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EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma

Al's Comment:

 This is the treatment guidelines from the European Association for Neuro-Oncology Task Force on Malignant Glioma.  I completely disagree with them.


 For young (up to 70 years old) newly diagnosed Glioblastoma patients, they say the treatment should be: Surgery (resection or biopsy), followed by radiotherapy with concurrent Temozolomide, followed by 6 months of Temozolomide.   For recurrent, they say more surgery, more radiation, more chemotherapy or Avastin.

For older patients, they say radiation is optional based on MGMT and performance status.


Here in the USA, the standard treatment for newly diagnosed younger patients is a clinical trial. IF that is not possible, then the standard therapy is the same as the EANO guidelines.  The EANO guidelines doesn't suggest clinical trials.


 I feel clinical trials are the best way to go, but if not, I would say to follow the standard surgery, radiation and temodar, AND  would also do a molecular testing such as the Foundation Medicine test.  If they find any mutations in your tumor that are targeted by available drugs then I would add those drugs also.


For Recurrent GBM, here in the USA, tumor treating fields (Novocure's TTF-100A device) are approved for recurrent GBM and is in trials for newly diagnosed.  Research  has shown that tumor treating fields may be the best treatment for recurrent GBMs.  The EANO guidelines do not mention it.  


The scary part is that the European governments can use this document to justify excluding payments for treatments not recommended.  That makes this a political document - based more on a cost / benefit ratio than based on what is best for the patient.


The only advantage the EANO guidelines have over the USA guidelines is the use of Gliolan, which is a dye used during surgery which allows more of the tumor to be removed safely.  It is standard in Europe but not even FDA approved here in the USA yet.



Posted on: 08/23/2014

EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma



This guideline provides recommendations for diagnostic and therapeutic procedures for patients with malignant gliomas. We differentiate evidence-based standards from reasonable options or non-evidence-based measures that should no longer be considered. The recommendations herein should provide a framework and assurance for the choice of diagnostic procedures and therapeutic measures and aim to reduce complications from unnecessary treatment and cost. The guideline contributes to a critical appreciation of concurrent drugs with a focus on the controlled use of anticonvulsants and steroids. It should serve as a guideline for all professionals involved in the diagnostics and care of glioma patients and also as a source of knowledge for insurance companies and other institutions involved in the cost regulation of cancer care in Europe. Implementation of the recommendations summarised here will need interdisciplinary structures of care for patients with brain tumours and structured processes of diagnostic and therapeutic procedures.


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