Neuro-onc Flashcards
location of meningiomas
“dural based” - anywhere from the dura, most commonly within the skull and at sites of dural reflection (convexity, falx cerebri, tentorium cerebelli, venous sinuses)
- so on imaging referred to as “dural based lesion”
Clinical presentation of meningioma
Clinically – asymptomatic (most often) OR seizures (30%) + focal findings (broad array depending on location)
Management of meningioma
IF young OR symptomatic, consult NSGY for resection evaluation (will need treatment at some point)
IF old OR asymptomatic, monitor – repeat MRI in 6 months
What defines oligodendroglioma?
Mutation in isocitrate dehydrogenase (IDH) type 1 or type 2 AND codeletion of chromosomes 1p and 19q
What defines GBM?
IDH wildtype + grade 4 glioma
What defines astrocytoma?
1p19q intact
Low grade – Frequently IDH mutant
Grade 4 astrocytoma – IDH mutant in minority
Grade 2 and Grade 3 astrocytoma management
Grade 2
If gross total resection →
IF residual disease AND no prior treatment other than surgery AND surgery within 5 years, vorasidenib 40 mg PO once daily
Grade 3
*Higher grade managed like GBM
Immediate postoperative concurrent RT + adjuvant chemotherapy (EORTC 26053 - CATNON trial)
Ependymoma 1) Additional required workup 2) G1-G4 management
1) LP
3) 2) Upfront surgery
IF G1 AND gross total resection, observation
*IF incompletely resected G2 or G3 – adjuvant XRT
Postop management of ependymoma
IF high grade (G2-G3) involved-field radiation therapy
IF G1, surveillance
Medulloblastoma management
upfront gross total resection with adjuvant radiation and adjuvant chemo
Answer to patient symptomatic several weeks after XRT for GBM (within first 3 months)
- pseudoprogression
Management of pseudoprogression in GBM
PO dexamethasone
additional workup required for CNS lymphoma
Fundoscopic exam with slit lamp evaluation
Drugs that need to be held with high dose MTX
- antibiotics (reduce clearance)
- duiretics (renal protection)
- PPIs
Next step in workup for classifying astrocytoma
CDK2A/B testing (homozygous deletion = Grade 4)