Gliomas / GBM

FACTS

  • GBM can be primary or a transformation of diffuse infiltrating astrocytoma (Grade 2/3)
    • primary: EGFR mutation; elderly usually primary
    • secondary: TP53 mutations

HPI

  • KPS

PHYSICAL EXAM

IMAGING

  • MR spectroscopy:
    • NAA/Creatine peaks DECREASED as grade INCREASES
    • Choline peak INCREASED
MRI without conttrast: HGG are DWI restricting (unlike LGG)
A/P
  • Treatment: Stupp Protocol
    • Maximal safe excision
    • Concurrent TMZ + Radiation (60 Gy over 30 sessions: 5d x 6 wks)
  • counsel: prognosis depends a lot on KPS, grade, neurologic deficit, histology, EOR, genetics (IDH, MGMT)
    • IDH mutation is good