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1、AnnalsofOncologyAdvanceAccesspublishedApril29,2014clinicalpracticeguidelinesAnnalsofOncology00:1–9,2014doi:10.1093/annonc/mdu050High-gradeglioma:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-up†R.Stupp1,M.Brada2,M.J.vandenBent3,J.-C.Tonn4&G.Pentheroudakis5onbehalfofthe
ESMO
2、GuidelinesWorkingGroup*1DepartmentofOncologyandCancerCentre,UniversityHospitalZurich,Zurich,Switzerland;2DepartmentofMolecularandClinicalCancerMedicine,Universityof
Liverpool,ClatterbridgeCancerCentre,Wirral,UK;3DepartmentofNeuro-Oncology,ErasmusMCCancerCenter,Rotterdam,Netherlands;4Depart
3、mentofNeurosurgery,
Ludwig-Maximilians-University,Munich,Germany;5DepartmentofMedicalOncology,MedicalSchool,UniversityofIoannina,Ioannina,GreeceincidenceandepidemiologyTheyearlyincidenceofmalignantgliomais∼3–5/100000withaslightpredominanceinmales.Malignantgliomamaydevelopatallages,withthep
4、eakincidencebeinginthefifthandsixthdecadesoflife[1–3].Exposuretoionisingirradiationhasbeenassociatedwithincreasedriskofdevelopmentofglioma,whileassociationwiththeuseofcellphonescouldnotbeconfirmedinepidemiologicalstudies.Rarehereditarysyndromescarryanincreasedriskforglioma:Cowden-,Turcot-,Ly
5、nch-,Li-Fraumenisyndromeandneurofibromatosistype1.diagnosisandpathologyThecommonlyusedWorldHealthOrganization(WHO)clas-sificationdistinguishestumoursaccordingtotheirpresumedcelloforigin(astrocytesoroligodendrocytes),andgradesthemfromgradeI–IV[4].GradeItumoursoccurmainlyinchildhood,andgradeII
6、(orlow-grade)gliomaareslow-growingtumoursbutwillalmostinvariablytransformovertimetoamoremalignantphenotype.GradeIIItumours(alsocommonlyreferredtoasanaplasticglioma)compriseanaplasticastrocy-toma,mixedanaplasticoligoastrocytomaandanaplasticoligodendroglioma,whileglioblastoma(GBM)representsW
7、HOgradeIV.Tissuediagnosisismandatory,andusuallyobtainedbystereotacticbiopsyoraftertumourresection.GBMadditionaltoolsfordiagnosisandtreatmentguidance(seebelow),andareofincreasingimportanceindailypractice.Adequatetissuecollectionandpreservation(e.g.sufficientmate
