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Evidence-Based Surgery

Role of Molecular Markers In Glioblastoma

Sanmugarajah Paramasvaran

John Fuller

14th June 2012

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Clinical Case

• 61 yr gentleman

• February 2012 – headache, left hemianopia

• MRI as shown

• Craniotomy for removal of tumour

• HPE : Glioblastoma

• WBRT and temozolamide

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Post Op Scan Recurrence in 10 weeks

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Clinical Questions:

Does molecular markers in glioblastoma have dependable diagnostic, prognostic and treatment guidance value to be considered as

routine investigation?

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Search strategy

• P = Patients with glioblastoma

• I = molecular markers

• C =

• O = better prognostic and treatment advice

Search Keywords (exp MESH )

1) “Molecular Markers” “

2) “Glioblastoma”

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DatabaseMedline OvidScopusCochrane

Search Keywords (exp MESH )

1) “Molecular Markers” “

2) “Glioblastoma”

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Search Process

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Genetic Markers Tumour Markers

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Medline Ovid Search Results

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Scopus

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Cochrane

Nil

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Selection Criteria

• Glioblatoma

• Molecular markers

• Diagnostic , prognostic and therapeutic significance

Exclusions: non GBM pathogenesis

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30 papers from Medline Ovid

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8 Papers from Scopus

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Levels of Evidence (NHMRC)

Class lll – 21 papers

7 prospective cohorts

14 retrospective cohorts

Class lV- 17 papers

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Conclusion

Marina N. Nikiforova, MD; Ronald L. Hamilton, MD, Arch Pathol Lab Med. 2011;135:558–568

MOLECULAR MARKERS SIGNIFICANCE

MGMT PROGNOSTICPREDICTIVE

EGFR AMPLIFICATION DIAGNOSTIC

IDH1 DIAGNOSTIC IN SECONDARY GBM(60-90%)

IDH 1 & 2 BETTER PROGNOSIS

PTEN DIAGNOSTIC OF PRIMARY GBM

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• Hegi and colleague reported , with temozolamide and RT

MGMT Alive at 2 yrs

Unmethylated 15%

Methylated 49%

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IDH1 & 2 mutation - survival( 31 vs 15 months)

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Thank You