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High grade glioma — Clinical Guidelines

Overview

High-grade gliomas (HGG) are aggressive intracranial malignancies with a poor prognosis, often necessitating tailored management strategies, especially in resource-limited settings 1. Despite advancements, outcomes remain challenging due to limited therapeutic options and significant symptom burden 3 5.

Diagnosis

Imaging studies (MRI with contrast) essential for diagnosis and grading 1.

Biopsy or surgical resection for definitive histopathological confirmation 1.

Grading based on histological features and molecular markers (e.g., IDH status, MGMT promoter methylation) 1.

Management

First-line treatment: Surgical resection followed by adjuvant therapy 1.

Radiation therapy: Recommended as part of standard care, with consideration for charged particle therapy (e.g., carbon ion or proton) for potential improved outcomes 2.

Chemotherapy: Temozolomide concurrent with radiotherapy is standard 1 2.

Supportive care: Management of symptoms including seizures, cognitive dysfunction, and neurological deficits 3 5.

Special Populations

Elderly patients: Radical resection with adjuvant therapy can improve survival in those ≥65 years, challenging ageist exclusion from trials 6 (Evidence: Moderate).

End-of-life care: Focus on comfort measures, with high preference for dying at home or in hospice settings across different countries 3 4 5 (Evidence: Moderate).

Key Recommendations

Implement comprehensive, context-specific management strategies adapted for low- and middle-income countries to improve patient outcomes 1 (Evidence: Expert opinion).

Consider charged particle therapy (carbon ion or proton) for high-grade gliomas, given its potential for enhanced efficacy and manageable side effects 2 (Evidence: Moderate).

Prioritize palliative and comfort care measures, aiming for patient-preferred end-of-life settings to enhance quality of life 3 4 5 (Evidence: Moderate).

References

1 Enam SA, Aziz HF, Bakhshi SK, Altaf A, Siddiqui K, Hafiz A et al.. Consensus guidelines for the management of adult high-grade gliomas for low and middle-income countries. JPMA. The Journal of the Pakistan Medical Association 2024. link 2 Wang Y, Liu R, Zhang Q, Dong M, Wang D, Chen J et al.. Charged particle therapy for high-grade gliomas in adults: a systematic review. Radiation oncology (London, England) 2023. link 3 Barbaro M, Blinderman CD, Iwamoto FM, Kreisl TN, Welch MR, Odia Y et al.. Causes of Death and End-of-Life Care in Patients With Intracranial High-Grade Gliomas: A Retrospective Observational Study. Neurology 2022. link 4 Koekkoek JA, Dirven L, Reijneveld JC, Sizoo EM, Pasman HR, Postma TJ et al.. End of life care in high-grade glioma patients in three European countries: a comparative study. Journal of neuro-oncology 2014. link 5 Sizoo EM, Taphoorn MJ, Uitdehaag B, Heimans JJ, Deliens L, Reijneveld JC et al.. The end-of-life phase of high-grade glioma patients: dying with dignity?. The oncologist 2013. link 6 Mukerji N, Rodrigues D, Hendry G, Dunlop PR, Warburton F, Kane PJ. Treating high grade gliomas in the elderly: the end of ageism?. Journal of neuro-oncology 2008. link

High grade glioma