Treatment of malignant glioma in adults

Most patients with malignant glioma are no better in 1995 than they did 30 years ago. However, high quality precision stereotactic biopsy is available in most centres, tumour resection is safer and more thorough than ever, focused radiation methods are achieving similar rates of tumour control while exposing normal tissues to lower doses of radiation, novel systems for regional drug delivery are being developed, and the chemosensitive nature of oligodendrogliomas has been firmly established. Clinical investigators are now willing to look more critically at methodological issues and address shortcomings in the design and conduct of future phase II and III trials. These advances, although modest, set the stage for a careful and critical evaluation of the first generation of molecular therapies for malignant glioma in adults.