Glioblastoma Multiforme Guidelines

Updated: Jul 28, 2021
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Guidelines

Guidelines Summary

The National Comprehensive Cancer Network (NCCN) has released guidelines on central nervous system (CNS) cancers which includes recommendations for the diagnosis and treatment of glioblastomas (grade IV gliomas). The goals of surgery are to obtain a diagnosis, alleviate symptoms of increased intracranial pressure or compression, increase survival, and decrease the need for corticosteroids. Adjuvant treatment options depend on the patient performance status (PS), age, and MGMT promoter methylation status. [58]  

Category 1 recommendations for first-line treatment [58] :

  • Patients 70 years or younger with good PS, regardless of the tumor's MGMT methylation status, should receive fractionated standard brain radiation therapy (RT) plus concurrent and adjuvant temozolomide (TMZ) with or without alternating electric field therapy.
  • Patients older than 70 years with good PS and MGMT promoter–methylated tumors should receive hypofractionated brain RT plus concurrent and adjuvant TMZ or standard brain RT plus concurrent and adjuvant TMZ and alternating electric field therapy.
  • Patients older than 70 years with good PS and MGMT unmethylated or indeterminant tumors should receive standard brain RT plus concurrent and adjuvant TMZ and alternating electric field therapy.

Palliative care

European Association for Neuro-Oncology (EANO) guidelines for palliative care in adults with glioma include the following recommendations for treatment of complicating signs and symptoms [125] :

  • Headache – Corticosteroids (dexamethasone) are the mainstay of treatment for headache in patients with gliomas. Analgesics and co-analgesics could also be considered in the treatment of headache (in accordance with the World Health Organization cancer pain ladder).
  • Seizures – If oral administration of antiepileptic drugs is not an option, intranasal midazolam and buccal clonazepam are a feasible way to treat seizures in the end of life phase, when patients often have difficulty swallowing.
  • Venous thromboembolism (VTE) – VTE prophylaxis with low molecular weight heparin should be started postoperatively within 24 hours. No data support extending primary VTE prophylaxis beyond the postoperative period; in brain tumor patients who have experienced VTE, the duration of secondary prophylaxis should be planned individually, but is lifelong in most patients.
  • Fatigue – There is to date no proof of efficacy for any pharmacologic or nonpharmacologic intervention for fatigue in glioma patients.
  • Mood and behavioral disorders – Limited evidence supports the use of several pharmacological interventions (eg, methylphenidate, donepezil) for mood disorders in glioma patients. Multimodal psychosocial intervention may improve depressive symptoms.
  • Neurorehabilitation – Brain tumor patients may benefit from postoperative early rehabilitation, as well as rehabilitation after tumor-specific treatment.
  • Cognition – Medical treatment to prevent or treat cognitive decline in brain tumor patients is not recommended. However, cognitive rehabilitation has modest positive effects and should be considered, especially in young glioma patients with relatively favorable prognosis.