Sweatman Treatment of Brain Tumors

Question 1

most common tumor in brain

Answer 1

mets to brain from other primary site

Question 2

mets to brain in what order

Answer 2

lung> breast>unknown>MELANOMA (high propensity)> renal

Question 3

80% of brain mets occur in what part

Answer 3

cerebral hemispheres

Question 4

15% OF BRAIN METS OCCUR INTO

Answer 4

cerebellum

Question 5

5% of mets to brain occur into

Answer 5

brain stem

Question 6

therapies to treat brain mets may also be more than just antitumorals

Answer 6

steroids to combat edema

anticonvulsants (to combat seizure but not until symptomatic)

Question 7

DEFINITIVE TREATMENT OF BRAIN CA

Answer 7

SURGERY
WHOLE BRAIN RADIATION
RADIOSURGERY

*ALONE OR IN COMBO

Question 8

T1 MODALITY

Answer 8

WATER IS dark

Fat is bright
contrast is white (hyperintense)

Question 9

T2 modality

Answer 9

fat is intermediate bright

water is bright

Question 10

t2 flair

Answer 10

stagnant water is bright

moving water is dark

but double check this shit

Question 11

routine use of conventional chemo for brain mets….

Answer 11

no strong evidence for support

Question 12

if you are going to use conentional chemo for brain mets…

Answer 12

need a BBB penetrating drug that reaches neuronal tissue in cytotoxic concentrations a(such as temozolomide) and WBRT (whole brain radiation therapy

Question 13

astrocytes and tumor cells connected via

Answer 13

gap junctions

thus resistance to chemo ca come about not only by mechanisms within the tumor cell but also by gene-related effects produced by the astrocyte

Question 14

key defining feature of CNS tumor resistance mechanisms that cause treatment outcomes to vary from the same tumoral types treated in the periphery

Answer 14

Tumor cells congregate and interconnect with astrocytes-via gap junctions-they provide “prevailing survival signalling” through differences in gene expresssion in the astrocyte that are passed on to the cancer cell

thus jsut because a cytotoxic agent reaches the CNA in proper concentrations-it doesnt necessarily have to respond as it would to the exact same concentration in the periphery

Question 15

non enzymatically activated prodrug yielding a DNA methylating agent

Answer 15

temozolimide

Question 16

temozolimide MOA

Answer 16

PRODUCES DNA DAMAGE
methylating agent that inhibits DNZ replication

METHYLATION MUTES MOST DNA

Question 17

MYELOSUPRESSANT, LEUKOPENIA, THROMBOCYTOPENIA

N/V CHILLS 1-3 HOURS AFTER THERAPY

Answer 17

TEMOZOLIMIDE

Question 18

CATEGORY X

Answer 18

temozolimide

Question 19

labeled uses for temozolomide

Answer 19

astrocytoma

GBM (astrocytoma IV grade)

Question 20

off label recommendations for temozolomide

Answer 20

malignant glioma

malignant melanoma

Question 21

SUICIDE REPAIR ENZYME IN SOME CANCER CELLS

Answer 21

MGMT

Question 22

ONE PATH OF RESISTANCE TO TMZ

Answer 22

UPREGULATION OF MGMT–> THE DAMAGED CELL REPAIRS THE DNA DAMAGE WE CAUSED BY ADMIN TMZ

Question 23

RESTORE 3D TOPOLOGY OF DNA ALLOWING CELL DIVISION TO CONTINUE

Answer 23

MGMT

Question 24

WHY DOES TMX CAUSE DOSE DEPENDENT MYELOSUPRESSIVE EFFECTS

Answer 24

HEMOTOPEITIC CELLS LACK THE ABILITY TO BEEF UP MGMT IN RESPINCE TO DNA METHYLATION CAUSED BY TMZ

Question 25

CARMUSTINE ALSO CALLED

Answer 25

BCNU

Question 26

LOMUSTINE ALSO CALLED

Answer 26

CCNU

Question 27

NITROSUREAS

Answer 27

CCNU AND BCNU | LOMUSTINE AND CARMUSTINE

Question 28

indications for BCNU (carmustine)

Answer 28

astrocytoma brain mets malignant glioma medulloblastoma

Question 29

indications for CCNU (Lomustine)

Answer 29

Malignant Glioma

Question 30

cause apoptosis activation by DNA alkylation

Answer 30

Carmustine and Lomustine

Question 31

additional benefit of carmustine

Answer 31

decomposition products carbamolyate proteins which inhibit DNA repair

Question 32

cross resistance with other alkylating products in CCNU and BCNU tx

Answer 32

uncommon

Question 33

works via DNA alkylaiton and carbaoylation of proteins (ninhibit DNA repair

Answer 33

carmustine

Question 34

main tissue affectd and side effects of systemic ceeNu and BicNU usage

Answer 34

``` hematopoetic supression pulmonary toxicity endocrine dysfunction esp with irraadiation therapy elevate LFTS encephalopathy seizures ```

Question 35

high lipophillic and non-ionized at physiologic pH

Answer 35

carmustine and lomustine

Question 36

alkyalting agent given orally

Answer 36

lomustine

Question 37

alkylating agent given parenterally

Answer 37

carmustine

Question 38

can be administered after surgical excision with a long acting wafer formulation at the primary site--> thus mitigating systemic toxicity

Answer 38

carmustine

Question 39

gliadel-carmustine wafer-indicated for

Answer 39

high grade glioma

Question 40

convection enhanced delivery

Answer 40

instillation of a catheter and infusion under pressure of chemo agen which will diffuse into the tumor and surrounding tissue

Question 41

Chemo therapy related cognitive impairment AKA

Answer 41

chemo-fog

Question 42

mechanism for CRCI

Answer 42

cytotoxics promote peripheral release of TNFalpha in response to cellular damage TNFalpha can access BBB tnfALPHA damages mitochondria and produces ROS via glial cell related mechanisms

Question 43

TNFalpha and CRCI can be blocked by

Answer 43

anti-tnfalpha antibodies