Clinical course of high-grade glioma patients with a "biopsy-only" surgical approach: a need for individualised treatment.

INTRODUCTION: 'Biopsy-only' high-grade glioma (HGG) patients get limited benefit from post-operative treatments, and as a group, negatively impact median survival outcomes. MATERIAL AND METHODS: We retrospectively evaluated clinical characteristics, treatment and overall survival of HGG patients with a 'biopsy- only' surgical approach diagnosed between 1997 and 2005 at a University Hospital in Spain. RESULTS: In 31% of 294 suspected gliomas, only a diagnostic biopsy was undertaken. Reasons for 'biopsy-only' for all patients were either location in eloquent areas: (motor area 18.7%, language area 25,3%, basal ganglia 7.7%, visual area 4.4%) or extension of the disease (corpus callosum invasion 14.3% and multicentricity/multifocality 28.6%). Seventy-four patients (80.4%) were HGG: 26% of all grade IV and 49% of all grade III tumours. For these patients, post-operative Karnofsky Performance Status of over 70%, median age and median survival were, respectively: 64 and 70%, 60.7 and 57 years old, and 23.1 and 42.7 weeks (p=0.0006). Patients lived longer if post-operative treatment was given, in all grades (p<0.0001). Nineteen patients (25.6%) died within 42 days after surgery. Only 60% of them initiated radiotherapy and 10% of them did not complete it. However, tumour grade, radiotherapy and temozolomide- based chemotherapy were independently associated with longer survival in multivariate analysis (p<0.05). CONCLUSION: Almost one third of HGG patients can undergo only a biopsy and not debulking surgery. Although radiotherapy improves survival, only 50% of them complete the treatment. An individualised approach to these patients is needed to facilitate a correct analysis of therapy results. New therapies must be investigated in these patients.

Medulloblastoma in young adults. Must we give adjuvant chemotherapy?

Medulloblastoma is a rare entity in adult patients. All data about treatment are from children, where this disease is the most common cerebral tumour. Reports of medulloblastoma in adults are scarce but in all of them the prognosis seems similar to the prognosis of children. We present our experience in five cases of medulloblastoma in young adults, treated at the University Hospital "Germans Trias i Pujol" from June 1994 to October 2003. This has not been a good experience as more than 50% of the patients had a recurrence in spite of the standard treatment. We have reviewed the literature, concluding that we have to adapt the findings in children to our adult patients, offering them adjuvant chemotherapy after surgery.

Development of a rat model of spinal cord injury and cellular transplantation.

BACKGROUND AND PURPOSE: Intravenously or intraspinally delivered human umbilical cord blood (UCB) cells and mesenchymal stem cells have been previously shown to improve the functional recovery of spinal cord-injured rats. Obtaining an animal model in the laboratory setting is critical for the development of experimental therapies. We have established a rat model of spinal cord injury (SCI) with basic histological and functional evaluations, ready to use for cell transplantation experiments. METHODS: In the first phase 10 Sprague-Dawley (SD) rats were used to standardize the laminectomy at D9-D10 without secondary lesions. In a second phase, 28 SD rats were laminectomized and injured at D9 by spinal cord compression for 3 to 5 seconds with an aneurysmal clip. Open-field behavior was assessed at days 2 and 7 postoperatively, and weekly until their sacrifice, using the Basso, Beattie, and Bresnahan locomotor rating scale. Two weeks postinjury, 14 immunosuppressed rats received a double intraspinal cell transplant of previously frozen UCB mononuclear cells (MNCs). Using a Hamilton syringe, 2.5 x 10(5) unlabelled MNCs in 10 microL medium were transplanted, rostrally and caudally to the lesion site. Rats were sacrificed at 4 weeks posttransplant by transcardial perfusion with 4% paraformaldehyde, and spinal cords were dissected and further fixated for histological analysis. RESULTS: No wound infections were observed. Thirteen rats developed urinary tract infections and two animals showed autophagia grade 3. We observed a common spontaneous mobility improvement until a certain limit, depending on the degree of lesion and intrinsic characteristics of the animal. CONCLUSIONS: An animal model of SCI has been established. Critical parameters in the survival and correct functional analysis are continuous animal care postinjury, urinary tract infections, autophagia, and weight loss. In addition, electrophysiological measures might be necessary to properly assess functional modifications.