Neuro-oncology


Diagnosis and Management of
Glioblastoma Multiforme

by Daniel R. Greenwald, MD

oncologist and hematologist

Cancer Center of Santa Barbara

 

Glioblastoma multiforme (GBM ) is the most common primary brain tumor in older adults and one of the most aggressive forms of cancer.

 

GBM can present with focal neurologic deficits or manifestations such as headache, seizure, loss of limb function or global cognitive impairment such as memory deficit or personality changes. Other diagnostic considerations include stroke, vascular abnormalities, infection or other forms of cancer.

 

 

Epidemiology and Risk Factors

As with many types of cancer, the precise cause of GBM remains unknown in the majority of cases. Described risk factors include age greater than 50 with a slightly increased risk in men compared with women.

 

Many associations with occupational exposure to chemicals, ionizing radiation and potential viral causes have been studied, although none has been conclusively linked as causal agents. Rare cases of defined familial inherited cancer syndrome arise, indicating multiple family members have inherited a susceptibility to develop one or more forms of cancer.

 

Diagnostic Considerations and Treatment Options

Neurologic symptoms typically prompt the evaluating physician to obtain a computed tomography scan or brain magnetic resonance imaging. Surgical excision of a revealed mass is required to diagnose the tumor type definitively.

 

Treatment options have historically consisted of surgical resection followed by radiation therapy with or without simultaneous chemotherapy. Standard cytotoxic chemotherapy can enhance the effect of initial treatment and slow disease progression in some cases, although tumor recurrence is common. The current standard remains surgery, when possible, followed by radiation in combination with an oral chemotherapy.

 

For patients not healthy enough to undergo surgery, other options may include stereotactic radiosurgery or conventional fractionated radiotherapy. Bevacizumab (Avastin©) infusions have been shown to improve the outcome for recurrent GBM following standard therapy.

 

For more information about services at Cancer Center of Santa Barbara, visit www.ccsb.org. To refer a patient, call (805) 682-7300.

 

  Image of glioblastoma/high grade glioma patient after three treatments with bevacizumab (Avastin) and CPT-11. The image on the left represents her magnetic resonance imaging prior to treatment, and on the right is her more recent study. The image taken after treatment (on the right) demonstrates a reduction in both the tumor size as well as the surrounding vasogenic edema associated with the tumor. The patient’s symptoms improved accordingly.

 

Ongoing Research

 

The Cancer Center of Santa Barbara has participated in glioblastoma tissue banking in support of the gene expression data analysis being conducted by the UCLA Neuro-Oncology Program.

 

“Genomic analysis helps clinicians and researchers better visualize and understand how gene expression relates to the overall survival of patients diagnosed with brain cancer,” says Daniel R. Greenwald, MD, oncologist and hematologist at Cancer Center of Santa Barbara. “After obtaining patient consent, we contribute for analysis tissue from individuals who are either newly diagnosed or experiencing recurrent primary brain tumors. The great majority of these patients are diagnosed with glioblastoma multiforme.”

 

The data collected for this genomic analysis research is shared with the scientific community to benefit patients with brain tumors.


 

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