Cerebral gliomas in adolescents and young adults: a scoping review of evidence gaps in diagnosis, treatment, and prognosis.

Abstract

Cerebral gliomas represent a heterogeneous group of tumours that pose unique diagnostic and therapeutic challenges. Adolescents and young adults (AYAs, 15-39 years) often fall into a clinical gap, receiving care modelled on paediatric or adult oncology, which may not address their distinct biological and psychosocial needs. A review was conducted to systematically map the existing literature on cerebral gliomas in AYAs and identify evidence gaps in diagnosis, treatment, and prognosis. Our scoping review was conducted following PRISMA-SR guidelines, using PubMed and Scopus to identify studies on gliomas in AYAs. Eligibility criteria consisted of articles focused on gliomas in AYAs, published in English between 2000 and 2024. Studies exclusively focused on AYA populations, as well as studies including AYAs within mixed populations, were considered eligible. Extracted data included study characteristics, population, interventions, and outcomes (survival, quality of life, molecular markers), which were synthesised thematically into epidemiology, molecular/histological profiles, treatments, outcomes, and psychosocial impacts. Our systematic review identified 33 studies on gliomas in AYAs. Most of the included studies (62.5%, n = 20) were published between 2020 and 2024. Geographically, the studies were primarily conducted in the USA (25%, n = 8), followed by Canada (9.4%, n = 3) and Europe (9.4%, n = 3). From an epidemiological perspective, gliomas were the most common cerebral tumours. Molecular analyses revealed overlap between pediatric- and adult-type alterations, emphasising diagnostic ambiguity and the need for comprehensive profiling. Treatment reports underscored surgery as central, with emerging roles for proton therapy, targeted agents, and immunotherapy, although the lack of AYA-specific trials remains a barrier. Prognostic and psychosocial studies highlight survival disparities associated with molecular markers and socioeconomic factors, as well as unmet needs related to fertility preservation, neurocognition outcomes, and palliative care.

Conclusion: The review identified major gaps, such as heterogeneous adoption of advanced diagnostic approaches, the absence of age-specific treatment protocols, and scarce research on long-term outcomes and quality of life in AYAs with gliomas. Addressing these issues requires AYA-focused clinical trials within a multidisciplinary care framework.

What is known: • Gliomas in adolescents and young adults (AYAs) present overlapping molecular and clinical features of paediatric and adult-type gliomas, determining diagnostic and therapeutic challenges in everyday care. • Current management of glioma in AYAs is usually extrapolated from paediatric or adult populations, with limited AYA-specific trials, without the presence of evidence-based guidlines.

What is new: • Our review has the aim to map the existing literature on cerebral gliomas in AYAs and to identify the major gaps in diagnosis, molecular profiling, treatment, outcome, and psychosocial aspects. • There is an urgent need to develop AYA-specific molecularly informed, multidisciplinary treatment strategies and clinical studies for gliomas focused on management and long-term outcomes.