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Kim JT, Chang SJC, Haghdel A, Ramakrishna RR, Pannullo SC, Schwartz TH, Osborne JR, Magge RS, Fine HA, Cisse B, Stieg P, Lin E, Roytman M, Palmer JD, Karakatsanis NA, Pisapia D, Liechty B, Knisely JPS, Ivanidze J. DOTATATE PET/MR Imaging Differentiates Secondary-Progressive from de Novo World Health Organization Grade 3 Meningiomas. AJNR Am J Neuroradiol 2024:ajnr.A8219. [PMID: 38604734 DOI: 10.3174/ajnr.a8219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/02/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND PURPOSE WHO grade 3 meningiomas are rare and poorly understood and have a higher propensity for recurrence, metastasis, and worsened clinical outcomes compared with lower-grade meningiomas. The purpose of our study was to prospectively evaluate the molecular profile, PET characteristics, and outcomes of patients with World Health Organization grade 3 meningiomas who were imaged with gallium 68 (68Ga) DOTATATE PET/MR imaging. MATERIALS AND METHODS Patients with World Health Organization grade 3 meningiomas enrolled in our prospective observational cohort evaluating the utility of (68Ga) DOTATATE PET/MR imaging in somatostatin receptor positive brain tumors were included. We stratified patients by de novo-versus-secondary-progressive status and evaluated the differences in the PET standard uptake value, molecular profiles, and clinical outcomes. RESULTS Patients met the inclusion criteria (secondary-progressive: 7/14; de novo: 7/14). The secondary-progressive cohort had a significantly higher per-patient number of surgeries (4.1 versus 1.6; P = .011) and trended toward a higher number of radiation therapy courses (2.4 versus 1.6; P = .23) and cumulative radiation therapy doses (106Gy versus 68.3Gy; P = .31). The secondary-progressive cohort had a significantly lower progression-free survival compared with the de novo cohort (4.8 versus 37.7 months; P = .004). Secondary-progressive tumors had distinct molecular pathology profiles with higher numbers of mutations (3.5 versus 1.2; P = .024). Secondary-progressive tumors demonstrated higher PET standard uptake values (17.1 versus 12.4; P = .0021). CONCLUSIONS Our study confirms prior work illustrating distinct clinical outcomes in secondary-progressive and de novo World Health Organization grade 3 meningiomas. Furthermore, our findings support (68Ga) DOTATATE PET/MR imaging as a useful management strategy in World Health Organization grade 3 meningiomas and provide insight into meningioma biology, as well as clinical management implications.
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Affiliation(s)
- Joon Tae Kim
- From the Weill Cornell Medical College (J.T.K., S.J.C.C., A.H.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Se Jung Chris Chang
- From the Weill Cornell Medical College (J.T.K., S.J.C.C., A.H.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Arsalan Haghdel
- From the Weill Cornell Medical College (J.T.K., S.J.C.C., A.H.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Rohan R Ramakrishna
- Department of Neurological Surgery (R.R.R., S.C.P., T.H.S., B.C., P.S.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Susan C Pannullo
- Department of Neurological Surgery (R.R.R., S.C.P., T.H.S., B.C., P.S.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Theodore H Schwartz
- Department of Neurological Surgery (R.R.R., S.C.P., T.H.S., B.C., P.S.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Joseph R Osborne
- Departments of Radiology (J.R.O., E.L., M.R., N.A.K., J.I.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Rajiv S Magge
- Department of Neurology (R.S.M., H.A.F.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Howard A Fine
- Department of Neurology (R.S.M., H.A.F.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Babacar Cisse
- Department of Neurological Surgery (R.R.R., S.C.P., T.H.S., B.C., P.S.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Philip Stieg
- Department of Neurological Surgery (R.R.R., S.C.P., T.H.S., B.C., P.S.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Eaton Lin
- Departments of Radiology (J.R.O., E.L., M.R., N.A.K., J.I.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Michelle Roytman
- Departments of Radiology (J.R.O., E.L., M.R., N.A.K., J.I.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Joshua D Palmer
- Department of Neuro-Oncology (J.D.P.), Ohio State University, Columbus, Ohio
| | - Nicolas A Karakatsanis
- Departments of Radiology (J.R.O., E.L., M.R., N.A.K., J.I.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - David Pisapia
- Department of Pathology and Laboratory Medicine (D.P., B.L.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Benjamin Liechty
- Department of Pathology and Laboratory Medicine (D.P., B.L.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Jonathan P S Knisely
- Department of Radiation Oncology (J.P.S.K.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
| | - Jana Ivanidze
- Departments of Radiology (J.R.O., E.L., M.R., N.A.K., J.I.), Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York
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Ohara K, Rendeiro AF, Bhinder B, Eng KW, Ravichandran H, Nguyen D, Pisapia D, Vosoughi A, Fernandez E, Shohdy KS, Manohar J, Beg S, Wilkes D, Robinson BD, Khani F, Bareja R, Tagawa ST, Ouseph MM, Sboner A, Elemento O, Faltas BM, Mosquera JM. The evolution of metastatic upper tract urothelial carcinoma through genomic-transcriptomic and single-cell protein markers analysis. Nat Commun 2024; 15:2009. [PMID: 38499531 PMCID: PMC10948878 DOI: 10.1038/s41467-024-46320-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/22/2024] [Indexed: 03/20/2024] Open
Abstract
The molecular characteristics of metastatic upper tract urothelial carcinoma (UTUC) are not well understood, and there is a lack of knowledge regarding the genomic and transcriptomic differences between primary and metastatic UTUC. To address these gaps, we integrate whole-exome sequencing, RNA sequencing, and Imaging Mass Cytometry using lanthanide metal-conjugated antibodies of 44 tumor samples from 28 patients with high-grade primary and metastatic UTUC. We perform a spatially-resolved single-cell analysis of cancer, immune, and stromal cells to understand the evolution of primary to metastatic UTUC. We discover that actionable genomic alterations are frequently discordant between primary and metastatic UTUC tumors in the same patient. In contrast, molecular subtype membership and immune depletion signature are stable across primary and matched metastatic UTUC. Molecular and immune subtypes are consistent between bulk RNA-sequencing and mass cytometry of protein markers from 340,798 single cells. Molecular subtypes at the single-cell level are highly conserved between primary and metastatic UTUC tumors within the same patient.
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Affiliation(s)
- Kentaro Ohara
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - André Figueiredo Rendeiro
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
- CeMM Research Center for Molecular Medicine of the Austrian Academy of Sciences, Lazarettgasse 14 AKH BT 25.3, 1090, Vienna, Austria
| | - Bhavneet Bhinder
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Kenneth Wha Eng
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Hiranmayi Ravichandran
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Duy Nguyen
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, 10065, USA
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Aram Vosoughi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Evan Fernandez
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Kyrillus S Shohdy
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Jyothi Manohar
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Shaham Beg
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - David Wilkes
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
| | - Rohan Bareja
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Scott T Tagawa
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, 10065, USA
- Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, New York, NY, 10065, USA
| | - Madhu M Ouseph
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Andrea Sboner
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
| | - Olivier Elemento
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, 1300 York Avenue, New York, NY, 10065, USA
- Institute for Computational Biomedicine, Weill Cornell Medicine, 1305 York Avenue, New York, NY, 10021, USA
- Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, New York, NY, 10065, USA
| | - Bishoy M Faltas
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA.
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY, 10065, USA.
- Sandra and Edward Meyer Cancer Center at Weill Cornell Medicine, New York, NY, 10065, USA.
- Departments of Cell and Developmental Biology, Weill Cornell Medicine, New York, NY, 10065, USA.
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, 10065, USA.
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, 10021, USA.
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3
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Khani F, Hooper WF, Wang X, Chu TR, Shah M, Winterkorn L, Sigouros M, Conteduca V, Pisapia D, Wobker S, Walker S, Graff JN, Robinson B, Mosquera JM, Sboner A, Elemento O, Robine N, Beltran H. Author Correction: Evolution of structural rearrangements in prostate cancer intracranial metastases. NPJ Precis Oncol 2023; 7:113. [PMID: 37919447 PMCID: PMC10622446 DOI: 10.1038/s41698-023-00469-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Affiliation(s)
- Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Xiaofei Wang
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Michael Sigouros
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Vincenza Conteduca
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medical and Surgical Sciences, Unit of Medical Oncology and Biomolecular Therapy, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sara Wobker
- Department of Pathology and Laboratory Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Sydney Walker
- Department of Medical Oncology, Oregon Health Sciences University, Portland, OR, USA
| | - Julie N Graff
- Department of Medical Oncology, Oregon Health Sciences University, Portland, OR, USA
| | - Brian Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Andrea Sboner
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | | | - Himisha Beltran
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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4
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Khani F, Hooper WF, Wang X, Chu TR, Shah M, Winterkorn L, Sigouros M, Conteduca V, Pisapia D, Wobker S, Walker S, Graff JN, Robinson B, Mosquera JM, Sboner A, Elemento O, Robine N, Beltran H. Evolution of structural rearrangements in prostate cancer intracranial metastases. NPJ Precis Oncol 2023; 7:91. [PMID: 37704749 PMCID: PMC10499931 DOI: 10.1038/s41698-023-00435-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
Intracranial metastases in prostate cancer are uncommon but clinically aggressive. A detailed molecular characterization of prostate cancer intracranial metastases would improve our understanding of their pathogenesis and the search for new treatment strategies. We evaluated the clinical and molecular characteristics of 36 patients with metastatic prostate cancer to either the dura or brain parenchyma. We performed whole genome sequencing (WGS) of 10 intracranial prostate cancer metastases, as well as WGS of primary prostate tumors from men who later developed metastatic disease (n = 6) and nonbrain prostate cancer metastases (n = 36). This first whole genome sequencing study of prostate intracranial metastases led to several new insights. First, there was a higher diversity of complex structural alterations in prostate cancer intracranial metastases compared to primary tumor tissues. Chromothripsis and chromoplexy events seemed to dominate, yet there were few enrichments of specific categories of structural variants compared with non-brain metastases. Second, aberrations involving the AR gene, including AR enhancer gain were observed in 7/10 (70%) of intracranial metastases, as well as recurrent loss of function aberrations involving TP53 in 8/10 (80%), RB1 in 2/10 (20%), BRCA2 in 2/10 (20%), and activation of the PI3K/AKT/PTEN pathway in 8/10 (80%). These alterations were frequently present in tumor tissues from other sites of disease obtained concurrently or sequentially from the same individuals. Third, clonality analysis points to genomic factors and evolutionary bottlenecks that contribute to metastatic spread in patients with prostate cancer. These results describe the aggressive molecular features underlying intracranial metastasis that may inform future diagnostic and treatment approaches.
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Affiliation(s)
- Francesca Khani
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Xiaofei Wang
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | | | | | - Michael Sigouros
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Vincenza Conteduca
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Medical and Surgical Sciences, Unit of Medical Oncology and Biomolecular Therapy, University of Foggia, Policlinico Riuniti, Foggia, Italy
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sara Wobker
- Department of Pathology and Laboratory Medicine, UNC Chapel Hill, Chapel Hill, NC, USA
| | - Sydney Walker
- Department of Medical Oncology, Oregon Health Sciences University, Portland, OR, USA
| | - Julie N Graff
- Department of Medical Oncology, Oregon Health Sciences University, Portland, OR, USA
| | - Brian Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Andrea Sboner
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- The HRH Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Physiology and Biophysics, Weill Cornell Medicine, New York, NY, USA
| | | | - Himisha Beltran
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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5
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Giantini-Larsen AM, Kharas N, Pisapia D, Schwartz TH. Histology of high-grade glioma samples resected using 5-ALA fluorescent headlight and loupe combination. Acta Neurochir (Wien) 2023; 165:567-575. [PMID: 36656388 DOI: 10.1007/s00701-023-05496-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE 5-Aminolevulinic acid (5-ALA) fluorescence-guided resection of high-grade gliomas (HGG) increases the extent of resection (EOR) and progression-free survival. The headlamp/loupe combination has been introduced as a method of performing fluorescent-guided surgery. This study aims to understand the correlation between fluorescent intensity and histology and between residual fluorescence and radiographic EOR utilizing the headlamp/loupe device. METHODS Intraoperative samples resected using the headlamp/loupe device from 14 patients were labeled as PINK, VAGUE, or NEGATIVE depending on the degree of fluorescence. Histological assessment of microvascular proliferation, necrosis, and cell density was performed, and samples were classified as histologically consistent with glioblastoma (GBM), high-grade infiltrating glioma (HGIG), IG, or non-diagnostic (NDX). The presence of intraoperative residual fluorescence was compared to EOR on post-operative MRI. RESULTS There was a significant difference in cell density comparing PINK, VAGUE, and NEGATIVE specimens (ANOVA, p < 0.00001). The PPV of PINK for GBM or HGIG was 88.4% (38/43). The NPV of NEGATIVE for IG or NDX was 74.4% (29/39). The relationship between the degree of fluorescence determination and histological results was significant (X2 (6 degrees of freedom, N = 101) = 42.57, p < 0.00001). The PPV of intraoperative GTR for post-operative GTR on MRI was 100%, while the NPV of intraoperative STR for post-operative STR on MRI was 60%. CONCLUSION The headlamp/loupe device provides information about histology, cell density, and necrosis with similar PPV for tumor to the operative microscope. Safe complete resection of florescence has a PPV of 100% for radiographic GTR and should be the goal of surgery.
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Affiliation(s)
- Alexandra M Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Natasha Kharas
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - David Pisapia
- Department of Pathology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA. .,Department of Neurosurgery, New York-Presbyterian Hospital, 525 East 68th Street, Box #99, New York, NY, 10065, USA.
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6
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Galbraith K, Vasudevaraja V, Serrano J, Shen G, Tran I, Abdallat N, Wen M, Patel S, Movahed-Ezazi M, Faustin A, Spino-Keeton M, Roberts LG, Maloku E, Drexler SA, Liechty BL, Pisapia D, Krasnozhen-Ratush O, Rosenblum M, Shroff S, Boué DR, Davidson C, Mao Q, Suchi M, North P, Hopp A, Segura A, Jarzembowski JA, Parsons L, Johnson MD, Mobley B, Samore W, McGuone D, Gopal PP, Canoll PD, Horbinski C, Fullmer JM, Farooqi MS, Gokden M, Wadhwani NR, Richardson TE, Umphlett M, Tsankova NM, DeWitt JC, Sen C, Placantonakis DG, Pacione D, Wisoff JH, Teresa Hidalgo E, Harter D, William CM, Cordova C, Kurz SC, Barbaro M, Orringer DA, Karajannis MA, Sulman EP, Gardner SL, Zagzag D, Tsirigos A, Allen JC, Golfinos JG, Snuderl M. Clinical utility of whole-genome DNA methylation profiling as a primary molecular diagnostic assay for central nervous system tumors-A prospective study and guidelines for clinical testing. Neurooncol Adv 2023; 5:vdad076. [PMID: 37476329 PMCID: PMC10355794 DOI: 10.1093/noajnl/vdad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Central nervous system (CNS) cancer is the 10th leading cause of cancer-associated deaths for adults, but the leading cause in pediatric patients and young adults. The variety and complexity of histologic subtypes can lead to diagnostic errors. DNA methylation is an epigenetic modification that provides a tumor type-specific signature that can be used for diagnosis. Methods We performed a prospective study using DNA methylation analysis as a primary diagnostic method for 1921 brain tumors. All tumors received a pathology diagnosis and profiling by whole genome DNA methylation, followed by next-generation DNA and RNA sequencing. Results were stratified by concordance between DNA methylation and histopathology, establishing diagnostic utility. Results Of the 1602 cases with a World Health Organization histologic diagnosis, DNA methylation identified a diagnostic mismatch in 225 cases (14%), 78 cases (5%) did not classify with any class, and in an additional 110 (7%) cases DNA methylation confirmed the diagnosis and provided prognostic information. Of 319 cases carrying 195 different descriptive histologic diagnoses, DNA methylation provided a definitive diagnosis in 273 (86%) cases, separated them into 55 methylation classes, and changed the grading in 58 (18%) cases. Conclusions DNA methylation analysis is a robust method to diagnose primary CNS tumors, improving diagnostic accuracy, decreasing diagnostic errors and inconclusive diagnoses, and providing prognostic subclassification. This study provides a framework for inclusion of DNA methylation profiling as a primary molecular diagnostic test into professional guidelines for CNS tumors. The benefits include increased diagnostic accuracy, improved patient management, and refinements in clinical trial design.
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Affiliation(s)
- Kristyn Galbraith
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Varshini Vasudevaraja
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Jonathan Serrano
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Guomiao Shen
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Ivy Tran
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Nancy Abdallat
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Mandisa Wen
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Seema Patel
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Misha Movahed-Ezazi
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Arline Faustin
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Marissa Spino-Keeton
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Leah Geiser Roberts
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Ekrem Maloku
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Steven A Drexler
- Department of Pathology and Laboratory Medicine, NYU, Mineola, New York, USA
- Current affiliations: Department of Pathology, Mount Sinai South Nassau Hospital, Oceanside, New York, USA
| | - Benjamin L Liechty
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College - New York Presbyterian Hospital, New York, New York, USA
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College - New York Presbyterian Hospital, New York, New York, USA
| | - Olga Krasnozhen-Ratush
- Department of Pathology and Laboratory Medicine, Baystate Health, Springfield, Massachusetts, USA
| | - Marc Rosenblum
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Seema Shroff
- Department of Pathology and Laboratory Medicine, AdventHealth Orlando, Orlando, Florida, USA
| | - Daniel R Boué
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, and the Ohio State University, Columbus, Ohio, USA
| | | | - Qinwen Mao
- Department of Pathology, University of Utah, Salt Lake City, Utah, USA
| | - Mariko Suchi
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Paula North
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Annette Segura
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jason A Jarzembowski
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lauren Parsons
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mahlon D Johnson
- Department of Pathology, University of Rochester School of Medicine, New York, USA
| | - Bret Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Wesley Samore
- Department of Pathology, Advocate Aurora Health, Chicago, Illinois, USA
| | - Declan McGuone
- Department of Pathology, Yale University School of Medicine, Connecticut, USA
| | - Pallavi P Gopal
- Department of Pathology, Yale University School of Medicine, Connecticut, USA
| | - Peter D Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, USA
| | - Craig Horbinski
- Departments of Pathology and Neurosurgery, Feinberg School of Medicine, Northwestern University, Illinois, USA
| | - Joseph M Fullmer
- Department of Pathology, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Midhat S Farooqi
- Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Murat Gokden
- Department of Pathology, University of Arkansas and Arkansas Children’s Hospital, Little Rock, Arkansas, USA
| | - Nitin R Wadhwani
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Illinois, USA
| | - Timothy E Richardson
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Umphlett
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nadejda M Tsankova
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John C DeWitt
- Department of Pathology, University of Vermont Medical Center
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | | | - Donato Pacione
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | - Jeffrey H Wisoff
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | | | - David Harter
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | - Christopher M William
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
| | - Christine Cordova
- Department of Neuro-oncology, NYU Langone, New York, New York, USA
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic, Cleveland, OH
| | - Sylvia C Kurz
- Department of Neuro-oncology, NYU Langone, New York, New York, USA
- Department of Interdisciplinary Neuro-Oncology, Comprehensive Cancer Center, University of Tuebingen, Tübingen, Germany
| | - Marissa Barbaro
- Department of Neuro-oncology, NYU Langone, New York, New York, USA
| | | | - Matthias A Karajannis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Langone, New York, New York, USA
| | | | - David Zagzag
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | | | - Jeffrey C Allen
- Department of Pediatrics, NYU Langone, New York, New York, USA
| | - John G Golfinos
- Department of Neurosurgery, NYU Langone, New York, New York, USA
| | - Matija Snuderl
- Department of Pathology, NYU Langone Health, New York, Department of Pathology, NYU Langone, New York, USA
- Laura and Isaac Perlmutter Cancer Center, New York, New York, USA
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7
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Knisely J, Chang SJ, Kim SH, Haghdel A, Roytman M, Madera G, Magge R, Liechty B, Pisapia D, Noch E, Fine H, Pannullo S, Juthani R, Ramakrishna R, Schwartz T, Stieg P, Cisse B, Brandmaier A, Karakatsanis N, Osborne J, Lin E, Ivanidze J. NIMG-92. DOTATATE PET/MR-GUIDED POSTOPERATIVE RADIOTHERAPY IN SUBTOTALLY RESECTED WHO-2 MENINGIOMA: EVALUATION OF PROGRESSION-FREE SURVIVAL IN A PROSPECTIVE COHORT. Neuro Oncol 2022. [PMCID: PMC9660819 DOI: 10.1093/neuonc/noac209.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
Current postoperative management recommendations for meningioma lack Level 1 evidence. NRG-0539 (NCT00895622) treated recurrent WHO-1 and newly diagnosed and completely resected (by postoperative MRI) WHO-2 meningiomas with postoperative fractionated radiotherapy to 54 Gy, but 3 year PFS remained below 60%. MRI, the standard of care (SOC) for meningioma radiotherapy planning, lacks sensitivity for postoperative small volume disease and osseous or parenchymal invasion. More sensitive and specific imaging biomarkers are needed to improve RT guidance and thereby clinical outcomes in meningioma. [68Ga]-DOTATATE is a PET radiotracer targeting somatostatin receptor 2 (SSTR2), a highly sensitive and specific meningioma biomarker. We developed a dedicated DOTATATE brain PET/MRI protocol allowing meningioma differentiation from post-treatment change, using SUV analysis and Patlak modeling. Our prospective observational trial (NCT04081701) has imaged over 90 patients with meningioma. This IRB-approved study evaluated PFS in patients with WHO-2 tumors who did not achieve GTR by [68Ga]-DOTATATE PET/MRI, managed with PET/MR guided RT, hypothesizing that the PFS of patients with STR by PET/MRI managed with PET/MR guided RT would be higher than for comparable patients enrolled on NRG 0539.
METHODS
92 patients with SSTR2-positive brain neoplasms were enrolled between 9/2019 and 5/2022 and imaged according to our previously published protocol. 7 patients met inclusion criteria (WHO-2 meningioma; postoperative PET/MR with residual activity) who underwent PET/MR-guided RT, followed with SOC MRI. Kaplan-Meier survival analysis was performed.
RESULTS
5/7 subjects (71%) were women; the mean age was 50.7 years. MRI follow-up data were available for a mean of 18.7 months (range: 16-24 months). All patients remain progression-free at this time; Kaplan-Meier analysis demonstrated 2-year PFS to be 100%, which is substantially higher than reported PFS in this clinical population using standard-of-care MRI-guided RT.
CONCLUSIONS
[68Ga]-DOTATATE PET/MR-guidance can improve PFS following postoperative RT in subtotally resected WHO-2 meningiomas.
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Affiliation(s)
| | | | - Sean H Kim
- Weill Cornell Medicine , New York CIty , USA
| | | | | | | | - Rajiv Magge
- Weill Cornell Medicine , New York CIty , USA
| | | | | | - Evan Noch
- Weill Cornell Medicine , New York CIty , USA
| | - Howard Fine
- Weill Cornell Medicine , New York CIty , USA
| | | | | | | | | | | | | | | | | | | | - Eaton Lin
- Weill Cornell Medicine , New York CIty , USA
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8
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Knisely J, Chang SJ, Kim SH, Haghdel A, Roytman M, Madera G, Magge R, Liechty B, Stieg P, Pannullo S, Schwartz T, Cisse B, Brandmaier A, Juthani R, Noch E, Fine H, Pisapia D, Ramakrishna R, Karakatsanis N, Osborne J, Lin E, Ivanidze J. NIMG-91. DOTATATE PET/MR-GUIDED POSTOPERATIVE MANAGEMENT IN WHO-2 MENINGIOMA: ACTIVE SURVEILLANCE BASED ON PET/MR EVIDENCE OF GROSS TOTAL RESECTION. Neuro Oncol 2022. [PMCID: PMC9660816 DOI: 10.1093/neuonc/noac209.709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
BACKGROUND
MRI, the standard of care (SOC) for meningioma radiotherapy planning, lacks sensitivity for postoperative small volume disease and osseous or parenchymal invasion. BN003 (NCT03180268) randomizes patients with WHO-2 meningiomas and MRI-determined GTR to observation or 60 Gy IMRT to the resection bed. More sensitive and specific imaging biomarkers may improve clinical outcomes in meningioma by limiting unnecessary radiation of normal tissues and improving radiation targeting. [68Ga]-DOTATATE is a PET radiotracer targeting somatostatin receptor 2 (SSTR2), a highly sensitive and specific meningioma biomarker. We developed a dedicated DOTATATE brain PET/MRI protocol allowing meningioma differentiation from post-treatment change, using SUV analysis and Patlak modeling. Our prospective observational trial (NCT04081701) has imaged over 90 patients with meningioma. This IRB-approved study evaluated PFS in patients with WHO-2 tumors and postoperative GTR by [68Ga]-DOTATATE PET/MRI who were managed solely with active surveillance. We hypothesized that the PFS of patients with GTR by PET/MRI managed with active surveillance would be higher than for patients with MRI-determined GTR, using NRG-BN003’s observation arm (randomized trial comparing observation to fractionated radiotherapy) as a reference standard.
METHODS
92 patients with SSTR2-positive brain neoplasms were enrolled between 9/2019 and 5/2022 and imaged according to our previously published protocol. 8 patients met inclusion criteria (WHO-2 meningioma & postoperative PET/MR GTR) and were followed with SOC MRI. Kaplan-Meier survival analysis was performed.
RESULTS
5/8 subjects (62.5%) were women; the mean age was 67 years. MRI follow-up data were available for a mean of 19.75 months (range: 7-38 months). One subject (12.5%) progressed at 21 months; the remainder remain progression-free. Kaplan-Meier analysis demonstrated 3-year PFS to be 80%, which is substantially higher than the reported 3-year PFS of 69% in the literature.
CONCLUSIONS
[68Ga]-DOTATATE PET can improve the specificity of imaging-based assessment of the extent of resection of WHO-2 meningiomas.
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Affiliation(s)
| | | | - Sean H Kim
- Weill Cornell Medicine , New York CIty , USA
| | | | | | | | - Rajiv Magge
- Weill Cornell Medicine , New York CIty , USA
| | | | | | | | | | | | | | | | - Evan Noch
- Weill Cornell Medicine , New York CIty , USA
| | - Howard Fine
- Weill Cornell Medicine , New York CIty , USA
| | | | | | | | | | - Eaton Lin
- Weill Cornell Medicine , New York CIty , USA
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9
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Guadix S, Garman T, Pisapia D, Souweidane M. SURG-03. Durability of an Early Management Strategy Facilitating Endoscopic Removal of Recurrent Choroid Plexus Carcinoma. Neuro Oncol 2022. [PMCID: PMC9165070 DOI: 10.1093/neuonc/noac079.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Choroid plexus carcinoma (CPC) is a rare, primarily intraventricular neoplasm with a dismal prognosis. Extent of surgical removal is correlated with improved outcomes but is frequently limited due to tumor vascularity and size. Information related to surgical management and molecular drivers of tumor recurrence is currently limited. Here we characterize a case of multiply recurrent CPC treated solely with sequential endoscopic tumor removals over a 10-year period and highlight its genomic properties. METHODS: We performed a retrospective review of a 16-year-old female treated for CPC with local and distal recurrences undergoing repeat excision with minimally invasive neuro-endoscopy. We describe technical nuances associated with neuro-endoscopic intervention, mean hospital stay, complications, and perioperative MRI. Whole exome sequencing (WES), targeted sequencing, and methylation profiling results over time are reviewed. RESULTS: Five years after standard treatment, the patient was evaluated for a distant intraventricular recurrence. A total endoscopic resection was performed given the local, non-disseminated recurrence pattern. WES results included NF1, PER1, and GLI3 mutations as well as FGFR3 gain, and was negative for TP53 alterations. Repeat sequencing on a recurrence 4 years later showed persistent NF1 and FGFR3 alterations. Methylation profiling was consistent with “plexus tumor, subclass pediatric B”. Overall, short-term surveillance neuroimaging detected four isolated recurrences, all treated with complete endoscopic resections at 5 years, 6.5 years, 9 years, and 10 years after initial CPC diagnosis. Mean hospital stay for all recurrences was 1 day with no complications from treatment. CONCLUSION: We describe a patient with 4 isolated recurrences of CPC over a decade, each treated with complete endoscopic removal, and identify an unusual set of molecular alterations that persisted over time. These outcomes support a strategy encompassing frequent neuroimaging surveillance to facilitate a minimally invasive endoscopic surgical approach at early detection and relatively low tumor mutagenicity.
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Affiliation(s)
- Sergio Guadix
- Department of Neurological Surgery, Weill Cornell Medicine, New York , NY , USA
| | - Tyler Garman
- Department of Neurological Surgery, Weill Cornell Medicine, New York , NY , USA
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York , NY , USA
| | - Mark Souweidane
- Department of Neurological Surgery, Weill Cornell Medicine, New York , NY , USA
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York , NY , USA
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10
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Lally L, Narula N, Goodfellow N, Luqmani R, Pisapia D, Spiera RF. Rho Kinase Expression in Giant Cell Arteritis: Validating pERM Intensity Score to Increase Sensitivity of Temporal Artery Biopsy. J Rheumatol 2022; 49:908-912. [DOI: 10.3899/jrheum.220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/22/2022]
Abstract
Objective Aberrant rho-kinase (ROCK) activity is implicated in several vascular and immunologic disorders. We previously demonstrated increased ROCK activity in histopathologically negative temporal artery biopsies (TAB) in subjects with clinical Giant Cell Arteritis (GCA) compared to those without GCA. This current study aimed to examine ROCK activity in a larger cohort of biopsy-negative GCA subjects and to validate the prior findings. Methods Subjects were categorized into 2 groups based on clinical data 6-months after TAB: biopsy-negative GCA and controls without GCA. Paraffin-embedded TAB were stained for phosphorylated ezrin/radixin/moesin (pERM), a surrogate of ROCK activity, and scored by two pathologists blinded to clinical diagnosis using a previously derived scoring system measuring staining intensity in three areas of the vessel Results 36 subjects with biopsy-negative GCA and 43 controls were analyzed. The mean pERM intensity score in non-GCA subjects was 3.9 – 1.4 (compared to 5.0 – 1.4 in those with GCA, p = 0.002). Using the predetermined cut-off of 4 to define high pERM intensity, subjects with GCA were significantly more likely to have a high pERM intensity score compared to non-GCA, OR 3.67, 95%CI :1.19,11.36; p= 0.019. The sensitivity of high pERM intensity score for diagnosis of GCA in histologically negative TAB was 86%, 95%CI: 70,95. Conclusion In this well-characterized cohort, those with biopsy-negative GCA had significantly higher pERM intensity scores compared to subjects without GCA. pERM staining has diagnostic significance in enhancing the sensitivity of TAB, and may help to define the clinically important group of biopsynegative GCA.
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11
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Pham K, Gottesdiener L, Simon MS, Trzebucki A, Maldarelli GA, Cisse B, Lieberman J, DeHaan E, Pisapia D. Corrigendum to: Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male. Open Forum Infect Dis 2022; 9:ofab635. [PMID: 35036468 PMCID: PMC8756187 DOI: 10.1093/ofid/ofab635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Khanh Pham
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Lee Gottesdiener
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Matthew S Simon
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alex Trzebucki
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Grace A Maldarelli
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Babacar Cisse
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA.,Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Joshua Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Elliot DeHaan
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Pisapia
- New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA.,Department of Pathology, Weill Cornell Medicine, New York, New York, USA
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12
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Ramos A, Giantini-Larsen A, Pannullo SC, Brandmaier A, Knisely J, Magge R, Wilcox JA, Pavlick AC, Ma B, Pisapia D, Ashamalla H, Ramakrishna R. A multidisciplinary management algorithm for brain metastases. Neurooncol Adv 2022; 4:vdac176. [PMID: 36532509 PMCID: PMC9749403 DOI: 10.1093/noajnl/vdac176] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
The incidence of brain metastases continues to present a management issue despite the advent of improved systemic control and overall survival. While the management of oligometastatic disease (ie, 1-4 brain metastases) with surgery and radiation has become fairly straightforward in the era of radiosurgery, the management of patients with multiple metastatic brain lesions can be challenging. Here we review the available evidence and provide a multidisciplinary management algorithm for brain metastases that incorporates the latest advances in surgery, radiation therapy, and systemic therapy while taking into account the latest in precision medicine-guided therapies. In particular, we argue that whole-brain radiation therapy can likely be omitted in most patients as up-front therapy.
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Affiliation(s)
- Alexander Ramos
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Alexandra Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Susan C Pannullo
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Jonathan Knisely
- Department of Radiation Oncology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Rajiv Magge
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Jessica A Wilcox
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anna C Pavlick
- Department of Oncology, Weill Cornell Medicine, New York Presbyterian, New York, New York, USA
| | - Barbara Ma
- Department of Oncology, Weill Cornell Medicine, New York Presbyterian, New York, New York, USA
| | - David Pisapia
- Department of Pathology, Weill Cornell Medicine, New York Presbyterian, New York, New York, USA
| | - Hani Ashamalla
- Department of Neurology, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Rohan Ramakrishna
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
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13
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Pham K, Gottesdiener L, Simon MS, Trzebucki A, Maldarelli GA, Cisse B, Lieberman J, DeHaan E, Pisapia D. Meningovascular Syphilis Presenting as a Brain Mass in an Immunocompetent Male. Open Forum Infect Dis 2021; 8:ofab455. [PMID: 34557566 PMCID: PMC8454516 DOI: 10.1093/ofid/ofab455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 11/14/2022] Open
Abstract
We present a case of a human immunodeficiency virus-negative man with syphilitic meningovascular disease with subjacent involvement of brain parenchyma leading to a mass-forming inflammatory lesion that was pathologically distinct from a typical gumma. Syphilis was diagnosed after tissue obtained from a brain biopsy demonstrated spirochetes consistent with Treponema pallidum and confirmed by 16S ribosomal RNA sequencing.
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Affiliation(s)
- Khanh Pham
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Correspondence: Khanh Pham, MD, New York–Presbyterian Hospital, Weill Cornell Medical Center, 1300 York Ave, A-421, New York, NY 10021, USA ()
| | - Lee Gottesdiener
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Matthew S Simon
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alex Trzebucki
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Grace A Maldarelli
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA
| | - Babacar Cisse
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Joshua Lieberman
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Elliot DeHaan
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - David Pisapia
- New York–Presbyterian Hospital, Weill Cornell Medical Center, New York, New York, USA,Department of Pathology, Weill Cornell Medicine, New York, New York, USA
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14
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Roth O'Brien DA, Kaye SM, Poppas PJ, Mahase SS, An A, Christos PJ, Liechty B, Pisapia D, Ramakrishna R, Wernicke AG, Knisely JPS, Pannullo SC, Schwartz TH. Time to administration of stereotactic radiosurgery to the cavity after surgery for brain metastases: a real-world analysis. J Neurosurg 2021:1-11. [PMID: 34049277 DOI: 10.3171/2020.10.jns201934] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/09/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Publications on adjuvant stereotactic radiosurgery (SRS) are largely limited to patients completing SRS within a specified time frame. The authors assessed real-world local recurrence (LR) for all brain metastasis (BM) patients referred for SRS and identified predictors of SRS timing. METHODS The authors retrospectively identified BM patients undergoing resection and referred for SRS between 2012 and 2018. Patients were categorized by time to SRS, as follows: 1) ≤ 4 weeks, 2) > 4-8 weeks, 3) > 8 weeks, and 4) never completed. The relationships between timing of SRS and LR, LR-free survival (LRFS), and survival were investigated, as well as predictors of and reasons for specific SRS timing. RESULTS In a cohort of 159 patients, the median age at resection was 64.0 years, 56.5% of patients were female, and 57.2% were in recursive partitioning analysis (RPA) class II. The median preoperative tumor diameter was 2.9 cm, and gross-total resection was achieved in 83.0% of patients. All patients were referred for SRS, but 20 (12.6%) did not receive it. The LR rate was 22.6%, and the time to SRS was correlated with the LR rate: 2.3% for patients receiving SRS at ≤ 4 weeks postoperatively, 14.5% for SRS at > 4-8 weeks (p = 0.03), and 48.5% for SRS at > 8 weeks (p < 0.001). No LR difference was seen between patients whose SRS was delayed by > 8 weeks and those who never completed SRS (48.5% vs 50.0%; p = 0.91). A similar relationship emerged between time to SRS and LRFS (p < 0.01). Non-small cell lung cancer pathology (p = 0.04), earlier year of treatment (p < 0.01), and interval from brain MRI to SRS (p < 0.01) were associated with longer intervals to SRS. The rates of receipt of systemic therapy also differed significantly between patients by category of time to SRS (p = 0.02). The most common reasons for intervals of > 4-8 weeks were logistic, whereas longer delays or no SRS were caused by management of systemic disease or comorbidities. CONCLUSIONS Available data on LR rates after adjuvant SRS are often obtained from carefully preselected patients receiving timely treatment, whereas significantly less information is available on the efficacy of adjuvant SRS in patients treated under "real-world" conditions. Management of these patients may merit reconsideration, particularly when SRS is not delivered within ≤ 4 weeks of resection. The results of this study indicate that a substantial number of patients referred for SRS either never receive it or are treated > 8 weeks postoperatively, at which time the SRS-treated patients have an LR risk equivalent to that of patients who never received SRS. Increased attention to the reasons for prolonged intervals from surgery to SRS and strategies for reducing them is needed to optimize treatment. For patients likely to experience delays, other radiotherapy techniques may be considered.
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Affiliation(s)
| | | | | | | | - Anjile An
- 3Division of Biostatistics and Epidemiology, and
| | | | - Benjamin Liechty
- 4Department of Neuropathology, Weill Cornell Medical College/NewYork-Presbyterian Hospital
| | - David Pisapia
- 4Department of Neuropathology, Weill Cornell Medical College/NewYork-Presbyterian Hospital
| | | | | | | | | | - Theodore H Schwartz
- 2Department of Neurosurgery.,Departments of6Otolaryngology and.,7Neuroscience, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, New York
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15
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Roth O'Brien DA, Poppas P, Kaye SM, Mahase SS, An A, Christos PJ, Liechty B, Pisapia D, Ramakrishna R, Wernicke AG, Knisely JPS, Pannullo S, Schwartz TH. Timing of Adjuvant Fractionated Stereotactic Radiosurgery Affects Local Control of Resected Brain Metastases. Pract Radiat Oncol 2021; 11:e267-e275. [PMID: 33578001 DOI: 10.1016/j.prro.2021.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/05/2021] [Accepted: 01/27/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE For resected brain metastases (BMs), stereotactic radiosurgery (SRS) is often offered to minimize local recurrence (LR). Although the aim is to deliver SRS within a few weeks of surgery, a variety of socioeconomic, medical, and procedural issues can cause delays. We evaluated the relationship between timing of postoperative SRS and LR. METHODS AND MATERIALS We retrospectively identified a consecutive series of patients with BM managed with resection and SRS or fractionated SRS at our institution from 2012 to 2018. We assessed the correlation of time to SRS and other demographic, disease, and treatment variables with LR, local recurrence-free survival, distant recurrence, distant recurrence-free survival, and overall survival. RESULTS A total of 133 patients met inclusion criteria. The median age was 64.5 years. Approximately half of patients had a single BM, and median BM size was 2.9 cm. Gross total resection was achieved in 111 patients (83.5%), and more than 90% of patients received fractionated SRS. The median time to SRS was 37.0 days, and the LR rate was 16.4%. Time to SRS was predictive of LR. The median time from surgery to SRS was 34.0 days for patients without LR versus 61.0 days for those with LR (P < .01). The LR rate was 2.3% with SRS administered ≤4 weeks postoperatively, compared with 23.6% if SRS was administered >4 weeks postoperatively (P < .01). Local recurrence-free survival was also improved for patients who underwent SRS at ≤4 weeks (P = .02). Delayed SRS was also predictive of distant recurrence (P = .02) but not overall survival. CONCLUSIONS In this retrospective study, the strongest predictor of LR after postoperative SRS for BM was time to SRS, and a cutoff of 4 weeks was a reliable predictor of recurrence. These findings merit investigation in a prospective, randomized trial.
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Affiliation(s)
- Diana A Roth O'Brien
- Stich Radiation Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Phillip Poppas
- Department of Neurosurgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Sydney M Kaye
- Department of Neurosurgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Sean S Mahase
- Stich Radiation Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Anjile An
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Benjamin Liechty
- Department of Neuropathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - David Pisapia
- Department of Neuropathology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Rohan Ramakrishna
- Department of Neurosurgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | | | - Jonathan P S Knisely
- Stich Radiation Oncology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Susan Pannullo
- Department of Neurosurgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Theodore H Schwartz
- Department of Neurosurgery, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York; Department of Otolaryngology, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York; Department of Neuroscience, Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York.
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Tosi U, Kommidi H, Adeuyan O, Guo H, Maachani UB, Chen N, Su T, Zhang G, Pisapia D, Dahmane N, Ting R, Souweidane M. EXTH-55. PET, IMAGE-GUIDED HDAC INHIBITION OF PEDIATRIC DIFFUSE MIDLINE GLIOMA IMPROVES SURVIVAL IN MURINE MODELS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Efforts at altering the dismal prognosis of pediatric midline gliomas focus on direct-delivery strategies like convection-enhanced delivery (CED), where a cannula is implanted into tumor. Successful CED treatments require confirmation of tumor coverage, dosimetry, and longitudinal in vivo pharmacokinetics monitoring. These properties would be best determined clinically with image guided dosimetry using theranostic compounds, agents with both therapeutic and imaging properties. In this study, we combine CED with novel, molecular-grade positron emission tomography (PET) imaging. We synthesized PETobinostat, a novel PET-imageable HDAC inhibitor, and showed its effectiveness against DIPG models in vitro and in vivo. Cell studies against a library of DIPG cells show nanomolar IC50, allowing for rapid in vivo translation. When injected in mice, PET shows the need of CED to achieve high brain concentrations, as systemic delivery yields inferior brain permeation. PET also shows that CED has significant mouse-to-mouse variability: imaging is used to modulate CED infusions to maximize tumor saturation over time. By determining condition-specific clearance half-life (ranging between 60 and 120 minutes), we maximized tumor permeation above therapeutic concentrations for at least 12 hours. This PET-guided approach resulted in decrease tumor cellularity (p= 0.001), increased apoptosis (p= 0.034), decreased dividing cells (p= 0.003), and recovery of histone-3 acetylation (p < 0.0001) when compared against vehicle and systemic-treated controls in tumor-bearing mice. Further, the PET-guided CED of PETobinostat resulted in survival prolongation (67.5 vs. 35 days, p = 0.0001) when compared to systemic administration of another potent HDAC inhibitor (Panobinostat). CED without PET guidance failed at improving survival (37.5 vs. 35 days, p = 0.74). No significant toxicity was observed following CED of PETobinostat. This work demonstrates how personalized image-guided drug delivery of a novel HDAC inhibitor may be useful in potentiating CED-based treatment platforms, and supports a foundation for the clinical translation of PETobinostat.
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Affiliation(s)
| | | | | | - Hua Guo
- Weill Cornell Medicine, New York, NY, USA
| | | | - Nandi Chen
- Weill Cornell Medicine, New York, NY, USA
| | | | | | | | | | | | - Mark Souweidane
- NY Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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Barbaro M, Pan P, Pisapia D, Schwartz T, Ramakrishna R, Knisely J, Fine H, Chiang G, Magge R. NIMG-15. EVALUATING FLUCTUATING ENHANCEMENT IN OLIGODENDROGLIOMAS ON MAGNETIC RESONANCE IMAGING. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVE
To identify and characterize patterns of fluctuating contrast enhancement on magnetic resonance imaging (MRI) in patients with oligodendrogliomas.
INTRODUCTION
Gliomas, particularly oligodendrogliomas, can exhibit fluctuating enhancement (FE) on MRI that can make it difficult to differentiate between treatment effect and active tumor.
METHODS
We are conducting a single-center retrospective review of clinical and radiographic data for patients with oligodendrogliomas treated at Weill Cornell Medicine (WCM) from 2/2000-5/2018. We have identified patients with FE on MRI and tracked lesions > 5mm in at least one dimension to the resolution of the lesion or last available MRI. We have recorded time from initial diagnosis to development of FE, time from radiation to development of FE, and time from development to resolution of FE as well as molecular characteristics of each tumor.
RESULTS
A total of 122 patients with oligodendrogliomas were identified. Thus far, fluctuating enhancement has been identified in 11 patients (5 men, 6 women) with 38 total fluctuating lesions. Isocitrate dehydrogenase-1 (IDH-1) mutation was present in 5 tumors, and 1p/19q co-deletion was present in 6. Mean time from initial diagnosis to development of FE was 44.6 months. In patients who developed FE after radiation, mean time from radiation to development of FE was 35.0 months. Twenty-seven lesions resolved, and mean time from onset to resolution of FE was 5.6 months, while mean time from start of radiation to resolution of FE was 41.0 months. Additionally, we will perform perfusion analysis on lesions > 5mm and identify patients who underwent surgical biopsy of FE with pathologic diagnosis.
CONCLUSIONS
FE has been identified in 11 patients thus far. We are expanding our analysis to identify a larger cohort of patients with FE. Characterizing patterns of FE may aid clinicians in differentiating FE due to treatment effect from active tumor.
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Affiliation(s)
| | - Peter Pan
- NYP / Columbia University Irving Medical Center, New York, NY, USA
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O’Brien DR, Kaye S, Poppas P, Mahase S, An A, Christos P, Liechty B, Pisapia D, Ramakrishna R, Wernicke AG, Knisely J, Pannullo S, Schwartz T. 45. DELAY OR FAILURE TO ADMINISTER STEREOTACTIC RADIOSURGERY TO THE CAVITY AFTER SURGERY FOR BRAIN METASTASES. AN INTENTION-TO-TREAT ANALYSIS. Neurooncol Adv 2020. [PMCID: PMC7401377 DOI: 10.1093/noajnl/vdaa073.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data regarding the efficacy of adjuvant stereotactic radiosurgery (SRS) for resected brain metastases (BM) is often limited to patients completing SRS within a specified timeframe. We performed an intention-to-treat analysis to determine local recurrence (LR) for all BM patients referred for SRS. METHODS We retrospectively identified resected BM patients referred for SRS between 2012 and 2018. Patients were divided based on delay to SRS into four categories: 1) ≤4 weeks, 2) >4–8 weeks, 3) >8 weeks, and 4) never received. We investigated the relationship between delay to SRS and LR, local recurrence-free survival (LRFS), and overall survival, as well as the predictors of and reason for delays. RESULTS In our cohort of 159 patients, median age was 64.0 years, 56.5% patients were female, median tumor diameter was 2.9 cm, and gross total resection was achieved in 83.0%. On intention-to-treat analysis, LR was 22.6%. Delays to SRS correlated with LR: 2.3% with SRS ≤4 weeks postoperatively, 14.5% with SRS at >4–8 weeks (p=0.03), 48.5% with SRS at >8 weeks (p<0.001). No LR difference was observed with SRS delayed by >8 weeks, vs. never completed, 48.5% vs. 50.0% (p=0.91). 53 (33.3%) patients comprised these latter two categories. A similar relationship emerged between delay to SRS and LRFS (p<0.01). Non-small cell lung cancer pathology (p=0.04) and earlier year of treatment (p<0.01) were predictive of delays. Common reasons for delays included logistics, management of systemic disease, complications, or comorbidities. CONCLUSION A significant number of patients referred for SRS never receive it, or are treated with a delay >8 weeks, conferring equivalent LR risk. Accordingly, the actual efficacy of adjuvant SRS may need reassessment. Reasons for delays and mechanisms for reducing them are discussed. For patients likely to experience significant delays, other techniques, such as preoperative SRS or intraoperative brachytherapy, may be considered.
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Affiliation(s)
- Diana Roth O’Brien
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Sydney Kaye
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Phillip Poppas
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Sean Mahase
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Anjile An
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Paul Christos
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Benjamin Liechty
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - David Pisapia
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Rohan Ramakrishna
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | | | - Jonathan Knisely
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Susan Pannullo
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
| | - Theodore Schwartz
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, NY, USA
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Roth O’Brien D, Poppas P, Kaye S, Mahase S, An A, Christos P, Liechty B, Pisapia D, Ramakrishna R, Wernicke AG, Knisely J, Pannullo S, Schwartz T. 43. DELAYS IN ADJUVANT STEREOTACTIC RADIOSURGERY REDUCE LOCAL CONTROL FOR RESECTED BRAIN METASTASES. Neurooncol Adv 2020. [PMCID: PMC7401358 DOI: 10.1093/noajnl/vdaa073.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE For resected brain metastases (BM), stereotactic radiosurgery (SRS) is often offered to minimize local recurrence (LR). Although the aim is to deliver SRS within a few weeks of surgery, a variety of socioeconomic, medical, and procedural issues can cause delays. We evaluated the relationship between timing of postoperative SRS and LR. METHODS We retrospectively identified a consecutive series of BM patients managed with resection and adjuvant SRS, recommended within two weeks of surgery, at our institution from 2012–2018. We assessed the correlation between time to SRS, as well as other demographic, disease, and treatment variables, and LR, distant recurrence (DR), and overall survival (OS). RESULTS 133 patients met inclusion criteria. Median age was 64.5 years. Approximately half of patients had a single BM, and median BM size was 2.9 cm. Gross total resection was achieved in 111 (83.6%) patients, and >90% received fractionated SRS. Median time to adjuvant SRS was 37.0 days and LR rate was 16.4%. The factor most predictive of LR was time from surgery to SRS. Median time from surgery to SRS was 34.0 days for patients without LR, versus 61.0 days for those with LR (p<0.01). LR was 2.3% with SRS administered ≤4 weeks postoperatively, compared to 23.6% if delayed >4 weeks (p<0.01). Local recurrence-free survival (LRFS) was also improved for patients who had SRS at ≤4 weeks (p=0.02). Delayed SRS was also predictive of DR (p=0.02), but not OS. CONCLUSIONS We demonstrate that the strongest predictor of failure of postoperative SRS for BM is the delay to SRS. A cut-off of 4 weeks is a reliable predictor of increased LR. Every effort should be made to perform SRS within 4 weeks of surgery, and if this cannot be achieved, other RT modalities, such as brachytherapy or preoperative SRS, should be strongly considered.
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Affiliation(s)
- Diana Roth O’Brien
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Phillip Poppas
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Sydney Kaye
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Sean Mahase
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Anjile An
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Paul Christos
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Benjamin Liechty
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - David Pisapia
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Rohan Ramakrishna
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | | | - Jonathan Knisely
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Susan Pannullo
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
| | - Theodore Schwartz
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY, USA
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Sboner A, Sternberg C, Mosquera JM, Song W, Kluk M, Tam W, Rennert H, Pisapia D, Catalano J, Cheang G, Wilkes D, Bulaon D, Martin ML, Sigaras A, Eng K, Bareja R, Kim R, Loda M, Elemento O. Abstract IA33: Precision medicine at Weill Cornell Medicine/New York Presbyterian: Breaking silos, integrating resources, being inclusive. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp19-ia33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Genomic testing with next-generation sequencing (NGS) has become a pillar of precision medicine, whose aim is to identify the genomic alterations of a patient’s tumor and provide guidelines to clinicians for optimal treatment. Clinical testing is typically performed with targeted panels interrogating a limited set of genes, selected based on our best scientific knowledge on their diagnostic or prognostic role. Despite more recent efforts to be more inclusive, most genomic databases have a limited representation of non-European populations, resulting in a biased selection of those genes, and the potential exclusion of under-represented groups from the benefit of precision medicine. At the Englander Institute for Precision Medicine (EIPM), we developed a whole-exome sequencing (WES) clinical test, EXaCT-1, which interrogates about 21,000 protein coding genes for single-nucleotide variants, indels, and copy number. EXaCT-1 enables an unbiased view of the genomic landscape of a patient’s tumor and allows for the collection of data to investigate genomic diversity. We also tackled one of the major barriers of precision medicine: the infrastructure to execute clinical sequencing. From ordering a test, collecting and processing samples, to the analysis and review of the data and generation of reports, several systems, procedures, and expertise are involved, and their effective coordination is a key component for the timely delivery of results. We have built a framework supporting the entire process of clinical genomic testing: a Laboratory Information Management System (LIMS) helps the clinical lab to receive orders, acquire and process specimens, and seamlessly communicate with the sequencers and the computational pipelines. Molecular pathologists use NGSReporter, a secure web application, to review the data and sign-out reports. NGSReporter integrates the results of a test with our Precision Medicine Knowledge Base (PMKB – https://pmkb.weill.cornell.edu), which classifies variants based on their relevance to clinical management and provides standardized interpretations. Reports are sent to the electronic health record (EHR) as PDFs as well as discrete entities, enabling queries such as: “Which Hispanic patients with KRAS mutations are diabetic?” Sharing de-identified data is also a key aspect of precision medicine. To this end, we provide our investigators and collaborators with a protected cBioPortal instance that, in addition to publicly available datasets, includes internal data, thus enabling the exploration of hypotheses about the role of alterations across different cohorts and clinical features. Being in the center of New York City has the added benefit of an ethnically diverse patient population. Finding the “right treatment for the right person and at the right time” requires a concerted effort of multiple partners. The EIPM infrastructure facilitates these efforts, with the goal of making precision medicine accessible to everyone.
Citation Format: Andrea Sboner, Cora Sternberg, Juan Miguel Mosquera, Wei Song, Michael Kluk, Wayne Tam, Hanna Rennert, David Pisapia, Jeffrey Catalano, Gloria Cheang, David Wilkes, Danielle Bulaon, M. Laura Martin, Alexandros Sigaras, Kenneth Eng, Rohan Bareja, Rob Kim, Massimo Loda, Olivier Elemento. Precision medicine at Weill Cornell Medicine/New York Presbyterian: Breaking silos, integrating resources, being inclusive [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr IA33.
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Affiliation(s)
| | | | | | - Wei Song
- Weill Cornell Medicine, New York, NY
| | | | - Wayne Tam
- Weill Cornell Medicine, New York, NY
| | | | | | | | | | | | | | | | | | | | | | - Rob Kim
- Weill Cornell Medicine, New York, NY
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Linkous A, Balamatsias D, Snuderl M, Edwards L, Miyaguchi K, Milner T, Reich B, Cohen-Gould L, Storaska A, Nakayama Y, Schenkein E, Singhania R, Cirigliano S, Magdeldin T, Lin Y, Nanjangud G, Chadalavada K, Pisapia D, Liston C, Fine HA. Modeling Patient-Derived Glioblastoma with Cerebral Organoids. Cell Rep 2020; 26:3203-3211.e5. [PMID: 30893594 DOI: 10.1016/j.celrep.2019.02.063] [Citation(s) in RCA: 238] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 11/14/2018] [Accepted: 02/15/2019] [Indexed: 12/11/2022] Open
Abstract
The prognosis of patients with glioblastoma (GBM) remains dismal, with a median survival of approximately 15 months. Current preclinical GBM models are limited by the lack of a "normal" human microenvironment and the inability of many tumor cell lines to accurately reproduce GBM biology. To address these limitations, we have established a model system whereby we can retro-engineer patient-specific GBMs using patient-derived glioma stem cells (GSCs) and human embryonic stem cell (hESC)-derived cerebral organoids. Our cerebral organoid glioma (GLICO) model shows that GSCs home toward the human cerebral organoid and deeply invade and proliferate within the host tissue, forming tumors that closely phenocopy patient GBMs. Furthermore, cerebral organoid tumors form rapidly and are supported by an interconnected network of tumor microtubes that aids in the invasion of normal host tissue. Our GLICO model provides a system for modeling primary human GBM ex vivo and for high-throughput drug screening.
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Affiliation(s)
- Amanda Linkous
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Matija Snuderl
- Division of Neuropathology, Department of Pathology, NYU Langone Medical Center and Medical School, New York, NY, USA
| | - Lincoln Edwards
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Ken Miyaguchi
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Teresa Milner
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Batsheva Reich
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Leona Cohen-Gould
- Department of Biochemistry, Weill Cornell Medicine, New York, NY, USA
| | - Andrew Storaska
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Yasumi Nakayama
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Emily Schenkein
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Richa Singhania
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | | | - Tarig Magdeldin
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Ying Lin
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Gouri Nanjangud
- Memorial Sloan Kettering Cancer Center Molecular Cytogenetics Core, New York, NY, USA
| | - Kalyani Chadalavada
- Memorial Sloan Kettering Cancer Center Molecular Cytogenetics Core, New York, NY, USA
| | - David Pisapia
- Department of Pathology & Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Conor Liston
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Howard A Fine
- Meyer Cancer Center, Division of Neuro-Oncology, Department of Neurology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
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Youn T, Al'Aref SJ, Narula N, Salvatore S, Pisapia D, Dweck MR, Narula J, Lin FY, Lu Y, Kumar A, Virmani R, Min JK. 18F-Sodium Fluoride Positron Emission Tomography/Computed Tomography in Ex Vivo Human Coronary Arteries With Histological Correlation. Arterioscler Thromb Vasc Biol 2019; 40:404-411. [PMID: 31875701 DOI: 10.1161/atvbaha.119.312737] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE 18F-sodium fluoride (NaF) position emission tomography (PET) activity correlates with high-risk plaque. We examined the correlation between 18F-NaF PET activity and extent of calcification (microcalcification and macrocalcification) in coronary arteries. Approach and Results: Eighteen ex vivo human coronary arteries were imaged with 18F-NaF PET/CT, and target to background ratios were analyzed from 101 plaques. Histopathologic analysis evaluated for microcalcification and macrocalcification, plaque morphology, and inflammation. Plaques with microcalcification demonstrated higher 18F-NaF PET activity (n=84; mean target to background ratio±SD, 9.0±9.7,) than plaques without microcalcification (n=17, 2.9±3.8; P<0.0001). Higher 18F-NaF PET activity was associated with advanced plaques characterized by fibroatheroma (n=54, 10.7±10.3) compared with plaques with intimal thickening (n=22, 3.5±3.9) or pathological intimal thickening (n=25, 6.1±8.4; P=0.004). No significant association was found between 18F-NaF PET activity and inflammation (P=0.08). CONCLUSIONS In ex vivo human coronary arteries, higher 18F-NaF PET activity was associated with microcalcification and advanced plaque morphology. Since microcalcification and fibroatheromas are high-risk plaque features, 18F-NaF PET/CT may improve risk-stratification.
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Affiliation(s)
- Trisha Youn
- From the Department of Radiology (T.Y., S.J.A., J.K.M.), Weill Cornell Medicine, NY
| | - Subhi J Al'Aref
- From the Department of Radiology (T.Y., S.J.A., J.K.M.), Weill Cornell Medicine, NY.,Dalio Institute of Cardiovascular Imaging (S.J.A., F.Y.L., Y.L., A.K., J.K.M.), Weill Cornell Medicine, NY
| | - Navneet Narula
- Department of Pathology, New York University Langone Medical Center (N.N.)
| | - Steven Salvatore
- Department of Pathology (S.S., D.P.), Weill Cornell Medicine, NY
| | - David Pisapia
- Department of Pathology (S.S., D.P.), Weill Cornell Medicine, NY
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Scotland, United Kingdom (M.R.D.)
| | - Jagat Narula
- Division of Cardiology, Mount Sinai Hospital, New York (J.N.)
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging (S.J.A., F.Y.L., Y.L., A.K., J.K.M.), Weill Cornell Medicine, NY
| | - Yao Lu
- Dalio Institute of Cardiovascular Imaging (S.J.A., F.Y.L., Y.L., A.K., J.K.M.), Weill Cornell Medicine, NY
| | - Amit Kumar
- Dalio Institute of Cardiovascular Imaging (S.J.A., F.Y.L., Y.L., A.K., J.K.M.), Weill Cornell Medicine, NY
| | | | - James K Min
- From the Department of Radiology (T.Y., S.J.A., J.K.M.), Weill Cornell Medicine, NY.,Dalio Institute of Cardiovascular Imaging (S.J.A., F.Y.L., Y.L., A.K., J.K.M.), Weill Cornell Medicine, NY
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Pan P, Pisapia D, Ramakrishna R, Schwartz T, Stieg P, Fine H, Pannullo S, Knisely J, Chiang G, Ivanidze J, Liechty B, Brandmaier A, Magge R. MNGI-10. ATYPICAL MENINGIOMA: EARLY OUTCOMES WITH OR WITHOUT POSTOPERATIVE RADIATION. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Adjuvant radiotherapy (RT) in atypical meningioma, especially for gross-totally resected tumors, remains controversial.
METHODS
We retrospectively identified histologically-confirmed cases of WHO Grade II atypical meningioma at a large academic institution from 2004–2018. Clinicodemographic, surgical, radiation therapy (RT), and histopathologic data were collected, as well as imaging and clinical outcomes, with a median follow-up time of 26 months (IQR 32). Patients were stratified by resection status and whether or not upfront RT was administered. Additionally, subanalyses were performed to compare external beam RT (EBRT) and stereotactic radiosurgery (SRS). Progression was defined by radiology report.
RESULTS
Of 122 patients, 45 were excluded for lacking adequate records of previous treatment, less than 3 months follow-up, or lacking MR imaging. Of 77 patients analyzed, 57% (44/77) were female; median 59-years-old. 48% (24/50) of gross-total-resections (GTR) received upfront RT – only a single case progressed, at 39 months. Of 26 GTR patients without upfront RT, 8/26 (31%) progressed at median 19.5 months – of these, 2 were lost to follow-up, 5 received salvage RT, and 1 had surgery alone. Adjuvant RT was associated with superior progression free survival (PFS) in GTR (Cox proportional hazard ratio 0.15, likelihood-ratio p=0.025; median PFS not reached). Of 15 subtotal resections (STR) receiving upfront RT, 11 received EBRT and 4 received SRS – 6 progressed (median 37 months), all after EBRT. Upfront SRS demonstrated superior PFS over EBRT following STR (p=0.036). Across the cohort there was one confirmed death, a GTR patient (without RT) who suffered an ischemic stroke at 11 months.
CONCLUSION
This large single-center retrospective analysis indicates adjuvant RT improves PFS in GTR atypical meningiomas, in concordance with prior studies. It is limited by short median follow-up, possibly related to long-term stability in treated patients. In STR tumors, SRS may contribute to improved PFS compared to EBRT.
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Affiliation(s)
- Peter Pan
- NewYork Presbyterian - Columbia and Cornell, New York, NY, USA
| | - David Pisapia
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Rohan Ramakrishna
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Theodore Schwartz
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Philip Stieg
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Howard Fine
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Susan Pannullo
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Jonathan Knisely
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Gloria Chiang
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Jana Ivanidze
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Benjamin Liechty
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Andrew Brandmaier
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
| | - Rajiv Magge
- NewYork Presbyterian - Weill Cornell Medical Center, New York, NY, USA
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Ivanidze J, Lum M, Pisapia D, Magge R, Ramakrishna R, Kovanlikaya I, Fine HA, Chiang GC. MRI Features Associated with TERT Promoter Mutation Status in Glioblastoma. J Neuroimaging 2019; 29:357-363. [PMID: 30644143 DOI: 10.1111/jon.12596] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Telomerase reverse transcriptase (TERT) promoter mutations are associated with worse prognosis in glioblastoma. The purpose of this study was to evaluate whether TERT mutation status was associated with specific morphologic and quantitative imaging features. METHODS Twenty-nine patients with isocitrate dehydrogenase 1/2-wildtype glioblastoma (13 TERT-wildtype, 16 TERT-mutated), who underwent preoperative magnetic resonance (MR) imaging were included in this retrospective study. Qualitative imaging phenotypes were evaluated using the Visually Accessible Rembrandt Images (VASARIs) feature set. Histogram analysis of apparent diffusion coefficient (ADC) and dynamic contrast-enhanced MR perfusion values were performed on enhancing tumor volumes-of-interest, and differences between TERT-wildtype and TERT-mutated tumors were assessed. RESULTS VASARI analysis demonstrated that the majority of morphologic features were not significantly different between TERT-wildtype and TERT-mutated tumors, although a higher proportion of TERT-wildtype tumors featured nonenhancing tumor crossing midline (P = .014). TERT-mutated tumors demonstrated lower median rate constant kep (.38 vs. .76, P = .03) and lower median volume transfer coefficient Ktrans (.13 vs. .31, P = .02). There was no significant difference in median plasma volume vp (P = .92) or ADC values (P = .66) between the two groups. We further found a significant interaction between median kep and Ktrans and TERT status, respectively, suggesting greater risk of death with increasing blood-brain barrier dysfunction in TERT-mutated but not in TERT-wildtype tumors. CONCLUSION Our study demonstrates evidence of altered permeability metrics associated with TERT mutation in glioblastoma, laying the foundation for future prospective studies assessing implications for therapeutic management and clinical outcomes.
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Affiliation(s)
- Jana Ivanidze
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Mark Lum
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
| | - David Pisapia
- Department of Pathology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Rajiv Magge
- Department of Neurology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Rohan Ramakrishna
- Department of Neurologic Surgery, New York Presbyterian Hospital-Cornell, New York, NY
| | - Ilhami Kovanlikaya
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Howard A Fine
- Department of Neurology, New York Presbyterian Hospital-Cornell, New York, NY
| | - Gloria C Chiang
- Department of Radiology, New York Presbyterian Hospital-Cornell, New York, NY
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Pisapia D, Motanagh S, Sobner A, Eng K, Kluk M, Mosquera JM, Elemento O, Ramakrishna R. GENE-10. IDENTIFICATION OF MXRA5 AND DSP AS RELEVANT TARGETS IN INFILTRATING ASTROCYTOMAS: A WHOLE EXOME ANALYSIS AT A SINGLE INSTITUTION. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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26
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Greenfield JP, Maachani U, Taha B, Bareja R, Wang K, Sboner A, Haussner T, Hoffman CE, Mason CE, Souweidane MM, Elemento O, Pisapia D, Rajappa P. 217 Precision Sequencing Algorithm in Pediatric Neurosurgery. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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27
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Rajappa P, Maachani U, Bareja R, Wang K, Sboner A, Hoffman C, Souweidane M, Elemento O, Pisapia D, Greenfield J. TBIO-15. UTILIZING A HISTOLOGY-SPECIFIC SEQUENCING ALGORITHM FOR PRECISION NEURO-ONCOLOGY. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Wang J, Yao Z, Jonsson P, Allen A, Qin ACR, Pisapia D, Rosen N, Taylor BS, Pratilas CA. Abstract A129: A second-site mutation in BRAF confers resistance to RAF inhibition in a BRAF V600E-mutant brain tumor. Mol Cancer Ther 2018. [DOI: 10.1158/1535-7163.targ-17-a129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BRAF V600E drives tumors by hyperactivating ERK signaling, is activated in a RAS-independent manner, and signals as a monomer. Selective inhibitors of RAF potently inhibit BRAF V600E and downstream ERK signaling, and have been associated with impressive clinical responses in patients whose tumors harbor V600E mutations in BRAF. Almost all patients, however, ultimately develop resistance. To date, acquired resistance mechanisms validated in patient samples have included splice forms of BRAF, mutations in NRAS, and BRAF amplification, all of which promote formation of RAF dimers, and mutations in MEK. Second-site point mutations in BRAF that promote dimer formation and are associated with acquired resistance have not previously been identified in RAF inhibitor-resistant tumors.
Here, we report a complete response followed by clinical progression of a BRAF V600E-mutant pediatric brain tumor treated with the RAF inhibitor dabrafenib. We identified a second-site mutation in BRAF at the time of progression that was not present in the pretreatment tumor. Further study indicated the acquired mutation is in cis with V600E. We demonstrate that the acquired resistance mutation induces RAF dimer formation, and is sufficient to confer resistance to dabrafenib. Moreover, we showed that ERK signaling activated by the double mutation is sensitive to MEK inhibition or to the RAF plus and MEK inhibitor combination. We also find that two novel RAF dimer inhibitors may overcome resistance mediated by the novel mutation in BRAF.
This is the first study, to our knowledge, that demonstrates the emergence of a confirmed second-site mutation in BRAF V600E and validates that this mutation is responsible for acquired resistance in an initially responding patient treated with dabrafenib. The mechanism of acquired resistance can be abrogated by the novel RAF dimer inhibitors. Our data confirm that a novel class of RAF dimer inhibitors are active against an acquired resistance mutation, suggesting an improved personalized treatment option for patients who harbor similar second-site mutations in BRAF.
Citation Format: Jiawan Wang, Zhan Yao, Philip Jonsson, Amy Allen, Alice Can Ran Qin, David Pisapia, Neal Rosen, Barry S. Taylor, Christine A. Pratilas. A second-site mutation in BRAF confers resistance to RAF inhibition in a BRAF V600E-mutant brain tumor [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A129.
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Affiliation(s)
| | - Zhan Yao
- 2Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Philip Jonsson
- 2Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Amy Allen
- 1Johns Hopkins University, Baltimore, MD
| | | | | | - Neal Rosen
- 2Memorial Sloan Kettering Cancer Center, New York City, NY
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Huang L, Fernandes H, Zia H, Tavassoli P, Rennert H, Pisapia D, Imielinski M, Sboner A, Rubin MA, Kluk M, Elemento O. The cancer precision medicine knowledge base for structured clinical-grade mutations and interpretations. J Am Med Inform Assoc 2017; 24:513-519. [PMID: 27789569 PMCID: PMC5391733 DOI: 10.1093/jamia/ocw148] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/26/2016] [Indexed: 12/02/2022] Open
Abstract
Objective: This paper describes the Precision Medicine Knowledge Base (PMKB; https://pmkb.weill.cornell.edu), an interactive online application for collaborative editing, maintenance, and sharing of structured clinical-grade cancer mutation interpretations. Materials and Methods: PMKB was built using the Ruby on Rails Web application framework. Leveraging existing standards such as the Human Genome Variation Society variant description format, we implemented a data model that links variants to tumor-specific and tissue-specific interpretations. Key features of PMKB include support for all major variant types, standardized authentication, distinct user roles including high-level approvers, and detailed activity history. A REpresentational State Transfer (REST) application-programming interface (API) was implemented to query the PMKB programmatically. Results: At the time of writing, PMKB contains 457 variant descriptions with 281 clinical-grade interpretations. The EGFR, BRAF, KRAS, and KIT genes are associated with the largest numbers of interpretable variants. PMKB’s interpretations have been used in over 1500 AmpliSeq tests and 750 whole-exome sequencing tests. The interpretations are accessed either directly via the Web interface or programmatically via the existing API. Discussion: An accurate and up-to-date knowledge base of genomic alterations of clinical significance is critical to the success of precision medicine programs. The open-access, programmatically accessible PMKB represents an important attempt at creating such a resource in the field of oncology. Conclusion: The PMKB was designed to help collect and maintain clinical-grade mutation interpretations and facilitate reporting for clinical cancer genomic testing. The PMKB was also designed to enable the creation of clinical cancer genomics automated reporting pipelines via an API.
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Affiliation(s)
- Linda Huang
- Institute for Precision Medicine.,Institute for Computational Biomedicine
| | - Helen Fernandes
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Hamid Zia
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Peyman Tavassoli
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Hanna Rennert
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David Pisapia
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Marcin Imielinski
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Andrea Sboner
- Institute for Precision Medicine.,Institute for Computational Biomedicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mark A Rubin
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael Kluk
- Institute for Precision Medicine.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Institute for Precision Medicine.,Institute for Computational Biomedicine
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30
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Jain M, Wu B, Pisapia D, Salvatore S, Mukherjee S, Narula N. A component-by-component characterisation of high-risk atherosclerotic plaques by multiphoton microscopic imaging. J Microsc 2017; 268:39-44. [PMID: 28556893 DOI: 10.1111/jmi.12584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/17/2022]
Abstract
AIMS Atherosclerotic plaques vulnerable to rupture are almost always inflamed, and carry a large lipid core covered by a thin fibrous cap. The other components may include neovascularisation, intraplaque haemorrhage and spotty calcification. In contrast, stable plaques are characterised by a predominance of smooth muscle cells and collagen, and lipid core is usually deep seated or absent. This study is a proof of principle experiment to evaluate the feasibility of multiphoton microscopy (MPM) to identify aforementioned plaque components. METHODS AND RESULTS MPM is a nonlinear optical technique that allows imaging based on intrinsic tissue signals including autofluorescence and higher-order scattering. In our study, MPM imaging was performed on morphologically diverse aortic and coronary artery plaques obtained during autopsy. Various histologically verified plaque components including macrophages, cholesterol crystals, haemorrhage, collagen and calcification were recognised by MPM. CONCLUSIONS Recognition of the distinct signatures of various plaque components suggests that MPM has the potential to offer next-generation characterisation of atherosclerotic plaques. The higher lateral resolution (comparable to histology) images generated by MPM for identifying plaque components might complement larger field of view and greater imaging depth currently available with optical coherence tomography imaging. As the next step MPM would need to be evaluated for intact vessel imaging ex vivo and in vivo.
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Affiliation(s)
- M Jain
- Department of Dermatology, Memorial Sloan Kettering Cancer Center, NY, U.S.A.,Department of Pathology, Weill Cornell Medical College, NY, U.S.A
| | - B Wu
- Department of Biochemistry, Weill Cornell Medical College, NY, U.S.A.,Department of Physics, Southern Connecticut State University, New Haven, CT, U.S.A
| | - D Pisapia
- Department of Pathology, Weill Cornell Medical College, NY, U.S.A
| | - S Salvatore
- Department of Pathology, Weill Cornell Medical College, NY, U.S.A
| | - S Mukherjee
- Department of Biochemistry, Weill Cornell Medical College, NY, U.S.A
| | - N Narula
- Department of Pathology, Weill Cornell Medical College, NY, U.S.A
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31
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Nakahara T, Dweck MR, Narula N, Pisapia D, Narula J, Strauss HW. Coronary Artery Calcification. JACC Cardiovasc Imaging 2017; 10:582-593. [DOI: 10.1016/j.jcmg.2017.03.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 01/02/2023]
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32
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Pauli C, Hopkins BD, Prandi D, Shaw R, Fedrizzi T, Sboner A, Sailer V, Augello M, Puca L, Rosati R, McNary TJ, Churakova Y, Cheung C, Triscott J, Pisapia D, Rao R, Mosquera JM, Robinson B, Faltas BM, Emerling BE, Gadi VK, Bernard B, Elemento O, Beltran H, Demichelis F, Kemp CJ, Grandori C, Cantley LC, Rubin MA. Personalized In Vitro and In Vivo Cancer Models to Guide Precision Medicine. Cancer Discov 2017; 7:462-477. [PMID: 28331002 PMCID: PMC5413423 DOI: 10.1158/2159-8290.cd-16-1154] [Citation(s) in RCA: 628] [Impact Index Per Article: 89.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/07/2023]
Abstract
Precision medicine is an approach that takes into account the influence of individuals' genes, environment, and lifestyle exposures to tailor interventions. Here, we describe the development of a robust precision cancer care platform that integrates whole-exome sequencing with a living biobank that enables high-throughput drug screens on patient-derived tumor organoids. To date, 56 tumor-derived organoid cultures and 19 patient-derived xenograft (PDX) models have been established from the 769 patients enrolled in an Institutional Review Board-approved clinical trial. Because genomics alone was insufficient to identify therapeutic options for the majority of patients with advanced disease, we used high-throughput drug screening to discover effective treatment strategies. Analysis of tumor-derived cells from four cases, two uterine malignancies and two colon cancers, identified effective drugs and drug combinations that were subsequently validated using 3-D cultures and PDX models. This platform thereby promotes the discovery of novel therapeutic approaches that can be assessed in clinical trials and provides personalized therapeutic options for individual patients where standard clinical options have been exhausted.Significance: Integration of genomic data with drug screening from personalized in vitro and in vivo cancer models guides precision cancer care and fuels next-generation research. Cancer Discov; 7(5); 462-77. ©2017 AACR.See related commentary by Picco and Garnett, p. 456This article is highlighted in the In This Issue feature, p. 443.
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Affiliation(s)
- Chantal Pauli
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Davide Prandi
- Center for Integrative Biology, University of Trento, Trento, Italy
| | - Reid Shaw
- Cure First and SEngine Precision Medicine, Seattle, Washington
| | | | - Andrea Sboner
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Verena Sailer
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Michael Augello
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Loredana Puca
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Rachele Rosati
- Cure First and SEngine Precision Medicine, Seattle, Washington
| | - Terra J McNary
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Yelena Churakova
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Cynthia Cheung
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Joanna Triscott
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - David Pisapia
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rema Rao
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Juan Miguel Mosquera
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Brian Robinson
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Bishoy M Faltas
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | | | - Vijayakrishna K Gadi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Brady Bernard
- Cure First and SEngine Precision Medicine, Seattle, Washington
| | - Olivier Elemento
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Himisha Beltran
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, New York
| | - Francesca Demichelis
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
- Center for Integrative Biology, University of Trento, Trento, Italy
| | - Christopher J Kemp
- Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Carla Grandori
- Cure First and SEngine Precision Medicine, Seattle, Washington
| | - Lewis C Cantley
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
| | - Mark A Rubin
- Englander Institute for Precision Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
- Meyer Cancer Center, Weill Cornell Medicine, New York, New York
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Huang Y, Rajappa P, Hu W, Hoffman C, Cisse B, Kim JH, Gorge E, Yanowitch R, Cope W, Vartanian E, Xu R, Zhang T, Pisapia D, Xiang J, Huse J, Matei I, Peinado H, Bromberg J, Holland E, Ding BS, Rafii S, Lyden D, Greenfield J. A proangiogenic signaling axis in myeloid cells promotes malignant progression of glioma. J Clin Invest 2017; 127:1826-1838. [PMID: 28394259 DOI: 10.1172/jci86443] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/16/2017] [Indexed: 01/13/2023] Open
Abstract
Tumors are capable of coopting hematopoietic cells to create a suitable microenvironment to support malignant growth. Here, we have demonstrated that upregulation of kinase insert domain receptor (KDR), also known as VEGFR2, in a myeloid cell sublineage is necessary for malignant progression of gliomas in transgenic murine models and is associated with high-grade tumors in patients. KDR expression increased in myeloid cells as myeloid-derived suppressor cells (MDSCs) accumulated, which was associated with the transformation and progression of low-grade fibrillary astrocytoma to high-grade anaplastic gliomas. KDR deficiency in murine BM-derived cells (BMDCs) suppressed the differentiation of myeloid lineages and reduced granulocytic/monocytic populations. The depletion of myeloid-derived KDR compromised its proangiogenic function, which inhibited the angiogenic switch necessary for malignant progression of low-grade to high-grade tumors. We also identified inhibitor of DNA binding protein 2 (ID2) as a key upstream regulator of KDR activation during myeloid differentiation. Deficiency of ID2 in BMDCs led to downregulation of KDR, suppression of proangiogenic myeloid cells, and prevention of low-grade to high-grade transition. Tumor-secreted TGF-β and granulocyte-macrophage CSF (GM-CSF) enhanced the KDR/ID2 signaling axis in BMDCs. Our results suggest that modulation of KDR/ID2 signaling may restrict tumor-associated myeloid cells and could potentially be a therapeutic strategy for preventing transformation of premalignant gliomas.
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Abstract
Plasmacytoma of the calvarium is a well-described feature of multiple myeloma and in some cases has been reported as a solitary lesion. However, when associated with multiple myeloma these are typically identified after the initial diagnosis is made. This case is unusual in that the diagnosis of plasmacytoma was first suspected in a patient thought to have a meningioma on the day of surgery, when a magnetic resonance imaging (MRI) demonstrated spontaneous involution of the mass. Recognition of evolving changes in a calvarial or dural-based lesion should prompt the practitioner to consider alternative diagnoses other than meningioma prior to proceeding with surgical resection.
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Affiliation(s)
- Peter Morgenstern
- Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medical Center
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35
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Bander E, Singh H, Ogilvie C, Cusic R, Pisapia D, Tsiouris A, Anand V, Schwartz T. Endoscopic Endonasal versus Transcranial Approach to Tuberculum Sella and Planum Meningiomas in a Similar Cohort of Patients. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Evan Bander
- New York Presbyterian - Neurological Surgery, New York City, New York, United States
| | - Harminder Singh
- Stanford University School of Medicine, Stanford, California, United States
| | - Colin Ogilvie
- Weill Cornell Medical College, New York City, New York, United States
| | - Ryan Cusic
- Weill Cornell Medical College, New York City, New York, United States
| | - David Pisapia
- Weill Cornell Medical College, New York City, New York, United States
| | | | - Vijay Anand
- Weill Cornell Medical College, New York City, New York, United States
| | - Theodore Schwartz
- New York Presbyterian - Neurological Surgery, New York City, New York, United States
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36
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Omay S, Chen YN, Almeida J, Ruiz-Treviño A, Boockvar J, Stieg P, Greenfield J, Souweidane M, Kacker A, Pisapia D, Anand V, Schwartz T. Do Craniopharyngioma Molecular Signatures Correlate with Clinical Characteristics? Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sacit Omay
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Yu-Ning Chen
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Joao Almeida
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Armando Ruiz-Treviño
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - John Boockvar
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Philip Stieg
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Jeffrey Greenfield
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Mark Souweidane
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Ashutosh Kacker
- Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - David Pisapia
- Department of Pathology, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Vijay Anand
- Department of Otolaryngology, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
| | - Theodore Schwartz
- Department of Neurosurgery, Otolaryngology and Neuroscience, Weill Cornell Medical College, New York Presbyterian hospital, New York, New York, United States
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37
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Kossatz S, Carney B, Schweitzer M, Carlucci G, Miloushev VZ, Maachani UB, Rajappa P, Keshari KR, Pisapia D, Weber WA, Souweidane MM, Reiner T. Biomarker-Based PET Imaging of Diffuse Intrinsic Pontine Glioma in Mouse Models. Cancer Res 2017; 77:2112-2123. [PMID: 28108511 DOI: 10.1158/0008-5472.can-16-2850] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 12/20/2022]
Abstract
Diffuse intrinsic pontine glioma (DIPG) is a childhood brainstem tumor with a universally poor prognosis. Here, we characterize a positron emission tomography (PET) probe for imaging DIPG in vivo In human histological tissues, the probes target, PARP1, was highly expressed in DIPG compared to normal brain. PET imaging allowed for the sensitive detection of DIPG in a genetically engineered mouse model, and probe uptake correlated to histologically determined tumor infiltration. Imaging with the sister fluorescence agent revealed that uptake was confined to proliferating, PARP1-expressing cells. Comparison with other imaging technologies revealed remarkable accuracy of our biomarker approach. We subsequently demonstrated that serial imaging of DIPG in mouse models enables monitoring of tumor growth, as shown in modeling of tumor progression. Overall, this validated method for quantifying DIPG burden would serve useful in monitoring treatment response in early phase clinical trials. Cancer Res; 77(8); 2112-23. ©2017 AACR.
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Affiliation(s)
- Susanne Kossatz
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Brandon Carney
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Chemistry, Hunter College and PhD Program in Chemistry, The Graduate Center of the City University of New York, New York, New York
| | - Melanie Schweitzer
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Giuseppe Carlucci
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Vesselin Z Miloushev
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Uday B Maachani
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Prajwal Rajappa
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Kayvan R Keshari
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York.,Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Pisapia
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Wolfgang A Weber
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Mark M Souweidane
- Department of Neurological Surgery, Weill Cornell Medical College, New York, New York.,Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Thomas Reiner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York. .,Department of Radiology, Weill Cornell Medical College, New York, New York
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38
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Rajappa P, Pisapia D. PDTB-27. PRECISION MEDICINE IN PEDIATRIC NEURO-ONCOLOGY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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39
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Rae K, Fischer C, Rajappa P, Connors S, Pisapia D, Greenfield J, Khakoo Y. MPTH-05. RAPID AUTOPSY PROGRAM FOR PEDIATRIC NEURO-ONCOLOGY. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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40
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Abstract
Low-grade gliomas, such as pilocytic astrocytoma and subependymoma, are often characterized as benign tumors due to their relative circumscription radiologically and typically non-aggressive biologic behavior. In contrast, low-grades that are by their nature diffusely infiltrative, such as diffuse astrocytomas and oligodendrogliomas, have the potential to transform into malignant high-grade counterparts and, given sufficient time, invariably do so. These high-grade gliomas carry very poor prognoses and are largely incurable, warranting a closer look at what causes this adverse transition. A key characteristic that distinguishes low- and high-grade gliomas is neovascularization: it is absent in low-grade gliomas, but prolific in high-grade gliomas, providing the tumor with ample blood supply for exponential growth. It has been well described in the literature that bone marrow-derived cells (BMDCs) may contribute to the angiogenic switch that is responsible for malignant transformation of low-grade gliomas. In this review, we will summarize the current literature on BMDCs and their known contribution to angiogenesis-associated tumor growth in gliomas.
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Affiliation(s)
- Raymond Xu
- Neurological Surgery, Weill Cornell Medical College
| | | | - Jeffrey P Greenfield
- Neurological Surgery, Weill Cornell Medical College ; New York Presbyterian Hospital
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41
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Li S, Connors S, Pisapia D, Huang Y, Xu R, Greenfield J. EPIG-09GENETIC AND EPIGENETIC TUMOR EVOLUTION IN GLIOMATOSIS CEREBRI. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov214.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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42
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Abstract
A 21-year-old man presented with triventricular hydrocephalus due to a tectal mass. He underwent an endoscopic third ventriculostomy, and multiple nodules were identified at the floor of the third ventricle intraoperatively. Surgical pathology of one of these lesions demonstrated that the tissue represented a low-grade astrocytoma. The case highlights the existing potential of neuroendoscopy to reveal neuroimaging-occult lesions, in spite of the significant advances of MRI. Furthermore, the combination of the age of the patient, the nonenhancing MRI appearance, and the multifocality of the lesions constitutes a rare and interesting neoplastic presentation within the brain. The constellation of findings likely represents dissemination of a low-grade tectal glioma via the CSF compartment.
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Affiliation(s)
| | | | - William Cope
- Weill Cornell Medical College, New York, New York
| | - David Pisapia
- Pathology and Laboratory Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital; and
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Abstract
Our molecular understanding of glioma has undergone a sea change over the last decade. In this review, we discuss two recent articles that employed whole genome sequencing to subclassify gliomas vis-à-vis known molecular alterations. We further discuss the relevance of these findings vis-à-vis current treatment paradigms.
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Affiliation(s)
- Rohan Ramakrishna
- Neurological Surgery, Weill Cornell Medical College ; Neurological Surgery, NewYork-Presbyterian/Weill Cornell Medical Center
| | - David Pisapia
- Pathology, Weill Cornell Medical College ; Pathology, New York Presbyterian Hospital
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44
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Gill B, Pisapia D, Malone H, Goldstein H, Lei L, Sonabend A, Yun J, Samanamud J, Banu M, Dovas A, Sims J, Teich A, Sheth S, McKhann G, Sisti M, Bruce J, Sims P, Canoll P. GE-12 * RADIOGRAPHICALLY-LOCALIZED BIOPSIES REVEAL SUBTYPE-SPECIFIC PATTERNS IN MOLECULAR AND CELLULAR COMPOSITION AT THE INFILTRATIVE MARGINS OF GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou256.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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45
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Rajappa P, Huang Y, Vartanian E, Pisapia D, Lyden D, Bromberg J, Greenfield J. ME-17 * JAK 1/2 INHIBITION FOLLOWING BONE MARROW TRANSPLANTATION MITIGATES Cd11b + /GR1+ MEDIATED LOW-GRADE GLIOMA NEOANGIOGENESIS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou261.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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46
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Canoll P, Sims P, Gil B, Pisapia D, Malone H, Goldstein H, Lei L, Sonabend A, Yun J, Samanamud J, Sims J, Teich A, Sheth S, McKhann G, Sisti M, Bruce J. IMAGE GUIDED RNA-SEQ REVEALS SUBTYPE-SPECIFIC PATTERNS AT THE INFILTRATIVE MARGINS OF GLIOBLASTOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou206.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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47
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Ellis JA, Gill BJ, Pisapia D, Winfree CJ. Superficial temporal artery pseudoaneurysm following trigeminal nerve stimulator placement. Neuromodulation 2014; 17:788-90. [PMID: 24628868 DOI: 10.1111/ner.12143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 10/05/2013] [Accepted: 10/31/2013] [Indexed: 01/20/2023]
Affiliation(s)
- Jason A Ellis
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA
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Ambady P, Holdhoff M, Ferrigno C, Grossman S, Anderson MD, Liu D, Conrad C, Penas-Prado M, Gilbert MR, Yung AWK, de Groot J, Aoki T, Nishikawa R, Sugiyama K, Nonoguchi N, Kawabata N, Mishima K, Adachi JI, Kurisu K, Yamasaki F, Tominaga T, Kumabe T, Ueki K, Higuchi F, Yamamoto T, Ishikawa E, Takeshima H, Yamashita S, Arita K, Hirano H, Yamada S, Matsutani M, Apok V, Mills S, Soh C, Karabatsou K, Arimappamagan A, Arya S, Majaid M, Somanna S, Santosh V, Schaff L, Armentano F, Harrison C, Lassman A, McKhann G, Iwamoto F, Armstrong T, Yuan Y, Liu D, Acquaye A, Vera-Bolanos E, Diefes K, Heathcock L, Cahill D, Gilbert M, Aldape K, Arrillaga-Romany I, Ruddy K, Greenberg S, Nayak L, Avgeropoulos N, Avgeropoulos G, Riggs G, Reilly C, Banerji N, Bruns P, Hoag M, Gilliland K, Trusheim J, Bekaert L, Borha A, Emery E, Busson A, Guillamo JS, Bell M, Harrison C, Armentano F, Lassman A, Connolly ES, Khandji A, Iwamoto F, Blakeley J, Ye X, Bergner A, Dombi E, Zalewski C, Follmer K, Halpin C, Fayad L, Jacobs M, Baldwin A, Langmead S, Whitcomb T, Jennings D, Widemann B, Plotkin S, Brandes AA, Mason W, Pichler J, Nowak AK, Gil M, Saran F, Revil C, Lutiger B, Carpentier AF, Milojkovic-Kerklaan B, Aftimos P, Altintas S, Jager A, Gladdines W, Lonnqvist F, Soetekouw P, van Linde M, Awada A, Schellens J, Brandsma D, Brenner A, Sun J, Floyd J, Hart C, Eng C, Fichtel L, Gruslova A, Lodi A, Tiziani S, Bridge CA, Baldock A, Kumthekar P, Dilfer P, Johnston SK, Jacobs J, Corwin D, Guyman L, Rockne R, Sonabend A, Cloney M, Canoll P, Swanson KR, Bromberg J, Schouten H, Schaafsma R, Baars J, Brandsma D, Lugtenburg P, van Montfort C, van den Bent M, Doorduijn J, Spalding A, LaRocca R, Haninger D, Saaraswat T, Coombs L, Rai S, Burton E, Burzynski G, Burzynski S, Janicki T, Marszalek A, Burzynski S, Janicki T, Burzynski G, Marszalek A, Cachia D, Smith T, Cardona AF, Mayor LC, Jimenez E, Hakim F, Yepes C, Bermudez S, Useche N, Asencio JL, Mejia JA, Vargas C, Otero JM, Carranza H, Ortiz LD, Cardona AF, Ortiz LD, Jimenez E, Hakim F, Yepes C, Useche N, Bermudez S, Asencio JL, Carranza H, Vargas C, Otero JM, Bartels C, Quintero A, Restrepo CE, Gomez S, Bernal-Vaca L, Lema M, Cardona AF, Ortiz LD, Useche N, Bermudez S, Jimenez E, Hakim F, Yepes C, Mejia JA, Bernal-Vaca L, Restrepo CE, Gomez S, Quintero A, Bartels C, Carranza H, Vargas C, Otero JM, Carlo M, Omuro A, Grommes C, Kris M, Nolan C, Pentsova E, Pietanza M, Kaley T, Carrabba G, Giammattei L, Draghi R, Conte V, Martinelli I, Caroli M, Bertani G, Locatelli M, Rampini P, Artoni A, Carrabba G, Bertani G, Cogiamanian F, Ardolino G, Zarino B, Locatelli M, Caroli M, Rampini P, Chamberlain M, Raizer J, Soffetti R, Ruda R, Brandsma D, Boogerd W, Taillibert S, Le Rhun E, Jaeckle K, van den Bent M, Wen P, Chamberlain M, Chinot OL, Wick W, Mason W, Henriksson R, Saran F, Nishikawa R, Carpentier AF, Hoang-Xuan K, Kavan P, Cernea D, Brandes AA, Hilton M, Kerloeguen Y, Guijarro A, Cloughsey T, Choi JH, Hong YK, Conrad C, Yung WKA, deGroot J, Gilbert M, Loghin M, Penas-Prado M, Tremont I, Silberman S, Picker D, Costa R, Lycette J, Gancher S, Cullen J, Winer E, Hochberg F, Sachs G, Jeyapalan S, Dahiya S, Stevens G, Peereboom D, Ahluwalia M, Daras M, Hsu M, Kaley T, Panageas K, Curry R, Avila E, Fuente MDL, Omuro A, DeAngelis L, Desjardins A, Sampson J, Peters K, Ranjan T, Vlahovic G, Threatt S, Herndon J, Boulton S, Lally-Goss D, McSherry F, Friedman A, Friedman H, Bigner D, Gromeier M, Prust M, Kalpathy-Cramer J, Poloskova P, Jafari-Khouzani K, Gerstner E, Dietrich J, Fabi A, Villani V, Vaccaro V, Vidiri A, Giannarelli D, Piludu F, Anelli V, Carapella C, Cognetti F, Pace A, Flowers A, Flowers A, Killory B, Furuse M, Miyatake SI, Kawabata S, Kuroiwa T, Garciarena P, Anderson MD, Hamilton J, Schellingerhout D, Fuller GN, Sawaya R, Gilbert MR, Gilbert M, Pugh S, Won M, Blumenthal D, Vogelbaum M, Aldape K, Colman H, Chakravarti A, Jeraj R, Dignam J, Armstrong T, Wefel J, Brown P, Jaeckle K, Schiff D, Brachman D, Werner-Wasik M, Tremont-Lukats I, Sulman E, Mehta M, Gill B, Yun J, Goldstein H, Malone H, Pisapia D, Sonabend AM, Mckhann GK, Sisti MB, Sims P, Canoll P, Bruce JN, Girvan A, Carter G, Li L, Kaltenboeck A, Chawla A, Ivanova J, Koh M, Stevens J, Lahn M, Gore M, Hariharan S, Porta C, Bjarnason G, Bracarda S, Hawkins R, Oudard S, Zhang K, Fly K, Matczak E, Szczylik C, Grossman R, Ram Z, Hamza M, O'Brien B, Mandel J, DeGroot J, Han S, Molinaro A, Berger M, Prados M, Chang S, Clarke J, Butowski N, Hashimoto N, Chiba Y, Tsuboi A, Kinoshita M, Hirayama R, Kagawa N, Oka Y, Oji Y, Sugiyama H, Yoshimine T, Hawkins-Daarud A, Jackson PR, Swanson KR, Sarmiento JM, Ly D, Jutla J, Ortega A, Carico C, Dickinson H, Phuphanich S, Rudnick J, Patil C, Hu J, Iglseder S, Nowosielski M, Nevinny-Stickel M, Stockhammer G, Jain R, Poisson L, Scarpace L, Mikkelsen T, Kirby J, Freymann J, Hwang S, Gutman D, Jaffe C, Brat D, Flanders A, Janicki T, Burzynski S, Burzynski G, Marszalek A, Jiang C, Wang H, Jo J, Williams B, Smolkin M, Wintermark M, Shaffrey M, Schiff D, Juratli T, Soucek S, Kirsch M, Schackert G, Kakkar A, Kumar S, Bhagat U, Kumar A, Suri A, Singh M, Sharma M, Sarkar C, Suri V, Kaley T, Barani I, Chamberlain M, McDermott M, Raizer J, Rogers L, Schiff D, Vogelbaum M, Weber D, Wen P, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Trojanec R, Hajduch M, Kneblova M, Ehrmann J, Kanner AA, Wong ET, Villano JL, Ram Z, Khatua S, Fuller G, Dasgupta S, Rytting M, Vats T, Zaky W, Khatua S, Sandberg D, Foresman L, Zaky W, Kieran M, Geoerger B, Casanova M, Chisholm J, Aerts I, Bouffet E, Brandes AA, Leary SES, Sullivan M, Bailey S, Cohen K, Mason W, Kalambakas S, Deshpande P, Tai F, Hurh E, McDonald TJ, Kieran M, Hargrave D, Wen PY, Goldman S, Amakye D, Patton M, Tai F, Moreno L, Kim CY, Kim T, Han JH, Kim YJ, Kim IA, Yun CH, Jung HW, Koekkoek JAF, Reijneveld JC, Dirven L, Postma TJ, Vos MJ, Heimans JJ, Taphoorn MJB, Koeppen S, Hense J, Kong XT, Davidson T, Lai A, Cloughesy T, Nghiemphu PL, Kong DS, Choi YL, Seol HJ, Lee JI, Nam DH, Kool M, Jones DTW, Jager N, Northcott PA, Pugh T, Hovestadt V, Markant S, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schuller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Krel R, Krutoshinskaya Y, Rosiello A, Seidman R, Kowalska A, Kudo T, Hata Y, Maehara T, Kumthekar P, Bridge C, Patel V, Rademaker A, Helenowski I, Mrugala M, Rockhill J, Swanson K, Grimm S, Raizer J, Meletath S, Bennett M, Nestor VA, Fink KL, Lee E, Reardon D, Schiff D, Drappatz J, Muzikansky A, Hammond S, Grimm S, Norden A, Beroukhim R, McCluskey C, Chi A, Batchelor T, Smith K, Gaffey S, Gerard M, Snodgras S, Raizer J, Wen P, Leeper H, Johnson D, Lima J, Porensky E, Cavaliere R, Lin A, Liu J, Evans J, Leuthardt E, Dacey R, Dowling J, Kim A, Zipfel G, Grubb R, Huang J, Robinson C, Simpson J, Linette G, Chicoine M, Tran D, Liubinas SV, D'Abaco GM, Moffat B, Gonzales M, Feleppa F, Nowell CJ, Gorelick A, Drummond KJ, Morokoff AP, O'Brien TJ, Kaye AH, Loghin M, Melhem-Bertrandt A, Penas-Prado M, Zaidi T, Katz R, Lupica K, Stevens G, Ly I, Hamilton S, Rostomily R, Rockhill J, Mrugala M, Mandel J, Yust-Katz S, de Groot J, Yung A, Gilbert M, Burzynski S, Janicki T, Burzynski G, Marszalek A, Pachow D, Kliese N, Kirches E, Mawrin C, McNamara MG, Lwin Z, Jiang H, Chung C, Millar BA, Sahgal A, Laperriere N, Mason WP, Megyesi J, Salehi F, Merker V, Slusarz K, Muzikansky A, Francis S, Plotkin S, Mishima K, Adachi JI, Suzuki T, Uchida E, Yanagawa T, Watanabe Y, Fukuoka K, Yanagisawa T, Wakiya K, Fujimaki T, Nishikawa R, Moiyadi A, Kannan S, Sridhar E, Gupta T, Shetty P, Jalali R, Alshami J, Lecavalier-Barsoum M, Guiot MC, Tampieri D, Kavan P, Muanza T, Nagane M, Kobayashi K, Takayama N, Shiokawa Y, Nakamura H, Makino K, Hideo T, Kuroda JI, Shinojima N, Yano S, Kuratsu JI, Nambudiri N, Arrilaga I, Dunn I, Folkerth R, Chi S, Reardon D, Nayak L, Omuro A, DeAngelis L, Robins HI, Govindan R, Gadgeel S, Kelly K, Rigas J, Reimers HJ, Peereboom D, Rosenfeld S, Garst J, Ramnath N, Wing P, Zheng M, Urban P, Abrey L, Wen P, Nayak L, DeAngelis LM, Wen PY, Brandes AA, Soffietti R, Peereboom DM, Lin NU, Chamberlain M, Macdonald D, Galanis E, Perry J, Jaeckle K, Mehta M, Stupp R, van den Bent M, Reardon DA, Norden A, Hammond S, Drappatz J, Phuphanich S, Reardon D, Wong E, Plotkin S, Lesser G, Raizer J, Batchelor T, Lee E, Kaley T, Muzikansky A, Doherty L, LaFrankie D, Ruland S, Smith K, Gerard M, McCluskey C, Wen P, Norden A, Schiff D, Ahluwalia M, Lesser G, Nayak L, Lee E, Muzikansky A, Dietrich J, Smith K, Gaffey S, McCluskey C, Ligon K, Reardon D, Wen P, Bush NAO, Kesari S, Scott B, Ohno M, Narita Y, Miyakita Y, Arita H, Matsushita Y, Yoshida A, Fukushima S, Ichimura K, Shibui S, Okamura T, Kaneko S, Omuro A, Chinot O, Taillandier L, Ghesquieres H, Soussain C, Delwail V, Lamy T, Gressin R, Choquet S, Soubeyran P, Maire JP, Benouaich-Amiel A, Lebouvier-Sadot S, Gyan E, Barrie M, del Rio MS, Gonzalez-Aguilar A, Houllier C, Tanguy ML, Hoang-Xuan K, Omuro A, Abrey L, Raizer J, Paleologos N, Forsyth P, DeAngelis L, Kaley T, Louis D, Cairncross JG, Matasar M, Mehta J, Grimm S, Moskowitz C, Sauter C, Opinaldo P, Torcuator R, Ortiz LD, Cardona AF, Hakim F, Jimenez E, Yepes C, Useche N, Bermudez S, Mejia JA, Asencio JL, Carranza H, Vargas C, Otero JM, Lema M, Pace A, Villani V, Fabi A, Carapella CM, Patel A, Allen J, Dicker D, Sheehan J, El-Deiry W, Glantz M, Tsyvkin E, Rauschkolb P, Pentsova E, Lee M, Perez A, Norton J, Uschmann H, Chamczuck A, Khan M, Fratkin J, Rahman R, Hempfling K, Norden A, Reardon DA, Nayak L, Rinne M, Doherty L, Ruland S, Rai A, Rifenburg J, LaFrankie D, Wen P, Lee E, Ranjan T, Peters K, Vlahovic G, Friedman H, Desjardins A, Reveles I, Brenner A, Ruda R, Bello L, Castellano A, Bertero L, Bosa C, Trevisan E, Riva M, Donativi M, Falini A, Soffietti R, Saran F, Chinot OL, Henriksson R, Mason W, Wick W, Nishikawa R, Dahr S, Hilton M, Garcia J, Cloughesy T, Sasaki H, Nishiyama Y, Yoshida K, Hirose Y, 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NEURO/MEDICAL ONCOLOGY. Neuro Oncol 2013; 15:iii98-iii135. [PMCID: PMC3823897 DOI: 10.1093/neuonc/not182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
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Banks GP, Weiss SA, Pisapia D, Willey JZ. A case of late-onset leukoencephalopathy, calcifications, and cysts presenting with intracerebral hemorrhage resembling a neoplasm. Cerebrovasc Dis 2013; 35:396-7. [PMID: 23635489 DOI: 10.1159/000348312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Garrett P Banks
- Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Abstract
A 21-year-old man presented to his local emergency department with 5 days of headache, which was dull, occipital, bilateral, nonthrobbing, and progressively worsening. It was associated with mild fever, photophobia, and neck pain and stiffness. He had no history of headache, chronic illness, recent vaccinations, cutaneous rash, cough, diarrhea, arthralgia, or myalgia. He was from Ecuador and had been living in the United States for less than 1 year. He had been incarcerated while in Ecuador. Sublingual temperature on admission was 102.6°F. Other vital signs were within normal limits. On physical examination, he appeared thin but not cachectic. He had meningismus and photophobia, but no papilledema and his mental status was alert and attentive. There were no focal neurologic deficits. CSF contained red blood cells: 24 × 10(3)/μL; white blood cells: 85/μL (lymphocytic predominant); protein: 128 mg/dL; and glucose: 48 mg/dL (CSF/serum glucose ratio = 0.53). CSF Gram stain and cultures, PPD test, and blood and urine cultures were all negative. CT scan of the head on day of admission was entirely normal. MRI without gadolinium contrast showed a single punctate T2 hyperintensity in the left frontal periventricular white matter. Chest radiograph was clear. He received empiric vancomycin, ceftriaxone, and acyclovir. Corticosteroids were not given. The patient did not improve with antibiotics and continued to be intermittently febrile. On day 5, he became abruptly more somnolent, then comatose, opening eyes only to pain, his pupils were 5 mm and reactive, he had intact brainstem reflexes, withdrawing both arms and legs. Emergent head CT showed development of hydrocephalus and a ventriculoperitoneal shunt was emergently placed. The neurologic examination did not improve after shunt placement, and repeat head CT showed increased hydrocephalus with bilateral cerebral infarcts. On day 11, he was transferred to Columbia University Medical Center for intensive care. He was febrile and comatose. He did not open his eyes to pain, pupils were 7 mm minimally reactive, brainstem reflexes were intact, and he exhibited extensor posturing to pain. Mannitol was given, corticosteroid therapy was started, and an extraventricular drain was placed. The next day, his right pupil was 8 mm and nonreactive. MRI showed diffuse contrast enhancement of the arachnoid, extensive infarction of basal ganglia, midbrain, and pons, and small ring-enhancing lesions in the cerebellum (figure 1, A-D). Repeat lumbar puncture showed red blood cells: 550 × 10(3)/μL; white blood cells: 250/μL (14% neutrophils, 80% lymphocytes, 6% monocytes); protein: 65 mg/dL; and glucose: <10 mg/dL (CSF/serum glucose ratio = 0.08). CSF testing for Cryptococcus and toxoplasmosis was negative. CSF acid fast bacilli (AFB) smear was negative ×2, and CSF nucleic acid amplification test was also negative for tuberculosis. Serum HIV test was negative. Not until 14 days after initial presentation and 3 days after transfer to the intensive care unit was antituberculosis therapy finally started, because the pattern of infarcts on the MRI suggested basilar meningitis and he had not improved on broad-spectrum antibiotics. That same day, the first sputum AFB smear was positive, as were all succeeding daily sputum AFB smears. Tuberculosis nucleic acid amplification was positive from the sputum, but persistently negative from the CSF. Daily portable chest radiographs had been normal (read as likely atelectasis), but chest CT showed dense consolidations in the left lung and diffuse micronodular opacities throughout both lungs. Two days later, only 21 days after the onset of his headache, the patient died of cardiopulmonary arrest secondary to transtentorial cerebral herniation. Thirteen days later, the CSF culture became positive for Mycobacterium tuberculosis sensitive to streptomycin, isoniazid, ethambutol, rifampin, and pyrazinamide.
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Affiliation(s)
- Amy C Jongeling
- Department of Neurology, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, NY, USA.
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