title: The role of cytotoxic chemotherapy in the management of progressive glioblastoma : a systematic review and evidence-based clinical practice guideline.
abstract: OBJECTIVE
  What is the impact of cytotoxic chemotherapy on disease control and survival in the adult patient with progressive glioblastoma?
  
  
  METHODS
  This recommendation applies to adults patients with progressive glioblastoma.
  Temozolomide is recommended as superior to procarbazine in patients with first relapse of glioblastoma after having received nitrosourea chemotherapy or no prior cytotoxic chemotherapy at the time of initial therapy. The use of BCNU-impregnated biodegradable polymer wafers is recommended in the management of progressive glioblastoma as a surgical adjunct when cytoreductive surgery is indicated, taking into account the associated toxicities seen with this modality.
  
  
  METHODS
  Consideration of a variety of cytotoxic chemotherapy agents of uncertain benefit is recommended in the setting of progressive glioblastoma based on the judgment of the treating physician taking into account the individual patients prior treatment exposure, systemic health, and likelihood of tolerance of the toxicities of any given agent. It is recommended in such cases that enrollment in available clinical trials be encouraged.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA, jolson@emory.edu.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Olson
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: D Ryan
authors.initials: DR
authors.lastname: Ormond
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.forename: Steven N
authors.initials: SN
authors.lastname: Kalkanis
mesh_terms: D020341:Absorbable Implants; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000601:surgery; D002330:Carmustine / Q000008:administration & dosage / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003606:Dacarbazine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D018450:Disease Progression; D019317:Evidence-Based Medicine; D005909:Glioblastoma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D000077204:Temozolomide
chemical_list: D000970:Antineoplastic Agents; D003606:Dacarbazine; D002330:Carmustine; D000077204:Temozolomide
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