Neuro-oncology practice最新文献

Background: This study aimed to identify healthcare professionals' perceptions of the facilitators and barriers impacting the management of brain tumor-related personality and behavior changes in adults.

Methods: We conducted semi-structured interviews with neuro-oncology healthcare professionals' working in Australia (N = 22). Interview recordings were transcribed, and codebook thematic analysis methods applied.

Results: Two themes identified as barriers in managing brain tumor-related personality changes were (1) Systemic challenges, with two sub themes of "fall between the gaps" and waitlist and unavailability of services and (2) patient and carer factors, comprising three sub-themes of "evolving injury," complexities of non-disclosure, and attitudes toward help seeking. Two themes identified as facilitators were (1) systemic supports for healthcare professionals encompassing three sub-themes; stepped care model, multidisciplinary team approach, and professional development opportunities. The second facilitator theme was (2) infrastructure, with four sub-themes: accessible specialist care with follow-up, up-to-date information resources, carer supports, and Cancer Care Coordinator model.

Conclusions: The findings emphasize the need for improved infrastructure and systemic supports for healthcare professionals to allow for a more integrated approach with routine screening of psychosocial needs including patient personality and behavior changes, timely referrals, and multidisciplinary team care across the disease trajectory. Addressing barriers and promoting facilitators is essential for improving the quality of life for people with brain tumor and reducing the potential for burden on carers related to personality and behavior changes. Results of this study provide a starting point with a proposed stepped-care approach that requires further testing in clinical practice.

Background: The aim of this nationwide study was to identify predictive factors for isolated local, non-local, and combined treatment failure in newly diagnosed glioblastoma patients.

Methods: All adults with newly diagnosed glioblastoma in Denmark between 2014 and 2019 who were planned for long-course (chemo)radiotherapy were included. The MRI scan of first progression following RANO criteria was used to assess the site of failure. Multivariable multinomial logistic regression was applied to analyze the association between potential risk factors and the site of failure. Prediction models were derived.

Results: We included 939 patients, of whom 758 had radiographic progression. Of those, 525 patients (69%) had isolated local failure, 114 (15%) non-local, and 119 (16%) combined. In patients with an MGMT promotor methylated (300) versus unmethylated (398) tumor, local failure was 66 versus 73%, non-local 21 versus 10%, and combined 12 versus 17%, respectively (P-value < .001). In multivariable analysis, MGMT promotor methylation status and tumor location were significantly associated with the failure site. In a model using MGMT promotor methylation status, tumor location, focality, extent of resection, and WHO performance status (poorly calibrated, C-index 0.63), the predicted probability (95% CI) of local failure varied from 0.47 (0.24 to 0.70) to 0.85 (0.74 to 0.97) between respective subgroups. That of non-local varied from 0.03 (0.00 to 0.07) to 0.36 (0.15 to 0.57) and combined from 0.05 (0.03 to 0.14) to 0.35 (0.05 to 0.65).

Conclusions: It was not feasible to identify strong predictors for the site of first treatment failure, and hence, to derive an accurate prediction model. Isolated local failure was dominant in both patients with an MGMT promotor methylated and unmethylated tumor.

Background: This study aims to evaluate the surgical outcomes and prognostic factors influencing overall survival (OS) and progression-free survival (PFS) in patients with molecularly confirmed oligodendrogliomas focussing on the extent of resection (EOR) and volumetric analysis.

Methods: We conducted a retrospective analysis of 115 adult patients with oligodendroglioma at our institution from January 2010 to December 2020. Inclusion criteria encompassed histologically and molecularly confirmed grade 2 and 3 oligodendroglioma, age above 18 years, availability of pre- and postoperative imaging, and complete follow-up data. Surgical outcomes were categorized by EOR and volumetric assessments were performed using neuroimaging. Mean OS and PFS were calculated using the Kaplan-Meier method (As mortality was < 50%) and univariate/multivariate analyses were conducted to identify prognostic factors.

Results: The cohort had a median age of 42 years (range 18-77), with GTR achieved in 47% of primary operations. Median follow-up was 6.3 years. OS was significantly influenced by age (p < 0.0001) and EOR, with a mean OS of 134 months and a mean PFS of 117 months. Volumetric reduction of tumor volume greater than 80% correlated positively with both OS and PFS. The analysis also highlighted the importance of adjuvant therapy in improving PFS.

Conclusion: This study confirms that younger age, extensive volumetric reduction, and intraoperative adjuncts are associated with improved OS and PFS in patients with oligodendroglioma. While the EOR impacts OS significantly in grade 3 tumors, further research is necessary to determine optimal surgical strategies for grade 2 oligodendrogliomas.

Background: We aimed to evaluate the preferred and received end-of-life (EoL) care in glioblastoma patients who participated in a local nurse-led advance care planning (ACP) program, as well as the perceived quality of care.

Methods: Twelve proxies of patients with glioblastoma who participated in an ACP program completed a study-specific questionnaire after the patient deceased, comprising the following topics: organization of EoL care, patient's preferences and wishes, received care during the last 3 months, and proxies' experiences with EoL care. The outcomes were compared with those from a historical cohort of Dutch patients with glioblastoma (n = 71) who did not receive ACP.

Results: Nine out of 12 patients lived at home 3 months before death and most (8/12) died at home. In 11/12 cases, the general practitioner was responsible for EoL care in the last week before death. Proxies indicated that most patients rated their quality of received EoL care as very good to excellent in the last 3 months and last week before death (67% and 75%, respectively), that 8/12 patients died with dignity and that all proxies were involved as much as they wanted in decision-making. One-third of the patients in the ACP cohort were relocated at least once in the last 3 months versus 48% of the patients in the historical cohort.

Conclusions: Despite the limited number of participants, this study suggests that a nurse-led ACP program has a positive impact on several aspects of EoL care for patients with glioblastoma.

Background: Fibroblast growth factor receptor (FGFR) alterations are potential oncogenic drivers that occur in a subset of patients with gliomas, but the natural history of these tumors is not clearly defined. An understanding of outcomes of FGFR-driven glioma has implications for targeted drug development for FGFR inhibitors, which are approved for other cancers.

Methods: We performed a retrospective cohort study of patients with gliomas who harbored FGFR alterations, including fusions, single nucleotide variant (SNV), and copy number variant (CNV) alterations seen at Massachusetts General Hospital between 2003 and 2023. The electronic medical record was searched to identify additional molecular data, treatment, and MRI scans. Kaplan-Meier analysis was used to assess progression-free and overall survival (OS).

Results: Thirty-one patients with glioblastoma (GBM), diffuse astrocytoma, and glioneuronal tumors with FGFR alterations were identified: 17 with FGFR fusions, 10 with SNV, and 4 with CNV. FGFR3-TACC3 was the most common fusion in patients with GBM or diffuse astrocytoma. Median OS in patients with GBM was 2.75 years, despite 55% of tumors having an unmethylated MGMT promoter. There were no clearly co-occurring mutations with an FGFR alteration. Of 7 patients who underwent subsequent surgery, 6 lost the original FGFR alteration. No patient received an FGFR inhibitor.

Conclusions: While FGFR alterations are rare in glioma, patients with FGFR-altered GBM may have prolonged survival, which has implications for clinical trial design. We found loss of FGFR alteration at the time of subsequent surgery, raising concern for the therapeutic potential of FGFR-targeting agents in recurrent gliomas.

Background: Infiltrating gliomas are progressive brain tumors with an invariably fatal prognosis. Nutritional interventions, such as the ketogenic diet (KD) and caloric restriction, have been explored as adjunct therapies. This systematic review assesses the evidence for the efficacy and safety of these dietary strategies in the management of diffuse gliomas.

Methods: A systematic search was conducted in PubMed, covering studies up to February 23, 2024. Inclusion criteria were English-language clinical and observational studies that examined the impact of dietary interventions on diffuse glioma outcomes. Studies were evaluated for risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool and synthesized descriptively due to the heterogeneity of study designs and outcomes.

Results: Eighteen studies (2 randomized clinical trials [RCTs] and 16 observational studies) met the inclusion criteria. The RCTs, classified as high-quality evidence, did not demonstrate significant survival benefits from dietary interventions. Observational studies, while supporting the feasibility and safety of these interventions, provided inconsistent evidence regarding their efficacy in improving overall survival (OS) or progression-free survival (PFS). Methodological limitations, including small sample sizes, variability in dietary adherence, and patient heterogeneity, were common across studies.

Discussion: The evidence suggests that while dietary interventions like KD and caloric restriction are generally safe and feasible for diffuse glioma patients, their efficacy in improving survival outcomes remains inconclusive. Limitations such as small sample sizes and variability in adherence underscore the need for larger, well-designed trials to evaluate the clinical benefits of these interventions.

Background: Patients with primary brain tumors navigate a devastating diagnosis and cognitive and physical decline. Available educational materials should be easily comprehensible, informative, reliable, culturally sensitive, and patient oriented.

Methods: We assessed websites of major brain tumor centers in the United States and patient organizations for readability using multiple calculators, quality and reliability using DISCERN and JAMA tools, and cultural sensitivity using the Cultural Sensitivity Assessment Tool scale. We determined whether sites addressed practical, emotional, social, and spiritual needs of a patient. Brain tumor centers were categorized based on NCI-designation and fulfillment of Guiding Principles developed by the American Brain Tumor Association.

Results: Websites of 91 brain tumor centers and 8 patient organizations were examined. Fewer than 10% of brain tumor centers' websites were readable at an eighth-grade level. There was no significant difference in readability between brain tumor centers and patient organizations. Patient organizations outperformed brain tumor centers on both quality measures, with no differences seen based on the category of centers. Only 48% of brain tumor centers and 63% of patient organizations scored at recommended levels on all cultural sensitivity scales. Most patient organizations, but few brain tumor centers, addressed practical, social, emotional, and spiritual needs.

Conclusions: Publicly available brain tumor education materials are frequently at a high reading level. Quality and cultural sensitivity can be improved by citing sources, describing treatment risks, describing outcomes without treatment, addressing quality of life during treatment, addressing myths, and visually representing more patients. Patient organizations can provide models for addressing patient needs.

Background: To address the unmet support needs of neuro-oncology family caregivers, our team developed an 8-week intervention, CARING. CARING consists of electronic Social Network Assessment Program (eSNAP), a web-based tool to identify and organize support resources, and manualized navigation sessions for caregivers. Our objective is to evaluate the methodological feasibility of our randomized controlled trial (RCT) study design, and caregiver engagement and acceptability of CARING.

Methods: The RCT compared CARING to a waitlist control. RCT feasibility was evaluated based on caregiver and patient recruitment and retention. CARING intervention engagement was evaluated via caregiver participation data over 8 weeks. CARING intervention acceptability was evaluated via quantitative satisfaction scales, as well as qualitative debrief interviews of caregiver participants at 8 weeks.

Results: Of 502 potentially eligible patient-caregiver dyads approached, 148 consented (29%). Although effective, randomization was ended due to mid-study coronavirus disease (COVID)-related administrative issues that impacted recruitment rates. In the last year, all participants were assigned to the intervention condition to prioritize the evaluation of CARING. Of those enrolled, 87% of caregivers and 77% of patients completed the Week-8 assessment. Of the 81 caregivers assigned to CARING, 88% used eSNAP at least once, and 73% engaged with 6+ navigation topics. At 8 weeks, 77% of caregivers reported that they liked CARING and 81% found it helpful. Qualitative data provided additional insights into intervention acceptability.

Conclusions: Results suggest that the RCT methodology used is feasible, and neuro-oncology caregivers engaged with CARING components and found the intervention acceptable. Future studies can apply key lessons in developing or implementing other caregiver interventions.