Glioma

Treatment of glioma

Gliomas are treated with a combination of surgery, radiotherapy, and chemotherapy. Of these, surgery is the basis of all treatment, as it is not only used to determine the type of tumor, but also the most effective method in terms of removing as much of the tumor as possible. In almost all cases, however, it is impossible to remove a glioma entirely, as distinguishing the boundary with healthy brain tissue is difficult (see illustration). This is because glioma usually infiltrates into surrounding healthy brain tissues. In advanced tumors, the amount of tumor that can be removed correlates strongly with survival time, and removing as much of it as possible is important.

Tokai University Hospital is one of the few hospitals worldwide to use MRI during brain tumor surgery, enabling this operation to be performed safely and reliably. We have also introduced an image navigation system and fluorescent tumor labeling (also called "vital staining" of the tumor) used during the surgery for sequential surgical removal of the tumor. However, simply removing as much of the tumor as possible is not enough; tumor removal cannot be permitted to damage basic nerve function. Glioma surgery at Tokai University Hospital therefore proceeds according to the policy of removing as much of the tumor as possible without causing severe neurological damage. We use techniques such as electroencephalography during surgery, and if necessary may talk to the patient during the operation to monitor language function.

Unfortunately, even if as much of the tumor as possible has been surgically removed, fragments of glioma remain hidden somewhere in the brain in most cases. Such residual tumor is treated with radiotherapy and chemotherapy. The standard therapy for advanced glioma currently consists of 6 weeks of radiotherapy (once daily, 5 days a week) combined with an oral medication called Temodar. Radiotherapy may be used over a somewhat wider area or confined to a narrow area (see illustration).

In either case, the introduction of MRI during surgery by Tokai University Hospital has improved the tumor removal rate by 10%, resulting in longer survival times. The average survival period for this tumor is short, however, meaning that we try to provide each patient with an individually tailored, well-balanced treatment that is best for them and prioritizes their quality of life.

[ Infiltration of the tumor ]

M Matsumae. Understanding the tumor. Clinical study. Vol 29, No. 14, 2008
Medical Friend Co. Ltd. Illustrator Kitahara Isao

[ Images of the stereotactic radiotherapy ]

M Matsumae. Understanding the tumor. Clinical study. Vol 29, No. 14, 2008
Medical Friend Co. Ltd. Illustrator Kitahara Isao

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