NCCN Guidelines for Patients
Brain Cancer – Gliomas, Version 1.2016
addresses follow-up care. Follow-up care
is started when your doctor thinks that the cancer
has been fully treated. A brain MRI is advised at 2 to
6 weeks after radiation therapy has ended. Images
will be made with and without contrast.
At first, your brain may look worse in the scans
because of the radiation. However, these results may
not mean that the cancer is growing. Instead, early
scans are used to give you the right dose of steroids
and check for tumor growth beyond where radiation
Later scans are used to find any new brain tumors
early. A brain MRI is advised every 2 to 4 months for
2 to 3 years. If these results are stable, then MRIs
are needed less often. If you can’t have MRI, you
may receive a CT scan with and without contrast.
lists treatment options for a recurrence.
In addition, a clinical trial may be another option.
A recurrence is the return of cancer after a period
of time without signs of cancer. MRI results during
follow-up care may have suggested a recurrence.
However, tissue death from radiation can look like a
tumor on an MRI scan. Getting an MR spectroscopy,
MR perfusion, or brain PET may help your doctor
decide if there’s cancer.
If there’s a recurrence, options are based on if the
cancer is or is not widespread in your brain. These
options include chemotherapy. Regimens for a
recurrence are temozolomide, lomustine, carmustine,
PCV, irinotecan, cyclophosphamide, etoposide, and
platinum-based regimens. Bevacizumab (targeted
therapy) may also be received. Chemotherapy may
be added to bevacizumab if it doesn’t work by itself.
The cancer isn’t widespread
Your surgeon will assess if surgery is an option.
If you undergo surgery, you may have the option
to receive carmustine wafers. The wafers will be
inserted into your brain after the tumor is removed.
You may not be able to join some clinical trials if you
receive carmustine wafers.
After surgery, a brain MRI is advised within 24 to 72
hours to assess results. If you can’t have MRI, you
may receive a CT scan. Images will be made with
and without contrast.
After surgery, you may receive more treatment if
you are healthy enough. One option is to receive
chemotherapy. Another option is to receive radiation
therapy again. Radiation may work well if it’s been
a long time since your last radiation treatment or it
worked well before.
Supportive care aims to improve your quality of life.
It includes treatment for symptoms caused by the
cancer or prior treatment. It is an option if you can’t
have more cancer treatment after surgery. It is also
an option if the recurrence can’t be treated with
The cancer is widespread
Widespread cancer may be treated with
chemotherapy if you are healthy enough. A KPS
score of 60 or higher is a sign of good health.
However, you and your doctor should discuss what’s
best for you. Surgery may also be an option for large
tumors causing symptoms. If your KPS score is 59
or less, you may receive supportive care to improve
your quality of life.