Publications by authors named "Omar Arnaout"
Neuronal-glioma interactions are increasingly recognized as critical in the development and progression of central nervous system tumors. Recent research highlights that gliomas can integrate into neural circuits through various mechanisms, including the synaptogenic factor thrombospondin-1 (TSP-1). This new mechanistic understanding of cancer neuroscience allows for novel insights into target discovery.
View Article and Find Full Text PDFBackground And Objectives: Grade 2 meningiomas are associated with variable rates of local recurrence, and the role of adjuvant radiation therapy (RT) remains debated.
Methods: This was a multi-institutional retrospective cohort study including all adult patients with newly diagnosed and previously untreated grade 2 meningioma treated at Mass General Brigham hospitals from 2006 to 2020. Cox proportional-hazards modeling was used to analyze the impact of adjuvant RT on progression-free survival (PFS).
Background: Schwannomas are nerve sheath tumors arising at cranial and peripheral nerves, either sporadically or in patients with a schwannomatosis-predisposition syndrome. There is limited understanding of the transcriptional heterogeneity of schwannomas across genetic backgrounds and anatomic locations.
Methods: Here, we prospectively profile by single-cell full-length transcriptomics tumors from 22 patients with NF2-related schwannomatosis, non-NF2-related schwannomatosis, and sporadic schwannomas, resected from cranial and peripheral nerves.
PD-L1, Tumor Mutational Burden, and Outcomes in NSCLC With Brain Metastases: A Brief Report.
JTO Clin Res Rep
April 2025
Introduction: Patients with NSCLC and brain metastases have a poor prognosis. Combining brain-directed radiation therapy (RT) with immune checkpoint inhibitors (ICIs) may be synergistic. Nevertheless, predictors of response and toxicity are lacking.
View Article and Find Full Text PDFArticle Synopsis
- Glioblastoma is described as immunologically "cold," making it resistant to solo immune-checkpoint inhibitors (ICI) like pembrolizumab, although neoadjuvant use may improve survival based on prior studies.
- A study involving 25 additional patients analyzed tumor tissue for gene signatures and found that neoadjuvant pembrolizumab led to decreased cancer proliferation genes and increased T-cell activity, indicating a specific response to this treatment.
- Despite observing these molecular changes, the study did not confirm an overall survival benefit from neoadjuvant pembrolizumab, suggesting that some patients may inherently resist ICI and may need additional therapies for effective treatment.
Large language models in neurosurgery: a systematic review and meta-analysis.
Acta Neurochir (Wien)
November 2024
Article Synopsis
- Large Language Models (LLMs) are gaining attention in neurosurgery, with potential benefits, but their effectiveness across various surgical tasks remains under-researched.
- A systematic review of literature revealed 51 articles focusing on LLM applications, notably in clinical text generation, exam question answering, and decision-making support, predominantly using models like GPT-3.5 and GPT-4.
- While many studies utilized LLMs in a straightforward manner, there is a call for more rigorous guidelines and reproducibility in future research to fully harness their capabilities.
Pilot Trial of Perampanel on Peritumoral Hyperexcitability in Newly Diagnosed High-grade Glioma.
Steven Tobochnik
,
Michael S Regan
,
Maria K C Dorotan
,
Dustine Reich
,
Emily Lapinskas
,
Omar Arnaout
Clin Cancer Res
December 2024
Article Synopsis
- The study explored the effect of perampanel, an AMPA receptor antagonist, on reducing hyperexcitability around gliomas, which could promote tumor growth.
- An open-label trial compared perampanel with standard care in patients with high-grade glioma undergoing surgery, measuring outcomes like high-frequency oscillation rates and seizure occurrence.
- Results showed no significant difference in hyperexcitability outcomes between perampanel and standard care, and early termination of the trial indicated similar seizure rates and overall survival for both treatments.
Article Synopsis
- CPA meningiomas are challenging to treat due to their location near vital nerves and blood vessels, leading to potential postoperative complications and unpredictable recovery outcomes.
- A study of 95 patients at Mass General Brigham found that common symptoms included hearing loss, ataxia, and headaches, with gross total resection achieved in 62.1% of cases, which was more likely with smaller tumors and when the internal auditory canal was drilled.
- Post-surgery, most patients experienced stable or improved hearing, but 25.3% showed tumor progression or recurrence, with lower odds of progression linked to complete resection grades and older age.
Article Synopsis
- Neurosurgical resection can provide significant benefits for breast cancer patients with brain metastases, particularly for those with HER2-positive disease, despite potential delays in systemic therapy.
- A study analyzed 633 patients with brain metastases from breast cancer to identify outcomes based on breast cancer subtypes, revealing that HER2-positive patients require more subsequent treatments when surgery is omitted.
- The findings suggest that upfront neurosurgical resection may reduce local recurrence and improve overall treatment outcomes for HER2-positive patients compared to other subtypes, highlighting the need for careful patient selection.
Article Synopsis
- Ventricular shunts are the primary treatment for adult hydrocephalus, but diagnosing shunt malfunctions can be tricky; computer vision algorithms might help automate this process.
- A feasibility study involved 191 adult hydrocephalus patients and their CT scans, where a machine learning algorithm was trained to identify brain ventricle sizes.
- The algorithm showed a high performance (average Dice score of 0.809) and accurately predicted shunt revisions in 92.3% of cases, indicating its potential reliability in clinical settings.
Article Synopsis
- Glioblastoma is a highly aggressive brain tumor with a median survival of only 6-9 months after progression, due to factors like molecular pathways and tumor microenvironment.
- Current treatments like surgery, radiation, and chemotherapy can manage the primary tumor but not effectively prevent relapse, and the role of surgery for recurrent cases is debated.
- New innovative therapies for recurrent glioblastoma are being developed, including checkpoint inhibitors and CAR T-cell therapy, aimed at improving treatment outcomes.
Article Synopsis
- Nearly all neurosurgeons in the U.S. will face a malpractice claim before they retire, so this study looks at trends in those lawsuits to help them understand their risks.
- Researchers checked databases for malpractice cases involving open brain surgery from 1987 to 2023, finding out details like how much money was awarded and what went wrong.
- Out of 1,550 cases studied, they found 252 related to surgery, with the average payout being about $2.75 million, and many claims were due to complications during or after surgery.
Article Synopsis
- The study investigated the effects of the AMPA receptor antagonist perampanel on hyperexcitability and clinical outcomes in patients undergoing surgery for high-grade glioma.
- The trial compared perampanel to standard care using levetiracetam, measuring intraoperative hyperexcitability through high-frequency oscillation (HFO) rates and tracking seizure-free outcomes and overall survival.
- Results indicated no significant difference in hyperexcitability or survival outcomes between the two treatments, leading to the early termination of the trial due to futility, while perampanel was found to be safe and well-tolerated.
Article Synopsis
- A study assessed the responses of GPT-4.0 to 35 clinical questions in neurosurgery, evaluated by attending neurosurgeons for accuracy, safety, and helpfulness.
- Overall, GPT-4.0 showed a high consistency with medical guidelines and provided clinically useful information; however, it also generated some unrealistic and potentially risky responses.
- The model's citation accuracy was poor, with only 50% of references deemed valid, highlighting the need for clinicians to be cautious when using AI in medical practice.
Article Synopsis
- Effective management of acute myocardial infarction (AMI) after oncologic neurosurgery involves careful balancing of heart risks and bleeding complications.
- There's a lack of solid human studies to determine the best time to start antiplatelet or anticoagulant therapy post-surgery.
- For cancer patients with AMI after surgery, a staged approach to percutaneous coronary intervention (PCI) may help preserve heart function while reducing bleeding risks, supported by genetic testing for platelet response.
Article Synopsis
- Pituitary adenomas, categorized as functional or silent, represent around 15% of all brain tumors, with early evidence suggesting different clinical outcomes between these types.
- A study looked at medical records from 2007-2018 of patients who had surgery for either silent pituitary adenomas (SPAs) or functional pituitary adenomas (FPAs), using statistical methods to analyze outcomes and recurrence predictors.
- Findings showed that SPAs were generally larger, had lower total resection rates, and demonstrated a higher likelihood of recurrence and need for retreatment compared to FPAs, with factors like incomplete resection and younger age increasing risks for SPAs.
Positioning SUMO as an immunological facilitator of oncolytic viruses for high-grade glioma.
Front Cell Dev Biol
October 2023
Article Synopsis
- Oncolytic viral (OV) therapies are a new treatment option for hard-to-treat cancers like glioblastoma in the central nervous system but face challenges in effectiveness due to delivery issues and immune responses.
- The SUMO pathway, which regulates various physiological processes, plays a role in both CNS cancers and viral interactions, making it a target for enhancing OV treatments.
- The authors provide an overview of the SUMO pathway's impact on CNS malignancies, the current status of OV therapies, and how the SUMO pathway interacts with the viral lifecycle and immune responses.
Inaugural Results of the Individualized Screening Trial of Innovative Glioblastoma Therapy: A Phase II Platform Trial for Newly Diagnosed Glioblastoma Using Bayesian Adaptive Randomization.
Rifaquat Rahman
,
Lorenzo Trippa
,
Eudocia Q Lee
,
Isabel Arrillaga-Romany
,
Geoffrey Fell
,
Omar Arnaout
J Clin Oncol
December 2023
Article Synopsis
- The INSIGhT trial is a phase II study focused on evaluating new treatments for glioblastoma using adaptive randomization and genomic profiling to quickly identify promising therapies for further testing.
- Patients with a specific type of glioblastoma were randomly assigned to receive either standard treatment or one of three experimental drugs: abemaciclib, neratinib, or CC-115, with data guiding ongoing treatment allocation based on effectiveness.
- Results showed that abemaciclib and neratinib were generally well tolerated and led to a longer progression-free survival compared to standard treatment, while CC-115 had a high rate of severe toxicity and did not improve progression-free survival.
Article Synopsis
- Glioblastoma patients often experience myelosuppression due to treatment, impacting blood-based biomarkers like lymphopenia and neutrophil-to-lymphocyte ratio (NLR).
- A cohort study of 764 patients revealed that high NLR and lymphopenia during chemotherapy and after recurrence were linked to poorer survival rates.
- The findings suggest that incorporating blood biomarker assessments in clinical trial design could enhance patient eligibility criteria and outcome evaluations.
Metastatic pituitary tumors: an institutional case series.
Alexander G Yearley
,
Eric J Chalif
,
Saksham Gupta
,
Joshua I Chalif
,
Joshua D Bernstock
,
Omar Arnaout
Pituitary
October 2023
Article Synopsis
- Pituitary carcinomas are rare tumors that do not respond well to treatment and have an unpredictable disease progression.
- A study reviewed 14 cases treated over 30 years, revealing a median progression-free survival of 1.4 years and overall survival of 8.4 years, with most patients showing invasive characteristics before metastasizing.
- While chemotherapy and radiation improved progression-free survival, they did not significantly impact overall survival, highlighting the need for a specialized treatment approach.
Article Synopsis
- Machine learning (ML) is rapidly growing in neurosurgery, leading to more complex publications that neurosurgeons need to understand to effectively use in practice.
- The authors conducted a literature search for ML studies in neurosurgery and developed a checklist with 14 questions to help readers evaluate ML methodologies and findings.
- With the goal of enhancing neurosurgeons' ability to incorporate ML into their work, the authors emphasize the need for education on ML techniques and the review process.
An expanded role for surgery in grade 3 1p/19q co-deleted oligodendroglioma.
Neurooncol Adv
April 2023
Article Synopsis
- Grade 3 1p/19q co-deleted oligodendroglioma is a rare brain tumor that often progresses and recurs; this study focuses on the effects of repeat surgery on patient survival.
- A cohort of 80 patients treated from 2001 to 2020 showed that those who had a second surgery after progression had better overall survival, while time to progression remained unchanged.
- Key factors linked to higher mortality included a preoperative Karnofsky Performance Status below 80, not achieving gross total resection during initial surgery, and having ongoing neurological deficits post-surgery.