Long-term outcomes after irradiation (RT) for pediatric low-grade glioma.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10549-10549
Author(s):  
Derek S. Tsang ◽  
Erin Sennett Murphy ◽  
Thomas E. Merchant
Keyword(s):  
Systemic Therapy ◽  
Cumulative Incidence ◽  
High Grade Glioma ◽  
Tumor Location ◽  
Low Grade Glioma ◽  
Low Grade ◽  
High Grade ◽  
Who Grade ◽  
Extent Of Surgery

10549 Background: Treatment for pediatric low-grade glioma (LGG) is variable, depending on age and tumor location. Systemic therapy (ST) is often used to delay RT, but ST does not result in durable local control. The goal of this study was to evaluate event-free survival (EFS) and toxicities for pediatric LGG treated with RT over a 30-year period. Methods: All patients age ≤21 with intracranial pediatric LGG (WHO grade I-II) treated with RT at a single institution since May 1986 were included in this retrospective review. Patients with metastatic disease (M+) received craniospinal irradiation (CSI); otherwise, RT was conformal. EFS and overall survival (OS) were measured from the first day of RT. Events included death, progression, or secondary high-grade glioma. Results: 221 patients were eligible. Median follow-up was 11.3 yrs (range, 0.1-30.5). Median RT dose was 54 Gy. 10-yr EFS and OS were 67.9% (95% CI 60.4-74.3) and 91.1% (95% CI 85.8-94.5) for non-metastatic patients, respectively. For 12 M+ patients treated with CSI, 10-yr EFS and OS were 58.9% (95% CI 23.4-82.5) and 70.0% (32.9-89.2), respectively. 28.6% developed pseudoprogression (PP) with median time to onset and resolution of 6.1 months (IQR 3.6-14.6) and 6.4 months (IQR 3.5-11.7), respectively. Patients with PP had improved 10-yr EFS (83.4% vs. 61.0%, HR 0.40, p = .006). Patients with grade II tumors and who received pre-RT ST had lower EFS (Table). Sex, NF-1, tumor location, extent of surgery and CSI were not independently associated with EFS. 10-yr cumulative incidence of grade ≥2 vasculopathy was 7.5% (95% CI 4.9-11.4). There were 12 cases of secondary high-grade glioma, with a 20-yr cumulative incidence of 5.5% (95% CI 2.6-11.4). Conclusions: Irradiation provides long-term control of pediatric LGG in a majority of patients. Receipt of pre-RT systemic therapy was associated with reduced EFS; this association requires further investigation. [Table: see text]

scholarly journals Survival and low-grade glioma: the emergence of genetic information

2015 ◽  
Vol 38 (1) ◽  
pp. E6 ◽  
Author(s):  
Elizabeth B. Claus ◽  
Kyle M. Walsh ◽  
John K. Wiencke ◽  
Annette M. Molinaro ◽  
Joseph L. Wiemels ◽  
...  
Keyword(s):  
Expression Profiles ◽  
Young Patients ◽  
High Grade Glioma ◽  
The United States ◽  
Low Grade Glioma ◽  
World Health ◽  
Low Grade ◽  
High Grade ◽  
Who Grade ◽  
Health Organization

Significant gaps exist in our understanding of the causes and clinical management of glioma. One of the biggest gaps is how best to manage low-grade (World Health Organization [WHO] Grade II) glioma. Low-grade glioma (LGG) is a uniformly fatal disease of young adults (mean age 41 years), with survival averaging approximately 7 years. Although LGG patients have better survival than patients with high-grade (WHO Grade III or IV) glioma, all LGGs eventually progress to high-grade glioma and death. Data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute suggest that for the majority of LGG patients, overall survival has not significantly improved over the past 3 decades, highlighting the need for intensified study of this tumor. Recently published research suggests that historically used clinical variables are not sufficient (and are likely inferior) prognostic and predictive indicators relative to information provided by recently discovered tumor markers (e.g., 1p/19q deletion and IDH1 or IDH2 mutation status), tumor expression profiles (e.g., the proneural profile) and/or constitutive genotype (e.g., rs55705857 on 8q24.21). Discovery of such tumor and constitutive variation may identify variables needed to improve randomization in clinical trials as well as identify patients more sensitive to current treatments and targets for improved treatment in the future. This article reports on survival trends for patients diagnosed with LGG within the United States from 1973 through 2011 and reviews the emerging role of tumor and constitutive genetics in refining risk stratification, defining targeted therapy, and improving survival for this group of relatively young patients.

scholarly journals Cumulative incidence and risk factors for radiation induced leukoencephalopathy in high grade glioma long term survivors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Robert Terziev ◽  
Dimitri Psimaras ◽  
Yannick Marie ◽  
Loic Feuvret ◽  
Giulia Berzero ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
High Grade Glioma ◽  
High Grade ◽  
Nucleotide Polymorphisms ◽  
Increased Risk ◽  
Radiation Induced ◽  
Long Term Survivors

AbstractThe incidence and risk factors associated with radiation-induced leukoencephalopathy (RIL) in long-term survivors of high-grade glioma (HGG) are still poorly investigated. We performed a retrospective research in our institutional database for patients with supratentorial HGG treated with focal radiotherapy, having a progression-free overall survival > 30 months and available germline DNA. We reviewed MRI scans for signs of leukoencephalopathy on T2/FLAIR sequences, and medical records for information on cerebrovascular risk factors and neurological symptoms. We investigated a panel of candidate single nucleotide polymorphisms (SNPs) to assess genetic risk. Eighty-one HGG patients (18 grade IV and 63 grade III, 50M/31F) were included in the study. The median age at the time of radiotherapy was 48 years old (range 18–69). The median follow-up after the completion of radiotherapy was 79 months. A total of 44 patients (44/81, 54.3%) developed RIL during follow-up. Twenty-nine of the 44 patients developed consistent symptoms such as subcortical dementia (n = 28), gait disturbances (n = 12), and urinary incontinence (n = 9). The cumulative incidence of RIL was 21% at 12 months, 42% at 36 months, and 48% at 60 months. Age > 60 years, smoking, and the germline SNP rs2120825 (PPARg locus) were associated with an increased risk of RIL. Our study identified potential risk factors for the development of RIL (age, smoking, and the germline SNP rs2120825) and established the rationale for testing PPARg agonists in the prevention and management of late-delayed radiation-induced neurotoxicity.

scholarly journals SURG-32. THE USE OF 5-AMINOLEVULINIC ACID IN LOW-GRADE GLIOMA RESECTION: A SYSTEMATIC REVIEW

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi246-vi246
Author(s):  
Ahmad Almekkawi ◽  
Tarek El Ahmadieh ◽  
Karl Abi-Aad ◽  
Salah Aoun ◽  
Najib EL Tecle ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Index ◽  
Aminolevulinic Acid ◽  
High Grade Glioma ◽  
Extent Of Resection ◽  
Low Grade Glioma ◽  
Low Grade ◽  
High Grade ◽  
Visualization Technology ◽  
Glioma Resection

Abstract BACKGROUND 5-aminolevulinic acid is a reliable tool for optimizing high-grade glioma resection. However, its efficacy in low-grade glioma resection remains unclear. OBJECTIVE To study the role of 5-aminolevulinic acid in low-grade glioma resection and assess positive fluorescence rates and effect on the extent of resection. METHODS A systematic review of PubMed, Google Scholar, and Cochrane was performed from the date of inception to February 1, 2019. Studies that correlated 5-aminolevulinic acid fluorescence with low-grade glioma in the setting of operative resection were selected. Studies with biopsy only were excluded. Positive fluorescence rates were calculated. Quality index of the selected papers using the Downs and Black criteria checklist was provided. RESULTS Twelve articles met the selection criteria with 244 histologically-confirmed low-grade glioma patients who underwent microsurgical resection. All patients received 20 mg/kg body weight of 5-aminolevulinic acid. Only 60 patients (n=60/244; 24.5%) demonstrated visual intra-operative 5-aminolevulinic acid fluorescence. The extent of resection was reported in 4 studies, however, the data combined low- and high-grade tumors. Only 2 studies reported on tumor location. Only 3 studies reported on clinical outcomes. The Zeiss OPMI Pentero microscope was most commonly used across all studies. The average quality index was 14.58 (range: 10–17) which correlated with an overall good quality. CONCLUSION There is an overall low correlation between 5-aminolevulinic acid fluorescence and low-grade glioma. Advances in visualization technology and using standardized fluorescence quantification methods may further improve the visualization and reliability of 5-aminolevulinic acid fluorescence in low-grade glioma resection.

scholarly journals Homotopic functional connectivity disruptions in glioma patients are associated with tumor malignancy and overall survival

2021 ◽  
Author(s):  
Andy G S Daniel ◽  
Carl D Hacker ◽  
John J Lee ◽  
Donna Dierker ◽  
Joseph B Humphries ◽  
...  
Keyword(s):  
Overall Survival ◽  
Functional Connectivity ◽  
Healthy Subjects ◽  
High Grade Glioma ◽  
Tumor Grade ◽  
World Health ◽  
Low Grade ◽  
High Grade ◽  
Healthy Controls ◽  
Who Grade

Abstract Background Gliomas exhibit widespread bilateral functional connectivity (FC) alterations that may be associated with tumor grade. Limited studies have examined the connection-level mechanisms responsible for these effects. Given the typically strong FC observed between mirroring/homotopic brain regions in healthy subjects, we hypothesized that homotopic connectivity (HC) is altered in low-grade and high-grade glioma patients and the extent of disruption is associated with tumor grade and predictive of overall survival (OS) in a cohort of de novo high-grade glioma (World Health Organization [WHO] grade 4) patients. Methods We used a mirrored FC-derived cortical parcellation to extract blood-oxygen-level-dependent (BOLD) signals and to quantify FC differences between homotopic pairs in normal-appearing brain in a retrospective cohort of glioma patients and healthy controls. Results Fifty-nine glioma patients (WHO grade 2, n = 9; grade 4 = 50; mean age, 57.5 years) and thirty healthy subjects (mean age, 65.9 years) were analyzed. High-grade glioma patients showed lower HC compared to low-grade glioma patients and healthy controls across several cortical locations and resting-state networks. Connectivity disruptions were also strongly correlated with hemodynamic lags between homotopic regions. Finally, in high-grade glioma patients with known survival times (n = 42), HC in somatomotor and dorsal attention networks were significantly correlated with OS. Conclusions These findings demonstrate an association between tumor grade and HC alterations that may underlie global FC changes and provide prognostic information.

Brain Tumor Classification into High Grade and Low Grade Gliomas

2019 ◽  
pp. 785-790
Author(s):  
Sanjeet Pandey ◽  
Brijesh Bharadwaj ◽  
Himanshu Pandey ◽  
Vineet Kr. Singh
Keyword(s):  
Invasive Procedure ◽  
High Grade Glioma ◽  
Low Grade Glioma ◽  
World Health ◽  
Low Grade ◽  
High Grade ◽  
Learning Approaches ◽  
Sampling Errors ◽  
Promising Alternative ◽  
Glioma Grading

Brain is recognized as one of the complex organ of the human body. Abnormal formation of cells may affect the normal functioning of the brain. These abnormal cells may belong to category of benign cells resulting in low grade glioma or malignant cells resulting in high grade glioma. The treatment plans vary according to grade of glioma detected. This results in need of precise glioma grading. As per World Health Organization, biopsy is considered to be gold standard in glioma grading. Biopsy is an invasive procedure which may contains sampling errors. Biopsy may also contain subjectivity errors. This motivated the clinician to look for other methods which may overcome the limitations of biopsy reports. Machine learning and deep learning approaches using MRI is considered to be most promising alternative approach reported by scientist in literature. The presented work were based on the concept of AdaBoost approach which is an ensemble learning approach. The developed model was optimized w.r.t to two hyper parameters i.e. no. of estimators and learning rate keeping the base model fixed. The decision tree was us ed as a base model. The proposed developed model was trained and validated on BraTS 2018 dataset. The developed optimized model achieves reasonable accuracy in carrying out classification task i.e. high grade glioma vs. low grade glioma.

Diffusion Weighted Imaging of Brain Gliomas in the Differential Diagnosis Value

2020 ◽  
Author(s):  
Jian JIANG ◽  
Liangcai BAI ◽  
Xueling ZHANG ◽  
Jianli LIU ◽  
Junlin ZHOU
Keyword(s):  
Brain Metastases ◽  
Diffusion Weighted Imaging ◽  
High Grade Glioma ◽  
Low Grade Glioma ◽  
Control Group ◽  
Low Grade ◽  
High Grade ◽  
Imaging Data ◽  
Grade Group ◽  
Diffusion Weighted

Background: To evaluate the diagnostic value of diffusion weighted imaging (DWI) and apparent diffusion coefficient measurement (ADC) in glioma. cient measurement (ADC) in glioma. Methods: Thirty two low-grade glioma patients and 31 high-grade glioma patients who were confirmed by pathology in Lanzhou University Second Hospital, Lanzhou, China from February 2016 to January 2019 were selected. The other 30 patients with brain metastases were selected as a control group. DWI imaging data of the three groups were collected, and ADC, relative ADC (rADC) values in tumor parenchyma, peritumor edema area, and contralateral normal white matter area were measured, and the levels of n-acetyl aspartic acid (NAA), choline (Cho), creatine (Cr) of tumor metabolites were analyzed. Results: rADC values in the peri-tumor edema areas of the high-grade glioma group were significantly lower than those in the low-grade group and the metastatic group （P=0.011）, and the low-grade group was significantly lower than that in the metastatic group (P < 0.05). NAA/Cho and NAA/Cr in parenchymal and peritumor edema areas of patients in the advanced group were significantly lower than those in the metastatic group (P < 0.05), and Cho /Cr was significantly higher than those in the metastatic group (P < 0.05). Conclusion: the rADC value, NAA/Cho, NAA/Cr and Cho/Cr in parenchymal and peritumor edema areas of the tumor can help to distinguish high-grade glioma, low-grade glioma and brain metastases.

Temozolomide after Radiotherapy for Newly Diagnosed High-grade Glioma and Unfavorable Low-grade Glioma in Children

2005 ◽  
Vol 76 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Alberto Broniscer ◽  
Murali Chintagumpala ◽  
Maryam Fouladi ◽  
Matthew J. Krasin ◽  
Mehmet Kocak ◽  
...  
Keyword(s):  
High Grade Glioma ◽  
Low Grade Glioma ◽  
Low Grade ◽  
High Grade ◽  
Newly Diagnosed

scholarly journals Contribution of combined intraoperative electrophysiological investigation with 3-T intraoperative MRI for awake cerebral glioma surgery: comprehensive review of the clinical implications and radiological outcomes

2016 ◽  
Vol 40 (3) ◽  
pp. E14 ◽  
Author(s):  
Diana Ghinda ◽  
Nan Zhang ◽  
Junfeng Lu ◽  
Cheng-Jun Yao ◽  
Shiwen Yuan ◽  
...  
Keyword(s):  
Learning Curve ◽  
High Grade Glioma ◽  
Awake Craniotomy ◽  
Low Grade ◽  
High Grade ◽  
Short Term ◽  
Glioma Surgery ◽  
Eloquent Area ◽  
Short And Long Term

OBJECTIVE This study aimed to assess the clinical efficiency of combined awake craniotomy with 3-T intraoperative MRI (iMRI)–guided resection of gliomas adjacent to eloquent cortex performed at a single center. It also sought to explore the contribution of iMRI to surgeons' learning process of maximal safe resection of gliomas. METHODS All patients who underwent an awake craniotomy and iMRI for resection of eloquent area glioma during the 53 months between January 2011 and June 2015 were included. The cases were analyzed for short- and long-term neurological outcome, progression-free survival (PFS), overall survival (OS), and extent of resection (EOR). The learning curve was assessed after dividing the cohort into Group A (first 27 months) and Group B (last 26 months). Statistical analyses included univariate logistic regression analysis on clinical and radiological variables. Kaplan-Meier and Cox regression models were used for further analysis of OS and PFS. A p value < 0.05 was considered statistically significant. RESULTS One hundred six patients were included in the study. Over an average follow-up period of 24.8 months, short- and long-term worsening of the neurological function was noted in 48 (46.2%) and 9 (8.7%) cases, respectively. The median and mean EOR were 100% and 92%, respectively, and complete radiographic resection was achieved in 64 (60.4%) patients. The rate of gross-total resection (GTR) in the patients with low-grade glioma (89.06% ± 19.6%) was significantly lower than that in patients with high-grade glioma (96.4% ± 9.1%) (p = 0.026). Thirty (28.3%) patients underwent further resection after initial iMRI scanning, with a 10.1% increase of the mean EOR. Multivariate Cox proportional hazards modeling demonstrated that the final EOR was a significant predictor of PFS (HR 0.225, 95% CI 0.070–0.723, p = 0.012). For patients with high-grade glioma, the GTR (p = 0.033), the presence of short-term motor deficit (p = 0.027), and the WHO grade (p = 0.005) were independent prognostic factors of OS. Performing further resection after the iMRI (p = 0.083) and achieving GTR (p = 0.05) demonstrated a PFS benefit trend for the patients affected by a low-grade glioma. Over time, the rate of performing further resection after an iMRI decreased by 26.1% (p = 0.005). A nonsignificant decrease in the rate of short-term (p = 0.101) and long-term (p = 0.132) neurological deficits was equally noted. CONCLUSIONS Combined awake craniotomy and iMRI is a safe and efficient technique allowing maximal safe resection of eloquent area gliomas with possible subsequent OS and PFS benefits. Although there is a learning curve for applying this technique, it can also improve the surgeon's ability in eloquent glioma surgery.

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