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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016

Guide 10

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 needed 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 11

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. Nearly all glioblastomas


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 know 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, cyclophosphamide, 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.

Deciding factors for surgery include where the tumor

is in your brain, your performance status, and the

size of the tumor. Your surgeon may decide surgery

is too risky if the tumor is in a critical spot, your

health is poor, or the tumor is large.

If you undergo surgery, another option is to receive

carmustine wafers. The wafers will be inserted into

the space where the tumor was 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. A third option may be alternating

electric field therapy. It may cause fewer severe side

effects than chemotherapy.

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. A third option may be

alternating electric field therapy. It may cause fewer

severe side effects than chemotherapy. If your KPS

score is below 60, you may receive supportive care

to improve your quality of life.



Glioblastomas and gliosarcomas