Effect of Neoadjuvant Iodine-125 Brachytherapy Upon Resection of Glioma

Background: A more extensive surgical resection of glioma contributes to improved overall survival (OS) and progression-free survival (PFS). However, some of the patients lost the chance of surgical resection when the tumor involves critical structures. Purpose: The present study aimed to assess the feasibility of neoadjuvant 125I brachytherapy followed by total gross resection for initially inoperable glioma.Methods:Six patients diagnosed with inoperable glioma due to invasion of eloquent areas, bi-hemispheric diffusion, or large tumor volume received 125I brachytherapy. Surgical resection was performed when the tumor shrank, allowing a safe resection, assessed by the neurosurgeons. Patients were followed up after surgery.Results:Tumor shrinkage after adjuvant 125I brachytherapy enabled a total gross resection of all six patients. Four patients were still alive at the last follow-up, with the longest survival time of more than 50 months, two of which returned to a normal life with the KPS of 100. Another two patients got a neurological injury with the KPS of 80 and 50, respectively. One patient with grade Ⅱ glioma died 34 months, and another patient with grade Ⅳ glioma died 40 months later after the combined therapy.Conclusions: In the present study, the results demonstrated that 125I brachytherapy enabled a complete resection of patients with initially unresectable gliomas. 125I brachytherapy may offer a proper neoadjuvant therapy method for glioma.

MANAGEMENT OF ADRENO CORTICAL CARCINOMA: CASE REPORT

Objective: Adreno cortical carcinoma (ACC) is a rare malignancy. Currently, surgical resection offers the best chance of cure with localized tumor. Multimodal therapy including systemic chemotherapy and radiation therapy are often required for locally advanced and metastatic disease aims to decrease these high recurrence rates. Case(s) presentation: A 42-year-old male patient was referred from internist due to mass in left adrenal. Solid mass with calcification on left adrenal gland within size 9 x 11.8 x 11.5 cm was found in MSCT. We performed complete surgical resection (adrenalectomy), and results from pathology anatomy was ACC functional T2N1M0 (stage 3). The patient was planned eight times chemotherapy with etoposide and carboplatin, but he decided to stop the treatment after six times due to no constitutional complaint. We found no residual mass on follow up six months after operation and patient demonstrated a good clinical outcome after one year. Discussion: We perform open adrenalectomy and after surgery mitotane plus etoposide, cisplatin, doxorubicin (EDP) administered as first-line therapy but we only did chemotherapy with etoposide and carboplatin because mitotane was not covered by patient insurance. We chose to not perform radiation therapy due to lesser benefit of adjuvant radiotherapy as evidenced by many studies in term of recurrence-free survival and overall survival. Conclusion: In our case, adreno cortical carcinoma treated with open adrenalectomy combined with 6 times chemotherapy used etoposide and carboplatin demonstrated a good clinical outcome after 1 year.

Surgery vs. Biopsy in the Treatment of Butterfly Glioblastoma: A Systematic Review and Meta-Analysis

Butterfly glioblastomas (bGBM) are grade IV gliomas that spread to bilateral hemispheres by infiltrating the corpus callosum. Data on the effect of surgery are limited to small case series. The aim of this meta-analysis was to compare resection vs. biopsy in terms of survival outcomes and postoperative complications. A systematic review of the literature was conducted using PubMed, EMBASE, and Cochrane databases through March 2021 in accordance with the PRISMA checklist. Pooled hazard ratios were calculated and meta-analyzed in a random-effects model including assessment of heterogeneity. Out of 3367 articles, seven studies were included with 293 patients. Surgical resection was significantly associated with longer overall survival (HR 0.39, 95%CI 0.2–0.55) than biopsy. Low heterogeneity was observed (I2: 0%). In further analysis, the effect persisted in extent of resection subgroups of both ≥80% and <80%. No statistically significant difference between surgery and biopsy was detected in terms of postoperative complications, although these were numerically larger for surgery. In patients with bGBM, surgical resection was associated with longer survival prospects compared with biopsy.

Transcatheter Arterial Embolization in A Newborn with Cervical Kaposiform Hemangioendothelioma and Kasabach-Merritt Phenomenon.

We report a case of a 9-day-old newborn who underwent arterial embolization for Kaposiform hemangioendothelioma (KHE) with Kasabach-Merritt phenomenon (KMP), combined with sirolimus treatment, and the outcome was favorable. To the best of our knowledge, there are no case reports of such small infants undergoing arterial embolization to treat KHE. Our successful experience of treating KHE with KMP showed that transcatheter arterial embolization is feasible and can be used as an alternative to surgical resection, even in small infants.

The Role of Geriatric Nutritional Risk Index in Predicting Postoperative Pulmonary Complications in Elderly Lung Cancer Patients Undergoing Surgical Resection

Background The relationship between immunonutritional status (eg. Prognostic nutritional index [PNI] and Controlling Nutritional Status [COUNT] score) and risk of postoperative pulmonary complications (PPCs) after surgical resection of lung cancer had reported before. However, another immunonutritional parameter- Geriatric Nutritional Risk Index (GNRI)-had never explored. Method To address this issue, in this study we retrospectively analyzed patients’ characteristics and PPCs in a cohort of lung cancer patients who were treated by surgical resection at our center. The clinical utility of patients’ characteristics for predicting PPCs was evaluated by receiver operating characteristic curve analysis and the Youden index. Univariate and multivariate analysis were applied to find the most important factors. Result A total of 128 patients met the inclusion criteria for this study. Significant differences in sex, GNRI, FEV1%, LY% were found between the PPC and non-PPC groups (all P<0.05). The difference in pathology between the 2 groups showed borderline statistical significance (P=0.052). We determined the best cutoff value of each parameter and calculated the corresponding sensitivity and specificity, and found that GNRI, FEV1% and LY% had similar diagnostic value. Multivariate analysis reveled GNRI, sex, LY% and FEV1% were filtered to be correlated to PPCs of elderly lung cancer patients received surgery therapy. Conclusion These results indicate that preoperative immunonutritional parameters of GNRI can be used to identify elderly lung cancer patients at risk of PPCs.