CNS

Question 1

IDH mutation prognosis

Answer 1

Favorable

Predicts benefit from addition of chemo to RT

Question 2

1p/19q codeletion prognosis

Answer 2

Favorable

Question 3

MGMT promoter methylation associations

Answer 3

Increased benefit from temozolomide
Prolonged survival in GBM
Pseudoprogression after chemoRT

Question 4

GBM initial treatment

Answer 4

Resection followed by involved-field RT with concurrent TMZ, then maintenance TMZ (+/- tumor-treating fields)

Question 5

Anaplastic astrocytoma (grade III) treatment

Answer 5

Resection followed by RT

Concurrent and adjuvant TMZ often used but somewhat controversial

Question 6

Diffuse astrocytoma and oligodendroglioma (grade II) treatment

Answer 6

Typically resect if symptomatic/feasible, can consider observation if asymptomatic/stable
Can use immediate post-op RT or delayed RT at time of progression
Can use RT + adjuvant PCV, + adjuvant TMZ, or + concurrent and adjuvant TMZ

Question 7

Anaplastic oligodendroglioma (grade III) treatment

Answer 7

Resection followed by RT

Can add concurrent and adjuvant TMZ or adjuvant PCV (procarbazine, lomustine, vincristine)

Question 8

Primary CNS lymphoma treatment

Answer 8

Backbone is high-dose MTX (3.5-8g/m2)

Consider auto transplant for consolidation or recurrent disease