scholarly journals Opportunities to enhance our management, outcomes, and interventions for patients with CNS malignancy

2019 ◽  
Vol 6 (4) ◽  
pp. 247-248
Author(s):  
Jeffrey S Wefel
Keyword(s):  
Cns Malignancy

ONE YEAR RETROSPECTIVE AUDIT OF CNS MALIGNANCY 2 WW REFERRALS

2015 ◽  
Vol 86 (11) ◽  
pp. e4.126-e4
Author(s):  
Elizabeth Ashton ◽  
Benjamin Smeeton ◽  
Stuart Weatherby
Keyword(s):  
Waiting Times ◽  
Final Diagnosis ◽  
Referral Process ◽  
Radiological Imaging ◽  
Outpatient Appointment ◽  
Detection Rates ◽  
Subsequent Time ◽  
Retrospective Audit ◽  
One Year ◽  
Cns Malignancy

BackgroundSince its introduction in 2000, concerns have been raised about the two week wait (2 WW) referral system for suspected malignancy. Studies have demonstrated poor compliance to guidelines, low detection rates and questioned the time effectiveness of the referral process.MethodAll patients referred under the 2 WW system for suspected CNS malignancy to Derriford Hospital, Plymouth Hospitals NHS trust, over a one-year period were retrospectively audited. Data was gained from clinic letters and radiological imaging. The aims were to determine the number of referrals, their appropriateness and subsequent time taken to outpatient appointment, imaging and final diagnosis.Results103 referrals were made between September 2013 and September 2014 with just 48.5% fulfilling NICE referral guidelines for suspected CNS malignancy. Just three tumours were diagnosed with guidelines identifying all of these. Only 28% of 2 WW referrals received diagnostic imaging and an outpatient appointment within two weeks.ConclusionsUnnecessary referrals are placing strain on the 2 WW system. We suggest that a potential solution is for general practitioners to refer patients for imaging at the same time as they make their neurological 2 WW referral in order to cut down waiting times.

scholarly journals Tumor cell phenotype and heterogeneity differences in IDH1 mutant vs wild-type gliomas

2019 ◽  
Author(s):  
Michael E. Berens ◽  
Anup Sood ◽  
Jill S. Barnholtz-Sloan ◽  
John F. Graf ◽  
Sanghee Cho ◽  
...  
Keyword(s):  
Spatial Heterogeneity ◽  
Tumor Grade ◽  
Cell Phenotype ◽  
Imaging Features ◽  
Cellular Interactions ◽  
Protein Markers ◽  
Cancer Hallmarks ◽  
Magnetic Resonance Imaging Mri ◽  
Cell Data ◽  
Cns Malignancy

AbstractGlioma is recognized to be a highly heterogeneous CNS malignancy, whose diverse cellular composition and cellular interactions have not been well characterized. To gain new clinical- and biological-insights into the genetically-bifurcated IDH1 mutant (mt) vs wildtype (wt) forms of glioma, we integrated multiplexed immunofluorescence single cell data for 43 protein markers across cancer hallmarks, in addition to cell spatial metrics, genomic sequencing and magnetic resonance imaging (MRI) quantitative features. Molecular and spatial heterogeneity scores for angiogenesis and cell invasion differ between IDHmt and wt gliomas irrespective of prior treatment and tumor grade; these differences also persisted in the MR imaging features of peritumoral edema and contrast enhancement volumes. Longer overall survival for IDH1mt glioma patients may reflect generalized altered cellular, molecular, spatial heterogeneity which manifest in discernable radiological manifestations.

scholarly journals P14.86 Bevacizumab-associated intracerebral hemorrhage in patients with CNS malignancy: A single-center retrospective cohort study

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii88-iii88
Author(s):  
N Clarke ◽  
M Ruff
Keyword(s):  
Intracerebral Hemorrhage ◽  
Functional Status ◽  
Retrospective Chart Review ◽  
Primary Diagnosis ◽  
Recurrent Glioblastoma ◽  
Adult Patients ◽  
Single Center ◽  
Cns Neoplasms ◽  
Ich Score ◽  
Cns Malignancy

Abstract BACKGROUND Gliomas are a known risk factor for the development of spontaneous intracranial hemorrhage (ICH) independent of therapies directed against them, with studies reporting an incidence of 1.9–3.8%. Bevacizumab (BEV) is a humanized monoclonal antibody targeting vascular endothelial growth factor (VEGF) FDA approved for recurrent glioblastoma. ICH is commonly considered to be a potential adverse effect of BEV use in patients with glioma, with previous retrospective studies describing incidence of intracerebral hemorrhage ranging from 1.9–3.3%. Material and METHODS We performed a single center (Mayo Clinic, Rochester, MN) retrospective chart review of all patients who received BEV therapy at our institution for a diagnosis of primary CNS malignancy. We used ICD-9 and ICD-10 codes to identify adult patients with primary CNS neoplasms that subsequently developed ICH. RESULTS We screened 10,507 adult patients with a diagnosis of primary CNS neoplasm treated at our center from 01/31/2008 to 12/31/2018 and found 644 patients treated with bevacizumab. Of these, 23 (3.6%) suffered an ICH within 12 weeks of a BEV infusion (median 9 days post infusion, 1–24 IQR). The dose of BEV in all hemorrhages was either 10 mg/kg every two weeks (n = 21) or 15 mg/kg every three weeks (n = 2). No patients treated with infusions at 7.5 mg/kg every three weeks (n = 79) or 5 mg/kg every two weeks (n = 17) suffered ICH events, however this did not meet significance (P = 0.06) when compared to patients on 10 mg/kg or above. The median ICH score was 1 (0–2 IQR). There was an increase in ECOG scores documented at clinical follow up following the hemorrhage compared to the pre-hemorrhage functional status (ECOG 3.28 versus 1.2, p = < 0.0001), with 13 patients (56%) having developed severe debility or death (ECOG 4 n = 3, ECOG 5 n = 10). CONCLUSION In our single-center cohort of patients with a primary diagnosis of CNS neoplasms treated with BEV, ICH occurred in 3.6% of patients. Those who experienced an ICH in proximity to BEV infusion had significant morbidity and mortality with a clear decline in functional status. There was a signal of dose response as far as ICH incidence in our cohort with dosages 10 mg/kg per infusion or above.

scholarly journals CSF-ctDNA SMSEQ Analysis to Tailor the Treatment of a Patient with Brain Metastases: A Case Report

2018 ◽  
Vol 11 (1) ◽  
pp. 68-74 ◽  
Author(s):  
Wen-Tsung  Huang ◽  
Na-Mi Lu ◽  
Wen-Yuan Hsu ◽  
Shih-En Chang ◽  
Alex Atkins ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Biological Fluid ◽  
Neurological Complications ◽  
Disease Monitoring ◽  
Disease Course ◽  
Advanced Imaging ◽  
Extensive Information ◽  
Ctdna Analysis ◽  
Cns Malignancy ◽  
Fast Evolution

Brain metastases are the most common neurological complications of adult cancers, accounting for more than half of brain tumors. The incidence of brain metastases may be increasing due to improved detection of small lesions by advanced imaging technologies. Given the fast evolution of targeted and immunotherapy regimens, it is essential to serially assess brain malignancies during the disease course for disease monitoring and tailoring of the therapeutic management. For such serial and repetitive assessment, cerebrospinal fluid (CSF) could be the biological fluid of choice to supplement cytology examination for the presence or absence of CNS malignancy, as well as provide extensive information on tumor mutational profile for personalization of treatment. The case described here emphasizes the importance of CSF-ctDNA analysis with the CellMax SMSEQ technology that led to treatment adjustment resulting in clinical remission of the patient.

Immunotoxins and central nervous system neoplasia

1992 ◽  
Vol 76 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Walter A. Hall ◽  
Øystein Fodstad
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Malignant Disease ◽  
High Specificity ◽  
Intrathecal Administration ◽  
Treatment Modalities ◽  
Content Type ◽  
Toxic Agents ◽  
Cns Malignancy

✓ The poor prognosis associated with central nervous system (CNS) malignancy has led investigators to seek new, innovative treatment modalities. Immunotoxins, carrier molecules linked to toxic agents, combine high specificity for tumor-associated antigens with extreme potency. The rationale for both the development of these compounds and for their application to CNS neoplasia is explained. This report discusses the design and construction of immunoconjugates, using toxins that differ in their mechanism of action bound to ligands directed against various antigens. A comparison is made between the in vitro efficacy of standard chemotherapy and immunotoxins in glioblastoma- and medulloblastoma-derived cell lines. A review is included of the results of experiments in animals with leptomeningeal neoplasia, where prolongation of survival following intrathecal administration of immunotoxins has been reported. The obstacles encountered in clinical trials with other types of cancer are addressed and approaches to optimize the use of these novel agents in the context of treating malignant disease of the CNS are suggested.

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