Glioblastoma multiforme (GBM)

Glioblastoma multiforme (GBM) is the most common form of primary malignant brain tumor, according to the American Brain Tumor Association.

Glioblastomas arise from glial cells, which normally help support and nourish nerve cells of the brain (neurons) and form scar tissue that helps repair brain damage in response to injury. Glioblastoma are often very aggressive and grow into surrounding brain tissue. The tumors also are comprised of the body's own white blood cells that arise from the bone marrow. These microglia and macrophages are involved in tumor immunity and can also be targeted in the emerging therapies being developed at Penn Medicine and other major medical centers. 

In most cases, the exact underlying cause of glioblastoma multiforme is unknown. In rare cases, it can occur in people with certain genetic syndromes, such as neurofibromatosis type 1, Turcot syndrome and Li Fraumeni syndrome. In these cases, affected people usually have other characteristic features of the condition that are all caused by mutations in a specific gene. 

Glioblastoma multiforme is typically diagnosed based on a physical exam that identifies characteristic symptoms and various imaging studies, such as computed tomography (CT) and/or magnetic resonance imaging (MRI). MRI is the "gold standard" for imaging of glioblastoma. Advanced neuroimaging, available at Penn Medicine, can further define fiber tracts (DTI), blood volume, and metabolic function of the tumor (MR spectroscopy). These imaging studies are useful for neurosurgical planning, evaluating response to therapy, monitoring for tumor recurrence, and as endpoints for clinical trials.

Surgical removal of the tumor, or a small biopsy, can confirm the diagnosis, and provide additional information for planning therapy.

Approximately 15,000 new cases of glioblastoma are diagnosed every year, although historically, glioblastomas have been uniformly fatal with average survival only 12 to 15 months, during the past decade there has been a significant increase in survival, reported in many clinical reports and clinical trials with an increasing number of patients living more than 3 to 5 years. The increased survival is likely due to a combination of factors:

• Care in specialized centers of excellence; where you go for care initially does make a difference
• Refinement of neurosurgical technology using brain mapping, computerized simulation and intraoperative MRI-guided tracking, intraoperative fluorescence; electrophysiological stimulation and Neuromonitoring; awake craniotomies to achieve "maximal safe resection" per NCCN guidelines;
• Targeted molecular therapy based on next-generation genomic sequencing;
• Advanced radiation therapy techniques including proton therapy;
• Robust clinical trials that lead to a survival advantage because of the intensity of medical care;
• Improved patient and caregiver education with online education and access to expert care.
• Superior outcomes are achievable when care is delivered at major centers that specialize in brain tumor care with specialists (surgeons, oncologists, radiation oncologists, - who are expert in brain tumor care.)