Current treatment for gliomas, a comprehensive update

Abstract

Gliomas, especially, diffuse gliomas are rare but challenging cancers in human beings. We have still many issues to solve in both diagnostics and therapeutics for diffuse gliomas. Recently, however, there have been several advancements that are now available in daily practice in Japan. One of these are progresses in surgery, such as technologies of image guidance of surgery with navigations and intraoperative MRIs. Awake surgery becomes popular for preservation of brain functions, such as language, and other higher brain functions. All these are helpful to achieve the “maximal safe resection”, which is a goal of resection for basically all diffuse glioma subtypes. An intraoperative photodynamic diagnosis with 5–aminolevulinic acid and a photodynamic therapy with talaporfin sodium plus a laser light can be applicable during surgery. Intraoperative chemotherapy with CCNU can be used and its wafers are placed on the postoperative resection cavity wall. In terms of progress in therapeutics, we have now new and unique adjuvant therapies, such as a tumor–treating field therapy and an oncolytic viral therapy for glioblastomas. Here, in this article, current diagnosis and therapies for diffuse gliomas are described and discussed, based on the latest WHO classification of central nervous system tumors, the 5th Edition, released in 2021.