The multifocal glioblastomas (GBM) are tumors with multiple discrete areas of contrast enhancing tumors which have considerably poorer prognosis than solitary GBM. Median overall survival of diagnosed patients almost ...The multifocal glioblastomas (GBM) are tumors with multiple discrete areas of contrast enhancing tumors which have considerably poorer prognosis than solitary GBM. Median overall survival of diagnosed patients almost twice as less than solitary presentation. We present a case report of multifocal GBM. A 72-year old right-handed male was evaluated at the Neuro-Oncology Clinic of Baylor Scott and White Hospital (Central Division). Patient presented at this hospital because of persistent progressive headaches, confusion, and an incident of fall. Physical evaluation revealed neurological impairments. Brain magnetic resonance imaging (MRI) revealed heterogeneous contrast enhancing lesions with associated vasogenic oedema. Patient underwent a stereotactic biopsy analysis of the larger lesion and pathology evaluation concluded an isocitrate dehydrogenase 1 and 2 wild type GBM with unmethylated O-6-methylguanine- DNA methyltransferase. Treatment remedies: Patient received 4 weeks concurrent radiation therapy along with combination of temozolomide at dose of 75 mg/m^2 followed adjuvant temozolomide for 10 cycles with bevacizumab at 10 mg/kg every 2 weeks and Optune treatment. Post treatment evaluation: Repeat MRIs showed near complete resolution of the tumors at 26 months of treatment along with improvement of neurological status. Conclusion: Due to limitations of surgical manipulations in multifocal GBM diagnosed patients, combinational chemo and radiation therapy is the treatment of choice for most cases. Using additional novel treatment with non-invasive therapeutic device proven to be effective is another excellent approach to the established practice. Therefore, combination therapy of Optune plus temozolomide and bevacizumab might be a promising remedy for newly diagnosed multifocal glioblastomas.展开更多
Despite improved survival outcomes across many cancer types,the prognosis remains grim for certain solid organ cancers including glioblastoma and pancreatic cancer.Invariably in these cancers,the control achieved by t...Despite improved survival outcomes across many cancer types,the prognosis remains grim for certain solid organ cancers including glioblastoma and pancreatic cancer.Invariably in these cancers,the control achieved by time-limited interventions such as traditional surgical resection,radiation therapy,and chemotherapy is short-lived.A new form of anti-cancer therapy called therapeutic alternating electric fields(AEFs)or tumor treating fields(TTFields)has been shown,either by itself or in combination with chemotherapy,to have anti-cancer effects that translate to improved survival outcomes in patients.Although the pre-clinical and clinical data are promising,the mechanisms of TTFields are not fully elucidated.Many investigations are underway to better understand how and why TTFields is able to selectively kill cancer cells and impede their proliferation.The purpose of this review is to summarize and discuss the reported mechanisms of action of TTFields from pre-clinical studies(both in vitro and in vivo).An improved understanding of how TTFields works will guide strategies focused on the timing and combination of TTFields with other therapies,to further improve survival outcomes in patients with solid organ cancers.展开更多
目的评价肿瘤电场治疗同步放化疗方案用于治疗新诊断胶质母细胞瘤患者的安全性。方法回顾性分析南京医科大学第一附属医院神经外科自2022年2月至2022年11月收治的23例新诊断胶质母细胞瘤患者的临床资料。所有患者皆采取肿瘤电场治疗同...目的评价肿瘤电场治疗同步放化疗方案用于治疗新诊断胶质母细胞瘤患者的安全性。方法回顾性分析南京医科大学第一附属医院神经外科自2022年2月至2022年11月收治的23例新诊断胶质母细胞瘤患者的临床资料。所有患者皆采取肿瘤电场治疗同步放化疗方案。按照常见不良事件通用术语5.0版标准(CTCAE 5.0)和肿瘤电场治疗相关皮肤不良反应(dAE)分级标准记录不良事件。治疗依从性通过Optume Nove TTF-200A治疗设备的使用数据进行评估,以每日肿瘤电场治疗使用时间的百分比计算。结果23例新诊断胶质母细胞瘤患者每日治疗中位时长为20.0 h,治疗依从性中位值为83.3%,dAE发生率为60.8%,主要为1级(56.5%)和2级(4.3%),无3~4级dAE。dAE主要表现为接触性皮炎、水泡、皮损等。21.7%(5/23)患者出现1~2级放化疗相关血液学不良反应,未发生严重血液系统疾病和重度电解质紊乱。结论新诊断胶质母细胞瘤术后采取肿瘤电场治疗同步放化疗方案是安全可靠的。展开更多
文摘The multifocal glioblastomas (GBM) are tumors with multiple discrete areas of contrast enhancing tumors which have considerably poorer prognosis than solitary GBM. Median overall survival of diagnosed patients almost twice as less than solitary presentation. We present a case report of multifocal GBM. A 72-year old right-handed male was evaluated at the Neuro-Oncology Clinic of Baylor Scott and White Hospital (Central Division). Patient presented at this hospital because of persistent progressive headaches, confusion, and an incident of fall. Physical evaluation revealed neurological impairments. Brain magnetic resonance imaging (MRI) revealed heterogeneous contrast enhancing lesions with associated vasogenic oedema. Patient underwent a stereotactic biopsy analysis of the larger lesion and pathology evaluation concluded an isocitrate dehydrogenase 1 and 2 wild type GBM with unmethylated O-6-methylguanine- DNA methyltransferase. Treatment remedies: Patient received 4 weeks concurrent radiation therapy along with combination of temozolomide at dose of 75 mg/m^2 followed adjuvant temozolomide for 10 cycles with bevacizumab at 10 mg/kg every 2 weeks and Optune treatment. Post treatment evaluation: Repeat MRIs showed near complete resolution of the tumors at 26 months of treatment along with improvement of neurological status. Conclusion: Due to limitations of surgical manipulations in multifocal GBM diagnosed patients, combinational chemo and radiation therapy is the treatment of choice for most cases. Using additional novel treatment with non-invasive therapeutic device proven to be effective is another excellent approach to the established practice. Therefore, combination therapy of Optune plus temozolomide and bevacizumab might be a promising remedy for newly diagnosed multifocal glioblastomas.
基金supported by the McNair Medical Institute at The Robert and Janice McNair Foundation.
文摘Despite improved survival outcomes across many cancer types,the prognosis remains grim for certain solid organ cancers including glioblastoma and pancreatic cancer.Invariably in these cancers,the control achieved by time-limited interventions such as traditional surgical resection,radiation therapy,and chemotherapy is short-lived.A new form of anti-cancer therapy called therapeutic alternating electric fields(AEFs)or tumor treating fields(TTFields)has been shown,either by itself or in combination with chemotherapy,to have anti-cancer effects that translate to improved survival outcomes in patients.Although the pre-clinical and clinical data are promising,the mechanisms of TTFields are not fully elucidated.Many investigations are underway to better understand how and why TTFields is able to selectively kill cancer cells and impede their proliferation.The purpose of this review is to summarize and discuss the reported mechanisms of action of TTFields from pre-clinical studies(both in vitro and in vivo).An improved understanding of how TTFields works will guide strategies focused on the timing and combination of TTFields with other therapies,to further improve survival outcomes in patients with solid organ cancers.
文摘目的评价肿瘤电场治疗同步放化疗方案用于治疗新诊断胶质母细胞瘤患者的安全性。方法回顾性分析南京医科大学第一附属医院神经外科自2022年2月至2022年11月收治的23例新诊断胶质母细胞瘤患者的临床资料。所有患者皆采取肿瘤电场治疗同步放化疗方案。按照常见不良事件通用术语5.0版标准(CTCAE 5.0)和肿瘤电场治疗相关皮肤不良反应(dAE)分级标准记录不良事件。治疗依从性通过Optume Nove TTF-200A治疗设备的使用数据进行评估,以每日肿瘤电场治疗使用时间的百分比计算。结果23例新诊断胶质母细胞瘤患者每日治疗中位时长为20.0 h,治疗依从性中位值为83.3%,dAE发生率为60.8%,主要为1级(56.5%)和2级(4.3%),无3~4级dAE。dAE主要表现为接触性皮炎、水泡、皮损等。21.7%(5/23)患者出现1~2级放化疗相关血液学不良反应,未发生严重血液系统疾病和重度电解质紊乱。结论新诊断胶质母细胞瘤术后采取肿瘤电场治疗同步放化疗方案是安全可靠的。
