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PubMed This is a summary of 24 peer-reviewed journal articles Updated
Neurosurgery · Glioma

Treatment Strategy: Surgery, Radiation, and Medical Therapies for Gliomas

At a Glance

Glioma treatment requires a combination of therapies starting with maximal safe resection to remove as much tumor as possible. Post-surgery care often includes radiation, chemotherapy, or targeted drugs like Vorasidenib, depending on the tumor's grade and specific molecular profile.

Treating a glioma is not a “one-size-fits-all” process. Because these tumors are infiltrative—meaning they weave into healthy brain tissue—the goal is to remove as much of the tumor as possible while protecting the parts of the brain that make you who you are [1]. This approach is called maximal safe resection [2]. Your care team will combine surgery with targeted therapies, radiation, and chemotherapy to create a comprehensive plan [3][4].

The Surgical Foundation

The “Extent of Resection” (EOR) refers to how much of the tumor the surgeon is able to remove. Removing a larger volume of the tumor is strongly linked to better survival and longer periods of time before the tumor grows back [5][6].

To navigate the complex landscape of the brain, surgeons use advanced technologies:

  • Awake Craniotomy: For tumors near eloquent areas (parts of the brain responsible for speech, movement, or vision), you may be gently awakened during surgery [7]. This allows the surgeon to map your brain in real-time, ensuring they don’t remove critical tissue [8].
  • 5-ALA (“The Pink Drink”): You may drink a special liquid before surgery that causes high-grade tumor cells to glow bright pink under a specific light [9]. This helps the surgeon distinguish between the tumor and healthy brain tissue [10].
  • Functional MRI (fMRI): This specialized scan maps brain activity before surgery to help the team plan the safest route to the tumor [11].

Standard Post-Surgical Care

The treatment path after surgery depends heavily on the grade and molecular profile of the tumor:

  • Grade 4 (Glioblastoma): The global standard of care for newly diagnosed glioblastomas is the Stupp Protocol [3]. This consists of Radiation Therapy (typically 30 sessions over six weeks) and Temozolomide (TMZ) (a chemotherapy pill taken daily) [12]. Following this, a device called Tumor Treating Fields (Optune) is often added [13]. Optune uses electric fields to disrupt cancer cell division; however, it requires the patient to maintain a completely shaved head and wear the arrays on their scalp for at least 18 hours a day [14][15].
  • Grade 2 and 3 Gliomas: For mid-grade tumors, treatment typically involves radiation combined with either TMZ or a different chemotherapy combination known as PCV [3]. Because treatments like TMZ or PCV can affect fertility, younger adult patients should proactively ask their doctors about fertility preservation options before beginning treatment.

New Targeted Options

The landscape for IDH-mutant gliomas changed significantly with the emergence of Vorasidenib [16].

  • What it is: An oral pill that specifically targets the mutated IDH protein [17].
  • The Impact: In clinical trials, it significantly delayed the time before the tumor began growing again in Grade 2 gliomas [16].
  • The Benefit: Because it is generally well-tolerated, it may allow some patients to delay more aggressive treatments like radiation or intensive chemotherapy for years [18][19].
  • Important Consideration: Patients on Vorasidenib require routine blood tests to monitor liver enzymes, as hepatic (liver) toxicity is a known but manageable side effect.

The Role of Clinical Trials

Because gliomas are complex, researchers are constantly searching for better “keys” to unlock new treatments. Clinical trials are not just a “last resort”; they are the primary way patients can access tomorrow’s therapies today [20].

  • Precision Medicine: Trials often target specific mutations found in your pathology report, such as BRAF or specific immune markers [21].
  • Innovative Approaches: From “cancer vaccines” to oncolytic viruses (viruses that kill cancer), trials offer paths beyond the current standard of care [22][23].
  • A “Trial-First” Mindset: Many specialists recommend looking for an available clinical trial at every major decision point in your care [24].

Return to Home

Common questions in this guide

What is maximal safe resection for a glioma?
Maximal safe resection is a surgical approach that aims to remove as much of the tumor as possible without damaging critical areas of the brain. Removing more of the tumor is strongly linked to better survival and longer periods before the tumor regrows.
What is an awake craniotomy and why is it used?
An awake craniotomy is a surgical technique used when a tumor is near areas of the brain that control essential functions like speech, movement, or vision. You are gently awakened during surgery so the surgeon can map your brain function in real-time and avoid removing healthy tissue.
What is the Stupp Protocol?
The Stupp Protocol is the global standard of care for newly diagnosed Grade 4 gliomas, also known as glioblastomas. It combines a course of radiation therapy with a daily chemotherapy pill called Temozolomide, which is often followed by the use of a wearable device called Optune.
How does Vorasidenib help treat IDH-mutant gliomas?
Vorasidenib is a targeted daily pill that blocks the mutated IDH protein found in certain gliomas. It has been shown to significantly delay tumor regrowth in Grade 2 gliomas, which may allow you to safely postpone more aggressive treatments like radiation or chemotherapy for years.
Should I consider a clinical trial for my glioma?
Because gliomas are highly complex tumors, clinical trials provide a way to access the newest precision medicines and innovative therapies before they are widely available. Many neuro-oncologists recommend exploring clinical trials at every major decision point in your treatment journey.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.What is the 'eloquence' of the area where my tumor is located, and how does that affect the surgery?
  2. 2.What specific surgical tools, like 5-ALA or awake mapping, do you recommend for my procedure?
  3. 3.Based on my molecular profile, is the Stupp Protocol the most appropriate next step, or should we consider a clinical trial?
  4. 4.Am I a candidate for Vorasidenib, and if so, how does that change the timing of radiation or chemotherapy?
  5. 5.How often will we need to monitor my progress with MRIs during and after treatment?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (24)
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    The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade III Cerebral Gliomas in Adults: Version 2019.01.

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This page provides general information about glioma treatment strategies. Always consult your neuro-oncologist and surgical team to determine the safest and most effective treatment plan for your specific tumor type and grade.

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