Recurrent malignant gliomas

Abstract

In almost all patients, malignant glioma recurs following initial treatment with maximal safe resection, conformal radiotherapy, and temozolomide. This review describes the many options for treatment of recurrent malignant gliomas, including reoperation, alternating electric field therapy, chemotherapy, stereotactic radiotherapy or radiosurgery, or some combination of these modalities, presenting the evidence for each approach. No standard of care has been established, though the antiangiogenic agent, bevacizumab; stereotactic radiotherapy or radiosurgery; and, perhaps, combined treatment with these 2 modalities appear to offer modest benefits over other approaches. Clearly, randomized trials of these options would be advantageous, and novel, more efficacious approaches are urgently needed.

Figure

Radiation Therapy Oncology Group (RTOG) protocol 1205, a randomized trial of bevacizum (BVZ) vs radiotherapy + BVZ in BVZ-naïve patients with recurrent glioma. In this trial, 3D conformal radiotherapy, intensity-modulated radiotherapy, proton therapy, and stereotactic radiosurgery (SRS) techniques are permitted. However, SRS is not required.