REVIEW
Introdução: Gliomas representam 80% dos tumores intracranianos, sendo que o subtipo mais comum é o glioblastoma multiforme (GBM). O diagnóstico e a terapêutica do GBM evoluíram significativamente desde sua descrição inicial, no entanto a sobrevida dos pacientes não mudou significativamente. Uma constante na maioria dos pacientes com GBM é o acometimento neurocognitivo, especialmente na forma de transtornos depressivos. Objetivo: Esse artigo tem por objetivo resumir o estado atual da literatura sobre a associação entre a depressão e o GBM. Métodos: Esta é uma revisão narrativa da literatura, feita a partir da pesquisa nas bases de dados PubMed, Scopus, Web of Science e Cochrane Library, usando-se as palavras-chave Depression, Glioma, Glioblastoma, Glioblastoma multiforme. Resultados: A associação do GBM com sintomas neuropsiquiátricos tem sido observada em diversos estudos, sendo que alguns apontam para uma possível correlação entre a piora do prognóstico e esses sintomas. Isso é particularmente importante quando observamos que o diagnóstico, por exemplo, de transtornos depressivos em pacientes com GBM é difícil pois se confunde com os sintomas da neoplasia em si. Alguns fatores de risco têm sido associados ao desenvolvimento de depressão em pacientes com GBM, dentre eles: presença de edema peritumoral, local do tumor, menor grau de escolaridade e disfunção cognitiva-motora. O tratamento para os sintomas neuropsiquiátricos em pacientes com GBM ainda é controverso, visto que a remoção cirúrgica não é completamente eficiente e as possibilidades farmacológicas podem interferir na progressão da neoplasia. Conclusões: O GBM ainda representa um grande desafio para a medicina moderna. A única conclusão direta que se pode fazer para a associação entre o tumor e sintomas depressivos é sua localização na região ventral do lobo frontal. Quanto ao tratamento, a remoção cirúrgica do tumor não remove completamente os sintomas neuropsiquiátricos e o tratamento farmacológico apresenta o risco de efeitos adversos com a possibilidade de melhora apenas parcial dos sintomas.
Introduction: gliomas represent 80% of intracranial tumors, with the most common subtype being glioblastoma multiforme (GBM). GBM diagnosis and therapy have evolved significantly since its initial description, however patient survival has not changed significantly. A constant in most GBM patients is neurocognitive impairment, especially in the form of depressive disorders. Objective: therefore, this article aims to summarize the current state of the literature on the association between depression and GBM. Methods: this work is a narrative review of the literature, carried out by searching the databases PubMed, Scopus, Web of Science and Cochrane Library, using the keywords Depression, Glioma, Glioblastoma, Glioblastoma multiforme. Results: the association of GBM with neuropsychiatric symptoms has been observed in several studies, with some pointing to a possible correlation between the worsening of the prognosis and these symptoms. This is particularly important when we observe that the diagnosis, for example, of depressive disorders in patients with GBM is difficult as it is confused with the symptoms of the neoplasia itself. Some risk factors have been associated with the development of depression in patients with GBM, including presence of peritumoral edema, tumor location, lower level of education and cognitive-motor dysfunction. Treatment for neuropsychiatric symptoms in patients with GBM is still controversial, as surgical removal is not completely efficient and pharmacological possibilities may interfere with the progression of the neoplasm. Conclusion: GBM still represents a major challenge for modern medicine. The only direct conclusion that can be made regarding the association between the tumor and depressive symptoms is its location in the ventral region of the frontal lobe. Regarding treatment, surgical removal of the tumor does not completely remove neuropsychiatric symptoms and pharmacological treatment presents the risk of adverse effects with the possibility of only partial improvement of symptoms.
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1Faculdade de Medicina, Universidade Federal do Triângulo Mineiro – UFTM, Uberaba, MG, Brasil.
2Neurosurgery Division, Universidade Federal de Sergipe – UFS, Aracaju, SE, Brasil.
3Discipline of Neurosurgery, Hospital das Clínicas, Universidade Federal do Triângulo Mineiro – UFTM, Uberaba, MG, Brasil.
Received June 17, 2022
Accepted June 25, 2024
