Journal of Neuro-Oncology最新文献

Purpose: Few studies have evaluated the health-related quality of life (HRQoL) of patients with diffuse low-grade glioma (LGG) during a clinical and radiological monitoring period. We report a cross sectional cohort study of HRQoL in patients with LGG and compare the results with normative population data. We then explore factors associated with HRQoL.

Methods: We used the European Organisation for Research and Treatment of Cancer QLQ-C30, BN-20 and the Hospital Anxiety and Depression Scale (HADS) to evaluate HRQoL. Averaged QLQC30 and HADS scores were compared with scores of a normative population. A general linear model multivariate analysis of variance was used to investigate the association between HRQoL and independent factors.

Results: A total of 62 patients with LGG completed HRQoL questionnaires. Compared with a normative population, LGG patients reported statistical and clinically significant lower cognitive, emotional, role and social functioning. Fatigue, anxiety, depression and sleep disturbances were frequently reported. Awake surgery and preserved high Karnofsky Performance Status were found to be independent prognostic factors for better global HRQoL, while radiotherapy was associated with worsened HRQoL.

Conclusion: Despite a non-therapeutic and progression free phase, LGG patients report noticeable limitations in several HRQoL subscales. Our study highlights the importance of HRQoL assessment not only at diagnosis or during active therapeutic stage. Further studies are needed to develop better adapted tools of HRQoL assessment.

Purpose: Advances in multidisciplinary treatment of childhood brain tumors have significantly prolonged survival and reduced treatment-related complications. This makes the accessibility of digital neurocognitive assessment an important issue in the post-pandemic era.

Methods: Twenty pediatric brain tumor patients were recruited between August 2023 and August 2024, and a total of eight standardized Cambridge Neuropsychological Test Automated Battery (CANTAB) tests targeting executive function, memory, and attention were applied on a digital system. Subjects with test data exceeding the 5th and 95th percentile ranges were defined as outlier in this context. Three domains (DMS, PAL, SWM) of the normative data for adult patients provided by CANTAB test were used for comparison. Mann-Whitney U test was used to compare differences in treatment modalities and age groups.

Results: Four patients (4/20, 20%) exhibited impairments across four to six cognitive domains, with more than 14 sub-items falling outside the 5th and 95th percentiles.Another 7 patients (7/20, 35%) had impairments confined to a single domain, even though 4 out of 7 (57%) had a total IQ above 100. The subtle neurocognitive impairment of different domains can be effectively identified by automatic digital threshold analysis and reasonably associated with clinical characteristics. The normative data provided by the CANTAB battery for adult populations further enhances the accuracy of detecting neurofunctional impairments.

Conclusion: The CANTAB test was shown to be an evaluable and user-friendly neurocognitive assessment tool for post-treatment follow-up in pediatric patients with brain tumors.

Background: Global comparisons of the burden and impact of cancers of the brain and central nervous system (CNS) are critical for developing effective control strategies and generating etiological hypotheses to drive future research.

Methods: National incidence estimates were obtained from GLOBOCAN 2022, and recorded incidence data from the Cancer in Five Continents series, both developed and compiled by the International Agency for Research on Cancer. We examined the estimated age-standardized incidence rates in 185 countries, as well as time trends in recorded incidence in 35 countries, quantifying the direction and change in the magnitude of the rates using the estimated average percentage change (EAPC).

Results: In 2022, 322,000 new cases of brain and CNS tumors were estimated globally. By world region, the highest incidence rate was seen in Northern America (5.46 per 100,000), Eastern Asia (3.95), and Western Europe (5.56). Africa had relatively lower incidence rates. By country and age group, Austria and the U.S. exhibited the highest rates in boys (3.5 in both), while in adolescents and young adults (AYA), Norway had the highest incidence rates in both males (4.7) and females (3.8). Among adults (+ 40yo), the highest rates in males were observed in the Northern European countries of Norway (18.6), Lithuania (18.4), and Latvia (16.7). In terms of time trends, incidence rates tended to be rather stable in most world regions over the last decade, though increases were observed in selected countries. Trends-based predictions indicate that if incidence rates remain stable, population ageing and growth would mean there would be 474,000 new cases by the year 2045, a 47% increase from 2022.

Conclusion: While the increased incidence rates in certain populations require further study, the future predictions based on stable rates to 2045 are of particular concern, with a close to 50% increase in the number of brain and CNS cancer patients expected over the coming decades. A global 2% decline in rates would be needed to ensure the future brain and CNS cancer burden does not exceed present levels.

Background: Medulloblastoma is the most commonly occurring malignant brain tumor of childhood. Treatment includes a combination of surgery, radiation therapy, and chemotherapy, all of which are associated with cognitive impairments. Despite appreciation of the value of neuropsychological evaluations to assess for cognitive impairments, there are barriers to these evaluations. This study aimed to identify potential demographic, medical, or neighborhood factors associated with barriers to neuropsychological evaluations.

Methods: Retrospective chart review identified pediatric patients with a medulloblastoma diagnosed between 2005 and 2024. Demographic, medical, and neighborhood factors were gleaned from the medical records.

Results: Of the 67 identified patients, only 36 (53.73%) completed a clinical neuropsychological evaluation. Patients who obtained a neuropsychological evaluation were more likely to be non-Hispanic [X² (1,62) = 9.20, p = <.01], diagnosed at younger ages [t(60) = - 8.40, p =  < 0.001], treated with photon radiation therapy [X² (1,62) = 15.24, p =  < 0.001], live closer to the hospital [t(60) = 3.19, p = 0.001], and live in communities with higher health-related resources [t(60) = - 2.09, p = 0.02]. The two groups did not differ by any of the medical/clinical factors.

Conclusions: Neuropsychological evaluations assess for cognitive changes following cancer directed treatment, clarify other diagnostic possibilities (e.g., learning or attention difficulties), and facilitate access to appropriate accommodations and school- and community- based services. Although neuropsychological evaluations are recommended as standard of care following treatment for medulloblastoma, we identified demographic, medical, and neighborhood-level factors that serve as barriers to clinical neuropsychological evaluations. Implications for clinical care and recommendations to address these barriers are discussed.

Background and objectives: Recently, reduction of transcallosal inhibition by contralateral navigated repetitive transcranial magnetic stimulation (nrTMS) improved neurorehabilitation of glioma patients with new postoperative paresis. This multicentric study examines the effect of postoperative nrTMS in brain tumor patients to treat surgery-related upper extremity paresis.

Methods: This is a secondary analysis of two randomized and three one-arm studies in brain tumor patients with new/progressive postoperative paresis. Patients underwent either low frequency contralesional nrTMS or sham stimulation followed by physiotherapy. Outcome was assessed on postoperative day 1, 7, and after 3 months using British Medical Research Council score (BMRC), Fugl-Meyer assessment (FMA), Karnofsky Performance Scale (KPS) and National Institutes of Health Stroke Scale (NIHSS).

Results: A total of 135 patients (mean age of 53.8 years, 60 women) were included, of whom 51 patients were treated in RCTs (30 treatment group, 21 sham group) and 84 in prospective, single-arm studies. Linear mixed models showed an advantage for the treatment group for the BMRC (7 days: OR 3.28; 95%CI: 1.08-9.99; 3 months: OR 2.03, 95%CI: 0.65-6.39) and KPS (7 days: mean difference (MD) 11, 95%CI: 2-19; 3 months: MD 11, 95%CI: 2-20), less pronounced for the FMA (7 days: MD 0.28, 95%CI: -0.34-0.9; 3 months: MD 0.14, 95%CI: -0.52-0.81). A stronger treatment effect was evident with proven ischemia on the postoperative MRI. To observe an improvement by at least one grade at 3 months, the number needed to treat (NNT) for the entire cohort is 4 (BMRC) and 3 patients (KPS), respectively.

Conclusion: Our multicenter data confirm the positive treatment effect of nrTMS to reduce transcallosal inhibition with a considerably low NNT - especially if caused by ischemia.

Purpose: Craniopharyngiomas are histologically benign tumors, but their proximity to vital neurovascular structures can significantly deteriorate functional prognoses and severely restrict patients' social interaction and activity. We retrospectively identified risk factors related to the functional prognoses in patients with craniopharyngioma treated at our center.

Methods: A retrospective analysis was conducted on 40 patients who underwent surgery for craniopharyngioma and follow-up at our institution between 2003 and 2022. Functional prognoses were evaluated in terms of obesity (body mass index [BMI] ≥ 25 for adults, BMI-Z ≥ 1.65 for children), visual function, endocrine function, and social participation. We investigated whether patient characteristics, tumor size, tumor location, hypothalamic involvement, surgical hypothalamic damage, extent of resection, and recurrence rate correlated with these functional prognostic factors.

Results: The median age at diagnosis was 28.0 years, with a median follow-up of 80.5 months. Postoperative obesity was present in 22 patients, and those with postoperative obesity had a significantly higher preoperative BMI or BMI-Z (preoperative BMI for adults: p = 0.074; preoperative BMI-Z for children: p = 0.020) and were significantly correlated with preoperative hypothalamic involvement grade 2 (p = 0.012) and surgical hypothalamic damage grade II (p = 0.0001). Deterioration in social participation was significantly associated with a larger tumor size (p = 0.023) and tumor recurrence (p = 0.0047).

Conclusions: Patients with higher preoperative BMI or BMI-Z and hypothalamic involvement have a greater risk of postoperative obesity, and larger tumor size and recurrence can significantly deteriorate the rate of patients' social participation.

Purpose: The aim of this nationwide retrospective cohort study was to evaluate the timing of the first specialist palliative care (SPC) contact and its impact on the use of hospital resources at the end of life in patients with brain tumors.

Materials and methods: The analysis comprised 373 brain tumor patients who died during 2019 in Finland. Patients were divided into two groups according to the time of first SPC contact: early, i.e. first SPC contact more than 30 days before death, and late, i.e. no SPC contact or 30 days or less before death.

Results: 216 (58%) were male, with a mean age of 67 years (range 18-94). SPC contact was established for 102 (27%) patients and the median time of first SPC contact before death was 76 days. Patients with an early SPC contact had fewer outpatient clinic contacts (28% vs. 53%; p-value < 0.001) and fewer hospitalization (10% vs. 37%; p-value < 0.001) in secondary care compared with patients with late SPC contact. Early SPC contact had no impact on emergency department contacts. Patients with early SPC contact were more likely to die at long term care facility or in SPC wards instead of hospital (p-value < 0.001) compared to patients with late SPC contact (hospital deaths 51% vs. 80%, respectively).

Conclusions: Early SPC contact reduced the burden on secondary care for brain tumor patients in the last months of life. Palliative care contact should be offered early to all brain tumor patients.

Purpose: To investigate the prognostic significance of contrast enhancement (CE) in grade 2 oligodendroglioma (ODG) and explore its clinical implications.

Methods: Patients diagnosed with isocitrate dehydrogenase (IDH)-mutant, 1p/19q co-deleted ODG between 2009 and 2016 were retrospectively enrolled from a single institution. The presence of CE was identified on preoperative MRIs, and clinical, radiologic, and histopathological data that was extracted. Subgroup analyses were performed to evaluate differences in these factors and prognoses. Cox proportional hazards regression analyses were used to identify prognostic factors.

Results: 258 patients with pathologically confirmed WHO grade 2 ODGs were included. The entire cohort was divided into the CE group (n = 133, 51.6%) and the non-CE group (n = 125, 48.4%). Patients with CE on preoperative MRI showed significantly worse progression-free survival (PFS) compared to those without CE (median PFS: 133 months vs. not reached; p < 0.001) and overall survival (OS) (mean OS: 151 months vs. 155 months; median OS: not reached; p = 0.021). Furthermore, CE presence was identified as an independent prognostic factor in the Cox multivariate analysis. Patients within the CE cohort were further categorized into strong and weak CE subgroups based on the pattern of CE. Logistic regression analysis revealed that non-frontal lobe location (OR = 3.287, p = 0.042), higher Ki-67 index (OR = 3.782, p = 0.027), and 1q/19p co-polysomy (OR = 9.658, p = 0.001) were significantly associated with a higher incidence of the strong CE in ODGs. Furthermore, ODG patients in the strong CE subgroup demonstrated the poorest survival outcomes.

Conclusion: CE on preoperative MRI is a valuable prognostic marker in the grade 2 ODGs, with strong CE indicating the poorest survival outcomes. Further validation through larger cohort studies will help confirm these findings and refine survival stratification in clinical practice.

Background: The receptor tyrosine kinase (RTK)/Ras/Raf/MEK/ERK signaling pathway is one of the most tumorigenic pathways in cancer, with its hyperactivation strongly linked to the aggressive nature of glioblastoma (GBM). Although extensive research has focused on developing therapeutics targeting this pathway, clinical success remains elusive due to the emergence of resistance mechanisms.

Objective: This review investigates how inhibition of the RTK/Ras/Raf/MEK/ERK pathway alters transcription factors, contributing to acquired resistance mechanisms in GBM. It also highlights the critical role of transcription factor dysregulation in therapeutic resistance.

Methods & results: Findings from key studies on the RTK/Ras/Raf/MEK/ERK pathway in GBM were synthesized to explore the role of transcription factor dysregulation in resistance to targeted therapies, radiation, and chemotherapy. The review highlights that transcription factors undergo significant dysregulation following RTK/Ras/Raf/MEK/ERK pathway inhibition, contributing to therapeutic resistance.

Conclusion: Transcription factors are promising targets for overcoming treatment resistance in GBM, with cotreatment strategies combining RTK/Ras/Raf/MEK/ERK pathway inhibitors and transcription factor-targeted therapies presenting a novel approach. Despite the challenges of targeting complex structures and interactions, advancements in drug development and precision technologies hold great potential. Continued research is essential to refine these strategies and improve outcomes for GBM and other aggressive cancers.