How does the updated classification system of gliomas impact your recommendations for radiation?

Minesh Mehta and @Dr. First Last, Miami Cancer Institute

In 2021, the World Health Organization (WHO) introduced significant new changes to the classification of tumors of the central nervous system (CNS) in their 5^th edition (WHO CNS5) (Louis et al., PMID 34185076). This step was the first of many to come, where molecular characterization takes precedence, and tumors are now referred to as “types”. Consequently, WHO CNS5 now includes only three types of adult diffuse gliomas: Astrocytoma, IDH-m...

The issue of IDH wild type malignant glioma without TERT promoter mutations remains one of the vexing issues with the current classification. It is estimated that perhaps about 20% of GBMs lack genetic alterations in IDH (hence IDH wild-type) and also the TERT promoter (hence TERTp wild-type). An intriguing paper published in 2018 (Diplas et al., PMID 29802247) addresses this subset in a fascinating manner. The authors point out that GBMs with TERTp mutations rely on these mutations to maintain ...

ASTRO guidelines just published https://www.practicalradonc.org/article/S1879-8500(22)00144-8/fulltext#relatedArticles.