[Pattern of care of high-grade gliomas]

Abstract

High grade gliomas are the most frequent and malignant primary brain tumours in adults. Prognosis depends on age, performance status and histological grade. Associated with symptomatic treatments, surgery, radiotherapy and chemotherapy represent the main weapons of the specific multidisciplinary therapy of malignant gliomas. Surgery is necessary for histological diagnosis. In malignant gliomas, surgery may improve survival in case of complete removal, and debulking provides an improvement of the quality of life and a symptomatic relief. Radiation therapy has been shown to improve survival in malignant glioma. The place of chemotherapy is growing not only for anaplastic oligodendrogliomas, more chemosensitive (particularly when they harbor 1p19q codeletions), but also for glioblastomas patients, which have been shown to benefit from radiotherapy plus concomitant and adjuvant temozolomide. This effect was particularly clear for patients with MGMT inactivation in the tumour, confirming here also the impact of molecular biology for future management of gliomas.