Note: Some citations in the text of this section are followed by a level of evidence. The PDQ editorial boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
For patients with glioblastoma (World Health Organization grade IV), the cure rate is very low with standard local treatment. These patients are appropriate candidates for clinical trials designed to improve local control by adding newer forms of treatment to standard treatment. (Refer to the Glioblastoma section in the Classification section of this summary for more information.) Age may not be a survival factor. Recent reviews and case studies have shown equal survival for patients older than 65 years if they are treated regardless of age.[1,2,3,4]
Note: Some citations in the text of this section are followed by a level of evidence. The PDQ Editorial Boards use a formal ranking system to help the reader judge the strength of evidence linked to the reported results of a therapeutic strategy. (Refer to the PDQ summary on Levels of Evidence for more information.)
There is no consensus as to the optimal treatment of newly diagnosed craniopharyngioma. Little data exist to compare the different modalities in terms of recurrence rate or quality...
Patients with glioblastoma multiforme aged 70 to 85 years were randomly assigned in a clinical trial (NCT00430911) to receive radiation therapy plus supportive care or supportive care only. Surgical resection was attempted in all patients, and the extent of surgery was the same in both groups. A survival benefit of 12.2 weeks was seen in the combined treatment group. The 21-week follow-up showed a median survival of 29.1 weeks for the 39 patients who received radiation therapy plus supportive care and 16.9 weeks for the 42 patients who received only supportive care. The hazard ratio of death in the radiation therapy arm was 0.47 (95% confidence interval [CI], 0.29-0.76; P = .002).[Level of evidence: 1iiA]
A randomized study of patients 60 years and older compared 60 Gy administered over the course of 6 weeks (standard course) with 40 Gy in 15 fractions administered over the course of 3 weeks (short course). Karnofsky performance status scores were similar. Overall survival (OS) was similar in the two groups in this underpowered study (lower-bound 95% CI, -13.7%).[Level of evidence: 1iiA]
Surgery plus radiation therapy and chemotherapy.[7,8,9,10,11]
A randomized cooperative study showed no additional benefit from brachytherapy added to external-beam radiation therapy (EBRT) and carmustine (BCNU).[Level of evidence: 1iiA]
BCNU-impregnated polymer (Gliadel wafer) implanted during initial surgery.
A randomized double-blinded controlled trial with 240 patients with high-grade glioma showed a survival advantage for patients who had BCNU-impregnated polymer placed intraoperatively at the time of initial surgery when they were compared with the placebo-treated group. The median survival was 13.9 months in the treated group and 11.6 months in the control group (OS, P = .03).[Level of evidence: 1iA]
Radiation therapy and concurrent chemotherapy.
A randomized study (European Organization for the Research and Treatment of Cancer [EORTC-26981]) of radiation therapy versus radiation therapy plus temozolomide followed by 6 months of adjuvant temozolomide in patients with newly diagnosed glioblastoma multiforme demonstrated a statistically significant increase in median survival of 3 months in the combination-treated group. The 2-year survival rate was 26.5% in the combination group compared with only 10.4% in the radiation-only group. The treatment is relatively safe and well tolerated.[14,15,16,17,18][Level of evidence: 1iiA]