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GBM

Dec 05, 20232 min read

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🌱來自: snippets

GBM

Age⇐ 70, PS 1

Glioblastoma, NOS (WHO grade IV), IDH-wildtype glioblastoma, left parietal 3.8cm with perifocal edema, Ki-67: 33% s/p brain tumor excision on 2018/8/22

**methylated/unmethylated?/indetermine

  • Initial presentation:
  • 2018/9/11 Clinical benefit from temozolomide is likely to be lower in patients whose tumors lack MGMT promoter methylation. Consider temozolomide if tumor is MGMT promoter methylated. Within 1st 3 months after completion of RT and concomitant temozolomide, diagnosis of recurrence can be indistinguishable from pseudoporgression on neuroimaging
  • Follow up parameter: brain MRI 2-6 wk after RT, then every 2-4 mo for 3 yr, then every 6 mo
  • Treatment plan: standard brain RT + concurrent temozolomide and adjuvant temozolomide + alternating eletric field therapy (for supratentorial disease)
  • 2018/9/11 Adjuvant treatment: Concurrent (with RT) temozolomide 75mg/m2 daily (for 42 days, no longer than 49 days), rest for 4 week, Post RT temozolomide 150-200mg/m2 5/28 schedule for 6 cycles (150mg/m2 at first cycle and then titrate to 200mg/m2 in subsequent cycles). PJP prophylaxis during CCRT
  • RT: 60 Gy/30 Fr/6 weeks (2018/9/11~) @ give #1 temozolomide 75mg/m2 today (BSA 1.9, use 120mg first and titrate next cycle), RTC 2 weeks for lab and #2 temozolomide. @ Baktar prophylaxis TIW **AEs of temozolomiade such as myelosuppression (dose-limiting), nausea/vomiting (mild to moderate). headache, fatigue, elevated of AST/ALT, photosensitivity, and teratogenic and carcinogenic

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