ReviewEANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma
Introduction
This guideline for the diagnosis and treatment of gliomas follows the Third Revision of the WHO Classification of Tumours of the Central Nervous System.1 It covers WHO grade III anaplastic astrocytomas, oligodendrogliomas, and oligoastrocytomas; WHO grade IV glioblastomas (including its variants) and gliomatosis cerebri; and WHO grade III and IV gliomas of brainstem and spinal cord. The guideline covers prevention, early diagnosis and screening, therapy, follow-up, and rehabilitation for patients with malignant gliomas. It does not cover differential diagnoses of gliomas and adverse effects of therapeutic measures in depth. The structure of the guideline was based on the national guideline on gliomas of the German Society of Neurology and the German Cancer Society.
The guideline aims to serve medical professionals of all disciplines involved in the diagnosis and care of patients with glioma, particularly neurologists, neurosurgeons, radiation oncologists, neuropathologists, neuroradiologists, oncologists, paediatric oncologists, epileptologists, psycho-oncologists, rehabilitation specialists, palliative care nursing specialists, and neuro-oncology nursing specialists. Furthermore, the recommendations could serve as a valuable source of information for patients, relatives, other health professionals, and health insurance companies.
Section snippets
General recommendations
Recommendations for the general approach to patients with malignant gliomas, including diagnostic aspects—ie, early diagnosis and prevention, history, clinical examination, neuroimaging, cerebrospinal-fluid analyses, electroencephalography, preoperative management, biopsy and resection, histological classification and grading, molecular diagnostics—and general recommendations for therapy (eg, surgical therapy, radiotherapy, pharmacotherapy, and other therapeutic approaches) are summarised in
Anaplastic astrocytoma—WHO grade III
Anaplastic astrocytomas have inhomogeneous density on CT scans and appear as hyperintense, space-occupying lesions on T2-weighted fluid-attenuated inversion recovery (FLAIR) MRI. They tend to show patchy enhancement after contrast administration and often have peritumoural oedema. However, a substantial proportion (up to 30%) of these tumours can show no enhancement on CT or MRI. Abnormal vessels can be visualised by MRI angiography. Favourable prognostic factors include young age, high
Monitoring and follow-up
Whenever feasible, MRI should be used to monitor the efficacy of pharmacotherapy or as surveillance imaging after completion of treatment.60 Intervals of 3 months are recommended for most patients with malignant gliomas, although longer intervals might be considered for patients with lengthy disease control, notably young patients with 1p/19q-co-deleted oligodendroglial tumours.
Raised intracranial pressure
Raised intracranial pressure due to growth of a glioma is an emergency situation that needs immediate intervention, often with high doses of steroids and occasionally with osmotic agents. Acute surgical decompression is rarely needed. Whether decompressive surgical interventions make sense in the further course of disease, once the diagnosis has already been established and primary therapy given, needs consideration of the options for further treatment after the surgical intervention.
Thromboembolic events
Patients
Conclusions
Guidelines reflect the state of knowledge at a given timepoint. Table 3 summarises the key recommendations of the EANO task force in 2013. The EANO website will inform of future updates on this guideline.
References (72)
- et al.
Molecular neuro-oncology in clinical practice: a new horizon
Lancet Oncol
(2013) - et al.
Radiotherapy for newly diagnosed malignant glioma in adults: a systematic review
Radiother Oncol
(2002) - et al.
New clinical, pathological and molecular prognostic models and calculators in patients with locally diagnosed anaplastic oligodendroglioma or oligoastrocytoma. A prognostic factor analysis of European Organisation for Research and Treatment of Cancer Brain Tumour Group Study 26951
Eur J Cancer
(2013) - et al.
Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial
Lancet Oncol
(2012) - et al.
Gross total but not incomplete resection of GBM prolongs survival in the era of radiochemotherapy
Ann Oncol
(2013) - et al.
Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial
Lancet Oncol
(2006) - et al.
Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial
Lancet Oncol
(2012) - et al.
Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial
Lancet Oncol
(2009) - et al.
Reirradiation of recurrent high-grade gliomas using amino acid PET (SPECT)/CT/MRI image fusion to determine gross tumor volume for stereotactic fractionated radiotherapy
Int J Radiat Oncol Biol Phys
(2005) - et al.
Single-agent bevacizumab or lomustine versus a combination of bevacizumab plus lomustine in patients with recurrent glioblastoma (BELOB study): a randomised controlled phase 2 trial
Lancet Oncol
(2014)
Brainstem tumors
Handb Clin Neurol
PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma
J Thromb Haemost
Epilepsy meets cancer: when, why, and what to do about it?
Lancet Oncol
WHO classification of tumours of the central nervous system
ATRX loss refines the classification of anaplastic gliomas and identifies a subgroup of IDH mutant astrocytic tumors with better prognosis
Acta Neuropathol
Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas: a cooperative clinical trial
J Neurosurg
Randomized comparisons of radiotherapy and nitrosoureas for the treatment of malignant glioma after surgery
N Engl J Med
Chemotherapy in adult high-grade glioma: a systematic review and meta-analysis of individual patient data from 12 randomised trials
Lancet
Randomized trial of procarbazine, lomustine, and vincristine in the adjuvant treatment of high-grade astrocytoma: a Medical Research Council trial
J Clin Oncol
NOA-04 randomized phase III trial of sequential radiochemotherapy of anaplastic glioma with procarbazine, lomustine, and vincristine or temozolomide
J Clin Oncol
Prognostic or predictive value of MGMT promoter methylation in gliomas depends on IDH1 mutation
Neurology
Multicenter phase II trial of temozolomide in patients with anaplastic astrocytoma or anaplastic oligoastrocytoma at first relapse
J Clin Oncol
Temozolomide versus procarbazine, lomustine, and vincristine in recurrent high-grade glioma
J Clin Oncol
Bevacizumab plus irinotecan in recurrent WHO grade 3 malignant gliomas
Clin Cancer Res
Salvage chemotherapy with bevacizumab for recurrent alkylator-refractory anaplastic astrocytoma
J Neurooncol
Bevacizumab alone or in combination with irinotecan in recurrent WHO grade II and grade III gliomas
Eur Neurol
Upregulating mutations in the TERT promoter commonly occur in adult malignant gliomas and are strongly associated with total 1p19q loss
Acta Neuropathol
Phase III trial of chemoradiotherapy for anaplastic oligodendroglioma: long-term results of RTOG 9402
J Clin Oncol
Phase III trial of chemotherapy plus radiotherapy compared with radiotherapy alone for pure and mixed anaplastic oligodendroglioma: Intergroup Radiation Therapy Oncology Group Trial 9402
J Clin Oncol
Adjuvant procarbazine, lomustine, and vincristine improves progression-free survival but not overall survival in newly diagnosed anaplastic oligodendrogliomas and oligoastrocytomas: a randomized European Organisation for Research and Treatment of Cancer phase III trial
J Clin Oncol
Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951
J Clin Oncol
Bevacizumab for recurrent alkylator-refractory anaplastic oligodendroglioma
Cancer
Bevacizumab and irinotecan for recurrent oligodendroglial tumors
Neurology
Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma
J Neurosurg
Patients with IDH1 wild type anaplastic astrocytomas exhibit worse prognosis than IDH1-mutated glioblastomas, and IDH1 mutation status accounts for the unfavorable prognostic effect of higher age: implications for classification of gliomas
Acta Neuropathol
Debulking or biopsy of malignant glioma in elderly people—a randomised study
Acta Neurochir (Wien)
Cited by (602)
Columbianadin suppresses glioblastoma progression by inhibiting the PI3K-Akt signaling pathway
2024, Biochemical PharmacologyEngineered exosomes with enhanced stability and delivery efficiency for glioblastoma therapy
2024, Journal of Controlled ReleaseGlioblastoma vaccines: past, present, and opportunities
2024, eBioMedicineExosomal long non-coding RNAs in glioblastoma
2024, Clinica Chimica ActaEuropean Cancer Organisation Essential Requirements for Quality Cancer Care: Adult glioma
2023, Journal of Cancer Policy