# Neuro-Oncology and Brain Tumors — GCMD Library living collection

Updated: n/a · 6 episodes · 46 cited statements

## Episodes
### Glioblastoma Management
- [Essential Evidence for Glioblastoma: A Must-Know for Neurosurgery Exams](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639) — video · 11:06 · [machine version](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639.md)
- [Time-dependent cytokine landscapes in an ex vivo microfluidic glioblastoma platform](https://library.globalcastmd.com/watch/time-dependent-cytokine-landscapes-in-an-ex-vivo-microfluidic-glioblastoma-platform-13615) — article · [machine version](https://library.globalcastmd.com/watch/time-dependent-cytokine-landscapes-in-an-ex-vivo-microfluidic-glioblastoma-platform-13615.md)
- [Investigating the effects of arginine methylation inhibitors on microdissected brain tumour biopsies maintained in a miniaturised perfusion system](https://library.globalcastmd.com/watch/investigating-the-effects-of-arginine-methylation-inhibitors-on-microdissected-brain-tumour-biopsies-maintained-in-a-miniaturised-perfusion-system-13617) — article · [machine version](https://library.globalcastmd.com/watch/investigating-the-effects-of-arginine-methylation-inhibitors-on-microdissected-brain-tumour-biopsies-maintained-in-a-miniaturised-perfusion-system-13617.md)
- [HULL'S MAGIC BOX: BUILDING THE CASE FOR CLINICAL TRIALS USING ARGININE METHYLATION INHIBITORS AGAINST GBM](https://library.globalcastmd.com/watch/hull-s-magic-box-building-the-case-for-clinical-trials-using-arginine-methylation-inhibitors-against-gbm-13620) — article · [machine version](https://library.globalcastmd.com/watch/hull-s-magic-box-building-the-case-for-clinical-trials-using-arginine-methylation-inhibitors-against-gbm-13620.md)
- [Our novel glioblastoma  microfluidic platform](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640) — video · 4:32 · [machine version](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640.md)

### Radiosurgery and Radiation Therapy
- [Efficacy and safety of stereotactic radiosurgery versus whole brain radiotherapy for the treatment of brain metastasis: a systematic review and meta-analysis](https://library.globalcastmd.com/watch/efficacy-and-safety-of-stereotactic-radiosurgery-versus-whole-brain-radiotherapy-for-the-treatment-of-brain-metastasis-a-systematic-review-and-meta-analysis-13616) — article · [machine version](https://library.globalcastmd.com/watch/efficacy-and-safety-of-stereotactic-radiosurgery-versus-whole-brain-radiotherapy-for-the-treatment-of-brain-metastasis-a-systematic-review-and-meta-analysis-13616.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=0) Introduction and Evidence-Based Medicine Framework (Ep 1)
- [1:01](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=61) Stupp Protocol - Standard of Care (Ep 1)
- [2:15](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=135) RANO Criteria for Extent of Resection (Ep 1)
- [4:40](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=280) 5-ALA Fluorescence-Guided Surgery (Ep 1)
- [7:14](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=434) Awake Craniotomy for Eloquent Area Tumors (Ep 1)
- [7:56](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=476) Intraoperative MRI (Ep 1)
- [9:00](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=540) Bevacizumab Anti-VEGF Therapy (Ep 1)
- [9:50](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=590) Tumor Treating Fields (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=0) Introduction and rationale for patient-derived GBM tissue platform (Ep 5)
- [0:59](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=59) Microfluidic chip design and experimental protocol (Ep 5)
- [2:09](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=129) Cytokine analysis methodology (Ep 5)
- [2:41](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=161) Tissue viability results (Ep 5)
- [3:30](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=210) Cytokine response to treatment and conclusions (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The Stupp protocol was published in 2005 as a landmark paper combining radiotherapy and chemotherapy with maximal surgical resection as the gold standard. (clinical) [Ep 1 · 1:07](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=67)
- The Stupp protocol radiotherapy consists of 60 Gy over 6 weeks, with 2 Gy daily Monday to Friday (30 fractions total). (clinical) [Ep 1 · 1:33](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=93)
- Concomitant temozolomide in the Stupp protocol is 75 mg daily for six weeks during radiotherapy. (clinical) [Ep 1 · 1:50](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=110)
- Adjuvant temozolomide is 150-200 mg per meter squared for the first 5 days of each 28-day cycle for a total of 6 cycles. (clinical) [Ep 1 · 1:57](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=117)
- RANO (Response Assessment in Neuro-Oncology) criteria classify resections based on residual contrast-enhancing tumor on T1 and non-contrast-enhancing hyperintense tissue on FLAIR, believed to represent glioblastoma infiltrative tissue. (clinical) [Ep 1 · 2:21](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=141)
- RANO Class 1 (supramaximal contrast-enhancing resection) is defined as 0 cubic centimeters of contrast-enhancing and less than 5 cubic centimeters of non-contrast-enhancing tissue postoperatively, with median overall survival of 24 months. (clinical) [Ep 1 · 3:09](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=189)
- Maximal surgical resection (leaving less than 1 cubic centimeter of contrast-enhancing tissue) leads to 19 months median overall survival. (clinical) [Ep 1 · 3:39](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=219)
- Submaximal contrast-enhancing resection (leaving less than 5 or more than 5 cubic centimeters of contrast-enhancing tissue) leads to 15 months overall survival, which is the gold standard quoted to patients. (clinical) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=247)
- Biopsy only (Class 4, no tumor volume reduction) gives 10 months overall survival if the patient receives chemoradiotherapy. (clinical) [Ep 1 · 4:31](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=271)
- 5-ALA crosses the blood-brain barrier and is converted in mitochondria to protoporphyrin IX, which accumulates in glioblastoma cells because ferrochelatase enzyme is less effective in these tumors. (clinical) [Ep 1 · 5:01](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=301)
- Protoporphyrin IX emits bright pink fluorescence when exposed to blue light microscope with wavelength 405 to 633 nanometers, allowing tumor visualization during surgery. (clinical) [Ep 1 · 5:46](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=346)
- 5-ALA is administered as 1.5 g powder reconstituted in 50 mL drinking water (30 mg/mL oral solution) at a dosage of 20 mg per kg, given 2 to 4 hours before surgery. (clinical) [Ep 1 · 6:11](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=371)
- A randomized controlled trial of fluorescence-guided surgery with 5-ALA showed complete contrast-enhancing resection in 65% of patients using 5-ALA compared to 36% using white light. (clinical) [Ep 1 · 6:50](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=410)
- 5-ALA fluorescence-guided surgery allows higher 6-month progression-free survival compared to white light surgery. (clinical) [Ep 1 · 7:10](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=430)
- Awake craniotomy offers significant advantages over general anesthesia for glioblastomas near eloquent brain by allowing real-time patient interaction to map and preserve critical functions like speech and movement. (clinical) [Ep 1 · 7:17](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=437)
- Awake craniotomy helps maximize tumor resection while minimizing postoperative neurological deficits, ultimately improving outcomes. (clinical) [Ep 1 · 7:36](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=456)
- Drawbacks of awake craniotomy include careful patient selection requirements, potential discomfort and anxiety during surgery, and longer operative times in some cases. (clinical) [Ep 1 · 7:45](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=465)
- Intraoperative MRI allows real-time imaging during surgery, enhancing the surgeon's ability to achieve maximal resections and increasing the rate of complete resections. (clinical) [Ep 1 · 8:02](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=482)
- Intraoperative MRI is not available in all hospitals and requires strong infrastructure and investment to install in neurosurgical theaters. (clinical) [Ep 1 · 8:18](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=498)
- Senft 2011 study on intraoperative MRI showed more patients had complete tumor resection than the control group, and postoperative neurological deficits did not differ between groups. (clinical) [Ep 1 · 8:33](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=513)
- VEGF (vascular endothelial growth factor) is responsible for stimulating endothelial cell proliferation and migration in the glioblastoma microenvironment. (clinical) [Ep 1 · 9:00](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=540)
- Bevacizumab reduces regression of existing microvessels and inhibits growth of new blood vessels, acting like dexamethasone but with more potent effect. (clinical) [Ep 1 · 9:10](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=550)
- Overall survival is increased by only a few months using bevacizumab alone. (clinical) [Ep 1 · 9:23](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=563)
- Bevacizumab is FDA approved in the United States but has not been proven cost-effective by the European Medicines Agency or UK NICE guidance. (guideline) [Ep 1 · 9:32](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=572)
- Tumor treating fields is a non-invasive modality applying mild electric fields that disturb cancer cell division. (clinical) [Ep 1 · 9:50](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=590)
- Tumor treating fields combined with temozolomide shows significant improvement in progression-free survival. (clinical) [Ep 1 · 9:50](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=590)
- There is currently a trial running in the UK to evaluate tumor treating fields effectiveness for inclusion in NICE guidelines. (clinical) [Ep 1 · 10:10](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=610)
- Tumor treating fields plus temozolomide versus temozolomide alone increased progression-free survival by 2.7 months and overall survival by 4.9 months. (clinical) [Ep 1 · 10:19](https://library.globalcastmd.com/watch/essential-evidence-for-glioblastoma-a-must-know-for-neurosurgery-exams-13639?t=619)
- Traditional methods like animal models and 2D cell cultures fall short in replicating the complexity of glioblastoma microenvironment. — Ammar (opinion) [Ep 5 · 0:16](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=16)
- Patient GBM tissue is the best option for closely mimicking the microenvironment of GBM and testing therapeutic interventions. — Ammar (opinion) [Ep 5 · 0:34](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=34)
- The microfluidic chip can maintain patient-derived GBM tissue for 8 days and in some cases 12 days in the laboratory. — Ammar (clinical) [Ep 5 · 0:46](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=46)
- Fresh GBM tissue is obtained during surgery with patient consent, placed in nutrient media immediately, and transferred to the lab within one hour. — Ammar (clinical) [Ep 5 · 0:59](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=59)
- The microfluidic chip uses a cylindrical shape with an inner tube connected to a syringe containing nutrient media with or without treatment. — Ammar (clinical) [Ep 5 · 1:18](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=78)
- The treatments tested were temozolomide (the classic treatment) plus protein arginine methylation inhibitors. — Ammar (clinical) [Ep 5 · 1:36](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=96)
- The chip is connected to an effluent tube collecting released cytokines and placed in a Harvard syringe pump with a flow rate of 3 microliters per minute over 8 to 12 days. — Ammar (clinical) [Ep 5 · 1:42](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=102)
- Effluent containing cytokines is collected every 24 hours and stored at -80°C to maintain cytokine integrity. — Ammar (clinical) [Ep 5 · 1:58](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=118)
- The R&D Systems protein profiler membrane allows 105 human cytokines to be tested on a single membrane in duplicate form. — Ammar (clinical) [Ep 5 · 2:09](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=129)
- Selected cytokines from the 105-cytokine panel were validated by ELISA. — Ammar (clinical) [Ep 5 · 2:15](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=135)
- The study includes data from 13 patients over 12 days. — Ammar (epidemiological) [Ep 5 · 2:32](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=152)
- H&E staining shows GBM tissue cells maintain their integrity after 8 days on the chip and also at 12 days. — Ammar (clinical) [Ep 5 · 2:45](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=165)
- GBM tissue viability in the microfluidic chip shows minimal difference over the first 4 days (96 hours). — Ammar (clinical) [Ep 5 · 3:07](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=187)
- After 96 hours (4 days), GBM tissue begins to decrease and change patterns, with more pronounced changes at 12 days. — Ammar (clinical) [Ep 5 · 3:19](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=199)
- EGF and MMP9 are significantly reduced under the novel treatment (temozolomide plus protein arginine methylation inhibitors) compared to control. — Ammar (clinical) [Ep 5 · 3:30](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=210)
- SENES3-like 1, a cytokine mainly related to colon cancer, is abundant in GBM and increases against treatment, potentially indicating a resistance mechanism. — Ammar (clinical) [Ep 5 · 3:30](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=210)
- The microfluidic platform demonstrates viability of maintaining glioblastoma tissue for 8–12 days while testing different treatments against control. — Ammar (opinion) [Ep 5 · 3:59](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=239)
- The microfluidic model represents a potential GBM model for testing therapeutic interventions and observing effects over 8 to 12 days. — Ammar (opinion) [Ep 5 · 3:59](https://library.globalcastmd.com/watch/our-novel-glioblastoma-microfluidic-platform-13640?t=239)

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