Table 2

Radiation oncology: Royal College of Physicians guidelines

BCNU, bischloroethylnitrosourea; CCNU, chloroethylcyclohexlnitrosourea; PCV, procarbazine, CCNU, and vincristine.
Radiotherapy treatment
  • Performance status should be recorded before treatment

  • Patients and relatives should take part in the decision about whether or not to have radiotherapy

  • All patients should be offered a suitable wig to cope with hair loss

  • The acceptable and effective total tumour dose for patients who are fit is 60 Gy in 30 fractions

  • Localised irradiation is preferable to whole brain irradiation

  • Volumes should encompass the presenting enhancing radiological abnormality with margins 2–3 cm

  • The optimum radiation schedule for poor prognosis patients is unknown. A palliative course of 30 Gy in 2 weeks and similar palliative regimens are acceptable

  • The time from surgery to start of radiotherapy should be kept to a minimum ideally <4 weeks

  • Supportive management includes weekly neurological assessment (this should be documented) and the development of a care plan for the patient and carer

Follow up and advice
  • Care should ideally be supervised by a single specialist and team and a key coordinator (for example, nurse)

  • Patients and relatives must know a main point of contact for advice/support at all stages of their illness and easy access to designated clinics for neuro-oncology patients

  • Rehabilitation, support, and counselling to patients and their relatives must be offered early in the course of disease and treatment

  • Information should be given to patients and relatives about further sources of support

  • Performance status (for example, Karnofsky) and simple measures of quality of life should be recorded at follow up

  • Patients who are treated with steroids alone should be considered for referral to a palliative care

  • Information leaflets should be kept available in the department accessible and well displayed

  • The patient’s GP should always be informed of the diagnosis, arrangements for follow up and management if possible before the patient has to see them again

  • Patients should be offered the chance to speak with a social worker about any benefits for which they may be eligible, and be offered physiotherapy, occupational therapy, and speech therapy services

Chemotherapy treatment
  • Routine adjuvant chemotherapy at primary diagnosis is not recommended; however, if the patient and/or clinician determine that chemotherapy should be administered the appropriate treatment is either single agent nitrosourea (BCNU or CCNU) or a combination (for example, PCV therapy)

  • Patients whose disease has relapsed after a reasonable period, and who are not severely disabled, should be considered for palliative chemotherapy (for example, BCNU or PCV) with experimental protocols

Treatment options following recurrence
  • Further treatment after failure of chemotherapy should be considered. (Nevertheless it is essential not to raise unrealistic hopes for patients who initially responded well to primary treatment and whose performance score and perceived quality of life is still high)

  • Selected patients may be considered for further surgery if it will relieve distressing symptoms