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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016

Glioblastomas and gliosarcomas

Glioblastoma is the most common brain cancer in

adults. Among every 100 adults with brain cancer, 54

have a glioblastoma. Thus, there is more research on

which to base treatment compared to other gliomas.

Gliosarcoma is a rare type of glioblastoma.

Surgery is very important for diagnosis and

treatment. The goals of surgery are to remove

enough tissue for testing, relieve symptoms, extend

life, and decrease the need for corticosteroids.

Corticosteroids are used to reduce swelling in the


Guide 9

lists treatment options for glioblastoma.

Your surgeon will assess how much of the tumor he

or she can remove. The amount that will be removed

depends on where the tumor is, your age and health,

and other factors. Your surgeon does not want you to

be less able to think, speak, and move afterward.

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

glioblastoma is often hard to do. Some tumors have

a tentacle-like growth pattern.

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. The 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 wafers.



Glioblastomas and gliosarcomas

Guide 9. Diagnosis and treatment


Your surgery status

What are the options?

Approved and agree to removing most of the tumor


• Maximal safe resection ± carmustine wafer

Approved and agree to removing some of the tumor


• Stereotactic biopsy


• Open biopsy


• Subtotal resection