BACKGROUND: The aim of this retrospective study is to analyze a consecutive cohort of brain metastasis (BM) patients treated off clinical trials through combination of surgery and radiotherapy over the last 15 years in a tertiary neurooncology center. MATERIALS AND METHODS: All BM patients operated between 2007-2019 received adjuvant linac-based radiotherapy categorized to whole brain radiotherapy (WBRT) and tumor bed stereotactic radiotherapy. Survival outcomes and local control was analyzed. RESULTS: In total, 118 patients were enrolled, those with stereotactic radiotherapy (41%) had better baseline characteristics mirrored in longer overall survival (OS) [18 vs. 7.1 months, p < 0.001; hazard ratio (HR) 0.47, p = 0.004] with median follow-up of 58 months. Cumulative incidence for local, distant, and extracranial control was not significantly different between groups, with 12-month cumulative control of 22% vs. 18%, 44% vs. 29%, and 35% vs. 32% for stereotactic and WBRT group, respectively. WBRT was an independent factor for better distal brain control. CONCLUSIONS: Real world data demonstrating significantly better overall survival in patients treated with postoperative targeted radiotherapy compared with postoperative WBRT is presented, with no significant difference in cumulative incidence for local or distant brain control. The majority of patients with targeted radiotherapy had a fractionated dose schedule with outcomes comparable to single-dose radiation trials of postoperative targeted radiotherapy.
- Publikační typ
- časopisecké články MeSH
Glioblastoma (GBM) is regarded as an aggressive brain tumor that rarely develops extracranial metastases. Despite well-investigated molecular alterations in GBM, there is a limited understanding of these associated with the metastatic potential. We herein present a case report of a 43-year-old woman with frontal GBM with primitive neuronal component who underwent gross total resection followed by chemoradiation. Five months after surgery, the patient was diagnosed with an intraspinal GBM metastasis. Next-generation sequencing analysis of both the primary and metastatic GBM tissues was performed using the Illumina TruSight Tumor 170 assay. The number of single nucleotide variants observed in the metastatic sample was more than two times higher. Mutations in TP53, PTEN, and RB1 found in the primary and metastatic tissue samples indicated the mesenchymal molecular GBM subtype. Among others, there were two inactivating mutations (Arg1026Ile, Trp1831Ter) detected in the NF1 gene, two novel NOTCH3 variants of unknown significance predicted to be damaging (Pro1505Thr, Cys1099Tyr), one novel ARID1A variant of unknown significance (Arg1046Ser), and one gene fusion of unknown significance, EIF2B5-KIF5B, in the metastatic sample. Based on the literature evidence, the alterations of NF1, NOTCH3, and ARID1A could explain, at least in part, the acquired invasiveness and metastatic potential in this particular GBM case.
- Publikační typ
- kazuistiky MeSH
High-grade gliomas are primary brain tumors with poor prognosis, despite surgical treatment followed by radiotherapy and concomitant chemotherapy. We present two cases of long-term survival in patients treated for high-grade glioma and concomitant prolonged bacterial wound infection. The first patient treated for glioblastoma IDH-wildtype had been without disease progression for 61 months from the first resected recurrence. Despite incomplete chemotherapy-induced myelosuppression in the second patient with anaplastic astrocytoma IDH-mutant, she died without disease relapse after 14 years from the diagnosis due to other comorbidities. We assume that the documented prolonged survival could be related to the bacterial infection.
- Publikační typ
- kazuistiky MeSH
- MeSH
- dospělí MeSH
- gliom diagnostické zobrazování MeSH
- lidé MeSH
- nádory mozku * diagnostické zobrazování MeSH
- pozitronová emisní tomografie metody MeSH
- předoperační vyšetření MeSH
- progrese nemoci MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition associated with the development of early brain injury (EBI) and delayed cerebral ischemia (DCI). Pharmacological treatment of vasospasm following aSAH currently mainly comprises nimodipine administration. In the past few years, many drugs that can potentially benefit cases of subarachnoid hemorrhage have become available. The objective of this review is to critically assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) following aSAH. A systematic literature review was conducted following PRISMA guidelines. The search was aimed at studies addressing aSAH and NSAIDs during the 2010 to 2019 period, and it yielded 13 articles. Following the application of search criteria, they were divided into two groups, one containing 6 clinical articles and the other containing 7 experimental articles on animal models of aSAH. Inflammatory cerebral changes after aneurysm rupture contribute to the development of EBI, DCI and cerebral vasospasm. It appears that NSAIDs (especially coxibs) are even more effective in reducing vasospasm than nimodipine. Other beneficial effects of NSAIDs include reduction in mortality, improved functional outcome and increased hypoaggregability. However, despite these positive effects, there is only one randomized, double-blind, placebo-controlled trial showing a tendency towards a better outcome with lower incidence of vasospasm or mortality in patients following aSAH.
- MeSH
- antiflogistika nesteroidní terapeutické užití MeSH
- dvojitá slepá metoda MeSH
- intrakraniální vazospazmus farmakoterapie etiologie patofyziologie MeSH
- ischemie mozku farmakoterapie etiologie patofyziologie MeSH
- lidé MeSH
- nimodipin terapeutické užití MeSH
- randomizované kontrolované studie jako téma metody MeSH
- subarachnoidální krvácení komplikace farmakoterapie patofyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
Prezentujeme soubor čtyř pacientů s benigním nádorem nervu na horní končetině, které jsme diagnostikovali pomocí sonografie. Ve dvou případech se jednalo o schwannom, u dalších dvou pacientů o intraneurální perineuriom. Klinicky měli pacienti progredující fokální rezistenci v místě předpokládaného průběhu nervu a ve třech případech vykazovali progredující mononeuropatii. Cílem článku je upozornit neurology na sonografii periferních nervů jako vhodnou skríningovou metodu první volby při suspekci na nádor periferního nervového systému. Článek obsahuje základní přehled problematiky a kazuistiky s bohatou obrazovou dokumentací.
We present four cases of patients with benign peripheral nerve tumors in the upper limbs that were diagnosed with ultrasound.Two cases were identified as schwannoma and the other two as intraneural perineurioma. Clinically, the patients had progressivefocal resistance at the site of the presumed course of the nerve, with three of the cases exhibiting progressive neuropathy. The aimof this article is to highlight peripheral nerve ultrasonography as a suitable first-choice screening method for a suspected tumorof the peripheral nervous system. The article includes a basic overview and case studies with abundant pictorial documentation.
- MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- elektromyografie MeSH
- horní končetina diagnostické zobrazování inervace patofyziologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- nádory nervové pochvy diagnóza patologie terapie MeSH
- nádory periferního nervového systému * diagnostické zobrazování diagnóza chirurgie klasifikace MeSH
- neurilemom diagnóza patologie terapie MeSH
- neurofibrom patologie MeSH
- ultrasonografie * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
