Early Post-Operative MRI: Correlation with Progression-Free Survival and Overall Survival Time in Malignant Gliomas

Size: px
Start display at page:

Download "Early Post-Operative MRI: Correlation with Progression-Free Survival and Overall Survival Time in Malignant Gliomas"

Transcription

1 J. Exp. Clin. Cancer Res., 25, 2, 2006 Early Post-Operative MRI: Correlation with Progression-Free Survival and Overall Survival Time in Malignant Gliomas A. Vidiri 1, C. M. Carapella 2, A. Pace 3, A. Mirri 4, A. Fabi 5, M. Carosi 6, D. Giannarelli 7, A. Pompili 2, B. Jandolo 3, E. Occhipinti 2, S. Di Giovanni 1 and M. Crecco 1 Department of Diagnostic Imaging 1, Neurosurgery 2, Neurology 3, Radiotherapy 4, First Medical Oncology 5, Anatomo-Pathology 6 Statistical Unit 7, "Regina Elena" Cancer Institute, Rome - Italy and Forty-seven patients with Glioblastoma (42) and Anaplastic Astrocytoma (5) were studied with MR 24 hrs after surgery. In order to evaluate the role of early MR in defining the extent of surgical resection and its relation with the prognosis of malignant glioma patients, three categories of surgical resection were considered: gross total, sub-total and partial resection. The results were correlated with progression-free survival (PFS) and overall survival (ST). As demonstrated by early-mr, gross total resection was performed in 17 patients, sub-total and partial resection in 19 and 11 patients, respectively. The PFS was 6 months in gross total resection, 6 and 3 months in sub-total and in partial resection, respectively. The median survival time was 16 months in total resection patients, 13 months and 7 months in sub-total resection and partial resection patients, respectively. The study confirms that early-mr has to be considered an accurate technique for monitoring the extension of malignant glioma surgical resection and shows a good correlation between early-mr findings, PFS and ST. Key Words:MR, Early MR, Glioblastoma, Anaplastic astrocytoma The extension of tumor resection on the outcome of patients affected by malignant brain tumors is still discussed as reported in the literature, and there is modest evidence that aggressive surgical treatment prolongs overall survival time (1,2,3). As far as the extent of the resection is concerned, the reliability of the surgeon, without imaging confirmation, is rather poor. Early post-operative neuroimaging has clearly contributed to highlight the role of surgical resection utilizing post-operative CT or MRI with contrast medium administration in the first three days after surgical procedure (3,4,5) The purpose of this study was to define the role of early-mr in the evaluation of surgical resection in patients affected by malignant gliomas, comparing the observed results with the final outcome in terms of Progression Free Survival (PFS) and Survival Time (ST). Materials and Methods Forty-seven patients affected by malignant gliomas [42 Glioblastoma (GBM) and 5 Anaplastic Astrocytoma (AA)] were studied. The median age was 58 years (33-76 years); all patients were eligible for surgery; tumors of the basal ganglia, brain stem and corpus callosum were excluded. Multicenter tumors, or non-enhancing gliomas were not reported. Median Karnosfky Performance Status (KPS) was 80 (40-100): KPS > 80 in 35 patients and KPS < 50 in 3 patients. After surgery, the combined therapeutic strategy implied radiotherapy (55-60 Gray), followed by chemotherapy according to the Procarbazine, Carmustine and Vincristine combination regimen (PCV), and/or Temozolomide. Thirty-five patients received both radiotherapy and chemotherapy, 10 chemotherapy alone and two patients did not receive any complementary treatment due to old age and low KPS. MR imaging was performed within 24 hrs after surgery utilizing both 1.5 and 0.5 T superconductive scanners. A head-coil, matrix of 256 x 256 and 6-mm. tickness slices were used. Before the contrast medium injection, SE T1-weighted sequences (TR 560 ms, TE 15 ms) in the axial and coronal plane were obtained; in addition Turbo SE T2-weighted sequences in the coronal plane (TR 2500 ms, TE ms), and FLAIR in the axial plane (TR 6000 ms, TE 150 ms, TI 2000) were per- 177

2 A. Vidiri et al. formed. After contrast medium administration of 0,2 mmol/kg of gadolinium diethylemetriamine pentacetic acid (Gd-DTPA) SE T1-weighted sequences in the axial, coronal and sagittal planes were performed. In the pre-operative MRI, site and dimensions of the tumor were considered, referring the anterior-posterior, transversal and longitudinal diameters. Analysis of the early post-operative MR images was performed considering: 1. The areas of hyperintensity in T1 weighted sequences before c.m. injection were correlated with the presence of haemostatic agents. 2. The areas with nodular or mass-like shape enhancement after c.m. injection were correlated with the presence of residual tumor tissue. 3. TSE T2 and FLAIR sequences were used for the evaluation of the probable ischemic lesions linked to surgical maneuvers. The extent of tumor removal evaluated by early-mr was classified into three categories: 1. Gross total resection: complete or greater than 98% removal of contrast enhancing pre-operative lesion. 2. Sub-total resection: between 88 and 98% removal of contrast enhancing pre-operative lesion. 3. Partial resection: less than 88% removal of contrast enhancing pre-operative lesion. The follow-up scans were obtained 30 days after surgery and then every 2 to 4 months. The peripheral enhancement, eventually outlining tumor resection cavity, was considered benign when linear geometry was displayed or it disappeared after 6 months. Any nodular or mass-like enhancement related with the resection cavity was considered as tumor relapse or progression. All early-mrs were evaluated independently by two neuroradiologists; the experience of the surgeons in the treatment of high grade gliomas.was equivalent The data obtained with early-mr examinations have been confirmed by serial MR controls at follow-up. Patients outcome was considered evaluating PFS and ST, as well as post-surgical therapies (radiotherapy, chemotherapy or both), and these data were correlated with the results of early-mr. Progression-free survival was defined as the time between the date of histologic diagnosis and the date of first evidence of disease progression or death. Overall survival was defined as the time between the date of histologic diagnosis and the date of patient's death, or it was censored at the date of the last follow-up. Survival curves were estimated with the Kaplan- Meier method. Differences between curves were tested by log-rank test. The Cox model was used for multivariate analysis of survival data. Results All the tumors presented hypointensity on T1 weighted-sequences, hyperintensity in T2 and FLAIR sequences, and non-homogeneous enhancement after Gd-DTPA administration by evaluation of the pre-surgical MRI. In early-mr the hyperintensity areas on the T1 sequences, before c.m. injection, near the site of surgery were linked to the presence of haemostatic agents (surgicel), a strong oxidant agent that accelerates methemoglobin formation, and that is considered responsible for the hyperintensity areas on the T1 sequences. After Gd-DTPA infusion all the areas showing enhancement were classified as residual tumor tissue (Figs 1, 2, 3). The early dural and leptomeningeal enhancement usually near the craniotomy site was considered as postsurgical modification. In two cases the FLAIR and T2 weighted sequences showed ischemic infarction without gyral enhancement after contrast medium infusion On early-mr, gross total resection was observed in 17 patients; sub-total and partial resection in 19 and in 11 patients, respectively. The median PFS was 6 months in gross total resection, 6 months in sub-total resection, and 3 months in partial resection. These differences were statistically significant (p<0.0001). The median ST was 16 months in patients with total resection, 13 months and 7 months in patients with subtotal and partial resection, respectively (P=0.0002) The ST at one year was 65% in patients with gross resection, and 53% in subtotal resection; only two patients with partial removal were still alive at one year (p< ) (Fig. 4). The median PFS was 3 months in patients with KPS < 80 and 6 months for KPS > 80 (P = ), while the median ST was 7 months in patients with KPS < 80 and 15 months for KPS > 80 (P = 0.001). Considering only the patients submitted to both radiotherapy and chemotherapy (35 pts.; 6 with partial, 15 with subtotal and 14 with gross total resection), median survival time was 7 months after partial removal, 15 months and 16 months respectively after subtotal and gross total surgical resection (p=0.03). Median survival was 15 months in patients who received post-operative radiotherapy and chemotherapy, 7 months in patients who received only one or no 178

3 Early Post-Operative MRI in Malignant Gliomas A B C D Fig. 1 - Gross Total resection of Glioblastoma. A: SE T1 weighted sequence after Gd- DTPA infusion and after biopsy show a mass with strong enhancement in the parasagittal left frontal lobe. B: SE T1 sequence after surgery and before mdc infusion shows a millimetric area of the hyperintensity signal in relationship to the hemostatic agents in relationships to the inferior site of the resection cavity. C: SE T1 after mdc shows post-surgical dural enhancement in the absence of residual tumors. D: SE T1 after six months shows a benign linear post-surgical enhancement contouring the resection cavity A B C D Fig. 2 - Fig. 2: Gross Total resection of Glioblastoma A: SE T1 weighted sequence after Gd-DTPA infusion shown a mass with strong enhancement in parasagittal left parietal lobe. B: SE T1 weighted sequence after surgery and before mdc infusion shows the hyperintensity signal in relationship to the hemostatic agents in the resection cavity. C: SE T1 after mdc, in the same plane, shows enhancement of the falx in absence of relapse. D: SE T1 after ten months shows a mass with enhancement after mdc in relationship to the relapse. 179

4 A. Vidiri et al. A B C Fig. 3: Subtotal resection of Anaplastic Astrocitoma A: SE T1 weighted sequence after Gd-DTPA infusion shows a necrotic mass with peripheral enhancement in the right parasagittal parietal lobe. B: SE T1 weighted sequence without contrast medium after surgery: there are no post-surgical effects rendering the interpretation of the MRI difficult. C: SE T1 after Gd-DTPA shows an area of enhancement near the ventricle correlated to the residual neoplastic tissue. related to survival, a multivariate analysis was performed: when KPS, combined radio- and chemotherapy treatment, and type of resection were tested only these two latter variables entered the model meaning that independently influence overall survival (P = and P = 0.004, respectively), while PFS was influenced by the extent of resection (P = 0.003) and KPS (P = 0.001) (Tab.I). Fig. 4 - Overall survival according to type of resection on early- MR. treatment (P= ): such an outcome confirms the importance of well tailored combined therapeutic strategies. Age of patients and histotype (probably due to the very limited number of anaplastic astrocytomas) in the present series do not seem to influence overall survival. In order to identify independent prognostic factors Discussion The prognosis of the patients affected by malignant glioma is poor; the median survival time after diagnosis reported in literature is approximately 12 months, and notwithstanding new diagnostic and surgical techniques these data do not differ from the results of the last 20 years. Some Authors have reported a 3-year survival rate, in particular for young patients affected by malignant gliomas, with good performance status and submitted to radical surgery (2). As reported by several Authors, the elements that improve the prognosis of 180

5 Early Post-Operative MRI in Malignant Gliomas Table I - Time to event: multivariate analysis P.F.S. univariate P.F.S. multivariate O.S. univariate O.S. multivariate Type of resection P < P =0.003 P = P = Gross vs partial 0.17 ( ) 0.21 ( ) 0.19 ( ) 0.21 ( ) Subtotal vs partial 0.25 ( ) 0.27 ( ) 0.27 ( ) 0.28 ( ) Treatment received P = 0.02 P = n.s. P = P = None or only one vs 2.26 ( ) 3.54 ( ) 3.23 ( ) both CT and RT K.P.S. P < P = P = P = n.s. < 80% vs > 80% 4.81 ( ) 4.09 ( ) 3.20 ( ) these patients are different and include age, KPS score, tumor location and the characteristics of preoperative MRI such as the presence of necrosis (1,6,7,8,9,10). As stated by some authors, radical surgery as well as KPS score and patients age reperesent important prognostic factors (3), but on the contrary Kowalczuk et al. (6) demonstrated that aggressive surgical resection did not lead to a significant increase in survival time. The role of the aggressive surgical treatment has not yet been defined, due to the fact that in several studies the extent of the resection has been only quantified on the basis of the surgical reports without imaging confirmation (11-12). Usually patients with GBM or AA are submitted to MR post-operative evaluation before the radiation therapy; in most cases this examination shows post-contrast enhancement due to hypervascularization and the disruption of the blood-brain barrier, with difficult findings about any possible residual tumor tissue. In order to evaluate the extention of surgical removal current diagnostic methods are ecotomography or MR and early CT or MR performed hrs after surgery (5). Results on animal models with serial CT-scans after brain tumor removal showed that the enhancement at the borders of resection cavity is not evident before the fifth day after surgery. Some Authors demonstrated that before the fifth post-surgery day enhancement reflects the residual gliomas only (13-14); for this reason the early-mr could minimize interpretative difficulties caused by post-surgical artifacts due to scar tissue. The aim of our study was to evaluate the role of MR performed during the first 24 hrs after surgery in order to determine residual tumor and the extension of surgical removal. Few studies utilized early-mr after surgery in the evaluation of malignant gliomas, demonstrating that parenchimal enhancement after c.m. infusion showed by early MR was always correlated to the presence of residual cancer tissue (3, 13-14); the other possible causes of the enhancement in early-mr are the early dural and leptomeningeal enhancement near the craniotomy site, enhancement of the ependymal layer, the choroid plexus or dilated veins at the operative site. Further potential diagnostic inaccuracy derives from the presence in the resection cavity of haemostatic agents such as hydrogen peroxide; this agent is a strong oxidant that accelerates methemoglobin formation, determining hyperintensity areas on T1 sequences before c.m. administration. For these reasons, in early-mr, we generally used two scan planes in T1 sequences before contrast medium infusion, usually axial and coronal planes in relation to tumor site; these images must be compared with those after c.m. infusion in the same planes in order to better define the residual neoplastic tissue showing enhancement after Gd-DTPA. We prefer perform early-mr in the first 24 hrs after surgery for the absence of enhancement due to possible ischemic lesion correlate to surgery, but we think that there is no difference in the utility of the early-mr performed within the first day versus the first three days as advocated by previous studies (3). Despite the small patient cohort, our results suggest significant correlation between the evidence of early MR and the extent of surgical removal. In fact when early MR showed no evidence of residual tumor tissue (gross total resection) median PFS was 6 months and median ST was 16 months; while in patients with subtotal resection PFS was 6 months and median ST was

6 A. Vidiri et al. months, and respectively 3 and 7 months for patients submitted to partial resection, with significant statistical correlation. Multivariate analysis confirms that the extent of tumor resection, as documented by the early-mr, and adjuvant treatment significantly influence survival time, being longer in patients submitted to gross-total removal and chemo-radiotherapy. Furthermore, gross total surgical removal and KPS > 80 positively influence progression free survival. Conclusion: Present data show, in accordance with other Authors (18,19,20), that early post-operative MR is a valuable method in determining residual tumor tissue, or gross total surgical removal; this technique minimizes interpretative inaccuracy caused by surgical artifacts and represents a necessary baseline measure to assess the activity of multimodality treatment of malignant gliomas. Acknowledgments: We thank Maurizio Abrugia for his technical assistance, Ivana Zardin and Mauro Di Giovanni for the photography support and P. Franke for assistance with the English version. References 1. Lacroix M., Abi-Said D., Fourney D.R., Gokaslan Z.L., Shi W., De Monte F. et al.: A multivariate analysis of 416 patients with glioblastomas multiforme: prognosis, extent of resection, and survival. J. Neurosur. 95: , Stupp R., Dietrich P.Y., Ostermann Kraljievic S.: Promising survival for patients with newly diagnosed glioblastoma multiforme with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J. Clin. Oncol. 20: , Albert F.K., Forsting M., Sartor K. : Early postoperative magnetic resonance imaging after resection of malignant gliomas: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34: 45-61, Forsyth P.A.J., Petrov E., Mahallati H., Cairncross J.G., Brasher P., MacRae M.E. et al.: Prospective study of postoperative magnetic resonance imaging in patients with malignant gliomas. J Clin Oncol 15: , Becker G., Hofmann E., Woydt M., Huslsmann U., Maurer M., Lindner A. et al.: Postoperative neuroimaging of high-grade gliomas: comparison of transcranial sonography, magnetic resonance imaging, and computed tomography. Neurosurgery 44: , Kowalczuk A., Macdonald L., Amidei C., Dohrmann G., Erickson R.K., Hekmatpanah J. et al.: Quantitative imaging study of extent of surgical resection and prognosis of malignant astrocytomas. Neurosurgery 41: , Burger P.C., Green S.B.: Patients age, histological features and length of survival in patients with Glioblastoma Multiforme. Cancer 59: , Gilbert H., Kagan A.R., Cassidy K.: Glioblastoma Multiforme is not a uniform disease. Cancer 4:87-89, Hammoud M.A., Sawaya R., Shi W.: Prognostic significance of preoperative MRI scans in Glioblastoma Multiforme. J. Neuroncol. 27: 65-73, Nitta T., Sato K.: Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer 5: , Kreeth F.W., Warnke P.C., Scherenet R.: Surgical resection and radiation therapy versus biopsy and radiation therapy in treatment of Glioblastoma Multiforme. J. Neurosur. 78: , Curran W.J. Jr., Scott C.B., Horton J.: Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci. A report from three Radiation Therapy Oncology Group (RTOG) trials. J. Neuroncol. 12: , Cairncross J.G., Pexman J.H.W., Rathbone M.P., Delmaestro R.F.: Postoperative contrast enhancement in patients with brain tumors. Ann. Neurol. 17: , Jeffries B.F., Kishore P.R.S., Singh K.S., Ghatak N.R., Krempa J.: Contrast enhancement in the postoperative brain. Radiology 139: , Ringe J.G., Clanton J.A., Price A.C., Herzer W.A., Allen J.H., Partain C.L. et al.: Evaluation of contrast enhanced MR imaging in a brain abscess model. A.J.N.R. 6: , Sze G.: New aplications of MR contrast agents in neuroradiology. Neuroradiology 32: , Elster A.D., Dipersio D.A.: Cranial post-operative site: assessment with contrast-enhanced MR imaging. Radiology 174:93-98, Ammirati M., Vick N.A., Liao Y., Ciric I., Mikhael M.A.: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocitoma. Neurosurgery 21:21-26, Ciric I., Ammirati M., Vick N.A., Mikhael M.A.: Supratentorial gliomas: surgical consideration s and immediate postoperative results. Neurosurgery 21: , Ciric I., Vick N.A., Mikhael M.A., Cozzens J., Eller T., Walsh A.: Aggressive surgery for malignant supratentorial gliomas. Clin. Neurosurg. 36: , Received: February 20, 2006 Accepted after revision: March 1, 2006 Antonello Vidiri Department of Diagnostic Imaging, "Regina Elena" Cancer Insitute Via Elio Chianesi 53, Rome, Italy. vidiri@ifo.it Phone number:

The Use of Early Postoperative MR in Detecting Residual Juvenile Cerebellar Pilocytic Astrocytoma

The Use of Early Postoperative MR in Detecting Residual Juvenile Cerebellar Pilocytic Astrocytoma AJNR Am J Neuroradiol 19:151 156, January 1998 The Use of Early Postoperative MR in Detecting Residual Juvenile Cerebellar Pilocytic Astrocytoma Nancy K. Rollins, Perry Nisen, and Kenneth N. Shapiro PURPOSE:

More information

Systemic Treatment. Third International Neuro-Oncology Course. 23 May 2014

Systemic Treatment. Third International Neuro-Oncology Course. 23 May 2014 Low-Grade Astrocytoma of the CNS: Systemic Treatment Third International Neuro-Oncology Course São Paulo, Brazil 23 May 2014 John de Groot, MD Associate Professor, Neuro-Oncology UT MD Anderson Cancer

More information

Intraoperative MR Imaging Increases the Extent of Tumor Resection in Patients with High-Grade Gliomas

Intraoperative MR Imaging Increases the Extent of Tumor Resection in Patients with High-Grade Gliomas AJNR Am J Neuroradiol 20:1642 1646, October 1999 Intraoperative MR Imaging Increases the Extent of Tumor Resection in Patients with High-Grade Gliomas Michael Knauth, Christian R. Wirtz, Volker M. Tronnier,

More information

PROCARBAZINE, lomustine, and vincristine (PCV) is

PROCARBAZINE, lomustine, and vincristine (PCV) is RAPID PUBLICATION Procarbazine, Lomustine, and Vincristine () Chemotherapy for Anaplastic Astrocytoma: A Retrospective Review of Radiation Therapy Oncology Group Protocols Comparing Survival With Carmustine

More information

Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project

Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project J Neurosurg 99:467 473, 2003 Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project EDWARD R. LAWS, M.D., IAN F. PARNEY, M.D.,

More information

Survival of High Grade Glioma Patients Treated by Three Radiation Schedules with Chemotherapy: A Retrospective Comparative Study

Survival of High Grade Glioma Patients Treated by Three Radiation Schedules with Chemotherapy: A Retrospective Comparative Study Original Article Research in Oncology June 2017; Vol. 13, No. 1: 18-22. DOI: 10.21608/resoncol.2017.552.1022 Survival of High Grade Glioma Patients Treated by Three Radiation Schedules with Chemotherapy:

More information

Enormous effort has been invested in clinical trials for malignant

Enormous effort has been invested in clinical trials for malignant Published February 13, 2008 as 10.3174/ajnr.A0963 REVIEW ARTICLE J.W. Henson S. Ulmer G.J. Harris Brain Tumor Imaging in Clinical Trials SUMMARY: There are substantial challenges in the radiologic evaluation

More information

Astroblastoma: Radiologic-Pathologic Correlation and Distinction from Ependymoma

Astroblastoma: Radiologic-Pathologic Correlation and Distinction from Ependymoma AJNR Am J Neuroradiol 23:243 247, February 2002 Case Report Astroblastoma: Radiologic-Pathologic Correlation and Distinction from Ependymoma John D. Port, Daniel J. Brat, Peter C. Burger, and Martin G.

More information

Carmustine implants and Temozolomide for the treatment of newly diagnosed high grade glioma

Carmustine implants and Temozolomide for the treatment of newly diagnosed high grade glioma National Institute for Health and Clinical Excellence Health Technology Appraisal Carmustine implants and Temozolomide for the treatment of newly diagnosed high grade glioma Personal statement Conventional

More information

Prognostic significance of surgery and radiation therapy in cases of anaplastic astrocytoma: retrospective analysis of 170 cases

Prognostic significance of surgery and radiation therapy in cases of anaplastic astrocytoma: retrospective analysis of 170 cases J Neurosurg 106:575 581, 2007 Prognostic significance of surgery and radiation therapy in cases of anaplastic astrocytoma: retrospective analysis of 170 cases TAKUMA NOMIYA, M.D., PH.D., 1 KENJI NEMOTO,

More information

Clinical Management Protocol Chemotherapy [Glioblastoma Multiforme (CNS)] Protocol for Planning and Treatment

Clinical Management Protocol Chemotherapy [Glioblastoma Multiforme (CNS)] Protocol for Planning and Treatment Protocol for Planning and Treatment The process to be followed when a course of chemotherapy is required to treat: GLIOBLASTOMA MULTIFORME (CNS) Patient information given at each stage following agreed

More information

Collection of Recorded Radiotherapy Seminars

Collection of Recorded Radiotherapy Seminars IAEA Human Health Campus Collection of Recorded Radiotherapy Seminars http://humanhealth.iaea.org The Role of Radiosurgery in the Treatment of Gliomas Luis Souhami, MD Professor Department of Radiation

More information

THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION. Mustafa Rashid Issa

THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION. Mustafa Rashid Issa THE EFFECTIVE OF BRAIN CANCER AND XAY BETWEEN THEORY AND IMPLEMENTATION Mustafa Rashid Issa ABSTRACT: Illustrate malignant tumors that form either in the brain or in the nerves originating in the brain.

More information

Citation Pediatrics international (2015), 57.

Citation Pediatrics international (2015), 57. Title Long-term efficacy of bevacizumab a pediatric glioblastoma. Umeda, Katsutsugu; Shibata, Hirofum Author(s) Hiramatsu, Hidefumi; Arakawa, Yoshi Nishiuchi, Ritsuo; Adachi, Souichi; Ken-Ichiro Citation

More information

Clinical Trials for Adult Brain Tumors - the Imaging Perspective

Clinical Trials for Adult Brain Tumors - the Imaging Perspective Clinical Trials for Adult Brain Tumors - the Imaging Perspective Whitney B. Pope, M.D., Ph.D. Department of Radiology David Geffen School of Medicine at UCLA August 22, 2015 1 Disclosure of Financial Relationships

More information

Newcastle Neuro-oncology Team Audit of Outcome of Glioblastoma Multiforme Chemoradiotherapy Treatment

Newcastle Neuro-oncology Team Audit of Outcome of Glioblastoma Multiforme Chemoradiotherapy Treatment Newcastle Neuro-oncology Team Audit of Outcome of Glioblastoma Multiforme Chemoradiotherapy Treatment Jennifer Wright Neurosurgery SSC Audit Team Jennifer Wright, Rachel Tresman, Cyril Dubois, Surash Surash,

More information

3-D conformal radiotherapy with concomitant and adjuvant temozolomide for patients with glioblastoma multiforme and evaluation of prognostic factors

3-D conformal radiotherapy with concomitant and adjuvant temozolomide for patients with glioblastoma multiforme and evaluation of prognostic factors research article 213 3-D conformal radiotherapy with concomitant and adjuvant temozolomide for patients with glioblastoma multiforme and evaluation of prognostic factors Yilmaz Tezcan and Mehmet Koc Department

More information

Improved Survival after Gross Total Resection of Malignant Gliomas in Pediatric Patients from the HIT-GBM Studies

Improved Survival after Gross Total Resection of Malignant Gliomas in Pediatric Patients from the HIT-GBM Studies Improved Survival after Gross Total Resection of Malignant Gliomas in Pediatric Patients from the HIT-GBM Studies CHRISTOF M. KRAMM 1, SABINE WAGNER 2, STEFAN VAN GOOL 3, HANSJÖRG SCHMID 4, RONALD STRÄTER

More information

ORIGINAL PAPERS. The Impact of Surgery on the Efficacy of Adjuvant Therapy in Glioblastoma Multiforme

ORIGINAL PAPERS. The Impact of Surgery on the Efficacy of Adjuvant Therapy in Glioblastoma Multiforme ORIGINAL PAPERS Adv Clin Exp Med 2015, 24, 2, 279 287 DOI: 10.17219/acem/40456 Copyright by Wroclaw Medical University ISSN 1899 5276 Anna Brzozowska 1, 2, A D, Anna Toruń 3, G, Maria Mazurkiewicz1, 2,

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium temozolomide 5, 20, 100 and 250mg capsules (Temodal ) Schering Plough UK Ltd No. (244/06) New indication: for the treatment of newly diagnosed glioblastoma multiforme concomitantly

More information

See the corresponding editorial in this issue, pp 1 2. J Neurosurg 115:3 8, An extent of resection threshold for newly diagnosed glioblastomas

See the corresponding editorial in this issue, pp 1 2. J Neurosurg 115:3 8, An extent of resection threshold for newly diagnosed glioblastomas See the corresponding editorial in this issue, pp 1 2. J Neurosurg 115:3 8, 2011 An extent of resection threshold for newly diagnosed glioblastomas Clinical article Nader Sanai, M.D., 1 Mei-Yin Polley,

More information

Institute of Oncology & Radiobiology. Havana, Cuba. INOR

Institute of Oncology & Radiobiology. Havana, Cuba. INOR Institute of Oncology & Radiobiology. Havana, Cuba. INOR 1 Transition from 2-D 2 D to 3-D 3 D conformal radiotherapy in high grade gliomas: : our experience in Cuba Chon. I, MD - Chi. D, MD - Alert.J,

More information

Incidence of Early Pseudo-progression in a Cohort of Malignant Glioma Patients Treated With Chemoirradiation With Temozolomide

Incidence of Early Pseudo-progression in a Cohort of Malignant Glioma Patients Treated With Chemoirradiation With Temozolomide 405 Incidence of Early Pseudo-progression in a Cohort of Malignant Glioma Patients Treated With Chemoirradiation With Temozolomide Walter Taal, MD 1 Dieta Brandsma, MD, PhD 1 Hein G. de Bruin, MD, PhD

More information

Hypofractionated radiation therapy for glioblastoma

Hypofractionated radiation therapy for glioblastoma Hypofractionated radiation therapy for glioblastoma Luis Souhami, MD, FASTRO Professor McGill University Department of Oncology, Division of Radiation Oncology Montreal Canada McGill University Health

More information

PRESURGICAL PLANNING. Strongly consider neuropsychological evaluation before functional imaging study Strongly consider functional imaging study

PRESURGICAL PLANNING. Strongly consider neuropsychological evaluation before functional imaging study Strongly consider functional imaging study NOTE: Consider Clinical Trials as treatment options for eligible patients. Page 1 of 6 RADIOLOGICAL PRESENTATION PRESURGICAL PLANNING TREATMENT Imaging study suggestive of glioma 1 Left hemisphere speech/motor

More information

The Radiologic Evaluation of Glioblastoma (GBM) and Differentiation from Pseudoprogression

The Radiologic Evaluation of Glioblastoma (GBM) and Differentiation from Pseudoprogression The Radiologic Evaluation of Glioblastoma (GBM) and Differentiation from Pseudoprogression Alexis Roy, Harvard Medical School, Year III Our Patient AB: Clinical Presentation 53 year old female with a past

More information

UPDATES ON CHEMOTHERAPY FOR LOW GRADE GLIOMAS

UPDATES ON CHEMOTHERAPY FOR LOW GRADE GLIOMAS UPDATES ON CHEMOTHERAPY FOR LOW GRADE GLIOMAS Antonio M. Omuro Department of Neurology Memorial Sloan-Kettering Cancer Center II International Neuro-Oncology Congress Sao Paulo, 08/17/12 CHALLENGES IN

More information

Improvements in Quality of Care Resulting From a Formal Multidisciplinary Tumour Clinic in the Management of High-grade Glioma

Improvements in Quality of Care Resulting From a Formal Multidisciplinary Tumour Clinic in the Management of High-grade Glioma Original Article 347 Improvements in Quality of Care Resulting From a Formal Multidisciplinary Tumour Clinic in the Management of High-grade Glioma Michael F Back, 1-3 FRANZCR, Emily LL Ang, 2 RN, Wai-Hoe

More information

CNS Tumors: The Med Onc Perspective. Ronald J. Scheff, MD Associate Clinical Professor Weill Medical College of Cornell U.

CNS Tumors: The Med Onc Perspective. Ronald J. Scheff, MD Associate Clinical Professor Weill Medical College of Cornell U. CNS Tumors: The Med Onc Perspective Ronald J. Scheff, MD Associate Clinical Professor Weill Medical College of Cornell U. Disclosure Speakers Bureau, Merck Basic Oncology Concepts Tissue Diagnosis Stage

More information

Concomitant (without adjuvant) temozolomide and radiation to treat glioblastoma: A retrospective study

Concomitant (without adjuvant) temozolomide and radiation to treat glioblastoma: A retrospective study Concomitant (without adjuvant) temozolomide and radiation to treat glioblastoma: A retrospective study T Sridhar 1, A Gore 1, I Boiangiu 1, D Machin 2, R P Symonds 3 1. Department of Oncology, Leicester

More information

Prior to 1993, the only data available in the medical

Prior to 1993, the only data available in the medical Neuro-Oncology Prospective clinical trials of intracranial low-grade glioma in adults and children Edward G. Shaw 1 and Jeffrey H. Wisoff Department of Radiation Oncology, Wake Forest University School

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Brachytherapy, Intracavitary Balloon Catheter for Brain Cancer File Name: Origination: Last CAP Review: Next CAP Review: Last Review: brachytherapy_intracavitary_balloon_catheter_for_brain_cancer

More information

Structural and functional imaging for the characterization of CNS lymphomas

Structural and functional imaging for the characterization of CNS lymphomas Structural and functional imaging for the characterization of CNS lymphomas Cristina Besada Introduction A few decades ago, Primary Central Nervous System Lymphoma (PCNSL) was considered as an extremely

More information

Zurich Open Repository and Archive. Long-term survival of glioblastoma patients treated with radiotherapy and lomustine plus temozolomide

Zurich Open Repository and Archive. Long-term survival of glioblastoma patients treated with radiotherapy and lomustine plus temozolomide University of Zurich Zurich Open Repository and Archive Winterthurerstr. 190 CH-8057 Zurich http://www.zora.uzh.ch Year: 2009 Long-term survival of glioblastoma patients treated with radiotherapy and lomustine

More information

Zurich Open Repository and Archive. Long-term survival of glioblastoma patients treated with radiotherapy and lomustine plus temozolomide

Zurich Open Repository and Archive. Long-term survival of glioblastoma patients treated with radiotherapy and lomustine plus temozolomide University of Zurich Zurich Open Repository and Archive Winterthurerstr. 19 CH-857 Zurich http://www.zora.uzh.ch Year: 29 Long-term survival of glioblastoma patients treated with radiotherapy and lomustine

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM ANAPLASTIC GLIOMAS CNS Site Group Anaplastic Gliomas Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION

More information

Value of Subtraction Images in the Detection of Hemorrhagic Brain Lesions on Contrast-Enhanced MR Images

Value of Subtraction Images in the Detection of Hemorrhagic Brain Lesions on Contrast-Enhanced MR Images 681 Value of Subtraction Images in the Detection of Hemorrhagic Brain Lesions on Contrast-Enhanced MR Images Soheil L. Hanna 1 James W. Langston Suzanne A. Gronemeyer Contrast-enhanced T1-weighted MR images

More information

21/03/2017. Disclosure. Practice Changing Articles in Neuro Oncology for 2016/17. Gliomas. Objectives. Gliomas. No conflicts to declare

21/03/2017. Disclosure. Practice Changing Articles in Neuro Oncology for 2016/17. Gliomas. Objectives. Gliomas. No conflicts to declare Practice Changing Articles in Neuro Oncology for 2016/17 Disclosure No conflicts to declare Frances Cusano, BScPharm, ACPR April 21, 2017 Objectives Gliomas To describe the patient selection, methodology

More information

Efficacy of Treatment for Glioblastoma Multiforme in Elderly Patients (65+): A Retrospective Analysis

Efficacy of Treatment for Glioblastoma Multiforme in Elderly Patients (65+): A Retrospective Analysis Efficacy of Treatment for Glioblastoma Multiforme in Elderly Patients (65+): A Retrospective Analysis Igal Kushnir MD 1 * and Tzahala Tzuk-Shina MD 2 1 Oncology Insitute, Tel Aviv Sourasky Medical Center,

More information

Masses of the Corpus Callosum

Masses of the Corpus Callosum Masses of the Corpus Callosum Kesav Raghavan, HMS Year III Dr. Agenda Corpus Callosum Development and Anatomy Our Patient: Clinical Presentation Differential Diagnosis of Masses in the Corpus Callosum

More information

Treatment Outcome of Supratentorial High Grade Astrocytoma and Glioblastoma Multiform

Treatment Outcome of Supratentorial High Grade Astrocytoma and Glioblastoma Multiform Med. J. Cairo Univ., Vol. 77, No. 1, March [2]: 163-170, 2009 www.medicaljournalofcairouniversity.com Treatment Outcome of Supratentorial High Grade Astrocytoma and Glioblastoma Multiform LAILA A.S. KORASHY,

More information

MR of Recurrent High-Grade Astrocytomas after Intralesional Immunotherapy

MR of Recurrent High-Grade Astrocytomas after Intralesional Immunotherapy MR of Recurrent High-Grade Astrocytomas after Intralesional Immunotherapy Michelle M. Smith, Jill E. Thompson, Mauricio Castillo, Sharon Cush, Suresh K. Mukherji, Claramae H. Miller, and Keith B. Quattrocchi

More information

Temozolomide in the treatment of recurrent malignant glioma in Chinese patients!"#$%&'()*+,-./0,1234

Temozolomide in the treatment of recurrent malignant glioma in Chinese patients!#$%&'()*+,-./0,1234 Key words: Astrocytoma; Brain neoplasms; Disease-free survival; Glioblastoma; Neoplasm recurrence!!"!"!"#$ DTM Chan WS Poon YL Chan HK Ng Hong Kong Med J 2005;11:452-6 The Chinese University of Hong Kong,

More information

National Institute for Health and Clinical Excellence. Single Technology Appraisal (STA)

National Institute for Health and Clinical Excellence. Single Technology Appraisal (STA) National Institute for Health and Clinical Excellence Appendix C Comment 1: the draft scope Single Technology Appraisal (STA) Carmustine implants for the treatment of recurrent glioblastoma multiforme

More information

Morbidity of Stereotactic Biopsy for Intracranial Lesions

Morbidity of Stereotactic Biopsy for Intracranial Lesions Kobe J. Med. Sci., Vol. 56, No. 4, pp. E148-E153, 2010 Morbidity of Stereotactic Biopsy for Intracranial Lesions MASAMITSU NISHIHARA 1 *, TAKASHI SASAYAMA 2, HIROSHI KUDO 3, and EIJI KOHMURA 2 1 Department

More information

ASJ. Surgical Outcomes of High-Grade Spinal Cord Gliomas. Asian Spine Journal. Introduction

ASJ. Surgical Outcomes of High-Grade Spinal Cord Gliomas. Asian Spine Journal. Introduction Asian Spine Journal Asian Spine Clinical Journal Study Asian Surgical Spine J 2015;9(6):935-941 outcomes of high-grade http://dx.doi.org/10.4184/asj.2015.9.6.935 intramedullary tumor 935 Surgical Outcomes

More information

Surgery of high grade gliomas - pros in favor of maximal cytoreductive surgery

Surgery of high grade gliomas - pros in favor of maximal cytoreductive surgery 38 C. Abrudan et al Surgery of high grade gliomas Surgery of high grade gliomas - pros in favor of maximal cytoreductive surgery C. Abrudan 1,2, Adriana Cocis 2, Dana Cernea 3, B. Suciu 2, Marilena Cheptea

More information

Technology appraisal guidance Published: 27 June 2007 nice.org.uk/guidance/ta121

Technology appraisal guidance Published: 27 June 2007 nice.org.uk/guidance/ta121 Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma Technology appraisal guidance Published: 27 June 2007 nice.org.uk/guidance/ta121 NICE 2018. All rights reserved.

More information

Temozolomide Concomitant and Adjuvant to Radiotherapy in Elderly Patients With Glioblastoma

Temozolomide Concomitant and Adjuvant to Radiotherapy in Elderly Patients With Glioblastoma Temozolomide Concomitant and Adjuvant to Radiotherapy in Elderly Patients With Glioblastoma Correlation With MGMT Promoter Methylation Status Alba A. Brandes, MD 1 ; Enrico Franceschi, MD 1 ; Alicia Tosoni,

More information

Revisiting Anaplastic Astrocytomas I: An Expansive Growth Pattern is Associated with a Better Prognosis

Revisiting Anaplastic Astrocytomas I: An Expansive Growth Pattern is Associated with a Better Prognosis JOURNAL OF MAGNETIC RESONANCE IMAGING 28:1311 1321 (2008) Original Research Revisiting Anaplastic Astrocytomas I: An Expansive Growth Pattern is Associated with a Better Prognosis Hugh D. Moulding, MD,

More information

Radioterapia no Tratamento dos Gliomas de Baixo Grau

Radioterapia no Tratamento dos Gliomas de Baixo Grau Radioterapia no Tratamento dos Gliomas de Baixo Grau Dr. Luis Souhami University Montreal - Canada Low Grade Gliomas Relatively rare Heterogeneous, slow growing tumors WHO Classification Grade I Pilocytic

More information

성균관대학교삼성창원병원신경외과학교실신경종양학 김영준. KNS-MT-03 (April 15, 2015)

성균관대학교삼성창원병원신경외과학교실신경종양학 김영준. KNS-MT-03 (April 15, 2015) 성균관대학교삼성창원병원신경외과학교실신경종양학 김영준 INTRODUCTIONS Low grade gliomas (LGG) - heterogeneous group of tumors with astrocytic, oligodendroglial, ependymal, or mixed cellular histology - In adults diffuse, infiltrating

More information

Response to postoperative radiotherapy as a prognostic factor for patients with low-grade gliomas

Response to postoperative radiotherapy as a prognostic factor for patients with low-grade gliomas ONCOLOGY LETTERS 4: 455-460, 2012 Response to postoperative radiotherapy as a prognostic factor for patients with low-grade gliomas MICHAL SPYCH 1,2, LESZEK GOTTWALD 3, EMILIA JESIEŃ LEWANDOWICZ 1,2, SŁAWOMIR

More information

Magnetic Resonance Imaging for Neurological Conditions. Lawrance Yip Department of Radiology Queen Mary Hospital

Magnetic Resonance Imaging for Neurological Conditions. Lawrance Yip Department of Radiology Queen Mary Hospital Magnetic Resonance Imaging for Neurological Conditions Lawrance Yip Department of Radiology Queen Mary Hospital Outline Strength and limitations of MRI for neurological conditions MR Imaging techniques

More information

A Randomized Phase III study: Comparison between Intravenous and Intraarterial ACNU Administration in Newly Diagnosed Primary Glioblastomas

A Randomized Phase III study: Comparison between Intravenous and Intraarterial ACNU Administration in Newly Diagnosed Primary Glioblastomas A Randomized Phase III study: Comparison between Intravenous and Intraarterial ACNU Administration in Newly Diagnosed Primary Glioblastomas F. IMBESI 1, E. MARCHIONI 2, E. BENERICETTI 3, F. ZAPPOLI 4,

More information

Temozolomide with Radiotherapy for the Treatment of Malignant Gliomas, Center Experience

Temozolomide with Radiotherapy for the Treatment of Malignant Gliomas, Center Experience Temozolomide with Radiotherapy for the Treatment of Malignant Gliomas, Center Experience *Ehab Abdou and **Mohamed Gaafar *Department of Radiation Oncology, Faculty of Medicine, Al-Azhar University, Cairo,

More information

The Utility of MR in Planning the Radiation Therapy of Oligodendroglioma

The Utility of MR in Planning the Radiation Therapy of Oligodendroglioma 93 The Utility of MR in Planning the Radiation Therapy of Oligodendroglioma William P. Shuman' Brian R. Griffin2 David R. Haynor' David C. Jones 2 J. Steve Johnson 2 Laurence D. Cromwell' George E. Laramore

More information

Bevacizumab rescue therapy extends the survival in patients with recurrent malignant glioma

Bevacizumab rescue therapy extends the survival in patients with recurrent malignant glioma Original Article Bevacizumab rescue therapy extends the survival in patients with recurrent malignant glioma Lin-Bo Cai, Juan Li, Ming-Yao Lai, Chang-Guo Shan, Zong-De Lian, Wei-Ping Hong, Jun-Jie Zhen,

More information

Anatomic locations in high grade glioma

Anatomic locations in high grade glioma Romanian Neurosurgery (2015) XXIX 3: 271-277 271 Anatomic locations in high grade glioma A. Oslobanu 1, St.I. Florian 2 University of Medicine and Pharmacy, Iuliu Hatieganu Cluj-Napoca 1 Assistant Professor

More information

Chemotherapy plus Radiotherapy versus Radiotherapy Alone for Patients with Anaplastic Oligodendroglioma: Long Term Results of RTOG 9402

Chemotherapy plus Radiotherapy versus Radiotherapy Alone for Patients with Anaplastic Oligodendroglioma: Long Term Results of RTOG 9402 Chemotherapy plus Radiotherapy versus Radiotherapy Alone for Patients with Anaplastic Oligodendroglioma: Long Term Results of RTOG 9402 Gregory Cairncross, Meihua Wang, Edward Shaw, Berndt Scheithauer

More information

Case 7391 Intraventricular Lesion

Case 7391 Intraventricular Lesion Case 7391 Intraventricular Lesion Bastos Lima P1, Marques C1, Cabrita F2, Barbosa M2, Rebelo O3, Rio F1. 1Neuroradiology, 2Neurosurgery, 3Neuropathology, Coimbra University Hospitals, Portugal. University

More information

University of Alberta. Evaluation of Concomitant Temozolomide Treatment in Glioblastoma Multiforme Patients in Two Canadian Tertiary Care Centers

University of Alberta. Evaluation of Concomitant Temozolomide Treatment in Glioblastoma Multiforme Patients in Two Canadian Tertiary Care Centers University of Alberta Evaluation of Concomitant Temozolomide Treatment in Glioblastoma Multiforme Patients in Two Canadian Tertiary Care Centers by Ibrahim Alnaami A thesis submitted to the Faculty of

More information

MRI imaging in meningeal diseases

MRI imaging in meningeal diseases Original article MRI imaging in meningeal diseases 1Dr. Narendrakumar M Shah, 2 Dr Vaishali D M 1Associate professor, Department of Radiodiagnosis, SDM Medical college, Dharwad 2Consultant radiologist,

More information

Diffusion Restriction Precedes Contrast Enhancement in Glioblastoma Multiforme

Diffusion Restriction Precedes Contrast Enhancement in Glioblastoma Multiforme Diffusion Restriction Precedes Contrast Enhancement in Glioblastoma Multiforme Adil Bata 1, Jai Shankar 2 1 Faculty of Medicine, Class of 2017 2 Department of Diagnostic Radiology, Division of Neuroradiology,

More information

Clinical Policy: Electric Tumor Treating Fields (Optune) Reference Number: PA.CP.MP.145

Clinical Policy: Electric Tumor Treating Fields (Optune) Reference Number: PA.CP.MP.145 Clinical Policy: Electric Tumor Treating Fields (Optune) Reference Number: PA.CP.MP.145 Effective Date: 01/18 Last Review Date: 04/18 Coding Implications Revision Log Description Electric tumor treating

More information

Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male

Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Case Reports in Radiology Volume 2016, Article ID 6434623, 4 pages http://dx.doi.org/10.1155/2016/6434623 Case Report Intracranial Capillary Hemangioma in the Posterior Fossa of an Adult Male Jordan Nepute,

More information

The Role of Surgery in High-grade Glioma Is Surgical Resection Justified? A Review of the Current Knowledge

The Role of Surgery in High-grade Glioma Is Surgical Resection Justified? A Review of the Current Knowledge 358 Surgical Resection for High-grade Glioma Boon-Chuan Pang et al Review Article The Role of Surgery in High-grade Glioma Is Surgical Resection Justified? A Review of the Current Knowledge Boon-Chuan

More information

CT & MRI Evaluation of Brain Tumour & Tumour like Conditions

CT & MRI Evaluation of Brain Tumour & Tumour like Conditions CT & MRI Evaluation of Brain Tumour & Tumour like Conditions Dr. Anjana Trivedi 1, Dr. Jay Thakkar 2, Dr. Maulik Jethva 3, Dr. Ishita Virda 4 1 M.D. Radiology, Professor and Head, P.D.U. Medical College

More information

Survival Following CyberKnife Radiosurgery and Hypofractionated Radiotherapy for Newly Diagnosed Glioblastoma Multiforme

Survival Following CyberKnife Radiosurgery and Hypofractionated Radiotherapy for Newly Diagnosed Glioblastoma Multiforme Technology in Cancer Research and Treatment ISSN 1533-0346 Volume 7, Number 3, June 2008 Adenine Press (2008) Survival Following CyberKnife Radiosurgery and Hypofractionated Radiotherapy for Newly Diagnosed

More information

IMAGING OF INTRACRANIAL INFECTIONS

IMAGING OF INTRACRANIAL INFECTIONS IMAGING OF INTRACRANIAL INFECTIONS Dr Carolina Kachramanoglou LYSHOLM DEPARTMENT OF NEURORADIOLOGY NATIONAL HOSPITAL FOR NEUROLOGY AND NEUROSURGERY Plan Introduce MR sequences that are useful in the diagnosis

More information

Intensity modulated radiotherapy (IMRT) for treatment of post-operative high grade glioma in the right parietal region of brain

Intensity modulated radiotherapy (IMRT) for treatment of post-operative high grade glioma in the right parietal region of brain 1 Carol Boyd March Case Study March 11, 2013 Intensity modulated radiotherapy (IMRT) for treatment of post-operative high grade glioma in the right parietal region of brain History of Present Illness:

More information

General Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27

General Identification. Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 General Identification Name: 江 X X Age: 29 y/o Gender: Male Height:172cm, Weight: 65kg Date of admission:95/09/27 Chief Complaint Sudden onset of seizure for several minutes Present illness This 29-year

More information

Glioblastoma: Adjuvant Treatment Abdulrazag Ajlan, MD, MSc, FRCSC, UCNS(D)

Glioblastoma: Adjuvant Treatment Abdulrazag Ajlan, MD, MSc, FRCSC, UCNS(D) Glioblastoma: Adjuvant Treatment Abdulrazag Ajlan, MD, MSc, FRCSC, UCNS(D) *Neurosurgery Consultant, King Saud University, Riyadh, KSA *Adjunct Teaching Faculty, Neurosurgery, Stanford School Of Medicine,

More information

Neuro-Oncology Practice

Neuro-Oncology Practice Neuro-Oncology Practice Neuro-Oncology Practice 3(2), 71 76, 2016 doi:10.1093/nop/npv043 Advance Access date 16 October 2015 Anaplastic astrocytoma and non-1p/19q co-deleted anaplastic oligoastrocytoma:

More information

Contemporary Management of Glioblastoma

Contemporary Management of Glioblastoma Contemporary Management of Glioblastoma Incidence Rates of Primary Brain Tumors Central Brain Tumor Registry of the United States, 1992-1997 100 Number of Cases per 100,000 Population 10 1 0.1 x I x I

More information

CNS SESSION 3/8/ th Multidisciplinary Management of Cancers: A Case based Approach

CNS SESSION 3/8/ th Multidisciplinary Management of Cancers: A Case based Approach CNS SESSION Chair: Ruben Fragoso, MD/PhD UC Davis Fellow: Michael Cardenas, MD UC Davis Panel: Gordon Li, MD Stanford Seema Nagpal, MD Stanford Jennie Taylor, MD UCSF HPI: 46 yo right handed woman who

More information

Gl i o b l a s t o m a multiforme is the most common

Gl i o b l a s t o m a multiforme is the most common J Neurosurg 110:583 588, 2009 Gliadel (BCNU) wafer plus concomitant temozolomide therapy after primary resection of glioblastoma multiforme Clinical article Ma t t h e w J. McGi r t, M.D., 1 Kh o i D.

More information

LOW GRADE ASTROCYTOMAS

LOW GRADE ASTROCYTOMAS LOW GRADE ASTROCYTOMAS This article was provided to us by David Schiff, MD, Associate Professor of Neurology, Neurosurgery, and Medicine at University of Virginia, Charlottesville. We appreciate his generous

More information

Oncological Management of Brain Tumours. Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013

Oncological Management of Brain Tumours. Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013 Oncological Management of Brain Tumours Anna Maria Shiarli SpR in Clinical Oncology 15 th July 2013 Outline General considerations of Primary Brain Tumours: epidemiology, pathology, presentation. Diagnosis

More information

Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain. Original Policy Date

Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain. Original Policy Date MP 8.01.23 Intracavitary Balloon Catheter Brain Brachytherapy for Malignant Gliomas or Metastasis to the Brain Medical Policy Section Therapy Issue 12/2013 Original Policy Date 12/2013 Last Review Status/Date

More information

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES

PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES CENTRAL NERVOUS SYSTEM MENINGIOMA CNS Site Group Meningioma Author: Dr. Norm Laperriere Date: February 20, 2018 1. INTRODUCTION 3 2. PREVENTION

More information

A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia

A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia A Population-Based Study on the Uptake and Utilization of Stereotactic Radiosurgery (SRS) for Brain Metastasis in Nova Scotia Gaurav Bahl, Karl Tennessen, Ashraf Mahmoud-Ahmed, Dorianne Rheaume, Ian Fleetwood,

More information

Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas

Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas J Neurosurg 93:201 207, 2000 Efficacy of neuroradiological imaging, neurological examination, and symptom status in follow-up assessment of patients with high-grade gliomas EVANTHIA GALANIS, M.D., JAN

More information

High spatial resolution reveals excellent detail in pediatric neuro imaging

High spatial resolution reveals excellent detail in pediatric neuro imaging Publication for the Philips MRI Community Issue 46 2012/2 High spatial resolution reveals excellent detail in pediatric neuro imaging Achieva 3.0T with 32-channel SENSE Head coil has become the system

More information

Amide Proton Transfer Imaging: A Novel MR Method for High-grade Brain Tumors.

Amide Proton Transfer Imaging: A Novel MR Method for High-grade Brain Tumors. Amide Proton Transfer Imaging: A Novel MR Method for High-grade Brain Tumors. Poster No.: C-1732 Congress: ECR 2013 Type: Scientific Exhibit Authors: M. Ida, M. Ishizuka, T. Suzuki, Y. Kubo, K. Hino, S.

More information

Prognostic value of ADC in glioblastoma multiforme and its correlation with survival and MGMT promoter methylation status.

Prognostic value of ADC in glioblastoma multiforme and its correlation with survival and MGMT promoter methylation status. Prognostic value of ADC in glioblastoma multiforme and its correlation with survival and MGMT promoter methylation status. R. Zalazar, M.D. Hernández, M. Páramo, P. Slon, M. Millor Muruzabal, J. Solorzano

More information

Oligodendroglioma: imaging findings, radio-pathological correlation and evolution

Oligodendroglioma: imaging findings, radio-pathological correlation and evolution Oligodendroglioma: imaging findings, radio-pathological correlation and evolution Poster No.: C-2104 Congress: ECR 2013 Type: Authors: Keywords: DOI: Scientific Exhibit A. Hernandez Castro, M. D. Monedero

More information

To analyse whether ADC values have a correlation with survival or EGFR amplification status in glioblastoma

To analyse whether ADC values have a correlation with survival or EGFR amplification status in glioblastoma To analyse whether ADC values have a correlation with survival or EGFR amplification status in glioblastoma R. Zalazar, M. Páramo, M. Hernández, P. Domínguez, J.Etxano, P.García Barquín, H.Quiceno Arias,

More information

Lynn S. Ashby 1*, Kris A. Smith 2 and Baldassarre Stea 3

Lynn S. Ashby 1*, Kris A. Smith 2 and Baldassarre Stea 3 Ashby et al. World Journal of Surgical Oncology (2016) 14:225 DOI 10.1186/s12957-016-0975-5 REVIEW Gliadel wafer implantation combined with standard radiotherapy and concurrent followed by adjuvant temozolomide

More information

Planning TTFields treatment using the NovoTAL system-clinical case series beyond the use of MRI contrast enhancement

Planning TTFields treatment using the NovoTAL system-clinical case series beyond the use of MRI contrast enhancement Connelly et al. BMC Cancer (2016) 16:842 DOI 10.1186/s12885-016-2890-0 CASE REPORT Planning TTFields treatment using the NovoTAL system-clinical case series beyond the use of MRI contrast enhancement Jennifer

More information

doi: /bjr/

doi: /bjr/ doi: 10.1259/bjr/29022270 Prognostic factors in the consecutive institutional series of glioblastoma multiforme patients who received high-dose particle radiotherapy or conventional radiotherapy Masahide

More information

Background. Central nervous system (CNS) tumours. High-grade glioma

Background. Central nervous system (CNS) tumours. High-grade glioma 25 4. Central nervous system (CNS) tumours Background Two important considerations underpin the choice of treatment fractionation in neurooncology. First, the results of treatment vary widely and, second,

More information

Cilengitide (Impetreve) for glioblastoma multiforme. February 2012

Cilengitide (Impetreve) for glioblastoma multiforme. February 2012 Cilengitide (Impetreve) for glioblastoma multiforme February 2012 This technology summary is based on information available at the time of research and a limited literature search. It is not intended to

More information

Transdural Spread of Glioblastoma with Endonasal Growth in a Long-Term Survivor Patient: Case Report and Literature Review

Transdural Spread of Glioblastoma with Endonasal Growth in a Long-Term Survivor Patient: Case Report and Literature Review DOI: 10.5137/1019-5149.JTN.10743-14.0 Received: 17.02.2014 / Accepted: 28.03.2014 Published Online: 21.03.2016 Case Report Transdural Spread of Glioblastoma with Endonasal Growth in a Long-Term Survivor

More information

MRI Findings Of An Atypical Cystic Meningioma A Rare Case

MRI Findings Of An Atypical Cystic Meningioma A Rare Case ISPUB.COM The Internet Journal of Radiology Volume 14 Number 1 MRI Findings Of An Atypical Cystic Meningioma A Rare Case D Saxena, P Rout, K Pavan, B Philip Citation D Saxena, P Rout, K Pavan, B Philip.

More information

gliomas of the cerebral hemispheres: the role of

gliomas of the cerebral hemispheres: the role of J7oural of Neurology, Neurosurgery, and Psychiatry 1996;61:291-296 Institute of Neurosurgery, Catholic University, Rome, Italy M Scerrati R Roselli M Iacoangeli A Pompucci G F Rossi Correspondence to:

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Analysis of MGMT Promoter Methylation in Malignant Gliomas File Name: Origination: Last CAP Review: Next CAP Review: Last Review: analysis_of_mgmt_promoter_methylation_in_malignant_gliomas

More information

Attenuation value in HU From -500 To HU From -10 To HU From 60 To 90 HU. From 200 HU and above

Attenuation value in HU From -500 To HU From -10 To HU From 60 To 90 HU. From 200 HU and above Brain Imaging Common CT attenuation values Structure Air Fat Water Brain tissue Recent hematoma Calcifications Bone Brain edema and infarction Normal liver parenchyma Attenuation value in HU From -500

More information

journals/eano/index.html Homepage: Online Database Featuring Author, Key Word and Full-Text Search

journals/eano/index.html Homepage: Online Database Featuring Author, Key Word and Full-Text Search Volume 3 (2013) // Issue 2 // e-issn 2224-3453 Neurology Neurosurgery Medical Oncology Radiotherapy Paediatric Neurooncology Neuropathology Neuroradiology Neuroimaging Nursing Patient Issues Journey of

More information

NON-SURGICAL STRATEGY FOR ADULT EPENDYMOMA

NON-SURGICAL STRATEGY FOR ADULT EPENDYMOMA NON-SURGICAL STRATEGY FOR ADULT EPENDYMOMA Roberta Rudà Department of Neuro-Oncology University and City of Health and Science Hospital of Turin, Italy EORTC EANO ESMO Conference 2015 Istanbul, March 27-28

More information