CNS adult and peds Flashcards
NF type 1 or von Recklinghausen’s disease. what CNS tumor association?
meningioma, astrocytoma or GBM or LGG?
astrocytoma!. pilocytic most common.
NF type 2, what intracranial tumor most common?
Schwannomas, most often b/l acoustic neuromas are more common than meningioma or astrocytomas.
what are the negative risk factors for scoring LGG per Pignatti?
Age greater than 40, astrocytoma subtype, tumor larger than 6cm, tumor crossing midline, presence of neurolgoical deficit prior to surgery. 2+ factors is low risk group with MS of 7.7yrs , whereas 3 or more is high risk with MS of 3 years.
EORTC 22844, Believer’s Trial in LGG showed what?
LGG randomized to immediate PORT with 45 or 59.4Gy. 25% had GTR. dose escalation did not improve OS, PFS.
Dose max to cochlea and pituitary?
Max 36. stnd fx. srs dose to chiasm is 8-10Gy
what does MGMT do?
it is a DNA repair enzyme that repairs damage induced by alkylating agents, such as TMZ. those with methylated MGMT were found to have improved OS with RT and TMZ.
EORTC 22845, “Non Believers” Trial showed what?
LGG randomized to early vs delayed RT. PFS imrpoved in early RT (5.3 vs 3.4yrs) but no difference in OS (7yrs). But better seizure control in early RT (25 vs 41%) Median dose was 54Gy.
EORTC 26951, LGG pts randomized after surgery and RT +/- chemotherapy. what did it show?
AO’s after surgery and RT to either obs vs adj pCV (procarbazine, lomustine, vincristine). 5yr results lin 2006 showed PFS only (1.9 vs 1.1yrs). 1p19q deletion had 5yr OS of 74 vs 30%. in 12 yr f/u, PCV improved PFS and OS. MS 42 vs 31 mos. those with the deletion did not reach median survival yet at 12 yrs.
what evidence do we have that 60Gy is the max dose for HGG? What evidence is there that young people have better prognosis in HGG?
ECOG/RTOG trial from 1983 looking at stnd 60Gy WBRT+10Gy bst, 60Gy+BCNU, 60Gy WBRT+CCNU+DTIC vs 60Gy alone. Age was most pronstoic with better survival in <40yrs. BCNU did nto improve survival compared to 60Gy WBRT Alone. CCNU+DTIC was more thrombocytopenic than BCNU.
per RTOG 90 05, what is the SRS dose in brain mets and gliomas?
<2cm, 2-3cm, 3-4cm?
<2cm (24Gy)
2-3cm (18Gy)
3-4cm (15Gy)
48% fail locally, but most o fthose are gliomas than mets that fail locally.
how is TMZ given
with GBM, given minutes before RT at dose of 75mg/m2, then adjuvantly at 150-200mg/m2 x 6 cycles.
the OS benefit at 5yrs was 10% vs 2%.
initial report in 2005 at 2yrs showed MS of 14.6 vs 12 mos. 2yrOS was 27% vs 11%.
MGMT status is te strongest predictor of outcome.
Bauman elderly GBM trial showed what MS with RT vs best supportive care?
=>60yrs and KPS=<50 got 30/10fx, MS imrpoved from 1 vs 10mos.
Roa, elderly GBM trial with hypofx RT for poor prognosis pts showed what?
60/30fx vs 40/15fx. same OS, MS (5mos).
30fx less likely to finish RT (74% vs 90%) and also needed an increased in steroids post tx.
what was teh RT dose in the elderly GBM study by Keime-Guibert?
=>70, KPS =>70 got best supportive care or 50.8/28fx. the MS was prolonged at 29 vs 17 wks, w/o RT. QoL did not differ.
what pathologic association with meningiomas?
psammoma bodies = meningioma
rosenthal fibers = astrocytomas
psuedorosettes = ependymoma
Homer-Wright rosettes = medulloblastoma
per Goldsmith, what is the 5yr PFS for meningiomas after GTR? STR? PORT in STR? PORT for malignant meningioma? using 54Gy
GTR 5yr PFS: 89% STR PFS = 50% PORT in STR = >85% PORT in malingant RT = 40-50% outcomes are much worse when dose <52Gy
for ependymoma, is GTR more common in supratentorial or infratentorial? LF vs DF? RT dose?
GTR more commonly achieved in supratentorial. resection extent is the most important predictor of outcome. LR is most common, therefore dose is 59.4Gy.
RTOG 94-02 looked at oligos with PORT with 59.4Gy +/- PCV chemo. what were the outcomes?
pts got either PORT alone or 4cycles of PCV followed by PORT. PFS was better wtih PCV, 2.6 vs 1.7yrs. but more toxicity with PCV. On FISH, 1p19q deletion had MS >7yrs and better PFS. On 11.yr f/u update, MS of the codeleted pts was 14.7yrs with PCV vs 7yrs without PCV.
how many mitoses per 10 HPF makes anaplastic meningioma?
20.
What are the 4 Simpson grading systems?
I: GTR, bone and dura II: GTR, coagulation of dural attachment III: GTR, with intact dura IV: STR. Kadish staging is used for estesioneuroblastoma btw.
what does the neurohypophysis secret?
the posterior lobe of the pituitary or neurohypophysis, secretes ADH and oxytocin.
the anterior lobe or adenohypophysis, secretes, prolactin, TSH, GH, LH, FSH, ACTH.
what is the order that the hypothalamic pituitary axis hormones are affected from RT?
GH, ACTH, LH/FSH, TSH (Merchant. Early neuro-otologic effects…IJROBP, 2004)
what are the contents of the cavernous sinus?
III, IV, VI then V1 and V2.
what is the COMS classification? collaborative ocular melanoma study
small= 1-3mm thick and 8mm thick and >16mm dimension
