Johns Hopkins Advanced Studies in Oncology 9 ABSTRACT The management of glioma has evolved con- siderably during the last decade as significant advances in surgery, cytotoxic chemotherapy, targeted biological therapy , and molecular tumor profiling have entered clinical practice. Gross total resection (GTR) has increasingly been used to treat patients with high-grade glioma, and recent clinical studies have documented improved quality of life and delayed time to glioma recur- rence with this approach. Carmustine (BCNU) wafers may be considered for the treatment of focal tumors that are potentially treatable using GTR and that are not situated near critical func- tional brain areas. Newer biopsy techniques have made it possible to obtain tissue samples from brain regions that were previously inacces- sible. In several clinical trials of temozolomide and radiation therapy, the DNA repair enzyme O 6 -methylguanine methyltransferase has emerged as an important predictor of disease course and response to therapy. Other biomark- ers that have recently been evaluated in patients with glioma include protei ns that a re important in DNA repair and tumorigenesis, as well as newer magnetic resonance and positron emission tomography imaging techniques that provide information about tumor structure and metabo- lism. Recent clinical trials have continued to refine our understanding of the role of temozolomide, radiation therapy, inhibition of angiogenesis, and other approaches to the treatment of patients with glioma. Although glioma remains a chal- lenging disease with a dismal long-term progno- sis, recent advances provide encouragement for the continued development of new treatment options for these patients. ( Adv St ud Onc ol. 2010;3(1):9-23) SURGICAL R ESECTION FOR P ATIENTS WITH NEWLY DIAGNOSE D OR R ECURRENT GLIOMA A growing body of recent r esearch has changed the way that many surgeo ns view the role of surgi cal resection for patients with newly diagnosed or recurrent glioma. During the last decade, gross total resection (GTR) has increasingly been selected for patients with high- and low-grade glioma, and promising new strategies have been developed that combine local therapy, chemotherapy, and radiation. New surgical techniques are also making it possible to obtain pathology samples from patients who have traditionally been considered inoperable, and the information provided by these techniques often has significant implications for patient management. G ROSS T OTAL R ESECTION Surgical resection has traditionally been considered PROCEEDINGS CURRENT CONTROVERSIES IN THE MANAGEMENT OF HIGH GRADE GLIOMAS: AN INTERACTIVE CASE DISCUSSION * — Alessandro Olivi, MD, † Jaishri Blakeley, MD, ‡ and Allen K. Sills, MD, FACS § *Based on the proceedings from a symposium held during the 2009 Joint Meeting of SNO and AANS/CNS Section on Tumors on October 22, 2009, in New Orleans, Louisiana. † Professor of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland. ‡ Assistant Professor of Neurology, Oncology, and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. § Associate Professor, Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, T ennessee. Address correspondence to: Alessandro Olivi, MD, Professor of Neurosurgery and Oncology, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Department of Neurosurgery, Phipps Building, 1-100, 600 N. Wolfe Street, Baltimore, MD 21287. E-mail: [email protected].

Current Controversies in the Management of High Grade Gliomas

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