Brainstem Glioma in Adults

Hu, Jethro; Western, Stephen; Kesari, Santosh

doi:10.3389/fonc.2016.00180

Cited by 48 publications

(47 citation statements)

References 43 publications

(51 reference statements)

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“…Brainstem tumors are, in general, considered to be risky for biopsy or surgical intervention and thus difficult to manage . In a brainstem tumor in the present study (Figure ).…”

Section: Discussionmentioning

confidence: 69%

Measurement of glycine in healthy and tumorous brain by triple‐refocusing MRS at 3 T in vivo

Tiwari

Ganji

et al. 2017

NMR in Biomedicine

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Glycine (Gly) is implicated in several neurological disorders, including malignant brain tumors. Precise measurement of Gly is challenging largely due to the spectral overlap with myo-inositol (mI). We report a new triple-refocusing sequence for reliable co-detection of Gly and mI at 3T and evaluation of Gly in healthy and tumorous brain. The sequence parameters were optimized with density-matrix simulations and phantom validation. With a total TE of 134 ms, the sequence gave complete suppression of mI signal between 3.5 and 3.6 ppm and consequently well-defined Gly (3.55 ppm) and mI (3.64 ppm) peaks. In-vivo 1H MRS data were acquired from the gray-matter (GM) dominant medial-occipital and white-matter (WM) dominant left-parietal regions in six healthy subjects and analyzed with LCModel using in-house calculated basis spectra. Tissue segmentation was performed to obtain the GM and WM contents within the MRS voxels. Metabolites were quantified with reference to GM-rich medial occipital total creatine at 8 mM. The Gly and mI concentrations were estimated to be 0.63±0.05 and 8.6±0.6 mM for medial occipital and 0.34±0.05 and 5.3±0.8 mM for left parietal, respectively. From linear regression of the metabolite estimates versus fractional GM content, the concentration ratio between pure GM and pure WM was estimated as 2.6 and 2.1 for Gly and mI, respectively. Clinical application of the optimized sequence was performed in four subjects with brain tumor. The Gly levels in tumors were higher compared to healthy brain. Gly elevation was more extensive in a post-contrast enhancing region than in a non-enhancing region. Data indicated that the optimized triple-refocusing sequence may provide reliable co-detection of Gly and mI and alterations of Gly in brain tumors can be precisely evaluated.

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“…Brainstem tumors are, in general, considered to be risky for biopsy or surgical intervention and thus difficult to manage . In a brainstem tumor in the present study (Figure ).…”

Section: Discussionmentioning

confidence: 69%

Measurement of glycine in healthy and tumorous brain by triple‐refocusing MRS at 3 T in vivo

Tiwari

Ganji

et al. 2017

NMR in Biomedicine

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“…Brainstem gliomas account for about 20% of primary brain tumors in children and for <2% of gliomas in adult patients (1)(2)(3). Gliomas of the brainstem are most commonly located in the pons, but are also found in the mesencephalon, the cerebellar peduncles or the medulla oblongata (4).…”

mentioning

confidence: 99%

Rotating Gamma System Irradiation: A Promising Treatment for Low-grade Brainstem Gliomas

Phương

Hưng

Ngoc

et al. 2018

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Brainstem gliomas account for about 20% of primary brain tumors in children and for <2% of gliomas in adult patients (1-3). Gliomas of the brainstem are most commonly located in the pons, but are also found in the mesencephalon, the cerebellar peduncles or the medulla oblongata (4). A tumor located in the brainstem can be associated with severe clinical or even life-threatening symptoms, since this part of the brain regulates motion functions, as well as respiratory and circulatory functions. Such tumors include low-and high-grade lesions. The median survival time for patients with a brainstem glioma is about 10 months in children and 30-40 months in adult patients (5). The prognosis depends on the grade according to the World Health Organization (WHO) (6). In a retrospective study from the United States, median survival was 77 months for patients with WHO grade II lesions, 21 months for those with grade III lesions and 15 months for those with grade IV lesions (5). A great amount of research has been carried out on the treatment of higher grade (III or IV) lesions, whereas fewer data are available for patients with low-grade (grade II) gliomas (7-11). Therefore, the present study focused on low-grade gliomas of the brainstem and aimed to provide additional data for this less common situation.Since complete surgical resection is not safely possible in many of these patients, radiotherapy is the most common treatment. In order to allow for optimal sparing of normal tissues and structures surrounding the tumor, radiotherapy of brainstem gliomas should ideally be performed with highprecision techniques such as intensity-modulated radiotherapy, fractionated stereotactic radiation therapy or stereotactic radiosurgery (SRS). SRS is defined as singlefraction treatment, mostly performed with a linear accelerator or a gamma system. Two gamma systems are used for radiosurgery of cerebral lesions, including those located in the brainstem. The classic Gamma-Knife was already introduced about 50 years ago by Lars Leksell (12). The other system, the rotating gamma system (RGS), was developed in the late 1990s (13). The latter system includes technical features of the classic Gamma-Knife (Cobalt-60 sources) and linear acceleratorbased radiosurgery (a rotating gantry). Although radiosurgery with a gamma system appears to be a reasonable option for 957

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“…When biopsy is performed, a low-grade histology (gradeⅡglioma) is found in most cases, whereas in children a grade Ⅳglioma is the most frequent phenotype, which accounts for the better prognosis of the adult cases [4]. Radiation therapy with a dose of 54 Gy to 60 Gy is considered standard upfront therapy [3]. However, no literature in the past has ever reported complete remission by radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

“…The median survival time for adult brainstem glioma is 30 months to 40 months, while pediatric Diffuse Intrinsic Pontine Glioma (DIPG) is associated with a dismal prognosis of 10 months to 12 months [2]. Resection is often not possible, and even biopsies are challenging and with significant risk for complications [3]. When biopsy is performed, a low-grade histology (gradeⅡglioma) is found in most cases, whereas in children a grade Ⅳglioma is the most frequent phenotype, which accounts for the better prognosis of the adult cases [4].…”

Section: Introductionmentioning

confidence: 99%

“…According to the report from Central Brain Tumor Registry of the USA, brainstem tumors account for 2.0% of all primary Central Nervous System (CNS) tumors, 3.6% of all malignant CNS tumors, and 4.3% of CNS glioma [1]. The median survival time for adult brainstem glioma is 30 months to 40 months, while pediatric Diffuse Intrinsic Pontine Glioma (DIPG) is associated with a dismal prognosis of 10 months to 12 months [2].…”

Section: Introductionmentioning

confidence: 99%

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