Journal of Neuro-Oncology最新文献

{"title":"Efficacy and safety of proton radiotherapy for progressive or surgically unfavorable adult pilocytic astrocytoma: a single-center experience.","authors":"Fabian J K Allmendinger, Yuliia Cherniienko, Jonathan Lischalk, Jannik Walter, Lucas Mose, Ricarda Wickert, Maximilian Deng, Sebastian Regnery, Lars Wessel, Katharina Kozyra, Thomas Tessonnier, Sandro Krieg, Jürgen Debus, Laila König, Tanja Adena-Eichkorn","doi":"10.1007/s11060-026-05798-8","DOIUrl":"10.1007/s11060-026-05798-8","url":null,"abstract":"<p><strong>Purpose: </strong>Progressive adult pilocytic astrocytoma is rare, and management of surgically unfavorable disease remains insufficiently defined. Given the favorable long-term prognosis of WHO grade 1 glioma, local tumor control must be balanced against late toxicity. This study evaluated the efficacy and safety of PRT in adults with pilocytic astrocytoma.</p><p><strong>Methods: </strong>Fourteen adult patients with progressive or surgically unfavorable pilocytic astrocytoma treated with PRT at a single institution were retrospectively analyzed. Patient, tumor, treatment, radiographic, survival, and toxicity data were assessed. Radiographic response was evaluated using bidirectional T2-weighted measurements. Overall survival (OS), progression-free survival (PFS), and radiation-induced contrast enhancement (RICE)-free probability were estimated using Kaplan-Meier analysis. Toxicity was graded according to CTCAE.</p><p><strong>Results: </strong>Median prescribed dose was 54.0 Gy(RBE). PRT was delivered as salvage treatment in 10 patients (71%) or primary therapy in 4 patients (29%). Tumors frequently involved anatomically complex regions, including the posterior fossa, ventricular and midline structures, the optic pathway, and the suprasellar compartment. At last follow-up, radiographic regression included complete response in 3, partial response in 7, and minor response in 2 of 14 patients. Estimated OS at 3 and 5 years was 100%, whereas estimated PFS was 83.3% at both time points. RICE occurred in 3 patients, with 3- and 5-year RICE-free probabilities of 76.2%. Toxicity was predominantly low grade, with no grade 4 or 5 events.</p><p><strong>Conclusion: </strong>PRT was associated with durable tumor control, marked radiographic regression, favorable survival, and acceptable toxicity in selected adults with progressive or surgically unfavorable pilocytic astrocytoma.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13588830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002021","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":"Quantitative stability of MGMT promoter methylation in recurrent glioma and implications for temozolomide rechallenge.","authors":"Henry Noren, Gabriella Pelofsky, Brianna Suffren, Laura Mittelman, Christine Yohn, Aminah Twyman, Christopher A Febres-Aldana, Arevik Abramyan, Aparna Sertil, Randy S D'Amico, Jonathan H Sherman, Morana Vojnic","doi":"10.1007/s11060-026-05778-y","DOIUrl":"10.1007/s11060-026-05778-y","url":null,"abstract":"<p><strong>Purpose: </strong>O^6^-methylguanine-DNA methyltransferase (MGMT) promoter methylation is a key predictive biomarker for temozolomide (TMZ) response in glioma. MGMT status is routinely assessed at diagnosis; however, its utility at recurrence remains incompletely characterized. We aimed to quantify MGMT methylation stability and assess the clinical relevance of reported status changes in recurrent glioma.</p><p><strong>Methods: </strong>We analyzed paired tumor samples from 426 patients with recurrent glioma in a large commercial molecular database containing quantitative methylation percentage and binary methylation status at two sample time points. A separate multi-institutional clinical cohort (n = 27) with detailed treatment annotation was analyzed to explore associations between MGMT status at recurrence and treatment decision-making. Statistical analyses assessed quantitative methylation dynamics and time between samples as a surrogate for disease course.</p><p><strong>Results: </strong>MGMT status remained unchanged in 84% of tumors across recurrence. 16% demonstrated a status change, commonly among tumors with low baseline methylation near classification thresholds. Longitudinal quantitative methylation changes were modest overall. Tumors that remained, gained, or lost hypermethylation demonstrated longer intervals between samples compared to consistently unmethylated tumors (p < 0.01). In the clinical cohort, TMZ rechallenge was more frequently pursued in patients retaining hypermethylation at recurrence.</p><p><strong>Conclusion: </strong>MGMT promoter methylation is quantitatively stable in the majority of recurrent gliomas. Status changes predominantly occur in tumors with borderline methylation, highlighting the limitations of binary classification. These findings support routine reassessment of MGMT at recurrence and underscore the value of quantitative reporting to better inform therapeutic decision-making, particularly regarding TMZ rechallenge.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582029/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982835","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":"MRI-based radiomics for prognosis of non-midline, pediatric high-grade gliomas.","authors":"Mariam Tolba, Michael Zhang, Jonathan K Duh, Linda Liverani, Julia Chang, Nucharin Supakul, Robert M Lober, Samuel H Cheshier, Sarah A Mattonen, Alok Jaju, Laura M Prolo, Kristen W Yeom","doi":"10.1007/s11060-026-05785-z","DOIUrl":"10.1007/s11060-026-05785-z","url":null,"abstract":"<p><strong>Purpose: </strong>Non-midline, pediatric high-grade gliomas (HGG) represent one of the leading causes of cancer-related deaths in children with underlying molecular genetics and driver mutations that are distinct from adult HGGs. Image-based biomarkers that assist pediatric HGG risk-stratification could potentiate treatment strategies. Towards this, we investigated radiomics approaches for non-midline pediatric HGG prognosis.</p><p><strong>Methods: </strong>We identified 77 children (mean age: 140 months; 43 males) with non-midline-origin, hemispheric pediatric HGG tumors across five pediatric institutions. We extracted 1800 image-biomarker standardization initiative (IBSI)-based radiomics tumor features from treatment-naïve, axial gadolinium-enhanced axial T1- and axial T2-weighted brain MRI (Gad T1-MRI, T2-MRI). We performed k-fold cross validation and Cox regression to identify optimal predictive features of overall survival. We calculated the risk scores for each patient using a linear combination of the selected features weighted by their coefficients determined by the Cox regression model. Patients were stratified based on the median risk score into high- and low-risk groups. Python (version 3.10.0) was used for all model development.</p><p><strong>Results: </strong>The Cox regression model that included both clinical (age and sex) and MRI-derived radiomics features demonstrated a concordance of 0.78 (95% CI: 0.70-0.83) compared to concordance of 0.75 (95% CI: 0.69-0.82) that used radiomics features alone and concordance of 0.61 (95% CI: 0.54-0.67) that used clinical features (age and sex) alone. Using the risk scores derived from our radiomics model, we present a Kaplan-Meier curve on our HGG cohort. Median overall survival was 21.7 months in the high-risk group and 44.6 months in the low-risk group (log-rank P = 0.007; hazard ratio 2.42, 95% CI 1.26-4.66).</p><p><strong>Conclusion: </strong>In this multi-center, pilot study, we identified optimal radiomics features in the creation of a prognostic pediatric HGG model. Computational MRI techniques may offer new approaches for quantitatively evaluating tumor phenotype and serve a potential future role in therapy planning and clinical trials eligibility.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977041","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 5-ALA and sodium fluorescein on FLAIR volume extent of resection and survival in IDH-wildtype glioblastoma.","authors":"Castaldo Margherita, Zeppa Pietro, Bianconi Andrea, Bradaschia Leonardo, Dolci Lorenzo, Bruno Francesco, Antonio Melcarne, Morana Giovanni, Rudà Roberta, Garbossa Diego, Cofano Fabio","doi":"10.1007/s11060-026-05802-1","DOIUrl":"10.1007/s11060-026-05802-1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine whether the choice of fluorophore (5-aminolevulinic acid [5-ALA], sodium fluorescein [SF], or their combination) influences the extent of resection (EOR) of FLAIR-hyperintense regions and, consequently, patient survival in IDH-wildtype glioblastoma.</p><p><strong>Methods: </strong>This single-center retrospective study included 154 adult patients who underwent surgical resection of supratentorial glioblastoma between January 2021 and January 2023. Patients received 5-ALA (n = 63), SF (n = 69), or both (n = 22), depending on institutional drug availability over the study period. Volumetric analysis was performed using semi-automated segmentation on preoperative and early postoperative MRI. EOR was calculated separately for contrast-enhancing (CE) and FLAIR components. Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazards analyses.</p><p><strong>Results: </strong>No statistically significant differences were observed between fluorophore groups regarding EOR-CE (p = 0.298), EOR-FLAIR (p = 0.060), or EOR-total (p = 0.293). However, 5-ALA use was associated with significantly improved progression-free survival (median 8.5 vs. 6.0 months; HR 1.89, 95% CI 1.26-2.81, p = 0.002) and overall survival (median 17.0 vs. 11.0 months; HR 2.32, 95% CI 1.33-4.04, p = 0.003) compared with SF. The survival advantage remained significant after adjustment for age, KPS, MGMT status, and adjuvant treatment (p < 0.05).</p><p><strong>Conclusion: </strong>While no significant differences in FLAIR volume resection were observed between fluorophores, 5-ALA was associated with longer PFS and OS. The association persisted in multivariable models adjusting for residual tumor volumes, continuous EOR and RANO resect category. This may reflect a more biologically selective resection within the FLAIR-hyperintense region, a hypothesis that remains to be tested prospectively.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 3","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982811","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 evolution of RTOG and NRG Oncology CNS tumors clinical trials.","authors":"Kavita Sehrawat, Mei-Yin C Polley, Michael A Vogelbaum, Mark Gilbert, Arnab Chakravarti, Daniel P Cahill, Andrew B Lassman, David R Raleigh, Erik P Sulman, Mitch Machtay, Quynh Thu Le, Walter Curran, Vinai Gondi, Minesh P Mehta","doi":"10.1007/s11060-026-05788-w","DOIUrl":"10.1007/s11060-026-05788-w","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation Therapy Oncology Group (RTOG) and NRG Oncology have played a key role in shaping evidence-based management of central nervous system (CNS) tumors. These have defined standards for radiotherapy delivery, integrated systemic therapies for multimodal approaches, and advanced trial methodology across a range of CNS malignancies through large, multi-institutional studies. This is a comprehensive narrative review of trials involving adult CNS tumors, focused on gliomas, metastases, meningioma, and primary CNS lymphoma (PCNSL).</p><p><strong>Methods: </strong>Trials were identified through protocol archives, published literature, and curated trial inventories, and were analyzed with respect to treatment strategies, trial evolution, and impact on practice.</p><p><strong>Results: </strong>Early trials established foundational radiotherapy paradigms, including dose, volume, and fractionation standards. Subsequent studies demonstrated limitations of dose escalation and led to development of prognostic tools such as recursive partitioning analysis (RPA). In gliomas, these trials defined the role of chemoradiation, setting new standards of care (SOC), and clarified the limited benefit of treatment intensification, while recent studies explored molecularly selected therapies. In BM, randomized trials transformed management through stereotactic radiosurgery (SRS)-based approaches and hippocampal-avoidance whole brain radiotherapy (HA-WBRT), with incorporation of neurocognitive function (NCF) and quality-of-life (QOL) endpoints. Trials in meningioma provided some of the first prospective data supporting role of radiotherapy, and PCNSL trials established the superiority of chemoradiotherapy, and response-adapted deployment of WBRT.</p><p><strong>Conclusion: </strong>RTOG and NRG Oncology trials have driven iterative, evidence-based advances in transitioning to precision. These efforts continue to inform contemporary guidelines and provide a framework for future trials integrating molecular stratification, advanced imaging, and novel therapeutic strategies.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977139","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":"Brain dose burden is associated with treatment-related lymphopenia in IDH-wildtype glioblastoma: dosimetric determinants and prognostic impact.","authors":"Paolo Tini, Flavio Donnini, Giuseppe Battaglia, Pierpaolo Pastina, Giovanni Rubino, Tommaso Carfagno, Marta Vannini, Annamaria Didona, Eleonora Vanzi, Fabrizio Banci Buonamici","doi":"10.1007/s11060-026-05801-2","DOIUrl":"10.1007/s11060-026-05801-2","url":null,"abstract":"<p><strong>Background and purpose: </strong>Treatment-related lymphopenia is common during chemoradiotherapy for glioblastoma and has been associated with adverse outcome. Prior studies have implicated whole-brain V20Gy-V25Gy, mean brain dose, and treatment-volume reduction, but the relative contribution of target size and cerebral dose burden remains uncertain. We evaluated the relationship between brain dose-volume exposure, longitudinal lymphocyte depletion, and landmark outcome in 102 patients with IDH-wildtype glioblastoma.</p><p><strong>Materials and methods: </strong>This retrospective single-center cohort included 102 adults with histologically confirmed IDH-wildtype glioblastoma, paired blood counts, target-volume and brain-DVH data, and clinical follow-up. Absolute lymphocyte count (ALC) was assessed before radiotherapy and at treatment completion. Brain mean dose, V5Gy, V10Gy, V15Gy, V20Gy, V25Gy, integral dose, target volumes, corticosteroid exposure, temozolomide, and clinical-molecular variables were evaluated. V20Gy was used as the principal clinically interpretable dosimetric exposure, with the remaining dose metrics treated as correlated secondary exposures. Multivariable robust linear regression modeled log2 end-of-radiotherapy ALC after adjustment for baseline ALC and major confounders. Survival analyses were anchored at radiotherapy completion.</p><p><strong>Results: </strong>Median ALC decreased from 1810 to 1050 cells/µL, corresponding to a median relative decline of 42.6%. Grade ≥ 2 and grade ≥ 3 lymphopenia occurred in 33 (32.4%) and 14 (13.7%) patients, respectively. Greater cerebral dose burden was associated with lower lymphocyte preservation. In adjusted models, mean brain dose (β per 5 Gy, - 0.251; 95% CI, - 0.430 to - 0.071; p = 0.006), V15Gy (β per 10% points, - 0.198; p = 0.005), V20Gy (β, - 0.241; p = 0.003), V25Gy (β, - 0.262; p = 0.004), and integral dose (β per 5 Gy·L, - 0.197; p = 0.001) predicted lower end-of-radiotherapy ALC; V10Gy was also significant, whereas V5Gy was not. PTV was strongly correlated with V20Gy (ρ = 0.78, p < 0.001) but showed little direct association with lymphocyte preservation (ρ=-0.06, p = 0.55). Grade ≥ 2 lymphopenia was independently associated with inferior landmark overall survival (HR, 2.43; 95% CI, 1.30-4.56; p = 0.005) and progression-free survival (HR, 2.42; 95% CI, 1.37-4.29; p = 0.004).</p><p><strong>Conclusion: </strong>Greater cerebral dose burden is associated with treatment-related lymphocyte depletion beyond the information conveyed by target volume alone. The most consistent associations involve mean brain dose, V15Gy-V25Gy, and integral dose, while clinically relevant grade ≥ 2 lymphopenia identifies patients with substantially inferior landmark outcome. These findings support prospective evaluation of immune-sparing radiotherapy strategies that reduce unnecessary cerebral dose exposure without compromising target coverage.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969459","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":"CD73 and PD-L1 expression in WHO grade 1 and grade 2 meningiomas: an exploratory analysis of purinergic and immune-related profiles.","authors":"João Victor Garcia de Souza, Kailane Paula Pretto, Laryssa Vitória Gomes da Silva, Brendha Aparecida Macedo Oenning, Chen Pin, Jerso Menegassi, Francini Franscescon, Matheus Bianchini Chimelo, Marcelo Lemos Vieira da Cunha, Débora Tavares de Resende E Silva","doi":"10.1007/s11060-026-05786-y","DOIUrl":"10.1007/s11060-026-05786-y","url":null,"abstract":"<p><strong>Background: </strong>Meningiomas are the most common primary central nervous system tumors and exhibit heterogeneous biological behavior across WHO grades. Emerging evidence suggests that purinergic signaling and immune-related pathways may contribute to meningioma biology.</p><p><strong>Objective: </strong>This study evaluated the expression and activity of CD39/ENTPD1 and CD73/NT5E, the expression of PD-L1/CD274, and the systemic inflammatory profile in patients undergoing surgical resection of meningiomas.</p><p><strong>Results: </strong>Forty patients were included, with specific subgroups available for molecular, immunohistochemical, enzymatic, and cytokine analyses. Molecular comparisons were restricted to WHO grade 1 and grade 2 tumors. NT5E/CD73 expression was higher in WHO grade 2 tumors at both mRNA and protein levels, whereas CD274/PD-L1 expression was lower. Peripheral CD39/CD73 enzymatic activity also differed between study groups, while plasma cytokines showed non-significant trends toward higher concentrations in patients with WHO grade 2 tumors.</p><p><strong>Conclusion: </strong>Given the cross-sectional design, small sample sizes for specific analyses, and the absence of direct measurements of adenosine signaling or longitudinal clinical outcomes, these findings should be interpreted as exploratory patterns associated with tumor grade rather than evidence of tumor progression or a causal mechanism of immune evasion. Overall, the results identify CD73 as a candidate biomarker associated with WHO grade, warranting validation in larger, longitudinal, and mechanistic studies.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969504","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":"Correction to: Anatomical and surgical factors associated with postoperative hydrocephalus after central neurocytoma resection: a large single-center cohort study.","authors":"Jian He, Meng Kang, Yang Wang, Runting Li, Yutao Zhang, Xijie Wang, Wancheng Li, Rui Tao, Dali Sui, Zhixian Gao, Song Lin, Zhen Wu, Dabiao Zhou","doi":"10.1007/s11060-026-05796-w","DOIUrl":"10.1007/s11060-026-05796-w","url":null,"abstract":"","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13574910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148969442","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 outcomes after adjuvant radiotherapy in adult spinal ependymomas: a multicenter study by the trod Neuro-Oncology research group (07 - 005).","authors":"Ertugrul Senturk, Petek Erpolat, Serra Kamer, Birsen Yücel, Büşra Şahin Barış, Pantea Bayatfard, Beste Atasoy, Hasan Oğuz Çetinayak, Ebru Atasever Akkaş, Papatya Bahar Baltalarlı, Ela Delikgöz Soykut","doi":"10.1007/s11060-026-05793-z","DOIUrl":"10.1007/s11060-026-05793-z","url":null,"abstract":"<p><strong>Purpose: </strong>The optimal adjuvant treatment strategy for spinal ependymomas (SEs) is controversial, especially in patients with adverse risk factors. The efficacy of adjuvant radiotherapy (RT) and its prognostic factors remain understudied.</p><p><strong>Methods: </strong>This retrospective, multicenter study analyzed 45 adult patients (≥ 18 years) with histologically proven SE (WHO Grade 2 and 3) treated with RT between 1998 and 2024. Patients with Grade 1 tumors or surgery-to-RT intervals exceeding 6 months were excluded. Clinical outcomes were estimated using the Kaplan-Meier method, and prognostic factors were identified using multivariate Cox regression analysis.</p><p><strong>Results: </strong>In the Grade 2 cohort (n = 37; median follow-up: 7.9 years), gross total resection (GTR) was achieved in 43.2% of patients. Extent of resection served as the primary determinant of disease control: zero local failures occurred in the GTR group (100% 10-year local control (LC) and disease-free survival (DFS), whereas 41.2% of non-GTR patients experienced local failure (5- and 10-year DFS: 63.9% and 54.7%, respectively; p = 0.006). Despite superior local control with GTR, overall survival remained statistically similar between resection groups (10-year OS: 88.9% for GTR vs. 74.3% for non-GTR; p = 0.70). In non-GTR patients without initial dissemination, a surgery-to-RT interval exceeding 1.5 months was identified as the sole independent predictor of early recurrence (HR: 13.3 and 15.9 for DFS and PFS, p = 0.04 for both). Additionally, younger age and baseline spinal dissemination were independent adverse prognostic factors for progression and mortality. For Grade 3 tumors, the 5-year LC, progression-free survival, and OS rates were 56.3%, 41.7%, and 75.0%, respectively, with a 62.5% progression rate. Although GTR achieved complete LC in Grade 3 tumors, distant metastasis remained a primary pattern of failure, occurring in 60% of progressive cases. For patients with initial spinal dissemination, the progression rate was 60% with a median OS of 15.2 months.</p><p><strong>Conclusion: </strong>While GTR remains the gold standard for long-term prognosis, adjuvant RT provides effective LC in Grade 2 SE patients with residual disease. Early adjuvant RT (within 1.5 months post-surgery) is a critical management strategy for non-GTR cases. Grade 3 histology and initial spinal dissemination remain significant indicators of poor long-term survival.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944984","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 significance of walking ability at hospital discharge for overall survival in newly diagnosed glioblastoma: a comparison across six peri-treatment assessments.","authors":"Shuhei Tokiwa, Keisuke Natsume, Akira Yoshida, Hajime Yonezawa, Kentaro Kawamura, Kazuki Nakanishi, Nayuta Higa, Ryosuke Hanaya, Megumi Shimodozono","doi":"10.1007/s11060-026-05784-0","DOIUrl":"10.1007/s11060-026-05784-0","url":null,"abstract":"<p><strong>Purpose: </strong>Walking ability is readily assessed at the bedside; however, whether it adds prognostic information beyond global performance status in glioblastoma (GBM) is unknown. We examined the Functional Ambulation Category (FAC) at six peri-treatment time points and whether discharge FAC is associated with overall survival (OS) independently of contemporaneous performance status.</p><p><strong>Methods: </strong>This retrospective single-center study included 185 adults with newly diagnosed GBM treated from 2011 to 2020. FAC was assessed preoperatively, on postoperative day 5, before chemoradiotherapy, at discharge, and 1 and 4 months after discharge. The primary analysis used a discharge landmark, with FAC grouped as 0-1, 2-4, and 5 and adjustment for age, sex, extent of resection, and discharge Karnofsky Performance Status (KPS). Incremental performance was assessed using Akaike information criterion (AIC) and Harrell's C-index.</p><p><strong>Results: </strong>Higher FAC was associated with longer OS at all six time points, with the strongest univariable association at discharge. In the discharge-landmark model (n = 162; 138 deaths), adjusted hazard ratios versus FAC 0-1 were 0.45 (95% CI, 0.27-0.73) for FAC 2-4 and 0.33 (95% CI, 0.17-0.63) for FAC 5. Adding FAC improved fit and discrimination (ΔAIC, - 8.4; ΔC-index, + 0.022; p = 0.002). Estimates were unchanged after additional adjustment for bevacizumab and post-discharge temozolomide.</p><p><strong>Conclusion: </strong>Discharge FAC carries prognostic information not captured by contemporaneous global performance status and is a practical bedside marker at the transition to post-discharge care, rather than a stand-alone prediction tool.</p><p><strong>Registration: </strong>This study was not prospectively registered.</p><p><strong>Protocol: </strong>No prospective study protocol was prepared.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":"179 2","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13569522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944989","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}