Info
🌱來自: Pocket Oncology
NEUROLOGICAL ONCOLOGY
Presentation and diagnosis • Suspect if new focal neurologic deficits, seizure, memory or balance issues, or evidence of ↑ intracranial pressure (HA, n/v, vision change) • MRI brain for suspected CNS tumors; CT less Se. Consider LP if c/f CNS lymphoma. Primary CNS tumors • Meningioma: histopath. grading (WHO grades). Grade 1 = benign, asx/small → observe. Large or sx → resection if able, radiation if not. Grade 2–3 → resection + adjuvant RT (defer if risk of RT complication high and tumor totally resected). • Glioma: histopath. grading, Grade 1/2/3: astrocytoma, oligodendroglioma most common; Grade 4: glioblastoma. Grade 3/4 = “high grade” (Neuro Oncol 2021;23:1231). • Notable testing: 1p/19q, IDH, MGMT methylation (predicts sensitivity to temozolomide) • Treatment: max resection as feasible → adjuvant RT + temozolomide → surveillance. Steroids if neuro sx, hold until biopsy if c/f 1° CNS lymphoma. Anti-epileptics if seizures. • Prognosis based on grade & histology. For glioblastoma, overall survival 12–15 mos, based on extent of tumor resection (J Neurosurg 2014;120:31).