Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Tumour > tumor treatment > Flashcards

tumor treatment Flashcards

1
Q

What is bevacizumab?

A

An angiogenes inhibiting agent.

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

What finding might be seen on MRI after use of Bevacizumab and other angiogenes inhibitors?

A

Psudoregression of the tumor. - but its the effect of a BBB stabilisation that is seen, not tumor regression.

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

What is “RANO”?

A

Response Assessment in Neuro-Oncology. the size of the contrast enhancing tumorcomponent is measured in a special way. That is combined w info of cortison treatment and clinical status.
Non-contrast enhancing tumors with high T2 or T2 FLAIR intensity are also measured.
Smallest “countable” lesion acording to RANO is 1 cm2.

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

What are the outcomes in RANO?

A
  • response
  • partiell response
  • stable disease
  • progression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the difference in diagnostication of glioma between WHO CNS 2016 and 2021?

A

In 2016, molecular alterations together with histopathology were defining diagnosis.

In 2021 molecular data are implemented to a large extent and will form the basis for a continous revision of CNS tumor classification.

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

What is the drug used for flourescence based visualization of tumor tissue called?

A

5-aminolevulinic acid.

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

What is the goal of radiotherapy for glioma?

A

To improve local control without inducing neurotoxicity

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

What determibes the timing, dosing and scheduling of radiotherapy?

A
  • disease subtype
  • age
  • KPS
  • recidual tumor volume.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When should radiotherapy start after surgery?

A

3-5 weeks

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

What is the most common dose of radiotherapy for grade 2-3 gliomas?

A

50-60 Gy, in 1.8-2 Gy daily fractions.

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

What does hypofractioned radiotherapy mean?

A

Higher dose per fraction, and a lower total dose. ex 15x2.67Gy.

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

When is hypofractionate radiotherapy after glioma considered?

A

Typically in older patients (more than 65-70yo) and in those with PKS under 70.

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

What does KPS under 70 mean for an oncologist?

A

poor prognosis

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

How much is added to “the gross tumour volume” to account for microscopic invasion?

A

1-2 cm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What structures are at higher risk of toxicity from radiotherapy?

A

Optic nerves
Optic chiasm
Retinae
Lenses
Brainstem
Pituitary
Cochlea
Hippocampi.

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

What are the good things with proton therapy instead of conventional radiotherapy?

A

It avoids delayed toxicities and might be options for tumors close to brain regions at risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are requirements for pharmacological treatment of glioma pt?

A
  • hepatic and renal laboratory values within the normal ranges
  • exclusion of major lung or heart disease
  • exclusion of ongoing infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most commonly used drug in glioma treatment?

A

Temozolomide.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is Temozolomide?

A

An oral DNA alkylating agent that penetrates the BBB.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the risks with Temozolomide treatment?

A

After 2-3 weeks:
* myelosuppression - noteably thrombocytopenia as its main dose-limiting toxicity
* hepatic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

name alkylating agents from the nitrosurea class

A

Lomustine
Carmustine
w more

22
Q

Nitrosurea alkylating agents have their worst sideeffects after 4-6 weeks. What are they?

A

cumulative leukopenia and thrombocytopenia that might necessitate treatment interruptions.

23
Q

What is usually the composition of PCV?

A
  • Lomustine (nitrosurea alkylating)
  • Procarbazine
  • Vincristine
24
Q

What are feared long term risks of alkylating agent chemotherapy?

A
  • potential long-term toxicities
  • risk of inducing hypermutator phenotype of the tumor.
25
Q

Therapy recommendations for IDH-mutant 1p/19q codeleted oligodendroglioma WHO grade 2

A
  1. surgery
  2. watch and wait in gross total resection and also possibly for younger (40) w incomplete resection if the tumor has not caused neurological deficits beyond EP.
  3. If more is deemed necessary:
  4. Radiotherapy
  5. PCV.
26
Q

2nd line treatment for all gliomas

A

Options determined by KPS, neurologic function and prior treatment.
* repeat surgery
* alkylating chemotherapy
* Re-irradiation
* Experimental therapy

27
Q

How many times is re-irradiation possible?

A

For those with disease relapse after radiotherapy, re-irradiation after a minimum interval of ~12 months following the first course of radiotherapy is an option, although tumour size and patterns of recurrence limit the option of re-irradiation and the overall efficacy of this strategy remains uncertain in the absence of data from RCTs.

28
Q

How many times can Themozolomide treatment be given?

A
29
Q

Do we know if Temozolomide would work as well as PCV for the lower grade tumors?

A

No. There are ongoing studies.

30
Q

Is there any “rescue” third line treatment for low grade glioma if neither radiotherapy or alkylating worked or patient was intolerant?

A

Only for IDH mut, 1p/19q codeletion tumors=oligodendrogliomas.
Bevacizumab, but its unknown what effect it would have.

31
Q

First line treatment for Astrocytoma, IDH mut, WHO 2?

A

Same as for oligodendroglioma, IDH mutant, 1p19q codeleted.

  • GTR, age under 40, no neurologic deficit (except EP)
    Wait and see OR radiotherapy (50Gy 1.8fractions) followed by PCV. (or when needed)

Obs progression free survival, but not OS has been shown to be prolonged by early radiotherapy but not by RT at disease progression.

32
Q

EANO:
The standard of care for IDH-mutant astrocytomas, WHO grade 2 requiring further treatment ?

A

Resection as feasible or biopsy followed by involved field radiotherapy and maintenance PCV polychemotherapy.

33
Q

Whats the recomendations for 1st line treatment of grade 3 IDH mut astrocytomas?

A

The standard of care for IDH-mutant astrocytomas, WHO grade 3 includes resection as feasible or biopsy followed by involved field radiotherapy and maintenance temozolomide (CATNON)88. C: II; L: B.

34
Q

What 2nd line treatment is recomended for IDH mut, 1p/19q codel tumors grade 2 ?

A

Always consider surgery.
Patients with IDH-mutant and 1p/19q-codeleted oligodendrogliomas, WHO grade 2 requiring further treatment should be treated with radiotherapy followed by PCV polychemotherapy. C: III; L: B.

35
Q

What 2nd line treatment is recomended for IDH mut, 1p/19q codel tumors grade 3 ?

A

Always consider surgery.
Patients with IDH-mutant and 1p/19q-codeleted oligodendrogliomas, WHO grade 3 should be treated with radiotherapy followed by PCV polychemotherapy (EORTC 26951, RTOG 9402)79,80. C: II; L: B.

36
Q

2nd line recomendation for IDH mut astrocytomas, grade 2 or 3.

A

Always consider surgery.
Temozolomide chemotherapy is standard treatment at progression after surgery and radiotherapy for most patients with IDH-mutant gliomas, WHO grade 2 or 3. C: II; L: B.

37
Q

What is the standard of care after surgery for adults with newly diagnosed glioblastoma who are in good general and neurological condition and are aged <70 years?

A

CONCOMITANT radiotherapy and chemotherapy with temozolomide (75 mg/m2 DAILY throughout radiotherapy, including at weekends) plus SIX cycles of maintenance temozolomide (150–200 mg/m2, 5 out of 28 days).

38
Q

Does radiotherapy have a role in the treatment of Glioblastomas?

A

For decades, radiotherapy (60 Gy in 1.8–2 Gy fractions) has been the standard of care for glioblastoma, approximately doubling median OS duration.

39
Q

How many times can PCV be given?

A

Alkylating agent-based chemotherapy should be considered for patients who have not received previous chemotherapy and with disease progression after radiotherapy. Temozolomide and nitrosoureas are probably equally effective in this setting.
My note: It seems like PCV is given (the three substances in a special pattern that takes 3 weeks in total) once every 6th week for up to 4-6 times or until progress is seen. I have not found info that the whole schedule can be given more than once.

40
Q

What is first line treatment for Oligodendroglioma grade 3?

A

For grade 3, usually straight to Radiotherapy followed by PCV.

41
Q

1st line treatment for Astrocytoma IDH mutant WHO grade 3

A

(or if grade 2 and older pt, neurological deficit or residual tumor)

Radiotherapy followed by
TEMOZOLOMIDE

42
Q

1st line treatment for Astrocytoma, IDH mutant, WHO grade 4?

A

Radiotherapy followed by TEMOZOLOMIDE wo/w CONCOMITANT temozolomide

43
Q

Treatment of Glioblastoma after surgery/biopsy for pt over 70 yo

A

Patients with tumours lacking MGMT promoter methylation or of unknown MGMT promoter methylation status should be treated with hypofractionated radiotherapy alone. Those with tumours with MGMT promoter methylation status should receive temozolomide alone (5 out of 28 days until disease progression or for 12 month).

44
Q

Glioblastoma - what cyto to use in the newly diagnosed setting?

A

Combining temozolomide with lomustine might extend OS in patients with MGMT promoter-methylated glioblastoma

45
Q

Glioblastoma - second surgery?

A

Second surgery is an option for ~20–30% of patients, commonly with symptomatic but circumscribed relapses diagnosed not earlier than 6 months after initial surgery. Second surgery earlier than 6 months after initial surgery increases the risk of unnecessary intervention on the basis of pseudoprogression and is unlikely to provide durable benefit if the initial surgery followed by radiotherapy did not provide tumour control for more than a few months. ( If the reason was not inadequate surgery)

46
Q

EANO _ rec:
The standard of care for patients with IDH-wild-type glioblastoma aged <70 years and with a KPS >70 ?

A

Resection as feasible or biopsy followed by involved-field radiotherapy AND concomitant radiotherapy AND six cycles of maintenance temozolomide chemotherapy

47
Q

EANO _ rec:
Does it matter if a glioblastoma patient has a methylated MGMT promotor?

A

Temozolomide might only be active in patients with MGMT promoter-methylated tumours whereas its activity in patients with MGMT promoter-unmethylated tumours is probably marginal

48
Q

What is involved field radiotherapy?

A
49
Q

EANO _ rec:
The findings of MGMT methylation dependency for reslut of treatment has changed rec. for elderly (over 70 yo). How?

A

Elderly patients not considered candidates for temozolomide chemoradiotherapy should be treated on the basis of MGMT promoter methylation status (NOA-08, Nordic Trial) with radiotherapy (such as 15 × 2.66 Gy) or temozolomide (5 out of 28 days) alone

50
Q

EANO _ rec:
What to do when the glioblastoma reoccur?

A

At recurrence, standards of care are less well defined. Surgery and radiotherapy might be considered. Nitrosourea regimens, temozolomide rechallenge and, with consideration of the country-specific label, bevacizumab are options of pharmacotherapy but an impact on OS remains unproven. ( inte i EU) When available, recruitment into appropriate clinical trials should be considered.

51
Q

EANO rec:
Steroids in glioblastoma?

A

Steroids should not be given to treat asymptomatic or minimally symptomatic oedema and should be tapered as soon as possible, considering their unfavourable safety profile upon long-term administration. Furthermore, steroid use has been shown to be a negative prognostic factor for OS in patients with glioblastoma from three separate large cohorts123 and might interfere with the efficacy of radiotherapy, chemotherapy and immunotherapy.

Tumour (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions