Acute toxicity analysis of patients receiving surgery, Gliadel wafer implantation, and postoperative daily temozolomide with radiation therapy for primary high-grade glioma

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 11504-11504 ◽  
Author(s):  
C. R. Heery ◽  
A. Desjardins ◽  
J. A. Quinn ◽  
J. N. Rich ◽  
S. Gururangan ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Acute Toxicity ◽  
High Grade Glioma ◽  
Wound Complications ◽  
Hematologic Toxicity ◽  
Who Grade ◽  
Initial Surgery ◽  
Grade 3 ◽  
Who Grade Iii ◽  
Grade Iii

11504 Background: Treatment of patients with newly diagnosed malignant glioma using Gliadel wafer implantation at initial surgery has been shown to increase survival (Westphal et al 2003). Similarly, administration of temozolomide during and after radiotherapy has also been shown to increase survival in this patient population (Stupp et al 2005). Accordingly use of both Gliadel and temozolomide may be advantageous for these patients although it is possible that the toxicity of these two approaches used together might be prohibitive. Methods: The Preston Robert Tisch Brain Tumor Center at Duke has occasionally treated with this approach over the last several years, and we now present an analysis of the observed acute toxicity. We retrospectively reviewed the Duke patients treated with surgery plus Gliadel wafer placement followed by daily temozolomide (75 mg/m2-150 mg/m2) and radiation therapy. Results: Of 28 patients reviewed, four patients were diagnosed with AA (WHO grade III), two patients were diagnosed with AO (WHO grade III) and the remaining 22 patients were diagnosed with glioblastoma multiforme (WHO grade IV). Two of the 28 7.1%) patients experienced grade 3 or 4 hematologic toxicity during radiation and daily temozolomide therapy. This is similar to the 7% of patients found to have hematologic toxicity reported by Stupp et al (2005). Three patients (10.7%) had grade 3 or 4 seizure activity. Two patients (7.1%) had grade 4 pulmonary emboli. No events of cerebral edema or wound complications were noted in this review of patient events following Gliadel wafer placement. Conclusions: In summary, the addition of Gliadel wafer placement at the time of surgery followed by radiation therapy with concurrent daily low dose temozolomide does not appear to have significant acute toxicity over that observed with radiation therapy and daily temozolomide. Future formal trials combining these therapeutic strategies may allow evaluation of the possible survival advantage associated with this approach. [Table: see text]

scholarly journals High-grade glioma with anterior skull base erosion and intranasal extension: case report

2017 ◽  
Vol 126 (5) ◽  
pp. 1484-1487 ◽  
Author(s):  
Matthew T. Stib ◽  
Michael Johnson ◽  
Alan Siu ◽  
M. Isabel Almira-Suarez ◽  
Zachary Litvack ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Radiation Treatment ◽  
High Grade Glioma ◽  
Brain Parenchyma ◽  
Anterior Skull Base ◽  
High Grade ◽  
Who Grade ◽  
Who Grade Iii ◽  
Grade Iii

The authors describe the case of a large WHO Grade III anaplastic oligoastrocytoma extending through the anterior skull base and into the right nasal cavity and sinuses. Glial neoplasms are typically confined to the intracranial compartment within the brain parenchyma and rarely extend into the nasal cavity without prior surgical or radiation therapy. This 42-year-old woman presented with progressive headaches and sinus congestion. MR imaging findings revealed a large intracranial lesion with intranasal extension. Endoscopic nasal biopsy revealed pathology consistent with an infiltrating glioma. The patient subsequently underwent a combined transcranial/endonasal endoscopic approach for resection of this lesion. Pathological diagnosis revealed a WHO Grade III oligoastrocytoma. This report reviews the mechanisms of extradural glioma extension. To the authors' knowledge, it is the second report of a high-grade glioma exhibiting nasal extension without prior surgical or radiation treatment.

High-grade gliomas and molecular biology of neurosurgical oncology

2019 ◽  
pp. 89-106
Author(s):  
Stephen J Price ◽  
Harry Bulstrode ◽  
Richard Mair
Keyword(s):  
Molecular Markers ◽  
Who Classification ◽  
High Grade Glioma ◽  
High Grade ◽  
Optimal Management ◽  
Who Grade ◽  
Normal Human ◽  
Who Grade Iii ◽  
Grade Iii

The term high-grade glioma (HGG) encompasses a number of histological entities that are considered by the WHO Classification as WHO Grade III and IV tumours. They have traditionally been considered as having similar behaviour and had been treated in a similar manner but recent advances in our understanding of tumour biology have led to the identification of molecular markers that are now central to the classification of these tumours. Normal human cells develop into cancer cells through a stepwise accumulation of genomic and epigenomic alterations and this chapter considers the molecular markers of gliomas and explains their significance before going on to discuss the optimal management.

scholarly journals EPID-09. PROGNOSTIC FACTORS IN ADULT PATIENTS WITH PRIMARY INTRACRANIAL EPENDYMOMAS: A POPULATION-BASED STUDY

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi76-vi76
Author(s):  
Helen Yang ◽  
Abdullah Malik ◽  
Sunit Das
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
Health Care Professionals ◽  
Adult Patients ◽  
Age At Diagnosis ◽  
Who Grade ◽  
Intracranial Ependymoma ◽  
One Year ◽  
Who Grade Iii ◽  
Grade Iii

Abstract BACKGROUND Outcomes for patients with intracranial ependymoma remain poor in the current era of cancer treatment. This study aims to investigate the prognostic value of demographic and clinical variables to predict survival using the largest current database of patients with intracranial ependymoma. METHODS The Surveillance, Epidemiology and End Results (SEER) registry was queried for prognostic factors and survival outcomes of adult (≥18 years) patients diagnosed with intracranial ependymoma from 2004–2016. Survival was estimated using Kaplan Meier curves. Cox proportional hazards modeling was used to identify correlates of survival. RESULTS We identified a cohort of 229 primary intracranial ependymoma patients. The cohort showed a slight male predominance (52%) and had a mean age of 43 ± 17 years. 107 patients (47%) had WHO grade II tumors and 122 patients (53%) had WHO grade III tumors. One year survival was 85% for the entire cohort. Increasing age at diagnosis (HR: 1.05, 95% CI: 1.03–1.07) and WHO grade III tumor (HR: 4.20, 95% CI: 2.02–8.75) were independently associated with mortality after adjusting for age, sex, tumor location, extent of surgery, use of radiation therapy, and use of chemotherapy. Use of radiation therapy was associated with better one-year survival in cases of gross total resection (GTR) and subtotal resection (STR). Use of chemotherapy was not associated with mortality in the adjusted analysis (HR: 2.16, 95% CI: 0.96–4.84). CONCLUSION Our results suggest that age at diagnosis and tumor grade are independent factors associated with mortality in adult patients with intracranial ependymoma. Furthermore, use of chemotherapy was not shown to decrease mortality. These findings help guide future prognostic model making and therapeutic strategies designed by health care professionals.

Temozolomide during and after radiation therapy for WHO grade III gliomas: preliminary report of a prospective multicenter study

2010 ◽  
Vol 103 (3) ◽  
pp. 503-512 ◽  
Author(s):  
Young-Hoon Kim ◽  
Chul-Kee Park ◽  
Won Ho Cho ◽  
In Ah Kim ◽  
Seyoung Moon ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Multicenter Study ◽  
Preliminary Report ◽  
Prospective Multicenter Study ◽  
Who Grade ◽  
Who Grade Iii ◽  
Grade Iii

Feasibility of Preoperative Chemotherapy With or Without Radiation Therapy in Localized Soft Tissue Sarcomas of Limbs and Superficial Trunk in the Italian Sarcoma Group/Grupo Español de Investigación en Sarcomas Randomized Clinical Trial: Three Versus Five Cycles of Full-Dose Epirubicin Plus Ifosfamide

2015 ◽  
Vol 33 (31) ◽  
pp. 3628-3634 ◽  
Author(s):  
Elena Palassini ◽  
Stefano Ferrari ◽  
Paolo Verderio ◽  
Antonino De Paoli ◽  
Javier Martin Broto ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Radiation Therapy ◽  
Soft Tissue ◽  
Randomized Clinical Trial ◽  
Preoperative Chemotherapy ◽  
Soft Tissue Sarcomas ◽  
Phase Iii ◽  
Wound Complications ◽  
Hematologic Toxicity ◽  
Grade 3

Purpose We report on feasibility of preoperative chemotherapy with or without radiation therapy (RT) in the context of a phase III randomized clinical trial involving localized, high-risk, soft tissue sarcomas. Patients and Methods Of 321 eligible patients, 161 were randomly assigned to three preoperative cycles of epirubicin 120 mg/m2 plus ifosfamide 9 g/m2, and 160 were randomly assigned to three preoperative plus two postoperative cycles. Among them, 303 patients were included in this analysis; 169 were male and 134 were female, with a median age of 48 years (range, 15 to 79 years). One hundred fifty-two patients received concurrent RT preoperatively at a total dose of 44 to 50 Gy. Preoperative chemotherapy-related hematologic toxicity and early postoperative complications were reported. The influence of RT, age, and sex on hematologic grade 3 or 4 toxicities and wound complications was analyzed. Chemotherapeutic dose intensity (DI) was analyzed. Results Among the patients, 61.4%, 22.4%, and 23.8% experienced, grade 4 leucopenia, grade 3 or 4 anemia, and grade 3 or 4 thrombocytopenia, respectively. Respective rates were 66.4%, 24.3%, and 31.6% when RT was added preoperatively, and 56.3%, 20.5%, and 15.9% when preoperative chemotherapy was administered alone. Patient age affected grade 3 or 4 thrombocytopenia. Grade 4 leucopenia and grade 3 or 4 anemia presented 2.5 times more frequently in female patients than in male patients. Wound complications were observed in 13.5% of patients: 17% with preoperative RT and 10% without. Chemotherapeutic DI was greater than 90%, even in patients receiving preoperative RT and in patients age 65 years or older. Conclusion This preoperative chemotherapy is feasible and can also be proposed for selected elderly patients. Grade 3 or 4 hematologic toxicity was common, but DI was excellent. Concurrent preoperative RT is safe, although an increased rate of grade 4 thrombocytopenia and limited increase in wound complications may be observed.

scholarly journals The Value of Enhanced MR Radiomics in Estimating the IDH1 Genotype in High-Grade Gliomas

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Lei Niu ◽  
Wei-hua Feng ◽  
Chong-feng Duan ◽  
Ying-chao Liu ◽  
Ji-hua Liu ◽  
...  
Keyword(s):  
High Grade Glioma ◽  
Validation Dataset ◽  
High Grade ◽  
Wild Type ◽  
Mr Images ◽  
Who Grade ◽  
Model Based ◽  
Idh Mutations ◽  
Who Grade Iii ◽  
Grade Iii

Background. The prognosis of IDH1-mutant glioma is significantly better than that of wild-type glioma, and the preoperative identification of IDH mutations in glioma is essential for the formulation of surgical procedures and prognostic assessment. Purpose. To explore the value of a radiomic model based on preoperative-enhanced MR images in the assessment of the IDH1 genotype in high-grade glioma. Materials and Methods. A retrospective analysis was performed on 182 patients with high-grade glioma confirmed by surgical pathology between December 2012 and January 2019 in our hospital with complete preoperative brain-enhanced MR images, including 79 patients with an IDH1 mutation (45 patients with WHO grade III and 34 patients with WHO grade IV) and 103 patients with wild-type IDH1 (33 patients with WHO grade III and 70 patients with WHO grade IV). Patients were divided into a primary dataset and a validation dataset at a ratio of 7 : 3 using a stratified random sampling; radiomic features were extracted using A.K. (Analysis Kit, GE Healthcare) software and were initially reduced using the Kruskal-Wallis and Spearman analyses. Lasso was finally conducted to obtain the optimized subset of the feature to build the radiomic model, and the model was then tested with cross-validation. ROC (receiver operating characteristic curve) analysis was performed to evaluate the performance of the model. Results. The radiomic model showed good discrimination in both the primary dataset ( AUC = 0.87 , 95% CI: 0.754 to 0.855, ACC = 0.798 , sensitivity = 85.5 % , specificity = 75.4 % , positive   predictive   value = 0.734 , and negative   predictive   value = 0.867 ) and the validation dataset ( AUC = 0.86 , 95% CI: 0.690 to 0.913, ACC = 0.789 , sensitivity = 91.3 % , specificity = 69.0 % , positive   predictive   value = 0.700 , and negative   predictive   value = 0.909 ). Conclusion. The radiomic model, based on the preoperative-enhanced MR, can effectively predict the IDH1 genotype in high-grade glioma.

scholarly journals CTNI-29. CODEL: PHASE III TRIAL OF RT ALONE, RT PLUS TMZ, OR TMZ ALONE FOR NEWLY-DIAGNOSED, 1p/19q CODELETED ANAPLASTIC OLIGODENDROGLIOMA. ANALYSIS FROM THE INITIAL STUDY DESIGN. (NCCTG N0577, ALLIANCE)

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii48-ii49
Author(s):  
Kurt Jaeckle ◽  
Karla Ballman ◽  
Martin van den Bent ◽  
Caterina Giannini ◽  
Evanthia Galanis ◽  
...  
Keyword(s):  
Cox Regression ◽  
Initial Study ◽  
Phase Iii ◽  
Newly Diagnosed ◽  
Who Grade ◽  
Phase Iii Trial ◽  
Grade 3 ◽  
Who Grade Iii ◽  
Grade Iii

Abstract BACKGROUND The original 3-arm CODEL design included a radiotherapy (RT)-alone control arm, an RT plus temozolomide (TMZ) arm, and an exploratory TMZ-alone arm. We report the analysis involving patients treated per the initial design. METHODS Adults (18+ years) with newly-diagnosed 1p/19q codeleted WHO grade III oligodendroglioma were randomized to RT (5940 cGy) alone (Arm A); RT with concomitant and adjuvant TMZ (Arm B); or TMZ alone (Arm C). Primary endpoint was OS, Arm A vs. B. Secondary comparisons were performed for OS and PFS, comparing pooled RT arms with the TMZ-alone arm. RESULTS 36 patients were randomized equally to the three arms. At median follow-up of 7.5 years, 83.3% (10/12) TMZ-alone patients had progressed, versus 37.5% (9/24) patients on the RT arms. PFS was shorter in TMZ-alone patients compared to RT-treated patients (HR=3.12; 95% CI: 1.26, 7.69; p=0.014). Death from disease progression occurred in 3/12 (25%) of TMZ-alone patients and 4/24 (16.7%) of RT-treated patients. OS did not statistically differ between arms, although this comparison was underpowered. After adjustment for IDH status (mutated vs. wildtype) in a Cox regression model, with IDH status and RT treatment status as co-variables (Arm C vs pooled A and B), PFS remained shorter for patients not receiving RT (HR= 3.33; 95% CI: 1.31, 8.45; p=0.011), and OS differences remained non-significant ((HR = 2.78; 95% CI 0.58, 13.22, p=0.20). Grade 3+ adverse events occurred in 25%, 42% and 33% patients (Arms A, B and C, respectively). Neurocognitive assessments, comparing baseline and 3 month timepoints, showed no significant differences between arms. CONCLUSIONS TMZ-alone treated patients experienced significantly shorter PFS than patients treated on the pooled RT arms, which remained significant when adjusting for IDH status. CODEL has been redesigned to compare the efficacy and toxicity of RT+PCV versus RT+TMZ. Clinicaltrials.gov Identifier: NCT00887146. Support: U10CA180821, U10CA180882, https://acknowledgments.alliancefound.org.

scholarly journals Long-term outcome of patients with WHO Grade III and IV gliomas treated by fractionated intracavitary radioimmunotherapy

2015 ◽  
Vol 123 (3) ◽  
pp. 760-770 ◽  
Author(s):  
Hans-Juergen Reulen ◽  
Gabriele Poepperl ◽  
Claudia Goetz ◽  
Franz Joseph Gildehaus ◽  
Michael Schmidt ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Long Term Results ◽  
Average Dose ◽  
Who Grade ◽  
Long Term Outcome ◽  
Grade 3 ◽  
Intracavitary Radioimmunotherapy ◽  
Who Grade Iii ◽  
Grade Iii

OBJECT The aim in this study was to present long-term results regarding overall survival (OS), adverse effects, and toxicity following fractionated intracavitary radioimmunotherapy (RIT) with iodine-131− or yttrium-90−labeled anti-tenascin monoclonal antibody (131I-mAB or 90Y-mAB) for the treatment of patients with malignant glioma. METHODS In 55 patients (15 patients with WHO Grade III anaplastic astrocytoma [AA] and 40 patients with WHO Grade IV glioblastoma multiforme [GBM]) following tumor resection and conventional radiotherapy, radioimmunoconjugate was introduced into the postoperative resection cavity. Patients received 5 cycles of 90Y-mAB (Group A, average dose 18 mCi/cycle), 5 cycles of 131I-mAB (Group B, average dose 30 mCi/cycle), or 3 cycles of 131I-mAB (Group C, 50, 40, and 30 mCi). RESULTS Median OS of patients with AA was 77.2 months (95% CI 30.8 to > 120). Five AA patients (33%) are currently alive, with a median observation time of 162.2 months. Median OS of all 40 patients with GBM was 18.9 months (95% CI 15.8–25.3), and median OS was 25.3 months (95% CI18–30) forthose patients treated with the 131I-mAB. Three GBM patients are currently alive. One-, 2-, and 3-year survival probabilities were 100%, 93.3%, and 66.7%, respectively, for AA patients and 82.5%, 42.5%, and 15.9%, respectively, for GBM patients. Restratification of GBM patients by recursive partitioning analysis (RPA) Classes III, IV, and V produced median OSs of 31.1, 18.9, and 14.5 months, respectively (p = 0.004), which was higher than expected. Multivariate analysis confirmed the role of RPA class, age, and treatment in predicting survival. No Grade 3 or 4 hematological, nephrologic, or hepatic toxic effects were observed; 4 patients developed Grade 3 neurological deficits. Radiological signs of radionecrosis were observed in 6 patients, who were all responding well to steroids. CONCLUSIONS Median OS of GBM and AA patients treated with 131I-mABs reached 25.3 and 77.2 months, respectively, thus markedly exceeding that of historical controls. Adverse events remained well controllable with the fractionated dosage regimen.

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