Neuro-oncology practice最新文献

Background: In patients with brain metastases (BMs), delay of systemic therapy (CTX) after oncologic surgery due to wound healing issues and postoperative radiotherapy might influence the oncologic outcome. Intraoperative radiotherapy (IORT) is an emerging option in neurooncology, possibly shortening the time for comprehensive treatment compared to conventional external beam radiotherapy (EBRT). The aim of this study was to compare the transition time to CTX in patients undergoing IORT or EBRT.

Methods: We performed a retrospective chart review analysis of patients undergoing surgery for BMs at our institution with either IORT or adjuvant EBRT. Either therapy was applied according to an internal standard operation procedure favoring IORT if feasible. The time (days) from surgery until the beginning of CTX was compared together with overall hospitalization time.

Results: Ninety-nine patients were analyzed from which 59 underwent adjuvant EBRT and 40 IORT. Patients undergoing resection of BMs with IORT had significantly shorter intervals to CTX (EBRT vs. IORT; 65.4 ± 54.3 days vs. 32.3 ± 28.0 days (mean±SD); P < .001). Comparing the interval to CTX between the last EBRT fraction and IORT showed no significant difference EBRT vs. IORT (26.2 ± 55.8 days vs. 32.3 ± 28.0 days (mean±SD); P = .52). The time spent hospitalized until CTX was significantly lower in the IORT group (EBRT vs. IORT 20.2 ± 9.4 days vs. 9.5 ± 7.1 days (mean±SD); P < .001).

Conclusions: IORT for BM surgery allows a faster transition to systemic oncologic therapy than conventional adjuvant EBRT.

Background: Cancer patients commonly use cannabis to improve symptoms or for presumed anticancer effects. However, the extent and type of cannabis use among Dutch primary brain tumor patients, along with their motivations, remains unclear. This study aims to determine the prevalence of prior or current cannabis use in patients with a primary brain tumor, the type of cannabis used, their motivation, how they perceived the effects of the cannabis, and what adverse effects they noticed.

Methods: We conducted a cross-sectional survey of adult primary brain tumor patients who visited the neuro-oncology outpatient clinic at Amsterdam UMC between August and October 2023.

Results: Of 100 responding patients, 51% had ever used cannabis and 14% currently used cannabis. Of the total group, 19% currently or previously used cannabis for tumor-related reasons, including symptom relief (n = 14; 74%) and presumed effect on the tumor (n = 8; 42%), indicating that some patients used it for multiple therapeutic purposes. Patients favored cannabidiol (CBD) over Δ⁹-tetrahydrocannabinol (THC). Self-reported sleep, anxiety, worrying, and depressive symptoms most frequently improved due to cannabis use, and the most common self-reported adverse events included drowsiness, dry mouth, and dizziness.

Conclusions: A considerable amount of primary brain tumor patients use cannabis, often for symptom relief or presumed antitumor effects. The user rate underscores a demand for clinical research into the therapeutic efficacy of cannabis, particularly concerning its impact on symptoms like sleep disturbances, depressive symptoms, and anxiety/worrying, as well as its tumor-inhibiting capabilities.

Background: Thrombocytopenia is a major temozolomide-induced adverse event during the standard treatment of glioblastoma. Consequently, platelet transfusions and treatment modifications may impact quality of life and long-term treatment outcomes. Understanding the impact of thrombocytopenia on healthcare utilization is crucial to mitigate the need for healthcare resources in glioblastoma patients. Here, we assess the influence of thrombocytopenia-related healthcare among patients diagnosed with glioblastoma.

Methods: We retrospectively collected patient information treated at the Brain Tumor Center Amsterdam between 2008 and 2021. The occurrence of thrombocytopenia, patient demographics, treatment details, and healthcare utilization data were gathered from patients who received standard glioblastoma treatment. Associations between temporal severity of thrombocytopenia as categorized by the Common Terminology Criteria for Adverse Events, patient characteristics, and healthcare utilization were analyzed using Generalized Linear Mixed Models.

Results: We included 206 patients with a median age of 58 years, 35.9% were female and we found that thrombocytopenia (any grade) occurred in 61.1% of patients. The occurrence of thrombocytopenia during CRT was associated with increased healthcare utilization and was largest in females who developed grade 4 thrombocytopenia compared to those who did not develop thrombocytopenia (OR = 5.9, P < .001 in females vs OR = 4.4, P < .001 in males). Grade 4 thrombocytopenia was also associated with heightened healthcare utilization during the adjuvant phase (OR = 7.6, P < .001), and was comparable between sexes.

Conclusions: Severe thrombocytopenia during glioblastoma treatment is linked to increased healthcare utilization, disproportionally impacting females. These data suggest that prevention and early management of thrombocytopenia can reduce healthcare utilization in patients with glioblastoma.

Background: Advance care planning (ACP) can help patients with primary malignant brain tumors to align treatments with their preferences. However, insights into patients' and caregivers' engagement with ACP remain scarce. This study elaborates on their knowledge, experiences, and preferences concerning ACP.

Methods: This was a secondary analysis of data from the "National Survey on the Needs and Support of Brain Tumor Patients and Caregivers" in Japan. Responses from 128 patients and 106 caregivers were included. Descriptive statistics, logistic regression, and qualitative analyses of free-text responses were performed.

Results: Patients were more willing than caregivers to participate in decisions regarding their treatment (96.8% vs. 82.5%, P < .001). Knowledge about ACP was low in both groups (12.3% of patients and 10.7% of caregivers), but willingness to participate in ACP was high (68.9% of patients and 65.9% of caregivers). Preference to initiate ACP at diagnosis was low in both groups, with caregivers showing a higher preference than patients (29.0% vs. 11.1%). A greater percentage of patients preferred to start ACP at recurrence than caregivers (47.0% vs. 18.3%, P < .0001). Frequent family discussions were significantly associated with actual experiences of ACP (OR = 3.7, 95% CI = 1.6-9.3, P = .0019).

Conclusions: The mismatch between respondents' willingness to participate in ACP and their knowledge and experience reveals a need to increase ACP awareness. Differences in ACP preferences between patients and their caregivers may indicate the need for improved communication strategies by healthcare professionals. Further research is needed to understand these differences.

Background: Managing brain tumor-related personality and behavior changes (BTrPBc) is complex with contributors including tumor location, type, and grade; treatment side effects; and psychological adjustment to a primary brain tumor diagnosis. Although carers of people with high-grade glioma consistently report BTrPBc as an area where they require support, there is a lack of guidelines for healthcare professionals to address BTrPBc. We aimed to explore how neuro-oncology healthcare professionals manage personality and behavior changes in adults with a primary brain tumor.

Methods: This study used an interpretive description approach. Semi-structured interviews were conducted with healthcare professionals practicing in neuro-oncology across Australia via face-to-face, telephone, and video conference. Codebook thematic analysis methods were used.

Results: Healthcare professionals (N = 22) from a range of medical and allied health disciplines participated in interviews with an average duration of 34 minutes. Four themes described how healthcare professionals seek to manage patients' personality and behavior changes: (i) Building trusting relationships, (ii) What is this brain's story?, (iii) Brief intervention; and (iv) Targeted intervention. Sub-themes were developed within each theme.

Conclusions: Our results highlight the diverse support healthcare professionals provide for the management of BTrPBc. There is a need for interventions to be formulation-driven, involve individualized care, provide education, and focus on the patient-carer dyad. A stepped-care approach to managing BTrPBc is recommended; however, further evaluation in clinical practice is necessary.

A significant proportion of patients with brain metastases experience a seizure event during their disease course, which can impact morbidity and long-term outcomes. A host of factors elevate the risk for seizures in patients with brain metastases, including patient factors, metabolic imbalances, tumor burden, and treatment modality. While reducing tumor burden via local and systemic therapies remains a critical component to mitigating seizure events, select patients may remain at risk. The use of prophylactic anti-seizure medications may be warranted in a subset of patients, though several clinical trials and guidelines from medical societies currently recommend against prophylactic use. Variability in the use of prophylactic anti-seizure medications in clinical practice underscores the need to update our current understanding of seizure risk in the era of multi-modality treatment and to identify opportunities to improve risk stratification and management. Herein, we provide a comprehensive literature review summarizing the current standard for seizure management in patients with brain metastases and assess the impact of multi-modal therapies on seizure risk. We additionally highlight gaps in the literature and present opportunities for future investigation.

Background: This study aimed to identify magnetic resonance imaging (MRI) markers predictive of essential surgical characteristics in meningiomas, including consistency, ease of dissection of meningioma from surrounding brain tissue, and vascularity, which are crucial for surgical decisions and outcomes.

Methods: We conducted preoperative MRI using a standardized protocol to measure signal intensities (SI) within meningiomas. Additionally, we administered intraoperative questionnaires and performed histological analyses on each tumor.

Results: A total of 100 consecutive patients (mean age, 58 years ± 13, 69 female) were enrolled in this prospective clinical trial. Meningioma volumes varied (0.4-185.6 cm³) with surgeries lasting on average 176 min (range 35-610 min). SI measurements on T1-weighted, time-of-flight (TOF), and T2-weighted imaging were significantly associated with tumor consistency and vascularity. Specifically, the sensitivity and specificity for predicting consistency grades above 3 (on a 1-5 grade scale) were 75% and 55% postcontrast on T1-weighted imaging (SI ≥ 711) and 73% and 70% on TOF imaging (SI ≥ 124.5). For vascularity grades above 5 (on a 1-10 grade scale), the values were 73% sensitivity and 54% specificity on TOF imaging (SI ≥ 123). No correlation was found between the surgical cleavage plane and MRI data; however, dissection plane type significantly influenced surgery duration and hospitalization length. A lower SI on T2-weighted imaging correlated with specific histological features.

Conclusion: Key surgical aspects of meningiomas can be predicted using conventional MRI sequences. This may improve patient counseling and surgical planning.

Background: The challenges and needs of people with brain tumors are complex and unique, particularly-but not limited to-the neurocognitive impacts they experience. These effects are subsequently impactful on their primary caregivers. Evidence suggests people with glioma and their caregivers experience a range of unmet needs in the clinical care setting.

Methods: Semi-structured interviews with people across the spectrum of glioma, and their caregivers in the United Kingdom, as part of a study exploring core outcomes for use across glioma trials. Interviews were analyzed using thematic analysis.

Results: Nineteen people with glioma and seven caregivers were interviewed. Three major themes were identified: (1) Well-being, support and coping, (2) Communication and care, and (3) Impact on caregivers. People with glioma and their caregivers experience uncertainty, and progressive impacts long after diagnosis. People with glioma across the spectrum of the disease have many challenges in common including long-term adjustments, impacts of glioma and its treatment, and communication/information gaps including prognostic uncertainty. These impacts also affect caregivers. While most patients and caregivers engaged in self-directed approaches to mitigate the impacts of glioma, gaps in follow-up support for lasting effects were a major source of frustration, impacting on ability to cope and manage the effects of glioma.

Conclusions: These interviews highlight the unmet needs of people with glioma and their caregivers. A consistent, systematic, and focused approach to assessing the needs of glioma patients and their caregivers in the clinical setting and support for long-term adjustment is required.