Disease Description (Causes and Symptoms)

Definition: Glioblastoma is the most malignant glioma among solid brain tumors in adults. It mainly originates from the astrocyte lineage and is a tumor with very high infiltrative and proliferative potential. Under the WHO classification, it is considered a high-grade (Grade 4) glioblastoma.
Causes/Pathophysiology: No single exact cause is known, and genetic and environmental factors act in combination. The tumor densely infiltrates the brain parenchyma, with necrosis and microvascular proliferation occurring frequently. Molecular markers (IDH status, MGMT methylation status, EGFR amplification, etc.) affect prognosis and treatment response.
Main symptoms: Headache (especially when severe in the morning), nausea and vomiting (increased intracranial pressure), epileptic seizures (convulsions), cognitive and behavioral changes, memory decline, and focal neurological deficits (hemiplegia, speech impairment, decreased sensation, etc.). Symptoms may worsen as a result of cerebral edema or hydrocephalus during progression.

Treatment Methods

Surgery: Maximal safe resection of the tumor. Complete resection is often impossible.
Radiotherapy: Standard postoperative whole-brain focal radiotherapy (targeted radiation) is performed.
Chemotherapy: The standard is temozolomide administered concurrently with radiotherapy, followed by maintenance therapy (the Stupp protocol). Methylation of the MGMT promoter is a predictive factor for the effectiveness of temozolomide.
Treatment for recurrence: Reoperation, reirradiation, chemotherapy (retreatment with temozolomide or other drugs), and bevacizumab may help improve symptoms (relieve edema), but improvement in overall survival is limited. Clinical trials are recommended for consideration.
Supportive and symptomatic treatment: Steroids (dexamethasone) to control edema, anticonvulsants to control seizures, pain management, nutritional support, rehabilitation, psychosocial support, and end-of-life and palliative care.
Newer and other treatments: Tumor-treating fields (TTFields) have been reported to extend survival in some patients. Targeted therapy and immunotherapy are under investigation in clinical trials.

Infection, bleeding, and neurological deficits (reduced motor or language function) may occur after surgery.
Bone marrow suppression, fatigue, hair loss, gastrointestinal side effects, and others related to radiotherapy and chemotherapy.
Long-term steroid use may cause hyperglycemia, increased infections, osteoporosis, and gastrointestinal problems.
Patients with a history of seizures need restrictions on driving and high-risk work.
Prognosis varies greatly depending on age, overall physical condition (KPS), tumor location and extent of resection, and molecular markers (MGMT, IDH, etc.) (in general, the median survival after standard treatment is in the range of 12–18 months).
Complications: Recurrence, radiation necrosis, progressive neurological impairment, infection, thromboembolism, and others.

Items to prepare (recommended to bring)
- A list of currently used medications (including prescription drugs, OTC drugs, and supplements)
- Medical history (records of surgery and radiotherapy or chemotherapy), test results, or imaging (MRI/CT), preferably the originals or a CD/USB
- A record of symptom changes (date symptoms began, frequency, aggravating and relieving factors, the form of seizures, etc.)
- Allergies and family history (particularly hereditary neurofibromatosis, etc.)
Items that are helpful to record in advance for the outpatient visit
- Whether seizures have occurred and their type, the pattern and frequency of recent headaches, cognitive and language changes, and abnormalities in walking or sensation
- Daily functioning (ability to perform activities of daily living, ability to work or drive)
Simple preparations that can be made for the outpatient visit
- Obtain recent MRI images if possible
- Record body temperature, blood pressure, and weight

What is the expected course of this disease, and what is the prognosis for someone my age and in my condition?
What treatment options do you recommend, and what are the expected effects and side effects of each treatment?
Apart from standard treatment, can clinical trials or additional treatments (e.g., TTFields) be considered?
Do the medications (or supplements) I am currently taking affect treatment?
What should I be careful about in daily life during treatment (driving, work, pregnancy, etc.)?

What is the molecular profile of my tumor (IDH status, MGMT promoter methylation, EGFR/TERT, etc.), and how does it affect treatment selection and prognosis?
How much was removed during surgery (extent of resection), and what is the additional treatment plan based on this? What options are available if the tumor recurs after surgery?

(If necessary, bringing test results or imaging findings can allow for more specific and personalized consultation)