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Teske N, Teske NC, Greve T, Karschnia P, Kirchleitner SV, Harter PN, Forbrig R, Tonn JC, Schichor C, Biczok A. Perifocal edema is a risk factor for preoperative seizures in patients with meningioma WHO grade 2 and 3. Acta Neurochir (Wien) 2024; 166:170. [PMID: 38581569 PMCID: PMC10998776 DOI: 10.1007/s00701-024-06057-3] [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: 11/28/2023] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Patients with intracranial meningiomas frequently suffer from tumor-related seizures prior to resection, impacting patients' quality of life. We aimed to elaborate on incidence and predictors for seizures in a patient cohort with meningiomas WHO grade 2 and 3. METHODS We retrospectively searched for patients with meningioma WHO grade 2 and 3 according to the 2021 WHO classification undergoing tumor resection. Clinical, histopathological and imaging findings were collected and correlated with preoperative seizure development. Tumor and edema volumes were quantified. RESULTS Ninety-five patients with a mean age of 59.5 ± 16.0 years were included. Most tumors (86/95, 90.5%) were classified as atypical meningioma WHO grade 2. Nine of 95 tumors (9.5%) corresponded to anaplastic meningiomas WHO grade 3, including six patients harboring TERT promoter mutations. Meningiomas were most frequently located at the convexity in 38/95 patients (40.0%). Twenty-eight of 95 patients (29.5%) experienced preoperative seizures. Peritumoral edema was detected in 62/95 patients (65.3%) with a median volume of 9 cm3 (IR: 0-54 cm3). Presence of peritumoral edema but not age, tumor localization, TERT promoter mutation, brain invasion or WHO grading was associated with incidence of preoperative seizures, as confirmed in multivariate analysis (OR: 6.61, 95% CI: 1.18, 58.12, p = *0.049). Postoperative freedom of seizures was achieved in 91/95 patients (95.8%). CONCLUSIONS Preoperative seizures were frequently encountered in about every third patient with meningioma WHO grade 2 or 3. Patients presenting with peritumoral edema on preoperative imaging are at particular risk for developing tumor-related seizures. Tumor resection was highly effective in achieving seizure freedom.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Nina C Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Tobias Greve
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Sabrina V Kirchleitner
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Center for Neuropathology and Prion Research, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Annamaria Biczok
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Karschnia P, Dono A, Young JS, Juenger ST, Teske N, Häni L, Sciortino T, Mau CY, Bruno F, Nunez L, Morshed RA, Haddad AF, Weller M, van den Bent M, Thon N, Beck J, Hervey-Jumper S, Molinaro AM, Tandon N, Rudà R, Vogelbaum MA, Bello L, Schnell O, Grau SJ, Chang SM, Berger MS, Esquenazi Y, Tonn JC. Associations between recurrence patterns and outcome in glioblastoma patients undergoing re-resection: A complementary report of the RANO resect group. Neuro Oncol 2024; 26:584-586. [PMID: 38164632 PMCID: PMC10911992 DOI: 10.1093/neuonc/noad237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Antonio Dono
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Jacob S Young
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | | | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Levin Häni
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Tommaso Sciortino
- Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Christine Y Mau
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | - Luis Nunez
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UTHealth Houston, Houston, Texas, USA
| | - Ramin A Morshed
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Alexander F Haddad
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Martin van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Juergen Beck
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Shawn Hervey-Jumper
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Annette M Molinaro
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Lorenzo Bello
- Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
- Klinikum Fulda, Academic Hospital of Marburg University, Fulda, Germany
| | - Susan M Chang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Mitchel S Berger
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
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Schmutzer-Sondergeld M, Gencer A, Niedermeyer S, Quach S, Stoecklein VM, Teske N, Schichor C, Terpolilli NA, Kunz M, Thon N. Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults. Acta Neurochir (Wien) 2024; 166:39. [PMID: 38280116 PMCID: PMC10821836 DOI: 10.1007/s00701-024-05950-1] [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: 10/21/2023] [Accepted: 12/30/2023] [Indexed: 01/29/2024]
Abstract
OBJECTIVE The best treatment strategies for cerebral arachnoid cysts (CAC) are still up for debate. In this study, we present CAC management, outcome data, and risk factors for recurrence after surgical treatment, focusing on microscopic/endoscopic approaches as compared to minimally invasive stereotactic procedures in children and adults. METHODS In our single-institution retrospective database, we identified all patients treated surgically for newly diagnosed CAC between 2000 and 2022. Microscopic/endoscopic surgery (ME) aimed for safe cyst wall fenestration. Stereotactic implantation of an internal shunt catheter (STX) to drain CAC into the ventricles and/or cisterns was used as an alternative procedure in patients aged ≥ 3 years. Treatment decisions in favor of ME vs. STX were made by interdisciplinary consensus. The primary study endpoint was time to CAC recurrence (TTR). Secondary endpoints were outcome metrics including clinical symptoms and MR-morphological analyses. Data analysis included subdivision of the total cohort into three distinct age groups (AG1, < 6 years; AG2, 6-18 years; AG3, ≥ 18 years). RESULTS Sixty-two patients (median age 26.5 years, range 0-82 years) were analyzed. AG1 included 15, AG2 10, and AG3 37 patients, respectively. The main presenting symptoms were headache and vertigo. In AG1 hygromas, an increase in head circumference and thinning of cranial calvaria were most frequent. Thirty-five patients underwent ME and 27 STX, respectively; frequency did not differ between AGs. There were two (22.2%) periprocedural venous complications in infants (4- and 10-month-old) during an attempt at prepontine fenestration of a complex CAC, one with fatal outcome in a 10-month-old boy. Other complications included postoperative bleeding (2, 22.2%), CSF leaks (4, 44.4%), and meningitis (1, 11.1%). Overall, clinical improvement and significant volume reduction (p = 0.008) were seen in all other patients; this did not differ between AGs. Median follow-up for all patients was 25.4 months (range, 3.1-87.1 months). Recurrent cysts were seen in 16.1%, independent of surgical procedure used (p = 0.7). In cases of recurrence, TTR was 7.9 ± 12.7 months. Preoperative ventricular expansion (p = 0.03), paresis (p = 0.008), and age under 6 years (p = 0.03) were significant risk factors for CAC recurrence in multivariate analysis. CONCLUSIONS In patients suffering from CAC, both ME and STX can improve clinical symptoms at low procedural risk, with equal extent of CAC volume reduction. However, in infants and young children, CAC are more often associated with severe clinical symptoms, stereotactic procedures have limited use, and microsurgery in the posterior fossa may bear the risk of severe venous bleeding.
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Affiliation(s)
| | - Aylin Gencer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Sebastian Niedermeyer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Veit M Stoecklein
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Nicole Angela Terpolilli
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Schmutzer-Sondergeld M, Quach S, Niedermeyer S, Teske N, Ueberschaer M, Schichor C, Kunz M, Thon N. Risk-benefit analysis of surgical treatment strategies for cystic craniopharyngioma in children and adolescents. Front Oncol 2024; 14:1274705. [PMID: 38292926 PMCID: PMC10825040 DOI: 10.3389/fonc.2024.1274705] [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] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Objective Treatment strategies for craniopharyngiomas are still under debate particularly for the young population. We here present tumor control and functional outcome data after surgical treatment focusing on stereotactic and microsurgical procedures for cystic craniopharyngiomas in children and adolescents. Methods From our prospective institutional database, we identified all consecutive patients less than 18 years of age who were surgically treated for newly-diagnosed cystic craniopharyngioma between, 2000 and, 2022. Treatment decisions in favor of stereotactic treatment (STX) or microsurgery were made interdisciplinary. STX included aspiration and/or implantation of an internal shunt catheter for permanent cyst drainage. Microsurgery aimed for safe maximal tumor resections. Study endpoints were time to tumor recurrence (TTR) and functional outcome including ophthalmological/perimetric, endocrinological, and body-mass index (BMI) data. Results 29 patients (median age 9.9 yrs, range 4-18 years) were analyzed. According to our interdisciplinary tumor board recommendation, 9 patients underwent stereotactic treatment, 10 patients microsurgical resection, and 10 patients the combination of both. Significant volume reduction was particularly achieved in the stereotactic (p=0.0019) and combined subgroups (p<0.001). Improvement of preoperative visual deficits was always achieved independent of the applied treatment modality. Microsurgery and the combinational treatment were associated with higher rates of postoperative endocrinological dysfunction (p<0.0001) including hypothalamic obesity (median BMI increase from 17.9kg/m2 to 24.1kg/m2, p=0.019). Median follow-up for all patients was 93.9 months (range 3.2-321.5 months). Recurrent tumors were seen in 48.3% and particularly concerned patients after initial combination of surgery and STX (p=0.004). In here, TTR was 35.1 ± 46.9 months. Additional radiation therapy was found indicated in 4 patients to achieve long-lasting tumor control. Conclusion In children and adolescents suffering from predominantly cystic craniopharyngiomas, stereotactic and microsurgical procedures can improve clinical symptoms at low procedural risk. Microsurgery, however, bears a higher risk of postoperative endocrine dysfunction. A risk-adapted surgical treatment concept may have to be applied repeatedly in order to achieve long-term tumor control even without additional irradiation.
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Karschnia P, Dietrich J, Bruno F, Dono A, Juenger ST, Teske N, Young JS, Sciortino T, Häni L, van den Bent M, Weller M, Vogelbaum MA, Morshed RA, Haddad AF, Molinaro AM, Tandon N, Beck J, Schnell O, Bello L, Hervey-Jumper S, Thon N, Grau SJ, Esquenazi Y, Rudà R, Chang SM, Berger MS, Cahill DP, Tonn JC. Surgical management and outcome of newly diagnosed glioblastoma without contrast enhancement (low-grade appearance): a report of the RANO resect group. Neuro Oncol 2024; 26:166-177. [PMID: 37665776 PMCID: PMC10768992 DOI: 10.1093/neuonc/noad160] [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: 07/19/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Resection of the contrast-enhancing (CE) tumor represents the standard of care in newly diagnosed glioblastoma. However, some tumors ultimately diagnosed as glioblastoma lack contrast enhancement and have a 'low-grade appearance' on imaging (non-CE glioblastoma). We aimed to (a) volumetrically define the value of non-CE tumor resection in the absence of contrast enhancement, and to (b) delineate outcome differences between glioblastoma patients with and without contrast enhancement. METHODS The RANO resect group retrospectively compiled a global, eight-center cohort of patients with newly diagnosed glioblastoma per WHO 2021 classification. The associations between postoperative tumor volumes and outcome were analyzed. Propensity score-matched analyses were constructed to compare glioblastomas with and without contrast enhancement. RESULTS Among 1323 newly diagnosed IDH-wildtype glioblastomas, we identified 98 patients (7.4%) without contrast enhancement. In such patients, smaller postoperative tumor volumes were associated with more favorable outcome. There was an exponential increase in risk for death with larger residual non-CE tumor. Accordingly, extensive resection was associated with improved survival compared to lesion biopsy. These findings were retained on a multivariable analysis adjusting for demographic and clinical markers. Compared to CE glioblastoma, patients with non-CE glioblastoma had a more favorable clinical profile and superior outcome as confirmed in propensity score analyses by matching the patients with non-CE glioblastoma to patients with CE glioblastoma using a large set of clinical variables. CONCLUSIONS The absence of contrast enhancement characterizes a less aggressive clinical phenotype of IDH-wildtype glioblastomas. Maximal resection of non-CE tumors has prognostic implications and translates into favorable outcome.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, LMU University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Jorg Dietrich
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Italy
| | - Antonio Dono
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | | | - Nico Teske
- Department of Neurosurgery, LMU University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Jacob S Young
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Tommaso Sciortino
- Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Levin Häni
- Department of Neurosurgery, Medical Center – University of Freiburg, Freiburg, Germany
| | - Martin van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Ramin A Morshed
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Alexander F Haddad
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Annette M Molinaro
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Juergen Beck
- Department of Neurosurgery, Medical Center – University of Freiburg, Freiburg, Germany
| | - Oliver Schnell
- Department of Neurosurgery, Medical Center – University of Freiburg, Freiburg, Germany
| | - Lorenzo Bello
- Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Shawn Hervey-Jumper
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Niklas Thon
- Department of Neurosurgery, LMU University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
| | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, TX, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Italy
| | - Susan M Chang
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Mitchel S Berger
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
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Teske N, Biczok A, Quach S, Dekorsy FJ, Forbrig R, Bodensohn R, Niyazi M, Tonn JC, Albert NL, Schichor C, Ueberschaer M. Postoperative [ 68Ga]Ga-DOTA-TATE PET/CT imaging is prognostic for progression-free survival in meningioma WHO grade 1. Eur J Nucl Med Mol Imaging 2023; 51:206-217. [PMID: 37642702 PMCID: PMC10684417 DOI: 10.1007/s00259-023-06400-3] [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: 04/23/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Tumor resection represents the first-line treatment for symptomatic meningiomas, and the extent of resection has been shown to be of prognostic importance. Assessment of tumor remnants with somatostatin receptor PET proves to be superior to intraoperative estimation with Simpson grading or MRI. In this preliminary study, we evaluate the prognostic relevance of postoperative PET for progression-free survival in meningiomas. METHODS We conducted a post hoc analysis on a prospective patient cohort with resected meningioma WHO grade 1. Patients received postoperative MRI and [68Ga]Ga-DOTA-TATE PET/CT and were followed regularly with MRI surveillance scans for detection of tumor recurrence/progression. RESULTS We included 46 patients with 49 tumors. The mean age at diagnosis was 57.8 ± 1.7 years with a male-to-female ratio of 1:1.7. Local tumor progression occurred in 7/49 patients (14%) after a median follow-up of 52 months. Positive PET was associated with an increased risk for progression (*p = 0.015) and a lower progression-free survival (*p = 0.029), whereas MRI was not. 20 out of 20 patients (100%) with negative PET findings remained recurrence-free. The location of recurrence/progression on MRI was adjacent to regions where postoperative PET indicated tumor remnants in all cases. Gross tumor volumes were higher on PET compared to MRI (*p = 0.032). CONCLUSION Our data show that [68Ga]Ga-DOTA-TATE PET/CT is highly sensitive in revealing tumor remnants in patients with meningioma WHO grade 1. Negative PET findings were associated with a higher progression-free survival, thus improving surveillance. In patients with tumor remnants, additional PET can optimize adjuvant radiotherapy target planning of surgically resected meningiomas.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Annamaria Biczok
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Franziska J Dekorsy
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Raphael Bodensohn
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Bavarian Center for Cancer Research (BZKF), Erlangen, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Nathalie L Albert
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Moritz Ueberschaer
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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7
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Teske N, Tonn JC, Karschnia P. How to evaluate extent of resection in diffuse gliomas: from standards to new methods. Curr Opin Neurol 2023; 36:564-570. [PMID: 37865849 DOI: 10.1097/wco.0000000000001212] [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] [Indexed: 10/23/2023]
Abstract
PURPOSE OF REVIEW Maximal safe tumor resection represents the current standard of care for patients with newly diagnosed diffuse gliomas. Recent efforts have highlighted the prognostic value of extent of resection measured as residual tumor volume in patients with isocitrate dehydrogenase (IDH)-wildtype and -mutant gliomas. Accurate assessment of such information therefore appears essential in the context of clinical trials as well as patient management. RECENT FINDINGS Current recommendations for evaluation of extent of resection rest upon standardized postoperative MRI including contrast-enhanced T1-weighted sequences, T2-weighted/fluid-attenuated-inversion-recovery sequences, and diffusion-weighted imaging to differentiate postoperative tumor volumes from ischemia and nonspecific imaging findings. In this context, correct timing of postoperative imaging within the postoperative period is of utmost importance. Advanced MRI techniques including perfusion-weighted MRI and MR-spectroscopy may add further insight when evaluating residual tumor remnants. Positron emission tomography (PET) using amino acid tracers proves beneficial in identifying metabolically active tumor beyond anatomical findings on conventional MRI. SUMMARY Future efforts will have to refine recommendations on postoperative assessment of residual tumor burden in respect to differences between IDH-wildtype and -mutant gliomas, and incorporate the emerging role of advanced imaging modalities like amino acid PET.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, LMU University Hospital, LMU Munich
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, LMU Munich
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, LMU University Hospital, LMU Munich
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
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Albert NL, Nelwan DV, Fleischmann DF, Quach S, von Rohr K, Kaiser L, Teske N, Unterrainer LM, Bartos LM, Ruf VC, Brendel M, Riemenschneider MJ, Wetzel C, Herms J, Rupprecht R, Thon N, Tonn JC, Belka C, Bartenstein P, von Baumgarten L, Niyazi M, Unterrainer M, Holzgreve A. Prognostic Value of TSPO PET Before Radiotherapy in Newly Diagnosed IDH-Wild-Type Glioblastoma. J Nucl Med 2023; 64:1519-1525. [PMID: 37536737 PMCID: PMC10586482 DOI: 10.2967/jnumed.122.265247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/23/2022] [Revised: 05/31/2023] [Indexed: 08/05/2023] Open
Abstract
The 18-kDa translocator protein (TSPO) is gaining recognition as a relevant target in glioblastoma imaging. However, data on the potential prognostic value of TSPO PET imaging in glioblastoma are lacking. Therefore, we investigated the association of TSPO PET imaging results with survival outcome in a homogeneous cohort of glioblastoma patients. Methods: Patients were included who had newly diagnosed, histologically confirmed isocitrate dehydrogenase (IDH)-wild-type glioblastoma with available TSPO PET before either normofractionated radiotherapy combined with temozolomide or hypofractionated radiotherapy. SUVmax on TSPO PET, TSPO binding affinity status, tumor volumes on MRI, and further clinical data, such as O 6-alkylguanine DNA methyltransferase (MGMT) and telomerase reverse transcriptase (TERT) gene promoter mutation status, were correlated with patient survival. Results: Forty-five patients (median age, 63.3 y) were included. Median SUVmax was 2.2 (range, 1.0-4.7). A TSPO PET signal was associated with survival: High uptake intensity (SUVmax > 2.2) was related to significantly shorter overall survival (OS; 8.3 vs. 17.8 mo, P = 0.037). Besides SUVmax, prognostic factors for OS were age (P = 0.046), MGMT promoter methylation status (P = 0.032), and T2-weighted MRI volume (P = 0.031). In the multivariate survival analysis, SUVmax in TSPO PET remained an independent prognostic factor for OS (P = 0.023), with a hazard ratio of 2.212 (95% CI, 1.115-4.386) for death in cases with a high TSPO PET signal (SUVmax > 2.2). Conclusion: A high TSPO PET signal before radiotherapy is associated with significantly shorter survival in patients with newly diagnosed IDH-wild-type glioblastoma. TSPO PET seems to add prognostic insights beyond established clinical parameters and might serve as an informative tool as clinicians make survival predictions for patients with glioblastoma.
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Affiliation(s)
- Nathalie L Albert
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Bavarian Cancer Research Center, Erlangen, Germany
| | - Debie V Nelwan
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Daniel F Fleischmann
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Katharina von Rohr
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lena Kaiser
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Nico Teske
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lena M Unterrainer
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Laura M Bartos
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Viktoria C Ruf
- Institute of Neuropathology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Matthias Brendel
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- SyNergy, University of Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
| | | | - Christian Wetzel
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; and
| | - Jochen Herms
- Institute of Neuropathology, Faculty of Medicine, LMU Munich, Munich, Germany
- SyNergy, University of Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, Munich, Germany
| | - Rainer Rupprecht
- Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany; and
| | - Niklas Thon
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Joerg-Christian Tonn
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Bavarian Cancer Research Center, Erlangen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- SyNergy, University of Munich, Munich, Germany
| | - Louisa von Baumgarten
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Bavarian Cancer Research Center, Erlangen, Germany
- Department of Neurosurgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Bavarian Cancer Research Center, Erlangen, Germany
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Marcus Unterrainer
- German Cancer Consortium, Partner Site Munich, German Cancer Research Center, Munich, Germany
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Adrien Holzgreve
- Department of Nuclear Medicine, LMU University Hospital, LMU Munich, Munich, Germany;
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9
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Karschnia P, Dono A, Young JS, Juenger ST, Teske N, Häni L, Sciortino T, Mau CY, Bruno F, Nunez L, Morshed RA, Haddad AF, Weller M, van den Bent M, Beck J, Hervey-Jumper S, Molinaro AM, Tandon N, Rudà R, Vogelbaum MA, Bello L, Schnell O, Grau SJ, Chang SM, Berger MS, Esquenazi Y, Tonn JC. Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection: A report of the RANO resect group. Neuro Oncol 2023; 25:1672-1685. [PMID: 37253096 PMCID: PMC10479742 DOI: 10.1093/neuonc/noad074] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm3 residual CE tumor was associated with longer survival than non-surgical management. Accordingly, "maximal resection" (class 2) had superior survival compared to "submaximal resection" (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, "supramaximal resection" of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Antonio Dono
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Jacob S Young
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | | | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - Levin Häni
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Tommaso Sciortino
- Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Christine Y Mau
- Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Italy
| | - Luis Nunez
- Department of Diagnostic and Interventional Imaging, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Ramin A Morshed
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Alexander F Haddad
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Martin van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Juergen Beck
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Shawn Hervey-Jumper
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Annette M Molinaro
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Italy
| | | | - Lorenzo Bello
- Division of Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
- Klinikum Fulda, Academic Hospital of Marburg University, Klinikum, Fulda, Germany
| | - Susan M Chang
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Mitchel S Berger
- Department of Neurosurgery and Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
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10
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Karschnia P, Young J, Ostorga AGD, Häni L, Sciortino T, Bruno F, Jünger ST, Teske N, Morshed RA, Haddad AF, Zhang Y, Stöcklein S, Weller M, Vogelbaum MA, Beck J, Tandon N, Hervey-Jumper SL, Molinaro A, Rudà R, Bello L, Schnell O, Esquenazi Y, Ruge MI, Grau SJ, Berger M, Chang SM, van den Bent M, Tonn JC. 215 Extent of Resection in Glioblastoma: Prognostic Validation of a New Classification from the RANO Resect Group. Neurosurgery 2023. [DOI: 10.1227/neu.0000000000002375_215] [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: 03/18/2023] Open
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11
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Zigler CK, Lin L, Ardalan K, Jacobe H, Lane S, Li SC, Luca NJC, Prajapati VH, Schollaert K, Teske N, Torok K. Cross-sectional quantitative validation of the pediatric Localized Scleroderma Quality of Life Instrument (LoSQI): A disease-specific patient-reported outcome measure. J Eur Acad Dermatol Venereol 2023. [PMID: 36950970 DOI: 10.1111/jdv.19059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND The Localized Scleroderma Quality of Life Instrument (LoSQI) is a disease-specific patient-reported outcome (PRO) measure designed for children and adolescents with localized scleroderma (LS; morphea). This tool was developed using rigorous PRO methods and previously cognitively tested in a sample of pediatric patients with LS. OBJECTIVE The purpose of this study was to evaluate the psychometric properties of the LoSQI in a clinical setting. METHODS Cross-sectional data from four specialized clinics in the US and Canada were included in the analysis. Evaluation included reliability of scores, internal structure of the survey, evidence of convergent and divergent validity, and test-retest reliability. RESULTS One-hundred ten patients with LS (age: 8-20 years) completed the LoSQI. Both exploratory and confirmatory factor analysis supported the use of two sub-scores: Pain & Physical Functioning and Body Image & Social Support. Correlations with other PRO measures were consistent with pre-specified hypotheses. LIMITATIONS This study did not evaluate longitudinal validity or responsiveness of scores. CONCLUSION Results from a representative sample of children and adolescents with LS continue to support the validity of the LoSQI when used in a clinical setting. Future work to evaluate the responsiveness is ongoing.
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Affiliation(s)
- C K Zigler
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - L Lin
- Duke University School of Medicine, Department of Population Health Sciences, Durham, NC, USA
| | - K Ardalan
- Duke University School of Medicine, Department of Pediatrics, Durham, NC, USA
- Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Departments of Pediatrics and Medical Social Sciences, Chicago, IL, USA
| | - H Jacobe
- UT Southwestern Medical Center, Department of Dermatology, Dallas, TX, USA
| | - S Lane
- University of Pittsburgh, School of Education, Pittsburgh, PA, USA
| | - S C Li
- Joseph M. Sanzari Children's Hospital, Hackensack Meridian School of Medicine, Department of Pediatrics, Hackensack, NJ, USA
| | - N J C Luca
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada
| | - V H Prajapati
- Section of Pediatric Rheumatology, Department of Pediatrics, Calgary, AB, Canada
- Section of Community Pediatrics, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
- Division of Dermatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Dermatology Research Institute, Calgary, AB, Canada
- Skin Health & Wellness Centre, Calgary, AB, Canada
- Probity Medical Research, Calgary, AB, Canada
| | - K Schollaert
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
| | - N Teske
- Oregon Health & Science University School of Medicine, Department of Dermatology, OR, USA
| | - K Torok
- University of Pittsburgh, School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
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12
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Teske N, Teske NC, Niyazi M, Belka C, Thon N, Tonn JC, Forbrig R, Karschnia P. Frequency and Prognostic Relevance of Volumetric MRI Changes in Contrast- and Non-Contrast-Enhancing Tumor Compartments between Surgery and Radiotherapy of IDHwt Glioblastoma. Cancers (Basel) 2023; 15:cancers15061745. [PMID: 36980633 PMCID: PMC10046652 DOI: 10.3390/cancers15061745] [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: 12/31/2022] [Revised: 02/23/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
In newly diagnosed IDH-wildtype glioblastoma, the frequency and prognostic relevance of tumor regrowth between resection and the initiation of adjuvant radiochemotherapy are unclear. In this retrospective single-center study we included 64 consecutive cases, for whom magnetic resonance imaging (MRI) was available for both the volumetric assessment of the extent of resection immediately after surgery as well as the volumetric target delineation before the initiation of adjuvant radiochemotherapy (time interval: 15.5 ± 1.9 days). Overall, a median new contrast-enhancement volume was seen in 21/64 individuals (33%, 1.5 ± 1.5 cm3), and new non-contrast lesion volume in 18/64 patients (28%, 5.0 ± 2.3 cm3). A multidisciplinary in-depth review revealed that new contrast-enhancement was either due to (I) the progression of contrast-enhancing tumor remnants in 6/21 patients or (II) distant contrast-enhancing foci or breakdown of the blood–brain barrier in previously non-contrast-enhancing tumor remnants in 5/21 patients, whereas it was unspecific or due to ischemia in 10/21 patients. For non-contrast-enhancing lesions, three of eighteen had progression of non-contrast-enhancing tumor remnants and fifteen of eighteen had unspecific changes or changes due to ischemia. There was no significant association between findings consistent with tumor regrowth and a less favorable outcome (overall survival: 14 vs. 19 months; p = 0.423). These findings support the rationale that analysis of the postsurgical remaining tumor-volume for prognostic stratification should be carried out on immediate postoperative MRI (<72 h), as unspecific changes are common. However, tumor regrowth including distant foci may occur in a subset of IDH-wildtype glioblastoma patients diagnosed per WHO 2021 classification. Thus, MRI imaging prior to radiotherapy should be obtained to adjust radiotherapy planning accordingly.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
- Correspondence: (N.T.); (P.K.); Tel.: +49-(0)89-4400-711361 (N.T.); +49-(0)89-4400-711365 (P.K.); Fax: +49-(0)89-4400-72592 (N.T. & P.K.)
| | - Nina C. Teske
- Department of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
- Department of Radiation Oncology, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- Bavarian Center for Cancer Research (BZKF), 91054 Erlangen, Germany
| | - Claus Belka
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
- Department of Radiation Oncology, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- Bavarian Center for Cancer Research (BZKF), 91054 Erlangen, Germany
| | - Niklas Thon
- Department of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, Munich University Hospital, LMU Munich, 81377 Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, Munich University Hospital, LMU Munich, 81377 Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany
- Correspondence: (N.T.); (P.K.); Tel.: +49-(0)89-4400-711361 (N.T.); +49-(0)89-4400-711365 (P.K.); Fax: +49-(0)89-4400-72592 (N.T. & P.K.)
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13
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Teske N, Chiquillo-Domínguez M, Skrap B, Harter PN, Rejeski K, Blobner J, von Baumgarten L, Tonn JC, Kunz M, Thon N, Karschnia P. Shunt dependency in supratentorial intraventricular tumors depends on the extent of tumor resection. Acta Neurochir (Wien) 2023; 165:1053-1064. [PMID: 36862214 PMCID: PMC10068640 DOI: 10.1007/s00701-023-05532-7] [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: 12/01/2022] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Supratentorial intraventricular tumors (SIVTs) are rare lesions of various entities characteristically presenting with hydrocephalus and often posing a surgical challenge due to their deep-seated localization. We aimed to elaborate on shunt dependency after tumor resection, clinical characteristics, and perioperative morbidity. METHODS We retrospectively searched the institutional database for patients with supratentorial intraventricular tumors treated at the Department of Neurosurgery of the Ludwig-Maximilians-University in Munich, Germany, between 2014 and 2022. RESULTS We identified 59 patients with over 20 different SIVT entities, most often subependymoma (8/59 patients, 14%). Mean age at diagnosis was 41 ± 3 years. Hydrocephalus and visual symptoms were observed in 37/59 (63%) and 10/59 (17%) patients, respectively. Microsurgical tumor resection was provided in 46/59 patients (78%) with complete resection in 33/46 patients (72%). Persistent postoperative neurological deficits were encountered in 3/46 patients (7%) and generally mild in nature. Complete tumor resection was associated with less permanent shunting in comparison to incomplete tumor resection, irrespective of tumor histology (6% versus 31%, p = 0.025). Stereotactic biopsy was utilized in 13/59 patients (22%), including 5 patients who received synchronous internal shunt implantation for symptomatic hydrocephalus. Median overall survival was not reached and did not differ between patients with or without open resection. CONCLUSIONS SIVT patients display a high risk of developing hydrocephalus and visual symptoms. Complete resection of SIVTs can often be achieved, preventing the need for long-term shunting. Stereotactic biopsy along with internal shunting represents an effective approach to establish diagnosis and ameliorate symptoms if resection cannot be safely performed. Due to the rather benign histology, the outcome appears excellent when adjuvant therapy is provided.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | | | - Benjamin Skrap
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, University Hospital, LMU Munich, Munich, Germany
| | - Kai Rejeski
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Medicine III, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Blobner
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Mathias Kunz
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
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14
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Xu T, Karschnia P, Cadilha BL, Dede S, Lorenz M, Seewaldt N, Nikolaishvili E, Müller K, Blobner J, Teske N, Herold JJ, Rejeski K, Langer S, Obeck H, Lorenzini T, Mulazzani M, Zhang W, Ishikawa-Ankerhold H, Buchholz VR, Subklewe M, Thon N, Straube A, Tonn JC, Kobold S, von Baumgarten L. In vivo dynamics and anti-tumor effects of EpCAM-directed CAR T-cells against brain metastases from lung cancer. Oncoimmunology 2023; 12:2163781. [PMID: 36687005 PMCID: PMC9851202 DOI: 10.1080/2162402x.2022.2163781] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Lung cancer patients are at risk for brain metastases and often succumb to their intracranial disease. Chimeric Antigen Receptor (CAR) T-cells emerged as a powerful cell-based immunotherapy for hematological malignancies; however, it remains unclear whether CAR T-cells represent a viable therapy for brain metastases. Here, we established a syngeneic orthotopic cerebral metastasis model in mice by combining a chronic cranial window with repetitive intracerebral two-photon laser scanning-microscopy. This approach enabled in vivo-characterization of fluorescent CAR T-cells and tumor cells on a single-cell level over weeks. Intraparenchymal injection of Lewis lung carcinoma cells (expressing the tumor cell-antigen EpCAM) was performed, and EpCAM-directed CAR T-cells were injected either intravenously or into the adjacent brain parenchyma. In mice receiving EpCAM-directed CAR T-cells intravenously, we neither observed substantial CAR T-cell accumulation within the tumor nor relevant anti-tumor effects. Local CAR T-cell injection, however, resulted in intratumoral CAR T-cell accumulation compared to controls treated with T-cells lacking a CAR. This finding was accompanied by reduced tumorous growth as determined per in vivo-microscopy and immunofluorescence of excised brains and also translated into prolonged survival. However, the intratumoral number of EpCAM-directed CAR T-cells decreased during the observation period, pointing toward insufficient persistence. No CNS-specific or systemic toxicities of EpCAM-directed CAR T-cells were observed in our fully immunocompetent model. Collectively, our findings indicate that locally (but not intravenously) injected CAR T-cells may safely induce relevant anti-tumor effects in brain metastases from lung cancer. Strategies improving the intratumoral CAR T-cell persistence may further boost the therapeutic success.
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Affiliation(s)
- Tao Xu
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany,CONTACT Philipp Karschnia
| | - Bruno Loureiro Cadilha
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sertac Dede
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Lorenz
- Department of Medicine I, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Niklas Seewaldt
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Elene Nikolaishvili
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Katharina Müller
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jens Blobner
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Nico Teske
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Julika J. Herold
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Kai Rejeski
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany,Department of Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sigrid Langer
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hannah Obeck
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Theo Lorenzini
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Matthias Mulazzani
- Immunology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Wenlong Zhang
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hellen Ishikawa-Ankerhold
- Department of Medicine I, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Veit R. Buchholz
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universitaet Muenchen (TUM), Munich, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Sebastian Kobold
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,Department of Neurosurgery, University Hospital of the Ludwig-Maximilians-University Munich, Munich, Germany,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany,Louisa von Baumgarten Department of Neurosurgery, Division of Neuro-Oncology, University Hospital of the Ludwig-Maximilians-University Munich, Marchioninistrasse 15/81377, Munich, Germany
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15
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Blobner J, Dengler L, Blobner S, Eberle C, Weller J, Teske N, Karschnia P, Rühlmann K, Heinrich K, Ziemann F, Greif PA, Jeremias I, Wuerstlein R, Hasselmann K, Dorostkar M, Harter PN, Quach S, Stoecklein V, Albert NL, Niyazi M, Tonn JC, Thon N, Christoph Westphalen B, von Baumgarten L. Significance of molecular diagnostics for therapeutic decision-making in recurrent glioma. Neurooncol Adv 2023; 5:vdad060. [PMID: 37287694 PMCID: PMC10243988 DOI: 10.1093/noajnl/vdad060] [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: 06/09/2023] Open
Abstract
Background Targeted therapies have substantially improved survival in cancer patients with malignancies outside the brain. Whether in-depth analysis for molecular alterations may also offer therapeutic avenues in primary brain tumors remains unclear. We herein present our institutional experience for glioma patients discussed in our interdisciplinary molecular tumor board (MTB) implemented at the Comprehensive Cancer Center Munich (LMU). Methods We retrospectively searched the database of the MTB for all recurrent glioma patients after previous therapy. Recommendations were based on next-generation sequencing results of individual patient's tumor tissue. Clinical and molecular information, previous therapy regimens, and outcome parameters were collected. Results Overall, 73 consecutive recurrent glioma patients were identified. In the median, advanced molecular testing was initiated with the third tumor recurrence. The median turnaround time between initiation of molecular profiling and MTB case discussion was 48 ± 75 days (range: 32-536 days). Targetable mutations were found for 50 recurrent glioma patients (68.5%). IDH1 mutation (27/73; 37%), epidermal growth factor receptor amplification (19/73; 26%), and NF1 mutation (8/73; 11%) were the most detected alterations and a molecular-based treatment recommendation could be made for all of them. Therapeutic recommendations were implemented in 12 cases (24%) and one-third of these heavily pretreated patients experienced clinical benefit with at least disease stabilization. Conclusions In-depth molecular analysis of tumor tissue may guide targeted therapy also in brain tumor patients and considerable antitumor effects might be observed in selected cases. However, future studies to corroborate our results are needed.
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Affiliation(s)
- Jens Blobner
- Jens Blobner, MD, Department of Neurosurgery, Division of Neuro-Oncology, Ludwigs Maximilians University School of Medicine, 81377 Munich, Germany ()
| | - Laura Dengler
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Sven Blobner
- MedicalFaculty Heidelberg, University of Heidelberg, Heidelburg, Germany
| | - Constantin Eberle
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Nico Teske
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Katharina Rühlmann
- Comprehensive Cancer Center München (CCC München), LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Kathrin Heinrich
- Department of Medicine, Hematology and Oncology Division and Cellular Immunotherapy Program, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Frank Ziemann
- Department of Medicine, Hematology and Oncology Division and Cellular Immunotherapy Program, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Philipp A Greif
- Department of Medicine, Hematology and Oncology Division and Cellular Immunotherapy Program, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Irmela Jeremias
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Dr. von Haunersches Children Hospital, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Rachel Wuerstlein
- Department of Obstetrics and Gynecology and CCC Munich LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Korbinian Hasselmann
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology and Oncology Division and Cellular Immunotherapy Program, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- Comprehensive Cancer Center München (CCC München), LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Mario Dorostkar
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Comprehensive Cancer Center München (CCC München), LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- Center for Neuropathology and Prion Research, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Patrick N Harter
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Comprehensive Cancer Center München (CCC München), LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Stefanie Quach
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Veit Stoecklein
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Benedikt Christoph Westphalen
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology and Oncology Division and Cellular Immunotherapy Program, LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- Comprehensive Cancer Center München (CCC München), LMU University Hospital, Ludwig Maximilians University (LMU), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Erlangen, Germany
| | - Louisa von Baumgarten
- Corresponding Authors: Louisa von Baumgarten, MD, Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, 81377 Munich, Germany ()
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16
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Teske N, Chiquillo-Domínguez M, Skrap B, von Baumgarten L, Kunz M, Tonn JC, Thon N, Karschnia P. SURG-39. SURGICAL RESULTS AND LONG-TERM OUTCOME IN SUPRATENTORIAL INTRAVENTRICULAR TUMORS. Neuro Oncol 2022. [PMCID: PMC9661220 DOI: 10.1093/neuonc/noac209.1003] [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
Intraventricular tumors (IVTs) are rare lesions of various entities, which pose a surgical challenge. We aimed to elaborate on surgical approaches and outcomes, postoperative morbidity, and elucidate whether preoperative hydrocephalus necessitates shunting despite surgical resection.
METHODS
We retrospectively searched the institutional database for patients with supratentorial intraventricular tumours that were treated in the Department of Neurosurgery of the Ludwig-Maximilians-University Munich, Germany between 2014 and 2022.
RESULTS
We identified 59 patients with supratentorial intraventricular tumors comprising over 15 different tumor entities, most often subependymoma (8/59 patients, 14%). Median age at diagnosis was 41.4 years (range 0-86 years) with 31 male patients (53%) and 28 female patients (48%). Microsurgical tumor resection was completed in 46/59 patients (78%) with incomplete tumor resection (≥ 1ml postoperative tumor volume) in 13/46 patients (28%) and complete tumor resection (< 1ml postoperative tumor volume) in 33/46 patients (72%). In cases where neurosurgical tumor resection was not feasible, stereotactic biopsy was provided in 13/59 patients (22%), often combined with stereotactic internal shunt implantation (5/59 patients, 8%). Mean follow-up was 24 months; median overall survival was not reached. Postoperative persistent hydrocephalus necessitating ventriculoperitoneal shunt placement was rare (5/59 patients, 8%). Ventriculocisternostomy was performed in one patient. New postoperative focal neurological deficits – mostly transient – were encountered in 16/59 patients (27%) at discharge with mild to moderate permanent focal neurological deficits at 3 months in 3/59 patients (5%).
CONCLUSION
Complete resection of IVT can often be achieved and forms the basis for favourable outcome. Permanent neurological deficits are rare, and hydrocephalus can almost always be alleviated which prevents the need for long-term shunting. If microsurgical resection is not feasible, stereotactic biopsy along with internal shunting represents an effective approach to establish diagnosis and ameliorate symptoms.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | | | - Benjamin Skrap
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Mathias Kunz
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
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17
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Xu T, Karschnia P, Cadilha B, Dede S, Lorenz M, Seewaldt N, Nikolaishvili E, Müller K, Blobner J, Teske N, Langer S, Obeck H, Lorenzini T, Mulazzani M, Zhang W, Ishikawa-Ankerhold H, Buchholz VR, Subklewe M, Thon N, Straube A, Tonn JC, Kobold S, von Baumgarten L. EXTH-02. ANTI-TUMOR EFFECTS AND IN VIVO DYNAMICS OF EPCAM-DIRECTED CAR T-CELLS FOR BRAIN METASTASES FROM LUNG CANCER. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.801] [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
Lung cancer patients are at a high risk for brain metastases, and affected patients frequently succumb to their intracranial disease. Chimeric Antigen Receptor (CAR) T-cells emerged as a powerful cell-based immunotherapy for hematological malignancies; however, it remains unclear whether CAR T-cells represent a viable therapeutic avenue for brain metastases.
METHODS
A fully immunocompetent, orthotopic cerebral metastasis model was established in mice by combining a chronic cranial window with repetitive intracerebral two-photon laser scanning microscopy. This approach enabled the in vivo-characterization of fluorescent CAR T-cells and tumor cells on a single-cell level over weeks. Intraparenchymal injection of EpCAM-expressing Lewis lung carcinoma cells was performed, and EpCAM-directed CAR T-cells (EpCAMCAR T-cells) were injected into the adjacent brain parenchyma after brain tumor formation.
RESULTS
All mice had visible tumor take with rapidly growing lesions following intracranial tumor cell injection. In mice treated with EpCAMCAR T-cells, we observed substantial CAR T-cell accumulation within the tumor compared to controls treated with undirected T-cells. This was paralleled by lower velocities of EpCAMCAR T-cells, characterizing antitumor cytotoxicity due to ‘immune cell’-‘tumor cell’ contacts. Consequently, treatment with EpCAMCAR T-cells resulted in reduced tumorous growth as determined per in vivo-microscopy (median tumor area on day 10: 1.8 versus 10.8 mm2; p=0.001) and immunohistochemistry of excised brains. However, the number of intratumoral EpCAMCAR T-cells within the tumor markedly decreased during the observation period, pointing towards insufficient persistence. Accordingly, survival was prolonged in mice receiving EpCAMCAR T-cells but long-lasting remission was rare (median survival: 15 versus 13 days; p=0.012). No CNS-specific or systemic toxicities of EpCAMCAR T-cells were encountered.
CONCLUSION
Our findings indicate that EpCAMCAR T-cells injected into the cerebral parenchyma may safely induce relevant anti-tumor effects in brain metastases from lung cancer. Strategies improving the CAR T-cell persistence within brain metastases are warranted to further boost the therapeutic success.
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Affiliation(s)
- Tao Xu
- The first authors contributed equally to the manuscript; Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Bruno Cadilha
- The first authors contributed equally to the manuscript; Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Sertac Dede
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Michael Lorenz
- Department of Medicine I, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Niklas Seewaldt
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Elene Nikolaishvili
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Katharina Müller
- Department of Neurology, Ludwig-Maximilians-University , Munich , Germany
| | - Jens Blobner
- Department of Neurosurgery, University Hospital Munich, LMU Munich, Germany , Munich , Germany
| | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Sigrid Langer
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Hannah Obeck
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Theo Lorenzini
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Matthias Mulazzani
- Immunology Division, Walter and Eliza Hall Institute of Medical Research , Parkville , Australia
| | - Wenlong Zhang
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | | | - Veit R Buchholz
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität Muenchen (TUM) , Munich , Germany
| | - Marion Subklewe
- Department of Medicine III, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Sebastian Kobold
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich , Munich , Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
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18
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Karschnia P, Young JS, Dono A, Häni L, Sciortino T, Bruno F, Jünger ST, Teske N, Morshed RA, Haddad AF, Zhang Y, Stöcklein S, Weller M, Vogelbaum M, Beck J, Tandon N, Hervey-Jumper SL, Molinaro A, Rudà R, Bello L, Schnell O, Esquenazi Y, Ruge MI, Grau SJ, Berger MS, Chang SM, van den Bent M, Tonn JC. SURG-19. PROGNOSTIC VALIDATION OF A NEW CLASSIFICATION SYSTEM FOR EXTENT OF RESECTION IN GLIOBLASTOMA: A REPORT OF THE RANO RESECT GROUP. Neuro Oncol 2022. [PMCID: PMC9660805 DOI: 10.1093/neuonc/noac209.985] [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
Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (I) explore the prognostic utility of the classification system and (II) define how much removed non-CE tumor translates into a survival benefit.
METHODS
The international RANO resect group retrospectively searched the databases from seven neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and post-operative MRI were collected.
RESULTS
We collected 1021 patients with newly diagnosed glioblastoma, including 1008 IDHwt patients. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC 26981/22981 (TMZ/RT→TMZ) following surgery. Among such homogenously treated patients, lower absolute residual tumor volumes (in cm3) were favorably associated with outcome: patients with ‘maximal CE resection’ (class 2) had superior outcome compared to patients with ‘submaximal CE resection’ (class 3) or ‘biopsy’ (class 4) (median OS: 19 versus 15 versus 10 months; p=0.001). Extensive resection of non-CE tumor (≤ 5 cm3 residual non-CE tumor) provided an additional survival benefit in patients with complete CE resection, thus defining class 1 (‘supramaximal CE resection’) (median OS: 24 versus 19 months; p=0.008). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers including MGMT promotor status. Relative tumor reduction (in percentage) was not prognostic for outcome on multivariate analysis, and inter-rater agreement for CE and non-CE tumor on post-operative MRI was sufficient.
CONCLUSION
The proposed “RANO categories for extent of resection in glioblastoma” are highly prognostic and may serve for stratification of clinical trials. Removal of non-CE tumor beyond the CE tumor borders translates into additional survival benefit, providing a rationale to explicitly denominate such a ‘supramaximal CE resection’.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Jacob S Young
- University of California San Francisco , San Francisco, CA , USA
| | - Antonio Dono
- Department of Neurosurgery, University of Texas , Houston, TX , USA
| | - Levin Häni
- Department of Neurosurgery, University of Freiburg , Freiburg , Germany
| | - Tommaso Sciortino
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan , Milan , Italy
| | - Francesco Bruno
- Department of Neurology, Castelfranco Veneto/Treviso Hospitals , Turin , Italy
| | | | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
| | - Ramin A Morshed
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco , San Francisco, CA , USA
| | - Alexander F Haddad
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco , San Francisco, CA , USA
| | - Yalan Zhang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco , San Francisco, CA , USA
| | - Sophia Stöcklein
- Department of Radiology, Ludwig-Maximilians-University , Munich , Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich , Zurich , Switzerland
| | - Michael Vogelbaum
- Department of NeuroOncology, Moffitt Cancer Center , Tampa, FL , USA
| | - Juergen Beck
- Department of Neurosurgery, University of Freiburg , Freiburg , Germany
| | - Nitin Tandon
- Department of Neurosurgery, University of Texas , Houston, TX , USA
| | | | | | - Roberta Rudà
- Department of Neurology, Castelfranco Veneto/Treviso Hospitals , Turin , Italy
| | - Lorenzo Bello
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan , Milan , Italy
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg , Freiburg , Germany
| | - Yoshua Esquenazi
- Department of Neurosurgery, University of Texas , Houston, TX , USA
| | - Maximilian I Ruge
- Department of Neurosurgery, University of Cologne , Cologne , Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne , Cologne , Germany
| | - Mitchel S Berger
- University of California, San Francisco , San Francisco, CA , USA
| | - Susan M Chang
- University of California, San Francisco , San Francisco, CA , USA
| | | | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine , Munich , Germany
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19
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Xu T, Karschnia P, Cadilha B, Dede S, Lorenz M, Seewaldt N, Nikolaishvili E, Müller K, Blobner J, Teske N, Langer S, Obeck H, Lorenzini T, Mulazzani M, Zhang W, Ishikawa-Ankerhold H, Buchholz VR, Subklewe M, Thon N, Straube A, Tonn J, Kobold S, von Baumgarten L. OS03.4.A In vivo dynamics and anti-tumor effects of EpCAM-directed CAR T-cells against brain metastases from lung cancer. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.036] [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
Background
Lung cancer patients are at a particularly high risk for brain metastases, and a considerable number of affected patients succumb due to their intracranial disease. Chimeric Antigen Receptor (CAR) T-cells emerged as a powerful class of cell-based immunotherapy for hematological malignancies. However, it remains unclear whether CAR T-cells also represent a safe and effective therapeutic option for brain metastases.
Material and Methods
A fully syngeneic orthotopic cerebral metastasis model in mice was established by combining a chronic cranial window with repetitive intracerebral two-photon laser scanning microscopy. This approach enabled the in vivo characterization of red fluorescent CAR T-cells and tumor cells on a single-cell level over weeks. Intraparenchymal injection of Lewis lung carcinoma cells (expressing the tumor cell-antigen EpCAM) was performed, and CAR T-cells directed against EpCAM (EpCAMCAR T-cells) were injected into the adjacent brain parenchyma after solid brain tumors have formed.
Results
All mice had visible tumor take four days after the intracranial tumor cell injection, and rapid growth of solitary lesions was seen in the following days. No toxicities mediated by intracranially injected EpCAMCAR T-cells were encountered. In mice treated with EpCAMCAR T-cells, we initially observed substantial CAR T-cell accumulation within the tumor compared to controls (median number: 1700 versus 939 cells/mm2; p = 0.007). This was paralleled by lower velocities of EpCAMCAR T-cells, characterizing T-cell receptor (TCR)-mediated antitumor cytotoxicity due to long-lasting contacts between effector immune cells and tumor cells. Consequently, treatment with EpCAMCAR T-cells resulted in reduced tumorous growth as determined per in vivo microscopy (median tumor area on day 10: 1.8 versus 10.8 mm2; p = 0.001) and immunohistochemistry of excised brains (median tumor volume on day 10: 3.6 versus 33.2 mm3; p = 0.001). However, the number of EpCAM-directed CAR T-cells within the tumor markedly decreased during the observation period, pointing towards insufficient persistence of EpCAM-directed CAR T-cells. In line with these findings, survival was prolonged in mice receiving EpCAMCAR T-cells but long-lasting remission was rare (median survival: 15 versus 13 days; p = 0.012).
Conclusion
Our findings indicate that CAR T-cells injected into the cerebral parenchyma may induce relevant anti-tumor effects in brain metastases from lung cancer. Due to the translational nature of our study, prospective clinical cohorts appear warranted. Strategies improving the intratumoral persistence of CAR T-cells in brain metastases may be utilized to further boost the success of such promising therapy.
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Affiliation(s)
- T Xu
- The first authors contributed equally , Munich , Germany
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - P Karschnia
- The first authors contributed equally , Munich , Germany
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , Munich , Germany
| | - B Cadilha
- The first authors contributed equally , Munich , Germany
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich , Munich , Germany
| | - S Dede
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - M Lorenz
- Department of Medicine I, Ludwig-Maximilians-University Munich , Munich , Germany
| | - N Seewaldt
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
| | - E Nikolaishvili
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
| | - K Müller
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - J Blobner
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , Munich , Germany
| | - N Teske
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
| | - S Langer
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - H Obeck
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich , Munich , Germany
| | - T Lorenzini
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich , Munich , Germany
| | - M Mulazzani
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - W Zhang
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - H Ishikawa-Ankerhold
- Department of Medicine I, Ludwig-Maximilians-University Munich , Munich , Germany
| | - V R Buchholz
- Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität Muenchen (TUM) , Munich , Germany
| | - M Subklewe
- Department of Medicine III, Ludwig-Maximilians-University Munich , Munich , Germany
| | - N Thon
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , Munich , Germany
| | - A Straube
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
| | - J Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
- German Cancer Consortium (DKTK), Partner Site Munich , Munich , Germany
| | - S Kobold
- Department of Medicine IV, Division of Clinical Pharmacology and Center of Integrated Protein Science Munich, Ludwig-Maximilians-University Munich , Munich , Germany
- The senior authors contributed equally , Munich , Germany
| | - L von Baumgarten
- Department of Neurology, Ludwig-Maximilians-University Munich , Munich , Germany
- Department of Neurosurgery, Ludwig-Maximilians-University Munich , Munich , Germany
- The senior authors contributed equally , Munich , Germany
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20
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Karschnia P, Young JS, Dono A, Häni L, Sciortino T, Bruno F, Juenger ST, Teske N, Morshed RA, Haddad AF, Zhang Y, Stoecklein S, Weller M, Vogelbaum MA, Beck J, Tandon N, Hervey-Jumper S, Molinaro AM, Rudà R, Bello L, Schnell O, Esquenazi Y, Ruge MI, Grau SJ, Berger MS, Chang SM, van den Bent M, Tonn JC. Prognostic validation of a new classification system for extent of resection in glioblastoma: a report of the RANO resect group. Neuro Oncol 2022; 25:940-954. [PMID: 35961053 PMCID: PMC10158281 DOI: 10.1093/neuonc/noac193] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [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: 06/19/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (I) explore the prognostic utility of the classification system and (II) define how much removed non-CE tumor translates into a survival benefit. METHODS The international RANO resect group retrospectively searched previously compiled databases from seven neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and post-operative MRI were collected. RESULTS We collected 1008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC 26981/22981 (TMZ/RT→TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm 3) were favorably associated with outcome: patients with 'maximal CE resection' (class 2) had superior outcome compared to patients with 'submaximal CE resection' (class 3) or 'biopsy' (class 4). Extensive resection of non-CE tumor (≤5 cm 3 residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 ('supramaximal CE resection'). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers. CONCLUSIONS The proposed "RANO categories for extent of resection in glioblastoma" are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such 'supramaximal CE resection'.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Jacob S Young
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Antonio Dono
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, United States of America
| | - Levin Häni
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Tommaso Sciortino
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Italy
| | | | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - Ramin A Morshed
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Alexander F Haddad
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Yalan Zhang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Michael A Vogelbaum
- Department of NeuroOncology, Moffitt Cancer Center, Tampa, Florida, United States of America
| | - Juergen Beck
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Nitin Tandon
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, United States of America
| | - Shawn Hervey-Jumper
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Annette M Molinaro
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Italy.,Division of Neurology, Castelfranco Veneto and Treviso Hospital, Italy
| | - Lorenzo Bello
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, United States of America
| | - Maximilian I Ruge
- Department Stereotactic and Functional Neurosurgery, Centre for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany.,Klinikum Fulda, Academic Hospital of Marburg University, Fulda, Germany
| | - Mitchel S Berger
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Susan M Chang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA, USA
| | - Martin van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Germany
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Walker A, Teske N, Zigler C, Jacobe H. 162 Validation of a patient-reported outcome measure in adults with morphea. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.169] [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: 11/29/2022]
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22
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Karschnia P, Young JS, Dono A, Häni L, Sciortino T, Bruno F, Jünger ST, Teske N, Weller M, Ruda R, Bello L, Schnell O, Esquenazi Y, Grau S, Molinaro AM, Berger MS, Chang SM, Van Den Bent MJ, Tonn J. Prognostic validation and refinement of a classification system for extent of resection in glioblastoma: A report of the RANO resect group. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.2003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2003 Background: Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system for glioblastoma was previously proposed based upon the absolute residual contrast-enhancing (CE) tumor (in cm3) and the relative reduction of CE tumor (in percentage) on postoperative MRI. Class 0 was defined as ‘supramaximal CE resection’ (also including removal of non-CE tumor), class 1 as ‘maximal CE resection’, class 2 as ‘submaximal CE resection’, and class 3 as ‘biopsy’. We aimed to (I) explore the prognostic utility of the proposed classification system and (II) define how much non-CE tumor needs to be removed to translate into a survival benefit. Methods: An international Response Assessment in Neuro-Oncology (RANO) group was formed, entitled RANO resect. The members of the RANO resect group retrospectively searched the databases from seven neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma. Clinical characteristics, volumetric information from pre- and postoperative MRI, and outcome were collected. Kaplan-Meier survival analysis and log-rank test were applied to calculate survival, and Cox’s proportional hazard regression model to adjust for multiple variables. Significance level was set at p ≤ 0.05. Results: We encountered 1021 patients with newly diagnosed glioblastoma, including 1008 IDHwt patients. 744 IDHwt patients were treated with radiochemotherapy per EORTC 26981/22981 following surgery. Among such homogenously treated patients, higher extent of resection was favorably associated with outcome: patients with ‘maximal CE resection’ (class 1) had superior outcome compared to patients with ‘submaximal CE resection’ (class 2) or ‘biopsy’ (class 3) (median OS: 20 versus 16 versus 10 months; p = 0.001). Similar findings were made when assessing progression (median PFS: 9 versus 8 versus 5 months; p = 0.001). Extensive resection of non-CE tumor (≥60% of non-CE tumor removed and ≤5 cm3 residual non-CE tumor) provided an additional survival benefit in patients with complete CE resection (class 1), thus defining class 0 (‘supramaximal CE resection’) (median OS: 29 versus 20 months; p = 0.003). Smaller pre-operative tumor volumes were associated with larger extent of resection. The favorable prognostic effect of CE resection was conserved in a multivariate analysis when stratifying for molecular and clinical markers including pre-operative tumor volume and MGMT promotor status ( p = 0.001). Conclusions: The proposed classification system for extent of surgery in glioblastoma is highly prognostic and may serve for stratification and design of clinical trials. Removal of non-CE tumor beyond the CE tumor borders translates into additional survival benefit in glioblastomas, providing a rationale to explicitly denominate such a 'supramaximal CE resection.'
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - Jacob S Young
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA
| | - Antonio Dono
- Department of Neurosurgery, University of Texas, Houston, TX
| | - Levin Häni
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Tommaso Sciortino
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Bruno
- Department of Neurology, Castelfranco Veneto/Treviso Hospitals, Turin, Italy
| | | | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roberta Ruda
- Department of Neurology, Castelfranco Veneto/Treviso Hospitals, Turin, Italy
| | - Lorenzo Bello
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | | | - Stefan Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
| | - Annette M. Molinaro
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA
| | - Mitchel S. Berger
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA
| | - Susan Marina Chang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA
| | | | - Joerg Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
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23
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Karschnia P, Young JS, Dono A, Häni L, Juenger ST, Sciortino T, Bruno F, Teske N, Morshed RA, Haddad AF, Zhang Y, Stoecklein S, Vogelbaum MA, Beck J, Tandon N, Hervey-Jumper S, Molinaro AM, Rudà R, Bello L, Schnell O, Esquenazi Y, Ruge MI, Grau SJ, van den Bent M, Weller M, Berger MS, Chang SM, Tonn JC. TERT promotor status does not add prognostic information in IDH-wildtype glioblastomas fulfilling other diagnostic WHO criteria: A report of the RANO resect group. Neurooncol Adv 2022; 4:vdac158. [PMID: 36325373 PMCID: PMC9616057 DOI: 10.1093/noajnl/vdac158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jacob S Young
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Antonio Dono
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Levin Häni
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | | | - Tommaso Sciortino
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesco Bruno
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
| | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Ramin A Morshed
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Alexander F Haddad
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Yalan Zhang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Sophia Stoecklein
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Juergen Beck
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | | | - Shawn Hervey-Jumper
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Annette M Molinaro
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy
- Division of Neurology, Castelfranco Veneto and Treviso Hospital, Treviso, Italy
| | - Lorenzo Bello
- Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Oliver Schnell
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Yoshua Esquenazi
- Department of Neurosurgery, McGovern Medical School at UT Health Houston, Houston, Texas, USA
| | - Maximilian I Ruge
- Department of Stereotactic and Functional Neurosurgery, Centre for Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Stefan J Grau
- Department of Neurosurgery, University of Cologne, Cologne, Germany
- Klinikum Fulda, Academic Hospital of Marburg University, Fulda, Germany
| | - Martin van den Bent
- Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Mitchel S Berger
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Susan M Chang
- Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California, USA
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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24
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Teske N, Karschnia P, Weller J, Siller S, Dorostkar MM, Herms J, von Baumgarten L, Tonn JC, Thon N. Extent, pattern, and prognostic value of MGMT promotor methylation: does it differ between glioblastoma and IDH-wildtype/TERT-mutated astrocytoma? J Neurooncol 2021; 156:317-327. [PMID: 34902093 PMCID: PMC8816375 DOI: 10.1007/s11060-021-03912-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/25/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022]
Abstract
Introduction The cIMPACT-NOW update 6 first introduced glioblastoma diagnosis based on the combination of IDH-wildtype (IDHwt) status and TERT promotor mutation (pTERTmut). In glioblastoma as defined by histopathology according to the WHO 2016 classification, MGMT promotor status is associated with outcome. Whether this is also true in glioblastoma defined by molecular markers is yet unclear.
Methods We searched the institutional database for patients with: (1) glioblastoma defined by histopathology; and (2) IDHwt astrocytoma with pTERTmut. MGMT promotor methylation was analysed using methylation-specific PCR and Sanger sequencing of CpG sites within the MGMT promotor region.
Results We identified 224 patients with glioblastoma diagnosed based on histopathology, and 54 patients with IDHwt astrocytoma with pTERTmut (19 astrocytomas WHO grade II and 38 astrocytomas WHO grade III). There was no difference in the number of MGMT methylated tumors between the two cohorts as determined per PCR, and also neither the number nor the pattern of methylated CpG sites differed as determined per Sanger sequencing. Progression-free (PFS) and overall survival (OS) was similar between the two cohorts when treated with radio- or chemotherapy. In both cohorts, higher numbers of methylated CpG sites were associated with favourable outcome. Conclusions Extent and pattern of methylated CpG sites are similar in glioblastoma and IDHwt astrocytoma with pTERTmut. In both tumor entities, higher numbers of methylated CpG sites appear associated with more favourable outcome. Evaluation in larger prospective cohorts is warranted.
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Affiliation(s)
- Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. .,Department of Neurosurgery, Division of Neuro-Oncology, Ludwig-Maximilians-University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Jonathan Weller
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Sebastian Siller
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Mario M Dorostkar
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Jochen Herms
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.,Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Joerg Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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Karschnia P, Xu T, Fitzinger E, Saliger JC, Blobner J, Teske N, von Muecke-Heim IA, Langer S, Konhäuser M, Ishikawa-Ankerhold H, Thon N, Tonn JC, von Baumgarten L. TAMI-02. DEPLETION OF INTRATUMORAL TUMOR-ASSOCIATED MACROPHAGES AND MICROGLIA (TAM/M) IMPROVES CHECKPOINT-INHIBITION THERAPY FOR BRAIN METASTASIS FROM LUNG CANCER. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.786] [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
Brain metastases dramatically limit prognosis of lung cancer patients. Unlike systemic disease, brain metastases from lung cancer poorly respond to checkpoint-inhibition therapy. Targeting the immunosuppressive tumor-associated macrophages and microglia (TAM/M) and their receptor CSF1R may increase efficacy of checkpoint-inhibitors.
METHODS
Cranial windows were prepared in fully immunocompetent, transgenic CX3CR1GFP/wt-mice with green-fluorescent TAM/M. Intracranial injection of red-fluorescent Lewis Lung Carcinoma-cells was performed, and mice received one of the following three treatments: PD1-inhibition only (n = 8); PD1-inhibition combined with an anti-CSF1R-antibody (exhibiting limited blood-brain-barrier permeability under physiologic conditions, n = 8); or PD1-inhibition combined with a small molecular CSF1R-inhibitor (exhibiting high blood-brain-barrier permeability, n = 7). Tumor growth and TAM/M were followed by repetitive two-photon laser-scanning-microscopy over weeks.
RESULTS
Following intracranial injection, metastases were detected in all three treatment groups within eight days. In mice receiving PD1-inhibition only, metastases showed exponential growth which was paralleled by intra- and peritumoral accumulation of TAM/M. Treatment with an anti-CSF1R-antibody resulted in significantly lower numbers of intratumoral TAM/M given increased tumoral blood-brain-barrier permeability, but did not substantially affect peritumoral TAM/M or TAM/M localized in the healthy contralateral hemisphere. In contrast, treatment with a small molecular CSF1R-inhibitor not only reduced the number of intratumoral TAM/M, but also of peritumoral and contralateral TAM/M. Compared to PD1-inhibition only, the addition of either an anti-CSF1R-antibody or a small molecular CSF1R-inhibitor resulted in decreased tumor growth (tumor size on day 12: 8.3 mm2 (PD1-inhibition only) versus 0.9 mm2 (PD1-inhibition + anti-CSF1R-antibody) versus 2.5 mm2 (PD1-inhibition + small molecular CSF1R-inhibitor)) (p = 0.01). The beneficial effects of the small molecular CSF1R-inhibitor in reducing tumor growth were similar to those of the anti-CSF1R-antibody.
CONCLUSION
Targeting intratumoral TAM/M using CSF1-inhibition may increase the efficacy of checkpoint-inhibition therapy for cerebral lung cancer metastases. This approach warrants further evaluation in preclinical and clinical studies.
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Affiliation(s)
| | - Tao Xu
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Esther Fitzinger
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Julia C Saliger
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Jens Blobner
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Nico Teske
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | | | - Sigrid Langer
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Marcel Konhäuser
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | | | - Niklas Thon
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Munich, Germany
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26
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Teske N, Karschnia P, Weller J, Siller S, Dorostkar MM, Herms J, von Baumgarten L, Tonn JC, Thon N. PATH-32. EXTENT, PATTERN, AND PROGNOSTIC VALUE OF MGMT PROMOTOR METHYLATION: DOES IT DIFFER BETWEEN GLIOBLASTOMA AND IDH-WILDTYPE/TERT-MUTATED ASTROCYTOMA? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.484] [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
The cIMPACT-NOW update 6 introduced glioblastoma diagnosis based on the combination of IDH-wildtype (IDHwt) status and TERT promotor mutation (pTERTmut). In glioblastoma as defined by histopathology according to the WHO 2016 classification, MGMT promotor status is associated with outcome. Whether this is also true in glioblastoma defined by molecular markers is yet unclear.
METHODS
We searched the institutional database for patients with: 1.) glioblastoma defined by histopathology; and 2.) IDHwt astrocytoma with pTERTmut. MGMT promotor methylation was analysed using methylation-specific PCR and Sanger sequencing of CpG sites within the MGMT promotor region.
RESULTS
We identified 224 patients with glioblastoma diagnosed based on histopathology, and 71 patients with IDHwt astrocytoma with pTERTmut (32 astrocytomas WHO grade II and 39 astrocytomas WHO grade III). There was no difference in the number of MGMT methylated tumors between the two groups as determined per PCR, and also neither the number nor the pattern of methylated CpG sites differed as determined per Sanger sequencing. Progression-free (PFS) and overall survival (OS) was similar between the two groups. Surgery was associated with improved overall survival in IDHwt astrocytoma with pTERTmut. In patients treated with radiochemotherapy or radiotherapy, higher numbers of methylated CpG sites were associated with favourable outcome in both groups.
CONCLUSION
Extent and pattern of methylated CpG sites are similar in glioblastoma and IDHwt astrocytoma with pTERTmut. In both groups, higher numbers of methylated CpG sites are associated with favourable outcome when radio/chemotherapy is administered. Surgery may form the basis for favourable outcome.
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Affiliation(s)
- Nico Teske
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | | | - Jonathan Weller
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Sebastian Siller
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Mario M Dorostkar
- Center for Neuropathology, Ludwig-Maximilians-University, Munich, Germany
| | - Jochen Herms
- Center for Neuropathology and Prion Research LMU, Munich, Germany
| | | | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Niklas Thon
- Ludwig-Maximilians-University School of Medicine, Munich, Germany
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27
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Zhang W, Karschnia P, von Mücke-Heim IA, Mulazzani M, Zhou X, Blobner J, Mueller N, Teske N, Dede S, Xu T, Thon N, Ishikawa-Ankerhold H, Straube A, Tonn JC, von Baumgarten L. In vivo two-photon characterization of tumor-associated macrophages and microglia (TAM/M) and CX3CR1 during different steps of brain metastasis formation from lung cancer. Neoplasia 2021; 23:1089-1100. [PMID: 34587566 PMCID: PMC8479202 DOI: 10.1016/j.neo.2021.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/06/2021] [Revised: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022] Open
Abstract
Brain metastases frequently occur in lung cancer and dramatically limit prognosis of affected patients. The influence of tumor-associated macrophages and microglia (TAM/M) and their receptor CX3CR1 on different steps of brain metastasis formation from lung cancer is poorly characterized. We established a syngeneic orthotopic cerebral metastasis model in mice by combining a chronic cranial window with repetitive intravital 2-photon laser scanning microscopy. This allowed in vivo tracking of fluorescence-expressing tumor cells and TAM/M on a single-cell level over weeks. Intracarotid injection of red tdTomato-fluorescent Lewis lung carcinoma cell was performed in transgenic mice either proficient or deficient for CX3CR1. After intracarotid cell injection, intravascular tumor cells extravasated into the brain parenchyma and formed micro- and mature macrometastases. We observed potential phagocytosis of extravasated tumor cells by TAM/M. However, during later steps of metastasis formation, these anti-tumor effects diminished and were paralleled by TAM/M accumulation and activation. Although CX3CR1 deficiency resulted in a lower number of extravasated tumor cells, progression of these extravasated cells into micro metastases was more efficient. Overall, this resulted in a comparable number of mature macrometastases in CX3CR1-deficient and -proficient mice. Our findings indicate that unspecific inhibition of CX3CR1 might not be a suitable therapeutic option to prevent dissemination of lung cancer cells to the brain. Given the close interaction between TAM/M and tumor cells during metastasis formation, other therapeutic approaches targeting TAM/M function may warrant further evaluation. The herein established orthotopic mouse model may be a useful tool to evaluate such concepts in vivo.
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Affiliation(s)
- Wenlong Zhang
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Philipp Karschnia
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany.
| | | | - Matthias Mulazzani
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Xiaolan Zhou
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Jens Blobner
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Niklas Mueller
- Department of Medicine III, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Nico Teske
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Sertac Dede
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Tao Xu
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Niklas Thon
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | | | - Andreas Straube
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Germany.
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Zhang W, Karschnia P, von Mücke-Heim IA, Mulazzani M, Zhou X, Xu T, Blobner J, Teske N, Langer S, Thon N, Ishikawa-Ankerhold H, Straube A, Tonn JC, von Baumgarten L. BSCI-08. In vivo two-photon characterization of tumor-associated macrophages and microglia (TAM/M) and CX3CR1 during different steps of brain metastasis formation from lung cancer. Neurooncol Adv 2021. [DOI: 10.1093/noajnl/vdab071.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Background
Brain metastases represent a common complication of lung cancer and dramatically limit prognosis in affected patients. The influence of tumor-associated macrophages and microglia (TAM/M) and their receptor CX3CR1 on different steps of brain metastasis formation from lung cancer is poorly characterized, but might be of therapeutic relevance.
Methods
We established an orthotopic cerebral metastasis model using CX3CR1-proficient (CX3CR1GFP/wt) and -deficient (CX3CR1GFP/GFP) mice with green-fluorescent TAM/M. A cranial window was prepared, and intracarotid injection of red-fluorescent Lewis Lung Carcinoma-cells (tdtLLC) was performed two weeks later. Formation of brain metastases was followed by repetitive two-photon laser scanning microscopy.
Results
After intracarotid injection, intravascular tumor cells extravasated into the cerebral parenchyma and eventually formed micrometastases (≤50 cells) and mature macrometastases (>50 cells). We observed phagocytosis of extravasated tumor cells by TAM/M during early steps of metastatic growth. Notably, these anti-tumor effects of TAM/M diminished during later steps of metastasis formation and were accompanied by TAM/M accumulation and activation. CX3CR1-deficiency resulted in a lower number of extravasated tumor cells, and only a small number of TAM/M were visualized during early steps of metastasis formation (extravasation, formation of micrometastases) in such mice. In contrast, progression of extravasated tumor cells into micrometastases was more frequently found in CX3CR1-deficient mice. Overall, these mechanisms resulted in a comparable number of mature macrometastases between CX3CR1-deficient and -proficient mice.
Conclusion
Our findings indicate that unspecific inhibition of CX3CR1 might not be a suitable therapeutic approach to prevent cerebral dissemination of lung cancer cells. Given the close interaction between TAM/M and tumour cells during metastasis formation, other therapeutic approaches targeting TAM/M function warrant evaluation. Such concepts might be evaluated in vivo using the herein established orthotopic mouse model.
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Affiliation(s)
| | | | | | | | - Xiolan Zhou
- Ludwig-Maximilians-University, Munich, Germany
| | - Tao Xu
- Ludwig-Maximilians-University, Munich, Germany
| | | | - Nico Teske
- Ludwig-Maximilians-University, Munich, Germany
| | | | - Niklas Thon
- Ludwig-Maximilians-University, Munich, Germany
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Karschnia P, Blobner J, Teske N, Schöberl F, Fitzinger E, Dreyling M, Tonn JC, Thon N, Subklewe M, von Baumgarten L. CAR T-Cells for CNS Lymphoma: Driving into New Terrain? Cancers (Basel) 2021; 13:cancers13102503. [PMID: 34065471 PMCID: PMC8161128 DOI: 10.3390/cancers13102503] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/17/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/13/2022] Open
Abstract
Primary CNS lymphomas (PCNSL) represent a group of extranodal non-Hodgkin lymphomas and secondary CNS lymphomas refer to secondary involvement of the neuroaxis by systemic disease. CNS lymphomas are associated with limited prognosis even after aggressive multimodal therapy. Chimeric antigen receptor (CAR) T-cells have proven as a promising therapeutic avenue in hematological B-cell malignancies including diffuse large B-cell lymphoma, B-cell acute lymphoblastic leukemia, and mantle-cell lymphoma. CARs endow an autologous T-cell population with MHC-unrestricted effectivity against tumor target antigens such as the pan B-cell marker CD19. In PCNSL, compelling and long-lasting anti-tumor effects of such therapy have been shown in murine immunocompromised models. In clinical studies on CAR T-cells for CNS lymphoma, only limited data are available and often include both patients with PCNSL but also patients with secondary CNS lymphoma. Several clinical trials on CAR T-cell therapy for primary and secondary CNS lymphoma are currently ongoing. Extrapolated from the available preliminary data, an overall acceptable safety profile with considerable anti-tumor effects might be expected. Whether these beneficial anti-tumor effects are as long-lasting as in animal models is currently in doubt; and the immunosuppressive tumor microenvironment of the brain may be among the most pivotal factors limiting efficacy of CAR T-cell therapy in CNS lymphoma. Based on an increasing understanding of CAR T-cell interactions with the tumor cells as well as the cerebral tissue, modifications of CAR design or the combination of CAR T-cell therapy with other therapeutic approaches may aid to release the full therapeutic efficiency of CAR T-cells. CAR T-cells may therefore emerge as a novel treatment strategy in primary and secondary CNS lymphoma.
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Affiliation(s)
- Philipp Karschnia
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
- Correspondence: (P.K.); (L.v.B.); Tel.: +49-(0)89-4400-711365 (P.K.); +49-(0)89-4400-712363 (L.v.B.)
| | - Jens Blobner
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
| | - Nico Teske
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
| | - Florian Schöberl
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, 81377 Munich, Germany;
| | - Esther Fitzinger
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
| | - Martin Dreyling
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, 81377 Munich, Germany;
| | - Joerg-Christian Tonn
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
| | - Niklas Thon
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
| | - Marion Subklewe
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, 81377 Munich, Germany;
- Gene Center of the LMU Munich, Laboratory for Translational Cancer Immunology, 81377 Munich, Germany
| | - Louisa von Baumgarten
- Department of Neurosurgery, Division of Neuro-Oncology, Ludwig Maximilians University School of Medicine, Marchioninistrasse, 1581377 Munich, Germany; (J.B.); (N.T.); (E.F.); (J.-C.T.); (N.T.)
- German Cancer Consortium (DKTK), Partner Site Munich, 80336 Munich, Germany;
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, 81377 Munich, Germany;
- Correspondence: (P.K.); (L.v.B.); Tel.: +49-(0)89-4400-711365 (P.K.); +49-(0)89-4400-712363 (L.v.B.)
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Karschnia P, Teske N, Thon N, Subklewe M, Tonn JC, Dietrich J, von Baumgarten L. Chimeric Antigen Receptor T Cells for Glioblastoma: Current Concepts, Challenges, and Future Perspectives. Neurology 2021; 97:218-230. [PMID: 33986138 DOI: 10.1212/wnl.0000000000012193] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/02/2021] [Indexed: 11/15/2022] Open
Abstract
Glioblastoma is the most common malignant primary brain tumor and is associated with a poor prognosis even after multimodal therapy. Chimeric antigen receptor (CAR) T cells have emerged as a promising therapeutic avenue in glioblastoma. CARs incorporate antigen-recognition moieties that endow autologous T cells with specificity against antigens expressed on glioblastoma (e.g., interleukin [IL]-13Rα2, epidermal growth factor receptor variant III [EGFRvIII], and human epidermal growth factor receptor 2 [HER2]). Compelling antitumor effects of such therapy have been shown in murine glioblastoma models. In humans, 5 phase I/II studies on IL-13Rα2-, EGFRvIII-, and HER2-directed CAR T cells for the treatment of glioblastoma have been published suggesting an acceptable safety profile. However, antitumor effects fell short of expectations in these initial clinical studies. Tumor heterogeneity, antigen loss, and the immunosuppressive tumor microenvironment are among the most important factors to limit the efficacy of CAR T-cell therapy in glioblastoma. Novel target antigens, modification of CAR T-cell design, the combination of CAR T-cell therapy with other therapeutic approaches, but also the use of CAR natural killer cells or CAR macrophages may optimize antitumor effects. Numerous clinical trials studying such approaches are ongoing, as well as several preclinical studies. With an increasing understanding of immune-escape mechanisms of glioblastoma and novel manufacturing techniques for CARs, CAR T cells may provide clinically relevant activity in glioblastoma. This review focuses on the use of CAR T cells in glioblastoma, but also introduces the basic structure, mechanisms of action, and relevant side effects of CAR T cells.
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Affiliation(s)
- Philipp Karschnia
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany.
| | - Nico Teske
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany
| | - Niklas Thon
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany
| | - Marion Subklewe
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany
| | - Joerg-Christian Tonn
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany
| | - Jorg Dietrich
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany
| | - Louisa von Baumgarten
- From the Department of Neurosurgery (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Department of Medicine, Hematology & Oncology Division (M.S.), Cellular Immunotherapy Program (M.S.), and Department of Neurology (L.v.B.), Ludwig-Maximilians-University School of Medicine, Munich, Germany; Department of Neurology (P.K., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston; and German Cancer Consortium (DKTK) (P.K., N. Teske, N. Thon, J.C.T., L.v.B.), Partner Site Munich, Germany.
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31
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Karschnia P, Strübing F, Teske N, Blumenberg V, Bücklein VL, Schmidt C, Schöberl F, Dimitriadis K, Forbrig R, Stemmler HJ, Tonn JC, von Bergwelt-Baildon M, Subklewe M, von Baumgarten L. Clinicopathologic Findings in Fatal Neurotoxicity After Adoptive Immunotherapy With CD19-Directed CAR T-Cells. Hemasphere 2021; 5:e533. [PMID: 33615147 PMCID: PMC7886479 DOI: 10.1097/hs9.0000000000000533] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/01/2021] [Indexed: 12/13/2022] Open
Affiliation(s)
- Philipp Karschnia
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Felix Strübing
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Nico Teske
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Viktoria Blumenberg
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Veit L. Bücklein
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian Schmidt
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Florian Schöberl
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | | | - Robert Forbrig
- Department of Neuroradiology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Hans-Joachim Stemmler
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Joerg-Christian Tonn
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
| | - Michael von Bergwelt-Baildon
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Marion Subklewe
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Medicine, Hematology & Oncology Division and Cellular Immunotherapy Program, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- Laboratory for Translational Cancer Immunology, Gene Center of the Ludwig-Maximilians-University Munich, Munich, Germany
| | - Louisa von Baumgarten
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig-Maximilians-University School of Medicine, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University School of Medicine, Munich, Germany
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Karschnia P, Teske N, Dorostkar MM, Siller S, Weller J, Baehring JM, Dietrich J, von Baumgarten L, Herms J, Tonn JC, Thon N. Extent and prognostic value of MGMT promotor methylation in glioma WHO grade II. Sci Rep 2020; 10:19758. [PMID: 33184319 PMCID: PMC7661705 DOI: 10.1038/s41598-020-76312-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 07/15/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022] Open
Abstract
MGMT promotor methylation is associated with favourable outcome in high-grade glioma. In glioma WHO grade II, it is unclear whether the extent of MGMT promotor methylation and its prognostic role is independent from other molecular markers. We performed a retrospective analysis of 155 patients with glioma WHO grade II. First, all 155 patients were assigned to three molecular groups according to the 2016 WHO classification system: (1) oligodendroglioma, IDH-mutant and 1p19q co-deleted (n = 81); (2) astrocytoma, IDH-mutant and 1p19q non-codeleted (n = 54); (3) astrocytoma, IDH-wildtype (n = 20). MGMT promotor methylation was quantified using Sanger sequencing of the CpG sites 74–98 within the MGMT promotor region. Highest numbers of methylated CpG sites were found for oligodendroglioma, IDH-mutant and 1p19q co-deleted. When 1p19q co-deletion was absent, numbers of methylated CpG sites were higher in the presence of IDH-mutation. Accordingly, lowest numbers were seen in the IDH-wildtype subpopulation. In the entire cohort, larger numbers of methylated CpG sites were associated with favourable outcome. When analysed separately for the three WHO subgroups, a similar association was only retained in astrocytoma, IDH-wildtype. Collectively, extent of MGMT promotor methylation was strongly associated with other molecular markers and added prognostic information in astrocytoma, IDH-wildtype. Evaluation in prospective cohorts is warranted.
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Affiliation(s)
- Philipp Karschnia
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site, Munich, Germany. .,Division of Neuro-Oncology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA. .,Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA.
| | - Nico Teske
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Mario M Dorostkar
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Sebastian Siller
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Jonathan Weller
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Joachim M Baehring
- Division of Neuro-Oncology, Department of Neurology, Yale School of Medicine, New Haven, CT, USA
| | - Jorg Dietrich
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Louisa von Baumgarten
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Jochen Herms
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany.,Center for Neuropathology and Prion Research, Ludwig-Maximilians-University School of Medicine, Munich, Germany
| | - Joerg-Christian Tonn
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Niklas Thon
- Division of Neuro-Oncology, Department of Neurosurgery, Ludwig Maximilians University School of Medicine, Marchioninistrasse 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), Partner Site, Munich, Germany.
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Scheld M, Fragoulis A, Nyamoya S, Zendedel A, Denecke B, Krauspe B, Teske N, Kipp M, Beyer C, Clarner T. Mitochondrial Impairment in Oligodendroglial Cells Induces Cytokine Expression and Signaling. J Mol Neurosci 2018; 67:265-275. [PMID: 30547416 DOI: 10.1007/s12031-018-1236-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 07/25/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Abstract
Widespread inflammatory lesions within the central nervous system grey and white matter are major hallmarks of multiple sclerosis. The development of full-blown demyelinating multiple sclerosis lesions might be preceded by preactive lesions which are characterized by focal microglia activation in close spatial relation to apoptotic oligodendrocytes. In this study, we investigated the expression of signaling molecules of oligodendrocytes that might be involved in initial microglia activation during preactive lesion formation. Sodium azide was used to trigger mitochondrial impairment and cellular stress in oligodendroglial cells in vitro. Among various chemokines and cytokines, IL6 was identified as a possible oligodendroglial cell-derived signaling molecule in response to cellular stress. Relevance of this finding for lesion development was further explored in the cuprizone model by applying short-term cuprizone feeding (2-4 days) on male C57BL/6 mice and subsequent analysis of gene expression, in situ hybridization and histology. Additionally, we analyzed the possible signaling of stressed oligodendroglial cells in vitro as well as in the cuprizone mouse model. In vitro, conditioned medium of stressed oligodendroglial cells triggered the activation of microglia cells. In cuprizone-fed animals, IL6 expression in oligodendrocytes was found in close vicinity of activated microglia cells. Taken together, our data support the view that stressed oligodendrocytes have the potential to activate microglia cells through a specific cocktail of chemokines and cytokines among IL6. Further studies will have to identify the temporal activation pattern of these signaling molecules, their cellular sources, and impact on neuroinflammation.
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Affiliation(s)
- Miriam Scheld
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.
| | - Athanassios Fragoulis
- Department of Anatomy and Cell Biology, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Stella Nyamoya
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany.,Department of Neuroanatomy, Faculty of Medicine, Ludwig-Maximilians-University of Munich, 80336, Munich, Germany
| | - Adib Zendedel
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Bernd Denecke
- IZKF Genomics Facility, Interdisciplinary Center for Clinical Research, RWTH Aachen University, 52074, Aachen, Germany
| | - Barbara Krauspe
- Clinic for Gynaecology and Obstetrics, Faculty of Medicine, RWTH Aachen University, 52074, Aachen, Germany
| | - Nico Teske
- Department of Neuroanatomy, Faculty of Medicine, Ludwig-Maximilians-University of Munich, 80336, Munich, Germany
| | - Markus Kipp
- Institute of Anatomy, Faculty of Medicine, University of Rostock, 18057, Rostock, Germany
| | - Cordian Beyer
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
| | - Tim Clarner
- Institute of Neuroanatomy, Faculty of Medicine, RWTH Aachen University, Wendlingweg 2, 52074, Aachen, Germany
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Teske N, Jacobe H. 598 Using the localized scleroderma cutaneous assessment tool to classify morphea by severity and identify clinically significant change in disease. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.606] [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: 10/17/2022]
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Teske N, Liessem A, Fischbach F, Clarner T, Beyer C, Wruck C, Fragoulis A, Tauber SC, Victor M, Kipp M. Chemical hypoxia-induced integrated stress response activation in oligodendrocytes is mediated by the transcription factor nuclear factor (erythroid-derived 2)-like 2 (NRF2). J Neurochem 2018; 144:285-301. [PMID: 29210072 DOI: 10.1111/jnc.14270] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 11/03/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 01/08/2023]
Abstract
The extent of remyelination in multiple sclerosis lesions is often incomplete. Injury to oligodendrocyte progenitor cells can be a contributing factor for such incomplete remyelination. The precise mechanisms underlying insufficient repair remain to be defined, but oxidative stress appears to be involved. Here, we used immortalized oligodendrocyte cell lines as model systems to investigate a causal relation of oxidative stress and endoplasmic reticulum stress signaling cascades. OLN93 and OliNeu cells were subjected to chemical hypoxia by blocking the respiratory chain at various levels. Mitochondrial membrane potential and oxidative stress levels were quantified by flow cytometry. Endoplasmic reticulum stress was monitored by the expression induction of activating transcription factor 3 and 4 (Atf3, Atf4), DNA damage-inducible transcript 3 protein (Ddit3), and glucose-regulated protein 94. Lentiviral silencing of nuclear factor (erythroid-derived 2)-like 2 or kelch-like ECH-associated protein 1 was applied to study the relevance of NRF2 for endoplasmic reticulum stress responses. We demonstrate that inhibition of the respiratory chain induces oxidative stress in cultured oligodendrocytes which is paralleled by the expression induction of distinct mediators of the endoplasmic reticulum stress response, namely Atf3, Atf4, and Ddit3. Atf3 and Ddit3 expression induction is potentiated in kelch-like ECH-associated protein 1-deficient cells and absent in cells lacking the oxidative stress-related transcription factor NRF2. This study provides strong evidence that oxidative stress in oligodendrocytes activates endoplasmic reticulum stress response in a NRF2-dependent manner and, in consequence, might regulate oligodendrocyte degeneration in multiple sclerosis and other neurological disorders.
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Affiliation(s)
- Nico Teske
- Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Annette Liessem
- Institute of Neuroanatomy and JARA-BRAIN, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Felix Fischbach
- Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Tim Clarner
- Institute of Neuroanatomy and JARA-BRAIN, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Cordian Beyer
- Institute of Neuroanatomy and JARA-BRAIN, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | - Christoph Wruck
- Department of Anatomy and Cell Biology, RWTH Aachen University, Aachen, Germany
| | | | - Simone C Tauber
- Department of Neurology, RWTH University Hospital Aachen, Aachen, Germany
| | - Marion Victor
- Institute of Anatomy II, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Markus Kipp
- Department of Anatomy II, Ludwig-Maximilians-University of Munich, Munich, Germany
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