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 !!!

Does the salvage surgery impact on the SURVIVAL of patients with recurrent high-grade glioma?

NOTNOTAcknowledgments: