Local therapy in glioma: An evolving paradigm from history to horizons (Review)

Ius,Tamara; Somma,Teresa; Pasqualetti,Francesco; Berardinelli,Jacopo; Vitulli,Francesca; Caccese,Mario; Cella,Eugenia; Cenciarelli,Carlo; Pozzoli,Giacomo; Sconocchia,Giuseppe; Zeppieri,Marco; Gerardo,Caruso; Caffo,Maria; Lombardi,Giuseppe

doi:10.3892/ol.2024.14573

Local therapy in glioma: An evolving paradigm from history to horizons (Review)

Authors:
- Tamara Ius
- Teresa Somma
- Francesco Pasqualetti
- Jacopo Berardinelli
- Francesca Vitulli
- Mario Caccese
- Eugenia Cella
- Carlo Cenciarelli
- Giacomo Pozzoli
- Giuseppe Sconocchia
- Marco Zeppieri
- Caruso Gerardo
- Maria Caffo
- Giuseppe Lombardi
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Affiliations: Unit of Neurosurgery, Head‑Neck and Neurosciences Department, University Hospital of Udine, I-33100 Udine, Italy, Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Federico II University, I-80128 Naples, Italy, Division of Radiation Oncology, Pisa University Hospital, I-56123 Pisa, Italy, Medical Oncology 1, Veneto Institute of Oncology‑IRCCS, I-35128 Padua, Italy, Institute of Translational Pharmacology, National Research Council, I-00133 Roma, Italy, Section of Pharmacology, Department of Healthcare Surveillance and Bioethics, Catholic University Medical School, Fondazione Policlinico Universitario A. Gemelli IRCCS, I-00168 Rome, Italy, Department of Ophthalmology, University Hospital of Udine, I-33100 Udine, Italy, Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University Hospital of Messina, I-98125 Messina, Italy
Published online on: July 17, 2024 https://doi.org/10.3892/ol.2024.14573
Article Number: 440
Copyright: © Ius et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Despite the implementation of multimodal treatments after surgery, glioblastoma (GBM) remains an incurable disease, posing a significant challenge in neuro‑oncology. In this clinical setting, local therapy (LT), a developing paradigm, has received significant interest over time due to its potential to overcome the drawbacks of conventional therapy options for GBM. The present review aimed to trace the historical development, highlight contemporary advances and provide insights into the future horizons of LT in GBM management. In compliance with the Preferred Reporting Items for Systematic Review and Meta‑Analysis Protocols criteria, a systematic review of the literature on the role of LT in GBM management was conducted. A total of 2,467 potentially relevant articles were found and, after removal of duplicates, 2,007 studies were screened by title and abstract (Cohen's κ coefficient=0.92). Overall, it emerged that 15, 10 and 6 clinical studies explored the clinical efficiency of intraoperative local treatment modalities, local radiotherapy and local immunotherapy, respectively. GBM recurrences occur within 2 cm of the radiation field in 80% of cases, emphasizing the significant influence of local factors on recurrence. This highlights the urgent requirement for LT strategies. In total, three primary reasons have thus led to the development of numerous LT solutions in recent decades: i) Intratumoral implants allow the blood‑brain barrier to be bypassed, resulting in limited systemic toxicity; ii) LT facilitates bridging therapy between surgery and standard treatments; and iii) given the complexity of GBM, targeting multiple components of the tumor microenvironment through ligands specific to various elements could have a synergistic effect in treatments. Considering the spatial and temporal heterogeneity of GBM, the disease prognosis could be significantly improved by a combination of therapeutic strategies in the era of precision medicine.

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