Clinical Neurology and Neurosurgery

Treatment strategies and outcomes for spinal rhabdomyosarcoma: A series of 11 cases in a single center and review of the literature

Rhabdomyosarcoma (RMS) involving the spine is rare. The aim of the present study is to explore the clinicopathological features, surgical treatments and outcomes of this rare disease. Eleven patients with spinal RMS who received surgery in our institution between 2012 and 2018 were retrospectively investigated. The literature on spinal RMS was also reviewed. Our study consisted of 7 cases of primary RMS and 4 cases of metastatic RMS. Seven primary and one metastatic spinal RMS received radical resection, the remaining three metastatic patients received palliative resection. Eight patients died with a median survival time of 8 months. The mean value of Ki-67 positivity was 48.2 %. Literature review revealed a total of 22 previously reported cases. 54.5 % of the pooled cases of the 33 patients were under the age of 18. Of the 20 patients with primary spinal RMS, 9 cases were diagnosed as embryonal, while 6 of the 13 metastatic patients were diagnosed as alveolar. Multiple modalities, including surgery and concurrent adjuvant therapy were performed in 19 patients. The median overall survival (OS) for 28 patients with detailed follow-up information was 10 months. Radical resection offered a significant longer median OS than non-radical resection (18 vs. 6 months, p = 0.027). Spinal RMS mainly affects young patients. The embryonal form and alveolar form is the most frequent subtype for primary and metastatic spinal RMS respectively. Spinal RMS is highly aggressive with dismal prognosis. Multimodality therapies are the mainstay of treatment. Radical resection is strongly recommended in eligible patients.

Prognostic factors in ovarian cancer patients with brain metastases: A retrospective analysis

Brain metastases (BM) from epithelial ovarian cancer (EOC) are rare but clinically significant due to their poor prognosis. This study aimed to investigate prognostic factors influencing survival in EOC patients who developed BM and to evaluate treatment-related outcomes. A retrospective review was conducted on 1123 patients with EOC treated between 2008 and 2021. Among them, 27 patients (2.4 %) developed BM. Demographic, clinical, and treatment-related data were collected. Overall survival after BM diagnosis was assessed using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed on 21 patients who received active treatment (surgery and/or radiotherapy). The median time from ovarian cancer diagnosis to BM was 27 months, and the median post-BM survival was 12 months. Survival was significantly longer in platinum-sensitive patients (38 vs. 7 months, p = 0.04). Median survival was 30 months with combined therapy, 13 months with radiotherapy alone, and 1 month with palliative care (p = 0.01). Within the radiotherapy group, the median survival was 13 months in patients treated with stereotactic radiosurgery (SRS) and 6 months in those who received whole-brain radiotherapy (WBRT). Univariate analysis identified platinum sensitivity (p = 0.075), number of metastases (p = 0.017), and lesion localization (p = 0.021) as factors associated with survival. In multivariate analysis, platinum sensitivity remained the only independent predictor of improved survival (HR: 0.34; 95 % CI: 0.16-0.71; p = 0.04). Platinum sensitivity is a key prognostic determinant in ovarian cancer patients with BM. Early identification and tailored multimodal treatment strategies may contribute to prolonged survival in selected patients.

Perifocal edema volume is not associated with immunohistochemical features reflecting proliferation potential, microvessel density, neoangiogenesis and invasiveness in brain metastasis

Perifocal edema of brain tumors is associated with survival and neurological symptoms. Our aim was to analyze associations between perifocal edema and immunohistochemical features including proliferation potential, microvessel density, neoangiogenesis and invasiveness in brain metastasis (BM). 35 patients with BM were included into the retrospective study. The tumors were localized supratentorial in 25 lesions (71.4%) and infratentorial in 10 lesions (28.6%). The following immunohistochemical features were calculated on histopathological specimens: microvessel density, proliferation index Ki 67, matrix-metallopeptidase 9 (MMP9) extracellular matrix metalloproteinase inducer (EMMPRIN) and vascular endothelial growth factor (VEGF) expression. Tumor and edema volumes were estimated semiautomatically on magnetic resonance images. There were no correlations between tumor volume and edema volume. Moreover, no correlation was identified between the investigated immunohistochemical features and tumor/edema volume. In the non-small cell lung cancer subgroup, a positive correlation between tumor volume and VEGF expression was observed (r = 0.52, P = 0.02) and edema volume correlated inversely with MMP9 expression (r = -0.53, P = 0.02). In BM, no linear associations exist between tumor volumes, edema volumes and immunohistochemical features reflecting proliferation potential, neoangiogenesis, microvessel density and MMP9 expression. However, in the subgroup of non-small cell lung cancer, there might be associations between MMP9 expression and edema volume as well as between tumor volume and angiogenesis.