TNM kalssifikatsioon - ei toimi McDonaldi kriteeriumid - ei
toimi Ajutuumori ravijrgne kontrasteerumine on mittespetsiifiline
MRT leid sltub ravist... Baseline Mlemad pseudoprogressioon ja
pseudovastus on seotud HEBi muutustega mittespetsiifilised Leid ei
pruugi korreleeruda tu suurusega ja aktiivsusega! Abiks advanced
instrumendid
Haiguse progressioon Teline ravivastus Pseudoprogressioon
(Hiline) radionekroos Pseudo-pseudoprogressioon Pseudovastus
Slide 8
(Ala)ga ravijrgne reaktsioon (TMZ+ RT) Kontrasteerumine Tuumori
maht 1-3 ( 2-5 ) kuud peale ravi alustamist Isepiirduv protsess Ei
korreleeru kliinikuga Ajukoe pletikuline reaktsioon kasvajale Ei
ole leebem ravijrgne nekroos 44 aastane GBM-ga naine.
Pseudoprogressioon Brandsma et al. Lancet Oncol; 2008
Slide 9
Hygino da Cruz et al, AJNR, 2011
Slide 10
Aithh!! Dr. li Roose
Slide 11
PP tagantjrgi tarkus? Uued biomarkerid? (PET-MRT?) Brandes et
al, Neuro-oncology, 2008 65 aastane GBM-ga mees. Pseudoprogressioon
PreopPostop, 8 kuud
ge reaktsioon (vaskulopaatia) Enamasti 18-24 kuud peale RT
Riski faktorid: Summaarne kogudoos (>65Gy) Hperfrakts. RT
(>2-5 Gy/p) Smptomaatiline (nt. IKR ) Vib vajada kraniotoomiat
Vib olla fataalne DDx: tu retsidiiv Radionekroos 60 a. naisel
Mullins et al, 2006. AJNR
Slide 16
Radionekroos 39 a. vanusel mehel. Brandsma et al. Lancet Oncol;
2008 3,5 kuud18 kuud
Anti-VEGF ravi -> Neoangiogenees Kontrasteerumine Kliinik
Elulemus? T2/FLAIR anomaaliad -> progressioon Drug holiday
muutuste inversioon Pseudovastus. Hygino da Cruz et al, AJNR,
2011
Slide 19
T2/FLAIR leid -> tu progressioon Angiogenic switch
Pseudovastus. Hygino da Cruz et al, AJNR, 2011
Slide 20
Slide 21
Ananthnarayan et al. J. Neurooncology, 2008
Slide 22
Aithh!! Dr. li Roose
Slide 23
Essig jt. AJNR, 2012
Slide 24
P. Sanghera et al, 2011 Baseline MRT 48 (72) t peale likust
Teine MRT 4-6 (8) nd. peale (TMZ)+RT Follow-up MRT (2-3 kuud)
Slide 25
Aithh!! Dr. Katrin Bakhoff 05.11 07.12 06.11 02.12
Slide 26
Belden et al, Radiographics, 2011
Slide 27
MRT-PET koregistreerimine. Grosu ja Weber, 2010
Slide 28
Essig jt. AJNR, 2012
Slide 29
Ananthnarayan S, Bahng J, Roring J, Nghiemphu P, Lai A,
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extended bevacizumab treatment. J Neurooncol. 2008
Jul;88(3):339-47. Epub 2008 Apr 4. Ananthnarayan SBahng JRoring
JNghiemphu PLai ACloughesy TPope WB Andrew S. Chi, Andrew D. Norden
and Patrick Y. Wen. Antiangiogenic strategies for treatment of
malignant gliomas. Volume 6, Number 3 (2009), 513-526. Andrew S.
ChiAndrew D. NordenPatrick Y. WenAntiangiogenic strategies for
treatment of malignant gliomasVolume 6, Number 3 Baeriswyl V,
Christofori G.The angiogenic switch in carcinogenesis. Semin Cancer
Biol. 2009 Oct;19(5):329-37. Epub 2009 May 29. Baeriswyl
VChristofori G Belden CJ, Valdes PA, Ran C, Pastel DA, Harris BT,
Fadul CE, Israel MA, Paulsen K, Roberts DW. Genetics of
glioblastoma: a window into its imaging and histopathologic
variability. Radiographics. 2011 Oct;31(6):1717-40. Belden CJValdes
PARan CPastel DAHarris BTFadul CEIsrael MAPaulsen KRoberts DW
Brandes AA, Tosoni A, Spagnolli F, Frezza G, Leonardi M, Calbucci
F, Franceschi E. Disease progression or pseudoprogression after
concomitant radiochemotherapy treatment: pitfalls in neurooncology.
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AATosoni ASpagnolli FFrezza GLeonardi MCalbucci FFranceschi E
Brandsma D, Stalpers L, Taal W, Sminia P, van den Bent MJ. Clinical
features, mechanisms, and management of pseudoprogression in
malignant gliomas. Lancet Oncol. 2008 May;9(5):453-61. Brandsma
DStalpers LTaal WSminia Pvan den Bent MJ Essig M, Anzalone N, Combs
SE, Drfler , Lee SK, Picozzi P, Rovira A, Weller M, Law M. MR
imaging of neoplastic central nervous system lesions: review and
recommendations for current practice. AJNR Am J Neuroradiol. 2012
May;33(5):803-17. Essig MAnzalone NCombs SEDrfler Lee SKPicozzi
PRovira AWeller MLaw M Frederic G Dhermain, Peter Hau, Heinrich
Lanfermann, Andreas H Jacobs, Martin J van den Bent.Advanced MRI
and PET imaging for assessment of treatment response in patients
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for radiation treatment planning of brain tumours. Radiother Oncol.
2010 Sep;96(3):325-7. Epub 2010 Aug 20. Grosu ALWeber WA Hygino da
Cruz LC Jr, Rodriguez I, Domingues RC, Gasparetto EL, Sorensen AG.
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Dec;32(11):1978-85. Epub 2011 Mar 10. Hygino da Cruz LC JrRodriguez
IDomingues RCGasparetto ELSorensen AG Henson JW, Ulmer S, Harris
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