Systemic management of malignant meningiomas: A comparative survival and molecular marker analysis between Octreotide in combination with Everolimus and Sunitinib.

PURPOSE: To compare the effectiveness of octreotide/everolimus vs. sunitinib for the systemic treatment of recurrent aggressive meningiomas. METHODS: 31 patients with recurrent or refractory WHO II or WHO III meningiomas were examined in two reference centers in Colombia. Patients who had systemic treatment (sunitinib, everolimus/octreotide) and a complete follow-up were included. Overall survival (OS), progression-free survival (PFS) and toxicities were evaluated. Additionally, tissue samples were examined for PDGFRß and VEGFR2, their expression was correlated with outcomes. RESULTS: Twenty-two patients (72%) were female with a median age of 55 years (SD±15.3). The most prevalent histology was anaplastic meningioma in 20 patients (65%) with 48% of patients suffering from three previous relapses before the start of systemic treatment. A total of 14 patients received combination therapy with octreotide/everolimus, 11 received sunitinib and the remaining 6 received other second-line agents. Median OS was 37.3 months (95%CI 28.5-42.1) and the PFS during the treatment with everolimus/octreotide (EO) and sunitinib (Su) was 12.1 months (95%CI 9.2-21.1) and 9.1 months (95%CI 6.8-16.8); p = 0.43), respectively. The OS of the group treated with the EO→Su→Bev sequence (1st/2nd/3rd line) was 6.5 months longer than the Su→EO→Bev sequence (36.0 vs. 29.5 months) (p = 0.0001). When analyzing molecular markers, the positive PDGFRß and negative VEGFR2 expression were associated with longer survival both in OS and PFS. CONCLUSION: Sunitinib and octreotide/everolimus have similar efficacy and safety in the systemic management of refractory meningioma. VEGFR2 and PDGFRß expression are associated with better outcomes.

[Hormonal dysfunction of nonpituitary lesions from midline and perisellar area]. / Disfunção hormonal em lesões não hipofisárias das regiões selar e periselar.

OBJECTIVE: To analyse clinical and/or laboratorial preoperative hormonal dysfunction, of the nonpituitary intracranial lesions from midline and parasellar area. METHOD: Forty-four patients were evaluated with nonpituitary intracranial lesions, who had images studies (computed tomography or magnetic resonance) and preoperative basal hormonal level; 16 had preoperative hypothalamus-hypophysial function tests (megatests). These patients were divided in two groups. Group I - 34 lesions from midline: 11 craniopharyngiomas, 8 meningiomas, 3 germinomas, 3 tumors of sphenoid sinus, 2 empty sella syndrome, 2 pylocitic astrocytomas, 1 giant aneurysm, 2 mucoceles, 1 III ventricle diverticulum and 1 Rathke's cleft cyst; Group II - 10 lesions from parasellar area: 9 meningiomas and 1 giant aneurysm. RESULTS: In group I, 25/34 (73.5%) patients showed laboratorial hormonal deficit (14 without clinical manifestations) 18/34 (52.9%) hyperprolactinemia (5 with galactorreia) and 8 (53.3%) showed growth hormone deficiency in 15 megatests available in this group; 3 (8.8 %) patients presented central diabetes insipidus (CDI). In group II, 6/10 (60%) patients showed laboratorial hormonal deficit (5 without clinical manifestations), 1 (10%) hyperprolactinemia and 1 growth hormone deficiency (single megatest realized in this group); no patient had preoperative CID. CONCLUSIONS: The presence of nonspecific or poorly valorized clinical manifestations, does not indicate absence of hormonal dysfunction; in this present serie, 19/38 (50%) patients with laboratorial abnormalities, didn't show clinical manifestations. Hormonal dysfunction is frequent in sellar and perisellar nonpituitary lesions, specially involving midline.

Estudo da fibrinólise em meningeomas / Study of fibrinolysis in meningiomas

Neste trabalho apresentamos os parâmetros da hemostasia em 3 pacientes com diagnóstico de meningeomas intracranianos, submetidos a craniotomia e exérese completa do tumor. A análise foi feita antes da cirurgia, durante a exérese do tumor, no primeiro dia do pós-operatório e após o trigésimo dia da cirurgia. Foram dosados os seguintes parâmetros: Tempo de Protrombina (TP), Tempo de Tromboplastina Parcial Ativado (TTPA), Tempo de Trombina (TT), Plaquetas (PQ), Alfa-2-Macroglobulina (A2MC), C 1 inibidor (C1), Antitrombina III (AT III), Fator V (FV), Fibrinogênio (FIBR), Plasminogênio (PLASM), area de Lise em Placa de Fibrina (ALPF), Produto de Degradaçäo da Fibrina e Fibrinogênio (PDF), Procalicreina Plasmática (PK) e Pr'e-Albumina (PRE ALB). Este estudo demonstrou a ocorrência de fibrinólise no intraoperatório e primeiro dia do pós-operatório de intensidade variável para cada paciente. Sugerimos, com base neste trabalho e revisäo da literatura que, durante o manuseio dos meningeomas, ocorrendo grande sangramento que näo se justifique por lesöes de grandes vasos, se deva fazer uso de drogas inibidoras da plasmina (Acido tranexâmico, Gabaxate, Acido Epsilon Amino Caproico)