Journal of Neuro-Oncology最新文献

{"title":"Epidemiology of WHO grade 2 and grade 3 gliomas from 2009 to 2021 in Germany.","authors":"Daniel Weidl, David Capper, Julia Onken, Ilon Liu, Doris Glaser, Felix Orben, Karolin Eberle, Jan Coburger, Lars Bullinger","doi":"10.1007/s11060-025-05068-z","DOIUrl":"https://doi.org/10.1007/s11060-025-05068-z","url":null,"abstract":"<p><strong>Purpose: </strong>This study provides a comprehensive analysis of the real-world epidemiology of histologically assessed IDH-mutated or IDH-wildtype grade II and III gliomas in Germany between 2009 and 2021, supplemented with a literature-based approach of setting the data in the context of the WHO 2021 classification.</p><p><strong>Methods: </strong>Data from the Centre for Cancer Registry Data (ZfKD) at the Robert Koch-Institute (RKI) was utilized, encompassing all incident cases of histologically (according to the WHO classification of the respective time) newly diagnosed grade II and III gliomas diagnosed between 2009 and 2021, representing a subgroup of the total number of 14,053 glioma cases (including high grade glioma). Data were supplemented with an exploratory literature review on IDH-mutation rates and epidemiology data from the German low-grade glioma (LoG-Glio) disease registry.</p><p><strong>Results: </strong>The tumor class distribution of newly diagnosed gliomas showed the majority being classified as grade IV glioma and only 9.0% and 9.2% as grade II or III, respectively. The incidence remained stable over the observation period. Literature data indicate mutation rates of IDH of approximately 86% in grade II and 60% in grade III gliomas diagnosed using pre-WHO-2021 criteria. Applying these proportions to 2009-2021 mean incidence cases numbers in an estimate of 459 grade 2 and 328 grade 3 IDH-mutated gliomas (combining astrocytoma and oligodendroglioma) and an incidence rate of 0.6 and 0.5 per 100.000 population for newly diagnosed IDH-mutated gliomas in Germany.</p><p><strong>Conclusion: </strong>This study gives an overview of the incidence of WHO grade 2 and grade 3 gliomas among the German population. Furthermore, this study highlights the need of molecular information being integrated into epidemiologic monitoring of gliomas to obtain more precise insights into survival and prognostic factors.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986505","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":"Percutaneous cryoablation in the management of spinal metastases: a comprehensive systematic review and meta-analysis.","authors":"Mohammad Sadegh Fallahi, S Farzad Maroufi, S Parmis Maroufi, MirHojjat Khorasanizadeh, Leonardo José Monteiro de Macêdo Filho, Konstantinos Margetis, Daipayan Guha, Claudio E Tatsui, Alireza Mansouri","doi":"10.1007/s11060-025-05064-3","DOIUrl":"https://doi.org/10.1007/s11060-025-05064-3","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive techniques such as vertebroplasty, kyphoplasty, radiofrequency ablation, and stereotactic body radiotherapy have been widely used to manage spinal metastases. Among these, percutaneous cryoablation (PCA) has emerged as a promising option for local tumor control and pain management, offering targeted treatment with minimal damage to surrounding tissues. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of PCA for spinal metastases.</p><p><strong>Methods: </strong>A systematic review was conducted using PubMed and Embase databases to identify studies that reported outcomes of PCA for spinal metastases. The reported radiologic, clinical, and complication outcomes were then combined and analyzed using meta-analytic methods including the calculation of pooled means and proportions, subgroup analysis, and meta-regression.</p><p><strong>Results: </strong>Eleven studies, including 229 patients, met inclusion criteria and were analyzed. Patients had a mean age of 61.8 years, with 60.6% being female. Breast (18.6%), lung (16.0%), and thyroid (8.0%) were the most common primary cancer sites. PCA was primarily conducted under general anesthesia (47.5%) and with CT/MRI guidance (93.9%). Local tumor control was achieved in 70.5% of cases over a mean follow-up of 12.6 months. Pain severity significantly decreased postoperatively, with a mean reduction of 4.5 points (P < 0.0001). Major and minor complication rates were 2.0% and 4.8%, respectively.</p><p><strong>Conclusions: </strong>PCA is an effective alternative treatment for spinal metastases, offering pain relief and local tumor control with low complication rates in appropriately selected patients. However, tumor location and patient age may influence treatment outcomes, underscoring the need for individualized treatment planning.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972040","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":"Development of a recursive partitioning analysis for prediction of radiation necrosis following single-fraction stereotactic radiosurgery for intact brain metastases.","authors":"Anirudh Bommireddy, Zachary S Mayo, Chandana A Reddy, Cole Billena, Erik M Davies, Robin W Davis, Erin S Murphy, John H Suh, Ehsan H Balagamwala, Timothy A Chan, Jennifer S Yu, Gene H Barnett, Lilyana Angelov, Alireza M Mohammadi, Glen H J Stevens, Matthew Grabowski, David M Peereboom, Samuel T Chao","doi":"10.1007/s11060-025-05062-5","DOIUrl":"https://doi.org/10.1007/s11060-025-05062-5","url":null,"abstract":"<p><strong>Purpose/objective: </strong>Radiation necrosis (RN) is a potential complication after stereotactic radiosurgery (SRS) for brain metastases. This study develops a recursive partitioning analysis (RPA) to identify patients at risk for RN following SRS.</p><p><strong>Methods: </strong>Patients who underwent single-fraction SRS for intact brain metastases at a single institution from 2017 to 2021 were identified. Cox regression identified factors associated with RN, and variables with p < 0.1 were included in the RPA. Patients with staged SRS, incomplete records, or less than 3 months of follow-up were excluded.</p><p><strong>Results: </strong>The study included 170 patients with 919 lesions, with median follow-up of 9 months. Primary disease sites were non-small cell lung cancer (NSCLC, 49%), breast cancer (12%), melanoma (11%), renal cancer (6%), and others (22%). Median prescription dose was 24 Gy, and median maximum lesion dimension (MLD) was 0.7 cm. RN occurred in 110 (12.2%) lesions, of which 32 (3.5%) were symptomatic, at median of 4.9 months after SRS. Variables for RPA included primary disease site, tumor location, MLD, prior SRS, number of SRS targets, dosimetry, prior hemorrhage, and concurrent systemic therapy. RPA identified four groups: Group 1 (MLD ≤ 0.8 cm, non-breast/NSCLC/renal), Group 2 (MLD ≤ 0.8 cm, breast/NSCLC/renal), Group 3 (MLD > 0.8 cm, no post-SRS hemorrhage), and Group 4 (MLD > 0.8 cm, post-SRS hemorrhage). Two-year RN free survival was 99% (Group 1), 89% (Group 2), 70% (Group 3), and 52% (Group 4).</p><p><strong>Conclusion: </strong>This is the first RPA model for RN after single-fraction SRS, which may aid in risk assessment and distinguishing RN from tumor progression.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022331","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":"Financial toxicity in pediatric and adolescent neurosurgical oncology.","authors":"Alexandra M Giantini-Larsen, Samantha Brown, Anne S Reiner, Stephanie Doyle Giandalone, Kyle Zappi, Zaki Abou-Mrad, Yasmin Khakoo, Ira J Dunkel, Matthias A Karajannis, Sameer F Sait, Caitlin E Hoffman, Jeffrey P Greenfield, Mark M Souweidane, W Christopher Newman","doi":"10.1007/s11060-025-05056-3","DOIUrl":"https://doi.org/10.1007/s11060-025-05056-3","url":null,"abstract":"<p><strong>Background: </strong>Financial toxicity (FT) encompasses the negative impact of medical costs on patients. In-depth analysis of FT in pediatric and adolescent neurosurgical oncology has not been performed. The aim of this study was to determine the incidence of FT in this population.</p><p><strong>Design: </strong>A retrospective review of medical and financial services data was conducted at Memorial Sloan Kettering Cancer Center of patients under 21 years of age who underwent neurosurgery for a cancer-related diagnosis from 2016 to 2020.</p><p><strong>Results: </strong>294 surgical procedures across 202 patients were analyzed. 16% (33/202) of patients experienced FT in the two years prior to the first neurosurgical procedure, and the most common toxicity identifier was utilization of the financial assistance program (45%). For all 202 patients, the 2-year cumulative incidence of FT following first neurosurgical procedure was 19% (CI:14%,24%). Among patients who survived for at least 2 years after surgery, 34% (29/86) experienced FT with the most common toxicity being having bills sent to collections (34%). Most patients who experienced FT had at least one commercial insurance policy. Presence of pre-operative FT was associated with a significantly higher cumulative incidence of post-operative FT (2-year estimates: pre-operative FT 61% (95%CI: [41%,75%]) vs. no pre-operative FT 11% (95%CI: [7%,16%]), p < 0.001).</p><p><strong>Conclusion: </strong>FT poses challenges in the pediatric neurosurgical oncology population. Pre-operative FT significantly influences post-operative FT. Most patients who experienced FT had at least one commercial insurance plan, providing evidence that even patients with insurance are not immune to FT.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030250","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 value of MIB-1 index in meningioma: a retrospective cohort study to establish an optimal cutoff for recurrence and survival.","authors":"Ishav Y Shukla, Ali Ebada, Nicholas Bever, Jeffrey I Traylor, Bingchun Wan, Darsh Shah, Samuel L Barnett, Matthew Z Sun","doi":"10.1007/s11060-025-05057-2","DOIUrl":"https://doi.org/10.1007/s11060-025-05057-2","url":null,"abstract":"<p><strong>Purpose: </strong>Predicting long-term outcomes after meningioma resection remains challenging. Ki-67/MIB-1 correlates with recurrence, yet its optimal cutoff is undefined. This study aims to establish a threshold that enhances risk stratification, improves recurrence prediction, and informs postoperative surveillance and adjuvant treatment strategies.</p><p><strong>Methods: </strong>This is retrospective study of patients who underwent meningioma resection. Receiver operating characteristic (ROC) analysis determined the optimal MIB-1 cutoff for predicting recurrence and survival, providing area under the curve (AUC). This cutoff was then applied in Kaplan-Meier survival analyses and multivariable Cox regressions, controlling for age, sex, tumor diameter, tumor location, extent of resection, and adjuvant radiotherapy.</p><p><strong>Results: </strong>A total of 404 patients were included. Median age was 55.0 years (range: 16-85) and 72.3% were female. The cohort primarily consisted of WHO Grade 1 (69.6%) and Grade 2 (30.0%) meningiomas. An optimal MIB-1 index cutoff of 4.1% was identified using ROC analysis with the Youden index for predicting recurrence (AUC = 0.661, p < 0.001) and survival (AUC = 0.717, p < 0.001). 241 patients (59.7%) had a MIB-1 < 4.1%, and 163 (40.3%) had a MIB-1 ≥ 4.1%. Patients with MIB-1 ≥ 4.1% had a higher risk of recurrence (HR = 2.9, p = 0.009) and mortality (HR = 2.8, p = 0.036). Patients with MIB-1 ≥ 4.1% demonstrated shorter recurrence-free survival (RFS) (119.0 vs. 129.0 months, p < 0.001) and overall survival (OS) (163.0 vs. 229.0 months, p < 0.001).</p><p><strong>Conclusion: </strong>We identified an optimal and actionable MIB-1 index cutoff of 4.1% which independently predicted recurrence, mortality, and shorter RFS and OS for patients undergoing meningioma resection. As the first study to establish and validate this threshold, our findings highlight its potential as an adjunct prognostic tool to refine risk stratification and guide postoperative management.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025716","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":"Evaluating safety and feasibility of same-day discharge after laser interstitial thermal therapy: a pilot study with a matched control group.","authors":"Adham M Khalafallah, Nikola Susic, Khushi H Shah, Maxon V Knott, Chandler N Berke, Muhammet E Gurses, Victor M Lu, Michael E Ivan, Ricardo J Komotar, Ashish H Shah","doi":"10.1007/s11060-025-05055-4","DOIUrl":"https://doi.org/10.1007/s11060-025-05055-4","url":null,"abstract":"<p><strong>Purpose: </strong>Laser interstitial thermal therapy (LITT) is a minimally invasive treatment for intracranial tumors. Enhanced recovery after surgery (ERAS) protocols aim to optimize patient outcomes, and same-day discharge (SDD) is an emerging strategy to improve efficiency while maintaining safety. This pilot study evaluates the feasibility and safety of SDD following LITT.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients who underwent LITT with planned SDD between May 2023 and June 2024 at our institution. Patients successfully discharged on the same day (study group) were match-paired 1:3 based on age, gender, and pathology, with patients discharged on post-ablation day 1 (control group) between January 2014 and April 2023. Demographic, perioperative, and treatment outcomes were compared.</p><p><strong>Results: </strong>SDD was achieved in 10 patients (mean age 56.80 ± 11.43 years, 70% males), compared to 30 controls (mean age 58.87 ± 12.23, 70% males). SDD patients had a significantly shorter observation period (p < 0.001). No differences were observed in postoperative edema (p = 0.640), midline shift (p = 0.195), Karnofsky Performance Status (KPS) at follow-up (p = 0.999), 30-day postoperative complications (p = 0.620), 30-day neurosurgical complications (p = 0.999), 30-day readmission (p = 0.584), 30-day neurosurgical readmission (p = 0.999), or 90-day mortality (p = 0.999) between groups.</p><p><strong>Conclusion: </strong>Our findings suggest that SDD following LITT is safe and feasible for appropriately selected patients. Rigorous patient selection and optimized perioperative protocols facilitate expedited recovery without compromising safety.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007164","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":"Congress of neurological surgeons systematic review and evidence-based guidelines for the role of imaging in newly diagnosed WHO grade II diffuse glioma in adults: update.","authors":"Chaitra Badve, Abraham Nirappel, Simon Lo, Daniel A Orringer, Jeffrey J Olson","doi":"10.1007/s11060-025-05043-8","DOIUrl":"https://doi.org/10.1007/s11060-025-05043-8","url":null,"abstract":"<p><strong>Target population: </strong>Adult patients with suspected or histologically proven WHO Grade II diffuse glioma. QUESTION 1: In adult patients with suspected or histologically proven WHO Grade II diffuse glioma, do advanced MRI techniques using magnetic resonance spectroscopy, perfusion weighted imaging or diffusion weighted imaging provide superior assessment of tumor grade, margins, progression, treatment-related effects, and prognosis compared to standard neuroimaging?</p><p><strong>Recommendation: </strong>Level II: The use of diffusion imaging and dynamic susceptibility contrast (DSC), dynamic contrast enhancement (DCE) and arterial spin labeling (ASL) sequences are suggested to differentiate WHO Grade II diffuse glioma from higher grade gliomas when this is not accomplished by T2 weighted and pre- and post-gadolinium contrast enhanced T1 weighted imaging.</p><p><strong>Level iii: </strong>The use of diffusion and perfusion is suggested for obtaining information in genomics, prognosis, and post treatment monitoring when this information would be of value to the clinician and is not obtained through other methods.</p><p><strong>Level iii: </strong>The use of MR Spectroscopy is suggested to differentiate WHO Grade II diffuse glioma from higher grade gliomas when this is not accomplished by standard MRI, perfusion and diffusion techniques and when such information would be of value to the clinician. QUESTION 2: In adult patients with suspected or histologically proven WHO Grade II diffuse glioma, does molecular imaging using amino acid PET tracers provide superior assessment of tumor grade, margins, progression, treatment-related effects, and prognosis compared to standard neuroimaging?</p><p><strong>Recommendation: </strong>Level III: If not already evident by MRI studies, the addition of amino acid PET with FET and FDOPA as a tracer is suggested to help determine if a brain lesion is a low grade glioma or high grade glioma.</p><p><strong>Level iii: </strong>If the standard clinical prognostic parameters are unclear and novel PET tracers are available, the clinician may consider FET to assist in determination of prognosis in an individual with grade II diffuse glioma.</p><p><strong>Level iii: </strong>Clinicians may use FDOPA PET in addition to MRI if additional information is required for detection of tumor progression.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007530","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 the biological characteristics of glioblastoma tumorspheres obtained from fresh and cryopreserved glioblastoma tissues.","authors":"Min Kyun Na, Yoojung Oh, Dongkyu Lee, Junseong Park, Seon-Jin Yoon, Jihwan Yoo, Seo Jin Kim, Jin-Kyoung Shim, Sewoom Baek, Ju Hyung Moon, Eui Hyun Kim, Wan-Yee Teo, Jong Hee Chang, Hak-Jun Sung, Seok-Gu Kang","doi":"10.1007/s11060-025-05052-7","DOIUrl":"https://doi.org/10.1007/s11060-025-05052-7","url":null,"abstract":"<p><strong>Purpose: </strong>Glioblastoma (GBM) is the most common and aggressive primary brain tumor. Human GBM tumorspheres (TS) are essential for preclinical drug screening and establishing patient-derived xenograft (PDX) models, but their derivation is often limited to fresh tissue. Whether TS from cryopreserved tissues retain comparable molecular and biological properties to those from fresh tissues remains underexplored. We hypothesized that TS from cryopreserved tissues could provide a reliable alternative for TS derivation, thereby expanding accessibility for GBM research.</p><p><strong>Methods: </strong>TS isolation rates were compared across 39 primary GBM samples. Tumor tissues collected during surgical resection were divided into two groups: one processed immediately as fresh tissue, and the other cryopreserved for 1 month before processing. Gene expression profiling via RNA sequencing and biological comparisons, including cell proliferation, neuroglial differentiation, stemness, invasiveness, and responsiveness to radiation and temozolomide, were performed on three matched TS samples from each group. Tumorigenesis was also assessed using PDX models.</p><p><strong>Results: </strong>TS were successfully isolated from 64.1% of fresh and 58.9% of cryopreserved tissues. Gene expression profiling revealed similar expression patterns in TS derived from both tissue types, despite variations in cancer subtypes. Cell proliferation, neuroglial differentiation, stemness, or invasiveness rates did not differ significantly between TS derived from fresh and cryopreserved tissues. All three GBM TS exhibited comparable responsiveness to temozolomide and radiation, as well as similar tumorigenic potential in the PDX models.</p><p><strong>Conclusion: </strong>These findings suggest an alternative method for isolating TS when immediate processing is not feasible, offering a time-independent approach for GBM research.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144007529","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":"Current trends in reoperation for recurrent glioblastoma: a meta-analysis (2007-2023).","authors":"Pavel S Pichardo-Rojas, Fabricio Garcia-Torrico, César B Espinosa-Cantú, Francisco A Rodriguez-Elvir, Andrea C Beltran-De la Fuente, Myriam S Hernandez-Garcia, James S Trippett, Alexis Morell, Ashish H Shah, Ricardo J Komotar, Yoshua Esquenazi","doi":"10.1007/s11060-025-05058-1","DOIUrl":"https://doi.org/10.1007/s11060-025-05058-1","url":null,"abstract":"<p><strong>Purpose: </strong>Despite conflicting evidence, reoperation for recurrent glioblastoma (rGBM) achieving complete resection of enhancing-tumor (CRET) may offer benefits over partial resection or salvage therapy alone. However, pooled analyses remain limited.</p><p><strong>Methods: </strong>A systematic search identified rGBM studies comparing reoperation and non-reoperation, including chemotherapy with/without radiotherapy, radiation-based therapies (RBT), and best supportive care (BSC).</p><p><strong>Results: </strong>Thirty-six studies, comprising 10,738 patients, were included, with 2,806 undergoing reoperation. Nine propensity-score-matched studies and one clinical trial were identified. Mean overall survival (OS) favored reoperation (19.66 months) over chemotherapy with/without radiotherapy (12.56 months, p < 0.00001) and BSC (4.04 months, p < 0.00001), but not over chemotherapy alone (14.60 months) or RBT (14.26 months)(p > 0.05). Multivariate OS favored reoperation over chemotherapy with/without radiation(HR = 0.62,95%CI:0.50-0.76,p < 0.00001), but not to stereotactic radiosurgery (SRS) (HR = 0.52,95%CI:0.25-1.08,p = 0.08) or chemotherapy alone (HR = 0.80,95%CI:0.63-1.00,p = 0.05). Progression-free survival after recurrence (PFS2) was only compared between reoperation and chemotherapy with/without radiotherapy, favoring reoperation (8.36 vs. 4.97 months, p < 0.00001). Multivariate analysis also favored reoperation (HR = 0.56, 95% CI:0.41-0.76,p = 0.0002).The mean post-recurrence survival (PRS) was 12.18 months in the reoperation group, 9.19 months in the chemotherapy with/without radiotherapy, and 9.64 months in SRS. Multivariate PRS favored reoperation over chemotherapy with/without radiotherapy (HR = 0.78, 95%CI: 0.62-0.98,p = 0.04). CRET with < 1 cm³ residual tumor correlated with improved PRS over incomplete resection (HR: 0.54, 95%CI:0.39-0.73, p = 0.04).</p><p><strong>Conclusion: </strong>The role of reoperation in rGBM remains uncertain. While it may improve survival in selected cases, limited high-quality data hinder definitive conclusions. Achieving CRET may correlate with improved PRS over partial resection. Further prospective trials are necessary to guide optimal management of rGBM.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144025715","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":"Extra-central nervous system metastasis from high-grade glioma: a single-institution experience.","authors":"Christina Abi Faraj, Ian E McCutcheon, Maria A Gubbiotti, Subha Perni, Maria K Gule-Monroe, Kadir Akdemir, Victoria E Clark, Evan D Bander, Monica E Loghin, Sujit S Prabhu, Frederick F Lang, Jeffrey S Weinberg","doi":"10.1007/s11060-025-04977-3","DOIUrl":"10.1007/s11060-025-04977-3","url":null,"abstract":"<p><strong>Purpose: </strong>Extra-central nervous system metastasis (ECM) from glioblastoma and other high-grade gliomas (HGGs) is exceedingly rare, likely due to central nervous system barriers and the short overall survival (OS) in HGG patients, limiting the timeframe for metastasis. Improved treatments have extended survival, potentially increasing ECM incidence, though mechanisms remain unclear.</p><p><strong>Methods: </strong>This retrospective study examines HGG patients (n = 16) with ECM treated at The University of Texas M. D. Anderson Cancer Center from 1993 to 2023.</p><p><strong>Results: </strong>Median age at HGG and ECM diagnoses were 33.6 and 35.1 years, respectively, with a slight female predominance. Diagnoses included glioblastoma, IDH-wildtype WHO Grade 4 (n = 11), epithelioid glioblastoma WHO Grade 4 (n = 2), astrocytoma IDH-mutant WHO Grade 4 (n = 2), and H3K27-altered diffuse midline glioma (n = 1). Median interval from HGG to ECM diagnosis was 10 months. The temporal lobe was the most common HGG site, with ECM primarily in cervical lymph nodes, bone, parotid gland, and cranial soft tissues. Genomic profiling identified TP53, EGFR, RB1, NF1, TERT promoter, and BRAF V600E mutations. Median OS from HGG diagnosis was 23.4 months, and median OS following ECM diagnosis was 5.9 months. Chemotherapy and radiotherapy to ECM sites extended survival. Leptomeningeal disease was present in 50% of cases and correlated with worse prognosis. ECM typically developed in advanced disease stages.</p><p><strong>Conclusion: </strong>This study highlights genomic alterations, management, and outcomes associated with ECM in HGG. Tumor spread may stem from neurosurgical manipulation and occur via hematogenous and/or lymphatic routes. Multimodal treatment extends survival. Targeted therapies based on molecular profiles should be explored.</p>","PeriodicalId":16425,"journal":{"name":"Journal of Neuro-Oncology","volume":" ","pages":"193-204"},"PeriodicalIF":3.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585967","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}