When the tumor shifts from epithelial towards mesenchymel features, then the tumor becomes more aggressive with infiltration and invasion as most important problem. At that time the cells are less proliferative so that some chemotherapies and radiotherapy will have less effect. At best this EMT is to be blocked. That is why the current concept is of high value.
Thank you! Am I correct in assuming that this would be the behaviour illustrated in the embedded time-lapse sequence here?http://www.sciencedirect.com/science/article/pii/S001448271630218X?via%3Dihub
Reading this makes me a bit stressed out regarding my upcoming (second) surgery. Should the EMT aspect stop me from going into a surgery that "could" be delayed? We are talking about a grade 2 Astrocytoma. Is the "risk" of EMT stronger or weaker than the benefits of removing as much of the tumor as possible? If anyone has answers that would be great!
Gross total resection of a low grade glioma is probably the single most important treatment responsible for prolonging survival. The benefits of removing as much of the tumor as possible outweighs the risk of EMT.
Where do you live? It could be worthwhile looking into "supratotal resection" as practised by Hugues Duffau in France.
http://www.sciencedirect.com.sci-hub.cc/science/article/pii/S0028377016301333 Supratotal resection of diffuse gliomas – an overview of its multifaceted implications
Identifying clinical risk in low grade gliomas and appropriate treatment strategies, with special emphasis on the role of surgery http://www.tandfonline.com.sci-hub.cc/doi/pdf/10.1080/14737140.2017.1342537?needAccess=true
Hi Stephen, thanks for the replies. Yeah, that is my belief, as well as going for a second surgery earlier rather than later to avoid having the accidental remaining cell mutating to more agressive between now and... later. I know about supratotal resection and my neurosurgeon is one of Duffau's disciples (cited in the latest publication you have linked to) :), so I know that at least on the surgery side of things. Regarding supratotal resection we've done the most on one side of the tumor, which is right against the motor area, so we cannot really dig any deeper there, but yes, if we could go supratotal in the rest of the tumor's surroundings, that would be great. I was just reading that thing about EMT, making me weigh the benefits of it all mixed together, as I had never read about it before.
Thanks again, also for the publication, which I've browsed through and mostly confirms what we had read before, except something that is quite new regarding "wait and watch" being obsolete. Which is quite comforting for a surgery due in 2 weeks, making me want even more to get as much out right now in this second surgery :).
Could you explain the significance of the transition?
ReplyDeleteThan you!
When the tumor shifts from epithelial towards mesenchymel features, then the tumor becomes more aggressive with infiltration and invasion as most important problem. At that time the cells are less proliferative so that some chemotherapies and radiotherapy will have less effect. At best this EMT is to be blocked. That is why the current concept is of high value.
DeleteThank you! Am I correct in assuming that this would be the behaviour illustrated in the embedded time-lapse sequence here?http://www.sciencedirect.com/science/article/pii/S001448271630218X?via%3Dihub
DeleteDo you have idea what stage is this anti- EMT application?
ReplyDeleteThank you
Luyeza
Reading this makes me a bit stressed out regarding my upcoming (second) surgery.
ReplyDeleteShould the EMT aspect stop me from going into a surgery that "could" be delayed?
We are talking about a grade 2 Astrocytoma.
Is the "risk" of EMT stronger or weaker than the benefits of removing as much of the tumor as possible? If anyone has answers that would be great!
Gross total resection of a low grade glioma is probably the single most important treatment responsible for prolonging survival. The benefits of removing as much of the tumor as possible outweighs the risk of EMT.
DeleteWhere do you live? It could be worthwhile looking into "supratotal resection" as practised by Hugues Duffau in France.
Deletehttp://www.sciencedirect.com.sci-hub.cc/science/article/pii/S0028377016301333
Supratotal resection of diffuse gliomas – an overview of its multifaceted implications
An even more recent publication by Duffau:
DeleteIdentifying clinical risk in low grade gliomas and appropriate treatment strategies, with special emphasis on the role of surgery
http://www.tandfonline.com.sci-hub.cc/doi/pdf/10.1080/14737140.2017.1342537?needAccess=true
Hi Stephen, thanks for the replies.
DeleteYeah, that is my belief, as well as going for a second surgery earlier rather than later to avoid having the accidental remaining cell mutating to more agressive between now and... later.
I know about supratotal resection and my neurosurgeon is one of Duffau's disciples (cited in the latest publication you have linked to) :), so I know that at least on the surgery side of things.
Regarding supratotal resection we've done the most on one side of the tumor, which is right against the motor area, so we cannot really dig any deeper there, but yes, if we could go supratotal in the rest of the tumor's surroundings, that would be great.
I was just reading that thing about EMT, making me weigh the benefits of it all mixed together, as I had never read about it before.
Thanks again, also for the publication, which I've browsed through and mostly confirms what we had read before, except something that is quite new regarding "wait and watch" being obsolete. Which is quite comforting for a surgery due in 2 weeks, making me want even more to get as much out right now in this second surgery :).
Another CUSP9 sibling published by Richard Kast (father of CUSP9). This one is called ADZT, designed for use with bevacizumab (Avastin).
ReplyDeletehttps://www.ncbi.nlm.nih.gov/pubmed/30274295 (pubmed abstract)
http://sci-hub.tw/10.3390/medsci6040084 (PDF download)