BRAIN TUMOR

Varieties of brain tumor are existing. Their symptoms and prognosis considerably differ as much by their histological types as by their topography.  Most of the time those tumours are developed at the expense of glial cells, which are protecting the neuronal tissue (neurones) against exterior aggressions and are vascularising the brain.

Those tumours rarely develop distant metastasis, and their main risk is the local relapse of the disease.

Symptoms of brain tumor:

The clinic expression (symptoms felt by patients) depends mostly on the location of the tumour in the brain and the speed at which it grows. The patients can present many symptoms; neurological deficit (weakness, modification of the visual field, …), behaviour troubles, develop epilepsies (convulsive crisis) linked to the irritation of the brain cortex, or even present signs of intracranial hypertension (headache, nausea, and morning vomiting).

Depending on the age of the patient, the type of tumour varies. Some tumours of low grade, with a slow or very slow evolution, are sometimes discovered fortuitously during a brain MRI, because they are asymptomatic. For the adults, often over 50 years, the most frequent tumour is represented by glioblastoma, which corresponds to astrocytic tumour (developed at the expense of astrocytes), of grade IV (most aggressive of WHO).

Which treatment for brain tumour ?

The treatment of glioblastoma is based on tight surgery as large as possible in each case which allows such procedures. The surgery is completed by concomitating radio-chemotherapy followed by an adjuvant chemotherapy based on TEMOZOLOMIDE.

When tumor is in a functional area, it is sometimes necessary to propose a surgery in awake conditions to the patient. In this case, the surgeon checks that the patient keeps all his motor functions in each step of the surgery. Before those interventions, a functional MRI is conducted to check if the lesion is not located in a cerebral area which control motor or sensorial functions.

The surgery must systematically be followed by a radiotherapy associated with an oral chemotherapy (TEMOZOLOMIDE) to lower the risk of a local relapse. Ideally it is a conformal radiotherapy with intensity modulation or a dynamic arc-therapy technic, which offers a great cover of the surgical bed or of the tumour (if it is in place) and protects also at maximum the healthy brain parenchyma. By sparing the hippocampal structures which are essentials for a great memory functioning, it allow to reduce the risk of neurocognitive toxicities due to the treatment (memory troubles, ideo-motor slow-down…).

Finally, if the patient can endure it, he can benefit from an oral adjuvant chemotherapy (six cycles every 28 days) after the concomitant chemotherapy which uses the same molecule as the radiotherapy, but at a higher dose.

Even if oncology progresses, those tumours keep severe prognostic considering the high risk of local recidivism. Their treatment must be conducted by a trained multidisciplinary team made of at least a neurosurgeon, a radiation oncologist, a neuro radiologist, an experimented anatomo-pathologist, and a neuro oncologist to offer the patient the best support he could expect.

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