Glioblastoma Multiforme Treatment Options

Glioblastoma Multiforme Treatment Options

Glioblastoma multiforme (GBM) is the most common and most aggressive type of primary brain tumor

Patient History
Primary Intracranial CNS Tumors
Gliomas
* Astrocytomas
o Pilocytic Astrocytomas (grade 1)
o Diffuse Astrocytomas (grade 2)
o Anaplastic Astrocytomas (grade 3)
o Glioblastoma Multiforme (grade 4 – 50%)
* Oligodendrogliomas
o Low Grade Oligodendroglioma (grade 2)
o Anaplastic Oligodendroglioma (grade 3)
* Mixed Oligoastrocytomas
o Low Grade Oligoastrocytoma (grade 2)
o Anaplastic Oligodendroglioma (grade 3)

Clinical Presentation
* Symptoms caused by mass effect or destruction of normal tissue
* Symptoms
o Headache
o Seizures
o Neurological Deficits
+ Personality Changes
+ Slowing of Motor Function/Hemiplegia
+ Hallucinations
+ Memory Impairment
+ Vision Impairment

Prognosis for GBM
* Mean survival 12-14 months from diagnosis
* Mean survival 4-5 months from recurrence
* 2 year survival 10%
* Recurrence occurs within 2-3 cm of the margins of the original tumor in 80% of patients

Prognostic Factors in GBM
* Age
* Performance status
* Neurologic functional status

Treatment

* Surgery
* Radiation
* Chemotherapy

Treatment - Surgery
* Surgery done for diagnosis and to relieve symptoms when possible
* Median survival after surgery alone is 3-4 months
* Resections are suboptimal secondary to preservation of normal brain tissue
* Re-excision at recurrence an option in patients with good performance status

Treatment - Radiation
* Radiation after surgery extends median survival to 9-11 months
* CNS tumors infiltrate into surrounding normal brain tissue up to 3 cm or more
* Radiation delivered on a focal field including the tumor bed with a 2-3 cm margin with total dose of 58-60 Gy

Treatment - Chemotherapy
* Nitrosoureas (BCNU/CCNU)
o Best known chemotherapy agents
o Metaanalysis showed increase in median survival of 2 months over surgery and radiation alone
o BCNU impregnated wafers show similar results to systemic therapy
* PVC (Procarbazine, CCNU, Vincristine)
* Temozolomide
* Thalidomide
* Tamoxifen
* BCNU + O6-Benzylguanine
* Gleevec

Conclusions
* Glioblastoma multiforme continues to have a dismal prognosis
* Significant work has been done to identify genetic pathways in glioma progression
* Genetic information being used to identify targets for therapies and has potential to identify chemotherapy responsive tumors

Glioblastoma Multiforme Treatment Options.ppt