In the recurrent setting, re-operation and re-irradiation may be the primary option since chemotherapeutic agents have proven modest activity. Thus, the therapeutic strategy must be tailored individually. Antiangiogenic therapy, such as the anti-VEGF monoclonal antibody bevacizumab, has been used due to its dramatic radiological response and improved progression-free survival [26]. However, the short-lasting response, the absence of a clear benefit in OS, the potential for inducing changes in the biological behavior of the tumor resulting in a more invasive and aggressive tumor, and its excessive cost make this approach still debatable, particularly in under developing countries.

Age, performance status, and extent of resection are important prognostic factors for glioma patients. For instance, elderly patients are expected to present shorter OS and higher treatment-related toxicity. In this age group, treatment options include best supportive care, short course radiotherapy, TMZ alone (especially in patients with MGMT methylated) [27], and chemoradiation. However, it is usually recommended that treatment decisions should not be based exclusively on chronological age but mostly on the patient’s performance status [28].