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Diffuse glioma

Key sources
The following summarized guidelines for the evaluation and management of diffuse glioma are prepared by our editorial team based on guidelines from the European Association of Neuro-Oncology (EANO 2021).
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Guidelines

1.Screening and diagnosis

Screening: recognize that screening and prevention have no major role for patients with gliomas.
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2.Classification and risk stratification

Classification: use the most recent WHO Classification of Tumors of the CNS for glioma classification, complemented by cIMPACT-NOW.
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3.Diagnostic investigations

History and physical examination: assess the Karnofsky performance score and neurological function, as well as the patient's age, individual risks, and benefits for clinical decision-making.
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  • Diagnostic imaging

4.Diagnostic procedures

Tissue diagnosis: perform resection or biopsy in the standard of care of patients with IDH-mutant astrocytomas, WHO grade 2 requiring further treatment, or grade 3.
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  • Analysis of biopsy specimens

5.Medical management

Chemotherapy: offer chemotherapy with procarbazine, lomustine and vincristine polychemotherapy after resection or biopsy in the standard of care of patients with IDH-mutant astrocytomas, WHO grade 2 requiring further treatment.
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6.Therapeutic procedures

Radiotherapy: perform field radiotherapy after resection or biopsy in the standard of care for patients with IDH-mutant astrocytomas, WHO grade 2 requiring further treatment or grade 3.
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7.Surgical interventions

Surgical resection: perform resection as feasible or biopsy followed by involved field radiotherapy and maintenance chemotherapy in the standard of care of patients with IDH-mutant astrocytomas, WHO grade 2 requiring further treatment, or grade 3.
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8.Specific circumstances

Elderly patients: offer radiotherapy (such as 2.66 Gy for 15 sessions) or chemotherapy with temozolomide (5 out of 28 days) based on MGMT promoter methylation status in elderly patients with IDH-wild-type glioblastoma ineligible for combined chemoradiotherapy.
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9.Patient education

Genetic counseling: refer patients with relevant germline variants or suspected hereditary cancer syndromes for genetic counseling and, subsequently, for possible molecular genetic testing.
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10.Follow-up and surveillance

Management of recurrent gliomas: recognize that standards of care of patients with IDH-wild-type glioblastomas are less well defined at recurrence.
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