Department of Radiation Oncology, University of Washington, Seattle, Washington.
Department of Radiation Oncology, Bon Secours Mercy Health, Greenville, South Carolina.
Pract Radiat Oncol. 2022 Sep-Oct;12(5):370-386. doi: 10.1016/j.prro.2022.05.004. Epub 2022 May 31.
This guideline provides evidence-based recommendations for adults with isocitrate dehydrogenase (IDH)-mutant grade 2 and grade 3 diffuse glioma, as classified in the 2021 World Health Organization (WHO) Classification of Tumours. It includes indications for radiation therapy (RT), advanced RT techniques, and clinical management of adverse effects.
The American Society for Radiation Oncology convened a multidisciplinary task force to address 4 key questions focused on the RT management of patients with IDH-mutant grade 2 and grade 3 diffuse glioma. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.
A strong recommendation for close surveillance alone was made for patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 2 after gross total resection without high-risk features. For oligodendroglioma, WHO grade 2 with any high-risk features, adjuvant RT was conditionally recommended. However, adjuvant RT was strongly recommended for oligodendroglioma, WHO grade 3. A conditional recommendation for close surveillance alone was made for astrocytoma, IDH-mutant, WHO grade 2 after gross total resection without high-risk features. Adjuvant RT was conditionally recommended for astrocytoma, WHO grade 2, with any high-risk features and strongly recommended for astrocytoma, WHO grade 3. Dose recommendations varied based on histology and grade. Given known adverse long-term effects of RT, consideration for advanced techniques such as intensity modulated radiation therapy/volumetric modulated arc therapy or proton therapy were given as strong and conditional recommendations, respectively. Finally, based on expert opinion, the guideline recommends assessment, surveillance, and management for toxicity management.
Based on published data, the American Society for Radiation Oncology task force has proposed recommendations to inform the management of adults with IDH-mutant grade 2 and grade 3 diffuse glioma as defined by WHO 2021 classification, based on the highest quality published data, and best translated by our task force of subject matter experts.
本指南提供了基于证据的推荐意见，适用于 2021 年世界卫生组织（WHO）肿瘤分类中分类的 IDH 突变型 2 级和 3 级弥漫性神经胶质瘤的成人患者。其中包括放疗（RT）的适应证、先进的 RT 技术以及不良反应的临床处理。
美国放射肿瘤学会召集了一个多学科工作组，针对 IDH 突变型 2 级和 3 级弥漫性神经胶质瘤患者的 RT 管理，重点解决了 4 个关键问题。推荐意见基于系统文献回顾，并使用预先确定的共识制定方法和证据质量分级以及推荐强度系统进行制定。
对于 1p/19q 共缺失、无高危特征的完全切除后 IDH 突变型、WHO 2 级少突胶质细胞瘤患者，强烈建议单独密切监测。对于有任何高危特征的 IDH 突变型、WHO 2 级少突胶质细胞瘤患者，有条件推荐辅助 RT。然而，对于 IDH 突变型、WHO 3 级少突胶质细胞瘤患者，强烈推荐辅助 RT。对于完全切除后无高危特征的 IDH 突变型、WHO 2 级星形细胞瘤患者，强烈建议单独密切监测。对于有任何高危特征的 IDH 突变型、WHO 2 级星形细胞瘤患者，有条件推荐辅助 RT；对于 IDH 突变型、WHO 3 级星形细胞瘤患者，强烈推荐辅助 RT。基于组织学和分级，剂量推荐有所不同。鉴于 RT 的已知长期不良影响，工作组分别作为强烈和有条件的推荐，考虑使用先进的技术，如调强放疗/容积调强弧形治疗或质子治疗。最后，根据专家意见，指南建议评估、监测和管理毒性管理。
根据已发表的数据，美国放射肿瘤学会工作组提出了建议，以根据 2021 年 WHO 分类，为 IDH 突变型 2 级和 3 级弥漫性神经胶质瘤的成人患者提供信息，这些建议基于最高质量的已发表数据，并由我们的主题专家工作组进行了最佳翻译。
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