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Diffuse glioma

Guidelines

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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Screening and diagnosis

Screening: as per EANO 2021 guidelines, recognize that screening and prevention have no major role for patients with gliomas.
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Classification and risk stratification

Classification: as per EANO 2021 guidelines, use the most recent WHO Classification of Tumors of the CNS for glioma classification, complemented by cIMPACT-NOW.
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Diagnostic investigations

History and physical examination: as per EANO 2021 guidelines, 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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Karnofsky Performance Scale
Patient description
Normal, no complaints, no evidence of disease
Able to carry on normal activity, minor signs or symptoms of disease
Normal activity with effort, some signs or symptoms of disease
Cares for self, unable to carry on normal activity or to do active work
Requires occasional assistance but is able to care for most personal needs
Requires considerable assistance and frequent medical care
Disabled, requires special care and assistance
Severely disabled, hospital admission is indicated, death not imminent
Very sick, hospital admission necessary, active supportive treatment necessary
Moribund
Dead
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  • Diagnostic imaging

Diagnostic procedures

Tissue diagnosis: as per EANO 2021 guidelines, 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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More topics in this section

  • Analysis of biopsy specimens

Medical management

Chemotherapy: as per EANO 2021 guidelines, 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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Therapeutic procedures

Radiotherapy: as per EANO 2021 guidelines, 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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Surgical interventions

Surgical resection: as per EANO 2021 guidelines, 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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Specific circumstances

Elderly patients: as per EANO 2021 guidelines, 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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Patient education

Genetic counseling: as per EANO 2021 guidelines, 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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Follow-up and surveillance

Management of recurrent gliomas: as per EANO 2021 guidelines, recognize that standards of care of patients with IDH-wild-type glioblastomas are less well defined at recurrence.
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