Emerging methods for disease monitoring in malignant gliomas

Ambady, Prakash; Bettegowda, Chetan; Holdhoff, Matthias

doi:10.2217/cns.13.44

Cited by 11 publications

(9 citation statements)

References 78 publications

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“…pseudoprogression, pseudoresponse and radiation necrosis. [55][56][57] The concept of radiogenomics takes quantitative imaging features and their impact on the clinical outcome into consideration while underlying aetiological and tumour-biological mechanisms are considered in the second step. With an increasing number of evolving imaging modalities from research towards clinical practice, there is growing need to carefully assess their practical use and to compare the additional benefit relative to the standard imaging, in an effort to complement and not to replace.…”

Section: New Therapeutic Strategiesmentioning

confidence: 99%

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

Neubeck¹,

Seidlitz²,

Kitzler³

et al. 2015

BJR

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Glioblastoma multiforme (GBM) is the most common primary brain tumour in adults. The standard therapy for GBM is maximal surgical resection followed by radiotherapy with concurrent and adjuvant temozolomide (TMZ). In spite of the extensive treatment, the disease is associated with poor clinical outcome. Further intensification of the standard treatment is limited by the infiltrating growth of the GBM in normal brain areas, the expected neurological toxicities with radiation doses .60 Gy and the dose-limiting toxicities induced by systemic therapy. To improve the outcome of patients with GBM, alternative treatment modalities which add low or no additional toxicities to the standard treatment are needed. Many Phase II trials on new chemotherapeutics or targeted drugs have indicated potential efficacy but failed to improve the overall or progression-free survival in Phase III clinical trials. In this review, we will discuss contemporary issues related to recent technical developments and new metabolic strategies for patients with GBM including MR (spectroscopy) imaging, (amino acid) positron emission tomography (PET), amino acid PET, surgery, radiogenomics, particle therapy, radioimmunotherapy and diets.

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Section: New Therapeutic Strategiesmentioning

confidence: 99%

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

Neubeck¹,

Seidlitz²,

Kitzler³

et al. 2015

BJR

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“…Presently, the evaluating system includes imaging studies such as magnetic resonance imaging (MRI) and computed tomography (CT) scan, cytologic test, and immunophenotypic biomarkers. The subclinical CNS tumor sites may remain undetected by conventional contrast-enhanced MRI scanning behind an intact neurovascular unit or blood-cerebrospinal fluid barrier, due to contrast enhancement is related to blood-brain barrier (BBB) integrity rather than actual tumor size,6,7 Then, it is difficult to make a definitive diagnosis of lymphoma CNS metastasis 8. Based on imaging techniques, the differential diagnoses also include glioma, multiple sclerosis, acute disseminated encephalomyelitis 9,10.…”

Section: Introductionmentioning

confidence: 99%

“…In order to improve the diagnostic efficacy, there is emerging interest in finding new biomarkers, such as circulating tumor cells (CTC), proteins, as well as micro-RNA and DNA 7,12,13. CNS disease typically developed within a few months before the initial clinical presentation, raising the question: whether occult CNS localization was already present at the time of diagnosis 14.…”

Section: Introductionmentioning

confidence: 99%

<p>Biomarkers Reflecting The Destruction Of The Blood-Brain Barrier Are Valuable In Predicting The Risk Of Lymphomas With Central Nervous System Involvement</p>

et al. 2019

OTT

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ObjectiveWe aimed to identify the biomarkers in cerebrospinal fluid (CSF) that facilitate the diagnosis of lymphomas with central nervous system (CNS) involvement.MethodsFour cases of non-Hodgkin’s lymphoma (NHL) patients with/without CNS involvement were enrolled respectively, and non-CNS tumor patients (n=3) were selected to be the controls. Lab biomarkers, cytokines, and tight junction proteins (TJs) in CSF and serum were measured.ResultsWhen comparing the CNS to non-CNS group, cytokine including MMP-9 (15.24 vs 0.36 ng/mL), CCL-2 (1922.04 vs 490.68 pg/mL), and sVCAM-1 (61.36 vs 9.00 pg/mL), TJs including OCLN (6.68 vs 2.59 pg/mL), and ZO-1 (710.04 vs 182.98 pg/mL) in CSF were significantly higher in lymphomas patients with CNS involvement than those without CNS involvement. However, serum biomarkers were not significantly elevated. Contrary to the major findings, all conventional biomarkers and MRI results showed no significant change.ConclusionCSF biomarkers affecting BBB disruption are valuable in mirroring the risk of lymphoma CNS metastasis. Further study with a larger sample size is needed to verify these biomarkers in predicting lymphoma CNS involvement.

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“…This is often challenging as treatment-related changes, commonly referred to as “pseudo-progression”, occur in 20–30% of patients and at a higher rate in patients with MGMT promoter methylation [ 1 – 5 ]. Unfortunately, contrast enhanced magnetic resonance imaging (MRI) as well as other advanced imaging techniques are currently unable to reliably differentiate true tumor progression from pseudo-progression [ 4 – 6 ]. As a result, the “gold standard” for assessment of disease status in many cases of presumed progression of glioblastoma rests on histopathological assessment.…”

Section: Introductionmentioning

confidence: 99%

The consistency of neuropathological diagnoses in patients undergoing surgery for suspected recurrence of glioblastoma

Holdhoff

Piotrowski

et al. 2018

J Neurooncol

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PurposeClinical factors and neuro-imaging in patients with glioblastoma who appear to progress following standard chemoradiation are unable to reliably distinguish tumor progression from pseudo-progression. As a result, surgery is commonly recommended to establish a final diagnosis. However, studies evaluating the pathologists’ agreement on pathologic diagnoses in this setting have not been previously evaluated.MethodsA hypothetical clinical history coupled with images of histological sections from 13 patients with glioblastoma who underwent diagnostic surgery for suspected early recurrence were sent to 101 pathologists from 50 NCI-designated Cancer Centers. Pathologists were asked to provide a final diagnosis (active tumor, treatment effect, or unable to classify) and to report on percent active tumor, treatment effect, and degree of cellularity and degree of mitotic activity.ResultsForty-eight pathologists (48%) from 30 centers responded. In three cases > 75% of pathologists diagnosed active tumor. In two cases > 75% diagnosed treatment effect. However, in the remaining eight cases the disparity in diagnoses was striking (maximum agreement on final diagnosis ranged from 36 to 68%). Overall, only marginal agreement was observed in the overall assessment of disease status [kappa score 0.228 (95% CI 0.22–0.24)].ConclusionsConfidence in any clinical diagnostic assay requires that very similar results are obtained from identical specimens evaluated by sophisticated clinicians and institutions. The findings of this study illustrate that the diagnostic agreement between different cases of repeat resection for suspected recurrent glioblastoma can be variable. This raises concerns as pathological diagnoses are critical in directing standard and experimental care in this setting.Electronic supplementary materialThe online version of this article (10.1007/s11060-018-03037-3) contains supplementary material, which is available to authorized users.

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Emerging methods for disease monitoring in malignant gliomas

Cited by 11 publications

References 78 publications

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

Glioblastoma multiforme: emerging treatments and stratification markers beyond new drugs

<p>Biomarkers Reflecting The Destruction Of The Blood-Brain Barrier Are Valuable In Predicting The Risk Of Lymphomas With Central Nervous System Involvement</p>

The consistency of neuropathological diagnoses in patients undergoing surgery for suspected recurrence of glioblastoma

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