Recurrent malignant glioma in adults.

摘要: Meaningful palliation is possible for selected patients with recurrent malignant glioma (glioblastoma multiforme, anaplastic astrocytoma, oligodendroglioma, or mixed oligoastrocytoma) using aggressive treatment. Although long-term disease-free survival occurs in fewer than 10% of patients, most who achieve such have been treated multiple recurrences. Surgical resection the placement lomustine-releasing wafers only therapy proven randomized trials to be beneficial gliomas. Reoperation indicated when local mass effect limits quality life. may make other treatments more effective by removing treatment-resistant hypoxic cells and thereby prolonging high-quality survival. Combination chemotherapy (including procarbazine a nitrosourea) provides dramatic benefit many aggressively behaving oligodendrogliomas oligoastrocytomas. For gliomas, single-agent cytotoxic (eg, intravenous lomustine platinums, oral carmustine, temozolomide, procarbazine) appears provide equivalent results better life at lower cost do combinations drugs. A phase II trial demonstrates that temozolomide longer progression-free standard-dose glioblastoma multiforme. Because benefits available astrocytoma are small, participation clinical appropriate patients. Reirradiation (using stereotactic three-dimensional conformal techniques without concomitant chemotherapy) as radiation sensitization can prolong Specific examples include radiosurgery gamma knife linear accelerators, intracavitary newly US Food Drug Administration-approved GliaSite (Proxima Therapeutics, Alpharetta, GA) system, low dose rate permanent-seed brachytherapy, high brachytherapy. Dexamethasone (used shortest time lowest doses) symptomatic benefits. Osmotic diuretics mannitol reduce edema rapidly.