Technological innovations in multimodal management of glioblastoma: from nano-drugs to imaging guided surgery and supra-maximal resection.

Abstract

Primary brain tumors are a major cause of morbidity and mortality in the United States. Approximately one-third of tumors are malignant and the remaining are benign or borderline malignant. High-grade glioma, in particular glioblastoma, management is a great challenge for both neurosurgeons and patients. More than 45% of CNS primary malignant tumours are glioblastoma and their 5 year-survival is only 5% on average. Although biomolecular differences between glioblastoma IDH-WT and IDH-mutant might account for different outcomes, treatment strategies, including surgical EOR, chemiotherapy and radiotherapy, are currently considered important factors associated with PFS and OS. objective of this thesis is the definition of a neuro-oncological protocol, to be reserved for patients with glioblastoma, which can establish a therapeutic path that starts with a safe and effective surgery and continues with a pharmacological treatment that may lead to the limitations of current antitumor therapy schemes. Two main research lines have been conducted, with these purposes: the first one, essentially clinical, has been analysed in two consecutive studies, first retrospectively, then prospectively, the results of the application of an intraoperative imaging protocol that foresees the use of Advanced neuronavigation, intraoperative fluorescence and intraoperative CT. The second line of research was instead based on the attempt to obtain a pharmacological preparation which provided for the combination of temozolomide with nano-vectors, able to increase its antiblastic efficacy and to increase its chances of delivery at the intracranial level.