Neuro-oncology Advances最新文献

{"title":"10233-GMC-17 CLINICAL SIGNIFICANCE OF GENETIC ANALYSIS FOR GLIOMA CASES IN OUR INSTITUTE","authors":"J. Yamaguchi, F. Ohka, K. Motomura, Y. Kibe, H. Shimizu, Tomohide Nishikawa, Sachi Maeda, Yuhei Takido, R. Saito","doi":"10.1093/noajnl/vdad141.089","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.089","url":null,"abstract":"Abstract The WHO Classification the 5th edition describes that identification of alterations in IDH gene, histone H3 gene, CDKN2A gene, and other genes are quite important for the diagnosis and grading of diffuse gliomas. It is important to efficiently analyze important genetic abnormalities and utilize them in actual clinical practice. In our institute, we have recently performed genetic analysis which is important for the diagnosis of glioma in all patients. Here, we report the results of these analyses. From March 2019 to June 2023, we performed Sanger sequencing for analyses of IDH1/2, H3F3A, TERT promoter, BRAF, and FGFR1 mutation in 235 patients with suspected glioma who underwent biopsy or resection at our hospital and affiliated institutions. In 145 cases, we performed MLPA analyses for detection of 1p/19q codeletion, CDKN2A homozygous deletion (HD), EGFR amplification, and Chromosome 7p gain/10q loss. Sanger sequencing identified 81 TERT promoter mutations, 70 IDH mutations (including 3 IDH2 mutations), 8 BRAF V600E mutations, 4 H3 K27M mutations, 3 H3 G34R/V mutations, and 1 FGFR1 mutation The alterations most frequently identified in MLPA were CDKN2A HD in 26 cases and 1p/19q codeletion in 19 cases. Of the 214 cases in which the pathology diagnosis was neoplastic disease, 85 (39.8%) had no abnormalities in the above genetic analysis. In 32 of these cases, the pathological diagnosis was glioblastoma, IDH-wildtype, while in many other cases, the pathological diagnosis was low-grade glioma. Genetic analysis focusing on important genes for diagnosis according to WHO classification the 5th edition was useful for diagnosis in many cases, but careful consideration is needed for diagnosis in cases without these genetic alterations.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":" 12","pages":"v22 - v22"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10091-COT-12 ELUCIDATING THE PATHOPHYSIOLOGY OF POST-OPERATIVE VENOUS THROMBOEMBOLISM IN IDH-WILDTYPE MALIGNANT GLIOMAS","authors":"M. Natsumeda, Kazuhiro Ando, J. Watanabe, Haruhiko Takahashi, Y. Tsukamoto, M. Okada, Y. Fujii, Makoto Oishi","doi":"10.1093/noajnl/vdad141.042","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.042","url":null,"abstract":"Abstract BACKGROUND We have previously reported elevated expression of podoplanin and high incidence of post-operative venous thromboembolism (VTE) in IDH-wildtype gliomas (Watanabe et al., World Neurosurgery, 2019). Podoplanin binds to C-type lectin-like receptor-2 (CLEC-2) on the surface of platelets and induces platelet aggregation, potentially leading to the development of VTE. In the present report, we monitor serum podoplanin and CLEC-2 after surgery in malignant glioma patients to directly determine if this is the cause of post-operative VTE. METHODS Fourty-four malignant glioma patients undergoing surgery at the Department of Neurosurgery, Niigata University Hospital between April, 2018 and August, 2020 were assessed. Platelet counts as well as serum D-dimer, podoplanin, soluble CLEC-2, and C2PAC index (soluble CLEC-2 divided by platelet count) were measured within 10 days after surgery. Serum podoplanin and soluble CLEC-2 were assessed by enzyme-linked immunosorbent assay (ELISA). Values for IDH-wildtype glioma patients and IDH-mutant glioma patients were compared to patients undergoing microvascular decompression (MVD) and healthy volunteers (HV). RESULTS Post-operative VTE was observed in 8 out of 35 (23%) IDH-wildtype glioma patients, compared to 1 out of 9 (11%) IDH-mutant glioma patients. Serum soluble CLEC-2 levels (p = 0.0004) and C2PAC index (p = 0.0002) were significantly elevated in IDH-wildtype glioma patients compared to IDH-mutant glioma, MVD and HV groups. A C2PAC index threshold of 3.7 provide an 87.5% sensitivity and 51.9% specificity to predict post-operative VTE in IDH-wildtype gliomas. We serially monitored podoplanin and soluble CLEC-2 in select patients, and found that podoplanin is transiently elevated, followed by soluble CLEC-2 after surgery. CONCLUSION Platelet aggregation due to the activation of podoplanin-CLEC2 axis leads to post-operative VTE in IDH-wildtype malignant glioma patients. The C2PAC index is a potential biomarker for the early detection of VTE after surgery in these patients.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":" 1084","pages":"v11 - v11"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10223-ML-12 SYSTEMIC RELAPSE OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA","authors":"Y. Miyakita, M. Ohno, Masamichi Takahashi, Shunsuke Yanagisawa, Y. Narita","doi":"10.1093/noajnl/vdad141.088","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.088","url":null,"abstract":"Abstract PCNSL remains a poor prognosis, with many patients relapsing despite induction high-dose MTX-based chemotherapy and subsequent maintenance therapy. Most recurrences occur in the brain parenchyma, but in rare cases, systemic relapse may occur. We report the clinical and pathological features of the patients with systemic relapse of PCNSL. We examined 165 PCNSLs treated at our hospital since 2005. 102 of the 165 had recurrence, and 11 of these were diagnosed as systemic relapse. The 11 patients at the time of initial diagnosis had 8 males and 3 females, age 49-81 years (median 67), and KPS 50-90 (median 70). The 11 patients at the time of recurrence had age 62-66 years (median 71), KPS 50-100 (median 60), and the sites of recurrence were abdominal lymph nodes in 3 patients, gastrointestinal tract in 3, pleural effusion in 3, and others in 2. The time to systemic relapse ranged from 11.3 to 156.1 months (median 36.4), survival after recurrence ranged from 0.1 to 89 months (median 16.1), and overall survival ranged from 16.5 to 192 months (median 66.5). Tissue sampling at relapse was performed in 9 patients, 8 of whom had DLBCL. Recurrence of PCNSL is often in the brain, and although recurrence outside the CNS occurs in less than 10%, careful follow-up is necessary. Although it has been reported that recurrence in the testes and breast is common, in our case, recurrence in lymph nodes and pleural effusions was common, and genetic histological evaluation, including discussion of the difference from the primary CNS, is considered necessary. Although the prognosis and KPS of PCNSL are poor, there are cases in which a good condition can be maintained with reliable diagnosis and treatment. Detailed clinical information, including genetic analysis at the time of initial onset and at the time of recurrence, is needed.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":" 13","pages":"v22 - v22"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138612977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10236-NI-11 IMAGING FEATURES AND CONSIDERATION OF PROGRESSION PATTERN OF DIFFUSE HEMISPHERIC GLIOMA, H3 G34-MUTANT","authors":"Kibe Yuji, F. Ohka, K. Motomura, J. Yamaguchi, Tomohide Nishikawa, Sachi Maeda, H. Shimizu, Yuhei Takido, R. Saito","doi":"10.1093/noajnl/vdad141.091","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.091","url":null,"abstract":"Abstract BACKGROUND Diffuse hemispheric gliomas, H3 G34-mutant (DHG-G34m) are newly recognized pediatric-type diffuse high-grade gliomas. We describe detail imaging features of seven cases of DHG-G34m and consider about progression pattern of DHG-G34m. RESULTS H3 G34R/V was detected by sanger sequencing in all tumors. Mean age of onset was 16.5 years (range: 10-26). Tumors were located on frontal (n=2), parietal (n=2), temporal lobe (n=1) and insular cortex (n=1), respectively. In one case, gliomatosis cerebri-like multiple lesions involving the cortex and basal ganglia occurred. Magnetic resonance imaging showed T2/FLAIR high lesions with poor contrast enhancement in all cases. All tumors harbored restriction of diffusion. Strong accumulation of methionine was observed in six cases. Tumors of these cases harbored T2/FLAIR high lesions in the deep white matter which showed methionine accumulation. All patients underwent surgery (total resection in one case, partial resection in five cases, and biopsy in one case) followed by radiation chemotherapy. The mean progression free survival was 9.9 months (range: 1.6-33.1 months). All recurrent tumors harbored diffuse infiltration along the white matter adjacent to surgical cavity, which was temporarily reduced by bevacizumab, but eventually invaded into cerebral peduncle via pyramidal tract and into contralateral brain via corpus callosum or anterior commissure in six cases. Extensive infiltration of tumor cells into the contralateral brain and brain stem was confirmed in the autopsy brain of one case. The mean overall survival was 21.6 months (range: 8.9-48.3 months). CONCLUSION DHG-G34m showed deep white matter infiltration from the time of initial onset, which made gross total resection difficult. Residual lesions extensively infiltrated along the white matter and eventually invaded the brainstem and contralateral brain, leading to death.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":" 1","pages":"v23 - v23"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10111-MPC-11 CLINICAL AND MOLECULAR NEUROPATHOLOGICAL FEATURES OF EPITHELIOID GLIOBLASTOMA","authors":"Takeo Uzuka, Takuma Sumi, Hadzuki Matsuda, Hiroyoshi Akutsu","doi":"10.1093/noajnl/vdad141.049","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.049","url":null,"abstract":"Abstract BACKGROUND Epithelioid Glioblastoma (E-GBM) has been identified as a pathological subtype of Glioblastoma. It is a rare glioblastoma and is mainly known in case reports, and the details of its clinical features and genetic characteristics are not clear. Here, we retrospecivly studied the results of clinical course and genetic features of E-GBM. METHODS Four patients who underwent surgery at our institution and were diagnosed with E-GBM were included in this study. Histological diagnosis was obtained by surgical excision in all cases. We extracted DNA from the resected tissues and analyzed glioma-related genes using various methods such as high resolution melting (HRM), MGMT methylation-specific HRM, digital PCR, and Multiple ligation-dependent probe amplification (MLPA) analysis. Moreover, we assayed methylation EPIC BeadChip arrays for each sample. RESULTS E-GBM tended to develop at a slightly younger age than other general glioblastoma. All patients underwent surgical resection followed by radiation therapy and concurrent temozolomide therapy. However, none of the patients were able to transition to temozolomide maintenance therapy due to disease progression, and the overall survival period was 8 to 19 weeks, indicating an extremely poor prognosis. Genetic analysis revealed both TERT promoter mutations and BRAFV600E mutation in all cases. In addition, IDH mutation was not found, and MGMT promoter methylation was unmethylated in all cases. EGFR amplification, CDKN2A/2B homozygous deletion and 1p/19q co-deletion were not found in any cases. Methylation-based classification did not reach E-GBM in all samples. CONCLUSION The simultaneous mutations of TERT promoter with BRAFV600E could serve as diagnostic molecular markers for the diagnosis of E-GBM. Standard therapy for glioblastoma was not expected to be effective in treating this tumor. It was considered necessary to introduce new therapeutic strategies such as early administration of BRAF and MEK inhibitors.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":" 7","pages":"v12 - v13"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138619075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10014-CBMS-2 CONCURRENT TARGETING OF MDM4 AND MDM2 USING CEP-1347 AS AN EFFECTIVE THERAPEUTIC STRATEGY FOR P53 WILD-TYPE MALIGNANT BRAIN TUMORS","authors":"Yuta Mitobe, Yukihiko Sonoda, C. Kitanaka","doi":"10.1093/noajnl/vdad141.008","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.008","url":null,"abstract":"Abstract The development of MDM4 inhibitors as an approach to reactivating p53 in human cancer is attracting increasing attention; however, whether they affect the function of MDM2 and how they interact with MDM2 inhibitors remain unknown. We addressed this question in the present study using CEP-1347, an inhibitor of MDM4 protein expression. The effects of CEP-1347, the genetic and/or pharmacological inhibition of MDM2, and their combination on the p53 pathway in malignant brain tumor cell lines expressing wild-type p53 were investigated by RT-PCR and Western blot analyses. The growth inhibitory effects of CEP-1347 alone or in combination with MDM2 inhibition were examined by dye exclusion and/or colony formation assays. The treatment of malignant brain tumor cell lines with CEP-1347 markedly increased MDM2 protein expression, while blocking CEP-1347-induced MDM2 overexpression by genetic knockdown augmented the effects of CEP-1347 on the p53 pathway and cell growth. Blocking the MDM2-p53 interaction using the small molecule MDM2 inhibitor RG7112, but not MDM2 knockdown, reduced MDM4 expression. Consequently, RG7112 effectively cooperated with CEP-1347 to reduce MDM4 expression, activate the p53 pathway, and inhibit cell growth. The present results suggest CEP-1347-induced MDM2 overexpression combined with the selective inhibition of MDM2's interaction with p53, while preserving its ability to inhibit MDM4 expression, as a novel and rational strategy to effectively reactivate p53 in wild-type p53 cancer cells.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":"92 1","pages":"v2 - v3"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138621780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10050-TB-1 ADDITIONAL RAS/MAPK PATHWAY ACTIVATION ALLOWS CELLS TO DIFFERENTIATE DURING TUMORIGENESIS.","authors":"Shunichiro Miki, Tomoyuki Koga, F. Furnari","doi":"10.1093/noajnl/vdad141.026","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.026","url":null,"abstract":"Abstract Activation of the RAS/MAPK pathway has been introduced in most of the glioblastoma models reported to date. To examine the roles of this pathway in tumorigenesis from different cells of origin, we differentiated human induced pluripotent stem cells (hiPSCs) with CDKN2A/2B null, PTEN null, and TERT promoter mutation (TPM), which we have previously generated, into neural stem cells (NPCs) and astrocytes, and also prepared cell lines with lentiviral EGFRvIII overexpression in both. 4 cell lines were transplanted into the brains of immunodeficient mice, and differences in tumorigenesis were compared between NPCs and astrocyte states with and without MAPK/RAS pathway activity. In NPCs, overexpression of EGFRvIII significantly shortened the time required for tumorigenesis. In Astrocytes, however, tumor formation was observed only in cells with EGFRvIII overexpression. RNA sequencing revealed the primary spheres formed from the tumors with EGFRvIII overexpression clustered similarly regardless of whether they were derived from NPCs or astrocytes, suggesting that similar tumors were formed from both sources. To further clarify the effect on the RAS/MAPK pathway, we prepared CDKN2A/2B null, PTEN null, TPM, and NF1 null iPSCs. Tumor formation was also confirmed when the cell line was differentiated into astrocytes and transplanted into immunodeficient mice. Although the cell of origin of glioblastoma is still controversial, recent reports indicate that tumorigenesis itself starts from undifferentiated cells. Our results suggest that the RAS/MAPK pathway activation in glioblastoma enhances tumorigenesis, allows cells to differentiate during the process, and also enables cells to transform even after differentiation by acquiring the activation.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":"48 1","pages":"v7 - v7"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138622024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10181-STMO-9 EFFECT OF INTRAOPERATIVE VENTRICULAR OPENING ON RECURRENCE PATTERNS FOLLOWING BCNU WAFER IMPLANTATION FOR NEWLY DIAGNOSED MALIGNANT GLIOMA","authors":"Kengo Yamada, R. Matsuda, Ryosuke Maeoka, S. Yokoyama, M. Kotsugi, K. Tamura, S. Yamada, F. Nishimura, I. Nakagawa, Eishu Boku","doi":"10.1093/noajnl/vdad141.073","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.073","url":null,"abstract":"Abstract To evaluate the effect of ventricular opening (VO) on recurrence patterns in patients with newly diagnosed malignant glioma treated with bis-chloroethyl-nitrosourea (BCNU) wafer implantation. This single-center retrospective study included 45 patients with newly diagnosed malignant glioma who received BCNU wafer implantation after tumor resection between March 2013 and December 2021. The patients were categorized into two groups based on whether VO occurred during the malignant glioma resection. While 20 patients received VO, 25 did not receive VO. Recurrence patterns classified as local, diffuse, distant, or multifocal and time to recurrence were compared between patients with and without VO. Median survival time was comparable between patients with VO and patients without VO (32 months vs. 26 months, p = 0.95). Recurrence occurred in 28/46 patients (60.8%) in entire cohort. The incidence of recurrence was comparable between patients with VO and patients without VO (12 [60%] vs. 16 [64%], p = 1.0). No significant differences were seen between the two groups in time to recurrence (p = 0.657) or recurrence patterns (p = 0.13). Ventricular opening during surgery with BCNU wafer implantation does not seem to influence the recurrence patterns. Ventricular opening does not induce distant recurrence if appropriate ventricular closure is performed.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":"4 18","pages":"v18 - v18"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138624577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10159-STMO-7 INTRAOPERATIVE MRI SURGERY FOR POSTERIOR FOSSA LESIONS","authors":"Mitsuto Hanihara, M. Ogiwara, Hirofumi Kazama, Hiroyuki Kinouchi","doi":"10.1093/noajnl/vdad141.063","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.063","url":null,"abstract":"Abstract Background: Intraoperative MRI (iMRI) is an important modality in brain tumor surgery to identify residual tumors, however, it is problematic due to patient positional limitations. In this study, we investigated the usefulness of iMRI for posterior fossa lesions. Materials and Methods: Of 320 cases of brain tumors removed using iMRI from June 2016 to April 2023, 24 cases of posterior fossa lesions were included. Tumor type, approach method, imaging availability, tumor removal rate, and complications were examined retrospectively. Results: Tumor types included 8 gliomas, 5 epidermoid cysts, 4 meningiomas, 3 metastatic brain tumors, 1 schwannoma, and 3 others. Eleven patients underwent midline suboccipital approach in the supine position, 8 patients underwent lateral suboccipital approach, 2 patients underwent occipital transtentorial approach, and 2 patients underwent anterior transpetrosal approach in the supine position. transpetrosal approach in 2 cases and subtemporal approach in 1 case. iMRI showed residual lesion in 14 of 24 patients. More than half of the gliomas and epidermoid cysts had intraoperative residual disease, whereas only one meningioma did. Total resection was achieved except for one case of intentional residual schwannoma and two cases of glioma. Discussion: iMRI requires the upper body to fit within a gantry, and it is difficult to image in the park bench position. However, various approaches is possible by using a supine-lateral or semi-prone position. In the concorde position, where the fourth ventricle and upper cerebellum are approached, it is useful to insert a mat in the anterior thoracic and raise the upper body. For tumors in the dorsal brainstem and upper cerebellum, the occipital transtentorial approach was used. iMRI is effective in the removal of all tumors, including gliomas in intramedullary tumors and epidermoid cysts in extramedullary tumors. Conclusion: iMRI can be used in posterior cranial fossa lesions.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":" 958","pages":"v16 - v16"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138610547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"10259-NQPC-9 CONTROVERSY ON INVASIVE AIRWAY MANAGEMENT IN PATIENTS WITH BRAIN STEM MALIGNANT GLIOMA.","authors":"Kensuke Ikeda, K. Saito, Yuki Yamagishi, N. Sasaki, Keiichi Kobayashi, Hirofumi Nakatomi, M. Nagane","doi":"10.1093/noajnl/vdad141.097","DOIUrl":"https://doi.org/10.1093/noajnl/vdad141.097","url":null,"abstract":"Abstract INTRODUCTION The prognosis for patients with malignant gliomas of the brainstem is poor. As the tumor progresses into the medulla oblongata, the lower cranial nerves are affected, resulting in dysphagia and eventually respiratory paralysis. On the other hand, higher cerebral function is often preserved, making it a palliative medical issue whether to perform invasive procedures to secure the airway. We report here three characteristic cases treated at our hospital. CASE 1 A-60-year-old male patient with diffuse midline glioma of the medulla oblongata was admitted to our hospital for radiation therapy and concomitant temozolomide. His consciousness level was clear, but dysphagia was noted. Although he was at risk for aspiration and choking, he did not wish to undergo surgery to prevent aspiration. After treatment was started, he died of choking. CASE 2 A-50-year-old male patient with recurrent astrocytoma in the brainstem was admitted for bevacizumab monotherapy. Despite the treatment, his dysphagia gradually worsened, and he developed respiratory failure due to aspiration pneumonia, resulting in tracheal intubation. Subsequently, he underwent glottis closure, and as a result, he lost his speech but recurrence of aspiration pneumonia and choking were prevented. CASE 3 A-50-year-old male patient with cerebellar glioma invading brainstem was admitted due to aspiration pneumonia. He was disoriented and required heavy care. He did not wish to undergo surgery to prevent aspiration, but with antimicrobial therapy and frequent oral suctioning, his aspiration pneumonia was cured. DISCUSSION Although invasive procedures are generally avoided in terminal-stage cancer patients, anti-aspiration procedures such as tracheostomy and glottis closure may be considered for the conscious patients with malignant glioma in the brainstem. These procedures might be an option at the end of life to avoid painful death due to choking and to prevent deterioration of the patient's condition due to repeated aspiration pneumonia.","PeriodicalId":19138,"journal":{"name":"Neuro-oncology Advances","volume":"112 9","pages":"v24 - v24"},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138608710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}