approximately 15 months following standard of care therapy.However, 10 % survival at 5 years was observed in a randomized phase III study.At GBM recurrence, the addition of bevacizumab (BEV), a humanized monoclonal antibody against circulating vascular endothelial growth factor (VEGF), resulted in a 3-4 month prolongation of progression-free survival (PFS) without improving overall survival (OS).A 45-year-old female who underwent surgery for left fronto-temporal WHO grade II astrocytoma associated with epilepsy in 2005, 125I seed implantation at disease progression in 2009 and seed explantation 9 months later, was diagnosed with MGMT methylated GBM on the occasion of partial tumor resection in 2010 followed by radiotherapy plus concomitant and adjuvant temozolomide (TMZ) chemotherapy, which was stopped after 4 months due to resection of a left temporal tumor cyst and recurrent cyst within 1 month.TMZ treatment causing prolonged thrombocytopenia was discontinued after 1 additional cycle.Immediately after this cycle, the patient experienced left median cerebral artery stroke resulting in right hemianopia, Broca's aphasia and severe hemiparesis of the right side.Three months later, BEV 10 mg/kg i.v.q14d was initiated, shortly interrupted for abdominal herniotomy in 2012, and continued for 3 years.Since 2014, concurrent low molecular weight heparin was given because of right lower limb deep venous thrombosis suspicion.Whereas GBM progression had not been detected for 2 years during anti-VEGF therapy, methionine PET MRI 6 months after BEV discontinuation revealed left temporal tumor recurrence.Rechallenge with BEV was initiated and the patient remained in stable clinical and radiographical condition for 10 months until now.This case highlights the utility of sequential BEV treatment in a patient being at high risk to develop chemotherapy-induced myelotoxicity.Long-term survival (> 3 years after diagnosis) in GBM has been attributed to patient-derived rather than tumor-derived factors.To our knowledge, this is the first description of effective long-term monotherapy with BEV for GBM and ongoing therapeutic response to single-agent BEV rechallenge in a patient with recurrent secondary GBM.

INTRODUCTION: High grade gliomas are the most frequent primary brain tumours. Despite improvement of novel targeted therapies survival is still poor. In the last years the importance of quality of life came to the fore. It is well known that patients who suffer from a primary malignant brain tumour differ in the end of life phase from other oncological patients. The aim of this study is to survey sign and symptoms as well as therapeutic strategies in patients with malignant gliomas in an end of life hospital setting. METHODS: The end of life of 57 consecutive patients, who died due to a malignant glioma in a hospital setting, was analysed prospectively using a standardized protocol. Clinical signs and symptoms and supportive therapy were analysed within the last 10 days before death. RESULTS: Sixty-eight percent of patients (n = 39/57) were male, 32% (n= 18/57) were female with a mean age of 59 years (Standard deviation [SD] ±11) and an overall survival of 48 weeks (SD ±47). Most frequent symptoms were decrease of vigilance (95%, n = 54/57), fever (88%, n = 50/54), dysphagia (65%, n = 37/54), seizures (65%, n = 37/57) and headache (33%, n = 19/57). Eighteen patients (32%) sustained pneumonia. In 13 patients (23%) a urinary tract infection was diagnosed. With respect to treatment, 95% (n = 54/57) needed opioids. In 77% (n = 44/57) NSAIDs were administered additively. 86% (n = 49/57) received gastric protection, 88% (n = 50/57) LMWH and 91% (n= 52/57) intravenous fluids. In 75% (n = 43/57) anticonvulsant medication was needed. Steroids were administered in 56% (n = 32/57) of patients and only 26% (n = 15/57) received antibiotics. DISCUSSION: Due to a decrease of vigilance and cognitive impairment, assessment of clinical signs and symptoms such as pain in the end of life is often difficult. As reported signs and symptoms such as headache, dysphagia, seizures and fever are the most common ones, interventions and treatment strategies should be focused on these symptoms. Our study emphasizes the importance of standardized guidelines for end of life care in patients with malignant gliomas.

Background: The Pancoast syndrome (PS) presents with a variety of clinical manifestations. Neurological symptoms are pain, radicular sensory and motor syndromes, and Horner'/INS;s syndrome. PS often bears a grim prognosis.

Clostridium septicum is one of the agents causing gas gangrene, and was notorious in injuries in battlefield. Infections of the CNS are very rare. Here, we present a 69year-old patient who died from a cerebral clostridium septicum infection. Clostridium septicum is an anaerobic, spore-forming, gram-positive bacillus. Its virulence depends on toxin building. Spontaneous clostridium septicum infections are rare and are associated with a high mortality (Khan AA et al., 2006, Marangou et al., 1992). Associations with this bacterium and colorectal malignancies have been reported (Khan et al., 2006, Kolbeinsson et al., 1991, Mirza et al., 2009). C. septicum causes disease in mammals and birds, and it was recognized historically as one of the causes of gas gangrene arising from battlefield injuries (Smith, 1984). In the 1960s and 1970s, it became apparent that those patients with hematologic malignancies were susceptible for this kind of infection (Alexander et al., 2010). The number of cases attributable to other malignancies, particularly colonic neoplasms, has increased.