Q l t t t d lh d li d b iQual o tratamento de escolha do glioma de baixo grau em progressão não candidato a cirurgia?

Sebastião CorrêaRadioncologista do Hospital Sírio-Libanês

Molekulare Biomarker ESTRO 2014

WHO grade (II)/III/IV gliomaH

ist

IDH-1/2

tology

triple-negative LGGs (5-year survival rate, 91% vs 54%).

wildtypewildtype

WHO d IV WHO dWHO d

mutant

WHO d II/III/(IV)

B

WHO grade IV

> 65 y 65 y

WHO gradeWHO gradeII/IIIII/III

WHO grade II/III/(IV)

1p/19q 1p/19q

Biom

ark> 65 y

MGMT MGMT+

65 y 1p/19qintact

1p/19qcodeleted

MGMTMGMT MGMT+

ker

PROGRESSIONPROGRESSIONMGMT- MGMT+

RT TMZ

MGMTMGMT-- MGMT+

RTRT TMZ

TMZ

RT

RT/PCV

TMZ/RTTMZ

TheraRT TMZ

TMZ/RTTMZ

RTRT TMZ

TMZ/RTTMZ PCV TMZ or PCV

apy

Suspected low-grade glioma

Histor and e amination S iIf presumed low risk and

History and examination Seizures

Diagnostic MRI Antiepileptics

asymptomatic or seizures are controlled

Not near eloquent cortices

Near or withineloquent cortices

Not a surgical candidatedue to size or infiltration

and progression.Preoperative

mapping with fMRI

Standardsurgical resection

Surgical –Uncontrolled orProgressive Symptons

Biopsy

LGG confirmedLGG confirmed

Low risk High risk 3,9 years overall survival10,8 years overall survivalPearls -Immediate

ObservationRecurrence- Re-resection or RT

RADIATION

High risk

Age>40y,KPS<70%,Tumor dimension >6cm, tumor crossing midline, One or no deletions on 1p,19q, IDH1 or 2 not mutated, increasing perfusion on image. Gemistocytic

EORTC Tumor Scoring System: Scoring System (A) and Outcome Predictors

A

System (A) and Outcome Predictors

A.EORTC Scoring System Score (Y/N)Age ≥40 years 1/0Astrocytoma histology (GEMISTOCÍTICO) 1/0Tumor diameter ≥6 cm 1/0T i idli 1/0Tumor crossing midline 1/0Neurologic deficits prior to surgery 1/0Data from Pignatti F, et al.7Data from Pignatti F, et al.B.Score Risk Group Median OS0 to 2 Low 7.72 years3 to 5 High 3.20 yearsD t f Pi tti F t l 7Data from Pignatti F, et al.7

Therapy for Glioma WHO II Not a surgical candidatedue to size or infiltration and progression.

2 – Radiotherapy - 3D RT- V MAT - IMRT- IMRT

- EORTC 22844 and a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group - RT 45/54 Gy.

Obrigado !Obrigado !