Journal of Neuro-Oncology最新文献

Introduction: Tumor Treating Fields (TTFields), as an emerging non-invasive therapeutic approach, has gradually demonstrated its potential as an adjuvant therapy in cancer treatment in recent years. Currently, TTFields has become an important adjunct to the standard treatment of glioblastoma (GBM). Real-world data on its clinical application, outcomes, and prognostic factors hold significant value for optimizing clinical practice. This study aims to evaluate the actual effectiveness of TTFields in treating GBM by providing clinical data and exploring potential clinical factors that may influence its efficacy.

Methods: This study is a retrospective cohort study that included 40 newly diagnosed glioblastoma (ndGBM) patients received TTFields treatment based on the Stupp regimen. Additionally, 48 ndGBM patients who did not receive TTFields treatment during the same period were selected as the control group through continuous sampling. Kaplan-Meier curves were employed to estimate the overall survival (OS) and progression-free survival (PFS) in both groups. To identify factors affecting these outcomes and the efficacy of TTFields, a Cox regression analysis was subsequently performed on various clinical variables.

Results: Patients receiving the TTFields demonstrated superior median PFS (12.0 months, 95%CI: 8.97-15.03) and OS (18.0 months, 95%CI: 13.65-22.35), versus 9.0 (95%CI: 7.06-10.94) and 12.0 (95%CI: 9.36-14.64) months in controls. Multivariate analysis showed that the extent of resection (P = 0.032, HR: 0.47, 95%CI: 0.24-0.94), the MGMT promoter methylation status (P = 0.024, HR: 0.51, 95%CI: 0.28-0.91) and whether accepted TTFields therapy (P = 0.022, HR: 0.50, 95%CI: 0.28-0.90) were independent prognostic factors affecting PFS. Additionally, patient compliance with TTFields therapy was significantly associated with their OS and PFS (OS: P = 0.004, HR: 0.12, 95%CI: 0.03-0.51; PFS: P = 0.007, HR: 0.24, 95%CI: 0.09-0.68). Further analysis revealed a certain relationship between the duration of TTFields therapy and survival. Comparative analysis revealed distinct survival outcomes based on treatment duration. The long-term (> 2 months) and short-term (≤ 2 months) TTFields groups had median OS of 21.0 (95%CI: 15.58-26.42) and 16.0 months (95%CI: 10.32-21.68) (P = 0.099), and median PFS of 20.0 (95%CI: 6.99-33.01) and 8.0 months (95%CI: 4.36-11.65) (P = 0.017), respectively, indicating a statistically significant PFS advantage for prolonged therapy.

Conclusions: The TTFields combined with Stupp regimen was associated with longer Survival outcome in patients with GBM. Additionally, higher patient compliance with TTFields treatment (≥ 0.81) and prolonged use of TTFields (> 2 months) are closely associated with improved prognosis.

Purpose: Primary central nervous system lymphoma (PCNSL) is relatively common among elderly patients, for whom survival outcomes remain limited and treatment-related decline in functional status is a major concern. This study evaluated the efficacy and functional preservation of reduced-dose whole-brain radiotherapy (WBRT) followed by a response-adapted focal boost as consolidation therapy for PCNSL, with a focus on elderly patients.

Methods: We retrospectively reviewed patients with PCNSL who received consolidation WBRT at a dose of 23.4 Gy after remission-induction therapy with methotrexate, procarbazine, and vincristine at Miyagi Cancer Center between 2015 and 2022. Patients who did not achieve a complete response (CR) after induction therapy received an additional focal boost of 21.6 Gy. Consolidation high-dose cytarabine was generally administered irrespective of response. Median progression-free survival (PFS), median overall survival (OS), and the duration of preserved Karnofsky Performance Status (KPS) scores ≥ 70 were assessed.

Results: Seventy-three patients were included, with a median age of 69 years. The median PFS and OS were 63 months and 90 months, respectively. Multivariate analyses showed that neither advanced age nor an Eastern Cooperative Oncology Group Performance Status (ECOG PS) score ≥ 2 significantly affected PFS or OS. At 4 years, the proportions of patients maintaining KPS scores ≥ 70 were 100%, 92%, and 80% in patients aged < 60, 60-69, and ≥ 70 years, respectively.

Conclusions: Reduced-dose WBRT (23.4 Gy) combined with a response-adapted focal boost was associated with favorable survival and sustained functional preservation, even in elderly or low-PS patients. This strategy may be an effective and feasible consolidation option for frail older patients with PCNSL.

Purpose: Brain tumors, characterized by the uncontrolled proliferation of abnormal cells within cerebral tissue, remain clinically challenging entities. Radiotherapy and chemotherapy constitute fundamental therapeutic modalities; however, their effects on healthy brain structures are not fully understood. This study aimed to evaluate the impact of these treatments on volumetric changes in brain structures and tumor size in patients with primary or metastatic brain tumors.

Methods: A retrospective cohort of 47 patients aged 18-90 years treated at Inonu University Turgut Özal Medical Center between 2012 and 2023 was analyzed. Brain MRI scans were evaluated at three time points: pre-treatment, post-radiotherapy, and post-chemotherapy. Radiotherapy was delivered at a median dose of 60 Gy in 30-33 fractions, and temozolomide was used as the chemotherapy agent. Volumetric measurements of the telencephalon, diencephalon, ventricles, white matter, brainstem, cerebellum, and cerebral cortex were performed using MRICloud, while tumor volumes were quantified using the VolBrain platform. All volumetric differences were statistically tested using repeated-measures ANOVA with corresponding p-values reported.

Results: A statistically significant increase in telencephalon volume was observed after radiotherapy, followed by a return toward baseline measurements after chemotherapy. The diencephalon demonstrated a significant and persistent volume reduction following radiotherapy (p < 0.05). No statistically significant volumetric changes were identified in the ventricles, white matter, brainstem, cerebellum, or cerebral cortex (p > 0.05). Tumor volume changes were also statistically evaluated and showed no significant differences across the three time points (p = 0.456), indicating stable disease during the treatment course.

Conclusion: Radiotherapy and chemotherapy lead to region-specific volumetric alterations in the brain. The transient telencephalon enlargement is more likely attributable to treatment-related edema or inflammatory processes rather than functional improvement. The persistent diencephalon volume decline may reflect early treatment-related tissue vulnerability. Incorporating automated volumetric assessment into routine follow-up may support early detection of therapy-related structural changes and facilitate more personalized treatment planning.