NCCN Guidelines® Insights: Central Nervous System Cancers, Version 2.2022

Abstract

The NCCN Guidelines for Central Nervous System (CNS) Cancers focus on management of the following adult CNS cancers: glioma (WHO grade 1, WHO grade 2–3 oligodendroglioma [1p19q codeleted, IDH-mutant], WHO grade 2–4 IDH-mutant astrocytoma, WHO grade 4 glioblastoma), intracranial and spinal ependymomas, medulloblastoma, limited and extensive brain metastases, leptomeningeal metastases, non–AIDS-related primary CNS lymphomas, metastatic spine tumors, meningiomas, and primary spinal cord tumors. The information contained in the algorithms and principles of management sections in the NCCN Guidelines for CNS Cancers are designed to help clinicians navigate through the complex management of patients with CNS tumors. Several important principles guide surgical management and treatment with radiotherapy and systemic therapy for adults with brain tumors. The NCCN CNS Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel’s most recent recommendations regarding molecular profiling of gliomas.

The Korean Society for Neuro-Oncology (KSNO) Guideline for the Management of Brain Tumor Patients During the Crisis Period: A Consensus Survey About Specific Clinical Scenarios (Version 2023.1)

“…However, in cases of WHO grade 2 astrocytoma and oligodendroglioma with high risk, particularly those with IDH mutations, radiotherapy with adjuvant PCV was found to have superior progression-free and overall survival compared to radiotherapy alone after surgery [ 2 ]. For these high-risk patients, the National Comprehensive Cancer Network (NCCN) guideline suggests using radiotherapy with adjuvant PCV as a category 1 recommendation during non-crisis periods [ 3 ]. Nevertheless, the panel did not believe that the addition of adjuvant PCV would have the same degree of benefit during the crisis period.…”

“…The panel had varying preferences for postoperative treatment strategies between patients with grade 3 oligodendroglioma, IDH -mutant/1p19q codeleted and grade 3 or 4 astrocytoma, IDH -mutant who have KPS ≥60. For patients with grade 3 oligodendroglioma, IDH -mutant/1p19q codeleted, the panel strongly recommended radiotherapy with adjuvant PCV, which is suggested as a preferred option in the national guidelines in the non-crisis period [ 3 6 ]. This recommendation is based on the findings of RTOG 9402 and EORTC 26951 trials, which demonstrate the substantial improvement in overall survival for patients with 1p19q codeleted oligodendroglioma who receive radiotherapy with adjuvant PCV compared to those who receive adjuvant radiotherapy alone [ 4 7 ].…”

“…As such, the panel made a weak recommendation for radiotherapy with concurrent and adjuvant TMZ for this cohort during the crisis period. During the non-crisis period, the NCCN guideline indicates a uniform consensus favoring either radiotherapy with concurrent and adjuvant TMZ or radiotherapy with adjuvant TMZ, based upon lower-level evidence [ 3 ]. For patients with KPS <60, the panel highly recommended best supportive care alone as the preferred option, followed by adjuvant radiotherapy alone, given the rarity of randomized studies in this cohort and the crisis situation.…”

Recent advances and future challenges of tumor vaccination therapy for recurrent glioblastoma

“…There are more than ten subtypes of glioma according to the 2021 WHO Classification of Tumors of the Central Nervous System [ 3 , 4 ], and among which, glioblastoma (GBM) has occupied a crucial role because of its highest malignancy and a 60% proportion of all patients [ 5 ]. The standard therapy, established by Stupp in EORTC-26981 trial in 2005, consists of grass total surgical resection, concurrent radiotherapy combined with temozolomide (TMZ) and adjuvant TMZ [ 6 ], and with the encouraging result of a 20.9-month overall survival (OS) in EF-14 trial [ 7 ], the latest standard of care has added concurrent treatment with alternating electric fields and adjuvant TMZ to the first-level choice as well as the EORTC-NCIC study-based adjuvant involved-field RT with concurrent and adjuvant TMZ [ 8 ]. However, the median OS is still about 14.4–16.7 months in most randomized clinical trials (RCTs) [ 2 , 9 , 10 ] with an almost inevitable tumor recurrence [ 11 ].…”

Multi-b-value diffusion stretched-exponential model parameters correlate with MIB-1 and CD34 expression in Glioma patients, an intraoperative MR-navigated, biopsy-based histopathologic study

“…According to the 2021 World Health Organization (WHO) criteria, gliomas are classified as grades I-IV ( 5 ), with different molecular subtypes and histopathology; these intrinsic subtypes showed different prognoses and outcomes ( 5 ). There exists a remarkable disparity in clinical treatment and prognosis between the different grades of glioma ( 3 , 6 ). Thus, the preoperative differential diagnosis is essential for therapeutic decisions and determining the prognosis of patients with glioma.…”