Glioma

Question 1

wounded glioma syndrome

Answer 1

High risk of hemorrhage and edema in post op partial tumor resection

Question 2

CI 🚫 surgery in diffuse glioma

Answer 2

1- extensive in dominant left , high grade
2- Butterfly gliomas
3-elderly
4- Karnofsky score < 70
5- multi centric Glioma
6- poor medical donation

Question 3

MCC malignant brain 🧠 tumors

Answer 3

GBM

Question 4

Precourser of GBM

Answer 4

Pre ventriclular zone

Question 5

Good prognosis factor for high grade diffuse Glioma grade 3 and 4

Answer 5

MGMT methylation
Age < 44
IDH 1
KPS >80

Question 6

Multiple Glioma (gliomatosis cerebri)

Answer 6

Involve >3 lobes , bilateral involvement, posterior fossa extension
Due to spread CSF , blood , white matter ( CC , IC , inter- thalami c,pedicure,uncinate fasiculus)

Question 7

Multiple Glioma syndroms

Answer 7

MS , NF , TSC

Question 8

Temozolomide efffective in which blow grade Glioma

Answer 8

Astrocytoma IDH mutant grade 2

Question 9

dLGG adult diffuse glioma grade 2 mangment

Answer 9

GTR if KPS > 80
Low risk patient ➡️ < 40y , GTR ➡️ mri f/u 3- 6 m
High risk patient ➡️ age > 40 ,tumors size , deficit :
📍 XRT followed by PCV
📍 XRT + temozolamide (concurrent or after XRT)
📍follow up mri

Question 10

Radiation dose dLGG (Astro / oligo )

Answer 10

54 Gy in fraction 1.8-2 Gy over 6 weeks

Question 11

SE WBXRT

Answer 11

leukoencephalopathy and cognitive impairment

Question 12

XRT after incomplete resection

Answer 12

Prolong PFS and disease specific survival

Question 13

Indication chemotherapy in dLGG

Answer 13

High risk patient or
Low risk with tumor progression

Question 14

PCV effective ⬆️ PFS and OS

Answer 14

IDH mutant only

Question 15

Pseudoresponse

Answer 15

Enhancement due to disruption BBB with out actual tumor growth
Associated angiogenesis inhibitors like bevacizumab
⬇️ steroid

Question 16

Pseudoprogression AIM

Answer 16

⬆️ contrast enhance < 3 month after TXRT and Temozolomied
Histology ➡️ radiation necrosis

Question 17

GBM Pseudoprogression

Answer 17

Recurrence of GBM in MRI within 6 months

Question 18

temozolomide SE

Answer 18

Low plat
Low wbc

Question 19

TZM MOA

Answer 19

Under physiologic pH to the active metabolite monomethyl triazenoimidazole carboxamide (MTIC).
The cytotoxic effect of MTIC is associated with alkylation (primarily methylation) of DNA at various sites, including the O 6 and N 7 positions on guanine.
➡️ forming O6-methylguanine ➡️ in cell death

Question 20

At which level MGMT methylation reposed well to TZM

Answer 20

MGMT levels < 30 fmol/m

Question 21

Alternative alkyl agent ( TZM )

Answer 21

Gliadel® wafer