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NCCN Guidelines for Patients



Brain Cancer – Gliomas, Version 1.2016

Guide 17

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. 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

decide 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, irinotecan, cyclophosphamide, etoposide, 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.

If you undergo surgery, you may have the option

to receive carmustine wafers. The wafers will be

inserted into your brain after the tumor is removed.

You may not be able to join some clinical trials if you

receive carmustine wafers.

After surgery, get a brain MRI within 24 to 72 hours

to assess results. If you can’t have MRI, you may

Guide 17. Recurrence

The cancer isn’t widespread

Your surgery status

What are the options?

Approved and agree to surgery


• Surgery ±

carmustine wafer


• Chemotherapy


• Radiation therapy again


• Best supportive care

Not approved or decline surgery


• Best supportive care

The cancer is widespread

Your performance status

What are the options?

KPS ≥60


• Chemotherapy


• Surgery for large tumors causing symptoms

KPS ≤59


• Best supportive care


Oligodendrogliomas and oligoastrocytomas Grade III anaplastic