Journal of Neuro-Oncology最新文献

Background: Malignant glioma patients face unique end-of-life (EOL) challenges due to their aggressive disease course and early neurocognitive decline. This study aimed to compare EOL patterns between patients with malignant glioma and those with solid tumors referred for palliative care (PC).

Methods: We conducted a retrospective cohort study of adults with malignant glioma or five major solid tumors (lung, colorectal, gastric, liver, and pancreato-biliary) who received PC consultation at a South Korean tertiary hospital (2018-2022). Clinical data were linked to the National Health Insurance Service database. Outcomes included documentation of advance care planning (ACP) elements, healthcare utilization, and place of death, which were analyzed using multivariable regression.

Results: Compared with 4,283 individuals with solid tumors, those with malignant glioma (n = 229) were younger and referred to PC earlier. ACP documentation was substantially lower (20.1% vs. 58.0%; aOR, 0.13; 95% CI, 0.09-0.19), and only 21.4% of life-sustaining treatment decisions were documented as patient-determined versus 67.1% in solid tumors (aOR, 0.07; 95% CI, 0.04-0.12). Malignant glioma was also associated with fewer emergency visits (29.3% vs. 48.7%) and less chemotherapy (29.7% vs. 42.0%) but lower hospice use (62.0% vs. 73.1%; aOR, 0.57; 95% CI, 0.43-0.77). Medical costs were higher six months before death but lower in the final month among patients with malignant glioma compared with those with solid tumors. Death occurred more often in nursing care hospitals (20.5% vs. 6.8%, p < 0.0001) or at home/non-hospital settings (15.3% vs. 10.0%, p = 0.0106).

Conclusion: In this single-center cohort, malignant glioma patients were less likely to have documented ACP elements and more likely to die in nursing hospitals than those with solid tumors. Early ACP and tailored palliative strategies are essential.

Background: Diffuse midline gliomas, including diffuse intrinsic pontine gliomas, represent one of the most aggressive pediatric malignancies in the central nervous system with a uniformly poor prognosis. They can be consistently identified by mutations in histone H3 K27M, which are associated with aggressive tumor biology, marked resistance to therapies, and abysmal survival. The current review critically assesses the existing application of immunotherapeutic modalities in DMGs, emphasizing biological hurdles in efficacy, translation methodologies, and prospects in attaining sustained responses.

Methods: We examined preclinical and early clinical studies in DMGs for immune therapies such as peptide vaccines against H3K27M antigens, chimeric antigen receptor T-cell therapies, immune checkpoint modulation, and radioimmunotherapy. Current developments in the interface of cancer neuroscience and tumor interaction with neurons were incorporated in a manner relevant to immune suppression in the microenvironment of DMG. Although these tumors have traditionally shown poor immune reactivity because of low tumor mutational burden, immune-privileged sites, and a strongly suppressive tumor microenvironment, a variety of different immune therapeutic approaches have shown promising early efficacy. Of particular interest are neoantigen-targeted vaccines and CAR T-cell therapy using surface antigens. Preliminary findings suggest an important role for neuron-glioma synaptic and paracrine signaling in mediating tumor progression and immune evasion.

Conclusions: Immunotherapy for DMGs is moving from a conceptual state to a translational reality. A better understanding of the realm of tumor immune-neural crosstalk, combination therapies, and immune biology in pediatric patients will be critical in addressing resistance and providing durable control for these aggressive malignancies.

Purpose: Palliative care (PC) remains underutilized among patients with primary brain tumors, despite the life-threatening nature of the disease and the high symptom burden. This study aimed to assess how the timing of a PC decision (i.e., terminate life-prolonging anticancer treatments) is associated with emergency department visits and hospitalizations at the end of life (EOL).

Methods: This single-center retrospective cohort study included adult patients (≥ 18 years) with primary brain tumor treated at the Comprehensive Cancer Center of Helsinki University Hospital during 2017-2018 who died by the end of 2018. Patients were categorized into "early PC decision" (> 30 days before death) or "late/no PC decision" (≤ 30 days or no decision). We extracted data on hospital resource use from electronic medical records.

Results: Among 162 patients (mean age 66 years, range 24-97; 57% male), 64% had a documented PC decision, with 43% of the total cohort having an early PC decision. Patients with an early PC decision had significantly fewer emergency department visits (10% vs. 25%; p = 0.015) and fewer hospitalizations (4% vs. 29%; p < 0.001) in their final month of life compared to those with a late/no decision. Overall, 34% of patients visited a dedicated PC unit, with a median of 93 days (range 5-619) from the first PC unit visit to death.

Conclusions: An early PC decision significantly reduced acute hospital resource use at EOL among brain tumor patients. Nonetheless, approximately one-third of patients had no documented PC decision, and similarly low numbers had PC unit visits, highlighting ongoing gaps in timely PC initiation.

Purpose: Postoperative seizures are a significant complication following glioma surgery. While prophylactic antiseizure medications (ASMs) are widely prescribed, the optimal duration of prophylaxis remains unclear. Current guidelines lack specificity regarding high-risk subgroups that may benefit from extended ASM therapy. Here, we aimed to determine whether ASM duration affects postoperative seizure occurrence and to identify patient subgroups in whom longer ASM prophylaxis significantly reduces seizure risk.

Methods: We conducted a retrospective cohort study of 206 adult high-grade glioma patients who underwent resection. Postoperative seizure occurrence was the primary outcome. ASM duration was modeled using logistic regression with cubic splines to detect non-linear effects, and a classification decision tree was trained to identify high-risk subgroups. Observed seizure rates were compared across data-driven ASM duration thresholds. Time-to-event analysis was also performed.

Results: Mean age was 48.1 years (SD 15.9); 48.5% were male. Most tumors were located in the frontal (43.3%) and temporal lobes (29.6%), with glioblastoma being the most common histology (65%). Spline regression revealed no statistically significant association between ASM duration and seizure occurrence (pseudo R² = 0.0066; p = 0.69). However, decision tree analysis suggested a clinically meaningful subgroup: patients aged > 52.5 years with subtotal resection had increased seizure risk when ASM duration was ≤ 135 days. In this group, extending ASM prophylaxis was associated with a lower seizure rate.

Conclusion: While extended ASM prophylaxis was not broadly associated with reduced seizure risk, tree-based analysis suggested an older, incompletely resected subgroup that may benefit from prolonged ASM use.

Registration number: IR.TUMS.SINAHOSPITAL.REC.1402.091 retrospectively registered.

Background: Brain metastases (BM) from non-small cell lung cancer (NSCLC) are associated with limited prognosis. Although surgical resection is part of multimodal management, the prognostic relevance of surgical intracranial tumor load reduction in the era of stereotactic radiotherapy and modern systemic therapies remains unclear.

Methods: This retrospective bicentric cohort study included 285 adults with histologically confirmed NSCLC who underwent BM resection. Pre- and postoperative MRI were used for volumetric assessment. Gross-total resection (GTR) was defined as the absence of measurable postoperative residual volume (RV). Outcomes were overall survival (OS) and intracranial progression-free survival (iPFS). Multivariable Cox regression models adjusted for age, preoperative performance status, extracranial metastases, number of BM, and postoperative radiotherapy and systemic therapies.

Results: Median OS was 14.3 months and median iPFS was 8.0 months. GTR was achieved in 96 patients (34% overall; 38% of patients with evaluable volumetric imaging) and was independently associated with longer OS (adjusted HR, 0.51; 95% CI, 0.30-0.86) and prolonged iPFS (adjusted HR, 0.55; 95% CI, 0.31-0.99). Postoperative RV, analyzed continuously or categorically, showed no consistent association with OS or iPFS. The benefit of GTR was most pronounced in patients with single BM or without extracranial metastases.

Conclusion: Achieving complete intracranial tumor resection, rather than the amount of postoperative residual volume, was consistently associated with improved survival and intracranial disease control. These findings support the clinical relevance of GTR in selected NSCLC-BM patients and may inform patient counselling and surgical decision-making, while warranting further investigation in patients with multifocal but safely resectable intracranial disease.