Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jul 2012
ReviewPassive immunotherapeutic strategies for the treatment of malignant gliomas.
This review provides historical and recent perspectives related to passive immunotherapy for high-grade gliomas. The authors discuss approaches that use lymphokine-activated killer cells, cytotoxic T lymphocytes, and monoclonal antibodies.
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Neurosurg. Clin. N. Am. · Jul 2012
ReviewUse of language mapping to aid in resection of gliomas in eloquent brain regions.
Studies looking at resection in high-grade gliomas have had mixed results. The authors briefly review the literature regarding the value of the extent of resection. They proceed to the preoperative and intraoperative tools available to the neurosurgeon to distinguish eloquent from noneloquent language cortex and fibers, including the emerging roles of functional magnetic resonance imaging diffusion tensor imaging tractography and direct cortical/subcortical stimulation in the surgical management of tumors in eloquent areas. Finally, the authors evaluate the postoperative course of these patients and the effect of language deficits on their quality of life.
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Novel immunotherapeutic modalities are being pursed in the treatment of high-grade gliomas. This article explains how tumors suppress immune function in the brain. ⋯ It also defines 3 different immunotherapeutic approaches to counteract this tumor-associated immunosuppression: cytokine therapy, passive immunotherapy (either serotherapy or adoptive immunotherapy), and active immunotherapy. Although immunotherapeutic approaches have met with mixed success so far, immunotherapy continues to be actively pursued because of its potential to attack infiltrating high-grade gliomas.
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High-grade gliomas (HGGs) are malignant tumors and typically include glioblastoma multiforme and anaplastic astrocytoma subtypes. Brainstem gliomas and ependymomas are separate entities with respect to clinical presentation, treatment, prognosis, and outcome in comparison with supratentorial HGGs. ⋯ These neoplasms are highly proliferative and mitotically active and of glial origin. This article reviews clinical, diagnostic, and pathologic features of HGG and current treatments and potential future therapies specific to pediatric patients with HGGs.
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High-grade glioma continues to impart poor prognosis in spite of maximal treatment. Attempted gross total surgical resection followed by concurrent temozolomide and radiation therapy has become standard of care for glioblastoma. Ongoing clinical efforts have been directed at the further development of radiosensitizing agents that exploit tumor biology to maximize effects of concurrently administered radiation. The current article outlines the scientific rationale for the use of radiosensitizing agents and preliminary results from clinical trials using a variety of these approaches.