title: Management of glioblastoma after recurrence: A changing paradigm.
abstract: Glioblastoma remains the most common primary brain tumor after the age of 40years. Maximal safe surgery followed by adjuvant chemoradiotherapy has remained the standard treatment for glioblastoma (GBM). But recurrence is an inevitable event in the natural history of GBM with most patients experiencing it after 6-9months of primary treatment. Recurrent GBM poses great challenge to manage with no well-defined management protocols. The challenge starts from differentiating radiation necrosis from true local progression. A fine balance needs to be maintained on improving survival and assuring a better quality of life. Treatment options are limited and ranges from re-excision, re-irradiation, systemic chemotherapy or a combination of these. Re-excision and re-irradiation must be attempted in selected patients and has been shown to improve survival outcomes. To facilitate the management of GBM recurrences, a treatment algorithm is proposed.
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: drsupriyamallick@gmail.com.
authors.forename: Supriya
authors.initials: S
authors.lastname: Mallick
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rony
authors.initials: R
authors.lastname: Benson
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakim
authors.affiliation: Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Goura K
authors.initials: GK
authors.lastname: Rath
mesh_terms: D003131:Combined Modality Therapy; D018450:Disease Progression; D005909:Glioblastoma / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Bevacizumab; Chemotherapy; Glioblastoma; NovoTTF; Re-irradiation; Recurrent