Brain tumour patient forum Paul de Souza Tests related to management


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Prof. Paul de Souza, University of Western Sydney, Department of Medical Oncology, Liverpool Hospitals presents at the Brain Tumour Patient Forum, hosted by the Cure Brain Cancer Foundation.

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  • The incidence of glioma by histologic subtype is as follows: glioblastoma, 54%; anaplastic astrocytoma, 6.8%; oligodendroglioma, 6.6%; ependymomas, 5.8%; pilocytic astrocytomas, 5.2%; all other gliomas, 11%; all other astrocytomas, 10.6%. Therefore, the majority of gliomas are glioblastomas.
  • MRI, magnetic resonance imaging.
    As shown by the brain scans on this slide, single-agent bevacizumab was started in March 2008 and the tumor had decreased in size from the initial scan in April 2008 to the second scan in August 2008.
  • Bev, bevacizumab; GBM, glioblastoma multiforme; OS, overall survival; PFS, progression-free survival; VEGF, vascular endothelial growth factor.
  • This slide shows an example of a patient with peritumoral edema who initiated bevacizumab therapy. In June 2009, the patient was receiving dexamethasone 8 mg twice daily, and by August 2009, the dose had been decreased to 2 mg once daily with concurrent bevacizumab every 2 weeks. Decreases in the size of the tumor as well as in the peritumoral edema were observed.
  • Brain tumour patient forum Paul de Souza Tests related to management

    1. 1. Tests related to management Prof. Paul de Souza Hosted by Cure Brain Cancer Foundation
    2. 2. Investigations during management for Brain Cancer Prof. Paul de Souza University of Western Sydney Department of Medical Oncology Liverpool Hospitals April 2014
    3. 3. Management principles Primary brain cancer: -Surgery / radiation / chemotherapy Tests related to each treatment: -Post-operative scans -Blood tests -Tests related to complications -Imaging during follow-up: essentially CT scan or MRI scans
    4. 4. Management principles Secondary cancers to the brain: -Surgery if possible -Radiation (alone or after surgery) -Possibly other treatments (eg. chemotherapy) Tests related to each treatment: -Postoperative scans -Blood tests -Imaging during follow-up: essentially CT scans, MRI scans, but also for primary disease and other metastatic disease
    5. 5. Evolutions in VEGF-Targeted Therapy for GBM Incidence Distribution of All Gliomas by Histology Subtype 54 6.8 6.6 5.8 5.2 11 10.6 Glioblastoma Anaplastic astrocytomas Oligodendrogliomas Ependymomas Pilocytic astrocytomas All other gliomas All other astrocytomas Central Brain Tumor Registry of the United States. Available at: NPCR-04-05/CBTRUS-NPCR2004-2005-Report-.pdf. Accessed December 16, 2009.
    6. 6. Anatomy of the brain
    7. 7. MRI features of GBM • Enhancing tumor • Surrounding oedema + tumour • ≈ 5% multifocal • Rapid progression key feature • Median survival: 9-14 months • NB: can be difficult to distinguish post-surgery scarring, leukoencephalopathy, tumour, “pseudo- progression” on MRI
    8. 8. CT scan of the brain
    9. 9. CT scan of the brain
    10. 10. MRI scanner
    11. 11. Difference between CT and MRI
    12. 12. 2010 Annual Meeting of the Society for Neuro-Oncology Case 1: Tumor Recurrence  Single-agent bevacizumab initiated March 27, 2008 MRI: August 28, 2008MRI: April 17, 2008
    13. 13. 2010 Annual Meeting of the Society for Neuro-Oncology Bevacizumab: Anti-VEGF Antibody 1. Vredenburgh JJ, et al. J Clin Oncol. 2007;25:4722-4729. 2. National Comprehensive Cancer Network guideline: CNS cancers (V.1.2008) Recurrent GBM at baseline[1] After 4 cycles bev/irinotecan[1]  Recommended second-line therapy in GBM[2]
    14. 14. Evolutions in VEGF-Targeted Therapy for GBM Peritumoral Edema June 16, 2009 Dexamethasone 8 mg Twice Daily August 24, 2009 Bevacizumab Every 2 wks Dexamethasone 2 mg Once Daily
    15. 15. Anatomy of the brain: PET scan