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43

NCCN Guidelines for Patients

®

:

Brain Cancer – Gliomas, Version 1.2016

Post-surgery treatment

Guide 9 also lists options for treatment after surgery.

Options are based on your performance status,

which is your ability to do activities. The KPS

(

K

arnofsky

P

erformance

S

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.

KPS ≥60 | Age ≤70 years

Temozolomide with fractionated EBRT is the standard

of care for people 70 years of age or younger. The

benefit of receiving temozolomide for more than

6 months is unknown. Alternating electric field

therapy may be added to standard of care for tumors

in the top half of the brain (supratentorial). A second

option for cancer with unmethylated MGMT promotor

regions or unknown status is fractionated EBRT.

KPS ≥60 | Age ≥71 years

Hypofractionated EBRT is an option if you are 71

years of age or older. It has been shown to treat

glioblastoma in older adults. Treatment is often

finished within 2 to 4 weeks.

Temozolomide has been shown to work well for

cancer cells with methylated MGMT promotor

regions. In this case, temozolomide may be received

with hypofractionated or fractionated EBRT. The

benefit of receiving temozolomide for more than

6 months is unknown. Alternating electric field

therapy may be added for tumors in the top half of

the brain (supratentorial). Another option for cancer

with methylated MGMT promotor regions may be

temozolomide alone.

Temozolomide likely doesn’t work as well for cancer

cells with unmethylated MGMT promotor regions.

Due to some benefit, receiving it with fractionated

EBRT may be an option for cancer with unmethylated

or unknown status of the MGMT promotor region.

Receiving temozolomide for more than 6 months

may or may not help. More research is needed.

Alternating electric field therapy may be added for

tumors in the top half of the brain (supratentorial).

KPS ≤59 | Age ≤70 years

Some cancer treatments can be harmful to your

health if your KPS score is 59 or less. Thus,

treatments that are the least likely to harm your

body are advised. Fractionated EBRT may an option

if you’re 70 years of age or younger. There are

also three options for people of any age that are

discussed next.

KPS ≤59 | All ages

Hyperfractionated EBRT may an option because it is

less likely to cause severe side effects. If fractionated

or hyperfractionated EBRT may be too harsh,

temozolomide may be another option. It should only

be used if the cancer cells have methylated MGMT

promotor regions. Supportive care is an option for

everyone.

3

Astrocytomas

Glioblastomas and gliosarcomas