Treating patients with gliomas requires a multidisciplinary approach, which often includes surgery, radiation and chemotherapy. Recent developments have demonstrated the efficacy of chemotherapeutic agents in patients with newly diagnosed or recurrent gliomas. Large clinical studies have provided important information on the impact of chemotherapy for anaplastic oligodendrogliomas in the upfront setting. Randomised trials have demonstrated the benefit of chemoradiation for patients with glioblastoma. Investigations are also under way to clarify the role of chemotherapy for low-grade gliomas. This review article summarises the recent developments and approaches in the use of chemotherapy to treat adult patients with astrocytomas and oligodendrogliomas.
Gliomas are primary central nervous system (CNS) tumours originating from neuroglial cells. The term includes the various histologic grades of astrocytoma, oligodendro-glioma and ependymoma. Although all are malignant, these tumours can be further separated into different grades according to their morphologic features that reflect their natural history or biologic behavior. Currently, the World Health Organization (WHO) classification is the most widely used system. Table 1 provides some details on the WHO grading of gliomas frequently seen in adults and their long-term survival.2 The biologic behaviour of the different grades of tumour can be markedly different, hence the need for varied treatment approaches. Grade I astrocytoma refers to a very specific histologic subtype, pilocytic astrocytoma as well as some rare, non-infiltrating tumours. These tumours are generally well-circumscribed, slowly growing and occurring mainly in children or very young adults (<20 years old). Pilocytic astrocytoma and ependymoma will not be addressed in this article.
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