Glioblastomas

Today, I will tell you about the most devastating brain tumor , glioblastoma. Glioblastomas are the subtype of gliomas, and the most common malignant primary brain tumors. They increase with age, with the highest rates in the 65 to 70 year age group. Glioblastomas grow very rapidly while invading normal brain tissue. Thus the clinical history is usually short. Neurologic symptoms and signs can be either general or focal and reflect the location of the tumor. Common presenting symptoms are headaches, seizures, motor weakness, and cognitive impairment.

Initial checks for glioblastomas includes an MRI. On an MRI, the tumors typically enhance with a contrast medium. In addition, they often have a central necrosis and edema. MR spectroscopy and PET study are also useful for further characterizing abnormalities.

The standard of care for glioblastomas includes maximal surgical resection followed by radiotherapy and chemotherapy. It is known as a multidisciplinary approach. The most common radiation dose is 60 Gy with 30 fractions, 5 days per week. Chemotherapeutic agent, temozolomide, is usually recommended. It is an alkylating agent and has excellent oral bioavailability with relatively low side effects. For recurrent glioblastomas, bevacizumab, which is the most promising targeted agent, is usually added.

Even with aggressive therapy, prognosis for glioblastomas remains poor, with a median survival of 15 months or so.