The American Society for Radiation Oncology (ASTRO) has issued a guide on the use of radiation therapy in adults with isocitrate dehydrogenase (IDH)-mutant grade 2 and grade 3 diffuse glioma.
The recommendations outline the multidisciplinary planning and delivery techniques to manage this subset of central nervous system tumors, according to the guideline, which was recently published in Practical Radiation Oncology.
Also, the guideline addresses clinical management of adverse effects and includes an algorithm that summarizes treatment paths. Key recommendations include the following:
- Close observation after surgery is typically recommended for patients diagnosed with lower-risk disease, while adjuvant therapy is recommended for those with any features of higher-risk disease.
- Early adjuvant therapy involving radiation therapy with sequential or concurrent/sequential chemotherapy following surgical resection is conditionally recommended for patients with grade 2, IDH-mutant oligodendroglioma (1p/19q codeleted) or astrocytoma, and any features of high-risk disease.
- Close surveillance involving MRI and clinical examination every six months following surgical resection is strongly recommended for patients with oligodendroglioma, World Health Organization (WHO) grade 2, IDH-mutant, 1p/19q codeleted who have more favorable disease prognosis. It is conditionally recommended for patients with grade 2, IDH-mutant astrocytoma and more favorable prognosis.
Additionally, the recommendations outline optimal radiation dosing, treatment planning, and delivery techniques, as well as survivorship care.
