High dose fractionated combined proton and photon radiation therapy of chordomas and low-grade chondrosarcomas of the skull base and cervical spine. I. Results in adult patients

Abstract BACKGROUND Pilocytic astrocytoma (PCA) is a low-grade glioma common in children but also rarely diagnosed in adults. The role of adjuvant radiation therapy (RT) in treating these tumors remains unclear. OBJECTIVE We investigated the effect of RT on overall survival, specifically among adult patients who had undergone subtotal PCA resection. METHODS Information on adult patients (age 18 years old) who had undergone subtotal PCA resection between 2004 and 2016 was collected from the National Cancer Database (NCDB). A multivariate Cox proportional hazards model was utilized to determine factors independently associated with overall survival. RESULTS A total of 451 patients were identified. The mean age of our patient cohort was 36.8 years old, and the majority of patients (83.4%) did not receive radiation treatment following subtotal PCA resection. Overall median survival was 93.8 months. Survival was longer (p < 0.001) in the patients who did not receive post-surgical RT (median: 98.3 months) compared to patients who did (median: 54.8 months). Patients who had older age at diagnosis (hazard ratio [HR]=1.05, 95% confidence interval [CI]=1.03-1.07, p < 0.01), were Black or African American (HR=2.76, CI=1.12-6.46, p=0.019), received radiation during their initial treatment (HR=4.53, CI=2.08-9.89, p < 0.01), or had a Charlson/Deyo score of > 1 (HR=3.68, CI=1.55, p=0.003) had a significantly higher risk of death following subtotal PCA resection. CONCLUSION Postoperative RT is independently associated with a significantly higher risk of death among adults who underwent subtotal PCA resection. Our findings provide a rationale for further investigation into the efficacy and safety of RT within this patient population.

Download Full-text

Histomolecular characterization of intracranial meningiomas developed in patients exposed to high-dose cyproterone acetate: an antiandrogen treatment

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz003 ◽

2019 ◽

Vol 1 (1) ◽

Cited By ~ 2

Author(s):

Sylvain Portet ◽

Rania Naoufal ◽

Gaëlle Tachon ◽

Adrien Simonneau ◽

Anaïs Chalant ◽

...

Keyword(s):

Skull Base ◽

Cyproterone Acetate ◽

Comparative Genomic ◽

High Dose ◽

Low Grade ◽

Pharmacological Interaction ◽

Pik3ca Mutations ◽

History Of ◽

Underlying Mechanisms ◽

Copy Number Changes

Abstract Background Meningiomas are the most common primary intracranial tumors in adults. The relationship between meningiomas and exogenous sex hormones such as cyproterone acetate (CPA) is well documented, yet the underlying mechanisms remain unknown. Defining the histomolecular status of meningiomas developed on CPA would help us to better understand the oncogenesis of these tumors. Methods We identified 30 patients operated for a meningioma after long-term high-dose CPA therapy and with a history of CPA discontinuation before establishing the indication for surgical intervention. We used array-comparative genomic hybridization (to characterize copy number changes in those 30 meningiomas and subsequently performed next-generation sequencing with the National Institute of Cancer (INCa) solid tumor panel, which is a targeted panel of clinically actionable genes. We also examined grade, type, and clinical features. Results We identified AKT1 mutations or PIK3CA mutations in 33.3% of CPA meningiomas. AKT1 and PIK3CA mutations were mutually exclusive. Enrichment in oncogenic PIK3CA mutations in the CPA cohort was detected. CPA meningiomas showed chromosomal stability and were located mainly in the skull base. Ninety percent of CPA meningiomas were low-grade meningiomas and 63.4% were meningotheliomas. Half of our CPA cohort had microcystic components. Conclusion Our study shows that low-grade meningothelial meningiomas of the skull base are predominant in CPA meningiomas. We identified PIK3CA/AKT1 pathway as a hypothetical actor in onco-pharmacological interaction between meningiomas and CPA. This signaling pathway could be an interesting target for precision medicine trials in meningioma patients who have been subjected to CPA. Our results could invite the scientific community to review the current classification of meningiomas and to evolve toward more specific histomolecular classification.

Download Full-text

High Dose Photon Radiotherapy in the Management of Chordoma and Chondrosarcoma of the Skull Base and Cervical Spine

Clinical Oncology ◽

10.1016/j.clon.2007.01.355 ◽

2007 ◽

Vol 19 (3) ◽

pp. S28 ◽

Cited By ~ 3

Author(s):

K.L. Foweraker ◽

K.E. Burton ◽

R. Jena ◽

S.J. Jefferies ◽

Burnet

Keyword(s):

Cervical Spine ◽

Skull Base ◽

High Dose ◽

Photon Radiotherapy

Download Full-text

High-dose Radiotherapy in the Management of Chordoma and Chondrosarcoma of the Skull Base and Cervical Spine: Part 1 — Clinical Outcomes

Clinical Oncology ◽

10.1016/j.clon.2007.04.004 ◽

2007 ◽

Vol 19 (7) ◽

pp. 509-516 ◽

Cited By ~ 40

Author(s):

K.L. Foweraker ◽

K.E. Burton ◽

S.E. Maynard ◽

R. Jena ◽

S.J. Jefferies ◽

...

Keyword(s):

Cervical Spine ◽

Skull Base ◽

Clinical Outcomes ◽

High Dose

Download Full-text

Distinct imaging patterns of pseudoprogression in glioma patients following proton versus photon radiation therapy

10.21203/rs.3.rs-197830/v1 ◽

2021 ◽

Author(s):

Reed Ritterbusch ◽

Lia M. Halasz ◽

Jerome J. Graber

Keyword(s):

Radiation Therapy ◽

Mr Imaging ◽

Tumor Progression ◽

Clinical Symptoms ◽

Molecular Subtype ◽

Tumor Grade ◽

Photon Radiation ◽

Low Grade ◽

Mean Time

Abstract Purpose Criteria by the Radiologic Assessment in Neuro-Oncology (RANO) group outline the diagnosis of pseudoprogression (Ps) after photon therapy for gliomas based on timing and location. We noted that patients receiving proton therapy manifested radiographic changes that appear different than Ps after photon therapy, which could be interpreted as tumor progression. In this study, we retrospectively reviewed MR imaging after proton or photon radiation for gliomas. We propose criteria to characterize proton pseudoprogression (ProPs) as distinct from Ps seen after photons. Methods Post-treatment MR imaging, clinical and pathological data of low grade glioma patients were reviewed. Overall, 57 patients receiving protons were reviewed for the presence of ProPs, and 43 patients receiving photons were reviewed for any equivalent imaging changes. Data collected included the location and timing of the new enhancement, tumor grade, molecular subtype, chemotherapy received, and clinical symptoms. Results Fourteen patients (24.6%) had new enhancement following radiation therapy that was unique to treatment with protons. The mean time to development of the ProPs was 15.4 months (7–27 months). We established the following criteria to characterize ProPs: located at the distal end of the proton beam; resolves without tumor-directed therapy; and subjectively multifocal, patchy, and small (< 1 cm). In the group receiving photons, none had changes that met our criteria for ProPs. Conclusion Patients who receive protons have unique imaging changes after radiation therapy. ProPs could be mistaken for tumor progression, but typically resolves on follow up. Further studies are needed to understand the radiobiology and pathophysiology underlying these imaging changes.

Download Full-text