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Review
. 2021 Feb 5:10:574012.
doi: 10.3389/fonc.2020.574012. eCollection 2020.

A Review of Newly Diagnosed Glioblastoma

Bryan Oronsky  1 , Tony R Reid  2 , Arnold Oronsky  3 , Navjot Sandhu  4 , Susan J Knox  4
Affiliations
Review

A Review of Newly Diagnosed Glioblastoma

Bryan Oronsky et al. Front Oncol. .

Abstract

Glioblastoma is an aggressive and inevitably recurrent primary intra-axial brain tumor with a dismal prognosis. The current mainstay of treatment involves maximally safe surgical resection followed by radiotherapy over a 6-week period with concomitant temozolomide chemotherapy followed by temozolomide maintenance. This review provides a summary of the epidemiological, clinical, histologic and genetic characteristics of newly diagnosed disease as well as the current standard of care and potential future therapeutic prospects.

Keywords: brain tumors; cancer; glioblastoma; high-grade gliomas; radiation therapy.

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Conflict of interest statement

Author BO is employed by the company EpicentRx. AO is currently employed by InterWest Partners. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hypoxia-neovascularization cycle in glioblastoma. The steps below are as follows: 1. Glioma cells consume oxygen provided by the functional vasculature. 2. Endothelial injury, prothrombotic factors and increased mechanical pressure in regions of high glioma cell density induce vaso-occlusion and necrosis. 3. Perivascular glioma cells switch to a “go” phenotype based on presence of hypoxia. 4. Pseudopalisading glioma cells secrete pro-angiogenic factors. 5. Pro-angiogenic factors stimulate the formation of aberrant, highly permeable neovasculature, which results in more hypoxia and accelerated progression. 6. Pseudopalisading cells migrate to a new vasculature where the cycle begins anew.
Figure 2
Figure 2
Palisades and pseudopalisading cells. Palisades are defined as a protective layer, similar to a fence or perimeter of wooden stakes or iron railings. (top figure) In glioblastoma, pseudopalisades or “false palisades” are dense migratory zones of cells in picket-fence or perimeter formation, which surround necrotic tissue; hence the term, “pseudopalisading necrosis”. The pervasive hypothesis is that pseudopalisading cells are “microenvironmental migrants” that co-localize in search of better oxygenated conditions due to the presence of vascular collapse and necrosis (40). (bottom figure)
Figure 3
Figure 3
Magnetic resonance imaging (MRI) appearance of glioblastoma: contrast enhancing rind of tumor surrounding a necrotic core (56).
See this image and copyright information in PMC

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