Glioma Recurrence: There Are Still Options
- A glioma diagnosis can be life-changing, and completing initial treatment — whether surgery, radiation, or both — is a major milestone. Yet for many patients and their loved ones, there’s a lingering worry: What if it comes back?
- Unfortunately, recurrence is common with gliomas, sometimes happening soon after treatment or even years down the road.
- It’s important to understand, though, that even at recurrence, there are treatment options for patients with glioma.
- Treatment may include surgery, radiation, chemotherapy, targeted therapies, enrolling in a clinical trial, or using a newly developed approach known as tumor treating fields (TTFs).
“We know that this is a diffuse [widely spread] disease. We hope that by doing surgery and then following with radiation and then chemotherapy, we will be targeting those cells,” Dr. Jensen explains. “But we know that some of those [cells] aren’t getting full treatment. We also know that there are stem cells that seem to be the origin of some of these tumors that also may not be receptive to these treatments.”
Read MoreUnderstanding Gliomas & Their Infiltrative Nature
Gliomas are tumors that arise from glial cells in the brain. These cells support and protect the nerve cells responsible for carrying messages throughout the body. One key reason gliomas can return is their infiltrative nature, meaning they often spread into nearby healthy brain tissue rather than forming a neatly defined mass. Because of this, surgery can’t always remove all of the cancer. Even the most skilled neurosurgeon may leave behind microscopic cancer cells that are difficult to distinguish from normal brain tissue. The goal is to remove as much of the tumor as possible while keeping the patient well neurologically — but removing every last cell can be impossible.“If you were to do a biopsy of someone who had a glioma, if you were to take that biopsy and go out even four or five centimeters away from the tumor you can see, you would find individual tumor cells scattered even that far away from the central area you call tumor. So we know that this is a diffuse disease,” Dr. Jensen explains.
Some researchers also believe small populations of “cancer stem cells” remain hidden after treatment, only to reactivate and fuel regrowth months or even years later.
“In that population of cells that are left behind, the majority of them are affected and treated properly. But there are a few cells that have mutated and they’re able to avoid whatever treatment we’ve given. So recurrence is a real risk,” Dr. Jensen explains.
Risk Factors That Can Influence Recurrence
A few risk factors could influence the likelihood of a glioma recurrence, including:
- Tumor Grade: High-grade gliomas tend to come back more quickly. Low-grade gliomas may lie dormant but can still return even a decade after diagnosis.
- Genetic Markers:
- IDH Mutations often indicate a slower-growing tumor.
- TP53 or ATRX Mutations may signal a greater risk of recurrence in some types of gliomas.
- MGMT Promoter Methylation can be linked to predict a better responsiveness to certain chemotherapy and radiation drugs.
- Extent of Surgery: Removing a larger portion of the tumor can lower the risk of regrowth.
- Age: Younger individuals sometimes have more favorable genetic tumor profiles.
- Tumor Size: Larger tumors are more challenging to remove completely.
The Importance of Lifelong Follow-Up
Gliomas can transform or reappear at any point. Therefore, even after you complete treatment, routine imaging (often MRI scans) is vital for early detection. Recurrences caught early can allow for more treatment options.
Sometimes, low-grade tumors can shift into more aggressive forms. Consistent check-ups help identify these changes promptly.
“Recurrence is a real risk, and that’s why we do an MRI every two to three months after glioma surgery, so that we can see how our treatments are working and be able to try to catch early any sign of recurrence at the sign of recurrence,” Dr. Jensen explains.
While repeated scans can be stressful, they’re essential to staying on top of possible regrowth.
What Happens If Glioma Returns?
A returning tumor doesn’t mean there are no options left. The best path forward depends on tumor characteristics, which treatments you’ve already had, and your overall health.
“At the sign of recurrence, there’s a couple of things we can do. Surgery is always an option for patients if it’s in a location that’s not going to give them a new deficit or if it’s part of a clinical trial. There are other chemotherapies. There’s always repeat radiation, although we tend to be very focal if we’re going to be repeat radiation. We don’t want to give maybe the big dose that we gave the first time around unless many years have passed since the first radiation,” Dr. Jensen explains.
Clinical trials may also be an option, and Dr. Jensen points out that there are many looking into the best ways to treat glioma recurrence.
Treating glioma recurrence may include the following approaches:
- Repeat Surgery (Re-resection): This may be recommended if the tumor is in an area where another operation is safe and beneficial. It can help relieve pressure and reduce symptoms if the recurrent tumor has grown.
- Radiation Therapy: This may include salvage radiation, or radiation given for the first time, or re-irradiation. More radiation is sometimes possible even if you had radiation before, particularly if the recurrent tumor is small and away from critical brain structures. Stereotactic radiosurgery (SRS) or proton therapy may help focus treatment on the tumor while sparing healthy tissue.
- Chemotherapy: Common drugs include temozolomide (TMZ), lomustine, carmustine, or multi-drug regimens (like PCV). Which drug is chosen often depends on what was tried before and any molecular markers in your tumor.
- Targeted Therapy & Immunotherapy: These treatments focus on specific genetic features, such as inhibitors aimed at IDH mutations or pathways like BRAF or NTRK. Immunotherapy approaches, still under study in clinical trials, aim to harness the body’s own immune system to fight the tumor.
- Tumor Treating Fields (TTFs): These are a specialized therapy mainly for glioblastoma. The approach uses low-intensity electric fields to disrupt cancer cell division.
- Clinical Trials: Trials offer access to experimental drugs, new combinations of existing therapies, or innovative techniques that are not yet widely available. They are often recommended because standard treatments may have limited effectiveness against recurrent tumors.
- Supportive or Palliative Care: This approach focuses on reducing symptoms and enhancing quality of life when aggressive treatment might no longer be an option.
Questions to Ask Your Doctor
- How soon and how often should follow-up scans be scheduled?
- Are there any specific genetic markers in my tumor that could guide treatment?
- If my tumor returns, what are the surgical or non-surgical options?
- Could I be a candidate for any clinical trials?
- What are the possible benefits or risks of each treatment plan?
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