OLIGODENDROGLIOMA

KYLEE MCCONNELL

Patient Information
Female
20 years old
Treated on SBRT
Oligodendroglioma in right parietal lobe

Medical History
Double uterus

Congenital absence of one kidney

Allergic to ampicillin and penicillin
Seizure
Happened on May 22, 2014
Consisted of blurry vision and jerky movements

Brain mass found in May 2014

Brain surgery in May 2014

Social History
Single

Lives with boyfriend

No children
Unemployed
Has never smoked or used tobacco
Does not drink or do drugs
Is sexually active

Social History cont.

Mother: Hypertension
Father: Coronary Artery Disease and diabetes
Grandfather: Had cancer, but patient was

unsure of what type

Question?
What are the two most common symptoms

that patients with CNS tumors will present

with?

Answer
1. Headaches

2. Seizures

Common Signs and Symptoms

Headaches: 70%
Seizures: 55%
Mental changes
Double vision
Nausea/vomiting
Dizziness
Visual disturbances
Difficulty with balancing
Weakness and stiffness in side or extremity
Facial weakness
Speech and personality changes

Signs and Symptoms

The patient did not experience any symptoms

indicating presence of a brain tumor.

She reported feeling perfectly fine until she

had the seizure, which then led to the

discovery of her brain tumor.

Etiology

There is not any proof, but CNS tumors are

thought to be associated to a genetic link.

Other possibilities:
Rubber compounds
Polyvinyl chloride
N-nitroso compounds
Polycyclic hydrocarbons

Epidemiology

1,2

1.5-2% of new cancers diagnosed are CNS

tumors.
80% of these are brain
For adults, 50% of primary brain tumors are

gliomas.
Oligodendrogliomas account for <5% of all
primary brain tumors.

Epidemiology cont.

1,2

About 23,130 new tumors of the CNS are

diagnosed annually in the United States. Of

these, there are around 14,080 deaths.
Peak ages of brain tumors are between 3-12
and 40-80. (Between ages 50-60 for gliomas.)
They are most common in the
cerebrum/supratentorial region.

Question?
What diagnostic studies are used for CNS

tumors, and why are some better than

others?

Diagnostic Studies

Neural workup, CT, MRI, PET, angiography

PET is used because the tumor cells take up the
radioactive material.
MRI is great for soft tissue visualization.
Angiography is used to see the vasculature
around the brain.
If a tumor is vascular, it is more sensitive to radiation

because the oxygen makes it fast growing.

fMRI allows the mapping of associations with the

brain and vital functions. The sensory and motor
acitvities alter the oxygen and blood flow to the
brain, and this study can detect that.

Diagnostic Studies cont.

This patient received both an MRI and a CT.
MRI before surgery/radiation

Diagnostic Studies cont.

CT before surgery/radiation

Diagnostic Studies cont.

MRI after surgery

Question?
Where is your parietal lobe, and what is its

function?

Anatomy & Physiology

4,5

The parietal lobe is in the cerebrum of the

brain.
The cerebrum has 2 cerebral hemispheres.
Each hemisphere is 4 different lobes.

Anatomy & Physiology cont.

The parietal lobe is for sensory information

and determining characteristics of objects.

Visual-spatial information is processed in the
non-dominant parietal lobe, while the
dominant lobe is important for ideomotor
skills.

Histopathology

Oligodendrogliomas mainly arise in gray matter

of the brain, or the white matter that is more

superficial.
The original, normal cell that an
oligodendroglioma arises from is an
oligodendrocyte.
The cell defines the tumor and how fast it grows.
May have a short arm on chromosome 1 and a
long arm on chromosome 19, which could help
increase the response to chemotherapy.

Grading
You do not stage brain tumors because there are

limited, if any, nodes associated with these

tumors, and there is not any metastasis.
Grading a CNS tumor is describing how
aggressive the tumor is and its differentiation.
Grading also determines survival rates.
The system is composed of 4 grades:

G1: Well differentiated

G2: Moderately differentiated
G3: Poorly differentiatied
G4: Undifferentiated

Question?
What is the most common grade for an

oligodendroglioma?

Grading cont.
This patient presented with a tumor of WHO

Grade II.
This is the most common grade for

oligodendrogliomas.
Grade II lesions consist of ones that are

infiltrating, yet low in mitotic activity.

They often are likely to recur.*
Some may even become a lesion of a higher grade.

Question?
What is the first step in treating a CNS tumor?
A. Radiation
B. Surgery
C. Chemotherapy

Adjuvant Course of Treatment

The first step to treatment is usually surgical

resection.
Post operative radiation therapy, using a 2-3
cm margin around the tumor area, is used for
tumors that could not be fully resected.
Dose is usually between 50-54 Gy using 180200 cGy/fx, and can go as high as 6000 cGy.
Chemotherapy is often used post surgery,
also.

Adjuvant Course of tx cont.

The first step to this patients treatment was surgical

resection of the tumor in May of 2014.

Along with post operative radiation, she got post op
chemotherapy of temodar (temozolomide,
alkylating agent) and dexamethasone
(corticosteroid).
The dexamethasone caused reactions like:

Decreased sleepiness
Increased urination
Heat tolerance
Facial swelling
These symptoms subsided once she was stopped taking it.

Radiation Treatment Plan

Most gliomas are treated with a dose of 5000-

7000 cGy at 150-200 cGy/fx, and there is a

possibility of a cone down after the primary
field.
This patients treatment was as follows:

6 MV
IMRT
5320 cGy (190 cGy/fx)
28 fxs
No cone down was prescribed

Question?
What would be an ideal set up for treating

this patient?

Patient Positioning
Supine

Conformal board
Q2 mask with custom short blue head rest
Arms on abdomen
Knee sponge
No removable dental work

Field Design and Arrangement

Field Design and Arrangement

cont.

Field Design and Arrangement

cont.

Critical Structures

DVH

Side Effects
Acute

Fatigue (Get plenty of rest)

Hair loss (Looked into getting a wig)
Slight worsening in seizures
Headaches
Fullness in ears

Chronic
Damage to spinal cord/brainstem
Possible damage to optic pathways, which could then

lead to vision problems

Dysfunction of the pituitary gland
Cataracts

Managing Side Effects

This patients only had a few side effects, but

overall, she still felt great after treatment.

She reported getting plenty of rest and
staying positive helped her get through it all.
Her support from her boyfriend helped a
great deal, also.

Disease Prognosis & Survival

Survival rate is 65-90% in 5 years and 30% in

15-20 years.
This patients treatment was considered
curative, so the prognosis seemed very good.

Metastasis
There is little chance of an oligodendroglioma

to spead, but it may spread to the bone

marrow.

Difficulties
The only difficulty experienced during the

entire course of treatment was the mask

being too tight at first, and then it got looser
towards the end of treatment.
Led to adding/subtracting shims.

Patient Perspective
Family

Insurance
Boyfriend
Wig
Friends

References

1. Hackworth, R. Adult CNS Tumors. [PowerPoint]. The Ohio State University Radiation Therapy
Program; 2013.

2. Hackworth, R. CNS Tumors. [PowerPoint]. The Ohio State University Radiation Therapy
Program; 2013.

3. Medscape. Pathology of Oligodendrogliomas. http://emedicine.medscape.com/article/1743896overview#aw2aab6b2. Accessed September 28, 2014.

4. Rehab Team Site. Overview: Anatomy and Pathophysiology.

http://calder.med.miami.edu/pointis/tbiprov/NURSING/over3.html. Accessed September 28,
2014.

5. Serendip Studio. Definition-Parietal Lobe.

http://serendip.brynmawr.edu/exchange/brains/definitions/def-parlobe. Accessed September 28,
2014.