GLIOBLASTOMA MULTIFORME

DEFINITION

Glioblastoma multiforme, also known as grade 4 astrocytoma, is the most common and aggressive type of primary brain tumor, accounting for 52% of all primary brain tumor cases and 20% of all intracranial tumors. Despite being the most prevalent form of primary brain tumor, GBMs occur in only 2-3 cases per 100,000 people in Europe and North America.

The kind of symptoms produced depends highly on the location of the tumor, more so than on its severity or pathological properties. The single most prevalent symptom is a progressive memory, personality, or neurological deficit. These occur when the tumor affects the temporal and frontal lobes of the brain.  Some other common symptoms of the disease include seizure, nausea and vomiting, headache, and weakness on one side of the body (hemiparesis). The tumor can start producing symptoms quickly, but occasionally is an asymptomatic condition until it reaches an enormous size.

Most glioblastoma tumors appear to be sporadic, without any genetic predisposition. No links have been found between glioblastoma and smoking, diet, cellular phones, or electromagnetic fields. Recently, some evidence for a viral cause has been discovered.

Other risk factors include:

• Sex: male (slightly more common in men than women)
• Age: over 50 years old
• Ethnicity: Caucasians, Latinos, Asians
• Having a low-grade astrocytoma (brain tumor), which occasionally develops into a higher-grade tumor
• Certain genetic disorders are associated with an increased incidence of gliomas, including Neurofibromatosis, Tuberous sclerosis, Von Hippel-Lindau disease, Li-Fraumeni syndrome, and Turcot syndrome

Glioblastoma is particularly difficult to treat for a variety of reasons. Its location in the brain makes treatments particularly delicate, as the brain is vulnerable to incidental  damage, and has limited capacity to repair itself. Many drugs that are effective in other types of tumor are not able to cross the blood-brain barrier, and the tumor itself tends to be particularly resistant to conventional tumor therapies. Nonetheless, many advances in microsurgery techniques, radiotherapy and chemotherapy are slowly increasing the survival time of patients diagnosed with glioblastoma. Treatment can involve chemotherapy, radiotherapy, and surgery.

Surgery is the first stage of treatment of glioblastoma. It is often only feasible to remove only a part of the tumor. In these cases, the surgical goals may be to take a section for diagnosis, to remove some of the symptoms of a large mass pressing against the brain, to remove disease before secondary resistance to radiotherapy and chemotherapy, and to prolong survival.

Generally, the greater the extent of tumor removal, the longer the survival time. Removal of 98% or more of the tumor has been associated with a significantly longer median survival time than if less than 98% of the tumor is removed. However, complete removal is not always possible, due to the tumor’s location in the brain.

Post-surgical radiotherapy is often used to further shrink the tumor. Three-dimensional conformal radiotherapy, which is targeted and more precise than whole-brain radiotherapy, is more effective at improving the patient’s survival.

Chemotherapy is also used in conjunction with surgery and radiotherapy to further shrink the tumor. It has been shown to increase the patient’s survival, without much additional toxicity (over that already caused by radiation).

In addition to attempting to remove or shrink the tumor, steroids can sometimes be administered to help relieve the patient’s symptoms. Anticonvulsant treatments can also be helpful to patients who are experiencing seizures as a result of the tumor.

neuro-oncology

More information on our neuro-oncology and non surgical brain click here

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