The prognosis for patients with newly diagnosed
malignant gliomas remains poor; however there have been some recent advances in treatment that have generated optimism. Medical management usually includes administration of
corticosteroids to control peritumoral
edema.
Anticonvulsants are indicated for patients with established
tumor-related
seizures; however, the prophylactic use of
anticonvulsants remains controversial. Advances in neurosurgical techniques have improved the safety of
tumor resection and most patients undergo the maximal safe surgical debulking of
tumor. The tissue sample obtained provides conclusive pathologic diagnosis and
tumor classification and extensive
tumor resection may impact patient outcome. For
glioblastoma, external beam radiation had been the conventional first line treatment; however a recent international phase III trial has provided level 1 evidence that a chemoradiation regimen using external beam radiation plus the oral
chemotherapy agent
temozolomide provides a survival advantage over radiation alone. Correlative studies were also performed that demonstrated better outcomes for patients with
tumors demonstrating methylation (inactivation) of the promoter region of methyl
guanine methyltransferase (MGMT) gene. Additional studies are in progress building on the clinical trial results using different dosing schedules of
temozolomide and combination regimens. Studies are also underway to develop molecular markers, such as expression of MGMT that may help select the patients most likely to benefit from this treatment.