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Cover - Brain 		1
ESTRO Course Book 		1
Multidisciplinary Management of 		1
Brain Tumours 		1
4 - 6 October, 2015 		1
Turin, Italy 		1
L02_ESTRO 2015 Brain Tumor Imaging_RB 		7
Modern Imaging of Brain Tumours 		7
Slide Number 2 		8
Slide Number 3 		9
Slide Number 4 		10
Slide Number 5 		11
Slide Number 6 		12
Slide Number 7 		13
Slide Number 8 		14
Slide Number 9 		15
Slide Number 10 		16
Slide Number 11 		17
Slide Number 12 		18
Slide Number 13 		19
Slide Number 14 		20
Slide Number 15 		21
Slide Number 16 		22
Slide Number 17 		23
Slide Number 18 		24
Slide Number 19 		25
Slide Number 20 		26
Slide Number 21 		27
Slide Number 22 		28
Slide Number 23 		29
Slide Number 24 		30
Trans-Cranial Magnetic Stimulation 		31
Trans-Cranial Magnetic Stimulation 		32
Slide Number 27 		33
Slide Number 28 		34
Slide Number 29 		35
Slide Number 30 		36
Slide Number 31 		37
Slide Number 32 		38
L03_What is new in brain tumor classification PC TP 		39
Slide Number 1 		39
Slide Number 2 		40
Brain tumor diagnosis: a challenge step by step 		41
Histological Parameters for Grading 		42
Slide Number 5 		43
Slide Number 6 		44
Slide Number 7 		45
Slide Number 8 		46
A grade IV glioma is histologically diagnosed in presence of: 		47
Brain tumor diagnosis: a challenge step by step 		48
Slide Number 11 		49
Slide Number 12 		50
Slide Number 13 		51
Slide Number 14 		52
Slide Number 15 		53
Slide Number 16 		54
Slide Number 17 		55
Neuropathology report should: 		56
Brain tumor diagnosis: a challenge step by step 		57
Slide Number 20 		58
Slide Number 21 		59
Slide Number 22 		60
Slide Number 23 		61
Brain tumor diagnosis: a challenge step by step 		62
Slide Number 25 		63
Slide Number 26 		64
Slide Number 27 		65
Neuropathology report should: 		66
L04_Bhangoo_Turin_RB 		67
Current Surgical Approaches for Brain Tumours 		67
Slide Number 2 		68
Slide Number 3 		69
Volumetric extent of resection studies in High-Grade Glioma 		70
Slide Number 5 		71
Slide Number 6 		72
Slide Number 7 		73
Slide Number 8 		74
Cochrane review 		75
Slide Number 10 		76
Slide Number 11 		77
Cortical and subcortical mapping strategies 		78
Motor mapping 		79
EEG Electrodes 		80
Cortical Strips – Ecog and Tonic Stimulation 		81
Cortical Strip over Upper Limb Representation 		82
EMG Outputs - Subcortical 		83
EMG Output - Subcortical 		84
Cortical and subcortical motor mapping 		85
Language mapping 		86
Language mapping 		87
Slide Number 22 		88
Intraoperative stimulation mapping – cinical relevance 		89
Beyond motor and language 		90
Slide Number 25 		91
Slide Number 26 		92
Intraoperative use of 5-ALA 		93
Slide Number 28 		94
Slide Number 29 		95
Slide Number 30 		96
Slide Number 31 		97
Slide Number 32 		98
Slide Number 33 		99
Slide Number 34 		100
Intra-operative MRI 		101
Slide Number 36 		102
Pre-operative planning in ACS view 		103
First and second US acquisition 		104
Towards end of resection 		105
Slide Number 40 		106
Slide Number 41 		107
Slide Number 42 		108
Slide Number 43 		109
Slide Number 44 		110
Slide Number 45 		111
Slide Number 46 		112
Slide Number 47 		113
Slide Number 48 		114
Slide Number 49 		115
Slide Number 50 		116
Slide Number 51 		117
Case III – postop course 		118
30 year old male – Left Hemiparesis 		119
Immediate Post –Op Scan 		120
3 Years Later 		121
Slide Number 56 		122
Dendritic-cell immunotherapy (DC-VAX) 		123
DC-Vax Production 		124
DC-Vax 		125
Use the Genomics 		126
Genetics 		127
Genetics 		128
Slide Number 63 		129
Slide Number 64 		130
Slide Number 65 		131
Slide Number 66 		132
Slide Number 67 		133
Slide Number 68 		134
Take-home Message 		135
L05_1 brain tumour RT - preparing pt for treatment_MB 		136
Slide Number 1 		136
Preparation for radiotherapy 		137
Preparation for radiotherapy 		138
Preparation for radiotherapy 		139
Patient position 		140
Patient position 		141
Preparation for radiotherapy 		142
Preparation for radiotherapy 		143
Preparation for radiotherapy 		144
Preparation for radiotherapy 		145
Preparation for radiotherapy 		146
Preparation for radiotherapy 		147
Preparation for radiotherapy 		148
Preparation for radiotherapy 		149
Preparation for radiotherapy 		150
Preparation for radiotherapy 		151
Preparation for radiotherapy 		152
Preparation for radiotherapy 		153
Preparation for radiotherapy 		154
Preparation for radiotherapy 		155
Preparation for radiotherapy 		156
Preparation for radiotherapy 		157
Principles of plan evaluation 		158
Principles of plan evaluation 		159
Preparation for radiotherapy 		160
Slide Number 26 		161
L06_Wide field irradiation_CM 		162
Slide Number 1 		162
Slide Number 2 		163
Radiotherapy technique 		164
A complex technique…. 		165
That has to be done properly…. 		166
A standard CSI technique 		167
CSI in 2015: new/improved tools 		168
Slide Number 8 		169
Slide Number 9 		170
Slide Number 10 		171
Coverage of the target volume: cribriform plate 		172
Coverage of the target volume: cribriform plate 		173
Slide Number 13 		174
Slide Number 14 		175
Slide Number 15 		176
Another new problem… extension of subarachnoid space around cranial nerves 		177
The lower cranial nerves too… 		178
Slide Number 18 		179
Slide Number 19 		180
Coverage of the spine: lateral borders 		181
Why is this important? 		182
Coverage of the spine: caudal extent of thecal sac 		183
Why is this important? 		184
Coverage of the spine: caudal extent of thecal sac 		185
Slide Number 25 		186
Bottom line… 		187
Radiotherapy technique: CSI 		188
A standard CSI technique 		189
Conventional technique 		190
Just some of the issues… 		191
Just some of the issues… 		192
Evolution of CSI technique 		193
Slide Number 33 		194
McGill technique 		195
McGill technique: junctions 		196
McGill technique: junctions 		197
McGill technique: junctions 		198
Comparison with other CT-based techniques 		199
Slide Number 39 		200
Long-term complications of radiotherapy 		201
Slide Number 41 		202
Slide Number 42 		203
Electrons for the spinal axis 		204
Slide Number 44 		205
Slide Number 45 		206
Slide Number 46 		207
Slide Number 47 		208
No junctions or field matching 		209
Slide Number 49 		210
Protons 		211
Slide Number 51 		212
CSI: concluding remarks 		213
CSI: concluding remarks 		214
Slide Number 54 		215
Slide Number 55 		216
Slide Number 56 		217
Slide Number 57 		218
Slide Number 58 		219
Slide Number 59 		220
Slide Number 60 		221
Slide Number 61 		222
Slide Number 62 		223
Slide Number 63 		224
Slide Number 64 		225
Slide Number 65 		226
Slide Number 66 		227
Slide Number 67 		228
L07_2 RT techniques - localised treatments 		229
Slide Number 1 		229
Localised radiotherapy for intracranial tumours 		230
Techniques of local radiation delivery 		231
Classification of radiotherapy technologies 		232
Classification of radiotherapy technologies 		233
Slide Number 6 		234
Slide Number 7 		235
Classification of radiotherapy technologies 		236
Methods of immobilization 		237
Methods of immobilization 		238
Methods of immobilization 		239
Comparison of immobilisation techniques 		240
Comparison of immobilisation techniques 		241
Comparison of immobilisation techniques 		242
Comparison of immobilisation techniques 		243
Classification of radiotherapy technologies 		244
Classification of radiotherapy technologies 		245
Classification of radiotherapy technologies 		246
Deconstructing stereotactic radiotherapy 		247
Classification of radiotherapy technologies 		248
Classification of radiotherapy technologies 		249
Classification of radiotherapy technologies 		250
Interfraction motion 		251
Intrafraction motion in CK radiosurgery 		252
Intrafraction motion in CK radiosurgery 		253
Classification of radiotherapy technologies 		254
Classification of radiotherapy technologies 		255
Radiotherapy of intracranial tumours 		256
Radiotherapy of intracranial tumours 		257
Radiotherapy of intracranial tumours 		258
High grade glioma 		259
High grade glioma 		260
Craniopharyngioma 		261
Craniopharyngioma 		262
Localised radiotherapy for CNS tumours 		263
Localised radiotherapy for CNS tumours 		264
Slide Number 37 		265
Slide Number 38 		266
Slide Number 39 		267
Slide Number 40 		268
Slide Number 41 		269
Slide Number 42 		270
Slide Number 43 		271
Localised radiotherapy for CNS tumours 		272
Comparison of conformal fixed field & multiple isocentre techniques 		273
Localised radiotherapy for CNS tumours 		274
Comparison of conformal radiotherapy techniques 		275
Comparison of conformal radiotherapy techniques 		276
Comparison of conformal radiotherapy techniques 		277
Localised radiotherapy for CNS tumours 		278
IMRT for meningioma 		279
Slide Number 52 		280
Comparison of conformal radiotherapy techniques 		281
Comparison of conformal radiotherapy techniques 		282
Comparison of conformal radiotherapy techniques 		283
Slide Number 56 		284
Slide Number 57 		285
Slide Number 58 		286
Collimation 		287
Collimation 		288
Collimation 		289
Comparison of conformal radiotherapy techniques 		290
Classification of radiotherapy technologies 		291
Slide Number 64 		292
L08_Radiation tolerance of the CNS_Damien Charles Weber_Brain tumor ESTRO 2015_150915 		293
Slide Number 1 		293
Why high-dose delivered to the brain? 		294
Acute toxicity 		295
Alopecia 		296
Alopecia 		297
Alopecia 		298
Late toxicity After Radiotherapy…. 		299
Type of Late Toxicity (CNS) 		300
Factors affecting toxicity (General) 		301
Brain Toxicity 		302
Brain Toxicity QUANTEC 		303
Brain Toxicity QUANTEC 		304
Brain necrosis Introduction 		305
Brain necrosis (0) 		306
Slide Number 15 		307
Brain necrosis (2) 		308
Slide Number 17 		309
Brain necrosis 		310
Brainstem tolerance 		311
Brainstem tolerance 		312
Pituitary 		313
Pituitary 		314
Pituitary 		315
Hearing Loss 		316
Hearing Loss 		317
Hearing Loss 		318
Hearing Loss 		319
Visual toxicity 		320
Visual toxicity 		321
Visual toxicity 		322
Visual toxicity 		323
Visual toxicity 		324
Visual toxicity 		325
Memory loss 		326
Memory loss 		327
Memory loss 		328
Memory Loss 		329
Memory loss 		330
Memory loss 		331
Conclusions (late toxicity) 		332
Slide Number 41 		333
L09_ESTRO_systemic-therapy-issues-Roth_PR 		334
Slide Number 1 		334
Slide Number 2 		335
Slide Number 3 		336
Slide Number 4 		337
Slide Number 5 		338
Slide Number 6 		339
Slide Number 7 		340
Slide Number 8 		341
Slide Number 9 		342
Slide Number 10 		343
Slide Number 11 		344
Slide Number 12 		345
Slide Number 13 		346
Slide Number 14 		347
Slide Number 15 		348
Slide Number 16 		349
PCV 		350
What is PCV? 		351
What is PCV? 		352
PCV toxicities EORTC 26951 vs RTOG 9402 		353
Systemic treatment of brain mets 		354
Slide Number 22 		355
Slide Number 23 		356
Slide Number 24 		357
Slide Number 25 		358
Slide Number 26 		359
Slide Number 27 		360
Slide Number 28 		361
Slide Number 29 		362
Slide Number 30 		363
Slide Number 31 		364
Slide Number 32 		365
Slide Number 33 		366
Slide Number 34 		367
Slide Number 35 		368
Slide Number 36 		369
L10_ESTRO Brain Tumour Course systemic novel agents Chalmers 4oct15 		370
Systemic treatment for gliomas:Novel therapies 		370
Slide Number 2 		371
Slide Number 3 		372
Slide Number 4 		373
Slide Number 5 		374
EGFR 		375
Slide Number 7 		376
Slide Number 8 		377
Slide Number 9 		378
Slide Number 10 		379
Slide Number 11 		380
Slide Number 12 		381
A phase 1 study evaluating ABT-414 in combination with temozolomide (TMZ) for subjects with recurrent or unresectable glioblastoma (GBM).2014 ASCO Annual Meeting 		382
Slide Number 14 		383
Slide Number 15 		384
Slide Number 16 		385
Slide Number 17 		386
Slide Number 18 		387
Slide Number 19 		388
Slide Number 20 		389
Slide Number 21 		390
Slide Number 22 		391
Slide Number 23 		392
Summary 		393
L11_TORINO 2015_ESTRO_QoL issues in Neuro-Oncology_RS 		394
QUALITY OF LIFE ISSUES IN NEURO-ONCOLOGY 		394
CONFLICT OF INTEREST 		395
OUTLINE 		396
Slide Number 4 		397
MEASURING HRQoL AND COGNITIVE FUNCTIONS IN BRAIN TUMORS PATIENTS: CRITICAL ISSUES 		398
Slide Number 6 		399
Slide Number 7 		400
Slide Number 8 		401
Slide Number 9 		402
Slide Number 10 		403
Slide Number 11 		404
Slide Number 12 		405
Slide Number 13 		406
Slide Number 14 		407
WBRT MAY NEGATIVELY IMPACT HEALTH-RELATED QUALI TY OF LIFE (HRQL) IN BRAIN METASTASIS 		408
EORTC 22952-26001 Quality of Life results of an EORTC phase III randomized trial of adjuvant Whole Brain Radiotherapy versus Observation after Radio surgery or Surgical Resection of 1-3 Cerebral Metastases of solid tumorsHRQOL results 		409
Results: Global health status / QoL 		410
Results: secondary QoL endpoints 		411
NEUROCOGNITIVE FUNCTIONING IN ADULT WHO GRADE II GLIOMAS : IMPACT OF OLD AND NEW TREATMENT MODALITIES 		412
Slide Number 20 		413
Slide Number 21 		414
IMPACT OF WBRT ON COGNITIVE FUNCTIONS : GENERAL CONCEPTS IN BRAIN METASTASIS 		415
WHAT HAVE WE LEARNED FROM CLINICAL TRIALS : EARLY DECLINE AFTER WBRT FOR BRAIN METASTASIS 		416
Slide Number 24 		417
Slide Number 25 		418
RATIONALE FOR NEUROPROTECTIVE DRUGS IN ASSOCIATION WITH WBRT 		419
Slide Number 27 		420
Slide Number 28 		421
RATIONALE FOR HIPPOCAMPAL AVOIDANCE IN ASSOCIATION WITH WBRT 		422
Hippocampal Injury from Cranial RT 		423
Slide Number 31 		424
Slide Number 32 		425
RATIONALE FOR NON-STEROIDAL ANTI-INFLAMMATORY THERAPY 		426
HOW TO TREAT RADIATION-ASSOCIATED NEUROCOGNITIVE SYMPTOMS ? 		427
Slide Number 35 		428
Slide Number 36 		429
RISK OF RADIONECROSIS FOLLOWING SRS TO THE RESECTION CAVITY 		430
RISK OF RADIONECROSIS FOLLOWING SRS TO THE RESECTION CAVITY 		431
RISKS OF NEUROLOGICAL COMPLICATIONS OTHER THAN RADIONECROSIS FOLLOWING SRS TO THE RESECTION CAVITY 		432
Slide Number 40 		433
L12_ESTRO low grade glioma Chalmers 4oct15_AC 		434
Management of low grade astrocytoma 		434
Slide Number 2 		435
Patients with grade 2 astrocytomas require treatment if: 		436
Slide Number 4 		437
Slide Number 5 		438
Slide Number 6 		439
Slide Number 7 		440
Slide Number 8 		441
Slide Number 9 		442
For patients with grade 2 astrocytoma WITHOUT 1p19q codeletion who DO require treatment, I would recommend: 		443
For patients with grade 2 astrocytoma WITHOUT 1p19q codeletion who require radiotherapy, I would recommend: 		444
Slide Number 12 		445
Slide Number 13 		446
Slide Number 14 		447
L13_ESTRO_Treatment _LOH1p19q_PR 		448
Slide Number 1 		448
Slide Number 2 		449
Slide Number 3 		450
Slide Number 4 		451
Slide Number 5 		452
Slide Number 6 		453
Slide Number 7 		454
Slide Number 8 		455
Slide Number 9 		456
Slide Number 10 		457
PCV toxicities EORTC 26951 vs RTOG 9402 		458
Reasons for discontinuation of PCV in EORTC 26951 		459
Slide Number 13 		460
Can we avoid RT and use chemotherapy alone? 		461
Time to treatment failure – by therapy 		462
Time to treatment failure – by therapy/histology 		463
Time to treatment failure – by molecular diagnosis 		464
Overall survival – by therapy 		465
Overall survival – by molecular diagnosis 		466
Efficacy outcomes – by molecular diagnosis/therapy 		467
Efficacy outcomes – across trial 		468
CODEL trial: initial design 		469
CODEL trial: updated design 		470
Slide Number 26 		471
And in patients with low-grade gliomas…? 		472
And in patients with low-grade gliomas…? 		473
Slide Number 30 		474
Slide Number 31 		475
Slide Number 32 		476
Slide Number 33 		477
Slide Number 34 		478
L14_Chalmers high grade astrocytoma ESTRO 5oct15 _AC 		479
Management of high grade glioma 		479
Prognostic factors 		480
Slide Number 3 		481
Slide Number 4 		482
Slide Number 5 		483
Slide Number 6 		484
Slide Number 7 		485
Slide Number 8 		486
The treatment I would recommend for a patient with grade 3 glioma without 1p19q codeletion is: 		487
Slide Number 10 		488
Slide Number 11 		489
Slide Number 12 		490
Slide Number 13 		491
Slide Number 14 		492
‘Stupp’ regime 		493
Mature data 		494
Slide Number 17 		495
48 year old patient with MGMT unmethylated GBM, >90% resection, PS=1 post-op. Completes RT-TMZ. She attends for 1st cycle adjuvant TMZ; PS now 2: fatigue, poor short term memory. Your recommendation is: 		496
61 year old science journalist from Los Angeles. MGMT methylated multifocal GBM, biopsy only. PS=1 post-op. Completes 1st cycle adjuvant TMZ with marked fatigue and ongoing mild cognitive deficit. Patient and wife seek your advice on (a) whether to go ahead with planned 5 week holiday to Italy for 30th wedding anniversary, visiting relatives, and (b) whether to continue with adjuvant TMZ. You advise: 		497
Chemoradiation for GBM 		498
Slide Number 21 		499
Slide Number 22 		500
Slide Number 23 		501
Slide Number 24 		502
Slide Number 25 		503
Slide Number 26 		504
Slide Number 27 		505
Slide Number 28 		506
Relapsed GBM after RT-TMZ 		507
Slide Number 30 		508
Slide Number 31 		509
42 year old patient with MGMT methylated GBM, >90% resection, RT-TMZ. Recurrent, inoperable disease 14 months after completing adjuvant TMZ; PS=1. I would recommend: 		510
61 year old patient with MGMT unmethylated GBM, >90% resection, RT-TMZ. Recurrent, inoperable disease 5 months after completing adjuvant TMZ; PS=1. I would recommend: 		511
L15_Ependymoma_Damien Charles Weber_Ranj Bhangoo_210915 		512
Slide Number 1 		512
Slide Number 2 		513
Introduction (1) 		514
Introduction (2) 		515
Slide Number 5 		516
Introduction (3) 		517
Outcome 		518
EP Prognostic factors 		519
Prognostic factors 		520
Slide Number 10 		521
EP and chemotherapy 		522
EP and chemotherapy 		523
EP and chemotherapy 		524
EP and chemotherapy 		525
Current stratgey 		526
Current strategy 		527
RT and EP (treatment volume) 		528
Slide Number 18 		529
RT and EP (dose) 		530
RT and treatment duration 		531
RT and treatment duration 		532
Slide Number 22 		533
L15_ependymomas_RB 		534
Management of ependymomas 		534
Slide Number 2 		535
Myxopapillary 		536
Slide Number 4 		537
Slide Number 5 		538
Slide Number 6 		539
Paediatric Ependymoma 		540
Paediatric Ependymoma 		541
Adult Ependymoma 		542
Drop Mets in Ependymoma 		543
Treatment 		544
Slide Number 12 		545
Anatomy of the Brain Stem 		546
Anatomy of the Brain Stem 		547
Slide Number 15 		548
Slide Number 16 		549
Slide Number 17 		550
Slide Number 18 		551
Neurological Outcome after Surgery 		552
Adjuvant Treatment 		553
Recurrence 		554
Conclusion 		555
L16_GCT_UR(very final) 		556
Slide Number 1 		556
Slide Number 2 		557
Slide Number 3 		558
Slide Number 4 		559
Slide Number 5 		560
Slide Number 6 		561
Slide Number 7 		562
Slide Number 8 		563
Slide Number 9 		564
Slide Number 10 		565
Slide Number 11 		566
Slide Number 12 		567
Slide Number 13 		568
Slide Number 14 		569
Slide Number 15 		570
CNS GCT: Extent of surgery 		571
Primary CNS Germinoma- Pathology 		572
CNS GCT: Diagnostic work-up and Staging 		573
Slide Number 19 		574
Slide Number 20 		575
Slide Number 21 		576
Germinoma: Management 		577
CSI: risk for late toxicities 		578
Slide Number 24 		579
Slide Number 25 		580
Slide Number 26 		581
Slide Number 27 		582
Slide Number 28 		583
Slide Number 29 		584
Slide Number 30 		585
Slide Number 31 		586
Slide Number 32 		587
Slide Number 33 		588
Slide Number 34 		589
Slide Number 35 		590
Slide Number 36 		591
Slide Number 37 		592
Slide Number 38 		593
Slide Number 39 		594
Slide Number 40 		595
Slide Number 41 		596
Slide Number 42 		597
Slide Number 43 		598
WVI: definition 		599
RT techniques for ventricular system irradiation 		600
WVI: concave-shaped target for IMRT 		601
Slide Number 47 		602
Slide Number 48 		603
Slide Number 49 		604
Slide Number 50 		605
Primary CNS Secreting GCT’s - Pathology 		606
Slide Number 52 		607
Slide Number 53 		608
Slide Number 54 		609
Slide Number 55 		610
Slide Number 56 		611
Slide Number 57 		612
Slide Number 58 		613
Slide Number 59 		614
Slide Number 60 		615
Slide Number 61 		616
Slide Number 62 		617
Slide Number 63 		618
L17_ESTRO_PCNSL_PR 		619
Slide Number 1 		619
Slide Number 2 		620
Slide Number 3 		621
Slide Number 4 		622
Slide Number 5 		623
Slide Number 6 		624
Slide Number 7 		625
Slide Number 8 		626
Slide Number 9 		627
Slide Number 10 		628
Slide Number 11 		629
Slide Number 12 		630
Slide Number 13 		631
Slide Number 14 		632
Slide Number 15 		633
Slide Number 16 		634
Slide Number 17 		635
Slide Number 19 		636
Slide Number 20 		637
Slide Number 21 		638
Slide Number 22 		639
Slide Number 23 		640
Slide Number 24 		641
Elderly PCNSL patients: a particular challenge 		642
Elderly PCNSL patients in G-PCNSL-SG1 		643
Elderly PCNSL patients in G-PCNSL-SG1 		644
MTX/TMZ vs. MPV-A in elderly patients 		645
MTX/TMZ vs. MPV-A in elderly patients 		646
MTX-based therapy in elderly patients 		647
Slide Number 31 		648
L18_HGG in children_DH 2015 Version 		649
Slide Number 1 		649
Biopsy of brainstem glioma is standard Ix! 		650
HGG biology is the same in children as in adults! 		651
The brainstem is a frequent location of childhood HGG. 		652
Infants (<3 yrs) with HGG have a worse prognosis than older child 		653
Management of high grade glioma in children 		654
Paediatric high grade glioma: Background 		655
Paediatric brain tumours 		656
High Grade Glioma in children 		657
Pathology 		658
Slide Number 11 		659
Epidemiology 		660
Clinical Presentation- non-brainstem HGG 		661
Diagnosis: HGG 		662
Brainstem Glioma in Children 		663
Brainstem tumors 		664
Diffuse Intrinsic Pontine glioma (DIPG) 		665
Slide Number 18 		666
DIPG: Clinical Presentation 		667
DIPG: Clinical Presentation 		668
Diagnosis: DIPG 		669
DIPG: To biopsy or not to biopsy? 		670
Ethics of Biopsy? 		671
Slide Number 24 		672
Slide Number 25 		673
Diffuse Intrinsic Pontine Glioma (DIPG) 		674
What is the standard of care for DIPG? 		675
Slide Number 28 		676
HFRT for DIPG 		677
Hypofractionated Radiotherapy in DIPG? 		678
Slide Number 31 		679
Slide Number 32 		680
Slide Number 33 		681
Slide Number 34 		682
Slide Number 35 		683
Why have we failed? 		684
Why have we failed? 		685
Slide Number 38 		686
Slide Number 39 		687
Slide Number 40 		688
Slide Number 41 		689
Why have we failed? 		690
Slide Number 43 		691
Slide Number 44 		692
Slide Number 45 		693
Pre-clinical Models 		694
Rapid Preclinical Development of a Targeted Therapy Combination for DIPG 		695
Preclinical Consortium 		696
Slide Number 49 		697
Slide Number 50 		698
Slide Number 51 		699
Slide Number 52 		700
Slide Number 53 		701
Slide Number 54 		702
Slide Number 55 		703
Why have we failed? 		704
Slide Number 57 		705
DIPG Specific Targets! 		706
Slide Number 59 		707
Why have we failed? 		708
Poor Drug Delivery 		709
Slide Number 62 		710
CED DIPG Trials 		711
Slide Number 64 		712
Slide Number 65 		713
Slide Number 66 		714
Slide Number 67 		715
Intra-arterial Clinical Trials 		716
Nanoparticles 		717
Intranasal Delivery 		718
Biopsy directed therapies 		719
BIOMEDE Study 		720
Three major targets selected 		721
Slide Number 74 		722
Three drugs selected 		723
Slide Number 76 		724
Slide Number 77 		725
Diagnostic workout 		726
Prognostic impact of histone mutations 		727
Slide Number 80 		728
Current standard treatments & outcomes for pHGG 		729
Surgery 		730
Surgery 		731
Slide Number 84 		732
Slide Number 85 		733
Slide Number 86 		734
Target volumes 		735
Slide Number 88 		736
Slide Number 89 		737
Slide Number 90 		738
Slide Number 91 		739
Slide Number 92 		740
Chemotherapy and autologous stem cell rescue 		741
Chemotherapy and autologous stem cell rescue 		742
Chemotherapy and autologous stem cell rescue 		743
Infant HGG (< 3 years) can be spared from radiation therapy with a good outcome 		744
Slide Number 97 		745
Slide Number 98 		746
What is the standard Rx in pHGG? 		747
Adult Glioblastoma- 1st Line therapy 		748
Slide Number 101 		749
EFS and OS rates of 90 HGG patients 		750
Slide Number 103 		751
Slide Number 104 		752
Paediatric high grade glioma: are they the same as HGG in adults? 		753
Slide Number 106 		754
Slide Number 107 		755
Slide Number 108 		756
Slide Number 109 		757
Identification of somatic H3F3A mutations 		758
Slide Number 111 		759
Slide Number 112 		760
Tumour location & Shared Targets? 		761
Paediatric and Adult HGGSimilarities and Differences 		762
Define a common backbone! 		763
Recent Trial in HGG 		764
Slide Number 117 		765
Slide Number 118 		766
Participating countries in this study 		767
Slide Number 120 		768
Slide Number 121 		769
Slide Number 122 		770
Slide Number 123 		771
Slide Number 124 		772
Slide Number 125 		773
MAPK Pathway Inhibitors 		774
SELECTIVE BRAF INHIBITORS 		775
Slide Number 128 		776
Slide Number 129 		777
Slide Number 130 		778
Slide Number 131 		779
BRAFV600 Mutations –pHGG Target? 		780
BRAF PATHWAY 		781
Brain Tumour Delivery with BRAFi?Worked in Melanoma Brain Mets! 		782
Slide Number 135 		783
Slide Number 136 		784
Slide Number 137 		785
Slide Number 138 		786
Slide Number 139 		787
Slide Number 140 		788
Slide Number 141 		789
Paediatric high grade glioma: conclusions 		790
Conclusions 		791
Conclusions 		792
L19_Medulloblastoma in children_UR(final) 		793
Slide Number 1 		793
Slide Number 2 		794
Slide Number 3 		795
Medulloblastoma 		796
Slide Number 5 		797
Slide Number 6 		798
Slide Number 7 		799
Slide Number 8 		800
Slide Number 9 		801
Slide Number 10 		802
Slide Number 11 		803
SIOP PNET 4 : survival by histologic subtypes 		804
Slide Number 13 		805
Histology + molecular variables 		806
Medulloblastoma: the (near) future 		807
Slide Number 16 		808
Slide Number 17 		809
Post-operative treatments 		810
Late toxicity related to CSI 		811
How can we reduce the risks associated with CSI? 		812
Slide Number 21 		813
Slide Number 22 		814
Slide Number 23 		815
Slide Number 24 		816
Standard risk childhood MB 		817
Slide Number 26 		818
Slide Number 27 		819
The posterior fossa boost 		820
CTV for the posterior fossa boost 		821
The posterior fossa boost 		822
Radiotherapy technique 		823
Whole PF: Lateral opposed → 3D CRT 		824
Whole PF: Lateral opposed → IMRT 		825
Whole PF vs tumour bed boost: ongoing trials 		826
Whole PF vs tumour bed 		827
Reduced volume tumour bed boost 		828
Limit volume boost (ACNS0331) 		829
Slide Number 38 		830
Slide Number 39 		831
Slide Number 40 		832
Slide Number 41 		833
Slide Number 42 		834
Medulloblastoma 		835
Slide Number 44 		836
Slide Number 45 		837
Slide Number 46 		838
Slide Number 47 		839
Radiotherapy dose 		840
Long-term complications of treatment 		841
Slide Number 50 		842
Slide Number 51 		843
Late toxicity related to CSI 		844
How can we reduce the risks associated with CSI? 		845
IMRT for the spine field 		846
Concluding remarks 		847
L20_Management of Low Grade Glioma in children_DH 2015 		848
Management of low grade glioma in children 		848
Pathology of LGG in adults and children is usually the same! 		849
Most common location for childhood LGG is cerebral hemisphere 		850
LGG in children <1 year has a better prognosis! 		851
Malignant transformation rate in childhood LGG is ~30%. 		852
Low Grade Glioma in Children 		853
Low Grade Glioma in Children 		854
Slide Number 8 		855
Pilocytic astrocytomas 		856
Juvenile Pilocytic Astrocytoma 		857
Low Grade Glioma in Children 		858
Low Grade Glioma in Children 		859
Aetiology of Childhood LGG 		860
Optic Pathway Glioma 		861
Slide Number 15 		862
MAPK Pathway 		863
Slide Number 17 		864
MAPK activation in PA 		865
Slide Number 19 		866
Slide Number 20 		867
Slide Number 21 		868
Slide Number 22 		869
Slide Number 23 		870
Slide Number 24 		871
Slide Number 25 		872
Slide Number 26 		873
Slide Number 27 		874
Slide Number 28 		875
Slide Number 29 		876
Slide Number 30 		877
Slide Number 31 		878
Slide Number 32 		879
Slide Number 33 		880
Slide Number 34 		881
Slide Number 35 		882
Slide Number 36 		883
Slide Number 37 		884
Slide Number 38 		885
Slide Number 39 		886
Slide Number 40 		887
Slide Number 41 		888
Slide Number 42 		889
Slide Number 43 		890
Slide Number 44 		891
Slide Number 45 		892
Slide Number 46 		893
Slide Number 47 		894
Low Grade Glioma in Children 		895
Slide Number 49 		896
Slide Number 50 		897
Slide Number 51 		898
Slide Number 52 		899
Slide Number 53 		900
Slide Number 54 		901
Slide Number 55 		902
Slide Number 56 		903
Slide Number 57 		904
Slide Number 58 		905
Slide Number 59 		906
Slide Number 60 		907
Slide Number 61 		908
Slide Number 62 		909
Slide Number 63 		910
FUTURE management of LGG 		911
Slide Number 65 		912
Slide Number 66 		913
Slide Number 67 		914
Slide Number 68 		915
Strategisches Konzept 		916
Slide Number 70 		917
Warum molekulare Biomarker? 		918
Warum molekulare Biomarker? 		919
Slide Number 73 		920
Slide Number 74 		921
Visual acuity (VA) as the primary measure 		922
Visual indications to treatment 		923
Vision-related severe symptoms (WHO def) 		924
Targeting BRAF and MEK pathway in LGG 		925
Outline 		926
BRAF abnormalities – hallmark signature for PA 		927
Slide Number 81 		928
BRAF driven mouse model of PA 		929
Sorafenib as a MEK inhibitor 		930
Sorafenib 		931
Sorafenib – in vitro inhibitory concentrations 		932
Slide Number 86 		933
Slide Number 87 		934
Slide Number 88 		935
Slide Number 90 		936
Slide Number 91 		937
Slide Number 92 		938
RAF inhibitors prime wild-type RAF to activate MAPK signaling and enhance tumor growth 		939
Slide Number 94 		940
A Phase 1 Study of AZD6244 in Children with Recurrent or Refractory Low Grade Gliomas: A Pediatric Brain Tumor Consortium Report.Anuradha Banerjee, Regina Jakacki, Arzu Onar-Thomas, Shengjie Wu, Theodore Nicolaides, David C. Turner, Stacye Richardson, Tina Young-Poussaint, Joanna Phillips, Michael Prados, Roger Packer, Ibrahim Qaddoumi, Sridharan Gururangan, Stewart Goldman, Ian Pollack, Austin Doyle, Clinton F. Stewart, James Boyett, Larry Kun, Maryam Fouladi 		941
A Phase 1 Study of AZD6244 in Children with Recurrent or Refractory Low Grade Gliomas: A Pediatric Brain Tumor Consortium Report. 		942
A Phase 1 Study of AZD6244 in Children with Recurrent or Refractory Low Grade Gliomas: A Pediatric Brain Tumor Consortium Report. 		943
Slide Number 98 		944
AZD 6244 - RESPONSE 		945
Largest Percentage Reduction in Tumor Volume from Baseline by BRAF Aberration (Min Tumor Volume/Baseline Volume) 		946
Slide Number 101 		947
PBTC29 – Phase II study 		948
Phase 1 study of dabrafenib in pediatric patients with relapsed or refractory BRAFV600-mutant high-grade gliomas, low-grade gliomas, histiocytosis, and other solid tumors 		949
Dabrafenib Activity in Adults With BRAFV600-mutant Melanoma 		950
Dabrafenib Activity in Brain Metastases 		951
BRAFV600 Mutations in Pediatric Tumors 		952
Study Objectives 		953
Slide Number 108 		954
Slide Number 109 		955
Methods 		956
Baseline Patient Characteristics 		957
Results 		958
Adverse Events 		959
Investigator-assessed Best Confirmed Responsea by Tumor Type 		960
Summary 		961
Conclusions 		962
Conclusions 		963
L21_Clinical Trials Adult Medulloblastoma Darren Hargrave 2015 		964
Adult Medulloblastoma 		964
Have you ever treated an adult MB patient? 		965
Adult Medulloblastoma: Data? 		966
Adult data needed for Clinical Trial Design? 		967
Incidence of adult medulloblastoma? 		968
Risk Groups 		969
What would be your standard Rx for adult SR-MB 		970
Slide Number 8 		971
Slide Number 9 		972
Slide Number 10 		973
Outcomes? 		974
Outcomes? 		975
Adult Medulloblastoma: Biology/ Novel Rx? 		976
Slide Number 14 		977
Slide Number 15 		978
Slide Number 16 		979
Slide Number 17 		980
Slide Number 18 		981
Gorlin Syndrome 		982
The SHH signalling pathway 		983
Slide Number 21 		984
Sonic Hedgehog & Corn Lillies 		985
Slide Number 23 		986
Slide Number 24 		987
The Hedgehog (Hh) Pathway 		988
Slide Number 26 		989
LDE225 induced tumor regression is associated with Gli1 suppression in tumor 		990
Slide Number 28 		991
Slide Number 29 		992
LDE225: responses in medulloblastoma 		993
Phase I/II: Study Design 		994
Phase I: Complete Tumor Responses in MB 		995
The 5-Gene Hh Signature 		996
Phase I: Best Overall Tumor Response and Correlation With 5-Gene Hh Signature in MB 		997
Clinical Trial Design Options? 		998
Which of the following trials do you prefer? 		999
Discussion on which trial is best/ feasible? 		1000
Slide Number 38 		1001
Randomized Phase II C2201 Study DesignHh-pathway activated relapsed MB in children and adults 		1002
Conclusions 		1003
L22_ESTRO course_Management of Skull base tumors_Damien Charles Weber__140915 		1004
L23_benign brain tumours_MB 		1051
Slide Number 1 		1051
Management of benign brain tumours 		1052
Management of benign brain tumours 		1053
Management options in benign brain tumours 		1054
Management options in benign brain tumours 		1055
Management options in benign brain tumours 		1056
Dose fractionation in benign brain tumours 		1057
Management of benign brain tumours 		1058
Management of benign brain tumours 		1059
Slide Number 10 		1060
Slide Number 11 		1061
Management options in pituitary adenoma 		1062
Management options in pituitary adenoma 		1063
Radiation for pituitary adenoma 		1064
Radiation for pituitary adenoma 		1065
Radiation for pituitary adenoma 		1066
Residual pituitary adenoma 		1067
Residual pituitary adenoma 		1068
Radiation for pituitary adenoma 		1069
Radiation for pituitary adenoma 		1070
Management options in pituitary adenoma 		1071
Management options in pituitary adenoma 		1072
Endpoints in the evaluation of irradiation 		1073
Comparison of high precision techniques 		1074
Conventional radiotherapy 		1075
Fractionated stereotactic radiotherapy (SCRT) 		1076
Conventional & stereotactic radiotherapy 		1077
Gamma knife radiosurgery in nonfunctioning p.a. 		1078
Endpoints in the evaluation of irradiation 		1079
Endpoints in the evaluation of irradiation 		1080
Slide Number 31 		1081
Conventional radiotherapy for acromegaly 		1082
GK radiosurgery for acromegaly 		1083
Endpoints in the evaluation of irradiation 		1084
Endpoints in the evaluation of irradiation 		1085
Slide Number 36 		1086
Slide Number 37 		1087
Slide Number 38 		1088
Slide Number 39 		1089
Slide Number 40 		1090
Slide Number 41 		1091
Slide Number 42 		1092
Slide Number 43 		1093
Slide Number 44 		1094
Endpoints in the evaluation of irradiation 		1095
Slide Number 46 		1096
Slide Number 47 		1097
Pituitary adenoma 		1098
Pituitary adenoma 		1099
Pituitary adenoma 		1100
Slide Number 51 		1101
Management of benign brain tumours 		1102
Slide Number 53 		1103
Management options in vestibular schwannoma 		1104
Management options in vestibular schwannoma 		1105
Surveillance 		1106
Surveillance 		1107
Surveillance 		1108
Surveillance 		1109
Management options in vestibular schwannoma 		1110
Fractionation in high precision radiotherapy 		1111
Fractionation in high precision radiotherapy 		1112
Stereotactic RT for acoustic neuroma 		1113
Stereotactic RT for acoustic neuroma 		1114
Stereotactic RT for acoustic neuroma 		1115
Stereotactic RT for acoustic neuroma 		1116
Fractionation in high precision radiotherapy 		1117
Kapoor et al 2010, Int J Rad Oncol Biol Phys, Johns Hopkins experience 		1118
Management of benign brain tumours 		1119
Management options in craniopharyngioma 		1120
Management options in craniopharyngioma 		1121
Surgery for craniopharyngioma 		1122
Craniopharyngioma management 		1123
Craniopharyngioma management 		1124
Craniopharyngioma management 		1125
Craniopharyngioma management 		1126
Craniopharyngioma management 		1127
Craniopharyngioma management 		1128
Radiotherapy for craniopharyngioma 		1129
Conventional radiotherapy for craniopharyngioma 		1130
High precision radiotherapy for craniopharyngioma 		1131
Tumour control following radiotherapy 		1132
Slide Number 83 		1133
L24_Brada brain mets_MB 		1134
Slide Number 1 		1134
Oncological management options 		1135
Oncological management options 		1136
Oncological management options 		1137
Oncological management options 		1138
Radiotherapy in the treatment of brain metastases 		1139
Radiotherapy in the treatment of brain metastases 		1140
Radiotherapy options 		1141
Radiotherapy options 		1142
Slide Number 10 		1143
Radiotherapy options 		1144
Radiotherapy options 		1145
Radiotherapy options 		1146
Radiotherapy options 		1147
Radiotherapy options 		1148
Radiotherapy options 		1149
Comparison of whole brain and partial brain RT 		1150
Partial brain RT after surgery for solitary brain metastases 		1151
Partial brain RT after surgery for solitary brain metastases 		1152
Radiotherapy options 		1153
Radiotherapy options 		1154
Radiotherapy options 		1155
Radiotherapy options 		1156
Radiosurgery for solitary brain metastases 		1157
Radiotherapy in the treatment of brain metastases 		1158
Oncological management options 		1159
Oncological management options 		1160
Prognosis in patients with brain metastases 		1161
Oncological management options 		1162
Prognosis in patients with brain metastases 		1163
Oncological management options 		1164
Brain metastases in malignancy 		1165
Slide Number 33 		1166
Brain metastases in malignancy 		1167
Oncological management options 		1168
Slide Number 36 		1169
Radiotherapy in the treatment of brain metastases 		1170
Evidence base for radiotherapy in the treatment of brain metastases 		1171
Evidence base for radiotherapy in the treatment of brain metastases 		1172
Evidence base for radiotherapy in the treatment of brain metastases 		1173
Slide Number 41 		1174
Slide Number 42 		1175
Evidence base for radiotherapy in the treatment of brain metastases 		1176
Radiosurgery for “solitary” brain metastases 		1177
Radiosurgery for solitary brain metastases 		1178
Radiosurgery for solitary brain metastases 		1179
Evidence base for radiotherapy in the treatment of brain metastases 		1180
Whole brain radiotherapy following surgery or radiosurgery 		1181
Whole brain radiotherapy following surgery or radiosurgery 		1182
Whole brain radiotherapy following surgery or radiosurgery 		1183
Whole brain radiotherapy following surgery or radiosurgery 		1184
Whole brain radiotherapy following surgery or radiosurgery 		1185
Whole brain radiotherapy following radiosurgery 		1186
Whole brain radiotherapy following radiosurgery 		1187
Whole brain radiotherapy following radiosurgery 		1188
Whole brain radiotherapy following radiosurgery 		1189
Evidence base for radiotherapy in the treatment of brain metastases 		1190
Evidence base for radiotherapy in the treatment of brain metastases 		1191
Effect of whole brain radiotherapy on survival 		1192
Brain metastases in malignancy 		1193
Evidence base for radiotherapy in the treatment of brain metastases 		1194
Effect of whole brain radiotherapy on survival & QOL 		1195
Effect of whole brain radiotherapy on survival & QOL 		1196
Effect of whole brain radiotherapy on survival & QOL 		1197
Effect of whole brain radiotherapy on survival & QOL 		1198
Evidence base for radiotherapy in the treatment of brain metastases 		1199
Evidence base for radiotherapy in the treatment of brain metastases 		1200
Evidence base for radiotherapy in the treatment of brain metastases 		1201
Evidence base for radiotherapy in the treatment of brain metastases 		1202
Radiosurgery for “solitary” brain metastases 		1203
Radiosurgery for oligometastases in the brain 		1204
Radiosurgery for oligometastases in the brain 		1205
Evidence base for radiotherapy in the treatment of brain metastases 		1206
Slide Number 74 		1207
Stereotactic radiotherapy utilisation 		1208
Stereotactic radiosurgery utilisation 		1209
Stereotactic radiotherapy utilisation 		1210
Stereotactic radiosurgery utilisation 		1211
Stereotactic radiosurgery utilisation 		1212
Stereotactic radiosurgery utilisation 		1213
Stereotactic radiosurgery utilisation 		1214
Oncological management options 		1215
Slide Number 83 		1216
Slide Number 84 		1217
Systemic therapy for brain metastases 		1218
Oncological management options 		1219
Slide Number 87 		1220
Evidence base for radiotherapy in the treatment of brain metastases 		1221
Slide Number 89 		1222
Slide Number 90 		1223
Slide Number 91 		1224
Evidence base for radiotherapy in the treatment of brain metastases 		1225
Radiosurgery for synchronous brain oligometastases 		1226
Radiosurgery for synchronous brain oligometastases 		1227
Evidence base for radiotherapy in the treatment of brain metastases 		1228
Additional systemic therapy in NSCLC brain metastases 		1229
Additional systemic therapy in NSCLC brain metastases 		1230
Evidence base for radiotherapy in the treatment of brain metastases 		1231
Slide Number 99 		1232
L25_ESTRO_supportive-treatment_Roth 		1233
Slide Number 1 		1233
Slide Number 2 		1234
Slide Number 3 		1235
Slide Number 4 		1236
Slide Number 5 		1237
Slide Number 6 		1238
Slide Number 7 		1239
Slide Number 8 		1240
Slide Number 9 		1241
Slide Number 10 		1242
Slide Number 11 		1243
Slide Number 12 		1244
Slide Number 13 		1245
Slide Number 14 		1246
Slide Number 15 		1247
Slide Number 16 		1248
Slide Number 17 		1249
Slide Number 18 		1250
Slide Number 19 		1251
Slide Number 20 		1252
Slide Number 21 		1253
Slide Number 22 		1254
Slide Number 23 		1255
Slide Number 25 		1256
Slide Number 26 		1257
Slide Number 27 		1258
Slide Number 29 		1259
Slide Number 31 		1260
Slide Number 32 		1261
Slide Number 33 		1262
Slide Number 34 		1263
Slide Number 35 		1264
Slide Number 37 		1265
Slide Number 38 		1266
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