The majority of high-grade gliomas (WHO grade 3 and 4) require radiotherapy following surgery. Although radiotherapy rarely cures glioblastoma, studies show that it doubles the median survival of patients, compared to supportive care alone. A recent important study (known as the 'Stupp' trial) showed a benefit for chemotherapy using temozolomide in patients with glioblastoma multiforme. In the study, the median survival of patients who received temozolomide in addition to radiotherapy was increased by 2.5 months and two-year survival by 16 percent. For grade 3 gliomas the options for treatment following surgery would involve radiotherapy alone or chemotherapy alone followed by surveillance (i.e. keeping an eye with regular scans). Following surgery to obtain tissue for biopsy or to resect a grade 4 glioma (or glioblastoma), the patient is scored on their general well being (WHO performance status) and those with performance status of 0 or 1 are offered high dose radiotherapy treatment along with Temozolomide tablets during the treatment.
Further details about radiotherapy can be obtained by viewing this booklet which has been designed specifically for patients treated at the University Hospitals Bristol NHS Foundation trust.
Chemotherapy is an integral part of the treatment of Cancer and the decision on when to use it is dependant again on the type of tumour, but also on the clinical status of the patient (i.e. how well is the patient and will he/she be able to tolerate the treatment). For grade I gliomas no chemotherapy is currently indicated. For grade 2 gliomas, the role of chemotherapy is limited and is currently restricted to clinical trials. For grade 3 gliomas (Astrocytomas, Oligo-astrocytomas amd Oligodendrogliomas) the options for treatment include either initial radiotherapy followed by chemotherapy with either Temozolomide or PCV (Procarbazine, CCNU and Vincristine). The exact management plan is arrived at after the Clinical Oncologist is able to have a full and complete discussion with the patient and family about the pros and cons of each treatment. For grade 4 gliomas, following surgical resection of the tumour where appropriate, a decision about additional treatment is made by the Clinical Oncologist depending on the general fitness level of the patient (see links to WHO performance status above). The current standard of treatment in a fit patient would be Radiotherapy to the tumour bed and concomitant administration of Temozolomide (i.e. Temozolomide taken orally during the administration of Radiotherapy) followed by a few cycles of adjuvant Temozolomide orally over a period of time. Additional information about Temozolomide can be found here.