scholarly journals PATH-19. MOLECULAR, HISTOLOGIC AND CLINICAL CHARACTERISTICS OF OLIGODENDROGLIOMAS: A MULTI-INSTITUTIONAL RETROSPECTIVE STUDY

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii168-ii168
Author(s):  
Antonio Dono ◽  
Kristin Alfaro-Munoz ◽  
Yuanqing Yan ◽  
Carlos Lopez-Garcia ◽  
Zaid Soomro ◽  
...  
Keyword(s):  
Health Science ◽  
Cancer Center ◽  
Subtotal Resection ◽  
Adjuvant Radiation ◽  
Science Center ◽  
Who Grade ◽  
Pik3ca Mutations ◽  
Increased Risk ◽  
Significant Difference ◽  
Grade 3

Abstract In the 2016 WHO classification of CNS tumors, oligodendrogliomas are molecularly defined by IDH1 or IDH2 mutations and 1p/19q co-deletion. Some reports suggest that PI3K pathway alterations may confer increased risk of progression and poor prognosis in oligodendroglioma. However, factors that influence prognosis in molecularly defined oligodendroglioma (mOGD) have not been thoroughly studied. Also, the benefits of adjuvant radiation and temozolomide in mOGDs remain to be determined. 107 mOGDs diagnosed between 2008-2018 at the University of Texas Health Science Center at Houston (n= 39) and MD Anderson Cancer Center (n= 68) were included. A retrospective review of the demographic, clinical, histologic, molecular, and outcomes were performed. Median age at diagnosis was 37 years and 61 (57%) patients were male. There were 64 (60%) WHO Grade 2 and 43 (40%) WHO Grade 3 tumors. Ninety-five (88.8%) tumors were IDH1-mutant and 12 (11.2%) were IDH2-mutant. Eighty-two (77%) patients were stratified as high-risk: older than 40-years and/or subtotal resection (RTOG 9802). Gross-total resection was achieved in 47 (45%) patients. Treatment strategies included observation (n= 15), temozolomide (n= 11), radiation (n= 13), radiation with temozolomide (n= 62) and other (n= 6). Our results show a benefit of temozolomide vs. observation in progression-free survival (PFS). However, no benefit in PFS or overall survival (OS) was observed when comparing radiation vs. radiation with temozolomide. PIK3CA mutations were detected in 15 (14%) cases, and patients with PIK3CA-mutant mOGDs showed worse OS (10.7-years vs 15.1-years, p= 0.009). Patients with WHO Grade 3 tumors had shorter PFS but no significant difference in OS was observed compared to grade 2. Our findings suggest that mOGDs harboring PIK3CA mutations have worse OS. Except for an advantage in PFS in temozolomide treated patients, adjuvant treatment with radiation or the combination of both, showed no significant advantage in terms of OS.

scholarly journals The effect of adjuvant radiotherapy on overall survival in adults with intracranial ependymoma

2019 ◽  
Vol 7 (4) ◽  
pp. 391-399
Author(s):  
Roshan S Prabhu ◽  
Christopher D Corso ◽  
Matthew C Ward ◽  
John H Heinzerling ◽  
Reshika Dhakal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Propensity Score ◽  
Adjuvant Radiotherapy ◽  
Subtotal Resection ◽  
National Cancer Database ◽  
Risk Of Death ◽  
Increased Risk ◽  
Intracranial Ependymoma ◽  
Male Sex ◽  
Grade 3

Abstract Background Adult intracranial ependymoma is rare, and the role for adjuvant radiotherapy (RT) is not well defined. Methods We used the National Cancer Database (NCDB) to select adults (age ≥ 22 years) with grade 2 to 3 intracranial ependymoma status postresection between 2004 and 2015 and treated with adjuvant RT vs observation. Four cohorts were generated: (1) all patients, (2) grade 2 only, (3) grade 2 status post–subtotal resection only, (4) and grade 3 only. The association between adjuvant RT use and overall survival (OS) was assessed using multivariate Cox and propensity score matched analyses. Results A total of 1787 patients were included in cohort 1, of which 856 patients (48%) received adjuvant RT and 931 (52%) were observed. Approximately two-thirds of tumors were supratentorial and 80% were grade 2. Cohorts 2, 3, and 4 included 1471, 345, and 316 patients, respectively. There was no significant association between adjuvant RT use and OS in multivariate or propensity score matched analysis in any of the cohorts. Older age, male sex, urban location, higher comorbidity score, earlier year of diagnosis, and grade 3 were associated with increased risk of death. Conclusions This large NCDB study did not demonstrate a significant association between adjuvant RT use and OS for adults with intracranial ependymoma, including for patients with grade 2 ependymoma status post–subtotal resection. The conflicting results regarding the efficacy of adjuvant RT in this patient population highlight the need for high-quality studies to guide therapy recommendations in adult ependymoma.

scholarly journals Enhancing Competency in Professionalism: Targeting Resident Advance Directive Education

2010 ◽  
Vol 2 (2) ◽  
pp. 278-282 ◽  
Author(s):  
Colleen Y. Colbert ◽  
Curtis Mirkes ◽  
Paul E. Ogden ◽  
Mary Elizabeth Herring ◽  
Christian Cable ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Medical School ◽  
Advance Directives ◽  
Advance Directive ◽  
Residency Program ◽  
Health Science ◽  
Science Center ◽  
Sufficient Knowledge ◽  
Significant Difference ◽  
School Curricula

Abstract Background Education about advance directives typically is incorporated into medical school curricula and is not commonly offered in residency. Residents' experiences with advance directives are generally random, nonstandardized, and difficult to assess. In 2008, an advance directive curriculum was developed by the Scott & White/Texas A&M University System Health Science Center College of Medicine (S&W/Texas A&M) internal medicine residency program and the hospital's legal department. A pilot study examining residents' attitudes and experiences regarding advance directives was carried out at 2 medical schools. Methods In 2009, 59 internal medicine and family medicine residents (postgraduate year 2–3 [PGY-2, 3]) completed questionnaires at S&W/Texas A&M (n  =  32) and The University of Texas Medical School at Houston (n  =  27) during a validation study of knowledge about advance directives. The questionnaire contained Likert-response items assessing attitudes and practices surrounding advance directives. Our analysis included descriptive statistics and analysis of variance (ANOVA) to compare responses across categories. Results While 53% of residents agreed/strongly agreed they had “sufficient knowledge of advance directives, given my years of training,” 47% disagreed/strongly disagreed with that statement. Most (93%) agreed/strongly agreed that “didactic sessions on advance directives should be offered by my hospital, residency program, or medical school.” A test of responses across residency years with ANOVA showed a significant difference between ratings by PGY-2 and PGY-3 residents on 3 items: “Advance directives should only be discussed with patients over 60,” “I have sufficient knowledge of advance directives, given my years of training,” and “I believe my experience with advance directives is adequate for the situations I routinely encounter.” Conclusion Our study highlighted the continuing need for advance directive resident curricula. Medical school curricula alone do not appear to be sufficient for residents' needs in this area.

Short-term outcomes associated with temozolomide or PCV chemotherapy for 1p/19q-codeleted WHO grade 3 oligodendrogliomas: a national evaluation

2022 ◽  
Author(s):  
Nayan Lamba ◽  
Malia McAvoy ◽  
Vasileios K Kavouridis ◽  
Timothy R Smith ◽  
Mehdi Touat ◽  
...  
Keyword(s):  
Cox Regression ◽  
Extent Of Resection ◽  
First Line ◽  
Short Term ◽  
Who Grade ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
Pcv Chemotherapy ◽  
Grade 3 ◽  
National Analysis

Abstract Background The optimal chemotherapy regimen between temozolomide and procarbazine, lomustine, and vincristine (PCV) remains uncertain for W.H.O. grade 3 oligodendroglioma (Olig3) patients. We therefore investigated this question using national data. Methods Patients diagnosed with radiotherapy-treated 1p/19q-codeleted Olig3 between 2010-2018 were identified from the National Cancer Database. The OS associated with first-line single-agent temozolomide vs. multi-agent PCV was estimated by Kaplan-Meier techniques and evaluated by multivariable Cox regression. Results 1,596 radiotherapy-treated 1p/19q-codeleted Olig3 patients were identified: 88.6% (n=1,414) treated with temozolomide and 11.4% (n=182) with PCV (from 5.4% in 2010 to 12.0% in 2018) in the first-line setting. The median follow-up was 35.5 months (interquartile range [IQR] 20.7-60.6 months) with 63.3% of patients alive at time of analysis. There was a significant difference in unadjusted OS between temozolomide (5yr-OS 58.9%, 95%CI: 55.6-62.0) and PCV (5yr-OS 65.1%, 95%CI: 54.8-73.5; p=0.04). However, a significant OS difference between temozolomide and PCV was not observed in the Cox regression analysis adjusted by age and extent of resection (PCV vs. temozolomide HR 0.81, 95%CI: 0.59-1.11, p=0.18). PCV was more frequently used for younger Olig3s, but otherwise was not associated with patient’s insurance status or care setting. Conclusions In a national analysis of Olig3s, first-line PCV chemotherapy was associated with a slightly improved unadjusted short-term OS compared to temozolomide; but not following adjustment by patient age and extent of resection. There has been an increase in PCV utilization since 2010. These findings provide preliminary data while we await the definitive results from the CODEL trial.

Rationale for the utilization of biological targeted agents (bTAs) in the treatment of metastatic colorectal cancer (mCRC), single tertiary cancer center experience.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e15589-e15589
Author(s):  
Ivan Barrera ◽  
Yahia A. Lakehal ◽  
Tomas Kavan ◽  
Petr Kavan
Keyword(s):  
Bowel Perforation ◽  
Primary Objective ◽  
Cancer Center ◽  
Gi Symptoms ◽  
Significant Difference ◽  
Common Grade ◽  
Jewish General Hospital ◽  
Grade 3 ◽  
Physician Patient ◽  
Tertiary Cancer Center

e15589 Background: Worldwide treatment for 1st line (1LTx) mCRC included doublet or triple chemotherapy with or without bTAs. In Quebec, the anti-EGFR therapy (panitumumab or cetuximab) was only recently approved in this setting for patients RAS WT, Bevacizumab (B) not eligible. In this study we evaluated the rational and outcomes using bTAs. Methods: Retrospective study assessing mCRC pts treated with or without bTAs at any time throughout the course of therapy at the Jewish General Hospital between 2010-2018. Pts were divided in 3 groups according to their 1LTx for analysis: Chemotherapy alone (1LChA), Chemotherapy plus B (1LChB), and anti-EGFR with or without chemotherapy (1LaEGFR). The primary objective was to assess the rational of bTAs prescription based in 1LTx selection. Secondary objectives included safety, PFS and OS. Results: Among a total of 463 pts with mCRC; 196 pts (42.3%) received 1LChA, 246 pts (53.2%) 1LChB, and 21 pts (4.5%) 1LaEGFR respectively. 1LChA group, 51% omitted bTAs for physician-patient preferences, 96 pts (49%) had contraindications for B, and 79 pts (40.3%) were potentially candidates for aEGFR, but did not receive it. 152/196 (77.5%) pts continued to 2LTx and 34.8% received bTAs. As for the 3LTx, 78/196 (40%) received a treatment, 48.7% received bTAs. The most common grade 3-4 adverse events (AEs) were hypertension and bowel perforation in B, gastrointestinal (GI) symptoms and skin reaction (SR) in aEGFR. 1LChB group, 31 pts (12.6%) presented AEs related to B. 191/246 pts (77.6%) continued to 2LTx with 48 pts (25%) receiving ChB despite progression in 1LTx on this bTA and 19 pts (10%) receiving aEGFR. The most common AEs reported in 2LTx were GI symptoms and neuropathy. In 3LTx, 54/91pts (59.3%) received aEGFR therapy and 8 pts (14.8%) had SR AEs. 46 pts (18.6%) continued to 4LTx, 13/46 pts (28.2%) received aEGFR. 1LaEGFR group, the most common AEs were SR and GI symptoms. 11/21 pts (52.3%) continued to 2LTx; 5 pts (45.4%) switching bTA class and receiving ChB. 81% pts started treatment between 2017-2018 and had at least two contraindication criteria for. The median PFS for the 1LChA and 1LChB groups were 10 and 11.5 months, respectively, and were not statistically significant (p=0.22). The OS with 1LChA and 1LChB was 33.26 vs. 27.80 months (p=0.27). The PFS and OS between 1LChA and 1LaEGFR were 10 vs 11 months (p= 0.27) and 33.26 vs. 35.07 months (p=0.13). Conclusions: The outcome and tolerability of bTAs in mCRC appear similar in our institution and randomised trials. We were not able to detect any significant difference among the three groups of comparison. The 1LaEGFR available data in this subset of patients are limited. Our data highlights the importance of optimal therapeutic sequencing to prolong OS. Dedicated studies are needed in order to determine the best bTAs therapeutic strategy in mCRC.

Cisplatin-associated nephrotoxicity in clinical trials using serum creatinine (SCr) versus calculated glomerular filtration rate (GFR) as inclusion criterion: A meta-analysis.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 272-272
Author(s):  
Arati Dahal ◽  
Brandon Kyle Bellows ◽  
Guru Sonpavde ◽  
Matt D. Galsky ◽  
Neeraj Agarwal
Keyword(s):  
Renal Function ◽  
Fixed Effects ◽  
Literature Search ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Inclusion Criteria ◽  
Who Grade ◽  
Increased Risk ◽  
Grade 3 ◽  
Re Methods

272 Background: Treatment with cisplatin (CIS) is associated with increased risk of nephrotoxicity and SCr is commonly used to screen patients for renal dysfunction prior to enrollment in trials using CIS. However, GFR is known to better estimate renal function than SCr. The objective of this trial-level meta-analysis was to indirectly compare incidence of WHO grade ≥3 nephrotoxicity associated with CIS therapy when renal function was assessed using SCr vs. calculated GFR during screening for these trials. Methods: A PubMed literature search was used to identify randomized trials comparing treatment regimens including CIS to those without CIS. Studies were included if they were performed between 1990 and 2005, reported SCr or GFR as inclusion criteria, and reported WHO grade ≥3 nephrotoxic events for both the CIS and non-CIS treatment arms. Studies were excluded if they were review articles, observational, phase 1, non-randomized, did not have a comparator group, or were not reported in English. Inverse variance weighted fixed effects (FE) and random effects (RE) methods were used to estimate the relative risk (RR) associated with CIS vs. non-CIS containing regimens with sub-group analyses of studies using SCr, GFR, and either SCr or GFR for screening. Results: The literature search identified 2359 studies. After exclusion criteria, 549 were reviewed and 24 studies (N=5524 patients) met all inclusion criteria for analysis. Of these, 16 studies used SCr (N=3955), 3 used GFR (N=692), and 5 used SCr or GFR (N=877) for screening. Overall incidence proportion of nephrotoxicity was higher for CIS vs. non-CIS regimens (2.1% vs. 0.7%). Overall RR for CIS vs. non-CIS regimens was 2.49 (95%CI 1.37-4.51, p=0.003). In sub-group analyses, the RR was 2.63 (95%CI 1.29-5.39, p=0.008) for SCr compared to 2.39 (95%CI 0.53-10.64, p=0.26) for GFR and 2.03 (95%CI 0.46-9.02, p=0.35) for either SCr or GFR. The RRs did not differ between the FE and RE methods. Conclusions: This indirect comparison meta-analysis shows CIS is associated with a higher likelihood of nephrotoxicity vs. non-CIS regimens, and may be higher when SCr is used instead of GFR as eligibility criteria.

Impact of bilateral mastectomy with or without immediate reconstruction on time to subsequent therapy in breast cancer in a community oncology clinic.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18154-e18154
Author(s):  
Rajshekhar Chakraborty ◽  
Ronald Regal ◽  
Brian Johnson ◽  
Jennifer Benedict ◽  
Bret Edward Buckley Friday
Keyword(s):  
Breast Cancer ◽  
Prophylactic Mastectomy ◽  
Contralateral Prophylactic Mastectomy ◽  
Bilateral Mastectomy ◽  
Cancer Center ◽  
Immediate Reconstruction ◽  
Community Oncology ◽  
Increased Risk ◽  
Significant Difference ◽  
Definitive Surgery

e18154 Background: Due to an increase in the elective decision to pursue contralateral prophylactic mastectomy (CPM), the incidence of bilateral mastectomy (BM) with/without postmastectomy reconstruction (R) [BM+/-R] has increased in the last decade. While prior studies at academic centers have investigated concerns regarding its impact on subsequent cancer therapy, we hypothesized that BM+/-R is associated with a delay in initiation of adjuvant therapy (AT) in a community oncology clinic. Methods: This study involved chart review of all patients who underwent mastectomy as definitive surgery for stage I-III breast cancer between 2007 and 2012 and were subsequently followed at Essentia Health Cancer Center. The primary endpoint of the study was the proportion of patients receiving subsequent AT within 6 weeks of surgery (TST6) when compared between different surgical groups. Results: A total of 478 patients were included in the study, with a median age of 63 years. Patients were divided into 4 groups, BM-R (n = 133), BM+R (n = 73), unilateral mastectomy (UM) –R (n = 244) and UM+R (n = 28). Significant demographic differences were identified between the groups including age ( p< 0.001), medical comorbidities ( p< 0.001), and BMI ( p< 0.001). The incidence of any major post-operative complication (including flap/implant failure, infection and wound necrosis/dehiscence) or additional surgeries within 6 weeks of surgery was higher in patients undergoing reconstruction, [BM+R (19%) and UM+R (18%)] compared to those who did not [BM-R (6%) and UM-R (4%)] ( p< 0.001). Patients having major complications or needing additional surgeries within 6 weeks had a lower adjusted likelihood of achieving TST6 compared to those who did not (OR = 0.35; p= 0.009). However, there was no significant difference in TST6 between the surgical groups ( p= 0.31). Conclusions: Immediate post-mastectomy reconstruction is associated with a significantly increased risk of postoperative complications or need for additional surgeries within 6 weeks. In an appropriately selected patient population, CPM and reconstruction do not significantly delay subsequent AT in a community oncology clinic.

Liver metastases in mCRPC patients post-therapy with abiraterone (Abi) and/or abiraterone/enzalutamide (Enza).

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 250-250
Author(s):  
Lahiru Ranasinghe ◽  
Patrick Cotogno ◽  
Elisa M. Ledet ◽  
Allie E. Steinberger ◽  
Allison H. Feibus ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Gleason Score ◽  
Pearson Correlation ◽  
Subsequent Development ◽  
Liver Lesion ◽  
Cancer Center ◽  
Lesion Volume ◽  
Total Liver ◽  
Increased Risk ◽  
Significant Difference

250 Background: Liver metastases (mets) are a particularly poor prognostic group among mCRPC patients. The objective of this study is to characterize mCRPC patients who have had treatment with Abi or Enza to identify risk factors that may be associated with subsequent development of liver mets. Methods: A sample of 67 patients (n = 17 liver mets and 50 non-liver met patients matched by treatment history) seen at Tulane Cancer Center were selected for analysis. All patients had prior Abi and or Abi/Enza. Race, age at PCa diagnosis and Gleason Score at PCa diagnosis were assessed. For patients with liver mets, total liver metastatic volume was measured using CT scans and correlated against PSA, LDH and AST values at the time of the scan. Wilcoxon rank sum tests were run analyzing PSA, LDH and AST at the start of Abi treatment, end of Abi treatment as well the duration of Abi treatment, and the nadir PSA for these patients. Results: Patients were predominantly Caucasian, had a median Gleason Score of 8 at diagnosis and were at a median age of 57 for those with liver mets and 62 for non-liver met at PCa diagnosis. Pearson correlation analysis of the total liver lesion volume and lab values revealed a significant correlation for LDH (R = 0.491, < 0.01) and AST (R = 0.368, p < 0.05), but not for PSA. Further evaluation of PSA and AST values at the start and end of Abi treatment as well as at nadir PSA revealed no statistically significant differences between liver met patients and non-liver met patients. However, there was a significant difference (p = 0.015) between LDH levels at the end of Abi treatment with a median of 347 U/L for liver met and 238 U/L for non-liver met patients. Conclusions: LDH and AST levels correlate with extent of liver metastases. Additionally, elevated LDH at the end of Abi treatment is indicative of an increased risk for developing liver metastases. Larger sample sizes and molecular characterization of these tumors are required to gain more insights into this important patient population.

Transfusion Efficacy of Apheresis Platelet Concentrates (APCs) Irradiated in Advance Is Significantly Lower Compared to Products Irradiated within 24 hours Before Transfusion.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 3139-3139
Author(s):  
Friedgard Julmy ◽  
Roland A Ammann ◽  
Behrouz Mansouri Taleghani ◽  
Stefano Fontana ◽  
Andreas Hirt ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Storage Time ◽  
Conflicts Of Interest ◽  
Who Grade ◽  
Significant Difference ◽  
Mixed Regression ◽  
Grade 3 ◽  
The Many ◽  
Gamma Irradiated ◽  
The Impact

Abstract Abstract 3139 Poster Board III-76 Background Several guidelines on gamma irradiation of blood components state that platelets can be irradiated at any stage in their five-day storage and can thereafter be stored up to their normal shelf life of five days after collection. We explored whether the timing of irradiation has an effect on the transfusion efficacy of APCs. Patients and methods Transfusion efficacy of 809 APCs (median 6/child; range 1-68) transfused to 113 children and adolescents (53 girls and 60 boys, age 0.1y-20.0y) with thrombocytopenia due to a reduced platelet production caused by their haematological/oncological disease itself or by the applied chemotherapy was evaluated retrospectively. Transfusions were divided according to 3 APCs-groups: nonirradiated, irradiated within 24 hours before transfusion (≤ 24h), and irradiated in advance (> 24h). Exclusion criteria were: splenomegaly, fever ≥38.5°C, hemorrhage ≥ WHO Grade 3, or discontinuation of transfusion due to transfusion reactions. Transfusion efficacy was measured by the 1-hour PPR, ( PPR1h [%] = (post-transfusion count [109/L] – pre-transfusion count [109/L]) x blood volume [L] / PLT dose [1011/L]). Accounting for the many patients receiving multiple transfusions, linear mixed regression was used for univariate and multivariate analyses. Results Univariate comparison of PPR1h is summarized in the table. We recently have shown that a variety of factors influences transfusion efficacy of APCs (TRANSFUSION 48; 2008, p.442; TRANSFUSION 49; 2009, p.21). Therefore, all these variables were included in the present analysis. Multivariate analysis, corrected for storage time, applied apheresis procedure, apheresis yield, ABO transfusion constellation, body weight of recipients, and platelet count before transfusion, confirmed that transfusion of APCs irradiated in advance was associated with a significantly inferior transfusion efficacy compared to nonirradiated APCs (estimated difference in PPR1h, 4.9%; 95% confidence interval, 1.3 to 8.5; p=0.008), while transfusion efficacy of APCs irradiated within 24 hours before transfusion was not (estimated difference in PPR1h, 2.3%; 95% confidence interval, -1.0 to 5.5; p=0.18). Discussion Interestingly, no significant difference in transfusion efficacy could be observed between nonirradiated and APCs irradiated within 24 hours before transfusion, while transfusions of platelets irradiated in advance were significantly less efficient. Although many studies, including our own, provide evidence that gamma irradiated platelets have a lower transfusion efficacy, there are no data exploring the impact of the timing of the irradiation. Although our retrospective study indicates a reduced transfusion efficacy of APCs irradiated in advance, only a prospective randomized trial can unequivocally answer the question when platelets should be irradiated. Conclusions Our data strongly support that irradiation of APCs should be performed at the latest within 24 hours before transfusion. APCs irradiated in advance are less efficient. Disclosures No relevant conflicts of interest to declare.

scholarly journals Grade III meningioma: 10 year single centre case series

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv18-iv18
Author(s):  
Hari Mcgrath ◽  
Jose Lavrador ◽  
Ioannis Christodoulides ◽  
Prajwal Ghimire ◽  
Richard Gullan ◽  
...  
Keyword(s):  
Case Series ◽  
Extent Of Resection ◽  
Tumour Recurrence ◽  
Subtotal Resection ◽  
Who Grade ◽  
Surgical Interventions ◽  
Grade 3 ◽  
Oncology Centre ◽  
Rhabdoid Features

Abstract Rationale WHO Grade 3 meningiomas are a rare, malignant subtype of meningioma. Few controlled case series detailing its treatment and follow-up are to be found in the literature. Methods Retrospective cohort study of patients treated in a single neuro-oncology centre in the period between September 2008 and March 2019 with an initial diagnosis of WHO Grade 3 meningioma. Demographic and clinical data has been collected from the available medical records. Results 9 patients were included in this series: 2 had convexity, 2 sphenoid wing, 2 parafalcine, 1 parasagittal with a further 3 multiple locations and 1 patient with parietal convexity meningioma. 3 tumours displayed rhabdoid features, whilst 4 displayed papillary features and a further 2 displayed epithelial structures. All patients underwent surgical intervention: 5 patients had a subtotal resection with 3 having total resection. 3/4 of reported Simpson Grading was grade 2, whilst the remaining 1/4 was grade 1. The extent of resection for 1 patient was uncertain. Post surgically, 6 received adjuvant radiotherapy, 2 had no further treatment and 1 received gamma knife therapy. No patient received chemotherapy. 5 patients saw no tumour recurrence at follow up appointments (mean 50 months). Within 2 years of their respective surgical interventions, 4 patients died due to tumour recurrence and associated complications (3 patients). Conclusion To establish a uniform approach to treatment of patients with WHO Grade 3 meningiomas is challenging. Management involves a patient-centred approach based on multidisciplinary meeting decisions. Multicentre registries may allow further conclusions.

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