PRACTICAL GUIDELINES FOR THE TREATMENT OF MALIGNANT GLIOMAS

The treatment of patients with malignant gliomas is palliative and enc ompasses surgery radiotherapy, and chemotherapy. Outcome measures have demonstrated improvement in both survival and neurologic performance ira patients undergoing complete or near-complete tumor resection. Aft er surgery, involved-field radiotherapy (radiotherapy administered to the tumor and to the tissue In a 3-cm radius surrounding the tumor) ha s been shown to further improve survival rates when given in a total d ose of 6000-6500 cGy. Survival is further improved by the coadministra tion of the chemoradiopotentiator hydroxycarbamide (hydroxyurea), The role of adjuvant or boost stereotactic radiotherapy it; unclear, despi te its frequent use, in addition, adjuvant chemotherapy has been shown to improve survival rates in approximately one-quarter of patients wi th glioblastoma multiforme and in the majority of patients with anapla stic astrocytoma, No a priori method exists, however, to predict which patient will benefit from adjuvant chemotherapy. As a consequence, al l physiological young patients with good performance status or limited neurologic disability are treated with chemotherapy. The best results of adjuvant chemotherapy are activated with a nitrosourea chemotherap y, either carmustine (BCNU) or a combination of procarbazine and lomus tine (CCNU) and vincristine, known as PCV-3 therapy. Salvage chemother apy is reserved for patients with tumor progression, some of whom bene fit from a re-operation. Occasional patients with recurrent gliomas ma y be palliated by stereotactic radiotherapy.