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Glioblastoma (GBM) is the most common malignant primary brain tumor in adults. Despite an established standard of care including surgical resection, radiation therapy, and chemotherapy, GBM unfortunately is associated with a dismal prognosis. Therefore, researchers are extensively evaluating avenues to expand GBM therapy and improve outcomes in patients with GBM. In this review, we provide a broad overview of novel GBM therapies that have recently completed or are actively undergoing study in clinical trials. These therapies expand across medical, surgical, and radiation clinical trials. We additionally review methods for improving clinical trial design in GBM. [ABSTRACT FROM AUTHOR]

Leptomeningeal disease (LMD) is a devastating sequelae of metastatic spread that affects approximately 5% of cancer patients. The incidence of LMD is increasing due to advancements in systemic therapy and enhanced detection methods. The purpose of this review is to provide a detailed overview of the evidence in the detection, prognostication, and treatment of LMD. A comprehensive literature search of PUBMED was conducted to identify articles reporting on LMD including existing data and ongoing clinical trials. We found a wide array of treatment options available for LMD including chemotherapy, targeted agents, and immunotherapy as well as several choices for radiotherapy including whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and craniospinal irradiation (CSI). Despite treatment, the prognosis for patients with LMD is dismal, typically 2–4 months on average. Novel therapies and combination approaches are actively under investigation with the aim of improving outcomes and quality of life for patients with LMD. Recent prospective data on the use of proton CSI for patients with LMD have demonstrated its potential survival benefit with follow-up investigations underway. There is a need for validated metrics to predict prognosis and improve patient selection for patients with LMD in order to optimize treatment approaches. [ABSTRACT FROM AUTHOR]

Aim: Acute type A aortic dissection is a life-threatening clinical situation with high mortality rates. Aortic valve insufficiency frequently accompanied to this disease. Despite the developments in the medical area, surgical intervention has difficulties especially in sinus of valsalva involvement. Aim of this study is evaluating the postoperative clinical outcomes in patients with type A aortic dissection operated without valve replacement and by using Teflon felt sandwich technique. Material and Methods: Between January 2016 and January 2021, 126 patients with acute type A aortic dissection accompanied by severe aortic valve insufficiency operated by using Teflon felt sandwich technique without aortic valve repair or replacement were included to this study. Postoperative clinical outcomes evaluated and the degree of the aortic valve insufficiency was compared before and after operation. Results: All the patients included to the study had severe aortic insufficiency before operation and dissected segment of the patients were limited to the ascendant aorta with sinus of valsalva involvement. Postoperative mortality rate was 6.3% (n=8). According to the results of the transthoracic echocardiography findings performed postoperative second day and first month, six of the patients had asymptomatic mild aortic regurgitation while no patients had severe or moderate aortic regurgitation. Conclusion: Acute type A aortic dissection and accompanied severe aortic valve insufficiency can be treated by using Teflon felt sandwich technique with low duration of operation and satisfactory improvement of the aortic valve functions. Cost effectiveness in the terms of not to use a valve for replacement and anticoagulant drugs after the operation are the additional advantages. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) is the most prevalent malignant tumor of the central nervous system. The prognosis of GBM is grim, with a median overall survival of 14.6 months and only 6.9% of patients surviving 5 years after the initial diagnosis. Despite poor outcomes, standard therapy of surgical resection, radiotherapy, chemotherapy, and tumor-treating fields has remained largely unchanged. The introduction of immune checkpoint inhibitors (ICI) has been a paradigm shift in oncology, with efficacy across a broad spectrum of cancer types. Nonetheless, investigations of ICIs in both newly diagnosed and recurrent GBM have thus far been disappointing. This lack of clinical benefit has been largely attributed to the highly immunosuppressive nature of GBM. However, immunotherapy still holds promise for the treatment of GBM, with combinatorial strategies offering hope for potentially overcoming these current limitations. In this review, we discuss the outcomes of clinical trials employing ICIs in patients with GBM. Afterward, we review ICI combination strategies and how these combinations may overcome the immunosuppressive microenvironment of GBM in the context of preclinical/clinical evidence and ongoing clinical trials. [ABSTRACT FROM AUTHOR]

Introduction: Proton craniospinal irradiation (pCSI) is a treatment option for leptomeningeal disease (LMD), which permits whole neuroaxis treatment while minimizing toxicity. Despite this, patients inevitably experience progression. Adding systemic therapy to pCSI may improve outcomes. Methods: In this single-institution retrospective case series, we present the feasibility of treatment with pCSI (30Gy, 10 fractions) and an immune checkpoint inhibitor (ICI) in two sequential patients with LMD from melanoma. Results: The first patient developed LMD related to BRAF V600E-mutant melanoma after prior ICI and BRAF-targeted therapy. After pCSI with concurrent nivolumab, the addition of relatlimab, and BRAF-targeted therapy, he remained alive 7 months after LMD diagnosis despite central nervous system progression. The second patient developed LMD related to BRAF-wildtype melanoma after up-front ICI. He received pCSI with concurrent ipilimumab and nivolumab, then nivolumab maintenance. Though therapy was held for ICI hepatitis, the patient remained progression-free 5 months after LMD diagnosis. Conclusion: Adding an ICI to pCSI is feasible for patients with LMD and demonstrates a tolerable toxicity profile. While prospective evaluation is ultimately warranted, pCSI with ICI may confer survival benefits, even after prior ICI. [ABSTRACT FROM AUTHOR]

This article discusses the advancements in radiotherapy strategies for the treatment of brain metastases (BrM), which are the most common intracranial neoplasm in adults. The article emphasizes the need for a multidisciplinary approach involving neurosurgery, radiation oncology, medical oncology, and neurology. It explores various treatment options such as surgical resection, whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and systemic therapies. The article also highlights the importance of personalized treatment approaches based on patient-specific factors and the incorporation of molecular markers into prognostic scoring systems. Ongoing clinical trials are expected to further enhance the personalization of radiotherapy delivery in patients with brain metastases. The document contains a list of references related to the topic, including studies on epidemiology, biology, treatment options, and guidelines for brain metastases. It is important to interpret the content in the context of the individual studies and guidelines referenced. [Extracted from the article]