Establish intent of treatment

• Longer term survival without expectation of cure
• Maintenance of quality of life
• Symptom palliation.

Treatment options

• Surgery is commonly the first therapeutic approach for tumour debulking and obtaining tissue for diagnosis. All patients with presumed high-grade glioma should be considered for surgery and, at the discretion of the treating neurosurgeon, maximal safe resection is encouraged.
• Residual enhancing disease should be determined within 48 hours after surgery using pre- and post-contrast MRI.
• Consider advanced surgical options to achieve maximal safe resection, such as fluorescence-assisted resection, intraoperative imaging and awake surgery.
• Consider all patients for radiation therapy and chemotherapy after surgery.
• These patients have specialised medication needs (corticosteroids, anticonvulsants, anticoagulants) and should be managed in conjunction with a specialist practitioner.

Palliative care

Consider referral to specialist palliative care for all patients. Early referral to palliative care can improve quality of life. Referral should be based on need, not prognosis. For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• communicating the treatment plan to the patient’s GP
• providing the patient and/or carer with information about safe mobility, seizures, possible side effects of treatment, self-management strategies and emergency contacts.

Checklist

Timeframe

Surgery should occur immediately for most cases, or within 4 weeks of diagnosis if not urgent (according to clinical need).

Begin radiation therapy within 6 weeks after surgery.

Chemotherapy or drug therapy should occur within 6 weeks following surgery or radiotherapy.