NIMG-34. DELAYED PSEUDOPROGRESSION IN GLIOBLASTOMA PATIENTS TREATED WITH TTFIELDS: A REPORT OF TWO CASES

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi136-vi136
Author(s):  
Norihiko Saito ◽  
Nozomi Hirai ◽  
Akinori Yagihashi ◽  
Shusaku Takahagi ◽  
Naoki Kushida ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Radiographic Progression ◽  
Cell Membrane Permeability ◽  
Newly Diagnosed ◽  
Left Temporal Lobe ◽  
Phase 3 ◽  
Tumor Treating Fields ◽  
Specific Effects ◽  
The Right

Abstract INTRODUCTION: Tumor treating fields (TTFields) is an established treatment modality for glioblastoma (GBM) and is administered with the portable Optune system. Although the EF-14 phase 3 trial demonstrated the efficacy of TTFields for newly diagnosed GBM, uncertainty regarding the specific effects of this treatment has prevented its widespread clinical use. Pseudoprogression in response to chemoradiation is a known problem in GBM patients and most commonly occurs within 3 months after radiotherapy. We report 2 cases of TTFields delayed pseudoprogression. CASE REPORT: Two GBM patients being treated with TTFields showed signs of radiographic progression at 5 to 6 months after completing radiotherapy. Patient 1 was a 37-year-old woman with gliosarcoma in the right temporal lobe. Patient 2 was a 70-year-old man with wildtype-IDH GBM in the left temporal lobe. Both patients received TTFields in addition to maintenance temozolomide (TMZ) after radiotherapy (RT). Radiographic progression was noted at 5 and 6 months after RT in Patients 1 and 2, respectively. Second resections were performed, and pathology showed only the treatment effect, which ultimately led to diagnosis of pseudoprogression. DISCUSSION: Both patients had radiographic progression outside the typical pseudoprogression window. Recent studies reported that TTFields increased plasma cell membrane permeability, which could result in additional gadolinium leakage into the extracellular space. CONCLUSIONS: Better characterization of delayed pseudoprogression would improve treatment and could potentially reduce unnecessary surgeries and discontinuation of successful therapies.

scholarly journals NIMG-37. DELAYED PSEUDOPROGRESSION IN TWO PATIENTS UNDERGOING TTFIELDS TREATMENT FOR NEWLY DIAGNOSED GLIOBLASTOMA

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii155-ii156
Author(s):  
Allison Lowman ◽  
Sarah Hurrell ◽  
Samuel Bobholz ◽  
Jennifer Connelly ◽  
Elizabeth Cochran ◽  
...  
Keyword(s):  
Dna Methyltransferase ◽  
Radiographic Progression ◽  
Methylation Status ◽  
Underlying Mechanism ◽  
Recurrent Glioblastoma ◽  
Newly Diagnosed ◽  
Methylguanine Dna Methyltransferase ◽  
Specific Effects ◽  
Newly Diagnosed Glioblastoma ◽  
Associated Risk Factors

Abstract PURPOSE Tumor treatment fields (TTFields) are approved by the FDA for newly diagnosed as well as recurrent glioblastoma (GBM). TTFields have been shown to extend survival by 4.9 months in newly diagnosed GBM, and a landmark overall survival rate of 13% at 5 years. However, the specific effects remain widely unknown, which has prevented widespread clinical use of this treatment. METHODS This case study examines two glioblastoma patients, IDH-1 wildtype, MGMT unmethylated, that received TTFields (Optune) in addition to maintenance temozolomide (TMZ) following radiation (RT). Both cases were followed using standard MR imaging. Second resections were performed due to radiographic progression of contrast enhancement. RESULTS Although imaging was concerning for tumor progression, pathology showed only treatment effect, ultimately leading to the diagnosis of pseudoprogression. Both patients fell outside the normal expected timeline for chemo-radiation induced pseudoprogression. Based on the pathology, both patients resumed treatment with TMZ/TTFields. One patient expired at 25 months and one is still alive. CONCLUSIONS Pathologic confirmation was essential for guiding further treatment and allowed patients to continue treatment that was effective despite contrary indications on imaging. These findings suggest that pathological confirmation should be strongly considered in patients receiving TMZ/TTFields who develop radiographic progression, potentially with a less invasive biopsy procedure. Future studies should look to characterize the underlying mechanism of interaction between TTFields/TMZ and quantify the prevalence, associated risk factors and whether there is a genotype more susceptible. Both patients reported here had O(6)-methylguanine-DNA methyltransferase (MGMT) unmethylated GBM, and while about 60% of glioblastomas are diagnosed likewise, it is possible that MGMT methylation status plays a role in TTFields response. Better characterization of this phenomenon will improve treatment guidance, potentially reducing unnecessary surgeries and the discontinuance of successful therapies.

scholarly journals ACTR-39. APPLICATION OF RTOG-RPA SCORES IN A PHASE 3 TRIAL OF TUMOR TREATING FIELDS WITH TEMOZOLOMIDE (TTFIELDS/TMZ) VERSUS TEMOZOLOMIDE (TMZ) ALONE IN NEWLY DIAGNOSED GLIOBLASTOMA

2017 ◽  
Vol 19 (suppl_6) ◽  
pp. vi8-vi9
Author(s):  
Kevin Choe ◽  
Ahmed Idbaih ◽  
Sophie Taillibert ◽  
Jordi Bruna Escuder ◽  
Jan Sroubek ◽  
...  
Keyword(s):  
Newly Diagnosed ◽  
Phase 3 ◽  
Tumor Treating Fields ◽  
Newly Diagnosed Glioblastoma

Damage of left temporal lobe resulting in conversion of speech to Sutra, a Buddhist prayer stored in the right hemisphere

Neurocase ◽  
2010 ◽  
Vol 16 (4) ◽  
pp. 317-320 ◽  
Author(s):  
Nobusada Shinoura ◽  
Toshiyuki Onodera ◽  
Kotoyo Kurokawa ◽  
Masanobu Tsukada ◽  
Ryozi Yamada ◽  
...  
Keyword(s):  
Temporal Lobe ◽  
Right Hemisphere ◽  
Left Temporal Lobe ◽  
The Right

scholarly journals ML-4 A case of primary CNS lymphoma diagnosed 5 years after stereotactic radiosurgery

2021 ◽  
Vol 3 (Supplement_6) ◽  
pp. vi23-vi23
Author(s):  
Yusuke Tabei ◽  
Ichirou Nakazato ◽  
Kenichi Ooyama ◽  
Masatou Kawashima ◽  
Akira Matsuno ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Tumor Cells ◽  
Temporal Lobe ◽  
Radiation Necrosis ◽  
B Cell Lymphoma ◽  
Unknown Primary ◽  
High Dose ◽  
Left Temporal Lobe ◽  
The Right

Abstract Central nervous system primary malignant lymphoma (PCNSL) is rarely diagnosed as multiple metastatic brain tumors. Almost tumors recure early after receiving stereotactic radiosurgery (SRS). Regardless of the fact, the following case report displays PCNSL, diagnosed five years after the initial treatment with SRS as brain metastases of unknown primary origin. This extraordinal case suggests long-term follow-up regarding PCNCL. The case was a 55-year-old woman with a history of a total hysterectomy for cervical cancer. She developed left paralysis. Brain MRI confirmed a 27 mm contrast-enhanced lesion in the right frontal lobe and three other lesions. SRS was performed as a diagnosis of multiple brain metastases for urgent symptom relief. No extra-cranial cancerous lesions were found. Unknown primary cancer was a probable diagnosis at that time. Two years after SRS, local regrowth of tumor of the right frontal primary motor area was discovered. Re-irradiation was performed. Cerebral edema, contrast enhancement, and left paralysis progressed following five months, taking an oral corticosteroid. Craniotomy and debulk. The pathological diagnosis was brain radiation necrosis due to no viable tumor cells. New lesions in the left temporal lobe and basal ganglia appeared three years after surgery. Awake craniotomy was performed for the left temporal lobe lesion. Histopathology showed diffuse growth of tumor cells with a high nucleo-cytoplasmic ratio and irregular nuclear shape. Immunohistochemistry revealed positive CD10, CD20, CD45 (LCA), MUM1, and negative CD3, CD5. The Ki- 67 labeling rate was as high as almost 100% to diagnose diffuse large B-cell lymphoma, PCNSL. Multidrug chemotherapy consisting of rituximab, high-dose methotrexate, procarbazine, and vincristine were performed. Complete remission was obtained without any serious adverse events. Considering the residual radiation necrosis, whole-brain irradiation was avoided. Moreover, consolidation therapy was performed only with high-dose cytarabine therapy.

scholarly journals RIGHT VS. LEFT TEMPORAL LOBE SEMIOLOGY IN DEMENTIA: LESSONS FROM TWO CASES WITH FOCAL FRONTOTEMPORAL DEMENTIA SYNDROMES

2021 ◽  
Author(s):  
Vitor Arca ◽  
Pedro Albuquerque ◽  
Victor Correia ◽  
Amanda Pires ◽  
Hugo Araújo ◽  
...  
Keyword(s):  
Frontotemporal Dementia ◽  
Temporal Lobe ◽  
Word Processing ◽  
Brain Mri ◽  
Cerebral Atrophy ◽  
Primary Progressive Aphasia ◽  
Left Temporal Lobe ◽  
Her Family ◽  
Mini Mental Status Examination ◽  
The Right

Background: Case 1: a 59-year old man presented to our service with 4 years of progressive cognitive and behavioral symptoms. He became forgetful and experienced difficulties managing his payments. After 4 years he could no longer recognise his relatives. Cognitive assessment showed a mini-mental status examination of 17/30. MRI and SPECT revealed respectively focal atrophy and hipoperfusion of the frontal regions and anterior right temporal lobe. Case 2: a 72-year-old woman was brought to evaluation with a 5-years history of progressive language and behavioral deterioration. Her family reported early speech errors and behavioral changes, with a marked aggressiveness, ritualistic behaviors and hyperorality. Cognitive evaluation revealed a MMSE of 6/30 mainly due to a relatively fluent afasia. Brain MRI showed asymmetric cerebral atrophy, more prominent in the anterior left temporal lobe. Objective: N/H Methods: N/H Results: N/H Conclusion: We describe two cases of suspected frontotemporal dementia (FTD) syndromes. The left ATL may receive proportionately more input from the lexical and phonological centers subserving word processing. The right ATL may receive more input from right-lateralized emotion processing hubs. Focal atrophy of the left anterior temporal lobe has been associated with the semantic type of primary progressive aphasia evolving to semantic dementia. In contrast, focal atrophy of the right temporal lobe has recently been described as a controversial entity reported as the right temporal variant of FTD.

Perception of Geometrical Figures in Persons with Damaged Temporal Lobes

Perception ◽  
1997 ◽  
Vol 26 (1_suppl) ◽  
pp. 244-244
Author(s):  
R Lukauskiene ◽  
A Bertulis ◽  
I Busauskiene ◽  
B Mickiene
Keyword(s):  
Visual Field ◽  
Temporal Lobe ◽  
Spatial Neglect ◽  
Right Visual Field ◽  
Size Discrimination ◽  
Left Temporal Lobe ◽  
Form Discrimination ◽  
Temporal Lobes ◽  
The Right ◽  
Better Than

Persons with damaged temporal lobes were tested with computerised tests for size and form discrimination developed by A Bulatov and A Bertulis (1994 Perception23 Supplement, 25). 48 persons with damaged right and 54 persons with damaged left temporal lobe were tested. 8 persons showed hemineglect of the right visual field and 10 persons hemineglect of the left visual field. Posner (1987 Neuropsychologia25 135) stated that persons with unilateral spatial neglect had a specific inability to disengage their attention from a given object in order to reallocate it to another object positioned to its left or right. In our studies we determined whether size discrimination abnormalities also occur in the neglected side, opposite to the damaged temporal lobe. We estimated the accuracy with which subjects judged the height of two squares of different colours. Two squares with sizes varying from 0.2 to 3.0 deg were generated on the right and left side of the monitor. Subjects viewed the patterns binocularly at a distance of 1 m and adjusted the size of the square on the left to make its height equal to that on the right. The error of the setting was recorded. Persons with hemineglect of the visual field were unable to concentrate their attention at two figures located on both sides of the monitor so they were unable to make the comparison. Persons with right and left temporal lobe damage without hemineglect of the visual field judged the geometrical figures better than those with hemineglect but worse than controls. Persons with damaged left temporal lobe judged figures less well than persons with damaged right temporal lobe.

Verbal Memory in Newly Diagnosed Patients and Patients with Chronic Left Temporal Lobe Epilepsy

2001 ◽  
Vol 2 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Marja Äikiä ◽  
Tuuli Salmenperä ◽  
Kaarina Partanen ◽  
Reetta Kälviäinen
Keyword(s):  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Verbal Memory ◽  
Newly Diagnosed ◽  
Left Temporal Lobe

scholarly journals ES-2 Phase 3 TRIDENT Trial: Radiation and Temozolomide with or without Tumor Treating Fields in newly diagnosed glioblastoma

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii3-ii3
Author(s):  
Mitsutoshi Nakada
Keyword(s):  
Progression Free Survival ◽  
Phase Iii ◽  
Therapeutic Effects ◽  
Type I ◽  
Newly Diagnosed ◽  
Phase 3 ◽  
Free Survival ◽  
Tumor Treating Fields ◽  
Post Surgery

Abstract Background: Tumor treating fields (TTFields) is a non-invasive, regional antimitotic treatment approved as a standard-of-care for glioblastoma. In the EF-14 Phase 3 trial, TTFields (200 kHz) plus temozolomide (TMZ) significantly increased survival of patients with newly diagnosed GBM(ndGBM) without increasing systemic toxicity. TTFields-related AEs were mainly skin AEs. In preclinical models, TTFields increase the therapeutic effects of radiation therapy (RT). A pilot study showed that TTFields concomitant with RT and TMZ is well tolerated. The benefit of concomitant TTFields with RT and TMZ will be tested in the TRIDENT trial. Methods: TRIDENT is an international phase III randomized trial comparing standard RT/TMZ vs the triple combination of RT/TMZ with concomitant TTFields. RT is delivered through the TTFields arrays. Patients in both arms will receive maintenance TTFields/TMZ. TTFields (200 kHz) will be delivered over18 hours/day using Optune. Patients will continue TTFields treatment until second recurrence. Patients with pathologically confirmed ndGBM, over 18 years old, KPS over 70, either sex, post-surgery or biopsy, and amenable for RT/TMZ therapy will be stratified by extent of resection and MGMT promoter methylation status. The primary endpoint is overall survival (OS). Secondary end points: progression free survival (PFS; RANO), 1- and 2-year survival rates, overall radiological response (ORR; RANO), progression-free survival (PFS2, PFS6, PFS12); severity and frequency of AEs (CTCAE V5.0); pathological changes in resected GBM tumors post treatment; quality of life (EORTC QLQ-C30); and correlation of OS to TTFields compliance. The hypothesis is that concomitant TTFields/RT/TMZ will significantly improve OS versus RT/TMZ. Sample size (N=950; 475/arm) will detect a HR lower than 0.8 with 5% type I error. Survival will be measured from the time of randomization until date of death. At the time of analysis, patients lost to follow-up or still on protocol follow-up will be censored at the last date known to be alive.

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