Histologically, this tumor is polymorphic and consists of various cells - gemistocytes, primitive neurons, granulocytes, etc. The prognosis for life with glioblastoma is influenced by the degree of malignancy. The tumor belongs to the category of the most aggressive, which is microscopically manifested by nuclear atypia, cellular polymorphism, high mitotic activity, microvascular proliferation and foci of necrosis.
In addition, the prognosis of life with grade 4 glioblastoma is influenced by the aggressiveness of cancer cells and their ability to grow rapidly.
Myth No. 2. Heavy use of a telephone or microwave can lead to a brain tumor.
Potentially, radio waves can cause some cellular mutations, but it is impossible to talk about this reliably, because existing research on this topic can hardly be called evidence-based, says Shavkat Kadyrov.
“Roughly speaking, out of seven billion people, two billion probably communicate by phone. However, not everyone develops a tumor, even if someone has been using a phone since its inception,” explains the expert.
Mikhail Laskov emphasizes that no connection has been established between brain tumors and telephones or microwaves. “Where did this myth come from? Well, this is understandable: we often hold a phone near our head, which has some kind of radiation that supposedly can cause cancer, which is actually not the case.”
Glioblastoma
Chemotherapy for glioblastoma
Drugs for the treatment of glioblastoma and their dose should be selected taking into account the stage of development of the disease, the patient’s age and state of health.
The action of chemotherapy drugs is aimed at the death of malignant tumor cells. For this purpose, temozolimide derivatives are used, which are given the name “Temodal”. International treatment standards include chemotherapy. Chemotherapy is carried out simultaneously with radiation therapy. Usually these are 6-8 cycles, lasting less than 5 days. The effect of chemotherapy occurs only in 20 cases out of 100. In the case of childhood illness, chemotherapy is prescribed instead of radiation treatment, because the latter has a negative effect on the development of the brain at a young age. This type of treatment should be used only after carefully weighing all the pros and cons, taking into account the health status, age of the person, shape and degree of malignancy of the tumor.
The patient will also need supportive care. For this purpose, doctors mainly prescribe Temodal. It should be taken 4 weeks after the end of the course of radiation therapy. Temodal is taken in 6 short courses, each lasting 5 days, with a break between them of at least 23 days. Doctors call this regimen 5/28,” that is, the drug is taken for 5 days of every 28-day cycle.
Avastin is considered a new drug to fight tumors; it has a specific mechanism of action. Avastin was developed by genetic engineers; it is an antibody to a growth factor produced by the vascular endothelium of a malignant neoplasm. This factor is a protein substance that glioblastoma secretes. Therefore, a vascular network is formed in the tumor for its favorable blood supply and development. The larger and more vessels there are, the faster the malignant focus will grow. Avastin is able to block this process of formation of the vascular network, thereby suppressing the development of the tumor. The drug Avastin appeared on the market quite recently. In 2005, publications appeared on the results of its effect on patients with glioblastoma.
Radiation therapy for glioblastoma
This method is used in most cases after surgery to completely remove the malignant tumor. Surgery does not always result in 100% removal of the tumor, because cancer cells can continue to multiply in the lesion. Radiation therapy in a small proportion of cases can replace surgical treatment - when the tumor is inoperable.
Radiation therapy has side effects that occur to a lesser or greater extent. These are fatigue, nausea, hair loss, weakness. Brain tissue may swell, leading to headaches. Necrotic processes are also likely to occur under the influence of radiation. Radiation therapy for the treatment of glioblastoma is aimed at selectively destroying malignant cells without affecting healthy areas of the brain.
Radiation therapy is carried out in several sessions. The irradiation area should cover areas of the brain located on the periphery of the lesion for more effective treatment. You should know that each session destroys not only pathological cells, but also healthy ones. Subsequent treatment stimulates the restoration of healthy tissues, while cancerous ones die.
Glioblastoma can manifest itself in several forms, so the entire irradiation process can include from 10 to 30 treatments, depending on the extent of the process. Radiation therapy increases the likelihood of increasing the life expectancy of every cancer patient.
Radiation therapy is given in fractions of 2 g per day for 5 days. The entire course lasts 6 weeks. The total radiation dose is 60-65 Gy. Such indicators correspond to the norms, while weaker radiation does not give the desired results, and a higher dosage causes undesirable complications. In parallel with radiation therapy, the person is given the drug Temodal - throughout the entire course.
Glioblastoma removal
In some cases, doctors consider glioblastoma not amenable to surgery. But, having a specific location, it can be removed surgically. This prolongs the patient’s life if an integrated approach is taken. It follows from this that chemotherapy and radiation therapy give more desirable results if a person’s glioblastoma is removed first.
As mentioned above, the edges of glioblastoma in some cases are difficult to determine. Therefore, even under a microscope, swollen brain tissue and cancerous tumors cannot always be distinguished. Therefore, a modern method of fluorescent detection of altered cells is used, using 5-aminolevulinic acid.
Preparation begins 4 hours before the start of the operation. The patient is given a special solution with this drug to drink. Then protoporphyrin begins to accumulate in tumor cells. This is necessary so that the contours of glioblastoma become clearer under special lighting. This will allow the neurosurgeon to see the tumor better. Thanks to the wavelength of 375-400 nanometers and the blue light emitted, malignant cells begin to glow.
Not so long ago, it was believed that it was impossible to completely remove glioblastoma, so the cancer cells were partially removed. Nowadays, thanks to the latest developments and modern technologies, glioblastoma can be completely removed.
Treatment of glioblastoma with folk remedies
Glioblastoma, as we have already noted, develops rapidly, with a high percentage of fatal cases due to the disease. But some people still rely on folk remedies for treatment.
One of the recipes is this... Take small radishes and grate them without peeling. Then add salt, mix and leave for 20 minutes to release the juice. The resulting mixture is rubbed into the head, then the head is covered with a warm scarf. A person will feel the heat for about half an hour, then instead of the heat there will be a feeling of warmth. The procedure should be carried out in the evening. In the morning, rinse your head with water (not too hot and not too cold). The next sessions of the procedure should be carried out 3 weeks 1 month after the previous one.
To treat glioblastoma with folk remedies, tinctures and decoctions are used. To prepare a decoction of Siberian cones, take 30-40 g of foliage and flowers and pour 200 ml of boiling water. Then the mixture is infused in a water bath for 30 minutes. The course of treatment includes taking the tincture up to 5 times a day, a third of a glass, for several months.
You can prepare a vinca tincture from fresh herbs, which is filled with alcohol (70%) and infused for 1-2 weeks. The resulting solution is taken 15 drops (strictly!) up to 3 times a day for 2-3 months.
Treatment of glioblastoma in Germany
Treatment of glioblastoma should be comprehensive. In Germany, several methods are used at once. There are known successful cases of treatment at the University Hospital Heidelberg, the RINECKER proton therapy center in Munich and at the university clinics in Düsseldorf and Freiburg.
Radiosurgery, namely cyber-knife and gamma knife, is used in the absence of the possibility of conventional surgery or as an addition to it. Protein therapy, which is used only in German clinics, has proven effective. This type of treatment is considered safer than chemotherapy.
Treatment of glioblastoma in Israel
In Israel, glioblastoma is treated at the Tel Aviv Medical Center, Rabin Clinic and Ishilov Hospital. As in German clinics, these use an integrated approach to treatment. In cases where complete removal is impossible, then partial resection is performed with intraoperative high-dose irradiation of the lesion. To reduce the risk of relapse, Gliadel capsules are widely used, which act as chemotherapy during surgery, acting locally. Systemic chemotherapy is used only for the purpose of relapses and metastases.
New treatments for glioblastoma
German professor Huber determined how to reduce the possibility of regenerative processes and increase the effect of radiation therapy. To do this, you need to block the TGF-β signaling pathways. The latter is considered a growth factor that is produced by the tumor and makes it more aggressive. The drug LY2109761 was developed to block it.
Israeli scientists have also developed new treatment methods. They invented a device with an adjustable electromagnetic field, the spectrum of which selectively kills cancer cells. So far, approval has been received only for the treatment of people with the most common and aggressive forms of brain tumors, including glioblastoma.
Cyber Knife in the treatment of glioblastoma tumors
The duration of therapy for treatment with this new method ranges from 1 to 3 days, one session lasts 30-90 minutes. There is no need to use anesthesia or make incisions, as with standard surgical methods for treating glioblastoma. It is possible to influence several tumors at once. In this case, the person is not hospitalized; immediately after treatment, the patient can live as usual.
CyberKnife is even used to treat those patients for whom the classic version of radiation therapy is contraindicated. If therapy is suspended due to excess
Neurosurgical treatment of glioblastoma tumor
Surgery is indicated to completely remove glioblastoma multiforme, which is the most common and most aggressive form of brain tumor. It accounts for up to 52% of primary brain tumors and up to 20% of all intracranial tumors. The operation significantly prolongs the patient's life. In addition, in the case of tumor removal, the use of radiation therapy and Temodal (an imidazotetrazine alkylating drug with antitumor activity) significantly increases the effectiveness of treatment.
Since the growth of glioblastoma is infiltrative (fast and characteristic of immature, malignant tumors), it is difficult to achieve complete resection. Some areas of the tumor completely merge with healthy edematous tissue. Therefore, even under a microscope it is difficult for a neurosurgeon to accurately determine its boundaries. In order to improve the visualization of a glioblastoma tumor during surgery, a method is used to determine the affected cells using 5-aminolevulinic acid. 4 hours before the start of the operation, the patient needs to drink a solution of the specified drug. In the human body, 5-aminolevulinic acid is converted to protoporphyrin. It, in turn, accumulates in glioblastoma multiforme cells.
Under illumination by a microscope generating blue light waves with a length of 375-400 nanometers, protoporphyrin provokes a fluorescent glow in malignant tumor cells. Thanks to this, the surgeon is able to perform the resection as accurately and efficiently as possible. Using this method, you can completely get rid of the disease glioblastoma multiforme. In the recent past, this was not possible, especially in cases where the tumor was localized in functional areas of the brain. Previously, neurosurgeons left a certain part of the tumor, fearing the risk of complications. Especially such as paralysis, impaired motor function, speech. But using the latest neuronavigation systems, the surgeon in most cases is able to remove glioblastoma multiforme completely.
For example, using a Zeiss Pentero operating microscope, which has fluorescent lighting and is equipped with an integrated module for angiography and resection of glioblastoma multiforme, as well as other hard-to-reach tumors. Only a few clinics around the world have such equipment. This system made it possible to operate on more than forty patients who were diagnosed with glioblastoma at the oncology center. In the case where tumor particles remain in the body after surgery, carmustine or another cytostatic antitumor chemotherapeutic drug is applied to its surface. They gradually spread throughout the remains of glioblastoma, slowly destroying malignant cells.
Maintenance chemotherapy with Temodal
Temodal is prescribed to patients in combination with radiation therapy. It is taken daily throughout the course of radiotherapy. Maintenance therapy with Temodal begins 4 weeks after completion of the course of radiotherapy necessary for the treatment of glioblastoma of the brain. Usually the doctor prescribes 6 short courses of Temodal. The duration of each course is 5 days. Between courses a break of 23 days is required. Thus, the patient receives a dose of the drug in the first 5 days of each 28-day cycle. That is why the Temodal maintenance therapy regimen is called “5/28”.
Maintenance chemotherapy with Avastin
Avastin is a drug that is essentially an antibody to tumor vascular endothelial growth factor. These antibodies are created through the use of genetic engineering. Endothelial growth factor is a protein compound that can be secreted by tumors. Glioblastoma of the brain develops due to the fact that its vessels begin continuous uncontrolled growth. Avastin has the ability to block vascular endothelial growth factor. Thus, it stops the growth of the tumor. Patients gained access to the drug Avastin (Bevacizumab) not so long ago.
Clinical trials in glioblastoma brain
Scientists at Duke University Medical Center (USA, New Carolina) have created a new vaccine. Based on the results of clinical trials, it can be argued that this drug can prolong the life of patients diagnosed with glioblastoma up to 33 months, and in some cases, more.
The studies involved 23 patients who had previously received conventional treatment (surgery, chemotherapy and radiotherapy). Each patient received a monthly injection of the newly created vaccine along with temozolomide (a drug used in chemotherapy). Temozolomide is believed to enhance the effect of the vaccine. And this despite the fact that chemotherapy drugs usually have a suppressive effect on the immune system. The leader of the study, neurosurgeon John Sampson, thus describes the mechanism for treating glioblastoma of the brain. “During the period when the patient’s body is recovering from a course of chemotherapy, immune mechanisms are at their highest activity. This provides the best prerequisites for curing glioblastoma of the brain with the introduction of a vaccine.” The new drug has no side effects, except for swelling of the skin at the injection site. In all patients who took part in clinical trials, the tumor did not increase over 16.6 months. The life of some patients was extended by 4 to 6 years, although this tumor was not treated. American scientists announced the effective result of clinical trials of a new vaccine, with the help of which it became possible to cure a disease such as glioblastoma multiforme of the brain.
The prognosis for patients with glioblastoma of the brain is disappointing. The average survival for patients treated only with surgery is 14 to 26 weeks. Additional radiation extends this period to 40 weeks. Chemotherapy with nitrosourea derivatives (such as procarbazine or carmustine) prolongs life for patients by up to 50 weeks and sometimes up to 18 months. But even in the case of the most favorable prognostic factors, most patients live less than 1 year. Only 15% of patients have a life expectancy of two years.
Death from glioblastoma
Glioblastoma is a terrible cancer that manifests itself with many symptoms. The more the cancer grows and the longer it goes untreated, the worse the symptoms become. Therefore, the last months of a person’s life with a diagnosis of glioblastoma can be extremely difficult.
In the last months of life, there is a constant headache, epileptic seizures and paralysis occur regularly, and mental activity is impaired. A person loses certain functions. Which ones exactly depend on which area of the brain is affected. The patient is constantly weak and feels a lack of strength.
Myth No. 6. Gamma knife is better than surgery.
Gamma Knife is a radiosurgery device for treating tumors in the cranial cavity. The operation is performed without skin incisions or craniotomy. For this purpose, radioactive radiation from a large number of cobalt-60 sources is used.
According to experts, it is incorrect to compare which is better - a gamma knife or surgery, since these are completely different methods and each of them has its own indications. “Both can be destructive, and both can be very useful,” Kadyrov clarifies. Laskov speaks about this: in his words, “each method is suitable for its own situation and for its patient.”
“For example, there are five small metastases in the patient’s brain, and we understand that we will not be able to cut them all off. Then radiosurgery is a good option, better than surgery. And if this is one large operable lesion, then, most likely, surgery is the best option,” the specialist sums up.
Causes of development and types of tumor
Scientists are still debating the reason why glioblastoma develops. Researchers believe that tumor growth can begin under the influence of the following provoking factors:
- Age-related changes. Despite the fact that glioneuroblastoma is detected in patients of all age groups, their average age is 64 years;
- Ionizing radiation. The risk of developing a tumor increases in people who have been exposed to radiation, work in areas of high radiation, or in chemical plants;
- Burdened heredity. The tumor often develops in family members with a rare hereditary disease - Li-Fraumeni syndrome;
- Neurofibromatosis. This is a hereditary disease that is accompanied by genetic disorders;
- Astrocytomas. Glioblastomas often develop from low-grade brain tumors – astrocytomas;
- The tumor may begin to develop under the influence of oncoviruses.
Glioblastomas of the brain vary in degree of malignancy. The most poorly differentiated and highly malignant is multiform multifocal glioblastoma of the brain.
Histologists distinguish the following types of glioblastomas:
- Giant cell – characterized by the presence of giant cells with several nuclei;
- Multiforme - consists of a variety of malignant cells, a large number of vessels and hemorrhages;
- Gliosarcoma is a neoplasm that includes a sarcomatous component.
The histological type of tumor is determined by pathologists by examining samples of the tumor. They study the differentiation of tumor cells under a microscope.
Symptoms
The morphological features of the tumor (infiltrative, “penetrating” growth, the rate of increase in the mass of glioblastoma) lead to the rapid development of symptoms.
The main symptoms can be divided into two parts: general cerebral and focal manifestations. General cerebral syndromes include hypertensive-hydrocephalic syndrome (expanding headaches, nausea, weakness), vestibular (uncertainty of gait, dizziness). Focal manifestations depend on the specific location of the tumor and include speech disorders, changes in the mental sphere, memory loss, inability to perform complex actions, etc.
Sometimes, against the background of a short period of general weakness and headache, a picture of a hemorrhagic stroke may develop due to extensive hemorrhage into the tumor tissue. If the brain stem is damaged, the patient's life and death are quickly threatened.
Based on the size of the tumor, its cytological nature (immaturity of the cells that make up the tumors and the rate of their growth) and some other parameters, four degrees of glioblastoma are distinguished.
Forecast
Complete recovery or long-term remission can be achieved only in cases where the disease is at stage 1 or 2. Surviving a diagnosis of glioblastoma is possible only with timely treatment.
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If the pathology is at stage 3, only about 10% of patients manage to survive for 2-5 years after treatment. But when a multiform type of tumor is established, death occurs 3-4 months after the formation of the tumor begins. This is due to the fact that it is impossible to completely remove glioblastoma. Relapse is observed in 80% of cases.
At the last stage, the tumor is inoperable and begins to disintegrate. Treatment in this case is aimed at relieving symptoms and alleviating the condition of patients. The prognosis is unfavorable. Patients often die due to complications.
Diagnostics
Diagnosis is carried out using the following steps of additional examination and laboratory and instrumental diagnostics:
• MRI
• CT
• PET – positron emission tomography
• echoencephaloscopy
• trephine biopsy, checking for gene mutation
• lumbar puncture and cerebrospinal fluid analysis.
Recently, stereotactic biopsy has been used to obtain tissue samples. To do this, a very miniature trepanation hole is made in the bones of the skull - up to 1 mm in diameter, through which, under the control of X-ray equipment, a biopsy needle is inserted directly into the tumor focus, and material is taken for research. Determination of the localization of the pathology and subsequent insertion of the needle occurs using a stereotactic frame (frame-based) or a navigation system.
