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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016



Anaplastic astrocytomas

Maximal safe resection

A maximal safe resection is a treatment plan to

remove all or most of the tumor as is safe. Hopefully,

the whole tumor will be removed but fully removing

anaplastic astrocytoma is often hard to do. Removal

of the whole tumor is called a gross total resection.

During surgery, your surgeon may decide that the

whole tumor can’t be removed. Removing only part

of the tumor is called a subtotal resection.

Carmustine wafers

Placement of carmustine wafers during surgery

may be an option. Wafers are sometimes used

for high-grade gliomas. Carmustine is a type of

chemotherapy. The wafers will be placed into the

space where the tumor was and will dissolve after

the surgical cut is closed.

Research has shown that this added treatment

may help extend life. However, if you receive

more chemotherapy after surgery, you may have

more severe side effects than if you hadn’t had

carmustine. Also, you may not be able to join some

clinical trials because you received carmustine


Other surgeries

There are other options if it is known before surgery

that a maximal safe resection can’t be done. These

options are a subtotal resection, open biopsy, and

stereotactic biopsy. The removed tissue will be

tested to confirm diagnosis and cancer grade.

Tests after surgery

The removed tissue will be sent to a pathologist for

testing. The pathologist will confirm if there’s cancer,

and if so, the cancer grade. Molecular markers of

gliomas will also be assessed.

You should receive a brain MRI if you had a gross

total or subtotal resection. MRI should be done within

24 to 72 hours after surgery. Images will be made

with and without contrast. This test can confirm how

much of the cancer was removed. If you can’t have

MRI, you may receive a CT scan with and without


Post-surgery treatment

Guide 6 also lists options for treatment after surgery.

Options are based on your performance status,

which is your ability to do activities. The KPS







tatus) is a rating system

used to score performance status. Scores range

from 0 to 100. The lower the score, the less able you

are to care for yourself.

You may have three options if your KPS score is

60 or higher. One option is to receive fractionated

EBRT. Another option is fractionated EBRT with

temozolomide. Temozolomide is often received

during and after EBRT. The third option is

chemotherapy with PCV or temozolomide.

You may have three options if your KPS score

is 59 or less. One option is to receive EBRT.

Hyperfractionated is preferred over fractionated

radiation. Another option is chemotherapy with PCV

or temozolomide. The third option is supportive care.

Supportive care aims to improve your quality of life.

It includes treatment for symptoms caused by the

cancer or prior treatment.