Development of effective treatments for high-grade glioma (HGG) is hampered by (1) the blood–brain barrier (BBB), (2) an infiltrative growth pattern, (3) rapid development of therapeutic resistance, and, in many cases, (4) dose-limiting toxicity due to systemic exposure. Convection-enhanced delivery (CED) has the potential to significantly limit systemic toxicity and increase therapeutic index by directly delivering homogenous drug concentrations to the site of disease. In this review, we present clinical experiences and preclinical developments of CED in the setting of high-grade gliomas.

Background: Surgery is an intrinsic component of healthcare, estimated to be involved in the treatment of 28–32% of the global burden of disease. Research is crucial to improving the quality of surgical care and thus patient outcomes. The aim of this study was to analyse global patterns of public and philanthropic investment in surgical research. Methods: Publicly available databases of human surgical research funding awards between 2016 and 2020 were searched. Awards were categorized by surgical specialty, cross-cutting research theme, and phase of research. Results: A total of 8042 awards were identified, with a total investment of $3.48 billion between 2016 and 2020 (approximately $0.7 billion annually), contrasting with $24.5 billion for cancer research in the same interval. Preclinical research received most of the funding ($2.46 billion (70.7%)), clinical trials received $0.72 billion (20.6%), and public health research received $0.30 billion (8.6%). By cross-cutting research theme, the largest investment was into intraoperative research ($1.4 billion (40.94%)), followed by postoperative research ($0.76 billion (21.9%)), preoperative/neoadjuvant studies ($0.43 billion (12.3%)), and interventional radiology ($0.04 billion (1.2%)). Global surgery was the least well-funded area of research ($0.03 billion (0.8%)). Conclusion: Surgical research remains underfunded in comparison with other specialties, with most investment directed towards preclinical research, not directly involving patients. Only a small proportion was invested in clinical trials, public health, and global surgery. These findings limit the impact of surgical research on improving population health and contrast starkly with the ubiquity of surgical treatments in the management of the global burden of disease. Urgent prioritization of surgical research and evaluation of priorities in research investment are required, to reflect surgery’s pivotal role in global healthcare.

Development of effective treatments for high-grade glioma (HGG) is hampered by 1) the blood-brain barrier (BBB), 2) an infiltrative growth pattern, 3) rapid development of therapeutic resistance, and, in many cases, 4) dose-limiting toxicity due to systemic exposure. Convec-tion-enhanced delivery (CED) has the potential to significantly limit systemic toxicity and in-crease therapeutic index by directly delivering homogenous drug concentrations to the site of disease. In this review, we present clinical experiences and preclinical developments of CED in the setting of high-grade gliomas.

Accurate information about locoregional treatments in breast cancer neoadjuvant systemic therapy (NST) trials is vital to support surgical decision-making and allow meaningful interpretation of long-term oncological outcomes. This systematic review (PROSPERO registration CRD42023470891) aimed to describe the current practice of outcome reporting in NST studies. A systematic search identified primary research studies published 01/01/2018-08/09/2023 reporting outcomes in patients receiving NST for breast cancer followed by locoregional treatment. Included were randomised controlled trials (RCTs) and non-randomised studies (NRS) with >250 participants reporting at least one locoregional treatment outcome. Outcomes were extracted verbatim and categorised using content analysis. Descriptive statistics were used to summarise results. Of the 3111 abstracts screened, 137 studies (22 RCTs and 115 NRS) reporting at least one locoregional outcome in 575,531 patients were included. The 137 studies reported a total of 510 surgical outcomes with a median of 3 (range 1-12) per study. No single outcome was reported in all studies. Type of breast (n = 129, 94.2 %) and axillary (n = 86, 62.8 %) surgery were reported most frequently. Only 34 % (n = 47) studies reported how treatment response was assessed and if/how this informed surgical decision-making. Only a fifth (n = 28) reported outcomes relating to surgical de-escalation. Only 72 studies (52.6 %) reported any radiation therapy (RT)-related outcome, most frequently whether RT had been received (n = 63/72, 87.5 %). Current reporting of locoregional treatment outcomes in NST studies is poor, inconsistent and urgently needs to be improved. A core outcome set and reporting guidelines may improve the quality and value of future research.