الملخص الإنجليزي
Advances in medical and surgical treatments in the last two to three decades have resulted in
quantum leaps in the overall survival of patients with many types of non-central nervous system (CNS) malignant
disease, while survival of patients with malignant gliomas (WHO grades 3 and 4) has only moderately improved.
Surgical resection, external fractionated radiotherapy and oral chemotherapy, during and after irradiation,
remain the pillars of malignant glioma therapy and have shown significant benefits. However, numerous clinical
trials with adjuvant agents, most of them administered systemically and causing serious complications and side
effects, have not achieved a noteworthy extension of survival, or only with considerable deterioration in patients'
quality of life. Significant attention was focussed in the last decades on the cell biology and molecular genetics of
gliomas. Improved understanding of the fundamental features of tumour cells has resulted in the introduction and
increasing clinical use of local therapies, which employ spatially defined delivery methods and tumour-selective
agents specifically designed to be used in the environment of a glioma-invaded brain. This review summarises the
key findings of some of the most recent and important clinical studies of locally administered novel treatments for
malignant glioma. Several such therapies have shown considerable anti-tumour activity and a favourable profile
of local and systemic side effects. These include biodegradable polymers for interstitial chemotherapy, targeted
toxins administered by convection enhanced delivery, and intra- and peritumourally injected genetically modified
viruses conferring glioma-selective toxicity. Areas of possible improvement of these therapies and essential future
developments are also outlined.
