1. Evidence-Based Surgery
Role of Molecular Markers In Glioblastoma
Sanmugarajah Paramasvaran
John Fuller
14th June 2012
1

2. 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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3. Post Op Scan Recurrence in 10 weeks
3

4. Clinical Questions:
 Does molecular markers in glioblastoma have
dependable diagnostic, prognostic and
treatment guidance value to be considered as
routine investigation?
4

5. 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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6. Database
Medline Ovid
Scopus
Cochrane
Search Keywords (exp MESH )
1) “Molecular Markers” “
2) “Glioblastoma”
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7. Search Process
7

8. 8

9. Genetic Markers Tumour Markers
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10. 10

11. 11

12. Medline Ovid Search Results
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13. 13

14. Scopus
14

15. Cochrane
Nil
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16. Selection Criteria
• Glioblatoma
• Molecular markers
• Diagnostic , prognostic and therapeutic significance
Exclusions:
 non GBM
 pathogenesis
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17. 30 papers from Medline Ovid
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18. 8 Papers from Scopus
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19. Levels of Evidence (NHMRC)
Class lll – 21 papers
7 prospective cohorts
14 retrospective cohorts
Class lV- 17 papers
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20. Conclusion
MOLECULAR MARKERS SIGNIFICANCE
MGMT PROGNOSTIC
PREDICTIVE
EGFR AMPLIFICATION DIAGNOSTIC
IDH1 DIAGNOSTIC IN
SECONDARY GBM
(60-90%)
IDH 1 & 2 BETTER PROGNOSIS
PTEN DIAGNOSTIC OF
PRIMARY GBM
Marina N. Nikiforova, MD; Ronald L. Hamilton, MD, Arch Pathol
Lab Med. 2011;135:558–568
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21. • Hegi and colleague reported , with
temozolamide and RT
MGMT Alive at 2 yrs
Unmethylated 15%
Methylated 49%
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22. 22

23. IDH1 & 2 mutation - survival
( 31 vs 15 months)
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24. Thank You
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