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  • Writer's pictureGregory Cannarsa, MD

Navigating the Complex Landscape of Glioblastoma Treatments: A Comprehensive Overview

Glioblastoma is one of the most aggressive and lethal forms of brain cancer. Treatment for glioblastoma is a multi-faceted approach involving surgery, radiation, and chemotherapy. The challenge lies in the tumor's propensity for rapid growth and infiltration into normal brain tissue, making complete surgical removal nearly impossible in most cases. Despite this, advances in technology and therapeutic strategies are continuously being developed to improve patient outcomes.


Surgical Resection

The first line of treatment often involves surgical resection to remove as much of the tumor as possible while preserving normal brain function. The goal is maximal safe resection while minimizing damage to surrounding healthy tissue. However, even with complete macroscopic resection, microscopic tumor cells typically remain, necessitating further treatment. Another benefit of surgery is biopsy of the tumor which allows for further study and exact molecular profiling of the tumor to enable the most targeted treatments possible.


Radiation Therapy

Postoperative radiation therapy is standard in glioblastoma management. Advanced techniques like intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) allow for targeted irradiation of the tumor, sparing adjacent normal tissue. This is often administered over several weeks and serves to eradicate the remaining microscopic cancer cells following surgery.


Chemotherapy

Temozolomide (TMZ) is the most commonly used chemotherapy agent in glioblastoma treatment. It's often administered in conjunction with radiation therapy, followed by adjuvant cycles. TMZ is an oral alkylating agent that interferes with DNA replication, disrupting the tumor's ability to grow and proliferate. Unfortunately, some tumors develop resistance to TMZ, necessitating exploration of alternative chemotherapy options.


Novel Therapies

Given the limited efficacy of standard treatments, there is ongoing research into novel therapies. Immunotherapy, which boosts the body’s natural defenses to fight cancer, is one such avenue under investigation. Checkpoint inhibitors like PD-1 and PD-L1 have shown some promise in early-phase trials. Similarly, oncolytic virus therapy, where engineered viruses selectively infect and kill cancer cells, is a field of active research.


Another emerging treatment option is tumor-treating fields (TTF), a non-invasive treatment that uses electric fields to disrupt cancer cell division. This treatment has been approved for use in combination with TMZ and has been shown to extend survival.


Personalized Treatment

Advancements in genomics and molecular profiling are opening doors to more personalized treatment plans. Some patients have specific mutations that can be targeted with molecular therapies. Although not curative, these therapies can add valuable time and quality of life for glioblastoma patients.


Palliative Care

Given the often-difficult prognosis, palliative care is a critical component of glioblastoma treatment. This involves not only symptom management but also psychosocial support for both patients and their families. An interdisciplinary approach involving neurologists, neurosurgeons, oncologists, psychologists, and palliative care specialists ensures comprehensive care.


In conclusion, the treatment of glioblastoma remains a significant challenge in neuro-oncology. The standard of care involves a multimodal approach of surgery, radiation, and chemotherapy. As research continues, it is hoped that novel therapies and a deeper understanding of tumor biology will improve outcomes for patients with this devastating disease. At Apex Brain & Spine, we partner with the area's lead medical and radiation oncologists to ensure you or your loved receives the best treatment possible.

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