Glioblastoma multiforme medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
The predominant therapy for glioblastoma multiforme is [[surgical resection]]. Adjunctive [[chemotherapy]] and [[radiation]] may be required.<ref name=ddd>Treatment of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref><ref name="pmid25468225">{{cite journal| author=Barani IJ, Larson DA| title=Radiation therapy of glioblastoma. | journal=Cancer Treat Res | year= 2015 | volume= 163 | issue= | pages= 49-73 | pmid=25468225 | doi=10.1007/978-3-319-12048-5_4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25468225 }} </ref><ref name="pmid20044633">{{cite journal| author=Minniti G, Muni R, Lanzetta G, Marchetti P, Enrici RM| title=Chemotherapy for glioblastoma: current treatment and future perspectives for cytotoxic and targeted agents. | journal=Anticancer Res | year= 2009 | volume= 29 | issue= 12 | pages= 5171-84 | pmid=20044633 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20044633 }} </ref> | *The predominant therapy for glioblastoma multiforme is [[surgical resection]]. Adjunctive [[chemotherapy]] and [[radiation]] may be required.<ref name=ddd>Treatment of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma</ref><ref name="pmid25468225">{{cite journal| author=Barani IJ, Larson DA| title=Radiation therapy of glioblastoma. | journal=Cancer Treat Res | year= 2015 | volume= 163 | issue= | pages= 49-73 | pmid=25468225 | doi=10.1007/978-3-319-12048-5_4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25468225 }} </ref><ref name="pmid20044633">{{cite journal| author=Minniti G, Muni R, Lanzetta G, Marchetti P, Enrici RM| title=Chemotherapy for glioblastoma: current treatment and future perspectives for cytotoxic and targeted agents. | journal=Anticancer Res | year= 2009 | volume= 29 | issue= 12 | pages= 5171-84 | pmid=20044633 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20044633 }} </ref> | ||
*Cytotoxic therapy for GBM has evolved due to the approval of temozolomide which is an alkylating agent. | |||
*Active agents include also the nitrosureas that include carmustine (BCNU) and lomustine (CCNU), platinum agents, etoposide, irinotecan and PCV combination. | |||
*Temozolomide is a newer oral alkylating agent that has excellent penetration into the central nervous system. | |||
===Radiotherapy=== | ===Radiotherapy=== | ||
*[[Radiotherapy|Post-operative radiotherapy]] is recommended among all patients who develop glioblastoma multiforme. | *[[Radiotherapy|Post-operative radiotherapy]] is recommended among all patients who develop glioblastoma multiforme. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Marjan Khan M.B.B.S.[2]
Overview
The predominant therapy for glioblastoma multiforme is surgical resection. Adjunctive chemotherapy and radiation may be required.[1][2][3] Supportive therapy for glioblastoma multiforme includes anticonvulsants and corticosteroids.Cytotoxic therapy for GBM has evolved due to the approval of temozolomide,an alkylating agent- for newly diagnosed GBM. Active agents include also the nitrosureas which include carmustine and lomustine, platinum agents, etoposide, irinotecan and PCV combination.
Medical Therapy
- The predominant therapy for glioblastoma multiforme is surgical resection. Adjunctive chemotherapy and radiation may be required.[1][2][3]
- Cytotoxic therapy for GBM has evolved due to the approval of temozolomide which is an alkylating agent.
- Active agents include also the nitrosureas that include carmustine (BCNU) and lomustine (CCNU), platinum agents, etoposide, irinotecan and PCV combination.
- Temozolomide is a newer oral alkylating agent that has excellent penetration into the central nervous system.
Radiotherapy
- Post-operative radiotherapy is recommended among all patients who develop glioblastoma multiforme.
- Adjuvant radiotherapy can reduce the tumor size to 107 cells.
- Radiotherapy may not cure the cancer, but can control the tumor and delay recurrence.
- Targeted three-dimensional conformal radiotherapy is preferred to whole brain radiotherapy.
- Total radiation dose of 5,000-6,000 cGy has been found to be optimal for treatment.[2]
Chemotherapy
- Chemotherapy is indicated as adjuvant therapy for glioblastoma multiforme.[3]
- Temozolomide (Temodar) is the preferred drug for the treatment of glioblastoma multiforme.[3]
- Other chemotherapeutic drugs that may be used for the treatment of glioblastoma multiforme include:
Supportive treatment
Supportive therapy for glioblastoma multiforme includes anticonvulsants and corticosteroids, which focuses on relieving symptoms and improving the patient’s neurologic function.
- Anticonvulsants are administered to the patients who have a seizure. Phenytoin given concurrently with radiation may have serious skin reactions such as erythema multiforme and Stevens-Johnson syndrome.
- Corticosteroids, usually dexamethasone given 4-10 mg every 4-6 h, can reduce peritumoral edema, diminish mass effect, and lower intracranial pressure with a decrease in headache or drowsiness.
References
- ↑ 1.0 1.1 Treatment of glioblastoma multiforme. Dr Dylan Kurda and Dr Frank Gaillard et al. Radiopaedia 2015. http://radiopaedia.org/articles/glioblastoma
- ↑ 2.0 2.1 2.2 Barani IJ, Larson DA (2015). "Radiation therapy of glioblastoma". Cancer Treat Res. 163: 49–73. doi:10.1007/978-3-319-12048-5_4. PMID 25468225.
- ↑ 3.0 3.1 3.2 3.3 Minniti G, Muni R, Lanzetta G, Marchetti P, Enrici RM (2009). "Chemotherapy for glioblastoma: current treatment and future perspectives for cytotoxic and targeted agents". Anticancer Res. 29 (12): 5171–84. PMID 20044633.