Glioblastoma: Difference between revisions
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It is a more [[pleomorphism|pleomorphic]] and faster-growing form of [[astrocytoma]], and is also called Grade IV astrocytoma. In addition to pleomorphism, the histopathology includes nuclear atypia, microhemorrhage, and necrosis. Margins are irregular and it is not encapsulated. | It is a more [[pleomorphism|pleomorphic]] and faster-growing form of [[astrocytoma]], and is also called Grade IV astrocytoma. In addition to pleomorphism, the histopathology includes nuclear atypia, microhemorrhage, and necrosis. Margins are irregular and it is not encapsulated. | ||
==Treatment== | ==Treatment== | ||
While surgery has always been the core of treatment, prior to the use of adjuvant radiation and chemotherapy, it could only have a limited effect, as the irregular margins and infiltrating nature of the mass preclude complete removal, and indeed extensive [[debulking]]. | While surgery has always been the core of treatment, prior to the use of adjuvant radiation and chemotherapy, it could only have a limited effect, as the irregular margins and infiltrating nature of the mass preclude complete removal, and indeed extensive [[debulking]]. The current standard of care begins with maximal feasible debulking, followed by radiation and chemotherapy. Excellent supportive therapy dealing with complications is essential. | ||
Techniques of radiation therapy continue to evolve. The standard of care is fractionated electron beam radiotherapy, but methods being investigated include [[brachytherapy]] with implanted <sub>131</sub>[[iodine]] seeds, <ref name=eMed-Treat>{{citation | |||
| Glioblastoma Multiforme: Treatment & Medication | |||
| author = Salah Uddin and Tambi Jarmi | |||
| journal = eMedicine | |||
| date = 19 April 2010 | |||
| url = http://emedicine.medscape.com/article/1156220-treatment}}</ref> | |||
While the preferred chemotherapeutic agent is [[temozolomide]], ongoing studies also show a value for [[BCNU]]. One study with temozolomide and radiation showed median survival of 14.6 months with radiation therapy plus temozolomide and 12.1 months with radiation therapy alone.<ref>{{citation | |||
| title = 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 | |||
| journal = The Lancet Oncology | volume=10 |issue=5 | pages 459-466 | |||
| author = R. Stupp, M. Hegi, W. Mason, M. van den Bent, M. Taphoorn, R. Janzer, S. Ludwin, A. Allgeier, B. Fisher, K. Belanger}}</ref> Some temozolomide-treated patients have survived for 5 years. | |||
==References== | ==References== | ||
{{reflist}} | {{reflist|2}} | ||
Revision as of 13:54, 18 June 2010
A glioblastoma or glioblastoma multiforme (GBM) is a highly invasive tumor of the central nervous system, primarily of the brain, and, more specifically, the cerebral hemispheres, basal ganglia, and commissural pathways.[1] It is not curable with present methods, although recent developments have improved median survival. Onset is most common in the fifth or sixth decade of life, but certainly can appear in any adult or adolescent stage.
It is termed "malignant", which usually refers to the propensity to metastasize, but, as typical of central nervous system neoplasms, does not metastasize beyond the blood-brain barrier but expands rapidly within the central nervous system. GBM is the most common and aggressive primary (i.e., not from metastasis) brain tumor.
Diagnosis
Symptoms
Histopathology
It is a more pleomorphic and faster-growing form of astrocytoma, and is also called Grade IV astrocytoma. In addition to pleomorphism, the histopathology includes nuclear atypia, microhemorrhage, and necrosis. Margins are irregular and it is not encapsulated.
Treatment
While surgery has always been the core of treatment, prior to the use of adjuvant radiation and chemotherapy, it could only have a limited effect, as the irregular margins and infiltrating nature of the mass preclude complete removal, and indeed extensive debulking. The current standard of care begins with maximal feasible debulking, followed by radiation and chemotherapy. Excellent supportive therapy dealing with complications is essential.
Techniques of radiation therapy continue to evolve. The standard of care is fractionated electron beam radiotherapy, but methods being investigated include brachytherapy with implanted 131iodine seeds, [2]
While the preferred chemotherapeutic agent is temozolomide, ongoing studies also show a value for BCNU. One study with temozolomide and radiation showed median survival of 14.6 months with radiation therapy plus temozolomide and 12.1 months with radiation therapy alone.[3] Some temozolomide-treated patients have survived for 5 years.
References
- ↑ Anonymous (2024), Glioblastoma (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Salah Uddin and Tambi Jarmi (19 April 2010), eMedicine
- ↑ R. Stupp, M. Hegi, W. Mason, M. van den Bent, M. Taphoorn, R. Janzer, S. Ludwin, A. Allgeier, B. Fisher, K. Belanger, "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", The Lancet Oncology 10 (5)