Radiation therapy for IDH-mutant grade 2 and grade 3 diffuse glioma: An ASTRO clinical practice guideline Guidelines


Authors: Halasz, L. M.; Attia, A.; Bradfield, L.; Brat, D. J.; Kirkpatrick, J. P.; Laack, N. N.; Lalani, N.; Lebow, E. S.; Liu, A. K.; Niemeier, H. M.; Palmer, J. D.; Peters, K. B.; Sheehan, J.; Thomas, R. P.; Vora, S. A.; Wahl, D. R.; Weiss, S. E.; Yeboa, D. N.; Zhong, J.; Shih, H. A.
Title: Radiation therapy for IDH-mutant grade 2 and grade 3 diffuse glioma: An ASTRO clinical practice guideline
Abstract: Purpose: This guideline provides evidence-based recommendations for adults with isocitrate dehydrogenase (IDH)–mutant grade 2 and grade 3 diffuse glioma, as classified in the 2021 World Health Organization (WHO) Classification of Tumours. It includes indications for radiation therapy (RT), advanced RT techniques, and clinical management of adverse effects. Methods: The American Society for Radiation Oncology convened a multidisciplinary task force to address 4 key questions focused on the RT management of patients with IDH-mutant grade 2 and grade 3 diffuse glioma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. Results: A strong recommendation for close surveillance alone was made for patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 2 after gross total resection without high-risk features. For oligodendroglioma, WHO grade 2 with any high-risk features, adjuvant RT was conditionally recommended. However, adjuvant RT was strongly recommended for oligodendroglioma, WHO grade 3. A conditional recommendation for close surveillance alone was made for astrocytoma, IDH-mutant, WHO grade 2 after gross total resection without high-risk features. Adjuvant RT was conditionally recommended for astrocytoma, WHO grade 2, with any high-risk features and strongly recommended for astrocytoma, WHO grade 3. Dose recommendations varied based on histology and grade. Given known adverse long-term effects of RT, consideration for advanced techniques such as intensity modulated radiation therapy/volumetric modulated arc therapy or proton therapy were given as strong and conditional recommendations, respectively. Finally, based on expert opinion, the guideline recommends assessment, surveillance, and management for toxicity management. Conclusions: Based on published data, the American Society for Radiation Oncology task force has proposed recommendations to inform the management of adults with IDH-mutant grade 2 and grade 3 diffuse glioma as defined by WHO 2021 classification, based on the highest quality published data, and best translated by our task force of subject matter experts. © 2022 American Society for Radiation Oncology
Keywords: adult; cancer surgery; genetics; histopathology; intensity modulated radiation therapy; cancer radiotherapy; radiation dose; brain tumor; glioma; brain neoplasms; cancer grading; evidence based medicine; treatment indication; practice guideline; radiation injury; patient care; radiation oncology; consensus development; world health organization; oligodendroglioma; adjuvant radiotherapy; astrocytoma; tumor classification; radiation field; follicular lymphoma; lymphoma, follicular; clinical observation; isocitrate dehydrogenase; volumetric modulated arc therapy; proton therapy; systematic review (topic); humans; human; article
Journal Title: Practical Radiation Oncology
Volume: 12
Issue: 5
ISSN: 1879-8519
Publisher: Elsevier Inc.  
Date Published: 2022-09-01
Start Page: 370
End Page: 386
Language: English
DOI: 10.1016/j.prro.2022.05.004
PUBMED: 35902341
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 3 October 2022 -- Source: Scopus
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  1. Emily Schapira Lebow
    49 Lebow