ESTRO-EANO guideline on target delineation and radiotherapy for IDH-mutant WHO CNS grade 2 and 3 diffuse glioma
Year: 2024
Type: article
Abstract: PURPOSE: This guideline will discuss radiotherapeutic management of IDH-mutant grade 2 and grade 3 diffuse glioma, using the latest 2021 WHO (5th) classification of brain tumours focusing on: imaging modalities, tumour volume delineation, irradiation dose and fractionation. METHODS: The ESTRO Guidelines Committee, CNS subgroup, nominated 15 European experts who identified questions for this guideline. Four working groups were established addressing specific questions concerning imaging, target volume delineation, radiation techniques and fractionation. A literature search was performed, and available literature was discussed. A modified two-step Delphi process was used with majority voting resulted in a decision or highlighting areas of uncertainty. RESULTS: Key issues identified and discussed included imaging needed to define target definition, target delineation and the size of margins, and technical aspects of treatment including different planning techniques such as proton therapy. CONCLUSIONS: The GTV should include any residual tumour volume after surgery, as well as the resection cavity. Enhancing lesions on T1 imaging should be included if they are indicative of residual tumour. In grade 2 tumours, T2/FLAIR abnormalities should be included in the GTV. In grade 3 tumours, T2/FLAIR abnormalities should also be included, except areas that are considered to be oedema which should be omitted from the GTV. A GTV to CTV expansion of 10 mm is recommended in grade 2 tumours and 15 mm in grade 3 tumours. A treatment dose of 50.4 Gy in 28 fractions is recommended in grade 2 tumours and 59.4 Gy in 33 fractions in grade 3 tumours. Radiation techniques with IMRT are the preferred approach.
Source: Radiotherapy and Oncology
Institutions: Kantonsspital Graubünden, Radboud University Medical Center, Amsterdam UMC Location University of Amsterdam, Amsterdam University Medical Centers, University of Cologne, University Hospital Cologne, Gdańsk Medical University, Essen University Hospital, Deutsches Konsortium für Translationale Krebsforschung, University of Freiburg, University Medical Center Freiburg, Sapienza University of Rome, University of Turin, Institut Gustave Roussy, Paul Scherrer Institute, Erasmus MC, Erasmus MC Cancer Institute, Universitätsklinikum Tübingen, University of Tübingen, Western General Hospital, Institute of Genetics and Cancer, University of Edinburgh
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,430
OpenAlex ID: W4403667887