Radiation Therapy for WHO Grade 4 Adult-Type Diffuse Glioma: An ASTRO Clinical Practice Guideline

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Clinical Guidelines

Background:

• World Health Organization (WHO) grade 4 adult-type diffuse gliomas are highly aggressive primary brain tumors.
• Effective multidisciplinary management strategies are crucial for improving patient outcomes.
• Existing literature often focuses on historical glioblastoma classifications.

Purpose of the Study:

• To provide evidence-based recommendations for the multidisciplinary management of WHO grade 4 adult-type diffuse gliomas.
• To address key aspects including diagnosis, initial treatment, reirradiation, and health disparities.
• To guide clinical practice for these challenging brain tumors.

Main Methods:

• A task force convened by the American Society for Radiation Oncology systematically reviewed literature.
• Key questions focused on radiation therapy (RT) and adjunctive therapies.
• Recommendations were developed using a predefined consensus-building methodology and evidence grading system.

Main Results:

• Concurrent RT with temozolomide followed by adjuvant temozolomide is recommended for eligible patients.
• Alternating electric field therapy is conditionally recommended.
• Hypofractionated RT is conditionally recommended for elderly patients; palliative care for frail patients.
• Reirradiation can be considered for recurrent tumors.
• Health disparities require attention to improve outcomes and clinical trial enrollment for underserved populations.

Conclusions:

• These recommendations establish best clinical practices for managing WHO grade 4 adult-type diffuse gliomas.
• Advancements in personalized medicine, biomarkers, and novel therapies are vital for future progress.
• Multidisciplinary care and clinical trial participation, especially for underserved groups, are critical for addressing poor prognoses.