Journal of Neuro-Oncology最新文献

{"title":"Patient-derived glioma organoids real time identification of IDH mutation, 1p/19q-codeletion and CDKN2A/B homozygous deletion with differential ion mobility spectrometry.","authors":"Ismaïl Hermelo, Ilkka Haapala, Meri Mäkelä, Dafne Jacome Sanz, Anton Kontunen, Markus Karjalainen, Philipp Müller, Kai Lehtimäki, Matti Nykter, Juhana Frösén, Hannu Haapasalo, Antti Roine, Niku Oksala, Kristiina Nordfors, Antti Vehkaoja, Joonas Haapasalo","doi":"10.1007/s11060-024-04891-0","DOIUrl":"https://doi.org/10.1007/s11060-024-04891-0","url":null,"abstract":"<p><strong>Purpose: </strong>Extent of brain tumor resection continues to be one of the central decisions taken during standard of care in glioma patients. Here, we aimed to evaluate the most essential molecular factors, such as IDH (isocitrate dehydrogenase) mutation in gliomas classification with patient-derived glioma organoids (PGOs) using differential mobility spectrometry (DMS).</p><p><strong>Methods: </strong>we prospectively recruited 12 glioma patients, 6 IDH-mutated and 6 IDH wild-type tumors, from which PGOs were generated ex-vivo. Altogether, 320 PGOs DMS spectra were analyzed with a classifier algorithm based on linear discriminant analysis (LDA).</p><p><strong>Results: </strong>LDA model classification accuracy (CA) obtained between IDH-mutant and IDH wild-type PGOs was 90% (91% sensitivity and 89% specificity). Furthermore, 1p/19q codeletion classification within IDH mutant PGOs reached 98% CA (93% sensitivity and 99% specificity), while CDKN2A/B homozygous loss status had 86% CA (63% sensitivity 93% specificity).</p><p><strong>Conclusion: </strong>DMS suitability to differentiate IDH-mutated PGOs was thus validated in ex vivo cultured samples, PGOs. Preliminary results regarding 1p/19q codeleted PGOs and CDKN2A/B loss PGOs identification endorse testing in a prospective intraoperative glioma patient cohort. Our results reveal a sample classification set-up that is compatible with real-time intraoperative surgery guidance.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142693172","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":"Early versus late construct failure in spine metastatic disease: implications for surgical strategy and oncologic outcome.","authors":"Daniel Kreatsoulas, Andrew George, Samuel Kolawole, Mark Damante, Santino Cua, Vikram B Chakravarthy, J Bradley Elder","doi":"10.1007/s11060-024-04884-z","DOIUrl":"https://doi.org/10.1007/s11060-024-04884-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to identify variables that portend early construct failure requiring surgical revision in patients undergoing instrumented fusion for spine metastases.</p><p><strong>Methods: </strong>A detailed retrospective chart review was performed. Demographic, surgical, and oncologic variables were collected and analyzed via independent samples t-testing, chi-square testing, and Kaplan-Meier method with log-rank testing. Significance was determined as p < 0.05.</p><p><strong>Results: </strong>482 spinal fusion operations for solid tumor metastases were performed between 2012 and 2022. Of these, 24 (5.0%) required revision surgery for construct failure. There were no major differences between the revision and non-revision patients in terms of several surgical characteristics. Thirteen (54.1%) were revised within 3 months of index surgery. These early construct failures were more likely to have functional neurological deficits at surgery (6/13 vs. 0/11 [p = 0.009]), longer constructs (mean 6.4±2.4 vs. 4.2 ± 1.4 levels [p = 0.015]), and cement-augmented pedicle screws (4/13 vs. 0/11 [p = 0.044)) compared to late construct failures (> 3 months after index surgery). Additionally, 17 symptomatic failures were identified, compared to 7 asymptomatic failures which were identified incidentally with routine follow-up imaging. All 7 asymptomatic construct failures occurred in the early revisions group [p = 0.004]. Revision surgery for early construct failure was associated with significantly reduced median overall survival compared to late failure (p = 0.010).</p><p><strong>Conclusion: </strong>Construct failures in our cohort were not associated with any classical characteristics of patients undergoing revision spine surgery. Early revision (< 3 months) portends a reduction in overall survival when compared with late revisions, and early revised patients were more likely to have had more extensive surgery and poorer neurological status at the time of index cases.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686937","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":"Immune checkpoint inhibitors for glioblastoma: emerging science, clinical advances, and future directions.","authors":"Aarav Badani, Ahmad Ozair, Mustafa Khasraw, Graeme F Woodworth, Pallavi Tiwari, Manmeet S Ahluwalia, Alireza Mansouri","doi":"10.1007/s11060-024-04881-2","DOIUrl":"https://doi.org/10.1007/s11060-024-04881-2","url":null,"abstract":"<p><p>Glioblastoma (GBM), the most common and aggressive primary central nervous system (CNS) tumor in adults, continues to have a dismal prognosis. Across hundreds of clinical trials, few novel approaches have translated to clinical practice while survival has improved by only a few months over the past three decades. Randomized controlled trials of immune checkpoint inhibitors (ICIs), which have seen impressive success for advanced or metastatic extracranial solid tumors, have so far failed to demonstrate a clinical benefit for patients with GBM. This has been secondary to GBM heterogeneity, the unique immunosuppressive CNS microenvironment, immune-evasive strategies by cancer cells, and the rapid evolution of tumor on therapy. This review aims to summarize findings from major clinical trials of ICIs for GBM, review historic failures, and describe currently promising avenues of investigation. We explore the biological mechanisms driving ICI responses, focusing on the role of the tumor microenvironment, immune evasion, and molecular biomarkers. Beyond conventional monotherapy approaches targeting PD-1, PD-L1, CTLA-4, we describe emerging approaches for GBM, such as dual-agent ICIs, and combination of ICIs with oncolytic virotherapy, antigenic peptide vaccines, chimeric antigenic receptor (CAR) T-cell therapy, along with nanoparticle-based delivery systems to enhance ICI efficacy. We highlight potential strategies for improving patient selection and treatment personalization, along with real-time, longitudinal monitoring of therapeutic responses through advanced imaging and liquid biopsy techniques. Integrated radiomics, tissue, and plasma-based analyses, may potentially uncover immunotherapeutic response signatures, enabling early, adaptive therapeutic adjustments. By specifically targeting current therapeutic challenges, outcomes for GBM patients may potentially be improved.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681910","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":"Congress of Neurological Surgeons systematic review and evidence-based guidelines for the role of chemotherapy in newly diagnosed WHO Grade II diffuse glioma in adults: update.","authors":"Mateo Ziu, Lia M Halasz, Priya U Kumthekar, Tresa M McGranahan, Simon S Lo, Jeffrey J Olson","doi":"10.1007/s11060-024-04861-6","DOIUrl":"https://doi.org/10.1007/s11060-024-04861-6","url":null,"abstract":"&lt;p&gt;&lt;p&gt;Questions and recommendations from the prior version of these guidelines without changeTarget populationAdult patients (older than 18 years of age) with newly diagnosed World Health Organization (WHO) Grade II gliomas (Oligodendroglioma, astrocytoma, mixed oligoastrocytoma).QuestionIs there a role for chemotherapy as adjuvant therapy of choice in treatment of patients with newly diagnosed low-grade gliomas?RecommendationLevel III: Chemotherapy is recommended as a treatment option to postpone the use of radiotherapy, to slow tumor growth and to improve progression free survival (PFS), overall survival (OS) and clinical symptoms in adult patients with newly diagnosed LGG.QuestionWho are the patients with newly diagnosed LGG that would benefit the most from chemotherapy?RecommendationLevel III: Chemotherapy is recommended as an optional component alone or in combination with radiation as the initial adjuvant therapy for all patients who cannot undergo gross total resection (GTR) of a newly diagnosed LGG. Patients with residual tumor &gt;1 cm on post-operative MRI, presenting diameter of 4 cm or older than 40 years of age should be considered for adjuvant therapy as well.QuestionAre there tumor markers that can predict which patients can benefit the most from initial treatment with chemotherapy?RecommendationLevel III: The addition of chemotherapy to standard RT is recommended in LGG patients that carry IDH mutation. In addition, temozolomide (TMZ) is recommended as a treatment option to slow tumor growth in patients who harbor the 1p/19q co-deletion.QuestionHow soon should the chemotherapy be started once the diagnosis of LGG is confirmed?RecommendationThere is insufficient evidence to make a definitive recommendation on the timing of starting chemotherapy after surgical/pathological diagnosis of LGG has been made. However, using the 12 weeks mark as the latest timeframe to start adjuvant chemotherapy is suggested. It is recommended that patients be enrolled in properly designed clinical trials to assess the timing of chemotherapy initiation once diagnosis is confirmed for this target population.QuestionWhat chemotherapeutic agents should be used for treatment of newly diagnosed LGG?RecommendationThere is insufficient evidence to make a recommendation of one particular regimen. Enrollment of subjects in properly designed trials comparing the efficacy of these or other agents is recommended so as to determine which of these regimens is superior.QuestionWhat is the optimal duration and dosing of chemotherapy as initial treatment for LGG?RecommendationInsufficient evidence exists regarding the duration of any specific cytotoxic drug regimen for treatment of newly diagnosed LGG. Enrollment of subjects in properly designed clinical investigations assessing the optimal duration of this therapy is recommended.QuestionShould chemotherapy be given alone or in conjunction with RT as initial therapy for LGG?RecommendationInsufficient evidence exists to make","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675972","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":"Multimodal treatment of glioblastoma with multiple lesions - a multi-center retrospective analysis.","authors":"Harald Krenzlin, Dragan Jankovic, Alice Dauth, Felipa Lange, Martin Wetzel, Leon Schmidt, Insa Janssen, Christoph Richter, Marcus Stockinger, Heinz Schmidberger, Marc A Brockmann, Clemens Sommer, Bernhard Meyer, Naureen Keric, Florian Ringel","doi":"10.1007/s11060-024-04810-3","DOIUrl":"10.1007/s11060-024-04810-3","url":null,"abstract":"<p><strong>Objective: </strong>The presence of multiple localizations (ML) in glioblastoma is rare and associated with perceived poor prognosis. The aim of this study is to evaluate the impact of a multimodal treatment on progression-free survival (PFS) and overall survival (OS) in ML glioblastoma.</p><p><strong>Methods: </strong>Patients presenting with CNS WHO grade 4 glioblastoma with ML to 2 major German Departments of Neurosurgery between January 1st, 2008, to December 31st, 2020 were included in this study. Primary outcome parameters were extent of resection (EOR) using the 2021 RANO criteria, progression free- and overall survival.</p><p><strong>Results: </strong>A total of 483 patients with newly diagnosed glioblastoma (CNS WHO grade 4) were assessed. 134 patients presented with ML (72 multifocal (MF), 62 multicentric (MC)). The median PFS and OS did not differ among MC and MF glioblastomas. The EOR was a significant predictor of PFS and OS in ML glioblastoma. complete-, near total-, and subtotal resection significantly prolonged PFS (p < 0.0001) and OS (p < 0.0001) compared to biopsy alone. Standard radiotherapy (p = 0.045) and hypofractionated (p < 0.0001) radiotherapy and adjuvant treatment (Stupp protocol) prolonged PFS (p = 0.0012) and OS (p < 0.0001). In multivariate analysis Karnfosky performance score, EOR, and concomitant adjuvant treatment remained significant factors influencing OS. Propensity score matching of patients with ML and solitary lesion tumors showed similar PFS and OS (p = 0.08).</p><p><strong>Conclusion: </strong>The presented data suggests that glioblastomas with multiple lesions treated with multimodal therapy equal survival rates compared to patients with solitary lesion tumors can be achieved. The results reflect the importance of an equally aggressive maximal treatment effort in this particular and often marginalized group of patients.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668174","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":"Optimal treatment regimen for very elderly patients with atypical meningioma: an analysis of survival outcomes using the National Cancer Database (NCDB).","authors":"Linda Tang, Sachiv Chakravarti, Evan Li, Yuncong Mao, A Karim Ahmed, Debraj Mukherjee","doi":"10.1007/s11060-024-04886-x","DOIUrl":"10.1007/s11060-024-04886-x","url":null,"abstract":"<p><strong>Purpose: </strong>We assess the efficacy of different surgical resection types, radiotherapy, systemic therapy on overall survival in very elderly patients (age > 80) with intracranial atypical meningioma in contrast with their elderly (65-80) counterparts.</p><p><strong>Methods: </strong>Patients > 65 years old with intracranial atypical meningiomas surgically resected and catalogued via the National Cancer Database were included. Cox proportional hazards models were developed to assess the association between surgical resection type, radiotherapy and systemic therapy with OS while controlling for sex, race, ethnicity, facility type, income, tumor size and CDCC score.</p><p><strong>Results: </strong>1747 elderly patients and 382 very elderly patients were included. 61.70% elderly patients and 58.90% very elderly patients received GTR. 26.50% elderly patients and 14.13% very elderly patients received radiotherapy. In multivariate analysis, subtotal resection is associated with worse survival (HR 1.28, p < 0.01) and radiotherapy is associated with improved survival (HR 0.76, p < 0.01). Systemic therapy was not associated with changes in survival outcomes (HR 1.17, p = 0.79). Using subgroup analysis, gross total resection is associated with better survival outcomes in both elderly and very elderly cohorts. Radiotherapy was not associated with improved survival (HR 0.85, p = 0.11) for patients between 65 and 80 years old, but was associated with improved survival (HR 0.51, p < 0.01) for patients > 80 years old.</p><p><strong>Conclusion: </strong>GTR provides survival advantage in both elderly and very elderly cohorts. Radiotherapy provides survival benefits for very elderly patients even though very elderly patients are less likely to received radiotherapy. Very elderly patients may benefit from more aggressive management in the treatment of atypical meningiomas.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668177","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":"Predicting intraoperative 5-ALA-induced tumor fluorescence via MRI and deep learning in gliomas with radiographic lower-grade characteristics.","authors":"Eric Suero Molina, Ghasem Azemi, Zeynep Özdemir, Carlo Russo, Hermann Krähling, Alexandra Valls Chavarria, Sidong Liu, Walter Stummer, Antonio Di Ieva","doi":"10.1007/s11060-024-04875-0","DOIUrl":"10.1007/s11060-024-04875-0","url":null,"abstract":"<p><strong>Purpose: </strong>Lower-grade gliomas typically exhibit 5-aminolevulinic acid (5-ALA)-induced fluorescence in only 20-30% of cases, a rate that can be increased by doubling the administered dose of 5-ALA. Fluorescence can depict anaplastic foci, which can be precisely sampled to avoid undergrading. We aimed to analyze whether a deep learning model could predict intraoperative fluorescence based on preoperative magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>We evaluated a cohort of 163 glioma patients categorized intraoperatively as fluorescent (n = 83) or non-fluorescent (n = 80). The preoperative MR images of gliomas lacking high-grade characteristics (e.g., necrosis or irregular ring contrast-enhancement) consisted of T1, T1-post gadolinium, and FLAIR sequences. The preprocessed MRIs were fed into an encoder-decoder convolutional neural network (U-Net), pre-trained for tumor segmentation using those three MRI sequences. We used the outputs of the bottleneck layer of the U-Net in the Variational Autoencoder (VAE) as features for classification. We identified and utilized the most effective features in a Random Forest classifier using the principal component analysis (PCA) and the partial least square discriminant analysis (PLS-DA) algorithms. We evaluated the performance of the classifier using a tenfold cross-validation procedure.</p><p><strong>Results: </strong>Our proposed approach's performance was assessed using mean balanced accuracy, mean sensitivity, and mean specificity. The optimal results were obtained by employing top-performing features selected by PCA, resulting in a mean balanced accuracy of 80% and mean sensitivity and specificity of 84% and 76%, respectively.</p><p><strong>Conclusions: </strong>Our findings highlight the potential of a U-Net model, coupled with a Random Forest classifier, for pre-operative prediction of intraoperative fluorescence. We achieved high accuracy using the features extracted by the U-Net model pre-trained for brain tumor segmentation. While the model can still be improved, it has the potential for evaluating when to administer 5-ALA to gliomas lacking typical high-grade radiographic features.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668180","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":"The impact of intraoperative mapping during re-resection in recurrent gliomas: a systematic review.","authors":"Mark P van Opijnen, Yasmin Sadigh, Miles E Dijkstra, Jacob S Young, Sandro M Krieg, Sebastian Ille, Nader Sanai, Jordina Rincon-Torroella, Takashi Maruyama, Philippe Schucht, Timothy R Smith, Brian V Nahed, Marike L D Broekman, Steven De Vleeschouwer, Mitchel S Berger, Arnaud J P E Vincent, Jasper K W Gerritsen","doi":"10.1007/s11060-024-04874-1","DOIUrl":"https://doi.org/10.1007/s11060-024-04874-1","url":null,"abstract":"<p><strong>Purpose: </strong>Previous evidence suggests that glioma re-resection can be effective in improving clinical outcomes. Furthermore, the use of mapping techniques during surgery has proven beneficial for newly diagnosed glioma patients. However, the effects of these mapping techniques during re-resection are not clear. This systematic review aimed to assess the evidence of using these techniques for recurrent glioma patients.</p><p><strong>Methods: </strong>A systematic search was performed to identify relevant studies. Articles were eligible if they included adult patients with recurrent gliomas (WHO grade 2-4) who underwent re-resection. Study characteristics, application of mapping, and surgical outcome data on survival, patient functioning, and complications were extracted.</p><p><strong>Results: </strong>The literature strategy identified 6372 articles, of which 125 were screened for eligibility. After full-text evaluation, 58 articles were included in this review, comprising 5311 patients with re-resection for glioma. Of these articles, 17% (10/58) reported the use of awake or asleep intraoperative mapping techniques during re-resection. Mapping was applied in 5% (280/5311) of all patients, and awake craniotomy was used in 3% (142/5311) of the patients.</p><p><strong>Conclusion: </strong>Mapping techniques can be used during re-resection, with some evidence that it is useful to improve clinical outcomes. However, there is a lack of high-quality support in the literature for using these techniques. The low number of studies reporting mapping techniques may, next to publication bias, reflect limited application in the recurrent setting. We advocate for future studies to determine their utility in reducing morbidity and increasing extent of resection, similar to their benefits in the primary setting.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142648338","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":"The clinical impact of EGFR alterations in elderly glioblastoma patients: results from a real-life cohort.","authors":"Séréna Pulcini, Ludivine Beaussire-Trouvay, Florent Marguet, Pierre-Julien Viailly, Olivier Langlois, Cristina Alexandru, Isabelle Tennevet, Fréderic Di Fiore, Nasrin Sarafan-Vasseur, Maxime Fontanilles","doi":"10.1007/s11060-024-04879-w","DOIUrl":"https://doi.org/10.1007/s11060-024-04879-w","url":null,"abstract":"<p><strong>Background: </strong>The incidence of glioblastoma in the elderly population is increasing as the worldwide population ages. The differential and poorer survival in the elderly population compared to younger patients is partially explained. The present study aimed to investigate the clinical impact of epidermal growth factor receptor EGFR-altered glioblastoma in a real-life elderly glioblastoma population.</p><p><strong>Patients and methods: </strong>A bicentric and retrospective study was conducted. Patients were 70 years or older and suffering from histomolecularly confirmed glioblastoma. Single nucleotide variants (SNV), amplification, or chromosome 7 polysomy were sought. The primary endpoint was the comparison of overall survival (OS) in patients with or without EGFR alteration. Secondary objectives were to determine other clinical parameters correlated with EGFR alteration status.</p><p><strong>Results: </strong>Seventy-three patients were analyzed: 41.1% had at least one EGFR alteration. The presence of EGFR alteration did not impact overall survival: HR 0.97 [0.6-1.57], p = 0.9; the median overall survival was 6.5 months [5.3-9.3] in the EGFR-altered group versus 7 months [4.5-10] in the EGFR wild-type group, p = 0.75. In multivariate analysis, tumor resection was associated with a significant overall survival improvement: the median OS in the resected group (n = 20) was 11 months [95% CI 7.8-22] versus a median OS of 5.5 months [4.6-7.8] in the unresected group (n = 53), without correlation to EGFR alteration status.</p><p><strong>Conclusion: </strong>In the modern era of molecular characterization and improved treatment modalities, the presence of at least one EGFR alteration did not influence survival outcomes in an elderly population of glioblastoma patients.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644445","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":"Association between tumor location and toxicity outcomes after stereotactic radiosurgery for brain metastases.","authors":"Boya Wang, Alexandra Bukowski, Orit Kaidar-Person, James M Choi, Deanna M Sasaki-Adams, Sivakumar Jaikumar, Dominique M Higgins, Matthew G Ewend, Soma Sengupta, Timothy M Zagar, Theodore K Yanagihara, Joel E Tepper, Lawrence B Marks, Colette J Shen","doi":"10.1007/s11060-024-04866-1","DOIUrl":"https://doi.org/10.1007/s11060-024-04866-1","url":null,"abstract":"<p><strong>Purpose: </strong>Toxicities associated with stereotactic radiosurgery (SRS) are important when considering treatment and supportive management for patients with brain metastases. We herein assessed the association between brain metastasis location and risk of toxicity after SRS.</p><p><strong>Methods: </strong>We conducted a retrospective institutional review of patients treated with SRS for brain metastases between 2008 and 2023. Outcomes included radiation necrosis, seizure, local failure, and overall survival (OS).</p><p><strong>Results: </strong>We reviewed 215 patients treated to 605 metastases (median diameter 10 mm, IQR 5-17 mm), in the frontal (34%), cerebellar (19%), parietal (16%), temporal (13%), and occipital (13%) regions. Median follow-up was 16 months (IQR 7-36). New-onset seizures developed in 11% (19/174) of patients without prior seizure and was higher in patients with motor or sensory cortex lesions (12/48, 25%) on multivariate analysis (MVA, P = 0.02). SRS-related grade ≥ 2 symptomatic radionecrosis occurred in 6% (33/605) of lesions and correlated with larger metastasis volume (P < 0.001) and renal cell carcinoma histology (P < 0.05), while supratentorial location was nearly significant (MVA, P = 0.06). Median OS across all patients was 16 months (95% CI 12-20). Patients with symptomatic radiation necrosis had a longer median survival compared to those who did not (43 vs. 14 months, P = 0.002), which remained significant alongside Karnofsky performance status and extracranial disease on MVA.</p><p><strong>Conclusion: </strong>Brain metastasis location in the motor or sensory cortex is associated with increased risk of new-onset seizure following SRS and may warrant consideration of steroid and/or anti-epileptic prophylaxis. Symptomatic radiation necrosis is uncommon in the cerebellum and may be increasing with improvements in survival.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622147","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}