Prophylactic Use of Pegfilgrastim in Patients Treated with a Nitrosourea and Teniposide for Recurrent Glioma

Thiepold, Anna-Luisa; Lemercier, Sophie; Franz, Kea; Atta, Johannes; Sulzbacher, Annette; Steinbach, Joachim P.; Rieger, Johannes

doi:10.1002/phar.1409

Cited by 2 publications

(1 citation statement)

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“…Temozolomid chemotherapy which may induce lymphopenia and myelosuppression has been associated with poor immune surveillance leading to opportunistic infection in patients with malignant glioma [ 42 , 43 ]. Other alkylating agents, such as Lomustine (CCNU) and PCV (Procarbazine—CCNU—Vincristine) induce predominantly neutropenia which can also increase the risk of infection [ 44 ]. Especially the combination of previous surgeries and radiochemotherapy can considerably contribute to wound-healing impairment.…”

Section: Discussionmentioning

confidence: 99%

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

Hong

Polemikos

Heissler

et al. 2018

Fluids Barriers CNS

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BackgroundCerebrospinal fluid (CSF) circulation disturbances may occur during the course of disease in patients with glioblastoma. Ventriculoperitoneal shunting has generally been recommended to improve symptoms in glioblastoma patients. Shunt implantation for patients with glioblastoma, however, presents as a complex situation and produces different problems to shunting in other contexts. Information on complications of shunting glioma patients has rarely been the subject of investigation. In this retrospective study, we analysed restropectively the course and outcome of glioblastoma-related CSF circulation disturbances after shunt management in a consecutive series of patients within a period of over a decade.MethodsThirty of 723 patients with histopathologically-confirmed glioblastoma diagnosed from 2002 to 2016 at the Department of Neurosurgery, Hannover Medical School, underwent shunting for CSF circulation disorders. Treatment history of glioblastoma and all procedures associated with shunt implementation were analyzed. Data on follow-up, time to progression and survival rates were obtained by review of hospital charts and supplemented by phone interviews with the patients, their relations or the primary physicians.ResultsMean age at the time of diagnosis of glioblastoma was 43 years. Five types of CSF circulation disturbances were identified: obstructive hydrocephalus (n = 9), communicating hydrocephalus (n = 15), external hydrocephalus (n = 3), trapped lateral ventricle (n = 1), and expanding fluid collection in the resection cavity (n = 2). All patients showed clinical deterioration. Procedures for CSF diversion were ventriculoperitoneal shunt (n = 21), subduroperitoneal shunt (n = 3), and cystoperitoneal shunt (n = 2). In patients with lower Karnofsky Performance Score (KPS) (< 60), there was a significant improvement of median KPS after shunt implantation (p = 0.019). Shunt revision was necessary in 9 patients (single revision, n = 6; multiple revisions, n = 3) due to catheter obstruction, catheter dislocation, valve defect, and infection. Twenty-eight patients died due to disease progression during a median follow-up time of 88 months. The median overall survival time after diagnosis of glioblastoma was 10.18 months.ConclusionsCSF shunting in glioblastoma patients encounters more challenge and is associated with increased risk of complications, but these can be usually managed by revision surgeries. CSF shunting improves neurological function temporarily, enhances quality of life in most patients although it is not known if survival rate is improved.

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Section: Discussionmentioning

confidence: 99%