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Local therapies for glioma: present status and future developments
  1. I R Whittle

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    Edited by M Westphal, C Tonn, Z Ram. Published by Springer Wien, New York, 2003, pp 176, €108 (hardback). ISBN 3-2-11-40355-8

    This small book, which is a supplement of Acta Neurochirurgica, represents the proceedings of a meeting held in Milan in 2003. It is organised by the EANS Neuro-oncology Executive, which is chaired by Professor Westphal. The point of the meeting was to describe the concepts and status of local therapies for glioma. Owing to the inevitable failure of surgery, chemotherapy, and external beam radiotherapy to prolong life in malignant gliomas, a great deal of research and pharmacological effort has been put into developing local therapies for gliomas.

    The rationale for placing compounds or therapies in the cavity created following resection of a glioma is reviewed in the editors’ preliminary remarks. Unfortunately, evaluating the effects of local therapies are also difficult because the therapy will induce radiological changes, which could be interpreted as reactivation of quiescent tumour. These difficulties in assessment are later discussed in a separate chapter. The first half dozen chapters cover current clinical investigation, management approaches, and assessment of gliomas with respect to state of the art technologies such as surgery incorporating image guided volumetric resection of gliomas, fluorescence guided resections, and experience with glioma surgery with intraoperative high field MRI, postoperative imaging after brain tumour resection, and the use of external beam conformal radiotherapy and interstitial stereotactic radiosurgery. These chapters are in a sense the ante pasta, because they set the scene for the latest novel local therapeutic approaches. They provide a solid, practical background for the subsequent chapters. The article on awake craniotomy in particular has thoughtful and useful information for those interested in the technique.

    A variety of local therapies are covered in subsequent chapters. Some of these are well known techniques that simply involve local deposition of a chemotherapeutic compound (for example implantable drug releasing biodegradable microspheres for local treatment of brain glioma and intracavity chemotherapy for glioblastoma; present status and further directions), which have already reached clinical practice after phase III trials. The particular difficulties with local gene therapy for gliomas are well covered in two succinct chapters, which are comprehensibly referenced. Other chapters describe novel approaches using specific techniques (for example non-invasive transcranial high intensity focused ultrasound (HIFUS) under MRI thermometry and guidance in the treatment of brain lesions; intralesional radioimmunotherapy in the treatment of malignant glioma, clinical and experimental findings; radioimmunotherapy targeting fibronectin; and comparing monoclonal antibodies and small peptidic hormones for local targeting of malignant gliomas). The use of convection enhanced delivery techniques are described for the delivery of IL4 pseudomonas exotoxin (NBI-3001) for treatment of patients with recurrent malignant glioma, together with interim findings from ongoing phase 1 studies of IL3-PE38QQR for treatment of the same condition.

    The remaining chapters reflect the editors’ particular interest in glioma cell invasion, the potential use of anti-angiogenic therapies, and stem cells in neuro-oncology. Pathophysiological advances in these areas could provide the basis for novel local therapies in the future.

    What does this book offer the neuro-clinician interested in oncology? Firstly, there are some good overviews of the current state of treatments, their evidence base, and the ways in which surgery and radiotherapy are likely to change in the not too distant future. The second group of chapters on true local therapies gives the reader an idea of the spectrum of current approaches, their biological basis, the simplicities and difficulties of their applications, and innovative thought of the developers.

    Overall this is a compact book that is well written. The authors represent their topics from an extremely practical viewpoint, being healthily critical about the difficulties confronting clinicians in malignant glioma management. All chapters are easy to read, well illustrated, and well referenced. For those interested in neuro-oncology it is a very useful reference source that covers a gamut of approaches, and overall has something for everyone interested in neuro-oncology. The editors are to be congratulated for their contributions, the selection of authors, focusing on this important and evolving area, and addressing it in a very practical, clinically orientated fashion.