Recurrent high-grade glioma.

摘要: Opinions vary on the best treatment options for recurrent high-grade glioma. Some argue that bevacizumab should become standard of care patients with glioblastoma, especially in light recent FDA approval this indication. However, opinion is not uniformly accepted. Age, performance status, histology, tumor size and location, O6-methylguanine-DNA methyltransferase (MGMT) methylation status 1p/19q oligodendroglial tumors, number types prior therapies are important considerations. In addition, disease must be distinguished from “pseudoprogression” due to effects. Enrollment a clinical trial optimal choice most glioma after failure radiation therapy temozolomide. For who ineligible or do have access trials, then either monotherapy combination second agent such as irinotecan recommended. Involved-field external beam considered anaplastic gliomas received radiation. astrocytoma progress radiotherapy, temozolomide may used. oligodendroglioma PCV chemotherapy options. Oligodendroglial tumors deletions more likely respond treatment. past, carmustine was commonly used treat glioma, but utility modern era unknown because studies were performed widespread use High-precision re-irradiation stereotactic radiosurgery another option poor bone marrow reserve inability tolerate chemotherapy, there paucity adequate controls. Surgery useful adjuvant symptoms mass effect requiring definitive histopathology, it generally combined modality. Emerging therapies, including dose-intense regimens, targeted molecular inhibitors, other antiangiogenic viral gene immunotherapies, convection-enhanced delivery immunotoxins, still under investigation.