Patterns of neuroaxis dissemination of gliomas: suggestion of a classification based on magnetic resonance imaging findings

Bordignon, Kelly C.; Neto, Maurício Coelho; Ramina, Ricardo; Meneses, Murilo S.; Zazula, Ana Denise; Almeida, Luiz G. M. P. de

doi:10.1016/j.surneu.2005.08.019

Cited by 26 publications

(36 citation statements)

References 15 publications

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“… Kaczmarek et al (1999) demonstrated that invasion is not only simply due to expansion by growth or a passive distribution of tumor cells but also the active translocation of tumors cells through cellular and extracellular matrix barriers of normal host tissue. Furthermore, Bordignon et al (2006) reported great variability in the biological behavior of gliomas according to the neuroaxis spreading patterns. Low-grade glioma neuroaxis dissemination rates range from 3.7 to 5.3% ( Figueiredo et al, 2003 ) while high-grade rates range from 10 to 27% ( Misaki et al, 2001 ).…”

Section: Discussionmentioning

confidence: 99%

Analysis of DTI-Derived Tensor Metrics in Differential Diagnosis between Low-grade and High-grade Gliomas

Jiang

Xiao

et al. 2017

Front. Aging Neurosci.

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Purpose: It is critical and difficult to accurately discriminate between high- and low-grade gliomas preoperatively. This study aimed to ascertain the role of several scalar measures in distinguishing high-grade from low-grade gliomas, especially the axial diffusivity (AD), radial diffusivity (RD), planar tensor (Cp), spherical tensor (Cs), and linear tensor (Cl) derived from diffusion tensor imaging (DTI).Materials and Methods: Fifty-three patients with pathologically confirmed brain gliomas (21 low-grade and 32 high-grade) were included. Contrast-enhanced T1-weighted images and DTI were performed in all patients. The AD, RD, Cp, Cs, and Cl values in the tumor zone, peritumoral edema zone, white matter (WM) adjacent to edema and contralateral normal-appearing white matter (NAWM) were calculated. The DTI parameters and tumor grades were statistically analyzed, and receiver operating characteristic (ROC) curve analysis was also performed.Results: The DTI metrics in the affected hemisphere showed significant differences from those in the NAWM, except for the AD values in the tumor zone and the RD values in WM adjacent to edema in the low-grade groups, as well as the Cp values in WM adjacent to edema in the high-grade groups. AD in the tumor zone as well as Cs and Cl in WM adjacent to edema revealed significant differences between the low- and high-grade gliomas. The areas under the curve (Az) of all three metrics were greater than 0.5 in distinguishing low-grade from high-grade gliomas by ROC curve analysis, and the best DTI metric was Cs in WM adjacent to edema (Az: 0.692).Conclusion: AD in the tumor zone as well as Cs and Cl in WM adjacent to edema will provide additional information to better classify gliomas and can be used as non-invasive reliable biomarkers in glioma grading.

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Section: Discussionmentioning

confidence: 99%

Analysis of DTI-Derived Tensor Metrics in Differential Diagnosis between Low-grade and High-grade Gliomas

Jiang

Xiao

et al. 2017

Front. Aging Neurosci.

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“…Historically, studies have shown a median survival after LMD diagnosis of 4 months with a high frequency in CGB [15,16]. Endo and colleagues noted that all five of their cerebellar HGG patients recurred with LMD, two of whom had CGB [17].…”

Section: Leptomeningeal Diseasementioning

confidence: 99%

Cerebellar glioblastoma: a retrospective review of 21 patients at a single institution

et al. 2011

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Primary cerebellar glioblastoma (CGB) comprises only 0.4-3.4% of all intracranial glioblastoma. The impact of surgical resection on survival and the efficacy of adjuvant therapies are uncertain as CGB is underrepresented in most studies. To elucidate prognostic factors we performed a single-institutional review of the largest series to date of CGB. The University of Texas MD Anderson Cancer Center database was reviewed from 1990 to 2010. Twenty-one consecutive patients met criteria for inclusion. The Kaplan-Meier product limit method was used to estimate overall survival (OS) and progression-free survival (PFS); groups were compared using the log-rank statistic. The multivariate Cox proportional hazards models were fitted to examine the association of resection with OS and PFS adjusted for other clinical variables. The median age was 39.9 years, and Karnofsky performance status (KPS) was ≥ 80 in 61.5% of patients. The mean extent of resection for contrast enhancement (EOR-CE) was 93.8% (SD = 10.4%; median = 100%), and the median follow-up was 18.4 months (range 1.5-116.1 months). There was no significant association of EOR with OS or PFS. On univariate analysis the presence of leptomeningeal disease (LMD) was associated with a worse OS (6.1 vs. 24.1 months; P = 0.0001) and PFS (3.3 vs. 9 months; P = 0.019). Patients who had adjuvant chemotherapy (CT) had extended PFS (10.1 vs. 2.8 months; P < 0.0001). Adjustment for the presence of leptomeningeal disease (LMD) tended toward an increased risk of progression (HR = 3.46; 95% confidence interval [CI], 0.83-14.5; P = 0.09) and was associated with a significantly increased risk of death (HR = 15.2; 95% CI, 1.3-180; P = 0.03). Having received adjuvant chemotherapy was associated with a decreased risk of progression (HR = 0.02; 95% CI, 0-0.26; P = 0.003). The presence of LMD is a critical factor in the clinical behavior of CGB resulting in markedly decreased OS and PFS. Adjuvant CT resulted in increased PFS but did not significantly affect OS. This was due to a lack of a sizable cohort who did not receive chemotherapy. Furthermore, three of the CT-naïve patients received CT at first progression. In the context of the high EOR in this study, an OS of 18.4 months was achieved.

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“…3,4,12,19 Although patients who receive repeat surgery may face a higher risk of leptomeningeal dissemination, our study showed that the interval between initial surgery and detection of leptomeningeal dissemination was similar in the single-and repeat-surgery groups. Moreover, there was no difference between the interval after initial surgery to dissemination in the single-surgery group and the interval after second surgery to dissemination in the repeat-surgery group (Fig.…”

Section: Discussionmentioning

confidence: 51%

Clinical significance and limitations of repeat resection for pediatric malignant neuroepithelial tumors

Kawaguchi

Kumabe

Saito

et al. 2013

PED

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Object Maximized tumor resection and minimized surgical morbidity are extremely important in the treatment of children with malignant neuroepithelial tumors. However, the indications for repeat surgery for these tumors remain unclear. The present study investigated the clinical significance and limitations of repeat resection for these tumors. Methods This study included 61 consecutive pediatric patients with malignant neuroepithelial tumor, histologically diagnosed as WHO Grades III and IV. All patients were initially treated between January 1997 and March 2011 and had follow-up of more than 2 years. The number of surgeries, presence of leptomeningeal dissemination, survival, WHO grade, and Eastern Cooperative Oncology Group performance status before and after surgery were retrospectively reviewed. Results Repeat resections were performed for 21 patients (34.4%). Eastern Cooperative Oncology Group performance status was not aggravated by surgery, even after multiple operations. The 5-year survival rates of patients who received single and repeat surgery were 58.6% and 38.7%, respectively (p = 0.12). The mean interval between initial surgery and leptomeningeal dissemination detection was 331 ± 108 days in the single-surgery group and 549 ± 122 days in the repeat-surgery group (p = 0.19). The median survival time after leptomeningeal dissemination was 580 days in the single-surgery group and 890 days in the repeat-surgery group (p = 0.74). Conclusions Repeat resection with minimized surgical morbidity is an effective method to achieve better local control of pediatric malignant neuroepithelial tumors. Leptomeningeal dissemination was a leading cause of death, but repeat surgery did not increase the frequency of death.

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Patterns of neuroaxis dissemination of gliomas: suggestion of a classification based on magnetic resonance imaging findings

Cited by 26 publications

References 15 publications

Analysis of DTI-Derived Tensor Metrics in Differential Diagnosis between Low-grade and High-grade Gliomas

Analysis of DTI-Derived Tensor Metrics in Differential Diagnosis between Low-grade and High-grade Gliomas

Cerebellar glioblastoma: a retrospective review of 21 patients at a single institution

Clinical significance and limitations of repeat resection for pediatric malignant neuroepithelial tumors

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