Understanding Your Glioma Treatment Path: An Overview For Patients

“Typically a glioma surgery can last four to five hours,” she adds. “And then afterwards you would go to our neuro critical care unit for your post-operative care. Usually patients spend one night or two in the ICU [intensive care unit] and then move onto the regular ward. Then they would discharge home after that.”

Once the medical team gets more information about a patient’s diagnosis, Dr. Menacho explains, the patient is linked up with additional specialists who may recommend radiation, chemotherapy, or clinical trials.

What Are My Treatment Options After Surgery?

The goal of surgery is to remove as much of the tumor as possible without damaging critical brain function. However, surgery alone is often not enough to completely eradicate the tumor, so additional treatments are usually necessary to target remaining cancerous cells.

Post-surgical treatment options include:

1. Radiation Therapy: This therapy uses high-energy rays to destroy remaining cancer cells and prevent tumor growth and re-growth. Radiation therapy is often recommended after surgery, especially for higher grade gliomas.
2. Chemotherapy: This involves the use of drugs to kill or slow the growth of cancer cells. Chemotherapy may be administered orally or through an IV and is commonly used in combination with radiation.
3. Targeted Therapy: Some gliomas have specific genetic mutations that can be targeted with specialized drugs. This approach can offer a more precise and effective treatment with fewer side effects compared to traditional chemotherapy.
4. Clinical Trials: Many new treatments are being tested in clinical trials, offering access to cutting-edge therapies that may not yet be widely available.

Your medical team should work with you to create a personalized treatment plan based on the type, location, and grade of your glioma. Your overall health and personal preferences will also play a significant role in determining the best course of care.

Are There Options When Surgery Isn’t Possible?

Not all gliomas are considered operable.

The location of the tumor, its size, or your overall health may prevent surgery as a treatment option. If surgery is not possible, there are still effective treatments available.

These include:

• Radiation Therapy: Often used as the primary treatment for inoperable gliomas, radiation therapy can help shrink the tumor and slow its progression.
• Chemotherapy: Some chemotherapeutic drugs can effectively penetrate the blood-brain barrier and target tumor cells, even in cases where surgery is not an option.
• Tumor-Treating Fields (TTF): This newer approach uses electrical fields to disrupt cancer cell division, potentially slowing tumor growth.
• Supportive Care and Palliative Treatment: If curative treatment is not feasible, palliative care can help manage symptoms and improve quality of life.

Even if surgery is not possible, your medical team will work with you to develop a treatment plan aimed at controlling tumor growth and enhancing your well-being.

My Glioma Has Returned: What Should I Do Now?

Recurrence is a reality for many glioma patients. If your tumor returns after initial treatment, you are not out of options. The next steps depend on several factors, including how aggressive the tumor is, how much time has passed since your last treatment, and your overall health.

Treatment options for recurrent gliomas include:

• Repeat Surgery: In some cases, a second surgery may be possible to remove new tumor growth.
• Re-Irradiation: A second course of radiation therapy may be recommended, though previous radiation exposure limits its feasibility.
• Chemotherapy: Alternative chemotherapy drugs or regimens may be explored, especially if the tumor did not respond well to the initial treatment.
• Targeted Therapy or Immunotherapy: Depending on the genetic profile of your tumor, new targeted treatments or immunotherapy approaches may be available. Immunotherapy is a treatment that uses your own immune system to fight disease.
• Clinical Trials: If standard treatments are not effective, participating in a clinical trial may provide access to new innovative therapies.

It is important to maintain open communication with your doctor and explore all available options to determine the best course of action for you.

What Side Effects Can I Expect From Treatment?

Every treatment comes with potential side effects, or toxicities as doctors may call them.

Understanding what to expect can help you prepare and manage any symptoms more effectively.

Here’s a breakdown of common side effects by treatment type but note that there can be other potential concerns and communication with your care team is paramount in this regard:

Surgery

• Swelling or fluid buildup in the brain
• Temporary or permanent neurological effects (motor skills, speech issues, coordination problems)
• Fatigue

Radiation Therapy

• Fatigue
• Skin irritation or hair loss at the treatment site
• Memory or cognitive issues over time

Chemotherapy

• Nausea and vomiting
• Hair loss
• Increased risk of infections due to lowered white blood cell counts

Targeted Therapy & Immunotherapy

• Skin rash
• Liver issues
• Autoimmune reactions (in rare cases)

Your healthcare team will work with you to manage side effects through medications, lifestyle adjustments, and supportive therapies. Be sure to communicate to your provider about any discomfort you experience so that adjustments can be made.

Questions to Ask Your Doctor

• Am I a good candidate for surgery?
• What sort of surgery will I undergo?
• How will we determine if I need additional treatment?
• Is there anything I can do to reduce the risk of recurrence?

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