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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016



Anaplastic astrocytomas

Guide 7

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

was given.

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.

Guide 8

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.