Glioblastoma: Risk factors, diagnosis and treatment options

Glioblastoma (GBM) , also known as glioblastoma multiforme, is the most common and lethal primary brain tumor which exhibits clinical, radiological and pathological heterogeneity. Based on the fact that the incidence has been documented to be constant in various reports, genetic variation is more likely to play a major role in developing GBM than environmental, geographical and nutritional factors. MRI with contrast enhancement is the most commonly used method in the initial evaluation and follow-up after treatment. The typical finding of GBM is ring enhanced white matter lesion with central necrosis and perilesional edema on MRI. Microvascular proliferation and necrosis have been used as the most critical factor in pathological confirmation. Recently, some biomarkers such as O6-methylguanine-DNA methyltransferase (MGMT) methylation, BRAF fusions, and IDH1 mutations have been suggested as possible prognostic and grading factors. Standard therapy includes microsurgical resection and a multimodal treatment of concomitant radiotherapy and chemotherapy, followed by adjuvant chemotherapy with temozolomide. In addition to functional or diffusion tensor MRI with navigation system or intraoperative MRI, fluorescence-guided resection helps surgeons to increase safety and accuracy in GBM surgery. MR spectroscopy and positron-emission tomography (PET) scans may provide useful information in differential diagnosis and making treatment plans. Anti-angiogenic therapy with antivascular endothelial growth factor antibodies (bevacizumab) is on its way into clinical practice. In this article, the authors discuss and highlight the advances in diagnosis and treatment of GBM with relevant reviews.