Tumor Treating Fields Increases Blood-Brain Barrier Permeability and Relative Cerebral Blood Volume in Patients With Glioblastoma

BACKGROUND AND OBJECTIVE: 200 kHz tumor treating fields (TTFields) is clinically approved for newly-diagnosed glioblastoma (nGBM). Because its effects on conventional surveillance MRI brain scans are equivocal, we investigated its effects on perfusion MRI (pMRI) brain scans. METHODS: Each patient underwent institutional standard pMRI: dynamic contrast-enhanced (DCE) and dynamic susceptibility contrast (DSC) pMRI at three time points: baseline, 2-, and 6-months on-adjuvant therapy. At each timepoint, the difference between T1 pre- versus post-contrast tumor volume (ΔT1) and these pMRI metrics were evaluated: normalized and standardized relative cerebral blood volume (nRCBV, sRCBV); fractional plasma volume (V RESULTS: Among 13 pMRI datasets (11 nGBM, 2 recurrent GBM), therapies included temozolomide-only ( CONCLUSION: Using pMRI, we provide initial in-human validation of pre-clinical studies regarding the effects of TTFields on tumor blood volume and BBB permeability in GBM

Clinical Utility of the 12-Gene DCIS Score Assay: Impact on Radiotherapy Recommendations for Patients with Ductal Carcinoma In Situ

OBJECTIVE: The aim of this study was to determine the impact of the results of the 12-gene DCIS Score assay on (i) radiotherapy recommendations for patients with pure ductal carcinoma in situ (DCIS) following breast-conserving surgery (BCS), and (ii) patient decisional conflict and state anxiety. METHODS: Thirteen sites across the US enrolled patients (March 2014–August 2015) with pure DCIS undergoing BCS. Prospectively collected data included clinicopathologic factors, physician estimates of local recurrence risk, DCIS Score results, and pre-/post-assay radiotherapy recommendations for each patient made by a surgeon and a radiation oncologist. Patients completed pre-/post-assay decisional conflict scale and state-trait anxiety inventory instruments. RESULTS: The analysis cohort included 127 patients: median age 60 years, 80 % postmenopausal, median size 8 mm (39 % ≤5 mm), 70 % grade 1/2, 88 % estrogen receptor-positive, 75 % progesterone receptor-positive, 54 % with comedo necrosis, and 18 % multifocal. Sixty-six percent of patients had low DCIS Score results, 20 % had intermediate DCIS Score results, and 14 % had high DCIS Score results; the median result was 21 (range 0–84). Pre-assay, surgeons and radiation oncologists recommended radiotherapy for 70.9 and 72.4 % of patients, respectively. Post-assay, 26.4 % of overall recommendations changed, including 30.7 and 22.0 % of recommendations by surgeons and radiation oncologists, respectively. Among patients with confirmed completed questionnaires (n = 32), decision conflict (p = 0.004) and state anxiety (p = 0.042) decreased significantly from pre- to post-assay. CONCLUSIONS: Individualized risk estimates from the DCIS Score assay provide valuable information to physicians and patients. Post-assay, in response to DCIS Score results, surgeons changed treatment recommendations more often than radiation oncologists. Further investigation is needed to better understand how such treatment changes may affect clinical outcomes. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1245/s10434-016-5583-7) contains supplementary material, which is available to authorized users

Brain tumor presenting as an acute pure motor hemiparesis

Acute pure motor hemiparesis is a clinical syndrome of isolated hemiparesis usually related to lacunar infarction, although other etiologies have been described. We recently encountered three patients with the abrupt onset of pure motor hemiparesis as the initial manifestation of primary or metastatic brain tumor. In each patient, early computed tomography demonstrated a nonhemorrhagic, right frontal, enhancing mass lesion. While the mechanism whereby brain tumor may present abruptly and simulate a stroke remains uncertain, these cases illustrate that pure motor hemiparesis can be the initial symptom of intracranial tumor. Early computed tomography or magnetic resonance imaging is suggested for all patients who present acutely with pure motor hemiparesis

Brain tumor presenting as an acute pure motor hemiparesis

Acute pure motor hemiparesis is a clinical syndrome of isolated hemiparesis usually related to lacunar infarction, although other etiologies have been described. We recently encountered three patients with the abrupt onset of pure motor hemiparesis as the initial manifestation of primary or metastatic brain tumor. In each patient, early computed tomography demonstrated a nonhemorrhagic, right frontal, enhancing mass lesion. While the mechanism whereby brain tumor may present abruptly and simulate a stroke remains uncertain, these cases illustrate that pure motor hemiparesis can be the initial symptom of intracranial tumor. Early computed tomography or magnetic resonance imaging is suggested for all patients who present acutely with pure motor hemiparesis