[Surgical and conservative treatment of patients with non-traumatic intracerebral hematoma: pros and cons]. / Khirurgicheskoe i konservativnoe lechenie patsientov s netravmaticheskoi vnutrimozgovoi gematomoi: za i protiv.

BACKGROUND: The risk and benefits of early neurosurgical intervention in patients with non-traumatic intracerebral hematoma (NICH) are still unclear. OBJECTIVE: To evaluate an effectiveness of early surgery in patients with NICH compared to primary conservative therapy. MATERIAL AND METHODS: There were 115 patients with indications for surgery. The indications were supratentorial NICH over 30 cm3 and GCS score >7 points. All patients were divided into 2 groups: the main group (n=59) - NICH removal within 24 hours; the control group (n=56) - conservative treatment only. Both groups were comparable by the main clinical, demographic and neuroimaging characteristics. We analyzed survival rates and functional status using Glasgow outcome scale extended (GOSE) 6 months later. RESULTS: Median survival in the main group was 71 days vs. 11 days in the control group (p<0.05); cumulative 6-month survival - 46% and 34%, respectively (p>0.05). Surgical treatment resulted higher number of patients with severe (13% vs. 5%) and moderate disability (29% vs. 23%). There were 2% of patients with good recovery in the group of surgical treatment and 4% of patients after conservative management. However, between-group differences were not significant (p>0.05). CONCLUSION: Early surgical evacuation of non-traumatic intracerebral hematoma is accompanied by less early postoperative mortality. There were no significant between-group differences in functional outcomes and survival rates after 6 months.

Local delivery of temozolomide via a biologically inert carrier (Temodex) prolongs survival in glioma patients, irrespectively of the methylation status of MGMT.

Glioma is the most common brain malignancy. Standard first-line therapy for glioma includes surgery, radiotherapy and systemic administration of temozolomide. However, temozolomide does not reach the brain in sufficient doses when administered orally and has poor efficiency in more than half of the patients. Strategies to improve the treatment of glial malignancies are therefore needed. We have recently developed a system (Temodex) for local administration of temozolomide by encapsulating the drug in a biologically inert matrix. Here, we assessed the effect of Temodex in combination with standard therapy in a small-scale clinical study. Since the efficacy of temozolomide therapy is known to depend on the methylation status of the O6-methylguanine-DNA methyltransferase gene (MGMT) promoter, we also analyzed whether the effect of Temodex was influenced by the methylation status of MGMT. Our data show that the combination of standard therapy and Temodex was more efficient than standard therapy alone, promoting the overall patient survival by up to 33 weeks. Moreover, the efficacy of Temodex was not dependent on the methylation status of MGMT. Local Temodex administration in combination with standard therapy thereby emerges as a novel therapeutic option, with applicability that is independent on the methylation status of the MGMT promoter.