Glioblastoma Treatment in Israel

The evaluation for glioblastoma takes 3-4 days and costs USD 2,472. Surgery for glioblastoma is performed by the leading neurosurgeon, Professor Z. Ram.

Neurosurgery: awake craniotomy, surgery using confocal laser endomicroscopy, magnetic imaging systems, optical coherence tomography.

Laser neurosurgery using the Visualase device.

Stereotactic radiosurgery.

The Optune device (alternating electric fields).

Chemotherapy: temozolomide (medication), local chemotherapy with Gliadel wafers.

Biological therapy: bevacizumab (an antiangiogenic agent).

What To Expect From The Evaluation At The Top Ichilov Clinic

Day 1: Initial Examination

Immediately after arrival at the Top Ichilov Clinic, the patient consults with Doctor I. Molchanova, Head of Cancer Diagnosis Division. The doctor compiles a health history, issues referrals for the necessary studies, and prepares all papers. If the patient has already undergone a biopsy of the growth and has brought the tissue samples (slides), they are sent to the clinic’s laboratory.

Day 2: Diagnostic Procedures

On day 2, the patient, accompanied by a medical coordinator-interpreter, undergoes all the recommended studies. To diagnose the condition, experts use the following tests and procedures:

• Complete blood count.
• Blood biochemistry.
• Urinalysis.
• Tumor marker tests.
• Computed tomography (CT) – provides layer-by-layer tissue images with the following computer processing; helps determine the location and the size of the tumor.
• Magnetic resonance imaging (MRI) – provides accurate visualization of the tumor and helps identify even the smallest structural changes in the brain tissues.
• Functional MRI – a method to assess blood flow in the tumor and the nearby tissues. Magnetic resonance spectroscopy – a diagnostic method that helps assess the metabolic rate in the tumor cells.
• Positron emission tomography (PET) – a diagnostic method based on the tumor cells’ propensity to accumulate the radioisotope more actively. It helps assess the structure of the cancerous growth as well as identify and locate any metastases.
• Biopsy (if not done earlier).

Day 3: Development of a Treatment Plan

After the evaluation, the patient consults with the dedicated experts (Professor Zvi Ram, Professor D. Blumenthal). The experts develop the best possible treatment plan. After the patient’s final consultation with Doctor I. Molchanova, Head of Cancer Diagnosis Division, specialists prepare, translate, and verify all the medical documents.

The duration of stay in Israel to complete the entire evaluation plan: 3-4 days. The cost of diagnosis: $2,472.

The Advantages Of Treatment In Israel

• High accuracy of diagnosis. The use of advanced diagnostic methods and the extensive expertise of the Top Ichilov Clinic specialists help make an accurate diagnosis, rule out false positive results, correctly determine the stage and the type of cancer. All these factors influence the treatment effectiveness and the outlook greatly.
• Use of the most advanced treatment methods. The Top Ichilov Clinic specialists treat glioblastoma with the most effective methods to ensure a favorable outlook and high treatment effectiveness. Treatment in Israel differs in that a specialist may combine treatment protocols when they believe that this approach might be the most effective one for the patient.
• Exchange of experience with the leading specialists from other countries. The close communication of the Top Ichilov Clinic specialists with the leading oncologists of all countries helps implement the most advanced scientific developments and introduce new, effective treatment methods.
• Use of new, promising treatment methods. Therapy in Israel includes the use of the newest treatment methods such as molecular therapy, gene therapy, immunotherapy as well as the promising method of antiangiogenesis (treatment aimed at inhibition of blood vessel formation in the tumor).

Treatment Methods

• Surgical treatment. Surgery aims to improve the patient’s condition and reduce intracranial hypertension. The particularities of glioblastoma growth and spread make the complete surgical removal of the tumor impossible.
• Radiotherapy. Irradiation of the cancerous growth helps reduce its size significantly with minimal damage to healthy tissues.
• Chemotherapy. The high metabolic rate of tumor cells makes glioblastoma very sensitive to chemotherapy. Chemotherapy is highly effective.
• Symptomatic treatment. Symptomatic treatment aims to reduce brain swelling and intracranial hypertension.

When Does The Recurrent Glioblastoma Require Surgery?

If the tumor is of large size and volume, and the patient’s condition is good according to the Karnofsky Performance Scale (and the patient themselves feels fine), doctors recommend repeated surgery. Surgical treatment is possible in about 60% of patients with this disease.

During the operation, the neurosurgeon aims to remove as much tumor tissue as possible: the studies have proved that the removal of at least 98% of the tumor greatly improves the patients’ survival. To plan surgery, experts use MRI and CT, but these methods are not accurate enough to assess the brain state or structure before tumor resection. This is why neurosurgeons improve visualization with the following methods:

• PET;
• Confocal laser endomicroscopy;
• Optical coherence tomography;
• Magnetic visualization systems, and other diagnostic methods.

If the tumor is small and there is no mass effect while the diagnosis is undoubted, surgical intervention is postponed. In cases where the tumor is small and has little to no mass effect, and the patient does not suffer from poorly controlled seizures, doctors usually proceed to second-line chemotherapy. Sometimes, they also consider the prospect of additional radiation therapy.

A brain tumor may be treated with an awake craniotomy. With this type of surgery, the neurosurgeon can map and preserve brain areas necessary for normal functioning. Even though the patient is awake during surgery, they do not feel pain because the brain has no pain receptors and the scalp is numbed with a local anesthetic. Besides, before surgery, the patient receives a sedative. During an awake craniotomy, the neurosurgeon asks the patient to complete some speech tests, read and move while specific brain areas are stimulated at the same time. This helps the doctor determine the safest way to the tumor. Within the last 10 years, this type of operation has become a regular treatment method used in neurosurgery to preserve important brain functions.

Professor Zvi Ram

Head of Neurosurgery Department

• Temozolomide, the Most Effective Drug for Glioblastoma Treatment

Temozolomide is one of the few chemotherapy agents that are effective against glioblastoma. This drug is used after radiation therapy. A clinical trial has shown that radiation therapy followed by treatment with temozolomide increases the patients’ survival by 16% in comparison with radiation therapy alone.

• The Gliadel Wafers: the Newest Brain Tumor Treatment Method

Gliadel is used in the form of wafers produced from biodegradable polymers. These wafers contain medication: 3.85% carmustine. During surgery, the wafers are placed into the cavity left after tumor resection. The drug is used both for primary and recurrent types of glioblastoma. A clinical trial has shown that the use of wafers increases the patients’ median survival by 2-4 months.

• The Optune Device

Unfortunately, only a few methods may be considered relatively effective for recurrent glioblastoma treatment. However, researchers have certain hopes for the method based on alternating electric fields. This is the foundation of the “Optune” device developed by American and Israeli specialists. The device consists of electrodes placed onto the patient’s head. The electrodes generate low-intensity electric fields that alternate with 200 kHz frequency and selectively block the division of cancer cells.

If the patient has already undergone treatment with the “Optune” device, the doctor may recommended another course because “Optune” is sufficiently effective against secondary tumors. Clinical trials show that the standard therapy enhanced with this method improves both the overall survival rates and the patients’ quality of life.

It is very important to promote close relationships between the patient and their family members because when the patients feel they have a support group, they are more open to new treatment methods in Israel. This, in turn, ensures better results. If the patient stops believing into the power of “Optune” and starts wearing it for only 50-60% of the time recommended by the doctor, the effectiveness of the device will probably suffer greatly.

• CAR T-Cell Immunotherapy

This type of therapy was developed to treat lymphoma and leukemia. Recently, however, physicians have started to use it for brain tumors – glioblastomas. The specialists take certain immune cells (white blood cells, or T-lymphocytes) from the patient and enhance them with a receptor created with gene engineering. This receptor contains a segment responsible for information about the specific target: the malignant tumor cell. This creates a controllable “missile” aimed at the cancerous cell.

After surgery, the modified T-lymphocytes are re-administered into the patient’s brain, into the part from where the tumor has been removed. Afterwards, the remaining malignant cells stop growing.

• Laser Neurosurgery Using the Visualase System

Cauterization of brain tumors with a laser is an advanced technology that has been growing in popularity during the last 10 years. It is used globally. Ichilov is the only medical center in Israel where laser cauterization of the tumor is performed with LITT (laser interstitial thermal therapy) using the Visualase device. This is a minimally invasive procedure carried out using MRI navigation. It ensures complete control over the process of tumor destruction.

The procedure consists of 2 stages:

• Stage 1 is performed in the operating room. The doctor inserts a thin optic fiber through a 3mm hole in the skull. The fiber is placed into the tumor under the navigation system control.
• Stage 2 is carried out at the MRI department where the optic fiber is connected to the Visualase system. It conducts a laser beam that heats up the growth and destroys cancerous tissue. The procedure is performed using thorough temperature control and causes no harm to the nearby areas of the brain.

How To Receive Glioblastoma Treatment In Top Ichilov

1. Call the clinic right now: +972-37621629
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