Ebs molecular markers june-pptx - copy

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Ebs molecular markers june-pptx - copy

  1. 1. Evidence-Based SurgeryRole of Molecular Markers In Glioblastoma Sanmugarajah Paramasvaran John Fuller 14th June 2012 1
  2. 2. Clinical Case• 61 yr gentleman• February 2012 – headache, left hemianopia• MRI as shown• Craniotomy for removal of tumour• HPE : Glioblastoma• WBRT and temozolamide 2
  3. 3. Post Op Scan Recurrence in 10 weeks 3
  4. 4. Clinical Questions: Does molecular markers in glioblastoma have dependable diagnostic, prognostic and treatment guidance value to be considered as routine investigation? 4
  5. 5. Search strategy• P = Patients with glioblastoma• I = molecular markers• C=• O = better prognostic and treatment adviceSearch Keywords (exp MESH )1) “Molecular Markers” “2) “Glioblastoma” 5
  6. 6. DatabaseMedline OvidScopusCochraneSearch Keywords (exp MESH )1) “Molecular Markers” “2) “Glioblastoma” 6
  7. 7. Search Process 7
  8. 8. 8
  9. 9. Genetic Markers Tumour Markers 9
  10. 10. 10
  11. 11. 11
  12. 12. Medline Ovid Search Results 12
  13. 13. 13
  14. 14. Scopus 14
  15. 15. Cochrane Nil 15
  16. 16. Selection Criteria• Glioblatoma• Molecular markers• Diagnostic , prognostic and therapeutic significanceExclusions: non GBM pathogenesis 16
  17. 17. 30 papers from Medline Ovid 17
  18. 18. 8 Papers from Scopus 18
  19. 19. Levels of Evidence (NHMRC)Class lll – 21 papers 7 prospective cohorts 14 retrospective cohortsClass lV- 17 papers 19
  20. 20. Conclusion MOLECULAR MARKERS SIGNIFICANCE MGMT PROGNOSTIC PREDICTIVE EGFR AMPLIFICATION DIAGNOSTIC IDH1 DIAGNOSTIC IN SECONDARY GBM (60-90%) IDH 1 & 2 BETTER PROGNOSIS PTEN DIAGNOSTIC OF PRIMARY GBMMarina N. Nikiforova, MD; Ronald L. Hamilton, MD, Arch Pathol Lab Med. 2011;135:558–568 20
  21. 21. • Hegi and colleague reported , with temozolamide and RT MGMT Alive at 2 yrs Unmethylated 15% Methylated 49% 21
  22. 22. 22
  23. 23. IDH1 & 2 mutation - survival( 31 vs 15 months) 23
  24. 24. Thank You 24

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