ABSTRACT
BACKGROUND: Glioblastoma invariably recurs after primary Stupp tumor therapy and portends a poor prognosis. Cryoablation is a well-established treatment strategy for extra-cranial tumors. The safety and efficacy of interventional MR-guided cryoablation (iMRgC) has not been explored in recurrent glioblastoma. METHODS: A retrospective analysis of data collected over a period of 24 months was performed. The inclusion criteria were: (I) recurrent glioblastoma despite Stupp protocol; (II) MRI followed by histological confirmation of recurrent glioblastoma; (III) location allowing iMRgC followed by microsurgical resection; and (IV) patient's consent. The primary objective was to assess feasibility in terms of complications. The secondary objective was to analyze progression-free survival (PFS), post-iMRgC survival and overall survival (OS). RESULTS: The study included 6 patients, with a mean age of 67±7.6 years [range, 54-70 years]. No major complications were observed. Median PFS was 7.5 months [IQR 3.75-9.75] and 6-month PFS was 50%. Median post-iMRgC survival was 9 months [IQR 7.5-15.25] and 6-month post-iMRgC survival was 80%. Median OS was 22.5 months [IQR 21.75-30]. CONCLUSION: iMRgC for recurrent glioblastoma demonstrated a good safety profile, with no major complications. Our data suggest improved PFS and OS. TRIAL REGISTRATION NUMBER: No. IRB00011687 retrospectively registred on July 7th 2021.
Subject(s)
Brain Neoplasms , Glioblastoma , Aged , Brain Neoplasms/pathology , Cryotherapy , Glioblastoma/surgery , Humans , Magnetic Resonance Imaging/methods , Microsurgery , Middle Aged , Neoplasm Recurrence, Local/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
The immunotherapy of cerebral glioblastoma has become a hot topic. Immune checkpoint blockade antibodies have progressively acquired a role in the management of malignant tumors. A multimodal approach using surgery, radiotherapy, chemotherapy in combination with immunotherapy represent a potent weapon against glioblastomas. In parallel, clinical applications of cryotherapy-freezing tumors based on repetition of rapid freeze-slow thaw cycle-for various cancers such as skin, lung, breast, esophagus, hepatic, kidney, prostate and bone tumors were developed. The future immunomodulatory approaches might be combined with brain tumors cryoablation to increase the cryoimmune response. The objective of this study was to analyze from the literature the relationship between cerebral cryosurgery and immunomodulation using PRISMA method. The animals' studies demonstrate the dendritic cells maturation and activation with the enhancement of antigen-presenting function after cryotherapy suggesting the potential usefulness of the association of cryotherapy and immunomodulator in the management of gliomas.
Subject(s)
Brain Neoplasms/therapy , Cryosurgery/methods , Glioblastoma/therapy , Immunotherapy/methods , Neurosurgical Procedures/methods , Combined Modality Therapy , Humans , Immune Checkpoint Inhibitors/therapeutic useABSTRACT
Stereotactic radiotherapy is a radiation technique, which is becoming more and more available and applicable for physicians. A good efficacy and safety are observed in clinical practice. However, the radiobiology of ablative radiation is still under question. The radiobiological principles of the 5R have to be discussed. The roles of hypoxia and vascularization, more specifically, angiogenesis and vasculogenesis seem to be dominating.
Subject(s)
Neoplasms/pathology , Neoplasms/surgery , Radiosurgery , Apoptosis , Cell Cycle/radiation effects , Cell Hypoxia/radiation effects , DNA Breaks, Double-Stranded/radiation effects , Humans , Hypoxia-Inducible Factor 1/metabolism , Linear Models , Membranes/radiation effects , Neoplasms/blood supply , Neoplasms/immunology , Neoplasms/metabolism , Neovascularization, Pathologic/therapy , Oxygen/metabolism , Radiotherapy DosageABSTRACT
The diallylglycol carbonate monomer causes dermatitis due to irritation in the optical industry. Cutaneous intolerance may effect as many as 70% of the exposed persons employed. Almost all control subjects who where patch-tested showed irritation at a 2% concentration. The histological effects were an acute oedema with inflammation of the papillary dermis, and diapedesis of neutrophil polymorphonuclear leukocytes. Experiments on animals confirmed the irritant nature of the product; in the rabbit, a single application produced irritation, but to a lesser degree than in humans. Tests for possible sensitizing effects in the guinea pig have given negative results. Chemical analysis of the monomer revealed the presence of diallyl carbonate and acrolein. Allyl alcohol was detected in only one case. Patch tests were carried out in a group of control subjects with acrolein, diallyl carbonate and allyl alcohol. The histological appearance of the lesions caused by acrolein was quite different from that due to diallyglycol carbonate. It is probable that the irritant is the diallylglycol carbonate monomer itself.
