Negligence in treatment of diseases like glioblastoma can be fatal, seminar told

Glioblastoma (GBM) is a fast-growing type of central nervous system tumour that forms from glial (supportive) tissue of the brain and spinal cord, with cells that look very different from normal ones,” said Dr Ata Ul Aleem Bhatti, ex-instructor neurosurgeon, Aga Khan University Medical College, Dar as Salaam, Tanzania, and consultant neurosurgeon at the South City Hospital, Karachi.

Addressing a public awareness seminar on World GBM Day 2022 in collaboration with the Neurospinal & Cancer Care Postgraduate Institute, he said: “Like most brain tumors, GBM grow more rapidly than their benign counterparts and affect the brain in many different ways depending on the part of the brain they are located.”

Dr Bhatti further explained: “Unfortunately, like most cancers in other parts of the body, the exact cause of GBM is unknown. Glioblastoma itself is not the only form of brain cancer, though it is the most common and most aggressive type. Other malignant brain tumours include medulloblastomas, lymphomas and anaplastic astrocytomas, to mention a few.”

Various risk factors linked to developing cancer in the brain include over exposure to radiation and some rare inherited conditions. In all of these cases, the exact connection or link remains a mystery, but we do see a pattern of occurrence.

“Again, unfortunately, there are no symptoms that will immediately tell someone they are developing a malignant brain tumour, however, there are some common things to look out for, when a person develops a mass or growth in the brain, either benign or malignant. These include a bad headache, but not the type one gets after spending hours in Karachi traffic or a stressful day. This headache is usually worse in the morning and persistent over several weeks. It may be associated with a feeling of wanting to vomit (nausea) or actually vomiting, which tends to make the person feel better.”

Unfortunately, according to Dr Bhatti, at the moment there is no cure for brain cancers. While there are many therapies that are being tried and a lot of experimental work going on, we are yet to find a cure.

Malignant brain tumours are usually treated with a combination of surgery, radiotherapy and chemotherapy.

“Sometimes, newer options like hormone therapy, immune therapy and others are also used. Which option is offered depends on the type of cancer involved. Surgery remains a main part of any treatment regime for GBM, since it allows for accurate diagnosis and also reduces the amount of tumour the body has to fight against.”

In some cases, an attempt is made to remove as much of the tumour as possible to allow the radiotherapy and chemotherapy be more effective.

Dr Adeel Ahmed Memon, consultant clinical & radiation oncologist and assistant professor at the Karachi Institute of Radiotherapy & Nuclear Medicine (KIRAN), gave a radiation oncologist perspective for GBM.

“Radiosurgery is a treatment method that uses specialized radiation delivery systems to focus radiation at the site of the tumor, while minimizing the radiation dose to the surrounding brain. Radiosurgery may be used in selective cases for tumor recurrence, often using additional information derived from MRS or PET scans,” he said.

“Studies have shown that radiation therapy provides most patients with improved outcomes and longer survival rates when given the combination of surgery, radiation and chemotherapy compared with surgery alone. Radiation also may be used as the sole treatment when a glioblastoma tumor is in an area that is not appropriate for surgery.”

Guest speaker Dr Reena Kumari, consultant medical oncologist & assistant professor at Dr Ziauddin University Hospital, also shared her views regarding the role of chemotherapy, targeted & immunotherapy and discussed why GBM was difficult to treat brain tumor.

When treating GBM, she explained, what makes treatment challenging is that you have tumor cells that are not active, meaning they are dormant. These cells are known as cancer stem cells and since they are not active they do not die by radiation and chemotherapy.

“Unlike other cancers such as breast or lung, brain tumors are extremely genetically heterogeneous means there is a high degree of variation within the same tumor cells that makes each individual glioblastoma molecularly distinct. This can be challenging when predicting prognosis and treatment, if it is in an area which is difficult access, or too close to major blood vessels or other important centers of the brain, it can make surgery tough, tendency of the tumor to come back aggressively is also a great challenge.”

A promising targeted treatment is the anti-vascular endothelial growth factor (VEGF) monoclonal antibody bevacizumab. It has been approved by FDA for several different types of cancer, including. Angiogenesis is a key survival feature of many cancers as tumors rely on nutrients from the vasculature to proliferate

A clinical trial has found that selinexor, the first of a new class of anti-cancer drugs called selective inhibitors of nuclear export (SINE) , is able to shrink tumors in almost a third of patients with recurrent glioblastoma,

Dr Kumari urged people to be careful, saying: “Negligence in treatment of diseases like GBM can be fatal.” She further said that timely treatment of brain tumor was very important as chances of relapsing increases with the grade of tumor.

Dr Sadia Afsar, in-Charge, Neurosurgery Department, Abbasi Shaheed Hospital , highlighted the problems faced by patients with GBM and other brain tumors as this is ignored by community.

“Government needs to realise that these conditions are quite common and provide more facilities for early diagnosis and treatment of GBM & other types of brain tumors like MRI, CT-Scan & PET-CT Scanner must be readily available across the country to enhance diagnosis.

“The scarcity of Radiotherapy modalities in the country has already been highlighted by her and said that a huge time is wasted in long queue, additionally. The teaching hospitals need to also be equipped to perform proper neurosurgery department and OT, as this is the first step in any treatment programme for brain tumors, including GMBs.”