Glioblastoma is an aggressive brain tumor, arising from cells within the brain known as astrocytes. However, the tumor itself may contain a number of different cell types, and some cells may respond better to one treatment over another. Regardless, the recommended glioblastoma treatment options for adults typically include surgery, oral chemotherapy and radiation therapy.
Treatment Path for Treating a Glioblastoma
The treatment path for glioblastoma is well-established. The above treatment options will be appropriate for 90 percent of glioblastoma patients of all ages. However, radiation treatment plans may differ depending on age, as discussed below.
Diagnosis and Resection
Though your treatment plan may vary slightly, surgery will always be required to treat your glioblastoma. Prior to actual treatment, however, a biopsy is required to take a sample of the tumor for tissue diagnosis. This will allow specialists to do genetic testing to better understand the pathology of your tumor, confirming your glioblastoma diagnosis.
When a biopsy is done during the resection procedure, the sample is sent to pathology for an immediate diagnosis. If the lab results say that resection is beneficial (usually for Glioblastomas, Metastatic, and other primary tumors), the surgeon will remove as much of the tumor as possible for a maximal safe resection. Complete removal is often not possible, so follow-up treatment will always be necessary after surgery. If the results say that resection will not be beneficial, often not recommended for lymphoma, small-cell lung cancer and similar types of cancer, the surgeon will not perform the resection and recommend a different glioblastoma path of treatment. In some cases, a stereotactic needle biopsy will be planned upfront if surgical resection cannot be done safely.
Glioblastoma treatment options almost always include a form of adjunct therapy. Adjunct therapy is necessary because any remaining tumor cells could potentially regrow, reforming the tumor. The first way of preventing this is a course of medication (chemotherapy). Your doctor will likely prescribe a six-week course of temozolomide (Temodar), a pill taken orally once a day to help eradicate any remaining tumor cells.
One of the difficulties with using medication to treat brain tumors is the body’s natural self-defense system, the blood-brain barrier. This protective feature prevents substances from crossing into the brain from the blood, which is certainly a useful quality, but it can make delivering medications troublesome.
However, temozolomide is one medication that is able to cross the blood-brain barrier and, thus, reach and target your tumor. This drug is generally well-tolerated by the body and has proven effective against glioblastoma.
While you are receiving chemotherapy, you will also be undergoing radiation therapy. Though there are different types of radiation therapy, one that has proven to be the most effective glioblastoma treatment option is fractionated radiotherapy.
For glioblastoma, fractionated radiotherapy is the preferred method over other brain tumor radiotherapy treatments such as whole brain radiation. Fractionated radiotherapy precisely locates and targets a small margin around the resection area with doses of high energy rays to prevent regrowth with minimal damage to surrounding healthy cells.
Glioblastoma radiotherapy treatment is fairly standard, but there may be modifications in the dose of radiation for older patients and your doctor may choose to reduce your radiation dose if there is a concern about your tolerance level.
Upon completion of your radiation therapy, you can expect to continue your temozolomide prescription. Your doctor will also establish a schedule of follow-up visits to monitor for recurrence of your tumor over your lifetime.
Additional Forms of Treatment Specifically for Adults
Though there is a well-established standard set of glioblastoma treatment options, new and emerging treatment methods may be an option for you as an adult patient. If they interest you, be sure to discuss them with your doctor at your next visit.
There may be vaccines or other chemotherapy methods in trial stages that are available to you as a patient if you meet certain criteria. A clinical trial is a study in which patients volunteer to try out a new treatment (including methods and/or medications) to determine its effectiveness in treating a condition.
Patients in clinical trials are often compensated, either financially or with reduced-cost, or even free, treatment. Your doctor can help you better understand the risks and benefits of any trial that you may be eligible for.
Optune is a new glioblastoma treatment option recently approved by the FDA for both first-time diagnosis and recurrent tumors. This method requires you to maintain a shaved head and receive treatment for approximately 18 hours per day via a device attached to the patient’s head.
The device bounces magnetic waves between the plates and disrupts cell division in an effort to stop the cancer by stopping it from growing or, possibly, shrinking the tumor. This is an extremely new treatment methodology and studies have shown to be effective in the treatment of glioblastoma.
Understanding Your Glioblastoma Treatment Options
As an adult glioblastoma patient, you can expect your treatment path to include the standard course of surgery, followed by oral chemotherapy and radiation therapy. Though your doctor may modify your radiation dose if he feels you may have reduced tolerance due to age or health conditions, 90 percent of glioblastomas are treated as outlined here.
Adult patients have novel therapies, including Optune and clinical trials, available as additional glioblastoma treatment options. Be sure to discuss them with your doctor if they have piqued your interest, or you have further questions. Self-education is a great way to better understand your upcoming treatment, and your doctor will be happy to discuss any questions you have in general or about anything you have learned here.