Consult CNS GBM

Counseling
Glioblastoma is the most common primary brain tumor in adults. Nearly 12,000 cases are diagnosed annually in the
United States. Despite aggressive therapy less than 5% of these patients are expected to live more than 5 years. Maximal surgical resection, although not tested in a prospective trial, is generally associated with more favorable outcome and is recommended whenever feasible.

After surgical resection of all or part of the tumor, radiation therapy remains the most effective single adjuvant treatment for newly diagnosed GBMs. Postoperative radiotherapy has been shown to provide a survival advantage in several clinical trials. Median survival for surgery followed by standard courses of radiation is 36 weeks, compared with 14 weeks for surgery alone.

The typical radiotherapy dose is 60 Gy in 6 weeks; dose escalation strategies have generally failed. Studies stereotactic radiosurgery (SRS) and brachytherapy, suggest dose responsiveness of the tumor to radiation effects. However,neither has resulted in extending overall survival in GBM patients in randomized trials when compared to standard fractionated radiotherapy.

Temozolomide (TemodarĀ®) is an oral alkalating agent that, when given during radiation to patients with newly diagnosed GBMs, has been shown in both a phase II and a randomized phase III trial to result in a modest improvement in overall survival without undue toxicity.

Plan
We recommended whole breast radiation to a dose of 60 Gy in 30 fractions. The risks, benefits and complications of radiation were discussed in detail including acute and chronic effects; Expected acute radiation-induced toxicities include hair loss, fatigue, and erythema or soreness of the scalp. Potential acute toxicities include nausea, altered taste, loss of appetite, and vomiting and temporary aggravation of brain tumor symptoms such as headaches, seizures, or weakness. Reactions in the ear canals and on the ear should be observed and treated symptomatically; these reactions could result in short-term hearing impairment.

Possible early delayed radiation effects include lethargy and transient worsening of existing neurological deficits occurring 1 to 3 months after radiotherapy treatment. Possible late delayed effects of radiotherapy include radiation necrosis, neurocognitive defects, endocrine dysfunction, dry mouth, blindness, metal status changes, and radiation-induced neoplasms. Permanent hearing impairment and visual damage are rare. Cataracts can be encountered.

After full discussion of the treatment options as well as the benefits and side-effects of radiation patient chose to receive radiation. Written consent was obtained.

Thank you Ref. MD again for asking us to see Patient Name. It was my pleasure.
Best Regards,

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