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GBM Presentation

This document describes a 66-year-old male patient presenting with a Glioblastoma Multiforme (GBM), which is a grade IV brain tumor. The patient began experiencing progressive balance issues and dizziness in May 2017. After medications did not help, he developed neurological deficits including facial droop and slurred speech. Imaging and biopsy confirmed a GBM tumor. The treatment plan involves surgical resection followed by radiation therapy of 6000 cGy in 30 fractions and chemotherapy with dexamethasone and temozolomide. Prognosis for GBM is poor with a 5-year survival rate of only 4-17% depending on age.

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73 views

GBM Presentation

This document describes a 66-year-old male patient presenting with a Glioblastoma Multiforme (GBM), which is a grade IV brain tumor. The patient began experiencing progressive balance issues and dizziness in May 2017. After medications did not help, he developed neurological deficits including facial droop and slurred speech. Imaging and biopsy confirmed a GBM tumor. The treatment plan involves surgical resection followed by radiation therapy of 6000 cGy in 30 fractions and chemotherapy with dexamethasone and temozolomide. Prognosis for GBM is poor with a 5-year survival rate of only 4-17% depending on age.

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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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GLIOBLASTOMA

MULTIFORME
Jackson Baumgartner
Patient Profile
 66 years old
 Caucasian male
 Treated at The James Cancer Center (Vault 7)
 Patient presents with a Glioblastoma Multiforme
(GBM) – What stage is this?
Patient Presentation
 Was in his usual state of health until May 2017
 Startedhaving progressive balance difficulties and
some dizziness
 Originallythis was only noticeable whenever he was
working (cutting trees)
 He was started on medications for dizziness, however,
symptoms became more pronounced
 Developed neurological deficits including facial droop
and slurred speech
 Experienced fatigue to the point where he could not
perform any activities
Medical/Social History
 Past Surgeries
 Release carpel tunnel surgery (2014)
 Married
 Never smoker
 Never used smokeless tobacco
 Does not drink alcohol
 No recreational drug use
 No outpatient prescriptions prior to visit
 No facility administered medications prior to visit
Brain Anatomy
Brain Anatomy
Brain Anatomy
Brain Anatomy
Brain Anatomy
Brain Anatomy
Brain Anatomy
Brain Anatomy
Epidemiology – CNS
 CNS Tumors represent 1.5-2% of newly diagnosed
cancer in the US per year
 80% of these diagnoses are in the brain
 Other 20% affect the Brainstem or Spinal Cord

 Approximately 23,800 new CNS tumors are diagnosed


annually on the US (13,450 males and 10,350 females)
and result in ~16,700 deaths
 Overall chance of developing in a person’s lifetime =
1/140 (males) and 1/180 (females)
 Peak ages are 3-12 and 40-80 years of age
Epidemiology - Gliomas
 Adults
 50% of all primary brain tumors
 Most commonly in cerebrum

 Children
 45% of all primary brain tumors
 Most commonly in the cerebellum and brain stem

 GBM – most common adult CNS malignant tumor


and has the worst prognosis
Etiology – Risk Factors
 Mostly unknown
 A genetic link is thought to exist but no definitive
proof:
 For example: Neurofibromatosis type 1 and 2 (NF1/2)
- also known as von Recklinghausen disease, is the most
common syndrome linked to brain or spinal cord tumors.
People with this condition have higher risks of
schwannomas, meningiomas, and certain types of
gliomas, as well as neurofibromas (benign tumors of
peripheral nerves)
Etiology – Risk Factors Cont.
 Possible link to exposure to rubber compounds,
polyvinyl chloride (used to make PVC pipes), and
polycyclic hydrocarbons (particles that exist in
nature – thought to be formed from the Big Bang)
 Possible link to previous radiation exposure
 Possible link to immune disorders
Common Presentation
 Common signs and symptoms
 Headache
 Nausea
 Vomiting
 Blurred vision
 Seizures
 Unilateral weakness
 Balance issues
 Mental changes (personality/behavioral)
 Fatigue
Screening
 Usually found/suspected by observing signs and
symptoms. If a tumor is suspected then further
testing is required
 Complete medical history (focusing on symptoms and
when they began)
 Neurological exam (checking brain/spinal cord
function – test reflexes, muscle strength, coordination,
etc.)
 Imaging (CT/MRI/PET scan)
 Chest X-rays also likely performed. Why?
 Biopsy
Images

Check out IHIS for full picture


Lymphatics

What nodes drain the brain?


Lymphatics

None!
Staging
 Staging follows the WHO Scale
 Grade I – lesions with low proliferative potention;
possibility of cure following surgical resection
 Grade II – lesions are generally infiltrating and low
in mitotic activity but recur
 Grade III – lesions with evidence of malignancy and
anaplasia
 Grade IV – lesions which are mitotically active,
necroting, and rapid evolution
Tx for GBMs
 Complete resection of tumor
 Post OP Radiation
 Tx borders and Dose
 Borders:2-3 cm beyond the edema on the CT
 Most commonly use 3D conformal, IMRT or VMAT

 TD: approximately 50 - 60 Gy using 1.8 - 2 Gy/Fx


Tx Plan for Patient
 Surgery
 Craniotomy
 EBRT
 Prescribed 6,000 cGy in 30 Fx’s (200cGy/Fx)
 Machine energy – 6MV Photons
 VMAT (3 Arcs) – 6 DOF used
 IMRT to spare Brainstem, Optic Nerves/Chiasm, and Cochlea
 Setup
 Patient supine, Aquaplast mask, Q2+Custom headrest, hands at side grasping
handles, legs in knee sponge
 Chemotherapy
 Dexamethasone
 Temozolomide
Tx Plan
Possible Side Effects
 Fatigue
 Skin reaction (Erythema usually first side effect
observed)
 Alopecia
 Mental changes
 Nausea, vomiting, and/or headaches
 Possible brain swelling
 Hormone changes
 Paralysis/debilitation
 Loss of strength to extremities
TD 5/5’s
 Whole Brain –
 Spinal Cord –
 Optic Chiasm –
 Optic Nerve –
 Lens of eye –
TD 5/5’s
 Whole Brain – 4500 cGy
 Spinal Cord – 4700 cGy
 Optic Chiasm – 5000 cGy
 Optic Nerve – 5000 cGy
 Lens of eye – 1000 cGy
Prognosis and Survival
 Not good
 5-year relative survival (based on age)
 20 – 44 (17%)
 45 – 54 (6%)

 55 – 64 (4%)
My discussion with the patient…
Sources
Washington CM, Leaver DT. Principles and Practice of Radiation
Therapy. St. Louis, MO: Elsevier, Mosby; 2016
What Are the Key Statistics About Brain and Spinal Cord
Tumors? American Cancer Society.
https://www.cancer.org/cancer/brain-spinal-cord-tumors-
adults/about/key-statistics.html. Accessed September 14,
2017.
What Are the Risk Factors for Brain and Spinal Cord Tumors?
American Cancer Society.
https://www.cancer.org/cancer/brain-spinal-cord-tumors-
adults/causes-risks-prevention/risk-factors.html. Accessed
September 14, 2017.

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