Glioma, also known as glioma, is a tumor that occurs in the neuroectodermal tissue. Among neuroepithelial tissue tumors, the incidence of glioma accounts for about 50%, and in China, it accounts for 33.3% to 58.9% of intracranial tumors, with an average of 43.5%. Gliomas are tumors that originate from glial cells, including astrocytic tumors, oligodendrocytic tumors, mixed glial cell tumors and ventricular meningeal tumors. They have different growth sites, pathological patterns, molecular biology, biological behavior (grade I-IV), imaging, treatment response and outcome. Currently, gliomas are incurable, and only 5.5% of patients diagnosed with glioblastoma in the United States survived for more than 5 years in 1980. After more than 20 years of exploration and development, the treatment of glioma has made great progress, but the two-year survival rates of low-grade astrocytoma, mesenchymal astrocytoma and glioblastoma multiforme are only 66%, 45% and 9%, respectively. Therefore, glioma is one of the most challenging tumors to treat in neurosurgery. Biological characteristics, treatment difficulties and trends of glioma The infiltrative growth pattern of glioma determines its malignant biological behavior. Tumor aggressiveness is a complex process in which tumor cells interact with the host and the extracellular matrix. Multiple growth factors are involved in the hyperproliferative and invasive behavior of glioma cells. The highly proliferative and aggressive behavior of glioma cells is one of the most difficult problems to treat today, to the extent that it has been compared to its ability to effectively “evade” surgical, radiotherapy, chemotherapy, and immunotherapy regimens, leading to the eventual incurability and death of the patient. At present, microsurgery can only achieve visual excision, and many glioma cells that grow in a “root-like” manner infiltrate into normal brain tissue, making total excision impossible; side effects of radiotherapy and chemotherapy, and “multi-drug resistance” cannot be solved yet. Targeted and gene therapy for glioma is the most interesting research area in recent years. Surgery is still the most effective treatment method, which aims to clarify the diagnosis, improve the symptoms, reduce the tumor load, and create conditions for further treatment. With the application of microsurgery, laser and navigation system and the continuous improvement of intraoperative electrophysiological monitoring, tumors that were considered inoperable in the past can be removed surgically. In particular, the application of intraoperative magnetic resonance, navigation system and intraoperative electrophysiological monitoring has greatly improved the total resection rate and reduced the risk of surgery. Intraoperative magnetic resonance can measure the size of resection area, and functional neurological navigation and intraoperative electrophysiological monitoring system can show the location of the operative field, clarify important functional areas, and prevent the increase of unnecessary neurological function damage. 2.Radiotherapy In recent years, the main progress of radiotherapy is focused on the improvement of radiation dose, radiation field and time interval, as well as the application and selection of radiation sensitizers. At present, the combined application of radiotherapy and chemotherapy significantly improves patient survival. A large phase III clinical study, the European Organization for Research and Treatment of Cancer and the National Cancer Institute of Canada (EORTC-NCIC), following the publication of an evidence-based medicine level I study in 2004, recently announced the final results: GBM patients receiving radiotherapy combined with TMZ synchronous and adjuvant therapy, the OS benefit remained significantly better than radiotherapy alone after a median follow-up of 5 years. The paper was published in The Lancet? Oncology [Lancet Oncol 2009 10(5):459]. A total of 573 patients were enrolled in the study and randomized to radiotherapy alone or radiotherapy combined with TMZ. At a median follow-up of 2, 3, 4, and 5 years, OS was 27.2%, 16.0%, 12.1%, and 9.8% in the TMZ group and 10.9%, 4.4%, 3.0%, and 1.9% in the radiotherapy group, respectively (P < 0.0001). benefit from TMZ treatment was seen in all subgroups of clinical prognostic factors. mGMT promoter methylation was the strongest TMZ treatment benefit and prognostic The strongest predictor of TMZ treatment benefit and prognosis was MGMT promoter methylation. Chemotherapy is an important part of the treatment of glioma. Surgery or (and) radiotherapy have resulted in good outcomes for some gliomas, however, most tumors inevitably recur. Chemotherapy plays a very important role in further killing residual tumor cells. There are many regimens of chemotherapy for glioma, but the main drugs used are single or combination drugs with nitrosoureas as the mainstay. The following regimens are commonly used in Europe and the United States: PCV regimen (lomustine, methylbenzylhydrazine, vincristine), mainly for highly malignant astrocytoma, oligodendroglioma, glioblastoma multiforme and mesenchymal astrocytoma; BC regimen (cisplatin, BCNU), mainly for highly malignant astrocytoma; cyclophosphamide or cisplatin single agent has good effect on medulloblastoma. In the case of recurrent disease, a combination of drugs is used, such as the EC regimen (VP-16 + carboplatin); MeCCNU + Vm-26 is mainly used for low-grade malignant gliomas, and vincristine and cisplatin have also been applied to treat low-grade malignant gliomas. For different types of tumors, there should be some differences in the chemotherapeutic drugs chosen; medulloblastoma, especially those with recurrence or disseminated implantation, is treated with PCV regimen, and brainstem glioma is treated with CCNU or BCNU alone or in combination with PCZ or VCR ventricular meningioma responds significantly to BCNU. There are at least 2 reasons affecting the efficacy of chemotherapy for glioma: (1) the presence of blood brain barrier (BBB) affects the entry of anti-tumor drugs into the brain; (2) a significant proportion of tumors are resistant to anti-cancer drugs. In recent years, with the gradual elucidation of molecular genetics of malignant glioblastoma, the important role of certain cellular signal transduction pathways and related genes in the occurrence and development of malignant glioblastoma has become clearer and clearer, which provides neuro-oncologists with a new solution for effective treatment of malignant glioblastoma - molecular targeted therapy. Targeted therapies that target genes that are abnormally expressed in malignant tumors, and their protein products, have opened up new approaches and tools for cancer treatment. In lung cancer, for example, 43%-89% of lung cancer patients have overexpression of vascular endothelial growth factor receptor (EGFR). There are two types of molecularly targeted therapies for EGFR in lung cancer: tyrosine kinase inhibitors (TKI), which bind to and inhibit intracellular tyrosine kinase, and synthetic monoclonal antibodies (MAb), which can bind to the extracellular binding region of EGFR, thereby blocking the ligand region of EGFR, thereby blocking the binding and activation of the ligand to EGFR. In this way, either extracellular blockade or inhibition of intracellular EGFR can affect the signaling system of cancer cells, thereby inhibiting the proliferation, division, and invasive growth of cancer cells. The above two drugs targeting EGFR in lung cancer can significantly improve the survival quality and clinical symptoms of lung cancer patients. Currently, molecularly targeted drugs for malignant glioblastoma are still in preclinical studies. However, many years of research have confirmed that proto-oncogenes (EGF and PDGF and their receptors) and tumor suppressor genes (including pl6INK4a, pl4ARF, PTEN, RB1 and TP53) are closely related to malignant glioblastoma development and progression, and in addition, common heterozygous deletions of 1P, 10p, 10q, 19q and 22q also affect the genetic expression of malignant glioblastoma In addition, common heterozygous deletions of 1P, 10p, 10q, 19q and 22q also affect the genetic expression of malignant glioblastoma. These existing research results have provided research targets for molecular targeted therapy of malignant glioblastoma. Biological therapy is known as the fourth tumor treatment method after surgery, radiotherapy and chemotherapy. It is mainly used to inhibit tumor growth by mobilizing the body's own natural defense mechanism or giving certain substances to the body. Biological therapy mainly includes: cytokines, hematopoietic immune cells, monoclonal antibodies, gene guides and vaccines, etc. Among them, immunotherapy and gene therapy and their combination constitute the main part of tumor biological therapy. 6.1 Immunotherapy includes active immunization with tumor vaccine, intra-lymph node injection of immune ribonucleic acid and application of immunomodulators such as levamisole, which have been used in clinical practice to reduce the response to radiotherapy and chemotherapy and enhance the immunity of the body. Currently, immunotherapy for glioma is mainly focused on the following aspects: 6.1.1 Tumor cell vaccine: irradiated or virally infected tumor cells or their lysis products are used as immunogens to study their therapeutic effects on the tumor-bearing organism, and the remission rate is low due to the weak immunogenicity of tumor cells. 65 cases of malignant astrocytes were treated with autologous tumor cell extracts and Fuchsin adjuvant as vaccine components by Trouillas et al. malignant astrocytomas were randomized into 4 groups and given radiotherapy, vaccine, radiotherapy plus vaccine and supportive therapy. 24 of 28 patients who received the vaccine developed delayed hypersensitivity reactions and the mean survival was 10.1 months in the radiotherapy plus vaccine group compared to only 7.5 months in the radiotherapy group. However, most of the other glioma treatment trials with autologous or allogeneic tumor cell vaccines during the same period were not effective. 6.1.2 Dendritic cell-based tumor vaccines: Siejo et al. were the first to report the results of animal studies on the use of Dendritic cell DC vaccines for brain tumors, in which they used autologous DCs sensitized with B16 glioma cells to immunize tumor-bearing rats to regress their intracranial tumors. Subsequent studies have reported that DC vaccines sensitized with brain tumor RNA, antigenic peptides or tumor cell extracts have achieved better therapeutic effects in tumor-bearing animals. 6.1.3 Cytokine therapy is a non-specific immunotherapeutic approach in which cytokines are administered systemically or locally to exert their direct anti-tumor effects or anti-tumor immunomodulation. The main cytokines used for immunotherapy of glioma are interferons, interleukins and tumor necrosis factor. 6.2 Gene therapy Gene therapy has been used to treat gliomas. A vector retrovirus with relative specificity for the tumor is applied, and a gene expressing simple scarab virus type I thymidine kinase (HSVtk) is introduced into glioma cells, followed by administration of the prodrug pentracycline guanosine (GCV). In 1992, Culver et al. assembled murine cells with a retrovirus expressing the HSVtk gene (VPC) and implanted these murine cells into an experimental brain tumor free of the HSVtk gene and then administered GCV, resulting in tumor shrinkage. The results caused tumor shrinkage. 1997 Ram et al. tested 15 cases of recurrent primary or metastatic brain tumors by applying a stereotactic approach and implanting murine VPCs into tumor enhancing areas shown by MRI for 7 d, followed by daily intravenous GCV for 2 weeks, showing that 5 of 19 lesions had tumor enhancing areas shrinking by more than 50% and maintaining response for 1 to 3 months. A 47-year-old male patient with recurrent glioblastoma multiforme showed complete response after treatment, and MRI examination showed complete disappearance of the tumor after 1 year, and recurrence was still not seen after 5 years. Photodynamic therapy (PDT) is a treatment method for malignant tumors developed in the 1970s, and this treatment method has various names, including photo-therapy, photochemotherapy, and light irradiation therapy. Photochemotherapy, photoradiationtheyapy. The basic principle is that the body ingests and stores a considerable dose of photosensitizer and then irradiates the tumor site with a certain wavelength of light source to activate the photosensitizer and produce a photochemical reaction, which damages the multi-cellular targets and interferes with the proliferation of tumor cells and tissues to achieve the therapeutic purpose. In theory, PDT has a therapeutic effect on brain tumors, especially gliomas, because brain tumor cells have a high ability to take up photosensitizers. Combined Chinese and Western medicine treatment Scholars in China have found that arsenic trioxide can inhibit the growth of glioma by various mechanisms such as inducing apoptosis, capturing glioma cells in the G2/M phase, and increasing the expression of p53 protein. Most of the patients can achieve the purpose of "increasing" and "decreasing" the toxicity through herbal treatment. The inhibitory effects of tretinoin and tretinoin on glioma cells are related to the promotion of bax expression, inhibition of bcl-2 expression, and apoptosis. In conclusion, glioma cannot be completely cured by any one method alone. The neurosurgeon must not be satisfied with the removal of the tumor and the task is done. Surgical operation is only the beginning of the treatment work, but it is necessary to apply multiple methods of comprehensive treatment in stages according to the multidisciplinary knowledge of tumor biology, cell kinetics, radiotherapy, pharmacology and immunology in order to obtain better results.