Brain (CNS)
Glioblastoma (GBM, WHO Grade IV)
교모세포종
Most common and aggressive primary brain tumor (astrocytic origin)
- How common
- ~3 per 100,000/yr
- Typical age
- Ages 50-70
What is it?
IDH-wildtype GBM arises de novo; infiltrative growth, necrosis, microvascular proliferation, spreads along white matter.
Commonly affected: Cerebral hemispheres (frontotemporal predominance)
How it develops
- Genetic alterationsTERT, EGFR, CDKN2A/B, PTEN
- Infiltrative growthDiffuse white matter spread
- Necrosis/MVPPathologic hallmarks of GBM
- Edema/raised ICPVasogenic edema, mass effect
Symptoms
- Progressive headacheWorse mornings, progressive
- Focal deficitsHemiparesis, aphasia, visual field cuts
- Seizures25-50% as first presentation
- Cognitive decline/personality changeFrontal involvement
- Raised ICP signsVomiting, papilledema
How it is examined
- KPS/neuro examKarnofsky score, deficit assessment
- Optic disc examLook for raised ICP
- Cognitive testingMMSE, executive function
Imaging
Contrast CT shows ring-enhancing mass.
- Ring-enhancing mass
- Extensive edema
- Midline shift
Contrast MRI is standard - irregular ring enhancement with central necrosis.
- Irregular ring enhancement
- Central necrosis
- Surrounding edema (T2/FLAIR)
- Butterfly lesion (corpus callosum)
Non-surgical care
- Dexamethasone4-16 mg/day to reduce edema/symptoms
- Antiseizure meds (if needed)Levetiracetam (prophylaxis not routine)
- Stupp protocol chemoradiationRT 60 Gy + concurrent temozolomide → 6 cycles adjuvant
- Tumor-treating fieldsScalp electric fields (Optune) - improves survival
- Recurrent: bevacizumab/trialsVEGF inhibitor, salvage chemo
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Diagnosis, cytoreduction, symptom relief
Procedures that may be discussed
- Maximal safe resection (awake craniotomy with neuronavigation)
- 5-ALA fluorescence-guided resection
- Stereotactic biopsy if unresectable
Outlook
Median survival 14-16 mo, 5-yr survival 5-10%. MGMT methylation predicts better response.