Recurrent High-Grade Glioma: Multiple Surgeries and Reirradiation

Abstract

Gliomas, representing the most common primary brain tumors, derive from cells resembling the CNS's normal glial components—astrocytes, oligodendrocytes, and ependymal cells. Notably, these tumors vary significantly in their biological aggressiveness. In this context, we explore the challenging journey of a 47-year-old man first diagnosed in 2007 with a grade III anaplastic oligoastrocytoma located in the frontal region. Initial treatment involved surgical resection, but unfortunately the tumor recurred locally four years later. A second surgery achieved complete removal, but histopathological findings confirmed the continued presence of grade III oligoastrocytoma. Following surgery, the patient received two cycles of adjuvant temozolomide chemotherapy. Considering the aggressive nature of the tumor, his age, and existing comorbidities, a combined approach of radiochemotherapy was subsequently adopted, followed by additional adjuvant chemotherapy. However, in 2023, he faced another setback—a second relapse. Subsequent surgical and histopathological evaluations disclosed a progression to grade IV astrocytoma. Postoperative treatment included six weeks of intensive concurrent radiochemotherapy. After completing this phase, he proceeded with ongoing chemotherapy, complemented by regular monitoring through serial brain MRIs. This case underscores the complexity and dynamism of glioma management and illustrates the critical need for tailored therapeutic strategies.