How do you approach a recurrence of grade 3 anaplastic astrocytoma after initial treatment with gross total resection followed by RT/adjuvant temozolomide?

As the questioner notes, this is an area where guidelines and published evidence are not as satisfying as we would like, so treatment has to be individualized. In addition, most trials until very recently did not test IDH status or 1p/19q status so the diagnoses may not be the same as people diagnos...

It depends on the timing of the recurrence. Clinical trial would be the first option. If the recurrence is >1 year after temozolomide, I usually re-challenge with temozolomide. If it's >1 year after RT, then repeat RT/temozolomide is possible too, depending on the tumor location and size. If there i...