhiko Mishima
- Department of Neuro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Shirahata Mitsuaki
- Department of Neuro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Junichi Adachi
- Department of Neuro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Eita Uchida
- Department of Neuro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan
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20
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Narita Y, Muragaki Y, Kagawa N, Asai K, Nagane M, Matsuda M, Ueki K, Kuroda J, Date I, Kobayashi H, Kumabe T, Beppu T, Kanamori M, Kasai S, Nishimura Y, Xiong H, Ocampo C, Yamada M, Mishima K. Safety and efficacy of depatuxizumab mafodotin in Japanese patients with malignant glioma: A nonrandomized, phase 1/2 trial. Cancer Sci 2021; 112:5020-5033. [PMID: 34609773 PMCID: PMC8645742 DOI: 10.1111/cas.15153] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 02/06/2023] Open
Abstract
INTELLANCE‐J was a phase 1/2 study of a potent antibody‐drug conjugate targeting epidermal growth factor receptor (EGFR), depatuxizumab mafodotin (Depatux‐M), as a second‐ or first‐line therapy, alone or combined with chemotherapy or chemoradiotherapy in 53 Japanese patients with World Health Organization (WHO) grade III/IV glioma. In second‐line arms, patients with EGFR‐amplified recurrent WHO grade III/IV glioma received Depatux‐M plus chemotherapy (temozolomide) or Depatux‐M alone regardless of EGFR status. In first‐line arms, patients with newly diagnosed WHO grade III/IV glioma received Depatux‐M plus chemoradiotherapy. The study was halted following lack of survival benefit with first‐line Depatux‐M in the global trial INTELLANCE‐1. The primary endpoint was 6‐month progression‐free survival (PFS) in patients with EGFR‐amplified tumors receiving second‐line Depatux‐M plus chemotherapy. Common nonocular treatment‐emergent adverse events (TEAEs) with both second‐line and first‐line Depatux‐M included lymphopenia (42%, 33%, respectively), thrombocytopenia (39%, 47%), alanine aminotransferase increase (29%, 47%), and aspartate aminotransferase increase (24%, 60%); incidence of grade ≥3 TEAEs was 66% and 53%, respectively. Ocular side effects (OSEs) occurred in 93% of patients receiving second‐line Depatux‐M plus chemotherapy and all patients receiving second‐line Depatux‐M alone or first‐line Depatux‐M plus chemoradiotherapy. Most OSEs were manageable with dose modifications and concomitant medications. The 6‐month PFS estimate was 25.6% (95% confidence interval [CI] 11.4‒42.6), and median PFS was 2.1 months (95% CI 1.9‒3.9) with second‐line Depatux‐M plus chemotherapy in the EGFR‐amplified subgroup. This study showed acceptable safety profile of Depatux‐M alone or plus chemotherapy/chemoradiotherapy in Japanese patients with WHO grade III/IV glioma. The study was registered at ClinicalTrials.gov (NCT02590263).
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Affiliation(s)
- Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Naoki Kagawa
- Department of Neurosurgery, Osaka University Hospital, Osaka, Japan
| | - Katsunori Asai
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Japan
| | - Motoo Nagane
- Faculty of Medicine, Department of Neurosurgery, Kyorin University, Tokyo, Japan
| | - Masahide Matsuda
- Department of Neurosurgery, University of Tsukuba, Ibaraki, Japan
| | - Keisuke Ueki
- Department of Neurosurgery, Dokkyo Medical University Hospital, Tochigi, Japan
| | - Junichiro Kuroda
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | - Isao Date
- Department of Neurosurgery, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Hokkaido University Hospital, Hokkaido, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University Hospital, Kanagawa, Japan
| | - Takaaki Beppu
- Department of Neurosurgery, Iwate Medical University Hospital, Iwate, Japan
| | - Masayuki Kanamori
- Department of Neurosurgery, Tohoku University Hospital, Miyagi, Japan
| | | | | | - Hao Xiong
- AbbVie Inc., North Chicago, Illinois, USA
| | | | - Masakazu Yamada
- Department of Ophthalmology, Kyorin University Hospital, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama Medical University, Saitama, Japan
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21
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Shimomura K, Minatogawa H, Mashiko T, Arioka H, Iihara H, Sugawara M, Hida N, Akiyama K, Nawata S, Tsuboya A, Mishima K, Izawa N, Miyaji T, Honda K, Inada Y, Ohno Y, Katada C, Morita H, Yamaguchi T, Nakajima T. LBA63 Placebo-controlled, double-blinded phase Ⅲ study comparing dexamethasone on day 1 with dexamethasone on days 1 to 4, with combined neurokinin-1 receptor antagonist, palonosetron, and olanzapine in patients receiving cisplatin-containing highly emetogenic chemotherapy: SPARED trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Adachi JI, Shirahata M, Suzuki T, Mishima K, Uchida E, Sasaki A, Nishikawa R. Droplet digital PCR assay for detecting TERT promoter mutations in patients with glioma. Brain Tumor Pathol 2021; 38:201-209. [PMID: 34128111 DOI: 10.1007/s10014-021-00403-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/08/2021] [Indexed: 12/14/2022]
Abstract
Two hot spot mutations (C228T, C250T) in the telomerase reverse transcriptase (TERT) gene are frequently identified in glioblastoma and oligodendroglioma. TERT mutations predicts an aggressive clinical course in isocitrate dehydrogenase (IDH) wild-type astrocytic tumors. Therefore, it is important to accurately detect TERT promoter mutations in glioma. Sanger DNA sequencing is the currently standard method for analyzing TERT mutations. However, PCR amplification in the first step of the sequencing has proven technically difficult because of the high GC content around the TERT mutation. In this report, we described a novel droplet digital PCR (ddPCR) assay to evaluate TERT hot spot mutations in fresh frozen and formalin-fixed paraffin-embedded (FFPE) specimens of glioma and verified the difference in results from the Sanger DNA sequencing results. We obtained the mutant allele fraction for TERT mutations of in a single ddPCR run in all cases, including the micro-dissected FFPE sections. On the contrary, up to twice the DNA sequences were required from fresh frozen tissue to obtain the results, consistent with ddPCR assay. When FFPE specimens were used, more time was required to evaluate TERT mutations through DNA sequencing. DdPCR is an effective and sensitive assay compared to the conventional standard Sanger DNA sequencing.
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Affiliation(s)
- Jun-Ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Eita Uchida
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
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23
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Mizuki S, Horie K, Imabayashi K, Mishima K, Oryoji K. POS0441 DEVELOPMENT OF RHEUMATOID ARTHRITIS AMONG ANTI-CITRULLINATED PROTEIN ANTIBODIES POSITIVE ASYMPTOMATIC INDIVIDUALS: A PROSPECTIVE OBSERVATIONAL STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In the idividuals with genetic and enviromental risk factors, immune events at mucosal surfaces occur and may precede systemic autoimmunity. Anti-citrullinated protein antibodies (ACPA) are present in the serum for an average of 3-5 years prior to the onset of rheumatoid arthritis (RA) during an asymptomatic period. In ACPA-positivite individuals, the additional presence of RA-related risk factors appears to add significant power for the development of RA. To date, there have been few reports in which clinical courses of ACPA-positive asymptomatic individuals were investigated prospectively.Objectives:To observe the clinical time course of ACPA-positive healthy population for the development of RA.Methods:Healthy volunteers without joint pain or stiffness, who attended the comprehensive health screening of our hospital, were enrolled in this prospective observational study. The serum ACPA levels were quantified by Ig-G anti-cyclic citrullinated peptide enzyme-linked immunosorbent assay with levels > 4.4 U/mL considered positive. ACPA-positive subjects were followed by rheumatologists of our department clinically or a questionnaire sent by mail for screening to detect arthritis.Results:5,971 healthy individuals without joint symptons were included. Ninty-two (1.5%) were positive for ACPA. Of these, 19 (20.7%) developed RA and two were suspected as RA by mail questionnaire. Their average age were 58-years, and women were 68%. The average duration between the date of serum sampling and diagnosis was 10.7 months. ACPA-positive individuals who developed to RA had higher serum ACPA and Ig-M rheumatoid factor levels than ACPA-positive individuals who did not (P value by Mann-Whitney U test: 0.002, 0.005, respectively).Conclusion:Among ACPA-positive asymptomatic individuals, 20% developed RA. The higher titer of ACPA and Ig-M rheumatoid factor levels are risk factors for devoloping RA.Disclosure of Interests:None declared
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24
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Ujihara M, Mishima K, Sasaki A, Adach JI, Shirahata M, Suzuki T, Nobusawa S, Nishikawa R. Unique pathological findings of astroblastoma with MN1 alteration in a patient with late recurrence. Brain Tumor Pathol 2021; 38:243-249. [PMID: 33913040 DOI: 10.1007/s10014-021-00401-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
Astroblastoma is an extremely rare brain tumor that has recently attracted attention owing to its association with MN1 gene alteration. However, its long-term clinical course remains unclear. We report a late recurrence of MN1-altered astroblastoma with unique pathological findings. A 24-year-old woman presented with seizures due to a left frontal lobe tumor. Gross total resection (GTR) was achieved, and the diagnosis was MN1-altered astroblastoma, which presented cell wrapping, i.e., presence of tumor cells enveloping one another. She received local radiotherapy (50 Gy). However, the tumor recurred after 12 years, and its size increased rapidly. The second surgery achieved GTR and confirmed increasing anaplasia. The patient was tumor-free for 1 year without any neurological deficits. This case implies the importance of long-term follow-up of MN1-altered astroblastoma. The pathological significance of cell wrapping in this case is unclear, but it may be associated with MN1-altered astroblastoma and should be noted in future cases.
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Affiliation(s)
- Masaki Ujihara
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan.
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Saitama, Japan
| | - Jun-Ichi Adach
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka, Saitama, 350-1298, Japan
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25
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Narita Y, Nagane M, Mishima K, Terui Y, Arakawa Y, Yonezawa H, Asai K, Fukuhara N, Sugiyama K, Shinojima N, Kitagawa J, Aoi A, Nishikawa R. Phase I/II study of tirabrutinib, a second-generation Bruton's tyrosine kinase inhibitor, in relapsed/refractory primary central nervous system lymphoma. Neuro Oncol 2021; 23:122-133. [PMID: 32583848 PMCID: PMC7850159 DOI: 10.1093/neuonc/noaa145] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background The safety, tolerability, efficacy, and pharmacokinetics of tirabrutinib, a second-generation, highly selective oral Bruton’s tyrosine kinase inhibitor, were evaluated for relapsed/refractory primary central nervous system lymphoma (PCNSL). Methods Patients with relapsed/refractory PCNSL, Karnofsky performance status ≥70, and normal end-organ function received tirabrutinib 320 and 480 mg once daily (q.d.) in phase I to evaluate dose-limiting toxicity (DLT) within 28 days using a 3 + 3 dose escalation design and with 480 mg q.d. under fasted conditions in phase II. Results Forty-four patients were enrolled; 20, 7, and 17 received tirabrutinib at 320, 480, and 480 mg under fasted conditions, respectively. No DLTs were observed, and the maximum tolerated dose was not reached at 480 mg. Common grade ≥3 adverse events (AEs) were neutropenia (9.1%), lymphopenia, leukopenia, and erythema multiforme (6.8% each). One patient with 480 mg q.d. had grade 5 AEs (pneumocystis jirovecii pneumonia and interstitial lung disease). Independent review committee assessed overall response rate (ORR) at 64%: 60% with 5 complete responses (CR)/unconfirmed complete responses (CRu) at 320 mg, 100% with 4 CR/CRu at 480 mg, and 53% with 6 CR/CRu at 480 mg under fasted conditions. Median progression-free survival was 2.9 months: 2.1, 11.1, and 5.8 months at 320, 480, and 480 mg under fasted conditions, respectively. Median overall survival was not reached. ORR was similar among patients harboring CARD11, MYD88, and CD79B mutations, and corresponding wild types. Conclusion These data indicate favorable efficacy of tirabrutinib in patients with relapsed/refractory PCNSL. Trial registration JapicCTI-173646.
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Affiliation(s)
- Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhito Terui
- Department of Hematology and Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hajime Yonezawa
- Department of Neurosurgery, Kagoshima University Hospital, Kagoshima, Japan
| | - Katsunori Asai
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kazuhiko Sugiyama
- Department of Medical Oncology, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Shinojima
- Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan
| | | | - Arata Aoi
- Ono Pharmaceutical Co, Ltd, Osaka, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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26
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Shirahata M, Mishima K. [Metastatic Brain Tumors]. Brain Nerve 2021; 73:5-11. [PMID: 33361509 DOI: 10.11477/mf.1416201707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Metastatic brain tumors are malignant lesions that spread to the brain from a primary neoplasm such as cancer or sarcoma located in other body organs. Brain metastases tend to cause deterioration of neurological function and negatively affect patients quality of life. Control of brain metastases is important, following improved outcomes that are being observed in patients with cancer. Recent advances in radiotherapy and drug therapy have led to a paradigm shift in the treatment of metastatic brain tumors. In this article, we review the clinical characterization of metastatic brain tumors that has reached a turning point in oncology.
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Affiliation(s)
- Mitsuaki Shirahata
- Department of Brain and Spinal Cord Tumor, Comprehensive Cancer Center, Saitama Medical University International Medical Center
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27
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Mishima K, Shirahata M, Adachi J, Suzuki T, Uchida E, Nishikawa R. SS-5 Current management of primary central nervous system lymphoma. Neurooncol Adv 2020. [PMCID: PMC7699117 DOI: 10.1093/noajnl/vdaa143.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Primary CNS Lymphomas (PCNSLs) is a highly aggressive malignant tumor with poor prognosis and increasing incidence in elderly patients. High-dose methotrexate (HD-MTX) followed by whole-brain radiation therapy (WBRT) improves survival in PCNSLs. Several HD-MTX–based regimens, in combination with alkylating agents and rituximab, have been developed that can achieve high and durable complete response rates in patients with newly diagnosed PCNSL. In Japan, the R-MPV regimen using rituximab, HD-MTX, procarbazine, and vincristine has been recognized as the standard treatment for initial induction for newly diagnosed PCNSL. The optimal consolidative therapy for patients with disease responsive to induction chemotherapy is not yet defined. WBRT at standard dose (30–45 Gy) has a risk of neurotoxicity. To minimize the effects of delayed neurotoxicity, high-dose chemotherapy supported by autologous stem cell transplantation, reduced dose WBRT (23.4Gy), non-myeloablative chemotherapy, and maintenance chemotherapy have been addressed in large randomized trials. Gene expression profiling has provided insights into the pathogenesis of PCNSL. Recent insight into the pathophysiology of PCNSL has led to the investigation of targeted agents in the treatment of recurrent disease. In March 2020, Tirabrutinib (TIR), a second-generation oral Bruton’s tyrosine kinase inhibitor, was approved for relapsed or refractory PCNSL based on the results of the phase I/II study in Japan. Seventeen of 44 patients treated with TIR at 480 mg fasted QD, an approved dose, had overall response rate of 52.9%, median progression-free survival of 5.8 months, and time to response as short as 0.92 months. The most common adverse event at any grade was rash (32%). The skin-related disorders were manageable with appropriate skin treatments. However, greater attention and management is needed the case of more rare adverse events such as severe skin-related disorders and pneumocystis pneumonia. This lecture aims to present the recent development in treatment for PCNSL.
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Affiliation(s)
- Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama medical University, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama medical University, Saitama, Japan
| | - Junichi Adachi
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama medical University, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama medical University, Saitama, Japan
| | - Eita Uchida
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama medical University, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, International Medical Center, Saitama medical University, Saitama, Japan
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28
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Mishima K, Narita Y, Nagane M, Terui Y, Arakawa Y, Yonezawa H, Asai K, Fukuhara N, Sugiyama K, Shinojima N, Aoi A, Nishikawa R. ML-05 One-year follow-up data of phase I/II study of tirabrutinib in patients with relapsed or refractory primary central nervous system lymphoma. Neurooncol Adv 2020. [PMCID: PMC7699054 DOI: 10.1093/noajnl/vdaa143.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In March 2020, Tirabrutinib (TIR), a second-generation oral Bruton’s tyrosine kinase inhibitor, was approved for the indication of relapsed or refractory PCNSL (r/rPCNSL) based on the results of a phase I/II study in Japan. In this study, 44 Japanese patients with r/rPCNSL were treated with TIR QD at 320 mg, 480 mg, or 480 mg in the fasted condition (480 mg fasted QD). The primary endpoint was overall response rate (ORR) assessed by an independent review committee according to International PCNSL Collaborative Group criteria. We previously reported the results of this study with data cutoff in June 2019 (Narita et al. Neuro Oncol. 2020). In the report, 17 of 44 patients were treated with TIR at 480 mg fasted QD which is an approved dose, and had ORR of 52.9%, median progression-free survival of 5.8 months, and median overall survival of not reached (median follow-up: 3.8 months). In 44 patients, ORR was similar among patients harboring either of the oncogenic mutants CARD11, MYD88, CD79B, or wild type. Throughout the whole patients, most common adverse events (AEs) at any grade were rash (31.8%), neutropenia (22.7%), leukopenia (18.2%), and lymphopenia (15.9%), and grade ≥3 AEs were neutropenia (9.1%), lymphopenia, leukopenia, and erythema multiforme (6.8% each). One patient with 480 mg QD had grade 5 AEs (pneumocystis jirovecii pneumonia and interstitial lung disease). We will present one-year follow-up data of this study at the meeting. As of data cutoff (February 2020), 11 of 44 patients continued to receive TIR, including 6 patients with 480 mg fasted QD. Updated data for overall survival, duration of response, and time to onset of AEs will also be presented. TIR is a promising new treatment for r/rPCNSL.
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Affiliation(s)
- Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshitaka Narita
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Motoo Nagane
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yasuhito Terui
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshiki Arakawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hajime Yonezawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Katsunori Asai
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Noriko Fukuhara
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhiko Sugiyama
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Naoki Shinojima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Arata Aoi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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Aoki T, Narita Y, Mishima K, Matsutani M. Current Status of Palliative and Terminal Care for Patients with Primary Malignant Brain Tumors in Japan. Neurol Med Chir (Tokyo) 2020; 60:600-611. [PMID: 33162468 PMCID: PMC7803700 DOI: 10.2176/nmc.oa.2020-0243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Palliative care and advance care planning (ACP) from the first diagnosis of glioblastoma are important. This questionnaire survey was conducted to understand the current status of palliative care for brain tumors in Japan. Representative characteristics of Japan in comparison with Western countries (P <0.01) are described below: (1) Gender ratio of male in physicians who treat brain tumors in Europe and the United States/Canada are about 70%, but 94% in Japan. (2) The specialty is predominantly neurosurgeon (93%) in Japan. The ratio of neurologists is predominantly 40% in Europe. In the United States/Canada, neurologist (27%) and neurosurgeon (29%) are main parts. (3) Years of medical experience over 15 in physicians is 73% in Japan. Proportions of those with over 15 years are 45% in Europe and 30% in the United States/Canada. (4) In practicing setting, the rate of academic medical centers is about 80% in Europe and the United States/Canada, and ~60% in Japan. Representative differences compared with past domestic data (2007) (P <0.01): (1) In glioblastoma, the rate of explaining about median survival time increases from 39% (2007) to 80% (2018). Explanation about medical conditions to the patient himself with his family increases from 20% (2007) to 39% (2018). (2) Place of death: The rate at hospital is decreasing from 96% (2007) to 79% (2018) and at home is increasing from 3% (2007) to 10% (2018) (3) The rate of ventilator in adult has decreased from 74% (2007) to 54% (2018), but nasal tube feeding has remained unchanged from 62% (2007) to 60% (2018). These results will be shared with physicians to make better care systems for patients with brain tumors.
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Affiliation(s)
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital
| | - Kazuhiko Mishima
- Department of Neurosurgery and Neuro-Oncology, Saitama Medical University, International Medical Center
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Kobayashi Y, Mishima K, Adachi JI, Suzuki T, Sasaki A, Nishikawa R. [Glioblastoma Mimicking Meningioma Recurrence: A Case Report]. Brain Nerve 2020; 72:1105-1111. [PMID: 33051400 DOI: 10.11477/mf.1416201657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Meningioma and glioma represent two common primary intracranial tumors. However, the coexistence of these two lesions in the same patient at the same location is rare. Here, we present a case of a fibroblastic meningioma with a secondary glioblastoma occurring at the same location. A 67-year-old woman underwent surgery for a left frontal parasagittal meningioma, and the tumor was subtotally removed. Two years and 11 months after the surgery, the patient had a tumor at the same location with invasion into the adjacent brain, suggesting recurrent meningioma with malignant transformation. The resected tumor was confirmed histopathologically as a glioblastoma. Genetic analysis revealed that the isocitrate dehydrogenase 1 and 2 genes were wild type, and the TERT promoter mutation was detected. The gene analysis suggests that the tumor was a de novo glioblastoma, not a secondary glioblastoma from a lower-grade glioma. (Received April 9, 2020; Accepted May 27, 2020; Published October 1, 2020).
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Affiliation(s)
- Yusuke Kobayashi
- Department of Neuro-Oncology, Saitama Medical University International Medical Center
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Imanishi A, Kawazoe T, Hamada Y, Kumagai T, Tsutsui K, Sakai N, Eto K, Noguchi A, Shimizu T, Takahashi T, Han G, Mishima K, Kanbayashi T, Kondo H. Early detection of Niemann-pick disease type C with cataplexy and orexin levels: continuous observation with and without Miglustat. Orphanet J Rare Dis 2020; 15:269. [PMID: 32993765 PMCID: PMC7523321 DOI: 10.1186/s13023-020-01531-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/07/2020] [Indexed: 12/30/2022] Open
Abstract
Study objectives Niemann-Pick type C (NPC) is an autosomal recessive and congenital neurological disorder characterized by the accumulation of cholesterol and glycosphingolipids. Symptoms include hepatosplenomegaly, vertical supranuclear saccadic palsy, ataxia, dystonia, and dementia. Some cases frequently display narcolepsy-like symptoms, including cataplexy which was reported in 26% of all NPC patients and was more often recorded among late-infantile onset (50%) and juvenile onset (38%) patients. In this current study, we examined CSF orexin levels in the 10 patients of NPC with and without cataplexy, which supports previous findings. Methods Ten patients with NPC were included in the study (5 males and 5 females). NPC diagnosis was biochemically confirmed in all 10 patients, from which 8 patients with NPC1 gene were identified. We compared CSF orexin levels among NPC, narcoleptic and idiopathic hypersomnia patients. Results Six NPC patients with cataplexy had low or intermediate orexin levels. In 4 cases without cataplexy, their orexin levels were normal. In 5 cases with Miglustat treatment, their symptoms stabilized or improved. For cases without Miglustat treatment, their conditions worsened generally. The CSF orexin levels of NPC patients were significantly higher than those of patients with narcolepsy-cataplexy and lower than those of patients with idiopathic hypersomnia, which was considered as the control group with normal CSF orexin levels. Discussion Our study indicates that orexin level measurements can be an early alert of potential NPC. Low or intermediate orexin levels could further decrease due to reduction in the neuronal function in the orexin system, accelerating the patients’ NPC pathophysiology. However with Miglustat treatment, the orexin levels stabilized or improved, along with other general symptoms. Although the circuitry is unclear, this supports that orexin system is indeed involved in narcolepsy-cataplexy in NPC patients. Conclusion The NPC patients with cataplexy had low or intermediate orexin levels. In the cases without cataplexy, their orexin levels were normal. Our study suggests that orexin measurements can serve as an early alert for potential NPC; furthermore, they could be a marker of therapy monitoring during a treatment.
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Affiliation(s)
- A Imanishi
- Department of Psychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - T Kawazoe
- Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Y Hamada
- Department of Pediatrics, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - T Kumagai
- National Center for Child Health and Development, Tokyo, Japan
| | - K Tsutsui
- Department of Psychiatry, Akita University Graduate School of Medicine, Akita, Japan
| | - N Sakai
- Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - K Eto
- Department of Pediatrics, Tokyo Women's Medical University, Tokyo, Japan
| | - A Noguchi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - T Shimizu
- Akita Mental Health and Welfare Center, Akita, Japan
| | - T Takahashi
- Department of Pediatrics, Akita University Graduate School of Medicine, Akita, Japan
| | - G Han
- International Institute for Integrative Sleep Medicine (IIIS), University of Tsukuba, Tsukuba, 305-8575, Japan
| | - K Mishima
- Department of Psychiatry, Akita University Graduate School of Medicine, Akita, Japan.,International Institute for Integrative Sleep Medicine (IIIS), University of Tsukuba, Tsukuba, 305-8575, Japan
| | - T Kanbayashi
- International Institute for Integrative Sleep Medicine (IIIS), University of Tsukuba, Tsukuba, 305-8575, Japan.
| | - H Kondo
- International Institute for Integrative Sleep Medicine (IIIS), University of Tsukuba, Tsukuba, 305-8575, Japan
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Mizuki S, Kai T, Mishima K, Ikeuchi H, Oryoji K. AB0904 PERSISTENCE AND REASONS FOR DISCONTINUATION OF DENOSUMAB IN PATIENTS WITH RHEUMATOID ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Denosumab, a fully human monoclonal antibody to receptor activator of nuclear factor kappa B ligand, which inhibits osteoclast differentiation, activation and survival, not only increases bone mineral density but also inhibits the progression of bone erosion in patients with rheumatoid arthritis (RA)1-3). Therefore, denosumab have been preferably prescribed for patients with RA recently. The persistence with denosumab, which is administered subcutaneously once every 6 months, was reported higher than with oral bisphosphonates4), and in the prospective cohort studies, the persistence rate for one year was reported to be 82-95%5-6). However, there have been no report about the persistence in patients with RA treated with denosumab, moreover the reasons for discontinuation of denosumab.Objectives:The aims of this single center retrospective cohort study were 1) to assess the persistence with denosumab in a routine clinical setting and 2) to identify the reasons of discontinuation in patients with RA. And we also reviewed the clinical outcomes of osteonecrosis of the jaw in patients with RA during denosumab treatment.Methods:The present study is based on databases from our hospital, which include age, gender, date of injection of denosumab, as well as information on patients’ characteristics. Patients were included in this study when denosumab were newly started at our department during the period from June 1, 2013 and September 30, 2017. In this study, persistence was defined as patients with an interval between injections of no longer than 6 months plus 8 weeks. Patients were followed until censoring (death, transferring to another hospital) or the end of the study (August 3, 2018).We investigated reasons for the discontinuation of denosumab. Major reasons for the discontinuation of denosumab were classified as adverse event, anxiety over adverse events, patient’s transfer or request, doctor’s careless lack of refilling an injection, and other reason.We identified patients who had been diagnosed as osteonecrosis of the jaw, and demographic, pharmacological, and clinical data were collected from medical records.Results:One hundred and seventy-five patients were identified. Kaplan–Meier analysis showed a slow decline of persistence after initiating denosumab therapy, dropping to 80.4 and 61.9 % after 1 and 2 years of follow-up. When analyzing the reason of discontinuation as adverse events, the persistence rate of denosumab was at 89.4, and 79.4% at 1, and 2 years of follow-up, respectively.During 2-year period, 72 patients discontinued denosumab. A total of 27 adverse events occurred, of which five events were osteonecrosis of the jaw. The other reasons for adverse event included death in four, fracture in three, and so on. Six patients discontinued due to anxiety over dental adverse event. Thirteen patients were in doctor’s careless lack of refilling an injectionAll five patients who were diagnosed as osteonecrosis of the jaw had received the treatment with prednisolone, and four were treated with biologic drugs. All patients stopped denosumab and switched to other drugs including teriparatide. All patients underwent surgical curettages of necrotic bone and cured.Conclusion:Persistence of denosumab in patients with RA is comparable to that in postmenopausal women with osteoporosis. Dental screening and care should be important to continue denosumab treatment.References:[1]Cohen SB.Arthritis Rheum. 2008;58:1299–1309.[2]Takeuchi T.Ann Rheum Dis. 2019;78:899–907.[3]Ebina K.Osteoporos Int. 2018;29:1627–1636.[4]Hadji P.Osteoporos Int. 2016;27:2967–2978.[5]Silverman SL.Arch Osteoporos. 2018;13:85. doi:10.1007/s11657-018-0491-z[6]Hadji P.Osteoporos Int. 2015;26:2479–2489.Disclosure of Interests:Shinichi Mizuki Speakers bureau: AbbVie, Asahi Kasei, Chugai, Eli Lilly, Janssen, Mitsubishi Tanabe, Ono, Tatsuya Kai: None declared, Koji Mishima: None declared, Hiroko Ikeuchi: None declared, Kensuke Oryoji: None declared
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Imanishi A, Yoshizawa K, Tsutsui K, Omori Y, Ono T, Ito Uemura S, Mishima K, Kondo H, Kanbayashi T. 0757 Increasing Number of Cases Who Had Both Hypersomnolence Disorders and Developmental Disorders With Orexin Measurements. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Recently, attention has been paid to the relationship between developmental disorders such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), and sleep disorders. We meet many developmental disorder patients who complaint hypersomnolence. Among these patients, cases with coexistence of central hypersomnia and developmental disorders, or developmental disorder alone were increased. Therefore, we first investigated patients with the complaint of hypersomnolence, who were also suspected developmental disorders. Furthermore, we have been measuring CSF orexin in 17 cases suspected of both disorders to investigate orexin levels of these patients.
Methods
86patients who complained of EDS with suspicion of developmental disorders had been examined. In order to diagnose hypersomnolence disorders, PSG and MSLT were performed. Psychological examinations were performed for diagnosing developmental disorders.We have been measuring for CSF orexin in 17 cases suspected both hypersomnolence and developmental disorders. We examined the onset of hypersomnolence and the clinical history of these ADHD or ASD cases for more details.
Results
In 86 examined cases, developmental disorders coexisted in 30 cases. Among 30 cases, ADHD were 18, ASD were 6 and both diagnosed were 6 cases. Among them, 20 cases diagnosed as having coexistence of hypersomnia (8: narcolepsy, 12: IHS) and developmental disorders (ADHD:12, ASD:4, ADHD/ASD:4). In 17 cases with orexin measurements, 10 cases coexisted ADHD and 4 cases coexisted ASD. Two cases diagnosed as both ADHD and ASD. In 10 ADHD cases, 3 cases had low orexin levels, and 7 cases had normal orexin levels. Other 7 ASD cases had normal orexin levels.
Conclusion
ADHD has a higher rate of central hypersomnia (12/18) compared with ASD and the rate of narcolepsy was also high (5/12). While patients in ASD was diagnosed as IHS (3/6), narcolepsy cases were not observed. It became clear that the majority of patients had developmental disorder or had a tendency for developmental disorder before the onset of hypersomnolence.Although it is possible that ADHD/ASD symptoms may be exacerbated by orexin dysfunctions, ADHD/ASD may not newly occur. There were cases with low orexin levels, but it seems that narcolepsy happened to coexist with developmental disorders.
Support
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Affiliation(s)
- A Imanishi
- Akita University School of Medicine, Akita, JAPAN
| | - K Yoshizawa
- Akita University School of Medicine, Akita, JAPAN
| | - K Tsutsui
- Akita University School of Medicine, Akita, JAPAN
| | - Y Omori
- Tokyo Metropolitan Geriatric Hospital, Tokyo, JAPAN
| | - T Ono
- Sleep & Circadian Neurobiology Laboratory, Stanford University,, California, CA
| | - S Ito Uemura
- Akita University Graduate School of Health Sciences, Akita, JAPAN
| | - K Mishima
- Akita University School of Medicine, Akita, JAPAN
| | - H Kondo
- International Institute for Integrative Sleep Medicine (IIIS), Tsukuba University,, Tsukuba, JAPAN
| | - T Kanbayashi
- International Institute for Integrative Sleep Medicine (IIIS), Tsukuba University,, Tsukuba, JAPAN
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Mishima K, Nishikawa R, Narita Y, Mizusawa J, Sumi M, Kinoshita M, Nagane M, Arakawa Y, Yoshimoto K, Shibahara I, Shinojima N, Asano K, Tsurubuchi T, Sasaki H, Asai A, Sasayama T, Momii Y, Sasaki A, Katayama H, Fukuda H. Randomized phase III study of high-dose methotrexate and whole brain radiotherapy with or without concomitant and adjuvant temozolomide in patients with newly diagnosed primary central nervous system lymphoma: JCOG1114C. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.2500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2500 Background: Temozolomide (TMZ) is an oral alkylating agent that penetrates the blood-brain barrier with moderate toxicity, and has shown anti-tumor activity in primary central nervous system lymphoma (PCNSL) in single arm studies. Our goal was to determine whether the addition of concomitant and adjuvant TMZ chemotherapy to standard treatment of high-dose methotrexate (HD-MTX) and whole brain radiotherapy (WBRT) for PCNSL improves survival in a randomized controlled trial. Methods: We did an open-label, randomized phase III trial at 30 hospitals in Japan enrolling immunocompetent patients (pts) aged 20-70 years with histologically confirmed newly diagnosed PCNSL. Pts enrolled at step 1 registration received HD-MTX (MTX; 3.5 g/m2 at day 1, 15, 29). Pts who received at least 1 cycle of HD-MTX were randomly assigned (1:1) at step 2 registration to receive WBRT (30 Gy) ± 10 Gy boost (control arm: A) or WBRT ± boost with concomitant TMZ (75 mg/m2 daily) and adjuvant TMZ (150-200 mg/m2 daily for 5 days every 28 days) for two years after initiation of HD-MTX or until tumor progression (experimental arm: B). Randomization was adjusted by institution, PS (0-1 / 2-3), age (≤60/≥61 years), presence or absence of intraparenchymal tumor after HD-MTX. The primary endpoint was overall survival (OS). The planned sample size was 130 pts in total, to provide an 80% power to detect a 0.52 hazard ratio (65% vs 80% in 2y-OS) for arm B to A and a one-sided alpha of 5%. Results: Between September 29, 2014 and October 15, 2018, 134 pts were enrolled, of whom 122 were randomly assigned and analyzed; 62 to arm A and 60 to arm B. At the planned interim analysis, the 2-y OS was 86.8% (95% CI: 72.5-94.0) in arm A and 71.4% (56.0-82.2) in arm B. The hazard ratio was 2.18 (95% CI: 0.95 to 4.98) with predictive probability for showing the superiority of arm B at the final analysis was calculated to be 1.3%. The study was terminated due to futility. The 2-y progression-free survival was 60.6% (43.6-73.8) in arm A and 49.9% (34.4-63.5) in arm B with a hazard ratio of 1.54 (0.88 to 2.70). The most common grade 3 and 4 toxicities were lymphopenia, observed in 7 (11.5%) pts during WBRT in arm A, 18 (30%) pts during WBRT + concomitant TMZ and 18 (37.5%) pts during adjuvant TMZ in arm B. Conclusions: This study failed to demonstrate the benefit of the addition of TMZ to WBRT and adjuvant TMZ in newly diagnosed PCNSL. Possible biomarkers including methylation status of the MGMT promoter in the tumors will be analyzed. Clinical trial information: jRCTs031180207 .
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Affiliation(s)
- Kazuhiko Mishima
- Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | | | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Minako Sumi
- Radiation Oncology Department, Cancer Institute Hospital, Japanese Foundation For Cancer Research, Tokyo, Japan
| | - Manabu Kinoshita
- Department of Neurosurgery, Osaka International Cancer Institute, Osaka, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, Kanagawa, Japan
| | | | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba,, Ibaraki, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University Hospital, Tokyo, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasutomo Momii
- Department of Neurosurgery, Oita University, Oita, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Saitama, Japan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
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Natsume A, Aoki K, Ohka F, Maeda S, Hirano M, Adilijiang A, Motomura K, Sumi M, Nishikawa R, Narita Y, Muragaki Y, Maruyama T, Ito T, Beppu T, Nakamura H, Kayama T, Sato S, Nagane M, Mishima K, Nakasu Y, Kurisu K, Yamasaki F, Sugiyama K, Onishi T, Iwadate Y, Terasaki M, Kobayashi H, Matsumura A, Ishikawa E, Sasaki H, Mukasa A, Matsuo T, Hirano H, Kumabe T, Shinoura N, Hashimoto N, Aoki T, Asai A, Abe T, Yoshino A, Arakawa Y, Asano K, Yoshimoto K, Shibui S, Okuno Y, Wakabayashi T. Genetic analysis in patients with newly diagnosed glioblastomas treated with interferon-beta plus temozolomide in comparison with temozolomide alone. J Neurooncol 2020; 148:17-27. [PMID: 32367437 DOI: 10.1007/s11060-020-03505-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/17/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE This study aimed to explore the genetic alterations and to identify good responders in the experimental arm in the tumor samples from newly diagnosed glioblastoma (GBM) patients enrolled in JCOG0911; a randomized phase II trial was conducted to compare the efficacy of interferonβ (IFNβ) plus temozolomide (TMZ) with that of TMZ alone. EXPERIMENTAL DESIGN: Of 122 tumors, we performed deep targeted sequencing to determine the somatic mutations, copy number variations, and tumor mutation burden; pyrosequencing for O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation; Sanger sequencing for the telomerase reverse transcriptase (TERT) promoter; and microsatellite instability (MSI) testing in 95, 91, 91 and 72 tumors, respectively. We performed a multivariable Cox regression analysis using backward stepwise selection of variables including clinical factors (sex, age, performance status, residual tumor after resection, tumor location) and genetic alterations. RESULTS Deep sequencing detected an IDH1 mutation in 13 tumors (14%). The MGMT promoter methylation by quantitative pyrosequencing was observed in 41% of the tumors. A mutation in the TERT promoter was observed in 69% of the tumors. While high tumor mutation burden (> 10 mutations per megabase) was seen in four tumors, none of the tumors displayed MSI-high. The clinical and genetic factors considered as independent favorable prognostic factors were gross total resection (hazard ratio [HR]: 0.49, 95% confidence interval, 0.30-0.81, P = 0.0049) and MGMT promoter methylation (HR: 0.43, 0.21-0.88, P = 0.023). However, tumor location at the temporal lobe (HR: 1.90, 1.22-2.95, P = 0.0046) was an independent unfavorable prognostic factor. No predictive factors specific to the TMZ + IFNβ + Radiotherapy (RT) group were found. CONCLUSION This additional sub-analytical study of JCOG0911 among patients with newly diagnosed GBM showed that tumor location at the temporal lobe, gross total resection, and MGMT promoter methylation were significant prognostic factors, although no factors specific to IFNβ addition were identified.
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Affiliation(s)
- Atsushi Natsume
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kosuke Aoki
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumiharu Ohka
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sachi Maeda
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Hirano
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Alimu Adilijiang
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuya Motomura
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Minako Sumi
- Radiation Oncology Department, Cancer Institute Hospital, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoshitaka Narita
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tamio Ito
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Takaaki Beppu
- Department of Neurosurgery, Iwate Medical University, Iwate, Japan
| | - Hideo Nakamura
- Department of Neurosurgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Takamasa Kayama
- Department of Neurosurgery, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Shinya Sato
- Department of Neurosurgery, Yamagata University Graduate School of Medicine, Yamagata, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Yoko Nakasu
- Department of Neurosurgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-Oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Takanori Onishi
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Mizuhiko Terasaki
- Department of Neurosurgery, Kurume University Graduate School of Medicine, Kurume, Japan
| | - Hiroyuki Kobayashi
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akira Matsumura
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hikaru Sasaki
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Akitake Mukasa
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takayuki Matsuo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirofumi Hirano
- Department of Neurosurgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobusada Shinoura
- Department of Neurosurgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan
| | - Naoya Hashimoto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomokazu Aoki
- Department of Neurosurgery, Kitano Hospital, Osaka, Japan
| | - Akio Asai
- Department of Neurosurgery, Kansai Medical University, Osaka, Japan
| | - Tatsuya Abe
- Department of Neurosurgery, Faculty of Medicine, Oita University, Oita, Japan
| | - Atsuo Yoshino
- Department of Neurological Surgery, Nihon University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiki Arakawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenichiro Asano
- Department of Neurosurgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koji Yoshimoto
- Department of Neurosurgery, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan
| | - Soichiro Shibui
- Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Okuno
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Toshihiko Wakabayashi
- Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Suzuki T, Mizuno R, Uchida E, Shirahata M, Adachi J, Mishima K, Fujimaki T, Yanagisawa T, Nishikawa R. PEDT-06 THERAPEUTIC STRATEGY FOR DISSEMINATED PILOCYTIC ASTROCYTOMAS. Neurooncol Adv 2019. [PMCID: PMC7213113 DOI: 10.1093/noajnl/vdz039.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pilocytic astrocytoma is one of the common tumors found during childhood. However, the clinical course of disseminated pilocytic astrocytoma is not clearly known. Here, we present two cases with disseminated pilocytic astrocytoma and discuss the treatment strategy. Patients We treated a 7-year-old female (case 1) and 9-year-old male (case 2) with hypothalamic pilocytic astrocytomas. The results of magnetic resonance imaging showed diffuse spinal dissemination at diagnosis. Chemotherapy with vincristine and carboplatin was administered as the firstline therapy. The tumors showed some shrinkage, and symptoms improved. During chemotherapy, the patients developed allergies to carboplatin. Therefore, we changed the chemotherapy treatment to vincristine. Other adverse events were not observed. In Case 1, we observed an intratumoral hemorrhage and hydrocephalus due to occlusion of the foramen Monro. Endoscopic surgery was performed, and no clinical deficit was observed. Case 2 underwent ventricular peritoneal shunt procedure for communicating hydrocephalus and a reoperation for shunt malfunction because of dense cerebrospinal fluid with elevated protein levels. The patients have not undergone radiotherapy until now. They had no severe clinical symptoms and went to school for 5 and 10 years, respectively, after the diagnoses. CONCLUSION Chemotherapy for disseminated pilocytic astrocytoma is effective and may help in avoiding radiotherapy. Chemotherapy should be administered before radiotherapy, considering long-term complications.
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Affiliation(s)
- Tomonari Suzuki
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Rena Mizuno
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Eita Uchida
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Mitsuaki Shirahata
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Junichi Adachi
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhiko Mishima
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takamitsu Fujimaki
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Takaaki Yanagisawa
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Ryo Nishikawa
- Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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Adachi J, Shirahata M, Suzuki T, Mishima K, Fujimaki T, Nishikawa R. GEN-06 CLINICAL COURSE AFTER TUMOR RECURRENCE OF MGMT HYPERMETHYLATED GLIOBLASTOMA. Neurooncol Adv 2019. [PMCID: PMC7213324 DOI: 10.1093/noajnl/vdz039.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
MGMT methylation in glioblastoma is a biomarker for determining treatment responsiveness and predicting prognosis. We analyzed whether there were differences in the prognosis between glioblastoma with MGMT hypermethylation and other glioblastomas after tumor recurrence. We enrolled 184 patients who underwent radiation therapy and temozolomide chemotherapy after tumor resection for newly diagnosed glioblastoma. MGMT methylation was quantitatively analyzed using methylation-specific high resolution melting analysis. The cut-off value for MGMT methylation had a difference of 35% from the previous values. The subjects were split into three groups according to their MGMT methylation levels, 122 in the low (L) methylation group (levels of 0–34%), 40 in the medium (M) methylation group (levels of 35–69%), and 22 in the high (H) methylation group (levels of 70% or more). We mainly focused on and compared the progression after recurrence. The progression-free survival (PFS) rate and overall survival (OS) rate were significantly longer in the M and H groups than in the L group. There was no difference in PFS between group M and group H, but OS was significantly longer in group H. The details of treatment for the 16 of 22 patients who had recurrences in group H are as follows: temozolomide, n = 1; bevacizumab, n = 8; investigational drugs (peptide vaccines and immune checkpoint inhibitors), n = 3; and supportive care, n = 4. The median survival rate for these 16 patients after recurrence was 18 months. Even patients who received only supportive care had a median survival time ranging between 9 and 17 months. Our results indicate that MGMT hypermethylation in glioblastoma is effective to a certain degree with other treatments even after recurrence. Even patients who underwent only supportive care survived for a relatively longer period of time. Biologically, MGMT hypermethylation may be associated with a moderately slow-growing tumor.
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Affiliation(s)
- Junichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Takamitsu Fujimaki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Yanagisawa T, Honda T, Yamaoka M, Akiyama M, Fukuoka K, Suzuki T, Adachi J, Mishima K, Nishikawa R, Masumoto A, Nonaka Y, Takei J, Mori R, Ishi Y, Akasaki Y, Murayama Y. PEDT-02 DIAGNOSIS, TREATMENT AND CLINICAL OUTCOME OF ATYPICAL BRAINSTEM TUMOUR IN CHILDHOOD. Neurooncol Adv 2019. [PMCID: PMC7213449 DOI: 10.1093/noajnl/vdz039.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Brainstem tumours account for 10–15% of brain tumors in childhood. Diffuse intrinsic pontine glioma (DIPG) accounts for 60–80% of them and are diagnosed based on clinical findings and radiologic features. All the rest of tumours excluding DIPG are very rare, heterogeneous group of tumours including low-grade glioma and malignant embryonal tumors. It is often difficult to diagnose and decide treatment strategy for their rarity. METHODS To present our experience with atypical brainstem tumours, a retrospective chart review was conducted to identify eligible cases treated over a ten-year period. All tumors involving brainstem, felt not to be DIPGs for absence of clinical/neuroimaging features were included. Demographic information, pathological findings, neuroimaging characteristics, surgical and nonsurgical management plans, and survival data were collected for analysis. RESULTS Between April 2007 and March 2017, 16 patients (14 initial and 2 recurrent) aged from 3 to 20 years were identified. 14 of them were symptomatic and 4 of them were asymptomatic at reference. Of 10 symptomatic cases, 10 were biopsied and pathological diagnosis was low-grade glioma in 8, glioblastoma in 2 cases. They had treatment depending on the pathological diagnosis. Of 4 asymptomatic cases, one with small focal tumour, with no findings suggesting malignant tumour with 11C-methioninePET or MRS, progressed to show typical clinical and image findings of DIPG in a year. For other three, they remain asymptomatic without progression with no treatment for 25months, 60months, and 65 months respectively. Malignant transformation was observed in one with biopsy-conformed oligoastrocytoma with no K27M-H3 mutations treated with chemotherapy and another with pilocytic astrocytoma treated with chemotherapy and radiotherapy. CONCLUSIONS Though molecular findings such as K27M-H3 mutations can predict clinical outcome in some cases, it still remains difficult to diagnose and find treatment strategy of atypical brainstem tumours. The need and usefulness of nationwide registry study is warranted.
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Affiliation(s)
- Takaaki Yanagisawa
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takaya Honda
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masatada Yamaoka
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masaharu Akiyama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kohei Fukuoka
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Tomonari Suzuki
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Junichi Adachi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiko Mishima
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Ryo Nishikawa
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Ai Masumoto
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichiro Nonaka
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Jun Takei
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Ryosuke Mori
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yudo Ishi
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yasuharu Akasaki
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan
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Mishima K, Shirahata M, Adachi JI, Suzuki T, Fujimaki T, Nishikawa R. ML-08 THE ROLE OF MAINTENANCE HIGH-DOSE METHOTREXATE CHEMOTHERAPY IN ELDERLY PRIMARY CNS LYMPHOMA PATIENTS. Neurooncol Adv 2019. [PMCID: PMC7213299 DOI: 10.1093/noajnl/vdz039.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The addition of high-dose methotrexate (HD-MTX)-based chemotherapy to whole brain irradiation (WBRT) has improved the prognosis of primary central nervous system lymphoma (PCNSL). However, the high neurotoxicity rates observed, especially in the elderly, raised interest in chemotherapy-only treatments. Withholding radiotherapy substantially decreases the risk of neurotoxicity, however, disease control may be compromised. In the elderly who cannot tolerate WBRT as a consolidation, maintenance treatment may serve as a feasible approach after an initial response. We treated ePCNSL with induction immunochemotherapy, maintenance chemotherapy with HD-MTX and deferred WBRT. Here, we retrospectively investigated the prognosis for ePCNSL that became CR after the induction chemotherapy.
MATERIAL AND METHODS
Newly diagnosed ePCNSL (median age: 74 years) received biweekly rituximab/HD-MTX for 6 cycles (induction) followed by monthly rituximab/HD-MTX for 2 cycles (consolidation) and then were treated differently according to the radiological response. With CR patients, HD-MTX was continued with every 3 months (maintenance) for 2 years. Patients who did not obtain consent for maintenance therapy were followed up. For PD patients, immunochemotherapy was interrupted and WBRT initiated immediately. Patients with PR and SD were treated with alternative chemotherapy with temozolomide and/or stereotactic radiotherapy or WBRT.
RESULTS
The median PFS was 24.6 months and median OS was 27 months for the entire cohort. Of the 42 ePCNSL, 26 had CR after induction and consolidation, of which 18 cases were carried out maintenance (M+) and 8 cases were followed up (M-). Median PFS was 73 months in the M+ group and 24.5 months in the M- group. Median OS is 102.2months versus 27.6 months, respectively. Both mPFS (P= 0.0125) and mOS (P =0.0015) were significantly prolonged by maintenance therapy.
CONCLUSION
It was suggested that maintenance treatment with HD-MTX may improve the prognosis for ePCNSL that reached complete response after induction therapy.
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Affiliation(s)
- Kazuhiko Mishima
- Departemnt of Neuro-Oncology/Neurosurgery, Saitama Medical University, Saitama, Japan
| | - Mitsuaki Shirahata
- Departemnt of Neuro-Oncology/Neurosurgery, Saitama Medical University, Saitama, Japan
| | - Jun-Ichi Adachi
- Departemnt of Neuro-Oncology/Neurosurgery, Saitama Medical University, Saitama, Japan
| | - Tomonari Suzuki
- Departemnt of Neuro-Oncology/Neurosurgery, Saitama Medical University, Saitama, Japan
| | - Takamitsu Fujimaki
- Departemnt of Neuro-Oncology/Neurosurgery, Saitama Medical University, Saitama, Japan
| | - Ryo Nishikawa
- Departemnt of Neuro-Oncology/Neurosurgery, Saitama Medical University, Saitama, Japan
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Aoki T, Narita Y, Mishima K, Matsutani M. NQPC-01 CURRENT STATUS AND PROBLEMS OF ADVANCE CARE PLANNING AND PALLIATIVE CARE FOR MALIGNANT BRAIN TUMOR. Neurooncol Adv 2019. [PMCID: PMC7213407 DOI: 10.1093/noajnl/vdz039.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Purpose Genomic medicine is in progress, but the median survival of glioblastoma is 14–16 months. It seems to have the same life prognosis as stage 4 like unresectable pancreatic cancer, lung cancer and colon cancer. Palliative care including Advance care planning (ACP) at first diagnosis of glioblastoma is important We conducted a questionnaire survey to understand the current status of Japanese oncologists. Method In July 2018, a questionnaire of 37 items was sent by e-mail to 767 members of Japanese Society of Neuro Oncology, and in August replies were received from 154 persons (20%). The same 22-item questionnaire in 2012–2013 was compared internationally with a report (Walbert T., et al., 2015) by Society of NeuroOncology and the European Association of NeuroOncology. In addition, we compared domestically with a 30-item questionnaire (Narita et al. 2009) in 2007. The Nonparametric Mann-Whitney’s U test was mainly used. Result 1 Characteristics of Japan in comparison with Western countries(p<0.01): 1. The number of doctors in charge is overwhelmingly male. 2. The specialty is predominantly neurosurgeons. 3. Aging of NeuroOncologists. 4, medical treatment place: the proportion of university is low. 5, frequent regular examination of the patient. Result 2Changes compared with domestic(Japan) data 11 years ago(p<0.01): 1 Explaining the condition in more detail. 2. Explaining to not only the family but also the patient. 3. Continuing chemotherapy more aggressively. 4. The place of death: decreasing at hospitals and increasing at home. 5, Frequency with a respirator decreased. 6, About 70% at the end of the period, nasal injection and gastrostomy are applied. Conclusion In the treatment of malignant brain tumors in Japan, a male neurosurgeon who has over 15 years of experience actively continues chemotherapy and appears to see it with nasal injection.
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Affiliation(s)
- Tomokazu Aoki
- Department of Neurosurgery, Kyoto Medical Center, Kyoto, Japan
| | | | | | - Masao Matsutani
- Department of Neurosurgery, Kyoto Medical Center, Kyoto, Japan
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Takaesu Y, Utsumi T, Okajima I, Shimura A, Kotorii N, Kuriyama K, Yamashita H, Suzuki M, Watanabe N, Mishima K. Psychosocial intervention for discontinuing benzodiazepine hypnotics in patients with chronic insomnia: a systematic review and meta-analysis. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Adachi JI, Shirahata M, Suzuki T, Mishima K, Nishikawa R. PATH-01. MGMT METHYLATION CUTOFF VALUE IN QUANTITATIVE ANALYSIS RELATED TO PROGNOSIS OF NEWLY DIAGNOSED GLIOBLASTOMA. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
MGMT promoter methylation is an important biomarker related to glioblastoma therapeutic response and prognosis. There are qualitative and quantitative methods as assays for MGMT methylation. Although the qualitative method is common, there is a disadvantage that low or high methylation cannot be distinguished. The quantitative method is an excellent method for evaluating methylation of tumors characterized by intratumoral heterogeneity like malignant glioma, but cutoff value of methylation that defines the prognosis of glioblastoma is unknown. Therefore, we examined the cutoff value of quantitative MGMT methylation assay determining the prognosis in glioblastoma.
METHODS
180 newly diagnosed glioblastoma which underwent radiotherapy and temozolomide treatment after tumor removal in our department were included. MGMT methylation was quantitatively analyzed by methylation-specific high resolution melting (MS-HRM) analysis. For each level of methylation, progression-free survival (PFS) and overall survival (OS) were calculated and statistically analyzed.
RESULTS
In the low MGMT methylation cases in which the proportion of methylation was 25% or less in PFS and 30% or less in OS, no difference was observed in PFS and OS as compared with those of unmethylated cases. The cutoff value of MGMT methylation most contributing to survival was calculated to be 35% by the survival classification and regression tree method.
CONCLUSION
The prognosis for MGMT hypomethylated group is as poor as unmethylated one. In the quantitative MS-HRM method, we found that the value of MGMT methylation of 35% is useful as a cut off determining the prognosis of glioblastoma.
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Affiliation(s)
- Jun-ichi Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Mitsuaki Shirahata
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Tomonari Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Kazuhiko Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Adachi J, Miyake Y, Suzuki T, Mishima K, Araki R, Nishikawa R. P13.01 TERTpromoter methylation is significantly associated withTERTupregulation and tumor progression in pituitary adenomas. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Activation of telomerase plays a critical role in tumor development. Somatic alterations in the promoter of the telomerase reverse transcriptase (TERT) gene are a major mechanism of upregulating telomerase. Several mechanisms have been associated with TERT abnormalities, including TERT promoter mutations or methylation. Mutations in the TERT promoter have been observed in a subset of brain tumors, especially in adult gliomas. In pituitary adenomas (PAs), however, TERT abnormalities are not fully understood. The present study aimed to investigate not only mutational but also methylation status changes in the TERT promoter in PAs and to analyze their correlations with clinical variables.
MATERIAL AND METHODS
We retrospectively studied 70 PAs consisting of 53 primary and 17 recurrent samples. Clinical data, including age at surgery, sex, tumor size, tumor subtype, resection rate, presence or absence of postoperative irradiation, and progression-free survival (PFS), were obtained from medical records. First, we investigated TERT promoter hotspot mutations via Sanger sequencing. Next, we quantified the methylation status of the TERT promoter using methylation-sensitive high-resolution melting analysis (MS-HRM). Finally, we investigated TERT mRNA expression levels using real-time quantitative PCR. Fisher’s exact test was applied to evaluate the statistical significance between TERT promoter methylation status and tumor recurrence. PFS was calculated using Kaplan-Meier estimates and compared between methylated with ummethylated PAs with the log-rank test. The correlation between TERT promoter methylation status and mRNA levels was analyzed with the Mann-Whitney U-test. PFS was analyzed using multivariate analysis with the Cox proportional hazards model and included the following variables: age, sex, tumor size, tumor subtype, resection rate, radiation therapy, and methylation status.
RESULTS
TERT promoter hotspot mutations were not observed in any PA sample. Nineteen percent of PAs exhibitedTERT promoter methylation, which was significantly predominant in recurrent PA samples. PFS was significantly shorter in the methylated cases than in the unmethylated cases. Higher TERT expression levels were correlated with methylation status.
CONCLUSION
We found that TERT promoter methylation upregulated TERT expression and was associated with shorter PFS in PAs. Our results suggest thatTERT promoter methylation may be a potential biomarker for predicting tumor recurrence in PAs.
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Affiliation(s)
- J Adachi
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Y Miyake
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - T Suzuki
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - K Mishima
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - R Araki
- Community Health Science Center, Saitama Medical University, Iruma, Saitama, Japan
| | - R Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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Mishima K, Shirahata M, Adachi J, Suzuki T, Fujimaki T, Nishikawa R. P14.113 The role of maintenance high-dose methotrexate chemotherapy in elderly primary CNS lymphoma patients with complete response to induction immunochemotherapy. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
The addition of high-dose methotrexate (HD-MTX)-based chemotherapy to whole brain irradiation (WBRT) has improved the prognosis of primary central nervous system lymphoma (PCNSL). However, the high neurotoxicity rates observed, especially in the elderly, raised interest in chemotherapy-only treatments. Withholding radiotherapy substantially decreases the risk of neurotoxicity, however, disease control may be compromised. Therefore, developing a novel treatment for the elderly PCNSL patients (ePCNSL) is crucial. In the elderly who cannot tolerate WBRT as a consolidation, maintenance treatment may serve as a feasible approach after an initial response. We treated ePCNSL with induction immunochemotherapy with rituximab (RIT) and HD-MTX, maintenance chemotherapy with HD-MTX and deferred WBRT. Here, we retrospectively investigated the prognosis for ePCNSL that became CR after the induction chemotherapy.
MATERIAL AND METHODS
Newly diagnosed ePCNSL (median age: 74 years) received biweekly RIT/ HD-MTX (375 mg/m2/dose; 3.5g/m2/dose) for 6 cycles (induction) followed by monthly RIT/MTX for 2 cycles (consolidation) and then were treated differently according to the radiological response. With CR patients, HD-MTX was continued with every 3 months (maintenance) for 2 years. Patients who did not obtain consent for maintenance therapy were followed up.
RESULTS
Of the 42 ePCNSL (median age 74 years), 26 had CR after induction and consolidation, of which 18 cases were carried out maintenance (M +) and 8 cases were followed up (M-). The median age was 74 and 76, respectively. Median progression-free survival (mPFS) was 73 months in the M+ group and 24.6 months in the M- group. Median overall survival (mOS) is 92.5 months versus 27.6 months, respectively. Both mPFS (P= 0.025) and mOS (P =0.0003) were significantly prolonged by maintenance therapy. In addition, ePCNSL with tumors involvement of deep brain structure had a poor prognosis.
CONCLUSION
It was suggested that maintenance treatment with HD-MTX may improve the prognosis for ePCNSL that reached complete response after induction therapy.
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Affiliation(s)
- K Mishima
- Saitama Medical University, Yamane, Hidaka-shi, Saitama, Japan
| | - M Shirahata
- Saitama Medical University, Yamane, Hidaka-shi, Saitama, Japan
| | - J Adachi
- Saitama Medical University, Yamane, Hidaka-shi, Saitama, Japan
| | - T Suzuki
- Saitama Medical University, Yamane, Hidaka-shi, Saitama, Japan
| | - T Fujimaki
- Saitama Medical University, Yamane, Hidaka-shi, Saitama, Japan
| | - R Nishikawa
- Saitama Medical University, Yamane, Hidaka-shi, Saitama, Japan
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45
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Takenawa T, Harada K, Fujiwara R, Hisano T, Mishima K. MON-PO406: Possibility of Direct Effect of Elemental Diet Elental® on Chemotherapy-Induced Oral Mucositis and Dermatitis. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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46
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Shirahata M, Adachi J, Kobayashi K, Yamasaki F, Tamura K, Suzuki T, Mishima K, Nagane M, Ichimura K, Nishikawa R. Stratified monotherapy approach according to MGMT methylation status in elderly patients with glioblastoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2050 Background: The elderly patients with glioblastoma have an extremely poor prognosis. As they often have some degree of age-related vulnerability, it is especially important to minimize a risk of treatment-related adverse events by optimizing treatment intensity for this population. We conducted phaseⅡ clinical trial to investigate the efficacy of stratified monotherapy approach according to O6-methylguanine-DNA methyltransferase (MGMT) methylation status in elderly patients with glioblastoma. Methods: Patients aged 70 years or older with Karnofsky performance status (KPS) of at least 60 were eligible for this study. MGMT methylation status was quantitatively assessed by pyrosequencing based on the average methylation ratio of 16 CpG sites in the MGMT gene promoter. The patients with highly methylated MGMT promoter defined as an average methylation ratio with 30% or higher were treated with temozolomide (TMZ) monotherapy (standard 5/28 regimen), while the others with low or intermediate levels of MGMT promoter methylation were treated with radiation therapy (40Gy/15fr) alone. Results: Between April 2013 and December 2017, 70 patients were enrolled in this study. Median age was 78 years (70-91) and median KPS was 60 (60-100). Of 70 patients, 19 patients with highly methylated MGMT promoter received TMZ monotherapy, while the remaining 51 patients were treated with radiation therapy. Median progression-free survival (PFS) and median overall survival (OS) were 7.5 and 17.4 months in the TMZ group, respectively. Median PFS and median OS were 4.6 and 10.4 months in the radiotherapy group, respectively. Conclusions: For elderly glioblastoma patients with highly methylated MGMT promoter, TMZ monotherapy could be a treatment option. Clinical trial information: UMIN000012172.
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Affiliation(s)
| | - Junichi Adachi
- Saitama Medical University International Medical Center, Saitama, Japan
| | | | | | - Kaoru Tamura
- Tokyo Medical and Dental University, Department of Neurosurgery, Tokyo, Japan
| | - Tomonari Suzuki
- Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhiko Mishima
- Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | | | - Ryo Nishikawa
- Department of Neuro-Oncology/Neurosurgery, Saitama Medical University International Medical Center, Saitama, Japan
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Narita Y, Muragaki Y, Maruyama T, Kagawa N, Asai K, Kuroda J, Kurozumi K, Nagane M, Matsuda M, Ueki K, Ocampo CJ, Matsumoto I, Odagawa R, Nishimura Y, Mishima K. Phase I/II study of depatuxizumab mafodotin (ABT-414) monotherapy or combination with temozolomide in Japanese patients with/without EGFR-amplified recurrent glioblastoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2065 Background: The poor prognosis of glioblastoma (GBM; WHO grade IV) results from a high rate of disease recurrence and lack of effective treatment options. Depatuxizumab mafodotin (depatux-m, ABT-414) is comprised of an EGFR-directed antibody, depatuxizumab (depatux, ABT-806), conjugated to the microtubule toxin monomethyl auristatin F (MMAF, mafodotin). Once bounded with tumor cells, depatux-m is internalized and releases the cytotoxin, resulting in cell death. Here, we report safety, pharmacokinetic (PK) and efficacy in an ongoing phase 1/2 study of Japanese patients with/without EGFR-amplified recurrent GBM (rGBM). Methods: M13-714 (INTELLANCE-J, NCT02590263) is a non-randomized, phase 1/2 study in Japanese patients. Phase 1 assessed tolerability and PK where the dose escalation of depatux-m was from 0.5 to 1.25 mg/kg/Q2W at day 1 and 15 during 28-day cycle until progression disease (PD) or intolerable toxicity. Phase 2 assessed efficacy and safety of depatux-m in EGFR-amplified, rGBM and patients received 1.0 mg/kg of depatux-m on day 1 and 15 + 150 mg/m2 temozolomide (TMZ) on days 1-5 during each 28-day cycle until PD or intolerable toxicity. Results: As of 10 Jan 2019, 38 patients (WHO grade ≥3) were enrolled (9 in phase 1, 29 in phase 2). There was no dose limiting toxicity in phase 1. The recommended phase 2 dose was 1.25 mg/kg where the most common adverse events (AEs) were punctate keratitis in 21 patients (72%); lymphopenia in 14 patients (45%), thrombocytopenia in 13 patients (41%). Grade 3/4 AEs included thrombocytopenia and lymphopenia in 20 patients (69%). Ocular AEs were reported in 27 patients (93%) including punctate keratitis (72%). PK results (31 patients) in both phases were similar to those of non-Japanese result. Progression Free Survival (PFS) of 27 patients in phase 2 for 12 and 6 months were 8% and 27.5% respectively. The median PFS was 4 months. The overall survival (OS) for 24, 12 and 6 months were 28%, 62.5% and 93% respectively. The median OS was 15.5 months. Conclusions: Preliminary safety, PK and efficacy in Japanese patients with/without EGFR-amplified, rGBM suggests depatux-m was tolerated and showed encouraging anti-GBM effects. Clinical trial information: NCT02590263.
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Affiliation(s)
| | | | - Takashi Maruyama
- Tokyo Women's Medical University Hospital, Shinjyuku-ku, Tokyo, Japan
| | | | | | | | - Kazuhiko Kurozumi
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama-shi, Okayama, Japan
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Masahid Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Keisuke Ueki
- Dokkyo Medical University Hospital, Tochigi, Japan
| | | | | | | | | | - Kazuhiko Mishima
- Saitama Medical University International Medical Center, Hidaka-shi, Saitama, Japan
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48
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Maeda T, Mishima K, Imanishi J, Shirahata M, Suzuki T, Adachi JI, Sasaki A, Nishikawa R. An Epidermoid Cyst of the Thoracic Spine in an Elderly Patient. World Neurosurg 2019; 127:113-116. [PMID: 30951916 DOI: 10.1016/j.wneu.2019.03.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Spinal epidermoid cysts are very rare tumors, especially in the thoracic spine; they represent 0.8% of all spinal epidermoids. In adult cases, they are often associated with surgical procedures such as lumbar puncture. We report a rare case of spinal epidermoid cyst in the thoracic spine of an elderly patient who had never undergone lumber puncture, thoracic spinal surgery, or trauma. CASE DESCRIPTION A 78-year old woman presented with a 1-month history of rapidly progressive impairment of sensation in both the lower limbs, with gait disturbance. She had no history of spinal surgery, trauma, or lumbar puncture. Her past medical history was unremarkable. Magnetic resonance imaging of the whole spine revealed an intraspinalextramedullary tumor at the Th 1-2 level. Diffusion-weighted imaging revealed significant homogeneous high intensity. We performed complete resection without damaging the spinal cord or nerve roots. The final histological examination indicated epidermoid cyst without malignancy. Her gait disturbance was completely resolved at 4-month follow-up. CONCLUSIONS Epidermoid cysts must be considered among spinal tumors in elderly patients. Early detection by diffusion-weighted imaging and complete resection may lead to good neurological outcome.
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Affiliation(s)
- Takuma Maeda
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan.
| | - Kazuhiko Mishima
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Jungo Imanishi
- Department of Orthopaedic Oncology and Surgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Mitsuaki Shirahata
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Jun-Ichi Adachi
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
| | - Atsushi Sasaki
- Department of Pathology, Saitama Medical University, Moroyama, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neurosurgery, International Medical Center, Saitama Medical University, Hidaka, Saitama, Japan
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Bin B, Lee S, Bhin J, Irié T, Kim S, Seo J, Mishima K, Lee T, Hwang D, Fukada T, Cho E. The epithelial zinc transporter
ZIP
10 epigenetically regulates human epidermal homeostasis by modulating histone acetyltransferase activity. Br J Dermatol 2018; 180:869-880. [DOI: 10.1111/bjd.17339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2018] [Indexed: 12/17/2022]
Affiliation(s)
- B.‐H. Bin
- Basic Research & Innovation Division AmorePacific R&D Unit Yongin 17014 Republic of Korea
- Department of Biological Sciences Ajou University Suwon 16499Republic of Korea
| | - S.‐H. Lee
- Biosolution Corporation Seoul 01811Republic of Korea
| | - J. Bhin
- Division of Molecular Carcinogenesis the Netherlands Cancer Institute Amsterdam 1066 CXthe Netherlands
| | - T. Irié
- Division of Pathology Department of Oral Diagnostic Sciences School of Dentistry Showa University Tokyo 142‐8666Japan
- Division of Anatomical and Cellular Pathology Department of Pathology Iwate Medical University Iwate 028‐3694Japan
| | - S. Kim
- Biosolution Corporation Seoul 01811Republic of Korea
| | - J. Seo
- Beauty in Longevity Science Research Division AmorePacific R&D Unit Yongin 17014 Republic of Korea
| | - K. Mishima
- Division of Pathology Department of Oral Diagnostic Sciences School of Dentistry Showa University Tokyo 142‐8666Japan
| | - T.R. Lee
- Basic Research & Innovation Division AmorePacific R&D Unit Yongin 17014 Republic of Korea
| | - D. Hwang
- Center for Systems Biology of Plant Senescence and Life History Institute for Basic Science Daegu 42988Republic of Korea
| | - T. Fukada
- Faculty of Pharmaceutical Sciences Tokushima Bunri University Tokushima 770‐8055 Japan
| | - E.‐G. Cho
- Basic Research & Innovation Division AmorePacific R&D Unit Yongin 17014 Republic of Korea
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50
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Adachi JI, Suzuki T, Mishima K, Nishikawa R. GENE-41. LIQUID BIOPSY USING CELL FREE DNA FROM THE CEREBROSPINAL FLUID (CSF) IN GLIOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jun-ichi Adachi
- Department of Neurosurgery/NeuroOncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tomonari Suzuki
- Department of Neurosurgery/NeuroOncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Kazuhiko Mishima
- Department of Neurosurgery/NeuroOncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ryo Nishikawa
- Department of Neurosurgery/NeuroOncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
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