Glioblastoma Treatment: How Do Doctors Treat This Brain Tumor?

Glioblastomas are notoriously wily and difficult to treat. Despite that, survival statics are inching up as doctors learn more about how to handle these difficult tumors.

When Senator John McCain of Arizona was diagnosed withglioblastomain 2017, news reports on his prognosis were grim. Most news outlets reported — accurately — that glioblastoma is an aggressive cancer with a poor prognosis.

While a cure remains elusive, oncologists are gradually improving the outlook for patients with glioblastoma. Mark Gilbert, MD, chief of the National Institute of Health’s Neuro-Oncology Branch, notes that progress against the disease has been real, but slow. “We have seen incremental improvements in survival. The median length of survival was only 8 to 10 months in the mid-1990s, but it has almost doubled to 15 to 18 months now,” he says. (1)

At that time, only a handful of patients lived five years. Now, 15 percent of them do. That’s real progress, but it falls far short of where oncologists would like to be. According to Dr. Gilbert, about 14,000 Americans get glioblastoma each year, most of them active, healthy people. They need better treatments. (1)

成人大脑和脊髓肿瘤是什么？

Brain and spinal cord tumors, like other tumors, are made of abnormal cells that grow out of control.

Elsewhere in the body, tumors can be benign — meaning they won’t spread elsewhere in the body — or malignant, which means they will. The malignant tumors are, of course, the most dangerous.

In the brain, things are different. Brain tumors do not usually spread to other parts of the body. But they can damage the brain tissue in which they reside, sometimes enough to be fatal. (2)

What Is a Glioblastoma Tumor Made Of?

Many kinds of tissue are found in the brain, and each can give rise to a tumor that's different from the tumors that occur in other cells. (2)

神经元是负责思想，记忆，情绪和其他较高大脑功能的大脑中的关键细胞。神经元通常不会引起肿瘤。

Glial cells are the supporting cells — the scaffolding that holds things together. There are three types of glial cells, each of which can give rise to tumors:

• Oligodendrocytes第一种类型的神经胶质细胞，少突诚丝素会使髓磷脂是一种围绕神经细胞轴突的脂肪化合物 - 携带电脉冲的长纤维。髓鞘是绝缘材料，例如橡胶灯绳或周围和隔热电线的电缆。这些细胞会引起寡胶质瘤。
• Ependymal CellsThe second type of cells line fluid-filled areas in the brain called ventricles. They can give rise to ependymomas.
• AstrocytesThe third type of glial cells, astrocytes help to nourish neurons. They form scar tissue when the brain is damaged. Tumors that begin in these cells are called astrocytomas or glioblastomas.

What Are the Symptoms of Glioblastoma?

症状取决于脑肿瘤发生的位置。有些发生在大脑的大脑外部，这是诸如情感，语言和推理以及视觉，听力和运动等事物的原因。（2）

For example, tumors that arise in the cerebrum can cause seizures, trouble speaking, a change in personality, and weakness in the body. Tumors in the cerebellum, which lies beneath the cerebrum, can cause problems walking, moving, swallowing, and speaking.

Why Are Glioblastomas So Hard to Treat?

All of these cells and tumors reside behind what’s called the blood-brain barrier, a network of capillaries that create a barrier to keep harmful toxins and infectious organisms from entering the brain. Unfortunately, this makes it harder for chemotherapy drugs to get to the tumors they are designed to fight.

Astrocytomas, unlike some other brain tumors, can spread throughout the brain, where they blend with normal, healthy tissue. That makes them difficult to excise with surgery. It’s hard to know where the tumor ends and the healthy tissue begins. If surgeons leave even a few glioblastoma cells behind, those remnants can continue to spread through the brain.

另一个问题，根据吉尔伯特的说法National Cancer Institute，是胶质母细胞瘤是异质的。也就是说，它们包含各种细胞种群，其中一些对治疗有反应，而另一些则没有。这些其他细胞徘徊并通过大脑传播，导致长期成功。（1）

还有更多。吉尔伯特说：“头骨为固定壳提出了治疗胶质母细胞瘤的另一个挑战。”“癌症疗法可能导致组织肿胀。例如，当我们治疗肝癌时，肝脏会在腹腔中肿胀。但是，就大脑而言，没有地方可以扩展，因为头骨是硬壳。我们必须非常谨慎地使用可能导致大脑肿胀的治疗，这限制了我们可以使用的治疗方法。”（1）

您的医生将用什么来治疗胶质母细胞瘤？

Surgery is often used to treat brain tumors. Radiation and chemotherapy also play a role. The doctors involved in treating brain tumors can include neurologists, oncologists, and endocrinologists, who look for disease in glands that secrete hormones. (3)

Doctors will often choose surgery as the first treatment for glioblastoma and other gliomas, although it is usually not entirely successful at removing all of the tumor cells. Radiation therapy is often used as a follow-up to destroy remaining tumor cells, and then chemotherapy.

According to the American Cancer Society, the chemotherapy drug used by most doctors istemozolomide, because it crosses the blood-brain barrier and can be taken as a pill. Other drugs your doctor might mention are铂（顺铂）,BiCNU (carmustine)， 和Gleostine (lomustine)。Combinations of drugs might also be used to treat the tumors.

These regimens can slow tumor growth, but are unlikely to cure the tumor. Also, brain tumors that occur in children can be different and require different treatments. (3)

What Does the Future Hold for Treatment of Glioblastoma?

沃尔特·J·柯伦（Walter J. Curran），医学博士, the executive director of the埃默里大学的Winship Cancer Institute在亚特兰大,乐观地认为treatin的进展g glioblastoma will continue, despite the difficulties.

他说：“手术方法有很大的改善，包括检测肿瘤解剖结构的新方法。”2017年7月发表的文章今天在Medpage上发表。That is, new techniques are making it easier to see where the tumor begins and ends, making radiation treatment more effective.

Gilbert notes that new techniques under development could improve the outlook for patients with glioblastoma. They include using the body’s own immune system to fight the tumors.

“Although the improvements in outcomes have been small and slow, we are optimistic that with continued research efforts, we will discover better, less-toxic treatments and make progress against this disease.” (4)