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Radical resection and diagnostic methods in gliomas:  review article
Ahmadii R, Esmaeilzadeh M, Unterberg A,
Volume 67, Issue 4 (7-2009)
Abstract

Gliomas include a group of primary central nervous system (CNS) neoplasms with characteristics of neuroglial cells (eg, astrocytes, oligodendrocytes). The gliomas are classified commonly to WHO grade I-IV gliomas. The grading is based on the presence of nuclear atypia, vascular proliferation, mitoses, and necrosis. The malignant gliomas are progressive brain tumors that are divided into anaplastic gliomas and glioblastoma based upon their histopathologic features. Today, different modalities such as surgery, radiation therapy (in the form of external beam radiation or the stereotactic approach using radiosurgery) and chemotherapy have been used for the treatment of gliom's tomors but unfortunately the prognosis and survival rate is poor in most of patients. The survival depends on the tumor's type, size, location and the patient's age. We reviewed the prognostic factors, diagnostic modalities and surgical management of patients with gliomas.


Automatic segmentation of glioma tumors from BraTS 2018 challenge dataset using a 2D U-Net network
Zahra Papi , Iraj Abedi, Fatemeh Dalvand, Alireza Amouheidari,
Volume 80, Issue 4 (7-2022)
Abstract
Background: Glioma is the most common primary brain tumor, and early detection of tumors is important in the treatment planning for the patient. The precise segmentation of the tumor and intratumoral areas on the MRI by a radiologist is the first step in the diagnosis, which, in addition to the consuming time, can also receive different diagnoses from different physicians. The aim of this study was to provide an automated method for segmenting the tumor and intratumoral areas.
Methods: This is a fundamental-applied study that was conducted from May 2020 to September 2021 using multimodal MRI images of 285 patients with glioma tumors from the BraTS 2018 Database. This database was collected from 19 different MRI imaging centers, including multimodal MRI images of 210 HGG patients, and 75 LGG patients. In this study, a 2D U-Net architecture was designed with a patch-based method for training, which comprises an encoding path for feature extraction and a symmetrical decoding path. The training of this network was performed in three separate stages, using data from high-grade gliomas (HGG), and low-grade gliomas (LGG), and combining two groups of 210, 75, and 220 patients, respectively.
Results: The proposed model estimated the Dice Similarity Coefficient (DSC) results in HGG datasets 0.85, 0.85, 0.77, LGG datasets 0.80, 0.66, 0.51, and the combination of the two groups 0.88, 0.79, 0.77 for regions the whole tumor, tumor core, and enhancing region in the training dataset, respectively. The results related to Hussdorf Distance (HD) for HGG datasets were 8.24, 9.92, 4.43, LGG datasets 11.5, 11.31, 2.23, and the combination of the two groups 7.20, 8.82, 4.43 for regions the whole tumor, tumor core, and enhancing region in the training dataset, respectively.
Conclusion: Using the U-Net network can help physicians in the accurate segmentation of the tumor and its various areas, as well as increase the survival rate of these patients and improve their quality of life through accurate diagnosis and early treatment.

An evaluation of treatment volume coverage and dose delivered to vital organs in the management of low-grade brain gliomas using three-dimensional conformal radiotherapy (3DCRT) compared to intensity-modulated radiation therapy (IMRT)
Reza Ghalehtaki, Mahdieh Razmkhah, Ali Kazemian, Mostafa Farzin, Samaneh Salarvand, Kasra Kolahdouzan, Ehsan Saraee,
Volume 82, Issue 10 (1-2025)
Abstract
Background: Gliomas are the most common primary brain tumors in adults, with low-grade gliomas making up 15% of cases. These slow-growing tumors often occur in young adults. Radiotherapy is one of the treatment options. New radiotherapy techniques like IMRT may reduce complications by sparing normal tissue. The study aims to determine which tumors benefit most from IMRT based on tumor location and size.
Methods: Patients diagnosed with low-grade glioma who were referred for treatment at the Cancer Institute of Imam Khomeini Hospital between September 2017 and September 2020 were included in this study. All patients underwent CT simulation with a thermoplastic mask for immobilization. A diagnostic MRI (performed within two weeks prior) was fused with the planning CT to define the target volume (GTV/CTV), with contours verified by a neuroradiologist. A doctor outlines the treatment volume and critical organs for both 3D and IMRT techniques. Radiotherapy physics experts design treatment plans using both techniques, which are then approved by a radiation oncologist. The treatment volume coverage and doses to critical organs are compared between the two techniques.
Results: Among 25 patients, 14 patients (56%) with single-lobe involvement, 7 (28%) with two lobes, and 4 (16%) with multifocal disease. Right-side brain involvement was seen in 32%, with the frontal lobe most affected. IMRT significantly reduced the mean and maximum cochlear dose on the treatment side in all patients. It also lowered the mean chiasma dose in those with both lobes involved and reduced cochlear dose on the opposite side in frontal lobe cases. No significant difference was found between the techniques for patients with multiple lobe involvement.
Conclusion: According to our study on 25 patients with low-grade glioma, it was shown that there is no clear difference between the two techniques. Given the young age and long survival of LGG patients, IMRT may be preferred when hearing preservation is a priority. Further studies with larger cohorts are needed to confirm these findings.

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