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Current Treatment Options in Oncology Dec 2000Gliomas are a heterogeneous group of neoplasms that comprise the majority of tumors originating in the central nervous system (CNS). In adults, the most frequently... (Review)
Review
Gliomas are a heterogeneous group of neoplasms that comprise the majority of tumors originating in the central nervous system (CNS). In adults, the most frequently encountered of these are high-grade or malignant neoplasms of astrocytic and oligodendrocytic lineage, ie, anaplastic astrocytoma (AA), glioblastoma multiforme (GBM), and anaplastic oligodendroglioma (AO), respectively. Tumors of mixed lineage are also seen, the most common of which is designated anaplastic oligoastrocytoma (AOA). Standard treatment for these tumors is typically surgery, followed by radiation then chemotherapy. Surgery is required for a definitive histopathologic diagnosis, which in turn will dictate subsequent therapy options. Moreover, aggressive tumor resection improves survival outcomes, and in many cases, the patient's neurologic function. We generally advocate the safest, maximal resection attainable for patients with these tumors as a way to improve prognosis. In almost all cases, surgery is followed by radiation therapy. Postsurgical irradiation is the most effective treatment currently available for improving survival. There is also mounting evidence to suggest that additional radiation, given in the form of brachytherapy or radiosurgery, at initial diagnosis as a "boost" to standard radiation or at tumor recurrence, may provide added improvement in survival outcome. Radiosurgery and brachytherapy are therapies often used to treat eligible patients at this institution. Adjuvant chemotherapy, conventionally given after radiation, may offer a modest survival benefit in some patients with GBM. Bischloroethylnitrosourea (BCNU) is the typical first-line agent used, but chemotherapy seems to be most beneficial in young patients, with little if any impact on survival for patients over 60 years old. At this institution, we often defer treatment with adjuvant chemotherapy for elderly patients with GBM due to lack of efficacy and the attendant risk with chemotherapy. For anaplastic astrocytomas, oligodendrogliomas, and oligoastrocytomas, a commonly accepted standard is adjuvant chemotherapy following irradiation with the three-drug regimen--procarbazine, CCNU, and vincristine (PCV). This is due to an earlier clinical trial that showed a survival advantage in patients treated with adjuvant PCV compared with patients that received BCNU. However, recent data suggest that treatment with either PCV or BCNU may be appropriate. Both regimens now appear to have equal efficacy for anaplastic gliomas in light of a more recent analysis done with larger numbers of patients. AOs are a unique case with respect to tumor chemosensitivity and patient survival. Molecular studies have identified a subpopulation of patients with AO whose tumors have lost chromosomes 1p and 19q. Patients with this molecular pattern have an exceptional responsiveness to PCV chemotherapy and have prolonged survival. Currently, trials are being conducted to confirm this finding and to determine the best treatment regimen for these patients, with particular regard to the timing of radiation and chemotherapy.
Topics: Antineoplastic Agents; Brain Neoplasms; Clinical Trials as Topic; Female; Glioma; Humans; Radiotherapy; Survival Rate
PubMed: 12057153
DOI: 10.1007/s11864-000-0073-2 -
Acta Neurochirurgica. Supplement 2022The use of deep learning (DL) is rapidly increasing in clinical neuroscience. The term denotes models with multiple sequential layers of learning algorithms,...
The use of deep learning (DL) is rapidly increasing in clinical neuroscience. The term denotes models with multiple sequential layers of learning algorithms, architecturally similar to neural networks of the brain. We provide examples of DL in analyzing MRI data and discuss potential applications and methodological caveats.Important aspects are data pre-processing, volumetric segmentation, and specific task-performing DL methods, such as CNNs and AEs. Additionally, GAN-expansion and domain mapping are useful DL techniques for generating artificial data and combining several smaller datasets.We present results of DL-based segmentation and accuracy in predicting glioma subtypes based on MRI features. Dice scores range from 0.77 to 0.89. In mixed glioma cohorts, IDH mutation can be predicted with a sensitivity of 0.98 and specificity of 0.97. Results in test cohorts have shown improvements of 5-7% in accuracy, following GAN-expansion of data and domain mapping of smaller datasets.The provided DL examples are promising, although not yet in clinical practice. DL has demonstrated usefulness in data augmentation and for overcoming data variability. DL methods should be further studied, developed, and validated for broader clinical use. Ultimately, DL models can serve as effective decision support systems, and are especially well-suited for time-consuming, detail-focused, and data-ample tasks.
Topics: Adult; Algorithms; Deep Learning; Glioma; Humans; Image Processing, Computer-Assisted; Magnetic Resonance Imaging; Neural Networks, Computer
PubMed: 34862531
DOI: 10.1007/978-3-030-85292-4_11 -
Neurology Apr 2000Low-grade oligodendrogliomas and mixed gliomas can be indolent and remain unchanged for years. Optimal timing and effectiveness of initial treatment is uncertain and...
BACKGROUND
Low-grade oligodendrogliomas and mixed gliomas can be indolent and remain unchanged for years. Optimal timing and effectiveness of initial treatment is uncertain and therapy can be associated with toxicity.
METHODS
Retrospective review of patients diagnosed between 1979 and 1997 with low-grade oligodendroglioma or mixed glioma. Time to progression, survival, prognostic factors, and treatment toxicities were evaluated.
RESULTS
A total of 106 patients (77 oligodendroglioma, 29 mixed glioma) were identified; median age was 36.7 years. Initial presenting symptoms were seizures in 76 (72%) and headache in 11 (10%); tumor was diagnosed as an incidental finding in five patients. Tumor progression was diagnosed in 72 patients (68%). Overall median time to progression (MTTP) was 5.0 years (range 0.5 to 14.2). Median overall survival (OS) was 16.7 years. No prognostic factors reached statistical significance. MTTP and OS were not significantly affected by treatment. Of 62 patients who received radiation therapy, 9 (15%) developed radiation necrosis and 13 developed radiation therapy-related cognitive changes, requiring ventriculoperitoneal shunting in six. Significant myelosuppression was seen in 35 of 76 (46%) patients treated with chemotherapy.
CONCLUSIONS
Low-grade oligodendroglioma and mixed glioma have a long median overall survival. There were no apparent differences in either immediate versus deferred treatment or choice of initial therapy on disease-free or overall survival. Chemotherapy was associated with significant acute toxicity in almost one half of patients; radiation therapy produced late neurotoxicity in one third, justifying deferred treatment until clinically necessary.
Topics: Adolescent; Adult; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Cisplatin; Cyclophosphamide; Disease-Free Survival; Female; Follow-Up Studies; Glioma; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Oligodendroglioma; Postoperative Complications; Radiotherapy, Adjuvant; Retrospective Studies; Survival Rate; Treatment Outcome; Vindesine
PubMed: 10751254
DOI: 10.1212/wnl.54.7.1442 -
Journal of Neuropathology and... Sep 1983The histopathologic features of four cases of mixed capillary hemangioblastoma and glioma are described. In three cases, two of which arose in the cerebellum and one in...
The histopathologic features of four cases of mixed capillary hemangioblastoma and glioma are described. In three cases, two of which arose in the cerebellum and one in the spinal cord, the hemangioblastic component may have originated from a neoplastic proliferation of the exuberant vascular stroma in a glial tumor. In a fourth case, a cerebellar hemangioblastoma was surrounded by a peripheral rim of atypical neoplastic-looking astrocytes ("reactive glioma"). The controversial concept of the "angioglioma" is reviewed, and it is proposed that the term be used to designate only true mixed tumors of glial and vascular tissue origin whose histologic features conform to the examples described in this report.
Topics: Aged; Cerebellar Neoplasms; Female; Glioma; Hemangiosarcoma; Humans; Middle Aged; Neoplasms, Multiple Primary; Spinal Cord Neoplasms
PubMed: 6684149
DOI: 10.1097/00005072-198309000-00002 -
Current Treatment Options in Oncology Dec 2001Low-grade gliomas are uncommon primary brain tumors classified as histologic grades I or II in the World Health Organization (WHO) classification. The most common... (Review)
Review
Low-grade gliomas are uncommon primary brain tumors classified as histologic grades I or II in the World Health Organization (WHO) classification. The most common variants are pilocytic and low-grade astrocytomas, oligodendrogliomas, and mixed oligo-astrocytomas located in the cerebral hemispheres. Prognostic factors that predict progression-free and overall survival include young age, pilocytic histology, good Karnofsky performance status, gross total resection, lack of enhancement on imaging, and small preoperative tumor volumes. Edema and vasogenic effects are typically managed with corticosteroids. Dexamethasone is given at an initial dosage of 4 mg given four times daily. Anticonvulsants are given prophylactically after resection and for patients who present with seizures. The rationale for open craniotomy depends on the need for immediate palliation of symptoms by reduction of intracranial pressure or focal mass effect, and/or improved oncologic control. Gross total resection of tumor is generally defined as the absence of residual enhancement on contrast-enhanced postoperative MRI scan. Most retrospective studies suggest that patients who have undergone a gross total resection of tumor have improved survival. Depending upon the proximity of the tumor to eloquent brain, gross total resection may or may not be possible. In these cases a stereotactic biopsy is required to provide the histologic diagnosis. Adjuvant radiotherapy is recommended for patients with incompletely resected grade II tumors or for patients older than age 40 regardless of extent of resection. It may be considered for any pilocytic astrocytoma from which a biopsy has been performed. Phase III randomized prospective trials have shown statistically significantly improved progression-free survival at 5 years with the addition of radiotherapy, though overall survival does not appear different. Based on prospective randomized phase III trials, 50.4 Gy to 54 Gy of conventionally fractionated radiotherapy appears to be a safe and effective regimen with minimal neurotoxicity; 45 Gy may be adequate for biopsied pilocytic astrocytomas. Currently, RTOG trial 98-02 is investigating the efficacy of postradiation PCV chemotherapy (procarbazine, CCNU, and vincristine) in the treatment of newly diagnosed unfavorable low-grade gliomas. Other areas of investigation include Temozolomide chemotherapy and the association of 1p and 19q chromosomal deletions with prolonged survival in oligodendrogliomas and sensitivity to PCV chemotherapy. Radiosurgery and/or experimental chemotherapy may provide some measure of local control in the recurrent disease setting.
Topics: Adolescent; Adult; Anti-Inflammatory Agents; Anticonvulsants; Antineoplastic Combined Chemotherapy Protocols; Brain Edema; Brain Neoplasms; Chemotherapy, Adjuvant; Combined Modality Therapy; Cranial Irradiation; Craniotomy; Dexamethasone; Epidemiologic Methods; Forecasting; Glioma; Humans; Prognosis; Radiosurgery; Radiotherapy Dosage; Radiotherapy, Adjuvant; Seizures; Survival Analysis; Survival Rate; Treatment Outcome
PubMed: 12057095
DOI: 10.1007/s11864-001-0071-z -
Surgical Neurology Nov 1992Long-term survival after the diagnosis of malignant glioma is uncommon but not rare. To define better the population of patients who have extended survival with this... (Review)
Review
Long-term survival after the diagnosis of malignant glioma is uncommon but not rare. To define better the population of patients who have extended survival with this disease, we reviewed the records of 22 of our patients who survived more than 4 years after the biopsy-proven diagnosis of anaplastic astrocytoma, malignant mixed glioma, or glioblastoma multiforme. Surprisingly, 21 of the 22 patients are still alive and being actively followed by the authors. The long-term survivors were typically young and with minimal or no functional impairment at the time of diagnosis. Survivals ranged from 4.2 to 15.8 years. The quality of survival was generally good, with the surviving patients having a mean Karnofsky Performance Score of 76. Three-quarters of the patients had no enhancement or mass effect on their most recent computed tomography scans. A review of the available literature, together with our own series, suggests that death from recurrent disease is unusual in glioma patients who survive more than 4 or 5 years.
Topics: Adult; Aged; Astrocytoma; Brain Neoplasms; Female; Glioblastoma; Glioma; Humans; Male; Middle Aged; Survival Analysis; Time Factors
PubMed: 1336626
DOI: 10.1016/0090-3019(92)90022-f -
FEBS Open Bio Feb 2021Glioma is a common primary malignant tumor that has a poor prognosis and often develops drug resistance. The coumarin derivative osthole has previously been reported to...
Glioma is a common primary malignant tumor that has a poor prognosis and often develops drug resistance. The coumarin derivative osthole has previously been reported to induce cancer cell apoptosis. Recently, we found that it could also trigger glioma cell necroptosis, a type of cell death that is usually accompanied with reactive oxygen species (ROS) production. However, the relationship between ROS production and necroptosis induced by osthole has not been fully elucidated. In this study, we found that osthole could induce necroptosis of glioma cell lines U87 and C6; such cell death was distinct from apoptosis induced by MG-132. Expression of necroptosis inhibitor caspase-8 was decreased, and levels of necroptosis proteins receptor-interacting protein 1 (RIP1), RIP3 and mixed lineage kinase domain-like protein were increased in U87 and C6 cells after treatment with osthole, whereas levels of apoptosis-related proteins caspase-3, caspase-7, and caspase-9 were not increased. Lactate dehydrogenase release and flow cytometry assays confirmed that cell death induced by osthole was primarily necrosis. In addition, necroptosis induced by osthole was accompanied by excessive production of ROS, as observed for other necroptosis-inducing reagents. Pretreatment with the RIP1 inhibitor necrostatin-1 attenuated both osthole-induced necroptosis and the production of ROS in U87 cells. Furthermore, the ROS inhibitor N-acetylcysteine decreased osthole-induced necroptosis and growth inhibition. Overall, these findings suggest that osthole induces necroptosis of glioma cells via ROS production and thus may have potential for development into a therapeutic drug for glioma therapy.
Topics: Apoptosis; Brain Neoplasms; Cell Line, Tumor; Coumarins; Drug Screening Assays, Antitumor; Glioma; Humans; Leupeptins; Membrane Potential, Mitochondrial; Mitochondria; Necroptosis; Reactive Oxygen Species
PubMed: 33350608
DOI: 10.1002/2211-5463.13069 -
European Journal of Oncology Nursing :... Feb 2013With poor prognosis and disabling symptomatology high-grade gliomas affect not only the patient but also the family. (Review)
Review
BACKGROUND
With poor prognosis and disabling symptomatology high-grade gliomas affect not only the patient but also the family.
PURPOSE
The aim of this systematic review is to explore the experiences and needs of patients with a high-grade glioma and their family caregivers.
METHOD
Based on literature search in six databases, sixteen qualitative studies, published between 2000 and 2010 and with mixed methodological quality, were included.
RESULTS
For both patients and their caregivers the diagnosis is marked by shock and recognition of death. For patients, coping with restriction seems to be most difficult to deal with. Especially loss of autonomy is hard. For caregivers, neurocognitive symptoms and personality changes irreversibly change the relationship with the patient leading to caregivers expressing a sense of total responsibility. The experience of being a caregiver is described by positive as well as negative feelings. Both patients and caregivers describe the need for hope, support and information.
CONCLUSION
The review provides some relevant insight in the experiences and needs of patients with a high-grade glioma and their caregivers. The methodological limitations of the included studies, however, urge for more research to refine our understanding of patients' and caregivers' experiences and needs to better tune care to their needs.
Topics: Activities of Daily Living; Adaptation, Psychological; Brain Neoplasms; Caregivers; Glioma; Humans; Needs Assessment; Social Support
PubMed: 22658206
DOI: 10.1016/j.ejon.2012.04.006 -
Australasian Radiology Nov 2001Low-grade gliomas are a diverse group of neoplasms which, as the name implies, are thought to arise from glial cells. Common among this group are astrocytomas (low-grade... (Review)
Review
Low-grade gliomas are a diverse group of neoplasms which, as the name implies, are thought to arise from glial cells. Common among this group are astrocytomas (low-grade astrocytoma; LGA), oligodendrogliomas and mixed gliomas. Among these, LGA is the commonest low-grade glioma and, occasionally, although incorrectly, the terms are used interchangeably. Advances in imaging technology have improved the accuracy of preoperative diagnosis. The management of low-grade gliomas is controversial. Recent evidence suggests that previously considered standard therapy (i.e. surgery plus radiotherapy) may not be in the patient's best interests. A review of the available published research concerning low-grade gliomas is therefore timely.
Topics: Astrocytoma; Brain Neoplasms; Disease Progression; Glioma; Humans; Magnetic Resonance Imaging; Oligodendroglioma; Prognosis; Telencephalon; Tomography, X-Ray Computed
PubMed: 11903181
DOI: 10.1046/j.1440-1673.2001.00959.x -
Medical Physics Jun 2022The number of patients who suffer from glioma has been increasing, and this malignancy is a serious threat to human health. The mainstream treatment for glioma is...
BACKGROUND
The number of patients who suffer from glioma has been increasing, and this malignancy is a serious threat to human health. The mainstream treatment for glioma is surgical resection; therefore, accurate resection can improve postoperative patient recovery.
PURPOSE
Many studies have investigated surgical navigation guided by mixed reality, with good outcomes. However, the limitations of mixed reality, such as spatial drift caused by environmental changes, limit its clinical application. Therefore, we present a mixed reality surgical navigation system for glioma resection. Preoperative information can be fused precisely with the real patient with the spatial compensation method to achieve clinically suitable accuracy.
METHODS
A head-mounted device was used to display virtual information, and a markerless spatial registration method was applied to precisely align the virtual anatomy with the real patient preoperatively. High-accuracy preoperative and intraoperative movement and spatial drift compensation methods were used to increase the positional accuracy of the mixed reality-guided glioma resection system when the patient's head is fixed to the bed frame. Several experiments were designed to validate the accuracy and efficacy of this system.
RESULTS
Phantom experiments were performed to test the efficacy and accuracy of this system under ideal conditions, and clinical tests were conducted to assess the performance of this system in clinical application. The accuracy of spatial registration was 1.18 mm in the phantom experiments and 1.86 mm in the clinical application.
CONCLUSIONS
Herein, we present a mixed reality-based multimodality-fused surgical navigation system for assisting surgeons in intuitively identifying the glioma boundary intraoperatively. The experimental results indicate that this system has suitable accuracy and efficacy for clinical usage.
Topics: Adult; Augmented Reality; Glioma; Humans; Imaging, Three-Dimensional; Phantoms, Imaging; Surgery, Computer-Assisted; Surgical Navigation Systems
PubMed: 35383964
DOI: 10.1002/mp.15650