《多伦多病童医院脑干胶质瘤PPT》由会员分享，可在线阅读，更多相关《多伦多病童医院脑干胶质瘤PPT（97页珍藏版）》请在装配图网上搜索。
1、 among brainstem gliomasA tectal gliomaB focal midbrain tumorC focal intrinsic pontine gliomaD dorsal/exophytic gliomaE diffuse intrinsic pontine glioma*F focal medullary gliomaG cervicomedullary gliomaA Few Important Distinctions* a form of high grade glioma, akin to anaplastic astrocytoma or gliob
2、lastoma multiforme August 2001 August 2006October 2014 August 2000 December 2001 December 2001 December 2002 Low grade glioma of the brainstem: chemotherapy with weekly vincristine and carboplatin Diagnosis (11/2013) 1/2015 (one year of VBL)BRAF V600 mutated tumour Typical DPG Typical BSG 13 year ol
3、d10 month history of progressive right sided weakness, (R) CN 7 and 8Grade 2 on histolology 17 year old12 month history of dizziness when lying downNo CN deficit, no Long tract sign, no ataxia 11 year-oldJanuary 2004 2010 (18 years old) January 2004 2010 1 day oldPM: PNET 1 day oldNo PM 4 month oldP
4、ilocytic AstrocytomaOn chemo DPGLGG Focal HGG DPG LGG 2 year-old, 5 months history of ataxia and gaze palsyBiopsy: low grade astrocytoma 3 years old, NF110/2012 7/2013 3 years old Mild hemiparesisBiopsy: infiltrative astrocytoma (grade 2)9/2012 10/2016 MALIGNANT GLIOMA OF PONSCANADIAN CASES BY YEAR
5、0510152025 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010Number Dxed Year Standard RT50-54 Gy in 1.8 GyDaily fractionsCurrent trend to move to conformal techniques Hyperfractionation: results of prospective studies Freeman et al, POG 9239, IJROBP1999 54 Gy in 30 fractions versus 39 Gy in 13
6、fractionsZhagloul et alRadiotherapy & Oncology 2014 PATIENT DIED AT 11 MONTHS POST DIAGNOSIS Age at Diagnosis(MONTHS) Sex Neurological Signs at Presentation Interval Between Onset of Symptoms and Diagnosis(Weeks) Initial Treatment Survival (Years)Cranial Nerve Palsy Pyramidal Deficits Cerebellar Sig
7、ns20 Male Yes Yes Yes 24 RT +Temozolomide +522 Male Yes Yes No 12-24 RT +4CLINICAL CHARACTERISTICS, TREATMENT AND OUTCOME OF SURVIVING PATIENTS MRI IMAGING OF LONG TERM SURVIVORS October 2011 January 2012 January 2017Long term survivor BiopsyCohort 1 MGMT- EGFR- Cohort 2 MGMT- EGFR+ Cohort 3 MGMT+ E
8、GFR- Cohort 4 MGMT+EGFR+RT Bevacizumab RTBevacizumab Erlotinib RTBevacizumabTemozolomide RTBevacizumab ErlotinibTemozolomide4 Weeks Bevacizumab 4 Weeks Bevacizumab Erlotinib 4 Weeks Bevacizumab 4 Weeks Bevacizumab ErlotinibMaintenance Bevacizumab Maintenance Bevacizumab Erlotinib MaintenanceBevacizu
9、mab Temozolomide Maintenance Bevacizumab ErlotinibTemozolomide MRI Diagnosis DIPGTREATMENT SCHEMA EnrollmentTissue Analyses Boston/UCSF protocol Dec 2013Oct 2013 30 Gy in 17 sessions Oct 2012: 54 Gy in 30 sessions DIPGsHGAs 1357911 2468101315171921X 1214161820221357 9111315171921X 246810121416182022
10、 DIPGs are genetically distinct from supratentorial high grade astrocytomas DIPGHGA 1234567891011123456 7891011 Chromosome 14 Chromosome 17p13 p12 p11.2 q11.1 q11.2 q12 q13.1 q21.1 q21.2 q21.3 q23.1q22.1 q23.2 q23.3 q24.1 q24.2 q24.3 q31.1 q31.3 q32.13 q32.2 q32.33 p13.3 p13.2 p13.1 p11.2p12 q11.2 q
11、12 q21.2 q21.31 q21.32 q21.33 q22 q23.2 q24.1 q24.2 q24.3 q25.1 q25.3p13 p12 p11.2 q11.1 q11.2 q12 q13.1 q21.1 q21.2 q21.3 q23.1q22.1 q23.2 q23.3 q24.1 q24.2 q24.3 q31.1 q31.3 q32.13 q32.2 q32.33 p13.3 p13.2 p13.1 p11.2p12 q11.2 q12 q21.2 q21.31 q21.32 q21.33 q22 q23.2 q24.1 q24.2 q24.3 q25.1 q25.3 DIPGs are genetically distinct from supratentorial high grade astrocytomas PDGFRA Gained in 4/11 DIPGs FISHQ-PCR PARP Other Genes Me Hemispheric ThalamicPontine (DIPG)20%H3.3K27MH3.3G34R/V 65%50%15%H3.1K27M 50%Spinal cord
多伦多病童医院脑干胶质瘤PPT
