scholarly journals The influence of subventricular zone involvement in extent of resection and tumor growth pattern of glioblastoma

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Yahya Ahmadipour ◽  
Julie-Inga Krings ◽  
Laurèl Rauschenbach ◽  
Oliver Gembruch ◽  
Mehdi Chihi ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Surgical Resection ◽  
Subventricular Zone ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Growth Patterns ◽  
Molecular Characteristics ◽  
Surgical Morbidity ◽  
Multifocal Tumor ◽  
Extent Of Surgical Resection

AbstractObjectivesIsocitrate dehydrogenase (IDH1/2) mutations and O6-alkylguanine DNA methyltransferase (MGMT) promoter methylations are acknowledged survival predictors in patients with glioblastoma (GB). Moreover, tumor growth patterns like multifocality and subventricular zone (SVZ) involvement seem to be associated with poorer outcomes. Here, we wanted to evaluate the influence of the SVZ involvement and the multifocal tumor growth on the extent of surgical resection and its correlation with overall survival (OS) and molecular characteristics of patients with GB.MethodsAdult patients with primary GB who underwent surgery at our department between 2012 and 2014 were included. Preoperative magnetic resonance imaging findings were analyzed with regard to tumor location, presence of multifocality and SVZ involvement. The extent of surgical resection as well as clinical and molecular parameters was collected from electronic patient records. Univariate and multivariate analyses were performed.ResultsTwo hundred eight patients were retrospectively analyzed, comprising 90 (43.3%) female individuals with a mean age of 62.9 (±12.26) years and OS of 10.2 months (±8.9). Unifocal tumor location was a predictor for better OS with a mean of 11.4 (±9.4) months (vs. 8.0 [±7.4] months, p=0.008). Affection of the SVZ was also associated with lower surgical resection rates (p<0.001). SVZ involvement revealed with 7.8 (±7.0) months a significant worse OS [vs. 13.9 (±10.1) months, p<0.001]. All six IDH1/2 wildtype tumors showed an unifocal location (p=0.066). MGMT promoter methylation was not associated with multifocal tumor growth (p=0.649) or SVZ involvement (p=0.348). Multivariate analysis confirmed independent association between the SVZ involvement and OS (p=0.001).ConclusionThe involvement of the SVZ appears to have an influence on a lower resection rate of GB. This negative impact of SVZ on GB outcome might be related to lesser extent of resection, higher rates of multifocality and greater surgical morbidity but not inevitably to IDH1/2 mutation and MGMT promoter methylation status.

Incidental Low-Grade Gliomas: Single-Institution Management Based on Clinical, Surgical, and Molecular Data

Neurosurgery ◽  
2019 ◽  
Author(s):  
Tamara Ius ◽  
Daniela Cesselli ◽  
Miriam Isola ◽  
Giada Pauletto ◽  
Barbara Tomasino ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Dna Methyltransferase ◽  
Tumor Volume ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Molecular Profile ◽  
Karnofsky Performance Scale ◽  
Low Grade ◽  
Extensive Resection ◽  
Low Grade Gliomas

Abstract BACKGROUND Incidentally discovered diffuse low-grade gliomas (iLGG) are poorly documented in the literature. They are diagnosed by chance during radiological examinations. OBJECTIVE To review a cohort of patients with iLGG surgically treated in our institution, analyzing clinical, molecular, and surgical aspects. METHODS Clinical, radiological, and treatment data of iLGG were retrieved and compared with those of symptomatic diffuse LGGs (sLGG). Histological and molecular review was carried out as well. The extent of resection was evaluated on preoperative and postoperative T2-weighted magnetic resonance imaging. RESULTS Thirty-four iLGG cases were identified within a monoinstitutional cohort of 332 patients operated for low-grade gliomas from 2000 to 2017. Clinically, patients with iLGG had higher preoperative karnofsky performance scale (KPS) (P = .003), smaller tumor volume (P = .0001), lower frequency of eloquent areas involvement (P = .0001), and higher rate of complete resection (P = .0001) compared to those with sLGG. No differences in the molecular profile and O6-methylguanine-DNA-methyltransferase promoter methylation were detected between iLGG and sLGG. Importantly, patients with iLGG had longer overall survival than those with sLGG (P = .0001), even when a complete surgical resection was achieved (P = .001). CONCLUSION Although the therapeutic strategy of iLGG is still a matter of debate, our data support the safety and the effectiveness of early surgical resection. The favorable prognosis of iLGG may be due to the higher practicability of extensive resection, noneloquent tumor location, and smaller tumor volume.

Greater Extent of Resection Improves Ganglioglioma Recurrence-Free Survival in Children

Neurosurgery ◽  
2014 ◽  
Vol 75 (1) ◽  
pp. 37-42 ◽  
Author(s):  
Devon H. Haydon ◽  
Sonika Dahiya ◽  
Matthew D. Smyth ◽  
David D. Limbrick ◽  
Jeffrey R. Leonard
Keyword(s):  
Survival Rate ◽  
High Risk ◽  
Surgical Resection ◽  
Clinical Features ◽  
Extent Of Resection ◽  
Clinical Variable ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Clinical Records ◽  
Extent Of Surgical Resection

Abstract BACKGROUND: Gangliogliomas are rare, low-grade, glial-neural tumors that are most often found in children. They can recur with varying frequency; yet few data are available that adequately predict such events. OBJECTIVE: To review our institution's large series of gangliogliomas in children and identify clinical features that predict recurrence-free survival. METHODS: Clinical records were retrospectively reviewed from 1990 to 2011. Fifty-three children were identified, and pertinent clinical features were analyzed against survival data to categorize lesions at high risk of recurrence. RESULTS: Fifteen children (28%) experienced a recurrence during the study period with a median time to recurrence of 8.8 months and a mean follow-up of 4.2 years. The 5-year recurrence-free survival rate was 70.5%, whereas the overall survival rate was 98.1%. Older age at diagnosis (P = .02), seizure history (P &lt; .001), supratentorial tumor location (P &lt; .001), and greater extent of surgical resection (P &lt; .001) were all associated with improved recurrence-free survival on univariate analysis. Extent of surgical resection was the only clinical variable that retained its significance in multivariate models (P = .01). Patients who received 94% or greater volumetric extent of resection had prolonged recurrence-free survival compared with those individuals who received a less than 94% resection (P = .02). CONCLUSION: Attention to specific clinical variables, most notably the extent of surgical resection, can further stratify grade I gangliogliomas into low- and high-risk groups among children. Although 100% resection should remain an operative goal for surgically accessible gangliogliomas, a thorough yet subtotal resection may improve recurrence-free survival.

Modern Surgical Considerations for Gastric Cancer

2008 ◽  
Vol 6 (9) ◽  
pp. 885-894 ◽  
Author(s):  
Quan P. Ly ◽  
Aaron R. Sasson
Keyword(s):  
Gastric Cancer ◽  
Surgical Resection ◽  
Gastric Adenocarcinoma ◽  
Extent Of Resection ◽  
Tumor Location ◽  
Resection Margins ◽  
Peritoneal Disease ◽  
Distal Stomach ◽  
Appropriate Treatment ◽  
Lymph Node Examination

Surgical resection remains the mainstay of treatment for localized gastric adenocarcinoma. The type and extent of resection depends on tumor location. Although the incidence of gastric cancer has been declining, a shift has occurred to more tumors involving the proximal compared with the distal stomach. Appropriate treatment depends on a thorough staging process to exclude the presence of distant metastatic disease. Current staging modalities include high-quality CT scan, endoscopic ultrasound, PET, and laparoscopy. The value of peritoneal lavage to detect occult peritoneal disease is under investigation. The principles of surgical resection have always included negative resection margins and adequate lymph node examination. Controversial topics requiring further study include laparoscopic resections and hepatic metastasectomy. This review highlights the salient points of current surgical management of gastric adenocarcinoma.

Comparison of Survival Between Cerebellar and Supratentorial Glioblastoma Patients

Neurosurgery ◽  
2013 ◽  
Vol 73 (2) ◽  
pp. 240-246 ◽  
Author(s):  
Sunil Jeswani ◽  
Miriam Nuño ◽  
Vanessa Folkerts ◽  
Debraj Mukherjee ◽  
Keith L. Black ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Survival Time ◽  
Surgical Resection ◽  
Median Survival ◽  
Median Survival Time ◽  
Extent Of Resection ◽  
Tumor Location ◽  
General Belief ◽  
Cerebellar Glioblastoma

Abstract BACKGROUND: Cerebellar glioblastoma multiforme (cGBM) is rare, and although there is a general belief that these tumors have a worse prognosis than supratentorial GBM (sGBM), few studies have been published to support this belief. OBJECTIVE: To investigate the effect of cerebellar location on survival through a case-control design comparing overall survival time of cGBM and sGBM patients. METHODS: The Surveillance, Epidemiology, and End Results (SEER) registry was used to identify 132 patients with cGBM (1973-2008). Each cGBM patient was matched with an sGBM patient from among 20 848 sGBM patients on the basis of age, extent of resection, decade of diagnosis, and radiation therapy using propensity score matching. RESULTS: Within the cGBM, 37% were older than 65 years of age, 62% were men, and 87% were white. Most patients underwent surgery and radiation (74%), whereas only 26% underwent surgical resection only. The median survival time for the cGBM and sGBM matched cohort was 8 months; however, the survival distributions differed (log-rank P = .04). Survival time for cGBM vs sGBM at 2 years was 21.5% vs 8.0%, and 12.7% vs 5.3% at 3 years. Multivariate analysis of survival among cGBM patients showed that younger age (P &lt; .0001) and having radiation therapy (P &lt; .0001) were significantly associated with reduced hazard of mortality. Among all patients, multivariate analysis showed that tumor location (P = .03), age (P &lt; .0001), tumor size (P = .009), radiation (P &lt; .0001), and resection (P &lt; .0001) were associated with survival time in the unmatched cohort. CONCLUSION: Median survival time for cGBM and sGBM patients was 8 months, but cGBM patients had a survival time advantage as the study progressed. These findings suggest that cGBM patients should be treated as aggressively as sGBM patients with surgical resection and radiation therapy.

scholarly journals Glioblastoma Proximity to the Lateral Ventricle Alters Neurogenic Cell Populations of the Subventricular Zone

2021 ◽  
Vol 11 ◽  
Author(s):  
Luisina B. Ripari ◽  
Emily S. Norton ◽  
Raquel Bodoque-Villar ◽  
Stephanie Jeanneret ◽  
Montserrat Lara-Velazquez ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Median Survival ◽  
Subventricular Zone ◽  
Immunohistochemical Analysis ◽  
Lateral Wall ◽  
Tumor Location ◽  
Rodent Model ◽  
Clinical Aspects ◽  
Cell Populations ◽  
Bidirectional Signaling

Despite current strategies combining surgery, radiation, and chemotherapy, glioblastoma (GBM) is the most common and aggressive malignant primary brain tumor in adults. Tumor location plays a key role in the prognosis of patients, with GBM tumors located in close proximity to the lateral ventricles (LVs) resulting in worse survival expectancy and higher incidence of distal recurrence. Though the reason for worse prognosis in these patients remains unknown, it may be due to proximity to the subventricular zone (SVZ) neurogenic niche contained within the lateral wall of the LVs. We present a novel rodent model to analyze the bidirectional signaling between GBM tumors and cells contained within the SVZ. Patient-derived GBM cells expressing GFP and luciferase were engrafted at locations proximal, intermediate, and distal to the LVs in immunosuppressed mice. Mice were either sacrificed after 4 weeks for immunohistochemical analysis of the tumor and SVZ or maintained for survival analysis. Analysis of the GFP+ tumor bulk revealed that GBM tumors proximal to the LV show increased levels of proliferation and tumor growth than LV-distal counterparts and is accompanied by decreased median survival. Conversely, numbers of innate proliferative cells, neural stem cells (NSCs), migratory cells and progenitors contained within the SVZ are decreased as a result of GBM proximity to the LV. These results indicate that our rodent model is able to accurately recapitulate several of the clinical aspects of LV-associated GBM, including increased tumor growth and decreased median survival. Additionally, we have found the neurogenic and cell division process of the SVZ in these adult mice is negatively influenced according to the presence and proximity of the tumor mass. This model will be invaluable for further investigation into the bidirectional signaling between GBM and the neurogenic cell populations of the SVZ.

scholarly journals Different prognostic effect of surgery, radiation and chemotherapy in pediatric medulloblastoma less and over three years old: A Surveillance, Epidemiology, and End Results (SEER) analysis

2021 ◽  
Author(s):  
Zhong Deng ◽  
Yichang Wang ◽  
Xixi Li ◽  
Hongxing Tang ◽  
Jia Yang ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Surgical Resection ◽  
Extent Of Resection ◽  
Gross Total Resection ◽  
Total Resection ◽  
Old Patients ◽  
Pediatric Medulloblastoma ◽  
The Impact ◽  
Extent Of Surgical Resection ◽  
End Results

Abstract Introduction To clarify the prognostic value of extent of surgical resection, radiation and chemotherapy in pediatric medulloblastoma patients < 3 years old and ≥ 3 years old. Methods We used the Surveillance, Epidemiology, and End Results program to identify 1,495 pediatric patients diagnosed between 1973 and 2016 with medulloblastoma. Patients with incomplete or unknown clinical information were excluded. Basic characteristics between patients < 3 years old and ≥ 3 years old were compared. Then, we used Cox regression to investigate the impact of extent of surgical resection, radiation and chemotherapy on patient outcome. Results Gross total resection only significantly improved patient outcome in those ≥ 3 years old, and radiation independently correlated to better OS and PFS in patients ≥ 3 years old (all p < 0.05). However, chemotherapy only benefited patient outcome in those < 3 years old (all p < 0.05). Furthermore, in those ≥ 3 years old patients underwent surgical procedures, radiation alone confer survival benefit only in those received gross total resection (p < 0.05) but not in partial resection or biopsy (p > 0.05). Notably, adjuvant radiation plus chemotherapy largely improved patient survival independent of extent of resection (p < 0.05). Conclusions The extent of resection should be differentially considered and applied between pediatric medulloblastoma patients < 3 years old and ≥ 3 years old, so are the adjuvant radio- and chemo- therapies.

scholarly journals NIMG-54. DIFFUSE TUMOR GROWTH PATTERN IS ASSOCIATED WITH WORSE OUTCOME ONLY IN IDH WILDTYPE BUT NOT IN IDH MUTANT GLIOMAS WHO II AND III

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii160-ii160
Author(s):  
Jonathan Weller ◽  
Sophie Katzendobler ◽  
Dorothee Gramatzki ◽  
Hans-Georg Wirsching ◽  
Athina Pangalu ◽  
...  
Keyword(s):  
Tumor Growth ◽  
Contrast Enhancement ◽  
Growth Pattern ◽  
Growth Patterns ◽  
Molecular Characteristics ◽  
Entire Group ◽  
Idh Mutation ◽  
Mutation Status ◽  
Delayed Treatment ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND Magnetic resonance imaging (MRI) based characterization has previously shown heterogeneity in tumor appearance according to IDH mutation status. We have recently investigated the relevance of contrast enhancement to be dependent on IDH mutation status in glioma WHO II and III. Here, we aimed at further characterizing tumor growth patterns and their prognostic value in these tumors. METHODS MRI and clinical data of patients with newly diagnosed glioma WHO II and III from two different centers were retrospectively reviewed. Radiological data such as localization, presence of contrast enhancement, T2-volume as well as tumor growth pattern (“diffuse” vs. “circumscript”) were obtained. Progression-free (PFS) and overall survival (OS) were determined and correlated with clinical, radiological and molecular characteristics using univariate and multivariate regression analyses. RESULTS 390 patients were included, 69% thereof having an IDH mutation. The median T2-volume was 46.0 ml, IDH mutant tumors being larger (50.7 ml) than IDH wildtype tumors (36.0 ml), p = 0.01. A total of 172 tumors were classified as “circumscript” and 218 as “diffuse”; the majority of IDH wildtype tumors (71%) were well delineated compared to 51% in the IDH mutant group (p&lt; 0.0001). Apart from clinical parameters such as younger age, lower KPS, complete resection and delayed treatment, “circumscript” tumor growth pattern was associated with improved survival in the entire group (p = 0.016). When analyzed according to IDH mutation status, “circumscript” tumor growth pattern was significantly associated with OS and PFS (p = 0.006 and p = 0.002) in the IDH wildtype, but not in the IDH mutant group (p = 0.34 and p = 0.81). CONCLUSION IDH wildtype tumors present more often with a ”circumscript” growth pattern on initial T2 MRI. However, this “circumscript” growth pattern was associated with improved survival only in the IDH wiltdtype but not in the IDH mutant group.

scholarly journals SURG-25. EFFECT OF VENTRICULAR ENTRY DURING GLIOBLASTOMA RESECTION ON PATIENT OUTCOMES

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii209-ii209
Author(s):  
Jacob Young ◽  
Andrew Gogos ◽  
Matheus Pereira ◽  
Ramin Morshed ◽  
Jing Li ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Tumor Location ◽  
Senior Author ◽  
Recurrent Glioblastoma ◽  
Leptomeningeal Disease ◽  
Newly Diagnosed ◽  
Ventriculoperitoneal Shunting ◽  
Two Factors ◽  
Postoperative Hydrocephalus

Abstract BACKGROUND Tumor proximity to the ventricle and ventricular entry (VE) during surgery have both been associated with poorer prognoses; however, the interaction between these two factors is poorly understood. METHODS The UCSF tumor registry was searched for patients with newly diagnosed and recurrent supratentorial glioblastoma who underwent surgical resection with the senior author between 2013 – 2018. Tumor location with respect to the subventricular zone (SVZ), size, VE, and extent of resection were assessed using pre and postoperative imaging. RESULTS In the 200-patient cohort of newly diagnosed and recurrent glioblastoma, 26.5% had VE. Comparing patients with VE to those without VE, there was no difference in postoperative hydrocephalus (1.9% vs. 4.8%, p = 0.36), ventriculoperitoneal shunting (0% vs. 3.4%, p = 0.17), pseudomeningoceles (7.5% vs. 5.4%, p = 0.58), or subdural hematomas (11.3% vs. 3.4%, p = 0.07). Importantly, rates of leptomeningeal disease (7.5% in VE vs. 10.2% w/o VE, p = 0.57) and distant parenchymal recurrence (17.9% in VE vs. 23.1% w/o VE, p = 0.35) were not different between the groups. There was no effect of VE on EOR when controlling for SVZ type. Newly diagnosed patients with tumors contacting the SVZ (Type 1 or 2) had worse survival than patients with tumors that did not contact the SVZ (Type 3 or 4) (1.27 vs 1.84 years, p = 0.014, HR 1.8, CI 1.08 – 3.03), but VE was not associated with worse survival in these patients with high risk SVZ Type 1 and 2 tumors (1.15 vs 1.68 years, p = 0.151, HR 0.59, CI 0.26 – 1.34). DISCUSSION VE was well tolerated with complications being rare events. There was no increase in leptomeningeal spread or distant parenchymal recurrence in patients with VE. Finally, VE did not change survival for patients with tumors contacting the ventricle.

scholarly journals Morbidity and extent of surgical resection of carcinoid tumors after endobronchial treatment

2021 ◽  
Author(s):  
E.M.B.P. Reuling ◽  
D.D. Naves ◽  
K.J. Hartemink ◽  
E.H.F.M. van der Heijden ◽  
P.W. Plaisier ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Carcinoid Tumors ◽  
Extent Of Surgical Resection
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