Cerebral gliomas account for 45% of all primary central nervous system (CNS) tumors. The median survival after the initial diagnosis of glioblastoma (GBM) is only 15 months, and less than 10% of patients survive three years post-diagnosis. Surgical treatment followed by adjuvant therapies such as radiotherapy and chemotherapy represents the classical strategy in glioma management.

The revised WHO 2016 classification now distinguishes the oligodendrogliomas with 1p19q codeletion and IDH mutation from the astrocytomas with or without IDH mutations, thereby creating homogenous and pathologically distinct subgroups. While the status of gene expression and mutations define components of GBM subtypes, it was also found that response to therapies was different for each subtype, suggesting that personalized treatment based on genomic alterations could lead to a more favorable outcome for this disease.

The presence of the blood-brain barrier selectively impedes the passage of numerous types of molecules inside the brain. This limits the efficacy of current drugs. The understanding of epigenetic modifications during neural differentiation and insight into oncogenesis processes will likely help in developing new epigenetic/genetic-based treatments acting upstream. These complex fields may reveal the most effective therapeutic modalities but need selective drug delivery systems to reach the tumor cells. Nanoparticles have recently emerged as a new frontier in reliable brain tumor therapy. Nanotechnology-based approaches to targeted delivery of drugs across the blood-brain barrier may be potentially engineered to carry out specific functions. Moreover, nanoparticles show tumor-specific targeting and long circulation times, with consequent low short-term toxicity. The molecular pharmacotherapeutic approach to high-grade gliomas includes gene therapy, antisense oligonucleotides, immunotherapy, small molecules inhibiting tyrosine kinase, farnesyltransferase and metalloproteinases.

Cerebral gliomas represent an interesting target for local gene therapy because of their restricted anatomical location and absence of metastases outside the CNS. This allows the delivery of vectors directly to the desired site with only a small risk of systemic toxicity. The blood-brain barrier selectively prevents the free passage of numerous molecules, especially macromolecules, such as many drugs are. The permeability of the blood-brain barrier is altered in the presence of a brain tumor. The efficacy of current anti-cancer strategies in gliomas is limited by the lack of specific therapies against malignant cells. Increased site-specificity and internalization could improve treatment efficacy while minimizing potential side effects.

In this Research Topic, we would like to present the recent advances in the diagnosis and therapy of glioma. Late translational/preclinical and clinical studies focusing on high-grade gliomas, especially glioblastoma are of particular interest. We welcome Original Research, Reviews, and Methods articles focusing on but not limited to:

1) Novel targeted therapies with a focus on high-grade gliomas, especially glioblastoma.
2) Novel strategies for brain drug delivery, including blood-brain barrier penetration along with novel therapies.
3) Irradiation pattern or systemic therapies at a preclinical or clinical level.
4) Innovative surgical approaches.
5) Novel experimental study on mechanisms of invasion of glioma.
6) Metabolism of a tumoral cerebral cell.

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