Journal of Neuro-Oncology最新文献

{"title":"Population-based histologic analysis of craniopharyngioma demographics and treatment in the US from 2000 to 2020.","authors":"Kevin E Agner, Michael C Larkins","doi":"10.1007/s11060-025-04988-0","DOIUrl":"10.1007/s11060-025-04988-0","url":null,"abstract":"<p><strong>Purpose: </strong>Craniopharyngiomas (CP) are rare tumors that serve as a source of significant morbidity despite relatively high survival rates. No analysis based on disease histology has been fully explored.</p><p><strong>Methods: </strong>Patients with CP were identified via the Surveillance, Epidemiology, and End Results (SEER) Program regarding the following ICD-O-3 codes: 9350 (CP, not otherwise specified; NOS), 9351 (adamantinomatous CP; ACP), and 9352 (papillary CP; PCP). Demographic and treatment variables were analyzed via Chi-squared tests and ten-year overall survival (10y OS) was assessed via Cox regression and log-rank analysis.</p><p><strong>Results: </strong>Variation in 10y OS was seen regarding patient age (p < 0.001), race (p < 0.001), Grade (p = 0.010), stage (p < 0.001), and treatment with radiotherapy (p < 0.001) with Cox regression analysis among the 2,359 patients identified. ACP or CP, NOS histologies were more frequent among patients < 25 years old (p < 0.001), while ACP was more common among male patients (p = 0.002) and PCP was less common among Black patients (p = 0.002). Univariate survival analysis revealed the ACP and CP, NOS histologies had improved 10y OS with treatment with radiotherapy (p < 0.001 and = 0.007, respectively). Finally, surgery was associated with improved 10y OS only among patients with the CP, NOS histology (p = 0.007).</p><p><strong>Conclusion: </strong>No difference in 10-year overall survival was seen regarding histology among diagnosed with craniopharyngioma on multivariate or univariate analysis. Differences in the frequency and survival were found among all three histologies stratified by demographics and treatment. Further investigation into these variables, and among different survival timeframes, is warranted.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"343-351"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710342","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":"Characterizing the molecular and spatial heterogeneity of midline gliomas in adults: a single institution analysis.","authors":"Bryan J Neth, Robert M Kraft, Kathryn L Eschbacher, Derek R Johnson, Paul A Decker, Ugur T Sener, Joon H Uhm, Michael W Ruff, Jonathan D Schwartz, William G Breen, Muhammad Asad Maqbool, David J Daniels, Terry C Burns, Ian F Parney, Aditya Raghunathan, Sani H Kizilbash","doi":"10.1007/s11060-025-04994-2","DOIUrl":"10.1007/s11060-025-04994-2","url":null,"abstract":"<p><strong>Purpose: </strong>Primary gliomas arising within midline structures of the central nervous system are associated with a worse prognosis compared with hemispheric gliomas. In adults, compared to their pediatric counterparts, adult midline gliomas are not as clearly characterized on the clinical behavior, prognostic factors, and treatment approaches for these diseases.</p><p><strong>Methods: </strong>This retrospective cohort assessed all adult (≥ 18 years) patients from our institution with diffuse gliomas arising from midline structures at time of diagnosis (2014-2020). Molecular features characterized using immunohistochemistry, targeted next-generation sequencing, and chromosomal microarray analysis were collected. Patient characteristics were compared across groups using analysis of variance, Kruskal-Wallis, and the chi-square test as appropriate. Cumulative progression-free survival (PFS) and overall survival (OS) probabilities were estimated using the Kaplan-Meier method. Comparisons across groups were made using the log rank test.</p><p><strong>Results: </strong>79 patients were included in analysis, with a median follow-up of 22.5 months (range, 0.6-123). The mean age at diagnosis was 44.5 years (range, 19.4-76.4), and 51% (n = 40) were female. Thalamus/basal ganglia was the most common primary tumor location (47%), followed by the brainstem (30%), and cerebellum (23%). For the entire cohort, median PFS was 11.5 months (95% CI 9.4-20.1), and median OS was 25.5 months (95% CI 22.0-38.2). We grouped primary tumor types into four distinct diagnostic entities based on integrated histological and molecular features, which had survival differences (log-rank p = 0.007)-diffuse midline glioma, H3 K27-altered (17% with median OS 19.4 months); astrocytoma, IDH-wild type, not otherwise specified (42% with median OS 25.5 months); glioblastoma, IDH-wild type (24% with median OS 11.0 months); and astrocytoma, IDH-mutant (18% with OS 63.3 months). There were no cases of IDH-mutant tumors in the thalamus/basal ganglia. IDH-mutant tumors had better prognosis (OS: IDH-mutant 63.3 months, IDH-wild type 22.5 months, log-rank p = 0.003). Tumor enhancement and diffusion restriction at initial diagnosis was associated with worse prognosis (OS: enhancing 22.0 months, non-enhancing 64.5 months, log-rank p < 0.001; OS: restriction 20.3 months, no restriction 30.6 months, log-rank p = 0.028).</p><p><strong>Conclusion: </strong>There is significant molecular heterogeneity between midline gliomas which has prognostic implications. These findings emphasize the need to molecularly characterize these tumors to facilitate personalized treatment approaches.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"369-381"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567326","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":"Long-term quality of life and hypothalamic dysfunction after craniopharyngioma.","authors":"Hermann L Müller","doi":"10.1007/s11060-025-04987-1","DOIUrl":"10.1007/s11060-025-04987-1","url":null,"abstract":"<p><strong>Background: </strong>After diagnosis and management of childhood-onset craniopharyngioma, patients frequently develop a rapid weight gain starting in the first 6-12 months after diagnosis and leading to morbid hypothalamic obesity due to disease- and/or treatment-associated hypothalamic lesions.</p><p><strong>Methods: </strong>A scoping review was performed after search of the MEDLINE/PubMed, Embase, and Web of Science databases for initial identification of articles. The search terms craniopharyngioma, hypothalamic obesity, and quality of life were used.</p><p><strong>Results: </strong>Hypothalamic obesity should be diagnosed and treated in the context of hypothalamic syndrome. Hypothalamic nuclei are the key-regulators of our body homeostasis. Hypothalamic syndrome includes endocrine deficiencies of hypothalamic-pituitary axes, disruption of circadian rhythm, disturbed hunger-satiety and thirst feelings, temperature dysregulation, and neurocognitive, sleep and psychosocial behavioral problems. Consequently, patients with hypothalamic syndrome develop hypothalamic obesity, chronic fatigue, increased daytime sleepiness and mood disorders resulting in isolation, school drop-out and inability to participate in daily life. Long-term follow-up is frequently impaired by increased risk for metabolic syndrome, cardiovascular health problems, severe impairments of health-related quality of life, and premature mortality. Treatment of hypothalamic syndrome is challenging. Hypothalamic syndrome is not a ,one-size-fits-all- disease, which may not require a ,one-size-fits-all- management. Recently, an algorithm for personalized, risk-specific treatment of hypothalamic syndrome after CP has been published. Dextro-amphetamines and other central stimulating agents (modafinil, methylphenidate) may cause weight loss, especially in children with hyperphagia or decreased resting-energy expenditure. Reports on the use of glucagon-like peptide-1 receptor (GLP-1R) agonists for acquired hypothalamic obesity have been contradictory, with successful reports but also series with limited results. Bariatric surgery is effective. However, non-reversible procedures are controversial due to ethical and legal considerations in minors.</p><p><strong>Conclusions: </strong>Hypothalamus-sparing treatment strategies and further research on novel therapeutic agents for hypothalamic syndrome are warranted.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"233-244"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649292","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 association of neighborhood-level deprivation with glioblastoma outcomes: a single center cohort study.","authors":"Yifei Sun, Dagoberto Estevez-Ordonez, Travis J Atchley, Burt Nabors, James M Markert","doi":"10.1007/s11060-025-05002-3","DOIUrl":"10.1007/s11060-025-05002-3","url":null,"abstract":"<p><p>Glioblastoma is the most common primary brain malignancy. Though literature has suggested the association of glioblastoma outcomes and socioeconomic status, there is limited evidence regarding the association of neighborhood-level socioeconomic deprivation on glioblastoma outcomes. The aim of this study was to assess the impact of neighborhood-level socioeconomic deprivation on glioblastoma survival. We retrospectively reviewed all adult glioblastoma patients seen at a single institution from 2008 to 2023. Neighborhood deprivation was assessed via Area Deprivation Index (ADI), with higher ADI indicating greater neighborhood socioeconomic disadvantage. Log-rank tests and multivariate cox regression was used to assess the effect of ADI and other socioeconomic variables while controlling for a priori selected clinical variables with known relevance to survival. In total, 1464 patients met inclusion criteria. The average age at diagnosis was 60 ± 14 years with a median overall survival of 13.8 months (IQR 13-14.8). The median ADI of the cohort was 66(IQR 46-84). Patients with high neighborhood disadvantage had worse overall survival compared to patients with those without (11.7 vs. 14.8 months, p =.001). In the multivariable model, patients with high neighborhood disadvantage had worse overall survival (HR 1.25, 95%CI 1.09-1.43). To account for changes in WHO guidelines, we implemented the model on patients diagnosed between 2017 and 2023 and findings were consistent (HR 1.26,95%CI 1.01-1.56). We report the first study demonstrating glioblastoma patients with higher neighborhood deprivation have worse survival after controlling for other socioeconomic and biomolecular markers. Neighborhood socioeconomic status may be a prognostic marker for glioblastoma survival.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"457-467"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12106151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795717","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":"Introducing the operative value index for glioma surgery: an integration of quality-adjusted life years with time-driven activity-based costing.","authors":"Advith Sarikonda, Danyal Quraishi, D Mitchell Self, Ashmal Sami, Steven Glener, Matthews Lan, Sanyam Ratan, Anthony Yulin Chen, Antony Fuleihan, Pranav Jain, Ayra Khan, Justin Santos, Conor Dougherty, Emily L Isch, Nicholas Clark, James J Evans, Kevin D Judy, Christopher J Farrell, Ahilan Sivaganesan","doi":"10.1007/s11060-025-04997-z","DOIUrl":"10.1007/s11060-025-04997-z","url":null,"abstract":"<p><strong>Background: </strong>Although many studies have examined outcomes after glioma surgery, few have explored the factors driving variation in the cost-effectiveness of surgical care. In this study, we integrate granular time-driven activity-based costing (TDABC) methodology with quality-adjusted life years (QALYs) to measure the true \"value\" (outcomes achieved per dollar spent) of glioma surgery.</p><p><strong>Methods: </strong>176 glioma surgeries performed at a single institution were reviewed. Process maps were designed to identify all resources utilized in the intraoperative episode. Costing software was developed to automate the extraction of this data from the electronic medical record (EMR). QALYs were calculated based on progression-free survival (PFS) and 6-month postoperative Karnofsky Performance Status (KPS) scores. The Operative Value Index (OVI) was defined as the QALYs achieved per $1,000 spent intraoperatively. Multivariable regression models were performed to examine factors driving variability in both costs and OVI.</p><p><strong>Results: </strong>The median total cost of surgery was $6,987, most of which was driven by the cost of supplies ($3,804, 53%) and personnel ($1,635, 23%). The median QALY was 0.96, PFS was 403 days (1.1 years), and the OVI was 0.14. Multivariable regression analysis revealed that awake surgery was associated with $2,540 of additional cost compared to surgery under general anesthesia, while World Health Organization Grade III (p < 0.001) and Grade IV (p < 0.001) gliomas were associated with significantly lower OVI.</p><p><strong>Conclusions: </strong>This study establishes a scalable, EMR-based framework for evaluating surgical value by integrating cost with outcomes. We show that awake surgery is associated with significantly higher total cost, and that increasing glioma disease severity is associated with worse outcomes achieved per dollar spent.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"397-407"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597235","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":"Synergistic activity of simvastatin and irinotecan chemotherapy against glioblastoma converges on TGF-β signaling.","authors":"Niket Yadav, Aizhen Xiao, Qing Zhong, Pankaj Kumar, Guruprasad Konduru, William Hart, Matthew Lazzara, Benjamin Purow","doi":"10.1007/s11060-025-05089-8","DOIUrl":"https://doi.org/10.1007/s11060-025-05089-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the synergistic therapeutic potential of a novel combination of the repurposed drug simvastatin with irinotecan chemotherapy towards glioblastoma (GBM) and the underlying molecular mechanisms.</p><p><strong>Methods: </strong>In vitro efficacy of simvastatin and irinotecan alone and in combination against diverse GBM lines (U251MG, G34, SB28) was assessed using mechanistically distinct cell viability assays. RNA-Sequencing was performed to uncover the top pathways and genes affected by these drugs, followed by validation of promising pathways (TGF-β signaling and cell death) using targeted phosphoproteomics and in vitro genetic manipulation and functional assays.</p><p><strong>Results: </strong>We observed robust in vitro synergy at nanomolar concentrations between simvastatin and irinotecan across diverse GBM lines. Notably, irinotecan alone and in combination with simvastatin reduced mRNA expression of TGF-β family members. Targeted phosphoproteomics and functional experiments further showed significant inhibition of TGF-β signaling with both treatment types. Additionally, a role for apoptosis and enrichment of caspase-independent cell death pathways (autophagy, ferroptosis) as well as immunological (interferons, complement, inflammatory responses, TNF-α) and oncogenic (K-RAS/ERK) signaling pathways were observed with the combination treatment.</p><p><strong>Conclusions: </strong>Besides the first detailed demonstration of a robust synergy between simvastatin and irinotecan against GBM lines, this study shows for the first time that both irinotecan and the combination treatment converge on inhibition of TGF-β signaling. This is notable given the lack of TGF-β inhibitors in the clinic. Collectively, this study provides preclinical data suggesting this novel drug combination be tested in patients with GBM and TGF-β driven cancers.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of bevacizumab on non-target intracranial meningiomas and non-vestibular schwannomas in NF2-related schwannomatosis: NF104.","authors":"Vihang Nakhate, Ina Ly, Alona Muzikansky, Otto Rapalino, Jeffrey C Allen, Jaishri O Blakeley, Jian L Campian, D Wade Clapp, Girish Dhall, Rakesh K Jain, Matthias A Karajannis, Roger J Packer, James Tonsgard, Nicole J Ullrich, Bruce R Korf, Michael J Fisher, Scott R Plotkin","doi":"10.1007/s11060-025-05020-1","DOIUrl":"https://doi.org/10.1007/s11060-025-05020-1","url":null,"abstract":"<p><strong>Purpose: </strong>Bevacizumab treatment is associated with imaging and hearing responses in progressive vestibular schwannoma (VS) caused by NF2-related schwannomatosis (NF2-SWN). However, its effect on co-existing intracranial non-vestibular schwannomas (NVS) and meningiomas is unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed tumor volumes of non-target intracranial NVS and meningiomas in patients with NF2-SWN and progressive VS who were prospectively treated with bevacizumab for two years on the Neurofibromatosis Clinical Trials Consortium (NFCTC) trial NF104 (NCT01767792). Radiographic response (RR) or progression (PD) were defined as ≥ 20% decrease or ≥ 20% increase in tumor volume compared to baseline, respectively. All other responses were defined as stable disease.</p><p><strong>Results: </strong>A total of 40 meningiomas in eight patients and 12 NVS in six patients were evaluated across 22 enrolled trial participants. On best response analysis, RR occurred in 13% (5/40) of meningiomas and in 42% (5/12) of NVS. On a per-patient basis, RR for meningioma occurred in 38% (3/8) of patients and for NVS in 67% (4/6) of patients. RR in two NVS were durable throughout the study period. During two years of treatment, PD occurred in 55% (22/40) of meningiomas and in 8% (1/12) of NVS. Median time to tumor progression was 15 months for meningiomas and was not reached for NVS.</p><p><strong>Conclusions: </strong>We observed greater activity of bevacizumab against intracranial NVS compared to meningioma, evidenced by more favorable RR rates, durability of response, and rates of PD. Potential biological differences between meningiomas and schwannomas that underlie this differential response to bevacizumab warrant further investigation.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159696","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":"Optimizing workflows for metastatic central nervous system disease: a systematic review and proposed guidelines.","authors":"John Y Chen, Aaliyah Schultz, Nadine M Khoury, Karthik Rangavajhula, Avi A Gajjar, Iñigo L Sistiaga, Mihir Tandon, Laura Mittelman, Daniel M Sciubba, Sheng-Fu L Lo, Daniel G Eichberg, Randy S D'Amico","doi":"10.1007/s11060-025-05084-z","DOIUrl":"https://doi.org/10.1007/s11060-025-05084-z","url":null,"abstract":"<p><strong>Introduction: </strong>Brain and spine metastases are a major cause of morbidity and mortality in patients with malignancy. Aside from advancements in medical, surgical, and radiation therapies, patient workflow optimization augments care. Here, we present the first systematic review to identify opportunities in workflow optimization and use these findings to present guidelines for operational excellence.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, and Web of Science databases were searched for peer-reviewed studies evaluating optimization points within treatment workflows for brain and spinal metastases. Inclusion criteria encompassed rapid diagnostic models, expedited care pathways, and quality improvement interventions for metastatic disease, whereas non-English and case reports were excluded. Eligible studies were screened, and data such as study design, outcomes, and bias were recorded using Cochrane's RoB-1 analysis. This protocol was prospectively registered in PROSPERO (CRD420251016218).</p><p><strong>Results: </strong>30 studies were included, with a total of 23,697 patient participants. These studies focused on patient education, referral to surgery, referral from surgery to radiation oncology, and referral from surgery to medical oncology. These studies highlighted the benefits of expediting triaging, referral speed, and treatment initiation in the context of valuable resources such as a comprehensive clinical team and artificial intelligence in radiology and cytopathology.</p><p><strong>Conclusions: </strong>Optimizing workflows around the current literature for metastatic brain and spine disease identifies critical areas of improvement to enhance outcomes. We draw from this literature to propose guidelines for delivering a comprehensive and standardized patient workflow. Future studies targeting these salient points will further improve quality and advance patient care.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and radiological features of pseudoprogression in brain tumors treated with immune checkpoint inhibitors.","authors":"Maria José Ibáñez-Juliá, Luis Bataller, Francisco Javier Cabello-Murgui, Ludovic Nguyen-Them, Agusti Alentorn, Alba Torres-Martínez, Miguel Mazón-Momparler, Regina Gironés-Sarrió","doi":"10.1007/s11060-025-05091-0","DOIUrl":"https://doi.org/10.1007/s11060-025-05091-0","url":null,"abstract":"<p><strong>Purpose: </strong>Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment, resulting in the emergence of various immune-related adverse effects, including pseudoprogression (PsP). We sought to evaluate the characteristics of pseudoprogression in adults treated with ICIs for brain tumors (either primary or secondary), and to compare it with a non- PsP group.</p><p><strong>Methods: </strong>We retrospectively identified adults with brain tumors treated with ICIs at our institution between 2015 and 2023. Eligibility required one brain magnetic resonance imaging scan prior to treatment and another obtained within 6 months after treatment initiation. PsP was defined as radiological worsening within 6 months of ICI initiation, followed by stabilization or improvement without therapy modification. Demographic, clinical, and radiological characteristics were analyzed and compared between the PsP and the non-PsP groups.</p><p><strong>Results: </strong>Among 102 eligible patients, 10 (9.8%) developed PsP. Clinical symptoms occurred in 4 (40%) cases, all of which showed favorable outcomes with corticosteroid therapy. The PsP group had higher baseline tumor burden (p = 1.29 × 10⁻¹³) and higher PD-L1 expression (p < 0.001) than the non-PsP group. Median progression-free survival and overall survival were numerically longer in the PsP group with no significant difference.</p><p><strong>Conclusions: </strong>PsP is a frequent complication of ICIs. We describe 4 symptomatic patients with pseudoprogression, challenging the iRANO criteria that recommend excluding this diagnosis in symptomatic cases. Clinical impairment should not automatically rule out pseudoprogression, and each case requires thorough evaluation. High PD-L1 expression and greater tumor burden may be associated with PsP, but further studies are needed to confirm these findings.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144159693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of second surgical resection in IDH wildtype recurrent glioblastoma following chemo-radiation therapy: a propensity score analysis cohort study.","authors":"Giacomo Bertolini, Tommaso Trombini, Corrado Zenesini, Stefania Mazza, Isabella Dascola, Antonio Pavarani, Maria Michiara, Giovanni Ceccon, Andrea Peluso, Francesco Maria Calamo Specchia, Pellegrino Crafa, Roberto Menozzi, Ermanno Giombelli","doi":"10.1007/s11060-025-05096-9","DOIUrl":"https://doi.org/10.1007/s11060-025-05096-9","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment for recurrent glioblastoma (rGBM) remains controversial. We explore the impact of re-surgical resection, compared to solely oncological treatment, in a cohort of isocitrate dehydrogenase (IDH) wild-type rGBM.</p><p><strong>Methods: </strong>A retrospective cohort study included adult patients diagnosed with IDHwt rGBM. At recurrence, patients recieved re-surgical resection (re-surgery group - RSG) or further oncological treatments (chemo-radiation group - CRG). Overall survival (OS) and progression-free survival (PFS) were analyzed. A Cox regression model was performed to identify variables related to outcomes. Furthermore, to minimize possible study design-related bias, a propensity score analysis was applied. Additionally, subgroup analysis to explore the role of adjuvant therapies was performed.</p><p><strong>Results: </strong>In a cohort of 104 patients with rGBM, 44 patients received re-surgical resection. Patients in RSG experienced a longer OS compared to CRG (21 vs. 12 months, p < 0.001); a shorter survival in the CRG was confirmed at the propensity score analysis (HR 2.16, p = 0.004). The median cohort PFS was 4 months. The PFS was similar between the RSG and CRG (6 vs. 4 months). The variables associated with OS were: age, subventricular zone involvement, repeated chemotherapy. The variables associated with PFS were: extent of resection at first surgery, MGMT methylation, no adjuvant therapies, and delayed radiotherapy. At the subgroup analysis, re-irradiation was not associated with OS or PFS benefit in the RSG; adjuvant chemo-radiation therapy offers a survival advantage compared to standard adjuvant chemotherapy in the CRG.</p><p><strong>Conclusions: </strong>Re-surgical resection offers a significant survival benefit compared to the sole adjuvant treatment in patients with IDHwt rGBM.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144150672","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}