Neuro-onc Flashcards

1
Q

location of meningiomas

A

“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”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Clinical presentation of meningioma

A

Clinically – asymptomatic (most often) OR seizures (30%) + focal findings (broad array depending on location)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of meningioma

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What defines oligodendroglioma?

A

Mutation in isocitrate dehydrogenase (IDH) type 1 or type 2 AND codeletion of chromosomes 1p and 19q

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What defines GBM?

A

IDH wildtype + grade 4 glioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What defines astrocytoma?

A

1p19q intact
Low grade – Frequently IDH mutant
Grade 4 astrocytoma – IDH mutant in minority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Grade 2 and Grade 3 astrocytoma management

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ependymoma 1) Additional required workup 2) G1-G4 management

A

1) LP
3) 2) Upfront surgery
IF G1 AND gross total resection, observation
*IF incompletely resected G2 or G3 – adjuvant XRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Postop management of ependymoma

A

IF high grade (G2-G3) involved-field radiation therapy
IF G1, surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Medulloblastoma management

A

upfront gross total resection with adjuvant radiation and adjuvant chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Answer to patient symptomatic several weeks after XRT for GBM (within first 3 months)

A
  • pseudoprogression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of pseudoprogression in GBM

A

PO dexamethasone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

additional workup required for CNS lymphoma

A

Fundoscopic exam with slit lamp evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Drugs that need to be held with high dose MTX

A
  • antibiotics (reduce clearance)
  • duiretics (renal protection)
  • PPIs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Next step in workup for classifying astrocytoma

A

CDK2A/B testing (homozygous deletion = Grade 4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Poor prognostic feature of astrocytoma

A

Homozygous deletion of CDKN2A/B

17
Q

Poor risk feature of medulloblastoma

A

MYC activation

18
Q

Next step after debulking surgery of medulloblastoma

A
  • second look surgery for maximal tumor debulking
19
Q

Adjuvant mgmt of oligodendroglioma

A

IF no prior chemo or RT AND not on steroids, vorasidenib
IF residual disease, RT + PCV

20
Q

Clinical benefit of TTF for GBM

A

PFS and OS benefit

21
Q

What defines astrocytoma?

A

IDH mutant + intact 1p/19q locus

22
Q

What defines oligodendroglioma?

A

IDH mutant + 1p/19q co-deletion

23
Q

What defines GBM?

A

IDH wildtype + molecular features of GBM (TERT mutation, EGFR amplification, chromosome +7/-10) or histopath features (necrosis and/or microvascular proliferation)

24
Q

Next step in mgmt for path after resection showing G3 astrocytoma + TERT promotor and wild-type IDH

A
  • GBM management (histopath with astrocytoma but GBM features (TERT) = GBM
25
Q

Molecular features of GBM

A

TERT mutation, EGFR amplification, chromosome +7/-10

26
Q

Standard of care adjuvant for astrocytoma

A
  • radiation therapy followed by adjuvant temozolomide
27
Q

temozolomide mechanism

A

Alkylating drug

28
Q

median OS for oligodendroglioma

A

G3 = 3-5 yrs
G2 = 10-15 years

29
Q

Adjuvant mgmt of G3 oligodendroglimoa

A
  • XRT w/ PCV
    OR
  • XRT w/ concurrent and adjuvant temodar
30
Q

Advanced age or borderline PS GBM management

A
  • hypofractionated XRT - 45 Gy over 3 weeks with concomitant and adjuvant temodar
31
Q

Small lesion within the fourth ventricle in asymptomatic patient is typically

A

subependymoma

32
Q

meningioma location + radiographic features

A
  • supratentorial
  • intense and homogenous contrast enhancement
33
Q

mutation that confers better prognosis in primary brain tumors

A
  • IDH
34
Q

EGFR amplification prognostic significance

A

Poor

35
Q

adjuvant management of ependymoma

A

IF G3 or incompletely resected G2, involved-field radiation therapy
IF G1, surveillance

36
Q

Most common radiation-induced CNS lesions

A

Meningioma