scholarly journals Could upfront temozolomide chemotherapy postpone the intervene of radiotherapy in young patients with high-risk low-grade gliomas?

2019 ◽  
Author(s):  
Zeyang Li ◽  
Shiwen Yuan ◽  
Hong Chen ◽  
Dongxiao Zhuang ◽  
Junfeng Lu ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Early Stage ◽  
Cognitive Impairments ◽  
Objective Response ◽  
Young Patients ◽  
Function Evaluation ◽  
Low Grade ◽  
Idh Mutation ◽  
Low Grade Gliomas ◽  
Temozolomide Chemotherapy

Abstract BackgroundLow-grade gliomas that involves eloquent areas are difficult to be removed totally. Standard strategies for these young patients are radiotherapy and chemotherapy after maximum safe resection. Radiotherapy always brings cognitive impairments. We wonder whether temozolomide chemotherapy can postpone the intervene of radiotherapy to protect cognitive function.MethodsPatients underwent temozolomide chemotherapy (75mg/m2/day for 21 days per 28-day for 6 cycles) and were followed up by MRI and cognitive function evaluation. Primary endpoints are objective response rate (ORR), and secondary endpoints are intensity of response (IOR), duration of response (DOR), cognitive function results and the safety of chemotherapy.Results65 patients were recruited with a median follow-up of 39.6 months, and ORR was 37/65(56.92%). IDH mutant patients had better ORR than IDH wildtype patients (64.29% vs 11.11%, p=0.004), and IOR of IDH mutant tumors was more obvious (p=0.023). IDH-mutant group had longer DOR than IDH-wildtype group (median DOR, 52.4 vs 25.8 months; log-rank p=0.0007; HR, 4.269; 95%CI, 3.411 - 47.35), and 1p/19q codeletion group had a longer DOR than 1p/19q retain group (median DOR, 52.4 vs 37.5 months; log-rank p=0.049; HR, 2.369; 95%CI, 1.012 - 5.397). Cognitive function results showed improvement in cognitive function at early stage compared with radiotherapy.ConclusionIDH mutation was a predictive factor for better temozolomide response. Cognitive function evaluation proved that temozolomide chemotherapy could avoid cognitive impairments at early stage. We propose that young patients with IDH mutation can use upfront chemotherapy to postpone radiotherapy until progression to avoid potential cognitive impairments.

scholarly journals Could upfront temozolomide chemotherapy postpone the need for radiotherapy in young patients with high-risk low-grade gliomas?

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Ze-Yang Li ◽  
Shi-Wen Yuan ◽  
Yan-Yan Song ◽  
N.U. Farrukh Hameed ◽  
Hong Chen ◽  
...  
Keyword(s):  
High Risk ◽  
Young Patients ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Temozolomide Chemotherapy

scholarly journals Domain Mapping and Deep Learning from Multiple MRI Clinical Datasets for Prediction of Molecular Subtypes in Low Grade Gliomas

2020 ◽  
Vol 10 (7) ◽  
pp. 463 ◽  
Author(s):  
Muhaddisa Barat Ali ◽  
Irene Yu-Hua Gu ◽  
Mitchel S. Berger ◽  
Johan Pallud ◽  
Derek Southwell ◽  
...  
Keyword(s):  
Molecular Subtypes ◽  
Negative Impact ◽  
Molecular Classification ◽  
Tumor Segmentation ◽  
Test Accuracy ◽  
Low Grade ◽  
Idh Mutation ◽  
Molecular Type ◽  
Low Grade Gliomas ◽  
Domain Mapping

Brain tumors, such as low grade gliomas (LGG), are molecularly classified which require the surgical collection of tissue samples. The pre-surgical or non-operative identification of LGG molecular type could improve patient counseling and treatment decisions. However, radiographic approaches to LGG molecular classification are currently lacking, as clinicians are unable to reliably predict LGG molecular type using magnetic resonance imaging (MRI) studies. Machine learning approaches may improve the prediction of LGG molecular classification through MRI, however, the development of these techniques requires large annotated data sets. Merging clinical data from different hospitals to increase case numbers is needed, but the use of different scanners and settings can affect the results and simply combining them into a large dataset often have a significant negative impact on performance. This calls for efficient domain adaption methods. Despite some previous studies on domain adaptations, mapping MR images from different datasets to a common domain without affecting subtitle molecular-biomarker information has not been reported yet. In this paper, we propose an effective domain adaptation method based on Cycle Generative Adversarial Network (CycleGAN). The dataset is further enlarged by augmenting more MRIs using another GAN approach. Further, to tackle the issue of brain tumor segmentation that requires time and anatomical expertise to put exact boundary around the tumor, we have used a tight bounding box as a strategy. Finally, an efficient deep feature learning method, multi-stream convolutional autoencoder (CAE) and feature fusion, is proposed for the prediction of molecular subtypes (1p/19q-codeletion and IDH mutation). The experiments were conducted on a total of 161 patients consisting of FLAIR and T1 weighted with contrast enhanced (T1ce) MRIs from two different institutions in the USA and France. The proposed scheme is shown to achieve the test accuracy of 74 . 81 % on 1p/19q codeletion and 81 . 19 % on IDH mutation, with marked improvement over the results obtained without domain mapping. This approach is also shown to have comparable performance to several state-of-the-art methods.

scholarly journals Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

1997 ◽  
Vol 2 (3) ◽  
pp. E1
Author(s):  
Roger J. Packer ◽  
Joanne Ater ◽  
Jeffrey Allen ◽  
Peter Phillips ◽  
Russell Geyer ◽  
...  
Keyword(s):  
Objective Response ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
Low Grade ◽  
Significant Prognostic Factor ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Low Grade Gliomas ◽  
Response To Chemotherapy

The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months-16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 ± 6% at 2 years and 68 ± 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 ± 11% vs. 75 ± 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 ± 7% compared with a rate of 39 ± 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.

scholarly journals P10.21 2-hydroxyglutarate as a biomarker for IDH mutation in low grade gliomas

2017 ◽  
Vol 19 (suppl_3) ◽  
pp. iii89-iii90
Author(s):  
R. Nejad ◽  
H. Sim ◽  
K. Aldape ◽  
W. Mason ◽  
M. Bernstein ◽  
...  
Keyword(s):  
Low Grade ◽  
Idh Mutation ◽  
Low Grade Gliomas

Temozolomide Low-dose Chemotherapy in Newly Diagnosed Low-grade Gliomas: Activity, Safety, and Long-term Follow-up

2016 ◽  
Vol 103 (3) ◽  
pp. 255-260 ◽  
Author(s):  
Veronica Villani ◽  
Roberta Merola ◽  
Antonello Vidiri ◽  
Alessandra Fabi ◽  
Mariantonia Carosi ◽  
...  
Keyword(s):  
Clinical Benefit ◽  
Low Dose ◽  
Karnofsky Performance Status ◽  
Objective Response ◽  
High Rate ◽  
Low Grade ◽  
Newly Diagnosed ◽  
Minor Response ◽  
Low Grade Gliomas

Purpose To explore the efficacy and toxicity of an extended schedule of temozolomide (50 mg/mq 1 week on/1 week off) in a population of newly diagnosed low-grade gliomas (LGG). Methods Primary endpoints were progression-free survival (PFS) at 12 and 24 months and response rate evaluated with Response Assessment in Neuro-Oncology Criteria. Secondary endpoints were clinical benefit (reduction of seizures frequency), reduction of steroid, and modifications of Karnofsky Performance Status. Results From 2006 to 2009, we enrolled 14 consecutive patients with newly diagnosed LGG: 8 grade II astrocytomas, 2 oligodendroglioma, and 4 oligo-astrocytoma. Temozolomide was administered for 18 cycles (mean) per patient (range 3-24 cycles). In 57.5% (n = 8), we observed stable disease, 28.5% (n = 4) presented a minor response, and 14% (n = 2) showed progression. Five patients presented early progression during the first year of treatment and the study was stopped. A relevant clinical benefit was observed in 85% of patients (seizure control). After 6 years of follow-up, only 4 patients died. Prolonged PFS was associated with 1p-19q codeletion over 1p-19q intact (35 vs 4 months; p<0.04) and IDH1 mutation over IDH1 wild-type (36 vs 6 months; p<0.009). Conclusions The study was interrupted for the high rate of progression observed in the first 14 patients enrolled. However, our results show that an extended low dose of temozolomide presents interesting activity with objective response and clinical benefit, but does not seem to prevent progression in patients presenting unfavorable molecular prognostic factors.

IDH mutation and 1p19q codeletion distinguish two radiological patterns of diffuse low-grade gliomas

2017 ◽  
Vol 133 (1) ◽  
pp. 37-45 ◽  
Author(s):  
Amélie Darlix ◽  
Jérémy Deverdun ◽  
Nicolas Menjot de Champfleur ◽  
Florence Castan ◽  
Sonia Zouaoui ◽  
...  
Keyword(s):  
Low Grade ◽  
Idh Mutation ◽  
Low Grade Gliomas ◽  
1P19q Codeletion ◽  
Radiological Patterns

scholarly journals Pharmacoresistant seizures and IDH mutation in low grade gliomas

2021 ◽  
Author(s):  
Carlos Eduardo Correia ◽  
Yoshie Umemura ◽  
Jessica R Flynn ◽  
Anne S Reiner ◽  
Edward K Avila
Keyword(s):  
Tumor Resection ◽  
Incidence Rates ◽  
P Value ◽  
Low Grade ◽  
Idh Mutation ◽  
Wild Type ◽  
Mutation Status ◽  
Low Grade Gliomas ◽  
Idh1 R132h ◽  
Idh Mutations

Abstract Purpose Many low-grade gliomas (LGG) harbor isocitrate dehydrogenase (IDH) mutations. Although IDH mutation is known to be epileptogenic, the rate of refractory seizures in LGG with IDH mutation vs wild-type had not been previously compared. We therefore compared seizure pharmacoresistance in IDH-mutated and wild-type LGGs. Methods Single-institution retrospective study of patients with histologic proven LGG, known IDH mutation status, seizures, and ≥ 2 neurology clinic encounters. Seizure history was followed until histological high-grade transformation or death. Seizures requiring ≥ 2 changes in anti-epileptic drugs were considered pharmacoresistant. Incidence rates of pharmacoresistant seizures were estimated using competing risks methodology. Results Of 135 patients, 25 patients (19%) had LGGs classified as IDH wild-type. Of those with IDH mutation, 104 (94.5%) were IDH1 R132H; only six were IDH2 R172K. 120 patients (89%) had tumor resection and 14 (10%) had biopsy. Initial post-surgical management included observation (64%), concurrent chemoradiation (23%), chemotherapy alone (9%), and radiotherapy alone (4%). Seizures became pharmacoresistant in 24 IDH-mutated patients (22%) and in 3 IDH wild-type patients (12%). The 4-year cumulative incidence of intractable seizures was 17.6% (95% CI: 10.6%-25.9%) in IDH-mutated and 11% (95% CI: 1.3%-32.6%) in IDH wild-type LGG (Gray’s P-value= 0.26). Conclusions 22% of the IDH-mutated patients developed pharmacoresistant seizures, compared to 12% of the IDH wild-type tumors.The likelihood of developing pharmacoresistant seizures in patients with LGG-related epilepsy is independent to IDH mutation status, however, IDH-mutated tumors were approximately twice as likely to experience LGG-related pharmacoresistant seizures.

Cerebellar Tumor Extension as a Late Event of Long-standing, Supratentorial Low-grade Gliomas: Case Report

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. E1210-E1210 ◽  
Author(s):  
Jonathan Roth ◽  
Dvora Nass ◽  
Zvi Ram
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Young Patients ◽  
Tumor Formation ◽  
Low Grade ◽  
Cerebellar Tumor ◽  
Resonance Imaging ◽  
Secondary Tumor ◽  
Low Grade Gliomas ◽  
Multicentric Tumor

Abstract OBJECTIVE AND IMPORTANCE: Nonpilocytic low-grade glial tumors in adults occur mostly in the supratentorial compartment. However, a few cases of infratentorial low-grade gliomas (LGG) have been described. The occurrence of LGG in the cerebellum in the setting of a previously existing supratentorial glioma is rare. CLINICAL PRESENTATION: We present three young patients with a histologically confirmed diagnosis of long-standing supratentorial LGG. All three patients presented years after their initial diagnosis with a second, nonenhancing lesion in the cerebellum, compatible with the radiological appearance of LGG. Two patients subsequently became symptomatic from these lesions and underwent surgical resection of the cerebellar lesions that were found to have similar pathological features to the original supratentorial tumors. This was confirmed by histology (both patients) and genetic markers (one patient). INTERVENTION: Magnetic resonance imaging did not demonstrate tumor continuity between the supratentorial and infratentorial lesions in any of the patients. The third patient has shown no cerebellar symptoms to date and is only followed with periodic magnetic resonance imaging. CONCLUSION: The anatomic/pathological basis of these rare cases may include a primary, multicentric tumor formation, or a secondary tumor infiltration of the cerebrocerebellar pathways, leading to the formation of the cerebellar tumor.

Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas

1997 ◽  
Vol 86 (5) ◽  
pp. 747-754 ◽  
Author(s):  
Roger J. Packer ◽  
Joanne Ater ◽  
Jeffrey Allen ◽  
Peter Phillips ◽  
Russell Geyer ◽  
...  
Keyword(s):  
Objective Response ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Response To Treatment ◽  
Low Grade ◽  
Significant Prognostic Factor ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Low Grade Gliomas ◽  
Response To Chemotherapy

✓ The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months—16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 ± 6% at 2 years and 68 ± 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 ± 11% vs. 75 ± 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 ± 7% compared with a rate of 39 ± 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.

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