scholarly journals EPEN-50. THE MANAGEMENT AND TREATMENT OF PEDIATRIC SPINAL CORD EPENDYMOMA: RESULTS FROM A COLLABORATIVE INTERNATIONAL MULTI-INSTITUTIONAL REVIEW

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii317-iii318
Author(s):  
John Lucas ◽  
Ella Kumirova ◽  
Derek Tsang ◽  
Anna Vinitsky ◽  
Jason Chiang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Recursive Partitioning ◽  
Extent Of Resection ◽  
Descriptive Statistics ◽  
Related Factors ◽  
Institutional Review ◽  
Initial Surgery ◽  
Spinal Cord Ependymoma ◽  
The Impact ◽  
Combined Failure

Abstract PURPOSE Pediatric Spinal cord ependymoma (SCE) is rare, and the management is often heterogeneous across centers. We evaluated the impact of clinical, pathologic, and treatment-related factors on outcomes in a multi-institutional, international cohort. METHODS SCE patients age <21 years were reviewed across 5 institutions. We utilized nonparametric descriptive statistics, survival, and recursive partitioning analysis (RPA) to examine patient, tumor, histopathologic and treatment characteristics, failure pattern, and cause of death. RESULTS 125 patients were identified, 18 (14.4%) with metastases. Initial surgery was GTR, and STR in 44, 56% of patients respectively. Histology was grade 1, 2, and 3 in 55, 17.7 and 23.2% respectively. 55 patients with initial GTR were observed (52.7%) or irradiated (43.6%); 60 patients had STR and were observed (40%) or irradiated (60%). The 7-year event-free (EFS) and overall survival (OS) was 60% (95% CI 51.5–71.4) and 79% (95% CI 71.1–87.8) respectively. STR and metastasis increased the hazard for death [HR 1.87, 95% CI 1.02–3.57, p=0.05 (vs. GTR)] and [HR 2.28, 95% CI 1.1–5.2, p=0.048 (vs. localized)] respectively. Across 43 failures, local failure predominated (48.8%). Distant and combined failure occurred in 30.2 and 13.9% respectively. Adjuvant RT offered a 20% absolute improvement (vs. observation) in EFS at 5 years regardless of extent of resection. RPA identified thoracic (vs. non-thoracic), grade (1 & 3 vs. 2), STR (vs. GTR) and metastases as determinants of inferior EFS. CONCLUSIONS Tumor and treatment-related factors are predictive of EFS. OS is favorable despite diverse schema and frequent distant failures.

scholarly journals SURG-12. PREDICTORS OF SURVIVAL AND UTILITY OF INTRAOPERATIVE MRI FOR RESECTION OF GRADE II ASTROCYTOMAS AND OLIGODENDROGLIOMAS: A MULTICENTER ANALYSIS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii205-ii206
Author(s):  
Alexander Yahanda ◽  
Bhuvic Patel ◽  
Amar Shah ◽  
Daniel Cahill ◽  
Garnette Sutherland ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Intraoperative Mri ◽  
Patient Treatment ◽  
Subtotal Resection ◽  
Related Factors ◽  
Kaplan Meier ◽  
Grade Ii ◽  
The Impact

Abstract BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative MRI (iMRI) in the resection of grade II gliomas. We assessed the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly-diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS/PFS. RESULTS 232 resections (112 astrocytomas, 120 oligodendrogliomas; 135 males; mean age 36.2 ± 0.9 years) were analyzed. Oligodendrogliomas had longer OS (p< 0.001) and PFS (p=0.009) than astrocytomas. Multivariate regression showed that extent of resection (EOR), including gross-total (GTR) versus near-total (NTR) resection (p=0.02, HR: 0.64, 95% CI: 0.25-.79) and GTR versus subtotal resection (STR) (p=0.006, HR: 0.23, 95% CI: 0.08-0.66), was associated with longer OS. GTR versus NTR (p=0.04, HR: 0.49, 95% CI: 0.29-.85), GTR versus STR (p=0.02, HR: .54, 95% CI: .32-.91) and iMRI use (p=0.02, HR: 0.54, 95% CI: 0.32-0.92) were associated with longer PFS. Frontal (p=0.048, HR: 2.11, 95% CI: 1.01-4.43) and occipital/parietal (p=0.003, HR: 3.59, 95% CI: 1.52-8.49) locations were associated with shorter PFS (versus temporal). Kaplan-Meier analyses showed longer OS with increasing EOR (p=0.03) and 1p/19q gene deletions (p=0.02). PFS improved with increasing EOR (p=0.01), GTR versus NTR (p=0.02), and resections above STR (p=0.04). Factors influencing adjuvant treatment (35.3% of patients) included age (p=0.002, OR: 1.04) and EOR (p=0.037, OR: 0.41 for NTR versus STR; p=0.003, OR: 0.39 for GTR versus STR), but not glioma subtype or location, as determined by logistic regression. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these cases. CONCLUSIONS EOR significantly improves OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

QOLP-22. THE PSYCHO-ONCOLOGICAL BURDEN OF PATIENTS WITH AGGRESSIVE MENINGIOMA – RESULTS FROM A RETROSPECTIVE CROSS-SECTIONAL STUDY

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi187-vi187
Author(s):  
Christine Jungk ◽  
Madlen Raedel ◽  
Julia Mattern-Tremper ◽  
Rolf Warta ◽  
Christel Herold-Mende ◽  
...  
Keyword(s):  
Internal Control ◽  
Multivariate Regression Analysis ◽  
Extent Of Resection ◽  
Cross Sectional Study ◽  
Related Factors ◽  
Cross Sectional ◽  
Who Grade ◽  
Eortc Qlq ◽  
The Impact

Abstract Despite the perception of meningioma as a benign disease, up to 35% of patients experience a clinically aggressive course with debilitating treatment and poor outcome. In contrast to the growing interest in novel therapies, the impact on health-related quality of life (HRQoL) is still understudied. Here, we analysed the psycho-oncological burden of patients with aggressive meningioma. Our institutional cohort was searched for meningioma patients with surgery as first intervention and HRQoL was assessed retrospectively at one time point with standardized self-assessment questionnaires (HADS-D, EORTC-QLQ-C30). Aggressive meningioma was defined as WHO grade 2 or 3 or recurrence of a WHO grade 1 meningioma within 5 years after index surgery. Results were correlated with demographic, tumor- and treatment-related factors by multivariate linear regression and compared to internal control patients (WHO grade 1 meningioma, no recurrence within the first 5 years). 400 out of 653 patients returned the questionnaires (62%). Of those, 95 patients (24%) were classified as aggressive meningioma while 305 patients served as internal control. Patients with and without aggressive meningioma differed with regard to sex (p=0.019), age (p=0.015), extent of resection (p< 0.0001) and adjuvant radiotherapy (p< 0.0001) at index surgery and KPS at 1st follow-up (p=0.037). 34% and 24% of aggressive meningioma patients were screened positive on the anxiety and depression subscales of HADS-D as opposed to 33% and 23% of internal controls (not significant). Aggressive meningioma patients fared significantly worse on most of the function scales of QLQ-C30 (QL: p=0.004; PF: p=0.049; RF: p=0.003; CF: p=0.01; SF: p=0.018) and reported more financial difficulties (FI: p=0.015). In multivariate regression analysis, female sex, KPS at 1st follow-up < 70 and aggressive meningioma were independent factors of impaired HRQoL. This cross-sectional analysis demonstrates that HRQoL is impaired in aggressive meningioma patients who should be screened and treated for their psycho-oncological needs.

scholarly journals Pediatric Non–Brain Stem High-Grade Glioma: A Single-Center Experience

2020 ◽  
Vol 9 (03) ◽  
pp. 162-169
Author(s):  
Ehsan Alimohammadi ◽  
Seyed Reza Bagheri ◽  
Nasrin Delfani ◽  
Roya Safari-Faramani ◽  
Maryam Janatolmakan
Keyword(s):  
Brain Stem ◽  
Poor Prognosis ◽  
Tumor Resection ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Tumor Location ◽  
High Grade ◽  
Related Factors ◽  
Single Center Experience ◽  
The Impact

Abstract Background Pediatric high-grade gliomas (PHGGs) consist of a heterogeneous class of central nervous system (CNS) neoplasms with a poor prognosis. We aimed to present our 10-year experience in the management of children with high-grade glioma focusing on patients’ survival and related factors. Methods All pediatric patients with high- grade glioma (HGG) who were admitted to our center between May 2009 and May 2018 were investigated. Overall survival (OS) was calculated from the time of diagnosis until the day of death. The impact of suggested variables on survival was evaluated using the univariate and multivariate analyses. Results There were 41 children with non–brain stem high-grade glioma (NBSHGG). The mean OS of patients was 21.24 ± 10.16 months. The extent of resection (p = 0.002, hazard ratio [HR] = 4.84), the grade of the tumor (p = 0.017, HR = 4.36), and temozolomide (TMZ) therapy (p = 0.038, HR = 3.57) were the independent predictors of OS in children with NBSHGG. Age, gender, tumor location, and size of tumor were not associated with the survival of these patients. Conclusion HGGs are uncommon pediatric tumors with an aggressive nature and a poor prognosis. Our results revealed that in NBSHGG cases, children with maximal safe tumor resection and children that received temozolomide therapy as well as children with grade III of the tumor had higher survival.

scholarly journals The Impact of Depression on Quality of Life and Depression Related Factors in Patients with Spinal Cord Injury

2018 ◽  
Vol 21 (3) ◽  
pp. 126-132
Author(s):  
Cemile Sevgi POLAT ◽  
Didem Sezgin ÖZCAN ◽  
Belma Füsun KÖSEOĞLU ◽  
Hilmi Umut TATLI ◽  
Şule ŞAHİN ONAT
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Related Factors ◽  
Cord Injury ◽  
The Impact

scholarly journals Management and Treatment of Pediatric Spinal Cord Ependymoma: Results from an International Multi-Institutional Review

2020 ◽  
Vol 108 (3) ◽  
pp. e235-e236
Author(s):  
D.S.C. Tsang ◽  
E. Kumirova ◽  
T.E. Merchant ◽  
A. Vinitsky ◽  
J.C. Chiang ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Institutional Review ◽  
Spinal Cord Ependymoma

Impact of Tumor Histology on Resectability and Neurological Outcome in Primary Intramedullary Spinal Cord Tumors

Neurosurgery ◽  
2015 ◽  
Vol 76 (suppl_1) ◽  
pp. S4-S13 ◽  
Author(s):  
Isaac O. Karikari ◽  
Shahid M. Nimjee ◽  
Tiffany R. Hodges ◽  
Erin Cutrell ◽  
Betsy D. Hughes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Outcome ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Neurological Outcomes ◽  
Tumor Histology ◽  
The Impact

Abstract BACKGROUND: Surgical outcomes for intramedullary spinal cord tumors are affected by many variables including tumor histology and preoperative neurological function. OBJECTIVE: To analyze the impact of tumor histology on neurological outcome in primary intramedullary spinal cord tumors. METHODS: A retrospective review of 102 consecutive patients with intramedullary spinal cord tumors treated at a single institution between January 1998 and March 2009. RESULTS: Ependymomas were the most common tumors with 55 (53.9%), followed by 21 astrocytomas (20.6%), 12 hemangioblastomas (11.8%), and 14 miscellaneous tumors (13.7%). Gross total resection was achieved in 50 ependymomas (90.9%), 3 astrocytomas (14.3%), 11 hemangioblastomas (91.7%), and 12 miscellaneous tumors (85.7%). At a mean follow-up of 41.8 months (range, 1-132 months), we observed recurrences in 4 ependymoma cases (7.3%), 10 astrocytoma cases (47.6%), 1 miscellaneous tumor case (7.1%), and no recurrence in hemangioblastoma cases. When analyzed by tumor location, there was no difference in neurological outcomes (P = .66). At the time of their last follow-up visit, 11 patients (20%) with an ependymoma improved, 38 (69%) remained the same, and 6 (10.9%) worsened. In patients with an astrocytoma, 1 (4.8%) improved, 10 (47.6%) remained the same, and 10 (47.6%) worsened. One patient (8.3%) with a hemangioblastoma improved and 11 (91.7%) remained the same. No patient with a hemangioblastoma worsened. In the miscellaneous tumor group, 2 (14.3%) improved, 10 (71.4%) remained the same, and 2 (14.3%) worsened. Preoperative neurological status (P = .02), tumor histology (P = .005), and extent of resection (P < .0001) were all predictive of functional neurological outcomes. CONCLUSION: Tumor histology is the most important predictor of neurological outcome after surgical resection because it predicts resectability and recurrence.

Impact of Tumor Histology on Resectability and Neurological Outcome in Primary Intramedullary Spinal Cord Tumors: A Single-Center Experience With 102 Patients

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 188-197 ◽  
Author(s):  
Isaac O. Karikari ◽  
Shahid M. Nimjee ◽  
Tiffany R. Hodges ◽  
Erin. Cutrell ◽  
Betsy D. Hughes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neurological Outcome ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Spinal Cord Tumors ◽  
Intramedullary Spinal Cord ◽  
Neurological Outcomes ◽  
Tumor Histology ◽  
The Impact

Abstract BACKGROUND: Surgical outcomes for intramedullary spinal cord tumors are affected by many variables including tumor histology and preoperative neurological function. OBJECTIVE: To analyze the impact of tumor histology on neurological outcome in primary intramedullary spinal cord tumors. METHODS: A retrospective review of 102 consecutive patients with intramedullary spinal cord tumors treated at a single institution between January 1998 and March 2009. RESULTS: Ependymomas were the most common tumors with 55 (53.9%), followed by 21 astrocytomas (20.6%), 12 hemangioblastomas (11.8%), and 14 miscellaneous tumors (13.7%). Gross total resection was achieved in 50 ependymomas (90.9%), 3 astrocytomas (14.3%), 11 hemangioblastomas (91.7%), and 12 miscellaneous tumors (85.7%). At a mean follow-up of 41.8 months (range, 1-132 months), we observed recurrences in 4 ependymoma cases (7.3%), 10 astrocytoma cases (47.6%), 1 miscellaneous tumor case (7.1%), and no recurrence in hemangioblastoma cases. When analyzed by tumor location, there was no difference in neurological outcomes (P = .66). At the time of their last follow-up visit, 11 patients (20%) with an ependymoma improved, 38 (69%) remained the same, and 6 (10.9%) worsened. In patients with an astrocytoma, 1 (4.8%) improved, 10 (47.6%) remained the same, and 10 (47.6%) worsened. One patient (8.3%) with a hemangioblastoma improved and 11 (91.7%) remained the same. No patient with a hemangioblastoma worsened. In the miscellaneous tumor group, 2 (14.3%) improved, 10 (71.4%) remained the same, and 2 (14.3%) worsened. Preoperative neurological status (P = .02), tumor histology (P = .005), and extent of resection (P < .0001) were all predictive of functional neurological outcomes. CONCLUSION: Tumor histology is the most important predictor of neurological outcome after surgical resection because it predicts resectability and recurrence.

A Study On Impact Of Work Life Related Factors On Employee Engagement In Health Care Sector Workers In Dindigul District.

2019 ◽  
Vol 118 (7) ◽  
pp. 20-26
Author(s):  
S. JAYARAMAN ◽  
R. Sindhya ◽  
P. Vijiyalakshmi
Keyword(s):  
Health Care ◽  
Path Analysis ◽  
Employee Engagement ◽  
Health Care Workers ◽  
Health Care Sector ◽  
Work Life ◽  
Primary Data ◽  
Related Factors ◽  
Care Workers ◽  
The Impact

this research aims to find out the intensity of Employee Engagement of the health care sector workers and the relationship between the Work life factors and Employee Engagement of Health care sector workers in Dindigul District. Primary data were used in this research, were collected from 298 Health care workers from Dindigul District. Questionnaire was the major tool used to gather the primary data from the selected sample respondents. For this purpose, a well structured questionnaire was constructed with the help of professionals and the practiced employees of various health care units in Dindigul District. The health care employees were chosen by simple random sampling method. The investigative measures of regression Path analysis, and simple percentage analysis were utilized to find the impact of work life related factors with the Employee Engagement. The maximum Health care workers were generally satisfied with their jobs. The analytical procedure of path analysis multiple regressions was utilized to determine the predicting strength among Work life factors and the employee engagement. This study provides an another view about the importance of Work life factors and Employee engagement for organizational effectiveness and performance .

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