Extracellular Vesicles as a Platform for Glioma Therapeutic Development.
Authors: Santiago-Dieppa DR, Gonda DD, Cheung VJ, Steinberg JA, Carter BS, Chen CC Abstract Normal and pathologic cells secrete extracellular vesicles (EV), which are defined as 30-2,000 nm spherical organelles. It has been found that EV mediate various biological functions including cellular remodeling and export of biomolecules, extracellular communication, immune stimulation and suppression, and modulation of the cellular microenvironment. EV secreted by human glioma cells contain a wealth of tumor-specific proteins and nucleic acids that can be isolated from patients with these neoplasms. Thus, EV cont...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Alternating Electric Fields Therapy for Malignant Gliomas: From Bench Observation to Clinical Reality.
Authors: Wong ET, Lok E, Swanson KD Abstract Alternating electric fields of intermediate frequencies, also known as Tumor Treating Fields (TTFields or TTF) is a novel anticancer treatment modality that disrupts tumor cell mitosis at the metaphase-anaphase transition, leading to mitotic catastrophe, aberrant mitotic exit, and/or cell death. It is realized through alteration of the cytokinetic cleavage furrow by interference of proteins possessing large dipole moments, like septin heterotrimer complex and α/β-tubulin, and that results in disordered membrane contraction and failed cytokinesis. Aberrant mito...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Perspectives of Nanotechnology in the Management of Gliomas.
Authors: Yoon JW, Jiang W, Rutka JT, Huang Y, Kim BYS Abstract Significant advances in the design and understanding of the materials and systems of 1-100 nm have provided unprecedented tools to probe, diagnose, and treat diseases at the molecular level with greater efficiency and accuracy. In particular, optical and chemical properties of nanomaterials are being exploited to improve the effectiveness of neuro-oncological and neurosurgical interventions. Modern nanotechnology-driven clinical applications may have significant impact on management of brain tumors. PMID: 29990985 [PubMed - in process] ...
Source: Progress in Neurological Surgery - July 11, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Fractionated Radiotherapy of Intracranial Gliomas.
Authors: Ghia AJ Abstract Fractionated radiotherapy (FRT) plays a critical role in the management of gliomas. For glioblastoma, the irradiation dose of 60 Gy in 30 fractions with concomitant and adjuvant temozolomide is currently considered as a standard of treatment, and further dose escalation has failed to be of benefit in clinical trials. Hypofractionated radiation schedules may be applied in elderly patients or those with poor performance status. For anaplastic gliomas, the high-risk region is typically irradiated to a total dose of approximately 60 Gy in 1.8-2 Gy per fraction. For patients with 1p/19...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery in the Multimodality Management of Residual or Recurrent Glioblastoma Multiforme.
Authors: Niranjan A, Monaco Iii EA, Kano H, Flickinger JC, Lunsford LD Abstract Management options for residual or recurrent glioblastoma multiforme (GBM) are limited despite advances in surgical, chemotherapeutic, and radiotherapeutic techniques. Stereotactic radiosurgery (SRS) is often beneficial in such cases providing improved survival of patients, but still remains underutilized as part of the multimodality management of malignant gliomas. During the last 20 years, 297 patients with histologically proven residual or recurrent GBM underwent Gamma Knife surgery in the University of Pittsburgh. Retrospec...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Stereotactic Radiosurgery of Intracranial Low-Grade Gliomas.
Authors: Ganz JC Abstract Low-grade gliomas (LGG), corresponding to WHO grades I and II, are an uncommon and heterogeneous group of tumors, which include several distinct histopathological types and subtypes. Because of their rarity, acquiring adequate data on which to base therapeutic decisions in such cases is difficult. According to present knowledge, it is reasonable to consider radiosurgery (in particular, Gamma Knife surgery) as a therapeutic option for some LGG. Nevertheless, there is a clear need for multicenter cooperation in order to augment the currently scanty data. PMID: 29393177 [PubM...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Brachytherapy of Intracranial Gliomas.
Authors: Nachbichler SB, Kreth FW Abstract Interstitial implantation of radioactive materials (brachytherapy [BT]) has been designed to protractedly deliver a high radiation dose to a well-defined target volume, while minimizing irradiation of the adjacent normal tissues. Even though promising results have been reported over time, the role of this treatment modality in the management of brain tumors is still poorly defined, and only a few centers worldwide apply it in clinical practice. Nevertheless, temporary or permanent interstitial implantation of low activity (<20 mCi) and low dose rate (≤10 cGy/...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Irradiation of Intracranial Gliomas in Children.
Authors: Kortmann RD, Seidel C, Müller K, Hirsch FW Abstract Attainment of local control is a cornerstone in the management of brain tumors in children. Treatment of progressive low-grade and all high-grade gliomas traditionally includes resection followed by fractionated radiotherapy (FRT) or FRT alone in neoplasms not amenable to surgical removal. While in younger children chemotherapy is typically used as a first-line non-surgical management option, FRT in such patients remains the standard of salvage therapy. Recent improvements in techniques for radiation treatment planning and delivery allow conform...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Role of Radiosensitizers in Radiation Treatment of Gliomas.
Authors: Cohen RJ, Mehta MP Abstract Malignant gliomas are the most common primary brain tumors and have devastatingly high mortality rates. Most recurrences are close to the surgical bed, despite adjuvant fractionated radiotherapy (FRT). Localized FRT to total dose of 60 Gy with concurrent and adjuvant temozolomide (TMZ) resulted in a statistically significant survival improvement of patients with newly diagnosed glioblastoma compared to those treated with FRT alone, and has emerged as the cornerstone of therapy. Despite this progress, long-term survival remains poor. Various signaling pathways have becom...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of High-Grade Astrocytomas in Adults.
Authors: Puduvalli VK, Hoang N Abstract Malignant gliomas have been historically considered unresponsive to chemotherapy due to their intrinsic resistance to conventional anticancer medications and the role of the blood-brain barrier in preventing access of the cytotoxic agents to the tumor. However, recent studies have demonstrated the efficacy of specific drugs in subsets of patients with high-grade astrocytomas that has revived the enthusiasm for the role of systemic chemotherapy against these neoplasms. Temozolomide, a monofunctional alkylator, was the first chemotherapeutic agent to definitively impro...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of Diffuse Astrocytoma (WHO grade II) in Adults.
Authors: Narita Y Abstract The effectiveness of chemotherapy or chemoradiotherapy for diffuse astrocytoma (DA) has been largely unknown until recently. However, a randomized controlled study (RTOG 9802) showed that adding of procarbazine, CCNU, and vincristine (PCV) chemotherapy to fractionated radiotherapy (FRT) in patients with "high-risk" WHO grade II gliomas, including DA, has significant positive impact on both progression-free survival and overall survival. Effectiveness of temozolomide (TMZ) in cases of low-grade gliomas was also reported, and a randomized phase III trial comparing FRT alone or in c...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of Oligodendrogliomas.
Authors: Drappatz J, Lieberman F Abstract Oligodendrogliomas are therapy-responsive tumors, which have better prognosis compared to their astrocytic counterparts. The goal of treatment in such cases is not only prolongation of the patients' survival, but maintaining high neurologic functioning and quality of life. Traditionally, after maximal surgical resection fractionated radiation therapy was given. However, prospective randomized trials comparing irradiation alone and its combination with chemotherapy demonstrated strong impact of the latter on prolongation of overall survival in 1p/19q co-deleted anap...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Chemotherapy of Intracranial Gliomas in Children.
Authors: Terashima K Abstract Under specific indications, chemotherapy may play an important role in the treatment of pediatric patients with intracranial gliomas. It can be effectively administered in inoperable low-grade tumors, particularly with the use of combination regimens based on carboplatin and vincristine. In very young children with high-grade gliomas (HGG), chemotherapy may result in control of tumor growth, which allows to postpone fractionated radiation therapy (FRT). At the same time, in difference with adults, there is no current evidence that addition of chemotherapy to aggressive surgica...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Perspectives of Personalized Chemotherapy of Gliomas Based on Molecular Tumor Profiling.
Authors: Soffietti R, Franchino F, Magistrello M, Pellerino A, Rudà R Abstract Histopathological typing and grading are the cornerstones of the World Health Organization classification of the central nervous system tumors. It provides clinicians with information on the natural course of the disease and thus guides therapeutic choices. Nonetheless, patients with histologically identical tumors may have different outcomes and response to therapy. In recent years, extensive research has been done on three molecular markers in adult gliomas, namely MGMT promoter methylation, 1p/19q co-deletion, and IDH1/IDH2 ...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research

Antiangiogenic Therapy of High-Grade Gliomas.
Authors: Jo J, Wen PY Abstract Angiogenesis plays a critical pathologic role in malignant gliomas. In the past few years, numerous studies using bevacizumab (BEV), a humanized monoclonal antibody against vascular endothelial growth factor (VEGF), have been conducted in patients with brain tumors. Current evidence suggests that such treatment produces favorable results in patients with recurrent glioblastoma multiforme (GBM), but is not associated with any benefits in newly diagnosed GBM and recurrent WHO grade III gliomas. Initial experience using BEV for management of central nervous system radiation necr...
Source: Progress in Neurological Surgery - February 4, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research