Glioblastoma treatment options in adults
Glioblastoma, also known as glioblastoma multiforme (GBM), is the most aggressive form of primary brain tumor in adults. Despite advances in neuroscience and oncology, glioblastoma remains one of the most challenging cancers to treat due to its rapid growth, invasive nature, and resistance to conventional therapies. Treatment options are multifaceted, typically involving a combination of surgery, radiotherapy, chemotherapy, and emerging targeted therapies, all aimed at prolonging survival and improving quality of life.
Surgical intervention is generally the first step in glioblastoma treatment whenever feasible. The primary goal is maximal safe resection—removing as much of the tumor as possible while preserving neurological function. Complete resection is often impossible because glioblastoma tends to infiltrate surrounding brain tissue. Nevertheless, even partial removal can reduce tumor burden, alleviate symptoms, and provide tissue samples for precise diagnosis. Advances in neuroimaging and surgical techniques, such as intraoperative MRI and awake craniotomy, have enhanced the safety and efficacy of tumor removal.
Following surgery, radiotherapy plays a pivotal role. The standard approach involves fractionated external beam radiation therapy administered over several weeks. This treatment aims to target residual tumor cells that surgery couldn’t remove. The typical dose is around 60 Gy, delivered in daily fractions. Radiotherapy not only helps control local tumor growth but also extends survival modestly. Recent developments include stereotactic radiosurgery and proton therapy, which offer more precise targeting, potentially reducing damage to healthy brain tissue.
Chemotherapy, primarily with the drug temozolomide (TMZ), is integrated with radiotherapy in standard care protocols. TMZ is an oral alkylating agent that can cross the blood-brain barrier, making it effective against glioblastoma cells. When combined with radiotherapy, it has been shown to improve median survival from approximately 12 months to about 15 months. The treatment usually continues post-radiation for several cycles, depending on patient tolerance and response. Researchers are actively investigating other chemotherapeutic agents, immunotherapies, and personalized medicine approaches to enhance outcomes further.
In recent years, targeted therapies and immunotherapies have emerged as promising options. For example, drugs targeting specific molecular pathways involved in glioblastoma growth—such as angiogenesis inhibitors like bevacizumab—have been used to manage recurrent disease. While these therapies can temporarily reduce tumor-related symptoms and slow progression, they have not yet significantly extended overall survival in most cases. Nonetheless, ongoing clinical trials are exploring novel agents, vaccine-based therapies, and immune checkpoint inhibitors, aiming to harness the body’s immune system against the tumor.
Tumor treating fields (TTFields) represent a novel, non-invasive treatment modality. This technology involves wearing a device that delivers low-intensity, alternating electric fields targeting dividing tumor cells. Approved for recurrent and newly diagnosed glioblastoma, TTFields have demonstrated a survival benefit when combined with chemotherapy, offering another option for patients.
Overall, the management of glioblastoma in adults is complex and highly individualized. While current treatments are not curative, they can extend life and improve quality, especially when tailored to the tumor’s molecular profile and the patient’s overall health. Multidisciplinary care involving neurosurgeons, oncologists, radiologists, and supportive care specialists is essential. Advances in research continue to bring hope for more effective therapies in the future.
