Epidemiological Profile of 96 Intracranial Tumors Treated in a Single Reference Center

Objectives The present study aims to categorize the prevalence of intracranial tumors surgically treated at the neurosurgery service of Hospital Universitário Evangélico Mackenzie (HUEM) between 2016 and 2018. Material and Methods This survey included patients surgically treated due to primary or metastatic intracranial neoplasia between 2016 and 2018 at a referral center in the city of Curitiba. These patients were analyzed for epidemiological, histopathological, and topographic data, and they underwent an assessment of the outcome at the time of hospital discharge. Results Atotal of 96patientsmet the inclusion criteria. Themost prevalent tumorwas the glioma, with 39.6% of the sample, with glioblastoma being themost prevalent histological type. Brainmetastases andmeningiomas represented, respectively, 21.9%and 18.8%of the total. There was a predominance of supratentorial and intra-axial tumors in our sample. Conclusion Glioma was the most commonly found tumor, directly associated with high morbidity and mortality. The development of new and more effective drugs with action directed at themolecular level of intracranial tumorsmay be the path to a longer survival and improvement in the quality of life of these patients.

Approaching glioblastoma during COVID-19 pandemic: current recommendations and considerations in Brazil / Abordando glioblastomas durante a pandemia pelo COVID-19: recomendações atuais e considerações no Brasil

ABSTRACT Background: Cancer patients in general and glioblastoma patients, in particular, have an increased risk of developing complications from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and reaching a balance between the risk of exposure to infection and the clinical benefit of their treatment is ideal. The aggressive behavior of this group of tumors justifies the need for a multidisciplinary team to assist in clinical decisions during the current pandemic. Brazil is now ranked #2 in the number of cases and deaths from COVID-19 pandemic, and existing disparities in the treatment of neuro-oncology patients in Brazil will challenge the clinical and surgical decisions of this population, possibly affecting global survival. Objective: To search the literature about the management of glioblastomas during COVID-19 pandemic to guide surgical and clinical decisions in this population of patients in Brazil. Methods: We performed a systematic search on the PubMed electronic database targeting consensus statements concerning glioblastoma approaches during COVID-19 pandemic up to July 18, 2020. Results: When approaching glioblastoma during the COVID-19 pandemic, important parameters that help in the decision-making process are age, performance status, tumor molecular profile, and patient consent. Younger patients should follow the standard protocol after maximal safe resection, mainly those with MGMT methylated tumors. Aged and underperforming patients should be carefully evaluated, and probably a monotherapy scheme is to be considered. Centers are advised to engage in telemedicine and to elaborate means to reduce local infection. Conclusion: Approaching glioblastoma during the COVID-19 pandemic will be challenging worldwide, but particularly in Brazil, where a significant inequality of healthcare exists.

RESUMO Introdução: Pacientes com câncer, em geral, e particularmente pacientes com glioblastoma estão sob elevado risco de desenvolver síndrome respiratória aguda grave devido à infecção pelo SARS-CoV-2, e alcançar um equilíbrio entre risco de exposição à infecção e benefício clínico do tratamento seria o ideal. O comportamento agressivo desse grupo de tumores justifica a necessidade de equipe multidisciplinar para auxiliar nas decisões clínicas durante a pandemia vigente. O Brasil ocupa hoje o segundo lugar em número de casos e óbitos pela COVID-19, e as atuais disparidades no tratamento de pacientes neuro-oncológicos desafiarão as decisões clínicas e cirúrgicas dessa população, possivelmente afetando a sobrevida global. Objetivo: Guiar decisões clínicas e cirúrgicas relacionadas ao manejo de glioblastoma durante a pandemia pelo COVID-19 no Brasil por meio de pesquisa em literatura. Métodos: Busca sistemática no banco de dados eletrônico da PubMed por estudos ou consensos quanto à abordagem de glioblastoma durante a pandemia por COVID-19 até 18/07/2020. Resultado: Ao abordar o glioblastoma durante a pandemia pela COVID-19, parâmetros importantes que auxiliam no processo de tomada de decisão são idade, desempenho, perfil molecular tumoral e consentimento do paciente. Pacientes jovens devem seguir protocolo padrão após máxima ressecção cirúrgica, principalmente aqueles com metilação do promotor MGMT. Idosos e pacientes debilitados devem ser cuidadosamente avaliados, e monoterapia deve ser provavelmente considerada. Centros de saúde são orientados a utilizar-se da telemedicina e de meios para reduzir infecção local. Conclusão: A abordagem do glioblastoma durante a pandemia por COVID-19 será mundialmente desafiadora, mas particularmente no Brasil, onde ainda existe significativa inequidade no cuidado com a saúde.

Epidemiología descriptiva y cambios en la frecuencia de tumores astrocíticos en el Instituto Nacional de Neurología y Neurocirugía de México / Descriptive epidemiology and frequency variations of astrocytic tumors in the National Institute of Neurology and Neurosurgery of Mexico

Resumen: Objetivo: Determinar distribución, localización y cambios de la frecuencia de tumores astrocíticos (TA) en un instituto mexicano de neurología. Material y métodos: Se revisaron los registros institucionales de TA de cinco décadas. Se compararon las relaciones TA/egresos quirúrgicos (EQ) y TA/total de tumores del sistema nervioso central (TSNC) de 1995 a 2014. Resultados: Se analizaron 2 287 TA (1 356 en hombres y 931 en mujeres). El glioma más común fue el glioblastoma multiforme (GBM), que estuvo presente en adultos jóvenes con una frecuencia mayor a la reportada en otros estudios. La relación TA/EQ y TA/TNSC fue similar entre 1995 y 2014. Conclusiones: En general, la frecuencia de TA atendidos en el Instituto es similar a la reportada internacionalmente. No obstante, los casos de TA en el subgrupo de adultos jóvenes con GBM son más frecuentes (40%) que las incidencias reportadas en otros estudios (menores al 5%). No se encontró variación significativa en la frecuencia de TA durante las últimas dos décadas.

Abstract: Objective: To determine distribution, localization and frequency variations of astrocytic tumors (AT) in a Mexican Institute of neurology. Materials and methods: Institutional registries of AT from five decades were analyzed. AT/Surgical discharges (SD) and AT/Central Nervous System Tumors (CNST) from 1995 to 2014 were compared. Results: Two thousand two hundred and eighty-seven AT (1 356 men and 931 women) were analyzed. The most common glioma was glioblastoma multiforme (GBM), found in young adults with a higher frequency to that reported in other studies. Relation of AT/SD, as well as, relation of AT/CNST was similar between 1995 and 2014. Conclusions: In general, the frequency of AT attended at the Institute is similar to that found worldwide, being only higher the number of GBM in younger adults. There was not significant variation in the frequency of AT during the time studied.

Survival Analysis in Elderly Patients with Glioblastomas: The Influence of Clinical Status, Tumor and Surgical Features

Introduction Glioblastomas are malignant neoplasms, notorious for their poor prognosis. We have conducted a survival analysis in a sample of elderly patients with glioblastomas. Methods The sample of the present study consisted of elderly patients consecutively admitted from January 2014 to January 2016 (24 months) at the Hospital do Servidor Público Estadual de São Paulo. We have evaluated the impact of age, Karnofsky scale (KS) score, tumor location, and occurrence of perioperative complications. Results A total of 42 patients were analyzed. Of these, 23 (54.7%) were men, and 19 (45.3%) were women. Patients > 60 years old, with low KS score, deep-seated tumors, and those with perioperative complications had worst outcomes. Discussion and conclusion Surgery, perioperative chemotherapy and radiotherapy add survival time and quality of life to these patients. In patients with low KS score, isolated radiotherapy and/or chemotherapy might be adequate. Decreasing perioperative complications is essential to adequately deliver adjuvant therapy in elderly patients.

Epidemiological profile and findings found intra operatively of glioblastoma at the neurosurgery service of Santa Casa of Ribeirão Preto Hospital - SP - Brazil / Perfil epidemiológico y hallazgos intraoperatorios de los glioblastomas en el servicio de neurocirurgia del Hospital Santa Casa de Ribeirão Preto - SP - Brasil

Introducción: El Glioblastoma (GB) o Astrocitoma grado IV (OMS), representan 15-20 por ciento de los tumores del SNC y aproximadamente 50 por ciento de los gliomas en adultos. Objetivo: Revelar el perfil epidemiológico del HSCMRP, correlacionar los hallazgos macroscópicos y microscópicos durante la cirugía de enero de 2011 a noviembre de 2015. Método: Estudio epimedeológico observacional, descriptivo, retrospectivo, 429 casos de tumores intracraneales a partir de los datos obtenidos de los archivos de La institución y los registros patológicos de los pacientes tratados quirúrgicamente. Resultados: Tumores encontrados 429 y 96 (22,37 por ciento) GB, edad media de 59 años, predominante séptima década 33 por ciento. Una relación entre mujeres y hombres fue de 1:1.12, respectivamente. Las quejas más frecuentes: dolor de cabeza (58 por ciento), confusión (41 por ciento), hemiparesia 37 por ciento. Comorbilidades frecuentes: hipertensión (64 por ciento), diabetes (22 por ciento) y fumadores (24 por ciento). La topografía más común fue la frente izquierdo. El tiempo medio de inicio de los síntomas a la cirugía fue de 39 días. Resección completa en 76 por ciento de los casos. La duración media de la recurrencia fue de 96 días, en 68% de los pacientes se observó una exuberancia de los vasos trombosados durante la cirugía Hallazgos patológicos: necrosis 98 por ciento, mitosis atípica 96 por ciento, proliferación microvascular 73 por ciento y polimorfismo nuclear 57 por ciento. Discusión: GB estado del arte. Conclusión: Nuestros resultados son similares con la literatura. Observación intraoperatoria de vasos trombosados y agresividad tumoral en pacientes con peor pronóstico y menor tiempo de recaída sugiere que es real, sin embargo. El pequeño número de casos, necesita más investigación, incluyendo otros hallazgos y resultados inmunohistoquímicos.

Introduction: Glioblastoma (GB) or Astrocytoma grade IV (WHO), represent 15-20 percent of CNS tumors and approximately 50 percent of gliomas in adults. Objective: Reveal the epidemiological profile of HSCMRP, correlate macroscopic and microscopic findings during surgery treated from January 2011 to November 2015. Method: Observational epidemiological study, descriptive, retrospective, of medical records of 429 cases of intracranial tumors from data obtained from the files of the institution and pathological records of patients treated surgically. Results: Total tumors found 429 and 96 (22.37 percent) GB with a mean age of 59 years, predominant seventh decade of life 33 percent. A relationship between women and men was with little difference 1:1.12, respectively. The most common complaints were headache (58 percent), confusion (41 percent), hemiparesis 37 percent. Most prevalent comorbidities: hypertension (64 percent) and diabetes (22 percent) and smokers (24 percent). Most common topography were followed by left front lesions. The average time of onset of symptoms to surgery was 39 days. Complete resection in 76 percent of cases. The mean length of postoperative recurrence was 96 days, in 68 percent patients were noticed an exuberance of thrombosed vessels during surgery. Pathological findings: necrosis 98%, atypical mitosis 96%, microvascular proliferation 73 percent and nuclear polymorphism 57 percent. Discussion: GB state of art. Conclusion: Our results are very slightly with the literature. The association of intraoperative observation thrombosed vessels, and tumor aggressiveness in patients with worse prognosis and shorter time to relapse, suggests that it is real, however, the small number of cases, needs further investigation, including other findings and immunohistochemical results.

Glioblastoma: análisis molecular y sus implicancias clínicas / Glioblastoma: molecular analysis and its clinical implications

El glioblastoma multiforme (GB) es el tumor cerebral primario del sistema nervioso central (SNC) más frecuente y más letal en la edad adulta. La evidencia epidemiológica indica que su incidencia es menor en la raza hispana. El tratamiento quirúrgico es la opción terapéutica preferente. Recientemente se han introducido nuevas estrategias que incrementan el volumen de resección. El uso de quimioterapia y radioterapia concurrentes mejora la supervivencia de los pacientes, aunque se asocia a toxicidad. La mejora en la comprensión de la biología molecular del GB ha permitido la identificación de biomarcadores predictivos de respuesta terapéutica y pronóstico, así como la identificación de dianas terapéuticas que han permitido el desarrollo de nuevas estrategias en el tratamiento de estos tumores. Entre los biomarcadores actualmente disponibles se encuentran la codelección 1p/19q, la mutación de IDH y la metilación del promotor O6- metilguanina DNA-metiltransferasa. La identificación de dianas terapéuticas permite el desarrollo de nuevas drogas y su evaluación posterior en ensayos clínicos, aunque ninguna de ellas ha sido validada prospectivamente en ensayos clínicos de fase III.

Glioblastoma (GB) is the most common and most lethal primary brain tumor. Epidemiologic information indicate that its incidence is lower in Hispanic race. Surgery is the only curative strategy and has recently introduced new strategies that increase resection rates. The use of concurrent chemotherapy with radiotherapy improves survival of patients but is associated with toxicity. Improved understanding of molecular biology of GB allows the identification of predictive biomarkers of response and prognosis as well as therapeutic targets for the development of new therapeutic strategies. Among biomarkers are currently available 1p /19q codeletion, IDH mutation and O6-methylguanine DNAmethyltransferase promoter methylation. The identification therapeutic targets enables the development of new drugs and their evaluation in clinical trials, but none has been prospectively validated in phase III clinical trials.

Desarrollo de glioblastoma multiforme tras una hemorragia intracerebral: reporte de un caso / Development of glioblastoma multiforme after intracerebral hemorrhage: case report

Varios factores han sido implicados como posibles causantes del desarrollo de tumores cerebrales; son pocos los autores que han proporcionado evidencia de la etiología traumática de un tumor cerebral. Presentamos el caso de un paciente masculino de 30 años quien se presento con un cuadro clínico de cefalea intensa de 15 días de evolución. Los estudios imagenológicos (TAC, RMN) revelaron lesión frontal intra axial. Se le realizo resección total de la lesión, cuyo resultado de patología fue compatible con glioblastoma multiforme. El paciente tenía antecedente de hemorragia intracerebral espontanea hacia 7 meses en el mismo lugar del tumor. Basados en la literatura en relación a glioblastoma multiforme y lesión traumática o vascular cerebral, hacemos una revisión crítica de ella.