Skip to content

Brain Cancer Health Center

Font Size

Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview

continued...

Repeat radiation therapy (re-irradiation)

Because there are no randomized trials, the role of repeat radiation after disease progression or the development of radiation-induced cancers is also ill defined. The literature is limited to small retrospective case series, which makes interpretation difficult.[18] The decision to use repeat radiation must be made carefully because of the risk of neurocognitive deficits and radiation-induced necrosis. One advantage of radiosurgery is the ability to deliver therapeutic doses to recurrences that may require the re-irradiation of previously irradiated brain tissue beyond tolerable dose limits.

Chemotherapy

Systemic chemotherapy

For many years, the nitrosourea carmustine (BCNU) was the standard chemotherapy added to surgery and radiation for malignant gliomas. This was based upon a randomized trial (RTOG-8302) of 467 patients conducted by the Brain Tumor Study Group that compared four regimens after initial resection:[19]

  1. Semustine (methyl-CCNU).
  2. Radiation therapy.
  3. Radiation therapy plus carmustine.
  4. Radiation therapy plus semustine.

The radiation therapy plus carmustine arm had the best survival rate.[19][Level of evidence: 1iiA] A modest impact on survival using nitrosourea-containing chemotherapy regimens for malignant gliomas was confirmed in a patient-level meta-analysis of 12 randomized trials (combined HR death = 0.85; 95% CI, 0.78–0.91).[20]

However, the oral agent, temozolomide, has since replaced the nitrosoureas as the standard systemic chemotherapy for malignant gliomas based upon a large multicenter trial (NCT00006353) of glioblastoma patients conducted by the EORTC-National Cancer Institute of Canada that showed a survival advantage.[21,22][Level of evidence: 1iiA] In that study, 573 patients with glioblastoma were randomly assigned to receive standard radiation to the tumor volume with a 2- to 3-cm margin (60 Gy, 2 Gy per fraction, over 6 weeks) alone or with temozolomide (75 mg/m2 orally per day during radiation therapy for up to 49 days, followed by a 4-week break, and then up to six cycles of five daily doses every 28 days at a dose of 150 mg/m2 increasing to 200 mg/m2 after the first cycle). Patients in the combined therapy group were given prophylactic therapy for pneumocystis carinii during the period of concomitant radiation therapy and temozolomide. OS was statistically significantly better in the combined radiation therapy/temozolomide group (HR for death = 0.6; 95% CI, 0.5–0.7; survival at 3 years was 16.0% vs. 4.4%).

1|2|3|4|5|6|7|8|9|10
Next Article:

Today on WebMD

doctor and patient
How to know when it’s time for home care
doctory with x-ray
Here are 10 to know.
 
sauteed cherry tomatoes
Fight cancer one plate at a time.
Lung cancer xray
See it in pictures, plus read the facts.
 
Malignant Gliomas
Article
Pets Improve Your Health
SLIDESHOW
 
Headache Emergencies
Video
life after a brain tumor
VIDEO
 

Would you consider trying alternative or complementary therapies?


WebMD Special Sections