Brain Tumor Res Treat.  2019 Oct;7(2):74-84. 10.14791/btrt.2019.7.e43.

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

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

• KMID: 2461179
• DOI: http://doi.org/10.14791/btrt.2019.7.e43

Abstract

BACKGROUND
There was no practical guideline for the management of patients with central nervous system tumor in Korea for many years. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has developed the guideline for glioblastoma. Subsequently, the KSNO guideline for World Health Organization (WHO) grade II cerebral glioma in adults is established.
METHODS
The Working Group was composed of 35 multidisciplinary medical experts in Korea. References were identified by searching PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL databases using specific and sensitive keywords as well as combinations of keywords regarding diffuse astrocytoma and oligodendroglioma of brain in adults.
RESULTS
Whenever radiological feature suggests lower grade glioma, the maximal safe resection if feasible is recommended globally. After molecular and histological examinations, patients with diffuse astrocytoma, isocitrate dehydrogenase (IDH)-wildtype without molecular feature of glioblastoma should be primarily treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy (Level III) while those with molecular feature of glioblastoma should be treated following the protocol for glioblastomas. In terms of patients with diffuse astrocytoma, IDH-mutant and oligodendroglioma (IDH-mutant and 1p19q codeletion), standard brain radiotherapy and adjuvant PCV (procarbazine+lomustine+vincristine) combination chemotherapy should be considered primarily for the high-risk group while observation with regular follow up should be considered for the low-risk group.
CONCLUSION
The KSNO's guideline recommends that WHO grade II gliomas should be treated by maximal safe resection, if feasible, followed by radiotherapy and/or chemotherapy according to molecular and histological features of tumors and clinical characteristics of patients.

Keyword

Korean Society for Neuro-Oncology; Guideline; Grade II Gliomas; Practice

MeSH Terms

Adult*
Astrocytoma
Brain
Central Nervous System
Drug Therapy
Drug Therapy, Combination
Follow-Up Studies
Glioblastoma
Glioma*
Humans
Isocitrate Dehydrogenase
Korea
Oligodendroglioma
Radiotherapy
World Health Organization
Isocitrate Dehydrogenase

Figure

• 

  Fig. 1 Guideline for diagnosis of WHO grade II glioma. To diagnose lower grade gliomas, MRI with gadolinium enhancement is essential even if the lesions do not have enhancement. A multidisciplinary approach for treatment planning is recommended if feasible. Primarily, WHO grade II gliomas should be diagnosed by based on both histopathological and molecular genetic features of the tissues obtained by neurosurgical intervention. KSNO, Korean Society for Neuro-Oncology; MRI, magnetic resonance image.

• 

  Fig. 2 Guideline for adjuvant therapy of patients with diffuse astrocytoma, IDH-wildtype. 1) Patients with diffuse astrocytoma, IDH-wildtype without molecular feature of glioblastoma should be primarily treated by standard brain radiotherapy and adjuvant temozolomide chemotherapy (Level III), 2) while those with molecular feature of glioblastoma should be treated following the protocol for glioblastomas. IDH, isocitrate dehydrogenase; KSNO, Korean Society for Neuro-Oncology; MRI, magnetic resonance image.

• 

  Fig. 3 Guideline for adjuvant therapy of patients with diffuse astrocytoma, IDH-mutant and oligodendroglioma. 1) The standard brain radiotherapy and adjuvant PCV (procarbazine+lomustine+vincristine) combination chemotherapy should be considered primarily for the high-risk group, 2) while observation with regular follow up should be considered for the low-risk group. IDH, isocitrate dehydrogenase; KSNO, Korean Society for Neuro-Oncology; PCV, procarbazine+lomustine+vincristine; MRI, magnetic resonance image.

• 

  Fig. 4 Guideline for recurrent WHO grade II gliomas. Surgical resection is always recommended, even in the recurrence of grade II gliomas with difficulty in complete resection such as diffuse, multi-focal, or deep located lesion in order to reduce the mass effect and improve the neurological symptoms. 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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