Neuro-oncology practice最新文献

Background: Neuro-oncology education in American neurology departments is highly variable, with no clear guidelines on appropriate practices. To better understand its current state, we focus on the perspective of departmental Grand Rounds (GR), views of adult neurology residency program directors (ANRPD), neuro-oncologists, and residents.

Methods: First, we obtained GR series from academic years 2017-2018 and 2018-2019 via an online search and direct emails to neurology residency programs. Second, two online surveys were dispensed to ANRPD and neuro-oncologists. Third, a cohort of neurology residents completed surveys with pre/post-didactic tests.

Results: Neuro-oncology consisted of 7% (28/ 411) GR in 2017-2018 and 6% (29/463) in 2018-2019; approximately 20% of institutions had no neuro-oncology GR. Twenty neuro-oncologists and 25 of the 175 ANRPDs completed the surveys. Respondents thought 1-to-4 GR annually was adequate. Thirty-five residents completed the survey. Residents might consider neuro-oncology with more exposure (77%, 27/35) and a stronger knowledge base (57%, 20/35). After 8-hours of didactics, residents demonstrated significant (P = .019) pre-/post-test improvement.

Conclusions: Here, we begin to define the status of several aspects of neuro-oncology education: 1 in 5 academic institutions do not have any neuro-oncology GR lectures annually, and both ANRPDs and neuro-oncologists agree that 1-to-4 lectures annually are adequate. Residents overwhelmingly stated they would be more interested in neuro-oncology with more exposure, and a pilot study of 8 hours of didactic did show knowledge improvement. While these initial datasets require confirmation in larger studies, it suggests that small changes to the current state at some institutions could have a meaningful impact.

Background: Brain metastases (BMs) are the most common intracranial malignancy in adults, contributing significantly to cancer-related morbidity and mortality. Early detection is critical for optimizing treatment and improving survival. This systematic review evaluates the diagnostic potential of liquid biopsy biomarkers for detecting BM from lung, breast, and other cancers.

Methods: A comprehensive search was conducted in MEDLINE, Embase, and BIOSIS databases using keywords related to liquid biopsy, biomarkers, and BMs. Data on participant characteristics, diagnostic reference standards, types of biomarkers, primary cancer origins, and diagnostic outcomes were independently extracted. Diagnostic performance was evaluated using sensitivity, specificity, and area under the curve (AUC). Risk of bias was assessed using the QUADAS-2 tool.

Results: Thirty-one studies involving 5676 participants were included, assessing biomarkers such as cfDNA, miRNAs, proteins (eg, neurofilament light [NfL], glial fibrillary acidic protein [GFAP], S100B), metabolomic profiles, and multi-marker models. NfL and GFAP emerged as the most promising biomarkers, demonstrating moderate to strong diagnostic performance across multiple cancer types. Multi-marker models combining NfL and GFAP achieved sensitivity and specificity exceeding 90%. S100B showed variable performance due to differences in study designs and thresholds. Emerging biomarkers like cfDNA and metabolomic profiles showed potential but require further validation.

Conclusions: Liquid biopsy biomarkers, particularly NfL and GFAP, hold promise for non-invasive BM detection. Clinical utility may be in the initial cancer workup for localized tumor to prompt brain imaging. Future research is required to validate biomarkers in larger, diverse populations across different cancer types.

Background: Language testing and mapping procedures are considered the gold standard for safe tumor resection and preservation of language and communication in patients with tumors located in an area eloquent for language, especially in the presence of low-grade gliomas. However, the current status of language testing in awake craniotomy in the United Kingdom is unknown. The main aim of this study was to describe the language testing practices in awake brain surgery across the United Kingdom.

Methods: An online survey was addressed to medical practitioners working with brain tumor patients during the phases of language testing. Questions inquired about the tests and approaches for language testing before, during, and after the surgery. The survey also explored the management of bilingual (for the sake of simplicity, the term bilingual is used throughout the article to refer to patients who speak 2 or more languages) brain tumor patients and gathered personal perspectives from clinicians.

Results: Responses were obtained from 37 clinicians. Speech and language therapists and neuropsychologists administered language tests to patients, and those with sufficient language skills for completing intraoperative tests were eligible for awake mapping. A combination of standardized language batteries and homemade tasks were used for language testing, leading to variability in testing practices across institutions. For language mapping, the most popular tasks were picture naming, sentence completion, and repetition. Object and action naming were used across both the monolingual and bilingual patient groups. The timing of postoperative assessments varied according to patient needs and clinician availability. Bilingual patients were evaluated with interpreters and limited materials, compared to monolinguals.

Conclusions: The provision of awake craniotomy language testing presents differences across UK-based institutions. Responders advocate for more comprehensive, updated, and inclusive materials to facilitate language testing in modern patient cohorts spanning a wide range of linguistic skills and foreign languages.

Background: High-grade gliomas (HGG) are the most aggressive and infiltrative subtype of primary brain tumors. The average survival rate from diagnosis is less than 2 years, and all patients eventually experience a recurrence. However, our understanding of patients' and their families' experiences and coping mechanisms concerning the inevitable recurrence remains limited. This qualitative study explored how patients with HGG and their close family members experience and cope with their fear of recurrence and the diagnosis of HGG recurrence.

Methods: Semistructured individual interviews were conducted with patients with HGG and their family members. Following an inductive phenomenological hermeneutical approach, the interviews were coded, and the findings were divided into themes.

Results: The study included 15 patients and 14 family members between the ages of 22 and 79. We identified 3 interrelated themes illustrating the complex experiences related to an HGG recurrence. Theme I, Navigating the fear of recurrence, describes experiences and coping mechanisms during the disease trajectory. Theme II, Facing reality and preparing for death and Theme III, Redefining hope in the era of recurrence, illustrate experiences related to the recurrence diagnosis and redefinition of hopes for the future.

Conclusion: Fear of recurrence is prominent in patients with HGG and their families, and the recurrence diagnosis triggers thoughts about death and the end-of-life phase. This new knowledge can be used to tailor support to patients and family members during the disease trajectory and personalize advance care planning consultations.

Background: Patients with IDH-mutant low-grade glioma (LGG) can achieve many years of survival with radiation (RT) and chemotherapy. There is a risk of overtreatment and negative treatment side effects if these patients are unnecessarily retreated due to perceived tumor progression in the absence of true tumor regrowth. A better understanding of volumetric postradiation FLAIR changes will help with the clinical interpretation of disease progression/treatment effect and will help guide management decisions. We conducted this research to characterize the changes in MRI FLAIR hyperintensity that occur in LGG patients following RT, to better understand the radiation-treatment effects or "pseudoprogression" that occurs in the absence of true tumor regrowth.

Methods: Serial MRI scans of patients with LGG were reviewed, including pre-RT and for 2.5 years post-RT. Segmentation for volumetric analysis was performed with manual supervision using ITK-SNAP (open-source segmentation software). Descriptive statistics are reported.

Results: Sixteen patients with histologic grade 2 gliomas were included. 159 MRI scans were segmented using ITK-SNAP (median 9.5 MRIs/patient). Nine of 16 MRIs showed decreasing FLAIR volume immediately post-RT, while 7/16 showed increasing FLAIR volume. After the initial post-RT MRI, 12/16 patients had MRIs with an increase in FLAIR volume sometime during the first year. The FLAIR volume stabilized or decreased a median of 18.4 months and a mean of 15.0 months post-RT.

Conclusions: FLAIR hyperintensity changes on MRI are highly variable in the first 1.5 years post-RT in low-grade glioma, but after 1.5 years, FLAIR volumes stabilize and decrease, likely indicating the inflection point where post-RT pseudoprogression stabilizes.

Background: Social determinants of health (SDOHs) may impact outcomes of patients with high-grade glioma (HGG). We examined the effect of rurality and socioeconomic status on treatment and survival of patients with newly diagnosed HGG.

Methods: This retrospective analysis used 2 cohorts from the Utah Cancer Registry, including all patients diagnosed with HGG (2000-2019) (cohort 1) and all HGG patients who underwent surgery (2000-2020) (cohort 2). Patient demographics were evaluated descriptively. Kaplan-Meier curves, log-rank tests, and multivariable Cox regression analysis were used for survival analyses.

Results: Patients from cohort 1 living in Frontier (n = 60), Rural (n = 363), and Urban (n = 1502) Utah traveled mean distances of 95.9 ± 69.7, 50.0 ± 66.5, and 10.7 ± 11.3 miles, respectively, for treatment (P < .001). Urban patients were diagnosed at a younger age (54.2 ± 20.2 years) than patients from Frontier (56.8 ± 20.3 years) and Rural (57.3 ± 17.6 years) areas (P < .019). Frontier patients were more likely to have lower income than Urban patients (30.7% vs 65.5%, P < .001). Rural patients (13.0 months [95% CI 11.2-14.8]) experienced shorter median survival than Urban patients (16 months [95% CI 14.3-17.7]) (P = .049). Among patients undergoing surgery, those with private insurance (54.2%, P < .001) and in high-income (60.2%, P = .007) and socioeconomic (60.4%, P = .005) quartiles received adjuvant chemotherapy and radiation more frequently.

Conclusion: HGG patients from Frontier and Rural counties in Utah encountered greater SDOH barriers without experiencing delays in resection. Rural patients had shorter survival than Urban patients. Further investigation is needed to determine whether additional SDOHs (income and insurance status) may intersect and contribute to shorter survival and less access to adjuvant therapy.

Background: Core Outcome Sets (COS) define the minimum outcomes that should be measured and reported in all clinical trials for a specific health condition or health area. The aim was to develop 2 COS for intracranial meningioma to be used in future clinical studies: COSMIC: Intervention for effectiveness trials and COSMIC: Observation for studies of incidental/untreated meningioma.

Methods: A study advisory group was formed with representation from international stakeholder groups: EORTC BTG, ICOM, EANO, SNO, RANO-PRO, BNOS, SBNS, BIMS, TBTC, International Brain Tumour Alliance, and Brainstrust. Outcomes of potential relevance to key stakeholders were identified and rationalized to populate 2 eDelphi surveys. Participants were recruited internationally and asked to rate each outcome on its importance for inclusion in the COS. The 2 final COS were ratified through 2, one-day, online consensus meetings.

Results: The COSMIC: Intervention eDelphi survey contained 25 items and was completed by 199 participants. Following the consensus meeting, 15 outcomes were included. The COSMIC: Observation eDelphi survey contained 17 items and was completed by 129 participants. Sixteen outcomes were included. Eight core outcomes were common to both COS; tumor growth, physical, emotional, and neurocognitive functioning, overall quality of life, progression-free survival, meningioma-specific mortality and overall survival. Role and social functioning were core outcomes in COSMIC: Observation but not COSMIC: Intervention.

Conclusions: Uptake of these COS in relevant future meningioma clinical studies will ensure that stakeholder-determined, critically important outcomes are consistently measured and reported across similar clinical studies.