Brain Tumor Res Treat.  2019 Apr;7(1):1-9. 10.14791/btrt.2019.7.e25.

The Korean Society for Neuro-Oncology (KSNO) Guideline for Glioblastomas: Version 2018.01

• 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: 2444789
• DOI: http://doi.org/10.14791/btrt.2019.7.e25

Abstract

BACKGROUND
There has been no practical guidelines for the management of patients with central nervous system (CNS) tumors in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, started to prepare guidelines for CNS tumors from February 2018.
METHODS
The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords.
RESULTS
First, the maximal safe resection if feasible is recommended. After the diagnosis of a glioblastoma with neurosurgical intervention, patients aged ≤70 years with good performance should be treated by concurrent chemoradiotherapy with temozolomide followed by adjuvant temozolomide chemotherapy (Stupp's protocol) or standard brain radiotherapy alone. However, those with poor performance should be treated by hypofractionated brain radiotherapy (preferred)±concurrent or adjuvant temozolomide, temozolomide alone (Level III), or supportive treatment. Alternatively, patients aged >70 years with good performance should be treated by hypofractionated brain radiotherapy+concurrent and adjuvant temozolomide or Stupp's protocol or hypofractionated brain radiotherapy alone, while those with poor performance should be treated by hypofractionated brain radiotherapy alone or temozolomide chemotherapy if the patient has methylated MGMT gene promoter (Level III), or supportive treatment.
CONCLUSION
The KSNO's guideline recommends that glioblastomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to the individual comprehensive condition of the patient.

Keyword

Korean Society for Neuro-Oncology; Guideline; Glioblastomas; Practice

MeSH Terms

Brain
Central Nervous System
Chemoradiotherapy
Diagnosis
Drug Therapy
Glioblastoma*
Humans
Korea
Radiotherapy

Figure

• 

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

• 

  Fig. 2 Guideline for patients with age ≤70 years. Patients with good performance are recommended to be treated by concurrent chemoradiotherapy with temozolomide followed by adjuvant temozolomide chemotherapy (Stupp's protocol) or standard brain radiotherapy alone. However, those with poor performance are recommended to be treated by hypofractionated brain radiotherapy (preferred)±concurrent or adjuvant temozolomide, temozolomide alone (Level III), or supportive treatment. KSNO, Korean Society for Neuro-Oncology; KPS, Karnofsky Performance Scale; ECOG, Eastern Cooperative Oncology Group; MRI, magnetic resonance image.

• 

  Fig. 3 Guideline for patients with age >70 years. Patients with good performance are recommended to be treated by hypofractionated brain radiotherapy+concurrent and adjuvant temozolomide, Stupp's protocol, or hypofractionated brain radiotherapy alone. However, those with poor performance are recommended to be treated by hypofractionated brain radiotherapy alone, temozolomide chemotherapy alone if they have a methylated MGMT gene promoter (Level III), or supportive treatment. KSNO, Korean Society for Neuro-Oncology; KPS, Karnofsky Performance Scale; ECOG, Eastern Cooperative Oncology Group; MRI, magnetic resonance image.

• 

  Fig. 4 Guideline for recurrent glioblastoma. Surgical resection is always recommended if feasible. Even in surgically unresectable diseases such as diffuse, multi-focal, and deep located lesions, surgical treatment can be considered to reduce the mass effect and improve neurological symptoms. After surgical resection, the following therapeutic options are considered: systemic chemotherapy, and/or reirradiation, and/or supportive treatment if poor performance status, and/or enrollment of clinical trials. KSNO, Korean Society for Neuro-Oncology.

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