High-grade gliomas are malignant, rapidly progressive primary brain tumors. It is best given a combined treatment plan, the latter integrating maximal surgical resection, adjuvant radiotherapy and adjuvant chemotherapy. Accurate diagnosis of recurrence or tumor progression is critical. Imaging changes due to initial treatment are indistinguishable from tumor progression. Continuation of temozolomide chemotherapy still requires adherence unless the likelihood of disease progression is clarified. Despite multiple treatments, almost all patients will eventually relapse. Treatment of recurrence or re-progression is difficult and there is no evidence that aggressive treatment regimens can prolong survival. The choice of treatment regimen should be individualized, taking into account patient preferences, previous treatment, physical status, quality of life, and the overall goals of treatment. In exceptional patients, surgical treatment may be effective, aiming to distinguish between recurrence or treatment-induced necrosis, to reduce the size of the recurrent tumor and to provide partial relief of symptoms. In exceptional patients with local recurrence, focal radiotherapy may have the effect of extending the progression-free period. For most recurrent or progressive high-grade gliomas, we recommend systemic treatment with bevacizumab. results from a phase 2 clinical trial study showed that bevacizumab reduced the patient’s dependence on corticosteroids, and imaging also showed an inhibition of tumor growth. Those patients who are not candidates for bevacizumab, or whose tumors continue to progress despite taking bevacizumab, may consider a nitrosourea and temozolomide rechemotherapy regimen. If possible, patients should first be enrolled in a clinical trial study. Regardless of the choice of subsequent etiologic therapy, all patients with recurrence should be given maximum supportive care, including pain relief and hospice care as needed.