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Dogra S, Zagzag D, Young M, Golfinos J, Orringer D, Jain R. Long-Term Follow-up of Multinodular and Vacuolating Neuronal Tumors and Implications for Surveillance Imaging. AJNR Am J Neuroradiol 2023; 44:1032-1038. [PMID: 37500290 PMCID: PMC10494952 DOI: 10.3174/ajnr.a7946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/16/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND AND PURPOSE Most multinodular and vacuolating neuronal tumors (MVNTs) are diagnosed and followed radiologically without any change across time. There are no surveillance guidelines or quantitative volumetric assessments of these tumors. We evaluated MVNT volumes during long follow-up periods using segmentation tools with the aim of quantitative assessment. MATERIALS AND METHODS All patients with MVNTs in a brain MR imaging report in our system were reviewed. Patients with only 1 brain MR imaging or in whom MVNT was not clearly the most likely diagnosis were excluded. All MVNTs were manually segmented. For all follow-up examinations, absolute and percentage volume change from immediately prior and initial examinations were calculated. RESULTS Forty-eight patients (32 women; median age, 50.5 years at first scanning) underwent 158 brain MRIs. The median duration between the first and last scan was 15.6 months (interquartile range, 5.7-29.6 months; maximum, 6.4 years) and between consecutive scans, it was 6.7 months (interquartile range, 3.3-12.4 months; maximum, 4.9 years). Pearson correlation coefficients between days since immediately prior scan versus absolute and percentage volume change from immediately prior scan were r = 0.05 (P = .60) and r = 0.07 (P = .45), respectively. For the relationship between days since the first scan versus absolute and percentage volume change from the first scan, values were r = -0.06 (P = .53) and r = -0.04 (P = .67), respectively. CONCLUSIONS MVNT segmentation across follow-up brain MR imaging examinations did not demonstrate significant volume differences, suggesting that these tumors do not enlarge with time. Hence, frequent surveillance imaging of newly diagnosed MVNTs may not be necessary.
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Affiliation(s)
- S Dogra
- From the Department of Radiology (S.D., M.Y., R.J.), New York University Grossman School of Medicine, New York, New York
| | - D Zagzag
- Department of Pathology (D.Z.), New York University Grossman School of Medicine, New York, New York
| | - M Young
- From the Department of Radiology (S.D., M.Y., R.J.), New York University Grossman School of Medicine, New York, New York
| | - J Golfinos
- Department of Neurosurgery (J.G., D.O., R.J.), New York University Grossman School of Medicine, New York, New York
| | - D Orringer
- Department of Neurosurgery (J.G., D.O., R.J.), New York University Grossman School of Medicine, New York, New York
| | - R Jain
- From the Department of Radiology (S.D., M.Y., R.J.), New York University Grossman School of Medicine, New York, New York
- Department of Neurosurgery (J.G., D.O., R.J.), New York University Grossman School of Medicine, New York, New York
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2
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Hollon T, Jiang C, Chowdury A, Nasir-Moin M, Kondepudi A, Aabedi A, Adapa A, Al-Holou W, Heth J, Sagher O, Lowenstein P, Castro M, Wadiura LI, Widhalm G, Movahed-Ezazi M, Neuschmelting V, Reinecke D, von Spreckelsen N, Berger M, Hervey-Jumper S, Golfinos J, Camelo-Piragua S, Freudiger C, Lee H, Orringer D. Artificial-intelligence-based molecular classification of diffuse gliomas using rapid, label-free optical imaging. Nat Med 2023; 29:828-832. [PMID: 36959422 PMCID: PMC10445531 DOI: 10.1038/s41591-023-02252-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 11/01/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023]
Abstract
Molecular classification has transformed the management of brain tumors by enabling more accurate prognostication and personalized treatment. However, timely molecular diagnostic testing for patients with brain tumors is limited, complicating surgical and adjuvant treatment and obstructing clinical trial enrollment. In this study, we developed DeepGlioma, a rapid (<90 seconds), artificial-intelligence-based diagnostic screening system to streamline the molecular diagnosis of diffuse gliomas. DeepGlioma is trained using a multimodal dataset that includes stimulated Raman histology (SRH); a rapid, label-free, non-consumptive, optical imaging method; and large-scale, public genomic data. In a prospective, multicenter, international testing cohort of patients with diffuse glioma (n = 153) who underwent real-time SRH imaging, we demonstrate that DeepGlioma can predict the molecular alterations used by the World Health Organization to define the adult-type diffuse glioma taxonomy (IDH mutation, 1p19q co-deletion and ATRX mutation), achieving a mean molecular classification accuracy of 93.3 ± 1.6%. Our results represent how artificial intelligence and optical histology can be used to provide a rapid and scalable adjunct to wet lab methods for the molecular screening of patients with diffuse glioma.
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Affiliation(s)
- Todd Hollon
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Cheng Jiang
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Asadur Chowdury
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Mustafa Nasir-Moin
- Department of Neurosurgery, New York University, Street, City, 10587, State, Country
| | - Akhil Kondepudi
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Alexander Aabedi
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Arjun Adapa
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Wajd Al-Holou
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Jason Heth
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Oren Sagher
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Pedro Lowenstein
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Maria Castro
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Lisa Irina Wadiura
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Georg Widhalm
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Misha Movahed-Ezazi
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Volker Neuschmelting
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - David Reinecke
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Niklas von Spreckelsen
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Mitchell Berger
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Shawn Hervey-Jumper
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - John Golfinos
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Sandra Camelo-Piragua
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Christian Freudiger
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Honglak Lee
- Machine Learning in Neurosurgery Laboratory, Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Ann Arbor, 48105, MI, USA
| | - Daniel Orringer
- Department of Neurosurgery, New York University, Street, City, 10587, State, Country
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3
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Nasir-Moin M, Wadiura LI, Juros D, Movahed-Ezazi M, Lee M, Weiss H, Müther M, Alber D, Ratna S, Fang C, Suero-Molina E, Hellwig S, Stummer W, Rössler K, Hainfellner J, Widhalm G, Kiesel B, Reichert D, Mischkulnig M, Jain R, Trautman J, Pastore S, Pacione D, Placantonakis D, Oermann E, Golfinos J, Hollon T, Snuderl M, Freudiger C, Orringer D. SURG-24. QUANTITATIVE ANALYSIS OF TUMOR CELL DENSITY AND PROTOPORPHYRIN IX FLOURESCENCE IN GLIOMA PATIENTS USING PAIRED STIMULATED RAMAN HISTOLOGY AND TWO-PHOTON EXCITATION FLUORESCENCE MICROSCOPY. Neuro Oncol 2022. [PMCID: PMC9661145 DOI: 10.1093/neuonc/noac209.990] [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
Fluorescence guidance is widely utilized to improve the precision of cancer surgery. 5-aminolevulinic acid, the most widely used fluorophore in glioma surgery, is thought to cause selective accumulation of fluorescent protoporphyrin IX (PpIX) in tumor cells by exploiting pathologic alterations in heme biosynthetic pathways. PpIX-induced fluorescence is highly specific for densely tumor-infiltrated tissue but less effective for visualizing the tumor periphery. To improve clinical detection of PpIX, we developed a microscope to perform paired stimulated Raman histology and two-photon excitation fluorescence microscopy (TPEF) and validated it in 175 fresh, unprocessed core tumor specimens from 75 high-grade glioma patients and three central nervous system lymphoma patients across three institutions. Surprisingly, intracellular PpIX accumulation was observed primarily in cells with histiocytic, rather than neoplastic morphology, and the number of cells concentrating PpIX within the cytoplasm was associated with the abundance of CD163 positive cells (p< 0.02). There was no correlation between the degree of tumor cellularity and the concentration of PpIX across all imaged specimens (R=-0.21). Our findings encourage reconsideration of the existing theory of 5-ALA-induced tumor cell fluorescence in gliomas and demonstrate how 5-ALA and TPEF imaging can provide a window into the immune microenvironment of human gliomas.
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Affiliation(s)
- Mustafa Nasir-Moin
- Department of Neurosurgery, NYU Grossman School of Medicine , New York, NY , USA
| | - Lisa Irina Wadiura
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | - Devin Juros
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | | | - Matthew Lee
- Department of Radiology, NYU Grossman School of Medicine , New York, NY , USA
| | - Hannah Weiss
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | - Michael Müther
- Department of Neurosurgery, Münster University Hospital , Münster , Germany
| | - Daniel Alber
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | - Sujay Ratna
- Invenio Imaging, Inc , Santa Clara, CA , USA
| | - Camila Fang
- Department of Pathology, NYU Grossman School of Medicine , New York , USA
| | - Eric Suero-Molina
- Department of Neurosurgery, Münster University Hospital , Münster , Germany
| | - Sönke Hellwig
- Department of Neurosurgery, Münster University Hospital , Münster , Germany
| | - Walter Stummer
- Department of Neurosurgery, Münster University Hospital , Münster , Germany
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | - Johannes Hainfellner
- Division of Neuropathology and Neurochemistry (Obersteiner Institute), Department of Neurology, Medical University Vienna , Vienna , Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | - David Reichert
- Center for Medical Physics and Biomedical Engineering, Medical University Vienna , Vienna , Austria
| | - Mario Mischkulnig
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | - Rajan Jain
- Department of Radiology, NYU Grossman School of Medicine , New York, NY , USA
| | | | | | - Donato Pacione
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | | | - Eric Oermann
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | - John Golfinos
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | - Todd Hollon
- Department of Neurosurgery, University of Michigan Medical School , Ann Arbor , USA
| | | | | | - Daniel Orringer
- Department of Neurosurgery, NYU Grossman School of Medicine , New York, NY , USA
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Kurz S, Zan E, Cordova C, Barbaro M, Troxel A, Silverman J, Snuderl M, Zagzag D, Golfinos J, Kondziolka D, Sulman E. CTNI-57. RADIONUCLIDE THERAPY WITH 177LU-DOTATATE (LUTATHERA) IN ADULTS WITH ADVANCED INTRACRANIAL MENINGIOMA - INTERIM ANALYSIS RESULTS OF A SINGLE-ARM, OPEN-LABEL, MULTICENTER PHASE II STUDY. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.322] [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
While most meningiomas are considered benign tumors, a subset of these tumors are characterized by a more aggressive clinical course and require multimodal treatment. Beyond surgical and radiotherapeutic options, there are no effective medical treatments available. Somatostatin receptor 2 (SSTR2) is expressed by the majority of meningiomas. 177Lu-DOTATATE is a SSTR2-targeting radionuclide that has been successful in neuroendocrine tumors. Here we report the results of the interim analysis of an ongoing clinical trial (NCT03971461) that is evaluating the effect of 177Lu-DOTATATE in treating progressive intracranial meningiomas.
METHODS
In this Simon two-stage design phase II study, adults with advanced intracranial meningiomas received 177Lu-DOTATATE 7.4 GBq (200 mCi) every eight weeks for four doses. 68Ga-DOTATATE PET-MRI was performed before and at the end of treatment. The primary endpoint was progression-free survival at 6 months (PFS-6). Correlative studies evaluated the association of PFS-6, objective response rate, progression-free survival, overall survival with radiographic tumor measurements, 68Ga-DOTATATE uptake on PET-MRI, SSTR2 expression in tumor, and meningioma methylation subclass.
RESULTS
Fourteen patients (F = 11, M = 3) with progressive meningiomas (WHO I = 3, II = 10, III = 1) have been enrolled. Median age was 63.1 (range 49-78) years. All patients previously underwent tumor resection and at least one course of radiation. Treatment with 177Lu-DOTATATE was well tolerated, no treatment-limiting toxicities were observed. Six of 14 patients (42%) achieved PFS-6. Radiographically, all six patients had achieved Stable Disease. A functional alteration of tumoral SSTR2 expression by 68Ga-DOTATATE PET-MR imaging was observed in three patients.
CONCLUSIONS
Treatment with SSTR2-targeting 177Lu-DOTATATE is well tolerated. In this interim analysis, six of 14 patients achieved PFS-6. This exceeds the predefined threshold to continue to stage two of this study. This clinical trial is now open to patient enrollment at two study sites in the US.
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Affiliation(s)
- Sylvia Kurz
- University of Tuebingen , Tuebingen , Germany
| | - Elcin Zan
- NYU Grossman School of Medicine , New York, NY , USA
| | | | | | - Andrea Troxel
- NYU Grossman School of Medicine , New York, NY , USA
| | | | | | - David Zagzag
- NYU Grossman School of Medicine , New York, NY , USA
| | - John Golfinos
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | | | - Erik Sulman
- NYU Grossman School of Medicine, Department of Radiation Oncology , New York, NY , USA
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5
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Hollon T, Jiang C, Nasir-Moin M, Kondepudi A, Chowdury A, Al-Holou W, Castro M, Lowenstein P, Wadiura LI, Widhalm G, Neuschmelting V, David R, von Spreckelsen N, Berger MS, Golfinos J, Hervey-Jumper SL, Camelo-Piragua S, Lee H, Freudiger C, Orringer D. NIMG-30. AI-BASED MOLECULAR CLASSIFICATION OF DIFFUSE GLIOMAS USING RAPID, LABEL-FREE OPTICAL HISTOLOGY. Neuro Oncol 2022. [PMCID: PMC9661039 DOI: 10.1093/neuonc/noac209.648] [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
INTRODUCTION
Molecular classification has transformed the management of brain tumors by enabling more accurate prognostication and personalized treatment. Access to timely molecular diagnostic testing for brain tumor patients is limited, complicating surgical and adjuvant treatment and obstructing clinical trial enrollment.
OBJECTIVE
We aim to develop a rapid (< 90 seconds), AI-based diagnostic screening system that can provide molecular classification of diffuse gliomas and report its use in a prospective, multicenter, international clinical trial of diffuse glioma patients (n = 153).
METHODS
By combining stimulated Raman histology (SRH), a rapid, label-free, non-consumptive, optical imaging method, and deep learning-based image classification, we are able to predict the molecular genetic features used by the World Health Organization (WHO) to define the adult-type diffuse glioma taxonomy, including IDH-1/2, 1p19q-codeletion, and ATRX loss. We developed a multimodal deep neural network training strategy that uses both SRH images and large-scale, public diffuse glioma genomic data in order to achieve optimal molecular classification performance.
RESULTS
One institution was used for model training (University of Michigan) and four institutions (NYU, UCSF, Medical University of Vienna, and University Hospital Cologne) were included for prospective patient enrollment and model testing. Using our system, called DeepGlioma, we achieved an average molecular genetic classification accuracy of 93.2% and identified the correct diffuse glioma molecular subgroup with 91.5% accuracy. DeepGlioma outperformed conventional IDH1-R132H immunohistochemistry (94.2% versus 91.4% accuracy, respectively) as a first-line molecular diagnostic screening method for diffuse gliomas, detecting canonical and non-canonical IDH mutations with high accuracy.
CONCLUSION
Our results demonstrate how artificial intelligence and optical histology can be used to provide a rapid and scalable alternative to wet lab methods for the molecular diagnosis of brain tumor patients during surgery.
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Affiliation(s)
- Todd Hollon
- Department of Neurosurgery, University of Michigan Medical School , Ann Arbor , USA
| | - Cheng Jiang
- University of Michigan , Ann Arbor, MI , USA
| | - Mustafa Nasir-Moin
- Department of Neurosurgery, NYU Grossman School of Medicine , New York, NY , USA
| | | | | | | | - Maria Castro
- University of Michigan Medical School , Ann Arbor, MI , USA
| | | | - Lisa Irina Wadiura
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna , Vienna , Austria
| | | | | | | | - Mitchel S Berger
- University of California, San Francisco , San Francisco, CA , USA
| | - John Golfinos
- Department of Neurosurgery, NYU Grossman School of Medicine , New York , USA
| | | | | | - Honglak Lee
- University of Michigan , Ann Arbor, MI , USA
| | | | - Daniel Orringer
- Department of Neurosurgery, NYU Grossman School of Medicine , New York, NY , USA
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Maas SLN, Stichel D, Hielscher T, Sievers P, Berghoff AS, Schrimpf D, Sill M, Euskirchen P, Blume C, Patel A, Dogan H, Reuss D, Dohmen H, Stein M, Reinhardt A, Suwala AK, Wefers AK, Baumgarten P, Ricklefs F, Rushing EJ, Bewerunge-Hudler M, Ketter R, Schittenhelm J, Jaunmuktane Z, Leu S, Greenway FEA, Bridges LR, Jones T, Grady C, Serrano J, Golfinos J, Sen C, Mawrin C, Jungk C, Hänggi D, Westphal M, Lamszus K, Etminan N, Jungwirth G, Herold-Mende C, Unterberg A, Harter PN, Wirsching HG, Neidert MC, Ratliff M, Platten M, Snuderl M, Aldape KD, Brandner S, Hench J, Frank S, Pfister SM, Jones DTW, Reifenberger G, Acker T, Wick W, Weller M, Preusser M, von Deimling A, Sahm F. Integrated Molecular-Morphologic Meningioma Classification: A Multicenter Retrospective Analysis, Retrospectively and Prospectively Validated. J Clin Oncol 2021; 39:3839-3852. [PMID: 34618539 PMCID: PMC8713596 DOI: 10.1200/jco.21.00784] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for individual patients is of pivotal importance. However, only biomarkers for highly aggressive tumors are established (CDKN2A/B and TERT), whereas no molecularly based stratification exists for the broad spectrum of patients with low- and intermediate-risk meningioma. METHODS DNA methylation data and copy-number information were generated for 3,031 meningiomas (2,868 patients), and mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNVs), mutations, and WHO grading were analyzed. Prediction power for outcome was assessed in a retrospective cohort of 514 patients, validated on a retrospective cohort of 184, and on a prospective cohort of 287 multicenter cases. RESULTS Both CNV- and methylation family-based subgrouping independently resulted in increased prediction accuracy of risk of recurrence compared with the WHO classification (c-indexes WHO 2016, CNV, and methylation family 0.699, 0.706, and 0.721, respectively). Merging all risk stratification approaches into an integrated molecular-morphologic score resulted in further substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference P = .005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (hazard ratio 4.34 [2.48-7.57] and 3.34 [1.28-8.72] retrospective and prospective validation cohorts, respectively). CONCLUSION Merging these layers of histologic and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision making for patients with meningioma on the basis of robust outcome prediction.
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Affiliation(s)
- Sybren L N Maas
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pathology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Damian Stichel
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Department of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anna S Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria.,Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Philipp Euskirchen
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christina Blume
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Areeba Patel
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Helin Dogan
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hildegard Dohmen
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany
| | - Marco Stein
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany.,Department of Neurosurgery, University Hospital Gießen, Giessen, Germany
| | - Annekathrin Reinhardt
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Abigail K Suwala
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Franz Ricklefs
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital Zurich, Zürich, Switzerland
| | | | - Ralf Ketter
- Department of Neurosurgery, University Hospital Homburg, Homburg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom.,Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Severina Leu
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Fay E A Greenway
- Department of Neurosurgery, St George's Hospital, London, United Kingdom
| | - Leslie R Bridges
- Department of Cellular Pathology, St George's Hospital, London, United Kingdom
| | - Timothy Jones
- Department of Neurosurgery, St George's Hospital, London, United Kingdom
| | - Conor Grady
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | | | - John Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, NY
| | - Christian Mawrin
- Department of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Jungk
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nima Etminan
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Gerhard Jungwirth
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Christel Herold-Mende
- Division of Exp. Neurosurgery, Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Patrick N Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Frankfurt, Germany.,Frankfurt Cancer Institute (FCI) and German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Heidelberg, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Miriam Ratliff
- Department of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, Medical Faculty Mannheim, MCTN, Heidelberg University, Heidelberg, Germany
| | - Matija Snuderl
- Department of Pathology, NYU Grossman School of Medicine, New York, NY
| | | | - Sebastian Brandner
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, United Kingdom.,Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Jürgen Hench
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Department of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Pediatric Oncology, Hematology, Immunology and Pulmonology, University Hospital Heidelberg, Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany.,Division of Pediatric Glioma Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University Medical Faculty, Düsseldorf, Germany.,German Cancer Consortium (DKTK), Partner Site Essen/Düsseldorf, Germany
| | - Till Acker
- Department of Neuropathology, University Hospital Gießen, Giessen, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Neurology and Neurooncology Program, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg and CCU Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
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7
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Liu E, Vasudevaraja V, Sviderskiy V, Feng Y, Tran I, Serrano J, Cordova C, Kurz S, Golfinos J, Sulman E, Placantonakis D, Possemato R, Snuderl M. NCOG-11. ASSOCIATION OF HYPERGLYCEMIA AND TUMOR SUBCLASS ON SURVIVAL IN IDH-WILDTYPE GLIOBLASTOMA. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.602] [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
BACKGROUND
RNA expression and DNA methylation studies have identified different subclasses of isocitrate dehydrogenase (IDH)-wildtype (wt) glioblastoma (GBM). However, the prognostic significance of molecular subclasses is unclear. Although hyperglycemia has been previously associated with worse survival, attempts to lower glucose have yielded mixed responses. The role of hyperglycemia may be confounded by molecular heterogeneity and have different impact in molecularly distinct GBM subclasses.
METHODS
Clinical, laboratory, and molecular data on 89 IDH-wt GBMs profiled by clinical next-generation sequencing and treated with Stupp protocol were reviewed. IDH-wt GBMs were subclassified into RTKI (Proneural), RTKII (Classical) and Mesenchymal subtypes using DNA methylation. Average glucose was calculated by time-weighting plasma glucose measurements between diagnosis and last follow-up.
RESULTS
Patients were stratified into three groups using average glucose: tertile one (< 100mg/dL), tertile two (100-115mg/dL), and tertile three ( > 115mg/dL). Comparison across glucose tertiles revealed no significant differences in Karfnosky Performance Status (KPS), dexamethasone dose, MGMT methylation, or methylation subclass. Overall survival (OS) was not affected by methylation subclass (log-rank p=0.9) but decreased with higher glucose (log-rank p=0.015). Higher glucose tertiles were associated with poorer OS among RTK I (log-rank p=0.08) and mesenchymal tumors (log-rank p=0.05), but not RTK II (log-rank p=0.99). After controlling for age, KPS, dexamethasone dose, and MGMT status, glucose remained significantly associated with survival (adjusted hazard ratio=5.2, p=0.02). DNA methylation clustering did not identify a unique signature associated with high or low glucose levels. Metabolomic analysis of 23 tumors showed minimal variation across metabolites within the cohort with no differences across molecular subclasses.
CONCLUSION
Higher average glucose values were associated with poorer OS in RTKI and Mesenchymal IDH-wt GBM, but not RTKII. There were no discernible epigenetic or metabolomic differences between tumors in different glucose environments, suggesting a potential survival benefit with systemic glucose lowering in selected molecular subtype.
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Affiliation(s)
- Elisa Liu
- NYU Grossman School of Medicine, New York, NY, USA
| | | | | | | | - Ivy Tran
- NYU Langone Health, New York, USA
| | | | | | - Sylvia Kurz
- NYU Grossman School of Medicine, New York, NY, USA
| | | | - Erik Sulman
- Department of Radiation Oncology at NYU Grossman School of Medicine, New York City, NY, USA
| | | | | | - Matija Snuderl
- Department of Pathology at NYU Grossman School of Medicine, New York City, NY, USA
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8
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Maas S, Stichel D, Hielscher T, Sievers P, Berghoff A, Schrimpf D, Sill M, Euskirchen P, Reuss D, Dohmen H, Stein M, Baumgarten P, Ricklefs F, Rushing E, Bewerunge-Hudler M, Ketter R, Schittenhelm J, Jaunmuktane Z, Leu S, Grady C, Serrano J, Golfinos J, Sen C, Mawrin C, Jungk C, Hänggi D, Westphal M, Lamszus K, Etminan N, Unterberg A, Harter P, Wirsching HG, Neidert MC, Ratliff M, Platten M, Snuderl M, Aldape K, Brandner S, Hench J, Frank S, Pfister S, Jones D, Reifenberger G, Acker T, Wick W, Weller M, Preusser M, von Deimling A, Sahm F. PATH-39. INTEGRATED MOLECULAR-MORPHOLOGICAL MENINGIOMA CLASSIFICATION: A MULTICENTER RETROSPECTIVE ANALYSIS, RETRO- AND PROSPECTIVELY VALIDATED. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.491] [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
PURPOSE
Meningiomas are the most frequent primary intracranial tumors. Patient outcome varies widely from cases with benign to highly aggressive, ultimately fatal courses. Reliable identification of risk of progression for the individual patient is of pivotal importance in clinical management. However, only biomarkers for highly aggressive tumors are established at present (CDKN2A/B and TERT), while no molecularly-based stratification exists for the broad spectrum of low- and intermediate-risk meningioma patients.
PATIENTS AND METHODS
DNA methylation data and copy-number information were generated for 3,031 meningiomas of 2,868 individual patients, with mutation data for 858 samples. DNA methylation subgroups, copy-number variations (CNV), mutations and WHO grading were comparatively analyzed. Prediction power for outcome of these parameters was assessed in an initial retrospective cohort of 514 patients, and validated on a retrospective cohort of 184, and on a prospective cohort of 287 multi-center cases, respectively.
RESULTS
Both CNV and methylation family- (MF)-based subgrouping independently resulted in an increase in prediction accuracy of risk of recurrence compared to the WHO classification (c-indexes WHO 2016, CNV, and MF 0.699, 0.706 and 0.721, respectively). Merging all independently powerful risk stratification approaches into an integrated molecular-morphological score resulted in a further, substantial increase in accuracy (c-index 0.744). This integrated score consistently provided superior accuracy in all three cohorts, significantly outperforming WHO grading (c-index difference p=0.005). Besides the overall stratification advantage, the integrated score separates more precisely for risk of progression at the diagnostically challenging interface of WHO grade 1 and grade 2 tumors (HR 4.56 [2.97;7.00], 4.34 [2.48;7.57] and 3.34 [1.28; 8.72] for discovery, retrospective, and prospective validation cohort, respectively).
CONCLUSIONS
Merging these layers of histological and molecular data into an integrated, three-tiered score significantly improves the precision in meningioma stratification. Implementation into diagnostic routine informs clinical decision-making for meningioma patients on the basis of robust outcome prediction.
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Affiliation(s)
- Sybren Maas
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Hielscher
- Dept. of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Sievers
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Anna Berghoff
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Daniel Schrimpf
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Sill
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | | | - David Reuss
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hildegard Dohmen
- Dept. of Neuropathology, University Hospital Gießen, Gießen, Germany
| | - Marco Stein
- Dept. of Neurosurgery, University Hospital Giessen, Germany, Gießen, Germany
| | - Peter Baumgarten
- Dept. of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Franz Ricklefs
- Dept. of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Elizabeth Rushing
- Dept. of Neuropathology, University Hospital Zurich, Zürich, Switzerland
| | | | - Ralf Ketter
- Dept. of Neurosurgery, University Hospital Homburg, Homburg, Germany
| | - Jens Schittenhelm
- Eberhard-Karls University Tübingen, Department of Neuropathology, Tübingen, Germany
| | - Zane Jaunmuktane
- Department of Clinical and Movement Neurosciences and Queen Square Brain Bank for Neurological Disorders, University College London, London, United Kingdom
| | - Severina Leu
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Conor Grady
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | | | - John Golfinos
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | - Chandra Sen
- Department of Neurosurgery, NYU Langone Hospital, New York, USA
| | - Christian Mawrin
- Dept. of Neuropathology, University Hospital Magdeburg, Magdeburg, Germany
| | - Christine Jungk
- Dept. of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Dept. of Neurosurgery, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nima Etminan
- Dept. of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Andreas Unterberg
- Division of Experimental Neurosurgery, Department of Neurosurgery, Ruprechts-Karls-University Heidelberg, Heidelberg, Germany
| | - Patrick Harter
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Frankfurt, Germany
| | - Hans-Georg Wirsching
- Dept. of Neurology, University Hospital and University of Zurich, Zürich, Switzerland
| | | | - Miriam Ratliff
- Dept. of Neurosurgery, University Medicine Mannheim, Mannheim, Germany
| | - Michael Platten
- Department of Neurology, MCTN, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matija Snuderl
- Department of Pathology at NYU Grossman School of Medicine, New York City, NY, USA
| | - Kenneth Aldape
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sebastian Brandner
- Department of Neurodegenerative Disease, Queen Square Institute of Neurology, University College London, London, UK
| | - Jürgen Hench
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stephan Frank
- Dept. of Neuropathology, University Hospital Basel, Basel, Switzerland
| | - Stefan Pfister
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - David Jones
- Hopp Children’s Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Guido Reifenberger
- Institute of Neuropathology, Heinrich Heine University, Düsseldorf, Germany
| | - Till Acker
- Dept. of Neuropathology, University Hospital Gießen, Gießen, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Michael Weller
- University Hospital and University of Zurich, Zurich, Switzerland
| | - Matthias Preusser
- Dept. of Medicine, Clinical Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, University of Heidelberg, Heidelberg, Germany
| | - Felix Sahm
- Dept. of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
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9
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London D, Patel D, Donahue B, Navarro R, Gurewitz J, Silverman J, Sulman E, Bernstein K, Palermo A, Golfinos J, Sabari J, Shum E, Velcheti V, Chachoua A, Kondziolka D. RADI-19. The Incidence of New Brain Metastases in Patients with Non-Small Cell Lung Cancer Following Discontinuation of Systemic Therapy. Neurooncol Adv 2021. [PMCID: PMC8351273 DOI: 10.1093/noajnl/vdab071.089] [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: 11/15/2022] Open
Abstract
Purpose Patients with non-small cell lung cancer (NSCLC) metastatic to the brain increasingly are living longer due to improvements in systemic therapy and local modalities. The risk of new brain metastases when these patients stop systemic therapy is unknown. Recognizing patterns of new tumor occurrence is necessary to determine the frequency of follow-up and the need for further treatment. Methods We included patients in a prospective registry who had non-small cell lung cancer (NSCLC) brain metastases, discontinued systemic therapy for at least 90 days, and underwent active surveillance. 63 patients with 73 off-periods were studied. The risk factors for the development of new tumors were determined using Cox regression and multi-state Markov modeling. Results The median time to new brain metastases off systemic therapy was 16.0 months. The probability of developing an additional new tumor at 6, 12, and 18 months was 26%, 40%, and 53%, respectively. There were no additional new tumors 22 months after stopping therapy. Patients who discontinued therapy due to intolerance or progression of the disease and those with mutations in RAS or receptor tyrosine kinase pathways (e.g. KRAS, EGFR) were more likely to develop new tumors (HR: 2.21, 95% CI: 1.25–3.91, p=6.3 x 10–3; HR: 2.03, 95% CI: 1.09–3.77, p=0.026, respectively). Conclusion The rate of new brain metastases from NSCLC in patients off systemic therapy decreases over time and is uncommon 2 years after cessation of cancer therapy. Patients who stop therapy due to toxicity or who have RAS or receptor tyrosine kinase pathway mutations have a higher rate of new metastases and should be followed more closely.
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Affiliation(s)
| | - Dev Patel
- NYU Langone Health, New York, NY, USA
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10
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Tordjman M, Madelin G, Gupta PK, Cordova C, Kurz SC, Orringer D, Golfinos J, Kondziolka D, Ge Y, Wang RL, Lazar M, Jain R. Functional connectivity of the default mode, dorsal attention and fronto-parietal executive control networks in glial tumor patients. J Neurooncol 2021; 152:347-355. [PMID: 33528739 DOI: 10.1007/s11060-021-03706-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/24/2020] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Resting state functional magnetic resonance imaging (rsfMRI) is an emerging tool to explore the functional connectivity of different brain regions. We aimed to assess the disruption of functional connectivity of the Default Mode Network (DMN), Dorsal Attention Network(DAN) and Fronto-Parietal Network (FPN) in patients with glial tumors. METHODS rsfMRI data acquired on 3T-MR of treatment-naive glioma patients prospectively recruited (2015-2019) and matched controls from the 1000 functional-connectomes-project were analyzed using the CONN functional toolbox. Seed-Based Connectivity Analysis (SBCA) and Independent Component Analysis (ICA, with 10 to 100 components) were performed to study reliably the three networks of interest. RESULTS 35 patients with gliomas (17 WHO grade I-II, 18 grade III-IV) and 70 controls were included. Global increased DMN connectivity was consistently found with SBCA and ICA in patients compared to controls (Cluster1: Precuneus, height: p < 10-6; Cluster2: subcallosum; height: p < 10-5). However, an area of decreased connectivity was found in the posterior corpus callosum, particularly in high-grade gliomas (height: p < 10-5). The DAN demonstrated small areas of increased connectivity in frontal and occipital regions (height: p < 10-6). For the FPN, increased connectivity was noted in the precuneus, posterior cingulate gyrus, and frontal cortex. No difference in the connectivity of the networks of interest was demonstrated between low- and high-grade gliomas, as well as when stratified by their IDH1-R132H (isocitrate dehydrogenase) mutation status. CONCLUSION Altered functional connectivity is reliably found with SBCA and ICA in the DMN, DAN, and FPN in glioma patients, possibly explained by decreased connectivity between the cerebral hemispheres across the corpus callosum due to disruption of the connections.
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Affiliation(s)
- Mickael Tordjman
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA.
| | - Guillaume Madelin
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Pradeep Kumar Gupta
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Christine Cordova
- Perlmutter Cancer Center, Brain and Spine Tumor Center, NYU Langone Health, 240 E 38th Street, New York, NY, 10016, USA
| | - Sylvia C Kurz
- Perlmutter Cancer Center, Brain and Spine Tumor Center, NYU Langone Health, 240 E 38th Street, New York, NY, 10016, USA
| | - Daniel Orringer
- Department of Neurosurgery, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - John Golfinos
- Department of Neurosurgery, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Douglas Kondziolka
- Department of Neurosurgery, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Yulin Ge
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Ruoyu Luie Wang
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Mariana Lazar
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
| | - Rajan Jain
- Department of Radiology, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA.,Department of Neurosurgery, New York University Grossman School of Medicine, 650 First Avenue, New York, NY, 10022, USA
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11
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Ades-Aron B, Lemberskiy G, Veraart J, Golfinos J, Fieremans E, Novikov DS, Shepherd T. Improved Task-based Functional MRI Language Mapping in Patients with Brain Tumors through Marchenko-Pastur Principal Component Analysis Denoising. Radiology 2020; 298:365-373. [PMID: 33289611 DOI: 10.1148/radiol.2020200822] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Functional MRI improves preoperative planning in patients with brain tumors, but task-correlated signal intensity changes are only 2%-3% above baseline. This makes accurate functional mapping challenging. Marchenko-Pastur principal component analysis (MP-PCA) provides a novel strategy to separate functional MRI signal from noise without requiring user input or prior data representation. Purpose To determine whether MP-PCA denoising improves activation magnitude for task-based functional MRI language mapping in patients with brain tumors. Materials and Methods In this Health Insurance Portability and Accountability Act-compliant study, MP-PCA performance was first evaluated by using simulated functional MRI data with a known ground truth. Right-handed, left-language-dominant patients with brain tumors who successfully performed verb generation, sentence completion, and finger tapping functional MRI tasks were retrospectively identified between January 2017 and August 2018. On the group level, for each task, histograms of z scores for original and MP-PCA denoised data were extracted from relevant regions and contralateral homologs were seeded by a neuroradiologist blinded to functional MRI findings. Z scores were compared with paired two-sided t tests, and distributions were compared with effect size measurements and the Kolmogorov-Smirnov test. The number of voxels with a z score greater than 3 was used to measure task sensitivity relative to task duration. Results Twenty-three patients (mean age ± standard deviation, 43 years ± 18; 13 women) were evaluated. MP-PCA denoising led to a higher median z score of task-based functional MRI voxel activation in left hemisphere cortical regions for verb generation (from 3.8 ± 1.0 to 4.5 ± 1.4; P < .001), sentence completion (from 3.7 ± 1.0 to 4.3 ± 1.4; P < .001), and finger tapping (from 6.9 ± 2.4 to 7.9 ± 2.9; P < .001). Median z scores did not improve in contralateral homolog regions for verb generation (from -2.7 ± 0.54 to -2.5 ± 0.40; P = .90), sentence completion (from -2.3 ± 0.21 to -2.4 ± 0.37; P = .39), or finger tapping (from -2.3 ± 1.20 to -2.7 ± 1.40; P = .07). Individual functional MRI task durations could be truncated by at least 40% after MP-PCA without degradation of clinically relevant correlations between functional cortex and functional MRI tasks. Conclusion Denoising with Marchenko-Pastur principal component analysis led to higher task correlations in relevant cortical regions during functional MRI language mapping in patients with brain tumors. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Benjamin Ades-Aron
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Gregory Lemberskiy
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Jelle Veraart
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - John Golfinos
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Els Fieremans
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Dmitry S Novikov
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
| | - Timothy Shepherd
- From the Center for Biomedical Imaging, Department of Radiology (B.A.A., G.L., J.V., E.F., D.S.N., T.S.) and Department of Neurosurgery (J.G.), New York University School of Medicine, 2nd Floor, 660 First Ave, New York, NY 10016; and Department of Electrical and Computer Engineering, New York University Tandon School of Engineering, New York, NY (B.A.A.)
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12
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Cordova C, Syeda MM, Corless B, Wiggins JM, Patel A, Kurz SC, Delara M, Sawaged Z, Utate M, Placantonakis D, Golfinos J, Schafrick J, Silverman JS, Jain R, Snuderl M, Zagzag D, Karlin-Neumann G, Polsky D, Chi AS. Abstract A65: Longitudinal detection of TERT-mutant plasma cell-free circulating tumor DNA in newly diagnosed glioblastoma patients. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.liqbiop20-a65] [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
Introduction: Liquid biopsies, especially plasma cell-free circulating tumor DNA (ctDNA), provide a potential opportunity to be a noninvasive biomarker for the diagnosis and monitoring of glioblastoma (GBM) patients. Previously, we detected TERT promoter hotspot mutations (C228T and C250T) in ctDNA of IDH wild-type (IDHwt) TERT promoter mutant GBM patients with 100% specificity using mutation-specific droplet digital PCR (ddPCR) assays. Here, we examine the association between mutant TERT ctDNA levels and clinical outcomes in newly diagnosed GBM patients undergoing chemoradiation.
Methods: We analyzed 76 serially collected plasma samples from 17 patients with suspected IDHwt GBM based on MRI before surgery. Twenty mL of whole blood was collected in EDTA tubes at predetermined times: pre- and postoperatively, at the end of chemoradiation, and 1, 3, and 6 months from the end of chemoradiation. TERT promoter mutations C228T or C250T were identified in FFPE tumor samples using ddPCR assays specific for these mutations. Plasma samples were analyzed for the patient’s tumor TERT mutation using the ddPCR assays. The analytically validated thresholds for positive ctDNA detection were 1.5 and 1.7 copies/mL for C228T and C250T, respectively.
Results: Sixteen of 17 (94%) IDHwt tumors had TERT mutations (10 C228T, 6 C250T) with MGMT methylated, unmethylated, or unknown status in 10, 5, and 1, respectively. Fourteen of the 16 patients (87.5%) had detectable mutant ctDNA at one or more time points (range 1.66 to 22.13 copies/mL). Of the 2 patients with undetectable ctDNA, one had diffuse and non-avidly enhancing disease and the other only had pre/postop plasma samples collected. Six patients had detectable ctDNA preop, and most had a dominant rim-enhancing mass with additional nonenhancing or enhancing lesion(s). Ten patients had detectable ctDNA up to 4 days postop, half of whom had undergone gross total resection. For 3 of 5 patients for whom there was a question of pseudoprogression versus true progression, ctDNA kinetics matched the clinical outcome. One patient with MGMT unmethylated multifocal GBM achieved ctDNA zeroconversion at 6 months post radiation (RT), and did not progress for another five months. Another patient was negative at all time points until their 3-month post RT follow-up, at which time they developed a recurrence. Another patient achieved zeroconversion at the end of RT but developed a borderline positive ctDNA at 6 months after RT, 2 months before documented radiographic progression.
Conclusions: In this pilot, prospective ctDNA monitoring study of IDHwt GBM, TERT mutant ctDNA was detected at one or more time points in the majority of patients. ctDNA kinetics were associated with clinical outcomes for some patients. These data suggest that additional, larger studies could refine how ctDNA monitoring may be used to enhance the clinical management of IDHwt GBM patients.
Citation Format: Christine Cordova, Mahrukh M. Syeda, Broderick Corless, Jennifer M. Wiggins, Amie Patel, Sylvia C. Kurz, Malcolm Delara, Zacharia Sawaged, Minerva Utate, Dimitris Placantonakis, John Golfinos, Jessica Schafrick, Joshua S. Silverman, Rajan Jain, Matija Snuderl, David Zagzag, George Karlin-Neumann, David Polsky, Andrew S. Chi. Longitudinal detection of TERT-mutant plasma cell-free circulating tumor DNA in newly diagnosed glioblastoma patients [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr A65.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andrew S. Chi
- 3NYU Langone Health, New York, NY; Neon Therapeutics, Boston, MA
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Karajannis M, Goldberg J, Thomas Roland J, Sen C, Placantonakis D, Golfinos J, Allen J, Dunbar E, Plotkin S, Akshintala S, Schneider R, Deng J, Neubert TA, Giancotti F, Zagzag D, O Blakeley J. ACTR-09. A PHASE 0 PHARMACODYNAMIC AND PHARMACOKINETIC STUDY OF EVEROLIMUS IN VESTIBULAR SCHWANNOMA (VS) AND MENINGIOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.052] [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
Inhibition of mTORC1 signaling has been shown to diminish growth of NF2 deficient tumors in preclinical studies, and clinical data suggest that everolimus, an orally administered mTORC1 inhibitor, may slow tumor progression in a subset of adult and pediatric NF2 patients with VS. To assess the pharmacokinetics, pharmacodynamics and potential mechanisms of treatment resistance, we performed a pre-surgical (“phase 0”) clinical trial of everolimus in patients undergoing surgery for VS or meningiomas.
METHODS
Eligible patients with meningioma or VS requiring tumor resection received everolimus 10 mg daily for 10 days immediately prior to surgery. Everolimus blood levels were determined immediately prior to and after surgery. Tumor samples were collected intraoperatively.
RESULTS
Ten patients completed protocol therapy, including 5 patients with NF2-related meningioma, 3 patients with sporadic meningioma, and 2 patients with NF2-related VS. Median pre- and post-operative plasma levels of everolimus were found to be in a high therapeutic range (17.4 ng/ml and 9.4 ng/ml, respectively). Median tumor tissue drug concentration determined by mass spectrometry was 24.3 ng/g (range 9.2–169.2), and median tumor tissue to post-operative plasma drug concentration ratio was 0.39. We observed only partial inhibition of phospho-S6 in the treated tumors, indicating incomplete target inhibition compared to matched control tissues from untreated patients (p = 0.005). Consistent with prior observations that inhibition of mTORC1 may lead to MAPK pathway activation through a PI3K-dependent feedback loop, we observed a statistically significant increase of phospho-ERK (p < 0.03) versus untreated controls.
CONCLUSIONS
In patients with meningioma or VS, treatment with everolimus leads to incomplete inhibition of mTORC1 signaling and upregulation phospho-ERK. These data may explain the limited anti-tumor effect of everolimus observed in clinical studies for NF2 patients and identify upregulation of phospho-ERK as a likely resistance mechanism that could be addressed with combination therapies.
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Mureb M, Jain R, Poisson L, Aguiar Littig I, Nunes Neto L, Wu CC, Ng V, Patel S, Patel S, Serrano J, Kurz S, Cahill D, Bendszus M, von Deimling A, Placantonakis D, Golfinos J, Kickingereder P, Snuderl M, Chi A. NIMG-09. NONINVASIVE PERFUSION IMAGING BIOMARKER OF MALIGNANT GENOTYPE IN ISOCITRATE DEHYDROGENASE MUTANT GLIOMAS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.681] [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
OBJECTIVE
A small subset of IDHmut astrocytomas behave aggressively, similarly to IDHwt glioblastoma. Genomic correlates of poor prognosis IDHmut astrocytomas include global relative DNA hypomethylation, MYCN amplification copy number variation (CNV) abundance, and CDKN2A/B homozygous deletion. We sought to identify a non-invasive imaging correlate of poor prognosis IDHmut astrocytomas.
METHODS
30 IDHmut astrocytomas (NYU=18, TCGA=12) were included. Relative cerebral blood volume was obtained from 4 regions of interest within the highest perfusion areas. Genomic CNV analysis and CDKN2A/B copy number status was obtained using Illumina Infinium 450k or Illumina EPIC methylation array data. Associations between rCBV, survival, and genomic alterations were evaluated. An additional 22 IDHmut astrocytomas were obtained from another institution for validation.
RESULTS
CNV stable (CNV-S, n=14) astrocytomas demonstrated significantly lower mean rCBV than and CNV unstable (CNV-U, n=16) (P=0.0.0155) ones. IDHmut astrocytomas with CDKN2A/B homozygous deletion (n=7) had higher rCBV (3.9 ± 2.3, mean ± SD) compared to those without this alteration (n=22; 1.8 ± 1.9, mean ± SD; P=0.0489). In the validation set, there was no significant evidence in rCBV between CNV-S and CNV-U tumors (P=0.3976). These results were sensitive to a single outlier in the CNV-S group. Excluding this case with rCBV=7.15, the CNV-S tumors demonstrated significantly lower mean rCBV (P=0.0279). IDHmut astrocytomas with CDKN2A/B homozygous deletion (n=9) tended to have higher rCBV (4.2 ± 1.8, mean ± SD) compared to those without this alteration (n=16; 2.5 ± 1.5, mean ± SD; P=0.0757, t-test). This led to significant discrimination (P=0.0328, Wilcoxon).
CONCLUSION
Our study is the first to identify a non-invasive imaging biomarker for prognostic genomic alterations in IDHmut astrocytomas. Greater CNV abundance and/or CDKN2A/B homozygous deletion have higher rCBV and worse prognosis. Our methods can be applied to standard clinical practice and may enhance informed treatment decisions in the preoperative and immediate postoperative settings.
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Affiliation(s)
- Monica Mureb
- New York University Langone Medical Center, New York, NY, USA
| | - Rajan Jain
- New York University Langone Medical Center, New York, NY, USA
| | | | | | | | - Chih-Chin Wu
- New York University Langone Medical Center, New York, NY, USA
| | - Victor Ng
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sohil Patel
- University of Virginia, Charlottesville, VA, USA
| | - Seema Patel
- New York University Langone Medical Center, New York, NY, USA
| | | | - Sylvia Kurz
- New York University Langone Health, New York, NY, USA
| | | | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | | | - John Golfinos
- New York University Langone Medical Center, New York, NY, USA
| | | | | | - Andrew Chi
- Perlmutter Cancer Center, New York, NY, USA
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Cooper B, Shenker R, Oh C, Tyburczy A, Golfinos J, Silverman J, Kondziolka D. A Prospective Observational Study Correlating Peripheral Biomarkers Associated with Changes to the Blood-Brain Barrier and Tumor Volume in Patients Treated with Radiation for Intracranial Metastases. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2329] [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: 11/16/2022]
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Cordova C, Syeda MM, Corless B, Wiggins JM, Patel A, Kurz SC, Delara M, Sawaged Z, Utate M, Placantonakis D, Golfinos J, Schafrick J, Silverman JS, Jain R, Snuderl M, Zagzag D, Shao Y, Karlin-Neumann GA, Polsky D, Chi AS. Plasma cell-free circulating tumor DNA (ctDNA) detection in longitudinally followed glioblastoma patients using TERT promoter mutation-specific droplet digital PCR assays. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.2026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2026 Background: There is a critical need for more specific and less invasive diagnostic and pharmacodynamic biomarkers in glioblastoma (GBM) patients (pts). Previously, we detected TERT promoter hotspot mutations (C228T and C250T) in the ctDNA of IDH wildtype ( IDHwt) TERT promoter mutant GBM pts with 100% specificity using mutation-specific droplet digital PCR (ddPCR) assays. Here, we explored the dynamics and clinical associations of mutant TERT ctDNA levels in GBM pts undergoing therapy. Methods: We examined 14 pts with suspected IDHwt GBM based on preoperative MRI. Plasma was isolated and frozen from ~15 mL whole blood samples collected pre- and post-op, at end of radiation (RT), and 1, 3, and 6 m after end of RT. TERT promoter mutations were identified in FFPE tumor samples using ddPCR assays for C228T/C250T. Plasma samples were analyzed using ddPCR assays specific for the corresponding tumor mutation. The validated thresholds for positive detection were 1.5 (C228T) and 1.7 copies/mL (C250T). Results: 13/14 (92.9%) IDHwt tumors had TERT mutations (7 C228T and 6 C250T). Six of these 13 (46%) pts had positive plasma TERT ctDNA preop (4 C228T, 2 C250T). The mean cross sectional area of enhancing disease at presentation for positive or negative preop mutant ctDNA was similar. All 4 pts with multiple contrast enhancing lesions had positive preop mutant ctDNA. 2 pts who were negative initially developed detectable mutant ctDNA preceding progression. 3/4 pts with equivocal radiographic pseudoprogression had ctDNA dynamics that correlated with eventual clinical outcome. One patient with unresectable GBM had declining mutant ctDNA in later collections during clinical stability. Conclusions: We detected plasma TERT ctDNA in 46% of TERT mutant GBM pts before surgery, and in 100% of pts with multiple contrast enhancing lesions. TERT mutant ctDNA levels correlated with pseudoprogression or true disease progression and predicted progression before MRI. These data suggest that larger studies to test circulating cell-free TERT mutation as a diagnostic and pharmacodynamic biomarker in GBM are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Golfinos
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | - Rajan Jain
- NYU Langone Medical Center, New York, NY
| | - Matija Snuderl
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - David Zagzag
- New York University School of Medicine, New York, NY
| | - Yongzhao Shao
- Department of Population Health, New York University School of Medicine, New York, NY
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Karajannis M, Wang S, Goldberg J, Roland T, Sen C, Placantonakis D, Golfinos J, Allen J, Dunbar E, Plotkin S, Akshintala S, Schneider R, Deng J, Neubert T, Giancotti F, Blakeley J. THER-07. A PHASE 0 PHARMACODYNAMIC AND PHARMACOKINETIC STUDY OF EVEROLIMUS IN VESTIBULAR SCHWANNOMA (VS) AND MENINGIOMA PATIENTS. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz036.214] [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: 11/13/2022] Open
Affiliation(s)
| | - Shiyang Wang
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Katz LM, Hielscher T, Liechty B, Silverman J, Zagzag D, Sen R, Wu P, Golfinos J, Reuss D, Neidert M, Wirsching HG, Baumgarten P, Herold-Mende C, Wick W, Harter P, Weller M, von Deimling A, Snuderl M, Sen C, Sahm F. MNGI-14. LOSS OF HISTONE H3K27me3 IDENTIFIES A SUBSET OF MENINGIOMAS WITH INCREASED RISK OF RECURRENCE. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.630] [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: 11/13/2022] Open
Affiliation(s)
- Leah M Katz
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | | | - Benjamin Liechty
- Langone Hospital, Department of Pathology, Division of Neuropathology, NYC, NY, USA
| | - Joshua Silverman
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | - David Zagzag
- Langone Hospital, Department of Pathology, Division of Neuropathology, NYC, NY, USA
| | - Rajeev Sen
- NYU Langone Hospital, Department of Neurosurgery, NYC, NY, USA
| | - Peter Wu
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | - John Golfinos
- NYU Langone Hospital, Department of Neurosurgery, NYC, NY, USA
| | - David Reuss
- Department of Neuropathology University Hospital Heidelberg, and Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany, Heidelberg, Germany
| | - Marian Neidert
- Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Christel Herold-Mende
- Div. of Experimental Neurosurgery, Dept. of Neurosurgery, University Hospital Heidelberg, Heidelberg
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany and Department of Neurology and Neurooncology Program. National Center for Tumor Diseases, Heidelberg University H, Heidelberg, Germany
| | - Patrick Harter
- Neurological Institute (Edinger Institute), Goethe University Frankfurt, Frankfurt am Main, Germany and German Cancer Consortium (DKTK), Partner site Frankfurt/Mainz, Germany; German Cancer Research Center (DKFZ), Heidelberg, Frankfurt, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - Chandra Sen
- NYU Langone Hospital, Department of Neurosurgery, NYC, NY, USA
| | - Felix Sahm
- University of Heidelberg and DKFZ, Heidelberg, Germany
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Kurz S, Liechty B, Kelly S, Vasudevaraja V, Bledea R, Wu P, Serrano J, Katz LM, Silverman J, Pacione D, Golfinos J, Chi A, Snuderl M. GENE-16. CLINICALLY AGGRESSIVE MENINGIOMAS ARE CHARACTERIZED BY MUTATIONAL SIGNATURES ASSOCIATED WITH DEFECTIVE DNA REPAIR AND MUTATIONS IN CHROMATIN REMODELING GENES. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy148.442] [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: 11/15/2022] Open
Affiliation(s)
- Sylvia Kurz
- Laura and Isaac Perlmutter Cancer Center / NYU Langone Medical Center, New York, NY, USA
| | - Benjamin Liechty
- NYU Langone Hospital, Department of Pathology, Division of Neuropathology, NYC, NY, USA
| | | | - Varshini Vasudevaraja
- Division of Advanced Research Technologies, NYU Langone Medical Center, New York, NY, USA
| | - Ramona Bledea
- Division of Advanced Research Technologies, NYU Langone Medical Center, New York, NY, USA
| | - Peter Wu
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | - Jonathan Serrano
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
| | - Leah M Katz
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | - Joshua Silverman
- NYU Langone Hospital, Department of Radiation Oncology, NYC, NY, USA
| | | | - John Golfinos
- NYU Langone Hospital, Department of Neurosurgery, New York, NY, USA
| | | | - Matija Snuderl
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA
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Wu CC, Jain R, Radmanesh A, Poisson LM, Guo WY, Zagzag D, Snuderl M, Placantonakis DG, Golfinos J, Chi AS. Predicting Genotype and Survival in Glioma Using Standard Clinical MR Imaging Apparent Diffusion Coefficient Images: A Pilot Study from The Cancer Genome Atlas. AJNR Am J Neuroradiol 2018; 39:1814-1820. [PMID: 30190259 DOI: 10.3174/ajnr.a5794] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/02/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Few studies have shown MR imaging features and ADC correlating with molecular markers and survival in patients with glioma. Our purpose was to correlate MR imaging features and ADC with molecular subtyping and survival in adult diffuse gliomas. MATERIALS AND METHODS Presurgical MRIs and ADC maps of 131 patients with diffuse gliomas and available molecular and survival data from The Cancer Genome Atlas were reviewed. MR imaging features, ADC (obtained by ROIs within the lowest ADC area), and mean relative ADC values were evaluated to predict isocitrate dehydrogenase (IDH) mutation, 1p/19q codeletion status, MGMT promoter methylation, and overall survival. RESULTS IDH wild-type gliomas tended to exhibit enhancement, necrosis, and edema; >50% enhancing area (P < .001); absence of a cystic area (P = .013); and lower mean relative ADC (median, 1.1 versus 1.6; P < .001) than IDH-mutant gliomas. By means of a cutoff value of 1.08 for mean relative ADC, IDH-mutant and IDH wild-type gliomas with lower mean relative ADC (<1.08) had poorer survival than those with higher mean relative ADC (median survival time, 24.2 months; 95% CI, 0.0-54.9 months versus 62.0 months; P = .003; and median survival time, 10.4 months; 95% CI, 4.4-16.4 months versus 17.7 months; 95% CI, 11.6-23.7 months; P = .041, respectively), regardless of World Health Organization grade. Median survival of those with IDH-mutant glioma with low mean relative ADC was not significantly different from that in those with IDH wild-type glioma. Other MR imaging features were not statistically significant predictors of survival. CONCLUSIONS IDH wild-type glioma showed lower ADC values, which also correlated with poor survival in both IDH-mutant and IDH wild-type gliomas, irrespective of histologic grade. A subgroup with IDH-mutant gliomas with lower ADC had dismal survival similar to that of those with IDH wild-type gliomas.
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Affiliation(s)
- C-C Wu
- From the Department of Radiology (C.-C.W., W.-Y.G.), Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine (C.-C.W., W.-Y.G.), National Yang-Ming University, Taipei, Taiwan, Republic of China
- Departments of Radiology (C.-C.W., R.J., A.R.)
| | - R Jain
- Departments of Radiology (C.-C.W., R.J., A.R.)
- Neurosurgery (R.J., D.P., J.G.)
| | - A Radmanesh
- Departments of Radiology (C.-C.W., R.J., A.R.)
| | - L M Poisson
- Department of Public Health Sciences and Hermelin Brain Tumor Center (L.M.P.), Henry Ford Hospital, Detroit, Michigan
| | - W-Y Guo
- From the Department of Radiology (C.-C.W., W.-Y.G.), Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
- School of Medicine (C.-C.W., W.-Y.G.), National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - D Zagzag
- Pathology (D.Z., M.S.), NYU School of Medicine, New York, New York
| | - M Snuderl
- Pathology (D.Z., M.S.), NYU School of Medicine, New York, New York
| | | | | | - A S Chi
- Neuro-Oncology Program (A.S.C.), Laura and Isaac Perlmutter Cancer Center, NYU School of Medicine and Langone Health, New York, New York
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Snuderl M, Kannan K, Pfaff E, Wang S, Stafford J, Serrano J, Heguy A, Ray K, Faustin A, Aminova O, Dolgalev I, Stapleton S, Zagzag D, Chiriboga L, Gardner S, Wisoff J, Golfinos J, Capper D, Hovestadt V, Rosenblum M, Placantonakis D, LeBoeuf S, Papagiannakopoulos T, Chavez L, Ahsan S, Eberhart C, Pfister S, Jones D, Karajannis M. EMBR-02. RECURRENT HOMOZYGOUS DELETION OF DROSHA AND MICRODUPLICATION OF PDE4DIP CONTAINING THE ANCESTRAL DUF1220 DOMAIN IN PINEOBLASTOMA. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy059.187] [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: 11/12/2022] Open
Affiliation(s)
| | | | - Elke Pfaff
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Rosenblum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Lukas Chavez
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sama Ahsan
- Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Stefan Pfister
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Jones
- German Cancer Research Center (DKFZ), Heidelberg, Germany
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Kurz SC, Kelly S, Vasudevaraja V, Liechty B, Bledea R, Wu P, Serrano J, Katz LM, Silverman JS, Pacione D, Russel S, Sen C, Golfinos J, Chi AS, Snuderl M. Characterization of clinically aggressive meningiomas by mutational signatures associated with DNA mismatch repair and aging. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e14044] [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: 11/20/2022] Open
Affiliation(s)
| | - Stephen Kelly
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | | | - Ramona Bledea
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - Peter Wu
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | - Leah M. Katz
- New York Presbyterian Hudson Valley Hospital, Peekskill, NY
| | | | - Donato Pacione
- NYU Langone Medical Center and School of Medicine, New York, NY
| | | | - Chandra Sen
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - John Golfinos
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - Andrew S. Chi
- NYU Langone Medical Center and School of Medicine, New York, NY
| | - Matija Snuderl
- NYU Langone Medical Center and School of Medicine, New York, NY
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Chi AS, Stafford JM, Sen N, Possemato R, Placantonakis D, Hidalgo ET, Harter D, Wisoff J, Golfinos J, Arrillaga-Romany I, Batchelor T, Wen P, Wakimoto H, Cahill D, Allen JE, Oster W, Snuderl M. EXTH-42. H3 K27M MUTANT GLIOMAS ARE SELECTIVELY KILLED BY ONC201, A SMALL MOLECULE INHIBITOR OF DOPAMINE RECEPTOR D2. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.334] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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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Kader M, Frenster J, Liechty B, Modrek A, Tsirigos A, Golfinos J, Eisele S, Jain R, Shepherd T, Fatterpekar G, MacNeil D, Shohdy N, Huang X, Chi AS, Snuderl M, Zagzag D, Placantonakis D. CBIO-19. CHARACTERIZATION OF GPR133 EXPRESSION IN GLIOMA SUBTYPES. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.138] [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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Jain R, Poisson LM, Littig I, Neto L, Wu CC, Ng V, Patel SH, Snuderl M, Zagzag D, Golfinos J, Chi AS. NIMG-33. CORRELATION BETWEEN IDH MUTATION STATUS, PATIENT SURVIVAL, AND BLOOD VOLUME ESTIMATES IN DIFFUSE GLIOMAS: A TCGA/TCIA PROJECT. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.608] [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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Cordova C, Corless B, Syeda M, Patel A, Delara M, Eisele S, Schafrick J, Placantonakis D, Pacione D, Silverman J, Fatterpekar G, Shepherd T, Jain R, Snuderl M, Zagzag D, Golfinos J, Jafar JJ, Shao Y, Karlin-Neumann G, Polsky D, Chi AS. PATH-42. DETECTION OF TERT MUTATIONS IN CELL-FREE CIRCULATING TUMOR DNA (ctDNA) OF GLIOBLASTOMA PATIENTS USING DROPLET DIGITAL PCR. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.732] [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: 11/13/2022] Open
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Kloetgen A, Serrano J, Patel S, Bowman C, Shen G, Zagzag D, Karajannis M, Golfinos J, Placantonakis D, Tsirigos A, Chi AS, Snuderl M. GENE-02. PERIPHERAL BLOOD DNA METHYLATION PROFILES IDENTIFY IDH1/2 MUTATION STATUS IN ADULTS WITH DIFFUSE GLIOMA. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.377] [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: 11/13/2022] Open
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Wu CC, Jain R, Patel S, Neto L, Zagzag D, Placantonakis D, Golfinos J, Chi AS, Snuderl M. NIMG-48. MR IMAGING PHENOTYPE CORRELATES WITH EXTENT OF GENOME-WIDE COPY NUMBER ABUNDANCE IN IDH MUTATED GLIOMAS. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.622] [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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Siow M, Barger J, Kader M, Phillips K, Sen C, Golfinos J, Lebowitz R, Placantonakis D. The Posterior Nasoseptal Flap: A Novel Technique for Closure after Endoscopic Transsphenoidal Resection of Pituitary Adenomas. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600836] [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)
- Matthew Siow
- NYU School of Medicine, New York, New York, United States
| | - James Barger
- NYU School of Medicine, New York, New York, United States
| | - Michael Kader
- NYU School of Medicine, New York, New York, United States
| | - Kate Phillips
- NYU School of Medicine, New York, New York, United States
| | | | - John Golfinos
- NYU School of Medicine, New York, New York, United States
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Sen R, Benjamin C, Golfinos J, Sen C, Roland J, Jethanamest D, Pacione D. Post-operative Sinus Thrombosis in the Setting of Skull Base and Parasagittal Surgery. Skull Base Surg 2017. [DOI: 10.1055/s-0037-1600693] [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)
- Rajeev Sen
- NYU School of Medicine, New York, United States
| | | | | | | | - John Roland
- NYU Langone Medical Center, New York, United States
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Chen H, Thomas C, Munoz FA, Alexandrescu S, Horbinski C, Olar A, McGuone D, Camelo-Piragua S, Wang L, Pentsova E, Phillips J, Aldape K, Iafrate AJ, Golfinos J, Chi A, Zagzag D, Rosenblum M, Ohman-Strickland P, Hameed M, Snuderl M. MPTH-34. THE PROGNOSTIC VALUE OF POLYSOMY IN OLIGODENDROGLIAL TUMORS. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.471] [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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Frenster J, Bayin NS, Kane JR, Rubenstein J, Modrek A, Baitamal R, Dolgalev I, Rudzenski K, Snuderl M, Golfinos J, Doyle W, Pacione D, Chi A, Heguy A, Shohdy N, MacNeil D, Huang X, Parker E, Zagzag D, Placantonakis D. STMC-25. GPR133 PROMOTES HYPOXIA-DRIVEN TUMOR PROGRESSION IN GLIOBLASTOMA. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.788] [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: 11/13/2022] Open
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Katz L, Liechty B, Sen R, Fatterpekar G, Silverman J, Golfinos J, Sen C, Zagzag D, Snuderl M. Global Loss of Histone H3K27 Trimethylation in Atypical and Anaplastic Meningiomas. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.2109] [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: 11/29/2022]
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Katz L, Sen R, Fatterpekar G, Silverman J, Liechty B, Snuderl M, Golfinos J, Pacione D, Sen C. Evaluation of Radiological Meningioma Margin is Superior to CSF Cleft in Predicting Surgical Ease. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.873] [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: 10/20/2022]
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Cage T, Benet A, Golfinos J, McDermott MW. A Superior Cerebellar Convexity Two-Part Craniotomy to Access the Paramedian Supra and Infratentorial Space: Technical Note. Cureus 2016; 8:e664. [PMID: 27493846 PMCID: PMC4968780 DOI: 10.7759/cureus.664] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A craniotomy over the superior cerebellar convexity for approaches to this region typically involves a small infratentorial craniotomy and then drilling down of the bone to expose some portion of the transverse/sigmoid sinuses. The authors describe the anatomy of the region and the method for a two-part paramedian occipital and suboccipital craniotomy (supra and infratentorial) that may have time-saving, safety, and cosmetic advantages. For this technique, a supratentorial craniotomy is used to expose the transverse sinus from above, and subsequently, dissection across the sinus over the cerebellar convexity can be done under direct vision. The two bone pieces are joined on the inner table side while plates for fixation above the superior nuchal line can be counter-sunk to avoid post-operative pain from the prominence of screws. There is no need for cranioplasty materials since there is no burring down of bone for adequate exposure of the transverse sinus. The technique has been used by two senior surgeons over the years convincing them of the speed, safety, and utility of the technique. Here, the authors present a single example of the technique.
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Affiliation(s)
- Tene Cage
- Department of Neurological Surgery, University of California, San Francisco
| | - Arnau Benet
- Department of Otolaryngology, University of California, San Francisco ; Department of Neurological Surgery, University of California, San Francisco
| | - John Golfinos
- Department of Neurosurgery, NYU Langone Medical Center
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Teng S, Friedmann D, McMenomey S, Golfinos J, Roland J. Transcochlear Approach to Resection of Cerebellopontine Angle Tumors: Patient Selection, Surgical Technique, and Outcomes. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579891] [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: 10/22/2022]
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Benjamin C, Sen R, Pacione D, Golfinos J, Sen C, Roland J, McMenomey S. Postoperative Sinus Thrombosis in the Setting of Skull Base Surgery. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579927] [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: 10/22/2022]
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Hill T, Shinseki M, Rokosh R, Choudhry O, Roland J, Kondziolka D, Golfinos J, Sen C, Pacione D. A Matched Cohort Comparison of Facial Nerve Outcomes in Salvage Surgery after Stereotactic Radiosurgery for Progressive Vestibular Schwannomas Compared with Microsurgery Alone. Skull Base Surg 2016. [DOI: 10.1055/s-0036-1579833] [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: 10/22/2022]
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Weiss S, Darvishian F, Tadepalli J, Shapiro R, Golfinos J, Pavlick A, Polsky D, Kirchhoff T, Osman I. Somatic and germline analyses of a long term melanoma survivor with a recurrent brain metastasis. BMC Cancer 2015; 15:926. [PMID: 26597176 PMCID: PMC4657192 DOI: 10.1186/s12885-015-1927-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 11/12/2015] [Indexed: 01/08/2023] Open
Abstract
Background Median overall survival (OS) of patients with melanoma brain metastases (MBM) is usually 6 months or less. There are rare reports of patients with treated MBM who survived for years. These outlier cases represent valuable opportunities to study the somatic and germline factors that may have influenced patient outcome and led to extended survival. Case presentation Here we report the clinical scenario of a 67 year old man with a recurrent brain metastasis from melanoma who has survived over 12 years post-resection. We review the literature relating to clinical and molecular variables associated with long term survival post-brain metastasis. We present the somatic characteristics of this individual patient’s tumor as well as an analysis of inherited genetic variants related to immune function. The patient’s resected brain tumor is BRAF V600E mutated, NRAS wild type (WT), and TERT C250T mutated. The patient is a carrier of germline variants in immunomodulatory loci associated with prolonged survival. Conclusions Our data suggest that genetic variants in immunomodulatory loci may partially contribute to this patient’s unusually favorable outcome and should not be overlooked. With further and future investigation, knowledge of inherited single nucleotide polymorphisms (SNPs) may provide clinicians with more individualized prognostic information for melanoma patients, with potential implications for surveillance strategies and therapeutic interventions.
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Affiliation(s)
- Sarah Weiss
- Deparment of Medicine, New York University School of Medicine, 522 First Ave., Smilow Building Room 403, New York, NY, 10016, USA. .,Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA.
| | - Farbod Darvishian
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA. .,Department of Pathology, New York University School of Medicine, 540-562 First Ave., New York, NY, 10016, USA.
| | - Jyothi Tadepalli
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 522 First Ave., Smilow 4th floor, New York, NY, 10016, USA.
| | - Richard Shapiro
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA. .,Department of Surgery, New York University School of Medicine, 160 E. 34th St., 4th floor, New York, NY, 10016, USA.
| | - John Golfinos
- Department of Neurosurgery, New York University School of Medicine, 530 First Ave., 8th floor, New York, NY, 10016, USA.
| | - Anna Pavlick
- Deparment of Medicine, New York University School of Medicine, 522 First Ave., Smilow Building Room 403, New York, NY, 10016, USA. .,Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA.
| | - David Polsky
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA. .,The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 522 First Ave., Smilow 4th floor, New York, NY, 10016, USA.
| | - Tomas Kirchhoff
- Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA. .,Departments of Population Health and Environmental Medicine, New York University School of Medicine, 522 First Ave., Smilow 12th floor, New York, NY, 10016, USA.
| | - Iman Osman
- Deparment of Medicine, New York University School of Medicine, 522 First Ave., Smilow Building Room 403, New York, NY, 10016, USA. .,Interdisciplinary Melanoma Cooperative Group, New York University School of Medicine, 522 First Ave., Smilow 403, New York, NY, 10016, USA. .,The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 522 First Ave., Smilow 4th floor, New York, NY, 10016, USA.
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Jain R, Griffith B, Alotaibi F, Zagzag D, Fine H, Golfinos J, Schultz L. Glioma Angiogenesis and Perfusion Imaging: Understanding the Relationship between Tumor Blood Volume and Leakiness with Increasing Glioma Grade. AJNR Am J Neuroradiol 2015. [PMID: 26206809 DOI: 10.3174/ajnr.a4405] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to investigate imaging correlates to the changes occurring during angiogenesis in gliomas. This was accomplished through in vivo assessment of vascular parameters (relative CBV and permeability surface-area product) and their changing relationship with increasing glioma grade. MATERIALS AND METHODS Seventy-six patients with gliomas underwent preoperative perfusion CT and assessment of relative CBV and permeability surface-area product. Regression analyses were performed to assess the rate of change between relative CBV and permeability surface-area product and to test whether these differed for distinct glioma grades. The ratio of relative CBV to permeability surface-area product was also computed and compared among glioma grades by using analysis of variance methods. RESULTS The rate of change in relative CBV with respect to permeability surface-area product was highest for grade II gliomas followed by grade III and then grade IV (1.64 versus 0.91 versus 0.27, respectively). The difference in the rate of change was significant between grade III and IV (P = .003) and showed a trend for grades II and IV (P = .098). Relative CBV/permeability surface-area product ratios were the highest for grade II and lowest for grade IV. The pair-wise difference among all 3 groups was significant (P < .001). CONCLUSIONS There is an increase in relative CBV more than permeability surface-area product in lower grade gliomas, whereas in grade III and especially grade IV gliomas, permeability surface-area product increases much more than relative CBV. The rate of change of relative CBV with respect to permeability surface-area product and relative CBV/permeability surface-area product ratio can serve as an imaging correlate to changes occurring at the tumor microvasculature level.
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Affiliation(s)
- R Jain
- From the Departments of Radiology (R.J.)
| | | | | | - D Zagzag
- Pathology (F.A., D.Z.) Neurosurgery (D.Z., J.G.)
| | - H Fine
- Medicine (H.F.), New York University School of Medicine, New York, New York
| | | | - L Schultz
- Public Health Sciences (L.S.), Henry Ford Hospital, Detroit, Michigan
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Osorio D, Filatov A, Hagiwara M, Mitchell C, Wisoff J, Golfinos J, Roland JT, Allen J, Karajannis M. TR-13 * EFFECTS OF EVEROLIMUS ON MENINGIOMA GROWTH IN PATIENTS WITH NEUROFIBROMATOSIS TYPE 2. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov061.158] [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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Lui KP, Silva IEDP, Weiss SA, Han SW, Darvishian F, Pavlick AC, Golfinos J, Moogk D, Krogsgaard M, Osman I. Immunologic profile of melanoma brain metastases (MBM) in patients (pts) with prolonged survival. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9070] [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: 11/20/2022] Open
Affiliation(s)
- Kevin P. Lui
- Ronald O. Perelman Department of Dermatology, NYU Langone Medical Center, New York, NY
| | | | | | - Sung Won Han
- Departments of Population Health and Environmental Medicine, New York University School of Medicine, New York, NY
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY
| | | | - John Golfinos
- New York University School of Medicine, New York, NY
| | | | - Michelle Krogsgaard
- Department of Pathology, New York University School of Medicine, New York, NY
| | - Iman Osman
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY
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Karajannis M, Osorio D, Filatov A, Hagiwara M, Mitchell C, Wisoff J, Golfinos J, Roland T, Allen J. AT-30 * EFFECTS OF EVEROLIMUS ON MENINGIOMA GROWTH IN PATIENTS WITH NEUROFIBROMATOSIS TYPE 2. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou237.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Cosetti M, Golfinos J, Roland JT. Quality of Life Assessment in Patients with Neurofibromatosis Type II. Otolaryngol Head Neck Surg 2014. [DOI: 10.1177/0194599814541627a209] [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] [Indexed: 11/15/2022]
Abstract
Objectives: (1) Develop a multidimensional metric for assessing quality of life (QoL) in patients with NF2. (2) Compare NF2 results with reference values for the general population and patients with head and neck or brain cancer. Methods: Structured interviews with NF2 providers and patients identified relevant domains. Items in these domains were extracted from validated EORTC modules, combined with items unique to NF2 and pre-tested on NF2 providers and patients (N = 118). The questionnaire included 61 items assessing overall QoL and 10 additional domains including hearing, balance, facial function, vision, oral intake, future uncertainty, psychosocial, cognition, sexual activity, pain and vocal communication. Responses were compared to reference values for the general population and head and neck cancer and brain cancer patients. Results: QoL in NF2 patients was lower than that of the general population ( P < .01) and similar to that of patients with cancer. NF2 patients whose treatment included radiation therapy had worse overall QoL than patients who did not undergo radiation. Patients with more facial weakness, hearing loss and imbalance reported significantly lower QoL. However, domains most predictive of overall QoL were psychosocial, future uncertainty and pain. When compared to patients with head and neck and brain cancer, NF2 patients demonstrated significantly higher levels of psychosocial stressors, including disease-related anxiety, personal and financial stress, and lack of social support ( P < .01). Conclusions: Psychosocial stress and pain significantly impact QoL in NF2 indicating that mental health, pain management, and financial counseling could have an important impact on QoL in this population.
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Tanweer O, Wilson T, Kalhorn S, Golfinos J, Huang P, Kondziolka D. E-017 Cerebrovascular Decision Making: Professional and Personal Preferences. J Neurointerv Surg 2014. [DOI: 10.1136/neurintsurg-2014-011343.84] [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: 11/04/2022]
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Tam M, Gruber M, Gruber D, Golfinos J, Parker E, Zagzag D, Narayana A. Phase 2 Trial of Temozolomide Plus Bevacizumab, Lithium, and Radiation Treatment for Newly Diagnosed High-Grade Gliomas: Interim Analysis. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.048] [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: 10/26/2022]
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Narayana A, Tam MM, Gruber DB, Golfinos J, Parker E, Zagzag D, Gruber ML. A phase II trial of lithium, bevacizumab, temozolomide, and radiation for newly diagnosed glioblastomas (GBM). J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.e13033] [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: 11/20/2022] Open
Abstract
e13033 Background: Invasion is a dominant escape mechanism following angiogenic blockade in glioblastomas (GBM). Lithium has shown anti-invasive activity in glioma cells by inhibiting Glycogen Synthetase Kinase -3. This phase II study evaluated the safety and efficacy of using lithium and bevacizumab (BEV) in newly diagnosed GBM. Methods: From 2010 through 2012, 20 GBM patients with residual disease after surgery were treated with involved-field radiation therapy to 5940 cGy and concomitant temozolomide (TMZ) (75 mg/m2 daily for 42 days) along with BEV (10 mg/kg every 2 weeks), starting 29 days after surgery. This was followed by six 28-day cycles of TMZ (150 mg/m2 on days 1-7, BEV (10 mg/kg) on days 8 and 22, and lithium 300 mg BID. Lithium was increased every 7 days up to 600 mg BID with a serum lithium goal level of 0.8 to 1.2 mEq/L. Results: The median follow-up was 9.9 months (range 1.9-24.5). Fourteen patients (70.0%) received at least one dose of lithium and three patients completed the entire course of therapy. The median number of BEV infusion was 9 (range 2-19). Five patients discontinued trial due to skin sensitivity (n = 2), pulmonary embolism (n = 1), infection (n = 1), and hematological toxicity (n=1). Two patients experienced dose limiting lithium toxicity which included drowsiness (n = 1) and tremor (n = 1). No patients experienced grade 3/4 intra-cranial hemorrhage. The median progression free survival (PFS) was 9.3 months. The 12-month PFS and OS were 31.9% and 59.3% respectively. For the 14 patients who received lithium, the 12-month PFS and OS were 42.9% and 69.2% respectively. Conclusions: The strategy of targeting angiogenesis and invasion simultaneously in newly diagnosed GBM is effective and feasible. Clinical trial information: NCT01105702.
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Affiliation(s)
| | - Moses M Tam
- New York University School of Medicine, New York, NY
| | | | - John Golfinos
- New York University School of Medicine, New York, NY
| | - Erik Parker
- New York University School of Medicine, New York, NY
| | - David Zagzag
- New York University School of Medicine, New York, NY
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Bie L, Ju Y, Jin Z, Donovan L, Birks S, Grunewald L, Zmuda F, Pilkington G, Kaul A, Chen YH, Dahiya S, Emnett R, Gianino S, Gutmann D, Poschl J, Bianchi E, Bockstaller M, Neumann P, Schuller U, Gevorgian A, Morozova E, Kazantsev I, Iukhta T, Safonova S, Punanov Y, Zheludkova O, Afanasyev B, Buss M, Remke M, Gandhi K, Kool M, Northcott P, Pfister S, Taylor M, Castellino R, Thompson J, Margraf L, Donahue D, Head H, Murray J, Burger P, Wortham M, Reitman Z, He Y, Bigner D, Yan H, Lee C, Triscott J, Foster C, Manoranjan B, Pambid MR, Fotovati A, Berns R, Venugopal C, O'Halloran K, Narendran A, Northcott P, Taylor MD, Singh SK, Singhal A, Rassekh R, Maxwell CA, Dunham C, Dunn SE, Pambid MR, Berns R, Hu K, Adomat H, Moniri M, Chin MY, Hessein M, Zisman N, Maurer N, Dunham C, Guns E, Dunn S, Koks C, De Vleeschouwer S, Graf N, Van Gool S, D'Asti E, Huang A, Korshunov A, Pfister S, Rak J, Gump W, Moriarty T, Gump W, Skjei K, Karkare S, Castelo-Branco P, Choufani S, Mack S, Gallagher D, Zhang C, Merino D, Wasserman J, Kool M, Jones DT, Croul S, Kreitzer F, Largaespada D, Conklin B, Taylor M, Weiss W, Garzia L, Morrissy S, Zayne K, Wu X, Dirks P, Hawkins C, Dick J, Stein L, Collier L, Largaespada D, Dupuy A, Taylor M, Rampazzo G, Moraes L, Paniago M, Oliveira I, Hitzler J, Silva N, Cappellano A, Cavalheiro S, Alves MT, Cerutti J, Toledo S, Liu Z, Zhao X, Mao H, Baxter P, Wang JCY, Huang Y, Yu L, Su J, Adekunle A, Perlaky L, Hurwitz M, Hurwitz R, Lau C, Chintagumpala M, Blaney S, Baruchel S, Li XN, Zhang J, Hariono S, Hashizume R, Fan Q, James CD, Weiss WA, Nicolaides T, Madsen PJ, Slaunwhite ES, Dirks PB, Ma JF, Henn RE, Hanno AG, Boucher KL, Storm PB, Resnick AC, Lourdusamy A, Rogers H, Ward J, Rahman R, Malkin D, Gilbertson R, Grundy R, Lourdusamy A, Rogers H, Ward J, Rahman R, Gilbertson R, Grundy R, Karajannis M, Fisher M, Pfister S, Milla S, Cohen K, Legault G, Wisoff J, Harter D, Merkelson A, Bloom M, Dhall G, Jones D, Korshunov A, Taylor MD, Pfister S, Eberhart C, Sievert A, Resnick A, Zagzag D, Allen J, Hankinson T, Gump J, Serrano-Almeida C, Torok M, Weksberg R, Handler M, Liu A, Foreman N, Garancher A, Rocques N, Miquel C, Sainte-Rose C, Delattre O, Bourdeaut F, Eychene A, Tabori U, Pouponnot C, Danielpour M, Levy R, Antonuk CD, Rodriguez J, Aravena JM, Kim GB, Gate D, Bannykh S, Svendsen C, Huang X, Town T, Breunig J, Amakye D, Robinson D, Rose K, Cho YJ, Ligon KL, Sharp T, Ando Y, Geoerger B, He Y, Doz F, Ashley D, Hargrave D, Casanova M, Tawbi H, Heath J, Bouffet E, Brandes AA, Chisholm J, Rodon J, Dubuc AM, Thomas A, Mita A, MacDonald T, Kieran M, Eisenstat D, Song X, Danielpour M, Levy R, Antonuk CD, Rodriguez J, Hashizume R, Aravena JM, Kim GB, Gate D, Bannykh S, Svendsen C, Town T, Breunig J, Morrissy AS, Mayoh C, Lo A, Zhang W, Thiessen N, Tse K, Moore R, Mungall A, Wu X, Van Meter TE, Cho YJ, Collins VP, MacDonald TJ, Li XN, Stehbens S, Fernandez-Lopez A, Malkin D, Marra MA, Taylor MD, Karajannis M, Legault G, Hagiwara M, Vega E, Merkelson A, Wisoff J, Younger S, Golfinos J, Roland JT, Allen J, Antonuk CD, Levy R, Kim GB, Town T, Danielpour M, Breunig J, Pak E, Barshow S, Zhao X, Ponomaryov T, Segal R, Levy R, Antonuk CD, Aravena JM, Kim GB, Svendsen C, Town T, Danielpour M, Zhu S, Breunig J, Chi S, Cohen K, Fisher M, Biegel J, Bowers D, Fangusaro J, Manley P, Janss A, Zimmerman MA, Wu X, Kieran M, Sayour E, Pham C, Sanchez-Perez L, Snyder D, Flores C, Kemeny H, Xie W, Cui X, Bigner D, Taylor MD, Sampson J, Mitchell D, Bandopadhayay P, Nguyen B, Masoud S, Vue N, Gholamin S, Yu F, Schubert S, Bergthold G, Weiss WA, Mitra S, Qi J, Bradner J, Kieran M, Beroukhim R, Cho YJ, Reddick W, Glass J, Ji Q, Paulus E, James CD, Gajjar A, Ogg R, Vanner R, Remke M, Aviv T, Lee L, Zhu X, Clarke I, Taylor M, Dirks P, Shuman MA, Hamilton R, Pollack I, Calligaris D, Liu X, Feldman D, Thompson C, Ide J, Buhrlage S, Gray N, Kieran M, Jan YN, Stiles C, Agar N, Remke M, Cavalli FMG, Northcott PA, Kool M, Pfister SM, Taylor MD, Project MAGIC, Rakopoulos P, Jan LY, Pajovic S, Buczkowicz P, Morrison A, Bouffet E, Bartels U, Becher O, Hawkins C, Truffaux N, Puget S, Philippe C, Gump W, Castel D, Taylor K, Mackay A, Le Dret L, Saulnier P, Calmon R, Boddaert N, Blauwblomme T, Sainte-Rose C, Jones C, Mutchnick I, Grill J, Liu X, Ebling M, Ide J, Wang L, Davis E, Marchionni M, Stuart D, Alberta J, Kieran M, Li KKW, Stiles C, Agar N, Remke M, Cavalli FMG, Northcott PA, Kool M, Pfister SM, Taylor MD, Project MAGIC, Tien AC, Pang JCS, Griveau A, Rowitch D, Ramkissoon L, Horowitz P, Craig J, Ramkissoon S, Rich B, Bergthold G, Tabori U, Taha H, Ng HK, Bowers D, Hawkins C, Packer R, Eberhart C, Goumnerova L, Chan J, Santagata S, Pomeroy S, Ligon A, Kieran M, Jackson S, Beroukhim R, Ligon K, Kuan CT, Chandramohan V, Keir S, Pastan I, Bigner D, Zhou Z, Ho S, Voss H, Patay Z, Souweidane M, Salloum R, DeWire M, Fouladi M, Goldman S, Chow L, Hummel T, Dorris K, Miles L, Sutton M, Howarth R, Stevenson C, Leach J, Griesinger A, Donson A, Hoffman L, Birks D, Amani V, Handler M, Foreman N, Sangar MC, Pai A, Pedro K, Ditzler SH, Girard E, Olson J, Gustafson WC, Meyerowitz J, Nekritz E, Charron E, Matthay K, Hertz N, Onar-Thomas A, Shokat K, Weiss W, Hanaford A, Raabe E, Eberhart C, Griesinger A, Donson A, Hoffman L, Amani V, Birks D, Gajjar A, Handler M, Mulcahy-Levy J, Foreman N, Olow AK, Dasgupta T, Yang X, Mueller S, Hashizume R, Kolkowitz I, Weiss W, Broniscer A, Resnick AC, Sievert AJ, Nicolaides T, Prados MD, Berger MS, Gupta N, James CD, Haas-Kogan DA, Flores C, Pham C, Dietl SM, Snyder D, Sanchez-Perez L, Bigner D, Sampson J, Mitchell D, Prakash V, Batanian J, Guzman M, Geller T, Pham CD, Wolfl M, Pei Y, Flores C, Snyder D, Bigner DD, Sampson JH, Wechsler-Reya RJ, Mitchell DA, Van Ommeren R, Venugopal C, Manoranjan B, Beilhack A, McFarlane N, Hallett R, Hassell J, Dunn S, Singh S, Dasgupta T, Olow A, Yang X, Hashizume R, Mueller S, Riedel S, Nicolaides T, Kolkowitz I, Weiss W, Prados M, Gupta N, James CD, Haas-Kogan D, Zhao H, Li L, Picotte K, Monoranu C, Stewart R, Modzelewska K, Boer E, Picard D, Huang A, Radiloff D, Lee C, Dunn S, Hutt M, Nazarian J, Dietl S, Price A, Lim KJ, Warren K, Chang H, Eberhart CG, Raabe EH, Persson A, Huang M, Chandler-Militello D, Li N, Vince GH, Berger M, James D, Goldman S, Weiss W, Lindquist R, Tate M, Rowitch D, Alvarez-Buylla A, Hoffman L, Donson A, Eyrich M, Birks D, Griesinger A, Amani V, Handler M, Foreman N, Meijer L, Walker D, Grundy R, O'Dowd S, Jaspan T, Schlegel PG, Dineen R, Fotovati A, Radiloff D, Coute N, Triscott J, Chen J, Yip S, Louis D, Toyota B, Hukin J, Weitzel D, Rassekh SR, Singhal A, Dunham C, Dunn S, Ahsan S, Hanaford A, Taylor I, Eberhart C, Raabe E, Sun YG, Ashcraft K, Stiles C, Han L, Zhang K, Chen L, Shi Z, Pu P, Dong L, Kang C, Cordero F, Lewis P, Liu C, Hoeman C, Schroeder K, Allis CD, Becher O, Gururangan S, Grant G, Driscoll T, Archer G, Herndon J, Friedman H, Li W, Kurtzberg J, Bigner D, Sampson J, Mitchell D, Yadavilli S, Kambhampati M, Becher O, MacDonald T, Bellamkonds R, Packer R, Buckley A, Nazarian J, DeWire M, Fouladi M, Stewart C, Wetmore C, Hawkins C, Jacobs C, Yuan Y, Goldman S, Fisher P, Rodriguez R, Rytting M, Bouffet E, Khakoo Y, Hwang E, Foreman N, Gilbert M, Gilbertson R, Gajjar A, Saratsis A, Yadavilli S, Wetzel W, Snyder K, Kambhampati M, Hall J, Raabe E, Warren K, Packer R, Nazarian J, Thompson J, Griesinger A, Foreman N, Spazojevic I, Rush S, Levy JM, Hutt M, Karajannis MA, Shah S, Eberhart CG, Raabe E, Rodriguez FJ, Gump J, Donson A, Tovmasyan A, Birks D, Handler M, Foreman N, Hankinson T, Torchia J, Khuong-Quang DA, Ho KC, Picard D, Letourneau L, Chan T, Peters K, Golbourn B, Morrissy S, Birks D, Faria C, Foreman N, Taylor M, Rutka J, Pfister S, Bouffet E, Hawkins C, Batinic-Haberle I, Majewski J, Kim SK, Jabado N, Huang A, Ladner T, Tomycz L, Watchmaker J, Yang T, Kaufman L, Pearson M, Dewhirst M, Ogg RJ, Scoggins MA, Zou P, Taherbhoy S, Jones MM, Li Y, Glass JO, Merchant TE, Reddick WE, Conklin HM, Gholamin S, Gajjar A, Khan A, Kumar A, Tye GW, Broaddus WC, Van Meter TE, Shih DJH, Northcott PA, Remke M, Korshunov A, Mitra S, Jones DTW, Kool M, Pfister SM, Taylor MD, Mille F, Levesque M, Remke M, Korshunov A, Izzi L, Kool M, Richard C, Northcott PA, Taylor MD, Pfister SM, Charron F, Yu F, Masoud S, Nguyen B, Vue N, Schubert S, Tolliday N, Kong DS, Sengupta S, Weeraratne D, Schreiber S, Cho YJ, Birks D, Jones K, Griesinger A, Amani V, Handler M, Vibhakar R, Achrol A, Foreman N, Brown R, Rangan K, Finlay J, Olch A, Freyer D, Bluml S, Gate D, Danielpour M, Rodriguez J, Shae JJ, Kim GB, Levy R, Bannykh S, Breunig JJ, Town T, Monje-Deisseroth M, Cho YJ, Weissman I, Cheshier S, Buczkowicz P, Rakopoulos P, Bouffet E, Morrison A, Bartels U, Becher O, Hawkins C, Dey A, Kenney A, Van Gool S, Pauwels F, De Vleeschouwer S, Barszczyk M, Buczkowicz P, Castelo-Branco P, Mack S, Nethery-Brokx K, Morrison A, Taylor M, Dirks P, Tabori U, Hawkins C, Chandramohan V, Keir ST, Bao X, Pastan IH, Kuan CT, Bigner DD, Bender S, Jones D, Kool M, Sturm D, Korshunov A, Lichter P, Pfister SM, Chen M, Lu J, Wang J, Keir S, Zhang M, Zhao S, Mook R, Barak L, Lyerly HK, Chen W, Ramachandran C, Nair S, Escalon E, Khatib Z, Quirrin KW, Melnick S, Kievit F, Stephen Z, Wang K, Silber J, Ellenbogen R, Zhang M, Hutzen B, Studebaker A, Bratasz A, Powell K, Raffel C, Guo C, Chang CC, Wortham M, Chen L, Kernagis D, Qin X, Cho YW, Chi JT, Grant G, McLendon R, Yan H, Ge K, Papadopoulos N, Bigner D, He Y, Cristiano B, Venkataraman S, Birks DK, Alimova I, Harris PS, Dubuc A, Taylor MD, Foreman NK, Vibhakar R, Ichimura K, Fukushima S, Totoki Y, Suzuki T, Mukasa A, Saito N, Kumabe T, Tominaga T, Kobayashi K, Nagane M, Iuchi T, Mizoguchi M, Sasaki T, Tamura K, Sugiyama K, Narita Y, Shibui S, Matsutani M, Shibata T, Nishikawa R, Northcott P, Zichner T, Jones D, Kool M, Jager N, Feychting M, Lannering B, Tynes T, Wesenberg F, Hauser P, Ra YS, Zitterbart K, Jabado N, Chan J, Fults D, Mueller S, Grajkowska W, Lichter P, Korbel J, Pfister S, Kool M, Jones DTW, Jaeger N, Northcott PA, Pugh T, Hovestadt V, Markant SL, Esparza LA, Bourdeaut F, Remke M, Taylor MD, Cho YJ, Pomeroy SL, Schueller U, Korshunov A, Eils R, Wechsler-Reya RJ, Lichter P, Pfister SM, Keir S, Pegram C, Lipp E, Rasheed A, Chandramohan V, Kuan CT, Kwatra M, Yan H, Bigner D, Chornenkyy Y, Buczkowicz P, Agnihotri S, Becher O, Hawkins C, Rogers H, Mayne C, Kilday JP, Coyle B, Grundy R, Sun T, Warrington N, Luo J, Brooks M, Dahiya S, Sengupta R, Rubin J, Erdreich-Epstein A, Robison N, Ren X, Zhou H, Ji L, Margo A, Jones D, Pfister S, Kool M, Sposto R, Asgharzadeh S, Clifford S, Gustafsson G, Ellison D, Figarella-Branger D, Doz F, Rutkowski S, Lannering B, Pietsch T, Broniscer A, Tatevossian R, Sabin N, Klimo P, Dalton J, Lee R, Gajjar A, Ellison D, Garzia L, Dubuc A, Pitcher G, Northcott P, Mariampillai A, Chan T, Skowron P, Wu X, Yao Y, Hawkins C, Peacock J, Zayne K, Croul S, Rutka J, Kenney A, Huang A, Yang V, Baylin S, Salter M, Taylor M, Ward S, Sengupta R, Rubin J, Garzia L, Morrissy S, Skowron P, Jelveh S, Lindsay P, Largaespada D, Collier L, Dupuy A, Hill R, Taylor M, Lulla RR, Laskowski J, Fangusaro J, DiPatri AJ, Alden T, Vanin EF, Tomita T, Goldman S, Soares MB, Rajagopal MU, Lau LS, Hathout Y, Gordish-Dressman H, Rood B, Datar V, Bochare S, Singh A, Khatau S, Fangusaro J, Goldman S, Lulla R, Rajaram V, Gopalakrishnan V, Morfouace M, Shelat A, Jaccus M, Freeman B, Zindy F, Robinson G, Guy K, Stewart C, Gajjar A, Roussel M, Krebs S, Chow K, Yi Z, Brawley V, Ahmed N, Gottschalk S, Lerner R, Harness J, Yoshida Y, Santos R, Torre JDL, Nicolaides T, Ozawa T, James D, Petritsch C, Vitte J, Chareyre F, Stemmer-Rachamimov A, Giovannini M, Hashizume R, Yu-Jen L, Tom M, Ihara Y, Huang X, Waldman T, Mueller S, Gupta N, James D, Shevtsov M, Yakovleva L, Nikolaev B, Dobrodumov A, Onokhin K, Bychkova N, Mikhrina A, Khachatryan W, Guzhova I, Martynova M, Bystrova O, Ischenko A, Margulis B, Martin A, Nirschl C, Polanczyk M, Cohen K, Pardoll D, Drake C, Lim M, Crowther A, Chang S, Yuan H, Deshmukh M, Gershon T, Meyerowitz JG, Gustafson WC, Nekritz EA, Swartling F, Shokat KM, Ruggero D, Weiss WA, Bergthold G, Rich B, Bandopadhayay P, Chan J, Santaga S, Hoshida Y, Golub T, Tabak B, Ferrer-Luna R, Grill J, Wen PY, Stiles C, Kieran M, Ligon K, Beroukhim R, Lulla RR, Laskowski J, Gireud M, Fangusaro J, Goldman S, Gopalakrishnan V, Merino D, Shlien A, Pienkowska M, Tabori U, Gilbertson R, Malkin D, Mueller S, Hashizume R, Yang X, Kolkowitz I, Olow A, Phillips J, Smirnov I, Tom M, Prados M, Berger M, Gupta N, Haas-Kogan D, Beez T, Sarikaya-Seiwert S, Janssen G, Felsberg J, Steiger HJ, Hanggi D, Marino AM, Baryawno N, Johnsen JI, Ostman A, Wade A, Engler JR, Robinson AE, Phillips JJ, Witt H, Sill M, Mack SC, Wani KM, Lambert S, Tzaridis T, Bender S, Jones DT, Milde T, Northcott PA, Kool M, von Deimling A, Kulozik AE, Witt O, Lichter P, Collins VP, Aldape K, Taylor MD, Korshunov A, Pfister SM, Hatcher R, Das C, Datar V, Taylor P, Singh A, Lee D, Fuller G, Ji L, Fangusaro J, Rajaram V, Goldman S, Eberhart C, Gopalakrishnan V, Griveau A, Lerner R, Ihrie R, Sugiarto S, Ihara Y, Reichholf B, Huillard E, Mcmahon M, James D, Phillips J, Buylla AA, Rowitch D, Petritsch C, Snuderl M, Batista A, Kirkpatrick N, de Almodovar CR, Riedemann L, Knevels E, Schmidt T, Peterson T, Roberge S, Bais C, Yip S, Hasselblatt M, Rossig C, Ferrara N, Klagsbrun M, Duda D, Fukumura D, Xu L, Carmeliet P, Jain R, Nguyen A, Pencreach E, Lasthaus C, Lobstein V, Guerin E, Guenot D, Entz-Werle N, Diaz R, Golbourn B, Faria C, Shih D, MacKenzie D, Picard D, Bryant M, Smith C, Taylor M, Huang A, Rutka J, Gromeier M, Desjardins A, Sampson JH, Threatt SJE, Herndon JE, Friedman A, Friedman HS, Bigner DD, Cavalli FMG, Morrissy AS, Li Y, Chu A, Remke M, Thiessen N, Mungall AJ, Bader GD, Malkin D, Marra MA, Taylor MD, Manoranjan B, Wang X, Hallett R, Venugopal C, Mack S, McFarlane N, Nolte S, Scheinemann K, Gunnarsson T, Hassell J, Taylor M, Lee C, Triscott J, Foster C, Dunham C, Hawkins C, Dunn S, Singh S, McCrea HJ, Bander E, Venn RA, Reiner AS, Iorgulescu JB, Puchi LA, Schaefer PM, Cederquist G, Greenfield JP, Tsoli M, Luk P, Dilda P, Hogg P, Haber M, Ziegler D, Mack S, Agnihotri S, Witt H, Shih D, Wang X, Ramaswamy V, Zayne K, Bertrand K, Massimi L, Grajkowska W, Lach B, Gupta N, Weiss W, Guha A, Zadeh G, Rutka J, Korshunov A, Pfister S, Taylor M, Mack S, Witt H, Jager N, Zuyderduyn S, Nethery-Brokx K, Garzia L, Zayne K, Wang X, Barszczyk M, Wani K, Bouffet E, Weiss W, Hawkins C, Rutka J, Bader G, Aldape K, Dirks P, Pfister S, Korshunov A, Taylor M, Engler J, Robinson A, Wade A, Molinaro A, Phillips J, Ramaswamy V, Remke M, Bouffet E, Faria C, Shih D, Gururangan S, McLendon R, Schuller U, Ligon K, Pomeroy S, Jabado N, Dunn S, Fouladi M, Rutka J, Hawkins C, Tabori U, Packer R, Pfister S, Korshunov A, Taylor M, Faria C, Dubuc A, Golbourn B, Diaz R, Agnihotri S, Sabha N, Luck A, Leadly M, Reynaud D, Wu X, Remke M, Ramaswamy V, Northcott P, Pfister S, Croul S, Kool M, Korshunov A, Smith C, Taylor M, Rutka J, Pietsch T, Doerner E, Muehlen AZ, Velez-Char N, Warmuth-Metz M, Kortmann R, von Hoff K, Friedrich C, Rutkowski S, von Bueren A, Lu YJ, James CD, Hashizume R, Mueller S, Phillips J, Gupta N, Sturm D, Northcott PA, Jones DTW, Korshunov A, Picard D, Lichter P, Huang A, Pfister SM, Kool M, Ward J, Teague C, Shriyan B, Grundy R, Rahman R, Taylor K, Mackay A, Morozova O, Butterfield Y, Truffaux N, Philippe C, Vinci M, de Torres C, Cruz O, Mora J, Hargrave D, Puget S, Yip S, Jones C, Grill J, Smith S, Ward J, Tan C, Grundy R, Rahman R, Bjerke L, Mackay A, Nandhabalan M, Burford A, Jury A, Popov S, Bax D, Carvalho D, Taylor K, Vinci M, Bajrami I, McGonnell I, Lord C, Reis R, Hargrave D, Ashworth A, Workman P, Jones C, Carvalho D, Mackay A, Burford A, Bjerke L, Chen L, Kozarewa I, Lord C, Ashworth A, Hargrave D, Reis R, Jones C, Marigil M, Jauregui PJ, Alonso M, Chan TS, Hawkins C, Picard D, Henkin J, Huang A, Trubicka J, Kucharczyk M, Pelc M, Chrzanowska K, Ciara E, Perek-Polnik M, Grajkowska W, Piekutowska-Abramczuk D, Jurkiewicz D, Luczak S, Borucka-Mankiewicz M, Kowalski P, Krajewska-Walasek M, de Mola RML, Laskowski J, Fangusaro J, Costa FF, Vanin EF, Goldman S, Soares MB, Lulla RR, Mann A, Venugopal C, Vora P, Singh M, van Ommeren R, McFarlane N, Manoranjan B, Qazi M, Scheinemann K, MacDonald P, Delaney K, Whitton A, Dunn S, Singh S, Sievert A, Lang SS, Boucher K, Madsen P, Slaunwhite E, Choudhari N, Kellet M, Storm P, Resnick A, Agnihotri S, Burrell K, Fernandez N, Golbourn B, Clarke I, Barszczyk M, Sabha N, Dirks P, Jones C, Rutka J, Zadeh G, Hawkins C, Murphy B, Obad S, Bihannic L, Ayrault O, Zindy F, Kauppinen S, Roussel M, Golbourn B, Agnihotri S, Cairns R, Mischel P, Aldape K, Hawkins C, Zadeh G, Rutka J, Rush S, Donson A, Kleinschmidt-DeMasters B, Bemis L, Birks D, Chan M, Smith A, Handler M, Foreman N, Gronych J, Jones DTW, Zuckermann M, Hutter S, Korshunov A, Kool M, Ryzhova M, Reifenberger G, Pfister SM, Lichter P, Jones DTW, Hovestadt V, Picelli S, Wang W, Northcott PA, Kool M, Jager N, Reifenberger G, Rutkowski S, Pietsch T, Sultan M, Yaspo ML, Landgraf P, Eils R, Korshunov A, Zapatka M, Pfister SM, Radlwimmer B, Lichter P, Huang Y, Mao H, Wang Y, Kogiso M, Zhao X, Baxter P, Man C, Wang Z, Zhou Y, Li XN, Chung AH, Crabtree D, Schroeder K, Becher OJ, Panosyan E, Wang Y, Lasky J, Liu Z, Zhao X, Wang Y, Mao H, Huang Y, Kogiso M, Baxter P, Adesina A, Su J, Picard D, Huang A, Perlaky L, Chintagumpala M, Lau C, Blaney S, Li XN, Huang M, Persson A, Swartling F, Moriarity B. Abstracts. Neuro Oncol 2013. [DOI: 10.1093/neuonc/not047] [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: 11/13/2022] Open
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Jethanamest D, Gupta S, Morcos J, Telischi F, Golfinos J, Roland J. Delayed Wound Infection Associated with Bone Wax in Lateral Skull Base Surgery. Skull Base Surg 2013. [DOI: 10.1055/s-0033-1336392] [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: 10/27/2022]
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Sethi R, Rush S, Liu S, Huang P, Parker E, Donahue B, Narayana A, Golfinos J. Marginal Misses in Gamma-knife Radiosurgery for Meningiomas: Are Treatment Volume and Dose Adequate? Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.725] [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: 10/27/2022]
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