Primary brain tumor: glioblastomas are malignant astrocytic tumors. These are the most frequent brain tumors that appear for adults aged 45 to 70 years.
Neurological signs are not specific: intracranial pressure, headache and vomiting, or even epilepsy. Changes in behavior, memory impairment, or neurological impairment should alert.
Genetic and molecular abnormalities (EGFR amplification, TP53 mutation, chromosome 10 loss) differ depending on whether it is primary glioblastoma (de novo) or secondary glioblastoma (developed with a benign astrocytic tumor). For glioblastoma or glioma grade 4, first-line treatment is a neurosurgery, if possible. If surgery is not possible, a biopsy will be performed to confirm the diagnosis.
Afterwards, radiotherapy of the tumor or the operated area is performed. Young patients have 30 sessions of 2 Gy (Gray: unit of measure (Gy symbol) of the dose absorbed by irradiation with ionizing radiation), i.e. a total dose of 60 Gy, in conjunction with daily oral chemotherapy, temodal or temozolomide at a dose of 75 mg / m2. After this radio-chemotherapy, temodal is taken five days a month until the disease is not progressing.
Brain MRI with a 3D-mm incision and gadolinium injection (T1 image, gadolinium and FLAIR images) allows a good assessment of the tumor and the edema provoked by it before radiotherapy. These MRI images are then combined with a dosimetry scanner to obtain a three-dimensional image necessary for high-quality radiation therapy.
Glioma grade 3, astrocytoma, oligodendroglioma and mixed anaplastic tumors are rare brain tumors. Malignant gliomas can develop de novo or result from the progression of a tumor of low severity (WHO grade II). They occur for adults around 40 years old. The most complete removal with the surgical method is proposed as a first-line treatment.
Otherwise, if the tumor is not operable, a biopsy should be performed.
1p / 19q analysis is recommended. The 1p / 19q co-deletion characterizes tumors with a better prognosis and has better chemosensitivity to PCV (procarbazine, CCNU, vincristine) and temodal.
There is no consensus and protocol regarding 2nd-line postoperative treatment. Inclusion in therapeutic studies is strongly recommended. For gliomas of grade III, radiotherapy can be carried out both without concomitant treatment or together with temozolomide. Each case is discussed individually at a multidisciplinary consultative conсilium. Chemotherapy is performed before or after, depending on the case.