Treatment for Glioblastoma Multiforme (GBM)
Glioblastoma multiforme (GBM) is a type of brain cancer tumor. Treatment is often done with surgery, radiation, and chemotherapy. GBM is a fast-growing cancer that tends to come back. Survival is usually less than a year, even with treatment.
Coping with treatment for glioblastoma multiforme
You will be working with a team of doctors and other medical staff. Make sure to ask them any questions you have. Talk with your team if you have side effects, have trouble keeping your appointments, or have problems in your personal life. Keep in mind that depression is a common problem during cancer treatment. Ask for a referral to a psychologist or psychiatrist if you need one. They can help you cope with your diagnosis and 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:
Neurologist or neurosurgeon. These are doctors who treat diseases of the brain.
Oncologist or neuro-oncologist. These are doctors who treat cancer.
Nurses. These healthcare providers work with you and your doctors to provide care.
Social worker. A social worker can help you make plans and decisions about your life.
Physical therapist (PT). A PT can help you regain strength and mobility.
Occupational therapist (OT). An OT can help you manage day-to-day tasks.
Goals of treatment
Your goals of treatment will depend on your age, your overall health, and the size and location of your tumor. They also depend on if the tumor has spread to other parts of your body. 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 radiation therapy.
Palliative care only. This is care with medicines or radiation therapy to ease symptoms only. Some people choose to have only palliative care. It helps a person be comfortable and have the best quality of life without active treatment of the cancer.
Your doctors will help you decide what’s best for you.
Types of treatment for GBM
The first step in active treatment is often surgery. This is done to remove as much of the tumor as possible while keeping as much brain function as possible. Removing the tumor (resection) is usually done if the tumor can be removed safely. Surgery also gives the healthcare team an exact diagnosis. And it reduces the tumor size. In some cases, the surgeon can’t remove the whole tumor. This may be because it is 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.
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. This may be done to kill any cancer cells left after surgery. Radiation therapy may be used as the main treatment if surgery is not an option. It can also help relieve symptoms caused by a tumor.
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, 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.
Newer medicines may be used that stop the ability of tumor cells to make blood vessels. A tumor needs nutrients in 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.
Other medicines might be used to help relieve symptoms caused by the tumor or its treatment. For instance, you might be given medicines to help prevent seizures or to help control swelling in the brain.
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 you should consider. In a clinical trial you may be able to get treatment that is 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
Changes in brain function
Nausea and vomiting
You will need regular follow-up care. This is to see how the treatment is working. It is also to watch for signs of the GBM growing back. Your follow-up care will include regular exams and MRIs. 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 will have the option of more treatment such as:
Repeat radiation therapy
Chemotherapy with temozolomide or other medicines
Additional surgery, which may include placement of chemotherapy wafers near the tumor
The use of low-energy electrical fields to treat the cancer (alternating electrical field therapy)
Taking part in a clinical trial