Recent advances in the treatment of gliomas : The multimodal care therapy / Omar Ibrahim Mohamed Ibrahim ; Supervised Mohamed Hafez Ramadan , Helmy Abdelalim Eldessouky , Hussein Elmaghraby

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Background: GBM is the most devastating primary malignancy of the central nervous system in adults. Currently, standard treatment consists of maximal safe surgical resection followed by radiotherapy (60 Gray) with concomitant daily temozolomide chemotherapy. Low-grade gliomas (LGGs) constitute approximately 15% of the nearly primary brain tumours diagnosed in adults each year. Extent of tumour resection has become a strong predictor of patient outcomes, alongside patient age, performance status, tumour histology, and molecular genetics (isocitrate dehydrogenase-1 and 1p/19q co-deletion status). Over the past two decades, surgeons have emphasized the importance of maximizing extent of resection and its impact on overall survival, progression-free survival, and time to malignant transformation. Methods: This is a Prospective analysis of 50 patients diagnosed with gliomas are enrolled in a joint supervision between Kasr Al Aini Hospital, Cairo University, Egypt and Coventry University Hospitals, England. Results: The study included 50 patients, 31 males and 19 females, ages ranged from 21 to 75 years (mean age 47.5 years). Gross total resection was achieved in 28 patients (56%). The most common surgical complication in our series was postoperative transient weakness in 4 patients (8%). Mean true survival of low-grade glioma patients was 40.5 months while the mean true survival for anaplastic astrocytoma (grade 3) patients was 38 months and that of GBM (grade 4) patients was 18.8 months. Conclusion: Despite persistent limitations in the quality of data, mounting evidence suggests that more extensive surgical resection is associated with longer life expectancy for both low- and high-grade gliomas

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