Safety and Efficacy of Neuronavigation via Middle Frontal Gyrus Endoport-assisted Endoscopic Resection for Thalamic Lesions

Abstract BackgroundSurgery for thalamic lesions is generally challenging because they are deep-seated and surrounded by vital neurovascular structures. Whether neuronavigation via middle frontal gyrus endoport-assisted endoscopic resection for thalamic lesions is safe and effective remains to be further evaluated.Materials and MethodsTwelve patients treated surgically were retrospectively reviewed using the neuronavigation endoport-assisted endoscopy between January 2016 and April 2021 at Zhongshan Hospital of Fudan University. Preoperative and tumor-related variables, as well as postoperative outcomes, were also collected.ResultsAll lesions located in the medial part of the thalamus, and some of them expanded forward, downward, or backward. The median size of lesions was 29 mm (range 16-56 mm). The final pathology results showed 4 cases of benign lesions, 4 cases of low-grade glioma, and 4 cases of glioblastoma. All of the cases with benign lesions and low-grade glioma (100%) achieved GTR, while 3/4 (75%) of cases with glioblastoma achieved NTR, and 1 (25%) case obtained STR. None of the patients in this study have postoperative seizures. In the benign lesions and low-grade glioma group, worse Karnofsky performance status scores at discharge were 25%, and all achieved long-term postoperative survival. For patients with glioblastoma, 3/4 cases had worse Karnofsky performance status scores at discharge, and died within 6 months. ConclusionCombining the advantages of neuronavigation, endoscopy, and endoport techniques via the middle frontal gyrus approach can safely and effectively remove benign lesions and low-grade glioma in the medial part of the thalamus.

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Endoscopic Resection Without Subsequent Ablation Therapy for Early Barrett’s Neoplasia: Endoscopic Findings and Long-Term Mortality

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-020-04836-8 ◽

2020 ◽

Author(s):

S. N. van Munster ◽

◽

E. A. Nieuwenhuis ◽

B. L. A. M. Weusten ◽

L. Alvarez Herrero ◽

...

Keyword(s):

Life Expectancy ◽

Endoscopic Resection ◽

Performance Status ◽

Eradication Therapy ◽

Low Grade ◽

Limited Life Expectancy ◽

Ablation Therapy ◽

Neoplastic Lesion ◽

Limited Life

Abstract Introduction After endoscopic resection (ER) of neoplasia in Barrett’s esophagus (BE), it is recommended to ablate the remaining BE to minimize the risk for metachronous disease. However, we report long-term outcomes for a nationwide cohort of all patients who did not undergo ablation of the remaining BE after ER for early BE neoplasia, due to clinical reasons or performance status. Methods Endoscopic therapy for BE neoplasia in the Netherlands is centralized in 8 expert centers with specifically trained endoscopists and pathologists. Uniformity is ensured by a joint protocol and regular group meetings. We report all patients who underwent ER for a neoplastic lesion between 2008 and 2018, without further ablation therapy. Outcomes include progression during endoscopic FU and all-cause mortality. Results Ninety-four patients were included with mean age 74 (± 10) years. ER was performed for low-grade dysplasia (LGD) (10%), high-grade dysplasia (HGD) (25%), or low-risk esophageal adenocarcinoma (EAC) (65%). No additional ablation was performed for several reasons; in 73 patients (78%), the main argument was expected limited life expectancy. Median C2M5 BE persisted after ER, and during median 21 months (IQR 11–51) with 4 endoscopies per patient, no patient progressed to advanced cancer. Seventeen patients (18%) developed HGD/EAC: all were curatively treated endoscopically. In total, 29/73 patients (40%) with expected limited life expectancy died due to unrelated causes during FU, none of EAC. Conclusion In selected patients, ER monotherapy with endoscopic surveillance of the residual BE is a valid alternative to eradication therapy with ablation.

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LGG-06. LONG-TERM OUTCOME OF NEWLY DIAGNOSED LOW GRADE GLIOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa222.391 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii367-iii367

Author(s):

Nongnuch Sirachainan ◽

Attaporn Boongerd ◽

Samart Pakakasama ◽

Usanarat Anurathapan ◽

Ake Hansasuta ◽

...

Keyword(s):

Surgical Management ◽

Progression Free Survival ◽

Low Grade Glioma ◽

Low Grade ◽

Newly Diagnosed ◽

Term Outcome ◽

Long Term Outcome ◽

Common Location ◽

Suprasellar Region

Abstract INTRODUCTION Low grade glioma (LGG) is the most common central nervous system (CNS) tumor in children accounted for 30–50%. Regarding benign characteristic of disease, surgical management remains the mainstay of treatment. However, surgical approach is limited in some conditions such as location at brainstem or infiltrative tumor. Chemotherapy and radiation treatments have been included in order to control tumor progression. The 5-years survival rate is approach 90% especially in patients who receive complete resection. However, the outcome of children with LGG in low to middle income is limited. Therefore, the aim of the study was to determine long-term outcome of children with newly diagnosed LGG. METHODS A retrospective study enrolled children aged <18 years who were newly diagnosed LGG during January 2006- December 2019. Diagnosis of LGG was confirmed by histological findings of grade I and II according to WHO criteria. RESULTS A total of 40 patients, female to male ratio was 1:1.35 and mean (SD) for age was 6.7 (4.0) years. The most common location was optic chiasmatic pathway (42.5%), followed by suprasellar region (25.0%). Sixty percent of patients received at least partial tumor removal. Chemotherapy and radiation had been used in 70% and 10.0% respectively. The 10-year progression free survival was 74.1±11.4% and overall survival was 96.2±3.8%. SUMMARY: Treatment of Pediatric LGG mainly required surgical management, however, chemotherapy and radiation had been used in progressive disease. The outcome was excellent.

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Clinicopathologic Features and Early Surgical Outcome of Astrocytomas in Eldoret, Kenya

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_562_17 ◽

2018 ◽

Vol 09 (03) ◽

pp. 363-369

Author(s):

Clifford C. Mwita ◽

Florentius Koech ◽

Titus Sisenda ◽

Kirtika Patel ◽

Benson Macharia ◽

...

Keyword(s):

Functional Status ◽

Tumor Size ◽

Karnofsky Performance Status ◽

Performance Status ◽

Neurological Deficits ◽

Low Grade ◽

Diffuse Astrocytoma ◽

Short Term ◽

Duration Of Illness ◽

Mri Score

ABSTRACT Background: Astrocytomas are primary central nervous system tumors arising from astrocytes and accounting for up to 37.8% of all brain tumors seen in hospital-based studies from Africa. Despite being common, their patterns and short-term outcomes remain poorly studied in Kenya. Materials and Methods: A prospective, descriptive study involving consecutive patients with a histological diagnosis of astrocytoma seen in three hospitals located in Eldoret, Kenya. Clinicopathologic characteristics and outcomes were recorded and patients followed up for 12 weeks. Results: Thirty-one patients were recruited over a 1-year period. Majority of them were female (51.6%). Headache (83.9%) and focal neurological deficits (64.5%) were the most common presenting features. Among patients with high-grade tumors, mean duration of illness was 106.03 ± 162.16 days, median functional status was Karnofsky performance status (KPS) score 50, mean tumor size was 110.22 ± 46.16 cm3, and median magnetic resonance imaging (MRI) score was 17. Among patients with low-grade astrocytomas, mean duration of illness was 213.03 ± 344.93 days, median functional status was KPS score 40, mean tumor size was 53.49 ± 54.96 cm3 and median MRI score was 9. Glioblastoma multiforme (GBM) (71%) and diffuse astrocytoma (22.6%) were the predominant histological subtypes. The median Ki-67 proliferative index was 6% for pilocytic astrocytoma, 1.6% for diffuse astrocytoma, and 60% for GBM. Systemic and regional surgical complications occurred in 6.5% and 38.7% of patients, respectively. In-hospital mortality was 19.4% and increased to 25.8% at 12 weeks. The KPS score at discharge was 50 and improved to 60 at 12 weeks. Only 9.7% of patients had acceptable functional status at 12 weeks follow-up. Conclusions: In this locality, headache, focal neurological deficits, and reduced functional status are the most common presenting features of astrocytomas while GBM is the most common histological subtype. Tumors are highly proliferative and in the short-term, both surgical and functional outcome are suboptimal.

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Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.4.1294 ◽

1997 ◽

Vol 15 (4) ◽

pp. 1294-1301 ◽

Cited By ~ 273

Author(s):

C Leighton ◽

B Fisher ◽

G Bauman ◽

S Depiero ◽

L Stitt ◽

...

Keyword(s):

Median Survival ◽

Karnofsky Performance Status ◽

Univariate Analysis ◽

Residual Tumor ◽

Low Grade Glioma ◽

Cancer Center ◽

Entire Group ◽

Low Grade ◽

Mixed Glioma ◽

Modern Imaging

PURPOSE To review the outcomes of patients with low-grade glioma diagnosed by modern imaging and treated at a center where postponing radiotherapy was common practice. METHODS We reviewed the records of patients (age > or = 18 years) with pathologically confirmed supratentorial low-grade fibrillary astrocytoma, oligodendroglioma, and mixed glioma treated at a regional cancer center in Canada between 1979 and 1995. RESULTS Median survival for the entire group (N = 167; mean age 40.6 years) was 10.5 years with 5- and 10-year survival rates of 72% and 50%, respectively. Median progression-free survival was 4.9 years with 5- and 10-year progression-free rates of 50% and 12%, respectively. Overall and progression-free survivals were longer for patients with an oligodendroglioma or mixed glioma than with astrocytoma (median 13 v 7.5 years, P = .003; progression-free 5.6 v 4.4 years, p = .054). Age at diagnosis < or = 40 years, seizures at presentation, minimal residual tumor after surgery, Karnofsky performance status > or = 70, and oligodendroglioma or mixed glioma pathology were associated with significantly longer median survival on univariate and multivariate analyses. Radiotherapy deferred until tumor progression (v immediate radiotherapy) was associated with longer survival on univariate analysis, but an imbalance in other variables accounted for this advantage such that timing of radiotherapy was not an independent (favorable or adverse) prognostic factor on multivariate analysis. CONCLUSION Patients with low-grade glioma diagnosed by modern imaging can be expected to live a long time; timing of radiotherapy may be a less important determinant of survival than nontreatment variables and residual tumor bulk.

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Interferon alfa-2a in advanced renal cell carcinoma: treatment results and survival in 159 patients with long-term follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.1993.11.7.1368 ◽

1993 ◽

Vol 11 (7) ◽

pp. 1368-1375 ◽

Cited By ~ 201

Author(s):

L M Minasian ◽

R J Motzer ◽

L Gluck ◽

M Mazumdar ◽

V Vlamis ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Prognostic Factors ◽

Cell Carcinoma ◽

Renal Cell ◽

Karnofsky Performance Status ◽

Performance Status ◽

Interferon Alfa ◽

Advanced Renal Cell Carcinoma ◽

Survival Duration

PURPOSE Three trials were conducted to define the efficacy and toxicity of interferon alfa-2a in the treatment of metastatic renal cell cancer. Univariate and multivariate analyses were performed to identify prognostic factors for survival. PATIENTS AND METHODS Prospectively, 159 patients were treated with interferon alfa-2a. In the first trial, 42 patients received 50 x 10(6) U/m2 intramuscularly three times per week. In the second trial, 64 patients received gradually escalating doses of interferon alfa-2a from 3 to 36 x 10(6) U subcutaneously administered daily. The third trial was randomized; 25 patients received daily interferon alfa-2a alone and 28 were treated with daily interferon alfa-2a and 0.15 mg/kg vinblastine every 3 weeks. RESULTS The overall response proportion was 10% (two complete and 14 partial responses). The median response duration was 12.2 months. The median survival duration was 11.4 months, with 3% of patients alive at 5 or more years. A univariate statistical analysis showed that a Karnofsky performance status > or = 80, prior nephrectomy, and interval from diagnosis to treatment of longer than 365 days were significant prognostic factors for survival. In a multivariate analysis, only prior nephrectomy and Karnofsky performance status > or = 80 were shown to be independent predictors of survival. CONCLUSION Interferon alfa-2a had minimal antitumor activity in patients with advanced renal cell carcinoma and long-term survival was achieved in a small proportion of patients. The need for continued investigation and the identification of more effective therapy for advanced renal cell carcinoma is evident from the poor overall survival rate observed in these 159 patients. The investigation of new agents and of interferon alfa-2a in combination with other agents remains a priority.

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Adult Supratentorial Low-Grade Glioma: Long-Term Experience at a Single Institution

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.01.010 ◽

2009 ◽

Vol 75 (5) ◽

pp. 1401-1407 ◽

Cited By ~ 58

Author(s):

Glenn Bauman ◽

Barbara Fisher ◽

Christopher Watling ◽

J. Gregory Cairncross ◽

David Macdonald

Keyword(s):

Low Grade Glioma ◽

Low Grade ◽

Single Institution ◽

Long Term Experience

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Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients

Neurology ◽

10.1212/wnl.56.10.1285 ◽

2001 ◽

Vol 56 (10) ◽

pp. 1285-1290 ◽

Cited By ~ 235

Author(s):

O. Surma-aho ◽

M. Niemela ◽

J. Vilkki ◽

M. Kouri ◽

A. Brander ◽

...

Keyword(s):

Low Grade Glioma ◽

Low Grade ◽

Long Term Effects ◽

Brain Radiotherapy

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Long-Term Results of Targeted Low-Grade Glioma Treatment with 213Bi-DOTA-[Thi8,Met(O2)11]-Substance P

Cancer Biotherapy & Radiopharmaceuticals ◽

10.1089/cbr.2018.2719 ◽

2019 ◽

Vol 34 (6) ◽

pp. 413-416 ◽

Cited By ~ 2

Author(s):

Dominik Cordier ◽

Adrian Merlo

Keyword(s):

Substance P ◽

Low Grade Glioma ◽

Long Term Results ◽

Low Grade

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[11C]-Methionine Positron Emission Tomography in the Postoperative Imaging and Followup of Patients with Primary and Recurrent Gliomas

ISRN Oncology ◽

10.1155/2014/463152 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Matteo Santoni ◽

Cristina Nanni ◽

Alessandro Bittoni ◽

Gabriele Polonara ◽

Alessandro Paccapelo ◽

...

Keyword(s):

Positron Emission Tomography ◽

Residual Disease ◽

Karnofsky Performance Status ◽

Performance Status ◽

High Sensitivity ◽

Emission Tomography ◽

Low Grade ◽

Postoperative Imaging ◽

Positron Emission ◽

Met Pet

We investigated the sensitivity and specificity of [11C]-methionine positron emission tomography ([11C]-MET PET) in the management of glioma patients. We retrospectively analysed data from 53 patients with primary gliomas (16 low grade astrocytomas, 15 anaplastic astrocytomas and 22 glioblastomas) and Karnofsky Performance Status (KPS) > 70. Patients underwent [11C]-MET PET scans (N=249) and parallel contrast-enhanced MRI (N=193) and/or CT (N=113) controls. In low grade glioma patients, MRI or CT findings associated with [11C]-MET PET additional data allowed discrimination residual disease from postsurgical changes in 96.22% of these cases. [11C]-MET PET early allowed detection of malignant progression from low grade to anaplastic astrocytoma with high sensitivity (91.56%) and specificity (95.18%). In anaplastic astrocytomas, we registered high sensitivity (93.97%) and specificity (95.18%) in the postoperative imaging and during the followup of these patients. In GBM patients, CT and/or MRI scans with additional [11C]-MET PET data registered a sensitivity of 96.92% in the postsurgical evaluation and in the tumour assessment during temozolomide therapy. A significant correlation was found between [11C]-MET mean uptake index and histologic grading (P<0.001). These findings support the notion that complementary information derived from [11C]-MET PET may be helpful in postoperative and successive tumor assessment of glioma patients.

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