Journal of Neuro-Oncology最新文献

{"title":"Long-term outcomes following upfront single-session gamma knife stereotactic radiosurgery for large volume meningiomas.","authors":"Suchet Taori, Zhishuo Wei, Constantinos G Hadjipanayis, Ajay Niranjan, L Dade Lunsford","doi":"10.1007/s11060-025-05000-5","DOIUrl":"10.1007/s11060-025-05000-5","url":null,"abstract":"<p><strong>Background: </strong>Stereotactic radiosurgery (SRS) for the management of small and medium-sized intracranial meningiomas is well defined. However, limited studies evaluating long-term outcomes following SRS for large-volume meningiomas (LVMs) exist. Here, we report a large single-institution experience in using upfront single-session SRS to manage LVMs.</p><p><strong>Methods: </strong>This retrospective review included 112 patients (83 female, 74%) managed with single-session SRS for LVMs (> 10 cc) between 1987 and 2022. Exclusion criteria consisted of prior meningioma surgical resection or follow-up < 2 years. Tumors were classified as supratentorial (35%) or skull-base (65%). The median tumor volume was 13 cc (range: 10-24.7), and the median margin dose was 12 Gy (range: 10-15). Overall, 101 (90%) patients were neurologically symptomatic at SRS.</p><p><strong>Results: </strong>The median follow-up was 106 months (range: 24-307). Sixteen (14%) LVMs demonstrated tumor progression at a median time of 43 months (range: 7-181) following SRS. Local tumor control (LTC) rates at 3-years, 5-years, and 10-years were 98% (95%CI: 91-99), 97% (95% CI: 94-100) and 88% (95% CI: 80-96), respectively. Tumor volume > 17 cc (HR: 3.26, 95% CI: 1.17-9.08, p = 0.023) was significantly associated with worsened LTC. Seven (6%) patients developed peritumoral edema adverse radiation effects (AREs) at a median time of 35 months (range: 4-182) following SRS. Meningiomas located in supratentorial regions (OR: 1.11, 95% CI: 1.01-1.22, p = 0.031), as compared to skull base tumors, had a significantly greater risk of peritumoral edema ARE development.</p><p><strong>Conclusions: </strong>In this select patient cohort, upfront single-session SRS provides durable long-term LTC and minimizes ARE risk for patients with LVMs.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"429-438"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753168","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":"Comparison of adjuvant radiation versus observation and salvage radiation after subtotal resection of a WHO grade I skull base meningioma: a propensity score-adjusted analysis.","authors":"Anish R Kosanam, Jun Ma, Alexandra J White, Roger Murayi, Pranay Soni, Pablo F Recinos, Varun R Kshettry","doi":"10.1007/s11060-025-04980-8","DOIUrl":"10.1007/s11060-025-04980-8","url":null,"abstract":"<p><strong>Purpose: </strong>In patients with subtotal resection (STR) of WHO grade I skull base meningiomas, treatment strategies of adjuvant radiation versus observation with salvage radiation, if necessary, were compared using progression-free survival (PFS) and radiation failure-free survival (RFFS).</p><p><strong>Methods: </strong>Patients with newly diagnosed WHO grade I skull base meningioma who underwent radiographically confirmed STR between 1995 and 2021 were included. PFS was measured from last treatment date. RFFS was measured from surgery date to first radiation failure. Multivariable Cox regression, adjusted for propensity score (PS) and inverse probability treatment weighted (IPTW), was performed.</p><p><strong>Results: </strong>Of 179 patients, 25 (14.0%) received adjuvant radiation. Among 154 observed patients, 90 (58.4%) experienced tumor progression and 64 (71.1%) received salvage radiation. Observation after STR had PFS at 3, 5, and 10 years of 60.6%, 47.5%, and 26.8%, respectively. Adjuvant radiation had PFS/RFFS at 3, 5, and 10 years of 84.2%, 77.2%, and 77.2%. Salvage radiation had PFS at 3, 5, and 10 years of 96.0%, 85.0%, and 80.0%. RFFS after observation with salvage radiation, if needed, at 3, 5, and 10 years was 100%, 97.7%, and 92.8%. PS and IPTW Cox regression models, controlling for residual tumor volume, demonstrated that observation with salvage radiation significantly prolonged RFFS (HR = 0.06, p = 0.013; HR 0.08, p = 0.026, respectively) compared to adjuvant radiation. Median follow-up was 77.5 months.</p><p><strong>Conclusion: </strong>Most patients will have tumor progression within 10 years of STR. Our data suggests that appropriately selected patients can be observed with close follow-up, reserving radiation for progression.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"297-304"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492323","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 predictors of overall survival in very elderly meningioma patients: a surveillance, epidemiology, and end results (SEER) database analysis.","authors":"Sai Chandan Reddy, Yuncong Mao, Julian Gendreau, A Karim Ahmed, Debraj Mukherjee","doi":"10.1007/s11060-025-04982-6","DOIUrl":"10.1007/s11060-025-04982-6","url":null,"abstract":"<p><strong>Objective: </strong>Surgical resection is the gold standard of management for symptomatic intracranial meningiomas. However, surgical intervention may be contraindicated in very elderly patients. In this study, we assessed the survival outcomes for elderly and very elderly patients and the impact of surgical intervention [e.g., subtotal resection (STR) and gross total resection (GTR)] and radiotherapy (RT).</p><p><strong>Methods: </strong>The Surveillance, Epidemiology, and End Results (SEER) database was queried to identify all patients ≥ 65 years of age diagnosed with intracranial meningiomas between 2000 and 2020. Baseline demographics, clinical characteristics, and survival outcomes were compared between elderly (65-79 years) and very elderly (80 + years) patients.</p><p><strong>Results: </strong>4,052 intracranial meningioma patients were identified- 3,462 elderly patients and 590 very elderly patients. Very elderly patients were less likely to undergo GTR compared to elderly patients (OR: 0.756, 95% CI: 0.631-0.905, p = 0.002) and less likely to receive RT (OR: 0.441, 95% CI: 0.294-0.642, p < 0.001). Achievement of GTR in very elderly patients did not decrease the risk of death (HR: 1.003, 95% CI: 0.682-1.475, p = 0.987). However, RT was associated with decreased risk of death in very elderly patients (HR: 0.212, 95% CI: 0.052-0.860, p = 0.030).</p><p><strong>Conclusion: </strong>In this retrospective study, we found pursual of aggressive surgical intervention in very elderly patients was not associated with increased mortality. Despite very elderly patients being much less likely to be prescribed radiotherapy, the administration of RT significantly increased overall survival, suggesting a greater role for radiotherapy in managing intracranial meningiomas in the very elderly population.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"439-447"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523660","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":"Education paths in neuro-oncology: combining technical skills with multidisciplinary care. A survey from the AINO (Italian Association for Neuro-Oncology) Youngster Committee.","authors":"Rina Di Bonaventura, Denis Aiudi, Silvia Chiesa, Alessia Pellerino, Francesco Bruno, Valeria Internò, Ciro Mazzarella, Edoardo Pronello, Roberto Colasanti, Teresa Somma, Tamara Ius, Giuseppe Maria Della Pepa, Valeria Barresi, Quintino Giorgio D'Alessandris, Roberta Rudà, Antonio Silvani","doi":"10.1007/s11060-025-05003-2","DOIUrl":"10.1007/s11060-025-05003-2","url":null,"abstract":"<p><strong>Purpose: </strong>Neuro-oncology is a multidisciplinary subspecialty that has evolved and expanded tremendously over the last 20 years. In Europe, notwithstanding a number of commendable initiatives, neither a specific neuro-oncology training curriculum nor a consensus on the ideal training tools have been set. In this context, the Youngster Committee of the Italian Association for Neuro-Oncology (AINO) has run a nationwide survey to take a snapshot of the current situation of neuro-oncology education in Italy.</p><p><strong>Methods: </strong>Between July and November 2023, we distributed through AINO a 34-question survey addressed to all Italian care providers dealing with neuro-oncology, irrespective of specialty and level of experience, as per AINO mission. The questionnaire was disseminated using an open link. We analyzed and stratified answers according to epidemiological characteristics of the respondents, i.e. age, gender, role, years of experience, type and case load of their work Institutions, geographical region.</p><p><strong>Results: </strong>We collected 254 valid questionnaires. The majority of respondents were under 40 years old (62.6%); neurosurgeons formed the largest specialty group (48%). Residency was a key step for neuro-oncology education according to 33% of participants; notably, younger respondents gave a significantly more positive assessment of residency programs compared to older ones (72% vs. 56%, p = 0.0193). PhD programs in Italy are focused only on research, according to 30% of respondents. Regarding the tools for continuing medical education in neuro-oncology, a striking contrast between the ideal ones, which should be the frequent participation in dedicated courses (59% responses), and the actual one, which is scientific literature (55%), was recorded. Mentorship programs are rare and inconsistent and should be strengthened. More than 90% of participants declared multidisciplinary collaboration as fundamental. Multispecialty societies like AINO have a key role in strengthening education in neuro-oncology through the organization of structured post-graduate programs.</p><p><strong>Conclusion: </strong>The results of this survey, by describing the status of the neuro-oncology training paths in Italy, can lay the foundation for initiatives aimed at harmonizing neuro-oncology education in Italy and Europe. The creation of a shared neuro-oncology curriculum and of a network of mentors is suggested.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"469-477"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657500","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":"Long-term impact of bevacizumab for the treatment of brain radiation necrosis.","authors":"Hila Nobel, Jonathan Ofer, Sara Faye Borenstein, Dror Limon, Omer Gal, Yosef Laviv, Andrew A Kanner, Tali Siegal, Shlomit Yust-Katz, Alexandra Benouaich-Amiel","doi":"10.1007/s11060-025-04979-1","DOIUrl":"10.1007/s11060-025-04979-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate short and long-term efficacy of bevacizumab (Bev), for the treatment of radiation necrosis (RN) in patients with brain metastasis after stereotactic radiosurgery (SRS).</p><p><strong>Methods: </strong>The database of a tertiary medical center was reviewed for all adult patients treated by Bev (from January 2018 to January 2023) for RN after having received SRS for BM. Clinical and MRI data were systematically collected at baseline, immediately after the completion of Bev treatment, and at 6, 12, and, when available, 24 months post-treatment.</p><p><strong>Results: </strong>The cohort included 23 patients with a total of 31 RN lesions (defined as target lesion) which have been previously treated by SRS, either as single-session SRS (27/31) or as fractionated stereotactic radiotherapy (4/31). Median follow-up time was 15 months (range: 8-28.5). Immediately after completion of Bev, 15 patients (65.2%) exhibited a complete/partial response, 6 (26.1%) had stable disease, and 2 had progressive disease (8.7%). thirteen patients (56%) improved clinically. Greater than 50% reduction in volume was observed in 84% of target lesions. At 12 months, among the 13 patients still evaluable (9 other being deceased, 1 loss to follow up), three continued to improve, and four remained stable. Median volume of target lesion was then 1.4 cm³ (range 0.7-2.9) demonstrating a reduction of 67.4% compared to the initial target volume, which was 4.35 cm³ (range 2.14-10.37). During the entire follow-up period, 11 patients experienced regrowth of the target lesion; median time to progression was 7 months. Five underwent Bev re-challenge, but only 2 responded.</p><p><strong>Conclusion: </strong>Bev for the treatment of SRS-induced RN was associated with a high initial response rate, significant lesion reduction, and prolonged clinical improvement. However, the high rate of lesion regrowth (50%) and poor response to Bev re-challenge highlight the complexity of diagnosis and treatment of RN.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"289-296"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143615761","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":"Impact of alternating electric fields therapy for newly diagnosed WHO grade 4 astrocytoma on patient survival: a real-world propensity-score adjusted prospective multicenter study.","authors":"Peter Y M Woo, Jenny K S Pu, Lai-Fung Li, Desiree K K Wong, Victor K H Hui, Danny T M Chan, Michael W Y Lee, Tony K T Chan, Jason M K Ho, Ka-Man Cheung, Teresa P K Tse, Sarah S N Lau, Joyce S W Chow, Natalie M W Ko, Herbert H F Loong, Aya El-Helali, Tai-Chung Lam, Fung-Ching Cheung, Wai-Sang Poon","doi":"10.1007/s11060-025-04985-3","DOIUrl":"10.1007/s11060-025-04985-3","url":null,"abstract":"<p><strong>Purpose: </strong>Alternating electric fields (AEF) therapy in addition to temozolomide chemoradiotherapy (TMZ CRT) is increasingly being recommended as first-line treatment for patients with newly-diagnosed WHO grade 4 astrocytoma. However, few have validated this treatment with real-world evidence.</p><p><strong>Methods: </strong>Consecutive adult patients with newly-diagnosed WHO grade 4 astrocytoma treated with adjuvant TMZ CRT across all neuro-oncology centers in Hong Kong were reviewed. Identified from a territory-wide prospective glioma registry, propensity-score matching (1:2) was performed to match patients that either received TMZ CRT with AEF or TMZ CRT alone. Matching was according to age, Karnofsky performance status, IDH-1 mutation, pMGMT methylation and extent of resection. The primary endpoint was overall survival (OS). Secondary endpoints were the incidence of AEF-associated adverse effects and mean monthly treatment compliance.</p><p><strong>Results: </strong>141 patients were reviewed, of whom 47 patients received AEF with TMZ CRT and 94 had CRT alone. Multivariate Cox proportional hazards analysis revealed that patients with pMGMT-methylated tumors (mOS: 30.8 months vs. 16.7 months [95% CI: 1.9-4.7] and those that received AEF (mOS: 22.8 vs. 14.3 months [95% CI: 1.9-4.7]) had longer OS. AEF therapy patients had a mOS benefit of 8.5 months. The mean monthly treatment compliance was 74 ± 12%. A compliance threshold of 60% conferred a survival benefit of 4.1 months (mOS: 21.5 months vs. 17.4 months [95% CI: 0.10-0.96]). The only identified AEF-associated adverse reaction was scalp dermatitis that occured in 77% (36/47) of patients.</p><p><strong>Conclusion: </strong>This post-approval study offers real-world evidence in support of the use of AEF therapy as first-line treatment.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"317-330"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605210","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":"Individualized therapeutic approaches for relapsed and refractory pediatric ependymomas: a single institution experience.","authors":"Pavel Tinka, Petra Pokorná, Michal Kýr, Zdeněk Pavelka, Klára Vejmělková, Hana Pálová, Jakub Neradil, Marta Ježová, Ondřej Slabý, Jaroslav Štěrba","doi":"10.1007/s11060-025-05004-1","DOIUrl":"10.1007/s11060-025-05004-1","url":null,"abstract":"<p><strong>Purpose: </strong>This retrospective study aims to show a real-life single-center experience with clinical management of relapsed pediatric ependymomas using results from comprehensive molecular profiling.</p><p><strong>Methods: </strong>Eight relapsed ependymomas were tested by whole exome sequencing, RNA sequencing, phosphoproteomic arrays, array comparative genome hybridization, and immunohistochemistry staining for PD-L1 expression and treated with an individualized approach implementing targeted inhibitors, immunotherapy, antiangiogenic metronomic treatment, or other agents. Treatment efficacy was evaluated using progression-free survival (PFS), overall survival (OS), survival after relapse (SAR), and PFS ratios.</p><p><strong>Results: </strong>Genomic analyses did not reveal any therapeutically actionable alterations. Surgery remained the cornerstone of patient treatment, supplemented by adjuvant radiotherapy. Empiric agents were chosen quite frequently, often involving drug repurposing. In six patients, prolonged PFS after relapse was seen because of immunotherapy, MEMMAT, or empiric agents and is reflected in the PFS ratio ≥ 1. The 5-year OS was 88%, the 10-year OS was 73%, the 2-year SAR was 88%, and the 5-year SAR was 66%.</p><p><strong>Conclusion: </strong>We demonstrated the feasibility and good safety profile. Promising was the effect of immunotherapy on ZFTA-positive ependymomas. However, further research is required to establish the most effective approach for achieving sustained remission in these patients.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"479-488"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986974","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":"Comment on \"The 5-factor modified frailty index as a prognostic factor for stereotactic radiosurgery in meningioma management\".","authors":"Samuel Adida, Roberta K Sefcik, Peter C Gerszten","doi":"10.1007/s11060-025-04983-5","DOIUrl":"10.1007/s11060-025-04983-5","url":null,"abstract":"","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"493-494"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542362","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":"Spatial invasion patterns of temporal lobe glioblastoma after complete resection of contrast-enhancing tumor.","authors":"Jawad Fares, Yizhou Wan, Binay Gurung, Thaaqib Nazar, Richard Mair, Alexis Joannides, Thomas Santarius, Tomasz Matys, Stephen J Price","doi":"10.1007/s11060-025-04991-5","DOIUrl":"10.1007/s11060-025-04991-5","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated invasion patterns of temporal lobe glioblastoma following complete resection of contrast-enhancing tumor and evaluated whether non-enhancing tumor presence in the anterior temporal tip predicts the site of progression.</p><p><strong>Methods: </strong>We retrospectively analyzed patients from a single-institution database who were diagnosed with IDH-wildtype temporal lobe glioblastoma and underwent complete resection of the contrast-enhancing region. Eligible patients had preoperative, immediate postoperative, and progression MRIs to assess tumor progression patterns. FLAIR imaging was examined for its predictive value in identifying progression sites. Surgical outcomes, progression-free survival (PFS), and overall survival were analyzed.</p><p><strong>Results: </strong>A total of 48 patients were identified, of whom 14 (29%) underwent anterior temporal lobectomy and were excluded from further analysis. Among the remaining 34 patients, 21 (62%) exhibited anterior progression. Expert assessment suggested that in 12 of these 21 patients (57%), an anterior temporal lobectomy might have encompassed the region of tumor progression. Superior, inferior, and lateral progression patterns were associated with longer median PFS (~ 11 months), whereas medial progression correlated with the shortest PFS (5.9 months). FLAIR signal at the temporal tip had moderate sensitivity (71.43%) but low specificity (18.52%) for predicting anterior progression, resulting in a high false-positive rate.</p><p><strong>Conclusions: </strong>Temporal lobe glioblastomas often progress anteriorly, suggesting that anterior temporal lobectomy may help reduce progression in select cases. FLAIR imaging had limited predictive value for anterior progression, emphasizing the need for advanced imaging techniques. Future research should identify reliable biomarkers and evaluate the role of anterior temporal lobectomy through well-designed prospective studies.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"353-360"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567370","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":"Unscheduled hospitalization as a potential trigger for specialist palliative care referral in patients with high grade glioma: a retrospective analysis in a tertiary hospital.","authors":"Juan Luis Torres-Tenor, Andrea García-Leal, David Hui, Eduardo Bruera, Virginia Martínez-Marín, Ana Castaño-Cantos, Alberto Alonso-Babarro","doi":"10.1007/s11060-025-04993-3","DOIUrl":"10.1007/s11060-025-04993-3","url":null,"abstract":"<p><strong>Purpose: </strong>Guidelines recommend early palliative care for patients with cancer, including high grade glioma (HGG), but referrals to palliative care are often delayed. Our study aimed to describe characteristics and outcomes of patients with HGG with a first unscheduled hospitalization, and assess if it should trigger palliative care referral.</p><p><strong>Methods: </strong>Retrospective study of medical oncology outpatients with HGG at a tertiary hospital, analyzing first unscheduled hospitalizations. Primary variable: Overall Survival (OS) after admission.</p><p><strong>Results: </strong>133 HGG consecutive patients were referred to the medical oncology outpatient clinic. By the study's end, 90% (N = 119) had died, with a median OS from diagnosis of 11 months (95% CI 10-14). Unscheduled hospitalizations occurred in 53% of patients (N = 71) and were associated to reduced median OS from diagnosis: 10.5 months vs. 14 months, HR (95% CI) = 1.9 (1.3-2.7), p = 0.0012. Mortality during hospitalization was 24% (N = 17). Median OS after admission was 2.5 months (95% CI 2-4). Poor ECOG performance status (p = 0.059), no prior cancer treatment (p = 0.0003), longer diagnosis-to-admission time (p = 0.0147), admission to acute palliative care unit (p = 0.0012), and discharge to Hospice (p < 0.0001) associated with lower survival. Of admitted patients, palliative care assessed 39% (N = 28) during hospitalization, 28% (N = 20) before, and 24% (N = 17) after. Median OS after admission was shorter for those referred before/during hospitalization: 2 months vs. 7 months, HR (95% CI) = 0.4 (0.2-0.7), p = 0.0012.</p><p><strong>Conclusion: </strong>The first unscheduled hospitalization in HGG patients could signal poor prognosis, yet palliative care referrals often occur late, highlighting missed opportunities for earlier intervention and suggesting unscheduled hospitalization as a potential trigger for referral.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"361-368"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567371","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}