1 Guidance

1 Guidance

Temozolomide and carmustine implants have been appraised separately for the treatment of newly diagnosed high-grade glioma. On the basis of the evidence presented to the Committee, no recommendation can be made regarding the sequential use of these treatments for newly diagnosed high-grade glioma.

1.1 Temozolomide, within its licensed indications, is recommended as an option for the treatment of newly diagnosed glioblastoma multiforme (GBM) in patients with a World Health Organization (WHO) performance status of 0 or 1.

1.2 Carmustine implants, within their licensed indications, are recommended as an option for the treatment of newly diagnosed high-grade glioma only for patients in whom 90% or more of the tumour has been resected.

1.3 Treatment with carmustine implants should be provided only within specialist centres that in general conform to guidance in 'Improving outcomes for people with brain and other central nervous system tumours' (NICE cancer service guidance 2006), and should be supervised by specialist neurosurgeons who spend at least 50% of their clinical programmed activities in neuro-oncological surgery. The specialists should also have access to:

  • multidisciplinary teams to enable preoperative identification of patients in whom maximal resection is likely to be achievable

  • magnetic resonance imaging (MRI) to enable preoperative identification of patients in whom maximal resection is likely to be possible, and

  • image-directed technology, such as neuronavigation, for use intraoperatively to assist the achievement of maximal resection.

1.4 Carmustine implants are not recommended for the treatment of newly diagnosed high-grade glioma for patients in whom less than 90% of the tumour has been resected.