Radiation Therapy for IDH-Mutant Grade 2 and Grade 3 Diffuse Glioma

Publication Date: May 30, 2022
Last Updated: July 5, 2022

Indication and timing for RT

Oligodendroglioma, IDH-mutant and 1p/19q codeleted

For patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 2, <4 to 6 cm tumor, with gross total resection (defined as <1 cm residual tumor on MRI) and age <40 years, close surveillance alone is recommended. (Strong, Low)
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For patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 2, with high-risk features, either RT with sequential chemotherapy or RT with concurrent/sequential chemotherapy is conditionally recommended. (Conditional, Low)
Implementation remark: High-risk features include any of the following: subtotal resection, age ≥40 years, tumor size ≥4 to 6 cm, tumor crosses midline, refractory seizures, or presurgical neurological symptoms from tumor.
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For patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 3, with any extent of surgery, either RT with sequential chemotherapy or RT with concurrent/sequential chemotherapy is recommended. (Strong, Moderate)
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Optimal dose of RT and target volume based on risk stratification

For patients with oligodendroglioma, IDH-mutant, 1p/19q codeleted, WHO grade 2 and astrocytoma, IDH-mutant, WHO grade 2, a total prescribed dose of 4500 to 5400 cGy in 180 cGy daily fractions is recommended. (Strong, High)
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Overview

Title

Radiation Therapy for IDH-Mutant Grade 2 and Grade 3 Diffuse Glioma

Authoring Organization

American Society for Radiation Oncology