Newly diagnosed high-grade gliomas.

OPINION STATEMENT: High-grade or malignant gliomas are aggressive cancers. The World Health Organization (WHO) grading system recognizes grade III and grade IV primary brain tumors of astrocytic, oligodendroglial, or mixed lineage. Identification of these tumors is prompted by symptoms such as insidious headaches, seizures, or focal weakness or numbness, with imaging findings of an enhancing mass lesion. Following surgery, radiation therapy has been known since the late 1970s to improve survival in malignant gliomas. More recently, the concurrent use of temozolomide (TMZ) and radiation therapy and the incorporation of bevacizumab have offered hope for patients with glioblastoma (WHO grade IV glioma). Although radiation is regularly used for up-front treatment of grade III gliomas, the role of chemotherapy is still being refined. In the past, patients with high-grade gliomas were often referred to a dedicated neuro-oncology center, but with improved outcomes and increased survival, these patients now are often treated by community oncologists. We believe substantial changes will develop with pending investigations that refine the dose and length of TMZ treatment, define specialized treatment for the elderly, and assess efficacy of bevacizumab in up-front therapy. The field is also conducting the required studies to define the role of chemotherapy for grade III malignant gliomas. These promising advances are needed as most patients with high-grade gliomas still succumb to their disease.