Audio and slides for this presentation are available on YouTube: http://youtu.be/pkB_mfPtjrA
Andrea K. Ng, MD, of Dana-Farber/Brigham and Women's Cancer Center Department of Radiation Oncology, gives an overview of the different types of radiation therapy, the side effects, and how it is used in the treatment of lymphoma. This presentation was given at the 2013 Lymphoma Research Foundation North American Forum on Sept. 29, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Audio and slides for this presentation are available on YouTube: http://youtu.be/pkB_mfPtjrA
Andrea K. Ng, MD, of Dana-Farber/Brigham and Women's Cancer Center Department of Radiation Oncology, gives an overview of the different types of radiation therapy, the side effects, and how it is used in the treatment of lymphoma. This presentation was given at the 2013 Lymphoma Research Foundation North American Forum on Sept. 29, 2013. http://www.dana-farber.org | http://www.lymphoma.org
Dose to the Dysphagia/Aspiration-Related Structures (DARS) is critical to ensure proper swallowing functions to the patients after IMRT to the head and neck region
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
Dose to the Dysphagia/Aspiration-Related Structures (DARS) is critical to ensure proper swallowing functions to the patients after IMRT to the head and neck region
Hypofractionation in early breast cancer is no more a research scholars topic. Multiple studies with robust data have proven its utility. It may hold an important role in many countries with constrained resources. This is a short presentation incorporating important completed and ongoing trials. Feel free to use this.
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Maxilla, Mandible & Hyoid Bone & Clinical Correlations by Dr. RIG.pptx
GLIOMA PANEL ISNOCON.pptx
1. LOW GRADE GLIOMA PANEL
5/5/2023 1
DR L N TRIPATHY
Senior Vice Chairman, Director
Senior Consultant, Neurosurgery
Medica Super specialty Hospital, Kolkata
ISNOCON 2023- KOLKATA
DR KANHU CHARAN PATRO
HOD, Radiation Oncology
Mahatma Gandhi Cancer Hospital & RI
Visakhapatnam
11. Definition
The term diffuse infiltrating means there is no
identifiable border between the tumour and
normal brain tissue, even though the borders
may appear well-marginated on imaging
5/5/2023 11
12. Some facts
• Diffuse astrocytomas, also referred to as low-grade infiltrative
astrocytomas, are designated as WHO II tumours of the brain.
• Commonly, astrocytomas are confined to white matter although they
can infiltrate and expand the adjacent cortex in later stages.
• However, oligodendroglioma is frequently a cortical-based tumor.
• Although contrast enhancement has been classically associated
with a higher degree of malignancy, contrast enhancement may be
seen in up to 20% of LGG
5/5/2023 12
13. Case details
39-year male
• P/w –frontal headache
• Personality changes- 6 month
• Single episode of generalized seizure
• Disturbance with selective attention
MRI
• LT. temporal lesion
• 6cm in greatest dimension
• Solid cystic pattern
• No enhancement
• Midline shift
• Mass effect
• Ventricular effacement
31. NEUROSURGERY
• What type surgery
• Eloquent location
• Stereotactic biopsy
• Imaging after surgery
• Awake craniotomy
32. Surgery recommendation
• It is assumed that surgery should aim for the greater extent of resection as it
would Increase survival and potentially alter the natural history of the disease:
gross total removal or subtotal tumor removal (when feasible and safe) is
superior to biopsy in terms of decreasing the rate of tumor progression and also
have positive impact in overall survival estimation of resection less than 50%
would lead to consider biopsy.
• A retrospective multicentric study analyzing 1097 patients (in which the
assessed population was divided into three subgroups depending on the extent
of resection: 100%, 50–99% and less than 50%) showed that the amount of
residual lesion impacted on the course of the disease (OS was 10.5 and 14
years for patients with a less than 50 and 50–99% Extent of resection, being
unreached instead after 15 years for patients with no residual tumor).
• Biopsy is indicated when diagnosis is needed in deep lesions (including
brainstem), diffuse and/or multicentric tumor or any other contraindication for
open resection.
• Biopsy can be stereotactic (framed or frameless) or open. Neuronavigated
non-framed biopsy is gaining acceptance.
5/5/2023 32
41. Layered reporting in brain tumors
Thus, to display the full range of diagnostic information available, the use of
layered (or tiered) diagnostic reports is strongly encouraged, as endorsed by
the International Society of Neuropathology—Haarlem consensus
guidelines and the International Collaboration on Cancer Reporting.
43. H/ P REPORT
• DIFFUSE GLIOMA
• GRADE ll
5/5/2023 43
1. Nuclear irregularities with fibrillary processes
are diagnosed as astrocytoma
2. Infiltrative, diffuse growth pattern with the
formation of secondary structures of Scherer
Moderately cellular
3. Irregular cell distribution
4. Nuclear atypia is typical, yet variable: enlarged
elongated hyperchromatic irregular nuclei
5. Variable amount of cytoplasm: may be scant
(naked nuclei) to moderate with processes
creating a fibrillary background
6. No mitotic activity (a single mitosis in a
sizable specimen is allowed)
7. No necrosis or microvascular proliferation
8. Variable microcystic change
9. Variable calcification
44. Oligodendroglioma
5/5/2023 44
Micrograph of an oligodendroglioma showing the characteristic branching,
small, chicken wire-like blood vessels and fried egg-like cells, with clear cytoplasm
and well-defined cell borders. H&E stain. Those with uniformly rounded nuclei and
perinuclear halo (‘‘fried egg’’) are considered oligodendrogliomas.
55. When will we call as glioblastoma?
• Diffuse astrocytoma IDH wild type with
• TERT promoter mutation
• Necrosis
• Microvascular proliferation
• EGFR gene amplification
• Combined entire gain of chromosome 7 and
entire loss of chromosome 10[+7/-10]
55
65. Planning for
observation
• Besides IDH wild-type status, other high-risk factors
include
– Age > 40 years,
– Subtotal resection/biopsy only,
– Astrocytic lineage (lack of 1p/19q codeletion),
– Neurologic deficits prior to surgery,
– Tumor diameter > 6 cm, tumor crossing the
midline of the brain,
– tumors located within or adjacent to eloquent
areas of the brain
• Patients without these risk factors can be considered at
low risk; therefore, after gross total resection, they
should be observed closely with surveillance MRI every
3 months initially, and if there is no demonstrated tumor
growth over a 1-year period, then the imaging interval
can be increased to every 4 months for another year,
and eventually every 6 months for the remainder of the
patient’s life
5/5/2023 65
81. Concurrent CTRT trial
5/5/2023 81
TRIAL INCLUSION ARM RESULT
RTOG 0424 LGG with >3 risk
factors for
recurrence (age >
40 years,
astrocytoma
histology,
bihemispheric
tumor, tumor
diameter[6 cm,
neurologic
function status
Concurrent
radiation
(54 Gy) with
TMZ f/b
monthly TMZ
1. The 3-year OS rate was 73% (95% CI
65.3–80.8%), significantly higher
than the historical control OS rate of
54% (p0.001).
2. The 5-year OS rate was 57.1% (95%
CI 47.7–66.5%), and the median OS
has not yet been reached.
3. The 3-year PFS was 59.2% (95% CI
50.7–67.8%) and median PFS was
4.5 years (95% CI 3.5–NA).
Fisher BJ. J Radiat Oncol Biol Phys.(2015)
82. For anaplastic astrocytoma IDHmt, the interim results of the CATNON trials strongly
suggest treatment with 59.4Gy radiotherapy in fractions of 1.8Gy followed by 12 cycles of
adjuvant temozolomide chemotherapy (200mg/m2 days 1–5 in a 4-week cycle
85. Adjuvant chemo
• After radiation, patient received adjuvant PCV
(procarbazine, CCNU, and vincristine) due to 1p/19q
co-deletion (per RTOG 9802).
86. PCV trial
5/5/2023 86
TRIAL INCLUSION ARM RESULT
RTOG 9802 1. Age >40 years
and/or subtotal
resection
RT (54 Gy)
VS
RT (54 Gy)
And 6 cycles
of adjuvant
PCV
1. Post-RT + PCV conferring a survival
advantage over RT alone: median OS
13.3 versus 7.8 years (HR: 0.59; 95%
CI 0.42–0.83; p = 0.003).
2. Median PFS was prolonged in
patients who received PCV (10.4
versus 4.0 years): HR: 0.50; 95% CI
0.36–0.68 (p0.001)
Buckner JC. N Engl J Med(2016)
90. Radiotherapy trials
5/5/2023 90
TRIAL INCLUSION ARM RESULT
EORTC 22844 1. Low-grade
astrocytomas
Low dose RT
(45 Gy)
VS
High dose RT
(59.4 Gy)
1. No significant difference in the 5-
years OS between low-dose arm
(58%) and high dose arm (59%).
2. No significant difference in the 5-
years PFS (47% verss 50%)
Karim AB. Int J Radiat Oncol Biol Phys
1996
91. Radiotherapy trials
5/5/2023 91
TRIAL INCLUSION ARM RESULT
EORTC 22845
Interim
1. Low-grade
astrocytoma
Early RT
(54 Gy)
VS
No RT
1. Early RT showed an improvement in
TTP (4.8 versus 3.4 years; p = 0.02).
HR = 0.68 (95% CI 0.50–0.94).
2. No differences in OS: HR = 1.15 (95%
CI 0.67–1.74).
3. The 5-year OS rate were: 63 versus
66% (p = 0.49).
(Karim AB. Int J Radiat Oncol Biol
Phys(2002)
92. Radiotherapy trials
5/5/2023 92
TRIAL INCLUSION ARM RESULT
EORTC 22845 1. WHO grade II RT (54 Gy)
after biopsy
resection,
VS
No RT until
progression
1. Early RT was associated with an
improvement PFS (5.3 versus 3.4
years): HR = 0.59; 95% CI 0.45–0.77
(p = 0.0001).
2. No difference in OS (7.4 versus 7.2
years): HR = 0.97; 95% CI 0.71–1.34
8 (p = 0.872)
3. Seizure control also improved in
patients treated with early
radiotherapy.
Van den Bent MJ. Lancet
2005)
93. Radiotherapy trials
5/5/2023 93
TRIAL INCLUSION ARM RESULT
NCCTG/RTOG/
ECOG
1. WHO grade II
gliomas
Low dose RT
(50.4 Gy)
VS
High dose RT
(64.8 Gy)
1. No differences in 2- and 5-year OS
between low dose (94 and 75%) and
high dose arm (85 and 64%) (p =
0.48)
2. Patients treated with high doses
showed higher rates of severe
radionecrosis (5 versus 2.5%)
Shaw EG. J Clin Oncol.
(2002)
94. Radiotherapy trials
5/5/2023 94
TRIAL INCLUSION ARM RESULT
RTOG 0424 LGG with >3 risk
factors for
recurrence (age >
40 years,
astrocytoma
histology,
bihemispheric
tumor, tumor
diameter[6 cm,
neurologic
function status
Concurrent
radiation
(54 Gy) with
TMZ f/b
monthly TMZ
1. The 3-year OS rate was 73% (95% CI
65.3–80.8%), significantly higher
than the historical control OS rate of
54% (p0.001).
2. The 5-year OS rate was 57.1% (95%
CI 47.7–66.5%), and the median OS
has not yet been reached.
3. The 3-year PFS was 59.2% (95% CI
50.7–67.8%) and median PFS was
4.5 years (95% CI 3.5–NA).
Fisher BJ. J Radiat Oncol Biol
95. Radiotherapy trials
5/5/2023 95
TRIAL INCLUSION ARM RESULT
EORTC 22033 LGG with at least
one high-risk
feature (aged>40
years,
progressive
disease, tumour
Size>5 cm, tumour
crossing the
midline, or
neurological
symptoms)
RT ( 50.4 Gy
VERSUS
Dose-dense
oral TMZ
(75 mg/m2
once daily for
21 days,
every
28 days, for a
maximum
of 12 cycles)
1. There was no significant difference
in PFS between TMZ group (39
months) and RT group (46 months):
HR: 1.16; 95% CI 0.9–1.5 (p = 0.22).
2. Median OS has not been reached.
3. Better PFS in IDH-mutant
noncodeleted patients treated with
radiotherapy: 55 versus 36 months.
HR 1.86; 95% CI 1.21–2.87 (p =
0.0043)
Baumert BG Lancet Oncol.
96. Radiotherapy trials
5/5/2023 96
TRIAL INCLUSION ARM RESULT
Wahl M,et al LGG and gross
residual disease
Monthly
cycles of TMZ
for up to 1
year or until
disease
progression
1. The median PFS and OS were 4.2
and 9.7 years, respectively.
2. Patients with 1p/19q codeletion
demonstrated a 0% risk of
progression during treatment
Neuro
Oncol.(2017)
97. Recommendation -1
• People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO
grade 2 should be offered radiation in combination with PCV
• TMZ is a reasonable alternative to PCV when toxicity is a concern
5/5/2023 97
98.
99. Recommendation -2
• People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO
grade 2, initial therapy may be deferred until radiographic or symptomatic
progression in some people with positive prognostic factors (eg, complete
resection and younger age) or concerns about toxicity
100. Recommendation -3
• People with oligodendroglioma, IDH-mutant, 1p19q codeleted, CNS WHO
grade 3 should be offered radiation in combination with PCV
• TMZ is a reasonable alternative to PCV when toxicity is a concern
102. Recommendation -4
• People with Astrocyoma, IDH-mutant, 1p19q NONcodeleted, CNS WHO
grade 2 should be offered radiation in combination with PCV
• TMZ is a reasonable alternative to PCV when toxicity is a concern
GRADE 2 IDH MUTANT AND NON-CODELETED TUMORS
103.
104. Recommendation -5
• People with Astrocytoma, IDH-mutant, 1p19q NONcodeleted, CNS WHO
grade 2, initial therapy may be deferred until radiographic or symptomatic
progression in some people with positive prognostic factors (eg, complete
resection and younger age) or concerns about toxicity
105.
106. Recommendation -6
• People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO
grade 3 should be offered RT with adjuvant TMZ
107.
108. Recommendation -7
• People with astrocytoma, IDH mutant CNS WHO grade 4 may be treated like an
astrocytoma, IDH-mutant, non-codeleted, CNS WHO grade 3 (formerly anaplastic
astrocytoma; see Recommendation 6) or like a glioblastoma, IDH-wildtype, CNS WHO
grade 4
109. Recommendation - 8
• People with astrocytomas, IDH-wildtype, CNS WHO grade 2 or 3 may be
treated according to recommendations for glioblastoma
110. Recommendation -9
• Concurrent TMZ and RT should be offered to people with newly diagnosed
glioblastoma, IDH-wildtype, CNS WHO grade 4
111. Recommendation -10
• Six months of adjuvant TMZ should be offered to people with newly diagnosed
glioblastoma, IDH-wildtype, CNS WHO grade 4 who have received concurrent
RT plus TMZ
112.
113. Recommendation -11
• Alternating electric field therapy may be added to adjuvant TMZ in people with
newly diagnosed supratentorial glioblastoma, IDH-wildtype, CNS WHO grade 4
who have completed chemoradiation therapy
114.
115. Recommendation -12
• Bevacizumab is not recommended for people with newly diagnosed
glioblastoma, IDH-wildtype, CNS WHO grade 4
116. Bevacizumab is not recommended for people with newly
diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4
Benefits do not outweigh harms
117. Recommendation -13
• In people with glioblastoma, IDH-wildtype, CNS WHO grade 4 where the expected survival
benefits of a 6-week radiation course combined with TMZ may not outweigh the harms,
hypofractionated RT combined with TMZ is a reasonable alternative
118.
119. Recommendation -14
• In people with glioblastoma, IDH-wildtype, CNSWHO grade 4 with older age, poor
performance status or with concerns about toxicity or prognosis, best supportive care
alone, hypofractionated RT alone (for MGMT promoter unmethylated tumors) or TMZ
alone (for MGMT promoter methylated tumors) are reasonable options.
120.
121. Recommendation -15
• No recommendation for or against any therapeutic strategy can be made for
treatment of recurrent glioblastoma, IDH wildtype, CNS WHO grade 4
• People with recurrent glioblastoma should be referred for participation in a
clinical trial where possible
122. Recommendation -16
• No recommendation for or against any therapeutic strategy can be made for
treatment of diffuse midline glioma
• People with diffuse midline glioma should be referred for participation in a
clinical trial when possible