Therapy for Diffuse Astrocytic and Oligodendroglial Tumors in Adults: ASCO-SNO Guideline
- Study type
- Clinical guideline
- Study name
- ASCO-SNO Diffuse Glioma 2022
- Design
- Clinical practice guideline based on a systematic literature review by an expert panel of ASCO and the Society for Neuro-Oncology (SNO)
- Sample size
- 59 randomised trials
- Source
- J Clin Oncol · 2022
In plain words
This joint guideline from the American Society of Clinical Oncology and the Society for Neuro-Oncology, based on 59 randomised trials, sets out the right treatment after surgery for each type of glioma in adults: radiotherapy with PCV or temozolomide chemotherapy for gliomas with an IDH mutation, and radiotherapy with temozolomide for glioblastoma.
Key points
Key guideline recommendations
- Grade of recommendation in the full guideline
IDH-mutant, 1p19q-codeleted oligodendroglioma, grades 2 and 3: radiotherapy and PCV; temozolomide is a reasonable alternative for patients who may not tolerate PCV, but it is not supported by high-level evidence.
- Grade of recommendation in the full guideline
IDH-mutant astrocytoma, grade 2: radiotherapy with adjuvant chemotherapy (temozolomide or PCV).
- Grade of recommendation in the full guideline
IDH-mutant astrocytoma, grade 3: radiotherapy and adjuvant temozolomide.
- Grade of recommendation in the full guideline
IDH-wild-type glioblastoma: temozolomide concurrent with radiotherapy followed by 6 months of adjuvant temozolomide; tumour treating fields should be considered; bevacizumab is not recommended.
- Grade of recommendation in the full guideline
Older patients, those with poor performance status or concern about toxicity: hypofractionated radiotherapy with temozolomide, or supportive care, radiotherapy alone (MGMT unmethylated) or temozolomide alone (MGMT methylated).
Study population
Adults with diffuse astrocytic and oligodendroglial tumours (diffuse gliomas).
Endpoints
Clinical practice guideline; no specific endpoint.
Safety and side effects
Not reported in the abstract.
Clinical significance and place in guidelines
The main framework for postoperative treatment of adult diffuse gliomas based on the WHO 2021 molecular classification. In 2025 a rapid update added vorasidenib as a conditional recommendation for grade 2 IDH-mutant gliomas after surgery when radiotherapy and chemotherapy can be deferred (J Clin Oncol 2025;43:2129-2133).
Limitations
The grade of evidence and strength of each recommendation are given in the full guideline.
This summary was prepared by the editorial team from the published paper; the original paper is the final reference. Read the original abstract on PubMed.