Guideline of Brain Tumor Guideline of Brain Tumor Guideline of Brain Tumor

Glioma

1. BRAIN TUMOR GUIDELINES

2. Torp, S. H., Solheim, O., & Skjulsvik , A. J. (2022). The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know-a minireview.  Acta neurochirurgica ,  164 (9), 2453–2464. https:// doi.org /10.1007/s00701-022-05301-y

3. Torp, S. H., Solheim, O., & Skjulsvik , A. J. (2022). The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know-a minireview.  Acta neurochirurgica ,  164 (9), 2453–2464. https:// doi.org /10.1007/s00701-022-05301-y

4. Torp, S. H., Solheim, O., & Skjulsvik , A. J. (2022). The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know-a minireview.  Acta neurochirurgica ,  164 (9), 2453–2464. https:// doi.org /10.1007/s00701-022-05301-y

5. Reifenberger , G., Wirsching, HG., Knobbe -Thomsen, C.  et al.  Advances in the molecular genetics of gliomas — implications for classification and therapy.  Nat Rev Clin Oncol   14 , 434–452 (2017). https:// doi.org /10.1038/nrclinonc.2016.204

6. Many studies showed that patients with IDH-mut gliomas have better survival compared to their IDH-Wild Type counterparts irrespective of histology and grade , making IDH mutation the most important prognostic factor for survival 1p19q codeletion stands for the combined loss of the short arm chromosome 1 (i.e. 1p) and the long arm of chromosome 19 (i.e. 19q) and is recognized as a genetic marker predictive of therapeutic response to both chemotherapy and combined chemoradiot herapy and overall longer survival in patients with diffuse gliomas Torp, S. H., Solheim, O., & Skjulsvik , A. J. (2022). The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know-a minireview.  Acta neurochirurgica ,  164 (9), 2453–2464. https:// doi.org /10.1007/s00701-022-05301-y

7. Fig. 4. Glioblastoma, IDH-wild type. A T2-FLAIR image and a T1 contrast-enhanced image show an enhancing mass in the left parietal lobe with multiple necrosis and perilesional T2 high-SI infiltrations. The tumor shows (C) necrosis and microvascular proliferation (D) IDH1 mutation negativity, and (E) positive results for MGMT methylation. IDH, isocitrate dehydrogenase; FLAIR, fluid-attenuated inversion recovery; SI, signal intensity; MGMT, O-5- methylguanine-DNA methyltransferase.

8. GUIDELINES

9. Adult Glioma / Oligodendroglioma

10. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

11. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

12. Adult Glioma IDH-Mutant Astrocytoma

13. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

14. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

15. Adult Glioma : Low Grade (WHO Grade 1 or 2)

16. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

17. Adult Glioma : Low Grade

18. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

19. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

20. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

21. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

22. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

23. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

24. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

25. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

26. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

27. EANO Guidelines for Glioma

28. Weller, M., van den Bent, M., Preusser , M.  et al.  EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood.  Nat Rev Clin Oncol   18 , 170–186 (2021). https:// doi.org /10.1038/s41571-020-00447-z

29. Weller, M., van den Bent, M., Preusser , M.  et al.  EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood.  Nat Rev Clin Oncol   18 , 170–186 (2021). https:// doi.org /10.1038/s41571-020-00447-z

30. Radiotherapy The goal of radiotherapy is to improve local control without inducing neurotoxicity. Indeed, radiotherapy delayed neurological deterioration and increased survival in several early clinical trials conducted in the past century. The timing, dosing and scheduling of radiotherapy are determined by the disease subtype and prognostic factors, including age, KPS and residual tumour volume . Radiotherapy should start within 3–5 weeks after surgery and is commonly administered at 50–60Gy in 1.8–2Gy daily fractions. Hypofractionated radiotherapy with a higher dose per fraction and a lower total dose (for example, 15×2.67Gy) is appropriate in older patients (>65–70 years of age) and in those with a poor prognosis (typically defined by a KPS of <70) Weller, M., van den Bent, M., Preusser , M.  et al.  EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood.  Nat Rev Clin Oncol   18 , 170–186 (2021). https:// doi.org /10.1038/s41571-020-00447-z

31. Radiotherapy Modern, highly conformal radiation techniques, including intensity-modulated radiotherapy for newly diagnosed tumours and stereotactic radiotherapy and radiosurgery for recurrent tumours , could provide superior target coverage and sparing of non-malignant brain tissue. Proton or heavy ion radiotherapy might be options to consider for patients with tumours close to brain regions at risk or in those with a favourable prognosis in order to avoid delayed toxicities, but RCTs are required to determine the tolerability, safety and efficacy of these approaches compared with standard radiotherapy. Accurate patient positioning is required for all highly conformal approaches and is achieved with reproducible immobilization and digital imaging during treatment. Interstitial brachytherapy approaches have been investigated over many years as an alternative to external beam treatment but have not yet been shown to have an application in routine practice. Weller, M., van den Bent, M., Preusser , M.  et al.  EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood.  Nat Rev Clin Oncol   18 , 170–186 (2021). https:// doi.org /10.1038/s41571-020-00447-z

32. Role of Radiotherapy in Glioma Patients Concomitant RT + TMZ is more effective and improves the overall survival and PFS in patients with newly diagnosed GBM

33. Meningiomas

34. Torp, S. H., Solheim, O., & Skjulsvik , A. J. (2022). The WHO 2021 Classification of Central Nervous System tumours: a practical update on what neurosurgeons need to know-a minireview.  Acta neurochirurgica ,  164 (9), 2453–2464. https:// doi.org /10.1007/s00701-022-05301-y

35. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

36. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

37. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

38. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

39. EANO Guidelines for Meningioma

40. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas.  Neuro Oncol . 2021;23(11):1821-1834. doi:10.1093/ neuonc /noab150

41. Radiosurgery SRS has been established as an alternative therapy to surgery in well-defined cases with small tumors in elderly or critically sick patients. Local control of small-sized intracranial meningiomas of a diameter of 3 cm or less after SRS was comparable to Simpson Grade I resection. Two retrospective series found that a reduction of tumor size after SRS or hypofractionated RT was predictive for long-time tumor control after 5 and 10 years. The 10-year recurrence-free survival was 93.4% and 95.7%, respectively, using doses above 13 Gy . Cranial nerve function is a major concern in the therapy of skull base meningiomas. Therefore the concept of combined treatment using subtotal surgery and SRS is increasingly used. Cranial nerve outcome was addressed in a registry-based analysis of 150 patients who received resection and SRS of skull base meningiomas at different locations. In 19% of patients, cranial nerve function improved after SRS, 10% suffered from deterioration 10 years after SRS. The rate of deterioration increased with time being 3.5% after 1 year, 5.5% after 3 years, and 7% after 5 years. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas.  Neuro Oncol . 2021;23(11):1821-1834. doi:10.1093/ neuonc /noab150

42. Fractionated External Beam RT Fractionated external beam RT remains an important component in the therapeutic armamentarium for the management of meningiomas. For patients with meningiomas not safely amenable to surgery, or after incomplete surgical resection, few large retrospective studies published over the past 3 years have confirmed current EANO guidelines giving class III evidence with recommendations B and C, on the use of fractionated RT. In a series of 7811 patients with WHO grade 2 and 1936 patients with WHO grade 3 meningiomas obtained from the US National Cancer Database who underwent surgical resection and/or RT from 2004 to 2014, the 5-year overall survival (OS) rate was 75.9% in patients with grade 2, and 55.4% in patients with grade 3 meningiomas (P < .0001). In patients with meningiomas grade 2, gross total resection and postsurgical fractionated RT were independent predictors of improved survival. Goldbrunner R, Stavrinou P, Jenkinson MD, et al. EANO guideline on the diagnosis and management of meningiomas.  Neuro Oncol . 2021;23(11):1821-1834. doi:10.1093/ neuonc /noab150

43. Brain Metastasis

44. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

45. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

46. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

47. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

48. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

49. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

50. Principle of Radiation Therapy for Brain Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

51. Principle of Radiation Therapy for Brain Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

52. Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

53. ASTRO Guideline Gondi, V et al.  (2022). Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.  Practical Radiation Oncology ,  12 (4), 265–282. https:// doi.org /10.1016/j.prro.2022.02.003

54. ASTRO Guideline Gondi, V et al.  (2022). Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.  Practical Radiation Oncology ,  12 (4), 265–282. https:// doi.org /10.1016/j.prro.2022.02.003

55. ASTRO Guideline for Limited Brain Metastasis Gondi, V et al.  (2022). Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.  Practical Radiation Oncology ,  12 (4), 265–282. https:// doi.org /10.1016/j.prro.2022.02.003

56. ASTRO Guideline for Limited Brain Metastasis Gondi, V et al.  (2022). Radiation Therapy for Brain Metastases: An ASTRO Clinical Practice Guideline.  Practical Radiation Oncology ,  12 (4), 265–282. https:// doi.org /10.1016/j.prro.2022.02.003

57. Brain Metastasis Rhun , É . L., et al (2021). EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours.  Annals of Oncology ,  32 (11), 1332–1347

58. Primary CNS Lymphoma

59. NCCN

60. Primary CNS Lymphoma Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

61. Primary CNS Lymphoma Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

62. Primary CNS Lymphoma Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

63. Primary CNS Lymphoma Burt Nabors, Jana Portnow , Jona Hattangadi-Gluth , Craig Horbinski , NCCN CNS tumor guidelines update for 2023,  Neuro-Oncology , Volume 25, Issue 12, December 2023, Pages 2114–2116,

64. EANO GUIDELINE

65. Hoang-Xuan K, Deckert M, Ferreri AJM, et al. European Association of Neuro-Oncology (EANO) guidelines for treatment of primary central nervous system lymphoma (PCNSL).  Neuro Oncol . 2023;25(1):37-53. doi:10.1093/ neuonc /noac196

66. Hoang-Xuan K, Deckert M, Ferreri AJM, et al. European Association of Neuro-Oncology (EANO) guidelines for treatment of primary central nervous system lymphoma (PCNSL).  Neuro Oncol . 2023;25(1):37-53. doi:10.1093/ neuonc /noac196

67. Hoang-Xuan K, Deckert M, Ferreri AJM, et al. European Association of Neuro-Oncology (EANO) guidelines for treatment of primary central nervous system lymphoma (PCNSL).  Neuro Oncol . 2023;25(1):37-53. doi:10.1093/ neuonc /noac196

68. Pituitary Adenoma

69. Introduction The majority of pituitary adenomas will be first treated with surgery. However, sometimes it is not possible to remove the whole tumour with surgery, this means that some of the tumour cells are left behind which is called ‘residual tumour’. In addition, sometimes the tumour can return following surgical treatment, this is called ‘recurrent tumour’. Both residual and recurrent tumours can grow and continue to cause harmful effects and may require further treatment. Combs SE, Baumert BG, Bendszus M, et al. ESTRO ACROP guideline for target volume delineation of skull base tumors .  Radiother Oncol . 2021;156:80-94. doi:10.1016/j.radonc.2020.11.014

70. Current treatments There are currently three treatment options for patients with residual and recurrent pituitary adenomas: further surgery conventional radiotherapy for larger or diffuse lesions SRS/SRT. In addition, there are medical treatments available for functioning pituitary adenomas. SRS/SRT is a current treatment option for some recurrent or residual pituitary adenomas. It can be used in certain highly selected relatively small tumours where primary surgery is not an option. Combs SE, Baumert BG, Bendszus M, et al. ESTRO ACROP guideline for target volume delineation of skull base tumors .  Radiother Oncol . 2021;156:80-94. doi:10.1016/j.radonc.2020.11.014

71. Combs SE, Baumert BG, Bendszus M, et al. ESTRO ACROP guideline for target volume delineation of skull base tumors .  Radiother Oncol . 2021;156:80-94. doi:10.1016/j.radonc.2020.11.014