Sunday, January 13, 2008

How to Treat Glioma


A glioma is a tumor arising from the interstitial cells of the brain, pineal gland, posterior pituitary gland, retina and spinal cord. Gliomas can be highly aggressive and fatal, even with prompt treatment. Brainstem gliomas have the highest mortality rate because they compress structures responsible for basic body function. They also cause rapid death from increased intracranial pressure. The following steps will show how to treat a brainstem glioma.


Difficulty: Challenging



Step One

Use focal radiotherapy as the preferred treatment of brainstem gliomas in adults. The recommended dose ranges from 54 to 60 Gy and doses greater than 72 Gy have not been shown to have any additional benefit. Focal radiotherapy is not recommended for children.

Step Two

Administer radiotherapy to any patient with clearly progressive tumors or neurologic symptoms. Treatment may not be recommended at all in some cases of adult patients with cervicomedullary or tectal lesions.

Step Three

Predict the long-term response to radiotherapy based on factors such as histologic type, tumor location and response to early treatment. Exophytic tumors are reported to have better survival rates than non-exophytic tumors.

Step Four

Perform surgical resection in conjunction with chemical or radiation therapy. The best candidates for surgery will have tumors of the cervicomedullary junction, cystic tumors, well-defined tumors that occupy a cavity and dorsal exophytic tumors that protrude into the fourth ventricle. Any benign tumor also should be considered for surgery.

Step Five

Ensure a neuro-oncologist is the primary care physician for patients with brain stem gliomas or consult a medical oncologist for guidance.

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