CNS Oncology最新文献

英文中文

Utility of flouro-deoxy-glucose positron emission tomography/computed tomography in the diagnostic and staging evaluation of patients with primary CNS lymphoma 氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在原发性中枢神经系统淋巴瘤患者的诊断和分期评估中的应用

Q1 Medicine

CNS Oncology

Pub Date : 2019-11-29 DOI: 10.2217/cns-2019-0016

Meetakshi Gupta, T. Gupta, N. Purandare, V. Rangarajan, A. Puranik, A. Moiyadi, P. Shetty, S. Epari, A. Sahay, A. Mahajan, A. Janu, B. Bagal, H. Menon, S. Kannan, R. Krishnatry, G. Sastri, R. Jalali

Aim: To prospectively assess the clinical utility of pretreatment flouro-deoxy-glucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients with primary central nervous system (CNS) lymphoma (PCNSL). Materials & methods: Patients with suspected/proven PCNSL underwent baseline whole-body 18F-FDG-PET/CT. Maximum standardized uptake value and tumor/normal tissue ratios were compared between CNS lymphoma and other histological diagnoses. Results: The mean maximum standardized uptake value (27.5 vs 18.2; p = 0.001) and mean tumor/normal tissue ratio (2.34 vs 1.53; p < 0.001) of CNS lymphoma was significantly higher than other histologic diagnoses. Five of 50 (10%) patients with biopsy-proven CNS lymphomas had pathologically increased FDG-uptake at extraneuraxial sites uncovering systemic lymphoma. Conclusion: Pretreatment whole-body 18F-FDG-PET/CT provides valuable complementary information in the diagnostic and staging evaluation of patients with PCNSL to guide therapeutic decision-making.

目的:前瞻性评价预处理氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描(18F-FDG-PET/CT)在原发性中枢神经系统淋巴瘤(PCNSL)患者中的临床应用价值。材料与方法:疑似/确诊PCNSL患者行基线全身18F-FDG-PET/CT检查。比较中枢神经系统淋巴瘤和其他组织学诊断的最大标准化摄取值和肿瘤/正常组织比率。结果:平均最大标准化摄取值(27.5 vs 18.2;P = 0.001)，平均肿瘤/正常组织比值(2.34 vs 1.53;p < 0.001)的发病率明显高于其他病理诊断。50例活检证实的中枢神经系统淋巴瘤患者中有5例(10%)在病理上在轴外部位fdg摄取增加，发现全身性淋巴瘤。结论:预处理全身18F-FDG-PET/CT为PCNSL患者的诊断和分期评估提供了有价值的补充信息，指导治疗决策。

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引用次数: 14

The role of chemotherapy in the treatment of central neurocytoma 化疗在中枢神经细胞瘤治疗中的作用

Q1 Medicine

CNS Oncology

Pub Date : 2019-11-01 DOI: 10.2217/cns-2019-0012

Margaret O Johnson, J. Kirkpatrick, Mallika P. Patel, A. Desjardins, D. Randazzo, H. Friedman, D. Ashley, K. Peters

Aim: Central neurocytoma (CN) is a rare WHO grade II central nervous system (CNS) tumor. This is an update on chemotherapeutic agents used in its treatment. Patients & methods: An institutional review board-approved, chart review of patients seen at our institution resulted in a single case treated with chemotherapy and is herein included. We proceeded with a comprehensive literature review. Results: We identified 18 citations, representing 39 cases of adult and pediatric CN treated with chemotherapy. With the addition of our single case, the total number of recurrent CN patients treated with temozolomide (TMZ) is nine. Conclusion: There exists marked heterogeneity in chemotherapy used to treat CN. TMZ is incorporated into treatment regimens in the setting of tumor recurrence: its role merits further study.

目的:中枢神经细胞瘤(CN)是一种罕见的WHOⅱ级中枢神经系统肿瘤。这是一个最新的化疗药物用于其治疗。患者和方法:经机构审查委员会批准，对在我们机构就诊的患者进行图表审查，结果是接受化疗的单个病例，并在此包括在内。我们进行了全面的文献综述。结果:我们确定了18条引文，代表了39例接受化疗的成人和儿童CN病例。加上我们的单一病例，使用替莫唑胺(TMZ)治疗的CN复发患者总数为9例。结论:CN的化疗方案存在明显的异质性。TMZ在肿瘤复发的情况下被纳入治疗方案，其作用值得进一步研究。

引用次数: 10

Biological intratumoral therapy for the high-grade glioma part II: vector- and cell-based therapies and radioimmunotherapy 高级别胶质瘤的生物瘤内治疗第二部分:载体和细胞为基础的治疗和放射免疫治疗

Q1 Medicine

CNS Oncology

Pub Date : 2019-11-01 DOI: 10.2217/cns-2019-0002

J. Loya, Charlie Zhang, Emily J Cox, A. Achrol, S. Kesari

Management of high-grade gliomas (HGGs) remains a complex challenge with an overall poor prognosis despite aggressive multimodal treatment. New translational research has focused on maximizing tumor cell eradication through improved tumor cell targeting while minimizing collateral systemic side effects. In particular, biological intratumoral therapies have been the focus of novel translational research efforts due to their inherent potential to be both dynamically adaptive and target specific. This two part review will provide an overview of biological intratumoral therapies that have been evaluated in human clinical trials in HGGs, and summarize key advances and remaining challenges in the development of these therapies as a potential new paradigm in the management of HGGs. Part II discusses vector-based therapies, cell-based therapies and radioimmunotherapy.

高级别胶质瘤(HGGs)的管理仍然是一个复杂的挑战，尽管积极的多模式治疗总体预后较差。新的转化研究侧重于通过改进肿瘤细胞靶向来最大限度地根除肿瘤细胞，同时最大限度地减少附带的全身副作用。特别是，由于生物肿瘤内治疗具有动态适应性和靶向特异性的内在潜力，因此一直是新型转化研究的重点。这两部分的综述将提供已经在HGGs人体临床试验中评估的生物肿瘤内治疗的概述，并总结这些治疗作为HGGs管理的潜在新范式的关键进展和仍然存在的挑战。第二部分讨论了基于载体的治疗、基于细胞的治疗和放射免疫治疗。

引用次数: 4

Biological intratumoral therapy for the high-grade glioma part I: intratumoral delivery and immunotoxins 高级别胶质瘤的生物瘤内治疗第一部分:瘤内输送和免疫毒素

Q1 Medicine

CNS Oncology

Pub Date : 2019-11-01 DOI: 10.2217/cns-2019-0001

J. Loya, Charlie Zhang, Emily J Cox, A. Achrol, S. Kesari

Management of high-grade gliomas remains a complex challenge. Standard of care consists of microsurgical resection, chemotherapy and radiation, but despite these aggressive multimodality therapies the overall prognosis remains poor. A major focus of ongoing translational research studies is to develop novel therapeutic strategies that can maximize tumor cell eradication while minimizing collateral side effects. Particularly, biological intratumoral therapies have been the focus of new translational research efforts due to their inherent potential to be both dynamically adaptive and target specific. This two-part review will provide an overview of biological intratumoral therapies and summarize key advances and remaining challenges in intratumoral biological therapies for high-grade glioma. Part I focuses on discussion of the concepts of intratumoral delivery and immunotoxin therapies.

高级别胶质瘤的治疗仍然是一个复杂的挑战。标准治疗包括显微外科手术切除、化疗和放疗，但尽管这些积极的多模式治疗，总体预后仍然很差。正在进行的转化研究的一个主要焦点是开发新的治疗策略，可以最大限度地根除肿瘤细胞，同时最大限度地减少副作用。特别是，由于生物肿瘤内治疗具有动态适应性和靶向特异性的内在潜力，因此一直是新的转化研究的焦点。这两部分的综述将提供生物肿瘤内治疗的概述，并总结高级别胶质瘤的肿瘤内生物治疗的关键进展和仍然存在的挑战。第一部分着重讨论肿瘤内递送和免疫毒素治疗的概念。

引用次数: 5

Prediagnostic presentations of glioma in primary care: a case–control study 初级保健中胶质瘤的诊断前表现:一项病例对照研究

Q1 Medicine

CNS Oncology

Pub Date : 2019-11-01 DOI: 10.2217/cns-2019-0015

Marthe C. M. Peeters, L. Dirven, J. Koekkoek, M. Numans, M. Taphoorn

Aim: This study aimed to assess the prevalence of symptoms glioma patients may present with to the general practitioner, and whether these can be distinguished from patients with other CNS disorders or any other condition. Methods: Glioma patients were matched to CNS patients and ‘other controls’ using anonymized general practitioner registries. Prevalences were evaluated in the 5 years prior to diagnosis. Result: CNS patients reported significantly more motor symptoms in the period 60–24 months, (p = 0.039). Moreover, <6 months before diagnosis CNS patients differed significantly in mood disorders/fear compared with ‘other controls’ (p = 0.012) but not glioma patients (p = 0.816). Conclusion: Glioma patients could not be distinguished from both control groups with respect to the number or type of prediagnostic symptoms.

目的:本研究旨在评估神经胶质瘤患者向全科医生可能出现的症状的患病率，以及这些症状是否可以与其他中枢神经系统疾病或任何其他疾病的患者区分开来。方法:使用匿名全科医生注册将胶质瘤患者与中枢神经系统患者和“其他对照组”进行匹配。在诊断前5年评估患病率。结果:中枢神经系统患者在60-24个月期间报告的运动症状显著增加(p = 0.039)。此外，在诊断前<6个月，中枢神经系统患者的情绪障碍/恐惧与“其他对照组”相比有显著差异(p = 0.012)，但胶质瘤患者没有差异(p = 0.816)。结论:胶质瘤患者在诊断前症状的数量和类型上无法与对照组区分。

引用次数: 3

Hemophagocytic lymphohistiocytosis in a patient with glioblastoma: a case report 胶质母细胞瘤患者的噬血细胞淋巴组织细胞增多症1例报告

Q1 Medicine

CNS Oncology

Pub Date : 2019-07-03 DOI: 10.2217/cns-2019-0013

Vaibhav Kumar, Patrick J. Eulitt, A. Bermudez, S. Khagi

Adult onset hemophagocytic lymphohistiocytosis (HLH) is a rare condition, usually secondary to either a precipitating infective or hematologic malignancy. We present a case of Epstein–Barr virus associated HLH in a 55-year-old female receiving treatment for a glioblastoma (GBM). It is possible that HLH is under recognized, as patients with GBM often have features of a nonspecific systemic inflammatory response syndrome, multiorgan failure and cognitive decline. A high index of suspicion and increased awareness can help improve timeliness of diagnosis. Therapeutically, Epstein–Barr virus associated HLH in patients with solid organ malignancy poses significant challenges. An individualized, multidisciplinary approach is essential when managing adult-onset HLH and providers will need to be mindful of the high mortality rate despite treatment.

成人发病的噬血细胞性淋巴组织细胞病(HLH)是一种罕见的疾病，通常继发于感染性疾病或血液恶性肿瘤。我们提出一个病例爱泼斯坦-巴尔病毒相关的HLH在一个55岁的女性接受治疗胶质母细胞瘤(GBM)。由于GBM患者通常具有非特异性全身炎症反应综合征、多器官功能衰竭和认知能力下降的特征，因此HLH可能未被充分认识。高怀疑指数和提高认识有助于提高诊断的及时性。在治疗上，爱泼斯坦-巴尔病毒相关的HLH对实体器官恶性肿瘤患者提出了重大挑战。在管理成人发病的HLH时，个性化、多学科的方法是必不可少的，提供者需要注意尽管接受了治疗，但死亡率仍然很高。

引用次数: 2

Radiographic appearance of leptomeningeal disease in patients with EGFR-mutated non-small-cell lung carcinoma treated with tyrosine kinase inhibitors: a case series 用酪氨酸激酶抑制剂治疗egfr突变的非小细胞肺癌患者的轻脑膜疾病的影像学表现:一个病例系列

Q1 Medicine

CNS Oncology

Pub Date : 2019-06-20 DOI: 10.2217/cns-2019-0010

Ugur T Sener, Nassim Matin, H. Yu, A. Lin, T. Yang, R. Malani

EGFR is frequently mutated in non-small-cell lung carcinomas (NSCLCs). Clinically available tyrosine kinase inhibitors (TKIs) are effective in treating EGFR-mutant NSCLC. In this case series, we present five patients with TKI-treated EGFR-mutated NSCLC who developed leptomeningeal disease (LMD) lacking characteristic imaging findings. All five patients received TKIs prior to development of cytology-confirmed LMD. Clinical signs of LMD preceded radiographic evidence by 2–12 months. T790M, the most common resistance mutation to first-generation EGFR inhibitors, was identified in four cases. These cases illustrate that in patients with EGFR-mutant NSCLC, TKIs may effectively control LMD, creating a lag between onset of symptoms and observation of radiographic findings.

EGFR在非小细胞肺癌(nsclc)中经常发生突变。临床可用的酪氨酸激酶抑制剂(TKIs)对治疗egfr突变型NSCLC有效。在本病例系列中，我们报告了5例经tki治疗的egfr突变的NSCLC患者，他们发展为缺乏特征性影像学发现的轻脑膜病(LMD)。所有5例患者在发生细胞学证实的LMD之前都接受了tki治疗。LMD的临床症状比影像学证据早2-12个月。T790M是对第一代EGFR抑制剂最常见的耐药突变，在4例中被发现。这些病例表明，在egfr突变的NSCLC患者中，TKIs可以有效地控制LMD，造成症状发作和观察影像学表现之间的滞后。

引用次数: 3

Analysis of cell-free circulating tumor DNA in 419 patients with glioblastoma and other primary brain tumors. 419例胶质母细胞瘤及其他原发性脑肿瘤患者游离循环肿瘤DNA分析。

Q1 Medicine

CNS Oncology

Pub Date : 2019-06-01 Epub Date: 2019-03-11 DOI: 10.2217/cns-2018-0015

David E Piccioni, Achal Singh Achrol, Lesli A Kiedrowski, Kimberly C Banks, Najee Boucher, Garni Barkhoudarian, Daniel F Kelly, Tiffany Juarez, Richard B Lanman, Victoria M Raymond, Minhdan Nguyen, Judy D Truong, Annie Heng, Jaya Gill, Marlon Saria, Sandeep C Pingle, Santosh Kesari

Aim: Genomically matched trials in primary brain tumors (PBTs) require recent tumor sequencing. We evaluated whether circulating tumor DNA (ctDNA) could facilitate genomic interrogation in these patients. Methods: Data from 419 PBT patients tested clinically with a ctDNA NGS panel at a CLIA-certified laboratory were analyzed. Results: A total of 211 patients (50%) had ≥1 somatic alteration detected. Detection was highest in meningioma (59%) and gliobastoma (55%). Single nucleotide variants were detected in 61 genes, with amplifications detected in ERBB2, MET, EGFR and others. Conclusion: Contrary to previous studies with very low yields, we found half of PBT patients had detectable ctDNA with genomically targetable off-label or clinical trial options for almost 50%. For those PBT patients with detectable ctDNA, plasma cfDNA genomic analysis is a clinically viable option for identifying genomically driven therapy options.

目的:原发性脑肿瘤(pbt)的基因组匹配试验需要最近的肿瘤测序。我们评估了循环肿瘤DNA (ctDNA)是否可以促进这些患者的基因组询问。方法:分析来自419名PBT患者的数据，这些患者在clia认证的实验室进行了ctDNA NGS面板的临床测试。结果:211例患者(50%)检出≥1种躯体改变。脑膜瘤(59%)和胶质母细胞瘤(55%)检出率最高。在61个基因中检测到单核苷酸变异，在ERBB2、MET、EGFR等基因中检测到扩增。结论:与之前的低产量研究相反，我们发现一半的PBT患者有近50%的基因组靶向标签外或临床试验选择可检测到ctDNA。对于那些可检测到ctDNA的PBT患者，血浆cfDNA基因组分析是确定基因组驱动治疗方案的临床可行选择。

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引用次数: 106

Efficacy and safety of immune checkpoint blockade for brain metastases. 免疫检查点阻断治疗脑转移瘤的疗效和安全性。

Q1 Medicine

CNS Oncology

Pub Date : 2019-06-01 Epub Date: 2019-03-11 DOI: 10.2217/cns-2018-0018

Maya Harary, David A Reardon, J Bryan Iorgulescu

hepatocellular carcinoma,

引用次数: 18

Patterns of long-term survivorship following bevacizumab treatment for recurrent glioma: a case series. 贝伐单抗治疗复发性胶质瘤后的长期生存模式:一个病例系列。

Q1 Medicine

CNS Oncology

Pub Date : 2019-06-01 Epub Date: 2019-07-11 DOI: 10.2217/cns-2019-0007

Liang Yen Liu, Matthew S Ji, Nhung T Nguyen, Frances E Chow, Donna M Molaie, Sean T Pianka, Richard M Green, Linda M Liau, Benjamin M Ellingson, Phioanh L Nghiemphu, Timothy F Cloughesy, Albert Lai

Aim: Long-term survivors (LTS) after glioma recurrence while on bevacizumab (Bev) therapy are rarely reported in the current literature. The purpose of this case series is to confirm the existence of and describe a large cohort of recurrent glioma LTS treated with Bev (Bev-LTS). Patients & methods: We identified Bev-LTS as patients with post-Bev initiation survival times of ≥3 years among 1397 Bev treated recurrent glioma patients. Results: Among 962 grade-IV, 221 grade III, and 214 grade II Bev-treated glioma patients, we identified 28 (2.9%), 14 (6.3%) and 8 (3.7%) Bev-LTS patients, respectively. 45 Bev-LTS patients recurred on Bev, with 36 of those patients continuing therapy. Conclusion: Our study shows that a small portion of grade-IV, -III, and -II glioma patients can have long-term survival on Bev therapy even after Bev recurrence.

目的:目前文献中很少报道胶质瘤复发后接受贝伐单抗治疗的长期幸存者(LTS)。本病例系列的目的是确认和描述一个用Bev治疗的复发性神经胶质瘤LTS (Bev-LTS)的大队列的存在。患者和方法:我们在1397例接受Bev治疗的复发性胶质瘤患者中，将Bev- lts确定为Bev起始生存期≥3年的患者。结果:在962例iv级、221例III级和214例II级bev治疗的胶质瘤患者中，我们分别确定了28例(2.9%)、14例(6.3%)和8例(3.7%)Bev-LTS患者。45例Bev- lts患者在Bev复发，其中36例患者继续治疗。结论:我们的研究表明，小部分iv级、-III级和-II级胶质瘤患者即使在Bev复发后也能通过Bev治疗获得长期生存。

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引用次数: 5

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