Brain Tumor Res Treat.  2019 Oct;7(2):63-73. 10.14791/btrt.2019.7.e42.

The Korean Society for Neuro-Oncology (KSNO) Guideline for WHO Grade III Cerebral Gliomas in Adults: Version 2019.01

• Kim YZ
• Kim CY
• Lim J
• Sung KS
• Lee J
• Oh HJ
• Kang SG
• Kang SH
• Kong DS
• Kim SH
• Kim SH
• Kim SH
• Kim YJ
• Kim EH
• Kim IA
• Kim HS
• Roh TH
• Park JS
• Park HJ
• Song SW
• Yang SH
• Yoon WS
• Yoon HI
• Lee ST
• Lee SW
• Lee YS
• Wee CW
• Chang JH
• Jung TY
• Jung HL
• Cho JH
• Choi SH
• Choi HS
• Hong JB
• Lim DH
• Chung DS
• KSNO Guideline Working Group

• KMID: 2461178
• DOI: http://doi.org/10.14791/btrt.2019.7.e42

Abstract

BACKGROUND
There was no practical guideline for the management of patients with central nervous system tumor in Korea in the past. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, developed the guideline for glioblastoma successfully and published it in Brain Tumor Research and Treatment, the official journal of KSNO, in April 2019. Recently, the KSNO guideline for World Health Organization (WHO) grade III cerebral glioma in adults has been established.
METHODS
The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searches in PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords. Scope of the disease was confined to cerebral anaplastic astrocytoma and oligodendroglioma in adults.
RESULTS
Whenever radiological feature suggests high grade glioma, maximal safe resection if feasible is globally recommended. After molecular and histological examinations, patients with anaplastic astrocytoma, isocitrate dehydrogenase (IDH)-mutant should be primary treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy whereas those with anaplastic astrocytoma, NOS, and anaplastic astrocytoma, IDH-wildtype should be treated following the protocol for glioblastomas. In terms of anaplastic oligodendroglioma, IDH-mutant and 1p19q-codeletion, and anaplastic oligodendroglioma, NOS should be primary treated by standard brain radiotherapy and neoadjuvant or adjuvant PCV (procarbazine, lomustine, and vincristine) combination chemotherapy.
CONCLUSION
The KSNO's guideline recommends that WHO grade III cerebral glioma of adults should be treated by maximal safe resection if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors.

Keyword

Korean Society for Neuro Oncology; Guideline; Grade III Gliomas; Practice

MeSH Terms

Adult*
Astrocytoma
Brain
Brain Neoplasms
Central Nervous System
Drug Therapy
Drug Therapy, Combination
Glioblastoma
Glioma*
Humans
Isocitrate Dehydrogenase
Korea
Lomustine
Oligodendroglioma
Radiotherapy
World Health Organization
Isocitrate Dehydrogenase
Lomustine

Figure

• 

  Fig. 1 Guideline for diagnosis of WHO grade III gliomas. To diagnose WHO grade III gliomas, MRI with gadolinium enhancement is essential. A multidisciplinary approach for treatment planning is recommended if feasible. Primarily, WHO grade III gliomas should be diagnosed histopathologically for tissues obtained by neurosurgical intervention. KSNO, Korean Society for Neuro-Oncology; MRI, magnetic resonance image; WHO, World Health Organization.

• 

  Fig. 2 Guideline for adjuvant therapy of patients with anaplastic astrocytoma, IDH-mutant, NOS, and IDH-wildtype. 1) For the patients with anaplastic astrocytoma, IDH-mutant, standard brain radiotherapy and adjuvant temozolomide chemotherapy, or standard brain radiotherapy with concurrent and adjuvant temozolomide chemotherapy, or standard brain radiotherapy with neoadjuvant or adjuvant PCV chemotherapy, or standard brain radiotherapy alone are recommended. 2) For the patients with anaplastic astrocytoma, NOS, and IDH-wildtype, the practical protocol for glioblastoma patients is recommended. IDH, isocitrate dehydrogenase; KSNO, Korean Society for Neuro-Oncology; PCV, procarbazine+lomustine+vincristine; MRI, magnetic resonance image.

• 

  Fig. 3 Guideline for adjuvant therapy of patients with anaplastic oligodendroglioma. The patients should be treated with following modalities; 1) standard brain radiotherapy and neoadjuvant or adjuvant PCV chemotherapy, or 2) standard brain radiotherapy with concurrent and adjuvant temozolomide chemotherapy, or 3) standard brain radiotherapy alone. KSNO, Korean Society for Neuro-Oncology; PCV, procarba zine+lomustine+vincristine; MRI, magnetic resonance image.

• 

  Fig. 4 Guideline for recurrent WHO grade III gliomas. Surgical resection is always recommended if feasible. After surgical resection, the following therapeutic options are considered: 1) systemic chemotherapy, and/or 2) reirradiation, and/or 3) enrollment of clinical trials and/or 4) supportive treatment if poor performance status. KSNO, Korean Society for Neuro-Oncology.

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