Patterns of care and predictors of adjuvant therapies in elderly patients with glioblastoma

Amsbaugh, M.J. et al. Cancer | Published online: 27 April 2017

Background: The objectives of this study were to characterize patterns of care and to identify predictors for adjuvant therapy in elderly patients with glioblastoma in the modern era.

Conclusions: In this analysis of elderly patients who had glioblastoma diagnosed from 2004 through 2012, a significant increase in the receipt of combined-modality therapy was observed. Combined-modality treatment produces improved survival outcomes and should be considered as adjuvant treatment for carefully selected elderly patients.

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Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases?

Yomo, S & Hayashi, M. BMC Cancer. Published online: 15 December 2016

B0010355 Human brain cancer stem cells treated with graphene, SEM

Image source: Suffian, I. et al. – Wellcome Images // CC BY-NC-ND 4.0

 

Image shows false-coloured scanning electron micrograph of human cancer stem cells isolated from patients with brain cancer

Background: Advanced age has been shown to be a factor predicting poor survival in patients with brain metastases (BM). There have been only a few studies focusing on stereotactic radiosurgery (SRS) for elderly BM patients. The present study aimed to investigate the efficacy and limitations of SRS for very elderly BM patients.

 

Conclusions: The present study suggested an upfront SRS strategy to offer a feasible and effective treatment option for very elderly patients with limited BM. In the majority of patients, neurological death could be delayed or even prevented.

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Coffee and green tea consumption in relation to brain tumor risk

Ogawa, T. et al. International Journal of Cancer. Published online: 25 August 2016

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Few prospective studies have investigated the etiology of brain tumor, especially among Asian populations. Both coffee and green tea are popular beverages, but their relation with brain tumor risk, particularly with glioma, has been inconsistent in epidemiological studies. In this study, we evaluated the association between coffee and greed tea intake and brain tumor risk in a Japanese population.

We evaluated a cohort of 106,324 subjects (50,438 men and 55,886 women) in the Japan Public Health Center-based Prospective Study (JPHC Study). Subjects were followed from 1990 for Cohort I and 1993 for Cohort II until December 31, 2012. 157 (70 men and 87 women) newly diagnosed cases of brain tumor were identified during the study period. Hazard ratio (HR) and 95% confidence intervals (95%CIs) for the association between coffee or green tea consumption and brain tumor risk were assessed using a Cox proportional hazards regression model.

We found a significant inverse association between coffee consumption and brain tumor risk in both total subjects (≥3 cups/day; HR=0.47, 95%CI=0.22-0.98) and in women (≥3 cups/day; HR=0.24, 95%CI=0.06-0.99), although the number of cases in the highest category was small. Furthermore, glioma risk tended to decrease with higher coffee consumption (≥3 cups/day; HR=0.54, 95%CI=0.16-1.80). No association was seen between green tea and brain tumor risk.

In conclusion, our study suggested that coffee consumption might reduce the risk of brain tumor, including that of glioma, in the Japanese population.

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Radiation therapy chemotherapy combination improves survival in adults with low-grade brain cancer

ScienceDaily. Published online: 7th April 2016

Image shows magnetic resonance imaging scan showing cystic cerebellar astrocytoma.

Patients with a low-grade type of brain tumor called glioma who received radiation therapy plus a chemotherapy regimen, including procarbazine, lomustine and vincristine (PCV), experienced a longer progression-free survival and overall survival than patients who received radiation therapy alone, according to the results of the clinical trial.

Between October 1998 and June 2002, 251 patients with low-grade glioma were enrolled in the RTOG 9802 trial. Patients enrolled were at high risk, compared to other patients with low-grade glioma, because they were 40 or older, or had a less-than-complete surgical removal of their tumor.

Patients were randomized to 1 of 2 trial arms, radiation therapy plus six cycles of PCV chemotherapy or radiation therapy alone. Before treatment, researchers conducted a pathology review on tumor samples and prepared for samples for correlative laboratory studies to assess mutational status and identify prognostic variables.

At a median follow-up time of 11.9 years, 67 percent of enrolled patients were identified as having tumor progression, and 55 percent of patients had died. Patients in the radiation therapy plus PCV chemotherapy arm had longer median survival times, compared with those in the trial arm who received radiation therapy alone (13.3 versus 7.8 years, respectively; p=0.003). Median progression- free survival time for patients receiving radiation therapy plus PCV chemotherapy versus radiation therapy alone was 10.4 years and 4.0 years, respectively. Ten-year, progression-free survival and overall survival rates for patients in the radiation therapy plus PCV chemotherapy arm versus those in the radiation therapy alone arm were 51 percent versus 21 percent and 60 percent versus 40 percent, respectively.

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Systematic review: brain metastases from colorectal cancer—Incidence and patient characteristics

Christensen, T. D. et al. BMC Cancer 16:260. Published online 1st April 2016

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Image source: Wellcome Images // CC BY-NC-ND 4.0 

Image shows magnetic resonance image (MRI), pre-contrast axial slice showing brain metastasis from primary cancer.

Background: Brain metastases (BM) from colorectal cancer (CRC) are a rare event. However, the implications for affected patients are severe, and the incidence has been reported to be increasing. For clinicians, knowledge about the characteristics associated with BM is important and could lead to earlier diagnosis and improved survival.

Method: In this paper, we describe the incidence as well as characteristics associated with BM based on a systematic review of the current literature, following the PRISMA guidelines.

Results: We show that the incidence of BM in CRC patients ranges from 0.6 to 3.2 %. BM are a late stage phenomenon, and young age, rectal primary and lung metastases are associated with increased risk of developing BM. Molecular markers such as KRAS, BRAF, NRAS mutation as well as an increase in CEA and CA19.9 levels are suggested predictors of brain involvement. However, only KRAS mutations are reasonably well investigated and associated with an increased risk of BM.

Conclusion: The incidence of BM from CRC is 0.6 to 3.2 % and did not seem to increase over time. Development of BM is associated with young age, lung metastases, rectal primary and KRAS mutation. Increased awareness of brain involvement in patients with these characteristics is necessary.

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Scientists create imaging ‘toolkit’ to help identify new brain tumor drug targets

Breckwoldt, M. et al. Correlated magnetic resonance imaging and ultramicroscopy (MR-UM) is a tool kit to assess the dynamics of glioma angiogenesis. eLife, 2016; 5

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Brain tumor vascularisation is visualized using T2*-weighted magnetic resonance imaging.
Credit: Breckwoldt, Bode et al.

Stopping the growth of blood vessels in tumors is a key target for glioblastoma therapies, and imaging methods are essential for initial diagnosis and monitoring the effects of treatments. A team of researchers has developed a combined magnetic resonance imaging (MRI) and ultramicroscopy ‘toolkit’ to study vessel growth in glioma models in more detail than previously possible.

In their study in mice, the team combined an MRI approach in vivo with ultramicroscopy of ex vivo whole brains cleared for imaging.

The technique is based on T2*-weighted (T2*-w) MRI images, one of the basic pulse sequences in MRI, with high resolution to allow for substantially more detail than conventional T2*-w imaging. Pre- and post-contrast MR scans were performed to define the growth of vessels during glioma development in two different glioma models.

The team further mapped the development of vessels by dual-colour ultramicroscopy of whole, cleared brains. Using fluorescent labelling of microvessels, they collected complementary 3D MR and ultramicroscopy data sets (dubbed the ‘MR-UM’), which could be compared side-by-side.

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Impact of vision loss among survivors of childhood central nervous system astroglial tumors

de Blank, P.M.K. et al. Cancer: Article first published online 11 JAN 2016

eye test.jpg

BACKGROUND: The impact of impaired vision on cognitive and psychosocial outcomes among long-term survivors of childhood low-grade gliomas has not been investigated previously but could inform therapeutic decision making.

METHODS: Data from the Childhood Cancer Survivor Study were used to investigate psychological outcomes (measures of cognitive/emotional function) and socioeconomic outcomes (education, income, employment, marital status, and independent living) among astroglial tumor survivors grouped by 1) vision without impairment, 2) vision with impairment (including unilateral blindness, visual field deficits, and amblyopia), or 3) bilateral blindness. The effect of vision status on outcomes was examined with multivariate logistic regression with adjustments for age, sex, cranial radiation therapy, and medical comorbidities.

 

RESULTS: Among 1233 survivors of childhood astroglial tumors 5 or more years after their diagnosis, 277 (22.5%) had visual impairment. In a multivariate analysis, survivors with bilateral blindness were more likely to be unmarried (adjusted odds ratio (OR), 4.7; 95% confidence interval [CI], 1.5-15.0), live with a caregiver (adjusted OR, 3.1; 95% CI, 1.3-7.5), and be unemployed (adjusted OR, 2.2; 95% CI, 1.1-4.5) in comparison with those without visual impairment. Bilateral blindness had no measurable effect on cognitive or emotional outcomes, and vision with impairment was not significantly associated with any psychological or socioeconomic outcomes.

 

CONCLUSIONS: Adult survivors of childhood astroglial tumors with bilateral blindness were more likely to live unmarried and dependently and to be unemployed. Survivors with visual impairment but some remaining vision did not differ significantly with respect to psychological function and socioeconomic status from those without visual impairment.

 

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