Department of Oncology, Tom Baker Cancer Centre and the University of Calgary, Calgary, AB.
Curr Oncol. 2011 Jun;18(3):e126-36. doi: 10.3747/co.v18i3.755.
Recommendation 1: Multidisciplinary ApproachTo optimize treatment outcomes, the management of patients with recurrent glioblastoma should be individualized and should involve a multidisciplinary team approach, including neurosurgery, neuropathology, radiation oncology, neuro-oncology, and allied health professions.Recommendation 2: ImagingThe standard imaging modality for assessment of recurrent glioblastoma is Gd-enhanced magnetic resonance imaging (mri). Tumour recurrence should be assessed according to the criteria set out by the Response Assessment in Neuro-Oncology Working Group. The optimal timing and frequency of mri after chemoradiation and adjunctive therapy have not been established.Recommendation 3: Pseudo-progressionProgression observed by mri after chemoradiation can be pseudo-progression. Accordingly, treated patients should not be classified as having progressive disease by Gd-enhancing mri within the first 12 weeks after the end of radiotherapy unless new enhancement is observed outside the radiotherapy field or viable tumour is confirmed by pathology at the time of a required re-operation. Adjuvant temozolomide should be continued and follow-up imaging obtained.Recommendation 4: Repeat SurgerySurgery can play a role in providing symptom relief and confirming tumour recurrence, pseudo-progression, or radiation necrosis. However, before surgical intervention, it is essential to clearly define treatment goals and the expected impact on prognosis and the patient's quality of life. In the absence of level 1 evidence, the decision to re-operate should be made according to individual circumstances, in consultation with the multidisciplinary team and the patient.Recommendation 5: Re-irradiationRe-irradiation is seldom recommended, but can be considered in carefully selected cases of recurrent glioblastoma.Recommendation 6: Systemic TherapyClinical trials, when available, should be offered to all eligible patients. In the absence of a trial, systemic therapy, including temozolomide rechallenge or anti-angiogenic therapy, may be considered. Combination therapy is still experimental; optimal drug combinations and sequencing have not been established.
建议 1：多学科方法
为了优化治疗效果，复发性胶质母细胞瘤患者的管理应个体化，并应涉及多学科团队方法，包括神经外科、神经病理学、放射肿瘤学、神经肿瘤学和相关的健康专业。
建议 2：影像学
评估复发性胶质母细胞瘤的标准影像学方式是钆增强磁共振成像（MRI）。肿瘤复发应根据神经肿瘤学反应评估工作组规定的标准进行评估。放化疗和辅助治疗后 MRI 的最佳时机和频率尚未确定。
建议 3：假性进展
放化疗后 MRI 观察到的进展可能是假性进展。因此，除非在放疗野外观察到新的增强或在需要再次手术时通过病理学证实存在存活肿瘤，否则在放疗结束后 12 周内，不应通过 Gd 增强 MRI 将接受治疗的患者归类为进展性疾病。应继续辅助替莫唑胺治疗并获得随访影像学检查。
建议 4：再次手术
手术可以起到缓解症状和确认肿瘤复发、假性进展或放射性坏死的作用。然而，在进行手术干预之前，必须明确治疗目标以及对预后和患者生活质量的预期影响。在没有 1 级证据的情况下，应根据个人情况，与多学科团队和患者协商后决定是否再次手术。
建议 5：再放疗
再放疗很少被推荐，但在精心挑选的复发性胶质母细胞瘤病例中可以考虑。
建议 6：系统治疗
如果有临床试验，应向所有符合条件的患者提供。在没有试验的情况下，可以考虑系统治疗，包括替莫唑胺再挑战或抗血管生成治疗。联合治疗仍处于实验阶段；尚未确定最佳药物组合和顺序。
