scholarly journals A Rare Case of Glioblastoma Multiforme with Osseous Metastases

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Rubens Barros Costa ◽  
Ricardo Costa ◽  
Jason Kaplan ◽  
Marcelo Rocha Cruz ◽  
Hiral Shah ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Median Overall Survival ◽  
Progressive Disease ◽  
Bone Biopsy ◽  
Case Reports ◽  
Multimodality Treatment ◽  
Central Nervous System Neoplasm ◽  
Extracranial Metastases ◽  
Early Progressive Disease ◽  
New Onset

Glioblastoma multiforme is the most common malignant primary central nervous system neoplasm in adults. It has a very aggressive natural history with a median overall survival estimated at 14.6 months despite multimodality treatment. Extracranial metastases are very rare with few case reports published to date. We report the case of a 65-year-old male who underwent maximal safe resection for a newly diagnosed brain mass after presentation with new neurologic symptoms. He then received standard postsurgical adjuvant treatment for glioblastoma. Subsequently, he underwent another resection for early progressive disease. Several months later, he was hospitalized for new-onset musculoskeletal complaints. Additional investigation revealed new metastatic osseous lesions which were initially felt to be a new malignancy. The patient opted for supportive care and died 12 days later. Despite choosing no treatment, he elected to undergo a bone biopsy to understand the new underlying process. Results were that of metastatic GBM and were reported after the patient expired. Physicians caring for patients with GBM and new nonneurologic symptoms may contemplate body imaging.

scholarly journals Leptomeningeal Carcinomatosis: A Clinical Dilemma in Neuroendocrine Neoplasms

Biology ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 277
Author(s):  
Leonidas Apostolidis ◽  
Jörg Schrader ◽  
Henning Jann ◽  
Anja Rinke ◽  
Sebastian Krug
Keyword(s):  
Brain Metastases ◽  
Median Overall Survival ◽  
Case Reports ◽  
Individual Case ◽  
Leptomeningeal Carcinomatosis ◽  
Neuroendocrine Neoplasms ◽  
Cns Involvement ◽  
Ki 67 ◽  
Sensory Deficits ◽  
Clinical Dilemma

Central nervous system (CNS) involvement by paraneoplastic syndromes, brain metastases, or leptomeningeal carcinomatosis (LC) in patients with neuroendocrine neoplasms (NEN) has only been described in individual case reports. We evaluated patients with LC in four neuroendocrine tumor (NET) centers (Halle/Saale, Hamburg, Heidelberg, and Marburg) and characterized them clinically. In the study, 17 patients with a LC were defined with respect to diagnosis, clinic, and therapy. The prognosis of a LC is very poor, with 10 months in median overall survival (mOS). This is reflected by an even worse course in neuroendocrine carcinoma (NEC) G3 Ki-67 >55%, with a mOS of 2 months. Motor and sensory deficits together with vigilance abnormalities were common symptoms. In most cases, targeted radiation or temozolomide therapy was used against the LC. LC appears to be similarly devastating to brain metastases in NEN patients. Therefore, the indication for CNS imaging should be discussed in certain cases.

RADT-04. STEREOTACTIC LASER ABLATION (SLA) FOLLOWED BY CONSOLIDATION STEREOTACTIC RADIOSURGERY (SRS) AS A TREATMENT STRATEGY FOR BRAIN METASTASIS THAT RECURRED LOCALLY AFTER INITIAL RADIOSURGERY (BMRS)

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi41-vi41
Author(s):  
Isabela Pena-Pino ◽  
Jun Ma ◽  
Yusuki Hori ◽  
Elena Fomchenko ◽  
Kathryn Dusenbery ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Steroid Therapy ◽  
Local Control ◽  
Treatment Strategy ◽  
Median Overall Survival ◽  
Systemic Disease ◽  
Wound Complications ◽  
Institutional Experience ◽  
New Onset

Abstract INTRODUCTION In independent clinical trials, ~30% of brain metastases recur locally after radiosurgery (BMRS). For these lesions, treatment with stereotactic laser ablation (SLA, also known as laser interstitial thermal therapy (LITT)) alone achieves a 12-month local control (LC12) of 54-85% while repeat SRS achieved LC12 of 54-79%. Here, we report favorable outcomes for BMRS treated with SLA followed by consolidation radiosurgery (SLA/cSRS). METHODS Clinical outcome of 18 patients with 19 histologically confirmed BMRS treated with SLA followed by consolidation SRS and >3 months follow-up were collected retrospectively across three institutions. Local control was defined as stability or decrease in contrast-enhancing (CE) and FLAIR volume. RESULTS SLA achieved ablation of 73-100% of the BMRS CE volumes. Consolidation hypo-fractionated radiosurgery (5 Gy x 5 or 6 Gy x 5) was carried out 16-40 days post-SLA (median of 26 days). With a median follow-up of 185 days (range: 93-1367 days) and median overall survival (OS) of 185 days (range: 99-1367 days), 100% LC12 was achieved. 13/18 (72%) patients that required steroid therapy prior to SLA/cSRS were successfully weaned off steroid by three months post-SLA/cSRS. Post-SLA, KPS declined for 3/19 (16%) patients and improved for 1/19 (5%) patients. No KPS changes occurred subsequent to consolidation SRS. There were no 30-day mortalities or wound complications. Two patients required re-admission within 30 days of SRS (severe headache that resolved with steroid therapy (n=1) and new-onset seizure (n=1)). Except for two patients who suffered histologically confirmed, local failure at 649 and 899 days, all other patients are either alive (n=6) or died from systemic disease progression (n=10). None of the treated patients developed symptomatic radiation necrosis. CONCLUSIONS This collaborative institutional experience support efficacy and safety of SLA followed by consolidation SRS as a treatment for BMRS. The treatment strategy warrants further investigations.

Glioblastoma Multiforme Metastasis Outside the CNS: Three Case Reports and Possible Mechanisms of Escape

2014 ◽  
Vol 32 (22) ◽  
pp. e80-e84 ◽  
Author(s):  
Jackson D. Hamilton ◽  
Marion Rapp ◽  
Timo Marcel Schneiderhan ◽  
Michael Sabel ◽  
Anne Hayman ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Case Reports

scholarly journals Primary adrenal insufficiency due to bilateral adrenal infarction in COVID-19: a case report

2021 ◽  
Author(s):  
Iza F R Machado ◽  
Isabel Q Menezes ◽  
Sabrina R Figueiredo ◽  
Fernando Morbeck Almeida Coelho ◽  
Debora R B Terrabuio ◽  
...  
Keyword(s):  
Case Report ◽  
Adrenal Insufficiency ◽  
Antiphospholipid Syndrome ◽  
Antiphospholipid Antibodies ◽  
Case Reports ◽  
Serum Cortisol ◽  
Primary Adrenal Insufficiency ◽  
Acute Adrenal Insufficiency ◽  
Adrenal Infarction ◽  
New Onset

Abstract Context Coronavirus disease 2019 (COVID-19) is a proinflammatory and prothrombotic condition, but its impact on adrenal function has not been adequately evaluated. Case report A 46-year-old woman presented with abdominal pain, hypotension, skin hyperpigmentation after COVID-19 infection. The patient had hyponatremia, serum cortisol <1.0 ug/dL, ACTH of 807 pg/mL and aldosterone <3 ng/dL. Computed tomography (CT) findings of adrenal enlargement with no parenchymal and minimal peripheral capsular enhancement after contrast were consistent with bilateral adrenal infarction. The patient had autoimmune hepatitis and positive antiphospholipid antibodies, but no previous thrombotic events. The patient was treated with intravenous hydrocortisone, followed by oral hydrocortisone and fludrocortisone. Discussion Among 115 articles, we identified nine articles, including case reports, of new-onset adrenal insufficiency and/or adrenal hemorrhage/infarction on CT in COVID-19. Adrenal insufficiency was hormonally diagnosed in five cases, but ACTH levels were measured in only three cases (high in one case and normal/low in other two cases). Bilateral adrenal non- or hemorrhagic infarction was identified in five reports (two had adrenal insufficiency, two had normal cortisol levels and one case had no data). Interestingly, the only case with well-characterized new-onset acute primary adrenal insufficiency after COVID-19 had a previous diagnosis of antiphospholipid syndrome. In our case, antiphospholipid syndrome diagnosis was established only after the adrenal infarction triggered by COVID-19. Conclusions Our findings support the association between bilateral adrenal infarction and antiphospholipid syndrome triggered by COVID-19. Therefore, patients with positive antiphospholipid antibodies should be closely monitored for symptoms or signs of acute adrenal insufficiency during COVID-19.

scholarly journals NIMG-33. CHANGES IN MAGNETIC RESONANCE IMAGING AFTER PROTON BOOST THERAPY FOR GLIOBLASTOMA WITH AND WITHOUT TUMOR TREATING FIELDS THERAPY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii155-ii155
Author(s):  
Hanna Goett ◽  
Alexandra Jensen ◽  
Tobias Struffert ◽  
Eberhard Uhl ◽  
Marco Stein
Keyword(s):  
Magnetic Resonance Imaging ◽  
Radiation Therapy ◽  
Magnetic Resonance ◽  
Contrast Enhancement ◽  
Median Overall Survival ◽  
Progressive Disease ◽  
Tumor Resection ◽  
Resonance Imaging ◽  
Tumor Treating Fields ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND Tumor treating fields (TTFields) are an approved glioblastoma (GBM) treatment modality that demonstrated a significant improved median overall survival in newly diagnosed GBM patients. Data about morphologic changes in serial magnetic resonance imaging (MRI) for patients with a combination therapy of TTFields and proton boost therapy does not exist. METHODS Twenty-two patients were included in this study. All patients were treated with initial tumor resection followed by combined chemo- and radiation therapy. Radiation therapy was performed with 50.0 Gy photons and a proton boost with 10 Gy equivalent (Gy(RBE)). 11 patients were additionally treated with TTFields. RESULTS A new increase in contrast enhancement and/or a progress in the T2 FLAIR hyperintensity was observed in 54.5% (N=12) at 3 months and in 31.8% (N=7) at 6 months. No differences were observed between patients with and without TTFields therapy at 3 months [63.6% (N=7) vs. 45.5% (N=5); P=0.392] and at 6 months [27.3 (N=3) vs. 36.3% (N=4); P=0.647). By the RANO criteria a progressive disease (PD) was observed in 6 patients (27.3%) at 3 months and in 7 patients (31.8%) at 6 months. Pseudoprogression (PP) was observed in in 36.4% (N=8) at months and in 27.3% (N=6) at 6 months. Neither for PD at 3 months [36.4% (N=4) vs. 18.2% (N=2); P=0.338] or at 6 months [36.4% (N=4) vs. 27.3% (N=3); P=0.647), nor for PP at 3 months [45.5% (N=5) vs. 27.2% (N=3); P=0.375] or at 6 months [18.2% (N=2) vs. 36.4% (N=4); P=0.338] differences for patients with and without TTFields therapy were found. CONCLUSION Increased contrast enhancement and/or increased T2 FLAIR MRI hyperintensity after proton boost therapy are common. Furthermore, the rates for new contrast enhancement, PD, and PP after photon therapy with and without additional TTFields therapy are comparable.

scholarly journals Real-world experience with Temozolomide & Sativex in patients with recurrent High Grade Gliomas

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv13-iv14
Author(s):  
Lillie Shahabi ◽  
Kerlann Le Calvez ◽  
Seema Dadhania ◽  
Catherine Blake ◽  
James Wang ◽  
...  
Keyword(s):  
Median Overall Survival ◽  
Progressive Disease ◽  
Phase 1 ◽  
Median Number ◽  
Phase 1 Study ◽  
Malignant Brain Tumour ◽  
Mri Scans ◽  
Recent Phase ◽  
Grade 3 ◽  
Number Of Cycles

Abstract Background Glioblastoma (GBM) is the most common malignant brain tumour in adults with a median survival from progression of 8 months. A recent phase 1 study of temozolomide (TMZ) and 1:1 CBD:THC (Sativex) offers evidence of efficacy in patients with recurrent GBM (NCT01812603). Methods All patients receiving TMZ & Sativex (75mg/m2 daily d1 – 21 q28; Sativex continuously) for relapsed GBM or grade 3 astrocytoma at our centre were identified. Patient, tumor and treatment characteristics were recorded, and response based on sequential MRI scans using modified RANO criteria assessed. Results 13 patients were treated over 18 months. The median age was 56; 69% were male. All had received initial chemo-radiotherapy (12 patients: 60 or 59.4Gy/30–33#; 1 patient: 45Gy/15#). 6 patients underwent reresection at recurrence. 4 patients were treated at first progression, 7 at second progression, and 2 at third or later progression. The median number of cycles of TMZ and sativex was 2. The combination treatment was tolerated well by all patients treated, with no Grade 3 or 4 toxicities, the only complaints being of discomfort in mouth after spray and ‘spaced out feeling’. Patients stopped treatment due to evidence of progressive disease on sequential MRI sign or physical deterioration. Median Overall Survival (OS) from initiation was 5.9 months (177 days); Progression Free Surival (PFS) at 3 months was 50%. Conclusion These results highlight some discrepancies in OS in comparison to the previous trial (NCT01812603), but our patients were treated at second/ third recurrence. We agree that the combination is well tolerated.

scholarly journals NIMG-55. TO ASSESS THE UTILITY OF ADVANCED QUANTITATIVE DIFFUSION MRI DERIVED FROM MULTI B VALUE ACQUISITIONS IN THE ASSESSMENT OF TREATMENT RESPONSE, USING A SPATIALLY-INDEPENDENT APPROACH

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi173-vi173
Author(s):  
Shah Islam ◽  
Melanie Morrison ◽  
Adam Waldman
Keyword(s):  
Treatment Response ◽  
Diffusion Mri ◽  
Tumour Growth ◽  
Progressive Disease ◽  
B Value ◽  
Subsequent Treatment ◽  
Tumour Heterogeneity ◽  
High B Value ◽  
Mri Protocol ◽  
Early Progressive Disease

Abstract PURPOSE To assess the utility of advanced diffusion MRI derived from multi b value acquisitions in the assessment of treatment response, using a spatially-independent approach. METHOD AND MATERIALS 13 GBM patients were enrolled into our multicentre study. All patients completed RT with TMZ. Imaging was performed pre-RT and mid RT. The MRI protocol included a ‘low’ b value acquisition (b= 0s/mm, 50s/mm, 150s/mm, 200s/mm, 500s/mm, 1000s/mm) from which monoexponential diffusion indices ADC and biexponential indices, IVIM parameters D*, D and f were calculated. A ‘high b value’ acquisition (b=0 s/mm, 500s/mm, 1000s/mm, 1500s/mm, 2000s/mm, 2500s/mm, 3000s/mm, 3500s/mm, 4000s/mm) was acquired to allow stretched exponential diffusion indices, DDC and alpha to be derived. FLAIR sequences were used to define ROI and clinical assessment of mid-treatment and end-treatment response using RANO criteria. Histograms were generated from voxels located within manually segmented ROIs defined by increased signal on T2 FLAIR images. Changes in histogram percentile profiles were evaluated across the two timepoints and compared with RANO assessment at the mid treatment and end treatment timepoints. RESULTS Following completion of treatment, 5 patients had PD, 4 SD and 4 CR. Patients with PD showed a histogram shift to the left across all diffusion models, in keeping with increasing diffusion restriction and implying increased cellularity. Patients with SD or CR showed little or no shift in the histogram. DDC and f are the most predictive of progression against RANO assessment, and appear superior to routine ADC. Reduction in 75th centile (f) and 95th centile (DDC) are the most sensitive histogram metrics for predicting early progressive disease. CONCLUSION Results suggest association between early changes in specific diffusion components and subsequent treatment response. Spatially-independent diffusion parameter comparisons provide unbiased sampling of tumour heterogeneity and abrogate the confound of voxel-to-voxel misregistration due to tumour growth/shrinkage.

Treatment of Glioblastoma Multiforme in Elderly Patients. Clinico-therapeutic Remarks in 22 Patients Older than 80 Years

2006 ◽  
Vol 92 (2) ◽  
pp. 98-103 ◽  
Author(s):  
Manolo Piccirilli ◽  
Simona Bistazzoni ◽  
Franco Maria Gagliardi ◽  
Alessandro Landi ◽  
Antonio Santoro ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Elderly Patients ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Multimodality Treatment ◽  
Good Health ◽  
Rank Test ◽  
Significant Prognostic Factor ◽  
Log Rank Test ◽  
Common Opinion

We report our remarks on 22 patients, 80 years of age and older, who were treated for glioblastoma multiforme. The 16 patients who underwent a multimodality treatment (surgery + radiotherapy + chemotherapy) had an average survival of 16.7 months versus the 5.8 months of the 8 patients treated with biopsy followed by radiotherapy and/or chemotherapy (log-rank test, P <0.001). Moreover, we point out the importance of MGMT hypermethylation as a significant prognostic factor: the 9 patients with nonmethylated MGMT had a mean survival of 7.7 months vs 17.9 months of the 13 patients with the MGMT promoter methylated (log-rank test, P = 0.0006). Several studies have pointed out age as an important negative factor for the outcome of elderly patients affected by glioblastoma multiforme. Elderly patients with a diagnosis of glioblastoma multiforme are thus generally excluded from clinical trials of treatment for the neoplasm, because it is a common opinion that the prognosis for such patients is particularly poor. On the contrary, according to our clinical and surgical experience, we firmly believe that patients older than 80 years with a histologically proven diagnosis of glioblastoma multiforme and in good health conditions (Karnofsky performance status >60) should be treated in the same way as younger patients.

scholarly journals A Practical Update of Surgical Management of Merkel Cell Carcinoma of the Skin

ISRN Surgery ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-17 ◽  
Author(s):  
Patricia Tai
Keyword(s):  
Adjuvant Chemotherapy ◽  
Cell Carcinoma ◽  
Merkel Cell Carcinoma ◽  
Recurrent Disease ◽  
Case Reports ◽  
Multimodality Treatment ◽  
Future Research ◽  
Merkel Cell ◽  
Recommended Treatment ◽  
Nodal Dissection

The role of surgeons in the treatment of Merkel cell carcinoma (MCC) of the skin is reviewed, with respect to diagnosis and treatment. Most of the data in the literature are case reports. Surgery is the mainstay of treatment. A wide local excision, with sentinel node (SLN) biopsy, is the recommended treatment of choice. If SLN is involved, nodal dissection should be performed; unless patient is unfit, then regional radiotherapy can be given. Surgeons should always refer patients for assessment of the need for adjuvant treatments. Adjuvant radiotherapy is well tolerated and effective to minimize recurrence. Adjuvant chemotherapy may be considered for selected node-positive patients, as per National Comprehensive Cancer Network guideline. Data are insufficient to assess whether adjuvant chemotherapy improves survival. Recurrent disease should be treated by complete surgical resection if possible, followed by radiotherapy and possibly chemotherapy. Generally results of multimodality treatment for recurrent disease are better than lesser treatments. Future research should focus on newer chemotherapy and molecular targeted agents in the adjuvant setting and for gross disease.

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