Treatment for Glioblastoma Multiforme (GBM)

Coping with treatment for glioblastoma multiforme

You'll be working with a team of healthcare providers. Make sure to ask them any questions you have. Talk with your team if you have side effects, trouble keeping your appointments, financial concerns, or problems in your personal life. They can help you and your family find support.

Also keep in mind that depression is very common during cancer treatment. Talk to your team about how you're feeling. Ask for a referral to a psychologist or psychiatrist if you need one. You and your family can get help as you cope with cancer and cancer treatment.

Your treatment team

Your treatment team will work together to help you decide the best way to treat and manage your GBM. Your team may include:

• Neurosurgeon. This healthcare provider does brain surgery and often leads your treatment team.

• Neurologist. This healthcare provider diagnoses and treats diseases of the brain.

• Radiation oncologist. This healthcare provider uses radiation to treat cancer.

• Medical oncologist. This healthcare provider uses chemotherapy and other medicines to treat cancer.

• Nurses. These healthcare providers work with you and other team members to give your cancer treatments and watch how you're doing during treatment.

• Social worker. A social worker can help you make plans and decisions about your life. They can help you with financial and insurance problems, too.

• Physical therapist (PT). A PT can help you regain strength and mobility.

• Occupational therapist (OT). An OT can help you learn how to manage day-to-day tasks.

Goals of treatment

Your treatment goals will depend on your overall health, the size of the tumor, it's location in your brain, and your preferences. They also depend on if the cancer has spread to other parts of your body. You may choose:

• Active treatment to try to cure the cancer, keep it from growing and spreading, or help delay its return. This most often includes surgery, as well as chemotherapy, radiation therapy, or both.

• Palliative care to ease symptoms only. These treatments are not used to treat the cancer itself. Some people choose to have only palliative care. It helps a person be comfortable and have the best quality of life for as long as possible.

Your healthcare providers will help you decide what’s best for you. Most experts agree that treatment in a clinical trial should be considered for people with GBM. This way people can get the best treatment available now and may also get the treatments that are thought to be even better.

Types of treatment for GBM

Surgery

The first treatment is often surgery. This is done to take out as much of the tumor as possible while keeping normal brain function. Removing the tumor (called resection) is only done if the tumor can be taken out safely. Surgery gives an exact diagnosis because the tumor can be tested in a lab. It also reduces the tumor size.

In some cases, the surgeon can’t remove all of the tumor. This may be because it's near key parts of the brain. Or it may be growing into the brain like fingers of a glove. But taking out even part of the tumor can help reduce pressure in the brain. This can help ease certain symptoms.

Radiation therapy

The goal of radiation is to kill cancer cells and keep them from growing. This is done using X-rays, gamma rays, or proton beams.

Radiation is most often given once a day, 5 days a week, for up to 6 weeks. It may be used to kill any cancer cells left after surgery. It may be the main treatment if surgery is not an option. It can also help relieve symptoms caused by the tumor.

Chemotherapy

Chemotherapy may be used after surgery. It is often given along with radiation. The goals are to kill cancer cells that may remain after surgery and help reduce the chance that the cancer will grow and spread. It may also help ease problems the tumor is causing.

In most cases, the chemotherapy medicines used are taken by mouth as pills. But they may also be put into your blood through an IV (intravenous) line. This is a soft catheter that's in a vein. Sometimes, wafers of chemotherapy are put right into the brain after the tumor is removed.

Targeted therapy

If treatment isn't working or the GBM comes back after treatment, medicines that keep the tumor cells from making blood vessels might be used. A tumor needs nutrients in the blood to grow and spread. When a tumor can't get blood, it starves and dies. Bevacizumab is a targeted medicine that may be used to treat GBM. It's often given along with chemotherapy.

Alternating electric field therapy

This treatment uses a battery-operated device that sends a mild electric current through 4 electrodes that stick on the scalp. It's believed to work by interfering with the growth and spread of tumor cells. It may be used along with chemo after surgery and radiation. It may be used alone if the tumor comes back after treatment.

Other medicines

Other medicines might be used to help ease symptoms caused by the tumor or cancer treatment. For instance, you might be given medicines to help prevent seizures or to help control swelling in the brain.

Clinical trials

GBM can be very hard to treat and control with the treatments available today. Researchers are looking for new and better ways to treat GBM. These new methods are tested in clinical trials. Taking part in a clinical trial means you get the best treatment available today. You might also get new treatments that are thought to be even better. Before starting treatment, you may want to ask your healthcare team if there are any clinical trials that might be right for you. In a clinical trial, you may be able to get treatment that's not yet widely available.

Side effects of treatment

Most cancer treatments have side effects. This is because they damage healthy cells along with the cancer cells. Talk with your healthcare provider about what side effects your types of treatment may have. Some common side effects include:

• Increased risk for infection

• Bleeding

• Extreme tiredness

• Changes in brain function

• Hair loss

• Nausea and vomiting

• Trouble sleeping

• Weight gain

• Mood swings

• Depression

Follow-up care

You'll need regular follow-up care. This is to see how the treatment is working. It's also to watch for signs that the GBM is growing back. Your follow-up care will include regular exams and MRIs every few months.

If GBM comes back

If your GBM comes back, you'll have the option of more treatment, such as:

• Repeat radiation therapy

• Chemotherapy

• More surgery, which may include putting chemotherapy wafers near the tumor

• Alternating electrical field therapy

• Palliative care

• Taking part in a clinical trial