Osteopathic manipulative treatment for chemotherapy-induced abdominal pain and anorexia in glioblastoma multiforme

Abstract

Background: Glioblastoma Multiforme (GBM) is a rapidly growing tumor of astrocyte cells in the Central Nervous System (CNS) with a five-year median survival rate of 5.6% in adults (ages 40+). On average, 12,000 glioblastoma cases are diagnosed each year in the United States.

Case Presentation: We present the case of a 53-year-old male who was diagnosed with the malignant brain tumor glioblastoma multiforme. The patient initially presented to the emergency department (ED) with a concern for seizure or stroke on 08/21/21. Magnetic resonance imaging of the patient’s head performed 8/28/21 revealed the presence of a ring-enhancing lesion in the left frontoparietal region extending to the dura, which helped support a diagnosis of glioblastoma multiforme, a highly malignant primary brain tumor. Targeted chemoradiation treatment supplemented with Temozolomide chemotherapy was implemented 10/06/21 - 11/24/21, followed by adjuvant treatment using Temozolomide from 12/15/21 - 04/19/22. The patient lost appetite for food during this treatment, and reduced eating led to a decrease in weight by 54 pounds, from 210 pounds on initial ED presentation on 08/21/21 to 156 pounds at his initial encounter following referral for osteopathic manipulative treatment (OMT) on 04/19/22. Despite appropriate therapy, there was evidence of continued tumor growth via MRI on 4/11/22. Given the disease progression along with significant side effects of treatment, the patient elected to discontinue radiation and pharmaceutical therapies. Therefore, the patient’s only intervention in terms of treatment of his symptoms from 4/19/22 to the time of this case report was OMT. Appointment weights were 152 pounds, 147 pounds, 154 pounds, and 166 pounds at respective, chronological one-month follow-ups. This weight re-gain demonstrates the effect of OMT in promoting appetite and feelings of wellness. The patient endorses increased appetite, alleviation of stomach cramping, and weight gain following OMT sessions consisting of visceral manipulation, myofascial release, soft tissue, and lymphatic techniques directed to the celiac, superior mesenteric, and inferior mesenteric ganglia.

Discussion: The case supports the use of these OMT techniques to promote appetite and improve patient-reported wellness in a patient with glioblastoma multiforme.