Elsevier

The Lancet Oncology

Volume 18, Issue 6, June 2017, Pages e315-e329
The Lancet Oncology

Review
European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas

https://doi.org/10.1016/S1470-2045(17)30194-8Get rights and content

Summary

The European Association for Neuro-Oncology guideline provides recommendations for the clinical care of adult patients with astrocytic and oligodendroglial gliomas, including glioblastomas. The guideline is based on the 2016 WHO classification of tumours of the central nervous system and on scientific developments since the 2014 guideline. The recommendations focus on pathological and radiological diagnostics, and the main treatment modalities of surgery, radiotherapy, and pharmacotherapy. In this guideline we have also integrated the results from contemporary clinical trials that have changed clinical practice. The guideline aims to provide guidance for diagnostic and management decisions, while limiting unnecessary treatments and costs. The recommendations are a resource for professionals involved in the management of patients with glioma, for patients and caregivers, and for health-care providers in Europe. The implementation of this guideline requires multidisciplinary structures of care, and defined processes of diagnosis and treatment.

Introduction

The European Association for Neuro-Oncology (EANO) guideline on the diagnosis and treatment of adult astrocytic and oligodendroglial gliomas follows the revision of the fourth edition of WHO classification of tumours of the central nervous system1 and builds on previous guidelines.2, 3 The guideline covers adult astrocytic and oligodendroglial gliomas of WHO grades II–IV, including glioblastomas, and variants of these tumours, and discusses prevention, early diagnosis and screening, histological and molecular diagnostics, therapy, and follow-up. However, the guideline does not address differential diagnosis, adverse effects of treatment, or supportive or palliative care.

Section snippets

Prevention, early diagnosis, and screening

The annual incidence of gliomas, including glioblastoma, is around six cases per 100 000 individuals worldwide. Serum markers for early detection have not been identified. Brain MRI has the highest sensitivity for the detection of small tumours. Gliomas can evolve rapidly over several weeks or months, presenting challenges for population-based prevention or early intervention. Screening is therefore limited to individuals at genetic risk—eg, patients with neurofibromatosis type I, Turcot

Prognostic factors

Younger age and better performance status are important positive, therapy-independent prognostic factors across glioma entities, and extent of resection is an important therapy-dependent prognostic factor (figure 2). Molecular markers that favour longer survival, such as IDH mutation and 1p/19q codeletion, are now at the core of the WHO classification and define more homogeneous diagnostic and prognostic entities.1, 26

Surgical therapy

Beyond a histological diagnosis, the goal of surgery is to remove as much of

Search strategy and selection criteria

This guideline was prepared by a task force nominated by the Executive Board of the European Association for Neuro-Oncology (EANO) in cooperation with the Brain Tumor Group of the European Organisation for Research and Treatment of Cancer in 2016. The task force represents the disciplines involved in the diagnosis and care of patients with glioma and reflects the multinational character of EANO. We used PubMed and the search terms “glioma”, “anaplastic”, “astrocytoma”, “oligodendroglioma”,

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