How to choose the most appropriate treatment plan Brain glioma has the characteristics of infiltrative growth and migration to distant places, and any single treatment plan such as surgery, radiotherapy and chemotherapy alone cannot kill the tumor completely. Only according to the different biological characteristics of the tumor cells, and under the guidance of molecular pathology, an individualized comprehensive treatment strategy including microsurgery, radiotherapy, individualized chemotherapy, and immune and molecular targeted therapy is the best treatment plan, which can achieve the best clinical results, effectively improve the quality of life of the patients, and achieve long-term survival. Why should we carry out comprehensive treatment Surgery and radiotherapy are local treatments, surgery can remove the tumor cells in the center of the tumor to the maximum extent; radiotherapy can reduce the residual tumor cells in the local and peripheral infiltration area as much as possible; chemotherapy is systemic treatment, it can kill as many tumor cells as possible throughout the whole brain, especially in the distant parts of the center of the lesion; molecular targeting can specifically kill tumor tissues by restricting the metabolic channels; immunotherapy and molecular targeting can specifically kill tumor tissues; other treatment options, such as immunotherapy, can further kill or inhibit the remaining tumor cells, and at the same time can also improve the patient’s resistance and enhance the level of autoimmunity. After surgery, radiotherapy, chemotherapy and molecular targeted therapy and immunotherapy can minimize the tumor cells in the body, strive to maximize the interval of recurrence, and then prolong the life of patients and improve their quality of life. Why surgery is only the beginning of comprehensive treatment Surgical resection is the most important part of the comprehensive treatment of glioma, but surgical treatment is not the whole of glioma treatment. The goal of surgery is to remove the maximum amount of tumor, reduce the tumor load in the body, reduce symptoms, provide pathology results, and support a better individualized comprehensive treatment plan. Combination therapy after surgery kills as many residual tumor cells as possible, as well as normal glial cells that have been invaded by tumor cells. The combination of multiple modalities can achieve the best therapeutic effect, minimize the possibility of recurrence after surgery, and ultimately achieve the goal of long-term survival. Therefore, surgery is only the beginning of comprehensive treatment for glioma. How to maximize tumor resection and protect function in microsurgery Surgical resection is the first and most critical step in the comprehensive treatment of glioma, but any surgery may cause secondary functional damage, especially in the case of functional gliomas, which are prone to new functional deficits during surgery. Maximum resection of the tumor and maximum preservation of the patient’s neurological function is the best surgical outcome, and achieving this goal requires a multidisciplinary approach: firstly, the patient is evaluated preoperatively by the world’s most advanced 3.0T magnetic resonance, and the anatomical location of the tumor and the normal functional area is clarified by functional MRI scanning, intraoperative neuronavigation and intraoperative ultrasound guidance are applied, intraoperative wake-up and intraoperative cortical electrical stimulation techniques are applied, and intraoperative neurological guidance and intraoperative ultrasound guidance are applied. Cortical electrical stimulation technology in anesthesia, precise positioning of the tumor and functional cortex location, under the most advanced surgical microscope to maximize the complete removal of the tumor, and to ensure that the function of the normal brain tissue is protected to the greatest extent possible, to achieve the best surgical results. What are the molecular pathology results of gliomas Conventional pathology results are graded solely on the basis of the malignancy of the tumor, but the regression and prognosis of the tumor cells are also related to alterations at the gene and/or protein level of the tumor cells, i.e., the biological behavior of the tumor. Molecular pathology detects changes in tumor cell receptors, growth factors, oncogenes, and oncogenes at the gene and/or protein level through immunohistochemical markers, chromosomal markers, and genetic markers of individualized tumor cells, based on which it can accurately determine the biological behaviors of a specific tumor cell, and purposefully design different therapeutic regimens, which are able to be more specifically targeted to Different tumor cell lines can be treated more specifically to achieve better individualized therapeutic effects. How to carry out individualized radiation therapy? Radiation therapy applies radiation to kill tumor cells by directly damaging the DNA of tumor cells or by secondary damage to tumor cells through free radicals generated by radiation. Three-dimensional shaped fractionated radiotherapy can irradiate the tumor periphery in a larger range, which is the first choice of radiotherapy for glioma. Stereotactic radiotherapy and local radioactive particle implantation radiotherapy are the powerful complement to three-dimensional shaped fractionated radiotherapy. Individualized selection of different radiotherapy methods and doses can achieve the best treatment effect. Why chemotherapy? Surgery and radiotherapy are localized treatments, while chemotherapy is systemic treatment. Glioma cells grow invasively, surgery can only remove the tumor in the core area of the glioma, and radiation therapy can only irradiate the brain tissue in the periphery of the core area in the range of 1-2cm. However, there may still be infiltration of tumor cells in the periphery of the core area, and tumor cells may even spread along the nerve fibers and the cerebrospinal fluid, and this part of the tumor cells must be eliminated as far as possible by chemotherapy. Chemotherapy makes use of the principle of recurrent value-adding of tumor cells, periodically kills and inhibits tumor cells with strong value-adding activity, effectively reduces the possibility of tumor recurrence, prolongs the cycle of recurrence, and then improves the quality of life of patients. The new type of chemotherapy measures, with better efficacy and lower side effects, is a safe and effective treatment option. What kind of intracranial tumors need chemotherapy Chemotherapy is the key link in the comprehensive treatment of intracranial tumors, and most intracranial malignant tumors require standardized chemotherapy. Including high grade malignant gliomas of WHO-grade III or above after postoperative adjuvant radiotherapy or radiotherapy; diffusely growing gliomas; low grade gliomas with aggressive growth that are difficult to be completely resected by surgery; all recurrent gliomas; all intracranial metastatic tumors, medulloblastomas, germ cell tumors, lymphomas, and malignant benign tumors and other intracranial tumors all need chemotherapy. Chemotherapy should be implemented as early as possible, and the principles of adequate, sufficient and combined chemotherapy should be adopted. Especially, individualized chemotherapy under the guidance of molecular pathology can reduce the influence of tumor cell resistance, effectively improve the efficacy of chemotherapy and reduce the side effects. What is chemotherapeutic drug sensitivity test As different individual tumor cells have different expressions at gene, protein and molecular levels, different chemotherapeutic drugs have different effects on tumor cells. Different chemotherapeutic agents will be applied to the tumor cells in vitro to observe the inhibition of tumor cell growth and proliferation, and select the chemotherapeutic agent with the best inhibition on tumor cells, so as to provide guidance and assistance for the clinic to select the most effective chemotherapeutic agent and formulate the individualized chemotherapy plan. How to implement individualized chemotherapy Chemotherapy is usually carried out after surgery and radiation therapy. Under the guidance of molecular pathology results and in vitro drug sensitivity test, specific chemotherapeutic regimens can be selected for tumor cells with different biological characteristics, and chemotherapeutic drugs with different mechanisms of action can be combined to kill tumor cells with different proliferative cell cycles in the surrounding area of the lesion and in the remote area of the lesion, so as to achieve the goal of individualized chemotherapy. In order to achieve the goal of individualized chemotherapy and minimize the side effects of chemotherapy while achieving the best therapeutic effect, what are the methods of chemotherapy? What are the methods of chemotherapy? Currently, the chemotherapy program for glioma mainly consists of two categories: oral chemotherapy and intravenous chemotherapy. Oral chemotherapy mainly applies the latest generation of chemotherapy drug temozolomide, which is easy to take, with little side effects and precise efficacy, does not require hospitalization, and only requires regular outpatient blood routine and imaging review. Intravenous chemotherapy is usually combined with a variety of different chemotherapeutic drugs, including oral chemotherapy drugs, which can maximize the killing of tumor cells with different proliferative cell cycles, safe and standardized, with good comprehensive efficacy. Features of oral chemotherapy with temozolomide Temozolomide is a new generation of chemotherapeutic drugs dedicated to glioma and other intracranial malignant tumors, with small molecular weight, easy to reach intracranial foci and precise efficacy; simple in vivo metabolism, small toxic side effects on bone marrow, digestive tract, liver and kidney, etc., and strong tolerance of patients; it can be taken orally at home and is easy to be used, and it is the first choice of chemotherapy for glioma and other intracranial malignant tumors at present. How to implement oral chemotherapy Oral chemotherapy mainly refers to temozolomide chemotherapy regimen. According to different molecular pathology results, temozolomide has different oral administration methods, including the most common five-day regimen, every other week regimen, and continuous administration regimen for adjuvant radiotherapy, etc. The attending physician will formulate individualized administration methods according to the patient’s different pathology results and personal situation. Oral temozolomide has fewer side effects, and the different regimens can be implemented at home, requiring only regular review of blood counts. Combination therapy with temozolomide and other intravenous chemotherapeutic agents usually requires hospitalization. How to implement molecular targeted therapy? Molecular targeted therapy is a therapeutic solution that inhibits the growth of tumor cells and neovascularization by specifically targeting the active signal transduction pathway of tumor cells and specifically kills tumor tissues without killing normal cells, so as to achieve the best therapeutic effect and minimize the side effects. Molecular targeted therapy combined with chemotherapy is more effective. How to implement immunotherapy Immunotherapy is one of the best complementary treatment options for gliomas besides surgery, radiotherapy and chemotherapy. Peripheral active and passive immunotherapy can produce therapeutically meaningful attack on the existing tumor cells, and also kill tumor cells by stimulating and supplementing the body’s anti-tumor immune ability, which has the characteristics of strong specificity, mild toxic side effect reaction and long-term memory. How to implement targeted radioimmunotherapy The surgeon places an Ommaya reservoir system in the tumor cavity during the glioma surgery, and after 2-4 weeks after the surgery when the wound is well healed, the radioimmunotherapy drug is injected into the reservoir capsule, and the drug will be directed to be distributed in the tumor bed, and the specific targeting against the tumor cells will effectively carry out the mesenchymal radiotherapy and immunotherapy. It reduces the radiation damage to normal brain tissue and improves the therapeutic effect. Comprehensive treatment of pediatric malignant glioma Intracranial tumors occurring in children, most of which are malignant tumors, including glioblastoma and medulloblastoma, etc. Since young children are in the state of growth and development, radiation therapy routinely carried out in adults after surgery has a greater impact on the development of children’s brains, therefore, children under the age of three years are usually first subjected to standardized chemotherapy after surgery, and then radiotherapy is carried out after their age has increased. The principle of individualized comprehensive treatment is that the treatment of glioma is a multidisciplinary cooperation for comprehensive treatment. Depending on the nature, size, location and molecular pathology of the tumor in different patients, and taking into account the patient’s age, family situation, etc., the treating physician will formulate an individualized comprehensive treatment plan in the hope of achieving the best possible clinical outcome – the best quality of life while prolonging the survival period as much as possible.