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Treatment for Glioblastoma Multiforme (GBM)

Glioblastoma multiforme (GBM) is a tumor in the brain that is cancer. This cancer starts in the glial cells which are part of the tissues that supports the brain.

GBM is treated with surgery, radiation, and/or chemotherapy. GBM is a fast-growing cancer that tends to spread and often comes back after treatment.

Coping with treatment for glioblastoma multiforme

You'll be working with a team of doctors and other healthcare providers. Make sure to ask them any questions you have. Talk with your team if you have side effects, have trouble keeping your appointments, financial concerns, or have problems in your personal life. They can help you find support.

Also, keep in mind that depression is common during cancer treatment. Talk to your team about how you're feeling. Ask for a referral to a psychologist or psychiatrist if you need one. You and your family can get help as you cope with cancer and cancer treatment.

Your treatment team

Your treatment team will work together to help you decide the best way to treat and manage your GBM. Your team may include:

  • Neurosurgeon This doctor does brain surgery and often leads your treatment team.

  • Neurologist This doctor diagnoses and treats diseases of the brain.

  • Radiation oncologist These are doctors who use radiation to treat cancer.

  • Medical oncologist These doctors use chemotherapy and other drugs to treat cancer.

  • Nurses. These healthcare providers work with you and your doctors to give your cancer treatments and watch how you're doing during treatment.

  • Social worker. A social worker can help you make plans and decisions about your life. They can help you with financial and insurance problems, too.

  • Physical therapist (PT). A PT can help you regain strength and mobility.

  • Occupational therapist (OT). An OT can help you learn how to manage day-to-day tasks.

Goals of treatment

Your goals of treatment will depend on your age, your overall health, the size of the tumor, where it is in your brain, and your preferences. They also depend on if the cancer has spread to other parts of your body. In general, you may choose:

  • Active treatment. Active treatment is done to try to cure the cancer, keep it from growing and spreading, or help delay its return. This most often includes surgery, chemotherapy, and/or radiation therapy.

  • Palliative care only. This is care to ease symptoms only. It's not used to treat the cancer itself. Some people choose to have only palliative care. It helps a person be comfortable and have the best quality of life for as long as possible.

Your doctors will help you decide what’s best for you. Most experts agree that treatment in a clinical trial should be considered for people with GBM. This way people can get the best treatment available now and may also get the treatments that are thought to be even better.

Types of treatment for GBM

Surgery

The first treatment is often surgery. This is done to take out as much of the tumor as possible while keeping normal brain function. Removing the tumor (called resection) is only done if the tumor can be removed safely. Surgery gives an exact diagnosis because the tumor can be tested in a lab. It also reduces the tumor size. In some cases, the surgeon can’t remove all of the tumor. This may be because it's near vital parts of the brain. Or it may be growing into the brain like fingers of a glove. But taking out even part of the tumor can help reduce pressure in the brain. This can help ease certain symptoms.

Radiation therapy

The goal of radiation is to kill cancer cells. This is done using X-rays, gamma rays, or proton beams. Radiation is most often given once a day, 5 days a week, for up to 6 weeks. It may be used to kill any cancer cells left after surgery. It may be used as the main treatment if surgery is not an option. It can also help relieve symptoms caused by the tumor.

Chemotherapy

Chemotherapy may be used after surgery and is often given along with radiation. Its goal is to kill cancer cells that may remain after surgery, help reduce the chance that the cancer will grow and spread, or help ease problems the tumor is causing. In most cases, the chemotherapy medicines used are taken by mouth as pills. But they may also be given by IV into a vein.

Targeted therapy

If treatment isn't working, medicines that keep the tumor cells from making blood vessels might be used. A tumor needs nutrients from the blood to grow and spread. When a tumor can't get to blood vessels it starves and dies. Bevacizumab is a targeted medicine that may be used to treat GBM when other treatments don't work. It's usually given along with chemotherapy.

Alternating electric field therapy

This treatment uses a battery-operated device that sends a mild electric current to electrodes that stick on the scalp. It's believed to work by interfering with the growth and spread of tumor cells. It may be used along with chemo after surgery and radiation. It may be used alone if the tumor comes back after treatment.

Other medicines

Other medicines might be used to help ease symptoms caused by the tumor or cancer treatment. For instance, you might be given medicines to help prevent seizures or to help control swelling in the brain.

Clinical trials

GBM can be very hard to treat and control with the treatments available today. Researchers are looking for new and better ways to treat GBM. These new methods are tested in clinical trials. Before starting treatment, you may want to ask your healthcare team if there are any clinical trials that might be right for you. In a clinical trial you may be able to get treatment that's not yet widely available.

Side effects of treatment

Most cancer treatments have side effects. This is because they damage healthy cells along with the cancer cells. Talk with your doctor about what side effects your types of treatment may have. Common side effects include:

  • Increased risk for infection

  • Bleeding

  • Tiredness

  • Changes in brain function

  • Hair loss

  • Nausea and vomiting

  • Trouble sleeping

  • Weight gain

  • Mood swings

  • Depression

Follow-up care

You'll need regular follow-up care. This is to see how the treatment is working. It's also to watch for signs that the GBM is growing back. Your follow-up care will include regular exams and MRIs every few months. Your doctor may send you for a PET (positron emission tomography) scan if he or she thinks the GBM is growing back.

If GBM returns

If your GBM returns, you'll have the option of more treatment, such as:

  • Repeat radiation therapy

  • Chemotherapy

  • Additional surgery, which may include putting chemotherapy wafers near the tumor

  • Alternating electrical field therapy

  • Palliative care

  • Taking part in a clinical trial         

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