Gliomas (HGG)

Question 1

HGG Treatment

Answer 1

Most important- surgical decompression
RT- considered for all.
ChemoRT - TMZ for grade 4/ grade 3 biopsy shown sig improvement with chemoRT.
Active supportive care- poor prognosis

Question 2

Surgery advantages

Answer 2

Relieves mass effect
extends survival
lowers steroid dose
improves neurological function
allows RT to start.

Question 3

Role of RT

Answer 3

Positives- Improves survival by 3-6months and quality of life.
Negatives- can make neurological effects worse.

Question 4

Chemo RT (TMZ)

Answer 4

can sig improve survival in young, fit px’s
taken orally daily with RT
2 yrs survival extended from 10%-26%

Question 5

HGG target vol

Answer 5

CTV- +2.5 margin on GTV encompass abnormal area on FLAIR MRI.
PTV- +0.35-0.5cm to CTV
GTV- palliative gross visible tumour on planning CT.

Question 6

Palliative RT

Answer 6

BDS,
Parallel pair
Lat beams
Coll to avoid eyes
CT & apply 2cm margin to > tumour vol.
30GY in 6# over 2 weeks. 3x a week

Question 7

HGG Prognosis

Answer 7

grade 3 have 50% survival at 3yrs.
young and good ps do best
extent of surgical resection impact on survival
brainstem origin associated with poor survival