NCCN Guidelines for Patients
Brain Cancer – Gliomas, Version 1.2016
Test and treatment overview
are lost, it is called a 1p19q co-deletion. PCR
eaction) and FISH (
ybridization) are tests that can show if
a deletion is present. Test results are used for
diagnosis and treatment planning. Radiation and
chemotherapy appear to treat cancer cells with
1p19q co-deletion better than cells without the
IDH1 and IDH2 mutations
IDH1 and IDH2 (
are proteins in cells. Many grade II and III gliomas
have mutations in the genes of these proteins. These
mutations are also found in glioblastomas that began
as grade II or III gliomas.
hemistry), PCR, or
pyrosequencing are tests for
mutations. Test results can help with diagnosis and
treatment planning. People treated with radiation
or alkylator chemotherapy tend to live longer if the
cancer cells have
MGMT promotor status
a protein in cells that repairs damaged DNA. It
helps repair DNA that was damaged by alkylator
The gene that helps to make MGMT is silenced
in some high-grade gliomas. The
silenced when the part of DNA that turns it on (called
a promotor region) is methylated. Methylated DNA
has added chemicals called methyl groups.
Tests for MGMT promotor methylation are PCR and
pyrosequencing. Test results are used for treatment
planning. Alkylator chemotherapy works better
overall for glioblastoma that has methylated MGMT
promotor regions compared to unmethylated regions.
Radiation therapy is used to treat gliomas that can’t
be removed by surgery. It is also used after surgery
to kill any cancer cells that remain in the brain.
Read Parts 3 through 5 to learn when radiation is an
option. What you can expect during radiation therapy
is briefly described next.
Radiation therapy is a cancer treatment that uses
high-energy, highly focused rays. The rays can be
x-rays, photons, or protons. The rays are delivered
to the tumor to damage DNA. This either kills the
cancer cells or stops new cancer cells from being
Radiation can also harm normal cells. Thus, your
radiation oncologist will use methods that limit how
much normal tissue receives radiation. A radiation
oncologist is a doctor who’s an expert in treating
cancer with radiation.
Depending on the type of glioma, radiation will be
delivered to the tumor plus some tissue around it that
may harbor cancer cells. The treated tissue around
the tumor is called the margin. Your radiation plan will
be tailored to you, your tumor, and your brain. You
are not radioactive after receiving radiation therapy.
herapy) is the
method used to treat gliomas. This method delivers
radiation from outside your body using a large
machine. The radiation passes through your skin
and other tissue to reach the tumor. You will not see,
hear, or feel the radiation.
To receive radiation, you must have a planning
(simulation) session. First, you will be guided and
adjusted into the position needed for treatment.
After this, pictures of your head and the tumor will
be taken with an imaging test. Usually, a CT scan is