Astrocytoma Guidelines

Updated: Mar 09, 2023
  • Author: Jeffrey N Bruce, MD; Chief Editor: Herbert H Engelhard, III, MD, PhD, FACS, FAANS  more...
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Guidelines Summary

Treatment guidelines for diffuse astrocytic and oligodendroglial tumors in adults have been published by the American Society of Clinical Oncology (ASCO) and Society of Neuro-Oncology (SNO). [49] The guidelines contain the following recommendations for treatment of astrocytomas:

  • For IDH-mutant, 1p19q non-codeleted, central nervous system (CNS) World Health Organization (WHO) grade 2  astrocytoma (low-grade diffuse glioma), offer radiation therapy (RT) with adjuvant chemotherapy (temozolomide [TMZ] or procarbazine, CCNU, and vincristine  [PCV]).

  • In IDH-mutant, 1p19q non-codeleted, CNS WHO grade 2 astrocytoma, given its natural history, initial therapy may be deferred until radiographic or symptomatic progression in some patients with positive prognostic factors (eg, complete resection, younger age) or concerns about short- and long-term toxicity.

  • For IDH-mutant, 1p19q non-codeleted CNS WHO grade 3 astrocytoma, offer RT with adjuvant TMZ.

  • IDH-mutant CNS WHO grade 4 astrocytoma may be treated like IDH-mutant, non-codeleted, CNS WHO grade 3 astrocytoma (formerly anaplastic astrocytoma); or like IDH-wildtype, CNS WHO grade 4 glioblastoma (formerly IDH-wildtype glioblastoma), with concurrent TMZ and RT.

  • IDH-wildtype, CNS WHO grade 2 or 3 astrocytoma may be treated according to recommendations for IDH-wildtype, CNS WHO grade 4 glioblastoma.

See the image below.

IDH-mutant astrocytoma treatment guidelines. IDH-mutant astrocytoma treatment guidelines.