Brain Tumor Res Treat.  2020 Apr;8(1):11-19. 10.14791/btrt.2020.8.e6.

A National Consensus Survey for Current Practicein Brain Tumor Management II:Diffuse Midline Glioma and Meningioma

• Kim SK
• Yoon HI
• Yoon WS
• Cho JM
• Moon J
• Kim KH
• Kim SH
• Kim YI
• Kim YZ
• Kim HS
• Dho YS
• Park JS
• Park JE
• Seo Y
• Sung KS
• Song JH
• Wee CW
• Lee SH
• Lim DH
• Im JH
• Chang JH
• Han MH
• Hong JB
• Hwang K
• Park CK
• Lee YS
• Gwak HS
• KSNO Guideline Working Group

• KMID: 2500117
• DOI: http://doi.org/10.14791/btrt.2020.8.e6

Abstract

Background
: The Guideline Working Group of the Korean Society for Neuro-Oncology (KSNO) conducted a nationwide questionnaire survey for diverse queries faced in the treatment of brain tumors. As part II of the survey, the aim of this study is to evaluate the national patterns of clinical practice for patients with diffuse midline glioma and meningioma.
Methods
: A web-based survey was sent to all members of the KSNO by email. The survey included 4 questions of diffuse midline glioma and 6 questions of meningioma (including 2 case scenarios). All questions were developed by consensus of the Guideline Working Group.
Results
: In the survey about diffuse midline glioma, 76% respondents performed histologic confirmation to identify H3K27M mutation on immunohistochemical staining or sequencing methods. For treatment of diffuse midline glioma, respondents preferred concurrent chemoradiotherapy with temozolomide (TMZ) and adjuvant TMZ (63.8%) than radiotherapy alone (34.0%). In the survey about meningioma, respondents prefer wait-and-see policy for the asymptomatic small meningioma without peritumoral edema. However, a greater number of respondents had chosen surgical resection as the first choice for all large size meningiomas without exception, and small size meningiomas with either peritumoral edema or eloquent location. There was no single opinion with major consensus on long-term follow-up plans for asymptomatic meningioma with observation policy. As many as 68.1% of respondents answered that they would not add any adjuvant therapies for World Health Organization grade II meningiomas if the tumor was totally resected including dura.
Conclusion
: The survey demonstrates the prevailing clinical practice patterns for patients with diffuse midline glioma and meningioma among members of the KSNO. This information provides a point of reference for establishing a practical guideline in the management of diffuse midline glioma and meningioma.

Keyword

Korean Society for Neuro-Oncology; Practice patterns; Brain tumors; Diffuse midline glioma; Meningioma; Guideline Working Group

Figure

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  Fig. 1 Pie chart demonstrating target of radiotherapy. Note that over 65% of respondents mainly performed radiotherapy focused on the high signal intensity lesion of T2-weighted MRI.

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  Fig. 2 Treatment modality preference of respondents for a 45-year-old woman with 3-cm-sized asymptomatic meningioma (left), and 70-year-old woman with 6-cm-sized asymptomatic meningioma (right) according to tumor location and presence of peritumoral edema (PTE).

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  Fig. 3 Responses about radiological follow-up plans for patients with asymptomatic meningioma by each respondent. Colored cells are time points to study. Responses with blue cells are answers with any consensus for long-term follow-up plans, while those with grey cells are with no plan for long-term follow ups after a year.

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