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Canadian Recommendations for the Treatment of Glioblastoma Multiforme

Princess Margaret Hospital, 610 University Avenue, Suite 18-717, Toronto, ON M5G 2M9, Canada
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Canadian GBM Recommendations Committee: Chair—Warren P. Mason, Department of Medicine, University of Toronto, and Princess Margaret Hospital, Toronto, Ontario; Members—Rolando Del Maestro, Department of Neurology and Neurosurgery and Department of Oncology, McGill University, and Brain Tumor Research Centre, Montreal Neurological Institute and Hospital, Montreal, Quebec; David Eisenstat, CancerCare Manitoba, Manitoba Institute of Cell Biology, and Departments of Pediatrics, Anatomy, and Ophthalmology, University of Manitoba, Winnipeg, Manitoba; Peter Forsyth, Clark Smith Integrative Brain Tumor Research Center, Calgary, Alberta; Dorcas Fulton, Department of Medicine, Cross Cancer Institute, and University of Alberta, Edmonton, Alberta; Normand Laperriere, Department of Radiation Oncology, University of Toronto, and Princess Margaret Hospital, Toronto, Ontario; David Macdonald, Department of Medicine, London Regional Cancer Center, and University of Western Ontario, London, Ontario; James Perry, Crolla Family Brain Tumour Research Centre, University of Toronto, Toronto, Ontario; and Brian Thiessen, British Columbia Cancer Agency, and University of British Columbia, Vancouver, British Columbia.
Curr. Oncol. 2007, 14(3), 110-117; https://doi.org/10.3747/co.2007.119
Received: 1 March 2007 / Revised: 4 April 2007 / Accepted: 2 May 2007 / Published: 1 June 2007
Recommendation 1: Management of patients with glioblastoma multiforme (GBM) should be highly individualized and should take a multidisciplinary approach involving neuro-oncology, neurosurgery, radiation oncology, and pathology, to optimize treatment outcomes. Patients and caregivers should be kept informed of the progress of treatment at every stage. Recommendation 2: Sufficient tissue should be obtained during surgery for cytogenetic analysis and, whenever feasible, for tumour banking. Recommendation 3: Surgery is an integral part of the treatment plan, to establish a histopathologic diagnosis and to achieve safe, maximal, and feasible tumour resection, which may improve clinical signs and symptoms. Recommendation 4: The preoperative imaging modality of choice is magnetic resonance imaging (MRI) with gadolinium as the contrast agent. Other imaging modalities, such as positron emission tomography with [18F]-fluoro-deoxy-D-glucose, may also be considered in selected cases. Postoperative imaging (MRI or computed tomography) is recommended within 72 hours of surgery to evaluate the extent of resection. Recommendation 5: Postoperative external-beam radiotherapy is recommended as standard therapy for patients with GBM. The recommended dose is 60 Gy in 2-Gy fractions. The recommended clinical target volume should be identified with gadolinium-enhanced T1-weighted MRI, with a margin in the order of 2–3 cm. Target volumes should be determined based on a postsurgical planning MRI. A shorter course of radiation may be considered for older patients with poor performance status. Recommendation 6: During rt, temozolomide 75 mg/m2 should be administered concurrently for the full duration of radio-therapy, typically 42 days. Temozolomide should be given approximately 1 hour before radiation therapy, and at the same time on the days that no radiotherapy is scheduled. Recommendation 7: Adjuvant temozolomide 150 mg/m2, in a 5/28-day schedule, is recommended for cycle 1, followed by 5 cycles if well tolerated. Additional cycles may be considered in partial responders. The dose should be increased to 200 mg/m2 at cycle 2 if well tolerated. Weekly monitoring of blood count is advised during chemoradiation therapy in patients with a low white blood cell count. Pneumocystis carinii pneumonia has been reported, and prophylaxis should be considered. Recommendation 8: For patients with stable clinical symptoms during combined radiotherapy and temozolomide, completion of 3 cycles of adjuvant therapy is generally advised before a decision is made about whether to continue treatment, because pseudo-progression is a common phenomenon during this time. The recommended duration of therapy is 6 months. A longer duration may be considered in patients who show continuous improvement on therapy. Recommendation 9: Selected patients with recurrent GBM may be candidates for repeat resection when the situation appears favourable based on an assessment of individual patient factors such as medical history, functional status, and location of the tumour. Entry into a clinical trial is recommended for patients with recurrent disease. Recommendation 10: The optimal chemotherapeutic strategy for patients who progress following concurrent chemoradiation has not been determined. Therapeutic and clinical–molecular studies with quality of life outcomes are needed.
Keywords: brain tumour; glioblastoma; radiotherapy; chemotherapy; temozolomide brain tumour; glioblastoma; radiotherapy; chemotherapy; temozolomide
MDPI and ACS Style

Mason, W.P.; Del Maestro, R.; Eisenstat, D.; Forsyth, P.; Fulton, D.; Laperrière, N.; Macdonald, D.; Perry, J.; Thiessen, B.; The Canadian GBM Recommendations Committee. Canadian Recommendations for the Treatment of Glioblastoma Multiforme. Curr. Oncol. 2007, 14, 110-117. https://doi.org/10.3747/co.2007.119

AMA Style

Mason WP, Del Maestro R, Eisenstat D, Forsyth P, Fulton D, Laperrière N, Macdonald D, Perry J, Thiessen B, The Canadian GBM Recommendations Committee. Canadian Recommendations for the Treatment of Glioblastoma Multiforme. Current Oncology. 2007; 14(3):110-117. https://doi.org/10.3747/co.2007.119

Chicago/Turabian Style

Mason, W.P., R. Del Maestro, D. Eisenstat, P. Forsyth, D. Fulton, N. Laperrière, D. Macdonald, J. Perry, B. Thiessen, and The Canadian GBM Recommendations Committee. 2007. "Canadian Recommendations for the Treatment of Glioblastoma Multiforme" Current Oncology 14, no. 3: 110-117. https://doi.org/10.3747/co.2007.119

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