Search

This study evaluated the usefulness of diffusion-weighted (DW) magnetic resonance imaging (MRI) and ADC maps in the differential diagnosis of brain abscesses from cystic or necrotic neoplasms. MR images of 49 patients with 54 lesions were examined retrospectively. All patients underwent conventional MRI and DWI, and ADC values were calculated by placing ROIs of 30 mm2 manually over the cystic part of the lesions. On DWI, all cystic portions of abscesses were hyperintense. Mean ADC values were 0.48×10 mm2/s (range 0.41–0.54×10 mm/s) for pyogenic abscesses, 0.73×10 mm2/s (range 0.65–0.91×10 mm/s) for mycotic abscesses and 0.6 mm2/s for Nocardia abscess. Cystic areas appeared hypointense on DWI in 33/44 tumours (mean value ADC 1.96 mm2/s). Eleven tumours (11/44) appeared hyperintense on DWI: eight metastases from lung cancer (mean ADC value 0.86 mm2/s, range 0.75–1.2 mm2/s), two GBMs (mean 0.7 mm2/s, range 0.67–0.76 mm2/s) and one anaplastic astrocytoma (ADC value 1.24 mm2/s). ADC values may help in differentiating pyogenic abscess from brain tumors or metastatic lesions.

Background The EANO ESMO guidelines have proposed a classification of leptomeningeal metastases (LM) based on clinical (typical/atypical), cytological (positive/negative/equivocal) and MRI (A linear, B nodular, C linear + nodular, D normal or hydrocephalus only) presentation. Type I LM is defined by the presence of tumor cells in the cerebrospinal fluid (CSF) (confirmed LM) whereas type II LM is defined by typical clinical and MRI signs (probable or possible LM). Here we explored the correlation between EANO ESMO subtypes of LM and outcome to assess their clinical utility. Methods We collected data from 254 patients with newly diagnosed LM from different primary solid tumors. Survival curves were estimated using the Kaplan-Meier method and compared by Log-rank test. Results Median age at LM diagnosis was 56.5 years (range 20-82 years). The main primary tumors were breast cancer (n = 98, 45%), lung cancer (n = 65, 25.5%) and melanoma (n = 51, 13.5%). Typical clinical LM symptoms or signs were noted in 225 patients (88.5%); only 13 patients (5%) were clinically asymptomatic. The most common MRI subtype was A seen in 117 patients (46%). Types B (n = 33, 13%), C (n = 54, 21%) and D (n = 50, 19.5%) were less common. Tumor cells were observed in the CSF in 186 patients (73%) whereas the CSF was equivocal in 24 (9.5%) and negative in 44 (17.5%) patients. Assignment to EANO ESMO classes was as follows: type IA 86 (34%), IB 19 (7.5%), IC 39 (15.5%), ID 45 (17.5%), IIA 28 (11%), IIB 13 (5%), IIC 16 (6.5%), IID 8 (3%). LM was confirmed in 189 (74.5%), probable in 51 (20%) and possible in 14 (5.5%) patients. The median overall survival (OS) was 2.75 months (range 0.09-220 months). OS was inferior in type I compared with type II LM patients (p = 0.0024). EANO ESMO subtype IIA patients had the longest survival (p = 0.0103). Patients with MRI patterns A and D pooled had poorer survival than B and C patients pooled in the presence of tumor cells in the CSF (type I) (p = 0.0402), but longer survival in the absence of tumor cells in the CSF (type II) (p = 0.0273). Conclusions The presence of tumor cells in the CSF appears to have a greater prognostic role than the neuroimaging presentation. EANO ESMO LM subtypes are prognostic and should be considered in the design of clinical trials. Legal entity responsible for the study University Hospital of Zurich. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.

International audience; Background: The efficacy of systemic antineoplastic therapy on recurrent World Health Organization (WHO) grades II and III meningiomas is unclear.Methods: We performed a retrospective multicenter analysis of serial cranial MRI in patients with recurrent WHO II and III meningiomas treated with antineoplastic systemic therapies. Growth rates for tumor volume and diameter, as well as change rates for edema size, were calculated for all lesions.Results: We identified a total of 34 patients (23 atypical, 11 anaplastic meningiomas) with a total of 57 meningioma lesions who had been treated at 6 European institutions. Systemic therapies included bevacizumab, cytotoxic chemotherapy, somatostatin analogues, and tyrosine kinase inhibitors. Overall, tumor growth rates decreased during systemic therapy by 51% for tumor diameter and 14% for tumor volume growth rates compared with the period before initiation of systemic therapy. The most pronounced decrease in meningioma growth rates during systemic therapy was evident in patients treated with bevacizumab, with a reduction of 80% in diameter and 59% in volume growth. Furthermore, a decrease in size of peritumoral edema after initiation of systemic therapy was exclusively observed in patients treated with bevacizumab (-107%).Conclusions: Our data indicate that systemic therapy may inhibit growth of recurrent WHO grades II and III meningiomas to some extent. In our small cohort, bevacizumab had the most pronounced inhibitory effect on tumor growth, as well as some anti-edematous activity. Prospective studies are needed to better define the role of medical therapies in this tumor type.

BACKGROUND: Lacosamide (LCM) has been suggested in some retrospective studies to improve seizure control as an add-on treatment in brain tumor patients. We present here the preliminary results of a prospective study focused on a cohort of patients with gliomas and active epilepsy who received LCM. METHODS: Eligibility criteria were as follows: 1) biopsy-proven grade II or III or IV gliomas according to WHO 2007; 2) persisting seizures (seizure frequency > 1 per month) despite a treatment with 1 or more antiepileptic drugs (AEDs) for at least 3 months and adequate serum concentration; 3) stable steroid dose; 4) available information on tumor response on MRI according to RANO criteria following chemotherapy or radiotherapy; 5) age > 18 years. LCM was given at 50 mg daily for one week with an increase of 50 mg twice daily every week to a target dose of 200-400 mg/day. The endpoints were > 50% decrease of seizure frequency and seizure freedom at 3 and 6 months. RESULTS: Since January 2012 42 patients were enrolled. There were 17 grade II gliomas (5 astrocytomas, 8 oligodendrogliomas, 4 oligoastrocytomas), 13 grade III (4 astrocytomas, 3 oligodendrogliomas, 6 gliomatosis cerebri) and 12 glioblastomas. Ten patients (23.8%) had generalized seizures and 32 (76.2%) partial seizures. Thirty-six patients (85.7%) were on AED monotherapy while 6 (14.3%) on polytherapy. Reasons for introduction of LCM were unacceptable side effects of traditional AEDs in 5 patients (12%) and/or lack of efficacy of previous AEDs associated with either PD in 16 (38%) or without PD in 26 (62%). Median duration of follow up was 6.6 months (range 3-24 months). Among low grade gliomas after 3 months of LCM 5/17 patients (29.4%) had a reduction of >50% of seizure frequency while seizure freedom was obtained in other 3/17 (17.6%); at 6 months a reduction of >50% of seizure frequency was observed in 5 (29.4%) while seizure freedom was obtained in other 2 (11.8%) for overall seizure control of 41.2%. As for high grade gliomas after 3 months 6/25 patients (24%) had a reduction of >50% of seizure frequency while seizure freedom was obtained in other 11/25 (44%); at 6 months a reduction of >50% of seizure frequency was observed in 7/22 (31.8%) and seizure freedom in other 6 (27.3%) for overall seizure control of 59.1% . A resolution of an epileptic status was obtained in 3 patients of whom one receveing LCM alone. Secondary generalized seizures disappeared in 4 patients. However, responding patients were not able to reduce the doses of previous AEDs. Most patients (97.6%) did not report significant toxicities: in 2 cases only LCM was withdrawn due to dizziness and fatigue and resistant epilepsy, respectively. CONCLUSION: Among patients both with high grade and low grade gliomas LCM is well tolerated without interactions with antitumoral treatments. LCM shows significant activity as add-on therapy regardless of tumor response to antineoplastic treatment.