Individual research recommendation details

Recommendation ID

NG99/1

Question

Managing glioma: management of IDH wildtype grade II glioma:- Does the addition of concurrent and adjuvant temozolomide to radiotherapy improve overall survival in patients with IDH wildtype grade II glioma?

Any explanatory notes
(if applicable)

Why this is important:- The World Health Organization (WHO) 2016 reclassification of brain tumours recognised that the molecular characteristics of glioma are extremely important in helping differentiate between disease entities with very different outcomes. Although evidence exists to guide management recommendations for certain molecular gliomas, such as codeleted and non-codeleted grade III glioma, currently no studies have investigated the best approach for the management of grade II glioma with IDH wildtype. The biological behaviour of these tumours is more like a high-grade glioma with a much shorter prognosis than IDH-mutated grade II glioma.
Because of this, some clinicians have advocated treating such tumours with concurrent chemoradiation recommended for grade IV glioma (glioblastoma multiforme, GBM). However, there is currently no research evidence to support this approach and this regimen is more intensive and people experience increased acute and late side effects compared to radiotherapy alone.
Research is needed to establish whether or not this approach is beneficial in terms of improved survival, and at what cost in terms of toxicity and, potentially, reduced quality of life.
To find out why the committee made the research recommendation on managing glioma, see rationale and impact.

Source guidance details

Comes from guidance

Brain tumours (primary) and brain metastases in adults

Number

NG99

Date issued

July 2018

Other details