Low grade glioma/benign

Question 1

Contents of cavernous sinus

Answer 1

occulomotor (CNIII), Trochlear (CNIV), V1 and V2, Abducens (CNVI), carotid

Question 2

G2 Oligodendroglioma s/p STR Adjuvant Therapy

Answer 2

Observation or Upfront RT + Chemo (54 Gy, adjuvant PCV or TMZ)

Question 3

IDH Mut + 1p19q codeletion is

Answer 3

Oligodendroglioma

Question 4

Negative Prognosis

Answer 4

2019 Meta-analysis:
STR/Biopsy
Size > 5 cm
Performance Status (KPS <80)
Eloquent area

Pignatti:
Age 40+
6 cm
Cross midline
Neuro Sx

Question 5

Chemotherapy for LGG

Answer 5

OS Benefit

RT –> Adj PCV (Procarbazine, Lomustine [CNNU], Vincristine)

or

consider TMZ (Stupp or Adjuvant)

Question 6

KPS ≤ 60 or Elderly Dose/Fx

Answer 6

40/15 or 34/10 are acceptable

Question 7

Target Volume IDH-Mut

Answer 7

GTV: T1+con. T2/FLAIR abnormalities; hard to differentiate if possible from edema vs. non-enhancing tumor. Cavity if s/p surg.

CTV + 1-2 cm

PTV 0.3 -0.5 cm

Question 8

Primary CNS Lymphoma Treatment

Answer 8

Usually treated with Induction Chemo (MTX based) –> More chemo + ASTC or RT

RT = Whole Brain RT
- CR: 23.4 Gy in 1.8 Gy per fx
- PR: 36 Gy WBRT –> Boost Residual to 45 Gy

Question 9

Adult Spinal Ependymoma Treatment

Answer 9

Surgery –> RT

RT: 54 - 59.4 Gy

• GTV: Pre and Post-op MRI T1 enhanced and T2/FLAIR
• CTV 1-2 cm sup/inf
• PTV 0.3-0.5 cm

Question 10

Dmax 60 Gy Spinal Cord - Risk of Radiation Myelitis?

Answer 10

60 Gy = 6%

50 Gy = 0.2%