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Lawson McLean AC, Löschner D, Farschtschi S, Dengler NF, Rosahl SK. Clinical severity grading of NF2-related schwannomatosis. Orphanet J Rare Dis 2025; 20:4. [PMID: 39762911 PMCID: PMC11706147 DOI: 10.1186/s13023-024-03512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/17/2024] [Indexed: 01/11/2025] Open
Abstract
BACKGROUND NF2-related schwannomatosis (NF2) is associated with various tumors of the central and peripheral nervous system. There is a wide range of disabilities these patients may suffer from and there is no validated clinical classification for disease severity. We propose a clinical classification consisting of three severity grades to assist in patient management. METHODS Patient records from 168 patients were screened for most common diagnoses with severe impact on everyday tasks, social interactions and life expectancy. Eight main categories were identified. One point was assigned to each category. Three severity grades were differentiated as follows: grade 1 (mild NF2): 0 points; grade 2 (moderate NF2): < 3 points; grade 3 (severe NF2): ≥ 3 points. This grading system was then evaluated with respect to inter-rater reliability and clinical significance. RESULTS The patients were grouped according to our new clinical grading system into grade 1 in 48% (n = 80), grade 2 in 43% (n = 72), and grade 3 in 10% of patients (n = 16). There was substantial inter-rater reliability between 3 raters with different levels of clinical experience (Fleiss' kappa = 0.62). The severity grades correlated significantly with hospitalization, number of operations and dependency on implants (such as cochlear implant, auditory brain-stem implants or ventriculoperitoneal shunts). CONCLUSIONS Clinical disease severity of NF2 patients is reflected in a simplified and rater-independent score with three grades. The score facilitates communication for medical personnel of varying experience and backgrounds, and adds a clinical tool to decision-making and research.
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Affiliation(s)
- Anna C Lawson McLean
- Department of Neurosurgery, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
- Department of Neurosurgery, Helios Klinikum Erfurt, Erfurt, Germany.
| | - Denise Löschner
- Department of Neurosurgery, Helios Klinikum Erfurt, Erfurt, Germany
| | - Said Farschtschi
- Department of Neurology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Nora F Dengler
- Department of Neurosurgery, Charité - Universitätsmedizin, Berlin, Germany
| | - Steffen K Rosahl
- Department of Neurosurgery, Helios Klinikum Erfurt, Erfurt, Germany
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2
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Wang JZ, Landry AP, Raleigh DR, Sahm F, Walsh KM, Goldbrunner R, Yefet LS, Tonn JC, Gui C, Ostrom QT, Barnholtz-Sloan J, Perry A, Ellenbogen Y, Hanemann CO, Jungwirth G, Jenkinson MD, Tabatabai G, Mathiesen TI, McDermott MW, Tatagiba M, la Fougère C, Maas SLN, Galldiks N, Albert NL, Brastianos PK, Ehret F, Minniti G, Lamszus K, Ricklefs FL, Schittenhelm J, Drummond KJ, Dunn IF, Pathmanaban ON, Cohen-Gadol AA, Sulman EP, Tabouret E, Le Rhun E, Mawrin C, Moliterno J, Weller M, Bi W(L, Gao A, Yip S, Niyazi M, The International Consortium on Meningiomas (ICOM), Aldape K, Wen PY, Short S, Preusser M, Nassiri F, Zadeh G. Meningioma: International Consortium on Meningiomas consensus review on scientific advances and treatment paradigms for clinicians, researchers, and patients. Neuro Oncol 2024; 26:1742-1780. [PMID: 38695575 PMCID: PMC11449035 DOI: 10.1093/neuonc/noae082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2024] Open
Abstract
Meningiomas are the most common primary intracranial tumors in adults and are increasing in incidence due to the aging population and increased access to neuroimaging. While most exhibit nonmalignant behavior, a subset of meningiomas are biologically aggressive and are associated with treatment resistance, resulting in significant neurologic morbidity and even mortality. In recent years, meaningful advances in our understanding of the biology of these tumors have led to the incorporation of molecular biomarkers into their grading and prognostication. However, unlike other central nervous system (CNS) tumors, a unified molecular taxonomy for meningiomas has not yet been established and remains an overarching goal of the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy-Not Official World Health Organization (cIMPACT-NOW) working group. Additionally, clinical equipoise still remains on how specific meningioma cases and patient populations should be optimally managed. To address these existing gaps, members of the International Consortium on Meningiomas including field-leading experts, have prepared this comprehensive consensus narrative review directed toward clinicians, researchers, and patients. Included in this manuscript are detailed overviews of proposed molecular classifications, novel biomarkers, contemporary treatment strategies, trials on systemic therapies, health-related quality-of-life studies, and management strategies for unique meningioma patient populations. In each section, we discuss the current state of knowledge as well as ongoing clinical and research challenges to road map future directions for further investigation.
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Affiliation(s)
- Justin Z Wang
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Alexander P Landry
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - David R Raleigh
- Department of Radiation Oncology, Neurological Surgery, and Pathology, University of California San Francisco, San Francisco, California, USA
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kyle M Walsh
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Leeor S Yefet
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jörg C Tonn
- Department of Neurosurgery, University Hospital Munich LMU, Munich, Germany
| | - Chloe Gui
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Quinn T Ostrom
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
- Department of Neurosurgery, Duke University, Durham, North Carolina, USA
| | - Jill Barnholtz-Sloan
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute, Bethesda, Maryland, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute, Bethesda, Maryland, USA
- Central Brain Tumor Registry of the United States, Hinsdale, Illinois, USA
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Yosef Ellenbogen
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - C Oliver Hanemann
- Peninsula Schools of Medicine, University of Plymouth University, Plymouth, UK
| | - Gerhard Jungwirth
- Division of Experimental Neurosurgery, Department of Neurosurgery, Heidelberg University, Heidelberg, Germany
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, UK
| | - Ghazaleh Tabatabai
- Department of Neurology and Interdisciplinary Neuro-Oncology, University Hospital Tübingen, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies,” Eberhard Karls University Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Tiit I Mathiesen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Michael W McDermott
- Division of Neuroscience, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Miami Neuroscience Institute, Baptist Health of South Florida, Miami, Florida, USA
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Christian la Fougère
- Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tübingen, Germany
- Cluster of Excellence (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies,” Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sybren L N Maas
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (IMN-3), Research Center Juelich, Juelich, Germany
| | - Nathalie L Albert
- Department of Nuclear Medicine, Ludwig Maximilians-University of Munich, Munich, Germany
| | - Priscilla K Brastianos
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Giuseppe Minniti
- Department of Radiological Sciences, Oncology and Anatomical Pathology, Sapienza University of Rome, Rome, Italy
| | - Katrin Lamszus
- Laboratory for Brain Tumor Biology, University Hospital Eppendorf, Hamburg, Germany
| | - Franz L Ricklefs
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | - Katharine J Drummond
- Department of Neurosurgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ian F Dunn
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Omar N Pathmanaban
- Division of Neuroscience and Experimental Psychology, Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK
| | - Aaron A Cohen-Gadol
- Department of Neurological Surgery, Indiana University, Indianapolis, Indiana, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Grossman School of Medicine, New York, New York, USA
| | - Emeline Tabouret
- CNRS, INP, Inst Neurophysiopathol, Aix-Marseille University, Marseille, France
| | - Emelie Le Rhun
- Department of Neurology & Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Christian Mawrin
- Department of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jennifer Moliterno
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Weller
- Department of Neurology and Brain Tumor Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Wenya (Linda) Bi
- Department of Neurosurgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Gao
- Department of Laboratory Medicine and Pathobiology, University Health Network, Toronto, Ontario, Canada
| | - Stephen Yip
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiation Oncology, University Hospital, Munich, Germany
- German Cancer Consortium (DKTK), Munich, Germany
| | - Maximilian Niyazi
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- Center for Neuro-Oncology, Comprehensive Cancer Center Tübingen-Stuttgart, University Hospital Tübingen, Tübingen, Germany
| | | | - Kenneth Aldape
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
| | - Patrick Y Wen
- Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan Short
- Leeds Institute of Medical Research, St James’s University Hospital, Leeds, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Farshad Nassiri
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- MacFeeters Hamilton Neuro-Oncology Program, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario, Canada
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3
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Plotkin SR, Yohay KH, Nghiemphu PL, Dinh CT, Babovic-Vuksanovic D, Merker VL, Bakker A, Fell G, Trippa L, Blakeley JO. Brigatinib in NF2-Related Schwannomatosis with Progressive Tumors. N Engl J Med 2024; 390:2284-2294. [PMID: 38904277 DOI: 10.1056/nejmoa2400985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
BACKGROUND NF2-related schwannomatosis (NF2-SWN, formerly called neurofibromatosis type 2) is a tumor predisposition syndrome that is manifested by multiple vestibular schwannomas, nonvestibular schwannomas, meningiomas, and ependymomas. The condition is relentlessly progressive with no approved therapies. On the basis of preclinical activity of brigatinib (an inhibitor of multiple tyrosine kinases) in NF2-driven nonvestibular schwannoma and meningioma, data were needed on the use of brigatinib in patients with multiple types of progressive NF2-SWN tumors. METHODS In this phase 2 platform trial with a basket design, patients who were 12 years of age or older with NF2-SWN and progressive tumors were treated with oral brigatinib at a dose of 180 mg daily. A central review committee evaluated one target tumor and up to five nontarget tumors in each patient. The primary outcome was radiographic response in target tumors. Key secondary outcomes were safety, response rate in all tumors, hearing response, and patient-reported outcomes. RESULTS A total of 40 patients (median age, 26 years) with progressive target tumors (10 vestibular schwannomas, 8 nonvestibular schwannomas, 20 meningiomas, and 2 ependymomas) received treatment with brigatinib. After a median follow-up of 10.4 months, the percentage of tumors with a radiographic response was 10% (95% confidence interval [CI], 3 to 24) for target tumors and 23% (95% CI, 16 to 30) for all tumors; meningiomas and nonvestibular schwannomas had the greatest benefit. Annualized growth rates decreased for all tumor types during treatment. Hearing improvement occurred in 35% (95% CI, 20 to 53) of eligible ears. Exploratory analyses suggested a decrease in self-reported pain severity during treatment (-0.013 units per month; 95% CI, -0.002 to -0.029) on a scale from 0 (no pain) to 3 (severe pain). No grade 4 or 5 treatment-related adverse events were reported. CONCLUSIONS Brigatinib treatment resulted in radiographic responses in multiple tumor types and clinical benefit in a heavily pretreated cohort of patients with NF2-SWN. (Funded by the Children's Tumor Foundation and others; INTUITT-NF2 ClinicalTrials.gov number, NCT04374305.).
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Affiliation(s)
- Scott R Plotkin
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Kaleb H Yohay
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Phioanh L Nghiemphu
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Christine T Dinh
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Dusica Babovic-Vuksanovic
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Vanessa L Merker
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Annette Bakker
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Geoffrey Fell
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Lorenzo Trippa
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
| | - Jaishri O Blakeley
- From Massachusetts General Hospital and Harvard Medical School (S.R.P., V.L.M.) and the Dana-Farber Cancer Institute (G.F., L.T.) - all in Boston; the NYU Grossman School of Medicine (K.H.Y.) and the Children's Tumor Foundation (A.B.) - both in New York; the University of California, Los Angeles, Los Angeles (P.L.N.); the University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami (C.T.D.); the Mayo Clinic, Rochester, MN (D.B.-V.); and Johns Hopkins University, Baltimore (J.O.B.)
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Ruiz-García C, Lassaletta L, López-Larrubia P, Varela-Nieto I, Murillo-Cuesta S. Tumors of the nervous system and hearing loss: Beyond vestibular schwannomas. Hear Res 2024; 447:109012. [PMID: 38703433 DOI: 10.1016/j.heares.2024.109012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024]
Abstract
Hearing loss is a common side effect of many tumor treatments. However, hearing loss can also occur as a direct result of certain tumors of the nervous system, the most common of which are the vestibular schwannomas (VS). These tumors arise from Schwann cells of the vestibulocochlear nerve and their main cause is the loss of function of NF2, with 95 % of cases being sporadic and 5 % being part of the rare neurofibromatosis type 2 (NF2)-related Schwannomatosis. Genetic variations in NF2 do not fully explain the clinical heterogeneity of VS, and interactions between Schwann cells and their microenvironment appear to be critical for tumor development. Preclinical in vitro and in vivo models of VS are needed to develop prognostic biomarkers and targeted therapies. In addition to VS, other tumors can affect hearing. Meningiomas and other masses in the cerebellopontine angle can compress the vestibulocochlear nerve due to their anatomic proximity. Gliomas can disrupt several neurological functions, including hearing; in fact, glioblastoma multiforme, the most aggressive subtype, may exhibit early symptoms of auditory alterations. Besides, treatments for high-grade tumors, including chemotherapy or radiotherapy, as well as incomplete resections, can induce long-term auditory dysfunction. Because hearing loss can have an irreversible and dramatic impact on quality of life, it should be considered in the clinical management plan of patients with tumors, and monitored throughout the course of the disease.
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Affiliation(s)
- Carmen Ruiz-García
- Department of Otorhinolaryngology, La Paz University Hospital. Paseo La Castellana 261, Madrid 28046, Spain; Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; PhD Program in Medicine and Surgery, Autonomous University of Madrid, Madrid, Spain
| | - Luis Lassaletta
- Department of Otorhinolaryngology, La Paz University Hospital. Paseo La Castellana 261, Madrid 28046, Spain; Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain
| | - Pilar López-Larrubia
- Biomedical Magnetic Resonance, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain
| | - Isabel Varela-Nieto
- Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain.
| | - Silvia Murillo-Cuesta
- Research in Otoneurosurgery. Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Universidad Autónoma de Madrid), Paseo La Castellana 261, Madrid 28046, Spain; Neuropathology of Hearing and Myelinopathies, Instituto de Investigaciones Biomédicas Sols-Morreale, CSIC-UAM. Arturo Duperier 4, Madrid 28029, Spain; Biomedical Research Networking Centre On Rare Diseases (CIBERER), Institute of Health Carlos III, Monforte de Lemos 9-11, Madrid 28029, Spain.
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5
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Lu S, Yin Z, Chen J, Wu L, Sun Y, Gao X, Huang P, Jordan JT, Plotkin SR, Xu L. Integrating Ataxia Evaluation into Tumor-Induced Hearing Loss Model to Comprehensively Study NF2-Related Schwannomatosis. Cancers (Basel) 2024; 16:1961. [PMID: 38893082 PMCID: PMC11171041 DOI: 10.3390/cancers16111961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
NF2-related Schwannomatosis (NF2-SWN) is a disease that needs new solutions. The hallmark of NF2-SWN, a dominantly inherited neoplasia syndrome, is bilateral vestibular schwannomas (VSs), which progressively enlarge, leading to sensorineural hearing loss, tinnitus, facial weakness, and pain that translates to social impairment and clinical depression. Standard treatments for growing VSs include surgery and radiation therapy (RT); however, both carry the risk of further nerve damage that can result in deafness and facial palsy. The resultant suffering and debility, in combination with the paucity of therapeutic options, make the effective treatment of NF2-SWN a major unmet medical need. A better understanding of these mechanisms is essential to developing novel therapeutic targets to control tumor growth and improve patients' quality of life. Previously, we developed the first orthotopic cerebellopontine angle mouse model of VSs, which faithfully mimics tumor-induced hearing loss. In this model, we observed that mice exhibit symptoms of ataxia and vestibular dysfunction. Therefore, we further developed a panel of five tests suitable for the mouse VS model and investigated how tumor growth and treatment affect gait, coordination, and motor function. Using this panel of ataxia tests, we demonstrated that both ataxia and motor function deteriorated concomitantly with tumor progression. We further demonstrated that (i) treatment with anti-VEGF resulted in tumor size reduction, mitigated ataxia, and improved rotarod performance; (ii) treatment with crizotinib stabilized tumor growth and led to improvements in both ataxia and rotarod performance; and (iii) treatment with losartan did not impact tumor growth nor ameliorate ataxia or motor function. Our studies demonstrated that these methods, paired with hearing tests, enable a comprehensive evaluation of tumor-induced neurological deficits and facilitate the assessment of the effectiveness of novel therapeutics to improve NF2 treatments.
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Affiliation(s)
- Simeng Lu
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Zhenzhen Yin
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Jie Chen
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Limeng Wu
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100073, China
| | - Yao Sun
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Xing Gao
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Peigen Huang
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Justin T. Jordan
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Scott R. Plotkin
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lei Xu
- Edwin L. Steele Laboratories, Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Nghiemphu PL, Vitte J, Dombi E, Nguyen T, Wagle N, Ishiyama A, Sepahdari AR, Cachia D, Widemann BC, Brackmann DE, Doherty JK, Kalamarides M, Giovannini M. Imaging as an early biomarker to predict sensitivity to everolimus for progressive NF2-related vestibular schwannoma. J Neurooncol 2024; 167:339-348. [PMID: 38372904 PMCID: PMC11023969 DOI: 10.1007/s11060-024-04596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE NF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS) often causing hearing and neurologic deficits, with currently no FDA-approved drug treatment. Pre-clinical studies highlighted the potential of mTORC1 inhibition in delaying schwannoma progression. We conducted a prospective open-label, phase II study of everolimus for progressive VS in NF2 patients and investigated imaging as a potential biomarker predicting effects on growth trajectory. METHODS The trial enrolled 12 NF2 patients with progressive VS. Participants received oral everolimus daily for 52 weeks. Brain imaging was obtained quarterly. As primary endpoint, radiographic response (RR) was defined as ≥ 20% decrease in target VS volume. Secondary endpoints included other tumors RR, hearing outcomes, drug safety and quality of life (QOL). RESULTS Eight participants completed the trial and four discontinued the drug early due to significant volumetric VS progression. After 52 weeks of treatment, the median annual VS growth rate decreased from 77.2% at baseline to 29.4%. There was no VS RR and 3 of 8 (37.5%) participants had stable disease. Decreased or unchanged VS volume after 3 months of treatment was predictive of stabilization at 12 months. Seven of eight participants had stable hearing during treatment except one with a decline in word recognition score. Ten of twelve participants reported only minimal changes to their QOL scores. CONCLUSIONS Volumetric imaging at 3 months can serve as an early biomarker to predict long-term sensitivity to everolimus treatment. Everolimus may represent a safe treatment option to decrease the growth of NF2-related VS in patients who have stable hearing and neurological condition. TRN: NCT01345136 (April 29, 2011).
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Affiliation(s)
- Phioanh Leia Nghiemphu
- Department of Neurology, UCLA Neuro‑Oncology Program, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, Los Angeles, CA, USA
| | - Jeremie Vitte
- Department of Head and Neck Surgery, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, 675 Charles E Young Dr. S, MRL 2240, Los Angeles, CA, 90095-7286, USA
| | - Eva Dombi
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Thien Nguyen
- Department of Neurology, UCLA Neuro‑Oncology Program, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Division of Pediatric Hematology, Oncology, Stem Cell Transplant and Regenerative Medicine, Stanford University, Palo Alto, CA, USA
| | - Naveed Wagle
- Department of Medicine, Division of Medical Oncology, Norris Cancer Center, University of Southern California, Los Angeles, CA, USA
- Department of Translational Neurosciences, Saint John's Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, USA
| | - Akira Ishiyama
- Department of Head and Neck Surgery, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, 675 Charles E Young Dr. S, MRL 2240, Los Angeles, CA, 90095-7286, USA
| | - Ali R Sepahdari
- Department of Radiology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Diagnostic Neuroradiology, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - David Cachia
- Department of Neurosurgery, Division of Neuro-oncology, Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Division of Hematology/Oncology, University of Massachusetts, Worcester, MA, USA
| | | | - Derald E Brackmann
- Department of Otolaryngology and Neurotology, House Clinic and Research Institute, Los Angeles, CA, USA
| | - Joni K Doherty
- Center for Neural Tumor Research, House Research Institute, Los Angeles, CA, USA
- Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, CA, USA
| | - Michel Kalamarides
- Department of Neurosurgery, Hôpital Pitié-Salpêtrière, APHP, Sorbonne Université, Paris, France
| | - Marco Giovannini
- Department of Head and Neck Surgery, David Geffen School of Medicine and Jonsson Comprehensive Cancer Center (JCCC), University of California, Los Angeles, 675 Charles E Young Dr. S, MRL 2240, Los Angeles, CA, 90095-7286, USA.
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7
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Wolters PL, Ghriwati NA, Baker M, Martin S, Berg D, Erickson G, Franklin B, Merker VL, Oberlander B, Reeve S, Rohl C, Rosser T, Vranceanu AM. Perspectives of adults with neurofibromatosis regarding the design of psychosocial trials: Results from an anonymous online survey. Clin Trials 2024; 21:73-84. [PMID: 37962219 PMCID: PMC10922214 DOI: 10.1177/17407745231209224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND/AIMS Individuals with neurofibromatosis, including neurofibromatosis 1 (NF1), neurofibromatosis 2 (NF2)-related schwannomatosis (SWN), and other forms of SWN, often experience disease manifestations and mental health difficulties for which psychosocial interventions may help. An anonymous online survey of adults with neurofibromatosis assessed their physical, social, and emotional well-being and preferences about psychosocial interventions to inform clinical trial design. METHODS Neurofibromatosis clinical researchers and patient representatives from the Response Evaluation in Neurofibromatosis and Schwannomatosis International Collaboration developed the survey. Eligibility criteria included age ≥ 18 years, self-reported diagnosis of NF1, NF2, or SWN, and ability to read and understand English. The online survey was distributed internationally by the Neurofibromatosis Registry and other neurofibromatosis foundations from June to August 2020. RESULTS Surveys were completed by 630 adults (18-81 years of age; M = 45.5) with NF1 (78%), NF2 (14%), and SWN (8%) who were mostly White, not Hispanic/Latino, female, and from the United States. The majority (91%) reported that their neurofibromatosis symptoms had at least some impact on daily life. In the total sample, 51% endorsed a mental health diagnosis, and 27% without a diagnosis believed they had an undiagnosed mental health condition. Participants indicated that neurofibromatosis affected their emotional (44%), physical (38%), and social (35%) functioning to a high degree. Few reported ever having participated in a drug (6%) or psychosocial (7%) clinical trial, yet 68% reported they "probably" or "definitely" would want to participate in a psychosocial trial if it targeted a relevant concern. Top treatment targets were anxiety, healthier lifestyle, and daily stress. Top barriers to participating in psychosocial trials were distance to clinic, costs, and time commitment. Respondents preferred interventions delivered by clinicians via individual sessions or a combination of group and individual sessions, with limited in-person and mostly remote participation. There were no significant group differences by neurofibromatosis type in willingness to participate in psychosocial trials (p = 0.27). Regarding interest in intervention targets, adults with SWN were more likely to prefer psychosocial trials for pain support compared to those with NF1 (p < 0.001) and NF2 (p < 0.001). CONCLUSION This study conducted the largest survey assessing physical symptoms, mental health needs, and preferences for psychosocial trials in adults with neurofibromatosis. Results indicate a high prevalence of disease manifestations, psychosocial difficulties, and untreated mental health problems in adults with neurofibromatosis and a high degree of willingness to participate in psychosocial clinical trials. Patient preferences should be considered when designing and implementing psychosocial interventions to develop the most feasible and meaningful studies.
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Affiliation(s)
- Pamela L Wolters
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Nour Al Ghriwati
- Clinical Research Directorate (CRD), Frederick National Laboratory for Cancer Research, Frederick, MD, USA
| | - Melissa Baker
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Staci Martin
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Dale Berg
- REiNS International Collaboration Patient Representative, Children's Tumor Foundation Volunteer Leadership Program, Minneapolis, MN, USA
| | - Gregg Erickson
- REiNS International Collaboration Patient Representative, NF Network, Wheaton, IL, USA
| | - Barbara Franklin
- REiNS International Collaboration Patient Representative, Morristown, NJ, USA
| | - Vanessa L Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - Beverly Oberlander
- REiNS International Collaboration Patient Representative, NF Network, Wheaton, IL, USA
| | - Stephanie Reeve
- REiNS International Collaboration Patient Representative, Fishers, IN, USA
| | - Claas Rohl
- REiNS International Collaboration Patient Representative, NF Kinder, NF Patients United, Vienna, Austria
| | - Tena Rosser
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
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8
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Madhani AS, King S, Zhu J, Karmali F, Welling DB, Cai W, Jordan JT, Lewis RF. Vestibular dysfunction in neurofibromatosis type 2-related schwannomatosis. Brain Commun 2023; 5:fcad089. [PMID: 37025569 PMCID: PMC10072238 DOI: 10.1093/braincomms/fcad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 12/09/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
Neurofibromatosis type 2-related schwannomatosis is a genetic disorder characterized by neurologic tumours, most typically vestibular schwannomas that originate on the vestibulo-cochlear nerve(s). Although vestibular symptoms can be disabling, vestibular function has never been carefully analysed in neurofibromatosis type 2-related schwannomatosis. Furthermore, chemotherapy (e.g. bevacizumab) can reduce tumour volume and improve hearing in neurofibromatosis type 2-related schwannomatosis, but nothing is known about its vestibular effects. In this report, we studied the three primary vestibular-mediated behaviours (eye movements, motion perception and balance), clinical vestibular disability (dizziness and ataxia), and imaging and hearing in eight untreated patients with neurofibromatosis type 2-related schwannomatosis and compared their results with normal subjects and patients with sporadic, unilateral vestibular schwannoma tumours. We also examined how bevacizumab affected two patients with neurofibromatosis type 2-related schwannomatosis. Vestibular schwannomas in neurofibromatosis type 2-related schwannomatosis degraded vestibular precision (inverse of variability, reflecting a reduced central signal-to-noise ratio) but not vestibular accuracy (amplitude relative to ideal amplitude, reflecting the central signal magnitude) and caused clinical disability. Bevacizumab improved vestibular precision and clinical disability in both patients with neurofibromatosis type 2-related schwannomatosis but did not affect vestibular accuracy. These results demonstrate that vestibular schwannoma tumours in our neurofibromatosis type 2-related schwannomatosis population degrade the central vestibular signal-to-noise ratio, while bevacizumab improves the signal-to-noise ratio, changes that can be explained mechanistically by the addition (schwannoma) and suppression (bevacizumab) of afferent neural noise.
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Affiliation(s)
- Amsal S Madhani
- Department of Otolargynology, Massachusetts Eye and Ear,
Boston, MA, USA
| | - Susan King
- Department of Otolargynology, Massachusetts Eye and Ear,
Boston, MA, USA
| | - Jennifer Zhu
- Department of Otolargynology, Massachusetts Eye and Ear,
Boston, MA, USA
| | - Faisal Karmali
- Department of Otolargynology, Massachusetts Eye and Ear,
Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical
School, Boston, MA, USA
| | - D Bradley Welling
- Department of Otolargynology, Massachusetts Eye and Ear,
Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical
School, Boston, MA, USA
| | - Wenli Cai
- Department of Neurology, Massachusetts General Hospital,
Boston, MA, USA
- Department of Radiology, Harvard Medical School,
Boston, MA, USA
| | - Justin T Jordan
- Department of Neurology, Massachusetts General Hospital,
Boston, MA, USA
- Department of Neurology, Harvard Medical School,
Boston, MA, USA
| | - Richard F Lewis
- Department of Otolargynology, Massachusetts Eye and Ear,
Boston, MA, USA
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical
School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital,
Boston, MA, USA
- Department of Neurology, Harvard Medical School,
Boston, MA, USA
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9
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Lawson McLean AC, Freier A, Lawson McLean A, Kruse J, Rosahl S. The German version of the neurofibromatosis 2 impact on quality of life questionnaire correlates with severity of depression and physician-reported disease severity. Orphanet J Rare Dis 2023; 18:3. [PMID: 36604703 PMCID: PMC9817379 DOI: 10.1186/s13023-022-02607-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) is a rare genetic disease that causes a wide range of disabilities leading to compromised quality of life (QOL). There is clear need for a validated disease-specific tool to assess quality of life among German-speaking patients with neurofibromatosis type 2 (NF2). The NFTI-QOL questionnaire has produced useful results in English-speaking cohorts. The aim of this study was to produce and validate a German version of the NFTI-QOL (NFTI-QOL-D) and to correlate QOL scores with a depression score (PHQ-9) and clinical disease severity. METHODS The original English-language NFTI-QOL was translated into German and then back-translated in order to preserve the questionnaire's original concepts and intentions. A link to an online survey encompassing the NFTI-QOL-D and the PHQ-9 depression questionnaire was then sent to 97 patients with NF2 by email. The respondents' scores were compared to clinician-reported disease severity scores. RESULTS 77 patients completed the online survey in full. Internal reliability among NFTI-QOL-D responses was strong (Cronbach's alpha: 0.74). Both PHQ-9 and clinician disease severity scores correlated with NFTI-QOL-D scores (Pearson's rho 0.63 and 0.62, respectively). CONCLUSIONS The NFTI-QOL-D is a reliable and useful tool to assess patient-reported QOL in German-speaking patients with NF2. The correlation of QOL with both psychological and physical disease parameters underlines the importance of individualized interdisciplinary patient care for NF2 patients, with attention paid to mental well-being as well as to somatic disease manifestations.
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Affiliation(s)
- Anna Cecilia Lawson McLean
- Department of Neurosurgery, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089, Erfurt, Germany. .,Department of Neurosurgery, University Hospital Jena, Jena, Germany.
| | - Anna Freier
- grid.8664.c0000 0001 2165 8627Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Aaron Lawson McLean
- grid.275559.90000 0000 8517 6224Department of Neurosurgery, University Hospital Jena, Jena, Germany
| | - Johannes Kruse
- grid.8664.c0000 0001 2165 8627Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Steffen Rosahl
- grid.491867.50000 0000 9463 8339Department of Neurosurgery, Helios Klinikum Erfurt, Nordhäuser Str. 74, 99089 Erfurt, Germany
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10
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Mullin RL, Smith R, Wood S, Swampillai A, Afridi S. Reliability of functional outcome measures in adults with neurofibromatosis 2. SAGE Open Med 2022; 10:20503121221118996. [PMID: 36003079 PMCID: PMC9393935 DOI: 10.1177/20503121221118996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To determine inter- and intra-rater reliability of functional performance outcome measures in people with neurofibromatosis 2. To ascertain how closely objective and subjective measures align. Methods Twenty-nine people with neurofibromatosis 2 were recorded performing the modified clinical test of sensory integration and balance, four square step test and modified nine-hole peg tests. Three raters scored each measure to determine inter-rater reliability. One rater scored the measures a second time to determine intra-rater reliability. Participants also completed a disease-specific quality of life questionnaire and dynamic visual acuity testing. Results Inter-rater and intra-rater reliability scores (intra-class correlation coefficient) were excellent for all tests (intra-class correlation coefficient r ⩾ 0.9). The four square step test correlated with perceived walking challenges and modified clinical test of sensory integration and balance correlated with perceived balance challenges in a neurofibromatosis 2 quality of life patient report outcome measure. Conclusion The modified clinical test of sensory integration and balance, four square step test and modified nine-hole peg tests are potentially useful measures for monitoring neurofibromatosis 2.
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Affiliation(s)
- Rebecca Louise Mullin
- National Centre for Neurofibromatosis, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Physiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Rebecca Smith
- National Centre for Neurofibromatosis, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Department of Physiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Susan Wood
- National Centre for Neurofibromatosis, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Angela Swampillai
- National Centre for Neurofibromatosis, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Shazia Afridi
- National Centre for Neurofibromatosis, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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11
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Wolters PL, Vranceanu AM, Thompson HL, Martin S, Merker VL, Baldwin A, Barnett C, Koetsier KS, Hingtgen CM, Funes CJ, Tonsgard JH, Schorry EK, Allen T, Smith T, Franklin B, Reeve S. Current Recommendations for Patient-Reported Outcome Measures Assessing Domains of Quality of Life in Neurofibromatosis Clinical Trials. Neurology 2021; 97:S50-S63. [PMID: 34230198 PMCID: PMC8594008 DOI: 10.1212/wnl.0000000000012421] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To review and recommend patient-reported outcome (PRO) measures assessing multidimensional domains of quality of life (QoL) to use as clinical endpoints in medical and psychosocial trials for children and adults with neurofibromatosis (NF) type 1, NF2, and schwannomatosis. METHODS The PRO working group of the Response Evaluation in Neurofibromatosis and Schwannomatosis (REiNS) International Collaboration used systematic methods to review, rate, and recommend existing self-report and parent-report PRO measures of generic and disease-specific QoL for NF clinical trials. Recommendations were based on 4 main criteria: patient characteristics, item content, psychometric properties, and feasibility. RESULTS The highest-rated generic measures were (1) the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales for NF clinical trials for children or for children through adults, (2) the Functional Assessment of Cancer Therapy-General for adult medical trials, and (3) the World Health Organization Quality of Life-BREF for adult psychosocial trials. The highest-rated disease-specific measures were (1) the PedsQL NF1 Module for NF1 trials, (2) the NF2 Impact on Quality of Life Scale for NF2 trials, and (3) the Penn Acoustic Neuroma Quality of Life Scale for NF2 trials targeting vestibular schwannomas. To date, there are no disease-specific tools assessing multidimensional domains of QoL for schwannomatosis. CONCLUSIONS The REiNS Collaboration currently recommends these generic and disease-specific PRO measures to assess multidimensional domains of QoL for NF clinical trials. Additional research is needed to further evaluate the use of these measures in both medical and psychosocial trials.
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Affiliation(s)
- Pamela L Wolters
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.).
| | - Ana-Maria Vranceanu
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Heather L Thompson
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Staci Martin
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Vanessa L Merker
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Andrea Baldwin
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Carolina Barnett
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Kimberley S Koetsier
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Cynthia M Hingtgen
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Christopher J Funes
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - James H Tonsgard
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Elizabeth K Schorry
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Taryn Allen
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Taylor Smith
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Barbara Franklin
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
| | - Stephanie Reeve
- From the Pediatric Oncology Branch (P.L.W., S.M.), National Cancer Institute, NIH, Bethesda, MD; Integrated Brain Health Clinical and Research Program (A.-M.V., C.J.F.), Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston; Department of Communication Sciences and Disorders (H.L.T.), California State University, Sacramento; Center for Healthcare Organization and Implementation Research (V.L.M.), Edith Nourse Rogers Memorial Veterans Hospital, Bedford; Clinical Monitoring Research Program Directorate (A.B., T.A.), Frederick National Laboratory for Cancer Research, National Cancer Institute, Frederick, MD; Division of Neurology (C.B.), Department of Medicine, University Health Network and University of Toronto, Ontario, Canada; Department of Otolaryngology/Head and Neck Surgery (K.S.K.), Leiden University Medical Center, the Netherlands; Department of Clinical Neurosciences (C.M.H.), Spectrum Health Medical Group and College of Human Medicine, Michigan State University, East Lansing; University of Chicago Pritzker School of Medicine (J.H.T.), IL; Division of Human Genetics (E.K.S.), Cincinnati Children's Hospital, OH; Department of Psychology and Child Development (T.S.), California Polytechnic State University, San Luis Obispo; and REiNS International Collaboration Patient Representative (B.F., S.R.)
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12
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Abi Jaoude S, Peyre M, Degos V, Goutagny S, Parfait B, Kalamarides M. Validation of a scoring system to evaluate the risk of rapid growth of intracranial meningiomas in neurofibromatosis type 2 patients. J Neurosurg 2021; 134:1377-1385. [PMID: 32442973 DOI: 10.3171/2020.3.jns192382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial meningiomas occur in about half of neurofibromatosis type 2 (NF2) patients and are very frequently multiple. Thus, estimating individual meningiomas' growth rates is of great interest to tailor therapeutic interventions. The Asan Intracranial Meningioma Scoring System (AIMSS) has recently been published to estimate the risk of tumor growth in sporadic meningiomas. The current study aimed to determine predictors of rapid meningioma growth in NF2 patients and to evaluate the AIMSS score in a specific NF2 cohort. METHODS The authors performed a retrospective analysis of 92 NF2 patients with 358 measured intracranial meningiomas that had been observed prospectively between 2012 and 2018. Tumor volumes were measured at diagnosis and at each follow-up visit. The growth rates were determined and evaluated with respect to the clinicoradiological parameters. Predictors of rapid tumor growth (defined as growth ≥ 2 cm3/yr) were analyzed using univariate followed by multivariate logistic regression to build a dedicated predicting model. Receiver operating characteristic (ROC) curves to predict the risk of rapid tumor growth with the AIMSS versus the authors' multivariate model were compared. RESULTS Sixty tumors (16.76%) showed rapid growth. After multivariate analysis, a larger tumor volume at diagnosis (p < 0.0001), presence of peritumoral edema (p = 0.022), absence of calcifications (p < 0.0001), and hyperintense or isointense signal on T2-weighted MRI (p < 0.005) were statistically significantly associated with rapid tumor growth. It is particularly notable that the genetic severity score did not seem to influence the growth rate of NF2 meningiomas. In comparison with the AIMSS, the authors' multivariate model's prediction did not show a statistically significant difference (area under the curve [AUC] 0.82 [95% CI 0.76-0.88] for the AIMSS vs AUC 0.86 [95% CI 0.81-0.91] for the authors' model, p = 0.1). CONCLUSIONS The AIMSS score is valid in the authors' cohort of NF2-related meningiomas. It adequately predicted risk of rapid meningioma growth and could aid in decision-making in NF2 patients.
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Affiliation(s)
| | - Matthieu Peyre
- 1Department of Neurosurgery and
- 2Sorbonne Universités, Paris
| | - Vincent Degos
- 2Sorbonne Universités, Paris
- 3Neurosurgical Intensive Care, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris
| | - Stéphane Goutagny
- 4Department of Neurosurgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris; and
| | - Béatrice Parfait
- 5Department of Genetics and Molecular Biology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France
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Radtke HB, Bergner AL, Goetsch AL, McGowan C, Panzer K, Cannon A. Genetic Counseling for Neurofibromatosis 1, Neurofibromatosis 2, and Schwannomatosis-Practice Resource of the National Society of Genetic Counselors. J Genet Couns 2020; 29:692-714. [PMID: 32602153 DOI: 10.1002/jgc4.1303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
The goal of this practice resource is to provide genetic counselors and other healthcare professionals with a resource to reference when providing genetic counseling services to individuals and families undergoing evaluation for neurofibromatosis (NF) or who have received a diagnosis of NF, including NF1, NF2, and schwannomatosis. This resource represents the opinions of a multi-center working group of Certified Genetic Counselors with experience in the care of individuals with NF, providing topics to be considered for the incorporation into a clinical genetic counseling session.
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Affiliation(s)
- Heather B Radtke
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Children's Tumor Foundation, New York, New York, USA
| | - Amanda L Bergner
- Department of Genetics and Development, Columbia University, New York, New York, USA
| | - Allison L Goetsch
- Division of Genetics, Birth Defects and Metabolism, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
- Department of Pediatrics, Northwestern University, Chicago, Illinois, USA
| | - Caroline McGowan
- Division of Genetics and Genomics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Karin Panzer
- Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Ashley Cannon
- Department of Genetics, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Farschtschi S, Mautner VF, McLean ACL, Schulz A, Friedrich RE, Rosahl SK. The Neurofibromatoses. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:354-360. [PMID: 32657748 DOI: 10.3238/arztebl.2020.0354] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 04/18/2019] [Accepted: 03/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Neurofibromatosis of types 1 and 2 (NF1, NF2) and schwannomatosis are the diseases that make up the neurofibromatosis spectrum. With respective incidences of 1 in 3000, 1 in 33 000, and 1 in 60 000 births, they form part of the group of rare tumor-suppressor syndromes. They give rise to a greater tumor burden for the nervous system than any other type of neoplastic disease. New approaches to symptomatic treatment are emerging. METHODS This review is based on articles retrieved by a selective literature search on the pathogenesis, diagnosis, and treatment of the neurofibromatoses. RESULTS NF1 and NF2 are monogenic diseases, while the genetics of schwannomatosis is complex. The three entities are clinically and pathophysiologically distinct. An important aspect of their tumor biology is the alternation of growth phases and growth pauses. Correlations between genotypes and phenotypes are variable, while new mutations and genetic mosaics are common. Ninety-nine percent of patients with NF1 have six or more café-au-lait spots by the age of 12 months; 90-95% of patients with NF2 develop bilateral vestibular schwannomas. In schwannomatosis, pain is the most prominent symptom; two-thirds of those affected develop spinal schwannomas. The severity and prognosis of these disorders are not closely correlated with the radiological findings; rather, neurologic deficits, malignant transformation, and psychosocial stress are of greater clinical importance. Advances in knowledge of pathophysiology have led to the development of targeted treatment approaches. Examples include the off-label treatment of vestibular schwannomas with bevacizumab and of plexiform neurofibromas with MEK inhibitors. CONCLUSION Patients with neurofibromatoses need individualized care. They should be treated in centers of expertise where interdisciplinary consultation is available and new types of pharmacotherapy can be provided.
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Affiliation(s)
- Said Farschtschi
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | - Victor-Felix Mautner
- International Center for Neurofibromatoses (ICNF), Department of Neurology, University MedicalCenter Hamburg-Eppendorf
| | | | | | - Reinhard E Friedrich
- Department of Oromaxillofacial Surgery, University Medical Center Hamburg-Eppendorf
| | - Steffen K Rosahl
- Neurofibromatosis Center, Department of Neurosurgery, Helios Hospital Erfurt
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Hamoy-Jimenez G, Kim R, Suppiah S, Zadeh G, Bril V, Barnett C. Quality of life in patients with neurofibromatosis type 1 and 2 in Canada. Neurooncol Adv 2020; 2:i141-i149. [PMID: 32642740 PMCID: PMC7317053 DOI: 10.1093/noajnl/vdaa003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is scarce data on the quality of life of people with neurofibromatosis type 1 (NF1) and type 2 (NF2) in Canada. METHODS A cross-sectional study of adults with NF1 and NF2 attending a tertiary center. Patients completed generic measures (SF-36, EQ-5D-5L, and PROMIS pain interference) and disease-specific questionnaires (PedsQL NF1 module and the NFTI-QOL for NF2). We compared generic scores between NF1 and NF2 individuals and used regression models to assess factors associated with quality of life. RESULTS Hundred and eighty-four participants were enrolled. Mean age was 33 years in NF1 and 40 years in NF2. NF1 and NF2 individuals had lower employment rates and lower scores in all domains of the SF-36 compared to the general Canadian population (P < .005). Using the EQ-5D-5L, there was a high proportion of pain (64% in NF1 and 74% in NF2) and anxiety/depression (60% in NF1 and 68% in NF2). Pain interference correlated with poor quality of life in NF1 and NF2; perceived physical appearance was the main predictor of mental well-being in NF1. CONCLUSIONS Individuals with NF1 and NF2 have low quality of life, and this correlates with pain, anxiety, and depression, which are prevalent in NF1 and NF2. Perceived physical appearance predicts quality of life in NF1. A multidisciplinary approach is necessary for patients with NF1 and NF2, including mental health and pain management.
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Affiliation(s)
- Geohana Hamoy-Jimenez
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Raymond Kim
- Division of Medical Oncology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Suganth Suppiah
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Gelareh Zadeh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Carolina Barnett
- Division of Neurology, Department of Medicine, University Health Network and University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Halliday D, Emmanouil B, Vassallo G, Lascelles K, Nicholson J, Chandratre S, Anand G, Wasik M, Pretorius P, Evans DG, Parry A. Trends in phenotype in the English paediatric neurofibromatosis type 2 cohort stratified by genetic severity. Clin Genet 2019; 96:151-162. [PMID: 30993672 DOI: 10.1111/cge.13551] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 01/05/2025]
Abstract
Childhood onset neurofibromatosis type 2 can be severe and genotype dependent. We present a retrospective phenotypic analysis of all ascertained children in England 1.0). Focal cortical dysplasia occurred in 26% group 3 and 4% 2A. A total of 48% of group 3 underwent ≥1 major intervention (intracranial/spinal surgery/Bevacizumab/radiotherapy) compared to 35% of 2A; with 23% group 3 undergoing spinal surgery (schwannoma/ependymoma/meningioma resection) compared to 4% of 2A. Mean age starting Bevacizumab was 12.7 in group 3 and 14.9 years in 2A. In conclusion, group 3 phenotype manifests earlier with greater tumour load, poorer visual outcomes and more intervention.
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Affiliation(s)
- Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford NF2 Unit, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Beatrice Emmanouil
- Oxford NF2 Unit, Oxford University Hospitals NHS Trust, Oxford, UK
- Oxford Brookes University, Faculty of Health and Life Sciences, Department of Psychology, Health and Professional Development, Oxford, UK
| | - Grace Vassallo
- Department of Paediatric Neurology, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Karine Lascelles
- Department of Paediatric Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - James Nicholson
- Department of Paediatric Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Saleel Chandratre
- Department of Paediatric Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Geetha Anand
- Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Martin Wasik
- Department of Ophthalmology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pieter Pretorius
- Depatment of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK
| | - Allyson Parry
- Oxford NF2 Unit, Oxford University Hospitals NHS Trust, Oxford, UK
- Department of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Efficacy and safety of bevacizumab for vestibular schwannoma in neurofibromatosis type 2: a systematic review and meta-analysis of treatment outcomes. J Neurooncol 2019; 144:239-248. [PMID: 31254266 DOI: 10.1007/s11060-019-03234-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 06/26/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Individual evidence suggests that the anti-angiogenic agent bevacizumab may control vestibular schwannoma (VS) growth and promote hearing preservation in patients with neurofibromatosis type 2 (NF2). However, such metadata has yet to be consolidated, as well as its side-effect profile yet to be fully understood. Our aim was to pool systematically-identified metadata in the literature and substantiate the clinical efficacy and safety of bevacizumab with respect to radiographic tumor response, hearing, and treatment outcomes. METHODS Searches of seven electronic databases from inception to March 2019 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. The incidence of outcomes was then extracted and pooled by random-effects meta-analysis of proportions. RESULTS Eight articles reporting 161 NF2 patients with 196 assessable VS met satisfied all criteria. Radiographic response to bevacizumab was partial regression in 41% (95% CI 31-51%), no change in 47% (95% CI 39-55%), and tumor progression in 7% (95% CI 1-15%). In patients with assessable audiometric data, bevacizumab treatment resulted in hearing improvement in 20% (95% CI 9-33%), stability in 69% (95% CI 51-85%) and additional loss in 6% (95% CI 1-15%) Serious bevacizumab toxicity was observed in 17% (95% CI 10-26%). Subsequent surgical intervention was required in 11% (95% CI 2-20%). CONCLUSIONS Bevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.
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Management and Screening in Neurofibromatosis Types 1 and 2. CURRENT GENETIC MEDICINE REPORTS 2019. [DOI: 10.1007/s40142-019-00165-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Shukla A, Hsu FC, Slobogean B, Langmead S, Lu Y, Blakeley JO, Strowd RE. Association between patient-reported outcomes and objective disease indices in people with NF2. Neurol Clin Pract 2019; 9:322-329. [PMID: 31583187 DOI: 10.1212/cpj.0000000000000648] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/12/2019] [Indexed: 11/15/2022]
Abstract
Objective The association between patient-reported outcomes and currently used clinical trial endpoints, including total vestibular schwannoma (VS) volume and word recognition score (WRS) in neurofibromatosis type 2 (NF2), is not known. Methods A prospective observational study enrolling adult patients with NF2 was conducted at a single specialty center. Measures included: NF2 impact on quality of life (NFTI-QOL), short form (SF)-36; total VS volume, WRS; provider- and patient-reported disease severity (ProvSev, PatSev) measured with an institutionally derived multi-item (e.g., symptom burden, age-of-onset, and fatality-risk) and single-item Likert (mild, moderate, severe) scale. Results Fifty-one patients were enrolled between June 2014 and August 2017. Mean age was 42.1 ± 18.2 years and 37.3% patients were male. Mean WRS was 74.4 ± 37.3%; mean total VS volume was 4.2 ± 5.2 cc. Additional lesions were common including meningioma (79.2%) and spinal ependymoma (39.6%). Mean NFTI-QOL score was 7.6 ± 4.9 and correlated with responses on the SF-36. NFTI-QOL also correlated well with PatSev (r = 0.63, p < 0.001) and both multi- and single-item ProvSev (r = 0.62, p < 0.001; r = 0.52, p < 0.001, respectively). A weak correlation was observed between NFTI-QOL and WRS (r = -0.34, p = 0.0156). There was no correlation with VS volume (r = 0.23, p = 0.15). Conclusions The NFTI-QOL correlated well with multiple measures of disease severity but not commonly accepted endpoints for NF2 clinical trials including total VS volume in this US cohort of patients with NF2. This suggests that the NFTI-QOL captures components of the patient experience not sufficiently represented by objective measures of disease and underscores the important and complementary role of patient-focused measures in therapeutic outcome assessment in people with NF2.
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Affiliation(s)
- Aishwarya Shukla
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
| | - Fang-Chi Hsu
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
| | - Bronwyn Slobogean
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
| | - Shannon Langmead
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
| | - Yao Lu
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
| | - Jaishri O Blakeley
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
| | - Roy E Strowd
- Johns Hopkins School of Medicine (AS, BS, SL, JOB), the Johns Hopkins Comprehensive Neurofibromatosis Center, Baltimore, MD; Department of Biostatistics and Data Science (F-CH), Wake Forest School of Medicine, Winston-Salem, NC; Division of Biostatistics and Epidemiology (YL), Weill Cornell Medical College, New York; Department of Neurology (RES), Wake Forest School of Medicine, Winston-Salem, NC; and Department of Neurology (RES), Johns Hopkins School of Medicine, Baltimore, MD
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Emmanouil B, Houston R, May A, Ramsden JD, Hanemann CO, Halliday D, Parry A, Mackeith S. Progression of hearing loss in neurofibromatosis type 2 according to genetic severity. Laryngoscope 2018; 129:974-980. [DOI: 10.1002/lary.27586] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 11/12/2022]
Affiliation(s)
| | - Rory Houston
- Department of ENTOxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Anne May
- Oxford NF2 Unit, Neurosciences Oxford United Kingdom
| | - James D. Ramsden
- Department of ENTOxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | | | - Dorothy Halliday
- Oxford NF2 Unit, Neurosciences Oxford United Kingdom
- Oxford Centre for Genomic MedicineOxford University Hospitals NHS Foundation Trust Oxford United Kingdom
| | - Allyson Parry
- Oxford NF2 Unit, Neurosciences Oxford United Kingdom
| | - Samuel Mackeith
- Oxford NF2 Unit, Neurosciences Oxford United Kingdom
- Department of ENTOxford University Hospitals NHS Foundation Trust Oxford United Kingdom
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21
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Psychological follow-up care of neurofibromatosis type 2 patients and their relatives. Neurochirurgie 2018; 64:381-385. [PMID: 29754738 DOI: 10.1016/j.neuchi.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/22/2022]
Abstract
Neurofibromatosis type 2 (NF2) confronts patients and their relatives with the dual issue of a progressive disease and disability. Deafness creates a brutal rupture in the patients' course of life, and other disabilities often follow in addition, that further deteriorates their quality of life. Hearing rehabilitation, via a cochlear implant and auditory brainstem implant, attempts to reduce the feeling of isolation and suffering due to communication impairment. A NF2-specific quality of life questionnaire not only helps to evaluate the impact of the disease but it is also useful therapy proposals (treatment, auditory implants). This may contribute to improve the quality of care for patients and their families. Within the multidisciplinary NF2 team, the psychologist offers constant listening of patients, and their suffering at each stage of the disease, that takes into account the life context in which the disease occurs, thus playing a major role in the patient care offered.
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22
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Emmanouil B, Browne K, Halliday D, Parry A. First report of the efficacy of vestibular rehabilitation in improving function in patients with Neurofibromatosis type 2: an observational cohort study in a clinical setting. Disabil Rehabil 2018; 41:1632-1638. [DOI: 10.1080/09638288.2018.1442505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Beatrice Emmanouil
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Katherine Browne
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Division of Vestibular Physiotherapy, Neuroscience Rehabilitation Department, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Dorothy Halliday
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Genomic Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Allyson Parry
- Oxford NF2 Unit, Department of Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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23
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Frew JW, Davidson M, Murrell DF. Disease-specific health related quality of life patient reported outcome measures in Genodermatoses: a systematic review and critical evaluation. Orphanet J Rare Dis 2017; 12:189. [PMID: 29284525 PMCID: PMC5747090 DOI: 10.1186/s13023-017-0739-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/07/2017] [Indexed: 12/30/2022] Open
Abstract
Background Health Related Quality of Life (HR-QoL) Patient reported outcome measures (PROMs) have high utility in evaluation of new interventions in genodermatoses, however inconsistent standards of development and validation have hampered widespread acceptance and adoption. Objectives To identify all published HR-QoL PROMs in genodermatoses and critically evaluate their development and measurement properties. Methods This systematic review was registered with PROSPERO (CRD42016053301). Ovid Medline, Embase and PsycINFO databases were utilised for literature review using predefined inclusion and exclusion criteria. PROM development was assessed using the COSMIN Checklist and measurement properties were assessed against quality criteria for measurement properties of health standard questionnaires. Results 15 HRQoL PROMs in genodermatoses were identified. Major areas of deficiency in development were internal consistency, reliability and structural validity. No PROM satisfied measurement property standards for agreement, responsiveness or floor and ceiling effects. Four PROMs included Minimal Important Change scores for interpretability. Issues regarding the generalisability of the evaluated PROMs in culturally diverse and paediatric populations remain unresolved. Conclusions The overall standards of development and measurement properties in PROMs in genodermatoses is fair, despite no single instrument meeting all requirements. None are perfectly validated according to COSMIN criteria but seven of the fifteen PROMs may be appropriate pending further validation. The development of culturally appropriate and child-specific variants of PROMs should be a priority in order to increase the utility of patient based outcome measures in genodermatoses in various patient populations. Electronic supplementary material The online version of this article (10.1186/s13023-017-0739-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John W Frew
- Department of Dermatology, Liverpool Hospital, Sydney, Australia. .,Faculty of Medicine, UNSW, Sydney, Australia.
| | | | - Dedee F Murrell
- Faculty of Medicine, UNSW, Sydney, Australia.,Department of Dermatology St George Hospital, Sydney, Australia
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24
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Spinal ependymomas in NF2: a surgical disease? J Neurooncol 2017; 136:605-611. [PMID: 29188529 DOI: 10.1007/s11060-017-2690-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
The management of spinal cord ependymomas in Neurofibromatosis Type 2 (NF2) has traditionally been conservative, in contrast to the management of sporadic cases; the assumption being that, in the context of NF2, they did not cause morbidity. With modern management and improved outcome of other NF2 tumours, this assumption, and therefore the lack of role for surgery, has been questioned. To compare the outcome of conservative treatment of spinal ependymomas in NF2 with surgical intervention in selected patients. Retrospective review at two NF2 centers, Manchester, UK and Paris/Lille, France. In Manchester patients were managed conservatively. In France surgery was a treatment option. Inclusion in the study was based on tumor length of greater than 1.5 cm. The primary parameter assessed was acquired neurological deficit measured by the Modified McCormick Outcome Score. 24 patients from Manchester and 46 patients from France were analyzed. From Manchester, 27% of these patients deteriorated during the course of follow-up. This effectively represents the natural history of ependymomas in NF2. Of the surgical cases, 23% deteriorated postoperatively, but only 2/18 (11%) of those operated on in the NF2 specialist centers. Comparison of the two specialist centers Manchester/France showed a significantly improved outcome (P = 0.012, χ2 test) in the actively surgical center. Spinal ependymomas produce morbidity. Surgery can prevent or improve this in selected cases but can itself can produce morbidity. Surgery should be considered in growing/symptomatic ependymomas, particularly in the absence of overwhelming tumor load where bevacizumab is the preferred option.
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25
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Halliday D, Emmanouil B, Pretorius P, MacKeith S, Painter S, Tomkins H, Evans DG, Parry A. Genetic Severity Score predicts clinical phenotype in NF2. J Med Genet 2017; 54:657-664. [PMID: 28848060 PMCID: PMC5740551 DOI: 10.1136/jmedgenet-2017-104519] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND: The clinical severity of disease in neurofibromatosis type 2 (NF2) is variable. Patients affected with a constitutional truncating NF2 mutation have severe disease, while missense mutations or mosaic mutations present with a milder attenuated phenotype. Genotype-derived natural history data are important to inform discussions on prognosis and management. METHODS We have assessed NF2 clinical phenotype in 142 patients in relation to the UK NF2 Genetic Severity Score to validate its use as a clinical and research tool. RESULTS The Genetic Severity Score showed significant correlations across 10 measures, including mean age at diagnosis, proportion of patients with bilateral vestibular schwannomas, presence of intracranial meningioma, spinal meningioma and spinal schwannoma, NF2 eye features, hearing grade, age at first radiotherapy, age at first surgery and age starting bevacizumab. In addition there was moderate but significant correlation with age at loss of useful hearing, and weak but significant correlations for mean age at death, quality of life, last optimum Speech Discrimination Score and total number of major interventions. Patients with severe disease presented at a younger age had a higher disease burden and greater requirement of intervention than patients with mild and moderate disease. CONCLUSIONS This study validates the UK NF2 Genetic Severity Score to stratify patients with NF2 for both clinical use and natural history studies.
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Affiliation(s)
- Dorothy Halliday
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.,Oxford NF2 Unit, Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Beatrice Emmanouil
- Oxford NF2 Unit, Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Pieter Pretorius
- Department of Neuroradiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Samuel MacKeith
- Department of ENT, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sally Painter
- Department of Ophthalmology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Helen Tomkins
- Department of Neurology, Derriford Hospital, Plymouth, Plymouth, UK
| | - D Gareth Evans
- Genomic Medicine, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, Greater Manchester, UK
| | - Allyson Parry
- Oxford NF2 Unit, Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Neurosciences, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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26
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Harris F, Tysome JR, Donnelly N, Durie-Gair J, Crundwell G, Tam YC, Knight RD, Vanat ZH, Folland N, Axon P. Cochlear implants in the management of hearing loss in Neurofibromatosis Type 2. Cochlear Implants Int 2017; 18:171-179. [PMID: 28335700 DOI: 10.1080/14670100.2017.1300723] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Review of cochlear implant (CI) outcomes in patients with Neurofibromatosis Type 2 (NF2), implanted in the presence of an ipsilateral vestibular schwannoma (VS). Hearing restoration was combined in some cases with a Bevacizumab regime. METHOD Retrospective review of 12 patients, managed over the period 2009-2016, at a tertiary referral multidisciplinary NF2 clinic. The patients are grouped by hearing outcomes to explore likely protective factors, and to generate a proposed decision-making tool for the selection of either CI or Auditory Brainstem Implant (ABI). RESULTS Four of the 12 patients achieved speech discrimination without lip-reading. In these individuals there is reason to think that the mechanism of their hearing loss was cochlear dysfunction. A further four patients received benefit to lip-reading and awareness of environmental sound. For such patients their hearing loss may have been due to both cochlear and neural dysfunction. Two patients gained access to environmental sound only from their CI. Two patients derived no benefit from their CIs, which were subsequently explanted. Both these latter patients had had prior ipsilateral tumour surgery, one just before the CI insertion. CONCLUSION Cochlear implantation can lead to open set speech discrimination in patients with NF2 in the presence of a stable VS. Use of promontory stimulation and intraoperative electrically evoked auditory brainstem response testing, along with case history, can inform the decision whether to implant an ABI or CI.
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Affiliation(s)
- Frances Harris
- a Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - James R Tysome
- b Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Neil Donnelly
- b Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Juliette Durie-Gair
- b Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Gemma Crundwell
- a Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Yu Chuen Tam
- a Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Richard D Knight
- b Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Zebunnisa H Vanat
- a Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Nicola Folland
- a Emmeline Centre for Hearing Implants, Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
| | - Patrick Axon
- b Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , UK
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27
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Ferner RE, Thomas M, Mercer G, Williams V, Leschziner GD, Afridi SK, Golding JF. Evaluation of quality of life in adults with neurofibromatosis 1 (NF1) using the Impact of NF1 on Quality Of Life (INF1-QOL) questionnaire. Health Qual Life Outcomes 2017; 15:34. [PMID: 28193237 PMCID: PMC5307827 DOI: 10.1186/s12955-017-0607-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 01/28/2017] [Indexed: 12/05/2022] Open
Abstract
Background Neurofibromatosis 1 (NF1) is an inherited, multi-system, tumour suppressor disorder with variable complications that cause psychological distress and social isolation. The study aim was to develop and validate a disease-specific questionnaire to measure quality of life (QOL) in NF1 that is suitable both as an assessment tool in clinical practice and in clinical trials of novel therapy. Methods The Impact of NF1 on Quality of Life (INF1-QOL) questionnaire was developed by a literature search for common terms, focus group (n = 6), semi-structured interviews (n = 21), initial drafts (n =50) and final 14 item questionnaire (n = 50). Bivariate correlations between items, exploratory factor analysis, correlations with severity and EuroQol were employed. Results INF1-QOL showed good internal reliability (Cronbach’s alpha 0.87), mean total INF1-QOL score was 8.64 (SD 6.3), median 7.00, range 0–30 (possible range 0–42); no significant correlations with age or gender. The mean total EuroQol score was 7.38 (SD 2.87), median 6.5, mean global EuroQol score was 76.34 (SD 16.56), median 80. Total INF1-QOL score correlated with total EuroQol r = 0.82, p < 0.0001. The highest impact on QOL was moderate or severe problems with anxiety and depression (32%) and negative effects of NF1 on role and outlook on life (42%). The mean inter-relater reliability for grading of clinical severity scores was 0.71 (range 0.65-0.79), and intra-class correlation was 0.92. The mean clinical severity score was 1.95 (SD 0.65) correlating r = 0.34 with total INF1-QOL score p < 0.05 and correlated 0.37 with total EuroQol score p < 0.01. The clinical severity score was mild in 17 (34%), moderate in 16 (32%) and 17 (34%) individuals had severe disease. Conclusions INF1-QOL is a validated, reliable disease specific questionnaire that is easy and quick to complete. Role and outlook on life and anxiety and depression have the highest impact on QOL indicating the variability, severity and unpredictability of NF1. INFI-QOL correlates moderately with clinical severity. The moderate relationship between INF1-QOL and physician rated severity emphasizes the difference between clinical and patient perception. INFI-QOL will be useful in individual patient assessment and as an outcome measure for clinical trials. Electronic supplementary material The online version of this article (doi:10.1186/s12955-017-0607-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rosalie E Ferner
- National Neurofibromatosis Service, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK. .,Department of Clinical Neuroscience, Intistute of Psychiatry, Psychology & Neuroscience, King's College London, Great Maze Pond, London, SE1 9RT, UK.
| | - Mary Thomas
- National Neurofibromatosis Service, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Gemma Mercer
- National Neurofibromatosis Service, Department of Genetic Medicine St. Mary's Hospital, Manchester, UK
| | - Victoria Williams
- National Neurofibromatosis Service, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Guy D Leschziner
- National Neurofibromatosis Service, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - Shazia K Afridi
- National Neurofibromatosis Service, Department of Neurology, Guy's and St. Thomas' NHS Foundation Trust, Great Maze Pond, London, SE1 9RT, UK
| | - John F Golding
- Department of Psychology, University of Westminster, London, UK
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28
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First use of patient reported outcomes measurement information system (PROMIS) measures in adults with neurofibromatosis. J Neurooncol 2016; 131:413-419. [DOI: 10.1007/s11060-016-2314-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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Gender-specific growth dynamics of neurofibromatosis type-2-related tumors of the central nervous system. Acta Neurochir (Wien) 2016; 158:2127-2134. [PMID: 27590907 DOI: 10.1007/s00701-016-2927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND To date, few studies have been published about the growth dynamics of tumors associated with neurofibromatosis type-2 (NF2), none of which evaluated gender-specific differences. Our aim was to compare radiographic data of female and male patients with NF2. METHODS MR images of 40 patients (20 female, 20 male) from the regional NF2 referral center were included in this analysis. Tumor sizes were determined by semi-automated volumetric measurement. Intracranial tumors were measured on post-contrast T1-weighted MRI datasets and volumes of intramedullary spinal tumors were determined from sagittal T2-weighted MRI datasets. RESULTS The median follow-up time was 91 months (range, 16-199 months) per patient. Intracranial tumors: On average, female patients had 13.4 neoplasms, while male patients had 6.75 (p = 0.042). The overall median time to tumor progression of ≥20 % was 20 months for females and 18 months for males. Tumors of the cerebellopontine angle (CPA) that had undergone previous surgery had shorter progression-free intervals in females than in males (16 and 24 months, respectively; p = 0.012). The median 1-year growth rate was 17.5 ± 44.6 % in females compared to 12.5 ± 44.9 % in males (p = 0.625). Intramedullary spinal tumors: On average, females had 2.05 tumors and males had 1.75 tumors (p = 0.721). Median time to tumor progression was 21 months in females and 44 months in males (p = 0.204). After 2 years, the median growth rate was 24.4 ± 56.8 % in female and 13.5 ± 40.4 % in male patients (p = 0.813). CONCLUSIONS The radiographic data in this study suggest that female patients are affected by a greater number of tumors than male patients and that post-surgery tumors of the CPA grow faster in females than in males.
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Blakeley JO, Plotkin SR. Therapeutic advances for the tumors associated with neurofibromatosis type 1, type 2, and schwannomatosis. Neuro Oncol 2016; 18:624-38. [PMID: 26851632 PMCID: PMC4827037 DOI: 10.1093/neuonc/nov200] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 08/17/2015] [Indexed: 01/08/2023] Open
Abstract
Neurofibromatosis type 1 (NF1), neurofibromatosis type 2 (NF2), and schwannomatosis (SWN) are tumor-suppressor syndromes. Each syndrome is an orphan disease; however, the tumors that arise within them represent the most common tumors of the nervous system worldwide. Systematic investigation of the pathways impacted by the loss of function of neurofibromin (encoded byNF1) and merlin (encoded byNF2) have led to therapeutic advances for patients with NF1 and NF2. In the syndrome of SWN, the genetic landscape is more complex, with 2 known causative genes (SMARCB1andLZTR1) accounting for up to 50% of familial SWN patients. The understanding of the molecular underpinnings of these syndromes is developing rapidly and offers more therapeutic options for the patients. In addition, common sporadic cancers harbor somatic alterations inNF1(ie, glioblastoma, breast cancer, melanoma),NF2(ie, meningioma, mesothelioma) andSMARCB1(ie, atypical teratoid/rhabdoid tumors) such that advances in management of syndromic tumors may benefit patients both with and without germline mutations. In this review, we discuss the clinical and genetic features of NF1, NF2 and SWN, the therapeutic advances for the tumors that arise within these syndromes and the interaction between these rare tumor syndromes and the common tumors that share these mutations.
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Affiliation(s)
- Jaishri O Blakeley
- Neurology, Neurosurgery and Oncology, Johns Hopkins University, Baltimore, MD (J.O.B.); Neurology, Harvard Medical School, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA (S.R.P.)
| | - Scott R Plotkin
- Neurology, Neurosurgery and Oncology, Johns Hopkins University, Baltimore, MD (J.O.B.); Neurology, Harvard Medical School, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA (S.R.P.)
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32
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Morris KA, Golding JF, Axon PR, Afridi S, Blesing C, Ferner RE, Halliday D, Jena R, Pretorius PM, Evans DG, McCabe MG, Parry A. Bevacizumab in neurofibromatosis type 2 (NF2) related vestibular schwannomas: a nationally coordinated approach to delivery and prospective evaluation. Neurooncol Pract 2016; 3:281-289. [PMID: 29692918 DOI: 10.1093/nop/npv065] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Indexed: 11/14/2022] Open
Abstract
Background NF2 patients develop multiple nervous system tumors including bilateral vestibular schwannomas (VS). The tumors and their surgical treatment are associated with deafness, neurological disability, and mortality.Medical treatment with bevacizumab has been reported to reduce VS growth and to improve hearing. In addition to evaluating these effects, this study also aimed to determine other important consequences of treatment including patient-reported quality of life and the impact of treatment on surgical VS rates. Methods Patients treated with bevacizumab underwent serial prospective MRI, audiology, clinical, CTCAE-4.0 adverse events, and NFTI-QOL quality-of-life assessments. Tumor volumetrics were classified according to the REiNs criteria and annual VS surgical rates reviewed. Results Sixty-one patients (59% male), median age 25 years (range, 10-57), were reviewed. Median follow-up was 23 months (range, 3-53). Partial volumetric tumor response (all tumors) was seen in 39% and 51% had stabilization of previously growing tumors. Age and pretreatment growth rate were predictors of response. Hearing was maintained or improved in 86% of assessable patients. Mean NFTI-QOL scores improved from 12.0 to 10.7 (P < .05). Hypertension was observed in 30% and proteinuria in 16%. Twelve treatment breaks occurred due to adverse events. The rates of VS surgery decreased after the introduction of bevacizumab. Conclusion Treatment with bevacizumab in this large, UK-wide cohort decreased VS growth rates and improved hearing and quality of life. The potential risk of surgical iatrogenic damage was also reduced due to an associated reduction in VS surgical rates. Ongoing follow-up of this cohort will determine the long-term benefits and risks of bevacizumab treatment.
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Affiliation(s)
- Katrina A Morris
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - John F Golding
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Patrick R Axon
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Shazia Afridi
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Claire Blesing
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Rosalie E Ferner
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Dorothy Halliday
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Raj Jena
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Pieter M Pretorius
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | | | - D Gareth Evans
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Martin G McCabe
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
| | - Allyson Parry
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK (K.A.M., A.P.); University of New South Wales, St Vincent's Clinical School, Darlinghurst, Australia (K.A.M.); University of Westminster, London, UK (J.F.G.); Institute of Psychiatry, King's College, London, UK (J.F.G., R.E.F.); Addenbrooke's Hospital, Cambridge, UK (P.R.A.); Department of Neurology, Guy's & St Thomas' Hospital, London, UK (S.A., R.E.F.); Oxford University Hospitals NHS Trust, Oxford, UK (D.H., C.B., A.P., P.M.P.); Department of Oncology, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK (R.J.); Genomic Medicine, Institute of Human Development, MAHSC, University of Manchester, St Mary's Hospital, Manchester, UK (D.G.E.); Centre for Paediatric, Teenage and Young Adult Cancer, Institute of Cancer Sciences, University of Manchester, Manchester, UK (M.G.M.)
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Shaw A. Diagnosis and Management of Hereditary Meningioma and Vestibular Schwannoma. Recent Results Cancer Res 2016; 205:17-27. [PMID: 27075346 DOI: 10.1007/978-3-319-29998-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Bilateral vestibular schwannomata and meningiomata are the tumours most commonly associated with neurofibromatosis type II (NF2). These tumours may also be seen in patients with schwannomatosis and familial meningioma, but these phenotypes are usually easy to distinguish. The main diagnostic challenge when managing these tumours is distinguishing between sporadic disease which carries low risk of subsequent tumours or NF2 with its associated morbidities and reduced life expectancy. This chapter outlines some of the diagnostic and management considerations along with associated evidence.
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Affiliation(s)
- Adam Shaw
- Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Cosetti MK, Golfinos JG, Roland JT. Quality of Life (QoL) Assessment in Patients with Neurofibromatosis Type 2 (NF2). Otolaryngol Head Neck Surg 2015; 153:599-605. [PMID: 25779467 DOI: 10.1177/0194599815573002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 01/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study was to develop a multidimensional metric for assessing quality of life (QoL) in patients with neurofibromatosis type 2 (NF2). STUDY DESIGN Electronically distributed questionnaire. SETTING University tertiary care hospital, NF2 support groups. SUBJECTS AND METHODS Structured interviews with NF2 providers and patients identified relevant domains. Items in each domain were extracted from validated QoL modules, then combined with items unique to NF2 and pretested on NF2 providers and patients. The final 61-item questionnaire was administered electronically to patients with NF2 (N = 118). The form assessed overall QoL and 11 additional domains, including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain, and vocal communication. Responses were compared with reference values for the general population, patients with head and neck cancer, and patients with brain cancer. RESULTS Overall, QoL in patients with NF2 was lower than that of the general population (P < .01) and similar to that of patients with cancer. Patients with more facial weakness, hearing loss, and imbalance reported significantly lower QoL. However, domains most predictive of overall QoL were psychosocial, future uncertainty, and pain. Compared with patients with head and neck and brain cancer, patients with NF2 demonstrated significantly higher levels of psychosocial stressors, including disease-related anxiety, personal and financial stress, and lack of social support (P < .01). CONCLUSION Psychosocial stress and pain significantly affect QoL in NF2, indicating that mental health, pain management, and financial counseling could have an important impact on QoL in this population.
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Affiliation(s)
- Maura K Cosetti
- Departments of Otolaryngology-Head & Neck Surgery and Neurosurgery, Louisiana State University, Shreveport, Louisiana, USA
| | - John G Golfinos
- Department of Neurosurgery, New York University, New York, New York, USA
| | - J Thomas Roland
- Department of Neurosurgery, New York University, New York, New York, USA Department of Otolaryngology, New York University, New York, New York, USA
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Current Concepts in Management of Vestibular Schwannomas in Neurofibromatosis Type 2. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014. [DOI: 10.1007/s40136-014-0067-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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