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Background
Malignant gliomas account for a high proportion of brain tumours. With new advances in neurooncology, the recurrence-free survival of patients with malignant gliomas has been substantially prolonged. It, however, remains dependent on the thoroughness of the surgical resection. The maximal tumour resection without additional postoperative...
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Context 1
... needle biopsy should be offered to all patients with nonresectable gliomas (Figure 8) to allow for the histology-guided adjuvant therapy. 13 Even with resectable tumours, prior needle biopsy is some- times preferred to the immediate tumour resection in order to allow for the more individualized ap- proach. ...Citations
... Glioma a primary tumor of the central nervous system that is associated with the highest levels of morbidity and mortality, and accounts for ~45% of intracranial malignant tumors (1). Glioma exhibits increased levels of invasive growth, and is prone to invasion and metastasis (2,3). At present, it is impossible to achieve total removal of the tumor, and following resection, poor prognosis and high recurrence rates are common (3). ...
IQ motif containing GTPase activating protein 1 (IQGAP1) is a scaffold protein, which is aberrantly expressed in several tumor types and is closely associated with the development, metastasis and prognosis of cancer. Several studies have demonstrated that IQGAP1 has broad prospects in the basic and clinical research of tumors. The present study aimed to explore the effects of IQGAP1‑small interfering (si) NA on the proliferation and metastasis of U251 and U373 glioma cell lines, which markedly expressed IQGAP1. The human glioma cell lines (U251 and U373) were transfected with siRNA and transfection efficacy was confirmed by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) and western blot analysis. Cell proliferation was detected using the Cell Counting kit‑8, and cell metastasis capabilities were detected using cell adhesion, migration and invasion assays. In addition, the expression levels of several tumor‑associated genes were determined by RT‑qPCR and western blotting. The results indicated that IQGAP1 was expressed at higher levels in glioma tissues compared with in normal brain tissues. IQGAP1‑siRNA significantly inhibited cell proliferation, and cell adhesion, migration and invasion. Furthermore, the expression levels of matrix metalloproteinase (MMP)2, Snail, MMP9, fibronectin 1 and Twist were suppressed, and E‑cadherin was upregulated in response to siRNA‑IQGAP1. The present study identified the function of IQGAP1 in glioma cell biology, and indicated that it may be considered a novel target for glioma treatment.
... Even combined with postoperative radiotherapy and chemotherapy, glioma has a high recurrence rate and poor prognosis. In consequence, novel therapies that can improve the therapeutic effect and reduce side effects have always been explored [1][2][3]. The strong capacity of light absorption of nano-particles extends the absorption of visible light and near infrared ray in PTA (photothermal ablation therapy). ...
This study was to prepare the functionalized nano-graphene oxide (nano-GO) particles, and observe targeted fluorescence imaging and photothermy of U251 glioma cells under near infrared (NIR) exposure.
The functionalized nano-GO-Tf-FITC particles were prepared and then were incubated with U251 glioma cells. Estimation of CCK8 cell activity was adopted for measurement of cytotoxicity. The effect of fluorescein imaging was detected by fluorescence microscope with anti-CD71-FITC as a control. Finally, we detected the killing efficacy with flow cytometry after an 808 nm NIR exposure.
Both nano-GO-Tf-FITC group and CD71-FITC group exhibited green-yellow fluorescence, while the control group without the target molecule nano-GO-FITC was negative. The nano-GO-Tf-FITC was incubated with U251 cells at 0.1 mg/ml, 1.0 mg/ml, 3.0 mg/ml and 5.0 mg/ml. After 48 h of incubation, the absorbance was 0.747 ± 0.031, 0.732 ± 0.043, 0.698 ± 0.051 and 0.682 ± 0.039, while the absorbance of control group is 0.759 ± 0.052. There is no significant difference between the nano-GO-FITC groups and control group. In addition, the apoptosis and death index of nano-GO-Tf-FITC group was significantly higher than that of nano-GO-FITC and blank control group (P < 0.05).
The nano-GO-Tf-FITC particles with good biological compatibility and low cytotoxicity are successfully made, which have an observed effect of target imaging and photothermal therapy on glioma U251 cells.
... 9,10 Operative treatment of brain tumours Surgery is usually the first choice of treatment; the goal of surgery is maximal tumour resection, but it is also important to provide the diagnosis and prevent symptoms of the mass effect. 11 In addition to microsurgery, several new techniques are used in brain tumour surgery, such as frameless, imageguided neuronavigation, preoperative functional MRI, fiber tracking and transcranial magnetic stimulation, intraoperative ultrasound and MRI, intraoperative neurophysiological monitoring (including direct cortical stimulation), fluorescenceguided removal of malignant gliomas, stereotactic needle biopsy, neuroendoscopy, awake surgery and brachytherapy. These novel techniques can help the surgeon to facilitate tumour removal, minimize the injury of the surrounding brain tissue and the occurrence of postoperative neurological deficit, thus resulting in better patient outocome. ...
Abstract
Background. The number of patients with malignant brain tumours is on the rise, but due to the novel treatment methods the survival rates are higher. Despite increased survival the consequences of tumour properties and treatment can have a significant negative effect on the patients’ quality of life. Providing timely and appropriate rehabilitation interventions is an important aspect of patient treatment and should be started immediately after surgery. The most important goal of rehabilitation is to prevent complications that could have a negative effect on the patients’ ability to function.
Conclusions. By using individually tailored early rehabilitation it is often possible to achieve the patients’ independence in mobility as well as in performing daily tasks before leaving the hospital. A more precise evaluation of the patients’ functional state after completing additional oncologic therapy should be performed to stratify the patients who should be directed to complex rehabilitation treatment. The chances of a good functional outcome in patients with malignant brain tumours could be increased with good early medical rehabilitation treatment.
... [6,7] Cavitron ultra sonic aspirator (CUSA), neuroendoscopy, neuronavigation, intraoperative ultrasound (iUS) are important tools to maximize the extent of tumor decompression and reduce the post operative morbidity. [8][9][10][11] The use of fluorescent tumor marker technique for intraoperative detection involves oral administration of the nonfluorescent prodrug, 5-aminolevulinic acid (ALA). In tumour tissue, 5-ALA is metabolized to fluorescent protoporphyrin IX (PpIX) through the heme biosynthesis pathway. ...
... It enhances the macroscopic total resection of malignant gliomas. [9,12] Intraoperative MRI allows surgeons to take MR scans during surgery, while the patient is still in the operating room. Surgery can be temporarily stopped, MRI is performed and MR scans are analysed to determine if the tumour has been removed completely, or if the surgery should continue. ...
... Among them, only AS-ODNs are already in clinical development. [9] The most advanced is a phosphorothioatemodified AS-ODN (Trabedersen, AP 12009, Antisense pharma) directed against the transforming growth factor-beta 2 (TGF-β2), a protein that is massively produced by high-grade gliomas and promotes tumor cell proliferation, angiogenesis, invasion and metastasis. Thus, inhibiting TGF-β2 production, Trabedersen exerts multiple antitumor effects. ...
Introduction: Generally Supratentorial tumors are glial in origin. Their management is challenging despite of various advancements. Therefore, there is need to integrate various diagnostic and therapeutic modalities to achieve best clinical outcome following neurosurgical interventions. Objective: Paper aims to review recent advances in the field of neuroimaging, operative techniques, intra-operative technologies, chemoradiation and other modalities of therapeutic interventions affecting the prognosis of supratentorial gliomas. Materials and Methods: Pre and post operative clinical evaluation, psychological assessment, neuroimaging with CT scan, or MRI brain with contrast and or MR spectroscopy were done in 18 patients of supratentorial gliomas operated and followed up in last 3 years. Per operative frozen section biopsy was obtained in each case. Results: Seizures and headache were common presentation of supratentorial gliomas. Craniotomy and tumor decompression were common neurosurgical intervention. MRI brain with contrast enhancement was the main modality of investigation in the preoperative and post operative evaluation of these patients. Pre operative frozen section biopsy guided the extent of the tumor resection. Majority of patients had shown significant neurological improvement after surgery. Conclusion: Pre-operative neurological status of the patient, neuroimaging, per-operative frozen section biopsy, histopathological grade of the tumor has guided treatment of supratentorial gliomas. Various technological advancements e.g. PET scan, functional MRI, intra operative ultra sonogram, intra operative MRI and other technologies, advances in chemoradiation, immunotherapy , molecular based therapy and other newer therapeutic interventions have been reviewed for better clinical outcome. In view of recent advances it is imperative to establish an evidence based guideline for the comprehensive management.
... Therefore, a maximal safe tumour resection is mostly recommended. 33 After surgery, the patients were typically treated with radiotherapy with or without systemic therapy. 9,34-38 Radiotherapy is usually performed at a dose level between 55 and 60 Gy applied at the tumour site with an additional 2 to 3 cm margin at preoperative MRI, 5 times weekly. ...
Glioblastoma is the most common primary brain tumour. It has a poor prognosis despite some advances in treatment that have been achieved over the last ten years. In Slovenia, 50 to 60 glioblastoma patients are diagnosed each year. In order to establish whether the current treatment options have any influence on the survival of the Slovenian glioblastoma patients, their data in the period from the beginning of the year 1997 to the end of the year 2008 have been analysed.
All patients treated at the Institute of Oncology Ljubljana from 1997 to 2008 were included in the retrospective study. Demographics, treatment details, and survival time after the diagnosis were collected and statistically analysed for the group as a whole and for subgroups.
From 1997 to 2008, 527 adult patients were diagnosed with glioblastoma and referred to the Institute of Oncology for further treatment. Their median age was 59 years (from 20 to 85) and all but one had the diagnosis confirmed by a pathologist. Gross total resection was reported by surgeons in 261 (49.5%) patients; good functional status (WHO 0 or 1) after surgery was observed in 336 (63.7%) patients, radiotherapy was performed in 422 (80.1%) patients, in 317 (75.1%) of them with radical intent, and 198 (62.5 %) of those received some form of systemic treatment (usually temozolomide). The median survival of all patients amounted to 9.7 months. There was no difference in median survival of all patients or of all treated patients before or after the chemo-radiotherapy era. However, the overall survival of patients treated with radical intent was significantly better (11.4 months; p < 0.05). A better survival was also noticed in radically treated patients who received additional temozolomide therapy (11.4 vs. 13.1 months; p = 0.014). The longer survival was associated with a younger age and a good performance status as well as with a more extensive tumour resection. In patients treated with radical intent, having a good performance status, and receiving radiotherapy and additional temozolomide therapy, the survival was significantly longer, based on multivariate analysis.
We observed a gradual increase in the survival of glioblastoma patients who were treated with radical intent over the last ten years. Good functional surgery, advances in radiotherapy and addition of temozolomide all contributed to this increase. Though the increased survival seems to be more pronounced in certain subgroups, we have still not been able to exactly define them. Further research, especially in tumour biology and genetics is needed.
... 3 The knowledge of the cell death mechanisms and tumorigenic properties of the cells, and development of advanced therapies is therefore a key to successful treatment. 18,19 In our study we showed that staurosporine, depending on concentration, induces at least two different forms of a regulated cell death. When cultured astrocytes were exposed to 10 -7 M staurosporine, a significant proportion of early apoptotic cells was observed in comparison to the control cells, while necroptosis was not influenced ( Figure 1A,B). ...
Astroglial cells are frequently involved in malignant transformation. Besides apoptosis, necroptosis, a different form of regulated cell death, seems to be related with glioblastoma genesis, proliferation, angiogenesis and invasion. In the present work we elucidated mechanisms of necroptosis in cultured astrocytes, and compared them with apoptosis, caused by staurosporine.
Cultured rat cortical astrocytes were used for a cell death studies. Cell death was induced by different concentrations of staurosporine, and modified by inhibitors of apoptosis (z-vad-fmk) and necroptosis (nec-1). Different forms of a cell death were detected using flow cytometry.
We showed that staurosporine, depending on concentration, induces both, apoptosis as well as necroptosis. Treatment with 10(-7) M staurosporine increased apoptosis of astrocytes after the regeneration in a staurosporine free medium. When caspases were inhibited, apoptosis was attenuated, while necroptosis was slightly increased. Treatment with 10(-6) M staurosporine induced necroptosis that occurred after the regeneration of astrocytes in a staurosporine free medium, as well as without regeneration period. Necroptosis was significantly attenuated by nec-1 which inhibits RIP1 kinase. On the other hand, the inhibition of caspases had no effect on necroptosis. Furthermore, staurosporine activated RIP1 kinase increased the production of reactive oxygen species, while an antioxidant BHA significantly attenuated necroptosis.
Staurosporine can induce apoptosis and/or necroptosis in cultured astrocytes via different signalling pathways. Distinction between different forms of cell death is crucial in the studies of therapy-induced necroptosis.
... In this study the line-source approximation was used for calculation of geometry function. By using this approximation, for the geometry function can be obtained from the following equation: [3] If the geometry function is obtained from equation [4]: [4] As denoted by Awan et al. 17 , considering the source active length L, the radial distance r and the angles θ and ß as showed in the Figure 2, equation [5] can be resulted from the above equation: [5] Thus if , the geometry function can be calculated directly in terms of r and θ from equation [5]. ...
... In this study the line-source approximation was used for calculation of geometry function. By using this approximation, for the geometry function can be obtained from the following equation: [3] If the geometry function is obtained from equation [4]: [4] As denoted by Awan et al. 17 , considering the source active length L, the radial distance r and the angles θ and ß as showed in the Figure 2, equation [5] can be resulted from the above equation: [5] Thus if , the geometry function can be calculated directly in terms of r and θ from equation [5]. ...
... In this study the line-source approximation was used for calculation of geometry function. By using this approximation, for the geometry function can be obtained from the following equation: [3] If the geometry function is obtained from equation [4]: [4] As denoted by Awan et al. 17 , considering the source active length L, the radial distance r and the angles θ and ß as showed in the Figure 2, equation [5] can be resulted from the above equation: [5] Thus if , the geometry function can be calculated directly in terms of r and θ from equation [5]. ...
Dosimetric characteristics of a high dose rate (HDR) GZP6 Co-60 brachytherapy source have been evaluated following American Association of Physicists in MedicineTask Group 43U1 (AAPM TG-43U1) recommendations for their clinical applications.
MCNP-4C and MCNPX Monte Carlo codes were utilized to calculate dose rate constant, two dimensional (2D) dose distribution, radial dose function and 2D anisotropy function of the source. These parameters of this source are compared with the available data for Ralstron (60)Co and microSelectron(192)Ir sources. Besides, a superimposition method was developed to extend the obtained results for the GZP6 source No. 3 to other GZP6 sources.
The simulated value for dose rate constant for GZP6 source was 1.104±0.03 cGyh-1U-1. The graphical and tabulated radial dose function and 2D anisotropy function of this source are presented here. The results of these investigations show that the dosimetric parameters of GZP6 source are comparable to those for the Ralstron source. While dose rate constant for the two (60)Co sources are similar to that for the microSelectron(192)Ir source, there are differences between radial dose function and anisotropy functions. Radial dose function of the (192)Ir source is less steep than both (60)Co source models. In addition, the (60)Co sources are showing more isotropic dose distribution than the (192)Ir source.
The superimposition method is applicable to produce dose distributions for other source arrangements from the dose distribution of a single source. The calculated dosimetric quantities of this new source can be introduced as input data to the GZP6 treatment planning system (TPS) and to validate the performance of the TPS.
... Therefore, a maximal safe tumour resection is mostly recommended. 33 After surgery, the patients were typically treated with radiotherapy with or without systemic therapy. 9,34-38 Radiotherapy is usually performed at a dose level between 55 and 60 Gy applied at the tumour site with an additional 2 to 3 cm margin at preoperative MRI, 5 times weekly. ...
Recognition of tumor margins is crucial for surgical oncology to ensure therapeutic resection and accurate prognosis and to maintain healthy tissues as well. There has been significant technical progress in recognizing tumor margins in recent decades. Herewith, we discuss the role of frozen-section analysis and newer techniques such as mass spectrometry-based techniques and fluorescence-guided surgery.KeywordsDigestive systemMalignancyFlow cytometryIntraoperativeResection margins
Objective
The cystic gliomas are the special type of malignant tumors in the brain and often lead to unsatisfied prognosis, but the microsurgical resection is still the most important treatment. However, they are difficult to be totally removed with craniotomy, especially for those who have flimsy cyst walls. Recently, we attempted to resect them via an innovative surgical technique, “Gelfoam Padding”, in order to improve the total resection rate of the tumors safely.
Patients and methods
Fifteen patients suffering intracerebral cystic gliomas underwent surgical intervention via “Gelfoam Padding” technique between 2015 and 2018, and the different histopathological results and their features of cyst walls were recorded. Then, the total resection rate of tumors as well as the complications after surgeries were analyzed to assess the applied value of this technique.
Results
All the patients were improved in the clinical symptoms after the operations. According to the intraoperative assessment and MRI examinations performed within 72 h after surgery, total resection of the tumor was achieved in all patients. Besides, there were no serious postoperative complications in these cases with this technique.
Conclusion
The cystic glioma with the flimsy wall was the best applied indication of “Gelfoam Padding” technique, which could not only improve the total resection rate of tumors, but also be safe for the patients.
