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Mian P, Maurer JM, Touw DJ, Vos MJ, Rottier BL. Pharmacy compounded pilocarpine: An adequate solution to overcome shortage of pilogel® discs for sweat testing in patients with cystic fibrosis. J Cyst Fibros 2024; 23:126-131. [PMID: 37775445 DOI: 10.1016/j.jcf.2023.09.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/01/2023]
Abstract
To respond to shortage of pilocarpine discs due to CE-licensing problems a pharmacy compounded pilocarpine HCL solution was developed and validated for use in CF diagnosis. The aim of this study was to compare the results from a pharmacy compounded pilocarpine HCL solution versus Pilogel® discs for the measurements of sweat chloride concentrations. Ten pediatric and adult patients with CF underwent a sweat test using both Pilogel® discs and pilocarpine HCL solution. The average difference between both methods was -3.25 mmol/L (95% Limits of Agreement: -7.19 [95% CI: -9.19;-5.19] and 0.69 [95% CI: -1.31;2.69] mmol/L. Passing-Bablok regression showed that zero was enclosed with the 95% CI of the calculated intercept (0.15 [95% CI: -1.70;1.42] mmol/L). These data show a good agreement in chloride concentrations obtained using the two pilocarpine products. Therefore, the pharmacy compounded pilocarpine HCL solution can be used as an alternative for Pilogel® discs during times of shortage.
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Affiliation(s)
- P Mian
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.
| | - J M Maurer
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - D J Touw
- Department of Clinical Pharmacy and Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands; Department of Pharmaceutical Analysis, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - M J Vos
- Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B L Rottier
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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van der Meer PB, Dirven L, Fiocco M, Vos MJ, Kerkhof M, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. Impact of timing of antiseizure medication withdrawal on seizure recurrence in glioma patients: a retrospective observational study. J Neurooncol 2023; 164:545-555. [PMID: 37755633 PMCID: PMC10589365 DOI: 10.1007/s11060-023-04450-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Withdrawal of antiseizure medication treatment (ASM) can be considered after completion of antitumour treatment in glioma patients who no longer suffer from seizures. We compared the risk for recurrent seizures after ASM withdrawal between patients with short-term, medium-term versus long-term seizure freedom after antitumour treatment. METHODS In this retrospective observational study, the primary outcome was time to recurrent seizure, from the starting date of no ASM treatment up to 36 months follow-up. Cox proportional hazards models were used to study the effect of risk factors on time to recurrent seizure. Stratification was done with information known at baseline. Short-term seizure freedom was defined as ≥ 3 months, but < 12 months; medium-term as 12-24 months; and long-term as ≥ 24 months seizure freedom from the date of last antitumour treatment. RESULTS This study comprised of 109 patients; 31% (34/109) were in the short-term, 29% (32/109) in the medium-term, and 39% (43/109) in the long-term group. A recurrent seizure was experienced by 47% (16/34) of the patients in the short-term, 31% (10/32) in the medium-term, and 44% (19/43) in the long-term group. Seizure recurrence risk was similar between patients in the short-term group as compared to the medium-term (cause-specific adjusted hazard ratio [aHR] = 0.65 [95%CI = 0.29-1.46]) and long-term group (cause-specific aHR = 1.04 [95%CI = 0.52-2.09]). CONCLUSIONS Seizure recurrence risk is relatively similar between patients with short-term, medium-term, and long-term seizure freedom after completion of antitumour treatment.
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Affiliation(s)
- Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marta Fiocco
- Department of Biomedical Data Sciences, Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
- Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Melissa Kerkhof
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, PO BOX 9600, 2300 RC, Leiden, The Netherlands
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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Crouzen JA, Petoukhova AL, Broekman MLD, Fiocco M, Fisscher UJ, Franssen JH, Gadellaa-van Hooijdonk CGM, Kerkhof M, Kiderlen M, Mast ME, van Rij CM, Nandoe Tewarie R, van de Sande MAE, van der Toorn PPG, Vlasman R, Vos MJ, van der Voort van Zyp NCMG, Wiggenraad RGJ, Wiltink LM, Zindler JD. SAFESTEREO: phase II randomized trial to compare stereotactic radiosurgery with fractionated stereotactic radiosurgery for brain metastases. BMC Cancer 2023; 23:273. [PMID: 36964529 PMCID: PMC10039548 DOI: 10.1186/s12885-023-10761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/20/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Stereotactic radiosurgery (SRS) is a frequently chosen treatment for patients with brain metastases and the number of long-term survivors is increasing. Brain necrosis (e.g. radionecrosis) is the most important long-term side effect of the treatment. Retrospective studies show a lower risk of radionecrosis and local tumor recurrence after fractionated stereotactic radiosurgery (fSRS, e.g. five fractions) compared with stereotactic radiosurgery in one or three fractions. This is especially true for patients with large brain metastases. As such, the 2022 ASTRO guideline of radiotherapy for brain metastases recommends more research to fSRS to reduce the risk of radionecrosis. This multicenter prospective randomized study aims to determine whether the incidence of adverse local events (either local failure or radionecrosis) can be reduced using fSRS versus SRS in one or three fractions in patients with brain metastases. METHODS Patients are eligible with one or more brain metastases from a solid primary tumor, age of 18 years or older, and a Karnofsky Performance Status ≥ 70. Exclusion criteria include patients with small cell lung cancer, germinoma or lymphoma, leptomeningeal metastases, a contraindication for MRI, prior inclusion in this study, prior surgery for brain metastases, prior radiotherapy for the same brain metastases (in-field re-irradiation). Participants will be randomized between SRS with a dose of 15-24 Gy in 1 or 3 fractions (standard arm) or fSRS 35 Gy in five fractions (experimental arm). The primary endpoint is the incidence of a local adverse event (local tumor failure or radionecrosis identified on MRI scans) at two years after treatment. Secondary endpoints are salvage treatment and the use of corticosteroids, bevacizumab, or antiepileptic drugs, survival, distant brain recurrences, toxicity, and quality of life. DISCUSSION Currently, limiting the risk of adverse events such as radionecrosis is a major challenge in the treatment of brain metastases. fSRS potentially reduces this risk of radionecrosis and local tumor failure. TRIAL REGISTRATION ClincalTrials.gov, trial registration number: NCT05346367 , trial registration date: 26 April 2022.
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Affiliation(s)
- J A Crouzen
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - M Fiocco
- Mathematical Institute of Leiden University, Leiden, The Netherlands
| | - U J Fisscher
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - M Kerkhof
- Haaglanden Medical Center, The Hague, The Netherlands
| | - M Kiderlen
- Haaglanden Medical Center, The Hague, The Netherlands
| | - M E Mast
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | | | | | - R Vlasman
- Radiotherapy Institute Friesland, Leeuwarden, The Netherlands
| | - M J Vos
- Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - L M Wiltink
- Leiden University Medical Center, Leiden, The Netherlands
| | - J D Zindler
- Haaglanden Medical Center, The Hague, The Netherlands.
- Holland Proton Therapy Center, Delft, The Netherlands.
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van der Meer P, Dirven L, Fiocco M, Vos MJ, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. Effectiveness of Antiseizure Medication Triple Therapy in Glioma Patients With Refractory Epilepsy: An Observational Cohort Study. Neurology 2023; 100:e1488-e1496. [PMID: 36754633 PMCID: PMC10104607 DOI: 10.1212/wnl.0000000000206852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 12/07/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND About 10% of glioma patients with epilepsy need antiseizure medication (ASM) triple-therapy due to refractory epilepsy. Aim of this study was to evaluate whether levetiracetam combined with valproic acid and clobazam (LEV+VPA+CLB), a frequently prescribed triple-therapy, has favorable effectiveness compared to other triple-therapy combinations in glioma patients. METHODS This was a multicenter retrospective observational cohort study, with as primary outcome the cumulative incidence of time to treatment failure for any reason, from start of ASM triple-therapy treatment. Secondary outcomes included cumulative incidences of: 1) time to treatment failure due to uncontrolled seizures; 2) time to treatment failure due to adverse effects; and 3) time to recurrent seizure. Patients were followed for a max. duration of 36 months. RESULTS Out of n=1435 patients in the original cohort, n=90 patients received ASM triple-therapy after second-line ASM treatment failure due to uncontrolled seizures. LEV+VPA+CLB was prescribed to 48% (43/90) and other ASM triple-therapy to 52% (47/90) patients. The cumulative incidence of treatment failure for any reason of LEV+VPA+CLB did not significantly differ from other ASM triple-therapy combinations (12 months: 47% [95%CI, 31-62%] versus 42% [95%CI, 27-56%], p=0.892). No statistical significant differences for treatment failure due to uncontrolled seizures (12 months: 12% [95%CI, 4-25%] versus 18% [95%CI, 8-30%], p=0.445), due to adverse effects (12 months: 22% [95%CI, 11-36%] versus 15% [95%CI, 7-27%], p=0.446), or recurrent seizure (1 month: 65% [95%CI, 48-78%] versus 63% [95%CI, 47-75%], p=0.911) were found. CONCLUSIONS LEV+VPA+CLB might show equivalent effectiveness compared to other ASM triple-therapy combinations in glioma patients. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for glioma patients with refractory epilepsy on triple-therapy ASMs, LEV+VPA+CLB demonstrated similar effectiveness and tolerability compared to other ASM triple-therapy combinations.
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Affiliation(s)
- Pim van der Meer
- . Leiden University Medical Center, Leiden .,. Haaglanden Medical Center, The Hague
| | - Linda Dirven
- . Leiden University Medical Center, Leiden.,. Haaglanden Medical Center, The Hague
| | | | - Maaike J Vos
- . Leiden University Medical Center, Leiden.,. Haaglanden Medical Center, The Hague
| | | | | | | | - Johan A F Koekkoek
- . Leiden University Medical Center, Leiden.,. Haaglanden Medical Center, The Hague
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Fritz L, Peeters MCM, Zwinkels H, Koekkoek JAF, Reijneveld JC, Vos MJ, Pasman HRW, Dirven L, Taphoorn MJB. Advance care planning (ACP) in glioblastoma patients: Evaluation of a disease-specific ACP program and impact on outcomes. Neurooncol Pract 2022; 9:496-508. [PMID: 36388414 PMCID: PMC9665067 DOI: 10.1093/nop/npac050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND The feasibility of implementing an advance care planning (ACP) program in daily clinical practice for glioblastoma patients is unknown. We aimed to evaluate a previously developed disease-specific ACP program, including the optimal timing of initiation and the impact of the program on several patient-, proxy-, and care-related outcomes. METHODS The content and design of the ACP program were evaluated, and outcomes including health-related quality of life (HRQoL), anxiety and depression, and satisfaction with care were measured every 3 months over 15 months. RESULTS Eighteen patient-proxy dyads and two proxies participated in the program. The content and design of the ACP program were rated as sufficient. The preference for the optimal timing of initiation of the ACP program varied widely, however, most of the participants preferred initiation shortly after chemoradiation. Over time, aspects of HRQoL remained stable in our patient population. Similarly, the ACP program did not decrease the levels of anxiety and depression in patients, and a large proportion of proxies reported anxiety and/or depression. The needed level of support for proxies was relatively low throughout the disease course, and the level of feelings of caregiver mastery was relatively high. Overall, patients were satisfied with the provided care over time, whereas proxies were less satisfied in some aspects. CONCLUSIONS The content and design of the developed disease-specific ACP program were rated as satisfactory. Whether the program has an actual impact on patient-, proxy-, and care-related outcomes proxies remain to be investigated.
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Affiliation(s)
- Lara Fritz
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Marthe C M Peeters
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers, Location VUmc, Amsterdam, the Netherlands
- Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, the Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - H Roeline W Pasman
- Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Expertise Center for Palliative Care, Department of Public and Occupational Health, Amsterdam, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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van Opijnen MP, Broekman MLD, de Vos FYF, Cuppen E, van der Hoeven JJM, van Linde ME, Compter A, Beerepoot LV, van den Bent MJ, Vos MJ, Fiebrich HB, Koekkoek JAF, Hoeben A, Kho KH, Driessen CML, Jeltema HR, Robe PAJT, Maas SLN. Study protocol of the GLOW study: maximising treatment options for recurrent glioblastoma patients by whole genome sequencing-based diagnostics—a prospective multicenter cohort study. BMC Med Genomics 2022; 15:233. [PMID: 36333718 PMCID: PMC9636658 DOI: 10.1186/s12920-022-01343-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022] Open
Abstract
Background Glioblastoma (GBM), the most common glial primary brain tumour, is without exception lethal. Every year approximately 600 patients are diagnosed with this heterogeneous disease in The Netherlands. Despite neurosurgery, chemo -and radiation therapy, these tumours inevitably recur. Currently, there is no gold standard at time of recurrence and treatment options are limited. Unfortunately, the results of dedicated trials with new drugs have been very disappointing. The goal of the project is to obtain the evidence for changing standard of care (SOC) procedures to include whole genome sequencing (WGS) and consequently adapt care guidelines for this specific patient group with very poor prognosis by offering optimal and timely benefit from novel therapies, even in the absence of traditional registration trials for this small volume cancer indication. Methods The GLOW study is a prospective diagnostic cohort study executed through collaboration of the Hartwig Medical Foundation (Hartwig, a non-profit organisation) and twelve Dutch centers that perform neurosurgery and/or treat GBM patients. A total of 200 patients with a first recurrence of a glioblastoma will be included. Dual primary endpoint is the percentage of patients who receive targeted therapy based on the WGS report and overall survival. Secondary endpoints include WGS report success rate and number of targeted treatments available based on WGS reports and number of patients starting a treatment in presence of an actionable variant. At recurrence, study participants will undergo SOC neurosurgical resection. Tumour material will then, together with a blood sample, be sent to Hartwig where it will be analysed by WGS. A diagnostic report with therapy guidance, including potential matching off-label drugs and available clinical trials will then be sent back to the treating physician for discussing of the results in molecular tumour boards and targeted treatment decision making. Discussion The GLOW study aims to provide the scientific evidence for changing the SOC diagnostics for patients with a recurrent glioblastoma by investigating complete genome diagnostics to maximize treatment options for this patient group. Trial registration: ClinicalTrials.gov Identifier: NCT05186064. Supplementary Information The online version contains supplementary material available at 10.1186/s12920-022-01343-4.
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van der Meer PB, Dirven L, Fiocco M, Vos MJ, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. Effectiveness of Antiseizure Medication Duotherapies in Patients With Glioma: A Multicenter Observational Cohort Study. Neurology 2022; 99:e999-e1008. [PMID: 36219797 PMCID: PMC9519253 DOI: 10.1212/wnl.0000000000200807] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 04/12/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES About 30% of patients with glioma need an add-on antiseizure medication (ASM) due to uncontrolled seizures on ASM monotherapy. This study aimed to determine whether levetiracetam combined with valproic acid (LEV + VPA), a commonly prescribed duotherapy, is more effective than other duotherapy combinations including either LEV or VPA in patients with glioma. METHODS In this multicenter retrospective observational cohort study, treatment failure (i.e., replacement by, addition of, or withdrawal of an ASM) for any reason was the primary outcome. Secondary outcomes included (1) treatment failure due to uncontrolled seizures and (2) treatment failure due to adverse effects. Time to treatment failure was estimated from the moment of ASM duotherapy initiation. Multivariable cause-specific Cox proportional hazard models were estimated to study the association between risk factors and treatment failure. The maximum duration of follow-up was 36 months. RESULTS A total of 1,435 patients were treated with first-line monotherapy LEV or VPA, of which 355 patients received ASM duotherapy after they had treatment failure due to uncontrolled seizures on monotherapy. LEV + VPA was prescribed in 66% (236/355) and other ASM duotherapy combinations including LEV or VPA in 34% (119/355) of patients. Patients using other duotherapy vs LEV + VPA had a higher risk of treatment failure for any reason (cause-specific adjusted hazard ratio [aHR] 1.50 [95% CI 1.07-2.12], p = 0.020), due to uncontrolled seizures (cause-specific aHR 1.73 [95% CI 1.10-2.73], p = 0.018), but not due to adverse effects (cause-specific aHR 0.88 [95% CI 0.47-1.67], p = 0.703). DISCUSSION This observational cohort study suggests that LEV + VPA has better efficacy than other ASM combinations. Similar toxicities were experienced in the 2 groups. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that for patients with glioma with uncontrolled seizures on ASM monotherapy, LEV + VPA has better efficacy than other ASM combinations.
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Affiliation(s)
- Pim B van der Meer
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands.
| | - Linda Dirven
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
| | - Marta Fiocco
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
| | - Maaike J Vos
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
| | - Mathilde C M Kouwenhoven
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
| | - Martin J van den Bent
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
| | - Martin J B Taphoorn
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
| | - Johan A F Koekkoek
- From the Department of Neurology (P.M., L.D., M.J.B.T., J.A.F.K.), Leiden University Medical Center; Department of Neurology (L.D., M.J.V., M.J.B.T., J.A.F.K.), Haaglanden Medical Center, The Hague; Department of Biomedical Data Sciences (M.F.), Medical Statistics, Leiden University Medical Center; Mathematical Institute (M.F.), Leiden University; Department of Neurology (M.C.M.K.), Amsterdam University Medical Centers, location VUmc; and Brain Tumor Center at Erasmus Medical Center Cancer Institute (M.J.B.), Rotterdam, the Netherlands
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van der Meer PB, Dirven L, Fiocco M, Vos MJ, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. P09.06.B The effectiveness of antiepileptic drug tripletherapy in refractory epileptic glioma patients: a multicenter observational cohort study. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.164] [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
About 10% of the glioma patients need antiepileptic drug (AED) tripletherapy due to refractory epilepsy. This study aimed to determine whether levetiracetam combined with valproic acid and clobazam (LEV+VPA+CLB), a commonly prescribed tripletherapy, has favourable effectiveness compared to other tripletherapy combinations in glioma patients.
Material and Methods
In this multicenter retrospective observational cohort study, the primary outcome was the cumulative incidence of treatment failure for any reason, from initiation of AED tripletherapy. Secondary outcomes included cumulative incidences of: 1) treatment failure due to uncontrolled seizures; 2) treatment failure due to adverse effects; and 3) recurrent seizure. Maximum duration of follow-up was 36 months.
Results
Ninety patients, from an initial cohort of n=1435 patients, received AED tripletherapy after second-line AED duotherapy treatment failure due to uncontrolled seizures. LEV+VPA+CLB was prescribed to 43 (48%) and other AED tripletherapy to 47 (52%) patients. The cumulative incidence of treatment failure for any reason of LEV+VPA+CLB did not significantly differ from other tripletherapy combinations (12 months: 47% [95%CI, 31-62%] versus 42% [95%CI, 27-56%], p=0.892). No statistical significant differences for treatment failure due to uncontrolled seizures (12 months: 12% [95%CI, 4-25%] versus 18% [95%CI, 8-30%], p=0.445), due to adverse effects (12 months: 22% [95%CI, 11-36%] versus 15% [95%CI, 7-27%], p=0.446), or recurrent seizure (1 month: 65% [95%CI, 48-78%] versus 63% [95%CI, 47-75%], p=0.911) were found.
Conclusion
LEV+VPA+CLB has not shown favourable efficacy or tolerability compared to other AED tripletherapy combinations in glioma patients. Therefore, we cannot specifically recommend CLB as tripletherapy add-on AED to LEV+VPA.
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Affiliation(s)
| | - L Dirven
- Leiden University Medical Center , Leiden , Netherlands
| | - M Fiocco
- Leiden University Medical Center , Leiden , Netherlands
| | - M J Vos
- Haaglanden Medical Center , The Hague , Netherlands
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9
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Oort Q, Zwinkels H, Koekkoek JAF, Vos MJ, Reijneveld JC, Taphoorn MJB, Dirven L. Is the EORTC QLQ-C30 emotional functioning scale appropriate as an initial screening measure to identify brain tumour patients who may possibly have a mood disorder? Psychooncology 2022; 31:995-1002. [PMID: 35083812 PMCID: PMC9303778 DOI: 10.1002/pon.5889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/22/2021] [Accepted: 12/20/2021] [Indexed: 11/12/2022]
Abstract
Background Screening glioma patients regularly for possible mood disorders may facilitate early identification and referral of patients at risk. This study evaluated if the EORTC QLQ‐C30 Emotional Functioning (EF) scale could be used as an initial screening measure to identify patients possibly having a mood disorder. Methods EORTC QLQ‐C30 EF and Hospital Anxiety and Depression Scale (HADS) scores were collected as part of a study assessing the impact of timing of patient‐reported outcome assessments on actual health‐related quality of life outcomes (N = 99). Spearman correlations and Mann‐Whitney U tests were used to determine the association between the EF and HADS (sub)scales. Receiver Operating Characteristic analyses were performed to determine optimal cut‐off EF scores to identify patients possibly having a mood disorder (i.e. HADS subscale score ≥8 points). Results EF and HADS (sub)scales correlated moderately (HADS‐A: r = −0.65; HADS‐D: r = −0.52). Significant EF score differences were found between patients with HADS ≥8 versus <8 points (HADS‐A: mean difference (MD) = 32 and HADS‐D: MD = 23). The EF scale had excellent (HADS‐A; AUC = 0.88) and borderline excellent (HADS‐D; AUC = 0.78) distinguishing capabilities. A statistically optimal (EF score <80) and a most inclusive (sensitivity of 100%, corresponding to an EF score <97) EF cut‐off score correctly identified 88.0% and 96.0% of patients with a possible mood disorder, respectively. Conclusion EORTC QLQ‐C30 EF scale seems to be an appropriate screening measure to identify glioma patients possibly having a mood disorder in need of further assessment.
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Affiliation(s)
- Quirien Oort
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Neurology, Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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10
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Zwinkels H, Dirven L, Bulbeck HJ, Grant R, Habets EJJ, Koekkoek JAF, Oberg I, Oliver K, Pace A, Rooney AG, Vos MJ, Taphoorn MJB. Identification of characteristics that determine behavioral and personality changes in adult glioma patients. Neurooncol Pract 2021; 8:550-558. [PMID: 34594569 DOI: 10.1093/nop/npab041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Glioma patients may experience behavioral and personality changes (BPC), negatively impacting their lives and that of their relatives. However, there is no clear definition of BPC for adult glioma patients, and here we aimed to determine which characteristics of BPC are relevant to include in this definition. Methods Possible characteristics of BPC were identified in the literature and presented to patients and (former) caregivers in an online survey launched via the International Brain Tumour Alliance. Participants had to rate the relevance of each presented characteristic of BPC, the three characteristics with the most impact on their lives, and possible missing characteristics. A cluster analysis and discussions with experts provided input to categorize characteristics and propose a definition for BPC. Results Completed surveys were obtained from 140 respondents; 35% patients, 50% caregivers, and 15% unknown. Of 49 proposed characteristics, 35 were reported as relevant by at least 25% (range: 7%-44%) of respondents. Patients and caregivers rated different characteristics as most important. Common characteristics included in the top 10 of both patients and caregivers were lack of motivation, change in being socially active, not able to finish things, and change in the level of irritation. No characteristics were reported missing by ≥5 respondents. Three categories of BPC were identified: (1) emotions, needs, and impulses (2) personality traits, and (3) poor judgement abilities. Conclusion The work resulted in a proposed definition for BPC in glioma patients, for which endorsement from the neuro-oncological community will be sought. A next step is to identify or develop an instrument to evaluate BPC in glioma patients.
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Affiliation(s)
- Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Helen J Bulbeck
- Brainstrust (The Brain Cancer People), Cowes, Isle of Wight, UK
| | - Robin Grant
- Edinburgh Centre for Neuro-Oncology, Western General Hospital, Edinburgh, UK
| | - Esther J J Habets
- Department of Medical Psychology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingela Oberg
- Department of Neuroscience, Cambridge University Hospitals, Cambridge, UK
| | - Kathy Oliver
- International Brain Tumour Alliance, Tadworth, UK
| | - Andrea Pace
- Neuro-Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alasdair G Rooney
- Division of Psychiatry, Royal Edinburgh Hospital, University of Edinburgh, Edinburgh, UK
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
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11
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De Swart ME, Ho VKY, Lagerwaard FJ, Brandsma D, Broen MP, French P, Gijtenbeek A, Geurts M, Hanse MCJ, Idema B, Klein M, Koekkoek JAF, Polman SK, Samuels CW, Seute T, Sijben AEJ, Smits M, Vos MJ, Walenkamp AME, Wesseling P, De Witt Hamer PC, Kouwenhoven MCM. P14.40 Trends in distribution of glioblastoma care and patient’s travel distance; results from the Dutch Brain Tumor Registry. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.157] [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
Over the past years, increasing worldwide attention towards centralization of complex cancer care has been pursued as higher volume centers have shown improved outcomes. Changes in distribution of care and the impact on travel distance in glioblastoma patients have not been determined yet. In this study, we determine trends in distribution of glioblastoma care in the Netherlands over the last three decades and assess whether the observed trends affected travel distance for individual patients.
MATERIAL AND METHODS
Data were obtained from the Dutch Brain Tumor Registry from 1989 to 2018. All glioblastoma patients (≥18 years) were included for analysis. Patients, neurosurgical centers and radiotherapy centers were geocoded. Data were analyzed in six time intervals of 5 years. High volume hospitals were defined as >50 cases per year. Travel distance was examined in two categories, ≤60km and >60km respectively. Trend analyses for proportions were used to analyze hospital volume changes and travel distances.
RESULTS
A total of 16.477 glioblastoma patients were registered, with an annual increase from 203 patients in 1989 to 917 patients in 2018. Neurosurgical centers increased from 16 to 17 and for radiotherapy from 19 to 22 centers between 1989–1993 and 2014–2018. Mean neurosurgical- and radiotherapy center volumes increased from 12 to 39 (P=0.025) and 7 to 27 (P=0.025) patients per hospital per year from 1989–1993 to 2014–2018. High volume neurosurgical centers were observed since 2004, and an increased number of patients were treated in these centers, 27.8%, 52.6% and 64.1% in the time periods 2004–2008, 2009–2013, and 2014–2018 (P<0.001). High volume radiology centers were observed since 2009, and 15.0% and 27.3% of patients were treated in these centers in the time periods 2009–2013 and 2014–2018 (P<0.001). Patients with a travel distance >60km to the neurosurgical center reduced from 15.8% to 13.2% (P=0.033). Travel distance >60km to the radiotherapy center did not reduce significantly (10.4% to 8.8%, P=0.601).
CONCLUSION
An increasing number of glioblastoma patients were differentially treated in high volume neurosurgery and radiotherapy centers. The observation that this did not translate into increased travel distances, indicates accessible specialized Neuro-Oncology care for glioblastoma patients in The Netherlands.
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Affiliation(s)
- M E De Swart
- Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - V K Y Ho
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | | | - D Brandsma
- Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - M P Broen
- Maastricht University Medical Center, Maastricht, Netherlands
| | - P French
- Erasmus Medical Center, Rotterdam, Netherlands
| | - A Gijtenbeek
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - M Geurts
- Erasmus Medical Center, Rotterdam, Netherlands
| | | | - B Idema
- Northwest Clinics, Alkmaar, Netherlands
| | - M Klein
- Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | | | | | | | - T Seute
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - M Smits
- Erasmus Medical Center, Rotterdam, Netherlands
| | - M J Vos
- Haaglanden Medical Center, The Hague, Netherlands
| | | | - P Wesseling
- Amsterdam UMC location VUmc, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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12
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De Swart ME, Ho VKY, Lagerwaard FJ, Brandsma D, Broen MP, French P, Gijtenbeek A, Geurts M, Hanse MCJ, Idema B, Klein M, Koekkoek JAF, Polman SK, Samuels CW, Seute T, Sijben AEJ, Smits M, Vos MJ, Walenkamp AME, Wesseling P, Kouwenhoven MCM, De Witt Hamer PC. P14.31 Between hospital variation in timings to multidisciplinary glioblastoma care in the Dutch Brain Tumor Registry. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.152] [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
BACKGROUND
Delay in cancer care may adversely affect emotional distress, treatment outcome and survival. Optimal timings in multidisciplinary glioblastoma care are a matter of debate and clear national guidelines only exist for time to neurosurgery. We evaluated the between-hospital variation in timings to neurosurgery and adjuvant radiotherapy and chemotherapy in newly diagnosed glioblastoma patients in the Netherlands.
MATERIAL AND METHODS
Data were obtained from the nation-wide Dutch Brain Tumor Registry between 2014 and 2018. All adult patients with glioblastoma were included, covering all 18 neurosurgical hospitals, 28 radiotherapy hospitals, and 33 oncology hospitals. Long time-to-surgery (TTS) was defined as >3 weeks from the date of first brain tumor diagnosis to surgery, long time-to-radiotherapy (TTR) as either >4 or >6 weeks after surgery, and long time-to-chemotherapy (TTC) as either >4 or >6 weeks after completion of radiotherapy. Between-hospital variation in standardized rate of long timings was analyzed in funnel plots after case-mix correction.
RESULTS
A total of 4203 patients were included. Median TTS was 20 days and 52.4% of patients underwent surgery within 3 weeks. Median TTR was 20 days and 24.6% of patients started radiotherapy within 4 weeks and 84.2% within 6 weeks after surgery. Median TTC was 28 days and 62.6% of patients received chemotherapy within 4 weeks and 91.8% within 6 weeks after radiotherapy. After case-mix correction, three (16.7%) neurosurgical hospitals had significantly more patients with longer than expected TTS. Three (10.7%) and one (3.6%) radiotherapy hospitals had significantly more patients with longer than expected TTR for >4 and >6 weeks, respectively. In seven (21.2%) chemotherapy hospitals, significantly less patients with TTC >4 weeks were observed than expected. In four (12.1%) chemotherapy hospitals, significantly more patients with TTC >4 weeks were observed than expected.
CONCLUSION
Between-hospital variation in timings to multidisciplinary treatment was observed in glioblastoma care in the Netherlands. A substantial percentage of patients experienced timings longer than anticipated.
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Affiliation(s)
- M E De Swart
- Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - V K Y Ho
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | | | - D Brandsma
- Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, Netherlands
| | - M P Broen
- Maastricht University Medical Center, Maastricht, Netherlands
| | - P French
- Erasmus Medical Center, Rotterdam, Netherlands
| | - A Gijtenbeek
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - M Geurts
- Erasmus Medical Center, Rotterdam, Netherlands
| | | | - B Idema
- Northwest Clinics, Alkmaar, Netherlands
| | - M Klein
- Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | | | | | | | - T Seute
- University Medical Center Utrecht, Utrecht, Netherlands
| | | | - M Smits
- Erasmus Medical Center, Rotterdam, Netherlands
| | - M J Vos
- Haaglanden Medical Center, The Hague, Netherlands
| | | | - P Wesseling
- Amsterdam UMC location VUmc, Amsterdam, Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
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13
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van der Meer PB, Dirven L, Fiocco M, Vos MJ, Kouwenhoven MCM, van den Bent MJ, Taphoorn MJB, Koekkoek JAF. First-line antiepileptic drug treatment in glioma patients with epilepsy: Levetiracetam vs valproic acid. Epilepsia 2021; 62:1119-1129. [PMID: 33735464 PMCID: PMC8251728 DOI: 10.1111/epi.16880] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/04/2021] [Accepted: 03/04/2021] [Indexed: 12/13/2022]
Abstract
Objective This study aimed at estimating the cumulative incidence of antiepileptic drug (AED) treatment failure of first‐line monotherapy levetiracetam vs valproic acid in glioma patients with epilepsy. Methods In this retrospective observational study, a competing risks model was used to estimate the cumulative incidence of treatment failure, from AED treatment initiation, for the two AEDs with death as a competing event. Patients were matched on baseline covariates potentially related to treatment assignment and outcomes of interest according to the nearest neighbor propensity score matching technique. Maximum duration of follow‐up was 36 months. Results In total, 776 patients using levetiracetam and 659 using valproic acid were identified. Matching resulted in two equal groups of 429 patients, with similar covariate distribution. The cumulative incidence of treatment failure for any reason was significantly lower for levetiracetam compared to valproic acid (12 months: 33% [95% confidence interval (CI) 29%–38%] vs 50% [95% CI 45%–55%]; P < .001). When looking at specific reasons of treatment failure, treatment failure due to uncontrolled seizures was significantly lower for levetiracetam compared to valproic acid (12 months: 16% [95% CI 12%–19%] vs 28% [95% CI 23%–32%]; P < 0.001), but no differences were found for treatment failure due to adverse effects (12 months: 14% [95% CI 11%–18%] vs 15% [95% CI 11%–18%]; P = .636). Significance Our results suggest that levetiracetam may have favorable efficacy compared to valproic acid, whereas level of toxicity seems similar. Therefore, levetiracetam seems to be the preferred choice for first‐line AED treatment in patients with glioma.
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Affiliation(s)
- Pim B van der Meer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Marta Fiocco
- Department of Biomedical Data Sciences, Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands.,Mathematical Institute, Leiden University, Leiden, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | | | | | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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14
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Peeters MC, Zwinkels H, Koekkoek JA, Vos MJ, Dirven L, Taphoorn MJ. The Impact of the Timing of Health-Related Quality of Life Assessments on the Actual Results in Glioma Patients: A Randomized Prospective Study. Cancers (Basel) 2020; 12:cancers12082172. [PMID: 32764261 PMCID: PMC7465107 DOI: 10.3390/cancers12082172] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/21/2022] Open
Abstract
Background: The aim of this study was to explore the impact of the timing of Health-Related Quality of Life (HRQoL) measurements in clinical care on the obtained HRQoL scores in glioma patients, and the association with feelings of anxiety or depression. Methods: Patients completed the European Organisation for Research and Treatment of Cancer (EORTC)’s Quality of Life Questionnaires (QLQ-C30 and QLQ-BN20), and the Hospital Anxiety and Depression Scale (HADS) twice. All patients completed the first measurement on the day of the Magnetic Resonance Imaging (MRI) scan (t = 0), but the second measurement (t = 1) depended on randomization; Group 1 (n = 49) completed the questionnaires before and Group 2 (n = 51) after the consultation with the physician. Results: median HRQoL scale scores on t0/t1 and change scores were comparable between the two groups. Between 8–58% of patients changed to a clinically relevant extent (i.e., ≥10 points) on the evaluated HRQoL scales in about one-week time, in both directions, with only 3% of patients remaining stable in all scales. Patients with a stable role functioning had a lower HADS anxiety change score. The HADS depression score was not associated with a change in HRQoL. Conclusions: Measuring HRQoL before or after the consultation did not impact HRQoL scores on a group level. However, most patients reported a clinically relevant difference in at least one HRQoL scale between the two time points. These findings highlight the importance of standardized moments of HRQoL assessments, or patient-reported outcomes in general, during treatment and follow-up in clinical trials.
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Affiliation(s)
- Marthe C.M. Peeters
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.A.F.K.); (L.D.); (M.J.B.T.)
- Correspondence: ; Tel.: +31-071-526-2547
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, 2262 BA The Hague, The Netherlands; (H.Z.); (M.J.V.)
| | - Johan A.F. Koekkoek
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.A.F.K.); (L.D.); (M.J.B.T.)
- Department of Neurology, Haaglanden Medical Center, 2262 BA The Hague, The Netherlands; (H.Z.); (M.J.V.)
| | - Maaike J. Vos
- Department of Neurology, Haaglanden Medical Center, 2262 BA The Hague, The Netherlands; (H.Z.); (M.J.V.)
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.A.F.K.); (L.D.); (M.J.B.T.)
- Department of Neurology, Haaglanden Medical Center, 2262 BA The Hague, The Netherlands; (H.Z.); (M.J.V.)
| | - Martin J.B. Taphoorn
- Department of Neurology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.A.F.K.); (L.D.); (M.J.B.T.)
- Department of Neurology, Haaglanden Medical Center, 2262 BA The Hague, The Netherlands; (H.Z.); (M.J.V.)
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15
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Peeters MCM, Dirven L, Koekkoek JAF, Gortmaker EG, Fritz L, Vos MJ, Taphoorn MJB. Prediagnostic symptoms and signs of adult glioma: the patients' view. J Neurooncol 2020; 146:293-301. [PMID: 31894516 DOI: 10.1007/s11060-019-03373-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/14/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Little is known about the symptoms glioma patients experience in the year before diagnosis, either or not resulting in health care usage. This study aimed to determine the incidence of symptoms glioma patients experienced in the year prior to diagnosis, and subsequent visits to a general practitioner (GP). METHODS Glioma patients were asked to complete a 30-item study-specific questionnaire focusing on symptoms they experienced in the 12 months before diagnosis. For each indicated symptom, patients were asked whether they consulted the GP for this issue. RESULTS Fifty-nine patients completed the questionnaires, 54 (93%) with input of a proxy. The median time since diagnosis was 4 months (range 1-12). The median number of symptoms experienced in the year before diagnosis was similar between gliomas with favourable and poor prognosis, i.e. 6 (range 0-24), as were the five most frequently mentioned problems: fatigue (n = 34, 58%), mental tiredness (n = 30, 51%), sleeping disorder (n = 24, 41%), headache (n = 23, 39%) and stress (n = 20, 34%). Twenty-six (44%) patients visited the GP with at least one issue. Patients who did consult their GP reported significantly more often muscle weakness (11 vs 3, p = 0.003) than patients who did not, which remained significant after correction for multiple testing, which was not the case for paralysis in hand/leg (10 vs 4), focussing (11 vs 6) or a change in awareness (9 vs 4). CONCLUSIONS Glioma patients experience a range of non-specific problems in the year prior to diagnosis, but only patients who consult the GP report more often neurological problems.
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Affiliation(s)
- Marthe C M Peeters
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Ellen G Gortmaker
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Lara Fritz
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Neurology, Haaglanden Medical Center, The Hague, The Netherlands
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16
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Fritz L, Zwinkels H, Koekkoek JAF, Reijneveld JC, Vos MJ, Dirven L, Pasman HRW, Taphoorn MJB. Advance care planning in glioblastoma patients: development of a disease-specific ACP program. Support Care Cancer 2019; 28:1315-1324. [PMID: 31243585 PMCID: PMC6989589 DOI: 10.1007/s00520-019-04916-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND It is unknown if the implementation of an advance care planning (ACP) program is feasible in daily clinical practice for glioblastoma patients. We aimed to develop an ACP program and assess the preferred content, the best time to introduce such a program in the disease trajectory, and possible barriers and facilitators for participation and implementation. METHODS A focus group with health care professionals (HCPs) and individual semi-structured interviews with patients and proxies (of both living and deceased patients) were conducted. RESULTS All predefined topics were considered relevant by participants, including the current situation, worries/fears, (supportive) treatment options, and preferred place of care/death. Although HCPs and proxies of deceased patients indicated that the program should be implemented relatively early in the disease trajectory, patient-proxy dyads were more ambiguous. Several patient-proxy dyads indicated that the program should be initiated later in the disease trajectory. If introduced early, topics about the end of life should be postponed. A frequently mentioned barrier for participation was that the program would be too confronting, while a facilitator was adequate access to information. CONCLUSION This study resulted in an ACP program specifically for glioblastoma patients. Although participants agreed on the program content, the optimal timing of introducing such a program was a matter of debate. Our solution is to offer the program shortly after diagnosis but let patients and proxies decide which topics they want to discuss and when. The impact of the program on several patient- and care-related outcomes will be evaluated in the next step.
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Affiliation(s)
- Lara Fritz
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
| | - Hanneke Zwinkels
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
| | - Johan A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology and Brain Tumor Center Amsterdam, Amsterdam University Medical Centers (location VUmc), Amsterdam, The Netherlands
- Department of Neurology, Amsterdam University Medical Centers (location Academic Medical Center), Amsterdam, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Center for Palliative care Amsterdam, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO BOX 2191, 2501, VC, The Hague, The Netherlands.
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.
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17
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Kerkhof M, Koekkoek JAF, Vos MJ, van den Bent MJ, Taal W, Postma TJ, Bromberg JEC, Kouwenhoven MCM, Dirven L, Reijneveld JC, Taphoorn MJB. Withdrawal of antiepileptic drugs in patients with low grade and anaplastic glioma after long-term seizure freedom: a prospective observational study. J Neurooncol 2019; 142:463-470. [PMID: 30778733 PMCID: PMC6478626 DOI: 10.1007/s11060-019-03117-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/31/2019] [Indexed: 12/16/2022]
Abstract
Background When glioma patients experience long-term seizure freedom the question arises whether antiepileptic drugs (AEDs) should be continued. As no prospective studies exist on seizure recurrence in glioma patients after AED withdrawal, we evaluated the decision-making process to withdraw AEDs in glioma patients, and seizure outcome after withdrawal. Methods Patients with a histologically confirmed low grade or anaplastic glioma were included. Eligible patients were seizure free ≥ 1 year from the date of last antitumor treatment, or ≥ 2 years since the last seizure when seizures occurred after the end of the last antitumor treatment. Patients and neuro-oncologists made a shared decision on the preferred AED treatment (i.e. AED withdrawal or continuation). Primary outcomes were: (1) outcome of the shared decision-making process and (2) rate of seizure recurrence. Results Eighty-three patients fulfilled all eligibility criteria. However, in 12/83 (14%) patients, the neuro-oncologist had serious objections to AED withdrawal. Therefore, 71/83 (86%) patients were analyzed; In 46/71 (65%) patients it was decided to withdraw AED treatment. In the withdrawal group, 26% (12/46) had seizure recurrence during follow-up. Seven of these 12 patients (58%) had tumor progression, of which three within 3 months after seizure recurrence. In the AED continuation group, 8% (2/25) of patients had seizure recurrence of which one had tumor progression. Conclusion In 65% of patients a shared decision was made to withdraw AEDs, of which 26% had seizure recurrence. AED withdrawal should only be considered in carefully selected patients with a presumed low risk of tumor progression.
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Affiliation(s)
- M Kerkhof
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.
| | - J A F Koekkoek
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands
| | - M J van den Bent
- Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - W Taal
- Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - T J Postma
- Brain Tumor Center Amsterdam at VU University Medical Center, Amsterdam, The Netherlands
| | - J E C Bromberg
- Brain Tumor Center at Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - M C M Kouwenhoven
- Brain Tumor Center Amsterdam at VU University Medical Center, Amsterdam, The Netherlands
| | - L Dirven
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - J C Reijneveld
- Brain Tumor Center Amsterdam at VU University Medical Center, Amsterdam, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO Box 2191, 2501 VC, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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18
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de Peuter MA, van Baest L, Bienfait HP, Dujardin K, Hanse MCJ, Vos MJ, de Vos FYFL, Ho VKY, Gijtenbeek JMM. P01.037 Quality criteria for glioma care, use in clinical practice: results of a national survey. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.079] [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)
- M A de Peuter
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
| | | | | | | | | | - M J Vos
- Haaglanden Medisch Centrum, Den Haag, Netherlands
| | | | - V K Y Ho
- Netherlands Comprehensive Cancer Organisation, Utrecht, Netherlands
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19
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Kerkhof M, Ganeff I, Wiggenraad RGJ, Lycklama À Nijeholt GJ, Hammer S, Taphoorn MJB, Dirven L, Vos MJ. Clinical applicability of and changes in perfusion MR imaging in brain metastases after stereotactic radiotherapy. J Neurooncol 2018; 138:133-139. [PMID: 29392588 PMCID: PMC5928168 DOI: 10.1007/s11060-018-2779-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 09/18/2017] [Accepted: 01/25/2018] [Indexed: 12/05/2022]
Abstract
To assess the applicability of perfusion-weighted (PWI) magnetic resonance (MR) imaging in clinical practice, as well as to evaluate the changes in PWI in brain metastases before and after stereotactic radiotherapy (SRT), and to correlate these changes to tumor status on conventional MR imaging. Serial MR images at baseline and at least 3 and 6 months after SRT were retrospectively evaluated. Size of metastases and the relative cerebral blood volume (rCBV), assessed with subjective visual inspection in the contrast enhanced area, were evaluated at each time point. Tumor behavior of metastases was categorized into four groups based on predefined changes on MRI during follow-up, or on histologically confirmed diagnosis; progressive disease (PD), pseudoprogression (PsPD), non-progressive disease (non-PD) and progression unspecified (PU). Twenty-six patients with 42 metastases were included. Fifteen percent (26/168) of all PW images could not be evaluated due to localization near large vessels or the scalp, presence of hemorrhage artefacts, and in 31% (52/168) due to unmeasurable residual metastases. The most common pattern (52%, 13/25 metastases) showed a high rCBV at baseline and low rCBV during follow-up, occurring in metastases with non-PD (23%, 3/13), PsPD (38%, 5/13) and PU (38%, 5/13). Including only metastases with a definite outcome generally showed low rCBV in PsPD or non-PD, and high rCBV in PD. Although non-PD and PsPD may be distinguished from PD after SRT using the PW images, the large proportion of images that could not be assessed due to artefacts and size severely hampers value of PWI in predicting tumor response after SRT.
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Affiliation(s)
- M Kerkhof
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.
| | - I Ganeff
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands
| | - R G J Wiggenraad
- Department of Radiotherapy, Haaglanden Medical Center, The Hague, The Netherlands
| | | | - S Hammer
- Department of Radiology, Haaglanden Medical Center, The Hague, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Dirven
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK, The Hague, The Netherlands
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20
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Kerkhof M, Koekkoek JAF, Vos MJ, van den Bent M, Taal W, Postma TJ, Bromberg JEC, Kouwenhoven M, Dirven L, Reijneveld JC, Taphoorn MJB. QLIF-11. WITHDRAWAL OF ANTIEPILEPTIC DRUGS IN GLIOMA PATIENTS AFTER LONG-TERM SEIZURE FREEDOM. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.821] [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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21
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Kerkhof M, Tans PL, Hagenbeek RE, Lycklama À Nijeholt GJ, Holla FK, Postma TJ, Straathof CS, Dirven L, Taphoorn MJ, Vos MJ. Visual inspection of MR relative cerebral blood volume maps has limited value for distinguishing progression from pseudoprogression in glioblastoma multiforme patients. CNS Oncol 2017; 6:297-306. [PMID: 28984142 DOI: 10.2217/cns-2017-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
AIM We examined whether visual interpretation of relative cerebral blood volume (rCBV) color maps made with dynamic susceptibility-weighted perfusion MRI can reliably distinguish progressive disease (PD) from pseudoprogression (PsPD) in glioblastoma patients during treatment with temozolomide chemoradiation. MATERIALS & METHODS Magnetic resonance (MR) perfusion-weighted images were evaluated based on visual inspection of rCBV maps. Sensitivity and specificity were calculated to assess if rCBV can reliably differentiate between PD and PsPD, during standard chemoradiation therapy. RESULTS Evaluation of dynamic susceptibility-weighted contrast-enhanced perfusion MRI by visual interpretation of rCBV maps did not differentiate PD from PsPD (sensitivity = 72%; specificity = 23%). Furthermore, the interpretation of the rCBV maps had no prognostic value regarding survival. CONCLUSION Qualitative rCBV-based dynamic susceptibility-weighted contrast-enhanced perfusion MRI does not reliably differentiate PD from PsPD, and is not prognostic for survival in glioblastoma multiforme patients during treatment with temozolomide chemoradiation.
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Affiliation(s)
- Melissa Kerkhof
- Department of Neurology, Haaglanden Medical Center, The Hague 2501 CK, The Netherlands
| | - Pauline L Tans
- Department of Neurology, Haaglanden Medical Center, The Hague 2501 CK, The Netherlands
| | - Rogier E Hagenbeek
- Department of Radiology, Haaglanden Medical Center, The Hague 2501 CK, The Netherlands
| | | | - Finn K Holla
- Department of Neurology, Haaglanden Medical Center, The Hague 2501 CK, The Netherlands
| | - Tjeerd J Postma
- Department of Neurology, VU University Medical Center, Amsterdam 1007 MB, The Netherlands
| | - Chiara S Straathof
- Department of Neurology, Leiden University Medical Center, Leiden 2300 RA, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden 2300 RA, The Netherlands
| | - Martin Jb Taphoorn
- Department of Neurology, Haaglanden Medical Center, The Hague 2501 CK, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden 2300 RA, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Haaglanden Medical Center, The Hague 2501 CK, The Netherlands
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22
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Kerkhof M, Hagenbeek RE, van der Kallen BFW, Lycklama À Nijeholt GJ, Dirven L, Taphoorn MJB, Vos MJ. Interobserver variability in the radiological assessment of magnetic resonance imaging (MRI) including perfusion MRI in glioblastoma multiforme. Eur J Neurol 2016; 23:1528-33. [PMID: 27424939 DOI: 10.1111/ene.13070] [Citation(s) in RCA: 11] [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] [Received: 10/21/2015] [Accepted: 05/13/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Conventional magnetic resonance imaging (MRI) has limited value for differentiation of true tumor progression and pseudoprogression in treated glioblastoma multiforme (GBM). Perfusion weighted imaging (PWI) may be helpful in the differentiation of these two phenomena. Here interobserver variability in routine radiological evaluation of GBM patients is assessed using MRI, including PWI. METHODS Three experienced neuroradiologists evaluated MR scans of 28 GBM patients during temozolomide chemoradiotherapy at three time points: preoperative (MR1) and postoperative (MR2) MR scan and the follow-up MR scan after three cycles of adjuvant temozolomide (MR3). Tumor size was measured both on T1 post-contrast and T2 weighted images according to the Response Assessment in Neuro-Oncology criteria. PW images of MR3 were evaluated by visual inspection of relative cerebral blood volume (rCBV) color maps and by quantitative rCBV measurements of enhancing areas with highest rCBV. Image interpretability of PW images was also scored. Finally, the neuroradiologists gave a conclusion on tumor status, based on the interpretation of both T1 and T2 weighted images (MR1, MR2 and MR3) in combination with PWI (MR3). RESULTS Interobserver agreement on visual interpretation of rCBV maps was good (κ = 0.63) but poor on quantitative rCBV measurements and on interpretability of perfusion images (intraclass correlation coefficient 0.37 and κ = 0.23, respectively). Interobserver agreement on the overall conclusion of tumor status was moderate (κ = 0.48). CONCLUSIONS Interobserver agreement on the visual interpretation of PWI color maps was good. However, overall interpretation of MR scans (using both conventional and PW images) showed considerable interobserver variability. Therefore, caution should be applied when interpreting MRI results during chemoradiation therapy.
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Affiliation(s)
- M Kerkhof
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
| | - R E Hagenbeek
- Department of Radiology, Medical Center Haaglanden, The Hague, The Netherlands
| | | | | | - L Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J B Taphoorn
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Vos
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
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23
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Holla FK, Postma TJ, Blankenstein MA, van Mierlo TJM, Vos MJ, Sizoo EM, de Groot M, Uitdehaag BMJ, Buter J, Klein M, Reijneveld JC, Heimans JJ. Prognostic value of the S100B protein in newly diagnosed and recurrent glioma patients: a serial analysis. J Neurooncol 2016; 129:525-532. [PMID: 27401156 PMCID: PMC5020117 DOI: 10.1007/s11060-016-2204-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/03/2016] [Indexed: 12/03/2022]
Abstract
The S100B protein is associated with brain damage and a breached blood–brain barrier. A previous pilot study showed that high serum levels of S100B are associated with shorter survival in glioma patients. The aim of our study was to assess the prognostic value in terms of survival and longitudinal dynamics of serum S100B for patients with newly diagnosed and recurrent glioma. We obtained blood samples from patients with newly diagnosed and recurrent glioma before the start (baseline) and at fixed time-points during temozolomide chemotherapy. S100B-data were dichotomized according to the upper limit of the reference value of 0.1 μg/L. Overall survival (OS) was estimated with Kaplan–Meier curves and groups were compared with the log rank analysis. To correct for potential confounders a Cox regression analysis was used. We included 86 patients with newly-diagnosed and 27 patients with recurrent glioma. Most patients in both groups had baseline serum levels within normal limits. In the newly diagnosed patients we found no significant difference in OS between the group of patients with S100B levels >0.1 μg/L at baseline compared to those with <0.1 μg/L. In the patients with recurrent glioma we found a significantly shorter OS for patients with raised levels. In both groups, S100B values did not change significantly throughout the course of the disease. Serum S100B levels do not seem to have prognostic value in newly diagnosed glioma patients. In recurrent glioma patients S100B might be of value in terms of prognostication of survival.
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Affiliation(s)
- F K Holla
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - T J Postma
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - M A Blankenstein
- Clinical Chemistry, VU University Medical Center, Amsterdam, The Netherlands
| | - T J M van Mierlo
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - M J Vos
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| | - E M Sizoo
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - M de Groot
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - B M J Uitdehaag
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - J Buter
- Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - M Klein
- Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - J C Reijneveld
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - J J Heimans
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
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24
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Wick W, Stupp R, Gorlia T, Bendszus M, Sahm F, Bromberg JE, Brandes AA, Vos MJ, Domont J, Idbaih A, Frenel JS, Clement PM, Fabbro M, Le Rhun E, Dubois F, Musmeci D, Platten M, Golfinopoulos V, Van Den Bent MJ. Phase II part of EORTC study 26101: The sequence of bevacizumab and lomustine in patients with first recurrence of a glioblastoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Roger Stupp
- University of Lausanne Hospitals, Lausanne, Switzerland
| | - Thierry Gorlia
- European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | | | - Felix Sahm
- Heidelberg University Hospital, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | - Maaike J Vos
- Medisch Centrum Haaglanden, The Hague, Netherlands
| | | | - Ahmed Idbaih
- Universite Pierre et Marie Curie Paris VI, Paris, France
| | | | | | | | | | | | | | - Michael Platten
- Heidelberg University Hospital,German Cancer Research Center (DKFZ), Heidelberg, Germany
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25
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Koekkoek JAF, Dirven L, Heimans JJ, Postma TJ, Vos MJ, Reijneveld JC, Taphoorn MJB. Seizure reduction is a prognostic marker in low-grade glioma patients treated with temozolomide. J Neurooncol 2015; 126:347-54. [PMID: 26547911 PMCID: PMC4718947 DOI: 10.1007/s11060-015-1975-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 10/24/2015] [Indexed: 01/02/2023]
Abstract
We aimed to analyze the value of seizure reduction and radiological response as prognostic markers of survival in patients with low-grade glioma (LGG) treated with temozolomide (TMZ) chemotherapy. We retrospectively reviewed adult patients with a progressive LGG and uncontrolled epilepsy in two hospitals (VUmc Amsterdam; MCH The Hague), who received chemotherapy with TMZ between 2002 and 2014. End points were a ≥50 % seizure reduction and MRI response 6, 12 and 18 months (mo) after the start of TMZ, and their relation with progression-free survival (PFS) and overall survival (OS). We identified 53 patients who met the inclusion criteria. Seizure reduction was an independent prognostic factor for both PFS (HR 0.38; 95 % CI 0.19–0.73; p = 0.004) and OS (HR 0.39; 95 % CI 0.18–0.85; p = 0.018) after 6mo, adjusting for age and histopathological diagnosis, as well as after 12 and 18mo. Patients with an objective radiological response showed a better OS (median 87.5mo; 95 % CI 62.0–112.9) than patients without a response (median 34.4mo; 95 % CI 26.1–42.6; p = 0.046) after 12mo. However, after 6 and 18mo OS was similar in patients with and without a response on MRI. Seizure reduction is an early and consistent prognostic marker for survival after treatment with TMZ, that seems to precede the radiological response. Therefore, seizure reduction may serve as a surrogate marker for tumor response.
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Affiliation(s)
- Johan A F Koekkoek
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands.
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - Linda Dirven
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Jan J Heimans
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Tjeerd J Postma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
- Department of Neurology, Medical Center Haaglanden, The Hague, The Netherlands
- Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
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26
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Zwinkels H, Dirven L, Vissers T, Habets EJ, Vos MJ, Reijneveld JC, van den Bent MJ, Taphoorn MJ. QOL-27PREVALENCE OF CHANGES IN PERSONALITY AND BEHAVIOR IN ADULT GLIOMA PATIENTS: A SYSTEMATIC REVIEW. Neuro Oncol 2015. [DOI: 10.1093/neuonc/nov230.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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27
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Zwinkels H, Dirven L, Vissers T, Habets EJJ, Vos MJ, Reijneveld JC, van den Bent MJ, Taphoorn MJB. Prevalence of changes in personality and behavior in adult glioma patients: a systematic review. Neurooncol Pract 2015; 3:222-231. [PMID: 31386058 DOI: 10.1093/nop/npv040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [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: 06/24/2015] [Indexed: 12/24/2022] Open
Abstract
Background Gliomas are rare, with a dismal outcome and an obvious impact on quality of life, because of neurological, physical and cognitive problems, as well as personality and behavioral changes. These latter changes may affect the lives of both patients and their relatives in a profound way, but it is unclear how often this occurs and to what extent. Methods We performed a systematic review to determine the prevalence of changes in personality and behavior in glioma patients. Searches were conducted in PubMed/Medline, PsycINFO, Cochrane, CINAHL and Embase. Based on predetermined in- and exclusion criteria, papers were screened for eligibility. Information on the topics of interest were extracted from the full-text papers. Results The search yielded 9895 papers, of which 18 were found to be eligible; 9 qualitative and 9 quantitative studies. The reported prevalence rates of changes in personality and/or behavior varied from 8%-67% in glioma patients, and was 100% in a case series with bilateral gliomas. Moreover, these changes were associated with distress and a lower quality of life of patients as well as informal caregivers. Methods of measurement of personality and behavioral changes differed considerably, as did the description of these changes. Conclusion To determine the true prevalence of changes in behavior and personality, present but poorly labeled in the reported studies, prospective studies are needed using proper definitions of personality and behavioral changes and validated measurement tools. Ultimately, these findings may result in improved supportive care of both patients and caregivers, during the disease trajectory.
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Affiliation(s)
- Hanneke Zwinkels
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Linda Dirven
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Thomas Vissers
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Esther J J Habets
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Maaike J Vos
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Jaap C Reijneveld
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Martin J van den Bent
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
| | - Martin J B Taphoorn
- Medical Center Haaglanden, Department of Neurology, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (H.Z., E.J.J.H., M.J.V., M.J.B.T.); Medical Center Haaglanden, Landsteiner Institute, Lijnbaan 32, 2512 VK The Hague, PO BOX 432, 2501 CK, The Hague, The Netherlands (T.V.); Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333ZA Leiden, The Netherlands (L.D., M.J.B.T.); Department of Neurology, VU Medical Center, de Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands (J.C.R.); Amsterdam Medical Center, Department of Neurology, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands (J.C.R.); Department of Neuro-oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands (M.J.v.d.B.)
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Dirven L, van den Bent MJ, Bottomley A, van der Meer N, van der Holt B, Vos MJ, Walenkamp AME, Beerepoot LV, Hanse MCJ, Reijneveld JC, Otten A, de Vos FYFL, Smits M, Bromberg JEC, Taal W, Taphoorn MJB. The impact of bevacizumab on health-related quality of life in patients treated for recurrent glioblastoma: results of the randomised controlled phase 2 BELOB trial. Eur J Cancer 2015; 51:1321-30. [PMID: 25899986 DOI: 10.1016/j.ejca.2015.03.025] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND The BELOB study, a randomised controlled phase 2 trial comparing lomustine, bevacizumab and combined lomustine and bevacizumab in patients with recurrent glioblastoma, showed that the 9-month overall survival rate was most promising in the combination arm. Here we report the health-related quality of life (HRQoL) results, a secondary trial end-point. METHODS HRQoL was measured at baseline and every 6weeks until progression using the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire (QLQ-C30) and brain module (QLQ-BN20). HRQoL was assessed over time for five preselected scales (global health (GH), physical (PF) and social functioning (SF), motor dysfunction (MD) and communication deficit (CD)). Moreover, mean changes in HRQoL from baseline until progression were determined. RESULTS 138/148 patients with at least a baseline HRQoL assessment were analysed. Over time, HRQoL remained relatively stable in all treatment arms for all five scales, at least during the first three treatment cycles. More than half (54-61%) of the patients showed stable (<10 point change) or improved (⩾10 point change) HRQoL during their progression-free time, except for SF (43%), irrespective of treatment arm. Deterioration of mean HRQoL was most profound at disease progression for all scales except SF, which deteriorated earlier in disease course. Compared to baseline, 40% of patients had clinically relevant (⩾10 points) worse GH, PF and SF, while 44% and 31% had increased MD and CD at disease progression, irrespective of treatment arm. CONCLUSIONS Bevacizumab, whether or not in combination with lomustine, did not negatively affect HRQoL in patients treated for recurrent glioblastoma in this randomised study.
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Affiliation(s)
- Linda Dirven
- VU University Medical Center, Department of Neurology, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
| | - Martin J van den Bent
- Erasmus MC Cancer Institute, Department of Neuro-oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Andrew Bottomley
- European Organisation for Research and Treatment of Cancer, Quality of Life Department, Emmanuel Mounierlaan 83, 1200 Brussels, Belgium
| | - Nelly van der Meer
- Erasmus MC Cancer Institute, Clinical Trial Center, PO Box 2040 3000 CA Rotterdam, The Netherlands
| | - Bronno van der Holt
- Erasmus MC Cancer Institute, Clinical Trial Center, PO Box 2040 3000 CA Rotterdam, The Netherlands
| | - Maaike J Vos
- Medical Center Haaglanden, Department of Neurology, PO Box 432, 2501 CK The Hague, The Netherlands
| | - Annemiek M E Walenkamp
- University Medical Center Groningen, Department of Medical Oncology, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | - Laurens V Beerepoot
- St. Elisabeth Hospital, Department of Oncology, PO Box 90151 5000 LC Tilburg, The Netherlands
| | - Monique C J Hanse
- Catharina Hospital Eindhoven, Department of Neurology, PO Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Jaap C Reijneveld
- VU University Medical Center, Department of Neurology, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Academic Medical Center, Department of Neurology, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Aja Otten
- Isala Kliniek, Department of Neurology, PO Box 10400, 8000 GK Zwolle, The Netherlands
| | - Filip Y F L de Vos
- University Medical Center Utrecht, Department of Medical Oncology, Utrecht clinical trial center, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Marion Smits
- Erasmus MC - University Medical Center Rotterdam, Department of Radiology, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jacoline E C Bromberg
- Erasmus MC Cancer Institute, Department of Neuro-oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Walter Taal
- Erasmus MC Cancer Institute, Department of Neuro-oncology, PO Box 5201, 3008 AE Rotterdam, The Netherlands
| | - Martin J B Taphoorn
- VU University Medical Center, Department of Neurology, PO Box 7057, 1007 MB Amsterdam, The Netherlands; Medical Center Haaglanden, Department of Neurology, PO Box 432, 2501 CK The Hague, The Netherlands
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Koekkoek JAF, Dirven L, Heimans JJ, Postma TJ, Vos MJ, Reijneveld JC, Taphoorn MJB. Seizure reduction in a low-grade glioma: more than a beneficial side effect of temozolomide. J Neurol Neurosurg Psychiatry 2015; 86:366-73. [PMID: 25055819 DOI: 10.1136/jnnp-2014-308136] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Seizures are a common symptom in patients with low-grade glioma (LGG), negatively influencing quality of life, if uncontrolled. Besides antiepileptic drugs, antitumour treatment might contribute to a reduction in seizure frequency. The aim of this study was to determine the effect of temozolomide (TMZ) chemotherapy on seizure frequency, to identify factors associated with post-treatment seizure reduction and to analyse the prognostic value of seizure reduction for survival. METHODS We retrospectively reviewed adult patients with supratentorial LGG and epilepsy who received chemotherapy with TMZ as initial treatment or for progressive disease in two hospitals (VUmc Amsterdam; MCH The Hague) between 2002 and 2012. RESULTS We identified 104 patients with LGG with epilepsy who had received TMZ. Uncontrolled epilepsy in the 3 months preceding chemotherapy was present in 66 of 104 (63.5%) patients. A ≥ 50% reduction in seizure frequency after 6 months occurred in 29 of 66 (43.9%) patients. Focal symptoms at presentation (OR 6.55; 95% CI 1.45 to 32.77; p = 0.015) appeared to be positively associated with seizure reduction. Seizure reduction was an independent prognostic factor for progression-free survival (HR 0.32; 95% CI 0.15 to 0.66; p = 0.002) and overall survival (HR 0.33; 95% CI 0.14 to 0.79; p = 0.013), along with a histological diagnosis of oligodendroglioma (HR 0.38; 95% CI 0.17 to 0.86; p = 0.021). Objective responses on MRI were similar for patients with and without seizure reduction. CONCLUSIONS TMZ may contribute to an important reduction in seizure frequency in patients with LGG. Seizure reduction following TMZ treatment has prognostic significance and may serve as an important clinical outcome measure in patients with LGG.
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Affiliation(s)
- Johan A F Koekkoek
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Linda Dirven
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jan J Heimans
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Tjeerd J Postma
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Maaike J Vos
- Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands
| | - Jaap C Reijneveld
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Martin J B Taphoorn
- Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands Department of Neurology, Medical Centre Haaglanden, The Hague, The Netherlands
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Abstract
CONTEXT SHBG is known as the major sex steroid binding protein in plasma, and it regulates the bioavailability of both T and estradiol levels required for effects on target tissues. We identified a man with an undetectable SHBG concentration in combination with low total T. He presented with a 7-year history of muscle weakness, fatigue, and a low libido. OBJECTIVES To determine the cause of the SHBG deficiency, we employed both genetic analysis of the SHBG gene and transgene SHBG expression. RESULTS Genetic analysis identified a novel homozygous missense mutation that was predicted to be deleterious for protein function. Transgene expression showed that the mutation resulted in a block in SHBG secretion accompanied by increased expression of the endoplasmic reticulum molecular chaperone HSPA5. The mutation results in accumulation of the mutant SHBG within the cell and failure to secrete the mutant protein. Screening of family members identified one sister who was also deficient for SHBG. CONCLUSIONS We have identified a family with a missense mutation within the SHBG gene, which results in a complete deficiency of plasma SHBG in the homozygous state. Although total T level was low in the male patient, it did not interfere with normal gonadal development and spermatogenesis, suggesting a limited role of SHBG in sexual maturation and male physiology.
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Affiliation(s)
- M J Vos
- Departments of Clinical Chemistry (M.J.V., J.M.M.R.) and Internal Medicine (G.S.M., P.H.P.G.), Isala Hospital, 8025 AB Zwolle, The Netherlands; and Department of Cell Biology (W.B.), University of Groningen, University Medical Center Groningen, 9713 AV Groningen, The Netherlands
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Koekkoek JAF, Kerkhof M, Dirven L, Heimans JJ, Postma TJ, Vos MJ, Bromberg JEC, van den Bent MJ, Reijneveld JC, Taphoorn MJB. Withdrawal of antiepileptic drugs in glioma patients after long-term seizure freedom: design of a prospective observational study. BMC Neurol 2014; 14:157. [PMID: 25124385 PMCID: PMC4236644 DOI: 10.1186/s12883-014-0157-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 07/25/2014] [Indexed: 12/22/2022] Open
Abstract
Background Epilepsy is common in patients with a glioma. Antiepileptic drugs (AEDs) are the mainstay of epilepsy treatment, but may cause side effects and may negatively impact neurocognitive functioning and quality of life. Besides antiepileptic drugs, anti-tumour treatment, which currently consists of surgery, radiotherapy and/or chemotherapy, may contribute to seizure control as well. In glioma patients with seizure freedom after anti-tumour therapy the question emerges whether AEDs should be continued, particularly in the case where anti-tumour treatment has been successful. We propose to explore the possibility of AED withdrawal in glioma patients with long-term seizure freedom after anti-tumour therapy and without signs of tumour progression. Methods/Design We initiate a prospective, observational study exploring the decision-making process on the withdrawal or continuation of AEDs in low-grade and anaplastic glioma patients with stable disease and prolonged seizure freedom after anti-tumour treatment, and the effects of AED withdrawal or continuation on seizure freedom. We recruit participants through the outpatient clinics of three tertiary referral centers for brain tumour patients in The Netherlands. The patient and the treating physician make a shared decision to either withdraw or continue AED treatment. Over a one-year period, we aim to include 100 glioma patients. We expect approximately half of the participants to be willing to withdraw AEDs. The primary outcome measures are: 1) the outcome of the shared-decision making on AED withdrawal or continuation, and decision related arguments, and 2) seizure freedom at 12 months and 24 months of follow-up. We will also evaluate seizure type and frequency in case of seizure recurrence, as well as neurological symptoms, adverse effects related to AED treatment or withdrawal, other anti-tumour treatments and tumour progression. Discussion This study addresses two issues that are currently unexplored. First, it will explore the willingness to withdraw AEDs in glioma patients, and second, it will assess the risk of seizure recurrence in case AEDs are withdrawn in this specific patient population. This study aims to contribute to a more tailored AED treatment, and prevent unnecessary and potentially harmful use of AEDs in glioma patients.
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Vos MJ, Stam CJ, Ronner HE, Wolf NI. Epilepsy with central spikes provoked by fever with a benign disease course. Clin Neurophysiol 2011; 122:2110-2. [DOI: 10.1016/j.clinph.2011.03.006] [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: 12/02/2010] [Revised: 03/07/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
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Vos MJ, Berkhof J, Hoekstra OS, Bosma I, Sizoo EM, Heimans JJ, Reijneveld JC, Sanchez E, Lagerwaard FJ, Buter J, Noske DP, Postma TJ. MRI and thallium-201 SPECT in the prediction of survival in glioma. Neuroradiology 2011; 54:539-46. [DOI: 10.1007/s00234-011-0908-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 07/01/2011] [Indexed: 10/18/2022]
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Bosma I, Reijneveld JC, Douw L, Vos MJ, Postma TJ, Aaronson NK, Muller M, Vandertop WP, Slotman BJ, Taphoorn MJB, Heimans JJ, Klein M. Health-related quality of life of long-term high-grade glioma survivors. Neuro Oncol 2008; 11:51-8. [PMID: 18617599 DOI: 10.1215/15228517-2008-049] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The objective of this study was to compare the health-related quality of life (HRQOL) of long-term to short-term high-grade glioma (HGG) survivors, determine the prognostic value of HRQOL for overall survival, and determine the effect of tumor recurrence on HRQOL for long-term survivors. Following baseline assessment (after surgery, before radiotherapy), self-perceived HRQOL (using the Medical Outcomes Study Short Form 36 [SF-36]) and brain tumor-specific symptoms (using the 20-item Brain Cancer Module) were assessed every 4 months until 16 months after histological diagnosis. Kaplan-Meier survival analysis and the Cox proportional hazards model were performed to estimate overall survival of patients with impaired scores on the aggregated SF-36 higher-order summary scores measuring physical functioning on a physical component scale and on a mental component scale (MCS). Sixteen patients with a short-term survival (baseline and 4-month follow-up) and 16 with a long-term survival (follow-up until 16 months after diagnosis) were selected out of 68 initially recruited HGG patients. At baseline, the short-term and long-term survivors did not differ in their HRQOL. Between baseline and the 4-month follow-up, HRQOL of short-term survivors deteriorated, whereas the long-term survivors improved to a level comparable to healthy controls. Patients with impaired mental functioning (MCS) at baseline had a shorter median survival than patients with normal functioning. After accounting for differences in patient and tumor characteristics, however, mental functioning was not independently related to poorer overall survival. Not surprisingly, in the group of long-term survivors, the five patients with recurrence had a more compromised HRQOL at the 16-month follow-up compared to the 11 patients without recurrence. We concluded that baseline HRQOL is not related to duration of survival and that long-term survivors show improvement of HRQOL to a level comparable to that of the healthy.
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Affiliation(s)
- Ingeborg Bosma
- VU University Medical Center, Department of Neurology, Amsterdam, the Netherlands.
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Vos MJ, Tony BN, Hoekstra OS, Postma TJ, Heimans JJ, Hooft L. Systematic review of the diagnostic accuracy of 201Tl single photon emission computed tomography in the detection of recurrent glioma. Nucl Med Commun 2007; 28:431-9. [PMID: 17460533 DOI: 10.1097/mnm.0b013e328155d131] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [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: 11/26/2022]
Abstract
OBJECTIVE To determine the diagnostic accuracy of 201Tl SPECT in the detection of tumour recurrence in patients with previous radiotherapy for supratentorial glioma. METHODS The databases of PubMed and Embase were searched for relevant studies. Two reviewers independently selected and extracted data on study characteristics, quality and accuracy of studies. Studies were included if they comprised at least six eligible patients who underwent 201Tl SPECT (index test) and in whom (histo)pathological confirmation (reference test) of the suspected brain lesion was obtained. Because of the methodological and statistical heterogeneity of the included studies, a quantitative meta-analysis was not performed. Instead, for every individual study, the sensitivity, specificity and diagnostic odds ratio of 201Tl SPECT was calculated. RESULTS Eight studies met the inclusion criteria. Only one was considered of high methodological quality. Methodological limitations referred most notably to blinding and patient selection. The diagnostic odds ratio was greater than 1 in all studies included, with a broad range (2-351), and relatively wide 95% confidence intervals. The sensitivity of 201Tl SPECT ranged from 0.43 to 1.00, and the specificity from 0.25 to 1.00. CONCLUSION 201Tl SPECT seems a valuable method in the detection of tumour recurrence in patients treated with radiotherapy for supratentorial glioma. However, the evidence is not very robust because of the low quality and high heterogeneity of the studies included. Future studies are warranted to further explore the diagnostic potential of 201Tl SPECT, and to determine optimum thresholds for the detection of glioma recurrence.
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Affiliation(s)
- Maaike J Vos
- Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands.
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Bosma I, Vos MJ, Heimans JJ, Taphoorn MJB, Aaronson NK, Postma TJ, van der Ploeg HM, Muller M, Vandertop WP, Slotman BJ, Klein M. The course of neurocognitive functioning in high-grade glioma patients. Neuro Oncol 2006; 9:53-62. [PMID: 17018697 PMCID: PMC1828106 DOI: 10.1215/15228517-2006-012] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.4] [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: 11/19/2022] Open
Abstract
We evaluated the course of neurocognitive functioning in newly diagnosed high-grade glioma patients and specifically the effect of tumor recurrence. Following baseline assessment (after surgery and before radiotherapy), neurocognitive functioning was evaluated at 8 and 16 months. Neurocognitive summary measures were calculated to detect possible deficits in the domains of (1) information processing, (2) psychomotor function, (3) attention, (4) verbal memory, (5) working memory, and (6) executive functioning. Repeated-measures analyses of covariance were used to evaluate changes over time. Thirty-six patients were tested at baseline only. Follow-up data were obtained for 32 patients: 14 had a follow-up at 8 months, and 18 had an additional follow-up at 16 months. Between baseline and eight months, patients deteriorated in information-processing capacity, psychomotor speed, and attentional functioning. Further deterioration was observed between 8 and 16 months. Of 32 patients, 15 suffered from tumor recurrence before the eight-month follow-up. Compared with recurrence-free patients, not only did patients with recurrence have lower information-processing capacity, psychomotor speed, and executive functioning, but they also exhibited a more pronounced deterioration between baseline and eight-month follow-up. This difference could be attributed to the use of antiepileptic drugs in the patient group with recurrence. This study showed a marked decline in neurocognitive functioning in HGG patients in the course of their disease. Patients with tumor progression performed worse on neurocognitive tests than did patients without progression, which could be attributed to the use of antiepileptic drugs. The possibility of deleterious effects is important to consider when prescribing antiepileptic drug treatment.
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Affiliation(s)
- Ingeborg Bosma
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
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Vos MJ, Berkhof J, Postma TJ, Hoekstra OS, Barkhof F, Heimans JJ. Thallium-201 SPECT: the optimal prediction of response in glioma therapy. Eur J Nucl Med Mol Imaging 2005; 33:222-7. [PMID: 16193315 DOI: 10.1007/s00259-005-1883-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2005] [Accepted: 06/08/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to estimate 201Tl SPECT and CT-MRI cut-off values that lead to a validated prognostic classification for the end-point overall survival, in order to discriminate glioma patients with good and poor prognosis at an early stage during chemotherapeutic treatment. METHODS We studied patients who underwent 201Tl SPECT and CT-MRI before and after two courses of chemotherapy. Cut-off values were retrieved from the Cox model. Patients were classified according to the computed cut-off values, creating subgroups of patients with different prognosis in terms of survival [tumour regression (TR); stable disease (SD); tumour progression (TP)]. The differences between the subgroups were assessed by Kaplan-Meier analyses. The predictive performance of the classification procedure was evaluated by a leave-one-out cross-validation method. RESULTS 201Tl SPECT classified 41% of the patients as SD, 25% as TR and 34% as TP. CT-MRI classified 82% of the patients as SD, and only 4% and 14% as TR and TP, respectively. Of those patients with a relatively long overall survival (i.e. > or =16 months), cross-validation estimates of 201Tl SPECT classification rates were 50% TR and 50% SD, and cross-validation estimates of CT-MRI classification rates were 7% TR, 72% SD, and 21% TP. CONCLUSION We constructed a 201Tl SPECT model that makes it possible to identify glioma patients with a good or a poor prognosis at an early stage during chemotherapeutic treatment. With this model, accurate predictions can be made with regard to the expected duration of survival.
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Affiliation(s)
- Maaike J Vos
- Department of Neurology, VU University Medical Centre, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Vos MJ, Turowski B, Zanella FE, Paquis P, Siefert A, Hideghéty K, Haselsberger K, Grochulla F, Postma TJ, Wittig A, Heimans JJ, Slotman BJ, Vandertop WP, Sauerwein W. Radiologic findings in patients treated with boron neutron capture therapy for glioblastoma multiforme within EORTC trial 11961. Int J Radiat Oncol Biol Phys 2005; 61:392-9. [PMID: 15667958 DOI: 10.1016/j.ijrobp.2004.06.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Revised: 05/11/2004] [Accepted: 06/06/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess the occurrence and development of cerebral radiologic changes (cerebral atrophy and white matter lesions) in patients treated with boron neutron capture therapy (BNCT) for primary supratentorial glioblastoma multiforme within the European Organization for Research and Treatment of Cancer (EORTC) trial 11961. METHODS AND MATERIALS Magnetic resonance imaging (MRI) scans were performed before and after surgery and at 1 week and 2, 4.5, 6, 9, 12, 15, and 18 months after BNCT. For the current study, MRI scans of all assessable patients were analyzed, with emphasis on cerebral atrophy and white matter abnormalities. RESULTS Twenty-six patients had been treated with BNCT according to the EORTC trial 11961, of whom 24 were assessable for the current study. The development of possible BNCT-related cerebral changes was observed in 12 patients (50%), 10 of whom had cerebral atrophy (42%) and 10 white matter changes (42%) after a median interval of 7.5 and 4.5 months, respectively. CONCLUSION In this study, cerebral radiologic changes appeared in 50% of patients within the first year after BNCT. Although a clear correlation between the BNCT dose and the development of cerebral changes could not be demonstrated, a relationship between the occurrence of these radiologic abnormalities and BNCT seems likely.
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Affiliation(s)
- Maaike J Vos
- Department of Neurology, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.
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Tony B, Vos MJ, Berkhof J, Postma TJ, van Lingen A, Heimans JJ, Hoekstra OS. Interobserver variability in the semi-quantitative assessment of 201Tl SPECT in cerebral gliomas. Nucl Med Commun 2005; 26:45-8. [PMID: 15604947 DOI: 10.1097/00006231-200501000-00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 11/27/2022]
Abstract
OBJECTIVES 201Tl SPECT is used successfully in the diagnosis of recurrent supratentorial glioma and in the evaluation of its response to chemotherapy. However, different methods are used to measure relative tracer uptake in tumour and background. The objective of this study was to assess the interobserver variability of such methods, and, if possible, to provide nomograms for data conversion. METHODS Using baseline and follow-up SPECT scans from 20 patients with recurrent glioma treated with chemotherapy, three observers applied manual and semi-automatic ROI techniques to define activity in tumour (manual, semi-automatic) as well as in reference tissue (scalp, mirror, hemisphere). RESULTS All tumour ROI techniques had intra-class correlation coefficients (ICC) > or = 0.80 indicating almost perfect agreement. The main source of variation with the manual techniques was the tumour intensity; with the semi-automatic method, observer agreement was independent of the level of tumour activity. Agreement for background ROIs was also adequate, but the mirror technique tended to perform poorer at follow-up SPECT scans (ICC 0.68). Measurement of fractional change during treatment revealed no significant differences between observers for any of the investigated ROI methodology variants. Conversion of quantitative methods to measure fractional change was possible using linear regression analysis. CONCLUSION 201Tl SPECT in recurrent glioma appears to be a robust method with acceptable interobserver variability. The clinical field in neuro-oncology should consider including 201Tl SPECT parameters in monitoring response to chemotherapy.
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Affiliation(s)
- Ban Tony
- Department of Nuclear Medicine and PET Research bNeurology, VU University Medical Centre, Amsterdam, The Netherlands
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Vos MJ, Postma TJ, Martens F, Uitdehaag BMJ, Blankenstein MA, Vandertop WP, Slotman BJ, Heimans JJ. Serum levels of S-100B protein and neuron-specific enolase in glioma patients: a pilot study. Anticancer Res 2004; 24:2511-4. [PMID: 15330206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Serum levels of S-100B protein (S-100B) and neuron-specific enolase (NSE) are elevated after various cerebral injuries and are considered markers of central nervous system damage. In brain tumor patients, literature data on the prognostic value of serum S-100(B) and NSE levels are scarse and conflicting. PATIENTS AND METHODS We assessed serum S-100B and NSE levels in 20 consecutive cerebral glioma patients, and evaluated serum levels in relation to survival to determine their prognostic value. Kaplan-Meier survival curves were constructed for patients with "high" (> median value) versus "low" (< or = median value) serum S-100B and NSE levels. RESULTS A statistically significant shorter survival was found in patients with high serum S-100B levels, whereas a similar classification of patients based on serum NSE levels demonstrated no statistically significant difference in survival between the two groups. CONCLUSION These preliminary data suggest that serum S-100B might be a prognostic variable in cerebral glioma patients. Further study is warranted to evaluate whether serum S-100B is an additional, independent prognostic variable.
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Affiliation(s)
- Maaike J Vos
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands.
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Vos MJ, Hoekstra OS, Barkhof F, Berkhof J, Heimans JJ, van Groeningen CJ, Vandertop WP, Slotman BJ, Postma TJ. Thallium-201 single-photon emission computed tomography as an early predictor of outcome in recurrent glioma. J Clin Oncol 2003; 21:3559-65. [PMID: 12913097 DOI: 10.1200/jco.2003.01.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [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: 11/20/2022] Open
Abstract
PURPOSE With limited response rates and potential toxicity of chemotherapeutic treatment in patients with recurrent glioma, reliable response assessment is essential. Currently, the assessment of treatment response in glioma patients is based on the combination of radiologic and clinical findings. However, response monitoring with computed tomography (CT) or magnetic resonance imaging (MRI) is hampered by several pitfalls and is prone to interobserver variability. The aim of this study was to establish the value of thallium-201 single-photon emission computed tomography (201Tl-SPECT) as a predictor of overall survival and response to chemotherapy in recurrent glioma, and to compare the value of 201Tl-SPECT with that of CT and MRI. PATIENTS AND METHODS We studied patients who underwent CT or MRI and 201Tl-SPECT before chemotherapy (n = 57), and patients who also had undergone CT or MRI and 201Tl-SPECT after two courses of chemotherapy (n = 44). The value of the radiologic variables (CT-MRI tumor size, 201Tl-SPECT tumor size, and maximal tumor intensity) at baseline and at follow-up in predicting overall survival, and the percentage of patients alive and progression-free at 6 months (APF6) were examined using Cox regression and logistic regression analysis. RESULTS Both at baseline and at follow-up, 201Tl-SPECT maximal tumor intensity was the strongest predictive variable and was inversely related to overall survival and APF6. In particular, progression of maximal tumor intensity after two courses of chemotherapy was a powerful predictor of poor outcome. CONCLUSION 201Tl-SPECT is superior to conventional CT-MRI in the early prediction of overall survival and response to chemotherapy in patients with recurrent glioma.
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Affiliation(s)
- Maaike J Vos
- Department of Neurology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands.
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Vos MJ, Uitdehaag BMJ, Barkhof F, Heimans JJ, Baayen HC, Boogerd W, Castelijns JA, Elkhuizen PHM, Postma TJ. Interobserver variability in the radiological assessment of response to chemotherapy in glioma. Neurology 2003; 60:826-30. [PMID: 12629241 DOI: 10.1212/01.wnl.0000049467.54667.92] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [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: 11/15/2022] Open
Abstract
OBJECTIVE To assess the interobserver variability in the radiologic assessment of response to chemotherapy in patients with recurrent glioma. METHODS Five clinicians with experience in the treatment and follow-up of patients with glioma measured tumor size in 20 pairs of CT and 20 pairs of MRI scans of 35 patients who had been treated with chemotherapy for recurrent glioma. Tumor size was defined as the product of the two largest perpendicular enhancing tumor diameters on the postcontrast images. To assess the interobserver variability in the measurements of tumor size, and in the classification according to the widely used Macdonald response criteria, intraclass correlation coefficients (ICC) and weighted kappa values were calculated. RESULTS Substantial interobserver agreement was noted in the manual, two-dimensional measurements of tumor size on CT and MRI in patients treated with chemotherapy for recurrent glioma (overall ICC 0.64). Classification of response to chemotherapy according to the Macdonald criteria resulted in moderate interobserver agreement (overall weighted kappa 0.51). In 65% of evaluated CT and in 55% of evaluated MRI studies, no complete consensus was found for the categorical tumor response measurement. CONCLUSION The radiologic assessment of response to chemotherapy in patients with recurrent glioma is susceptible to considerable interobserver variability. This underlines the difficulties that arise in scoring response to chemotherapy by conventional radiologic techniques.
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Affiliation(s)
- M J Vos
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands.
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Claessen FA, Vos MJ, Simoons-Smit AM, Debets-Ossenkopp YJ, Perenboom RM. [Manifestations of histoplasmosis]. Ned Tijdschr Geneeskd 2000; 144:1201-5. [PMID: 10897298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Two patients, a 34-year old man-to-woman transsexual and a 32-year-old man, with aids presented with pulmonary symptoms, fever, serious weight loss and an oral ulcer. A third patient, a 16-year-old boy, had signs of transverse myelitis and meningitis without immunodeficiency. All were South American citizens and had disseminated histoplasmosis. After antifungal treatment they recovered, although the third patient remained a wheelchair user. If pulmonary or miliary tuberculosis is suspected in a patient originating from South America, histoplasmosis should be considered. Oral ulcers and skin lesions can be diagnostic clues. Specific stainings of direct preparations and longer-lasting cultures of various materials, especially of biopsy samples, then provide the diagnosis.
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Affiliation(s)
- F A Claessen
- Afd. Inwendige geneeskunde, Academisch Ziekenhuis Vrije Universiteit, Amsterdam
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Vos MJ, Debets-Ossenkopp YJ, Claessen FA, Hazenberg GJ, Heimans JJ. Cerebellar and medullar histoplasmosis. Neurology 2000; 54:1441. [PMID: 10798952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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