Abstract
Patients affected with gliomas develop a complex set of clinical manifestations that deeply impact on quality of life and overall survival. Brain tumor-related epilepsy is frequently the first manifestation of gliomas or may occur during the course of disease; the underlying mechanisms have not been fully explained and depend on both patient and tumor factors. Novel treatment options derive from the growing use of third-generation antiepileptic drugs. Vasogenic edema and elevated intracranial pressure cause a considerable burden of symptoms, especially in high-grade glioma, requiring an adequate use of corticosteroids. Patients with gliomas present with an elevated risk of tumor-associated venous thromboembolism whose prophylaxis and treatment are challenging, considering also the availability of new oral anticoagulant drugs. Moreover, intracerebral hemorrhages can complicate the course of the illness both due to tumor-specific characteristics, patient comorbidities, and side effects of antithrombotic and antitumoral therapies. This paper aims to review recent advances in these clinical issues, discussing the medical management of gliomas through an updated literature review.
Highlights
Management of gliomas avails of multimodal and integrated curative options consisting of neurosurgical resection, chemotherapy (CT) and radiotherapy (RT)
This review aims to summarize knowledge and suggest approaches to optimize medical management of gliomas drawn from recent literature
Older age (> 75) Obesity Prolonged immobility, leg paresis Prior thromboembolic events Multiple medical comorbidities A and AB blood type Grading (HGG > low-grade gliomas (LGG)) Intraluminal thrombosis Subtotal tumor resection Recurrent disease Tumor size (> 5 cm) isocitrate dehydrogenase 1 (IDH1) wild-type status Post-operative period Chemotherapy Anti-vascular endothelial growth factor (VEGF) treatment Hypertension Older age High degree of neo-angiogenesis Blood vessel invasion Tumor necrotic evolution Development of aneurysms Anticoagulation Radiotherapy and chemotherapy usually smaller than those presenting with other symptoms, e.g., related to mass effect
Summary
Management of gliomas avails of multimodal and integrated curative options consisting of neurosurgical resection, chemotherapy (CT) and radiotherapy (RT). The control of seizures and symptoms related to peritumoral edema, and the treatment and prevention of hemorrhagic and thromboembolic events are core to the medical management of gliomas. These clinical issues are usually managed, along with curative treatments, by neuro-oncological multidisciplinary teams [5] requiring highly integrated, multiprofessional expertise. Medical Management of Gliomas especially in the elderly [6] and the recent introduction of new therapeutic options which could be useful in supportive care, as third generation anti-epileptic drugs (AEDs) [7] for management of brain tumor-related epilepsy (BTRE), and direct-acting oral anticoagulants (DOACs) for the treatment of venous thromboembolism (VTE). This review aims to summarize knowledge and suggest approaches to optimize medical management of gliomas drawn from recent literature
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