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Glioblastoma multiforme

Glioblastoma multiforme. Glioblastoma multiforme Histological Classification. Astrocytic Tumors : Meningeal Tumors Astrocytoma WHO I-IV Meningeoma Pleomorphic Xantho-astrocytoma Haemangiopericytoma Subependymal Giant-cell astrocytoma Melanocytic Tumors

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Glioblastoma multiforme

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  1. Glioblastoma multiforme

  2. Glioblastoma multiformeHistological Classification Astrocytic Tumors: Meningeal Tumors Astrocytoma WHO I-IV Meningeoma Pleomorphic Xantho-astrocytoma Haemangiopericytoma Subependymal Giant-cell astrocytoma Melanocytic Tumors Oligodendroglial Tumors Haemangioblastoma Mixed Gliomas Ependymal TumorsPrimary CNS Lymphoma Plexus choroideus Tumors Neuronal and mixed, neuronal-glial TumorsGerm Cell Tumors Gangliocytoma Germinoma Ganglioglioma Embryonal Carcinoma Pinealoocytoma Endodermal Sinustumor Embryonal Tumors Chorioncarcinoma MedulloblastomaHypophyseal Adenoma Primitive neuroectodermal Tumors (PNET)Craniopharyngioma Simplified according to WHO Classification

  3. Glioblastoma multiformeSymptoms Symptoms Patients (%) Lisa de Angelis, NEJM 2001

  4. Glioblastoma multiformePatients

  5. Glioblastoma multiforme Chemotherapeutic regimens I • CCNU 80-120 mg/m2 per os q 42 • Fotemustine 100 mg/m2 • Dacarbacine 200 mg/m2 • Carboplatin 150 mg/m2 d 1-3 • Etoposid 100 mg/m2 d1-3 q 21 q 21

  6. Glioblastoma multiformeChemotherapeutic regimens II • Cisplatin 20mg/m2, day 1 • CCNU 80 mg/m2, day 1 • Vincristin 2mg, day 8 + 21 • Procarbacine 60 mg/m2, day 8 -21, q 42

  7. Glioblastoma multiformeNeurosurgical procedures Group A B C n = 100 93 100 „complete“ resection 78 32 28 partial resection 22 21 46 stereotactic biopsy 0 40 21

  8. Glioblastoma multiformePostsurgical treatment Group A B C n = 100 93 100 Radiotherapy 22 58 95 Chemotherapy 6 30 98

  9. Glioblastoma multiformeOutcome of patients Group A B C n 100 93 100 early death 19 24 5 (within 10 weeks after diagnosis) survival > 1 year 24 12 33 progression free n.d. n.d. 28

  10. Glioblastoma multiformeTherapy at relapse Group A B C surgical resection 38 5 8 Chemotherapy 2nd line0 2 12

  11. Glioblastoma multiformeChemotherapeutic regimens Group A B C Polychemotherapy 6 19 0 (German Austrian Study) Carboplatin/Etoposid 0 4 10 CCNU 0 7 66 Fotemustine/Dacarbacine 0 0 22

  12. Glioblastoma multiformeAdjuvant Chemotherapy • Chemotherapy is feasible • Outpatient treatment is safe • Side effects are manageable • Results in long-term survivors • Benefit also for older patients • Benefit for patients with inoperable tumors

  13. Glioblastoma multiformeChemotherapy • Fotemustine 100 mg /m2 • Dacarbacine 200 mg /m2 intravenous q 21 days x8

  14. Glioblastoma multiformePCVChemotherapy of anaplastic oligodendroglioma • CCNU 110 mg /m2, day 1 • Vincristin 2 mg, day 8 + 29 • Procarbacin 60 mg /m2, day 8-21

  15. Glioblastoma multiformeResponse to PCV inrecurrent oligodendroglioma

  16. Glioblastoma multiformeChemotherapy • CCNU 100 mg /m2 orally, q 6-8 weeks for one year

  17. Glioblastoma multiformeToxicity of chemotherapeutic regimens

  18. Glioblastoma multiformeInhibition of angiogenensis:An attractive therapeutic approach in malignant tumors • highly tumor-selective • overexpression of VEGF in tumors as repeatedly demonstrated in GBM, especially near necrotic areas

  19. Glioblastoma multiformeThalidomidein recurrent malignant glioma Thalidomide 800 mg /day - 1200 mg/day Patients: n = 39 recurrent glioblastoma multiforme 25 recurrent anaplastic astrocytoma 12 recurrent anaplastic mixed glioma 2 Fine HA et al, JCO 18:708-715, 2000

  20. Glioblastoma multiformeThalidomidein recurrent malignant glioma TTP median 10 weeks OAS median 28 weeks radiographic response partial 2/39 stable 12/39 progressive 20/39 Fine HA et al, JCO 18:708-715, 2000

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