title: [Current concepts in Neuro-Oncology].
abstract: Over the last decade, understanding of gliomas on a molecular level has greatly expanded This update briefly reviews the potential utility of molecular markers in refining diagnosis, prognosis, and treatment decisions, focussing on 1p/19q co-deletion, MGMT promoter methylation, EGFR mutations, and IDH 1/2 mutation. In the past, clinicians relied primarily on clinical factors such as age, Karnofsky performance status and extent of resection to inform prognosis. These para-meters and others have been used to identify prognostically distinct classes using recursive partitioning analysis (RPA) for patients with anaplastic astrocytomas and glioblastomas. They have been proven useful and were validated by subsequent glioma trials both at dia-gnosis and recurrence. Today clinical trials incorporate molecular information, either as stratification factors to balance treatment arms in randomized studies, or as eligibility criteria. Currently two markers are recommended to guide a clinician in deciding treatment: LOH 1p 19q in WHO III glioma defines a subgroup which should be treated with postoperative chemotherapy and radiation therapy and the methylation of the MGMT gene promoter is predictive for chemotherapy in elderly patients with a glioblastoma. Neuroimaging as the basic tool to diagnose a glioma and monitor treatment response during the course of the disease has markedly evolved. Conventional T1 sequences with and without contrast and T2/FLAIR sequences still remain the gold standard to delineate a new lesion and inform about criteria of malignancy. During treatment, advanced MRI techniques and PET imaging are being incorporated and explored to reflect metabolic activity of a lesion.
authors.affiliation: Klinik für Onkologie, UniversitätsSpital Zürich.
authors.forename: S
authors.initials: S
authors.lastname: Hofer
mesh_terms: D001932:Brain Neoplasms / Q000628:therapy; D005910:Glioma; D006801:Humans; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011401:Promoter Regions, Genetic