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MCQS
Year : 2021  |  Volume : 58  |  Issue : 1  |  Page : 96-97
 

MCQs on “Reoperation does not provide a survival advantage in patients with recurrent Glioblastoma treated with irinotecan/bevacizumab treatment”


1 Department of Medical Oncology and Hemato-oncology, Command Hospital Air Force, Bangalore, Karnataka, India
2 Department of Surgical Oncology, Command Hospital Air Force, Bangalore, Karnataka, India
3 Department of Radiation Oncology, Command Hospital, Lucknow, Uttar Pradesh, India
4 Department of Internal Medicine, B. J. Government Medical College, Pune, Maharashtra, India

Date of Submission19-Jan-2021
Date of Decision20-Jan-2021
Date of Acceptance22-Jan-2021
Date of Web Publication24-Mar-2021

Correspondence Address:
H S Darling
Department of Medical Oncology and Hemato-oncology, Command Hospital Air Force, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_89_21

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How to cite this article:
Darling H S, Jaiswal P, Lohia N, Tiwari NR. MCQs on “Reoperation does not provide a survival advantage in patients with recurrent Glioblastoma treated with irinotecan/bevacizumab treatment”. Indian J Cancer 2021;58:96-7

How to cite this URL:
Darling H S, Jaiswal P, Lohia N, Tiwari NR. MCQs on “Reoperation does not provide a survival advantage in patients with recurrent Glioblastoma treated with irinotecan/bevacizumab treatment”. Indian J Cancer [serial online] 2021 [cited 2021 Apr 13];58:96-7. Available from: https://www.indianjcancer.com/text.asp?2021/58/1/96/311855


Q1. All the following are true about secondary Glioblastoma (GBM), except

  1. Secondary GBM arise from a low-grade glioma that has transformed into a higher grade tumor
  2. Secondary GBM is mainly found in elderly
  3. Is associated with favorable prognosis as compared to primary GBM
  4. Secondary GBM usually has a mutation in the isocitrate dehydrogenase (IDH1) gene and often have p53 mutations.


Q2. The standard postoperative radiotherapy dose in GBM is

  1. 45 Gy
  2. 70 Gy
  3. 50 Gy
  4. 60 Gy.


Q3. In this study, which of the following was the most common presenting clinical feature in the patients diagnosed with glioblastoma?

  1. Seizures
  2. Vision loss
  3. Headache
  4. Focal neurological deficit.


Q4. Based on the available data, which of the following best describes the median range of survival for patients diagnosed with glioblastoma?

  1. 3–6 months
  2. 20–24 months
  3. 12–15 months
  4. 4–10 months.


Q5. When is tumor-treating field (TTF) device used in newly diagnosed GBM

  1. After adjuvant chemoradiotherapy
  2. Prior to adjuvant chemoradiotherapy
  3. Along with consolidation temozolomide (TMZ) after completion of concurrent chemoradiotherapy
  4. After completion of adjuvant concurrent chemoradiotherapy and consolidation chemotherapy with TMZ.


Q6. What percentage of the patients in this study underwent the second surgery?

  1. 40%
  2. 10%
  3. 25%
  4. 8%.


Q7. Which of the following molecular markers has both predictive and prognostic values in GBM

  1. TERT promoter mutations
  2. MGMT methylation
  3. IDH1
  4. IDH2.


Q8. The least preferred treatment in a case of recurrent GBM is

  1. Chemotherapy
  2. Reoperation
  3. Re-irradiation
  4. Biological therapy.


Q9. The most important advantage of reoperation is

  1. Overall survival benefit
  2. Progression-free survival benefit
  3. Histopathological confirmation of recurrence
  4. Symptom relief.


Q10. The least important prognostic factor in GBM is

  1. Size of the lesion
  2. Performance status
  3. Mutation status
  4. Age.


Answers and References

1(b). Secondary GBM mainly found in elderly. Glioblastoma may arise de novo (primary) or from a low-grade glioma that has transformed into a higher-grade tumor (secondary). Secondary GBM arise in younger patients and are associated with a more favorable prognosis than those with primary GBM. Secondary GBM usually have a mutation in the IDH1 gene and often have p53 mutations.

(Gondi V, Vogelbaum MA, Grimm S, Mehta MP (2018). Chapter 38: Primary Intracranial Neoplasms. In : Halperin EC, Brady LW, Wazer DE, Perez CA, editors. Perez and Brady's principles and practice ofradiation oncology, 7th edition. Philadelphia: Wolters Kluwer).

2 (d). 60 Gy

Postoperative radiotherapy has been shown to provide a survival advantage in several clinical trials. The typical radiotherapy dose is 60 Gy in 6 weeks for younger and prognostically favorable patients. Dose escalation beyond 60 Gy has not proven to be effective.

(Gondi V, Vogelbaum MA, Grimm S, Mehta MP (2018). Chapter 38: Primary Intracranial Neoplasms. In : Halperin EC, Brady LW, Wazer DE, Perez CA, editors. Perez and Brady's principles and practice ofradiation oncology, 7th edition. Philadelphia: Wolters Kluwer).

3 (c). Headache

The most common presenting clinical feature in this study was headache (13/25 patients, 52%). Typically, 5/25 (20%) patients presented with a focal neurological deficit and 4/25 (16%) patients presented with an epileptic attack. None of the patients in this study reported vision loss as a presenting symptom.

4 (c). 12–15 months

Based on the current evidence, the median range of survival for diagnosed glioblastoma appears to be around 12–15 months.

5 (c). Along with consolidation TMZ after completion of concurrent chemoradiotherapy

For patients with newly diagnosed disease, the device is used after chemoradiotherapy during TMZ consolidation.

(Chang MS, Mehta MP, Vogelbaum MA, Taylor MD, & Ahluwalia MS (2019). Chapter 94: Neoplasmsof the Central Nervous System. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. DeVita, Hellman, and Rosenberg's Cancer: Principles and Practice of Oncology, 11th edition. Philadelphia, Pa: Lippincott Williams & Wilkins).

6 (a). 40%

In this study, 10/25 (40%) patients underwent a second surgery.

7 (b). MGMT methylation

(Hegi ME, Diserens AC, Gorlia T, Hamou MF, de Tribolet N, Weller M, Kros JM, et al. MGMT genesilencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005; 352:997-1003).

8 (c). Re-irradiation,

Re-operation, systemic chemotherapy, and/or bevacizumab treatment options are available for the treatment of recurrent disease, but the efficacy is still low.

9 (d). Symptom relief

Re-operation is useful for both the confirmation of the recurrent disease and to provide symptoms' relief, but its effect on survival is unknown

10 (a). Size of the lesion

(Gittleman H, Lim D, Kattan MW, Chakravarti A, Gilbert MR, Lassman AB, et al. An independently validated nomogram for individualized estimation of survival among patients with newly diagnosed glioblastoma: NRG Oncology RTOG 0525 and 0825. Neuro Oncol 2017; 19:669-677).






 

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