Basic principles of contemporary chemotherapy of malignant gliomas of the brain
DOI:
https://doi.org/10.25305/unj.258545Keywords:
malignant gliomas of the brain, chemotherapy, molecular markers, MGMT status, temozolomide, PCV polychemotherapy regimen, bevacizumab, IDH-mutation, 1p/19q co-deletionAbstract
The modern view on the place of antiblastic chemotherapy in clinical neuro-oncology based on NCCN 2021 clinical guidelines (The National Comprehensive Cancer Network), EANO recommendations (The European Association for Neuro-Oncology), cIMPACT-NOW (The Consortium for Inform Molecular and Practical Approaches to CNS Tumor Taxonomy) and many years of experience of the department of adjuvant treatment for the central nervous system tumors of the State Institution "Romodanov Neurosurgery Institute, Ukraine" is presented and the basic principles of its application in the complex treatment of malignant gliomas of the brain are substantiated.
Malignant gliomas are a heterogeneous group of the most numerous primary tumors of the central nervous system, differing in both the grade of malignancy and the prognosis of the disease. The latest WHO tumors classification 2021 defines this group of tumors as "diffuse gliomas" of the brain, that is, the term itself indicates infiltrative nature of their growth, that limits the possibility of surgical removal and requires a multimodal approach to their treatment in order to maximize the reduction of tumor tissue.
The new era of chemotherapy in neuro-oncology, as well as in general oncology, began with the study of the molecular profile of tumors, which is important both for predicting the course of the disease and for choosing tactics of chemotherapeutic treatment of malignant gliomas. It’s enough to give the following example: in the absence of IDH gene mutation and co-deletion of chromosome 1p/19q loci in grade 2 of anaplasia diffuse gliomas, the prognosis of the disease does not differ from that in glioblastoma multiforme.
For the same reason, in modern neuro-oncology, the designation of molecular genetic markers in malignant gliomas is essential for the personification of the treatment of pathology is essential to personalize the treatment of this pathology.
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