What should I do if my brain glioma recurs?

Generally speaking, except for grade one and a few grade two glioma patients who may be cured, most glioma patients must also face the problem of tumor recurrence. During our review and treatment process, we found new lesions near the original intracranial surgical area. What should we do?

Is our lesion a tumor recurrence or a radiation reaction? Commonly used identification examination methods mainly include nuclear magnetic resonance spectroscopy and perfusion imaging, PET. If it is a radiation reaction, conservative treatment methods such as hormones and bevacizumab can be selected to observe the progression of the lesion during treatment.

If recurrence is considered, a specific analysis should be conducted based on the patient's age, physical condition, lesion size, location, radiotherapy and chemotherapy, etc.

If the lesion is small, patients who have not received radiotherapy and chemotherapy can choose to undergo radiotherapy and chemotherapy first, and then observe the progression of the lesion. Patients who have undergone radiotherapy and chemotherapy can consider changing the chemotherapy plan. For example, temozolomide can be changed to irinotecan, or combined with targeted drugs. If the lesion is limited, gamma knife or cyberknife can be considered. Or participate in clinical trials.

If the lesion is large, first analyze whether another surgery is possible based on the situation. The patient is in good physical condition and the lesion is located on the anterior surface or non-functional area. Surgery will not cause serious neurological dysfunction and risks, so surgical resection is the first choice, and chemotherapy or radiotherapy is selected after surgery based on the situation. This can achieve the best treatment effect. If you can have surgery, try to have surgery first.

If the lesion is large, extensive, or deep, or the surgical risk may lead to severe neurological dysfunction or risk, then we first choose combined chemotherapy, targeted therapy, or clinical trials. Depending on the specific situation, some patients can undergo secondary radiotherapy. For recurrent brain gliomas, factors such as the dose of the first radiotherapy, the interval with the first radiotherapy, and the location and volume of the recurrent tumor should be considered.