Management of recurrent high-grade glioma

* Participation in clinical trials is encouraged.
¶ Systemic therapy options include bevacizumab, bevacizumab plus chemotherapy (eg, nitrosoureas, temozolomide, irinotecan, carboplatin), and chemotherapy alone.
Δ For glioblastoma; availability varies by region and center.
◊ Implantation of carmustine wafers at the time of resection may be considered in selected patients (eg, those with contraindications to systemic therapy) but may affect eligibility for some clinical trials.
§ Optimal candidates for reoperation are younger patients with large but well-circumscribed, symptomatic tumors that have recurred after an extended interval.