Neurology Division, Neuro-Oncology Service, Cardarelli Hospital, Naples, Italy.
Neurology Division, Neuro-Oncology Service, Cardarelli Hospital, Naples, Italy.
World Neurosurg. 2020 Nov;143:285-288. doi: 10.1016/j.wneu.2020.07.174. Epub 2020 Aug 4.
Primary intracranial sarcomas of the central nervous system are rare tumors. They mainly arise from intracranial mesenchymal tissue present in the meninges and can occur at any age. Sometimes osteosarcoma can involve the skull rather than long body bones. In this latter case it is the more common subtype. Surgery, when possible, is a mandatory option often associated with radiation therapy (RT) and chemotherapy. Brain radionecrosis (BRN) is commonly observed due to the growing use of radiosurgery and higher cumulative doses of radiation therapy. The combination of perfusion magnetic resonance imaging and fluoro-deoxy-glucose positron emission tomography can help to differentiate tumor progression from radiation injury. Steroids, anticoagulants, and bevacizumab usually control BRN. However, BRN can also have an unfavorable course.
Here, we present a case of a 60-year-old male who underwent surgery for a brain tumor. The examination showed a primary undifferentiated high-grade sarcoma. Adjuvant RT was given with a total dose of 60 Gy. Six months later, the patient underwent a second surgery that revealed a BRN progressing despite different pharmacologic attempts.
Primary intracranial sarcomas of the central nervous system are less prevalent among older adults with respect to the younger population. The use of RT alone or combined with chemotherapy is aimed at prolonging survival. However, it is not clearly defined if adjuvant treatments affect this parameter in older patients. RT should be carefully discussed owing to its potential severe neurologic toxicity. Indeed, a BRN can have a significant impact on quality of life and lead to death in certain cases.
原发性颅内中枢神经系统肉瘤较为罕见。它们主要起源于脑膜中的颅内间叶组织，可发生于任何年龄。有时骨肉瘤可累及颅骨而非长骨。在后一种情况下，它是更常见的亚型。手术是一种强制性选择，当可能时，通常与放射治疗（RT）和化疗联合进行。由于放射外科的广泛应用和放射治疗累积剂量的增加，脑放射性坏死（BRN）很常见。灌注磁共振成像和氟脱氧葡萄糖正电子发射断层扫描的联合应用有助于区分肿瘤进展与放射损伤。类固醇、抗凝剂和贝伐单抗通常可控制 BRN。然而，BRN 也可能具有不利的病程。
这里，我们报告了一例 60 岁男性患者，因脑肿瘤接受了手术治疗。检查显示为原发性未分化高级别肉瘤。给予辅助 RT，总剂量为 60 Gy。6 个月后，患者接受了第二次手术，尽管进行了不同的药物尝试，但仍显示 BRN 进展。
与年轻人群相比，原发性颅内中枢神经系统肉瘤在老年患者中较为少见。单独使用 RT 或联合化疗旨在延长生存时间。然而，辅助治疗是否会影响老年患者的这一参数尚不清楚。鉴于其潜在的严重神经毒性，RT 应谨慎讨论。事实上，BRN 会对某些患者的生活质量产生重大影响，并导致死亡。
