Treatment for Glioma: Retrospect and Prospect

Dear Colleagues,

Gliomas are the most common malignant primary brain tumor in adults. Generally, gliomas are divided into circumscribed and diffuse types, with the former being benign and curable after complete surgical resection and almost exclusively affecting children, and the latter being more malignant and unable to be cured following surgical resection alone. Despite growing knowledge of the molecular changes responsible for tumor development, gliomas remain neoplasms with unmet medical needs. Until very recently, the gold standard treatment for gliomas was surgical resection followed by radiotherapy plus temozolomide, according to the STUPP protocol. It is noteworthy that molecular alterations could represent important prognostic factors and specific targets for precision medicine trials in primary and recurrent gliomas. In the last few years, many translational and clinical studies have been performed, and new treatments with targeted therapy, such as precision medicine, immunotherapy, and their combination, are ongoing.

This Special Issue will cover all aspects of primary and recurrent gliomas, including original research on advanced imaging, molecular characteristics, current and experimental treatment options, supportive care, neurocognitive functions, and quality of life. Expert opinions, systematic reviews, and meta-analyses are also welcome.

Dr. Andrea Landi
Dr. Valentina Baro
Prof. Dr. Giuseppe Lombardi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• neurosurgery
• gliomas
• new diagnostic strategies
• preoperative planning
• new surgical treatment choices
• non-invasive therapies
• new oncologic treatments

Title: The Role of [18F]-FET-PET in the Pre-operative Management of Brain Tumors in Children and Young Adults: Preliminary Experience in Nine Patients.
Authors: Marta Menegatti; Andrea Di Rita; Chiara Spezzani; Alberto Parenti; Simone Peraio; Alice Noris; Iacopo Sardi; Ludovico D’Incerti; Iashar Laghai; Stelvio Sestini; Flavio Giordano
Affiliation: Cona Hospital – University of Ferrara - Italy; Meyer Children’s Hospital IRCCS – Firenze - Italy; Nuovo Ospedale Santo Stefano - Italy
Abstract: Purpose: Brain tumors are the second most common neoplasms in children and the most common solid neoplasms, with an overall 5-year survival rate of 75% depending on histology. These tumors show a strong histological heterogeneity that is crucial their best treatment. Currently, MR is considered the standard of care for neuroimaging and preoperative planning, as it provides detailed anatomical and structural information. However, [18F]-FET-PET allows to detect the active metabolic tissue at the level of the highlighted lesion, obtaining additional information regarding tumor. Furthermore, [18F]- FET-PET allows the differential diagnosis between true brain tumors relapse and post-therapeutic tissue changes. The aim of our study is to highlight the role of [18F]-FET-PET combined with pre-operative MR in the management of brain tumors in children. Methods: The medical charts of nine children and young adults (7 males and 2 females; range 2–16 age at initial diagnosis) with either newly diagnosed (n = 5) or pretreated (n = 4) brain tumors were retrospectively analyzed. All patients had previously undergone neuro-oncological work-up including cranial MR with gadolinium enhancement, and 7/9 also with DWI sequences. [18F]-FET-PET was then performed in the clinical process to better identify metabolic active tumor tissue within diffuse tumors or pretreated lesions as well as depicting their extent. This made it possible to decide whether to precisely select the target either before stereotactic biopsy (four patient) or computer assisted microsurgical biopsy (one patient) or tumor resection (four patient). Results: The addition of [18F]-FET-PET to the available information had an important impact on patient management. Sensitivity for tumor detection was 8/9, [18F]-FET-PET was false positive in only one pretreated patients. In fact, in our study we had 8 histological diagnoses of brain tumor (six patients with low grade glioma and two with high grade glioma) and only one diagnosis of reactive gliosis, in a patient previously surgically treated for medulloblastoma and then subjected to chemo and radiotherapy. Conclusion: We assessed the clinical impact and diagnostic accuracy of adding [18F]-FET PET to MRI in children with CNS tumors. The study demonstrates that [18F]-FET-PET is a valuable tool in the neuroimaging and preoperative planning of CNS tumors in children and young adults. It provides additional information about the biology of the tumor, aiding in accurate diagnosis and treatment decisions. By combining [18F]-FET-PET with MRI, clinicians can obtain both detailed anatomical and structural information as well as metabolic activity data, leading to a more comprehensive understanding of the tumor and ultimately improving patient outcomes.