Can a glioblastoma be cured?

Unfortunately, this question must be answered with a clear no. The mean survival time after diagnosis is one year. Of course, the individual case may differ considerably from the statistics.

Especially young patients (under 50 years) have a slightly better prognosis. On average, they survive for about 18 months. Occasionally there are also patients who are still alive after 5 years.

The fact that there are isolated patients worldwide who are still alive 10 years after diagnosis is possible, but certainly the absolute exception. At the current state of science, a cure for glioblastoma is not possible. Numerous research approaches are being pursued, but so far it is rather unlikely that such a groundbreaking therapy will be discovered in the next few years that could lead to a cure for the tumor. In all studies so far, only an extension of survival time in months has been achieved.

What is a multiform glioblastoma?

The term multiform literally means “multiform”, i.e. related to the tumor, that the tumor is characterized by a manifold appearance. This term comes from pathology. However, even the inexperienced physician can see in the MRI image that the tumor does not have a uniform structure.

Under the microscope, bleeding and necroses (=dead cells) can be seen. Every glioblastoma is by definition a multiform tumor. This inhomogeneous (uneven) composition characterizes the glioblastoma.

Therapy

The therapy consists of the most radical possible surgical removal of the tumor and subsequent irradiation with a total dose of 60 Gray (30 single fractions – 2 Gy/5 days/week for 6 weeks). The edema responds well to treatment with steroids such as dexamethasone. Under irradiation and anti-edematous therapy, a clinically impressive improvement may initially occur.

However, a recurrence or growth (relapse) of the tumor is unavoidable. These are considered to be essential prognostic factors: age and extent of clinical impairment at the start of therapy. Chemotherapy is also increasingly being combined with radiation, especially with the substance temozolomide, or used subsequently.

Nevertheless, the chances of therapy in glioma patients are low; the one-year survival rate for glioblastoma multiforme is 30-40%. Chemotherapy with nitrosene ureas (BCNU, CCNU) leads to a small life extension of only a few weeks to months. An alternative to nitrosureas is temozolomide, which has fewer side effects and can be administered on an outpatient basis as an oral cytostatic, a drug that inhibits cell division.

Combined radiotherapy and chemotherapy with temozolomide leads to an extension of life to 14 months (12 months without temozolomide) and an increased two-year survival rate of 26% (10% without temozolomide). Young patients under 45 years of age in good health seem to benefit most from this therapy. Temozolomide is also used in the recurrent treatment of malignant gliomas.

Recurrence therapy leads to stabilization of tumor growth in about 50% of patients and to an overall survival of 13 months after initiation of recurrence therapy. Surgical removal of a glioblastoma is chosen if the tumor is easily accessible and removable due to its location. In most cases, there is already evidence of rapid tumor growth; the cross-sectional imaging shows that surrounding tissue is displaced.

This is called a space-occupying effect. Last but not least, the patient’s general condition and anaesthetic ability are also decisive factors in the decision to undergo surgery. Tumors that are too close to important brain regions cannot be operated on.

If, for example, the speech or respiratory center is directly next to the tumor, surgery is not possible or sensible. In this case the tumor is considered inoperable. Surgery can never remove all tumor cells, i.e. isolated tumor cells are still present.

These can grow back into a large tumor. In order to prevent this or at least to kill as many remaining tumor cells as possible, radiation therapy follows after the operation. In this case not only the original tumor region is irradiated, but also a safety margin of 2-3 cm.

Sometimes the patient also receives chemotherapy in parallel to the radiation. In addition to surgery and radiation, chemotherapy is part of the standard therapy for glioblastomas. Since the tumor infiltrates the brain tissue weekly, not all tumor cells can be removed during surgery.

Therefore, chemotherapy can prolong recurrence-free survival by at least a few months. Temozolomide is the chemotherapeutic agent of choice. It can easily cross the blood–brain barrier.

It is available in tablet form and can be taken at home. In addition, it has relatively few side effects and is well tolerated. In the fight against malignant tumors, more and more immunotherapeutic agents are being used nowadays.

But what is actually meant by the term immunotherapy? In immunotherapy, the body’s own immune system is influenced by drugs to kill tumor cells. It is actually a collective term for numerous different approaches.

Glioblastoma is a very fast growing malignant brain tumor, which is associated with a very bad prognosis despite maximum therapy. Therefore many hopes rest on immunotherapy. In this area there are also very promising approaches, which are currently being intensively researched in clinical studies.Many patients and relatives now have new hope through media reports about methadone.

But what are the facts? It has been shown in the laboratory that methadone improves the response of cancer cells to chemotherapy and thus kills them more effectively. However, a study conducted at the Charité in Berlin on 27 patients could not show a survival advantage for the group treated with methadone.

However, other colleagues repeatedly report individual cases in which patients treated with methadone live 2-3 years longer without relapse. Currently it is therefore very difficult to make a recommendation. First laboratory results and individual case reports speak for methadone.

However, high-quality clinical studies with large patient collectives are still missing. One can surely only expect these data in about 3 years. Before then, no scientifically sound statement can be made about the significance of methadone in cancer therapy.

Patients affected by methadone have the possibility to discuss with their treating physician whether methadone as an off-label therapy can be prescribed nevertheless, in the sense of an experimental cure. An off-label therapy means that the physician prescribes a drug to the patient even though it is not approved for the treatment of a certain disease. Methadone is an old, long-proven drug.

However, it has not yet been approved as a supplement to chemotherapy for glioblastoma because there are no valid data to prove its effectiveness. Water retention (edema) around the tumor is often part of the disease, especially in the final stage of glioblastoma. This leads to a swelling of the nerve cells and thus increases the pressure on the brain.

This makes the so-called brain edema a potentially life-threatening clinical picture. Cortisone is needed to counteract the brain edema. It stabilizes the cell walls, the cells no longer absorb fluid in an uncontrolled manner and lose size again.

The brain swells. This happens within a few hours after the administration of cortisone. Therefore, cortisone is often a vital drug for the patient.