Brain Malignancy: Treatment and Abstacles to Glioblastoma

Glioblastoma is the most common and aggressive primary tumor in adults. This tumor is associated with a poor prognosis, resulting in significantly diminished survival times for patients. Glioblastoma represents the most prevalent and aggressive primary tumor observed in the adult population. Glioblastoma multiforme (GBM) is characterized as a multidisciplinary disease. Gliomas, and particularly glioblastomas (GBMs), are recognized as some of the most aggressive and treatment-resistant primary central nervous system (CNS) tumors. Current therapeutic approaches are surgical resection, followed by adjuvant chemotherapy utilizing temozolomide, and/or radiotherapy. The prevention of irreversible cerebral damage and the invasion of neoplasms, which ultimately leads to recurrence, are significant challenges in the management of GBM. The primary clinical impediments that contribute to the poor prognosis of GBM include late-stage diagnosis, diffuse infiltration, pseudo-palisading necrosis, microvascular proliferation, and resistance to standard therapeutic modalities. This review provides a summary of the relevant publications in PubMed database which were included due to being related. The standard of care for glioblastoma entails the maximization of safe resection, succeeded by radiation therapy and administration of temozolomide (TMZ), alongside daily TMZ and tumor treatment fields (TTFields) subsequent to irradiation. Current evidence does not support the efficacy of brachytherapy, stereotactic radiosurgery (SRS), fractional stereotactic radiotherapy (FSRT), and hyperfractionated radiotherapy compared to conventional external beam radiation therapy (EBRT) for the primary tumor. However, obstacles such as tumor heterogeneity, the blood-brain barrier, and treatment resistance complicate effective management. Some significant obstacles include: ۱) Blood-Brain Barrier: Numerous treatments face challenges in crossing this barrier, which restricts the effectiveness of drugs. ۲) Tumor Heterogeneity: The diversity of tumor cell types makes it difficult to pinpoint effective therapeutic targets. ۳) Clinical Trial Limitations: Patients frequently face exclusion from trials based on age and neurological symptoms, which impedes the advancement of new therapies. The evaluation of age and performance status in geriatric patients prior to treatment facilitates the application of hypofractionated radiotherapy. The investigation of tumor molecular signatures aids in determining the most appropriate targeted pharmacotherapy. In cases of recurrent glioblastoma, it is imperative to weigh the associated risks and benefits of re-irradiation in conjunction with bevacizumab. Data for the role of immunotherapy in the management of malignant gliomas are presently insufficient. GBM is recognized as the most prevalent and aggressive cerebral tumor, with a median survival duration of approximately ۱۵ months for affected individuals. This neoplasm is characterized by extensive invasiveness, accompanied by substantial necrotic and hypoxic regions that alter adjacent neuronal tissues. GBM exhibits considerable heterogeneity, characterized by various infiltrating cell types and multiple subcellular populations of tumor cells. Despite advancements in the treatment of glioblastoma with respect to local disease control, mortality rates remain close to ۱۲ months following diagnosis. To enhance therapeutic outcomes and minimize recurrence rates, forthcoming research must explore the cutting-edge of knowledge, including the elucidation of the molecular mechanisms underlying the tumor, the optimization of pharmacological agents to surmount the blood-brain barrier effectively, and the discovery of novel therapies targeted at the heterogeneous characteristics of this neoplasm.

کلیدواژه ها:

Neoplastic Stem Cells ، Brain Neoplasms ، glioblastoma ، Radiotherapy