Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends

Sales, Arthur H A; Beck, Jürgen; Schnell, Oliver; Fung, Christian; Meyer, Bernhard; Gempt, Jens

doi:10.3390/jcm11185354

Cited by 16 publications

(7 citation statements)

References 171 publications

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“…Several studies, including ours, have highlighted the fact that the average preoperative tumor volume is not a predictive factor of mortality; it correlates with age, symptoms, or the methylation status of the MGMT promoter [ 16 , 20 , 21 ]. Instead, the residual volume and, implicitly, the incomplete resection represent a risk factor for mortality, respectively determining a low survival [ 16 , 22 ]. Our research identified the presence of postoperative tumor volume as a risk factor for mortality (HR = 1.024), a result similar to the study conducted by Bette S et al (HR = 1.036) [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

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Implications of Cellular Immaturity in Necrosis and Microvascularization in Glioblastomas IDH-Wild-Type

Orășanu

Aschie

Deacu

et al. 2022

Clinics and Practice

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Necrosis and increased microvascular density in glioblastoma IDH-wild-type are the consequence of both hypoxia and cellular immaturity. Our study aimed to identify the main clinical-imaging and morphogenetic risk factors associated with tumor necrosis and microvascular in the prognosis of patient survival. We performed a retrospective study (10 years) in which we identified 39 cases. We used IDH1, Ki-67 and Nestin immunomarkers, as well as CDKN2A by FISH. The data were analyzed using SPSS Statistics. The clinical characterization identified only age over 50 years as a risk factor (HR = 3.127). The presence of the tumor residue, as well as the absence of any therapeutic element from the trimodal treatment, were predictive factors of mortality (HR = 1.024, respectively HR = 7.460). Cellular immaturity quantified by Nestin was associated with reduced overall survival (p = 0.007). Increased microvascular density was associated with an increased proliferative index (p = 0.009) as well as alterations of the CDKN2A gene (p < 0.001). CDKN2A deletions and cellular immaturity were associated with an increased percentage of necrosis (p < 0.001, respectively, p = 0.017). The main risk factors involved in the unfavorable prognosis are moderate and increased Nestin immunointensity, as well as the association of increased microvascular density with age over 50 years. Necrosis was not a risk factor.

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Section: Discussionmentioning

confidence: 99%

“…In this sense, the surgical approach technique must involve new techniques such as fluorescent guidance, brain mapping techniques, intraoperative radiotherapy, optical coherence tomography, etc. [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Implications of Cellular Immaturity in Necrosis and Microvascularization in Glioblastomas IDH-Wild-Type

Orășanu

Aschie

Deacu

et al. 2022

Clinics and Practice

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“…Recommendations seeing the best outcomes suggest gross total resection with aggressive margin control of low-grade diffuse gliomas with wild-type IDH, with only subtotal resection for diffuse gliomas with mutated IDH[ 17 ]. In anaplastic gliomas, wild-type IDH tumors are conservatively treated with enhancing tissue resection, while those with mutant IDH can either be treated by total gross resection if they do not possess a 1p/19q codeletion or a subtotal resection if a 1p/19q codeletion exists in a functional area[ 17 , 18 , 19 ].…”

Section: Operative Treatmentmentioning

confidence: 99%

Updates on management of gliomas in the molecular age

Mohamed,

Alshaibi,

Faragalla

et al. 2024

World J Clin Oncol

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Gliomas are primary brain tumors derived from glial cells of the central nervous system, afflicting both adults and children with distinct characteristics and therapeutic challenges. Recent developments have ushered in novel clinical and molecular prognostic factors, reshaping treatment paradigms based on classification and grading, determined by histological attributes and cellular lineage. This review article delves into the diverse treatment modalities tailored to the specific grades and molecular classifications of gliomas that are currently being discussed and used clinically in the year 2023. For adults, the therapeutic triad typically consists of surgical resection, chemotherapy, and radiotherapy. In contrast, pediatric gliomas, due to their diversity, require a more tailored approach. Although complete tumor excision can be curative based on the location and grade of the glioma, certain non-resectable cases demand a chemotherapy approach usually involving, vincristine and carboplatin. Additionally, if surgery or chemotherapy strategies are unsuccessful, Vinblastine can be used. Despite recent advancements in treatment methodologies, there remains a need of exploration in the literature, particularly concerning the efficacy of treatment regimens for isocitrate dehydrogenase type mutant astrocytomas and fine-tuned therapeutic approaches tailored for pediatric cohorts. This review article explores into the therapeutic modalities employed for both adult and pediatric gliomas in the context of their molecular classification.

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“…This RT and TMZ pharmacotherapy regimen was proposed by Stupp et al in 2005-the so-called Stupp protocol-when findings from a randomized controlled trial revealed that RT plus TMZ significantly improve the overall survival (OS) and progression-free survival (PFS) of newly diagnosed GBM patients compared to RT alone (14.6 vs. 12.1 months OS; 53.9% vs. 36.4% PFS at 6 months) (Stupp et al, 2005). GBM surgical resection is often challenging since the boundaries of the tumor are not easily distinguishable from the surrounding brain tissue, ultimately leading to tumor relapse due to the invasive potential of residual tumor cells (Sales et al, 2022). Apart from the SOC, four drugs and two medical devices are currently approved by the Food and Drug Administration (FDA) for the treatment of GBM (Figure 3): lomustine (1976), intravenous carmustine (1977), wafer implants of carmustine (Gliadel;1996: recurrent GBM;2003: newly diagnosed GBM), bevacizumab (2009, intratumoral thermotherapeutic iron oxide NPs (NanoTherm; 2010: recurrent GBM), and tumor treating fields (TTFs; Optune; 2011: recurrent GBM; 2015: newly diagnosed GBM) (de L azaro & Mooney, 2021).…”

Section: Gbm Treatment Options-standard Of Care (Soc) Limitations And...mentioning

confidence: 99%

Multi‐ligand functionalized blood‐to‐tumor sequential targeting strategies in the field of glioblastoma nanomedicine

Martins

Sarmento

2023

WIREs Nanomed Nanobiotechnol

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Glioblastoma (GBM) is an unmet clinical need characterized by a standard of care (SOC) 5‐year survival rate of only 5%, and a treatment mostly palliative. Significant hurdles in GBM therapies include an effective penetration of therapeutics through the brain protective barrier, namely the blood–brain barrier (BBB), and a successful therapeutic delivery to brain‐invading tumor cells post‐BBB crossing. These hurdles, along with the poor prognosis and critical heterogeneity of the disease, have shifted attention to treatment modalities with capacity to precisely and sequentially target (i) BBB cells, inducing blood‐to‐brain transport, and (ii) GBM cells, leading to a higher therapeutic accumulation at the tumor site. This sequential targeting allows therapeutic molecules to reach the brain parenchyma and compromise molecular processes that support tumor cell invasion. Besides improving formulation and pharmacokinetics constraints of drugs, nanomedicines offer the possibility of being surface functionalized with multiple possibilities of targeting ligands, while delivering the desired therapeutic cargos to the biological sites of interest. Targeting ligands exploit the site‐specific expression or overexpression of specific molecules on BBB and GBM cells, triggering brain plus tumor transport. Since the efficacy of single‐ligand functionalized nanomedicines is limited due to the GBM anatomical site (brain) and disease complexity, this review presents an overview of multi‐ligand functionalized, BBB and GBM sequentially‐ and dual‐targeted nanomedicines reported in literature over the last 10 years. The role of the BBB in GBM progression, treatment options, and the multiple possibilities of currently available targeting ligands will be summarized.This article is categorized under: Nanotechnology Approaches to Biology > Nanoscale Systems in Biology Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease

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Surgical Treatment of Glioblastoma: State-of-the-Art and Future Trends

Cited by 16 publications

References 171 publications

Implications of Cellular Immaturity in Necrosis and Microvascularization in Glioblastomas IDH-Wild-Type

Implications of Cellular Immaturity in Necrosis and Microvascularization in Glioblastomas IDH-Wild-Type

Updates on management of gliomas in the molecular age

Multi‐ligand functionalized blood‐to‐tumor sequential targeting strategies in the field of glioblastoma nanomedicine

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