does the salvage surgery impact on the survival of...
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Does the salvage surgery impact on the survival of patients with recurrent high-grade glioma?
Thiago Lins Almeida Médico Assistente do Hospital São José
Médico Titular do Hospital São JoaquimPós-Graduando da Faculdade de Medicina de Ribeirão Preto - USP
NOTNOT
Rescue TreatmentAre there an established standard therapy ?
Does the salvage surgery impact on the SURVIVAL of patients with recurrent high-grade glioma?
NOTNOT
Salvage Surgery
Bulk reduction Yes / Maybe
Symptoms control Yes / Maybe
AIES AED reduction Yes / Maybe
Accurate diagnosis Yes / Maybe
Cure No
ECOG Midline involvement Eloquent areas Tumor volume Resection
Does the salvage surgery impact on the SURVIVAL of patients with recurrent high-grade glioma?
NOTNOTThe patient selection
Results of the surgical intervention
PFS6 and OS are similar
OS 18.9 vs 9 (p?) bias: CHT and/or XRT
Control: PFS6 15% and OS 5-7 m
I N V A S I V E
JCO. 2010 Aug 20;28(24):3838-43
Eur J Cancer. 2012 May;48(8):1176-84
Neuro Oncol 2012;14(4):390-1
Jpn J Radiol. 2012 Apr;30(3):193-7
GTR PFS8 28%
mT re-operation to death 7.4 m J Clin Oncol. 2010 Aug 20;28(24):3838-43
Tools for Treatment Epidemiology
Symptoms (Duffau 2004 - 2012)
Diagnosis Images CT / PET / MRI (Lauterbur 1973 - 2012)
Neuropathology - WHO (1979 - 2002 - 2007)
Criteria Macdonald and RANO
Management Neurosurgery Radiotherapy Systemic intervention
(Hart 2000 - Park 2010)
(Walker 1978 - IGRT 2005 - Frosina 2009)
(Stewart 2002 - Stupp 2005)
(CBTRUS 2011)
(1990-2010)
J Transl Med. 2012; Clin Transl Oncol. 2012Cell Stress Chaperones. 2012; Med Oncol. 2012World J Clin Oncol. 2012
new insights
Does the salvage surgery impact on the SURVIVAL of patients with recurrent high-grade glioma?
NOTNOT
bevacizumab has become a mainstay of treatment for recurrence
Does the salvage surgery impact on the SURVIVAL of patients with recurrent high-grade glioma?
NOTNOT
CCNU, BCNUCarbo, CPT11, VP16
Hydrea, Imatinib
NovoTTF-systemPerillyl alcoholVacines CHT IT
reTMZBev (+ CPT11)
Impact on CHT and RXT
PFS6m bayesiana analysis
reTMZ 36%
Bev 29 - 42%
BCNU 19%
ReRXT 79%
The Cancer Genome Atlas Network: proneural, neural, classical, mesenchymal
MGMT, IDH1/2, EGFRvIII, PTEN, 1p19q, p53
CD133/44
Recurrent HGG
Does the salvage surgery impact on the SURVIVAL of patients with recurrent high-grade glioma?
NOTNOT
Does the salvage surgery impact on the survival?
NOTNOT
Does the salvage surgery impact on the QoL?
YesYes
There are other better interventions !!!