Overview of prognostic factors in adult gliomas

Abstract

Gliomas represent the majority of malignant central nervous system tumors, with the most aggressive subtype, glioblastoma, accounting for almost 57% of this entity. Type of glioma and its incidence can vary depending on the age of presentation. In turn, outcomes can vary significantly based on the actual type of glioma (histologically and molecularly) and age of the patient, as well as various tumor specific factors such as size, location, comorbidities, etc. In the last decade we have been able to identify key molecular features that have provided us with greater insight into the behavior of these tumors, but the spectrum of treatment options remains limited. In addition, ultimate causes of death in patients with gliomas are variable and stochastic in nature. Given these complicated factors, prognostication for gliomas remains extremely difficult. This review aims to discuss prognostication in low grade versus high grade gliomas, variability in treatment of these tumors, clinical features of poor prognosis, and differences in prognostic understanding between patients, caregivers, and providers. We will also make some general recommendations where appropriate on how to approach this subject from a palliative care perspective.

A novel protein encoded by ZCRB1-induced circHEATR5B suppresses aerobic glycolysis of GBM through phosphorylation of JMJD5

“…Glioblastoma multiforme (GBM) is a primary malignant tumor in the central nervous system with high morbidity and mortality rates, characterized by aggressive growth and a high recurrence rate [ 1 ]. The most widely accepted therapeutic approach for GBM is surgery with radiotherapy plus temozolomide, followed by an adjuvant phase with temozolomide alone [ 2 ].…”

Translational landscape of glioblastoma immunotherapy for physicians: guiding clinical practice with basic scientific evidence

“…This is also the most aggressive type of glioma, with 5-year survival rates ranging from 0.5 to 5.8%, depending on the study [ 2 , 7 ]. Some prognostic factors correlate with improved survival, including a higher Karnofsky performance status (KPS) score (> 70 is beneficial), extent of initial tumor resection (gross total resection is the standard of care), and younger age at diagnosis (< 65 years) [ 10 – 12 ]. Unfortunately, despite an improved understanding of etiology and outcomes, GBM has a population median survival of only 13.5 months with aggressive therapy [ 2 ].…”

The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial

“…With a median age at diagnosis of 64 years and an incidence rate of approximately 4 per 100,000 people in Canada [ 2 ] (4.53/100,000 in Atlantic Canada), glioblastoma is an aggressive tumor with an unfavorable prognosis, making it a significant public health issue [ 3 ]. Despite advances in surgical, radiotherapy, and chemotherapeutic approaches, the median survival remains discouraging, ranging from 14 months to 22 months [ 4 ].…”

“…Tumor location, treatment, and supportive medications all contribute to these troubling symptoms, which affect QOL. Although glioblastoma prognosis has been associated with numerous clinical factors (eg, patient age, extent of maximal safe resection), functional impairment has been consistently shown to be a significant predictor of greater symptom burden [ 16 , 17 ] and survival [ 4 , 14 , 18 , 19 ]. As an incurable disease, it is important to consider factors such as symptom management, maintaining functional independence, and preserving or improving QOL [ 14 , 20 ].…”