Glioblastoma Treatment

At MD Anderson’s Brain and Spine Center, some of the nation’s leading glioblastoma experts will develop your treatment plan based on your specific needs. They take a team approach, with neurosurgeons, neuro-oncologists and radiation oncologists working together to coordinate your care and deliver the best therapies with the fewest side effects. Your quality of life is also a key concern during treatment, and our care team constantly looks for ways to make patients as comfortable and self-sufficient as possible.

Glioblastoma treatment plan

The standard treatment for glioblastoma starts with surgery to remove as much of the tumor as safely as possible.

Surgery typically does not remove all of the tumor, though. This is because glioblastoma usually forms microscopic branches that spread into different parts of the brain.

After surgery, patients usually get a combination of chemotherapy and radiation therapy, followed by chemotherapy alone. Elderly patients and/or those who have little to no ability to care for themselves (such as bathing, dressing or feeding themselves) may not be able to withstand the combined chemotherapy and radiation therapy phase of treatment. In these cases, they may receive a modified combination or just one of the two therapies.

Surgery

Glioblastoma surgery is most successful when it’s performed by a neurosurgeon with extensive experience in brain tumor surgery. MD Anderson neurosurgeons are world renowned leaders in their field, with extensive experience operating on glioblastoma tumors.

At MD Anderson’s Brain and Spine Center, these surgeons have access to the most advanced surgical technologies in the world.

Among these technologies is the Brainsuite® intraoperative MRI, found in just a handful of hospitals around country. This technology images the brain during surgery, helping neurosurgeons safely remove as much of the tumor as possible. Our neurosurgeons also have access to functional magnetic resonance imaging (fMRI) and navigated transcranial magnetic stimulation (nTMS). These technologies highlight key areas of speech and motor function in the brain, helping surgeons plan their procedures.

There are a number of different surgical options for people with glioblastoma. Your physician will evaluate your case and discuss the best one for you.

Craniotomy

Craniotomies are the standard surgery for most brain tumors, including glioblastoma. Surgeons performing a craniotomy remove a section of the skull in order to access the tumor.

Awake craniotomy

One advanced type of surgery offered at MD Anderson is the awake craniotomy. This procedure is performed on patients whose tumor is located in a part of the brain that controls essential functions. During an awake craniotomy, doctors wake up the patient during the procedure. They can then interact with the patient to map the location of key areas of the brain. This lets the neurosurgeon avoid those functional areas during surgery while removing as much of the tumor as safely as possible. Because of local anesthesia and the brain’s lack of pain receptors, patients don’t feel any pain during the operation.

This is a highly specialized procedure that is only performed at a handful of hospitals across the country. Combined, the neurosurgeons at MD Anderson perform roughly two awake craniotomies a week, making them among the most experienced surgeons in the world for performing this procedure.

Laser interstitial thermal therapy

This treatment, also known as LITT, is primarily used to treat tumors that are difficult to reach with standard surgical techniques. During the procedure, neurosurgeons use an intraoperative MRI in an advanced operating room called the BrainSuite® to guide a small laser catheter to the tumor site. There, the laser heats the tumor, killing cancerous cells from the inside while minimizing damage to nearby healthy brain cells.

Radiation therapy

Radiation therapy uses focused, high-energy beams to kill tumors or tumor sections that cannot be removed with surgery. MD Anderson offers the most advanced radiation therapy techniques in the world. Each radiation plan is designed to have the maximum impact on the patient’s tumor while minimizing the effect on healthy brain tissue. The different radiation therapies used to treat glioblastoma are described below. Your radiation oncologist will evaluate your condition and recommend the one that is best for you.

3D conformal radiation therapy

This technique uses three-dimensional scans to determine the exact shape and size of the tumor. Tiny metal leaves inside the treatment machine, called a linear accelerator, are used to shape the radiation beams. These beams are designed to match the size and shape of the tumor, which minimizes radiation exposure to nearby healthy tissue.

Intensity modulated radiation therapy (IMRT)

IMRT focuses multiple beams of radiation with different intensity levels directly on the tumor, delivering the highest possible dose of radiation. Radiation oncologists at MD Anderson use special software to develop highly-targeted radiation treatment plans for each patient that minimizes the impact on healthy tissues near the tumor.

Proton therapy

Proton therapy is a specialized form of radiation therapy that delivers high doses of energy directly to the tumor site, with minimal impact on healthy tissue. It is only available at a few centers in the world and is often used to treat tumors located in very sensitive areas of the brain. Proton therapy is currently considered experimental for glioblastoma and would be recommended only as part of a clinical trial.

Stereotactic radiosurgery

Stereotactic radiosurgery (SRS) is a non-invasive treatment that uses dozens of tiny radiation beams to accurately target brain tumors with a single high dose of radiation. Despite its name, SRS is not a surgical procedure and does not require an incision or anesthesia. This technique is typically used for patients whose tumors have recurred and who have already received standard radiation treatments.

Chemotherapy

Chemotherapies are drugs that kill fast-growing cells, including cancer cells. MD Anderson has the most advanced chemotherapies for glioblastoma available.

Chemotherapy can be difficult to deliver to the brain because of the blood-brain barrier, a set of small blood vessels and brain cells that protect the brain from disease, but also act as a shield against chemotherapy drugs.

Tumor treating fields

This treatment requires patients to shave their heads and wear an adhesive skull cap with wires attached to a battery pack for 18 hours a day. During these hours, the device emits radio waves into the brain in order to slow or stop tumor cells from multiplying.

Clinical trials

Because glioblastoma is difficult to treat, doctors are constantly searching for new ways to fight the disease. MD Anderson has one of the most active glioblastoma clinical trials programs in the world. Some trials study entirely new treatments, while others look at new combinations of existing treatments that may benefit patients. Many use personalized approaches designed around the specific features of a patient’s cancer.

These include trials of surgeries, chemotherapies and radiation therapies. Doctors are also working to bring the latest breakthroughs in cancer care to glioblastoma treatments, including new targeted therapies and immunotherapies. Visit our clinical trials site to search for glioblastoma clinical trials.

Read more:

• Can immunotherapy treat glioblastoma? Understanding the latest study

Angiogenesis inhibitors

Angiogenesis is the process of creating new blood vessels. Some cancerous tumors are very efficient at creating new blood vessels, which increases blood supply to the tumor and allows it to grow rapidly.

Researchers developed drugs called angiogenesis inhibitors, or anti-angiogenic therapy, to disrupt the growth process. These drugs search out and bind themselves to VEGF molecules, which prohibits them from activating receptors on endothelial cells inside blood vessels. Other angiogenesis inhibitor drugs work on a different part of the process, by stopping VEGF receptors from sending signals to blood vessel cells.

Recurrent glioblastoma treatment

Because it is impossible to remove or destroy all glioblastoma cells in a tumor, all glioblastomas recur. The timing can range from weeks to years.

Some patients with recurrent glioblastoma may be eligible for another surgery or LITT to remove as much of the tumor as possible. Radiation therapy can also be used as a palliative measure to slow tumor progression and to relieve symptoms caused by the tumor.

However, many standard treatments haven’t proven effective for recurrent glioblastoma. Patients should work with their care team to consider available treatment options and choose a plan that meets their goals. Many clinical trials are available for recurrent glioblastoma, and MD Anderson has one of the largest glioblastoma clinical trial programs in the country, including trials that offer personalized care built around the characteristics of the patient’s specific disease.