High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up
Cet article présente les recommandations de l' "European Society for Medical Oncology" concernant le diagnostic et le traitement d'un gliome de haut grade ainsi que le suivi des patients
Résumé en anglais
Incidence and epidemiology : The yearly incidence of malignant glioma is ∼3–5/100 000 with a slight predominance in males. Malignant glioma may develop at all ages, with the peak incidence being in the fifth and sixth decades of life [1–3]. Exposure to ionising irradiation has been associated with increased risk of development of glioma, while association with the use of cell phones could not be confirmed in epidemiological studies. Rare hereditary syndromes carry an increased risk for glioma: Cowden-, Turcot-, Lynch-, Li-Fraumeni syndrome and neurofibromatosis type 1.
Diagnosis and pathology : The commonly used World Health Organization (WHO) classification distinguishes tumours according to their presumed cell of origin (astrocytes or oligodendrocytes), and grades them from grade I–IV [4]. Grade I tumours occur mainly in childhood, and grade II (or low-grade) glioma are slow-growing tumours but will almost invariably transform over time to a more malignant phenotype. Grade III tumours (also commonly referred to as anaplastic glioma) comprise anaplastic astrocytoma, mixed anaplastic oligoastrocytoma and anaplastic oligodendroglioma, while glioblastoma (GBM) represents WHO grade IV. Tissue diagnosis is mandatory, and usually obtained by stereotactic biopsy or after tumour resection. GBM carries the worst prognosis, while pure oligodendroglioma has a protracted natural history and better outcome, and excellent response to therapy. Prognosis of mixed anaplastic oligoastrocytoma and anaplastic astrocytoma is intermediate between GBM and pure anaplastic oligodendroglioma. Concordance between local diagnosis and central neuropathology review can be as low as 50%, thus careful review of the histology by an expert neuropathology team is recommended [5, 6]. Molecular markers are useful additional tools for diagnosis and treatment guidance (see below), and are of increasing importance in daily practice. Adequate tissue collection and preservation (e.g. sufficient material, fresh frozen tumour tissue) should be planned prospectively (see Table 1).
