The WHO 2016 classification for tumours of the central nervous system emphasised the role of molecular markers in tumour grading. Patients with IDH mutated anaplastic glioma form a subset of high-grade glioma patients with favourable outcomes following surgery, chemotherapy and radiotherapy, with an 80% survival at 7 years for anaplastic astrocytoma IDH mutated (AAmut) and a median survival of 12-15 years for Anaplastic oligodendroglioma (AOD). On surveillance imaging in the years following intensity modulated radiation therapy (IMRT) for primary brain cancer, there may be development...

Patients with IDH mutant anaplastic astrocytoma or anaplastic oligodendroglioma referred to the Neuro-Oncology Multidisciplinary Tumour Board at the Northern Sydney Cancer Centre in Australia were entered into a prospective database. This study included patients who had received IMRT as adjuvant of definitive therapy. Follow up MRI scans were assessed in a multi-disciplinary setting. Patients who developed contrast enhancing lesions were identified, with subsequent images reviewed to track changes of the enhancing lesions. Self-limiting post radiotherapy enhancement events (SPREE) were defined in this study as new...

160 patients with IDH mutated anaplastic glioma between 2008-2019 at the Northern Sydney Cancer Centre were included in this study. All of these patients were managed with IMRT either at initial diagnosis or at subsequent progression. The median age of this cohort is 38.9 years. Median follow up for this cohort is 8.8 years post RT, and the 10yr relapse free survival is 62% (53-73%) (Table 1-3). 49 patients (30%) had SPREE with 4 subsequently relapsing. The median time to development of SPREE was 8.6...

SPREE is a clinical entity occurring in 30% of patients with IDH mutated anaplastic glioma by five years post RT with no significant factors predictive of incidence or resolution time. Clinical awareness of SPREE may assist in reducing patient anxiety and helping to target the most appropriate investigations.

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