Tufts Medical Center Experience With Long-Term Follow-Up of Vestibular Schwannoma Treated With Gamma Knife Stereotactic Radiosurgery: Novel Finding of Delayed Pseudoprogression

Wage, J.L.; Mignano, John E.; Wu, Julian K.

doi:10.1016/j.adro.2021.100687

Cited by 6 publications

(5 citation statements)

References 47 publications

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“…Treatment failure can occur as late as 10 years after SRS, which is one reason for encouraging continued radiographic surveillance (47,48). In the current report and elsewhere, SRS treatment failure was defined as those patients requiring further therapeutic intervention because of continued tumor growth and progressive symptoms at least 2 years after the date of treatment or because of growth without progressive symptoms after 5 years (49–51). The authors do acknowledge that there is no clear consensus on the criteria for the diagnosis of SRS treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Cochlear Implantation and Salvage Translabyrinthine Resection of Vestibular Schwannoma after Radiotherapy

et al. 2023

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ObjectiveTo report on the novel use of simultaneous cochlear implantation (CI) during salvage translabyrinthine resection of vestibular schwannoma (VS) after failed stereotactic radiosurgery (SRS).PatientA 52-year-old woman presented with a medium-sized right VS. She experienced continued tumor growth despite previous SRS, resulting in medial extension beyond the internal auditory canal into the cerebellopontine angle. Associated symptoms included asymmetrical right moderate to severe sensorineural hearing loss, poor word recognition, tinnitus, and dizziness.InterventionSimultaneous CI with translabyrinthine VS resection.Main outcome measureCI-aided pure-tone averages.ResultsAfter 4 months of device use, CI-aided speech audiometry revealed hearing thresholds in the normal range, with a four-tone pure-tone, average of 16.3 dB. Speech perception with consonant-nucleus-consonant testing in the CI-only condition was 46%, representing a 12% improvement compared with preoperatively. Tinnitus and dizziness burden were subjectively reduced.ConclusionsDespite challenges inherent to second procedures after radiotherapy failure, successful CI outcomes can be achieved. The current study demonstrates the feasibility of simultaneous CI during salvage VS resection after SRS. A larger study should be undertaken to further substantiate these preliminary findings.

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Section: Discussionmentioning

confidence: 99%

Simultaneous Cochlear Implantation and Salvage Translabyrinthine Resection of Vestibular Schwannoma after Radiotherapy

et al. 2023

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“…The predictors that have been identified include radiation dose, tumor volume, appearance in MR images (solid vs cystic), and radiomic features. [1][2][3][6][7][8] Nonetheless, these results have been inconclusive and contradictory. In this study, our results revealed that some radiological features were associated with pseudoprogression/ fluctuation after GKRS and could be used as predictors of pseudoprogression.…”

Section: Discussionmentioning

confidence: 99%

“…Potential predictors include radiation dose, tumor volume, appearance in magnetic resonance (MR) images (solid vs cystic VS), and radiomic features. [1][2][3][6][7][8] However, these results have been inconclusive and contradictory. Moreover, most previous studies focused on the radiological features of entire tumor.…”

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confidence: 99%

Association Between Pseudoprogression of Vestibular Schwannoma After Radiosurgery and Radiological Features of Solid and Cystic Components

et al. 2023

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BACKGROUND AND OBJECTIVES: The pathophysiology of vestibular schwannoma (VS) pseudoprogression after Gamma Knife radiosurgery (GKRS) remains unclear. Radiological features in pretreatment magnetic resonance images may help predict VS pseudoprogression. This study used VS radiological features quantified using an automated segmentation algorithm to predict pseudoprogression after GKRS treatment. METHODS: This is a retrospective study comprising 330 patients with VS who received GKRS. After image preprocessing and T2W/contrast-enhanced T1-weighted image (CET1W) image generation, with fuzzy C-means clustering, VSs were segmented into solid and cystic components and classified as solid and cystic. Relevant radiological features were then extracted. The response to GKRS was classified into “nonpseudoprogression” and “pseudoprogression/fluctuation”. The Z test for two proportions was used to compare solid and cystic VS for the likelihood of pseudoprogression/fluctuation. Logistic regression was used to assess the correlation between clinical variables and radiological features and response to GKRS. RESULTS: The likelihood of pseudoprogression/fluctuation after GKRS was significantly higher for solid VS compared with cystic VS (55% vs 31%, P < .001). For the entire VS cohort, multivariable logistic regression revealed that a lower mean tumor signal intensity (SI) in T2W/CET1W images was associated with pseudoprogression/fluctuation after GKRS (P = .001). For the solid VS subgroup, a lower mean tumor SI in T2W/CET1W images (P = .035) was associated with pseudoprogression/fluctuation after GKRS. For the cystic VS subgroup, a lower mean SI of the cystic component in T2W/CET1W images (P = .040) was associated with pseudoprogression/fluctuation after GKRS. CONCLUSION: Pseudoprogression is more likely to occur in solid VS compared with cystic VS. Quantitative radiological features in pretreatment magnetic resonance images were associated with pseudoprogression after GKRS. In T2W/CET1W images, solid VS with a lower mean tumor SI and cystic VS with a lower mean SI of cystic component were more likely to have pseudoprogression after GKRS. These radiological features can help predict the likelihood of pseudoprogression after GKRS.

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“…As shown in Figure 6(d), we also observe that pseudo-progression occurs after tumor transient reduction with the initial value (u 0 , x 0 , y 0 )= (0.4, 0.05, 0.05). Indeed, we find the clinical case of this in [39]. In section 4, mouse data are used to fit model parameters, but there may be more complex situations in human body.…”

Section: Existence Stability and Bifurcation Analysis Of Positive Equ...mentioning

confidence: 99%

Mathematical investigation of the role of re-polarisation of M2 in cancer therapy

Guo

Fan

Wang

2023

DCDS-B

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<p style='text-indent:20px;'>Tumor-associated macrophages are one of the important immune cells in tumor microenvironment and they have both anti-tumor and pro-tumor roles as determined by their phenotypes. Recent experiments have shown that repolarizing pro-tumor M2 into anti-tumor M1 is a feasible antitumor therapy. Here we propose a mathematical model for the tumor-macrophage interactions with M2 re-polarisation delay to investigate the effect of M2 re-polarisation on tumor growth/decay. By using stability and bifurcation theories of DDE, we study the dynamic of this model analytically and numerically and find that the varies of M2 re-polarisation rate and time delay can cause complex dynamical behaviors such as the changes of stabilities of tumor-free, large and small tumor equilibria, the occurrences of saddle-node, Hopf, homoclinic and B-T bifurcation, etc. Moreover, our study reveals that the increase of M2 re-polarisation rate related to immunotherapeutic agent dose can control the tumor to small tumor dormancy and even eliminate the tumor, but this is not always available when immune escape occurs; Pharmacodynamic delay (M2 re-polarisation delay) also affects tumor progression and may cause persistent oscillatory behavior. In addition, the results also indicate the possibility of pseudo-progression in tumor therapy and efficacy of postoperative M2 re-polarisation therapy to prevent tumor recurrence.</p>

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Tufts Medical Center Experience With Long-Term Follow-Up of Vestibular Schwannoma Treated With Gamma Knife Stereotactic Radiosurgery: Novel Finding of Delayed Pseudoprogression

Cited by 6 publications

References 47 publications

Simultaneous Cochlear Implantation and Salvage Translabyrinthine Resection of Vestibular Schwannoma after Radiotherapy

Simultaneous Cochlear Implantation and Salvage Translabyrinthine Resection of Vestibular Schwannoma after Radiotherapy

Association Between Pseudoprogression of Vestibular Schwannoma After Radiosurgery and Radiological Features of Solid and Cystic Components

Mathematical investigation of the role of re-polarisation of M2 in cancer therapy

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