Journal of Neuro-Oncology最新文献

{"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}

{"title":"Dose selection and clinical decision-making after Gamma Knife surgery for large brain metastases: implications for early identification of true progression.","authors":"Yuta Koketsu, Toshinori Hasegawa, Takenori Kato, Takehiro Naito, Akihiro Mizuno, Yuto Ando, Naofumi Kosaka, Ryuta Saito","doi":"10.1007/s11060-026-05792-0","DOIUrl":"10.1007/s11060-026-05792-0","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate dose selection and post-treatment management after Gamma Knife surgery (GKS) for large brain metastases, with a focus on early identification of true progression.</p><p><strong>Methods: </strong>This retrospective single-institution study included 143 patients with large brain metastases (tumor volume ≥ 4 cm³) treated with primary GKS between 2016 and 2024. One dominant lesion per patient was analyzed. Treatment modality (single-session, staged, or hypofractionated) and dose selection were individualized. Radiographic progression was defined as a ≥ 20% increase in longest tumor diameter from nadir. True progression was defined as sustained enlargement or the need for salvage treatment, whereas lesions that stabilized or regressed without intervention were classified as pseudoprogression.</p><p><strong>Results: </strong>Median overall survival was 15.3 months. During follow-up, 47 lesions showed radiographic progression: 42 true progression, 4 pseudoprogression, and 1 intratumoral hemorrhage. The 6-, 12-, and 24-month cumulative incidences of true progression were 17.4%, 31.5%, and 33.1%, respectively. True progression did not differ by treatment modality or tumor volume. A marginal dose ≥ 57.6 Gy biologically effective dose (BED₁₀) was associated with a lower risk of true progression (subdistribution hazard ratio [SHR], 0.46; p = 0.02). Recurrent peritumoral edema developed earlier in true progression than pseudoprogression (median, 173.5 vs. 564 days; p = 0.001). Lower marginal dose at repeat GKS was associated with subsequent true progression (SHR, 0.82; p = 0.02).</p><p><strong>Conclusion: </strong>A BED₁₀ ≥ 57.6 Gy improved local control in large brain metastases. Recurrent peritumoral edema accompanying tumor enlargement within 1 year after GKS strongly suggested true progression and should prompt consideration of early salvage intervention.</p><p><strong>Clinical trial registration: </strong>Clinical trial number: not applicable.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111017","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":"Predictive modeling of lung cancer subtype with integration of clinical and thoracic imaging features to guide early brain metastasis management.","authors":"Jino Park, Paul Buclez, Jessica Lubisich, Krishna Hanubal, Andrea Inda, Caressa Hui, Jeremy Harris, Aaron Simon","doi":"10.1007/s11060-026-05812-z","DOIUrl":"10.1007/s11060-026-05812-z","url":null,"abstract":"<p><strong>Purpose: </strong>Optimal treatment for synchronous brain metastases at lung cancer diagnosis depends on subtype, but histologic/molecular profiling is often delayed. We developed machine-learning models using clinical and imaging data to classify lung cancer into three subtypes with distinct brain metastasis treatment implications: small cell lung cancer (SCLC), EGFR-mutated non-small cell lung cancer (EGFR+), and EGFR-wild-type non-small cell lung cancer (EGFR-).</p><p><strong>Methods: </strong>We retrospectively identified patients with metastatic lung cancer diagnosed from 2016 to 2025 at a single institution. Patients without brain metastases at diagnosis formed the training cohort, while patients presenting with synchronous brain metastases formed the testing cohort. Clinical variables and thoracic imaging features from diagnostic chest CT reports were used to train LASSO logistic regression and random forest models, evaluated via AUC and standard diagnostic metrics. Feature contributions were assessed using logistic regression coefficients and random forest permutation importance.</p><p><strong>Results: </strong>Of 305 patients, 182 were used for training and 123 comprised the testing cohort. Logistic regression achieved AUCs of 0.887, 0.811, and 0.801 for EGFR+, SCLC, and EGFR-, respectively; random forest achieved 0.907, 0.783, and 0.810. Adding imaging features to clinical variables improved prediction for EGFR + and SCLC. Contributory imaging features included fibrosis, emphysema, miliary pattern, cavitation, pleural attachment, and vessel encasement, among others. Three-way prediction showed highest positive predictive value for EGFR + and high negative predictive value for SCLC.</p><p><strong>Conclusion: </strong>Combined clinical and chest imaging features can help predict lung cancer subtype, supporting early multidisciplinary discussions for patients with synchronous brain metastases.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111101","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":"Surgical characteristics and postoperative outcomes in a retrospective cohort study of patients with molecularly defined oligodendroglioma.","authors":"Anita L Kalluri, Austin Carmichael, Maureen Rakovec, Kelly Jiang, Megan Parker, Carly Weber-Levine, Divyaansh Raj, Josh Materi, Karisa C Schreck, Iban Aldecoa, Kristin J Redmond, Matthias Holdhoff, Jon Weingart, Henry Brem, Xiaobu Ye, Chetan Bettegowda, Josep J González Sánchez, Jordina Rincon-Torroella","doi":"10.1007/s11060-026-05800-3","DOIUrl":"10.1007/s11060-026-05800-3","url":null,"abstract":"<p><strong>Purpose: </strong>Oligodendroglioma, an adult diffuse glioma now defined by molecular criteria, is typically managed first surgically. This retrospective cohort study correlates surgical characteristics with postoperative outcomes in purely molecularly defined oligodendroglioma.</p><p><strong>Methods: </strong>Adults with surgically managed 1p/19q co-deleted, IDH-mutated oligodendroglioma were identified. Medical records were reviewed for demographics, radiologic features, treatments, and postoperative outcomes.</p><p><strong>Results: </strong>Two hundred seventy-seven patients (207 grade 2, 70 grade 3) were included; most presented with seizures (173/267, 64.8%), non-contrast enhancing lesions (128/213, 60.1%), and frontal lobe tumors (170/267, 63.7%). Subtotal resection (STR, 115/249, 46.2%) and gross total resection (GTR, 97/249, 39.0%) were more common than biopsy (37/249, 14.9%). Awake procedures were performed in 25/173 (14.5%) cases. New permanent neurological deficits occurred in 24/254 (9.4%) patients. Median (IQR) follow-up was 57 (20-107) months. Individuals undergoing GTR or STR had longer median progression-free survival (PFS) than patients who underwent biopsy (76 versus 44 months, p = 0.007). In multivariable analysis, GTR, but not STR, was an independent predictor of improved PFS compared to biopsy after adjusting for demographics, grade, and adjuvant treatment (p = 0.026). The PFS benefit of GTR over biopsy was maintained in subgroup analyses of grade 2 tumors (p = 0.032) but not grade 3 tumors (p = 0.549).</p><p><strong>Conclusions: </strong>In this retrospective cohort of individuals with molecularly defined oligodendrogliomas, GTR was associated with prolonged PFS compared to biopsy without an observed increase in postoperative neurological deficits.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early experience with cerebrospinal fluid cell-free DNA molecular profiling in a neuro-oncology practice.","authors":"Cecile Riviere-Cazaux, Rahul Kumar, Julian S Rechberger, Derrick Obiri-Yeboah, Chao Dai, Jie Li, Yong Huang, Arthur E Warrington, Essa H Sharif, Elizabeth A Palmer, Xiaohong Wang, Daniel H Lachance, Sani H Kizilbash, Michael W Ruff, Ivan D Carabenciov, Shannon P Fortin Ensign, Gelareh Zadeh, Bryan J Neth, Ugur Sener, Pan Du, Shidong Jia, Terry C Burns","doi":"10.1007/s11060-026-05799-7","DOIUrl":"https://doi.org/10.1007/s11060-026-05799-7","url":null,"abstract":"<p><strong>Purpose: </strong>Cerebrospinal fluid (CSF) cell-free DNA (cfDNA) is increasingly used as a liquid biopsy in neuro-oncology for diagnosing lesions of uncertain etiology, distinguishing progression from pseudoprogression, and ruling out leptomeningeal disease (LMD). We assessed our institution's early experience with a new CSF cfDNA molecular profiling assay for detecting variant alleles (VA) and copy-number alterations (CNA) across these indications in our neuro-oncology practice.</p><p><strong>Methods: </strong>Beginning in August 2021, providers could request research CSF cfDNA sequencing from clinically indicated lumbar punctures. Following extraction, targeted next-generation sequencing (NGS) and/or low-pass whole-genome sequencing (LPWGS) were performed. VAs and CNAs were summarized by indication and integrated with clinical features, cfDNA yield, matched tissue data, and overall survival.</p><p><strong>Results: </strong>CSF samples from seventy-six consecutive patients were analyzed and retrospectively classified into three categories: lesions of uncertain etiology (46%), question of CNS progression (21%), or ruling out LMD (26%). Median cfDNA yield was 0.27 ng/mL (IQR = 0.05-0.61 ng/mL). VA and/or CNA detection, hereafter designated \"tumor calls,\" were identified in 20 patients (26%), with 29 patients having negative tumor calls (38%) and 27 patients (36%) having insufficient cfDNA yield/quality. A copy number burden threshold of 7.42 accurately identified tumor-specific CNAs (AUC 0.998) and was associated with poorer survival (HR 3.4, p = 0.006). Overall survival for patients with positive tumor calls was significantly lower than for patients with negative tumor calls or low yield (p = 0.003).</p><p><strong>Conclusion: </strong>Despite low cfDNA abundance, CSF NGS and LPWGS provide informative data across neuro-oncologic indications. Further work is underway to optimize the assays for low input CSF cfDNA.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"180 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111081","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}