Tumor Edema Research Articles

BIOM-57. PERITUMORAL EDEMA AS A PREDICTOR OF PD-1 EXPRESSION IN BRAIN METASTASES

Abstract Brain metastases represent a significant problem in oncology with associated high morbidity and mortality. They have been associated with increased peritumoral edema which can worsen neurological symptoms and patient outcomes. Peritumoral cerebral edema may be an important metric of interest as some MRI studies have suggested an association between molecular factors and peritumoral edema. We hypothesized that an association exists between PD-1 expression in brain mets from NSCLC and the radiographic peritumoral edema to enhancing tumor ratio (ETR). A retrospective analysis of tumor characteristics was conducted to identify patients with brain metastases from non-small cell lung cancer. Patients were stratified into three groups based on their tumor PD-1 expression levels: 0%, 1-49%, and 50% or higher. Tumor and edema volumes were measured in these patients using MRIs at the time of diagnosis and converted into edema to tumor ratios. Radiographic analysis has been completed for 19 patients with 9 having no PD-1 expression, 5 having low PD-1 expression, and 5 having high PD-1 expression. The no expression group had an average ETR of 3.02 while the low expression group had an average of 15.85 and the high expression group had an average of 9.12. These initial results show increased peritumoral edema in tumors with PD-1 expression when compared to tumors with no PD-1 expression, with a non-significant trend in favor of increased edema to tumor ratio (p = 0.055). The current project is ongoing with plans to expand patient cohorts to affirm or rule out significant ETR association by MRI.

NCMP-14. RADIOGRAPHIC RESPONSE TO BEVACIZUMAB IN TREATING RADIATION NECROSIS AND ASSOCIATED EDEMA IN BRAIN TUMORS

Abstract OBJECTIVE This study evaluates the efficacy of bevacizumab in treating radiation necrosis (RN) and associated perilesional edema in brain tumors. We aimed to measure changes in radiologic volumes and clinical performance following treatment. MATERIALS AND METHODS We retrospectively reviewed patients treated with radiation therapy and/or stereotactic radiosurgery between September 2017 and August 2023. We identified 10 metastatic brain tumors and one glioblastoma with symptomatic RN. Diagnosis was primarily through MRI, with one case confirmed pathologically. All patients received bevacizumab (7.5 mg/kg every 3 weeks). Volumes of RN and perilesional edema were measured using gadolinium-enhanced T1-weighted and T2-weighted/FLAIR MRI, respectively, analyzed with Brainlab software. Volume changes and clinical symptoms, graded by the ECOG Performance Status (PS) scale, were recorded. RESULTS The minimal follow-up was 4 months. The 11 patients received a median of 2 bevacizumab cycles (range, 2-3). Pre-treatment median volumes (ranges) were: tumor/RN 5.45 cc (2.66-13.56), perilesional edema (T2, FLAIR) 53.93 cc (7.46-115.32), 58.01 cc (15.18-131.2). Post-treatment median volumes (ranges) were: tumor/RN 2.5 cc (2.23-7.23), perilesional edema (T2, FLAIR) 4.05 cc (3.08-11.18), 7.38 cc (2.887-17.647). Median percentage volume reductions were: tumor 39%, RN 38%, perilesional edema (T2, FLAIR) 80%, 79%. Significant reductions in edematous volumes were observed. Pre-treatment ECOG PS median was 2 (range 2-3); post-treatment ECOG PS median remained 2 (range 2-3). Clinical performance improved in most patients, with two exception where deterioration occurred after the third cycle despite initial improvement. CONCLUSION Bevacizumab is effective in reducing RN and perilesional edema, particularly within the first two cycles of treatment. Most patients showed clinical improvement, though further research is needed to optimize treatment and understand long-term outcomes.

NIMG-62. SEX-DISTINCT TRANSCRIPTOMIC SIGNATURES UNDERLY MRI-DEFINED EDEMA PATTERNS IN HUMAN GLIOMAS

Abstract Magnetic resonance imaging (MRI) is key to clinically managing brain tumor patients, however connecting the biology to imaging remains challenging. We previously developed a two-compartment model of MRI signal intensity to quantitatively estimate relative edema abundance from T2-weighted MRIs. Using this model, we previously identified the fatty acid metabolism (FAM) and oxidative phosphorylation (OxPhos) pathways as sex-distinct, with both pathways amplified for high edema in males and low edema in females. The purpose of this project was to further delineate sex-distinct biology associated with MRI-estimated brain tumor edema abundance. We analyzed 179 multiregional samples (Female: 75; Male: 104) from 55 high grade glioma patients (Female: 21; Male: 34) for bulk RNA-Seq. Patients’ pre-surgical multiparametric MRIs were preprocessed and segmented for abnormal regions and normal tissue. Utilizing the segmentations and preprocessed images we estimated the relative fractions of extracellular and intracellular space based on the edema mathematical model. Samples were characterized by their edema scores, which were analyzed using differential expression for high and low edema, gene set enrichment analysis (GSEA) using MSigDB hallmarks, and leading edge interpretation. Based on transcriptomic leading edge analyses of high and low edema samples from sex-separated cohorts, we identified common and sex-distinct enrichment of the FAM and OxPhos pathways underlying edema patterns. Of the OxPhos pathway leading edge genes, 45 were common, 36 were unique to females, and 66 were unique to males. Of the FAM pathway leading edge genes, 8 were common, 39 were unique to females, and 29 were unique to males. Notably, expression of both IDH1 and IDH2 were increased for males in regions of high edema in the OxPhos pathway. IDH3a was decreased for females in regions of low edema in the OxPhos pathway. These data suggest that there may be sex-distinct metabolism underlying MRI measurable edema formation.

Evaluation of Factors Influencing Postoperative Cognitive Dysfunction in Patients After Cranial Tumor Surgery.

The authors retrospectively analyzed the perioperative data of 81 patients who underwent cranial tumor surgery to explore the factors influencing POCD in patients after the surgery. The authors evaluated preoperative cognitive dysfunction using the Mini-Mental State Examination (MMSE) score measured. For patients whose cognitive function was normal, the authors retrieved the MMSE score on the seventh day after surgery and compared it to determine whether the patients had POCD. The authors used a univariate logistic regression analysis to analyze the perioperative factors in patients, namely, age, gender, history of underlying diseases, tumor size, peritumoral edema, duration of surgery, blood loss, intraoperative fluid infusion, and type of anesthetic drugs. The authors then performed a multivariate logistic regression analysis for the statistically significant factors. The authors found that 23 of 81 patients (28.4%) developed POCD. Univariate logistic analysis showed that a history of diabetes mellitus, peritumoral edema, intraoperative blood loss, and anesthetic drugs were the risk factors for patients developing POCD after cranial tumor surgery. Multivariate logistic regression analysis showed that a history of diabetes mellitus, peritumoral edema, and use of ciprofol as the anesthetic drug were independent risk factors for POCD after cranial tumor surgery. A history of diabetes mellitus, the degree of brain tumor edema, and the choice of anesthetic drugs significantly influence the occurrence of POCD in patients after cranial tumor surgery.

Perifocal Edema in Gliomas. Pathogenesis, Clinical Picture, Treatment

Surgical treatment of malignant glial tumor is a complex task due to the lack of clear boundaries and contours, its high invasiveness in healthy brain tissues and the formation of intense edema, due to low differentiation in color and consistency between tumor and brain tissue. The main symptomatology of glial tumors is due to peritumoral edema, which can lead to severe symptoms, including neurological dysfunction, dislocation of structures and brain hernia. The main task of neurologists, neurosurgeons and resuscitators in the pre- and postoperative periods is to reduce the aggressive mass effect of the perifocal edema zone in gliomas. In recent years, steroid therapy has been the standard treatment for perifocal edema in space-occupying lesions of the brain. In recent years, the study of the role of cerebral lymphatic vessels involved in the regulation of cerebrospinal fluid and the formation of cerebral edema has changed views on the treatment of perifocal edema in gliomas. The aim of this study was to study the pathogenesis, clinical features and treatment of peritumoral edema in gliomas. The known mechanisms causing peritumoral edema in glial tumors of the brain have been studied and summarized. A comparative analysis and discussion of the results of modern methods for treating perifocal cerebral edema in glial tumors have been carried out and prospects for future methods for treating cerebral edema are presented. Further studies of perifocal edema around a glial tumor of the brain are needed to improve the prognosis of the pre- and postoperative periods and increase the effectiveness of edema treatment.

Fluid and Trace Element Content in Perifocal Edema in Glial Brain Tumors

Glial brain tumors are the most common brain tumors, and they are also in most cases malignant. Glial tumors in pathogenesis create an extensive pronounced zone of perifocal edema. The more malignant the glial tumor, the more pronounced the perifocal edema. According to the Monroe-Kelly doctrine, the equilibria of the three components must be observed in the skull, this position is disturbed in tumor diseases and neurological symptoms occur. The more malignant the tumor, the more pronounced the zone of perifocal edema. The severity of the clinical picture depends on the severity of perifocal edema. A small tumor node creates an extensive zone of perifocal edema, which in turn creates intracranial hypertension and dislocation syndrome that threaten the patient's life. An increase in intracranial hypertension leads to a violation of cerebral blood flow, this aggravates the increase in edema, edema, in turn, enhances the dislocation of brain structures, the dislocation of brain structures aggravates the severity of the patient's condition. Thus, a pathological closed circle is created, in which perifocal edema plays a major role. Perifocal edema in the acute period of the development of the disease is a buffer zone for healthy brain tissue, but subsequently serves as a beggar for migrating tumor cells, creating conditions for tumor recurrence in the near future.

AB038. Establishing a reliable semi-automated segmentation method for assessing chemoradiotherapy effects on the non-tumoral brain.

Current voxel-based morphometry (VBM) studies of chemoradiotherapy effects on healthy tissues of the glioblastoma multiforme (GBM) brain face a challenge with neuroanatomical distortions (tumor, tumor edema, and resection cavities) and limited comparisons can be drawn across studies due to lack of a universally accepted software package. Our aim is to compare current semi-automated segmentation methods and optimize them for reliability in investigating the effects of chemoradiotherapy on GBM patients. A publicly available dataset was used based on predefined inclusion and exclusion criteria. VBM pipelines CAT12 and FSL were tested and optimized to reduce the impact of neuroanatomical distortions. T1-weighted images were screened, and post-processed with FSL and CAT12. Gray matter (GM) and white matter (WM), and cerebrospinal fluid (CSF) volumes of whole brain, tumour-containing and non-tumor containing hemispheres, pre- and post-chemoradiotherapy were calculated and analyzed with Wilcoxon signed-rank tests. Agreement and consistency between FSL and CAT12 were assessed using Bland-Altman plots and intraclass correlation coefficients (ICCs). Post-chemoradiotherapy GM volumes were significantly reduced in whole brain with a compensatory significant increase in CSF volumes, while WM volumes had no significant changes. Similar trends were noted in tumor-containing and non-tumor-containing hemispheres. Bland-Altman plots showed good agreement between FSL and CAT12 processed GM and WM volumes of whole brain, tumor-containing, and non-tumor-containing hemispheres. ICC ≥0.70 was observed in GM [0.70 (0.53-0.82)] and WM [0.75 (0.60-0.85)] volumes of non-tumor-containing hemisphere, and WM [0.71 (0.55-0.83)] volumes of whole brain. GM volumes of tumor-containing hemisphere had good agreement but surprisingly, poor consistency [0.50 (0.25-0.68)]. CSF volumes in non-tumor-containing hemisphere had better agreement and consistency [0.55 (0.32-0.71)] than whole brain [0.49 (0.25-0.67)] and tumor-containing hemisphere CSF [0.36 (0.10-0.58)] volumes. Visual inspection revealed both CAT12 and FSL mis-segmented in the presence of neuroanatomical distortion although CAT12 was more susceptible in the presence of a hematoma. VBM studies of chemoradiotherapy effects on the brain post-tumor resection remain challenging due to neuroanatomical distortions. A reliable alternative is to use non-tumor-containing hemispheres with no anatomical distortion. Should tumor-containing brains be used, FSL is a more suitable choice, especially in the presence of hematoma distortion.

Prognostic Factors and Impact of Therapeutic Intervention in Patients With Brain Metastases at the Initial Presentation.

Background Studies investigating the normative characteristics and prognosis of patients diagnosed with brain metastases (BMs) at the onset of cancer are scarce. Therefore, we analyzed real-world treatment options. Methodology This retrospective study enrolled 112 patients newly diagnosed with BM between May 2006 and October 2021. The variables examined included patients' age, sex, recurrence split analysis, Glasgow prognostic score (GPS), number of lesions, tumor size, peripheral brain tumor edema, targeted therapy, supportive care, chemotherapy, and date of onset. Prognostic factors were assessed using recursive partitioning analysis (RPA), graded prognostic assessment (GPA) scores, and GPS scoring, with magnetic resonance imaging (MRI) andcomputed tomography (CT) studies. Primary treatment comprised whole-brain radiotherapy (WBRT), with regular follow-up. Results Data from 112 survivors were analyzed, revealing a median overall survival time (MST) of 7.7 months, with some patients surviving beyond 24 months post-WBRT. Univariate analysis revealed associations between MST and RPA class, GPS, and treatment modalities (including targeted therapy and chemotherapy). RPA class 2, GPSof 0, and targeted therapy were identified as predictors of better prognosis in the multivariate analysis. In the subgroup not receiving chemotherapy, no significant difference in prognosis was seen between groups with or without WBRT. Conclusions Alongside RPA, scores indicating chronic inflammatory changes, including GPS, were confirmed as crucial prognostic factors. Moreover, treatment with molecularly targeted drugs correlated with favorable prognoses. The treatment-naïve group exhibited poorer prognoses, and WBRT was not deemed a significant prognostic factor in the chemotherapy group.

Uncommon Causes of Interlobular Septal Thickening on CT Images and Their Distinguishing Features.

Interlobular septa thickening (ILST) is a common and easily recognized feature on computed tomography (CT) images in many lung disorders. ILST thickening can be smooth (most common), nodular, or irregular. Smooth ILST can be seen in pulmonary edema, pulmonary alveolar proteinosis, and lymphangitic spread of tumors. Nodular ILST can be seen in the lymphangitic spread of tumors, sarcoidosis, and silicosis. Irregular ILST is a finding suggestive of interstitial fibrosis, which is a common finding in fibrotic lung diseases, including sarcoidosis and usual interstitial pneumonia. Pulmonary edema and lymphangitic spread of tumors are the commonly encountered causes of ILST. It is important to narrow down the differential diagnosis as much as possible by assessing the appearance and distribution of ILST, as well as other pulmonary and extrapulmonary findings. This review will focus on the CT characterization of the secondary pulmonary lobule and ILST. Various uncommon causes of ILST will be discussed, including infections, interstitial pneumonia, depositional/infiltrative conditions, inhalational disorders, malignancies, congenital/inherited conditions, and iatrogenic causes. Awareness of the imaging appearance and various causes of ILST allows for a systematic approach, which is important for a timely diagnosis. This study highlights the importance of a structured approach to CT scan analysis that considers ILST characteristics, associated findings, and differential diagnostic considerations to facilitate accurate diagnoses.

Abstract 6168: Sex-distinct patterns of molecular pathways associated with brain tumor edema

Abstract Magnetic resonance imaging (MRI) is a centerpiece of clinical management of brain tumor patients, yet the biology underlying even commonly interpreted imaging changes is unclear. The purpose of this project was to understand what biology is associated with brain tumor edema abundance and if that association was sex distinct. We have developed a two-compartment model of MRI signal intensity to quantitatively estimate relative edema abundance from T2-weighted MRIs. Multiparametric MRIs were preprocessed with bias field correction and intensity normalization. The images were co-registered and segmented for abnormal regions and normal tissue. The segmentations and preprocessed images were utilized in the edema mathematical model to estimate the fraction of extracellular space (Fecs) and fraction of intracellular space (Fics). Through an ongoing image-localized biopsy collection protocol, we analyzed 179 samples (Female: 75; Male: 104) from 55 patients (Female: 21; Male: 34) for bulk RNA-Seq. Samples were characterized by their edema Fecs scores and underwent differential expression, gene set enrichment analysis using MSigDB hallmarks and cellular deconvolution using CIBERSORTx. Through differential expression and gene set enrichment analyses of these spatial biopsies, we have identified sex-distinct gene expression and pathways corresponding to regions of high vs low edema. Within highly edematous regions, male samples were amplified for respiratory pathways, while female samples were suppressed. Connecting changes on MRIs with molecular markers from image-localized biopsies provides an opportunity to identify the biological drivers of brain tumor associated imageable edema. Specifically, elucidating the sex-distinct patterns connecting changes on MRI with cellular populations and molecular pathways could be used to better interpret imaging of patients and interpreting treatment response. Citation Format: Pamela R. Jackson, Lee Curtin, Sara Ranjbar, Kyle W. Singleton, Maciej M. Mrugala, Richard S. Zimmerman, Bernard R. Bendok, Peter Canoll, Kristin R. Swanson. Sex-distinct patterns of molecular pathways associated with brain tumor edema [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6168.

10022-MET-2 CLINICAL FEATURES OF RENAL CELL CARCINOMA BRAIN METASTASES COMPARED WITH OTHER CARCINOMAS

Abstract INTRODUCTION In recent years, the positioning of surgical treatment for metastatic brain tumors has changed. To extract conditions suitable for surgical treatment, the background factors for each primary lesion were verified by retrospective analysis of our case. SUBJECTS AND METHODS From 2014 to 2022, 425 patients with metastatic brain tumors diagnosed and treated at our university were included. There were 219 lung cancers, 46 breast cancers, 64 gastrointestinal cancers, 26 renal cell carcinomas, and 70 others. First, the tumor volume and edema volume were measured, and the ROC curve was drawn for the presence or absence of symptoms to determine the cutoff value. After that, statistical analysis was performed on the following items for each primary lesion. The items were tumor volume (T), edema volume (E), tumor edema ratio (E/T), age, KPS, hemorrhage, cyst formation, meningitis, metastasis to other organs, posterior fossa, simultaneous detection, and single tumor. RESULTS The symptomatic cutoff was 1514mm3 for tumor volume (sensitivity 0.86 specificity 0.74) and 15616 mm3 for edema volume (sensitivity 0.85 specificity 0.85). The tumor edema ratio was significantly higher in renal cell carcinoma. Factors with significant differences were older age and multiple lesions in lung cancer, younger age and posterior fossa in breast cancer, lower KPS in gastrointestinal cancer, and solitary cases and bleeding in renal cell carcinoma. DISCUSSION/CONCLUSION In this analysis, many cases of brain metastasis from renal cell carcinoma are solitary, and because they exhibit extensive edema that seems to be affected by VEGF, they tend to develop symptoms while they are small, and they are characterized by hemorrhage easily during the course. These findings suggest that patients with brain metastases from renal cell carcinoma should be given priority for surgical treatment.

ANGI-03. NOVEL ROLE OF ENDOTHELIAL CELL AQUAPORIN-1 IN GLIOBLASTOMA VASCULAR PERMEABILITY AND TUMOR-ASSOCIATED EDEMA

Abstract Glioblastomas are the most common malignant brain tumors in adults, with a median survival of only 12-15 months. Glioblastomas are marked by an aberrant, leaky vasculature that promotes a hypoxic, immunosuppressive microenvironment. This aberrant vascularity not only affects treatment sensitivity but the integrity of the blood brain barrier (BBB). Disruption of the BBB can lead to increased flow of water into intercellular spaces, causing vasogenic edema. Increased intracranial pressure due to vasogenic edema in glioblastoma patients is a significant cause of morbidity and mortality. Severity of edema not only correlates with patient survival, but causes numerous harmful side effects, such as aphasia, cognitive decline, and acute herniation syndrome. Currently, the mainstay of treatment for brain tumor edema is glucocorticosteroids, such as dexamethasone. However, this treatment causes immune suppression and severe long-term adverse effects. To determine the potential role of vascular endothelial cells (ECs) in edema formation, we performed single cell RNAseq on a genetically engineered glioblastoma mouse model, which recapitulates the edema seen in human patients. We found that ECs from glioblastomas and normal brain tissue had distinct expression patterns, with selective expression of a water channel protein called Aquaporin-1 (AQP1) in glioblastoma ECs. In addition, siRNA-mediated AQP1 knockdown decreased GBM EC monolayer permeability. Inhibiting the water channel function of AQP1 alone through Bacopaside II treatment, however, did not alter EC monolayer permeability. Several tight junctions are downregulated in GBM ECs compared to normal brain ECs, and knocking down AQP1 via siRNA restored expression of the tight junction protein Claudin-5. These data suggest that AQP1 induces brain tumor edema by inhibiting tight junction protein expression via its non-water-channel function and that targeting AQP1 in glioblastoma ECs would be a novel therapeutic strategy to improve the BBB and decrease edema levels in vivo.

IMMU-05. TUMOR INFLAMMATION-ASSOCIATED NEUROTOXICITY (TIAN): A TOXICITY SYNDROME IN PATIENTS TREATED WITH IMMUNOTHERAPY FOR CENTRAL NERVOUS SYSTEM TUMORS

Abstract Immunotherapies have transformed the therapeutic landscape for various cancer indications; currently several preclinical and clinical studies are exploring immune-based therapies for the treatment of central nervous system (CNS) tumors. The recognition of toxicity syndromes and establishment of toxicity grading scales for cytokine release syndrome (CRS) and immune effector-cell associated neurotoxicity syndrome (ICANS) have improved the administration and management of chimeric antigen receptor (CAR)-based therapies for B cell malignancies. We have observed a localized neurotoxicity syndrome, distinct from CRS and ICANS, in patients treated with immunotherapies for CNS tumors, which we term tumor inflammation-associated neurotoxicity (TIAN). TIAN arises secondary to localized inflammation at the tumor site causing local neuronal dysfunction and/or local inflammation-induced edema leading to tissue shifts and increased intracranial pressure (ICP). Although TIAN can be associated with inflammation-induced tumoral edema and may share similarities with “pseudoprogression,” TIAN can also occur in the absence of edema due to neural-immune interactions causing primary local neural dysfunction. We distinguish two types of TIAN:1) type 1 TIAN occurs when tumor inflammation-induced edema leads to mechanical space constraints and results in increased ICP, hydrocephalus, and if unmanaged, may cause a herniation syndrome 2) type 2 TIAN reflects inflammation-induced local neural electrophysiological dysfunction resulting in transient worsening/development of new neurological symptoms. In order to facilitate the safe administration of immunotherapies for CNS tumors and standardize reporting and clinical management, we have proposed a TIAN grading scale that encompasses both types of TIAN. Even though type 1 TIAN typically consists of higher-grade toxicities than type 2 TIAN, high-grade toxicities can also be seen in type 2 TIAN when tumor inflammation affects critical cardiopulmonary functions. As the promise of immunotherapies for the treatment of CNS tumors materializes, recognizing TIAN as a distinct, local neurotoxicity syndrome will be essential for patient safety and clinical management.

Investigation of the pathogenesis, clinical course, and early and late consequences of the zone of perifocal edema of glial brain tumors with its surgical and drug correction

Introduction and Aim: Perifocal edema are the cause of the severity of patients, increasing intracranial pressure and dislocation syndrome. The objective of this study is to plan an adequate approach to the area of perifocal edema in the treatment of patients with glial brain tumors by studying the pathogenesis and consequences.
 
 Methods: 720 patients with glial tumors with varying degrees of malignancy and a zone of perifocal edema were operated and of these, 281 patients with GRADE I-IV astrocytoma, 147 patients with GRADE I-III oligodendroglioma, 115 patients with GRADE I-III ependymoma, and 177 patients with GRADE IV glioblastoma. The zone of perifocal edema was assessed by a point system from 1–5 points.
 
 Results: The glial tumor was significantly more common in the age group of 45-59 years (44.9 ± 2.1 cases per 100 patients). In the zone of perifocal edema at a distance from the tumor up to 1.5-2.0 cm, there was a site of apoptosis, demyelination, and destruction of nerve fibers.
 
 Conclusion: The surgical approach proposed by us with the removal of the apoptosis zone and the zone of perifocal inflammation is the key to the successful recovery of patients, without or with minimal postoperative complications.

Tumors of the lateral and third ventricles of the brain. Possibilities of endoscopic transventricular surgery. Prospects and prognosis

Tumors of the lateral and third ventricles of the brain are uncommon in the general population. Taking into account possible disability, expected duration and quality of life of the patient in the postoperative period, radical removal of these tumors, especially invasive ones, are debatable. Purpose: to determine the possibilities of endoscopic transventricular surgery for tumors of the lateral and third ventricles of the brain. Materials and methods. Between 2015 and 2021, 61 patients with lateral and third ventricle tumors were treated, 9 of which were primary and 52 were invasive.All patients had a preoperative Karnofsky Performance scale score ≥70 points. Preoperative neurological status: non-focal neurological symptoms were observed in all patients, central significant hemiparesis (up to 2 points) - in 5, cognitive-mnestic disorders - in 31, opto-chiasmatic syndrome - in 2. Obstructive hydrocephalus was diagnosed in all patients. All patients underwent full-endoscopic removal by frontal transcortical transventricular approach. Results. Total tumor resection (within healthy tissues) was performed in 34 patients, subtotal (up to 90%) – in 17, partial – in 10 patients. The postoperative condition according to Karnofsky Performance scale in all patients was ≥70 points. Hemiplegia was registered in 8 (13.1%) patients (sustained deficiency, hemiparesis (up to 3 points) - in 2 (1.22%) patients), hemianopsia - in 4 (6.5%) patients, short-term memory impairment - in 9 ( 14.75%), regression was observed 2–4 weeks after surgery. Thirty-seven (60.7%) patients died. The remaining patients (39.3%) are under observation. Median survival was 33 weeks (95% confidence interval (CI) 28–40 weeks). Postoperative survival in patients with glioblastoma was 15 weeks, median survival was 9.5 weeks (95% CI, 4–15 weeks). Of the patients with anaplastic astrocytoma, 13 (92.9%) patients died within 38 weeks after surgery, the median survival was 18 weeks (95% CI, 14.5–29.0 weeks), 1 (7.1%) patient was under observation. Patients with anaplastic oligodendroglioma had a median survival of 34.5 weeks (95% CI - 28-40 weeks), 15 (65.2%) patients died within 40 weeks, 8 (34.8%) patients are under observation. The difference between groups in survival was statistically significant (p<0.0001). Median survival in women was 34.5 weeks (95% CI, 29–40 weeks), in men, 28 weeks (95% CI, 18–39 weeks). There were 12 (42.9%) women and 12 (36.4%) men who survived for more than 60 weeks. No statistically significant difference was found between male and female survival rates (p=0.309). Conclusions. The ability of achieving the optimal resection volume of primary and invasive tumors of the third and lateral ventricles allows recommending the anterior endoscopic transcortical transventricular approach as an effective method of surgical treatment of these tumors. Radical endoscopic resection, as the first stage of combined treatment of patients with malignant tumors of the third and lateral ventricles, increases the patients’ life expectancy with a minimal risk of postoperative neurological complications, comparable to the life expectancy of patients with malignant tumors of supratentorial localization. To eliminate obstructive hydrocephalus and prevent the obstruction of CSF circulation in case of postoperative edema or continued growth in invasive tumors of the lateral and third ventricles, it is advisable to perform triventriculocisternostomy.

Quantification of Radiomics features of Peritumoral Vasogenic Edema extracted from fluid-attenuated inversion recovery images in glioblastoma and isolated brain metastasis, using T1-dynamic contrast-enhanced Perfusion analysis.

The peritumoral vasogenic edema (PVE) in brain tumors exhibits varied characteristics. Brain metastasis (BM) and meningioma barely have tumor cells in PVE, while glioblastoma (GB) show tumor cell infiltration in most subjects. The purpose of this study was to investigate the PVE of these three pathologies using radiomics features in FLAIR images, with the hypothesis that the tumor cells might influence textural variation. Ex vivo experimentation of radiomics analysis of T1-weighted images of the culture medium with and without suspended tumor cells was also attempted to infer the possible influence of increasing tumor cells on radiomics features. This retrospective study involved magnetic resonance (MR) images acquired using a 3.0-T MR machine from 83 patients with 48 GB, 21 BM, and 14 meningioma. The 93 radiomics features were extracted from each subject's PVE mask from three pathologies using T1-dynamic contrast-enhanced MR imaging. Statistically significant (< 0.05, independent samples T-test) features were considered. Features maps were also computed for qualitative investigation. The same was carried out for T1-weighted cell line images but group comparison was carried out using one-way analysis of variance. Further, a random forest (RF)-based machine learning model was designed to classify the PVE of GB and BM. Texture-based variations, especially higher nonuniformity values, were observed in the PVE of GB. No significance was observed between BM and meningioma PVE. In cell line images, the culture medium had higher nonuniformity and was considerably reduced with increasing cell densities in four features. The RF model implemented with highly significant features provided improved area under the curve results. The possible infiltrative tumor cells in the PVE of the GB are likely influencing the texture values and are higher in comparison with BM PVE and may be of value in the differentiation of solitary metastasis from GB. However, the robustness of the features needs to be investigated with a larger cohort and across different scanners in the future.

MET-8 EFFECT OF VEGF-TARGETED THERAPY FOR SYMPTOMATIC/REFRACTORY BRAIN EDEMA CAUSED BY METASTATIC BRAIN TUMORS

Abstract Background Molecular target therapy with EGFR and ALK inhibitors greatly improved the prognosis of lung cancer patients with driver mutation-positive metastatic brain tumors. Inhibitors of VEGF are also useful for treating brain edema induced by brain metastases. In this study, we examined the impact of VEGF inhibitors on symptomatic/refractory edema in metastatic brain tumors. Materials and Methods This retrospective study included the patients with metastatic brain tumors who received VEGF-targeted therapy for symptomatic/refractory brain edema. The primary cancer site, radiation therapy for metastatic brain tumors, corticosteroid administration, symptoms, Karnofsky performance status, and MR imagings before and after VEGF-targeted therapy were all gathered from the patient's medical records. Results 19 patients with symptomatic/refractory cerebral edema [NSCLC(15), LCNEC(1), SCLC(1), breast cancer(2), colorectal cancer (2)] were treated with anti-VEGF medication. Nine patients were treated with bevacizumab as a monotherapy, and 12 patients were treated with bevacizumab or ramucirumab in combination as a multi-drug therapy. Prior brain irradiation was administered to 17 patients. Corticosteroids were used to treat brain edema in 8 patients. VEGF inhibitors were effective in all patients, improving symptoms by reducing brain edema. Conclusion We recommend VEGF inhibitor for symptomatic/refractory edema of metastatic brain tumors. This treatment may be successful independent of the primary cancer site.

Comparison of clinical effect of MR imaging combined with simulated X-ray and magnetic resonance imaging in patients with benign and malignant bone tumors

ObjectiveTo explore the differential diagnosis results of MRI combined with simulated X-ray in patients with benign or malignant bone tumors. MethodsA total of 143 patients with typical benign or malignant skeletal system tumors were divided into benign (n = 78) and malignant groups (n = 65). They underwent simulated X-ray and MRI examinations before surgery. The imaging results were retrospectively analyzed, and the occurrence rates of various MRI signs and the detection accuracy of simulated X-ray examination in the two groups were calculated. Pathological diagnosis was used as the gold standard. The diagnosis of MRI examination and the combined MRI and X-ray examination for malignant tumor was compared and analyzed. Slope (enhancement slope value) and DER (centripetal enhancement rate) were calculated. The diagnostic effects of each critical point slope on skeletal system malignant tumors were analyzed. ResultsMRI signs showed that there were 107 cases of abnormal bone signals accompanied by solid soft tissue mass, 97.20% in the malignant group and 2.80% in the benign group (P < 0.05). There were 164 cases of peripheral tumor edema, with 68.29% in the malignant group and 31.71% in the benign group. There were 76 cases of radial periosteum reaction and periosteum triangle, with 94.74% in the malignant group and 5.26% in the benign group (P < 0.05). There were 11 cases of bone tumor in the malignant group. The accuracy of MRI combined with simulated X-ray was significantly higher than that of the two methods alone. There was a significant difference between malignant group and benign group in MRI detection slope value (P < 0.05). The slope value of different critical points had different effects in differentiating the characteristics of skeletal system tumors (P < 0.05). ConclusionMRI combined with simulated X-ray examination has a high accuracy rate in differentiating benign and malignant bone tumors. MRI signs showed abnormal signals in bone, accompanied by solid soft tissue mass, radial periosteum reaction and periosteum triangle, which can highly indicate malignant bone tumors.

Elevated Serum Lactate in Glioma Patients: Associated Factors.

IntroductionSerum lactate levels in brain cancer patients correlate with tumor malignancy grading, and serum lactate has been suggested as a potential biomarker and prognostic factor. The purpose of this study was to identify potential sources of elevated serum lactate in patients with brain gliomas by examining factors of importance for serum lactate production and clearance.MethodsIn this cross-sectional study, data were collected from 261 glioma patients who underwent surgery from March 2011 to June 2015. We recorded patient gender, age, blood serum measures of lactate, glucose, pH, hemoglobin and base excess, patient health status, medications, and tumor characteristics. Patients with elevated and normal serum lactate levels were compared, and we explored if there were correlations between the variables. The association of serum lactate with the measured variables was investigated by simple and multivariable linear regression models.Results and DiscussionPatients with elevated serum lactate had higher blood glucose, larger tumor volumes, and more tumor edema; more often needed pressor medication during surgery; and more often received corticosteroid treatment. The investigated variables were highly correlated. Multivariable linear regression indicated that gender, tumor volume, Charlson Comorbidity Index, hyperglycemia, and corticosteroid treatment were associated with serum lactate levels. Histopathology was not an independent factor. In conclusion, comorbidities, hyperglycemia, and presurgical corticosteroid treatment exhibited the strongest association with serum lactate in glioma patients.

Peculiarities of pathogenesis of perifocal edema in glial tumors of the brain and possibilities of its surgical and medical correction

Peculiarities of pathogenesis of perifocal edema in glial tumors of the brain and possibilities of its surgical and medical correction