Glioblastoma multiforme

Glioblastoma multiforme, (GBM) also known as grade 4 astrocytoma is the most common and aggressive type of primary brain tumor, accounting for 52 percent of all primary brain tumors cases.

Treatment

Surgery, when indicated, is mandatory. The chances of more prolonged survival increase with good surgical approach and removal of tumor with free healthy margins. The neurosurgeon will try to remove as much tumor as possible, regarding the location and the visual appearance of the tumor, which not always is easily distinguishable from normal healthy brain tissue. The extent of tumor excision must be judged upon several factors; age, general condition, involvemet of the so called eloquent areas (brain areas with specific and important functions, such as speech or motor skills), are some of the factors the team must deal with.

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After surgery, a number of different choices are available. Radiotherapy and/or chemotherapy are among them. In the first, the radiotherapist will prescribe a certain amount of radiation directed at the tumor previous location. The number of discharges will depend on the patients response. In general, any worsening of the clinical condition will prompt the stopping of the treatment. When some improvement is noticed and the patient is young, making it believable that the chances of good survival are real, more radiation will be given.

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There are not many chemical agents capable of detaining this tumor growth. This is one of the less responsive tumors to any kind of medication. A drug known as "Temodal" (trade name) has been used with some results, but the response is not as satisfactory as with other kind of neoplasias, such as certain types of leukemia with other agents.

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Sometimes, surgery is merely diagnostic. Through medical image, one can diagnose a GBM with great accuracy. In those cases where there is a doubt of any kind, the patient is not a good surgical candidate (eg, elderly) or the family agrees on a more conservative praxis, a biopsy can and should be performed. In most surgical centers, a stereotatic biopsy will be performed, which will take no more than 30 minutes and demands only a small burr hole to be performed. The patient can be discharged the next day or two. With a histopathological diagnosis in hand, the people involved could be certain of the situation and reliant on the decision.

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