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New Treatments for Malignant Gliomas: Careful Evaluation and Cautious Optimism Required

Mark R. Gilbert, MD
[+] Article and Author Information

From The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030.


Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Mark R. Gilbert, MD, Department of Neuro-oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030; e-mail, mrgilbert@mdanderson.org.


Ann Intern Med. 2006;144(5):371-373. doi:10.7326/0003-4819-144-5-200603070-00015
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The treatment of patients with glioblastoma is a showcase for improved technology in many disciplines of medicine. Imaging technology has improved substantially, leading to more accurate and rapid diagnosis; better anatomic localization, which leads to improvements in neurosurgical results; and earlier detection of recurrent or relapsing disease. Surgical techniques have improved with better tumor delineation, which results in a higher percentage of patients having what seems to be complete tumor resection while maintaining or even improving neurologic function. Radiation therapy has also improved, beginning with the recognition that regional treatment is better than whole-brain radiation for most malignant primary brain tumors. Technological advances, such as conformal radiation and intensity-modulated radiation therapy, have resulted in more accurate delivery of treatment and therefore less collateral damage to normal neuronal structures. Many new chemotherapeutic agents have been developed and tested, and multicenter clinical trial groups have formed. However, until very recently, chemotherapy did not substantially improve outcomes when added to the other treatment methods.

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