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Dr Kener Shalom ! Hi My brother In low was diagnose with Glioblastoma and had an operation. At this point we are waiting for the treatment stage and we are exploring the best treatment available for him. . can you tell us as soon as possible what should be our next stage? I know you have been communicating with my sister . I followed some of the corresponding you had. I guess our concern is that we are loosing time and might be missing a chance that we might have. Her is the response that i received from Germany to my question R.gorter medical-center-cologne "What should be our next stage? As soon as he has been operated he should receive dendritic cell vaccinations and if possible, local hyperthermia. Depending on stage and extensiveness of disease might require radiation and Temodal first; and then being treated at MCC in Cologne. I am aware about your approach to Hyperthermia. Can you please recommend to us the steps we should take? I think we are kind of lost in the see of information and maybe the professionals we approach are torn between knowing the harsh facts and the willingness to recommend treatments. Is it common to wait so long after the operation before treatment?. My brother in- low was not contacted yet by Tel Hashomer Would you recommend moving the treatment to Ichilov? Anybody in Israel works with Memorial Sloan-Kettering Cancer Center? Thank you for your kind help Eti Kohen

Dear Eti, The standard approach to GBM is a surgical resection if possible with the intention to remove as much tumor mass as possible. This should be followed by a combination of radiation treatment with chemotherapy (temozolamide). I would not recommand any experimental therapy at this stage, if not part of a clinical study. Hyperthermic therapy has not proven to be an effective treatment in cancer and specially not in brain tumors. There is no clincal trial that has shown any impact of this treatment on cancer. Usually treatment should start 3-4 weeks after the surgical procedure. Behazlaha Dr. A. Kanner