CNS Tumour Types Flashcards
What are the two most common types of brain tumours?
Gliomas and menigiomas
What are the three subtypes of gliomas?
Astrocytomas, Ependymomas, Oligodendroglioma
How many grades of Astrocytoma are there?
4
[Grades 1&2: Low]
[Grades 3&4 : High]
List the names given to each grade of astrocytoma
- Benign astrocytoma
- Low grade (diffuse) astrocytoma
- Anaplastic astrocytoma
- Glioblastoma multiforme (GBM)
What are the characteristics of low grade Astrocytomas?
- Arise frontal, parietal, temoral lobes of adults
- Lobal destruction unusal
- Slow growing
- Diffuse infiltrative growth - don’t destruct brain
- May be excised completely
What are the characteristics of high grade astrocytomas?
- 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
What are the treatment options for low grade Gliomas?
- Surgery [biopsy]
- RT [when disease progresses]
- ChemoRT
- Chemo
Discuss the suitability of RT for low grade Gliomas
- High risk of progression
- Poor prognostic features
- Tumour in area directly controlling functions
- Seizures unable to be controlled
What is the RT dose for standard risk low grade glioma patients?
5040 cGy 28# [daily]
What is the RT dose for high risk low grade glioma patients?
5400 cGy 30# [daily]
Potential for integrated boost to 6000 cGy
What are the treatment options for high grade Gliomas?
- Surgical debulking [quick symptom relief]
- RT
- ChemoRT
- Active supportive care
What are the benefits of tumour debulking sugery for high grade gliomas?
- Extends survival
- Relieves mass effect
- Improves neuro function
- Means reduced steriod dose can be used
- Allows RT to commence
What metrics are used to assess RT elgibility of high grade glioma patients?
Age and Karnofsky Performance Status
If a patient is < 70 and has a KPS > 70, what dose RT do they receive?
G3: 5940 cGy 33# [Daily]
6000 cGy 30# [Daily]
G4: 6000 cGy 30# [Daily]
(with oral chemo TMZ)
What is the palliative dose for high grade glioma patients?
30 Gy 6# [3x a week]
What ages are the peak incidence rates of ependymoma?
5 and 35
What are the common locations ependymomas arise in adults and paediatric patients?
Adults: Spinal tumours
Paediatric: Intracranial (typ. post fossa)
What cells do ependymomas arise from?
Ependymal cells lining ventricular system and central canal of spinal cord
How many grades of ependymoma are there?
3
What treament management is used for grade 1 ependymomas?
Subependymoma:
* Surgery usually curative
* RT if local progression
Myxopapillary:
* Usually only sub-total resection is possible.
* post-op RT excellent control rates
What treament management is used for grade 2 ependymomas?
- Surgery
- post-op RT [but some achieve remission without RT]
What treament management is used for grade 3 ependymomas?
- Surgery
- Immediate post-op RT
[CSRT was used, not no longer]
What are the standard doses for RT of ependymomas?
Spinal tumours: 50.4 Gy 28#
Cauda Equina: 54 Gy 30#
Intracranial: 55-60 Gy 30#
All meningiomas will attempted to be resected. What is the name of the system describing the level of resection acheived?
Simpson’s Grade of Resection (1-5)
How many WHO grades are there for menigioma?
3
From what cells do menigiomas arise?
Meninges
What are the indications for post-op RT for menigiomas?
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
What are the standard doses given to each grade of meningioma?
Grade 1:
50.4 Gy 28# [5.5 weeks]
Grade 2:
54-60 Gy 30# [6 weeks]
Grade 3:
60 Gy 30# [6 weeks]
