Journal of Neuro-Oncology

, Volume 118, Issue 3, pp 501–555 | Cite as

The role of cytotoxic chemotherapy in the management of progressive glioblastoma

A systematic review and evidence-based clinical practice guideline
  • Jeffrey J. Olson
  • Lakshmi Nayak
  • D. Ryan Ormond
  • Patrick Y. Wen
  • Steven N. Kalkanis



What is the impact of cytotoxic chemotherapy on disease control and survival in the adult patient with progressive glioblastoma?

Target population

This recommendation applies to adults patients with progressive glioblastoma.


Level II

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.

Level III

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.


Adult Chemotherapy Cytotoxic Glioblastoma Mortality Progressive Recurrent Relapsing Survival Temozolomide 



We would like to acknowledge the AANS/CNS Joint Guidelines Committee for their review, comments and suggestions, the contributions of Laura Mitchell, CNS Guidelines Manager for organizational assistance, Maxine Brown for searching for and retrieving literature and Amy Allison for reference library consultations. We would also like to acknowledge the following individual JGC members for their contributions throughout the review process: Sepideh Amin-Hanjani, MD, FAANS, FACS, FAHA, Martina Stippler, MD, Alexander Khalessi, MD, Isabelle Germano, MD, Sean D. Christie, MD, FRCS (C), Gregory J. Zipfel, MD, Zachary Litvack, MD, MCR, Ann Marie Flannery, MD, Patricia B Raksin, MD, Joshua M. Rosenow, MD, FACS, Steven Casha, MD, PhD, Julie G. Pilitsis, MD, PhD, Gabriel Zada, MD, Adair Prall, Krystal Tomei, MD, Gregory W Hawryluk, MD.

Conflict of interest

Task Force members report potential COIs prior to beginning work on the guideline and at the time of publication. COI disclosures are reviewed by the Task Force Chair and taken into consideration when determining writing assignments. Resolution of potential COIs included Task Force members were assigned to chapters that did not involve or in any way relate to the potential COIs disclosed.

Disclaimer of liability

The information in these guidelines reflects the current state of knowledge at the time of completion. The presentations are designed to provide an accurate review of the subject matter covered. These guidelines are disseminated with the understanding that the recommendations by the authors and consultants who have collaborated in their development are not meant to replace the individualized care and treatment advice from a patient’s physician(s). If medical advice or assistance is required, the services of a physician should be sought. The proposals contained in these guidelines may not be suitable for use in all circumstances. The choice to implement any particular recommendation contained in these guidelines must be made by a managing physician in light of the situation in each particular patient and on the basis of existing resources.

Funding source

These guidelines were funded exclusively by the CNS and Tumor Section of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons whom received no funding from outside commercial sources to support the development of this document unless otherwise stated in this section.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Jeffrey J. Olson
    • 1
  • Lakshmi Nayak
    • 2
  • D. Ryan Ormond
    • 1
  • Patrick Y. Wen
    • 2
  • Steven N. Kalkanis
    • 3
  1. 1.Department of NeurosurgeryEmory University School of MedicineAtlanta USA
  2. 2.Dana-Farber Cancer Institute, Department of NeurologyBrigham and Women’s Cancer CenterBoston USA
  3. 3.Department of NeurosurgeryHenry Ford Health SystemDetroit USA

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