The Role of Radiotherapy and Chemotherapy in the Treatment of Primary Adult High Grade Gliomas: Assessment of Patients for These Treatment Approaches and the Common Immediate Side Effects
Gliomas are the commonest primary brain tumours in adults. They are usually classified and graded according to the criteria by the World Health Organisation. High-grade gliomas are the most malignant primary brain tumours. Conventional therapies include surgery, radiotherapy, and chemotherapy. The tumours often demonstrate high levels of resistance to these conventional therapies, and in spite of treatment advances the prognosis remains poor. 1. Introduction Primary brain tumours are tumours that arise within the brain tissue and the environs while secondary tumours originate from elsewhere in the body and spread to the brain [1]. The main functional cell of the brain is called the neuron, while glial cells make up the supporting structures. These glial cells are of different types, namely, the oligodendrocytes which make myelin, astrocytes which take part in neurotransmission and neuronal metabolism, and the ependyma cells which line the ventricles and central canal of the spinal cord. Tumours arising from glial cells are called gliomas. These tumours are the most frequent primary tumours of the central nervous system [2, 3]. The World Health Organisation (WHO) classifies astrocytomas into four grades, depending on the microscopic pattern of the tumour, which include increased cellularity, nuclear atypia, mitosis, and vascular proliferation/necrosis. The different characteristics demonstrate the invasiveness and rate of growth of the various grades. WHO Grade I (Pilocytic astrocytoma) is that which does not demonstrate any of the microscopic patterns. WHO Grade II (diffuse astrocytoma) is characterized by only atypia. WHO Grade III (anaplastic astrocytoma) shows both atypia and mitosis. WHO Grade IV (glioblastoma multiforme) shows areas of necrosis and/or vascular proliferation [1, 4]. The tumours in WHO Grades I and II are referred to as low-grade gliomas while those in grades III and IV are called high-grade gliomas (HGG). By far, the HGG are the commonest primary brain tumours in adults [5, 6]. They can develop de novo or result from a progression of the low-grade gliomas [7–9]. Seventy percent of the 22,500 new cases of malignant primary brain tumours diagnosed in adults in the United States are due to HGG exhibiting an incidence of 5 per 100,000/per year [4, 10]. The most common type of HGG is glioblastoma accounting for 80% of the malignant gliomas while the Oligodendrogliomas constitute about 20% of glial tumours [11]. Males are more frequently affected than females with a ratio of 3？:？2 [3, 11]. A possible protective effect of the female
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