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      EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood

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          Abstract

          In response to major changes in diagnostic algorithms and the publication of mature results from various large clinical trials, the European Association of Neuro-Oncology (EANO) recognized the need to provide updated guidelines for the diagnosis and management of adult patients with diffuse gliomas. Through these evidence-based guidelines, a task force of EANO provides recommendations for the diagnosis, treatment and follow-up of adult patients with diffuse gliomas. The diagnostic component is based on the 2016 update of the WHO Classification of Tumors of the Central Nervous System and the subsequent recommendations of the Consortium to Inform Molecular and Practical Approaches to CNS Tumour Taxonomy — Not Officially WHO (cIMPACT-NOW). With regard to therapy, we formulated recommendations based on the results from the latest practice-changing clinical trials and also provide guidance for neuropathological and neuroradiological assessment. In these guidelines, we define the role of the major treatment modalities of surgery, radiotherapy and systemic pharmacotherapy, covering current advances and cognizant that unnecessary interventions and expenses should be avoided. This document is intended to be a source of reference for professionals involved in the management of adult patients with diffuse gliomas, for patients and caregivers, and for health-care providers.

          Abstract

          Herein, the European Association of Neuro-Oncology (EANO) provides recommendations for the diagnosis, treatment and follow-up of adult patients with diffuse gliomas. These evidence-based guidelines incorporate major changes in diagnostic algorithms based on the 2016 update of the WHO Classification of Tumors of the Central Nervous System as well as on evidence from recent large clinical trials.

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          The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment.

          To develop a 10-minute cognitive screening tool (Montreal Cognitive Assessment, MoCA) to assist first-line physicians in detection of mild cognitive impairment (MCI), a clinical state that often progresses to dementia. Validation study. A community clinic and an academic center. Ninety-four patients meeting MCI clinical criteria supported by psychometric measures, 93 patients with mild Alzheimer's disease (AD) (Mini-Mental State Examination (MMSE) score > or =17), and 90 healthy elderly controls (NC). The MoCA and MMSE were administered to all participants, and sensitivity and specificity of both measures were assessed for detection of MCI and mild AD. Using a cutoff score 26, the MMSE had a sensitivity of 18% to detect MCI, whereas the MoCA detected 90% of MCI subjects. In the mild AD group, the MMSE had a sensitivity of 78%, whereas the MoCA detected 100%. Specificity was excellent for both MMSE and MoCA (100% and 87%, respectively). MCI as an entity is evolving and somewhat controversial. The MoCA is a brief cognitive screening tool with high sensitivity and specificity for detecting MCI as currently conceptualized in patients performing in the normal range on the MMSE.
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            "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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              Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma

              Glioblastoma, the most common primary brain tumor in adults, is usually rapidly fatal. The current standard of care for newly diagnosed glioblastoma is surgical resection to the extent feasible, followed by adjuvant radiotherapy. In this trial we compared radiotherapy alone with radiotherapy plus temozolomide, given concomitantly with and after radiotherapy, in terms of efficacy and safety. Patients with newly diagnosed, histologically confirmed glioblastoma were randomly assigned to receive radiotherapy alone (fractionated focal irradiation in daily fractions of 2 Gy given 5 days per week for 6 weeks, for a total of 60 Gy) or radiotherapy plus continuous daily temozolomide (75 mg per square meter of body-surface area per day, 7 days per week from the first to the last day of radiotherapy), followed by six cycles of adjuvant temozolomide (150 to 200 mg per square meter for 5 days during each 28-day cycle). The primary end point was overall survival. A total of 573 patients from 85 centers underwent randomization. The median age was 56 years, and 84 percent of patients had undergone debulking surgery. At a median follow-up of 28 months, the median survival was 14.6 months with radiotherapy plus temozolomide and 12.1 months with radiotherapy alone. The unadjusted hazard ratio for death in the radiotherapy-plus-temozolomide group was 0.63 (95 percent confidence interval, 0.52 to 0.75; P<0.001 by the log-rank test). The two-year survival rate was 26.5 percent with radiotherapy plus temozolomide and 10.4 percent with radiotherapy alone. Concomitant treatment with radiotherapy plus temozolomide resulted in grade 3 or 4 hematologic toxic effects in 7 percent of patients. The addition of temozolomide to radiotherapy for newly diagnosed glioblastoma resulted in a clinically meaningful and statistically significant survival benefit with minimal additional toxicity. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Contributors
                michael.weller@usz.ch
                Journal
                Nat Rev Clin Oncol
                Nat Rev Clin Oncol
                Nature Reviews. Clinical Oncology
                Nature Publishing Group UK (London )
                1759-4774
                1759-4782
                8 December 2020
                8 December 2020
                2021
                : 18
                : 3
                : 170-186
                Affiliations
                [1 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, Department of Neurology, Clinical Neuroscience Center, , University Hospital and University of Zurich, ; Zurich, Switzerland
                [2 ]GRID grid.5645.2, ISNI 000000040459992X, Brain Tumor Center at Erasmus MC Cancer Institute, , University Medical Center Rotterdam, ; Rotterdam, Netherlands
                [3 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Division of Oncology, Department of Medicine I, , Medical University of Vienna, ; Vienna, Austria
                [4 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, Department of Neurosurgery, Clinical Neuroscience Center, , University Hospital and University of Zurich, ; Zurich, Switzerland
                [5 ]GRID grid.503422.2, ISNI 0000 0001 2242 6780, University of Lille, ; U1192 Lille, France
                [6 ]GRID grid.410463.4, ISNI 0000 0004 0471 8845, Centre Hospitalier Universitaire (CHU) Lille, Neuro-Oncology, General and Stereotaxic Neurosurgery Service, ; Lille, France
                [7 ]GRID grid.452351.4, ISNI 0000 0001 0131 6312, Oscar Lambret Center, Neurology, ; Lille, France
                [8 ]GRID grid.411095.8, ISNI 0000 0004 0477 2585, Department of Neurosurgery, , University Hospital Munich LMU, ; Munich, Germany
                [9 ]GRID grid.9024.f, ISNI 0000 0004 1757 4641, Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, , University of Siena, ; Siena, Italy
                [10 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Department of Neuroradiology, , University Hospital Heidelberg, ; Heidelberg, Germany
                [11 ]GRID grid.411438.b, ISNI 0000 0004 1767 6330, Catalan Institute of Oncology (ICO), , Hospital Germans Trias i Pujol, ; Badalona, Spain
                [12 ]Aix-Marseille Université, Assistance Publique–Hôpitaux de Marseille (APHM), CHU Timone, Department of Neuro-Oncology, Marseille, France
                [13 ]GRID grid.10419.3d, ISNI 0000000089452978, Department of Neurology, , Leiden University Medical Center, ; Leiden, Netherlands
                [14 ]GRID grid.414842.f, ISNI 0000 0004 0395 6796, Department of Neurology, , Haaglanden Medical Center, ; The Hague, Netherlands
                [15 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Neurology, , Erasmus MC, ; Rotterdam, Netherlands
                [16 ]GRID grid.8515.9, ISNI 0000 0001 0423 4662, Department of Clinical Neurosciences, , University Hospital Lausanne, ; Lausanne, Switzerland
                [17 ]GRID grid.1649.a, ISNI 000000009445082X, Department of Neurosurgery, , Sahlgrenska University Hospital, ; Gothenburg, Sweden
                [18 ]GRID grid.8761.8, ISNI 0000 0000 9919 9582, Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, , Sahlgrenska Academy, ; Gothenburg, Sweden
                [19 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Department of Neurology, Medical Faculty Mannheim, , Mannheim Center for Translational Neuroscience (MCTN), Heidelberg University, ; Mannheim, Germany
                [20 ]GRID grid.7497.d, ISNI 0000 0004 0492 0584, German Consortium of Translational Cancer Research (DKTK), Clinical Cooperation Unit Neuroimmunology and Brain Tumor Immunology, , German Cancer Research Center (DKFZ), ; Heidelberg, Germany
                [21 ]Department of Neuro-Oncology, University Hospital, Turin, Italy
                [22 ]GRID grid.443984.6, Leeds Institute of Medical Research, , St James’s University Hospital, ; Leeds, UK
                [23 ]GRID grid.5645.2, ISNI 000000040459992X, Department of Radiology and Nuclear Medicine, , Erasmus MC, University Medical Center Rotterdam, ; Rotterdam, Netherlands
                [24 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Department for Neuropathology, , University Hospital Heidelberg, ; Heidelberg, Germany
                [25 ]GRID grid.7497.d, ISNI 0000 0004 0492 0584, DKTK and Clinical Cooperation Unit Neuropathology, DKFZ, ; Heidelberg, Germany
                [26 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Neurosurgery, , University Hospital Hamburg, ; Hamburg, Germany
                [27 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Department of Neuropathology, , Heinrich Heine University Düsseldorf, ; Düsseldorf, Germany
                [28 ]DKTK partner site Essen/Düsseldorf, Düsseldorf, Germany
                [29 ]GRID grid.5253.1, ISNI 0000 0001 0328 4908, Neurology Clinic and National Center for Tumor Diseases, , University Hospital Heidelberg, ; Heidelberg, Germany
                [30 ]GRID grid.7497.d, ISNI 0000 0004 0492 0584, DKTK and Clinical Cooperation Unit Neurooncology, DKFZ, ; Heidelberg, Germany
                Author information
                http://orcid.org/0000-0001-5710-5127
                http://orcid.org/0000-0003-3541-2315
                http://orcid.org/0000-0003-1239-1603
                http://orcid.org/0000-0003-0771-0390
                http://orcid.org/0000-0002-0668-9529
                http://orcid.org/0000-0003-0855-6495
                http://orcid.org/0000-0002-2860-9331
                http://orcid.org/0000-0003-4423-7256
                http://orcid.org/0000-0001-5563-2871
                http://orcid.org/0000-0002-9204-7038
                http://orcid.org/0000-0002-6171-634X
                Article
                447
                10.1038/s41571-020-00447-z
                7904519
                33293629
                c73ca5a5-919e-4b2e-a274-48e65012af5f
                © The Author(s) 2020

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 19 October 2020
                Categories
                Evidence-Based Guidelines
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                © Springer Nature Limited 2021

                cns cancer
                cns cancer

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