Journal of Neuro-Oncology最新文献

{"title":"A phase I study of convection-enhanced delivery (CED) of liposomal-irinotecan using real-time magnetic resonance imaging in patients with recurrent high-grade glioma.","authors":"Kazim H Narsinh, Karishma Kumar, Krystof Bankiewicz, Alastair J Martin, Mitchell Berger, Jennifer Clarke, Jennie Taylor, Nancy Ann Oberheim Bush, Annette M Molinaro, Manish Aghi, Nicholas Butowski","doi":"10.1007/s11060-024-04904-y","DOIUrl":"https://doi.org/10.1007/s11060-024-04904-y","url":null,"abstract":"<p><strong>Background: </strong>Irinotecan demonstrates anti-tumor efficacy in preclinical glioma models but clinical results are modest due to drug delivery limitations. Convection enhanced delivery (CED) improves drug delivery by increasing intratumoral drug concentration. Real-time magnetic resonance imaging of infusate delivery during CED may optimize tumor coverage. This phase 1 trial examines the safety and tolerability of liposomal irinotecan and gadolinium delivered via CED using real-time MRI guidance in recurrent high-grade glioma patients.</p><p><strong>Methods: </strong>Initially, a 3 + 3 dose-escalating, single dose trial was planned with 4 cohorts based on a fixed drug dose and volume. After 9 patients, a protocol amendment allowed for variable volume and dose of the study agent based on tumor size. The amended design specified 'personalized' drug volume but fixed concentration of 20 mg/mL of liposomal irinotecan in the first cohort escalating to 40 mg/mL in the second cohort.</p><p><strong>Results: </strong>Eighteen patients with recurrent WHO grade 3 or 4 gliomas (diameter 1-4 cm) were treated. Based on the tumor volume, the total dose of liposomal irinotecan was 20-680 mg in a total volume of 2-17 ml. Technical challenges were overcome by real-time MRI guidance and protocol amendment. The only dose-limiting toxicity (DLT) was a grade 3 stroke. Safety and survival information is presented.</p><p><strong>Conclusions: </strong>CED of liposomal irinotecan using real-time MRI in patients with recurrent high-grade glioma is feasible. Image-guidance allowed for improved placement of CED cannulas and optimal tumor coverage. Our results warrant further study with repeat CED dosing.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931983","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":"Advances in molecular prognostication and treatments in ependymoma.","authors":"Emma Bakes, Rachel Cheng, Noralyn Mañucat-Tan, Vijay Ramaswamy, Jordan R Hansford","doi":"10.1007/s11060-024-04923-9","DOIUrl":"https://doi.org/10.1007/s11060-024-04923-9","url":null,"abstract":"<p><p>Ependymoma is the third most common brain tumour of childhood and historically has posed a major challenge to both pediatric and adult neuro-oncologists. Ependymoma can occur anywhere in the central nervous system throughout the entire age spectrum. Treatment options have been limited to surgery and radiation, and outcomes have been widely disparate across studies. Indeed, these disparate outcomes have rendered it extraordinarily difficult to compare studies and to truly understand which patients are low and high-risk. Over the past two decades there have been tremendous advances in our understanding of the biology of ependymoma, which have changed risk stratification dramatically. Indeed, it is now well accepted that ependymoma comprises multiple distinct entities, whereby each compartment (supratentorial, posterior fossa, spinal) are distinct, and within each compartment there exist unique groups. The driver events, demographics and response to treatment vary widely across these groups and allow for a better classification of thee disease. Herein, we review the advances in the molecular stratification of ependymoma including how an improved classification and risk stratification allows for more precise therapies.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931986","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":"Nimotuzumab and bevacizumab combined with temozolomide and radiotherapy in patients with newly diagnosed glioblastoma multiforme: a retrospective single-arm study.","authors":"Yaping Wu, Zhiying Chen, Mingtao Shi, Shuo Qiu, Yongchun Zhang","doi":"10.1007/s11060-024-04932-8","DOIUrl":"https://doi.org/10.1007/s11060-024-04932-8","url":null,"abstract":"<p><strong>Purpose: </strong>Glioblastoma (GBM), the most common malignant tumor of the central nervous system (CNS) in adults, continues to result in poor survival rates despite standard treatment. Advancements in understanding GBM's molecular complexity have increased interest in targeted therapeutic approaches. This retrospective, single-center, single-arm study combined nimotuzumab and bevacizumab with radiotherapy (RT) and temozolomide (TMZ) for the treatment of newly diagnosed GBM. The objectives were to determine the efficacy of this treatment combination and the associated toxicity.</p><p><strong>Methods: </strong>A retrospective analysis of clinical data of GBM patients treated at our institution from September 2021 to May 2023 with postoperative combination therapy of nimotuzumab, bevacizumab, and TMZ concurrent with RT, as well as maintenance therapy with bevacizumab and TMZ. Follow-ups were performed every 3 to 6 months via hospital visits and telephone interviews. The primary endpoints were overall survival (OS) and progression-free survival (PFS). The secondary endpoint was the incidence of adverse events (AEs).</p><p><strong>Results: </strong>A total of 18 patients were included. The median follow-up time was 23 months. The one-year PFS rate was 77.8%, and the one-year OS rate was 94.4%. The median PFS was 18 months (95%CI, 15.9-20.1), and the median OS was 28 months (95%CI, 18.9-37.1). All AEs were controllable.</p><p><strong>Conclusion: </strong>The combination of nimotuzumab and bevacizumab with TMZ and RT appears to demonstrate efficacy and safety in newly diagnosed GBM patients, providing a reference for clinical treatment. Further prospective studies are needed to confirm our results.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931988","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":"Creating a predictive model and online calculator for high-value care outcomes following glioblastoma resection: incorporating neighborhood socioeconomic status index.","authors":"Foad Kazemi, Julian L Gendreau, Megan Parker, Sachiv Chakravarti, Adrian E Jimenez, A Karim Ahmed, Jordina Rincon-Torroella, Christopher Jackson, Gary L Gallia, Chetan Bettegowda, Jon Weingart, Henry Brem, Debraj Mukherjee","doi":"10.1007/s11060-024-04927-5","DOIUrl":"https://doi.org/10.1007/s11060-024-04927-5","url":null,"abstract":"<p><strong>Purpose: </strong>Social determinants of health including neighborhood socioeconomic status, have been established to play a profound role in overall access to care and outcomes in numerous specialized disease entities. To provide glioblastoma multiforme (GBM) patients with high-quality care, it is crucial to identify predictors of hospital length of stay (LOS), discharge disposition, and access to postoperative adjuvant chemoradiation. In this study, we incorporate a novel neighborhood socioeconomic status index (NSES) and develop three predictive algorithms for assessing post-operative outcomes in GBM patients, offering a tool for preoperative risk stratification of GBM patients.</p><p><strong>Methods: </strong>Adult GBM patients who underwent surgical resection from a single center were identified; NSES was identified via patient street address of residence, with lower scores representing disadvantaged neighborhoods. Multivariate logistic regression analysis was used to predict high value care outcomes. The Hosmer-Lemeshow test was used to assess model calibration.</p><p><strong>Results: </strong>A total of 467 patients were included, with a mean age of 59.85 ± 13.21 years and 58.7% being male. The mean NSES for our cohort was 63.77 ± 14.91, indicating that the majority resided in neighborhoods with a higher socioeconomic status compared to the national average NSES of 50. One hundred nine (23.3%) patients had extended LOS, 28.9% had non-routine discharge, and 19.1% did not follow the Stupp protocol following surgery. On multivariate regression, worse NSES was significantly and independently associated with extended LOS (OR = 0.981, p = 0.026), non-routine discharge disposition (OR = 0.984, p = 0.033), and non-compliance with the Stupp protocol (OR = 0.977, p = 0.014). Our three models predicting high-value care outcomes had acceptable C-statistics > 0.70, and all models demonstrated adequate calibration (p > 0.05). Final models are accessible via online calculator. https://neurooncsurgery4.shinyapps.io/GBM_NSES_Caclulator/ CONCLUSION: NSES scores are readily available and may be utilized via our open-access calculators. After external validation, our predictive models have the potential to assist in providing patients with individualized risk estimates for post-operative outcomes following GBM resection.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927272","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":"Mifepristone achieves tumor suppression and ferroptosis through PR/p53/HO1/GPX4 axis in meningioma cells.","authors":"Qin Dai, Jinfei Wei, Ziwei Li, Ting Li, Yenan Fang, Xinyu Li, Bingyan Shen, Qiqi Xie, Min Wang, Wencan Wu","doi":"10.1007/s11060-024-04918-6","DOIUrl":"https://doi.org/10.1007/s11060-024-04918-6","url":null,"abstract":"<p><strong>Purpose: </strong>This study explores the effects of mifepristone on the proliferation, motility, and invasion of malignant and benign meningioma cells, aiming to identify mifepristone-sensitive types and investigate the underlying molecular mechanisms.</p><p><strong>Methods: </strong>IOMM-Lee and HBL-52 meningioma cells were treated with 0, vehicle control (VC), 5, 10, 20, 40, and 80 μM of mifepristone for 12, 24, 48, 72, and 96 h. Proliferation was assessed via CCK8 assay, while motility and invasion were measured using wound scratch and transwell assays. RNA sequencing and RT-PCR were used to analyze gene expression changes.</p><p><strong>Results: </strong>Mifepristone inhibited proliferation, motility, and invasion in both IOMM-Lee and HBL-52 cells in a dose- and time-dependent manner. RNA sequencing showed up-regulated genes significantly enriched in the ferroptosis pathway in both cell lines, confirmed by increased p53 and HO1 expression, decreased GPX4 expression, lipid peroxidation, Fe²⁺ accumulation, and ROS release. Immunofluorescence staining and RT-PCR also revealed a corresponding decrease in mifepristone-related progesterone receptor expression.</p><p><strong>Conclusion: </strong>Mifepristone induces ferroptosis in meningioma cells via the PR/p53/HO1/GPX4 axis, suggesting its potential as a treatment for ferroptosis-sensitive meningiomas. It also supplies new clues regarding ferroptosis as a treatment entry point for meningiomas.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921250","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":"Radiation therapy for childhood-onset craniopharyngioma: systematic review and meta-analysis.","authors":"Yuqi Miao, Di Wu, Yu Li, Yangmingyue Ji, Yanmei Sang","doi":"10.1007/s11060-024-04914-w","DOIUrl":"https://doi.org/10.1007/s11060-024-04914-w","url":null,"abstract":"<p><strong>Background: </strong>Craniopharyngioma (CP), a benign tumor originating from remnants of Rathke's pouch in the sellar region, accounts for approximately 30% of all cases of craniopharyngioma. Radiation therapy has been used to treat CP patients for decades; however, there is still a lack of systematic reviews on the long-term tumor control outcomes in pediatric CP patients treated with external radiation therapy.</p><p><strong>Methods: </strong>We conducted a comprehensive search of multiple databases for studies on the tumor progression rates of childhood-onset CP(COCP) patients who received external radiotherapy. We also recorded morbidities related to hypopituitarism and vasculopathy. A meta-analysis was performed to calculate the pooled incidence rates. Meta-regression was applied to explore potential sources of heterogeneity in the tumor progression rates.</p><p><strong>Results: </strong>A total of 22 studies were included after screening and eligibility assessment in accordance with PRISMA guidelines. The median (mean) follow-up period ranged from 2 to 14.9 years. The pooled overall tumor progression rate was 0.10 (95% CI 0.07-0.15). The recurrence rates were 0.14 (95% CI 0.09-0.19) for photon therapy and 0.04 (95% CI 0.01-0.07) for proton therapy. Meta-regression indicated that none of the following underlying risk factors significantly affected the heterogeneity of the recurrence rate: radiation modality (photon vs. proton), median (mean) follow-up duration, or the proportion of patients who did not undergo surgical resection. The pooled incidence of growth hormone deficiency (GHD), thyroid hormone deficiency (THD), adrenocorticotropic hormone deficiency (ACTHD), gonadotropin-releasing hormone deficiency (GnRHD), and diabetes insipidus (DI) were 0.81 (95% CI 0.70-0.90), 0.88 (95% CI 0.79-0.95), 0.69 (95% CI 0.52-0.85), 0.43 (95% CI 0.38-0.49), and 0.56 (95% CI 0.33-0.78), respectively. The pooled morbidity rate for vasculopathy was 0.06 (95% CI 0.04-0.09), with similar rates observed for both photon and proton therapy.</p><p><strong>Conclusion: </strong>Radiotherapy is a suitable adjuvant or alternative treatment method for childhood CP patients. However, patients inevitably face significant long-term treatment-related complications.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921619","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 METACER national cohort study of brain metastases in gastrointestinal cancers prospectively establishes prognostic factors.","authors":"Violaine Randrian, Fabienne Portales, Olivier Bouché, Simon Thezenas, Benoist Chibaudel, May Mabro, Eric Terrebonne, Claire Garnier-Tixidre, Christophe Louvet, Thierry André, Thomas Aparicio, Olivier Dubreuil, Gregoire Bouché, Marc Ychou, David Tougeron","doi":"10.1007/s11060-024-04905-x","DOIUrl":"https://doi.org/10.1007/s11060-024-04905-x","url":null,"abstract":"<p><strong>Purpose: </strong>Availability data are scarce and primarily retrospective in patients with brain metastasis (BM) from gastrointestinal (GI) cancers. The objective of this cohort was to determine prognostic factors for survival outcomes in patients with BM from GI cancers.</p><p><strong>Methods: </strong>METACER is a national multicentric prospective cohort study which included patients with BM diagnosis during a histologically proven digestive cancer follow-up between 2010 and 2014. The primary endpoint was overall survival (OS). The secondary endpoints were Progression-Free survival (PFS), prognostic factors, and BM-free survival as time from disease diagnosis to BM diagnosis.</p><p><strong>Results: </strong>METACER included 130 patients, with colorectal cancer (CRC) (N = 105) and eso-gastric (N = 25) cancer (EGC). The median OS was 6.6 months: 7.1 months (95%CI: 4.7-9.7) in CRC patients and 5.2 months, (95%CI: 1.9-7.6) in EG patients (p = 0.827). In multivariate analysis, cerebral BM location (versus cerebellar), BM surgery, performance status (0-1 versus 2), and a unique BM were significantly associated with prolonged OS. BM-free survival were 30.8 months (95%CI:25.2-36.9) in CRC patients and 7.8 months (95%CI:3.8-13.6) in EGC patients (p < 0.001). In synchronous metastatic disease, BM-free survival were 18.6 months (95%CI:13.1-25.2) in CRC patients and 3.7 months (95%CI:0.03-7.8) in EGC patients (p < 0.001).</p><p><strong>Conclusion: </strong>BM in GI cancers are of poor prognosis. BM surgery should be considered in case of unique brain lesion. In metastatic settings, EGC patients have shorter BM-free survival than CRC patients.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921664","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":"Bevacizumab exerts dose-dependent risk for intracranial hemorrhage in patients with malignant gliomas.","authors":"Sanghee Lim, Nathan H Clarke, Sara L Maloney, Ugur T Sener, Samantha J Caron, Sani H Kizilbash, Jian L Campian, Bryan J Neth, Ivan D Carabenciov, Joon Uhm, Michael W Ruff","doi":"10.1007/s11060-024-04916-8","DOIUrl":"https://doi.org/10.1007/s11060-024-04916-8","url":null,"abstract":"<p><strong>Purpose: </strong>Bevacizumab, an anti-VEGF monoclonal antibody, has become a mainstay therapeutic in the management of malignant glioma. It is unknown if the risk of intracranial hemorrhage (ICH), a major complication associated with bevacizumab use, is dose-dependent.</p><p><strong>Methods: </strong>This was a single institution retrospective analysis of patients treated with bevacizumab for the management of gliomas between 2009 and 2022. Incidence rates of ICH between patients receiving low-dose (< 5 mg/kg/week) and conventional-dose (5 mg/kg/week) bevacizumab regimens were compared via competing risk analysis over time. We evaluated post-progression survival (PPS) as a secondary outcome using multivariate Cox regression.</p><p><strong>Results: </strong>One hundred and seventy-three patients were identified (low-dose group, n = 51, conventional-dose group, n = 122) for inclusion in our analysis. Cumulative incidence rates of all cases of ICH and clinically symptomatic cases of ICH were higher in the conventional-dose (17.2% for all cases, 13.7% for symptomatic) relative to the low-dose group (3.9% for all cases, 2.0% for symptomatic); p-value 0.0296 for all cases, p-value 0.0274 for symptomatic cases. On multivariate Fine-Gray regression, conventional-dose bevacizumab therapy remained significantly associated with increased risk for symptomatic ICH (SHR 8.0560; p-value 0.0442). No difference in PPS was observed between the low-dose versus conventional-dose groups.</p><p><strong>Conclusions: </strong>Conventional-dose bevacizumab therapy (5 mg/kg/week) is associated with increased incidence of ICH in patients with malignant glioma compared to lower dose bevacizumab (< 5 mg/kg/week) in this single center retrospective cohort. No difference in PPS was observed between the low-dose versus conventional-dose groups.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921140","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":"Characteristics and survival outcomes in pediatric patients with spinal chordomas: insights from the National Cancer Database and review of the literature.","authors":"Victor Gabriel El-Hajj, Sruthi Ranganathan, Rami Rajjoub, Abdul Karim Ghaith, Nicholas Theodore, Adrian Elmi-Terander, Daniel Lubelski","doi":"10.1007/s11060-024-04921-x","DOIUrl":"https://doi.org/10.1007/s11060-024-04921-x","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal chordomas are aggressive tumors that rarely occur in the pediatric population. Demographics and post-treatment outcomes in this select group of patients is poorly studied. We hence aimed to analyze the clinical characteristics, demographics, and survival outcomes of pediatric patients with spinal chordomas, in contrast to the adult population. To address this, the literature was reviewed to evaluate the coverage on spinal chordomas of the pediatric population, and the National Cancer Database (NCDB) was analyzed to provide insights into the US experience over the past two decades.</p><p><strong>Methods: </strong>A search of the literature was performed leveraging the MEDLINE and Web of Science electronic databases from inception until March 2024, using the keywords \"spinal,\" \"chordoma,\" and \"pediatric\". Additionally, the NCDB was queried for pediatric patients (≤ 21 years) with chordoma treated between 2004 and 2017. Baseline characteristics, tumor specifics, treatment details, and survival outcomes were collected and analyzed.</p><p><strong>Results: </strong>From the literature, 45 pediatric chordoma patients were identified, with a median age of 7 years. Most chordomas were in the cervical spine (40%), and 93% of the patients received surgical treatment. Gross total resection was achieved in 59% of cases, and 49% received adjuvant radiotherapy. Recurrence, metastasis, and mortality rates were 7%, 18%, and 24%, respectively at a median follow-up of 12 months. In the NCDB cohort, 53 pediatric patients (≤ 21 years) and 980 adults (> 21 years) were compared. Despite having smaller tumors in size, pediatric patients presented with more advanced tumors with a higher proportion of stage 4 tumors. They had more mobile spine chordomas (83% vs. 51%) and traveled further for treatment (57 vs. 27 miles). Pediatric patients also received higher radiation doses (5420 vs. 5049 cGy). Surgical resection and adjuvant radiotherapy were common treatments in both groups. After matching, outcomes, including survival rates and early mortality, were similar between age groups. Kaplan-Meier analysis showed no difference in overall survival probabilities between the age groups both prior to and after matching.</p><p><strong>Conclusion: </strong>While pediatric patients with spinal chordomas present with more advanced stage tumors, they demonstrate similar overall survival outcomes when compared to adults. The current literature is mainly composed of single cases and other reports of low evidence levels.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921212","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":"Stereotactic implantation of diffusing alpha-emitters radiation therapy sources in the swine brain: a potential new focal therapy for brain tumors.","authors":"Yigal Shoshan, Moshe J Gomori, Lior Moss, Saleem Eben Bari, Nir Edery, Robert B Den, Lior Arazi, Aron Popovtzer, Jon Feldman, Samuel Moscovici","doi":"10.1007/s11060-024-04919-5","DOIUrl":"https://doi.org/10.1007/s11060-024-04919-5","url":null,"abstract":"<p><strong>Purpose: </strong>Diffusing alpha-emitters Radiation Therapy (\"Alpha DaRT\") is a new cancer treatment modality that employs radium-224-loaded metal sources implanted in solid tumors to disperse alpha-emitting atoms within a therapeutic \"kill-zone\" of a few millimeters around each source. Preclinical studies have demonstrated tumor growth delay in various cancer types, including glioblastoma multiforme, and the method is used in clinical trials for patients with skin and head and neck cancer. This study aims to assess the safety and feasibility of implementing Alpha DaRT for brain tumor treatment in a large animal model.</p><p><strong>Methods: </strong>Alpha-DaRT sources were delivered via image-guided stereotactic implantation into both hemispheres of eight swine. 1-3 layers of radial deployment of 7 sources were delivered through a single penetration point into each hemisphere. A 90-day follow-up period included clinical evaluation, brain MRI, head CT, blood, CSF, urine, and feces sampling, and an analysis of source location over time. Brain tissue pathology was performed on termination.</p><p><strong>Results: </strong>Alpha-DaRT sources were reproducibly and efficiently delivered to the brain cortex and subcortex. No unexpected abnormalities were detected in blood or CSF samples. MRI and CT scans revealed no evidence of major bleeding or infection. Measurements of ²¹²Pb in blood and CSF exhibited the expected exponential decay from day 7 to day 14 post-source implantation. Minimal spatial and temporal movements of the sources were noted. Histopathological analysis demonstrated locally confined findings in brain parenchyma in a very close proximity to the sources.</p><p><strong>Conclusion: </strong>Alpha-DaRT sources can be safely delivered into a large animal brain using image-guided stereotactic implantation. These findings support further exploration of Alpha DaRT as a potential treatment modality for brain tumors.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921707","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}