 Hello, everyone. Greetings from Manipal Hospital, Bhaner Pune. I am Dr. Karan Chanchlani. I am a neuro-oncologist and a radiation oncologist. And today, we will be talking about brain tumors or more generalize the central nervous system tumors. So, CNS tumors include brain tumors and less commonly even the spinal cord tumors. Taken together, the incidence of CNS tumors is between 5 to 10 cases per 1 lakh population in India. It requires a dedicated team as well as a specialized care for dealing with such type of tumors. There are different set of tumors which are common in the pediatric population and a different set of tumors in adults. So, pediatric tumors are more likely to arise from the stem cell like cells or the blastomas as we call them with middle of blastoma being the most common pediatric brain tumor. Gliomas or the tumors from the support cells are the more common tumors of the adults. Today, we will be restricting our discussion to gliomas. So, this includes the glioblastoma which is the most aggressive form of glioma which is grade 4. So, gliomas typically present with headache, nausea, vomiting as general symptoms along with focal symptoms depending upon the location of the tumor inside the brain. So, they may also cause paralysis, loss of vision, loss of speech and language disturbances. Typical evaluation includes an MRI and it is highly recommended that a multi parametric MRI including spectroscopy and perfusion values along with diffusion scans are also included so as to characterize the tumor properly. So, typically after stabilizing the patient we usually recommend a surgery first in such cases in which the neurosurgeon tries to remove most of the tumor as much as possible while preserving the rest of the neurological function. So, we call it as maximal safe resection and once the tumor is removed it is subjected to pathological testing and based on the surgical pathology report we sometimes require certain additional tests like molecular analysis, MGMD testing, IDH mutations and all and based on that we arrive at a composite diagnosis of the tumor type, the tumor grade as well as the molecular signature. So, this is as per the recommendation by the WHO with which is revised in the 2021 classification. So, once we ascertain the grade and the complete diagnosis of the tumor these tumors may and also we need to evaluate the extent of resection on an MRI after the surgery. So, once all these tests are done and the extent is ascertained on the MRI these tumors may sometimes require further treatment. So, typically the high grade tumors as well as partially resected tumors require further treatment with radiation as well as chemotherapy. For low grade tumors it depends mainly on the extent of resection as well as certain radiological parameters which need to be correlated and sometimes we may also need to treat these low grade tumors also. So, for high grade tumors when we usually we typically treat them with radiation with highly conformal techniques wherein we treat the area where the tumor had arrived along with certain margins and we need to reduce the doses to the other areas of the brain wherein we have other neurological function. So, as to preserve the rest of the neurological function including cognitive function like memory and etcetera. And typically these treatments go over 6, 6 and half weeks at 1.8 to 2 gray per fraction for around 59 to 60 gray equivalent doses and typically they are potentiated with concurrent administration of chemotherapy usually in the form of some tablets. And these tablets are also then given in the adjuvant setting that is after completion of this radiation therapy for a few months depending upon the response as well as the molecular tests. So, with advanced molecular techniques we are able to characterize into favorable tumors and certain not so favorable tumors and depending upon MGMT status and response evaluation on MRI we may go on with these tablets to almost up to a year. Typically it is recommended that a multi parametric MRI is done for response evaluation because there is a concern of progression of tumor or versus a scenario called as pseudo progression wherein the tumor actually may not be viable inside the body, but the sizes may increase on it MRI. So, your neuro oncologist along with the neuro radiologist are a better person to evaluate this scenarios and guide you accordingly. At Manipal Hospital Banir Pune we have one of the state of art facilities with a dedicated team in comprising of neurosurgeons, neurologist, clinical oncologist as well as medical oncologist. So, this is how we deal with neuro oncology tumors and we have the most modern technology to deliver the best of the treatments. Thank you.