Adult Neurology Residency

Adult Neurology Residency

Neuro-Oncology

Introduction and Goals

Although much less common than breast, lung, colon, or prostate cancers, tumors of the central nervous system are nonetheless an important public health problem, and one with which neurologists must have some familiarity. CNS tumors are in the differential for some of the most common chief complaints in neurology, including headache, seizure, and spells, and can result in acute, subacute, or chronically progressive focal deficits.

The goals of this elective rotation are for the PGY-3 or PGY-4 resident neurologist to develop an organized approach to the evaluation and treatment of patients with neurologic cancers with special emphasis on primary tumors. As time allows, residents may also be exposed to the treatment approach metastatic disease of the brain or spine. Residents will gain experience not only in medical oncology, but in radiation oncology, palliative care, neuroradiology, neuropathology, and interdisciplinary teamwork. Residents will also receive one-on-one didactic sessions with neuro-oncology faculty. 

Objectives and Evaluation Matrix

As with all of the neurology rotations, the specific objectives are reflected in the entrustable professional activities and individual milestones listed below. These form the basis for the end-of-rotation evaluation. (Please see the section End-of-Rotation Evaluations above for the list of milestone abbreviations).

Rotation Objectives
Upon completion of the curriculum, residents will . . .
#DescriptionMilestones
1Describe the treatment approach to newly- diagnosed and recurrent gliomas based on MRI findings, extent of surgery, pathology, and tumor markers.PC3, PC4, PC8, MK1, MK2
2Explain the role of tumor markers in glioma treatment and prognosis: MGMT methylation, IDH 1&2 mutations, 1p19 deletions, ATRX, TERT, & EGFR.PC3, PC4, PL1
3Describe the indications for, and side effects of, radiation, tumor treating field therapy, and specific drugs: Temozolomide, PVC chemotherapy, BCNU wafers, lomustine, bevacizumab, steroids and anti-convulsants.PC3, PC4, PL1
4Diagnose, and counsel patients and families regarding the following types of aphasia: Broca’s, Wernicke’s, conduction, anomic, and transcortical.PC3, MK1, IC1
5Use MRI, including T1 +/- contrast, T2, FLAIR, T2*, DWI, and PWI to differentiate tumor progression, pseudo- progression, and pseudo-response and the implications for treatment.PC8
6Classify primary CNS neoplasms using the old WHO scheme; demonstrate awareness of the new the WHO criteria and their implications for future practice.MK2
7Describe key studies that dictate therapy: EORTC-NCIC Phase 3; RTOG 9802, RTOG 0424, RTOG 9402, RTOG 0131.PL1
8Communicate bad news and empathize with patients and families and communicate effectively with the interdisciplinary treatment team, both verbally and through the electronic health recordSP3, SP4, PR1, IC3, IC4
Milestones
Please grade the resident on any of the following milestones you were able to evaluate during this rotation:
PL2, PR2

Schedule

AMMondayTuesdayWednesdayThursdayFriday
NeuropathologyInter-Disciplinary Neuro-Oncology ClinicNeuro-Oncology Follow-up ClinicNeuroradiologyDidactic Teaching and Feedback
Grand Rounds
PM1:45pm Brain Cutting1:45pm Brain CuttingSelf-Study
4pm Tumor BoardNeuroradiology

Work Hours

The estimated average number of work hours per week is ~ 50. There are no call responsibilities required during this rotation.

 

Suggested References

Nabors LB, Portnow J, Ammirati M, et al. NCCN Guidelines Insights: Central Nervous System Cancers, Version 1.2017. J Natl Compr Canc Netw. 2017;15(11):1331-1345.

Kruser TJ, Mehta MP, Robins HI. Pseudoprogression after glioma therapy: a comprehensive review. Expert Rev Neurother. 2013;13(4):389-403.

Tipping M, Eickhoff J, Ian Robins H. Clinical outcomes in recurrent glioblastoma with bevacizumab therapy: An analysis of the literature. J Clin Neurosci. 2017;44:101-106.

Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459-466.

CONTINUUM: Lifelong Learning in Neurology. 26(6, Neuro-oncology):December 2020.

 

 Latest revision: 5-14-2021

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