SEOM clinical guideline of diagnosis and management of low-grade glioma (2017) (original) (raw)
Related papers
Neuro-oncology, 2019
The finding that most grades II and III gliomas harbor isocitrate dehydrogenase (IDH) mutations conveying a relatively favorable and fairly similar prognosis in both tumor grades highlights that these tumors represent a fundamentally different entity from IDH wild-type gliomas exemplified in most glioblastoma. Herein we review the most recent developments in molecular neuropathology leading to reclassification of these tumors based upon IDH and 1p/19q status, as well as the potential roles of methylation profiling and deletional analysis of cyclin-dependent kinase inhibitor 2A and 2B. We discuss the epidemiology, clinical manifestations, benefit of surgical resection, and neuroimaging features of lower-grade gliomas as they relate to molecular subtype, including advanced imaging techniques such as 2-hydroxyglutarate magnetic resonance spectroscopy and amino acid PET scanning. Recent, ongoing, and planned studies of radiation therapy and both cytotoxic and targeted chemotherapies are summarized, including both small molecule and immunotherapy approaches specifically targeting the mutant IDH protein.
Postsurgical Approaches in Low‐Grade Oligodendroglioma: Is Chemotherapy Alone Still an Option?
The Oncologist
Background. Patients with low-grade gliomas (LGGs) with isocitrate dehydrogenase (IDH) mutation (mut) and 1p19q codeletion (codel) have a median overall survival of longer than 10 years. The aim of this study is to assess the role of postsurgical treatments. Subjects, Materials, and Methods. We evaluated patients with LGGs with IDH mut and 1p19q codel; IDH1/2 was performed by immunohistochemistry and quantitative polymerase chain reaction. In all wild-type cases, we performed next-generation sequencing. 1p19 codel analysis was performed by fluorescence in situ hybridization. Results. Among the 679 patients, 93 with LGGs with IDH mutation and 1p19q codel were included. Median followup (FU) was 96.1 months. Eighty-four patients (90.3%) were high risk according to Radiation Therapy Oncology Group criteria. After surgery, 50 patients (53.7%) received only FU, 17 (18.3%) chemotherapy (CT), and 26 (30.1%) radiotherapy (RT) with (RT + CT, 8 patients, 8.6%) or without (RT, 18 patients, 19.4%) chemotherapy. Median progression-free survival (mPFS) was 46.3 months, 50.8 months, 103.6 months, and 120.2 months in patients with FU alone, with CT alone, with RT alone, or with RT + CT, respectively. Median PFS was significantly longer in patients who received postsurgical treatment (79.5 months, 95% confidence interval [CI]: 66.4-92.7) than patients who received FU (46.3 months, 95% CI: 36.0-56.5). Moreover, mPFS was longer in patients who received RT (alone or in combination with CT, n = 26, 113.8 months, 95% CI: 57.2-170.5) than those who did not (n = 67, 47.3 months, 95% CI: 36.4-58.2). In particular, temozolomide alone did not improve PFS with respect to FU. Conclusion. RT with or without chemotherapy, but not temozolomide alone, could extend PFS in IDH mut 1p19q codel LGGs. The Oncologist 2019;24:664-670 Implications for Practice: Low-grade gliomas with high-risk features, defined according to Radiation Therapy Oncology Group criteria, receive radiotherapy and/or chemotherapy as postsurgical treatments. Radiotherapy, however, has serious long-term effects (cognitive impairment), which are to be taken into account in these young patients. Moreover, low-grade gliomas with isocitrate dehydrogenase mutation and 1p19q codeletion (oligodendrogliomas) have an extremely long survival and a better prognosis. This study suggests that postsurgical treatments prolong the time before tumor progression in patients with good prognosis as well as those with oligodendroglioma. Moreover, temozolomide alone might not be effective in prolonging progression-free survival.
The European Association for Neuro-Oncology guideline provides recommendations for the clinical care of adult patients with astrocytic and oligodendroglial gliomas, including glioblastomas. The guideline is based on the 2016 WHO classification of tumours of the central nervous system and on scientific developments since the 2014 guideline. The recommendations focus on pathological and radiological diagnostics, and the main treatment modalities of surgery, radiotherapy, and pharmacotherapy. In this guideline we have also integrated the results from contemporary clinical trials that have changed clinical practice. The guideline aims to provide guidance for diagnostic and management decisions, while limiting unnecessary treatments and costs. The recommendations are a resource for professionals involved in the management of patients with glioma, for patients and caregivers, and for health-care providers in Europe. The implementation of this guideline requires multidisciplinary structures of care, and defined processes of diagnosis and treatment.
Turkish Neurosurgery, 2022
AIM: To evaluate isocitrate dehydrogenase (IDH) mutation status and Ki67 percentages of tumors that were treated in our institution to determine whether these markers affected the initial diagnosis and survival rates. MATERIAL and METHODS: High-grade glioma patients, who were operated in our department between 2013 and 2018, were enrolled in the study and retrospectively reviewed. New immunohistochemistry staining studies were conducted and survival analyses were performed. RESULTS: Of 135 patients and 136 tumors, 117 were glioblastoma multiforme (GBM), 8 were grade III-IV glioma, 4 were anaplastic astrocytoma and 7 were anaplastic oligodendroglioma. One patient had two different lesions, which were GBM and anaplastic astrocytoma respectively. Mean age was 55 (7-85) years, and 88 (65%) were male and 47 (35%) were female. The most common complaint was motor deficit (56%). Fourteen patients underwent reoperation due to recurrent disease. Tumors were most commonly found in the frontal lobe (53, 39%). Magnetic resonance imaging (MRI) features showed that existence of necrosis is strongly related to GBM (p<0.01). Approximately 126 patients were found to be IDH-wildtype, which changed 6 patients' diagnosis to GBM, IDH wildtype from grade III-IV glioma. Five patients, who were diagnosed with anaplastic astrocytoma and anaplastic oligodendroglioma initially were found to be IDH wildtype. IDH mutation status, extend of resection, and age were found to affect survival. CONCLUSION: IDH mutation status is important in classifying high-grade gliomas, as well as its effects on prognosis. This mutation is related to several radiological features of tumors. Extent of resection and patient age are also profoundly affect survival. Detailing the diagnosis with molecular features will help physicians to shape targeted adjuvant therapies, which would better outcomes.
The dilemma of low grade glioma
Journal of Neurology, Neurosurgery & Psychiatry, 2004
he management of low grade glioma is one of the most controversial areas in clinical neurooncology. There are numerous reviews and editorials outlining the difficulties in management of these lesions. 1-3 Indeed, the pivotal questions about their management remain unanswered. However, the concept of management of low grade gliomas is not unitary but much more a composite of different challenges depending on the clinical presentation, signs, neuroradiology, perspectives of neurologists, the opinion of the neurosurgeon, and perhaps most importantly, the aspirations of the patient. It is true therefore that in many patients there will be a dilemma about what is considered optimal management since there is no good evidence base to underpin any single management undertaken. Conversely, however, there are many groups of patients with various low grade gliomas in whom management decisions are made more easily and pragmatically. In this review, the current approaches to different low grade gliomas presenting with different symptom complexes in different regions of the brain will be reviewed and the rationale for decision making discussed. THE SPECTRUM OF LOW GRADE GLIOMA c Under the recent World Health Organization classification of primary intracranial tumours, low grade gliomas would encompass grade I and grade II neuro-epithelial tumours. The more common grade I tumours are pilocytic astrocytoma, dysembryoblastic neuro-epithelial tumours (DNET), pleomorphic xantho-astrocytoma (PXA), neurocytoma, and ganglioglioma. The more common grade II tumours include astrocytoma, oligodendroglioma, and mixed oligoastrocytoma. This spectrum of discreet neuropathological entities is important since the grade I tumours generally can be cured by surgical excision and their symptoms very often alleviated. 4 Conversely, with the grade II tumours, these are generally incurable but have median survival times of. 5 years. 1-3 Tumours with oligodendodrial components generally do better than astrocytomas, with prognosis being partially related to gene deletions on chromosome 1p and 19q. 5 6 Some grade II gliomas are ''diffuse'' while others have relatively well defined brain-tumour interfaces. Neuropathological diagnosis and tumour characteristics will therefore profoundly influence the impact of treatment strategies. Currently, even with the best magnetic resonance imaging (MRI) scanners, differentiation between grade I, II, and even III tumours is very difficult, therefore establishing tissue diagnosis can be important. 1 7 Adverse prognostic features for patients with low grade glioma c Age. 40 years c Large tumour (. 6 cm) c Midline shift
EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood
Nature Reviews Clinical Oncology, 2020
The classification of gliomas has undergone major changes through the revision of the fourth edition of the WHO Classification of Tumors of the Central Nervous System 1 in 2016. Further refinements of the classification were subsequently proposed by the Consortium to Inform Molecular and Practical Approaches to CNS Tumour Taxonomy-Not Officially WHO (cIMPACT-NOW) 2-4. These documents enable a diagnosis of glioblastoma to be made not only based on histology but also on the basis of several molecular markers and propose the discontinuation of the term 'IDH-mutant glioblastoma'. To reflect these changes, the European Association of Neuro-Oncology (EANO) considered it necessary to update its guidelines for the management of adult patients with gliomas 5 (Box 1). In the present evidence-based guidelines, we cover the prevention, early diagnosis and screening, integrated histo molecular diagnostics, therapy and follow-up monitoring of adult patients with diffuse gliomas. Aspects such as differential diagnosis, adverse effects of treatment, and supportive and palliative care are beyond the scope of this guideline document. Methods These evidence-based guidelines were formulated by a task force nominated by the EANO Executive Board following a proposal by the Chair of the EANO guidelines committee. This task force includes representatives of all the disciplines involved in the diagnosis and care of adults with glioma and reflects the multinational character of EANO. References were retrieved from the PubMed database using the search terms 'glioma' , 'anaplastic' , 'astrocytoma' , 'oligodendroglioma' , 'glioblastoma' , 'trial' , 'clinical' , 'surgery' , 'radiotherapy' and 'chemotherapy' between January 2011 and July 2020. Publications were also identified through searches of the authors' own libraries. Only publications in English were reviewed.
Clinical management of grade III oligodendroglioma
Cancer Management and Research, 2015
Oligodendrogliomas represent the third most common type of glioma, comprising 4%-15% of all gliomas and can be classified by degree of malignancy into grade II and grade III, according to WHO classification. Only 30% of oligodendroglial tumors have anaplastic characteristics. Anaplastic oligodendroglioma (AO) is often localized as a single lesion in the white matter and in the cortex, rarely in brainstem or spinal cord. The management of AO is deeply changed in the recent years. Maximal safe surgical resection followed by radiotherapy (RT) was considered as the standard of care since paramount findings regarding molecular aspects, in particular co-deletion of the short arm of chromosome 1 and the long arm of chromosome 19, revealed that these subsets of AO, benefit in terms of overall survival (OS) and progressionfree survival (PFS), from the addition of chemotherapy to RT. Allelic losses of chromosomes 1p and 19q occur in 50%-70% of both low-grade and anaplastic tumors, representing a strong prognostic factor and a powerful predictor of prolonged survival. Several other molecular markers have potential clinical significance as IDH1 mutations, confirming the strong prognostic role for OS. Malignant brain tumors negatively impacts on patients' quality of life. Seizures, visual impairment, headache, and cognitive disorders can be present. Moreover, chemotherapy and RT have important side effects. For these reasons, "health-related quality of life" is becoming a topic of growing interest, investigating on physical, mental, emotional, and social well-being. Understanding the impact of medical treatment on health-related quality of life will probably have a growing effect both on health care strategies and on patients.