[Intrathecal chemotherapy for leptomeningeal metastases in patients with breast cancer]. / Intratekal'naya khimioterapiya pri leptomeningeal'nom metastazirovanii u bol'nykh rakom molochnoi zhelezy.

Leptomeningeal metastases are lesions of brain and/or spinal cord sheaths by tumor cells. They occur in 5% of patients with solid tumors, although autopsies reveal these lesions much more often (10-20% of cases). Leptomengeal metastases are an unfavorable prognostic factor. Despite the modern NCCN treatment standards, including intrathecal therapy (ITT), such patients receive only irradiation of the entire brain and/or spinal cord in most cases. OBJECTIVE: To evaluate the effectiveness of ITT in patients with leptomeningeal metastases in breast cancer. MATERIAL AND METHODS: Twenty-five patients with breast cancer and leptomeningeal metastases underwent intrathecal administration of methotrexate between 2016 and 2022. Intrathecal chemotherapy was administered through lumbar puncture. We performed an intensive course (intrathecal methotrexate 15 mg 2 times a week for 1 month (8 injections), then intrathecal methotrexate 15 mg 1 time a week (4 injections), and then 15 mg 1 time a month until progression or unacceptable toxicity). RESULTS: The median duration of ITT was 2.5 months. Complete neurological responses were observed in 3 out of 25 (12%) patients, partial neurological response - in 15 out of 25 (60%) patients, progression of neurological symptoms - in 7 (28%) patients. The number of complete cytological responses was observed in 6 out of 25 (24%) patients. The median overall survival after ITT was 6.7 months. CONCLUSION: Effectiveness of ITT is confirmed by higher quality of life (72% of patients), complete cytological responses (24%) and improvement in neuroimaging data. This is an important criterion for severe patients with limited treatment options. First-stage ITT before whole-brain irradiation is preferable, as this approach increases overall survival by 3 months. Undoubtedly, ITT is a treatment option that can be used in routine clinical practice for lesions of brain and spinal cord sheaths.

[Recurrent petrosal tumor: meningioma or solitary fibrous tumor?] / Retsidivnaya petrozal'naya opukhol': meningioma ili solitarnaya fibroznaya opukhol'?

Intracranial meningeal solitary fibrous tumors (SFT) originating from mesenchymal tissue are much less common than those with lesions of the visceral pleura or liver and were isolated as a nosological form only in 1996. These tumors are identical in clinical manifestations, MRI and light microscopy data to meningiomas. The pathognomonic difference of SFT, according to the 5th edition of the WHO classification, is the detection of overexpression of the protein encoded by the STAT6 gene. Estimation of other immunohistochemical markers is variable. At the same time, SFT has a tendency to more frequent recurrence and delayed malignancy. Transitional forms are possible. To form a clearer nosological outline of the SFT, it is necessary to accumulate clinical observations. A case of a giant meningioma of the posterior cranial fossa, which recurred 18 years after total removal at a 5-year annual control, is presented. Light microscopy of both primary and recurrent tumors revealed fibrous meningioma (WHO GI). Immunohistochemically revealed diffuse overexpression of CD34 and CD99. Determining the expression of the STAT6 protein was not technically possible. This case is regarded as a meningioma of the posterior surface of the pyramid of the temporal bone, growing into the cavity of the IV ventricle, with late recurrence without malignancy, with specific immunohistochemical profile.

[Giant petrosal meningioma invading the fourth ventricle: total removal of a recurrent tumor after eighteen years. Neurosurgical nuances. Case report and literature review]. / Gigantskaya meningioma zadnei poverkhnosti piramidy visochnoi kosti s porazheniem IV zheludochka: total'noe udalenie retsidiviruyushchei opukholi cherez 18 let. Neirokhirurgicheskie nyuansy. Sluchai iz praktiki i obzor literatury.

The authors present a patient and neurosurgical nuances of total resection of recurrent meningioma of posterior surface of petrous bone 65´35´30 mm. The tumor captured two critical zones of posterior cranial fossa with unusual frontal growth and spread from the surface of petrous bone to the fourth ventricle. The neoplasm filled the ventricle without lesion of ependyma. Extensive fibrous meningioma of posterior surface of petrous bone was totally excised 18 years ago. MRI was annually carried out for 5 years. Surgical nuances that ensured total extraction of tumor without cytoreduction were as follows: 1) en-bloc resection of tumor from the fourth ventricle due to smooth surface of tumor and minimum number of adhesions with cerebellum; MR-confirmed CSF strip between the tumor edges and walls of the ventricle; no signs of hydrocephalus in subtotal ventricular tamponade; 2) unusual frontal tumor growth under 45º required appropriate angular traction of tumor with minimal rotation; 3) traction was followed by sequential appearance of 3 segments of tumor: petrous, apertural and ventricular; 4) topography of the area of lateral eversion of the fourth ventricle was established by identifying the narrowing (constriction) of tumor; 5) in extracting the tumor from the fourth ventricle, we performed minimal rotation to avoid damage to ventricular walls and lateral aperture due to difference between the larger and smaller diameters (by 6 mm) of ovoid ventricular segment of tumor; 6) no CSF leakage following appearance of ventricular segment (tumor enlargement) indicated integrity of ependyma of the fourth ventricle. Histological examination confirmed fibrous meningioma. Fast and complete regression of focal symptoms was observed after surgery. A 3-year follow-up after surgery revealed no signs of tumor recurrence.

[Surgical management of brain metastases following female reproductive system cancers: analysis of 37 cases]. / Opyt khirurgicheskogo lecheniya tserebral'nykh metastazov opukholei organov zhenskoi reproduktivnoi sistemy: analiz 37 sluchaev.

Background. Previously, treatment of women with brain metastases following reproductive system cancers was palliative and included whole brain radiotherapy. Currently, treatment approaches have changed and life expectancy has increased. Nevertheless, the role of surgical treatment in these patients is still discussed. OBJECTIVE: To demonstrate an appropriateness and role of neurosurgical care in the complex management of women with brain metastases following reproductive system cancers. MATERIAL AND METHODS: There were 78 women with brain metastases following reproductive system cancer. All patients were treated at the Blokhin National Cancer Medical Research Center for the period 2004-2019. We have also reviewed the literature data for the last 30 years.Results and discussion. Resection of brain metastases in complex treatment of endometrial, ovarian and cervical cancer ensured favorable long-term survival in our material. Thus, mean life expectancy after resection of brain metastases was 16.3 months in patients with ovarian cancer, uterine cancer - 15.6 months, cervical cancer - 10.25 months. Obviously, surgery is not indicated in all cases. However, this approach improves local control and should be used in combination with other treatment methods for improvement of life expectancy and its quality in certain patients. CONCLUSION: Selective surgical approach should be essential in the treatment of patients with brain metastases following reproductive system cancer. A multidisciplinary approach ensures the best treatment outcomes.