Glioblastoma+Multiforme+(GBM)


 * Epidemiology: || GBM is the most malignant and the most common of the glial tumors. About 60% of the 17,000 diagnosed primary brain tumors in the U.S. Are gliomas. GBM is more common in Caucasians. GBM's are slightly more common in men than women. Brain tumors occur more so in adults over the age of 30. ||
 * Etiology: || Risk factors of the GBM include being a male, being over the age of 50 and being a Caucasian or Asian. Other risk factors include having a low grade astrocytoma which can develop into a higher grade tumor. Some genetic disorders associated with GDM include neurofibromatosis, tuberous sclerosis, Von hippel-lindau disease, li-fraumeni syndrome and turcot syndrome. ||
 * Signs & Symptoms: || Some symptoms include a headache, vomiting, nausea, slowing of cognitive function and personality changes. Headaches are usually more severe in the morning but can vary in intensity. In about 20% of the cases seizures may be present. Other signs include sensory loss, visual loss, aphasia, and hemiparesis. Early indicators include but not limited to mood changes, mental capacity loss, and lack of concentration. ||
 * Diagnostic Procedures: || The procedure of choice is an MRI with and without contrast to diagnose the GBM. Currently there is no lab study that can aide in diagnosing GBM. A CT scan can be used to help diagnose GBM and it will appear hypodense irregularly shaped lesion. Other scans that are useful is a PET scan and magnetic resonance spectroscopy. Other test to diagnose GBM's would be an EEG but it cannot find specifics for GBM's. ||
 * Histology: || GBM's composed of pleomorphic astrocytic cells, poorly differentiated with marked nuclear atypia and brisk mitotic activity. An essential feature in diagnosing GBM is necrosis. GBM's have peripheral grayish look and are poorly delineated.

|| For patients with poor prognastic factors and limited expected survival, palliative treatment of of 30Gy in 10 fractions in two weeks may provide adequate symptom control. Nitrosourea-based chemotherapy may be used adjuvantly or for recurrence. [1]
 * Lymph Node Drainage: || It is rare and uncommon for lymphnode drainage from a GBM tumor due to lack of true lymph nodes in the area. The cases that I found stemmed from patients that had multiple surgeries to the brain with stents that allowed the cells to spread to the cervical lymph nodes through the cerebrospinal fluid. ||
 * Metastatic Spread: || It is more common for the GBM's the invade locally and spread along the white matter pathways. They spread via the corpus callosum, optic radiation, internal capsule, anterior commisure, subependymal regions and fornix. If there is mets the most common sites are lungs, pleura, mediastinal and cervical lypmhnodes, bone or bone marrow and liver. ||
 * Grading: || [[image:grade.png]] ||
 * Staging: || [[image:stage.png]] ||
 * Radiation Side Effects: || Side effects from radiation would be fatigue and hair loss. Other possible side effects would be loss of mental sharpness and inability to complete and think of complex tasks. This cognitive impairment would be worse for larger treatment fields and would get worse as time went on. ||
 * Prognosis: || GBM's have a poor prognosis and survival time. Long term survivors are ones that are alive more than 2 years and these are extremely rare. With people under the age of 50 with a kps greater 90 the median survival time is 17.2 months. With people under the age of 50 with a kps less than 90 the median survival time is 11.2 months. With people over the age of 50 with a kps less than 70 the median survival time is 7.5 months. ||
 * Treatments: || The treatment of choice is surgery followed by adjuvant irradiation, with the addition of chemotherapy in selected patients. Because malignant gliomas are infiltrative, even gross total resection inevitably results in tumor recurrence. Localized irradiation volumes encompass either the contrast-enhanced volume with a 3 centimeter (cm) margin or the peritumoral edema with 2 to 3 cm margin. The total standard dose should be 60 to 64 Gray (Gy) in 1.8 to 2.0Gy daily fractions.

 || GBM: Standard dose, 60-64Gy. [1]
 * TD5/5: || TD 5/5: Normal Tissue Tolerances (Gy) (1.8-2.0 Gy per fraction). [2]

||

REFERENCES.

> [1] Chao C, Perez C, Brady L. Brain, Brainstem, and Cerebellum. //Radiation Oncology.// //2nd ed//. Philadelphia, PA: Lippincott Williams & Wilkins; 2002: 129-156. > [2] Vann A, Dasher B, Chestnut S, Wiggers N. Central Nervous System Tumors. //Portal Design in Radiation Therapy. 2nd ed.// Columbia, SC: The R.L. Bryan Company; 2006: 59-69. > > > = =
 * 1) = Website Article, Glioblastoma multiforme: found at __[|h]ttp://en.wikipedia.org/wiki/Gliblastoma_multiforme__ . Accessed 5-26-2011. =
 * 2) = Website Article, A Review of Glioblastoma Multiforme: found at __[|h]ttp://www.uspharmacist.com/content/s/125/c/20820__ . Accessed 5-27-2001. =
 * 3) = Website Article, Glioblastoma Multiforme: found at __[|h]ttp://emedicine.medscape.com/article/283252-overview__ . Accessed 5-28-2011 =
 * 4) = Chao C, Perez C, Brandy L. Radiation Oncology Management Decisions. 2nd ed. Lippincott Williams & Wilkins, Philadelphia, PA. 2002:129-156. =