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Clinical, Pathological, and Molecular Prognostic Parameters in Glioblastoma Patients Undergoing Chemo- and Radiotherapy

  • Paolo TiniEmail author
  • Clelia Miracco
  • Marzia Toscano
  • Silvia Palumbo
  • Sergio Comincini
  • Giovanni Luca Gravina
  • Luigi Pirtoli
Chapter
Part of the Current Clinical Pathology book series (CCPATH)

Abstract

The uncertainty in the knowledge of tumor initiation and progression of Glioblastoma and its eventually fatal course have driven research for many years towards an analytic approach of factors conditioning life expectancy of the affected patients. Patient-, treatment-, and tumor-related factors have been investigated in order to individuate parameters relevant for a balanced treatment approach in terms of benefit/risk ratio, and characteristics of natural history possibly suitable for new and more effective therapeutic approaches. This contribution is intended to give an overlook of these parameters from a clinical point of view at the present state-of-the-art. Age, performance, and neurological status have a strong prognostic impact, according to large case-series published over more than 20 years. Present therapeutic modalities (surgery, radiotherapy, and chemotherapy) have impacted on prognosis through more and more sophisticated implementations, and evidence exists of an improvement of survival over the last decades, due also to recent imaging techniques. Outcome in clinical series presently reaches a bridgehead at a 12–15 months median survival, and 2- and 5-year overall survival rates rarely exceed 25 % and 5 %, respectively. There is no sound evidence in favor of strategies overcoming these limits. Molecular classification, genome-wide characterization, and advanced knowledge of signal pathways of Glioblastoma identify several biological molecular parameters correlated with prognosis and tumor response to current standard postoperative therapy, that is, radiotherapy and temozolomide. How these disclosures might improve clinical outcome through agents (that is, monoclonal antibodies, tyrosine-kinase inhibitors, etc.) selectively interfering with the biological machinery is beyond the scope of this chapter, and is addressed elsewhere in this book. However, inconsistent clinical results were achieved on these grounds as yet, differently from other malignancies, and this warrants further translational research on Glioblastoma.

Keywords

Glioblastoma Prognosis Markers Radiotherapy Chemotherapy 

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Paolo Tini
    • 1
    • 2
    Email author
  • Clelia Miracco
    • 1
    • 3
  • Marzia Toscano
    • 1
    • 4
  • Silvia Palumbo
    • 4
  • Sergio Comincini
    • 5
  • Giovanni Luca Gravina
    • 6
  • Luigi Pirtoli
    • 1
    • 4
  1. 1.Tuscany Tumor InstituteFlorenceItaly
  2. 2.Unit of Radiation OncologyUniversity Hospital of Siena (Azienda Ospedaliera-Universitaria Senese)SienaItaly
  3. 3.Unit of Pathological Anatomy, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
  4. 4.Unit of Radiation Oncology, Department of Medicine, Surgery and NeurosciencesUniversity of SienaSienaItaly
  5. 5.Department of Technology and BiotechnologyUniversity of PaviaItalyItaly
  6. 6.Department of Radiological Sciences-Oncology and Pathological AnatomyState University of Rome (“La Sapienza”)RomeItaly

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