Treatment Guidelines for Patients with Newly Diagnosed Glioblastoma Multiforme
For the first time ever, the American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Section on Tumors has issued treatment guidelines for patients with newly diagnosed glioblastoma multiforme. The guidelines were published in the September issue of the Journal of Neuro-Oncology.
Approximately 20,000 people are diagnosed with primary brain cancer in the U.S. each year. Primary brain cancer is cancer that originates in the brain, as opposed to cancer that has spread to the brain from elsewhere in the body.
Glioblastoma multiforme (GBM) is one of the most common and fatal types of primary brain cancer. When glioblastoma is present, glial cells become malignant and grow rampantly. Glial cells are the most abundant cells present in the nervous system. They provide many supportive functions that facilitate the majority of processes conducted by neurons (cells that transmit impulses between the brain, spinal column, and nerves).
The prognosis for patients with GBM is poor, with most patients surviving less than one year from diagnosis. Because of the rapidly developing nature of GBM, early and aggressive treatment is important. Standard treatment options include surgical removal of the cancer when possible, radiation therapy, and/or chemotherapy.
Now, a group of researchers has reviewed the results of several studies to produce evidence-based guidelines for the treatment of patients with newly diagnosed GBM. The treatment guidelines consist of three levels:
- Level 1: For patients ages 18-70 with adequate overall health, chemotherapy treatment with temozolomide both during and after radiation is recommended.
- Level 2: Patients undergoing craniotomy (surgery to remove the tumor) are recommended to receive BCNU implants. A BCNU implant is a small, dime-sized wafer that contains the chemotherapeutic agent carmustine. During surgery, this wafer is placed directly into the cavity created when the brain tumor is removed. The wafer then slowly dissolves and delivers the chemotherapy. Currently, the Gliadel wafer is the only FDA-approved chemotherapeutic implant for use during surgical resection.
- Level 3: Patients who are older than 70 years with a Karnofsky performance status (KPS) above 50 may receive temozolomide in addition to radiation therapy. For patients who cannot tolerate temozolomide, radiation therapy followed by one of the nirtrosoureas is recommended.
The availability of these new guidelines provides an additional resource for physicians in making treatment decisions. Furthermore, it provides additional information for patients and helps increase awareness of treatment options.
Reference: Fadul, C., Wen, P., Kim, L., et al. Cytoxic chemotherapeutic management of newly diagnosed glioblastoma multiforme. Journal of Neuro-Oncology. 2008;89:339-357.