scholarly journals P01.064 Correlation with MGMT pyrosequencing-based methylation levels and overall survival in glioblastoma patients with gross total resection and concomitant chemio and radiotherapy

2018 ◽  
Vol 20 (suppl_3) ◽  
pp. iii244-iii244
Author(s):  
A Parlangeli ◽  
E Pirola ◽  
M Caroli ◽  
C Pesenti ◽  
S Buonamassa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Gross Total Resection ◽  
Total Resection

Letter to the Editor Regarding “Association Between Facility Volume and Overall Survival for Patients with Grade II Meningioma after Gross Total Resection”

2020 ◽  
Vol 142 ◽  
pp. 537
Author(s):  
Gustavo Correa Lordelo ◽  
Victor Salviato Nespoli ◽  
Iuri Santana Neville ◽  
Wellingson Silva Paiva
Keyword(s):  
Overall Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Letter To The Editor ◽  
Grade Ii

scholarly journals Low rates of recurrence and slow progression of pediatric pilocytic astrocytoma after gross-total resection: justification for reducing surveillance imaging

2016 ◽  
Vol 17 (5) ◽  
pp. 569-572 ◽  
Author(s):  
Andrew J. Dodgshun ◽  
Wirginia J. Maixner ◽  
Jordan R. Hansford ◽  
Michael J. Sullivan
Keyword(s):  
Overall Survival ◽  
Cost Savings ◽  
Tumor Location ◽  
Gross Total Resection ◽  
Total Resection ◽  
Routine Surveillance ◽  
Surveillance Imaging ◽  
Pilocytic Astrocytomas ◽  
Mri Scans ◽  
Mri Surveillance

OBJECTIVE Pilocytic astrocytomas (PAs) are common brain tumors in children. Optimal management of PA is gross-total resection (GTR), after which event-free survival (EFS) is excellent. The tempo of recurrences, when they do occur, is relatively sparsely reported, and there is no agreed upon surveillance recommendation for patients in this category. It has been suggested that surveillance MRI is performed too frequently and could be safely reduced in both frequency and duration. The authors conducted a retrospective review of pediatric patients with PA who underwent GTR at a single institution over an 18-year period and who had documented recurrences. METHODS All patients under 18 years of age who had undergone GTR of a PA between 1996 and 2013 were included in the study. Clinical, radiological, and tumor characteristics were recorded. RESULTS Sixty-seven patients met the criteria for GTR over the period studied. The 5-year EFS rate was 95% (95% CI 89%–100%) and overall survival was 100%. Recurrences showed a nonsignificant trend of occurring more commonly in patients with persistent nonenhancing FLAIR abnormalities after surgery, but there was no difference with regard to tumor location. All recurrences occurred before 3 years postresection, all were asymptomatic, and all patients were observed for at least one additional scan after the initial detection during routine surveillance MRI before further therapy was undertaken. CONCLUSIONS EFS and overall survival are excellent after GTR in this population with PAs. Progression after recurrence occurs slowly and is asymptomatic. A less intensive schedule of MRI surveillance in this group of patients would result in time and cost savings, without compromising safety. The authors suggest a schedule of 6 MRI scans to be obtained postoperatively, at 3–6 months, then at 1, 2, 3.5, and 5 years.

scholarly journals P14.116 Lack of correlation between incidental ipsilateral subventricular zone radiation dose and overall survival in glioblastoma patients

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii95-iii96
Author(s):  
G Hallaert ◽  
H Pinson ◽  
D Vanhauwaert ◽  
L Staelens ◽  
C Vandenbroecke ◽  
...  
Keyword(s):  
Overall Survival ◽  
Radiation Dose ◽  
Subventricular Zone ◽  
Cox Regression ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Karnofsky Performance Score ◽  
Mgmt Methylation ◽  
Gene Methylation ◽  
Total Resection

Abstract BACKGROUND The role of the subventricular zone (SVZ) in glioblastoma (GBM) is controversial. The past decade, several retrospective studies were published concerning the potential correlation between incidental radiation of the SVZ and survival in GBM patients. Although these publications showed conflicting results, a large study claimed an overall survival (OS) benefit for GBM patients after gross total resection if the ipsilateral SVZ received a higher dose than 40 Gy. We investigated this finding in our own population of GBM patients. MATERIAL AND METHODS A multicenter retrospective study was conducted including all adult patients treated for histologically proven GBM from 2003–2014. All patients received 60 Gy radiation therapy after surgery and concomitant temozolomide. Exclusion criteria were: infratentorial GBM; presence of other neoplasm(s); known previous history of low grade glioma; incomplete radiotherapy data. Demographic data were collected from the patient charts. O6-methylguanin-DNA-methyltransferase-promotor-gene (MGMT) methylation was determined on stored tumor samples using semi quantitative methylation-specific polymerase chain reaction (qMSP). SVZs (ipsilateral, contralateral and bilateral) were contoured on radiotherapy treatment plans. Multivariate Cox regression analysis was used to study the correlation between incidental SVZ radiation dose and OS. Age (cut-off 65 years), Karnofsky Performance Score (KPS; cut-off 70), methylation of the MGMT-promotor gene and extent of resection (biopsy; subtotal resection, groos total resection) were used as covariates. Patients alive at time of database closure were censored for analysis. RESULTS 183 patients were eligible for analysis. Mean age at diagnosis was 62 years, with an average KPS of 70. In 34% of patients, gross total resection (GTR) was achieved, while in 28% only a biopsy was taken. MGMT-promoter gene methylation was present in 39% of cases. Median ipsilateral, contralateral and bilateral SVZ doses were 46.1 Gy, 25.35 Gy and 34.8 Gy resp. In multivariate Cox regression, all covariates (age, P = 0.011; KPS, P = 0.001; MGMT methylation, P = 0.000; extent of resection, P = 0.000) were significantly associated with OS. Mean OS was 23 months, but median OS 13 months. There was no correlation between incidental radiation dose of the ipsilateral SVZ and OS for 46 Gy or 40 Gy (hazard ratio 0.82 (0.6–1.1), P = 0.225 and 0.89 (0.63–1.23), P = 0.52 resp.) for the whole group nor for the subgroup of gross total resection. CONCLUSION In this group of GBM patients, age, KPS, extent of resection and methylation of the MGMT-promotor gene were significantly correlated with OS, but not incidental ipsilateral SVZ radiation dose. The previously published positive results may result from bias, possibly arising from lack of inclusion of MGMT-promotor gene methylation as an important independent prognostic factor.

Pediatric Clival Chordoma: A Curable Disease that Conforms to Collins' Law

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 652-660 ◽  
Author(s):  
Marcio S Rassi ◽  
M Maher Hulou ◽  
Kaith Almefty ◽  
Wenya Linda Bi ◽  
Svetlana Pravdenkova ◽  
...  
Keyword(s):  
Overall Survival ◽  
Skull Base ◽  
Proton Beam ◽  
Statistical Significance ◽  
Progression Free Survival ◽  
Gross Total Resection ◽  
Total Resection ◽  
Free Survival ◽  
Proton Beam Radiotherapy ◽  
Skull Base Chordomas

Abstract BACKGROUND Skull base chordomas in children are extremely rare. Their course, management, and outcome have not been defined. OBJECTIVE To describe the preeminent clinical and radiological features in a series of pediatric patients with skull base chordomas and analyze the outcome of a cohort who underwent uniform treatment. We emphasize predictors of overall survival and progression-free survival, which aligns with Collins’ law for embryonal tumors. METHODS Thirty-one patients with a mean age of 10.7 yr (range 0.8-22) harboring skull base chordomas were evaluated. We retrospectively analyzed the outcomes and prognostic factors for 18 patients treated by the senior author, with uniform management of surgery with the aim of gross total resection and adjuvant proton-beam radiotherapy. Mean follow-up was 119.2 mo (range 8-263). RESULTS Abducens nerve palsy was the most common presenting symptom. Imaging disclosed large tumors that often involve multiple anatomical compartments. Patients undergoing gross total resection had significantly increased progression-free survival (P = .02) and overall survival (P = .05) compared with those having subtotal resection. Those who lived through the period of risk for recurrence without disease progression had a higher probability of living entirely free of progression (P = .03; odds ratio = 16.0). Age, sex, and histopathological variant did not yield statistical significance in survival. CONCLUSION Long-term overall and progression-free survival in children harboring skull base chordomas can be achieved with gross surgical resection and proton-beam radiotherapy, despite an advanced stage at presentation. Collins’ law does apply to pediatric skull base chordomas, and children with this disease have a high hope for cure.

scholarly journals Long-term Outcomes from Proton Therapy for Sinonasal Cancers

2021 ◽  
Vol 8 (1) ◽  
pp. 200-212
Author(s):  
Roi Dagan ◽  
Haruka Uezono ◽  
Curtis Bryant ◽  
Adam L. Holtzman ◽  
Christopher G. Morris ◽  
...  
Keyword(s):  
Overall Survival ◽  
Proton Therapy ◽  
Concurrent Chemotherapy ◽  
Gross Total Resection ◽  
High Grade ◽  
Total Resection ◽  
Sinonasal Cancer ◽  
Regional Control ◽  
Local Regional Control

Abstract Purpose To report long-term disease control, survival, and toxicity after proton therapy for sinonasal cancer. Patients and Methods We reviewed 143 cases of adults with nonmetastatic sinonasal cancers treated with primary (18%; n = 26) or adjuvant (82%; n = 117) proton therapy. The most common histologies were squamous cell carcinoma (29%; n = 42), olfactory neuroblastoma (23%; n = 33), and adenoid cystic carcinoma (16%; n = 23). Patients had predominantly advanced-stage disease (T3, 24%, n = 35; T4, 66%, n = 94) and high-grade histology (52%; n = 74). Surgery included endoscopic resection alone (50%) with craniotomy (10%) or open resection (40%), and 31% had gross disease present at radiotherapy. Most (91%) received high-dose (median, 73.6 Gy radiobiological equivalent [GyRBE]; 84% >70 GyRBE) passive-scatter proton therapy using accelerated hyperfractionation (1.2 GyRBE twice daily) and concurrent chemotherapy (70%). Univariate and multivariate models assessed prognostic factors. Grade 3+ toxicities were recorded per Common Terminology Criteria, version 4. Median follow-up was 3.4 years (range, 0.1–12.5 years) overall and 4.9 years (range, 0.9–12.5 years) for living patients. Results The 5-year outcomes were as follows: local control (LC), 80%; neck control, 96%; local-regional control, 78%; freedom from distant metastases, 71%; and disease-free survival, 62%; cause-specific survival, 64%; and overall survival, 59%. Surgery improved LC, but only with gross total resection (5-year LC 87% versus subtotal resection 62.9%, and biopsy alone 55% (P < 0.001). Gross residual disease was the only significant prognostic factor for local-regional control on multivariate analysis. High-grade, T4, and local recurrence were associated with decreased overall survival. Late (G3+) toxicity occurred in 22% (32 of 143), including central nervous system necrosis and vision loss in 6% (9 of 143) and 3.5% (5 of 143), respectively. Conclusion Proton therapy after gross-total resection provides excellent long-term LC in patients with locally advanced, high-grade sinonasal cancer. Moreover, LC remains strongly associated with long-term survival. With gross disease, about 60% of patients had long-term LC with proton therapy and induction or concurrent chemotherapy.

scholarly journals Clinical Factors and Outcomes of Atypical Meningioma: A Population-Based Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Gui-Jun Zhang ◽  
Xiao-Yin Liu ◽  
Chao You
Keyword(s):  
Overall Survival ◽  
Atypical Meningioma ◽  
Gross Total Resection ◽  
Concordance Index ◽  
Training Set ◽  
Total Resection ◽  
Calibration Curves ◽  
Significant Difference ◽  
Validation Set ◽  
Receiver Operating

ObjectiveAtypical meningioma is a non-benign tumor, and its prognostic factors and treatment strategies are unclear.MethodsPatients with atypical meningioma, between 2004 and 2016, were collected from the Surveillance, Epidemiology, and End Results database. Then, we randomly divided patients into a training set and a validation set at a ratio of 8:2. The nomogram was constructed based on the multivariate Cox regression analyses. And the concordance index, calibration curves, and receiver operating character were used to assess the predictive ability of the nomogram. We divided the patient scores into three groups and constructed a survival curve using Kaplan–Meier analysis.ResultsAfter our inclusion and exclusion criteria, 2358 patients were histologically diagnosed of atypical meningioma. The prognostic nomogram comprised factors of overall survival, including age, tumor size and surgery. The concordance index was 0.715 (95%CI=0.688-0.742) for overall survival in the training set and 0.688 (95%CI=0.629-0.747) for overall survival in the validation set. The calibration curves and receiver operating character also indicated the good predictability of the nomogram. Risk stratification revealed a statistically significant difference among the three groups of patients according to quartiles of risk score.ConclusionGross total resection is an independent factor for survival, and radiation after non-gross total resection potentially confers a survival advantage for patients with atypical meningioma.

scholarly journals Treatment of pediatric Grade II spinal ependymomas: a population-based study

2015 ◽  
Vol 15 (3) ◽  
pp. 243-249 ◽  
Author(s):  
Yimo Lin ◽  
Andrew Jea ◽  
Stephanie C. Melkonian ◽  
Sandi Lam
Keyword(s):  
Spinal Cord ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Pediatric Patients ◽  
Treatment Patterns ◽  
Gross Total Resection ◽  
Subtotal Resection ◽  
Total Resection ◽  
Spinal Ependymoma ◽  
Grade Ii

OBJECT Grade II spinal cord ependymomas occurring in pediatric patients are exceptionally rare neoplasms. In this paper the authors use a national cancer database to determine patient demographics, treatment patterns, and associated outcomes of this cohort. METHODS The Surveillance Epidemiology and End Results (SEER) database was used to analyze subjects younger than 18 years with histologically confirmed diagnoses of Grade II spinal cord ependymoma from the years 1973 to 2008. Descriptive data on the demographic characteristics of this cohort and the associated treatment patterns are shown. The Kaplan-Meier method was used to estimate overall survival at 1, 2, 5, and 10 years. RESULTS This cohort comprised 64 pediatric subjects with Grade II spinal ependymoma. The median age was 13 years, nearly half of the patients were male, and most were white (84%). The median follow-up was 9.2 years. Overall survival at 5 and 10 years was 86% and 83%, respectively. Gross-total resection was achieved in 57% of subjects, and radiation therapy was administered to 36%. Radiation therapy was administered to 78% of subjects after subtotal resection but only to 19% of patients after gross-total resection; this difference was significant (p < 0.001). In a multivariate regression model analyzing sex, age at diagnosis, year of diagnosis, radiotherapy, and extent of resection, female sex was found to be an independent predictor of decreased mortality (HR 0.15 [95% CI 0.02–0.94], p = 0.04). CONCLUSIONS These data show long-term outcomes for pediatric patients with Grade II spinal ependymoma. Radiotherapy was more likely to be administered in cases of subtotal resection than in cases of gross-total resection. Female sex is associated with decreased mortality, while other demographic or treatment modalities are not.

135 Pediatric Supratentorial Ependymoma: Clinical, Radiographic and Molecular Analysis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 231-231
Author(s):  
Jock Lillard ◽  
Paul Klimo ◽  
Garrett Thomas Venable
Keyword(s):  
Overall Survival ◽  
Molecular Analysis ◽  
Progression Free Survival ◽  
Tumor Grade ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Free Survival ◽  
Favorable Prognosis ◽  
Supratentorial Ependymoma

Abstract INTRODUCTION Recent molecular analyses support a behavioral and clinical distinction between supratentorial and infratentorial ependymomas, with supratentorial tumors, in general, having a more favorable prognosis. The goal of this study was todescribe our experience managing supratentorial ependymoma in children. METHODS A prospectively maintained neurooncology database was queried to identify cases ofsupratentorial ependymoma treated atSt Jude Children's Research Hospital (SJCRH) and LeBonheur from 1990 through December 31, 2014. Clinical, operative, and radiographic information were reviewed. Outcome measures, determined by review of clinic notes and subsequent imaging, included extent of resection, progression free survival (PFS), overall survival (OS), recurrence of disease and method of post-failure treatment, seizures, requirement of anti-seizure medications, hydrocephalus requiring shunt placement, and death.Detection ofthe C11or95-RELA fusion or rearrangement was performed using iFISH in those patients whose tumor tissue was still available. RESULTS >Seventy-four cases (42% male) of supratentorial ependymoma were identified. Median age at diagnosis was 6.8 years. In total, 59 (79.7%) of 74 patients underwent gross total resection (GTR). Overall survival was a median of 7.4 years. Fifteen patients died of disease. Progression free survival was a median of 3.6 years. Eighty percent of those children whose initial resection was subtotal developed recurrence compared to 50.8% in those who had a GTR. For those patients that recurred, all 42 received further treatment, including further resection, chemotherapy and radiation. Molecular analysis was available for 52 patients (70.3%). Age less than 3, gross total resection, and tumor grade were not associated with improved PFS or OS. Absence of C11-or95-RLEA fusion was associated with a significantly worse PFS, although OS was similar. CONCLUSION Supratentorial ependymoma often have a more favorable prognosis compared toinfratentorial variants. Like many pediatric tumors, supratentorial ependymomas can bestratified based on clinical, surgical and possibly molecular variables.

The effect of socioeconomic status on gross total resection, radiation therapy and overall survival in patients with gliomas

2017 ◽  
Vol 132 (3) ◽  
pp. 447-453 ◽  
Author(s):  
Sayantan Deb ◽  
Arjun Vivek Pendharkar ◽  
Matthew K. Schoen ◽  
Sean Altekruse ◽  
John Ratliff ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Gross Total Resection ◽  
Total Resection
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