Journal of Neuro-Oncology最新文献

{"title":"Retrospective study of leptomeningeal metastasis: unveiling the indolent and rapid progression phases.","authors":"Qiang Xie, Jiamin Hu, Yi Liu, George Takura Tabengwa, Jinlong Huang, Shuang Liu, Pin Chen, Qin Hu, Xiaobiao Zhang, Tao Xie","doi":"10.1007/s11060-025-05059-0","DOIUrl":"10.1007/s11060-025-05059-0","url":null,"abstract":"<p><strong>Purpose: </strong>Leptomeningeal metastasis (LM) is a severe cancer complication with poor prognosis and inconsistent treatment. Most studies are from Western countries, limiting understanding of LM in the Chinese population. This study aims to explore LM characteristics in Chinese patients and develop tailored treatment strategies.</p><p><strong>Methods: </strong>We retrospectively studied 103 Chinese LM patients, all confirmed by CSF cytology, from 2015 to 2024. Data on demographics, medical history, imaging, and follow-up were gathered. Survival analysis was conducted using the Kaplan - Meier method, and univariate and multivariate analyses were performed to identify prognostic factors. A nomogram was developed, and patients were stratified into risk groups based on these factors.</p><p><strong>Results: </strong>The median age was 54.99 ± 11.18 years, with 53.4% being female. Lung cancer was the primary tumor in 76.7% of patients. Headache was the most common symptom. The median survival was 441 days. Primary tumor site, CSF tumor cell proportion, and asymptomatic status at diagnosis were independent prognostic factors. The nomogram's C - index was 0.81. We identified two distinct groups of LM patients with markedly different characteristics, which we designated as the indolent and rapid progression phases of LM.</p><p><strong>Conclusions: </strong>The clinical characteristics of LM patients with positive CSF cytology at the center were described, with a longer median survival than previously reported. The developed nomogram demonstrated potential clinical predictive value. Two distinct LM patient groups were identified: the indolent and rapid progression phases, which hold significant clinical relevance.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"357-368"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knockdown of STK39 inhibits lung cancer brain metastasis by suppressing the CPSF4/NFκB/COX2 pathway.","authors":"Yue Shu, Yunzhu Dong, Bo Li, Yutong Wang, Quanyang Liao, Ziqin Su, Jun Wang, Pin Zuo, Hongpin Yuan, Chun Wang, Shujuan Li, Yaodong Fan, Xiaosan Su","doi":"10.1007/s11060-025-05072-3","DOIUrl":"10.1007/s11060-025-05072-3","url":null,"abstract":"<p><strong>Purpose: </strong>Lung cancer is the most common cancer worldwide, and approximately 30% of lung cancer patients will develop brain metastases. Serine/threonine kinase 39 (STK39) plays a significant role in various malignancies. However, the role and mechanism of STK39 in lung cancer brain metastasis have not been reported.</p><p><strong>Methods: </strong>The expression levels of STK39 in lung cancer cells were detected using quantitative reverse transcription PCR (RT-qPCR) and Western blotting. STK39 expression was knocked down in lung cancer cell lines PC9 and H1299 using RNA interference. Cell proliferation, apoptosis, cell cycle, migration, and invasion abilities were assessed using the CCK-8 assay, colony formation assay, flow cytometry, and Transwell chamber assay, respectively. Phosphoproteomics analysis was performed to identify phosphorylated target proteins of STK39 and associated signaling pathways. PC9 and H1299 cells with knocked-down STK39 were injected into nude mice via the common carotid artery to observe the formation of brain metastases. Finally, RT-qPCR and Western blotting were used to detect the expression of STK39, CPSF4/NFκB/COX2, and epithelial-mesenchymal transition (EMT) markers in lung cancer and brain metastasis tissues, and to analyze the correlation between STK39 expression and the size of metastatic tumors.</p><p><strong>Results: </strong>STK39 was highly expressed in lung cancer cell lines PC9 and H1299. Knockdown of STK39 inhibited proliferation, migration, and invasion of lung cancer cells, induced apoptosis, and caused cell cycle arrest. Phosphoproteomics and Phos-tag analyses showed that knockdown of STK39 significantly downregulated the expression of phosphorylated CPSF4 protein in PC9 and H1299 cells, along with significant downregulation of NFκB, COX2, and EMT markers. Knockdown of STK39 inhibited the formation of brain metastases by PC9 and H1299 cells in nude mice. Lung cancer brain metastasis tissues exhibited high expression of STK39, CPSF4, NFκB, and COX2, with their expression levels showing a significant positive correlation with the size of metastatic tumors.</p><p><strong>Conclusion: </strong>STK39 is highly expressed in lung cancer brain metastasis tissues, and knockdown of STK39 significantly inhibits brain metastasis in experimental models, accompanied by the suppression of the CPSF4/NFκB/COX2 signaling pathway and EMT process. Therefore, STK39 may be a key factor promoting lung cancer brain metastasis and a potential therapeutic target.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"411-430"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring perspectives on skull base chordoma management: a modified Delphi approach to consensus.","authors":"Saket Myneni, A Karim Ahmed, Foad Kazemi, Anirudh Saraswathula, Nathan T Zwagerman, Shirley Y Su, Garret Choby, Eric W Wang, Jamie J Van Gompel, Kristin J Redmond, Erin L McKean, Carl H Snyderman, Paul A Gardner, Nicholas R Rowan, Debraj Mukherjee","doi":"10.1007/s11060-025-05088-9","DOIUrl":"10.1007/s11060-025-05088-9","url":null,"abstract":"<p><strong>Objective: </strong>Current treatment for skull base chordomas utilizes both surgical resection and adjuvant radiation, but recent studies have demonstrated evidence that has brought the use of adjuvant radiotherapy into question. Chordomas differ greatly in molecular makeup and proliferation. These factors have led to significant variation in management across providers. We used a modified Delphi approach to work towards consensus on standardized operative definitions and evidence-based management of chordomas.</p><p><strong>Methods: </strong>Our multidisciplinary panel included participants representing the AANS/CNS Tumor Section and North American Skull Base Society (NASBS) with a track record of publishing on chordoma management. Our approach involved a four-step process: one statement-generation round, two voting rounds to establish consensus and refine statements, and a final external validation round by NASBS members. Anonymous voting was completed via Qualtrics surveys.</p><p><strong>Results: </strong>The statement-generation process produced 65 statements. Through the Delphi process, 36 statements reached consensus during the first round and an additional 17 were refined for further consensus in the second round. Moderate (67-80%) or strong (> 80%) consensus was achieved for 43 final statements. Forty-one items were externally validated. There was consensus that an endoscopic endonasal approach should be utilized whenever possible. They defined the tumor characteristics (molecular and cytogenic) to consider before offering adjuvant radiotherapy.</p><p><strong>Conclusions: </strong>This modified Delphi study generated consensus on 41 statements regarding skull base chordoma management. These statements aim to shed light on the consensus among providers regarding the use of surgery, neoadjuvant radiation, adjuvant radiation, adjuvant systemic therapies, and treatment of recurrence for chordoma.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"609-620"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144120028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of outcomes and machine Learning-based models to predict local failure risk following stereotactic radiosurgery for small brain metastases.","authors":"Sreenija Yarlagadda, Yanjia Zhang, Anshul Saxena, Tugce Kutuk, Ranjini Tolakanahalli, Haley Appel, Robert Herrera, Matthew D Hall, Robert H Press, D Jay J Wieczorek, Yongsook C Lee, Tatiana Bejarano, Michael W McDermott, Alonso N Gutierrez, Minesh P Mehta, Rupesh Kotecha","doi":"10.1007/s11060-025-05092-z","DOIUrl":"10.1007/s11060-025-05092-z","url":null,"abstract":"<p><strong>Introduction: </strong>We assessed the outcomes of stereotactic radiosurgery (SRS) for small intact brain metastases (SBM) (≤ 2 cm) and developed machine learning (ML) algorithms to predict the probability of local failure (LF).</p><p><strong>Methods: </strong>Consecutive patients with SBM treated with SRS between January 2017 and July 2022 were included. Propensity score matching (PSM) was performed with related factors to enhance balance for comparison. Variable selection and three time-varied generalized estimating equations (GEE) were used to create predictive models.</p><p><strong>Results: </strong>1503 SBMs in 235 patients treated over 358 SRS courses were analyzable. The actuarial 1-year cumulative rate of LF was lower in lesions treated with 24 Gy (5.9%, 95% CI: 4.2-8.2%) or 22 Gy (7.7%, 95% CI: 5.3-11.0%) compared to 20 Gy (25.3%, 95% CI: 18.1-34.7%) (p < 0.001). 22 Gy and 24 Gy were associated with a 63% and 74% reduction in risk in LF compared to 20 Gy (HR: 0.37; 95% CI: 0.24-0.57; p < 0.005 and HR: 0.26; 95% CI: 0.17-0.39; p < 0.005, respectively). The generated models could recommend the best dose with an individualized percentage probability of LF with each dose at 6 months, 1 year, and 2 years with a minimum AUC of 0.75. The 1-year model had the highest AUC (0.88), accuracy (88%), and specificity (91%), while the 2-year model had the highest sensitivity (89%).</p><p><strong>Conclusion: </strong>The ML models developed predict LF as a function of dose which could aid in clinical decision-making to select an appropriate dose for SBM to optimize tumor control outcomes and schedule appropriate follow-up.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"635-643"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144285014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PIK3R2 immunostaining status predicts prognosis in patients with newly diagnosed glioblastoma treated with an autologous tumor vaccine.","authors":"Kazuki Akutagawa, Shunichiro Miki, Erika Yamada, Noriaki Sakamoto, Tsubasa Miyazaki, Narushi Sugii, Alexander Zaboronok, Masahide Matsuda, Eiichi Ishikawa","doi":"10.1007/s11060-025-05102-0","DOIUrl":"10.1007/s11060-025-05102-0","url":null,"abstract":"<p><strong>Background: </strong>Glioblastoma (GBM) is the most common and aggressive primary brain tumor in adults, characterized by high invasiveness and a poor prognosis, with limited treatment options. Our previous study on fractionated radiotherapy, temozolomide, and an autologous formalin-fixed tumor vaccine (AFTV) for newly diagnosed grade 4 astrocytic tumors demonstrated that complete tumor resection and p53 negativity on immunohistochemistry were associated with favorable outcomes. PIK3R2, a key component of the PI3K-Akt signaling pathway, may modulate the host immune response to tumor antigens and influence the efficacy of immunotherapy. In this study, we further investigated whether PIK3R2, a candidate gene identified through gene panel sequencing as potentially associated with prognosis following AFTV treatment, influences patient outcomes after AFTV therapy.</p><p><strong>Methods: </strong>We analyzed 58 patients with newly diagnosed IDH wildtype GBM or IDH mutant grade 4 astrocytoma (Astro). Among them, 29 received standard treatment combined with AFTV (AFTV group), while 29 underwent standard treatment alone (control group). Immunostaining for PIK3R2 and p53 was performed, and patient characteristics, including age, sex, Karnofsky Performance Status at the time of surgery, and overall survival (OS), were evaluated. PIK3R2 expression levels were classified using a 34% cutoff value.</p><p><strong>Results: </strong>In the AFTV group, survival analysis based on PIK3R2 status (positive/negative) revealed an increased survival in the PIK3R2-negative group when comparing AFTV and control groups (p = 0.075 in GBM/Astro cases and p = 0.030 in GBM cases). When stratifying patients into four subgroups based on p53 and PIK3R2 status (p53-negative/PIK3R2-negative, p53-positive/PIK3R2-positive, p53-negative/PIK3R2-positive, and p53-positive/PIK3R2-negative), a significant improvement in OS was observed in the p53-negative/PIK3R2-negative group both in GBM/Astro cases and GBM cases. PD-1 demonstrated the strongest correlation with PIK3R2 in the regression analysis.</p><p><strong>Conclusion: </strong>Negative immunostaining for PIK3R2 as well as negative p53 revealed an increased survival in patients receiving AFTV therapy for GBM. In patients receiving AFTV, these immunostaining results may serve as a predictor of treatment efficacy and overall survival.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"709-719"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144275060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Synergistic activity of simvastatin and irinotecan chemotherapy against glioblastoma converges on TGF-β signaling.","authors":"Niket Yadav, Aizhen Xiao, Qing Zhong, Pankaj Kumar, Guruprasad Konduru, William Hart, Matthew Lazzara, Benjamin Purow","doi":"10.1007/s11060-025-05089-8","DOIUrl":"10.1007/s11060-025-05089-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the synergistic therapeutic potential of a novel combination of the repurposed drug simvastatin with irinotecan chemotherapy towards glioblastoma (GBM) and the underlying molecular mechanisms.</p><p><strong>Methods: </strong>In vitro efficacy of simvastatin and irinotecan alone and in combination against diverse GBM lines (U251MG, G34, SB28) was assessed using mechanistically distinct cell viability assays. RNA-Sequencing was performed to uncover the top pathways and genes affected by these drugs, followed by validation of promising pathways (TGF-β signaling and cell death) using targeted phosphoproteomics and in vitro genetic manipulation and functional assays.</p><p><strong>Results: </strong>We observed robust in vitro synergy at nanomolar concentrations between simvastatin and irinotecan across diverse GBM lines. Notably, irinotecan alone and in combination with simvastatin reduced mRNA expression of TGF-β family members. Targeted phosphoproteomics and functional experiments further showed significant inhibition of TGF-β signaling with both treatment types. Additionally, a role for apoptosis and enrichment of caspase-independent cell death pathways (autophagy, ferroptosis) as well as immunological (interferons, complement, inflammatory responses, TNF-α) and oncogenic (K-RAS/ERK) signaling pathways were observed with the combination treatment.</p><p><strong>Conclusions: </strong>Besides the first detailed demonstration of a robust synergy between simvastatin and irinotecan against GBM lines, this study shows for the first time that both irinotecan and the combination treatment converge on inhibition of TGF-β signaling. This is notable given the lack of TGF-β inhibitors in the clinic. Collectively, this study provides preclinical data suggesting this novel drug combination be tested in patients with GBM and TGF-β driven cancers.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"621-633"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263772/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing workflows for metastatic central nervous system disease: a systematic review and proposed guidelines.","authors":"John Y Chen, Aaliyah Schultz, Nadine M Khoury, Karthik Rangavajhula, Avi A Gajjar, Iñigo L Sistiaga, Mihir Tandon, Laura Mittelman, Daniel M Sciubba, Sheng-Fu L Lo, Daniel G Eichberg, Randy S D'Amico","doi":"10.1007/s11060-025-05084-z","DOIUrl":"10.1007/s11060-025-05084-z","url":null,"abstract":"<p><strong>Introduction: </strong>Brain and spine metastases are a major cause of morbidity and mortality in patients with malignancy. Aside from advancements in medical, surgical, and radiation therapies, patient workflow optimization augments care. Here, we present the first systematic review to identify opportunities in workflow optimization and use these findings to present guidelines for operational excellence.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, and Web of Science databases were searched for peer-reviewed studies evaluating optimization points within treatment workflows for brain and spinal metastases. Inclusion criteria encompassed rapid diagnostic models, expedited care pathways, and quality improvement interventions for metastatic disease, whereas non-English and case reports were excluded. Eligible studies were screened, and data such as study design, outcomes, and bias were recorded using Cochrane's RoB-1 analysis. This protocol was prospectively registered in PROSPERO (CRD420251016218).</p><p><strong>Results: </strong>30 studies were included, with a total of 23,697 patient participants. These studies focused on patient education, referral to surgery, referral from surgery to radiation oncology, and referral from surgery to medical oncology. These studies highlighted the benefits of expediting triaging, referral speed, and treatment initiation in the context of valuable resources such as a comprehensive clinical team and artificial intelligence in radiology and cytopathology.</p><p><strong>Conclusions: </strong>Optimizing workflows around the current literature for metastatic brain and spine disease identifies critical areas of improvement to enhance outcomes. We draw from this literature to propose guidelines for delivering a comprehensive and standardized patient workflow. Future studies targeting these salient points will further improve quality and advance patient care.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"557-585"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological features of pseudoprogression in brain tumors treated with immune checkpoint inhibitors.","authors":"Maria José Ibáñez-Juliá, Luis Bataller, Francisco Javier Cabello-Murgui, Ludovic Nguyen-Them, Agusti Alentorn, Alba Torres-Martínez, Miguel Mazón-Momparler, Regina Gironés-Sarrió","doi":"10.1007/s11060-025-05091-0","DOIUrl":"10.1007/s11060-025-05091-0","url":null,"abstract":"<p><strong>Purpose: </strong>Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment, resulting in the emergence of various immune-related adverse effects, including pseudoprogression (PsP). We sought to evaluate the characteristics of pseudoprogression in adults treated with ICIs for brain tumors (either primary or secondary), and to compare it with a non- PsP group.</p><p><strong>Methods: </strong>We retrospectively identified adults with brain tumors treated with ICIs at our institution between 2015 and 2023. Eligibility required one brain magnetic resonance imaging scan prior to treatment and another obtained within 6 months after treatment initiation. PsP was defined as radiological worsening within 6 months of ICI initiation, followed by stabilization or improvement without therapy modification. Demographic, clinical, and radiological characteristics were analyzed and compared between the PsP and the non-PsP groups.</p><p><strong>Results: </strong>Among 102 eligible patients, 10 (9.8%) developed PsP. Clinical symptoms occurred in 4 (40%) cases, all of which showed favorable outcomes with corticosteroid therapy. The PsP group had higher baseline tumor burden (p = 1.29 × 10⁻¹³) and higher PD-L1 expression (p < 0.001) than the non-PsP group. Median progression-free survival and overall survival were numerically longer in the PsP group with no significant difference.</p><p><strong>Conclusions: </strong>PsP is a frequent complication of ICIs. We describe 4 symptomatic patients with pseudoprogression, challenging the iRANO criteria that recommend excluding this diagnosis in symptomatic cases. Clinical impairment should not automatically rule out pseudoprogression, and each case requires thorough evaluation. High PD-L1 expression and greater tumor burden may be associated with PsP, but further studies are needed to confirm these findings.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"779-788"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiosurgery for central nervous system ependymomas: a systematic review and meta-analysis.","authors":"Amirhossein Zare, Amirhessam Zare, Bardia Hajikarimloo, Barbod Mohammadi, Jason P Sheehan, Arad Iranmehr","doi":"10.1007/s11060-025-05076-z","DOIUrl":"10.1007/s11060-025-05076-z","url":null,"abstract":"<p><strong>Background: </strong>Ependymomas, rare malignant central nervous system (CNS) lesions (2-6% of primary CNS tumors), are typically treated with maximal safe resection followed by fractionated radiation therapy. Stereotactic radiosurgery (SRS) has emerged as an alternative, particularly in recurrent or residual cases. This study evaluates the safety and efficacy of SRS for CNS ependymomas, while also identifying key prognostic factors.</p><p><strong>Method: </strong>A systematic search was conducted to identify studies that evaluated the efficacy and safety of SRS in WHO Grade 2/3 CNS ependymoma patients. Random-effect meta-analysis was employed.</p><p><strong>Results: </strong>Fourteen studies with 298 patients and 496 lesions were included. Our meta-analysis demonstrated an overall local tumor control (LTC) rate of 72% (95% CI: 65-79%). LTC rates at 1, 3, and 5 years were 83% (95% CI: 76-88%), 72% (95% CI: 64-78%), and 69% (95% CI: 61-76%), respectively. Progression-free survival (PFS) rates at 1, 3, and 5 years were estimated at 67% (95% CI: 50-80%), 56% (95% CI: 48-64%), and 51% (95% CI: 39-63%), respectively. Additionally, the 5-year overall survival (OS) rate was 58% (95% CI: 48-67%). The incidence of adverse radiation events (ARE) was 20% (95% CI: 12-31%). Meta-regression showed older age correlated with improved tumor control (P = 0.02) and lower ARE (P = 0.06) and radionecrosis rates (P < 0.01), while larger tumor volumes (P = 0.03) and anaplastic histology (P = 0.01) were associated with poorer PFS.</p><p><strong>Conclusions: </strong>SRS is a reasonably valuable therapeutic option in the multimodal management of WHO Grade 2/3 CNS ependymomas, especially for individuals with inoperable, recurrent, or residual lesions. Key patient and tumor characteristics have been analyzed to determine factors potentially impacting treatment outcomes.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"315-327"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110984","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk calculator for long-term survival prediction of spinal chordoma versus chondrosarcoma: a nationwide analysis.","authors":"Abdul Karim Ghaith, Xinlan Yang, Abdel-Hameed Al-Mistarehi, Linda Tang, Nathan Kim, Joshua Weinberg, Jawad Khalifeh, Yuanxuan Xia, Chase H Foster, Kristin Redmond, Sang Lee, Majid Khan, David Xu, Taha Khalilullah, Khaled Zaitoun, Nicholas Theodore, Daniel Lubelski","doi":"10.1007/s11060-025-05063-4","DOIUrl":"10.1007/s11060-025-05063-4","url":null,"abstract":"<p><strong>Purpose: </strong>Chordomas and chondrosarcomas are rare, aggressive spinal bone tumors with distinct origins, biological behavior, and treatment challenges, primarily due to their resistance to conventional chemotherapy and radiation. This study aimed to compare clinical characteristics, treatment strategies, and long-term outcomes between spinal chordoma and chondrosarcoma, and to develop a robust machine learning-based model for individualized survival prediction.</p><p><strong>Methods: </strong>We conducted a retrospective analysis using the National Cancer Database (NCDB) to identify patients diagnosed with spinal chordoma or chondrosarcoma from 2004 to 2017. Demographics, tumor characteristics, comorbidity indices, treatment modalities (surgery, radiation, chemotherapy), and outcomes were extracted. Kaplan-Meier and weighted log-rank analyses assessed overall survival (OS) at predefined intervals (30-day, 90-day, 1-year, 5-year, 10-year). Twelve machine learning and deep learning models were trained to predict 10-year OS. Model performance was evaluated using AUC, Brier Score, and Concordance Index (C-index). A web-based risk calculator was developed using the best-performing ensemble model.</p><p><strong>Results: </strong>A total of 3175 patients were included (chordoma: n = 1204; chondrosarcoma: n = 1971). Chordoma patients were significantly older, travelled farther for treatment, and had smaller tumors with lower rates of metastatic disease at presentation. Chondrosarcoma patients more frequently underwent gross total resection, while chordoma patients received more radiation therapy, often with higher doses and more frequent use of proton therapy. Kaplan-Meier analysis revealed that chordoma patients had superior 10-year OS compared to chondrosarcoma patients (p < 0.0001). Among those receiving radiation, chondrosarcoma patients treated with radiation alone had the poorest survival. DeepSurv achieved the highest C-index (0.83) and lowest Brier Score (0.14), while ensemble models integrating Gradient Boosting and CatBoost also demonstrated strong performance (AUC > 0.80). Age, tumor type, and radiation therapy were identified as the most influential predictors using SHAP analysis. A publicly accessible, web-based calculator was developed for individualized survival prediction.</p><p><strong>Conclusion: </strong>Spinal chordoma and chondrosarcoma differ significantly in clinical features and outcomes, with chordoma showing more favorable long-term survival. The findings highlight the importance of GTR and individualized radiation therapy in optimizing outcomes. The predictive model employing complicated machine learning models provides a valuable tool for estimating long-term survival and guiding personalized treatment strategies, though external validation is needed to strengthen its generalizability and clinical utility.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"511-525"},"PeriodicalIF":3.2,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}