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Management of recurrent malignant gliomas

INTRODUCTION

The malignant gliomas are rapidly progressive brain tumors that are divided into anaplastic gliomas (anaplastic astrocytoma, anaplastic oligodendroglioma, and anaplastic oligoastrocytoma) and glioblastoma (GBM) based upon their histopathologic features [1]. (See "Classification of brain tumors".)

Despite the survival benefit associated with adjuvant RT 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. (See "Complications of cranial irradiation", section on 'Radiation necrosis'.)

The optimal management for patients with recurrent or progressive malignant glioma is unclear, 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 malignant glioma, including surgery, radiation therapy (RT), and systemic therapy, is discussed here.

Other aspects of the management of malignant gliomas that are covered separately include:
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