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Do you know what ’ s in people ’ s head?

Do you know what ’ s in people ’ s head?. Brain tumors. 72 male HPI: presents to E.R. with history of confusion, change of personality, left sided H/A P/E: disorientation and aggressiveness, no focal signs Labs: WNL Imaging:. Brain tumors. Brain tumors. anatomy. Brain tumors.

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Do you know what ’ s in people ’ s head?

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  1. Do you know what’s in people’s head?

  2. Brain tumors • 72 male • HPI: presents to E.R. with history of confusion, change of personality, left sided H/A • P/E: disorientation and aggressiveness, no focal signs • Labs: WNL • Imaging:

  3. Brain tumors

  4. Brain tumors • anatomy

  5. Brain tumors

  6. Brain tumors

  7. Brain tumors

  8. Brain tumors • DDx: • Benign • Congenital • AVM/aneurism • Acquired • Infectious (toxoplasmosis, cyst) • stroke • Malignant • Primary • metastatic

  9. Glioblastoma multiforme Astrocytoma Oligodendroglioma Meningioma Brain stem tumors Medulloblastoma Ependymoma Sarcoma Lymphoma Craniopharyngioma Neurofibroma Germ cell tumors Schwannoma Pituitary tumors meningioma Brain tumors

  10. Brain tumors • Metastases • Single • Multiple

  11. Brain tumors

  12. Brain tumor

  13. Brain tumors

  14. Brain tumors • Management: • Medical support (steroids + PPI) • Staging • Surgical resection if indicated • Adjuvant therapies

  15. Brain tumors

  16. Brain tumors

  17. GBM • Radiation therapy • Standard dose: 60 Gy / 30 fractions • O.S. = 42 weeks (1979 study) • Radiation therapy + chemotherapy • Meta analysis shows improvement in general

  18. GBM • Best results to date: • Combination with temozolomide • 75 mg/m2 po od x 6 weeks (concurrent with xrt), then 150 mg/m2 po od on d1-5 every 28 days x 6 cycles

  19. GBM • If poor performance status • Hypofractionated xrt: • 40/15 • 35/10

  20. Brain tumors • 57 male • HPI: known lung cancer; developped gait instability • P/E: cerebellar exam abnormal • Imaging

  21. Brain tumors • Cerebellar metastasis on CT scan • Management: • Supportive care • Decadron (10 mg stat, then 4 mg po QID) + PPI

  22. Brain mets • Depends on stability of peripheral disease and extend of intra cerebral disease: • Peripheral disease stable: • confirm solitary status with MRI • If solitary: • consider surgical resection or stereotactic radiosurgery • Whole Brain Radiation Therapy (WBRT)

  23. Surgery Diagnostic Quicker steroid taper Quicker symptom relief Limited by localisation SRS Non invasive Less risk Less expensive Limited by size Radioresistance Melanoma Sarcoma Brain mets

  24. Brain mets • peripheral disease stable • More than 1 lesion • Surgery less of a consideration • WBRT +/- stereotactic radiosurgery boost • Criteria: • < or = 3 lesions • Volume: < 4 cm • Prognostic > 3 months • KPS >70

  25. Brain mets

  26. Brain mets • peripheral disease not stable • Palliative radiation therapy • Re-irradiation on a case by case basis

  27. Brain mets

  28. Brain mets • Prognostic: • Untreated: 1 month • Steroids: 2 months

  29. Brain mets • Radiation therapy

  30. Brain mets • Side effects • Alopecia • Skin erythema • Fatigue • Neurocognitive changes

  31. Brain mets

  32. Brain mets • Role of WBRT

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