When someone receives a diagnosis of glioma, understanding the treatment options available becomes one of the most important steps forward. Treatment approaches vary greatly depending on the type of tumor, its location, and the patient’s overall health, but modern medicine offers a combination of established therapies and promising research that continues to evolve.

How Treatment Approaches Are Tailored to Each Patient

The treatment of glioma is not a one-size-fits-all process. Each patient’s care plan is carefully designed based on several important factors. The type of glial cell from which the tumor developed matters significantly—whether it arose from astrocytes (star-shaped brain cells), oligodendrocytes, or ependymal cells determines the tumor’s behavior and response to treatment. The grade of the tumor is equally crucial, ranging from grade 1 (slow-growing) to grade 4 (highly aggressive). Additionally, molecular markers such as IDH mutations (changes in the isocitrate dehydrogenase gene) and specific genetic deletions have become essential in classifying gliomas and predicting how they will respond to therapy.^[2][3]

The primary goals of treatment are to control the tumor’s growth, relieve symptoms that affect daily life, and extend survival while maintaining the best possible quality of life. Because gliomas often grow in sensitive areas of the brain that control speech, movement, memory, or vision, treatment must balance effectiveness with preservation of neurological function. Doctors from multiple specialties—including neurosurgeons, medical oncologists, radiation oncologists, and specialized nurses—work together to create an individualized treatment plan for each patient.^[9][13]

Standard treatments approved by medical societies have been established through decades of research, but many patients also have the opportunity to participate in clinical trials exploring new therapies. These trials test innovative approaches that may eventually become standard care, offering hope for better outcomes in the future.^[12]

Standard Treatment Approaches for Glioma

Surgery: The Foundation of Glioma Treatment

For most patients with glioma, surgery is the first step in treatment. The goal of surgery, called a resection, is to remove as much of the tumor as possible without damaging surrounding healthy brain tissue. Neurosurgeons at specialized centers perform hundreds of these procedures each year, using advanced imaging and navigation tools to guide their work. In some cases, patients remain awake during surgery so doctors can monitor brain function in real time, ensuring that critical areas controlling speech or movement are not harmed.^[9][13]

The tissue removed during surgery serves a dual purpose. First, it reduces the mass of the tumor, which can relieve pressure inside the skull and improve symptoms such as headaches, seizures, or weakness. Second, the tissue is sent to a laboratory where pathologists examine it closely to determine the exact type and grade of glioma. This information is vital because it guides all subsequent treatment decisions.^[9]

Not all gliomas can be completely removed through surgery. Some tumors grow in locations that make complete removal too risky, such as deep within the brainstem or near vital structures. In these cases, surgeons may perform a partial resection or a biopsy—a procedure where only a small sample of tissue is taken for diagnosis. A stereotactic biopsy uses imaging guidance to precisely target the tumor through a small opening in the skull.^[9]

Radiation Therapy: Targeting Remaining Cancer Cells

Radiation therapy uses high-energy rays to destroy cancer cells that remain after surgery. It is a cornerstone of glioma treatment, particularly for higher-grade tumors. The radiation is carefully directed at the tumor site using advanced planning to minimize exposure to healthy brain tissue. Treatment typically involves daily sessions over several weeks, with the exact duration depending on the tumor type and grade.^[9][16]

For some patients with lower-grade gliomas, radiation may be delayed until there are signs that the tumor is growing. This approach, sometimes called “watch and wait,” allows patients to avoid the side effects of radiation when the tumor is stable. However, for aggressive gliomas like glioblastoma, radiation usually begins within a few weeks after surgery.^[16]

Side effects of radiation therapy can include fatigue, skin irritation in the treated area, and temporary hair loss. Some patients experience changes in memory or thinking skills months or years after treatment, particularly if large areas of the brain were treated. Doctors carefully weigh these risks against the benefits when planning radiation treatment.^[9]

Chemotherapy: Using Medications to Fight Cancer

Chemotherapy refers to cancer-fighting drugs that can be given as pills, through intravenous infusions, or even as wafers placed directly into the brain during surgery. The most commonly used chemotherapy drug for gliomas is temozolomide, which is taken as a pill. For glioblastoma, the standard approach involves taking temozolomide daily during radiation therapy, followed by additional cycles of higher doses after radiation ends. This combination has been shown to extend survival compared to radiation alone.^[9][12]

For certain types of gliomas, particularly those with specific genetic markers such as 1p/19q codeletion found in oligodendrogliomas, chemotherapy plays an even more important role. These tumors tend to respond better to drugs called PCV (a combination of procarbazine, CCNU, and vincristine) or temozolomide.^[12][16]

Another chemotherapy option is carmustine wafers, which are small discs placed directly into the cavity left after tumor removal. These wafers slowly release chemotherapy over several weeks, delivering high doses directly to the tumor site while limiting side effects to the rest of the body.^[12]

Chemotherapy side effects depend on the specific drugs used but commonly include nausea, fatigue, increased risk of infections due to low blood cell counts, and in some cases, lung or liver toxicity with long-term use. Doctors monitor patients closely through blood tests to adjust doses or pause treatment if side effects become severe.^[9]

Other Standard Therapies

In addition to surgery, radiation, and chemotherapy, some patients may benefit from tumor-treating fields, a therapy that uses electrical fields to disrupt cancer cell division. This treatment involves wearing a device on the scalp that delivers low-intensity electric fields continuously. Studies have shown it can extend survival when combined with temozolomide for glioblastoma, adding several months on average.^[12]

Patients may also receive medications to manage symptoms such as seizures (with anti-epileptic drugs), brain swelling (with corticosteroids like dexamethasone), or blood clots (with anticoagulants). These supportive treatments are an important part of maintaining quality of life during and after cancer therapy.^[9]

Treatment in Clinical Trials: Exploring New Hope

While standard treatments have improved outcomes for many patients with glioma, the search for more effective therapies continues through clinical trials. These research studies test new drugs, new combinations of existing treatments, or entirely novel approaches to fighting cancer. Participation in a clinical trial may give patients access to cutting-edge therapies that are not yet available to the general public.^[11][13]

Understanding Clinical Trial Phases

Clinical trials are conducted in phases, each with a specific purpose. Phase I trials focus primarily on safety, testing new drugs in small groups of patients to determine the correct dose and identify side effects. Phase II trials expand to larger groups to assess whether the treatment shows signs of effectiveness against the tumor. Phase III trials compare the new treatment directly to the current standard of care in large numbers of patients to determine if it offers better outcomes.^[12]

Patients considering clinical trials should discuss eligibility requirements with their healthcare team. Trials may be available at specialized cancer centers in various locations, including the United States, Europe, and other regions around the world.^[11]

Targeted Therapies Based on Genetic Mutations

One of the most promising areas of research involves developing drugs that target specific genetic changes in glioma cells. For example, tumors with mutations in the PDGFRA gene (platelet-derived growth factor receptor alpha) may respond to drugs that block the signals this gene produces. A drug called avapritinib, already approved for other types of cancer, is being studied in high-grade gliomas with PDGFRA mutations. Early research has shown that this drug can cross the blood-brain barrier—a major challenge for many brain tumor treatments—and shut down the abnormal signaling in tumor cells. In small studies, some patients experienced tumor shrinkage and tolerated the drug well.^[15]

For gliomas with IDH mutations, researchers are testing drugs called IDH inhibitors. These medications work by blocking the abnormal enzyme produced by the mutated IDH gene, which contributes to tumor growth. Early trials have shown that these drugs may slow tumor progression and delay the need for more intensive treatments like chemotherapy or radiation, potentially maintaining quality of life for longer periods.^[13]

Immunotherapy: Training the Immune System to Fight Cancer

Immunotherapy represents a revolutionary approach to cancer treatment by harnessing the body’s own immune system to recognize and attack tumor cells. Several types of immunotherapy are being tested in glioma clinical trials.^[12]

One approach involves vaccine therapy, where patients receive injections designed to teach their immune cells to recognize specific proteins found on glioma cells. These vaccines don’t prevent the disease like traditional vaccines; instead, they stimulate an immune response against existing tumors.^[12]

Another strategy uses checkpoint inhibitors, drugs that remove the “brakes” on the immune system. Cancer cells often exploit these checkpoints to hide from immune attack. By blocking these protective mechanisms, checkpoint inhibitors can help immune cells find and destroy tumor cells. While these drugs have shown remarkable success in other cancers, their effectiveness in gliomas is still being studied, as brain tumors have unique ways of evading the immune system.^[12]

Gene Therapy and Viral Approaches

Some clinical trials are exploring the use of modified viruses to attack glioma cells. These viruses are engineered in the laboratory to infect and kill cancer cells while leaving healthy cells unharmed. Once inside the tumor, the viruses replicate and destroy cancer cells from within, and as the cancer cells break apart, they release signals that attract immune cells to join the fight.^[12]

Combination Approaches

Many current clinical trials test combinations of different treatment types rather than single new drugs. For example, researchers are studying whether adding immunotherapy to standard chemotherapy and radiation produces better results than standard treatment alone. Other trials combine targeted drugs with chemotherapy or explore sequences where one treatment is given first to make tumors more vulnerable to a second treatment.^[12]

Most common treatment methods

• Surgical resection
  • Removal of as much tumor tissue as possible through an operation called a craniotomy
  • May be a total resection (removing all visible tumor) or partial resection depending on tumor location
  • Sometimes performed with the patient awake to monitor brain function during surgery
  • Stereotactic biopsy when full removal is not safe, using imaging-guided needles to obtain tissue samples
• Radiation therapy
  • Uses high-energy rays to kill cancer cells remaining after surgery
  • Typically given daily over several weeks
  • Treatment is carefully planned to minimize damage to healthy brain tissue
  • May be delayed for some low-grade gliomas under observation
• Chemotherapy
  • Temozolomide is the most commonly used chemotherapy drug, taken as pills
  • PCV combination (procarbazine, CCNU, and vincristine) for certain glioma types with specific genetic markers
  • Carmustine wafers placed directly into the surgical cavity to deliver medication locally
  • Duration ranges from several months to over a year depending on tumor type and response
• Tumor-treating fields
  • Device worn on the scalp that delivers low-intensity electrical fields
  • Disrupts cancer cell division and has been shown to extend survival when combined with temozolomide
  • Requires wearing the device for most of the day
• Targeted therapy
  • Drugs designed to block specific molecular changes in tumor cells
  • Avapritinib for tumors with PDGFRA gene mutations
  • IDH inhibitors for gliomas with IDH gene mutations
  • These treatments are often available through clinical trials or expanded access programs
• Immunotherapy
  • Vaccine therapies that train the immune system to recognize tumor proteins
  • Checkpoint inhibitors that remove blocks on immune cell activity
  • Currently being tested in clinical trials for various types of gliomas
• Supportive medications
  • Anti-epileptic drugs to control seizures
  • Corticosteroids like dexamethasone to reduce brain swelling
  • Anticoagulants to prevent blood clots
  • Medications to manage pain, nausea, and other symptoms