Outcome of High Grade Gliomas in Limited Resource Country (10 Years’ Experience in Alexandria University Oncology Center 2003-2012)

Abstract

Background: Gliomas are the most common form of malignant primary brain tumors in adults with an annual incidence of approximately five per 100,000 people. In Egypt, primary Central Nervous System (CNS) neoplasms are rare, constituting about 1-2% of all human neoplasms, with High Grade Gliomas (HGGs) being the most common type. The study aims to discover the histo-pathological aspect of HGGs, risk factors, and descriptive analysis of treatment received in Clinical oncology department affiliated with Alexandria University Hospital. Methods: Data were collected and analyzed for four hundred and thirty four patients with histologically proven HGGs in the period between 2003 and 2012. Results: Age of patients ranged from 21 to 83 years. Most cases (80.4%) were Glioblastoma Multiform (GBM), followed by Anaplastic Astrocytoma (AA) reaching14.3% of patients. In this study, 45.4% of patients had karnofsky performance score (KPS) more than 60%. Only 2.5% of patients underwent gross total resection (GTR), 25.6% underwent Subtotal Resection (STR) and 50% of patients underwent excisional biopsy. Patients received radiotherapy were 355 about 81.8% of patients with HGGs (80.2% of them received Radiotherapy (RT) only, 11.8% received RT followed by Adjuvant Chemotherapy (ACT), 4% received Concomitant Chemoradiotherapy (CCRT) and 4% received CCRT followed by ACT), 16.6% of patients received only best supportive care (BSC) and 2.3% did not receive treatment. The median Overall Survival (OS) was 10, 13, 19 and 15 months for patients received RT only, CCRT, CCRT followed by ACT and RT followed by ACT, respectively. Conclusion: Delayed presentation and inadequate GTR together with unavailability of TMZ could affect outcome in limited resource countries.

Prostate-Specific Membrane Antigen (PSMA) Expression in The Neovasculature of High Grade Gliomas (Histopathological and Immunohistochemical Study)

“…In the present study, the mean age was 43.54 ± 15.1 years, ranging from 7 to 74 years which was near to what was reported by Barakat et al, (2016); Gabal et al, (2018) and Saffar et al, (2018), where their patients' mean age was 50, 37.23 & 46 years respectively.…”

“…As regards the gender of cases, the males and females were nearly in equal proportion with slightly higher male incidence, which was slightly lower than Barakat et al, (2016), Hewedi et al, (2018) and Pouchieu et al, (2018) who reported male incidence as 60%, 63.3 % and 57.9% of cases respectively. The male gender predominance was also reported by CBTRUS Statistical Report which stated that the incidence was higher in males for most gliomas (Ostrom et al, 2021).…”

Ketogenic Metabolic Therapy, Without Chemo or Radiation, for the Long-Term Management of IDH1-Mutant Glioblastoma: An 80-Month Follow-Up Case Report

“…This strategy, in association with the surgical debulking, could have contributed in part to the slow growth and more effective resection of his GBM. It is well-documented that survival is longer in younger GBM patients (< 50 years) than in older GBM patients (> 50 years), and that patients receiving a more complete tumor resection generally survive longer than patients receiving a subtotal resection (10,(80)(81)(82). Total or subtotal neurosurgical resection, however, is generally obtained early after diagnosis to achieve a longer survival.…”

Management of Glioblastoma Multiforme in a Patient Treated With Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up

“…Glioblastoma multiforme (GBM) is the most common and malignant of the primary adult brain cancers ( 1 – 4 ). Although survival is better in younger adults (<50 years) than in older adults (>50 years), less than 20% of younger adults generally survive beyond 24 months ( 3 , 5 – 7 ). Accumulating evidence from cell culture studies and preclinical models indicate that glucose and glutamine are the primary fuels that drive the rapid growth of most tumors including GBM ( 8 – 11 ).…”