Recommendations for Front-line Systemic Therapy for Anaplastic Glioma

All members of the workgroup supported the adoption of NCCN guidelines. 1p/19q deletion should be tested on all anaplastic oligodendroglioma or oligoastrocytoma. For patients with good PS, and anaplastic astrocytoma, anaplastic oligodendroglioma or oligoastrocytoma without 1p19q co-deletion, fractionated external beam radiation therapy (EBRT) remains the standard after surgical intervention. Temozolomide or PCV with deferred RT is a reasonable choice. Fractionated RT concurrent with temozolomide is another reasonable option but has not been shown to be beneficial in a small local retrospective study. For patients with good PS, and anaplastic oligoastrocytoma or anaplastic oligodendroglioma harbouring 1p19q codeletion, we recommend RT with adjuvant PCV after surgical intervention. Fractionated RT concurrent with temozolomide is a reasonable option after discussion with patients regarding current limited phase III clinical data. For patients with poor PS, hypofractionated RT, temozolomide or best supportive care alone is reasonable.