Treatment of glioma is currently one of the most challenging problems in oncology, as well as in neurosurgery. Despite major advances in our understanding of the pathomechanism, diagnosis by imaging and the availability of powerful therapeutic tools, the life expectancy of patients with glioblastoma has only been slightly prolonged and a cure remains elusive. None of the currently available surgical tools, including operative microscopes, lasers and image-guided surgery, can enable the detection and removal of all of the tumor tissue. In recent years, however, the landscape has been changing immeasurably, and molecular studies over the past two decades have identified a variety of genetic aberrations that are specifically associated with individual types of gliomas. In addition, certain molecular abnormalities have been linked to therapy responses, thereby establishing clinical biomarkers and molecular targets, and the use of novel agents is being investigated. These agents have been specifically engineered to exert specific cytotoxicity against gliomas, either on their own as single agents or in combination with other modalities. Moreover, there has been an enormous surge of interest in the area of immunology and immunotherapy, which has been facilitated by our understanding of the molecular basis of gliomas. Although several kinds of immunotherapeutic trials have been undertaken, we still await a great breakthrough in terms of clinical efficacy to prolong the survival time of glioma patients.

This is truly an exciting time in the field of neuro-oncology, particularly in the area of hi- grade gliomas. The management of patients with high-grade gliomas has historically been one of the most challenging and disheartening fields in medicine, where failure is the rule and longevity is the exception. The jaded often state that despite purported advances in surgical and radiotherapeutic techniques and a myriad of clinical trials of medical therapies, the s- vival statistics for glioblastoma have not changed in the last three decades. The nihilism associated with these tumors is such that some practitioners still advise against treatment or even biopsy, recommending palliative care with the diagnosis based only on history and an MRI scan. If the current state-of-the-art in the diagnosis and management of high-grade gliomas was truly so bleak, there would be no reason to compile and publish a monograph on the subject. The fact is that we have recently entered an era where real progress is being made in our understanding and treatment of high-grade gliomas that is directly benefiting some patients. We are slowly but surely chipping away at this problem. One approach has exploited correlations between particular molecular markers and therapeutic response. The first such “breakthrough” in high-grade glioma was the observation that loss of chromosomes 1p and 19q uniformly predict chemosensitivity in anaplastic oligodendrogliomas (1).

Standard therapy for high grade glioma is a topic that is evolving, timely, and relevant. Guest Editors Isaac Yang, MD and Seunggu Han, MD have assembled a group of experts on management of high grade glioma. Some of the articles in this issue include: Use of language mapping to aid resection of eloquent gliomas; Clinical trials with immunotherapy; Clinical trials for small molecule inhibitors; Nanotechnology potential applications for GBM therapy; High Grade Gliomas in children; Modern Advances in Brain Tumor Treatments; Molecular pathways of Avastin interactions for the treatment of glioblastoma; and Quality of Life and Outcomes in Glioblastoma management.

Thoroughly revised to reflect the latest advances in neurosurgery, radiation oncology, chemotherapy, biological therapy, and the basic sciences, the Second Edition of this highly acclaimed volume is the most comprehensive, current reference on tumors of the central and peripheral nervous system. More than 100 of the foremost authorities present multimodality treatment strategies for specific tumor types and examine the mechanisms of tumorigenesis. Coverage includes state-of-the-art information on image-guided surgery, local delivery systems, intraoperative imaging, proton beam therapy, conformal systems, radiosurgery, new drugs and biological agents, and cell cycle deregulation and chromosomal abnormalities in tumorigenesis. This edition contains over 400 illustrations.