Medical treatment of high grade malignant gliomas in adults: an overview.

Cure of high grade malignant gliomas is seldom possible with surgery and adjuvant radiotherapy as first line treatment, so many trials have been carried out with adjuvant chemotherapy. During the last decade, clinical studies with immunotherapy in recurrent gliomas have been added to the therapeutic regimens. We made an extensive search of the literature on chemotherapy and immunotherapy of high grade malignant gliomas up to 1 January 1990. The median survival time (MST) of surgery and adjuvant radiation is about 35 weeks. Adjuvant single-agent chemotherapy extends the MST by some 15 weeks. Combination-agent chemotherapy did not achieve better results than single agents. Of the cytotoxic agents, the nitrosureas have been most extensively tested. Immunotherapy is in an early stage of clinical testing: however, very recent trials show promising results, especially those which make use of monoclonal antibodies for targeting therapeutics. In the future a combination of chemotherapy and immunotherapy might offer a better outcome in this malignancy.