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Treatment of recurrent high-grade gliomas

April 1, 2011|The Journal of Community and Supportive Oncology
Myrna R. Rosenfeld, MD, PhD;Karen Albright, CRNP;Amy A. Pruitt, MD
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Despite treatment, glioblastoma (GB) inevitably recurs, and there is often no clear standard of care to follow. This article reviews the treatment options for recurrent GB and anaplastic gliomas. The three FDA-approved treatments for recurrent GB are biodegradable carmustine-impregnated wafers; bevacizumab; and the NovoTTF-100A System, which delivers low-intensity, alternating electrical fields to the tumor bed. Treatment decisions must take into consideration prior therapies, the extent and location of recurrence, and the patient’s general medical condition, as well as the rapidity of tumor growth, extent of edema, mass effect, need for steroids, and symptoms. New treatment strategies are emerging based on the identification of prognostic and predictive markers and defining distinct molecular subtypes of GB.


Conclusion

High-grade gliomas are challenging to treat, and there is often no clear standard of care. The Glioma Outcomes Project tracked clinical practice patterns and outcomes among North American patients with malignant glioma between 1997 and 2000.43 The results showed that patients treated at academic centers were significantly more likely to receive chemotherapy or radiation therapy, to participate in clinical trials, and to have longer survival times than those treated at community centers. Whether these results would be the same today, with the routine use of temozolomide and bevacizumab, is unclear, but they do support referral of these patients to centers with multispecialty clinics. This is, however, not always feasible, and patients may choose to stay close to home.

For patients with recurrent high-grade gliomas, there are several available therapeutic options, including operation, irradiation, and additional systemic therapies, which are available at most centers. Although the optimal sequence in which therapies should be given has not been clarified, these treatments can delay the onset of neurologic deficits and result in improved quality of life and likely prolonged survival. Additionally, the appropriate management of comorbidities such as seizures and brain edema is essential, and several pertinent reviews are available.44,45

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