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Solid Tumor Oncology > CNS Tumors > Flashcards

CNS Tumors Flashcards

1
Q

What CNS tumor should you not perform surgical resection, even when technically feasible?

A

Primary CNS lymhoma

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2
Q

What are the idnications for seizure prevention in those with CNS tumors?

A

If they’ve had a seizure before. No role for prophylaxis if they’ve never had seizures

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3
Q

What is the preferred anti-epileptic prophylactic medication?

A

Levetiracetam

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4
Q

What is the most common primary brain tumor?

A

Meningioma

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5
Q

What is the most common malignant primary brain tumor?

A

Glioblastoma

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6
Q

What are the three types of adult type gliomas? What are the hallmark differentiators between them?

A

Glioblastoma: IDH wt (grade 4)
Oligodendroglioma: IDH mutant, 1p/19q codeletion (grade 2-3)
Astrocytoma: IDH mutant, ATRX loss, TP53 mutation (Grade 2-4)

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7
Q

Pathologic definition of Glioblastoma

A

IDH wild type AND
Microvascular proliferation or necrosis or TERT promoter mutation or EGFR amplification or Ch7 gain and loss of Chr10

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8
Q

What are two potential gene abnormalities that are seen in Glioblastoma?

A

TERT promoter mutation or EGFR amplification
Though actionable mutations are rare

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9
Q

Standard treatment for newly diagnosed Glioblastoma

A

Focal RT (60 Gy) concomitant with temozolomide with adjuvant temozolomide

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10
Q

What is the use of MGMT promoter methylation?

A

Predicts response to alkylating agents (like temozolomide)

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11
Q

What predicts for a good response to temozolomide in Glioblastoma?

A

MGMT promoter methylation

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12
Q

You see a patient who finished concurrent RT with temozolomide for glioblastoma. First MRI 2 months post-treatment shows growing brain lesion. Patient is asymptomatic. What next?

A

Continue temozolomide. Likely pseudoprogression

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13
Q

What treatment is another option for glioblastoma aside from adjuvant temozolomide?

A

Tumor Treatment Field
The thing you have to wear on your head, etc.

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14
Q

What is the most commonly used treatment for recurrent GBM after temozolomide?

A

Bevacizumab

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15
Q

What is the best treatment for recurrent GBM who has MGMT methylation?

A

Bevacizumab + chemotherapy (irinotecan)

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16
Q

You see an elderly patient with GBM with MGMT methylation. Relatively poor performance status. Best treatment?

A

Temozolomide alone or with hypofractionated WBRT

16
Q

You are given a stem with brain tumor with fried egg appearance on histology. Diagnosis?

A

Oligogendroglioma

17
Q

Grade 3 oligodendroglioma treatment

A

Chemotherapy (PCV) and RT

18
Q

Treatment for grade 2 oligodendroglioma

A

No standard of care
Follow radiographically after surgery
When progression: RT + PCV
For high-risk (age over 40 or have subtotal resection), can go strait to PCV+RT

19
Q

Treatment for Grade 3 IDH mutant astrocytoma

A

Concomitant RT + TMZ and adjuvant TMZ (same as glioblastoma)

20
Q

Treatment for Grade 2 IDH mut astrocytoma

A

Wait and see approach vs RT+TMZ and adjuvant TMZ for high risk features (big tumors, etc.)

21
Q

What mutations are seen in sub=ependymal giant cell astrocytoma

A

TSC mutation (tuberous sclerosis)
treat with mTOR inhibitor

22
Q

Mutation seen in pleomorphic xantroastrocytoma

A

BRAF V600E

23
Q

Treatment for circumscribed astrocytic gliomas?

A

Surgery is curative

24
Q

Treatment for leptomeningeal disease from ependymomas

A

Craniospinal radiation

25
Q

Mutation seen and treatment for hemangioblastoma

A

VHL mutation
HIF 2 alpha blocker Belzutifan

26
Q

In immunocompromised patients with primary CNS lymphomas, what infection is commonly implicated?

A

EBV

27
Q

Treatment for primary CNS lymphoma

A

High dose MTX based chemo, like R-MPV

28
Q

Treatment for meningioma

A

Asymptomatic: Follow radiographically
Symptomatic: surgery. If not resectable, then RT

29
Q

What molecular feature automatically upgrades an astrocytoma to Grade 4?

A

CDKN2A deletion

30
Q

What are two risk stratification criteria for grade 2 gliomas?

A

Age >40 and subtotal resection are high risk
<40 and gross total resection are low risk

31
Q

What prophylactic medication is needed to be given to patietns who are undergoing treatment for their GBM with temozolomide?

A

PJP prophylaxis, usually dapsone

32
Q

What genetic abnormalities confer a poor prognosis in GBM?

A

TERT promoter mutation
EGFR amplification

33
Q

Patient with a large symptomatic meningioma undergoes complete resection. Pathology shows grade III meningioma. What now?

A

Postoperative RT

34
Q

What two treatments can be used for radiation necrosis?

A

Steroids
Bevacizumab

Solid Tumor Oncology (21 decks)

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