High-grade glioma management and response assessment-recent advances and current challenges

The management of high-grade gliomas (HGGS) is complex and ever-evolving. The standard of care for the treatment of HGGS consists of surgery, chemotherapy, and radiotherapy. However, treatment options are influenced by multiple factors such as patient age and performance status, extent of tumour resection, biomarker profile, and tumour histology and grade. Follow-up cranial magnetic resonance imaging (MRI) to differentiate treatment response from treatment effect can be challenging and affects clinical decision-making. An assortment of advanced radiologic techniques-including perfusion imaging with dynamic susceptibility contrast MRI, dynamic contrast-enhanced MRI, diffusion-weighted imaging, proton spectroscopy, MRI subtraction imaging, and amino acid radiotracer imaging-can now incorporate novel physiologic data, providing new methods to help characterize tumour progression, pseudoprogression, and pseudoresponse. In the present review, we provide an overview of current treatment options for HGG and summarize recent advances and challenges in imaging technology.