Neurosurgical management of recurrences in low grade glioma

8/10/2019 Neurosurgical management of recurrences in low grade glioma

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NEUROSURGICALNEUROSURGICAL

GRADE GLIOMAGRADE GLIOMA

Ass Prof. Gorgan Mircea MD, PhD, Neacsu Angela MD,Ass Prof. Gorgan Mircea MD, PhD, Neacsu Angela MD,Bucur Narcisa MD,PhD,Bucur Narcisa MD,PhD,

Diaconu Nicoleta MD, Pruna Viorel MD, Craciunas Sorin MD,Diaconu Nicoleta MD, Pruna Viorel MD, Craciunas Sorin MD,

First Neurosurgical ClinicFirst Neurosurgical Clinic

Clinic Emergency Hospital "BagdasarClinic Emergency Hospital "Bagdasar-- Arseni" BucharestArseni" Bucharest

Sinaia, September 2006Sinaia, September 2006


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LOW GRADE GLIOMALOW GRADE GLIOMA

NONO YESYES

PALEATIVPALEATIV

TREATMENTTREATMENT

NONO

BIOPSYBIOPSY

YESYES

HISTOLOGICALHISTOLOGICAL

DIAGNOSTICDIAGNOSTIC

CRANIOTOMYCRANIOTOMY

HIGH GRADEHIGH GRADELOW GRADELOW GRADE

PREVIOUSPREVIOUS

RADIOTHERAPYRADIOTHERAPY

NONO YESYES NONO YESYES

RXRXSMALL FOCARSMALL FOCAR

TUMORTUMOR

SMALL FOCARSMALL FOCAR

TUMORTUMOR

SMALL FOCARSMALL FOCAR

TUMOR

CHCH OP+RXOP+RX RX +CHRX +CH OP + RX+CHOP + RX+CH CHCH OP+ RX + CHOP+ RX + CH


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1 The len th of 1 The len th of timetime of recurrenceof recurrence

2) The2) The morphological characteristicsmorphological characteristics of theof the

recurrence, location of the recurrence in closerecurrence, location of the recurrence in closeproximity of the original tumorproximity of the original tumor

3) The patients3) The patients age, performance statusage, performance status--

,, 4)4) Radiological recurrence priorRadiological recurrence priorto the clinicalto the clinical

5) Radiological appearance of5) Radiological appearance of tumor necrosis ortumor necrosis orabcessabcess

6) The6) The written optionwritten option of the family and patient toof the family and patient toaccept surgery.accept surgery.


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39 years old woman operated in January 1995 for left sided frontal fibrillary

as rocy oma, w ecompress ve cran o omy, o owe y c emo an

radiotherapy..


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e ruary - ree o umor


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March 1997- iant tumoral re rowth o erated reveals mali nanc

progression to secondary glioblastoma.


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38 case series of recurrent astrocytic tumors in

between 1995-2005by the same team in the

Emergency Hospital "Bagdasar - Arseni"

Buc arest.

All cases received ad uvant thera after the firstoperation.


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OPERATED GLIOMA CASE SERIES

1995-2005

Year 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Total

Glioma

Low

grade

I/II

8 9 6 8 11 5 8 12 8 10 10 95

25,13

Anapla

stic

(III)

5 11 5 9 6 5 8 7 10 9 9 84

22,22

Gliobla

stoma(IV)

21 14 22 20 18 23 17 16 15 17 16 199

52,64


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Histolo ical t e of o erated LGG

95 case series Fibrillary astrocytoma

39-41,05%

-9-9,47%

Subependimar astrcytoma

,

Ganglioglioma grade II 6-6,31%

Gangliocytoma 1-1,01%,

Protoplasmatic astrocytoma6-6,31%

Infundibuloma 1-1,01% Pleomorphic xantho-astrocytoma

(PXA) 2-2,10% ocyt c astrocytoma - ,

Oligoastrocytoma grade II

10-10,05%

Neurocytoma 3-3,15%

Dysembryoblastic neuro-epithelial

Oligodendroglioma grade II7-7,36%


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Fibrillary Gemistocytic SubependimarProtoplasmatic Pilocytic ProtoplasmaticOli oastroc toma Oli odendro lioma Mixed liomaGanglioglioma Gangliocytoma InfundibulomaXantoastrocytoma Neurocytoma


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on ro scan a er onco og c rea men


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38 cases of recidives

u w -

cases

Frontal Temporal Parietal Occipital Other


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The most frequent encountered tumor was

.

The mean reccurence time of this veryhetero eneous rou of tumors was 4 2 ears

(1,7 years for gemistocytic astrocytoma grade II,

.


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21 cases (55,26%) remained in the same tumoral grade

17 44 73 r n m li n n r r i n

All gemistocytic astrocytomas presented malingnant

.

12 recurrences supported total resection at initial

surgery 7 cases remained in the same grade, and 5 progressed to

a higher grade.

THE PROFILE OF REOPERATED


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THE PROFILE OF REOPERATED

FEMALES 16 42,10%

MALES 22 57,90%

RECURRENCE


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23 cases of recidive benefit from subtotal

resection at initial o eration 13 of them remained in the same grade

From 3 cases with biopsy followed by chemo

and radiothera 1 remained in the sametumoral grade and 2 progressed to a morea ressive rade.


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Histological profile of recidives/regrowth.

.

Number Number of Same % from Higher Higher %from

casesGrade

III

Grade

IV

astrocytoma, ,

Gemistocytic

astrocytoma9 9 0 0 3 6 100%

Subependimarastrcytoma 3 1 1 100% 0 0 0

Protoplasmatic 6 0 0 0 0 0 0astrocytoma

Oligoastrocytoma

grade II

10 5 3 60% 1 1 40%

go en rog oma

grade II, ,

Mixed glioma grade

II3 1 1 100% 0 0 0

Gangliogliomagrade II

6 2 2 100% 0 0 0

% from # = the percentage from the same anatomopathological category.


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28 ears old woman o erated in 1998 for a tem oral fibrillar

astrocytoma with postoperative radio and chemotherapy


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In 2001 she was o erated for a recidive with the same tumoral

grade adding a decompressive craniotomy


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In Januar 2005 she was o erated a ain for another recidive,

who remained in the same histological grade


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IRM Se tember 2006

>8 years of evolution


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None of the Grade I tumors showed evidence of

malignant progression.

Gangliocytoma grade I-IRM 5 years after operation


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years o man, w se zures s ar e n ay


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Biopsy,-fibrillary astrocytoma in November 2005

pos - opsy

The patient refused oncologic treatement.


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The tumor evolved after 10 months to a lioblastoma, and was

operated in august 2006


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Our results indicate that both tumor progression and

histopathological dedifferentiation were less commonlyseen w en a tota resect on cou e ac eve .

Data from this study demonstrate that tumorprogression occurs in 44,73% of a heterogenic group ofn trat ve s su ecte to next surger es.

Gross- total resection with postoperative adjuvanttherapy was associated with increased time to second

surgery, an ow nc ence o progress on omalignancy.

Neurosurgical management of recurrences in low grade glioma

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