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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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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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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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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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5
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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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6
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Meissner AK, Gutsche R, Galldiks N, Kocher M, Juenger ST, Eich ML, Wendl C, Goldbrunner R, Ruge M, Mauch C, Proescholdt M, Grau S, Lohmann P. NIMG-04. PREDICTING THE BRAF MUTATIONAL STATUS IN PATIENTS WITH MELANOMA BRAIN METASTASES USING RADIOMICS - A BICENTRIC STUDY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.504] [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
The BRAF V600E mutation is present in approximately 50% of patients with melanoma and is an important prerequisite for a response to targeted therapies such as BRAF inhibitors. In the majority of patients, the BRAF mutational status is based on the analysis of tissue samples from the extracranial primary tumor only. Since the extracranial and intracranial BRAF mutational status may be discrepant, the additional information on the BRAF mutational status of melanoma brain metastases would be of clinical value, e.g., for the prediction of response to targeted therapies. Here, we evaluated the potential of MRI radiomics for the determination of the intracranial BRAF mutational status in patients with melanoma brain metastases.
PATIENTS AND METHODS
Fifty-nine patients with melanoma brain metastases from two university hospitals (group 1, 45 patients; group 2, 14 patients) were operated with subsequent genetic analysis of the intracranial BRAF mutational status. All patients underwent structural MRI preoperatively. Areas of contrast enhancement were manually segmented and analyzed. Group 1 was used for model training and validation, group 2 for model testing. After image preprocessing and radiomics feature extraction, a test-retest analysis was performed to identify robust features prior to feature selection. Finally, the best performing radiomics model was applied to the test data. Diagnostic performances were evaluated using receiver operating characteristic (ROC) analyses.
RESULTS
Twenty-two patients (49%) in group 1, and 6 patients (43%) in group 2 had an intrametastatic BRAF V600E mutation. Using the best performing six parameter radiomics signature, a linear support vector machine classifier yielded an area under the ROC curve (AUC) of 0.92 (sensitivity, 83%; specificity, 88%) in the test data.
CONCLUSION
The developed radiomics classifier allows a non-invasive prediction of the intracranial BRAF V600E mutational status in patients with melanoma brain metastases and may be of value for treatment decisions.
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Affiliation(s)
- Anna-Katharina Meissner
- Center for Neurosurgery, Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Robin Gutsche
- Inst. of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
| | - Norbert Galldiks
- Inst. of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Martin Kocher
- Inst. of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
| | - Stephanie T Juenger
- Center for Neurosurgery, Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marie-Lisa Eich
- Dept. of Pathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christina Wendl
- Dept. of Radiology and Division of Neuroradiology, University Hospital Regensburg, Regensburg, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian Ruge
- Center for Neurosurgery, Dept. of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Cornelia Mauch
- Dept. of Dermatology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Proescholdt
- Dept. of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Grau
- Center for Neurosurgery, Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp Lohmann
- Inst. of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
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Meissner A, Gutsche R, Galldiks N, Kocher M, Juenger ST, Wendl C, Mauch C, Proescholdt M, Grau S, Lohmann P. P14.06 Radiomics for the non-invasive determination of the BRAF mutational status in patients with melanoma brain metastases. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
The BRAF V600E mutation is present in approximately 50% of patients with melanoma and is an important prerequisite for a response to targeted therapies such as BRAF inhibitors. In the majority of patients, the BRAF mutational status is based on the analysis of tissue samples from the extracranial primary tumor only. Since the extracranial and intracranial BRAF mutational status may be discrepant, the additional information on the BRAF mutational status of melanoma brain metastases would be of clinical value, e.g., for the prediction of response to targeted therapies. Here, we evaluated the potential of structural MRI radiomics for the determination of the intracranial BRAF mutational status in patients with melanoma brain metastases.
MATERIAL AND METHODS
Fifty-nine patients with melanoma brain metastases from two university hospitals (group 1, 45 patients; group 2, 14 patients) underwent surgery with subsequent genetic analysis of the brain metastases tissue to determine the BRAF mutational status. All patients underwent structural MRI preoperatively. Areas of contrast enhancement were manually segmented and analyzed. Group 1 was used for model training and validation, group 2 for model testing. After image preprocessing, 1,316 radiomics features were extracted using the open-source PyRadiomics package. A test-retest analysis was performed to identify robust features prior to feature selection. Finally, the best performing radiomics model was applied to the test data (group 2). Diagnostic performances were evaluated using receiver operating characteristic (ROC) analyses.
RESULTS
Twenty-two patients (49%) in group 1, and 6 patients (43%) in group 2 had an intrametastatic BRAF V600E mutation. Using a six parameter radiomics signature, a linear support vector machine classifier yielded an average area under the ROC curve (AUC) of 0.87 (accuracy, 85%; sensitivity, 78%; specificity, 91%) for prediction of the BRAF mutational status in the training data (group 1). Finally, the classifier achieved an AUC of 0.85 (accuracy, 86%; sensitivity, 83%; specificity, 88%) in the test data (group 2).
CONCLUSION
The developed radiomics classifier allows a non-invasive prediction of the intracranial BRAF V600E mutational status in patients with melanoma brain metastases and may be of value for treatment decisions.
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Affiliation(s)
- A Meissner
- Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - R Gutsche
- Inst. of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
| | - N Galldiks
- Inst. of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
- Dept. of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - M Kocher
- Inst. of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
- Dept. of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - S T Juenger
- Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - C Wendl
- Dept. of Radiology and Division of Neuroradiology, University Hospital Regensburg, Regensburg, Germany
| | - C Mauch
- Dept. of Dermatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M Proescholdt
- Dept. of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
- Wilhelm Sander Neuro-Oncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - S Grau
- Dept. of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - P Lohmann
- Inst. of Neuroscience and Medicine (INM-4), Research Center Juelich, Juelich, Germany
- Dept. of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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