WHEN TREATING LOW GRADE GLIOMA WITHOUT …rvmaiseventos.com.br/neuro-oncologia/aulas/17/1100-1105 -...
8
Transcript of WHEN TREATING LOW GRADE GLIOMA WITHOUT …rvmaiseventos.com.br/neuro-oncologia/aulas/17/1100-1105 -...
WHEN TREATING LOW GRADE GLIOMA WITHOUT MALIGNANCY ?
Thiago Lins Almeida Médico Assistente do Hospital São José
Médico Titular do Hospital São JoaquimPós-Graduando da Faculdade de Medicina de Ribeirão Preto - USP
AT THE SIGN OF PROGRESSAT THE SIGN OF PROGRESS
WHEN TREATING LOW GRADE GLIOMA WITHOUT MALIGNANCY ?
Treatment Goals
Cure
Symptoms Control
Progression Free Survival
Overall Survival
45 to 74% of cases, LGG subsequently transforms into higher grade glioma (Jaeckle 2010)
The spontaneous VDE varies with an average of 4 mm/year (Neurosurgery 2012)
Response rate
AT THE SIGN OF PROGRESS
symptoms
Natural history of disease
WHEN TREATING LOW GRADE GLIOMA WITHOUT MALIGNANCY ?
no symptoms Diagnosis
SURGERYAstrocytoma mOS 5 y
Oligodendroglioma mOS 10-16 y
Neurosurgery 63:700, 2008
RTOG 22845
GTR PFS+ 7y OS+ 12,5 y
RT PFS+ p<0.0001 OS- QoL?
Lancet 366:985, 2005
RTOG 9802RT vs RT + PCVPFS+ but not OS
J Clin Oncol. 2008
HGG
AT THE SIGN OF PROGRESS
rescue
Tools for Treatment – “The signs” Epidemiology
Symptoms (Duffau 2004 - 2012)
Diagnosis Images CT / PET / MRI (Lauterbur 1973 - 2012)
Neuropathology - WHO (1979 - 2002 - 2007)
Criteria Macdonald and RANO
Management Neurosurgery Radiotherapy Systemic intervention
(Hart 2000 - Park 2010)
(Walker 1978 - IGRT 2005 - Frosina 2009)
(Stewart 2002 - Stupp 2005)
WHEN TREATING LOW GRADE GLIOMA WITHOUT MALIGNANCY ?
(CBTRUS 2011)
(1990-2010)
J Transl Med. 2012; Clin Transl Oncol. 2012Cell Stress Chaperones. 2012; Med Oncol. 2012World J Clin Oncol. 2012
new insights
AT THE SIGN OF PROGRESS
WHEN TREATING LOW GRADE GLIOMA WITHOUT MALIGNANCY ?
AT THE SIGN OF PROGRESS
Approaches
Spectroscopy: metabolic data to PD = 96% accuracyArtif Intell Med 2012
MRI features are potentially predictive of IDH1 statusAJNR 2012;33:1349-55
IDH1 mut: worse OS = more aggressive surgeryCahill ASCO 2012 B#7
Awake surgery noneloquent = No anaplastic (p .037)J Neurosurg 2011
Rescue CB 85% No relation 1p19q ddTMZ postCx AINO PII ASCO 2012 B#25
Overal Survival plus QoL
WHEN TREATING LOW GRADE GLIOMA WITHOUT MALIGNANCY ?
AT THE SIGN OF PROGRESS
symptoms
imagens
GoStop
toxicity
epigeneticsno evidence
“ treat the patient and not only the tumor …
Thiago Lins Almeida Médico Assistente do Hospital São José
Médico Titular do Hospital São JoaquimPós-Graduando da Faculdade de Medicina de Ribeirão Preto - USP
Acknowledgments
