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Glioblastoma Multiforme (GBM)

Glioblastoma multiforme (GBM) is the most malignant form of high-grade astrocytoma. GBMs are the most common adult primary brain tumors, and make up approximately half of all astrocytomas. They can occur at any age, but are more common in older patients.

Symptoms

Initial symptoms, such as headache and nausea, usually are the result of increased intracranial pressure caused by the bulk of the tumor or a backup of the cerebrospinal fluid that surrounds the brain and spinal cord. The glial cells are widely distributed throughout the central nervous system, so these tumors can occur in a wide variety of locations, and therefore can cause a wide variety of other symptoms. Depending on the location of the mass, gliomas may cause seizures, weakness or numbness in the limbs, impairments in language function, blurred or double vision, gradual changes in mood or personality, and memory loss. In addition, high-grade astrocytomas are characterized by seizures and specific neurological deficits. GBMs may be large before they begin to cause symptoms.

Diagnosis

These tumors are diagnosed with imaging studies and tumor biopsy. In a biopsy, GBM can be characterized by the presence of necrosis, or cell death, which is not present in anaplastic astrocytomas. Currently, magnetic resonance imaging (MRI) is the best available imaging modality. Computed tomography (CT) scans also are used. For either study, an agent that provides contrast in the image is administered intravenously so neurological surgeons can visualize the tumor against the normal brain in the background. In some cases, neurological surgeons may employ an MRI scan with frameless stereotactic guidance. For this study, a contrast MRI is performed after special markers (called fiducials) are placed on the patient?s scalp. The fiducials are processed by a computer, which calculates the location of the tumor and creates a three-dimensional reconstruction. This image then is used at the time of surgery to help locate the tumor precisely, maximize tumor removal, and minimize injury to the surrounding brain.

Treatment

High-grade astrocytomas require aggressive, intense therapy. Surgery is the primary form of treatment, but its utility is limited because these tumors tend to penetrate healthy brain tissue, making complete resection unlikely and recurrence almost certain. As a result, surgery almost always is followed by radiation therapy, and then chemotherapy. Stereotactic radiosurgery also may be used in cases of tumor recurrence or to target areas missed during the surgical resection.

Research

New therapies, such as gene therapy and new chemotherapy drugs, are being examined.

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