Masa lalu 

adalah istilah yang digunakan untuk menunjukkan totalitas peristiwa yang terjadi sebelum

suatu titik waktu tertentu. Masa lalu dikontraskan dengan dan didefinisikan oleh sekarang dan masa
depan. Konsep masa lalu berasal dari mode linier di mana pengamat manusia mengalami waktu,
dan diakses melalui ingatan dan pengingatan. Selain itu, manusia mencatat masa lalu sejak
munculnya bahasa tertulis.
Masa lalu adalah objek studi dalam bidang - bidang seperti sejarah, ingatan, kilas
balik, pengingatan, arkeologi, arkeoastronomi, kronologi, geologi, Sejarah geologi, sejarah
linguistik, hukum, ontologi, paleontologi, paleobotani, paleoetnobotani, palaeogeografi, paleoklimatol
ogi, terminologi dan kosmologi fisik.

Portal Sejarah

Lihat pula

Radiotherapy is usually only used as a salvage treatment after chemotherapy failure or for bulky

disease.

Meningiomas
Meningiomas are the most common primary brain tumor, accounting for more than 32% of all
tumors. Meningiomas arise from the arachnoid cap cells. They are often discovered incidentally
when a patient undergoes neuroimaging for symptoms that are unrelated to the meningioma. The
radiographic appearance of meningiomas is one of the most specific of all brain tumors and
allows a confident diagnosis without the need for a confirmatory biopsy ( Figure 2 ). The most
common radiographic mimicker is a metastatic tumor to the meninges, but usually a patient in
this circumstance has a known history of malignancy. Small meningiomas may be followed with
serial imaging. Meningiomas that correlate with neurologic deficits or tumors that have grown
significantly over time should be treated.

Open full size image

Figure 2

Contrast-enhanced magnetic resonance image shows a homogeneously enhancing mass arising

from the dura, with the typical appearance of a meningioma.

Surgical resection is the preferred treatment if it can be safely accomplished, but it should be
avoided in the elderly. Meningiomas are graded WHO I to III; 90% are grade I (benign), and
grade III (anaplastic) are the most aggressive and likely to recur. Complete resection is curative
in most cases, but some meningiomas recur. If recurrent tumors are large or symptomatic,
surgery is the preferred treatment. Radiotherapy, either fractionated or stereotactic radiosurgery,
can be used postoperatively to treat residual tumor or to treat tumors that cannot be resected.
Meningiomas have an intermediate response to radiotherapy, and grade III tumors often show
minimal response.
There is no defined chemotherapy for meningiomas, although several drugs are being actively
investigated. Immunotherapy is also being investigated.

Gliomas
Gliomas consist of astrocytomas, oligodendrogliomas, and ependymomas, in decreasing order of
prevalence. It was once thought that these tumors derived from mutations of normal glial cells,
but it is increasingly recognized that gliomas derive from brain tumor progenitor cells.
Glioblastoma is the most malignant glioma and accounts for 60% to 70% of all gliomas. Gliomas
are classified by the glial cells from which they originate and the histologic features that give
them a grade according to the WHO classification ( Table 1 ). Grade III and IV tumors are high-
grade gliomas, and grade II tumors are low-grade gliomas. Grade I glioma (pilocytic
astrocytoma) is rarely seen in adults. A maximal surgical resection that leaves the patient with
minimal neurologic deficits is the preferred initial treatment for all grades of gliomas.

TABLE 1

World Health Organization Classification of Common Gliomas in Adults

Subtype World Health Organization Grade

Low-Grade Gliomas

Astrocytoma II

Oligodendroglioma II

Oligoastrocytoma II

High-Grade Gliomas

Anaplastic astrocytoma III

Anaplastic oligodendroglioma III

Anaplastic oligoastrocytoma III

Anaplastic ependymoma III

Glioblastoma IV

High-Grade Gliomas
Most high-grade gliomas are glioblastoma or anaplastic astrocytoma (WHO grade III); anaplastic
oligodendroglioma and anaplastic ependymoma are less common. The brain MRI often shows a
ring-enhancing mass centered in the white matter surrounded by edema and causing massive
effects ( Figure 3 ). A maximal surgical resection that leaves the patient without permanent
neurologic deficits is the goal in high-grade glioma. A maximal resection, younger age, and good
performance status are favorable prognostic factors. Methylation of the MGMT promoter
correlates with improved survival. High-grade gliomas are aggressive, incurable tumors; the
median survival for glioblastoma is 14 to 18 months and for anaplastic astrocytoma is 2 to 2.5
years. The isocitrate dehydrogenase I (IDH 1) mutation is less commonly seen in high-grade
gliomas and correlates with improved survival.

Open full size image

Figure 3

Contrast-enhanced magnetic resonance image shows a ring-enhancing mass with surrounding

edema with the typical appearance of glioblastoma.

Treatment of high-grade glioma is based on the histology of the tumor. The standard treatment of
glioblastoma consists of fractionated radiotherapy given over 6 weeks with temozolomide
(Temodar), an oral chemotherapeutic drug. Temozolomide is given 1 month after the completion
of radiotherapy, usually for 6 cycles. Tumor progression occurs on average around 7 months
after the original diagnosis for glioblastoma ( Table 2 ). There is no consensus on treatment of
anaplastic gliomas, although this is being clarified by two ongoing clinical trials (CATNON and
CODEL). Patients with anaplastic astrocytoma are usually treated with 6 weeks of radiotherapy
alone followed by adjuvant temozolomide. Patients with glioblastoma and anaplastic
astrocytoma are usually treated with 6 months of temozolomide, although some practitioners will
treat glioblastoma patients with up to 12 months of temozolomide. Tumor-treating fields (TTF)
therapy is a cap-like device worn on a shaved scalp. TTF delivers radiofrequency pulses to the
tumor. Based on the results of a large randomized clinical trial, TTF were approved to add on to
the standard therap