Staged Image-guided Robotic Radiosurgery and Deferred Chemotherapy to Treat a Malignant Glioma During and After Pregnancy

Romanelli, Pantaleo; Paiano, Milena; Crocamo,; Beltramo, G.; Bergantin, A.; Pantelis, E.; Antypas, Christos; Clerico, Aldo

doi:10.7759/cureus.2141

Cited by 3 publications

(3 citation statements)

References 10 publications

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“…37,38 The use of stereotactic radiosurgery, including CyberKnife (Accuray, Inc, Sunnyvale, CA), is rare in pregnant patients, and its risks in the gravid patient are similar to those of standard XRT regimens. 37,61 XRT should only be used in exceptional cases and only after radiation scatter to the fetus has been calculated by phantom measurements 4,17,62 to ensure fetal doses are within acceptable limits.…”

Section: Adjuvant Treatmentmentioning

confidence: 99%

Management of brain tumors presenting in pregnancy: a case series and systematic review

Rodrigues

Waldrop

Suharwardy

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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Patients who present with brain tumors during pregnancy require unique imaging and neurosurgical, obstetrical, and anesthetic considerations. Here, we review the literature and discuss the management of patients who present with brain tumors during pregnancy. Between 2009 and 2019, 9 patients were diagnosed at our institution with brain tumors during pregnancy. Clinical information was extracted from the electronic medical records. The median age at presentation was 29 years (range, 25e38 years). The most common symptoms at presentation included headache (n¼5), visual changes (n¼4), hemiparesis (n¼3), and seizures (n¼3). The median gestational age at presentation was 20.5 weeks (range, 11e37 weeks). Of note, 8 patients (89%) delivered healthy newborns, and 1 patient terminated her pregnancy. In addition, 5 patients (56%) required neurosurgical procedures during pregnancy (gestational ages, 14e37 weeks) because of disease progression (n¼2) or neurologic instability (n¼3). There was 1 episode of postneurosurgery morbidity (pulmonary embolism [PE]) and no surgical maternal mortality. The median length of follow-up was 15 months (range, 6e45 months). In cases demonstrating unstable or progressive neurosurgical status past the point of fetal viability, neurosurgical intervention should be considered. The physiological and pharmacodynamic changes of pregnancy substantially affect anesthetic management. Pregnancy termination should be discussed and offered to the patient when aggressive disease necessitates immediate treatment and the fetal gestational age remains previable, although neurologically stable patients may be able to continue the pregnancy to term. Ultimately, pregnant patients with brain tumors require an individualized approach to their care under the guidance of a multidisciplinary team.

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Section: Adjuvant Treatmentmentioning

confidence: 99%

Management of brain tumors presenting in pregnancy: a case series and systematic review

Rodrigues

Waldrop

Suharwardy

et al. 2021

American Journal of Obstetrics & Gynecology MFM

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“…Eight articles (11 cases) [2][3][4][5][6][7][8][9] were extracted from PubMed (Figure 2A), and 25 articles (30 cases) were extracted from Ichushi-Web (Figure 2B). Thus, 42 cases including our case were reviewed.…”

Section: Resultsmentioning

confidence: 99%

Management Strategies for Brain Tumors Diagnosed during Pregnancy: A Case Report and Literature Review

et al. 2021

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Background and Objectives: Maternal brain tumors diagnosed during pregnancy are very rare, and their clinical course remains incompletely understood. We recently experienced a case of a brain tumor diagnosed at 30 weeks of gestation, and the treatment was initiated after delivery at 32 weeks of gestation. In this study, we reviewed case reports of brain tumors diagnosed during pregnancy, focusing on whether the brain tumor was treated during pregnancy or after termination of pregnancy and on the timing of therapeutic intervention. Materials and Methods: We searched PubMed and Ichushi-Web for articles published after January 2000 that reported cases of maternal brain tumors diagnosed during pregnancy. The patients were divided into two groups according to whether the tumor was treated during pregnancy (Group A) or after termination of pregnancy (Group B). Results: In total, 42 patients were included in the study (13 (31%) in Group A and 29 (69%) in Group B). The most common symptoms before diagnosis were those caused by increased intracranial pressure (57.1%). The diagnosis was made at 18 ± 6 weeks of gestation in Group A and 26 ± 9 weeks of gestation in Group B (p = 0.007). In all cases diagnosed after 34 weeks of gestation, termination of pregnancy was followed by treatment. Treatment was initiated within two weeks of diagnosis in 50% of patients in Group A and 30% in Group B. Conclusions: When severe symptoms caused by increased intracranial pressure last for several weeks, imaging tests should be considered. Termination of pregnancy is a good option for a brain tumor diagnosed after 34 weeks of gestation, while comprehensive treatment decisions should be made based on the severity of symptoms and the course of pregnancy in other cases.

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“…The patient was qualified for stereotaxic radiotherapy in the 3x8 Gy regimen. A follow-up MRI of the brain performed 33 months after the end of radiotherapy showed complete regression [ 165 ].…”

Section: Development Prospects Of Radiotherapy In Glioblastomasmentioning

confidence: 99%

New Directions in the Therapy of Glioblastoma

Szklener

Mazurek²,

Wieteska³

et al. 2022

Cancers

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Glioblastoma is the most common histologic type of all gliomas and contributes to 57.3% of all cases. Despite the standard management based on surgical resection and radiotherapy, it is related to poor outcome, with a 5-year relative survival rate below 6.9%. In order to improve the overall outcome for patients, the new therapeutic strategies are needed. Herein, we describe the current state of knowledge on novel targeted therapies in glioblastoma. Based on recent studies, we compared treatment efficacy measured by overall survival and progression-free survival in patients treated with selected potential antitumor drugs. The results of the application of the analyzed inhibitors are highly variable despite the encouraging conclusions of previous preclinical studies. This paper focused on drugs that target major glioblastoma kinases. As far, the results of some BRAF inhibitors are favorable. Vemurafenib demonstrated a long-term efficacy in clinical trials while the combination of dabrafenib and trametinib improves PFS compared with both vemurafenib and dabrafenib alone. There is no evidence that any MEK inhibitor is effective in monotherapy. According to the current state of knowledge, BRAF and MEK inhibition are more advantageous than BRAF inhibitor monotherapy. Moreover, mTOR inhibitors (especially paxalisib) may be considered a particularly important group. Everolimus demonstrated a partial response in a significant proportion of patients when combined with bevacizumab, however its actual role in the treatment is unclear. Neither nintedanib nor pemigatinib were efficient in treatment of GBM. Among the anti-VEGF drugs, bevacizumab monotherapy was a well-tolerated option, significantly associated with anti-GBM activity in patients with recurrent GBM. The efficacy of aflibercept and pazopanib in monotherapy has not been demonstrated. Apatinib has been proven to be effective and tolerable by a single clinical trial, but more research is needed. Lenvatinib is under trial. Finally, promising results from a study with regorafenib may be confirmed by the ongoing randomized AGILE trial. The studies conducted so far have provided a relatively wide range of drugs, which are at least well tolerated and demonstrated some efficacy in the randomized clinical trials. The comprehensive understanding of the molecular biology of gliomas promises to further improve the treatment outcomes of patients.

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Staged Image-guided Robotic Radiosurgery and Deferred Chemotherapy to Treat a Malignant Glioma During and After Pregnancy

Cited by 3 publications

References 10 publications

Management of brain tumors presenting in pregnancy: a case series and systematic review

Management of brain tumors presenting in pregnancy: a case series and systematic review

Management Strategies for Brain Tumors Diagnosed during Pregnancy: A Case Report and Literature Review

New Directions in the Therapy of Glioblastoma

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