Ayhan ATTAR, Mehmet SELÇUKİ, Nihat EGEMEN, Ertekin ARASIL, Hasan Ç. UĞUR, Kenan KÖSE, Cumhur DİNÇER, Ali TAŞÇIOĞLU, Atilla ERDEM, Haluk DEDA, Ahmet ERDOĞAN

Nüks malign gliomalarda reoperasyon kriterleri

Ankara Üniversitesi Tıp Fakültesi Nöroşirurji kliniğinde 1985-1996 yılları arasında 150 olgu rekürren malign glial tümör nedeni ile öpere edildi. Olguların en küçüğü 9 en büyüğü 70 yaşındaydı (median 40). 37 olgunun (%24) patolojik tanısı glioblastoma multiforme, 113 olgunun (%76) anaplastik astrositom olarak değerlendirildi. İlk operasyonda anaplastik astrositom tanısı alan olguların 15 tanesinde (%13) ikinci patolojik tanı glioblastoma multiforme olarak değerlendirildi. Reoperasyon öncesi Kamofsky skalası (KS) 30-90 arasında değişmekte idi (median 60). Reoperasyon sonrası ilk 6 hafta içindeki ölümler mortalite olarak kabul edildi (% 18). Rekürren malign gljomalı hastalarda reoperasyonu geçerli ve kabul edilebilir temeller üzerine oturtabilmek için yaşam süresini uzatmak kadar yaşam kalitesini de arttırmak önemli bir kriter olmalıdır. Bu çalışmada yüksek standartlı yaşam kalitesi (YSYK) reoperasyon sonrası Kamofsky skalası 70'in üzerinde olan hastalar için kullanıldı. Bu çalışmada reoperasyon öncesi KS'nın 70'in üzerinde olan olgular ve ilk operasyonda gross total eksizyon yapılan olguların diğer değişkenler ile karşılaştırıldığında yaşam süresi ve kalitesine etki eden en önemli faktörler olduğu belirlendi.

Criteria for reoperation in nux malign gliomas

150 patients with recurrent malignant glial tu-mors were operated in Neurosurgery Clinic of University of Ankara between the years 1985-1996. The age of patients ranged between 9-70 (median 40). 37 of these (%24) patients were diagnosed as glioblastome multiforme and 113 (%76) were diagnosed as anaplastic astrocytoma. Of those 113 patients diagnosed as anaplastic astrocytoma, 15 (%13) were diagnosed having glioblastoma multiforme as a secondary patological diagnosis after the first operation. Kamofsky scale- ranged between 30-90 prior to reoperation (median 60). During the first six weeks following the reoperation the number of deaths was considered as mortality (%18). in the patients with recurrent malignant glioma increasing the life quality should be an important criteria as well as extending the life-span of the patients in order to base the reoperation on valid and acceptable grounds. in this study the High Quality Survival (HQS) was used on the patients whose Kamofsky scales were over 70 following the reoperation. When the results of the patients whose KS vvere över 70 prior to reoperation and the patients who undervent gross total exicion in the first operation were compared with the other variables, the former ones were accepted as the most important variables affecting the results.

PDF

___

1.Cobb CA, Youmans JR. Glial and neuronal tumors of the brain in adults, in Youmans JR (ed): Neurological sur-gery. Philadelphia, WB Saunders, 1982; p 2762.
2. Libermann AN, Ransohoff J. Treatmentof primary brain tu-mors. Med Clin North Am 63: 835-848, 1979.
3. Burger PC, Vogel FS. Surgical Pathology of the Nervous System and Its Coverings. New York, J VVİlley, 1976, pp 186-226.
4. Salcman M. Survivale in glioblastoma: Historical perspeeti-ve. Neurosurgery 1980; 7:435-9.
5. Eagen RT, Creagan ET, Bisel HF, Layton DD, Groover RV, Herman RC. Phase II study of dianhydrogalactitol based combination chemotherapy for recurrent brain tumors. Oncology 1981; 38:4-6.
6. European Organization for Research on treatment of Cancer Brain Tumor Group: Evaluation of CCNU, VM-26 plus CCNU, and procarbazine in supratentorial brain gli-omas: Final evaluation of a randomized study. J Nuero-surgery 1981; 55:27-31.
7. Gerosa MA, DiStefano E, Olivi A. VM-26 monoehemote-rapy trial in the treatment of recurrent supratentorial gli-omas: Preliminary report. Surgical Neurology. 1981; 15: 128-34.
8. Levin VA, VVilson CB, Davis R, VVara WM, Pischer TL, Irvvin L. A Phase III comparison of BCNÜ, hydroxyurea, and radiation therapy for treatment of primary malignant gli-omas. J Neurosurgery 1979; 51:526-532.
9. Galilicich JH, Deck M. Surgical localization of small lesions demostrated by the computerized tomographic scan. Neurosurgery 1978; 2:170.
10. Salcman M, Levin H, Rao K. Value of sequential computed tomography in the multimodality treatment of glioblas-toma multiforme. Neurosurgery 1981; 8:15-9.
11. Hochberg FH, Pruitt A. Assumptions in the radyotherapy of glioblastoma. Neurology 1980; 30: 907-11.
12. Salcman M, Kaplan RS, Samaras CM, Ducker TB, Broadvvell RD. Agressive multimodality therapy based on a multi-compartmantal model of glioblastoma, Surgery 1982; 92:250-9.
13. Young B, Oldfield EH, Markesberg VVR, Haack D, Tibbs PA, McCoombs P, Chin HW, Maruyama M, Meacham WF. Reoperation for glioblastoma. J Neurosurgery 55:917-921, 1981.
14. Kaplan EL, Meier P. Non-parametric estimation from in-complete observation. J Am Stat Assoc 1958; 53:457-81.
15. Cox DR. Regression models and life tables. J R Statist Soc B 1972; 34:187-220.
16. Jelsma R, Bucy PC. Glioblastoma multiforme: Its treatmant and some factors affeeting survivale. Arch Neurology 1969;20:161-9.
17. Sheline G. Radiation treatment of brain tumors. Cancer 39 (suppl 2):873-881, 1977.
18. Roth JG, Elvidge AR. Glioblastoma multiforme. A clinical survey, J Neurusurgery 1960; 17:736-50.
19. Cushing H. Intracranial tumors. Notes upon a Series of 2000 Verified cases vvith Surgical MortalityPercentages Perta-iningThereto. Springfield İL, Charles C Thomas, 1932 p32.
20. Ransohoff J, Lieberman AN. Surgical treatmant of primary malignant brain tumor. Clin Neurosurg 1978; 25:403-411.
21. De Vita VT. The relationship betvveen tumor mass and resis-tance to chemotherapy: Implacations for surgical adju-vant treatment of cancer. Cancer 1983; 51:1209-1220.
22. VVeiss HD, Gutin PH, VValker MD. Unresolved problems of treatment of gliomas. JAMA 1975; 229:1284-1285.
23. Ray BS. Surgery of recurrent intracranial tumor. Clin Neuro-surg 1964; 10:1-30.
24. Salcman M. Effect of age and reoperation on survival in combined multimodality treatment of malignant astocy-tomas. Neurosurgery 1982; 10:454-63.
25. Avellanosa A, VVest C, Barva N, Patel A. Intracavitary com-bination chemotherapy of recurrent malignant gliomas via Ommaya shunt: A pilot study. Proc Am Soc Clin On-col 1983; 2:917.
26. Hochbcg FH, Slotnick B. Neuropsychologic impairment in astrositoma survivors.Neurology (NY) 1980; 30:172-177.
27. Seiler RW. Late results of multimodality therapy of high gra-de supratentorial astrocytomas. Surg Neurol 1981; 15:88-91.
28. Gutin PH, Levin VA. Surgery, radiation, and chemotherapy in the treatment of malignant brain tumors, in Thompson RA, Green JA (eds ): Controversies in Neurology. Nevv York, Raven Press. 1982; pp 67-86.
29. Levin WA, Edvvards MSB, VVright DS. Modified procarbazi-ne, CCNU, and vincristine combination chemotherapy (UCSFPCV3) in the treatment of malignant brain tumors. Cancer Treat Rep 1980; 64:237-241.
30. Levin WA, Hoffman WF, Fischer TL, Seager ML, Boldrey EB, VVilson CW. BCNU, 5-FU combination in the treatment of malignant brain tumor. Cancer Treat Rep 1978; 62:2071-9.
31. Lieberman AN. Long term survivale among patients vvith malignant brain tumors. Neurosurgery 1982; 10:450-3.
32. Rostomily RC, Spence AM, Duong D, McCormik K, Bland M, Berger MS. Multimodality management of recurrent adult malignant gliomas: results of a phase II multiagent chemotherapy study and analysis of cytoreductive sur-gery. Neurosurgery 1994; 35(3):378-88.
33. Landy HJ, Feun L, Schvvade JG, Snodgrass S, Lu Y, Gutman F. Retreatment of intracranial gliomas. South Med J 1994; 87(2):211-4.
34. Stromblad LG, Anderson H, Malmstrom P, Salford LG. Re-operation for malignant astrocytomas: personal exsperi-ence and a revievv of the literatüre. British Journal of Ne-urosurgery 1993; 7(6):623-33.