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  • 1
    Language: English
    In: Journal of neuro-oncology, 2019-01-17, Vol.142 (2), p.211-221
    Description: Background Incidental discovery accounts for 30% of newly-diagnosed intracranial meningiomas. There is no consensus on their optimal management. This review aimed to evaluate the outcomes of different management strategies for these tumors. Methods Using established systematic review methods, six databases were scanned up to September 2017. Pooled event proportions were estimated using a random effects model. Meta-regression of prognostic factors was performed using individual patient data. Results Twenty studies (2130 patients) were included. Initial management strategies at diagnosis were: surgery (27.3%), stereotactic radiosurgery (22.0%) and active monitoring (50.7%) with a weighted mean follow-up of 49.5 months (SD = 29.3). The definition of meningioma growth and monitoring regimens varied widely impeding relevant meta-analysis. The pooled risk of symptom development in patients actively monitored was 8.1% (95% CI 2.7–16.1). Associated factors were peritumoral edema (OR 8.72 [95% CI 0.35–14.90]) and meningioma diameter ≥ 3 cm (OR 34.90 [95% CI 5.17–160.40]). The pooled proportion of intervention after a duration of active monitoring was 24.8% (95% CI 7.5–48.0). Weighted mean time-to-intervention was 24.8 months (SD = 18.2). The pooled risks of morbidity following surgery and radiosurgery, accounting for cross-over, were 11.8% (95% CI 3.7–23.5) and 32.0% (95% CI 10.6–70.5) respectively. The pooled proportion of operated meningioma being WHO grade I was 94.0% (95% CI 88.2–97.9). Conclusion The management of incidental meningioma varies widely. Most patients who clinically or radiologically progressed did so within 5 years of diagnosis. Intervention at diagnosis may lead to unnecessary overtreatment. Prospective data is needed to develop a risk calculator to better inform management strategies.
    Subject(s): Analysis ; Asymptomatic ; Clinical Neurology ; Diagnosis ; Edema ; Incidental ; Life Sciences & Biomedicine ; Management ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Meningioma ; Meta-analysis ; Morbidity ; Neurology ; Neurosciences & Neurology ; Oncology ; Radiosurgery ; Science & Technology ; Strategic planning (Business) ; Surgery ; Systematic review ; Topic Review ; Tumors
    ISSN: 0167-594X
    E-ISSN: 1573-7373
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: Alma/SFX Local Collection
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  • 2
    Language: English
    In: Acta neurochirurgica, 2018-06-18, Vol.160 (9), p.1793-1799
    Description: Background Intracranial subependymomas account for 0.2–0.7% of central nervous system tumours and are classified as World Health Organization (WHO) grade 1 tumours. They are typically located within the ventricular system and are detected incidentally or with symptoms of hydrocephalus. Due to paucity of studies exploring this tumour type, the objective was to determine the medium- to long-term outcome of intracranial subependymoma treated by surgical resection. Methods Retrospective case note review of adults with intracranial WHO grade 1 subependymoma diagnosed between 1990 and 2015 at the Walton Centre NHS Foundation Trust was undertaken. Tumour location, extent of resection (defined as gross total resection (GTR), sub-total resection (STR) or biopsy) and the WHO performance status at presentation and through follow-up were recorded. Results Thirteen patients (7 males; 6 females) with a mean age of 47.6 years (range 33–58 years) and a median follow-up of 46 months (range 25–220 months) were studied. Eight patients had symptomatic tumours (headache, visual disturbance); five had incidental finding. Tumours were most commonly located in the fourth ventricle ( n  = 8). The performance status scores at diagnosis were 0 ( n  = 8) and 1 ( n  = 5). The early post-operative performance status scores at 6 months were 0 ( n  = 5) and 1 ( n  = 8) and at last follow-up were 0 ( n  = 11) and 1 ( n  = 2). There was no evidence of tumour re-growth following GTR or STR. The commonest complication was hydrocephalus ( n  = 3). Conclusion Subependymoma are indolent tumours. No patients exhibited a worsening of performance status at medium- to long-term follow-up and there were no tumour recurrence suggesting a shorter follow-up time may be sufficient. Surgical resection is indicated for symptomatic tumours or those without a clear imaging diagnosis. Incidental intraventricular subependymoma can be managed conservatively through MRI surveillance.
    Subject(s): Adult ; Adults ; Biopsy ; Brain Neoplasms - surgery ; Central nervous system ; Cerebral Ventricles - surgery ; Diagnosis ; Female ; Females ; Glioma, Subependymal - surgery ; Headache ; Humans ; Hydrocephalus ; Hydrocephalus - epidemiology ; Hydrocephalus - etiology ; Interventional Radiology ; Intracranial subependymoma ; Magnetic resonance imaging ; Male ; Males ; Medicine ; Medicine & Public Health ; Middle Aged ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosurgery ; Neurosurgical Procedures - adverse effects ; Postoperative Complications - epidemiology ; Review - Brain Tumors ; Review Article - Brain Tumors ; Surgery ; Surgical Orthopedics ; Surgical outcome ; Tumors ; Ventricle ; Ventricles (cerebral) ; WHO performance status
    ISSN: 0001-6268
    E-ISSN: 0942-0940
    Source: Alma/SFX Local Collection
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  • 3
    Language: English
    In: British journal of neurosurgery, 2019-11-02, Vol.33 (6), p.641-647
    Description: Purpose: Meningiomas are the commonest predominantly non-malignant brain tumour in adults. The use of surgery appears to be increasing, and outcomes are thought to be good, but whole nation data for England is scarce. The aim of this report is to examine the epidemiology of patients operated for cranial and spinal meningioma in England, and to assess associations between outcomes and gender, age, meningioma site (cranial or spinal), and grade. Material and methods: A search strategy encompassing all patients coded with cranial and spinal meningioma treated between January 1999 and December 2013 was obtained from data linkage between the National Cancer Registration and Analysis Service and Hospital Episode Statistics for England. Results: 25,694 patients were diagnosed with meningioma in England between 1999 and 2013, in whom 24,302 were cranial and 1392 spinal. Of these patients, 14,229 (60%) cranial and 1188 (85%) spinal meningioma received surgery. Of those operated on 70.1% were women, and, where the tumour grade was recorded, 79.5% were WHO grade I, 18.4% grade II, and 2.1% grade III. Five and ten year net survival rates for surgically treated cranial meningiomas were respectively 90% and 81% for those with WHO grade I, 80% and 63% for grade II, and 30% and 15% for WHO grade III tumours. Overall survival after surgery is better in women, younger adults, and people with spinal or lower grade meningiomas. Outcomes have improved over the time period examined. Conclusion: The outcome for patients with meningioma is good and is improving. However, there remains a significant mortality related to the disease process.
    Subject(s): Adolescent ; Adult ; Age Factors ; Aged ; Aged, 80 and over ; Brain Neoplasms - epidemiology ; Brain Neoplasms - pathology ; Brain Neoplasms - surgery ; Child ; Child, Preschool ; Clinical Neurology ; England - epidemiology ; epidemiology ; Female ; Humans ; Infant ; Life Sciences & Biomedicine ; Male ; meningioma ; Meningioma - epidemiology ; Meningioma - pathology ; Meningioma - surgery ; Middle Aged ; Neoplasm Grading ; Neurosciences & Neurology ; Neurosurgical Procedures ; outcomes ; Registries ; Retrospective Studies ; Science & Technology ; Sex Factors ; spinal meningioma ; Spinal Neoplasms - epidemiology ; Spinal Neoplasms - pathology ; Spinal Neoplasms - surgery ; Surgery ; Survival Rate ; Treatment Outcome ; Young Adult
    ISSN: 0268-8697
    E-ISSN: 1360-046X
    Source: Taylor & Francis Open Access
    Source: Academic Search Ultimate
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
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  • 4
    Language: English
    In: Scientific reports, 2022-01-20, Vol.12 (1), p.1102-1102
    Description: Brain metastases comprise 40% of all metastatic tumours and breast tumours are among the tumours that most commonly metastasise to the brain, the role that epigenetic gene dysregulation plays in this process is not well understood. We carried out 450 K methylation array analysis to investigate epigenetically dysregulated genes in breast to brain metastases (BBM) compared to normal breast tissues (BN) and primary breast tumours (BP). For this, we referenced 450 K methylation data for BBM tumours prepared in our laboratory with BN and BP from The Cancer Genome Atlas. Experimental validation on our initially identified genes, in an independent cohort of BP and in BBM and their originating primary breast tumours using Combined Bisulphite and Restriction Analysis (CoBRA) and Methylation Specific PCR identified three genes (RP11-713P17.4, MIR124-2, NUS1P3) that are hypermethylated and three genes (MIR3193, CTD-2023M8.1 and MTND6P4) that are hypomethylated in breast to brain metastases. In addition, methylation differences in candidate genes between BBM tumours and originating primary tumours shows dysregulation of DNA methylation occurs either at an early stage of tumour evolution (in the primary tumour) or at a later evolutionary stage (where the epigenetic change is only observed in the brain metastasis). Epigentic changes identified could also be found when analysing tumour free circulating DNA (tfcDNA) in patient's serum taken during BBM biopsies. Epigenetic dysregulation of RP11-713P17.4, MIR3193, MTND6P4 are early events suggesting a potential use for these genes as prognostic markers.
    Subject(s): Biomarkers, Tumor - genetics ; Biopsy ; Brain - metabolism ; Brain Neoplasms - genetics ; Breast cancer ; Breast Neoplasms - genetics ; Breast Neoplasms - pathology ; Coding ; Databases, Genetic ; Deoxyribonucleic acid ; DNA ; DNA - genetics ; DNA methylation ; DNA Methylation - genetics ; Epigenesis, Genetic - genetics ; Epigenetics ; Epigenomics ; Female ; Gene Expression - genetics ; Gene Expression Profiling - methods ; Gene Expression Regulation, Neoplastic - genetics ; Genomes ; Humans ; Metastases ; Metastasis ; MicroRNAs ; Neoplasm Metastasis - genetics ; Prognosis ; Promoter Regions, Genetic - genetics ; Receptors, Cell Surface ; RNA, Untranslated - genetics ; Transcriptome - genetics ; Tumors
    E-ISSN: 2045-2322
    Source: Nature Open Access
    Source: Academic Search Ultimate
    Source: PubMed Central
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  • 5
    Language: English
    In: Journal of neuro-oncology, 2016-02-13, Vol.127 (3), p.463-472
    Description: The ability to diagnose cancer rapidly with high sensitivity and specificity is essential to exploit advances in new treatments to lead significant reductions in mortality and morbidity. Current cancer diagnostic tests observing tissue architecture and specific protein expression for specific cancers suffer from inter-observer variability, poor detection rates and occur when the patient is symptomatic. A new method for the detection of cancer using 1 μl of human serum, attenuated total reflection—Fourier transform infrared spectroscopy and pattern recognition algorithms is reported using a 433 patient dataset (3897 spectra). To the best of our knowledge, we present the largest study on serum mid-infrared spectroscopy for cancer research. We achieve optimum sensitivities and specificities using a Radial Basis Function Support Vector Machine of between 80.0 and 100 % for all strata and identify the major spectral features, hence biochemical components, responsible for the discrimination within each stratum. We assess feature fed-SVM analysis for our cancer versus non-cancer model and achieve 91.5 and 83.0 % sensitivity and specificity respectively. We demonstrate the use of infrared light to provide a spectral signature from human serum to detect, for the first time, cancer versus non-cancer, metastatic cancer versus organ confined, brain cancer severity and the organ of origin of metastatic disease from the same sample enabling stratified diagnostics depending upon the clinical question asked.
    Subject(s): Adolescent ; Adult ; Aged ; Aged, 80 and over ; Algorithms ; Analysis ; ATR-FTIR ; Biomarkers, Tumor - blood ; Brain Neoplasms - blood ; Brain Neoplasms - diagnosis ; Brain tumors ; Cancer ; Case-Control Studies ; Cell Differentiation ; Diagnosis ; Diagnostics ; Early Detection of Cancer ; Female ; Follow-Up Studies ; Glioma ; Gliomas ; Health aspects ; Humans ; Infrared spectroscopy ; Laboratory Investigation ; Male ; Medicine ; Medicine & Public Health ; Metastasis ; Middle Aged ; Mortality ; Neoplasm Grading ; Neurology ; Oncology ; Prognosis ; Rapid ; Serum ; Spectroscopy ; Spectroscopy, Fourier Transform Infrared - methods ; Support Vector Machine ; Young Adult
    ISSN: 0167-594X
    E-ISSN: 1573-7373
    Source: Alma/SFX Local Collection
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  • 6
    Language: English
    In: British journal of cancer, 2016-11-22, Vol.115 (11), p.1379-1382
    Description: Background:There is evidence that surgeons who perform more operations have better outcomes. However, in patients with brain tumours, all of the evidence comes from the USA.Methods:We examined all English patients with an intracranial neoplasm who had an intracranial resection in 2008-2010. We included surgeons who performed at least six operations over 3 years, and at least one operation in the first and last 6 months of the period.Results:The analysis data set comprised 9194 operations, 163 consultant neurosurgeons and 30 centres. Individual surgeon volumes varied widely (7-272; median=46). 72% of operations were on the brain, and 30 day mortality was 3%. A doubling of surgeon load was associated with a 20% relative reduction in mortality. Thirty day mortality varied between centres (0·95-8·62%) but was not related to centre workload.Conclusions:Individual surgeon volumes correlated with patient 30 day mortality. Centres and surgeons in England are busier than surgeons and centres in the USA. There is no relationship between centre volume and 30 day mortality in England. Services in the UK appear to be adequately arranged at a centre level, but would benefit from further surgeon sub-specialisation.
    Subject(s): brain tumours ; health Services ; mortality ; outcomes ; Short Communication ; surgery ; volumes
    ISSN: 0007-0920
    E-ISSN: 1532-1827
    Source: Nature Journals Online
    Source: PubMed Central
    Source: Alma/SFX Local Collection
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  • 7
    Language: English
    In: Journal of neuro-oncology, 2018-06-29, Vol.140 (1), p.123-134
    Description: Background Epilepsy is a major cause of morbidity and mortality in meningioma patients. The aims of this study were to determine which factors predispose meningioma patients to developing perioperative seizures and to understand the impact of antiepileptic drugs. Methods Patients treated for a histologically-confirmed intracranial meningioma at the authors’ institution between 2010 and 2015 were retrospectively examined. Clinical and imaging data were assessed. Multivariate analysis was performed using binary logistic regression. The effect of antiepileptic treatment was assessed using survival analysis. Results Two hundred and eighty-three patients met the selection criteria; seizures were present in 68 preoperatively (24%) and in 48 patients (17%) following surgery. Of the 68 with preoperative seizures, 19 continued to have them, whereas de-novo seizures arose postoperatively in 29 seizure-naïve patients. Risk factors of postoperative seizures were convexity location (OR 2.05 [95% CI 1.07–3.98], p = 0.030), fronto-parietal location (OR 4.42 [95% CI 1.49–13.16], p = 0.007) and preoperative seizures (OR 2.65 [95% CI 1.37–5.24], p = 0.005). The two locations, in addition to the presence of midline shift on preoperative imaging (OR 4.15 [95% CI 1.54–11.24], p = 0.005), were significantly correlated with postoperative seizures in seizure-naïve patients. Antiepileptic treatment in patients with those risk factors reduced the possibility of seizures at any time point within the 1st year postoperatively by approximately 40%, although this did not meet statistical significance. Conclusion Prophylactic antiepileptic treatment might be warranted in seizure-naïve meningioma patients with ≥ 1 risk factor. High-quality randomised controlled trials are required to verify those factors and to define the role of antiepileptics in meningioma practice.
    Subject(s): Anticonvulsants ; Anticonvulsants - therapeutic use ; Antiepileptic agents ; Antiepileptic drugs ; Clinical Study ; Clinical trials ; Data processing ; Drug therapy ; Drugs ; Epilepsy ; Female ; Health aspects ; Humans ; Male ; Medical research ; Medicine ; Medicine & Public Health ; Medicine, Experimental ; Meningeal Neoplasms - epidemiology ; Meningeal Neoplasms - surgery ; Meningioma ; Meningioma - epidemiology ; Meningioma - surgery ; Middle Aged ; Morbidity ; Mortality ; Multivariate analysis ; Neurology ; Oncology ; Patient Selection ; Patients ; Post-operative seizure ; Postoperative Complications - epidemiology ; Postoperative Complications - prevention & control ; Retrospective Studies ; Risk ; Risk factors ; Seizures ; Seizures (Medicine) ; Seizures - epidemiology ; Seizures - etiology ; Seizures - prevention & control ; Surgery ; Survival analysis
    ISSN: 0167-594X
    E-ISSN: 1573-7373
    Source: Alma/SFX Local Collection
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  • 8
    Article
    Article
    2019
    ISSN: 0268-8697 
    Language: English
    In: British journal of neurosurgery, 2019-03-04, Vol.33 (2), p.237-250
    ISSN: 0268-8697
    E-ISSN: 1360-046X
    Source: Academic Search Ultimate
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  • 9
    Language: English
    In: Neuro-oncology (Charlottesville, Va.), 2020-02-20, Vol.22 (2), p.278-289
    Description: Abstract Background Asymptomatic meningioma is a common incidental finding with no consensus on the optimal management strategy. We aimed to develop a prognostic model to guide personalized monitoring of incidental meningioma patients. Methods A prognostic model of disease progression was developed in a retrospective cohort (2007–2015), defined as: symptom development, meningioma-specific mortality, meningioma growth or loss of window of curability. Secondary endpoints included non-meningioma-specific mortality and intervention. Results Included were 441 patients (459 meningiomas). Over a median of 55 months (interquartile range, 37–80), 44 patients had meningioma progression and 57 died (non-meningioma-specific). Forty-four had intervention (at presentation, n = 6; progression, n = 20; nonprogression, n = 18). Model parameters were based on statistical and clinical considerations and included: increasing meningioma volume (hazard ratio [HR] 2.17; 95% CI: 1.53–3.09), meningioma hyperintensity (HR 10.6; 95% CI: 5.39–21.0), peritumoral signal change (HR 1.58; 95% CI: 0.65–3.85), and proximity to critical neurovascular structures (HR 1.38; 95% CI: 0.74–2.56). Patients were stratified based on these imaging parameters into low-, medium- and high-risk groups and 5-year disease progression rates were 3%, 28%, and 75%, respectively. After 5 years of follow-up, the risk of disease progression plateaued in all groups. Patients with an age-adjusted Charlson comorbidity index ≥6 (eg, an 80-year-old with chronic kidney disease) were 15 times more likely to die of other causes than to receive intervention at 5 years following diagnosis, regardless of risk group. Conclusions The model shows that there is little benefit to rigorous monitoring in low-risk and older patients with comorbidities. Risk-stratified follow-up has the potential to reduce patient anxiety and associated health care costs.
    Subject(s): Adult ; Aged ; Aged, 80 and over ; asymptomatic ; Clinical Decision-Making - methods ; Clinical Investigations ; Cohort Studies ; Decision Support Systems, Clinical ; Disease Progression ; Female ; Humans ; incidental ; Incidental Findings ; Male ; Meningeal Neoplasms - classification ; Meningeal Neoplasms - pathology ; Meningeal Neoplasms - therapy ; meningioma ; Meningioma - classification ; Meningioma - pathology ; Meningioma - therapy ; Middle Aged ; Precision Medicine - methods ; Prognosis ; Retrospective Studies ; risk score
    ISSN: 1522-8517
    E-ISSN: 1523-5866
    Source: PubMed Central
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  • 10
    Language: English
    In: Cancer research (Chicago, Ill.), 2018-02-01, Vol.78 (3), p.610-616
    Description: Brain metastases are common and are usually detected by MRI. Diffusion tensor imaging (DTI) is a derivative MRI technique that can detect disruption of white matter tracts in the brain. We have matched preoperative DTI with image-guided sampling of the brain-tumor interface in 26 patients during resection of a brain metastasis and assessed mean diffusivity and fractional anisotropy (FA). The tissue samples were analyzed for vascularity, inflammatory cell infiltration, growth pattern, and tumor expression of proteins associated with growth or local invasion such as Ki67, S100A4, and MMP2, 9, and 13. A lower FA in the peritumoral region indicated more white matter tract disruption and independently predicted longer overall survival times (HR for death = 0.21; 95% confidence interval, 0.06-0.82; = 0.024). Of all the biological markers studied, only increased density of CD3 lymphocytes in the same region correlated with decreased FA (Mann-Whitney = 0.037) as well as confounding completely the effect of FA on multivariate survival analyses. We conclude that the T-cell response to brain metastases is not a surrogate of local tumor invasion, primary cancer type, or aggressive phenotype and is associated with patient survival time regardless of these biological factors. Furthermore, it can be assayed by DTI, potentially offering a quick, noninvasive, clinically available method to detect an active immune microenvironment and, in principle, to measure susceptibility to immunotherapy. These findings show that white matter tract integrity is degraded in areas where T-cell infiltration is highest, providing a noninvasive method to identify immunologically active microenvironments in secondary brain tumors. .
    Subject(s): Adult ; Aged ; Biomarkers ; Brain cancer ; Brain Neoplasms - mortality ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Brain tumors ; Cancer ; CD3 antigen ; Cell survival ; Confidence intervals ; Diffusion ; Diffusion Magnetic Resonance Imaging - methods ; Female ; Follow-Up Studies ; Gelatinase A ; Humans ; Immunotherapy ; Infiltration ; Inflammation ; Integrity ; Lymphocytes ; Lymphocytes T ; Magnetic resonance imaging ; Male ; Metastases ; Metastasis ; Microenvironments ; Middle Aged ; Neoplasms - mortality ; Neoplasms - pathology ; Neoplasms - surgery ; Neuroimaging ; Phenotypes ; Prognosis ; Prospective Studies ; Proteins ; S100A4 protein ; Substantia alba ; Survival ; Survival Rate ; T-Lymphocytes - pathology ; Tumors ; Young Adult
    ISSN: 0008-5472
    E-ISSN: 1538-7445
    Source: HighWire Press (Free Journals)
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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