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Humphries W, Wang Y, Qiao W, Reina-Ortiz C, Abou-Ghazal MK, Crutcher LM, Wei J, Kong LY, Sawaya R, Rao G, Weinberg J, Prabhu SS, Fuller GN, Heimberger AB. Correction: Detecting the percent of peripheral blood mononuclear cells displaying p-STAT-3 in malignant glioma patients. J Transl Med 2024; 22:296. [PMID: 38515188 PMCID: PMC10958894 DOI: 10.1186/s12967-024-05093-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Affiliation(s)
- William Humphries
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Yongtao Wang
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Wei Qiao
- Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Chantal Reina-Ortiz
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Mohamed K Abou-Ghazal
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Lamonne M Crutcher
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jun Wei
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Ling-Yuan Kong
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Amy B Heimberger
- Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
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Noll KR, Asman P, Tasnim I, Hall M, Connelly K, Swamy C, Ene C, Tummala S, Grasu RM, Liu HL, Kumar VA, Muir M, Prinsloo S, Michener H, Wefel JS, Ince NF, Prabhu SS. Intraoperative language mapping guided by real-time visualization of gamma band modulation electrocorticograms: Case report and proof of concept. Neurooncol Pract 2024; 11:92-100. [PMID: 38222047 PMCID: PMC10785572 DOI: 10.1093/nop/npad059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
Background Electrocorticography (ECoG) language mapping is often performed extraoperatively, frequently involves offline processing, and relationships with direct cortical stimulation (DCS) remain variable. We sought to determine the feasibility and preliminary utility of an intraoperative language mapping approach guided by real-time visualization of electrocorticograms. Methods A patient with astrocytoma underwent awake craniotomy with intraoperative language mapping, utilizing a dual iPad stimulus presentation system coupled to a real-time neural signal processing platform capable of both ECoG recording and delivery of DCS. Gamma band modulations in response to 4 language tasks at each electrode were visualized in real-time. Next, DCS was conducted for each neighboring electrode pair during language tasks. Results All language tasks resulted in strongest heat map activation at an electrode pair in the anterior to mid superior temporal gyrus. Consistent speech arrest during DCS was observed for Object and Action naming tasks at these same electrodes, indicating good correspondence with ECoG heat map recordings. This region corresponded well with posterior language representation via preoperative functional MRI. Conclusions Intraoperative real-time visualization of language task-based ECoG gamma band modulation is feasible and may help identify targets for DCS. If validated, this may improve the efficiency and accuracy of intraoperative language mapping.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Priscella Asman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Israt Tasnim
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Matthew Hall
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Katherine Connelly
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chandra Swamy
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roxana M Grasu
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hayley Michener
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nuri F Ince
- Department of Biomedical Engineering, University of Houston, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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3
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Haider AS, McCutcheon IE, Ene CI, Fuller GN, Schomer DF, Gule-Monroe M, DeMonte F, Ferguson SD, Lang FF, Prabhu SS, Raza SM, Suki D, Weinberg JS, Sawaya R. Subependymomas of the fourth ventricle: To operate or not to operate? J Clin Neurosci 2023; 118:147-152. [PMID: 37944358 DOI: 10.1016/j.jocn.2023.10.025] [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: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND There is a paucity of literature regarding the clinical characteristics and management of subependymomas of the fourth ventricle due to their rarity. Here, we describe the operative and non-operative management and outcomes of patients with such tumors. METHODS This retrospective single-institution case series was gathered after Institutional Review Board (IRB) approval. Patients diagnosed with a subependymoma of the fourth ventricle between 1993 and 2021 were identified. Clinical, radiology and pathology reports along with magnetic resonance imaging (MRI) images were reviewed. RESULTS Patients identified (n = 20), showed a male predominance (n = 14). They underwent surgery (n = 9) with resection and histopathological confirmation of subependymoma or were followed with imaging surveillance (n = 11). The median age at diagnosis was 51.5 years. Median tumor volume for the operative cohort was 8.64 cm3 and median length of follow-up was 65.8 months. Median tumor volume for the non-operative cohort was 0.96 cm3 and median length of follow-up was 78 months. No tumor recurrence post-resection was noted in the operative group, and no tumor growth from baseline was noted in the non-operative group. Most patients (89 %) in the operative group had symptoms at diagnosis, all of which improved post-resection. No patients were symptomatic in the non-operative group. CONCLUSIONS Surgical resection is safe and is associated with alleviation of presenting symptoms in patients with large tumors. Observation and routine surveillance are warranted for smaller, asymptomatic tumors.
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Affiliation(s)
- Ali S Haider
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
| | - Ian E McCutcheon
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Chibawanye I Ene
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Donald F Schomer
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Maria Gule-Monroe
- Neuroradiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Shaan M Raza
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Departments of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA; Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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4
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Rubino F, Catalino MP, Andrade de Almeida RA, S Prabhu S. Lateral ventricle subependymoma resected with a transcallosal approach: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23265. [PMID: 37539862 PMCID: PMC10555596 DOI: 10.3171/case23265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/20/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND Subependymomas are World Health Organization grade I tumors, and 30% occur in the lateral ventricles. Surgery is the mainstay of treatment, and the transcallosal or transcortical/transsulcal approaches are preferred for those tumors occurring near the foramen of Monro or atrium. Visualization, proximity to the fornix and basal ganglia, hydrocephalus, and brain retraction during surgery make these operations challenging. The authors present the case of a 65-year-old male with a subependymoma located in the left lateral ventricle. The tumor was completely resected using an interhemispheric/transcallosal approach. OBSERVATIONS The authors analyze the anatomopathological features of subependymoma, along with the clinical behavior and therapeutic options. The authors discuss in detail the advantages and disadvantages of the interhemispheric/transcallosal approach for resection of these tumors. LESSONS Subependymomas are slow-growing lesions with an indolent yet complicated course making surgical removal challenging yet feasible using the correct techniques. The interhemispheric transcallosal approach offers an excellent route for the resection of large subependymomas, but there is still a significant risk for postoperative complications.
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5
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Suvarna P, Pai SB, Prabhu SS. Phantom Hernia—Two Cases of Post Herpetic Abdominal Bulge. Actas Dermosifiliogr 2023:S0001-7310(23)00341-1. [PMID: 37169333 DOI: 10.1016/j.ad.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/26/2021] [Indexed: 05/13/2023] Open
Affiliation(s)
- P Suvarna
- Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), 576104 Manipal, Karnataka, India.
| | - S B Pai
- Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), 576104 Manipal, Karnataka, India
| | - S S Prabhu
- Department of Dermatology, Venereology and Leprosy, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), 576104 Manipal, Karnataka, India
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Ozkizilkaya HI, Johnson JM, O’Brien BJ, McCutcheon IE, Prabhu SS, Ghia AJ, Fuller GN, Huse JT, Ballester LY. Intracranial mesenchymal tumor, FET::CREB fusion-positive in the lateral ventricle. Neurooncol Adv 2023; 5:vdad026. [PMID: 37051329 PMCID: PMC10084497 DOI: 10.1093/noajnl/vdad026] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Affiliation(s)
- Hanim I Ozkizilkaya
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jason M Johnson
- Division of Diagnostic Imaging, Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Barbara J O’Brien
- Division of Cancer Medicine, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Ian E McCutcheon
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sujit S Prabhu
- Division of Surgery, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Amol J Ghia
- Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Gregory N Fuller
- Division of Diagnostic Imaging, Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, USA
- Division of Pathology and Lab Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jason T Huse
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
- Division of Pathology and Lab Medicine, Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Leomar Y Ballester
- Corresponding Author: Leomar Y. Ballester, MD, PhD, Assistant Professor, Neuropathology and Molecular Genetic Pathology, Department of Pathology, Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe, Unit 85, Houston, TX 77030, USA ()
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7
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Hasanov M, Milton DR, Bea Davies A, Sirmans E, Saberian C, Posada EL, Opusunju S, Gershenwald JE, Torres-Cabala CA, Burton EM, Colen R, Huse JT, Glitza Oliva IC, Chung C, McAleer MF, McGovern SL, Yeboa DN, Kim BYS, Prabhu SS, McCutcheon IE, Weinberg J, Lang FF, Tawbi HA, Li J, Haydu LE, Davies MA, Ferguson SD. Changes In Outcomes And Factors Associated With Survival In Melanoma Patients With Brain Metastases. Neuro Oncol 2022:6889653. [PMID: 36510640 DOI: 10.1093/neuonc/noac251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUD Treatment options for patients with melanoma brain metastasis (MBM) have changed significantly in the last decade. Few studies have evaluated changes in outcomes and factors associated with survival in MBM patients over time. The aim of this study is to evaluate changes in clinical features and overall survival (OS) for MBM patients. METHODS Patients diagnosed with MBMs from 1/1/2009-12/31/2013 (Prior Era; PE) and 1/1/2014-12/31/2018 (Current Era; CE) at The University of Texas MD Anderson Cancer Center were included in this retrospective analysis. The primary outcome measure was OS. Log-rank test assessed differences between groups; multivariable analyses were performed with Cox proportional hazards models and recursive partitioning analysis (RPA). RESULTS 791 MBM patients (PE, n=332; CE, n=459) were included in analysis. Median OS from MBM diagnosis was 10.3 months (95% CI, 8.9 - 12.4) and improved in the CE versus PE (14.4 vs. 10.3 months, P < .001). Elevated serum LDH was the only factor associated with worse OS in both PE and CE patients. Factors associated with survival in CE MBM patients included patient age, primary tumor Breslow thickness, prior immunotherapy, leptomeningeal disease (LMD), symptomatic MBMs, and whole brain radiation therapy (WBRT). Several factors associated with OS in the PE were not significant in the CE. RPA demonstrated that elevated serum LDH and prior immunotherapy treatment are the most important determinants of survival in CE MBM patients. CONCLUSIONS OS and factors associated with OS have changed for MBM patients. This information can inform contemporary patient management and clinical investigations.
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Affiliation(s)
- Merve Hasanov
- Department of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Denái R Milton
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alicia Bea Davies
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Sirmans
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chantal Saberian
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eliza L Posada
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sylvia Opusunju
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey E Gershenwald
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Elizabeth M Burton
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Rivka Colen
- Center for Artificial Intelligence Innovation in Medical Imaging, University of Pittsburg, Pittsburg, PA
| | - Jason T Huse
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Isabella C Glitza Oliva
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Caroline Chung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Debra N Yeboa
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hussein A Tawbi
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lauren E Haydu
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX
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8
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Yeh MY, Chen HS, Hou P, Kumar VA, Johnson JM, Noll KR, Prabhu SS, Ferguson SD, Schomer DF, Peng HH, Liu HL. Cerebrovascular Reactivity Mapping Using Resting-State Functional MRI in Patients With Gliomas. J Magn Reson Imaging 2022; 56:1863-1871. [PMID: 35396789 DOI: 10.1002/jmri.28194] [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: 01/10/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Recently, a data-driven regression analysis method was developed to utilize the resting-state (rs) blood oxygenation level-dependent signal for cerebrovascular reactivity (CVR) mapping (rs-CVR), which was previously optimized by comparing with the CO2 inhalation-based method in health subjects and patients with neurovascular diseases. PURPOSE To investigate the agreement of rs-CVR and the CVR mapping with breath-hold MRI (bh-CVR) in patients with gliomas. STUDY TYPE Retrospective. POPULATION Twenty-five patients (12 males, 13 females; mean age ± SD, 48 ± 13 years) with gliomas. FIELD STRENGTH/SEQUENCE Dynamic T2*-weighted gradient-echo echo-planar imaging during a breath-hold paradigm and during the rs on a 3-T scanner. ASSESSMENT rs-CVR with various frequency ranges and resting-state fluctuation amplitude (RSFA) were assessed. The agreement between each rs-based CVR measurement and bh-CVR was determined by voxel-wise correlation and Dice coefficient in the whole brain, gray matter, and the lesion region of interest (ROI). STATISTICAL TESTS Voxel-wise Pearson correlation, Dice coefficient, Fisher Z-transformation, repeated-measure analysis of variance and post hoc test with Bonferroni correction, and nonparametric repeated-measure Friedman test and post hoc test with Bonferroni correction were used. Significance was set at P < 0.05. RESULTS Compared with bh-CVR, the highest correlations were found at the frequency bands of 0.04-0.08 Hz and 0.02-0.04 Hz for rs-CVR in both whole brain and the lesion ROI. RSFA had significantly lower correlations than did rs-CVR of 0.02-0.04 Hz and a wider frequency range (0-0.1164 Hz). Significantly higher correlations and Dice coefficient were found in normal tissues than in the lesion ROI for all three methods. DATA CONCLUSION The optimal frequency ranges for rs-CVR are determined by comparing with bh-CVR in patients with gliomas. The rs-CVR method outperformed the RSFA. Significantly higher correlation and Dice coefficient between rs- and bh-CVR were found in normal tissue than in the lesion. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Mei-Yu Yeh
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Henry S Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Hsu-Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Muir M, Gadot R, Prinsloo S, Michener H, Traylor J, Athukuri P, Tummala S, Kumar VA, Prabhu SS. Comparative study of preoperative functional imaging combined with tractography for prediction of iatrogenic motor deficits. J Neurosurg 2022:1-8. [DOI: 10.3171/2022.10.jns221684] [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: 07/20/2022] [Accepted: 10/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE
Robust preoperative imaging can improve the extent of resection in patients with brain tumors while minimizing postoperative neurological morbidity. Both structural and functional imaging techniques can provide helpful preoperative information. A recent study found that transcranial magnetic stimulation (TMS) tractography has significant predictive value for permanent deficits. The present study directly compares the predictive value of TMS tractography and task-based functional MRI (fMRI) tractography in the same cohort of glioma patients.
METHODS
Clinical outcome data were collected from charts of patients with motor eloquent glioma and preoperative fMRI and TMS studies. The primary outcome was a new or worsened motor deficit present at the 3-month postoperative follow-up, which was termed a "permanent deficit." Postoperative MR images were overlaid onto preoperative plans to determine which imaging features were resected. Multiple fractional anisotropic thresholds (FATs) were screened for both TMS and fMRI tractography. The predictive value of the various thresholds was modeled using receiver operating characteristic curve analysis.
RESULTS
Forty patients were included in this study. Six patients (15%) sustained permanent postoperative motor deficits. A significantly greater predictive value was found for TMS tractography than for fMRI tractography regardless of the FAT. Despite 35% of patients showing clinically relevant neuroplasticity captured by TMS, only 2.5% of patients showed a blood oxygen level–dependent signal displaced from the precentral gyrus. Comparing the best-performing FAT for both modalities, TMS seeded tractography showed superior predictive value across all metrics: sensitivity, specificity, positive predictive value, and negative predictive value.
CONCLUSIONS
The results from this study indicate that the prediction of permanent deficits with TMS tractography is superior to that with fMRI tractography, possibly because TMS tractography captures clinically relevant neuroplasticity. However, future large-scale prospective studies are needed to fully illuminate the proper role of each modality in comprehensive presurgical workups for patients with motor-eloquent tumors.
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Affiliation(s)
| | | | | | | | - Jeffrey Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Sudhakar Tummala
- Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston; and
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10
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Gates EDH, Suki D, Celaya A, Weinberg JS, Prabhu SS, Sawaya R, Huse JT, Long JP, Fuentes D, Schellingerhout D. Cellular Density in Adult Glioma, Estimated with MR Imaging Data and a Machine Learning Algorithm, Has Prognostic Power Approaching World Health Organization Histologic Grading in a Cohort of 1181 Patients. AJNR Am J Neuroradiol 2022; 43:1411-1417. [PMID: 36109124 PMCID: PMC9575543 DOI: 10.3174/ajnr.a7620] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Recent advances in machine learning have enabled image-based prediction of local tissue pathology in gliomas, but the clinical usefulness of these predictions is unknown. We aimed to evaluate the prognostic ability of imaging-based estimates of cellular density for patients with gliomas, with comparison to the gold standard reference of World Health Organization grading. MATERIALS AND METHODS Data from 1181 (207 grade II, 246 grade III, 728 grade IV) previously untreated patients with gliomas from a single institution were analyzed. A pretrained random forest model estimated voxelwise tumor cellularity using MR imaging data. Maximum cellular density was correlated with the World Health Organization grade and actual survival, correcting for covariates of age and performance status. RESULTS A maximum estimated cellular density of >7681 nuclei/mm2 was associated with a worse prognosis and a univariate hazard ratio of 4.21 (P < .001); the multivariate hazard ratio after adjusting for covariates of age and performance status was 2.91 (P < .001). The concordance index between maximum cellular density (adjusted for covariates) and survival was 0.734. The hazard ratio for a high World Health Organization grade (IV) was 7.57 univariate (P < .001) and 5.25 multivariate (P < .001). The concordance index for World Health Organization grading (adjusted for covariates) was 0.761. The maximum cellular density was an independent predictor of overall survival, and a Cox model using World Health Organization grade, maximum cellular density, age, and Karnofsky performance status had a higher concordance (C = 0.764; range 0.748-0.781) than the component predictors. CONCLUSIONS Image-based estimation of glioma cellularity is a promising biomarker for predicting survival, approaching the prognostic power of World Health Organization grading, with added values of early availability, low risk, and low cost.
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Affiliation(s)
- E D H Gates
- From the Departments of Imaging Physics (E.D.H.G., A.C., D.F.)
- University of Texas MD Anderson Cancer Center UTHealth Houston Graduate School of Biomedical Sciences (E.D.H.G.), Houston, Texas
| | - D Suki
- Neurosurgery (D. Suki, J.S.W., S.S.P., R.S.)
| | - A Celaya
- From the Departments of Imaging Physics (E.D.H.G., A.C., D.F.)
| | | | - S S Prabhu
- Neurosurgery (D. Suki, J.S.W., S.S.P., R.S.)
| | - R Sawaya
- Neurosurgery (D. Suki, J.S.W., S.S.P., R.S.)
| | - J T Huse
- Translational Molecular Pathology (J.T.H.)
| | | | - D Fuentes
- From the Departments of Imaging Physics (E.D.H.G., A.C., D.F.)
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11
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Muir M, Traylor JI, Gadot R, Patel R, Prabhu SS. Repeat laser interstitial thermal therapy for recurrent primary and metastatic intracranial tumors. Surg Neurol Int 2022; 13:311. [PMID: 35928321 PMCID: PMC9345120 DOI: 10.25259/sni_418_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Repeat craniotomy in patients with primary and metastatic brain tumors carries significant morbidity and can delay adjuvant treatments. Repeat laser interstitial thermal therapy (LITT) for recurrent disease has been described and could benefit patients with limited cytoreductive options. We aim to describe the indications, safety, and efficacy of repeat LITT for recurrent primary and metastatic intracranial tumors. Methods: Patients undergoing repeat ablations for the same lesion were included in the study. We retrospectively analyzed 13 patients treated with 29 total LITT ablations. Results: Eleven patients were treated for glioblastoma (GBM), while two had brain metastases. Eleven patients had LITT performed only 2 times, while three patients underwent three total iterations of LITT for disease recurrence. Median length of stay after the 1st ablation was 2 days, while the median length of stay after the 2nd ablation was 1 day. The median time to resuming adjuvant treatments after the 1st LITT was 11 days. The median time to resuming adjuvant treatments after the 2nd LITT was 28 days. Four patients after the 1st and 2nd LITT sustained deficits persisting through 30-day follow-up. The median progression-free survival among the GBM patients from the first ablation was 6.0 months, 3.2 months from the 2nd ablation, and 2.1 months from the 3rd ablation. Conclusion: Recurrent tumors, especially GBM, can be safely treated using repeat LITT when surgery cannot be effectively performed. Our results indicate that patients tolerate the procedure well and have a meaningful survival given the salvage nature of the procedure.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, United States
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, UT Southwestern, Dallas, United States
| | - Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Rajan Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States
| | - Sujit S. Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, United States
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12
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Muir M, Prinsloo S, Traylor JI, Patel R, Ene C, Tummala S, Prabhu SS. Transcranial magnetic stimulation tractography and the facilitation of gross total resection in a patient with a motor eloquent glioblastoma: illustrative case. Journal of Neurosurgery: Case Lessons 2022; 3:CASE22128. [PMCID: PMC9379643 DOI: 10.3171/case22128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
In patients with perieloquent tumors, neurosurgeons must use a variety of techniques to maximize survival while minimizing postoperative neurological morbidity. Recent publications have shown that conventional anatomical features may not always predict postoperative deficits. Additionally, scientific conceptualizations of complex brain function have shifted toward more dynamic, neuroplastic theories instead of traditional static, localizationist models. Functional imaging techniques have emerged as potential tools to incorporate these advances into modern neurosurgical care. In this case report, we describe our observations using preoperative transcranial magnetic stimulation data combined with tractography to guide a nontraditional surgical approach in a patient with a motor eloquent glioblastoma.
OBSERVATIONS
The authors detail the use of preoperative functional and structural imaging to perform a gross total resection despite tumor infiltration of conventionally eloquent anatomical structures. The authors resected the precentral gyrus, specifically the paracentral lobule, localized using intraoperative mapping techniques. The patient demonstrated mild transient postoperative weakness and made a full neurological recovery by discharge 1 week later.
LESSONS
Preoperative functional and structural imaging has potential to not only optimize patient selection and surgical planning, but also facilitate important intraoperative decisions. Innovative preoperative imaging techniques should be optimized and used to identify safely resectable structures.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Jeffrey I. Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rajan Patel
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas; and
| | - Sujit S. Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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13
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Muir M, Prinsloo S, Traylor JI, Bastos D, Prabhu SS. 512 TMS Seeded DTI Tractography Provides Superior Identification of Eloquent Cortex Compared to Anatomic Seeded Tractography. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_512] [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: 11/19/2022] Open
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14
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Abdelfattah N, Kumar P, Wang C, Leu JS, Flynn WF, Gao R, Baskin DS, Pichumani K, Ijare OB, Wood SL, Powell SZ, Haviland DL, Parker Kerrigan BC, Lang FF, Prabhu SS, Huntoon KM, Jiang W, Kim BYS, George J, Yun K. Single-cell analysis of human glioma and immune cells identifies S100A4 as an immunotherapy target. Nat Commun 2022; 13:767. [PMID: 35140215 PMCID: PMC8828877 DOI: 10.1038/s41467-022-28372-y] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [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: 11/09/2020] [Accepted: 01/17/2022] [Indexed: 12/24/2022] Open
Abstract
A major rate-limiting step in developing more effective immunotherapies for GBM is our inadequate understanding of the cellular complexity and the molecular heterogeneity of immune infiltrates in gliomas. Here, we report an integrated analysis of 201,986 human glioma, immune, and other stromal cells at the single cell level. In doing so, we discover extensive spatial and molecular heterogeneity in immune infiltrates. We identify molecular signatures for nine distinct myeloid cell subtypes, of which five are independent prognostic indicators of glioma patient survival. Furthermore, we identify S100A4 as a regulator of immune suppressive T and myeloid cells in GBM and demonstrate that deleting S100a4 in non-cancer cells is sufficient to reprogram the immune landscape and significantly improve survival. This study provides insights into spatial, molecular, and functional heterogeneity of glioma and glioma-associated immune cells and demonstrates the utility of this dataset for discovering therapeutic targets for this poorly immunogenic cancer.
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Affiliation(s)
- Nourhan Abdelfattah
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - Parveen Kumar
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Caiyi Wang
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA.,Xiangya Hospital, Central South University, Changsha, P. R. China
| | - Jia-Shiun Leu
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA
| | - William F Flynn
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Ruli Gao
- Center for Bioinformatics and Computational Biology. Houston Methodist Research Institute Houston, Houston, TX, USA
| | - David S Baskin
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.,Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.,Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
| | - Kumar Pichumani
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.,Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.,Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA
| | - Omkar B Ijare
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.,Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Stephanie L Wood
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA
| | - Suzanne Z Powell
- Kenneth R. Peak Center for Brain and Pituitary Tumor Treatment and Research, Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, TX, USA.,Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA.,Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA.,Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | - David L Haviland
- Flow Cytometry Core, Houston Methodist Research Institute, Houston, TX, USA
| | - Brittany C Parker Kerrigan
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristin M Huntoon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Wen Jiang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Betty Y S Kim
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The Brain Tumor Center, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, USA
| | - Joshy George
- The Jackson Laboratory for Genomic Medicine, Farmington, CT, USA
| | - Kyuson Yun
- Department of Neurology, Houston Methodist Research Institute, Houston, TX, USA. .,Department of Neurology, Weill Cornell Medical College, New York, NY, USA.
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15
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Shepard MJ, Haider AS, Prabhu SS, Sawaya R, DeMonte F, McCutcheon IE, Weinberg JS, Ferguson SD, Suki D, Fuller GN, Lang FF. Long term outcomes following surgery for pineal region tumors. J Neurooncol 2022; 156:491-498. [PMID: 35083579 DOI: 10.1007/s11060-021-03919-z] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/01/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Pineal region tumors are surgically demanding tumors to resect. Long term neuro-oncologic outcomes following surgical excision of tumors from this region have been underreported. We sought to define the long term outcomes of patients undergoing resection of pineal region tumors. METHODS A retrospective analysis of a prospectively maintained database was performed on patients who underwent intended surgical excision of pineal region tumors. Overall survival (OS) and progression free survival (PFS) were the primary endpoints of this study. Factors associated with OS, PFS and the degree of resection were analyzed, along with 30-day complication rates and dependence on CSF diversion. RESULTS Sixty-eight patients with a mean age of 30.9 ± 15.3 years were analyzed. The median clinical and radiographic follow-up was 95.7 and 48.2 months, respectively. The supracerebellar infratentorial and the occipital transtentorial corridors were utilized in the majority of cases (80.9%). The gross total resection (GTR) rate was 52.9% (n=36). The 5-year OS and PFS rates were 70.2% and 58.5%, respectively. Achieving GTR was associated with improved OS (HR 0.39, p = 0.03) and PFS (HR 0.4, p = 0.006). The 30-day mortality rate was 5.9%. The need for CSF diversion was high with 77.9% of patients requiring a shunt or ETV by last follow-up. CONCLUSIONS This is the first modern surgical series providing long term follow-up for patients undergoing surgical resection of pineal region tumors. Obtaining a GTR of these challenging tumors is beneficial with regards to PFS/OS. Higher grade tumors have diminished PFS/OS and are treated with adjuvant chemotherapy and/or radiotherapy.
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Affiliation(s)
- Matthew J Shepard
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Department of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ali S Haider
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Franco DeMonte
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Dima Suki
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Gregory N Fuller
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030, USA. .,Brain Tumor Center, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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16
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Al-Holou WN, Suki D, Hodges TR, Everson RG, Freeman J, Ferguson SD, McCutcheon IE, Prabhu SS, Weinberg JS, Sawaya R, Lang FF. Circumferential sulcus-guided resection technique for improved outcomes of low-grade gliomas. J Neurosurg 2022; 137:1-11. [PMID: 34996044 DOI: 10.3171/2021.9.jns21718] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/20/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Many neurosurgeons resect nonenhancing low-grade gliomas (LGGs) by using an inside-out piecemeal resection (PMR) technique. At the authors' institution they have increasingly used a circumferential, perilesional, sulcus-guided resection (SGR) technique. This technique has not been well described and there are limited data on its effectiveness. The authors describe the SGR technique and assess the extent to which SGR correlates with extent of resection and neurological outcome. METHODS The authors identified all patients with newly diagnosed LGGs who underwent resection at their institution over a 22-year period. Demographics, presenting symptoms, intraoperative data, method of resection (SGR or PMR), volumetric imaging data, and postoperative outcomes were obtained. Univariate analyses used ANOVA and Fisher's exact test. Multivariate analyses were performed using multivariate logistic regression. RESULTS Newly diagnosed LGGs were resected in 519 patients, 208 (40%) using an SGR technique and 311 (60%) using a PMR technique. The median extent of resection in the SGR group was 84%, compared with 77% in the PMR group (p = 0.019). In multivariate analysis, SGR was independently associated with a higher rate of complete (100%) resection (27% vs 18%) (OR 1.7, 95% CI 1.1-2.6; p = 0.03). SGR was also associated with a statistical trend toward lower rates of postoperative neurological complications (11% vs 16%, p = 0.09). A subset analysis of tumors located specifically in eloquent brain demonstrated SGR to be as safe as PMR. CONCLUSIONS The authors describe the SGR technique used to resect LGGs and show that SGR is independently associated with statistically significantly higher rates of complete resection, without an increase in neurological complications, than with PMR. SGR technique should be considered when resecting LGGs.
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Affiliation(s)
- Wajd N Al-Holou
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
- 3Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Dima Suki
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Tiffany R Hodges
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Richard G Everson
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Jacob Freeman
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Sherise D Ferguson
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Ian E McCutcheon
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Sujit S Prabhu
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Jeffrey S Weinberg
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Raymond Sawaya
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
| | - Frederick F Lang
- 1Department of Neurosurgery
- 2Brain Tumor Center, The University of Texas MD Anderson Cancer Center, Houston, Texas; and
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17
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Muir M, Prinsloo S, Michener H, Shetty A, de Almeida Bastos DC, Traylor J, Ene C, Tummala S, Kumar VA, Prabhu SS. Transcranial magnetic stimulation (TMS) seeded tractography provides superior prediction of eloquence compared to anatomic seeded tractography. Neurooncol Adv 2022; 4:vdac126. [PMID: 36128584 PMCID: PMC9476227 DOI: 10.1093/noajnl/vdac126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
For patients with brain tumors, maximizing the extent of resection while minimizing postoperative neurological morbidity requires accurate preoperative identification of eloquent structures. Recent studies have provided evidence that anatomy may not always predict eloquence. In this study, we directly compare transcranial magnetic stimulation (TMS) data combined with tractography to traditional anatomic grading criteria for predicting permanent deficits in patients with motor eloquent gliomas.
Methods
We selected a cohort of 42 glioma patients with perirolandic tumors who underwent preoperative TMS mapping with subsequent resection and intraoperative mapping. We collected clinical outcome data from their chart with the primary outcome being new or worsened motor deficit present at 3 month follow up, termed “permanent deficit”. We overlayed the postoperative resection cavity onto the preoperative MRI containing preoperative imaging features.
Results
Almost half of the patients showed TMS positive points significantly displaced from the precentral gyrus, indicating tumor induced neuroplasticity. In multivariate regression, resection of TMS points was significantly predictive of permanent deficits while the resection of the precentral gyrus was not. TMS tractography showed significantly greater predictive value for permanent deficits compared to anatomic tractography, regardless of the fractional anisotropic (FA) threshold. For the best performing FA threshold of each modality, TMS tractography provided both higher positive and negative predictive value for identifying true nonresectable, eloquent cortical and subcortical structures.
Conclusion
TMS has emerged as a preoperative mapping modality capable of capturing tumor induced plastic reorganization, challenging traditional presurgical imaging modalities.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
| | - Sarah Prinsloo
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
| | - Hayley Michener
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
| | - Arya Shetty
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
| | | | - Jeffrey Traylor
- Department of Neurological Surgery, The University of Texas Southwestern Medical Center , Dallas, Texas , USA
| | - Chibawanye Ene
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
| | - Sudhakar Tummala
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center , Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center , Houston, Texas , USA
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18
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Muir M, Patel R, Traylor JI, de Almeida Bastos DC, Kamiya C, Li J, Rao G, Prabhu SS. Laser interstitial thermal therapy for newly diagnosed glioblastoma. Lasers Med Sci 2021; 37:1811-1820. [PMID: 34687390 DOI: 10.1007/s10103-021-03435-6] [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: 01/29/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Abstract
Gliomas are the most frequent primary brain tumor in adults. Patients with glioblastoma (GBM) tumors deemed inoperable with open surgical techniques and treated only with chemo/radiation have a median overall survival of less than 9 months. Laser interstitial thermal therapy (LITT) has emerged as a cytoreductive alternative to surgery for these patients. The present study describes the outcomes of twenty patients with newly diagnosed, IDH wild-type glioblastoma treated with LITT. We retrospectively reviewed patients with newly diagnosed, unresectable GBM who underwent LITT at our institution. Progression-free survival (PFS) was the primary endpoint measured in our study, defined as time from LITT to disease progression. Results Twenty patients were identified with newly diagnosed, inoperable GBM lesions who underwent LITT. The overall median PFS was 4 months (95% CI = 2 - N/A, upper limit not reached). The median progression-free survival (PFS) for patients with less than 1 cm 3 residual tumor (gross total ablation, GTA) was 7 months (95% CI = 6 - N/A, upper limit not reached), compared to 2 months (95% CI = 1 - upper limit not reached) for patients with a lower GTA (p = .0019). The median overall survival was 11 months (95% CI = 6 - upper limit not reached). Preoperative Karnofsky performance score (KPS) less than or equal to 80 and deep-seated tumor location were significantly associated with decreased PFS (HR, .18, p = .03; HR, .08, p = .03, respectively). At the end of 1 month, only 4 patients (20%) experienced persistent motor deficits. LITT is a safe and effective treatment for patients with unresectable, untreated GBM with rates of survival and local recurrence comparable to patients with surgically accessible lesions treated with conventional resection. Careful patient selection is needed to determine if GTA is attainable.
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Affiliation(s)
- Matthew Muir
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA.
| | - Rajan Patel
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Dhiego Chaves de Almeida Bastos
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Carlos Kamiya
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Room FC7.2000, Unit 442, Houston, TX, 77030-4009, USA
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Pyne P, Das Mahanta D, Gohil H, Prabhu SS, Mitra RK. Correlating solvation with conformational pathways of proteins in alcohol-water mixtures: a THz spectroscopic insight. Phys Chem Chem Phys 2021; 23:17536-17544. [PMID: 34369530 DOI: 10.1039/d1cp01841h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Water, being an active participant in most of the biophysical processes, is important to trace how protein solvation changes as its conformation evolves in the presence of solutes or co-solvents. In this study, we investigate how the secondary structures of two diverse proteins - lysozyme and β-lactoglobulin - change in the aqueous mixtures of two alcohols - ethanol and 2,2,2-trifluoroethanol (TFE) using circular dichroism measurements. We observe that these alcohols change the secondary structures of these proteins and the changes are protein-specific. Subsequently, we measure the collective solvation dynamics of these two proteins both in the absence and in the presence of alcohols by measuring the frequency-dependent absorption coefficient (α(ν)) in the THz (0.1-1.2 THz) frequency domain. The alcohol-water mixtures exhibit a non-ideal behaviour with the highest absorption difference (Δα) obtained at Xalcohol = 0.2. The protein solvation in the presence of the alcohols shows an oscillating behaviour in which Δαprotein changes with Xalcohol. Such an oscillatory behaviour of protein solvation results from a delicate interplay between the protein-water, protein-alcohol and water-alcohol associations. We attempt to correlate the various structural conformations of the proteins with the associated solvation.
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Affiliation(s)
- Partha Pyne
- Department of Chemical, Biological & Macromolecular Sciences, S.N. Bose National Centre for Basic Sciences, Block-JD; Sector-III; Salt Lake, Kolkata-700106, India.
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Zakaria R, Prabhu SS. Letter to the Editor Regarding "Safety Analysis of Bilateral Laser Interstitial Thermal Therapy for Treatment of Butterfly Glioma". World Neurosurg 2021; 147:236-237. [PMID: 33685011 DOI: 10.1016/j.wneu.2020.10.161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 01/31/2023]
Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
| | - Sujit S Prabhu
- Department of Neurosurgery, University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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21
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de Groot J, Penas-Prado M, Alfaro-Munoz K, Hunter K, Pei BL, O'Brien B, Weathers SP, Loghin M, Kamiya Matsouka C, Yung WKA, Mandel J, Wu J, Yuan Y, Zhou S, Fuller GN, Huse J, Rao G, Weinberg JS, Prabhu SS, McCutcheon IE, Lang FF, Ferguson SD, Sawaya R, Colen R, Yadav SS, Blando J, Vence L, Allison J, Sharma P, Heimberger AB. Window-of-opportunity clinical trial of pembrolizumab in patients with recurrent glioblastoma reveals predominance of immune-suppressive macrophages. Neuro Oncol 2021; 22:539-549. [PMID: 31755915 DOI: 10.1093/neuonc/noz185] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We sought to ascertain the immune effector function of pembrolizumab within the glioblastoma (GBM) microenvironment during the therapeutic window. METHODS In an open-label, single-center, single-arm phase II "window-of-opportunity" trial in 15 patients with recurrent (operable) GBM receiving up to 2 pembrolizumab doses before surgery and every 3 weeks afterward until disease progression or unacceptable toxicities occurred, immune responses were evaluated within the tumor. RESULTS No treatment-related deaths occurred. Overall median follow-up time was 50 months. Of 14 patients monitored, 10 had progressive disease, 3 had a partial response, and 1 had stable disease. Median progression-free survival (PFS) was 4.5 months (95% CI: 2.27, 6.83), and the 6-month PFS rate was 40%. Median overall survival (OS) was 20 months, with an estimated 1-year OS rate of 63%. GBM patients' recurrent tumors contained few T cells that demonstrated a paucity of immune activation markers, but the tumor microenvironment was markedly enriched for CD68+ macrophages. CONCLUSIONS Immune analyses indicated that pembrolizumab anti-programmed cell death 1 (PD-1) monotherapy alone can't induce effector immunologic response in most GBM patients, probably owing to a scarcity of T cells within the tumor microenvironment and a CD68+ macrophage preponderance.
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Affiliation(s)
- John de Groot
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Marta Penas-Prado
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristin Alfaro-Munoz
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathy Hunter
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Be Lian Pei
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Barbara O'Brien
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shiao-Pei Weathers
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Monica Loghin
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carlos Kamiya Matsouka
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - W K Alfred Yung
- Departments of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jacob Mandel
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Jimin Wu
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ying Yuan
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shouhao Zhou
- Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory N Fuller
- Neuropathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason Huse
- Neuropathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ian E McCutcheon
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick F Lang
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Raymond Sawaya
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rivka Colen
- Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shalini S Yadav
- Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jorge Blando
- Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Luis Vence
- Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James Allison
- Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Padmanee Sharma
- Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy B Heimberger
- Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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22
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Traylor JI, Patel R, Muir M, de Almeida Bastos DC, Ravikumar V, Kamiya-Matsuoka C, Rao G, Thomas JG, Kew Y, Prabhu SS. Laser Interstitial Thermal Therapy for Glioblastoma: A Single-Center Experience. World Neurosurg 2021; 149:e244-e252. [PMID: 33610872 DOI: 10.1016/j.wneu.2021.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Surgical resection has been shown to prolong survival in patients with glioblastoma multiforme (GBM), although this benefit has not been demonstrated for reoperation following tumor recurrence. Laser interstitial thermal therapy (LITT) is a minimally invasive ablation technique that has been shown to effectively reduce tumor burden in some patients with intracranial malignancy. The aim of this study was to describe the safety and efficacy of LITT for recurrent and newly diagnosed GBM at a large tertiary referral center. METHODS Patients with GBM receiving LITT were retrospectively analyzed. Overall survival from the time of LITT was the primary end point measured. RESULTS There were 69 patients identified for inclusion in this study. The median age of the cohort was 56 years (range, 15-77 years). Median tumor volume was 10.4 cm3 (range, 1.0-64.0 cm3). A Kaplan-Meier estimate of median overall survival for the series from the time of LITT was 12 months (95% confidence interval 8-16 months). Median progression-free survival for the cohort from LITT was 4 months (95% confidence interval 3-7 months). Adjuvant chemotherapy significantly prolonged progression-free survival and overall survival (P < 0.01 for both) in the cohort. Gross total ablation was not significantly associated with progression-free survival (P = 0.09). CONCLUSIONS LITT can safely reduce intracranial tumor burden in patients with GBM who have exhausted other adjuvant therapies or are poor candidates for conventional resection techniques.
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Affiliation(s)
- Jeffrey I Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Neurological Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Rajan Patel
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew Muir
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Visweswaran Ravikumar
- Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan, USA
| | - Carlos Kamiya-Matsuoka
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jonathan G Thomas
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yvonne Kew
- Department of Neurology, Baylor St. Luke's Medical Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
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23
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Noll KR, Chen HS, Wefel JS, Kumar VA, Hou P, Ferguson SD, Rao G, Johnson JM, Schomer DF, Suki D, Prabhu SS, Liu HL. Alterations in Functional Connectomics Associated With Neurocognitive Changes Following Glioma Resection. Neurosurgery 2021; 88:544-551. [PMID: 33080024 PMCID: PMC7884148 DOI: 10.1093/neuros/nyaa453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/20/2020] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Decline in neurocognitive functioning (NCF) often occurs following brain tumor resection. Functional connectomics have shown how neurologic insults disrupt cerebral networks underlying NCF, though studies involving patients with brain tumors are lacking. OBJECTIVE To investigate the impact of brain tumor resection upon the connectome and relationships with NCF outcome in the early postoperative period. METHODS A total of 15 right-handed adults with left perisylvian glioma underwent resting-state functional magnetic resonance imaging (rs-fMRI) and neuropsychological assessment before and after awake tumor resection. Graph theoretical analysis was applied to rs-fMRI connectivity matrices to calculate network properties. Network properties and NCF measures were compared across the pre- to postoperative periods with matched pairs Wilcoxon signed-rank tests. Associations between pre- to postoperative change in network and NCF measures were determined with Spearman rank-order correlations (ρ). RESULTS A majority of the sample showed postoperative decline on 1 or more NCF measures. Significant postoperative NCF decline was found across measures of verbal memory, processing speed, executive functioning, receptive language, and a composite index. Regarding connectomic properties, betweenness centrality and assortativity were significantly smaller postoperatively, and reductions in these measures were associated with better NCF outcomes. Significant inverse associations (ρ = -.51 to -.78, all P < .05) were observed between change in language, executive functioning, and learning and memory, and alterations in segregation, centrality, and resilience network properties. CONCLUSION Decline in NCF was common shortly following resection of glioma involving eloquent brain regions, most frequently in verbal learning/memory and executive functioning. Better postoperative outcomes accompanied reductions in centrality and resilience connectomic measures.
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Affiliation(s)
- Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Henry S Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chen HSM, Kumar VA, Johnson JM, Chen MM, Noll KR, Hou P, Prabhu SS, Schomer DF, Liu HL. Effect of brain normalization methods on the construction of functional connectomes from resting-state functional MRI in patients with gliomas. Magn Reson Med 2021; 86:487-498. [PMID: 33533052 DOI: 10.1002/mrm.28690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 11/07/2022]
Abstract
PURPOSE Spatial normalization is an essential step in resting-state functional MRI connectomic analysis with atlas-based parcellation, but brain lesions can confound it. Cost-function masking (CFM) is a popular compensation approach, but may not benefit modern normalization methods. This study compared three normalization methods with and without CFM and determined their impact on connectomic measures in patients with glioma. METHODS Fifty patients with glioma were included. T1 -weighted images were normalized using three different methods in SPM12, with and without CFM, which were then overlaid on the ICBM152 template and scored by two neuroradiologists. The Dice coefficient of gray-matter correspondence was also calculated. Normalized resting-state functional MRI data were parcellated using the AAL90 atlas to construct an individual connectivity matrix and calculate connectomic measures. The R2 among the different normalization methods was calculated for the connectivity matrices and connectomic measures. RESULTS The older method (Original) performed significantly worse than the modern methods (Default and DARTEL; P < .005 in observer ranking). The use of CFM did not significantly improve the normalization results. The Original method had lower correlation with the Default and DARTEL methods (R2 = 0.71-0.74) than Default with DARTEL (R2 = 0.96) in the connectivity matrix. The clustering coefficient appears to be the most, and modularity the least, sensitive connectomic measures to normalization performance. CONCLUSION The spatial normalization method can have an impact on resting-state functional MRI connectome and connectomic measures derived using atlas-based brain parcellation. In patients with glioma, this study demonstrated that Default and DARTEL performed better than the Original method, and that CFM made no significant difference.
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Affiliation(s)
- Henry Szu-Meng Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Melissa M Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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25
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Pyne P, Samanta N, Gohil H, Prabhu SS, Mitra RK. Alteration of water absorption in the THz region traces the onset of fibrillation in proteins. Chem Commun (Camb) 2021; 57:998-1001. [PMID: 33399590 DOI: 10.1039/d0cc06500e] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Using terahertz spectroscopy, we established the alteration of the collective hydration of water during the fibrillation process (native → intermediate → fibril) of a model protein bovine serum albumin. This label-free study concludes that water dynamics change systematically with protein conformational changes as it experiences a hydrophobic environment during the initial protein unfolding process, followed by the release of bound water during oligomerization and finally the hydrophobic interior of the fibril.
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Affiliation(s)
- Partha Pyne
- Department of Chemical, Biological & Macro-Molecular Sciences, Satyendra Nath Bose National Centre for Basic Sciences, Block-JD; Sector-III; Salt Lake, Kolkata-700106, India.
| | - Nirnay Samanta
- Department of Chemical, Biological & Macro-Molecular Sciences, Satyendra Nath Bose National Centre for Basic Sciences, Block-JD; Sector-III; Salt Lake, Kolkata-700106, India. and Institute for Physical and Theoretical Chemistry, TU Braunschweig, 38106 Braunschweig, Germany
| | - Himanshu Gohil
- Department of Condensed Matter Physics And Material Science, Tata Institute of Fundamental Research, Homi Bhahba Road, Colaba, Mumbai-400005, India.
| | - S S Prabhu
- Department of Condensed Matter Physics And Material Science, Tata Institute of Fundamental Research, Homi Bhahba Road, Colaba, Mumbai-400005, India.
| | - Rajib Kumar Mitra
- Department of Chemical, Biological & Macro-Molecular Sciences, Satyendra Nath Bose National Centre for Basic Sciences, Block-JD; Sector-III; Salt Lake, Kolkata-700106, India.
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Gates EDH, Weinberg JS, Prabhu SS, Lin JS, Hamilton J, Hazle JD, Fuller GN, Baladandayuthapani V, Fuentes DT, Schellingerhout D. Estimating Local Cellular Density in Glioma Using MR Imaging Data. AJNR Am J Neuroradiol 2021; 42:102-108. [PMID: 33243897 PMCID: PMC7814791 DOI: 10.3174/ajnr.a6884] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/13/2020] [Accepted: 08/22/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Increased cellular density is a hallmark of gliomas, both in the bulk of the tumor and in areas of tumor infiltration into surrounding brain. Altered cellular density causes altered imaging findings, but the degree to which cellular density can be quantitatively estimated from imaging is unknown. The purpose of this study was to discover the best MR imaging and processing techniques to make quantitative and spatially specific estimates of cellular density. MATERIALS AND METHODS We collected stereotactic biopsies in a prospective imaging clinical trial targeting untreated patients with gliomas at our institution undergoing their first resection. The data included preoperative MR imaging with conventional anatomic, diffusion, perfusion, and permeability sequences and quantitative histopathology on biopsy samples. We then used multiple machine learning methodologies to estimate cellular density using local intensity information from the MR images and quantitative cellular density measurements at the biopsy coordinates as the criterion standard. RESULTS The random forest methodology estimated cellular density with R 2 = 0.59 between predicted and observed values using 4 input imaging sequences chosen from our full set of imaging data (T2, fractional anisotropy, CBF, and area under the curve from permeability imaging). Limiting input to conventional MR images (T1 pre- and postcontrast, T2, and FLAIR) yielded slightly degraded performance (R2 = 0.52). Outputs were also reported as graphic maps. CONCLUSIONS Cellular density can be estimated with moderate-to-strong correlations using MR imaging inputs. The random forest machine learning model provided the best estimates. These spatially specific estimates of cellular density will likely be useful in guiding both diagnosis and treatment.
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Affiliation(s)
- E D H Gates
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.)
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (E.D.H.G.), Houston, Texas
| | | | | | - J S Lin
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.)
- Baylor College of Medicine (J.S.L.), Houston, Texas
- Department of Bioengineering (J.S.L.), Rice University, Houston, Texas
| | - J Hamilton
- Neuroradiology (J.H., D.S.)
- Radiology Partners (J.H.), Houston, Texas
| | - J D Hazle
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.)
| | | | - V Baladandayuthapani
- Department of Computational Medicine and Bioinformatics (V.B.), University of Michigan School of Public Health, Ann Arbor, Michigan
| | - D T Fuentes
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.)
| | - D Schellingerhout
- Neuroradiology (J.H., D.S.)
- Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
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Ott M, Tomaszowski KH, Marisetty A, Kong LY, Wei J, Duna M, Blumberg K, Ji X, Jacobs C, Fuller GN, Langford LA, Huse JT, Long JP, Hu J, Li S, Weinberg JS, Prabhu SS, Sawaya R, Ferguson S, Rao G, Lang FF, Curran MA, Heimberger AB. Profiling of patients with glioma reveals the dominant immunosuppressive axis is refractory to immune function restoration. JCI Insight 2020; 5:134386. [PMID: 32721947 PMCID: PMC7526457 DOI: 10.1172/jci.insight.134386] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/24/2020] [Indexed: 01/17/2023] Open
Abstract
In order to prioritize available immune therapeutics, immune profiling across glioma grades was conducted, followed by preclinical determinations of therapeutic effect in immune-competent mice harboring gliomas. T cells and myeloid cells were isolated from the blood of healthy donors and the blood and tumors from patients with glioma and profiled for the expression of immunomodulatory targets with an available therapeutic. Murine glioma models were used to assess therapeutic efficacy of agents targeting the most frequently expressed immune targets. In patients with glioma, the A2aR/CD73/CD39 pathway was most frequently expressed, followed by the PD-1 pathway. CD73 expression was upregulated on immune cells by 2-hydroxyglutarate in IDH1 mutant glioma patients. In murine glioma models, adenosine receptor inhibitors demonstrated a modest therapeutic response; however, the addition of other inhibitors of the adenosine pathway did not further enhance this therapeutic effect. Although adenosine receptor inhibitors could recover immunological effector functions in T cells, immune recovery was impaired in the presence of gliomas, indicating that irreversible immune exhaustion limits the effectiveness of adenosine pathway inhibitors in patients with glioma. This study illustrates vetting steps that should be considered before clinical trial implementation for immunotherapy-resistant cancers, including testing an agent’s ability to restore immunological function in the context of intended use. Immune profiling of glioma patients reveals that the immune suppressive adenosine axis predominates but is refractory to modulation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Jian Hu
- Department of Cancer Biology
| | | | | | | | | | | | | | | | - Michael A Curran
- Department of Immunology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Tzeng CWD, Teshome M, Katz MHG, Weinberg JS, Lai SY, Antonoff MB, Bird JE, Shafer A, Davis JW, Adelman DM, Moon B, Reece G, Prabhu SS, DeSnyder SM, Skibber JM, Mehran R, Schmeler K, Roland CL, Tran Cao HS, Aloia TA, Caudle AS, Swisher SG, Vauthey JN. Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience. Ann Surg 2020; 272:e106-e111. [PMID: 32675511 PMCID: PMC7373457 DOI: 10.1097/sla.0000000000004092] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To summarize the multi-specialty strategy and initial guidelines of a Case Review Committee in triaging oncologic surgery procedures in a large Comprehensive Cancer Center and to outline current steps moving forward after the initial wave. SUMMARY OF BACKGROUND DATA The impetus for strategic rescheduling of operations is multifactorial and includes our societal responsibility to minimize COVID-19 exposure risk and propagation among patients, the healthcare workforce, and our community at large. Strategic rescheduling is also driven by the need to preserve limited resources. As many states have already or are considering to re-open and relax stay-at-home orders, there remains a continued need for careful surgical scheduling because we must face the reality that we will need to co-exist with COVID-19 for months, if not years. METHODS The quality officers, chairs, and leadership of the 9 surgical departments in our Division of Surgery provide specialty-specific approaches to appropriately triage patients. RESULTS We present the strategic approach for surgical rescheduling during and immediately after the COVID-19 first wave for the 9 departments in the Division of Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. CONCLUSIONS Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase.
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Affiliation(s)
- Ching-Wei D Tzeng
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew H G Katz
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Justin E Bird
- Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aaron Shafer
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Adelman
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryan Moon
- Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory Reece
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John M Skibber
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza Mehran
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathleen Schmeler
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christina L Roland
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hop S Tran Cao
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Nicolas Vauthey
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Ballester LY, Meis JM, Lazar AJ, Prabhu SS, Hoang KB, Leeds NE, Fuller GN. Intracranial Myxoid Mesenchymal Tumor With EWSR1-ATF1 Fusion. J Neuropathol Exp Neurol 2020; 79:347-351. [PMID: 32016322 DOI: 10.1093/jnen/nlz140] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 05/18/2019] [Accepted: 12/11/2019] [Indexed: 11/14/2022] Open
Abstract
Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor that arises primarily in the extremities of young adults. Recurrent gene fusions involving EWSR1 with members of the cAMP response element binding protein (CREB) family have been reported in a diverse group of tumors, including AFH. AFH-like lesions have been reported to occur intracranially and the reported cases show low proliferation indices, frequently have a connection with the dura, and show recurrent EWSR1 rearrangements. These tumors have been termed intracranial myxoid mesenchymal tumor with EWSR1-CREB family gene fusions. A literature search identified 11 reported cases of intracranial AFH-like lesions with an EWSR1 rearrangement. Here, we report a case of intracranial myxoid mesenchymal tumor with an EWSR1-ATF1 fusion in an adult patient, and review the existing literature on this recently described entity.
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Affiliation(s)
- Leomar Y Ballester
- From the Department of Pathology and Laboratory Medicine.,Vivian L. Smith Department of Neurosurgery (LYB), University of Texas Health Science Center at Houston, Houston, Texas.,Memorial Hermann Hospital-Texas Medical Center, Houston, Texas
| | | | | | | | | | - Norman E Leeds
- Department of Diagnostic Radiology (Section of Neuroradiology) (NEL), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Bastos DCDA, Fuentes DT, Traylor J, Weinberg J, Kumar VA, Stafford J, Li J, Rao G, Prabhu SS. The use of laser interstitial thermal therapy in the treatment of brain metastases: a literature review. Int J Hyperthermia 2020; 37:53-60. [DOI: 10.1080/02656736.2020.1748238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
| | - David T. Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Traylor
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Vinodh A. Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit S. Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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31
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Kumar VA, Heiba IM, Prabhu SS, Chen MM, Colen RR, Young AL, Johnson JM, Hou P, Noll K, Ferguson SD, Rao G, Lang FF, Schomer DF, Liu HL. The role of resting-state functional MRI for clinical preoperative language mapping. Cancer Imaging 2020; 20:47. [PMID: 32653026 PMCID: PMC7353792 DOI: 10.1186/s40644-020-00327-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Task-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, particularly in cognitively impaired patients who cannot perform language paradigms. Resting-state functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. The purpose of our study is to determine the utility of rs-fMRI for clinical preoperative language mapping when tb-fMRI is limited. Methods We retrospectively reviewed 134 brain tumor patients who underwent preoperative fMRI language mapping. rs-fMRI was post-processed with seed-based correlation (SBC) analysis, when language tb-fMRI was limited. Two neuroradiologists reviewed both the tb-fMRI and rs-fMRI results. Six neurosurgeons retrospectively rated the usefulness of rs-fMRI for language mapping in their patients. Results Of the 134 patients, 49 cases had limited tb-fMRI and rs-fMRI was post-processed. Two neuroradiologists found rs-fMRI beneficial for functional language mapping in 41(84%) and 43 (88%) cases respectively; Cohen’s kappa is 0.83, with a 95% confidence interval (0.61, 1.00). The neurosurgeons found rs-fMRI “definitely” useful in 26 cases (60%) and “somewhat” useful in 13 cases (30%) in locating potential eloquent language centers of clinical interest. Six unsuccessful rs-fMRI cases were due to: head motion (2 cases), nonspecific functionality connectivity outside the posterior language network (1 case), and an unknown system instability (3 cases). Conclusions This study is a proof of concept that shows SBC rs-fMRI may be a viable alternative for clinical language mapping when tb-fMRI is limited.
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Affiliation(s)
- Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Islam M Heiba
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa M Chen
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rivka R Colen
- Department of Diagnostic Radiology, The University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Angela L Young
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jason M Johnson
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyle Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donald F Schomer
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Bastos DCDA, Weinberg J, Kumar VA, Fuentes DT, Stafford J, Li J, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy in the treatment of brain metastases and radiation necrosis. Cancer Lett 2020; 489:9-18. [PMID: 32504657 DOI: 10.1016/j.canlet.2020.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/16/2023]
Abstract
Stereotactic Radiosurgery has become the main treatment for patients with limited number of brain metastases (BM). Recently, with the increasing use of this modality, there is a growth in recurrence cases. Recurrence after radiation therapy can be divided in changes favoring either tumor recurrence or radiation necrosis (RN). Laser Interstitial Thermal Therapy (LITT) is minimally invasive treatment modality that has been used to treat primary and metastatic brain tumors. When associated with real-time thermometry using Magnetic Resonance Imaging, the extent of ablation can be controlled to provide maximum coverage and avoid eloquent areas. The objective of this study was to investigate the use of LITT in the treatment of BM. An extensive review of the relevant literature was conducted and the outcome results are discussed. There is an emphasis on safety and local control rate of patients treated with this modality. The findings of our study suggest that LITT is a viable safe technique to treat recurrent BM, especially in patients with deep-seated lesions where surgical resection is not an option.
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Affiliation(s)
- Dhiego Chaves de Almeida Bastos
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
| | - Jeffrey Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
| | - Vinodh A Kumar
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Unit 1482, Houston, Texa, 77030-4008, USA.
| | - David T Fuentes
- Department of Imaging Physics - UNIT 1472, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT14.5000, Houston, TX, 77030, USA.
| | - Jason Stafford
- Department of Imaging Physics - UNIT 1472, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, FCT14.5000, Houston, TX, 77030, USA.
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Unit 1482, PO Box 301402, Houston, TX, 77030, USA.
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1400 Holcombe Blvd, FC7.2000, Unit Number: 442, Houston, TX, 77030, USA.
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Noticewala SS, Ludmir EB, Bishop AJ, Chung C, Ghia AJ, Grosshans D, McGovern S, Paulino ADLC, Wang C, Woodhouse KD, Yeboa DN, Prabhu SS, Weathers SP, Das P, Koong AC, McAleer MF, Li J. Radiation for Glioblastoma in the Era of Coronavirus Disease 2019 (COVID-19): Patient Selection and Hypofractionation to Maximize Benefit and Minimize Risk. Adv Radiat Oncol 2020; 5:743-745. [PMID: 32775785 PMCID: PMC7251361 DOI: 10.1016/j.adro.2020.04.040] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/16/2022] Open
Abstract
We describe the institutional guidelines of a major tertiary cancer center with regard to using hypofractionated radiation regimens to treat glioblastoma as a measure to minimize exposure to coronavirus disease 2019 (COVID-19) while not sacrificing clinical outcomes. Our guidelines review level one evidence of various hypofractionated regimens, and recommend a multidisciplinary approach while balancing the risk of morbidity and mortality among individuals at high risk for severe illness from COVID-19 infection. We also briefly outline strategies our department is taking in mitigating risk among our cancer patients undergoing radiation.
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Affiliation(s)
- Sonal S Noticewala
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ethan B Ludmir
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andrew J Bishop
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Caroline Chung
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amol J Ghia
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Grosshans
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Susan McGovern
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Chenyang Wang
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristina D Woodhouse
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Debra N Yeboa
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shiao-Pei Weathers
- Department of Neurooncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Prajnan Das
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Albert C Koong
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mary Frances McAleer
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jing Li
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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34
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Vega RA, Traylor JI, Patel R, Muir M, Bastos DC, Prabhu SS. Combined Surgical Resection and Laser Interstitial Thermal Therapy for Glioblastoma: Technical Note. J Neurol Surg A Cent Eur Neurosurg 2020; 81:348-354. [DOI: 10.1055/s-0040-1709163] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Background Glioblastoma multiforme (GBM) is an aggressive intracranial malignancy that confers a poor prognosis despite maximum surgical resection and chemoradiotherapy. Survival decreases further with deep-seated lesions. Laser interstitial thermal therapy (LITT) is an emerging minimally invasive technique for tumor ablation shown to reduce tumor burden effectively, particularly in deep-seated locations less amenable to gross total resection. We describe our initial technical experience of using the combination of LITT followed by surgical resection in patients with GBMs that exhibit both an easily accessible and deep-seated component.
Materials and Methods Patients with GBM who received concurrent LITT and surgical resection at our institution were identified. Patient demographic and clinical information was procured from the University of Texas MD Anderson Cancer Center electronic medical record along with preoperative, postoperative, and 1-month follow-up magnetic resonance imaging (MRI).
Results Four patients (n = 2 male, n = 2 female) with IDH-wild type GBM who received combined LITT and surgical resection were identified and analyzed retrospectively. All patients received chemoradiotherapy before presentation. All but one patient (75%) received resection before presentation. Median age was 54 years (range: 44–56 years). Median length of hospital stay was 6.5 days (range: 2–47 days). Median extent of combined ablation/resection was 90.4%. One of the four patients experienced complications in the perioperative or immediate follow-up periods. Local recurrence was observed in one patient during the follow-up period.
Conclusion Malignant gliomas in deep-seated locations or in close proximity to white matter structures are challenging to manage. LITT followed by surgical resection may provide an alternative for tumor debulking that minimizes potential morbidities and extent of residual tumor. Further studies comparing this approach with standard resection techniques are warranted.
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Affiliation(s)
- Rafael A. Vega
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Jeffrey I. Traylor
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Rajan Patel
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Matthew Muir
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Dheigo C.A. Bastos
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Sujit S. Prabhu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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35
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Gates EDH, Lin JS, Weinberg JS, Hamilton J, Prabhu SS, Hazle JD, Fuller GN, Baladandayuthapani V, Fuentes D, Schellingerhout D. Guiding the first biopsy in glioma patients using estimated Ki-67 maps derived from MRI: conventional versus advanced imaging. Neuro Oncol 2020; 21:527-536. [PMID: 30657997 DOI: 10.1093/neuonc/noz004] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Undersampling of gliomas at first biopsy is a major clinical problem, as accurate grading determines all subsequent treatment. We submit a technological solution to reduce the problem of undersampling by estimating a marker of tumor proliferation (Ki-67) using MR imaging data as inputs, against a stereotactic histopathology gold standard. METHODS MR imaging was performed with anatomic, diffusion, permeability, and perfusion sequences, in untreated glioma patients in a prospective clinical trial. Stereotactic biopsies were harvested from each patient immediately prior to surgical resection. For each biopsy, an imaging description (23 parameters) was developed, and the Ki-67 index was recorded. Machine learning models were built to estimate Ki-67 from imaging inputs, and cross validation was undertaken to determine the error in estimates. The best model was used to generate graphical maps of Ki-67 estimates across the whole brain. RESULTS Fifty-two image-guided biopsies were collected from 23 evaluable patients. The random forest algorithm best modeled Ki-67 with 4 imaging inputs (T2-weighted, fractional anisotropy, cerebral blood flow, Ktrans). It predicted the Ki-67 expression levels with a root mean square (RMS) error of 3.5% (R2 = 0.75). A less accurate predictive result (RMS error 5.4%, R2 = 0.50) was found using conventional imaging only. CONCLUSION Ki-67 can be predicted to clinically useful accuracies using clinical imaging data. Advanced imaging (diffusion, perfusion, and permeability) improves predictive accuracy over conventional imaging alone. Ki-67 predictions, displayed as graphical maps, could be used to guide biopsy, resection, and/or radiation in the care of glioma patients.
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Affiliation(s)
- Evan D H Gates
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas.,UT MDACC UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Jonathan S Lin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas.,Baylor College of Medicine, Houston, Texas.,Department of Bioengineering, Rice University, Houston, Texas
| | | | - Jackson Hamilton
- Department of Diagnostic Radiology, UT MDACC, Houston, Texas.,Radiology Partners, Houston, Texas
| | | | - John D Hazle
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas
| | | | | | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center (UT MDACC), Houston, Texas
| | - Dawid Schellingerhout
- Department of Diagnostic Radiology, UT MDACC, Houston, Texas.,Department of Cancer Systems Imaging, UT MDACC, Houston, Texas
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36
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Gates EDH, Lin JS, Weinberg JS, Prabhu SS, Hamilton J, Hazle JD, Fuller GN, Baladandayuthapani V, Fuentes DT, Schellingerhout D. Imaging-Based Algorithm for the Local Grading of Glioma. AJNR Am J Neuroradiol 2020; 41:400-407. [PMID: 32029466 DOI: 10.3174/ajnr.a6405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Gliomas are highly heterogeneous tumors, and optimal treatment depends on identifying and locating the highest grade disease present. Imaging techniques for doing so are generally not validated against the histopathologic criterion standard. The purpose of this work was to estimate the local glioma grade using a machine learning model trained on preoperative image data and spatially specific tumor samples. The value of imaging in patients with brain tumor can be enhanced if pathologic data can be estimated from imaging input using predictive models. MATERIALS AND METHODS Patients with gliomas were enrolled in a prospective clinical imaging trial between 2013 and 2016. MR imaging was performed with anatomic, diffusion, permeability, and perfusion sequences, followed by image-guided stereotactic biopsy before resection. An imaging description was developed for each biopsy, and multiclass machine learning models were built to predict the World Health Organization grade. Models were assessed on classification accuracy, Cohen κ, precision, and recall. RESULTS Twenty-three patients (with 7/9/7 grade II/III/IV gliomas) had analyzable imaging-pathologic pairs, yielding 52 biopsy sites. The random forest method was the best algorithm tested. Tumor grade was predicted at 96% accuracy (κ = 0.93) using 4 inputs (T2, ADC, CBV, and transfer constant from dynamic contrast-enhanced imaging). By means of the conventional imaging only, the overall accuracy decreased (89% overall, κ = 0.79) and 43% of high-grade samples were misclassified as lower-grade disease. CONCLUSIONS We found that local pathologic grade can be predicted with a high accuracy using clinical imaging data. Advanced imaging data improved this accuracy, adding value to conventional imaging. Confirmatory imaging trials are justified.
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Affiliation(s)
- E D H Gates
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas.,University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences (E.D.H.G.), Houston, Texas
| | - J S Lin
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas.,Baylor College of Medicine (J.S.L.), Houston, Texas.,Department of Bioengineering (J.S.L.), Rice University, Houston, Texas
| | - J S Weinberg
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - S S Prabhu
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Hamilton
- Radiology Partners (J.H.), Houston, Texas
| | - J D Hazle
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - G N Fuller
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - V Baladandayuthapani
- Department of Computational Medicine and Bioinformatics (V.B.), University of Michigan School of Public Health, Ann Arbor, Michigan
| | - D T Fuentes
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
| | - D Schellingerhout
- From the Departments of Imaging Physics (E.D.H.G., J.S.L., J.D.H., D.T.F.), Neurosurgery (J.S.W., S.S.P.), Pathology (G.N.F.), Neuroradiology (D.S.), and Cancer Systems Imaging (D.S.), University of Texas MD Anderson Cancer Center, Houston, Texas
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Hsu AL, Chen HSM, Hou P, Wu CW, Johnson JM, Noll KR, Prabhu SS, Ferguson SD, Kumar VA, Schomer DF, Chen JH, Liu HL. Presurgical resting-state functional MRI language mapping with seed selection guided by regional homogeneity. Magn Reson Med 2019; 84:375-383. [PMID: 31793025 DOI: 10.1002/mrm.28107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 01/09/2023]
Abstract
PURPOSE Resting-state functional MRI (rs-FMRI) has shown potential for presurgical mapping of eloquent cortex when a patient's performance on task-based FMRI is compromised. The seed-based analysis is a practical approach for detecting rs-FMRI functional networks; however, seed localization remains challenging for presurgical language mapping. Therefore, we proposed a data-driven approach to guide seed localization for presurgical rs-FMRI language mapping. METHODS Twenty-six patients with brain tumors located in left perisylvian regions had undergone task-based FMRI and rs-FMRI before tumor resection. For the seed-based rs-FMRI language mapping, a seeding approach that integrates regional homogeneity and meta-analysis maps (RH+MA) was proposed to guide the seed localization. Canonical and task-based seeding approaches were used for comparison. The performance of the 3 seeding approaches was evaluated by calculating the Dice coefficients between each rs-FMRI language mapping result and the result from task-based FMRI. RESULTS With the RH+MA approach, selecting among the top 6 seed candidates resulted in the highest Dice coefficient for 81% of patients (21 of 26) and the top 9 seed candidates for 92% of patients (24 of 26). The RH+MA approach yielded rs-FMRI language mapping results that were in greater agreement with the results of task-based FMRI, with significantly higher Dice coefficients (P < .05) than that of canonical and task-based approaches within putative language regions. CONCLUSION The proposed RH+MA approach outperformed the canonical and task-based seed localization for rs-FMRI language mapping. The results suggest that RH+MA is a robust and feasible method for seed-based functional connectivity mapping in clinical practice.
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Affiliation(s)
- Ai-Ling Hsu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Henry Szu-Meng Chen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ping Hou
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan.,Brain and Consciousness Research Center, Shuang Ho Hospital, New Taipei, Taiwan
| | - Jason M Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kyle R Noll
- Section of Neuropsychology, Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Donald F Schomer
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jyh-Horng Chen
- Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Ho-Ling Liu
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Sarkar R, Ghindani D, Devi KM, Prabhu SS, Ahmad A, Kumar G. Independently tunable electromagnetically induced transparency effect and dispersion in a multi-band terahertz metamaterial. Sci Rep 2019; 9:18068. [PMID: 31792270 PMCID: PMC6889216 DOI: 10.1038/s41598-019-54414-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/12/2019] [Indexed: 11/09/2022] Open
Abstract
In this article, we experimentally and numerically investigate a planar terahertz metamaterial (MM) geometry capable of exhibiting independently tunable multi-band electromagnetically induced transparency effect (EIT). The MM structure exhibits multi-band EIT effect due to the strong near field coupling between the bright mode of the cut-wire (CW) and dark modes of pair of asymmetric double C resonators (DCRs). The configuration allows us to independently tune the transparency windows which is challenging task in multiband EIT effect. The independent modulation is achieved by displacing one DCR with respect to the CW, while keeping the other asymmetric DCR fixed. We further examine steep dispersive behavior of the transmission spectra within the transparency windows and analyze slow light properties. A coupled harmonic oscillator based theoretical model is employed to elucidate as well as understand the experimental and numerical observations. The study can be highly significant in the development of multi-band slow light devices, buffers and modulators.
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Affiliation(s)
- Rakesh Sarkar
- Department of Physics, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India.
| | - Dipa Ghindani
- Tata Institute of Fundamental Research, Navy Nagar, Colaba, Mumbai, 400005, India
| | - Koijam Monika Devi
- Department of Physics, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
| | - S S Prabhu
- Tata Institute of Fundamental Research, Navy Nagar, Colaba, Mumbai, 400005, India
| | - Amir Ahmad
- College of Information Technology, United Arab Emirates University, Al Ain, 15551, United Arab Emirates.
| | - Gagan Kumar
- Department of Physics, Indian Institute of Technology Guwahati, Guwahati, 781039, Assam, India
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Traylor JI, Patel R, Habib A, Muir M, de Almeida Bastos DC, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy to the Posterior Fossa: Challenges and Nuances. World Neurosurg 2019; 132:e124-e132. [DOI: 10.1016/j.wneu.2019.08.242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/15/2022]
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Krivosheya D, Rao G, Tummala S, Kumar V, Suki D, Bastos DCA, Prabhu SS. Impact of Multi-modality Monitoring Using Direct Electrical Stimulation to Determine Corticospinal Tract Shift and Integrity in Tumors using the Intraoperative MRI. J Neurol Surg A Cent Eur Neurosurg 2019; 82:375-380. [PMID: 31659724 DOI: 10.1055/s-0039-1698383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Preserving the integrity of the corticospinal tract (CST) while maximizing the extent of tumor resection is one of the key principles of brain tumor surgery to prevent new neurologic deficits. Our goal was to determine the impact of the use of perioperative diffusion tensor imaging (DTI) fiber-tracking protocols for location of the CSTs, in conjunction with intraoperative direct electrical stimulation (DES) on patient neurologic outcomes. The role of combining DES and CST shift in intraoperative magnetic resonance imaging (iMRI) to enhance extent of resection (EOR) has not been studied previously. METHODS A total of 53 patients underwent resection of tumors adjacent to the motor gyrus and the underlying CST between June 5, 2009, and April 16, 2013. All cases were performed in the iMRI (BrainSuite 1.5 T). Preoperative DTI mapping and intraoperative cortical and subcortical DES including postoperative DTI mapping were performed in all patients. There were 32 men and 21 women with 40 high-grade gliomas (76%), 4 low-grade gliomas (8%), and 9 (17%) metastases. Thirty-four patients (64%) were newly diagnosed, and 19 (36%) had a previous resection. There were 31 (59%) right-sided and 22 (42%) left-sided tumors. Eighteen patients (34%) had a re-resection after the first intraoperative scan. Most patients had motor-only mapping, and one patient had both speech and motor mapping. Relative to the resection margin, the CST after the first iMRI was designated as having an outward shift (OS), inward shift (IS), or no shift (NS). RESULTS A gross total resection (GTR) was achieved in 41 patients (77%), subtotal resection in 4 (7.5%), and a partial resection in 8 (15%). Eighteen patients had a re-resection, and the mean EOR increased from 84% to 95% (p = 0.002). Of the 18 patients, 7 had an IS, 8 an OS, and in 3 NS was noted. More patients in the OS group had a GTR compared with the IS or NS groups (p = 0.004). Patients were divided into four groups based on the proximity of the tumor to the CST as measured from the preoperative scan. Group 1 (32%) included patients whose tumors were 0 to 5 mm from the CST based on preoperative scans; group 2 (28%), 6 to 10 mm; group 3 (13%), 11 to 15 mm; and group 4 (26%), 16 to 20 mm, respectively. Patients in group 4 had fewer neurologic complications compared with other groups at 1 and 3 months postoperatively (p = 0.001 and p = 0.007, respectively) despite achieving a similar degree of resection (p = 0.61). Furthermore, the current of intraoperative DES was correlated to the distance of the tumor to the CST, and the regression equation showed a close linear relationship between the two parameters. CONCLUSIONS Combining information about intraoperative CST and DES in the iMRI can enhance resection in brain tumors (77% had a GTR). The relative relationship between the positions of the CST to the resection cavity can be a dynamic process that could further influence the surgeon's decision about the stimulation parameters and EOR. Also, the patients with an OS of the CST relative to the resection cavity had a GTR comparable with the other groups.
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Affiliation(s)
- Daria Krivosheya
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio, United States
| | - Ganesh Rao
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Sudhakar Tummala
- Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Vinodh Kumar
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Dima Suki
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Dheigo C A Bastos
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, Texas, United States
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Salem U, Kumar VA, Madewell JE, Schomer DF, de Almeida Bastos DC, Zinn PO, Weinberg JS, Rao G, Prabhu SS, Colen RR. Neurosurgical applications of MRI guided laser interstitial thermal therapy (LITT). Cancer Imaging 2019; 19:65. [PMID: 31615562 PMCID: PMC6792239 DOI: 10.1186/s40644-019-0250-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/30/2019] [Indexed: 02/02/2023] Open
Abstract
MRI-guided laser interstitial thermal therapy (LITT) is the selective ablation of a lesion or a tissue using heat emitted from a laser device. LITT is considered a less invasive technique compared to open surgery that provides a nonsurgical solution for patients who cannot tolerate surgery. Although laser ablation has been used to treat brain lesions for decades, recent advances in MRI have improved lesion targeting and enabled real-time accurate monitoring of the thermal ablation process. These advances have led to a plethora of research involving the technique, safety, and potential applications of LITT.LITT is a minimally invasive treatment modality that shows promising results and is associated with decreased morbidity. It has various applications, such as treatment of glioma, brain metastases, radiation necrosis, and epilepsy. It can provide a safer alternative treatment option for patients in whom the lesion is not accessible by surgery, who are not surgical candidates, or in whom other standard treatment options have failed. Our aim is to review the current literature on LITT and provide a descriptive review of the technique, imaging findings, and clinical applications for neurosurgery.
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Affiliation(s)
- Usama Salem
- Department of Radiology, The University of Texas Medical Branch at Galveston, Galveston, TX, 77555, USA.
| | - Vinodh A Kumar
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - John E Madewell
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Donald F Schomer
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | | | - Pascal O Zinn
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Rivka R Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. .,Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA.
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Bhattacharya A, Ghindani D, Prabhu SS. Enhanced terahertz emission bandwidth from photoconductive antenna by manipulating carrier dynamics of semiconducting substrate with embedded plasmonic metasurface. Opt Express 2019; 27:30272-30279. [PMID: 31684276 DOI: 10.1364/oe.27.030272] [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] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/23/2019] [Indexed: 06/10/2023]
Abstract
In this article, we demonstrate a technique to enhance the Terahertz (THz) emission bandwidth from photo-conductive antenna (PCA) based on semiconducting substrates by manipulating the surface carrier dynamics of the semiconductor. Bandwidths in PCAs are limited by the decay of the photogenerated charge carriers, which in case of SI-GaAs is in the orders of 50 picoseconds. We show, with an embedded design of plasmonic meta-surface in the photoconductive gap of a PCA, it is possible to enhance the emission bandwidths by more than 50 percent. This is due to the fact that these nano-structures act as local recombination sites for the photogenerated carriers, effectively reducing the carriers' lifetime. Additionally, the defect sites reduce the terminal current, thereby reducing the Joule heating in the device. Furthermore, the meta-surface also facilitates higher in-coupling of the exciting infrared light on to the PCA, thereby increasing the optical-to-THz conversion efficiency of the device.
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Bastos DCDA, Rao G, Oliva ICG, Loree JM, Fuentes DT, Stafford RJ, Beechar VB, Weinberg JS, Shah K, Kumar VA, Prabhu SS. Predictors of Local Control of Brain Metastasis Treated With Laser Interstitial Thermal Therapy. Neurosurgery 2019; 87:112-122. [DOI: 10.1093/neuros/nyz357] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/01/2019] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Laser Interstitial Thermal Therapy (LITT) has been used to treat recurrent brain metastasis after stereotactic radiosurgery (SRS). Little is known about how best to assess the efficacy of treatment, specifically the ability of LITT to control local tumor progression post-SRS.
OBJECTIVE
To evaluate the predictive factors associated with local recurrence after LITT.
METHODS
Retrospective study with consecutive patients with brain metastases treated with LITT. Based on radiological aspects, lesions were divided into progressive disease after SRS (recurrence or radiation necrosis) and new lesions. Primary endpoint was time to local recurrence.
RESULTS
A total of 61 consecutive patients with 82 lesions (5 newly diagnosed, 46 recurrence, and 31 radiation necrosis). Freedom from local recurrence at 6 mo was 69.6%, 59.4% at 12, and 54.7% at 18 and 24 mo. Incompletely ablated lesions had a shorter median time for local recurrence (P < .001). Larger lesions (>6 cc) had shorter time for local recurrence (P = .03). Dural-based lesions showed a shorter time to local recurrence (P = .01). Tumor recurrence/newly diagnosed had shorter time to local recurrence when compared to RN lesions (P = .01). Patients receiving systemic therapy after LITT had longer time to local recurrence (P = .01). In multivariate Cox-regression model, the HR for incomplete ablated lesions was 4.88 (P < .001), 3.12 (P = .03) for recurrent tumors, and 2.56 (P = .02) for patients not receiving systemic therapy after LITT. Complication rate was 26.2%.
CONCLUSION
Incompletely ablated and recurrent tumoral lesions were associated with higher risk of treatment failure and were the major predicting factors for local recurrence. Systemic therapy after LITT was a protective factor regarding local recurrence.
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Affiliation(s)
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Jonathan M Loree
- Department of Medical Oncology, BC Cancer, Vancouver Centre, Vancouver, Canada
| | - David T Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - R Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vivek B Beechar
- Department of Neurosurgery, Baylor College of Medicine, Texas Medical Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Komal Shah
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Vinodh A Kumar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Traylor JI, Patel R, Muir M, Habib A, Bastos DCDA, Rao G, Prabhu SS. Laser Interstitial Thermal Therapy to the Posterior Fossa: Challenges and Nuances. Neurosurgery 2019. [DOI: 10.1093/neuros/nyz310_461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with laser interstitial thermal therapy (LITT) for the management of brain metastases and radiation necrosis of the posterior fossa.
METHODS
We retrospectively analyzed 13 patients with metastases and radiation necrosis of the posterior fossa managed with LITT. Patient data were extracted from the electronic medical record along with magnetic resonance images (MRI) preoperatively, immediately postoperatively, and at each follow-up.
RESULTS
Thirteen patients with histopathologically confirmed radiation necrosis (n = 5) and metastases (n = 8) of the posterior fossa underwent LITT. The median preoperative tumor and postoperative ablation cavity volume was 4.66 and 6.29 cm3, respectively. The median volume of the ablation cavity decreased to 2.90 cm3 at 9-mo follow-up. The median volume of peritumoral edema was 12.25 cm3, which fell to a median 5.77 cm3 at 1-mo follow-up. Median progression-free survival was 7 mo (range 3-14 mo) from LITT. The mean overall survival (OS) was 40 months (range 2-49 mo). There were no intraoperative complications. One patient experienced palsy of the seventh and eighth cranial nerves on follow-up, attributable to LITT. Two patients received 2 LITT treatments for their respective lesions.
CONCLUSION
Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. We demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.
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Traylor JI, Bastos DCA, Fuentes D, Muir M, Patel R, Kumar VA, Stafford RJ, Rao G, Prabhu SS. Dynamic Contrast-Enhanced MRI in Patients with Brain Metastases Undergoing Laser Interstitial Thermal Therapy: A Pilot Study. AJNR Am J Neuroradiol 2019; 40:1451-1457. [PMID: 31371353 DOI: 10.3174/ajnr.a6144] [Citation(s) in RCA: 2] [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: 04/22/2019] [Accepted: 06/19/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Tumor recurrence is difficult to predict in patients receiving laser ablation for intracranial malignancy. We assessed the efficacy of the initial area under the time-to-signal intensity curve at 60 seconds (iAUC60) from dynamic contrast-enhanced MR imaging in predicting progression-free survival in patients with brain metastases following laser interstitial thermal therapy. MATERIALS AND METHODS The study population was a consecutive series of patients undergoing laser interstitial thermal therapy for brain metastases. Patient demographics including age, sex, tumor histology, and Karnofsky Performance Scale were collected prospectively. Preoperative, postoperative, and 1-month follow-up dynamic contrast-enhanced MRIs were analyzed. Values of iAUC60 were computed using a trapezoidal rule applied to the time history of contrast uptake over the first 60 seconds postenhancement. The change in iAUC60 (ΔiAUC60) was calculated by taking the difference between the values of iAUC60 from 2 time points. Pearson correlation coefficients were calculated between progression-free survival, defined as the time from laser interstitial thermal therapy to tumor recurrence, and iAUC60 or ΔiAUC60 values. RESULTS Thirty-three cases of laser interstitial thermal therapy for 32 brain metastases in a cohort of 27 patients were prospectively analyzed. A significant relationship was observed between the values of iAUC60 from postoperative dynamic contrast-enhanced MR imaging and progression-free survival with Pearson correlation (P = .03) and Cox univariate analysis (P = .01). The relationship between preoperative and 1-month follow-up dynamic contrast-enhanced MR imaging was not significantly correlated with progression-free survival. Similarly, no statistically significant relationship was observed with ΔiAUC60 and progression-free survival between any time points. CONCLUSIONS Progression-free survival is difficult to predict in patients undergoing laser interstitial thermal therapy for brain metastases due to confounding with posttreatment change. iAUC60 extracted from postoperative dynamic contrast-enhanced MR imaging shows promise for accurately prognosticating patients following this operative therapy.
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Affiliation(s)
- J I Traylor
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - D C A Bastos
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | | | - M Muir
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - R Patel
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - V A Kumar
- Diagnostic Radiology (V.A.K.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - G Rao
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
| | - S S Prabhu
- From the Departments of Neurosurgery (J.I.T., D.C.A.B., M.M., R.P., G.R., S.S.P.)
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Gates EDH, Yang J, Fukumura K, Lin JS, Weinberg JS, Prabhu SS, Long L, Fuentes D, Sulman EP, Huse JT, Schellingerhout D. Spatial Distance Correlates With Genetic Distance in Diffuse Glioma. Front Oncol 2019; 9:676. [PMID: 31417865 PMCID: PMC6682615 DOI: 10.3389/fonc.2019.00676] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/10/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Treatment effectiveness and overall prognosis for glioma patients depend heavily on the genetic and epigenetic factors in each individual tumor. However, intra-tumoral genetic heterogeneity is known to exist and needs to be managed. Currently, evidence for genetic changes varying spatially within the tumor is qualitative, and quantitative data is lacking. We hypothesized that a greater genetic diversity or “genetic distance” would be observed for distinct tumor samples taken with larger physical distances between them. Methods: Stereotactic biopsies were obtained from untreated primary glioma patients as part of a clinical trial between 2011 and 2016, with at least one biopsy pair collected in each case. The physical (Euclidean) distance between biopsy sites was determined using coordinates from imaging studies. The tissue samples underwent whole exome DNA sequencing and epigenetic methylation profiling and genomic distances were defined in three separate ways derived from differences in number of genes, copy number variations (CNV), and methylation profiles. Results: Of the 31 patients recruited to the trial, 23 were included in DNA methylation analysis, for a total of 71 tissue samples (14 female, 9 male patients, age range 21–80). Samples from an 8 patient subset of the 23 evaluated patients were further included in whole exome and copy number variation analysis. Physical and genomic distances were found to be independently and positively correlated for each of the three genomic distance measures. The correlation coefficients were 0.63, 0.65, and 0.35, respectively for (a) gene level mutations, (b) copy number variation, and (c) methylation status. We also derived quantitative linear relationships between physical and genomic distances. Conclusion: Primary brain tumors are genetically heterogeneous, and the physical distance within a given glioma correlates to genomic distance using multiple orthogonal genomic assessments. These data should be helpful in the clinical diagnostic and therapeutic management of glioma, for example by: managing sampling error, and estimating genetic heterogeneity using simple imaging inputs.
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Affiliation(s)
- Evan D H Gates
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, United States
| | - Jie Yang
- Graduate School of Biomedical Sciences, The University of Texas MD Anderson Cancer Center UTHealth, Houston, TX, United States.,Department of Radiation Oncology, NYU Langone School of Medicine, New York, NY, United States
| | - Kazutaka Fukumura
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jonathan S Lin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Medical Scientist Training Program, Baylor College of Medicine, Houston, TX, United States.,Department of Bioengineering, Rice University, Houston, TX, United States
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Lihong Long
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - David Fuentes
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Erik P Sulman
- Department of Radiation Oncology, NYU Langone School of Medicine, New York, NY, United States
| | - Jason T Huse
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Dawid Schellingerhout
- Departments of Neuroradiology and Cancer Systems Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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Al-Holou WN, Hodges TR, Everson RG, Freeman J, Zhou S, Suki D, Rao G, Ferguson SD, Heimberger AB, McCutcheon IE, Prabhu SS, Lang FF, Weinberg JS, Wildrick DM, Sawaya R. Perilesional Resection of Glioblastoma Is Independently Associated With Improved Outcomes. Neurosurgery 2019; 86:112-121. [PMID: 30799490 PMCID: PMC8253299 DOI: 10.1093/neuros/nyz008] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 01/22/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Resection is a critical component in the initial treatment of glioblastoma (GBM). Often GBMs are resected using an intralesional method. Circumferential perilesional resection of GBMs has been described, but with limited data. OBJECTIVE To conduct an observational retrospective analysis to test whether perilesional resection produced a greater extent of resection. METHODS We identified all patients with newly diagnosed GBM who underwent resection at our institution from June 1, 1993 to December 31, 2015. Demographics, presenting symptoms, intraoperative data, method of resection (perilesional or intralesional), volumetric imaging data, and postoperative outcomes were obtained. Complete resection (CR) was defined as 100% resection of all contrast-enhancing disease. Univariate analyses employed analysis of variance (ANOVA) and Fisher's exact test. Multivariate analyses used propensity score-weighted multivariate logistic regression. RESULTS Newly diagnosed GBMs were resected in 1204 patients, 436 tumors (36%) perilesionally and 766 (64%) intralesionally. Radiographic CR was achieved in 69% of cases. Multivariate analysis demonstrated that perilesional tumor resection was associated with a significantly higher rate of CR than intralesional resection (81% vs 62%, multivariate odds ratio = 2.5, 95% confidence interval: 1.8-3.4, P < .001). Among tumors in eloquent cortex, multivariate analysis showed that patients who underwent perilesional resection had a higher rate of CR (79% vs 58%, respectively, P < .001) and a lower rate of neurological complications (11% vs 20%, respectively, P = .018) than those who underwent intralesional resection. CONCLUSION Circumferential perilesional resection of GBM is associated with significantly higher rates of CR and lower rates of neurological complications than intralesional resection, even for tumors arising in eloquent locations. Perilesional resection, when feasible, should be considered as a preferred option.
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Affiliation(s)
- Wajd N Al-Holou
- Department of Neurosurgery, Wayne State University Medical School, Karmanos Cancer Institute, Detroit, Michigan
| | - Tiffany R Hodges
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Richard G Everson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jacob Freeman
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shouhao Zhou
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Dima Suki
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ganesh Rao
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherise D Ferguson
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy B Heimberger
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ian E McCutcheon
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frederick F Lang
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Wildrick
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Raymond Sawaya
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas,Correspondence: Raymond Sawaya, MD, Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 442, Houston, TX 77030-4009. E-mail:
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Shukla RA, Achanta VG, De Barbaro P, Dugad SR, Heering A, Gupta SK, Mirza I, Prabhu SS, Rumerio P. Microscopic characterisation of photodetectors used in the hadron calorimeter of the Compact Muon Solenoid experiment. Rev Sci Instrum 2019; 90:023303. [PMID: 30831735 DOI: 10.1063/1.5046465] [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] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/24/2019] [Indexed: 06/09/2023]
Abstract
The Hybrid Photodetector (HPD) is a hybrid unit with a single accelerating gap between a common photocathode and an array of PIN diodes. Customised HPDs with 19 channels were used to detect scintillation light from hadron calorimeter in the Compact Muon Solenoid (CMS) experiment. In this paper, we present results on radiation damage studies carried out on the used HPDs in the outer hadron (HO) and the end-cap hadron (HE) calorimeter of the CMS experiment operating at CERN. The calorimeter is made of alternating layers of scintillating tiles and metals, such as brass or iron. The scintillating light was transmitted to the HPDs by means of optical fibres. Due to excessive exposure to scintillation light and ionising radiation during data taking at the Large Hadron Collider, the performance of the HPDs was expected to degrade significantly in the HE detector. Independent studies on radiation damage of these used photosensors were important to assess the degradation in the performance of the calorimeter. Microscopic scans of relative photon detection efficiencies for two HPDs (one each from HO and HE detector) were made using micron resolution optical scanner. The scanner was specially designed and built for microscopic characterisation of photosensors. Imprints of each fibre (∼1 mm in diameter) on the photocathode with varying damage within the same pixel of the HPD were observed. The localised damage of the photocathode was determined to vary with the amount of scintillation (or calibration) light transmitted by optical fibres to the HPD.
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Affiliation(s)
- R A Shukla
- Department of High Energy Physics, Tata Institute of Fundamental Research, Mumbai, Maharashtra 400005, India
| | - V G Achanta
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Mumbai, Maharashtra 400005, India
| | - P De Barbaro
- Department of Physics and Astronomy, University of Rochester, Rochester, New York 14527-0171, USA
| | - S R Dugad
- Department of High Energy Physics, Tata Institute of Fundamental Research, Mumbai, Maharashtra 400005, India
| | - A Heering
- Department Physics, University of Notre Dame, Notre Dame, Indiana 46556, USA
| | - S K Gupta
- Department of High Energy Physics, Tata Institute of Fundamental Research, Mumbai, Maharashtra 400005, India
| | - I Mirza
- Department of High Energy Physics, Tata Institute of Fundamental Research, Mumbai, Maharashtra 400005, India
| | - S S Prabhu
- Department of Condensed Matter Physics and Materials Science, Tata Institute of Fundamental Research, Mumbai, Maharashtra 400005, India
| | - P Rumerio
- Department of Physics and Astronomy, University of Alabama, Tuscaloosa, Alabama 35487-0324, USA
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Prabhu SS. The Indian Society of Neuro-oncology guidelines: A "personalized" approach to treating adult diffuse gliomas. Neurol India 2019; 67:183-184. [PMID: 30860120 DOI: 10.4103/0028-3886.253602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sujit S Prabhu
- Department of Neurosurgery, UT MD Anderson Cancer Center; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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50
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Mathai C, Jain R, Achanta VG, Duttagupta SP, Ghindani D, Joshi NR, Pinto R, Prabhu SS. Sensing at terahertz frequency domain using a sapphire whispering gallery mode resonator. Opt Lett 2018; 43:5383-5386. [PMID: 30383013 DOI: 10.1364/ol.43.005383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/08/2018] [Indexed: 06/08/2023]
Abstract
In this Letter, we experimentally demonstrate a terahertz (THz) whispering gallery mode (WGM) sensor based on a sapphire WGM resonator. The fundamental mode at 129.49 GHz with a Q-factor of 4.63×103 is used to study its sensitivity to adsorbed molecules. The efficiency of our sensor to detect rhodamine 6G dye molecules in a polyvinyl alcohol matrix at room temperature has been manifested, and a detection sensitivity of 25 parts per million has been achieved. Also, we report an analytical approach based on coupled-mode theory between the waveguide mode and the spherical resonator mode to evaluate the absorption coefficient of the adsorbed molecule on the resonator. The model is modified to evaluate optical constants of materials. The results obtained have been verified by continuous-wave THz transmission results. The results are of importance in sensing, metrology, and material characterization.
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