Glioblastoma

These tests use x-rays, strong magnets, or radioactive substances to create pictures of the inside of your body, including your brain. They are often the first type of test done if a brain tumor is suspected.

• MRI (magnetic resonance imaging): This is the most common test to look for a brain tumor. It can almost always show the size, shape, and location of a tumor. Special MRI techniques like MR perfusion or MR spectroscopy (MRS) can also be done to learn more about the tumor.
• CT scan (computed tomography): This x-ray test can also be used to look at the brain, especially in emergencies or if MRI can’t be done for some reason.

Sometimes the way a brain tumor looks on an imaging test makes it clear that it is a high-grade tumor such as a glioblastoma. If this is the case, your doctors will likely recommend starting treatment with surgery, if it can be done (see below). The neurosurgeon will remove as much of the tumor as possible, and part of it can then be tested in the lab to confirm the diagnosis and learn more about it.

If surgery can’t be done for some reason, or if it’s less clear what type of tumor it might be, a biopsy might be done first instead to get a sample of the tumor for testing. This is most often done using a thin, hollow needle that is put into the tumor through a small hole in the skull. Imaging tests taken beforehand are used to help guide the needle into place.

Testing of surgery or biopsy samples

The surgery or biopsy tissue from the brain will be looked at and tested in the lab to confirm the diagnosis. The tissue will also likely be tested for certain gene or protein changes, which is known as molecular testing. For example:

• MGMT promoter methylation: This can help predict how well chemotherapy is likely to work.
• IDH gene mutations: These are often linked to better outcomes.
• Other genetic or molecular tests: These may be used to look for gene changes such as BRAF V600E or NTRK fusion mutations. People whose tumor cells have one of these mutations might be helped by treatment with a targeted drug (see below).

These tests can sometimes help guide treatment decisions.

Surgery is typically the first treatment if an imaging test shows what is likely a glioblastoma, although the specific type of tumor might not be known until after the operation. The goal is to remove as much of the tumor as is safely possible (known as a maximal safe resection). But because glioblastoma tends to spread in finger-like projections into normal brain tissue, it’s very hard to remove it completely.

Still, surgery can often help relieve symptoms, and it can provide tissue samples to confirm the diagnosis and for other lab tests (see above).

To learn more, see Surgery for Brain Tumors in Adults.

After surgery (or if surgery can’t be done for some reason), most people get radiation therapy to the area to try to kill remaining cancer cells. This is usually given 5 days a week for about 6 weeks.

To learn more, see Radiation Therapy for Brain Tumors in Adults.

Chemotherapy (chemo) is typically given along with radiation therapy and then continued afterward. The chemo drug used most often is temozolomide, which is taken by mouth as a pill. Other chemo drugs might also be options, especially if temozolomide is no longer helpful.

To learn more, see Chemotherapy for Brain Tumors in Adults.

Optune Gio is a device that creates alternating electric fields (known as tumor treating fields, or TTF), which can interfere with tumor cells’ ability to grow and spread. For this treatment, 4 sets of electrodes are placed on the scalp to generate mild electric currents in the brain. The electrodes are attached to a battery pack (kept in a backpack) and are worn for most of the day.

This device can be used along with chemo (after surgery and radiation) as part of the first line of treatment for glioblastoma, or it can be used by itself (instead of chemo) for tumors that come back after treatment.

To learn more, see Tumor Treating Fields for Brain Tumors in Adults.

In some people with glioblastoma, the tumor cells might have certain gene or protein changes, such as a BRAF V600E or NTRK fusion mutation. People whose tumor cells have one of these mutations might be helped by treatment with a drug that specifically targets cells with this change.

If chemotherapy is no longer helpful, the targeted drug bevacizumab (Avastin, other brand names) may be an option for some people, either alone or with chemo.

To learn more, see Targeted Therapy Drugs for Brain Tumors in Adults.

Supportive care is meant to help prevent or treat symptoms from the tumor, rather than treat it directly. This is an important part of treatment for people with glioblastoma. Examples of supportive treatments include:

• Steroids to reduce brain swelling and improve symptoms
• Anti-seizure medicines
• Rehabilitation such as physical, occupational, or speech therapy
• Pain medicines or other types of palliative care to help manage symptoms and maintain a person’s quality of life

Many people and their families can also benefit from counseling and support groups.

Glioblastoma is very hard to cure with current treatments. Because of this, scientists are studying many new types of treatment for glioblastoma, including:

• Immunotherapy, including vaccines (to help the immune system fight the cancer)
• New targeted drugs
• Gene therapies
• Oncolytic viral therapies

Taking part in a clinical trial might offer access to new treatments that are not yet otherwise available.