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> Malignant Astrocytomas - Glioblastoma multiforme
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Malignant Astrocytomas - Glioblastoma multiforme
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Glioblastoma multiforme most commonly presents in the sixth decade with an increasing incidence with each decade of life. These tumors account for 50% of all astrocytic tumors and 25% of primary brain tumors in adults. Their highly malignant nature is evidenced by a relatively short duration of symptoms which is less than 6 months in two-thirds of patients. The presenting symptoms also reflects a rapidly growing mass lesion, with signs of increased intracranial pressure and focal neurologic deficits predominating. Headaches, papilledema (swelling of the optic nerve due to increased intracranial pressure), mental status changes, and hemiparesis (weakness of one half of the body) are present in over 60% of patients. Vomiting, aphasia, hemianopia (loss of one side of vision due to damage to the visual area of one half of the brain), and a decreased level of consciousness are present in one-third of patients at the time of diagnosis. With aggressive surgery, radiotherapy, and chemotherapy, median survival is still approximately one year.
Other modalities such as interstitial implants of Gliadel® Wafers (carmustine-impregnated, biodegradeble wafers) are approved for use in patients with recurrent glioblastoma. Some physicians are implanting these wafers at the time of initial surgery for malignant gliomas (probably best done with the preoperative approval of the insurance company) and there are several ongoing studies evaluating this indication. A stereotactic radiosurgery boost with the Gamma Knife to the residual or recurrent tumor bed may also play a role in the initial and subsequent management of these tumors. Many other treatment options including gene therapy, biologic modifiers and various chemotherapy regimens are available and an excellent starting point for investigating these options is Al Musella's List of Clinical Trials and Noteworthy Treatments. |
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