Dr Merrell on Current Treatment Modalities for Gliomas

“For most of the malignant gliomas, radiation has been shown to be effective and still is considered a gold standard, especially in high grade gliomas such as glioblastoma and [other] grade 3 tumors.”

Ryan T. Merrell, MD, an associate professor of neurology and chief of the Neuro-Oncology Division at Vanderbilt-Ingram Cancer Center, discussed current treatment modalities for gliomas in recognition of Brain Tumor Awareness Month, emphasizing the standard therapeutic approach for both low-grade and high-grade disease.

For malignant gliomas, particularly grade 3 tumors and glioblastoma, radiation therapy remains a foundational component of treatment and continues to be regarded as a gold standard for this patient population, Merrell explained. The current standard of care for glioblastoma involves concurrent chemoradiotherapy with intensity-modulated radiation therapy (IMRT) administered, and patients receiving chemoradiation can also be administered daily temozolomide. This regimen is typically followed by temozolomide as monotherapy. Temozolomide an oral alkylating agent and remains the most widely used chemotherapy in this setting due to its favorable penetration across the blood-brain barrier and manageable toxicity profile.

Surgical resection also remains a critical initial step in the management of gliomas across all grades, Merrell said. He emphasized that achieving maximal safe resection is a consistent and independent prognostic factor to improve both overall and progression-free survival, irrespective of tumor grade. The extent of resection is particularly relevant in high-grade gliomas, where minimizing residual tumor burden before adjuvant therapy is associated with improved clinical outcomes.

For lower-grade gliomas, treatment strategies are more nuanced and often tailored based on molecular markers, patient age, performance status, and extent of resection. Observation may be appropriate in select low-risk cases, and higher-risk patients may undergo postoperative radiation with or without chemotherapy.