Journal of Neuro-Oncology最新文献

{"title":"Radiological features of peritumoral brain injury and neurological outcomes after glioma surgery: a prospective observational study.","authors":"Jintong Cheng, Zhenghe Chen, Depei Li, Zhuoxin Guo, Yadi Yang, Xiao Luo, Ji Zhang, Yinsheng Chen, Xiaobing Jiang, Fuhua Lin, Qinqin Zhao, Zhihuan Zhou, Zhongping Chen","doi":"10.1007/s11060-026-05828-5","DOIUrl":"10.1007/s11060-026-05828-5","url":null,"abstract":"<p><strong>Purpose: </strong>Despite significant advances in glioma surgery, early postoperative neuroimaging frequently reveals signs of surgical brain injury (SBI). This prospective observational study aimed to investigate the incidence, radiological characteristics, neurological outcomes and risk factors of SBI following glioma resection.</p><p><strong>Methods: </strong>Patients with newly diagnosed supratentorial gliomas who undergo tumor resection were prospectively enrolled. Serial MRI examinations were administrated early postoperative (≤ 72 h) and on postoperative days 7, 14 and 28 to assess the characteristics of infarction, edema and microhemorrhage. Neurological outcomes were evaluated using the modified Rankin Scale (mRS) at postoperative day 28.</p><p><strong>Results: </strong>A total of 64 patients was included. Postoperative infarction was identified in 14 patients (21.9%), with all anatomically localized to the basal ganglia, thalamus, or insular regions. Intraoperative blood loss ≥ 300 mL was independently associated with postoperative infarction (Odd Ratio [OR]: 4.62, p = 0.035). Microhemorrhage was observed in 53.8% of patients. Peritumoral edema occurred in all cases and exhibited two distinct patterns: residual tumor-associated edema (n = 42) and de novo surgery-induced edema (n = 22). The average volume of tumor-associated edema decreased, whereas that of surgery-induced edema increased over time. Among the 53 patients who completed neurological outcome assessments, 13 developed disability (mRS ≥ 2). Risk factors were higher intraoperative blood loss (OR: 8.88, p = 0.013) and postoperative infarction (OR: 6.33, p = 0.031).</p><p><strong>Conclusion: </strong>SBI, including infarction and edema, is common following glioma surgery and associated with adverse neurological outcomes. Meticulous intraoperative hemostatic management is essential to prevent postoperative infarction and even disability outcome.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182444","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":"Weekly hippocampal diffusion changes during partial-brain radiation therapy for high-grade glioma: associations with dose and early memory change.","authors":"Ory Haisraely, Bikash Panthi, Kyle Richard Noll, Eleni Konstantinopoulou, Andrew Elliott, Sara Thrower, Holly Langshaw, Wasif Talpur, Catherine Sullaway, Todd Swanson, Chenyang Wang, Martin C Tom, Thomas Beckham, Wen Jiang, Debra Nana Yeboa, Mary Frances McAleer, Amol Ghia, Susan Lynne McGovern, Jing Li, Jeffrey Scott Wefel, Caroline Chung","doi":"10.1007/s11060-026-05822-x","DOIUrl":"10.1007/s11060-026-05822-x","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the weekly trajectory of hippocampal diffusion during fractionated partial-brain radiation therapy (RT) for high-grade glioma and determine whether the magnitude of change is associated with planned hippocampal dose.</p><p><strong>Methods: </strong>Forty-five adults enrolled in a prospective observational imaging study and treated with 60 Gy in 30 fractions with concurrent temozolomide underwent diffusion MRI before RT and weekly during treatment. Relative bilateral hippocampal apparent diffusion coefficient (ADC) change and fractional anisotropy (FA) were evaluated longitudinally. Linear mixed-effects models included treatment week and planned mean bilateral hippocampal dose as fixed main effects. A secondary laterally-specific analysis evaluated baseline-to-Week-6 ADC change separately in the hippocampi ipsilateral and contralateral to the tumor.</p><p><strong>Results: </strong>Hippocampal ADC increased progressively from a median relative change of 0.5% at Week 1 to 12% (IQR, 6%-18%) at Week 6. The ADC time coefficient was + 2.2% points per week (95% CI, 1.8-2.5; P < 0.001). After accounting for week, higher planned mean bilateral hippocampal dose was associated with greater ADC change (+ 0.81% points/Gy; 95% CI, 0.76-0.93; P < 0.001). In the secondary laterally-specific analysis, higher dose was associated with greater Week-6 ADC change in both the ipsilateral hippocampus (β = 0.83% points/Gy; 95% CI, 0.52-1.26; P = 0.013) and the contralateral hippocampus (β = 0.36% points/Gy; 95% CI, 0.05-0.712; P = 0.046). FA remained stable through Week 3 and declined during Weeks 4-6.</p><p><strong>Conclusion: </strong>Weekly diffusion MRI demonstrates a progressive, dose-associated hippocampal response during fractionated RT. The laterality-specific findings further support an association between local radiation exposure and ADC change and support hippocampal ADC as a candidate treatment-phase imaging phenotype for prospective validation.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149182446","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":"Leveraging traditional and advanced machine learning for comprehensive oncology data integration and outcome prediction.","authors":"Grace Hey, Michael Del Sesto, Megan Still, Gopi Patel, Nellie Crlenjak, Abeer Dagra, Yonghui Wu, Yi Guo, Ashley P Ghiaseddin","doi":"10.1007/s11060-026-05774-2","DOIUrl":"10.1007/s11060-026-05774-2","url":null,"abstract":"<p><strong>Background: </strong>Outcome prediction in neuro-oncology remains challenging due to heterogeneity in tumor biology, imaging characteristics, treatment response, and patient-specific clinical factors. Although molecular databases have advanced understanding of brain tumor biology, many datasets lack broader data necessary for generalizable predictive modeling. Artificial intelligence (AI) and machine learning (ML) are increasingly being explored to integrate these heterogeneous data sources and support precision neuro-oncology.</p><p><strong>Methods: </strong>A narrative review was performed using PubMed and Embase to identify studies evaluating oncology databases, ML models, multimodal data integration, and AI applications relevant to neuro-oncology. Studies published between 2020 and 2026 were preferentially reviewed, with additional landmark studies included when relevant.</p><p><strong>Results: </strong>Traditional ML approaches including regression-based models, random forests, support vector machines, and gradient boosting algorithms have been applied to survival prediction, recurrence classification, treatment response estimation, and molecular biomarker prediction using clinical, imaging, molecular, and population-level datasets. More advanced architectures including natural language processing, large language models, vision transformers, geometric deep learning, and graph neural networks have expanded the ability to analyze unstructured and multimodal data sources including radiology reports, histopathology slides, MRI volumes, molecular datasets, and electronic health records. Multimodal AI systems integrating imaging, molecular, histopathologic, clinical, and socioeconomic data frequently demonstrated improved predictive performance compared with single-modality models. However, widespread clinical implementation remains limited by dataset heterogeneity, limited external validation, interpretability concerns, and inconsistent representation across patient populations.</p><p><strong>Conclusions: </strong>AI and ML approaches are increasingly capable of integrating complex neuro-oncology datasets in ways that more closely reflect real-world clinical decision-making. Although most current models remain investigational, multimodal AI frameworks may ultimately improve prognostic assessment, treatment stratification, and precision neuro-oncology care. Continued progress will require larger representative datasets, improved data harmonization, external validation, and clinically interpretable models.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166255","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":"Comparative dosing of bevacizumab for radiation necrosis: impact of tumor type on edema response.","authors":"Sydney E Schultz, Milisia Labib, Jeff Breit, Jason N Barreto, Carolyn Mead-Harvey, Mohamad Behair, Aylin Nurioglu, Jessica White, Allison Valerius, Nishika Karbhari, Jodi Taraba, Scott Soefje, Gena Hoefs, Samantha J Caron, Michael W Ruff, Joon H Uhm, Daniel H Lachance, Sani H Kizilbash, Jian L Campian, Susan M Geyer, Bryan J Neth, Ugur Sener","doi":"10.1007/s11060-026-05826-7","DOIUrl":"10.1007/s11060-026-05826-7","url":null,"abstract":"<p><strong>Purpose: </strong>Bevacizumab is an effective treatment for radiation necrosis; however, dose -dependent radiographic and edema response data are lacking.</p><p><strong>Methods: </strong>Multicenter, retrospective cohort study of adult patients with primary central nervous system (CNS) tumors or brain metastases who received bevacizumab for radiation necrosis between June 2021 and July 2024. Patients were grouped by bevacizumab dose (7.5 mg/kg vs. 10 mg/kg administered every three weeks). Primary outcome was edema response, assessed by a blinded neuro-oncologist. Secondary outcomes included contrast enhancing disease response, clinical response, adverse events, treatment discontinuation, and re-dosing for recurrent radiation necrosis. Analyses were performed with and without adjustment for tumor type.</p><p><strong>Results: </strong>104 patients were included (7.5 mg/kg, n = 53; 10 mg/kg, n = 51). Tumor type differed significantly between cohorts (p < 0.001), with more primary CNS tumors in the 10 mg/kg group. Edema response differed between dosing groups in unadjusted analyses (p = 0.032), favoring the 7.5 mg/kg cohort; however, this association was attenuated after adjustment for tumor type. Contrast enhancing disease response did not differ between groups in either unadjusted or adjusted analyses (p = 0.43). Clinical response was higher in the 7.5 mg/kg group (65.2% vs. 37.8%, p = 0.013). Rates of adverse events, treatment discontinuation, and re-dosing were similar.</p><p><strong>Conclusions: </strong>Taken together, both 7.5 mg/kg and 10 mg/kg dosing strategies achieved similar radiographic outcomes. Prospective, tumor-stratified studies incorporating edema-focused and patient-centered endpoints are needed to better define optimal dosing strategies in this heterogeneous population. These findings support an individualized approach to bevacizumab dosing in radiation necrosis and highlight the need for prospective, tumor-stratified studies.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165734","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":"Tumor-related epilepsy and preoperative cognitive performance in glioma: a preliminary study.","authors":"Fang-Tzu Chuang, Ko-Ting Chen, Kuo-Chen Wei, Yi-Chun Chen, Wei-Han Wang, Yu-Chi Liao, Hsin-Te Chang","doi":"10.1007/s11060-026-05820-z","DOIUrl":"10.1007/s11060-026-05820-z","url":null,"abstract":"<p><strong>Purpose: </strong>Tumor-related epilepsy (TRE) is also associated with younger age, less aggressive tumor characteristics, and isocitrate dehydrogenase (IDH)-mutant gliomas, all of which may influence cognition. We examined whether preoperative cognitive performance differed according to seizure presentation after accounting for demographic and tumor-related factors.</p><p><strong>Methods: </strong>Sixty-five treatment-naïve patients with newly diagnosed glioma were included (TRE, n = 30; non-TRE, n = 35). Neuropsychological performance was expressed as demographically adjusted percentile ranks. Group differences were examined using Mann-Whitney U tests with Benjamini-Hochberg false discovery rate correction. Multivariable regression examined whether the association between seizure presentation and cognition persisted after adjustment for age and enhancing tumor volume. Sensitivity analyses additionally incorporated IDH status and other demographic and clinicopathological variables.</p><p><strong>Results: </strong>Patients with TRE were younger more educated, had smaller enhancing tumor volumes, lower-grade tumors, and more frequent IDH mutations. Although several cognitive measures favored the TRE group, only Trail Making Test Part A remained significant after correction (median percentile, 83 vs. 21; q = 0.04; r = .41). In multivariable analysis, seizure presentation remained significantly associated with better TMT-A performance after adjustment for age and enhancing tumor volume (B = 0.276, p = .017). The association remained significant in the sensitivity model incorporating IDH status and additional clinicopathological characteristics.</p><p><strong>Conclusion: </strong>Seizure presentation was associated with better preoperative TMT-A performance after adjustment for selected demographic and tumor-burden factors. The persistence of this association across sensitivity analyses suggests that TRE may capture clinically relevant aspects of the tumor-brain context that are not fully reflected by conventional demographic, pathological, and molecular characteristics.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148374","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":"Longitudinal spatial changes of the contralesional corticospinal tract in high-grade glioma: a within-patient DTI tractography study.","authors":"Bingzhen Li, Raimunde Liang, Ghaith Altawalbeh, Lisa Hoenikl, Eugen Ursu, Axel Schroeder, Haosu Zhang, Philipp Karschnia, Chiara Negwer, Bernhard Meyer, Arthur Wagner","doi":"10.1007/s11060-026-05823-w","DOIUrl":"10.1007/s11060-026-05823-w","url":null,"abstract":"<p><strong>Purpose: </strong>The contralesional corticospinal tract (CST) is often used as an internal reference in glioma tractography, but its longitudinal stability remains poorly understood. We explored within-patient changes in contralesional CST characteristics between primary and recurrent high-grade glioma.</p><p><strong>Methods: </strong>Twenty-nine patients with paired preoperative diffusion tensor imaging at primary and recurrent assessments were retrospectively analyzed. The contralesional CST was reconstructed using anatomically guided deterministic tractography at fractional anisotropy thresholds (FATs) of 0.10 and 0.15. Tract-averaged fractional anisotropy (FA), tract length, and tract volume were compared longitudinally. Spatial changes were assessed using patient-level slice-wise centroid trajectories and paired voxel-wise analyses in standardized space, with HCP842 used as a fixed normative spatial reference.</p><p><strong>Results: </strong>No longitudinal differences in FA, tract length, or tract volume remained significant after BH-FDR correction. In contrast, slice-wise analyses showed a predominantly anterior CST displacement at recurrence, with mean paired Y-axis differences of 2.576 mm at FAT 0.10 and 2.078 mm at FAT 0.15; 57 and 21 slices, respectively, remained significant after correction. Mediolateral changes were smaller and less consistent, and no voxel-wise differences survived correction. Relative to HCP842, both assessments were posterior to the reference trajectory, while the recurrent CST was less posterior.</p><p><strong>Conclusion: </strong>The contralesional CST showed longitudinal spatial displacement without corresponding corrected changes in tractography-derived FA, tract length, or tract volume. These findings indicate that its spatial position may not remain fixed between primary and recurrent glioma assessments.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147501","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":"Supratentorial ependymoma: a comprehensive review of molecular classification, management strategies, and clinical outcomes (Part II of pediatric ependymomas across compartments).","authors":"Frederic A Vallejo, Meredith A Monsour, Nathan S Fredricks, Derek S Tsang, George Koutsouras, Timothy A Ritzmann, Kristian Aquilina, Vijay Ramaswamy, Michael C Dewan","doi":"10.1007/s11060-026-05818-7","DOIUrl":"10.1007/s11060-026-05818-7","url":null,"abstract":"<p><strong>Purpose: </strong>To review the clinical, molecular, and imaging landscape of pediatric supratentorial ependymoma (ST-EP) and outline current management principles guiding surgical and adjuvant treatment decisions.</p><p><strong>Methods: </strong>Synthesis of literature regarding biology, diagnosis, and management of ST-EP, focusing on recently emerging molecular subtypes.</p><p><strong>Results: </strong>ST-EP is an important and clinically significant intracranial malignancy comprising roughly 30-40% of all ependymoma cases. The 2021 WHO molecular classification stratified ST-EP into ZFTA-fusion, YAP1-fusion, and NEC subtypes, fundamentally altering our understanding of this pathology. ZFTA-fused tumors represent the majority of ST-EP, are seen in older patients and harbor a relatively worse prognosis while YAP1-fused tumors, though rarer, are enriched for younger children and carry a substantially more favorable prognosis. Management of very young children presents a unique therapeutic challenge, balancing disease control against the neurocognitive sequelae of cranial irradiation and aggressive surgery in the developing brain.</p><p><strong>Conclusion: </strong>Across molecular subtypes, maximal safe surgical resection remains the dominant prognostic factor, with adjuvant focal radiotherapy well-supported based on tumor grade and extent of resection. Maintenance chemotherapy following radiotherapy has not demonstrated a survival benefit. Further multi-institutional investigation is needed to formalize molecularly-stratified treatment protocols, better characterize NEC subgroups, and identify targeted therapeutics for high-risk disease.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13649942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149136972","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":"Risk stratification for unfavorable outcome after resection of selected brain metastases in patients with multiple brain metastases.","authors":"Thomas Eibl, Petra Andreea Mercea, Adrian Liebert, Leonard Ritter, Jakob Rossmann, Arwin Rezai, Maja Moskwa, Hannah Hurtig, Claudia Stadler, Stephan Wunderlich, Jonas Feldheim, Jan Liman, Christoph Schwartz, Christoph J Griessenauer, Karl-Michael Schebesch","doi":"10.1007/s11060-026-05819-6","DOIUrl":"10.1007/s11060-026-05819-6","url":null,"abstract":"<p><strong>Objective: </strong>Surgical removal of brain metastases (BM) may improve patients' prognosis when substantial tumor debulking is achieved. Patients with multiple lesions may be offered surgery for symptomatic lesions or to obtain histopathologic diagnosis. There is only few evidence on risk analysis for resection of selected BMs in patients with multiple BMs.</p><p><strong>Methods: </strong>In this bicentric study, patients with multiple BM (i.e. n ≥ 2) who underwent microsurgery for selected lesions between 2021 and 2024 were included. Demographic data, Karnofsky Performance Status (KPS), 5-item modified frailty index (mFI-5), clinical course and MR-imaging including volumetric assessment of tumor volumes were analyzed. The primary endpoint was 90-day mortality. Secondary endpoints were institutional discharge, length of inpatient stay, and allocation to adjuvant treatment.</p><p><strong>Results: </strong>One-hundred-and-thirty-two patients met the inclusion criteria. Median age was 63 years (IQR 21.8) and 54 (40.9%) were female. Ninety patients (68.2%) had 2-4 BMs and 42 patients (31.8%) had ≥ 5 BMs. The median resected tumor volume was 15.4 (IQR 21.6) cm³ per patient. The 90-day mortality was 28% (37/132). Factors associated with increased 90-day mortality included advanced age (p < 0.001), lower preoperative KPS (p = 0.048), lack of adjuvant treatment (p < 0.001) and higher mFI-5 score (p = 0.008). Lower preoperative KPS (p < 0.001) and higher mFI-5 scores (p < 0.001) were significantly associated with discharge to institutional care rather than home. Length of postoperative in-hospital stay inversely correlated with KPS (rs = -0.29, p = 0.001) and positively with mFI-5 score (rs = 0.26, p = 0.003) but not with age, tumor volumes or number of lesions.</p><p><strong>Conclusion: </strong>In patients with multiple BM, increasing age, increased frailty and low preoperative KPS influenced 90-day mortality and short-term outcome. Resection for symptom relief or tissue diagnosis in these patients may be performed with these precautions.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137029","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":"Volumetric analysis of radiographic changes after stereotactic radiosurgery for treatment of non-responding brain metastases.","authors":"Shashank Rajkumar, Harrison Moy, XueMei Ji, Mariam Aboian, Veronica Chiang","doi":"10.1007/s11060-026-05824-9","DOIUrl":"10.1007/s11060-026-05824-9","url":null,"abstract":"<p><strong>Purpose: </strong>Stereotactic radiosurgery (SRS) effectively treats brain metastases, yet some lesions ultimately require post-SRS surgery due to local failure. We examined whether the use of volumetric changes in FLAIR hyperintensity and/or necrosis in conjunction with enhancing volumetric changes after Gamma Knife SRS correlate with pathological outcome at subsequent surgery.</p><p><strong>Methods: </strong>We queried our institutional database for patients who received first-time SRS for a single brain metastasis and later underwent surgical resection of the same lesion. Tumor volumes were measured manually before SRS and at 6 weeks, 3 months, and 6 months post-treatment. FLAIR:enhancing (FER) and enhancing:necrotic ratios were analyzed. Linear mixed-effects models assessed variables influencing volume trajectories; Pearson correlation examined associations with pathological outcome.</p><p><strong>Results: </strong>Thirty-six patients met inclusion criteria. Mean enhancing volume changed - 28.5%, - 25.8%, and - 18.9% from baseline at 6 weeks, 3 months, and 6 months, respectively. Mean FLAIR volume changed - 16.9%, - 22.2%, and - 2.4% at the same intervals. Percent changes in FLAIR and enhancing volume correlated significantly at 6 weeks (p = 0.004) and 3 months (p < 0.001). FER trended differently between RN and recurrent tumor with patients who developed radiation necrosis (RN) having significantly lower FLAIR volumes at 6 weeks compared to those with recurrent tumor. Baseline lesion size, FLAIR volume, FER (all p < 0.001), primary cancer type, and sex (both p = 0.02) influenced FLAIR trajectories.</p><p><strong>Conclusions: </strong>Perilesional edema and enhancement trajectories after SRS are variable but may help distinguish RN from recurrent tumor, particularly at early follow-up. Incorporation of automated edema volumetry should be considered in routine post-SRS surveillance.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127809","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":"Spinal ependymoma: a comprehensive review of molecular classification, management guidelines, and clinical outcomes with a focus on the pediatric population (Part III of ependymomas across compartments).","authors":"Anthony M Price, Nathan S Fredricks, George Koutsouras, Frederic A Vallejo, Christopher Bonfield, Devang J Pastakia, Leo Y Luo, Frederick Boop, Vijay Ramaswamy, Michael C Dewan","doi":"10.1007/s11060-026-05816-9","DOIUrl":"10.1007/s11060-026-05816-9","url":null,"abstract":"<p><strong>Purpose: </strong>Spinal ependymomas are rare tumors of the central nervous system characterized by distinct anatomical, histological, and molecular subtypes. This review aims to synthesize current evidence regarding the presentation, diagnosis, surgical management, adjuvant therapy, and outcomes of spinal ependymomas, with a focus on the pediatric population.</p><p><strong>Methods: </strong>We conducted a narrative review of contemporary literature, consensus recommendations, and relevant treatment-related molecular classifications. Key topics included preoperative evaluation, neuraxis imaging, intraoperative strategies, extent of resection, histopathologic and molecular risk stratification, adjuvant radiotherapy and chemotherapy, recurrence patterns, and long-term surveillance. Representative clinical cases illustrating the surgical management of intramedullary spinal ependymomas and myxopapillary ependymomas are provided in the supplementary material.</p><p><strong>Results: </strong>Spinal ependymomas encompass spinal ependymoma, spinal ependymoma with MYCN amplification, spinal subependymoma, and spinal myxopapillary ependymoma. The primary therapeutic goal is maximal safe gross total resection, which is the most consistent modifiable predictor of progression-free survival. Molecular classification enhances risk stratification, especially for the aggressive MYCN-amplified subgroup. However, histologic grade and the extent of resection remain critical to management. Adjuvant radiotherapy is generally recommended for cases involving subtotal resection, grade 3 disease, tumor dissemination, capsular violation in myxopapillary tumors, or high-risk biology. Chemotherapy does not have a well-established role as a first-line treatment. Much of this evidence is extrapolated from adult or mixed-age cohorts, however, and pediatric-specific data remain limited across nearly every management domain, a gap we characterize systematically.</p><p><strong>Conclusion: </strong>Management of spinal ependymomas is centered around surgery and adapted to individual risk factors. Overall survival is generally favorable for spinal ependymomas, but recurrence risk remains substantial and varies by extent of resection and molecular subtype. Lifelong surveillance is crucial, as both local recurrence and craniospinal dissemination may occur long after treatment.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111048","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}