Evidence base: Glioma

A summary of the evidence base for the management of glioma.

CT scan showing a rapidly growing glioma (yellow) (Photograph: SPL)
CT scan showing a rapidly growing glioma (yellow) (Photograph: SPL)

CLINICAL TRIALS

  • European Organisation for Research and Treatment of Cancer 22845 randomised trial.

A European study of 314 patients with low grade gliomas randomised to receive either early radiotherapy after surgery or deferred radiotherapy until the time of progression. The main findings were that early radiotherapy did not increase the overall survival but did improve the seizure control. Lancet 2005; 366: 985-90

  • NCOG 6G61 randomised phase III trial.

A North American trial of post-radiation chemotherapy in 148 patients with high grade gliomas with either carmustine alone or combination therapy with PCV. The latter was found to be associated with significantly longer survivals. Int J Radiat Oncol Biol Phys 1990; 18(2): 321-4 and J Neurosurg 1985; 63(2): 2: 18-23


GUIDELINES

  • NICE Technology Appraisal. Carmustine implants and temozolomide for the treatment of newly diagnosed high grade glioma. London, NICE, 2007.
  • NICE. Improving outcomes for people with brain and other central nervous system tumours. London, NICE, 2006.
  • NICE Technology Appraisal. Temozolomide for the treatment of recurrent malignant glioma. London, NICE, 2001.


KEY TEXTS

  • McGirt M, Chaichana K, Gathinji M, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110(1): 156-62
  • McGirt M, Chaichana K, Attenello F, et al. Extent of surgical resection is independently associated with survival in patients with hemispheric infiltrating low-grade gliomas. Neurosurgery 2008; 63(4): 700-7
  • Westphal M, Hilt D, Bortey E, et al. A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro Oncol 2003; 5(2): 79-88
  • Stupp R, Dietrich P, Ostermann Kraljevic S, et al. Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 2002; 20(5): 1375-82

CURRICULUM

The RCGP covers this topic in statement 12 of the RCGP curriculum, Care of People with Cancer and Palliative Care.


ONLINE

  • Cancer Help UK. Information for doctors and patients on living with brain tumours. 
  • Macmillan Cancer Support Clear information on gliomas, their treatment and how to get help, especially useful for patients.

 

Contributed by Mr Keyoumars Ashkan, consultant neurosurgeon and senior lecturer, King’s College Hospital, London.

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