Marker-independent identification of glioma-initiating cells.

Tumor-initiating cells with stem cell properties are believed to sustain the growth of gliomas, but proposed markers such as CD133 cannot be used to identify these cells with sufficient specificity. We report an alternative isolation method purely based on phenotypic qualities of glioma-initiating cells (GICs), avoiding the use of molecular markers. We exploited intrinsic autofluorescence properties and a distinctive morphology to isolate a subpopulation of cells (FL1(+)) from human glioma or glioma cultures. FL1(+) cells are capable of self-renewal in vitro, tumorigenesis in vivo and preferentially express stem cell genes. The FL1(+) phenotype did not correlate with the expression of proposed GIC markers. Our data propose an alternative approach to investigate tumor-initiating potential in gliomas and to advance the development of new therapies and diagnostics.

Stratégies thérapeutiques pour le traitement des gliomes [Therapeutic strategies for the management of gliomas]

The management of gliomas remains challenging and requires a multidisciplinary approach that involves neurosurgeons, radiation therapists and oncologists. For patients with glioblastomas, progress has been made in recent years with the introduction of a combined modality treatment associating radiation therapy and concomitant chemotherapy with the novel alkylating agent temozolomide. This combination resulted in a significant prolongation of survival and increase in the number of patients with survival well beyond two years. Since then, interest in developing new agents in this disease has dramatically increased. In parallel, molecular markers, such as methylation status of MGMT or identification of the translocation of 1p and 19q in oligodendrogliomas have allowed to identify distinct subtypes with exquisite response to treatment or different prognosis. These developments have implications for the development of clinical trials of new potential drug treatments. In this article, we provide a review of the current management of low- and high-grade gliomas, including astrocytomas, oligodendrogliomas and glioblastomas and provide an outlook into future potential therapies.

Patterns of care in recurrent glioblastoma in Switzerland: a multicentre national approach based on diagnostic nodes.

Despite moderate improvements in outcome of glioblastoma after first-line treatment with chemoradiation recent clinical trials failed to improve the prognosis of recurrent glioblastoma. In the absence of a standard of care we aimed to investigate institutional treatment strategies to identify similarities and differences in the pattern of care for recurrent glioblastoma. We investigated re-treatment criteria and therapeutic pathways for recurrent glioblastoma of eight neuro-oncology centres in Switzerland having an established multidisciplinary tumour-board conference. Decision algorithms, differences and consensus were analysed using the objective consensus methodology. A total of 16 different treatment recommendations were identified based on combinations of eight different decision criteria. The set of criteria implemented as well as the set of treatments offered was different in each centre. For specific situations, up to 6 different treatment recommendations were provided by the eight centres. The only wide-range consensus identified was to offer best supportive care to unfit patients. A majority recommendation was identified for non-operable large early recurrence with unmethylated MGMT promoter status in the fit patients: here bevacizumab was offered. In fit patients with late recurrent non-operable MGMT promoter methylated glioblastoma temozolomide was recommended by most. No other majority recommendations were present. In the absence of strong evidence we identified few consensus recommendations in the treatment of recurrent glioblastoma. This contrasts the limited availability of single drugs and treatment modalities. Clinical situations of greatest heterogeneity may be suitable to be addressed in clinical trials and second opinion referrals are likely to yield diverging recommendations.

Verbal emotional memory in a case with left amygdala damage.

The amygdala nuclei appear to be critically implicated in emotional memory. However, in most studies, encoding and consolidation processes cannot be analyzed separately. We thus studied the verbal emotional memory in a young woman with a ganglioglioma of the left amygdala and analyzed its impact (1) on each step of the memory process (encoding, retrieval, and recognition) (2) on short- and long-term consolidation (1-hour and 1-week delay) and (3) on processing of valence (positive and negative items compared to neutral words). Results showed emotional encoding impairments and, after encoding was controlled for, emotional long-term consolidation. Finally, although the negative words were not acknowledged as emotionally arousing by the patient, these words were specifically poorly encoded, recalled, and consolidated. Our data suggest that separate cerebral networks support the processing of emotional versus neutral stimuli.

Neurocirugia radioguiada en los tumores cerebrales de alto grado, experiencia INC

La cirugía radioguiada es una rama de la medicina nuclear con la cual se marca el tejido tumoral con un radiotrazador (MIBI) y mediante el uso de una gamasonda o gamacámara poder diferenciarlo del tejido cerebral sano in vivo en la sala de cirugía. Esta técnica se ha aplicado con éxito en tumores del SNC (Gliomas de alto grado, metástasis, meningiomas). Los tumores del SNC representan el 1% de todos los tumores pero son la tercera causa de mortalidad por cáncer en el mundo. Hay un mejor pronóstico de los pacientes con mayor extensión de la resección. Objetivos: Evaluar la factibilidad de la técnica y optimizar los procesos en el INC con la finalidad de desarrollar un protocolo de línea de investigación en esta materia. Materiales y métodos: se realiza un reporte de casos de pacientes con diagnóstico de tumor cerebral supratentorial. Se realizó SPECT cerebral con MIBI para confirmar captación del radiotrazador. En los pacientes que marcaron positivo se programó cirugía radioguiada con gamacámara portátil Sentinel Resultados: En 5 pacientes con tumores supratentoriales se realizó SPECT cerebral con MIBI: 3 de ellos fueron positivos los cuales fueron programados para cirugía radioguiada y los 2 restantes con cirugía convencional. Dos de los casos positivos correspondieron a Tumor de alto grado y un caso de tumor abscedado. En quienes se practicó la cirugía radioguiada se consiguió resección tumoral completa tumoral por imagen de gamacámara intraquirúrgica

Malignant transformation of pleomorphic xanthoastrocytoma: Case report

We report a case of a pleomorphic xantoastrocytoma which manifested itself as a cystic isodense lesion in the right fronto-temporal lobe in a 26 year-old woman. It appeared as a soft yellow tumor with cystic cavities on surgery. Five months after this surgery, the patient was submitted to a new operation, which revealed a friable tumor, easily differentiated from the normal parenchyma, with cystic components. The histopathological examination demonstrated pleomorphic xanthoastrocytoma with malignant transformation. Histologically, the tumor at first procedure was composed of pleomorphic astrocytes with multinucleated and foamy cells. A rare case of malignant transformation in pleomorphic xanthoastrocytoma is presented, discussed and illustrated in this paper.

Isolated Richter's syndrome in central nervous system: Case report

Diffuse large cell non Hodgkin's lymphoma associated with chronic lymphoid leukemia (CLL), or Richter's syndrome, is a rare and serious complication. Isolated Richter's syndrome in the central nervous system is very rare; only 12 cases have been reported. We describe a 74-year-old patient with diffuse large cell non Hodgkin's lymphoma in the right frontal region with the appearance of multiform glioblastoma.

O cuidador de paciente com neoplasia cerebral maligna primária: os desafios do cuidado

Patients with primary malignant brain tumor endure several motor and cognitive dysfunctions, demanding the presence of a caregiver even more because the time necessary for their assistance increases considerably. Usually this task is performed by a family relative, whose activities include taking care of the patient’s personal hygiene, escorting them to medical appointments, managing their money and performing their housework. All of this overwhelms the caregiver both physical and psychologically. This bibliographic research intends to analyze the role in which a caregiver plays in the quality of life of those kinds of patients, the complications of such task, the caregivers’ needs and the daily life of those terminal patients. It was used CAPES, PubMed and Google Academic databases for researching articles related to family caregivers who assisted adult patients with primary malignant brain tumor. The study concluded that being a caregiver of patients in such conditions harms one’s quality of life, with consequences such as stress, insomnia, financial problems and lack of social support. Theirs needs include: having someone to talk to about the matter, attending programs for reducing stress and increasing their knowledge about the disease. In advanced phases of the condition, the patient shows great mobility problems, aphasia and regular seizures, which end up overwhelming the caregiver. The level of quality of life found was above other types of cancer’s caregivers. Therefore, they represent a group with special needs, which should be especially handled by health professionals.

Características tomográficas de neoplasias encefálicas primárias em cães

Computed tomography (CT) can be considered an important test to identify the presence of primary brain neoplasias in dogs. CT results can help define the type of brain tumor when associated with clinical findings. It allows the identification of lesions and their features, such as size, location, compression and invasion of adjacent tissue. One must analyze the density, mass effect, peritumoral edema, calcification, and image enhancement after intravenous injection of contrast medium. Gliomas, meningiomas and tumors of the choroid plexus and pituitary are the most common primary brain neoplasms diagnosed by CT in dogs. The aim of this paper is to review the literature related to primary brain tumors and report their most important tomographic features, in order to help clinicians achieve a presumptive diagnosis of tumor type.

Monitoramento por imagem de ressonância magnética do crescimento tumoral no modelo C6 de glioblastoma com perspectivas de avaliação da terapia de magnetohipertemia

Objetivo: Estabelecer um padrão de crescimento tumoral (volume) em ratos Wistar submetidos ao modelo C6 de glioblastoma multiforme por meio de imagens de ressonância magnética para posterior verificação de redução de volume tumoral com a terapia de magnetohipertermia. Métodos: Para o modelo C6, utilizamos ratos Wistar, machos, jovens, pesando entre 250 e 300 g. Após anestesiados (cetamina 55 mg/kg e xilazina 11 mg/kg) foram injetadas estereotaxicamente células tumorigênicas linhagem C6 suspensas em meio de cultura (105 células em 10 µL) no córtex frontal direito (coordenadas a partir do bregma: anteroposterior = 2,0 mm; látero-lateral = 3,0 mm; profundidade = 2,5 mm) com uma seringa Hamilton. No Grupo Controle, houve a injeção do meio de cultura sem as células. Posteriormente, foram feitas imagens mediante a técnica de imagem por ressonância magnética em 14, 21 e 28 dias após a injeção em um escâner de imagem por ressonância magnética 2.0 T (Bruker BioSpec, Germany). Para o exame, os animais foram anestesiados com cetamina 55 mg/kg e xilazina 11 mg/kg. Multifatias coronais foram adquiridas utilizando uma sequência spin-echo padrão com os seguintes parâmetros: TR/TE = 4,000 ms/67,1 ms, FOV = 3,50, Matrix 192, slice thickness = 0,4 mm e slice separation = 0 mm. Resultados: A análise das imagens de ressonância magnética do tumor possibilitou a clara visualização da massa tumoral, sendo possível ainda estabelecer parâmetros de volume tumoral nos diferentes dias analisados. O volume de 14 dias após a indução do foi de 13,7 ± 2,5 mm3 . Aos 21 dias, o volume alcançado foi de 31,7 ± 6,5 mm3 e, aos 28 dias, a massa tumoral atingiu 122,1 ± 11,8 mm3 . Conclusão: Estes resultados mostraram a possiblidade de avaliação do volume tumoral no modelo C6 em ratos, o que possibilitará, no futuro, a aplicação da terapia de magnetohipertermia bem como verificação de seus resultados.

Targeted alpha-radionuclide therapy of functionally critically located gliomas with 213Bi-DOTA-[Thi8,Met(O2)11]-substance P: a pilot trial

Functionally critically located gliomas represent a challenging subgroup of intrinsic brain neoplasms. Standard therapeutic recommendations often cannot be applied, because radical treatment and preservation of neurological function are contrary goals. The successful targeting of gliomas with locally injected beta radiation-emitting (90)Y-DOTAGA-substance P has been shown previously. However, in critically located tumours, the mean tissue range of 5 mm of (90)Y may seriously damage adjacent brain areas. In contrast, the alpha radiation-emitting radionuclide (213)Bi with a mean tissue range of 81 microm may have a more favourable toxicity profile. Therefore, we evaluated locally injected (213)Bi-DOTA-substance P in patients with critically located gliomas as the primary therapeutic modality.

IDH/MGMT-driven molecular classification of low-grade glioma is a strong predictor for long-term survival

BACKGROUND Low-grade gliomas (LGGs) are rare brain neoplasms, with survival spanning up to a few decades. Thus, accurate evaluations on how biomarkers impact survival among patients with LGG require long-term studies on samples prospectively collected over a long period. METHODS The 210 adult LGGs collected in our databank were screened for IDH1 and IDH2 mutations (IDHmut), MGMT gene promoter methylation (MGMTmet), 1p/19q loss of heterozygosity (1p19qloh), and nuclear TP53 immunopositivity (TP53pos). Multivariate survival analyses with multiple imputation of missing data were performed using either histopathology or molecular markers. Both models were compared using Akaike's information criterion (AIC). The molecular model was reduced by stepwise model selection to filter out the most critical predictors. A third model was generated to assess for various marker combinations. RESULTS Molecular parameters were better survival predictors than histology (ΔAIC = 12.5, P< .001). Forty-five percent of studied patients died. MGMTmet was positively associated with IDHmut (P< .001). In the molecular model with marker combinations, IDHmut/MGMTmet combined status had a favorable impact on overall survival, compared with IDHwt (hazard ratio [HR] = 0.33, P< .01), and even more so the triple combination, IDHmut/MGMTmet/1p19qloh (HR = 0.18, P< .001). Furthermore, IDHmut/MGMTmet/TP53pos triple combination was a significant risk factor for malignant transformation (HR = 2.75, P< .05). CONCLUSION By integrating networks of activated molecular glioma pathways, the model based on genotype better predicts prognosis than histology and, therefore, provides a more reliable tool for standardizing future treatment strategies.

Clinical Proton MR Spectroscopy in Central Nervous System Disorders.

A large body of published work shows that proton (hydrogen 1 [(1)H]) magnetic resonance (MR) spectroscopy has evolved from a research tool into a clinical neuroimaging modality. Herein, the authors present a summary of brain disorders in which MR spectroscopy has an impact on patient management, together with a critical consideration of common data acquisition and processing procedures. The article documents the impact of (1)H MR spectroscopy in the clinical evaluation of disorders of the central nervous system. The clinical usefulness of (1)H MR spectroscopy has been established for brain neoplasms, neonatal and pediatric disorders (hypoxia-ischemia, inherited metabolic diseases, and traumatic brain injury), demyelinating disorders, and infectious brain lesions. The growing list of disorders for which (1)H MR spectroscopy may contribute to patient management extends to neurodegenerative diseases, epilepsy, and stroke. To facilitate expanded clinical acceptance and standardization of MR spectroscopy methodology, guidelines are provided for data acquisition and analysis, quality assessment, and interpretation. Finally, the authors offer recommendations to expedite the use of robust MR spectroscopy methodology in the clinical setting, including incorporation of technical advances on clinical units. © RSNA, 2014 Online supplemental material is available for this article.