Updates on management of gliomas in the molecular age

Abstract

Gliomas are primary brain tumors derived from glial cells of the central nervous system, afflicting both adults and children with distinct characteristics and therapeutic challenges. Recent developments have ushered in novel clinical and molecular prognostic factors, reshaping treatment paradigms based on classification and grading, determined by histological attributes and cellular lineage. This review article delves into the diverse treatment modalities tailored to the specific grades and molecular classifications of gliomas that are currently being discussed and used clinically in the year 2023. For adults, the therapeutic triad typically consists of surgical resection, chemotherapy, and radiotherapy. In contrast, pediatric gliomas, due to their diversity, require a more tailored approach. Although complete tumor excision can be curative based on the location and grade of the glioma, certain non-resectable cases demand a chemotherapy approach usually involving, vincristine and carboplatin. Additionally, if surgery or chemotherapy strategies are unsuccessful, Vinblastine can be used. Despite recent advancements in treatment methodologies, there remains a need of exploration in the literature, particularly concerning the efficacy of treatment regimens for isocitrate dehydrogenase type mutant astrocytomas and fine-tuned therapeutic approaches tailored for pediatric cohorts. This review article explores into the therapeutic modalities employed for both adult and pediatric gliomas in the context of their molecular classification.

Keywords: Gliomas; Chemotherapy; Radiotherapy; Isocitrate dehydrogenase type mutant; Pediatric gliomas; Astrocytoma; Oligodendroglioma; 1p/19q-codeleted

Core Tip: Gliomas are primary brain tumors derived from glial cells of the central nervous system, afflicting both adults and children. This review article explores the therapeutic modalities employed for both adult and pediatric gliomas in the context of their molecular classification. Gliomas are classified by World Health Organization using a grading system grade 1 to 4 differentiating the grades by the gliomas attributes such as progression. The current trident approach to glioma treatment is surgery, radiotherapy, and chemotherapy. Pediatric cases are more nuanced, creating a more challenging approach to treating pediatric gliomas compared to their adult counterpart.