Glioma

The Treatment Path

Once the biopsy is obtained and the diagnosis of glioma is made, various treatment options can be recommended. The recommendations take into account the type of the glioma, the tumor grade, and well as patient specific factors including tumor location, size, your age, and overall health.

The main treatment options include:

• Observation: Some gliomas that are benign, small, and without symptoms or tumors located in inoperable locations can be recommended for observation.
• Surgery: Surgery is often the first-line treatment for gliomas, with the goal of achieving maximal safe resection where the largest amount of tumor is removed without causing significant neurologic deficits. For low-grade gliomas, surgery alone can sometimes be curative.
• Radiation therapy: This uses high-energy x-rays to target and kill tumor cells. Radiation is often used after surgery to target residual tumor cells.
• Chemotherapy: These medications kill or slow the growth of cancer cells. Chemotherapy can be used alongside radiation, or following radiation and is often used in higher-grade tumors.
• Targeted therapy and immunotherapy: These are newer treatments that are designed to target specific genetic mutations in the tumor or to stimulate the immune system to fight the cancer. Their role in the treatment for gliomas is continuing to evolve.

The important thing to remember is that every treatment plan and recommendation made by your healthcare team is personalized based off of details specific to your disease, your overall health, and treatment goals.

Treating Advanced Glioma

High-grade gliomas tend to have a more aggressive disease course and require multiple types of treatment. This may include surgery, radiation, and chemotherapy, among others.

Glioblastoma (GBM) is the most aggressive and lethal form of primary brain tumor. Classified as a Grade IV glioma by the World Health Organization (WHO), glioblastoma presents significant challenges for treatment due to its highly invasive nature, rapid growth, and resistance to most conventional therapies.

While new treatment approaches are continually being explored through ongoing clinical trials, the standard of care for glioblastoma has remained largely consistent since 2005, following a landmark trial that established the current treatment, which combines maximal safe surgical resection (surgery to remove as much of the cancer as possible) followed by chemotherapy and radiation.

“What we attempt to do to achieve that control of the disease is we often follow surgery with some form of chemotherapy as well as radiation to help control the microscopic disease of infiltration,” Dr. Ganish Shankar, a neurosurgeon at Massachusetts General Hospital, tells SurvivorNet. The typical course after surgery is chemotherapy and radiation therapy together, followed by additional chemotherapy.

More recently, a clinical trial published in 2017 found that the addition of tumor treating fields (Optune) to the chemotherapy following combined chemoradiation improved survival further with minimal increase in toxicity.