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 service guidance for improving outcomes for people with brain and other central nervous system tumours. 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).
The recommendations in this guidance represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take this guidance fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this guidance is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the guidance to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.