Glioma is one of the most common tumors in the nervous system, and its incidence has been on the rise in recent years. Because gliomas occur in the brain parenchyma and have a strong infiltrative character, tumor cells have often infiltrated to more distant sites along the nerve fibers or extravascular spaces by the time the tumor is detected. In order to protect important neurological functions, surgery cannot completely remove the tumor, thus the tumor has the possibility of recurrence. In terms of the current treatment of glioma, it cannot be simply reduced to the comprehensive treatment of surgery + radiotherapy + chemotherapy + gene targeting therapy, etc. It is still necessary to formulate a comprehensive treatment plan according to the location, size, malignancy, extent of infiltration, relationship with the surrounding important blood vessels and nerve function areas, in addition to the patient’s age, physical condition, expectation of the treatment effect and economic strength. In addition, the patient’s age, physical condition, expectations of treatment outcome, and financial resources should be considered. Personally, I believe that glioma treatment is like a long-lasting battle, in which a general strategy must be developed before the battle begins, and then specific tactics are developed under this strategy. Strategic thinking about surgical treatment: In general, glioma surgery is divided into: near-total resection: removing more than 90% of the tumor, majority resection: removing more than 75% of the tumor, and partial resection and biopsy surgery. For the treatment effect of tumor, naturally the more tumor removed and the less residual the better, but conversely the more tumor removed also increases the possibility of damaging important neurological functions, which requires the surgeon to have not only rich professional knowledge and surgical experience, but also fine operating skills, as well as the ability and condition to utilize various advanced technologies. For example, I personally once worked with an anesthesiologist to complete the first surgical case in China in which a glioma in the speech area was removed with the cooperation of wake-up anesthesia. It was at the critical moment of removing the tumor in the speech area that the patient was woken up, and in the process of the patient’s communication with the anesthesiologist using language, the tumor was quickly removed from my side, and finally the patient’s speech function was successfully preserved. This kind of surgery requires close cooperation not only between the surgeon and the anesthesiologist, but also between the patient. Biopsy surgery can be divided into stereotactic biopsy and open biopsy. Stereotactic biopsy is mainly used for deep lesions and can be performed under local anesthesia with minimal injury and risk, but has the disadvantage of a false negative rate, which is related to the small number of tissue specimens obtained and the heterogeneity of gliomas. The small number of tissue specimens sometimes does not reflect the true picture of the lesion, so I will try to obtain as many points of lesion tissue as possible if the situation allows. If the biopsy can identify a tumor, it is definitely a tumor, but if the biopsy does not reveal typical tumor cells, then the possibility of a tumor cannot be completely ruled out, so we have to consider whether to perform dynamic observation, or to perform another stereotactic biopsy or open biopsy according to the specific situation. Some people often ask me how many times a glioma patient undergoes craniotomy, and this question cannot be generalized, but should be analyzed on a case-by-case basis. The highest level of pursuit is to win the game without losing a single piece, but in the specific process of chess, there are trade-offs according to the specific situation and battle conditions, and the general principle is to lose a pawn to protect a horse, a knight to protect a rook, and a rook to protect a commander. Applying this principle to glioma surgery, the pawn, knight and rook are equivalent to the different neurological functions of a person, and the handsome is equivalent to the life of a person. Each time a patient receives surgical treatment, he or she may pay a certain price, but this price should be as small as possible. If the cost of the surgery is a “horse or cart”, it is important to inform the patient’s family clearly and obtain their consent before proceeding. If the cost of the surgery is “handsome”, then I am afraid that the surgery cannot be done unless the patient and family strongly request it. Strategic thinking about radiotherapy: Radiotherapy is used to treat glioma by using various kinds of radiation to damage the DNA of tumor cells. From the perspective of tumor treatment effect, naturally the higher the radiation dose the better the treatment effect, but because in many cases glioma cells are mixed with normal nerve cells and radiation has scattering characteristics, radiotherapy also has damage to normal nerve cells, and the higher the radiation dose the greater the damage to nerve cells. In addition, studies have confirmed that the tolerance level of tumor cells and normal brain cells to radiation damage is very close, and the total radiation dose for the whole course of treatment should not exceed 60 GY. Therefore, it is necessary to choose the appropriate total radiation dose and split dose for each case, in order to maximize the killing effect on tumor cells and minimize the side effects on normal cells. This also brings another problem, that is, radiotherapy will not have the same immediate effect as surgery, but will take a longer time to take effect, and will also cause different degrees of cerebral edema or even radiation necrosis, which is the pseudo-progression of tumor as I mentioned before. In addition, different tumors have different sensitivity to radiotherapy, and the effect of radiotherapy can be very different. Glioma belongs to tumors that are moderately sensitive to radiotherapy; therefore, there is almost no possibility of complete elimination of the tumor by radiotherapy alone. Strategic thinking about chemotherapy: Chemotherapy is a method of treating tumors through the use of certain chemical drugs. Although there are now more than a hundred kinds of chemotherapy drugs, both intravenous and oral, which are systemic administration of chemotherapy, there are fewer drugs that can cross the blood-brain barrier into the brain and have therapeutic effects on glioma. Because of the systemic administration, chemotherapy drugs have a killing effect on proliferating cells, and it is impossible to distinguish which are tumor cells and which are normal cells, so chemotherapy drugs not only have a killing effect on tumor cells, but also have a corresponding toxic effect on bone marrow hematopoietic cells and sperm cells, and even damage to liver and kidney organs, which is what I often call “killing a thousand enemies and damaging oneself”. This is what I often call “killing a thousand enemies and damaging oneself”. Therefore, chemotherapy must be carried out under the guidance of professional doctors, and the damage of chemotherapy drugs to normal tissue cells should be reduced through the use of adjuvant drugs, and chemotherapy should be carried out according to the course of treatment in order to obtain sufficient recovery time for normal tissue cells. In addition, research on local chemotherapy for glioma has made some progress in recent years, and we expect to conduct a clinical trial study on local treatment of glioma with carmustine extended-release implantation this year. In addition, I would also like to say here that there is no evidence to confirm that Chinese medicine has a therapeutic effect on glioma, but it does have some effect in regulating body functions. From my personal point of view, I do not agree that some patients should take large amounts of Chinese medicine for a long time to treat or prevent glioma, which not only does not achieve the purpose of treating glioma, but also is likely to bring more side effects and even other unexpected damages. Strategic thinking on gene targeting therapy: In recent years, with the in-depth research on molecular biology of tumors, people found that the occurrence and development of tumors are closely related to the mutation of genes, and some corresponding gene targeting drugs have been produced for some mutated genes. However, for most tumors, tumor occurrence and development are the result of multiple mutations, and this is also true for gliomas. My personal research has revealed that the number of gene mutations in the same grade and type of glioma can be as few as several hundred or as many as several thousand, varying far beyond our initial imagination. From this it can be deduced that one genetic drug cannot cure glioma completely from the root, it must be used in combination with other chemotherapeutic drugs for better results. In fact, we all think about everything, but the results of each person’s thinking vary greatly, and the resulting understanding can be vastly different. These are just some of my personal thoughts on the current treatment of glioma, and I would be most happy to share them with you, if I can bring some inspiration and help to my colleagues and readers who are interested.