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Glioblastoma : diferenças entre sobreviventes curtos e longos numa série do Hospital de Santa Maria
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Introdução: O glioblastoma corresponde ao tumor primário mais comum e agressivo do SNC, com sobrevida média de 12 a 15 meses após o tratamento standard. Contudo, alguns doentes com este diagnóstico conseguem ter uma sobrevida acima da média, nomeadamente superior a 36 meses, designando-se de LTS, sendo os doentes com sobrevida inferior a 36 meses designados de STS. Métodos: Foram incluídos no estudo doentes com diagnóstico de glioblastoma operados no CHULN-HSM entre 2005 e 2018. Foram criados dois grupos - um constituído por 32 doentes LTS e outro com 32 doentes STS, tendo-se realizado a recolha retrospetiva de dados clínicos. Resultados: Nos LTS, 30 tinham tumor unilateral e 2 tumor ao nível do tronco cerebral; nos STS, 20 tinham tumor unilateral e 5 tumor bilateral. Verificou-se a existência de desvio da linha média em 7 LTS e 17 STS (24 LTS e 10 STS sem desvio). Havia alterações do estado de consciência em 6 LTS e 14 STS. A média de KPS foi de 74.4 e 67 nos LTS e STS, respetivamente. Quanto ao tratamento dos LTS, 26 foram submetidos a cirurgia com radioterapia e quimioterapia e 3 a biópsia com quimioterapia e radioterapia; dos STS, 14 a cirurgia com quimioterapia e radioterapia, 3 foram submetidos a biópsia e radioterapia; 4 a biópsia com radioterapia e quimioterapia; 1 a cirurgia com radioterapia e 1 a cirurgia com quimioterapia. Conclusões: Verificou-se que não é comum os LTS apresentarem tumor bilateral, ao contrário dos STS, tal como é mais frequente os STS apresentarem-se com desvio da linha média. É mais comum os STS apresentarem alterações do estado de consciência face aos LTS, tal como é mais comum os STS terem valores mais baixos de KPS. Os LTS mais frequentemente do que os STS realizam cirurgia, quimioterapia e radioterapia, enquanto que os STS realizam uma maior variedade de abordagens; os LTS realizam sempre quimioterapia e radioterapia, enquanto que os STS, por vezes, realizam apenas uma dessas opções.
Background: Glioblastoma is the most common and aggressive primary tumor at the CNS level, with a median survival of 12 to 15 months after standard treatment. Even so, some patients with this diagnosis manage to achieve an above-average survival - they are referred as LTS when achieve a survival equal or greater than 36 months and are referred as STS when achieve a survival less than 36 months. Methods: All patients diagnosed with glioblastoma operated on at the CHULN-HSM between 2005 and 2018 were considered. Two groups were created - one consisting of 32 LTS patients and the other of 32 STS patients. The last group was matched with the first one by age, sex and date of surgery, after which clinical retrospective data was collected. Results: 30 LTS had an unilateral tumor and 2 LTS had a brainstem tumor; 27 STS had an unilateral tumor and 5 STS had a bilateral tumor. Midline deviation - 7 LTS and 17 STS with deviation (24 LTS and 10 STS without deviation). Mental status changes - identified in 6 LTS and 14 STS. The mean KPS was 74.4 in LTS and 67 in STS patients. Treatment - 26 LTS underwent surgery with radiotherapy and chemotherapy; 3 LTS underwent biopsy with chemotherapy and radiotherapy; 14 STS underwent surgery with chemotherapy and radiotherapy; 3 STS underwent biopsy and radiotherapy; 4 STS underwent biopsy with chemotherapy and radiotherapy; 1 STS underwent surgery with radiotherapy; 1 STS underwent surgery with chemotherapy. Conclusions: It was found that it is not common for LTS to present with a bilateral tumor, unlike STS, as it is more common for STS to present with midline deviation. It is more common for STS to present mental status changes when compared to LTS, as it is more common for STS to have lower KPS values. LTS patients undergo surgery, chemotherapy and radiotherapy more often than STS, whereas STS undergo a greater variety of approaches; LTS always undergo chemotherapy and radiotherapy, whereas STS sometimes undergo only one of these options.
Background: Glioblastoma is the most common and aggressive primary tumor at the CNS level, with a median survival of 12 to 15 months after standard treatment. Even so, some patients with this diagnosis manage to achieve an above-average survival - they are referred as LTS when achieve a survival equal or greater than 36 months and are referred as STS when achieve a survival less than 36 months. Methods: All patients diagnosed with glioblastoma operated on at the CHULN-HSM between 2005 and 2018 were considered. Two groups were created - one consisting of 32 LTS patients and the other of 32 STS patients. The last group was matched with the first one by age, sex and date of surgery, after which clinical retrospective data was collected. Results: 30 LTS had an unilateral tumor and 2 LTS had a brainstem tumor; 27 STS had an unilateral tumor and 5 STS had a bilateral tumor. Midline deviation - 7 LTS and 17 STS with deviation (24 LTS and 10 STS without deviation). Mental status changes - identified in 6 LTS and 14 STS. The mean KPS was 74.4 in LTS and 67 in STS patients. Treatment - 26 LTS underwent surgery with radiotherapy and chemotherapy; 3 LTS underwent biopsy with chemotherapy and radiotherapy; 14 STS underwent surgery with chemotherapy and radiotherapy; 3 STS underwent biopsy and radiotherapy; 4 STS underwent biopsy with chemotherapy and radiotherapy; 1 STS underwent surgery with radiotherapy; 1 STS underwent surgery with chemotherapy. Conclusions: It was found that it is not common for LTS to present with a bilateral tumor, unlike STS, as it is more common for STS to present with midline deviation. It is more common for STS to present mental status changes when compared to LTS, as it is more common for STS to have lower KPS values. LTS patients undergo surgery, chemotherapy and radiotherapy more often than STS, whereas STS undergo a greater variety of approaches; LTS always undergo chemotherapy and radiotherapy, whereas STS sometimes undergo only one of these options.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Glioblastoma Long-term survivors Short-term survivors Neurocirurgia