Therapeutic options for recurrent malignant glioma

Area of Science:

• Neuro-oncology
• Malignant Glioma Research
• Cancer Recurrence Studies

Background:

• High-grade malignant gliomas frequently recur locally or locoregionally despite advances in neuro-oncology.
• Salvage strategies are crucial for managing recurrent gliomas, with several options now in clinical practice.

Purpose of the Study:

• To review the current status of salvage strategies for recurrent high-grade glioma.
• To provide an overview of available treatment options for patients with glioma recurrence.

Main Methods:

• PubMed and ISI Web of Science databases were searched using terms like "Glioma," "Recurrence," "Radiosurgery," and "Drug Therapy."
• ASCO abstracts from 2008-2009 were analyzed for relevant information.

Main Results:

• Salvage options include re-resection, re-irradiation (e.g., stereotactic radiosurgery, fractionated radiotherapy), and chemotherapy (single/poly-chemotherapy, targeted drugs).
• Re-operation carries high risks but is viable for select patients.
• Re-irradiation is increasingly used, with precise fractionated radiotherapy being optimal; it offers modest improvement in time to secondary progression.
• Conventional chemotherapy provides modest benefits with frequent toxicities; targeted agents are under investigation.

Conclusions:

• Current re-treatment options for recurrent high-grade glioma offer only modest efficacy.
• The comparative effectiveness and optimal sequencing of salvage modalities are not yet established.