Abstract
The management of high-grade gliomas (hggs) is complex and ever-evolving. The standard of care for the treatment of hggs consists of surgery, chemotherapy, and radiotherapy. However, treatment options are influenced by multiple factors such as patient age and performance status, extent of tumour resection, biomarker profile, and tumour histology and grade. Follow-up cranial magnetic resonance imaging (mri) to differentiate treatment response from treatment effect can be challenging and affects clinical decision-making. An assortment of advanced radiologic techniques-including perfusion imaging with dynamic susceptibility contrast mri, dynamic contrast-enhanced mri, diffusion-weighted imaging, proton spectroscopy, mri subtraction imaging, and amino acid radiotracer imaging-can now incorporate novel physiologic data, providing new methods to help characterize tumour progression, pseudoprogression, and pseudoresponse. In the present review, we provide an overview of current treatment options for hgg and summarize recent advances and challenges in imaging technology.
Highlights
Gliomas are malignant tumours derived from glial cells or their precursors; in the United States, they constitute 80% of all primary intra-axial malignancies of the central nervous system and 28% of all cancers involving the central nervous system[1]
The presence of mgmt promoter methylation and 1p/19q co-deletion can affect treatment decisions, because either of those mutations predicts a better outcome in patients treated with alkylating chemotherapy[5,9]
In the case of mgmt promoter methy lation, inferior outcomes have been reported in elderly patients when such patients are treated with conventionally fractionated radiotherapy alone compared with chemotherapy[8]
Summary
Gliomas are malignant tumours derived from glial cells or their precursors; in the United States, they constitute 80% of all primary intra-axial malignancies of the central nervous system and 28% of all cancers involving the central nervous system[1]. The noa-8 trial demonstrated that, compared with the tmz group, the rt-alone group of patients without mgmt promoter methylation experienced superior event-free survival. Those trials suggest that treatment with tmz or rt alone in elderly patients is acceptable depending on mgmt status. The results of the ongoing eortc 26081-22086 trial (NCT00887146) comparing rt followed by pcv with rt and concomitant and adjuvant tmz will hopefully add some clarity about the role of tmz in patients with anaplastic oligodendroglioma. The peptide-based synthetic vaccine rindopepimut (against epidermal growth factor receptor variant iii) was shown to increase overall survival in a phase ii trial[28], and further studies are currently underway to confirm its efficacy and safety (NCT01498328, NCT01480479, NCT00458601). Research is currently ongoing, studying the PVSRIPO polio virus (NCT01491893) and the retroviral replicating factor e384
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