Impact of Early Reoperation on the Prognosis of Patients Operated on for Glioblastoma.

BACKGROUND: The prognosis for patients with glioblastoma depends particularly on the degree of tumor resection. Patients with tumor remnants in postsurgical magnetic resonance imaging (<72 hours) may benefit from early reoperation. We present our results concerning the impact on overall survival (OS) and progression-free survival (PFS) of reoperation in patients who have already undergone surgery for glioblastoma. METHODS: This study included all patients who had undergone surgery for glioblastoma with control magnetic resonance imaging, who received adjuvant therapy as per the Stupp protocol, with a minimum follow-up of 24 months. We recorded the number of complete resections, partial resections, and early reoperations. We determined the impact on OS and PFS of the early reoperations and the functional status. We considered complete resection when the volume of the residual tumor was 0 cm3. RESULTS: A total of 112 patients were diagnosed with glioblastoma between March 2014 and March 2017. The study included 58 patients who fulfilled all the inclusion criteria. Complete resection was achieved in 24 patients (41.4%) and partial resection in 34 (58.6%). Of these 34 patients, 11 (32.35%) underwent early reoperation. The final result was complete resection in 58.62% of the patients. In the patients who underwent reoperation, OS and PFS were 30.3 months and 16.6 months compared with 12.7 months and 6.75 months in those without reoperation (P = 0.013 and P = 0.012). The functional prognosis was similar between the 2 groups. CONCLUSIONS: Early reoperation in patients with residual tumor improved OS and PFS without increasing the number of complications compared with the patients who did not undergo reoperation.

LINAC radiosurgery treatment for vestibular schwannoma / Tratamiento con radiocirugía micromultiláminas de schwannomas vestibulares

Objective: The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. Material and methods: This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. Results: The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). Conclusions: In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression

Objetivo: Los objetivos del estudio fueron evaluar la respuesta tumoral en una serie de pacientes con schwannoma vestibular (SV) tratados con radiocirugía (RC) mediante acelerador lineal de electrones (LINAC), describir las complicaciones y analizar las variables relacionadas con la respuesta al tratamiento. Material y métodos: Estudio descriptivo retrospectivo de 64 pacientes tratados entre 2010-2016 con seguimiento mínimo de un año, excluyendo pacientes con neurofibromatosis. Se evaluaron parámetros clínico-radiológicos. El tratamiento se realizó mediante RC-LINAC. La dosis prescrita fue de 12Gy al 90% de isodosis. Resultados: La edad media al tratamiento fue de 53 años, 56% mujeres. El 98% de los pacientes presentaban hipoacusia, el 71% grado iii según la clasificación Gardner-Robertson. El volumen medio al tratamiento fue de 2,92cc, y la media de seguimiento 40,95 meses. El éxito terapéutico global fue del 90% siendo del 100% a los 12 y 24 meses y del 86% a partir de los 36 meses de seguimiento. El resultado radiológico se relacionaba con el volumen tumoral inicial (p<0,037). En 20 pacientes se evidenció un crecimiento tumoral transitorio compatible con seudoprogresión. El 37,5% tuvieron complicaciones agudas siendo transitorias el 50%. Se recogieron complicaciones crónicas en el 20%, siendo permanentes en el 84%. La tasa de complicaciones agudas era menor en pacientes con regresión (p<0,016). Las complicaciones crónicas fueron más frecuentes en el grupo de 41-60 años (p<0,040). Conclusiones: En nuestra serie, el control tumoral global obtenido es acorde con otras series publicadas. El resultado radiológico estaba relacionado con el volumen tumoral inicial al tratamiento. La tasa de complicaciones agudas fue menor en pacientes con regresión

LINAC radiosurgery treatment for vestibular schwannoma.

OBJECTIVE: The aims of our study were to evaluate tumour response in a series of patients with vestibular schwannoma (VS) treated with linear accelerator stereotactic radiosurgery (LINAC-RS), to describe the complications and to analyze the variables associated with the response to treatment. MATERIAL AND METHODS: This retrospective descriptive study included 64 patients treated from 2010 to 2016 with a minimum follow-up of one year, excluding patients with neurofibromatosis. Clinical-radiological parameters were evaluated. The treatment was performed using LINAC-RS. The prescribed dose was 12Gy at 90% isodose. RESULTS: The mean age at treatment was 53 years, 56% were women. Ninety-eight percent of the patients had hearing loss, 71% with grade III according to the Gardner-Robertson Classification. The mean volume at treatment was 2.92cc and the mean follow-up, 40.95 months. The overall therapeutic success was 90%, reaching 100% at 12 and 24 months, and 86% after 36 months of follow-up. The radiological result was significantly related to the initial tumour volume (p<0.037). In 20 patients there was evidence of transient tumour growth compatible with pseudoprogression. Acute complications were present in 37.5%, and transitory complications in 50%. Chronic complications were found in 20%, with 84% being permanent. The rate of acute complications was lower in patients with regression (p<0.016). Chronic complications were more frequent in the 41-60 year old age group (p<0.040). CONCLUSIONS: In our study, the overall tumour control was in accordance with other published series. The radiological result significantly related to the tumour volume at the commencement of treatment. The rate of acute complications was lower in patients with regression.

Primary cerebral malignant melanoma in insular region with extracranial metastasis: case report and review literature.

BACKGROUND: Primary brain melanomas are very infrequent and metastasis outside central nervous system very uncommon. There are some cases in the literature about primary melanoma in the temporal lobe; nevertheless, the insular location has never been described. CASE PRESENTATION: The patient presented as left insular intraparenchymal hematoma with multiple bleedings. Complementary tests did not show any tumoral nor vascular pattern in relation with these bleedings. A complete surgical resection was performed, and the diagnosis of malignant melanoma, with BRAF mutation, was obtained after histology exam. Extension studies were negative for skin or mucous melanoma. 18F-FDG PET/CT was performed and a metastatic lymph node was found. The diagnosis was primary brain melanoma with extracerebral metastasis. Dabrafenib 150 mg/12 h was the only chemotherapy during 5 months. After that, Trametinib 2 mg/24 h was added to the treatment. Eighteen months after surgery, the patient is independent, with stable situation, and without new metastasis. CONCLUSIONS: Although malignant melanomas have poor prognosis, total surgical resection and new therapies are increasing the overall survival and improving quality of life. In a patient with suspected brain melanoma, in spite of having extracerebral metastasis, aggressive treatment may be considered.

Complicaciones y pronóstico de pacientes ancianos diagnosticados de meningioma intracraneal / Complications and outcomes in the elderly with intracranial meningioma

Objetivo. El tratamiento quirúrgico de los pacientes mayores de 70 años diagnosticados de meningioma intracraneal se plantea como una controversia. Los estudios muestran resultados dispares en cuanto al riesgo-beneficio de la cirugía. Nuestro objetivo es identificar las complicaciones posquirúrgicas y el pronóstico funcional en pacientes mayores de 70 años intervenidos de meningioma intracraneal. Método. Realizamos una revisión retrospectiva entre enero de 2010 y marzo de 2014 de pacientes ancianos diagnosticados de meningioma. Análisis descriptivo de la incidencia de complicaciones posquirúrgicas y la existencia de factores de riesgo para la aparición de las mismas. Analizamos la evolución a corto y largo plazo mediante la Glasgow Outcome Scale y el Karnofsky, respectivamente. Comparamos, por un lado, pacientes ≥ 70 años operados con ≥ 70 años manejados de forma conservadora. Por otro lado, comparamos las complicaciones posquirúrgicas entre los operados ≥ 70 años con operados < 70 años. Resultados. Cuarenta y ocho pacientes mayores de 70 años fueron diagnosticados de meningioma intracraneal. Treinta y siete se intervinieron y 11 se manejaron de forma conservadora. No existen diferencias significativas (p = 0,39) entre operados y no operados en cuanto al estado funcional neurológico al alta (Glasgow Outcome Scale 5 67,6 vs. 72,2%, respectivamente). No se aprecian diferencias a los 6 meses entre ambos grupos, manteniendo la misma puntuación Karnofsky o descendiendo 10 puntos en la mayoría de los casos (p = 0,486). En cuanto a las complicaciones posquirúrgicas precoces y tardías, no existen diferencias significativas entre menores y mayores de 70 años intervenidos (p = 0,64 y p = 0,23, respectivamente). Conclusión. A pesar de que la edad debe ser un factor a tener en cuenta, este no debe ser limitante a la hora de indicar una cirugía, ya que, según nuestra serie, no existen diferencias estadísticamente significativas en cuanto al pronóstico funcional respecto a los ancianos no intervenidos, ni existe mayor tasa de complicaciones respecto al grupo menor de 70 años (AU)

Object. Surgical treatment in patients older than 70 years old with intracranial meningioma is still subject to controversy. The benefit/risk ratio of this surgery has not been assessed due to the lack of objective criteria. The aim of this study is to assess the surgical complications and outcomes in elderly patients in our centre. Method. A retrospective analysis was performed on patients with intracranial meningioma between January 2010 and March 2014. The incidence of post-surgical complications, as well as their associated risk factors, was also analysed. Functional outcomes were compared with Glasgow Outcome Scale and Karnofsky index with those who underwent surgery and those with conservative management. Finally, a comparison was made between patients younger than 70 years old operated on for intracranial meningioma. Results. A total of 48 patients diagnosed with intracranial meningioma older than 70 years old, of which 37 were operated on and 11 were followed up with conservative management. There were no differences between the groups in neurological status at discharge (Glasgow Outcome Scale 5 67.6 vs. 72.2%, respectively). No differences were observed in functional outcome during 6 months of follow up in the Karnofsky index between surgical and non-surgical patients (P = .486). In the comparison between older and younger than 70 years old, there were no differences in the incidence of surgical complications (P = .64 in early complications and P = .23 in late complications). Conclusion. The results of the present study suggest that age should not be a limitation in surgical indications in patients older than 70 years old with intracranial meningioma. No statistical differences were found in functional status compared with conservative management or in surgical complications between younger and elderly patients (AU)

[Complications and outcomes in the elderly with intracranial meningioma]. / Complicaciones y pronóstico de pacientes ancianos diagnosticados de meningioma intracraneal.

OBJECT: Surgical treatment in patients older than 70 years old with intracranial meningioma is still subject to controversy. The benefit/risk ratio of this surgery has not been assessed due to the lack of objective criteria. The aim of this study is to assess the surgical complications and outcomes in elderly patients in our centre. METHOD: A retrospective analysis was performed on patients with intracranial meningioma between January 2010 and March 2014. The incidence of post-surgical complications, as well as their associated risk factors, was also analysed. Functional outcomes were compared with Glasgow Outcome Scale and Karnofsky index with those who underwent surgery and those with conservative management. Finally, a comparison was made between patients younger than 70 years old operated on for intracranial meningioma. RESULTS: A total of 48 patients diagnosed with intracranial meningioma older than 70 years old, of which 37 were operated on and 11 were followed up with conservative management. There were no differences between the groups in neurological status at discharge (Glasgow Outcome Scale 5 67.6 vs. 72.2%, respectively). No differences were observed in functional outcome during 6 months of follow up in the Karnofsky index between surgical and non-surgical patients (P=.486). In the comparison between older and younger than 70 years old, there were no differences in the incidence of surgical complications (P=.64 in early complications and P=.23 in late complications). CONCLUSION: The results of the present study suggest that age should not be a limitation in surgical indications in patients older than 70 years old with intracranial meningioma. No statistical differences were found in functional status compared with conservative management or in surgical complications between younger and elderly patients.