Treatment of malignant glioma: a problem beyond the margins of resection

The treatment of malignant glioma remains problematic. Surgical removal fol lowed by external beam irradiation represents a standard treatment that has demonstrated a prolonged time to progression and survival. However, the ca pacity to locally invade normal brain invariably leads to formation of a re current tumor most often immediately adjacent to the site of resection, Thi s clinical everyday experience prompts the hypothesis that improved local c ontrol of the tumor may translate into a delayed time to progression and po ssibly survival, specifically because systemic chemotherapy for most of the se tumors has failed to significantly improve survival. Local treatment str ategies including chemotherapy, gene therapy, and immunotherapy are rapidly developing and progressing to clinical trials. Several theoretical conside rations suggest that these approaches may be promising in the treatment of brain tumors.