TY - JOUR
T1 - Local therapy in glioma: An evolving paradigm from history to horizons (Review)
AU - Ius, Tamara
AU - Somma, Teresa
AU - Pasqualetti, Francesco
AU - Berardinelli, Jacopo
AU - Vitulli, Francesca
AU - Caccese, Mario
AU - Cella, Eugenia
AU - Cella, Elisa
AU - Cenciarelli, Carlo
AU - Pozzoli, Giacomo
AU - Sconocchia, Giuseppe
AU - Zeppieri, Marco
AU - Gerardo, Caruso
AU - Caffo, Maria
AU - Lombardi, Giuseppe
AU - Lombardi, Gaia Surya
PY - 2024
Y1 - 2024
N2 - Despite the implementation of multimodal treatments after surgery, glioblastoma (GBM) remains an incurable disease, posing a significant challenge in neuro‑oncology. In this clinical setting, local therapy (LT), a developing paradigm, has received significant interest over time due to its potential to overcome the drawbacks of conventional therapy options for GBM. The present review aimed to trace the historical development, highlight contemporary advances and provide insights into the future horizons of LT in GBM management. In compliance with the Preferred Reporting Items for Systematic Review and Meta‑Analysis Protocols criteria, a systematic review of the literature on the role of LT in GBM management was conducted. A total of 2,467 potentially relevant articles were found and, after removal of duplicates, 2,007 studies were screened by title and abstract (Cohen's κ coefficient=0.92). Overall, it emerged that 15, 10 and 6 clinical studies explored the clinical efficiency of intraoperative local treatment modalities, local radiotherapy and local immunotherapy, respectively. GBM recurrences occur within 2 cm of the radiation field in 80% of cases, emphasizing the significant influence of local factors on recurrence. This highlights the urgent requirement for LT strategies. In total, three primary reasons have thus led to the development of numerous LT solutions in recent decades: i) Intratumoral implants allow the blood‑brain barrier to be bypassed, resulting in limited systemic toxicity; ii) LT facilitates bridging therapy between surgery and standard treatments; and iii) given the complexity of GBM, targeting multiple components of the tumor microenvironment through ligands specific to various elements could have a synergistic effect in treatments. Considering the spatial and temporal heterogeneity of GBM, the disease prognosis could be significantly improved by a combination of therapeutic strategies in the era of precision medicine.
AB - Despite the implementation of multimodal treatments after surgery, glioblastoma (GBM) remains an incurable disease, posing a significant challenge in neuro‑oncology. In this clinical setting, local therapy (LT), a developing paradigm, has received significant interest over time due to its potential to overcome the drawbacks of conventional therapy options for GBM. The present review aimed to trace the historical development, highlight contemporary advances and provide insights into the future horizons of LT in GBM management. In compliance with the Preferred Reporting Items for Systematic Review and Meta‑Analysis Protocols criteria, a systematic review of the literature on the role of LT in GBM management was conducted. A total of 2,467 potentially relevant articles were found and, after removal of duplicates, 2,007 studies were screened by title and abstract (Cohen's κ coefficient=0.92). Overall, it emerged that 15, 10 and 6 clinical studies explored the clinical efficiency of intraoperative local treatment modalities, local radiotherapy and local immunotherapy, respectively. GBM recurrences occur within 2 cm of the radiation field in 80% of cases, emphasizing the significant influence of local factors on recurrence. This highlights the urgent requirement for LT strategies. In total, three primary reasons have thus led to the development of numerous LT solutions in recent decades: i) Intratumoral implants allow the blood‑brain barrier to be bypassed, resulting in limited systemic toxicity; ii) LT facilitates bridging therapy between surgery and standard treatments; and iii) given the complexity of GBM, targeting multiple components of the tumor microenvironment through ligands specific to various elements could have a synergistic effect in treatments. Considering the spatial and temporal heterogeneity of GBM, the disease prognosis could be significantly improved by a combination of therapeutic strategies in the era of precision medicine.
KW - brachytherapy
KW - carmustine wafer
KW - convection enhanced delivery
KW - glioblastoma
KW - thermotherapy
KW - immunotherapy
KW - local therapy
KW - photodynamic therapy
KW - high‑ grade gliomas
KW - brachytherapy
KW - carmustine wafer
KW - convection enhanced delivery
KW - glioblastoma
KW - thermotherapy
KW - immunotherapy
KW - local therapy
KW - photodynamic therapy
KW - high‑ grade gliomas
UR - http://hdl.handle.net/10807/297999
U2 - 10.3892/ol.2024.14573
DO - 10.3892/ol.2024.14573
M3 - Article
SN - 1792-1074
VL - 28
SP - N/A-N/A
JO - Oncology Letters
JF - Oncology Letters
ER -