Chemotherapy for low-grade gliomas

Low-grade gliomas are the most common histological type of pediatric brain tumor. They can arise in any part of the nervous system. Although low-grade gliomas are slow growing, they often recur or progress, especially in areas such as the diencephalon or brain stem, where resection is limited by proximity to vital and eloquent structures. Radiation has been used to treat progressive low-grade gliomas, but it is not clear that it improves long-term outcome. Radiotherapy also has potential significant cognitive, endocrine, and vascular side- effects. There is a growing body of evidence to suggest that chemotherapy can delay and may obviate the need for radiation therapy or aggressive surgery. This chapter reviews the published chemotherapeutic trials. Chemotherapy appears to have a major role in the management of children with progressive low-grade gliomas. Received: 12 April 1999     

立体定向等体积切除幕上低级别胶质瘤

目的 探讨立体定向等体积切除术在低级别胶质瘤手术中的应用价值。方法 利用MR导向立体定向等体积切除方法切除大脑半球不同部位的低级别胶质瘤58例，其中功能区39例。对本术式的手术疗效、优越性及注意事项进行分析。结果 全组病例均达到肿瘤影像学全切除。术后症状改善或无变化51例(87．9％)，症状加重7例，除1例未恢复外，其余6例均在短期内恢复。结论 立体定向等体积切除术可以精确定位并确定手术切除范围，有助于提高低级别胶质瘤的全切除率及降低手术并发症的发生。     

Two-dimensional high-end ultrasound imaging compared to intraoperative MRI during resection of low-grade gliomas

Ultrasound (US) is being used increasingly in intraoperative imaging. Its reliability in identifying low-grade gliomas (LGG), however, has not been shown definitively. We compared the quality and reliability of high-end two-dimensional (2D) ultrasound (US) and 1.5 Tesla intraoperative MRI (iopMRI) images in 11 patients with LGG. The parameters evaluated were: tumor border; internal structure; vascularity, location, and relation to landmarks and vessels; and accuracy in detecting remnants. Both methods allowed good visualization of internal characteristics of the tumor and its location. The tumor border was clear on 10 of 11 MRI and on 9 of 11 US. During surgery, however, the quality of US images diminished, leading to some difficulties in interpretation. One small superficial remnant was not identified and in one patient an artifact was falsely interpreted as a remnant. While iopMRI appeared superior for visualizing different stages of hemispheric LGG resection, 2D US still allows accurate initial tumor delineation and for almost real-time control of tumor resection.     

边缘系统低级别胶质瘤与顽固性癫痫

目的 探讨边缘系统低级别胶质瘤致顽固性癫痫的临床特征、手术方法及疗效。方法 对自1993年3月一2000年12月本科因顽固性癫痫进行手术切除的11例边缘系统低级别胶质瘤作一回顾性分析。结果 11例患者中10例以癫痫起病，平均病程26个月，发作类型为复杂性部分性发作和继发性全身发作。11例患者均经扩大翼点入路行胶质瘤全切加上标准前额叶切除。术后病理为少枝突胶质瘤3例，星形细胞瘤Ⅰ级5例，星形细胞瘤Ⅰ—Ⅱ级3例。11例患者随访10个月一3年，复查CT或MRI检查，无肿瘤复发迹象，癫痫控制满意。结论 边缘系统低级别胶质瘤致顽固性癫痫，病程长，久治不愈，年龄偏轻，通过完全的肿瘤切除加上标准前额叶切除，可大大降低肿瘤的复发率，极好地控制癫痫。     

Chemotherapy for diffuse low-grade gliomas in adults

Diffuse low-grade gliomas (LGGs) in adults are progressive brain tumours that are radiologically characterized by slow and continuous growth that precedes anaplastic transformation. Standard treatment includes surgery and radiotherapy though the optimal timing of radiotherapy remains unsettled. Several retrospective and phase II studies have demonstrated that chemotherapy is also an interesting treatment option. However, several questions remain unanswered regarding its optimal use. The present review focuses on past, recent and ongoing developments in LGGs chemotherapy, including response assessment and potential predictive biomarkers of chemosensitivity.     

Leptomeningeal dissemination of low-grade intramedullary gliomas: About one case and review

Leptomeningeal (LM) dissemination arises rarely in patients with low-grade gliomas. Few cases of LM dissemination of spinal cord low-grade gliomas have been reported in children. Here, we report a case of an intramedullary spinal cord low-grade glioma occurring in an adult presenting by LM dissemination.     

Outcome of children with low-grade cerebellar astrocytoma: long-term complications and quality of life

Objects  To study the long-term outcome of surgically treated low-grade cerebellar astrocytomas in children. Materials and methods  We followed 31 consecutive patients under 16 years of age who were diagnosed between 1980 and 2005 in a single institution. In 21 of 31 survivors (median follow-up time 7.9 years; range 5.6–27.4 years) who agreed to participate, tumor control, neurological and cognitive complications, and their impact on behavioral and emotional adjustment and health-related quality of life (HRQoL) were comprehensively assessed qualitatively and quantitatively. Results  Neurological sequelae were found in 43%. However, age-appropriate ability to perform daily life activities was normal in all patients. Remarkably, cognitive deficits leading to significant school problems occurred in 19% and behavioral and emotional adjustment disturbances in 27%. In comparison with healthy controls, the survivors rated their HRQoL similarly or even higher. Conclusion  Childhood low-grade cerebellar astrocytomas have an excellent cure rate by tumor surgery alone. When compared with other pediatric brain tumors, the risk of neurological, cognitive, emotional, and behavioral complications is relatively small. HRQoL is similar to that of healthy controls.     

成人低级别致痫性胶质瘤的手术治疗

目的探讨低级别伴发癫痫胶质瘤的处理方式。方法回顾分析2007年6月至2009年3月我科手术治疗的26例伴发癫痫的Ⅰ～Ⅱ级胶质瘤患者临床资料。术前结合磁共振和脑磁图定位癫痫起源部位。结果导航下手术切除肿瘤并处理癫痫起源部位后癫痫症状消失23例,缓解3例。结论低级别胶质瘤有较高的癫痫发生率,肿瘤切除的同时应重视癫痫起源部位的处理。     

Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: a follow-up from 1990 to 2003

Objectives To assess the long-term survival of brain tumor patients, and in particular to evaluate the relation of quality of life (QOL) to survival among low-grade glioma patients. Methods The postoperative survival of 101 brain tumor patients was followed from surgery (1990–1992) until the end of the year 2003. Depression was evaluated by the Beck Depression Inventory (BDI) and QOL with Sintonen’s 15D scale before operation and at one year as well as at five years after operation. Results The mean survival times in years (SD) were significantly related to tumor malignancy, being the shortest, 1.9 (0.6), for patients with high-grade gliomas, while patients with low-grade gliomas or a benign brain tumor had mean survival times of 9.1 (1.0) and 11.6 (0.5), respectively. At all follow-ups, depressed low-grade glioma patients had a significantly shorter survival time, 3.3–5.8 years, compared to non-depressed low-grade glioma patients, 10.0–11.7 years. A decreased level of QOL in low-grade glioma patients was significantly related to the shorter survival. Conclusions The results suggest that depression and decreased QOL among low-grade glioma patients is related to shorter survival at long-term follow-up. Decreased QOL may serve as an indicator for poor prognosis in low-grade glioma patients.     

Anatomical location differences between mutated and wild-type isocitrate dehydrogenase 1 in low-grade gliomas

Anatomical location of gliomas has been considered as a factor implicating the contributions of a specific precursor cells during the tumor growth. Isocitrate dehydrogenase 1 (IDH1) is a pathognomonic biomarker with a significant impact on the development of gliomas and remarkable prognostic effect. The correlation between anatomical location of tumor and IDH1 states for low-grade gliomas was analyzed quantitatively in this study. Ninety-two patients diagnosed of low-grade glioma pathologically were recruited in this study, including 65 patients with IDH1-mutated glioma and 27 patients with wide-type IDH1. A convolutional neural network was designed to segment the tumor from three-dimensional magnetic resonance imaging images. Voxel-based lesion symptom mapping was then employed to study the tumor location distribution differences between gliomas with mutated and wild-type IDH1. In order to characterize the location differences quantitatively, the Automated Anatomical Labeling Atlas was used to partition the standard brain atlas into 116 anatomical volumes of interests (AVOIs). The percentages of tumors with different IDH1 states in 116 AVOIs were calculated and compared. Support vector machine and AdaBoost algorithms were used to estimate the IDH1 status based on the 116 location features of each patient. Experimental results proved that the quantitative tumor location measurement could be a very important group of imaging features in biomarker estimation based on radiomics analysis of glioma.     

高癎龄癫癎患者智力及生活质量的研究

目的　探讨高癎龄癫癎患者的智力及生活质量。方法　对 12 5例高癎龄癫癎患者进行研究。结果　高癎龄癫癎患者智力不受影响 ,生活质量低于正常人。结论　高癎龄癫癎在给予抗癫癎药物治疗的同时 ,应配合心理治疗 ,以提高其生活质量     

The assessment of prognostic factors in surgical treatment of low-grade gliomas: A prospective study

Objective

A prospective volumetric analysis of extent of resection (EOR) was carried out to assess surgical outcomes in adults diagnosed with hemispheric low grade gliomas (LGGs).

Materials and methods

68 consecutive patients diagnosed with LGGs were enrolled in the study. Pre- and post-operative tumor volumes and EOR were measured based on FLAIR MRI. Dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC MRI) was used for the assessment of relative cerebral blood volume (rCBV). Three outcome measures were assessed: overall survival (OS), progression-free survival (PFS), and malignant degeneration-free survival (MFS).

Results

In 6 (9%) patients permanent neurologic deficits were observed. No statistically significant dependence between the EOR and the occurrence of permanent deficits was found. The eloquent or close to the eloquent location was statistically connected with lower EOR (p = 0.023). The preoperative volume of tumors treated with gross total resection was significantly smaller than the volume of tumors in subtotal or partial resection groups (p = 0.020, p < 0.001, respectively). OS was predicted by age at diagnosis (p = 0.032), and rCBV (p = 0.002). Progression and malignant transformation occurred in 22 (32%) and 11 (16%) out of 68 patients. PFS was predicted by preoperative tumor volume (p = 0.005), postoperative tumor volume (p = 0.008), the EOR (p = 0.001), and by the rCBV (p = 0.033). MFS was predicted by preoperative tumor volume (p = 0.034), the EOR (p p = 0.020), and by rCBV (p = 0.022). Postoperative tumor volume was associated with a trend of improved MFS (p = 0.072). The univariate analysis shows the statistical trend for the relationship between histological subtype and PFS and MFS (p = 0.079, p = 0.078, respectively). Multivariate analysis selected preoperative tumor volume and rCBV as independently associated with PFS (p = 0.009, p = 0.019, respectively) and MFS (p = 0.023, p = 0.035, respectively). EOR was associated with a trend of improved PFS, and MFS (p = 0.069, p = 0.094, respectively).

Conclusions

Tumor resection of LGG with the use of intraoperative monitoring and neuronavigation is associated with a low risk of new permanent deficits, but EOR significantly decreases with the size of the tumor and/or its location in/close to the eloquent areas. Smaller preoperative tumor volume and greater EOR are significantly associated with longer OS, PFS and MFS. Preoperative rCBV is one of the important prognostic factors significantly connected with survival. Prognosis in LGGs is still under discussion. Other factors such as age, histopathological subtype and KPS should not be underestimated.     

Radio-induced low-grade glioma: report of two cases and review of the literature

With the increasing number of cancer survivors, we can observe a population that will present a higher risk of developing secondary long-term toxicities related to adjuvant chemo and radiotherapy regimens. Among these, children surviving from acute lymphoblastic leukemia (ALL) that were treated with prophylactic cranial irradiation represent a group of patients at a high risk of developing secondary brain tumors. Radiation-induced intracranial tumors have been documented since 1950, and today, more than one-hundred cases have been described. We report our experience with two young patients who were hospitalized for low grade gliomas and had a positive anamnesis for ALL and consequent radiotherapy.     

高原军人应对方式特征及其与生活质量的相关分析

目的 了解高原军人的应对方式及其与生存质量的关系。方法 对驻西藏高原某部队485例官兵应用简易应对方式问卷和世界卫生组织生存质量测定量表简表进行调查研究。结果 高原军人采取积极应对方式的比例占23.5％,高于采取消极应对方式的16.2％的比例。最常采取的应对方式是自我安慰占41．2％和克制负性情绪占36.9％;积极应对方式得分与生存质量的生理、心理、社会关系及环境领域得分呈显著正相关,而消极应对得分则呈显著负相关。结论 不同应对方式对生存质量的影响作用不同,积极应对方式有助于高原军人的身心健康,消极应对则有负面影响。     

下丘脑胶质瘤的临床诊疗分析

目的 探讨下丘脑胶质瘤(HG)的临床表现和影像学特点,评估手术疗效和预后.方法 回顾分析南方医院神经外科收治的36例HG患者的临床资料,并行长期随访.结果 囊实性HG多见于毛细胞型星形细胞瘤;钙化多见于星形或少突星形细胞瘤.术后早期内分泌均有不同程度下降,多轴激素缺乏和尿崩发生率,在全切除组和次全切除+部分切除组间差异无统计学意义(P =0.409和0.324).随访期7例肿瘤复发,全切除组3例均为高级别肿瘤,低于次全切除+部分切除组(P =0.022).两组生活质量差异无统计学意义(P =0.421).结论 明确HG临床和影像学特点,有助于术前诊断.手术仍为首选,全切除能降低肿瘤复发率,且未加重术后尿崩和内分泌水平改变.对下丘脑界面不清的病例,以充分减压为基础的次全切除,在减少围术期病死率的同时,能获得较好的临床效果.     

Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke

OBJECTIVE: The aim of the present study was to examine the predictive value of cognitive impairment in the acute phase after stroke as a risk factor for long-term (six to ten months after stroke) depressive symptoms (DS) and a reduced quality of life (QOL), independent of demographic and neurological predictors. METHODS: We evaluated 143 patients within the first 3 weeks post-stroke. Predictor variables included domain-specific cognitive function, demographic data, vascular risk factors, lesion characteristics, and clinical factors. Predictor variables associated with long-term DS (Montgomery Asberg Depression Rating Scale >or=7) and QOL (Stroke-Specific Quality of Life Scale) were identified with multiple logistic and linear regression. RESULTS: Long-term DS were independently predicted by cognitive impairment at baseline, DS at baseline, female sex, diabetes mellitus, and previous TIA(s). Cognitive impairment, increasing age, and functional dependence predicted a reduced QOL, whereas hypercholesterolaemia predicted a better QOL. Among all cognitive disorders, unilateral neglect was the greatest risk factor for DS after 6 months, whereas a disorder in visual perception and construction affected QOL the most. CONCLUSIONS: Cognitive impairment and vascular risk factors are important predictors of long-term DS and QOL after stroke. The prognostic value of cognition suggests a reactive component in the development or continuation of long-term DS.     

B超实时引导在低级别胶质瘤切除术中的应用

目的 探讨B超实时引导在低级别胶质瘤切除术中的应用价值.方法 回顾性分析2012年6月至2016年6月佳木斯市中心医院神经外科收治的72例低级别胶质瘤患者的临床资料.36例行B超实时引导下肿瘤切除术（观察组）,36例行常规术前定位下肿瘤切除术（对照组）.比较两组的手术情况、肿瘤定位准确率、手术全切除率、日常生活活动能力（ADL）量表评分以及Karnofsky功能状态评分（KPS）.结果 观察组的手术时间少于对照组（P＜0.01）.观察组的肿瘤定位准确率、手术全切除率均高于对照组（均P＜0.01）.随访6个月时观察组的ADL评分较治疗前改善[分别为（84.7±8.8）分和（66.4±7.6）分,P ＜0.001],而对照组治疗前、治疗后6个月的ADL评分差异无统计学意义（P＞0.05）.随访6个月时,观察组和对照组的KPS评分[分别为（81.1±7.8）分和（71.4±9.9）分]均较治疗前[分别为（58.1±8.2）分和（56.9±9.2）分]改善（均P＜0.001）,且观察组的改善更为明显（P＜0.01）.结论 B超实时引导应用于低级别胶质瘤切除术中可获得良好的临床效果,可显著缩短手术时间,提高患者的生命质量.     

A scoring system to quantify late effects in children after treatment for medulloblastoma/ependymoma and its correlation with quality of life and neurocognitive functioning

Background  The aim of this study was to quantify the severity of late effects by a simple numerical score (late effects severity score, LESS) in patients who received radiochemotherapy for medulloblastoma or ependymoma. The LESS was correlated with neurocognitive and quality of life (QoL) outcomes. Patients and methods  The LESS was calculated by assigning 0, 1, or 2 points within each of four different categories (neurology, endocrine, visual/auditory, others). Twenty-three patients with medulloblastoma (n = 18) or ependymoma (n = 5) underwent extensive neurocognitive and QoL testing at a median of 56 months (range, 1–174) after the end of treatment. Eight patients with low-grade glioma (LGG) who underwent tumor resection only served as control group. Results  Patients with medulloblastoma/ependymoma had significantly higher LESS and significantly lower Wechsler Adult Intelligence Scale (WAIS)/Wechsler Intelligence Scales for Children (WISC) scores compared to patients with LGG. There was no statistically significant correlation between neurocognitive performance and QoL. The total LESS was negatively correlated with WAIS/WISC, attention, concentration, and verbal learning scores. Comparison of QoL and late effects in patients with medulloblastoma/ependymoma demonstrated a significant negative correlation only for neurological late effects and the KINDL score suggesting that younger patients with more severe late effects reported on a worse QoL. Conclusions  This LESS seems to be a simple and practical tool to quantify late effects in former brain tumor patients. Although both groups differ significantly with regard to neurocognitive parameters and severity of late effects, this does not apply for all QoL outcomes. Neurological late effects seem to be most predictive for an impaired QoL in younger children. The study was presented in part at the 38th Annual Conference of the International Society of Paediatric Oncology SIOP 2006, Geneva, Switzerland, September 18–21, 2006. Katharina Spiegl and Anita Winter contributed equally to this work.     

住院精神分裂症患者生存质量研究

目的：探讨住院精神分裂症患者的生存质量及其影响因素。方法：量表采用MOS健康状况调查问卷(SF-36)、简明精神病评定量表(BPRS)、副反应量表(TESS)、焦虑自评量表(SAS)、抑郁自评量表(SDS)等对125例住院精神分裂症患者进行评定，并与120名正常健康者进行对照。结果：精神分裂症患者SF-36评分显著低于对照组；家庭支持少、病程短、年龄轻、初次住院、住院时间短的患者生存质量差。多因素逐步回归分析显示，影响患者生存质量的主要因素依次为BPRS、SAS、TESS和病程。结论：住院精神分裂症患者的生存质量全面低下，影响因素是多方面的，应予以重视。     

Predictors of quality of life after resective extratemporal epilepsy surgery in adults in long-term follow-up

PurposeTo present long-term outcome and predictors of the health related quality of life (HRQOL) in a large group of patients operated for refractory extratemporal epilepsy.MethodsA German QOLIE-31 questionnaire and additional questions has been mailed for all adult patients operated for extratemporal epilepsy in the Bethel Epilepsy Centre, between 1992 and 2003, 87 patients were eligible for this study.ResultsSeizure freedom, intake of antiepileptic drugs (AEDs), presence of AEDs side effect medical comorbidities and driving a car were significantly correlated to HRQOL in all subscales of QOLIE-31. Gender, age at epilepsy onset, the presence of a partner, psychiatric disease, the presence of auras and tumour pathology have a correlation to QOL in some subscales.Stepwise regression for all patients revealed that seizure freedom and medical comorbidities were highly predictive for most of the subscales of QOLIE-31. Intake of anti-epileptic drugs and AED side effects had a modest effect on QOL. The need for psychiatric treatment predicted poor cognitive function scores. Epilepsy onset at an older age predicted a minimal increase in the overall health scores. An aura at the last follow-up predicted poor medication scores.Regarding the importance of the predictors, seizure freedom and medical comorbidities were the most important predictors of QOL after surgery. AED intake and side effects had an intermediate effect on QOL; however, the gender of the patient and age at epilepsy onset had a minimal effect on QOL.ConclusionsHRQOL after extratemporal epilepsy surgery has multiple determinants. Medical comorbidities should be considered a negative risk factor for QOL during preoperative and postoperative evaluation process.