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Chelliah A, Wood DA, Canas LS, Shuaib H, Currie S, Fatania K, Frood R, Rowland-Hill C, Thust S, Wastling SJ, Tenant S, Foweraker K, Williams M, Wang Q, Roman A, Dragos C, MacDonald M, Lau YH, Linares CA, Bassiouny A, Luis A, Young T, Brock J, Chandy E, Beaumont E, Lam TC, Welsh L, Lewis J, Mathew R, Kerfoot E, Brown R, Beasley D, Glendenning J, Brazil L, Swampillai A, Ashkan K, Ourselin S, Modat M, Booth TC. Glioblastoma and Radiotherapy: a multi-center AI study for Survival Predictions from MRI (GRASP study). Neuro Oncol 2024:noae017. [PMID: 38285679 DOI: 10.1093/neuonc/noae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The aim was to predict survival of glioblastoma at eight months after radiotherapy (a period allowing for completing a typical course of adjuvant temozolomide), by applying deep learning to the first brain MRI after radiotherapy completion. METHODS Retrospective and prospective data were collected from 206 consecutive glioblastoma, IDH-wildtype patients diagnosed between March 2014-February 2022 across 11 UK centers. Models were trained on 158 retrospective patients from three centers. Holdout test sets were retrospective (n=19; internal validation), and prospective (n=29; external validation from eight distinct centers).Neural network branches for T2-weighted and contrast-enhanced T1-weighted inputs were concatenated to predict survival. A non-imaging branch (demographics/MGMT/treatment data) was also combined with the imaging model. We investigated the influence of individual MR sequences; non-imaging features; and weighted dense blocks pretrained for abnormality detection. RESULTS The imaging model outperformed the non-imaging model in all test sets (area under the receiver-operating characteristic curve, AUC p=0.038) and performed similarly to a combined imaging/non-imaging model (p>0.05). Imaging, non-imaging, and combined models applied to amalgamated test sets gave AUCs of 0.93, 0.79, and 0.91. Initializing the imaging model with pretrained weights from 10,000s of brain MRIs improved performance considerably (amalgamated test sets without pretraining 0.64; p=0.003). CONCLUSIONS A deep learning model using MRI images after radiotherapy, reliably and accurately determined survival of glioblastoma. The model serves as a prognostic biomarker identifying patients who will not survive beyond a typical course of adjuvant temozolomide, thereby stratifying patients into those who might require early second-line or clinical trial treatment.
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Affiliation(s)
| | | | | | - Haris Shuaib
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stuart Currie
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kavi Fatania
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Russell Frood
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Stefanie Thust
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
- University of Nottingham, Nottingham, United Kingdom
| | - Stephen J Wastling
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
- University College London, London, United Kingdom
| | - Sean Tenant
- The Christie NHS Foundation Trust, Withington, Manchester, United Kingdom
| | | | - Matthew Williams
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Qiquan Wang
- Imperial College Healthcare NHS Trust, London, United Kingdom
- Imperial College London, London, United Kingdom
| | - Andrei Roman
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
- Oncology Institute Prof. Dr. Ion Chiricuta, Cluj-Napoca, Romania
| | - Carmen Dragos
- Buckinghamshire Healthcare NHS Trust, Amersham, United Kingdom
| | | | - Yue Hui Lau
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Ahmed Bassiouny
- King's College London, London, United Kingdom
- Mansoura University, Mansoura, Egypt
| | - Aysha Luis
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Young
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Juliet Brock
- Brighton and Sussex University Hospitals NHS Trust, England, United Kingdom
| | - Edward Chandy
- Brighton and Sussex University Hospitals NHS Trust, England, United Kingdom
| | - Erica Beaumont
- Lancashire Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - Tai-Chung Lam
- Lancashire Teaching Hospitals NHS Foundation Trust, England, United Kingdom
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Joanne Lewis
- Newcastle upon Tyne Hospitals NHS Foundation Trust, England, United Kingdom
| | - Ryan Mathew
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- University of Leeds, Leeds, UK
| | | | | | - Daniel Beasley
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Lucy Brazil
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Keyoumars Ashkan
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Marc Modat
- King's College London, London, United Kingdom
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Thomas C Booth
- King's College London, London, United Kingdom
- King's College Hospital NHS Foundation Trust, London, United Kingdom
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2
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Bhaskaran D, Savage J, Patel A, Collinson F, Mant R, Boele F, Brazil L, Meade S, Buckle P, Lax S, Billingham L, Short SC. A randomised phase II trial of temozolomide with or without cannabinoids in patients with recurrent glioblastoma (ARISTOCRAT): protocol for a multi-centre, double-blind, placebo-controlled trial. BMC Cancer 2024; 24:83. [PMID: 38225549 PMCID: PMC10790538 DOI: 10.1186/s12885-023-11792-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common adult malignant brain tumour, with an incidence of 5 per 100,000 per year in England. Patients with tumours showing O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation represent around 40% of newly diagnosed GBM. Relapse/tumour recurrence is inevitable. There is no agreed standard treatment for patients with GBM, therefore, it is aimed at delaying further tumour progression and maintaining health-related quality of life (HRQoL). Limited clinical trial data exist using cannabinoids in combination with temozolomide (TMZ) in this setting, but early phase data demonstrate prolonged overall survival compared to TMZ alone, with few additional side effects. Jazz Pharmaceuticals (previously GW Pharma Ltd.) have developed nabiximols (trade name Sativex®), an oromucosal spray containing a blend of cannabis plant extracts, that we aim to assess for preliminary efficacy in patients with recurrent GBM. METHODS ARISTOCRAT is a phase II, multi-centre, double-blind, placebo-controlled, randomised trial to assess cannabinoids in patients with recurrent MGMT methylated GBM who are suitable for treatment with TMZ. Patients who have relapsed ≥ 3 months after completion of initial first-line treatment will be randomised 2:1 to receive either nabiximols or placebo in combination with TMZ. The primary outcome is overall survival time defined as the time in whole days from the date of randomisation to the date of death from any cause. Secondary outcomes include overall survival at 12 months, progression-free survival time, HRQoL (using patient reported outcomes from QLQ-C30, QLQ-BN20 and EQ-5D-5L questionnaires), and adverse events. DISCUSSION Patients with recurrent MGMT promoter methylated GBM represent a relatively good prognosis sub-group of patients with GBM. However, their median survival remains poor and, therefore, more effective treatments are needed. The phase II design of this trial was chosen, rather than phase III, due to the lack of data currently available on cannabinoid efficacy in this setting. A randomised, double-blind, placebo-controlled trial will ensure an unbiased robust evaluation of the treatment and will allow potential expansion of recruitment into a phase III trial should the emerging phase II results warrant this development. TRIAL REGISTRATION ISRCTN: 11460478. CLINICALTRIALS Gov: NCT05629702.
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Affiliation(s)
- Divyalakshmi Bhaskaran
- School of Medicine, University of Leeds, LS2 9JT, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Amit Patel
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Fiona Collinson
- School of Medicine, University of Leeds, LS2 9JT, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rhys Mant
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Florien Boele
- School of Medicine, University of Leeds, LS2 9JT, Leeds, UK
| | - Lucy Brazil
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sara Meade
- University Hospitals Birmingham Foundation Trust, Birmingham, UK
| | | | - Siân Lax
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), Institute of Cancer & Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Susan C Short
- School of Medicine, University of Leeds, LS2 9JT, Leeds, UK.
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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3
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Ashkan K, Baig Mirza A, Soumpasis C, Syrris C, Kalaitzoglou D, Sharma C, James ZJ, Khoja AK, Ahmed R, Vastani A, Bartram J, Chia K, Al-Salihi O, Swampilai A, Brazil L, Laxton R, Reisz Z, Bodi I, King A, Gullan R, Vergani F, Bhangoo R, Al-Sarraj S, Lavrador JP. MGMT Promoter Methylation: Prognostication beyond Treatment Response. J Pers Med 2023; 13:999. [PMID: 37373988 DOI: 10.3390/jpm13060999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
MGMT promoter methylation is related to the increased sensitivity of tumour tissue to chemotherapy with temozolomide (TMZ) and thus to improved patient survival. However, it is unclear how the extent of MGMT promoter methylation affects outcomes. In our study, a single-centre retrospective study, we explore the impact of MGMT promoter methylation in patients with glioblastoma who were operated upon with 5-ALA. Demographic, clinical and histology data, and survival rates were assessed. A total of 69 patients formed the study group (mean age 53.75 ± 15.51 years old). Positive 5-ALA fluorescence was noted in 79.41%. A higher percentage of MGMT promoter methylation was related to lower preoperative tumour volume (p = 0.003), a lower likelihood of 5-ALA positive fluorescence (p = 0.041) and a larger extent of resection EoR (p = 0.041). A higher MGMT promoter methylation rate was also related to improved progression-free survival (PFS) and overall survival (OS) (p = 0.008 and p = 0.006, respectively), even when adjusted for the extent of resection (p = 0.034 and p = 0.042, respectively). A higher number of adjuvant chemotherapy cycles was also related to longer PFS and OS (p = 0.049 and p = 0.030, respectively). Therefore, this study suggests MGMT promoter methylation should be considered as a continuous variable. It is a prognostic factor that goes beyond sensitivity to chemotherapy treatment, as a higher percentage of methylation is related not only to increased EoR and increased PFS and OS, but also to lower tumour volume at presentation and a lower likelihood of 5-ALA fluorescence intraoperatively.
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Affiliation(s)
- Keyoumars Ashkan
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Asfand Baig Mirza
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Christos Soumpasis
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Christoforos Syrris
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | | | - Chaitanya Sharma
- GKT School of Medicine, Kings College London, London SE1 1UL, UK
| | | | | | - Razna Ahmed
- GKT School of Medicine, Kings College London, London SE1 1UL, UK
| | - Amisha Vastani
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - James Bartram
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Kazumi Chia
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Omar Al-Salihi
- Department of Neuro-Oncology, Cancer Centre, Guys Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Angela Swampilai
- Department of Neuro-Oncology, Cancer Centre, Guys Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Lucy Brazil
- Department of Neuro-Oncology, Cancer Centre, Guys Hospital, Great Maze Pond, London SE1 9RT, UK
| | - Ross Laxton
- Department of Neuropathology, Kings College London, London SE5 9RS, UK
| | - Zita Reisz
- Department of Neuropathology, Kings College London, London SE5 9RS, UK
| | - Istvan Bodi
- Department of Neuropathology, Kings College London, London SE5 9RS, UK
| | - Andrew King
- Department of Neuropathology, Kings College London, London SE5 9RS, UK
| | - Richard Gullan
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Francesco Vergani
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Ranjeev Bhangoo
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Safa Al-Sarraj
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Jose Pedro Lavrador
- Kings College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
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Lopez J, Häfliger S, Plummer R, Clement P, Läubli H, Roth P, Evans T, Brazil L, Tabatabai G, Wick A, Wing Y, Wunderlich B, Beebe K, Eisner J, Engelhardt M, Kaindl T, Lane H, Hau P, Hundsberger T, Steinbach J. 83P Evaluation of response-predictive biomarkers for lisavanbulin: A phase II study in patients with recurrent glioblastoma. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.100941] [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: 04/05/2023] Open
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5
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Shuaib H, Barker GJ, Sasieni P, De Vita E, Chelliah A, Andrei R, Ashkan K, Beaumont E, Brazil L, Rowland-Hill C, Lau YH, Luis A, Powell J, Swampillai A, Tenant S, Thust SC, Wastling S, Young T, Booth TC. Overcoming challenges of translating deep-learning models for glioblastoma: the ZGBM consortium. Br J Radiol 2023; 96:20220206. [PMID: 35616700 PMCID: PMC10997010 DOI: 10.1259/bjr.20220206] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/19/2022] [Accepted: 04/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To report imaging protocol and scheduling variance in routine care of glioblastoma patients in order to demonstrate challenges of integrating deep-learning models in glioblastoma care pathways. Additionally, to understand the most common imaging studies and image contrasts to inform the development of potentially robust deep-learning models. METHODS MR imaging data were analysed from a random sample of five patients from the prospective cohort across five participating sites of the ZGBM consortium. Reported clinical and treatment data alongside DICOM header information were analysed to understand treatment pathway imaging schedules. RESULTS All sites perform all structural imaging at every stage in the pathway except for the presurgical study, where in some sites only contrast-enhanced T1-weighted imaging is performed. Diffusion MRI is the most common non-structural imaging type, performed at every site. CONCLUSION The imaging protocol and scheduling varies across the UK, making it challenging to develop machine-learning models that could perform robustly at other centres. Structural imaging is performed most consistently across all centres. ADVANCES IN KNOWLEDGE Successful translation of deep-learning models will likely be based on structural post-treatment imaging unless there is significant effort made to standardise non-structural or peri-operative imaging protocols and schedules.
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Affiliation(s)
- Haris Shuaib
- Guy’s & St Thomas’ NHS Foundation Trust,
King’s College, London, United Kingdom
| | | | | | | | | | - Roman Andrei
- The Oncology Institute "Prof. Dr. Ion Chiricuţă"
Cluj-Napoca, Cluj-Napoca, Romania
| | - Keyoumars Ashkan
- King’s College Hospital NHS Foundation
Trust, London, United Kingdom
| | - Erica Beaumont
- Lancashire Teaching Hospitals NHS Foundation
Trust, Lancashire, United Kingdom
| | - Lucy Brazil
- Guy’s & St Thomas’ NHS Foundation Trust,
King’s College, London, United Kingdom
| | | | - Yue Hui Lau
- King’s College Hospital NHS Foundation
Trust, London, United Kingdom
| | - Aysha Luis
- King's College London, London, United
Kingdom
| | - James Powell
- Velindre University NHS Trust, Wales, United
Kingdom
| | - Angela Swampillai
- Guy’s & St Thomas’ NHS Foundation Trust,
King’s College, London, United Kingdom
| | - Sean Tenant
- The Christie NHS Foundation Trust, Manchester,
United Kingdom
| | - Stefanie C Thust
- National Hospital for Neurology and Neurosurgery, UCL
Institute of Neurology, London, United Kingdom
| | - Stephen Wastling
- National Hospital for Neurology and Neurosurgery, UCL
Institute of Neurology, London, United Kingdom
| | - Tom Young
- Guy’s & St Thomas’ NHS Foundation Trust,
King’s College, London, United Kingdom
| | - Thomas C Booth
- Guy’s & St Thomas’ NHS Foundation Trust,
King’s College, London, United Kingdom
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6
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Gupta S, Swampillai A, Brazil L, Al-Salihi O. RADT-30. RADIATION INDUCED MENINGIOMA IN BACKGROUND OF CHILDHOOD CRANIAL IRRADIATION: A CASE SERIES. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.220] [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
Cranial irradiation as part of prophylactic (PCI) or radical treatment for childhood malignancies can be associated with late consequences such as radiotherapy induced meningioma.
METHODS
We are reporting 5 such patients treated at our institute.
RESULTS
Case 1: 24y female received PCI for Acute Lymphoblastic Leukemia at the age of 2, and developed right frontal meningioma which was resected and pathology confirmed grade 2 atypical meningioma. It was treated with radiotherapy 60Gy/30fr and 2 year follow up scans remain stable. Case 2: 31y male received PCI as a child, and developed parieto-occipital meningioma which was excised multiple times. Pathology revealed Grade 2 atypical meningioma and was treated with radiotherapy 60Gy/30fr. Follow up scans 3.5 yrs later remain stable.Case3: 37y male received PCI at the age of 3, and developed multiple site meningiomas which were excised. Pathology showed likely Grade 2 meningioma. The sphenoid wing lesion progressed 2 years later, was re-excised and treated recently with radiotherapy 60Gy/30fr. Case 4: 52y female treated with radiotherapy for retinoblastoma at the age of 6-8 wks, developed left sphenoid wing meningioma which was resected and pathology revealed malignant meningioma. Radiotherapy 60Gy/30fr was recently completed.Case 5: 24y female treated with radiotherapy for medulloblastoma at the age of 5, developed meningiomas at multiple sites. Over the span of 10 years the frontal and clinoid lesions increased in size, and were treated with SRS/SRT recently.
CONCLUSION
All patients had background of cranial radiation and developed meningioma with latency period ranging 19 to 52 years. It is not possible to make an inference on gender, site of meningioma or craniaI dose correlation because of small number of cases and lack of data on dose. Further research is needed on how to prevent secondary malignancies in such patients and on standard of care for secondary meningiomas.
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Affiliation(s)
- Sunnia Gupta
- Guys' and St Thomas' NHS foundation Trust , London , United Kingdom
| | - Angela Swampillai
- Guys' and St. Thomas' NHS Foundation trust , london , United Kingdom
| | - Lucy Brazil
- Guys' and St. Thomas' NHS Foundation trust , london , United Kingdom
| | - Omar Al-Salihi
- Guys' and St. Thomas' NHS Foundation trust , london , United Kingdom
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7
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Hurwitz V, La J, Hedges S, Robinson C, Kostick E, Suarez A, Lavrador J, Bhangoo R, Brazil L. QLTI-03. AN INNOVATIVE APPROACH TO ACCESSIBLE INFORMATION FOR BRAIN TUMOUR PATIENTS AND THEIR LOVED ONES. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac209.905] [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
Patient information for cancer patients is acknowledged for its vital contribution to informed consent and a positive patient experience. It forms a measure to which UK oncology centres are held to account in the national cancer patient experience survey. It could be argued that this has driven the production of such information rather than it being designed to best meet the need of the neuro-oncology patient. With this in mind a YouTube channel was set up after consulting current High Grade Glioma patients on their preferred medium. Patients wanted short clips in a conversational style explaining aspects of their treatment and the pathway. They wanted it to be available in a medium that they were familiar with either s a podcast or YouTube shorts. The CNS team requested patients choose the name of the channel and began making short videos with patients and professionals on subjects suggested by patients. In twelve weeks, we have produced 23 videos, which have had 2282 views and 105 hours of watch time. The average person watches for two hours and forty-six minutes. It is possible to extrapolate from this that people are engaging with the content. The availability of information in this form has reduced the length of conversations and emails with the CNS’s pre-operatively. Patients have reported a greater sense of comfort from hearing other patient’s stories. The authors acknowledge there is not enough data available yet to formerly support this. In conclusion patient information should be designed to meet the needs of the patient not the guidance. It needs to be accessible to patients who have neurological impairments including changes in vision and concentration and provided in a medium that is current, visual and easily accessible.
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Affiliation(s)
| | - Jessica La
- Kings College Hospital , london , United Kingdom
| | - Sarah Hedges
- Kings College Hospital , london , United Kingdom
| | | | | | - Aeron Suarez
- Kings College Hospital , london , United Kingdom
| | | | | | - Lucy Brazil
- Guys' and St. Thomas' NHS Foundation trust , london , United Kingdom
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8
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Haris PA, Al-Salihi O, Blythe K, Chia K, Hassan S, Sisodia C, Brazil L. NCOG-02. STEREOTACTIC RADIOSURGERY (SRS) FOR BRAIN METASTASES FROM MELANOMA: AN EVALUATION OF OUTCOMES AT A UK TERTIARY CENTRE. Neuro Oncol 2022. [PMCID: PMC9660838 DOI: 10.1093/neuonc/noac209.755] [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
Brain metastases (BM) are common in melanoma and historically associated with poor prognosis. Targeted systemic treatment have improved prognosis, and stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic option. We evaluated the outcomes and potential prognostic factors of patients treated with SRS.
METHODS
Retrospective study of patients treated with linac-based SRS for BM from melanoma in a UK tertiary centre between August 2017-September 2021. Overall survival (OS), intracranial progression-free survival (IPFS), and prognostic factors were evaluated using Kaplan–Meier analysis, log-rank test, and Cox proportional-hazards model.
RESULTS
Median follow up was 32 months. 69 patients were included. Median age was 59 years old (range 30-93), and 63% were male. 99% had performance status of 0/1. 45% had BRAF mutation, and 68% had stable extracranial disease at SRS. 62 patients had first-line treatment with SRS. 133 BM were treated, with mean volume of 0.39 cm3(range 0.02-18.82). Median prescription dose was 23 Gy (range 14-24Gy), prescribed to 100% isodose. Median OS and IPFS from SRS was 18 months (95% CI 5-31), and 12 months (95% CI 6-18), respectively. 6 months and 1 year local control (LC) rate were 79% and 64 %, respectively. 91% had out-of-field recurrences. Patients with BRAF mutation had shorter IPFS compared to BRAF WT (7 months vs 18 months, HR 2, p=0.04). 36% were on BRAF inhibitors, and IPFS were longer for patients on immunotherapy within 3 months of SRS (15 months vs 4 months, HR 2.6, p=0.03). There was non-significant trend towards shorter OS and IPFS for patients who were male, ≥ 65 years old, BRAF mutant, progressive extracranial disease, > 4 BM, and total volume of ≥ 5cm3.
CONCLUSION
SRS demonstrates good OS and LC for treatment of BM from melanoma. Prospective studies should establish the synergistic effects between targeted treatment and SRS.
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Affiliation(s)
| | - Omar Al-Salihi
- Guys' and St. Thomas' NHS Foundation trust , london , United Kingdom
| | | | - Kazumi Chia
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | | | | | - Lucy Brazil
- Guys' and St. Thomas' NHS Foundation trust , london , United Kingdom
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9
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Kostick E, La J, Hurwitz V, Hedges S, Robinson C, Suarez A, Ashkan K, Bhangoo R, Gullan R, Vergani F, Brazil L, Al-Salihi O, Swampillai A, Chia K, Cikurel K, Joe D, Finnerty G, Lavrador JP. How Can Clinical Teams Support Patients With a Brain Tumour Diagnosis With Sex Relationships and Intimacy? Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac200.056] [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
AIMS
There is a gap in supporting patients with sexual relationships and intimacy. The aim of this study is to establish if patients with a brain tumour feel they are able to ask questions and concerns about sex, relationships and intimacy following diagnosis; is there an unmet need and how can this be addressed.
METHOD
An anonymous survey was sent to patients known to a neuro-oncology team. Questions were in relation to their experiences of sex relationships and intimacy. Patients were asked if they had concerns about changes in their relationships since their diagnosis. They were also asked for their comments on the subject so we can better understand how as a service we can improve to ensure holistic care.
RESULTS
There are 40 responses. The majority of respondents had concerns about their relationship since diagnosis and that their relationships have changed. 57% were concerned about a physical relationship with a partner/ future partners. 50% agreed their physical relationship had changed. 45% of people agreeing their emotional relationships have changed. 38 out of the 40 people questioned, had not asked their clinical team for advice about sex and relationships. 46% suggested clinicians initiating these conversations.
CONCLUSION
Sex relationships and intimacy are significant for most adult populations, encompassing connection with their loved ones, self esteem and psychological and emotional well-being. With brain tumour diagnosis this part of people’s lives can hugely impacted. Historically clinicians have found this a difficult subject to discuss. Further work is required to understand the barriers initiating this subject
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Affiliation(s)
| | | | | | | | | | | | - Keyoumars Ashkan
- Neurosurgical Department, King’s College Hospital Foundation Trust , London , UK
| | - Ranjeev Bhangoo
- Neurosurgical Department, King’s College Hospital Foundation Trust , London , UK
| | - Richard Gullan
- Neurosurgical Department, King’s College Hospital Foundation Trust , London , UK
| | - Francesco Vergani
- Neurosurgical Department, King’s College Hospital Foundation Trust , London , UK
| | | | | | | | | | | | | | | | - Jose Pedro Lavrador
- Neurosurgical Department, King’s College Hospital Foundation Trust , London , UK
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10
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Hurwitz V, La J, Lavrador J, Brazil L, Chia K, Swampillai A, Al-Salihi O, Bhangoo R, Vergani F, Ashkan K, Hedges S, Kostick E, Suarez A, Robinson C. P16.03.A Epithelioid gliobastoma requires rapid treatment and BRAF inhibitors should be made readily available for their treatment. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.307] [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
Epithelioid glioblastoma is a rare subtype of Glioblastoma. We examine two cases who presented acutely with symptoms of headache, neck stiffness and an eye squint. The purpose of this case review is to look at their management, the spread of the disease and propose the availability of BRAF inhibiting agents be made readily available for this subtype.
Material and Methods
The clinical records including pathology and surgical reports, multi-disciplinary team meeting documents, oncology plans and inpatient notes have all been reviewed alongside the literature on epithelioid GBM and BRAF V600e mutations and inhibitors.
Results
Patients were females aged 25 and 32 presenting with acute onset headache and neck stiffness to emergency Department. The 25 year old had developed a right eye squint within seven days of the other symptoms, her tumour was right frontal with midline shift. The 32 year old had symptoms for 10 days prior to presentation, the tumour was right temporal. They both underwent craniotomies. The frontal tumour was totally resected, while the temporal lobe tumour was haemorrhagic in nature and minimally de-bulked. Pre-operative stealth imaging showed that there had been an increase in the size of the temporal lesion in the fourteen days since presentation. Histology proved these to be epithelioid GBM’s with BRAF V600e mutations, IDH wild-type and TERT promoter mutant. Full pathology reports with molecular markers were available within ten days. The frontal lobe patient began chemo-radiation sixteen days from her surgical date. On day two she was admitted with severe headache and nausea. She became agitated, confused, and transferred back to the neurosurgery unit for management of hydrocephalus. She was diagnosed with PRES and simultaneously treated for this and hydrocephalus. Clinically she suffered storming, passing away exactly eight weeks from presentation. Seven days after surgery the temporal lobe tumour patient suffered a seizure and admitted for symptom management and expedite oncology treatment. She passed away six days later suffering continual neurological deterioration and the tumour progression with leptomeningeal spread. This was exactly four weeks from initial presentation.
Conclusion
The prognosis for epithelioid Glioblastoma is limited to weeks to short months. Extent of resection in these case studies demonstrates benefit in delaying progression though it is clear that time is of the essence from presentation, to surgery, to adjuvant treatment. Neither of these tumours were methylated meaning the standard treatment for glioblastoma is likely to lack efficacy. BRAF inhibitors should be made readily available for this rare sub-type to commence treatment expediently. Both patients suffered distressing neurological symptoms in their final days which require expert management and are best managed in a neurosurgical centre.
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Affiliation(s)
- V Hurwitz
- Kings College Hospital , London , United Kingdom
| | - J La
- Kings College Hospital , London , United Kingdom
| | - J Lavrador
- Kings College Hospital , London , United Kingdom
| | - L Brazil
- Kings College Hospital , London , United Kingdom
| | - K Chia
- Kings College Hospital , London , United Kingdom
| | - A Swampillai
- Kings College Hospital , London , United Kingdom
| | - O Al-Salihi
- Guys and St Thomas , London , United Kingdom
| | - R Bhangoo
- Kings College Hospital , London , United Kingdom
| | - F Vergani
- Kings College Hospital , London , United Kingdom
| | - K Ashkan
- Kings College Hospital , London , United Kingdom
| | - S Hedges
- Kings College Hospital , London , United Kingdom
| | - E Kostick
- Kings College Hospital , London , United Kingdom
| | - A Suarez
- Kings College Hospital , London , United Kingdom
| | - C Robinson
- Kings College Hospital , London , United Kingdom
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Manik V, Brazil L, Swampillai A, Chia K, Al-Salihi O. P17.08.B Single institutional retrospective review of re-irradiation in High Grade Gliomas in a tertiary UK centre. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.316] [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: 11/15/2022] Open
Abstract
Abstract
Background
Recurrent high grade gliomas (HGG) pose a treatment challenge as no definite guidelines exist. Re-excision could be appropriate in some cases while systemic therapy options are only a handful. We thus need to resort to the option of re-irradiation at some point but there could be a wide variety of techniques, volumes & doses to choose from due to lack of robust evidence. The UK wide BRIOCHe study for Glioblastoma Multiforme (GBM) will help in providing some standardisation. With this retrospective study, we aim to review our institutional practice with re-irradiation & our patient outcomes.
Material and Methods
Electronic health records over a period of 3 years from 1 Jun 2019 to 30 May 2021 were searched for patients with HGG that underwent a course of re-irradiation. Various patient factors, tumour & treatment factors at baseline and at recurrence and survival data were collected.
Results
Total of 8 patients received re-irradiation with all except one having a performance status of 1 at the time of treatment. Seven patients had GBM, one had transformation from baseline G2 glioma and the eighth patient had anaplastic oligodendroglioma (ODG). MGMT was methylated in 62.5% patients while IDH mutation was present only in the transformed glioma. Majority patients had radiotherapy dose of 60Gy/30 fractions with concurrent temozolomide (TMZ) at baseline to a median CTV volume of 186cc. A median of 6 cycles of TMZ were given in the adjuvant setting. Median time to recurrence from completion of adjuvant treatment was 6.7 months (range: 0.9 - 171.6 months). Most recurrences were in the same or an adjacent lobe whereas 1 patient had a multi-focal recurrence. Half the patients at recurrence underwent a re-resection. All patients had salvage chemotherapy at the time of recurrence with a median of 2 regimens and a median of 6 cycles prior to re-irradiation. All patients received a re-irradiation dose of 35Gy in 10 fractions to a median CTV volume of 149cc. The median interval from previous radiotherapy was 18.9 months (range: 11.6 - 190.5 months). The median time to progression from re-RT was 5.4 months (CI: 3.4 - 7.4) and median survival from re-RT was 7 months (CI: 6.2 - 7.8). The median overall survival since diagnosis was 35.1 months (CI: 22.2 - 48.1), one patient was lost to follow up.
Conclusion
Re-irradiation is a safe & feasible treatment option in carefully selected cases of high grade glioma.
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Affiliation(s)
- V Manik
- Guys & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - L Brazil
- Guys & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - A Swampillai
- Guys & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - K Chia
- Guys & St Thomas' NHS Foundation Trust , London , United Kingdom
| | - O Al-Salihi
- Guys & St Thomas' NHS Foundation Trust , London , United Kingdom
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12
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La J, Bhangoo R, Hurwitz V, Ashkan K, Vergani F, Gullan R, Lavrador JP, Robinson C, Kostick E, Suarez A, Hedges S, Brazil L, Swampillai A, Al-Salihi O, Chia K, Cikurel K, Joe D. P11.06.A benefits of carbohydrate loading drinks pre-operatively for patients with a presumed high-grade glioma planned for an awake craniotomy. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.195] [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
As part of enhanced recovery after surgery in neuro oncology, carbohydrate loading drinks were reviewed to see if there were any benefits in administering this pre operatively, in particularly for patients for awake craniotomy electively. This method is currently used in colorectal and spinal teams within the trust. Carbohydrate loading drinks are clear, and can be consumed up to 2 hours before induction of anaesthesia. Currently reviewed for patients for awake craniotomy with the vision to implement for all patients planned for craniotomy, both asleep and awake. The concept of this drink, is that it helps with post-operative nausea and vomiting , insulin resistance, helps with energy boost which is helpful during awake craniotomies and potentially during their engagement with therapists post operatively and wound healing (Hausel J et al, 2005). This could essentially lead to safer discharge, reduced risk of wound infection and reduced length of stay.
Material and Methods
In a single centre, data for patients who have undergone awake craniotomies this year were abstracted. Patients planned for an awake surgery were prescribed carb-loading drinks. Due to the start date of this study, there were already a number of patients who have had their awake craniotomies without having carb-loading drinks prescribed. The data for both cohorts enabled comparison on engagement during and after awake craniotomies with therapists and length of stay.
Results
The current data collected has found that the average length of stay in the group who were not prescribed carbohydrate loading drinks pre operatively, had an average length of stay 7.2 days in total, 50% had experienced nausea and vomiting post operatively, which led therapists unable to perform assessments. 66% of patients in this group were found to have some form of difficulties engaging with the therapists during the awake phase of their craniotomies. Compared with patients who were prescribed the carbohydrate loading drink, the average length of stay was 4.6 days, with no post operative nausea and vomiting, no difficulties engaging with therapists post operatively.
Conclusion
Though the current data is of a small volume, carbohydrate loading pre-operatively can help patients for elective awake craniotomies and reduce length of stay in hospital, optimising their recovery in a fast yet safe manner to ensure they are in the best performance status prior to commencing oncology treatment. With further analysis into the use of carb-loading drinks pre-operatively, this can be used widely within neuro-oncology surgeries.
Hausel J, Nygren J, Thorell A et al Randomized clinical trial of the effects of oral preoperative carbohydrates on postoperative nausea and vomiting after laparoscopic cholecystectomy. Br J Surg 2005; : 415-421. [PubMed] [Google Scholar]
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Affiliation(s)
- J La
- Kings College Hospital , London , United Kingdom
| | - R Bhangoo
- Kings College Hospital , London , United Kingdom
| | - V Hurwitz
- Kings College Hospital , London , United Kingdom
| | - K Ashkan
- Kings College Hospital , London , United Kingdom
| | - F Vergani
- Kings College Hospital , London , United Kingdom
| | - R Gullan
- Kings College Hospital , London , United Kingdom
| | - J P Lavrador
- Kings College Hospital , London , United Kingdom
| | - C Robinson
- Kings College Hospital , London , United Kingdom
| | - E Kostick
- Kings College Hospital , London , United Kingdom
| | - A Suarez
- Kings College Hospital , London , United Kingdom
| | - S Hedges
- Kings College Hospital , London , United Kingdom
| | - L Brazil
- Guys & St Thomas Hospital , London , United Kingdom
| | - A Swampillai
- Guys & St Thomas Hospital , London , United Kingdom
| | - O Al-Salihi
- Guys & St Thomas Hospital , London , United Kingdom
| | - K Chia
- Guys & St Thomas Hospital , London , United Kingdom
| | - K Cikurel
- Kings College Hospital , London , United Kingdom
| | - D Joe
- Kings College Hospital , London , United Kingdom
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Abdul Haris P, Brazil L, Blythe K, Chia K, Hassan S, Loganathan T, Smith D, Swampillai A, Al-Salihi O. P11.30.A Stereotactic Radiosurgery (SRS) for brain metastases in breast cancer: An evaluation of outcomes at a UK tertiary centre. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.219] [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
Brain metastases (BM) occur in approximately 10-30% of patients with breast cancer (BC). Patients with advanced breast cancer are living longer, and the incidence of BM are increasing. Stereotactic Radiosurgery (SRS) has emerged as a strategy to treat BM. We evaluated the outcomes and potential prognostic factors of patients with BM treated with SRS.
Material and Methods
Retrospective review of patients treated with linac-based SRS for BM from BC in a single tertiary centre between August 2017-September 2021. Overall survival (OS), intracranial progression-free survival (IPFS), and prognostic factors were evaluated using Kaplan-Meier analysis, log-rank test, and Cox proportional-hazards model.
Results
76 patients were included in the analysis. Out of these, 56 had first-line local treatment with SRS, either as primary (n=34) or adjuvant to surgery (n=22). Median age was 58 years old (range 37-86), and 88% had PS 0/1. One-year survival rate was 56%.
Median OS and IPFS from SRS was 16 months (95% CI 8-24) and 7 months (95% CI 2-12), respectively. However, there were significant differences in OS (p<0.001) and IPFS (p=0.001) based on molecular subtypes. Patients with triple-negative breast cancer (TNBC) (n=14) had median OS of 7 months (95% CI 2-12), ER+/HER2- (n=22) median OS of 22 months, ER-/HER2+ (n=8) median OS of 4 months (95% CI 0-9), and ER+/HER2+ (n=11) median OS of 36 months. Similar trend was seen with IPFS.
Patients with progressive extracranial disease compared to stable disease had shorter median OS (4 months vs 23 months, HR 2.4, p=0.01) and median IPFS (4 months vs 13 months, HR 2, p=0.03). Age ≥65 years was associated with shorter median OS (4 vs 23 months, HR 2.3, p=0.02). Patients with ≥4 brain metastases had shorter IPFS (4 months vs 11 months, HR 2.4, p=0.012), but no significant difference in OS. Volume of metastases did not affect outcome in this series.
30% of patients progressed intracranially after first-line SRS. 94 % had out-of-field recurrences, and 6% in-field recurrences. 59% had further SRS, 12 % WBRT, 6% surgery, and 23% had no further local treatment.
26 patients had second-line local treatment with SRS after first-line SRS (n=9), WBRT (n=9), or surgery +/- WBRT (n=8). There were no significant differences in outcome based on the modality of first-line local treatment.
Conclusion
SRS is an effective treatment for BM from BC. There were significant differences in survival based on age, molecular subtypes, and extracranial disease status.
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Affiliation(s)
- P Abdul Haris
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - L Brazil
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - K Blythe
- Guy's and St Thomas' NHS Trust , London , United Kingdom
- Department of Medical Physics, Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - K Chia
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - S Hassan
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - T Loganathan
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - D Smith
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - A Swampillai
- Guy's and St Thomas' NHS Trust , London , United Kingdom
| | - O Al-Salihi
- Guy's and St Thomas' NHS Trust , London , United Kingdom
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Gupta S, Brazil L, Swampillai A, Al-Salihi O. P11.38.A Case reports on aggressive Pilocytic astrocytoma in TYA and adults: patient tailored approach or standard of care? Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.227] [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
Pilocytic astrocytoma (piloA) is a low grade brain tumour and most of the literature is based on paediatric patients with limited data on adults. Surgical resection followed by adjuvant treatment for recurrent lesions is standard of care. While previous literature was mainly based on historical classification, molecular analysis of tumour is adding to the subgroup classification.
Material and Methods
We are reporting 3 cases of adult piloA treated at our institute.
Results: Case1
31y female with headaches and visual problems was diagnosed with optic nerve glioma, biopsy confirmed piloA, and was treated with conventional radiotherapy 50Gy/30fr. A month later developed CSF dissemination requiring 10xTemozolamide. Two years later, developed L5 and S2 deposits which were resected and confirmed piloA. 5 years later there was progression of primary disease treated with 12xTemozolamide and a year later developed further progression and hydrocephalus. She received 1xPCV and succumbed to disease at the age of 42. Case 2: 29y female with severe dizziness on moving head, worsening headaches, word finding difficulty, and positive family history of anaplastic astrocytoma, was diagnosed with Tectal plate lesion. Surgical debulking was performed and pathology showed piloA with Methylated MGMT promoter, IDH wild-type, H3K27M negative, and no BRAF fusion. 3 years later developed recurrence which was treated with chemotherapy (5xPCV: 6th omitted due to recurrent infections) as patient was reluctant for radiotherapy. Follow up scans 6 months post chemotherapy remain stable. Case 3: 24y female with background of 2 haemorrhagic strokes, left spastic hemi-paralysis and left hemianopia, and negative family history, had a biopsy performed for Right Mesotemopral Cavenous Angioma. Pathology showed low grade neoplasm favouring Ganglioglioma with CD34 and IDH1 negative, ATRX retained, KI-67 focal index 5%, and no BRAF fusion or mutation. Surveillance imaging showed progressively increasing suprasellar mass and right temporal region enhancement which was surgically debulked at the age of 27. Repeat pathology examination favoured piloA considering the radiological progression. Methylation array failed but immunohistochemistry showed tumour cells positive with synaptophysin, ATRX and trimethylated H3K27 retained, H3K27M, NeuN, H3G34R and CD34 negative, p53 negative, and Ki-67 3-4%. Repeat imaging 10 months later showed further progressive suprasellar tumour and enhancing lesion in the right temporal area accompanied by rapid loss of right side vision. We have planned for radical radiotherapy 54Gy/30fr with IMRT.
Conclusion
There is a gap in management of piloA in adults with treatment extrapolated from paediatrics and does require further research. We want to approach other centres to establish consensus on treating such cases.
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Affiliation(s)
- S Gupta
- Guys and St Thomas Hospital , London , United Kingdom
| | - L Brazil
- Guys and St Thomas Hospital , London , United Kingdom
| | - A Swampillai
- Guys and St Thomas Hospital , London , United Kingdom
| | - O Al-Salihi
- Guys and St Thomas Hospital , London , United Kingdom
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Abdul Haris P, Smith D, Al-Salihi O, Blythe K, Brazil L, Chia K, Hassan S, Mazumder A, Skwarski M, Swampillai A. Stereotactic radiosurgery (SRS) for brain metastases from lung cancer: an evaluation of outcomes at a UK tertiary centre. Lung Cancer 2022. [DOI: 10.1016/s0169-5002(22)00172-6] [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: 12/01/2022]
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Manik V, Swampillai A, Al-Salihi O, Chia K, Brazil L. RADT-20. SINGLE INSTITUTION REVIEW OF LARGE VOLUME HIGH GRADE GLIOMA PATIENTS TREATED WITH RADIOTHERAPY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.178] [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
AIM
Not uncommonly, we come across significantly large high grade glioma cases (HGGs). With standard delineation protocols, we end up irradiating a large volume of normal brain. Emami & QUANTEC data define normal brain tolerance doses, however they are often of limited use in clinic practice. Thus, we reviewed our patients with significant tumor volumes to derive a safe dose/ volume level for brain.
METHODOLOGY
Patients with HGGs over the last 3 years were extracted from Mosaiq™ information system. The output was sorted with respect to clinical target volumes from lowest to highest. The top 25 percentile i.e. patients with a CTV of > 412cc (n=53) were identified for this study. Data was collected with respect to clinical, tumor characteristics and radiotherapy parameters.
RESULTS
Median age of population was 53 and majority (n=38) were males. Nine patients had multi-focal tumors while six had bilateral extension. Majority of the study group had Glioblastoma Multiforme (n=44), whereas 6 had Grade 3 tumors. Most of the patients could only have a biopsy (n=27). Molecular profile showed 42 were Isocitrate-Dehydrogenase negative and 26 were unmethylated tumors. Stupp’s & Perry’s regimen were the commonly used protocols, however patients (n=7) with significant volumes near critical structures were treated with doses in the range of 50.4 – 55Gy in 30 fractions. The CTV volumes in the population ranged from 412 – 1223 cc while total brain volume range was 1112 – 1667 cc. Median of 43.5% of brain volume was covered in the PTV, while median of 5% of brain volume outside the PTV was treated to BED2 of 100Gy. Median survival was 12.4 months.
CONCLUSION
Our study shows reasonable tolerance of radiotherapy doses of > 50 Gy to larger volumes of brain. We propose a multi-center collaborative study to derive a new standardized dose volume tolerance.
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Preusser M, Silvani A, Le Rhun E, Soffietti R, Lombardi G, Sepulveda JM, Brandal P, Brazil L, Bonneville-Levard A, Lorgis V, Vauleon E, Bromberg J, Erridge S, Cameron A, Lefranc F, Clement PM, Dumont S, Sanson M, Bronnimann C, Balaná C, Thon N, Lewis J, Mair MJ, Sievers P, Furtner J, Pichler J, Bruna J, Ducray F, Reijneveld JC, Mawrin C, Bendszus M, Marosi C, Golfinopoulos V, Coens C, Gorlia T, Weller M, Sahm F, Wick W. Trabectedin for recurrent WHO grade 2 or 3 meningioma: a randomized phase 2 study of the EORTC Brain Tumor Group (EORTC-1320-BTG). Neuro Oncol 2021; 24:755-767. [PMID: 34672349 DOI: 10.1093/neuonc/noab243] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND No systemic treatment has been established for meningioma progressing after local therapies. METHODS This randomized, multicenter, open-label, phase 2 study included adult patients with recurrent WHO grade 2 or 3 meningioma. Patients were 2:1 randomly assigned to intravenous trabectedin (1.5 mg/m 2 every three weeks) or local standard of care (LOC). The primary endpoint was progression-free survival (PFS). Secondary endpoints comprised overall survival (OS), objective radiological response, safety, quality of life (QoL) assessment using the QLQ-C30 and QLQ-BN20 questionnaires, and we performed tissue-based exploratory molecular analyses. RESULTS Ninety patients were randomized (n=29 in LOC, n=61 in trabectedin arm). With 71 events, median PFS was 4.17 months in the LOC and 2.43 months in the trabectedin arm (hazard ratio [HR]=1.42; 80% CI, 1.00-2.03; p=0.294) with a PFS-6 rate of 29.1% (95% CI, 11.9%-48.8%) and 21.1% (95% CI, 11.3%-32.9%), respectively. Median OS was 10.61 months in the LOC and 11.37 months in the trabectedin arm (HR=0.98; 95% CI, 0.54-1.76; p=0.94). Grade ≥3 adverse events occurred in 44.4% patients in the LOC and 59% of patients in the trabectedin arm. Enrolled patients had impeded global QoL and overall functionality and high fatigue before initiation of systemic therapy. DNA methylation class, performance status, presence of a relevant co-morbidity, steroid use, and right hemisphere involvement at baseline were independently associated with OS. CONCLUSIONS Trabectedin did not improve PFS and OS and was associated with higher toxicity than LOC treatment in patients with non-benign meningioma. Tumour DNA methylation class is an independent prognostic factor for OS.
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Affiliation(s)
- Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Antonio Silvani
- Department of Neuro-oncology, IRCCS Fondazione Istituto Neurologico Carlo Besta, Via Giovanni Celoria 11, 20133 Milan, Italy
| | - Emilie Le Rhun
- University of Lille, U-1192, F-59000 Lille, France; Inserm, U-1192, F-59000 Lille, France; CHU Lille, General and Stereotaxic Neurosurgery service, F-59000 Lille, France; Oscar Lambret Center, Medical Oncology Department, F-59000 Lille
| | - Riccardo Soffietti
- Dept. Neuro-Oncology, University and City of Health and Science Hospital, Via Cherasco 15, 10126 Turin, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV- IRCCS, Via Gattamelata 64, 35128 Padua, Italy
| | - Juan Manuel Sepulveda
- Neurooncology Unit, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain
| | - Petter Brandal
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424 Oslo, Norway
| | - Lucy Brazil
- St Thomas' Hospital, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | | | - Veronique Lorgis
- Department of Medical Oncology, Centre Georges François Leclerc, 1 Rue du Professeur Marion, 21000 Dijon, France
| | - Elodie Vauleon
- Department of Medical Oncology, Centre Eugene Marquis, Avenue de la Bataille Flandres Dunkerque, 25042 Rennes, France
| | - Jacoline Bromberg
- Department of Neuro-Oncology, Erasmus MC University Medical Center Cancer Center, Doctor Molewaterplein 40, 3015 Rotterdam, The Netherlands
| | - Sara Erridge
- Edinburgh Cancer Centre, Western General Hospital, Crewe Rd S, Edinburgh EH4 2XU, United Kingdom
| | - Alison Cameron
- Bristol Cancer Institute, University Hospitals Bristol, Marlborough St, Bristol BS1 3NU, United Kingdom
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme; Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Paul M Clement
- Department of Oncology, KU Leuven and Department of General Medical Oncology, UZ Leuven, Leuven Cancer Institute, Herestraat 49, 3000 Leuven, Belgium
| | - Sarah Dumont
- Institut Gustave-Roussy, Université Paris-Saclay, Medical Oncology Department, 114 Rue Edouard Vaillant, 94805 Villejuif, France
| | - Marc Sanson
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2-Mazarin, 47-83 Boulevard del l'Hôpital, 75013, Paris, France
| | - Charlotte Bronnimann
- Department of Medical Oncology, Bordeaux University Hospital-CHU, Bordeaux, France, University of Bordeaux, Place Amélie Raba Léon, 33000 Bordeaux, France
| | - Carmen Balaná
- Department of Medical Oncology, Catalan Institute of Oncology, Carretera Canyet sn, 08916 Badalona , Barcelona, Spain
| | - Niklas Thon
- Department of Neurosurgery, Faculty of Medicine and University Hospital, University of Munich LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - Joanne Lewis
- Freeman Hospital, Freeman Rd, High Heaton, Newcastle NE7 7DN, United Kingdom
| | - Maximilian J Mair
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Philipp Sievers
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany, Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research DKTK), German Cancer Research Center DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Julia Furtner
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Josef Pichler
- Department of Internal Medicine and Neurooncology, Neuromed Campus, Kepler University Hospital, Johannes Kepler University of Linz, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Jordi Bruna
- Unit of Neuro-Oncology, Hospital Universitari de Bellvitge-Institut Català D'Oncologia L'Hospitalet, Avinguda de la Granvia de l'Hospitalet, 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francois Ducray
- Unit of Neuro-Oncology, Hospices Civils de Lyon and Department of Cancer Cell Plasticity, Cancer Research Center of Lyon, Claude Bernard University, 28 Rue Laennec, 69008 Lyon, France
| | - Jaap C Reijneveld
- Brain Tumor Center, Cancer Center Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, Netherlands and Stichting Epilepsie Instellingen Nederland, Achterweg 3, 2103 SW Heemstede, Netherlands
| | - Christian Mawrin
- Department of Neuropathology, Otto-von-Guericke-University, Leipziger Straße 44, 39120 Magdeburg, Germany
| | - Martin Bendszus
- Department of Neuroradiology, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Christine Marosi
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Vassilis Golfinopoulos
- European Organisation for Research and Treatment of Cancer EORTCHeadquarter, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer EORTCHeadquarter, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer EORTCHeadquarter, Avenue E. Mounier 83/11, 1200 Brussels, Belgium
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany, Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research DKTK), German Cancer Research Center DKFZ), Im Neuenheimer Feld 224, 69120 Heidelberg, Germany
| | - Wolfgang Wick
- Neurology Clinic, Heidelberg University Medical Center, Clinical Cooperation Unit, Neurooncology, German Cancer Research Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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18
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Bhadra K, Al-Salihi O, Hassan S, Swampillai A, Blythe K, Forner S, Sisodia C, Brazil L. NCOG-01. STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES AT THE GUY’S CANCER CENTER, LONDON: AN AUDIT FOR THE FIRST 17 MONTHS. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.540] [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: 11/12/2022] Open
Abstract
Abstract
INTRODUCTION
Stereotactic radiosurgery (SRS) commenced at Guy’s Cancer Hospital in August 2017. We report our first seventeen months’ data (August 2017 to December 2018) for brain metastases SRS.
METHOD
Patients referred via Neuro Oncology MDT were assessed for suitability for SRS via clinical review and 1mm-slice MRI. Treatment was planned on Eclipse v15.6 and delivered using Truebeam STx Linac(FFF) and Align RT v5.1 for matching. Dose prescription, according to departmental protocol, was set at 100% isodose, ranging from 18Gy to 25Gy, with fractionation varying from single to five fractions depending on factors including size, volume and locations. Post-treatment, patients were discharged back to their primary treating team for 3-monthly MRI.
RESULTS
Between Aug-17 to Dec-18, 70 patients with brain metastases were treated with a total of 122 lesions. Mean age was 66 years (range 37-93) and Median follow-up 9 months. Primary tumour sites mainly included lung 34(48.5%), breast 16(22.8%) and melanoma 17(24.3%). Brain-only metastases, including small volume primary with brain metastases were found in 85.4% cases, whilst visceral disease with brain metastases were found in 14.5% patients. Out of 122 lesions, the majority were treated in the primary setting; 95(77.8%) vs 27(22.1%) in the adjuvant setting. At 9-months follow up, local failure rate was in 26(21.3%) sites and 17 new sites in distant brain appeared. 31(44.2%) patients received no systemic therapy after SRS, whilst immunotherapy was received by 14(20%), with the remaining receiving hormones or chemotherapy. Median Overall Survival was 9.2 months (95% CI: 4.5-13.8) and Median progression-free survival was 5.9 months (95% CI: 7.0-10.4).
CONCLUSION
Overall Survival results were encouraging with initial auditing proving SRS as effective approach. Local control rates correlate well with randomized control trials results for SRS in brain metastases.
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Affiliation(s)
- Kallol Bhadra
- Guy’s Cancer Center, Guy’s & St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Sheila Hassan
- Guy’s Cancer Center. Guy’s & St Thomas’ Foundation Trust, London, United Kingdom
| | | | - Kirsty Blythe
- Guy’s Cancer Center. Guy’s & St Thomas’ Foundation Trust, London, United Kingdom
| | - Samantha Forner
- Guy’s Cancer Center. Guy’s & St Thomas’ Foundation Trust, London, United Kingdom
| | - Caroline Sisodia
- Guy’s Cancer Center. Guy’s & St Thomas’ Foundation Trust, London, United Kingdom
| | - Lucy Brazil
- Guy’s Hospital, GSTT, London, London, United Kingdom
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19
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Forner S, Al-Salihi O, Brazil L, Swampillai A. EPID-16. EPIDEMIOLOGICAL TRENDS FOR LONGER TERM GBM SURVIVORS POST STUPP. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.334] [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
Patients with Glioblastoma Multiforme (GBM) have a poor prognosis with few long-term survivors (>2 years from diagnosis). This review analyses key characteristics of this cohort. METHODS: Retrospective single-centre review of GBM patients treated with the STUPP protocol at a Regional Neuro-oncology centre, Nov-09–Sept-19. Demographics, histology and treatment details were reviewed, with progression (PFS) and overall survival (OS) analysed. RESULTS: In 282 patients (mean age 55 years;M:F ratio 2:1), 77% of patients underwent de-bulking surgery and 35% were MGMT-methylated. Median OS was 72.1 weeks with a statistically significant survival benefit in patients who underwent debulking surgery (p=0.0001), were methylated for MGMT (P=0.0026) or those less than 50yrs (p=< 0.0001). 14% patients were treated within clinical trials. 66 patients (23%) were alive at 24 months. Baseline characteristics - mean age 52yrs; 53% MGMT-methylated; 88% debulking surgery; 16 (24%) patients with histological low grade components and 1 (1%) was of small cell. 55 (83%) relapsed of which (19) 35% received 2 lines of further treatment,14 (25%) had re do surgery, 32 (80%) received CCNU/PCV with or without surgery (24% vs 56%), 7 (13%) received TMZ-alone and 3 (5%) were not suitable for treatment. 8 (3%) were alive at 5 years. Baseline characteristics - mean age 46 years; MGMT (4 methylated, 2 unmethylated, 2 unknown); 3 (38%) had lower-grade histological components. 6 (75%) relapsed - 1 patient received TMZ (within a clinical trial) and 5 PCV/CCNU (2 within a clinical trial). 3 patients had further progression of which 2 received a further 1 line of treatment and 1 a further 3 lines. 6 (75%) remain alive, 2 (33%) in remission following STUPP. CONCLUSIONS: This real world data demonstrates that despite poor prognosis, features including methylation, younger age and surgical resection assist to predict long-term survivors. This highlights the importance of clinical trials.
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Affiliation(s)
| | | | - Lucy Brazil
- Guy’s Hospital, GSTT, London, London, United Kingdom
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20
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Little J, Al-Salihi O, Brazil L, Swampillai A. COVD-03. ASSESSING THE IMPACT OF CORONAVIRUS 19 PANDEMIC ON NEURO-ONCOLOGY AT GUY’S CANCER CENTRE LONDON. Neuro Oncol 2020. [PMCID: PMC7650407 DOI: 10.1093/neuonc/noaa215.088] [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: 12/03/2022] Open
Abstract
BACKGROUND Immunosuppressive treatment increases COVID-19 risk. Neuro-oncology patients may not qualify for ITU if they deteriorate, but without oncological treatment, prognosis is poor. The pandemic has seen the introduction of new guidelines; including alternative treatment schedules which balance risks of contracting COVID-19, against safely delivering effective cancer treatment. We assess COVID-19 impact on neuro-oncology treatment at Guy’s Cancer Centre, London. METHODS Notes of patients seen March-April 2020 were reviewed. Demographic data, tumour grade, treatment and changes due to COVID-19 recorded. RESULTS 111 patients were identified (69 male: 42 female, median age 51years). 65 were WHO Grade 4, 24 Grade 3, 17 Grade 2, 2 Grade 1, 1 metastatic-neuroblastoma, 1 anaplastic-medulloblastoma and 1 radiological diagnosis of high-grade-glioma. 14% (32) of consultations were in person (16 new, 7 consents, 9 attending for treatment); 86% (198) were telephone. 8 had concurrent chemo-radiotherapy, 22 radiotherapy alone, 64 chemotherapy alone, 15 had active-surveillance and 2 best-supportive-care. To minimise COVID-19 risk, 22.5% (25) had treatment altered: - A 76-year-old had a radiological diagnosis; - 4 had hypofractionated radiotherapy (30Gy in 6#) to minimise hospital visits; - 7 had no chemotherapy (5 were unmethylated /age, 2 patient choice); - 4 switched from PCV to Lomustine; - 11 stopped chemotherapy early; - 50% (36) were given prophylactic GCS-F; - No patients were recruited for trials. 19 reported possible COVID-19 symptoms – 7 had delays and 3 stopped treatment. 4 tested COVID-19 positive (although not all tested). 1 died of COVID-19 (off treatment). Review of March-April 2020 service showed similar new patient referrals compared to the same time in 2019 (16 and 19 respectively). CONCLUSION Despite concern about decreasing new referrals during the pandemic, this wasn’t the case for our service. 77.5% of patients had no treatment changes due to COVID-19 and all 22 patients on trial were able to continue treatment throughout this period.
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Affiliation(s)
| | | | - Lucy Brazil
- Guy’s Hospital, GSTT, London, London, United Kingdom
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21
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Booth TC, Luis A, Brazil L, Thompson G, Daniel RA, Shuaib H, Ashkan K, Pandey A. Glioblastoma post-operative imaging in neuro-oncology: current UK practice (GIN CUP study). Eur Radiol 2020; 31:2933-2943. [PMID: 33151394 PMCID: PMC8043861 DOI: 10.1007/s00330-020-07387-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/13/2020] [Accepted: 10/07/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES MRI remains the preferred imaging investigation for glioblastoma. Appropriate and timely neuroimaging in the follow-up period is considered to be important in making management decisions. There is a paucity of evidence-based information in current UK, European and international guidelines regarding the optimal timing and type of neuroimaging following initial neurosurgical treatment. This study assessed the current imaging practices amongst UK neuro-oncology centres, thus providing baseline data and informing future practice. METHODS The lead neuro-oncologist, neuroradiologist and neurosurgeon from every UK neuro-oncology centre were invited to complete an online survey. Participants were asked about current and ideal imaging practices following initial treatment. RESULTS Ninety-two participants from all 31 neuro-oncology centres completed the survey (100% response rate). Most centres routinely performed an early post-operative MRI (87%, 27/31), whereas only a third performed a pre-radiotherapy MRI (32%, 10/31). The number and timing of scans routinely performed during adjuvant TMZ treatment varied widely between centres. At the end of the adjuvant period, most centres performed an MRI (71%, 22/31), followed by monitoring scans at 3 monthly intervals (81%, 25/31). Additional short-interval imaging was carried out in cases of possible pseudoprogression in most centres (71%, 22/31). Routine use of advanced imaging was infrequent; however, the addition of advanced sequences was the most popular suggestion for ideal imaging practice, followed by changes in the timing of EPMRI. CONCLUSION Variations in neuroimaging practices exist after initial glioblastoma treatment within the UK. Multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment. KEY POINTS • Variations in imaging practices exist in the frequency, timing and type of interval neuroimaging after initial treatment of glioblastoma within the UK. • Large, multicentre, longitudinal, prospective trials are needed to define the optimal imaging schedule for assessment.
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Affiliation(s)
- Thomas C Booth
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK. .,Department of Neuroradiology Ruskin Wing, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK.
| | - Aysha Luis
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK.,Department of Neuroradiology, National Hospital For Neurology and Neurosrgery, London, WC1N 3BG, UK
| | - Lucy Brazil
- Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - Gerry Thompson
- Centre for Clinical Brain Sciences, Edinburgh, EH16 4SB, UK
| | - Rachel A Daniel
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, SE1 7EH, UK
| | - Haris Shuaib
- Department of Medical Physics, Guy's & St. Thomas' NHS Foundation Trust, London, SE1 7EH, UK.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Anmol Pandey
- Faculty of Life Sciences and Medicine, King's College London Strand, London, WC2R 2LS, UK
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22
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Ghimire P, Lavrador JP, Onyiriuka L, Robinson C, La J, Mullens L, Hurwitz V, Cikurel K, Al-Salihi O, Swampillai A, Brazil L, Bhangoo R, Vergani F, Gullan R, Ashkan K. Patient-reported Experience Measure for Neuro-oncology Telephone Clinics during the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 33:e87. [PMID: 32828636 PMCID: PMC7438996 DOI: 10.1016/j.clon.2020.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/05/2022]
Affiliation(s)
- P Ghimire
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - J P Lavrador
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - L Onyiriuka
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - C Robinson
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - J La
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - L Mullens
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - V Hurwitz
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - K Cikurel
- Department of Neurology, Kings College Hospital, London, UK
| | - O Al-Salihi
- Department of Oncology, Guys' and St Thomas' Hospital/Kings Health Partners, London, UK
| | - A Swampillai
- Department of Oncology, Guys' and St Thomas' Hospital/Kings Health Partners, London, UK
| | - L Brazil
- Department of Oncology, Guys' and St Thomas' Hospital/Kings Health Partners, London, UK
| | - R Bhangoo
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - F Vergani
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - R Gullan
- Department of Neurosurgery, Kings College Hospital, London, UK
| | - K Ashkan
- Department of Neurosurgery, Kings College Hospital, London, UK
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23
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Jung J, Tailor J, Dalton E, Glancz LJ, Roach J, Zakaria R, Lammy S, Chari A, Budohoski KP, Livermore LJ, Yu K, Jenkinson MD, Brennan PM, Brazil L, Bunce C, Bourmpaki E, Ashkan K, Vergani F. Management evaluation of metastasis in the brain (MEMBRAIN)-a United Kingdom and Ireland prospective, multicenter observational study. Neurooncol Pract 2020; 7:344-355. [PMID: 32537183 PMCID: PMC7274191 DOI: 10.1093/nop/npz063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In recent years an increasing number of patients with cerebral metastasis (CM) have been referred to the neuro-oncology multidisciplinary team (NMDT). Our aim was to obtain a national picture of CM referrals to assess referral volume and quality and factors affecting NMDT decision making. METHODS A prospective multicenter cohort study including all adult patients referred to NMDT with 1 or more CM was conducted. Data were collected in neurosurgical units from November 2017 to February 2018. Demographics, primary disease, KPS, imaging, and treatment recommendation were entered into an online database. RESULTS A total of 1048 patients were analyzed from 24 neurosurgical units. Median age was 65 years (range, 21-93 years) with a median number of 3 referrals (range, 1-17 referrals) per NMDT. The most common primary malignancies were lung (36.5%, n = 383), breast (18.4%, n = 193), and melanoma (12.0%, n = 126). A total of 51.6% (n = 541) of the referrals were for a solitary metastasis and resulted in specialist intervention being offered in 67.5% (n = 365) of cases. A total of 38.2% (n = 186) of patients being referred with multiple CMs were offered specialist treatment. NMDT decision making was associated with number of CMs, age, KPS, primary disease status, and extent of extracranial disease (univariate logistic regression, P < .001) as well as sentinel location and tumor histology (P < .05). A delay in reaching an NMDT decision was identified in 18.6% (n = 195) of cases. CONCLUSIONS This study demonstrates a changing landscape of metastasis management in the United Kingdom and Ireland, including a trend away from adjuvant whole-brain radiotherapy and specialist intervention being offered to a significant proportion of patients with multiple CMs. Poor quality or incomplete referrals cause delay in NMDT decision making.
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Affiliation(s)
- Josephine Jung
- Department of Neurosurgery, King’s College Hospital, London, UK
- Neurosciences Clinical Trials Unit, King’s College Hospital, London, UK
| | - Jignesh Tailor
- Department of Neurosurgery, St. George’s Hospital, London, UK
- The Hospital for Sick Children, Toronto, Canada
| | - Emma Dalton
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Laurence J Glancz
- Department of Neurosurgery, Queen’s Medical Centre, Nottingham University Hospital, UK
| | - Joy Roach
- Wessex Neurological Centre, University Hospitals Southampton, UK
| | - Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Integrative Biology, University of Liverpool, UK
| | - Simon Lammy
- Department of Neurosurgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Aswin Chari
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | | | | | - Kenny Yu
- Department of Neurosurgery, Salford Royal Hospital, Manchester, UK
- Faculty of Biology, Medicine and Health, University of Manchester, UK
| | | | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - Lucy Brazil
- Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, UK
| | - Catey Bunce
- Department of Primary Care & Public Health Sciences, Kings College London, UK
| | - Elli Bourmpaki
- Department of Primary Care & Public Health Sciences, Kings College London, UK
| | - Keyoumars Ashkan
- Neurosciences Clinical Trials Unit, King’s College Hospital, London, UK
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24
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Brazil L, Swampillai AL, Mak KM, Edwards D, Mesiri P, Clifton-Hadley L, Shaffer R, Lewis J, Watts C, Jeffries S, Gkogkou P, Chalmers AJ, Fersht NL, Hackshaw A, Short SC. Hydroxychloroquine and short-course radiotherapy in elderly patients with newly diagnosed high-grade glioma: a randomized phase II trial. Neurooncol Adv 2020; 2:vdaa046. [PMID: 32642699 PMCID: PMC7236384 DOI: 10.1093/noajnl/vdaa046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/17/2022] Open
Abstract
Background Effective treatment for patients at least 70 years with newly diagnosed glioblastoma remains challenging and alternatives to conventional cytotoxics are appealing. Autophagy inhibition has shown promising efficacy and safety in small studies of glioblastoma and other cancers. Methods We conducted a randomized phase II trial to compare radiotherapy with or without hydroxychloroquine (2:1 allocation). Patients aged at least 70 years with newly diagnosed high-grade glioma deemed suitable for short-course radiotherapy with an ECOG performance status of 0-1 were included. Radiotherapy treatment consisted of 30 Gy, delivered as 6 fractions given over 2 weeks (5 Gy per fraction). Hydroxychloroquine was given as 200 mg orally b.d. from 7 days prior to radiotherapy until disease progression. The primary endpoint was 1-year overall survival (OS). Secondary endpoints included progression-free survival (PFS), quality of life, and toxicity. Results Fifty-four patients with a median age of 75 were randomized between May 2013 and October 2016. The trial was stopped early in 2016. One-year OS was 20.3% (95% confidence interval [CI] 8.2-36.0) hydroxychloroquine group, and 41.2% (95% CI 18.6-62.6) radiotherapy alone, with a median survival of 7.9 and 11.5 months, respectively. The corresponding 6-month PFS was 35.3% (95% CI 19.3-51.7) and 29.4% (95% CI 10.7-51.1). The outcome in the control arm was better than expected and the excess of deaths in the hydroxychloroquine group appeared unrelated to cancer. There were more grade 3-5 events in the hydroxychloroquine group (60.0%) versus radiotherapy alone (38.9%) without any clear common causation. Conclusions Hydroxychloroquine with short-course radiotherapy did not improve survival compared to radiotherapy alone in elderly patients with glioblastoma.
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Affiliation(s)
- Lucy Brazil
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Ka Man Mak
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Darren Edwards
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | | | | | - Joanne Lewis
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals Trust, Newcastle, UK
| | - Colin Watts
- University of Birmingham/Queen Elizabeth Hospital, Birmingham, UK
| | - Sarah Jeffries
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | | | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
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25
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Robinson C, Pedro Lavrador J, Gullan R, Brazil L, Swampillai A, Al’Salihi O, Bhangoo R, Vergani F, Hurwitz V, La J, Mullens L, Ford L, Mcewan M, Ashkan K. Low grade glioma patients: how does this patient group perceive their quality of life prior to surgical or oncological interventions? Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.038] [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
Introduction
Literature analysing how patients with a provisional low-grade glioma perceive their own quality of life prior to any surgical or oncological intervention is scarce. This patient group are often highly functioning individuals, able to lead ordinary lives which stresses that their management must be carefully considered in a holistic sense. Low grade gliomas represent 5 % of brain tumours and they are typically of a younger cohort who will be less equipped to manage the uncertainties a diagnosis like this brings.
Methods
Prospective single centre cohort study over 14 months where 56 patients completed the EORTC QLQ – BN 20 and 30 prior to initial consultation in the dedicated low grade glioma clinic.
Results
54% of patients did not feel ‘limited in doing work or other daily activities’ but of those who were affected to some degree, 21% of women felt ‘very much affected’ compared to 3% of men. 78% of patients expressed to a degree some ‘uncertainty about the future’ and this was shown to be a common theme among all age groups which reflects the huge burden of anxiety this patient group faces regardless of age.
Conclusion
Data demonstrated a variety of quality of life scores that are not particular to a certain age group/gender which reinforces the importance of individual assessment as assumptions of patients in a particular category cannot be made. By assessing quality of life, clinical management is improved as a more in-depth assessment is facilitated on an individual basis and patient experience is enhanced.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jess La
- King’s College Hospital, United Kingdom
| | | | - Liz Ford
- King’s College Hospital, United Kingdom
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26
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Lavrador J, Ghimire P, Acharya S, Swampillai A, Glendenning J, Brazil L, Alsahib O, Gullan R, Vergani F, Bhangoo R, Ashkan K. Redo-Surgery for Recurrent Glioblastoma: A 10-year single-institution series. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz167.081] [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
Introduction
Multiple surgeries for recurrent / progressive glioblastomas is a matter of debate within the neuro-oncology community reflecting the higher risk of complications and the limited adjuvant treatment options for patients who recurred after initial treatment. Therefore it is crucial to identify who may benefit of a more aggressive approach and if the neurosurgical practice has changed in the last years.
Methods
Single-Neuro-Oncology Surgical Centre (1 neurosurgical and 2 medical neuro-oncology units) retrospective cohort study of patients with more than one surgery for intracranial Glioblastoma Multiforme (GBM). All patient diagnised with GBM at the time of the first surgery in the period between 2009–2018. Second surgery within 2-months time following initial biopsy or surgical complication or prior to chemo-radiotherapy were excluded. Demographic and clinical data was collected from the medical records.
Results
96 patients underwent second surgery (63 males, 33 females, mean age of 52.6) met criteria for surgery at progression. At the time of the first surgery, the extent of resection (EOR) was: 15 biopsy, 17 subtotal rescetion (STR) and 35 gross total resection (GTR) – 29 missing data. With regards to the molecular markers, 26 were IDH mutant, 73 were MGMT methylated. All of the patients recieved adjuvant chemoradiotherapy following the STUPP protocol prior.
Conclusion
Our data corresponds to the data in the current literature. Further qualitative study will provide an insight into the effectiveness and aggressive approach to the recurrent GBMs.
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Affiliation(s)
- José Lavrador
- King’s College Hospital Foundation Trust, United Kingdom
| | | | - Shami Acharya
- King’s College Hospital Foundation Trust, United Kingdom
| | - Angela Swampillai
- Department of Oncology, King’s Health Partners, London, UK, United Kingdom
| | - Jennifer Glendenning
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Maidstone, United Kingdom
| | - Lucy Brazil
- Department of Oncology, King’s Health Partners, London, UK, United Kingdom
| | - Omar Alsahib
- Department of Oncology, King’s Health Partners, London, UK, United Kingdom
| | - Richard Gullan
- King’s College Hospital Foundation Trust, United Kingdom
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Velikova G, Williams LJ, Willis S, Dixon JM, Loncaster J, Hatton M, Clarke J, Kunkler IH, Russell NS, Alhasso A, Adamson D, Algurafi H, Allerton R, Anandadas C, Bahl A, Barraclough L, Barrett-Lee P, Barthakur U, Bedi C, Beresford M, Bishop J, Blackman G, Bliss P, Bloomfield D, Blunt M, Branson T, Brazil L, Brunt A, Chakrabarti A, Chittalie A, Churn M, Clarke J, Cleator S, Crellin P, Danwata F, De-Silva-Minor S, Dhadda A, Eicholz A, Fernando I, Forrest J, Fraser J, Geropantas K, Goodman A, Grieve R, Griffin M, Hadaki M, Hall A, Hatton M, Hicks J, Hignett S, Hogg M, Jyothirmayi R, Khan M, Kumar S, Lawton P, Lee D, Lewinski C, Lim C, Locke I, Loncaster J, Lumsden G, Lupton S, Magee B, Marshall J, Masinghe S, McGregor C, McLennan M, Memtsa P, Milanovic D, Misra V, Mithal N, Mukesh MB, Neal A, Needleman S, Persic M, Quigley M, Raj S, Riddle P, Ritchie D, Roberts F, Robson P, Roe H, Rolles M, Shah N, Sharma R, Sherwin E, Simmonds P, Skailles G, Skaria S, Soe W, Sripadam R, Stevens A, Stockdale A, Storey N, Storey N, Syndikus I, Thorp N, Thorp N, Upadhyay S, Varughese M, Walji N, Welch R, Wells T, Wolstenholme V, Wolstenholme V, Woodings P, Yuille F. Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial. Lancet Oncol 2018; 19:1516-1529. [DOI: 10.1016/s1470-2045(18)30515-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022]
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La J, Hurwitz V, Mullens L, Brazil L, Gullan R, Bhangoo R, Vergani F, Beaney R, Ashkan K, Rooprai B, Swampillai A. HOW SHOULD WE SUPPORT PATIENTS WITH PRIMARY BRAIN TUMOURS WHO ELECT TO TAKE CANNABINOIDS? Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy129.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Brazil L, Swampillai A, Mak K, Hackshaw A, Edwards D, Mesiri P, Clifton-Hadley L, Shaffer R, Lewis J, Watts C, Gkogkou P, Chalmers A, Fersht N, Short SC. P01.072 Hydroxychloroquine and short course radiotherapy for elderly patients with glioma: a randomised study. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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)
- L Brazil
- Guys and St Thomas’s Hospital, London, United Kingdom
| | - A Swampillai
- Guys and St Thomas’s Hospital, London, United Kingdom
| | - K Mak
- University College London, London, United Kingdom
| | - A Hackshaw
- University College London, London, United Kingdom
| | - D Edwards
- University College London, London, United Kingdom
| | - P Mesiri
- University College London, London, United Kingdom
| | | | - R Shaffer
- Royal Surrey County Hospital, Guildford, United Kingdom
| | - J Lewis
- Newcastle Hospitals, Newcastle, United Kingdom
| | - C Watts
- University of Birmingham, Birmingham, United Kingdom
| | - P Gkogkou
- Norfolk and Norwich University Hospitals, Norwich, United Kingdom
| | - A Chalmers
- University of Glasgow, Glasgow, United Kingdom
| | - N Fersht
- University College London Hospital, London, United Kingdom
| | - S C Short
- University of Leeds, Leeds, United Kingdom
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Mullens L, Maccoll J, Vergani F, Bhangoo R, Gullan R, Brazil L, Swampillai A, Beaney R, Urwin R, Hurwitz V, Ford L, La J, Ashkan K. Low-grade gliomas quality of life: patients’ prospective. Neuro Oncol 2018. [DOI: 10.1093/neuonc/nox238.078] [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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Nunn A, Polyzoidis S, Piechowski-Jozwiak B, Brazil L, Ashkan K. Primary glioblastoma multiforme of the conus medullaris with leptomeningeal metastasis. J Neurol Sci 2017; 381:315-317. [DOI: 10.1016/j.jns.2017.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/01/2017] [Accepted: 09/04/2017] [Indexed: 12/27/2022]
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deSouza RM, Shaweis H, Han C, Sivasubramaniam V, Brazil L, Beaney R, Sadler G, Al-Sarraj S, Hampton T, Logan J, Hurwitz V, Bhangoo R, Gullan R, Ashkan K. Has the survival of patients with glioblastoma changed over the years? Br J Cancer 2016; 114:e20. [PMID: 27228296 PMCID: PMC4984463 DOI: 10.1038/bjc.2016.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Booth TC, Ashkan K, Brazil L, Jäger R, Waldman AD. Re: Tumour progression or pseudoprogression? A review of post-treatment radiological appearances of glioblastoma. Clin Radiol 2016; 71:495-6. [PMID: 26896081 DOI: 10.1016/j.crad.2016.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 11/23/2015] [Accepted: 01/24/2016] [Indexed: 10/22/2022]
Affiliation(s)
- T C Booth
- King's College Hospital NHS Foundation Trust, London, UK.
| | - K Ashkan
- King's College Hospital NHS Foundation Trust, London, UK
| | - L Brazil
- King's College Hospital NHS Foundation Trust, London, UK
| | - R Jäger
- National Hospital for Neurology & Neurosurgery, London, UK
| | - A D Waldman
- Imperial College Healthcare NHS Trust, London, UK
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Aizpurua M, Laxton R, Doey L, Bodi I, King A, Bhangoo R, Beaney R, Brazil L, Ashkan K, Al-Sarraj S. PO13ON THE BIOLOGICAL BEHAVIOUR AND PROGNOSIS OF ANAPLASTIC OLIGODENDROGLIOMA WITH NECROSIS. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov284.11] [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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Rooprai H, Ashkan K, Brazil L, Selway R, Lodhi R, Aitchison K, Gullan R, Beaney R. Role of a Combination of Seven Micronutrients in the Management of Glioblastoma Multiforme. Clin Oncol (R Coll Radiol) 2015; 27:370-1. [DOI: 10.1016/j.clon.2015.01.010] [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] [Received: 10/23/2014] [Accepted: 01/08/2015] [Indexed: 11/16/2022]
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Polyzoidis S, Tuazon J, Brazil L, Beaney R, Al-Sarraj ST, Doey L, Logan J, Hurwitz V, Jarosz J, Bhangoo R, Gullan R, Mijovic A, Richardson M, Farzaneh F, Ashkan K. Active dendritic cell immunotherapy for glioblastoma: Current status and challenges. Br J Neurosurg 2014; 29:197-205. [PMID: 25541743 DOI: 10.3109/02688697.2014.994473] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Dendritic cell (DC) immunotherapy is developing as a promising treatment modality for patients with glioblastoma multiforme (GBM). The aim of this article is to review the data from clinical trials and prospective studies evaluating the safety and efficacy of DC vaccines for newly diagnosed (ND)- and recurrent (Rec)-GBM and for other high-grade gliomas (HGGs). By searching all major databases we identified and reviewed twenty-two (n=22) such studies, twenty (n=20) of which were phase I and II trials, one was a pilot study towards a phase I/II trial and one was a prospective study. GBM patients were exclusively recruited in 12/22 studies, while 10/22 studies enrolled patients with any diagnosis of a HGG. In 7/22 studies GBM was newly diagnosed. In the vast majority of studies the vaccine was injected subcutaneously or intradermally and consisted of mature DCs pulsed with tumour lysate or peptides. Median overall survival ranged between 16.0 and 38.4 months for ND-GBM and between 9.6 and 35.9 months for Rec-GBM. Vaccine-related side effects were in general mild (grade I and II), with serious adverse events (grade III, IV and V) reported only rarely. DC immunotherapy therefore appears to have the potential to increase the overall survival in patients with HGG, with an acceptable side effect profile. The findings will require confirmation by the ongoing and future phase III trials.
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Laxton R, Doey L, Aizpurua M, Bodi I, King A, Chandler C, Bhangoo R, Beaney R, Brazil L, Ashkan K, Al-Sarraj S. P64 * QUANTITATIVE MGMT METHYLATION ANALYSIS BY PYROSEQUENCING REVEALS A STRONG CORRELATION BETWEEN 1P/19Q CO-DELETION AND HIGH LEVEL METHYLATION IN HIGH GRADE GLIOMAS. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou249.50] [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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Knighton C, Logan J, Hurwitz V, King A, Hodgkiss A, Cikurel K, Beaney R, Brazil L. OP23 * AN AUDIT TO ASSESS PSYCHIATRIC CONDITIONS THAT MANIFEST IN PATIENTS WITH HIGH-GRADE BRAIN TUMOURS DURING TREATMENT. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou251.23] [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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Ajaz M, Jefferies S, Brazil L, Watts C, Chalmers A. Current and investigational drug strategies for glioblastoma. Clin Oncol (R Coll Radiol) 2014; 26:419-30. [PMID: 24768122 DOI: 10.1016/j.clon.2014.03.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/21/2022]
Abstract
Medical treatments for glioblastoma face several challenges. Lipophilic alkylators remain the mainstay of treatment, emphasising the primacy of good blood-brain barrier penetration. Temozolomide has emerged as a major contributor to improved patient survival. The roles of procarbazine and vincristine in the procarbazine, lomustine and vincristine (PCV) schedule have attracted scrutiny and several lines of evidence now support the use of lomustine as effective single-agent therapy. Bevacizumab has had a convoluted development history, but clearly now has no major role in first-line treatment, and may even be detrimental to quality of life in this setting. In later disease, clinically meaningful benefits are achievable in some patients, but more impressively the combination of bevacizumab and lomustine shows early promise. Over the last decade, investigational strategies in glioblastoma have largely subscribed to the targeted kinase inhibitor paradigm and have mostly failed. Low prevalence dominant driver lesions such as the FGFR-TACC fusion may represent a niche role for this agent class. Immunological, metabolic and radiosensitising approaches are being pursued and offer more generalised efficacy. Finally, trial design is a crucial consideration. Progress in clinical glioblastoma research would be greatly facilitated by improved methodologies incorporating: (i) routine pharmacokinetic and pharmacodynamic assessments by preoperative dosing; and (ii) multi-stage, multi-arm protocols incorporating new therapy approaches and high-resolution biology in order to guide necessary improvements in science.
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Affiliation(s)
- M Ajaz
- Surrey Cancer Research Institute, University of Surrey, Guildford, UK.
| | - S Jefferies
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK
| | - L Brazil
- Guy's, St Thomas' and King's College Hospitals, London, UK
| | - C Watts
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - A Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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Laxton RC, Popov S, Doey L, Jury A, Bhangoo R, Gullan R, Chandler C, Brazil L, Sadler G, Beaney R, Sibtain N, King A, Bodi I, Jones C, Ashkan K, Al-Sarraj S. Primary glioblastoma with oligodendroglial differentiation has better clinical outcome but no difference in common biological markers compared with other types of glioblastoma. Neuro Oncol 2013; 15:1635-43. [PMID: 24158110 DOI: 10.1093/neuonc/not125] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Glioblastoma multiforme with an oligodendroglial component (GBMO) has been recognized in the World Health Organization classification-however, the diagnostic criteria, molecular biology, and clinical outcome of primary GBMO remain unclear. Our aim was to investigate whether primary GBMO is a distinct clinicopathological subgroup of GBM and to determine the relative frequency of prognostic markers such as loss of heterozygosity (LOH) on 1p and/or 19q, O(6)-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and isocitrate dehydrogenase 1 (IDH1) mutation. METHODS We examined 288 cases of primary GBM and assessed the molecular markers in 57 GBMO and 50 cases of other primary GBM, correlating the data with clinical parameters and outcome. RESULTS GBMO comprised 21.5% of our GBM specimens and showed significantly longer survival compared with our other GBM (12 mo vs 5.8 mo, P = .006); there was also a strong correlation with younger age at diagnosis (56.4 y vs 60.6 y, P = .005). Singular LOH of 19q (P = .04) conferred a 1.9-fold increased hazard of shorter survival. There was no difference in the frequencies of 1p or 19q deletion, MGMT promoter methylation, or IDH1 mutation (P = .8, P = 1.0, P = 1.0, respectively). CONCLUSIONS Primary GBMO is a subgroup of GBM associated with longer survival and a younger age group but shows no difference in the frequency of LOH of 1p/19q, MGMT, and IDH1 mutation compared with other primary GBM.
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Affiliation(s)
- Ross C Laxton
- Corresponding Author: Ross Laxton, PhD, Department of Clinical Neuropathology, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
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Roth P, Silginer M, Goodman SL, Hasenbach K, Thies S, Schraml P, Tabatabai G, Moch H, Tritschler I, Weller M, Perin A, Verginelli F, Dali R, Hei Man Fung K, Lo R, Longatti P, Guiot M, Del Maestro RF, Rossi S, Di Porzio U, Stechishin O, Weiss S, Stifani S, Sanzey M, Golebiewska A, Stieber D, Nazarov P, Muller A, Vallar L, Niclou SP, Lawler SE, Chiocca E, Williams SP, Wanka C, Steinbach JP, Rieger J, Lavon I, Zrihan D, Refael M, Siegal T, Sminia P, Van Nifterik KA, Van den Berg J, Lafleur VM, Stalpers LJA, Slotman BJ, Di stefano A, Enciso-Mora V, Marie Y, Desestret V, Labussiere M, Idbaih A, Hoang-Xuan K, Delattre J, Houlston R, Sanson M, Woehrer A, Slavc I, Stefanits H, Waldhoer T, Heinzl H, Zielonke N, Czech T, Hainfellner JA, Haberler C, Zouaoui S, Darlix A, Virion J, Rigau V, Mathieu-Daude H, Bauchet F, Figarella-Branger D, Duffau H, Taillandier L, Bauchet L, Naydenov E, Popov R, Tanova R, Minkin K, De Vleeschouwer S, Van Gool S, Cavaletti G, Wilbers J, Hoebers F, Boogerd W, van Werkhoven E, Nowee M, Hart G, van Dijk E, Kappelle A, Dorresteijn L, Furuse M, Miyata T, Yoritsune E, Kawabata S, Kuroiwa T, Miyatake S, Boele FW, Heimans JJ, Aaronson NK, Peereboom DM, Sloan AE, Supko JG, Ye X, Rich JN, Prados MD, Ahluwalia M, Grossman SA, Spiegl-Kreinecker S, Loetsch D, Taphoorn MJB, Wild M, Ghanim B, Pirker C, Pichler J, Serge W, Lenz S, Wurm G, Berger W, Tamiya T, Miyake K, Postma TJ, Okada M, Kawai N, Grossi I, Rigakos G, Lampropoulos S, Stavridi F, Tsoulos N, Nasioulas G, Papadopoulou E, Razis E, Reijneveld JC, Schroeteler J, Klosterkemper Y, Schwake M, Stummer W, Ewelt C, Field KM, Rosenthal MA, Wheeler H, Cher L, Hovey E, Klein M, Nowak AK, Brown C, Livingstone A, Sawkins K, Simes J, Linsenmann T, Jawork A, Hagemann C, Kessler AF, Berg F, Habets EJJ, Lohr M, Ernestus RI, Vince GH, Rodriguez FJ, Heaphy CM, Nguyen DN, de Wilde RF, Orr B, Raabe E, Eberhart CG, Taphoorn MJB, Meeker AK, Klein SP, Van Calenbergh F, van Loon J, Menten J, Clement P, De Vleeschouwer S, Goffin J, Lonardi F, Gioga G, Nederend S, Bonometti M, Ferigo L, Buonocore F, Campostrini F, Golebiewska A, Bougnaud S, Stieber D, Brons N, Vallar L, Hertel F, Klein M, Bjerkvig R, Niclou S, Strik HM, Carl B, Kallenberg K, Moiyadi AV, Gupta T, Shetty P, Nair V, Jalali R, Delgadillo D, Compter I, de Kunder SL, Houben RMA, Jager JJ, Bosmans G, Anten MHME, Baumert BG, Duerinck J, Du Four S, Van Binst A, Xuan KH, Everaert H, Michotte A, D'haens J, Neyns B, Basmaci M, Hasturk AE, de Kunder SL, Compter I, Schijns OEMG, ter Laak-Poort MP, Bottomley A, Anten MHME, Jansen RLH, Baumert BG, Happold C, Roth P, Wick W, Schmidt N, Florea A, Reifenberger G, Weller M, Van den Bent MJ, Ho C, Leugner D, Easaw J, Lim G, Rosenberg T, Thomassen M, Jensen S, Larsen M, Sorensen K, Hermansen S, Reijneveld JC, Kruse T, Kristensen B, Pichler J, Hollmuller I, Ghanim B, Spiegl-Kreinecker S, Ursu R, Ferrari D, Bailon O, Augier A, Minaya Flores P, Dubessy A, Banissi C, Belin C, Levy C, Carpentier AF, Boudouresque F, Delphino C, Metellus P, Pirisi V, Figarella-Branger D, Chinot O, Ouafik L, Berthois Y, Nakamura H, Makino K, Hide T, Yano S, Kuratsu J, Stevens GHJ, Ahluwalia M, Hashemi N, Berbis J, Peereboom D, Barnett GH, Wibom C, Ghasimi S, Van Loo P, Brannstrom T, Trygg J, Henriksson R, Bergenheim T, Andersson U, Auquier P, Ryden P, Melin B, Ackerl MS, Flechl B, Dieckmann K, Preusser M, Widhalm G, Sax C, Marosi C, Seliger C, Kumthekar PU, Leukel P, Jachnik B, Bogdahn U, Vollmann A, Hau P, Chung SA, Luk PP, Shen H, Decollogne S, Day BW, Grimm SA, Stringer BW, Hogg PJ, Dilda PJ, McDonald KL, Cernea DR, Pruteanu P, Todor N, Florian S, Bogdan V, Cercea C, Chandler J, Leibetseder A, Ackerl M, Flechl B, Sax C, Widhalm G, Dieckmann K, Preusser M, Marosi C, Torres-Martin M, Pena-Granero C, Helenowski IB, Isla A, Pinto GR, Custodio AC, Melendez B, Castresana JS, Rey JA, Banissi C, Maubant S, Rancic M, Carpentier AF, Marymont M, Stancheva G, Goranova T, Laleva M, Kamenova M, Mitkova A, Velinov N, Kaneva R, Poptodorov G, Mitev V, Gabrovsky N, Rademaker A, Piccirillo SGM, Spiteri I, Sottoriva A, Marko N, Tavare' S, Collins P, Watts C, Fedrigo CA, Da Rocha AB, Stalpers LJA, Wagner L, Baumert BG, Slotman B, Peters GJ, Sminia P, Fernandez M, Gawrisch VJ, Ruttgers M, Jachnik B, Proescholdt M, Bogdahn U, Stell B, Vollmann-Zwerenz A, Hau P, Trevisan E, Magistrello M, Bertero L, Bosa C, Greco Crasto S, Garbossa D, Lolli I, Ruda R, Raizer J, Soffietti R, Ichikawa T, Kurozumi K, Onishi M, Ishida J, Shimazu Y, Fujii K, Inoue S, Chiocca EA, Kaur B, Kumthekar PU, Date I, Dictus C, Friauf S, Valous NA, Muerle B, Unterberg AW, Herold-Mende CC, Caroli M, Di Dristofori A, Lucarella F, Grimm S, Menghetti C, Lanfranchi G, Gaini SM, Duerinck J, Clement P, Bouttens F, Neyns B, D'Hondt L, Gennigens C, Staelens Y, Jacobs DI, Joosens E, Van Fraeyenhove F, Rogiers A, Darlix A, Baumann C, Lorgis V, Blonski M, Chauffert B, Zouaoui S, Beauchesne P, Stell BV, Taillandier L, Vaccaro V, Pace A, Vidiri A, Vari S, Telera S, Giannarelli D, Russillo M, Anelli V, Carapella CM, Rademaker A, Fabi A, Florian SI, Soritau O, Neagoe I, Abrudan C, Tomuleasa C, Cernea D, Petrescu M, Baritchii A, Florian SI, Chandler J, Abrudan C, Baritchii A, Fornara O, Mirza S, Khan Z, Odeberg J, Stragliotto G, Butler L, Soderberg-Naucler C, Soderberg Naucler C, Marymont MH, Stragliotto G, Peredo I, Rahbar A, Lilja A, Taher C, Orrego A, Wolmer Solberg N, Brandes AA, Depenni R, Marcello N, Helenowski IB, Valentini A, Faedi M, Urbini B, Crisi G, Franceschi E, Poggi R, Baruzzi A, Berghauser Pont LME, Kloezeman JJ, French PJ, Wagner L, Dirven CMF, Lamfers MLM, Leenstra SL, Stragliotto G, Bartek J, Hylin S, Peredo I, Rahbar A, Soderberg Naucler C, Dahlrot RH, Raizer JJ, Kristensen BW, Hjelmborg JVB, Herrstedt J, Hansen S, Nittby HC, Persson BRR, Ceberg C, Widegren B, Salford LG, Poulsen HS, Claudel G, Grunnet K, Michaelsen SR, Broholm H, Christensen IJ, Tinchon A, Oberndorfer S, Marosi C, Ruda R, Sax C, Calabek B, Muller C, Grisold W, Bouwens T, Trouw L, Heijsman D, Kremer A, van der Spek P, Dirven C, Lamfers M, Al-Khawaja H, Pollanz S, Colmar K, Tinchon A, Calabek B, Oberndorfer S, Pohnl R, Grisold W, Hong Y, Ko K, Lee E, De Groot M, Choenni EP, Garat E, Sizoo EM, Uitdehaag B, Buter J, Van Linde ME, Postma TJ, Taphoorn MJB, Heimans JJ, Reijneveld JC, Bertero L, Bosa C, Beauchesne P, Trevisan E, Tarenzi L, Garbossa D, Mantovani C, Soffietti R, Ruda R, Lotsch D, Spiegl-Kreinecker S, Pirker C, Hlavaty J, Hassani K, Petznek H, Grusch M, Berger W, Kaloshi G, Spahiu O, Djamandi P, Djamandi P, Ruka M, Haxhihyseni E, Bushati T, Bethune B, Petrela M, Tabatabai G, Felsberg J, Sabel M, Hofer S, Westphal M, Weller M, Reifenberger G, Wertz M, Padovani L, Nguyen-Thi P, Bequet-Boucard C, Barrie M, Matta M, Muracciole X, Chinot O, Timmer M, Rohn G, Goldbrunner R, Thon N, Kreth F, Di Patrizio P, Simon M, Westphal M, Schackert G, Nikkhah G, Tatagiba M, Hentschel B, Weller M, Tonn J, Smrdel U, Fack F, Taillandier L, Zheng L, Frezza C, Keunen O, Kalna G, Nazarov P, Gottlieb E, Niclou SP, Bjerkvig R, Radic J, Murgic J, Sizoo EM, Maric Brozic J, Jazvic M, Soldic Z, Bolanca A, Raizer J, Grimm S, Levy R, Muro K, Rosenow J, Chandler J, Taphoorn MJB, Bredel M, Kalita O, Vaverka M, Hrabalek L, Zlevorova M, Cechakova E, Trojanec R, Kneblova M, Hajduch M, Ehrmann J, Uitdehaag B, Naskhletashvili DR, Gorbounova V, Bychkov M, Bekyashev A, Karakhan V, Aloshin V, Fu R, Moskvina E, Gaziel TB, Poulsen HS, Heimans JJ, Muhic A, Rahbar A, Peredo I, Wolmer Solberg N, Taher C, Dzabic M, Xu X, Skarman P, Tammik C, Stragliotto G, Deliens L, Soderberg-Naucler C, Ahluwalia MS, hashemi-Sadraei N, Barnett GH, Fabbro M, Laigre M, Langlois C, Castan F, Bauchet L, Duffau H, Reijneveld JC, Bonafe A, Spoor JKH, Khorami K, Kloezeman J, Balvers R, Dirven C, Lamfers M, Leenstra S, Spoor JKH, van der Kaaij M, Pasman HW, Kloezeman J, Geurtjens M, Dirven C, Lamfers M, Leenstra S, Trister AD, Neal ML, Cloke T, Baldock AL, Ahn S, Rampling RP, 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I, Kang S, Sin G, Shim J, Lee S, Huh Y, Kim E, Chang J, Kim S, Hong Y, Kim D, Lefranc F, Verschuere T, De Witte O, Van Gool S, Kiss R, DeVleeschouwer S, Ewelt C, Ardon H, Suero E, Gunes D, Wolfer J, Fischer B, Stummer W, Thorsteinsdottir J, Fu P, Gehrmann M, Multhoff G, Tonn JC, Schichor C, Jachtenberg J, Bakker Schut T, Puppels G, French P, Kros M, Lamfers M, Leenstra S, Costello PC, McDonald W, MacDonald D, Zlatescu M, Megyesi J, Rossetto M, Gallego Perez-Larraya J, Boisselier B, Ciccarino P, Labussiere M, Marie Y, Delattre J, SANSON M, Ilhan-Mutlu A, Wohrer A, Berghoff AS, Widhalm G, Marosi C, Wagner L, Preusser M, Di Stefano A, Gallego Perez-Larraya J, Ducray F, Boisselier B, Labussiere M, Paris S, Cheneau C, Delattre J, Sanson M, Lonnqvist F, Gaillard PJ, Gladdines W, Boogerd W, van Tellingen O, Milojkovic Kerklaan B, Schellens JHM, Brandsma D, Denicolai E, Baeza-Kallee N, Tchoghandjian A, Beclin C, Figarella-Branger D, Rahman CV, Smith SJ, Morgan PS, Langmack KA, Macarthur DC, Rose FR, Shakesheff KM, Grundy RG, Rahman R, Nowosielski M, DiFranco MD, Putzer D, Seiz M, Jacobs AH, Stockhammer G, Hutterer M, Okada M, Shishido H, Hatakeyama T, Shinomiya A, Miyake K, Kawai N, Tamiya T, Miyake K, Shinomiya A, Okada M, Hatakeyama T, Kawai N, Tamiya T, Alexiou GA, Tsiouris S, Papadopoulos A, Al-Bokharhli J, Kyritsis AP, Voulgaris S, Fotopoulos AD, Roelcke U, Boxheimer L, Fathi AR, Schwyzer L, Ortega M, Berberat J, Grobholz R, Remonda L, Oikawa M, Sato K, Ito T, Sugio H, Ozaki Y, Nakamura H, Schwyzer L, Berberat J, Boxheimer L, Remonda L, Roelcke U, Kozic D, Njagulj V, Gacesa JP, Prvulovic N, Semnic R, Basmaci M, Hasturk AE, Hasturk AE, Basmaci M, Bahr O, Weise L, Harter PN, Weiss C, Starzetz T, Steinbach JP, Mittelbronn M, Hattingen E, Price SJ, Young AMH, Thomas OM, Mohsen LA, Frary AJ, Lupson VC, McLean MA, Weiss C, Neuschmelting V, Eisenbeis A, Nettekoven C, Grefkes C, Goldbrunner R, Weiss C, Neuschmelting V, Eisenbeis A, Nettekoven C, Grefkes C, Goldbrunner R, Weiss C, Neuschmelting V, Eisenbeis A, Nettekoven C, Rehme A, Grefkes C, Goldbrunner R, Grech-Sollars M, Saunders DE, Phipps KP, Clayden JD, Clark CA, Schwyzer L, Berberat J, Boxheimer L, Remonda L, Roelcke U, Booth TC, Larkin T, Yuan Y, Kettunen M, Markowetz F, Scoffings D, Jefferies S, Brindle KM, Pica A, Hauf M, Slotboom J, Beck J, Schucht P, Aebersold DM, Wiest R, Pace A, Marzi S, Fabi A, Carapella CM, Giovinazzo G, Marucci L, Anelli V, Vidiri A, Riva M, Castellano A, Raneri F, Pessina F, Fava E, Falini A, Bello L, Gahramanov S, Muldoon LL, Varallyay CG, Li X, Kraemer DF, Fu R, Hamilton BE, Rooney WD, Neuwelt EA, Hawkins-Daarud A, Rockne R, Muzi M, Patridge S, Kinahan P, Swanson KR, Radbruch A, Fladt J, Wiestler B, Baumer P, Heiland S, Wick W, Bendszus M, Lwin M, Al-Salihi O, Sharpe G, Izmailov TR, Panshin GA, Datsenko PV, Kavsan VM, Balynska EV, Chernolovskaya EL, Zenkova MA, Buhl RM, Janz C, Gomez Gallego J, Albanna W, Rashidi A, Schmiegelow P, Buhl RM, Alexiou GA, Vartholomatos G, Karamoutsios A, Voulgaris S, Shen D, Wang J, Qiu Z, Chen F, Chen Z, Miwa K, Shinoda J, Ito T, Yokoyama K, Yamada M, Yamada J, Yano H, Iwama T, Brokinkel B, Schober O, Heindel W, Hargus G, Paulus W, Stummer W, Woelfer J, Aoki T, Arakawa Y, Ueba T, Miyatake S, Nozaki K, Taki W, Tsukahara T, Miyamoto S, Matsutani M, Satou K, Ito T, Takanashi M, Oikawa M, Ozaki Y, Sugio H, Nakamura H. Abstracts of the 10th Congress of the European Association of NeuroOncology. Marseille, France. September 6-9, 2012. Neuro Oncol 2012; 14 Suppl 3:iii1-109. [PMID: 22977921 DOI: 10.1093/neuonc/nos183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Birks S, Altinkaya M, Altinkaya A, Pilkington G, Kurian KM, Crosby C, Hopkins K, Williams M, Donovan L, Birks S, Eason A, Bosak V, Pilkington G, Birks S, Holliday J, Corbett I, Pilkington G, Keeling M, Bambrough J, Simpson J, Higgins S, Dogra H, Pilkington G, Kurian KM, Zhang Y, Bradley M, Schmidberger C, Hafizi S, Noorani I, Price S, Dubocq A, Jaunky T, Chatelain C, Evans L, Gaissmaier T, Pilkington GJ, An Q, Hurwitz V, Logan J, Bhangoo R, Ashkan K, Gullan A, Beaney R, Brazil L, Kokkinos S, Blake R, Singleton A, Shaw A, Iyer V, Kurian KM, Jeyapalan JN, Morley IC, Hill AA, Mumin MA, Tatevossian RG, Qaddoumi I, Ellison DW, Sheer D, Frary A, Price S, Jefferies S, Harris F, Burnet N, Jena R, Watts C, Haylock B, Leow-Dyke S, Rathi N, Wong H, Dunn J, Baborie A, Crooks D, Husband D, Shenoy A, Brodbelt A, Walker C, Bahl A, Larsen J, Craven I, Metherall P, McKevitt F, Romanowski C, Hoggard N, Jellinek DA, Bell S, Murray E, Muirhead R, James A, Hanzely Z, Jackson R, Stewart W, O'Brien A, Young A, Bell S, Hanzely Z, Stewart W, Shepherd S, Cavers D, Wallace L, Hacking B, Scott S, Bowyer D, Elmahdi A, Frary AJ, O'Donovan DG, Price SJ, Kia A, Przystal JM, Nianiaris N, Mazarakis ND, Mintz PJ, Hajitou A, Karakoula K, Phipps K, Harkness W, Hayward R, Thompson D, Jacques T, Harding B, Darling J, Warr T, Leow-Dyke S, Rathi N, Haylock B, Crooks D, Jenkinson M, Walker C, Brodbelt A, Zhou L, Ercolano E, Ammoun S, Schmid MC, Barczyk M, Hanemann CO, Rowther F, Dawson T, Ashton K, Darling J, Warr T, Maherally Z, Hatherell KE, Kroese K, Hafizi S, Pilkington GJ, Singh P, McQuaid S, Al-Rashid S, Prise K, Herron B, Healy E, Shoakazemi A, Donnelly M, McConnell R, Harney J, Conkey D, McGrath E, Lunsford L, Kondziolka D, Niranjan A, Kano H, Hamilton R, Flannery T, Majani Y, Smith S, Grundy R, Rahman R, Saini S, Hall G, Davis C, Rowther F, Lawson T, Ashton K, Potter N, Goessl E, Darling J, Warr T, Brodbelt A, Jenkinson M, Walker C, Leow-Dyke S, Haylock B, Dunn J, Wilkins S, Smith T, Petinou V, Nicholl I, Singh J, Lea R, Welsby P, Spiteri I, Sottoriva A, Marko N, Tavare S, Collins P, Price SJ, Watts C, Su Z, Gerhard A, Hinz R, Roncaroli F, Coope D, Thompson G, Karabatsou K, Sofat A, Leggate J, du Plessis D, Turkheimer F, Jackson A, Brodbelt A, Jenkinson M, Das K, Crooks D, Herholz K, Price SJ, Whittle IR, Ashkan K, Grundy P, Cruickshank G, Berry V, Elder D, Iyer V, Hopkins K, Cohen N, Tavare J, Zilidis G, Tibarewal P, Spinelli L, Leslie NR, Coope DJ, Karabatsou K, Green S, Wall G, Bambrough J, Brennan P, Baily J, Diaz M, Ironside J, Sansom O, Brunton V, Frame M, Young A, Thomas O, Mohsen L, Frary A, Lupson V, McLean M, Price S, Arora M, Shaw L, Lawrence C, Alder J, Dawson T, Hall G, Rada L, Chen K, Shivane A, Ammoun S, Parkinson D, Hanemann C, Pangeni RP, Warr TJ, Morris MR, Mackinnon M, Williamson A, James A, Chalmers A, Beckett V, Joannides A, Brock R, McCarthy K, Price S, Singh A, Karakoula K, Dawson T, Ashton K, Darling J, Warr T, Kardooni H, Morris M, Rowther F, Darling J, Warr T, Watts C, Syed N, Roncaroli F, Janczar K, Singh P, O'Neil K, Nigro CL, Lattanzio L, Coley H, Hatzimichael E, Bomalaski J, Szlosarek P, Crook T, Pullen NA, Anand M, Birks S, Van Meter T, Pullen NA, Anand M, Williams S, Boissinot M, Steele L, Williams S, Chiocca EA, Lawler S, Al Rashid ST, Mashal S, Taggart L, Clarke E, Flannery T, Prise KM. Abstracts from the 2012 BNOS Conference. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos198] [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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Abstract
This study estimated lifetime cost of treatment for patients in the United Kingdom (UK) presenting with stage IV breast cancer. To determine patterns of treatment and resource use in the absence of direct observational data, a cancer physician panel was surveyed. The survey questionnaire described four predefined treatment phases: active treatment; follow-up after active treatment until disease progression; active supportive care after progression; and end-of-life care. Physicians were asked their major treatment strategies for each phase. Monthly cost and average lifetime cost per patient were calculated. Only five cancer registries in the UK document the proportion of breast cancer patients diagnosed with stage IV disease. Their data was used to estimate the incidence of metastatic breast cancer at presentation throughout the UK. This value, together with lifetime cost per patient and projected survival time, allowed approximation of the overall cost for this population of cancer patients in the UK. Annual incidence of stage IV breast cancer at presentation in the UK is approximately 2100; according to treatment practice in 2002, lifetime cost per patient is pound 12 500 and total population cost is approximately pound 26 million. The substantial economic burden associated with patients diagnosed with metastatic breast cancer should be considered when developing strategies for reducing its incidence such as increased awareness, screening and preventative measures.
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Affiliation(s)
- E Remák
- MEDTAP International, 20 Bloomsbury Square, London WC1A 2NS, UK.
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Nutting C, Brada M, Brazil L, Sibtain A, Saran F, Westbury C, Moore A, Thomas DG, Traish D, Ashley S. Radiotherapy in the treatment of benign meningioma of the skull base. J Neurosurg 1999; 90:823-7. [PMID: 10223446 DOI: 10.3171/jns.1999.90.5.0823] [Citation(s) in RCA: 139] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT This study was undertaken to assess the long-term efficacy and toxicity of conventional fractionated external-beam radiation in the treatment of benign skull base meningioma. METHODS This is a retrospective study of 82 patients with histologically verified benign skull base meningioma treated by surgery followed by fractionated external-beam radiation at the Royal Marsden Hospital between 1962 and 1992. The 5- and 10-year progression-free survival (PFS) rates were 92% and 83%, respectively, with the site of disease being the only independent prognostic factor for tumor control according to multivariate analysis. The 10-year PFS rate for patients with sphenoid ridge meningiomas was 69% compared with 90% for those with tumors in the parasellar region. The overall 10-year survival rate was 71%, with performance status and patient age found to be significant independent prognostic factors. Six patients had worsening vision, which was due to cataract in five cases and retinopathy in one. There were no recorded cases of cranial nerve neuropathy. CONCLUSIONS The excellent long-term tumor control and length of survival with minimal toxicity associated with conventional external-beam radiation should serve as a baseline for evaluation of new treatment strategies such as radiosurgery and skull base surgery.
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Affiliation(s)
- C Nutting
- Computing Department, Institute of Cancer Research and the Royal Marsden National Health Service Trust, Sutton, Surrey, United Kingdom
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Brazil L, Thomas R, Laing R, Hines F, Guerrero D, Ashley S, Brada M. Verbally administered Barthel Index as functional assessment in brain tumour patients. J Neurooncol 1997; 34:187-92. [PMID: 9210067 DOI: 10.1023/a:1005710729748] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate verbally administered Barthel Index as a measure of functional status in patients with high grade gliomas. BACKGROUND Barthel Index (BI) is a performance score of activities of daily living which has been validated in patients with neurological disability. While any assessment of quality of life in brain tumour patients should include all the aspects of CNS function we concentrated on measurement of physical performance status and evaluated the role of BI as a measure of palliative effect of treatment in patients with high grade glioma undergoing radiotherapy. METHODS BI was verbally administered on 504 occasions in 107 patients with high grade glioma. The BI scores were correlated with Karnofsky performance score (KPS), and neurological performance score (NPS) as a measure of inter-index reliability. The BI's prognostic value was assessed using actuarial survival data. RESULTS BI was sensitive to change and reflected the degree of functional impairment. In patients with high grade glioma BI correlated with KPS, and NPS (R2 = 0.872 and 0.658 respectively). BI score was also of prognostic value in terms of survival. The median survival of patients with functional independence was 9 months with moderate disability 5 months and with severe disability 4 months. CONCLUSION Verbally administered Barthel Index is easy to use, reliable and sensitive to change and is of prognostic value. It is a useful tool in the management of patients with gliomas, as an objective evaluation of palliative effectiveness of treatment in patients with functional disability.
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Affiliation(s)
- L Brazil
- Neuro-Oncology Unit, Royal Marsden NHS Trust, Surrey, UK
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Abstract
We document a case of a patient who had been treated for a medullary cell carcinoma of the thyroid three years previously and who presented with a three month history of ataxia, weakness and headache. A CT scan showed contrast enhancing lesions in the posterior fossa. An MIBG uptake scan showed that there was some uptake in the cerebellar lesions; however, it was not sufficient to rely on this alone for treatment. The larger of these lesions was therefore surgically resected. Immunocytochemistry, using CAM 5.2, CEA and chromogranin, demonstrated a positive reaction which strongly favoured a diagnosis of metastases from a medullary cell carcinoma of the thyroid. However, absolute confirmation of the diagnosis was obtained using immunocytochemistry with calcitonin. Medullary cell carcinomas of the thyroid usually spread locally and metastasis to the brain has never before been reported.
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Affiliation(s)
- J Timothy
- Regional Neurosciences Department, Brook General Hospital, Woolwich, London, UK
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Derlon JM, Petit-taboué MC, Dauphin F, Courtheoux P, Chapon F, Creissard P, Darcel F, Houtteville JP, Kaschten B, Sadzot B, Stevenaert A, Tjuvajev JG, Macapinlac HA, Daghighian F, Ginos JZ, Finn RD, Jiaju Zhang MS, Beattie B, Graham M, Larson SM, Blasberg RG, Levivier M, Goldman S, Pirotte B, Brucher JM, Balériaux D, Luxen A, Hildebrand J, Brotchi J, Go KG, Kamman RL, Mooyaart EL, Heesters MAAM, Sijens PE, Oudksrk M, van Dijk P, Levendag PC, Vecht CJ, Metz RJ, Kennedy DN, Rosen BR, Hochberg FH, Fishman AJ, Filipek PA, Caviness VS, Gross MW, Weinzierl FX, Trappe AE, Goebel WE, Frank AM, Becker G, Krone A, Schmidt K, Hofmann E, Bogdahn U, Bencsch H, Fclber S, Finkenstedt G, Kremser C, Sfockhammer G, Aichner F, Bogdahn U, Fröhlich T, Becker G, Krone A, Schlief R, Schürmann J, Jachimczak P, Hofmann E, Roggendorf W, Roosen K, Carapella CM, Carpinelli G, Passalacqua R, Raus L, Giannini M, Mastrostefano R, Podo F, Tofani A, Maslrostefano R, Mottoles M, Ferraironi A, Scelsa MG, Oppido P, Riccio A, Maini CL, Collombier L, Taillandier L, Dcbouverie M, Laurens MH, Thouvenot P, Weber M, Bertrand A, Cruickshank GS, Patterson J, Hadley D, De Witte O, Hildebrand J, Luxen A, Goldman S, Reifenberger J, Liu L, James CD, Wechsler W, Collins VP, Fabel-Schulte K, Jachimczak P, Heßdörfer B, Baur I, Schlingensiepen KH, Ernestus RI, Brysch W, Bogdahn U, Blesch A, Bosserhoff AK, Apfel R, Lottspeich F, Jachimczak P, Büttner R, Bogdahn U, Cece R, Bockhorst K, Barajon I, Tazzari S, Cavaletti G, Torri-Tarelli L, Tredici G, Hecht B, Turc-Carel C, Atllas R, Chatel M, Gaudray P, Eis M, Gioanni J, Hecht F, Balledux J, Rothbart D, Criscuolo GR, de Campos JM, Kusak ME, Rey JA, Bello MJ, Sarasa JL, Els T, Dubois F, Blond S, Parent M, Assaker R, Gosselin P, Christiaens JL, Feld R, Moringlane JR, Steudel WI, Schaudies JR, Hoehn-Berlage M, Janka M, Tonn JC, Fischer U, Meese E, Roosen K, Remmelink M, Salmon I, Cras P, Pasteels JL, Brotchi J, Gliese M, Kiss R, Bensadoun RJ, Frenay M, Formento JL, Milano G, Lagrange JL, Grellier P, Lee JY, Ernestus RI, Riese HH, Fründ R, Cervós-Navarro J, Reutter W, Lippitz B, Scheitinger C, Scholz M, Weis J, Gilsbach JM, Füzesi L, Koochekpour S, Merzak A, Geissler A, Pilkington GJ, Sanson M, Li YJ, Hoang-Xuan K, Delattre JY, Poisson M, Hamelin R, Van de Kelft E, Dams E, Martin JJ, Woertgen C, Willems P, Lehrke R, Voges J, Treuer H, Erdmann J, Müller RP, Sturm V, Wurm RE, Warrington AP, Laing RW, Holzschuh M, Sardell S, Hines F, Graham JD, Brada M, Ushio Y, Kuratsu JI, Kochi M, Kitz K, Aichholzer M, Rössler K, Goldman S, Alesch F, Ertl A, Sorensen PS, Helweg-Larsen S, Mourldsen H, Hansen HH, El Sharoum SY, Berfelo MW, Theunissen PHMH, Jager JJ, Levivier M, de Jong JMA, Fedorcsák I, Nyáry I, Osztie É, Horvath Á, Kontra G, Frenay M, Burgoni-chuzel J, Paquis P, Lagrange JL, Pirotte B, Helweg-Larsen S, Hansen SW, Sørensen PS, Salmon I, Kiss R, Krauseneck P, Müller B, Morche M, Tonn JC, Lagerwaard FJ, Brucher JM, Levendag PC, Eijkenboom WMH, Schmilz PIM, Lentzsch S, Weber F, Franke J, Dörken B, Lunardi P, Schettini G, Osman FJ, Luxen A, Qasho R, Mocellini C, Ruda R, Soffietti R, Garabello D, Sales S, De Lucchi R, Vasario E, Schiffer D, Muracciole X, Brotchi J, Régis J, Manera L, Peragut JC, Juin P, Sedan R, Nieder C, Niewald M, Walter K, Schnabel K, Nieder C, Hildebrand J, Niewald N, Nestle U, Schnabel K, Berberich W, Oschmann P, Theißen RD, Reuner KH, Kaps M, Dorndorf W, Martin KK, Hausmann O, Akinwunmi J, Rooprai HK, Kennedy A, Linke A, Ognjenovic N, Pilkington GJ, Svadovsky AI, Peresedov VV, Bulakov AA, Butyalko MY, Merlo A, Zhirnova IG, Labunsky DA, Gnazdizky VV, Gannushkina IV, Taphoorn MJB, Potman R, Barkhof F, Weerts JG, Karim ABMF, Heimans JJ, Jerrnann E, van de Pol M, van Aalst VC, Wilmink JT, Twijnstra A, van der Sande JJ, Boogerd W, Kröger R, Jäger A, Wismeth C, Dekant A, Uirich J, Brysch W, Schlingensiepen KH, Jachimczak P, Bogdahn U, Pirolte B, Cool V, Gérard C, Levivier M, Dargent JL, Goldman S, Chiquet-Ehrismann R, Brotchi J, Hildebrand J, Velu T, Herrlinger U, Schabet M, Ohneseit P, Buchholz R, Zhu J, Reszka R, Weber F, Müller J, Walther W, Zhang LI, Brock M, Roosen N, Rock JP, Zeng H, Feng J, Fenstermacher JD, Rosenblum ML, Siegal T, Mäcke H, Gabizon A, Beljanski M, Crochet S, Bergenheim AT, Zackrisson B, Elfverson J, Bergström P, Henriksson R, Butti G, Baetta R, Gratzl O, Magrassi L, De Renzis MR, Soma MR, Davegna C, Pezzotta S, Paoletti R, Fumagalli R, Infuso L, Sankar AA, Darling JL, Herholz K, Thomas DGT, Defer GL, Brugières P, Gray F, Chomienne C, Poirier J, Degos L, Degos JD, Colombo BM, DiDonato S, Ghaemi M, Finocchiaro G, Hebeda KM, Sterenborg HJCM, Saarnak AE, Wolbers JG, van Gemert MJC, Kaaijk P, Troost D, Leenstra S, Das PK, Würker M, Bosch DA, Kostron H, Hochleitner BW, Obwegeser A, Ortler M, Seiwald M, Vooys W, Krouwer HGJ, de Gast GC, Marx JJM, Pietrzyk U, Osman FJ, Lunardi P, Puzzilli F, Menovsky T, Beek JF, Wolbers JG, van Gemert MJC, Naujocks G, Wiestler OD, Schirrmacher V, Heiss WD, Schramm J, Schmitz A, Eis-Hübinger AM, Piepmeier PH, Pedersen P, Greer C, Quigley MR, Shih T, Elrifal A, Rothfus W, Kotitschke K, Maroon JC, Rohertson L, Rampling R, Whoteley TL, Piumb JA, Kerr DJ, Falina PA, Crossan IM, Roosen N, Rock JP, Brandl M, Feng J, Zeng H, Ho KL, Fenstermacher JD, Rosenblum ML, Ruchoux MM, Vincent S, Jonca F, Plouet J, Lecomte M, Tonn JC, Samid D, Thibault A, Ram Z, Oldfield EH, Myers CE, Reed E, Schabet M, Herrlinger U, Buchholz R, Shoshan Y, Haase A, Siegal T, Siegal T, Shezen E, Siegal T, Stockhammer G, Rosenblum M, Samid D, Lieberman F, Terzis AJA, Bjerkvig R, Bogdahn U, Laerum OD, Arnold H, Thibault A, Samid D, Figg WD, Myers CE, Reed E, Thomas R, Flux G, Chittenden S, Kotitschke K, Doshi P, Brazil L, Thomas DGT, Bignor D, Zalutsky M, Brada M, Tjuvajev J, Kaplitt M, Desai R, Bradley MS, Muigg S, Bettie BS, Gansbacher B, Blasberg R, Haugland HK, Saraste J, Rooseni K, Laerum OD, Vincent AJPE, Avezaat CJJ, Bout A, Felber S, Noteboom JL, Vecht CH, 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Abstracts. J Neurooncol 1994. [DOI: 10.1007/bf01070874] [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: 10/25/2022]
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