grade glioma University of Louisville低级别胶质瘤路易斯威尔大学课件_1.pptVIP

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grade glioma University of Louisville低级别胶质瘤路易斯威尔大学课件_1.ppt

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grade glioma University of Louisville低级别胶质瘤路易斯威尔大学课件_1

neurocognitive decline prospective study of 26 patients treated for low-grade brain tumors 46-56 gy in 1.8-2 gy fractions excluded patients with pre-existing vascular disease diabetes hypertension coronary artery disease armstrong et al. neurology;59:40-48. neurocognitive decline armstrong et al, cont’d 4-hour neuropsychological testing at baseline (after surgery, before rt) yearly for 6 years mri evaluated for white matter disease atrophy neurocognitive decline armstrong et al, cont’d mild decline in visual learning after 5 years improvement in multiple parameters no correlation between cognitive decline and mri changes neurocognitive decline neurocognitive decline tumor progression probably most significant cause other factors do contribute chemotherapy radiotherapy non-treatment related patients live long de-escalation of therapy worthy of further study future directions interesting randomized trials evaluating rt alone temozolomide alone rt and concurrent temozolomide eortc 22033 phase III trial of patients with… progressive disease uncontrolled seizures despite anti-convulsants neurological symptoms randomized to standard dose rt vs temozolomide pfs and os are primary endpoints ecog-e3f05 phase III trial of patients with… progressive disease uncontrolled neurological symptoms age 40 randomized to 50.4 gy +/- concurrent and adjuvant temozolomide pfs and os are primary endpoints conclusions low-grade glioma slow-growing but progressive disease surgery, radiotherapy, chemotherapy all have role optimal sequence, duration unknown patients live long enough to experience toxicity of treatment tumor progression most important cause of neurocognitive decline questions??? eortc 22484 outcome analyzed by extent of resection significant improvements in os and pfs with more extensive surgery no dose response eortc 22484 eortc 22484 eortc 22484 acute toxicity more common in high-dose arm 15% vs 8% required 1 week break no difference in late toxicity no radionecrosis i