%0 Journal Article
%T Malignant transformation of low grade gliomas into glioblastoma a series of 10 cases and review of the literature
%A D. Rotariu1
%A S. Gaivas1
%A Z. Faiyad1
%A D. Haba2
%A B. Iliescu1
%A I. Poeata1
%J Romanian Neurosurgery
%D 2010
%I Romanian Society of Neurosurgery
%X Background: Diffuse infiltrative low-gradegliomas (LGG) of the cerebral hemispheresin the adult are tumors with distinctclinical, histological and molecularcharacteristics. WHO (World HealthOrganization) classification recognizesgrade II astrocytomas, oligodendrogliomasand oligoastrocytomas. Conventional MRIis used for differential diagnosis, guidingsurgery, planning radiotherapy andmonitoring treatment response.Advanced imaging techniques areincreasing the diagnostic accuracy. Lowgradegliomas have been documented toundergo transformation into high-gradegliomas, and the time interval of thistransformation has been reported togenerally occur within 5 years in about 50%of patients diagnosed with low-gradegliomas.Methods: We have reviewed all adultpatients operated on for hemisphericglioblastoma at N Oblu Hospital in Iasibetween 2006 and 2009 and in particularthose patients with secondary glioblastoma.Results: from the total 110 cases ofglioblastoma, ten of them were secondaryto malignant transformation of anpreviously operated low grade glioma. Ofthe 10 patients with secondaryglioblastoma, the initial histology was: gr IIastocytoma in 6 cases, oligoastocytoma in 2cases and in oligodendroglioma in 2 cases.The mean patient age was 46.1¡À 0.9 yearsand the most frequent symptom wasrepresented by seizures 70%, the mean timefrom the first symptom to diagnosis was11,2 months. 40% of the cases had subtotalresection and 60% had total resection(defined by the surgeon at the time ofoperation). 5 patients received radiotherapypostoperatively, 2 received both radio andchemotherapy and 3 had no adjuvanttreatment. In our series the median time tomalignant transformation was 32,5 months.Conclusions: Younger age, normalneurological examination andoligodendroglial histology are favorableprognostic factors, total/near total resectioncan improve seizure control, progressionfreeand overall survival, mean whilereducing the risk of malignanttransformation. Early post-operativeradiotherapy improves progression free butnot overall survival. Chemotherapy can beuseful both at recurrence after radiotherapyand as initial treatment after surgery todelay the risk of late neurotoxicity fromlarge-field radiotherapy.
%K astrocytoma
%K low-grade glioma
%K glioblastoma
%K oligodendroglioma
%K malignant transformation
%U http://www.roneurosurgery.eu/atdoc/4RotariuDMalignantTransformation.pdf