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Dullea JT, Chaluts D, Vasan V, Rutland JW, Gill CM, Ellis E, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. NF2 mutation associated with accelerated time to recurrence for older patients with atypical meningiomas. Br J Neurosurg 2023:1-7. [PMID: 37096420 PMCID: PMC10598238 DOI: 10.1080/02688697.2023.2204927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/01/2023] [Accepted: 04/15/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Meningiomas occur more frequently in older adults, with the incidence rates increasing from 5.8/100,000 for adults 35-44 years old to 55.2/100,000 for those 85+. Due to the increased risk of surgical management in older adults, there is a need to characterize the risk factors for aggressive disease course to inform management decisions in this population. We therefore sought to determine age-stratified relationships between tumour genomics and recurrence after resection of atypical meningiomas. METHODS We identified 137 primary and recurrent Grade 2 meningiomas from our existing meningioma genomic sequencing database. We examined the differential distribution of genomic alterations in those older than 65 compared to younger. We then performed an age stratified survival analysis to model recurrence for a mutation identified as differentially present. RESULTS In our cohort of 137 patients with grade 2 meningiomas, alterations in NF2 were present at a higher rate in older adults compared to younger (37.8% in < 65 vs. 55.3% in > 65; recurrence adjusted p-value =0.04). There was no association between the presence of NF2 and recurrence in the whole cohort. In the age-stratified model for those less than 65 years old, there was again no relationship. For patients in the older age stratum, there is a relationship between NF2 and worsened recurrence outcomes (HR = 3.64 (1.125 - 11.811); p = 0.031). CONCLUSIONS We found that mutations in NF2 were more common in older adults. Further, the presence of mutant NF2 was associated with an increased risk of recurrence in older adults.
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Affiliation(s)
- Jonathan T. Dullea
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Danielle Chaluts
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - John W. Rutland
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Corey M. Gill
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Ethan Ellis
- Department of Genetics and Genomic Sciences, Icahn School
of Medicine at Mount Sinai, New York, NY
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Russell B. McBride
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
- The Institute for Translational Epidemiology, Icahn School
of Medicine at Mount Sinai, New York, NY
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School
of Medicine at Mount Sinai, New York, NY
- Sema4, A Mount Sinai venture, Stamford, CT
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Raj K. Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at
Mount Sinai, New York, NY
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Vasan V, Dullea JT, Devarajan A, Ali M, Rutland JW, Gill CM, Kinoshita Y, McBride RB, Gliedman P, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. NF2 mutations are associated with resistance to radiation therapy for grade 2 and grade 3 recurrent meningiomas. J Neurooncol 2023; 161:309-316. [PMID: 36436149 DOI: 10.1007/s11060-022-04197-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE High grade meningiomas have a prognosis characterized by elevated recurrence rates and radiation resistance. Recent work has highlighted the importance of genomics in meningioma prognostication. This study aimed to assess the relationship between the most common meningioma genomic alteration (NF2) and response to postoperative radiation therapy (RT). METHODS From an institutional tissue bank, grade 2 and 3 recurrent meningiomas with both > 30 days of post-surgical follow-up and linked targeted next-generation sequencing were identified. Time to radiographic recurrence was determined with retrospective review. The adjusted hazard of recurrence was estimated using Cox-regression for patients treated with postoperative RT stratified by NF2 mutational status. RESULTS Of 53 atypical and anaplastic meningiomas (29 NF2 wild-type, 24 NF2 mutant), 19 patients underwent postoperative RT. When stratified by NF2 wild-type, postoperative RT in NF2 wild-type patients was associated with a 78% reduction in the risk of recurrence (HR 0.216; 95%CI 0.068-0.682; p = 0.009). When stratified by NF2 mutation, there was a non-significant increase in the risk of recurrence for NF2 mutant patients who received postoperative RT compared to those who did not (HR 2.43; 95%CI 0.88-6.73, p = 0.087). CONCLUSION This study demonstrated a protective effect of postoperative RT in NF2 wild-type patients with recurrent high grade meningiomas. Further, postoperative RT may be associated with no improvement and perhaps an accelerated time to recurrence in NF2 mutant tumors. These differences in recurrence rates provide evidence that NF2 may be a valuable prognostic marker in treatment decisions regarding postoperative RT. Further prospective studies are needed to validate this relationship.
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Affiliation(s)
- Vikram Vasan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Floor 8, New York, NY, 10129, USA.
| | - Jonathan T Dullea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Muhammad Ali
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Floor 8, New York, NY, 10129, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul Gliedman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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3
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Dullea JT, Vasan V, Rutland JW, Gill CM, Chaluts D, Ranti D, Ellis E, Subramanium V, Arrighi-Allisan A, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. Association between tumor mutations and meningioma recurrence in Grade I/II disease. Oncoscience 2022; 9:70-81. [PMID: 36514795 PMCID: PMC9733702 DOI: 10.18632/oncoscience.570] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Meningiomas are common intracranial tumors with variable prognoses not entirely captured by commonly used classification schemes. We sought to determine the relationship between meningioma mutations and oncologic outcomes using a targeted next-generation sequencing panel. MATERIALS AND METHODS We identified 184 grade I and II meningiomas with both >90 days of post-surgical follow-up and linked targeted next-generation sequencing. For mutated genes in greater than 5% of the sample, we computed progression-free survival Cox-regression models stratified by gene. We then built a multi-gene model by including all gene predictors with a p-value of less than 0.20. Starting with that model, we performed backward selection to identify the most predictive factors. RESULTS ATM (HR = 4.448; 95% CI: 1.517-13.046), CREBBP (HR = 2.727; 95% CI = 1.163-6.396), and POLE (HR = 0.544; HR = 0.311-0.952) were significantly associated with alterations in disease progression after adjusting for clinical and pathologic factors. In the multi-gene model, only POLE remained a significant predictor of recurrence after adjusting for the same clinical covariates. Backwards selection identified recurrence status, resection extent, and mutations in ATM (HR = 7.333; 95% CI = 2.318-23.195) and POLE (HR = 0.413; 95% CI = 0.229-0.743) as predictive of recurrence. CONCLUSIONS Mutations in ATM and CREBBP were associated with accelerated meningioma recurrence, and mutations in POLE were protective of recurrence. Each mutation has potential implications for treatment. The effect of these mutations on oncologic outcomes and as potential targets for intervention warrants future study.
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Affiliation(s)
- Jonathan T. Dullea
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA,Correspondence to:Jonathan T. Dullea, email:
| | - Vikram Vasan
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - John W. Rutland
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Corey M. Gill
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Danielle Chaluts
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Daniel Ranti
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Ethan Ellis
- 4Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Varun Subramanium
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Annie Arrighi-Allisan
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Yayoi Kinoshita
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Russell B. McBride
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA,3The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Joshua Bederson
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Michael Donovan
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Robert Sebra
- 4Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA,5Sema4, A Mount Sinai Venture, Stamford, CT 06902, USA
| | - Melissa Umphlett
- 2Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
| | - Raj K. Shrivastava
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, USA
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4
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Chaluts D, Dullea JT, Ali M, Vasan V, Devarajan A, Rutland JW, Gill CM, Ellis E, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Umphlett M, Shrivastava RK. ARID1A mutation associated with recurrence and shorter progression-free survival in atypical meningiomas. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04442-y. [DOI: 10.1007/s00432-022-04442-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022]
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Alvarez-Breckenridge C, Markson SC, Stocking JH, Nayyar N, Lastrapes M, Strickland MR, Kim AE, de Sauvage M, Dahal A, Larson JM, Mora JL, Navia AW, Klein RH, Kuter BM, Gill CM, Bertalan M, Shaw B, Kaplan A, Subramanian M, Jain A, Kumar S, Danish H, White M, Shahid O, Pauken KE, Miller BC, Frederick DT, Hebert C, Shaw M, Martinez-Lage M, Frosch M, Wang N, Gerstner E, Nahed BV, Curry WT, Carter B, Cahill DP, Boland GM, Izar B, Davies MA, Sharpe AH, Suvà ML, Sullivan RJ, Brastianos PK, Carter SL. Microenvironmental Landscape of Human Melanoma Brain Metastases in Response to Immune Checkpoint Inhibition. Cancer Immunol Res 2022; 10:996-1012. [PMID: 35706413 DOI: 10.1158/2326-6066.cir-21-0870] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/12/2021] [Revised: 01/12/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022]
Abstract
Melanoma-derived brain metastases (MBM) represent an unmet clinical need because central nervous system progression is frequently an end stage of the disease. Immune checkpoint inhibitors (ICI) provide a clinical opportunity against MBM; however, the MBM tumor microenvironment (TME) has not been fully elucidated in the context of ICI. To dissect unique elements of the MBM TME and correlates of MBM response to ICI, we collected 32 fresh MBM and performed single-cell RNA sequencing of the MBM TME and T-cell receptor clonotyping on T cells from MBM and matched blood and extracranial lesions. We observed myeloid phenotypic heterogeneity in the MBM TME, most notably multiple distinct neutrophil states, including an IL8-expressing population that correlated with malignant cell epithelial-to-mesenchymal transition. In addition, we observed significant relationships between intracranial T-cell phenotypes and the distribution of T-cell clonotypes intracranially and peripherally. We found that the phenotype, clonotype, and overall number of MBM-infiltrating T cells were associated with response to ICI, suggesting that ICI-responsive MBMs interact with peripheral blood in a manner similar to extracranial lesions. These data identify unique features of the MBM TME that may represent potential targets to improve clinical outcomes for patients with MBM.
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Affiliation(s)
- Christopher Alvarez-Breckenridge
- Departments of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel C Markson
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
- Evergrande Center for Immunological Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jackson H Stocking
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Naema Nayyar
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Matt Lastrapes
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew R Strickland
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Albert E Kim
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Magali de Sauvage
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Ashish Dahal
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Juliana M Larson
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Joana L Mora
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Andrew W Navia
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts
- Ragon Institute, Harvard University, Massachusetts Institute of Technology, and Massachusetts General Hospital, Cambridge, Massachusetts
| | - Robert H Klein
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Benjamin M Kuter
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Corey M Gill
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Mia Bertalan
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Brian Shaw
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Alexander Kaplan
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Megha Subramanian
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Aarushi Jain
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Swaminathan Kumar
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Husain Danish
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York
- Weill Cornell Medical Center, New York, New York
| | - Michael White
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Osmaan Shahid
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kristen E Pauken
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
- Evergrande Center for Immunological Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian C Miller
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
- Evergrande Center for Immunological Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Dennie T Frederick
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christine Hebert
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - McKenzie Shaw
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Maria Martinez-Lage
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew Frosch
- C. S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nancy Wang
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | | | - Brian V Nahed
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Bob Carter
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Genevieve Marie Boland
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin Izar
- Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, New York
- Columbia Center for Translational Immunology, New York, New York
| | - Michael A Davies
- Department of Melanoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Arlene H Sharpe
- Department of Immunology, Blavatnik Institute, Harvard Medical School, Boston, Massachusetts
- Evergrande Center for Immunological Diseases, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Mario L Suvà
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Pathology and Center for Cancer Research, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan J Sullivan
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Priscilla K Brastianos
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Scott L Carter
- Broad Institute, Harvard University and Massachusetts Institute of Technology, Cambridge, Massachusetts
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts
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Dullea J, Rutland J, Gill CM, Ranti D, Arrighi-Allisan AE, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Umphlett M, Shrivastava RK. 821 Association Between Tumor Mutations and Meningioma Recurrence in Grade I/II Disease. Neurosurgery 2022. [DOI: 10.1227/neu.0000000000001880_821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Rutland JW, Dullea JT, Gill CM, Chaluts D, Ranti D, Ellis E, Arrighi-Allisan A, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Umphlett M, Shrivastava RK. Association of mutations in DNA polymerase epsilon with increased CD8+ cell infiltration and prolonged progression-free survival in patients with meningiomas. Neurosurg Focus 2022; 52:E7. [PMID: 35104796 DOI: 10.3171/2021.11.focus21592] [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: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Prior studies have demonstrated a relationship between underlying tumor genetics and lymphocyte infiltration in meningiomas. In this study, the authors aimed to further characterize the relationship between meningioma genomics, CD4+ and CD8+ T-cell infiltration, and oncological outcomes of meningiomas. Understanding specific characteristics of the inflammatory infiltration could have implications for treatment and prognostication. METHODS Immunohistochemically stained meningioma slides were reviewed to assess the CD4+ and CD8+ cell infiltration burden. The relationship between immune cell infiltration and tumor genomics was then assessed using an adjusted ANOVA model. For a specific gene identified by the ANOVA, the relationship between that mutation and tumor recurrence was assessed using Cox regression. RESULTS In immunohistochemically stained samples from a subcohort of 25 patients, the mean number of CD4+ cells was 42.2/400× field and the mean number of CD8+ cells was 69.8/400× field. Elevated CD8+ cell infiltration was found to be associated with the presence of a mutation in the gene encoding for DNA polymerase epsilon, POLE (51.6 cells/hpf in wild-type tumors vs 95.9 cells/hpf in mutant tumors; p = 0.0199). In a retrospective cohort of 173 patients, the presence of any mutation in POLE was found to be associated with a 46% reduction in hazard of progression (HR 0.54, 95% CI 0.311-0.952; p = 0.033). The most frequent mutation was a near-C-terminal nonsense mutation. CONCLUSIONS A potential association was found between mutant POLE and both an increase in CD8+ cell infiltration and progression-free survival. The predominant mutation was found outside of the known exonuclease hot spot; however, it was still associated with a slight increase in mutational burden, CD8+ cell infiltration, and progression-free survival. Alterations in gene expression, resulting from alterations in POLE, may yield an increased presentation of neoantigens, and, thus, greater CD8+ cell-mediated apoptosis of neoplastic cells. These findings have suggested the utility of checkpoint inhibitors in the treatment of POLE-mutant meningiomas.
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Affiliation(s)
- John W Rutland
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Jonathan T Dullea
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Corey M Gill
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Danielle Chaluts
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Daniel Ranti
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Ethan Ellis
- 2Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai
| | | | - Yayoi Kinoshita
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Russell B McBride
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai.,4The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Joshua Bederson
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
| | - Michael Donovan
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Robert Sebra
- 2Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai.,5Sema4, A Mount Sinai venture, Stamford, Connecticut
| | - Mary Fowkes
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Melissa Umphlett
- 3Department of Pathology, Icahn School of Medicine at Mount Sinai
| | - Raj K Shrivastava
- 1Department of Neurosurgery, Icahn School of Medicine at Mount Sinai
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8
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Gill CM, D'Andrea MR, Tomita S, Suhner J, Umphlett M, Zakashansky K, Blank SV, Tsankova N, Shrivastava RK, Fowkes M, Kolev V. Tumor immune microenvironment in brain metastases from gynecologic malignancies. Cancer Immunol Immunother 2021; 70:2951-2960. [PMID: 33713153 PMCID: PMC10992931 DOI: 10.1007/s00262-021-02909-4] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The density and distribution of the tumor immune microenvironment associated with brain metastases (BM) from gynecologic malignancies are unknown and have not been previously reported. We sought to describe the clinical features of a cohort of patients with BM from gynecologic malignancies and to characterize the tumor immune microenvironment from available archival surgical specimens. METHODS We performed a retrospective review of electronic medical records from 2002 to 2018 for patients with BM from gynecologic malignancies. Data on patient characteristics, treatment regimens, and clinical outcomes were procured. CD4, CD8, CD45RO, CD68, CD163, and FOXP3 immunohistochemistry were evaluated from available archival surgical specimens from primary disease site and neurosurgical resection. RESULTS A cohort of 44 patients with BM from gynecologic malignancies was identified, 21 (47.7%) endometrial primaries and 23 (52.3%) ovarian primaries. Tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) were evaluated in 13 primary cases and 15 BM cases. For the 13 primary cases, CD4+ TILs were evident in 76.9% of cases, CD8+ in 92.3%, CD45RO+ in 92.3%, and FOXP3+ in 46.2%, as well as CD68+ TAMs in 100% and CD163+ in 100%. For the 15 BM cases, CD4+ TILs were evident in 60.0% of cases, CD8+ in 93.3%, CD45RO+ in 73.3%, and FOXP3+ in 35.7%, as well as CD68+ TAMs in 86.7% and CD163+ in 100%. CONCLUSION An active tumor immune microenvironment is present with similar distribution in the primary disease site and BM from patients with gynecologic malignancies.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Megan R D'Andrea
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Shannon Tomita
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Jessa Suhner
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Konstantin Zakashansky
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Stephanie V Blank
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Nadejda Tsankova
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Valentin Kolev
- Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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9
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Gill CM, Loewenstern J, Rutland JW, Arib H, Francoeur N, Wang YC, Fishman N, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Smith M, Sebra R, Shrivastava RK, Fowkes M. Recurrent IDH mutations in high-grade meningioma. Neuro Oncol 2021; 22:1044-1045. [PMID: 32179909 DOI: 10.1093/neuonc/noaa065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nancy Francoeur
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ying-Chih Wang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nataly Fishman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Smith
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Sebra
- Sema4, A Mount Sinai venture, Stamford, Connecticut
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Gill CM, Loewenstern J, Rutland J, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride R, Bederson JB, Donovan M, Sebra R, Fowkes M, Shrivastava RK. Peritumoral Edema Correlates with Mutational Burden in Meningiomas. Neurosurgery 2020. [DOI: 10.1093/neuros/nyaa447_797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Gill CM, Orfanelli T, Yoxtheimer L, Roy-McMahon C, Suhner J, Tomita S, Kalir T, Liu Y, Houldsworth J, Kolev V. Histology-specific FGFR2 alterations and FGFR2-TACC2 fusion in mixed adenoid cystic and neuroendocrine small cell carcinoma of the uterine cervix. Gynecol Oncol Rep 2020; 34:100668. [PMID: 33241100 PMCID: PMC7672274 DOI: 10.1016/j.gore.2020.100668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/25/2020] [Accepted: 10/26/2020] [Indexed: 01/28/2023] Open
Abstract
Neuroendocrine small cell carcinoma of the uterine cervix portends a dismal prognosis with limited treatment options. Rarely, tumors of mixed-lineage appear in gynecologic malignancies. Here, we report a 77-year-old woman who presented with complete uterine prolapse and 4-month history of vaginal bleeding. Histopathologic evaluation revealed a mixed adenoid cystic carcinoma and neuroendocrine small cell carcinoma of the uterine cervix. The tumor was PD-L1 and HPV 35 positive. The patient was treated with up-front surgery and adjuvant radiation. Independent, histology-specific alterations in FGFR2 and a FGFR2-TACC2 fusion were identified. Progression of disease occurred within 6 months for which she received chemotherapy and immunotherapy. However, the patient expired within a year. We comprehensively review how screening for and targeting of FGFR alterations in recurrent and metastatic cervical cancer might serve as a touchstone for future treatment regimens.
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Affiliation(s)
- Corey M Gill
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Theofano Orfanelli
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lorene Yoxtheimer
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Christine Roy-McMahon
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jessa Suhner
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Shannon Tomita
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Tamara Kalir
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yuxin Liu
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jane Houldsworth
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Valentin Kolev
- Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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12
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Gill CM, Fowkes M, Shrivastava RK. Emerging Therapeutic Targets in Chordomas: A Review of the Literature in the Genomic Era. Neurosurgery 2020; 86:E118-E123. [PMID: 31504814 DOI: 10.1093/neuros/nyz342] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 03/21/2019] [Accepted: 06/13/2019] [Indexed: 12/18/2022] Open
Abstract
Chordomas are rare primary malignant tumors of the bones that occur along the skull base, spine, and sacrum. Long-term survival and neurological outcome continue to be challenging with continued low percentages of long-term survival. Recent studies have used genome, exome, transcriptome, and proteome sequencing to assess the mutational profile of chordomas. Most notably, Brachyury, or T-protein, has been shown to be an early mutational event in chordoma evolution. Clinically actionable mutations, including in the PI3K pathway, were identified. Preliminary evidence suggests that there may be mutational differences associated with primary tumor location. In this study, we review the therapeutic landscape of chordomas and discuss emerging targets in the genomic era.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mary Fowkes
- Department of Pathology, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery, Mount Sinai Medical Center, Icahn School of Medicine at Mount Sinai, New York, New York
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13
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Nayyar N, Shih DJ, Bihun I, Dagogo-Jack I, Gill CM, Aquilanti E, Bertalan M, Kaplan A, D'Andrea MR, Chukwueke U, Alvarez-Breckenridge C, Lastrapes M, Kuter B, Strickland MR, Martinez-Gutierrez JC, Nagabhushan D, De Sauvage M, White MD, Castro BA, Hoang K, Paek SH, Park SH, Martinez-Lage M, Berghoff AS, Merrill P, Gerstner ER, Batchelor TT, Frosch MP, Frazier RP, Borger DR, Iafrate AJ, Santagata S, Preusser M, Cahill DP, Carter SL, Brastianos PK. Abstract 4729: Identifying genomic drivers of lung adenocarcinoma brain metastases. Cancer Res 2020. [DOI: 10.1158/1538-7445.am2020-4729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Although lung adenocarcinomas frequently metastasize to the brain, treatment options for lung adenocarcinoma brain metastases (BM-LUAD) are limited. We discovered novel candidate drivers of progression by using case-control analyses to compare whole-exome sequencing data from a cohort of 73 BM-LUAD to a control cohort of 503 primary lung adenocarcinomas. We identified MYC, YAP1 and MMP13 as genomic regions with significantly more frequent amplifications in BM-LUAD compared to control cohort. We validated that MYC, YAP1 and MMP13 can drive brain metastases in a patient-derived xenograft mouse model, where incidence of brain metastases was higher in mice injected with tumor cells expressing the candidate drivers compared to tumor cells expressing LacZ. These results indicate that somatic alterations can drive lung adenocarcinomas to metastasize to the brain. These candidate drivers may serve as therapeutic targets in patients with brain metastatic lung adenocarcinomas.
Citation Format: Naema Nayyar, David J. Shih, Ivanna Bihun, Ibiayi Dagogo-Jack, Corey M. Gill, Elisa Aquilanti, Mia Bertalan, Alexander Kaplan, Megan R. D'Andrea, Ugonma Chukwueke, Christopher Alvarez-Breckenridge, Matthew Lastrapes, Ben Kuter, Matthew R. Strickland, Juan Carlos Martinez-Gutierrez, Deepika Nagabhushan, Magali De Sauvage, Michael D. White, Brandyn A. Castro, Kaitlin Hoang, Sun Ha Paek, Sun Hye Park, Maria Martinez-Lage, Anna S. Berghoff, Parker Merrill, Elizabeth R. Gerstner, Tracy T. Batchelor, Matthew P. Frosch, Ryan P. Frazier, Darrell R. Borger, A John Iafrate, Sandro Santagata, Matthias Preusser, Daniel P. Cahill, Scott L. Carter, Priscilla K. Brastianos. Identifying genomic drivers of lung adenocarcinoma brain metastases [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4729.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ben Kuter
- 3Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | | | | | - Sun Ha Paek
- 4Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Hye Park
- 4Seoul National University College of Medicine, Seoul, Republic of Korea
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14
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. Peritumoral edema correlates with mutational burden in meningiomas. Neuroradiology 2020; 63:73-80. [PMID: 32789536 DOI: 10.1007/s00234-020-02515-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 06/01/2020] [Accepted: 08/04/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Meningiomas are the most common primary central nervous system tumor. Emerging data supports that higher mutational burden portends worse clinical outcomes in meningiomas. However, there is a lack of imaging biomarkers that are associated with tumor genomics in meningiomas. METHODS We performed next-generation targeted sequencing in a cohort of 75 primary meningiomas and assessed preoperative imaging for tumor volume and peritumoral brain edema (PTBE). An Edema Index was calculated. RESULTS Meningiomas that were high grade (WHO grade II or grade III) had significantly larger tumor volume and were more likely to present with PTBE. Moreover, PTBE was associated with brain invasion on histopathology and reduced overall survival. There was a direct association between Edema Index and mutational burden. For every one increase in Edema Index, the number of single nucleotide variants increased by 1.09-fold (95% CI: 1.02, 1.2) (P = 0.01). CONCLUSION These data support that Edema Index may serve as a novel imaging biomarker that can inform underlying mutational burden in patients with meningiomas.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai venture, Stamford, CT, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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15
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Gill CM, Fowkes M, Shrivastava RK. In Reply: Emerging Therapeutic Targets in Chordomas: A Review of the Literature in the Genomic Era. Neurosurgery 2020; 86:E483. [PMID: 31996907 DOI: 10.1093/neuros/nyaa008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corey M Gill
- Department of Neurosurgery Icahn School of Medicine Mount Sinai Medical Center New York, New York
| | - Mary Fowkes
- Department of Pathology Icahn School of Medicine Mount Sinai Medical Center New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery Icahn School of Medicine Mount Sinai Medical Center New York, New York
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16
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Rutland JW, Gill CM, Ladner T, Goldrich D, Villavisanis DF, Devarajan A, Pai A, Banihashemi A, Miles BA, Sharma S, Balchandani P, Bederson JB, Iloreta AM, Shrivastava RK. Surgical outcomes in patients with endoscopic versus transcranial approach for skull base malignancies: a 10-year institutional experience. Br J Neurosurg 2020; 36:79-85. [PMID: 32538686 DOI: 10.1080/02688697.2020.1779659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Object: The authors performed an extensive comparison between patients treated with open versus an endoscopic approach for skull base malignancy with emphasis on surgical outcomes.Methods: A single-institution retrospective review of 60 patients who underwent surgery for skull base malignancy between 2009 and 2018 was performed. Disease features, surgical resection, post-operative morbidities, adjuvant treatment, recurrence, and survival rates were compared between 30 patients who received purely open surgery and 30 patients who underwent purely endoscopic resection for a skull base malignancy.Results: Of the 60 patients with skull base malignancy, 30 underwent open resection and 30 underwent endoscopic resection. The most common hisotype for endoscopic resection was squamous cell carcinoma (26.7%), olfactory neuroblastoma (16.7%), and sarcoma (10.0%), and 43.3%, 13.3%, and 10.0% for the open resection cohort, respectively. There were no statistical differences in gross total resection, surgical-associated cranial neuropathy, or ability to achieve negative margins between the groups (p > 0.1, all comparisons). Patients who underwent endoscopic resection had shorter surgeries (320.3 ± 158.5 minutes vs. 495.3 ± 187.6 minutes (p = 0.0003), less intraoperative blood loss (282.2 ± 333.6 ml vs. 696.7 ± 500.2 ml (p < 0.0001), and shorter length of stay (3.5 ± 3.7 days vs. 8.8 ± 6.0 days (p < 0.0001). Additionally, patients treated endoscopically initiated adjuvant radiation treatment more quickly (48.0 ± 20.3 days vs. 72.0 ± 20.5 days (p = 0.01).Conclusions: An endoscopic endonasal approach facilitates a clinically meaningful improvement in surgical outcomes for skull base malignancies.
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Affiliation(s)
- John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Travis Ladner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Goldrich
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dillan F Villavisanis
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akila Pai
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amir Banihashemi
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priti Balchandani
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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17
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D'Andrea MR, Gill CM, Umphlett M, Tsankova NM, Fowkes M, Bederson JB, Brastianos PK, Shrivastava RK. Brain Metastases from Biliary Tract Cancers: A Case Series and Review of the Literature in the Genomic Era. Oncologist 2020; 25:447-453. [PMID: 31694894 PMCID: PMC7216433 DOI: 10.1634/theoncologist.2019-0306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Biliary tract cancers (BTCs) are highly fatal malignancies that make up less than 1% of all cancers. BTC is often diagnosed at an unresectable stage; surgical resection remains the only definitive treatment. Brain metastases (BMs) from BTC are extremely rare, and few studies on patients with BMs from BTC exist. The aim of this study was to identify clinical characteristics associated with poor prognosis for patients with BMs from BTC. MATERIALS AND METHODS We performed a retrospective review of electronic medical records for patients with BMs from BTC managed at Mount Sinai Hospital from 2000 to 2017. Data on patient characteristics, magnetic resonance imaging findings, treatment regimens, and clinical outcomes were analyzed. RESULTS We identified 1,910 patients with BTC. Nine patients developed BMs, with an incidence of 0.47%. Of these nine patients, six had intrahepatic cholangiocarcinoma, two had extrahepatic cholangiocarcinoma, and one had gallbladder cancer. Six (66.7%) patients had one BM, one (11.1%) patient had two BMs, and two (22.2%) patients had three or more BMs. Four (44.4%) patients underwent BM resection, and seven (77.8%) received BM radiation. Median overall survival from time of BM diagnosis was 3.8 months (95% confidence interval 0.1-16.9). CONCLUSION Development of BMs from BTC is rare; however, prognosis is less than 4 months. BM diagnosis can occur within 2 years of primary diagnosis. As targeted therapeutics emerge, future studies ought to focus on identifying genomic BM markers associated with BTC subtypes. IMPLICATIONS FOR PRACTICE In the largest retrospective study of biliary tract cancer brain metastases, the clinical presentation and outcomes are reported of nine patients with an extremely rare clinical entity. The genomic literature and potential therapeutic targets for these patients with limited treatment options is comprehensively and exhaustively discussed.
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Affiliation(s)
- Megan R. D'Andrea
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Corey M. Gill
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Melissa Umphlett
- Department of Pathology, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | | | - Mary Fowkes
- Department of Pathology, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Joshua B. Bederson
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
| | - Priscilla K. Brastianos
- Department of Neurology and Cancer Center, Massachusetts General HospitalBostonMassachusettsUSA
| | - Raj K. Shrivastava
- Department of Neurosurgery, Mount Sinai Medical CenterNew YorkNew YorkUSA
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18
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. STK11 mutation status is associated with decreased survival in meningiomas. Neurol Sci 2020; 41:2585-2589. [PMID: 32253637 DOI: 10.1007/s10072-020-04372-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/24/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emerging evidence suggests that STK11 mutations may influence clinical outcome and response to immunotherapy in cancer. MATERIALS AND METHODS Next-generation targeted sequencing of STK11 mutation status in a large cohort of 188 meningiomas. RESULTS STK11 loss-of-function mutations were identified in 3.7% of meningiomas. STK11 mutations were found in both low- and high-grade lesions and samples from primary and recurrent disease. There was a 2.8-fold increased risk of death for patients whose meningioma harbored an STK11 mutation, after controlling for lesion grade and occurrence status. The median overall survival for patients with STK11-mutated meningiomas was 4.4 years compared with 16.8 years. CONCLUSION These data identify recurrent STK11 mutations in a subset of meningiomas. Genotyping of STK11 is encouraged for meningioma patients undergoing immunotherapy-based therapy.
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Affiliation(s)
- Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
| | - Joshua Loewenstern
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Hanane Arib
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret Pain
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Melissa Umphlett
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yayoi Kinoshita
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Russell B McBride
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
| | - Michael Donovan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Sema4, A Mount Sinai Venture, Stamford, CT, USA
| | - Mary Fowkes
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA
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19
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Shih DJH, Nayyar N, Bihun I, Dagogo-Jack I, Gill CM, Aquilanti E, Bertalan M, Kaplan A, D'Andrea MR, Chukwueke U, Ippen FM, Alvarez-Breckenridge C, Camarda ND, Lastrapes M, McCabe D, Kuter B, Kaufman B, Strickland MR, Martinez-Gutierrez JC, Nagabhushan D, De Sauvage M, White MD, Castro BA, Hoang K, Kaneb A, Batchelor ED, Paek SH, Park SH, Martinez-Lage M, Berghoff AS, Merrill P, Gerstner ER, Batchelor TT, Frosch MP, Frazier RP, Borger DR, Iafrate AJ, Johnson BE, Santagata S, Preusser M, Cahill DP, Carter SL, Brastianos PK. Genomic characterization of human brain metastases identifies drivers of metastatic lung adenocarcinoma. Nat Genet 2020; 52:371-377. [PMID: 32203465 PMCID: PMC7136154 DOI: 10.1038/s41588-020-0592-7] [Citation(s) in RCA: 156] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 02/18/2020] [Indexed: 01/08/2023]
Abstract
Brain metastases from lung adenocarcinoma (BM-LUAD) frequently cause patient mortality. To identify genomic alterations that promote brain metastases, we performed whole-exome sequencing of 73 BM-LUAD cases. Using case-control analyses, we discovered candidate drivers of brain metastasis by identifying genes with more frequent copy-number aberrations in BM-LUAD compared to 503 primary LUADs. We identified three regions with significantly higher amplification frequencies in BM-LUAD, including MYC (12 versus 6%), YAP1 (7 versus 0.8%) and MMP13 (10 versus 0.6%), and significantly more frequent deletions in CDKN2A/B (27 versus 13%). We confirmed that the amplification frequencies of MYC, YAP1 and MMP13 were elevated in an independent cohort of 105 patients with BM-LUAD. Functional assessment in patient-derived xenograft mouse models validated the notion that MYC, YAP1 or MMP13 overexpression increased the incidence of brain metastasis. These results demonstrate that somatic alterations contribute to brain metastases and that genomic sequencing of a sufficient number of metastatic tumors can reveal previously unknown metastatic drivers.
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Affiliation(s)
- David J H Shih
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
| | - Naema Nayyar
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Program in Molecular Medicine, UMass Medical School, Worcester, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ivanna Bihun
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Corey M Gill
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Elisa Aquilanti
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Mia Bertalan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander Kaplan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Megan R D'Andrea
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Ugonma Chukwueke
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Franziska Maria Ippen
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Nicholas D Camarda
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew Lastrapes
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Devin McCabe
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Ben Kuter
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin Kaufman
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Matthew R Strickland
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Juan Carlos Martinez-Gutierrez
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Deepika Nagabhushan
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Magali De Sauvage
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Michael D White
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Brandyn A Castro
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kaitlin Hoang
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Kaneb
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Emily D Batchelor
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sun Hye Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pathology, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Anna S Berghoff
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Parker Merrill
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Matthew P Frosch
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ryan P Frazier
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Darrell R Borger
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce E Johnson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
- Laboratory for Systems Pharmacology, Harvard Medical School, Boston, MA, USA
- Ludwig Center at Harvard Medical School, Boston, MA, USA
| | - Matthias Preusser
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Comprehensive Cancer Center Vienna, Vienna, Austria
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Scott L Carter
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Priscilla K Brastianos
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, USA.
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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20
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Gill CM, Loewenstern J, Rutland JW, Arib H, Pain M, Umphlett M, Kinoshita Y, McBride RB, Bederson J, Donovan M, Sebra R, Fowkes M, Shrivastava RK. In Reply: Retention of ATRX and DAXX Expression in Meningiomas. Neurosurgery 2020; 86:E244-E246. [PMID: 31803910 DOI: 10.1093/neuros/nyz504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Corey M Gill
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Joshua Loewenstern
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - John W Rutland
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Hanane Arib
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York, New York
| | - Margaret Pain
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Melissa Umphlett
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Yayoi Kinoshita
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Russell B McBride
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York.,The Institute for Translational Epidemiology Icahn School of Medicine at Mount Sinai New York, New York
| | - Joshua Bederson
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
| | - Michael Donovan
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Robert Sebra
- Department of Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York, New York.,Sema4 A Mount Sinai Venture Stamford, Connecticut
| | - Mary Fowkes
- Department of Pathology Icahn School of Medicine at Mount Sinai New York, New York
| | - Raj K Shrivastava
- Department of Neurosurgery Icahn School of Medicine at Mount Sinai New York, New York
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21
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D'Andrea MR, Gill CM, Umphlett M, Govindaraj S, Del Signore A, Bederson JB, Iloreta AMC, Shrivastava RK. Benefit of Endoscopic Surgery in the Management of Acute Invasive Skull Base Fungal Rhinosinusitis. J Neurol Surg B Skull Base 2020; 82:e330-e334. [PMID: 34306957 DOI: 10.1055/s-0040-1701681] [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: 04/05/2019] [Accepted: 12/24/2019] [Indexed: 10/20/2022] Open
Abstract
Objective This article aims to characterize 14 patients who underwent purely endoscopic surgical debridement of acute invasive skull base fungal rhinosinusitis, and to evaluate postoperative outcomes and risk for recurrence. Design Retrospective cohort study. Setting Tertiary single-institution neurosurgery department. Participants We performed a retrospective analysis of all patients with skull base fungal infections treated with a purely endoscopic surgical approach at Mount Sinai Hospital from 1998 to 2018. Main Outcome Measures Clinical presentation, number of recurrences, and mortality rate. Results The most common underlying medical comorbidities were hematologic malignancy in 8 (57.1%) patients and poorly controlled diabetes mellitus in 7 (50%) patients. Presenting symptoms included headache (50%), eye pain (35.7%), facial pain (28.6%), visual changes (21.4%), and nasal congestion (14.3%). The fungal organisms identified on culture were Aspergillus (42.9%), Mucorales (28.6%), Fusarium (14.3%), Penicillium (7.1%), and unspecified (7.1%). Eight (57.1%) patients developed recurrence and required multiple surgical debridements. Patients who had only a hematologic malignancy were more likely to require multiple surgical debridements compared with those who did not have a hematologic malignancy or those who had both hematologic malignancy and underlying diabetes mellitus ( p = 0.03). The mortality rate from surgery was 42.9%. Conclusion Surgical endoscopic intervention is an option for definitive management of acute invasive skull base fungal rhinosinusitis; however, postoperative mortality and risk of recurrence requiring additional surgical interventions remains high. Patients with hematologic malignancy may be more susceptible to recurrent infection requiring multiple surgical debridements. We recommend early aggressive multimodal treatment. Multiple debridements may be warranted in most cases; close clinical surveillance is needed during neurosurgical intervention.
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Affiliation(s)
- Megan R D'Andrea
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Corey M Gill
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Melissa Umphlett
- Department of Pathology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Satish Govindaraj
- Department of Otolaryngology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Anthony Del Signore
- Department of Otolaryngology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Joshua B Bederson
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Alfred M C Iloreta
- Department of Otolaryngology, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
| | - Raj K Shrivastava
- Department of Neurosurgery, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, United States
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22
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Rutland JW, Delman BN, Gill CM, Zhu C, Shrivastava RK, Balchandani P. Emerging Use of Ultra-High-Field 7T MRI in the Study of Intracranial Vascularity: State of the Field and Future Directions. AJNR Am J Neuroradiol 2020; 41:2-9. [PMID: 31879330 DOI: 10.3174/ajnr.a6344] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 08/23/2019] [Accepted: 10/15/2019] [Indexed: 12/23/2022]
Abstract
Cerebrovascular disease is a major source of mortality that commonly requires neurosurgical intervention. MR imaging is the preferred technique for imaging cerebrovascular structures, as well as regions of pathology that include microbleeds and ischemia. Advanced MR imaging sequences such as time-of-flight, susceptibility-weighted imaging, and 3D T2-weighted sequences have demonstrated excellent depiction of arterial and venous structures with and without contrast administration. While the advantages of 3T compared with 1.5T have been described, the role of ultra-high-field (7T) MR imaging in neurovascular imaging remains poorly understood. In the present review, we examine emerging neurosurgical applications of 7T MR imaging in vascular imaging of diverse conditions and discuss current limitations and future directions for this technique.
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Affiliation(s)
- J W Rutland
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - B N Delman
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
- Diagnostic, Molecular, and Interventional Radiology (B.N.D.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - C M Gill
- Departments of Neurosurgery (J.W.R., C.M.G., R.K.S.)
| | - C Zhu
- Department of Radiology and Biomedical Imaging (C.Z.), University of California San Francisco, San Francisco, California
| | | | - P Balchandani
- From the Translational and Molecular Imaging Institute (J.W.R., B.N.D., P.B.)
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23
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Rutland JW, Govindaraj S, Gill CM, Shohet M, Iloreta AMC, Bederson JB, Shrivastava RK, Delman BN. Correlation of spontaneous and traumatic anterior skull base CSF leak flow rates with fluid pattern on early, delayed, and subtraction volumetric extended echo train T2-weighted MRI. J Neurosurg 2019; 134:286-294. [PMID: 31881543 DOI: 10.3171/2019.10.jns192500] [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: 09/11/2019] [Accepted: 10/22/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE CSF leakage is a potentially fatal condition that may result when a skull base dural defect permits CSF communication between the cranial vault and sinonasal cavities. Flow rate is an important property of CSF leaks that can contribute to surgical decision-making and predispose patients to complications and inferior outcomes. Noninvasive preoperative prediction of the leak rate is challenging with traditional diagnostic tools. The present study compares fluid configurations on early and late volumetric extended echo train T2-weighted MRI by using image tracings and sequence subtraction as a novel method of quantifying CSF flow rate, and it correlates radiological results with intraoperative findings and clinical outcomes. METHODS A total of 45 patients met inclusion criteria for this study and underwent 3-T MRI. Imaging sequences included two identical CUBE T2 (vendor trade name for volumetric extended echo train T2) acquisitions at the beginning and end of the scanning session, approximately 45 minutes apart. Twenty-five patients were confirmed to have definitive spontaneous or traumatic anterior skull base CSF leaks. Semiautomated volumetric segmentation of CSF intensity was performed on both CUBE data sets by using 3D-Slicer software, and volumes were subtracted to obtain accumulated CSF volume. These imaging-derived fluid accumulations were correlated with high- or low-flow states, as well as ultimate treatment outcomes including recurrences. RESULTS Of the 45 patients, 25 (55.6%) had definitive evidence of CSF leakage, and 22 (88%) of these underwent surgical repair. Patients with high-flow CSF leaks had higher early (4.058 cm3 vs 0.982 cm3, p = 0.04), late (4.58 cm3 vs 1.096 cm3, p = 0.04), and accumulated (0.53 cm3 vs 0.11 cm3, p = 0.01) fluid volume measurements than patients with low-flow leaks. The 5 (22.7%) patients who exhibited postoperative CSF leak recurrence had significantly greater early (6.30 cm3 vs 1.23 cm3, p = 0.008) and late (6.87 cm3 vs 1.45 cm3, p = 0.008) volumes. Accumulated volume was not significantly greater in patients with leak recurrence (0.58 cm3 vs 0.22 cm3, p = 0.07). Early, late, and accumulated volumes were significantly correlated with postoperative hospital stay as well as duration of postoperative lumbar drain placement (p < 0.05 for all measures). CONCLUSIONS High-resolution CUBE T2 MRI, coupled with precise volumetric segmentation and subtraction of sinonasal hyperintensity, not only demonstrated predictive value in differentiating low- and high-flow CSF leaks, but also correlated with postoperative complications such as leak recurrence. These findings may be useful in the clinical workup and neurosurgical management of patients with skull base CSF leaks.
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Affiliation(s)
| | | | | | | | | | | | | | - Bradley N Delman
- 3Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Williams SR, Juratli TA, Castro BA, Lazaro TT, Gill CM, Nayyar N, Strickland MR, Babinski M, Johnstone SE, Frosch MP, Silverman IM, Ely HA, Kaplan AB, D'Andrea MR, Bihun IV, Hoang K, Batchelor E, Christiansen J, Cahill DP, Barker FG, Brastianos PK. Genomic Analysis of Posterior Fossa Meningioma Demonstrates Frequent AKT1 E17K Mutations in Foramen Magnum Meningiomas. J Neurol Surg B Skull Base 2019; 80:562-567. [PMID: 31750041 PMCID: PMC6864425 DOI: 10.1055/s-0038-1676821] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/13/2018] [Indexed: 01/21/2023] Open
Abstract
Objective Posterior fossa meningiomas are surgically challenging tumors that are associated with high morbidity and mortality. We sought to investigate the anatomical distribution of clinically actionable mutations in posterior fossa meningioma to facilitate identifying patients amenable for systemic targeted therapy trials. Methods Targeted sequencing of clinically targetable AKT1 , SMO , and PIK3CA mutations was performed in 61 posterior fossa meningioma using Illumina NextSeq 500 to a target depth of >500 × . Samples were further interrogated for 53 cancer-relevant RNA fusions by the Archer FusionPlex panel to detect gene rearrangements. Results AKT 1 ( E17K ) mutations were detected in five cases (8.2%), four in the foramen magnum and one in the cerebellopontine angle. In contrast, none of the posterior fossa tumors harbored an SMO ( L412F ) or a PIK3CA ( E545K ) mutation. Notably, the majority of foramen magnum meningiomas (4/7, 57%) harbored an AKT1 mutation. In addition, common clinically targetable gene fusions were not detected in any of the cases. Conclusion A large subset of foramen magnum meningiomas harbor AKT1 E17K mutations and are therefore potentially amenable to targeted medical therapy. Genotyping of foramen magnum meningiomas may enable more therapeutic alternatives and guide their treatment decision process.
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Affiliation(s)
- Sally R. Williams
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Tareq A. Juratli
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Division of Neuro-Oncology, Department of Neurology, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Brandyn A. Castro
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Tyler T. Lazaro
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Corey M. Gill
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Naema Nayyar
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew R. Strickland
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Melanie Babinski
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah E. Johnstone
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Matthew P. Frosch
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | | | - Alexander B. Kaplan
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Megan R. D'Andrea
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Ivanna V. Bihun
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kaitlin Hoang
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Emily Batchelor
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | | | - Daniel P. Cahill
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Frederick G. Barker
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Priscilla K. Brastianos
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Division of Neuro-Oncology, Department of Neurology, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Division of Hematology/Oncology, Department of Medicine, Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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25
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Rutland JW, Huang KH, Gill CM, Villavisanis DF, Alper J, Verma G, Bederson JB, Delman BN, Shrivastava RK, Balchandani P. First application of 7-T ultra-high field diffusion tensor imaging to detect altered microstructure of thalamic-somatosensory anatomy in trigeminal neuralgia. J Neurosurg 2019; 133:839-847. [PMID: 31470412 PMCID: PMC7325446 DOI: 10.3171/2019.6.jns19541] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Trigeminal neuralgia (TN) is a debilitating neurological disease that commonly results from neurovascular compression of the trigeminal nerve (CN V). Although the CN V has been extensively studied at the site of neurovascular compression, many pathophysiological factors remain obscure. For example, thalamic-somatosensory function is thought to be altered in TN, but the abnormalities are inadequately characterized. Furthermore, there are few studies using 7-T MRI to examine patients with TN. The purpose of the present study was to use 7-T MRI to assess microstructural alteration in the thalamic-somatosensory tracts of patients with TN by using ultra-high field MRI. METHODS Ten patients with TN and 10 age- and sex-matched healthy controls underwent scanning using 7-T MRI with diffusion tensor imaging. Structural images were segmented with an automated algorithm to obtain thalamus and primary somatosensory cortex (S1). Probabilistic tractography was performed between the thalamus and S1, and the microstructure of the thalamic-somatosensory tracts was compared between patients with TN and controls. RESULTS Fractional anisotropy of the thalamic-somatosensory tract ipsilateral to the site of neurovascular compression was reduced in patients (mean 0.43) compared with side-matched controls (mean 0.47, p = 0.01). The mean diffusivity was increased ipsilaterally in patients (mean 6.58 × 10-4 mm2/second) compared with controls (mean 6.15 × 10-4 mm2/second, p = 0.02). Radial diffusivity was increased ipsilaterally in patients (mean 4.91 × 10-4 mm2/second) compared with controls (mean 4.44 × 10-4 mm2/second, p = 0.01). Topographical analysis revealed fractional anisotropy reduction and diffusivity elevation along the entire anatomical S1 arc in patients with TN. CONCLUSIONS The present study is the first to examine microstructural properties of the thalamic-somatosensory anatomy in patients with TN and to evaluate quantitative differences compared with healthy controls. The finding of reduced integrity of these white matter fibers provides evidence of microstructural alteration at the level of the thalamus and S1, and furthers the understanding of TN neurobiology.
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Affiliation(s)
- John W Rutland
- 1Translational and Molecular Imaging Institute, and
- Departments of2Neurosurgery
| | | | | | | | - Judy Alper
- 1Translational and Molecular Imaging Institute, and
| | - Gaurav Verma
- 1Translational and Molecular Imaging Institute, and
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26
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Alvarez-Breckenridge C, Giobbie-Hurder A, Gill CM, Bertalan M, Stocking J, Kaplan A, Nayyar N, Lawrence DP, Flaherty KT, Shih HA, Oh K, Batchelor TT, Cahill DP, Sullivan R, Brastianos PK. Upfront Surgical Resection of Melanoma Brain Metastases Provides a Bridge Toward Immunotherapy-Mediated Systemic Control. Oncologist 2019; 24:671-679. [PMID: 30796152 PMCID: PMC6516108 DOI: 10.1634/theoncologist.2018-0306] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/03/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Immune checkpoint blockade has systemic efficacy in patients with metastatic melanoma, including those with brain metastases (MBMs). However, immunotherapy-induced intracranial tumoral inflammation can lead to neurologic compromise, requiring steroids, which abrogate the systemic efficacy of this approach. We investigated whether upfront neurosurgical resection of MBM is associated with a therapeutic advantage when performed prior to initiation of immunotherapy. MATERIAL AND METHODS An institutional review board-approved, retrospective study identified 142 patients with MBM treated with immune checkpoint blockade between 2010 and 2016 at Massachusetts General Hospital, of whom 79 received surgery. Patients were classified based on the temporal relationship between immunotherapy, surgery, and development of central nervous system metastases. Overall survival (OS) was calculated from the date of diagnosis of MBM until death from any cause. Multivariate model building included a prognostic Cox model of OS, the effect of immunotherapy and surgical sequencing on OS, and the effect of immunotherapy and radiation sequencing on OS. RESULTS The 2-year overall survival for patients treated with cytotoxic T-lymphocyte antigen 4, programmed death 1, or combinatorial blockade was 19%, 54%, and 57%, respectively. Among immunotherapy-naïve melanoma brain metastases, surgery followed by immunotherapy had a median survival of 22.7 months (95% confidence interval [CI], 12.6-39.2) compared with 10.8 months for patients treated with immunotherapy alone (95% CI, 7.8-16.3) and 9.4 months for patients treated with immunotherapy followed by surgery (95% CI, 4.1 to ∞; p = .12). On multivariate analysis, immunotherapy-naïve brain metastases treated with immunotherapy alone were associated with increased risk of death (hazard ratio, 1.72; 95% CI, 1.00-2.99) compared with immunotherapy-naïve brain metastases treated with surgery followed by immunotherapy. CONCLUSION In treatment-naïve patients, early surgical resection for local control should be considered prior to commencing immunotherapy. A prospective, randomized trial comparing the sequence of surgery and immunotherapy for treatment-naïve melanoma brain metastases is warranted. IMPLICATIONS FOR PRACTICE In this retrospective study of 142 patients with melanoma brain metastases treated with immune checkpoint blockade, the development of melanoma brain metastases following immunotherapy was associated with decreased survival compared with diagnosis of immunotherapy-naïve brain metastases. The benefit of surgical intervention was seen in immunotherapy-naïve brain metastases in contrast to brain metastases that developed on immunotherapy. These results suggest that upfront local control with surgery for immunotherapy-naïve melanoma brain metastasis may provide a bridge toward immunotherapy-mediated systemic control.
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Affiliation(s)
| | - Anita Giobbie-Hurder
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Corey M Gill
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mia Bertalan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jackson Stocking
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alexander Kaplan
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Naema Nayyar
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Donald P Lawrence
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith T Flaherty
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin Oh
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan Sullivan
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Priscilla K Brastianos
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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27
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Gill CM, Azevedo DC, Oliveira AL, Martinez-Salazar EL, Torriani M, Bredella MA. Sex differences in pericardial adipose tissue assessed by PET/CT and association with cardiometabolic risk. Acta Radiol 2018; 59:1203-1209. [PMID: 29444586 DOI: 10.1177/0284185118756950] [Citation(s) in RCA: 8] [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] [Indexed: 01/26/2023]
Abstract
Background Recent studies suggest that pericardial adipose tissue (PAT) is associated with whole body adiposity and insulin resistance. Moreover, the incidence of cardiovascular disease (CVD) differs between men and women. Although CVD is more prevalent in men, women suffering from CVD have a higher mortality compared to men. Differences in PAT may account for some of the observed sex differences in manifestations of CVD. Purpose To assess pericardial adipose tissue (PAT) as a biomarker for cardiometabolic risk and to assess potential sex differences. Material and Methods We studied 303 individuals (151 women, 152 men; mean age = 57 ± 17 years) across the weight spectrum. PAT and abdominal adipose tissue were quantified using clinical computed tomography (CT) scans obtained as part of a positron emission tomography (PET)/CT. Cardiometabolic risk factors were assessed from medical records. Linear regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate associations between PAT and cardiometabolic risk. Results PAT was higher in overweight and obese individuals compared to lean individuals and higher in men compared to women. PAT was positively associated with body mass index, abdominal fat ( P < 0.0001), fasting glucose, and serum lipids ( P < 0.05) with stronger associations in women than in men. PAT was accurate in detecting the prevalence of the metabolic syndrome with 74% sensitivity and 76% specificity (AUC = 0.80). Conclusion PAT is associated with measures of cardiometabolic risk and these associations are stronger in women compared to men. PAT could serve as a biomarker for opportunistic screening for cardiometabolic risk in patients undergoing chest CT.
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Affiliation(s)
- Corey M Gill
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Current affiliation: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Debora C Azevedo
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Current affiliation: Hospital Israelita Albert Einstein - Setor de Imaginologia, São Paulo, SP, Brazil
| | - Adriana L Oliveira
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Current affiliation: Clínica Prodimagem, Manaus, AM, Brazil
| | - Edgar L Martinez-Salazar
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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28
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Alvarez-Breckenridge C, Stocking J, Lastrapes M, Nayyar N, Gill CM, Bertalan M, Kaplan A, McCabe D, Horbinski C, Zakaria R, Nassiri F, Zadeh G, Alvarez MML, Nahed BV, Curry WT, Izar B, Suva M, Sullivan R, Cahill DP, Carter S, Brastianos P. 218 Divergent Clonal Evolution of Melanoma Brain Metastases in Response to Immunotherapy. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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29
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DeSilva JM, Gill CM, Prang TC, Bredella MA, Alemseged Z. A nearly complete foot from Dikika, Ethiopia and its implications for the ontogeny and function of Australopithecus afarensis. Sci Adv 2018; 4:eaar7723. [PMID: 29978043 PMCID: PMC6031372 DOI: 10.1126/sciadv.aar7723] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 05/21/2023]
Abstract
The functional and evolutionary implications of primitive retentions in early hominin feet have been under debate since the discovery of Australopithecus afarensis. Ontogeny can provide insight into adult phenotypes, but juvenile early hominin foot fossils are exceptionally rare. We analyze a nearly complete, 3.32-million-year-old juvenile foot of A. afarensis (DIK-1-1f). We show that juvenile A. afarensis individuals already had many of the bipedal features found in adult specimens. However, they also had medial cuneiform traits associated with increased hallucal mobility and a more gracile calcaneal tuber, which is unexpected on the basis of known adult morphologies. Selection for traits functionally associated with juvenile pedal grasping may provide a new perspective on their retention in the more terrestrial adult A. afarensis.
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Affiliation(s)
- Jeremy M. DeSilva
- Department of Anthropology, Dartmouth College, Hanover, NH 03755, USA
- Corresponding author. (J.M.D.); (Z.A.)
| | - Corey M. Gill
- Department of Anthropology, Boston University, Boston, MA 02215, USA
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Thomas C. Prang
- Center for the Study of Human Origins, Department of Anthropology, New York University, New York, NY 10003, USA
- New York Consortium in Evolutionary Anthropology, New York, NY, USA
| | - Miriam A. Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Zeresenay Alemseged
- Department of Organismal Biology and Anatomy, University of Chicago, Chicago, IL 60637, USA
- Corresponding author. (J.M.D.); (Z.A.)
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30
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Barrett TF, Gill CM, Miles BA, Iloreta AMC, Bakst RL, Fowkes M, Brastianos PK, Bederson JB, Shrivastava RK. Brain metastasis from squamous cell carcinoma of the head and neck: a review of the literature in the genomic era. Neurosurg Focus 2018; 44:E11. [DOI: 10.3171/2018.2.focus17761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Squamous cell carcinoma of the head and neck (HNSCC) affects nearly 500,000 individuals globally each year. With the rise of human papillomavirus (HPV) in the general population, clinicians are seeing a concomitant rise in HPV-related HNSCC. Notably, a hallmark of HPV-related HNSCC is a predilection for unique biological and clinical features, which portend a tendency for hematogenous metastasis to distant locations, such as the brain. Despite the classic belief that HNSCC is restricted to local spread via passive lymphatic drainage, brain metastases (BMs) are a rare complication that occurs in less than 1% of all HNSCC cases. Time between initial diagnosis of HNSCC and BM development can vary considerably. Some patients experience more than a decade of disease-free survival, whereas others present with definitive neurological symptoms that precede primary tumor detection. The authors systematically review the current literature on HNSCC BMs and discuss the current understanding of the effect of HPV status on the risk of developing BMs in the modern genomic era.
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Affiliation(s)
| | | | | | | | | | - Mary Fowkes
- 4Pathology, Mount Sinai Medical Center, New York, New York; and
| | - Priscilla K. Brastianos
- 5Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, Massachusetts
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31
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Shankar GM, Abedalthagafi M, Vaubel RA, Merrill PH, Nayyar N, Gill CM, Brewster R, Bi WL, Agarwalla PK, Thorner AR, Reardon DA, Al-Mefty O, Wen PY, Alexander BM, van Hummelen P, Batchelor TT, Ligon KL, Ligon AH, Meyerson M, Dunn IF, Beroukhim R, Louis DN, Perry A, Carter SL, Giannini C, Curry WT, Cahill DP, Barker FG, Brastianos PK, Santagata S. Germline and somatic BAP1 mutations in high-grade rhabdoid meningiomas. Neuro Oncol 2017; 19:535-545. [PMID: 28170043 DOI: 10.1093/neuonc/now235] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [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: 06/16/2016] [Accepted: 10/04/2016] [Indexed: 12/30/2022] Open
Abstract
Background Patients with meningiomas have widely divergent clinical courses. Some entirely recover following surgery alone, while others have relentless tumor recurrences. This clinical conundrum is exemplified by rhabdoid meningiomas, which are designated in the World Health Organization Classification of Tumours as high grade, despite only a subset following an aggressive clinical course. Patient management decisions are further exacerbated by high rates of interobserver variability, biased against missing possibly aggressive tumors. Objective molecular determinants are needed to guide classification and clinical decision making. Methods To define genomic aberrations of rhabdoid meningiomas, we performed sequencing of cancer-related genes in 27 meningiomas from 18 patients with rhabdoid features and evaluated breast cancer [BRCA]1-associated protein 1 (BAP1) expression by immunohistochemistry in 336 meningiomas. We assessed outcomes, germline status, and family history in patients with BAP1-negative rhabdoid meningiomas. Results The tumor suppressor gene BAP1, a ubiquitin carboxy-terminal hydrolase, is inactivated in a subset of high-grade rhabdoid meningiomas. Patients with BAP1-negative rhabdoid meningiomas had reduced time to recurrence compared with patients with BAP1-retained rhabdoid meningiomas (Kaplan-Meier analysis, 26 mo vs 116 mo, P < .001; hazard ratio 12.89). A subset of patients with BAP1-deficient rhabdoid meningiomas harbored germline BAP1 mutations, indicating that rhabdoid meningiomas can be a harbinger of the BAP1 cancer predisposition syndrome. Conclusion We define a subset of aggressive rhabdoid meningiomas that can be recognized using routine laboratory tests. We implicate ubiquitin deregulation in the pathogenesis of these high-grade malignancies. In addition, we show that familial and sporadic BAP1-mutated rhabdoid meningiomas are clinically aggressive, requiring intensive clinical management.
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Affiliation(s)
- Ganesh M Shankar
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Malak Abedalthagafi
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Pathology, King Fahad Medical City, Riyadh, Saudi Arabia.,King Abdulaziz City for Science and Technology, Riyadh, Saudi Arabia
| | - Rachael A Vaubel
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Parker H Merrill
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Naema Nayyar
- Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Corey M Gill
- Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan Brewster
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wenya Linda Bi
- Department of Neurosurgery, Brigham and Hospital, Boston, Massachusetts, USA
| | - Pankaj K Agarwalla
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Aaron R Thorner
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - David A Reardon
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Ossama Al-Mefty
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Hospital, Boston, Massachusetts, USA
| | - Patrick Y Wen
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian M Alexander
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA
| | - Paul van Hummelen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tracy T Batchelor
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keith L Ligon
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Azra H Ligon
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Clinical Cytogenetics Laboratory, Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Matthew Meyerson
- Broad Institute of MIT and Harvard, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ian F Dunn
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurosurgery, Brigham and Hospital, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rameen Beroukhim
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Center for Neuro-Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - David N Louis
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Arie Perry
- Department of Pathology and Neurological Surgery, University of California-San Francisco, San Francisco, California, USA
| | - Scott L Carter
- Harvard Medical School, Boston, Massachusetts, USA.,Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Joint Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Caterina Giannini
- Department of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - William T Curry
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel P Cahill
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Frederick G Barker
- Harvard Medical School, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Priscilla K Brastianos
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Broad Institute of MIT and Harvard, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Cancer Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandro Santagata
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Ludwig Center at Harvard, Boston, Massachusetts, USA
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32
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Brastianos PK, Nayyar N, Rosebrock D, Leshchiner I, Gill CM, Livitz D, Bertalan MS, D'Andrea M, Hoang K, Aquilanti E, Chukwueke UN, Kaneb A, Chi A, Plotkin S, Gerstner ER, Frosch MP, Suva ML, Cahill DP, Getz G, Batchelor TT. Resolving the phylogenetic origin of glioblastoma via multifocal genomic analysis of pre-treatment and treatment-resistant autopsy specimens. NPJ Precis Oncol 2017; 1:33. [PMID: 29872714 PMCID: PMC5871833 DOI: 10.1038/s41698-017-0035-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 03/07/2017] [Revised: 08/01/2017] [Accepted: 08/02/2017] [Indexed: 12/13/2022] Open
Abstract
Glioblastomas are malignant neoplasms composed of diverse cell populations. This intratumoral diversity has an underlying architecture, with a hierarchical relationship through clonal evolution from a common ancestor. Therapies are limited by emergence of resistant subclones from this phylogenetic reservoir. To characterize this clonal ancestral origin of recurrent tumors, we determined phylogenetic relationships using whole exome sequencing of pre-treatment IDH1/2 wild-type glioblastoma specimens, matched to post-treatment autopsy samples (n = 9) and metastatic extracranial post-treatment autopsy samples (n = 3). We identified “truncal” genetic events common to the evolutionary ancestry of the initial specimen and later recurrences, thereby inferring the identity of the precursor cell population. Mutations were identified in a subset of cases in known glioblastoma genes such as NF1(n = 3), TP53(n = 4) and EGFR(n = 5). However, by phylogenetic analysis, there were no protein-coding mutations as recurrent truncal events across the majority of cases. In contrast, whole copy-loss of chromosome 10 (12 of 12 cases), copy-loss of chromosome 9p21 (11 of 12 cases) and copy-gain in chromosome 7 (10 of 12 cases) were identified as shared events in the majority of cases. Strikingly, mutations in the TERT promoter were also identified as shared events in all evaluated pairs (9 of 9). Thus, we define four truncal non-coding genomic alterations that represent early genomic events in gliomagenesis, that identify the persistent cellular reservoir from which glioblastoma recurrences emerge. Therapies to target these key early genomic events are needed. These findings offer an evolutionary explanation for why precision therapies that target protein-coding mutations lack efficacy in GBM. Non-coding and structural alterations may be early drivers of brain cancer development. A team led by Priscilla Brastianos and Tracy Batchelor from Massachusetts General Hospital, Boston, USA, analyzed the genetic landscape of glioblastoma by comparing pre-treatment and autopsy tumor specimens from 12 patients who died of the aggressive brain cancer. They identified a common set of four genetic events that occurred early in the evolution of nearly every patient’s cancer: three losses or gains of chromosome regions or entire chromosomes, and mutations in the gene-activating promoter of TERT, which encodes an enzyme implicated in the cancer’s growth. The findings help explain why therapies that target protein-coding mutations don’t work in brain cancer when they do in other tumor types. They also point to new drug targets.
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Affiliation(s)
- Priscilla K Brastianos
- 1Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,2Broad Institute of MIT and Harvard, Boston, Massachusetts USA.,3Harvard Medical School, Boston, Massachusetts USA.,4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Naema Nayyar
- 2Broad Institute of MIT and Harvard, Boston, Massachusetts USA.,4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | | | | | - Corey M Gill
- 4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Dimitri Livitz
- 2Broad Institute of MIT and Harvard, Boston, Massachusetts USA
| | - Mia S Bertalan
- 4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Megan D'Andrea
- 4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Kaitlin Hoang
- 4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Elisa Aquilanti
- 1Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,2Broad Institute of MIT and Harvard, Boston, Massachusetts USA.,3Harvard Medical School, Boston, Massachusetts USA.,4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Ugonma N Chukwueke
- 4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Andrew Kaneb
- 4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Andrew Chi
- 6Laura and Isaac Perlmutter Cancer Center, NYU Langone Medical Center, New York, NY USA
| | - Scott Plotkin
- 1Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,3Harvard Medical School, Boston, Massachusetts USA.,4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Elizabeth R Gerstner
- 1Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,3Harvard Medical School, Boston, Massachusetts USA.,4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Mathew P Frosch
- 3Harvard Medical School, Boston, Massachusetts USA.,7Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Mario L Suva
- 3Harvard Medical School, Boston, Massachusetts USA.,7Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Daniel P Cahill
- 3Harvard Medical School, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA.,8Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Gad Getz
- 2Broad Institute of MIT and Harvard, Boston, Massachusetts USA.,3Harvard Medical School, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA.,7Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts USA
| | - Tracy T Batchelor
- 1Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,3Harvard Medical School, Boston, Massachusetts USA.,4Division of Neuro-Oncology, Massachusetts General Hospital, Boston, Massachusetts USA.,5Cancer Center, Massachusetts General Hospital, Boston, Massachusetts USA
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Simeone FJ, Gill CM, Taneja AK, Torriani M, Bredella MA. Glenohumeral position during CT arthrography with arthroscopic correlation: optimization of diagnostic yield. Skeletal Radiol 2017; 46:769-776. [PMID: 28361351 DOI: 10.1007/s00256-017-2613-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 02/15/2017] [Accepted: 02/22/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the diagnostic yield of two acquisitions of single-contrast CT arthrography (CTA) of the shoulder in internal, neutral, or external glenohumeral rotation with arthroscopic correlation. MATERIALS AND METHODS The CT study was obtained using two acquisitions (first the humerus positioned in maximum tolerated external rotation with the arm along the body and the second with the humerus in internal rotation with the palm placed flat on the table). Two independent readers blinded to the arthroscopic results evaluated the CTA images for labral tears, glenoid bone loss/fractures, and cartilage loss. For each CTA acquisition, sensitivity and specificity for detection of the aforementioned pathology were assessed. Inter-reader agreement was quantified by weighted ĸ statistics. RESULTS Sensitivity and specificity for detecting anteroinferior or posterior labral tears was highest with neutral rotation (sensitivity 91-100%, specificity 61-100%). For glenoid fracture, sensitivity (67%) was highest with external rotation and specificity (100%) was highest with internal rotation. For cartilage loss, sensitivity (64%) and specificity (89%) was highest with external rotation and neutral rotation, respectively. Neutral rotation showed high sensitivity and specificity for glenoid fractures and cartilage loss. Inter-reader agreement ranged from fair to very good. CONCLUSIONS Neutral glenohumeral position in shoulder CT arthrography was adequately sensitive and specific for the detection of intra-articular pathology, avoiding the use of more than one acquisition.
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Affiliation(s)
- F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6046, Boston, MA, 02114, USA.
| | - Corey M Gill
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6046, Boston, MA, 02114, USA
| | - Atul K Taneja
- Musculoskeletal Imaging, Hospital Israelita Albert Einstein, Hospital do Coração (HCor) and Teleimagem, São Paulo, SP, Brazil
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6046, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, YAW 6046, Boston, MA, 02114, USA
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Azria D, Lapierre A, Gourgou S, De Ruysscher D, Colinge J, Lambin P, Brengues M, Ward T, Bentzen SM, Thierens H, Rancati T, Talbot CJ, Vega A, Kerns SL, Andreassen CN, Chang-Claude J, West CML, Gill CM, Rosenstein BS. Data-Based Radiation Oncology: Design of Clinical Trials in the Toxicity Biomarkers Era. Front Oncol 2017; 7:83. [PMID: 28497027 PMCID: PMC5406456 DOI: 10.3389/fonc.2017.00083] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/13/2017] [Indexed: 12/15/2022] Open
Abstract
The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost-utility advantage. Conversely, for patients predicted to be at high risk for toxicity, either a more conformal form or a new technique of RT, or a multidisciplinary approach employing surgery could be included in the trial design to avoid or mitigate RT when the potential toxicity risk may be higher than the risk of disease recurrence. In addition, for patients at high risk of recurrence and low risk of toxicity, dose escalation, such as a greater boost dose, or irradiation field extensions could be considered to improve local control without severe toxicities, providing enhanced clinical benefit. In cases of high risk of toxicity, tumor control should be prioritized. In this review, toxicity biomarkers with sufficient evidence for clinical testing are presented. In addition, clinical trial designs and predictive models are described for different clinical situations.
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Affiliation(s)
- David Azria
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Ariane Lapierre
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Sophie Gourgou
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Dirk De Ruysscher
- Department of Radiation Oncology, Maastricht University Medical Centre, MAASTRO Clinic, Maastricht, Netherlands
- Radiation Oncology, KU Leuven, Leuven, Belgium
| | - Jacques Colinge
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Philippe Lambin
- Department of Radiation Oncology, Maastricht University Medical Centre, MAASTRO Clinic, Maastricht, Netherlands
| | - Muriel Brengues
- Department of Radiation Oncology, Radiobiology Unit, Biometric and Bio-informatic Divisions, Montpellier Cancer Institute (ICM), IRCM, INSERM U1194, Montpellier, France
| | - Tim Ward
- Patient Advocate, Manchester, UK
| | - Søren M. Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hubert Thierens
- Department of Basic Medical Sciences, Ghent University, Ghent, Belgium
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Ana Vega
- Fundacion Publica Galega de Medicina Xenomica-SERGAS, Grupo de Medicina Xenomica-USC, IDIS, CIBERER, Santiago de Compostela, Spain
| | - Sarah L. Kerns
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg (UCCH), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Catharine M. L. West
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital NHS Trust, Manchester, UK
| | - Corey M. Gill
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barry S. Rosenstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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35
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Alvarez-Breckenridge C, Miller JJ, Nayyar N, Gill CM, Kaneb A, D'Andrea M, Le LP, Lee J, Cheng J, Zheng Z, Butler WE, Multani P, Chow Maneval E, Ha Paek S, Toyota BD, Dias-Santagata D, Santagata S, Romero J, Shaw AT, Farago AF, Yip S, Cahill DP, Batchelor TT, Iafrate AJ, Brastianos PK. Clinical and radiographic response following targeting of BCAN-NTRK1 fusion in glioneuronal tumor. NPJ Precis Oncol 2017; 1:5. [PMID: 29872694 PMCID: PMC5871889 DOI: 10.1038/s41698-017-0009-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 10/06/2016] [Revised: 12/05/2016] [Accepted: 12/30/2016] [Indexed: 12/26/2022] Open
Abstract
Glioneuronal tumors constitute a histologically diverse group of primary central nervous system neoplasms that are typically slow-growing and managed conservatively. Genetic alterations associated with glioneuronal tumors include BRAF mutations and oncogenic fusions. To further characterize this group of tumors, we collected a cohort of 26 glioneuronal tumors and performed in-depth genomic analysis. We identified mutations in BRAF (34%) and oncogenic fusions (30%), consistent with previously published reports. In addition, we discovered novel oncogenic fusions involving members of the NTRK gene family in a subset of our cohort. One-patient with BCAN exon 13 fused to NTRK1 exon 11 initially underwent a subtotal resection for a 4th ventricular glioneuronal tumor but ultimately required additional therapy due to progressive, symptomatic disease. Given the patient's targetable fusion, the patient was enrolled on a clinical trial with entrectinib, a pan-Trk, ROS1, and ALK (anaplastic lymphoma kinase) inhibitor. The patient was treated for 11 months and during this time volumetric analysis of the lesion demonstrated a maximum reduction of 60% in the contrast-enhancing tumor compared to his pre-treatment magnetic resonance imaging study. The radiologic response was associated with resolution of his clinical symptoms and was maintained for 11 months on treatment. This report of a BCAN-NTRK1 fusion in glioneuronal tumors highlights its clinical importance as a novel, targetable alteration.
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Affiliation(s)
| | - Julie J Miller
- 2Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Naema Nayyar
- 2Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA.,3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Corey M Gill
- 3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Andrew Kaneb
- 3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Megan D'Andrea
- 3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Long P Le
- 4Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Jesse Lee
- 4Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Ju Cheng
- 4Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Zongli Zheng
- 4Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - William E Butler
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | | | | | - Sun Ha Paek
- 6Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Brian D Toyota
- 7Division of Neurosurgery, Department of Surgery, University of British Columbia, Vancouver, BC Canada
| | - Dora Dias-Santagata
- 4Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Sandro Santagata
- 8Department of Pathology, Division of Neuropathology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Javier Romero
- 9Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Alice T Shaw
- 3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Anna F Farago
- 3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Stephen Yip
- 10Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, BC Canada
| | - Daniel P Cahill
- 1Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Tracy T Batchelor
- 2Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA.,11Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA.,12Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - A John Iafrate
- 4Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Priscilla K Brastianos
- 2Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA.,3Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
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36
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Roongpiboonsopit D, Kuijf HJ, Charidimou A, Xiong L, Vashkevich A, Martinez-Ramirez S, Shih HA, Gill CM, Viswanathan A, Dietrich J. Evolution of cerebral microbleeds after cranial irradiation in medulloblastoma patients. Neurology 2017; 88:789-796. [PMID: 28122904 PMCID: PMC5344076 DOI: 10.1212/wnl.0000000000003631] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/28/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the temporal and spatial pattern of cerebral microbleeds (CMBs) after cranial irradiation in patients with medulloblastoma. METHODS We retrospectively identified patients with medulloblastoma treated with craniospinal irradiation at the Massachusetts General Hospital between 1999 and 2015. Longitudinal MRI including T2*-weighted gradient-recalled echo (GRE) sequences were reviewed, and the prevalence, spatial pattern, and risk factors associated with CMBs were characterized. RESULTS We identified a total of 27 patients; 5 patients were children (median age 6.3 years) and 22 patients were adults (median age 28.8 years). CMBs were found in 67% (18/27) of patients, who were followed for a median of 4.1 years. Patients with CMBs had longer GRE follow-up time compared to those without CMBs (4.9 vs 1.7 years, p = 0.035). The median latency of the appearance of CMBs was 2.79 years (interquartile range 1.76-4.26). The prevalence of CMBs increased with each year from time of radiation therapy, and the cumulative prevalence was highest in patients age <20 years (100% cumulative prevalence, vs 59% in adult patients treated at age ≥20 years). CMBs were mostly found in lobar distribution and predominately in bilateral occipital lobes. Patients using antithrombotic medications developed CMBs at a significantly higher rate (p = 0.041). CONCLUSIONS Our data demonstrate a high prevalence of CMBs following cranial irradiation, progressively increasing with each year from time of radiation therapy.
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Affiliation(s)
- Duangnapa Roongpiboonsopit
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Hugo J Kuijf
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Andreas Charidimou
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Li Xiong
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Anastasia Vashkevich
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Sergi Martinez-Ramirez
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Helen A Shih
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Corey M Gill
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Anand Viswanathan
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston
| | - Jorg Dietrich
- From The Hemorrhagic Stroke Research Program (D.R., A.C., L.X., A.V., S.M.-R., A.V.), J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine (D.R.), Faculty of Medicine, Naresuan University, Phitsanulok, Thailand; Image Sciences Institute (H.J.K.), University Medical Center Utrecht, the Netherlands; Department of Radiation Oncology (H.A.S.), Massachusetts General Hospital, Boston; and Department of Neurology (C.M.G., J.D.), Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, and Center for Regenerative Medicine, Harvard Medical School, Boston.
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Bachmann KN, Schorr M, Bruno AG, Bredella MA, Lawson EA, Gill CM, Singhal V, Meenaghan E, Gerweck AV, Slattery M, Eddy KT, Ebrahimi S, Koman SL, Greenblatt JM, Keane RJ, Weigel T, Misra M, Bouxsein ML, Klibanski A, Miller KK. Vertebral Volumetric Bone Density and Strength Are Impaired in Women With Low-Weight and Atypical Anorexia Nervosa. J Clin Endocrinol Metab 2017; 102:57-68. [PMID: 27732336 PMCID: PMC5413107 DOI: 10.1210/jc.2016-2099] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/07/2016] [Indexed: 11/19/2022]
Abstract
CONTEXT Areal bone mineral density (BMD) is lower, particularly at the spine, in low-weight women with anorexia nervosa (AN). However, little is known about vertebral integral volumetric BMD (Int.vBMD) or vertebral strength across the AN weight spectrum, including "atypical" AN [body mass index (BMI) ≥18.5 kg/m2]. OBJECTIVE To investigate Int.vBMD and vertebral strength, and their determinants, across the AN weight spectrum. DESIGN Cross-sectional observational study. SETTING Clinical research center. PARTICIPANTS 153 women (age 18 to 45): 64 with low-weight AN (BMI <18.5 kg/m2; 58% amenorrheic), 44 with atypical AN (18.5≤BMI<23 kg/m2; 30% amenorrheic), 45 eumenorrheic controls (19.2≤BMI<25 kg/m2). MEASURES Int.vBMD and cross-sectional area (CSA) by quantitative computed tomography of L4; estimated vertebral strength (derived from Int.vBMD and CSA). RESULTS Int.vBMD and estimated vertebral strength were lowest in low-weight AN, intermediate in atypical AN, and highest in controls. CSA did not differ between groups; thus, vertebral strength (calculated using Int.vBMD and CSA) was driven by Int.vBMD. In AN, Int.vBMD and vertebral strength were associated positively with current BMI and nadir lifetime BMI (independent of current BMI). Int.vBMD and vertebral strength were lower in AN with current amenorrhea and longer lifetime amenorrhea duration. Among amenorrheic AN, Int.vBMD and vertebral strength were associated positively with testosterone. CONCLUSIONS Int.vBMD and estimated vertebral strength (driven by Int.vBMD) are impaired across the AN weight spectrum and are associated with low BMI and endocrine dysfunction, both current and previous. Women with atypical AN experience diminished vertebral strength, partially due to prior low-weight and/or amenorrhea. Lack of current low-weight or amenorrhea in atypical AN does not preclude compromise of vertebral strength.
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Affiliation(s)
| | | | - Alexander G. Bruno
- Harvard–Massachusetts Institute of Technology Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139;
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, 02215
| | | | | | | | - Vibha Singhal
- Neuroendocrine Unit,
- Pediatric Endocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, 02114
| | - Erinne Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114;
| | - Anu V. Gerweck
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114;
| | - Meghan Slattery
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, 02114;
| | | | - Seda Ebrahimi
- Cambridge Eating Disorders Center, Cambridge, Massachusetts, 02138;
| | | | | | | | - Thomas Weigel
- Klarman Center, McLean Hospital, and Harvard Medical School, Belmont, Massachusetts, 02478; and
| | - Madhusmita Misra
- Neuroendocrine Unit,
- Pediatric Endocrine Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, 02114
| | - Mary L. Bouxsein
- Harvard–Massachusetts Institute of Technology Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, Massachusetts, 02139;
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, Massachusetts, 02215
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Dichtel LE, Schorr M, Gill CM, Economopoulos KP, Gerweck AV, Swearingen B, Hodin R, Bredella MA, Miller KK. Body composition in pituitary, adrenal and iatrogenic Cushing's syndrome and effects of DHEAS levels. Clin Endocrinol (Oxf) 2017; 86:160-162. [PMID: 27696526 PMCID: PMC5164987 DOI: 10.1111/cen.13251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Laura E Dichtel
- Neuroendocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Corey M Gill
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Anu V Gerweck
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Brooke Swearingen
- Department of Neurosurgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Richard Hodin
- Department of General Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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39
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Strickland MR, Gill CM, Nayyar N, D'Andrea MR, Thiede C, Juratli TA, Schackert G, Borger DR, Santagata S, Frosch MP, Cahill DP, Brastianos PK, Barker FG. Targeted sequencing of SMO and AKT1 in anterior skull base meningiomas. J Neurosurg 2016; 127:438-444. [PMID: 27885953 DOI: 10.3171/2016.8.jns161076] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Meningiomas located in the skull base are surgically challenging. Recent genomic research has identified oncogenic SMO and AKT1 mutations in a small subset of meningiomas. METHODS The authors performed targeted sequencing in a large cohort of patients with anterior skull base meningiomas (n = 62) to better define the frequency of SMO and AKT1 mutations in these tumors. RESULTS The authors found SMO mutations in 7 of 62 (11%) and AKT1 mutations in 12 of 62 (19%) of their cohort. Of the 7 meningiomas with SMO mutations, 6 (86%) occurred in the olfactory groove. Meningiomas with an SMO mutation presented with significantly larger tumor volume (70.6 ± 36.3 cm3) compared with AKT1-mutated (18.2 ± 26.8 cm3) and wild-type (22.7 ± 23.9 cm3) meningiomas, respectively. CONCLUSIONS Combined, these data demonstrate clinically actionable mutations in 30% of anterior skull base meningiomas and suggest an association between SMO mutation status and tumor volume. Genotyping of SMO and AKT1 is likely to be high yield in anterior skull base meningiomas with available surgical tissue.
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Affiliation(s)
| | | | | | | | | | - Tareq A Juratli
- Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Gabriele Schackert
- Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Darrell R Borger
- Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston; and
| | - Matthew P Frosch
- Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Fred G Barker
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Abstract
Development of brain metastasis (BM) portends a dismal prognosis for patients with cancer. Melanomas and carcinomas of the lung, breast, and kidney are the most common malignancies to metastasize to the brain. Recent advances in molecular genetics have enabled the identification of actionable, clinically relevant genetic alterations within primary tumors and their corresponding metastases. Adoption of genotype-guided treatment strategies for the management of systemic malignancy has resulted in dramatic and durable responses. Unfortunately, despite these therapeutic advances, central nervous system (CNS) relapses are not uncommon. Although these relapses have historically been attributed to limited blood brain barrier penetration of anti-neoplastic agents, recent work has demonstrated genetic heterogeneity such that metastatic sites, including BM, harbor relevant genetic alterations that are not present in primary tumor biopsies. This improved insight into molecular mechanisms underlying site specific recurrences can inform strategies for targeting these oncogenic drivers. Thus, development of rational, genomically guided CNS-penetrant therapies is crucial for ongoing therapeutic success.
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Affiliation(s)
- Ibiayi Dagogo-Jack
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Corey M Gill
- Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Daniel P Cahill
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sandro Santagata
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - Priscilla K Brastianos
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
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Neagu MR, Gill CM, Batchelor TT, Brastianos PK. Genomic profiling of brain metastases: current knowledge and new frontiers. Chin Clin Oncol 2016; 4:22. [PMID: 26112808 DOI: 10.3978/j.issn.2304-3865.2015.06.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/08/2015] [Indexed: 11/14/2022]
Abstract
Brain metastases (BM) constitute the majority of intracranial cancers and carry with them a dismal prognosis. Several common cancers have a particular predilection for spread to the brain, amongst them lung cancer, breast cancer, melanoma, renal cell carcinoma (RCC), and more rarely gastrointestinal (GI) cancers. While prognosis has historically been poor and multimodality treatment combining surgery and radiation therapy was the mainstay of treatment, the genomic revolution in cancer therapy is finding increasing applications in treatment of central nervous system (CNS) disease. Targeted therapy, combined with advances in the evaluation of BM for targetable mutations, is showing increased efficacy. Developments in the understanding of brain tropism and targetable signaling pathways in metastasis are elucidating entirely new treatment approaches. This review focuses on advances made in the understanding of the genomics of BM and how this may change the role of targeted therapeutics in this common complication of cancer.
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Affiliation(s)
- Martha R Neagu
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Corey M Gill
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Tracy T Batchelor
- Stephen E. and Catherine Pappas Center for Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Priscilla K Brastianos
- Division of Neuro-Oncology, Stephen E. and Catherine Pappas Center for Neuro-Oncology, Harvard Medical School, 55 Fruit Street, Yawkey 9E, Boston, MA 02114, USA.
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Bachmann KN, Bruno AG, Bredella MA, Schorr M, Lawson EA, Gill CM, Singhal V, Meenaghan E, Gerweck AV, Eddy KT, Ebrahimi S, Koman SL, Greenblatt JM, Keane RJ, Weigel T, Dechant E, Misra M, Klibanski A, Bouxsein ML, Miller KK. Vertebral Strength and Estimated Fracture Risk Across the BMI Spectrum in Women. J Bone Miner Res 2016; 31:281-8. [PMID: 26332401 PMCID: PMC4833882 DOI: 10.1002/jbmr.2697] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/03/2015] [Accepted: 08/25/2015] [Indexed: 01/23/2023]
Abstract
Somewhat paradoxically, fracture risk, which depends on applied loads and bone strength, is elevated in both anorexia nervosa and obesity at certain skeletal sites. Factor-of-risk (Φ), the ratio of applied load to bone strength, is a biomechanically based method to estimate fracture risk; theoretically, higher Φ reflects increased fracture risk. We estimated vertebral strength (linear combination of integral volumetric bone mineral density [Int.vBMD] and cross-sectional area from quantitative computed tomography [QCT]), vertebral compressive loads, and Φ at L4 in 176 women (65 anorexia nervosa, 45 lean controls, and 66 obese). Using biomechanical models, applied loads were estimated for: 1) standing; 2) arms flexed 90°, holding 5 kg in each hand (holding); 3) 45° trunk flexion, 5 kg in each hand (lifting); 4) 20° trunk right lateral bend, 10 kg in right hand (bending). We also investigated associations of Int.vBMD and vertebral strength with lean mass (from dual-energy X-ray absorptiometry [DXA]) and visceral adipose tissue (VAT, from QCT). Women with anorexia nervosa had lower, whereas obese women had similar, Int.vBMD and estimated vertebral strength compared with controls. Vertebral loads were highest in obesity and lowest in anorexia nervosa for standing, holding, and lifting (p < 0.0001) but were highest in anorexia nervosa for bending (p < 0.02). Obese women had highest Φ for standing and lifting, whereas women with anorexia nervosa had highest Φ for bending (p < 0.0001). Obese and anorexia nervosa subjects had higher Φ for holding than controls (p < 0.03). Int.vBMD and estimated vertebral strength were associated positively with lean mass (R = 0.28 to 0.45, p ≤ 0.0001) in all groups combined and negatively with VAT (R = -[0.36 to 0.38], p < 0.003) within the obese group. Therefore, women with anorexia nervosa had higher estimated vertebral fracture risk (Φ) for holding and bending because of inferior vertebral strength. Despite similar vertebral strength as controls, obese women had higher vertebral fracture risk for standing, holding, and lifting because of higher applied loads from higher body weight. Examining the load-to-strength ratio helps explain increased fracture risk in both low-weight and obese women.
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Affiliation(s)
- Katherine N Bachmann
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Alexander G Bruno
- Harvard-MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, MA, USA.,Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Lawson
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Corey M Gill
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erinne Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Anu V Gerweck
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Kamryn T Eddy
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Seda Ebrahimi
- Cambridge Eating Disorders Center, Cambridge, MA, USA
| | | | | | | | - Thomas Weigel
- Klarman Center, McLean Hospital and Harvard Medical School, Belmont, MA, USA
| | - Esther Dechant
- Klarman Center, McLean Hospital and Harvard Medical School, Belmont, MA, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.,Pediatric Endocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mary L Bouxsein
- Harvard-MIT Health Sciences and Technology Program, Massachusetts Institute of Technology, Cambridge, MA, USA.,Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Karen K Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Chang CY, Gill CM, Joseph Simeone F, Taneja AK, Huang AJ, Torriani M, Bredella MA. Comparison of the diagnostic accuracy of 99 m-Tc-MDP bone scintigraphy and 18 F-FDG PET/CT for the detection of skeletal metastases. Acta Radiol 2016; 57:58-65. [PMID: 25533313 DOI: 10.1177/0284185114564438] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 08/13/2014] [Accepted: 11/22/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is commonly performed for cancer staging, as it can detect metastatic disease in multiple organ systems. However, there has been some controversy in the scientific literature when comparing FDG PET/CT and technetium-99 m-bone scintigraphy (bone scan) for the detection of skeletal metastases. PURPOSE To compare the accuracy of FDG PET/CT with bone scan for the detection of skeletal metastases. MATERIAL AND METHODS The study group comprised 202 adult cancer patients who underwent both FDG PET/CT and bone scan within 31 days for staging. Bone scans and FDG PET/CT were evaluated by two musculoskeletal radiologists for the presence and location of skeletal metastatic disease. Confirmation of the final diagnosis was based on the CT or magnetic resonance imaging (MRI) appearance, follow-up imaging, or histology. RESULTS The sensitivity, specificity, and accuracy for detecting skeletal metastatic disease of FDG PET/CT were 97%, 98%, and 98%, respectively, and of bone scan were 83%, 98%, and 93%, respectively. The lesions that bone scan most commonly missed were located in the pelvis, spine, and sacrum. FDG PET/CT missed mostly lesions that were outside of the field of view, but in all of these cases the patient had additional sites of skeletal metastatic disease. Bone scan falsely identified six metastatic lesions and FDG PET/CT falsely identified three metastatic lesions. CONCLUSION FDG PET/CT is an accurate technique for detection of skeletal metastases, and is superior to bone scan, especially in the spine and pelvis.
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Affiliation(s)
- Connie Y Chang
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Corey M Gill
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - F Joseph Simeone
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Atul K Taneja
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ambrose J Huang
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Torriani
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Miriam A Bredella
- Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Gill CM, Bredella MA, DeSilva JM. Skeletal development of hallucal tarsometatarsal joint curvature and angulation in extant apes and modern humans. J Hum Evol 2015; 88:137-145. [DOI: 10.1016/j.jhevol.2015.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 06/01/2015] [Accepted: 07/13/2015] [Indexed: 11/26/2022]
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Brastianos PK, Carter SL, Santagata S, Cahill DP, Taylor-Weiner A, Jones RT, Van Allen EM, Lawrence MS, Horowitz PM, Cibulskis K, Ligon KL, Tabernero J, Seoane J, Martinez-Saez E, Curry WT, Dunn IF, Paek SH, Park SH, McKenna A, Chevalier A, Rosenberg M, Barker FG, Gill CM, Van Hummelen P, Thorner AR, Johnson BE, Hoang MP, Choueiri TK, Signoretti S, Sougnez C, Rabin MS, Lin NU, Winer EP, Stemmer-Rachamimov A, Meyerson M, Garraway L, Gabriel S, Lander ES, Beroukhim R, Batchelor TT, Baselga J, Louis DN, Getz G, Hahn WC. Genomic Characterization of Brain Metastases Reveals Branched Evolution and Potential Therapeutic Targets. Cancer Discov 2015; 5:1164-1177. [PMID: 26410082 PMCID: PMC4916970 DOI: 10.1158/2159-8290.cd-15-0369] [Citation(s) in RCA: 699] [Impact Index Per Article: 77.7] [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: 03/30/2015] [Accepted: 08/11/2015] [Indexed: 12/30/2022]
Abstract
UNLABELLED Brain metastases are associated with a dismal prognosis. Whether brain metastases harbor distinct genetic alterations beyond those observed in primary tumors is unknown. We performed whole-exome sequencing of 86 matched brain metastases, primary tumors, and normal tissue. In all clonally related cancer samples, we observed branched evolution, where all metastatic and primary sites shared a common ancestor yet continued to evolve independently. In 53% of cases, we found potentially clinically informative alterations in the brain metastases not detected in the matched primary-tumor sample. In contrast, spatially and temporally separated brain metastasis sites were genetically homogenous. Distal extracranial and regional lymph node metastases were highly divergent from brain metastases. We detected alterations associated with sensitivity to PI3K/AKT/mTOR, CDK, and HER2/EGFR inhibitors in the brain metastases. Genomic analysis of brain metastases provides an opportunity to identify potentially clinically informative alterations not detected in clinically sampled primary tumors, regional lymph nodes, or extracranial metastases. SIGNIFICANCE Decisions for individualized therapies in patients with brain metastasis are often made from primary-tumor biopsies. We demonstrate that clinically actionable alterations present in brain metastases are frequently not detected in primary biopsies, suggesting that sequencing of primary biopsies alone may miss a substantial number of opportunities for targeted therapy.
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Affiliation(s)
- Priscilla K. Brastianos
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, all in Boston
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, all in Boston
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, all in Boston
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Scott L. Carter
- Joint Center for Cancer Precision Medicine, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Sandro Santagata
- Department of Cancer Biology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Daniel P. Cahill
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Amaro Taylor-Weiner
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Robert T. Jones
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Eliezer M. Van Allen
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Michael S. Lawrence
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Peleg M. Horowitz
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Kristian Cibulskis
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Keith L. Ligon
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Josep Tabernero
- Department of Medical Oncology, Department of Pathology, Barcelona - all in Spain
| | - Joan Seoane
- Department of Medical Oncology, Department of Pathology, Barcelona - all in Spain
| | - Elena Martinez-Saez
- Vall d'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona - all in Spain
| | - William T. Curry
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Ian F. Dunn
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Sun Ha Paek
- Department of Neurosurgery and Department of Pathology, Seoul National University College of Medicine - all in Korea
| | - Sung-Hye Park
- Department of Neurosurgery and Department of Pathology, Seoul National University College of Medicine - all in Korea
| | - Aaron McKenna
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Aaron Chevalier
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Mara Rosenberg
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Frederick G. Barker
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Corey M. Gill
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Paul Van Hummelen
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Aaron R. Thorner
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Bruce E. Johnson
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Mai P. Hoang
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Toni K. Choueiri
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Sabina Signoretti
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Carrie Sougnez
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Michael S. Rabin
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Nancy U. Lin
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Eric P. Winer
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Anat Stemmer-Rachamimov
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Matthew Meyerson
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Levi Garraway
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Joint Center for Cancer Precision Medicine, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Stacey Gabriel
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Eric S. Lander
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Rameen Beroukhim
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Department of Cancer Biology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - Tracy T. Batchelor
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Jose Baselga
- Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York City
| | - David N. Louis
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, all in Boston
| | - Gad Getz
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, all in Boston
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
| | - William C. Hahn
- Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
- Broad Institute, Brigham and Women's Hospital, Harvard Medical School - all in Boston
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Abstract
PURPOSE To investigate the composition, cross-sectional area (CSA), and hormonal correlates of different fat depots in women with anorexia nervosa (AN) and control subjects with normal weights to find out whether patients with AN have lower fat CSA but higher attenuation than did control subjects and whether these changes may be mediated by gonadal steroids, cortisol, and thyroid hormones. MATERIALS AND METHODS This study was institutional review board approved and HIPAA compliant. Written informed consent was obtained. Forty premenopausal women with AN and 40 normal-weight women of comparable age (mean age ± standard deviation, 26 years ± 5) were studied. All individuals underwent computed tomography of the abdomen and thigh with a calibration phantom. Abdominal subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), thigh SAT, and thigh intermuscular adipose tissue CSA and attenuation were quantified. Serum estradiol, thyroid hormones, and urinary free cortisol levels were assessed. Variables were compared by using analysis of variance. Associations were examined by using linear regression analysis. RESULTS Women with AN had higher fat attenuation than did control subjects (-100.1 to -46.7 HU vs -117.6 to -61.8 HU, P < .0001), despite lower fat CSA (2.0-62.8 cm(2) vs 5.5-185.9 cm(2), P < .0001). VAT attenuation but not CSA was inversely associated with lowest prior lifetime body mass index in AN (r = -0.71, P = .006). Serum estradiol levels were inversely associated with fat attenuation (r = -0.34 to -0.61, P = .03 to <.0001) and were positively associated with fat CSA of all compartments (r = 0.42-0.64, P = .007 to <.0001). Thyroxine levels and urinary free cortisol levels were positively associated with thigh SAT attenuation (r = 0.64 [P = .006] and r = 0.68 [P = .0004], respectively) and were inversely associated with abdominal SAT and VAT CSA (r = -0.44 to -0.58, P = .04 to .02). CONCLUSION Women with AN have differences in fat composition, with higher fat attenuation than that of control subjects, as well as low fat mass. VAT attenuation but not CSA is inversely associated with lowest prior lifetime body mass index, suggesting that fat attenuation may serve as a biomarker of prior and current disease status in AN.
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Affiliation(s)
- Corey M Gill
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
| | - Martin Torriani
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
| | - Rachel Murphy
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
| | - Tamara B Harris
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
| | - Karen K Miller
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
| | - Anne Klibanski
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
| | - Miriam A Bredella
- From the Department of Radiology (C.M.G., M.T., M.A.B.) and Neuroendocrine Unit (K.K.M., A.K.), Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Bethesda, Md (R.M., T.B.H.)
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Brastianos PK, Shankar GM, Gill CM, Taylor-Weiner A, Nayyar N, Panka DJ, Sullivan RJ, Frederick DT, Abedalthagafi M, Jones PS, Dunn IF, Nahed BV, Romero JM, Louis DN, Getz G, Cahill DP, Santagata S, Curry WT, Barker FG. Dramatic Response of BRAF V600E Mutant Papillary Craniopharyngioma to Targeted Therapy. J Natl Cancer Inst 2015; 108:djv310. [PMID: 26498373 DOI: 10.1093/jnci/djv310] [Citation(s) in RCA: 148] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Abstract
We recently reported that BRAF V600E is the principal oncogenic driver of papillary craniopharyngioma, a highly morbid intracranial tumor commonly refractory to treatment. Here, we describe our treatment of a man age 39 years with multiply recurrent BRAF V600E craniopharyngioma using dabrafenib (150mg, orally twice daily) and trametinib (2mg, orally twice daily). After 35 days of treatment, tumor volume was reduced by 85%. Mutations that commonly mediate resistance to MAPK pathway inhibition were not detected in a post-treatment sample by whole exome sequencing. A blood-based BRAF V600E assay detected circulating BRAF V600E in the patient's blood. Re-evaluation of the existing management paradigms for craniopharyngioma is warranted, as patient morbidity might be reduced by noninvasive mutation testing and neoadjuvant-targeted treatment.
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Affiliation(s)
- Priscilla K Brastianos
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Ganesh M Shankar
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Corey M Gill
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Amaro Taylor-Weiner
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Naema Nayyar
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - David J Panka
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Ryan J Sullivan
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Dennie T Frederick
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Malak Abedalthagafi
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Pamela S Jones
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Ian F Dunn
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Brian V Nahed
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Javier M Romero
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - David N Louis
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Gad Getz
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Daniel P Cahill
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Sandro Santagata
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - William T Curry
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
| | - Fred G Barker
- Department of Medicine (PKB, RS), Department of Neurology (PKB, CMG), Department of Neurosurgery (GMS, PJ, BN, DPC, WTC, FGB), Department of Surgical Oncology (DTF), Department of Pathology (GG, DNL), Cancer Center (PKB, CMG, NN, DNL), Department of Radiology (JR) Massachusetts General Hospital, Harvard Medical School, Boston, MA; Broad Institute (ATW, GG), Department of Pathology, (MA, SS) and Department of Neurosurgery, Brigham and Women's Hospital (IFD), Boston, MA; Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (DJP)
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Eisele SC, Gill CM, Shankar GM, Brastianos PK. PLEKHA5: A Key to Unlock the Blood-Brain Barrier? Clin Cancer Res 2015; 21:1978-80. [PMID: 25779946 DOI: 10.1158/1078-0432.ccr-14-2604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 01/26/2015] [Indexed: 11/16/2022]
Abstract
Brain metastases represent a devastating complication of melanoma. Our understanding of the mechanisms driving metastasis to the brain is limited. PLEKHA5 functions as a regulator of brain metastasis in melanoma, and further investigation is warranted to explore the use of PLEKHA5 as a potential therapeutic target.
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Affiliation(s)
- Sylvia C Eisele
- Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Corey M Gill
- Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ganesh M Shankar
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Priscilla K Brastianos
- Division of Neuro-Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts. Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Taneja AK, Miranda FC, Braga CAP, Gill CM, Hartmann LGC, Santos DCB, Rosemberg LA. MRI features of the anterolateral ligament of the knee. Skeletal Radiol 2015; 44:403-10. [PMID: 25427785 DOI: 10.1007/s00256-014-2052-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 10/03/2014] [Accepted: 11/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Evaluate the visibility and describe the anatomical features of the anterolateral ligament of the knee using MRI. MATERIALS AND METHODS Magnetic resonance imaging examinations of the knee were independently reviewed by two musculoskeletal radiologists and assessed for the visibility of the anterolateral ligament under direct cross-referencing of axial and coronal images as complete, partial, or non-visible. Distal insertion site (tibial, meniscal), distance to lateral tibial plateau, measurements (length, width, thickness), and associated imaging findings were also tabulated. Clinical and surgical records were also reviewed. RESULTS Seventy MRI scans from 60 consecutive subjects were included in the study. Mean age was 40 years, body mass 74.9 kg, and height 1.72 m. The subject population was 53% male, most of the knees were from the left side (51%), and chronic pain was the main clinical symptom (40%). Nine knees (13 %) had undergone previous surgery. The anterolateral ligament was identified in 51% of the knees: completely visible in 11% and partially visible in 40%. In all visible cases, the distal insertion site was identified on the tibia, with a mean distance of 5.7 mm to the plateau. A completely visible ligament had a mean length of 33.2 mm, width of 5.6 mm, and thickness of 1.9 mm [corrected]. Inter-observer agreement for ligament presence was significant (κ = 0.7). Statistical analyses showed a trend to be more visible in men, with a longer length compared with women. CONCLUSIONS Magnetic resonance imaging clearly identifies the anterolateral ligament of the knee in slightly more than half of cases, being partially visible in most of them. In all cases, a tibial insertion is characterized.
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Affiliation(s)
- Atul K Taneja
- Musculoskeletal Radiology Division, Imaging Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Morumbi, São Paulo, SP, Brazil,
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Torriani M, Gill CM, Daley S, Oliveira AL, Azevedo DC, Bredella MA. Compartmental neck fat accumulation and its relation to cardiovascular risk and metabolic syndrome. Am J Clin Nutr 2014; 100:1244-51. [PMID: 25332322 PMCID: PMC6443294 DOI: 10.3945/ajcn.114.088450] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Neck circumference is a predictor of cardiovascular disease (CVD) risk. However, detailed assessment of neck fat has not been explored, and the contribution from individual neck fat compartments to CVD risk is unknown. OBJECTIVE The objective was to measure neck adipose tissue (NAT) compartments and examine relations with CVD risk markers, with the hypothesis that neck adipose tissue (NAT) accumulation preferentially involves specific compartments that contribute differently to metabolic risk. DESIGN We retrospectively studied 303 subjects with successfully treated malignancies or benign etiologies [151 women, 152 men; mean (± SD) age: 55 ± 17 y; mean body mass index (BMI; in kg/m(2)): 28 ± 6] who underwent whole-body positron emission tomography/computed tomography. NAT was measured at the level of the C5 vertebral body, subdivided into posterior (NATpost), subcutaneous (NATsc), and perivertebral (NATperivert) compartments. Data on CVD risk factors (BMI, abdominal circumference, visceral and abdominal subcutaneous adipose tissue, blood pressure, serum lipids, and fasting plasma glucose) were collected. We compared NAT compartments across lean, overweight, and obese groups and performed multivariate regression models correlating NAT with CVD risk factors. Receiver operating characteristic curve and prevalence ratio analyses were performed to examine the association of NAT compartments with metabolic syndrome. RESULTS NATpost and NATsc were more consistently associated with cardiometabolic risk, especially in women, correlating with visceral adipose tissue (P < 0.0001) and triglycerides (P < 0.001) and a nearly 1.5-fold increase in the prevalence ratio for metabolic syndrome after adjustment for age and BMI (P < 0.05). NATsc was most abundant in women, whereas intermuscular compartments (NATpost and NATperivert) were higher in men. In both sexes, NATpost and NATperivert showed the largest increment between lean and obese subjects. CONCLUSIONS Neck fat compartments expand differently with increasing adiposity, correlate with CVD risk factors, and are associated with metabolic syndrome, most notably NATpost and NATsc in women. Although neck circumference remains an important method to assess metabolic risk, cross-sectional NAT assessment provides further insight into fat accumulation in the neck. This trial was registered at clinicaltrials.gov as NCT02205021.
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Affiliation(s)
- Martin Torriani
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Corey M Gill
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Scott Daley
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Adriana L Oliveira
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Debora C Azevedo
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Miriam A Bredella
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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