The European Society of Oncology (ESMO) has issued guidelines for the treatment and follow-up of high-grade gliomas, which include the following recommendations for the treatment of recurrent high-grade gliomas: for patients who have relapsed and are in good general condition, they may benefit from chemotherapy with this class of drugs if they have not had chemotherapy with cytotoxic agents; mesenchymal astrocytomas may be more effective than glioblastomas for temozolomide. No definitive chemotherapy regimen is available for relapsed patients who have had chemotherapy; patients will be best treated by participating in various clinical drug trials. In unscreened relapsed patients, nitrosoureas have benefited some patients; randomized studies suggest EGFR inhibitors, and PDGFR inhibitors have not been shown to inhibit tumor growth. Bevacizumab ± CPT 11 has a high imaging response rate but short duration, the mechanism of which is likely due to altered permeability of the blood vessels.