Understanding Your Options When Glioma Recurs
- Unfortunately, glioma recurrences are common — but it’s important to remember there are still options.
- Repeat surgery may be an option for some, but this will depend on factors like the size and location of the recurrent tumor.
- You may be a candidate for targeted therapies based on your molecular profile, so it’s important to ask your doctor about molecular testing.
- Tumor treating fields are also an option for some with recurrent/progressive gliomas if not used previously
- Still, clinical trials should be explored given the limited treatment options.
Dr. Ashley Ghiaseddin, a neuro-oncology expert from University of Florida Health, emphasizes the importance of exploring all possibilities.
Read MoreCan I Have Surgery Again?
The possibility of a second surgery depends on the size and location of the recurrent tumor. Tumors in critical areas of the brain—such as the motor cortex (movement), sensory cortex (sensation), optic pathway (vision), and brainstem—are often deemed inoperable due to the risk of severe neurologic complications or even death. However, if the recurrence is near the initial surgical site and does not involve these critical areas, a second surgery may be feasible.Your neurosurgeon will carefully evaluate imaging studies and your overall health to determine if surgery is a safe and beneficial option for you.
If surgery is not possible, several other treatments are available to manage recurrent gliomas. Your care team will tailor a treatment plan based on your response to prior therapies, functional status, and ability to tolerate potential side effects. Molecular testing, if not performed previously, can also guide the use of targeted therapies.
Chemotherapy Options
Chemotherapy remains a cornerstone of glioma treatment. The following options may be considered as salvage therapy (treatment after recurrence):
- PCV (Procarbazine, Lomustine, Vincristine): If you did not receive this therapy initially, it may be offered as a second-line option.
- Temozolomide (TMZ): This may also be considered if it was not used in your initial treatment.
- Carmustine or Lomustine: These alkylating agents can be used alone or in combination with other therapies.
- Etoposide: This is an alternative for patients who cannot tolerate other chemotherapy regimens.
- Carboplatin or Cisplatin: These platinum-based drugs may be considered for patients with limited tolerance to other treatments.
Your oncologist will discuss the risks and benefits of each option to help you make an informed decision.
Targeted Therapy Options
Targeted therapies offer a more precise approach to treating gliomas by focusing on specific genetic mutations or pathways involved in tumor growth. Some options include:
- Bevacizumab (Avastin): A widely used second-line therapy for recurrent gliomas. It can be given alone or in combination with chemotherapy such as carmustine.
- Regorafenib: This dual-targeted inhibitor has anti-angiogenic activity, meaning it reduces the tumor’s blood supply by inhibiting VEGFR2-TIE2 tyrosine kinase pathways.
- IDH Inhibitors: These are typically used as a first-line treatment for low-grade gliomas but may also be offered after recurrence if not previously used.
- BRAF Inhibitors: If molecular testing reveals a BRAF V600E mutation, this targeted therapy may be an option.
- NTRK Inhibitors: If your tumor has an NTRK fusion gene, you may benefit from this therapy.
Molecular testing is crucial to identify whether these therapies are appropriate for you. Your doctor can explain the testing process and what the results mean for your treatment plan.
Radiation Therapy
In recurrence, radiation therapy can be revisited under certain circumstances, including:
- Salvage Radiation: If you did not receive radiation during your initial treatment, it may be offered now, either alone or in combination with chemotherapy.
- Re-irradiation: Even if you had radiation upfront, repeat radiation might be possible, especially for small, well-defined recurrences located away from critical areas of the brain. Re-irradiation typically involves a short course (1–10 treatments) and may use advanced techniques such as stereotactic radiosurgery or proton therapy.
Your radiation oncologist will carefully assess whether this option is safe and beneficial for you.
Tumor Treating Fields (TTFs)
TTFs are an innovative treatment option primarily for glioblastoma patients. If you did not receive TTF therapy initially, you might be offered this treatment at recurrence. TTFs use non-ionizing electromagnetic waves to disrupt cancer cell division while sparing healthy tissue. However, this therapy is not typically offered for lower-grade gliomas.
What About Clinical Trials?
Clinical trials offer access to cutting-edge therapies that are not yet widely available. Many trials explore new treatments for recurrent gliomas, including novel drugs, immunotherapies, and combination approaches.
You can explore clinical trial opportunities by visiting ClinicalTrials.gov, a comprehensive resource for ongoing studies, or using SurvivorNet’s simple Clinical Trial Finder. Your healthcare team can also help identify trials that match your specific diagnosis and treatment history.
Questions to Ask Your Doctor
Facing a glioma recurrence is nerve-wracking. If you’re feeling at a loss for how to discuss your treatment plan with your doctor, considering starting with these questions.
- What grade is my glioma at?
- Should I undergo molecular testing?
- What is the standard treatment path for someone with my diagnosis?
- Are there any clinical trials I should consider?
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