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.)

STANDARD TREATMENT OPTIONS:

1. Surgery alone or in conjunction with chemotherapy.[1,2,3]
2. Radiation therapy if not previously used, alone or with chemotherapy.
3. Interstitial radiation therapy.[4]
4. Chemotherapy.[5]
5. In a nonrandomized trial of patients with recurrent anaplastic oligodendrogliomas and oligoastrocytomas, significant response rates (i.e., 29% complete response and 29% partial response) were seen with procarbazine, lomustine, and vincristine after radiation therapy.[6][Level of evidence: 3iiiDiii] Time to progression was prolonged in both tumor types.

TREATMENT OPTIONS UNDER CLINICAL EVALUATION:

• Numerous clinical trials (particularly phase II trials) are evaluating the use of newer drugs in the treatment of brain tumors.
• Carmustine (BCNU)-impregnated polymer may be implanted during surgery.[7,8]

Information about ongoing clinical trials is available from the NCI Web site.

References:

1. Salcman M, Kaplan RS, Ducker TB, et al.: Effect of age and reoperation on survival in the combined modality treatment of malignant astrocytoma. Neurosurgery 10 (4): 454-63, 1982.
2. Rodriguez LA, Levin VA: Does chemotherapy benefit the patient with a central nervous system glioma? Oncology (Huntingt) 1 (9): 29-36, 40-1, 1987.
3. Young B, Oldfield EH, Markesbery WR, et al.: Reoperation for glioblastoma. J Neurosurg 55 (6): 917-21, 1981.
4. Leibel SA, Gutin PH, Sneed PK, et al.: Interstitial irradiation for the treatment of primary and metastatic brain tumors. Cancer: Principles and Practice of Oncology Updates 3 (7): 1-11, 1989.
5. Chinot OL, Honore S, Dufour H, et al.: Safety and efficacy of temozolomide in patients with recurrent anaplastic oligodendrogliomas after standard radiotherapy and chemotherapy. J Clin Oncol 19 (9): 2449-55, 2001.
6. Brandes AA, Tosoni A, Vastola F, et al.: Efficacy and feasibility of standard procarbazine, lomustine, and vincristine chemotherapy in anaplastic oligodendroglioma and oligoastrocytoma recurrent after radiotherapy. A Phase II study. Cancer 101 (9): 2079-85, 2004.
7. Brem H, Piantadosi S, Burger PC, et al.: Placebo-controlled trial of safety and efficacy of intraoperative controlled delivery by biodegradable polymers of chemotherapy for recurrent gliomas. The Polymer-brain Tumor Treatment Group. Lancet 345 (8956): 1008-12, 1995.
8. Brem H, Ewend MG, Piantadosi S, et al.: The safety of interstitial chemotherapy with BCNU-loaded polymer followed by radiation therapy in the treatment of newly diagnosed malignant gliomas: phase I trial. J Neurooncol 26 (2): 111-23, 1995.