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Gbm Case Studies

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BACKGROUND
Glioblastoma Multiforme (GBM) is a primary central nervous system (CNS) cancer that causes tumors of the glial cells in the brain. The third most frequently reported histology overall, and the most common malignant histology1. It’s also the most common and the most malignant primary central nervous system tumors2. GBM accounts for 15.1% of all primary brain tumors and 46.1% of primary malignant brain tumors1. The Central Brain Tumor Registry of The United States (CBTRUS) estimated that 24,790 new cases of primary malignant brain tumors to be diagnosed in the United States in 20161.

The CBTRUS also estimates a prevalence rate for all primary brain and CNS tumors to be 221.8 per 100,000, in which 61.9 per 100,000 in malignant tumors3. …show more content…

The five-year survival rate is low, with 5.1%1.

The standard treatment for GBM consists of maximal surgical resection, radiotherapy, and concomitant and adjuvant chemotherapy with TMZ. Radiation therapy may be used alone or in combination with surgery and/or chemotherapy in the treatment of primary or metastatic brain cancers. The standard radiation treatment used for GBM is to deliver photo radiation therapy at 60 Gy.

Some of the issues and complications using chemotherapy and radiotherapy are that, some chemotherapeutic agents are excluded by the blood-brain barrier (BBB) and that is why novel methods of intracranial drug delivery systems are being developed to deliver higher concentration of chemotherapeutic agents to the tumor cells while avoiding the adverse systemic effects of these medications. Although chemotherapy targets dividing tumor cells, there are normal dividing cells in the body, which are consequently targeted and may lead to side effects. In men, chemotherapy can cause mutations in the sperm, which can be harmful to the growth and development of a fetus; therefore, it is crucial not to father a child while taking the …show more content…

Currently, this technique is now being used at the brain tumor site to heat up the cells and non-invasively ablate them 6. One issue with this method however, is the thermal damage to the skull and unintended tissue damage from the high-intensity of the ultrasound 7. The benefit of combining focused ultrasound with MBs enables the use of a lower-intensity ultrasound field and therefore is less damaging as well as opening up the opportunity to not just ablate a tumor but to also deliver medication locally. MBs are manufactured vesicles composed of lipid or albumin outer shells that range from 1-10μm and travel through the vasculature and microvasculature. The MBs are injected intravenously and when passing by the focal point of the ultrasound are physically and mechanically manipulated8 to then interact with the vessel wall through widening tight junctions and activating transcellular mechanisms to transiently permeate the BBB9 and restore it after about 4-6 hours10. These improvements to a previously developed technology, high-intensity focused ultrasound, means that all that is needed to enable this new approach is to make a few simple modification to these devices to enable low-intensity bursts 11. Studies have shown that BBB disruption occurs over a range of parameters, which then

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