Though all patients differ – and you are no exception – glioblastoma treatment options are fairly standard, and most patients experience a similar treatment path. A glioblastoma is a tumor that can contain many different types of cells, each of which may respond better to one treatment than another. This necessitates a combination approach to therapy, employing different methodologies to maximize effectiveness.
While your doctor may develop a plan that includes other treatment options or a different schedule, most glioblastomas are treated with surgery, followed by a course of medication (chemotherapy) and radiation therapy. The explanation below will help you understand each of the glioblastoma treatment options and the reasons why all are necessary for most patients.
Treatment Path for Glioblastoma
Though your individual path may differ somewhat, the following is a generalized summary of glioblastoma treatment options. Your doctor will take many factors into consideration when developing your treatment plan, including the size and location of your tumor, its aggressiveness and any complicating health conditions. However, in general, you can expect a plan similar to this:
Step 1 – Diagnosis and Resection/Biopsy
After a neurological exam and imaging tests, if it is determined that your tumor will be receptive to surgery (brain metastases or glioblastoma), a full resection is planned. This is the case 90% of the time. The surgeon will remove as much of the tumor as safely possible, and take a sample to be sent to pathology for further research. The pathologist will provide a more in-depth diagnosis by identifying the genetic characteristics and the grade of the brain tumor. This will help determine your post-operation treatment.
For glioblastomas, complete removal is often not an option, so a follow-up treatment path including chemotherapy and radiation therapy will be created for you based on the findings from the biopsy.
If the neurological exam and imaging tests indicates that the tumor is unsafe to remove or there is question as to the diagnosis based on the MRI, a needle biopsy is planned.
During your needle biopsy procedure, your neurosurgeon will collect a tissue sample and send it to pathology for further testing. When the results of the biopsy come back, your surgeon will create treatment path catered to you and your specific diagnosis. This may entail additional surgery, radiation, chemotherapy, or some combination thereof.
Step 2 – Oral Chemotherapy
Following surgery, adjunct therapies, such as chemotherapy and/or radiation therapy, are required to eliminate any remaining tumor cells. This is because, if any part of your glioblastoma remains after resection, it could potentially regrow into another tumor. Follow-up therapies are always necessary to prevent this from happening.
Chemotherapy is the use of medications to treat a condition. Not all brain tumors are treatable using chemotherapy due to a natural protective feature of the body – the blood-brain barrier. The blood-brain barrier prevents many substances from crossing out of the bloodstream and entering the brain, which is a great natural defense but also problematic for chemotherapeutic treatments.
However, there are some drugs that can cross the blood-brain barrier, including Temozolomide (Temodar), a pill that is taken once daily. Temozolomide is generally well-tolerated by the body and is able to reach – and shrink – your glioblastoma. Your doctor will most likely prescribe it to you for the first six weeks following your surgery.
Step 3 – Radiation Therapy
Concurrent with your oral chemotherapy, you will also receive radiation therapy. Glioblastoma is often infiltrative into the brain and needs a broad field of coverage to treat the tumor.
For this reason, fractionated radiotherapy is the preferred option of treatment for Glioblastomas. This technique provides doctors the ability to precisely target and deliver appropriate doses of radiation to the brain tumor. The accuracy of the procedure prevents loss of healthy cells surrounding the tumor and decreases treatment time compared to traditional methods.
Step 4 – Oral Chemotherapy and Monitoring
After your radiation therapy is complete, you will likely continue with your oral chemotherapy (Temozolomide). You can expect to have regular follow-up visits with your doctor and lifelong monitoring for recurrence. Your doctor will work with you to develop an appropriate monitoring schedule. In addition, for adult patients, clinical trials and new treatment options are an option. If the following methods interest you, make sure to bring it up to your doctors.
A clinical trial is a study where patients that meet certain criterias can volunteer to test out a new treatment to determine its effectiveness. It is possible that there are vaccines or other chemotherapy methods in trial stages that you may qualify for. Depending on the trial, patients are usually, if not alway compensated (i.e. reduced cost of treatment). It is best to discuss with your doctor this option of treatment to fully understand the risks and benefits of clinical trials.
There is a new FDA approved glioblastoma treatment option for both first-time diagnosis and recurrent tumors, called Optune. During this treatment, the patient must have a shaved head at all times and carry a device with you that administers treatment 18 hours a day via a head attachment.
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. Although this method is new to the medical market, early studies have shown positive results in treating glioblastoma.
A Better Understanding of Your Glioblastoma Treatment Options
At this point, you should have a better understanding of the general course of treatment for your glioblastoma. Again, because your case will not be exactly like any other patient’s, there may be nuances that necessitate treatment modifications. However, most glioblastoma patients can expect to undergo surgery, followed by chemotherapy and radiation therapy.
Chances are this information has raised some new questions in your mind. Be sure to address them with your treating physician at your next appointment. Your doctor is there for you and will be happy to answer any questions you have before, during and following your treatment. Self-education and taking an active role in your treatment will ensure confidence in your care and help contribute to your peace of mind.