Effect of grade on survival in IDH-mutant grade II and grade III gliomas.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 2036-2036
Author(s):  
Giuseppe Lamberti ◽  
Enrico Franceschi ◽  
Alicia Tosoni ◽  
Antonella Mura ◽  
Alexandro Paccapelo ◽  
...  
Keyword(s):  
Residual Disease ◽  
Molecular Characteristics ◽  
Diffuse Gliomas ◽  
Grade Ii ◽  
Exon 4 ◽  
The Difference ◽  
Surgical Treatments ◽  
Next Generation Sequencing Ngs ◽  
Grade Iii

2036 Background: The 2016 WHO classification dramatically changed the diagnosis of gliomas. Diffuse gliomas are classified according to the presence of IDH-mutation (IDH-mut) and the deletion of both 1p and 19q chromosome arms (1p/19q codel). Now debate is whether grade still has an independent prognostic value. The aim of this study was to find out if grade is a prognostic factor independently of molecular status. Methods: We analyzed our institutional data warehouse for all consecutive patients (pts) with newly diagnosed, histologically proven Grade II or Grade III IDH-mut gliomas. IDH 1/2 assessment by polymerase chain reaction (PCR)or immunohistochemistry (IHC) was accepted. Next Generation Sequencing (NGS) for IDH1(exon 4) and IDH2(exon 4) was performed on all specimens wild-type for the IDH. Results: The analysis included all the 399 pts who had a grade II (n = 250, 62.7%) or grade III (n = 149, 37.3%). Median follow-up time was 105.3 months. After surgery, 72 pts (18.0%) received RT alone, 44 (11.0%) received CT alone, 135 (33.8%) received both RT and CT, and 142 (35.6%) follow-up without any treatment. Median survival was 148.1 months. In multivariate analysis Grade (HR = 0.342, 95%CI: 0.221 – 0.531; P < 0.001) and 1p/19q codeletion (HR = 0.440, 95%CI: 0.290 – 0.668; P < 0.001) were independently associated with a lower risk for death. The difference in survival remained when adjusted for histological subtype. Residual disease after surgery or biopsy negatively affected survival (HR 2.151, 95%CI 1.375 – 3.367, P = 0.001). Post-surgical treatment with RT + adjuvant CT improves survival in respect to follow-up and other treatments (HR: 0.316, 95%CI 0.156 – 0.641, P = 0.001). Conclusions: Grade still affects survival in IDH mutant Grade II and III gliomas. This effect was independent onmolecular features, surgical extension and post-surgical treatments. Clinical management of gliomas should continue to take into account grade as well as molecular characteristics.

Neoadjuvant chemotherapy with docetaxel and cisplatin followed by concomitant chemoradiotherapy (CT-RT) in the management of locally advanced laryngeal carcinoma

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16507-16507
Author(s):  
F. S. Sayed ◽  
A. Karim ◽  
M. Hossain ◽  
D. Ahmed ◽  
M. A. Khan ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Adverse Events ◽  
Ct Scan ◽  
Laryngeal Cancer ◽  
Residual Disease ◽  
Locally Advanced ◽  
Outpatient Basis ◽  
Grade Ii ◽  
Grade Iii

16507 Background: Neoadjuvant chemotherapy has been used effectively in the treatment of locally advanced head and neck cancers. We conducted a study to evaluate the efficacy and adverse events associated with neoadjuvant chemotherapy schedule comprising of docetaxel and cisplatin followed by concomitant CT-RT from July 2004 to June 2006. Methods: 25 patients with locally advanced supraglottic laryngeal cancer were enrolled to receive docetaxel 75 mg/m2 and cisplatin 75 mg/m2 every 3 weekly for 3 cycles followed by one cycle of concomitant external beam radiotherapy (6000 cGy) and docetaxel 75 mg/m2+cisplatin 75 mg/m2 on day 7 of radiotherapy. All patients after completion of neoadjuvant chemotherapy were evaluated by CT scan and direct laryngoscopy and biopsy from any residual disease. All patients were followed up every month up to disease progression. Follow-up was done by physical examination and indirect laryngoscopy and by 3 monthly CT scan. Adverse events were treated mostly on outpatient basis. Results: Out of 25 patients, 9 had residual disease after completion of treatment and 2 had a disease relapse within 5 months of disease completion. The remaining 14 patients were disease free from a duration of 6 to14 months follow-up period. Median progress free survival had not been reached. 9 (36%) patients had severe mucositis and neutropenia while receiving concomitant CT-RT. 6 (24%) patients had grade III mucositis and rest 3 (12%) patients had grade II mucositis and all the 9 (36%) patients had grade III neutropenia. All of them were treated with G-CSF and prophylactic antibiotics. All the rest had grade I and grade II mucositis and neutropenia Conclusions: In our experience, neoadjuvant chemotherapy with docetaxel and cisplatin (3 cycles) followed by 1 cycle of concomitant CT-RT may be a good choice in treating locally advanced supraglottic laryngeal cancer. The toxicity profile was also manageable. No significant financial relationships to disclose.

scholarly journals Importance of a Follow-Up Ultrasound Protocol in Monitoring Posttraumatic Spleen Complications in Children Treated with a Non-Operative Management

Medicina ◽  
2021 ◽  
Vol 57 (8) ◽  
pp. 734
Author(s):  
Ivona Djordjevic ◽  
Dragoljub Zivanovic ◽  
Ivana Budic ◽  
Ana Kostic ◽  
Danijela Djeric
Keyword(s):  
Splenic Abscess ◽  
Operative Management ◽  
High Energy ◽  
Significant Difference ◽  
Injury Grade ◽  
Grade Ii ◽  
The Mean ◽  
Non Operative Management ◽  
Grade Iii

Background and objectives: For the last three decades, non-operative management (NOM) has been the standard in the treatment of clinically stable patients with blunt spleen injury, with a success rate of up to 95%. However, there are no prospective issues in the literature dealing with the incidence and type of splenic complications after NOM. Materials and methods: This study analyzed 76 pediatric patients, up to the age of 18, with blunt splenic injury who were treated non-operatively. All patients were included in a posttraumatic follow-up protocol with ultrasound examinations 4 and 12 weeks after injury. Results: The mean age of the children was 9.58 ± 3.97 years (range 1.98 to 17.75 years), with no statistically significant difference between the genders. The severity of the injury was determined according to the American Association for Surgery of Trauma (AAST) classification: 7 patients had grade I injuries (89.21%), 21 patients had grade II injuries (27.63%), 33 patients had grade III injuries (43.42%), and 15 patients had grade IV injuries (19.73%). The majority of the injuries were so-called high-energy ones, which were recorded in 45 patients (59.21%). According to a previously created posttraumatic follow-up protocol, complications were detected in 16 patients (21.05%). Hematomas had the highest incidence and were detected in 11 patients (14.47%), while pseudocysts were detected in 3 (3.94%), and a splenic abscess and pseudoaneurysm were detected in 1 patient (1.31%), respectively. The complications were in a direct correlation with injury grade: seven occurred in patients with grade IV injuries (9.21%), five occurred in children with grade III injuries (6.57%), three occurred in patients with grade II injuries (3.94%), and one occurred in a patient with a grade I injury (1.31%). Conclusion: Based on the severity of the spleen injury, it is difficult to predict the further course of developing complications, but complications are more common in high-grade injuries. The implementation of a follow-up ultrasound protocol is mandatory in all patients with NOM of spleen injuries for the early detection of potentially dangerous and fatal complications.

scholarly journals NIMG-53. GLUTAMATE/GABA RATIO ON MRS IS ELEVATED IN PATIENTS WITH LOWER GRADE GLIOMAS AND SEIZURES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii159-ii160
Author(s):  
Roberta Rudà ◽  
Riccardo Pascuzzo ◽  
Francesca Mo ◽  
Alessia Pellerino ◽  
Peter B Barker ◽  
...  
Keyword(s):  
Tumor Location ◽  
Resonance Spectroscopy ◽  
Lower Grade ◽  
Lack Of Information ◽  
Baseline Evaluation ◽  
Grade Ii ◽  
Grade Iii

Abstract BACKGROUND There is lack of information on the role of excitatory and inhibitory neurotransmitters in the development of seizures in patients with lower grade gliomas. Increase of glutamate and downregulation of GABA have been suggested in preclinical models and human surgical samples to be associated with brain tumor-related epilepsy. MATERIAL AND METHODS We prospectively investigated with the use of magnetic resonance spectroscopy (MRS) the differences in the ratio of metabolites (glutamate/GABA, glutamate/creatine and GABA/creatine) in the peritumoral areas between patients with or without seizures in a series of lower grade gliomas. Tumors were classified according to WHO Classification of 2016 as follows:11 grade II IDH mutated and 1p/19q codeleted; 3 grade III IDH mutated and 1p/19q codeleted; 6 grade II IDH mutated and 1p/19q intact; 1 grade III IDH mutated and 1p/19q intact; 1 grade II IDH wild-type. Patients received surgery alone or followed by temozolomide chemotherapy according to the presence of risk factors. RESULTS At baseline evaluation, maximum glutamate/GABA values were significantly higher (p=0.023) in the peritumoral area of patients with seizures (1.008 ± 0.368) with respect to those without seizures (0.691 ± 0.170). No other metabolites ratio showed significant differences between the two groups. Similar results were obtained when analyzing the metabolites ratio in the examinations during the follow-up. In the cohort of patients with seizures (n.14) variations of metabolite ratios were not associated with tumor location, 1p/19q codeletion, use of AEDs, concomitant chemotherapy or seizure characteristics (type, duration, frequency). CONCLUSIONS The study is ongoing with the aim of analyzing further the correlations between ratio of metabolites and status of the tumor (stable vs progressive).

scholarly journals Renal scintigraphy in children with urinary tract infections

2005 ◽  
Vol 62 (10) ◽  
pp. 745-749 ◽  
Author(s):  
Boris Ajdinovic ◽  
Zoran Krstic ◽  
Marija Dopudja ◽  
Ljiljana Jaukovic
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Statistical Significance ◽  
International Study ◽  
Renal Scintigraphy ◽  
Grade Ii ◽  
The Difference ◽  
Tract Infections ◽  
Vesico Ureteral Reflux ◽  
Grade Iii

Background/Aim. To determine the incidence of abnormal Technetium Tc 99m Dimercaptosuccinic Acid (Tc99m DMSA) renal scintigraphy findings in the children with urinary tract infection (UTI), and to evaluate the difference between the children with UTI and vesico-ureteral reflux (VUR), and the children with UTI without VUR. Methods. Tc99m DMSA renal scintigraphy was performed in 170 children with UTI, mean age 7.07 years (1 month to 14 years, 137 were girls and 33 were boys). In 88 of the children, VUR was proved by micturating cystouretherography (MCU), while in 82 VUR could not be detected by MCU. VUR was graded in accordance with MCU recommended by the international study of VUR. In 13 of the children the grade of VUR was grade I, in 30 was grade II, in 23 grade III, in 17 grade IV, while the grade V was in 5 of the children. Findings of Tc99m DMSA renal scintigraphy were classified as: 1 - normal, 2 - probably normal, 3 - equivocal, 4 - probably abnormal, and 5 - abnormal. The degree of the significance of the difference of the findings was estimated using ?2, taking p < 0.01 as the limit of statistical significance. Results. Of the total number of 170 studied children, the abnormal findings were detected in 30% (51/170), normal findings in 62% (106/170), and equivocal in 8% (13/170). In the children with UTI and VUR, the incidence of abnormal findings was 49% (43/88), of normal 43% (38/88), and of equivocal findings 8% (7/88). All the children with VUR grade V had the abnormal findings (the incidence of the abnormal findings was 100%). In the children with VUR grade IV, the abnormal findings were 71%. In the children with VUR grade I, 77% of the findings were normal, in the children with VUR grade II, 53% of the findings were normal and in the children with VUR grade III, 30% of the findings of renal scintigraphy were normal. In the children with UTI without VUR, the incidence of abnormal findings was 10% (8/82), of normal findings 83% (68/82), and of equivocal findings 7% (6/82). The incidence of abnormal findings was significantly higher in the children with UTI and VUR than in those with UTI without VUR (p < 0.01). Also, the incidence of the abnormal findings was higher in the children with VUR grades IV and V than in the children with VUR grade I (p < 0.01). Conclusion. DMSA renal scintigraphy in the children with ITU revealed the abnormal findings in 30% of the cases. The incidence of the abnormal findings was significantly higher when VUR was present, as well as if the grade of VUR was higher. Our results confirmed that Tc99m DMSA renal scintigraphy was a very important technique in the evaluation of the children with ITU.

An evaluation of the SAFIRE grading scale as a predictor of long-term outcomes for patients in the Barrow Ruptured Aneurysm Trial

2021 ◽  
pp. 1-5
Author(s):  
Joshua S. Catapano ◽  
Mohamed A. Labib ◽  
Fabio A. Frisoli ◽  
Megan S. Cadigan ◽  
Jacob F. Baranoski ◽  
...  
Keyword(s):  
Univariate Analysis ◽  
Ruptured Aneurysm ◽  
Poor Outcome ◽  
Increased Risk ◽  
Grade Ii ◽  
Grading Scale ◽  
Poor Outcomes ◽  
Grade Iii

OBJECTIVEThe SAFIRE grading scale is a novel, computable scale that predicts the outcome of aneurysmal subarachnoid hemorrhage (aSAH) patients in acute follow-up. However, this scale also may have prognostic significance in long-term follow-up and help guide further management.METHODSThe records of all patients enrolled in the Barrow Ruptured Aneurysm Trial (BRAT) were retrospectively reviewed, and the patients were assigned SAFIRE grades. Outcomes at 1 year and 6 years post-aSAH were analyzed for each SAFIRE grade level, with a poor outcome defined as a modified Rankin Scale score > 2. Univariate analysis was performed for patients with a high SAFIRE grade (IV or V) for odds of poor outcome at the 1- and 6-year follow-ups.RESULTSA total of 405 patients with confirmed aSAH enrolled in the BRAT were analyzed; 357 patients had 1-year follow-up, and 333 patients had 6-year follow-up data available. Generally, as the SAFIRE grade increased, so did the proportion of patients with poor outcomes. At the 1-year follow-up, 18% (17/93) of grade I patients, 22% (20/92) of grade II patients, 32% (26/80) of grade III patients, 43% (38/88) of grade IV patients, and 75% (3/4) of grade V patients were found to have poor outcomes. At the 6-year follow-up, 29% (23/79) of grade I patients, 24% (21/89) of grade II patients, 38% (29/77) of grade III patients, 60% (50/84) of grade IV patients, and 100% (4/4) of grade V patients were found to have poor outcomes. Univariate analysis showed that a SAFIRE grade of IV or V was associated with a significantly increased risk of a poor outcome at both the 1-year (OR 2.5, 95% CI 1.5–4.2; p < 0.001) and 6-year (OR 3.7, 95% CI 2.2–6.2; p < 0.001) follow-ups.CONCLUSIONSHigh SAFIRE grades are associated with an increased risk of a poor recovery at late follow-up.

scholarly journals Chondrosarcoma of bone in children and adolescents

2020 ◽  
Vol 14 (4) ◽  
pp. 330-334
Author(s):  
Yoichi Kaneuchi ◽  
Tomohiro Fujiwara ◽  
Yusuke Tsuda ◽  
Shinichirou Yoshida ◽  
Jonathan D. Stevenson ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Young Patients ◽  
Good Prognosis ◽  
Level Of Evidence ◽  
Biological Behaviour ◽  
Children And Adolescent ◽  
Grade Ii ◽  
Surgical Treatments ◽  
Ray Amputation

Purpose Chondrosarcomas typically present in adults during the fifth to seventh decades and are rare in young patients. The biological behaviour and oncological outcomes may be different in children and adolescents. Methods We retrospectively evaluated the outcomes of all patients with chondrosarcoma of bone who were younger than 18 years of age at the time of diagnosis and were treated at our centre between 1995 and 2018. Results The 15 consecutive patients studied included nine male and six female cases, with a mean age at diagnosis of 13 years (7 to 17). The median follow-up was 117 months (30 to 277). The tumours were primary and secondary in ten and five patients, respectively. The tumours were central in 13 and surface in two patients. The tumour locations were the humerus in five, digits in five, femur in three, radius in one and pelvis in one patient. The histological grades were grade I in seven, grade II in seven and grade III in one patient. The surgical treatments were limb salvage in ten patients and ray amputation in five patients. The surgical margins were wide in eight, marginal in two and intralesional in five patients. All the patients were alive and continuously free of disease at the time of the last follow-up. No patient developed metastases or local recurrence. Conclusion Chondrosarcoma of bone in children and adolescent patients has a very good prognosis and is less aggressive compared with published outcomes in older patients. Level of evidence IV

Histopathological grading affects survival in patients with IDH-mutant grade II and grade III diffuse gliomas

2020 ◽  
Vol 137 ◽  
pp. 10-17
Author(s):  
Enrico Franceschi ◽  
Alicia Tosoni ◽  
Stefania Bartolini ◽  
Santino Minichillo ◽  
Antonella Mura ◽  
...  
Keyword(s):  
Diffuse Gliomas ◽  
Grade Ii ◽  
Histopathological Grading ◽  
Grade Iii

Stereotactic radiation treatment for recurrent nonbenign meningiomas

2007 ◽  
Vol 106 (5) ◽  
pp. 846-854 ◽  
Author(s):  
Carlos A. Mattozo ◽  
Antonio A. F. De Salles ◽  
Ivan A. Klement ◽  
Alessandra Gorgulho ◽  
David McArthur ◽  
...  
Keyword(s):  
Radiation Treatment ◽  
Progression Free Survival ◽  
Malignant Progression ◽  
World Health ◽  
Who Grade ◽  
Stereotactic Radiation ◽  
Grade Ii ◽  
Health Organization ◽  
Grade Iii

Object The authors analyzed the results of stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) for the treatment of recurrent meningiomas that were described at initial resection as showing aggressive, atypical, or malignant features (nonbenign). Methods Twenty-five patients who underwent SRS and/or SRT for nonbenign meningiomas between December 1992 and August 2004 were included. Thirteen of these patients underwent treatment for multiple primary or recurrent lesions. In all, 52 tumors were treated. All histological sections were reviewed and reclassified according to World Health Organization (WHO) 2000 guidelines as benign (Grade I), atypical (Grade II), or anaplastic (Grade III) meningiomas. The median follow-up period was 42 months. Seventeen (68%) of the cases were reclassified as follows: WHO Grade I (five cases), Grade II (11 cases), and Grade III (one case). Malignant progression occurred in eight cases (32%) during the follow-up period; these cases were considered as a separate group. The 3-year progression-free survival (PFS) rates for the Grades I, II, and III, and malignant progression groups were 100, 83, 0, and 11%, respectively (p < 0.001). In the Grade II group, the 3-year PFS rates for patients treated with SRS and SRT were 100 and 33%, respectively (p = 0.1). After initial treatment, 22 new tumors required treatment using SRS or SRT; 17 (77%) of them occurred inside the original resection cavity. Symptomatic edema developed in one patient (4%). Conclusions Stereotactic radiation treatment provided effective local control of “aggressive” Grade I and Grade II meningiomas, whereas Grade III lesions were associated with poor outcome. The outcome of cases in the malignant progression group was intermediate between that of the Grade II and Grade III groups, with the lesions showing a tendency toward malignancy.

Treatment of clubfoot with the modified Copenhagen method: A 10-year follow-up

2017 ◽  
Vol 42 (3) ◽  
pp. 328-335
Author(s):  
Elia Utrilla-Rodríguez ◽  
Pedro V Munuera-Martínez ◽  
Manuel Albornoz-Cabello
Keyword(s):  
Cluster Analysis ◽  
Retrospective Study ◽  
Health Professionals ◽  
Nonoperative Treatment ◽  
First Metatarsal ◽  
Metatarsal Angle ◽  
The World ◽  
Grade Ii ◽  
Grade Iii

Background: Clubfoot is one of the most frequent congenital malformations in the world. Non-operative methods follows limiting surgery to a minimum. The modified Copenhagen method has not been studied enough. Study Design: longitudinal retrospective study. Objectives: To evaluate prognostic factors for clinical rehabilitation with the modified Copenhagen method in a 10-year follow-up period. Methods: A retrospective study was carried out on a 10-year follow-up of 82 children diagnosed with clubfoot at birth and treated with the modified Copenhagen method. Their sex, side, severity, bilaterality, forefoot orientation, and age when the nonoperative treatment was started were registered, and a cluster analysis was performed to determine which variables were most significant for predicting whether surgical treatment was needed. Results: Of the clubfeet, 13.4% were grade I, 65.9% were grade II, and 20.7% were grade III according to the Harrold and Walker classification. In total, 58 patients needed surgery at some point during the follow-up period. The severity and talo-first metatarsal angle made it possible to determine whether the patients required surgery in 68% (56/82) of the cases. Conclusion: The results of the study suggest the possibility of providing physicians with an algorithm which might facilitate assessing whether the children will require surgery or not, depending on the data obtained from the cluster analysis. Clinical relevance This study provides health professionals with an algorithm that might facilitate assessing whether the children will require surgery or not.

scholarly journals Transformation of grade II to grade III rhabdoid-papillary meningioma: Is SRS the culprit?

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv19-iv19
Author(s):  
Ioannis Christodoulides ◽  
Jose Pedro Lavrador ◽  
Francesco Vergani ◽  
Ranjeev Bhangoo ◽  
Richard Gullan ◽  
...  
Keyword(s):  
Malignant Transformation ◽  
Recent Trend ◽  
Brain Invasion ◽  
Papillary Meningioma ◽  
Estimated Risk ◽  
Grade Ii ◽  
Local Disease Control ◽  
Local Brain ◽  
Grade Iii

Abstract Objectives Meningiomas demonstrate specific genetic and epigenetic mutations, whose effect on recurrence and progression is still of limited understanding. Single-fraction stereotactic radiosurgery (SRS) is an established alternative treatment to surgical resection, proven to achieve excellent local disease control with minimal side effects. However, its effects on tumorigenesis and malignant transformation are still uncertain. The published estimated risk ranges from 0.04%-2.6% at 15 years. Design Case report Subjects Female patient referred to our neurosurgical service Methods Retrospective analysis of patient’s notes, histopathology reports, clinic letters, MDT decisions and imaging studies Results This report describes a case of a grade II parafalcine meningioma, that was initially resected with a Simpson 2 clearance, and upon recurrence, was managed with a single dose of SRS. More than 7 years later, the meningioma recurred, and due to its increasing size on follow-up imaging, it was re-resected. Histopathology revealed a grade III rhabdoid-papillary lesion, with local brain invasion. Conclusions To our knowledge, this was the first report to describe malignant transformation of a grade II to a grade III meningioma following SRS therapy to date. Therefore, considering the recent trend towards SRS-treatment for meningiomas, the treating team should always consider its potential effects on tumorigenesis.

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