Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline
Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline
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DOI：
10.1200/jco.21.02036
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发表时间：
2022-02-01
影响因子：
45.3
通讯作者：
Blakeley, Jaishri
中科院分区：
文献类型：
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作者：
Mohile, Nimish A.;Messersmith, Hans;Blakeley, Jaishri
目的为临床医生提供指导，治疗成人弥漫性星形细胞和少突胶质细胞肿瘤。方法ASCO和神经肿瘤学会召集了一个专家小组，并进行了系统的文献回顾。结果59个随机试验集中在治疗管理。建议新诊断的少突胶质细胞瘤，异柠檬酸脱氢酶（IDH）突变，1 p19 q共缺失CNS WHO 2级和3级应提供放射治疗（RT）和甲基苄肼，洛莫司汀和长春新碱（PCV）。替莫唑胺（TMZ）是一个合理的替代患者谁可能不耐受PCV，但没有高级别的证据支持在这种情况下的前期TMZ。新诊断的星形细胞瘤、IDH突变、1 p19 q非共缺失CNS WHO 2级患者应接受RT联合辅助化疗（TMZ或PCV）。星形细胞瘤、IDH突变、1 p19 q非共缺失CNS WHO 3级患者应给予RT和辅助TMZ。患有星形细胞瘤、IDH突变型、CNS WHO 4级的患者可以遵循星形细胞瘤、IDH突变型、1 p19 q非共缺失CNS WHO 3级或胶质母细胞瘤、IDH野生型、CNS WHO 4级的建议。对于新诊断的胶质母细胞瘤、IDH野生型、CNS WHO 4级患者，应同时给予TMZ和RT，随后给予6个月的辅助TMZ。对于这些患者，应考虑采用美国食品和药物管理局批准的交变电场疗法。不推荐使用贝伐单抗。在6周RT加TMZ的获益可能不超过危害的情况下，大分割RT加TMZ是合理的。对于年龄>= 60->= 70岁、体力状态差或存在毒性或预后问题的患者，单独使用最佳支持治疗、单独使用RT（用于MGMT启动子非甲基化肿瘤）或单独使用TMZ（用于MGMT启动子甲基化肿瘤）是合理的治疗选择。更多信息请访问www.asco.org/neurooncology-guidelines。
PURPOSE To provide guidance to clinicians regarding therapy for diffuse astrocytic and oligodendroglial tumors in adults.METHODS ASCO and the Society for Neuro-Oncology convened an Expert Panel and conducted a systematic review of the literature.RESULTS Fifty-nine randomized trials focusing on therapeutic management were identified.RECOMMENDATIONS Adults with newly diagnosed oligodendroglioma, isocitrate dehydrogenase (IDH)-mutant, 1p19q codeleted CNS WHO grade 2 and 3 should be offered radiation therapy (RT) and procarbazine, lomustine, and vincristine (PCV). Temozolomide (TMZ) is a reasonable alternative for patients who may not tolerate PCV, but no high-level evidence supports upfront TMZ in this setting. People with newly diagnosed astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 2 should be offered RT with adjuvant chemotherapy (TMZ or PCV). People with astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 should be offered RT and adjuvant TMZ. People with astrocytoma, IDH-mutant, CNS WHO grade 4 may follow recommendations for either astrocytoma, IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 or glioblastoma, IDH-wildtype, CNS WHO grade 4. Concurrent TMZ and RT should be offered to patients with newly diagnosed glioblastoma, IDH-wildtype, CNS WHO grade 4 followed by 6 months of adjuvant TMZ. Alternating electric field therapy, approved by the US Food and Drug Administration, should be considered for these patients. Bevacizumab is not recommended. In situations in which the benefits of 6-week RT plus TMZ may not outweigh the harms, hypofractionated RT plus TMZ is reasonable. In patients age >= 60 to >= 70 years, with poor performance status or for whom toxicity or prognosis are concerns, best supportive care alone, RT alone (for MGMT promoter unmethylated tumors), or TMZ alone (for MGMT promoter methylated tumors) are reasonable treatment options. Additional information is available at www.asco.org/neurooncology-guidelines.