Special Issue "Optimizing Management of High Grade Glioma"

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Clinical Neuroscience".

Deadline for manuscript submissions: closed (15 February 2019).

Special Issue Editor

Guest Editor
Assoc. Prof. Michael Back

Director of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
The Brain Cancer Group, Sydney, New South Wales, Australia
Website | E-Mail
Interests: neuro-oncology; brain tumour target volume delineation for radiation therapy

Special Issue Information

Dear Colleagues,

In 2005, the EORTC (European Organisation for Research and Treatment of Cancer) 26981-NCI Canada CE3 Phase III Trial in Glioblastoma was published and demonstrated that the addition of an oral chemotherapy drug Temozolomide to standard radiation therapy resulted in a doubling of two year survival (Stupp, et al., 2005). An update of the study in 2009 has confirmed that almost 10% of patients are alive at 5 years post diagnosis.

The promising outcome in this study subsequently led to a greater emphasis on optimizing outcome and research in patients with high grade glioma; not only for systemic therapy options, but also with in regards to molecular neuropathology, diagnostic procedures, neurosurgical care, radiotherapy delivery and supportive care. These include more aggressive neurosurgical resection utilizing awake craniotomy, MRI guidance or endoscopic resection; sophisticated radiation therapy techniques such as Intensity Modulated Radiation Therapy; and enrolment of patients into clinical trials utilizing targeted therapies in addition to temozolomide. Demand for more supportive care services through neuro-oncology tumour boards and cancer care coordinators have also expanded in response to the perceived improved outcome and complexity of care following the introduction of multidisciplinary care.

Although clinical trials over the subsequent fifteen years since the initial EORTC 26981-NCI Canada CE3 publication have not produced a major change to the treatment protocol for glioblastoma; the quality initiatives that have resulted along the whole patient management pathway have provided further incremental improvements in median survival. This has been not just for those diagnosed with glioblastoma, but also for anaplastic glioma and other primary CNS tumours. Such improvements have allowed more effective patient selection for therapies, less morbidity from interventions and a better understanding of disease natural history.

This Special Issue will highlight potential multidisciplinary technical and supportive care initiatives that may optimize the current management of patients with high grade glioma in the future and thus further improve upon patient care and outcomes.

Stupp, R.; Mason, W.P.; van den Bent, M.J.; Weller, M.; Fisher, B.; Taphoorn, M.J.B.; Belanger, K.; Brandes, A.A.; Marosi, C.; Bogdahn, U.; et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N. Engl. J. Med. 2005, 352, 987–996.

Assoc. Dr. Michael Back
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • High grade glioma
  • glioblastoma
  • neuro-oncology
  • Seizures

Published Papers (5 papers)

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Research

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Open AccessArticle
Brain Mapping as Helpful Tool in Brain Glioma Surgical Treatment—Toward the “Perfect Surgery”?
Brain Sci. 2018, 8(11), 192; https://doi.org/10.3390/brainsci8110192
Received: 4 September 2018 / Revised: 28 September 2018 / Accepted: 24 October 2018 / Published: 26 October 2018
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Abstract
Gliomas are the most common primary malignant brain tumours in adults, representing nearly 80%, with poor prognosis in their high-grade forms. Several variables positively affect the prognosis of patients with high-grade glioma: young age, tumour location, radiological features, recurrence, and the opportunity to [...] Read more.
Gliomas are the most common primary malignant brain tumours in adults, representing nearly 80%, with poor prognosis in their high-grade forms. Several variables positively affect the prognosis of patients with high-grade glioma: young age, tumour location, radiological features, recurrence, and the opportunity to perform post-operative adjuvant therapy. Low-grade gliomas are slow-growing brain neoplasms of adolescence and young-adulthood, preferentially involving functional areas, particularly the eloquent ones. It has been demonstrated that early surgery and higher extent rate ensure overall longer survival time regardless of tumour grading, but nowadays, functional preservation that is as complete as possible is imperative. To achieve the best surgical results, along with the best functional results, intraoperative mapping and monitoring of brain functions, as well as different anaesthesiology protocols for awake surgery are nowadays being widely adopted. We report on our experience at our institution with 28 patients affected by malignant brain tumours who underwent brain mapping-aided surgical resection of neoplasm: 20 patients underwent awake surgical resection and 8 patients underwent asleep surgical resection. An analysis of the results and a review of the literature has been performed. Full article
(This article belongs to the Special Issue Optimizing Management of High Grade Glioma)
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Open AccessArticle
Optimising Outcomes for Glioblastoma through Subspecialisation in a Regional Cancer Centre
Brain Sci. 2018, 8(10), 186; https://doi.org/10.3390/brainsci8100186
Received: 18 September 2018 / Revised: 5 October 2018 / Accepted: 9 October 2018 / Published: 15 October 2018
Cited by 1 | PDF Full-text (514 KB) | HTML Full-text | XML Full-text
Abstract
Delivery of highly sophisticated, and subspecialised, management protocols for glioblastoma in low volume rural and regional areas creates potential issues for equivalent quality of care. This study aims to demonstrate the impact on clinical quality indicators through the development of a novel model [...] Read more.
Delivery of highly sophisticated, and subspecialised, management protocols for glioblastoma in low volume rural and regional areas creates potential issues for equivalent quality of care. This study aims to demonstrate the impact on clinical quality indicators through the development of a novel model of care delivering an outsourced subspecialised neuro-oncology service in a regional centre compared with the large volume metropolitan centre. Three hundred and fifty-two patients with glioblastoma were managed under the European Organisation for Research and Treatment of Cancer and National Cancer Institute of Canada Clinical Trials Group (EORTC-NCIC) Protocol, and survival outcome was assessed in relation to potential prognostic factors and the geographical site of treatment, before and after opening of a regional cancer centre. The median overall survival was 17 months (95% CI: 15.5–18.5), with more favourable outcome with age less than 50 years (p < 0.001), near-total resection (p < 0.001), Eastern Cooperative Oncology Group (ECOG) Performance status 0, 1 (p < 0.001), and presence of O-6 methylguanine DNA methyltransferase (MGMT) methylation (p = 0.001). There was no difference in survival outcome for patients managed at the regional centre, compared with metropolitan centre (p = 0.35). Similarly, no difference was seen with clinical quality process indicators of clinical trial involvement, rates of repeat craniotomy, use of bevacizumab and re-irradiation. This model of neuro-oncology subspecialisation allowed equivalent outcomes to be achieved within a regional cancer centre compared to large volume metropolitan centre. Full article
(This article belongs to the Special Issue Optimizing Management of High Grade Glioma)
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Open AccessArticle
Chaperonology: The Third Eye on Brain Gliomas
Brain Sci. 2018, 8(6), 110; https://doi.org/10.3390/brainsci8060110
Received: 10 May 2018 / Revised: 5 June 2018 / Accepted: 13 June 2018 / Published: 14 June 2018
Cited by 2 | PDF Full-text (907 KB) | HTML Full-text | XML Full-text
Abstract
The European Organization for Research and Treatment of Cancer/National Cancer Institute of Canada Phase III trial has validated as a current regimen for high-grade gliomas (HGG) a maximal safe surgical resection followed by radiotherapy with concurrent temozolamide. However, it is essential to balance [...] Read more.
The European Organization for Research and Treatment of Cancer/National Cancer Institute of Canada Phase III trial has validated as a current regimen for high-grade gliomas (HGG) a maximal safe surgical resection followed by radiotherapy with concurrent temozolamide. However, it is essential to balance maximal tumor resection with preservation of the patient’s neurological functions. Important developments in the fields of pre-operative and intra-operative neuro-imaging and neuro-monitoring have ameliorated the survival rate and the quality of life for patients affected by HGG. Moreover, even though the natural history remains extremely poor, advancement in the molecular and genetic fields have opened up new potential frontiers in the management of this devastating brain disease. In this review, we aim to present a comprehensive account of the main current pre-operative, intra-operative and molecular approaches to HGG with particular attention to specific chaperones, also called heat shock proteins (Hsps), which represent potential novel biomarkers to detect and follow up HGG, and could also be therapeutic agents. Full article
(This article belongs to the Special Issue Optimizing Management of High Grade Glioma)
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Review

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Open AccessReview
New Hope in Brain Glioma Surgery: The Role of Intraoperative Ultrasound. A Review
Brain Sci. 2018, 8(11), 202; https://doi.org/10.3390/brainsci8110202
Received: 17 October 2018 / Revised: 7 November 2018 / Accepted: 16 November 2018 / Published: 19 November 2018
Cited by 1 | PDF Full-text (253 KB) | HTML Full-text | XML Full-text
Abstract
Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have [...] Read more.
Maximal safe resection represents the gold standard for surgery of malignant brain tumors. As regards gross-total resection, accurate localization and precise delineation of the tumor margins are required. Intraoperative diagnostic imaging (Intra-Operative Magnetic Resonance-IOMR, Intra-Operative Computed Tomography-IOCT, Intra-Operative Ultrasound-IOUS) and dyes (fluorescence) have become relevant in brain tumor surgery, allowing for a more radical and safer tumor resection. IOUS guidance for brain tumor surgery is accurate in distinguishing tumor from normal parenchyma, and it allows a real-time intraoperative visualization. We aim to evaluate the role of IOUS in gliomas surgery and to outline specific strategies to maximize its efficacy. We performed a literature research through the Pubmed database by selecting each article which was focused on the use of IOUS in brain tumor surgery, and in particular in glioma surgery, published in the last 15 years (from 2003 to 2018). We selected 39 papers concerning the use of IOUS in brain tumor surgery, including gliomas. IOUS exerts a notable attraction due to its low cost, minimal interruption of the operational flow, and lack of radiation exposure. Our literature review shows that increasing the use of ultrasound in brain tumors allows more radical resections, thus giving rise to increases in survival. Full article
(This article belongs to the Special Issue Optimizing Management of High Grade Glioma)
Open AccessReview
End-of-Life Care in High-Grade Glioma Patients. The Palliative and Supportive Perspective
Brain Sci. 2018, 8(7), 125; https://doi.org/10.3390/brainsci8070125
Received: 11 June 2018 / Revised: 22 June 2018 / Accepted: 28 June 2018 / Published: 30 June 2018
Cited by 2 | PDF Full-text (244 KB) | HTML Full-text | XML Full-text
Abstract
High-grade gliomas (HGGs) are the most frequently diagnosed primary brain tumors. Even though it has been demonstrated that combined surgical therapy, chemotherapy, and radiotherapy improve survival, HGGs still harbor a very poor prognosis and limited overall survival. Differently from other types of primary [...] Read more.
High-grade gliomas (HGGs) are the most frequently diagnosed primary brain tumors. Even though it has been demonstrated that combined surgical therapy, chemotherapy, and radiotherapy improve survival, HGGs still harbor a very poor prognosis and limited overall survival. Differently from other types of primary neoplasm, HGG manifests also as a neurological disease. According to this, palliative care of HGG patients represents a peculiar challenge for healthcare providers and caregivers since it has to be directed to both general and neurological cancer symptoms. In this way, the end-of-life (EOL) phase of HGG patients appears to be like a journey through medical issues, progressive neurological deterioration, and psychological, social, and affective concerns. EOL is intended as the time prior to death when symptoms increase and antitumoral therapy is no longer effective. In this phase, palliative care is intended as an integrated support aimed to reduce the symptoms burden and improve the Quality Of Life (QOL). Palliative care is represented by medical, physical, psychological, spiritual, and social interventions which are primarily aimed to sustain patients’ functions during the disease time, while maintaining an acceptable quality of life and ensuring a dignified death. Since HGGs represent also a family concern, due to the profound emotional and relational issues that the progression of the disease poses, palliative care may also relieve the distress of the caregivers and increase the satisfaction of patients’ relatives. We present the results of a literature review addressed to enlighten and classify the best medical, psychological, rehabilitative, and social interventions that are addressed both to patients and to their caregivers, which are currently adopted as palliative care during the EOL phase of HGG patients in order to orientate the best medical practice in HGG management. Full article
(This article belongs to the Special Issue Optimizing Management of High Grade Glioma)
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