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Klempka A, Ackermann E, Brehmer S, Clausen S, Groden C. Advanced Imaging of Shunt Valves in Cranial CT Scans with Photon-Counting Scanner. Tomography 2024; 10:654-659. [PMID: 38787010 DOI: 10.3390/tomography10050050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
This brief report aimed to show the utility of photon-counting technology alongside standard cranial imaging protocols for visualizing shunt valves in a patient's cranial computed tomography scan. Photon-counting CT scans with cranial protocols were retrospectively surveyed and four types of shunt valves were encountered: proGAV 2.0®, M.blue®, Codman Certas®, and proSA®. These scans were compared with those obtained from non-photon-counting scanners at different time points for the same patients. The analysis of these findings demonstrated the usefulness of photon-counting technology for the clear and precise visualization of shunt valves without any additional radiation or special reconstruction patterns. The enhanced utility of photon-counting is highlighted by providing superior spatial resolution compared to other CT detectors. This technology facilitates a more accurate characterization of shunt valves and may support the detection of subtle abnormalities and a precise assessment of shunt valves.
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Affiliation(s)
- Anna Klempka
- Department of Neuroradiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Eduardo Ackermann
- Department of Neuroradiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Sven Clausen
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Layer JP, Shiban E, Brehmer S, Diehl CD, de Castro DG, Hamed M, Dejonckheere CS, Cifarelli DT, Friker LL, Herrlinger U, Hölzel M, Vatter H, Schneider M, Combs SE, Schmeel LC, Cifarelli CP, Giordano FA, Sarria GR, Kahl KH. Multicentric Assessment of Safety and Efficacy of Combinatorial Adjuvant Brain Metastasis Treatment by Intraoperative Radiation Therapy and Immunotherapy. Int J Radiat Oncol Biol Phys 2024; 118:1552-1562. [PMID: 38199383 DOI: 10.1016/j.ijrobp.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/12/2024]
Abstract
PURPOSE After surgical resection of brain metastases (BMs), intraoperative radiation therapy (IORT) provides a promising alternative to adjuvant external beam radiation therapy by enabling superior organ-at-risk preservation, reduction of in-hospital times, and timely admission to subsequent systemic treatments, which increasingly comprise novel targeted immunotherapeutic approaches. We sought to assess the safety and efficacy of IORT in combination with immune checkpoint inhibitors (ICIs) and other targeted therapies (TTs). METHODS AND MATERIALS In a multicentric approach incorporating individual patient data from 6 international IORT centers, all patients with BMs undergoing IORT were retrospectively assessed for combinatorial treatment with ICIs/TTs and evaluated for toxicity and cumulative rates, including wound dehiscence, radiation necrosis, leptomeningeal spread, local control, distant brain progression (DBP), and estimated overall survival. RESULTS In total, 103 lesions with a median diameter of 34 mm receiving IORT combined with immunomodulatory systemic treatment or other TTs were included. The median follow-up was 13.2 (range, 1.2-102.4) months, and the median IORT dose was 25 (range, 18-30) Gy prescribed to the applicator surface. There was 1 grade 3 adverse event related to IORT recorded (2.2%). A 4.9% cumulative radiation necrosis rate was observed. The 1-year local control rate was 98.0%, and the 1-year DBP-free survival rate was 60.0%. Median time to DBP was 5.5 (range, 1.0-18.5) months in the subgroup of patients experiencing DBP, and the cumulative leptomeningeal spread rate was 4.9%. The median estimated overall survival was 26 (range, 1.2 to not reached) months with a 1-year survival rate of 74.0%. Early initiation of immunotherapy/TTs was associated with a nonsignificant trend toward improved DBP rate and overall survival. CONCLUSIONS The combination of ICIs/TTs with IORT for resected BMs does not seem to increase toxicity and yields encouraging local control outcomes in the difficult-to-treat subgroup of larger BMs. Time gaps between surgery and systemic treatment could be shortened or avoided. The definitive role of IORT in local control after BM resection will be defined in a prospective trial.
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Affiliation(s)
- Julian P Layer
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany; Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Hospital Augsburg, Augsburg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Mannheim, Germany
| | - Christian D Diehl
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Cas S Dejonckheere
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany
| | - Daniel T Cifarelli
- Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
| | - Lea L Friker
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany; Institute of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Michael Hölzel
- Institute of Experimental Oncology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | | | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany; DKFZ-Hector Cancer Institute of the University Medical Center Mannheim, Mannheim, Germany; Mannheim Institute of Intelligent Systems in Medicine (MIISM), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Bonn, Germany.
| | - Klaus-Henning Kahl
- Department of Radiooncology, University Hospital Augsburg, Augsburg, Germany
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Altunbüker H, Hinz F, Sahm F, Brehmer S, Wenz H. Incidentally exploring natural course of a rare entity: representative case for rosette-forming glioneuronal tumors. Neurol Sci 2023; 44:3763-3766. [PMID: 37041397 PMCID: PMC10495497 DOI: 10.1007/s10072-023-06781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/24/2023] [Indexed: 04/13/2023]
Abstract
Rosette-forming glioneuronal tumors (RGNT) are extremely rare mostly benign tumors of the central nervous system, which are often studied for its histological aspects despite relatively small numbers of clinical especially radiological knowledge.Despite the increasing number of publications on different localizations and treatment protocols, the morphologic and temporal development process of this rare tumor entity is not clear. We were able to coincidentally observe the entire course of the tumor growth of a RGNT on subsequent MRI examinations in a typical case with mild clinical symptoms and no other neurological illnesses, thus possible clinical complications were prevented.
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Affiliation(s)
- Hira Altunbüker
- Department of Neuroradiology, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Felix Hinz
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Hopp Children's Cancer Center Heidelberg (KiTZ), Heidelberg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, Medical Faculty Mannheim, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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4
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Diehl CD, Giordano FA, Grosu AL, Ille S, Kahl KH, Onken J, Rieken S, Sarria GR, Shiban E, Wagner A, Beck J, Brehmer S, Ganslandt O, Hamed M, Meyer B, Münter M, Raabe A, Rohde V, Schaller K, Schilling D, Schneider M, Sperk E, Thomé C, Vajkoczy P, Vatter H, Combs SE. Opportunities and Alternatives of Modern Radiation Oncology and Surgery for the Management of Resectable Brain Metastases. Cancers (Basel) 2023; 15:3670. [PMID: 37509330 PMCID: PMC10377800 DOI: 10.3390/cancers15143670] [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: 04/18/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Postsurgical radiotherapy (RT) has been early proven to prevent local tumor recurrence, initially performed with whole brain RT (WBRT). Subsequent to disadvantageous cognitive sequalae for the patient and the broad distribution of modern linear accelerators, focal irradiation of the tumor has omitted WBRT in most cases. In many studies, the effectiveness of local RT of the resection cavity, either as single-fraction stereotactic radiosurgery (SRS) or hypo-fractionated stereotactic RT (hFSRT), has been demonstrated to be effective and safe. However, whereas prospective high-level incidence is still lacking on which dose and fractionation scheme is the best choice for the patient, further ablative techniques have come into play. Neoadjuvant SRS (N-SRS) prior to resection combines straightforward target delineation with an accelerated post-surgical phase, allowing an earlier start of systemic treatment or rehabilitation as indicated. In addition, low-energy intraoperative RT (IORT) on the surgical bed has been introduced as another alternative to external beam RT, offering sterilization of the cavity surface with steep dose gradients towards the healthy brain. This consensus paper summarizes current local treatment strategies for resectable brain metastases regarding available data and patient-centered decision-making.
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Affiliation(s)
- Christian D Diehl
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 80336 München, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Anca-L Grosu
- Department of Radiation Oncology, University Medical Center, Medical Faculty, 79106 Freiburg, Germany
| | - Sebastian Ille
- Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany
| | - Klaus-Henning Kahl
- Department of Radiation Oncology, University Medical Center Augsburg, 86156 Augsburg, Germany
| | - Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiotherapy and Radiation Oncology, University Medical Center Göttingen, 37075 Göttingen, Germany
- Comprehensive Cancer Center Niedersachsen (CCC-N), 37075 Göttingen, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, 53127 Bonn, Germany
| | - Ehab Shiban
- Department of Neurosurgery, University Medical Center Augsburg, 86156 Augsburg, Germany
| | - Arthur Wagner
- Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany
| | - Jürgen Beck
- Department of Neurosurgery, University Hospital Freiburg, 79106 Freiburg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Oliver Ganslandt
- Neurosurgical Clinic, Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Faculty of Medicine, Technical University of Munich, 81675 München, Germany
| | - Marc Münter
- Department of Radiation Oncology, Klinikum Stuttgart Katharinenhospital, 70174 Stuttgart, Germany
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Veit Rohde
- Department of Neurosurgery, Universitätsmedizin Göttingen, 37075 Göttingen, Germany
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva Medical Center & Faculty of Medicine, 1211 Geneva, Switzerland
| | - Daniela Schilling
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Elena Sperk
- Mannheim Cancer Center, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Klinikum rechts der Isar, 81675 München, Germany
- Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, 85764 Neuherberg, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, 80336 München, Germany
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Sommerlath VN, Buergy D, Etminan N, Brehmer S, Reuss D, Sarria GR, Guiot MC, Hänggi D, Wenz F, Petrecca K, Giordano FA. Molecular features of glioblastomas in long-term survivors compared to short-term survivors—a matched-pair analysis. Radiat Oncol 2022; 17:15. [PMID: 35073955 PMCID: PMC8785532 DOI: 10.1186/s13014-022-01984-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 01/09/2022] [Indexed: 01/28/2023] Open
Abstract
Background Although glioblastoma (GB) is associated with a devastating prognosis, a small proportion of patients achieve long-term survival rates. We herein present a matched-pair analysis of molecular factors found in long- and short-term survivors (LTS, STS).
Methods We performed a cross-institutional analysis of 262 patient records and matched a group of 91 LTS (≥ 3 years) with two groups of STS (STS-1, n = 91; STS-2, n = 80). Matching was performed according to age, Karnofsky Performance Status, initial therapy and adjuvant therapy. Molecular factors were compared between LTS (total of 91 patients) v. STS-1, and LTS (subgroup of 80 patients) v. STS-2. We included glial fibrillary acidic protein (GFAP), O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, isocitrate dehydrogenase 1 (IDH-1); furthermore, the proliferation index was analyzed (Ki-67/MIB-1). Results IDH-1 and decreased Ki-67 were numerically associated with LTS but the difference was only significant compared to STS-1 (n.s. v. STS-2). LTS was associated with MGMT promoter hypermethylation (p = 0.013 and p = 0.022) and GFAP expression (p < 0.001 and p = 0.001). Positivity for both factors combined compared to negativity for one factor occurred more often in the LTS group (p = 0.002 and p = 0.006); negativity for both factors combined did not occur in the LTS group. Conclusion In this retrospective analysis, GFAP expression and MGMT promoter methylation were associated with LTS. Given the hypothesis-generating nature of our study, these observations should be confirmed in prospective clinical trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-01984-w.
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Enders F, Rothfuss A, Brehmer S, Stallkamp J, Schulte DM, Hänggi D. Optimized Intraoperative Imaging for Stereotactic Planning with a Multiaxial Robotic C-arm System: Technical Note and Case Series. J Neurol Surg A Cent Eur Neurosurg 2021; 83:588-595. [PMID: 34781408 DOI: 10.1055/s-0041-1731754] [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: 10/19/2022]
Abstract
BACKGROUND The preoperative preparation of the planning dataset for frame-based stereotactic brain biopsy is often associated with logistical effort and burden on the patient. Intraoperative imaging modalities need to be investigated to overcome these limitations. OBJECTIVE The objective of the study was to develop and apply a new method for the intraoperative acquisition of the planning dataset with the multiaxial robotic C-arm system Artis zeego. METHODS An indication-customized dose-reduced protocol for Artis zeego was developed and implemented into the workflow. A sample of 14 patients who had undergone intraoperative imaging with Artis zeego was analyzed. A sample of 10 patients with conventional preoperative imaging by cranial computed tomography (CT) was used as a control group. Outcomes were compared with regard to target deviation, diagnostic value of the biopsies, complications, and procedure time. RESULTS In all patients, a suitable intraoperative planning dataset could be acquired with Artis zeego. Total procedure time was shorter for the Artis zeego group (p = 0.01), whereas time in the operating room area was longer in the Artis zeego group (p = 0.04). Biopsy results were diagnostic in 12 patients (86%) in the Artis zeego group and in 8 patients (80%) in the control group. There were no significant differences in target size, trajectory length, or target deviation. CONCLUSION Intraoperative imaging for frame-based stereotactic brain biopsy with Artis zeego is an easy and feasible method. Accuracy is comparable to conventional CT, whereas radiation exposure could be additionally reduced. It allows a significant reduction of the total procedure length and improves the comfort for the patient and staff.
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Affiliation(s)
- Frederik Enders
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Rothfuss
- Fraunhofer IPA Mannheim - Fraunhofer-Projektgruppe für Automatisierung in der Medizin und Biotechnologie PAMB, Mannheim, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Jan Stallkamp
- Fraunhofer IPA Mannheim - Fraunhofer-Projektgruppe für Automatisierung in der Medizin und Biotechnologie PAMB, Mannheim, Germany
| | | | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany.,Department of Neurosurgery, University Hospital Dusseldorf, Dusseldorf, Nordrhein-Westfalen, Germany
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Brehmer S, Grimm MA, Förster A, Seiz-Rosenhagen M, Welzel G, Stieler F, Wenz F, Groden C, Mai S, Hänggi D, Giordano FA. Study Protocol: Early Stereotactic Gamma Knife Radiosurgery to Residual Tumor After Surgery of Newly Diagnosed Glioblastoma (Gamma-GBM). Neurosurgery 2020; 84:1133-1137. [PMID: 29688510 DOI: 10.1093/neuros/nyy156] [Citation(s) in RCA: 4] [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: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glioblastoma (GBM) is the most common malignant brain tumor in adult patients. Tumor recurrence commonly occurs around the resection cavity, especially after subtotal resection (STR). Consequently, the extent of resection correlates with overall survival (OS), suggesting that depletion of postoperative tumor remnants will improve outcome. OBJECTIVE To assess safety and efficacy of adding stereotactic radiosurgery (SRS) to the standard treatment of GBM in patients with postoperative residual tumor. METHODS Gamma-GBM is a single center, open-label, prospective, single arm, phase II study that includes patients with newly diagnosed GBM (intraoperative via frozen sections) who underwent STR (residual tumor will be identified by native and contrast enhanced T1-weighted magnetic resonance imaging scans). All patients will receive SRS with 15 Gy (prescribed to the 50% isodose enclosing all areas of residual tumor) early (within 24-72 h) after surgery. Thereafter, all patients undergo standard-of-care therapy for GBM (radiochemotherapy with 60 Gy external beam radiotherapy [EBRT] plus concomitant temozolomide and 6 cycles of adjuvant temozolomide chemotherapy). The primary outcome is median progression-free survival, secondary outcomes are median OS, occurrence of radiation induced acute (<3 wk), early delayed (<3 mo), and late (>3 mo post-SRS) neurotoxicity and incidence of symptomatic radionecrosis. EXPECTED OUTCOMES We expect to detect efficacy and safety signals by the immediate application of SRS to standard-of-care therapy in newly diagnosed GBM. DISCUSSION Early postoperative SRS to areas of residual tumor could bridge the therapeutic gap between surgery and adjuvant therapies.
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Affiliation(s)
- Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Mario Alexander Grimm
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Uni-versity Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Grit Welzel
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Florian Stieler
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, Uni-versity Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Sabine Mai
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
| | - Frank Anton Giordano
- Depa-rtment of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim University of Heidelberg, Mannheim, Germany
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Cifarelli CP, Brehmer S, Vargo JA, Hack JD, Kahl KH, Sarria-Vargas G, Giordano FA. Intraoperative radiotherapy (IORT) for surgically resected brain metastases: outcome analysis of an international cooperative study. J Neurooncol 2019; 145:391-397. [PMID: 31654248 DOI: 10.1007/s11060-019-03309-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/05/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE The ideal delivery of radiation to the surgical cavity of brain metastases (BMs) remains the subject of debate. Risks of local failure (LF) and radiation necrosis (RN) have prompted a reappraisal of the timing and/or modality of this critical component of BM management. IORT delivered at the time of resection for BMs requiring surgery offers the potential for improved local control (LC) afforded by the elimination of delay in time to initiation of radiation following surgery, decreased uncertainty in target delineation, and the possibility of dose escalation beyond that seen in stereotactic radiosurgery (SRS). This study provides a retrospective analysis with identification of potential predictors of outcomes. METHODS Retrospective data was collected on patients treated with IORT immediately following surgical resection of BMs at three institutions according to the approval of individual IRBs. All patients were treated with 50kV portable linear accelerator using spherical applicators ranging from 1.5 to 4.0 cm. Statistical analyses were performed using IBM SPSS with endpoints of LC, DBC, incidence of RN, and overall survival (OS) and p < 0.05 considered significant. RESULTS 54 patients were treated with IORT with a median age of 64 years. The most common primary diagnosis was non-small cell lung cancer (40%) with the most common location in the frontal lobe (38%). Median follow-up was 7.2 months and 1-year LC, DBC, and OS were 88%, 58%, and 73%, respectively. LMD was identified in 2 patients (3%) and RN present in 4 patients (7%). The only predictor of LC was extent of resection with 1-year LC of 94% for GTR versus 62% for STR (p = 0.049). CONCLUSIONS IORT is a safe and effective means of delivering adjuvant radiation to the BM resection cavities with high rates of LC and low incidence of RN. Further studies are warranted directly comparing LC outcomes to SRS.
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Affiliation(s)
- Christopher P Cifarelli
- Department of Neurosurgery, West Virginia University, 1 Medical Center Drive, Suite 4300, Morgantown, WV, 26505, USA. .,Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA.
| | - Stefanie Brehmer
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Joshua D Hack
- Department of Radiation Oncology, West Virginia University, Morgantown, WV, USA
| | - Klaus Henning Kahl
- Department of Radiation Oncology, University Medical Center Augsburg, Augsburg, Germany
| | - Gustavo Sarria-Vargas
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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9
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Sarria GR, Sperk E, Han X, Sarria GJ, Wenz F, Brehmer S, Fu B, Min S, Zhang H, Qin S, Qiu X, Hänggi D, Abo-Madyan Y, Martinez D, Cabrera C, Giordano FA. Intraoperative radiotherapy for glioblastoma: an international pooled analysis. Radiother Oncol 2019; 142:162-167. [PMID: 31629553 DOI: 10.1016/j.radonc.2019.09.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 07/15/2019] [Revised: 08/27/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To report the results of the first international pooled analysis of patients with glioblastoma treated with intraoperative radiotherapy (IORT) in addition to standard of care therapy. METHODS Data from 51 patients treated at five centers in Germany, China and Peru were analyzed. All patients underwent tumor resection followed by a single application of IORT (10-40 Gy, prescribed to the applicator surface) with low-energy X-rays. Thereafter, standard adjuvant radiochemotherapy and maintenance chemotherapy were applied. Factors of interest were overall survival (OS), progression-free survival (PFS), local PFS (L-PFS; defined as appearance of new lesions ≤1 cm to the cavity border) and distant PFS (D-PFS; lesions >1 cm). The same endpoints were estimated at 1-, 2- and 3-years using the Kaplan-Meier method. Additionally, rates and severity (as per Common Terminology Criteria for Adverse Events Version 5.0) of radionecrosis (RN) were analyzed. RESULTS The median age was 55 years (range: 16-75) and the median Karnofsky Performance Status was 80 (20-100). At a median follow-up of 18.0 months (2-42.4), the median OS, PFS, L-PFS and D-PFS were 18.0 months (95% CI: 14.7-21.3), 11.4 months (95%CI: 7.58-15.22), 16 months (95%CI: 10.21-21.8) and 30.0 months (95%CI: 18.59 - 41.41), respectively. The estimated 1-, 2- and 3-year OS, PFS, L-PFS and D-PFS were 79.5%, 38.7% and 25.6%; 46.2%, 29.4%, and 5.9%; 60.9, 37.9%, and 12.6%; and 76.7%, 65.0%, and 39.0% respectively. First progression occurred locally in only 35.3% of cases. Grade 1 RN was detected in 7.8% and grade 3 in 17.6% of the patients. No grade 4 toxicity was reported and no treatment-related deaths occurred. CONCLUSION Compared to historical data, this pooled analysis suggests improved efficacy and safety of IORT with low-energy X-rays for newly diagnosed glioblastoma. Prospective data is warranted to confirm these findings.
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Affiliation(s)
- Gustavo R Sarria
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Xiaodi Han
- Department of Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurosurgery, Beijing Tiantan Puhua Hospital, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Gustavo J Sarria
- Department of Radiotherapy, Oncosalud - AUNA, Lima, Peru; Department of Radiotherapy, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; University Medical Center Freiburg, Freiburg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bing Fu
- Department of Neurosurgery, Beijing Tiantan Puhua Hospital, China
| | - Siming Min
- Department of Neurosurgery, Beijing Tiantan Puhua Hospital, China
| | - Hongjun Zhang
- Department of Neurosurgery, Beijing Tiantan Puhua Hospital, China
| | - Shusen Qin
- Department of Neurosurgery, Beijing Tiantan Puhua Hospital, China
| | - Xiaoguang Qiu
- Department of Radiotherapy, Beijing Tiantan Puhua Hospital, Capital Medical University, Beijing, China
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Martinez
- Department of Radiotherapy, Oncosalud - AUNA, Lima, Peru
| | - Carla Cabrera
- Department of Radiotherapy, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Cifarelli CP, Vargo JA, Hack J, Renz PB, Poplawski L, Jacobson GM, Kahl KH, Brehmer S, Sarria G, Giordano FA. Intraoperative radiotherapy (IORT) for surgically resected brain metastases: Local control and dosimetric analysis. J Glob Oncol 2019. [DOI: 10.1200/jgo.2019.5.suppl.114] [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: 11/20/2022] Open
Abstract
114 Background: The optimal use of adjuvant radiation following surgical resection of large brain metastases (BM) remains undetermined. Time to initiation following surgery and target delineation both impact local control (LC). Intraoperative radiotherapy (IORT) allows for elimination of lag time between surgery and radiation, direct cavity targeting, and safe dose escalation beyond traditional stereotactic radiosurgery (SRS). The current study provides an analysis of local disease control and dosimetric parameters related to intracranial IORT. Methods: Retrospective data was collected on patients treated with IORT immediately following surgical resection of BMs at three institutions according to the approval of individual IRBs. All patients were treated with the Zeiss Intrabeam device (Carl Zeiss Meditech, Germany) using spherical applicators ranging from 1.5 to 4.0cm with 50kV output. Statistical analyses were performed using SPSS (IBM) with endpoints of LC and incidence of RN, with p < 0.05 considered significant. Dosimetric comparisons between IORT and SRS were made based on V10, V12, and dose homogeneity based on percent of GTV receiving greater than 20Gy or 30Gy. Results: 54 patients were treated with IORT with a median age of 64 years. The most common primary diagnosis was non-small cell lung cancer (40%) with the most common location in the frontal lobe (38%). Median follow-up was 7.2 months and 1-year LC rate was 88% with radiation necrosis (RN) present in 4 patients (7%). The dosimetric comparison of a single IORT case revealed non-target V10 and V12 volumes as 24.75cm3 and 14.76cm3, respectively, for the SRS treatment plan of 16Gy to the margin. The V10 and V12 for the IORT treatment plan were 20.83cm3 and 9.93cm3 with a surface dose of 30Gy. The volumes exceeding 20Gy and 30Gy in the SRS plan were 14.73cm3 and 0.328cm3, respectively, while the corresponding volumes in the IORT plan were 9.8cm3 and 0cm3. Conclusions: IORT is a safe and effective means of delivering adjuvant radiation to the BM resection cavities with a high rate of LC, low incidence of RN, increased homogeneity of target dose and ability to escalate dose beyond traditional SRS plans.
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Affiliation(s)
| | | | | | - Paul B. Renz
- West Virginia University Cancer Insitute, Morgantown, WV
| | | | | | | | - Stefanie Brehmer
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | - Frank Anton Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
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Weller J, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Hau P, Krex D, Grauer O, Goldbrunner R, Bähr O, Uhl M, Seidel C, Tabatabai G, Brehmer S, Bullinger L, Galldiks N, Schaub C, Kebir S, Stummer W, Simon M, Fimmers R, Coch C, Glas M, Herrlinger U, Schäfer N. Health-related quality of life and neurocognitive functioning with lomustine-temozolomide versus temozolomide in patients with newly diagnosed, MGMT-methylated glioblastoma (CeTeG/NOA-09): a randomised, multicentre, open-label, phase 3 trial. Lancet Oncol 2019; 20:1444-1453. [PMID: 31488360 DOI: 10.1016/s1470-2045(19)30502-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The CeTeG/NOA-09 trial showed significantly longer overall survival with combined lomustine-temozolomide therapy compared with standard temozolomide for patients with glioblastoma with methylated MGMT promoter. The trial also aimed to investigate the effect of lomustine-temozolomide therapy on health-related quality of life (HRQOL) and neurocognitive function, which we report here. METHODS In this randomised, multicentre, open-label, phase 3 trial, newly diagnosed, chemoradiotherapy-naive patients with MGMT-methylated glioblastoma, aged 18-70 years, with a Karnofsky performance score of 70% or higher, were recruited and enrolled at 17 university hospitals in Germany. Patients received standard radiotherapy (60 Gy) and were randomly assigned (1:1, stratified by centre by allocating complete blocks of six to a centre, without masking) to either six 6-week courses of oral combined lomustine (100 mg/m2 on day 1) plus temozolomide (100-200 mg/m2 on days 2-6) or standard oral temozolomide (75 mg/m2 daily during radiotherapy plus six 4-week courses of temozolomide [150-200 mg/m2] on days 1-5, every 4 weeks). The primary endpoint was overall survival. HRQOL, assessed using the European Organisation for Research and Treatment of Cancer (EORTC) quality of life questionnaire core-30 and the EORTC brain cancer module (BN20); and neurocognitive function, assessed using the Mini Mental State Examination (MMSE), plus a neurocognitive test battery (NOA-07), including Trail Making Test A and B (TMT-A and B), working memory tests, and tests for lexical (Controlled Oral Word Association [COWA]) and semantic verbal fluency, were secondary endpoints analysed in the modified intention-to-treat population (mITT; all randomly assigned patients who received at least one dose of study chemotherapy). We used linear mixed-model analyses to investigate differences between treatment groups regarding HRQOL (clinically relevant ≥10 points) and MMSE scores (clinically relevant ≥3 points). The trial is registered with ClinicalTrials.gov, NCT01149109. FINDINGS Between June 17, 2011 and April 8, 2014, 141 patients were randomly assigned and 129 patients began treatment and were included in the mITT population (63 in the temozolomide and 66 in the lomustine-temozolomide group). Median follow-up for HRQOL (the item global health) was 19·4 months (IQR 7·8-38·6), for MMSE was 15·3 months (4·1-29·6), and for COWA was 11·0 months (0-27·5). We found no significant impairment regarding any item of HRQOL in the lomustine-temozolomide group (difference between the groups for global health 0·30 [95% CI -0·23 to 0·83]; p=0·26). Differences in MMSE were in favour of the temozolomide group (difference -0·11 [95% CI -0·19 to -0·03]; p=0·0058) but were not clinically relevant (1·76/30 points over 4 years). We found no significant difference between the groups in any subtest of the neurocognitive test battery (difference for COWA 0·04 [95% CI -0·01 to 0·09]; p=0·14). INTERPRETATION The absence of systematic and clinically relevant changes in HRQOL and neurocognitive function combined with the survival benefit of lomustine-temozolomide versus temozolomide alone suggests that a long-term net clinical benefit exists for patients with newly diagnosed glioblastoma with methylation of the MGMT promoter and supports the use of lomustine-temozolomide as a treatment option for these patients. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Joachim Peter Steinbach
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt am Main, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Oliver Bähr
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt am Main, Germany
| | - Martin Uhl
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neurooncology, University of Tübingen, Tübingen, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University of Mannheim, Mannheim, Germany
| | - Lars Bullinger
- Department of Internal Medicine, University of Ulm, Ulm, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine, Forschungszentrum Juelich, Juelich, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Study Center Bonn, University Hospital Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center, German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology, University Hospital Bonn, Bonn, Germany
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Sarria G, Sperk E, Xiaodi H, Sarria G, Wenz F, Brehmer S, Fu B, Min S, Zhang H, Qin S, Qiu X, Abo-Madyan Y, Hänggi D, Martinez D, Cabrera C, Giordano F. Intraoperative Radiotherapy for Glioblastoma: An International Pooled Analysis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.2308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Cifarelli C, Vargo JA, Hack J, Kahl KH, Brehmer S, Sarria G, Giordano F. RADI-20. RETROSPECTIVE OUTCOME ANALYSIS OF INTRAOPERATIVE RADIOTHERAPY (IORT) FOR SURGICALLY RESECTED BRAIN METASTASES: AN INTERNATIONAL COOPERATIVE STUDY. Neurooncol Adv 2019. [PMCID: PMC7213303 DOI: 10.1093/noajnl/vdz014.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND & OBJECTIVE: The ideal delivery of adjuvant radiation to the surgical cavity of brain metastases (BMs) remains the subject of debate. Risks of leptomeningeal dissemination (LMD), local failure (LF) and radiation necrosis (RN) have prompted a reappraisal of the timing and/or modality of this critical component of BM management. IORT delivered at the time of resection for BMs requiring surgery offers the potential for improved LC and decreased LMD afforded by the elimination of delay in time to initiation of radiation following surgery and the possibility of dose escalation beyond that seen in stereotactic radiosurgery (SRS). This study provides a retrospective analysis with identification of potential predictors of outcomes. METHODS: Retrospective data was collected on patients treated with IORT immediately following surgical resection of BMs at three institutions according to the approval of individual IRBs. All patients were treated with the Zeiss Intrabeam device (Carl Zeiss Meditech, Germany) using spherical applicators ranging from 1.5 to 4.0cm with 50kV output. Statistical analyses were performed using SPSS (IBM) with endpoints of LF, DBF, incidence of RN, and overall survival (OS) and p< 0.05 considered significant. RESULTS: 54 patients were treated with IORT with a median age of 64 years. The most common primary diagnosis was non-small cell lung cancer (40%) with the most common location in the frontal lobe (38%). Median follow-up was 7.2 months and 1-year LC, DBF, and OS were 88%, 58%, and 73%, respectively. LMD was identified in 2 patients (3%) and RN present in 4 patients (7%). The only predictor of LC was extent of resection with 1-yr LC of 94% for GTR vs 62% for STR (p=0.049). CONCLUSIONS: IORT is a safe and effective means of delivering adjuvant radiation to the BM resection cavities with high rates of LC and low incidence of RN.
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Affiliation(s)
| | | | - Joshua Hack
- West Virginia University, Morgantown, WV, USA
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14
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Herrlinger U, Tzaridis T, Mack F, Steinbach JP, Schlegel U, Sabel M, Hau P, Kortmann RD, Krex D, Grauer O, Goldbrunner R, Schnell O, Bähr O, Uhl M, Seidel C, Tabatabai G, Kowalski T, Ringel F, Schmidt-Graf F, Suchorska B, Brehmer S, Weyerbrock A, Renovanz M, Bullinger L, Galldiks N, Vajkoczy P, Misch M, Vatter H, Stuplich M, Schäfer N, Kebir S, Weller J, Schaub C, Stummer W, Tonn JC, Simon M, Keil VC, Nelles M, Urbach H, Coenen M, Wick W, Weller M, Fimmers R, Schmid M, Hattingen E, Pietsch T, Coch C, Glas M. Lomustine-temozolomide combination therapy versus standard temozolomide therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter (CeTeG/NOA-09): a randomised, open-label, phase 3 trial. Lancet 2019; 393:678-688. [PMID: 30782343 DOI: 10.1016/s0140-6736(18)31791-4] [Citation(s) in RCA: 309] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/12/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is an urgent need for more effective therapies for glioblastoma. Data from a previous unrandomised phase 2 trial suggested that lomustine-temozolomide plus radiotherapy might be superior to temozolomide chemoradiotherapy in newly diagnosed glioblastoma with methylation of the MGMT promoter. In the CeTeG/NOA-09 trial, we aimed to further investigate the effect of lomustine-temozolomide therapy in the setting of a randomised phase 3 trial. METHODS In this open-label, randomised, phase 3 trial, we enrolled patients from 17 German university hospitals who were aged 18-70 years, with newly diagnosed glioblastoma with methylated MGMT promoter, and a Karnofsky Performance Score of 70% and higher. Patients were randomly assigned (1:1) with a predefined SAS-generated randomisation list to standard temozolomide chemoradiotherapy (75 mg/m2 per day concomitant to radiotherapy [59-60 Gy] followed by six courses of temozolomide 150-200 mg/m2 per day on the first 5 days of the 4-week course) or to up to six courses of lomustine (100 mg/m2 on day 1) plus temozolomide (100-200 mg/m2 per day on days 2-6 of the 6-week course) in addition to radiotherapy (59-60 Gy). Because of the different schedules, patients and physicians were not masked to treatment groups. The primary endpoint was overall survival in the modified intention-to-treat population, comprising all randomly assigned patients who started their allocated chemotherapy. The prespecified test for overall survival differences was a log-rank test stratified for centre and recursive partitioning analysis class. The trial is registered with ClinicalTrials.gov, number NCT01149109. FINDINGS Between June 17, 2011, and April 8, 2014, 141 patients were randomly assigned to the treatment groups; 129 patients (63 in the temozolomide and 66 in the lomustine-temozolomide group) constituted the modified intention-to-treat population. Median overall survival was improved from 31·4 months (95% CI 27·7-47·1) with temozolomide to 48·1 months (32·6 months-not assessable) with lomustine-temozolomide (hazard ratio [HR] 0·60, 95% CI 0·35-1·03; p=0·0492 for log-rank analysis). A significant overall survival difference between groups was also found in a secondary analysis of the intention-to-treat population (n=141, HR 0·60, 95% CI 0·35-1·03; p=0·0432 for log-rank analysis). Adverse events of grade 3 or higher were observed in 32 (51%) of 63 patients in the temozolomide group and 39 (59%) of 66 patients in the lomustine-temozolomide group. There were no treatment-related deaths. INTERPRETATION Our results suggest that lomustine-temozolomide chemotherapy might improve survival compared with temozolomide standard therapy in patients with newly diagnosed glioblastoma with methylated MGMT promoter. The findings should be interpreted with caution, owing to the small size of the trial. FUNDING German Federal Ministry of Education and Research.
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Affiliation(s)
- Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany.
| | - Theophilos Tzaridis
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Frederic Mack
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | | | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Michael Sabel
- Department of Neurosurgery, University of Düsseldorf, Düsseldorf, Germany
| | - Peter Hau
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | | | - Dietmar Krex
- Department of Neurosurgery, University of Dresden, Dresden, Germany
| | - Oliver Grauer
- Department of Neurology, University of Münster, Münster, Germany
| | | | - Oliver Schnell
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany; Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Oliver Bähr
- Dr Senckenberg Institute of Neurooncology, University of Frankfurt, Frankfurt, Germany
| | - Martin Uhl
- Department of Neurology and Wilhelm Sander Neurooncology Unit, University Hospital Regensburg, Regensburg, Germany
| | - Clemens Seidel
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
| | - Ghazaleh Tabatabai
- Interdisciplinary Division of Neurooncology, University of Tübingen, Tübingen, Germany
| | - Thomas Kowalski
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Germany
| | - Florian Ringel
- Department of Neurosurgery, Technical University of Munich, Munich, Germany; Department of Neurosurgery, University of Mainz, Mainz, Germany
| | | | - Bogdana Suchorska
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University of Mannheim, Mannheim, Germany
| | - Astrid Weyerbrock
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Miriam Renovanz
- Department of Neurosurgery, University of Mainz, Mainz, Germany
| | - Lars Bullinger
- Department of Internal Medicine, University of Ulm, Ulm, Germany
| | - Norbert Galldiks
- Department of Neurology, University of Cologne, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University of Berlin, Berlin, Germany
| | - Martin Misch
- Department of Neurosurgery, Charité University of Berlin, Berlin, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Moritz Stuplich
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Niklas Schäfer
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Johannes Weller
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Christina Schaub
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
| | - Jörg-Christian Tonn
- Department of Neurosurgery, Ludwig Maximillian University of Munich and German Cancer Consortium, Partner Site Munich, Munich, Germany
| | - Matthias Simon
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Vera C Keil
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Michael Nelles
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Horst Urbach
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany; Department of Neuroradiology, University of Freiburg, Freiburg, Germany
| | - Martin Coenen
- Study Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Wolfgang Wick
- Department of Neurology, University of Heidelberg and German Cancer Research Center, Heidelberg, Germany
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Rolf Fimmers
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Torsten Pietsch
- Institute of Neuropathology and DGNN Brain Tumor Reference Centre, University Hospital Bonn, Bonn, Germany
| | - Christoph Coch
- Study Centre Bonn, University Hospital Bonn, Bonn, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany; Division of Clinical Neurooncology, Department of Neurology and West German Cancer Center, German Cancer Consortium, Partner Site Essen, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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15
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Förster A, Böhme J, Maros ME, Brehmer S, Seiz-Rosenhagen M, Hänggi D, Wenz F, Groden C, Pope WB, Giordano FA. Longitudinal MRI findings in patients with newly diagnosed glioblastoma after intraoperative radiotherapy. J Neuroradiol 2019; 47:166-173. [PMID: 30659892 DOI: 10.1016/j.neurad.2019.01.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/31/2018] [Accepted: 01/14/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Post-radiation treatment effects (pseudoprogression/radionecrosis) may bias MRI-based tumor response evaluation. To understand these changes specifically after high doses of radiotherapy, we analyzed MRIs of patients enrolled in the INTRAGO study (NCT02104882), a phase I/II dose-escalation trial of intraoperative radiotherapy (20-40 Gy) in glioblastoma. METHODS INTRAGO patients were evaluated and compared to control patients who received standard therapy with focus on contrast enhancement patterns/volume, T2 lesion volume, and mean rCBV. RESULTS Overall, 11/15 (73.3%) INTRAGO patients (median age 60 years) were included. Distant failure was observed in 7/11 (63.6%) patients, local tumor recurrence in one patient (9.1%). On the first follow-up MRI all but one patient demonstrated enhancement of varying patterns around the resection cavity which were: in 2/11 (18.2%) patients thin and linear, in 7/11 (63.6%) combined linear and nodular, and in 1/11 (9.1%) voluminous, indistinct, and mesh-like. In the course of treatment, most patients developed the latter two patterns (8/11 [72.7%]). INTRAGO patients demonstrated more often combined linear and nodular and/or voluminous, indistinct, mesh-like components (8/11 [72.7%]) in comparison to control patients (3/12 [25%], P = 0.02). INTRAGO patients demonstrated significantly increasing enhancing lesion (P = 0.001) and T2 lesion volumes (P < 0.001) in the longitudinal non-parametric analysis in comparison to the control group. rCBV showed no significant differences between both groups. CONCLUSIONS High doses of radiotherapy to the tumor cavity result in more pronounced enhancement patterns/volumes and T2 lesion volumes. These results will be useful for the response evaluation of patients exposed to high doses of radiotherapy in future studies.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
| | - Johannes Böhme
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Máté E Maros
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Whitney B Pope
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
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16
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Förster A, Brehmer S, Seiz-Rosenhagen M, Mildenberger I, Giordano FA, Wenz H, Reuss D, Hänggi D, Groden C. Heterogeneity of glioblastoma with gliomatosis cerebri growth pattern on diffusion and perfusion MRI. J Neurooncol 2018; 142:103-109. [PMID: 30565029 DOI: 10.1007/s11060-018-03068-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/30/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE Gliomatosis cerebri (GC) is a rare growth pattern of glioblastoma whose diffuse nature is reflected by unspecific, relatively uniform findings on conventional MRI. In the present study we sought to evaluate the additional value of diffusion (DWI) and perfusion weighted (PWI) MRI for a more detailed characterization. METHODS We analyzed the MRI findings in patients with histologically proven glioblastoma with GC growth pattern with a specific emphasis on T2 lesion pattern, volume, relative apparent diffusion coefficient (rACD), and relative cerebral blood volume (rCBV) and compared these to age-/gender-matched patients with localized glioblastoma. RESULTS Overall, 16 patients (median age 59.5 years, 4 male) were included in the study. Of these, 8 patients had a glioblastoma with GC growth pattern, and 8 a classical localized growth pattern. While the median rADC (1.27 [IQR 1.12-1.41]) within the T2 lesion was significant lower in glioblastoma with GC growth pattern compared to localized glioblastoma (1.74 [IQR 1.45-1.96]; p = 0.003), the median T2 lesion volume and rCBV within the T2 lesion did not differ significantly. Furthermore, six patients with glioblastoma with GC growth pattern showed focal areas with significantly reduced rADC (p = 0.043), and/or increased rCBV (p = 0.028). CONCLUSIONS Lower rADC in glioblastoma with GC growth pattern might reflect the diffuse tumor cell infiltration whereas focal areas with decreased rADC and/or increased rCBV probably indicate high tumor cell density and/or abnormal tumor vessels which may be useful for biopsy guidance.
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Affiliation(s)
- Alex Förster
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Iris Mildenberger
- Department of Neurology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - David Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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17
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Sommerlath VN, Brehmer S, Guiot M, Hetjens S, Seiz-Rosenhagen M, Hänggi D, Wenz F, Petrecca K, Giordano FA. P01.123 Matched-pair analysis of long- versus short-term survivors of glioblastoma: molecular markers make the difference. Neuro Oncol 2018. [DOI: 10.1093/neuonc/noy139.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - S Brehmer
- Department of Neurosurgery, Mannheim, Germany
| | - M Guiot
- Department of Pathology, Montreal, QC, Canada
| | - S Hetjens
- Department of Medical Statistics, Mannheim, Germany
| | | | - D Hänggi
- Department of Neurosurgery, Mannheim, Germany
| | - F Wenz
- Department of Radiation Oncology, Mannheim, Germany
| | - K Petrecca
- Department of Neurosurgery, Montreal, QC, Canada
| | - F A Giordano
- Department of Radiation Oncology, Mannheim, Germany
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18
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Capper D, Jones DTW, Sill M, Hovestadt V, Schrimpf D, Sturm D, Koelsche C, Sahm F, Chavez L, Reuss DE, Kratz A, Wefers AK, Huang K, Pajtler KW, Schweizer L, Stichel D, Olar A, Engel NW, Lindenberg K, Harter PN, Braczynski AK, Plate KH, Dohmen H, Garvalov BK, Coras R, Hölsken A, Hewer E, Bewerunge-Hudler M, Schick M, Fischer R, Beschorner R, Schittenhelm J, Staszewski O, Wani K, Varlet P, Pages M, Temming P, Lohmann D, Selt F, Witt H, Milde T, Witt O, Aronica E, Giangaspero F, Rushing E, Scheurlen W, Geisenberger C, Rodriguez FJ, Becker A, Preusser M, Haberler C, Bjerkvig R, Cryan J, Farrell M, Deckert M, Hench J, Frank S, Serrano J, Kannan K, Tsirigos A, Brück W, Hofer S, Brehmer S, Seiz-Rosenhagen M, Hänggi D, Hans V, Rozsnoki S, Hansford JR, Kohlhof P, Kristensen BW, Lechner M, Lopes B, Mawrin C, Ketter R, Kulozik A, Khatib Z, Heppner F, Koch A, Jouvet A, Keohane C, Mühleisen H, Mueller W, Pohl U, Prinz M, Benner A, Zapatka M, Gottardo NG, Driever PH, Kramm CM, Müller HL, Rutkowski S, von Hoff K, Frühwald MC, Gnekow A, Fleischhack G, Tippelt S, Calaminus G, Monoranu CM, Perry A, Jones C, Jacques TS, Radlwimmer B, Gessi M, Pietsch T, Schramm J, Schackert G, Westphal M, Reifenberger G, Wesseling P, Weller M, Collins VP, Blümcke I, Bendszus M, Debus J, Huang A, Jabado N, Northcott PA, Paulus W, Gajjar A, Robinson GW, Taylor MD, Jaunmuktane Z, Ryzhova M, Platten M, Unterberg A, Wick W, Karajannis MA, Mittelbronn M, Acker T, Hartmann C, Aldape K, Schüller U, Buslei R, Lichter P, Kool M, Herold-Mende C, Ellison DW, Hasselblatt M, Snuderl M, Brandner S, Korshunov A, von Deimling A, Pfister SM. DNA methylation-based classification of central nervous system tumours. Nature 2018; 555:469-474. [PMID: 29539639 PMCID: PMC6093218 DOI: 10.1038/nature26000] [Citation(s) in RCA: 1580] [Impact Index Per Article: 263.3] [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: 05/05/2017] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
Accurate pathological diagnosis is crucial for optimal management of patients with cancer. For the approximately 100 known tumour types of the central nervous system, standardization of the diagnostic process has been shown to be particularly challenging-with substantial inter-observer variability in the histopathological diagnosis of many tumour types. Here we present a comprehensive approach for the DNA methylation-based classification of central nervous system tumours across all entities and age groups, and demonstrate its application in a routine diagnostic setting. We show that the availability of this method may have a substantial impact on diagnostic precision compared to standard methods, resulting in a change of diagnosis in up to 12% of prospective cases. For broader accessibility, we have designed a free online classifier tool, the use of which does not require any additional onsite data processing. Our results provide a blueprint for the generation of machine-learning-based tumour classifiers across other cancer entities, with the potential to fundamentally transform tumour pathology.
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Affiliation(s)
- David Capper
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lukas Chavez
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Huang
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristian W Pajtler
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Leonille Schweizer
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Damian Stichel
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Adriana Olar
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina 29425, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA
- Hollings Cancer Center, Charleston, South Carolina 29425, USA
| | - Nils W Engel
- Department of Oncology and Hematology with Sections Bone Marrow Transplant and Pneumology, Hubertus Wald Tumorzentrum/University Cancer Center Hamburg, University Medical Center Hamburg, Hamburg, Germany
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Kerstin Lindenberg
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick N Harter
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Anne K Braczynski
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Karl H Plate
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
| | - Hildegard Dohmen
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Boyan K Garvalov
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Roland Coras
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Annett Hölsken
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ekkehard Hewer
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Schick
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Roger Fischer
- Genomics and Proteomics Core Facility, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Rudi Beschorner
- Institute of Pathology and Neuropathology, Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Jens Schittenhelm
- Institute of Pathology and Neuropathology, Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Ori Staszewski
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Khalida Wani
- Department of Translational Molecular Pathology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
| | - Pascale Varlet
- Department of Neuropathology, Centre Hospitalier Sainte Anne, Paris, France
| | - Melanie Pages
- Department of Neuropathology, Centre Hospitalier Sainte Anne, Paris, France
| | - Petra Temming
- Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | - Dietmar Lohmann
- Eye Cancer Research Group, Faculty of Medicine, University of Duisburg-Essen, Essen, Germany
| | - Florian Selt
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Pediatric Oncology (G340), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Hendrik Witt
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Till Milde
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Pediatric Oncology (G340), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Olaf Witt
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
- CCU Pediatric Oncology (G340), German Cancer Research Center (DKFZ) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Eleonora Aronica
- Department of (Neuro)Pathology, Academic Medisch Centrum (AMC), University of Amsterdam, Amsterdam, The Netherlands
- Swammerdam Institute for Life Sciences, Center for Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Amsterdam, The Netherlands
| | - Felice Giangaspero
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Elisabeth Rushing
- Department of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Christoph Geisenberger
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Hubrecht Institute-KNAW (Royal Netherlands Academy of Arts and Sciences), Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Fausto J Rodriguez
- Division of Neuropathology of the Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Albert Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Matthias Preusser
- Department of Medicine I, Comprehensive Cancer Center Vienna, CNS Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | | | - Rolf Bjerkvig
- Department of Biomedicine, University of Bergen, Bergen, Norway
- NORLUX Neuro-Oncology Laboratory, Department of Oncology, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Michael Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
| | - Martina Deckert
- Department of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Hench
- Department of Neuropathology, Institute of Pathology, Basel University Hospital, Basel, Switzerland
| | - Stephan Frank
- Department of Neuropathology, Institute of Pathology, Basel University Hospital, Basel, Switzerland
| | | | | | | | - Wolfgang Brück
- Institute of Neuropathology, University Medical Center Göttingen, Göttingen, Germany
| | - Silvia Hofer
- Division of Oncology, Luzerner Kantonsspital, Luzern, Switzerland
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Volkmar Hans
- Institut für Neuropathologie, Evangelisches Krankenhaus Bielefeld gGmbH, Bielefeld, Germany
- Institut für Neuropathologie, Universitätskinikum Essen, Essen, Germany
| | - Stephanie Rozsnoki
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Jordan R Hansford
- Children's Cancer Centre, Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, University of Melbourne, Melbourne, Victoria, Australia
- Department of Pediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Patricia Kohlhof
- Institute for Pathology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Bjarne W Kristensen
- Department of Pathology, Odense University Hospital, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Matt Lechner
- University College London Cancer Institute and University College London Hospitals, London, UK
| | - Beatriz Lopes
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Christian Mawrin
- Institute of Neuropathology, Otto-von-Guericke-University, Magdeburg, Germany
| | - Ralf Ketter
- Department of Neurosurgery, University Hospital Saarland, Homburg, Saar, Germany
| | - Andreas Kulozik
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ziad Khatib
- Nicklaus Children's Hospital Brain Institute, Miami, Florida 33155, USA
| | - Frank Heppner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
- Cluster of Excellence, NeuroCure, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Arend Koch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neuropathology, Berlin, Germany
| | - Anne Jouvet
- Département de Pathologie et Neuropathologie, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
| | - Catherine Keohane
- Department of Neuropathology, Cork University Hospital, Cork, Ireland
| | - Helmut Mühleisen
- Department of Pathology, Ludwigsburg Hospital, Ludwigsburg, Germany
| | - Wolf Mueller
- Department of Neuropathology, Leipzig University, Leipzig, Germany
| | - Ute Pohl
- Department of Cellular Pathology, Queen's Hospital, Romford, UK
| | - Marco Prinz
- Institute of Neuropathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Axel Benner
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Zapatka
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nicholas G Gottardo
- Department of Pediatric Oncology and Haematology, Princess Margaret Hospital for Children, GPO Box D184, Perth, Western Australia 6840, Australia
- Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, Western Australia 6872, Australia
- School of Paediatrics and Child Health, University of Western Australia, GPO Box D184, Perth, Western Australia 6840, Australia
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christof M Kramm
- Division of Pediatric Hematology and Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Hermann L Müller
- Department of Pediatrics and Pediatric Hematology/Oncology, Klinikum Oldenburg AöR, Medical Campus University Oldenburg, 26133 Oldenburg, Germany
| | - Stefan Rutkowski
- Department for Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katja von Hoff
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department for Pediatric Hematology and Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Michael C Frühwald
- Children's Hospital Augsburg, Swabian Children's Cancer Centre, Augsburg, Germany
| | - Astrid Gnekow
- Children's Hospital Augsburg, Swabian Children's Cancer Centre, Augsburg, Germany
| | - Gudrun Fleischhack
- Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | - Stephan Tippelt
- Pediatrics III, Pediatric Oncology and Hematology, University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology/Oncology, University of Bonn Medical Center, Bonn, Germany
| | - Camelia-Maria Monoranu
- Department of Neuropathology, Insitute of Pathology, Comprehensive Cancer Center (CCC) Mainfranken, University of Würzburg, Würzburg, Germany
| | - Arie Perry
- Department of Pathology, University of California San Francisco, San Francisco, California, USA
| | - Chris Jones
- Division of Molecular Pathology, Institute of Cancer Research, London, UK
| | - Thomas S Jacques
- Developmental Biology and Cancer Programme, UCL Great Ormond Street Institute of Child Health and Histopathology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Bernhard Radlwimmer
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marco Gessi
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Torsten Pietsch
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Johannes Schramm
- Medical Faculty, University of Bonn Medical School, Bonn, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Reifenberger
- Department of Neuropathology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- German Cancer Consortium (DKTK), partner site Essen/Düsseldorf, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pieter Wesseling
- Department of Pathology, Princess Máxima Center for Pediatric Oncology and University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Vincent Peter Collins
- Department of Pathology, Division of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Ingmar Blümcke
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Annie Huang
- Department of Pediatrics, Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Nada Jabado
- Division of Hematology/Oncology, McGill University, Montreal, Quebec, Canada
| | - Paul A Northcott
- Department of Developmental Neurobiology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Amar Gajjar
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Giles W Robinson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael D Taylor
- Division of Neurosurgery, Arthur and Sonia Labatt Brain Tumor Research Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Zane Jaunmuktane
- Division of Neuropathology, UCL Hospitals, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
- Department of Molecular Neuroscience, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
- Department of Neurodegeneration, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
| | | | - Michael Platten
- Department of Neurology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Matthias A Karajannis
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz, Frankfurt am Main, German Cancer Research Center (DKFZ) Heidelberg, Germany
- NORLUX Neuro-Oncology Laboratory, Luxembourg Institute of Health (LIH), Luxembourg, Luxembourg
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg, Luxembourg
- Laboratoire national de santé (LNS), Dudelange, Luxembourg
- Luxembourg Centre of Neuropathology (LCNP), Luxembourg, Luxembourg
| | - Till Acker
- Institute of Neuropathology, University of Giessen, Giessen, Germany
| | - Christian Hartmann
- Department of Neuropathology, Hannover Medical School (MHH), Hannover, Germany
| | - Kenneth Aldape
- Department of Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Ulrich Schüller
- Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
- Institute of Neuropathology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
- Research Institute Children's Cancer Center, Hamburg, Germany
- Department of Pediatric Hematology and Oncology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Rolf Buslei
- Neuropathological Institute, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Section Neuropathology, Institute of Pathology, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Germany
| | - Peter Lichter
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcel Kool
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - David W Ellison
- Department of Pathology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Matija Snuderl
- Division of Neuropathology, Department of Pathology, NYU Langone Medical Center, New York, New York, USA
| | - Sebastian Brandner
- Division of Neuropathology, UCL Hospitals, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
- Department of Neurodegeneration, Institute of Neurology, University College London, Queen Square, WC1N 3BG London, UK
| | - Andrey Korshunov
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
- Clinical Cooperation Unit Neuropathology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center at the NCT Heidelberg (KiTZ), Heidelberg, Germany
- Division of Pediatric Neurooncology, German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Oncology, Hematology and Immunology, University Hospital Heidelberg, Heidelberg, Germany
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Giordano FA, Brehmer S, Mürle B, Welzel G, Sperk E, Keller A, Abo-Madyan Y, Scherzinger E, Clausen S, Schneider F, Herskind C, Glas M, Seiz-Rosenhagen M, Groden C, Hänggi D, Schmiedek P, Emami B, Souhami L, Petrecca K, Wenz F. Intraoperative Radiotherapy in Newly Diagnosed Glioblastoma (INTRAGO): An Open-Label, Dose-Escalation Phase I/II Trial. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy018] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Bettina Mürle
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Anke Keller
- Clinical Trials Coordination Center of the Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Elisabeth Scherzinger
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Sven Clausen
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Frank Schneider
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Carsten Herskind
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Martin Glas
- Division of Clinical Neuro-Oncology, Department of Neurology, University Hospital Essen, Essen, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Christoph Groden
- Department of Neuroradiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Peter Schmiedek
- Department of Neurosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Bahman Emami
- Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois
| | - Luis Souhami
- Division of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - Kevin Petrecca
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, Montreal, Canada
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany
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Förster A, Winkler M, Brehmer S, Seiz-Rosenhagen M, Hänggi D, Wenz F, Groden C, Giordano FA. NIMG-56. CHARACTERISTIC RESPONSE PATTERNS IN PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA AFTER TREATMENT WITH HIGH SINGLE DOSES OF RADIOTHERAPY. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.630] [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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Herrlinger U, Tzaridis T, Mack F, Steinbach J, Schlegel U, Sabel M, Hau P, Kortman RD, Krex D, Grauer O, Goldbrunner R, Schnell O, Baehr O, Uhl M, Tabatabai G, Ringel F, Schmidt-Graf F, Brehmer S, Weyerbrock A, Bullinger L, Vajkoczy P, Vatter H, Schäfer N, Kebir S, Weller J, Stummer W, Simon M, Keil V, Nelles M, Fimmers R, Pietsch T, Hattingen E, Coch C, Glas M. ACTR-58. PHASE III TRIAL OF CCNU/TEMOZOLOMIDE (TMZ) COMBINATION THERAPY VS. STANDARD TMZ THERAPY FOR NEWLY DIAGNOSED MGMT-METHYLATED GLIOBLASTOMA PATIENTS: THE CeTeg/NOA-09 trial. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox168.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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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Schweizer Y, Meszaros Z, Jones DT, Koelsche C, Boudalil M, Fiesel P, Schrimpf D, Piro RM, Brehmer S, von Deimling A, Kerl U, Seiz-Rosenhagen M, Capper D. Molecular Transition of an Adult Low-Grade Brain Tumor to an Atypical Teratoid/Rhabdoid Tumor Over a Time-Course of 14 Years. J Neuropathol Exp Neurol 2017; 76:655-664. [DOI: 10.1093/jnen/nlx044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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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Giordano F, Brehmer S, Mürle B, Welzel G, Sperk E, Keller A, Abo-Madyan Y, Clausen S, Schneider F, Herskind C, Seiz-Rosenhagen M, Groden C, Schmiedek P, Glas M, Hänggi D, Petrecca K. PO-0632: Phase I/II Trial on Intraoperative Radiotherapy (IORT) in Glioblastoma Multiforme (INTRAGO I/II). Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31069-1] [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: 11/29/2022]
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Sahm F, Schrimpf D, Stichel D, Jones DTW, Hielscher T, Schefzyk S, Okonechnikov K, Koelsche C, Reuss DE, Capper D, Sturm D, Wirsching HG, Berghoff AS, Baumgarten P, Kratz A, Huang K, Wefers AK, Hovestadt V, Sill M, Ellis HP, Kurian KM, Okuducu AF, Jungk C, Drueschler K, Schick M, Bewerunge-Hudler M, Mawrin C, Seiz-Rosenhagen M, Ketter R, Simon M, Westphal M, Lamszus K, Becker A, Koch A, Schittenhelm J, Rushing EJ, Collins VP, Brehmer S, Chavez L, Platten M, Hänggi D, Unterberg A, Paulus W, Wick W, Pfister SM, Mittelbronn M, Preusser M, Herold-Mende C, Weller M, von Deimling A. DNA methylation-based classification and grading system for meningioma: a multicentre, retrospective analysis. Lancet Oncol 2017; 18:682-694. [PMID: 28314689 DOI: 10.1016/s1470-2045(17)30155-9] [Citation(s) in RCA: 497] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/13/2017] [Accepted: 01/16/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The WHO classification of brain tumours describes 15 subtypes of meningioma. Nine of these subtypes are allotted to WHO grade I, and three each to grade II and grade III. Grading is based solely on histology, with an absence of molecular markers. Although the existing classification and grading approach is of prognostic value, it harbours shortcomings such as ill-defined parameters for subtypes and grading criteria prone to arbitrary judgment. In this study, we aimed for a comprehensive characterisation of the entire molecular genetic landscape of meningioma to identify biologically and clinically relevant subgroups. METHODS In this multicentre, retrospective analysis, we investigated genome-wide DNA methylation patterns of meningiomas from ten European academic neuro-oncology centres to identify distinct methylation classes of meningiomas. The methylation classes were further characterised by DNA copy number analysis, mutational profiling, and RNA sequencing. Methylation classes were analysed for progression-free survival outcomes by the Kaplan-Meier method. The DNA methylation-based and WHO classification schema were compared using the Brier prediction score, analysed in an independent cohort with WHO grading, progression-free survival, and disease-specific survival data available, collected at the Medical University Vienna (Vienna, Austria), assessing methylation patterns with an alternative methylation chip. FINDINGS We retrospectively collected 497 meningiomas along with 309 samples of other extra-axial skull tumours that might histologically mimic meningioma variants. Unsupervised clustering of DNA methylation data clearly segregated all meningiomas from other skull tumours. We generated genome-wide DNA methylation profiles from all 497 meningioma samples. DNA methylation profiling distinguished six distinct clinically relevant methylation classes associated with typical mutational, cytogenetic, and gene expression patterns. Compared with WHO grading, classification by individual and combined methylation classes more accurately identifies patients at high risk of disease progression in tumours with WHO grade I histology, and patients at lower risk of recurrence among WHO grade II tumours (p=0·0096) from the Brier prediction test). We validated this finding in our independent cohort of 140 patients with meningioma. INTERPRETATION DNA methylation-based meningioma classification captures clinically more homogenous groups and has a higher power for predicting tumour recurrence and prognosis than the WHO classification. The approach presented here is potentially very useful for stratifying meningioma patients to observation-only or adjuvant treatment groups. We consider methylation-based tumour classification highly relevant for the future diagnosis and treatment of meningioma. FUNDING German Cancer Aid, Else Kröner-Fresenius Foundation, and DKFZ/Heidelberg Institute of Personalized Oncology/Precision Oncology Program.
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Affiliation(s)
- Felix Sahm
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Daniel Schrimpf
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Damian Stichel
- Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David T W Jones
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Sebastian Schefzyk
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Konstantin Okonechnikov
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Koelsche
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David E Reuss
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - David Capper
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominik Sturm
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Haematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Georg Wirsching
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Peter Baumgarten
- Neurological Institute (Edinger-Institute), Goethe University, Frankfurt, Germany
| | - Annekathrin Kratz
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Kristin Huang
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Annika K Wefers
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Hovestadt
- Division of Molecular Genetics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Sill
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Hayley P Ellis
- Brain Tumour Research Group, Institute of Clinical Neurosciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Kathreena M Kurian
- Brain Tumour Research Group, Institute of Clinical Neurosciences, Southmead Hospital, University of Bristol, Bristol, UK
| | - Ali Fuat Okuducu
- Department of Pathology, University Hospital Nürnberg, Nürnberg, Germany
| | - Christine Jungk
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Matthias Schick
- Genomics and Proteomics Core Facility, Micro-Array Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Melanie Bewerunge-Hudler
- Genomics and Proteomics Core Facility, Micro-Array Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | | | - Ralf Ketter
- Department of Neurosurgery, Saarland University, Homburg, Germany
| | - Matthias Simon
- Department of Neurosurgery, Evangelische Krankenhaus Bielefeld, Bielefeld, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Lamszus
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Albert Becker
- Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Arend Koch
- Department of Neuropathology, Charité Medical University, Berlin, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Elisabeth J Rushing
- Department of Neuropathology, University Hospital and University of Zurich, Zurich, Switzerland
| | - V Peter Collins
- Department of Molecular Histopathology, University of Cambridge, Cambridge, UK
| | - Stefanie Brehmer
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Lukas Chavez
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Michael Platten
- Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany; Neurology Clinic, University Hospital Mannheim, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Hospital Mannheim, Mannheim, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Werner Paulus
- Institute of Neuropathology, University Hospital Münster, Münster, Germany
| | - Wolfgang Wick
- Clinical Cooperation Unit Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Neurology Clinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan M Pfister
- Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Pediatric Oncology, Haematology and Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michel Mittelbronn
- Neurological Institute (Edinger-Institute), Goethe University, Frankfurt, Germany
| | - Matthias Preusser
- Department of Medicine I, CNS Tumours Unit, Medical University of Vienna, Vienna, Austria
| | | | - Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Andreas von Deimling
- Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany; Clinical Cooperation Unit Neuropathology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Giordano FA, Brehmer S, Mürle B, Welzel G, Sperk E, Keller A, Abo-Madyan Y, Clausen S, Schneider F, Herskind C, Seiz-Rosenhagen M, Groden C, Schmiedek P, Glas M, Hänggi D, Petrecca K, Wenz F. RTHP-05. INTRAOPERATIVE RADIOTHERAPY (IORT) USING LOW-ENERGY X-RAYS IN A COHORT OF PREDOMINANTLY INCOMPLETELY RESECTED NEWLY DIAGNOSED GLIOBLASTOMA MULTIFORME (INTRAGO TRIAL). Neuro Oncol 2016. [DOI: 10.1093/neuonc/now212.731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Giordano F, Brehmer S, Muerle B, Welzel G, Sperk E, Schneider F, Clausen S, Schmiedek P, Groden C, Hänggi D, Abo-Madyan Y, Wenz F. Initial Results of a Phase 1/2 Trial on Intraoperative Radiation Therapy (IORT) in Newly Diagnosed Glioblastoma Multiforme (INTRAGO). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Giordano FA, Brehmer S, Muerle B, Welzel G, Sperk E, Schneider F, Clausen S, Schmiedek P, Groden C, Hänggi D, Abo-Madyan Y, Wenz FK. Phase I/II trial on intraoperative radiotherapy (IORT) in glioblastoma multiforme (INTRAGO). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e13503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frank Anton Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Bettina Muerle
- Neuroradiology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
| | - Frank Schneider
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sven Clausen
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany., Mannheim, Germany
| | - Peter Schmiedek
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Neuroradiology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany., Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany., Mannheim, Germany
| | - Frederik K. Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
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Herrlinger U, Schäfer N, Steinbach JP, Weyerbrock A, Hau P, Goldbrunner R, Friedrich F, Rohde V, Ringel F, Schlegel U, Sabel M, Ronellenfitsch MW, Uhl M, Maciaczyk J, Grau S, Schnell O, Hänel M, Krex D, Vajkoczy P, Gerlach R, Kortmann RD, Mehdorn M, Tüttenberg J, Mayer-Steinacker R, Fietkau R, Brehmer S, Mack F, Stuplich M, Kebir S, Kohnen R, Dunkl E, Leutgeb B, Proescholdt M, Pietsch T, Urbach H, Belka C, Stummer W, Glas M. Bevacizumab Plus Irinotecan Versus Temozolomide in Newly Diagnosed O6-Methylguanine–DNA Methyltransferase Nonmethylated Glioblastoma: The Randomized GLARIUS Trial. J Clin Oncol 2016; 34:1611-9. [DOI: 10.1200/jco.2015.63.4691] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In patients with newly diagnosed glioblastoma that harbors a nonmethylated O6-methylguanine–DNA methyltransferase promotor, standard temozolomide (TMZ) has, at best, limited efficacy. The GLARIUS trial thus explored bevacizumab plus irinotecan (BEV+IRI) as an alternative to TMZ. Patients and Methods In this phase II, unblinded trial 182 patients in 22 centers were randomly assigned 2:1 to BEV (10 mg/kg every 2 weeks) during radiotherapy (RT) followed by maintenance BEV (10 mg/kg every 2 weeks) plus IRI(125 mg/m2 every 2 weeks) or to daily TMZ (75 mg/m2) during RT followed by six courses of TMZ (150-200 mg/m2/d for 5 days every 4 weeks). The primary end point was the progression-free survival rate after 6 months (PFS-6). Results In the modified intention-to-treat (ITT) population, PFS-6 was increased from 42.6% with TMZ (95% CI, 29.4% to 55.8%) to 79.3% with BEV+IRI (95% CI, 71.9% to 86.7%; P <.001). PFS was prolonged from a median of 5.99 months (95% CI, 2.7 to 7.3 months) to 9.7 months (95% CI, 8.7 to 10.8 months; P < .001). At progression, crossover BEV therapy was given to 81.8% of all patients who received any sort of second-line therapy in the TMZ arm. Overall survival (OS) was not different in the two arms: the median OS was 16.6 months (95% CI, 15.4 to 18.4 months) with BEV+IRI and was 17.5 months (95% CI, 15.1 to 20.5 months) with TMZ. The time course of quality of life (QOL) in six selected domains of the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaire (QLQ) –C30 and QLQ-BN20 (which included cognitive functioning), of the Karnofsky performance score, and of the Mini Mental State Examination score was not different between the treatment arms. Conclusion BEV+IRI resulted in a superior PFS-6 rate and median PFS compared with TMZ. However, BEV+IRI did not improve OS, potentially because of the high crossover rate. BEV+IRI did not alter QOL compared with TMZ.
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Affiliation(s)
- Ulrich Herrlinger
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Niklas Schäfer
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Joachim P. Steinbach
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Astrid Weyerbrock
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Peter Hau
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Roland Goldbrunner
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Franziska Friedrich
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Veit Rohde
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Florian Ringel
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Uwe Schlegel
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Michael Sabel
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Michael W. Ronellenfitsch
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Martin Uhl
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Jaroslaw Maciaczyk
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Stefan Grau
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Oliver Schnell
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Mathias Hänel
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Dietmar Krex
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Peter Vajkoczy
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Rüdiger Gerlach
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Rolf-Dieter Kortmann
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Maximilian Mehdorn
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Jochen Tüttenberg
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Regine Mayer-Steinacker
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Rainer Fietkau
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Stefanie Brehmer
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Frederic Mack
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Moritz Stuplich
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Sied Kebir
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Ralf Kohnen
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Elmar Dunkl
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Barbara Leutgeb
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Martin Proescholdt
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Torsten Pietsch
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Horst Urbach
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Claus Belka
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Walter Stummer
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
| | - Martin Glas
- Ulrich Herrlinger, Niklas Schäfer, Frederic Mack, Moritz Stuplich, Sied Kebir, Torsten Pietsch, and Martin Glas, University of Bonn, Bonn; Joachim P. Steinbach and Michael W. Ronellenfitsch, University of Frankfurt, Frankfurt; Astrid Weyerbrock and Horst Urbach, University of Freiburg, Freiburg; Peter Hau and Martin Uhl, University Hospital Regensburg, Regensburg; Roland Goldbrunner and Stefan Grau, University of Cologne, Cologne; Franziska Friedrich and Rolf-Dieter Kortmann, University of Leipzig,
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Brehmer S, Guthier CV, Clausen S, Schneider F, Schulte DM, Benker M, Bludau F, Glatting G, Marx A, Schmiedek P, Hesser J, Wenz F, Giordano FA. Combined stereotactic biopsy and stepping-source interstitial irradiation of glioblastoma multiforme. J Neurosurg Sci 2016; 62:214-220. [PMID: 26771176 DOI: 10.23736/s0390-5616.16.03547-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients diagnosed with glioblastoma multiforme receiving stereotactic biopsy only either due to tumor localization or impaired clinical status face a devastating prognosis with very short survival times. One strategy to provide an initial cytoreductive and palliative therapy at the time of the stereotactic biopsy is interstitial irradiation through the pre-defined trajectory of the biopsy channel. We designed a novel treatment planning system and evaluated the treatment potential of a fixed-source and a stepping-source algorithm for interstitial radiosurgery on non-spherical glioblastoma in direct adjacency to risk structures. Using both setups, we show that radiation doses delivered to 100% of the gross tumor volume shifts from sub-therapeutic (10-12 Gy) to sterilizing single doses (25-30 Gy) when using the stepping source algorithm due to improved sparing of organs-at-risk. Specifically, the maximum doses at the brain stem were 100% of the PTV dose when a fixed central source and 38% when a stepping-source algorithm was used. We also demonstrated precision of intracranial target points and stability of superficial and deep trajectories using both a phantom and a body donor study. Our setup now for the first time provides a basis for a clinical proof-of-concept trial and may widen palliation options for patients with limited life expectancy that should not undergo time-consuming therapies.
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Affiliation(s)
- Stefanie Brehmer
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christian V Guthier
- Experimental Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Sven Clausen
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank Schneider
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Dirk-Michael Schulte
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Frederic Bludau
- Department of Orthopedic and Trauma Surgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gerhard Glatting
- Medical Radiation Physics/Radiation Protection, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexander Marx
- Department of Pathology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Peter Schmiedek
- Department of Neurosurgery, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jürgen Hesser
- Experimental Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Frank A Giordano
- Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany -
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Sahm F, Schrimpf D, Olar A, Koelsche C, Reuss D, Bissel J, Kratz A, Capper D, Schefzyk S, Hielscher T, Wang Q, Sulman EP, Adeberg S, Koch A, Okuducu AF, Brehmer S, Schittenhelm J, Becker A, Brokinkel B, Schmidt M, Ull T, Gousias K, Kessler AF, Lamszus K, Debus J, Mawrin C, Kim YJ, Simon M, Ketter R, Paulus W, Aldape KD, Herold-Mende C, von Deimling A. TERT Promoter Mutations and Risk of Recurrence in Meningioma. J Natl Cancer Inst 2015; 108:djv377. [PMID: 26668184 DOI: 10.1093/jnci/djv377] [Citation(s) in RCA: 246] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/05/2015] [Indexed: 01/01/2023] Open
Abstract
The World Health Organization (WHO) classification and grading system attempts to predict the clinical course of meningiomas based on morphological parameters. However, because of high interobserver variation of some criteria, more reliable prognostic markers are required. Here, we assessed the TERT promoter for mutations in the hotspot regions C228T and C250T in meningioma samples from 252 patients. Mutations were detected in 16 samples (6.4% across the cohort, 1.7%, 5.7%, and 20.0% of WHO grade I, II, and III cases, respectively). Data were analyzed by t test, Fisher's exact test, log-rank test, and Cox proportional hazard model. All statistical tests were two-sided. Within a mean follow-up time in surviving patients of 68.1 months, TERT promoter mutations were statistically significantly associated with shorter time to progression (P < .001). Median time to progression among mutant cases was 10.1 months compared with 179.0 months among wild-type cases. Our results indicate that the inclusion of molecular data (ie, analysis of TERT promoter status) into a histologically and genetically integrated classification and grading system for meningiomas increases prognostic power. Consequently, we propose to incorporate the assessment of TERT promoter status in upcoming grading schemes for meningioma.
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Affiliation(s)
- Felix Sahm
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Daniel Schrimpf
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Adriana Olar
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Christian Koelsche
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - David Reuss
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Juliane Bissel
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Annekathrin Kratz
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - David Capper
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Sebastian Schefzyk
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Thomas Hielscher
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Qianghu Wang
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Erik P Sulman
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Sebastian Adeberg
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Arend Koch
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Ali Fuat Okuducu
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Stefanie Brehmer
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Jens Schittenhelm
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Albert Becker
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Benjamin Brokinkel
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Melissa Schmidt
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Theresa Ull
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Konstantinos Gousias
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Almuth Friederike Kessler
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Katrin Lamszus
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Jürgen Debus
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Christian Mawrin
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Yoo-Jin Kim
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Matthias Simon
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Ralf Ketter
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Werner Paulus
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Kenneth D Aldape
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Christel Herold-Mende
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
| | - Andreas von Deimling
- Affiliations of authors:Department of Neuropathology, Institute of Pathology, Ruprecht-Karls-University Heidelberg , Heidelberg , Germany (FS, DS, CK, DR, JB, AK, DC, SS, AvD); Clinical Cooperation Unit Neuropathology, German Consortium for Translational Cancer Research (DKTK), German Cancer Research Center (DKFZ), Heidelberg , Germany (FS, DS, CK, DR, AK, DC, AvD); Department of Pathology (AO), Department of Genomic Medicine (QW), Department of Radiation Oncology (QW, EPS), and Department of Bioinformatics and Computational Biology (QW), The University of Texas MD Anderson Cancer Center , Houston, TX ; Department of Radiation Oncology (SA, JD) and Department of Neurosurgery (MSc, TU, CHM), University Hospital Heidelberg , Heidelberg , Germany ; Department of Neuropathology, Charité Medical University , Berlin , Germany (AK); Department of Pathology, University Hospital Nürnberg , Nürnberg , Germany (AFO): Department of Neurosurgery, Medical Faculty of the Ruprecht-Karls-University of Heidelberg , Mannheim , Germany (SB); Department of Neuropathology, Institute of Pathology and Neuropathology, University Tübingen , Tübingen , Germany (JS); Department of Neuropathology, University of Bonn , Bonn , Germany (AB); Department of Neurosurgery (BB) and Institute of Neuropathology (WP), University Hospital Münster , Münster , Germany (BB); Department of Neurosurgery, University Hospital Bonn , Bonn , Germany (KG, MSi); Department of Neurosurgery, University Hospital Würzburg , Würzburg , Germany (AFK); Department of Neurosurgery, University Hospital Hamburg , Hamburg , Germany (KL); Department of Neuropathology, Otto von Guericke University Magdeburg , Magdeburg , Germany (CM); Institute of Pathology, Saarland University , Homburg, Saarland , Germany (YJK); Department of Neurosurgery, Saarland University , Homburg , Germany (RK); MacFeeters-Hamilton Brain Tumour Centre, Princess Margaret Cancer Center , Toronto, Ontario , Canada (KDA); Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg , Germany (TH)
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Giordano FA, Welzel G, Gehweiler JE, Brehmer S, Appelt JU, von Deimling A, Seiz-Rosenhagen M, Schmiedek P, Wenz FK. Metronomic chemotherapy with daily low-dose temozolomide and celecoxib in elderly patients with newly diagnosed glioblastoma multiforme. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e13046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Frank Anton Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Julian Emanuel Gehweiler
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
| | - Stefanie Brehmer
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | | | - Andreas von Deimling
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Marcel Seiz-Rosenhagen
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Peter Schmiedek
- Department of Neurosurgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - Frederik K. Wenz
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Ruprecht- Karls-University Heidelberg, Mannheim, Germany
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Giordano FA, Brehmer S, Abo-Madyan Y, Welzel G, Sperk E, Keller A, Schneider F, Clausen S, Herskind C, Schmiedek P, Wenz F. INTRAGO: intraoperative radiotherapy in glioblastoma multiforme—a phase I/II dose escalation study. BMC Cancer 2014; 14:992. [PMID: 25535398 PMCID: PMC4364103 DOI: 10.1186/1471-2407-14-992] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [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: 07/15/2014] [Accepted: 12/16/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is the most frequent primary malignant brain tumor in adults. Despite multimodal therapies, almost all GBM recur within a narrow margin around the initial resected lesion. Thus, novel therapeutic intensification strategies must target both, the population of dispersed tumor cells around the cavity and the postoperative microenvironment. Intraoperative radiotherapy (IORT) is a pragmatic and effective approach to sterilize the margins from persistent tumor cells, abrogate post-injury proliferative stimuli and to bridge the therapeutic gap between surgery and radiochemotherapy. Therefore, we have set up INTRAGO, a phase I/II dose-escalation study to evaluate the safety and tolerability of IORT added to standard therapy in newly diagnosed GBM. In contrast to previous approaches, the study involves the application of isotropic low-energy (kV) x-rays delivered by spherical applicators, providing optimal irradiation properties to the resection cavity. METHODS/DESIGN INTRAGO includes patients aged 50 years or older with a Karnofsky performance status of at least 50% and a histologically confirmed (frozen sections) supratentorial GBM. Safety and tolerability (i.e., the maximum tolerated dose, MTD) will be assessed using a classical 3 + 3 dose-escalation design. Dose-limiting toxicities (DLT) are wound healing deficits or infections requiring surgical intervention, IORT-related cerebral bleeding or ischemia, symptomatic brain necrosis requiring surgical intervention and early termination of external beam radiotherapy (before the envisaged dose of 60 Gy) due to radiotoxicity. Secondary end points are progression-free and overall survival. TRIAL REGISTRATION The study is registered with clinicaltrials.gov, number: NCT02104882 (Registration Date: 03/26/2014).
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Affiliation(s)
- Frank A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
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Sahm F, Bissel J, Koelsche C, Schweizer L, Capper D, Reuss D, Böhmer K, Lass U, Göck T, Kalis K, Meyer J, Habel A, Brehmer S, Mittelbronn M, Jones DTW, Schittenhelm J, Urbschat S, Ketter R, Heim S, Mawrin C, Hainfellner JA, Berghoff AS, Preusser M, Becker A, Herold-Mende C, Unterberg A, Hartmann C, Kickingereder P, Collins VP, Pfister SM, von Deimling A. AKT1E17K mutations cluster with meningothelial and transitional meningiomas and can be detected by SFRP1 immunohistochemistry. Acta Neuropathol 2013; 126:757-62. [PMID: 24096618 DOI: 10.1007/s00401-013-1187-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/25/2013] [Accepted: 09/26/2013] [Indexed: 10/26/2022]
Abstract
The activating E17K mutation in the AKT1 gene has been detected in several tumor entities. Currently several clinical studies with specific AKT1 inhibitors are under way. To determine whether AKT1 mutations are involved in human tumors of the nervous system, we examined a series of 1,437 tumors including 391 primary intracranial brain tumors and 1,046 tumors of the coverings of the central and peripheral nervous system. AKT1E17K mutations were exclusively seen in meningiomas and occurred in 65 of 958 of these tumors. A strong preponderance was seen in the variant of meningothelial meningioma WHO grade I of basal and spinal localization. In contrast, AKT1E17K mutations were rare in WHO grade II and absent in WHO grade III meningiomas. In order to more effectively detect this mutation, we tested for immunohistochemical markers associated with this alteration. We observed strong up-regulation of SFRP1 expression in all meningiomas with AKT1E17K mutation and in HEK293 cells after transfection with mutant AKT1E17K, but not in meningiomas and HEK293 cells lacking this mutation.
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Brehmer S, Pusch S, Schmieder K, von Deimling A, Hartmann C. Mutational analysis of D2HGDH and L2HGDH in brain tumours without IDH1 or IDH2 mutations. Neuropathol Appl Neurobiol 2011; 37:330-2. [DOI: 10.1111/j.1365-2990.2010.01114.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
We investigate the phase diagram of antiferromagnetic spin ladders with additional exchange interactions on diagonal bonds by variational and numerical methods. These generalized spin ladders interpolate smoothly between the [Formula: see text] chain with competing nn and nnn interactions, the [Formula: see text] chain with alternating exchange and the antiferromagnetic (AF) S = 1 chain. The Majumdar - Ghosh ground states are formulated as matrix product states and are shown to exhibit the same type of hidden order as the AF S = 1 chain. Generalized matrix product states are used for a variational calculation of the ground state energy and the spin and string correlation functions. Numerical (Lanczos) calculations of the energies of the ground state and of the low-lying excited states are performed, and compare reasonably with the variational approach. Our results support the hypothesis that the dimer and Majumdar - Ghosh points are in the same phase as the AF S = 1 chain.
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Affiliation(s)
- S Brehmer
- Institut für Theoretische Physik, Universität Hannover, 30167 Hannover, Germany
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