scholarly journals A prospective interventional study evaluating seizure activity during a radiotherapy course for high-grade gliomas (SURF-ROGG)

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dirk Rades ◽  
Jaspar Witteler ◽  
Denise Olbrich ◽  
Peter Trillenberg ◽  
Steven E. Schild ◽  
...  
Keyword(s):  
Patient Monitoring ◽  
Seizure Activity ◽  
Alternative Hypothesis ◽  
Statistical Significance ◽  
Prospective Trial ◽  
Progression Rate ◽  
High Grade ◽  
Interventional Study ◽  
Link Type ◽  
High Grade Gliomas

Abstract Background Gliomas are often associated with symptoms including seizures. Most patients with high-grade gliomas are treated with radiotherapy or radio-chemotherapy. Since irradiation causes inflammation, it may initially aggravate symptoms. Studies focusing on seizure activity during radiotherapy for gliomas are not available. Such knowledge may improve patient monitoring and anti-epileptic treatment. This study evaluates seizure activity during radiotherapy for high-grade gliomas. Methods The primary objective this prospective interventional study is the evaluation of seizure activity during a course of radiotherapy for high-grade gliomas. Progression of seizure activity is defined as increased frequency of seizures by > 50%, increased severity of seizures, or initiation/increase by ≥25% of anti-epileptic medication. Seizure frequency up to 6 weeks following radiotherapy and electroencephalography activity typical for epilepsy will also be evaluated. Patients keep a seizure diary during and up to 6 weeks following radiotherapy. Every day, they will document number (and type) of seizures and anti-epileptic medication. Once a week, the findings of the diary are checked and discussed with a neurologist to initiate or adjust anti-epileptic medication, if necessary. Patients complete a questionnaire regarding their satisfaction with the seizure diary. If the dissatisfaction rate is > 40%, the seizure diary will be considered not suitable for the investigated indication. Thirty-five patients (32 patients plus drop-outs) should be enrolled. With this sample size, a one-sample binomial test with a one-sided significance level of 2.5% has a power of 80% to yield statistical significance, if the rate of patients with progression of seizure activity is 30% (rate under the alternative hypothesis), assuming a ‘natural’ background progression-rate of 10% without radiotherapy (null hypothesis). Discussion If an increase in seizure activity during a course of radiotherapy for high-grade glioma occurs, the findings of this study may pave the way for a larger prospective trial and will likely lead to closer patient monitoring and better anti-epileptic treatment. Trial registration clinicaltrials.gov (NCT04552756); registered on 16th of September, 2020.

An analysis of two different schedules of radiochemotherapy with concomitant temozolomide in high grade gliomas

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 2035-2035 ◽  
Author(s):  
G. R. D’Agostino ◽  
M. Balducci ◽  
C. Anile ◽  
S. Manfrida ◽  
G. Di Lella ◽  
...  
Keyword(s):  
Overall Survival ◽  
Statistical Significance ◽  
Residual Tumor ◽  
Hematological Toxicity ◽  
High Grade ◽  
Safe Alternative ◽  
Neurological Toxicity ◽  
Tumor Bed ◽  
Historical Series ◽  
High Grade Gliomas

2035 Background: We compared two different schedules of temozolomide (TMZ) concomitant therapy in terms of toxicity and outcome. Methods: 70 patients (median age 61 years, range 27–80) affected by high grade gliomas were treated with concomitant chemoradiation. Conformal radiotherapy (5,940 cGy, 180 cGy/day; CTV2: tumor bed + residual tumor if present + oedema, 3,960 cGy; CTV1: tumor bed + residual tumor if present + margins, 1,980 cGy) was associated with one of the following TMZ schedules: TMZ1: (75 mg/m2 × 5 days, first and last week of radiotherapy); TMZ2 (75 mg/m2, 7 days/week, from the first to the last day of radiotherapy); Toxicities were graded according to RTOG criteria. Survival analysis based on the Kaplan-Meier model. Results: From October, 2000 to March, 2006, 54 patients high grade gliomas were evaluated. 41 patients (29 GBL, 70.7%; 12 AA, 29.3%) were treated between October 2003 and March 2006 with TMZ2, and compared to an historical series of 29 patients (25 GBL, 86.2%; 4 AA, 13.%) treated in our Institution before 2003 with TMZ1. All patients received adjuvant chemotherapy with TMZ for 6 cycles or until disease progression. Hematological toxicity was mild in both group, whereas neurological toxicity (seizures) was higher in TMZ2 group, with a grade > 2 toxicity registered in 11/41 pts (26.8%) compared to 1/29 of the TMZ1 group (3.5%), even if this difference failed to achieve statistical significance (p=0.06). The overall survival did not significantly differ among the 2 schedules (p=0.60). In fact, at a median follow-up of 21 months (range 3- 68), median survival time was 21 months and 19 months, for TMZ1 and TMZ2 groups, respectively, with a 1-year and 2-year overall survival of 73.1% in the TMZ1 group and 75.3% in the TMZ2 group, respectively. Conclusions: In our experience, the concomitant administration of TMZ at the daily dose of 75 mg/m2 given continuously or only in the first and the last week of radiotherapy obtained comparable results in terms of outcome, with a heavier neurological toxicity when given 7 days per week, from the first to the last day of radiotherapy. These data suggest that, in selected cases, the TMZ1 schedule can be considered as a safe, alternative strategy, which does not impact significantly on patient outcome, compared to the standard TMZ2. No significant financial relationships to disclose.

scholarly journals Relación Entre El Coeficiente De Difusión Aparente y la celularidad. [Relación Entre El Coeficiente De Difusión Aparente yLa Celularidad De Gliomas en Centro de tercer nivel de Panamá]

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
José María Barría Castro ◽  
Linamar Antuaneth Caballero Vega ◽  
Javier Augusto Pimentel Sández ◽  
Fernando Miguel Sucre Grimaldo
Keyword(s):  
Magnetic Resonance ◽  
Malignant Tumors ◽  
Histological Grade ◽  
Statistical Significance ◽  
Region Of Interest ◽  
Low Grade ◽  
High Grade ◽  
Anatomic Site ◽  
Adc Values ◽  
High Grade Gliomas

<p>Resumen<br /><br />Introducción: Los gliomas son tumores malignos altamente celulares del sistema nervioso central. Su grado histológico preoperatorio es de utilidad en el manejo quirúrgico, por lo que la resonancia magnética con secuencias avanzadas intenta brindar mayor información tumoral.  <br />Objetivo: Relacionar el coeficiente aparente de difusión (CAD) y celularidad de los gliomas de pacientes entre enero 2015 a diciembre 2017.</p><p><br />Metodología:Retrospectivamente se obtuvieron de archivos clínicos la edad, sexo, tipo, grado histológicoy sitio anatómico. Se calculó el CAD en 5mm2 en los estudios de resonancia magnética preoperatorias y se utilizó las laminillas para conteo de celularidad en 5mm2 digitalmente. Se utilizó análisis estadísticos descriptivos y coeficiente de correlación entre CDA con celularidad. Se utilizaron valores de p &lt; 0.05 para significancia estadística.<br />Resultados: 46 casos fueron incluidos, 56.5% fueron hombres. El rango de 41-64 años fueron los más afectados. El glioblastoma fue el tipo histológico más frecuente (47.8%), así como los gliomas de alto grado (73.9%). El 95.7% fueron supratentoriales. La celularidad promedio fue de 3970 ± 2900 vs 2436 ± 948 núcleos/5mm2 (p = 0.13), con valores promedio de CDA mínimo de 0.813 x 10-3 ± 0.229 mm2/s vs 1.052 x 10-3 ± 0.196 mm2/s (p = 0.002), para los gliomas de alto y bajo grado respectivamente. La correlación entre CDA y celularidad fue débil (R = - 0.13, p = 0.37).</p><p><br />Conclusión: Existe correlación débil inversamente proporcional entre el CDA y la celularidad con distinción de gliomas de bajo y alto grado con valores de CDA mínimos.<br /><br /> <br />Abstract<br />Introduction: Gliomas are highly cellular malignant tumors of the central nervous system. Itspreoperative histological grade is useful in surgical management,so magnetic resonance imaging with advanced sequences tries to provide more tumor information.</p><p><br />Objective:Correlateapparent diffusion coefficient (ADC) and cellularity of gliomas of patients between January 2015 to December 2017.<br />Methodology:Data of age, sex, type, histologic grade and anatomic site were retrospectively obtained from clinical archives.The preoperative magnetic resonance ADC was calculated in a 5 mm2 region of interest and the microscope slides were used for the cellularity digitally count in 5 mm2. Descriptive statistical analysis and correlation coefficient between ADC and cellularity were used. Values of p &lt;0.05 were used for statistical significance.</p><p><br />Results: 46 cases were included, 56.5% were men. The 41-64 years ranges were the most affected. Glioblastoma was the most frequent histological type (47.8%), as well as high grade gliomas (73.9%). 95.7% were supratentorial. The average cellularity was 3970 ± 2900 vs 2436 ± 948 nuclei/ 5mm2 (p = 0.13), with average minimum ADC values of 0.813 x 10-3 ± 0.229 mm2/s vs 1052 x 10-3 ± 0.196 mm2/s (p = 0.002), for high- and low-grade gliomas, respectively. The correlation between ADC and cellularity was weak (R = - 0.13, p = 0.37).</p><p><br />Conclusions:There is a weak inversely proportional correlation between ADC and cellularity. With distinction of low- and high-grade gliomas with minimum ADC values.<br /><br /></p>

scholarly journals Second window ICG predicts postoperative MRI gadolinium enhancement in high grade gliomas and brain metastases

2022 ◽  
Vol 6 (1) ◽  
pp. V8
Keyword(s):  
Brain Metastases ◽  
Near Infrared ◽  
Prospective Trial ◽  
High Grade ◽  
Gadolinium Enhancement ◽  
Postoperative Mri ◽  
Nir Imaging ◽  
Residual Neoplasm ◽  
High Grade Gliomas ◽  
Higher Sensitivity

A prospective trial evaluating the utility of second window indocyanine green (SWIG) in predicting postoperative MRI gadolinium enhancement was performed on high-grade gliomas (HGGs) and brain metastases. Compared to white light alone, SWIG demonstrated a higher sensitivity, negative predictive value, and accuracy in predicting residual neoplasm on MRI. The specificity of SWIG for predicting MRI enhancement was higher in HGGs than brain metastases. Clinically, near-infrared (NIR) imaging was better able to predict tumor recurrence than postoperative MRI. These results illustrate how SWIG is able to take advantage of gadolinium-like distribution properties to extravasate into the tumor microenvironment, enabling guidance in surgical resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21204

Prospective trial of radiotherapy after hyperbaric oxygenation with chemotherapy for high-grade gliomas

2003 ◽  
Vol 67 (1) ◽  
pp. 63-67 ◽  
Author(s):  
Kazuhiko Ogawa ◽  
Yoshihiko Yoshii ◽  
Osamu Inoue ◽  
Takafumi Toita ◽  
Atsushi Saito ◽  
...  
Keyword(s):  
Hyperbaric Oxygenation ◽  
Prospective Trial ◽  
High Grade ◽  
High Grade Gliomas

scholarly journals Diffusion and perfusion magnetic resonance imaging in evaluation of primary glial brain tumors

2009 ◽  
Vol 56 (4) ◽  
pp. 25-30
Author(s):  
T.L. Stosic-Opincal ◽  
M.V. Macvanski ◽  
S.S. Gavrilovic ◽  
M.S. Gavrilov ◽  
D.S. Damjanovic ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Statistical Significance ◽  
Roc Curves ◽  
Perfusion Magnetic Resonance Imaging ◽  
Low Grade ◽  
High Grade ◽  
Mean Values ◽  
Conventional Mri ◽  
High Grade Gliomas ◽  
Two Parameters

Introduction: Diffusion (DWI) and perfusion (PWI) imaging can give important data about physiological characteristics of tissue, which complete morphologic findings from conventional MRI. The aim of this study is to estimate the value of these MRI technics in evaluation of primary glial brain tumors. Materials and methods: The significance of DWI and PWI in differentiation of histologically proven low- and high-grade gliomas was estimated in 48 patient with diagnosed brain gliomas. ADC and rCBV values were compared by application of Mann-Whitney test, and logistic regression analysis was used to determine which of these two parameters contributed the most in increasing the diagnostic accuracy, ia. its sensitivity, specificity and predictive velues. ROC curves were constructed to determine threshold values for differentiation of low- from highgrade lesions. Results: Statistical significance were showed between mean values of rCBV for low-grade (0,82) and high-grade (5,32) gliomas, which was not found for values of ADC parameters. Threshold rCBV value of 1,23 was determinated for discrimination between low- and high-grade gliomas with a sensitivity of 83,2% and a specificity of 77,5%. Conclusion: Conventional MRI combined with PWI increases the accuracy in determination of glioma grade.

RADT-09. ROLE OF RADIOTHERAPY IN MANAGEMENT OF PRIMARY SPINAL HIGH GRADE GLIOMA: A SINGLE INSTITUTION RETROSPECTIVE ANALYSIS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi42-vi43
Author(s):  
Rituraj Upadhyay ◽  
Swapnil Khose ◽  
Halyna Pokhylevych ◽  
Arnold dela Cruz Paulino ◽  
Mary Frances McAleer ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Univariate Analysis ◽  
Concurrent Chemotherapy ◽  
Leptomeningeal Disease ◽  
High Grade ◽  
Single Institution ◽  
Who Grade ◽  
Mgmt Promoter ◽  
High Grade Gliomas ◽  
H3k27m Mutation

Abstract BACKGROUND Primary spinal high-grade gliomas(S-HGG) are rare, aggressive tumors and radiation therapy(RT) plays a dominant role in the management given their infiltrative nature. We conducted a single-institution retrospective review to study the clinicopathological features and management of S-HGGs. METHODS Patients with biopsy-proven S-HGG who received RT from 2001-2020 were analyzed for patient, tumor, and treatment characteristics. Kaplan-Meier estimate and Cox proportional hazard regression method were used for survival analyses. RESULTS Twenty-nine patients were identified with a median age of 25.9 years (range 1-74y). Four patients had gross total resection(GTR) while 25 underwent subtotal resection or biopsy. Nineteen patients had WHO grade 4 tumor. IDH1 mutation and MGMT promoter methylation were analyzed in 14 and four patients respectively; all were IDH wildtype and MGMT-promoter unmethylated. H3K27M mutation was present in five out of 10 patients tested. Twenty-two patients received photon-based radiation and 7 received proton therapy. Median RT dose was 50.4 Gy (range 39.6-54Gy) with 79% receiving &gt;45Gy. 65% patients received concurrent chemotherapy, most commonly temozolomide. Twenty-three (79%) patients had documented recurrence. Overall, 16 patients relapsed locally, 10 relapsed in the brain and 8 developed leptomeningeal disease; only 8(35%) had isolated local relapse. Median OS from diagnosis was 21.3 months and median PFS after RT was 9.7 months. On univariate analysis, age, sex, GTR, grade, RT modality, RT dose and concurrent chemotherapy did not predict for survival. Patients with H3K27M mutation had a poorer median PFS after RT compared to those without the mutation but the difference did not reach statistical significance (p = 0.26). CONCLUSIONS Although 86% of patients had gross disease at RT and received a lower median RT dose than typically used in cerebral high-grade gliomas, only 55% of patients failed locally. H3K27M mutation may portend worse survival; future studies to improve the therapeutic approach in these patients are warranted.

scholarly journals Qualitative head-to-head comparison of headlamp and microscope for visualizing 5-ALA fluorescence during resection of glioblastoma

2022 ◽  
Vol 6 (1) ◽  
pp. V7
Keyword(s):  
Aminolevulinic Acid ◽  
Standard Of Care ◽  
High Grade ◽  
Operative Field ◽  
Guided Surgery ◽  
Link Type ◽  
Fluorescence Guided Surgery ◽  
Similar Images ◽  
High Grade Gliomas

Fluorescence-guided surgery (FGS) for high-grade gliomas using 5-aminolevulinic acid has become a new standard of care for neurosurgeons in several countries. In this video the authors present the case of a man with glioblastoma who underwent FGS in which similar images of the operative field were acquired alternating between the microscope and a new commercially available headlight, facilitating the comparison of visualization quality between the two devices. The authors also review some of the principles of fluorescence-guidance surgery that may explain the improved brightness and contrast that they observed when using the headlamp versus the microscope. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21181

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

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