Management of recurrent high-grade gliomas
- Tracy Batchelor, MD, MPH
Tracy Batchelor, MD, MPH
- Giovanni Armenise Professor of Neurology
- Harvard Medical School
- Helen A Shih, MD
Helen A Shih, MD
- Associate Professor of Radiation Oncology
- Harvard Medical School
- Attending Radiation Oncologist
- Massachusetts General Hospital
- Bob S Carter, MD, PhD
Bob S Carter, MD, PhD
- Professor and Division Chief of Neurosurgery
- University of California - San Diego
- Section Editors
- Jay S Loeffler, MD
Jay S Loeffler, MD
- Section Editor — Neurooncology
- Professor of Radiation Oncology
- Harvard Medical School
- Patrick Y Wen, MD
Patrick Y Wen, MD
- Section Editor — Neurooncology
- Professor of Neurology
- Harvard Medical School
High-grade gliomas are malignant and often rapidly progressive brain tumors that are divided into anaplastic gliomas (anaplastic astrocytoma, anaplastic oligodendroglioma, and anaplastic oligoastrocytoma) and glioblastoma based upon their histopathologic features . (See "Classification and pathologic diagnosis of gliomas", section on 'Histopathologic and molecular classification'.)
Despite the survival benefit associated with adjuvant radiation and chemotherapy, the majority of patients relapse following initial therapy. Progressive disease can be difficult to distinguish from radiation necrosis or other radiation-induced imaging changes, and this distinction has important implications for further treatment.
Treatment decisions for patients with recurrent or progressive high-grade glioma must be individualized, since therapy is not curative and there are no randomized trials that directly compare active intervention versus supportive care. The benefit of reintervention must be balanced by the risk of iatrogenic neurotoxicity and its impact on quality of life.
The management of patients with recurrent or progressive high-grade glioma, including surgery, radiation therapy, and systemic therapy, is discussed here.
Other aspects of the management of high-grade gliomas that are covered separately include:
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- EARLY PROGRESSION VERSUS PSEUDOPROGRESSION
- ASSESSMENT OF RESPONSE AND PROGRESSION
- GENERAL APPROACH
- Prognostic assessment
- Patients with good performance status
- Patients with poor performance status
- LOCALIZED THERAPY
- - Carmustine wafers
- - Involved field radiation
- - Stereotactic radiosurgery
- - Brachytherapy
- SYSTEMIC THERAPY
- - Efficacy
- - Dose
- - Side effects
- Temozolomide rechallenge
- ALTERNATING ELECTRIC FIELDS
- SUPPORTIVE CARE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS