Abstract
The management of recurrent high-grade gliomas is highly challenging, and treatment outcome remains invariably poor. High-grade gliomas (HGGs) are highly malignant tumor, which complete surgical resection of all microscopic extensions cannot be always achieved. All high-grade gliomas nearly recur and survival following disease progression is doomed to be approximately 6 months for GBMs and 10 months for anaplastic gliomas. Therapy options for recurrent HGGs are limited and may include surgery, re-irradiation, chemotherapy and targeted therapy. We present a case of a 33-year-old male with recurrent anaplastic astrocytoma after initial surgery. The patient underwent the treatment of radiation therapy with concurrent chemotherapy of nimotuzumab and oral temozolomide for 6 weeks followed by six cycles of adjuvant temozolomide for tumor local recurrences, and the patient still do not relapse with a long-term progression free survival lasting seven years. The median survival in patients with recurrent anaplastic astrocytoma is usually 10 months after recurrence, and this unique case illustrates that comprehensive therapy can achieve long-term survival in select situations. We recommend that the treatment of each recurrent patient should be based on each clinical situation and aspire for quality of life and improved longevity.
Highlights
Gliomas which originated from glial cells and made up 80% of all primary CNS tumors in the United States were classified as “low grade” (WHO grades I and II) and “high grade” (WHO grades III and IV) according to histopathologic changes [1,2]
The median time-to-tumor progression for patients with newly diagnosed GBMs is approximately 6.9 months and these tumors unavoidably relapse with a median overall survival of only 15 months [3]
We present the unique case of a 33-year-old gentleman who initially presented with a several days history of headaches behind the right brain, with associated “vomiting”
Summary
Gliomas which originated from glial cells and made up 80% of all primary CNS tumors in the United States were classified as “low grade” (WHO grades I and II) and “high grade” (WHO grades III and IV) according to histopathologic changes [1,2]. We report the case of a recurrent anaplastic astrocytoma patient with the long-term progression free survival (PFS) after the combination of radiation therapy with concurrent chemotherapy of nimotuzumab and temozolomide followed adjuvant temozolomide. Gliomas with the DNA repair enzyme O-6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, chromosomal 1p and 19q co-deletion or isocitrate dehydrogenase 1 and 2 (IDH1/2) mutations is associated with a better prognosis [12,13,14,15] In this patient, the chromosomal 1p and 19q co-deletion was detected by FISH; and the MGMT promoter methylation was positive and Isocitrate dehydrogenase 1 was mutation type, which was one of the reason of long-term progression free survival (PFS). Due to the application of targeted therapies, a fewer proportion of recurrent HGGs patients are going through diagnostic or therapeutic re-surgery
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