Abstract
Over the past two decades, management of newly diagnosed glioblastoma has undergone significant evolution. While surgery has long been a mainstay of management for this disease, and while radiotherapy has a proven survival role, initial efforts at radiotherapy dose escalation, use of radiosurgery, brachytherapy, and altered fractionation did not improve patient survival. Recently, multiple modality therapy integrating maximal safe resection, postoperative radiation, and new systemic therapies have resulted in improved patient outcomes compared with older regimens utilizing surgery and postoperative radiation alone. Numerous trials are currently underway investigating the combination of surgery, radiation, and systemic therapy with targeted agents to find ways to further improve outcomes for adults with glioblastoma.
Highlights
Glioblastoma (GBM) remains a highly lethal and aggressive tumor with dismal prognosis
Malignant astrocytomas constitute around 80% of all gliomas, with WHO grade IV glioma or glioblastoma representing the vast majority of high-grade gliomas (Jukich et al, 2001; Wrensch et al, 2002; Black and Loeffler, 2005)
A recent phase III study using 5-aminolevulinic acid (5-ALA) for fluorescence-guided resection showed an almost 20% improvement in 6-month progression-free survival compared with tumors resected under white light alone, underscoring the importance of complete resection in these highly infiltrative tumors whose borders are difficult to discern (Stummer et al, 2006)
Summary
Over the past two decades, management of newly diagnosed glioblastoma has undergone significant evolution. While surgery has long been a mainstay of management for this disease, and while radiotherapy has a proven survival role, initial efforts at radiotherapy dose escalation, use of radiosurgery, brachytherapy, and altered fractionation did not improve patient survival. Multiple modality therapy integrating maximal safe resection, postoperative radiation, and new systemic therapies have resulted in improved patient outcomes compared with older regimens utilizing surgery and postoperative radiation alone. Numerous trials are currently underway investigating the combination of surgery, radiation, and systemic therapy with targeted agents to find ways to further improve outcomes for adults with glioblastoma
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