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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016

Grade III anaplastic

Anaplastic oligodendrogliomas are rare in adults

but have a better outlook than other grade III

gliomas. 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 15

lists treatment options for anaplastic

oligodendrogliomas and oligoastrocytomas. 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. Many grade III

oligodendrogliomas can be fully removed. 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. 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

helps 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.

Other surgeries

Sometimes, the tumor can’t be fully removed

because it is in a key area of the brain. There are

other options if it is known before surgery that

a maximal safe resection can’t be done. These

options are a subtotal resection, open biopsy, and

stereotactic biopsy.

Guide 15. 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


Oligodendrogliomas and oligoastrocytomas Grade III anaplastic