scholarly journals The role of surgery in low-grade gliomas: do timing and extent of resection matter?

CNS Oncology ◽  
2017 ◽  
Vol 6 (3) ◽  
pp. 179-183 ◽  
Author(s):  
Hugues Duffau
Keyword(s):  
Extent Of Resection ◽  
Low Grade ◽  
Low Grade Gliomas

Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature—a systematic review of the literature

2020 ◽  
Author(s):  
Lucas Alverne F. Albuquerque ◽  
João Paulo Almeida ◽  
Leonardo José Monteiro de Macêdo Filho ◽  
Andrei F. Joaquim ◽  
Hugues Duffau
Keyword(s):  
Systematic Review ◽  
Extent Of Resection ◽  
Molecular Signature ◽  
Low Grade ◽  
Review Of The Literature ◽  
Low Grade Gliomas

378 Analysis of Molecular Markers and Volumetric Extent of Resection on Survival for Insular Gliomas

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 289-290
Author(s):  
Chikezie Eseonu ◽  
Karim ReFaey ◽  
Gugan Raghuraman ◽  
Alfredo Quiñones-Hinojosa
Keyword(s):  
Molecular Markers ◽  
Survival Rate ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Idh1 Mutation ◽  
Low Grade ◽  
High Grade ◽  
Free Survival ◽  
Low Grade Gliomas

Abstract INTRODUCTION Insular gliomas are challenging tumors to surgically resect due to the anatomy surrounding them. This study evaluates the role of extent of resection (EOR) and molecular markers on surgical outcome and survival for insular gliomas. METHODS Seventy-four patients who had undergone an initial resection for an insular glioma by the same surgeon from 2006 to 2016 were analyzed. Low(grade II) and high(grade III/IV) grade gliomas were analyzed for the prognostic role of volumetric EOR and molecular markers (IDH1 mutation, 1p/19q codeletion) on patient survival outcomes. RESULTS >The cohort includes 25 low grade gliomas (LGGs) patients(33.8%), and 49 high grade glioma(HGGs) patients(66.2%). The median EOR was 91.7% (range 10–100%). New permanent postoperative deficits were found in 2.7% of patients. LGG patients with a = 90% EOR had a 5-year survival rate of 100% and patients with a <90% EOR had 5-year survival of 80%. HGG patients with a = 90% EOR had a 2-year survival rate of 83.7%, and patients with a <90% EOR had 2-year survival of 43.8%. For LGGs, accounting for EOR, IDH1 mut, 1p/19 codeletion, the EOR was predictive of OS(P = 0.017), progression free survival (PFS, P = 0.039), and malignant progression free survival (MPFS, P = 0.014), while the 1p/19q co-deletion was predictive for PFS (P = 0.014). For HGGs, the EOR was predictive of OS (P = 0.020) and PFS(P = 0.024). Preoperative tumor volume was a factor that most significantly affected the EOR for insular gliomas (R2 = 0.053, P = 0.048). CONCLUSION Extensive resections of insular gliomas can be achieved with low morbidity and can improve OS and PFS. In this series of low-grade gliomas, EOR was associated with longer MPFS, and the 1p/19q co-deletion was predictive of PFS.

Changes in gamma-aminobutyric acid and somatostatin in epileptic cortex associated with low-grade gliomas

1992 ◽  
Vol 77 (2) ◽  
pp. 209-216 ◽  
Author(s):  
Michael M. Haglund ◽  
Mitchel S. Berger ◽  
Dennis D. Kunkel ◽  
JoAnn E. Franck ◽  
Saadi Ghatan ◽  
...  
Keyword(s):  
Epileptiform Activity ◽  
Aminobutyric Acid ◽  
Low Grade ◽  
Tumor Infiltration ◽  
Gamma Aminobutyric Acid ◽  
Content Type ◽  
Low Grade Gliomas ◽  
Neuronal Populations ◽  
Significant Difference

✓ The role of specific neuronal populations in epileptic foci was studied by comparing epileptic and nonepileptic cortex removed from patients with low-grade gliomas. Epileptic and nearby (within 1 to 2 cm) nonepileptic temporal lobe neocortex was identified using electrocorticography. Cortical specimens taken from four patients identified as epileptic and nonepileptic were all void of tumor infiltration. Somatostatin- and γ-aminobutyric acid (GABAergic)-immunoreactive neurons were identified and counted. Although there was no significant difference in the overall cell count, the authors found a significant decrease in both somatostatin- and GABAergic-immunoreactive neurons (74% and 51 %, respectively) in the epileptic cortex compared to that in nonepileptic cortex from the same patient. It is suggested that these findings demonstrate changes in neuronal subpopulations that may account for the onset and propagation of epileptiform activity in patients with low-grade gliomas.

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

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 808-814 ◽  
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.

scholarly journals Therapeutic and Prognostic Implications of BRAF V600E in Pediatric Low-Grade Gliomas

2017 ◽  
Vol 35 (25) ◽  
pp. 2934-2941 ◽  
Author(s):  
Alvaro Lassaletta ◽  
Michal Zapotocky ◽  
Matthew Mistry ◽  
Vijay Ramaswamy ◽  
Marion Honnorat ◽  
...  
Keyword(s):  
Quantitative Imaging ◽  
Progression Free Survival ◽  
Extent Of Resection ◽  
Braf V600e ◽  
Low Grade ◽  
Low Grade Gliomas ◽  
Molecular Stratification ◽  
Treatment Data ◽  
Poor Outcomes ◽  
Independent Cohort

Purpose BRAF V600E is a potentially highly targetable mutation detected in a subset of pediatric low-grade gliomas (PLGGs). Its biologic and clinical effect within this diverse group of tumors remains unknown. Patients and Methods A combined clinical and genetic institutional study of patients with PLGGs with long-term follow-up was performed (N = 510). Clinical and treatment data of patients with BRAF V600E mutated PLGG (n = 99) were compared with a large international independent cohort of patients with BRAF V600E mutated-PLGG (n = 180). Results BRAF V600E mutation was detected in 69 of 405 patients (17%) with PLGG across a broad spectrum of histologies and sites, including midline locations, which are not often routinely biopsied in clinical practice. Patients with BRAF V600E PLGG exhibited poor outcomes after chemotherapy and radiation therapies that resulted in a 10-year progression-free survival of 27% (95% CI, 12.1% to 41.9%) and 60.2% (95% CI, 53.3% to 67.1%) for BRAF V600E and wild-type PLGG, respectively ( P < .001). Additional multivariable clinical and molecular stratification revealed that the extent of resection and CDKN2A deletion contributed independently to poor outcome in BRAF V600E PLGG. A similar independent role for CDKN2A and resection on outcome were observed in the independent cohort. Quantitative imaging analysis revealed progressive disease and a lack of response to conventional chemotherapy in most patients with BRAF V600E PLGG. Conclusion BRAF V600E PLGG constitutes a distinct entity with poor prognosis when treated with current adjuvant therapy.

scholarly journals The role of clinical and molecular characteristics in low grade gliomas

2017 ◽  
Vol 28 ◽  
pp. vi75-vi76
Author(s):  
A. Mura ◽  
E. Franceschi ◽  
S. Minichillo ◽  
A. Tosoni ◽  
A. Fioravanti ◽  
...  
Keyword(s):  
Molecular Characteristics ◽  
Low Grade ◽  
Low Grade Gliomas

Exploring the role of inflammation in the malignant transformation of low-grade gliomas

2016 ◽  
Vol 297 ◽  
pp. 132-140 ◽  
Author(s):  
Nicole Michelson ◽  
Jordina Rincon-Torroella ◽  
Alfredo Quiñones-Hinojosa ◽  
Jeffrey P. Greenfield
Keyword(s):  
Malignant Transformation ◽  
Low Grade ◽  
Low Grade Gliomas

Low grade glioma patients with IDH mutation and 1p19q codeletion: To treat or not to treat?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2017-2017 ◽  
Author(s):  
Enrico Franceschi ◽  
Dario De Biase ◽  
Alexandro Paccapelo ◽  
Antonella Mura ◽  
Alicia Tosoni ◽  
...  
Keyword(s):  
Extent Of Resection ◽  
Low Grade ◽  
Incomplete Resection ◽  
Idh Mutation ◽  
1P19q Codeletion ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Surgical Treatments

2017 Background: Molecular characterization of low grade gliomas (LGG) is essential for diagnosis and treatment of these diseases. LGG patients (pts) with IDH mutation and 1p19q codeletion (codel) are characterized by a median OS (mOS) longer than 10 years. Thus, the role of treatments and side effects should be carefully evaluated. Methods: We evaluated LGG pts from our data warehouse (n=679 pts) who received surgery and had sufficient tissue to assess biomarkers characterization. Pts with gliomatosis were excluded. IDH1/2 assessment was performed on formalin-fixed paraffin-embedded samples by qPCR. In wild type cases we performed NGS. 1p/19 codel analysis was performed by FISH. Results: 93 consecutive LGG with IDH mutation and codel were included. The median follow up (FU) was 96.1 months. Mean age was 40 yrs (range: 25-66); 8 pts (8.6%) underwent biopsy, 61 pts (65.6%) partial resection, 24 pts (25.8%) complete resection. 84 pts (90.3%) were considered high risk using RTOG criteria (>40 years and/or incomplete resection). Fifty pts (53.7%) received only FU, 17 pts (18.3%) received chemotherapy (CT), 18 pts (19.4%) received radiotherapy (RT), 8 pts (8.6%) received RT + CT. Median PFS (mPFS) was 59.6 months (95%CI: 41.8-77.4) and was significantly longer in pts who received postsurgical treatments (79.5 months, 95%CI: 66.4-92.7) than pts who received FU (46.3 months, 95%CI: 36.0-56.5; P=0.001). mPFS was 50.8 months (95%CI: 17.4-84.3), 103.6 months (95%CI: 11.7-195.6) and 120.2 months (95%CI: 40.5-199.8) in pts treated with CT alone, RT alone and RT + CT, respectively. Multivariate analysis showed that receiving a post-surgical treatment (P<0.001), and the extent of resection (P=0.043) were significantly correlated with PFS. Conclusions: Our study evaluated the role of treatments in LGG pts assessed with NGS and FISH. Post-surgical treatments are crucial to extend PFS in pts with IDH mutation and codel. The choice of post-surgical treatments seems to have a role, being CT alone less effective than RT and RT+CT. Longer FU is needed to provide information about OS.

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