Treatment Strategies - Brain and Spinal Cord Cancer Treatment Strategies - Brain and Spinal Cord Cancer

Glioblastoma Multiforme (GBM) Glioblastoma multiforme (GBM) is considered the most malignant of primary brain cancers with only about 12% of patients living beyond 36 months (long-term survivors).1,2 GBM is heterogeneous in cellular composition consisting of tumor stem cells, mesenchymal cells, and host stromal cells.3-6 In addition to the neoplastic cell populations, tumorassociated macrophages/monocytes (TAM) also comprise a significant cell population in GBM sometimes equaling the number of tumor cells.7-12 TAM indirectly contribute to tumor progression through release of pro-inflammatory and pro-angiogenic factors.8,10,12,13 It is often difficult to determine with certainty whether cells with macrophage characteristics are part of the stroma or are part of the neoplastic cell population.14 Many of the neoplastic cells in GBM invade through the neural parenchyma well beyond the main tumor mass making complete surgical resections exceedingly rare.15,16 Our goal is to review information on the current status of care for GBM and to provide information on how the restricted ketogenic diet (RKD) might serve as an effective alternative to the current standard of care for controlling growth and enhancing survival in patients with GBM. The therapeutic and health benefits of the KD are realized when the diet is consumed in reduced or restricted amounts. Much of the information in this review was compiled from our previous papers and reviews on this subject.10,17-24