scholarly journals P03.09 Real world management and prognosis of glioma patients:SYSUCC report from China

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii27
Author(s):  
D Li ◽  
Y Chen ◽  
C Guo ◽  
Q Yang ◽  
S Wu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Real World ◽  
Cancer Center ◽  
Low Grade ◽  
High Grade ◽  
Who Grade ◽  
Low Grade Gliomas ◽  
Pathological Subtype ◽  
High Grade Gliomas ◽  
Grade Iii

Abstract Background: The conventional way of patient treatment should be following guidelines. While in clinical practice, patients received treatments very often away from suggested guideline. In this report, we reviewed glioma patients received real world treatment at Sun Yat-sen University Cancer Center (SYSUCC) and results of this patient series. Methods: Total of 1215 glioma patients received surgery at SYSUCC from 2000 to 2017 were enclosed for analysis. The pathologic diagnosis of patients has followed WHO classification (initially 2007 standard, than 2016 standard). Results: A total of 1001 newly diagnosed brain glioma patients were analyzed, including 90 cases WHO grade I, 307 grade II, 239 grade III and 365 grade IV. The median age of onset was 14 (1–75), 35 (2–69), 41 (8–82) and 50 (2–86) years old, respectively, for grade I, II, III and IV glioma patients. Tumor total resection was achieved in 567 patients (57.5%). Among all patients, 331 high-grade gliomas (54.8%) and 159 low-grade glioma (40.1%) received radiotherapy, whereas 285 high-grade gliomas (47.1%) and 80 low-grade tumors (20.2%) received chemotherapy. Among high-grade gliomas, the median OS of glioblastoma, anaplastic astrocytoma and anaplastic oligodendroglial tumors were 17.7 months (15.7–19.7 months), 33.7 months (24.0–43.4 months) and 110.6 months (43.5–177.7 months), respectively, whereas the median OS of low-grade gliomas was not reach. The 5-year survival rate of grade I, II, III and IV gliomas was 94.7%, 73.7%, 45.1% and 18.6%, respectively. Multivariate analysis identified that onset age, Karnofsky performance status, tumor location, preoperative seizure, pathological subtype, resection extent and post-surgical treatment were independent predictors of OS for patients with high-grade gliomas. Patients received post-surgical radiotherapy and (or) chemotherapy had better survival than those without adjuvant treatment (grade III: 53.3 vs. 20.6 months, p =0.012; grade IV: 22.9 vs. 12.3 months, p < 0.001). For low-grade gliomas, patients’ age, Ki-67 index, tumor subtype and resection extent were associated with clinical outcomes. Conclusions: Glioma patients received treatments do not always following guidelines in clinical practice. Although standard care for patients may beneficial for prognosis, personalized treatment may more acceptable for patients and even resulting better outcome which should keep in mind in routine clinical practice.

scholarly journals Comparison of Intravoxel Incoherent Motion Diffusion-Weighted MR Imaging and Arterial Spin Labeling MR Imaging in Gliomas

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Yuankai Lin ◽  
Jianrui Li ◽  
Zhiqiang Zhang ◽  
Qiang Xu ◽  
Zhenyu Zhou ◽  
...  
Keyword(s):  
Diffusion Coefficient ◽  
White Matter ◽  
Mr Imaging ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
Intravoxel Incoherent Motion ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
High Grade Gliomas

Gliomas grading is important for treatment plan; we aimed to investigate the application of intravoxel incoherent motion (IVIM) diffusion-weighted imaging (DWI) in gliomas grading, by comparing with the three-dimensional pseudocontinuous arterial spin labeling (3D pCASL). 24 patients (13 high grade gliomas and 11 low grade gliomas) underwent IVIM DWI and 3D pCASL imaging before operation; maps of fast diffusion coefficient (D∗), slow diffusion coefficient (D), fractional perfusion-related volume (f), and apparent diffusion coefficient (ADC) as well as cerebral blood flow (CBF) were calculated and then coregistered to generate the corresponding parameter values. We found CBF andD∗were higher in the high grade gliomas, whereas ADC,D, andfwere lower (allP<0.05). In differentiating the high from low grade gliomas, the maximum areas under the curves (AUC) ofD∗, CBF, and ADC were 0.857, 0.85, and 0.902, respectively. CBF was negatively correlated withfin tumor (r=-0.619,P=0.001). ADC was positively correlated withDin both tumor and white matter (r=0.887,P=0.000andr=0.824,P=0.000, resp.). There was no correlation between CBF andD∗in both tumor and white matter (P>0.05). IVIM DWI showed more efficiency than 3D pCASL but less validity than conventional DWI in differentiating the high from low grade gliomas.

scholarly journals Immuno-Phenotyping of High-Grade Glioma Infiltrating Immune Cells Reveals Grade Specific Differences in Cells of Myeloid Origin

2020 ◽  
Author(s):  
Raksha A. Ganesh ◽  
Jayashree V. Raghavan ◽  
Pranali Sonpatki ◽  
Divya Naik ◽  
Priyanka Arunachalam ◽  
...  
Keyword(s):  
Immune Cells ◽  
Immune Cell ◽  
Myeloid Cells ◽  
Suppressor Cells ◽  
High Grade Glioma ◽  
Low Grade ◽  
High Grade ◽  
High Grade Gliomas ◽  
Cell Phenotypes ◽  
Grade Iii

AbstractGliomas are heavily infiltrated with immune cells of myeloid origin. Past studies have shown that high-grade gliomas have a higher proportion of alternatively activated and suppressive myeloid cells when compared to low-grade gliomas, which correlate with poor prognosis. However, the differences in immune cell phenotypes within high-grade gliomas (between grade III and IV) are relatively less explored, and a correlation of phenotypic characteristics between immune cells in the blood and high grade tumors has not been performed. Additionally, myeloid cells of granulocytic origin present in gliomas remain poorly characterized. Herein, we address these questions through phenotypic characterizations of monocytes and neutrophils present in blood and tumors of individuals with glioblastoma (GBM, grade IV) or grade III gliomas. Our data show that CD163 expressing M2 monocytes are present in greater proportions in GBM tissue when compared to grade III glioma tissue. In addition, we observe that neutrophils are highly heterogeneous among individuals with glioma, and a greater proportion of granulocytic myeloid-derived suppressor cells are present in grade III gliomas when compared to GBM. Finally, we show that the expression levels of CD86 and CD63 showed a high correlation between blood and tumor, and suggest that these may be used as possible markers for prognosis.

scholarly journals Antibiotic Allergy and Blood Eosinophils Percent Could Be Prognostic Indicators of Glioma

2021 ◽  
Author(s):  
Liming Cao ◽  
Zhanghua Lv ◽  
Weiliang Wang ◽  
Xue Li ◽  
Jing Shi ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Tumor Grade ◽  
Blood Eosinophil ◽  
Low Grade ◽  
High Grade ◽  
Cox Regression Analysis ◽  
Low Grade Gliomas ◽  
Antibiotic Allergy ◽  
High Grade Gliomas

Abstract Background: Antibiotic allergy and blood eosinophil percentage (EOS%) may play an important role in the prognosis of gliomas, but few studies reported the relationship between antibiotic allergy and glioma as well as EOS% and glioma. The aim of our study was to estimate the relationships between antibiotic allergy, blood eosinophil percentage (EOS%) and glioma prognosis and to conduct a nomogram model for glioma patients. Estimating the effect of antibiotic allergy and EOS% on glioma prognosis may conduce to finding low-cost and safe prognostic indicators of glioma.Methods: We conducted a retrospective cohort study with 656 glioma patients to estimate the associations between antibiotic allergy, EOS% and glioma prognosis by Kaplan-Meier and Cox regression analysis. Stratified analyses were performed according to tumor grade. We constructed a nomogram with age at diagnosis, gender, tumor grade, antibiotic allergy, EOS% to predict the survival probabilities of glioma. Results: During 12 months follow-up, a total of 227 patients were alive and 318 patients died. Antibiotic allergy and EOS% >1.65 conferred a survival advantage on glioma patients. In the stratified analysis by tumor grade, antibiotic allergy was significantly associated with the prognosis of the prognosis of low-grade gliomas (HR = 0.36, 95%CI: 0.13-0.97) and high-grade gliomas (HR = 0.58, 95%CI: 0.36-0.93) in the univariate Cox regression analysis. However, after adjusting for confounding factors in the multivariate Cox regression analysis, antibiotic allergy was only significantly associated with high-grade gliomas (HRadj = 0.50, 95%CI: 0.30-0.82); the relationship between EOS% and glioma prognosis was restricted to low-grade gliomas (HRadj = 0.50, 95%CI: 0.30-0.82). The C-index of nomogram was 0.74.Conclusions: Antibiotic allergy was a protective prognosis factor of high-grade gliomas, EOS% >1.65 was a protective prognosis factor of low-grade gliomas. The nomogram with antibiotic allergy and EOS% could effectively predict the survival probability of glioma.

Temozolomide-induced hypermutation is associated with high-grade transformation, distant recurrence, and reduced survival after transformation in initially low-grade IDH-mutant diffuse gliomas.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 2506-2506
Author(s):  
Nancy Ann Oberheim Bush ◽  
Yao Yu ◽  
Javier Villanueva-Meyer ◽  
Matthew Grimmer ◽  
Stephanie Hilz ◽  
...  
Keyword(s):  
Somatic Hypermutation ◽  
Molecular Subtype ◽  
Distant Recurrence ◽  
Clinical Implications ◽  
Low Grade ◽  
High Grade ◽  
Who Grade ◽  
Low Grade Gliomas ◽  
Diffuse Gliomas ◽  
High Grade Transformation

2506 Background: Temozolomide, a commonly used alkylating agent to treat gliomas, can induce somatic hypermutation. The prevalence and clinical implications of this phenomenon are not well characterized. Methods: We used targeted and whole exome sequencing from a cohort of 82 patients with recurrent IDH-mutant low grade gliomas undergoing re-operation to evaluate the prevalence as well as the clinical implications of hypermutation. Results: Hypermutation was identified at transformation in 57% of recurrent gliomas exposed to Temozolomide, 94% of which were transformed to higher WHO grades. All patients who developed hypermutation were exposed to Temozolomide. Hypermutation was associated with transformation to higher WHO grade (OR 12.0 95% CI 2.5 – 115.5, p = 0.002) and shorter survival after transformation (HR 2.1, 95% CI 1.1-4.0, p = 0.018) compared with non-hypermutated transformed tumors, controlling for grade, molecular subtype, age, and prior radiotherapy. Patients with transformation to glioblastoma had poor survival regardless of hypermutation (p = 0.78). Hypermutated tumors were associated with development of discontiguous disease at a significantly higher frequency (p = 0.003), including four cases with spinal dissemination. Conclusions: TMZ-induced hypermutation is associated with high grade transformation, unique patterns of dissemination and shortened survival after transformation. Next generation sequencing should be considered in this patient population. These data have important implications for the management of newly diagnosed and recurrent IDH-mutant low grade gliomas.

Correlation of dual energy computed tomography electron density measurements with cerebral glioma grade

2021 ◽  
pp. 197140092110474
Author(s):  
Ritwik Chakrabarti ◽  
Vivek Gupta ◽  
Sameer Vyas ◽  
Kirti Gupta ◽  
Vikram Singh
Keyword(s):  
Computed Tomography ◽  
Electron Density ◽  
Dual Energy ◽  
Low Grade ◽  
High Grade ◽  
Cerebral Glioma ◽  
Density Measurements ◽  
Dual Energy Computed Tomography ◽  
Low Grade Gliomas ◽  
High Grade Gliomas

Objective To correlate dual energy computed tomography electron density measurements with histopathological cerebral glioma grading to determine whether it can be used as a non-invasive predictor of cerebral glioma grade. Materials and methods Fifty patients with suspected cerebral gliomas on imaging scheduled to undergo resection were included. We tested our hypothesis that with increasing glioma grade, increased tumor cellularity should translate into increased electron density and if a statistically significant difference between electron density of low-grade gliomas and high-grade gliomas is seen, we may have a clinical use of dual energy computed tomography as a non-invasive tool to predict cerebral glioma grade. A pre-operative dual energy computed tomography scan of the brain was performed, and electron density measurements calculated from the solid part of the tumor. Obtaining a ratio with electron density of contralateral normal brain parenchyma normalized these values. The minimum, maximum and mean electron density and their normalized values recorded between high-grade gliomas and low-grade gliomas were compared for presence of statistical significance. Results A statistically significant difference was found between all six parameters recorded (minimum electron density and normalized values, mean electron density and normalized values, maximum electron density and normalized values) between low-grade gliomas and high-grade gliomas. The predictivity ranged from 75% (for minimum electron density and maximum normalized values) to 81.25% (for mean normalized values). All six parameters were found to have statistically significant positive correlation with Ki-67 index. Conclusion Dual energy computed tomography electron density measurements in cerebral gliomas are predictive of pre-operative differentiation of low-grade gliomas from high-grade gliomas and show a linear, statistically significant positive correlation with Ki-67 index.

scholarly journals Use of fluorescence to guide resection or biopsy of primary brain tumors and brain metastases

2014 ◽  
Vol 36 (2) ◽  
pp. E10 ◽  
Author(s):  
Serge Marbacher ◽  
Elisabeth Klinger ◽  
Lucia Schwyzer ◽  
Ingeborg Fischer ◽  
Edin Nevzati ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Brain Tumors ◽  
Brain Metastases ◽  
Low Grade ◽  
High Grade ◽  
Open Resection ◽  
Who Grade ◽  
Primary Brain Tumors ◽  
High Grade Gliomas ◽  
Surgical Adjunct

Object The accurate discrimination between tumor and normal tissue is crucial for determining how much to resect and therefore for the clinical outcome of patients with brain tumors. In recent years, guidance with 5-aminolevulinic acid (5-ALA)–induced intraoperative fluorescence has proven to be a useful surgical adjunct for gross-total resection of high-grade gliomas. The clinical utility of 5-ALA in resection of brain tumors other than glioblastomas has not yet been established. The authors assessed the frequency of positive 5-ALA fluorescence in a cohort of patients with primary brain tumors and metastases. Methods The authors conducted a single-center retrospective analysis of 531 patients with intracranial tumors treated by 5-ALA–guided resection or biopsy. They analyzed patient characteristics, preoperative and postoperative liver function test results, intraoperative tumor fluorescence, and histological data. They also screened discharge summaries for clinical adverse effects resulting from the administration of 5-ALA. Intraoperative qualitative 5-ALA fluorescence (none, mild, moderate, and strong) was documented by the surgeon and dichotomized into negative and positive fluorescence. Results A total of 458 cases qualified for final analysis. The highest percentage of 5-ALA–positive fluorescence in open resection was found in glioblastomas (96%, n = 99/103). Among other tumors, 5-ALA–positive fluorescence was detected in 88% (n = 21/32) of anaplastic gliomas (WHO Grade III), 40% (n = 8/19) of low-grade gliomas (WHO Grade II), no (n = 0/3) WHO Grade I gliomas, and 77% (n = 85/110) of meningiomas. Among metastases, the highest percentage of 5-ALA–positive fluorescence was detected in adenocarcinomas (48%, n = 13/27). Low rates or absence of positive fluorescence was found among pituitary adenomas (8%, n = 1/12) and schwannomas (0%, n = 0/7). Biopsies of high-grade primary brain tumors showed positive rates of fluorescence similar to those recorded for open resection. No clinical adverse effects associated with use of 5-ALA were observed. Only 1 patient had clinically silent transient elevation of liver enzymes. Conclusions Study findings suggest that the administration of 5-ALA as a surgical adjunct for resection and biopsy of primary brain tumors and brain metastases is safe. In light of the high rate of positive fluorescence in high-grade gliomas other than glioblastomas, meningiomas, and a variety of metastatic cancers, 5-ALA seems to be a promising tool for enhancing intraoperative identification of neoplastic tissue and optimizing the extent of resection.

scholarly journals Arterial spin labeling in the grading of brain gliomas: could it help?

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Ahmed A. ElBeheiry ◽  
Doaa M. Emara ◽  
Amany Abdel-Bary Abdel-Latif ◽  
Mohamed Abbas ◽  
Amal S. Ismail
Keyword(s):  
Perfusion Imaging ◽  
Arterial Spin Labeling ◽  
Spin Labeling ◽  
High Morbidity ◽  
Low Grade ◽  
Dynamic Susceptibility ◽  
High Grade ◽  
Low Grade Gliomas ◽  
High Grade Gliomas ◽  
Brain Gliomas

Abstract Background Gliomas are characterized by high morbidity and mortality with low cure and high recurrence rates, which depends to a great degree on the angiogenesis of the tumor. Assessment of such angiogenesis by perfusion techniques is of utmost importance for the preoperative grading of gliomas. The purpose of this study was to assess the role of arterial spin labeling (ASL) perfusion as a non-contrast MRI technique in the grading of brain gliomas, in correlation with the dynamic susceptibility contrast perfusion imaging (DSC-PI). The study was carried out on 35 patients admitted to the Neurosurgery Department with MRI features of gliomas and sent for further perfusion imaging. Non-contrast ASL followed by DSC-PI was done for all cases. The final diagnosis of the cases was established by histopathology. Results Fourteen patients (14/35) had low-grade gliomas while twenty-one (21/35) had high-grade gliomas. In low-grade gliomas, four cases out of 14 were falsely graded as high-grade tumors showing hyperperfusion on ASL, three of which showed DSC-PI hypoperfusion. In high-grade gliomas, two cases out of 21 were interpreted as an indeterminate grade by ASL showing isoperfusion, however showed hyperperfusion on DSC-PI. ROC curve analysis showed ASL-derived rCBF > 2.08 to have 80.95% sensitivity, 85.71% specificity, and overall accuracy of 82.86% compared to 100% sensitivity, specificity, and accuracy of DSC-PI-derived rCBV and rCBF of > 1.1 and > 0.9, respectively. A significant positive correlation was noted between ASL and DSC-PI with correlation coefficient reaching r = 0.80 between ASL-rCBF and DSC-rCBF (p < 0.01) and r = 0.68 between ASL and DSC-rCBV (p < 0.01). Conclusions ASL is a relatively recent non-contrast perfusion technique that obtains results which are in fair agreement with the more established DSC perfusion imaging making it an alternative method for preoperative assessment of perfusion of gliomas, especially for patients with contraindications to contrast agents.

scholarly journals Oncology is changing: the challenge of effectively assessing response within clinical trials in low-grade gliomas

2011 ◽  
pp. 75-76
Author(s):  
Ilaria Imarisio ◽  
Chiara Fumagalli
Keyword(s):  
Central Nervous System ◽  
Clinical Trials ◽  
Nervous System ◽  
Who Classification ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
Microvascular Proliferation ◽  
Grade Iii

The current WHO classification of primary central nervous system (CNS) tumors recognizes four separate tumor grades (I–IV), which can be grouped into low-grade (I and II) or high-grade (III and IV), depending on the absence or presence of high-grade histopathological features, such as microvascular proliferation and necrosis...

Oncology is changing: the challenge of effectively assessing response within clinical trials in low-grade gliomas

2011 ◽  
Vol 5 (2) ◽  
pp. 75
Author(s):  
Ilaria Imarisio ◽  
Chiara Fumagalli
Keyword(s):  
Central Nervous System ◽  
Clinical Trials ◽  
Nervous System ◽  
Who Classification ◽  
Low Grade ◽  
High Grade ◽  
Low Grade Gliomas ◽  
Microvascular Proliferation ◽  
Grade Iii

The current WHO classification of primary central nervous system (CNS) tumors recognizes four separate tumor grades (I–IV), which can be grouped into low-grade (I and II) or high-grade (III and IV), depending on the absence or presence of high-grade histopathological features, such as microvascular proliferation and necrosis...

Sign in / Sign up

Export Citation Format

Share Document