scholarly journals A Position Statement on the Utility of Interval Imaging in Standard of Care Brain Tumour Management: Defining the Evidence Gap and Opportunities for Future Research

2021 ◽  
Vol 11 ◽  
Author(s):  
Thomas C. Booth ◽  
Gerard Thompson ◽  
Helen Bulbeck ◽  
Florien Boele ◽  
Craig Buckley ◽  
...  
Keyword(s):  
Health Economics ◽  
Brain Tumour ◽  
Study Design ◽  
Brain Tumours ◽  
Data Science ◽  
Standard Of Care ◽  
Structural Mri ◽  
Adult Brain ◽  
Current Evidence ◽  
Imaging Biomarkers

Objectiv eTo summarise current evidence for the utility of interval imaging in monitoring disease in adult brain tumours, and to develop a position for future evidence gathering while incorporating the application of data science and health economics.MethodsExperts in ‘interval imaging’ (imaging at pre-planned time-points to assess tumour status); data science; health economics, trial management of adult brain tumours, and patient representatives convened in London, UK. The current evidence on the use of interval imaging for monitoring brain tumours was reviewed. To improve the evidence that interval imaging has a role in disease management, we discussed specific themes of data science, health economics, statistical considerations, patient and carer perspectives, and multi-centre study design. Suggestions for future studies aimed at filling knowledge gaps were discussed.ResultsMeningioma and glioma were identified as priorities for interval imaging utility analysis. The “monitoring biomarkers” most commonly used in adult brain tumour patients were standard structural MRI features. Interval imaging was commonly scheduled to provide reported imaging prior to planned, regular clinic visits. There is limited evidence relating interval imaging in the absence of clinical deterioration to management change that alters morbidity, mortality, quality of life, or resource use. Progression-free survival is confounded as an outcome measure when using structural MRI in glioma. Uncertainty from imaging causes distress for some patients and their caregivers, while for others it provides an important indicator of disease activity. Any study design that changes imaging regimens should consider the potential for influencing current or planned therapeutic trials, ensure that opportunity costs are measured, and capture indirect benefits and added value.ConclusionEvidence for the value, and therefore utility, of regular interval imaging is currently lacking. Ongoing collaborative efforts will improve trial design and generate the evidence to optimise monitoring imaging biomarkers in standard of care brain tumour management.

scholarly journals Developing guidelines for the management of brain tumour related epilepsy

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv3-iv4
Author(s):  
Elizabeth Vacher ◽  
Miguel Rodriguez Ruiz ◽  
Jeremy Rees
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Brain Tumour ◽  
Brain Tumours ◽  
Current Evidence ◽  
Low Grade ◽  
Clinical Nurse Specialists ◽  
Primary Brain Tumours ◽  
Low Incidence

Abstract Aims Brain Tumour Related Epilepsy (BTRE) has a significant impact on Quality of Life with implications for driving, employment and social and domestic activities. Management of BTRE is complex due to the higher incidence of pharmacoresistance and the potential for interaction between anti-cancer therapy and anti-epileptic drugs (AEDs). Neurologists, oncologists, palliative care physicians and clinical nurse specialists treating these patients would benefit from up-to-date clinical guidelines. We aim to review the current evidence to adapt current NICE guidelines for Epilepsy and to outline specific recommendations for the optimal treatment of BTRE, encompassing both primary and metastatic brain tumours. Method A comprehensive search of the literature from the past 20 years on BTRE was carried out in three databases: Embase, Medline and EMCARE. A broad search strategy was used and the evidence was evaluated and graded based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Results All patients with BTRE should be treated with AEDs. There is no proven benefit for the use of prophylactic AEDs, although there are no randomised trials testing newer agents. Seizure frequency varies between 10-40% (Class 2a evidence) in patients with Brain Metastases (BM) and from 30% (high-grade gliomas) to 90% (low-grade gliomas) (Class 2a evidence) in patients with Primary Brain Tumours (PBT). In patients with BM, risk factors include number of BM and melanoma histology (Class 2b evidence). In patients with PBT, risk factors include frontal and temporal location, oligodendroglial histology, IDH mutation and cortical infiltration (Class 2b evidence). There is a low incidence of seizures (13%) after stereotactic radiosurgery for BM (Class 2b evidence). Non-enzyme inducing AEDs are recommended as first line treatment for BTRE, but up to 50% of patients with BTRE due to PBT remain resistant (Class 2b evidence). Conclusion The review has highlighted the relative dearth of high quality evidence for the management of BTRE, and provides a framework for further studies aiming to improve seizure control, quality of life, and indications for AEDs.

scholarly journals Functional neurological disorders in patients with brain tumours

2021 ◽  
Vol 23 (Supplement_4) ◽  
pp. iv12-iv12
Author(s):  
Charmaine Toh ◽  
Dorothy Joe ◽  
Katia Cikurel ◽  
Julia Johnson ◽  
Francesco Vergani ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Neurological Disorders ◽  
Neurological Disorder ◽  
Brain Tumours ◽  
Neurological Symptoms ◽  
Adult Brain ◽  
Case Review ◽  
Functional Neurological Symptoms ◽  
Functional Neurological Disorders ◽  
Functional Neurological Disorder

Abstract Aims Signs and symptoms that develop in people with brain tumours are often attributed to their tumour. The prevalence and management of functional neurological symptoms in brain tumour patients have received little attention. This is surprising because functional neurological symptoms complicate management greatly and misdiagnosis can lead to inappropriate treatment and iatrogenic side-effects. Therefore, we investigated the presentation, diagnosis and management of functional neurological disorders (FND) in patients who had a brain or meningeal tumour. Method A retrospective case review was performed from 2017 - 2021 to identify adult brain tumour patients who developed a functional neurological disorder that caused significant disability necessitating expedited investigations. All patients attended a regional neuro-oncology centre. We recorded type of brain tumour and diagnostic investigations. The onset of functional symptoms was divided into three time windows: before tumour diagnosis, after diagnosis and before treatment or after tumour treatment. A neuropsychological review looked for evidence of previous adverse life events. Therapeutic interventions for functional neurological disorder and their outcomes were documented. The case review was combined with a systematic review of the literature to identify the published presentations of functional neurological disorder in the adult brain tumour population. MEDLINE, EMBASE and PsycINFO databases were searched for studies published between January 1980 and February 2021. Results Six patients (5 female, 1 male) were identified from the case review with a median age of 41 (range 29 - 56) years old. Four patients had non-epileptic attack disorder, which was diagnosed with videotelemetry of habitual attacks. One patient had a functional hemiparesis with normal central motor conduction time. One patient had a functional speech disorder with normal EEG. Half of these patients had functional neurological symptoms prior to surgery/oncological treatment. Five patients (83%) were referred for further neuropsychiatric or psychological evaluation. A history of significant psychological trauma prior to the brain tumour diagnosis was elicited in four (66%) patients. Conclusion Patients with either a brain or meningeal tumour may develop functional neurological symptoms. Our findings suggest the possibility that diagnosis of a brain tumour may precipitate a debilitating functional neurological disorder. The neurobiological basis for functional neurological disorders is being actively investigated. There are suggestions in the literature that some brain diseases increase the risk of developing a functional neurological disorder. Further work is needed to determine whether this is true for patients with brain tumours. Increased awareness of functional neurological disorders will improve management. Withdrawal of unnecessary treatment, such as anticonvulsant drugs, reduces the risk of iatrogenic side effects. Initiation of multi-disciplinary care pathways, e.g. physiotherapy, speech and language therapy and psychological treatments, promotes recovery. Collectively, these interventions improve our patients’ quality of life.

Paediatric brain tumours

2019 ◽  
pp. 1009-1022
Author(s):  
Jonathan Roth ◽  
Shlomi Constantini
Keyword(s):  
Brain Tumour ◽  
Blood Volume ◽  
Brain Tumours ◽  
Genetic Factors ◽  
Adult Population ◽  
Adult Brain ◽  
Related Factors ◽  
The Subject ◽  
Surgical Aspects ◽  
Paediatric Brain Tumours

Paediatric brain tumours (PBT) are a unique entity, in children and in the overall general brain tumour population. They are distinct from adult brain tumours for several reasons, including patient-related factors (size, blood volume), location of the tumours, histological and genetic factors, treatment factors, and prognosis. Even technical surgical aspects may differ from those applied in the adult population. This chapter reviews the main aspects of PBT and their treatment in relation to the aforementioned factors. This text has pinpointed the most important topics of PBT but due to the breadth of the subject, this text cannot be a comprehensive account of every aspect of these pathologies or their treatments.

scholarly journals Mortality due to primary brain tumours in China and detection rate in people with suspected symptoms: a nationally representative cross-sectional survey

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Bin Jiang ◽  
Hongmei Liu ◽  
Dongling Sun ◽  
Haixin Sun ◽  
Xiaojuan Ru ◽  
...  
Keyword(s):  
Brain Tumour ◽  
Brain Tumours ◽  
Detection Rate ◽  
Epidemiological Data ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Detection Rates ◽  
Primary Brain Tumours ◽  
Symptom Screening ◽  
Nationally Representative

Abstract Background and purpose Epidemiological data on primary brain tumours (PBTs) are lacking due to the difficulty in case ascertainment among the population. Thus, we aimed to estimate mortality due to PBTs in China nationwide and the detection rate in people with suspected symptoms. Methods A multistage, complex sampling survey regarding mortality due to PBTs in Chinese individuals was carried out by reviewing all causes of death within a year. The detection rates in people with suspected symptoms were estimated based on PBT symptom screening and neurologist reviews and compared between groups by logistic regression analysis. Results Weighted mortality due to PBT was 1.6 (0.8–3.3) per 100,000 population in Chinese individuals, 1.8 (0.7–4.6) per 100,000 population in men, and 1.5 (0.5–4.5) per 100,000 population in women. Among 14,990 people with suspected symptoms, the PBT detection rate was 306.9 (95% CI 224.7–409.3) per 100,000 population in the total population, 233.0 (95% CI 135.7–373.1) per 100,000 population in men, and 376.9 (95% CI 252.4–546.3) per 100,000 population in women. People with an unsteady gait (OR 2.46; 95% CI 1.09–5.51; P=0.029), visual anomalies (3.84; 1.88–7.85; P<0.001), and headache (2.06; 1.10–3.86; P=0.023) were more likely to have a brain tumour than those without corresponding symptoms, while people with dizziness/vertigo were less likely to have a brain tumour than those without corresponding symptoms (0.45; 0.23–0.87; P=0.017). Conclusions Mortality due to PBT in China was low, with a nationwide estimate of 21,215 (10,427–43,165) deaths attributable to PBTs annually. However, the detection rate of PBTs can be greatly improved based on symptom screening in the population.

scholarly journals Automated Machine-Learning Radiotherapy Planning for Pediatric and Adult Brain Tumours

2021 ◽  
Vol 52 (2) ◽  
pp. S3
Author(s):  
Grace Tsui ◽  
Derek S. Tsang ◽  
Chris McIntosh ◽  
Thomas G. Purdie ◽  
Glenn Bauman ◽  
...  
Keyword(s):  
Machine Learning ◽  
Brain Tumours ◽  
Adult Brain ◽  
Radiotherapy Planning ◽  
Automated Machine Learning

scholarly journals COVD-25. THE PARADOXICAL EFFECTS OF COVID-19 ON CANCER CARE IN THE NEURO-ONCOLOGY SETTING

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii26-ii26
Author(s):  
Nicole Cort ◽  
Alex Broom ◽  
Katherine Kenny ◽  
Alexander Page ◽  
Jennifer Durling ◽  
...  
Keyword(s):  
Cancer Care ◽  
Standard Of Care ◽  
Adult Brain ◽  
Evidence Based ◽  
Negative Consequences ◽  
Traditional Practice ◽  
Delivery Of Care ◽  
Paradoxical Effects ◽  
Oncology Care ◽  
The Impact

Abstract COVID-19 has caused ongoing interruptions to healthcare systems worldwide, shifting care to virtual platforms, and placing significant economic and logistical burdens on clinical practice. The pandemic has created uncertainty in delivering the standard of care, both in areas of cancer diagnosis and treatment, especially within neuro-oncology. Due to the pandemic, care and operational planning goals have shifted to infection prevention, modifying recommendations to decrease viral transmission and increasing telemedicine use, potentially creating a burden on implementing evidence-based medicine. These dynamics have since begun to redefine traditional practice and research regimens, impacting the comprehensive care that cancer patients can and should receive; and the enduring consequences for the delivery of healthcare. The impact of COVID-19 on oncology practice and trials might endure well beyond the short- to mid-term of the active pandemic. Therefore, these shifts must be accompanied by improved training and awareness, enhanced infrastructure, and evidence-based support to harness the positives and offset the potential negative consequences of the impacts of COVID-19 on cancer care. To address these paradoxical effects, we will conduct iterative, qualitative (face-to-face/video conference) interviews with neuro-oncology clinical and research professionals and adult brain tumor patients receiving care during the pandemic. We will capture unique aspects of oncology care: the lived, subjective, situated, and contingent accounts of patients and medical professionals, especially during a pandemic. We will also specifically compare the impact of telehealth during the pandemic on delivery of care to complex neuro-oncology patients. A summary of this in-depth, qualitative approach will result in a sophisticated understanding of neuro-oncology care on the frontline at a time of crisis, as experienced during a pandemic, to articulate best practices for future implementation.

scholarly journals The evolution of alternative splicing in glioblastoma under therapy

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lin Wang ◽  
Karin Shamardani ◽  
Husam Babikir ◽  
Francisca Catalan ◽  
Takahide Nejo ◽  
...  
Keyword(s):  
Alternative Splicing ◽  
Standard Of Care ◽  
Surface Proteins ◽  
Adult Brain ◽  
Primary Tumors ◽  
Cell Therapies ◽  
Therapeutic Development ◽  
Human Gbm ◽  
Tissue Specimens ◽  
Splicing Patterns

Abstract Background Alternative splicing is a rich source of tumor-specific neoantigen targets for immunotherapy. This holds promise for glioblastomas (GBMs), the most common primary tumors of the adult brain, which are resistant to standard-of-care therapy. Although most clinical trials enroll patients at recurrence, most preclinical studies have been done with specimens from primary disease. There are limited expression data from GBMs at recurrence and surprisingly little is known about the evolution of splicing patterns under therapy. Result We profile 37 primary-recurrent paired human GBM specimens via RNA sequencing. We describe the landscape of alternative splicing in GBM at recurrence and contrast that to primary and non-malignant brain-tissue specimens. By screening single-cell atlases, we identify cell-type-specific splicing patterns and novel splicing events in cell-surface proteins that are suitable targets for engineered T cell therapies. We identify recurrent-specific isoforms of mitogen-activated kinase pathway genes that enhance invasiveness and are preferentially expressed by stem-like cells. Conclusion These studies shed light on gene expression in recurrent GBM and identify novel targets for therapeutic development.

scholarly journals Construction of the National Brain Tumor Registry of China for better management and more efficient use of data: a protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040055
Author(s):  
Liwei Zhang ◽  
Wang Jia ◽  
Nan Ji ◽  
Deling Li ◽  
Dan Xiao ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Clinical Research ◽  
Brain Tumour ◽  
Brain Tumours ◽  
Benefit Sharing ◽  
Data Quality Control ◽  
Clinical Trial Registry ◽  
Discharge Data ◽  
Tumor Registry ◽  
Depth Analysis

IntroductionBrain tumours encompass a complex group of intracranial tumours that mostly affect young adults and children, with a high incidence rate and poor prognosis. It remains impossible to systematically collect data on patients with brain tumours in China and difficult to perform in-depth analysis on the status of brain tumours, medical outcomes or other important medical issues through a multicentre clinical study. This study describes the first nation-wide data platform including the entire spectrum of brain tumour entities, which will allow better management and more efficient application of patient data in China.Methods and analysisThe National Brain Tumor Registry of China (NBTRC) is a registry of real-word clinical data on brain tumours. It is established and managed by the China National Clinical Research Center for Neurological Diseases and administered by its scientific and executive committees. The 54 participating hospitals of the NBTRC are located in 27 provinces/municipalities, performing more than 40 000 brain tumour surgeries per year. The data consist of in-hospital medical records, images and follow-up information after discharge. Data can be uploaded in three ways: the web portal, remote physical servers and offline software. The data quality control scheme is seven-dimensional. Each participating hospital could focus on a single pathology subtype and public subtypes of brain tumour for which they expect to conduct related multicentre clinical research. The standardised workflow to conduct clinical research is based on the benefit-sharing mechanism. Data collection will be conducted continuously from 1 February 2019 to 31 January 2024.Ethics and disseminationInformed consent will be obtained from all participants. Consent for the adolescents’ participation will be also obtained from their guardians via written consent. The results will be published in professional journals, in both Chinese and English.Trial registration numberChinese Clinical Trial Registry (ChiCTR1900021096).

The development of a cognitive rehabilitation and psycho-social group programme for teenage and young adult survivors of brain tumours: A feasibility study

2021 ◽  
pp. 135910452110555
Author(s):  
Daniel Glazer ◽  
Xeni Daniilidi ◽  
Charlotte Valentino
Keyword(s):  
Young Adult ◽  
Feasibility Study ◽  
Social Group ◽  
Brain Tumours ◽  
Cognitive Rehabilitation ◽  
Real Life ◽  
Adult Survivors ◽  
Strategy Training ◽  
Current Evidence ◽  
Current Evidence Base

Introduction and aims Treatment for childhood and adolescent brain tumours is often intensive, with significant neurocognitive and psycho-social late effects ( Zeltzer et al., 2009 ). This feasibility Study aimed to inform the development of a cognitive rehabilitation and psycho-social group intervention for Teenage and Young Adult (TYA) survivors of brain tumours. Methods A group-based intervention incorporated ideas from the current evidence base, including psychoeducation and compensatory strategy training, with a focus on real-life goals and improving quality of life. Participants ( N = 19, 13–24 years) were recruited from the University College London Hospital TYA Oncology Service. Participants had received treatment for a malignant brain tumour and had completed their treatment at least 1 year prior to participation. Four group-based, whole-day interventions ran every 3 months throughout a year. Feasibility criteria were established to answer questions about acceptability of the intervention and recruitment. Results Qualitative and quantitative feedback from all four groups demonstrated acceptability and suitability of the intervention with regards to the content, structure and delivery. Recruitment presented more of a challenge with 35% fewer referrals than expected. Discussion and conclusion Feedback suggests that the intervention is suitable and acceptable, whilst limitations include numbers of referrals and referral pathways. Future directions are discussed.

Sign in / Sign up

Export Citation Format

Share Document