The Role of Neoadjuvant Therapy to Improve the Extent of Resection in “Unresectable” Gliomas

• Published in: World neurosurgery Vol. 146; pp. 53 - 58
• Main Authors: Jacobo, Javier A., Mejia-Perez, Sonia, Moreno-Jimenez, Sergio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2021
• Subjects: Chemotherapy; Glioma; Neoadjuvant; Resection; Temozolomide; TMZ; PCV; Resection; GTR; OS; MRI; IDH1; Neoadjuvant; EOR; HGG; LGG; Chemotherapy; Glioma; BV; Temozolomide; GB; PFS; PD-1; WHO
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2020.10.109

Surgical resection plays a pivotal role in the management of glial tumors and a greater extent of resection (EOR) should be the goal in most surgeries to improve overall survival. Many factors may limit the EOR. A potential role for preoperative chemotherapy to decrease the volume and/or infiltration of gliomas, thereby facilitating a safe radical resection, has been recently suggested. This review aims to provide an overview of the current state of neoadjuvant therapy in the field of glioma surgery. A systematic review was conducted according to PRISMA guidelines to identify articles of low- and high-grade gliomas that received neoadjuvant chemotherapy prior to surgery to improve the EOR from 2000 to 2020. Full-text articles that addressed this subject were included for evaluation. Case reports and clinical trials have been published for the use of chemotherapy as a neoadjuvant therapy to improve surgical resection in low-grade gliomas. More scarce information exists regarding this strategy for high-grade glioma surgery. Neoadjuvant chemotherapy has played a role in overcoming obstacles that limit the EOR in patients with complex gliomas, especially low-grade gliomas.