1 / 134

Brain Tumours

Brain Tumours. Mostafa EL-Haddad M.B.B.ch., Msc ., MD., FRCR(UK)., Kasr El- Ainy Hospital Cairo University (NEMROCK ) 2012. Genetic Syndromes. Infra tentorial tumors more common in children ( inf ants). Also in midline. in adults Supratentorail more. Sex. In general male more.

ranger
Download Presentation

Brain Tumours

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Brain Tumours Mostafa EL-Haddad M.B.B.ch., Msc., MD., FRCR(UK)., Kasr El-Ainy Hospital Cairo University (NEMROCK)2012

  2. Genetic Syndromes

  3. Infratentorial tumors more common in children (infants). Also in midline. • in adults Supratentorail more.

  4. Sex • In general male more. • Meningioma and Shwannomas more in female • Ependymoma and nerve sheath equally distributed.

  5. Anatomy • Circle of Willis. • Optic Chiasma.

  6. ANATOMY

  7. Staging • AJCC 2002: NO • Old TNM • M staging and medulloblastoma • Biopsy no biopsy.

  8. Commonest Brain Tumor? • Brain Metastasis.

  9. Imaging • T2 and FLAIR (fluid-attenuated inversion recovery) images are more sensitive for detecting edema. • For nonenhancing tumors, especially glial neoplasms, the FLAIR sequence and T2 sequences are best for the definition of tumor extent.

  10. WHO Grading • Classification idea: -Neuroepithelial. -Germ cells. -Meningeal . -Etc……… OLIGODENDROGLIOMA WHY SPECIAL?

  11. Brain Alpha-Beta ratio • Implication in Dose and fractionation.

  12. General Management • Newer generation anticonvulsants, such as levetiracetam, lamotrigine, and pregabalin that do not affect cytochrome P450 activity are now preferred.

  13. Choose Your Patient • Low Grade. • High grade. • Children. • Boost or No Boost? • Dose escalation in low and High grade gliomas. • Risk structures.

  14. CT-Simulator • Patient preparation. • IV contrast. • Treatment position: Supine? Prone?. • Neck flexed or extended .WHEN? • Fixation methods

  15. Define your target • Margin for Low grade tumors • Margin in High grade tumors.

  16. GTV • A central low-density area is evaluated as necrosis and is surrounded by an annular enhancing area corresponding to a densely cellular zone of viable neoplasm called the “rim.” (IF any) The external limit of the rim corresponds to the GTV

  17. GTV In High Grade Glioma • MRI or CT? both with contrast. • Best with T1 MRI with contrast.

  18. GTV in Low grade Glioma • CT in Low grade glioma, tumor is non enhancing so its very difficult to delineate. • MRI T1 or T2?

  19. CTV in High Grade Glioma • 2-3 cm beyond any existing edema. • Which imaging study will you use to adequately define your edema?? MRI ?? T1 or T2? .

  20. Brain Metastasis

  21. Brain Metastasis Gaspar et al IJROBP 1997

  22. Factors NOT in The RTOG Prognostic Factors • Number of the lesions. • Primary site (breast, lung…). • Time interval between the Metastasis and the primary. • Location. • Neurologic Function. • Radiation dose. • Tumor response.

  23. Karnofsky scale • 100%: Normal no complaints; no evidence of disease • 90%: Able to carry on normal activity; minor signs or symptoms of disease. • 80%: Normal activity with effort; some signs or symptoms of disease. • 70%: Cares for self; unable to carry on normal activity or to do active work. • 60%: Requires occasional assistance, but is able to care for most of his personal needs.

  24. 50%:Requires considerable assistance and frequent medical care. • 40%: Disabled; requires special care and assistance. • 30%:Severely disabled; hospital admission is indicated although death not imminent. • 20%: Very sick; hospital admission necessary; active supportive treatment necessary. • 10%: Moribund; fatal processes progressing rapidly. • 0 Dead

  25. Value of Whole Brain Irradiation • Increase Median Survival from 1 to 4 months.

  26. Radio-surgery When? • RTOG 9508. • RPA class III. • RPA class I. • Single Mets.

  27. Can we avoid WBI? • EORTC: 22952 –26001. • The American Surgeons Oncology Group. • Japanese Radiation Oncology Study Group.

  28. Landmarks • Sella turcica is centrally located and marks the lower border of the median telencephalon and diencephalon. • Reid's baseline and the Frankfort horizontal plane. • Optic canal runs at most 1 cm superior and 1 cm anterior to that point. • Pineal body 1 cm posterior and 3 cm superior to the external auditory meatus.

  29. What’s FLAIR? • Think of the FLAIR sequence as a bit of a 'negative', in that FLAIR will show areas of differing fluid concentration (not blood). • FlAIR are modified T2-weighted sequences on which fluid in motion, such as cerebrospinal fluid, remains dark, whereas tumor or edema remains white. • This sequence is useful for the delineation of periventricular lesions.

  30. MR Spectroscopy • MR spectroscopy is a promising approach for both metabolic and functional evaluation of GTV and CTV. This technique provides information about tumor activity based on the levels of cellular metabolites.

  31. Choline is a neurotransmitter and membrane component that is increased in glioma and the degree of elevation of the choline level correlates with elevation of tumor cell density. • N-acetylaspartate is a neuronal metabolite that is decreased in glioma implying an increase in the choline-to-N-acetylaspartate ratio.

  32. Creatine indicates a cellular energetic process, and lactate is a catabolite of anaerobic metabolism that can be used as a surrogate marker for necrosis or hypoxia.

  33. CT and MRI delineation of GTV and CTV for untreated glioma remains a controversial and difficult issue, mainly because of the discrepancy between real tumor invasion and that estimated by CT or MRI.

More Related