Devita, Hellman, and Rosenberg's Cancer

LWBK1006-28 LWW-Govindan-Review December 9, 2011 16:52

Chapter 28•Neoplasms of the Central Nervous System 385

Question 28.11. All of the following are associated with poor prognosis in patients with

low-grade gliomas, EXCEPT:

A. Age≥40 years

B. Tumor diameter≥6cm

C. Tumor crossing midline

D. Oligodendroglioma

Question 28.12. A 45-year-old man presents with generalized seizures, and MRI of the

brain reveals a nonenhancing mass measuring 7 cm. Biopsy is done, and

the tumor histology is reported as grade 2 astrocytoma. The patient under-

goes surgery, and a partial (85%–90%) tumor resection is achieved. Fur-

ther treatment should include:

A. Watchful waiting

B. Chemotherapy

C. Radiotherapy, 50.4 Gy in 1.8 Gy fractions

D. Radiotherapy with chemotherapy (procarbazine, CCNU, and vin-

cristine)

Question 28.13. In patients with GBM, who have disease recurrence following initial

treatment with temozolomide and radiation, the second-line treatment

of choice is:

A. Erlotinib

B. Imatinib

C. Topotecan

D. Bevacizumab

Question 28.14. A 55-year-old man presents with headache and mental status changes.

MRI scan of the brain reveals a 5-cm contrast-enhancing mass with sur-

rounding edema. He undergoes stereotactic biopsy revealing GBM. The

patient undergoes resection of the tumor, and further treatment should

include:

A. Focal external beam irradiation with 45 Gy in 30 fractions plus con-

current temozolomide

B. Focal external beam irradiation with 60 Gy plus a 10 Gy boost plus

concurrent temozolomide

C. Focal external beam irradiation with 60 Gy in 30 fractions plus con-

current temozolomide

D. Hyperfractionated dose of 72 Gy in 1.2 Gy fractions plus concurrent

temozolomide