US Senator John McCain recently had removal of an aggressive brain tumor known as glioblastoma multiform. It is a highly aggressive form of cancer that often returns quickly to the same spot, even with surgery, radiation therapy, and chemotherapy. McCain;s tumor was associated with a small blood clot above the Arizona Republican’s left eye, and surgeons removed it using a minimally invasive procedure. A statement from the senator’s office explains that imaging suggests that the neurosurgeon successfully removed the abnormality, at least the gross, measurable tumor.
What is Glioblastoma?
A brain tumor is a mass of abnormal cells that originated in the brain itself. GMB arises from supportive tissue (not the nerves themselves) in the brain (glial cells). Rarely, glioblastoma runs in families, but most individuals with GBM have no family history of the disease. While cancer can spread to the brain from other organs such as the lungs, GBM begins in the brain and only uncommonly spreads outside of it. For most individuals, we do not know the cause of GBM, but exposure to radiation to the brain is a known risk factor for the future development of cancer of the brain.
Following a recovery period of 3 to 4 weeks, patients typically proceed to radiation therapy (RT). The RT targets the tumor (or where it use to be) and often the surrounding edema (water) plus an inch or so. Often, those with GBM also have an oral chemotherapy known as temozolamide at the same time as radiation therapy (and sometimes after it). This approach of fractionated (for example, Monday through Friday for 6 weeks) radiotherapy plus oral chemotherapy is a category 1 recommendation of the National Comprehensive Cancer Network, a group of some of the top cancer treatment facilities in America. For those over 70, one may consider this approach versus a shortened course of radiation therapy versus chemotherapy with deferred radiation therapy.
In 2011, the Food and Drug Administration approached a portable medical device that generates low-intensity electric fields termed Tumor Treating Fields (TTF) for GBM. The use of this device (placed on the head) may yield results similar to chemotherapy, but with lower toxicity and improved quality of life.
Half of patients will survive beyond about 18 months. While 10 year survival is quite uncommon, it is possible. We need better treatments, and clinical trials are an important part of achieving this. I’m Dr. Michael Hunter.
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