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Chinese Clinical Oncology Apr 2024The role of adjuvant radiotherapy (RT) after gross total resection (GTR) of the World Health Organization (WHO) grade II ependymoma is controversial. Therefore, we aimed... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The role of adjuvant radiotherapy (RT) after gross total resection (GTR) of the World Health Organization (WHO) grade II ependymoma is controversial. Therefore, we aimed to compare the outcomes of adjuvant RT against observation after GTR of WHO grade II ependymoma. We also compared the outcomes of adjuvant RT against observation after subtotal resection (STR) of WHO grade II ependymoma and performed further subgroup analysis by age and tumor location.
METHODS
PubMed and Embase were systematically reviewed for studies published up till 25 November 2022. Studies that reported individual-participant data on patients who underwent surgery followed by adjuvant RT/observation for WHO grade II ependymoma were included. The exposure was whether adjuvant RT was administered, and the outcomes were recurrence and overall survival (OS). Subgroup analyses were performed by the extent of resection (GTR or STR), tumor location (supratentorial or infratentorial), and age at the first surgery (<18 or ≥18 years old).
RESULTS
Of the 4,647 studies screened, three studies reporting a total of 37 patients were included in the analysis. Of these 37 patients, 67.6% (25 patients) underwent GTR, and 51.4% (19 patients) underwent adjuvant RT. Adjuvant RT after GTR was not significantly associated with both recurrence (odds ratio =5.50; 95% confidence interval: 0.64-60.80; P=0.12) and OS (P=0.16). Adjuvant RT was also not significantly associated with both recurrence and OS when the cohort was analyzed as a whole and on subgroup analysis by age and tumor location. However, adjuvant RT was associated with significantly longer OS after STR (P=0.03) with the median OS being 6.33 years, as compared to 0.40 years for patients who underwent STR followed by observation.
CONCLUSIONS
Based on our meta-analysis of 37 patients, administration of adjuvant RT after GTR was not significantly associated with improvement in OS or recurrence in patients with WHO grade II ependymoma. However, due to the small number of patients included in the analysis, further prospective controlled studies are warranted.
Topics: Humans; Ependymoma; Radiotherapy, Adjuvant; Female; Male; Neoplasm Grading; World Health Organization
PubMed: 38644544
DOI: 10.21037/cco-23-136 -
Cureus Mar 2024This systematic review aims to evaluate CyberKnife (Accuray, Madison, WI, USA) radiosurgery's efficacy, safety, and outcomes in treating meningiomas, focusing on tumour... (Review)
Review
This systematic review aims to evaluate CyberKnife (Accuray, Madison, WI, USA) radiosurgery's efficacy, safety, and outcomes in treating meningiomas, focusing on tumour control rates, symptom relief, survival rates, quality of life, and adverse events. A comprehensive literature search was conducted across PubMed, EMBASE, Web of Science, Google Scholar, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), covering studies published in the last 20 years and available in English. The inclusion criteria targeted studies involving patients with meningioma treated with CyberKnife radiosurgery, reporting on specific outcomes of interest. Quality assessment was performed using the Newcastle-Ottawa Scale for observational studies, and a narrative synthesis approach was adopted for data analysis. Twenty-one studies met the inclusion criteria, encompassing various design types and patient demographics. The review highlights CyberKnife's effectiveness in managing benign and atypical meningiomas and specific challenging cases like perioptic lesions and large cranial base tumours. Key findings include high tumour control rates, preservation or improvement of visual functions in perioptic lesions, and promising results in benign spinal tumours and supratentorial meningiomas. Comparative analyses suggest better radiographic tumour control and a lower incidence of post-treatment complications with stereotactic radiotherapy over stereotactic radiosurgery. Long-term outcomes and safety profiles underline the viability of CyberKnife as a treatment option, with minimal permanent side effects reported. CyberKnife radiosurgery is a highly effective and safe treatment modality for meningiomas. It offers significant benefits in tumour control, symptom relief, and maintaining the quality of life with minimal adverse effects. The precision and adaptability of CyberKnife technology make it a valuable addition to the treatment arsenal for meningiomas. It necessitates further research and adoption in clinical practice, especially in regions like the United Arab Emirates, where its use is emerging.
PubMed: 38528994
DOI: 10.7759/cureus.56848 -
Child and Adolescent Psychiatry and... Oct 2023This study aimed to evaluate the association between the location (supratentorial or infratentorial) of brain tumors and the development of depression and anxiety in... (Review)
Review
OBJECTIVE
This study aimed to evaluate the association between the location (supratentorial or infratentorial) of brain tumors and the development of depression and anxiety in childhood cancer survivors. Understanding the risk factors for the development of depression and anxiety disordersin these patients is crucial for early diagnosis and successful treatment.
METHODS
The meta-analysis included articles that listed patients diagnosed with an intracranial tumor before the age of 18 years, provided the location of the tumor, had exact data on the prevalence of anxiety and depression, or measured these disorders using different assessment tools. The search was conducted in five different databases (MEDLINE, Embase, Web of Science, Scopus, and Cochrane Library). Risk of bias was assessed using QUIPS-2. Outcome measures used were prevalences and standardized means.
RESULTS
The analysis included 42 eligible articles with a total number of 1071 patients. Relevant articles were cohort studies, cross-sectional studies, and case series. Based on the available data infratentorial brain tumor survivors had significantly higher scores on various assessment tools measuring anxiety (MRAW (raw mean scores): 36.24 [CI (confidence interval): 28.81-43.67]; versus MRAW: 23.21 (CI 0.91-45.51); p = 0.02, and depression (MRAW: 27.57 (CI 14.35-40.78) versus MRAW: 13.84 (CI 11.43-16.26); p < 0.01.
CONCLUSION
Childhood infratentorial cancer survivors have more impairments in terms of depression and anxiety; these children and adults should be monitored more frequently and may require closer follow-up on their mental health. The main limitation of our study originates from the lack of data on follow-up times used by different studies.
PubMed: 37891679
DOI: 10.1186/s13034-023-00665-0 -
Neurosurgical Review Aug 2023The current knowledge regarding the prevalence and persistence of edematous changes postmeningioma surgery is limited. Our hypothesis was that peritumoral edema is... (Review)
Review
The current knowledge regarding the prevalence and persistence of edematous changes postmeningioma surgery is limited. Our hypothesis was that peritumoral edema is frequently irreversible gliosis, potentially influencing long-term postoperative epilepsy. We conducted a systematic literature search in PubMed, Cochrane Library, and Scopus databases. We included studies with adult patients undergoing first supratentorial meningioma surgery, which reported pre- and postoperative peritumoral brain edema (T2WI and FLAIR hyperintensity on MRI). Risk of bias was assessed based on detailed reporting of five domains: (1) meningioma characteristics, (2) extent of resection, (3) postoperative radiation therapy, (4) neurological outcome, and (5) used MRI sequence. Our loose search strategy yielded 1714 articles, of which 164 were reviewed and seven met inclusion criteria. Persistent edema rates ranged from 39% to 83% with final follow-up occurring between 0, 14, and 157 months. Among patient cohorts exhibiting persistent edema, a smaller portion achieved seizure resolution compared to a cohort without persistent edema. Relatively reliable assessment of persistent T2/FLAIR hyperintensity changes can be made earliest at one year following surgery. All studies were classified as low quality of evidence, and therefore, quantitative analyses were not conducted. Persistent T2/FLAIR hyperintensity changes are frequently observed in MRI imaging following meningioma surgery. The term "edema," which is reversible, does not fully capture pre- and postoperative T2WI and FLAIR hyperintensity changes. Future studies focusing on peritumoral meningioma-related edema, its etiology, its persistence, and its impact on postoperative epilepsy are needed.
Topics: Adult; Humans; Meningioma; Meningeal Neoplasms; Retrospective Studies; Magnetic Resonance Imaging; Brain Edema; Edema; Epilepsy
PubMed: 37541985
DOI: 10.1007/s10143-023-02094-1 -
Frontiers in Medicine 2023Glioblastoma is the most common and malignant primary brain tumour with median survival of 14.6 months. Personalised medicine aims to improve survival by targeting...
INTRODUCTION
Glioblastoma is the most common and malignant primary brain tumour with median survival of 14.6 months. Personalised medicine aims to improve survival by targeting individualised patient characteristics. However, a major limitation has been application of targeted therapies in a non-personalised manner without biomarker enrichment. This has risked therapies being discounted without fair and rigorous evaluation. The objective was therefore to synthesise the current evidence on survival efficacy of personalised therapies in glioblastoma.
METHODS
Studies reporting a survival outcome in human adults with supratentorial glioblastoma were eligible. PRISMA guidelines were followed. MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library were searched to 5th May 2022. Clinicaltrials.gov was searched to 25th May 2022. Reference lists were hand-searched. Duplicate title/abstract screening, data extraction and risk of bias assessments were conducted. A quantitative synthesis is presented.
RESULTS
A total of 102 trials were included: 16 were randomised and 41 studied newly diagnosed patients. Of 5,527 included patients, 59.4% were male and mean age was 53.7 years. More than 20 types of personalised therapy were included: targeted molecular therapies were the most studied (33.3%, 34/102), followed by autologous dendritic cell vaccines (32.4%, 33/102) and autologous tumour vaccines (10.8%, 11/102). There was no consistent evidence for survival efficacy of any personalised therapy.
CONCLUSION
Personalised glioblastoma therapies remain of unproven survival benefit. Evidence is inconsistent with high risk of bias. Nonetheless, encouraging results in some trials provide reason for optimism. Future focus should address target-enriched trials, combination therapies, longitudinal biomarker monitoring and standardised reporting.
PubMed: 37122327
DOI: 10.3389/fmed.2023.1166104 -
Pathogens (Basel, Switzerland) Mar 2023Accumulating evidence suggests that toxoplasmosis in immunocompetent hosts can be severe and life-threatening. (Review)
Review
BACKGROUND
Accumulating evidence suggests that toxoplasmosis in immunocompetent hosts can be severe and life-threatening.
METHODS
We performed a systematic review of severe toxoplasmosis cases in immunocompetent patients to gain insight into the epidemiology, clinical characteristics, radiological findings, and outcomes of these cases. We classified severe toxoplasmosis as cases with the symptomatic involvement of target organs (the lungs, central nervous system (CNS), and heart), disseminated disease, prolonged disease (>3 months), or a fatal outcome. Our primary analysis focused on cases published from 1985-2022 to avoid confounding with cases in AIDS patients.
RESULTS
We identified 82 pertinent articles (1985-2022) with a total of 117 eligible cases; the top five countries for these cases were French Guiana (20%), France (15%), Colombia (9%), India (9%), and Brazil (7%). Overall, 44% (51/117) of cases had pulmonary involvement, 39% (46/117) CNS, 31% (36/117) cardiac, 24% (28/117) disseminated disease, 2% (2/117) had prolonged disease, and 8% (9/117) of patients died. More than one organ was involved in 26% (31/117) of cases. Eighty-four percent (98/117) of cases occurred in the context of a recent acute primary infection; for the remaining, the exact timing of infection was unclear. Genotyping data were very sparse. Among those reporting genotyping data, 96% (22/23) were caused by atypical non-type II strains; one case was caused by a type-II strain. Only half of the cases reported risk factors. The most common risk factors were eating raw/undercooked meat or eating game meat (47% (28/60)), drinking untreated water (37% (22/60)), or living in a toxoplasmosis high-prevalence area (38% (23/60)). For the 51 pulmonary cases, the main clinical presentation was pneumonia or pleural effusions in 94% (48/51) and respiratory failure in 47% (24/51). For the 46 CNS cases, the main clinical presentation was encephalitis in 54% (25/46), meningitis in 13% (6/46), focal neurologic findings in 24% (11/46), cranial nerve palsies in 17% (8/46), Guillain-Barre syndrome or Miller Fisher syndrome in 7% (3/46), and Brown-Sequard syndrome in 2% (1/46) of cases; more than one clinical manifestation could also be present. Among the 41 CNS cases reporting the CNS imaging findings, 68% (28/41) had focal supratentorial lesions and 7% (3/41) had focal infratentorial lesions. Brain abscess-like/mass-like lesions were seen in 51% (21/41) of cases. For the 36 cardiac cases, the main clinical presentation was myocarditis in 75% (27/36), pericarditis in 50% (18/36), heart failure and/or cardiogenic shock in 19% (7/36), and cardiac arrhythmias in 22% (8/36); more than one manifestation could also be present. Illness was critical in 49% (44/90) of cases intensive care unit care was needed in 54% (29/54) of cases among those reporting this information, and 9 patients died.
CONCLUSION
The diagnosis of severe toxoplasmosis in immunocompetent hosts can be challenging. Toxoplasmosis should be considered in the differential diagnosis of immunocompetent patients presenting with severe illness of unclear etiology with pulmonary, cardiac, CNS, or multiorgan involvement/failure, or prolonged febrile illness, even in the absence of common exposure risk factors or common manifestations of toxoplasmosis (e.g., fever, mononucleosis-like illness, lymphadenopathy, and chorioretinitis). Fatal outcomes can also rarely occur in immunocompetent patients. Prompt initiation of anti- treatment can be lifesaving.
PubMed: 37111429
DOI: 10.3390/pathogens12040543 -
Journal of Neuro-oncology Dec 2022Surgical resection offers survival benefits in patients with diffuse low-grade glioma (DLGG) but its association with functional outcomes is uncertain. This systematic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical resection offers survival benefits in patients with diffuse low-grade glioma (DLGG) but its association with functional outcomes is uncertain. This systematic review assessed functional outcomes associated with extent of resection (EoR) in adults with DLGG.
METHODS
We searched Medline, Embase and CENTRAL on the 19th of February 2021 for observational studies reporting functional outcomes after surgical resection for patients aged ≥ 18 years with a new diagnosis of supratentorial DLGG according to any World Health Organization classification of primary brain tumors. The Newcastle-Ottawa Scale (NOS) informed our risk of bias assessments. The proportion of patients returning to work within 12 months entered a random-effects meta-analysis. PROSPERO registration number CRD42021238387.
RESULTS
There were seven eligible moderate to high-quality (NOS > 6) observational studies identified from 1,183 records involving 234 patients with DLGG. Functional outcomes reported included neurocognition (n = 2 studies), performance status (n = 3), quality of life (QoL) (n = 1) and return to work (n = 6). The proportion of patients who returned to work within 12 months of surgery was 84% (95% confidence interval [CI] 50-96%, I-squared = 38%, 5 studies) for gross total resection, 66% (95% CI 14-96%, I = 57%, 5 studies) for subtotal resection, and 31% (95% CI 4-82%, I = 0%, 4 studies) for partial resection. There was insufficient data on other functional outcomes for quantitative synthesis.
CONCLUSION
A higher proportion of DLGG patients returned to work following gross total resection compared with those who had a subtotal or partial resection. Further studies with standardized assessments can clarify the association between EoR and different functional outcomes.
Topics: Adult; Humans; Quality of Life; Brain Neoplasms; Neurosurgical Procedures; Glioma
PubMed: 36404358
DOI: 10.1007/s11060-022-04192-4 -
Brain Circulation 2022Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage,... (Review)
Review
Cerebral cavernous malformations (CMs) are slow-flow vascular lesions that affect up to 0.5% of the pediatric population. These lesions are at risk for hemorrhage, causing seizures, and leading to neurological deficits. Here, we conduct a literature review and then present a report of a supratentorial CM in a 2-year-old patient with no significant past medical history who presented at our institution with 1 month of eye twitching. We performed a literature search of five databases of all articles published before 2020. Our inclusion criteria included cohort and case series of children with mean age under 12 years. Our search yielded 497 unique articles, of which 16 met our inclusion criteria. In our pooled literature analysis, a total of 558 children were included, 8.3% of which had a positive family history and 15.9% had multiple CMs. About 46.1% of the children had seizures, and 88.4% of those who underwent surgery had a total resection. About 85.1% of those with epilepsy were Engel Class 1 postsurgery. Over a mean follow-up of 4.1 years, 3.4% of patients had additional neurological deficits, including paresis and speech deficits. Our analysis of published literature shows surgical intervention should be considered first-line therapy for patients who are symptomatic from CM, present with seizure, and have surgically accessible lesions. Additional work is needed on outcomes and long-term effects of minimally invasive treatments, including radiosurgery and laser ablation, in pediatric populations.
PubMed: 36267435
DOI: 10.4103/bc.bc_26_22 -
Cancers Sep 2022The incidence of recurrent metastatic brain tumors is increasing due to advances in local therapy, including surgical and radiosurgical management, as well as improved... (Review)
Review
The incidence of recurrent metastatic brain tumors is increasing due to advances in local therapy, including surgical and radiosurgical management, as well as improved systemic disease control. The management of recurrent brain metastases was previously limited to open resection and/or irradiation. In recent years, laser interstitial thermal therapy (LITT) has become a promising treatment modality. As systemic and intracranial disease burden increases in a patient, patients may no longer be candidates for surgical resection. LITT offers a relatively minimally invasive option for patients that cannot tolerate or do not want open surgery, as well as an option for accessing deep-seated tumors that may be difficult to access via craniotomy. This manuscript aims to critically review the available data regarding the use of LITT for recurrent intracranial brain metastasis. Ten of seventy-two studies met the criteria for review. Generally, the available literature suggests that LITT is a safe and feasible option for the treatment of recurrent brain metastases involving supratentorial and cortical brain, as well as posterior fossa and deep-seated locations. Among all studies, only one directly compared craniotomy to LITT in the setting of recurrent brain metastasis. Prospective studies are needed to better elucidate the role of LITT in the management of recurrent brain metastases.
PubMed: 36139527
DOI: 10.3390/cancers14184367 -
Neuroanatomical regions associated with non-progressive dysarthria post-stroke: a systematic review.BMC Neurology Sep 2022Dysarthria is a common and persisting sequela to stroke. It can have a negative influence on psychological wellbeing, and quality of life. This systematic review aimed...
BACKGROUND
Dysarthria is a common and persisting sequela to stroke. It can have a negative influence on psychological wellbeing, and quality of life. This systematic review aimed to describe and identify the neuroanatomical regions associated with non-progressive dysarthria following stroke.
METHODS
A systematic search of PubMed, Ovid Medline, CINAHL, Cochrane, Scopus, and ScienceDirect was conducted to identify all relevant articles published in peer-reviewed journals up to December 2021. Following data extraction, the National Institutes of Health (NIH) quality assessment tools were used to evaluate the methodological quality of the included studies.
RESULTS
Out of 2186 papers found in the literature related to dysarthria post-stroke, 24 met the inclusion criteria. Eligible articles assessed 1150 post-stroke subjects. Out of them, 420 subjects had dysarthria from isolated lesions. Regarding dysarthric subjects with ischemic strokes, 153 sustained supratentorial infarctions, while 267 had infratentorial infarctions. The majority had pontine infarctions (n = 142), followed by infarctions in the corona radiata (n = 104), and the cerebellum (n = 64).
CONCLUSION
This systematic review is the first step toward establishing a neuroanatomical model of dysarthria throughout the whole brain. Our findings have many implications for clinical practice and provide a framework for implementing guidelines for early detection and management of dysarthria post-stroke.
Topics: Dysarthria; Humans; Infarction; Ischemic Stroke; Quality of Life; Stroke; United States
PubMed: 36114518
DOI: 10.1186/s12883-022-02877-x