Novel Focal Treatment Modalities in Glioma Management

Malignant gliomas, including glioblastomas (GBMs) and anaplastic astrocytomas (AAs), remain difficult to treat. Overall prognosis for patients harboring these tumors is poor despite maximal surgical resection with appropriate chemotherapy and radiation. Here we outline several novel treatment modalities for focal control of malignant gliomas. The first set of therapies described rely on bypassing the blood brain barrier (BBB) to better deliver chemotherapeutics directly to the tumor and tumor cells infiltrating into the brain parenchyma. These include convection-enhanced drug delivery, intra-arterial (IA) chemotherapy, focused ultrasound, and laser interstitial thermal therapy. Another modality that has shown promising tumor control is tumor treatment fields therapy, which disrupts tumor mitosis and has increased survival in some studies. We also discuss the challenges associated with these treatments and examine the future of these and other glioma management strategies.