Gliomatosis cerebri medical therapy

Radiotherapy and chemotherapy are recommended among all patients who develop gliomatosis cerebri. Temozolomide and PCV 3 combination chemotherapy are the preferred drugs for the treatment of high-grade and low-grade gliomatosis cerebri, respectivel Supportive therapy for gliomatosis cerebri includes anticonvulsants and corticosteroids.

The medical therapy of gliomatosis cerebri includes:

• Post-operative radiotherapy is recommended among all patients who develop gliomatosis cerebri.^[1]
• Radiotherapy may not cure the cancer but can control the tumor, delay recurrence, and increase survival.
• Radiation therapy is associated with temporary improvement of clinical symptoms.^[2]
• External beam radiation therapy is preferred to whole brain radiotherapy.^[3]
• The median dose of radiation is 60 Gy (range: 50-72 Gy).^[1]

• Chemotherapy is indicated as adjuvant therapy for gliomatosis cerebri.
• Temozolomide (Temodar) is the preferred drug for the treatment of high-grade gliomatosis cerebri.^[4][5]
• PCV 3 combination chemotherapy is the preferred drug regimen for slow growing, low-grade gliomatosis cerebri.^[6]
  • CCNU is administered on day 1, procarbazine is administered daily for 14 days beginning on day 8, and vincristine is administered on days 8 and 29 of each 6-week cycle of therapy.^[7]
• Other chemotherapeutic drugs that may be used for the treatment of gliomatosis cerebri include:^[8][9][10]
  • Carmustine
  • Cisplatin
  • Erlotinib
  • Hydroxyurea
  • 6-thioguanine

• Supportive therapy for gliomatosis cerebri includes anticonvulsants and corticosteroids, which focuses on relieving symptoms and improving the patient’s neurologic function.^[2]
  • Anticonvulsants are administered to the patients who have a seizure. Phenytoin given concurrently with radiation may have serious skin reactions such as erythema multiforme and Stevens-Johnson syndrome.
  • Corticosteroids, usually dexamethasone given 4-10 mg every 4-6 h, can reduce peritumoral edema, diminish mass effect, and lower intracranial pressure with a decrease in headache or drowsiness.

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