Recurrent malignant glioma in adults

Area of Science:

• Neuro-oncology
• Surgical Oncology
• Radiation Oncology

Background:

• Recurrent malignant gliomas, including glioblastoma multiforme, present significant treatment challenges.
• Long-term disease-free survival is rare, with most survivors experiencing multiple recurrences.

Purpose of the Study:

• To review current therapeutic strategies for recurrent malignant gliomas.
• To identify effective palliation and survival-prolonging treatments for selected patients.

Main Methods:

• Surgical resection with lomustine-releasing wafers as a proven therapy.
• Reoperation for quality of life improvement and enhancing other treatments.
• Chemotherapy regimens including combination and single-agent cytotoxic drugs.
• Reirradiation techniques such as stereotactic radiosurgery and brachytherapy.
• Pharmacological management with dexamethasone and osmotic diuretics.

Main Results:

• Surgical resection with lomustine wafers is the only randomized trial-proven benefit for recurrent malignant gliomas.
• Reoperation can improve quality of life and potentially prolong survival.
• Combination chemotherapy shows benefit for anaplastic oligodendrogliomas and mixed oligoastrocytomas.
• Single-agent chemotherapy (temozolomide, lomustine, carmustine, procarbazine) offers comparable results and better quality of life for other gliomas.
• Temozolomide demonstrated superior progression-free survival and quality of life compared to procarbazine in glioblastoma multiforme.
• Reirradiation can prolong high-quality survival in selected patients.
• Dexamethasone and mannitol provide symptomatic relief.

Conclusions:

• Meaningful palliation is achievable for selected patients with recurrent malignant gliomas through aggressive multimodal treatment.
• Participation in clinical trials is encouraged due to limited benefits from current cytotoxic chemotherapy for anaplastic astrocytoma and glioblastoma.
• Optimizing treatment involves surgical interventions, chemotherapy, reirradiation, and supportive care tailored to individual patient needs.