Re-do craniotomy for recurrent glioblastoma

Triethylammonium Salts of Dicoumarol: Synthesis, Characterization, Human Antiglioblastoma, Antimicrobial and Antioxidant Studies

The most typical primary brain tumor, glioblastoma multiforme (GBM), has a dismal prognosis. They are removed through arduous, potentially fatal operations. The primary cause of tumor recurrence following surgery is glioblastoma stem cells (GSCs). In order to combat the recurrent glioblastoma malignant cells, medications have been developed. Chemotherapies now in use are expensive and encounter resistance. To combat inherent and developed resistance, new and powerful chemotherapeutics are being synthesized. In this regard, dicoumarols were deprotonated by triethylamine to produce corresponding salts which are reported and used for the first time for human antiglioblastoma activity. Spectroscopic characterizations like 1H and 13C-NMR were carried out. The cytotoxicity of normal human astrocytes (NHA) and human glioblastoma cells (A172 and LN229) were both examined in terms of dose and time dependence. The range of the IC50 value for all the deprotonated derivatives against A172 was found to be 2.81-0.24 µM, whereas the range against LN229 was found to be 2.50-0.85 µM. According to cytotoxicity results, malignant cell death was seen in GBM cells treated with triethylamine salts of dicoumarols compared to the control group, which suggested that salts may cause apoptosis in GBM cells. Antimicrobial and antifungal activities were also investigated for all the triethylamine salts of dicoumarols suggesting that salt formation enhances antimicrobial potentials manyfolds compared to the standard drug used. Free radical activities were also investigated using DPPH free radicals.

Nasal Drug Delivery of Anticancer Drugs for the Treatment of Glioblastoma: Preclinical and Clinical Trials

Glioblastoma (GBM) is the most lethal form of brain tumor, being characterized by the rapid growth and invasion of the surrounding tissue. The current standard treatment for glioblastoma is surgery, followed by radiotherapy and concurrent chemotherapy, typically with temozolomide. Although extensive research has been carried out over the past years to develop a more effective therapeutic strategy for the treatment of GBM, efforts have not provided major improvements in terms of the overall survival of patients. Consequently, new therapeutic approaches are urgently needed. Overcoming the blood–brain barrier (BBB) is a major challenge in the development of therapies for central nervous system (CNS) disorders. In this context, the intranasal route of drug administration has been proposed as a non-invasive alternative route for directly targeting the CNS. This route of drug administration bypasses the BBB and reduces the systemic side effects. Recently, several formulations have been developed for further enhancing nose-to-brain transport, mainly with the use of nano-sized and nanostructured drug delivery systems. The focus of this review is to provide an overview of the strategies that have been developed for delivering anticancer compounds for the treatment of GBM while using nasal administration. In particular, the specific properties of nanomedicines proposed for nose-to-brain delivery will be critically evaluated. The preclinical and clinical data considered supporting the idea that nasal delivery of anticancer drugs may represent a breakthrough advancement in the fight against GBM.

Repeated craniotomies for intracranial tumors: is the risk increased? Pooled analysis of two prospective, institutional registries of complications and outcomes

Purpose

Deciding whether to re-operate patients with intracranial tumor recurrence or remnant is challenging, as the data on safety of repeated procedures is limited. This study set out to evaluate the risks for morbidity, mortality, and complications after repeated operations, and to compare those to primary operations.

Methods

Retrospective observational two-center study on consecutive patients undergoing microsurgical tumor resection. The data derived from independent, prospective institutional registries. The primary endpoint was morbidity at 3 months (M3), defined as significant decrease on the Karnofsky Performance Scale (KPS). Secondary endpoints were mortality, rate and severity of complications according to the Clavien–Dindo Grade (CDG).

Results

463/2403 (19.3%) were repeated procedures. Morbidity at M3 occurred in n = 290 patients (12.1%). In univariable analysis, patients undergoing repeated surgery were 98% as likely as patients undergoing primary surgery to experience morbidity (OR 0.98, 95% CI 0.72–1.34, p = 0.889). In multivariable analysis adjusted for age, sex, tumor size, histology and posterior fossa location, the relationship remained stable (aOR 1.25, 95% CI 0.90–1.73, p = 0.186). Mortality was n = 10 (0.4%) at discharge and n = 95 (4.0%) at M3, without group differences. At least one complication occurred in n = 855, and the rate (35.5% vs. 35.9%, p = 0.892) and severity (CDG; p = 0.520) was similar after primary and repeated procedures. Results were reproduced in subgroup analyses for meningiomas, gliomas and cerebral metastases.

Conclusions

Repeated surgery for intracranial tumors does not increase the risk of morbidity. Mortality, and both the rate and severity of complications are comparable to primary operations. This information is of value for patient counseling and the informed consent process.

Electronic supplementary material

The online version of this article (10.1007/s11060-018-03058-y) contains supplementary material, which is available to authorized users.