Seizures, Edema, Thrombosis, and Hemorrhages: An Update Review on the Medical Management of Gliomas

Abstract

Patients affected with gliomas develop a complex set of clinical manifestations that deeply impact on quality of life and overall survival. Brain tumor-related epilepsy is frequently the first manifestation of gliomas or may occur during the course of disease; the underlying mechanisms have not been fully explained and depend on both patient and tumor factors. Novel treatment options derive from the growing use of third-generation antiepileptic drugs. Vasogenic edema and elevated intracranial pressure cause a considerable burden of symptoms, especially in high-grade glioma, requiring an adequate use of corticosteroids. Patients with gliomas present with an elevated risk of tumor-associated venous thromboembolism whose prophylaxis and treatment are challenging, considering also the availability of new oral anticoagulant drugs. Moreover, intracerebral hemorrhages can complicate the course of the illness both due to tumor-specific characteristics, patient comorbidities, and side effects of antithrombotic and antitumoral therapies. This paper aims to review recent advances in these clinical issues, discussing the medical management of gliomas through an updated literature review.

Influencing Factors and Nomogram for the Development of Epilepsy in Advanced Lung Cancer Patients With Brain Metastases

“…In addition, a retrospective study by Gaggero et al (2009) reported that epilepsy is a common symptom in pediatric patients with supratentorial brain tumors, with a high rate of 53.57%. Patients with brain tumors or BM are at risk for intracranial hemorrhage (ICH), which can occur as an early clinical manifestation of brain tumors, or as a complication of cancer treatment (Zoccarato et al, 2021). Wakai et al (1982) conducted a retrospective study and confirmed that spontaneous ICH was observed in 94 out of 1861 patients with brain tumors.…”

Assessment of radiographic and prognostic characteristics of programmed death-ligand 1 expression in high-grade gliomas

“…Glioma-associated edema is considered to be vasogenic and is caused by increased vascular permeability [34]. This vascular permeability is due to immature tumor vessels that are induced by an excessive secretion of angiogenetic factors, such as the vascular endothelial growth factor (VEGF) [35]. VEGF expression is shown to be positively associated with PD-L1 expression in several cancers, including gliomas [36][37][38].…”

Treatment patterns and outcomes for patients with newly diagnosed glioblastoma multiforme: a retrospective cohort study

“…A meta-analysis of patients with GBM (22 publications, n = 8752) also showed that steroid treatment was associated with shorter OS (HR: 1.54; 95% CI: 1.37–1.75; p < 0.01) and PFS (HR: 1.28; 95% CI: 1.1–1.49; p < 0.01) [ 21 ]. The difference in survival outcomes may be due to the fact that patients with more severe GBM are more likely to receive steroid treatment, which is the standard of care for decreasing brain edema and for alleviating symptoms such as pain and loss of appetite [ 22 ]. As for methylation status, there were no significant differences in OS or PFS when comparing steroid use with non-use within the methylated cohort or when comparing steroid use with non-use within the unmethylated cohort in this study.…”