In the wake of political figures such Sen. John McCain, Sen. Edward Kennedy and Beau Biden passing away from glioblastoma, you might might have questions about this form of brain cancer.
Dr. Kamran Parsa discusses glioblastoma, treatment options and when it might be necessary to stop treatment and start planning for end-of-life care.
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Glioblastoma
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Learn more about Kamran Parsa, DO
Kamran Parsa, DO
Kamran Parsa, DO. is a Neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center.Learn more about Kamran Parsa, DO
Transcription:
Melanie Cole (Host): In the wake of political figures passing away from glioblastoma; you might have questions about this form of brain cancer. My guest today is Dr. Kamran Parsa. He’s a neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center. Dr. Parsa, we have been hearing a lot in the media about glioblastoma. Tell us what it is and who is at risk for this type of brain cancer?
Dr. Kamran Parsa (Guest): Hi Melanie. So, glioblastoma multiforme is a form of brain cancer that develops primarily in the brain. It does not metastasize from anywhere else. It’s essentially a grade four cancer. What I mean by that is that it is the most aggressive form. It is not curable unfortunately. And within brain cancers there are four grades with grades three and four being the most aggressive. It comes from the original name is a grade four astrocytoma but because of its multiple different clinical presentations and microscopic presentations, it is called a multiforme glioblastoma.
Melanie: Who is at risk? Is this because you said it’s not metastasized from somewhere else and that it is the primary tumor? Does it just show up? Is this a random thing because it’s not really that common is it?
Dr. Parsa: No, it’s not. It is not a common cancer at all. And there are no specific genetic markers that definitively place any certain population at risk. There are some markers that may – for treatment purposes, may potentially respond to adjuvant therapy, but really, it’s a spontaneous form of cancer. It can hit anyone, anytime. Usually, the age range that it hits is between 40 and 60 years old, but it can even present in younger children and in older adults.
Melanie: So, tell us what symptoms or red flags would send somebody to see a neurosurgeon or a neurooncologist or a neurologist or their primary care provider if they are experiencing these? Because Dr. Parsa, people get a headache and they think oh my gosh, I have a brain tumor. So, you know people go to these far reaches in their mind. What are the real symptoms? What do you want people to look out for?
Dr. Parsa: Again, it’s very – you touched on the exact point why it’s difficult to advise anyone to go immediately to their doctor. Because that is an initial presentation. Headaches. And we all have headaches. I had a headache two days ago. So, it’s very, very difficult to advise anyone who has a headache to rush to their primary care or a neurological specialist. But, there are some other symptoms. If there are headaches that are associated with neurological findings. What that means is if you have a headache and you find that you cannot speak as well, or you are just not yourself or your family member say wait a minute, why did you just do that. That’s not your normal behaviors or if you have numbness, tingling in your arms, legs associated with the headaches. Those are scenarios where I would advocate to seek medical attention as soon as possible to make sure that it is not obviously something as serious as GBM.
Melanie: So, you mentioned that there are treatments, but most of them are going to be working on the symptoms. Tell us about some of the promising new therapies whether it’s immunotherapy or CAR-T cell, what are some of the promising new therapies available today for glioblastoma?
Dr. Parsa: Let me start with what the standard is, and I’ll go to new therapies. The standard therapy – well first you look at the patient themselves and the disease process. If untreated, glioblastoma multiforme is the most aggressive cancer known to man. Generally speaking, it will take your life within two to three months. So, the standard treatment is maximal surgical resection with adjuvant chemotherapy and radiation therapy. These three are the standard treatment and this has increased survivability to approximately two years at this point. Now the new treatments that are being performed at tertiary care centers throughout the country are all – none are standardized. It’s essentially different approaches trying to treat a very aggressive tumor. Some involve as you mentioned, immunotherapy using different vectors such as viruses to go to the tumor. Others are looking at more stem cell-based treatment patterns. Some are looking at more effective radiotherapy. Others are repeat surgery with a different wafers or intraoperative treatment patterns. You name it. There is probably dozens of clinical trials going on in the country that are available to the public and all of these centers are taking patients and attempting these promising treatments just we don’t have any form of cure or definitive direction where everybody’s going towards. Sort of all over the place.
Melanie: Dr. Parsa, as a result of what you just said, when is it necessary to stop treatment and start planning for end of life care and how do you discuss that with the patient or what do you want listeners to know about when that discussion starts as it did for certain political figures and we heard about it, that discussion has to come into play at some point.
Dr. Parsa: Well, so we have a grading scale that we go by called the Karnofsky Grading Scale and what that is, is it essentially looks at different – gives points to different activities of daily living. And it’s a multiple questionnaire and it’s done with a physical therapist and once the number comes up, generally speaking, if you are above a grade of 70; it is recommended to attempt to be aggressive and do all the treatments possible. Once you start to hit below 70; or you have an advanced age as well; then in those scenarios it may be a better idea to focus on quality of life as opposed to longevity and repeat brain surgeries and chemotherapies and radiation therapies, really take a toll on the body. So, that is – it’s an extensive discussion generally held by neurosurgeon and a neurologist, neurooncologist. It’s a team approach with the family members. If the patient is cognitively able to; I always leave it up to the patient to decide obviously. But if anyone is diagnosed with a GBM and is initially cognitively functional, I would advocate to as soon as possible indicate who their medical power of attorney would be so it the scenario arises to decide whether it’s palliative care or continued therapy; it is more appropriately directed. So, it’s a long discussion. We use the – to summarize, long discussion. We use the Karnofsky score from the medical aspect. Ultimately, having a team approach of family members, multiple medical specialists and seeing what the patient and their family want is the best and we generally advise to go that route.
Melanie: Dr. Parsa, wrap it up for us with so much information out there today, summarize it. Glioblastoma explain just what you would like us to take away from everything that we are seeing in the media and what you have said here today.
Dr. Parsa: So, glioblastoma multiforme or GBM is unfortunately a very aggressive tumor, the most aggressive we know of. Its treatments should be directed from a multidisciplinary approach and have an extensive discussion involving the patient and family. There is no cure at this time. There is only – not only but treatments which have significantly increased survivability, but the key component is also considering quality of life. Open communication, transparency is the key I believe in all of this. And really palliative care also plays a major role as well.
Melanie: Thank you so much Dr. Parsa for being on with us today and sharing your expertise explaining all of this for us. Because it can be a little confusing when so much information comes at you. So, thank you again for joining us. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information please visit www.palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Melanie Cole (Host): In the wake of political figures passing away from glioblastoma; you might have questions about this form of brain cancer. My guest today is Dr. Kamran Parsa. He’s a neurosurgeon and a member of the medical staff at Palmdale Regional Medical Center. Dr. Parsa, we have been hearing a lot in the media about glioblastoma. Tell us what it is and who is at risk for this type of brain cancer?
Dr. Kamran Parsa (Guest): Hi Melanie. So, glioblastoma multiforme is a form of brain cancer that develops primarily in the brain. It does not metastasize from anywhere else. It’s essentially a grade four cancer. What I mean by that is that it is the most aggressive form. It is not curable unfortunately. And within brain cancers there are four grades with grades three and four being the most aggressive. It comes from the original name is a grade four astrocytoma but because of its multiple different clinical presentations and microscopic presentations, it is called a multiforme glioblastoma.
Melanie: Who is at risk? Is this because you said it’s not metastasized from somewhere else and that it is the primary tumor? Does it just show up? Is this a random thing because it’s not really that common is it?
Dr. Parsa: No, it’s not. It is not a common cancer at all. And there are no specific genetic markers that definitively place any certain population at risk. There are some markers that may – for treatment purposes, may potentially respond to adjuvant therapy, but really, it’s a spontaneous form of cancer. It can hit anyone, anytime. Usually, the age range that it hits is between 40 and 60 years old, but it can even present in younger children and in older adults.
Melanie: So, tell us what symptoms or red flags would send somebody to see a neurosurgeon or a neurooncologist or a neurologist or their primary care provider if they are experiencing these? Because Dr. Parsa, people get a headache and they think oh my gosh, I have a brain tumor. So, you know people go to these far reaches in their mind. What are the real symptoms? What do you want people to look out for?
Dr. Parsa: Again, it’s very – you touched on the exact point why it’s difficult to advise anyone to go immediately to their doctor. Because that is an initial presentation. Headaches. And we all have headaches. I had a headache two days ago. So, it’s very, very difficult to advise anyone who has a headache to rush to their primary care or a neurological specialist. But, there are some other symptoms. If there are headaches that are associated with neurological findings. What that means is if you have a headache and you find that you cannot speak as well, or you are just not yourself or your family member say wait a minute, why did you just do that. That’s not your normal behaviors or if you have numbness, tingling in your arms, legs associated with the headaches. Those are scenarios where I would advocate to seek medical attention as soon as possible to make sure that it is not obviously something as serious as GBM.
Melanie: So, you mentioned that there are treatments, but most of them are going to be working on the symptoms. Tell us about some of the promising new therapies whether it’s immunotherapy or CAR-T cell, what are some of the promising new therapies available today for glioblastoma?
Dr. Parsa: Let me start with what the standard is, and I’ll go to new therapies. The standard therapy – well first you look at the patient themselves and the disease process. If untreated, glioblastoma multiforme is the most aggressive cancer known to man. Generally speaking, it will take your life within two to three months. So, the standard treatment is maximal surgical resection with adjuvant chemotherapy and radiation therapy. These three are the standard treatment and this has increased survivability to approximately two years at this point. Now the new treatments that are being performed at tertiary care centers throughout the country are all – none are standardized. It’s essentially different approaches trying to treat a very aggressive tumor. Some involve as you mentioned, immunotherapy using different vectors such as viruses to go to the tumor. Others are looking at more stem cell-based treatment patterns. Some are looking at more effective radiotherapy. Others are repeat surgery with a different wafers or intraoperative treatment patterns. You name it. There is probably dozens of clinical trials going on in the country that are available to the public and all of these centers are taking patients and attempting these promising treatments just we don’t have any form of cure or definitive direction where everybody’s going towards. Sort of all over the place.
Melanie: Dr. Parsa, as a result of what you just said, when is it necessary to stop treatment and start planning for end of life care and how do you discuss that with the patient or what do you want listeners to know about when that discussion starts as it did for certain political figures and we heard about it, that discussion has to come into play at some point.
Dr. Parsa: Well, so we have a grading scale that we go by called the Karnofsky Grading Scale and what that is, is it essentially looks at different – gives points to different activities of daily living. And it’s a multiple questionnaire and it’s done with a physical therapist and once the number comes up, generally speaking, if you are above a grade of 70; it is recommended to attempt to be aggressive and do all the treatments possible. Once you start to hit below 70; or you have an advanced age as well; then in those scenarios it may be a better idea to focus on quality of life as opposed to longevity and repeat brain surgeries and chemotherapies and radiation therapies, really take a toll on the body. So, that is – it’s an extensive discussion generally held by neurosurgeon and a neurologist, neurooncologist. It’s a team approach with the family members. If the patient is cognitively able to; I always leave it up to the patient to decide obviously. But if anyone is diagnosed with a GBM and is initially cognitively functional, I would advocate to as soon as possible indicate who their medical power of attorney would be so it the scenario arises to decide whether it’s palliative care or continued therapy; it is more appropriately directed. So, it’s a long discussion. We use the – to summarize, long discussion. We use the Karnofsky score from the medical aspect. Ultimately, having a team approach of family members, multiple medical specialists and seeing what the patient and their family want is the best and we generally advise to go that route.
Melanie: Dr. Parsa, wrap it up for us with so much information out there today, summarize it. Glioblastoma explain just what you would like us to take away from everything that we are seeing in the media and what you have said here today.
Dr. Parsa: So, glioblastoma multiforme or GBM is unfortunately a very aggressive tumor, the most aggressive we know of. Its treatments should be directed from a multidisciplinary approach and have an extensive discussion involving the patient and family. There is no cure at this time. There is only – not only but treatments which have significantly increased survivability, but the key component is also considering quality of life. Open communication, transparency is the key I believe in all of this. And really palliative care also plays a major role as well.
Melanie: Thank you so much Dr. Parsa for being on with us today and sharing your expertise explaining all of this for us. Because it can be a little confusing when so much information comes at you. So, thank you again for joining us. You’re listening to Palmdale Regional Radio with Palmdale Regional Medical Center. For more information please visit www.palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.