Carmustine implants are recommended as a possible treatment for people with newly diagnosed high-grade glioma only if 90% or more of their tumour has been removed. People should have carmustine implants only at specialist treatment centres under the care of a team of experts, as described in ‘Improving outcomes for people with brain and other central nervous system tumours’ (NICE cancer service guidance 2006; www.nice.org.uk/csgbraincns). Treatment should be supervised by specialist neurosurgeons who:
- spend at least half of their time working in surgery to treat cancers of the brain and spinal cord
- work with a team of other specialists and have access to magnetic resonance imaging (MRI) to help predict before the operation whether it will be possible to remove 90% of the person’s tumour
- have access to technology that helps them precisely locate the tumour during the operation.
Carmustine implants are not recommended for people with newly diagnosed high-grade glioma if less than 90% of their tumour has been removed.
Temozolomide is recommended as a possible treatment for people with newly diagnosed glioblastoma multiforme (a type of high-grade glioma) who have a World Health Organization (WHO) performance status of 0 (they are able to carry out all normal activity without restriction) or 1 (they are restricted in strenuous activity but are able to move around and carry out light work).