The tumor's cells are abnormal, and the tumor creates new blood vessels as it grows. The tumor may accumulate dead cells necrosis in its core. Despite all the advances in treatment, we still don't understand what causes GBMs. They are not hereditary. The standard of treatment for a GBM is surgery , followed by daily radiation and oral chemotherapy for six and a half weeks, then a six-month regimen of oral chemotherapy given five days a month.
To start, the neurosurgeon will remove as much of the tumor as possible and may implant medicated wafers right into the brain. Developed at Johns Hopkins, these wafers dissolve naturally and gradually release chemotherapy drugs into the tumor area over time. Another chemotherapy drug called temozolomide was approved by the FDA in and is commonly used to treat GBMs and other advanced brain cancers.
The drug is taken in pill form and works by slowing down tumor growth. An effective supportive care entails managing the various signs and symptoms of the disease, which comprises of managing cerebral edema, seizures, gastrointestinal tract disturbances, osteoporosis, venous thromboembolism, cognitive impairment and mood disorders Norden and Wen, Symptomatic relief of neurological symptoms is brought about by administering corticosteroids, however due to its substantial side effects; it is usually tapered off early in the treatment regime.
Dexamethasone, is usually the preferred corticosteroid in these patients due to its low mineralocorticoid activity Omuro and DeAngelis, In patients with seizures, Levetiracetam is often prescribed because of its low toxicity profile and no drug to drug interactions with chemotherapeutic agents Omuro and DeAngelis, Surgery is the principal component of standard care Ohka et al. Depending on the tumor type surgery can accomplish many things including reduction of tumor burden, control seizures, reversal of neurological deficit, introduction of local therapeutic agent and improve quality of life Newton et al.
The extent of surgical resection depends upon the site and eloquence of the brain area involved. However, in case of newly diagnostic patients the extent of surgical resection holds prognostic worth Scott et al.
Surgical treatment can be followed by radiotherapy to kill remaining tumor cells. It has been shown to improve life expectancy of patients having high grade gliomas Scott et al. Subgroups of patients that have undergone a gross total resection may get a survival advantage after receiving stereotactic radiotherapy. On the contrary, hyperfractionated radiotherapy has shown that survival outcomes in GBM may actually be unfavorable in certain patient subgroups Chang et al. Several limitation and risk factors are associated with radiation therapy including the invasive nature of GBM, radiation necrosis, radiation-induced permanent neuronal damage and radio-resistance of some tumors Iacob and Dinca, Intensity-modulated radiation therapy and boron neuron capture therapy are some of the new radiation based treatment modalities, which are recently being carried out in patients with malignant gliomas to evaluate their efficacy.
Treatment with these therapies have shown less toxicity and less exposure to normal tissues and results suggest that these are not inferior to conventional radiotherapy being used in brain tumor patients Norden and Wen, To improve the survival of patients several chemotherapeutic agents have been tested for their effectiveness in the treatment of GBM Curado et al.
BCNU and CCNU are harshly cytotoxic and treatment with these drugs results in early development of resistance which further limits their benefit and moreover they are also associated with many side effects Table 1 Friedman et al. The principal mechanism responsible for the cytotoxicity of TMZ is to methylate DNA at the N7 and O6 position on guanine which leads to the failure of DNA miss match repair system to find a complementary base for methylated guanine thus resulting in long live nicks in DNA and consequently blocks the cell cycle at the G2-M boundary and triggers apoptosis Scott et al.
However, it has been reported that high levels of Methyl Guanine Methyl Transferase MGMT activity in tumor cells is associated with poor temozolomide response. Although TMZ has slightly increased the survival of patients, it is also responsible for inducing many side effects Friedman et al.
Clinical trials have shown that BCNU wafers have shown some significant survival benefits but again they are associated with dreadful side effects Iacob and Dinca, Carboplatin, oxaliplatin, etoposide and irinotecan are the second line drugs for patients who do not respond to the drugs mentioned above. This review discusses the key aspects of GBM and provides comprehensive knowledge of the disease.
To date GBM remains incurable due to its heterogeneity and complex pathogenesis. Continued research efforts will help to provide better treatment options to combat the disease in future.
The authors declare, they have no competing interests as defined by the Asian Pacific Journal of Cancer Prevention. National Center for Biotechnology Information , U. Asian Pac J Cancer Prev. Author information Copyright and License information Disclaimer.
This article has been cited by other articles in PMC. Abstract Glioblastoma multiforme GBM is one of the most malignant types of central nervous system tumors. Keywords: Glioblastoma multiforme, epidemiology, MRI scan, mutations, temozolomide. Introduction Glioblastoma Multiforme GBM Glioma is a general term used to describe primary brain tumors, and is classified according to their presumed cell of origin.
Etiology of GBM Little is known about the etiology of brain neoplasms which are usually highly incurable. Genetic and Molecular Pathogenesis Contemporary advancement in genomic technology has improved understanding of key molecular alterations that trigger GBM. Open in a separate window. Figure 1. Clinical Presentation Over half of the patients with GBM usually present with a short clinical history which ranges between months, however if tumor develops from a low-grade astrocytoma, the clinical history spans over a number of years Clarke, ; Salah Uddin and Jarmi, Imaging Imaging techniques carried out on individuals suspected of having brain tumors include invasive procedures such as catheter angiography and non-invasive tests such as computed tomography CT and magnetic resonance imaging MRI scans which are more routinely used for the purpose of visualising the tumors Nelson, Figure 2.
Surgery Surgery is the principal component of standard care Ohka et al. Radiation Therapy Surgical treatment can be followed by radiotherapy to kill remaining tumor cells. Chemotherapy To improve the survival of patients several chemotherapeutic agents have been tested for their effectiveness in the treatment of GBM Curado et al. Vincristine 1.
Statement The authors declare, they have no competing interests as defined by the Asian Pacific Journal of Cancer Prevention. Glioblastoma multiforme:a review of where we have been and where we are going. Expert Opin Investig Drugs. Glioblastoma, a brief review of history, molecular genetics, animal models and novel therapeutic strategies. Glioblastoma:pathology, molecular mechanisms and markers. Acta Neuropathol.
Brain tumor epidemiology:consensus from the brain tumor epidemiology consortium. Radiotherapy and radiosensitizers in the treatment of glioblastoma multiforme. Clin Adv Hematol Oncol. Atlanta: American Cancer Society, Inc. Cancer: Principles and Practice of Oncology. Menu Contact Dictionary Search. Understanding Cancer. What Is Cancer? Cancer Statistics. Cancer Disparities. Cancer Causes and Prevention. Risk Factors. Cancer Prevention Overview. Cancer Screening Overview. Screening Tests. Diagnosis and Staging.
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Finding Health Care Services. Advance Directives. Using Trusted Resources. Berger is a pioneer of intraoperative brain mapping—a technique used to avoid functional areas of the brain during surgical resection of a tumor. His work has enabled surgeons to perform more extensive resection of tumor with less chance of producing sensorimotor or language deficit. In addition to speech and motor mapping, his specific research interests lie in identifying molecular markers related to the progression and prognosis of glial tumor; correlating tissue biomarkers with novel imaging characteristics from physiologic and metabolic imaging; and developing in vivo gene editing for brain tumor treatment using CRISPR technology.
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