Glioma Treatment Options: How Doctors Decide What’s Next

“The data has shown that the best outcomes happen when patients get a maximum safe resection [removal of the tumor],” Dr. Prashant Vempati, a neuro-oncologist at UH Seidman Cancer Center in Cleveland, Ohio, tells SurvivorNet. “So, a good surgery where they’re able to take most of the tumor out without causing too many side effects for the patient, followed by radiation and chemotherapy together for six weeks, followed by more chemotherapy.”

Currently, the treatment modalities for glioma include surgery, radiation therapy, chemotherapy, and targeted therapies.

Grade alone isn’t the whole picture when it comes to making treatment decisions. In recent years, doctors have increasingly relied on molecular and genetic tests to understand a tumor’s unique biology. Markers like a mutation in something known as the IDH may indicate that a patient is more likely to respond to a specific treatment approach.

Treatment Choice For Lower-Grade Gliomas 

Surgical resection remains a key component of therapy. Neurosurgeons typically aim to remove as much of the tumor as they can without damaging healthy tissue that controls speech, movement, or other essential functions. Extensive resection often correlates with better long-term outcomes, but each surgical decision must be individualized.

The next step, following surgery recovery, is often radiation therapy. The addition of chemotherapy in this scenario is not mandatory, and the medical team will weigh in on the need for it according to each case.

“For lower-grade gliomas, for grade II or so, we usually do end up doing the maximum safe resection, so the best surgery a patient can have followed by radiation therapy, and sometimes we add systemic therapy [chemotherapy] … either with the radiation or after the radiation,” explains Dr. Vempati.

Making Individual Treatment Choices

Interestingly, he also goes on to say how important it is to consider each patient as unique and think in terms of long-term outcomes with each decision made. For some patients, a new drug called vorasidenib, an IDH inhibitor, may be the best treatment option after surgery.

“I use that as, especially in my younger patients, where I can delay the radiation in turn, delay the long-term side effects of radiation,” Dr. Vempati explains.

Vorasidenib targets IDH mutations in gliomas. These mutations are common in low-grade, slow-growing gliomas, and they play a key role in tumor development.

Recent studies regarding this drug have come out in the past year and show a promising and powerful choice for patients with low-grade tumors. The drug allows some patients to put off getting radiation.

“Vorasidenib is a drug that can stop the cancer from growing, but eventually patients will need some kind of radiation which kills the cancer cells,” Dr. Vempati explains.

“Some patients are young, and their brains are still developing, and delaying radiation for another five or 10 years might give their brains the time to develop and have fewer side effects long term.”

Treatment Choice For High-Grade Gliomas

Moving into high-grade territory, Grade III and IV gliomas are malignant and grow faster than low-grade tumors. These tumors require quick management, and surgery is still the standard approach whenever possible.

In specific situations where removal is not possible due to the tumor’s invasive nature, every effort is made to reduce its mass. A thorough surgical resection helps alleviate immediate symptoms — such as headache or neurological deficits caused by pressure in the brain — and aids in confirming the exact diagnosis and molecular characteristics. Combined radiation and chemotherapy typically follows surgery.

A doctor’s treatment choice for managing glioma is not one size fits all. Instead, physicians follow certain official guidelines, but they also customize these guidelines to your specific situation.

It is strongly encouraged to ask about clinical trials as this could be a first consideration that one could explore with larger cancer centers in particular with a portfolio of options in many cases.

To sum up, doctors make treatment recommendations for glioma patients based on several factors, including:

• Location and Extent of Your Tumor: Tumors near vital areas of the brain may limit surgical options or affect how radiation is delivered.
• Genetic and Molecular Profiles: IDH mutations, 1p/19q codeletions, and MGMT methylation guide chemotherapy choices and predict responses to certain drugs.
• Previous Treatments: If a glioma recurs after initial therapy, doctors may adjust the treatment plan to address any changes in the tumor’s behavior or characteristics.
• Overall Health and Lifestyle: Your daily activities, general fitness, and personal preferences shape how aggressive or conservative your treatment approach might be.

By integrating all these variables, your care team aims for a plan that maximizes tumor control and symptom relief while supporting your quality of life.

Questions To Ask Your Doctor

• How does my tumor’s specific grade and genetic profile affect the treatments you’re recommending?
• What can I expect in terms of side effects or recovery time for the therapies you’ve proposed?
• Are there any clinical trials or emerging treatments that could be right for my type of glioma?

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