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B Y : J AHNAVI U DAIKUMAR D IRECTOR : D R. R ICHARD S ANKER, P H D R ETROSPECTIVE A NALYSIS ON D IFFERENTIAL E FFECTS OF T REATMENT S TRATEGY ON O UTCOME AND S URVIVAL ON M ALIGNANT G LIOBLASTOMA M ULTIFORME P ATIENTS

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Etymology glia, blastos, oma 1926 Percival Bailey and Harvey Cushing Basic tumor characterization Grades GBM nature WHAT IS GLIOBLASTOMA?

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Primary Glioblastoma Secondary Glioblastoma GBM PATHOGENESIS

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Genetic mutations Cell phone usage Post-head injury Occupational hazards Electromagnetic field exposure Race and Gender Lifestyle habits ETIOLOGY Post-head injuries

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Viral entrance and immunosuppression External risk factors Lead into molecular alterations ETIOLOGY Malaria viral entrance and GBM relationship

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10q P53 MDM2 PGDF-alpha PTEN MAC1-E1, MAGE-E1, NRP/B P16 and RB MOLECULAR ALTERATIONS Molecular alterations characterized

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10q p53 10Q AND P53 Loss of heterozygosity on Chromosome 10q

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EGFR MDM2 EGFR AND MDM2 EGFR Pathway MDM2 Pathway

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PGDF-alpha PTEN MAC1-E1 MAGE-E1 NRP/B PGDF-ALPHA, PTEN, MAC1-E1, MAGE-E1, NRP/B PGDF-alpha pathway PTEN pathway

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P16 RB P16 AND RB RB response

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Transcription factor Hes3 IDH1 gene and mutations Metabolism Ion channel upregulation STEM-LIKE CELL, METABOLISM AND ION CHANNEL PROBLEMS IDH1 gene mutant

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MRI and CT MR spectroscopy and perfusion MRI Biomarkers Ex: IDH1 gene mutations DIAGNOSIS GBM MRI

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Signs and Symptoms Vomiting, headaches, memory loss, neurological deficits, hemiparesis Prevalence North America and Europe Gender and age SIGNS, SYMPTOMS, AND PREVALENCE

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Surgery, Radiotherapy, Chemotherapy Patients over 70 years of age and MGMT methylation Phase III trial results TREATMENT

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Surgery Radiotherapy Brachytherapy and radiosensitizers SURGERY AND RADIOTHERAPY

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Carmustine (BCNU) Cis-Platinum Temozolomide Nitrosoureas and Gliadel wafers CHEMOTHERAPY

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Gene therapy MGMT methylation and promoter Problems and progression Bevacizumab Tyrosine kinase inhibitors OTHER TREATMENTS

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Patient survival depends on certain factors Results of study Further GBM management approaches PROGNOSIS

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Purpose of the Glioma study Methodology IRB HIPPA Variables of interest PURPOSE AND METHODOLOGY

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Univariate Analysis results RESULTS Post-head injuries Median Survival (95% CI)HR (95% CI)P-value Grade Low15.8010.0524.54 1.000 High7.987.039.171.7681.4182.204