Neurosurgical management of recurrences in low grade glioma
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Transcript of Neurosurgical management of recurrences in low grade glioma
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NEUROSURGICALNEUROSURGICAL
GRADE GLIOMAGRADE GLIOMA
Ass Prof. Gorgan Mircea MD, PhD, Neacsu Angela MD,Ass Prof. Gorgan Mircea MD, PhD, Neacsu Angela MD,Bucur Narcisa MD,PhD,Bucur Narcisa MD,PhD,
Diaconu Nicoleta MD, Pruna Viorel MD, Craciunas Sorin MD,Diaconu Nicoleta MD, Pruna Viorel MD, Craciunas Sorin MD,
First Neurosurgical ClinicFirst Neurosurgical Clinic
Clinic Emergency Hospital "BagdasarClinic Emergency Hospital "Bagdasar-- Arseni" BucharestArseni" Bucharest
Sinaia, September 2006Sinaia, September 2006
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LOW GRADE GLIOMALOW GRADE GLIOMA
NONO YESYES
PALEATIVPALEATIV
TREATMENTTREATMENT
NONO
BIOPSYBIOPSY
YESYES
HISTOLOGICALHISTOLOGICAL
DIAGNOSTICDIAGNOSTIC
CRANIOTOMYCRANIOTOMY
HIGH GRADEHIGH GRADELOW GRADELOW GRADE
PREVIOUSPREVIOUS
RADIOTHERAPYRADIOTHERAPY
NONO YESYES NONO YESYES
RXRXSMALL FOCARSMALL FOCAR
TUMORTUMOR
SMALL FOCARSMALL FOCAR
TUMORTUMOR
SMALL FOCARSMALL FOCAR
TUMOR
CHCH OP+RXOP+RX RX +CHRX +CH OP + RX+CHOP + RX+CH CHCH OP+ RX + CHOP+ RX + CH
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1 The len th of 1 The len th of timetime of recurrenceof recurrence
2) The2) The morphological characteristicsmorphological characteristics of theof the
recurrence, location of the recurrence in closerecurrence, location of the recurrence in closeproximity of the original tumorproximity of the original tumor
3) The patients3) The patients age, performance statusage, performance status--
,, 4)4) Radiological recurrence priorRadiological recurrence priorto the clinicalto the clinical
5) Radiological appearance of5) Radiological appearance of tumor necrosis ortumor necrosis orabcessabcess
6) The6) The written optionwritten option of the family and patient toof the family and patient toaccept surgery.accept surgery.
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39 years old woman operated in January 1995 for left sided frontal fibrillary
as rocy oma, w ecompress ve cran o omy, o owe y c emo an
radiotherapy..
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e ruary - ree o umor
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March 1997- iant tumoral re rowth o erated reveals mali nanc
progression to secondary glioblastoma.
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38 case series of recurrent astrocytic tumors in
between 1995-2005by the same team in the
Emergency Hospital "Bagdasar - Arseni"
Buc arest.
All cases received ad uvant thera after the firstoperation.
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OPERATED GLIOMA CASE SERIES
1995-2005
Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Total
Glioma
Low
grade
I/II
8 9 6 8 11 5 8 12 8 10 10 95
25,13
Anapla
stic
(III)
5 11 5 9 6 5 8 7 10 9 9 84
22,22
Gliobla
stoma(IV)
21 14 22 20 18 23 17 16 15 17 16 199
52,64
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Histolo ical t e of o erated LGG
95 case series Fibrillary astrocytoma
39-41,05%
-9-9,47%
Subependimar astrcytoma
,
Ganglioglioma grade II 6-6,31%
Gangliocytoma 1-1,01%,
Protoplasmatic astrocytoma6-6,31%
Infundibuloma 1-1,01% Pleomorphic xantho-astrocytoma
(PXA) 2-2,10% ocyt c astrocytoma - ,
Oligoastrocytoma grade II
10-10,05%
Neurocytoma 3-3,15%
Dysembryoblastic neuro-epithelial
Oligodendroglioma grade II7-7,36%
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Fibrillary Gemistocytic SubependimarProtoplasmatic Pilocytic ProtoplasmaticOli oastroc toma Oli odendro lioma Mixed liomaGanglioglioma Gangliocytoma InfundibulomaXantoastrocytoma Neurocytoma
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on ro scan a er onco og c rea men
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38 cases of recidives
u w -
cases
Frontal Temporal Parietal Occipital Other
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The most frequent encountered tumor was
.
The mean reccurence time of this veryhetero eneous rou of tumors was 4 2 ears
(1,7 years for gemistocytic astrocytoma grade II,
.
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21 cases (55,26%) remained in the same tumoral grade
17 44 73 r n m li n n r r i n
All gemistocytic astrocytomas presented malingnant
.
12 recurrences supported total resection at initial
surgery 7 cases remained in the same grade, and 5 progressed to
a higher grade.
THE PROFILE OF REOPERATED
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THE PROFILE OF REOPERATED
FEMALES 16 42,10%
MALES 22 57,90%
RECURRENCE
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23 cases of recidive benefit from subtotal
resection at initial o eration 13 of them remained in the same grade
From 3 cases with biopsy followed by chemo
and radiothera 1 remained in the sametumoral grade and 2 progressed to a morea ressive rade.
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Histological profile of recidives/regrowth.
.
Number Number of Same % from Higher Higher %from
casesGrade
III
Grade
IV
astrocytoma, ,
Gemistocytic
astrocytoma9 9 0 0 3 6 100%
Subependimarastrcytoma 3 1 1 100% 0 0 0
Protoplasmatic 6 0 0 0 0 0 0astrocytoma
Oligoastrocytoma
grade II
10 5 3 60% 1 1 40%
go en rog oma
grade II, ,
Mixed glioma grade
II3 1 1 100% 0 0 0
Gangliogliomagrade II
6 2 2 100% 0 0 0
% from # = the percentage from the same anatomopathological category.
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28 ears old woman o erated in 1998 for a tem oral fibrillar
astrocytoma with postoperative radio and chemotherapy
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In 2001 she was o erated for a recidive with the same tumoral
grade adding a decompressive craniotomy
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In Januar 2005 she was o erated a ain for another recidive,
who remained in the same histological grade
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IRM Se tember 2006
>8 years of evolution
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None of the Grade I tumors showed evidence of
malignant progression.
Gangliocytoma grade I-IRM 5 years after operation
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years o man, w se zures s ar e n ay
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Biopsy,-fibrillary astrocytoma in November 2005
pos - opsy
The patient refused oncologic treatement.
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The tumor evolved after 10 months to a lioblastoma, and was
operated in august 2006
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Our results indicate that both tumor progression and
histopathological dedifferentiation were less commonlyseen w en a tota resect on cou e ac eve .
Data from this study demonstrate that tumorprogression occurs in 44,73% of a heterogenic group ofn trat ve s su ecte to next surger es.
Gross- total resection with postoperative adjuvanttherapy was associated with increased time to second
surgery, an ow nc ence o progress on omalignancy.