The role of radiotherapy in the management of progressive glioblastoma: A systematic review and evidence-based clinical practice guideline

Question: Can re-irradiation (by using conventional radiotherapy, fractionated radiosurgery, or single fraction radiosurgery) be used in patients with progressive glioblastoma multiforme after the first adjuvant combined multimodality treatment with radiation and chemotherapy? Target population: These recommendations apply to adult patients with progressive glioblastoma after first line combined multimodality treatment with chemotherapy and radiation. Recommendations Level III: When the target tumor is amenable for additional radiation, re-irradiation is recommended as it provides improved local tumor control, as measured by best imaging response. Such re-irradiation can take the form of conventional fractionation radiotherapy, fractionated radiosurgery, or single fraction radiosurgery. Level III: Re-irradiation is recommended in order to maintain or improve a patient's neurological status and quality of life prior to any further tumor progression.