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Affordable Treatments for Glioblastoma (GBM) Brain Tumors

Glioblastoma Multiforme, Glioblastomas or GBM, in short, are tumors which arise from astrocytes. Astrocytes are star-shaped cells which make the ‘glue-like’ supportive tissue of the brain. GBM tumors are generally highly cancerous (malignant) because these cells are found to reproduce quickly & are also supported by a large network of blood vessels. Glioblastomas are usually found within cerebral hemispheres of the brain but can also be found elsewhere inside the brain or the spinal cord. These cancerous tumors are typically found to contain a mix of cell types. It is however not unusual for these tumors to contain calcium deposits, cystic mineral, blood vessels and/or mixed grade of cells. These glioblastoma tumors are highly malignant & where a large number of tumor cells are found reproducing at any given time. They are also well nourished by an ample supply of blood. Dead cells are also found here, especially within the center of the tumor. Since GBM tumors originate from normal brain cells, it is, therefore, easy for them to invade & live within the normal tissue of the brain. Nevertheless, glioblastomas are rarely found to spread to any other parts of the body.

 

Glioblastoma (GBM) Brain Tumors

Types of Glioblastomas

There are two main types of Glioblastomas.

  • Primary or De Novo GlioblastomaThese GBM tumors tend to quickly form & make their presence known. This is the most common form of glioblastoma & is very aggressive in nature.
  • Secondary GlioblastomaThese GBM tumors have a longer & somewhat slower type of growth history but are however still very aggressive. These are generally found to begin as low-grade tumors but which eventually become high-grade over time. Secondary GBM tumors tend to be found among people who are 45 years of age or younger. Secondary GBM tumors represent about 10 percent of all glioblastomas.

Signs & Symptoms of Glioblastomas

Since glioblastomas can rapidly grow, most common signs & symptoms are usually caused by increased pressure within the brain. Common symptoms of GBM tumors include drowsiness, vomiting, nausea & headache. GBM tumor patients can develop a variety of other symptoms like visual changes, weakness on one side of the body & memory and/or difficulties in a speech which will depend upon the location of the tumor. Moreover, clinical history of GBM patients is usually very short, less than 3 months in 50 percent of the patients.

Common presenting symptoms of glioblastoma patients include the following.

  • Seizures
  • Headaches
  • Slowly progressive neurological deficit which usually includes motor weakness.
  • Generalized symptoms with increased intracranial pressure causing cognitive impairment, vomiting, nausea & headaches.

Neurological signs & symptoms can either be general or focal & reflect the location of the tumor.

  • General SymptomsThese include personality changes, slowing of cognitive function, vomiting, nausea & headaches.
  • Focal Signs These include aphasia, visual loss, sensory loss, hemiparesis & others.

Incidence of Glioblastoma Tumors

Glioblastoma tumors represent about 15.4 percent of all primary brain tumors & about 60 – 75 percent of all astrocytomas. The incidence of GBM tumors increase in frequency with age of the patient & are found to affect more men than women. Moreover, only about 3 percent of childhood brain tumors are found to be glioblastomas.

Causes of Glioblastoma Tumors

Like many other types of tumors, the exact cause of development of glioblastoma tumor is not yet known. Although etiology of GBM tumors is unknown in most cases, suggested causes, however, include the following.

  • Race
  • Genetic Factors
  • Head Injuries
  • N-Nitroso Compounds
  • Occupational Hazards
  • Electromagnetic Field Exposure (inconclusive)
  • Cell Phone Use (controversial)

Diagnosing Glioblastoma Tumors

No specific laboratory studies have so far been helpful in diagnosing GBM tumors. Tumor genetics are however useful in predicting response to adjuvant therapy. Imaging studies of the brain are therefore extremely essential for diagnosing including the following.

  • MRI – Magnetic Resonance Imaging, with or without contrast
  • CT Scan – Computed Tomography
  • PET – Positron Emission Tomography
  • MRS – Magnetic Resonance Spectroscopy
  • CA – Cerebral Angiography is not necessary

Diagnosing Glioblastoma (GBM) Brain Tumors

Other diagnostic methods which can also be considered include the following.

  • ElectroencephalographyThis may show suggestive findings, but specific findings for GBM tumors will not be observed.
  • Lumbar Puncture Generally contraindicated but it is occasionally essential for ruling out lymphoma.
  • Cerebrospinal Fluid Studies This does not significantly facilitate specific diagnosis of GBM tumors.

However, in most GBM tumor cases, complete staging is neither possible nor practical. GBM tumors do not have clearly defined margins, therefore they tend to locally invade & spread along the white matter pathways & create an appearance of multiple multicentric gliomas or GBMs on imaging studies.

Management of Glioblastoma Tumors

No present treatments for glioblastomas are curative. Some standard treatments for glioblastoma tumors consist of the following.

  • Radiotherapy, maximal surgical resection, & concomitant & adjuvant chemotherapy with temozolomide.
  • Patients less than 70 years of age can consider less aggressive therapy using radiation or temozolomide alone.

Key points regarding radiotherapy for GBM tumors include the following:

  • The addition of radiotherapy to glioblastoma tumor surgery increase survival rates.
  • Responsiveness of GBM tumors to radiotherapy are found to vary.
  • Interstitial brachytherapy allows limited use & is therefore rarely used.
  • Radiosensitizers like antiangiogenic agents, targeted molecular agents & newer chemotherapeutic agents are found to increase therapeutic effects of radiotherapy.
  • Application of radiotherapy for recurrent GBM tumors is controversial.

Optimal chemotherapeutic regimen for glioblastoma tumors is not defined yet, but adjuvant chemotherapy is found to yield significant survival benefits in more than 25 percent of GBM tumor patients. Agents which are commonly used for chemotherapy include the following.

  • Temozolomide
  • Tyrosine Kinase Inhibitors (Erlotinib, Gefitinib)
  • Nitrosoureas (Carmustine [BCNU])
  • Bevacizumab for recurrent glioma (alone or with irinotecan)
  • Cisplatin
  • Inhibitors of MGMT (O6-benzylguanine)
  • Investigational therapies (like synthetic chlorotoxin, peptide & dendritic cell vaccines, gene therapy, radiolabeled drugs & antibodies).

Since GBM tumors cannot be surgically cured, surgical goals, however, remain as follows.

  • Helpful in establishing a pathological diagnosis.
  • Relieving any mass effect.
  • To achieve gross total resection in order to facilitate adjuvant therapy where it is possible.
  • Biopsy Vs Resection – Extent of surgery has shown through a number of studies to affect the length of survival in patients. Surgical options, however, include the following.
    • Gross Total Resection (has shown better survival)
    • Subtotal Resection

Stereotactic biopsy in some cases is followed by radiation therapy, especially for patients with GBM tumors located in eloquent areas of the brain, among patients whose tumors have minimal mass effect & in patients with the poor medical condition who cannot bear to undergo general anesthesia for surgery.

Treatment Procedures for Glioblastoma Tumors

Glioblastoma tumors can be difficult to treat mainly because these tumors contain many different types of cells. While some of these cells might respond well to certain therapies; others show no kind of response. This is generally why treatment plans for GBM tumors may often combine several approaches. The first step towards treatment for glioblastoma involves a procedure which is meant to make a diagnosis, relieve pressure on brain & thereafter safely remove as much of tumor as is possible through surgical intervention. However, it is very difficult to completely remove glioblastomas since they contain finger-like tentacles. This fact is particularly true in cases where GBM tumors are growing near parts of the brain which control important functions like language & coordination. Chemotherapy & radiation are commonly used to slow growth of GBM tumors which cannot be removed through surgery. Chemotherapy is also used to delay the need for radiation therapy among young children with glioblastoma tumors. Some newer types of glioblastoma treatments are also available through research studies conducted on GBM patients medically termed as clinical trials.

Glioblastoma Tumor Treatment Outcomes

Prognosis of glioblastoma tumors is generally reported in years of ‘median survival’. This is usually the time at which an equal number of patients do better while an equal number of patients worsen. Median survival for adults with anaplastic astrocytoma is between 2 – 3 years, while for adults with far more aggressive glioblastomas treated with concurrent radiation therapy & temozolomide is about 14.6 months & 2-year survival is about 30 percent. However, some studies have reported that almost 10 percent of the patients suffering from glioblastoma may be able to live 5 years or longer. Children who are down with high-grade tumors like grade III & grade IV, tend to do much better than adults & have reported 5-year survival in about 25 percent of child cases of glioblastoma. Additionally, glioblastoma tumor patients who have shut-off their MGMT gene through a process called methylation also have prolonged rates of survival. MGMT gene is thought to be a significant predictor of response. However, not all glioblastoma tumors are found to have the same kind of biologic abnormalities. This could be a good reason as to why different patients are found to respond differently to similar treatments & also why different GBM patients with similar tumors have different outcomes. Researchers, however, continue to study common characteristics of long-term brain tumor survivors & as to how targeted & personalized glioblastoma treatments may be optimally utilized in order to treat patients with brain tumors.

Emerging Biomarkers in Glioblastoma

There are several biomarkers or molecular signatures, which hold a potential to contribute to prediction, diagnosis & prognosis of a response to therapy in dealing with glioblastoma tumors. GBM or Glioblastoma Multiforme is by far the most common & most malignant of glial tumors. Among the estimated 17,000 primary brain tumors which are diagnosed in the United States every year, approximately 60 percent of these are found to be gliomas. Gliomas generally comprise of a heterogeneous group of neoplasms which differ in age & sex distribution, location within the central nervous system, in the potential for growth, the extent of invasiveness, in the tendency for progression, morphological features & in response to treatment procedures.

General Composition of Glioblastomas

Glioblastomas are generally composed of a heterogeneous mix of poorly differentiated neoplastic astrocytes which primarily affect adults & which are preferentially located within cerebral hemispheres. However, less commonly GBM tumors can also affect the brainstem, especially among children, & the spinal cord in general. These GBM tumors may also develop from lower-grade astrocytomas (grade II) or anaplastic astrocytomas (grade III), while more frequently they manifest de novo, without providing any evidence of a lesser malignant precursor lesion. Treatment of glioblastomas is usually palliative & generally includes chemotherapy, radiotherapy & surgery.

Affordable Treatments for Brain Tumors & Cancer in India

Thanks to a large & expert pool of efficient doctors & surgeons alongside a robust & extensive healthcare infrastructure comprising of nationally & internationally accredited hospital facilities, India has emerged as a favorite global medical tourism destination providing a wide variety of affordable medical solutions including cancer treatments like chemotherapy, radiotherapy & surgery for glioblastoma tumors to people from all around the world. Most healthcare facilities in India are equipped with the latest technologies at par with the best in the world & are well managed by English speaking nurses & highly skilled professional staff. With the cost of healthcare rising across the world, India is able to bring in the needed respite for international tourists who are willing to travel to developing countries offering high-quality medical procedures at reasonable costs.

Low-Cost Glioblastoma Treatments with IndianMedTrip

Based in South Asia, IndianMedTrip is one of the fastest growing & globally reputed healthcare tourism companies providing a wide spectrum of medical procedures to international patients. Associated with top-ranked surgeons & accredited hospitals, IndianMedTrip is ideally placed to pass-on cost benefits to patients without compromising on the quality of treatments. Seamless services offered by IndianMedTrip begin with the first telephonic conversation with the patient & quickly moves on to identifying the best doctor & an ideal hospital facility for the patient. Wide range of other services offered by IndianMedTrip includes assisting the patient & his accomplice obtain medical visas for travel to India, a warm reception at airport when the patient arrives for treatment, arrangements for convenient local travel, comfortable options for accommodation in budget hotels, luxury hotels or serviced apartments near the treatment facility, scheduled appointments for medical procedures with doctors & surgeons without any waiting period, choice of availing an exotic recuperative holiday at reasonable costs, follow-up evaluation checks & farewell sendoff at the airport when the patient is departing back home.

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