ABSTRACT
Radiochemotherapy is leading the universal research effort in fighting lethality: it is improving relapse-free survival of patients with inoperable glioblastoma, the most pernicious brain tumor in adults. Its effectiveness was found to depend on expression of Mgmt gene of tumor DNA reparation following radiochemotherapy and adequate medication based on the molecular phenotype of tumor. Our study involved a 40-year old male with a low level of Mgmt gene expression as established by stereotactic biopsy. The patient received hypofractionated three-dimensional conformational proton therapy with the benefit of temozolomide (140 mg/24 hr). Subsequently, the dose was raised to 360 mg/24 hr, on days 1-5 of the cycle. Contrast-enhanced MRI examination established significant diminishing of the size of tumors on completion of cycles 7 and 8; patients felt better, memory and blood indices improved. As of the time this paper was written, relapse-free survival was 17.5 months, as compared with the literature data on inoperable glioblastoma--5.5 months.
Subject(s)
Biomarkers, Tumor/metabolism , Brain Neoplasms/metabolism , Brain Neoplasms/radiotherapy , DNA Modification Methylases/metabolism , DNA Repair Enzymes/metabolism , Dacarbazine/analogs & derivatives , Glioblastoma/metabolism , Glioblastoma/radiotherapy , Proton Therapy , Radiotherapy, Conformal , Tumor Suppressor Proteins/metabolism , Adult , Antineoplastic Agents, Alkylating/therapeutic use , Brain Neoplasms/pathology , Chemotherapy, Adjuvant , DNA, Neoplasm/drug effects , DNA, Neoplasm/radiation effects , Dacarbazine/therapeutic use , Dose Fractionation, Radiation , Gene Expression Regulation, Neoplastic , Glioblastoma/pathology , Humans , Magnetic Resonance Imaging , Male , Radiotherapy, Adjuvant , Radiotherapy, Conformal/methods , Temozolomide , Treatment OutcomeABSTRACT
The article presents results of a complex clinico-neurological and radiological examination of 47 patients with posttraumatic chronic subdural hematomas. Clinical features of the course of chronic hematomas against the background of a severe cranio-cerebral injury are established. On the basis of an analysis of data of a complex examination and results of the surgical treatment, the indications to using different methods of surgery are specified. The optimum methods of surgical treatment of patients with chronic subdural hematomas were found to be minimally invasive operations.
