Carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma

NICE technology appraisals [TA121] Published date:

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).

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