Gliomas are the most common type of primary brain tumor in adults and often present complex challenges in treatment. The care pathway for glioma patients involves multiple steps and specialties to ensure the most effective treatment plan. Dr. Henry Friedman, Deputy Director of the Preston Robert Tisch Brain Tumor Center at Duke, explains how glioma treatment typically unfolds and the critical decisions that guide it.
Read More
Surgery and Diagnostics
The next step in treatment often involves surgery to remove as much of the tumor as safely possible. “We maximize the amount of tumor that can be removed through surgical intervention,” Dr. Friedman explains, but sometimes only a biopsy can be performed, especially if the tumor is in a delicate or inaccessible area.
After surgery, pathologists examine the tumor tissue to understand its molecular makeup. “We go through a very elaborate process of diagnostics, which includes looking at it under the microscope through our pathology team,” Dr. Friedman adds. This helps doctors determine the best treatment approach moving forward.
Molecular Testing and Targeted Therapy
A key part of the diagnostic process is molecular testing, which allows doctors to examine the tumor’s genetic makeup for mutations that can guide treatment decisions. As Dr. Friedman explains, ‘The modern way of doing medicine is to look at the entire genomic or gene composition of the tumor.’
One common mutation appreciated through molecular testing in gliomas is the IDH (isocitrate dehydrogenase) mutation, which can now be targeted with new treatments like Vorasidenib.
The Role of Chemotherapy and Radiation Therapy
While surgery is often the first step in treating gliomas, removing the tumor completely is usually not possible due to the tumor’s ability to spread into surrounding brain tissue. This is where chemotherapy and radiation therapy come into play, working to target any remaining cancer cells after surgery.
Chemotherapy uses drugs to kill cancer cells or stop them from growing. It is typically administered orally or intravenously and can help shrink the tumor or slow its growth. Dr. Friedman explains, “There’s always going to be microscopic disease left behind even after what appears to be a gross total resection, and the tumor can certainly evolve.” Chemotherapy is used to help control this residual disease.
Radiation therapy uses high-energy rays to target and destroy cancer cells that surgery may have missed. It is often combined with chemotherapy to increase effectiveness. Dr. Friedman and his team work closely with radiation oncologists to determine the most appropriate radiation plan for each patient, balancing the need to destroy cancer cells while minimizing damage to healthy brain tissue.
Together, surgery, chemotherapy, and radiation form the core standard of care for glioma patients, providing a comprehensive approach to tackling the disease from multiple angles.
Standard of Care and Clinical Trials
For glioma patients, there are generally two main treatment paths: standard care, which includes surgery, radiation, and chemotherapy, or clinical trials, which offer new and potentially more effective treatments. “If [patients] fit into a clinical trial paradigm, terrific. If not, there is the standard of care,” Dr. Friedman notes.
The Role of a Multidisciplinary Team
Treating gliomas requires a team-based approach, with input from neurosurgeons, neuro-oncologists, and radiation oncologists. Dr. Friedman explains the collaborative approach at Duke: “The first step is always neurosurgery. How much can you take out? Is it safe to do surgery? Do you have to rely on a biopsy? Then the neuro-oncologist figures out what would be the best step.”
This multidisciplinary approach ensures that every aspect of the patient’s care is carefully coordinated to achieve the best possible outcomes.
Conclusion
The treatment path for glioma patients involves a combination of surgery, diagnostics, and molecular testing to determine the best possible therapies. Thanks to advances in molecular medicine and the availability of targeted treatments, patients with gliomas now have more options than ever before. As Dr. Friedman notes, these innovations are providing new hope for patients: “We have more weapons, the patient feels better, the physician feels better, and it’s a feel-good story.”
Learn more about SurvivorNet's rigorous medical review process.