Navigating brain tumors: A comprehensive insight into epidemiology, mechanisms, diagnosis, and emerging therapeutic frontiers

Abstract

Brain tumors are a heterogeneous group of neoplasms with diverse histopathological, molecular, and clinical features. Despite advances in diagnosis and treatment, malignant brain tumors continue to cause significant morbidity, mortality, recurrence, and therapeutic resistance. Genetic and epigenetic alterations, metabolic reprogramming, tumor microenvironment, and immune evasion play important roles in tumor progression and treatment response. This review summarizes current advances in brain tumor epidemiology, classification, molecular biology, diagnosis, treatment, and precision medicine. Molecular markers including IDH1/2, 1p/19q, MGMT, EGFR, TERT, ATRX, TP53, H3, and BRAF contribute to tumor classification, prognosis, and therapeutic decision-making. Conventional management includes surgery, radiotherapy, and chemotherapy, while emerging approaches include targeted and immune-based therapies, cancer vaccines, CAR-T/CAR-NK cells, oncolytic viruses, nanotechnology, gene/RNA therapies, ferroptosis-based strategies, and artificial intelligence-assisted precision oncology. Advanced neuroimaging, liquid biopsy, radiomics, and molecular profiling are also improving diagnostic and prognostic assessment. However, intratumoral heterogeneity, blood–brain barrier limitations, recurrence, treatment resistance, and toxicity remain major challenges. Integrating molecular classification, advanced diagnostics, and individualized therapies may improve brain tumor management and support the development of more effective and durable treatment strategies.