Implantation of carmustine wafers (Gliadel ® ) for high-grade glioma treatment. A 9-year nationwide retrospective study
AbstractBackgroundCarmustine wafers (CW) are approved to treat newly or recurrent high-grade gliomas (HGG). Widespread use has been limited regarding some doubtful uncertainties about their efficacy, related increased risk of infection and expensive cost.ObjectiveTo describe the epidemiology of CW implantation, search for related complications, long-term survival and associated prognostic factors.MethodsWe processed the French medico-administrative national database to retrieve appropriate cases operated between 2010 and 2018. A survival analysis was conducted.ResultsWe identified 1659 patients treated in 39 institutions. Median age at CW implantation was 61 years and there was an over-representation of male (63.5%). 491 patients (29.6%) had previous diagnosis of glioma. Time between the first surgery and CW implantation was 0.9 years, IQR[0.6, 1.6]. The frontal lobe was the most frequently involved 29%. 131 patients (7.9%) had to be re operated on f or a complication of which 121 for surgical site infection. At one year, 514 patients (31%) had died. Median overall survival (OS) was 1.4 years,95% CI [1.3, 1.5]. OS at 1 and 2 year was 66%,95%CI [63.7, 68.5], 32.3%,95%CI [29.9, 35]. In the adjusted Cox regression, male gender&age at CW implantation were established as independent factors of OS in all three groups. Patients with recurrent HGG have a significant worse prognosis (HR = 0.71,95% CI [0.62, 0.80]p
This report is of a rare case of glioblastoma, coexisting with a cerebral AVM. A 20-year-old male presented with progressive right hemiparesis within 1 month. Cranial magnetic resonance imaging revealed a large bleeding tumor with surrounding dilated vessels. Cerebral angiography demonstrated a left frontal AVM with a 1.2 cm nidus. The patient underwent preoperative embolization and radical resection. The coincidence of glioma and AVM was a rare association. However, the concept of hypervascular glioblastoma has been used in different states from different literature reviews; therefore, the role of proangiogenic factors should be addressed
Conclusion : Stereotactic biopsy is a less invasive procedure for obtaining samples of brain tumors for diagnosis. The bleeding of the tissue-resection cavity that includes asymptomatic hemorrhage occurs at a constant rate. It is important to reduce the symptomatic bleeding associated with stereotactic biopsy. J. Med. Invest. 66 : 314-318, August, 2019. PMID: 31656296 [PubMed - in process]
CONCLUSION: We found increased VEGF and PDGF serum levels in CNS patient's tumor. A different role for PDGF was found in the pathogenesis of neovascularization of meningioma, as well as oligodendroglioma. No significant result was found for FGF. TNF-α and IL-1β can serve as key prognostic biomarker in high-grade glioma and meningioma patients. PMID: 31653130 [PubMed - in process]
ConclusionsAccording to our data, ICH occurred in nearly 20% anticoagulated patients with HGG, as described in literature, and did not correlate with poorer prognosis. High ECOG performance status was an independent risk factor for ICH. Further effort towards better prediction models for VTE and ICH in HGG is warranted.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureAll authors have declared no conflicts of interest.
ConclusionsStereotactic frameless biopsy is a safe, feasible, and fast procedure to obtain a histological and molecular diagnosis.
ConclusionsConcomitant treatment with RT and nimotuzumab was feasible in an outpatient setting. The PFS and OS were comparable to results achieved with RT and intensive chemotherapy in hospitalized setting.
Conclusion: This unedited video offers all detailed aspects that are, as the senior author JH considers, essential for a neurosurgeon when performing an efficient and safe surgery for a large PA in the posterior fossa. Videolink: http://surgicalneurologyint.com/videogallery/cerebellar-tumor. PMID: 30595956 [PubMed]
This study represents the first assessment of VTE-associated health care burden specific to primary brain cancer. We confirm that VTE affects a large number of patients with MG (27%) and limits the time spent at home due to increased hospitalizations and emergency room visits. VTE may be a preventable complication and further studies are needed to investigate safe prevention strategies for patients with MG.DisclosuresNo relevant conflicts of interest to declare.
CONCLUSION: By reviewing the literature and discussing the critical interaction between valproate sodium and warfarin, we conclude that intravenous VPA and the co-administrated warfarin may develop critical but underrecognized complications due to effects on the function of hepatic enzymes and displacement of protein binding sites. PMID: 30285858 [PubMed - in process]
Publication date: July 2018Source: Journal of Clinical Neuroscience, Volume 53Author(s): Christopher Beynon, Shilai Wei, Alexander Radbruch, David Capper, Andreas W. Unterberg, Karl L. KieningAbstractParenchymal hemorrhage is considered a major risk factor for perioperative morbidity in patients undergoing stereotactic brain biopsy. Studies on patients undergoing surgical procedures have suggested that evaluation of prothrombin time (PT) and activated partial thromboplastin time (aPTT) is of limited value with regard to prevention of haemorrhagic complications. However, this issue has not yet been addressed in patients und...