Management of glioblastoma: a perspective from Mexico

Abstract

Access to healthcare in Mexico is available to its population via publicly and privately funded institutions. The public sector, administered by both the local and federal government under the jurisdiction of the Department of Health, provides healthcare to the majority of the country's population. Privately funded institutions vary in size and scope of practice, ranging from small clinics focused on family practice, to large tertiary hospitals with capacity for treating patients with complex conditions and performing clinical research. The evaluation and treatment of patients with cancer in Mexico is also available through both sectors. In the country's capital, Mexico City, patients with glioblastoma are primarily treated at the National Institute of Neurology and Neurosurgery and the National Institute of Oncology. Epidemiological data is incomplete due to the lack of a national cancer registry. In the case of neoplasms of the central nervous system, the available information suggests that gliomas represent 33% of all intracranial tumors. The treatment of patients in Mexico diagnosed with glioblastoma has not been standardized owing to the lack of resources in some communities and the expense of antineoplastic agents. Current options range from a biopsy only to maximal safe resection followed by adjuvant treatment with radiation and chemotherapy.Currently, basic science and clinical research is being conducted in academic institutions associated with universities and in private hospitals. Studies include the evaluation of tumor biology, neuroimaging biomarkers and new treatment options such as the use of chloroquine.

Glioblastoma Treatment: State-of-the-Art and Future Perspectives

“…This consideration does not discourage the efforts to achieve gross total resection when feasible. If possible, GTR is advised in recurrent cases with a time interval of >6 months since the first surgery, especially in younger patients with a good clinical state [2,27,29].…”

“…Uncontrolled chronic cough, hemiplegia with motor function <2 on the Daniel's scale, severe dysphasia, and big tumors with mass effect resulting in >2 cm of midline shift are all absolute contraindications for awake craniotomy [27]. However, individualization of the patient is essential, considering that adaptation is possible in some instances [22,29] During AC, different anesthetic approaches are employed, including conscious sedation (CS) and the asleep-awake-asleep procedure (AAA). Conscious sedation entails supplementary oxygen, spontaneous ventilation, and modest doses of sedative medications.…”