Case no. | Initial pathology (*differential) | Initial treatment plan | Integrated diagnosis | New treatment plan | Methylation profiling impact |
---|---|---|---|---|---|
1 | Glioma NOS –IDH1 (R132H)-neg, high-grade features | Offered FSRT/TMZ & adjuvant TMZ | DNET | Observation | 1) Avoided unnecessary treatment 2) Resolved anxiety due to initial diagnosis/treatment |
2 | Anaplastic oligodendroglioma –IDH1 (R132H)-neg, 1p/19q-codeletion | 1) Received FSRT 2) Planned for PCV | Anaplastic PXA | 1) Hold PCV 2) Observe | Avoided unnecessary treatment |
3 | Glioma NOS –IDH1 (R132H)-neg, anaplastic features | Offered FSRT/TMZ and adjuvant TMZ | DLGNT | Observation | Avoided unnecessary treatment |
4 | 1) GBM* 2) Anaplastic PXA – IDH1 (R132H)-neg, BRAF (V600E)-mut, high-grade features | FSRT/TMZ and adjuvant TMZ | Anaplastic PXA | Surgery, chemotherapy, and BRAF inhibitor after recurrence | 1) Resolved depression due to unclear diagnosis 2) Avoided potential medical assisted death due to diagnosis given |
5 | Schwannoma –SOX10-pos, S100-pos, Ki-67 10% | FSRT | Anaplastic pilocytic astrocytoma –Malignant glial tumor | Provided full craniospinal radiation at recurrence | Received potentially insufficient initial treatment |
6 | 1) PXA* 2) Other high-grade gliomas – IDH1 (R132H)-neg, BRAF (V600E)-neg | Considered reduced dosing for FSRT/TMZ & adjuvant TMZ | GBM, IDH wildtype | Treatment fully completed | Avoided possible insufficient initial treatment |
7 | Metastatic high-grade neuro-endocrine tumor –TTF1-pos, IDH1 (R132H)-neg, well demarcated | 1) SRS post-op 2) FSRT and cisplatin/etopside for 1st recurrence 3) Surgery and WBRT for second recurrence | GBM, IDH wildtype | Temozolomide provided after second recurrence | 1) Received insufficient treatment and recurred 2) May have avoided unnecessary invasive biopsies |