ABSTRACT
Introducción: Nimotuzumab es una inmunoglobina de isotipo IgG1, obtenido por tecnología de ADN recombinante. La expectativa de vida de niños con tumores cerebrales recurrentes, refractarios a tratamientos a la cirugía, la radioterapia y la quimioterapia es de un mes aproximadamente. Con este tratamiento la supervivencia alcanza 44,5 meses. Objetivos: Presentar el caso clínico de un paciente con diagnóstico de Astrocitoma anaplásico que recibió tratamiento oncoespecífico concurrente con Nimotuzumab. Presentación de caso: Se realizó la descripción del diagnóstico, tratamiento y evolución de un paciente de 31 años de edad que fue diagnosticado con una neoplasia del sistema nervioso central. (Astrocitoma anaplásico). Recibió la combinación terapéutica de cirugía, radioterapia y anticuerpos monoclonales, lográndose una sobrevida de 39 meses. Conclusiones: La adición del anticuerpo monoclonal al tratamiento estándar de los tumores cerebrales aumentó la sobrevida del paciente, convirtiéndose en una alternativa terapéutica segura, ventajosa y factible como parte del tratamiento convencional en las condiciones asistenciales(AU)
Introduction: Nimotuzumab is an IgG1 isotype immunoglobin, obtained by recombinant DNA technology. Life expectancy is approximately one month in children with recurrent brain tumors, refractory to treatments to surgery, radiotherapy and chemotherapy. Survival reaches 44.5 months when using Nimotuzumab. Objectives: To report the clinical case of a patient diagnosed with anaplastic astrocytoma who received concurrent oncospecific treatment with Nimotuzumab. Case report: This paper describes the diagnosis, treatment and evolution of a 31-year-old male patient with neoplasm of the central nervous system (Anaplastic astrocytoma). He received the therapeutic combination of surgery, radiotherapy and monoclonal antibodies, achieving a survival of 39 months. Conclusions: The adding the monoclonal antibody to the standard treatment of brain tumors increased patient survival, making it a safe, advantageous and feasible therapeutic alternative as part of conventional treatment in healthcare conditions(AU)
Subject(s)
Humans , Male , Adult , Astrocytoma/surgery , Astrocytoma/diagnosis , Astrocytoma/therapy , Central Nervous System , Reference Drugs , Antibodies, Monoclonal, Humanized/therapeutic use , Survival AnalysisABSTRACT
Na atualidade cresce a preocupação com a neurotoxicidade do tratamento antineoplásico e o neurodesenvolvimento. O objetivo deste estudo foi comparar o impacto da modalidade de tratamento sobre a capacidade intelectiva de 22 sobreviventes de Tumores de Fossa Posterior e Leucemia Linfóide Aguda com idades entre seis e 14 anos. Participantes com astrocitoma foram submetidos à cirurgia; aqueles com meduloblastoma à cirurgia, à quimioterapia sistêmica e à radioterapia de crânio e neuroeixo (54Gy) e; aqueles com LLA à quimioterapia sistêmica e intratecal. Apenas os participantes com astrocitoma obtiveram desempenho dentro do esperado. Observou-se contrastes estatisticamente significativos entre os grupos, notadamente entre as crianças com meduloblastoma e as demais nos escores não verbais. Sugere-se que a combinação cirurgia, quimioterapia sistêmica e radioterapia potencializou as sequelas cognitivas, e reforça-se a hipótese de que a radioterapia acarreta danos à substância branca. A quimioterapia intratecal associada à sistêmica promoveu impactos significativos sobre o funcionamento executivo.
Concerns about the neurotoxicity of antineoplastic treatment and neurodevelopment are increasing nowadays. The aim of this study was to compare the impact of treatment modality on intellectual functioning of 22 survivors of Posterior Fossa Tumors and Acute Lymphoblastic Leukemia aged from six to 14 years. The astrocytoma group underwent surgery; the medulloblastoma group underwent surgery, systemic chemotherapy, and cranial and neuraxis radiation (54Gy); the LLA group underwent systemic and intrathecal chemotherapy. Only the astrocytoma group obtained average performance. Significant contrasts were obtained between groups, especially among the medulloblastoma group and others in non-verbal scores. Results suggest that the combination of surgery, radiotherapy and systemic chemotherapy increase the cognitive sequelae and enhance the hypothesis that radiation damages white matter. The association between intrathecal and systemic chemotherapy leads to significant impact on executive functioning.
Subject(s)
Humans , Male , Female , Child , Adolescent , Radiotherapy/adverse effects , Astrocytoma/therapy , Cognition , Drug Therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/therapy , Medulloblastoma/therapyABSTRACT
Anaplastic Oligodendroglioma / Anaplastic Oligoastrocytoma [AO/AOA] is a WHO Grade-III primary brain tumor. These tumors comprise about 5 - 10% of all gliomas, which make them the third most common primary brain tumors after glioblastoma multiforme and astrocytomas. For many years standard of treatment remained Maximum Safe Resection [MSR] followed by Radiotherapy [RT]. These tumors have also been known to be sensitive to alkylator-based chemotherapy particularly the subset having 1p/19q co-deletion signature. There is robust data showing that these tumors are responsive to chemotherapy in recurrent or progressive setting. Recently, up front chemotherapy has been added to standard post-surgery RT. It has been found that subset of AO/AOA having 1p/19q co-deletion responded very well to the addition of chemotherapy. This substantial benefit in terms of median Overall Survival [OS] and median Progression Free Survival [PFS] have intrigued the personalized treatment of AO/AOA on the basis of molecular signature markers
Subject(s)
Humans , Oligodendroglioma/surgery , Astrocytoma/surgery , Astrocytoma/therapy , Brain Neoplasms , Oligodendroglioma/radiotherapy , Oligodendroglioma/prevention & control , Oligodendroglioma/classification , Oligodendroglioma/diagnosis , Radiotherapy , Antineoplastic AgentsABSTRACT
Descrever um caso de astrocitoma pilomixoide, um tumor do sistema nervoso central raro, descrito e classificado recentemente diante de sintomatologia e achados pouco específicos. Análise e descrição de um caso de astrocitoma pilomixoide submetido a tratamento cirúrgico no Instituto José Frota, Fortaleza, Ceará. Paciente evolui com regressão importante dos sintomas, sem indícios de recidiva tumoral. O diagnóstico e a classificação correta dos tumores cerebrais são de extrema importância clínica, pois modificam de forma impactante o prognóstico, assim como a abordagem terapêutica.
To describe a pilomyxoid astrocytoma case, a tumor of the central nervous system rare recently described and classified in the face of a specific symptomatology and little found. Analysis and description of a case of pilomyxoid astrocytoma underwent surgical treatment at the José Frota Institute in Fortaleza, Ceará. Patient developed a significant decrease of symptoms without evidence of tumor relapse. The diagnosis and the correct classification of cerebral tumors are of extreme clinical importance, because it changes so as impacting the prognosis as well as therapeutic approach.
Subject(s)
Humans , Female , Child , Astrocytoma/surgery , Astrocytoma/diagnosis , Astrocytoma/therapy , Infratentorial NeoplasmsABSTRACT
Astrocytoma is the most malignant intracranial neoplasm and is characterized by high neovascularization and peritumoural brain oedema. Angiogenesis is a complicated process in oncogenesis regulated by the balance between angiogenic and antiangiogenic factors. The expression of two angiogenic growth factors, vascular endothelial growth factor and basic fibroblast growth factor were investigated using immunohistochemistry for astrocytoma from 82 patients and 11 normal human tissues. The expression of vascular endothelial growth factor and basic fibroblast growth factor positively correlate with the pathological grade of astrocytoma, microvessel density numbers and brain oedema, which may be responsible for the increased tumour neovascularization and peritumoural brain oedema. The results support the idea that inhibiting vascular endothelial growth factor and basic fibroblast growth factor are useful for the treatment of human astrocytoma and to improve patient's clinical outcomes and prognosis
Subject(s)
Humans , Male , Female , Neovascularization, Pathologic , Brain Edema , Vascular Endothelial Growth Factors , Fibroblast Growth Factors , Astrocytoma/therapy , Prognosis , ImmunohistochemistryABSTRACT
OBJECTIVES: To describe the medical history, psychosocial aspects and the rehabilitation management of a patient with a high-grade astrocytoma of the spinal cord. To review the literature regarding the epidemiology, classification, treatment, prognosis, and outcomes of astrocytomas involving the spinal cord. To discuss issues and controversies in the rehabilitation management of spinal cord high-grade astrocytomas. SETTING: Inpatient Spinal Cord Injury Rehabilitation Unit of Veterans Affair Medical Center; San Juan, Puerto Rico. MAIN OUTCOME MEASURES: Survival time and Functional Independence Measure (FIM) prior to and after receiving comprehensive intensive inpatient rehabilitation treatment. RESULTS: Aggressive multimodality treatment including acute inpatient interdisciplinary rehabilitation approach provided excellent results exceeding survival time and functional expectations for a patientwith high-grade astrocytoma. CONCLUSIONS: This case report stands out for two main reasons: (1) the survival time of more than three years, which exceeded the expected survival time of ten months for a patient diagnosed with spinal cord high grade astrocytoma and (2) for the outcomes achieved through an intensive comprehensive acute inpatient interdisci-plinary rehabilitation program which helped the patient achieve previous premorbid functional goals. Further studies are needed to compare these outcomes versus the ones that can be achieved through the implementation of rehabilitation management and care programs in long term care facilities such as nursing homes and hospice among others.
Subject(s)
Humans , Male , Middle Aged , Astrocytoma , Spinal Cord Neoplasms , Astrocytoma/diagnosis , Astrocytoma/therapy , Spinal Cord Neoplasms/diagnosis , Spinal Cord Neoplasms/therapy , Thoracic VertebraeABSTRACT
Many aspects of the management of low-grade gliomas have been controversial. Warren Mason reviews the new evidence addressing some of them in the article Advances in the management of low-grade gliomas, published in Can J. Neurol. Sci. 2005. This information should be specially useful for tailoring therapies to each particular situation. The presence of an oligodendroglial component and 1p and 19q deletions confers a better prognosis and better response rates to chemotherapy and radiotherapy. Delaying interventions in stable, asymptomatic patients does not seem to affect overall survival. More extensive resections are associated to longer and better quality survival. Early radiotherapy prolongs time to progression, but not overall survival as compared to delayed radiotherapy. The optimal dose is in the range between 45Gy and less than 59.4 Gy. Chemotherapy produces responses in most of these patients.
Subject(s)
Humans , Glioma/diagnosis , Glioma/therapy , Brain Neoplasms/therapy , Astrocytoma/therapy , Dacarbazine/therapeutic use , Oligodendroglioma/therapy , Radiotherapy/methodsABSTRACT
Presentamos los resultados del tratamiento quirúrgico de 120 casos de astrocitomas supratentoriales operados en el Instituto de Enfermedades Neoplásicas entre 1984 - 1994. El objetivo del presente estudio fue determinar si existen factores pronósticos relacionados con los parámetros clínico y tratamiento. La población de estudio estuvo conformada por 61 mujeres y 59 hombres; 23 fueron niños y 97 adultos; con una edad media de 39, 4 años; los síntomas y signos más frecuentes fueron: cefalea 90,8 por ciento, déficit motor 42,5 por ciento, convulsiones 41,6 por ciento, papiledema 70,8 por ciento, diversos grados de hemiparesia 58,3 por ciento. Localización: lóbulo parietal y frontal (24 y 18 casos); compromiso de dos o más lóbulos en 31 pacientes (25,8 por ciento); en cuerpo calloso y ganglios basases (14 en cada uno); región quiasmática y pineal en cinco y uno respectivamente. Se realizó biopsia en 36 (30 por ciento) casos, resección subtotal en 69 (58 por ciento) y total en 15 casos (13 por ciento). Recibieron radioterapia 85 pacientes. La histopatología de Kernohan confirmó: grado I y II en 29 (24 por ciento) casos, grado III en 42 (35 por ciento) pacientes y grado IV en 49 (14 por ciento) pacientes. La mortalidad operatoria fue 10,8 por ciento. a media de sobrevida en 23 niños fue 24 meses y en 84 adultos fue 10 meses, con diferencias estadísticamente significativas (p menor 0,008). Las mejores condiciones clínicas de karnofski en el preoperatorio, dieron los mejores resultados en el postoperatorio. La media de sobrevida en pacientes con astrocitomas grado I-II fue 43 meses, en el grado III, 16 meses y en el grado IV fue 7 meses, con diferencias estadísticamente significativas entre grado I-II con el grado III (p menor 0,001) y grado IV (p menor 0,0001). En 29 casos con astrocitoma grado I-II, la media de sobrevida en resección total (S casos), subtotal (14 pacientes) y biopsia (10 casos) fue 571 45 y 28 meses respectivamente, con diferencias estadísticamente significativas entre resección total y biopsia (p menor 000,1). En 37 casos con astrocitoma grado III, la media de sobrevida en resección total (S casos), subtotal (18 pacientes) y biopsia (14 casos) fue 72, 17 y ocho meses, con diferencias estadísticamente significativas entre resección total con resección subtotal y biopsia (p menor 0,001)...
Subject(s)
Humans , Male , Female , Adolescent , Adult , Astrocytoma/diagnosis , Astrocytoma/radiotherapy , Astrocytoma/therapy , Carcinoma , Glioblastoma/diagnosis , Glioblastoma/radiotherapy , Glioblastoma/therapy , Data Interpretation, Statistical , Retrospective Studies , Hospitals, StateABSTRACT
Supratentroial astrocytomas are the most common brain tumors. Judging the benefits of treatment for brain tumors is difficult because crude survival rates are unsatisfactory and the quality as well as the length of survival needs to be examined critically. Opinions vary as to the extent of resection in these tumors. The present study proves the usefulness of subtotal excision over open minimal biopsy by comparing the post operative quality of life enjoyed by patients undergoing these procedures. This study has shown that the patients undergoing subtotal excision enjoy.a better quality of life in the late post-operative period than those who underwent open minimal biopsy
Subject(s)
Humans , Male , Female , Astrocytoma/therapy , Supratentorial Neoplasms/surgery , Supratentorial Neoplasms/radiotherapy , Tomography, X-Ray ComputedABSTRACT
Presentamos los resultados del tratamiento de 120 casos de astrocitomas supratentoriales operados en el Instituto de Enfermedades Neoplásicas entre 1984-1994. El objetivo del presente estudio fue determinar si existen factores pronósticos relacionados con los parámetros clínicos y tratamiento. La población de estudio estuvo conformada por 61 mujeres y 59 hombres; de los cuales 23 fueron niños y 97 adultos; con una edad media de 39,4 años; los síntomas y signos más frecuentes fueron: cefalea en 109 casos (90,8 por ciento) déficit motor en 51 pacientes (42,5 por ciento), convulsiones en 50 casos (41,6 por ciento), papiledodema en 85 casos (70,8 por ciento), diversos grados de hemiparesia en 70 pacientes (58,3 por ciento), afasia en nueve casos (7,5 por ciento). Localización: en el lóbulo parietal; 24, frontal: 18, temporal: 12, compromiso de dos o más lóbulos: 31, cuerpo calloso: 14, área quiasmática: 5, ganglios basales e hipotálamos: 14. Se realizó biopsia en 36 casos, resección subtotal en 69 y total en 15 casos. Se dió radioterapia en 85 casos (en 77 con rango 50-60 Gy). Histología (Kernohan): 29 casos con astrocitomas grado I y II, 42 pacientes con astrocitomas grado III y 49 casos con astrocitomas grado IV. Mortalidad operatoria: 13 casos (10,8 por ciento. La media global de sobrevida en 23 niños fue 44,5 meses y en 84 adultos fue 22,9 meses, con diferencias estadísticamente significativas. Las mejores condiciones de Karnofski en el preoperatorio, dieron los mejores resultados en el postoperatorio. La media de sobrevida en astrocitomas grado II fue de 50.8 meses y la sobrevida a tres años fue 69 por ciento. En astrocitomas grado III, la media de sobrevida fue 24,8 meses y la sobrevida a 12 meses fue 54 por ciento....
Subject(s)
Child, Preschool , Child , Adolescent , Adult , Middle Aged , Humans , Male , Female , Astrocytoma/diagnosis , Astrocytoma/drug therapy , Astrocytoma/radiotherapy , Astrocytoma/therapy , Glioblastoma , Karnofsky Performance Status , Signs and Symptoms , StatisticsABSTRACT
Os astrocitomas malignos säo os tumores mais freqüentes do Sistema Nervoso Central no adulto. Para o tratamento têm sido utilizadas a cirurgia, radioterapia e eventualmente quimioterapia. Os resultados näo säo bons. Revimos 46 casos de astrocitomas malignos tratados com cirurgia, radioterapia e quimioterapia, no Centro de Oncologia Campinas. O presente trabalho mostra estes dados e os compara com outros da literatura