Neuro-oncology practice最新文献

{"title":"Foreword.","authors":"Martin J B Taphoorn","doi":"10.1093/nop/npae087","DOIUrl":"10.1093/nop/npae087","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 Suppl 1","pages":"i1"},"PeriodicalIF":2.4,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703361/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952277","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":"Impact of neurotoxicity and steroid therapy on cancer progression-free survival in lymphoma patients treated with anti-CD19 CAR T cells.","authors":"Umberto Pensato, Lorenzo Muccioli, Daniela Taurino, Federica Pondrelli, Gian Maria Asioli, Chiara de Philippis, Daniele Mannina, Gianmarco Bagnato, Simona Marcheselli, Pier Luigi Zinzani, Francesca Bonifazi, Stefania Bramanti, Maria Guarino","doi":"10.1093/nop/npae128","DOIUrl":"10.1093/nop/npae128","url":null,"abstract":"<p><strong>Background: </strong>Immune effector cell-associated neurotoxicity syndrome (ICANS) is a frequent complication of chimeric antigen receptor (CAR) T-cell therapy. Most patients achieve complete symptom resolution without long-term neurological sequelae, yet the impact of ICANS and steroid therapy on oncological outcomes remains inadequately explored. We investigated the association between ICANS and steroid therapy with progression-free survival (PFS).</p><p><strong>Methods: </strong>We included large B-cell lymphoma patients treated with anti-CD19 CAR T cells. The primary outcome was 90-day PFS. The secondary outcomes included PFS, complete response, and overall survival (OS) at 30, 90, 180, and 365 days. The association between outcomes and ICANS and steroid treatment was assessed using logistic regression analyses adjusted for baseline factors.</p><p><strong>Results: </strong>Overall, 241 patients were included. The median age was 60 years (interquartile range [IQR] = 51-66), 81 (33.6%) were females, 67 (27.8%) developed ICANS, and 142 (58.9%) achieved 90-day PFS. There was no association between 90-day PFS and ICANS development (adjusted odds ratio [aOR] 1.39 [95% confidence interval {CI} = 0.75-2.61]), maximum grade (aOR 1.24 [0.97-1.59]), duration (aOR 1.00 [95% CI = 0.95-1.05] per 1-day increase), or day of onset (aOR 0.98 [95% CI = 0.86-1.11] per 1-day increase). There was no association between 90-day PFS and steroid therapy (aOR 1.25 [95% CI = 0.73-2.14]) or cumulative dose (aOR 1.00 [95% CI = 0.98-1.01] per 100-mg increase). Similar results were observed for secondary outcomes, except for an association between ICANS and OS at 30 days (aOR 0.05 [95% CI = 0.01-0.54]) and 90 days (aOR 0.35 [95% CI = 0.15-0.80]).</p><p><strong>Conclusions: </strong>Our findings suggest that ICANS and steroid therapy do not adversely impact the PFS in lymphoma patients receiving anti-CD19 CAR T cells. Yet, ICANS might be associated with reduced early OS.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 3","pages":"531-539"},"PeriodicalIF":2.4,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248924","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":"Validation of the EORTC QLQ-C30 and QLQ-BN20, including WHO performance status interrater reliability, for evaluation of patients with intracranial meningiomas.","authors":"Robert F Nilsson, Erik Ström, A Tommy Bergenheim, Rickard L Sjöberg, Peter Lindvall, Klas Holmgren","doi":"10.1093/nop/npae125","DOIUrl":"10.1093/nop/npae125","url":null,"abstract":"<p><strong>Background: </strong>The EORTC questionnaires QLQ-C30 and QLQ-BN20 are commonly used to evaluate health-related quality of life in patients with meningiomas but have not undergone a disease-specific validation. The study aimed to address this issue and to determine the interrater reliability of WHO performance status (PS) assessments in these patients.</p><p><strong>Methods: </strong>This population-based study included prospectively enrolled intracranial meningiomas treated at Umeå University Hospital between October 14, 2010, and December 31, 2021, followed up until March 30, 2023. Patients were assessed by the EORTC questionnaires before and at 3 months after surgery. WHO PS categorized as high (0-1) or low (2-5) were evaluated for interrater reliability and used together with sick-leave status to determine the questionnaires' clinical validity. Remaining psychometric properties of the questionnaires were analyzed by conventional methods.</p><p><strong>Results: </strong>Of 513 eligible surgeries, 454 (88.5%) had responded to at least 1 questionnaire. WHO PS interrater agreement was 94.4%. The EORTC questionnaires' ability to distinguish between clinically distinct groups was high. Items correlated better with their own scale than others (most <i>r</i> > 0.70). Items measuring various aspects of the same construct showed good internal consistency (nearly all α > 0.70). Questionnaire responsiveness to symptom changes over time was acceptable. Several scales displayed floor and ceiling effects.</p><p><strong>Conclusions: </strong>The EORTC QLQ-C30 and QLQ-BN20 are overall valid instruments to evaluate patients with intracranial meningiomas but require awareness of certain limitations when specific functions and symptoms are addressed. WHO PS assessments can be applied to meningioma patients with high reproducibility between observers.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 3","pages":"467-477"},"PeriodicalIF":2.4,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137214/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248931","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":"Challenges in implementing 2021 WHO CNS tumor classification in a resource-limited setting.","authors":"Ahmed Gilani, Ahmed Altaf, Muhammad Shakir, Khurram Minhas, Syed Ather Enam","doi":"10.1093/nop/npae124","DOIUrl":"10.1093/nop/npae124","url":null,"abstract":"<p><strong>Background: </strong>The 2021 World Health Organization classification of Central Nervous System tumors (CNS5) includes molecular biomarkers in the necessary diagnostic criteria for many tumors. Identifying these markers often requires next-generation sequencing (NGS) and/or DNA methylation profiling, presenting challenges in diagnosing these tumors in low or middle-income countries (LMICs) and other resource-limited settings. Here, we will illustrate the real-world scope of the problem by presenting a neuropathologist's experience with implementing the CNS5 criteria in an academic medical center in Karachi, Pakistan.</p><p><strong>Methods: </strong>CNS tumor biopsies received by a single neuropathologist (AG) in Karachi during a 6-month period (October 2022 to March 2023) were included in the study. Routine histologic processing, H&E and immunohistochemistry were performed.</p><p><strong>Results: </strong>A total of 443 tumor cases were received, 87 of those (19.64% of total, 36.86% of glial, embryonal, and glioneuronal tumors) could not be assigned a CNS5 diagnosis. Top reasons for failure to reach a CNS5 diagnosis were low-grade gliomas or infiltrative glioma in pediatric/ adolescent young adults not further classifiable on histology, IDH-mutant tumors requiring 1p/19q testing to rule out oligodendroglioma, undifferentiated tumors with unclear lineage and adult grade 2 or 3 IDH-wildtype astrocytomas suspicious for glioblastoma, IDH-wildtype. Send-out DNA methylation testing in 22 cases resolved the diagnostic questions in all except one case.</p><p><strong>Conclusions: </strong>Without access to molecular testing, up to a third of all glial, embryonal, and glioneuronal tumors could not be assigned a CNS5 diagnosis, leading to diagnostic ambiguity and therapeutic confusion. Until affordable molecular assays are available, CNS5 diagnostic criteria have limited applicability in resource-limited settings.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 3","pages":"401-412"},"PeriodicalIF":2.4,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248918","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":"When survival is not enough-Quality of life as a decision endpoint for patients.","authors":"Tobias Walbert","doi":"10.1093/nop/npae123","DOIUrl":"10.1093/nop/npae123","url":null,"abstract":"","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 2","pages":"177-178"},"PeriodicalIF":2.4,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664117","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":"Exploring spirituality in everyday neuro-oncology practice - nurses' and physicians' spiritual care toolbox.","authors":"Daniela Völz, Reinhard Grabenweger, Megan C Best, Peter Hau, Kate F Jones, Ralf Linker, Piret Paal, Elisabeth Bumes","doi":"10.1093/nop/npae120","DOIUrl":"10.1093/nop/npae120","url":null,"abstract":"<p><strong>Background: </strong>Patients with primary malignant brain tumors suffer from symptoms of both neoplastic and neurological disease, resulting in a limited prognosis and high symptomatic burden, including aphasia and mental deterioration. Thus, special spiritual care needs arise for these patients, which may be challenging. We explore spiritual tools that neurological and neurosurgical healthcare workers use when confronted with spiritual distress of their patients.</p><p><strong>Methods: </strong>A vignette-based, cross-sectional, multicenter online survey was conducted to collect qualitative data. In total, 143 nurses and physicians working on 41 neurological and neurosurgical units in Bavarian hospitals participated and their self-reported behavior was analyzed using reflexive thematic analysis.</p><p><strong>Results: </strong>A total of 5 themes regarding the spiritual tools implemented by nurses and physicians in neuro-oncology were generated: (1) from physical to spiritual care, (2) feeling togetherness between the words, (3) listening to each other: one word at a time, (4) away from the dooming \"why\"-escaping the thought spirals, and (5) taking life back into one's own hands. These themes represent a spectrum including nonverbal tools like building a physical connection, allowing for emotional connection, and active listening. The verbal approach focuses on conversation strategies to relieve patients of guilt, facilitate spiritual discussions at the end-of-life, and communicate the diagnosis, prognosis, and treatment to strengthen self-efficacy.</p><p><strong>Conclusions: </strong>Verbal, nonverbal, and holistic approaches to spiritual care in neuro-oncology were identified and can be used to develop a spiritual care toolbox for nurses and physicians in neuro-oncology, given the unique needs of patients with primary malignant brain tumors.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 3","pages":"520-530"},"PeriodicalIF":2.4,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137210/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248921","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":"Brain tumors and fitness to drive: A review and multi-disciplinary approach.","authors":"Mark Willy L Mondia, Edward K Avila, Jeffrey S Wefel, Rachel F Hehn, Alex R Bowers, Brian S Cox, Daniel J Cox, David Schiff","doi":"10.1093/nop/npae119","DOIUrl":"10.1093/nop/npae119","url":null,"abstract":"<p><strong>Background: </strong>Patients with brain tumors and their families often inquire about driving safety. Currently, there is no consensus regarding fitness-to-drive (FTD) for patients with central nervous system tumors. Our paper aims to provide a multi-disciplinary perspective to address this issue.</p><p><strong>Methods: </strong>We performed a literature review for brain tumors and driving. Additionally, we solicited input from experts in tumor-related epilepsy, ophthalmology, neuropsychology, occupational therapy, and driving simulators.</p><p><strong>Results: </strong>We qualitatively analyzed 14 published articles. FTD determination varies internationally and regionally in most developed nations. Significant motor weakness and major cognitive impairment clearly prevent patients from driving. There are specialized tests for motor, vision, and cognitive correlates important to driving, but driving simulators and on-the-road tests provide the most comprehensive assessments. FTD for patients with seizures is dependent on region-specific laws that take into account the duration of seizure-free intervals and history of motor vehicular crashes.</p><p><strong>Conclusions: </strong>We recommend a symptom-based approach that highlights the importance of interdisciplinary assessment to ensure that brain tumor patients have the minimum operational skills required to drive. It is crucial to document seizure control, visual acuity impairment, and visual field deficits because these factors usually become the default basis in practice to determine if driving privileges can be maintained. Appropriately, timed assessment of cognitive function may provide pertinent information to determine FTD. Formalized testing with practical driving evaluation may eventually be necessary in patients who have hemiparesis, hemiplegia, hemineglect, homonymous visual field loss, or any form of cognitive dysfunction to determine FTD.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 2","pages":"183-196"},"PeriodicalIF":2.4,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664076","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":"Role of the tumor board when prescribing mutant isocitrate dehydrogenase inhibitors to patients with isocitrate dehydrogenase-mutant glioma.","authors":"Patrick Roth, David Capper, Evan Calabrese, Lia M Halasz, Asgeir S Jakola","doi":"10.1093/nop/npae100","DOIUrl":"10.1093/nop/npae100","url":null,"abstract":"<p><p>Isocitrate dehydrogenase (IDH)-mutant gliomas, comprising both astrocytomas and oligodendrogliomas, represent a distinct group of tumors that pose an interdisciplinary challenge. Addressing the needs of affected patients requires close collaboration among various disciplines, including neuropathology, neuroradiology, neurosurgery, radiation oncology, neurology, medical oncology, and other relevant specialties when necessary. Interdisciplinary tumor boards are central in determining the ideal diagnostic and therapeutic strategies for these patients. The key tasks of a tumor board include the evaluation of imaging findings, selecting the appropriate surgical approach, discussing additional treatment options, and identification/determination of tumor recurrence and progression. In addition to established treatments such as radiotherapy and alkylating chemotherapy, patients with an isocitrate dehydrogenase (IDH)-mutant glioma for whom additional treatment is indicated may now also have the option of receiving treatment with an mutant isocitrate dehydrogenase inhibitor such as vorasidenib or ivosidenib. In this regard, the collaborative nature of tumor boards becomes even more crucial for evaluating comprehensively the needs of these patients. Through interdisciplinary discussions, tumor boards aim to develop personalized treatment strategies that maximize therapeutic efficacy while minimizing potential side effects and preserving patients' quality of life.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 Suppl 1","pages":"i29-i37"},"PeriodicalIF":2.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952282","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":"How do I prescribe and manage mIDH inhibitors in patients with IDH-mutant glioma?","authors":"Megan E H Still, Rachel S F Moor, Ashley P Ghiaseddin, Annette Leibetseder, Andreas F Hottinger, Anna Berghoff, Denise Leung","doi":"10.1093/nop/npae112","DOIUrl":"10.1093/nop/npae112","url":null,"abstract":"<p><p>Recent interest has been in using mIDH inhibitors in patients with IDH-mutant gliomas. This review paper summarizes the indications, side effects, recommended dosing, and management for patients on ivosidenib and vorasidenib.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 Suppl 1","pages":"i19-i25"},"PeriodicalIF":2.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952278","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":"Risk factors for type I leptomeningeal metastasis derived from non-small cell lung cancer and the impact of treatment for brain metastases on its development.","authors":"Toshihiko Iuchi, Masato Shingyoji, Satoko Mizuno, Hironori Ashinuma, Yuzo Hasegawa, Taiki Setoguchi, Junji Hosono, Tsukasa Sakaida","doi":"10.1093/nop/npae118","DOIUrl":"10.1093/nop/npae118","url":null,"abstract":"<p><strong>Background: </strong>Preventing Type I leptomeningeal metastasis (LM) is critical when treating brain metastases (BMs). The aim of this study was to extract risk factors for Type I LM and to clarify the optimal treatment for BMs from the perspective of Type I LM prevention.</p><p><strong>Methods: </strong>The clinical course of consecutive cases of BMs derived from non-small cell lung cancer (NSCLC) treated at our hospital was retrospectively evaluated. The relationship between clinicopathological factors, including molecular background, and Type I LM development was verified. In addition, the difference in the time to Type I LM because of treatment for BMs was evaluated to clarify the effectiveness of each treatment in preventing Type I LM.</p><p><strong>Results: </strong>Of 784 patients with BMs, 44 exhibited Type I LM at the onset of BMs. Poor performance status (<i>P</i> < .0001) and mutated epidermal growth factor receptor (<i>EGFR</i>) gene (<i>P</i> = .004) were significant risk factors for Type I LM. Among the 740 patients without LMC at diagnosis, 85 developed Type I LM. Younger age (<i>P</i> = .011) and mutated <i>EGFR</i> (<i>P</i> < .0001) were risk factors for developing LMC after BMs. Osimertinib reduced the incidence of Type I LM (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.24-0.97) in <i>EGFR</i>-mutated cases. Immune checkpoint inhibitors (ICIs) showed a tendency to prolong the time to Type I LM (HR: 0.15; 95% CI: 0.02-1.11) in <i>EGFR</i>-wild-type cases.</p><p><strong>Conclusions: </strong>Patients with <i>EGFR</i>-mutated NSCLC are prone to developing Type I LM. Osimertinib for <i>EGFR</i>-mutated cases and ICIs are expected to prevent Type I LM after the diagnosis of BMs.</p>","PeriodicalId":19234,"journal":{"name":"Neuro-oncology practice","volume":"12 3","pages":"448-457"},"PeriodicalIF":2.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137222/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144248927","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}