Treatment Paradigm Flashcards
What is the typical Tx paradigm for DIPG?
Steroids/shunts → RT
What type of BSG is amenable to surgical resection?
Dorsally exophytic BSGs have a 75% 10-yr OS with Sg. These are usually pilocytic astrocytomas with a good prognosis.
What is the typical RT volume for DIPG?
Tumor as defined by MRI + a margin of 1–2 cm
What is the typical RT dose for DIPG?
The typical RT dose for DIPG is 54 Gy in 1.8–2 Gy/fx.
What proportion of DIPG pts will have stabilization or improvement of Sx after RT?
After RT, two-thirds of pts will have stabilization or improvement of Sx.
How are midbrain tectal plate tumors managed? What is their histology?
Tectal plate tumors are typically managed with observation and a ventriculoperitoneal shunt to relieve obstruction. They are typically pilocytic astrocytomas (indolent).
What are the major prognostic factors dictating outcome in pts with BSGs?
Diffuse vs. focal
Adult vs. child
Histology (for BSGs other than DIPG)
What usually causes death in pts with BSGs?
Local expansion usually causes death in pts with BSGs.
What is the RT dose tolerance of the brainstem?
The dose tolerance of the brainstem is 54 Gy (if fractionated EBRT) and 12 Gy (if SRS).
What is the typical treatment sequence for children with a diffusely infiltrating pontine glioma?
What is the role for chemotherapy?
Steroids/shunt (if necessary), followed by radiation (54–59 Gy in 1.8–2 Gy fx). Chemotherapy has not shown to be effective in the treatment of diffuse pontine gliomas. Most recently, temozolomide was tested in a COG phase II trial and found to be ineffective.
Cohen, KJ, Heideman, RL, Zhou, T, et al. Temozolomide in the treatment of children with newly diagnosed diffuse intrinsic pontine gliomas: a report from the Children’s Oncology Group. Neuro Oncol. 2011;13:410-416.
