Treatment Recommendations for Adult Patients with Diffuse Gliomas of Grades II and III According to the New WHO Classification in 2016

Abstract

With advanced understanding of molecular background and correlation with therapeutic outcomes, the revised 4th edition of World Health Organization (WHO) classification of central nervous system (CNS) tumors incorporated molecular information into the definition of diffuse gliomas. Indeed, oligodendroglioma and astrocytoma are now defined by molecular signature, with diagnosis of glioblastoma being made by histology. In parallel, numerous clinical trials are underway all over the world, and important findings are being produced every year that have an impact on patient outcomes. Moreover, novel therapies/technologies are also being actively developed; however, there are still many CNS tumors for which no effective therapy has been established except radiotherapy. In this article, the authors review the recent results of major clinical trials and present their treatment recommendations for patients with adult, supratentorial diffuse gliomas of grades II and III stratified according to the new WHO classification.

Influence of Concurrent and Adjuvant Temozolomide on Health-Related Quality of Life of Patients with Grade III Gliomas: A Secondary Analysis of a Randomized Clinical Trial (KNOG-1101 Study)

“…Anaplastic gliomas, referred to in this study as grade III gliomas via the 2007 WHO classification, account for 20% of adult gliomas comprising the most common type of primary brain tumors [ 1 ]. With current management focusing on maximal surgical resection followed by adjuvant RT [ 2 , 19 – 21 ], prognosis remains poor with a median survival range of 2–5 years [ 22 , 23 ]. However, growing evidence for nitrosourea-based chemotherapy with the advent of temozolomide highlights the need for investigation on the effects of combined chemoradiotherapy on not only survival outcome but, more importantly, quality of life during those additional years of life [ 3 – 5 , 24 ].…”

Multi-parametric arterial spin labelling and diffusion-weighted magnetic resonance imaging in differentiation of grade II and grade III gliomas

“…Differentiation between World Health Organisation (WHO) grade II and III gliomas is of upmost importance for selecting and developing appropriate treatment, detecting early treatment failure, and identifying accurate and clinically relevant biological endpoints for high-risk but potentially highly rewarding tumoural specific therapies tailored to the unique biology of an individual brain tumour [1][2][3][4]. Another benefit of imaging is the possibility of identifying the most malignant areas within a tumour in order to minimise the risk of biopsy sampling errors.…”

Concurrent and Adjuvant Temozolomide for Newly Diagnosed Grade III Gliomas without 1p/19q Co-deletion: A Randomized, Open-Label, Phase 2 Study (KNOG-1101 Study)

“…. While surgery and radiotherapy may prolong life, prognosis remains dismal, with a median survival of 2-5 years [2][3][4]. To date, despite inconclusive data, there has been growing evidence of improved survival that the addition of nitrosourea-based chemotherapy to radiotherapy could be beneficial for patients with WHO grade III gliomas [5].…”