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Frosina G. Advancements in Image-Based Models for High-Grade Gliomas Might Be Accelerated. Cancers (Basel) 2024; 16:1566. [PMID: 38672647 PMCID: PMC11048778 DOI: 10.3390/cancers16081566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
The first half of 2022 saw the publication of several major research advances in image-based models and artificial intelligence applications to optimize treatment strategies for high-grade gliomas, the deadliest brain tumors. We review them and discuss the barriers that delay their entry into clinical practice; particularly, the small sample size and the heterogeneity of the study designs and methodologies used. We will also write about the poor and late palliation that patients suffering from high-grade glioma can count on at the end of life, as well as the current legislative instruments, with particular reference to Italy. We suggest measures to accelerate the gradual progress in image-based models and end of life care for patients with high-grade glioma.
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Affiliation(s)
- Guido Frosina
- Mutagenesis & Cancer Prevention Unit, IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132 Genova, Italy
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Tosi U, Souweidane M. Diffuse Midline Gliomas: Challenges and New Strategies in a Changing Clinical Landscape. Cancers (Basel) 2024; 16:219. [PMID: 38201646 PMCID: PMC10778507 DOI: 10.3390/cancers16010219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Diffuse intrinsic pontine glioma (DIPG) was first described by Harvey Cushing, the father of modern neurosurgery, a century ago. Since then, the classification of this tumor changed significantly, as it is now part of the broader family of diffuse midline gliomas (DMGs), a heterogeneous group of tumors of midline structures encompassing the entire rostro-caudal space, from the thalamus to the spinal cord. DMGs are characterized by various epigenetic events that lead to chromatin remodeling similarities, as two decades of studies made possible by increased tissue availability showed. This new understanding of tumor (epi)biology is now driving novel clinical trials that rely on targeted agents, with finally real hopes for a change in an otherwise unforgiving prognosis. This biological discovery is being paralleled with equally exciting work in therapeutic drug delivery. Invasive and noninvasive platforms have been central to early phase clinical trials with a promising safety track record and anecdotal benefits in outcome.
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Affiliation(s)
- Umberto Tosi
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Mark Souweidane
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10021, USA
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Abstract
Diffuse intrinsic pontine glioma (DIPG) is a primary brainstem tumor of childhood that carries a dismal prognosis, with median survival of less than 1 year. Because of the brain stem location and pattern of growth within the pons, Dr. Harvey Cushing, the father of modern neurosurgery, urged surgical abandonment. Such a dismal prognosis remained unchanged for decades, coupled with a lack of understanding of tumor biology and an unchanging therapeutic panorama. Beyond palliative external beam radiation therapy, no therapeutic approach has been widely accepted. In the last one to two decades, however, increased tissue availability, an improving understanding of biology, genetics, and epigenetics have led to the development of novel therapeutic targets. In parallel with this biological revolution, new methods intended to enhance drug delivery into the brain stem are contributing to a surge of exciting experimental therapeutic strategies.
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Affiliation(s)
- Umberto Tosi
- Department of Neurosurgery, Weill Cornell Medicine, 525 E 68th St Box 99, New York, NY, 10021, USA
| | - Mark Souweidane
- Department of Neurosurgery, Weill Cornell Medicine, 525 E 68th St Box 99, New York, NY, 10021, USA.
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Yang N, Xiao X, Gu G, Wang X, Zhang X, Wang Y, Pan C, Zhang P, Ma L, Zhang L, Liao H. Diffusion MRI-based connectomics features improve the noninvasive prediction of H3K27M mutation in brainstem gliomas. Radiother Oncol 2023; 186:109789. [PMID: 37414255 DOI: 10.1016/j.radonc.2023.109789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/02/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To establish an individualized predictive model to identify patients with brainstem gliomas (BSGs) at high risk of H3K27M mutation, with the inclusion of brain structural connectivity analysis based on diffusion MRI (dMRI). MATERIALS AND METHODS A primary cohort of 133 patients with BSGs (80 H3K27M-mutant) were retrospectively included. All patients underwent preoperative conventional MRI and dMRI. Tumor radiomics features were extracted from conventional MRI, while two kinds of global connectomics features were extracted from dMRI. A machine learning-based individualized H3K27M mutation prediction model combining radiomics and connectomics features was generated with a nested cross validation strategy. Relief algorithm and SVM method were used in each outer LOOCV loop to select the most robust and discriminative features. Additionally, two predictive signatures were established using the LASSO method, and simplified logistic models were built using multivariable logistic regression analysis. An independent cohort of 27 patients was used to validate the best model. RESULTS 35 tumor-related radiomics features, 51 topological properties of brain structural connectivity networks, and 11 microstructural measures along white matter tracts were selected to construct a machine learning-based H3K27M mutation prediction model, which achieved an AUC of 0.9136 in the independent validation set. Radiomics- and connectomics-based signatures were generated and simplified combined logistic model was built, upon which derived nomograph achieved an AUC of 0.8827 in the validation cohort. CONCLUSION dMRI is valuable in predicting H3K27M mutation in BSGs, and connectomics analysis is a promising approach. Combining multiple MRI sequences and clinical features, the established models have good performance.
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Affiliation(s)
- Ne Yang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, China(3)
| | - Xiong Xiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China(4)
| | - Guocan Gu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China(4)
| | - Xianyu Wang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, China(3)
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, China(3)
| | - Yi Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China(4)
| | - Changcun Pan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China(4)
| | - Peng Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China(4)
| | - Longfei Ma
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, China(3)
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, China(4); China National Clinical Research Center for Neurological Diseases, China(4); Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, China(4)
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, China(3).
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Zhao X, Li D, Qiao Z, Wang K, Chen Q, Pan C, Wu Y, Xiao D, Xi T, Zhang L, Ai L. (11)C-methionine PET imaging characteristics in children with diffuse intrinsic pontine gliomas and relationship to survival and H3 K27M mutation status. Eur J Nucl Med Mol Imaging 2023. [PMID: 36697961 DOI: 10.1007/s00259-022-06105-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/30/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE This study aimed to describe 11C-methionine (11C-MET) PET imaging characteristics in patients with paediatric diffuse intrinsic pontine glioma (DIPG) and correlate them with survival and H3 K27M mutation status. METHODS We retrospectively analysed 98 children newly diagnosed with DIPG who underwent 11C-MET PET. PET imaging characteristics evaluated included uptake intensity, uniformity, metabolic tumour volume (MTV), and total lesion methionine uptake (TLMU). The maximum, mean, and peak of the tumour-to-background ratio (TBR), calculated as the corresponding standardised uptake values (SUV) divided by the mean reference value, were also recorded. The associations between the PET imaging characteristics and clinical outcomes in terms of progression-free survival (PFS) and overall survival (OS) and H3 K27M mutation status were assessed, respectively. RESULTS In univariate analysis, imaging characteristics significantly associated with shorter PFS and OS included a higher uniformity grade, higher TBRs, larger MTV, and higher TLMU. In multivariate analysis, larger MTV at diagnosis, shorter symptom duration, and no treatment were significantly correlated with shorter PFS and OS. The PET imaging features were not correlated with H3 K27M mutation status. CONCLUSION Although several imaging features were significantly associated with PFS and OS, only MTV, indicating the size of the active tumour, was identified as a strong independent prognostic factor.
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De Clercq E, Grotzer M, Landolt MA, von Helversen B, Flury M, Rössler J, Kurzo A, Streuli J. No wrong decisions in an all-wrong situation. A qualitative study on the lived experiences of families of children with diffuse intrinsic pontine glioma. Pediatr Blood Cancer 2022; 69:e29792. [PMID: 35652529 DOI: 10.1002/pbc.29792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/29/2022] [Accepted: 05/02/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a rare, but lethal pediatric brain tumor with a median survival of less than 1 year. Existing treatment may prolong life and control symptoms, but may cause toxicity and side effects. In order to improve child- and family-centered care, we aimed to better understand the treatment decision-making experiences of parents, as studies on this topic are currently lacking. PROCEDURE The data for this study came from 24 semistructured interviews with parents whose children were diagnosed with DIPG in two children's hospitals in Switzerland and died between 2000 and 2016. Analysis of the dataset was done using reflexive thematic analysis. RESULTS For most parents, the decision for or against treatment was relatively straightforward given the fatality of the tumor and the absence of treatment protocols. Most of them had no regrets about their decision for or against treatment. The most distressing factor for them was observing their child's gradual loss of independence and informing them about the inescapability of death. To counter this powerlessness, many parents opted for complementary or alternative medicine in order to "do something." Many parents reported psychological problems in the aftermath of their child's death and coping strategies between mothers and fathers often differed. CONCLUSION The challenges of DIPG are unique and explain why parental and shared decision-making is different in DIPG compared to other cancer diagnoses. Considering that treatment decisions shape parents' grief trajectory, clinicians should reassure parents by framing treatment decisions in terms of family's deeply held values and goals.
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Affiliation(s)
- Eva De Clercq
- Institute of Bioethics and History of Medicine, University of Zürich, Zurich, Switzerland
| | - Michael Grotzer
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus A Landolt
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | - Maria Flury
- University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jochen Rössler
- Cancer Center Inselspital UCI, Inselspital University, Bern, Switzerland
| | - Andrea Kurzo
- Cancer Center Inselspital UCI, Inselspital University, Bern, Switzerland
| | - Jürg Streuli
- Institute of Bioethics and History of Medicine, University of Zürich, Zurich, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
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Gielen GH, Baugh JN, van Vuurden DG, Veldhuijzen van Zanten SEM, Hargrave D, Massimino M, Biassoni V, Morales la Madrid A, Karremann M, Wiese M, Thomale U, Janssens GO, von Bueren AO, Perwein T, Nussbaumer G, Hoving EW, Niehusmann P, Gessi M, Kwiecien R, Bailey S, Pietsch T, Andreiuolo F, Kramm CM. Pediatric high-grade gliomas and the WHO CNS Tumor Classification—Perspectives of pediatric neuro-oncologists and neuropathologists in light of recent updates. Neurooncol Adv 2022; 4:vdac077. [PMID: 35733513 PMCID: PMC9209749 DOI: 10.1093/noajnl/vdac077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The WHO Classification of Tumors of the Central Nervous System has undergone major restructuring. Molecularly defined diagnostic criteria were introduced in 2016 (revised 4th edition) and expanded in 2021 (5th edition) to incorporate further essential diagnostic molecular parameters. We investigated potential differences between specialists in perception of these molecularly defined subtypes for pediatric high-grade gliomas (pedHGG).
Methods
We designed a 22-question survey studying the impact of the revised 4th edition of the WHO classification on pedHGG. Data were collected and statistically analyzed to examine the spectrum of viewpoints and possible differences between neuro-oncologists and neuropathologists.
Results
465 participants from 53 countries were included; 187 pediatric neuro-oncologists (40%), 160 neuropathologists (34%), and 118 additional experts (26%). Neuro-oncologists reported issues with the introduction of molecularly defined tumor types, as well as the abolishment or renaming of established tumor entities, while neuropathologists did not to the same extent. Both groups indicated less relevant or insufficient diagnostic definitions were available in 2016. Reported issues were classified and assessed in the 2021 WHO classification and a substantial improvement was perceived. However, issues of high clinical relevance remain to be addressed, including the definition of clinical phenotypes for diffuse intrinsic pontine glioma and gliomatosis cerebri.
Conclusions
Within the WHO classification of pediatric brain tumors, such as pedHGG, rapid changes in molecular characterization have been introduced. This study highlights the ongoing need for cross talk between pathologist and oncologist to advance the classification of pedHGG subtypes and ensure biological relevance and clinical impact.
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Affiliation(s)
- Gerrit H Gielen
- Institute of Neuropathology, Medical Center Bonn , Bonn , Germany
| | - Joshua N Baugh
- Princess Máxima Center for Pediatric Oncology , Utrecht , The Netherlands
| | | | - Sophie E M Veldhuijzen van Zanten
- Princess Máxima Center for Pediatric Oncology , Utrecht , The Netherlands
- Erasmus University Medical Center, Department of Radiology and Nuclear Medicine , Rotterdam , The Netherlands
| | - Darren Hargrave
- Great Ormond Street Hospital for Children, NHS Trust , London , UK
| | - Maura Massimino
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori , Milan , Italy
| | - Veronica Biassoni
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori , Milan , Italy
| | - Andres Morales la Madrid
- Pediatric Neuro-Oncology, Department of Pediatric Oncology, Hospital Sant Joan de Deu, Passeig Sant Joan de Déu 2 , Barcelona , Spain
| | - Michael Karremann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University , Mannheim , Germany
| | - Maria Wiese
- Division of Pediatric Hematology and Oncology , University Medical Center Goettingen , Goettingen , Germany
| | - Ulrich Thomale
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Geert O Janssens
- Princess Máxima Center for Pediatric Oncology , Utrecht , The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - André O von Bueren
- Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Hospital of Geneva , Geneva , Switzerland
- CANSEARCH research platform in Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics,University of Geneva , Switzerland
| | - Thomas Perwein
- Division of Pediatric Hemato-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz , Graz , Austria
| | - Gunther Nussbaumer
- Division of Pediatric Hemato-Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz , Graz , Austria
| | - Eelco W Hoving
- Princess Máxima Center for Pediatric Oncology , Utrecht , The Netherlands
| | - Pitt Niehusmann
- Department of Neuropathology, Oslo University Hospital , Oslo , Norway
| | - Marco Gessi
- Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Robert Kwiecien
- Institute of Biostatistics and Clinical Research, Faculty of Medicine, University of Münster , Münster , Germany
| | - Simon Bailey
- Sir James Spence Institute of Child Health, Royal Victoria Infirmary , Newcastle upon Tyne , UK
| | - Torsten Pietsch
- Institute of Neuropathology, Medical Center Bonn , Bonn , Germany
| | - Felipe Andreiuolo
- Institute of Neuropathology, Medical Center Bonn , Bonn , Germany
- Instituto Estadual Do Cérebro Paulo Niemeyer and the IDOR Institute , Rio de Janeiro , Brazil
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology , University Medical Center Goettingen , Goettingen , Germany
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