Abstract
Gliomas are the most common primary malignancies of central nervous system. Progress in neuroradiology with use of magnetic resonance imaging allows establishing diagnosis in earlier when an opportune treatment can be perfformed. Even though prognosis is poor for this group of patients, evidence has showed that treatments with surgery, radiotherapy and chemotherapy have a significant impact in quality of life and survival.
Chemotherapy by temozolomide is indicated in the treatment of glioblastoma associated to surgery and radiotherapy. In anaplastic astrocytomas, anaplastic oligodendrogliomas and oligoastrocytomas chemotherapy is a second line therapy if tumor progression after surgery and radiotherapy has occurred. Although their high malignancy grades these tumors have a relative sensibility to chemotherapy. Molecular genetics of grade III gliomas allow establishing good prognosis factors of response to chemotherapy. The 1p19q deletion in oligodendroglioma and oligoastrocitomas and the inhibition of protein methylguanin-methyltransferase in glioblastomas are associated with better prognosis. Chemotherapy in grade II gliomas as alternative to radiotherapy in non operable tumors is a subject of current clinical research. Temozolomide had showed to be effective in reducing size tumor and delaying progression to higher malignancy grades. Bevacizumab is a monoclonal antibody targeted against the endothelial growth factor receptor that have demonstrated efficacy in the treatment of recurrent glioblastomas. At present this therapy represents one of the most hopeful approaches to high grade gliomas and current clinical essays might found its place as a first line of chemotherapy in this group of patients. The aim of this review is to resume the main aspects in classification, radiological aspects and most useful treatment used in patient affected by gliomas.
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