Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 18.914
Filtrar
1.
Nat Commun ; 11(1): 5376, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33110059

RESUMO

The molecular characterisation of medulloblastoma, the most common paediatric brain tumour, is crucial for the correct management and treatment of this heterogenous disease. However, insufficient tissue sample, the presence of tumour heterogeneity, or disseminated disease can challenge its diagnosis and monitoring. Here, we report that the cerebrospinal fluid (CSF) circulating tumour DNA (ctDNA) recapitulates the genomic alterations of the tumour and facilitates subgrouping and risk stratification, providing valuable information about diagnosis and prognosis. CSF ctDNA also characterises the intra-tumour genomic heterogeneity identifying small subclones. ctDNA is abundant in the CSF but barely present in plasma and longitudinal analysis of CSF ctDNA allows the study of minimal residual disease, genomic evolution and the characterisation of tumours at recurrence. Ultimately, CSF ctDNA analysis could facilitate the clinical management of medulloblastoma patients and help the design of tailored therapeutic strategies, increasing treatment efficacy while reducing excessive treatment to prevent long-term secondary effects.


Assuntos
Neoplasias Encefálicas/líquido cefalorraquidiano , DNA Tumoral Circulante/líquido cefalorraquidiano , Meduloblastoma/líquido cefalorraquidiano , Biomarcadores Tumorais/líquido cefalorraquidiano , Biomarcadores Tumorais/genética , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , DNA Tumoral Circulante/genética , DNA de Neoplasias/líquido cefalorraquidiano , DNA de Neoplasias/genética , Genômica , Humanos , Meduloblastoma/diagnóstico , Meduloblastoma/genética
3.
Biomed Khim ; 66(4): 317-325, 2020 Jul.
Artigo em Russo | MEDLINE | ID: mdl-32893821

RESUMO

Express MS identification of biological tissues has become a much more accessible research method due to the application of direct specimen ionization at atmospheric pressure. In contrast to traditional methods of analysis employing GC-MS methods for determining the molecular composition of the analyzed objects it eliminates the influence of mutual ion suppression. Despite significant progress in the field of direct MS of biological tissues, the question of mass spectrometric profile attribution to a certain type of tissue still remains open. The use of modern machine learning methods and protocols (e.g., "random forests") enables us to trace possible relationships between the components of the sample MS profile and the result of brain tumor tissue classification (astrocytoma or glioblastoma). It has been shown that the most pronounced differences in the mass spectrometric profiles of these tumors are due to their lipid composition. Detection of statistically significant differences in lipid profiles of astrocytoma and glioblastoma may be used to perform an express test during surgery and inform the neurosurgeon what type of malignant tissue he is working with. The ability to accurately determine the boundaries of the neoplastic growth significantly improves the quality of both surgical intervention and postoperative rehabilitation, as well as the duration and quality of life of patients.


Assuntos
Astrocitoma , Biomarcadores Tumorais , Neoplasias Encefálicas , Glioblastoma , Lipídeos , Biomarcadores Tumorais/análise , Neoplasias Encefálicas/diagnóstico , Glioblastoma/diagnóstico , Humanos , Lipídeos/análise , Masculino , Qualidade de Vida
4.
Life Sci ; 261: 118486, 2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-32976881

RESUMO

BACKGROUND: Glioblastoma (GBM) is the most common subtype of brain cancer, encompassing 16% of all primary brain cancers. The prognosis of GBM is poor, with a 5-year-survial of approximately 5%. Increasing evidence has revealed that chemokines in the tumor microenvironment (TME) are often altered, thus affecting tumor proliferation and metastasis. METHOD: Multi-omics and bioinformatics tools were utilized to clarify the role of CXC chemokine in GBM. RESULT: Most CXC chemokines were found to be differentially regulated in GBM, which correlated with patient prognosis. CXC chemokines were found to activate cancer-related signaling pathways, thus affecting immune infiltration. Interestingly, this was found to be associated with drug resistance. Most CXC chemokines were significantly correlated with abundance of B cells, CD8+ cells and dendritic cells. Furthermore, somatic copy number alterations of CXC chemokines can inhibit dendritic cell infiltration. Moreover, CXCL1 was selected as a hub gene, and several kinase, miRNA and transcription factor targets of CXCL1 were identified. CONCLUSION: our study provides novel insights into CXC chemokine expression and their role in the GBM microenvironment. These results are able to provide more data about prognostic biomarkers and therapeutic targets of GBM.


Assuntos
Neoplasias Encefálicas/genética , Quimiocinas CXC/genética , Regulação Neoplásica da Expressão Gênica , Glioblastoma/genética , Neoplasias Encefálicas/diagnóstico , Redes Reguladoras de Genes , Glioblastoma/diagnóstico , Humanos , Prognóstico , Microambiente Tumoral
5.
Cochrane Database Syst Rev ; 9: CD013564, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32901926

RESUMO

BACKGROUND: Brain tumours are recognised as one of the most difficult cancers to diagnose because presenting symptoms, such as headache, cognitive symptoms, and seizures, may be more commonly attributable to other, more benign conditions. Interventions to reduce the time to diagnosis of brain tumours include national awareness initiatives, expedited pathways, and protocols to diagnose brain tumours, based on a person's presenting symptoms and signs; and interventions to reduce waiting times for brain imaging pathways. If such interventions reduce the time to diagnosis, it may make it less likely that people experience clinical deterioration, and different treatment options may be available. OBJECTIVES: To systematically evaluate evidence on the effectiveness of interventions that may influence: symptomatic participants to present early (shortening the patient interval), thresholds for primary care referral (shortening the primary care interval), and time to imaging diagnosis (shortening the secondary care interval and diagnostic interval). To produce a brief economic commentary, summarising the economic evaluations relevant to these interventions. SEARCH METHODS: For evidence on effectiveness, we searched CENTRAL, MEDLINE, and Embase from January 2000 to January 2020; Clinicaltrials.gov to May 2020, and conference proceedings from 2014 to 2018. For economic evidence, we searched the UK National Health Services Economic Evaluation Database from 2000 to December 2014. SELECTION CRITERIA: We planned to include studies evaluating any active intervention that may influence the diagnostic pathway, e.g. clinical guidelines, direct access imaging, public health campaigns, educational initiatives, and other interventions that might lead to early identification of primary brain tumours. We planned to include randomised and non-randomised comparative studies. Included studies would include people of any age, with a presentation that might suggest a brain tumour. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles identified by the search strategy, and the full texts of potentially eligible studies. We resolved discrepancies through discussion or, if required, by consulting another review author. MAIN RESULTS: We did not identify any studies for inclusion in this review. We excluded 115 studies. The main reason for exclusion of potentially eligible intervention studies was their study design, due to a lack of control groups. We found no economic evidence to inform a brief economic commentary on this topic. AUTHORS' CONCLUSIONS: In this version of the review, we did not identify any studies that met the review inclusion criteria for either effectiveness or cost-effectiveness. Therefore, there is no evidence from good quality studies on the best strategies to reduce the time to diagnosis of brain tumours, despite the prioritisation of research on early diagnosis by the James Lind Alliance in 2015. This review highlights the need for research in this area.


Assuntos
Neoplasias Encefálicas/diagnóstico , Detecção Precoce de Câncer/métodos , Humanos , Fatores de Tempo
6.
PLoS One ; 15(9): e0238591, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886718

RESUMO

Extracellular vesicles (EVs), are important for intercellular communication in both physiological and pathological processes. To explore the potential of cancer derived EVs as disease biomarkers for diagnosis, monitoring, and treatment decision, it is necessary to thoroughly characterize their biomolecular content. The aim of the study was to characterize and compare the protein content of EVs derived from three different cancer cell lines in search of a specific molecular signature, with emphasis on proteins related to the carcinogenic process. Oral squamous cell carcinoma (OSCC), pancreatic ductal adenocarcinoma (PDAC) and melanoma brain metastasis cell lines were cultured in CELLine AD1000 flasks. EVs were isolated by ultrafiltration and size-exclusion chromatography and characterized. Next, the isolated EVs underwent liquid chromatography-mass spectrometry (LC-MS) analysis for protein identification. Functional enrichment analysis was performed for a more general overview of the biological processes involved. More than 600 different proteins were identified in EVs from each particular cell line. Here, 14%, 10%, and 24% of the identified proteins were unique in OSCC, PDAC, and melanoma vesicles, respectively. A specific protein profile was discovered for each cell line, e.g., EGFR in OSCC, Muc5AC in PDAC, and FN1 in melanoma vesicles. Nevertheless, 25% of all the identified proteins were common to all cell lines. Functional enrichment analysis linked the proteins in each data set to biological processes such as "biological adhesion", "cell motility", and "cellular component biogenesis". EV proteomics discovered cancer-specific protein profiles, with proteins involved in processes promoting tumor progression. In addition, the biological processes associated to the melanoma-derived EVs were distinct from the ones linked to the EVs isolated from OSCC and PDAC. The malignancy specific biomolecular cues in EVs may have potential applications as diagnostic biomarkers and in therapy.


Assuntos
Vesículas Extracelulares/patologia , Neoplasias/patologia , Proteínas/análise , Biomarcadores Tumorais/análise , Neoplasias Encefálicas/química , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Carcinoma Ductal Pancreático/química , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/patologia , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Linhagem Celular Tumoral , Vesículas Extracelulares/química , Humanos , Espectrometria de Massas , Melanoma/química , Melanoma/diagnóstico , Melanoma/patologia , Neoplasias Bucais/química , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Neoplasias/química , Neoplasias/diagnóstico , Neoplasias Pancreáticas/química , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Proteômica
7.
Oncogene ; 39(38): 6043-6052, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32801336

RESUMO

Although rare, glioblastoma is a devastating tumor of the central nervous system characterized by a poor survival and an extremely dark prognosis, making its diagnosis, treatment, and monitoring highly challenging. Numerous studies have highlighted extracellular vesicles (EVs) as key players of tumor growth, invasiveness, and resistance, as they carry oncogenic material. Moreover, EVs have been shown to communicate locally in a paracrine way but also at remote throughout the organism. Indeed, recent reports demonstrated the presence of brain tumor-derived EVs into body fluids such as plasma and cerebrospinal fluid. Fluid-associated EVs have indeed been suspected to reflect quantitative and qualitative information about the status and fate of the tumor and can potentially act as a resource for noninvasive biomarkers that might assist in diagnosis, treatment, and follow-up of glioblastoma patients. Here, we coined the name vesiclemia to define the concentration of plasmatic EVs, an intuitive term to be directly transposed in the clinical jargon.


Assuntos
Neoplasias Encefálicas/metabolismo , Vesículas Extracelulares/metabolismo , Glioblastoma/metabolismo , Animais , Transporte Biológico , Biomarcadores Tumorais , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , Comunicação Celular , Fracionamento Celular/métodos , Gerenciamento Clínico , Progressão da Doença , Glioblastoma/sangue , Glioblastoma/diagnóstico , Glioblastoma/genética , Humanos , Técnicas de Diagnóstico Molecular , Microambiente Tumoral/genética
8.
Cancer Treat Rev ; 89: 102083, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32736188

RESUMO

Melanoma brain metastases (MBM) are common and associated with a particularly poor prognosis; they directly cause death in 60-70% of melanoma patients. In the past, systemic treatments have shown response rates around 5%, whole brain radiation as standard of care has achieved a median overall survival of approximately three months. Recently, the combination of immune checkpoint inhibitors and combinations of MAP-kinase inhibitors both have shown very promising response rates of up to 55% and 58%, respectively, and improved survival. However, current clinical evidence is based on multi-cohort studies only, as prospectively randomized trials have been carried out rarely in MBM, independently whether investigating systemic therapy, radiotherapy or surgical techniques. Here, an interdisciplinary expert team reviewed the outcome of prospectively conducted clinical studies in MBM, identified evidence gaps and provided recommendations for the diagnosis, treatment, outcome evaluation and monitoring of MBM patients. The recommendations refer to four distinct scenarios: patients (i) with 'brain-only' disease, (ii) with oligometastatic asymptomatic intra- and extracranial disease, (iii) with multiple asymptomatic metastases, and (iv) with multiple symptomatic MBM or leptomeningeal disease. Changes in current management recommendations comprise the use of immunotherapy - preferably combined anti-CTLA-4/PD-1-immunotherapy - in asymptomatic MBM minus/plus stereotactic radiosurgery which remains the mainstay of local brain therapy being safe and effective. Adjuvant whole-brain radiotherapy provides no clinical benefit in oligometastatic MBM. Among the systemic therapies, combined MAPK-kinase inhibition provides, in BRAFV600-mutated patients with rapidly progressing or/and symptomatic MBM, an alternative to combined immunotherapy.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias Encefálicas/terapia , Melanoma/patologia , Melanoma/terapia , Animais , Neoplasias Encefálicas/diagnóstico , Ensaios Clínicos como Assunto , Estudos de Coortes , Terapia Combinada , Humanos , Melanoma/diagnóstico , Equipe de Assistência ao Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
9.
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732262

RESUMO

OBJECTIVES: Acute nystagmus (AN) is an uncommon neurologic sign in children presenting to pediatric emergency departments. We described the epidemiology, clinical features, and underlying causes of AN in a large cohort of children, aiming at identifying features associated with higher risk of severe underlying urgent conditions (UCs). METHODS: Clinical records of all patients aged 0 to 18 years presenting for AN to the pediatric emergency departments of 9 Italian hospitals in an 8-year period were retrospectively reviewed. Clinical and demographic features and the underlying causes were analyzed. A logistic regression model was applied to detect predictive variables associated with a higher risk of UCs. RESULTS: A total of 206 patients with AN were included (male-to-female ratio: 1.01; mean age: 8 years 11 months). The most frequently associated symptoms were headache (43.2%) and vertigo (42.2%). Ataxia (17.5%) and strabismus (13.1%) were the most common neurologic signs. Migraine (25.7%) and vestibular disorders (14.1%) were the most common causes of AN. Idiopathic infantile nystagmus was the most common cause in infants <1 year of age. UCs accounted for 18.9% of all cases, mostly represented by brain tumors (8.3%). Accordant with the logistic model, cranial nerve deficits, ataxia, or strabismus were strongly associated with an underlying UC. Presence of vertigo or attribution of a nonurgent triage code was associated with a reduced risk of UCs. CONCLUSIONS: AN should be considered an alarming finding in children given the risk of severe UCs. Cranial nerve palsy, ataxia, and strabismus should be considered red flags during the assessment of a child with AN.


Assuntos
Nistagmo Patológico/etiologia , Ataxia/complicações , Ataxia/diagnóstico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico , Infecções do Sistema Nervoso Central/complicações , Infecções do Sistema Nervoso Central/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Doenças dos Nervos Cranianos/complicações , Doenças dos Nervos Cranianos/diagnóstico , Doenças Desmielinizantes/complicações , Doenças Desmielinizantes/diagnóstico , Tontura/etiologia , Serviço Hospitalar de Emergência , Feminino , Cefaleia/etiologia , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/diagnóstico , Itália , Masculino , Transtornos de Enxaqueca/complicações , Transtornos de Enxaqueca/diagnóstico , Náusea/etiologia , Envenenamento/complicações , Envenenamento/diagnóstico , Estudos Retrospectivos , Estrabismo/etiologia , Vertigem/etiologia , Doenças Vestibulares/complicações , Doenças Vestibulares/diagnóstico , Vômito/etiologia
10.
J Infect Public Health ; 13(9): 1274-1289, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32758393

RESUMO

Cancer is a fatal illness often caused by genetic disorder aggregation and a variety of pathological changes. Cancerous cells are abnormal areas often growing in any part of human body that are life-threatening. Cancer also known as tumor must be quickly and correctly detected in the initial stage to identify what might be beneficial for its cure. Even though modality has different considerations, such as complicated history, improper diagnostics and treatement that are main causes of deaths. The aim of the research is to analyze, review, categorize and address the current developments of human body cancer detection using machine learning techniques for breast, brain, lung, liver, skin cancer leukemia. The study highlights how cancer diagnosis, cure process is assisted using machine learning with supervised, unsupervised and deep learning techniques. Several state of art techniques are categorized under the same cluster and results are compared on benchmark datasets from accuracy, sensitivity, specificity, false-positive metrics. Finally, challenges are also highlighted for possible future work.


Assuntos
Aprendizado de Máquina , Neoplasias/diagnóstico , Neoplasias Encefálicas/diagnóstico , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Imagem por Ressonância Magnética , Masculino , Neoplasias/terapia , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Sensibilidade e Especificidade , Neoplasias Cutâneas/diagnóstico , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
11.
J Clin Neurosci ; 78: 114-120, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620474

RESUMO

The growing elderly population in Western societies has led to an increasing number of primary brain tumors occurring in patients beyond the age of 65. The purpose of this study was to assess and compare the safety, efficacy, and outcomes of oncological craniotomy procedures between patients above and below 65 years. We performed a retrospective analysis of the ACS-NSQIP database to identify patients undergoing supratentorial and infratentorial tumor excisions by neurosurgeons between 2008 and 2016. We stratified them based on a cutoff age of 65 years and analyzed for minor and major complications, reoperation, the total length of hospital stay, and mortality within a standardized 30-day follow-up. Among the 30,183 analyzed patients, 9,652 (32%) were elderly (age ≥ 65). The bivariate analysis demonstrated significantly increased risk of complications, including major and minor complications and mortality in patients with metabolic syndrome, preoperative steroid use, and ASA classification ≥3. (p-value ≤ 0.001***). After controlling for confounding variables in our logistic regression models, older age, metabolic syndrome, extended operative time beyond 5 h, dependent functional health status, ASA class ≥3, steroid use pre-operatively, and black/African American race were found to be significant predictors of major and minor complication. Our study provides a comprehensive analysis of perioperative risk factors and predictors of adverse outcomes following craniotomy for supratentorial and infratentorial tumors in elderly patients. We identified increased age as an independent risk factor for minor and major adverse events as well as extended hospitalization.


Assuntos
Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Craniotomia/normas , Complicações Pós-Operatórias/epidemiologia , Melhoria de Qualidade/normas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias Encefálicas/diagnóstico , Estudos de Casos e Controles , Craniotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/diagnóstico , Melhoria de Qualidade/tendências , Reoperação/efeitos adversos , Reoperação/normas , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
12.
Rev Assoc Med Bras (1992) ; 66(6): 794-799, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32696872

RESUMO

OBJECTIVES HOXB2 is a new prognostic indicator for lung cancer. But it is unclear whether HOXB2 holds an effect in glioblastoma (GBM) progression. The purpose of this article was to probe the influences of HOXB2 on GBM pathogenesis. METHODS HOXB2 expression level and prognostic power in GBM patients were analyzed. Then the mRNA and protein expression levels of HOXB2 in GBM cell lines were tested by qRT-PCR and western blotting. Cell proliferation, invasion, and migration were determined by CCK8 and transwell assay, severally. The protein levels of PI3K/AKT-pathway associated proteins were analyzed by western blotting. RESULTS The results indicated that HOXB2 was distinctly overexpressed in GBM patients and high expression of HOXB2 was related to a poor prognosis. Moreover, the expression of HOXB2 was higher in all GBM cell lines U251, U-87MG, GOS-3 than that in HEB cells (normal control). Meanwhile, decreased expression of p-PI3K and p-AKT were identified after HOXB2 knockdown. CONCLUSIONS These data demonstrated that HOXB2 had a vital role in GBM progression and could serve as a promising target for GBM treatment.


Assuntos
Neoplasias Encefálicas/diagnóstico , Genes Homeobox/fisiologia , Glioblastoma/diagnóstico , Biomarcadores , Linhagem Celular Tumoral , Proliferação de Células , Regulação Neoplásica da Expressão Gênica , Humanos , Fosfatidilinositol 3-Quinases , Prognóstico
13.
Medicine (Baltimore) ; 99(28): e21147, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664146

RESUMO

High-grade gliomas (HGGs) are a rapidly progressive and highly recurrent group of primary brain tumors. Despite aggressive surgical resection with chemoradiotherapy, prognoses remained poor. Valproic acid (VPA), a histone deacetylase inhibitor has shown the potential to inhibit glioma cell growth in vitro through several diverse mechanisms. However clinical studies regarding the effect of VPA on HGGs are limited. This study aimed to investigate whether using VPA in patients with HGGs under temozolomide (TMZ) would lead to a better overall survival (OS).We used the Taiwan National Health Insurance Research database to conduct this population-based cohort study. A total of 2379 patients with HGGs under TMZ treatment were included and were further classified into VPA (n = 1212, VPA ≥ 84 defined daily dose [DDD]) and non-VPA (n = 1167, VPA < 84 DDD) groups. Each patient was followed from 1998 to 2013 or until death. A Cox proportional hazard regression was performed to evaluate the effect of VPA and OS.The VPA group had a longer mean OS time compared with the non-VPA group (OS: 50.3 ±â€Š41.0 vs 42.0 ±â€Š37.2 months, P < .001). In patients between 18 and 40 years old, the difference is most significant (OS: 70.5 ±â€Š48.7 vs 55.1 ±â€Š46.0, P = .001). The adjusted hazard ratio is 0.81 (95% confidence interval, 0.72-0.91) for the VPA group relative to the non-VPA group.VPA at over 84 DDD improved OS in HGGs TMZ treatment.


Assuntos
Neoplasias Encefálicas/tratamento farmacológico , Glioma/tratamento farmacológico , Estadiamento de Neoplasias , Vigilância da População/métodos , Temozolomida/uso terapêutico , Ácido Valproico/uso terapêutico , Adolescente , Adulto , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/mortalidade , Inibidores Enzimáticos/uso terapêutico , Feminino , Seguimentos , Glioma/diagnóstico , Glioma/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Taiwan/epidemiologia , Adulto Jovem
14.
J Neuropathol Exp Neurol ; 79(7): 763-766, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32483596

RESUMO

The power and widespread use of next-generation sequencing (NGS) in surgical neuropathology has raised questions as to whether NGS might someday fully supplant histologic-based examination. We therefore sought to determine the feasibility of relying on NGS alone for diagnosing infiltrating gliomas. A total of 171 brain lesions in adults, all of which had been analyzed by GlioSeq NGS, comprised the study cohort. Each case was separately diagnosed by 6 reviewers, based solely on age, sex, tumor location, and NGS results. Results were compared with the final integrated diagnoses and scored on the following scale: 0 = either wrong tumor type or correct tumor type but off by 2+ grades; 1 = off by 1 grade; 2 = exactly correct. Histology alone was treated as a seventh reviewer. Overall reviewer accuracy ranged from 81.6% to 94.2%, while histology alone scored 87.1%. For glioblastomas, NGS was more accurate than histology alone (93.8%-97.9% vs 87.5%). The NGS accuracy for grade II and III astrocytoma and oligodendroglioma was only 54.3%-84.8% and 34.4%-87.5%, respectively. Most uncommon gliomas, including BRAF-driven tumors, could not be accurately classified just by NGS. These data indicate that, even in this era of advanced molecular diagnostics, histologic evaluation is still an essential part of optimal patient care.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/genética , Glioma/diagnóstico , Glioma/genética , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Adolescente , Adulto , Estudos de Coortes , Feminino , Sequenciamento de Nucleotídeos em Larga Escala/normas , Humanos , Masculino , Adulto Jovem
15.
Brain Tumor Pathol ; 37(3): 95-99, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32504153

RESUMO

We report a rare case of oligodendroglioma with gangliocytic differentiation. A 31-year-old male without a past medical history was admitted with a sudden seizure. On magnetic resonance imaging, an approximately 7-cm mass with necrosis was noted in the right frontal lobe. The patient underwent surgical resection. On microscopy, two morphologically distinct areas with oligodendroglioma- and ganglioglioma-like features were found. Immunohistochemistry showed an absence of CD34 expression, whereas isocitrate dehydrogenase 1 (IDH1) was positive in the glial component. Moreover, IDH1 was positive in the ganglion-like cells as well as in the glial component. Subsequent 1p/19q co-deletion was confirmed by fluorescence in situ hybridization. Finally, a diagnosis of oligodendroglioma with gangliocytic differentiation was made. IDH1/2 molecular test would be basic and essential diagnostic tool in central nervous system tumor of young patients.


Assuntos
Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologia , Oligodendroglioma/diagnóstico , Oligodendroglioma/patologia , Adulto , Antígenos CD34 , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/patologia , Humanos , Isocitrato Desidrogenase/genética , Imagem por Ressonância Magnética , Masculino , Mutação
17.
Nat Med ; 26(7): 1044-1047, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32572265

RESUMO

Definitive diagnosis of intracranial tumors relies on tissue specimens obtained by invasive surgery. Noninvasive diagnostic approaches provide an opportunity to avoid surgery and mitigate unnecessary risk to patients. In the present study, we show that DNA-methylation profiles from plasma reveal highly specific signatures to detect and accurately discriminate common primary intracranial tumors that share cell-of-origin lineages and can be challenging to distinguish using standard-of-care imaging.


Assuntos
Biomarcadores Tumorais/sangue , Neoplasias Encefálicas/diagnóstico , Metilação de DNA/genética , Epigenoma/genética , Neoplasias Encefálicas/sangue , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/patologia , Ácidos Nucleicos Livres/sangue , Ilhas de CpG/genética , DNA de Neoplasias/sangue , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Masculino
18.
Anticancer Res ; 40(6): 3387-3393, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487635

RESUMO

AIM: To retrospectively assess toxicity and survival in 15 selected Glioblastoma patients treated with a sequential fractionated stereotactic radiotherapy (FSRT) boost after chemo-radiotherapy (CHT-RT) and compare their survival outcomes with a control group. PATIENTS AND METHODS: Toxicity was assessed with the CTCAE 3.0 scale. The Kaplan-Meier method was used to design survival curves, log-rank test for bivariate analysis and Cox proportional hazard regression model for multivariate analysis. RESULTS: The median follow-up was 16 months (range=5-60). One case of headache and one of radionecrosis (RN) occurred. Median overall survival (OS) was 25 months in the boost group vs. 14 in the no-boost group (p=0.004). Median progression-free survival (PFS) was 15 months in the boost group versus 8 in the no-boost group (p=0.046). At multivariate analysis FSRT boost resulted significantly associated with OS and PFS. CONCLUSION: In our series a sequential FSRT boost resulted in safe outcomes and significantly associated with survival.


Assuntos
Neoplasias Encefálicas/radioterapia , Fracionamento da Dose de Radiação , Glioblastoma/radioterapia , Radiocirurgia , Adulto , Idoso , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/mortalidade , Estudos de Coortes , Feminino , Glioblastoma/diagnóstico , Glioblastoma/mortalidade , Humanos , Estimativa de Kaplan-Meier , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador , Radioterapia Guiada por Imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
19.
Anticancer Res ; 40(6): 3453-3457, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487644

RESUMO

BACKGROUND/AIM: Gliomas present a uniquely challenging clinical situation in the context of pregnancy, with no standard recommendations. This case series aimed to describe the treatment regimen and outcomes of five pregnant patients with gliomas. PATIENTS AND METHODS: This is a retrospective study. A patient database from electronic medical records was evaluated to identify pregnant patients with gliomas treated at our institution between 2008-2018. RESULTS: Five study patients who were pregnant with gliomas were identified. Of these, 4 were diagnosed during pregnancy, while 1 was diagnosed prior to her pregnancy. One patient had grade 2 astrocytoma, 1 had grade 3 anaplastic astrocytoma, and 3 had grade 4 glioblastomas (GBM). All patients received surgery, and one patient received radiation therapy without concurrent chemotherapy during her pregnancy. All delivered healthy babies. Three of the 5 patients remain alive, and 2 of the 5 were progression-free at the last follow-up. CONCLUSION: Treatment plans must be specifically tailored to the individual patient based on the glioma grade, the mother's desire to continue the pregnancy, and the risks of delaying treatment until after pregnancy. Additional studies need to be performed to definitively establish uniform guidelines for the treatment of pregnant patients with glioma.


Assuntos
Neoplasias Encefálicas/diagnóstico , Glioma/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Adulto , Biomarcadores , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/terapia , Terapia Combinada , Feminino , Glioma/etiologia , Glioma/terapia , Humanos , Imagem por Ressonância Magnética , Mutação , Gradação de Tumores , Gravidez
20.
ESMO Open ; 4(Suppl 2)2020 05.
Artigo em Inglês | MEDLINE | ID: covidwho-360021

RESUMO

The COVID-19 pandemic has created major insecurities regarding whether we can and should maintain the current standards of diagnosis and treatment and access to care for patients with cancer. This is particularly true in the field of neuro-oncology, where the perceived benefit of therapeutic interventions is often low, although this notion is partially incorrect. We acknowledge that the recommendations for care of patients with cancer have become a moving target and that all recommendations are subject to modification based on national and institutional regulations. Still, some important considerations and proposals may apply broadly. First, it is important to note that old age and cardiovascular and pulmonary co-morbidities are the major risk factors for experiencing a severe course of and for dying of COVID-19, not chronic immunosuppression and cancer. Second, many of the considerations on how we should adapt clinical practice in neuro-oncology in view of COVID-19 that are now dominating discussions at local tumour boards, as well as on the institutional level and within societies of neuro-oncology, are not novel but have been valid before and only now have become a priority. More than ever, it seems to be mandatory to adhere to evidence-based medicine and not to prescribe potentially toxic, notably immunsuppresssive systemic therapy where evidence for efficacy is low. Furthermore, it is more obvious now that oncologists must not miss the right time for advance care planning, that is, supporting patients in understanding and sharing their personal values, life goals and preferences regarding future medical care. The major psychological impact of transforming oncology care to teleconferences and videoconferences and of the important strict recommendation of social distancing must not be overlooked in a patient population that is characterised by significant prevalence of cognitive decline and by the general perception that their life span may not exceed the life span of the COVID-19 pandemic.


Assuntos
Neoplasias Encefálicas/terapia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus/isolamento & purificação , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/virologia , Ensaios Clínicos como Assunto , Infecções por Coronavirus/complicações , Humanos , Oncologia/métodos , Oncologia/normas , Pandemias , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA