Do we need dosimetry for optimization of theranostics in CNS tumors?

Radiopharmaceutical theranostic treatments have grown exponentially worldwide, and internal dosimetry has attracted attention and resources. Despite some similarities with chemotherapy, radiopharmaceuticals treatments are essentially radiotherapy treatments, as the release of radiation into tissues is the determinant of the observed clinical effects. Therefore, absorbed dose calculations are key to explain dose-effect correlations and to individualize radiopharmaceutical treatments. The present article introduces the basic principles of internal dosimetry and provides an overview of available locoregional and systemic radiopharmaceutical treatments for CNS tumors. The specific characteristics of dosimetry as applied to these treatments are highlighted, along with their limitations and most relevant results. Dosimetry is performed with higher precision and better reproducibility than in the past, and dosimetric data should be systematically collected, as treatment planning and verification may help exploit the full potential of theranostic of CNS tumors.

Purines and purinergic receptors in primary tumors of the central nervous system.

Purine nucleotides and nucleosides play critical roles in various pathological conditions, including tumor cell growth. Adenosine triphosphate (ATP) activates pro-tumor receptors, while adenosine (ADO) is a potent immunosuppressant and modulator of cell growth. This study aims to analyze the purinergic actions of ATP and its metabolites, associated enzymes, and P1 or P2 class receptors in primary central nervous system tumors. Additionally, we sought to correlate the levels of nucleosides and the density of P1, P2X, and P2Y receptors in cells with tumor progression. The results indicate that purinergic signaling depends on the receptor concentration and signaling molecules specific to each cell type, tissue, and tumor histology. The purinergic system may function as either a tumor-promoting agent or an antitumor factor, depending on the microenvironmental conditions and the concentrations of receptors and their respective activators. Notably, ATP emerges as the most significant extracellular signal, capable of being converted into other cellular stimulators pertinent to neoplasms, such as adenosine diphosphate, adenosine monophosphate, adenosine, and inosine. Consequently, a cascade of responses to these stimuli promotes tumor development, cell division, and metastasis. Purine nucleotides in central nervous system tumors are pivotal in cellular responses in glioblastoma multiforme, vestibular schwannoma, medulloblastoma, adenomas, gliomas, meningiomas, and pineal tumors. These findings hold the potential for developing novel therapeutic strategies and aiding in therapeutic management.

Psychosocial Impact of Brain Tumors: A Cross-Sectional Study on Existential Anxiety in Saudi Arabian Patients.

Background Existential anxiety is a significant concern for patients with life-threatening illnesses like brain tumors. This study explores the prevalence and impact of existential anxiety among brain tumor patients in Saudi Arabia, examining relationships between demographic, clinical, and psychological variables and death anxiety. Methods A cross-sectional study was conducted with 120 brain tumor patients from inpatient and outpatient settings at King Abdulaziz University Hospital, King Fahad Hospital, and King Abdullah Medical Complex in Saudi Arabia. Data were collected using the Death Anxiety Scale (DAS), Spiritual Well-Being Scale (SWBS), Meaning in Life Questionnaire (MLQ), and the 12-item Short Form Survey (SF-12). Descriptive and inferential statistics analyzed the relationships between variables. Results Females exhibited significantly higher DAS scores (77.9 ± 14.2) compared to males (48.5 ± 19.4) (p < 0.001). Educational attainment was inversely related to DAS, with illiterate patients scoring highest (83 ± 13.5) and those with higher education scoring lowest (47.3 ± 18.2) (p < 0.001). Widowed patients had higher anxiety (68.5 ± 22.1) compared to married (51.4 ± 21.5) and single patients (50 ± 12) (p < 0.001). Monthly income showed an inverse relationship with DAS. Patients with chronic medical conditions reported lower DAS scores compared to those without (p = 0.004). The tumor stage significantly influenced DAS, with third-stage patients showing lower anxiety than those in the first and second stages (p < 0.001). Longer duration since diagnosis was associated with lower DAS scores (p = 0.03). Conclusion This study highlights the significant psychosocial impact of brain tumors on Saudi Arabian patients, emphasizing the need to address demographic factors in managing death anxiety. Findings indicate that chronic medical conditions and advanced tumor stages might be associated with lower anxiety, revealing potential resilience factors. The positive influence of spiritual well-being and meaning in life on quality of life underscores the importance of holistic care approaches. Integrating psychological and spiritual support tailored to individual patient demographics could enhance management strategies and improve patient outcomes. Future research should explore longitudinal changes in existential anxiety, the role of cultural factors, and the effectiveness of holistic interventions in reducing anxiety and improving quality of life.

Enhancing brain tumor detection in MRI images using YOLO-NeuroBoost model.

Brain tumors are diseases characterized by abnormal cell growth within or around brain tissues, including various types such as benign and malignant tumors. However, there is currently a lack of early detection and precise localization of brain tumors in MRI images, posing challenges to diagnosis and treatment. In this context, achieving accurate target detection of brain tumors in MRI images becomes particularly important as it can improve the timeliness of diagnosis and the effectiveness of treatment. To address this challenge, we propose a novel approach-the YOLO-NeuroBoost model. This model combines the improved YOLOv8 algorithm with several innovative techniques, including dynamic convolution KernelWarehouse, attention mechanism CBAM (Convolutional Block Attention Module), and Inner-GIoU loss function. Our experimental results demonstrate that our method achieves mAP scores of 99.48 and 97.71 on the Br35H dataset and the open-source Roboflow dataset, respectively, indicating the high accuracy and efficiency of this method in detecting brain tumors in MRI images. This research holds significant importance for improving early diagnosis and treatment of brain tumors and provides new possibilities for the development of the medical image analysis field.

Comparing Knowledge and Perceptions of Palliative Care Among Neuro-Oncology Patients, Caregivers, and Providers to a Representative U.S. Sample.

BACKGROUND: Primary brain tumors (PBTs) pose a significant health challenge, affecting patients and their caregivers. While early integration of palliative care (PC) has shown benefits in advanced cancer, its integration for PBT patients, particularly glioblastoma (GBM) patients, remains complex. We hypothesized that our previous PC integration efforts may have failed due to knowledge-gaps and misconceptions among patients, caregivers, and providers. OBJECTIVE: This study aimed to identify knowledge gaps and misconceptions about PC among patients with primary brain tumors (PBTs), their caregivers, and their medical providers. METHOD: An electronic survey was distributed to PBT patients, caregivers, and medical providers, that included questions regarding PC from the Health Information National Trends Survey (HINTS). Survey responses were analyzed; comparisons were made between the 3 groups as well as the general population. RESULTS: Of 141 respondents (59 patients, 57 caregivers, and 25 providers), each group held perspectives on PC differing from the general population. While all groups had an improved understanding of PC's role in symptom management, uncertainty persisted among patients and caregivers regarding life-prolonging treatment and certain PC goals like caregiver support or end-of-life care. CONCLUSION: Understanding gaps in knowledge and perceptions of PC among PBT patients and caregivers is crucial for effective intervention, with caregivers playing a vital role in advocating for PC. Future research should explore factors influencing these perceptions and development of targeted education to improve early PC referrals for patients with PBTs.

Brain tumor image segmentation method using hybrid attention module and improved mask RCNN.

To meet the needs of automated medical analysis of brain tumor magnetic resonance imaging, this study introduces an enhanced instance segmentation method built upon mask region-based convolutional neural network. By incorporating squeeze-and-excitation networks, a channel attention mechanism, and concatenated attention neural network, a spatial attention mechanism, the model can more adeptly focus on the critical regions and finer details of brain tumors. Residual network-50 combined attention module and feature pyramid network as the backbone network to effectively capture multi-scale characteristics of brain tumors. At the same time, the region proposal network and region of interest align technology were used to ensure that the segmentation area matched the actual tumor morphology. The originality of the research lies in the deep residual network that combines attention mechanism with feature pyramid network to replace the backbone based on mask region convolutional neural network, achieving an improvement in the efficiency of brain tumor feature extraction. After a series of experiments, the precision of the model is 90.72%, which is 0.76% higher than that of the original model. Recall was 91.68%, an increase of 0.95%; Mean Intersection over Union was 94.56%, an increase of 1.39%. This method achieves precise segmentation of brain tumor magnetic resonance imaging, and doctors can easily and accurately locate the tumor area through the segmentation results, thereby quickly measuring the diameter, area, and other information of the tumor, providing doctors with more comprehensive diagnostic information.

Unveiling the neuroplastic capacity of the bilingual brain: insights from healthy and pathological individuals.

Research on the neural imprint of dual-language experience, crucial for understanding how the brain processes dominant and non-dominant languages, remains inconclusive. Conflicting evidence suggests either similarity or distinction in neural processing, with implications for bilingual patients with brain tumors. Preserving dual-language functions after surgery requires considering pre-diagnosis neuroplastic changes. Here, we combine univariate and multivariate fMRI methodologies to test a group of healthy Spanish-Basque bilinguals and a group of bilingual patients with gliomas affecting the language-dominant hemisphere while they overtly produced sentences in either their dominant or non-dominant language. Findings from healthy participants revealed the presence of a shared neural system for both languages, while also identifying regions with distinct language-dependent activation and lateralization patterns. Specifically, while the dominant language engaged a more left-lateralized network, speech production in the non-dominant language relied on the recruitment of a bilateral basal ganglia-thalamo-cortical circuit. Notably, based on language lateralization patterns, we were able to robustly decode (AUC: 0.80 ± 0.18) the language being used. Conversely, bilingual patients exhibited bilateral activation patterns for both languages. For the dominant language, regions such as the cerebellum, thalamus, and caudate acted in concert with the sparsely activated language-specific nodes. In the case of the non-dominant language, the recruitment of the default mode network was notably prominent. These results demonstrate the compensatory engagement of non-language-specific networks in the preservation of bilingual speech production, even in the face of pathological conditions. Overall, our findings underscore the pervasive impact of dual-language experience on brain functional (re)organization, both in health and disease.

Identifying research priorities and essential elements of palliative care services for people facing malignant brain tumors: A participatory co-design approach.

Background: Primary malignant brain tumors (ie, brain cancer) impact the quality of life (QoL) for patients and care partners in disease-specific ways involving cognition and communication. Palliative care (PC) addresses patient/care partner QoL, but it is not known how PC may address the unique needs of brain cancer patients. The purpose of this project was to identify brain cancer PC research priorities using participatory co-design methods. Methods: Participatory co-design included the formation of a longitudinal, collaborative advisory group, engagement frameworks, design-thinking processes, and social media-based engagement over a 1-year period. Community-identified brain cancer QoL needs and research priorities were mapped to proposed "essential elements" of brain cancer PC services. Results: We engaged an estimated 500 patients, care partners, healthcare professionals, and others with an interest in QoL and PC services for people with malignant brain tumors. Research priorities included testing the early introduction of PC services designed to address the unique QoL needs of brain cancer patients and care partners. Essential elements of brain cancer PC include: (1) addressing brain cancer patients' unique range of QoL needs and concerns, which change over time, (2) tailoring existing services and approaches to patient needs and concerns, (3) enhancing the involvement of interprofessional care team members, and (4) optimizing timing for PC services. This was the first participatory research effort exploring brain cancer patient and care partner QoL needs and PC services. Conclusions: The brain tumor community calls for research testing PC service models for patients that incorporate the "essential elements" of palliative care.

Primary Malignant Meningeal Melanoma Complicated by Cerebral Venous Sinus Thrombosis: An Illustrative Case With a Systematic Review of the Literature.

Melanocytic tumors of the central nervous system (CNS) such as meningeal melanoma are exceedingly rare tumours derived from leptomeningeal melanocytes. We report an illustrative case of a previously healthy 47-year-old male who presented with tonic-clonic seizure. Magnetic resonance imaging (MRI) with contrast demonstrated a homogenously enhancing right temporal extra-axial lesion. The patient was stabilized on anti-epileptic medications and dexamethasone prior to proceeding with complete surgical resection of the lesion. Intraoperatively, the lesion was heavily pigmented with invasion of the surrounding dura and skull. Histopathology revealed a poorly differentiated neoplasm with nuclear atypia and melanin-containing cells with strong SOX10 and variable S100 positivity. Computed tomography (CT) of the chest, abdomen, and pelvis showed no metastatic disease, and molecular profiling was negative including absent BRAF mutation. He began checkpoint inhibitor therapy and subsequently developed cerebral venous sinus thrombosis managed with anticoagulation. Sixteen months post-operatively, he was neurologically intact, working full-time, and had resumed immunotherapy. We systematically reviewed the literature on primary intracranial malignant melanoma (PIMM) with the goal of understanding the prognosis and best treatment options for this disease. Our systematic review produced 82 articles (118 unique cases) of PIMM. The average age at diagnosis was 45.9 years (95% CI:42.9-48.9), and headache (54.2%) was the most common initial presentation. Eighty-nine percent of patients had primary surgical resection, and 41.0% of these individuals experienced a recurrence with a mean time to recurrence of 19.6 months (95% CI:6.95-32.23). Adjuvant therapy was administered in 65.7% of surgically resected patients; including radiotherapy, chemotherapy, immunotherapy, or a combination. In summary, PIMM is a rare tumour that can appear radiographically similar to meningioma. The results of our systematic review demonstrate that surgical resection remains the mainstay of therapy for best long-term prognosis.

Multiple Glioblastomas Ablation by Laser Interstitial Thermal Therapy (LITT): A Rare Case.

Multiple glioblastomas (GBMs) are aggressive, malignant, and sporadic brain tumors. We present the case of a 58-year-old patient with two GBMs in the right frontal lobe and associated edema. The patient presented with sudden left limb weakness accompanied by abnormal gait for five consecutive days. Magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT), a minimally invasive technique that disperses thermal energy was used to cauterize the deep-seated brain lesions. Following two sessions of MRg-LITT, the patient showed full remission from symptoms. However, the disruption of the blood-brain barrier (BBB) induced vasogenic edema surrounding the necrotic GBMs. Post-operative nine-month MRI images revealed severe vasogenic edema and compression on the ventricles, shifting the midline toward the left side. Therefore the patient underwent an emergency craniectomy and continues to live with close follow-ups. Here, we established that LITT procedures were effective in cauterizing GBMs with no recurrence.

A Comprehensive Review on the Role of MRI in the Assessment of Supratentorial Neoplasms: Comparative Insights Into Adult and Pediatric Cases.

Magnetic resonance imaging (MRI) is a critical diagnostic tool in assessing supratentorial neoplasms, offering unparalleled detail and specificity in brain imaging. Supratentorial neoplasms in the cerebral hemispheres, basal ganglia, thalamus, and other structures above the tentorium cerebelli present significant diagnostic and therapeutic challenges. These challenges vary notably between adult and pediatric populations due to differences in tumor types, biological behavior, and patient management strategies. This comprehensive review explores the role of MRI in diagnosing, planning treatment, monitoring response, and detecting recurrence in supratentorial neoplasms, providing comparative insights into adult and pediatric cases. The review begins with an overview of the epidemiology and pathophysiology of these tumors in different age groups, followed by a detailed examination of standard and advanced MRI techniques, including diffusion-weighted imaging (DWI), perfusion-weighted imaging (PWI), and magnetic resonance spectroscopy (MRS). We discuss the specific imaging characteristics of various neoplasms and the importance of tailored approaches to optimize diagnostic accuracy and therapeutic efficacy. The review also addresses the technical and interpretative challenges unique to pediatric imaging and the implications for long-term patient outcomes. By highlighting the comparative utility of MRI in adult and pediatric cases, this review aims to enhance the understanding of its pivotal role in managing supratentorial neoplasms. It underscores the necessity of age-specific diagnostic and therapeutic strategies. Emerging MRI technologies and future research directions are also discussed, emphasizing the potential for advancements in personalized imaging approaches and improved patient care across all age groups.

Nod-like receptors: The relevant elements of glioblastoma`s prognostic puzzle.

Despite considerable improvements in understanding the biology of glioblastoma (GB), it still remains the most lethal type of brain tumor in adults. The role of innate immune cells in the development of GB was recently described. In particular, the tumor-immune cell interactions are thought to be critical in enabling tumor tolerance and even protection against therapeutics. Interestingly, the GB cells express proteins belonging to the family of intracellular pattern-recognition receptors, namely the NOD-like receptors (NLRs). Their activation may trigger the formation of the inflammasome complex leading to the secretion of mature IL-1ß and IL-18 and thus resulting in cell death. Intrudingly, the expression of most NLRs was found to be correlated with tumor progression and poor prognosis. We speculate that recognizing the role of NOD-like receptors in GB has the potential to improve the effectiveness of diagnostic tools and prognosis, while also encouraging the development of novel precision medicine-based therapies.

Observations from the first 100 cases of intraoperative MRI - experiences, trends and short-term outcomes.

BACKGROUND: We sought to analyze, in well-defined clinical setting, the first 100 patients treated at the intraoperative MRI (iMRI) hybrid surgical theatre at our facility in a population-based setting to evaluate which pathologies are best approached with iMRI assisted surgeries, as this is not yet clearly defined. METHODS: Patients undergoing surgery in the 3T iMRI hybrid surgical theatre at our neurosurgical department between December 2017 to May 2021 were included after informed consent. Demographic, clinical, surgical, histological, radiological and outcome parameters, as well as variables related to iMRI, were retrospectively collected and analyzed. Patients were subdivided into adult and pediatric cohorts. RESULTS: Various neurosurgical procedures were performed; resection of tumors and epileptic foci, endoscopic skull base procedures including pituitary lesions, deep brain stimulation (DBS) and laser interstitial thermal therapy (LITT). In total, 41 patients were pediatric. An iMRI scan was carried out in 96% of cases and led to continuation of surgery in 50% of cases, mainly due to visualized remaining pathological tissue (95.2%). Median time to iMRI from intubation was 280 min and median total duration of surgery was 445 min. The majority of patients experienced no postoperative complications (70%), 13 patients suffered permanent postoperative deficits, predominantly visual. CONCLUSION: Herein, we demonstrate the first 100 patients undergoing neurosurgery aided by iMRI at our facility since introduction. Indications for surgery differed between pediatric and adult patients. The iMRI was utilized for tumor surgeries, particularly adult low-grade gliomas and pediatric tumors, as well as for epilepsy surgery and DBS. In this heterogenous population, iMRI led to continuation of surgery in 50%. To establish the benefit in maximizing the extent of resection in these brain pathologies future studies are recommended. CLINICAL TRIAL NUMBER: Not applicable.

AB072. Intraoperative mapping and preservation of executive functions in awake craniotomy: a systematic review.

BACKGROUND: Awake craniotomy (AC) allows intraoperative brain mapping (ioBM) for maximum lesion resection while monitoring and preserving neurological function. Conventionally, language, visuospatial assessment, and motor functions are mapped, while assessment of executive functions (EFs) is uncommon. Impaired EF may lead to occupational, personal, and social limitations, thus, a compromised quality of life. METHODS: A comprehensive literature search was conducted through Scopus, Medline, and Cochrane Library using a pre-defined search strategy. Articles were selected after duplicates removal, initial screening, and full-text assessment. The demographic details, ioBM techniques, intraoperative tasks, and their assessments, the extent of resection (EOR), post-op EF and neurocognitive status, and feasibility and potential adverse effects of the procedure were reviewed. The correlations of tumor locations with intraoperative EF deficits were also assessed. RESULTS: A total of 13 studies with intraoperative EF assessment of 351 patients were reviewed. Awake-asleep-awake protocol was most commonly used. Most studies performed ioBM using bipolar stimulation, with a frequency of 60 Hz, pulse durations ranging 1-2 ms, and intensity ranging 2-6 mA. Cognitive function was monitored with the Stroop task, spatial-2 back test, line-bisection test, trail-making-task, and digit-span tests. All studies reported similar or better EOR in patients with ioBM for EF. When comparing the neuropsychological outcomes of patients with ioBM of EF to those without it, all studies reported significantly better EF preservation in ioBM groups. Most authors reported EF mapping as a feasible tool to obtain satisfactory outcomes. Adverse effects included intraoperative seizures which were easily controlled. CONCLUSIONS: AC with ioBM of EF is a safe, effective, and feasible technique that allows satisfactory EOR and improved neurocognitive outcomes with minimal adverse effects.

Characteristics of Patients Hospitalized to Community Hospitals With Malignant Brain Tumors and Factors Associated With Discharge Destination.

Background: Our main objective was to compare the characteristics and hospital outcomes of patients with primary and metastatic brain malignancies and to investigate the associated factors related to hospital outcomes. Methods: We conducted a retrospective, cross-sectional study of 1628 patients with brain malignancies from 8 community hospitals between 2017 and 2022 who were identified using International Classification of Disease codes. A stepwise logistic regression was used to identify demographics and clinical characteristics associated with in-hospital mortality and home discharge. Results: The median age was 65 years old, with 72.5% of patients having metastatic brain malignancies. After 7.2 days of hospital stay, 49.2% were discharged home, and 102 patients expired during hospitalization. Increased age, medical coverage by Medicare, hemiplegia or paraplegia, lower initial hemoglobin level, increased length of stay, and the use of electrolyte replacement, antibiotics, laxatives, heparin, and anticonvulsants were associated with a decreased likelihood of discharge to home. No medical insurance, Medicaid insurance coverage, comorbidities of cerebrovascular disorder, the need to stay in the intensive care unit, patient safety indicator events, and the use of antibiotics, oral analgesics, and ipratropium-albuterol were associated with increased odds of in-hospital mortality. Conclusion: We identified several predictor variables that delineate differences between both mortality risk and home discharge in patients with primary and metastatic brain tumors. Understanding these predictor variables can be helpful in improving the acute and post-acute care of this population.

Segmentation of pre- and posttreatment diffuse glioma tissue subregions including resection cavities.

Background: Evaluating longitudinal changes in gliomas is a time-intensive process with significant interrater variability. Automated segmentation could reduce interrater variability and increase workflow efficiency for assessment of treatment response. We sought to evaluate whether neural networks would be comparable to expert assessment of pre- and posttreatment diffuse gliomas tissue subregions including resection cavities. Methods: A retrospective cohort of 647 MRIs of patients with diffuse gliomas (average 55.1 years; 29%/36%/34% female/male/unknown; 396 pretreatment and 251 posttreatment, median 237 days post-surgery) from 7 publicly available repositories in The Cancer Imaging Archive were split into training (536) and test/generalization (111) samples. T1, T1-post-contrast, T2, and FLAIR images were used as inputs into a 3D nnU-Net to predict 3 tumor subregions and resection cavities. We evaluated the performance of networks trained on pretreatment training cases (Pre-Rx network), posttreatment training cases (Post-Rx network), and both pre- and posttreatment cases (Combined networks). Results: Segmentation performance was as good as or better than interrater reliability with median dice scores for main tumor subregions ranging from 0.82 to 0.94 and strong correlations between manually segmented and predicted total lesion volumes (0.94 < R 2 values < 0.98). The Combined network performed similarly to the Pre-Rx network on pretreatment cases and the Post-Rx network on posttreatment cases with fewer false positive resection cavities (7% vs 59%). Conclusions: Neural networks that accurately segment pre- and posttreatment diffuse gliomas have the potential to improve response assessment in clinical trials and reduce provider burden and errors in measurement.

Occupational exposure to radiofrequency electromagnetic fields and brain tumor risk: Application of the INTEROCC job-exposure matrix.

Radiofrequency electromagnetic fields (RF-EMF, 100 kHz to 300 GHz) are classified by IARC as possibly carcinogenic to humans (Group 2B). This study evaluates the potential association between occupational RF-EMF exposure and brain tumor risk, utilizing for the first time, a RF-EMF job-exposure matrix (RF-JEM) developed in the multi-country INTEROCC case-control study. Cumulative and time-weighted average (TWA) occupational RF-EMF exposures were estimated for study participants based on lifetime job histories linked to the RF-JEM using three different methods: (1) by considering RF-EMF intensity among all exposed jobs, (2) by considering RF-EMF intensity among jobs with an exposure prevalence ≥ the median exposure prevalence of all exposed jobs, and (3) by considering RF-EMF intensity of jobs of participants who reported RF-EMF source use. Stratified conditional logistic regression models were used, considering various lag periods and exposure time windows defined a priori. Generally, no clear associations were found for glioma or meningioma risk. However, some statistically significant positive associations were observed including in the highest exposure categories for glioma for cumulative and TWA exposure in the 1- to 4-year time window for electric fields (E) in the first JEM application method (odds ratios [ORs] = 1.36, 95% confidence interval [95% CI] 1.08, 1.72 and 1.27, 95% CI 1.01, 1.59, respectively), as well as for meningioma for cumulative exposure in the 5- to 9-year time window for electric fields (E) in the third JEM application method (OR = 2.30, 95% CI 1.11, 4.78). We did not identify convincing associations between occupational RF-EMF exposure and risk of glioma or meningioma.

Transforming brain cancer therapeutics: unlocking the power of blood-brain barrier-targeting strategies for superior treatment outcomes and precision medicine.

The treatment of brain tumors is significantly hindered by the Blood-Brain Barrier (BBB), a selective barrier that restricts the passage of therapeutic agents to the brain. Recent advancements in BBB-targeting therapies offer promising strategies to overcome this challenge, providing new avenues for the effective treatment of brain cancer. This article reviews innovative approaches, including Convection-Enhanced Delivery (CED) and RNA-based therapeutics, which enhance drug delivery directly to tumor sites, bypassing the BBB and reducing systemic toxicity. Additionally, the use of theranostic nanoparticles and CRISPR-Cas9 gene editing presents novel opportunities for real-time monitoring and precision-targeted therapy, respectively. Techniques such as magnetic nanoparticles, intranasal drug administration, and focused ultrasound with microbubbles are also being refined to improve drug penetration across the BBB. Furthermore, peptide-based delivery systems and small molecules designed to mimic endogenous transport pathways are accelerating the discovery of more effective therapies. The exploration of combination therapies that synergize BBB-penetrant drugs with conventional chemotherapeutic agents or immunotherapies holds the potential to enhance treatment efficacy and patient outcomes. Continued research and interdisciplinary collaboration are essential to develop predictive models, personalized treatment strategies, and alternative delivery methods that ensure the long-term safety and effectiveness of these novel therapies. Advancements in BBB-targeting therapeutics are poised to transform the landscape of brain cancer treatment, offering renewed hope for improved survival rates and quality of life for patients.

Central nervous system pediatric multi-disciplinary tumor board: a single center experience.

BACKGROUND: The Multidisciplinary Tumor Board (MTB) is a collaborative platform involving specialists in oncology, surgery, radiology, pathology, and radiotherapy, and aims to optimize diagnostics and treatments. Despite MTB's widespread benefits, limited literature addresses its application in pediatric neuro-oncology. After a literature revision on pediatric neuro-oncology MTB, our study describes our institute's pediatric neuro-oncology MTB, focuses on evaluating its impact and the neuroradiologist's role in patient-centric approaches, considering recent genetic insights into pediatric brain tumors. MATERIALS AND METHODS: Literature Review concerning pediatric neuro-oncology MTB from January 2002 to June 2024. CLINICAL DATA: retrospective study of all patient files presented in the pediatric neuro-oncology MTB (pnMTB) between 2019 and 2022. Statistical analysis was mainly carried out by directly comparing the absolute or relative values of the respective parameters examined; qualitative variables compared mainly with the chi-square test, quantitative variables mainly with the t-test. RESULTS: Literature Review: 7 papers encompass a multidisciplinary approach for the pediatric CNS tumors. CLINICAL DATA: A total of 236 discussions were analyzed representing 107 patients. Median age was 14,3 years (range: 6 months - 17 years). The requests for case evaluations primarily came from the pediatric oncologists (83%) and neurosurgeons (14.8%), and they were mainly addressed to the neuroradiologists (70.3%). Proposals during pnMTB mainly involved imaging follow-up (47.8%) and management with chemotherapy (34.7%). Changes in patient treatment (CPT) occurred in 115 cases, and pediatric neuroradiologist intervention contributed to 72.4% of these changes. CONCLUSION: Thanks to their multidisciplinarity, high number of cases discussed, and usual respect for their proposals, the pnMTB has made it possible to improve the coordination among specialties involved in patient management, to apply the recent protocols, and to exchange knowledge among teams managing pediatric CNS tumors.