High Grade Glioma




Is there any role of chemotherapy in HGG?



Is there any role of Adjuvant chemo in HGG?



Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial


High Grade Glioma

Role of RT after surgery

  • Walker MD, Alexander Jr E, Hunt WE, MacCarty CS, Mahaley Jr MS, Mealey Jr J, Norrell HA, Owens G, Ransohoff J, Wilson CB, Gehan EA. Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: a cooperative clinical trial. Journal of neurosurgery. 1978 Sep;49(3):333-43.

  • Kristiansen K, Hagen S, Kollevold T, Torvik A, Holme I, Stat M, Nesbakken R, Hatlevoll R, Lindgren M, Brun A, Lindgren S. Combined modality therapy of operated astrocytomas grade III and IV. Confirmation of the value of postoperative irradiation and lack of potentiation of bleomycin on survival time: a prospective multicenter trial of the Scandinavian Glioblastoma Study Group. Cancer. 1981 Feb 15;47(4):649-52.

Is there any role of Adjuvant chemo in HGG?

  • Medical Research Council Brain Tumor Working Party. Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial. Journal of clinical oncology: official journal of the American Society of Clinical Oncology. 2001 Jan 15;19(2):509.

  • van den Bent MJ, Brandes AA, Taphoorn MJ, Kros JM, Kouwenhoven MC, Delattre JY, Bernsen HJ, Frenay M, Tijssen CC, Grisold W, Sipos L. Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. Journal of clinical oncology. 2012 Oct 15;31(3):344-50.

  • Fine HA, Dear KB, Loeffler JS, Mc Black PL, Canellos GP. Metaanalysis of radiation therapy with and without adjuvant chemotherapy for malignant gliomas in adults. Cancer. 1993 Apr 15;71(8):2585-97.

  • Stewart LA. Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials. Lancet. 2002;359(9311):1011-8.

  • Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459-66.

  • Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, et al. A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma. Neuro Oncol. 2003;5(2):79-88.


Is there any role of only chemotherapy in HGG?

  • Wick W, Platten M, Meisner C, Felsberg J, Tabatabai G, Simon M, et al. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol. 2012;13(7):707-15.

Combined CCRT

  • Cairncross G, Wang M, Shaw E, Jenkins R, Brachman D, Buckner J, Fink K, Souhami L, Laperriere N, Curran W, Mehta M. Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402. Journal of clinical oncology. 2012 Oct 15;31(3):337-43.
RT In elder population


  • Malmström A, Grønberg BH, Marosi C, Stupp R, Frappaz D, Schultz H, Abacioglu U, Tavelin B, Lhermitte B, Hegi ME, Rosell J. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. The lancet oncology. 2012 Sep 30;13(9):916-26.