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RO3 > CNS Tumour Types > Flashcards

CNS Tumour Types Flashcards

1
Q

What are the two most common types of brain tumours?

A

Gliomas and menigiomas

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2
Q

What are the three subtypes of gliomas?

A

Astrocytomas, Ependymomas, Oligodendroglioma

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3
Q

How many grades of Astrocytoma are there?

A

4
[Grades 1&2: Low]
[Grades 3&4 : High]

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4
Q

List the names given to each grade of astrocytoma

A
  1. Benign astrocytoma
  2. Low grade (diffuse) astrocytoma
  3. Anaplastic astrocytoma
  4. Glioblastoma multiforme (GBM)
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5
Q

What are the characteristics of low grade Astrocytomas?

A
  • Arise frontal, parietal, temoral lobes of adults
  • Lobal destruction unusal
  • Slow growing
  • Diffuse infiltrative growth - don’t destruct brain
  • May be excised completely
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6
Q

What are the characteristics of high grade astrocytomas?

A
  • Significant damage to neuro function
  • Degeneration, necrosis, haemorrhage
  • Rarely operable
  • surrounded by extensive oedema
  • Grow rapidly by direct extension
  • Can spread through white matter
  • Cannot restore neuro function
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7
Q

What are the treatment options for low grade Gliomas?

A
  • Surgery [biopsy]
  • RT [when disease progresses]
  • ChemoRT
  • Chemo
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8
Q

Discuss the suitability of RT for low grade Gliomas

A
  • High risk of progression
  • Poor prognostic features
  • Tumour in area directly controlling functions
  • Seizures unable to be controlled
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9
Q

What is the RT dose for standard risk low grade glioma patients?

A

5040 cGy 28# [daily]

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10
Q

What is the RT dose for high risk low grade glioma patients?

A

5400 cGy 30# [daily]
Potential for integrated boost to 6000 cGy

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11
Q

What are the treatment options for high grade Gliomas?

A
  • Surgical debulking [quick symptom relief]
  • RT
  • ChemoRT
  • Active supportive care
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12
Q

What are the benefits of tumour debulking sugery for high grade gliomas?

A
  • Extends survival
  • Relieves mass effect
  • Improves neuro function
  • Means reduced steriod dose can be used
  • Allows RT to commence
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13
Q

What metrics are used to assess RT elgibility of high grade glioma patients?

A

Age and Karnofsky Performance Status

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14
Q

If a patient is < 70 and has a KPS > 70, what dose RT do they receive?

A

G3: 5940 cGy 33# [Daily]
6000 cGy 30# [Daily]

G4: 6000 cGy 30# [Daily]
(with oral chemo TMZ)

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15
Q

What is the palliative dose for high grade glioma patients?

A

30 Gy 6# [3x a week]

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16
Q

What ages are the peak incidence rates of ependymoma?

A

5 and 35

17
Q

What are the common locations ependymomas arise in adults and paediatric patients?

A

Adults: Spinal tumours
Paediatric: Intracranial (typ. post fossa)

18
Q

What cells do ependymomas arise from?

A

Ependymal cells lining ventricular system and central canal of spinal cord

19
Q

How many grades of ependymoma are there?

A

3

20
Q

What treament management is used for grade 1 ependymomas?

A

Subependymoma:
* Surgery usually curative
* RT if local progression

Myxopapillary:
* Usually only sub-total resection is possible.
* post-op RT excellent control rates

21
Q

What treament management is used for grade 2 ependymomas?

A
  • Surgery
  • post-op RT [but some achieve remission without RT]
22
Q

What treament management is used for grade 3 ependymomas?

A
  • Surgery
  • Immediate post-op RT

[CSRT was used, not no longer]

23
Q

What are the standard doses for RT of ependymomas?

A

Spinal tumours: 50.4 Gy 28#
Cauda Equina: 54 Gy 30#
Intracranial: 55-60 Gy 30#

24
Q

All meningiomas will attempted to be resected. What is the name of the system describing the level of resection acheived?

A

Simpson’s Grade of Resection (1-5)

25
Q

How many WHO grades are there for menigioma?

A

3

26
Q

From what cells do menigiomas arise?

A

Meninges

27
Q

What are the indications for post-op RT for menigiomas?

A

WHO grade 1:
* RT only for Simpson’s grade 3-5. Based on life expectency etc

WHO grade 2:
* All patients considered for RT

WHO grade 3:
* All patients considered for immediate RT

28
Q

What are the standard doses given to each grade of meningioma?

A

Grade 1:
50.4 Gy 28# [5.5 weeks]

Grade 2:
54-60 Gy 30# [6 weeks]

Grade 3:
60 Gy 30# [6 weeks]

RO3 (10 decks)

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