Society for Neuro-Oncology Latin America - SNOLA

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Society for Neuro-Oncology Latin America - SNOLA

A latin american society that commits to the learning and integration of all specialties in our continent involved somehow in neuro-oncology

For becoming a SNOLA member please access the following link:

https://snola.org/system/form_tbl_seja_membro/

15/02/2024

The largest Neuro Oncology congress in Latin America is coming.
Snola 2024 - State of art in Neuro Oncology will take place in São Paulo, March 22nd and 23rd, 2024.
With great experts from all over the world, covering the most up-to-date information and reviewing already known concepts.
Come be part of this important event.

Registration is now open, visit: snola2024.com

02/09/2022

The importance of the molecular signature of low grade gliomas has risen highly over the last years. The occurrence of IDH mutation, TERT mutation, CDKN2A mutation and hystona alteration have been discussed. Differently from high grade gliomas, the MGMT methylation status (mMGMT) has not yet been established as a prognostic and predictive marker.
Haque et al (2022) did a retrospective analysis with data from an oncology database of the US. For treatment purposes, patients are traditionally subdivided into high or low risk. Risk assessment goes mainly through age (>40 year-old) and extent of resection (subtotal resection). Of the 11,223 grade II gliomas from this study, 9,971 (89%) had no mMGMT testing. Of the following patients, 634 (50.6%) were mMGMT and 618 (49.4%) were uMGMT. The mMGMT group presented with greater overall survival (OS) when compared to the uMGMT (77.3m x 42.6m). Untested group presented with intermediate results (61.9m).
In the subgroup analysis, MGMT status was predictive of greater OS in the gross total resection x subtotal and biopsy groups (p

12/08/2022

Throughout the history of neurosurgery, awake craniotomies have been used for different indications with the overarching goal of enhancing safety. Meta-analyses based on cohorts of patients with low-grade glioma suggest that awake craniotomy could be valuable for increasing the extent of resection while preventing postoperative neurological deficits. Evidence from small retrospective studies has supported the hypothesis that this approach could also be beneficial for patients with glioblastoma. However, discussion continues about the indication setting of awake surgery in these patients because its impact in clinically important subgroups is still unknown.
The international, multicentre GLIOMAP study assessed the association between awake mapping and survival, functional, neurological, and radiological outcomes in 1047 patients with eloquent, primary glioblastoma. This is the first study to assess the effect of this approach in clinically relevant patient subgroups.
In the overall matched cohort, awake craniotomy versus asleep resection resulted in fewer neurological deficits at 3 months (p = 0.019) and 6 months (p = 0.0048) postoperatively, longer overall survival (p = 0.00054) and progression-free survival (p = 0.0060). In subgroup analyses, awake craniotomy was especially useful to improve postoperative outcomes in patients younger than 70 years, with a NIHSS score of 0–1, or a preoperative KPS of 90–100. For patients aged 70 years and older, with a preoperative NIHSS scores of 2 or higher, or a preoperative KPS of 80 or lower, it should be considered with the goal of preventing late neurological morbidity.
These findings, therefore, provide neurosurgeons with the evidence to assess the optimal surgical strategy and to improve the decision-making process in individual patients with glioblastoma.
Author:
Cleiton Formentin is a Neurological Surgeon from University of Campinas (UNICAMP) and a former Neurosurgical Oncology fellow.
Article link:
https://doi.org/10.1016/S1470-2045(22)00213-3

14/07/2022

The main goal in Awake monitoring with intraoperative electrical mapping is maintain the quality of life (QOL) by maximizing the extent of resection (EOR) while sparing critical neural structures. And what about neurocognitive outcomes?

In the paper "Cognitive preservation following awake mapping-based neurosurgery for low-grade gliomas: A longitudinal, within-patient design study”, 157 patients with DLGG were longitudinally evaluated before and 3 months after surgery with neuropsychological assessments.

Eighty-seven patients (55.4%) had preoperative cognitive impairments. Eighty-six percent of patients exhibited no postoperative cognitive decline, and among them, 10% exhibited cognitive improvement despite a mean EOR of 92.3% -+7.8%. The postoperative volume and tumor lateralization had a significant association with cognitive decline. No patients demonstrated permanent postoperative neurologic deficits, but 5.8% did not resume their
preoperative professional activities.

- This is the largest, homogeneous, and consecutive series of DLGG with systematic neuropsychological assessment to date;

-The present study supports the idea that awake surgery with cognitive mapping is a safe and effective therapeutic approach in newly diagnosed DLGG patients.

-Surprisingly, a greater EOR did not correlate with cognitive deficits but instead with improvement in certain tasks (eg. memory encoding). These results may be due to better control of mass effect
and/or seizure control in the early postoperative setting. The challenge in addressing the “onco-functional balance” may be accomplished with an awake mapping surgery, which will optimize extent of surgical resection while sparing critical neural structures.

-DLGG are most commonly found in young adults following onset of seizures but who otherwise enjoy an active, normal life. As such, preserving QOL of an otherwise healthy and active patient is of utmost importance.

Maíra Cristina Velho is a neurological surgeon from Nossa Senhora das Graças Hospital and 2nd treasurer of SNOLA.

Article link: https://doi.org/10.1093/neuonc/noab275

30/06/2022

This is a very interesting study conducted by Di et al who evaluated the safety and effectiveness of the so-called radical supramaximal resection (SMR) for glioblastoma GBM). By the way, this might be one of the most debated topics in neurosurgical oncology recently.
Extent of resection (EOR) is a well-established prognostic factor in patients with GBM, and SMR has arisen as a possible substitute for gross-total resection (GTR). The rationale is that SMR may improve progression-free survival (PFS) and overall survival (OS).
Here, the authors report a retrospective review of all patients undergoing resection of newly diagnosed left-sided eloquent GBM at their institution. SMR was defined as resection beyond abnormalities seen on T1 contrast-enhanced, with at least ≥ 40% resection of preoperative FLAIR volume.
A total of 102 patients were included in this study: 48 (47.1%) underwent SMR and 54 (52.9%) underwent GTR. On multivariate analysis, SMR was associated with both improved OS (HR 0.968, p = 0.003) and PFS (HR 0.975, p = 0.004). A final matched cohort (accounting for age, preoperative KPS, and tumor location) of 54 cases (27 SMR, 27 GTR) was created and a propensity-matched analysis was performed to compare survival outcome between GTR and SMR. The median OS for patients receiving GTR was 15.49 months compared to 21.55 months of patients receiving SMR (p = 0.0098). Furthermore, patients receiving SMR also showed significantly improved PFS at 4.51 months compared to 3.59 months in patients receiving GTR (p = 0.041).
These data reported in this retrospective study suggest that SMR, when utilized with functional mapping techniques, is a safe and feasible surrogate to traditional GTR (lesionectomy alone) for patients with eloquent GBM, with a potential survival benefit to SMR over GTR.

Iuri S. Neville is a neurological surgeon from University of Sao Paulo and 1st treasurer of Snola.

Article link: https://doi.org/10.3171/2022.3.JNS212399

17/06/2022

ASTRO (American Society for Radiation Oncology) Guideline For Brain Metastases

ASTRO recently published the guideline for the management of patients with brain metastases. The guideline was organized based on a systematic review and the recommendations were developed by using a system for grading evidence quality and recommendation asset.

The recommendations were:
• Strong recommendations for radiosurgery (SRS) for patients with limited brain metastases and ECOG performance status 0 to 2;
• Multidisciplinary discussion with neurosurgery for surgical resection for patients with tumors causing mass effect and/or that are greater than 4 cm;
• Upfront local therapy is strongly recommended for patients with symptomatic disease;
• Multidisciplinary discussion and patient-centered decision-making to determine whether local therapy may be safely deferred for patients with asymptomatic brain metastases eligible for central nervous system-active systemic therapy;
• Post-operative SRS to the tumor bed is strongly recommended to improve local control;
• Hippocampal avoidance and memantine are strongly recommended for patients with favorable prognosis and brain metastases receiving whole brain radiation therapy;
• Early introduction of palliative care for symptom management and caregiver support are strongly recommended for patients with poor prognosis.

Gustavo Nader Marta
Radiation Oncologist at Hospital Sírio-Libanês
President of SNOLA

Reference:Gondi V, Bauman G, Bradfield L, Burri SH, Cabrera AR, Cunningham DA, Eaton BR, Hattangadi-Gluth JA, Kim MM, Kotecha R, Kraemer L, Li J, Nagpal S, Rusthoven CG, Suh JH, Tomé WA, Wang TJC, Zimmer AS, Ziu M, Brown PD. Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol. 2022 May 6:S1879-8500(22)00054-6.

02/06/2022

Patients regularly question neuro-oncologists about a potential link between cellular telephones and the risk of developing a brain tumor. The recent launch of the fifth generation of wireless technologies brought this subject to light once again, and more than ever, smartphones are an everyday gadget worldwide.
In this study, an update on a prospective large-scale British study on the association between cellular telephone use and the risk of developing a primary brain tumor could not associate cellular telephone use with an increased risk of developing a brain tumor. During 14 years of follow-up of 776.156 women who completed a questionnaire, 3.268 incident brain tumors were registered. The adjusted relative risk for ever vs. never cellular use were 0.97 (95% CI = 0.90 to 1.04) for all brain tumors, 0.89 (95% CI = 0.80 to 0.99) for glioma, and not statistically significantly different to 1.0 for meningioma, pituitary tumors, and acoustic neuroma. For gliomas occurring in the temporal and parietal lobes, regions most likely to
receive radio-frequency electromagnetic fields from cellular telephones, relative risks were slightly below 1.0.
No other environmental risk factor other than ionizing radiation is associated with the development of a primary brain tumor.

Gabriel Batistella is a Neurologist and Neuro-Oncologist from EPM/UNIFESP
Neuro-Oncologist at HCOR
Assistant at the Neuro-Oncology Sector EPM/UNIFESP
First secretary of Snola

Article link: https://doi.org/10.1093/jnci/djac042

18/05/2022

This trial conducted by the University of Basel evaluated the effectiveness of different physical activities in patients with high grade glioma and the impact on their quality of life. Endurance and strengths training were employed to investigate their impact on symptoms of depression, feelings of stress and anxiety, fatigue, insomnia, and physical fitness, compared to an active control condition.

After neurosurgical treatment and during adjuvant radiotherapy and chemotherapy or combined radiochemotherapy, a total of 29 patients were randomly assigned to endurance training (n = 10); strengths training (n = 11); or active control condition (n = 😎. Three weeks and six weeks later at the end of the study physical fitness was objectively measured with a 6-min walk test (6MWT) and a handgrip test. Participants completed a series of questionnaires covering sociodemographic information, symptoms of depression, stress, anxiety, fatigue, and insomnia.

In the endurance training and active control condition, self-rated symptoms of depression, stress, state and trait anxiety, and insomnia decreased over the time, while mere strengths training appeared to neither improve, nor decrease dimensions of psychological functioning.

Overall, endurance training and an active control condition appeared to favorably impact on psychological well-being among patients with high-grade glioma after neurosurgery and undergoing radiochemotherapy.

Caroline Chaul Barbosa Zampieri is a Neuro Oncologist from DASA and vice president of SNOLA

Article link: https://doi.org/10.1016/j.jpsychires.2022.03.058

04/05/2022

With this post, SNOLA starts an educational project that will include short reviews on relevant articles in the practice of Neuro-Oncology.
We started the project with the IMPASSE study, a retrospective cohort of patients with incidental meningiomas diagnosed in 14 centers in 10 countries. A total of 727 patients who underwent radiosurgery (SRS) with a mean follow-up of 57.2 months and 388 patients who were conservatively followed for a mean time of 43.5 months were included in the analysis. Local control with radiosurgery reached 99.0% versus 64.2% in active surveillance cases (p

04/05/2022

Siga a Snola no Instagram:

07/10/2020

snola.webinario.online
É hoje nosso último Webinar interativo da série de 2020, com participação do ilustre Dr. Roger Stupp!
Participe!!!

30/09/2020

https://corp.webmeeting.com.br/sites_avulsos/choice/?code=WADWW&password=DEC27

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01401-000

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