Standard Treatment for Newly Diagnosed High Grade Gliomas
Depending on your type of brain tumor, your provider may recommend radiation, chemotherapy or both of these as part of your treatment. Radiation is delivered to the area of the brain where the tumor is or the area where it was before surgery. Chemotherapy, particularly Temador (temozolomide), reaches this same area by going through the blood stream and then into the brain. Many times, radiation and chemotherapy are combined for an additive effect and to produce better treatment results. Your treatment plan will be discussed with you in detail. The standard therapy for a glioblastoma multiforme (GBM, grade IV tumors) is outlined below. The same treatment is frequently prescribed for anaplastic (AA, grade III tumors) as well.
Standard treatment for glioblastoma multiforme ( and also many grade III tumors) is based on the Stupp Protocol published by the New England Journal of Medicine, 2005. This consists of:
- Six week of radiation treatment
5 days per week (Monday - Friday)
- Combined with 6 weeks of oral chemotherapy (Temodar also called temozolomide)
7 days per week (Monday - Friday)
- This is followed by a four week break from treatment (no radiation or chemotherapy)
- Then six more months of Temodar ONLY
5 days per month
Remember, this is the standard treatment outline. You may be participating in an experimental trial/study which may add other medications or modalities to your treatment plan. These trials/studies may also prolong the length of time you are taking a particular drug. If you are participating in such a trial/suday, this information will be explained to you during the discussion of the trial/study.
Your medical oncologist will give you prescriptions for the following:
Chemotherapy - Temozolomide (TEMODAR)
- Take TEMODAR 60 minutes prior to radiation on an empty stomach.
- Never crush or open the TEMODAR capsules.
- TEMODAR doses on the weekend should be taken at the same time you would take them durin gthe week.
- Stop the TEMODAR when the radiation stops, even if you have pills left over.
Antiemetics - Ondansetron (ZOFRAN) or Granisetron (KYTRIL) or Dolasetron (ANZEME)
- Take 30 minutes prior to TEMODAR
Antiemetic's are medications given to reduce nausea and vomiting caused by chemotherapy. They usually control nausea well and cause few side effects.
Antibiotic - Sulfamethoxazole/Trimethoprim (BACTRIM DS)
- Take Monday, Wednesday and Friday
Bactrim is an antibiotic used to treat infections and in some cases to prevent infections. Treatment with steroids, radiation and chemotherapy may weaken a patient's immune system and increase the risk for infection.
Your medical oncologist will arrange the following appointments for you:
Blood Counts -
Lab work will be ordered weekly to access your blood counts. Electrolytes and other labs will be obtained periodically as well. These labs are important. If your "blood counts" drop, the chemotherapy may have to be paused or stopped for your safety.
Magnetic resonance imaging (MRI)'s will be ordered periodically for routine surveillance of your tumor. Typically, you will be scheduled for an MRI brain scan:
- One month after completing combined radiation and chemotherapy treatment
- Every 2 months after starting adjuvant chemotherapy ONLY
- Every 6 months after completing adjuvant chemotherapy ONLY