Efficacy of low frequency pulsed electromagnetic field therapy in treatment of peritumoral edema of glioma / 上海预防医学

Objective To evaluate the efficacy of low frequency pulsed electromagnetic field (LFPEMF) on peritumoral edema in patients with glioma, providing a theoretical basis for clinical treatment of peritumoral edema. Methods This study included 32 patients with recurrent cerebral glioma with peritumoral edema after the operation of glioma in department of glioma, Beijing Shijitan Hospital, Capital Medical University from March 2017 to December 2018.The period of LFPEMF treatment was 10-14 days.The clinical symptoms related to brain edema were recorded before and after treatment.The National Institutes of Health Stroke Scale (National Institute of health stroke scale, NIHSS), Karnofsky quality of life score (KPS), brain edema and tumor range in cranial MRI, T lymphocyte subgroup CD4+/CD8+, superoxide dismutase (SOD) were recorded.The SPSS21.0 statistical analysis software was used to carry out analysis by using self controlled study.P < 0.05 was statistically significant. Results After the treatment of LFPEMF, the results showed that LFPEMF was effective in 25 patients, invalid in 7 patients, and the total effective percentage was 78.13%.The area of brain edema was significantly improved after using LFPEMF(P < 0.05).There was no significant improvement in the area of brain tumor after using LFPEMF therapy (P>0.05).KPS and NIHSS scores improved significantly after using LFPEMF (P < 0.05). Conclusion In the patients with peritumoral edema of glioma, the application of LFPEMF in the patients′ Yongquan point and Lao Gong point can reduce peritumoral edema, and improve clinical symptoms.

Efficacy of low frequency pulsed electromagnetic field therapy in treatment of peritumoral edema of glioma / 上海预防医学

Objective To evaluate the efficacy of low frequency pulsed electromagnetic field (LFPEMF) on peritumoral edema in patients with glioma, providing a theoretical basis for clinical treatment of peritumoral edema. Methods This study included 32 patients with recurrent cerebral glioma with peritumoral edema after the operation of glioma in department of glioma, Beijing Shijitan Hospital, Capital Medical University from March 2017 to December 2018.The period of LFPEMF treatment was 10-14 days.The clinical symptoms related to brain edema were recorded before and after treatment.The National Institutes of Health Stroke Scale (National Institute of health stroke scale, NIHSS), Karnofsky quality of life score (KPS), brain edema and tumor range in cranial MRI, T lymphocyte subgroup CD4+/CD8+, superoxide dismutase (SOD) were recorded.The SPSS21.0 statistical analysis software was used to carry out analysis by using self controlled study.P < 0.05 was statistically significant. Results After the treatment of LFPEMF, the results showed that LFPEMF was effective in 25 patients, invalid in 7 patients, and the total effective percentage was 78.13%.The area of brain edema was significantly improved after using LFPEMF(P < 0.05).There was no significant improvement in the area of brain tumor after using LFPEMF therapy (P>0.05).KPS and NIHSS scores improved significantly after using LFPEMF (P < 0.05). Conclusion In the patients with peritumoral edema of glioma, the application of LFPEMF in the patients′ Yongquan point and Lao Gong point can reduce peritumoral edema, and improve clinical symptoms.

The progress on the delineation of target volume in postoperative intensity-modulated radiotherapy for glioblastoma / 中华放射肿瘤学杂志

The standard treatments of glioblastoma include surgery,postoperative radiotherapy and concurrent and adjuvant temozolomide-based chemotherapy.Radiotherapy is directly related to the overall survival rate.Nevertheless,the standard delineation of target volume during radiotherapy remains controversial.In this article,different standpoints upon the range of delineation of tumor volume were analyzed and the recurrence pattern of glioblastoma after radiotherapy was summarized.Besides,the technical causes of the failure to accurately delineate the tumor outline were identified.It is of significance to deliver individualized delineation of target volume by referring to the clinical and pathological characteristics of each patient.Finally,the application prospect of radiotherapy in the treatment of glioblastoma was discussed in this article,aiming to enhance the accuracy of target volume delineation during radiotherapy and maximize the clinical benefits to the patients.

Related factors of aggravated cerebral edema after meningioma surgery / 局解手术学杂志

Objective To investigate the risk factors of aggravated cerebral edema after meningioma surgery.MethodsRespectively analyze the clinical data of 187 patients received neurosurgery operation in our hospital from January 1, 2016 to February 5, 2018 and their postoperative aggravated cerebral edema, the related risk factors for brain edema after meningioma surgery was summarized.Results The incidence of aggravated cerebral edema in patients without preoperative edema (26.23％) was higher than that in patients with preoperative edema (13.8％), the difference was not statistically significant, probably due to the small number of cases or other related factors.Multivariate analysis of all related factors found that preoperative edema was the influencing factor for the increase of brain edema after meningioma surgery (P=0.005).It was found by single factor analysis that tumor site was a risk factor for the aggravation of cerebral edema after meningioma surgery.Multivariate analysis and multiple rate comparisons revealed that the sagittal sinus falx area was an independent risk factor for the aggravation of cerebral edema after meningioma surgery.ConclusionThe presence of peritumoral edema before surgery may be a protective factor for the postoperative brain edema.The incidence of postoperative cerebral edema was significantly higher in meningiomas located near the sagittal sinus falx than that of other sites.Therefore, meningiomas located near the sagittal sinus falx should be attached great importance.During the operation, the venous drainage should be protected, the perioperative management should be strengthened, and hormone and subsequent dehydration should be given timely to improve the prognosis of patients.

Relationship Between Cytogenetic Complexity and Peritumoral Edema in High-Grade Astrocytoma

BACKGROUND: The purpose of the study is to reveal the association of cytogenetic compltyexi and peritumoral edema volume (PTEV) and its prognostic significance in high-grade astrocytoma patients by culturing patient tumor cells. METHODS: Twenty-seven high-grade astrocytoma patients were divided into three groups according to karyotype complexity: normal, non-complex karyotype (NCK), and complex karyotype (CK). Endothelial growth factor receptor (EGFR) amplification was detected by FISH, and its association with chromosome 7 abnormalities was analyzed. Mean PTEV of each group was compared by ANOVA to evaluate the relationship between PTEV and cytogenetic complexity. RESULTS: The PTEV of patients in normal (n=6), NCK (n=8), and CK (n=13) groups were 24.52±17.73, 34.26±35.04, and 86.31±48.7 cm3, respectively (P=0.005). Ten out of 11 patients with EGFR amplification showed abnormalities in chromosome 7. The mean PTEV of EGFR-amplified and non-amplified groups were 80.4±53.7 and 41.3±37.9 cm3, respectively (P=0.035). The average survival of patients with PTEV less than 90 cm3 was 30.52±26.11 months, while in patients with PTEVs over or equal to 90 cm3, it was 10.83±5.53 months (P=0.007). CONCLUSIONS: The results show an association of complex karyotype with the PTEV of high-grade astrocytoma. EGFR amplification plays a significant role in the formation of peritumoral edema, causing PTEV to increase, which is related with survival. This implies that cytogenetic karyotype can be applied as a prognostic factor.

Correlational study of peritumoral brain edema,histological grades and the expression of Ki-67 in glio-mas / 国际肿瘤学杂志

Objective To explore the correlation of peritumoral brain edema( PTBE)size,histologi-cal grades and the expression rate of Ki-67 in gliomas. Methods The data and specimens about 74 cases of gliomas in People's Hospital of Xinjiang Uygur Autonomous Region during 2010-2013 were collected. All cases were confirmed by surgery and pathology. According to preoperative MRI,PTBE was graded. Immunohisto-chemical discriminate the expression of Ki-67. HE coloration distinguish the histological grades. Results In this study,90. 54%(67/74)patients occured PTBE,the incidence of PTBE inⅠ,Ⅱ,Ⅲ,Ⅳlevel of groups were 100%(3/3),78. 95%(15/19),83. 33%(15/18),100%(34/34). Ki-67 expression was positive in 75. 68%(56/74)patients,and the rates were 0,36. 84%(7/19),94. 44%(17/18),94. 12%(32/34) in Ⅰ,Ⅱ,Ⅲ,Ⅳ level of groups. The expression rate of Ki-67 was 57. 14%(4/7),60. 00%(6/10),and 80. 70%(46/57)in normal group,Ⅰ-level groups of PTBE,Ⅱ-level groups of PTBE. The result of Kruskal-Wallis H showed that the PTBE from different grades was statistically significant(H=11. 304,P=0. 010). The expression rate of Ki-67 in different grade gliomas was statistically significant(H=38. 530,P﹤0. 05), The difference of expression Ki-67 in gliomas of different PTBE was statistically significant( H=6. 478,P=0. 039). The result of Spearman rank correlation analysis showed that the PTBE level increased with the histo-logical grade up in gliomas(r=0. 385,P=0. 001). The expression rate of Ki-67 increased with the histologi-cal grade up in gliomas(r=0. 692,P﹤0. 05),and the expression rate of Ki-67 increased with the degree of PTBE up in glomas( r =0. 256,P =0. 028 ). Conclusion Accorrding to the PTBE size,the histological grades and proliferation ability of glioma can be judged pre-operation. Ki-67 can be used as the indicator of pro-liferation activity of tumor,and also be used as the important basis of histological grades.

Solid Cerebellar Hemangioblastoma with Peritumoral Edema: 5-Years Follow up

Hemangioblastomas are angioblastic tumors of the central nervous system. Cerebellar hemangioblastomas are traditionally classified into two morphologic types-cystic and solid. Cystic hemangioblastomas are associated with peritumoral edema, but solid hemangioblastomas are not. We report a case of solid cerebellar hemangioblastoma with massive peritumoral edema. An 83-year-old female visited our hospital due to a sudden headache. Five years ago, she had been admitted to our hospital with similar headache and diagnosed with cerebellar hemangioblastoma. Follow-up brain MRI 5 years later showed an increased size of a homogeneous enhancing mass with aggravated peritumoral edema in the left lower cerebellar hemisphere. Cerebral angiography showed a highly vascularized mass in the cerebellum, which was compatible with a solid-type hemangioblastoma.

Research progress on peritumoral edema-related molecular biology factors of the metastasis tumor of brain / 中国肿瘤临床

Peritumoral edema (PTE) of the metastasis tumor of brain (MTB) refers to the abnormal increase of moisture in the surrounding cerebral parenchyma of the brain tumor. The mechanism of PTE occurrence of MTB is complicated, and the influencing factors are diverse. PTE is one of the key factors that affect patient survival and cure. Researchers from China and overseas believe that it may be related to the expression of the vascular endothelial growth factor (VEGF) or VEGF receptor, aquaporin-4 (AQP-4), matrix metalloproteinase-9, interleukin-6, hypoxia inducible factor-1a, and other molecular biology factors. Studies of these molecular biologi-cal factors provide objective scientific evidence for the prevention, control, monitoring, treatment, and prognosis of PTE of metasta-sized brain tumor. In addition to the traditional dehydration therapy of PTE, the use of PTE-related molecular biological factors pro-vides a new approach for the treatment. AQP-4 agonists or antagonists and VEGF receptor antagonists also have good therapeutic poten-tials. In this paper, the authors reviewed the PTE-related molecular biological factors of MTB.

The influence of peritumoral edema at newly diagnosed glioma on recurrence patterns after total resection / 中国神经精神疾病杂志

Objective To explore the influence of peritumoral edema (PTE) on the tendency of recurrent location and morphological character after total resection using MRI. Methods MRI data was collected from 43 patients with recur-rent brain glioma after total resection from four clinical centers and then the influence of of PTE on recurrence patterns af-ter total resection was retrospectively analyzed based on the T2 weighted image. Results The PTE had a significant influ-ence on the recurrent patterns of brain gliomas after total resection. When PTE was mild, the shapes of recurrent gliomas tended to be focal (6/8) and the recurrent locations tended to be local (5/8). When PTE was severe, the shapes of the recur- rent gliomas tended to be spread(30/35 and the recurrent locations tended to be distant (25/35), followed by marginal (7/35), In addition, the morphological patterns and locations of recurrent gliomas were significantly different among different PTE types (all P<0.001). When PTE was ring shape, the shapes of recurrent gliomas tended to be focal (7/9) and the recur-rent locations tended to be local (6/9), followed by marginal (2/9) and distant (1/9). When PTE was irregular shape, most of recurrent locations tended to be distant (25/34), followed by marginal (7/34) but rarely local (2/34). Conclusions The de-grees and the types of brain glioma PTE can significantly influence the locations and morphological patterns of recurrent gliomas after total resection.

Expression of vascular endothelial growth factor in human meningiomas and peritumoral brain areas / 肿瘤研究与临床

Objective To explore the formation mechanism of peritumoral brain edema(PTBE)by vascular endothelial growth factor(VEGF).Methods 40 biopsies were obtained from 37 patients.Inmunohistochemical staining and Western blot were performed to detect the expression of VEGF protein.Reverse-transcriptase polymerase chain reaction(RT-PCR)was used to analyze the presence and quantity of VEGF mRNA.The extent of PTBE was estimated as an edema index(EI)based on preoperative magnetic resonance imaging.Results In VEGF-positive cases,a decreasing gradient of VEGF protein expression was observed with increasing distance from tumors(0.38±0.08,0.20±0.03,0.04±0.02).In meningiomas,the protein level and the mRNA level were congruent and the expression of both protein and mRNA had a significant correlation with EI(protein: r =0.892,RNA: r =0.875,P ＜ 0.05).However,in peritumoral areas,protein level were not consistent with the mRNA level.Protein results showed high correlation with EI(r =0.912,P ＜ 0.05),but mRNA almost was almost undetectable(0.06±0.02).Conclusion VEGF is impartant on PTBE.It is concluded that VEGF macromolecules are secreted by tumor tissue and enter peritumoral normal brain tissue to induce edemagenesis in meningiomas.

Radiation-Induced Intratumoral Necrosis and Peritumoral Edema after Gamma Knife Radiosurgery for Intracranial Meningiomas

OBJECTIVE: To study the clinical significance and relevant factors of radiation-induced intratumoral necrosis (RIN) and peritumoral edema (PTE) after Gamma knife radiosurgery (GKRS) for intracranial meningiomas. METHODS: We retrospectively analyzed the data of 64 patients who underwent GKRS for intracranial meningioma. The mean lesion volume was 4.9 cc (range, 0.3-20), and the mean prescription dose of 13.4 Gy (range, 11-18) was delivered to the mean 49.9% (range, 45-50) isodose line. RIN was defined as newly developed or enlarged intratumoral necrosis after GKRS. RESULTS: RIN and new development or aggravation of PTE were observed in 21 (32.8%) and 18 (28.1%) cases of meningioma, respectively during the median follow-up duration of 19.9+/-1.0 months. Among various factors, maximum dose (>25 Gy) and target volume (>4.5 cc) were significantly related to RIN, and RIN and maximum dose (>24 Gy) were significantly related to the development or aggravation of PTE. In 21 meningiomas with development of RIN after GKRS, there was no significant change of the tumor volume itself between the times of GKRS and RIN. However, the PTE volume increased significantly compared to that at the time of GKRS (p=0.013). The median interval to RIN after GKRS was 6.5+/-0.4 months and the median interval to new or aggravated PTE was 7.0+/-0.7 months. CONCLUSION: A close observation is required for meningiomas treated with a maximum dose >24 Gy and showing RIN after GKRS, since following or accompanying PTE may deteriorate neurological conditions especially when the location involves adjacent critical structures.

Sudden Death due to Undiagnosed Intracranial Meningioma: A Case Report / 대한법의학회지

Since patients with intracranial neoplasms usually represent their neurological symptoms rather early in the course of the disease, sudden unexpected death due to intracranial neoplasms is an uncommon event seen only exceptionally in medicolegal autopsy practice. Although meningiom is one of the most common primary intracranial neoplasms, sudden death due to the tumor is an uncommon event. We report a sudden, unexpected death of a 56-year-old female with an undiagnosed olfactory groove meningioma. It is assumed that peritumoral edema is related to the sudden death among the several mechanisms.

Radiological Characteristics of Peritumoral Edema in Meningiomas

OBJECTIVES: The purpose of this study is to evaluate the radiological charactersitics related to the formation of peritumoral edema in meningiomas. METHODS: Fifty patients with meningioma were examined by magnetic resonance images and cerebral angiography. The predictive factors associated peritumoral edema, such as, tumor size, peritumoral rim (cerebrospinal fluid cleft), shape of tumor margin, signal intensity of tumor in T2WI, and pial blood supply were evaluated. RESULTS: Tumor size, peritumoral rim and pial blood supply correlated with peritumoral edema on univariate analyses. But in multivariate analyses, pial blood supply was statistically significant as a factor for peritumoral edema in meningioma. CONCLUSION: In our results, pial blood supply is significant contributing factor for peritumoral edema in meningioma.

Correlation of Clinical and Biological Parameters with Peritumoral Edema in Meningioma

OBJECTIVE: Peritumoral edema(PTE) in meningioma occurs variably and can adversely affect the clinical course. Moreover, the etiology of PTE in meningioma is not well documented. To examine possible correlations with PTE, the authors report an investigation of the clinical parameters and the expressions of vascular endothelial growth factor(VEGF), matrix metalloproteinases(MMPs), and their inhibitors(TIMPs) in 20 meningiomas. METHODS: Tumor volume and edema volume estimation was done using Osiris software with magnetic resonance images and the edema index was calculated. The expression of VEGF, MMP, and TIMP were estimated in all 20 meningiomas by Western blotting, zymography, and laser densitometry. RESULTS: Tumor location was closely related with PTE. Meningiomas of the frontal lobe or the frontotemporal base had large PTEs, whereas those of the occipitoparietal lobe, posterior fossa or petroclivus were small. The level of VEGF expression bore no correlation with histologic malignancy and PTE extent. MMP-2 and -9 were detected in 100% of meningiomas and these levels were significantly related with PTE. TIMP-1 and -2 were detected in 19(95%) and 12(60%) of meningiomas respectively and their presence had no significant correlations statistically with PTE. CONCLUSION: Meningiomas with severe PTE expressed high levels of MMP-9 and low levels of MMP-2. The expressions of VEGF, MMP-2, MMP-9, and TIMPs in meningioma seems to be strongly related with PTE, which might be important factors of the etiology of PTE.

Gamma Knife Radiosurgery for Intracranial Meningioma

OBJECTIVE: To analyze the radiosurgical results of intracranial meningiomas after Gamma Knife radiosurgery (GKS) and to assess the possible factors related to the outcome and complications in treating meningiomas. PATIENTS AND METHODS: We retrospectively reviewed the clinical and radiological data in 179 patients(194 lesions) treated with GKS for intracranial meningiomas between May 1992 and October 2000. Radiosurgical responses were categorized as shrinkage, stasis and enlargement, and we defined the shrunken and static group as a radiological control. A Cox proportional hazards model was used to evaluate the correlation between the radiosurgical outcomes and various factors such as location and size of tumor, age and gender of patients, relation to venous sinus, pre-GKS degree of edema, treatment modality, radiosurgical parameters, and pathologic findings. RESULTS: Patients were grouped into skull base meningiomas(57.7%), non-skull base tumor including convexity, parasagittal, and falx meningiomas(37.1%), and others(5.2%) according to the location of tumors. The mean maximum dose and the margin dose of tumor was 30.0Gy(19-45Gy) and 15.1Gy(9.5-24.5Gy), respectively. The mean volume of the tumors was 9.4cc(0.003-45.0cc). The radiologic control rate was 97.1%. The radiation induced imaging change with or without neurologic deficit was the most common complication(23.6%). There were seen mostly in convexity, parasagittal, and falx meningiomas which were deeply embedded in cortex. CONCLUSION: GKS for intracranial meningioma seems to be safe and effective treatments. However, GKS should be considered very cautiously in non-skull base tumor such as convexity, parasagittal, or falx meningiomas with regards to patient's age and general condition, size and location of tumor, pattern of embedding into cortex, presenting symptoms and patient's preference.

A Study of the Effects of Clinicobiological Factors upon the Meningioma-Associated Peritumoral Edema Formation

It is thought that the biological aggressiveness of meningioma is closely related to the development of peritumoral edema. However, the effects of mechanical tumor factors on the venous return of underlying brain tissue, as well as those of MIB-1 or p53 immunoreactivity on the brain edema formation are still not clear. To identify factors which may influence meningioma-associated peritumoral edema development, the authors examined 28 histologically proven intracranial meningiomas(22 benign, 4 atypical, and 2 malignant meningioma patients). Correlation between the degree of brain edema and various factors including volume of the tumor, venous sinus involvements, tumor location, histologic subtypes, MIB-1 labeling index(LI), and immunoreactivity of p53 protein was analyzed retrospectively. The degree of brain edema(edema ratio) was measured by maximum edema area to maximum tumor area as seen on T2 and T1 enhanced magnetic resonance images, respectively. Mean maximum tumor area and the volume of the tumor were 15.7cm2 and 50.2cm3, respectively. The mean area of maximum edema extension was 23.3cm2 and the mean ratio between maximum edema area and tumor area was 1.90(range: 0-11.5). Tumor volume and the area of edema showed significant correlation(p=0.015). MIB-1 LI, however, correlated inversely with edema ratio(p=0.039). p53 protein expression, venous sinus involvement, age, sex, and histologic characteristics did not correlated with edema area or ratio. In conclusion, this study showed there was inverse correlation between edema development and MIB-1 LI, and no correlation with p53 expression. It was thus speculated that peritumoral edema in meningioma may not be a sign of biological aggressiveness.

Permeability Changes of Capillary Endothelial Monolayer according to the Malignancy of Co-cultured Cell Lines

Even though many hypotheses have been derived from the anatomical and functional analysis of in vivo models of brain tumors, it is still impossible to explain the mechanism of peritumoral edema. To determine whether increased permeability in a blood-brain barrier model correlated with the malignancy of a co-cultured brain tumor, the authors established an in vitro brain capillary endothelial monolayer co-culture model. Water-soluble factors which might explain the pathogenetic mechanism of peritumoral edema in brain tumors were expected and observed. The benign cell co-culture model used co-cultured astrocytoma cell lines such as C6 and H683 in the second compartment of a brain capillary endothelial monolayer culture model circumscribed with a 0.4u sized porous membrane which permitted communication of the media but limited cell migration to another compartment, and the malignant cell co-culture model used co-cultured glioblastoma cell lines such as 87MG and 373MG. Permeability at molecular weight 373 increased in the astrocytoma and glioblastoma co-culture models to 150% and 240% respectively, of that in a normal astrocyte co-culture model. Permeability at this molecular weight also increased in the astrocytoma- and glioblastoma-conditioned medium culture models to 38% and 131%, respectively, of that in a normal astrocytoma-conditioned medium culture model. The observed result was that permeability of the endothelial monolayer increased in accordance with the malignancy of co-cultured cells in the system permitting-other than cell migration-media transfer only. The result suggested that some factor soluble in media secreted from co-cultured cells changes the permeability of the endothelial monolayer and could explain the pathogenetic mechanism of peritumoral edema in malignant brain tumors.