Treatment of recurrent meningeoma Disclosure No conflict of - PowerPoint PPT Presentation

ESMO Preceptorship Programme Brain Tumours – Athens, Greece– 28 Sep-29 Sep 2018 Marko Bebek University Hospital Center “Zagreb” Zagreb - Croatia Treatment of recurrent meningeoma

Disclosure  No conflict of interests ESMO PRECEPTORSHIP PROGRAM

Patient B.M.  61 years old  from Zagreb, Croatia  Family history : father had colorectal cancer  Past medical history : hypertension, chronic gastritis  Medication : ranitidine, lercadipine, oxcarbazepine, ketoprofen  Health-related behavior: non-smoker. Doesn’t use alcohol. ESMO PRECEPTORSHIP PROGRAM

 August 2001. – surgery because anaplastic meningeoma, gr III  September-October 2001. – adjuvant radiotherapy, TD 60 Gy/30x  October 2016 . – Neurosurgery department hospitalization after diagnostic imaging (Brain MSCT and after that brain MRI) set a diagnosis of meningeoma recurrence (left FP extracranial tumor process on a convexity and small extracranial process in right temporal lobe)  Symptoms: headache, nausea and vomiting, seizures  Physical examination: at admission day patient didn’t had mayor neurological deficit  11 October 2016. – 2. SURGERY – left FTP craniotomy with tumor reduction and Palacos cranioplastic ESMO PRECEPTORSHIP PROGRAM

 PHD: Atypical meningeoma, 11 mitosis on 10 VVP, Ki 67 15%, extensive and huge necrotic area, bone infiltration and destruction  Oncologist indicate 3D CBRT reiradiation  March-May 2017. – radiotherapy, TD 56 Gy/28x ESMO PRECEPTORSHIP PROGRAM

 August 2017. - patient had in mean time left hip fracture on 29 May 2017. She had on control examination abnormal gait, fatigue and depression.  Brain MRI – no meningeoma recurrence in right frontal postoperative area, extensive postiradiation leukomalacia in both hemispheres. Right temporal lobe meningeoma dimension 8x5 mm without compresive effect. In comparation with MRI from 2013., there is unchanged small (6x3 mm) meningeoma next to posterior border of petrous part of the left temporal bone, also without compresive effect. ESMO PRECEPTORSHIP PROGRAM

 Follow-up was recommended, examination with chest X-ray, abdominal ultrasound and routine lab after 2 months. Examination with brain MRI after 4 months. Initiate physical rehabilitation.  November 2017: chest X-ray, abdominal ultrasound and routine lab were ok. Patient is feeling better physically after rehabilitation.  April 2018. – brain MRI – stationary finding  Follow-up recommendation – examination and brain MRI in 6 months. ESMO PRECEPTORSHIP PROGRAM