Low-Grade Glioma: High-Grade Tumor Recurrence

Abstract BACKGROUND 5-aminolevulinic acid is a reliable tool for optimizing high-grade glioma resection. However, its efficacy in low-grade glioma resection remains unclear. OBJECTIVE To study the role of 5-aminolevulinic acid in low-grade glioma resection and assess positive fluorescence rates and effect on the extent of resection. METHODS A systematic review of PubMed, Google Scholar, and Cochrane was performed from the date of inception to February 1, 2019. Studies that correlated 5-aminolevulinic acid fluorescence with low-grade glioma in the setting of operative resection were selected. Studies with biopsy only were excluded. Positive fluorescence rates were calculated. Quality index of the selected papers using the Downs and Black criteria checklist was provided. RESULTS Twelve articles met the selection criteria with 244 histologically-confirmed low-grade glioma patients who underwent microsurgical resection. All patients received 20 mg/kg body weight of 5-aminolevulinic acid. Only 60 patients (n=60/244; 24.5%) demonstrated visual intra-operative 5-aminolevulinic acid fluorescence. The extent of resection was reported in 4 studies, however, the data combined low- and high-grade tumors. Only 2 studies reported on tumor location. Only 3 studies reported on clinical outcomes. The Zeiss OPMI Pentero microscope was most commonly used across all studies. The average quality index was 14.58 (range: 10–17) which correlated with an overall good quality. CONCLUSION There is an overall low correlation between 5-aminolevulinic acid fluorescence and low-grade glioma. Advances in visualization technology and using standardized fluorescence quantification methods may further improve the visualization and reliability of 5-aminolevulinic acid fluorescence in low-grade glioma resection.

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Phase II open-label, global study evaluating dabrafenib in combination with trametinib in pediatric patients with BRAF V600–mutant high-grade glioma (HGG) or low-grade glioma (LGG)

Annals of Oncology ◽

10.1093/annonc/mdy273.395 ◽

2018 ◽

Vol 29 ◽

pp. viii132 ◽

Cited By ~ 1

Author(s):

D. Hargrave ◽

O. Witt ◽

K. Cohen ◽

R. Packer ◽

A. Lissat ◽

...

Keyword(s):

Phase Ii ◽

Pediatric Patients ◽

High Grade Glioma ◽

Low Grade Glioma ◽

Low Grade ◽

High Grade ◽

Open Label ◽

Global Study

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Brain Tumor Classification into High Grade and Low Grade Gliomas

International Journal of Scientific Research in Science Engineering and Technology ◽

10.32628/ijsrset1962176 ◽

2019 ◽

pp. 785-790

Author(s):

Sanjeet Pandey ◽

Brijesh Bharadwaj ◽

Himanshu Pandey ◽

Vineet Kr. Singh

Keyword(s):

Invasive Procedure ◽

High Grade Glioma ◽

Low Grade Glioma ◽

World Health ◽

Low Grade ◽

High Grade ◽

Learning Approaches ◽

Sampling Errors ◽

Promising Alternative ◽

Glioma Grading

Brain is recognized as one of the complex organ of the human body. Abnormal formation of cells may affect the normal functioning of the brain. These abnormal cells may belong to category of benign cells resulting in low grade glioma or malignant cells resulting in high grade glioma. The treatment plans vary according to grade of glioma detected. This results in need of precise glioma grading. As per World Health Organization, biopsy is considered to be gold standard in glioma grading. Biopsy is an invasive procedure which may contains sampling errors. Biopsy may also contain subjectivity errors. This motivated the clinician to look for other methods which may overcome the limitations of biopsy reports. Machine learning and deep learning approaches using MRI is considered to be most promising alternative approach reported by scientist in literature. The presented work were based on the concept of AdaBoost approach which is an ensemble learning approach. The developed model was optimized w.r.t to two hyper parameters i.e. no. of estimators and learning rate keeping the base model fixed. The decision tree was us ed as a base model. The proposed developed model was trained and validated on BraTS 2018 dataset. The developed optimized model achieves reasonable accuracy in carrying out classification task i.e. high grade glioma vs. low grade glioma.

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Diffusion Weighted Imaging of Brain Gliomas in the Differential Diagnosis Value

Iranian Journal of Public Health ◽

10.18502/ijph.v49i6.3363 ◽

2020 ◽

Author(s):

Jian JIANG ◽

Liangcai BAI ◽

Xueling ZHANG ◽

Jianli LIU ◽

Junlin ZHOU

Keyword(s):

Brain Metastases ◽

Diffusion Weighted Imaging ◽

High Grade Glioma ◽

Low Grade Glioma ◽

Control Group ◽

Low Grade ◽

High Grade ◽

Imaging Data ◽

Grade Group ◽

Diffusion Weighted

Background: To evaluate the diagnostic value of diffusion weighted imaging (DWI) and apparent diffusion coefficient measurement (ADC) in glioma. cient measurement (ADC) in glioma. Methods: Thirty two low-grade glioma patients and 31 high-grade glioma patients who were confirmed by pathology in Lanzhou University Second Hospital, Lanzhou, China from February 2016 to January 2019 were selected. The other 30 patients with brain metastases were selected as a control group. DWI imaging data of the three groups were collected, and ADC, relative ADC (rADC) values in tumor parenchyma, peritumor edema area, and contralateral normal white matter area were measured, and the levels of n-acetyl aspartic acid (NAA), choline (Cho), creatine (Cr) of tumor metabolites were analyzed. Results: rADC values in the peri-tumor edema areas of the high-grade glioma group were significantly lower than those in the low-grade group and the metastatic group （P=0.011）, and the low-grade group was significantly lower than that in the metastatic group (P < 0.05). NAA/Cho and NAA/Cr in parenchymal and peritumor edema areas of patients in the advanced group were significantly lower than those in the metastatic group (P < 0.05), and Cho /Cr was significantly higher than those in the metastatic group (P < 0.05). Conclusion: the rADC value, NAA/Cho, NAA/Cr and Cho/Cr in parenchymal and peritumor edema areas of the tumor can help to distinguish high-grade glioma, low-grade glioma and brain metastases.

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Arterial spin labeling MR imaging for differentiation between high- and low-grade glioma—a meta-analysis

Neuro-Oncology ◽

10.1093/neuonc/noy095 ◽

2018 ◽

Vol 20 (11) ◽

pp. 1450-1461 ◽

Cited By ~ 4

Author(s):

Alberto Falk Delgado ◽

Francesca De Luca ◽

Danielle van Westen ◽

Anna Falk Delgado

Keyword(s):

Mr Imaging ◽

Arterial Spin Labeling ◽

Diagnostic Performance ◽

Meta Analysis ◽

Spin Labeling ◽

Low Grade Glioma ◽

Cochrane Library ◽

Low Grade ◽

High Grade ◽

Operating Characteristics

Abstract Background Arterial spin labeling is an MR imaging technique that measures cerebral blood flow (CBF) non-invasively. The aim of the study is to assess the diagnostic performance of arterial spin labeling (ASL) MR imaging for differentiation between high-grade glioma and low-grade glioma. Methods Cochrane Library, Embase, Medline, and Web of Science Core Collection were searched. Study selection ended November 2017. This study was prospectively registered in PROSPERO (CRD42017080885). Two authors screened all titles and abstracts for possible inclusion. Data were extracted independently by 2 authors. Bivariate random effects meta-analysis was used to describe summary receiver operating characteristics. Trial sequential analysis (TSA) was performed. Results In total, 15 studies with 505 patients were included. The diagnostic performance of ASL CBF for glioma grading was 0.90 with summary sensitivity 0.89 (0.79–0.90) and specificity 0.80 (0.72–0.89). The diagnostic performance was similar between pulsed ASL (AUC 0.90) with a sensitivity 0.85 (0.71–0.91) and specificity 0.83 (0.69–0.92) and pseudocontinuous ASL (AUC 0.88) with a sensitivity 0.86 (0.79–0.91) and specificity 0.80 (0.65–0.87). In astrocytomas, the diagnostic performance was 0.89 with sensitivity 0.86 (0.79 to 0.91) and specificity 0.79 (0.63 to 0.89). Sensitivity analysis confirmed the robustness of the findings. TSA revealed that the meta-analysis was adequately powered. Conclusion Arterial spin labeling MR imaging had an excellent diagnostic accuracy for differentiation between high-grade and low-grade glioma. Given its low cost, non-invasiveness, and efficacy, ASL MR imaging should be considered for implementation in the routine workup of patients with glioma.

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Long-term outcomes after irradiation (RT) for pediatric low-grade glioma.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.10549 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 10549-10549

Author(s):

Derek S. Tsang ◽

Erin Sennett Murphy ◽

Thomas E. Merchant

Keyword(s):

Systemic Therapy ◽

Cumulative Incidence ◽

High Grade Glioma ◽

Tumor Location ◽

Low Grade Glioma ◽

Low Grade ◽

High Grade ◽

Who Grade ◽

Extent Of Surgery

10549 Background: Treatment for pediatric low-grade glioma (LGG) is variable, depending on age and tumor location. Systemic therapy (ST) is often used to delay RT, but ST does not result in durable local control. The goal of this study was to evaluate event-free survival (EFS) and toxicities for pediatric LGG treated with RT over a 30-year period. Methods: All patients age ≤21 with intracranial pediatric LGG (WHO grade I-II) treated with RT at a single institution since May 1986 were included in this retrospective review. Patients with metastatic disease (M+) received craniospinal irradiation (CSI); otherwise, RT was conformal. EFS and overall survival (OS) were measured from the first day of RT. Events included death, progression, or secondary high-grade glioma. Results: 221 patients were eligible. Median follow-up was 11.3 yrs (range, 0.1-30.5). Median RT dose was 54 Gy. 10-yr EFS and OS were 67.9% (95% CI 60.4-74.3) and 91.1% (95% CI 85.8-94.5) for non-metastatic patients, respectively. For 12 M+ patients treated with CSI, 10-yr EFS and OS were 58.9% (95% CI 23.4-82.5) and 70.0% (32.9-89.2), respectively. 28.6% developed pseudoprogression (PP) with median time to onset and resolution of 6.1 months (IQR 3.6-14.6) and 6.4 months (IQR 3.5-11.7), respectively. Patients with PP had improved 10-yr EFS (83.4% vs. 61.0%, HR 0.40, p = .006). Patients with grade II tumors and who received pre-RT ST had lower EFS (Table). Sex, NF-1, tumor location, extent of surgery and CSI were not independently associated with EFS. 10-yr cumulative incidence of grade ≥2 vasculopathy was 7.5% (95% CI 4.9-11.4). There were 12 cases of secondary high-grade glioma, with a 20-yr cumulative incidence of 5.5% (95% CI 2.6-11.4). Conclusions: Irradiation provides long-term control of pediatric LGG in a majority of patients. Receipt of pre-RT systemic therapy was associated with reduced EFS; this association requires further investigation. [Table: see text]

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The Use of 5-Aminolevulinic Acid in Low-Grade Glioma Resection: A Systematic Review

Operative Neurosurgery ◽

10.1093/ons/opz336 ◽

2019 ◽

Vol 19 (1) ◽

pp. 1-8

Author(s):

Ahmad Kareem Almekkawi ◽

Tarek Y El Ahmadieh ◽

Eva M Wu ◽

Abdullah M Abunimer ◽

Karl R Abi-Aad ◽

...

Keyword(s):

Systematic Review ◽

Quality Index ◽

Aminolevulinic Acid ◽

Extent Of Resection ◽

Low Grade Glioma ◽

Low Grade ◽

High Grade ◽

Patient Consent ◽

Visualization Technology ◽

Glioma Resection

Abstract BACKGROUND For optimizing high-grade glioma resection, 5-aminolevulinic acid is a reliable tool. However, its efficacy in low-grade glioma resection remains unclear. OBJECTIVE To study the role of 5-aminolevulinic acid in low-grade glioma resection and assess positive fluorescence rates and the effect on the extent of resection. METHODS A systematic review of PubMed, Google Scholar, and Cochrane was performed from the date of inception to February 1, 2019. Studies that correlated 5-aminolevulinic acid fluorescence with low-grade glioma in the setting of operative resection were selected. Studies with biopsy only were excluded. Positive fluorescence rates were calculated. The quality index of the selected papers was provided. No patient information was used, so Institutional Review Board approval and patient consent were not required. RESULTS A total of 12 articles met the selection criteria with 244 histologically confirmed low-grade glioma patients who underwent microsurgical resection. All patients received 20 mg/kg body weight of 5-aminolevulinic acid. Only 60 patients (n = 60/244; 24.5%) demonstrated visual intraoperative 5-aminolevulinic acid fluorescence. The extent of resection was reported in 4 studies; however, the data combined low- and high-grade tumors. Only 2 studies reported on tumor location. Only 3 studies reported on clinical outcomes. The Zeiss OPMI Pentero microscope was most commonly used across all studies. The average quality index was 14.58 (range: 10-17), which correlated with an overall good quality. CONCLUSION There is an overall low correlation between 5-aminolevulinic acid fluorescence and low-grade glioma. Advances in visualization technology and using standardized fluorescence quantification methods may further improve the visualization and reliability of 5-aminolevulinic acid fluorescence in low-grade glioma resection.

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