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  • 1
    Online Resource
    Online Resource
    Effect of awake craniotomy in glioblastoma in eloquent areas (GLIOMAP): a propensity score-matched analysis of an international, multicentre, cohort study
    Elsevier BV ; 2022
    In:  The Lancet Oncology Vol. 23, No. 6 ( 2022-06), p. 802-817
    Details
    In: The Lancet Oncology, Elsevier BV, Vol. 23, No. 6 ( 2022-06), p. 802-817
    Type of Medium: Online Resource
    ISSN: 1470-2045
    URL: Article
    DOI: 10.1016/S1470-2045(22)00213-3
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2049730-1
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  • 2
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    Impact of maximal extent of resection on postoperative deficits, patient functioning, and survival within clinically important glioblastoma subgroups
    Oxford University Press (OUP) ; 2023
    In:  Neuro-Oncology Vol. 25, No. 5 ( 2023-05-04), p. 958-972
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 25, No. 5 ( 2023-05-04), p. 958-972
    Abstract: The impact of extent of resection (EOR), residual tumor volume (RTV), and gross-total resection (GTR) in glioblastoma subgroups is currently unknown. This study aimed to analyze their impact on patient subgroups in relation to neurological and functional outcomes. Methods Patients with tumor resection for eloquent glioblastoma between 2010 and 2020 at 4 tertiary centers were recruited from a cohort of 3919 patients. Results One thousand and forty-seven (1047) patients were included. Higher EOR and lower RTV were significantly associated with improved overall survival (OS) and progression-free survival (PFS) across all subgroups, but RTV was a stronger prognostic factor. GTR based on RTV improved median OS in the overall cohort (19.0 months, P  & lt; .0001), and in the subgroups with IDH wildtype tumors (18.5 months, P = .00055), MGMT methylated tumors (35.0 months, P  & lt; .0001), aged & lt;70 (20.0 months, P  & lt; .0001), NIHSS 0–1 (19.0 months, P = .0038), KPS 90–100 (19.5 months, P = .0012), and KPS ≤80 (17.0 months, P = .036). GTR was significantly associated with improved OS in the overall cohort (HR 0.58, P = .0070) and improved PFS in the NIHSS 0–1 subgroup (HR 0.47, P = .012). GTR combined with preservation of neurological function (OFO 1 grade) yielded the longest survival times (median OS 22.0 months, P  & lt; .0001), which was significantly more frequently achieved in the awake mapping group (50.0%) than in the asleep group (21.8%) (P  & lt; .0001). Conclusions Maximum resection was especially beneficial in the subgroups aged & lt;70, NIHSS 0–1, and KPS 90–100 without increasing the risk of postoperative NIHSS or KPS worsening. These findings may assist surgical decision making in individual glioblastoma patients.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noac255
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 3
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    Neurosurgical resection for locally recurrent brain metastasis
    Oxford University Press (OUP) ; 2021
    In:  Neuro-Oncology Vol. 23, No. 12 ( 2021-12-01), p. 2085-2094
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 23, No. 12 ( 2021-12-01), p. 2085-2094
    Abstract: In patients with locally recurrent brain metastases (LRBMs), the role of (repeat) craniotomy is controversial. This study aimed to analyze long-term oncological outcomes in this heterogeneous population. Methods Craniotomies for LRBM were identified from a tertiary neuro-oncological institution. First, we assessed overall survival (OS) and intracranial control (ICC) stratified by molecular profile, prognostic indices, and multimodality treatment. Second, we compared LRBMs to propensity score-matched patients who underwent craniotomy for newly diagnosed brain metastases (NDBM). Results Across 180 patients, median survival after LRBM resection was 13.8 months and varied by molecular profile, with & gt;24 months survival in ALK/EGFR+ lung adenocarcinoma and HER2+ breast cancer. Furthermore, 102 patients (56.7%) experienced intracranial recurrence; median time to recurrence was 5.6 months. Compared to NDBMs (n = 898), LRBM patients were younger, more likely to harbor a targetable mutation and less likely to receive adjuvant radiation (P & lt; 0.05). After 1:3 propensity matching stratified by molecular profile, LRBM patients generally experienced shorter OS (hazard ratio 1.67 and 1.36 for patients with or without a mutation, P & lt; 0.05) but similar ICC (hazard ratio 1.11 in both groups, P & gt; 0.20) compared to NDBM patients with similar baseline. Results across specific molecular subgroups suggested comparable effect directions of varying sizes. Conclusions In our data, patients with LRBMs undergoing craniotomy comprised a subgroup of brain metastasis patients with relatively favorable clinical characteristics and good survival outcomes. Recurrent status predicted shorter OS but did not impact ICC. Craniotomy could be considered in selected, prognostically favorable patients.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noab173
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 4
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    Passive Data Use for Ethical Digital Public Health Surveillance in a Postpandemic World
    JMIR Publications Inc. ; 2022
    In:  Journal of Medical Internet Research Vol. 24, No. 2 ( 2022-2-15), p. e30524-
    Details
    In: Journal of Medical Internet Research, JMIR Publications Inc., Vol. 24, No. 2 ( 2022-2-15), p. e30524-
    Abstract: There is a fundamental need to establish the most ethical and effective way of tracking disease in the postpandemic era. The ubiquity of mobile phones is generating large amounts of passive data (collected without active user participation) that can be used as a tool for tracking disease. Although discussions of pragmatism or economic issues tend to guide public health decisions, ethical issues are the foremost public concern. Thus, officials must look to history and current moral frameworks to avoid past mistakes and ethical pitfalls. Past pandemics demonstrate that the aftermath is the most effective time to make health policy decisions. However, an ethical discussion of passive data use for digital public health surveillance has yet to be attempted, and little has been done to determine the best method to do so. Therefore, we aim to highlight four potential areas of ethical opportunity and challenge: (1) informed consent, (2) privacy, (3) equity, and (4) ownership.
    Type of Medium: Online Resource
    ISSN: 1438-8871
    URL: Article
    DOI: 10.2196/30524
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2028830-X
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  • 5
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    Thirty-Day Outcomes After Craniotomy for Primary Malignant Brain Tumors : A National Surgical Quality Improvement Program Analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Neurosurgery Vol. 83, No. 6 ( 2018-12-01), p. 1249-1259
    Details
    In: Neurosurgery, Ovid Technologies (Wolters Kluwer Health), Vol. 83, No. 6 ( 2018-12-01), p. 1249-1259
    Type of Medium: Online Resource
    ISSN: 0148-396X
    URL: Article
    DOI: 10.1093/neuros/nyy001
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 1491894-8
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  • 6
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    Leptomeningeal disease in neurosurgical brain metastases patients: A systematic review and meta-analysis
    Oxford University Press (OUP) ; 2021
    In:  Neuro-Oncology Advances Vol. 3, No. 1 ( 2021-01-01)
    Details
    In: Neuro-Oncology Advances, Oxford University Press (OUP), Vol. 3, No. 1 ( 2021-01-01)
    Abstract: Leptomeningeal disease (LMD) is a complication distinguished by progression of metastatic disease into the leptomeninges and subsequent spread via cerebrospinal fluid (CSF). Although treatments for LMD exist, it is considered fatal with a median survival of 2–4 months. A broader overview of the risk factors that increase the brain metastasis (BM) patient's risk of LMD is needed. This meta-analysis aimed to systematically review and quantitatively assess risk factors for LMD after surgical resection for BM. Methods A systematic literature search was performed on 7 May 2021. Pooled effect sizes were calculated using a random-effects model for variables reported by three or more studies. Results Among 503 studies, thirteen studies met the inclusion criteria with a total surgical sample size of 2105 patients, of which 386 patients developed LMD. The median incidence of LMD across included studies was 16.1%. Eighteen unique risk factors were reported as significantly associated with LMD occurrence, including but not limited to: larger tumor size, infratentorial BM location, proximity of BM to cerebrospinal fluid spaces, ventricle violation during surgery, subtotal or piecemeal resection, and postoperative stereotactic radiosurgery. Pooled results demonstrated that breast cancer as the primary tumor location (HR = 2.73, 95% CI: 2.12–3.52) and multiple BMs (HR = 1.37, 95% CI: 1.18–1.58) were significantly associated with a higher risk of LMD occurrence. Conclusion Breast cancer origin and multiple BMs increase the risk of LMD occurrence after neurosurgery. Several other risk factors which might play a role in LMD development were also identified.
    Type of Medium: Online Resource
    ISSN: 2632-2498
    URL: Article
    DOI: 10.1093/noajnl/vdab162
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 3009682-0
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  • 7
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    Quality of reporting and assessment of patient-reported health-related quality of life in patients with brain metastases: a systematic review
    Oxford University Press (OUP) ; 2018
    In:  Neuro-Oncology Practice Vol. 5, No. 4 ( 2018-11-02), p. 214-222
    Details
    In: Neuro-Oncology Practice, Oxford University Press (OUP), Vol. 5, No. 4 ( 2018-11-02), p. 214-222
    Abstract: Brain metastases (BMs) have become increasingly prevalent and present unique considerations for patients, including neurocognitive sequelae and advanced disease burden. Therefore, assessing health-related quality of life (HRQoL) via patient-reported outcome measures (PROMs) is an important element of managing these patients. A systematic review of the literature was conducted with the aims of (1) assessing how PROMS used in BM patients were validated, (2) assessing PROM content, and (3) evaluating quality of PROM-results reporting. PROM validation and quality of reporting were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) grading criteria and International Society of Quality of Life (ISOQOL)-recommended PROM-reporting standards, respectively. Forty-seven studies reporting on 5178 patients with a range of primacy cancer types were included. Eight different PROMs were applied, ranging from general to brain-specific questionnaires. Weaknesses in the validation of these PROMs were assessed by the COSMIN criteria. Many of these PROMs were not developed for BM patients and contained little information on cognitive symptoms. The overall quality of PROM reporting was insufficient based on the ISOQOL scale. Given the unique clinical considerations in BM patients, our results indicate the need for a standardized, validated questionnaire to assess HRQoL in this population. Additionally, there is room for quality improvement with regard to reporting of PROM-related results.
    Type of Medium: Online Resource
    ISSN: 2054-2577 , 2054-2585
    URL: Article
    DOI: 10.1093/nop/npy024
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2018
    detail.hit.zdb_id: 2768945-1
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  • 8
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    Treatment and survival differences across tumor sites in malignant peripheral nerve sheath tumors: a SEER database analysis and review of the literature
    Oxford University Press (OUP) ; 2019
    In:  Neuro-Oncology Practice Vol. 6, No. 2 ( 2019-03-29), p. 134-143
    Details
    In: Neuro-Oncology Practice, Oxford University Press (OUP), Vol. 6, No. 2 ( 2019-03-29), p. 134-143
    Abstract: Currently, literature is scarce on differences across all possible tumor sites in malignant peripheral nerve sheath tumors (MPNSTs). To determine differences in treatment and survival across tumor sites and assess possible predictors for survival, we used the Surveillance, Epidemiology, and End Results (SEER) database. Methods MPNST cases were obtained from the SEER database. Tumor sites were recoded into: intracranial, spinal, head and neck (H & N), limbs, core (thorax/abdomen/pelvis), and unknown site of origin. Patient and tumor characteristics, treatment modalities, and survival were extracted. Overall survival (OS) was assessed using univariable and multivariable Cox regression hazard models. Kaplan-Meier survival curves were constructed per tumor site for OS and disease-specific survival (DSS). Results A total of 3267 MPNST patients were registered from 1973 to 2013; 167 intracranial (5.1%), 119 spinal (3.6%), 449 H & N (13.7%), 1022 limb (31.3%), 1307 core (40.0%), and 203 unknown (6.2%). The largest tumors were found in core sites (80.0 mm, interquartile range [IQR]: 60.0-115.0 mm) and the smallest were intracranial (37.4 mm, IQR: 17.3-43.5 mm). Intracranial tumors were least frequently resected (58.1%), whereas spinal tumors were most often resected (83.0%). Radiation was administered in 35.5% to 41.8%. Independent factors associated with decreased survival were: older age, male sex, black race, no surgery, partial resection, large tumor size, high tumor grade, H & N site, and core site (all P 〈 .05). Intracranial and pediatric tumors show superior survival (both P 〈 .05). Intracranial tumors show superior OS and DSS curves, whereas core tumors have the worst (P 〈 .001). Conclusion Superior survival is seen in intracranial and pediatric MPNSTs. Core and H & N tumors have a worse prognosis.
    Type of Medium: Online Resource
    ISSN: 2054-2577 , 2054-2585
    URL: Article
    DOI: 10.1093/nop/npy025
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 9
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    Deep learning for natural language processing of free-text pathology reports: a comparison of learning curves
    BMJ ; 2020
    In:  BMJ Innovations Vol. 6, No. 4 ( 2020-10), p. 192-198
    Details
    In: BMJ Innovations, BMJ, Vol. 6, No. 4 ( 2020-10), p. 192-198
    Abstract: Although clinically derived information could improve patient care, its full potential remains unrealised because most of it is stored in a format unsuitable for traditional methods of analysis, free-text clinical reports. Various studies have already demonstrated the utility of natural language processing algorithms for medical text analysis. Yet, evidence on their learning efficiency is still lacking. This study aimed to compare the learning curves of various algorithms and develop an open-source framework for text mining in healthcare. Methods Deep learning and regressions-based models were developed to determine the histopathological diagnosis of patients with brain tumour based on free-text pathology reports. For each model, we characterised the learning curve and the minimal required training examples to reach the area under the curve (AUC) performance thresholds of 0.95 and 0.98. Results In total, we retrieved 7000 reports on 5242 patients with brain tumour (2316 with glioma, 1412 with meningioma and 1514 with cerebral metastasis). Conventional regression and deep learning-based models required 200–400 and 800–1500 training examples to reach the AUC performance thresholds of 0.95 and 0.98, respectively. The deep learning architecture utilised in the current study required 100 and 200 examples, respectively, corresponding to a learning capacity that is two to eight times more efficient. Conclusions This open-source framework enables the development of high-performing and fast learning natural language processing models. The steep learning curve can be valuable for contexts with limited training examples (eg, rare diseases and events or institutions with lower patient volumes). The resultant models could accelerate retrospective chart review, assemble clinical registries and facilitate a rapid learning healthcare system.
    Type of Medium: Online Resource
    ISSN: 2055-8074 , 2055-642X
    URL: Article
    DOI: 10.1136/bmjinnov-2019-000410
    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 10
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    Subtype switching in breast cancer brain metastases: a multicenter analysis
    Oxford University Press (OUP) ; 2020
    In:  Neuro-Oncology Vol. 22, No. 8 ( 2020-08-17), p. 1173-1181
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 22, No. 8 ( 2020-08-17), p. 1173-1181
    Abstract: Breast cancer (BC) brain metastases (BM) can have discordant hormonal or human epidermal growth factor receptor 2 (HER2) expression compared with corresponding primary tumors. This study aimed to describe incidence, predictors, and survival outcomes of discordant receptors and associated subtype switching in BM. Methods BCBM patients seen at 4 tertiary institutions who had undergone BM resection or biopsy were included. Surgical pathology reports were retrospectively assessed to determine discordance between the primary tumor and the BCBM. In discordant cases, expression in extracranial metastases was also assessed. Results In BM from 219 patients, prevalence of any discordance was 36.3%; receptor-specific discordance was 16.7% for estrogen, 25.2% for progesterone, and 10.4% for HER2. Because estrogen and progesterone were considered together for hormonal status, 50 (22.8%) patients switched subtype as a result; 20 of these switches were HER2 based. Baseline subtype predicted switching, which occurred in up to 37.5% of primary HR+ patients. Moreover, 14.8% of initially HER2-negative patients gained HER2 in the BM. Most (63.6%) discordant patients with extracranial metastases also had discordance between BM and extracranial subtype. Loss of receptor expression was generally associated with worse survival, which appeared to be driven by estrogen loss (hazard ratio = 1.80, P = 0.03). Patients gaining HER2 status (n = 8) showed a nonsignificant tendency toward improved survival (hazard ratio = 0.64, P = 0.17). Conclusions In this multicenter study, we report incidence and predictors of subtype switching, the risk of which varies considerably by baseline subtype. Switches can have clinical implications for prognosis and treatment choice.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noaa013
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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