Prospective therapies for high-grade glial tumours: A literature review

Abstract

After three decades of intensive research, cytoreductive surgery remains the gold standard of treatment of malignant gliomas. Survivorship at both 1-year and 5-years has not drastically changed in the UK. Concomitant chemo- and radiotherapy has enhanced the efficiency of surgery, enabling more aggressive tumour resection whilst also preserving the surrounding healthy brain parenchyma. More accurate imaging techniques have also played a role in tumour identification, key to this has been pre- and intra-operative contrast enhancement and compounds that have a high affinity in binding to glioma cells. Intra-operative imaging has heralded the ability to give the operating surgeon continuous feedback to assess the completeness of resection. Research is shifting into investigating the complex cellular and molecular glial tumour-genesis, and has led to the development of efficacious chemotherapy agents and trial novel therapies. Oncolytic virotherapy has shown promise in clinical trials and gene therapy in-vitro studies. Surgery however remains the primary therapeutic option for the management of malignant gliomas removing the mass of proliferating malignant tumour cells and decompression of the space-occupying lesion.

Hormones and immunity in cancer: are thyroid hormones endocrine players in the microglia/glioma cross-talk?

“…Malignant gliomas are aggressive, highly invasive, and neurologically destructive tumors considered to be among the deadliest of human cancers. Three decades of intensive research and a variety of chemotherapy regimes, radiotherapy and surgical approaches have been trialed and investigated, however the prognosis for patients with malignant glioma has not changed significantly (Desjardins et al, 2005 ; Taylor, 2010 ; Talibi et al, 2014 ). This has stimulated active research in multiples areas and the advent of new treatment strategies.…”

Imaging and treatment of brain tumors through molecular targeting: Recent clinical advances

“…Gliomas are the most common primary brain tumors, accounting for nearly 70% of central nervous system (CNS) cancers, with glioblastoma (GBM) being the most frequent and malignant of the high grade gliomas (HGG) [16]. Maximal surgical resection is often the primary aim in the management of HGGs, although there is no consensus on the role of surgery for low-grade gliomas (LGGs) [17][18][19]. Therefore, an accurate assessment of tumor extent is mandatory to achieve gross total resection.…”

“…2-[ 18 F]fluoro-2-deoxy-D-glucose ([ 18 F]FDG) is a glucose analog which is transported by the transmembrane glucose transporters (GLUTs) and is phosphorylated by hexokinase in the first step of glycolysis. Owing to the physiologically high [ 18 F]FDG uptake in normal brain tissue, tumors may present with a relatively low tumor-tobackground ratio, which may hinder detection especially in low-grade brain neoplasms [12]. There are several PET tracers that target metabolic pathways with a higher tumor-to-background ratio, such as protein synthesis, membrane lipid synthesis, and fatty acid synthesis [13,14].…”

Management of Gliomas: Overview of the Latest Technological Advancements and Related Behavioral Drawbacks

“…The current mainstay for treatment of HGG is maximal resection (ideally, gross total resection: >95% of the lesion) followed within 30 days from surgery by radiation therapy with concurrent or adjuvant chemotherapy [ 4 ]. Clinical evidence that a proactive and aggressive treatment plan improved the outcome of glioma patients when compared to biopsy alone prompted maximum but safe resection to become the ultimate goal of the neurosurgical treatment [ 4 , 5 ]. Nonetheless, the improvement of patient outcome following gross total resection of HGG mainly relies on extended progression-free survival, rather than on improved QoL or overall survival.…”