Overview
Malignant gliomas are aggressive primary brain tumors arising from glial cells, predominantly affecting adults and characterized by rapid progression and poor prognosis despite treatment advances. 1234Diagnosis
Imaging: MRI is essential for diagnosis, delineating tumor extent and location. 123
Biopsy: Histological examination confirms malignancy and grading (WHO classification). 123
Fluorescence-guided surgery: 5-ALA can enhance visualization of tumor margins intraoperatively. 5
Grading: Based on WHO criteria (I-IV), with high-grade gliomas (III-IV) being malignant. 123Management
First-line treatment: Temozolomide (TMZ) chemotherapy is standard for newly diagnosed glioblastoma (GBM). 1
Radiation therapy: Concurrent with TMZ for initial management of GBM. 12
Surgical resection: Maximal safe resection improves survival and is often combined with adjuvant therapies. 25
Adjunctive therapies: Sonodynamic therapy (SDT) using focused ultrasound and 5-ALA shows promise in preclinical studies for enhancing treatment efficacy with minimal normal tissue damage. 2
Palliative care: Early integration recommended to manage symptoms and improve quality of life. 34Special Populations
Palliative care: Older age, female sex, higher education, white race, and lower income correlate with higher hospice enrollment, suggesting potential disparities in end-of-life care access. 3
Elderly: No specific guidelines provided in abstracts; however, palliative care integration is crucial given their higher symptom burden and potential for poorer outcomes. 4Key Recommendations
Utilize temozolomide as first-line chemotherapy for newly diagnosed glioblastoma, supported by extensive real-world safety data. (Evidence: Strong 1)
Integrate palliative care early in the disease course to manage symptoms effectively and improve quality of life, particularly in patients with significant symptom burden. (Evidence: Moderate 34)
Consider sonodynamic therapy as a potential adjunctive treatment modality, especially in settings where advanced imaging and focused ultrasound are available, based on promising preclinical results. (Evidence: Weak 2)References
1 Lin Y, Deng M, Xu S, Chen C, Ding J, Ding J. Post-Marketing Safety of Temozolomide: A Pharmacovigilance Study Based on the Food and Drug Administration Adverse Event Reporting System. Oncology 2025. link
2 Yoshida M, Kobayashi H, Terasaka S, Endo S, Yamaguchi S, Motegi H et al.. Sonodynamic Therapy for Malignant Glioma Using 220-kHz Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound and 5-Aminolevulinic acid. Ultrasound in medicine & biology 2019. link
3 Forst D, Adams E, Nipp R, Martin A, El-Jawahri A, Aizer A et al.. Hospice utilization in patients with malignant gliomas. Neuro-oncology 2018. link
4 Sundararajan V, Bohensky MA, Moore G, Brand CA, Lethborg C, Gold M et al.. Mapping the patterns of care, the receipt of palliative care and the site of death for patients with malignant glioma. Journal of neuro-oncology 2014. link
5 Ewelt C, Stummer W, Klink B, Felsberg J, Steiger HJ, Sabel M. Cordectomy as final treatment option for diffuse intramedullary malignant glioma using 5-ALA fluorescence-guided resection. Clinical neurology and neurosurgery 2010. link
6 Gantt JS, Key JL. Molecular cloning of a pea H1 histone cDNA. European journal of biochemistry 1987. link
7 Nittner K. Surprise finding 5 years after stereotactic amygdalotomy. Applied neurophysiology 1978. link