title: [Management of gliomas].
abstract: Gliomas are the most frequent primary brain tumors. Their care is difficult because of the proximity of organs at risk. The treatment of glioblastoma includes surgery followed by chemoradiation with the protocol of Stupp et al. The addition of bevacizumab allows an increase in progression-free survival by 4 months but it does not improve overall survival. This treatment is reserved for clinical trials. Intensity modulation radiotherapy may be useful to reduce the neurocognitive late effects in different types of gliomas. In elderly patients an accelerated radiotherapy 40 Gy in 15 fractions allows a similar survival to standard radiotherapy. O(6)-methylguanine-DNA methyltransferase (MGMT) status may help to choose between chemotherapy and radiotherapy. There is no standard for the treatment of recurrent gliomas. Re-irradiation in stereotactic conditions allows a median survival of 8 to 12.4 months. Anaplastic gliomas with 1p19q mutation have a greater sensibility to chemotherapy by procarbazine, lomustine and vincristine. Chemoradiotherapy in these patients has become the standard treatment. Many studies are underway testing targeted therapies, their place in the therapeutic management and new radiotherapy techniques.
authors.affiliation: Service de radiothérapie oncologique, centre Henry-Kaplan, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnelé, 37000 Tours, France.
authors.forename: S
authors.initials: S
authors.lastname: Lévy
authors.affiliation: Service de radiothérapie oncologique, centre Henry-Kaplan, université François-Rabelais, CHRU de Tours, 2, boulevard Tonnelé, 37000 Tours, France.
authors.forename: S
authors.initials: S
authors.lastname: Chapet
authors.affiliation: Service de radiothérapie oncologique, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex, France; Université Paris VI, 75651 Paris cedex, France. Electronic address: jean-jacques.mazeron@psl.aphp.fr.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Mazeron
mesh_terms: D000367:Age Factors; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002872:Chromosome Deletion; D002878:Chromosomes, Human, Pair 1 / Q000235:genetics / Q000648:ultrastructure; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D019008:Drug Resistance, Neoplasm; D005910:Glioma / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008130:Lomustine / Q000008:administration & dosage; D008745:Methylation; D015337:Multicenter Studies as Topic; D009363:Neoplasm Proteins / Q000378:metabolism; D019635:Neurosurgical Procedures; D019853:O(6)-Methylguanine-DNA Methyltransferase / Q000378:metabolism; D011344:Procarbazine / Q000008:administration & dosage; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects; D000077204:Temozolomide; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018906:Antineoplastic Agents, Alkylating; D009363:Neoplasm Proteins; D000068258:Bevacizumab; D011344:Procarbazine; D014750:Vincristine; D008130:Lomustine; D003606:Dacarbazine; D019853:O(6)-Methylguanine-DNA Methyltransferase; D000077204:Temozolomide
keywords: Glioblastoma; Glioblastome; Glioma; Gliome; Intensity modulation radiotherapy; Radiothérapie conformationnelle avec modulation d’intensité