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Acute Myeloid Leukemia PediatricGlioblastoma multiforme Brain cancer is a malignant tumor of the cells of the brain (this implies the primary occurrence of a tumor in the brain and not cancer that has metastasized to the brain from other organs). In brain cancer, normal brain cells transform into cancerous ones. In a healthy body, cells appear in the right amount and die off at a certain time, giving the space for the new ones. Cancer cells begin to grow uncontrollably, without dying off. Their accumulation forms a brain tumor. Gliomas are the most common types of brain tumors. There are 4 degrees of malignancy of such formations, based on the type of cells of the nervous tissue. Glioblastoma is the most malignant type of brain tumor, characterized by the highest rate of growth and the absence of distinguishable borders. Thus, glioblastoma belongs to brain tumors of the highest degree of malignancy, which represent the greatest difficulties for medical science in the matter of treatment. The exact causes of brain cancer have not been established. It may be associated with a hereditary predisposition, as well as with the impact of dangerous working conditions.
- Symptoms:
The main warning signs for brain tumors are: • Frequent nausea and vomiting
• Headache in the morning or headache that goes away after vomiting
• Visual impairment, hearing impairment, problems with speech
• Loss of balance and unstable gait
• The weakness of one side of the body
• Unusual sleepiness or changes in daily activity levels
• Radical changes in personality or behavior
- Diagnosis:
When carrying out computed tomography, a layered image of brain tissue is obtained. Thus, CT allows assessing the size of brain tumors and the exact location of the neoplasms. MRI is a more detailed visualization of brain tissue, in which even the smallest changes in the anatomical structure of the brain are visible. Using functional magnetic resonance imaging, the doctor evaluates blood circulation in the brain tumors and brain tissues. Magnetic resonance spectroscopy is a research technique in which the metabolism in the tissues of brain tumors is investigated. Magnetic resonance angiography reflects the relationship between the brain tumor and large arterial and venous vessels.
Treatment:
Currently, there are three types of treatment for glioblastoma beyond stage one-three. These types are surgery, radiation therapy, and chemotherapy. At the present stage, progress has been made in each of the types of treatments, but their combination gives the best results.
• Surgery.
With the information on the exact localization of the brain tumor based on MRI results, the neurosurgeon can remove a tumor without subsequent side effects. In some cases, when the brain tumor is located close to the motor or speech centers, the surgery is performed under local anesthesia, which allows patients to be conscious and allows doctors to control the speech function. After the removal of glioma, most patients have an improvement in neurological symptoms. Postoperative mortality, even for glioblastoma, reaches 1%, and the worsening of the condition is seen in up to 5% of cases. The best results are achieved after radical resection (compared to partial tumor resection or biopsy). The development of innovative methods of diagnosis and treatments allows the surgeon to successfully perform the radical removal of glioblastomas in most cases of brain tumors of such types. If the tumor is located close to the functionally important cortical structures, the surgeon should consider performing functional MRI before surgery. Using stereotactic navigation and intraoperative monitoring, an attempt should be made to remove the entire brain tumor. Time spent on carefully performed resection will be rewarded with increased survival and quality of life for patients. If the brain tumor cannot be removed, a stereotactic biopsy should be performed. Patients with a metastasized type of brain cancer should receive radiation therapy followed by chemotherapy. If the disease recurs, resection of the tumor should be considered, followed by second-line chemotherapy, experimental therapy, or participation in the clinical trials.
• Radiation therapy.
Brain tumors often recur in their previous area. That is why total radiation therapy is often performed after the surgery in order to prevent the relapse. Another type of irradiation, the localized radiation therapy, is aimed precisely at tumor cells in the brain. The development of neuroimaging techniques allows the radiologist to reduce the complications of radiation therapy by targeting the brain tumor without affecting the healthy brain structures. Therefore, it is better to use both local radiation therapy and total radiation therapy for the whole brain. Even with these precautions, delayed damage to healthy brain tissue remains a significant long-term problem. At the present stage, stereotactic surgery is the most effective and safe method to treat brain tumors. This method can be considered an alternative to the traditional surgery. This allows a large dose of radiation to be delivered to the brain tumor without an additional radiation load on healthy tissues. Modern computer technologies in imaging make it possible to carry out this type of surgery accurately. None of the currently existing surgical systems can excise the brain tumor with the same precision. The effect of radiation therapy for glioblastoma can be assessed only in several months after the procedure. The tumor is not destroyed, but it stops growing and decreases in size. Stereotactic surgery is applied in the treatment of small brain tumors that do not exceed three centimeters in diameter and have clear boundaries. Stereotactic surgery is not suitable for rapidly growing brain tumors.
• Chemotherapy.
Cane be used in combination with radiotherapy and In the stage 4 glioblastoma treatment, chemotherapy should be considered the optimal treatment, since these tumors penetrate deep into the normal brain and tumor cells are often found at a distance of up to four centimeters from the primary focus. Chemotherapy drugs cross the blood-brain barrier and can reach every tumor cell in the central nervous system. Glioblastomas are heterogeneous. Genetic and biochemical abnormalities that have been identified in glioblastomas generally only occur in certain cells. Not all glioblastoma cells have the same histochemical features, and this must be considered when choosing the treatment of glioblastoma multiforme grade 4
1- Diagnosis:
The program includes:
Required documents
Price from: On request
Type of program: Outpatient
Expected duration of the program: 3 days
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2- Surgery:
The program includes:
Required documents
Price from: on request
Type of program: Inpatient
Expected duration of the program: 10 days
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3- Chemo-radiotherapy:
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will elaborate the chemotherapy regimen, conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation in order to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Chemotherapy and radiation therapy are carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.
Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.
During the chemotherapy session, after the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.
After the completion of the chemotherapy and radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.
Required documents
Price from: on request
Type of program: Outpatient
Expected duration of the program: 39 days
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4- Chemotherapy
The program includes:
How program is carried out
During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).
Chemotherapy is carried out as outpatient according to chemotherapy protocol type. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.
After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course and control examinations you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.
Required documents
Price from: On request (regarding chemotherapy protocol)
Type of program: outpatient
Expected duration of the program: from 1 to 4 days per cycle (regarding chemotherapy protocol)
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