Glioblastoma Multiformes (GBMs) are high-grade gliomas that arise from
the brain’s supportive tissue, known as glial cells. These are aggressive
tumors that rapidly infiltrate adjacent healthy brain tissue and, as a result,
are difficult to treat.
The majority of GBMs, roughly 65%, occur in the cerebral hemispheres, which
control higher functions like speech, movement, thought and sensation. They can
also develop in the part of the brain that identifies sensations such as
temperature, pain and touch and the region of the brain that controls balance
and motor function.
These tumors are usually diagnosed between the ages of 5 and 9, and occur in
boys and girls equally. GBMs occur with increased frequency in children with
certain genetic syndromes, including neurofibromatosis 1, Li-Fraumeni syndrome,
hereditary nonpolyposis colon cancer and tuberous sclerosis. Most GBMs,
however, have no known cause.
Children with GBMs are treated Dana-Farber/Boston Children's through our Glioma
Program, one of the world's largest treatment programs focused on this kind
of cancer. Our glioma specialists have extensive expertise in treating all
types of gliomas, including GBMs. Our patients receive multidiciplinary care from
neuro-oncologists, neurosurgeons, neurologists, and pediatric subspecialists.
When doctors diagnose a brain tumor, they “stage” it, or give it a grade,
according to whether it has spread, and if so, how far. This helps us determine
treatment options and prognosis. The World Health Organization classification
scheme includes four grades of gliomas, which are:
Glioblastoma multiforme is a grade IV tumor. These are aggressive tumors
that spread to adjacent healthy brain tissue.
Brain tumors can cause a variety of symptoms in children based primarily on
the location of the tumor, its size and whether it has spread. Keep in mind
that the symptoms of a brain tumor may resemble other more common conditions or
medical problems. It is important to consult your child's physician for a
Most GBM symptoms result from increased pressure within the head. Other
symptoms relate to the tumor’s specific location, rate of growth and associated
Symptoms can develop slowly over time or begin very suddenly. The following
are the most common:
As a parent, you undoubtedly want
to know what may have caused your child’s tumor. It’s important to understand
that these and other brain tumors most often occur with no known cause. There’s
nothing that you could have done or avoided doing that would have prevented the
tumor from developing.
There are certain hereditary conditions that are linked to these tumors.
GBMs can occur with increased frequency in families with conditions including Li-Fraumeni
syndrome, hereditary nonpolyposis colon cancer, tuberous
sclerosis and neurofibromatosis
The first step in treating your child is forming an accurate
and complete diagnosis. In the case of GBMs, this is primarily done with a
combination of imaging and biopsy. Your child’s physician may order a number of
different tests including:
There may be other diagnostic tests that your doctor will discuss with
you depending on your child's individual situation. After we complete all
necessary tests, our experts meet to review and discuss what they have learned
about your child's condition. Then we will meet with you and your family to
discuss the results and outline the best possible treatment options. All patients undergoing resection of brain tumors in our program are also
invited to participate in our ongoing research studies which allow genetic
profiling of each child’s tumor. These studies may potentially guide personalized (precision) medicine.
physician will determine a specific course of treatment based on several
factors, including your child's age, overall health and medical history, the
type, location, and size of the tumor and the extent of the disease.
Treatments for GBMs include:
Clinical trials, or research studies
evaluating new treatment approaches, are a major offering at Dana-Farber/Boston
Children’s Cancer and Blood Disorders Center. Clinical trials are very
important for children with hard-to-treat or relapsed conditions.
For many children with brain tumors or other rare or hard-to-treat
conditions, clinical trials provide new options.
that your child will be eligible to participate in one of our brain tumor clinical trials.
In addition to launching our own clinical trials, we also offer trials
available through collaborative groups such as the Children's Oncology Group
(COG), the Pacific
Pediatric Neuro-Oncology Consortium (PNOC). If your child has
progressive or recurrent tumor, she may be eligible for a number of
experimental therapies available through these groups, or from one of our
independent clinical investigators.
Clinical and basic scientists at Dana-Farber/Boston Children’s are
conducting numerous research studies to help clinicians better understand and
treat malignant gliomas. Through the consortia of researchers to which we
belong, a number of novel therapies are available for children with both newly
diagnosed and current brain tumors. Participation
in any clinical trial is completely voluntary. We will take care to fully
explain all elements of the treatment plan prior to the start of the trial, and
you may remove your child from the medical study at any time.
Unfortunately, the prognosis for GBM remains very poor. In general, more
complete surgical removal of the tumor, when possible,
results in greater chance of survival. Your child’s doctor will discuss
treatment options with you, including experimental clinical trials and
For children with relapsed GBMs, we offer access to the
latest clinical trials and experimental therapies. Current trials include novel
medications, as well as new methods for the delivery of more traditional
Our Pediatric Advanced
Care Team (PACT) is available to provide supportive treatments intended to
optimize your child’s quality of life and promote comfort and healing for
children with life-threatening illnesses. In addition, PACT can provide
psychosocial support and help arrange end-of-life care, when necessary.
treated for a GBM should visit a survivorship clinic yearly to manage disease
complications, screen for recurrence
and manage late treatment side effects. A typical follow-up visit is likely to
include a physical exam, laboratory testing and imaging scans.
Through our Stop
& Shop Family Pediatric Neuro-Oncology Outcomes Clinic, children are able to meet with their neurosurgeon, radiation
oncologist, pediatric neuro-oncologist and neurologists at the same follow-up
visit. Our multidisciplinary approach and depth of expertise will give your
child on-site access to endocrinologists, neuro-psychologists and
alternative/complementary therapy specialists. School liaison and psychosocial
personnel from the pediatric brain tumor team are also available. In addition, children needing rehabilitation may
meet with speech, physical, and occupational therapists during and after their
The Brain Tumor Center's Peter Manley, MD, discusses the issues that survivors of childhood brain cancers should know.