Glossary and summary of XRT and SACT options

For specific Chemotherapy regimens see Local CNS Chemotherapy Protocols. Regimens include:

• Oral CCNU (lomustine) 100mg/m2 (D1) + oral Procarbazine 100mg/m2 (D2-11) +/- intravenous vincristine 1.4mg/m2, max 2mg (D1) - (PCV or PC)
• Single agent oral CCNU (lomustine) 100-130mg/m2
• Concomitant (75mg/m2 daily with XRT) and adjuvant Temozolomide (150 – 200mg/m2 D1-5, Q 4 weekly) - 6 or 12 cycles (Younger patients get 6 weeks chemoXRT and up to 6 months of adjuvant chemotherapy. Older patients get 3 weeks of chemoXRT with up to 12 months of adjuvant chemotherapy as per clinical trial. Refer to local protocol for further details.)
• Standard dose 5-day Temozolomide (150-200mg/m2 D1-5, Q 4 weekly). Cycle number varies depending on clinical circumstances, response, tolerance.
• Dose intense 21 day Temozolomide, (various regimens eg 100mg/m2 daily for 6 weeks, Q 8 weekly) - only for use in patients demonstrating prior response to standard 5-day Temozolomide schedule
• Intravenous Carboplatin (AUC5) + Etoposide (100mg/m2) – various regimens offered, etoposide can be from 1 to 3 days in duration, oral (200mg/m2) substituting for some iv doses. Q 3 weekly. Usually reserved for later relapses after multiple previous interventions or specific disease types.

For specific Radiotherapy details see Local CNS Radiotherapy Protocols.

Standard regimens are:

• 6000cGy/30# for Gd 4 disease;
• 5400-5940cGy, 180cGy/# in Gd 3 disease;
• 4500-5400cGy 180cGy/# in Low grade disease (Gd 1,2).

Short course (hypofractionated) regimens include:

• 4000-4005cGy/15#,
• 3000cGy/6# alternate days over 2 weeks, or 3400cGy/10#.

For palliative re-irradiation, a hypofractionated regimen is preferred, eg 3500cGy/10#.

MGMT - methyl guanine methyl transferase (methylation status refers to the promoter region of the expressing gene)

PC(+/-V) – procarbazine, CCNU/lomustine +/- vincristine

IDH-1/2 – isocitrate dehydrogenase, a genetic marker of prognosis in glioma

XRT – radiotherapy

LOH – loss of heterozygosity, loss of one of the normal two copies of a chromosome or part of a chromosome

MR(S) – magnetic resonance imaging (spectroscopy)

SPECT – single positron emission computerised tomography

CT – computerised tomography imaging

ICP – intracranial pressure 

PS – performance status