An integrated approach to solving the problem of highly malignant glial tumors

INTRODUCTION. High-grade gliomas are known as therapeutically resistant tumors. Over the past 35 years, their number has doubled. The processes occurring in the peritumoral zone directly affect the progression of the tumor process. The life expectancy of patients is the result of the work of a large number of specialists working in neurosurgery and for the needs of neurosurgery. These include, along with neurosurgeons, doctors of radiation diagnostics, neuromorphologists, geneticists, rehabilitation specialists, specialists working in the field of studying and assessing the contribution of oncogenic factors to the development of malignant gliomas. MATERIALS AND METHODS. The study material was current biopsies of 72 highly malignant glial tumors. Astrocytoma, with a mutation in the IDH genes, was classified as Grade IV (42 cases), glioblastoma, without mutations in the IDH genes (30   cases). The peritumorous zone of the tumors was studied, where inflammation was detected, which, when aggravated, accelerates the proliferation processes. RESULTS. Glioblastoma without mutations in the IDH genes in the studied material accounted for 41.7 %, astrocytoma with mutations in the IDH genes, respectively, accounted for 58.3 %. A detailed study of the peritumorous zone made it possible to   carry out etiotropic therapy using antiviral drugs aimed at combating exacerbation of chronic inflammation. With this approach, survival without continued growth was 17.2 months for glioblastoma, while in the control group, where antiviral treatment was not used – 6.1 months. Overall survival up to 1 year in the group of patients who received antiviral treatment in the early postoperative period was 95.8%, in the control group 43.5 %. The obtained results of complex treatment of patients with   glioblastomas as well as with astrocytomas, with a mutation in the IDH genes classified as Grade IV. Showed a significant improvement in one-year survival in this group. The emergence of mutations leading to the development of glioblastoma is usually spontaneous and has no proven association with most external factors. Risk estimates are calculated for a group of people, determined by gender, year of birth, ethnicity, occupation, lifestyle or other characteristics, as well as for specific exposure conditions. In accordance with the Law of the Republic of Belarus dated 26.05.2012 No. 385-Z «On the legal regime of territories subjected to radioactive contamination as a result of the Chernobyl disaster» it is approved to develop and implement new approaches to reduce the level of radioactive contamination of the territory and its harmful effects on people (taking into account other harmful factors, development of programs to overcome the consequences of the disaster, distribution of material and technical resources and finances allocated for these purposes, financing of scientific and technical programs covering various aspects of research to assess the long-term impact of the radiation factor).The use of rehabilitation to prolong the comfort of life for patients with glioblastoma, taking into account the individual characteristics of patients who have lost functions related to the surgical intervention area, cannot be underestimated. CONCLUSION. Methods of surgical interventions on the brain are constantly being improved, new methods are constantly being proposed for specific localizations taking into account many factors that have not yet received a clear classification. Unification of various approaches taking into account clinical, morphological and genetic characteristics will significantly improve treatment results patients of this category. In addition, existing methods of treating highly malignant gliomas often require multiple surgical interventions, which should also be worked out in detail with a possible individual approach. This will allow for the introduction of a systemic approach to surgical interventions along with consideration of general practices for specific localizations. Systematization of the multifactorial approach with the help of legal support will facilitate the work of specialists, facilitating their work in basic areas with patients.

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