Malignant hemangiopericytoma: Treatment patterns and survival.

e13520 Background: Hemangiopericytoma (HPC), or solitary fibrous tumor of the central nervous system (CNS), is a rare mesenchymal tumor that arises from the pericytes of the meningeal capillaries. These tumors account for less than 1% of all CNS tumors and are categorized into low-grade (WHO grade I and II) or high-grade (WHO grade III, anaplastic) neoplasms. The optimal treatment for grade III HPC is unclear. The aim of this study was to evaluate treatment patterns and survival for grade III HPC using the California Cancer Registry (CCR). Methods: Treatment and demographic data were extracted from the CCR for patients with grade III HPC of the CNS, from 1988-2010. Overall Survival (OS) was evaluated as a function of treatment (surgery, radiation or both), as well as extent of resection. Kaplan Meier survival analyses were performed for OS. Bivariate and multivariable analyses were done via cox proportional hazard regression models for all demographic and treatment variables. Results: A total of 94 patients with grade III HPC were identified from the registry. The most prevalent demographics were age > 50 years (59%), female (61%), non-Hispanic White (60%), and married (54%). 54% received radiation, and subtotal resection (STR) (63%) was the most common surgical outcome. However, survival was greatest in patients that received gross total resection (GTR) with radiation (median OS not reached). GTR/radiation (median OS not reached) demonstrated improved OS compared to STR/radiation (median OS 10.3 years; HR = 0.389, 95%CI 0.157-0.960) or GTR alone (median OS 6.6 years; HR = 0.254, 95%CI 0.073-0.880). Age < 50 (median OS 15.7 years), Asian/PI (median OS not reached) and married (median OS 9.9 years) were significant predictors of OS. In the multivariable cox model worse overall survival remained for older age (HR = 3.079, 95%CI 1.428-6.636) and divorced/widowed/separated (HR = 2.027, 95%CI 1.054-3.897) when compared to their younger and married counterparts. Conclusions: Patients that received GTR and radiation demonstrated the best long-term prognosis. Demographic analyses identified additional independent predictors of survival.

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Prognostic significance of clinical parameters in patients with cerebral low-grade glioma

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh200513085j ◽

2020 ◽

pp. 85-85

Author(s):

Milos Jokovic ◽

Radovan Mijalcic ◽

Vladimir Bascarevic ◽

Nemanja Jovanovic

Keyword(s):

Overall Survival ◽

Tumor Biology ◽

Prognostic Significance ◽

Extent Of Resection ◽

Categorical Variables ◽

Low Grade ◽

Clinical Parameters ◽

Site Location ◽

Who Grade ◽

Low Grade Gliomas

Introduction/Objective. Low-grade gliomas (LGG) affect younger adults and carry a favorable prognosis. We aim to describe clinical patterns of low-grade gliomas as well as prognosis in different groups of patients. Our intention was to determine clinical parameters that may affect prognosis, and whether a greater extent of resection would increase the long-term progression-free or overall survival of patients with low-grade gliomas. Methods. We analyzed data obtained from the files of the patients with a diagnosis of WHO grade II gliomas. The relationships among categorical variables were analyzed using standard statistical tools and a 95% confidence interval (CI). Results. We analyzed 118 patients with median age of 34 years. Over 57% were male and the primary site location was the cerebrum. All these patients were operated on and some of them received radiation and/or chemotherapy. Median overall survival was 9.6 years and better prognosis is associated with younger age, frontal and noneloquent zone location, seizures as the first symptom of disease and gross total resection of the tumor. Indications for early surgery are increased intracranial pressure, preoperative neurologic deficit, tumor size larger than 6 cm with contrast enhancement and older age. Conclusion. Tumor location, 1p/19q co-deletion and age were the main determinants of treatment received and overall survival, likely reflecting tumor biology differences. Any form of treatment was preferred over watchful waiting. This study found that a greater extent of resection could significantly increase the overall survival of patients with low-grade gliomas.

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The concept of the “Hexahedron” in the supratotal resection of the frontal gliomas: A technical note

10.21203/rs.3.rs-926821/v1 ◽

2021 ◽

Author(s):

Pu Cai ◽

Gang Bai ◽

Jun Peng ◽

Yun Li ◽

Shanli Che ◽

...

Keyword(s):

Tumour Volume ◽

Extent Of Resection ◽

Technical Note ◽

Subtotal Resection ◽

Diffuse Astrocytoma ◽

Who Grade ◽

Grade Ii ◽

Supratotal Resection ◽

Who Grade Iii ◽

Grade Iii

Abstract OBJECTIVE To evaluate the value of the concept of the “Hexahedron” in the supratotal resection (SPTR) of frontal gliomas in both dominant and nondominant hemispheres . METHODS All consecutive patients who underwent SPTR for frontal gliomas under the guidance from the concept of the “Hexahedron” were retrospectively analysed for lesion location, pathology, extent of resection (EOR), and complications from May 2020 to June 2021. Volumetric EOR was measured and classified as SPTR, (in which the volume of the postoperative cavity was larger than the preoperative tumour volume), gross total resection (GTR, > 95% by volume) or subtotal resection (STR, ≤ 95% by volume) after independent radiological review. RESULTS Six men and two women (mean age: 47.13 years; range: 26–69 years) were included. All eight patients underwent frontal craniotomy combined frontotemporal craniotomy for resection of frontal gliomas. Neuropathological examination confirmed a diagnosis of glioblastoma WHO Grade IV in 4 patients, anaplastic oligodendroglioma WHO Grade III in 1, anaplastic astrocytoma WHO Grade III in 2 and diffuse astrocytoma WHO Grade II in 1. SPTR was achieved in six patients and STR was achieved in two. The main postoperative complications were contralateral paresis in 2 patients and memory disturbances in 1 patient. There were no cases of rebleeding or secondary operation during hospitalization. CONCLUSIONS In the presented eight cases the concept of the “Hexahedron” allowed for safe surgical supratotal resection of frontal gliomas.

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Oligodendroglioma resection: a Surveillance, Epidemiology, and End Results (SEER) analysis

Journal of Neurosurgery ◽

10.3171/2016.11.jns161974 ◽

2018 ◽

Vol 128 (4) ◽

pp. 1076-1083 ◽

Cited By ~ 9

Author(s):

Ali A. Alattar ◽

Michael G. Brandel ◽

Brian R. Hirshman ◽

Xuezhi Dong ◽

Kate T. Carroll ◽

...

Keyword(s):

Overall Survival ◽

Cox Regression ◽

Primary Cns Lymphoma ◽

Extent Of Resection ◽

Subtotal Resection ◽

Cns Lymphoma ◽

Who Grade ◽

Kaplan Meier ◽

Clinical Benefits ◽

End Results

OBJECTIVEThe available evidence suggests that the clinical benefits of extended resection are limited for chemosensitive tumors, such as primary CNS lymphoma. Oligodendroglioma is generally believed to be more sensitive to chemotherapy than astrocytoma of comparable grades. In this study the authors compare the survival benefit of gross-total resection (GTR) in patients with oligodendroglioma relative to patients with astrocytoma.METHODSUsing the Surveillance, Epidemiology, and End Results (SEER) Program (1999–2010) database, the authors identified 2378 patients with WHO Grade II oligodendroglioma (O2 group) and 1028 patients with WHO Grade III oligodendroglioma (O3 group). Resection was defined as GTR, subtotal resection, biopsy only, or no resection. Kaplan-Meier and multivariate Cox regression survival analyses were used to assess survival with respect to extent of resection.RESULTSCox multivariate analysis revealed that the hazard of dying from O2 and O3 was comparable between patients who underwent biopsy only and GTR (O2: hazard ratio [HR] 1.06, 95% confidence interval [CI] 0.73–1.53; O3: HR 1.18, 95% CI 0.80–1.72). A comprehensive search of the published literature identified 8 articles without compelling evidence that GTR is associated with improved overall survival in patients with oligodendroglioma.CONCLUSIONSThis SEER-based analysis and review of the literature suggest that GTR is not associated with improved survival in patients with oligodendroglioma. This finding contrasts with the documented association between GTR and overall survival in anaplastic astrocytoma and glioblastoma. The authors suggest that this difference may reflect the sensitivity of oligodendroglioma to chemotherapy as compared with astrocytomas.

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WP1-17 Risk factors and patterns of progression in a surgical cohort of low grade glioma patients

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-abn.18 ◽

2019 ◽

Vol 90 (3) ◽

pp. e6.2-e6

Author(s):

S Acharya ◽

J Lavrador ◽

R Visagan ◽

V Narbad ◽

J Jung ◽

...

Keyword(s):

Risk Factors ◽

Performance Status ◽

Extent Of Resection ◽

Low Grade Glioma ◽

Subtotal Resection ◽

Low Grade ◽

Neurosurgical Procedures ◽

Volumetric Change ◽

Who Grade ◽

Adjusted Analysis

ObjectivesTo understand the risk factors for and patterns of progression of low grade glioma (LGG).DesignSingle centre retrospective cohort study.SubjectsPatients undergoing at least two neurosurgical procedures for LGG, the first being for diffuse LGG (WHO 2). 22 patients included (14M; 8F); mean age at time of first operation 37.7±2.7 years. 20 patients had a Performance Status (PS) 0–1 and 2 patients had a PS 2.MethodsAll patients with LGG diagnosed in between 2009–2018 were retrospectively evaluated. Variables of interest included demographics, staging, performance status, time to re-operation (TTR), extent of resection, molecular genetics (1p19q co-deletion, IDH status). Tumour volumes were estimated from MRI images by the validated ABC/2 equation. Statistical analyses were performed by Stata13.0.ResultsThe tumour progressed in WHO grade in 18 patients (WHO grade 3 (n=15); WHO grade 4 (n=3). Mean time to re-operation after the first surgery was 7.0±1.2 years following gross total resection (GTR) and 3.2±0.7 years following subtotal resection (STR). Non-adjusted analysis of risk factors for time to re-operation (TTR) showed absence of 1p19q co-deletion as a risk factor (p=0.021). Adjusted analysis revealed that GTR, 1p19q mutation, PS 0 at 1 st surgery and tumour volumetric change decrease the risk for re-intervention (p<0.05). Chemo-radiotherapy was not associated with TTR.ConclusionsIn our cohort, TTR in LGG was influenced by the amount of initial resection, 1p19q deletion, PS and post-operative volumetric change.

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Pathology of Spinal Ependymomas

Neurosurgery ◽

10.1227/01.neu.0000430764.02973.78 ◽

2013 ◽

Vol 73 (2) ◽

pp. 247-255 ◽

Cited By ~ 34

Author(s):

Phiroz E. Tarapore ◽

Peter Modera ◽

Agne Naujokas ◽

Michael C. Oh ◽

Beejal Amin ◽

...

Keyword(s):

Adjuvant Radiotherapy ◽

Histological Grade ◽

Progression Free Survival ◽

Extent Of Resection ◽

World Health ◽

Subtotal Resection ◽

Who Grade ◽

Grade Ii ◽

Health Organization ◽

Grade Iii

AbstractBACKGROUND:Ependymomas constitute approximately 40% of primary intraspinal tumors. Current World Health Organization (WHO) grading may not correlate with observed progression-free survival (PFS).OBJECTIVE:This retrospective study of prospectively collected data examines whether PFS is influenced by the histological grade or by the extent of resection. It also analyzes the usage and effectiveness of postoperative adjuvant radiotherapy.METHODS:We reviewed 134 consecutive patients with ependymomas of all grades. Pathology slides were re-reviewed and the histological grades were confirmed by a single neuropathologist. Postoperative residual or recurrence was evaluated with follow-up magnetic resonance imaging.RESULTS:There were 85 male and 49 female patients, ranging from 10 to 79 (median 41) years of age. Thirty patients had WHO grade I tumors, 101 had grade II tumors, and 3 had grade III tumors. Kaplan-Meier analysis of PFS demonstrated a mean duration of 6 years for grade I, 14.9 years for grade II, and 3.7 years for grade III (P < .001). In grade II ependymomas, mean PFS was 11.2 years with subtotal resection and 17.8 years with gross total resection (P < .01). PFS of patients who underwent subtotal resection was not significantly changed by adjuvant radiotherapy (P < .36).CONCLUSION:Patients with grade II ependymoma have significantly longer PFS than patients with grade I ependymoma. The extent of resection did not affect PFS in grade I ependymoma but it did in grade II. Contrary to its higher grade, WHO grade II ependymoma carries a better prognosis than WHO grade I ependymoma.

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NCOG-48. TRANSFORMATION FROM LOW GRADE MENINGIOMA AND PROGNOSTIC FACTORS FOR SHORTER TIME TO RECURRENCE OF WHO GRADE III MENINGIOMA DIAGNOSIS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.586 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii140-ii140

Author(s):

Jessica Chew ◽

William Chen ◽

Matthew S Susko ◽

Harish N Vasudevan ◽

Steve Braunstein ◽

...

Keyword(s):

Overall Survival ◽

Survival Rates ◽

Unmet Need ◽

Low Grade ◽

Who Grade ◽

Subsequent Transformation ◽

Time To Recurrence ◽

Who Grade Iii ◽

Grade Iii

Abstract BACKGROUND WHO grade III meningiomas are rare, and clinical outcomes data are limited. To address this problem, we analyzed a single institution retrospective cohort of patients with WHO grade III meningiomas. METHODS Patients who underwent resection of WHO grade III meningiomas between 1983 and 2019 with available follow-up data were included. Treatment, local recurrence, and overall survival rates were obtained. Kaplan-Meier analysis, log rank tests, and Student’s t tests were used for statistical analyses. RESULTS Ninety consecutive patients met inclusion criteria. Median follow-up was 3.2 years (IQR: 1.2-7.9), median age was 58 years (IQR: 46-67). Twenty-three patients (26%) underwent resection alone, and 58 (64%) underwent resection with adjuvant radiotherapy. Fifty-one patients developed local recurrences, with median time to recurrence of 1.0 year (IQR: 0.6-2.9) and higher MIB-1 labeling index for tumors that recurred within 1 year (25% versus 17%, p=0.04). There was a median of 2 recurrences per patient (IQR: 1-3), with a median of 2 resections and 2 radiotherapy courses for initial and salvage treatments. Thirty-nine patients with recurrences died, with median overall survival of 3.7 years (IQR: 1.8-8.8). Thirty-seven patients (41%) had prior low grade meningioma diagnoses with subsequent transformation to grade III, including 6 (7%) with grade I, 16 (18%) with grade II, and 15 (17%) with unknown grade. There was a median of 1 low grade recurrence per patient (IQR: 0-3) before transformation to grade III, which occurred a median of 4.3 years (IQR: 2.4-9.9) after initial diagnosis. Prior low grade diagnosis was associated with shorter time to recurrence of WHO grade III meningioma (p=0.01), and worse overall survival (p=0.03). CONCLUSION Patients with WHO grade III meningioma have poor outcomes despite aggressive multimodal therapy, and there is an urgent, unmet need for new high grade meningioma treatments.

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Association Between the Extent of Resection and Prognosis in Adult Patients With WHO Grade III Gliomas: a Population-based Study

10.21203/rs.3.rs-1138010/v1 ◽

2021 ◽

Author(s):

Dongjie He ◽

Siying Zhu ◽

Peiwen Wu ◽

Qiming Wang ◽

Gaiyan Li ◽

...

Keyword(s):

Overall Survival ◽

Cox Regression ◽

Demographic Data ◽

Multivariable Analysis ◽

Extent Of Resection ◽

Adult Patients ◽

Anaplastic Glioma ◽

Who Grade ◽

Anaplastic Gliomas ◽

Cause Specific Survival

Abstract PurposeThe role of surgical resection in the treatment of anaplastic glioma is poorly understood. The aim of the present retrospective study was to clarify the survival of patients with anaplastic gliomas.MethodsWe utilized the SEER database to assess the association between prognostic and demographic data, tumor characteristics, and treatment factors in adult patients with anaplastic glioma. Overall survival and cause-specific survival were analyzed using multivariable Cox regression and competing risk regression, respectively.ResultsA total of 3979 patients with anaplastic glioma who had undergone surgical intervention were included in the analysis. Patients who underwent gross total resection (GTR) had significantly better 5-year and 10-year overall survival (OS) (59.9% vs. 44.0%, 45.0% vs. 29.4%, p < 0.001) than those who did not. The 5-year and 10-year cumulative incidence rates of cancer-specific death in the GTR group were lower than those in the corresponding N-GTR group (36.6% vs.51.9%, 49.9% vs. 65.5%, p < 0.001). Multivariable analysis identified GTR as an independent significant predictor for prolonged OS (HR:0.72; 95% confidence interval [CI] 0.65-0.79, P<0.05) and cause-specific survival (CSS) (HR:0.72, 95% CI 0.65-0.80, P<0.05).Further subgroup analysis revealed a stable association between the extent of resection and OS (P values for interaction >0.05), except for tumor location and histologic type groups.ConclusionsWhile the survival of patients with anaplastic glioma remains poor, GTR is associated with increased OS and CSS compared to N-GTR.

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RADT-29. EFFECT OF RADIATION THERAPY ON OVERALL SURVIVAL FOLLOWING SUBTOTAL RESECTION OF ADULT PILOCYTIC ASTROCYTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.782 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii187-ii188

Author(s):

Adham Khalafallah ◽

Adrian Jimenez ◽

Henry Brem ◽

Debraj Mukherjee

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Pilocytic Astrocytoma ◽

Radiation Treatment ◽

Cox Proportional Hazards Model ◽

Adult Patients ◽

Subtotal Resection ◽

Adjuvant Radiation ◽

Low Grade ◽

Risk Of Death

Abstract BACKGROUND Pilocytic astrocytoma (PCA) is a low-grade glioma common in children but also rarely diagnosed in adults. The role of adjuvant radiation therapy (RT) in treating these tumors remains unclear. OBJECTIVE We investigated the effect of RT on overall survival, specifically among adult patients who had undergone subtotal PCA resection. METHODS Information on adult patients (age 18 years old) who had undergone subtotal PCA resection between 2004 and 2016 was collected from the National Cancer Database (NCDB). A multivariate Cox proportional hazards model was utilized to determine factors independently associated with overall survival. RESULTS A total of 451 patients were identified. The mean age of our patient cohort was 36.8 years old, and the majority of patients (83.4%) did not receive radiation treatment following subtotal PCA resection. Overall median survival was 93.8 months. Survival was longer (p < 0.001) in the patients who did not receive post-surgical RT (median: 98.3 months) compared to patients who did (median: 54.8 months). Patients who had older age at diagnosis (hazard ratio [HR]=1.05, 95% confidence interval [CI]=1.03-1.07, p < 0.01), were Black or African American (HR=2.76, CI=1.12-6.46, p=0.019), received radiation during their initial treatment (HR=4.53, CI=2.08-9.89, p < 0.01), or had a Charlson/Deyo score of > 1 (HR=3.68, CI=1.55, p=0.003) had a significantly higher risk of death following subtotal PCA resection. CONCLUSION Postoperative RT is independently associated with a significantly higher risk of death among adults who underwent subtotal PCA resection. Our findings provide a rationale for further investigation into the efficacy and safety of RT within this patient population.

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Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012005000017 ◽

2013 ◽

Vol 71 (1) ◽

pp. 31-34 ◽

Cited By ~ 7

Author(s):

André de Macedo Bianco ◽

Flavio Key Miura ◽

Carlos Clara ◽

Jose Reynaldo W. Almeida ◽

Clemar Correa da Silva ◽

...

Keyword(s):

Overall Survival ◽

Tumor Resection ◽

Progression Free Survival ◽

Subtotal Resection ◽

Low Grade ◽

Brain Areas ◽

Free Survival ◽

Eloquent Areas ◽

Eloquent Area ◽

Extent Of Surgical Resection

A retrospective study of 81 patients with low-grade astrocytoma (LGA) comparing the efficacy of aggressive versus less aggressive surgery in eloquent and non-eloquent brain areas was conducted. Extent of surgical resection was analyzed to assess overall survival (OS) and progression- free survival (PFS). Degree of tumor resection was classified as gross total resection (GTR), subtotal resection (STR) or biopsy. GTR, STR and biopsy in patients with tumors in non-eloquent areas were performed in 31, 48 and 21% subjects, whereas in patients with tumors in eloquent areas resections were 22.5, 35 and 42.5%. Overall survival was 4.7 and 1.9 years in patients with tumors in non-eloquent brain areas submitted to GTR/STR and biopsy (p=0.013), whereas overall survival among patients with tumors in eloquent area was 4.5 and 2.1 years (p=0.33). Improved outcome for adult patients with LGA is predicted by more aggressive surgery in both eloquent and non-eloquent brain areas.

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The Role of Extent of Resection in IDH1 Wild-Type or Mutant Low-Grade Gliomas

Neurosurgery ◽

10.1093/neuros/nyx265 ◽

2017 ◽

Vol 82 (6) ◽

pp. 808-814 ◽

Cited By ~ 20

Author(s):

Toral Patel ◽

Evan D Bander ◽

Rachael A Venn ◽

Tiffany Powell ◽

Gustav Young-Min Cederquist ◽

...

Keyword(s):

Cox Regression ◽

Extent Of Resection ◽

World Health ◽

Low Grade ◽

Wild Type ◽

Who Grade ◽

Cox Regression Analysis ◽

Low Grade Gliomas ◽

Grade Ii ◽

The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) improves outcomes in adults with World Health Organization (WHO) grade II low-grade gliomas (LGG). However, recent studies demonstrate that LGGs bearing a mutation in the isocitrate dehydrogenase 1 (IDH1) gene are a distinct molecular and clinical entity. It remains unclear whether maximizing EOR confers an equivalent clinical benefit in IDH mutated (mtIDH) and IDH wild-type (wtIDH) LGGs. OBJECTIVE To assess the impact of EOR on malignant progression-free survival (MPFS) and overall survival (OS) in mtIDH and wtIDH LGGs. METHODS We performed a retrospective review of 74 patients with WHO grade II gliomas and known IDH mutational status undergoing resection at a single institution. EOR was assessed with quantitative 3-dimensional volumetric analysis. The effect of predictor variables on MPFS and OS was analyzed with Cox regression models and the Kaplan–Meier method. RESULTS Fifty-two (70%) mtIDH patients and 22 (30%) wtIDH patients were included. Median preoperative tumor volume was 37.4 cm3; median EOR of 57.6% was achieved. Univariate Cox regression analysis confirmed EOR as a prognostic factor for the entire cohort. However, stratifying by IDH status demonstrates that greater EOR independently prolonged MPFS and OS for wtIDH patients (hazard ratio [HR] = 0.002 [95% confidence interval {CI} 0.000-0.074] and HR = 0.001 [95% CI 0.00-0.108], respectively), but not for mtIDH patients (HR = 0.84 [95% CI 0.17-4.13] and HR = 2.99 [95% CI 0.15-61.66], respectively). CONCLUSION Increasing EOR confers oncologic and survival benefits in IDH1 wtLGGs, but the impact on IDH1 mtLGGs requires further study.

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