5 new ideas that are changing the management of brain tumor patients:1. Prognosis and glioma subtypes. The cell of origin of the glioblastoma has never been defined. In his pioneering work “Death Foretold,” Dr. Christakis says “prognosis gives diagnosis its affective component, striking fear in patients and physicians alike.” There has been a lot of therapeutic nihilism about the treatment of glioblastoma, but that is now changing. Image source: Sen. Ted Kennedy who died of glioma in 2009.
2. Diagnosis and imaging mimics. Acute stroke in the luxury perfusion stage is probably the most common mimic of a brain tumor. Diffusion MRI sequences and perfusion CT scan are helpful in differentiating stroke from tumor by showing hypoperfusion as would be expected, rather than hyperperfusion seen in tumors.
3. Treatment and pseudoprogression. Temozolomide is an oral drug, which is changed into MTIC (methyltriazeno-imidazole-carboxamide), a DNA-methylating drug. The concomitant use of radiation therapy and adjuvant temozolomide in glioblastoma patients showed a median survival of 14.6 months.
Increase in contrast enhancement and mass effect can mimic tumor progression. The term “pseudoprogression” describes the inflammatory reaction to effective treatment. Increasing steroid doses can control the edema.
4. Antiepileptic drugs. Prophylactic use of antiepileptic drugs (AEDs) is not recommended in patients with brain tumor due to lack of efficacy. The interactions between AEDs and chemotherapy can also be problematic.
5. Quality of life issues. The incidence of common symptoms reported was fatigue (90%–94%), sleep disturbance (32%–52%), headache (50%), and cognitive impairment (50%). Ritalin, modafinil, and Aricept have all been shown to have a positive effect on mood and cognition. Cause of death was presumed brain herniation 73% of the time.
References:
Diagnosis, treatment, and prognosis of glioma. Five new things. Lynne P. Taylor, MD. Neurology November 2, 2010 vol. 75 no. 18 Supplement 1 S28-S32.
Image source: Sen. Kennedy who died of glioma in 2009, Wikipedia, GNU Free Documentation license.
I have undergone a surgical intervention for GBM, followed by radiotherapy and chemiotherapy with temozolomide. I'm now living, as you can see, I feel well even if I suffer sometimes for headache, I have no neuromuscolar deficit,no epilepsy, I see well, I drive my car, in this year I risked no crash, I live my normal life. My ultrasonic examinations show no recurrences of the tumour: so I think that a big help from the therapy rises from our inner soul. When I had the diagnosis I felt like a soldier who had to win a battle. I decided never to give up to the tumour and to fight against it not only making therapies but also living my life as if it should never hurt me, working, taking my time for what I wished to do as travels (I went twice in the Greek egean islands), spending a lot of time with my family possibly in happiness, and never talking with them about my disease in order to help them to live this situation. And now I feel fine (I've undergone the surgical intervention 13 monthes ago). So I advise to all the patients sick for glioblastoma to keep their lifes the best they can as if the tumour shouldn't exist and never loose their hope. I mean "follow the follow-up procedures and do what the doctors say, but live your life keeping that the word "to heal" hasn't been completely cancelled by your vocacabulary." Mauro from Italy
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