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Glioblastoma Multiforme

Updated : June 16, 2022





Background

The most prevalent primary brain tumor in adults is glioblastoma multiforme (GBM), which accounts for 45.2 percent of all malignant primary brain and CNS tumors. GBM is still an incurable disease with a 15-month median survival rate. Only 5.5 percent of patients lived for five years after being diagnosed.

GBMs are divided into primary and secondary subtypes that develop through various genetic routes, affecting individuals at different ages with varying outcomes.

Primary GBMs account for 80% of GBMs and are found in people over 62. In contrast, secondary GBMs are seen in patients under the age of 45 and are caused by lower-grade astrocytoma or oligodendroglioma.

Secondary GBMs are more commonly found in the frontal lobe, show less necrosis, and have a better prognosis than main GBMs. GBM is a grade IV malignancy that is aggressive, mitotically active, and necrosis-prone, according to the WHO. The prognosis for GBM is poor.

Epidemiology

The average yearly age-adjusted incidence rate (IR) of GBM is 3.19/per 100,000 population, according to the 2013 CBTRUS (Central Brain Tumor Registry of the United States) study. Malignant brain and CNS tumors have the most incredible incidence rate.

Adults with a median age of 64 years are most diagnosed with GBM. It is exceptionally uncommon among children. The incidence rises with age, peaking between 75 and 84 years old and declining after 85. Given the aging population in the United States, the number of cases is likely to rise.

Men are more likely than women to develop GBMs; men have a 1.57 percent higher incidence rate than women. Primary GBMs are more common in men, while secondary GBMs are more common in women.

Whites have the highest rate of GBM, followed by blacks. GBMs are most common in the supratentorial region and highly uncommon in the cerebellum and spinal cord.

Anatomy

Pathophysiology

Mutations cause aberrant proliferation, growth, and angiogenesis in malignant cells. Many genetic and epigenetic modifications have been discovered in GBM. Conversions must be identified and classified to understand tumor behavior and treatment resistance throughout the clinical course.

Glioblastoma multiforme is divided into primary tumors developing from neural stem cell progenitors and secondary tumors arising from mutations in mature brain cells such as astrocytes due to several triggering mutations in addition to essential alterations in GBM stem cells.

Modifications in genetic information, resulting in gene expression and suppression relative to physiological levels in healthy brain cells, cause cellular and extracellular matrix changes, resulting in various biochemical manifestations. Because of the wide range of genotypic variability, the species is called multiforme.

Etiology

In glioblastoma multiforme, many genetic and environmental factors have been explored, but no risk factor that accounts for a high proportion of GBM has been identified. GBM, like many other malignancies, is sporadic, yet research found that patients with GBM have a high prevalence (17%) of past therapeutic irradiation.

Irradiation and the onset of GBM can take a few years to several decades. Various studies linked decreased sensitivity to allergies, immunological factors, immune genes, and some single nucleotide polymorphisms found in genome-wide association studies to an increased risk of GBM.

Allergies and atopic diseases have been linked to a lower risk of gliomas in studies. Anti-inflammatory medicine used for fewer than 10 years is also linked to a protective effect against GBM in the near run. There is no convincing evidence that GBM is linked to lifestyle factors such as smoking, alcohol consumption, drug use, or N-nitroso compound exposure.

Studies have demonstrated that using a cell phone does not raise the chance of developing GBM; nevertheless, the link between long-term use and the development of GBM needs to be confirmed.

Genetics

Prognostic Factors

Age, performance status, MGMT methylation status, and IDH1/2 mutation status have all been demonstrated to affect survival. Compared to their counterparts, young age, good performance status, MGMT methylation, and IDH 1/2 mutant variety confers enhanced survival.

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

 

carmustine

7.7 mg 8 wafers i.e., 61.6 mg of total dose implanted intracranially



temozolomide

Concomitant phase :

75

mg/m^2

once a day

42

days


Monotherapy Phase:
Cycle 1: 50 mg/m2 orally/IV once a day 5 days followed by 23 days without treatment
Cycles 2-6: 200 mg/m2 orally/IV by mouth once a day First 5 days of each cycl



 
 

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK558954/

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Glioblastoma Multiforme

Updated : June 16, 2022




The most prevalent primary brain tumor in adults is glioblastoma multiforme (GBM), which accounts for 45.2 percent of all malignant primary brain and CNS tumors. GBM is still an incurable disease with a 15-month median survival rate. Only 5.5 percent of patients lived for five years after being diagnosed.

GBMs are divided into primary and secondary subtypes that develop through various genetic routes, affecting individuals at different ages with varying outcomes.

Primary GBMs account for 80% of GBMs and are found in people over 62. In contrast, secondary GBMs are seen in patients under the age of 45 and are caused by lower-grade astrocytoma or oligodendroglioma.

Secondary GBMs are more commonly found in the frontal lobe, show less necrosis, and have a better prognosis than main GBMs. GBM is a grade IV malignancy that is aggressive, mitotically active, and necrosis-prone, according to the WHO. The prognosis for GBM is poor.

The average yearly age-adjusted incidence rate (IR) of GBM is 3.19/per 100,000 population, according to the 2013 CBTRUS (Central Brain Tumor Registry of the United States) study. Malignant brain and CNS tumors have the most incredible incidence rate.

Adults with a median age of 64 years are most diagnosed with GBM. It is exceptionally uncommon among children. The incidence rises with age, peaking between 75 and 84 years old and declining after 85. Given the aging population in the United States, the number of cases is likely to rise.

Men are more likely than women to develop GBMs; men have a 1.57 percent higher incidence rate than women. Primary GBMs are more common in men, while secondary GBMs are more common in women.

Whites have the highest rate of GBM, followed by blacks. GBMs are most common in the supratentorial region and highly uncommon in the cerebellum and spinal cord.

Mutations cause aberrant proliferation, growth, and angiogenesis in malignant cells. Many genetic and epigenetic modifications have been discovered in GBM. Conversions must be identified and classified to understand tumor behavior and treatment resistance throughout the clinical course.

Glioblastoma multiforme is divided into primary tumors developing from neural stem cell progenitors and secondary tumors arising from mutations in mature brain cells such as astrocytes due to several triggering mutations in addition to essential alterations in GBM stem cells.

Modifications in genetic information, resulting in gene expression and suppression relative to physiological levels in healthy brain cells, cause cellular and extracellular matrix changes, resulting in various biochemical manifestations. Because of the wide range of genotypic variability, the species is called multiforme.

In glioblastoma multiforme, many genetic and environmental factors have been explored, but no risk factor that accounts for a high proportion of GBM has been identified. GBM, like many other malignancies, is sporadic, yet research found that patients with GBM have a high prevalence (17%) of past therapeutic irradiation.

Irradiation and the onset of GBM can take a few years to several decades. Various studies linked decreased sensitivity to allergies, immunological factors, immune genes, and some single nucleotide polymorphisms found in genome-wide association studies to an increased risk of GBM.

Allergies and atopic diseases have been linked to a lower risk of gliomas in studies. Anti-inflammatory medicine used for fewer than 10 years is also linked to a protective effect against GBM in the near run. There is no convincing evidence that GBM is linked to lifestyle factors such as smoking, alcohol consumption, drug use, or N-nitroso compound exposure.

Studies have demonstrated that using a cell phone does not raise the chance of developing GBM; nevertheless, the link between long-term use and the development of GBM needs to be confirmed.

Age, performance status, MGMT methylation status, and IDH1/2 mutation status have all been demonstrated to affect survival. Compared to their counterparts, young age, good performance status, MGMT methylation, and IDH 1/2 mutant variety confers enhanced survival.

carmustine

7.7 mg 8 wafers i.e., 61.6 mg of total dose implanted intracranially



temozolomide

Concomitant phase :

75

mg/m^2

once a day

42

days


Monotherapy Phase:
Cycle 1: 50 mg/m2 orally/IV once a day 5 days followed by 23 days without treatment
Cycles 2-6: 200 mg/m2 orally/IV by mouth once a day First 5 days of each cycl



https://www.ncbi.nlm.nih.gov/books/NBK558954/

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