Biomarker concordance between molecular stereotactic biopsy and open surgical specimens in gliomas

Aims. To compare 1p/19q codeletion, MGMT promoter methylation, and IDH mutation status in stereotactic biopsy and open craniotomy specimens.Clinical rationale. The latest WHO classification of gliomas requires assessment of the expression of molecular markers. Samples can be obtained for molecular assays via open craniotomy or molecular stereotactic biopsy (MSB). However, there is uncertainty as to whether MSB is representative of the entire tumour, and therefore how reliable it is for treatment planning.Patients and methods. We examined 11 patients diagnosed with brain tumours suspicious of glioma who underwent open craniotomy after stereotactic biopsy and in whom multiple biomarkers were assessed in both sets of samples by methylation-specific multiplex ligation-dependent probe amplification. Institutional Review Board ethical approval was granted (KB 694/2018).Results. The initial histopathological grade as determined by stereotactic biopsy was the same as in the samples obtained by open surgery. Further, the marker profile used here was valid in both high- and low-grade gliomas.Conclusion and clinical implication. MSB is a reliable way to obtain material for precision medicine approaches

An update on the epidemiology, imaging and therapy of brain metastases

Introduction.The incidence of brain metastases (BM) is rapidly increasing, with most cases occurring in patients aged 50–80 years and in 10–40% of patients with systemic neoplastic disease. The Graded Prognostic Assessment (GPA) is the most impartial prognostic method, according to which the average survival rate of patients with brain metastases is only 7.18 months. Purpose.To present a systematic review of the currently available evidence-based literature on the epidemiology, dia­gnosis, and treatment of BM. Methods.The authors searched PubMed up to March 2020 using the phrases “brain metastases”, “brain metastasis surgery”, and “brain metastases treatment”, which returned 65 citations. Conclusions.The choice of imaging and therapy for brain metastases remains a significant clinical problem. MRI, including T1, T1 + C, T2, FLAIR, and SWI sequences, is the most sensitive method for solitary BM detection, while other techniques such as spectroscopy, perfusion imaging, or fractional anisotropy contribute to diagnosis precision and neurological deficit avoidance in cases eligible for surgery. According to current treatment algorithms, three main methods are used to mana­ge BM: surgery, chemotherapy, and radiotherapy, depending on the expected effect and the patient’s clinical condition. Surgery is most often used, offering neurological deficit remission in 60 to 90% of patients. Most chemotherapeutics do not cross the blood-brain barrier, so immunotherapy with antibodies such as pembrolizumab and ipilimumab, as well as antineoplastic vaccines, are a promising therapeutic prospect

An optimal dose‐fractionation for stereotactic body radiotherapy in peripherally, centrally and ultracentrally located early‐stage non‐small lung cancer

Abstract Stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), is commonly used in inoperable patients with early‐stage non‐small lung cancer (NSCLC). This treatment has good outcomes and low toxicity in peripherally located tumors. However, in lesions which are located close to structures such as the bronchial tree or mediastinum the risk of severe toxicity increases. This review summarizes the evidence of dose‐fractionation in SBRT of NSCLC patients in various locations

Prognostic value of subventricular zone involvement in relation to tumor volumes defined by fused MRI and O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET imaging in glioblastoma multiforme

Abstract Background Subventricular zone (SVZ) involvement is associated with a dismal prognosis in patients with glioblastoma multiforme (GBM). Dual-time point (dtp) O-(2-[18F]fluoroethyl)-L-tyrosine (FET) PET/CT (PET) may be a time- and cost-effective alternative to dynamic FET PET, but its prognostic value, particularly with respect to SVZ involvement, is unknown. Methods Thirty-five patients had two scans 5–15 and 50–60 min after i.v. FET injection to define tumor volumes and SVZ involvement before starting radiotherapy. Associations between clinical progression markers, MRI- and dtp FET PET-based tumor volumes, or SVZ involvement and progression-free (PFS) and overall survival (OS) were assessed in univariable and multivariable analyses. Results The extent of resection was not related to outcomes. Albeit non-significant, dtp FET PET detected more SVZ infiltration than MRI (60% vs. 51%, p = 0.25) and was significantly associated with poor survival (p < 0.03), but PET-T1-Gad volumes were larger in this group (p < 0.002). Survival was shorter in patients with larger MRI tumor volumes, larger PET tumor volumes, and worse Karnofsky performance status (KPS), with fused PET-T1-Gad and KPS significant in multivariable analysis (p < 0.03). Uptake kinetics was not associated with treatment outcomes. Conclusions FET PET-based tumor volumes may be useful for predicting worse prognosis glioblastoma. Although the presence of SVZ infiltration is linked to higher PET/MRI-based tumor volumes, the independent value of dtp FET PET parameters and SVZ infiltration as prognostic markers pre-irradiation has not been confirmed

Case of emergency and sudden illness in Poland based on correlation descriptive study on cause ambulance service according to ICD-10: head to head analysis data from ambulance station Bydgoszcz vs. Konin

Wstęp. W stanie nagłego zagrożenia zdrowia lub życia do pierwszego kontaktu między pacjentem a systemem opieki zdrowotnej dochodzi w pogotowiu ratunkowym. Cel pracy. Określenie najczęstszych przyczyn wzywania pogotowia ratunkowego według klasyfikacji ICD-10. Materiał i metody. Opis zgodnie z ICD-10 przyczyn interwencji zespołów PR (pogotowia ratunkowego) na podstawie danych Wojewódzkiej Stacji Pogotowia Ratunkowego (WSPR) z Bydgoszczy i z Konina, które pracują na tym samym systemie teleinformatycznym wspomagającym zarządzanie zasobami PR. Wyniki. Procentowa struktura wyjazdów PR: „R” 23,91–37,61 (średnio 30), „I” 15,34–23,81 (nieco ponad 20), „S–T” 18,77–21,80 (ok. 20), zaś najrzadziej (< 1%): „A”, „B”, „C”, „D”, „H”, „L”, „M”, „P”, „Q” oraz „V”. Wnioski. 1. Struktura interwencji w poszczególnych stacjach PR jest do siebie podobna. 2. Według ICD-10, najczęstszą przyczyną interwencji zespołów wyjazdowych PR są rozpoznania „R” (prawie 30%), następnie „I” (ponad 20%) oraz „S–T” (ok. 20%). 3. Najrzadsze (< 1%) przyczyny według klasyfikacji ICD-10 to: „A”, „B”, C”, „D”, „H”, „L”, „M”, „P”, „Q” oraz „V”. Słowa kluczowe: stany zagrożenia życia i nagłe zachorowanie, biofizyka i biostatystyka, bierne badanie korelacyjne i porównanie bezpośrednie, pogotowie ratunkowe, dane podstawowe i statystyka w pogotowiu ratunkowym, inżynieria procesów.Background. In case of emergency or sudden illness the first contact of patients with health care system takes place in emergency ambulance service. Objectives. The authors determined the most common causes of emergency calls according to ICD-10. Material and methods. The authors described causes of intervention according to ICD-10 based on data from WSPR (regional centre of emergency medical service in Poland) from Bydgoszcz and Konin, which use one IT system – a new idea system to support lead ambulances. Results. Percent structure of emergency medical intervention according to ICD-10 is as follows: “R” 23.91–37.61 (on average 30), “I” 15.34–23.81 (slightly above 20), “S–T” 18.77–21.80 (around 20), and least often (< 1%): “A”, “B”, “C”, “D”, “H”, “L”, “M”, “P”, “Q”, and “V”. Conclusions. Structure of emergency medical intervention in different PR station is similar. The most frequent cause of accidents are “I”, next “R” and “S–T”, and rarely: “A”, “B”, “C”, “D”, “H”, “L”, “M”, “P”, “Q” and “V”

Relationship between Glioblastoma Dose Volume Parameters Measured by Dual Time Point Fluoroethylthyrosine-PET and Clinical Outcomes

Glioblastoma multiforme (GBM) is highly invasive. Despite irradiation with wide margins, GBM usually recurs in-field. Recent in vitro data have suggested that progression might be promoted by sublethal irradiation. Fluoroethylthyrosine-PET (FET-PET) can be used to detect glioblastoma invasion not apparent on MRI. We therefore performed a retrospective analysis of a prospective clinical study to examine whether glioblastoma outcomes depend on dose volume parameters measured by MRI and FET-PET. Twenty-three patients were prospectively recruited to a study examining the role of dual time point FET-PET in the treatment planning of GBM radiotherapy. The dose delivered to the site of recurrence was subdivided into suboptimal-dose (SOD) and high-dose (HD) areas. Types of progression were defined for correlation with dosimetric parameters including V100% of gross tumor volume (GTV)PET, GTVPETMRI, and GTVMRI. The HD area did not cover the entire GTVPETMRI in any case. Recurrences were significantly more frequent in the SubD area (chi-squared test, p = 0.004). There was no relationship between increasing dose volume and progression. The V100% for GTVPET and progression-free survival (PFS) was positively correlated (Spearman’s rho 0.417; p = 0.038). Progression is more common in areas with suboptimal dosing. Dose heterogeneity within GTVPET may be responsible for shorter PFS

Combining amino acid PET and MRI imaging increases accuracy to define malignant areas in adult glioma

Abstract Accurate determination of the extent and grade of adult-type diffuse gliomas is critical to patient management. In clinical practice, contrast-enhancing areas of diffuse gliomas in magnetic resonance imaging (MRI) sequences are usually used to target biopsy, surgery, and radiation therapy, but there can be discrepancies between these areas and the actual tumor extent. Here we show that adding 18F-fluoro-ethyl-tyrosine positron emission tomography (FET-PET) to MRI sequences accurately locates the most malignant areas of contrast-enhancing gliomas, potentially impacting subsequent management and outcomes. We present a prospective analysis of over 300 serial biopsy specimens from 23 patients with contrast-enhancing adult-type diffuse gliomas using a hybrid PET-MRI scanner to compare T2-weighted and contrast-enhancing MRI images with FET-PET. In all cases, we observe and confirm high FET uptake in early PET acquisitions (5–15 min after 18F-FET administration) outside areas of contrast enhancement on MRI, indicative of high-grade glioma. In 30% cases, inclusion of FET-positive sites changes the biopsy result to a higher tumor grade

The Sum of Tumour-to-Brain Ratios Improves the Accuracy of Diagnosing Gliomas Using 18F-FET PET.

Gliomas are common brain tumours, but obtaining tissue for definitive diagnosis can be difficult. There is, therefore, interest in the use of non-invasive methods to diagnose and grade the disease. Although positron emission tomography (PET) with 18F-fluorethyltyrosine (18F-FET) can be used to differentiate between low-grade (LGG) and high-grade (HGG) gliomas, the optimal parameters to measure and their cut-points have yet to be established. We therefore assessed the value of single and dual time-point acquisition of 18F-FET PET parameters to differentiate between primary LGGs (n = 22) and HGGs (n = 24). PET examination was considered positive for glioma if the metabolic activity was 1.6-times higher than that of background (contralateral) brain, and maximum tissue-brain ratios (TBRmax) were calculated 10 and 60 min after isotope administration with their sums and differences calculated from individual time-point values. Using a threshold-based method, the overall sensitivity of PET was 97%. Several analysed parameters were significantly different between LGGs and HGGs. However, in a receiver operating characteristics analysis, TBR sum had the best diagnostic accuracy of 87% and sensitivity, specificity, and positive and negative predictive values of 100%, 72.7%, 80%, and 100%, respectively. 18F-FET PET is valuable for the non-invasive determination of glioma grade, especially when dual time-point metrics are used. TBR sum shows the greatest accuracy, sensitivity, and negative predictive value for tumour grade differentiation and is a simple method to implement. However, the cut-off may differ between institutions and calibration strategies would be useful