Treatment for Disease Glioblastoma

Antonio Russo^*
*Correspondence: Antonio Russo, Department of Oncology, University of Palermo Medical School, Italy, Tel: 39-091-6552500, Email:

Keywords

Glioblastoma• Cancer • Tumor capillary

Introduction

GBMs are biologically aggressive tumors that present unique treatment challenges because of the next characteristics:

• Localization of tumors within the brain

• Inherent resistance to standard therapy

• Limited capacity of the brain to repair it

• Migration of malignant cells into adjacent brain tissue

• The variably disrupted tumor blood supply which inhibits effective drug delivery

• Tumor capillary leakage, leading to an accumulation of fluid round the tumor; (peritumoral edema) and intracranial hypertension

• A limited response to therapy

• The resultant neurotoxicity of treatments directed at gliomas

Glioblastomas have traditionally been divided into primary and secondary; the previous arising de novo (90%) whereas the latter developed from a pre-existing lower grade tumor (10%).

These correlate closely to IDH mutation status:

• IDH mutant: generally secondary glioblastoma, nearly always MGMT methylated 17

• IDH wild-type: generally primary glioblastoma

Primary

Primary glioblastomas are people that arise de novo, without a preexisting lower grade diffuse astrocytoma. They account for 90% of all glioblastomas and are more aggressive than secondary glioblastomas which they have a tendency to occur in older individuals. Primary glioblastomas are almost invariably IDH wild-type. they have a tendency to possess amplification of EGFR and overexpression of MDM2, PTEN mutation and/or loss of heterozygosity of chromosome 10p [1].

Secondary

Secondary glioblastomas, in contrast, are those which arise from a pre-existing lower grade diffuse astrocytoma. they're relatively uncommon, only accounting for about 10% of all glioblastomas. These tumors tend to be less aggressive than primary glioblastomas and that they tend to occur in younger patients. Interestingly, and of uncertain significance, they need a predilection for the frontal lobes. Characteristically, and in contrast to primary tumors, secondary glioblastomas tend to be IDH mutant (positive), a mutation shared by over 80% of grade II and III astrocytomas. Secondary glioblastomas also demonstrate p53 mutations, amplification of PDGF-A, loss of heterozygosity of chromosomes 10q and 17p, loss of 19q and increased telomerase activity and hTERT expression [2].

Patients with glioblastomas develop symptoms rapidly thanks to mass effect from the tumor itself or from the fluid surrounding the tumor (edema) that causes further brain swelling. for instance , common symptoms at diagnosis are associated with the increased pressure within the brain (nausea, vomiting, and severe headaches which are typically worse within the morning). Patients can also present with neurological symptoms which are enthusiastic to the tumor location (for example, weakness or sensory changes of face, arm or leg, balance difficulties and neurocognitive/memory issues). Other common presentation includes seizures.

Sophisticated imaging techniques can very accurately pinpoint things of brain tumors. Diagnostic tools include Computed Tomography (CT or CAT scan) and Resonance Imaging (MRI). Intraoperative MRI also can be useful during surgery to guide tissue biopsies and tumor removal. Resonance Spectroscopy (MRS) is used to seem at the tumor's chemical profile, with Positron Emission Tomography (PET scan) helpful in detecting tumor recurrence [3].

Glioblastoma are often difficult to treat since some cells may respond well to certain therapies, while others won't be affected within the least. Due to this, the treatment plan for glioblastoma may combine several approaches. the primary step in treating glioblastoma could also be a surgery to make a diagnosis, to alleviate pressure on the brain, and to securely remove the utmost amount tumor as possible. Glioblastomas are diffuse and have finger-like tentacles that infiltrate the brain, which makes them very difficult to get rid of completely. this is often particularly true when the tumors are growing near important regions of the brain that control functions like language and movement/coordination. Radiation and chemotherapy are used to hamper the expansion of residual tumor after surgery and for tumors that cannot be removed with surgery. Tumor Treating Fields (TTFields) even be |is also"> could even be even be offered alongside chemotherapy. Standard of care treatment for newly diagnosed GBM depends on a spread of things, including molecular biomarkers (MGMT status & IDH mutation) and age. Recurrent GBM is treated supported the patient’s response to initial treatments and assessment of disease progression [4].

References

1. Mary Elizabeth, Davis. “Glioblastoma: Overview of disease and treatment”. Clin J Oncol Nurs  20(2016):S2.
2. Wolfgang, Wick, and Thierry, Gorlia.” Lomustine and bevacizumab in progressive glioblastoma”. N Engl  J Med  377(2017):1954-1963.
3. Adriana, Olar , and Kenneth, Aldape.” Using the molecular classification of glioblastoma to inform personalized treatment”. J Pathol 232(2014):165-177.
4. Nadiya, Teplyuk, and Brit, Mollenhauer. “MicroRNAs in cerebrospinal fluid identify glioblastoma and metastatic brain cancers and reflect disease activity”. Neuro-oncology 14(2012):689-700.