Journal of Neuro-Oncology最新文献

Purpose: Leptomeningeal disease (LMD) is a devastating complication of advanced solid tumors with limited prognostic and response-assessment tools. Because LMD molecular evolution is frequently compartmentalized behind CNS barriers, cerebrospinal fluid (CSF) circulating tumor DNA (ctDNA) may provide CNS-specific molecular readouts of disease activity. We evaluated whether baseline CSF ctDNA profiles and longitudinal ctDNA kinetics associate with survival in LMD.

Methods: We performed a systematic review and meta-analysis (PROSPERO CRD420251068543) of Embase, PubMed, Cochrane CENTRAL, WHO ICTRP, ClinicalTrials.gov, Europe PMC, and Web of Science from inception through June 2025. Eligible studies included adults with solid-tumor LMD undergoing anti-cancer therapy with CSF ctDNA assessed at baseline and/or serially and reported associations with overall survival (OS) and/or progression-free survival (PFS). Random-effects models pooled hazard ratios (HRs). Longitudinal studies were analyzed separately due to limited availability.

Results: Fourteen studies (n = 963) evaluated baseline CSF ctDNA and two studies (n = 26) evaluated longitudinal kinetics. Adverse (non-reference) baseline ctDNA status (e.g., EGFR mutation positive vs. negative) was associated with inferior OS (pooled HR 2.40, 95% CI 1.73-3.33; I²=36.6%) and PFS (pooled HR 2.45, 95% CI 1.36-4.44; I²=15.5%). Longitudinally, increasing CSF ctDNA variant allele fraction was associated with worse OS (pooled HR 4.11, 95% CI 1.25-13.48; I²=8.5%). Across longitudinal reports, serial CSF ctDNA measurements tracked progression and response.

Conclusion: Baseline and serial CSF ctDNA measurements are associated with survival outcomes in LMD and may complement clinical and radiographic assessment. These findings support prospective, standardized, multi-timepoint CSF ctDNA studies in LMD and warrant CSF-access-enabled monitoring to inform therapeutic adaptation.

Purpose: To determine the extent of decisional regret (DR) and contributing factors after treatment of primary and secondary brain tumors (BT).

Methods: Patients who received radiotherapy (RT) for a BT between 2010 and 2024 were eligible for this bicentric cross-sectional study. DR was assessed using the 5-item Decision Regret Scale (DRS). Overall and treatment-specific DR was determined. Besides DR, health related quality of life (HRQoL), distress, anxiety, depression, and satisfaction with medical care were determined. Associations between DR and covariates were examined in univariate analyses. Linear regression models were calculated for multivariable analyses.

Results: From 310 eligible contacted patients, 162 were included. Ninety-four patients (58%) suffered from malignant glioma, and 68 (42%) had brain metastases (BM). Median age was 58 years, median interval between the last RT fraction and study participation 22 months. Thirty-two patients (20%) reported no, 85 (53%) mild, and 45 (28%) strong overall DR. Regarding their decision towards specific treatments, 37 patients (23%) expressed strong DR concerning RT, 45 (30%) regarding chemotherapy, and 29 patients (20%) with regard to brain surgery. Global HRQoL was inversely correlated to DR (r = -0.35, p < 0.001). Physical functioning (r = -0.33, p < 0.001) and social functioning (r = -0.32, p < 0.001) demonstrated moderate correlation. As symptoms, fatigue (r = 0.32, p < 0.001), future uncertainty (r = 0.37, p < 0.001), motor dysfunction (r = 0.32, p < 0.001), depression (r = 0.37, p < 0.001) and satisfaction with medical care (r = -0.39, p < 0.001) showed strong correlations with DR. In multivariable linear regression, low satisfaction with medical care, unemployment, future uncertainty and BM stayed associated with DR.

Conclusions: DR is frequent in patients with BT. Rather than treatment-related, low satisfaction with medical care and unemployment/financial uncertainty appear particularly linked to higher DR.

Background: Although brain metastases (BM) represent an uncommon manifestation of colorectal cancer (CRC), their occurrence is associated with a markedly reduced life expectancy. Advances in systemic therapies and neuroimaging have led to a growing number of detected cases. However, data on prognostic markers and optimal management still remain limited. This dual center analysis from two major German cancer centers sought to describe clinical characteristics, treatment approaches and survival determinants in patients with CRC who developed BM.

Methods: All individuals diagnosed with CRC and subsequent BM between January 2000 and December 2024 were retrospectively identified from the tumor registries of the University Hospitals Wuerzburg and Frankfurt. Demographic, pathological and therapeutic parameters were extracted and analyzed. Overall survival following BM diagnosis was assessed using a multivariable Cox proportional hazards model with backward stepwise likelihood ratio selection (entry criterion p < 0.05, removal p > 0.10). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated.

Results: The study included 279 patients (Wuerzburg 48.4%, Frankfurt 51.6%). The mean age at CRC diagnosis was 62.1 years and at BM diagnosis 65.1 years; 61.6% of the patients were male. The median interval between CRC diagnosis and BM detection in metachronous patients was 40.5 months, with 11.1% exhibiting synchronous BM. Liver, lung, and bone metastases were present in 50.9%, 64.2%, and 22.6% of patients, respectively. Among tested cases, KRAS mutations were found in 54.2%. Surgical resection of BM was undertaken in 36.2%, and radiotherapy in 67.0%. On multivariable analysis, Karnfosky Performance Status emerged as independent predictors of prolonged survival (HR = 0.98; 95% CI 0.97-1-00; p = 0.008). Brain metastasis surgery showed a borderline association with improved survival (HR 0.51; 95% CI 0.26-1.00; p = 0.050). Median survival from the time of BM diagnosis was 20 months (95% CI 14.140-25.860) in the operated group compared with 3 months (95% CI 2.089-3.911) in the non-operated group.

Conclusion: Patients with CRC who develop BM are a subgroup with heterogeneous courses of disease. In addition to KPS, surgical resection of BM was associated with improved survival. This emphasizing the benefit of local treatment in appropriately cases. Collaborative, prospective studies are required to validate these findings and to refine therapeutic strategies for this rare entity.

Background: Surgical retreatment of recurrent vestibular schwannoma (VS) remains challenging, particularly in balancing tumor control with facial nerve (FN) preservation. This bicentric study aimed to evaluate facial nerve outcomes and risk factors for second recurrence following repeated retrosigmoid craniotomy.

Methods: We retrospectively analyzed 35 patients with sporadic VS who underwent repeated retrosigmoid surgery for recurrent VS between 2002 and 2024. Facial nerve function was assessed using the House-Brackmann (HB) grading. Predictors of postoperative FN deterioration at 3-months after repeated surgery and second recurrence were evaluated.

Results: FN deterioration occurred in 11 patients (31.4%) at 3-months after repeated surgery. The time between primary and repeated surgery was significantly shorter in patients with postoperative FN deterioration (mean 42.4 vs. 81.2 months, p = 0.008). ROC analysis identified a cut-off of 102 months (AUC = 0.61; 95% CI: 0.42-0.79) for predicting facial nerve preservation. Regarding tumor control, a second recurrence was observed in 4 patients (11.4%). The volumetric extent of resection (EoR) during repeated surgery was significantly associated with second recurrence (p = 0.011). ROC analysis revealed a critical EoR cut-off of 62.0% (AUC = 0.96; 95% CI: 0.89-1.00), with 100% sensitivity and 92.9% specificity. Adjuvant radiotherapy after incomplete resection was not significantly associated with reduced re-recurrence (p = 0.77).

Conclusions: Repeated retrosigmoid surgery for recurrent VS offers favorable tumor control with acceptable facial nerve outcomes. More aggressive VSs with shorter intervals between surgeries may increase the risk of facial nerve deterioration. Local repeated surgery appears to be of importance regarding further tumor control.