The Korean Society for Neuro-Oncology (KSNO) Guideline for Adult Diffuse Midline Glioma: Version 2021.1open access
- Authors
- Yoon, Hong In; Wee, Chan Woo; Kim, Young Zoon; Seo, Youngbeom; Im, Jung Ho; Dho, Yun-Sik; Kim, Kyung Hwan; Hong, Je Beom; Park, Jae-Sung; Choi, Seo Hee; Kim, Min-Sung; Moon, Jangsup; Hwang, Kihwan; Park, Ji Eun; Cho, Jin Mo; Yoon, Wan-Soo; Kim, Se Hoon; Kim, Young Il; Kim, Ho Sung; Sung, Kyoung Su; Song, Jin Ho; Lee, Min Ho; Han, Myung Hoon; Lee, Se-Hoon; Chang, Jong Hee; Lim, Do Hoon; Park, Chul-Kee; Lee, Youn Soo; Gwak, Ho-Shin
- Issue Date
- Apr-2021
- Publisher
- 대한뇌종양학회
- Keywords
- Korean Society for Neuro-Oncology; Guideline; Diffuse midline glioma; Practice
- Citation
- Brain Tumor Research and Treatment, v.9, no.1, pp.1 - 8
- Indexed
- KCI
- Journal Title
- Brain Tumor Research and Treatment
- Volume
- 9
- Number
- 1
- Start Page
- 1
- End Page
- 8
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/142020
- DOI
- 10.14791/btrt.2021.9.e8
- ISSN
- 2288-2405
- Abstract
- Background
There have been no guidelines for the management of adult patients with diffuse midline glioma (DMG), H3K27M-mutant in Korea since the 2016 revised WHO classification newly defined this disease entity. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, had begun preparing guidelines for DMG since 2019.
Methods
The Working Group was composed of 27 multidisciplinary medical experts in Korea. References were identified through searches of PubMed, MEDLINE, EMBASE, and Cochrane CENTRAL using specific and sensitive keywords as well as combinations of keywords. As ‘diffuse midline glioma’ was recently defined, and there was no international guideline, trials and guidelines of ‘diffuse intrinsic pontine glioma’ or ‘brain stem glioma’ were thoroughly reviewed first.
Results
The core contents are as follows. The DMG can be diagnosed when all of the following three criteria are satisfied: the presence of the H3K27M mutation, midline location, and infiltrating feature. Without identification of H3K27M mutation by diagnostic biopsy, DMG cannot be diagnosed. For the primary treatment, maximal safe resection should be considered for tumors when feasible. Radiotherapy is the primary option for tumors in case the total resection is not possible. A total dose of 54 Gy to 60 Gy with conventional fractionation prescribed at 1-2 cm plus gross tumor volume is recommended. Although no chemotherapy has proven to be effective in DMG, concurrent chemoradiotherapy (± maintenance chemotherapy) with temozolomide following WHO grade IV glioblastoma’s protocol is recommended.
Conclusion
The detection of H3K27M mutation is the most important diagnostic criteria for DMG.
Combination of surgery (if amenable to surgery), radiotherapy, and chemotherapy based on comprehensive multidisciplinary discussion can be considered as the treatment options for DMG.
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