Glioblastoma
multiforme (GBM) is the most common malignant primary brain tumor.
These tumors are often aggressive and infiltrate surrounding brain
tissue. GBMs arise from glial cells, which are cells that form the
tissue that surrounds and protects other nerve cells found within the
brain and spinal cord. GBMs are mainly composed of star-shaped glial
cells known as astrocytes. The general term glioma includes any type of
brain tumor such as astrocytoma and oligodendroglioma that arise from
glial cells.
Astrocytomas
are classified according to a grading system developed by the World
Health Organization (WHO). Astrocytomas come in four grades based upon
how fast the cells are reproducing and that likelihood that they will
infiltrate nearby tissue. Grades I or II astrocytomas are nonmalignant
and may be referred to as low-grade. Grades III and IV astrocytomas are
malignant and may be referred to as high-grade astrocytomas. Grade III
astrocytomas are known as anaplastic astrocytomas. Grade IV astrocytomas
are known as glioblastoma multiforme.
Treatment of specific tumours
Grades 1 and 2 tumours: - This includes pilocytic astrocytomas, pleomorphic xanthoastrocytomas and subependymomas.
- They can be cured by complete resection.
- Incompletely resected tumours may not cause any problems or can be treated further with radiotherapy.
- If these measures fail then, rarely, chemotherapy may help.
Grade 3 tumours:
- Maximum possible surgical debulking.
- Radiotherapy is used as standard treatment.
- Adjuvant chemotherapy has been used in trials but its role needs to be clearly established, eg bevacizumab and irinotecan.
- However, recurrence after radiotherapy should be treated with chemotherapy. NICE recommends that patients with recurrent malignant glioma who have failed first-line chemotherapy treatment with other agents may be considered for treatment withtemozolomide.
- NICE advises carmustine implants in patients with newly diagnosed high-grade glioma if 90% or more of the tumour has been removed.
Glioblastoma multiforme (GBM):
- Surgery is the mainstay of therapy, but the tumour is usually infiltrative and therefore complete resection is difficult.
- Radiotherapy improves survival rates.
- Temozolomide is recommended by NICE as an option for the treatment of newly diagnosed GBM.
- Concomitant and adjuvant chemotherapy with temozolomide given during and after radiotherapy improves survival.
- Recurrence can be treated with a second resection if possible and/or further chemotherapy with temozolomide.
Symptoms
Common symptoms include, but are not limited to:
- Headache: The most common symptom, it's caused by an increased pressure in the brain
- Hemiparesis
- Nausea
- Seizure
- Progressive memory
- Personality deficit
- Vomiting
The
kind of symptoms produced depends highly on the location of the tumour,
more so than on its pathological properties. The tumour can start
producing symptoms quickly, but occasionally is an asymptomatic
condition until it reaches a larger size.A GBM
is the most common and most aggressive malignant primary brain tumour.
These tumours contain various cell types, hence the name multiforme, the
most common being astrocytes.Most
of these tumours occur in the cerebral hemispheres but can develop in
other parts of the brain such as the corpus callosum, brainstem or
spinal cord. The cells of these tumours grow quickly, are not well
defined, and can spread throughout the brain.Like
many brain tumour types, the exact cause of glioblastoma multiforme is
not known, but increasingly research is pointing toward genetic
mutations.
- Can be composed of several different cell types
- Can develop directly or evolve from a lower grade glioma (secondary GBM)
- Less common in children
- Most common in older individuals and more common in men than women
- Most of these tumours occur in the cerebral hemisphere and often involves the corpus callosumThe cells of these tumours grow quickly, are not well defined, and they may frequently spread throughout the brain.
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