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Robert G. Whitmore, Jaroslaw Krejza, Gurpreet S. Kapoor, Jason Huse, John H. Woo, Stephanie Bloom, Joanna Lopinto, Ronald L. Wolf, Kevin Judy, Myrna R. Rosenfeld, Jaclyn A. Biegel, Elias R. Melhem and Donald M. O'rourke

Object

Treatment of patients with oligodendrogliomas relies on histopathological grade and characteristic cytogenetic deletions of 1p and 19q, shown to predict radio- and chemosensitivity and prolonged survival. Perfusion weighted magnetic resonance (MR) imaging allows for noninvasive determination of relative tumor blood volume (rTBV) and has been used to predict the grade of astrocytic neoplasms. The aim of this study was to use perfusion weighted MR imaging to predict tumor grade and cytogenetic profile in oligodendroglial neoplasms.

Methods

Thirty patients with oligodendroglial neoplasms who underwent preoperative perfusion MR imaging were retrospectively identified. Tumors were classified by histopathological grade and stratified into two cytogenetic groups: 1p or 1p and 19q loss of heterozygosity (LOH) (Group 1), and 19q LOH only on intact alleles (Group 2). Tumor blood volume was calculated in relation to contralateral white matter. Multivariate logistic regression analysis was used to develop predictive models of cytogenetic profile and tumor grade.

Results

In World Health Organization Grade II neoplasms, the rTBV was significantly greater (p < 0.05) in Group 1 (mean 2.44, range 0.96–3.28; seven patients) compared with Group 2 (mean 1.69, range 1.27–2.08; seven patients). In Grade III neoplasms, the differences between Group 1 (mean 3.38, range 1.59–6.26; four patients) and Group 2 (mean 2.83, range 1.81–3.76; 12 patients) were not significant. The rTBV was significantly greater (p < 0.05) in Grade III neoplasms (mean 2.97, range 1.59–6.26; 16 patients) compared with Grade II neoplasms (mean 2.07, range 0.96–3.28; 14 patients). The models integrating rTBV with cytogenetic profile and grade showed prediction accuracies of 68 and 73%, respectively.

Conclusions

Oligodendroglial classification models derived from advanced imaging will improve the accuracy of tumor grading, provide prognostic information, and have potential to influence treatment decisions.

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Masayuki Nitta, Yoshihiro Muragaki, Takashi Maruyama, Soko Ikuta, Takashi Komori, Katsuya Maebayashi, Hiroshi Iseki, Manabu Tamura, Taiichi Saito, Saori Okamoto, Mikhail Chernov, Motohiro Hayashi and Yoshikazu Okada

survivors. 21 The role of chemotherapy in diffuse astrocytoma is unclear, and no controlled clinical trial has focused on diffuse astrocytoma. Recent developments in molecular analysis, especially for the 1p/19q locus and the IDH1 (isocitrate dehydrogenase I) gene, have allowed more convenient molecular subclassification. 10 Furthermore, the above-mentioned factors have prognostic and predictive value for several tumor subtypes. Thus, LGG treatment should be decided based on the tumor's histological and molecular characteristics. Since 2000, our institute has

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Gabriel Zada, Whitney W. Woodmansee, Shakti Ramkissoon, Jordan Amadio, Vania Nose and Edward R. Laws Jr.

utility of this new classification invoked some controversy following its initial description. 2 , 6 , 10 , 13 , 15 , 17 , 25 , 34 Since that time, few studies have reported clinical experience with the new WHO classification of atypical pituitary adenomas, with regard to incidence, tumor subtype, and clinicopathological characteristics. 19 , 22 , 27 , 29 In the current study, the institutional experience at the Brigham and Women's Hospital following surgical treatment for 121 pituitary adenomas over an 18-month period was reviewed. The aim of this study was to

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Catherine Miller, Daniel Guillaume, Kathryn Dusenbery, H. Brent Clark and Christopher Moertel

, which prompted us to investigate possible alternative therapies. Increasing sophistication in genetic testing has allowed for the detection of specific mutations within tumor subtypes that could represent targets for individualized tumor treatment. The MAPK pathway and, more specifically, BRAF mutations have been shown to be prevalent in pediatric astrocytomas and could represent important areas to target. Pathways identified in tumorigenesis are the targets for many inhibiting or altering agents. However, as the MAPK pathway is involved in development, inhibition

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C. Rory Goodwin, Eric W. Sankey, Ann Liu, Benjamin D. Elder, Thomas Kosztowski, Sheng-Fu L. Lo, Charles G. Fisher, Michelle J. Clarke, Ziya L. Gokaslan and Daniel M. Sciubba

limited life expectancy (less than 3 months) or poor health status. 12 , 50 , 79 Metastatic epidural spinal cord compression (MESCC) is a common and debilitating process associated with spinal metastases, in which compression of the spinal cord causes neurological deficit and compromises ambulation. 20 , 38 MESCC occurs in 5%–10% of patients with cancer and can be associated with any tumor subtype. 22 , 42 As the diagnosis and treatment of metastatic disease improves, the number of patients diagnosed with primary skin malignancies and spinal column metastases is

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Ranjith Babu, Jacob H. Bagley, Jong G. Park, Allan H. Friedman and Cory Adamson

. The use of resection (HR 0.60 [95% CI 0.46–0.78], p = 0.0002) was seen to significantly improve survival compared with biopsy alone. The gemistocytic tumor subtype (HR 1.62 [95% CI 1.27–2.07], p = 0.0001) resulted in significantly worse survival than fibrillary tumors, although the protoplasmic variant did not affect survival (HR 1.03 [95% CI 0.64–1.65], p = 0.91). Patient sex and race were not seen to significantly affect overall survival. TABLE 2: Univariate analysis of patient, tumor, and treatment factors of patients with fibrillary, protoplasmic, or

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Eric K. Oermann, Marie-Adele S. Kress, Jonathan V. Todd, Brian T. Collins, Riane Hoffman, Huma Chaudhry, Sean P. Collins, David Morris and Matthew G. Ewend

exploration in a rigorous prospective manner. These results are particularly relevant in light of 2 recent studies suggesting that cancer-related deaths and symptomatic progression in patients with brain metastases are associated with locally progressive intracerebral disease. 5 , 18 With the expanding use of radiosurgery for brain metastases and a trend toward applying it to larger lesions by fractionating the dose, this is also a timely observation. Several other studies have examined the tumor subtype of brain metastases as a predictor of local control in the case of

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Michael T. Bounajem, Michael Karsy and Randy L. Jensen

uses of liquid biopsies have been qualified, certain shortcomings remain. Many mutations and upregulated proteins have been found to be identifiable on liquid biopsy, but not all are specific to tumor subtypes, and therefore some overlap in diagnosis may occur. The accuracy of liquid biopsy results compared with the gold standard of tissue biopsies remains to be shown in pediatric brain tumors. Molecular techniques for liquid biopsies remain predominantly relegated to research settings. Although liquid biopsies are significantly less invasive compared with

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Katie Pricola Fehnel, Micah Duggins-Warf, David Zurakowski, Maxwell McKee-Proctor, Rajarshi Majumder, Michael Raber, Xuezhe Han and Edward R. Smith

date there have not been studies of urinary biomarkers specific to JPA. Focus on this tumor subtype is important because it is the most common pediatric brain tumor and has the potential to progress or recur years later. As a consequence of this need for long-term follow-up, patients with JPA represent a cohort uniquely suited to benefit from the noninvasive, cheap, easily accessible screening capability offered by urinary biomarkers. 6 Selection of Biomarker Species Historically, bFGF was one of the first described proangiogenic factors 11 and was noted to be

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Rupa Gopalan, Kasandra Dassoulas, Jessica Rainey, Jonathan H. Sherman and Jason P. Sheehan

✓ The management of craniopharyngioma involves balancing adequate reduction in tumor volume and prevention of recurrence while minimizing damage to delicate surrounding structures. Because of the lesion's proximity to the optic chiasm and its relationship to the hypothalamic–pituitary axis, morbidity rates following treatment can be high. Gamma Knife surgery (GKS) is now being considered as a viable method of providing tumor control while ensuring minimal side effects. The authors conducted a literature review of 10 studies in which GKS was used to treat craniopharyngioma; some lesions had been previously treated and some had not. The mean marginal dose ranged from 5 to 16.4 Gy (mean 12.3 Gy). Tumor control was achieved in 75% of cases overall and varied with tumor subtype (cystic, solid, mixed). Control was seen in 90% of solid, 80% of cystic, and 59% of mixed tumors. The overall morbidity rate resulting from radiosurgery was 4% and the overall mortality rate was 0.5%. These results suggest that GKS may provide a favorable benefit-to-risk profile for many patients with craniopharyngiomas.