Brain Tumors: Symptoms, Diagnosis, and Modern Treatment Methods

What is a brain tumor?

Brain tumors are an abnormal growth of cells within the skull. They can be either benign or malignant. Among malignant brain tumors in adults, glioblastoma (GBM) is considered the most aggressive [2]. The prognosis for patients with glioblastoma, especially for elderly individuals with multiple comorbidities and a high tumor volume, is often extremely poor. In such cases, standard treatments like surgery and chemoradiotherapy may be poorly tolerated, highlighting an urgent need for effective, low-toxicity palliative treatment options [1].

Symptoms of brain tumors: what to look for?

Symptoms of brain tumors can vary greatly depending on their size, location, and growth rate. They often develop gradually but can also manifest acutely. It is important to note that many of these symptoms are non-specific and can be caused by other, less serious conditions such as migraines or infections.

• Headaches: Often the first and most common symptom. They can be persistent, worsen over time, and be accompanied by nausea and photophobia [3, 5].
• Speech disorders: Progressive difficulties with speech, such as aphasia, can be a sign of a tumor, especially if it is located in the left frontal lobe [1, 5].
• Focal neurological symptoms:
  • Weakness or numbness: Unilateral weakness (hemiparesis) or sensory changes in the limbs [4, 5].
  • Vision problems: Episodic vision loss [5].
• Seizures: Sudden, uncontrollable attacks that may be the first manifestation of a tumor [5].
• Mental status changes: Confusion, personality changes, or behavioral changes.
• Nausea and vomiting: Especially in the morning, may indicate increased intracranial pressure.

If any of these symptoms appear, especially if they are progressive or unusual in nature, it is necessary to consult a doctor immediately for an accurate diagnosis.

Diagnosis: from MRI to molecular profiling

Diagnosing brain tumors is a complex process that includes several stages:

• Neurological examination: The doctor evaluates the patient's reflexes, muscle strength, coordination, vision, hearing, and mental state.
• Imaging studies: Contrast-enhanced magnetic resonance imaging (MRI) of the brain is the primary diagnostic method. It allows for precise determination of the tumor's size, location, and characteristics [1, 4, 5]. In some cases, CT or PET scans may be used.
• Biopsy and histological examination: To definitively confirm the diagnosis and determine the tumor type, a tissue sample (biopsy) and subsequent microscopic examination are required. This is the "gold standard" of diagnosis [2].
• Molecular genetic testing: Analyzing tumor tissue for specific molecular markers is crucial for choosing treatment tactics and determining prognosis. For example, methylation of the O6-methylguanine-DNA methyltransferase (MGMT) gene promoter is an important prognostic factor and a predictor of response to temozolomide chemotherapy in glioblastoma [1]. Mutations in IDH1/2 and BRAF V600E genes are also investigated [1].

Modern approaches to brain tumor treatment

Treatment for brain tumors is usually comprehensive and involves a combination of various methods adapted to the tumor type, size, location, the patient's general condition, and the tumor's molecular characteristics.

• Surgery: The goal of the operation is to remove as much of the tumor as possible while preserving vital brain functions. In some cases, especially with glioblastoma, complete removal may be difficult due to the infiltrative growth of the tumor [1].
• Chemotherapy:
  • Temozolomide (TMZ): Is the standard chemotherapeutic agent for treating glioblastoma [1, 2]. Studies show that universal access to temozolomide can significantly improve patient survival rates [2].
  • Role of MGMT methylation: Patients with a methylated MGMT promoter respond better to temozolomide therapy [1].
  • Special cases: For very elderly patients with glioblastoma, high tumor volume, multiple severe comorbidities (epilepsy, heart failure, type 2 diabetes, cerebral infarction, severe malnutrition), and poor physical condition (ECOG 4, KPS 30), standard approaches may be poorly tolerated. In such cases, low-dose temozolomide in combination with valproic acid is considered as a low-toxicity palliative treatment [1].
• Radiation therapy: Often used after surgical removal of the tumor or as a standalone treatment method, especially when surgery is not possible. It is aimed at destroying remaining tumor cells or slowing tumor growth.

Radiation therapy and its potential complications

Radiation therapy, including cranial irradiation, is an important component of treatment for many brain tumors. However, like any powerful treatment method, it can have delayed side effects.

• SMART syndrome: One of the rare but serious delayed complications of cranial irradiation is SMART syndrome (Stroke-like Migraine Attacks after Radiation Therapy) [5].
• Manifestation: This syndrome can develop years or even decades after brain irradiation [5].
• Symptoms: SMART syndrome is characterized by a complex of neurological symptoms, including severe headaches, episodic vision loss, stroke-like hemiparesis (unilateral weakness), sensory changes, and seizures [5].
• Diagnosis and treatment: Diagnosing SMART syndrome requires careful exclusion of other causes. In one reported case of a 60-year-old man with an acute onset of hemiparesis, aphasia, altered sensation, and recurrent seizures, the diagnosis of SMART syndrome was confirmed. Successful treatment was achieved using high-dose pulse corticosteroid therapy (e.g., 1000 mg/day of intravenous methylprednisolone for 3 days), which led to an improvement in clinical and radiological indicators [5].

Sources

1. Low-dose temozolomide combined with valproic acid in the treatment of an elderly patient with MGMT-methylated glioblastoma and multiple comorbidities: a case report. https://pubmed.ncbi.nlm.nih.gov/42597355/
2. Real-World Survival Outcomes of Glioblastoma Patients Under Universal Temozolomide Access in Uruguay: A Retrospective Cohort Study (2009-2018) and Implications for Health Policy. https://pubmed.ncbi.nlm.nih.gov/42634750/
3. Herpes zoster ophthalmicus with atypical occipital lobe and splenial lesions: A case report. https://pubmed.ncbi.nlm.nih.gov/41732535/
4. Reduced Frequency of Prolonged Sporadic Hemiplegic Migraine Attacks Following Fremanezumab Treatment-A Case Report. https://pubmed.ncbi.nlm.nih.gov/41589756/
5. Stroke-like migraine attacks after radiation therapy (SMART) syndrome: a study in diagnosis, treatment and outcome. https://pubmed.ncbi.nlm.nih.gov/41991235/

The information provided in this article is for reference purposes only and cannot replace professional medical advice. Always consult a qualified specialist for diagnosis and treatment.