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Hudelist B, Elia A, Roux A, Paun L, Schumacher X, Hamza M, Demasi M, Moiraghi A, Dezamis E, Chrétien F, Benzakoun J, Oppenheim C, Zanello M, Pallud J. Impact of frailty on survival glioblastoma, IDH-wildtype patients. J Neurooncol 2024:10.1007/s11060-024-04699-y. [PMID: 38762828 DOI: 10.1007/s11060-024-04699-y] [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: 03/09/2024] [Accepted: 04/26/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Frailty increases the risk of mortality among patients. We studied the prognostic significance of frailty using the modified 5-item frailty index (5-mFI) in patients harboring a newly diagnosed supratentorial glioblastoma, IDH-wildtype. METHODS We retrospectively reviewed records of patients surgical treated at a single neurosurgical institution at the standard radiochemotherapy era (January 2006 - December 2021). Inclusion criteria were: age ≥ 18, newly diagnosed glioblastoma, IDH-wildtype, supratentorial location, available data to assess the 5-mFI index. RESULTS A total of 694 adult patients were included. The median overall survival was longer in the non-frail subgroup (5-mFI < 2, n = 538 patients; 14.3 months, 95%CI 12.5-16.0) than in the frail subgroup (5-mFI ≥ 2, n = 156 patients; 4.7 months, 95%CI 4.0-6.5 months; p < 0.001). 5-mFI ≥ 2 (adjusted Hazard Ratio (aHR) 1.31; 95%CI 1.07-1.61; p = 0.009) was an independent predictor of a shorter overall survival while age ≤ 60 years (aHR 0.78; 95%CI 0.66-0.93; p = 0.007), KPS score ≥ 70 (aHR 0.71; 95%CI 0.58-0.87; p = 0.001), unilateral location (aHR 0.67; 95%CI 0.52-0.87; p = 0.002), total removal (aHR 0.54; 95%CI 0.44-0.64; p < 0.0001), and standard radiochemotherapy protocol (aHR 0.32; 95%CI 0.26-0.38; p < 0.0001) were independent predictors of a longer overall survival. Frailty remained an independent predictor of overall survival within the subgroup of patients undergoing a first-line oncological treatment after surgery (n = 549) and within the subgroup of patients who benefited from a total removal plus adjuvant standard radiochemotherapy (n = 209). CONCLUSION In newly diagnosed supratentorial glioblastoma, IDH-wildtype patients treated at the standard combined radiochemotherapy era, frailty, defined using a 5-mFI score ≥ 2 was an independent predictor of overall survival.
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Affiliation(s)
- Benoît Hudelist
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Angela Elia
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Alexandre Roux
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Luca Paun
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Xavier Schumacher
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Meissa Hamza
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Marco Demasi
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Edouard Dezamis
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
| | - Fabrice Chrétien
- Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Joseph Benzakoun
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Catherine Oppenheim
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, F-75014, France
| | - Marc Zanello
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France
| | - Johan Pallud
- Service de Neurochirurgie H?pital, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, 1, rue Cabanis, Paris, F-75014, France.
- Institute of Psychiatry and Neuroscience of Paris (IPNP), Université Paris Cité, INSERM U1266, IMA-Brain, Paris, F-75014, France.
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Jung K, Kempter J, Prokop G, Herrmann T, Griessmair M, Kim SH, Delbridge C, Meyer B, Bernhardt D, Combs SE, Zimmer C, Wiestler B, Schmidt-Graf F, Metz MC. Quantitative Assessment of Tumor Contact with Neurogenic Zones and Its Effects on Survival: Insights beyond Traditional Predictors. Cancers (Basel) 2024; 16:1743. [PMID: 38730694 PMCID: PMC11083354 DOI: 10.3390/cancers16091743] [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: 03/26/2024] [Revised: 04/23/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
So far, the cellular origin of glioblastoma (GBM) needs to be determined, with prevalent theories suggesting emergence from transformed endogenous stem cells. Adult neurogenesis primarily occurs in two brain regions: the subventricular zone (SVZ) and the subgranular zone (SGZ) of the hippocampal dentate gyrus. Whether the proximity of GBM to these neurogenic niches affects patient outcome remains uncertain. Previous studies often rely on subjective assessments, limiting the reliability of those results. In this study, we assessed the impact of GBM's relationship with the cortex, SVZ and SGZ on clinical variables using fully automated segmentation methods. In 177 glioblastoma patients, we calculated optimal cutpoints of minimal distances to the SVZ and SGZ to distinguish poor from favorable survival. The impact of tumor contact with neurogenic zones on clinical parameters, such as overall survival, multifocality, MGMT promotor methylation, Ki-67 and KPS score was also examined by multivariable regression analysis, chi-square test and Mann-Whitney-U. The analysis confirmed shorter survival in tumors contacting the SVZ with an optimal cutpoint of 14 mm distance to the SVZ, separating poor from more favorable survival. In contrast, tumor contact with the SGZ did not negatively affect survival. We did not find significant correlations with multifocality or MGMT promotor methylation in tumors contacting the SVZ, as previous studies discussed. These findings suggest that the spatial relationship between GBM and neurogenic niches needs to be assessed differently. Objective measurements disprove prior assumptions, warranting further research on this topic.
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Affiliation(s)
- Kirsten Jung
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
| | - Johanna Kempter
- Department of Neurology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (J.K.); (G.P.); (F.S.-G.)
| | - Georg Prokop
- Department of Neurology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (J.K.); (G.P.); (F.S.-G.)
| | - Tim Herrmann
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
| | - Michael Griessmair
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
| | - Su-Hwan Kim
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
| | - Claire Delbridge
- Department of Pathology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany;
| | - Bernhard Meyer
- Department of Neurosurgery, School of Medicine and Health, Technical University of Munich, 81675 München, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (D.B.); (S.E.C.)
| | - Stephanie E. Combs
- Department of Radiation Oncology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (D.B.); (S.E.C.)
| | - Claus Zimmer
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
| | - Benedikt Wiestler
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
- TranslaTUM, Technical University of Munich, 81675 München, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (J.K.); (G.P.); (F.S.-G.)
| | - Marie-Christin Metz
- Department of Neuroradiology, School of Medicine and Health, Technical University of Munich, 81675 München, Germany; (T.H.); (M.G.); (S.-H.K.); (C.Z.); (B.W.); (M.-C.M.)
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Bae H, Lee B, Hwang S, Lee J, Kim HS, Suh YL. Clinicopathological and Molecular Characteristics of IDH-Wildtype Glioblastoma with FGFR3::TACC3 Fusion. Biomedicines 2024; 12:150. [PMID: 38255255 PMCID: PMC10813214 DOI: 10.3390/biomedicines12010150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The World Health Organization Classification of Tumors of the Central Nervous System recently incorporated histological features, immunophenotypes, and molecular characteristics to improve the accuracy of glioblastoma (GBM) diagnosis. FGFR3::TACC3 (F3T3) fusion has been identified as an oncogenic driver in IDH-wildtype GBMs. Recent studies have demonstrated the potential of using FGFR inhibitors in clinical trials and TACC3-targeting agents in preclinical models for GBM treatment. However, there is limited information on the clinicopathological and genetic features of IDH-wildtype GBMs with F3T3 fusion. The aim of this study was to comprehensively investigate the clinical manifestations, histological features, and mutational profiles of F3T3-positive GBMs. Between September 2017 and February 2023, 25 consecutive cases (5.0%) of F3T3-positive GBM were extracted from 504 cases of IDH-wildtype GBM. Clinicopathological information and targeted sequencing results obtained from 25 primary and 4 recurrent F3T3-positive GBMs were evaluated and compared with those from F3T3-negative GBMs. The provisional grades determined by histology only were distributed as follows: 4 (26/29; 89.7%), 3 (2/29; 6.9%), and 2 (1/29; 3.4%). Grade 2-3 tumors were ultimately diagnosed as grade 4 GBMs based on the identification of the TERT promoter mutation and the combined gain of chromosome 7 and loss of chromosome 10 (7+/10-). F3T3-positive GBMs predominantly affected women (2.6 females per male). The mean age of patients with an F3T3-positive GBM at initial diagnosis was 62 years. F3T3-positive GBMs occurred more frequently in the cortical locations compared to F3T3-negative GBMs. Imaging studies revealed that more than one-third (12/29; 41.4%) of F3T3-positive GBMs displayed a circumscribed tumor border. Seven of the seventeen patients (41.2%) whose follow-up periods exceeded 20 months died of the disease. Histologically, F3T3-positive GBMs more frequently showed curvilinear capillary proliferation, palisading nuclei, and calcification compared to F3T3-negative GBMs. Molecularly, the most common alterations observed in F3T3-positive GBMs were TERT promoter mutations and 7+/10-, whereas amplifications of EGFR, PDGFRA, and KIT were not detected at all. Other genetic alterations included CDKN2A/B deletion, PTEN mutation, TP53 mutation, CDK4 amplification, and MDM2 amplification. Our observations suggest that F3T3-positive GBM is a distinct molecular subgroup of the IDH-wildtype GBM. Both clinicians and pathologists should consider this rare entity in the differential diagnosis of diffuse astrocytic glioma to make an accurate diagnosis and to ensure appropriate therapeutic management.
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Affiliation(s)
- Hyunsik Bae
- Pathology Center, Seegene Medical Foundation, Seoul 04805, Republic of Korea;
| | - Boram Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (B.L.); (S.H.)
| | - Soohyun Hwang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (B.L.); (S.H.)
| | - Jiyeon Lee
- Department of Pathology, Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
| | - Hyun-Soo Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (B.L.); (S.H.)
| | - Yeon-Lim Suh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (B.L.); (S.H.)
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Pallud J, Roux A, Moiraghi A, Aboubakr O, Elia A, Guinard E, Oppenheim C, Tauziede-Espariat A, Parraga E, Gavaret M, Chrètien F, Huberfeld G, Zanello M. Characteristics and Prognosis of Tumor-Related Epilepsy During Tumor Evolution in Patients With IDH Wild-Type Glioblastoma. Neurology 2024; 102:e207902. [PMID: 38165369 PMCID: PMC10834129 DOI: 10.1212/wnl.0000000000207902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Tumor-related epilepsy is a well-known symptom of glioblastoma. However, the particular characteristics of epileptic seizures related to glioblastoma, isocitrate dehydrogenase (IDH)-wild-type is almost unexplored longitudinally during the whole course of the disease. We assessed tumor-related epilepsy and seizure control during tumor evolution and the prognostic significance of tumor-related epilepsy. METHODS We performed an observational, retrospective single-center study at one tertiary referral neuro-oncology surgical center (2000-2020). We included adult patients treated for a newly diagnosed supratentorial glioblastoma, IDH-wild-type with available preoperative and postoperative MRI and with available epileptic seizure status at diagnosis. To determine factors associated with tumor-related epilepsy or seizure control, univariate analyses were performed using the χ2 or Fisher exact tests for categorical variables and the unpaired t test or Mann-Whitney rank-sum test for continuous variables. Predictors associated with tumor-related epilepsy and seizure control in unadjusted analysis were entered into backward stepwise logistic regression models. RESULTS One thousand six patients were enrolled. The cumulative incidence of tumor-related epilepsy increased during tumor evolution (33.1% at diagnosis, 44.7% after oncologic treatment, 52.4% at progression, and 51.8% at the end-of-life phase) and is related to tumor features (cortex involvement, no necrosis, and small volume). Uncontrolled epileptic seizures increased during tumor evolution (20.1% at diagnosis, 32.0% after oncologic treatment, 46.7% at progression, and 41.1% at the end-of-life phase). Epileptic seizure control after oncologic treatment was related to seizure features (uncontrolled before oncologic treatment and focal-to-bilateral tonic-clonic seizures) and to the extent of resection. Epileptic seizure control at tumor progression was related to seizure features (presence at diagnosis and uncontrolled after oncologic treatment) and to the time to progression. Tumor-related epilepsy at diagnosis was a predictor of a longer overall survival (adjusted hazard ratio, 0.78; 95% CI 0.67-0.90; p < 0.001) independent of age, Karnofsky Performance Status score, tumor location and volume, extent of resection, standard combined chemoradiotherapy, levetiracetam use, and MGMT promoter methylation. DISCUSSION The progression of tumor-related epilepsy with the evolution of glioblastoma, IDH-wild-type and the effects of surgery on seizure control argue for proper antiseizure medication and maximal safe resection. Tumor-related epilepsy is an independent predictor of a longer survival.
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Affiliation(s)
- Johan Pallud
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Alexandre Roux
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Alessandro Moiraghi
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Oumaima Aboubakr
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Angela Elia
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Eléonore Guinard
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Catherine Oppenheim
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Arnault Tauziede-Espariat
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Eduardo Parraga
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Martine Gavaret
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Fabrice Chrètien
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Gilles Huberfeld
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
| | - Marc Zanello
- From the Université Paris Cité (J.P., A.R., A.M., A.E., E.G., C.O., M.G., M.Z.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; Departments of Neurosurgery (J.P., A.R., A.M., O.A., A.E., E.P., M.Z.), Neurophysiology (E.G., M.G.), Neuroradiology (C.O.), Neuropathology (A.T.-E., F.C.), and Neurology (G.H.), Hôpital Fondation Adolphe de Rothschild; and Neuroglial Interactions in Cerebral Physiopathology (G.H.), Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Université PSL Paris, France
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Roux A, Elia A, Aboubakr O, Moiraghi A, Simboli GA, Tauziede-Espariat A, Dezamis E, Parraga E, Benevello C, Fathallah H, Chretien F, Oppenheim C, Zanello M, Pallud J. Efficacy and Safety of Carmustine Wafer Implantation After Ventricular Opening in Glioblastomas, Isocitrate Dehydrogenase-Wildtype, in Adults. Neurosurgery 2024:00006123-990000000-01012. [PMID: 38189433 DOI: 10.1227/neu.0000000000002817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES We assessed the impact of ventricular opening on postoperative complications and survival of carmustine wafer implantation during surgery of newly diagnosed supratentorial glioblastomas, isocitrate dehydrogenase (IDH)-wildtype in adults. METHODS We performed an observational, retrospective, single-center cohort study at a tertiary surgical neuro-oncological center between January 2006 and December 2021. RESULTS One hundred ninety-four patients who benefited from a first-line surgical resection with carmustine wafer implantation were included. Seventy patients (36.1%) had a ventricular opening. We showed that ventricular opening (1) did not increase overall postoperative complication rates (P = .201); (2) did not worsen the early postoperative Karnofsky Performance Status score (P = .068); (3) did not increase the time interval from surgery to adjuvant oncological treatment (P = .458); (4) did not affect the completion of the standard radiochemotherapy protocol (P = .164); (5) did not affect progression-free survival (P = .059); and (6) did not affect overall survival (P = .142). CONCLUSION In this study, ventricular opening during first-line surgical resection did not affect the survival and postoperative complications after use of carmustine wafer implantation in adult patients with a newly diagnosed supratentorial glioblastoma, IDH-wildtype. This warrants a prospective and multicentric study to clearly assess the impact of the ventricular opening after carmustine wafer implantation in glioblastoma, IDH-wildtype.
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Affiliation(s)
- Alexandre Roux
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Angela Elia
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Oumaima Aboubakr
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Alessandro Moiraghi
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Giorgia Antonia Simboli
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Arnault Tauziede-Espariat
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
| | - Edouard Dezamis
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
| | - Eduardo Parraga
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
| | - Chiara Benevello
- Service de Neurochirurgie, Hôpital Européen de Paris - La Roseraie, Aubervilliers, France
| | - Houssem Fathallah
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
| | - Fabrice Chretien
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte-Anne, Paris, France
| | - Catherine Oppenheim
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
- Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
| | - Marc Zanello
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, Paris, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris, INSERM U1266, Paris, France
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Kossmann MRP, Ehret F, Roohani S, Winter SF, Ghadjar P, Acker G, Senger C, Schmid S, Zips D, Kaul D. Histopathologically confirmed radiation-induced damage of the brain - an in-depth analysis of radiation parameters and spatio-temporal occurrence. Radiat Oncol 2023; 18:198. [PMID: 38087368 PMCID: PMC10717523 DOI: 10.1186/s13014-023-02385-3] [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: 09/23/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Radiation-induced damage (RID) after radiotherapy (RT) of primary brain tumors and metastases can be challenging to clinico-radiographically distinguish from tumor progression. RID includes pseudoprogression and radiation necrosis; the latter being irreversible and often associated with severe symptoms. While histopathology constitutes the diagnostic gold standard, biopsy-controlled clinical studies investigating RID remain limited. Whether certain brain areas are potentially more vulnerable to RID remains an area of active investigation. Here, we analyze histopathologically confirmed cases of RID in relation to the temporal and spatial dose distribution. METHODS Histopathologically confirmed cases of RID after photon-based RT for primary or secondary central nervous system malignancies were included. Demographic, clinical, and dosimetric data were collected from patient records and treatment planning systems. We calculated the equivalent dose in 2 Gy fractions (EQD22) and the biologically effective dose (BED2) for normal brain tissue (α/β ratio of 2 Gy) and analyzed the spatial and temporal distribution using frequency maps. RESULTS Thirty-three patients were identified. High-grade glioma patients (n = 18) mostly received one normofractionated RT series (median cumulative EQD22 60 Gy) to a large planning target volume (PTV) (median 203.9 ccm) before diagnosis of RID. Despite the low EQD22 and BED2, three patients with an accelerated hyperfractionated RT developed RID. In contrast, brain metastases patients (n = 15; 16 RID lesions) were often treated with two or more RT courses and with radiosurgery or fractionated stereotactic RT, resulting in a higher cumulative EQD22 (median 162.4 Gy), to a small PTV (median 6.7 ccm). All (n = 34) RID lesions occurred within the PTV of at least one of the preceding RT courses. RID in the high-grade glioma group showed a frontotemporal distribution pattern, whereas, in metastatic patients, RID was observed throughout the brain with highest density in the parietal lobe. The cumulative EQD22 was significantly lower in RID lesions that involved the subventricular zone (SVZ) than in lesions without SVZ involvement (median 60 Gy vs. 141 Gy, p = 0.01). CONCLUSIONS Accelerated hyperfractionated RT can lead to RID despite computationally low EQD22 and BED2 in high-grade glioma patients. The anatomical location of RID corresponded to the general tumor distribution of gliomas and metastases. The SVZ might be a particularly vulnerable area.
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Affiliation(s)
- Mario R P Kossmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Radiotherapy and Radiation Oncology, Pius-Hospital Oldenburg, Georgstr. 12, 26121, Oldenburg, Germany
| | - Felix Ehret
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Siyer Roohani
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sebastian F Winter
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Pirus Ghadjar
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Güliz Acker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurosurgery, Charitéplatz 1, 10117, Berlin, Germany
| | - Carolin Senger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Simone Schmid
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuropathology, Charitéplatz 1, 10117, Berlin, Germany
| | - Daniel Zips
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Kaul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Radiation Oncology, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Berlin, Germany; German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Bao H, Wang H, Sun Q, Wang Y, Liu H, Liang P, Lv Z. The involvement of brain regions associated with lower KPS and shorter survival time predicts a poor prognosis in glioma. Front Neurol 2023; 14:1264322. [PMID: 38111796 PMCID: PMC10725945 DOI: 10.3389/fneur.2023.1264322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/14/2023] [Indexed: 12/20/2023] Open
Abstract
Background Isocitrate dehydrogenase-wildtype glioblastoma (IDH-wildtype GBM) and IDH-mutant astrocytoma have distinct biological behaviors and clinical outcomes. The location of brain tumors is closely associated not only with clinical symptoms and prognosis but also with key molecular alterations such as IDH. Therefore, we hypothesize that the key brain regions influencing the prognosis of glioblastoma and astrocytoma are likely to differ. This study aims to (1) identify specific regions that are associated with the Karnofsky Performance Scale (KPS) or overall survival (OS) in IDH-wildtype GBM and IDH-mutant astrocytoma and (2) test whether the involvement of these regions could act as a prognostic indicator. Methods A total of 111 patients with IDH-wildtype GBM and 78 patients with IDH-mutant astrocytoma from the Cancer Imaging Archive database were included in the study. Voxel-based lesion-symptom mapping (VLSM) was used to identify key brain areas for lower KPS and shorter OS. Next, we analyzed the structural and cognitive dysfunction associated with these regions. The survival analysis was carried out using Kaplan-Meier survival curves. Another 72 GBM patients and 48 astrocytoma patients from Harbin Medical University Cancer Hospital were used as a validation cohort. Results Tumors located in the insular cortex, parahippocampal gyrus, and middle and superior temporal gyrus of the left hemisphere tended to lead to lower KPS and shorter OS in IDH-wildtype GBM. The regions that were significantly correlated with lower KPS in IDH-mutant astrocytoma included the subcallosal cortex and cingulate gyrus. These regions were associated with diverse structural and cognitive impairments. The involvement of these regions was an independent predictor for shorter survival in both GBM and astrocytoma. Conclusion This study identified the specific regions that were significantly associated with OS or KPS in glioma. The results may help neurosurgeons evaluate patient survival before surgery and understand the pathogenic mechanisms of glioma in depth.
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Affiliation(s)
- Hongbo Bao
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Huan Wang
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Qian Sun
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Yujie Wang
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Hui Liu
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Peng Liang
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
| | - Zhonghua Lv
- Department of Neurosurgery, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, China
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Liu X, Zhang Q, Li J, Xu Q, Zhuo Z, Li J, Zhou X, Lu M, Zhou Q, Pan H, Wu N, Zhou Q, Shi F, Lu G, Liu Y, Zhang Z. Coordinatized lesion location analysis empowering ROI-based radiomics diagnosis on brain gliomas. Eur Radiol 2023; 33:8776-8787. [PMID: 37382614 DOI: 10.1007/s00330-023-09871-y] [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: 10/12/2022] [Revised: 05/09/2023] [Accepted: 05/16/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES To assess the value of coordinatized lesion location analysis (CLLA), in empowering ROI-based imaging diagnosis of gliomas by improving accuracy and generalization performances. METHODS In this retrospective study, pre-operative contrasted T1-weighted and T2-weighted MR images were obtained from patients with gliomas from three centers: Jinling Hospital, Tiantan Hospital, and the Cancer Genome Atlas Program. Based on CLLA and ROI-based radiomic analyses, a fusion location-radiomics model was constructed to predict tumor grades, isocitrate dehydrogenase (IDH) status, and overall survival (OS). An inter-site cross-validation strategy was used for assessing the performances of the fusion model on accuracy and generalization with the value of area under the curve (AUC) and delta accuracy (ACC) (ACCtesting-ACCtraining). Comparisons of diagnostic performances were performed between the fusion model and the other two models constructed with location and radiomics analysis using DeLong's test and Wilcoxon signed ranks test. RESULTS A total of 679 patients (mean age, 50 years ± 14 [standard deviation]; 388 men) were enrolled. Based on tumor location probabilistic maps, fusion location-radiomics models (averaged AUC values of grade/IDH/OS: 0.756/0.748/0.768) showed the highest accuracy in contrast to radiomics models (0.731/0.686/0.716) and location models (0.706/0.712/0.740). Notably, fusion models ([median Delta ACC: - 0.125, interquartile range: 0.130]) demonstrated improved generalization than that of radiomics model ([- 0.200, 0.195], p = 0.018). CONCLUSIONS CLLA could empower ROI-based radiomics diagnosis of gliomas by improving the accuracy and generalization of the models. CLINICAL RELEVANCE STATEMENT This study proposed a coordinatized lesion location analysis for glioma diagnosis, which could improve the performances of the conventional ROI-based radiomics model in accuracy and generalization. KEY POINTS • Using coordinatized lesion location analysis, we mapped anatomic distribution patterns of gliomas with specific pathological and clinical features and constructed glioma prediction models. • We integrated coordinatized lesion location analysis into ROI-based analysis of radiomics to propose new fusion location-radiomics models. • Fusion location-radiomics models, with the advantages of being less influenced by variabilities, improved accuracy, and generalization performances of ROI-based radiomics models on predicting the diagnosis of gliomas.
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Affiliation(s)
- Xiaoxue Liu
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China
| | - Qirui Zhang
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China
| | - Jianrui Li
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China
| | - Qiang Xu
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Junjie Li
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xian Zhou
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China
| | - Mengjie Lu
- School of Public Health, Shanghai JiaoTong University School of Medicine, Shanghai, 200240, China
| | - Qingqing Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, 211100, China
| | - Hao Pan
- Department of Neurosurgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Nan Wu
- Department of Pathology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China
| | - Qing Zhou
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, 200232, China
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, 200232, China
| | - Guangming Lu
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, 210093, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhiqiang Zhang
- Department of Diagnostic Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, 305#, Eastern Zhongshan Rd, Nanjing, 210002, China.
- State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing, 210093, China.
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Salvalaggio A, Pini L, Gaiola M, Velco A, Sansone G, Anglani M, Fekonja L, Chioffi F, Picht T, Thiebaut de Schotten M, Zagonel V, Lombardi G, D’Avella D, Corbetta M. White Matter Tract Density Index Prediction Model of Overall Survival in Glioblastoma. JAMA Neurol 2023; 80:1222-1231. [PMID: 37747720 PMCID: PMC10520843 DOI: 10.1001/jamaneurol.2023.3284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/07/2023] [Indexed: 09/26/2023]
Abstract
Importance The prognosis of overall survival (OS) in patients with glioblastoma (GBM) may depend on the underlying structural connectivity of the brain. Objective To examine the association between white matter tracts affected by GBM and patients' OS by means of a new tract density index (TDI). Design, Setting, and Participants This prognostic study in patients with a histopathologic diagnosis of GBM examined a discovery cohort of 112 patients who underwent surgery between February 1, 2015, and November 30, 2020 (follow-up to May 31, 2023), in Italy and 70 patients in a replicative cohort (n = 70) who underwent surgery between September 1, 2012, and November 30, 2015 (follow-up to May 31, 2023), in Germany. Statistical analyses were performed from June 1, 2021, to May 31, 2023. Thirteen and 12 patients were excluded from the discovery and the replicative sets, respectively, because of magnetic resonance imaging artifacts. Exposure The density of white matter tracts encompassing GBM. Main Outcomes and Measures Correlation, linear regression, Cox proportional hazards regression, Kaplan-Meier, and prediction analysis were used to assess the association between the TDI and OS. Results were compared with common prognostic factors of GBM, including age, performance status, O6-methylguanine-DNA methyltransferase methylation, and extent of surgery. Results In the discovery cohort (n = 99; mean [SD] age, 62.2 [11.5] years; 29 female [29.3%]; 70 male [70.7%]), the TDI was significantly correlated with OS (r = -0.34; P < .001). This association was more stable compared with other prognostic factors. The TDI showed a significant regression pattern (Cox: hazard ratio, 0.28 [95% CI, 0.02-0.55; P = .04]; linear: t = -2.366; P = .02). and a significant Kaplan-Meier stratification of patients as having lower or higher OS based on the TDI (log-rank test = 4.52; P = .03). Results were confirmed in the replicative cohort (n = 58; mean [SD] age, 58.5 [11.1] years, 14 female [24.1%]; 44 male [75.9%]). High (24-month cutoff) and low (18-month cutoff) OS was predicted based on the TDI computed in the discovery cohort (accuracy = 87%). Conclusions and Relevance In this study, GBMs encompassing regions with low white matter tract density were associated with longer OS. These findings indicate that the TDI is a reliable presurgical outcome predictor that may be considered in clinical trials and clinical practice. These findings support a framework in which the outcome of GBM depends on the patient's brain organization.
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Affiliation(s)
- Alessandro Salvalaggio
- Clinica Neurologica, Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Lorenzo Pini
- Clinica Neurologica, Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Matteo Gaiola
- Clinica Neurologica, Department of Neuroscience, University of Padova, Padova, Italy
| | - Aron Velco
- Clinica Neurologica, Department of Neuroscience, University of Padova, Padova, Italy
| | - Giulio Sansone
- Clinica Neurologica, Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Lucius Fekonja
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence “Matters of Activity. Image Space Material,” Humboldt University, Berlin, Germany
| | - Franco Chioffi
- Division of Neurosurgery, Azienda Ospedaliera Università di Padova, Padova, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité Universitätsmedizin Berlin, Berlin, Germany
- Cluster of Excellence “Matters of Activity. Image Space Material,” Humboldt University, Berlin, Germany
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France
- Groupe d’Imagerie Neurofonctionnelle, Institut des Maladies Neurodégénératives-UMR 5293, CNRS, CEA University of Bordeaux, Bordeaux, France
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padova, Italy
| | - Domenico D’Avella
- Academic Neurosurgery, Department of Neurosciences, University of Padova, Padova, Italy
| | - Maurizio Corbetta
- Clinica Neurologica, Department of Neuroscience, University of Padova, Padova, Italy
- Padova Neuroscience Center, University of Padova, Padova, Italy
- Venetian Institute of Molecular Medicine, Fondazione Biomedica, Padova, Italy
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Osadebey M, Liu Q, Fuster-Garcia E, Emblem KE. Interpreting deep learning models for glioma survival classification using visualization and textual explanations. BMC Med Inform Decis Mak 2023; 23:225. [PMID: 37853371 PMCID: PMC10583453 DOI: 10.1186/s12911-023-02320-2] [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: 12/12/2022] [Accepted: 10/02/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Saliency-based algorithms are able to explain the relationship between input image pixels and deep-learning model predictions. However, it may be difficult to assess the clinical value of the most important image features and the model predictions derived from the raw saliency map. This study proposes to enhance the interpretability of saliency-based deep learning model for survival classification of patients with gliomas, by extracting domain knowledge-based information from the raw saliency maps. MATERIALS AND METHODS Our study includes presurgical T1-weighted (pre- and post-contrast), T2-weighted and T2-FLAIR MRIs of 147 glioma patients from the BraTs 2020 challenge dataset aligned to the SRI 24 anatomical atlas. Each image exam includes a segmentation mask and the information of overall survival (OS) from time of diagnosis (in days). This dataset was divided into training ([Formula: see text]) and validation ([Formula: see text]) datasets. The extent of surgical resection for all patients was gross total resection. We categorized the data into 42 short (mean [Formula: see text] days), 30 medium ([Formula: see text] days), and 46 long ([Formula: see text] days) survivors. A 3D convolutional neural network (CNN) trained on brain tumour MRI volumes classified all patients based on expected prognosis of either short-term, medium-term, or long-term survival. We extend the popular 2D Gradient-weighted Class Activation Mapping (Grad-CAM), for the generation of saliency map, to 3D and combined it with the anatomical atlas, to extract brain regions, brain volume and probability map that reveal domain knowledge-based information. RESULTS For each OS class, a larger tumor volume was associated with a shorter OS. There were 10, 7 and 27 tumor locations in brain regions that uniquely associate with the short-term, medium-term, and long-term survival, respectively. Tumors located in the transverse temporal gyrus, fusiform, and palladium are associated with short, medium and long-term survival, respectively. The visual and textual information displayed during OS prediction highlights tumor location and the contribution of different brain regions to the prediction of OS. This algorithm design feature assists the physician in analyzing and understanding different model prediction stages. CONCLUSIONS Domain knowledge-based information extracted from the saliency map can enhance the interpretability of deep learning models. Our findings show that tumors overlapping eloquent brain regions are associated with short patient survival.
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Affiliation(s)
- Michael Osadebey
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway.
| | - Qinghui Liu
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
| | - Elies Fuster-Garcia
- Biomedical Data Science Laboratory,Instituto Universitario de Tecnologias de la Informacion Comunicaciones, Universitat Politècnica de València, 46022, Valencia, Spain
| | - Kyrre E Emblem
- Department of Physics and Computational Radiology, Division of Radiology and Nuclear Medicine, Oslo University Hospital, Sognsvannsveien 20, 0372, Oslo, Norway
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11
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Nakajima R, Kinoshita M, Okita H, Nakada M. Glioblastomas at the white matter of temporo-parietal junction cause a poor postoperative independence level. J Neurooncol 2023; 165:191-199. [PMID: 37847481 DOI: 10.1007/s11060-023-04479-0] [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: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Right cerebral hemispheric glioblastomas (GBMs) often decrease the Karnofsky performance status (KPS) score postoperatively, despite the patient having sufficient patient function while performing daily living. This study aimed to evaluate the factors that could cause poor KPS scores during the postoperative chronic phase in patients with right cerebral hemispheric GBMs. METHODS Data of 47 patients with newly diagnosed right cerebral hemispheric GBMs were analyzed. All patients were assessed preoperatively and 3 months postoperatively to determine KPS and brain function. To determine tumor location related to the postoperative KPS scores, we used voxel-based lesion symptom mapping (VLSM). The patients were divided into two groups (involvement and non-involvement groups) based on whether their lesion involved a significant region identified by VLSM. We then compared functional factors and prognosis between the groups using the chi-squared and log-rank tests, respectively. RESULTS The KPS score significantly decreased after surgery compared to that preoperatively measured (p = 0.023). VLSM revealed that tumors in the white matter of temporo-parietal junction (WM-TPJ) caused a significant decline in the KPS score at three months postoperatively. The patients in the involvement group had a higher probability of impaired attention, visuospatial cognition, emotion recognition, and visual field than did those in the non-involvement group. In addition, tumor in the WM-TPJ were associated with shorter progression-free survival and overall survival (p = 0.039 and 0.023, respectively). CONCLUSIONS GBMs involving the right WM-TPJ are more likely to result in poor postoperative KPS scores and prognoses. Impairments of several kinds of brain functions caused by tumor invasion to the WM-TPJ may be associated with lower KPS scores.
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Affiliation(s)
- Riho Nakajima
- Department of Occupational Therapy, Faculty of Health Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Hirokazu Okita
- Department of Physical Medicine and Rehabilitation, Kanazawa University Hospital, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Division of Neuroscience, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
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12
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Guo X, Gu L, Li Y, Zheng Z, Chen W, Wang Y, Wang Y, Xing H, Shi Y, Liu D, Yang T, Xia Y, Li J, Wu J, Zhang K, Liang T, Wang H, Liu Q, Jin S, Qu T, Guo S, Li H, Wang Y, Ma W. Histological and molecular glioblastoma, IDH-wildtype: a real-world landscape using the 2021 WHO classification of central nervous system tumors. Front Oncol 2023; 13:1200815. [PMID: 37483487 PMCID: PMC10358772 DOI: 10.3389/fonc.2023.1200815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Glioblastoma (GBM), the most lethal primary brain malignancy, is divided into histological (hist-GBM) and molecular (mol-GBM) subtypes according to the 2021 World Health Organization classification of central nervous system tumors. This study aimed to characterize the clinical, radiological, molecular, and survival features of GBM under the current classification scheme and explore survival determinants. Methods We re-examined the genetic alterations of IDH-wildtype diffuse gliomas at our institute from 2011 to 2022, and enrolled GBMs for analysis after re-classification. Univariable and multivariable analyses were used to identify survival determinants. Results Among 209 IDH-wildtype gliomas, 191 were GBMs, including 146 hist-GBMs (76%) and 45 mol-GBMs (24%). Patients with mol-GBMs were younger, less likely to develop preoperative motor dysfunction, and more likely to develop epilepsy than hist-GBMs. Mol-GBMs exhibited lower radiographic incidences of contrast enhancement and intratumoral necrosis. Common molecular features included copy-number changes in chromosomes 1, 7, 9, 10, and 19, as well as alterations in EGFR, TERT, CDKN2A/B, and PTEN, with distinct patterns observed between the two subtypes. The median overall survival (mOS) of GMB was 12.6 months. Mol-GBMs had a higher mOS than hist-GBMs, although not statistically significant (15.6 vs. 11.4 months, p=0.17). Older age, male sex, tumor involvement of deep brain structure or functional area, and genetic alterations in CDK4, CDK6, CIC, FGFR3, KMT5B, and MYB were predictors for a worse prognosis, while MGMT promoter methylation, maximal tumor resection, and treatment based on the Stupp protocol were predictive for better survival. Conclusion The definition of GBM and its clinical, radiological, molecular, and prognostic characteristics have been altered under the current classification.
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Affiliation(s)
- Xiaopeng Guo
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Anti-Cancer Association Specialty Committee of Glioma, Peking Union Medical College Hospital, Beijing, China
| | - Lingui Gu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yilin Li
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- ’4 + 4’ Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiyao Zheng
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Research Unit of Accurate Diagnosis, Treatment, and Translational Medicine of Brain Tumors (No.2019RU011), Chinese Academy of Medical Sciences, Beijing, China
| | - Wenlin Chen
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaning Wang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuekun Wang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hao Xing
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yixin Shi
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Delin Liu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tianrui Yang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xia
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junlin Li
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiaming Wu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kun Zhang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingyu Liang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hai Wang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qianshu Liu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shanmu Jin
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- ’4 + 4’ Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tian Qu
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siying Guo
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanzhang Li
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Wang
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Anti-Cancer Association Specialty Committee of Glioma, Peking Union Medical College Hospital, Beijing, China
| | - Wenbin Ma
- Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- China Anti-Cancer Association Specialty Committee of Glioma, Peking Union Medical College Hospital, Beijing, China
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13
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Deboeuf L, Moiraghi A, Debacker C, Peeters SM, Simboli GA, Roux A, Dezamis E, Oppenheim C, Chretien F, Pallud J, Zanello M. Feasibility and Accuracy of Robot-Assisted, Stereotactic Biopsy Using 3-Dimensional Intraoperative Imaging and Frameless Registration Tool. Neurosurgery 2023; 92:803-811. [PMID: 36700740 DOI: 10.1227/neu.0000000000002294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Robot-assisted stereotactic biopsy is evolving: 3-dimensional intraoperative imaging tools and new frameless registration systems are spreading. OBJECTIVE To investigate the accuracy and effectiveness of a new stereotactic biopsy procedure. METHODS Observational, retrospective analysis of consecutive robot-assisted stereotactic biopsies using the Neurolocate (Renishaw) frameless registration system and intraoperative O-Arm (Medtronic) performed at a single institution in adults (2019-2021) and comparison with a historical series from the same institution (2006-2016) not using the Neurolocate nor the O-Arm. RESULTS In 100 patients (55% men), 6.2 ± 2.5 (1-14) biopsy samples were obtained at 1.7 ± 0.7 (1-3) biopsy sites. An histomolecular diagnosis was obtained in 96% of cases. The mean duration of the procedure was 59.0 ± 22.3 min. The mean distance between the planned and the actual target was 0.7 ± 0.7 mm. On systematic postoperative computed tomography scans, a hemorrhage ≥10 mm was observed in 8 cases (8%) while pneumocephalus was distant from the biopsy site in 76%. A Karnofsky Performance Status score decrease ≥20 points postoperatively was observed in 4%. The average dose length product was 159.7 ± 63.4 mGy cm. Compared with the historical neurosurgical procedure, this new procedure had similar diagnostic yield (96 vs 98.7%; P = .111) and rate of postoperative disability (4.0 vs 4.2%, P = .914) but was shorter (57.8 ± 22.9 vs 77.8 ± 20.9 min; P < .001) despite older patients. CONCLUSION Robot-assisted stereotactic biopsy using the Neurolocate frameless registration system and intraoperative O-Arm is a safe and effective neurosurgical procedure. The accuracy of this robot-assisted surgery supports its effectiveness for daily use in stereotactic neurosurgery.
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Affiliation(s)
- Louise Deboeuf
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Sophie M Peeters
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA
| | - Giorgia Antonia Simboli
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
| | - Catherine Oppenheim
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuroradiology, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
- Department of Neuropathology, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris - Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
- Université de Paris, Paris , France
- INSERM UMR 1266, IMA-BRAIN, Institute of Psychiatry and Neurosciences of Paris, Paris, France
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14
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You W, Mao Y, Jiao X, Wang D, Liu J, Lei P, Liao W. The combination of radiomics features and VASARI standard to predict glioma grade. Front Oncol 2023; 13:1083216. [PMID: 37035137 PMCID: PMC10073533 DOI: 10.3389/fonc.2023.1083216] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Background and Purpose Radiomics features and The Visually AcceSAble Rembrandt Images (VASARI) standard appear to be quantitative and qualitative evaluations utilized to determine glioma grade. This study developed a preoperative model to predict glioma grade and improve the efficacy of clinical strategies by combining these two assessment methods. Materials and Methods Patients diagnosed with glioma between March 2017 and September 2018 who underwent surgery and histopathology were enrolled in this study. A total of 3840 radiomic features were calculated; however, using the least absolute shrinkage and selection operator (LASSO) method, only 16 features were chosen to generate a radiomic signature. Three predictive models were developed using radiomic features and VASARI standard. The performance and validity of models were evaluated using decision curve analysis and 10-fold nested cross-validation. Results Our study included 102 patients: 35 with low-grade glioma (LGG) and 67 with high-grade glioma (HGG). Model 1 utilized both radiomics and the VASARI standard, which included radiomic signatures, proportion of edema, and deep white matter invasion. Models 2 and 3 were constructed with radiomics or VASARI, respectively, with an area under the receiver operating characteristic curve (AUC) of 0.937 and 0.831, respectively, which was less than that of Model 1, with an AUC of 0.966. Conclusion The combination of radiomics features and the VASARI standard is a robust model for predicting glioma grades.
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Affiliation(s)
- Wei You
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Yitao Mao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Jiao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Dongcui Wang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Jianling Liu
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Peng Lei
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Molecular Imaging Research Center, Central South University, Changsha, China
- *Correspondence: Weihua Liao,
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Abd Elmaogod EA, Daoud SA, Mostafa ZM, Mahmoud EMM. Prognostic significance of HIF1-α immunohistochemical expression in gliomas and it's relation to IDH1 mutation status. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00325-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Abstract
Background
Gliomas are the commonest primary adults’ brain tumors. Hypoxia performs an essential role in gliomas’ initiation as well as progression through hypoxia inducible factor (HIF-1α) activation, which could serve as a promising target in treatment of gliomas. Our study aimed to evaluate types and grades of glioma cases and detect isocitrate dehydrogenase 1 (IDH1) mutation status and expression of HIF-1α in all included cases and its correlation with clinical data and pathological parameters.
Results
Samples from 71 patients who were diagnosed with glioma were studied immunohistochemically for IDH1-R132H (if indicated) and HIF-1α expression. Expression of HIF-1α was detected in 73.2% of the included 71 gliomas. HIF-1α expression significantly increased in older patients, in high-grade gliomas and in tumors positive for necrosis. We studied IDH1 mutation in the histologically diagnosed grade 2, 3and 4 astrocytic and oligodendroglial tumors (51 cases out of the included 71 gliomas). IDH1-R132H immunohistochemical expression was positive in 62.7% of cases. IDH1 mutation was significantly higher with younger age. IDH1 mutation was noted also with lower tumor grade. A statistically significant relation was detected between negative IDH1-R132H expression and high level of HIF-1α immunohistochemical expression.
Conclusion
Absence of IDH1 mutation with increased HIF-1α expression among high-grade gliomas suggesting both as predicting indicators for poor prognosis.
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A Head-to-Head Comparison of 18F-Fluorocholine PET/CT and Conventional MRI as Predictors of Outcome in IDH Wild-Type High-Grade Gliomas. J Clin Med 2022; 11:jcm11206065. [PMID: 36294385 PMCID: PMC9605635 DOI: 10.3390/jcm11206065] [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: 08/22/2022] [Revised: 10/01/2022] [Accepted: 10/06/2022] [Indexed: 01/24/2023] Open
Abstract
(1) Aim: To study the associations between imaging parameters derived from contrast-enhanced MRI (CE-MRI) and 18F-fluorocholine PET/CT and their performance as prognostic predictors in isocitrate dehydrogenase wild-type (IDH-wt) high-grade gliomas. (2) Methods: A prospective, multicenter study (FuMeGA: Functional and Metabolic Glioma Analysis) including patients with baseline CE-MRI and 18F-fluorocholine PET/CT and IDH wild-type high-grade gliomas. Clinical variables such as performance status, extent of surgery and adjuvant treatments (Stupp protocol vs others) were obtained and used to discriminate overall survival (OS) and progression-free survival (PFS) as end points. Multilesionality was assessed on the visual analysis of PET/CT and CE-MRI images. After tumor segmentation, standardized uptake value (SUV)-based variables for PET/CT and volume-based and geometrical variables for PET/CT and CE-MRI were calculated. The relationships among imaging techniques variables and their association with prognosis were evaluated using Pearson’s chi-square test and the t-test. Receiver operator characteristic, Kaplan−Meier and Cox regression were used for the survival analysis. (3) Results: 54 patients were assessed. The median PFS and OS were 5 and 11 months, respectively. Significant strong relationships between volume-dependent variables obtained from PET/CT and CE-MRI were found (r > 0.750, p < 0.05). For OS, significant associations were found with SUVmax, SUVpeak, SUVmean and sphericity (HR: 1.17, p = 0.035; HR: 1.24, p = 0.042; HR: 1.62, p = 0.040 and HR: 0.8, p = 0.022, respectively). Among clinical variables, only Stupp protocol and age showed significant associations with OS and PFS. No CE-MRI derived variables showed significant association with prognosis. In multivariate analysis, age (HR: 1.04, p = 0.002), Stupp protocol (HR: 2.81, p = 0.001), multilesionality (HR: 2.20, p = 0.013) and sphericity (HR: 0.79, p = 0.027) derived from PET/CT showed independent associations with OS. For PFS, only age (HR: 1.03, p = 0.021) and treatment protocol (HR: 2.20, p = 0.008) were significant predictors. (4) Conclusions: 18F-fluorocholine PET/CT metabolic and radiomic variables were robust prognostic predictors in patients with IDH-wt high-grade gliomas, outperforming CE-MRI derived variables.
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17
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Ashraf M, Abdelsadg M, Grivas A. Relationship between molecular characteristics of glioblastoma multiforme and the subventricular zone. Br J Neurosurg 2022:1-8. [PMID: 35038937 DOI: 10.1080/02688697.2021.2024144] [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: 08/25/2021] [Revised: 11/13/2021] [Accepted: 12/24/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aims to assess the relationship between the molecular characteristics of glioblastoma multiforme (GBM) and the subventricular zone (SVZ). MATERIAL AND METHODS Eligible patients had their data anonymously collected from an institutional database, including age, sex, preoperative performance status, the extent of tumour resection, anatomical location, IDH mutation and MGMT methylation status. An Institutional picture archiving and communications system was used for volumetric and morphometric analysis. All measurements were made on T1-weighted magnetic resonance images with gadolinium contrast enhancement. IDH wild-type and mutant GBMs were stratified by MGMT methylation status. The relationship between tumour volume, distance from the tumour's enhancing edge and the tumour's geometric centre to the SVZ and their molecular characteristics were assessed. RESULTS Fifty IDH wild-type GBMs were studied. Twenty-three were MGMT methylated, Twenty-seven were unmethylated. IDH wild-type MGMT methylated GBMs were significantly associated with a tumour's enhancing boundary being contiguous to the SVZ (P < 0.001). Ninety percent of tumours contiguous to the SVZ were wild-type methylated (n = 18) and 10% were unmethylated (n = 2). Mean GBM geometric centre distance to SVZ was significantly less for methylated wild-type GBMs compared to unmethylated (P = 0.025) and median GBM distance from the tumour's edge of enhancement to the SVZ was significantly shorter in methylated tumours compared to unmethylated (P < 0.001). Mean and median distances to SVZ from the edge of enhancement was 3.8 millimetres (mm) and 0 mm, respectively, for wild-type methylated GBMs, while for unmethylated wild-types, 14.6 mm, and 12.5 mm. There was no anatomical localisation of IDH wild-type GBMs by MGMT methylation status to a cerebral hemisphere or lobe. CONCLUSION IDH wild-type GBMs contiguous to the SVZ are highly likely to be MGMT methylated. Replication by further studies is required to affirm our results and conclusion.
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Affiliation(s)
- Mohammad Ashraf
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
- Medical Student, Wolfson School of Medicine, University of Glasgow, Scotland, UK
| | - Mohamed Abdelsadg
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Athanasios Grivas
- Department of Neurosurgery, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
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Roux A, Varlet P, Pallud J. Age influences the distribution of diffuse gliomas. Aging (Albany NY) 2021; 13:19083-19084. [PMID: 34376624 PMCID: PMC8386541 DOI: 10.18632/aging.203414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Alexandre Roux
- Service de Neurochirurgie, GHU Paris – Hôpital Sainte-Anne, Paris, France
- Université de Paris, Sorbonne Paris Cité, Paris, France
- Inserm UMR 1266, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Pascale Varlet
- Service de Neurochirurgie, GHU Paris – Hôpital Sainte-Anne, Paris, France
- Université de Paris, Sorbonne Paris Cité, Paris, France
- Service de Neuropathologie, GHU Paris – Hôpital Sainte-Anne, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris – Hôpital Sainte-Anne, Paris, France
- Université de Paris, Sorbonne Paris Cité, Paris, France
- Inserm UMR 1266, IMA-BRAIN, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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19
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Pallud J, Roux A, Trancart B, Peeters S, Moiraghi A, Edjlali M, Oppenheim C, Varlet P, Chrétien F, Dhermain F, Zanello M, Dezamis E. Surgery of Insular Diffuse Gliomas-Part 2: Probabilistic Cortico-Subcortical Atlas of Critical Eloquent Brain Structures and Probabilistic Resection Map During Transcortical Awake Resection. Neurosurgery 2021; 89:579-590. [PMID: 34383936 DOI: 10.1093/neuros/nyab255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/12/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Insular diffuse glioma surgery is challenging, and tools to help surgical planning could improve the benefit-to-risk ratio. OBJECTIVE To provide a probabilistic resection map and frequency atlases of critical eloquent regions of insular diffuse gliomas based on our surgical experience. METHODS We computed cortico-subcortical "eloquent" anatomic sites identified intraoperatively by direct electrical stimulations during transcortical awake resection of insular diffuse gliomas in adults. RESULTS From 61 insular diffuse gliomas (39 left, 22 right; all left hemispheric dominance for language), we provided a frequency atlas of eloquence of the opercula (left/right; pars orbitalis: 0%/5.0%; pars triangularis: l5.6%/4.5%; pars opercularis: 37.8%/27.3%; precentral gyrus: 97.3%/95.4%; postcentral and supramarginal gyri: 75.0%/57.1%; temporal pole and superior temporal gyrus: 13.3%/0%), which tailored the transcortical approach (frontal operculum to reach the antero-superior insula, temporal operculum to reach the inferior insula, parietal operculum to reach the posterior insula). We provided a frequency atlas of eloquence identifying the subcortical functional boundaries (36.1% pyramidal pathways, 50.8% inferior fronto-occipital fasciculus, 13.1% arcuate and superior longitudinal fasciculi complex, 3.3% somatosensory pathways, 8.2% caudate and lentiform nuclei). Vascular boundaries and increasing errors during testing limited the resection in 8.2% and 11.5% of cases, respectively. We provided a probabilistic 3-dimensional atlas of resectability. CONCLUSION Functional mapping under awake conditions has to be performed intraoperatively in each patient to guide surgical approach and resection of insular diffuse gliomas in right and left hemispheres. Frequency atlases of opercula eloquence and of subcortical eloquent anatomic boundaries, and probabilistic 3-dimensional atlas of resectability could guide neurosurgeons.
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Affiliation(s)
- Johan Pallud
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alexandre Roux
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Bénédicte Trancart
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Alessandro Moiraghi
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Myriam Edjlali
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Neuroradiology, GHU Paris - Sainte-Anne Hospital, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Neuroradiology, GHU Paris - Sainte-Anne Hospital, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Department of Neuropathology, GHU Paris - Sainte-Anne Hospital, Paris, France
| | - Fabrice Chrétien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Department of Neuropathology, GHU Paris - Sainte-Anne Hospital, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Marc Zanello
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Edouard Dezamis
- Department of Neurosurgery, GHU Paris - Sainte-Anne Hospital, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, U1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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20
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Fyllingen EH, Bø LE, Reinertsen I, Jakola AS, Sagberg LM, Berntsen EM, Salvesen Ø, Solheim O. Survival of glioblastoma in relation to tumor location: a statistical tumor atlas of a population-based cohort. Acta Neurochir (Wien) 2021; 163:1895-1905. [PMID: 33742279 PMCID: PMC8195961 DOI: 10.1007/s00701-021-04802-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/03/2021] [Indexed: 02/03/2023]
Abstract
Purpose Previous studies on the effect of tumor location on overall survival in glioblastoma have found conflicting results. Based on statistical maps, we sought to explore the effect of tumor location on overall survival in a population-based cohort of patients with glioblastoma and IDH wild-type astrocytoma WHO grade II–III with radiological necrosis. Methods Patients were divided into three groups based on overall survival: < 6 months, 6–24 months, and > 24 months. Statistical maps exploring differences in tumor location between these three groups were calculated from pre-treatment magnetic resonance imaging scans. Based on the results, multivariable Cox regression analyses were performed to explore the possible independent effect of centrally located tumors compared to known prognostic factors by use of distance from center of the third ventricle to contrast-enhancing tumor border in centimeters as a continuous variable. Results A total of 215 patients were included in the statistical maps. Central tumor location (corpus callosum, basal ganglia) was associated with overall survival < 6 months. There was also a reduced overall survival in patients with tumors in the left temporal lobe pole. Tumors in the dorsomedial right temporal lobe and the white matter region involving the left anterior paracentral gyrus/dorsal supplementary motor area/medial precentral gyrus were associated with overall survival > 24 months. Increased distance from center of the third ventricle to contrast-enhancing tumor border was a positive prognostic factor for survival in elderly patients, but less so in younger patients. Conclusions Central tumor location was associated with worse prognosis. Distance from center of the third ventricle to contrast-enhancing tumor border may be a pragmatic prognostic factor in elderly patients. Supplementary Information The online version contains supplementary material available at 10.1007/s00701-021-04802-6.
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21
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Feasibility, Safety and Impact on Overall Survival of Awake Resection for Newly Diagnosed Supratentorial IDH-Wildtype Glioblastomas in Adults. Cancers (Basel) 2021; 13:cancers13122911. [PMID: 34200799 PMCID: PMC8230499 DOI: 10.3390/cancers13122911] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary A few studies have suggested the benefits of awake surgery by maximizing the extent of resection while preserving neurological function and improving survival in high-grade glioma patients. However, the histomolecular heterogeneity in these series, mixing grade 3 with grade 4, and IDH-mutated with IDH-wildtype gliomas, represents a major selection bias that may influence survival analyses. For the first time, in a large homogeneous single-institution cohort of newly diagnosed supratentorial IDH-wildtype glioblastoma in adult patients, we assessed feasibility, safety and efficacy of awake surgery using univariate, multivariate and case-matched analysis. Awake surgery was associated with higher resection rates, lower residual tumor rates, and more supratotal resections than asleep resections, allowed standard radiochemotherapy to be performed systematically within a short time between surgery and radiotherapy, and was an independent predictor of progression-free survival and overall survival in the whole series, together with the extent of resection, MGMT promoter methylation status, and standard. Abstract Background: Although awake resection using intraoperative cortico-subcortical functional brain mapping is the benchmark technique for diffuse gliomas within eloquent brain areas, it is still rarely proposed for IDH-wildtype glioblastomas. We have assessed the feasibility, safety, and efficacy of awake resection for IDH-wildtype glioblastomas. Methods: Observational single-institution cohort (2012–2018) of 453 adult patients harboring supratentorial IDH-wildtype glioblastomas who benefited from awake resection, from asleep resection, or from a biopsy. Case matching (1:1) criteria between the awake group and asleep group: gender, age, RTOG-RPA class, tumor side, location and volume and neurosurgeon experience. Results: In patients in the awake resection subgroup (n = 42), supratotal resections were more frequent (21.4% vs. 3.1%, p < 0.0001) while partial resections were less frequent (21.4% vs. 40.1%, p < 0.0001) compared to the asleep (n = 222) resection subgroup. In multivariable analyses, postoperative standard radiochemistry (aHR = 0.04, p < 0.0001), supratotal resection (aHR = 0.27, p = 0.0021), total resection (aHR = 0.43, p < 0.0001), KPS score > 70 (HR = 0.66, p = 0.0013), MGMT promoter methylation (HR = 0.55, p = 0.0031), and awake surgery (HR = 0.54, p = 0.0156) were independent predictors of overall survival. After case matching, a longer overall survival was found for awake resection (HR = 0.47, p = 0.0103). Conclusions: Awake resection is safe, allows larger resections than asleep surgery, and positively impacts overall survival of IDH-wildtype glioblastoma in selected adult patients.
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22
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Roux A, Pallud J, Saffroy R, Edjlali-Goujon M, Debily MA, Boddaert N, Sanson M, Puget S, Knafo S, Adam C, Faillot T, Cazals-Hatem D, Mandonnet E, Polivka M, Dorfmüller G, Dauta A, Desplanques M, Gareton A, Pages M, Tauziede-Espariat A, Grill J, Bourdeaut F, Doz F, Dhermain F, Mokhtari K, Chretien F, Figarella-Branger D, Varlet P. High-grade gliomas in adolescents and young adults highlight histomolecular differences from their adult and pediatric counterparts. Neuro Oncol 2021; 22:1190-1202. [PMID: 32025728 DOI: 10.1093/neuonc/noaa024] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Considering that pediatric high-grade gliomas (HGGs) are biologically distinct from their adult counterparts, the objective of this study was to define the landscape of HGGs in adolescents and young adults (AYAs). METHODS We performed a multicentric retrospective study of 112 AYAs from adult and pediatric Ile-de-France neurosurgical units, treated between 1998 and 2013 to analyze their clinicoradiological and histomolecular profiles. The inclusion criteria were age between 15 and 25 years, histopathological HGG diagnosis, available clinical data, and preoperative and follow-up MRI. MRI and tumoral samples were centrally reviewed. Immunohistochemistry and complementary molecular techniques such as targeted/next-generation sequencing, whole exome sequencing, and DNA-methylation analyses were performed to achieve an integrated diagnosis according to the 2016 World Health Organization (WHO) classification. RESULTS Based on 80 documented AYA patients, HGGs constitute heterogeneous clinicopathological and molecular groups, with a predominant representation of pediatric subtypes (histone H3-mutants, 40%) but also adult subtypes (isocitrate dehydrogenase [IDH] mutants, 28%) characterized by the rarity of oligodendrogliomas, IDH mutants, and 1p/19q codeletion and the relative high frequency of "rare adult IDH mutations" (20%). H3G34-mutants (14%) represent the most specific subgroup in AYAs. In the H3K27-mutant subgroup, non-brainstem diffuse midline gliomas are more frequent (66.7%) than diffuse intrinsic pontine gliomas (23.8%), contrary to what is observed in children. We found that WHO grade has no prognostic value, but molecular subgrouping has major prognostic importance. CONCLUSIONS HGGs in AYAs could benefit from a specific classification, driven by molecular subtyping rather than age group. Collaborative efforts are needed from pediatric and adult neuro-oncology teams to improve the management of HGGs in AYAs.
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Affiliation(s)
- Alexandre Roux
- Department of Neurosurgery, University Hospital Group (GHU) Paris-Sainte-Anne Hospital, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm Unit 1266, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Johan Pallud
- Department of Neurosurgery, University Hospital Group (GHU) Paris-Sainte-Anne Hospital, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm Unit 1266, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Raphaël Saffroy
- Department of Biochemistry, Paul-Brousse Hospital, Villejuif, France
| | | | - Marie-Anne Debily
- Inserm Unit 981, Biomarkers and New Therapeutic Targets in Oncology Team, Genomics and Oncogenesis of Brain Tumors, Paris-Sud University, Paris-Saclay University, Villejuif, France.,Evry University, Paris-Saclay University, Evry cedex, France
| | - Nathalie Boddaert
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neuroradiology, Necker Enfants-Malades Hospital, Paris, France
| | - Marc Sanson
- Brain and Spine Institute (ICM), Experimental Neuro-Oncology Department, Inserm U1127, Sorbonne University, Paris, France.,Department of Neurology 2, Mazarin Unit, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Puget
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Neurosurgery, Necker Enfants-Malades Hospital, Paris, France
| | - Steven Knafo
- Department of Neurosurgery, Bicêtre Hospital, Paris-Sud University, Kremlin-Bicêtre, France
| | - Clovis Adam
- Department of Pathology, Bicêtre Hospital, Paris-Sud University, Kremlin-Bicêtre, France
| | - Thierry Faillot
- Department of Neurosurgery, Beaujon Hospital, Clichy, France
| | | | - Emmanuel Mandonnet
- Department of Neurosurgery, Lariboisière Hospital, Paris, France.,Paris 7 University, Paris, France
| | - Marc Polivka
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm Unit 1266, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France.,Department of Pathology, Lariboisière Hospital, Paris, France
| | - Georges Dorfmüller
- Department of Pediatric Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Aurélie Dauta
- Department of Neurosurgery, Henri-Mordor Hospital, Créteil, France
| | | | - Albane Gareton
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Mélanie Pages
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm Unit 1266, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France.,Department of Pathology, Lariboisière Hospital, Paris, France
| | - Arnault Tauziede-Espariat
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm Unit 1266, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France
| | - Jacques Grill
- Inserm Unit 981, Biomarkers and New Therapeutic Targets in Oncology Team, Genomics and Oncogenesis of Brain Tumors, Paris-Sud University, Paris-Saclay University, Villejuif, France.,Department of Pediatric Oncology, Gustave-Roussy University Hospital, Paris-Sud University, Paris-Saclay University, Villejuif, France
| | - Franck Bourdeaut
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - François Doz
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,SIREDO Oncology Center (Care, Innovation and Research for Children and AYA with Cancer), Institut Curie, Paris, France
| | - Frédéric Dhermain
- Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France
| | - Karima Mokhtari
- Department of Neuroradiology, Necker Enfants-Malades Hospital, Paris, France.,Department of Neuropathology, Pitié-Salpêtrière Hospital, Paris, France
| | - Fabrice Chretien
- Department of Neurosurgery, University Hospital Group (GHU) Paris-Sainte-Anne Hospital, Paris, France
| | | | - Pascale Varlet
- Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Inserm Unit 1266, Imaging Biomarkers of Brain Disorders, Institute of Psychiatry and Neurosciences of Paris, Paris, France
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23
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Tatekawa H, Uetani H, Hagiwara A, Yao J, Oughourlian TC, Ueda I, Raymond C, Lai A, Cloughesy TF, Nghiemphu PL, Liau LM, Bahri S, Pope WB, Salamon N, Ellingson BM. Preferential tumor localization in relation to 18F-FDOPA uptake for lower-grade gliomas. J Neurooncol 2021; 152:573-582. [PMID: 33704629 DOI: 10.1007/s11060-021-03730-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/01/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Although tumor localization and 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine (FDOPA) uptake may have an association, preferential tumor localization in relation to FDOPA uptake is yet to be investigated in lower-grade gliomas (LGGs). This study aimed to identify differences in the frequency of tumor localization between FDOPA hypometabolic and hypermetabolic LGGs using a probabilistic radiographic atlas. METHODS Fifty-one patients with newly diagnosed LGG (WHO grade II, 29; III, 22; isocitrate dehydrogenase wild-type, 21; mutant 1p19q non-codeleted,16; mutant codeleted, 14) who underwent FDOPA positron emission tomography (PET) were retrospectively selected. Semiautomated tumor segmentation on FLAIR was performed. Patients with LGGs were separated into two groups (FDOPA hypometabolic and hypermetabolic LGGs) according to the normalized maximum standardized uptake value of FDOPA PET (a threshold of the uptake in the striatum) within the segmented regions. Spatial normalization procedures to build a 3D MRI-based atlas using each segmented region were validated by an analysis of differential involvement statistical mapping. RESULTS Superimposition of regions of interest showed a high number of hypometabolic LGGs localized in the frontal lobe, while a high number of hypermetabolic LGGs was localized in the insula, putamen, and temporal lobe. The statistical mapping revealed that hypometabolic LGGs occurred more frequently in the superior frontal gyrus (close to the supplementary motor area), while hypermetabolic LGGs occurred more frequently in the insula. CONCLUSION Radiographic atlases revealed preferential frontal lobe localization for FDOPA hypometabolic LGGs, which may be associated with relatively early detection.
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Affiliation(s)
- Hiroyuki Tatekawa
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Uetani
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Jingwen Yao
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Bioengineering, Henry Samueli School of Engineering, University of California Los Angeles, Los Angeles, CA, USA
| | - Talia C Oughourlian
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Neuroscience Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Issei Ueda
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda M Liau
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Shadfar Bahri
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Whitney B Pope
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Blvd., Suite 615, Los Angeles, CA, 90024, USA. .,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Bioengineering, Henry Samueli School of Engineering, University of California Los Angeles, Los Angeles, CA, USA. .,Neuroscience Interdepartmental Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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24
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Tatekawa H, Hagiwara A, Uetani H, Bahri S, Raymond C, Lai A, Cloughesy TF, Nghiemphu PL, Liau LM, Pope WB, Salamon N, Ellingson BM. Differentiating IDH status in human gliomas using machine learning and multiparametric MR/PET. Cancer Imaging 2021; 21:27. [PMID: 33691798 PMCID: PMC7944911 DOI: 10.1186/s40644-021-00396-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to develop a voxel-wise clustering method of multiparametric magnetic resonance imaging (MRI) and 3,4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (FDOPA) positron emission tomography (PET) images using an unsupervised, two-level clustering approach followed by support vector machine in order to classify the isocitrate dehydrogenase (IDH) status of gliomas. Methods Sixty-two treatment-naïve glioma patients who underwent FDOPA PET and MRI were retrospectively included. Contrast enhanced T1-weighted images, T2-weighted images, fluid-attenuated inversion recovery images, apparent diffusion coefficient maps, and relative cerebral blood volume maps, and FDOPA PET images were used for voxel-wise feature extraction. An unsupervised two-level clustering approach, including a self-organizing map followed by the K-means algorithm was used, and each class label was applied to the original images. The logarithmic ratio of labels in each class within tumor regions was applied to a support vector machine to differentiate IDH mutation status. The area under the curve (AUC) of receiver operating characteristic curves, accuracy, and F1-socore were calculated and used as metrics for performance. Results The associations of multiparametric imaging values in each cluster were successfully visualized. Multiparametric images with 16-class clustering revealed the highest classification performance to differentiate IDH status with the AUC, accuracy, and F1-score of 0.81, 0.76, and 0.76, respectively. Conclusions Machine learning using an unsupervised two-level clustering approach followed by a support vector machine classified the IDH mutation status of gliomas, and visualized voxel-wise features from multiparametric MRI and FDOPA PET images. Unsupervised clustered features may improve the understanding of prioritizing multiparametric imaging for classifying IDH status. Supplementary Information The online version contains supplementary material available at 10.1186/s40644-021-00396-5.
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Affiliation(s)
- Hiroyuki Tatekawa
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Diagnostic and Interventional Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akifumi Hagiwara
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Uetani
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shadfar Bahri
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Catalina Raymond
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Albert Lai
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Linda M Liau
- UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.,Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Whitney B Pope
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Noriko Salamon
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Benjamin M Ellingson
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA. .,Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA. .,UCLA Neuro-Oncology Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.
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Zanello M, Roux A, Debacker C, Peeters S, Edjlali-Goujon M, Dhermain F, Dezamis E, Oppenheim C, Lechapt-Zalcman E, Harislur M, Varlet P, Chretien F, Devaux B, Pallud J. Postoperative intracerebral haematomas following stereotactic biopsies: Poor planning or poor execution? Int J Med Robot 2021; 17:e2211. [PMID: 33345461 DOI: 10.1002/rcs.2211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/14/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Postoperative intracerebral haematomas represent a serious complication following stereotactic biopsy. We investigated the possible underlying causes - poor planning or poor execution - of postoperative intracerebral haematomas following stereotactic biopsies. METHODS We performed a technical investigation using a retrospective single-centre consecutive series of robot-assisted stereotactic biopsies for a supratentorial diffuse glioma in adults. Each actual biopsy trajectory was reviewed to search for a conflict with an anatomical structure at risk. RESULTS From 379 patients, 12 (3.2%) presented with a postoperative intracerebral haematoma ≥20 mm on postoperative CT-scan (3 requiring surgical evacuation); 11 of them had available intraoperative imaging (bi-planar stereoscopic teleangiography x-rays at each biopsy site). The actual biopsy trajectory was similar to the planned biopsy trajectory in these 11 cases. In 72.7% (8/11) of these cases, the actual biopsy trajectory was found to contact a structure at risk (blood vessel and cerebral sulcus) and identified as the intracerebral haematoma origin. CONCLUSIONS Robot-assisted stereotactic biopsy is an accurate procedure. Postoperative intracerebral haematomas mainly derive from human-related errors during trajectory planning.
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Affiliation(s)
- Marc Zanello
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Clément Debacker
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Sophie Peeters
- Department of Neurosurgery, University of California, Los Angeles, California, USA
| | - Myriam Edjlali-Goujon
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Frédéric Dhermain
- Département d'Oncologie Radiothérapie, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France
| | - Edouard Dezamis
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Catherine Oppenheim
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuroradiologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Emmanuèle Lechapt-Zalcman
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Marc Harislur
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Pascale Varlet
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Fabrice Chretien
- Université de Paris, Sorbonne Paris Cité, Paris, France.,Service de Neuropathologie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France
| | - Bertrand Devaux
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU Paris - Psychiatrie et Neurosciences - Hôpital Sainte-Anne, Paris, France.,Université de Paris, Sorbonne Paris Cité, Paris, France.,Inserm, UMR1266, IMA-Brain, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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Scheufele K, Subramanian S, Biros G. Fully Automatic Calibration of Tumor-Growth Models Using a Single mpMRI Scan. IEEE TRANSACTIONS ON MEDICAL IMAGING 2021; 40:193-204. [PMID: 32931431 PMCID: PMC8565678 DOI: 10.1109/tmi.2020.3024264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Our objective is the calibration of mathematical tumor growth models from a single multiparametric scan. The target problem is the analysis of preoperative Glioblastoma (GBM) scans. To this end, we present a fully automatic tumor-growth calibration methodology that integrates a single-species reaction-diffusion partial differential equation (PDE) model for tumor progression with multiparametric Magnetic Resonance Imaging (mpMRI) scans to robustly extract patient specific biomarkers i.e., estimates for (i) the tumor cell proliferation rate, (ii) the tumor cell migration rate, and (iii) the original, localized site(s) of tumor initiation. Our method is based on a sparse reconstruction algorithm for the tumor initial location (TIL). This problem is particularly challenging due to nonlinearity, ill-posedeness, and ill conditioning. We propose a coarse-to-fine multi-resolution continuation scheme with parameter decomposition to stabilize the inversion. We demonstrate robustness and practicality of our method by applying the proposed method to clinical data of 206 GBM patients. We analyze the extracted biomarkers and relate tumor origin with patient overall survival by mapping the former into a common atlas space. We present preliminary results that suggest improved accuracy for prediction of patient overall survival when a set of imaging features is augmented with estimated biophysical parameters. All extracted features, tumor initial positions, and biophysical growth parameters are made publicly available for further analysis. To our knowledge, this is the first fully automatic scheme that can handle multifocal tumors and can localize the TIL to a few millimeters.
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Mistry AM, Mummareddy N, Salwi S, Davis LT, Ihrie RA. Glioblastoma Distance From the Subventricular Neural Stem Cell Niche Does Not Correlate With Survival. Front Oncol 2020; 10:564889. [PMID: 33363006 PMCID: PMC7759619 DOI: 10.3389/fonc.2020.564889] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
Objective To determine the relationship between survival and glioblastoma distance from the ventricular-subventricular neural stem cell niche (VSVZ). Methods 502 pre-operative gadolinium-enhanced, T1-weighted MRIs with glioblastoma retrieved from an institutional dataset (n = 252) and The Cancer Imaging Atlas (n=250) were independently reviewed. The shortest distance from the tumor contrast enhancement to the nearest lateral ventricular wall, the location of the VSVZ, was measured (GBM-VSVZDist). The relationship of GBM-VSVZDist with the proportion of glioblastomas at each distance point and overall survival was explored with a Pearson's correlation and Cox regression model, respectively, adjusting for the well-established glioblastoma prognosticators. Results 244/502 glioblastomas had VSVZ contact. The proportion of non-VSVZ-contacting glioblastomas correlated inversely with GBM-VSVZDist (partial Pearson's correlation adjusted for tumor volume R=-0.79, p=7.11x10-7). A fit of the Cox regression model adjusted for age at diagnosis, Karnofsky performance status score, post-operative treatment with temozolomide and/or radiotherapy, IDH1/2 mutation status, MGMT promoter methylation status, tumor volume, and extent of resection demonstrated a significantly decreased overall survival only when glioblastoma contacted the VSVZ. Overall survival did not correlate with GBM-VSVZDist. Conclusions In the two independent cohorts analyzed, glioblastomas at diagnosis were found in close proximity or in contact with the VSVZ with a proportion that decreased linearly with GBM-VSVZDist. Patient survival was only influenced by the presence or absence of a gadolinium-enhanced glioblastoma contact with the VSVZ. These results may guide analyses to test differential effectiveness of VSVZ radiation in VSVZ-contacting and non-contacting glioblastomas and/or inform patient selection criteria in clinical trials of glioblastoma radiation.
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Affiliation(s)
- Akshitkumar M Mistry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Nishit Mummareddy
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sanjana Salwi
- School of Medicine, Vanderbilt University, Nashville, TN, United States
| | - Larry T Davis
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Rebecca A Ihrie
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN, United States.,Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN, United States
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Incekara F, van der Voort SR, Dubbink HJ, Atmodimedjo PN, Nandoe Tewarie R, Lycklama G, Vincent AJPE, Kros JM, Klein S, van den Bent M, Smits M. Topographical Mapping of 436 Newly Diagnosed IDH Wildtype Glioblastoma With vs. Without MGMT Promoter Methylation. Front Oncol 2020; 10:596. [PMID: 32477929 PMCID: PMC7235346 DOI: 10.3389/fonc.2020.00596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/01/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: O6-methylguanine-methyltransferase (MGMT) promoter methylation and isocitrate dehydrogenase (IDH) mutation status are important prognostic factors for patients with glioblastoma. There are conflicting reports about a differential topographical distribution of glioblastoma with vs. without MGMT promoter methylation, possibly caused by molecular heterogeneity in glioblastoma populations. We initiated this study to re-evaluate the topographical distribution of glioblastoma with vs. without MGMT promoter methylation in light of the updated WHO 2016 classification. Methods: Preoperative T2-weighted/FLAIR and postcontrast T1-weighted MRI scans of patients aged 18 year or older with IDH wildtype glioblastoma were collected. Tumors were semi-automatically segmented, and the topographical distribution between glioblastoma with vs. without MGMT promoter methylation was visualized using frequency heatmaps. Then, voxel-wise differences were analyzed using permutation testing with Threshold Free Cluster Enhancement. Results: Four hundred thirty-six IDH wildtype glioblastoma patients were included; 211 with and 225 without MGMT promoter methylation. Visual examination suggested that when compared with MGMT unmethylated glioblastoma, MGMT methylated glioblastoma were more frequently located near bifrontal and left occipital periventricular area and less frequently near the right occipital periventricular area. Statistical analyses, however, showed no significant difference in topographical distribution between MGMT methylated vs. MGMT unmethylated glioblastoma. Conclusions: This study re-evaluated the topographical distribution of MGMT promoter methylation in 436 newly diagnosed IDH wildtype glioblastoma, which is the largest homogenous IDH wildtype glioblastoma population to date. There was no statistically significant difference in anatomical localization between MGMT methylated vs. unmethylated IDH wildtype glioblastoma.
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Affiliation(s)
- Fatih Incekara
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sebastian R van der Voort
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Hendrikus J Dubbink
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Peggy N Atmodimedjo
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | - Geert Lycklama
- Department of Radiology, Haaglanden MC, The Hague, Netherlands
| | - Arnaud J P E Vincent
- Department of Neurosurgery, Brain Tumor Center, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Johan M Kros
- Department of Pathology, Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Stefan Klein
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Martin van den Bent
- Department of Neurology, Brain Tumor Center, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Marion Smits
- Department of Radiology and Nuclear Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, Netherlands
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