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.
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