ReviewTherapeutic options for recurrent malignant glioma
Section snippets
Background and purpose
Currently treatment of glioblastoma (GBM) is based on a multidisciplinary approach including surgery and adjuvant radio-chemotherapy, followed by maintenance chemotherapy.
Concurrent and adjuvant administration of temozolomide (TMZ) improved 2-year survival of patients with newly diagnosed malignant glioma (mainly GBM) from 11.2% to 27.3%, 3-year survival from 4.4% to 16.0% and 5-year survival from 1.9% to 9.8% [1], [2]. Although the use of TMZ has improved outcomes considerably, almost all
Methods and materials
Using the following MESH headings and combinations of these terms the pubmed database was searched for randomized, prospective and retrospective trials (all sample sizes were considered).
“Glioma”, “Recurrence”, “Neoplasm Recurrence, Local”, “Radiosurgery”, “Brachytherapy”, “Neurosurgical Procedures” and “Drug Therapy”.
For citation crosscheck, the ISI web of science database was used employing the same search terms. In parallel, the abstracts of ASCO 2008–2009 were analyzed accordingly.
A focus
Surgery
In contrast to first-line treatment where radical resection of the tumor has a major impact on outcome [12], its role for recurrent MG needs still to be defined and cannot be considered as a standard. Six major case series were extracted from the literature.
Surgery as salvage option has been described very early [13], [14], [15], [16]. Approximately one quarter of patients with GBM develop a type of recurrence which allows for repeated neurosurgical resection [17]. This relatively small
State of the art
Re-operation is a feasible option in recurrent MG but limited by treatment side effects; high intra-, peri- and post-operative morbidity- and mortality-rates were reported in the past.
Despite these limitations, surgical treatment of recurrent MG should always be considered in selected patients, especially in those with high KPS. Though hampered by an inherent selection bias, the retrospective analysis of Mandl et al. suggests that administration of additional salvage treatment after repeated
Conclusions
As one has to discuss which sequence of salvage treatments should be chosen, there are several aspects to be considered.
Though the relative value of each approach compared to other options is unknown as well as no optimal sequence of modalities has been defined yet, we propose the following pragmatic solution.
If a local treatment – re-operation or RT – seems to be applicable, this is the treatment of choice. Re-irradiation in malignant glioma is a feasible and safe treatment option, and the
Authors’ contributions
M.N. performed the literature search and wrote the manuscript. A.S., S.B.S., U.G., F.W.K. and J.C.T. participated in the preparation of the manuscript. C.B. participated in the conception as well as the preparation of the manuscript. All authors read and approved the final manuscript.
Conflicts of interest
The authors declare that they have no competing interests.
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2022, Life SciencesCitation Excerpt :Gliomas, the most common primary brain tumors in adults, account for 80% of malignant tumors, and the survival rate is considerably low worldwide [2,3]. Various drugs with known efficacies, such as temozolomide (TMZ), are used for malignant glioma treatment [4,5]; however, there are limitations in their treatment, such as drug resistance development and disease recurrence [6]. Therefore, further studies are needed to test the curative efficacies of the drugs used for the treatment.