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