Gliomas are a family of tumors comprising primarily of astrocytomas and oligodendrogliomas, the most aggressive primary brain tumor being the glioblastoma (GBM). These tumors are the most common primary brain tumors in adults.
Symptoms & Diagnosis
The typical symptoms of brain tumors are headaches, nausea, confusion or seizures, which may be caused by increased intracranial (within the head) pressure. An MRI scan is usually used to diagnose gliomas, such as glioblastoma. However, newer technologies such as Magnetic Resonance Spectroscopy (MRS), which looks at the chemical make-up of a tumor, can be helpful in diagnosis before a patient undergoes biopsy.
Determining Treatment Options
The first step is a biopsy or larger surgical removal of the tumor. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center surgeons use the latest advances in neurosurgical navigational techniques as well as intra-operative MRI, to ensure precise removal during biopsy or resection. The tissue obtained during the biopsy or resection is helpful in determining the type of cell and how aggressive the brain tumor is. Neuropathologists grade tumors based on the World Health Organization (WHO) system. The higher the number, the more aggressive the tumor.
The information obtained from the biopsy will influence how the tumor is treated. Molecular testing, which provides information about the genetic makeup of a tumor, is playing an increasing role in treatment decisions and the development of new targeted therapies.
One of the latest treatment options for brain tumors is convection-enhanced delivery (CED). Convection enhanced delivery allows potent drugs that would otherwise be too toxic to the body, or those that are not capable of passing through the blood-brain barrier, to be slowly and continuously infused into certain brain tumors.
Cleveland Clinic's Rose Ella Burkhardt Brain Tumor Center has ongoing pharmaceutical and NCI-sponsored trials using continuous infusions of immunotoxins (IL1 -PE38) for recurrent high-grade gliomas like glioblastoma. Ongoing neurosurgical trials through the American College of Surgeons Oncology Group also are available. Computer-assisted stereotactic navigational techniques, pioneered at Cleveland Clinic and used during CED, have resulted in improved patient outcomes.
The Center offers conventional radiotherapy as well as stereotactic radiosurgery utilizing the Gamma Knife. In January 2010, specialists at Cleveland Clinic's Gamma Knife Center treated their 3000th case with this non-surgical, outpatient procedure. Our Gamma Knife Center has also upgraded to the Gamma Knife Perfexion, the most technologically advanced model available. The new model offers enhanced planning using all image modalities, including PET CT and MRI, as well as reduced treatment time. In addition, Rose Ella Burkhardt Brain Tumor Center specialists also utilize the Novalis radiosurgery equipment. This provides treatment via intensity modulated radiotherapy (IMRT), which shapes the radiation beam and modifies its intensity to deliver highly focused radiation to the target area.
Radiation can also be delivered locally using Gliasite brachytherapy in which liquid radiation is placed into a balloon that has been implanted in the surgical cavity of a resected tumor. Clinical trials are currently being completed through multicenter pharmaceutical studies and through the New Approaches to Brain Tumor Therapy consortium. The Center has participated in several radiation sensitizer studies and remains active in the Radiation Therapy Oncology Group.