Neuro-oncology practice最新文献

Background: Radiation necrosis is a recognized complication following radiotherapy for primary brain tumors, presenting diagnostic and therapeutic challenges, and potentially masquerading as tumor recurrence. This study aims to delineate the clinical trajectory, management strategies, and outcomes of histologically confirmed radiation necrosis in patients treated for primary brain tumors.

Methods: We conducted a retrospective review of patients who underwent surgical intervention for suspected tumor recurrence at our institution between 2010 and 2022, following adjuvant radiotherapy. Cases with histopathologically confirmed radiation necrosis were identified and analyzed for onset, clinical symptoms, radiological features, correlation with radio- and chemotherapy, management approaches, and disease progression.

Results: Out of 276 patients operated for suspected recurrent brain tumors, 14 (5%) were histopathologically diagnosed with radiation necrosis. The latency period from radiotherapy to diagnosis ranged from 3 to 40 months. Notably, patients with oligodendrogliomas exhibited a significantly higher incidence of radiation necrosis (26%), underscoring a substantial risk association (P < 0.001). Conversely, the rates of radiation necrosis in patients with glioblastoma and astrocytoma (WHO grade II and III) were lower, at 2% and 0%, respectively, suggesting a lower risk association (P < 0.001 and P = 0.036, respectively). The majority (79%) of these patients were asymptomatic and exhibited a favorable clinical course, with most cases showing no progression of necrosis. During the follow-up period, tumor recurrence was verified in 2 patients.

Conclusion: Radiation necrosis post-radiotherapy for primary brain tumors occurs infrequently but predominantly in patients with oligodendrogliomas, often following a benign course. The study underscores the importance of close monitoring for this condition, given the potential for sampling errors and the critical need for histopathological confirmation to guide appropriate management.

[This corrects the article DOI: 10.1093/nop/npae093.].

[This corrects the article DOI: 10.1093/nop/npae079.].

Background: Prior investigations into meningioma disparities have explored associative relationships of socioeconomic status (SES) and race-ethnicity but face gaps in the range of other social determinants/drivers of health (SDoH) factors considered and sample size. Furthermore, none have explored causal relationships between SDoH-factors and outcomes. Thus, this study aims to utilize a recent, national sampling of meningioma patients incorporating comprehensive inferential and causal-mediation approaches to delineate which SDoH-factors objectively drive care and prognostic disparities.

Methods: This retrospective study of a specialized Surveillance-Epidemiology-End Results 2020 dataset for community-/census tract-level (Yost-Index, a composite SES measure and Rurality-Urbanicity) and individual-level (sex, race-ethnicity) SDoH-factors performed age-adjusted multivariate cox-hazards and logistic regressions, and covariate-adjusted causal-mediation analyses to assess differences in overall survival, treatment receipt, and delay of treatment initiation.

Results: In age-adjusted multivariate analyses of 110,042 meningioma patients from 2010-2018, lower community-level SES significantly increased overall mortality (HR 1.31, 95%CI 1.28-1.34), decreased interventional treatment receipt (Surgery-OR 0.89, 95%CI 0.87-0.91; Radiation 0.83, 0.79-0.87), and increased treatment delay (1.13, 1.09-1.16). Minoritized race/ethnicity featured increased interventional treatment receipt (Surgery 1.18, 1.15-1.22; Radiation 1.18, 1.12-1.24) and decreased treatment delay (0.90, 0.87-0.93). In covariate-adjusted causal analyses, community-level SES showed total mediation effects of race-ethnicity in influencing overall survival and negative partial mediation effects in treatment receipt and delay.

Conclusion: For overall survival, community-level SES primarily drove meningioma disparities even when accounting for other SDoH-factors. For treatment receipt and delay, race-ethnicity caused greater differences that were partially affected by community-level SES. In turn, these comprehensive analyses provide definitive causes of meningioma disparities.

Background: Brain metastases (BM) frequently occur in patients with non-small cell lung cancer (NSCLC) with actionable genomic alterations (AGA). Targeted therapies (TTs) improve outcomes, but differences in BM screening and eligibility criteria across trials make comparisons challenging. While stage IV NSCLC guidelines recommend BM screening, it is not mandatory, and imaging techniques vary.

Methods: Registrational and phase II/III trials of FDA/EMA-approved TTs for advanced NSCLC with AGA, published since 2012, were included. Main focus of the review was evaluation of baseline brain screening practices across trials. Information on BM follow-up, BM incidence, and BM-related outcomes was retrieved.

Results: Of 51 trials, 71% mandated baseline BM screening, and 27% mandated follow-up imaging for all patients. MRI was specified for BM assessment in 31% of the trials. BM incidence at baseline was high, up to 40% in the first-line setting. While most trials included patients with BM, eligibility criteria varied, and 43% of trials prespecified BM-related outcomes; 56% of phase III trials used BM as a stratification factor.

Conclusion: This review highlights the increasing attention to BM screening in NSCLC TT trials. However, substantial heterogeneity remains in BM eligibility, screening, outcomes, and follow-up. Standardizing these aspects in future trials is essential.

Background: The expanding repertoire of studies generating genome-scale omic datasets from glioma samples provides a generational opportunity to uncover mechanisms driving aggressive biology and develop new treatments. However, ensuring such studies reflect the breadth of racial groups and ethnicities affected by gliomas is critical to support equity in future therapeutic advances. We therefore report a contemporary snapshot of the representation of race and ethnicity in omic glioma studies.

Methods: We searched PubMed, Embase, Web of Science, and Scopus and systematically reviewed articles published between January and November 2023 reporting de novo genome-scale sequencing data generated using samples from patients diagnosed with glioma (according to World Health Organization 2021 criteria) to characterize the reporting and composition of race and ethnicity data.

Results: Thirty-five studies involving 5601 patients were analyzed. Race or ethnicity data was reported in only 3 studies (8.6%), of which none provided omic data in a format that could be stratified by race or ethnicity. Reporting varied by continent with all 3 studies including race or ethnicity data based in North America. Where racial data was available, we found that samples used for genome-scale characterization came from patients reported as being White in 91.1% cases (41 patients), with 6.7% (3 patients) reported as Black and 2.2% (1 patient) as Hispanic.

Conclusions: These studies underscore an urgent need for improved reporting and representation to enhance our understanding of glioma biology across different populations and guide targeted initiatives from policymakers and funders to support equitable improvements in healthcare.

Background: One in 3 patients with advanced cancer develops brain metastases. Surgical resection of brain metastases is done in 15%-20% of these patients. While gross total resection (GTR) is believed to extend overall survival (OS), concerns exist regarding increased morbidity. This study examines the impact of surgical resection, particularly GTR, on self-reported symptoms, focusing on quality of life (QoL) and motor dysfunction.

Methods: We conducted a prospective cohort study involving adult patients undergoing surgical resection for brain metastases from solid tumors in a defined region of Norway between 2017 and 2021. Clinical data were collected at inclusion prior to surgery and every 3 months the first year. Patients completed monthly questionnaires assessing QoL and motor dysfunction. QoL was measured using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL, while motor dysfunction was evaluated using the EORTC QLQ-BN20.

Results: A total of 155 patients were included and median OS was 13 months. GTR was achieved in 69 (44%) patients and was associated with longer median OS compared to subtotal resection (17.7 vs. 10.9 months, P = .04). Mean QoL remained stable throughout the follow-up period. Improved motor dysfunction 1 month after surgery was reported by 23% of the patients, while 25% reported worse motor dysfunction. Factors associated with a high motor dysfunction score at 1 month were age >70 years, higher baseline motor dysfunction, and multiple brain metastases. Neither GTR nor location of metastases in motor-associated areas were associated with worsened motor dysfunction.

Conclusion: Self-reported QoL is maintained after surgery for brain metastases. Complete resection is associated with extended OS without compromising self-reported motor function.

Background: The Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group for diffuse intrinsic pontine glioma (DIPG) recently published its recommendations. We aim to test the operative performance of the RAPNO DIPG criteria imaging component by retrospectively applying it to a patient sample from the International DIPG/DMG Registry (IDIPGR).

Methods: Longitudinal MRIs for 46 patients were independently reviewed by 2 pediatric neuro-radiologists. Utilizing RAPNO DIPG imaging criteria for the pontine lesions, response was categorized as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). The response category for each MRI was compared between 2 readers and classified as concordant if they agreed, minor discordant if one reported SD and the other reported PR or PD, and major discordant if one reported PR and the other reported PD.

Results: A total of 277 paired MRIs were analyzed, and 124 paired MRIs were evaluated for concordance. The response category was concordant between readers in 84 (68%) MRI comparisons. In 31 MRI comparisons (25%) the reads were minor discordant, and major discordant in 9 (7%). No CRs were reported. Minor discordant cases were within 10% of the boundary for PR or PD in 20 (65%) of these cases. The median difference between the 2 readers' measurements was 2 mm (range 0-29 mm).

Conclusion: This study demonstrated that RAPNO DIPG imaging criteria can be applied with concordance or minor discordance between readers in 93% of the cases. Discordant measurements were largely at the boundaries of response type.

Background: Nausea and vomiting remain feared cancer treatment-related side effects. Antiemetic guideline trials exclude malignant glioma patients. In patients receiving radiation with concurrent temozolomide, chemoradiation-induced nausea; vomiting (cRINV) rates are 35% and 26%, respectively, which reduce quality of life, treatment adherence, and cancer control.

Methods: This randomized phase-II open-label trial, evaluated efficacy, patient preference, and satisfaction of ondansetron (short-acting 5HT3-RA; 3 h-half-life) monotherapy versus rolapitant (long-acting NK1-RA; 180 h-half-life) plus ondansetron in preventing cRINV during 6 weeks of temozolomide (75 mg/m²/day × 42 day) with radiation. Fifty-three eligible patients were randomized to Sequence-A (ondansetron-8 mg days: 1-42, day 22 rolapitant-180 mg) or Sequence-B (rolapitant day 1 plus daily ondansetron). Primary endpoint was percentage achieving cRINV-complete response (no vomiting/antiemetic rescue) during the first 2 weeks of radiation. Secondary endpoints: cRIN/cRIV rates, preference/satisfaction for rolapitant/ondansetron, toxicity, and adherence.

Results: Forty-eight (Sequence-A: 25; Sequnce-B: 23) initiated chemoradiation. Mean age = 53, 58% male, 73% Karnofsky performance status (KPS) > 90%, and 73% glioblastoma. During first 2 weeks of radiation, cRINV-CR was 57% with ondansetron and 74% receiving rolapitant/ondansetron (P = .27). Patient-reported 6-week cRINV-CR was 55% for both arms. First 2-week cRIN rates (38% Sequence-A; 32% Sequence-B) were more than cRIV rates (19% Sequence-A; 0% Sequence-B). Patients receiving ondansetron alone vomited more during the first 2 weeks and overall (26%) than with rolapitant/ondansetron (11%). Among 35 completers, 20% preferred rolapitant/ondansetron, 60% preferred ondansetron, and 20% had no preference (P = .0004). Adverse-events attributable to antiemetics were grade 1-2.

Conclusions: No difference was found in cRINV-CRs between the first 2-week treatments or overall satisfaction. Although not a positive study, less vomiting occurred with rolapitant/ondansetron. While patients prefer ondansetron monotherapy, most perceived better effectiveness with rolapitant/ondansetron.