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{{Astrocytoma}}
{{Astrocytoma}}
{{CMG}}; {{AE}} {{Fs}}
==Overview==
==Overview==
The optimal therapy of astrocytoma depends on the stage of diagnosis. Chemotherapy is recommended for children. Radiation and chemotherpy with stem cell transplant is recommended for adults with high grade astrocytoma.
The mainstay of treatment for [[low grade astrocytoma]] is wait and see approach, [[Radiation therapy|radiation]] therapy and [[chemotherapy]]. Treatment for [[anaplastic astrocytoma]] is [[radiotherapy]] with adjunctive [[chemotherapy]], [[Radiation therapy|radiotherapy]] alone and [[chemotherapy]] alone. Treatment for [[Glioblastoma multiforme|glioblastoma multiform]] is [[chemotherapy]] and [[Radiation therapy|radiotherapy]], [[Bevacizumab]], alternating electric fields and [[Carmustine]] polymer wafers.
 
==Medical Therapy==
==Medical Therapy==
* Post surgical medical therapy is recommended in all patients with astrocytoma tumor.


===Chemotherapy===
=== Astrocytoma ===
*Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Combination chemotherapy is the use of more than one anticancer drug.
* '''1 Grade 1 and 2 - Low grade astrocytomas'''
*Systemic chemotherapy is used in the treatment of children with astrocytoma. The way the chemotherapy is given depends on the type of tumor and where the tumor formed in the brain or spinal cord.
** 1.1 Wait and see<ref name="pmid17469128">{{cite journal |vauthors=Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E, Kujas M, Mokhtari K, Taillibert S, Laigle-Donadey F, Carpentier AF, Omuro A, Capelle L, Duffau H, Cornu P, Guillevin R, Sanson M, Hoang-Xuan K, Delattre JY |title=Dynamic history of low-grade gliomas before and after temozolomide treatment |journal=Ann. Neurol. |volume=61 |issue=5 |pages=484–90 |date=May 2007 |pmid=17469128 |doi=10.1002/ana.21125 |url=}}</ref><ref name="pmid18976072">{{cite journal |vauthors=Shaw EG, Berkey B, Coons SW, Bullard D, Brachman D, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta M |title=Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial |journal=J. Neurosurg. |volume=109 |issue=5 |pages=835–41 |date=November 2008 |pmid=18976072 |pmc=3833272 |doi=10.3171/JNS/2008/109/11/0835 |url=}}</ref>
 
*** The wait and see approach is for young patient with complete or nearly complete [[tumor]] resection.
====High-dose chemotherapy with stem cell transplant====
*** since the [[low grade astrocytoma]] will finally grow to [[high grade astrocytoma]], we should screen these patients with contrast [[MRI]] every 4 month.
* High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.* Treatment depends on the size and type of tumor and the child's general health. The goals of treatment may be to cure the tumor, relieve symptoms, and improve brain function or the child's comfort
** 1.2 [[Radiation therapy]]<ref name="pmid16168780">{{cite journal |vauthors=van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmström PO, Collette L, Piérart M, Mirimanoff R, Karim AB |title=Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial |journal=Lancet |volume=366 |issue=9490 |pages=985–90 |date=2005 |pmid=16168780 |doi=10.1016/S0140-6736(05)67070-5 |url=}}</ref><ref name="pmid26530266">{{cite journal |vauthors=Ryken TC, Parney I, Buatti J, Kalkanis SN, Olson JJ |title=The role of radiotherapy in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline |journal=J. Neurooncol. |volume=125 |issue=3 |pages=551–83 |date=December 2015 |pmid=26530266 |doi=10.1007/s11060-015-1948-1 |url=}}</ref>
* Two related drugs have been shown to shrink or stabilize supependymal giant cell tumors: [[rapamycin]] and [[everolimus]]. These both belong to the [[mTOR]] inhibitor class of immunosuppressants, and are both contraindicated in patients with severe infections.
*** Immediate post [[surgery]] [[radiation therapy]] can reduce the progression rate.
:* [[Rapamycin]] showed efficacy in five cases of SEGA in TSC patients, shrinking their tumor volumes by an average of 65%. However, after the drug was stopped, the tumors regrew.
*** It doesn't affect survival since it cannot prevent transformation of [[low grade astrocytoma]] to [[high grade astrocytoma]].
:* [[Everolimus]] which has a similar structure as rapamycin, but with slightly increased bioavailability and shorter half-life, was studied in 28 patients with SEGA.  There was a significant reduction in SEGA size in 75% of the patients, and a mild improvement in their seizures. [[Everolimus]] was approved for the treatment of SEGA by the US Food and Drug Administration (FDA) in October, 2010.
*** Preferred regimen: 50 t0 54 Gy
* Medicines used to treat primary brain tumors in children include:
** 1.3 Adjunctive [[chemotherapy]]<ref name="pmid28801186">{{cite journal |vauthors=van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, Brandes AA, Clement PM, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Brachman DG, Taal W, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Weber DC, Lesimple T, Clenton S, Gijtenbeek A, Pascoe S, Herrlinger U, Hau P, Dhermain F, van Heuvel I, Stupp R, Aldape K, Jenkins RB, Dubbink HJ, Dinjens WNM, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, Wick W, Kros JM |title=Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study |journal=Lancet |volume=390 |issue=10103 |pages=1645–1653 |date=October 2017 |pmid=28801186 |pmc=5806535 |doi=10.1016/S0140-6736(17)31442-3 |url=}}</ref><ref name="pmid27050206">{{cite journal |vauthors=Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ |title=Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma |journal=N. Engl. J. Med. |volume=374 |issue=14 |pages=1344–55 |date=April 2016 |pmid=27050206 |pmc=5170873 |doi=10.1056/NEJMoa1500925 |url=}}</ref><ref name="pmid22851558">{{cite journal |vauthors=Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP |title=Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802 |journal=J. Clin. Oncol. |volume=30 |issue=25 |pages=3065–70 |date=September 2012 |pmid=22851558 |pmc=3732006 |doi=10.1200/JCO.2011.35.8598 |url=}}</ref>
:* [[Corticosteroid]]s to reduce brain swelling
*** 1.3.1 [[Temozolomide]]
:* [[Diuretics]] (water pills) to reduce brain swelling and pressure
*** 1.3.2 PVC ([[Procarbazine]], [[Lomustine]], [[Vincristine]])
:* [[Anticonvulsant]]s to reduce or prevent seizures
*** Based on previous studies, patients who get [[chemotherapy]] along with [[Radiation therapy|radiotherapy]] immediately after [[surgery]] has better outcome.
:* Pain medicines
* Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve quality of life.
* Despite decades of therapeutic research, curative intervention is still nonexistent for high grade astrocytomas; patient care ultimately focuses on [[palliative]] management.
==Radiation Therapy==
* Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
** External radiation therapy uses a machine outside the body to send radiation toward the cancer.
** Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.


* External radiation therapy is used to treat astrocytoma in children. The way the radiation therapy is given depends on the type of tumor and where the tumor formed in the brain or spinal cord.Radiation therapy to the brain can affect growth and development in young children. Certain ways of giving radiation therapy can lessen the damage to healthy brain tissue:


** Conformal radiation therapy uses a computer to make a 3-dimensional (3-D) picture of the tumor and shapes the radiation beams to fit the tumor. This allows a high dose of radiation to reach the tumor and causes less damage to normal tissue around the tumor.
* '''2 Grade 3 - [[Anaplastic astrocytoma]]'''
** Intensity-modulated radiation therapy (IMRT) uses images created by a computer that show the size and shape of the tumor. Thin beams of radiation of different strengths are aimed at the tumor from many angles.
** 2.1 [[Radiation therapy|Radiotherapy]]+ [[chemotherapy]] ([[Temozolomide]])<ref name="pmid26033545">{{cite journal |vauthors=Juratli TA, Lautenschläger T, Geiger KD, Pinzer T, Krause M, Schackert G, Krex D |title=Radio-chemotherapy improves survival in IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma patients |journal=J. Neurooncol. |volume=124 |issue=2 |pages=197–205 |date=September 2015 |pmid=26033545 |doi=10.1007/s11060-015-1822-1 |url=}}</ref><ref name="pmid27401155">{{cite journal |vauthors=Shin JY, Diaz AZ |title=Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy |journal=J. Neurooncol. |volume=129 |issue=3 |pages=557–565 |date=September 2016 |pmid=27401155 |doi=10.1007/s11060-016-2210-1 |url=}}</ref>
** Stereotactic radiation therapy uses a rigid head frame attached to the skull to aim radiation directly to the tumor, causing less damage to normal tissue around the tumor. The total dose of radiation is divided into several smaller doses given over several days. This procedure is also called stereotactic external-beam radiation therapy and stereotaxic radiation therapy.
*** Studies demonstrated that the combination of [[radiotherapy]] and [[chemotherapy]] with [[temozolomide]] is more effective.
** Proton beam radiation therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged particles of matter) to kill tumor cells.
** 2.2 [[Radiation therapy|Radiation]]
** 2.3 [[Chemotherapy]]
*** 2.3.1 [[Procarbazine]], [[Lomustine]], [[Vincristine]]
*** 2.3.2 [[Procarbazine]], [[Lomustine]], [[Temozolomide]]<ref name="pmid19901110">{{cite journal |vauthors=Wick W, Hartmann C, Engel C, Stoffels M, Felsberg J, Stockhammer F, Sabel MC, Koeppen S, Ketter R, Meyermann R, Rapp M, Meisner C, Kortmann RD, Pietsch T, Wiestler OD, Ernemann U, Bamberg M, Reifenberger G, von Deimling A, Weller M |title=NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide |journal=J. Clin. Oncol. |volume=27 |issue=35 |pages=5874–80 |date=December 2009 |pmid=19901110 |doi=10.1200/JCO.2009.23.6497 |url=}}</ref><ref name="pmid27370396">{{cite journal |vauthors=Wick W, Roth P, Hartmann C, Hau P, Nakamura M, Stockhammer F, Sabel MC, Wick A, Koeppen S, Ketter R, Vajkoczy P, Eyupoglu I, Kalff R, Pietsch T, Happold C, Galldiks N, Schmidt-Graf F, Bamberg M, Reifenberger G, Platten M, von Deimling A, Meisner C, Wiestler B, Weller M |title=Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide |journal=Neuro-oncology |volume=18 |issue=11 |pages=1529–1537 |date=November 2016 |pmid=27370396 |pmc=5063521 |doi=10.1093/neuonc/now133 |url=}}</ref>


* For children younger than 3 years, chemotherapy may be given instead, to delay or reduce the need for radiation therapy.


* '''3 Grade 4 - [[Glioblastoma multiforme|Glioblastoma multiform]]'''
** 3.1 [[Chemotherapy]] (± [[Radiation therapy|radiotherapy]])<ref name="pmid15758009">{{cite journal |vauthors=Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO |title=Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma |journal=N. Engl. J. Med. |volume=352 |issue=10 |pages=987–96 |date=March 2005 |pmid=15758009 |doi=10.1056/NEJMoa043330 |url=}}</ref><ref name="pmid27172136">{{cite journal |vauthors=Kole AJ, Park HS, Yeboa DN, Rutter CE, Corso CD, Aneja S, Lester-Coll NH, Mancini BR, Knisely JP, Yu JB |title=Concurrent chemoradiotherapy versus radiotherapy alone for "biopsy-only" glioblastoma multiforme |journal=Cancer |volume=122 |issue=15 |pages=2364–70 |date=August 2016 |pmid=27172136 |doi=10.1002/cncr.30063 |url=}}</ref>
*** 3.1.1 [[Temozolomide]]
** 3.2 [[Bevacizumab]]<ref name="pmid21135282">{{cite journal |vauthors=Lai A, Tran A, Nghiemphu PL, Pope WB, Solis OE, Selch M, Filka E, Yong WH, Mischel PS, Liau LM, Phuphanich S, Black K, Peak S, Green RM, Spier CE, Kolevska T, Polikoff J, Fehrenbacher L, Elashoff R, Cloughesy T |title=Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme |journal=J. Clin. Oncol. |volume=29 |issue=2 |pages=142–8 |date=January 2011 |pmid=21135282 |pmc=3058273 |doi=10.1200/JCO.2010.30.2729 |url=}}</ref>
*** A [[Monoclonal antibodies|monoclonal antibody]] which bind to [[VEGF]] and inactivate it.
** 3.3 Alternating electric fields<ref name="pmid22608262">{{cite journal |vauthors=Stupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V, Kirson ED, Taillibert S, Liebermann F, Dbalý V, Ram Z, Villano JL, Rainov N, Weinberg U, Schiff D, Kunschner L, Raizer J, Honnorat J, Sloan A, Malkin M, Landolfi JC, Payer F, Mehdorn M, Weil RJ, Pannullo SC, Westphal M, Smrcka M, Chin L, Kostron H, Hofer S, Bruce J, Cosgrove R, Paleologous N, Palti Y, Gutin PH |title=NovoTTF-100A versus physician's choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality |journal=Eur. J. Cancer |volume=48 |issue=14 |pages=2192–202 |date=September 2012 |pmid=22608262 |doi=10.1016/j.ejca.2012.04.011 |url=}}</ref>
*** A portable device which will be placed on the [[scalp]] for generating TT fields. The combination of this device with [[Temozolomide]] will significantly increase survival.
** 3.4 [[Carmustine]] polymer wafers<ref name="pmid12672279">{{cite journal |vauthors=Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, Whittle IR, Jääskeläinen J, Ram Z |title=A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma |journal=Neuro-oncology |volume=5 |issue=2 |pages=79–88 |date=April 2003 |pmid=12672279 |pmc=1920672 |doi=10.1093/neuonc/5.2.79 |url=}}</ref>
*** Implanted at the time of [[surgery]].
*** Can be used in combination with [[chemotherapy]] or [[radiation]].
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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[[Category:Neurosurgery]]
[[Category:Neurosurgery]]
[[Category:Pathology]]
[[Category:Pathology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]

Latest revision as of 19:19, 14 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Overview

The mainstay of treatment for low grade astrocytoma is wait and see approach, radiation therapy and chemotherapy. Treatment for anaplastic astrocytoma is radiotherapy with adjunctive chemotherapy, radiotherapy alone and chemotherapy alone. Treatment for glioblastoma multiform is chemotherapy and radiotherapy, Bevacizumab, alternating electric fields and Carmustine polymer wafers.

Medical Therapy

  • Post surgical medical therapy is recommended in all patients with astrocytoma tumor.

Astrocytoma



References

  1. ↑ Ricard D, Kaloshi G, Amiel-Benouaich A, Lejeune J, Marie Y, Mandonnet E, Kujas M, Mokhtari K, Taillibert S, Laigle-Donadey F, Carpentier AF, Omuro A, Capelle L, Duffau H, Cornu P, Guillevin R, Sanson M, Hoang-Xuan K, Delattre JY (May 2007). "Dynamic history of low-grade gliomas before and after temozolomide treatment". Ann. Neurol. 61 (5): 484–90. doi:10.1002/ana.21125. PMID 17469128.
  2. ↑ Shaw EG, Berkey B, Coons SW, Bullard D, Brachman D, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta M (November 2008). "Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial". J. Neurosurg. 109 (5): 835–41. doi:10.3171/JNS/2008/109/11/0835. PMC 3833272. PMID 18976072.
  3. ↑ van den Bent MJ, Afra D, de Witte O, Ben Hassel M, Schraub S, Hoang-Xuan K, Malmström PO, Collette L, Piérart M, Mirimanoff R, Karim AB (2005). "Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial". Lancet. 366 (9490): 985–90. doi:10.1016/S0140-6736(05)67070-5. PMID 16168780.
  4. ↑ Ryken TC, Parney I, Buatti J, Kalkanis SN, Olson JJ (December 2015). "The role of radiotherapy in the management of patients with diffuse low grade glioma: A systematic review and evidence-based clinical practice guideline". J. Neurooncol. 125 (3): 551–83. doi:10.1007/s11060-015-1948-1. PMID 26530266.
  5. ↑ van den Bent MJ, Baumert B, Erridge SC, Vogelbaum MA, Nowak AK, Sanson M, Brandes AA, Clement PM, Baurain JF, Mason WP, Wheeler H, Chinot OL, Gill S, Griffin M, Brachman DG, Taal W, Rudà R, Weller M, McBain C, Reijneveld J, Enting RH, Weber DC, Lesimple T, Clenton S, Gijtenbeek A, Pascoe S, Herrlinger U, Hau P, Dhermain F, van Heuvel I, Stupp R, Aldape K, Jenkins RB, Dubbink HJ, Dinjens W, Wesseling P, Nuyens S, Golfinopoulos V, Gorlia T, Wick W, Kros JM (October 2017). "Interim results from the CATNON trial (EORTC study 26053-22054) of treatment with concurrent and adjuvant temozolomide for 1p/19q non-co-deleted anaplastic glioma: a phase 3, randomised, open-label intergroup study". Lancet. 390 (10103): 1645–1653. doi:10.1016/S0140-6736(17)31442-3. PMC 5806535. PMID 28801186. Vancouver style error: initials (help)
  6. ↑ Buckner JC, Shaw EG, Pugh SL, Chakravarti A, Gilbert MR, Barger GR, Coons S, Ricci P, Bullard D, Brown PD, Stelzer K, Brachman D, Suh JH, Schultz CJ, Bahary JP, Fisher BJ, Kim H, Murtha AD, Bell EH, Won M, Mehta MP, Curran WJ (April 2016). "Radiation plus Procarbazine, CCNU, and Vincristine in Low-Grade Glioma". N. Engl. J. Med. 374 (14): 1344–55. doi:10.1056/NEJMoa1500925. PMC 5170873. PMID 27050206.
  7. ↑ Shaw EG, Wang M, Coons SW, Brachman DG, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta MP (September 2012). "Randomized trial of radiation therapy plus procarbazine, lomustine, and vincristine chemotherapy for supratentorial adult low-grade glioma: initial results of RTOG 9802". J. Clin. Oncol. 30 (25): 3065–70. doi:10.1200/JCO.2011.35.8598. PMC 3732006. PMID 22851558.
  8. ↑ Juratli TA, Lautenschläger T, Geiger KD, Pinzer T, Krause M, Schackert G, Krex D (September 2015). "Radio-chemotherapy improves survival in IDH-mutant, 1p/19q non-codeleted secondary high-grade astrocytoma patients". J. Neurooncol. 124 (2): 197–205. doi:10.1007/s11060-015-1822-1. PMID 26033545.
  9. ↑ Shin JY, Diaz AZ (September 2016). "Anaplastic astrocytoma: prognostic factors and survival in 4807 patients with emphasis on receipt and impact of adjuvant therapy". J. Neurooncol. 129 (3): 557–565. doi:10.1007/s11060-016-2210-1. PMID 27401155.
  10. ↑ Wick W, Hartmann C, Engel C, Stoffels M, Felsberg J, Stockhammer F, Sabel MC, Koeppen S, Ketter R, Meyermann R, Rapp M, Meisner C, Kortmann RD, Pietsch T, Wiestler OD, Ernemann U, Bamberg M, Reifenberger G, von Deimling A, Weller M (December 2009). "NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide". J. Clin. Oncol. 27 (35): 5874–80. doi:10.1200/JCO.2009.23.6497. PMID 19901110.
  11. ↑ Wick W, Roth P, Hartmann C, Hau P, Nakamura M, Stockhammer F, Sabel MC, Wick A, Koeppen S, Ketter R, Vajkoczy P, Eyupoglu I, Kalff R, Pietsch T, Happold C, Galldiks N, Schmidt-Graf F, Bamberg M, Reifenberger G, Platten M, von Deimling A, Meisner C, Wiestler B, Weller M (November 2016). "Long-term analysis of the NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with PCV or temozolomide". Neuro-oncology. 18 (11): 1529–1537. doi:10.1093/neuonc/now133. PMC 5063521. PMID 27370396.
  12. ↑ Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (March 2005). "Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma". N. Engl. J. Med. 352 (10): 987–96. doi:10.1056/NEJMoa043330. PMID 15758009.
  13. ↑ Kole AJ, Park HS, Yeboa DN, Rutter CE, Corso CD, Aneja S, Lester-Coll NH, Mancini BR, Knisely JP, Yu JB (August 2016). "Concurrent chemoradiotherapy versus radiotherapy alone for "biopsy-only" glioblastoma multiforme". Cancer. 122 (15): 2364–70. doi:10.1002/cncr.30063. PMID 27172136.
  14. ↑ Lai A, Tran A, Nghiemphu PL, Pope WB, Solis OE, Selch M, Filka E, Yong WH, Mischel PS, Liau LM, Phuphanich S, Black K, Peak S, Green RM, Spier CE, Kolevska T, Polikoff J, Fehrenbacher L, Elashoff R, Cloughesy T (January 2011). "Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme". J. Clin. Oncol. 29 (2): 142–8. doi:10.1200/JCO.2010.30.2729. PMC 3058273. PMID 21135282.
  15. ↑ Stupp R, Wong ET, Kanner AA, Steinberg D, Engelhard H, Heidecke V, Kirson ED, Taillibert S, Liebermann F, Dbalý V, Ram Z, Villano JL, Rainov N, Weinberg U, Schiff D, Kunschner L, Raizer J, Honnorat J, Sloan A, Malkin M, Landolfi JC, Payer F, Mehdorn M, Weil RJ, Pannullo SC, Westphal M, Smrcka M, Chin L, Kostron H, Hofer S, Bruce J, Cosgrove R, Paleologous N, Palti Y, Gutin PH (September 2012). "NovoTTF-100A versus physician's choice chemotherapy in recurrent glioblastoma: a randomised phase III trial of a novel treatment modality". Eur. J. Cancer. 48 (14): 2192–202. doi:10.1016/j.ejca.2012.04.011. PMID 22608262.
  16. ↑ Westphal M, Hilt DC, Bortey E, Delavault P, Olivares R, Warnke PC, Whittle IR, Jääskeläinen J, Ram Z (April 2003). "A phase 3 trial of local chemotherapy with biodegradable carmustine (BCNU) wafers (Gliadel wafers) in patients with primary malignant glioma". Neuro-oncology. 5 (2): 79–88. doi:10.1093/neuonc/5.2.79. PMC 1920672. PMID 12672279.

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