An integrated approach to solving the problem of developing criteria for clinical course and early progression for patients with glioblastomas

High-grade gliomas are the most aggressive form of brain tumors; the average survival rate of patients with this diagnosis does not exceed one and a half years. Tumors occur with a frequency of three cases per 100 thousand population per year. Over the past 35 years, their number has doubled. Malignant gliomas are the third most common cause of death from neoplasms in the group of young people under the age of 35 years.

AIM. To study the possibilities of an integrated approach to solving the problem of developing criteria for the characteristics of the clinical course and early progression for patients with glioblastomas, taking into account the growth mechanisms of gliomas.

MATERIALS AND METHODS. Archival biopsies of 425 glioblastomas in patients from 18 to 80 years old, operated on at the Republican Scientific and Practical Center of Neurology and Neurosurgery (Minsk). Immunohistochemical markers were used to identify factors responsible for tumor growth rate. The number of vessels was determined, which was counted under the control of monoclonal antibodies to CD34; monoclonal antibodies CD45 (total leukocyte factor), CD8 (T-lymphocytes), CD20 (B-lymphocytes), P53 were used to identify inflammatory infiltration. Comprehensive studies of 6 deceased patients with glioblastoma aged from 18 to 63 years were also used using post-mortem MRI (Russian Research Institute named after Prof. A.L. Polenov). The studied tumors according to the WHO classification belong to glioblastoma NOS, when studies of mutations of the IDH1 and IDH genes were not performed.

RESULTS. The time of relapse-free period in patients with glioblastomas, as well as ten-year survival rate, were analyzed, problems arising in the diagnosis and treatment of patients in this category, problems arising during rehabilitation, as well as the legal framework that one has to face when conducting research in neurosurgery were studied, and points related to the risks of surgical interventions.

CONCLUSION. To achieve results in increasing the survival rate of patients with glioblastoma, an integrated approach is required to study the heterogeneity of the tumor, develop individual technologies for surgical interventions taking into account the mechanisms of tumor growth and its individual characteristics associated with the histological form in close connection with its molecular genetic characteristics. To reduce the percentage of disability, rehabilitation is required to be as individual as the approach to surgical intervention. By studying the possibilities of cellular technologies in cell cultures, new approaches to the treatment of glioblastoma may be identified. The development of legal support for surgical interventions for patients with highly malignant gliomas is a serious problem for implementation within the framework of the convergence of the legislation of the Republic of Belarus and the Russian Federation on ensuring equal rights of citizens of the Union State.

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