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Suggest Treatment For Grade-4 Glioblastoma Multiforme

Posted on Sat, 3 Jun 2017

Question: My mom is diagnosed with Glibolastoma multiforme(Who grade IV), her age is 70 please advise.

Answered by Dr. Indranil Ghosh (16 minutes later)

Brief Answer:
Radiotherapy

Detailed Answer:
Hi
Thanks for your query.

In glioblastoma, after surgery standard is radiotherapy. We may add temozolomide oral Chemotherapy along with it. After finishing radiotherapy, temozolomide continues for 5 days a month for six months.

However, result is not good. Disease usually starts growing again soon. Average survival around a year.

Hope this helps. I will be available for further follow up.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (32 minutes later)

Doctors said Surgery is not possible so Radiation is an option?

Answered by Dr. Indranil Ghosh (8 minutes later)

Brief Answer:
Yes then radiation

Detailed Answer:
in that case, directly we can go for radiotherapy and temozolomide

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (32 minutes later)

What are side effects of radiotherapy?

Can I have the second opinion?

She had a biopsy on May 9 how soon they can start Radiotherapy? I am in USA and would like to plan my travel plans

Answered by Dr. Indranil Ghosh (1 hour later)

Brief Answer:
If only stereotactic biopsy then no need to wait

Detailed Answer:
it can then be stsrted as soon as possible. maybe in next 7-10 days

Brief Answer:
Weakness, hair loss, vomiting, nausea

Detailed Answer:
There may be rise of brain pressure too causing drowsiness, paralysis, etc.
temozolomide can cause fall in blood counts, infection, vomiting, diarrhea, rise in liver enzymes.

These will need regular monitoring and can be managed accordingly.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (1 hour later)

Are there any better chances with cyberknife radiotherapy?

Answered by Dr. Indranil Ghosh (7 hours later)

Brief Answer:
Not really

Detailed Answer:
For glioblastoma usually, cyberknife doesn't add anything compared to conventional radiation. If radiation is required again later, then it can be considered.

Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Indranil Ghosh (48 minutes later)

What is the frequency of the Radiation treatment? is it every day or weekly?
How much it cost per each sitting?
What might be side effects and the life span of treatment and after treatment?

Thank you

Answered by Dr. Indranil Ghosh (4 hours later)

Brief Answer:
Radiation daily

Detailed Answer:
It is Monday to Friday every week for 6 weeks.

Cost may range from 70k to 150k INR for the entire duration depending on type and technology used.

Side effects I have already mentioned in previous response. Not everything happens in every patient and severity is widely variable.

Survival also mentioned, average 1 yr but again may be much less or even more in an individual patient.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Indranil Ghosh (20 hours later)

what is the most advanced radiotherapy you suggest for this one.

Thank you.

Answered by Dr. Indranil Ghosh (8 hours later)

Brief Answer:
I would recommend 3d conformal radiotherapy

Detailed Answer:
in glioblastoma, role of more advanced precision radiotherapy is not proven. So I would recommend 3d conformal radiotherapy or 3dCRT

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indranil Ghosh (2 days later)

Apollo hospital recommended for IGRT radiotherapy with chemo tablets. I spoke
One of my friend's dad in the USA he recommended for immuno chemical analysis and glioblastoma panel specific genomics sequencing.

What do you say, sir?

Thank you

Answered by Dr. Indranil Ghosh (5 hours later)

Brief Answer:
As I said IGRT has little extra advantage

Detailed Answer:
Precision radiotherapy is not of much advantage in glioblastoma. There may be slight benefit in preserving higher mental function. You can go for it, no harm.

Regarding the genomic tests, they are mainly to predict survival. They are still not very effective in choosing treatment.

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Above answer was peer-reviewed by : Dr. Remy Koshy