Fighting Diffuse Gliomas

Introduction

Diffuse gliomas account for over 80% of all malignant brain tumors, with WHO grade IV glioblastoma is by far the most frequent and severe tumor type. Magnetic resonance imaging (MRI) is commonly used to make initial diagnoses, which are progressively being augmented by functional, anatomical, and metabolic imaging data. The most essential tumor-specific treatment techniques include surgery, radiation therapy (RT), chemotherapy, and any combination of these. Complete resections determined by imaging enhance outcomes in glioma patients. Complete resections may also have a predictive influence in cases of recurrence. Because there is no such thing as complete tumor removal/local control, further treatments are required.

Surgical management

The first step in the management of diffuse gliomas of WHO grade II, III, and IV is open tumor excision. At the population level, prognosis favorable full resection is obtained in around 40%–75% of surgical interventions. The majority of patients who were chosen for gross total surgery nonetheless had an incomplete resection.

Biopsy

• Biopsy rather than resection is a rather uncommon surgical method in glioma treatment concepts: only 10%–20% of patients have a glioma diagnosis based only on open/stereotactic biopsy operations. Biopsied patients usually undergo less intrusive treatment regimens and are frequently excluded from major randomized controlled trials due to the anticipated poor clinical performance state and negative prognostic profile.
• However, new studies have shown that biopsy is only effective in patients with not-safely-resectable high-grade glioma, even with acceptable clinical performance ratings and little co-morbidity, and is not linked with a poorer prognosis when compared to partial resection.
• Nonetheless, side effects from the biopsy were substantially less common than after partial resection. To avoid therapeutic nihilism, these facts should be regarded as indications in favor of biopsy in the event of not safely resectable malignancies.
• If the entire tumor volume can be safely removed, microsurgical resection should indeed be undertaken. In the absence of a clear differential diagnosis and/or an undesirable risk-benefit ratio for microsurgery, molecular stereotactic biopsy becomes a very viable option.
• If the molecular profile reveals increasing chemo- and/or radiation resistance, surgical resection may get even more critical for improving the overall prognosis. When upfront chemotherapy/irradiation has been successfully performed, delayed resection may be considered for remaining eloquently placed tumors.

Radiation Therapy

RT is essential in the treatment of gliomas. Significant breakthroughs in RT therapy and image-guidance technologies have resulted in substantial gains in the ability to optimize definitive and salvage treatment regimens, including re-irradiation methods, during the last decade. Therapy decisions are based on clinical features, traditional prognostic indicators, and an expanding number of genetic, metabolic, and imaging biomarkers to match tumor profiles to existing treatment ideas, each of which should be modified for risk and potential benefit.

Tumour-treating fields

Tumor-treating fields (TTF) are a recently approved novel antimitotic treatment modality that meddles with glioblastoma cell division and organelle assembly by providing low-intensity (1–3 V/cm) intermediate frequency (200 kHz) alternating electrical fields to the tumor, resulting in a dramatic improvement in progression-free survival and overall survival in high grade glioma patients with minimal treatment-related side effects.

Conclusion

Patients with diffuse gliomas need the right mix of surgical resection and adjuvant therapy (Radiation therapy with concurrent oral chemotherapy). All this contribute in improving the overall survival of the patient with better quality of life.