BACKGROUND: Glioblastoma (GBM) is the most common and aggressive primary brain cancer. The treatment of GBM consists of a combination of surgery and subsequent oncological therapy, i.e., radiotherapy, chemotherapy, or their combination. If postoperative oncological therapy involves irradiation, magnetic resonance imaging (MRI) is used for radiotherapy treatment planning. Unfortunately, in some cases, a very early worsening (progression) or return (recurrence) of the disease is observed several weeks after the surgery and is called rapid early progression (REP). Radiotherapy planning is currently based on MRI for target volumes definitions in many radiotherapy facilities. However, patients with REP may benefit from targeting radiotherapy with other imaging modalities. The purpose of the presented clinical trial is to evaluate the utility of 11C-methionine in optimizing radiotherapy for glioblastoma patients with REP. METHODS: This study is a nonrandomized, open-label, parallel-setting, prospective, monocentric clinical trial. The main aim of this study was to refine the diagnosis in patients with GBM with REP and to optimize subsequent radiotherapy planning. Glioblastoma patients who develop REP within approximately 6 weeks after surgery will undergo 11C-methionine positron emission tomography (PET/CT) examinations. Target volumes for radiotherapy are defined using both standard planning T1-weighted contrast-enhanced MRI and PET/CT. The primary outcome is progression-free survival defined using RANO criteria and compared to a historical cohort with REP treated without PET/CT optimization of radiotherapy. DISCUSSION: PET is one of the most modern methods of molecular imaging. 11C-Methionine is an example of a radiolabelled (carbon 11) amino acid commonly used in the diagnosis of brain tumors and in the evaluation of response to treatment. Optimized radiotherapy may also have the potential to cover those regions with a high risk of subsequent progression, which would not be identified using standard-of-care MRI for radiotherapy planning. This is one of the first study focused on radiotherapy optimization for subgroup of patinets with REP. TRIAL REGISTRATION: NCT05608395, registered on 8.11.2022 in clinicaltrials.gov; EudraCT Number: 2020-000640-64, registered on 26.5.2020 in clinicaltrialsregister.eu. Protocol ID: MOU-2020-01, version 3.2, date 18.09.2020.
- MeSH
- dospělí MeSH
- glioblastom * diagnostické zobrazování terapie diagnóza radioterapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie metody MeSH
- methionin * MeSH
- nádory mozku * diagnostické zobrazování terapie radioterapie diagnóza MeSH
- PET/CT metody MeSH
- plánování radioterapie pomocí počítače metody MeSH
- progrese nemoci * MeSH
- prospektivní studie MeSH
- radiofarmaka terapeutické užití MeSH
- radioizotopy uhlíku MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky MeSH
BACKGROUND: Changes in the hippocampus after brain metastases radiotherapy can significantly impact neurocognitive functions. Numerous studies document hippocampal atrophy correlating with the radiation dose. This study aims to elucidate volumetric changes in patients undergoing whole-brain radiotherapy (WBRT) or targeted stereotactic radiotherapy (SRT) and to explore volumetric changes in the individual subregions of the hippocampus. METHOD: Ten patients indicated to WBRT and 18 to SRT underwent brain magnetic resonance before radiotherapy and after 4 months. A structural T1-weighted sequence was used for volumetric analysis, and the software FreeSurfer was employed as the tool for the volumetry evaluation of 19 individual hippocampal subregions. RESULTS: The volume of the whole hippocampus, segmented by the software, was larger than the volume outlined by the radiation oncologist. No significant differences in volume changes were observed in the right hippocampus. In the left hippocampus, the only subregion with a smaller volume after WBRT was the granular cells and molecular layers of the dentate gyrus (GC-ML-DG) region (median change -5 mm3, median volume 137 vs. 135 mm3; P = .027), the region of the presumed location of neuronal progenitors. CONCLUSIONS: Our study enriches the theory that the loss of neural stem cells is involved in cognitive decline after radiotherapy, contributes to the understanding of cognitive impairment, and advocates for the need for SRT whenever possible to preserve cognitive functions in patients undergoing brain radiotherapy.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The aim of this retrospective study is to analyze a consecutive cohort of brain metastasis (BM) patients treated off clinical trials through combination of surgery and radiotherapy over the last 15 years in a tertiary neurooncology center. MATERIALS AND METHODS: All BM patients operated between 2007-2019 received adjuvant linac-based radiotherapy categorized to whole brain radiotherapy (WBRT) and tumor bed stereotactic radiotherapy. Survival outcomes and local control was analyzed. RESULTS: In total, 118 patients were enrolled, those with stereotactic radiotherapy (41%) had better baseline characteristics mirrored in longer overall survival (OS) [18 vs. 7.1 months, p < 0.001; hazard ratio (HR) 0.47, p = 0.004] with median follow-up of 58 months. Cumulative incidence for local, distant, and extracranial control was not significantly different between groups, with 12-month cumulative control of 22% vs. 18%, 44% vs. 29%, and 35% vs. 32% for stereotactic and WBRT group, respectively. WBRT was an independent factor for better distal brain control. CONCLUSIONS: Real world data demonstrating significantly better overall survival in patients treated with postoperative targeted radiotherapy compared with postoperative WBRT is presented, with no significant difference in cumulative incidence for local or distant brain control. The majority of patients with targeted radiotherapy had a fractionated dose schedule with outcomes comparable to single-dose radiation trials of postoperative targeted radiotherapy.
- Publikační typ
- časopisecké články MeSH
Cerebral tumors and multiple sclerosis (MS) can show overlapping clinical and magnetic resonance imaging (MRI) features and even occur concurrently. Due to the emergence of new symptoms, not usually MS related, an MRI was conducted in a 29-year-old woman with relapsing-remitting MS and showed a significant size progression of a parieto-occipital lesion, with mild clinical correlates, such as blurred vision, difficulty in speaking, and headache. Contrast-enhanced MRI and fluorothymidine positron-emission tomography (PET) did not point toward neoplasm, a lesion biopsy, however, showed astrocytoma, which was confirmed as grade III astrocytoma after the radical resection of the tumor. In the case of an atypical lesion, a tumor should be considered in patients with MS. A small fraction of high-grade gliomas show no enhancement on MRI and no hypermetabolism on PET. Biopsy proved to be the essential step in a successful diagnostic workup. To the best of our knowledge, this is the first case of anaplastic astrocytoma with these radiological features reported in a patient with MS.
- Publikační typ
- kazuistiky MeSH
BACKGROUND: The landscape of brain metastases radiotherapy is evolving, with a shift away from whole-brain radiotherapy (WBRT) toward targeted stereotactic approaches aimed at preserving neurocognitive functions and maintaining overall quality of life. For patients with multiple metastases, especially in cases where targeted radiotherapy is no longer feasible due to widespread dissemination, the concept of hippocampal sparing radiotherapy (HA_WBRT) gains prominence. METHODS: In this narrative review we explore the role of the hippocampi in memory formation and the implications of their postradiotherapy lateral damage. We also consider the potential advantages of selectively sparing one hippocampus during whole-brain radiotherapy (WBRT). Additionally, by systematic evaluation of relevant papers published on PubMed database over last 20 years, we provide a comprehensive overview of the various changes that can occur in the left or right hippocampus as a consequence of radiotherapy. RESULTS: While it is important to note that various neurocognitive functions are interconnected throughout the brain, we can discern certain specialized roles of the hippocampi. The left hippocampus appears to play a predominant role in verbal memory, whereas the right hippocampus is associated more with visuospatial memory. Additionally, the anterior part of the hippocampus is more involved in episodic memory and emotional processing, while the posterior part is primarily responsible for spatial memory and pattern separation. Notably, a substantial body of evidence demonstrates a significant correlation between post-radiotherapy changes in the left hippocampus and subsequent cognitive decline in patients. CONCLUSION: In the context of individualized palliative radiotherapy, sparing the unilateral (specifically, the left, which is dominant in most individuals) hippocampus could expand the repertoire of strategies available for adapted WBRT in cases involving multiple brain metastases where stereotactic radiotherapy is not a viable option. Prospective ongoing studies assessing various memory-sparing radiotherapy techniques will define new standard of radiotherapy care of patients with multiple brain metastases.
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
Paliativní ozáření podstupuje téměř třetina dospělých onkologických pacientů. Cílem tohoto přehledového článku je poskytnout základní informace o možnostech radioterapie k ovlivnění nejčastějších symptomů u pacientů v paliativní léčbě, její toxicitě a efektivitě.
Almost one third of adult cancer patients undergo palliative radiation therapy. This review article provides basic information on the methods radiotherapy uses to affect the most common symptoms in patients undergoing palliative treatment. It also focuses on the toxicity and effectiveness of radiotherapy.
- Klíčová slova
- paliativní radioterapie,
- MeSH
- lidé MeSH
- nádory radioterapie MeSH
- paliativní péče * MeSH
- radioterapie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Paliativní péče (PP) je aktivní multidisciplinární péče, která primárně není zaměřena na prodloužení života nebo léčby u onkologických pacientů, ale na zmírnění symptomů základního onemocnění a tím i zlepšení kvality jejich života. PP by měla být poskytována již v průběhu komplexní onkologické péče a být její nedílnou součástí. Tento trend se týká rovněž neuroonkologických pacientů s primárním nádorem mozku. Pacienti s primárním nádorem mozku nepatří v rámci onkologických pacientů ke skupině nejpočetnější, ale vzhledem k tomu, že vedle celkových příznaků onkologického onemocnění se u nich projevuje i postižení progresivním neurologickým onemocněním, jedná se o specifickou skupinu pacientů. PP se v průběhu onemocnění snaží řešit a pozitivně ovlivnit nejen symptomy související s onkologickým onemocněním, nýbrž zahrnuje i péči psychologickou, sociální a spirituální. V případě, že jsou možnosti onkologické protinádorové léčby vyčerpány, nebo je léčba z různých důvodů ukončena, stává se PP hlavním léčebným postupem. Pro pacienty s HGG (high grade glioma) - s ohledem na progresivní průběh tohoto onemocnění - by měla být PP zahájena ihned po operaci současně se zahájením začátkem jejich onkologické terapie. U pacientů s LGG (low grade glioma), kdy je průběh jejich nemoci mnohem pozvolnější - nejsou jednoznačná doporučení pro zahájení multidisciplinární PP. Ta by měla být indikována a zahájena či započata v závislosti na jejich aktuálním zdravotním a psychickém stavu, s cílem co nejdéle udržet dobrou kvalitu jejich života v průběhu onemocnění. Cílem tohoto sdělení je přinést přehled nejčastějších symptomů u pacientů s primárním nádorem mozku s možností ovlivnění těchto symptomů v rámci PP.
Palliative care (PP) is active multidisciplinary care, which is not primarily aimed at prolonging life or treatment of cancer patients, but at alleviating the symptoms of the underlying disease and thereby improving their quality of life. PP should already be provided during complex oncological care and be an integral part of it. This trend also applies to neuro-oncology patients with a primary brain tumour. Patients with a primary brain tumour do not belong to the most numerous group of oncology patients, but given that, in addition to general symptoms of oncological disease, they are also affected by a progressive neurological disease, they are a specific group of patients. During the care of these patients, PP tries to solve and positively influence not only the symptoms related to the oncological disease, but also includes psychological, social and spiritual care. In the event that the possibilities of oncological antitumor treatment are exhausted, or the treatment is terminated for various reasons, PP becomes the main treatment procedure. For patients with HGG (high grade glioma) - considering the progressive course of this disease - PP should be started immediately after surgery at the same time as the start of their oncological therapy. In patients with LGG (low grade glioma) - when the course of their disease is much more gradual - there are no clear recommendations for the initiation of multidisciplinary PP. This should be indicated and started depending on their current health and psychological state, with the aim of maintaining their good quality of life as long as possible during the course of the disease. The aim of this review article is to provide an overview of the most common symptoms in patients with a primary brain tumour with the possibility of influencing these symptoms within the framework of PP.
