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Garcia G, Mantziaris G, Pikis S, Dumot C, Lunsford LD, Niranjan A, Wei Z, Srinivasan P, Tang LW, Liscak R, May J, Lee CC, Yang HC, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin R, Elazzazi AH, Martínez Moreno N, Martínez Álvarez R, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Alzate JD, Kondziolka D, Tripathi M, Sheehan JP. Repeat stereotactic radiosurgery for persistent cerebral arteriovenous malformations in pediatric patients. J Neurosurg Pediatr 2024; 33:307-314. [PMID: 38277659 DOI: 10.3171/2023.12.peds23465] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/05/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVE The purpose of this study was to describe the long-term outcomes and associated risks related to repeat stereotactic radiosurgery (SRS) for persistent arteriovenous malformations (AVMs) in pediatric patients. METHODS Under the auspices of the International Radiosurgery Research Foundation, this retrospective multicenter study analyzed pediatric patients who underwent repeat, single-session SRS between 1987 and 2022. The primary outcome variable was a favorable outcome, defined as nidus obliteration without hemorrhage or neurological deterioration. Secondary outcomes included rates and probabilities of hemorrhage, radiation-induced changes (RICs), and cyst or tumor formation. RESULTS The cohort included 83 pediatric patients. The median patient age was 11 years at initial SRS and 15 years at repeat SRS. Fifty-seven children (68.7%) were managed exclusively using SRS, and 42 (50.6%) experienced hemorrhage prior to SRS. Median AVM diameter and volume were substantially different between the first (25 mm and 4.5 cm3, respectively) and second (16.5 mm and 1.6 cm3, respectively) SRS, while prescription dose and isodose line remained similar. At the 5-year follow-up evaluation from the second SRS, nidus obliteration was achieved in 42 patients (50.6%), with favorable outcome in 37 (44.6%). The median time to nidus obliteration and hemorrhage was 35.5 and 38.5 months, respectively. The yearly cumulative probability of favorable outcome increased from 2.5% (95% CI 0.5%-7.8%) at 1 year to 44% (95% CI 32%-55%) at 5 years. The probability of achieving obliteration followed a similar pattern and reached 51% (95% CI 38%-62%) at 5 years. The 5-year risk of hemorrhage during the latency period after the second SRS reached 8% (95% CI 3.2%-16%). Radiographically, 25 children (30.1%) had RICs, but only 5 (6%) were symptomatic. Delayed cyst formation occurred in 7.2% of patients, with a median onset of 47 months. No radiation-induced neoplasia was observed. CONCLUSIONS The study results showed nidus obliteration in most pediatric patients who underwent repeat SRS for persistent AVMs. The risks of symptomatic RICs and latency period hemorrhage were quite low. These findings suggest that repeat radiosurgery should be considered when treating pediatric patients with residual AVM after prior SRS. Further study is needed to define the role of repeat SRS more fully in this population.
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Affiliation(s)
- Gracie Garcia
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Chloe Dumot
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - L Dade Lunsford
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Ajay Niranjan
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Zhishuo Wei
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Priyanka Srinivasan
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Lilly W Tang
- 2Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania
| | - Roman Liscak
- 3Department of Stereotactic and Radiation Neurosurgery, Nemocnice Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- 3Department of Stereotactic and Radiation Neurosurgery, Nemocnice Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Selcuk Peker
- 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 6Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 8Neurosurgery Department, Benha University, Qalubiya, Egypt
| | - Wael A Reda
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 8Neurosurgery Department, Benha University, Qalubiya, Egypt
| | - Sameh R Tawadros
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdel Karim
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Reem Emad Eldin
- 7Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 10Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | | | - Varun Padmanaban
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Francis J Jareczek
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kevin M Cockroft
- 12Department of Neurosurgery, Pennsylvania State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | | | | | - Manjul Tripathi
- 14Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Mantziaris G, Pikis S, Dumot C, Dayawansa S, Liscak R, May J, Lee CC, Yang HC, Martínez Moreno N, Martinez Álvarez R, Lunsford LD, Niranjan A, Wei Z, Srinivasan P, Tang LW, Nabeel AM, Reda WA, Tawadros SR, Abdel Karim K, El-Shehaby AMN, Emad Eldin RM, Elazzazi AH, Peker S, Samanci Y, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Mathieu D, Aldakhil S, Alzate JD, Kondziolka D, Tripathi M, Palmer JD, Upadhyay R, Lin M, Zada G, Yu C, Cifarelli CP, Cifarelli DT, Shaaban A, Xu Z, Sheehan JP. Effect of cerebral arteriovenous malformation location on outcomes of repeat, single-fraction stereotactic radiosurgery: a matched-cohort analysis. J Neurosurg 2023:1-9. [PMID: 38134430 DOI: 10.3171/2023.10.jns231957] [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] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/17/2023] [Indexed: 12/24/2023]
Abstract
OBJECTIVE Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes. METHODS This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose. RESULTS After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference -18%, 95% CI -30.9 to -5.8%, p = 0.004) and AVM obliteration (probability difference -18%, 95% CI -30.1% to -6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI -2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI -10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047). CONCLUSIONS AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.
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Affiliation(s)
- Georgios Mantziaris
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Stylianos Pikis
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Chloe Dumot
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
- 2Department of Neurological Surgery, Hospices Civils de Lyon, France
| | - Sam Dayawansa
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Roman Liscak
- 3Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- 3Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Cheng-Chia Lee
- 4Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Huai-Che Yang
- 4Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan
- 5School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - L Dade Lunsford
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ajay Niranjan
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Zhishuo Wei
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | | | - Lilly W Tang
- 7Department of Neurological Surgery, University of Pittsburgh, Pennsylvania
| | - Ahmed M Nabeel
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 9Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Sameh R Tawadros
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 10Neurosurgery Department and
| | - Khaled Abdel Karim
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 21Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 10Neurosurgery Department and
| | - Reem M Emad Eldin
- 8Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- 11Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Selcuk Peker
- 12Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- 12Department of Neurosurgery, Koç University School of Medicine, Istanbul, Turkey
| | - Varun Padmanaban
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Francis J Jareczek
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - James McInerney
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Kevin M Cockroft
- 13Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - David Mathieu
- 14Department of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Canada
| | - Salman Aldakhil
- 14Department of Neurosurgery, University of Sherbrooke, CHUS Research Center, Sherbrooke, Canada
| | | | | | - Manjul Tripathi
- 16Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Joshua D Palmer
- 17Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Rituraj Upadhyay
- 17Department of Radiation Oncology, The James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio
| | - Michelle Lin
- 18Department of Neurosurgery, University of Southern California, Los Angeles, California; and
| | - Gabriel Zada
- 18Department of Neurosurgery, University of Southern California, Los Angeles, California; and
| | - Cheng Yu
- 18Department of Neurosurgery, University of Southern California, Los Angeles, California; and
| | | | - Daniel T Cifarelli
- 20Radiation Oncology, West Virginia University, Morgantown, West Virginia
| | - Ahmed Shaaban
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Zhiyuan Xu
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Pikis S, Mantziaris G, Dumot C, Shaaban A, Protopapa M, Xu Z, Niranjan A, Wei Z, Srinivasan P, Tang LW, Liscak R, May J, Martinez Moreno N, Martinez Álvarez R, Peker S, Samanci Y, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Elazzazi AH, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Lunsford D, Sheehan JP. Third Stereotactic Radiosurgery for Residual Arteriovenous Malformations: A Retrospective Multicenter Study. Neurosurgery 2023:00006123-990000000-01004. [PMID: 38108313 DOI: 10.1227/neu.0000000000002805] [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] [Received: 08/03/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are no studies evaluating the efficacy and safety of more than 2 stereotactic radiosurgery (SRS) procedures for cerebral arteriovenous malformations (AVM). The aim of this study was to provide evidence on the role of third single-session SRS for AVM residual. METHODS This multicenter, retrospective study included patients managed with a third single-session SRS procedure for an AVM residual. The primary study outcome was defined as AVM nidus obliteration without AVM bleeding or symptomatic radiation-induced changes (RIC). Secondary outcomes evaluated were AVM obliteration, AVM hemorrhage, asymptomatic, and symptomatic RIC. RESULTS Thirty-eight patients (20/38 [52.6%] females, median age at third SRS 34.5 [IQR 20] years) were included. The median clinical follow-up was 46 (IQR 14.8) months, and 17/38 (44.7%) patients achieved favorable outcome. The 3-year and 5-year cumulative probability rates of favorable outcome were 23% (95% CI = 10%-38%) and 53% (95% CI = 29%-73%), respectively. The cumulative probability of AVM obliteration at 3 and 5 years after the third SRS was 23% (95% CI = 10%-37%) and 54% (95% CI = 29%-74%), respectively. AVM bleeding occurred in 2 patients, and 1 of them underwent subsequent resection. The cumulative probability rate of post-SRS AVM hemorrhage remained constant at 5.3% (95% CI = 1%-16%) during the first 5 years of follow-up. Transient symptomatic RIC managed conservatively occurred in 5/38 patients (13.2%) at a median time of 12.5 (IQR 22.5) months from third SRS. Radiation-induced cyst formation was noted in 1 patient (4.2%) 19 months post-SRS. No mortality, radiation-associated malignancy, or permanent symptomatic RIC was noted during follow-up. CONCLUSION A third single-session SRS to treat a residual intracranial AVM offers obliteration in most patients. The risk of RIC was low, and these effects were transient. While not often required, a third SRS can be performed in patients with persistent residual AVMs.
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Affiliation(s)
- Stylianos Pikis
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Radiotherapy and Stereotactic Radiosurgery, Mediterraneo Hospital, Glyfada, Greece
| | - Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Chloe Dumot
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
- Department of Neurological Surgery, Hospices Civils de Lyon, Lyon, France
| | - Ahmed Shaaban
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Maria Protopapa
- Department of Radiotherapy and Stereotactic Radiosurgery, Mediterraneo Hospital, Glyfada, Greece
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Priyanka Srinivasan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lilly W Tang
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Roman Liscak
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic
| | | | | | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department, Benha University, Qalubya, Egypt
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ahmed Hesham Elazzazi
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Francis J Jareczek
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Kevin M Cockroft
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
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Aung T, Mallela A, Ho J, Tang LW, Abou-Al-Shaar H, Gonzalez Martinez J. Challenging Cortical Explorations in Difficult-to-Localize Seizures: The Rationale and Usefulness of Perisylvian Paralimbic Explorations With Orthogonal Stereoelectroencephalography Depth Electrodes. Neurosurgery 2023:00006123-990000000-00982. [PMID: 38047640 DOI: 10.1227/neu.0000000000002787] [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] [Received: 08/08/2023] [Accepted: 10/14/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Stereoelectroencephalography (SEEG) is an invasive monitoring method designed to define and localize the epileptogenic zone (EZ) and explore the putative network responsible for the electroclinical seizures using anatomo-functional-electroclinical correlations. When indicated by semiology in selected patients, exploration of both limbic and paralimbic (PL) regions is indispensable. However, the PL cortex is located in deep and highly vascularized areas in proximity to the anterior Sylvian fissure and middle cerebral artery branches. Thus, those explorations are considered surgically challenging because of the multilobar location and fear of hemorrhagic events. Here, we discuss and illustrate the rationale and SEEG methodology approach in usefulness of exploring the PL regions using standard orthogonal SEEG depth electrode trajectories with the Talariach reference system. METHODS We retrospectively studied PL exploration from a cohort of 71 consecutive SEEG procedures from Nov 2019 to Nov 2022 and identified 31 patients who underwent PL trajectories. RESULTS In 31 patients, there were 32 SEEG trajectories, and no major complications were observed. PL electrodes were consistently implanted in the C10/D10 coordinates of the Talariach reference coordinates. The most common confirmed EZ in our cohort was mesio-temporal (45%), followed by temporo-perisylvian regions (16%), ventromedial frontal (13%), and mesio-lateral temporal regions (13%). The PL contacts were involved in the EZ in 10 patients (32%). Of 31 patients, 25 underwent resective surgery, and 19 obtained Engel 1 outcome with a mean follow-up of 25 months (range 12-41 months) after surgery. CONCLUSION The orthogonal perisylvian PL trajectories are feasible and useful in sampling multiple PL regions with single-electrode trajectories. In patients with perisylvian seizures, sampling PL structures may contribute to an improved understanding of seizure propagation and the optimal anatomic demarcation of the EZs in this surgically challenging region.
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Affiliation(s)
- Thandar Aung
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arka Mallela
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonathan Ho
- Department of Neurology, University of Pittsburgh Medical Center and University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Lilly W Tang
- Department of Neurology, University of Pittsburgh Medical Center and University of Pittsburgh Medical School, Pittsburgh, Pennsylvania, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jorge Gonzalez Martinez
- University of Pittsburgh Comprehensive Epilepsy Center (UPCEC), Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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5
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Wei Z, Luy DD, Jose S, Deng H, Yavan S, Worrell S, Belkhir JR, Tang LW, Niranjan A, Lunsford LD. Single-Session Gamma Knife Radiosurgery for Patients With 20 or More Brain Metastases. Neurosurgery 2023; 93:857-866. [PMID: 37018427 DOI: 10.1227/neu.0000000000002482] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/08/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a widely accepted treatment modality for brain metastases. The role of SRS in patients with higher numbers of metastases remains controversial. OBJECTIVES To define outcomes in patients with ≥20 brain metastases managed using single-session SRS. METHODS This single-institution retrospective cohort study studied 75 patients (26 non-small-cell lung cancer, 21 small-cell lung cancer, 14 breast cancer, and 14 melanoma) undergoing single-session SRS. The median number of tumors per patient was 24, and the median cumulative tumor volume was 3.70 cc. The median margin dose prescribed to each individual tumor was 16 Gy. The median integral cranial dose was 5492 mJ. The median beam on time was 160 minutes. Univariate and multivariate analyses were performed with significance set at P < .05. RESULTS The median overall survival after SRS was 8.8 months (patients with non-small-cell lung cancer), 4.6 months (patients with small-cell lung cancer), 11.3 months (patients with breast cancer), and 4.1 months (patients with melanoma). Primary cancer type, number of brain metastases, and concurrent immunotherapy were significant factors in predicting survival. Local tumor control rate per patient was 97.3% and 94.6% at 6 and 12 months after SRS, respectively. Thirty-six patients underwent additional SRS for new tumor development with a median time after SRS of 5 months. Three patients experienced adverse radiation events. CONCLUSION Single-session SRS is a well-tolerated palliative treatment option even in patients with ≥20 brain metastases, achieving local control rate >90% with low risks of neurotoxicity while continuing concurrent systemic oncological care.
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Affiliation(s)
- Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Diego D Luy
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Shalini Jose
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - Sila Yavan
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Stephen Worrell
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - J Raouf Belkhir
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Lilly W Tang
- University of Pittsburgh School of Medicine, Pittsburgh , Pennsylvania , USA
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh , Pennsylvania , USA
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6
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Mantziaris G, Pikis S, Dumot C, Dayawansa S, Liščák R, May J, Lee CC, Yang HC, Martinez Moreno N, Martinez Álvarez R, Lunsford LD, Niranjan A, Wei Z, Srinivasan P, Tang LW, Nabeel AM, Reda WA, Tawadros SR, Abdelkarim K, El-Shehaby AMN, Emad RM, Hesham Elazzazi A, Peker S, Samanci Y, Padmanaban V, Jareczek FJ, McInerney J, Cockroft KM, Mathieu D, Aldakhil S, Alzate JD, Kondziolka D, Tripathi M, Palmer JD, Upadhyay R, Lin M, Zada G, Yu C, Cifarelli CP, Cifarelli DT, Xu Z, Sheehan JP. Outcome Evaluation of Repeat Stereotactic Radiosurgery for Cerebral Arteriovenous Malformations. Stroke 2023. [PMID: 37350270 DOI: 10.1161/strokeaha.123.042515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Repeat stereotactic radiosurgery (SRS) for persistent cerebral arteriovenous malformation (AVM) has generally favorable patient outcomes. However, reporting studies are limited by small patient numbers and single-institution biases. The purpose of this study was to provide the combined experience of multiple centers, in an effort to fully define the role of repeat SRS for patients with arteriovenous malformation. METHODS This multicenter, retrospective cohort study included patients treated with repeat, single-fraction SRS between 1987 and 2022. Follow-up began at repeat SRS. The primary outcome was a favorable patient outcome, defined as a composite of nidus obliteration in the absence of hemorrhage or radiation-induced neurological deterioration. Secondary outcomes were obliteration, hemorrhage risk, and symptomatic radiation-induced changes. Competing risk analysis was performed to compute yearly rates and identify predictors for each outcome. RESULTS The cohort comprised 505 patients (254 [50.3%] males; median [interquartile range] age, 34 [15] years) from 14 centers. The median clinical and magnetic resonance imaging follow-up was 52 (interquartile range, 61) and 47 (interquartile range, 52) months, respectively. At last follow-up, favorable outcome was achieved by 268 (53.1%) patients (5-year probability, 50% [95% CI, 45%-55%]) and obliteration by 300 (59.4%) patients (5-year probability, 56% [95% CI, 51%-61%]). Twenty-eight patients (5.6%) experienced post-SRS hemorrhage with an annual incidence rate of 1.38 per 100 patient-years. Symptomatic radiation-induced changes were evident in 28 (5.6%) patients, with most occurring in the first 3 years. Larger nidus volumes (between 2 and 4 cm3, subdistribution hazard, 0.61 [95% CI, 0.44-0.86]; P=0.005; >4 cm3, subdistribution hazard, 0.47 [95% CI, 0.32-0.7]; P<0.001) and brainstem/basal ganglia involvement (subdistribution hazard, 0.6 [95% CI, 0.45-0.81]; P<0.001) were associated with reduced probability of favorable outcome. CONCLUSIONS Repeat SRS confers reasonable obliteration rates with a low complication risk. With most complications occurring in the first 3 years, extending the latency period to 5 years generally increases the rate of favorable patient outcomes and reduces the necessity of a third intervention.
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Affiliation(s)
- Georgios Mantziaris
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Stylianos Pikis
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Chloe Dumot
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Samantha Dayawansa
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Roman Liščák
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J.M.)
| | - Jaromir May
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czech Republic (R.L., J.M.)
| | - Cheng-Chia Lee
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taiwan (C.-c.L., H.-c.Y.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-c.L., H.-c.Y.)
| | - Huai-Che Yang
- Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taiwan (C.-c.L., H.-c.Y.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (C.-c.L., H.-c.Y.)
| | | | | | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Priyanka Srinivasan
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Lilly W Tang
- Department of Neurological Surgery, University of Pittsburgh, PA (R.D.L., A.N., Z.W., P.S., L.W.T.)
| | - Ahmed M Nabeel
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department, Benha University, Qalubya, Egypt (A.M.N., W.A.R.)
| | - Wael A Reda
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department, Benha University, Qalubya, Egypt (A.M.N., W.A.R.)
| | - Sameh R Tawadros
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Khaled Abdelkarim
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Amr M N El-Shehaby
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Reem M Emad
- Gamma Knife Center Cairo, Nasser Institute Hospital, Cairo, Egypt (A.M.N., W.A.R., S.R.T., K.A., A.M.N.E.-S., R.M.E.)
- Radiation Oncology Department, National Cancer Institute, Cairo University, Egypt (R.M.E.)
| | - Ahmed Hesham Elazzazi
- Neurosurgery Department and Clinical Oncology Department, Ain Shams University, Cairo, Egypt (S.R.T., K.A., A.M.N.E.-S., A.H.E.)
| | - Selcuk Peker
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey (S. Peker, Y.S.)
| | - Yavuz Samanci
- Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey (S. Peker, Y.S.)
| | - Varun Padmanaban
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - Francis J Jareczek
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - James McInerney
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - Kevin M Cockroft
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, PA (V.P., F.J.J., J.M., K.M.C.)
| | - David Mathieu
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada (D.M., S.A.)
| | - Salman Aldakhil
- Department of Neurosurgery, Université de Sherbrooke, Centre de recherche du CHUS, Sherbrooke, Canada (D.M., S.A.)
| | | | | | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India (M.T.)
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Comprehensive Cancer Center Ohio State University, Columbus (J.D.P., R.U.)
| | - Rituraj Upadhyay
- Department of Radiation Oncology, The James Comprehensive Cancer Center Ohio State University, Columbus (J.D.P., R.U.)
| | - Michelle Lin
- Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
| | - Gabriel Zada
- Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
| | - Cheng Yu
- Department of Neurosurgery, University of Southern California (M.L., G.Z., C.Y.)
| | - Christopher P Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown (C.P.C., D.T.C.)
| | - Daniel T Cifarelli
- Departments of Neurosurgery and Radiation Oncology, West Virginia University, Morgantown (C.P.C., D.T.C.)
| | - Zhiyuan Xu
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
| | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville (G.M., S. Pikis, C.D., S.D., Z.X., J.P.S.)
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Tang LW, Mallela AN, Deng H, Richardson TE, Hervey-Jumper SL, McBrayer SK, Abdullah KG. Preclinical modeling of lower-grade gliomas. Front Oncol 2023; 13:1139383. [PMID: 37051530 PMCID: PMC10083350 DOI: 10.3389/fonc.2023.1139383] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023] Open
Abstract
Models for human gliomas prove critical not only to advancing our understanding of glioma biology but also to facilitate the development of therapeutic modalities. Specifically, creating lower-grade glioma (LGG) models has been challenging, contributing to few investigations and the minimal progress in standard treatment over the past decade. In order to reliably predict and validate the efficacies of novel treatments, however, LGG models need to adhere to specific standards that recapitulate tumor genetic aberrations and micro-environment. This underscores the need to revisit existing models of LGG and explore prospective models that may bridge the gap between preclinical insights and clinical translation. This review first outlines a set of criteria aimed to address the current challenges hindering model development. We then evaluate the strengths and weaknesses of existing preclinical models of LGG with respect to these established standards. To conclude, the review discusses potential future directions for integrating existing models to maximize the exploration of disease mechanisms and therapeutics development.
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Affiliation(s)
- Lilly W. Tang
- Physician Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Arka N. Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hansen Deng
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Timothy E. Richardson
- Department of Pathology, Cell and Molecular Based Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Shawn L. Hervey-Jumper
- Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States
| | - Samuel K. McBrayer
- Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Kalil G. Abdullah
- Physician Scientist Training Program, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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8
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Wei Z, Luy DD, Tang LW, Deng H, Jose S, Scanlon S, Niranjan A, Lunsford LD. Gamma Knife radiosurgery for gynecologic metastases to the brain: Analysis of pathology, survival, and tumor control. Gynecol Oncol 2023; 172:21-28. [PMID: 36924726 DOI: 10.1016/j.ygyno.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/01/2023] [Accepted: 03/06/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE This study aims to evaluate the efficacy of stereotactic radiosurgery (SRS) in improving health outcomes of patients with gynecologic brain metastases. METHODS Patients with gynecologic metastases treated with SRS from 2008 to 2020 were retrospectively reviewed. The median age at SRS was 63 years old (cervical 45.5, endometrial 65.5, ovarian 61). The median number of tumors was 3 (range 1-27), and cumulative tumor volume was 2.33 cc (range 0.03-45.63). Median margin dose prescribed was 16 Gy (range 14 Gy - 20 Gy). The median 12 Gy volume was 7.30 cc (range 0.21-74.14 cc). Outcome variables included overall survival (OS) after SRS, local tumor control (LTC), distant tumor control, and adverse radiation effect (ARE). RESULTS Fifty patients (4 cervical, 25 endometrial, and 21 ovarian cancer) were identified. The OS at 6 and 12 months after SRS was 48%, and 44%, respectively. Eight patients (16%) died from CNS disease progression. The number of brain metastases (p = 0.011) and the Karnofsky Performance Scale (KPS) ≥ 70 (p = 0.020) were significant predictors of OS. LTC rate at 6 and 12 months were 92%, and 87%, respectively. Margin dose ≥16Gy correlated with significantly better local tumor control (p = 0.0001) without increased risk of ARE (p = 0.055). The risk of developing new metastases at 6 and 12 months were 12% and 24% respectively. SRS-induced ARE events occurred in 7 patients. CONCLUSION Intracranial metastases from gynecologic malignancy can be effectively treated using SRS with low risk of neurotoxicity. Margin dose ≥16Gy can provide significantly better tumor control. Repeat SRS can be utilized to treat new metastases while avoiding the potential cognitive symptoms associated with WBRT.
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Affiliation(s)
- Zhishuo Wei
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Diego D Luy
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Lilly W Tang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Hansen Deng
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Shalini Jose
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Sydney Scanlon
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Ajay Niranjan
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - L Dade Lunsford
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
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9
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Sharma N, Mallela AN, Shi DD, Tang LW, Abou-Al-Shaar H, Gersey ZC, Zhang X, McBrayer SK, Abdullah KG. Isocitrate dehydrogenase mutations in gliomas: A review of current understanding and trials. Neurooncol Adv 2023; 5:vdad053. [PMID: 37287696 PMCID: PMC10243983 DOI: 10.1093/noajnl/vdad053] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Isocitrate dehydrogenase (IDH) is a key enzyme in normal metabolism and homeostasis. However, mutant forms of IDH are also defining features of a subset of diffuse gliomas. In this review, we highlight current techniques targeting IDH-mutated gliomas and summarize current and completed clinical trials exploring these strategies. We discuss clinical data from peptide vaccines, mutant IDH (mIDH) inhibitors, and PARP inhibitors. Peptide vaccines have the unique advantage of targeting the specific epitope of a patient's tumor, inducing a highly tumor-specific CD4+ T-cell response. mIDH-inhibitors, on the other hand, specifically target mutant IDH proteins in cancer cell metabolism and thus help halt gliomagenesis. We also explore PARP inhibitors and their role in treating diffuse gliomas, which exploit IDH-mutant diffuse gliomas by allowing the persistence of unrepaired DNA complexes. We summarize various completed and current trials targeting IDH1 and IDH2 mutations in diffuse gliomas. Therapies targeting mutant IDH have significant promise in treating progressive or recurrent IDH-mutant gliomas and may significantly change treatment paradigms in the next decade.
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Affiliation(s)
- Nikhil Sharma
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arka N Mallela
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Diana D Shi
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts, USA
| | - Lilly W Tang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary C Gersey
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Xiaoran Zhang
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Samuel K McBrayer
- Children’s Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kalil G Abdullah
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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10
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Liu C, Tose AJ, Verharen JPH, Zhu Y, Tang LW, de Jong JW, Du JX, Beier KT, Lammel S. An inhibitory brainstem input to dopamine neurons encodes nicotine aversion. Neuron 2022; 110:3018-3035.e7. [PMID: 35921846 PMCID: PMC9509462 DOI: 10.1016/j.neuron.2022.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/18/2021] [Revised: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 01/07/2023]
Abstract
Nicotine stimulates the dopamine (DA) system, which is essential for its rewarding effect. Nicotine is also aversive at high doses; yet, our knowledge about nicotine's dose-dependent effects on DA circuits remains limited. Here, we demonstrate that high doses of nicotine, which induce aversion-related behavior in mice, cause biphasic inhibitory and excitatory responses in VTA DA neurons that can be dissociated by distinct projections to lateral and medial nucleus accumben subregions, respectively. Guided by computational modeling, we performed a pharmacological investigation to establish that inhibitory effects of aversive nicotine involve desensitization of α4β2 and activation of α7 nicotinic acetylcholine receptors. We identify α7-dependent activation of upstream GABA neurons in the laterodorsal tegmentum (LDT) as a key regulator of heterogeneous DA release following aversive nicotine. Finally, inhibition of LDT GABA terminals in VTA prevents nicotine aversion. Together, our findings provide a mechanistic circuit-level understanding of nicotine's dose-dependent effects on reward and aversion.
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Affiliation(s)
- Christine Liu
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Amanda J Tose
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Jeroen P H Verharen
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Yichen Zhu
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Lilly W Tang
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Johannes W de Jong
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Jessica X Du
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA
| | - Kevin T Beier
- Department of Physiology and Biophysics, University of California Irvine, 825 Health Sciences Road, Med Sci D320, Irvine, CA 92697, USA
| | - Stephan Lammel
- Department of Molecular and Cell Biology and Helen Wills Neuroscience Institute, University of California, California, Berkeley, CA 94720, USA.
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Chen XY, Qin JF, Tang LW, Zhang RR. [Construction and application of home self-sampling processes for cervical human papillomavirus detection]. Zhonghua Yu Fang Yi Xue Za Zhi 2021; 55:1145-1148. [PMID: 34619935 DOI: 10.3760/cma.j.cn112150-20210126-00080] [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: 11/05/2022]
Abstract
To construct and develop the home self-sampling processes of cervical human papillomavirus (HPV) detection and evaluate its application effect. An integrated HPV self-sampling detection platform is scheduled to include three terminals: a user terminal, a detection terminal and a medical terminal. It covers a wide range of functions of self-sampling kit acquisition of user, sample logistics tracking, inspection services, report query, medical consultation, health management, and follow-up tracking. A total of 8 053 users applied for self-sampling kits and all completed online user information registration from January to November 2020. The average age of users ranged from 17 to 84 with a median age of 42 years old. Registered users of the platform were distributed in Jiangsu, Jiangxi, Hebei, Shanxi, Shanghai, Ningxia, Anhui, Zhejiang, Inner Mongolia, Beijing and Xinjiang. 8 045 users completed self-sampling with a kit return rate of 99.9%. Six users lost the kits during the express delivery, and 2 users had the kits contaminated due to improper application; The amount of exfoliated cells collected from 8 045 cases in the sample kits were all within the endogenous internal standard of the nucleic acid kit, and the qualified rate of kits was 100%. The proportion of test report issued by the detection platform within 3 d accounts for 96.93% (7 799/8 054). Among the 763 positive users, 742 completed 6-month reexamination, with a reexamination rate of 97.25%. Unfortunately, 21 cases were lost to follow-up. Taken together, HPV home-based self-sampling is simple, convenient and efficient in use. It can expand the coverage of cervical cancer screening and may help promote HPV screening.
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Affiliation(s)
- X Y Chen
- Department of Obstetrics and Gynaecology, Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University,Hangzhou 310020, China
| | - J F Qin
- Nursing Department, Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310020, China
| | - L W Tang
- Nursing Department, Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310020, China
| | - R R Zhang
- Nursing Department, Run Run Shaw Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310020, China
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Hou GQ, Liang XL, Chen R, Tang LW, Wang Y, Xu PY, Zhang YR, Ou CH. Copper transportion of WD protein in hepatocytes from Wilson disease patients in vitro. World J Gastroenterol 2001; 7:846-51. [PMID: 11854914 PMCID: PMC4695607 DOI: 10.3748/wjg.v7.i6.846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2001] [Revised: 09/19/2001] [Accepted: 09/28/2001] [Indexed: 02/06/2023] Open
Abstract
AIM To study the effect of copper transporting P-type ATPase in copper metabolism of hepatocyte and pathogenesis of Wilson disease (WD). METHODS WD copper transporting properties in some organelles of the cultured hepatocytes were studied from WD patients and normal controls.These cultured hepatocytes were incubated in the media of copper 15 mg x L(-1) only, copper 15 mg x L(-1) with vincristine (agonist of P-type ATPase) 0.5mg x L(-1), or copper 15 mg x L(-1) with vanadate (antagonist of P-type ATPase) 18.39 mg x L(-1) separately. Microsome (endoplasmic reticulum and Golgi apparatus), lysosome, mitochondria, and cytosol were isolated by differential centrifugation. Copper contents in these organelles were measured with atomic absorption spectrophotometer, and the influence in copper transportion of these organelles by vanadate and vincristine were comparatively analyzed between WD patients and controls. WD copper transporting P-type ATPase was detected by SDS-PAGE in conjunction with Western blot in liver samples of WD patients and controls. RESULTS The specific WD proteins (M(r)155,000 lanes) were expressed in human hepatocytes, including the control and WD patients. After incubation with medium containing copper for 2 h or 24 h, the microsome copper concentration in WD patients was obviously lower than that of controls, and the addition of vanadate or vincristine would change the copper transporting of microsomes obviously. When incubated with vincristine, levels of copper in microsome were significantly increased, while incubated with vanadate, the copper concentrations in microsome were obviously decreased. The results indicated that there were WD proteins, the copper transportion P-type ATPase in the microsome of hepatocytes. WD patients possessed abnormal copper transporting function of WD protein in the microsome, and the agonist might correct the defect of copper transportion by promoting the activity of copper transportion P-type ATPase. CONCLUSION Copper transportion P-type ATPase plays an important role in hepatocytic copper metabolism. Dysfunction of hepatocytic WD protein copper transportion might be one of the most important factors for WD.
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Affiliation(s)
- G Q Hou
- Department of Neurology, Guangzhou First Municipal People's Hospital, Guangzhou Medical College, Guangdong Province, China.
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Abstract
Due to rapid economic development in Taiwan, a large quantity of construction sand and gravel is needed to support domestic civil construction projects. However, a construction sand and gravel processing plant is often a major source of air pollution, due to its associated fugitive dust emission. To predict the amount of fugitive dust emitted from this kind of processing plant, a semiempirical model was developed in this study. This model was developed on the basis of the actual dust emission data (i.e., total suspended particulate, TSP) and four on-site operating parameters (i.e., wind speed (u), soil moisture (M), soil silt content (s), and number (N) of trucks) measured at a construction sand and gravel processing plant. On the basis of the on-site measured data and an SAS nonlinear regression program, the expression of this model is E = 0.011.u2.653.M-1.875.s0.060.N0.896, where E is the amount (kg/ton) of dust emitted during the production of each ton of gravel and sand. This model can serve as a facile tool for predicting the fugitive dust emission from a construction sand and gravel processing plant.
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Affiliation(s)
- C H Lee
- Department of Environmental Engineering, Da-Yeh University, 112, Shan-Jiau Road, Da-Tsuen, Chang-Hwa, Taiwan, R.O.C.
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Abstract
Since 1988, through fierce industry-driven competition and patients' preference for minimally invasive procedures, widely diffused through the media, laparoscopic cholecystectomy was universally adopted and rapidly became the "gold standard" for symptomatic cholelithiasis. Robotically assisted video enhanced-endoscopic coronary artery bypass surgery (RAVE-CABG) will most likely follow suit with its similar developmental processes for symptomatic coronary artery disease. Since 1998, there are currently two surgical robotic systems that have been used in a clinical setting for endoscopic coronary artery bypass (ECABG): the da Vinci and the ZEUS system. Although each has separate learning curves to overcome, as with any new technology, both offer the promise to contribute in the interests of reduced hospital days, earlier return to normal activity, less pain, better cosmesis, and the rethinking of surgical dogma such as wide exposure.
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Affiliation(s)
- L W Tang
- State University of New York at Buffalo, School of Medicine and Biomedical Sciences, and Kaleida Health-Buffalo General Hospital, USA
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15
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Abstract
Daily rhythms in response output and accuracy were examined when reinforcement for a complex operant was uncoupled from accuracy of performance. Rats housed in operant conditioning chambers earned their daily ration of food under a targeted percentile procedure for responding on two levers. The targeted pattern was a series of consecutive responses on the left lever (a "run"), followed by a single response on the right lever. The targeted run length was either "O" (i.e., undefined, under the nondifferential baseline), 6, 12 or 24. Under baseline, a random third of all trials ended in pellet delivery; under the percentile conditions, trials with runs closer to the target than two-thirds of the runs from the most recent 24 trials ended in pellet delivery. This contingency shaped run lengths while ensuring that approximately one-third of all trials produced pellets. Responding tracked the target value well, with mean obtained run lengths equal to 90% of the target or better. Daily rhythms were clearly evident in measures of overall output, with subjects responding primarily 3-7 h into the dark period. The only substantial light-period responding observed in all subjects occurred during the 2 h after noon, when the chambers were serviced. No systematic variation in this pattern was observed as a function of target. Run length was much less variable across the daily cycle than was response output, with only a suggestion under the longest target that response accuracy was lower during periods removed from the period of peak activity.
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Affiliation(s)
- G Galbicka
- Department of Neurobehavioral Assessment, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA. Dr. Gregory
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