NCCN Guidelines for Patients
Brain Cancer – Gliomas, Version 1.2016
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.
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
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
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.