Introduction

Article Outline

• Copyright

This issue of Seminars in Radiation Oncology highlights a number of important clinical and preclinical advancements in the management of patients with high-grade gliomas. Because of the recent progress in the imaging of these tumors, pathologic evaluation with molecular analysis, and systemic therapy, the standard of care for this disease has changed with encouraging results. The articles in this issue have been written by noted authorities and provide a comprehensive and current discussion of the issues involved in managing these complicated patients.

The first article discusses the importance of pathologic evaluation. With the inclusion of molecular biomarkers (ie, O-6-methylguanine-DNA methyltransferase [MGMT]), the stratification and staging of these patients is becoming more accurate and perhaps more complex. The second article in this issue discusses the use of temozolomide in combination with radiotherapy and the efficacy of the combination based on MGMT status. It also describes the use of novel agents in the clinic and the rich pipeline of drugs that are being tested for use in patients with these tumors. In the next article, molecular imaging is highlighted as a method to add to our understanding as well as to the complexity of the patient with a high-grade glioma.

The next 2 articles describe work being performed in the laboratory and early clinical trials. The first focuses on the tumor cell as the target for combination therapy, and the second focuses on the microenvironment as the target for therapy. It is likely that the next breakthrough in this disease will come from the important work being performed in multiple laboratories around the world. The penultimate article discusses the “newest” technologies that are available to treat these patients as well as a critical evaluation of the benefit of these technologies in this group of patients. Because no review would be complete without an article on the effects of our therapy on normal tissues, the last article describes the information we possess about early and late toxicity of combination therapy.

I would like to thank Joel Tepper and the editorial board for giving me the chance to work with the knowledgeable authors who prepared the articles in this issue of the journal. I hope you find it as rewarding as I have.