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Medicina
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High-Grade Gliomas: Updates and Challenges
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High-Grade Gliomas: Updates and Challenges

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Oncology".

Deadline for manuscript submissions: 30 November 2025 | Viewed by 1696

Special Issue Editors

Dr. Sandra Leisz

E-Mail Website
Guest Editor
Department of Neurosurgery, Medical Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle, Germany
Interests: neuroprotection; apoptosis; nimodipine; calcium channel blocker; schwann cell; neuronal cell death; vestibular schwannoma; neurofibromatosis
Dr. Maximilian Scheer

E-Mail Website
Guest Editor Assistant
Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
Interests: neurosurgery; glioma; neurology

Special Issue Information

Dear Colleagues,

Despite constant advances in medicine, high-grade gliomas are associated with an unfavourable prognosis. They represent a complex and challenging interdisciplinary field where the modern approach to imaging and therapy involves a multidisciplinary team of neurosurgeons, neurologists, neuroradiologists, and radiotherapists.

In recent years, advances in imaging, optimisation of radiation treatment plans, new developments in adjuvant drug therapy, and other intraoperative modalities such as intraoperative ultrasound have improved the overall diagnosis and management of this disease. The use of alternating electric fields (TTFields) as an adjunct therapy, the promising use of IDH-inhibiting drugs, and the trend of supramarginal resection, where safe, are also worthy of mention. In this Special Issue of Medicina, we aim to publish articles on further advances in high-grade gliomas in as broad a context as possible to provide readers with a comprehensive overview of the latest developments.

Comprehensive reviews, technical notes, opinions, and clinical and basic science research on high-grade gliomas are welcome in this Special Issue.

Dr. Sandra Leisz
Guest Editor

Dr. Maximilian Scheer
Guest Editor Assistant

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 submissions that pass pre-check are 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. Medicina 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 2200 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

  • glioma
  • glioblastoma
  • neuro-oncology
  • tumour biology
  • imaging
  • radiotherapy
  • chemotherapy

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Published Papers (2 papers)

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15 pages, 2983 KB  
Article
A Comparative Study of Five Target Volume Definitions for Radiotherapy in Glioblastoma Multiforme
by Kamuran Ibis, Kubra Ozkaya Toraman, Canan Koksal Akbas, Ozlem Guler Guniken, Korhan Kokce, Sezi Ceren Gunay, Rasim Meral and Musa Altun
Medicina 2025, 61(10), 1860; https://doi.org/10.3390/medicina61101860 - 16 Oct 2025
Viewed by 308
Abstract
Background and Objectives: This study aimed to compare target volumes and organ-at-risk (OAR) doses using five different volume definitions in radiotherapy (RT) planning of patients with glioblastoma multiforme (GBM). Materials and Methods: Rigid image fusion was performed using simulation computed tomography and postoperative [...] Read more.
Background and Objectives: This study aimed to compare target volumes and organ-at-risk (OAR) doses using five different volume definitions in radiotherapy (RT) planning of patients with glioblastoma multiforme (GBM). Materials and Methods: Rigid image fusion was performed using simulation computed tomography and postoperative magnetic resonance imaging scans of 20 patients with GBM. Volumetric modulated arc therapy (VMAT) plans were generated according to three two-phase protocols—American Brain Tumor Consortium (ABTC), North Central Cancer Treatment Group/Alliance (NCCTG/Alliance), and Radiation Therapy Oncology Group/NRG (RTOG/NRG)—and two single-phase protocols—European Organisation for Research and Treatment of Cancer (EORTC) and European Society for Radiotherapy and Oncology–European Association of Neuro-Oncology (ESTRO/EANO)—each delivering a total dose of 60 Gy. OARs and dose constraints were evaluated. Statistical analysis was performed using the paired sample t-test. Results: The ESTRO/EANO volume had the smallest median PTV overall (p < 0.001). The lowest brain-PTV Dmean in the initial phase was observed in the ABTC group, followed closely by ESTRO/EANO (p < 0.001). Among boost volumes, the ABTC volume was the smallest, and the median brain-PTV Dmean was lowest in the ESTRO/EANO volume. ESTRO/EANO provided the lowest doses for contralateral and ipsilateral cochlea Dmean, brainstem D1cc, and contralateral lens Dmax. Notably, both EORTC and ESTRO/EANO plans maintained OAR doses within acceptable constraints, with ESTRO/EANO achieving the most consistently minimised exposure. Conclusions: Reduced irradiated brain volume, acceptable OAR preservation and practical applicability, the use of ESTRO-EANO and EORTC target volumes in radiotherapy of glioblastoma multiforme may provide dosimetric advantages that require further validation in clinical outcome studies. Full article
(This article belongs to the Special Issue High-Grade Gliomas: Updates and Challenges)
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22 pages, 4538 KB  
Systematic Review
Total Intravenous Versus Inhalational Anesthesia in High-Grade Glioma Surgery: A Systematic Review and Meta-Analysis
by Plamen Penchev, Boris Tablov, Mariano Gallo Ruelas, Daniela Milanova-Ilieva, Lyubomir Gaydarski, Nikolay Yordanov, Eduardo Alonso, Danna Espinoza, Petar-Preslav Petrov, Ivelina Lukanova, Pavel Stanchev, Julian Dichev, Ivana Korentova and Nikolai Ramadanov
Medicina 2025, 61(8), 1463; https://doi.org/10.3390/medicina61081463 - 14 Aug 2025
Viewed by 1146
Abstract
Background and Objectives: High-grade gliomas (HGGs) are aggressive primary brain tumors with a poor prognosis despite multimodal treatment. The anesthetic technique used during surgery may influence tumor progression and survival, but its role in HGGs remains unclear. This meta-analysis evaluated the effect [...] Read more.
Background and Objectives: High-grade gliomas (HGGs) are aggressive primary brain tumors with a poor prognosis despite multimodal treatment. The anesthetic technique used during surgery may influence tumor progression and survival, but its role in HGGs remains unclear. This meta-analysis evaluated the effect of total intravenous anesthesia (TIVA) versus inhalational anesthesia (INHA) on overall survival (OS) and progression-free survival (PFS) in HGG patients. Materials and Methods: A systematic search was conducted in PubMed, Scopus, and Cochrane databases for studies assessing the impact of TIVA versus INHA on OS and PFS in HGG patients. Statistical analysis was performed using R version 4.3.1. Heterogeneity across studies was quantified using the Cochrane Q test alongside the I2 statistic. A random-effects model was employed to derive the pooled hazard ratios (HRs). Results: A total of five studies involving 827 participants (mean age 58 years, mean females 38%) were included, of whom 406 (49%) received TIVA. No statistically significant differences were observed in OS (HR 0.77; 95% CI [0.58–1.02]; p = 0.07; I2 = 67%) or PFS (HR 0.88; 95% CI [0.70–1.10]; p = 0.27; I2 = 51%) between the groups. A subgroup analysis revealed that TIVA was associated with improved OS in patients with grade IV tumors (HR 0.70; 95% CI [0.51–0.96]; p = 0.03), while no significant effect was observed in the mixed grade III–IV subgroup. However, the test for subgroup differences was not statistically significant (p = 0.0669), and this finding should be interpreted with caution. No significant differences were observed in median OS or PFS, or in single-arm meta-analyses. Conclusions: This meta-analysis found no statistically significant differences in overall or progression-free survival between TIVA and INHA in patients undergoing surgery for HGGs. Although a subgroup analysis suggested a possible survival advantage of TIVA in grade IV tumors, the lack of a statistically significant subgroup difference test limits the strength of this finding. Further investigation is needed to determine whether anesthetic technique influences outcomes in this subgroup. Full article
(This article belongs to the Special Issue High-Grade Gliomas: Updates and Challenges)
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