Autorët: |
Gentian Kaloshi, Ermir Roci, Arben Rroji, Francois Ducray, Mentor Petrela |
Object
The aim of this study was to evaluate the impact of CCNU chemotherapy alone on low-grade glioma (LGG) growth dynamics.
Methods
The authors measured the evolution of the mean tumor diameter (MTD) in adult patients with LGG before (n = 28 patients) and after (n = 38 patients) CCNU administration.
Results
Natural (spontaneous) growth of LGG in the present study was 4.3 mm/year (range 2.1–6.6 mm/year). The median MTD decrease after CCNU was 5.1 mm/year (range 1–8.9 mm/year). MTD decrease was noted in 30 patients (late decrease in 4 patients, and ongoing decrease in 24 patients with oligodendroglial tumors and 2 with astrocytic tumors).
The median duration it took for the MTD to decrease after initiation of CCNU treatment was 619 days (1038 days for oligodendroglial tumors vs 377 days for astrocytic tumors; p = 0.003).
Conclusion
These results show that CCNU as a single agent has a significant impact on LGG tumor growth. The impact of CCNU seems to be comparable to the previously reported impact of temozolomide therapy and of combined procarbazine, CCNU, and vincristine chemotherapy.
Artikull i botuar në “JNS, Journal of Neurosurgery”, Revista e Neurokirurgjisë, botim i AANS (American Association of Neurological Surgeons), 2015.
Copyright © 2015
Background
Stereotactic radiosurgery (SRS) is considered to be a relatively safe procedure in cerebral arteriovenous malformation management. There are very few reported cases of SRS-associated/induced malignancies.
Methods
We show the case of a 21-year-old female who presented with a 21-mm3 ruptured AVM in the right mesial frontocallosal region. Embolization and/or radiosurgery was proposed. She preferred radiosurgery. The AVM was treated with CyberKnife® SRS.
Results
She presented behavior changes 6 years after SRS. MRI showed a right subcortical frontal lesion with increased perfusion, more consistent with high-grade glioma. The lesion’s center was within the irradiated region of the previous SRS, having received an estimated radiation dose of 4 Gy. Pathological examination noted a hypercellular tumor showing astrocytic tumor cells with moderate pleomorphism in a fibrillary background, endothelial proliferation, and tumor necrosis surrounded by perinecrotic pseudopalisades. Numerous mitotic figures were seen. The appearances were those of glioblastoma, WHO grade IV, with neuronal differentiation. SRS-associated/-induced GBM after treatment of a large AM is exceptional. SRS-associated/-induced malignancies are mostly GBMs and occur on average after a latency of 9.4 years, within very low-dose peripheral regions as well as the full-dose regions; 33.3 % of patients were under 20 years at the time of SRS, and in 66 % the lesion treated was a vascular pathology.
Conclusion
Although it is unlikely that the risk of radiation induced cancer will change the current standard of practice, patients must be warned of this potential possibility before treatment.
Ky Artikull është botuar në “ACTA Neurochirurgica”, Revista Europiane e Neurokirurgjisë,
botim i EANS (Europian Association of Neurosurgical Societies), me faktor impakti 1.78 (2013).
Copyright © 2015