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 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.
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
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