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Tumors of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Neuroepithelial-derived tumors: Tumors of glial tissue, classically categorized according to the cell of origin with molecular genetics increasingly influencing classification: Astrocytoma (including glioblastoma multiforme [GBM]) (Figure 15.2): Low-grade astrocytoma.Anaplastic astrocytoma.Glioblastoma.Subependymal giant cell astrocytoma.Pilocytic astrocytoma (Figure 15.3).Oligodendroglioma.Oligoastrocytoma.Ependymoma/subependymoma.Pleomorphic xanthoastrocytoma (PXA).Choroid plexus papilloma and carcinoma.Neuronal and mixed neuronal–glial tumors: Gangliocytoma.Ganglioglioma.Dysembryoplastic neuroepithelial tumor (DNET).Paraganglioma.Esthesioneuroblastoma.Embryonal tumors: Embryonal tumor with multilayered rosettes.Atypical teratoid/rhabdoid tumor.
Transitioning from conventional photon therapy to proton therapy for primary brain tumors
Published in Acta Oncologica, 2023
Hanna Ek, Ingrid Fagerström Kristensen, Lars Stenberg, Sara Kinhult, Hunor Benedek, Simon Ek, Svend Aage Engelholm, Silke Engelholm, Per Munck af Rosenschöld
A total of 143 patients, treated during 2012–2019, were retrospectively identified, out of which 44 were treated with PT (2016–2019), and 98 were treated with XRT (2012–2019). One patient received PT and XRT consecutively, and data about that patient was missing. The most common diagnosis was astrocytoma followed by oligodendroglioma, pleomorphic xantoastrocytoma, oligoastrocytoma, and ganglioglioma. Patient characteristics are shown in Table 1. Three patients (1 PT, 2 XRT) were discontinued after 5.4 Gy, 18 Gy, and 46.8 Gy of radiation due to lowering of consciousness, imminent herniation followed by acute surgery, and pleuropneumonia in need of draining, respectively. All 142 patients were, however, included in pretreatment analyses (dosimetry and treatment planning data). The patients receiving 5.4, respectively, 18 Gy of radiation were excluded in analyses of outcomes (PsP, side effects, PFS and OS) but the patient receiving 46.8 Gy of radiation was included, since most of the treatment was given. Seven patients were lost to follow-up, and side-effect data were not available for another five patients receiving XRT.
Incidence trends of adult malignant brain tumors in Finland, 1990–2016
Published in Acta Oncologica, 2019
Tuomas Natukka, Jani Raitanen, Hannu Haapasalo, Anssi Auvinen
A difference in incidence trends between histological types during 1990–2006 was evident (likelihood ratio test p<.001). The incidence trend of glioblastoma was slightly increasing (APC: +0.8%; 95% CI: −0.0, +1.7 for 1990–2006 and +1.9%; 95% CI: +0.2, +3.5 for 2007–2016; Tables 2 and 3). A decreasing ASR was found for unspecified tumors of the brain (APC: −4.5%; 95% CI: −6.0, −2.9 for 1990–2006 and −6.0%; 95% CI: −8.6, −3.3 for 2007–2016), whereas incidence of unspecified malignant glioma increased by +6.7% per year (95% CI: +2.6, +11.0)) in 1990–2006 and at a nearly identical rate in 2007–2016. Incidence of oligoastrocytoma increased in 1990–2006 (APC: +6.6%; 95% CI: +3.8, +9.5), but not any more during the later period. During the earlier study period, significant increase in ASRs was also observed for anaplastic oligodendroglioma (APC: +6.0%; 95% CI: +2.3, +9.8), while incidence trend of astrocytoma showed a decrease of −2.8% per year (95% CI: −4.4, −1.1). Incidence of anaplastic astrocytoma increased in 2007–2016 (APC: +7.3%; 95% CI: +2.2, +12.7). In addition, imputing specific histologic types (in similar proportion to those with known cell type) to unspecified tumors had no substantial effect on the incidence trends in 1990–2006 (Supplementary Table 1).
National practice patterns of proton versus photon therapy in the treatment of adult patients with primary brain tumors in the United States
Published in Acta Oncologica, 2019
Jeffrey M. Ryckman, Vaishnavi Ganesan, Adams Kusi Appiah, Chi Zhang, Vivek Verma
The advent of the WHO staging system update in 2016 underscored the importance of molecular subtyping, as genotype can now trump histological phenotype in staging [42]. In fact, a large subset of tumors is now defined based on presence or absence of 1p/19q codeletion and IDH mutation, which one could largely expect the diagnosis of anaplastic oligoastrocytomas to largely disappear [43]. Of the 2527 oligoastrocytoma and anaplastic oligoastrocytoma patients in this study, only 537 (21.3%) had information on 1p/19q deletion. However, the frequency of molecular information in regards to 1p/19q codeletion improved in the latter years, with 528 of 1242 of cases (42.5%) containing this information in the years 2010 or later, suggesting improvement of coding in more recent years. In fact, dropping 2004–2009 from the dataset only loses 9 patients who had 1p/19q codeletion status for the subset of oligoastrocytoma and anaplastic oligoastrocytoma patients in this study. Isocitrate dehydrogenase (IDH) status is not tabulated in the NCDB. Therefore, this study was unable to tease out differences in utilization of proton therapy for WHO II versus WHO III gliomas in the modern era due to inherent limitations related to the coding of molecular status within the NCDB. Accordingly, future studies utilizing the NCDB wishing to investigate patterns of care in the molecular era should be aware of the paucity of molecular information before the year 2010.