June 2024 Oncology Cartoons By Dr Kanhu Charan Patro

une 2024 Oncology Cartoons By Dr Kanhu Charan Patro

1. DR KANHU CHARAN PATRO M.D, D.N.B[RT], MBA, FICRO, FAROI, PDCR, CEPC www.slideshare.net/search/slideshow?searchfrom=header&q=oncology+cartoons www.facebook.com/oncologycartoons/photos_albums 99 th Volume/JUNE 2024 ONCOLOGY CRATOONS EDUCATIVE E-BOOK

2. RECOMMENDATION FOR PREVENTION OF ORN AFTER RADIATION THERAPY Douglas E. Peterson/JCO/2024 16 th MAY 2024/ H/N In partial thickness ORN ( ClinRad stage I or II), surgical management can start with transoral minor intervention which can lead to resolution. This may include debridement, sequestrectomy, alveolectomy , soft tissue flap closure Qualifying statement: Partial thickness ORN is defined as disease extent whereby removal of all necrotic bone leaves native jaw with enough structural integrity such that oroantral or oronasal defect is unlikely in the maxilla, and pathological fracture in unlikely in the mandible Small defects <2.5 cm in length may heal spontaneously with local measures. It is recommended that larger defects be covered with vascularized tissue In full thickness ORN ( ClinRad selected stage II and all stage III), segmental maxillectomy or mandibulectomy with free flap reconstruction is recommended Qualifying statement: Full thickness ORN is defined as disease extent whereby removal of all necrotic bone is likely to result in oroantral or oronasal defect in the maxilla or pathological fracture in the mandible In full thickness ORN or extensive partial thickness ORN where conservative therapy has not yielded appropriate disease control ( ClinRad stage II or III), segmental resection is recommended Maxillectomy defects that extend into the sinus ( ClinRad stage III) can be reconstructed with myocutaneous flaps or osteomyocutaneous flaps, whereby the latter has the additional benefit of allowing dental implantation where desired. Obturation of the defect with a prosthetic appliance may also be done for those patients who are poor candidates for microvascular surgery Osteomyocutaneous free flap reconstructions are recommended for mandibular continuity defects. A spanning reconstruction plate across a segmental defect covered by a myocutaneous flap may be an alternative in select settings where the medical status of the patient is compromised, or the treating institution has a limited scope of maxillofacial reconstruction Free flaps are recommended over pedicle flaps. Free flaps offer greater versatility and improved outcomes. Pedicle flaps can be used, especially in salvage procedures, with some limitations Informal consensus. Preoperative radiographic interpretation of extent of compromised bone, with intraoperative confirmation via bleeding bone endpoint, should be utilized in determination of resection borders. The potential for intraoperative findings to alter the resection margin should be a consideration in planning. If prefabricated cutting guides are used, contingency planning is recommended When patients are unfit to undergo definitive surgical treatment, the management should be focused on symptom control Informal consensus Removal of superficial bony sequestra should be performed if viewed as low risk by the clinician. Reduction of the disease burden and the biofilm environment can be synergistic with the ongoing systemic therapy.

3. Immunization in cancer survivors Mini Kambo /JCO/2024 17 th MAY 2024/ PREVENTION

4. Central Brain Tumor Registry of the United States (CBTRUS) Statistical Report Michael Weller /NATURES REVIEW/2024 18 th MAY 2024/ BRAIN

5. MOLECULAR ALTERATIONS IN ADULT DIFFUSE GLIOMA Michael Weller /NATURES REVIEW/2024 19 th MAY 2024/ BRAIN

6. MOLECULAR ALTERATIONS IN PEDIATRIC HIGH GARDE DIFFUSE GLIOMA Michael Weller /NATURES REVIEW/2024 20 th MAY 2024/ BRAIN

7. MOLECULAR ALTERATIONS IN PEDIATRIC LOW GARDE DIFFUSE GLIOMA Michael Weller /NATURES REVIEW/2024 21 st MAY 2024/ BRAIN

8. MOLECULAR ALTERATIONS IN CIRCUMSCRIBED ASTROCYTIC GLIOMA Michael Weller /NATURES REVIEW/2024 22 nd MAY 2024/ BRAIN

9. MOLECULAR ALTERATIONS IN EPENDYMAL TUMORS Michael Weller /NATURES REVIEW/2024 23 rd MAY 2024/ BRAIN

10. Neuron–glioma interactions drive glioma pathogenesis Michael Weller /NATURES REVIEW/2024 24 th MAY 2024/ BRAIN

11. Therapeutic approaches to IDH-mutant gliomas in adults Michael Weller /NATURES REVIEW/2024 25 th MAY 2024/ BRAIN

12. Therapeutic approaches to IDH- wild gliomas in adults Michael Weller /NATURES REVIEW/2024 26 th MAY 2024/ BRAIN

13. Emerging molecularly targeted treatment options for patients with glioma Michael Weller /NATURES REVIEW/2024 27 th MAY 2024/ BRAIN

14. Therapeutic approaches to ependymoma beyond efforts at gross total resection Michael Weller /NATURES REVIEW/2024 28 th MAY 2024/ BRAIN

15. Molecular subtyping of ependymoma Ka Young Lim/brain tumor pathology 2022 29 th MAY 2024/ BRAIN

16. PROPOSED ALGORITHM IN SEIZURE Mx OF GLIOMA EDWARD K. AVILA /NEUROONCOLOGY/2024 30 th MAY 2024/ BRAIN

17. GLTATMATE IS THE MAIN FACTOR SEIZURE DEVELOPMENT IN BRAIN TUMORS EDWARD K. AVILA /NEUROONCOLOGY/2024 31 ST MAY 2024/ BRAIN

18. PROPHYLACTIC AN TISEIZURE MEDICATION IN BRAIN TUMORS EDWARD K. AVILA /NEUROONCOLOGY/2024 1 ST JUNE 2024/ BRAIN IN THE ABSENCE OF SEIZURES, THERE IS INSUFFICIENT HIGH-QUALITY EVIDENCE TO SUPPORT ANIT SEIZURE MEDICATION Currently, the most common protocol is to treat with levetiracetam for 7 days after craniotomy and supratentorial tumor resection Levetiracetam, Brivaracetam ARE THE BEST TO USE WITH TEMOZOLOMIDE AS THEY ARE NON-ENZYME INDUCERS POSTERIOR FOSSA TUMORS DO NOT REQUIRE ANY ANTIEPILEPTIC TREATMENT UNLESS INDICATED IN POST OP SETTINGS

19. SEIZURE CONTROL WITH TRAGETED THERAPY IN BRAIN TUMORS EDWARD K. AVILA /NEUROONCOLOGY/2024 2 nd JUNE 2024/ BRAIN Common pathways of tumor growth and epileptogenesis exist and may be successfully targeted with specific inhibitors. The best example is everolimus which targets the hyperactive mTOR pathway in subependymal giant cells astrocytomas of tuberous sclerosis, leading to control of both tumor growth and seizures Another potential approach being investigated is the targeting of IDH1/2 mutations with specific inhibitors ( ivosidenib , vorasidenib ). Despite increasing knowledge of basic mechanisms underlying the relationship between IDH mutations and seizures, clinical data supporting the use of IDH inhibitors for seizure control are scarce and limited to a case report. The phase 3 INDIGO trial compared the use of an IDH1/2 inhibitor ( vorasidenib ) versus placebo in grade 2 gliomas with a residual or recurrent tumor after surgery. In this trial, seizure control has been included as a secondary endpoint, which may add new insights concerning the potential impact of IDH inhibitors on seizures

20. ISRS GUIDE FOR SPORADIC INTRACANALICULAR VESTIBULAR SCHWANNOMAS ANNE BALOSSIER /NEUROONCOLOGY/2024 3 rd JUNE 2024/ BRAIN

21. Comparison of Radiotherapy Margins by Cooperative Groups and selected Studies ANNE BALOSSIER /NEUROONCOLOGY/2024 4 th JUNE 2024/ BRAIN

22. Suggested treatment for DIPG. Hideaki Abe /FRONTIERS IN ONCOLOGY/2020 5 th JUNE 2024/ BRAIN

23. SUMMARY OF IDH MUTANT GLIOMAS JULIE J. MILLER /NEUROONCOLOGY/2023 6 th JUNE 2024/ BRAIN

24. Molecular Hallmarks of IDH-mutant Glioma 7 th JUNE 2024/ BRAIN JULIE J. MILLER /NEUROONCOLOGY/2023

25. Management algorithm for IDH mutant glioma 8 th JUNE 2024/ BRAIN JULIE J. MILLER /NEUROONCOLOGY/2023

26. Most relevant diagnostic and prognostic molecular alterations in pediatric glioma 9 th JUNE 2024/ BRAIN FELIX SAHM /NEUROONCOLOGY/2023

27. Maintenance bevacizumab for NF2-related vestibular schwannoma 10 th JUNE 2024/ BRAIN SCOTT R. PLOTKIN /NEUROONCOLOGY/2023

28. The potential role of targeted therapies in histological subtypes OF SARCOMA ANDREW J. HAYES /BJC/2024 11 th JUNE 2024/ SARCOMA

29. THE RECOMMENDATION OF SYSTEMIC THERAPIES IN SARCOMA ANDREW J. HAYES /BJC/2024 12 TH JUNE 2024/ SARCOMA Systemic treatments for the majority of advanced STS are not curative; median survival time is 12-18 months. Published chemotherapy response rates vary enormously; from 10 – 50% depending on the drugs used, patient selection, and tumour grade and histological subtype(I,B). Treatment recommendations should be guided by patient performance status, disease extent, rate of progression, and potential sensitivity to treatment (I,A) Standard fi rst-line treatment is single-agent doxorubicin (I,A). Ifosfamide may be used fi rst-line if anthracyclines are contraindicated and is a standard option for second-line therapy (I,B) Although the combination of doxorubicin and ifosfamide has not been demonstrated to improve survival in comparison to single agent doxorubicin fi rst-line, response rates and progression free survival are higher, and it may be considered in individual patients where a response would improve symptoms or facilitate other treatment modalities (II,B) Additional second-line agents include trabectedin, and the combination of gemcitabine/ docetaxel or gemcitabine/dacarbazine. The choice of agent depends on histology, toxicity pro fi le and patient preference (II,B). Increasingly treatments more speci fi c for sarcoma subtypes are being elucidated, such as NTRK inhibitors for tumours harbouring NTRK-fusions, and immunotherapy in subtypes such as alveolar soft part sarcoma (ASPS). For those diseases, such as ASPS, which do not respond to chemotherapy, a targeted therapy should be considered fi rst-line, if a suitable drug is available (III,A). Surgical resection of locally recurrent disease should be considered where feasible. For patients with oligometastatic disease surgery, radiotherapy, or ablative therapies (RFA, SABR, cryotherapy, microwave, ECT) should be considered in individual cases, although there are limited data on survival bene fi t (III,B)

30. Recommendations : Gynaecologic sarcomas ANDREW J. HAYES /BJC/2024 13 th JUNE 2024/ SARCOMA Standard treatment for all localised uterine sarcomas is total abdominal hysterectomy. Lymphadenectomy is not routinely indicated.(III,B) Total abdominal hysterectomy with bilateral oophorectomy is indicated for endometrial stromal sarcoma. These patients should not have post-operative hormone replacement therapy. Use of adjuvant oestrogen deprivation therapy is not indicated.(III,B) Adjuvant pelvic radiotherapy has not been shown to improve survival and is not routinely indicated in FIGO stage I and II disease. However, it could be considered for selected high-risk cases.(IV,C) Advanced/metastatic LMS and undifferentiated endometrial sarcoma are treated with the same drugs as STS at other sites. (IIIB) There is retrospective evidence that ifosfamide may be less effective in leiomyosarcoma (III,C). Advanced/metastatic ESS can be treated with oestrogen deprivation therapy, with an aromatase inhibitor or progestogen. Tamoxifen is not recommended

31. Recommendations : Breast sarcomas ANDREW J. HAYES /BJC/2024 14 th JUNE 2024/ SARCOMA Close collaboration between a breast cancer MDT and a sarcoma MDT is necessary for the management of patients with breast sarcomas. Patients with sarcomatous differentiation within a metaplastic carcinoma should be managed as for an epithelial breast cancer. For large, aggressive primary breast sarcomas or malignant phyllodes tumours breast conservation may not be possible, and reconstruction should be considered as a delayed rather than a synchronous procedure performed at the time of the mastectomy. Post operative radiotherapy should be considered for large and/or high-grade tumours with close /positive margins. (III,B) Radiation induced angiosarcoma has an aggressive biology with a high risk of both local and distant relapse. Pre-operative communication between the breast and sarcoma MDT is of paramount importance. Surgery should be undertaken by a surgeon who is experienced in the management of this disease. Consideration should be given to resurfacing plastic surgical procedures to gain wide margins if necessary. Induction chemotherapy should be considered in locally advanced disease in which surgery would be excessively morbid and/or oncologically futile (IV,C)

32. JUNE- CANCER SURVIVOR MONTH G oogle 15 th JUNE 2024/ PUBLIC National Cancer Survivors Day is an annual, treasured celebration of life that is held in hundreds of communities around the world on the first Sunday in June An individual is considered a cancer survivor from the time of diagnosis through the rest of life. Learn why the number of cancer survivors is increasing and more Acute survivorship starts with diagnosis and ends when cancer treatment ends. Extended survivorship may include the months after treatment ends. Permanent survivors are cancer-free for several years.