Brain cancer treatments in Germany
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Glioblastoma is a malignant neoplasm that arises from glial cells of the brain. The tumor is heterogeneous and requires a differentiated therapeutic approach. When elaborating a treatment regimen, German oncologists take into account the molecular and genetic composition of the tumor and its location in relation to vital parts of the brain. The clinics in Germany offer innovative medical devices and drugs, thanks to which the doctors make maximum use of all therapeutic options. These include surgical resection and irradiation, chemotherapy, immunotherapy, therapy with tumor treatment fields, and experimental gene techniques.
Content
- Surgery and radiation therapy are the treatment basis
- Supportive chemotherapy
- Therapy in the tumor treating fields
- Immunotherapy – updated information
- Experimental gene therapies
- Hospitals and costs of treatment
- Booking Health – complete arrangement of glioblastoma treatment in Germany
Surgery and radiation therapy are the treatment basis
A surgical procedure is the first step in the comprehensive brain tumor treatment in Germany. The completeness of tumor removal largely determines the success of subsequent therapeutic stages. Glioblastoma can rarely be removed totally since it has infiltrative growth and affects vital regions of the brain.
It is difficult to distinguish the tumor from healthy brain tissue with a naked eye, and therefore fluorescence-guided navigation with 5-ALA is used during surgery. 5-ALA selectively accumulates in cancer cells and provides clear imaging of the glioblastoma growth boundary.
The doctors use a stereotactic technique to increase the accuracy of neurosurgical procedures, which allows for determining the tumor location in a 3D coordinate system using MRI. The surgery can be performed using an open method or minimally invasive catheter techniques (for example, laser ablation with the Visualase system).
Due to the elimination of the remaining cancer cells in the brain, radiation therapy consolidates the result of surgical treatment. The safest irradiation technique is proton therapy. Proton therapy in Germany has less pronounced side effects compared to conventional irradiation.
Supportive chemotherapy
As a rule, chemotherapy for brain cancer is not administered as a first-line option since tumor cells mutate rapidly and become resistant to drugs. The indications for chemotherapy include:
- Surgical removal of more than 90% of the tumor volume
- Risk of relapse after the initial intervention
- Relapse of the disease (for slowing the disease progression)
Also, the doctors can administer chemotherapy drugs, if the surgical intervention is contraindicated. In this situation, the drug is administered orally. When chemotherapy complements surgery, the implant with the active substance is placed in the brain, near the tumor. This method of administration can improve the accuracy of the chemotherapy drug delivery, thereby allowing it to penetrate the blood-brain barrier.
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Therapy in the tumor treating fields
In 2012, phase III of a randomized clinical trial was completed. This trial studied a fundamentally new method of treating brain cancer, namely the effect of tumor treating fields (TTF). The TTFs have been used in patients with recurrent glioblastoma who have not tolerated supportive chemotherapy. The study showed the same efficacy of TTF and chemotherapy, while TTF had a significant advantage due to the absence of toxicity and a higher quality of life.
In 2015, scientists received additional data on the increase in survival rates when using TTF, after which FDA, the reputable American organization, approved the use of the "Optune" device. The "Optune" and its analogs create an electric field around the neoplasm that suppresses the multiplication of cancer cells. At the same time, the TTF technique guarantees the absence of negative effects on healthy tissues.
Immunotherapy – updated information
Glioblastoma has traditionally been considered a "cold tumor," a type of brain cancer in which immunotherapy is ineffective. However, the results of the 2019 studies showed an extension of the period of remission and the life expectancy of patients with neoadjuvant immunotherapy. The studies used monoclonal antibody preparations.
With neoadjuvant administration, monoclonal antibodies form the antitumor immunity during the active stage of treatment, when the tumor cannot "mask" and suppress the immune system. As a result, the patient's T-lymphocytes can subsequently recognize and destroy cancer cells.
Prescription of immunotherapy is preceded by mandatory genetic testing since monoclonal antibodies have the best possible effect on the neoplasms with changed MAPK signaling pathways. At the same time, the tumors with PTEN mutations are more resistant.
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Experimental gene therapies
Glioblastoma can be different in its histological structure and molecular genetic status. The large University Hospitals and Research Centers carry out genetic testing aimed at finding genes unique to all tumor types.
Such studies resulted in the creation of an MKNK2 hybrid gene. Normally, this gene provides the synthesis of two types of tumor proteins – MKNK2a, which inhibits tumor growth, and MKNK2b, which stimulates tumor growth. The MKNK2 hybrid gene shifts this balance towards the MKNK2a protein. As a result, glioblastoma either becomes smaller in size or disappears completely.
At the moment, the safety and effectiveness of the MKNK2 molecule are being studied in the laboratory on a mouse model. Given the high rates in both parameters, one can hope that people will soon use the technique.
Hospitals and costs of treatment
The following German hospitals are the leaders in the glioblastoma treatment:
- University Hospital Muenster. The Department of Neurosurgery is mentioned among the top German departments for the treatment of brain tumors. It specializes in the treatment of gliomas and skull base tumors. Here, fluorescence-controlled resection of tumors using 5-ALA, intraoperative functional monitoring, and Cavitation Ultrasonic Surgical Aspirator (CUSA) are actively used. This allows doctors to achieve excellent functional results of interventions on the brain.
- Charite University Hospital Berlin. The Department of Adult and Pediatric Neurosurgery actively performs surgeries on patients with glioblastomas, astrocytomas, meningiomas, and brain metastases. More than 5,000 interventions are performed here annually. The operating rooms of the department are equipped with Zeego intraoperative angiography, AIRO intraoperative computed tomographs, neuromonitoring systems, surgical microscopes, and X-ray machines.
- Beta Klinik Bonn. The Department of Neurosurgery and Interventional Neuroradiology specializes in conservative therapy and microsurgical interventions for brain tumors. Here, seizures and cerebral edema against the background of an oncological process are successfully treated; chemotherapy and other systemic treatment methods are also used. Microsurgery allows physicians to remove brain tumors without opening the skull.
- University Hospital Freiburg. The Department of Adult and Pediatric Neurosurgery is a part of the certified Neuro-Oncology Center specializing in treating gliomas and meningiomas. Surgical interventions on the base of the skull are also successfully carried out here. Healthcare professionals actively use stereotactic and functional neurosurgery to remove tumors and prevent neurological complications completely.
- University Hospital Frankfurt-am-Main. The Department of Adult and Pediatric Neurosurgery is mentioned among the top German hospitals specializing in the surgical treatment of brain tumors. Modern equipment allows doctors to actively use functional imaging, image-guided neuronavigation, intraoperative mapping, and intraoperative videoangiography in their practice. Thanks to its successful clinical experience, the department has the status of an international Center of Expertise for the treatment of complex brain pathologies.
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Booking Health – complete arrangement of glioblastoma treatment in Germany
Glioblastoma treatment in Germany is available to both German citizens and patients from other countries. The foreign patients seek the medical help of the German oncologists via the Booking Health international portal.
Booking Health is a medical tourism operator with an established system of cooperation with German clinics. This allows offering patients modern treatment in a short time. The Booking Health specialists will also help you with the following organizational and medical aspects:
- Selection of the clinic, which specializes in glioblastoma treatment
- Direct communication with your attending physician
- Preliminary elaboration of an individual treatment program, without repeating previous examinations
- Provision of the favorable cost of surgery or other types of therapy, without overpricing and additional coefficients for foreign patients (saving up to 50%)
- Making an appointment with a doctor or hospitalization on the desired date
- Independent monitoring of the medical program at all its stages
- Assistance in buying and forwarding medicines
- Communication with the clinic after the medical program completion
- Control of invoices and return of unspent funds
- Organization of additional diagnostic examinations and rehabilitation measures
- Top-class service: booking hotels, airplane tickets, transfer
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Authors:
The article was edited by medical experts, board certified doctors Dr. Vadim Zhiliuk, Dr. Nadezhda Ivanisova. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!
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