Glioblastoma is one of the most common types of brain tumor and is classified as a glioma. The tumor of the brain tissue occurs most frequently in middle-aged people (45 to 70 years). It is known for its rapid and diffuse growth. Here you will find further information as well as selected glioblastoma specialists and centers.
Glioblastomas are so-called diffuse infiltrating brain tumors. This means that they grow into healthy brain tissue instead of displacing it. The term "glioma" refers to the outdated assumption that glioblastomas originate from the supporting tissue of the nervous system, the so-called glial cells.
Due to its characteristics, the World Health Organization (WHO) classifies glioblastomas as grade IV and therefore as an aggressive tumor. In the majority of cases, the glioblastoma first forms in one of the two cerebral hemispheres (Fig. 1)
Fig. 1: Glioblastoma in the MRI (left) and with representation of the infiltration zone not visible in the left MRI (double arrows) and the path of movement (arrow). [Source: Prof. Dr. Andreas Raabe, Inselspital Bern]
The intensity and severity of the symptoms of a glioblastoma depend on where exactly the brain tumor is located. Depending on the region of the brain affected, completely different symptoms occur, which often makes diagnosis difficult.
The symptoms generally appear within a few weeks.
The brain cannot escape the space-occupying tumor within the hard skull. It is also unable to adapt to the changed pressure conditions. This is why those affected primarily suffer from headaches - especially at night or in the early hours of the morning.
Patients report that the pain initially improves by itself during the course of the day. However, unlike other headaches, glioblastoma headaches recur at regular intervals. Over-the-counter remedies, such as those available in drugstores and pharmacies, become ineffective over time.
In addition, patients with glioblastoma are also more likely to experience the following symptoms, which can be observed in all brain tumors:
The exact causes of glioblastomas are still unknown. Nevertheless, these tumors are among the most common brain tumors of all. The majority of patients are diagnosed between the ages of 60 and 70. The average age at diagnosis is 64, but this does not exclude the possibility that children can also develop glioblastomas.
It is interesting to note that men are affected by glioblastoma about 1.7 times more frequently than women. Data from the American Brain Tumor Registry also shows that people of white skin color in particular are affected by glioblastoma.
Nowadays, a distinction is made between primary and secondary glioblastoma according to their origin.
A primary glioblastoma, for example, develops from astrocytes, i.e. from important supporting cells of the central nervous system. As these astrocytes are regularly renewed, errors can occur during cell renewal. The cells then begin to grow uncontrollably and eventually form a glioblastoma.
Secondary glioblastomas in turn develop from existing tumors. They therefore form the final stage of a disease that has been ongoing for some time.
Ionizing radiation is also discussed as a possible factor in the development of glioblastoma. The Internet is therefore full of theories and opinions on the influence of cell phones on glioblastomas and their development. But do brain tumors really develop through the use of mobile phones or smartphones?
According to the current state of research, experts say that even large-scale epidemiological studies on humans have so far found no evidence that the use of cell phones leads to an increased risk of developing a brain tumor.
In contrast, extensive animal studies indicate an increased risk of tumors in male rats and mice due to mobile phone radiation. However, they cannot show a dose-response relationship or explain the lack of effect in female animals. Different authorities therefore classify the risk potential very differently: From "harmless" to "possibly slightly carcinogenic not excluded"
As the symptoms of glioblastoma usually appear suddenly, some patients first consult a neurologist. The neurologist begins by taking the patient's medical history.
The most important diagnostic tool for reliably detecting glioblastoma is and remains magnetic resonance imaging (MRI for short). This imaging procedure enables doctors to visualize the tumour (Fig. 2).
Fig. 2: Axial MRI T1 sequence with contrast agent (left) and T2 sequence of the MRI (right). A glioblastoma typically appears as an irregular, ring-shaped mass that absorbs contrast medium. The yellow arrow shows the tumor with its compartments and the white double arrows show the surrounding cerebral edema. [Source: Prof. Dr. Andreas Raabe, Inselspital Bern]
A bright, ring-shaped structure on the MRI images, for example, is a suspected tumor area in the brain.
If a glioblastoma is suspected, doctors sometimes confirm this with the help of a tissue sample, known as a biopsy. In most cases, however, the tumor is operated on immediately without a biopsy.
Due to the rapid growth of a glioblastoma, surgery should be performed as soon as possible. With increasing time and size of the tumor, more cells migrate into the surrounding area. This causes the tumor to expand further and further. At the same time, the risk of surgery increases. Surgery should therefore ideally be performed within 1-2 weeks of diagnosis.
The current "standard therapy" for glioblastomas consists of a combination of
Experts currently assume that at least 80% of the tumor must be surgically removed. Patients then have a survival advantage as a result of the operation.
However, only MRI-complete removal offers a clear survival advantage.
For optimal preparation for surgery, a special MRI is required for the most accurate assessment and surgical planning possible. Depending on the localization, further examinations may be required.
Surgical removal (resection) is now an integral part of the treatment concept and its first step. A higher degree of resection has a favorable effect on the course of the disease, so the aim of the operation is an MRI-complete tumor resection. Furthermore, removal of the tumor reduces the mass effect and thus also the symptoms.
The surgical removal of the tumor tissue also enables the histological and molecular biological examination of the respective glioblastoma.
In addition, the more tumor is removed, the greater the survival benefit of the operation. However, it is often difficult to distinguish between tumor and brain tissue, especially in the peripheral area.
Various modern technologies are therefore used here. These include microscope-controlled image guidance, known as neuronavigation, using a GPS-like process for millimeter-precise operations.
The powerful surgical microscope allows real precision work on the brain. The surgical microscope can be used to
can be virtually superimposed and projected onto the surface of the head (Fig. 3). This "augmented reality" allows the surgeon to orientate himself better and plan the approach to the tumor in advance in a tailored manner. It is based on the principle of "as small as possible, but as large as necessary".
Fig. 3: Virtual reality by superimposing the marked tumor and the fiber tracts in the surgical microscope. A strip of skin is visible in the center, which was shaved, disinfected and covered with foil before the operation. The tumor is superimposed in red and the important fiber tracts in color. [Source: Prof. Dr. Andreas Raabe, Inselspital Bern]
After the operation, an MRI image is taken 24 to 48 hours later for quality control purposes.
Glioblastomas grow very diffusely into the brain tissue. Therefore, even after a "complete" resection in the MRI, a few tumor cells always remain. These must be destroyed by subsequent radiotherapy and chemotherapy. This means that radiochemotherapy is always given regardless of the MRI image.
If tumor remnants are visible in the early 24-48 h control MRI, these should be removed in a second operation. The prerequisite is that their location allows it. This operation often takes place the very next day.
Experience shows that despite all technical aids, removable residual tumor tissue remains in 5-10% of patients. A second operation is advisable in these cases. The experts at Inselspital Bern (Switzerland), for example, were able to show in a study of their own patients that
The hospital stay was only extended by around two additional days as a result.
Glioblastomas belong to the group of grade IV tumors. They are therefore assigned to the highest WHO classification level for the assessment of tumors.
The prognosis is significantly improved by rapid subsequent therapy and, above all, surgical removal of the tumor. The two pillars of glioblastoma treatment are
In terms of life expectancy, current research has already shown an improvement in the number of patients with long-term survival. On average, life expectancy of 2 years or more can now be achieved with optimal and individually adapted therapy conditions.
The individual prognosis depends on a number of factors. The following list shows some of these factors that are thought to have a positive effect on prognosis, such as
For the individual patients, only a rough estimate of the time course is possible, but no exact prediction. All figures quoted are ultimately based on the "average value" of a large number of patients and do not allow any conclusions to be drawn about individual patients.
A word about methadone
In recent years, the topic of methadone has been increasingly discussed in connection with glioblastoma. There are many posts about it on internet forums, while standard therapies are criticized in the same context.
However, the assumption that methadone helps is not based on systematic, scientifically collected and publicly available data. To date, there is no evidence for the effectiveness of methadone therapy for glioblastoma.
Furthermore, methadone is not without side effects and can significantly reduce quality of life if used inappropriately. In this context, reference should also be made to the statement of the German Neuro-Oncological Working Group.
Glioblastoma is one of the most malignant brain tumors. It develops in a relatively short time. It mainly affects middle-aged people. The risk factors are largely unknown.
The literature on human medicine is limited to the establishment of assumptions that do not go beyond the stage of a theory.
Despite intensive treatment methods, the life expectancy of half of those affected is only 1-2 years after diagnosis. The other half of patients live longer. However, the disease remains incurable, despite advances in modern medicine and research.
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