Advances in the management of high-grade glial tumors

Abstract

This comprehensive review delves into recent advancements in the diagnosis and treatment of gliomas, which constitute a significant portion of primary brain tumors. Recent progress in genomic, transcriptomic, and epigenetic profiling has redefined the classification and treatment approaches. The incorporation of genotypic markers alongside histological markers has expanded the WHO classification, considering distinctions in molecular pathogenesis and prognosis. Macroscopic resection of glial tumors has demonstrated positive impacts. However, this review emphasizes the need to balance the benefits of extended resection with potential neurological deterioration based on the tumor’s anatomical location. Surgical techniques and emerging technologies aim to improve resection without compromising postoperative functional status. This review highlights the limitations of conventional diagnostic tools such as CT, MRI, and PET in glioma characterization, emphasizing the ongoing progress in diagnostic tools and therapeutic approaches. Despite multimodal therapeutic strategies, survival rates remain discouraging due to the invasive nature of gliomas. The emergence of innovative therapeutic interventions, including brain mapping, fluorescence-guided surgery, intraoperative imaging, and novel cytotoxic treatments, provides hope for improved outcomes. Advancements in radiotherapy, including hypofractionation, proton therapy, and radiosurgery, are explored. Tumor-treating fields and immunotherapy, leveraging oncolytic viruses and therapeutic vaccines, present promising avenues. Nanocarriers for drug delivery offer a novelapproach, enhancing permeability through the blood-brain barrier. Lastly, we highlight the discussion of targeted therapies, focusing on inhibitors for NTRK, FGFR, BRAF, and IDH1/2 mutations. These targeted therapies show promise in managing specific glioma subtypes, representing a shift towards more personalized and effective treatment strategies. Overall, this review underscores the transformative impact of recent technological and therapeutic advances on the glioma diagnosis and treatment landscape, offering new hope for patients and clinicians alike.