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Brain Tumors Flashcards

1
Q 
86 dogs w brain tumors
41 definitive Tx (Sx, Co60 3.8-4Gyx12 MWF, I125, chemo)
7 no Tx
38 symptomatic Tx
All had neuro signs

OMST =

A

OMST = 1 mo

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2
Q 
86 dogs w brain tumors
41 definitive Tx (Sx, Co60 3.8-4Gyx12 MWF, I125, chemo)
7 no Tx
38 symptomatic Tx
All had neuro signs

MST w Sx =

A

MST w Sx = 1 mo

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3
Q 
86 dogs w brain tumors
41 definitive Tx (Sx, Co60 3.8-4Gyx12 MWF, I125, chemo)
7 no Tx
38 symptomatic Tx
All had neuro signs

MST w RT =

A

MST w RT = 5 mo

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4
Q 
86 dogs w brain tumors
41 definitive Tx (Sx, Co60 3.8-4Gyx12 MWF, I125, chemo)
7 no Tx
38 symptomatic Tx
All had neuro signs

MST w medical management =

A

MST w medical management = 2 weeks

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5
Q 
86 dogs w brain tumors
41 definitive Tx (Sx, Co60 3.8-4Gyx12 MWF, I125, chemo)
7 no Tx
38 symptomatic Tx
All had neuro signs

3 positive prognostic factors =

A

Less neurological signs
Solitary tumor
RT treatment

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6
Q

14 dogs w brian masses
4 meningiomas, 1 LSA, 1 pituitary tumor
Orthovoltage
9 39Gy RT, 5 45 Gy RT

OMST =

A

OMST = 16 mo

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7
Q

14 dogs w brian masses
4 meningiomas, 1 LSA, 1 pituitary tumor
Orthovoltage
9 39Gy RT, 5 45 Gy RT

MST w 39Gy total =

A

MST w 39Gy total = 5 mo

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8
Q

14 dogs w brian masses
4 meningiomas, 1 LSA, 1 pituitary tumor
Orthovoltage
9 39Gy RT, 5 45 Gy RT

MST w 45Gy total =

A

MST w 45Gy total = 17 mo

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9
Q

14 dogs w brian masses
4 meningiomas, 1 LSA, 1 pituitary tumor
Orthovoltage
9 39Gy RT, 5 45 Gy RT

What’s the technique to overcome skin SE?

A

3 fields technique

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10
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

OMST =

A

OMST = 11 mo

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11
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

MST in extra-axial tumor =

A

MST in extra-axial tumor = 12.4 mo

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12
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

MST in intra-axial tumor =

A

MST in intra-axial tumor = 10 mo

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13
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

MST in pituitary tumor =

A

MST in pituitary tumor = 5 mo

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14
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

___ dogs died d/t deterioration ____ days post RT

A

2 dogs

2-3 days

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15
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

___ % died of late SE (brain nectosis)

A

14%

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16
Q

83 dogs w brain masses
38Gy total RT w megavoltage manual plans
5, 7, 8, 9, 9 Gy q1w (dose escalating plan)

RT necrosis: severe rapid neuro decline over ____ days; focal necrosis & hemorrhage 2ndary to ____

A

2-5 days

vascular endothelial prolifeartion

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17
Q

29 dogs w intracranial masses
22 meningiomas, 4 gliomas, 3 choroid plexus
Co-60, 48Gy (3Gy x 16, M-F)
Whole brain target

MST =

A

MST = 8 mo

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18
Q

29 dogs w intracranial masses
22 meningiomas, 4 gliomas, 3 choroid plexus
Co-60, 48Gy (3Gy x 16, M-F)
Whole brain target

_____ dogs died d/t PD during RT

A

2 dogs died

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19
Q

29 dogs w intracranial masses
22 meningiomas, 4 gliomas, 3 choroid plexus
Co-60, 48Gy (3Gy x 16, M-F)
Whole brain target

_____ % died d/t PD/recurrence

A

76%

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20
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

OPFS =

A

OPFS = 30 mo

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21
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

PF (proliferative fraction) PCNA = %

A

PF PCNA = 24%

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22
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

Progesterone receptor = ______ %

A

Progesterone R = 70%

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23
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

Estrogen receptor = ______ %

A

Estrogens R = 0%

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24
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

PF PCNA & progesterone ____________ correlated

A

PF PCNA & progesterone inversely correlated

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25
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

OPFS 2 years = _______ %

A

OPFS 2 years = 68%

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26
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

Prognostic factor of PFS =

A

PF PCNA

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27
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

2 years PFS w PF PCNA > 24% =

A

42%

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28
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

2 years PS w PF PCNA < 24% =

29
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

High PF PCNA ______ times more likely recur

30
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

1 RI tumor = __________, ______ mo post RT

A

Glioma

39 mo post RT

31
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

PCNA expressed in _______ phase

32
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

Loss of progesterone may be associated w _____ tumor

A

Aggressive tumor

33
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

Human common RI tumor = ________

A

Maningiomas

34
Q

20 dogs w meningioma
Incomplete Sx + Co60 (4Gy x 12= 48Gy)

When CT or MR should be done after Sx?

A

within a few days

If you wait 1 week, contrast changes due to Sx become more evident.

35
Q

31 dogs w brain meningiomas treated w Sx alone or Sx+RT (Co-60 or magavoltage) with 40-49.5Gy

MST Sx alone =

36
Q

31 dogs w brain meningiomas treated w Sx alone or Sx+RT (Co-60 or magavoltage) with 40-49.5Gy

MST w Sx + RT =

37
Q

31 dogs w brain meningiomas treated w Sx alone or Sx+RT (Co-60 or magavoltage) with 40-49.5Gy

Is there sig difference bw RT type?
Is there dog difference bw RT dose?

A

No on both RT type and RT dose

38
Q

46 dogs w brain tumors w neurological signs treated w RT
34 had CT based RT wo Sx
Total 35-52.5 Gy in 2.5-4 Gy fraction size
22 extra, 13 intra, 13 pituitary tumors

Meningioma specific MST =

A

Meningioma specific MST = 23 mo

39
Q

46 dogs w brain tumors w neurological signs treated w RT
34 had CT based RT wo Sx
Total 35-52.5 Gy in 2.5-4 Gy fraction size
22 extra, 13 intra, 13 pituitary tumors

MST w worsening sings dogs =
(Unknown tumor recurrence or AE of RT)

40
Q

46 dogs w brain tumors w neurological signs treated w RT
34 had CT based RT wo Sx
Total 35-52.5 Gy in 2.5-4 Gy fraction size
22 extra, 13 intra, 13 pituitary tumors

Prognostic factors =

A

None

Within location, size, signs at presentation

41
Q

42 endoscopic-assisted intracranial tumor removal in dogs & cats
(33 dogs, 6 cats) (90% meningiomas, 10% others)

MST for forebrain meningioma =

42
Q

42 endoscopic-assisted intracranial tumor removal in dogs & cats
(33 dogs, 6 cats) (90% meningiomas, 10% others)

MST for caudal brain meningioma =

43
Q

7 dogs w frontal lobe meningiomas treated w Sx + RT
5 had Sx
3 Gy x 12 = 36 Gy total (M, W, F)
Megavoltage

Mean ST treated w Sx + RT =

44
Q

7 dogs w frontal lobe meningiomas treated w Sx + RT
5 had Sx
3 Gy x 12 = 36 Gy total (M, W, F)
Megavoltage

Poor prognostic factor =

A

Frontal lobe

d/t difficulty to remove tumor b/c of olfactory bulb tumor

45
Q

7 dogs w frontal lobe meningiomas treated w Sx + RT
5 had Sx
3 Gy x 12 = 36 Gy total (M, W, F)
Megavoltage

WHO grade in humans
G2 =
G3 =
Canine, feline meningiomas = 
Invasion of brain in type I meningioma results in prognosis equivalent to \_\_\_\_\_\_\_ meningiomas
A

G2 = atypical
G3 = anaplastic/malignant
Canine, feline maningiomas = G1 w G2 like behavior
Invasion of brain in type I meningioma results in prognosis equivalent to atypical meningiomas

46
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

MST for non specific reasons =

47
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

MST for specific meningioma =

48
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

Sig difference in ST between RT alone & Sx+RT?

A

No difference

49
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

AE was related to =

A

Volume irradiated

50
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

% of primary brain tumor had 2nd brain tumor at necropsy
Also % of meningioma within the 2nd brain tumors

A

23% progressed 2nd brain tumors

Of the 2nd brain tumor, 27% were meningiomas

51
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

% of meningiomas showed iso-hyper broad based mass on CT

52
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

% of maningiomas showed moderate-marked contrast enhancement

53
Q 
31 dogs w brain meningiomas 
3DCRT alone or Sx + RT
Dx: 10 histology, 21 imaging
Megavoltage 
2.5-3 Gy x 15-20 = 45-54 Gy total (M-F)

% had well-defined margins
% had moderate mass effect
% had minimum peritumoral edema
% ring enhancement

A

83% had well-defined margins
50% had moderate mass effect
67% had minimum peritumoral edema
11% ring enhancement

54
Q

51 dogs w primary brain tumors
Frameless SRS
38 meningiomas, 4 pituitary, 4 trigeminal, 3 gliomas, 1 HSA, 1 choroid plex
15 Gy x 1

OMST =

55
Q

51 dogs w primary brain tumors
Frameless SRS
38 meningiomas, 4 pituitary, 4 trigeminal, 3 gliomas, 1 HSA, 1 choroid plex
15 Gy x 1

Disease specific MST =

56
Q

51 dogs w primary brain tumors
Frameless SRS
38 meningiomas, 4 pituitary, 4 trigeminal, 3 gliomas, 1 HSA, 1 choroid plex
15 Gy x 1

Difference in ST bw tumor types?

A

No difference

57
Q

51 dogs w primary brain tumors
Frameless SRS
38 meningiomas, 4 pituitary, 4 trigeminal, 3 gliomas, 1 HSA, 1 choroid plex
15 Gy x 1

Difference in ST bw tumor size?

A

Yes. Smaller tumors did better.

58
Q

51 dogs w primary brain tumors
Frameless SRS
38 meningiomas, 4 pituitary, 4 trigeminal, 3 gliomas, 1 HSA, 1 choroid plex
15 Gy x 1

% showed acute grade 3 CNS AE (altered mentation)

59
Q

30 dogs w brain meningiomas
SRT w 8Gy x 3

MST =

60
Q

30 dogs w brain meningiomas
SRT w 8Gy x 3

____% worsen signs ____ weeks post RT

A

37%, 3-16 weeks post RT

61
Q

30 dogs w brain meningiomas
SRT w 8Gy x 3

____% died of worsen signs within 6 months

62
Q

30 dogs w brain meningiomas
SRT w 8Gy x 3

Worsen signs post RT

  1. _______ was predictive
  2. Should be ___________
A
  1. Normal brain volume received Rx was predictive

2. Should be volume <1.1 cc at Rx dose

63
Q

30 dogs w brain meningiomas
SRT w 8Gy x 3

Developed ________________ AE based on transient nature & timing

A

Subacute demyelination

64
Q

30 dogs w infratentorial brain tumors
3DCRT vs pred alone as Tx
Variety of Rx and protocol, but more definitive RT

OMST =

65
Q

30 dogs w infratentorial brain tumors
3DCRT vs pred alone as Tx
Variety of Rx and protocol, but more definitive RT

MST w 3DCRT =

66
Q

30 dogs w infratentorial brain tumors
3DCRT vs pred alone as Tx
Variety of Rx and protocol, but more definitive RT

MST w pred alone =

67
Q

30 dogs w infratentorial brain tumors
3DCRT vs pred alone as Tx
Variety of Rx and protocol, but more definitive RT

____ Gy had longer ST although not sig different

68
Q

30 dogs w infratentorial brain tumors
3DCRT vs pred alone as Tx
Variety of Rx and protocol, but more definitive RT

Infratentorial brain tumor in this study showed ______ outcome compared to other literature

A

Better

Not sig worse than cranial brain tumors

RO literature (4 decks)

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