2
|
Bruno F, Pellerino A, Conti Nibali M, Pronello E, Cofano F, Rossi M, Levis M, Bertero L, Soffietti R, Cassoni P, Garbossa D, Bello L, Rudà R. Association of Clinical, Tumor, and Treatment Characteristics With Seizure Control in Patients With IDH1/2-Mutant Lower-Grade Glioma. Neurology 2024; 102:e209352. [PMID: 38684041 DOI: 10.1212/wnl.0000000000209352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with IDH1/2-mutant lower-grade glioma have a high frequency of seizures. We aimed to investigate the correlations between seizures and tumor/patient characteristics and the impact of surgery and adjuvant treatments (AT) on seizure control along the disease trajectory. METHODS We retrospectively included patients with IDH1/2-mutant lower-grade glioma who underwent surgery at the neurosurgery divisions of the University of Turin and Milan and were treated at the Division of Neuro-Oncology of Turin. Inclusion criteria were a diagnosis according to the 2021 WHO Classification and presentation with seizures; exclusion criteria were presence of CDKN2A/B homozygous deletion, intense/ring contrast enhancement on MRI at presentation, and small tissue biopsy. We evaluated seizure freedom for 2 months after surgery, 6 months from starting observation or AT, at recurrence, and for 6 months after treatments of recurrence. RESULTS We included 150 patients. There were 77 (51%) and 31 (21%) patients with IDH-mutant/1p19q-codeleted grade 2 and 3 oligodendroglioma and 30 (20%) and 12 (8%) with IDH-mutant grade 2 and 3 astrocytoma, respectively. Total resection was accomplished in 68 (45%). Seventy-five patients (50%) received AT while the remaining 75 were observed with MRI. After 6 months after AT, 28 of 29 patients (96.5%) displayed seizure reduction, 5 of 28 (18%) being seizure-free. 66 of 124 patients (53%) had seizures at recurrence. After 6 months after second-line treatments, 60 of 66 patients (91%) had seizure reduction, 11 (17%) being seizure-free. In multivariable analyses, grade 3 histology positively correlated with seizure freedom at 2 months after surgery (OR 3.5, 1.4-8.9, p = 0.008), 6 months after AT (OR 9.0, 1.5-54.9, p = 0.017), and 6 months after treatment of recurrence (OR 4.9, 1.5-16.5, p = 0.009). Adjuvant radiotherapy reduced seizures at recurrence in a univariate analysis (OR 0.14, 0.03-0.7, p = 0.020). Patients with seizure freedom after surgery and AT displayed longer progression-free survival (PFS) (65, 24.5-105, vs 48 months, 32-63.5, p = 0.037). DISCUSSION This study analyzed seizure control in patients with IDH1/2-mutant lower-grade glioma across multiple time points. Grade 3 correlated with better seizure control throughout the entire disease trajectory, and seizure freedom after surgery and AT correlated with a longer PFS regardless of tumor grade. These results could serve as an external control arm in clinical trials evaluating the efficacy on seizures of antitumor agents in patients with IDH-mutant lower-grade glioma.
Collapse
Affiliation(s)
- Francesco Bruno
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Alessia Pellerino
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Marco Conti Nibali
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Edoardo Pronello
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Fabio Cofano
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Marco Rossi
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Mario Levis
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Luca Bertero
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Riccardo Soffietti
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Paola Cassoni
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Diego Garbossa
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Lorenzo Bello
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| | - Roberta Rudà
- From the Division of Neuro-Oncology (F.B., A.P., R.S., R.R.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital, Turin; Neurosurgical Oncology Unit (M.C.N., M.R., L. Bello), "Galeazzi - Sant'Ambrogio" IRCCS, Milan; Departments of Oncology and Hemato-Oncology (L. Bello) and Medical Biotechnology and Translational Medicine (M.R.), University of Milan; Division of Neuro-Oncology (E.P.), Department of Neuroscience "Rita Levi di Montalcini", University and City of Health and Science Hospital, Turin; Neurology Unit (E.P.), Department of Translational Medicine, University of Eastern Piedmont, Novara; Division of Neurosurgery (F.C., D.G.), Department of Neuroscience "Rita Levi Montalcini", University and City of Health and Science Hospital; Division of Radiotherapy (M.L.), Department of Oncology; and Pathology Unit (L. Bertero, P.C.), Department of Medical Sciences, University of Turin, Italy
| |
Collapse
|
3
|
Tang T, Wang Y, Dai Y, Liu Q, Fan X, Cheng Y, Tang J, Xiao X, Shan Y, Wei P, Zhao G. IDH1 mutation predicts seizure occurrence and prognosis in lower-grade glioma adults. Pathol Res Pract 2024; 254:155165. [PMID: 38286053 DOI: 10.1016/j.prp.2024.155165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/21/2024] [Accepted: 01/21/2024] [Indexed: 01/31/2024]
Abstract
Epileptic seizures are frequently the first symptom in glioma patients. However, the causal relationship between glioma and epilepsy is not yet fully understood, as it cannot be explained solely by tumor mass effect or peritumoral factors. In this study, we retrospectively enrolled 320 patients with grade 2-4 glioma who received treatment between January 2019 and July 2022, and explored the biomarkers of seizure occurrence and seizure outcome prediction using univariate and multivariate logistic regression analyses. Our results showed that IDH1 R132H mutation was an independent risk factor for seizure occurrence in lower-grade glioma (LGG) patients (OR = 4.915, 95%CI = 1.713 - 14.103, P = 0.003). Additionally, IDH1 R132H mutation predicted higher seizure-free ratios in LGG patients with intact ATRX expression (OR = 6.793, 95%CI = 1.217 - 37.923, P = 0.029) one year after diagnosis. Therefore, our findings suggest that IDH1 mutation can predict seizure occurrence and control in LGG patients, providing further insights into the relationship between glioma and epilepsy.
Collapse
Affiliation(s)
- Ting Tang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yihe Wang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yang Dai
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Quanlei Liu
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Xiaotong Fan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China; Clinical Research Center for Epilepsy, Capital Medical University, Beijing 100053, China
| | - Ye Cheng
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yongzhi Shan
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China; Clinical Research Center for Epilepsy, Capital Medical University, Beijing 100053, China
| | - Penghu Wei
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China; Clinical Research Center for Epilepsy, Capital Medical University, Beijing 100053, China.
| | - Guoguang Zhao
- Department of Neurosurgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China; Clinical Research Center for Epilepsy, Capital Medical University, Beijing 100053, China; Beijing Municipal Geriatric Medical Research Center, Beijing 100053, China.
| |
Collapse
|