Future Directions

A host of novel experimental therapies, including gene-based therapy and immunotherapy, have emerged based on our continually evolving understanding of HGG biology. The delivery of many of these newer therapies involves the technical expertise of the neurosurgeon [34]. The following examples of emerging therapeutic approaches emphasize how targeting specific aspects of glioma tumor biology translates into new treatment strategies, and how the delivery of these agents - often with novel techniques -is likely to further involve the neurosurgeon in the future treatment of HGG.

Immunotherapy approaches include the use of antibodies conjugated to radioactive compounds, or toxins directed against tumor-specific antigens (such as transferrin receptors, EGFRvIII, tenascin, and VEGF receptors). Tumor vaccines are being developed, and other means to boost inherent immune responses to tumor antigens, such as dendritic cell therapies, are being actively pursued. Gene therapy encompasses a multitude of different approaches as well. Early clinical trials of gene therapy used the local administration into glioma resection beds of retroviruses engineered with bacterial enzymes (thymidine kinase) capable of converting prodrugs (ganciclovir) into cytotoxic metabolites. Other, newer, gene-based

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