Before surgery

Some decisions can only be made once

Almost everything about glioblastoma can be reconsidered later: the chemotherapy, the radiotherapy, the trials, the second opinions. The operating room is the exception. What is not requested before the operation cannot be recovered afterwards, and it closes doors that were open, including some of the most promising experimental therapies.

The window that does not reopen

Fresh frozen tissue: without it, there is no vaccine

Dendritic-cell vaccines and autologous tumour-lysate vaccines are manufactured from the patient's own tumour. They need living tumour tissue, frozen fresh in the operating theatre itself, at the moment of resection. Several cell therapies work the same way.

By default, the tissue removed goes to the pathology lab, is fixed in formalin and embedded in paraffin. That is correct: diagnosis comes first. But formalin degrades the tumour's DNA and RNA, and paraffin tissue cannot be used to manufacture a vaccine. If nobody asked for a fresh frozen fraction to be set aside, months later there is nothing to work with, whatever the family is willing to pay or travel.

What to request, and when

  • WhenIn the pre-op appointment, days before. Not on the day of surgery: the biobank and the pathology lab have to be told in advance.
  • WhatThat a fraction of the tumour be frozen fresh and deposited in the hospital biobank, in addition to the paraffin sample needed for diagnosis. Diagnosis is never compromised.
  • To whomTo the neurosurgeon, and ask them to leave it written in the surgical plan. Also mention it to the pathology department if you can.
  • AfterwardsConfirm in writing that the sample is stored, under what reference, and that you could request its transfer to another hospital or laboratory.

What it opens up

  • VaccinesDendritic-cell and autologous tumour-lysate vaccines, in trials and in some compassionate-use programmes.
  • Cell therapySome CAR-T and tumour-infiltrating-lymphocyte approaches start from fresh tissue.
  • Molecular studiesFrozen tissue is the reference standard for the most complete studies: full sequencing, RNA-seq, methylation profile.
  • ModelsOrganoids and cultures of your own tumour, used to test drugs before giving them to the patient.
Requesting it does not commit you to anything, does not delay surgery and does not interfere with the diagnosis. Not requesting it is irreversible.
Everything else worth preparing

Eight things that are decided before, not after

None of this replaces your medical team's judgement. They are questions you have every right to ask, and answers worth having in writing.

Take it with you

Checklist for the pre-op appointment

Print it and take it to the appointment before surgery. There is space to write down each answer, and to note who gave it.

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