Low-Dose Fractionated Radiation Therapy and Temozolomide in Treating Patients with Recurrent Anaplastic Astrocytoma or Glioblastoma Multiforme

Inclusion Criteria

• Patients must have recurrent glioblastoma multiforme (GBM) or anaplastic astrocytoma
• The diagnosis of GBM or anaplastic astrocytoma must be histologically confirmed
• Patients must have been previously treated with surgical resection (any extent okay) and radiation therapy plus temozolomide
• Patients must be at least 12 months from completion of radiation therapy (to be consistent with the "rechallenge" group from Perry et al. Journal of Clinical Oncology [JCO] 2010 where the median time from completion of adjuvant radiation therapy to the time of progression was 19.69 months)
• At least 2 months from completion of temozolomide (to be consistent with the “rechallenge” group from Perry et al. JCO 2010)
• Eastern Cooperative Oncology Group (ECOG) performance status =< 2 (Karnofsky >= 60%)
• There must be measurable disease on magnetic resonance imaging (MRI)
• Leukocytes >= 3,000/mcL
• Absolute neutrophil count >= 1,500/mcL
• Platelets >= 100,000/mcL
• Total bilirubin within normal institutional limits
• Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 X institutional upper limit of normal
• Creatinine within normal institutional limits OR creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
• If a woman is of child-bearing potential, a negative urine or serum pregnancy test must be demonstrated prior to treatment; women of childbearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) for the duration of study participation and for up to 12 weeks following the study; should a women become pregnant or suspect she is pregnant while participating in this study she should inform her treating physician immediately
• Ability to understand and the willingness to sign a written informed consent document
• Temozolomide re-treatment is planned by the treating neuro-oncologist
• The most recent brain tumor pathology obtained for the patient must be glioblastoma or anaplastic astrocytoma

Exclusion Criteria

• Patients who are unable to receive MRIs will be excluded from the study since MRIs will be critical in monitoring the efficacy of therapy
• Patients may not be receiving any other investigational cancer treatment agents at the time of enrollment
• Patients may not have previously failed treatment with salvage temozolomide
• Patients may not have previously failed treatment with a vascular endothelial growth factor (VEGF) inhibitor
• Patients may not have previously been treated with > 1 course of radiotherapy to the brain
• Patients may not have previously been treated with radiosurgery to the brain
• Uncontrolled intercurrent illness including, but not limited to ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
• Pregnant and/or breastfeeding women are excluded; women of child-bearing potential who are unwilling or unable to use and acceptable method of birth control to avoid pregnancy for the entire study period and up to 12 weeks after the study are excluded; male subjects must also agree to use effective contraception for the same period as above