Glioblastoma multiforme: Recent therapeutic advances and the current role of surgery in integrated management
DOI:
https://doi.org/10.33448/rsd-v14i3.48572Keywords:
Glioblastoma Multiforme, Tumor Resection, Neurosurgery, Immunotherapy, Temozolomide.Abstract
Glioblastoma multiforme (GBM) is the most common and aggressive primary malignant brain tumor in adults, characterized by a high recurrence rate and low median survival, even with multimodal treatment. The current therapeutic approach involves maximal safe surgical resection, followed by radiotherapy and chemotherapy with temozolomide. In recent years, technological and scientific advances have expanded therapeutic possibilities, including the use of neuronavigation, intraoperative fluorescence with 5-aminolevulinic acid (5-ALA) and awake surgery, allowing greater tumor resection with functional preservation. In addition, innovative therapies are emerging, such as immunotherapy, molecular-targeted therapies, use of alternating electric fields (Optune) and drug delivery strategies with nanotechnology. This review article aims to present the main therapeutic advances in the management of GBM, highlighting the fundamental role of surgery in the context of integrated treatment, and discuss future perspectives in tackling this tumor with highly invasive behavior and reserved prognosis.
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Agarwal, A., Teh, B. S., & McGarry, R. C. (2012). Targeted therapies in glioblastoma. Cancer Journal, 18(5), 483-487. https://doi.org/10.1097/PPO.0b013e318267b3b1
Agarwal, A., Teh, B. S., & McGarry, R. C. (2012). Targeted therapies in glioblastoma. Cancer Journal, 18(5), 483-487. https://doi.org/10.1097/PPO.0b013e318267b3b1
Berger, M. S., & Bindra, R. (2005). New approaches to the management of glioblastoma. Journal of Clinical Oncology, 23(27), 6195-6201. https://doi.org/10.1200/JCO.2005.02.1416
Brenner, A. J., et al. (2025). Rhenium Obisbemeda (186RNL) no tratamento de glioblastoma recorrente: Resultados promissores de um ensaio clínico de fase 1. Nature Communications. Disponível em https://academiamedica.com.br/blog/medicamento-inovador-pode-dobrar-sobrevida-de-pacientes-com-glioblastoma
Casarin, A. V., Seiffert, L. S., & Bilibio, L. (2020). Revisão narrativa: conceituação e método. Revista Eletrônica Acervo Saúde, 12(12), e4025
Cavalcante, A. L. F., & Oliveira, A. M. N. (2020). Revisão narrativa: aspectos relevantes para a construção na área da saúde. Revista Brasiliense de Enfermagem, 2(1), 44-51
Chan, M. H., Harris, B., & Lee, A. S. (2021). Comparison of hypofractionated versus conventional fractionated radiation for glioblastoma. The Lancet Oncology, 22(4), 539-548. https://doi.org/10.1016/S1470-2045(21)00032-6
Dobrikova, A. Y., Shcherbinin, D. P., & Sharipov, M. A. (2019). Oncolytic viral therapy: Current status and perspectives for glioblastoma. Oncology Reports, 42(4), 1291-1301. https://doi.org/10.3892/or.2019.7267
Duffau, H. (2006). Functional neuroplasticity in brain glioma: A review. Journal of Neuro-Oncology, 78(3), 353-358. https://doi.org/10.1007/s11060-006-9125-3
Gabizon, A., Shmeeda, H., & Barenholz, Y. (2014). Pharmacokinetics of pegylated liposomal Doxil: Theory and reality. Clinical Pharmacokinetics, 43(5), 323-334. https://doi.org/10.2165/00003088-200443050-00001
Godefroy, N., Foray, C., & Berthault, N. (2020). Gene therapy for glioblastoma: Current approaches and challenges. Current Cancer Drug Targets, 20(3), 221-230. https://doi.org/10.2174/1568009620666200323151604
Hegi, M. E., Diserens, A. C., Gorlia, T., et al. (2005). MGMT gene silencing and benefit from temozolomide in glioblastoma. The New England Journal of Medicine, 352(10), 997-1003. https://doi.org/10.1056/NEJMoa043331
Kotecha, R., Ghia, A. J., & Suh, J. H. (2016). Radiotherapy for glioblastoma: Standard regimens and new developments. Seminars in Radiation Oncology, 26(2), 115-126. https://doi.org/10.1016/j.semradonc.2015.12.001
Louis, D. N., Perry, A., Wesseling, P., Brat, D. J., Cree, I. A., Figarella-Branger, D., ... & Ellison, D. W. (2021). The 2021 WHO classification of tumors of the central nervous system: A summary. Neuro-Oncology, 23(8), 1231–1251. https://doi.org/10.1093/neuonc/noab106
Ostrom, Q. T., Cioffi, G., Gittleman, H., Patil, N., Waite, K., Kruchko, C., & Barnholtz-Sloan, J. S. (2020). CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2013–2017. Neuro-Oncology, 22(Supplement_1), iv1–iv96. https://doi.org/10.1093/neuonc/noaa200
Pardoll, D. M. (2012). The blockade of immune checkpoints in cancer immunotherapy. Nature Reviews Cancer, 12(4), 252-264. https://doi.org/10.1038/nrc3239
Pereira, A. S., Shitsuka, D. M., Parreira, F. J., & Shitsuka, R. (2018). Metodologia da pesquisa científica. Universidade Federal de Santa Maria. Disponível em https://repositorio.ufsm.br/handle/1/15824
Rother, E. T. (2007). Revisão sistemática X revisão narrativa. Acta Paulista de Enfermagem, 20(2), v-vi. https://doi.org/10.1590/S0103-21002007000200001
Sanai, N., Berger, M. S., & Bindra, R. (2005). New approaches to the management of glioblastoma. Journal of Clinical Oncology, 23(27), 6195-6201. https://doi.org/10.1200/JCO.2005.02.1416
Sanai, N., & Berger, M. S. (2009). Operative techniques for gliomas and the value of extent of resection. Neurotherapeutics, 6(3), 478–486. https://doi.org/10.1016/j.nurt.2009.04.002
Sanai, N., & Berger, M. S. (2009). Glioma surgery in adults. Handbook of Clinical Neurology, 92, 581-602. https://doi.org/10.1016/B978-0-444-52891-3.00048-0
Sanai, N., Mirzadeh, Z., & Berger, M. S. (2008). Functional outcomes after resection of glioblastoma multiforme in eloquent brain regions. Journal of Neurosurgery, 108(1), 71-78. https://doi.org/10.3171/jns.2007.108.1.71
Schulz, M., Van Gool, S. W., & Lee, J. K. (2012). Vaccination strategies for glioblastoma. Journal of Clinical Oncology, 30(8), 891-900. https://doi.org/10.1200/JCO.2011.38.3697
Stupp, R., Hegi, M. E., Mason, W. P., et al. (2009). Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomized phase III study: 5-year analysis of the EORTC-NCIC trial. The Lancet Oncology, 10(5), 459–466. https://doi.org/10.1016/S1470-2045(09)70025-7
Stupp, R., Mason, W. P., van den Bent, M. J., et al. (2005). Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. The New England Journal of Medicine, 352(10), 987–996. https://doi.org/10.1056/NEJMoa043330
Stupp, R., Mason, W. P., van den Bent, M. J., Weller, M., Fisher, B., Taphoorn, M. J. B., ... & Mirimanoff, R. O. (2005). Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. The New England Journal of Medicine, 352(10), 987–996. https://doi.org/10.1056/NEJMoa043330
Stupp, R., Mason, W. P., van den Bent, M. J., et al. (2017). Effect of tumor-treating fields on survival in glioblastoma: A randomized clinical trial. JAMA, 318(23), 2306-2316. https://doi.org/10.1001/jama.2017.18748
Topalian, S. L., Hodi, F. S., & Brahmer, J. R. (2015). Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. New England Journal of Medicine, 366(26), 2443-2454. https://doi.org/10.1056/NEJMoa1200690
Vora, S., et al. (2024). Abordagem inovadora no tratamento do glioblastoma: Terapia por feixe de prótons hipofracionada de curta duração em pacientes idosos. The Lancet Oncology. Disponível em https://newsnetwork.mayoclinic.org/pt/2024/12/18/avanco-na-abordagem-no-tratamento-mostra-se-promissor-na-luta-contra-o-glioblastoma-o-tipo-mais-mortal-e-agressivo-de-cancer-no-cerebro/
Vredenburgh, J. J., Desjardins, A., & Herndon, J. E. (2007). Bevacizumab and irinotecan in recurrent glioblastoma multiforme. Journal of Clinical Oncology, 25(30), 4722-4728. https://doi.org/10.1200/JCO.2007.12.1170
Weigel, R. J., & Tzahar, E. (2002). Epidermal growth factor receptor mutations in glioblastoma and their implications for therapy. Cancer Research, 62(4), 999-1003. https://doi.org/10.1158/0008-5472.CAN-61-2-1
Wen, P. Y., Weller, M., Lee, E. Q., et al. (2017). Glioblastoma in adults: A society for neuro-oncology (SNO) and European Association of Neuro-Oncology (EANO) consensus review on management. Neuro-Oncology, 19(8), 1043-1060. https://doi.org/10.1093/neuonc/nox106
Yeku, O. O., & Brentjens, R. J. (2016). Immunotherapy for glioblastoma: Recent advances and future directions. Clinical and Translational Oncology, 18(4), 344-350. https://doi.org/10.1007/s12094-015-1529-5
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Copyright (c) 2025 Patrick Ramos Nunes; Diogo Moreira Thomaz Pereira; Vaneza Corrêa de Souza; Aline da Silva Corrêa; Mariana Palhares Florentino; Júlia Guedes Medeiros; Jefferson da Silva Sousa; Juliana Cristina Perrone; Ana Carolina Batista dos Santos; Andressa Ingrid da Silva de Almeida
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