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Rossi S, Barresi S, Colafati GS, Genovese S, Tancredi C, Costabile V, Patrizi S, Giovannoni I, Asioli S, Poliani PL, Gardiman MP, Cardoni A, Del Baldo G, Antonelli M, Gianno F, Piccirilli E, Catino G, Martucci L, Quacquarini D, Toni F, Melchionda F, Viscardi E, Zucchelli M, Dal Pos S, Gatti E, Liserre R, Schiavello E, Diomedi-Camassei F, Carai A, Mastronuzzi A, Gessi M, Giannini C, Novelli A, Onetti Muda A, Miele E, Alesi V, Alaggio R. PATZ1-Rearranged Tumors of the Central Nervous System: Characterization of a Pediatric Series of Seven Cases. Mod Pathol 2024; 37:100387. [PMID: 38007157 DOI: 10.1016/j.modpat.2023.100387] [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: 08/14/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 11/27/2023]
Abstract
PATZ1-rearranged sarcomas are well-recognized tumors as part of the family of round cell sarcoma with EWSR1-non-ETS fusions. Whether PATZ1-rearranged central nervous system (CNS) tumors are a distinct tumor type is debatable. We thoroughly characterized a pediatric series of PATZ1-rearranged CNS tumors by chromosome microarray analysis (CMA), DNA methylation analysis, gene expression profiling and, when frozen tissue is available, optical genome mapping (OGM). The series consisted of 7 cases (M:F=1.3:1, 1-17 years, median 12). On MRI, the tumors were supratentorial in close relation to the lateral ventricles (intraventricular or iuxtaventricular), preferentially located in the occipital lobe. Two major histologic groups were identified: one (4 cases) with an overall glial appearance, indicated as "neuroepithelial" (NET) by analogy with the corresponding methylation class (MC); the other (3 cases) with a predominant spindle cell sarcoma morphology, indicated as "sarcomatous" (SM). A single distinct methylation cluster encompassing both groups was identified by multidimensional scaling analysis. Despite the epigenetic homogeneity, unsupervised clustering analysis of gene expression profiles revealed 2 distinct transcriptional subgroups correlating with the histologic phenotypes. Interestingly, genes implicated in epithelial-mesenchymal transition and extracellular matrix composition were enriched in the subgroup associated to the SM phenotype. The combined use of CMA and OGM enabled the identification of chromosome 22 chromothripsis in all cases suitable for the analyses, explaining the physical association of PATZ1 to EWSR1 or MN1. Six patients are currently disease-free (median follow-up 30 months, range 12-92). One patient of the SM group developed spinal metastases at 26 months from diagnosis and is currently receiving multimodal therapy (42 months). Our data suggest that PATZ1-CNS tumors are defined by chromosome 22 chromothripsis as causative of PATZ1 fusion, show peculiar MRI features (eg, relation to lateral ventricles, supratentorial frequently posterior site), and, although epigenetically homogenous, encompass 2 distinct histologic and transcriptional subgroups.
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Affiliation(s)
- Sabrina Rossi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Sabina Barresi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giovanna Stefania Colafati
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Neuroscience, Imaging and Clinical Sciences (DNISC), University "Gabriele D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Silvia Genovese
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chantal Tancredi
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Valentino Costabile
- Multimodal Research Area, Unit of Microbiology and Diagnostics in Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Patrizi
- Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Isabella Giovannoni
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM)-Surgical Pathology Section-Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Pietro Luigi Poliani
- Pathology Unit, San Raffaele Hospital Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Marina Paola Gardiman
- Surgical Pathology and Cytopathology Unit, Department of Medicine, University Hospital of Padua, Padua, Italy
| | - Antonello Cardoni
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giada Del Baldo
- Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Manila Antonelli
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy
| | - Francesca Gianno
- Department of Radiology, Oncology and Anatomic Pathology, University La Sapienza, Rome, Italy; IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Eleonora Piccirilli
- Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Neuroscience, Imaging and Clinical Sciences (DNISC), University "Gabriele D'Annunzio" of Chieti-Pescara, Chieti, Italy
| | - Giorgia Catino
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Licia Martucci
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Denise Quacquarini
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Toni
- Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fraia Melchionda
- SSD Oncoematologia Pediatrica, IRCCS AOU Policlinico S.Orsola, Bologna, Italy
| | - Elisabetta Viscardi
- Department of Pediatrics, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Mino Zucchelli
- Paediatric Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Sandro Dal Pos
- Department of Radiology, Azienda Ospedale-Università di Padova, Padova, Italy
| | - Enza Gatti
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Andrea Carai
- Neurosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Gessi
- Neuropathology Unit, Pathology Division, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica S.Cuore, Rome, Italy
| | - Caterina Giannini
- Department of Biomedical and Neuromotor Sciences (DIBINEM)-Surgical Pathology Section-Alma Mater Studiorum - University of Bologna, Bologna, Italy; Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota
| | - Antonio Novelli
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Evelina Miele
- Onco-Hematology, Cell Therapy, Gene Therapies and Hemopoietic Transplant, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Viola Alesi
- Laboratory of Medical Genetics, Translational Cytogenomics Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rita Alaggio
- Pathology Unit, Department of Laboratories, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy; Department of Medico-surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
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Branzoli F, Liserre R, Deelchand DK, Poliani PL, Bielle F, Nichelli L, Sanson M, Lehéricy S, Marjańska M. Neurochemical Differences between 1p/19q Codeleted and Noncodeleted IDH-mutant Gliomas by in Vivo MR Spectroscopy. Radiology 2023; 308:e223255. [PMID: 37668523 PMCID: PMC10546286 DOI: 10.1148/radiol.223255] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
Background Noninvasive identification of glioma subtypes is important for optimizing treatment strategies. Purpose To compare the in vivo neurochemical profiles between isocitrate dehydrogenase (IDH) 1-mutant 1p/19q codeleted gliomas and their noncodeleted counterparts measured by MR spectroscopy at 3.0 T with a point-resolved spectroscopy (PRESS) sequence optimized for D-2-hydroxyglutarate (2HG) detection. Materials and Methods Adults with IDH1-mutant gliomas were retrospectively included for this study from two university hospitals (inclusion period: January 2015 to July 2016 and September 2019 to June 2021, respectively) based on availability of 1p/19q codeletion status and a PRESS acquisition optimized for 2HG detection (echo time, 97 msec) at 3.0 T before any treatment. Spectral analysis was performed using LCModel and a simulated basis set. Metabolite quantification was performed using the water signal as a reference and correcting for water and metabolite longitudinal and transverse relaxation time constants. Concentration ratios were computed using total creatine (tCr) and total choline. A two-tailed unpaired t test was used to compare metabolite concentrations obtained in codeleted versus noncodeleted gliomas, accounting for multiple comparisons. Results Thirty-one adults (mean age, 39 years ± 8 [SD]; 19 male) were included, and 19 metabolites were quantified. Cystathionine concentration was higher in codeleted (n = 13) than noncodeleted (n = 18) gliomas when quantification was performed using the water signal or tCr as references (2.33 mM ± 0.98 vs 0.93 mM ± 0.94, and 0.34 mM ± 0.14 vs 0.14 mM ± 0.14, respectively; both P < .001). The sensitivity and specificity of PRESS to detect codeletion by means of cystathionine quantification were 92% and 61%, respectively. Other metabolites did not show evidence of a difference between groups (P > .05). Conclusion Higher cystathionine levels were detected in IDH1-mutant 1p/19q codeleted gliomas than in their noncodeleted counterparts with use of a PRESS sequence optimized for 2HG detection. Of 19 metabolites quantified, only cystathionine showed evidence of a difference in concentration between groups. Clinical trial registry no. NCT01703962 © RSNA, 2023 See also the editorial by Lin in this issue.
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Affiliation(s)
- Francesca Branzoli
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Roberto Liserre
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Dinesh K. Deelchand
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Pietro Luigi Poliani
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Franck Bielle
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Lucia Nichelli
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Marc Sanson
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Stéphane Lehéricy
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
| | - Małgorzata Marjańska
- From the Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, Paris Brain Institute–L’Institut du Cerveau et de la Moelle Épinière (ICM), 47 boulevard de l’Hôpital, 75013 Paris, France (F. Branzoli, L.N., M.S., S.L.); Center for Neuroimaging Research (CENIR), L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (F. Branzoli, S.L.); Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy (R.L.); Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minn (D.K.D., M.M.); Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy (P.L.P.); Laboratory R Escourolle (F. Bielle), Department of Neuroradiology (L.N., S.L.), and Department of Neurology 2 (M.S.), University Hospital La Pitié-Salpêtrière-Charles Foix, AP-HP, Paris, France; and Onconeurotek Tumor Bank, L’Institut du Cerveau et de la Moelle Épinière (ICM), Paris, France (M.S.)
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Liserre R, Branzoli F, Pagani F, Gryzik M, Cominelli M, Miele E, Marjańska M, Doglietto F, Poliani PL. Exceptionally rare IDH1-mutant adult medulloblastoma with concurrent GNAS mutation revealed by in vivo magnetic resonance spectroscopy and deep sequencing. Acta Neuropathol Commun 2023; 11:47. [PMID: 36941703 PMCID: PMC10029199 DOI: 10.1186/s40478-023-01531-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/17/2023] [Indexed: 03/23/2023] Open
Abstract
Medulloblastoma (MB) is the most common malignant brain tumor occurring in childhood and rarely found in adults. Based on transcriptome profile, MB are currently classified into four major molecular groups reflecting a considerable biological heterogeneity: WNT-activated, SHH-activated, group 3 and group 4. Recently, DNA methylation profiling allowed the identification of additional subgroups within the four major molecular groups associated with different clinic-pathological and molecular features. Isocitrate dehydrogenase-1 and 2 (IDH1 and IDH2) mutations have been described in several tumors, including gliomas, while in MB are rarely reported and not routinely investigated. By means of magnetic resonance spectroscopy (MRS), we unequivocally assessed the presence the oncometabolite D-2-hydroxyglutarate (2HG), a marker of IDH1 and IDH2 mutations, in a case of adult MB. Immunophenotypical work-up and methylation profiling assigned the diagnosis of MB, subclass SHH-A, and molecular testing revealed the presence of the non-canonical somatic IDH1(p.R132C) mutation and an additional GNAS mutation, also rarely described in MB. To the best of our knowledge, this is the first reported case of MB simultaneously harboring both mutations. Of note, tumor exhibited a heterogeneous phenotype with a tumor component displaying glial differentiation, with robust GFAP expression, and a component with conventional MB features and selective presence of GNAS mutation, suggesting co-existence of two different major tumor subclones. These findings drew attention to the need for a deeper genetic characterization of MB, in order to get insights into their biology and improve stratification and clinical management of the patients. Moreover, our results underlined the importance of performing MRS for the identification of IDH mutations in non-glial tumors. The use of throughput molecular profiling analysis and advanced medical imaging will certainly increase the frequency with which tumor entities with rare molecular alterations will be identified. Whether these findings have any specific therapeutic implications or prognostic relevance requires further investigations.
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Affiliation(s)
- Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Francesca Branzoli
- Paris Brain Institute - Institut du Cerveau (ICM), Centre de NeuroImagerie de Recherche (CENIR), Paris, France
- Sorbonne Université, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, F-75013, Paris, France
| | - Francesca Pagani
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, P.le Spedali Civili 1, 25125, Brescia, BS, Italy
| | - Magdalena Gryzik
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, P.le Spedali Civili 1, 25125, Brescia, BS, Italy
| | - Manuela Cominelli
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, P.le Spedali Civili 1, 25125, Brescia, BS, Italy
| | - Evelina Miele
- Department of Pediatric Onco-Hematology and Cell and Gene Therapy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Francesco Doglietto
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Catholic University School of Medicine, Rome, Italy
| | - Pietro Luigi Poliani
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, P.le Spedali Civili 1, 25125, Brescia, BS, Italy.
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Guerini AE, Nici S, Magrini SM, Riga S, Toraci C, Pegurri L, Facheris G, Cozzaglio C, Farina D, Liserre R, Gasparotti R, Ravanelli M, Rondi P, Spiazzi L, Buglione M. Adoption of Hybrid MRI-Linac Systems for the Treatment of Brain Tumors: A Systematic Review of the Current Literature Regarding Clinical and Technical Features. Technol Cancer Res Treat 2023; 22:15330338231199286. [PMID: 37774771 PMCID: PMC10542234 DOI: 10.1177/15330338231199286] [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: 04/28/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Possible advantages of magnetic resonance (MR)-guided radiation therapy (MRgRT) for the treatment of brain tumors include improved definition of treatment volumes and organs at risk (OARs) that could allow margin reductions, resulting in limited dose to the OARs and/or dose escalation to target volumes. Recently, hybrid systems integrating a linear accelerator and an magnetic resonance imaging (MRI) scan (MRI-linacs, MRL) have been introduced, that could potentially lead to a fully MRI-based treatment workflow. METHODS We performed a systematic review of the published literature regarding the adoption of MRL for the treatment of primary or secondary brain tumors (last update November 3, 2022), retrieving a total of 2487 records; after a selection based on title and abstracts, the full text of 74 articles was analyzed, finally resulting in the 52 papers included in this review. RESULTS AND DISCUSSION Several solutions have been implemented to achieve a paradigm shift from CT-based radiotherapy to MRgRT, such as the management of geometric integrity and the definition of synthetic CT models that estimate electron density. Multiple sequences have been optimized to acquire images with adequate quality with on-board MR scanner in limited times. Various sophisticated algorithms have been developed to compensate the impact of magnetic field on dose distribution and calculate daily adaptive plans in a few minutes with satisfactory dosimetric parameters for the treatment of primary brain tumors and cerebral metastases. Dosimetric studies and preliminary clinical experiences demonstrated the feasibility of treating brain lesions with MRL. CONCLUSIONS The adoption of an MRI-only workflow is feasible and could offer several advantages for the treatment of brain tumors, including superior image quality for lesions and OARs and the possibility to adapt the treatment plan on the basis of daily MRI. The growing body of clinical data will clarify the potential benefit in terms of toxicity and response to treatment.
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Affiliation(s)
- Andrea Emanuele Guerini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
- Co-first authors
| | - Stefania Nici
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
- Co-first authors
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Stefano Riga
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
| | - Cristian Toraci
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
| | - Ludovica Pegurri
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Giorgio Facheris
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - Claudia Cozzaglio
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
| | - Davide Farina
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Ravanelli
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Paolo Rondi
- Radiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili Hospital, Brescia, Italy
- Co-last author
| | - Michela Buglione
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
- Co-last author
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5
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Branzoli F, Deelchand DK, Liserre R, Poliani PL, Nichelli L, Sanson M, Lehéricy S, Marjańska M. The influence of cystathionine on neurochemical quantification in brain tumor in vivo MR spectroscopy. Magn Reson Med 2022; 88:537-545. [PMID: 35381117 PMCID: PMC9232981 DOI: 10.1002/mrm.29252] [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: 11/09/2021] [Revised: 02/15/2022] [Accepted: 03/10/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To evaluate the ability of the PRESS sequence (TE = 97 ms, optimized for 2-hydroxyglutarate detection) to detect cystathionine in gliomas and the effect of the omission of cystathionine on the quantification of the full neurochemical profile. METHODS Twenty-three subjects with a glioma were retrospectively included based on the availability of both MEGA-PRESS and PRESS acquisitions at 3T, and the presence of the cystathionine signal in the edited MR spectrum. In eight subjects, the PRESS acquisition was performed also in normal tissue. Metabolite quantification was performed using LCModel and simulated basis sets. The LCModel analysis for the PRESS data was performed with and without cystathionine. RESULTS All subjects with glioma had detectable cystathionine levels >1 mM with Cramér-Rao lower bounds (CRLB) <15%. The mean cystathionine concentrations were 3.49 ± 1.17 mM for MEGA-PRESS and 2.20 ± 0.80 mM for PRESS data. Cystathionine concentrations showed a significant correlation between the two MRS methods (r = 0.58, p = .004), and it was not detectable in normal tissue. Using PRESS, 19 metabolites were quantified with CRLB <50% for more than half of the subjects. The metabolites that were significantly (p < .0028) and mostly affected by the omission of cystathionine were aspartate, betaine, citrate, γ-aminobutyric acid (GABA), and serine. CONCLUSIONS Cystathionine was detectable by PRESS in all the selected gliomas, while it was not detectable in normal tissue. The omission from the spectral analysis of cystathionine led to severe biases in the quantification of other neurochemicals that may play key roles in cancer metabolism.
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Affiliation(s)
- Francesca Branzoli
- Paris Brain Institute-Institut du Cerveau (ICM), Center for Neuroimaging Research (CENIR), Paris, France.,Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France
| | - Dinesh K Deelchand
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Pietro Luigi Poliani
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Lucia Nichelli
- Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France
| | - Marc Sanson
- Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neurology 2, Pitié-Salpêtrière Hospital, Paris, France.,Onconeurotek Tumor Bank, Paris, France
| | - Stéphane Lehéricy
- Paris Brain Institute-Institut du Cerveau (ICM), Center for Neuroimaging Research (CENIR), Paris, France.,Sorbonne University, UMR S 1127, Inserm U 1127, CNRS UMR 7225, ICM, Paris, France.,Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France
| | - Małgorzata Marjańska
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
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6
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Abstract
Magnetic resonance spectroscopy (MRS), being able to identify and measure some brain components (metabolites) in pathologic lesions and in normal-appearing tissue, offers a valuable additional diagnostic tool to assess several pediatric neurological diseases. In this review we will illustrate the basic principles and clinical applications of brain proton (H1; hydrogen) MRS (H1MRS), by now the only MRS method widely available in clinical practice. Performing H1MRS in the brain is inherently less complicated than in other tissues (e.g., liver, muscle), in which spectra are heavily affected by magnetic field inhomogeneities, respiration artifacts, and dominating signals from the surrounding adipose tissues. H1MRS in pediatric neuroradiology has some advantages over acquisitions in adults (lack of motion due to children sedation and lack of brain iron deposition allow optimal results), but it requires a deep knowledge of pediatric pathologies and familiarity with the developmental changes in spectral patterns, particularly occurring in the first two years of life. Examples from our database, obtained mainly from a 1.5 Tesla clinical scanner in a time span of 15 years, will demonstrate the efficacy of H1MRS in the diagnosis of a wide range of selected pediatric pathologies, like brain tumors, infections, neonatal hypoxic-ischemic encephalopathy, metabolic and white matter disorders.
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Affiliation(s)
- Roberto Liserre
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Lorenzo Pinelli
- Department of Radiology, Neuroradiology Unit, ASST Spedali Civili University Hospital, Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical-Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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7
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Orzan F, Pagani F, Cominelli M, Triggiani L, Calza S, De Bacco F, Medicina D, Balzarini P, Panciani PP, Liserre R, Buglione M, Fontanella MM, Medico E, Galli R, Isella C, Boccaccio C, Poliani PL. A simplified integrated molecular and immunohistochemistry-based algorithm allows high accuracy prediction of glioblastoma transcriptional subtypes. J Transl Med 2020; 100:1330-1344. [PMID: 32404931 DOI: 10.1038/s41374-020-0437-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/18/2020] [Accepted: 04/19/2020] [Indexed: 12/18/2022] Open
Abstract
Glioblastomas (GBM) can be classified into three major transcriptional subgroups (proneural, mesenchymal, classical), underlying different molecular alterations, prognosis, and response to therapy. However, transcriptional analysis is not routinely feasible and assessment of a simplified method for glioblastoma subclassification is required. We propose an integrated molecular and immunohistochemical approach aimed at identifying GBM subtypes in routine paraffin-embedded material. RNA-sequencing analysis was performed on representative samples (n = 51) by means of a "glioblastoma transcriptional subtypes (GliTS) redux" custom gene signature including a restricted number (n = 90) of upregulated genes validated on the TCGA dataset. With this dataset, immunohistochemical profiles, based on expression of a restricted panel of gene classifiers, were integrated by a machine-learning approach to generate a GliTS based on protein quantification that allowed an efficient GliTS assignment when applied to an extended cohort (n = 197). GliTS redux maintained high levels of correspondence with the original GliTS classification using the TCGA dataset. The machine-learning approach designed an immunohistochemical (IHC)-based classification, whose concordance was 79.5% with the transcriptional- based classification, and reached 90% for the mesenchymal subgroup. Distribution and survival of GliTS were in line with reported data, with the mesenchymal subgroup given the worst prognosis. Notably, the algorithm allowed the identification of cases with comparable probability to be assigned to different GliTS, thus falling within overlapping regions and reflecting an extreme heterogeneous phenotype that mirrors the underlying genetic and biological tumor heterogeneity. Indeed, while mesenchymal and classical subgroups were well segregated, the proneural types frequently showed a mixed proneural/classical phenotype, predicted as proneural by the algorithm, but with comparable probability of being assigned to the classical subtype. These cases, characterized by concomitant high expression of EGFR and proneural biomarkers, showed lower survival. Collectively, these data indicate that a restricted panel of highly sensitive immunohistochemical markers can efficiently predict GliTS with high accuracy and significant association with different clinical outcomes.
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Affiliation(s)
- Francesca Orzan
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute, FPO IRCCS, Torino, Italy
| | - Francesca Pagani
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Manuela Cominelli
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Calza
- Biostatistics & Bioinformatics Unit, University of Brescia, Brescia, Italy
| | - Francesca De Bacco
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute, FPO IRCCS, Torino, Italy
| | - Daniela Medicina
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Piera Balzarini
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Pier Paolo Panciani
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Michela Buglione
- Radiation Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Marco Maria Fontanella
- Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Enzo Medico
- Laboratory of Oncogenomics, Candiolo Cancer Institute, FPO IRCCS, Brescia, Italy.,Department of Oncology, University of Torino, Torino, Italy
| | - Rossella Galli
- Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute, Brescia, Italy
| | - Claudio Isella
- Laboratory of Oncogenomics, Candiolo Cancer Institute, FPO IRCCS, Brescia, Italy
| | - Carla Boccaccio
- Laboratory of Cancer Stem Cell Research, Candiolo Cancer Institute, FPO IRCCS, Torino, Italy.,Department of Oncology, University of Torino, Torino, Italy
| | - Pietro Luigi Poliani
- Pathology Unit, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.
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8
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Zanin L, Poliani PL, Liserre R, Panciani PP. Neuroendocrine breast carcinoma metastasis to the brain. BMJ Case Rep 2019; 12:12/3/e228846. [PMID: 30850573 DOI: 10.1136/bcr-2018-228846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Luca Zanin
- Neurosurgery, Spedali Civili University Hospital of Brescia, Brescia, Italy
| | - Pietro Luigi Poliani
- Department of Molecular and Translational Medicine, Pathology Unit, University of Brescia School of Medicine, Brescia, Italy
| | - Roberto Liserre
- Neuroradiology, Spedali Civili University Hospital of Brescia, Brescia, Italy
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9
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Grisanti S, Ferrari VD, Buglione M, Agazzi GM, Liserre R, Poliani L, Buttolo L, Gipponi S, Pedersini R, Consoli F, Panciani P, Roca E, Spena G, Triggiani L, Berruti A. Second line treatment of recurrent glioblastoma with sunitinib: results of a phase II study and systematic review of literature. J Neurosurg Sci 2016; 63:458-467. [PMID: 27680966 DOI: 10.23736/s0390-5616.16.03874-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Second line treatment of recurrent or progressive glioblastoma multiforme (GBM) is not standardized. Anti-angiogenic strategies with tyrosine-kinase inhibitors have been tested with conflicting results. We tested the association of sunitinib plus irinotecan (CPT-11) in a phase II trial in terms of response rate (RR) and 6-months progression-free survival (6-PFS). We also reviewed the clinical evidence from all the trials with sunitinib in this setting published to date and summarized it in a meta-analysis. EVIDENCE ACQUISITION Patients with GBM recurrent or progressive after surgery and standard chemo-radiotherapy were treated with sunitinib 37.5 mg/day for 14 days + CPT-11 125 mg/sqm every 14 days in a Simon's two-stage phase II study. A summary data meta-analysis was performed to establish the 6-PFS in patients with ascertained histological diagnosis of GBM treated with sunitinib. EVIDENCE SYNTHESIS Six patients were enrolled in the stage I of the trial and only one had a stable disease. The overall response rate was 17% and 6-PFS was not reached. Therefore, the trial was stopped early for insufficient activity. All toxicities were grade 1-2. Systematic review of the literature identified 9 studies (including the present one) for a total of 221 patients. Pooled 6-PFS was 15.1% (95% CI: 9.0-24.4). Subgroup analysis by different schedule revealed a 6-PFS of 17.5% (95% CI: 10.3-28.1) in the weekly setting which was consistent across all the studies (I2=0%, P=0.66) and a pooled 6-PFS of 12.7% (95% CI: 4.9-29.1) in the daily setting with a substantial amount of heterogeneity (I2=65%, P=0.01). CONCLUSIONS Results of this trial and those of the systematic review indicate that, compared to conventional chemotherapy or bevacizumab, sunitinib has insufficient activity in the setting of recurrent GBM. Better patient's molecular stratification for second-line treatment in GBM is warranted.
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Affiliation(s)
- Salvatore Grisanti
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy -
| | - Vittorio D Ferrari
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Michela Buglione
- Department of Radiation Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Giorgio M Agazzi
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Roberto Liserre
- Department of Neuro-Radiology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Luigi Poliani
- Department of Pathology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Luciano Buttolo
- Department of Neuro-Surgery, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Stefano Gipponi
- Department of Neurology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Rebecca Pedersini
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Francesca Consoli
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Pierpaolo Panciani
- Department of Neuro-Surgery, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Elisa Roca
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Giannantonio Spena
- Department of Neuro-Surgery, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - Alfredo Berruti
- Department of Medical Oncology, Spedali Civili di Brescia and University of Brescia, Brescia, Italy
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10
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Buglione M, Pedretti S, Poliani PL, Liserre R, Gipponi S, Spena G, Borghetti P, Pegurri L, Saiani F, Spiazzi L, Tesini G, Uccelli C, Triggiani L, Magrini SM. Pattern of relapse of glioblastoma multiforme treated with radical radio-chemotherapy: Could a margin reduction be proposed? J Neurooncol 2016; 128:303-12. [PMID: 27025858 DOI: 10.1007/s11060-016-2112-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 09/24/2015] [Accepted: 03/23/2016] [Indexed: 11/25/2022]
Abstract
To analyse the pattern of recurrence of patients treated with Stupp protocol in relation to technique, to compare in silico plans with reduced margin (1 cm) with the original ones and to analyse toxicity. 105 patients were treated: 85 had local recurrence and 68 of them were analysed. Recurrence was considered in field, marginal and distant if >80 %, 20-80 % or <20 % of the relapse volume was included in the 95 %-isodose. In silico plans were retrospectively recalculated using the same technique, fields angles and treatment planning system of the original ones. The pattern of recurrence was in field, marginal and distant in 88, 10 and 2 % respectively and was similar in in silico plans. The margin reduction appears to spare 100 cc of healthy brain by 57 Gy-volume (p = 0.02). The target coverage was worse in standard plans (pt student < 0.001), especially if the tumour was near to organs at risk (pχ2 < 0.001). PTV coverage was better with IMRT and helical-IMRT, than conformal-3D (pAnova test = 0.038). This difference was no more significant with in silico planning. A higher incidence of asthenia and leuko-encephalopathy was observed in patients with greater percentage of healthy brain included in 57 Gy-volume. No differences in the pattern of recurrence according to margins were found. The margin reduction determines sparing of healthy brain and could possibly reduce the incidence of late toxicity. Margin reduction could allow to use less sophisticated techniques, ensuring appropriate target coverage, and the choice of more costly techniques could be reserved to selected cases.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy.
| | - Sara Pedretti
- Radiation Oncology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Pietro Luigi Poliani
- Pathology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Roberto Liserre
- Neuroradiology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Stefano Gipponi
- Neurology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Giannantonio Spena
- Neurosurgery Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Paolo Borghetti
- Radiation Oncology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Ludovica Pegurri
- Radiation Oncology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Federica Saiani
- Medical Physics Department, Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Luigi Spiazzi
- Medical Physics Department, Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Giulia Tesini
- Medical Physics Department, Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Chiara Uccelli
- Medical Physics Department, Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Luca Triggiani
- Radiation Oncology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
| | - Stefano Maria Magrini
- Radiation Oncology Department, University and Spedali Civili, P.le Spedali Civili 1, Brescia, Italy
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11
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Buglione M, Borghetti P, Pedretti S, Triggiani L, Fontanella MM, Spena G, Grisanti S, Liserre R, Poliani LP, Gipponi S, Spiazzi L, Magrini SM. Post-surgical therapeutic approaches to glioblastoma patients submitted to biopsy (BA) or "partial" resection (PR): the possibilities to treat also them without renunciations. Study from the Brescia Neuro-Oncology Group. Radiol Med 2015; 120:975-81. [PMID: 25773653 DOI: 10.1007/s11547-015-0528-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 12/07/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
Abstract
The extent of surgery predicts overall survival (OS) in patients treated for glioblastoma (GBM). The therapeutic approach after partial resection (PR) or biopsy alone (BA) is not clearly defined. This retrospective analysis was therefore planned to analyse clinical features, treatment and survival of patients undergoing PR or BA. We analysed the clinical/therapeutic features and the outcome of 232 patients submitted to BA/PR and treated with radiotherapy (RT) with/without chemotherapy. Two subgroups (pre- and post-Temozolomide-era) were identified. The BA/PR ratio did not change with the accrual periods. In the TMZ-era, 50 % of the patients had chemotherapy; "small" volume, hypo-fractionated and "low" dose RT (<54 Gy) were delivered to 93, 38 and 44 % of the patients; corresponding values for the previous period were 4, 28, 11 and 2 % (P < 0.001). Better two-year OS was evident in the TMZ-era (18 vs 7 %); PR and chemotherapy affected OS in patients treated with hypo-fractionated, low doses RT (P = 0.02, 0.04). Limited volume, more often MRI-based, and "short" RT treatments were given mostly to unfavourably selected patients, without compromising the results of the whole group. This strategy, combined with an increased use of chemotherapy, resulted in reduced treatment burden, in an improved 2-year OS rate and prospectively in better quality of life, even in this prognostically worse subset of glioma patients.
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Affiliation(s)
- Michela Buglione
- Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy.
| | - Paolo Borghetti
- Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy
| | - Sara Pedretti
- Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy
| | - Luca Triggiani
- Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy
| | | | | | | | - Roberto Liserre
- Department of Neuroradiology, University of Brescia, Brescia, Italy
| | | | - Stefano Gipponi
- Department of Neurology, University of Brescia, Brescia, Italy
| | - Luigi Spiazzi
- Department of Medical Physics, Spedali Civili Brescia, Brescia, Italy
| | - Stefano Maria Magrini
- Department of Radiation Oncology, University of Brescia, P.le Spedali Civili, 1, 25123, Brescia, BS, Italy
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12
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Cominelli M, Grisanti S, Mazzoleni S, Branca C, Buttolo L, Furlan D, Liserre B, Bonetti MF, Medicina D, Pellegrini V, Buglione M, Liserre R, Pellegatta S, Finocchiaro G, Dalerba P, Facchetti F, Pizzi M, Galli R, Poliani PL. EGFR amplified and overexpressing glioblastomas and association with better response to adjuvant metronomic temozolomide. J Natl Cancer Inst 2015; 107:djv041. [PMID: 25739547 DOI: 10.1093/jnci/djv041] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Lack of robust predictive biomarkers, other than MGMT promoter methylation, makes temozolomide responsiveness in newly diagnosed glioblastoma (GBM) patients difficult to predict. However, we identified patients with long-term survival (≥35 months) within a group of newly diagnosed GBM patients treated with standard or metronomic adjuvant temozolomide schedules. We thus investigated possible molecular profiles associated with longer survival following temozolomide treatment. METHODS We investigated the association of molecular features with progression-free (PFS) and overall survival (OS). Human-derived GBM cancer stem cells (CSCs) were used to investigate in vitro molecular mechanisms associated with temozolomide responsiveness. Surgically removed recurrences allowed investigation of molecular changes occurring during therapy in vivo. Statistical analyses included one- and two-way analysis of variance, Student's t test, Cox proportional hazards, and the Kaplan-Meier method. All statistical tests were two-sided. RESULTS No association was found between survival and gene classifiers associated with different molecular GBM subtypes in the standard-treated group, while in metronomic-treated patients robust association was found between EGFR amplification/overexpression and PFS and OS (OS, EGFR-high vs low: hazard ratiodeath = 0.22, 95% confidence interval = 0.09 to 0.55, P = .001). The result for OS remained statistically significant after Bonferroni correction (P interaction < .0005). Long-term survival following metronomic temozolomide was independent from MGMT and EGFRvIII status and was more pronounced in EGFR-overexpressing GBM patients with PTEN loss. In vitro findings confirmed a selective dose- and time-dependent decrease in survival of temozolomide-treated EGFR+ human-derived glioblastoma CSCs, which occurred through inhibition of NF-κB transcriptional activity. In addition, reduction in EGFR-amplified cells, along with a statistically significant decrease in NF-κB/p65 expression, were observed in specimens from recurrent metronomic-treated EGFR-overexpressing GBM patients. CONCLUSIONS EGFR-amplified/overexpressing glioblastomas strongly benefit from metronomic temozolomide-based therapies.
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Affiliation(s)
- Manuela Cominelli
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Salvatore Grisanti
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Stefania Mazzoleni
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Caterina Branca
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Luciano Buttolo
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Daniela Furlan
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Barbara Liserre
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Maria Fausta Bonetti
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Daniela Medicina
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Vilma Pellegrini
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Michela Buglione
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Roberto Liserre
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Serena Pellegatta
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Gaetano Finocchiaro
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Piero Dalerba
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Fabio Facchetti
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Marina Pizzi
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Rossella Galli
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
| | - Pietro Luigi Poliani
- Pathology (MC, BL, MFB, DM, VP, FF, PLP) and Pharmacology Units (CB, MP), Department of Molecular and Translational Medicine, University of Brescia and National Institute of Neuroscience, Italy; Medical Oncology (SG), Neurosurgery (LB), Radiation Oncology (MB), and Neuroradiology Departments (RL), Spedali Civili of Brescia, University of Brescia, Italy; Neural Stem Cell Biology Unit, Division of Regenerative Medicine, Stem Cells & Gene Therapy, San Raffaele Scientific Institute, Milan (SM, RG); Pathology Unit, Department of Surgical and Morphological Sciences, University of Insubria, Italy (DF); Neurological Institute Besta, Milan, Italy (SP, GF); Herbert Irving Comprehensive Cancer Center, Department of Pathology & Cell Biology and Department of Medicine, Division of Digestive and Liver Diseases, Columbia University, New York, NY (PD); IRCCS San Camillo Hospital, Venice, Italy (MP)
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13
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Buglione M, Pedretti S, Gipponi S, Todeschini A, Pegurri L, Costa L, Donadoni L, Grisanti S, Fontanella M, Liserre R, Facchetti F, Padovani A, Magrini SM. Radiotherapy in low-grade glioma adult patients: a retrospective survival and neurocognitive toxicity analysis. Radiol Med 2013; 119:432-9. [PMID: 24297587 DOI: 10.1007/s11547-013-0347-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/30/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The treatment of low-grade glioma is still debated. Surgery is the first-line approach, and the correct timing of radiation therapy has not yet been defined since "early" radiation therapy improves relapse-free survival but not overall survival. Since a longer progression-free survival is desirable, the main issue related to radiotherapy is the incidence of late neurocognitive toxicity. MATERIALS AND METHODS Ninety-five patients with low-grade glioma were consecutively treated with early (within 3 months) or late (at disease progression) post-surgical radiation therapy. Clinical and therapeutic factors were entered into the analysis overall (OS) and progression-free (PFS) survival, and the distribution in two accrual periods identified based on the evolution of imaging procedures and radiotherapy techniques were compared. For 6/18 long survivors (LS) without evidence of disease, neurocognitive evaluation was obtained and the dose to the hippocampus region was retrospectively calculated. RESULTS Univariate analysis of OS showed a statistically significant advantage for grade 1 and oligodendroglioma histology, better performance status [Karnofsky index (KI)], age <40 years, radical surgery, no steroid treatment; PFS was significantly related with younger age, better KI and "early" radiotherapy. Multivariate analysis of OS confirmed the significance of all variables except surgery; for PFS, only "early" radiotherapy and better KI retained significance. Memory impairment was evident in 4/6 of the LS tested; quality of life was good and executive functions were normal. CONCLUSION Radiotherapy remains an essential component in the treatment of low-grade glioma. Prospective studies are needed to evaluate the relative contributions of the disease itself and of surgery, radiation and chemotherapy to long-term neurocognitive damage.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy,
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14
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Buglione M, Triggiani L, Grisanti S, Liserre R, Buttolo L, Gipponi S, Bonetti F, Todeschini A, Spiazzi L, Magrini SM. Retreatment of recurrent adult medulloblastoma with radiotherapy: a case report and review of the literature. J Med Case Rep 2013; 7:64. [PMID: 23497715 PMCID: PMC3599802 DOI: 10.1186/1752-1947-7-64] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction Medulloblastoma, the most frequent brain tumor in childhood, also occurs with a wide range of characteristics in adult patients. Late relapse is common in adult medulloblastoma, and the overall survival of relapsed patients usually ranges from 12 to 15 months. Treatment at recurrence is still debated and after reoperation includes stereotactic or normofractionated radiotherapy, and high-dose chemotherapy with autologous bone marrow transplantation. Case presentation We report on the case of a 31-year-old Caucasian woman who underwent re-irradiation for a recurrence of medulloblastoma at nine years after first irradiation (56Gy), focusing on the radiobiological background and a review of previous studies involving re-irradiation of recurrent medulloblastoma. After surgical excision of the relapsed tumor and medical multi-agent treatment, the site of recurrence was treated using three-dimensional conformal radiotherapy to a total dose of 52.8Gy (1.2Gy/fraction/twice daily). A total biological equivalent dose of 224.6Gy (α:β = 2 Gy) was delivered to the posterior fossa (first and second treatments). No radionecrosis or local recurrence was evident at 18 months after re-irradiation. Conclusion Re-irradiation can be considered a possible and safe treatment in selected cases of recurrent medulloblastoma in adults. The reported radiobiological considerations could be useful in other cases involving re-irradiation of brain tumors.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, Brescia University, P,le Spedali Civili 1, 25123 Brescia, Italy.
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15
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Ponzoni M, Bonetti F, Poliani PL, Vermi W, Bottelli C, Dolcetti R, Cangi MG, Ferreri AJ, Cin ED, Pasini E, Liserre R, Doglioni C, Rossi G, Facchetti F. Central nervous system marginal zone B-cell lymphoma associated with Chlamydophila psittaci infection. Hum Pathol 2011; 42:738-42. [DOI: 10.1016/j.humpath.2010.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Revised: 08/24/2010] [Accepted: 08/27/2010] [Indexed: 10/18/2022]
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16
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Grisanti S, Pedersini R, Ferrari VD, Liserre R, Consoli F, Poliani L, Buglione M, Rangoni G, Montini E, Simoncini E. Phase II study of sunitinib and irinotecan in patients with recurrent high-grade glioma (HGG). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e12537] [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: 11/20/2022] Open
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17
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Gasparotti R, Grassi M, Mardighian D, Frigerio M, Pavia M, Liserre R, Magoni M, Mascaro L, Padovani A, Pezzini A. Perfusion CT in patients with acute ischemic stroke treated with intra-arterial thrombolysis: predictive value of infarct core size on clinical outcome. AJNR Am J Neuroradiol 2009; 30:722-7. [PMID: 19164437 PMCID: PMC7051771 DOI: 10.3174/ajnr.a1439] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 11/03/2008] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND PURPOSE A potential role of perfusion CT (PCT) in selecting patients with stroke for reperfusion therapies has been recently advocated. The purpose of the study was to assess the reliability of PCT in predicting clinical outcome of patients with acute ischemic stroke treated with intra-arterial thrombolysis (IAT). MATERIALS AND METHODS Twenty-seven patients with acute hemispheric ischemic stroke were investigated with PCT and treated with IAT between 3 and 6 hours of stroke onset. The infarct core was outlined on cerebral blood volume (CBV) maps by using accepted viability thresholds. The penumbra was defined as time-to-peak (TTP)-CBV mismatch. Clinical outcome was assessed by modified Rankin Scale (mRS) scores at 3 months and dichotomized into favorable (mRS score, 0-2) and unfavorable (mRS score, 3-6). Data were retrospectively analyzed by multiple regression to identify predictors of clinical outcome among the following variables: age, sex, National Institutes of Health Stroke Scale score, serum glucose level, thrombolytic agent, infarct core and mismatch size, collateral circulation, time to recanalization, and recanalization rate after IAT. RESULTS Patients with favorable outcome had smaller cores (P = .03), increased mismatch ratios (P = .03), smaller final infarct sizes (P < .01), higher recanalization rates (P = .03), and reduced infarct growth rates (P < .01), compared with patients with unfavorable outcome. The core size was the strongest predictor of clinical outcome in an "all subset" model search (P = .01; 0.96 point increase in mRS score per any increment of 1 SD; 95% confidence interval, +0.17 to +1.75). CONCLUSIONS PCT is a reliable tool for the identification of irreversibly damaged brain tissue and for the prediction of clinical outcome of patients with acute stroke treated with IAT.
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Affiliation(s)
- R Gasparotti
- Dipartimento di Diagnostica per Immagini, Neuroradiologia, Università di Brescia, Brescia, Italy.
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18
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Gasparotti R, Valsecchi P, Carletti F, Galluzzo A, Liserre R, Cesana B, Sacchetti E. Reduced fractional anisotropy of corpus callosum in first-contact, antipsychotic drug-naive patients with schizophrenia. Schizophr Res 2009; 108:41-8. [PMID: 19103476 DOI: 10.1016/j.schres.2008.11.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 10/20/2008] [Accepted: 11/08/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND Corpus callosum is the most important commissure of the brain and therefore represents a first-choice candidate to challenge hypotheses of disrupted inter-hemispheric connectivity and white matter pathology in patients with schizophrenia. Recent studies on diffusion tensor imaging (DTI) of corpus callosum yielded promising but equivocal evidence of reduced fractional anisotropy (FA) in schizophrenia patients who were, for the most part, chronic cases on medication for a lengthy period of time. To exclude potentially confounding effects of the course of the disorder and its treatment, we compared callosal FA of first-contact, antipsychotic drug-naive schizophrenia patients (n=21) and healthy controls (n=21). METHODS Splenium and genu FA were obtained by two independent observers utilizing large, rectangular, tractography-guided regions of interest outlined on directional color-coded maps. Inter-observer agreement on FA was evaluated by means of the Bland and Altman and the Passing and Bablok procedures together with an estimate of the intra-class correlation coefficient. RESULTS Strong inter-observer agreement of FA values emerged from each of the three statistical approaches utilized. ANCOVA showed a significant effect on FA for the interaction between patient-control membership and callosal region (F=5.354; p=0.026); post hoc multiple comparisons demonstrated that, when compared to the controls, the patients had lower mean FA values (p=0.005) in the splenium but not in the genu and that this difference tended to be more evident in males (p=0.090). CONCLUSIONS Lowered mean FA values in the splenium of first-contact, antipsychotic drug-naive patients with respect to healthy controls strongly support the hypothesis that processes operant at least since the earliest phases of the disorder and independent from exposition to antipsychotic drugs contribute to reduced anisotropy in schizophrenia.
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Affiliation(s)
- Roberto Gasparotti
- Department of Diagnostic Imaging, Neuroradiology Unit, Brescia University School of Medicine and Brescia Spedali Civili, Brescia, Italy
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Affiliation(s)
- Roberto Gasparotti
- Neuroradiology Unit, Department of Diagnostic Imaging, Spedali Civili, University of Brescia, Brescia, Italy.
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