Neuro-oncology practice最新文献

{"title":"Performance and Symptom Validity Indicators among Children undergoing Cognitive Surveillance following Treatment for Craniopharyngioma","authors":"Brian S. Potter, Valerie Mc Laughlin Crabtree, J. Ashford, Yimei Li, Jia Liang, Yian Guo, Merrill S Wise, Evelyn S Skoda, T. Merchant, H. Conklin","doi":"10.1093/nop/npae005","DOIUrl":"https://doi.org/10.1093/nop/npae005","url":null,"abstract":"\u0000 \u0000 \u0000 Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to neuropsychological evaluations, helping ensure findings reflect true abilities or concerns. It is unclear how PVTs and SVTs perform in children who received radiotherapy for brain tumors. Accordingly, we investigated the rate of noncredible performance on validity indicators as well as associations with fatigue and lower intellectual functioning.\u0000 \u0000 \u0000 \u0000 Embedded PVTs and SVTs were investigated in 98 patients with pediatric craniopharyngioma undergoing proton radiotherapy (PRT). The contribution of fatigue, sleepiness, and lower intellectual functioning to embedded PVT performance was examined. Further, we investigated PVTs and SVTs in relation to cognitive performance at pre-PRT baseline and change over time.\u0000 \u0000 \u0000 \u0000 SVTs on parent measures were not an area of concern. PVTs identified 0-31% of the cohort as demonstrating possible noncredible performance at baseline, with stable findings one-year following PRT. Reliable Digit Span (RDS) noted highest PVT failure rate; RDS has been criticized for false positives in pediatric populations, especially children with neurological impairment. Objective sleepiness was strongly associated with PVT failure, stressing need to consider arousal level when interpreting cognitive performance in children with craniopharyngioma. Lower intellectual functioning also needs to be considered when interpreting task engagement indices as it was strongly associated with PVT failure.\u0000 \u0000 \u0000 \u0000 Embedded PVTs should be used with caution in pediatric craniopharyngioma patients who have received PRT. Future research should investigate different cut-off scores and validity indicator combinations to best differentiate noncredible performance due to task engagement versus variable arousal and/or lower intellectual functioning.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140490182","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":"A longer and/or better life for the oldest old with glioblastoma.","authors":"Katrina Roberto, James R Perry","doi":"10.1093/nop/npae007","DOIUrl":"10.1093/nop/npae007","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10940815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"App-based assessment of patient-reported outcomes in the Molecular Tumor Board in the Center for Personalized Medicine - (TRACE)","authors":"L. Dörner, L. Grosse, F. Stange, H. Hille, S. Kurz, H. Becker, Sebastian Volkmer, M. Hippler, D. Rieger, Paula Bombach, J. Rieger, Lina Weinert, Laura Svensson, Carolin Anders, Sila Cekin, F. Paulsen, Ö. Öner, K. Ruhm, Holly Sundberg Malek, Y. Möller, M. Tatagiba, M. Wallwiener, Nils Eckert, P. Escher, Nico Pfeifer, A. Forschner, A. Bauer, Daniel Zips, M. Bitzer, N. Malek, Cihan Gani, G. Tabatabai, M. Renovanz","doi":"10.1093/nop/npae002","DOIUrl":"https://doi.org/10.1093/nop/npae002","url":null,"abstract":"\u0000 \u0000 \u0000 Biomarker-based therapies are increasingly used in cancer patients outside clinical trials. Systematic assessment of patient-reported outcomes (PRO) is warranted to take patients’ perspective during biomarker-based therapies into consideration. We assessed feasibility of an electronic PRO assessment via a smartphone application.\u0000 \u0000 \u0000 \u0000 An interdisciplinary expert panel developed a smartphone application based on symptom burden and health-related quality of life (HRQoL) metrics reported in a retrospective analysis in 292 neuro-oncological patients. The app included validated assessments of health-related quality of life (HRQoL), burden of symptoms and psychological stress. Feasibility and usability were tested in a pilot study.\u0000 Semi-structured interviews with patients and health care professionals (HCP) were conducted, transcribed and analyzed according to Mayring´s qualitative content analysis. Furthermore, we assessed compliance and descriptive data of ePROs.\u0000 \u0000 \u0000 \u0000 A total of 14 patients have been enrolled, (9 female, 5 male). A total of 4 HCPs, 9 patients and one caregiver were interviewed regarding usability/feasibility. Main advantages were the possibility to complete questionnaires at home and comfortable implementation in daily life. Compliance was high, e.g., 82% of the weekly distributed NCCN Distress Thermometer questionnaires were answered on time, however, with interindividual variability We observed a median distress score of 5 (range 0-10, 197 results, n=12, weekly assessed) and a median Global health score of 58.3 according to the EORTC QLQ-C30 instrument (range 16.7-100, 77 results, n=12, monthly assessed).\u0000 \u0000 \u0000 \u0000 This pilot study proved feasibility and acceptance of the app. We will therefore expand its application during biomarker-guided therapies to enable systematic PRO assessments.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139524072","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":"Multi-modal imaging with Magnetization Transfer and Diffusion Tensor Imaging reveals evidence of myelin damage in children and youth treated for a brain tumour","authors":"Jovanka Skocic, Logan Richard, Ashley Ferkul, Elizabeth Cox, Julie Tseng, S. Laughlin, E. Bouffet, D. Mabbott","doi":"10.1093/nop/npae003","DOIUrl":"https://doi.org/10.1093/nop/npae003","url":null,"abstract":"\u0000 \u0000 \u0000 The microstructural damage underlying compromise of white matter following treatment for paediatric brain tumours is unclear. We use multi-modal imaging employing advanced diffusion (DTI) and magnetization transfer (MTI) MRI methods to examine chronic microstructural damage to white matter in children and adolescents treated for paediatric brain tumour. Notably, MTI may be more sensitive to macromolecular content, including myelin, than DTI.\u0000 \u0000 \u0000 \u0000 Fifty patients treated for brain tumours (18 treated with surgery +/- chemotherapy and 32 treated with surgery followed by cranial-spinal radiation; time from diagnosis to scan ~ 6 years) and 45 matched healthy children completed both MTI and DTI scans. Voxelwise and region of interest approaches were employed to compare white matter microstructure metrics (Magnetization Transfer Ratio (MTR); DTI - FA, RD, AD, MD) between patients and healthy controls.\u0000 \u0000 \u0000 \u0000 MTR was decreased across multiple white matter tracts in patients when compared to healthy children, p<0.001. These differences were observed for both patients treated with radiation and those treated with only surgery, p<0.001. We also found that children and adolescents treated for brain tumours exhibit decreased FA and increased RD/AD/MD compared to their healthy counterparts in several white matter regions, ps < 0.02. Finally, we observed that MTR and DTI metrics were related in multiple white matter tracts in patients, ps < .01, but not healthy control children.\u0000 \u0000 \u0000 \u0000 Our findings provide evidence that the white matter damage observed in patients years after treatment of pediatric posterior fossa tumors, likely reflects myelin disruption.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139525669","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":"Hypofractionated radiotherapy for glioblastoma: a large institutional retrospective assessment of two approaches","authors":"Thomas H Beckham, M. K. Rooney, M. F. McAleer, A. Ghia, Martin C. Tom, S. Perni, S. McGovern, D. Grosshans, Caroline Chung, Chenyang Wang, Brain De, Todd Swanson, A. Paulino, Wen Jiang, S. Ferguson, Chirag B. Patel, Jing Li, D. Yeboa","doi":"10.1093/nop/npae004","DOIUrl":"https://doi.org/10.1093/nop/npae004","url":null,"abstract":"\u0000 \u0000 \u0000 Glioblastoma (GBM) poses therapeutic challenges due to its aggressive nature, particularly for patients with poor functional status and/or advanced disease. Hypofractionated radiotherapy regimens have demonstrated comparable disease outcomes for this population while allowing treatment to be completed more quickly. Here, we report our institutional outcomes of patients treated with two hypofractionated radiotherapy regimens: 40 Gy/15fx (3w-RT) and 50 Gy/20fx (4w-RT).\u0000 \u0000 \u0000 \u0000 A single-institution retrospective analysis was conducted of 127 GBM patients who underwent 3w-RT or 4w-RT. Patient characteristics, treatment regimens, and outcomes were analyzed. Univariate and multivariable Cox regression models were used to estimate progression free survival (PFS) and overall survival (OS). The impact of chemotherapy and radiotherapy schedule was explored through subgroup analyses.\u0000 \u0000 \u0000 \u0000 Median OS for the entire cohort was 7.7 months. There were no significant differences in PFS or OS between 3w-RT and 4w-RT groups overall. Receipt and timing of temozolomide (TMZ) emerged as the variable most strongly associated with survival, with patients receiving adjuvant only or concurrent and adjuvant TMZ having significantly improved PFS and OS (p<0.001). In a subgroup analysis of patients that did not receive TMZ, patients in the 4w-RT group demonstrated a trend towards improved OS as compared to the 3w-RT group (p=0.12).\u0000 \u0000 \u0000 \u0000 This study demonstrates comparable survival outcomes between 3w-RT and 4w-RT regimens in GBM patients. Receipt and timing of TMZ was strongly associated with survival outcomes. The potential benefit of dose-escalated hypofractionation for patients not receiving chemotherapy warrants further investigation and emphasizes the importance of personalized treatment approaches.\u0000","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139614188","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":"Diagnosing Pseudoprogression in Glioblastoma: A challenging clinical issue","authors":"N. Galldiks","doi":"10.1093/nop/npad078","DOIUrl":"https://doi.org/10.1093/nop/npad078","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2023-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139006467","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":"Long-Term Neurocognitive and Psychological Outcomes in Meningioma Survivors: Individual Changes Over Time and Radiation Dosimetry","authors":"Angela Sekely, Konstantine K Zakzanis, Donald Mabbott, Derek S Tsang, Paul Kongkham, Gelareh Zadeh, Kim Edelstein","doi":"10.1093/nop/npad072","DOIUrl":"https://doi.org/10.1093/nop/npad072","url":null,"abstract":"Abstract Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors, and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influence neurocognitive and psychological outcomes. Results Most (range=41-93%) survivors demonstrated stable – albeit often below average - neurocognitive and psychological trajectories, although some also exhibited improvements (range=0-31%) or declines (range=0-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2=0.462) and cerebellum (partial R2=0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2=0.367) and trait anxiety (partial R2=0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to quality of survivorship in this growing population.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135725902","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":"Switch to generic formulation of temozolomide results in statistically significant increase in grade 3 and 4 bone marrow toxicity in glioma patients in the province of Alberta","authors":"Egiroh Omene, Omar Abdel-Rahman, Eugene Batuyong, Samir Patel, Roland Coppens, Jacob Easaw, Kelvin Young","doi":"10.1093/nop/npad065","DOIUrl":"https://doi.org/10.1093/nop/npad065","url":null,"abstract":"Abstract Background Temozolomide (TMZ) is an oral, systemic chemotherapy used chiefly for treating high grade glioma. Due to the rising costs of systemic chemotherapy, many jurisdictions have replaced brand-name with generic formulations. The aim of this study was to determine whether or not there was difference in the incidence of grade 3 or 4 bone marrow toxicity and median overall survival in patients treated with brand-name vs generic TMZ in the province of Alberta, Canada. The province suspended use of generic TMZ based on preliminary data pointing to excess toxicity. Methods This multicenter, retrospective study included data from patients with newly diagnosed high grade glioma that received treatment with TMZ in Alberta. Multivariate logistic regression analysis was performed to determine association between grade 3 or 4 toxicity to generic vs. brand-name TMZ exposure, ECOG score and age. Kaplan-Meier survival estimates and log-rank testing were used to determine differences in overall survival between the brand-name and generic TMZ cohorts, as well as the cytopenic vs non-cytopenic patients. Furthermore, a screening analysis for grade 3 or 4 bone marrow toxicity was conducted on all de novo glioma patients treated with brand-name TMZ after Alberta preemptively stopped generic TMZ. Results Grade 3 or 4 neutropenia and thrombocytopenia were observed in 15% and 19% of patients treated with generic TMZ (n=156) as compared to 3% and 5% of patients (n=100) treated with brand-name TMZ treated patients; p= 0.003 and 0.001. A trend towards increased median overall survival in GBM patients treated with generic TMZ (13.7 months) versus brand-name (15.8 months, p = 0.178.) was also observed though meeting statistical significance. Based on these results, the province stopped the use of generic TMZ and reverted to the Merck TMZ. An initial review of all new glioma patients (n= 89) treated with Merck TMZ since the province stopped generic drug demonstrated 3.4% and 10.1% grade 3 or 4 neutropenia, and respectively. Conclusions The statistically significant difference in toxicity profile has prompted the province of Alberta to replace generic TMZ for brand-name TMZ in high grade glioma patients pending more detailed analysis. Our study provides evidence supporting the importance of conducting prospective studies on long-term safety for generic chemotherapies.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136318174","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":"Impact of CTV margin reduction in glioblastoma patients treated with concurrent chemoradiation","authors":"Dario Di Perri, David Hofstede, Dianne Hartgerink, Karin Terhaag, Ruud Houben, Alida A Postma, Ann Hoeben, Monique Anten, Linda Ackermans, Inge Compter, Daniëlle B P Eekers","doi":"10.1093/nop/npad071","DOIUrl":"https://doi.org/10.1093/nop/npad071","url":null,"abstract":"Abstract Background Glioblastoma (GBM) is widely treated using large radiotherapy margins, resulting in substantial irradiation of the surrounding cerebral structures. In this context, the question arises whether these margins could be safely reduced. In 2018, clinical target volume (CTV) expansion was reduced in our institution from 20 to 15 mm around the gross target volume (GTV) (ie, the contrast-enhancing tumor/cavity). We sought to retrospectively analyze the impact of this reduction. Methods All adult patients with GBM treated between January 2015 and December 2020 with concurrent chemoradiation (60Gy/2Gy or 59.4Gy/1.8Gy) were analyzed. Patients treated using a 20 (CTV20, n = 57) or 15 mm (CTV15, n = 56) CTV margin were compared for target volumes, dose parameters to the surrounding organs, pattern of recurrence, and survival outcome. Results Mean GTV was similar in both groups (ie, CTV20: 39.7cm3; CTV15: 37.8cm3; P = .71). Mean CTV and PTV were reduced from 238.9cm3 to 176.7cm3 (P = .001) and from 292.6cm3 to 217.0cm3 (P &amp;lt; .001), for CTV20 and CTV15, respectively. As a result, average brain mean dose (Dmean) was reduced from 25.2Gy to 21.0Gy (P = .002). Significantly lower values were also observed for left hippocampus Dmean, brainstem D0.03cc, cochleas Dmean, and pituitary Dmean. Pattern of recurrence was similar, as well as patient outcome, ie, median progression-free survival was 8.0 and 7.0 months (P = .80), and median overall survival was 11.0 and 14.0 months (P = .61) for CTV20 and CTV15, respectively. Conclusions In GBM patients treated with chemoradiation, reducing the CTV margin from 20 to 15 mm appears to be safe and offers the potential for less treatment toxicity.","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136234161","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":"Time to treat the climate and nature crisis as one indivisible global health emergency","authors":"Kamran Abbasi, Parveen Ali, Virginia Barbour, Thomas Benfield, Kirsten Bibbins-Domingo, Stephen Hancocks, Richard Horton, Laurie Laybourn-Langton, Robert Mash, Peush Sahni, Wadeia Mohammad Sharief, Paul Yonga, Chris Zielinski","doi":"10.1093/nop/npad066","DOIUrl":"https://doi.org/10.1093/nop/npad066","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135217667","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}